35 100 60591 https://digital.lib.buffalo.edu/files/original/b3edc60af2be48ce4d345841489ead09.pdf 90507d817819483b3b40c9aa2f51766f PDF Text Text --- - --------- - -- - State University of New York at Buffalo School of Medicine and Biomedical Sciences, Autumn 1997 �BUFFALO PHYSICIAN \ olume 31, Number 4 ASSOCIATE VICE PRESIDENT FOR UNIVERSITY SERVICES Dr Carole ~m1th Petro DIRECTOR OF PUBLICATIONS Kathryn .-\ Sa\mer EDITOR Judson \1ead (lntenm) ART DIRECTOR/DESIGNER AlanJ Kegler PRODUCTION MANAGER \nn Raszmann Brown STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES Dr John \\'nght, /ntcmn Dean and V1<r P•cllllrntfor Climwl A{fw11 EDITORIAL BOARD Dr Bertram Partin, Chail Dr \t1artm Brecher Dr llarold Brodv Dr Lmda J . Corder Dr Alan J . Drmnan Dr james Kanski Dr Barbara Majerom Dr Elizabeth Olmsted Dr Charles Paganelli Dr Stephen ~pauldmg Dr Bradley T Trua' Roy Vongtama Dr Frankhn Zeplow 1tz TEACHING HOSPITALS AND LIAISONS The Buffalo General Hospnal .\1iclwcl Sha" The Chlidren·s llospnal of Buffalo Eric County 'Vted1cal Center Mercy Health System Mlila~d Fillmore Health '>ystem Frcmll Sm·a Niagara falls Memonal Med1cal Center Roswell Park Cancer lnsutute ~!Sters of Chanty llospnal Dl'mm .\1cCw thy Veterans Affairs Western New York Heahhcare System The Stale vni\'CrSil\' of New York at Buffalo If) Buf{tdo Pl11 sician IS published quarter\) b\' the State UmverSil)' of Ne" York at Buffalo School of Medicine and Biomedical Sciences and the Office of Pubhcauons. It IS ~cnt , free of charge , to alumni , faculty . students, reSidents, ami fnends . The staff resenes the nghtto ed1t all cop\ and submissions accepted for pubhcauon Address qucsuons. comments , and submisswns to: The Ednor, Buffalo Plnsiciwt, State Lmvcrsity of Nc\\ Y~rk at Buffalo, Office of Publi cations , 136 Crofts Hall , Buffalo, m 14260 Send address changes to: Buffalo Physician , 146 B10med1cal Educauon BuHdmg, H 35 'Vtam ~lreel, Buffalo , NY 14214. Dear Alumni and Friends, As I POI>..;TED OUT TO THIS YEAR's INC0\11NG \1EDICAL STL>DENT'>, these are rapidly changing times, and the task of meshing the art with the science of medicine is becoming ever more challenging. Voltaire is said to have observed, "The art of medicine consists of amusing the patient while nature cures the disease"; yet the scientific basis of medicine continues to expand and now offers glimpses of disease mechanisms and body function that provide new and exciting vistas for the healing arts. But as Victor McKusick noted on a visit to Buffalo, "There is a widening gap between how to diagnose and how to treat, and between what we think we know and what we really know." I suspect that this statement is as valid today as it was just five years ago. We can take solace, however, in the fact that the quality of our entering class has not only been maintained but-no offense, alumni!-actually improved. Our curriculum has also changed: While it still has many of the traditional features familiar to most of our alumni, the new Clinical Practice of Medicine (CPM) and Scientific Basis of Medicine (SBM) courses introduce the art of clinical problem solving through the mechanism of self-directed learning. This should not only add a little excitement to the curriculum but also better equip our students to become "lifelong learners." Finally, we look forward to welcoming Stephanie Unger as the new editor of Buffalo Physician. A senior editor and writer with the City of Hope ational Medical Center/ Beckman Research Institute, in Duarte, CA, Ms. Unger will come on board in October. In the meantime, a very special thanks to Judson Mead, editorial manager of the UB Publications Office, for serving as interim editor. / ~ .127_/ ~f/L~ c:;7' JInterim Wright, M.D. 1~~~;R. Dean, School of Medicine and Biomedical Sciences Interim Vice President for Clinical Affairs Dear Fellow Alumni, THE CLASS OF 2001, CONSIST\ G OF 135 FRESH\1.\"1 medical students, has embarked on an exciting journey. It is a bit shocking to realize that they will complete their basic medical school education in the next millennium. I'm sure I speak for all alumni in expressing my appreciation for the extensive skills and energy of interim dean Dr.john Wright. I look forward to his continued participation, counsel, and guidance as he works to maintain and improve the quality and status this medical school has achieved over the past two decades under the leadership of former dean Dr. john Naughton. This year we are excited about a new mentoring program, conceived by Dr. Wright, in which interested freshmen will be matched with alumni volunteers who will act as a friend and mentor, as well as serve as a source of information, advice, and assistance. I can't think of a better way for students to get to know the alumni and our association. We already have more than 100 students from the freshman class, and judging by the numbers of alumni volunteers, they seem to be equally enthusiastic. If any alumni who have not been contacted would be interested in participating in the mentoring program, please contact the Medical Alumni Association office. The mentoring program committee is being chaired by past Medical Alumni Association president Dr. jack Coyne. ~.,;;w, ~D~ President, Medical Alumni Association �V OLUME 3 1, N UM B E R 4 A UTUMN 4 Dr. Mahoney Becomes Dr. Mahoney 8 DNA on Ice ROSWELL PARK ' S DNA LIBRARIES-FROM G IVING UP A SILKWORMS TO PLASMODIUM VIVAX. by Jessica Ancker CAREER IN 1 997 "The Woman's Way of Seeing and Doing" 12 PUBLIC HEALTH FOR REFLECTIONS ON MEDICINE. PIONEERING WOMEN I N by Michael Beebe MEDICINE AT UB. by Christopher Densmore Research GAIT-RELATED PROBLEMS. PESTICIDES AND BREAST CANCER. HIGH CHOLES- TEROL AND STRESS . Orientation '97 LET THE HARD WORK BEGIN! Development Medical School News MEDICAL SCHOOL REUNION A Student's Perspective LESSONS FROM THE GIVING PROGRAM. MINI MED SCHOOL. LATE MIDDLE AGES. P AG ANELLI HONORED . PET CENTER GRANT. MAGGIE Alumni News WRIGHT RETIRES. TONE .JOHNSON .JR . DEAN'S ADVISORY COUNCIL. UB COMPLETE S WHI E NROLLMENT . by Judith Toski, Class of 2000 '75 AWARDED BRONZE STAR. 1 9 9 8 SPRING CLINICAL DAY PLAN S. Classnotes �mr· ................................................................................. UB researchers study gait-related problems ALTERED STRIDE MECHANICS MAY LEAD TO SECONDARY INJURIES sing a force-measuring treadmill called the Gaitway, developed by the Kistler Instrument Corp. of Amherst, Y, in conjunction with the UB biomechanics laboratory , UB researchers are looking at two distinct kinds of gait mechanics: running after a leg injury , and walking after hip-replacement surgery. RLN"'ING INJLRIES One area of interest is the relationship between initial and secondary injuries in runne rs . Harold Burton, Ph.D. , UB associate professor of physica l therapy and nutri- ~ tion and exercise science, and his : coinvestigator on the study ,john Leddy, "' M.D., associate director of the UB Sports Medicine Institute, have been able to show that runners who develop a muscle injury in the lower extremities alter their running pallerns unconsciously after an injury. This change in running mechanics causes a deviation in the foot's normal impact and push-off force , which can be measured on the treadmill. A change in running mechanics may affect the way that force is dissipated. As a result , the added or altered forces are absorbed by joints and/or muscles unaccustomed to this stress, which may lead to a secondary injury in areas such as the knee , hip , or lower back. "By getting an idea of how a person with a particular problem changes running strategy, we hope to eventually identify a pattern and predict the risk and location of a secondary injury," 0 Burton says. "If we can predict what's going to happen , intervention with corrective measures , such as an orthotic, can prevent the secondary injury from occurring." The study, which involved 10 male recreational runners , examined the effect of injury to the thigh muscles. After coll ecting baseline measurements during level treadmill running, researchers had the participants induce muscle "injury" by running downhill for two 20minute sessions. Downhill running can cause microscopic muscle-fiber tears. For four consecutive days following the injury session, researchers recorded the walking pallern a patient has developed to cope with the pain of arthritis. According to Scott White , Ph.D., associate professor of physical therapy and nutrition and exercise science, relearning a proper walking pallern helps to prevent injuries after surgery and speeds rehabilitation . White is using a Kistler treadmill equipped with a computer that displays measurements of force for patients to read as they walk. When reinforced by verbal coaching from a physical therapist, the visual aids can help patients see the problems with their gait and get immediate feedback on improvements. vertical foot-ground reaction force generated by each runner during level treadmill running. Results showed that the runners who got sore, or "injured ," after running downhill produced altered forces during the next running session, indicating alterations in running mechanics. "These altered mechanics may predispose the individual to secondary injuries of other structures, such as joints, ligaments, and tendons ," Burton says. Among runners , this is no small problem. According to Burton, 50 percent of the people who run regularly experience some type of injury during any one year and need more education about what can happen as a result. A patient with a pronounced limp , for example, can be shown two rectangles that represent the relative lengths of the strides he makes with his right foot and with his left foot. By trying to make the two rectangles match in size as he walks, the patient learns what the correct, symmetrical walking pattern feels like. The Gaitway system's software also lets researchers record the data and perform a number of different analyses. In a three-year study funded by the Arthritis Foundation, White is testing the technique on a prototype Gaitway machine , working in collaboration with Robert Lifeso , M.D., clinical professor in the Department of Orthopedic Surgery, who performs hipreplacement surgery and often refers his patients to White's group for postoperative therapy. + HlP REPLACEMEt\TS Hip-replacement surgery can take care of the pain and immobility associated with arthritis, but many times it fails to correct a related problem-the cramped B u f f a l o - L OtS physician B AKER AND JESSICA A NCKER Autumn 1 9 9 7 �· · · ···· · · · · · ···· · · · ···· · . ... . . .. . . . . . . . . . ... .. ..... . . .. . m .... . ················· [(1~--~ .. . Study questions breast-cancer High cholesterol boosts blood risk trom pesticides and PCBs for pressure in high-stress situations women who breast-feed eople with normal blood pressure n research involving 154 postmenopausal women with breast cancer and ] 92 healthy \\Omen of similar age selected randomly from the general population, Kirsten Moy ich, Ph.D., research instructor in the UB Department of Social and Prcvcnti,·c Medicine and chief investigator on the study, has found no link between breastcancer risk and exposure to pesticides and PCBs in \Yomcn who breast-fed. Researchers measured blood levels of certain organochlorines-DOE, HCB, mircx, and PCBs. Since these compounds arc stored in body fat and arc not easily broken dm.,n , they accumulate in the body over time. Some of these chemicals ha\ c been shown to increase estrogen activity in animals and consequently have been linked to breast-cancer risk. \\'hen separated into groups according to histor) of breast-feeding, .,.,-omen '" ith breast cancer who had never breastfed had significantly higher levels of organochlorines than healthy women who had nc,·cr breast-fed. "These chemicals arc stored in fatty tissue, including breast tissue ," Moysich savs. "The chief mechanism for climin;ting them from breast tissue is lactation , .,, hich Oushcs them from the svstem." She adds that even though tl1c nursing baby is exposed to these substances, the beneficial effects ofbrcastfccding appear to outw cigh potential risks associated '' ith these organochlorines. The study was p rcsc n ted at the International Socict} for Environmental Epidemiology in Taiwan in August. + --- B u f f 0 I 0 can experience greater increases in blood pressure during stressful situations if they have high cholesterol, according to a study published by Bong Hce Sung, Ph.D., UB associate professor of medicine, in the june issue of the American journal of Hypertension. Conversely , the study found that lowering cholesterol with drugs and diet also lowers stress-related increases in blood pressure. It is the first study showing a link between cholesterol levels and hypertension. "We don't know the cause of high blood pressure in 90 percent of hypertensives," Sung says. "These findings shed some light on the mechanisms that cause high blood pressure, opening up possible new avenues for treatment and prevention. "Our results indicate that lowering cholesterol may have the added benefit of controlling blood pressure better during stress, which will lower the chances of developing hypertension and heart disease." The effect of cholesterol on vasoconstriction has been well documented in isolated peripheral vessels, but until now the o,·erall effect of cholesterol on blood pressure has not been studied. To assess the relationship between high cholesterol and blood pressure, ung and colleagues established a study group composed of 70 people with normal blood pressure, 33 of whom had normal cholesterol and 37 with high cholesterol. Blood pressure was monitored in both groups while they took a mental arithmetic test , a standard method to simulate psychological stress. Physician Autumn 1 9 9 7 ~ Researchers added stress to the equation, Sung says, because a dramatic increase in blood pressure during physical or mental challenges has been shown to be a risk factor for later development of hypertension and cardiovascular disease. Recent evidence also shows that the damage to organs caused by hypertension is more closely linked to blood-pressure response to stress than to "casual" blood pressure. Results showed that during the stress test, systolic blood pressure increased to the hypertension range (greater than 140 mm Hg) in 46 percent of the high-cholesterol group, compared to 18 percent of the normalcholesterol group. Sung says that high cholesterol appears to impair the ability of the endothelium (blood-vessel lining) to relax and constrict normally. The study's second phase was designed to determine if lowering cholesterol lowers blood-pressure response to stress. ln a double-blind design, half of 26 members of the high-cholesterol group took a cholesterol-lowering drug for six weeks, while the other half received a placebo; the protocol were then re,·ersed. Total cholesterol fell 26 percent during drug treatment. Participants repeated the mental arithmetic stress test after both the drug period and the placebo period. Results showed that peak systolic blood pressure during stress dropped from 141 mm Hg without treatment to 133 mm Hg after treatment. Sung's coauthor on the study were joseph L. lzzojr., M.D., UB professor of medicine and professor of pharmacology and toxicology, and Michael F. Wilson, M.D., UB professor of medicine. + L o 5 8 A K E R �~f~HI[~ ~f~f~H~ are key to progress in genetics research If DNA is the book of life , the laboratory of Pieter dejong , Ph.D. , is the printing press . BY JESSICA PHOTOS 0 B u f BY f a K l o He and his colleagues in the Human Genetics Department at Roswell Park Cancer Institute are the world's leading suppliers of the DNA libraries that make genetics research possible. They have supplied the gene libraries in which the two breast-cancer genes (BRCA1 and BRCA2) were identified in 1994 and 1995, as well as a host of less ANCKER famous genes involved in such illnesses as C . KRATT spinal muscular atrophy , pancreatic tumors, and Wilm's tumor. More than 40 research centers in 10 countries are using dejong's libraries to hunt for specific genes , create gene maps , or sequence large stretches of human D A. Their work makes them a crucial participant in the Human Genome Project. They're also applying their methods to a wide variety of other organisms, building libraries of the DNA of mice , rats , baboons , silkworms , the Legionnaire's disease organism Legionella, and the malaria parasite Plasmodi um vivax. They're even working with genetic material from a Doberman pinscher that suffers p hysician A u t v m n 1 9 9 7 �library and its copies occupy three tightly packed seven-foot freezers. "So, clearly, you can see that one of the things we need is technical improvements so the libraries will take up less space," de j ong says. The libraries are shipped to researchers all over the world. One of the biggest advantages of using a standardized library is that it provides a common reference system. lf, for example, a scientist identifies a disease gene made up of several fragments from de jong's DNA library, other researchers anywhere in the world can verify the work by placing an order with de jong for copies of those bacterial colonies. A LTER from narcolepsy, supported in part by a grant from the American Kennel Club. "ln this lab, you get calls from the strangest places," de jong says. CR EAT ING LIBRA RIES ln de jong's lab, human chromosomes are cut into pieces between 100 and 300 kilobases long, and the pieces are linked to fragments of artificially produced bacterial D A. The resulting circular chromosomes are made up of mostly human D A but also include important elements that allow them to "pass" as bacterial chromosomes when they are inserted into bacteria. One of these is a D A sequence that ensures that whenever the bacterium divides, it will produce copies of the artificial chromosome for the daughter bacteria. These bacterial artificial chromosomes, or BACs, are inserted into specially bred strains of the common bacteria E. coli. When the bacteria are properly cultured and separated, the result is an array of hundreds of thousands of separate bacterial colonies. Each colony, which is tagged with a unique identifying number, contains hundreds of copies of a unique fragment of human D A. Together, all the colonies are known as a library. Building the library is tricky work. At each step, many of the bacteria die from the unusual stresses imposed upon them. For example, electric shocks are used to punch holes in bacterial membranes so the BACs can enter-and the shocks are strong enough to kill a substantial portion of the bacteria. "At each step, we have a rather narrow window of opportunity," dejong points out. The library can be stored indefinitely by freezing in glycerol, or it can be copied by a "printing press" that dips a tiny metal spike into each colony, picks up bacteria, and touches a clean well of agar where the bacteria will grow and form a new colony of clones genetically identical to the mother colony. Dejong's lab makes 12 copies of each DNA library in order to accommodate requests from future researchers; a single ATE SYSTE MS IN v ENTED Although there are many ways to build aD A library, most have serious drawbacks. Some techniques package the human D A fragments into viruses, which then infect bacterial cells. But to fit in the viruses, the human DNA has to be cut into very tiny pieces; and since human genes may be as long as 1,000 kilobases, it's not very useful to have to cut the D A into fragments of only 15 kilobases or so. The invention of the yeast artificial chromosome, or YAC, overcame the size problem, but introduced other difficulties. YACs, which are grown in yeast, can be used for fragments of several hundred kilobases-large enough to contain an entire gene, or at least a substantial portion of one. However, up to 60 percent of these fragments are altered in unpredictable ways in the yeast. Sometimes, two or more pieces of human D A become inserted in the same YAC, making unrelated human D A sequences appear to be neighbors. Other times, the YAC D A gets rearranged or combines with other YACs inside the yeast. �~(~[ll[~ ~(~(~H~ Today, de Jong and many other scientists usc a system based on the bacterial artificial chromosome, or BAC. ABA can accept large fragments of human D A, and bacteria faith full} reproduce them without confusing rcarrangemcn ts or recombinations. Dejong also uses a libra[} system he invented several years ago, a variation upon the BAC called a PAC because it uses some fragments from an organism called the rl bacteriophage. His PAC librar) is being used b) researchers all o<.er the world, including the world's largest gene- equencing center, the Wellcome Trust Centre for Human Genetics, in England. "They sequence more than all the other centers put together, and they use our PAC libra[} exclusively," dejong says. ETHICAL TROUBLES RESOLVED The Human Genome Project was in full swing, with research APPLICATIONS I CA CER RESEARCH delving into four major D A libraries (including dejong's), Libraries from Roswell Park haw already been instrumental when an international dispute broke out about ethical probin Identifying the t\\o known breast-cancer genes and in lems involved in the collection of the D A samples. It was studying man} other cancers. discovered that the samples in the libraries were not taken In an example from Roswell Park , dcjong's PAC library is from a cross section of the population, but from a few donors helping to pin down precise information about the chromowho worked in the laboratories, and that these donors had somaltranslocations that cause leukemia. never signed informed-consent releases. Also, no measures Peter D. Aplan, M.D., a member of the Ros\\cll Park had been taken to safeguard their anonymity, leading to the faculty and a B assistant professor of pediatrics and of possibility that they could run into trouble obtaining health microbiology and immunology, says that many research insurance if any genetic anomalies were discovered. methods can provide some information about these transloThese problems arose when the researchers who were cations, but only molecular biology can pinpoint the exact building the libraries treated places where chromosomes the human samples as they break and rejoin. "We want to Some ethicists fear that genetic would samples from other ornarrO\> it down to the precise information will lead to the temptation ganisms. "The focus was not base pair ," he says. on the individual. It was on the Aplan and his colleagues to tinker with the human genome. species," de Jong says. compare D A from leukemia cicntists involved with the patients \l-ith DNA from de Human Genome Project also worried that they would be accused jong's PAC library. B} subjecting both to digestion \\Ith of elitism for studying only the genes of fellow scientists. restriction enzymes , and then comparing the patterns of In response to the findings, the ational Institutes of resulting fragments , the researchers can narro\\ down the Health awarded grants to build a new set of libraries that location of the break-point to a region of less than l ,000 base comply with strict guidelines. Dejong's group was awarded pairs. This region is small enough to be sequenced in an $1 million to build two new libraries, one of DNA from a automatic D A sequencer. woman's white blood cells, the other from a man's. Dozens of "Pieter' Pl clones provide a framework that we usc to volunteer rc ponded to an advertisement in the Buffalo map our findings onto ," Aplan sa)S. cws, and after screening by Roswell Park's genetic counseUsing methods like these, Aplan has identified and charlor, 20 men and20 women were selected as potential donors. acterized a nm·el gene that , when disrupted by translocaThe final selection of blood samples was made on a doubletions, apparently helps to cause T-cell acute lymphoblastic blind basis, so neither the volunteers nor the scientist know leukemia. He has also studied the mechanisms of action of whose genes are in the new library. distorted gene products im olvcd in other leukemias and has The male D A library hasjust been completed; the female proposed an explanation for ho\\ chemotherapy for a prione is next. Meanwhile, the old libraric may still be used mary cancer can trigger therapy-related acute myeloid leukemia many } cars later. because the donors signed consent form , de jong says. 0 B u f f a L 0 Physician A u t u m n 1 9 9 7 I �TH E PROMISE Cancer is not the only target. By studying inheritance patterns in an extended family, researchers at ew York University have narrowed down the location of a potential epilepsy gene to a region of aboutSOO,OOO base pairs on one chromosome. They can go no further with gene mapping, so they have approached dejong about making aD A library from a particular patient thought to have the gene. And many of the world's most prominent genetics research centers, including the Wellcome, the Whitehead Institute/MIT Center for Genome Research, and the Sanger Centre in England, are using dejong's libraries to sequence human D A as part of the Human Genome Project. Each segment of human D A is subdivided until it is small enough to be analyzed by an automated D A sequencer. Some 16,000 of the estimated 50,000 to 100,000 human genes have been mapped, but the function of many of these genes is still unknown. A comprehensive sequence of the human genome will reveal many more unknown genes, so the next step must be to investigate their function through such techniques as comparing them with homologous genes from other organisms. There are many questions about the best uses of the new genetic information. Some ethicists fear that it will lead to the temptation to tinker with the human genome for trivial or monetary reasons. But Thomas Shows, Ph.D., chair of the Department of Human Genetics at Roswell Park, is optimistic that complete information about human genes will focus medicine on what he calls "preventive maintenance." "We could become predictors of disease," he says. "Preventive medicine is so much less expensive than treating disease after the fact. " Prenatal testing can already identify more than 200 genetic disorders. Ultimately, Shows hopes, physicians will be able not only to identify potential problems but to prevent them. "Genetic testing might allow DNA library plates are stored us to find out what cards we're at -85 degrees Celsius. dealt with in the game of life," he says. "Do we have a royal flush , or a couple of two's? Whichever, we need this information to play the game." + For more informoHon obout BACs ond PACs, visit Pieter de Jong's Web site ot http/ jbocpoc.med.buffolo.edu. j essica Ancl1er, a Cleveland-based freelan ce writer, is tlte fann er editor of Buffa lo Physician. 1. Extract DNA Human white blood cells are embedded in agarose, then digested with enzymes, leaving the DNA behind in the agarose gel. How to Build a DNA Library: THE RECIPE 2. Cut up DNA The DNA is incubated with a dilute solution of restriction enzymes, which cut the chromosomes at specific nucleotide sequences, producing a pool of DNA fragments of different lengths. 3. Select fragments In gel electrophoresis, small DNA fragments embedded in a gel move through an electric field at speeds proportional to their size. In order to separate large fragments, the orientation of the electric field is changed every few seconds in a process known as pulsed-field gel electrophoresis. Fragments of the desired size-] 00 to 200 kilobases-can be isolated using this process. 4. Build artificial chromosomes The DNA fragments are linked with the vector DNA to make circular bacterial artificial chromosomes, or BACs. Naturally occurring enzymes are used to seal the pieces of DNA together. S. Insert into bacteria Ashock of a few thousand volts of electricity creates a hole in a bacterium's membrane that lasts long enough for a BAC to squeeze inside, a procedure called electroporation.ln order to create enough holes in enough membranes, the jolt must be strong enough to kill a substantial fraction of the cells. 6. Weed out failures Only a few of the surviving cells will have successfully taken up BACs. Each BAC has been constructed with agene that confers resistance to a particular antibiotic. By exposing the E. coli to that antibiotic, the researchers can kill off any cells that don't have a BAC inside. 7. Grow colonies of clones The surviving bacteria are spread thinly over plates of growing medium and allowed to reproduce. Each colony will be made up of the genetically identical descendants of a single bacterium. 8. Plant colonies Arobot identifies the round white colonies, picks asample from each, and plants the samples in the library plates. Each library plate, which is about the size of a large index card, has 384 tiny wells filled with growing medium and thus can support 384 clones. Each well is identified with a unique address, and each plate is labeled with a bar code. An entire human genome library will contain more than 500,000 clones and fill some l ,500 plates. 9. Store or reproduce The plates can be stored indefinitely at -85 degrees Celsius. The colony-picking robot can also act as a "printing press" to make copies of the plates. �MARTIN MAHOI\L\ \\'.\~ON Ill.,\\;\\ to a stellar career in the field of public health as an epidemiologist whose doctoral dissertation revealed higher-than-expected cancer rates among Seneca Indians and as director of ew York's cancer-surveillance program-all before he reached the age of 30. He also had teaching appointments in the School of Public Health at the State University of ew York at Albany and in the Roswell Park Cancer Institute's graduate division. Arthur Michalek, Ph.D., a leading cancer researcher at Roswell Park who first had Mahoney as a student, then later conducted groundbreaking research with him, recalls that he had the makings of "a leader in the field." So what is Mahoney, now 35, doing with a stethoscope around his neck, checking a youngster's sore throat, asking an elderly patient how that new medication is working, and seeing anyone who comes in the door of the family practice clinic at the relatively low-profile DeGraff Memorial Hospital in orth Tonawanda, ew York? Mahoney, who still carries the oversized shoulders of a competitive swimmer from his undergraduate days at Canisius College, smiles at the question. "It's something I always wanted to do," he says. He obviously wanted to do it pretty badly. 0 e u f f a 1 o phys ici an Autumn 1 9 9 7 �PHOTOS BY FRANK CESARIO �- FROM PUBLIC HEALTH TO PRIMARY CARE ~--------------------------------------~ WHEN HE FIRST APPLIED to the University at Buffalo medical school in 1983, after graduating with honors in history from Canisius, he was not accepted (true of about 90 percent of those who apply). His grades were good, his board scores were okay, and he had taken the necessary science courses despite his history degree. He just wasn't close enough to the front of the line. David Valai k , Ph.D., his history professor as well as his swim coach at Canisius, doesn't think much of a medical school admission committee that would reject Mahoney. Valaik couldn't have asked for a better student or swimmer. Last year Mahoney was the first swimmer since Canisius started its swimming program in the 1960s to be inducted into the college's sports hall of fame. "Martin never needed the lecture 1 give to some students," Valaik says. "He had it. " Without the option of attending medical school, Mahoney decided to study epidemiology, earning both a master of science degree and a doctorate at UB before going to work with the ew York State Health Department in Albany. As director of the state's cancer-surveillance programs, Mahoney found both rewards and frustrations in public health. He suddenly had access to millions of health records and powerful computers to analyze the data . He traveled throughout the state, looking at clusters of cancer and trying to find relationships . But as he discovered in May 1989 , there are limits to what an epidemiologist can do . Mahoney came from Albany to orth Tonawanda with the results of his latest study, a look at cancer cases near a plastics factory. A nine-year survey of local medical records showed cancer was not on the increase. lt was not what the hostile audience wanted to hear . "We are not going to buy that ," said the city's mayor at the time , Elizabeth C. Hoffman , who had ovarian cancer herself. " ot when people see house after house with people with cancer." Mahoney felt the call of medicine and its more immediate results even more strongly after he first gained the confidence of the Seneca Indians and then published his study showing that cancer rates were much higher among that ative American population than expected. The study, and later work by Mahoney , Michalek, and others, showed that while cancer deaths increased by 4 percent in the general population, they jumped by 10 percent among ative Americans, who have the poorest cancer survival rates in the United States. Yet health-care providers to these Indian populations gave cancer a lower priority behind alcoholism, diabetes , injuries , and cardiovascular disease. "As a researcher," Mahoney says, "l thought it would be easy to implement. But I didn't see anyone jumping on it. " So in 1990, Mahoney again applied to medical school and this time , armed with credentials that most medical schools would die for, was easily accepted. B u f f a l a Mahoney's first rejection was reall y not unusual, says Roseanne Berger, M.D., associate dean for graduate medical education at the UB Medical School. "Despite the questions in the press about whether we're training too many physicians or whether income is going down , the number of applications to medical schools continues to increase. The talent pool is really remarkable ." But going to medical school and interrupting a successful career to do so is difficult, as Mahoney found out. He and his wife, Ellen, were expecting their first child (their daughter Christine is now 6), and they had to sell their home in Albany and go apartment hunting in Buffalo. Mahoney also had to give up a good income with the state and face stiff tuition bills again. His wife was behind him all the way. "Why not do it? " he says. "I figured this was always going to haunt me if I didn't." To put it mildly , Mahoney was not your typical medical student. He kept his teaching appointments at SU Y/Albany and Roswell , continued his research with his mentor Michalek, and picked up a part-time job as a medical epidemologist with the Buffalo Otolaryngology Group. "T hey were sitting on a large amount of data from their patients over the years, and I helped set up a database," he recalls. Mahoney, who received one of the public-health industry's most prestigious honors in 1992-thejay S. Drotman Memorial Award-for his pioneering research with the Senecas, also started making a name for himself in national medical circles. He was elected first as a student representative, then later as a resident representative, to the American Academy of Family Physicians' Commission on Public Health. Then this past spring, he received the American Medical Association's Glaxo Wellcome Leadership Award, the resident's award from the ew York State Academy of Family Physicians, and the MeadjohnsonAward for graduate education in family practice. Described by those who know him as soft spoken but vocal when he needs to be , Mahoney seems almost embarrassed by the attention . "I guess I've just been fortunate to be recognized for some of my accomplishments," he says. Mahoney feels that his public-health background is invaluable when searching for the cause of a patient's illness in the clinic. Like epidemiology, he reasons , medicine is a case of examining a problem thoroughly and then reducing the odds. If it's not this, it could be that; if you eliminate this , it might be that. Physician Autumn 1 9 9 7 �FROM PUBLIC HEALTH TO PRIMARY CARE - ~--------------------------------------~ Practicing medicine, in the same way, is helping him with his research. While serving part of his residency in the Deaconess Hospital, where he saw a mostly minority, low-income population, Mahoney noticed that many of the new mothers were not nursing their babies. "Physicians are naturally inquisitive, and would probably notice this and say something about it to their fellow physicians or spouses," says Berger, the associate dean and Mahoney's ultimate boss during his residency. But Mahoney's public-health background gave him the expertise and confidence to follow his curiosity and develop a questionnaire and a database to further study the reasons behind this phenomenon, she says. Noting that the results are still coming in, Mahoney says that it appears that breast-feeding in these women is not something that is passed down from one generation to another, perhaps because they have children at such an early age and the generations pass so quickly. His work at Roswell Park Cancer Institute, where his research partners include Michael Cummings, Ph.D., one of the nation's preeminent antismoking experts, has led him to what he feels is one of his most exciting projects: Tar Wars. Conceived by two Denver physicians and run in past years on a shoestring budget, Tar Wars has been adopted and funded by the American Academy of Family Physicians. Mahoney serves on the Tar Wars board of directors and is its coordinator in Western ew York. ''I've really bought into this," Mahoney says. "I think it's a terrific program. "You can't tell kids that smoking is going to shorten their life and that they may die when they are 40, 50, or 60 years old," he said. "When they're l l or 12, they think they're going to live forever. So we mention the negative effectsbad breath , yellow teeth, smelly clothes. Plus smoking costs a lot of money. It begins to get them to focus on how advertisers set them up. You never see these effects of smoking, or ashtrays or burns in the clothes in the ads. We get them to figure out how much smoking costs, about 60 or $70 a month. That's a small fortune for a kid-that's three CDs and a in tendo game." Mahoney intends to hit the road this year to spread the message of the Tars Wars campaign in classrooms. It's not that he has a lot of free time. In addition to his work , Mahoney and his wife now have two other children, icholas (5) and Madeline (15 months). He also is the medical director for the Cantalician Center for Learning; a board member of the Allegany Regional Development Corporation, which helps serve the Seneca ation of Indians in Salamanca, Y; and a board member for the iagara Frontier Vocational Rehabilitation Services, a group that trains and finds jobs for disabled people. And for the past year, he has served as vice chair of the residents section s u f f a l a Physician representing family physicians on the national Council on Medical Specialty ocieties. He is a founding member and on the steering committee for the etwork for Cancer Control Research in American Indian and Alaska Native Populations. In addition, he serves as a referee for five professional journals, including the Intcmationaljou rnal of Epidemiology, and he i an author, coauthor, or contributor to 57 research projects. "My wife understands my work," he says. "She knows this makes me happy. I'm one of the luckiest people in the world." Mahoney has just completed his residency-he also was chief resident-and signed a contract with the medical school, one that allows him to practice medicine, teach medical students, and continue his research. 'Ttl spend 60 percent of my time in clinical work, supervising residents and seeing patients. Twenty percent of the time I'll teach, 10 percent for administration, and 10 percent for research. That doesn't sound like a lot of research, but right now I'm doing all my research on my own time." It would have been simpler, of course, had Mahoney gotten into medical school the first time. But now that he's completed the training for his dual careers, he wouldn't have it any other way. His former mentor, Michalek, who has developed a deep friendship with Mahoney, says his medical degree helps Mahoney bring a fresh perspective to the public-health field . "I think he'll have the best of both worlds," Michalek says. "An M.D. has a real appreciation for the clinical approach. Most people in public health may have a Ph.D., but they don't have an appreciation for disease. That clinical training gives him the ability to better evaluate the research ." It also has a beneficial side effect for Michalek: After all these years of teaching medical students, Michalek has finally chosen one to serve as his own personal primary-care physician-Or. Martin C. Mahoney, Ph.D., M.D. + .\1ichacl Beebe is a reporter for the Buffalo Autumn l 9 9 7 ews. �MEDICAL STUDENTS �"DOES THE WOMAN'S WAY OF SEEING AND DOING EVER HANDICAP HER?" BY CHRISTOPHER DENSMORE , 'E HtJNDRED YE-\RS> AGO , - on April 27, 1897, Dr. Maude j. Frye addressed the graduating class of the University of Buffalo School of Medicine on the subject of "The Woman's Place in Medicine." An 1892 graduate of the medical school, in 1897 Dr. Frye was on the faculty as a clinical instructor in the diseases of children. I am going to use Dr. Frye's address, along with the recollections of UB's first female medical school graduate, Dr. Mary Blair-Moody, and editorials of Dr. Austin Flint that appeared in the Buffalo Medical]oumal, to illuminate the experience of these pioneering ._. women medical students. I will use, as much as possible, their own words. First, Dr. Frye: "I WISH TO PRESENT to you tonight some thoughts concerning woman's place in medicine; the limit of her work, [and) the line which she will oftenest follow. "Whether we like to confess it or not, woman's physical organization necessarily sets a limitto her achievements ... [Here Dr. Frye refers to the proposal that women serve in the National Guard. She is a bit skeptical.] In reckoning the chances of woman's success when she comes into competition with man, the physical factor has always to be taken into account. That medical work which makes the least demand on woman's physique is, other things being equal, that in which she will best succeed." In looking at the past, it is sometimes apparent that beliefs can change. One of the hot topics of the medical literature of the 1890s was whether women should ride bicycles: Would the exertion harm them? Of possible relevance here is an illustration in the first UB yearbook (the Iris), in 1898, of a woman with a bicycle waving a UB pennant. ow back to Dr. Frye: "IT IS, HOWEVER, concerning a feature of woman's mental equipment for work in medicine that I wish especially to speak. I do not expect many of you to agree with me, yet I ask you to think on these things. We must acknowledge between the average man and the average woman an unlikeness of mental capacity comparable to their physical unlikeness, a sex in mind, if I may use the term. This is not equivalent to saying that man is superior to woman. There is equality with diversity. The elm is not better than the oak, nor the oak than the elm, but each is B u f f a l o Physician good of its kind. There are mental processes which are identical in the sexes, there are others which may oftentimes give advantage to the woman in the work of the physician. Does the woman's way of seeing and doing ever handicap her? Let us try to answer the question." lt was this last sentence that first got my attention. A gendered way of "seeing and doing?" Sounds like Men Are from Mars, Women Are from Venus, and other books of that ilk. The debate about whether men and women are essentially the same, or essentially different, has been going on for some time, with, so far as I can see, little chance of final resolution. But to return to Dr. Frye: "IN THE EARLY DAYS when the woman who began the study of medicine was of heroic type, her success was assured from the beginning, for the courage which dared to commence the struggle was equal to any hardship or any emergency which arose later. She has opened the way for the woman of average ability, the woman who but for her pioneer work would be teacher or nurse. The average woman has not, as a rule, the daring of an Elizabeth Blackwell." Dr. Frye is speaking to us from a century ago, 1897. Fifty years earlier, in the fall of 1847, Elizabeth Blackwell had become the first woman to study medicine in the United States when she entered Geneva Medical College. Or rather, she became the first woman to be recognized by the Autumn 1 9 9 7 �medical profession as a physician. Women have been studying and practicing medicine for a lot longer than 150 years. We are in fact talking about the institutional recognition of women as physicians by the medical profession. Elizabeth Blackwell's story is not unconnected with the history of the University of Buffalo. In 1847, many of the people who taught at Geneva in the fall came to Buffalo in the spring to lecture at the VB medical school. All of the teachers at Geneva mentioned by Elizabeth Blackwell in her autobiography were also on the faculty here at UB. One member of our faculty (who did not teach at Geneva) was Austin Flint, after whom Flint Road on the university's North Campus is named. Dr. Flint was the editor of the Buffalo Medical journal and an early supporter of what was then the novel experiment of educating women to be physicians. ln an editorial published in January 1848, Flint looked forward to seeing women as physicians, even though he also stated that "We should regret to see any innovations tending to lead woman from her appropriate sphere-the domestic hearth and the social circle-but we can perceive no good reasons why females whose duties are not prescribed by domestic or social relation should be denied ... exercising usefully their faculties in the capacity of medical practitioners, under proper limitations." To modern sensibilities, this may seem rather lukewarm support, but Flint did, in my e LimaLion, provide important upport to Blackwell by publishing her dissertation in the pages of the Buffalo Medical journal and by writing approvingly of her progress in the medical profession. But advances are not always sustained. Flint's successor as editor of the Buffalo Medicaljoumal was emphatically opposed to women doctors, and when Elizabeth Blackwell's sister Emily applied for admission to the VB medical school in ovember 1851, her application was rejected by the faculty. Women continued to be educated as physicians, but only in such institutions as the Female Medical College of Philadelphia and the ew England Female Medical College, not at the older male institutions. UB's true pioneer woman medical student was Mary Blair-Moody, whose application for admission to the medical school was accepted in 1874. In 1896 Dr. Blair-Moody's reOections on her own experiences were published in the Buffalo Medicaljoumal: "EARLY IN THE AUTUMN of 1874 the majority of the faculty of the medical department of the University of Buffalo decided to favorably consider an application made some years before by a woman resident of their ® B u f f a I o own city, to pursue the study of medicine in their classes on the same footing as the male students. Sex was to be left out of the question as much as possible. The minority, finding it difficult to wholly approve, yielded with true American spirit and also welcomed the innovator with what grace they could command. My youngest brother, then about passing out of his teens, having just previously decided to pursue the study of medicine in that institution, became a member of my family, and together we went into the search for the precious possibilities of the healing art. Every day we measured our work, not by what was required, but by what was possible to be done, making that also include the required. The personnel of the faculty at that time always recurs to my memory as being of a somewhat unusually high order. There was a keen love of truth among them for its own sake. "Two of them said to me, at different times in the course, 'Do not believe what we tell you in medicine or what anybody says until you prove it.' All did not teach in that way for obvious reasons, especially the demonstrator in anatomy.ltwould be impossible. Professor Hadley's classes in chemistry had been and continued always to be open to women. Not only so, women were cordially welcomed and encouraged to do the best work of which they were capable. Dr. Mason frequently had women visitors in his physiology classes and delighted in enlightening them on such practical points as choice of good respiratory mechanism, effects of certain nervous lesions, and similar branches of the subject. "After being well started in my work, and having become quite enthusiastic over the clearness and elegance with which the professor of surgery, Dr. Moore, instructed his classes, I chanced to be in one of the other professor's rooms when he entered without noticing me and exclaimed: 'How is it that we have a woman here?' Dr. Potter entered at that moment and replied: 'J assume the responsibility.' He was dean at the time, and one of them-1 do not remember whom-remarked: 'If we do not like it when she gets through, we can close the doors.' They have never been closed; but, nevertheless, it is my impression that it is liable to remain what it was in the beginning, a man's college, courteously conceding as a privilege to women advantages not taken into account by its charter members. "This has its uses; chivalry on one side and gratitude on the other are encouraged. It is like a bit of the romance of the Middle Ages dropped into the life of a wide-awake, not to say prosaic, American city. Some of the professors said when they decided to leave the doors open to women: 'It shall never be a woman's college. If they wish to study as the men do, well and good. We shall not advertise it as a college admitting women, nor make special arrangements for them, nor consult their convenience.' One of the professors who took this stand and maintained it expressed at one time a thought which is shared by too many and is Physician Autumn 1 9 9 7 �I = - - - - - -- - - -- - - - ------ - -~~-------~ ~ ~ -- --~----- --- mentioned for that reason: 'No lady will wish to study medicine, with the emphasis on lady.' "It was a question in my mind soon after entering how to manage ... I soon felt that there was a majority of the students that would intelligently sustain fair play in the matter. That was a great help to me. What I would have done had that sentiment not prevailed in the class Ido not know.! am sure that this sentiment also prevailed among the professors. There were a few rough fellows in the class who occasionally called my attention to themselves by cat-calls when I entered, excessive smoking at recess, close to my seat, and other manifestations of ill breeding. The class endured it for a while in silence, simply attempting to frown it down. It happened, however, one day that one of the ringleaders of this movement was discovered in some such trick, I do not know just what, and was doubled up and handed over the tops of the iron seats from one man to another from the back row right down to the desk and rolled over that in no gentle manner to the lecturer's usual place. The quietest, most scholarly, and most gentlemanly men in the class took hold with a will and received him with open arms as he was handed along too rapidly to help himself, starting as he did doubled up like a jackknife. This happened just before lecture time.lt was done quite sternly, almost silently, and ---- = and "Of course," recalled Dr. Blair-Moody, "he would not be just ready when I wanted to go home." " ... At graduation the announcement was received with rather more than the usual cheers and congratulations, six little pairs of hands in the gallery joining in the applause." By the time Dr. Blair-Moody penned her recollections, and when Dr. Frye gave her lecLUre, women medical students at UB were no longer an experiment. In the 1880s and 1890s, women made up as much as 15 percent of the graduating classes. Women would remain a minority until the 1970s, but their fitness to swdy medicine was no longer seriously questioned. On October 17, 1889, the women students at the University of Buffalo met to consider "the advisability of fonning a society of women students of the university." Since the time the college admiued women, and Mrs. Moody became a student, the effort of coeducation had been a success, and the time was now ripe for women to bind themselves to support one another to work, not as a few timorous individuals upon whom the world should frown disapprovingly, but as a sisterhood whose object should be mutual encouragement, support, and aid in matters social, educational, and professional. The organization founded , known only by the initials S.E.V., sponsored lectures, study sessions, and social events. Women were to some degree accepted, but continued to feel the need to create separate organizations for mutual support. Organizations by and for women at the university have now been functioning for more than a century. Returning to the remarks of Dr. Maude Frye in 1897: iiiiiiiiiiiiiiiiiiiiiiiiiiiiii must have noforce, small amount ofrequired muscular as he was not a slight fellow to whom this dose was administered. It amused me greatly, as the man seemed to shrink from attracting attention to himself in any way afterward ... "... John, the janitor, was my faithful friend through it all. He was always interested in my work, kind and helpful. Among the boys he had the reputation of being afraid of nothing, living or dead. He, too, liked to see fair play, at least so far as I was concerned, and occasionally so expressed himself to the students in his own inimitable way. 'She pays her money like the rest,' he said to one rough student one day. 'She has just as good a right here as anyone.' "But there were limits, by common consent apparently, to my privileges. It was to be fair play but no favor on account of sex. Our professor in medicine ... once overstepped the bounds, according to class sentiment. We were studying diseases of the chest under his instruction. A prize had been ... offered for the best report on a certain set of lectures on this subject. Perhaps to try the temper ofthe men and their opinions on the subject, he called me out at several successive clinics to make the chest examination, which was a coveted privilege and could not well be accorded to everyone. About the third time a hiss of disapproval was sufficiently expressive to convey the class sentiment of fair play and no favor ... " Mary Blair-Moody was what we now think of as a "nontraditional" swde nt~older, married , and with children of her own. When she entered the medical school, she was in her late 30s with six children. She doesn't mention her child-care arr;ngcments or support network, but occasionally at the end of a long lecture day her family came down to pick her up, and the children would sit with her in the upper seats of the lecture hall. One of her boys would take off his shoes and stockings, B u f f a 1 a Physician "THERE IS ONE quality which more than any other makes for success in certain lines of medical work. It is the type of courage more or less common to all men, rarely found in women-the courage which dares. It is the courage of the soldier, and the explorer. It is the courage which makes possible the great surgeon." ote here that Dr. Frye is talking about two forms of diversity in the mind: a diversity among women, between the heroic pioneers in the mold of an Elizabeth Blackwell and most women; and a generalized diversity between men and women. "ON THE OTHER HAND, through all time woman's genius has given this character to her work. It has not turned to great deeds but has contented itself with the humbler, often holier, tasks of the home, the school-room, and the sick chamber ... It is the courage whose other name is patient endurance ... "The lack of daring does not make a physician less trustworthy, nay rather she may be more worthy of trust, but the lack does not work to her material advantage. There are departments of medicine, notably bacteriology, for which not only woman's type of courage, but her whole manner of training, from her youth up, should eminently fit her, Autumn l 9 9 7 �and in such work as this I believe she will excel. But the woman who gains wealth and fame in the practice of general medicine or of surgery will be the woman who possesses, without necessarily losing anything of her outward womanliness, the masculine type of courage. She will be the woman who would rather be wrong than not try. The average woman would rather not try than risk being wrong. "There is a special message which I wish to give to the young women receiving their diplomas tonight. It is concerning your work among women. Whether you intend to be a gynecologist or not, every woman who enters your office expects you to be. Setting aside your right to do whatever you can and desire to do, the fact that women wish women physicians is the only reason for your being such. You will come to feel later the great power for good-not altogether in a professional way, but as friend and counselor-which is yours, for the good woman who is a good physician has before her, in teaching to her sex right ways of living and true views of life, a work which will bring satisfaction to herself and blessing to others. "... Except for the woman of unusual talent, wifehood and motherhood are of themselves a vocation. Because of this and because other occupations demanding less of her physically and mentally and offering quicker success are open to woman, the number of women physicians will always be few . Yet whether we ever occupy a great place in medicine or not, a place is ours. We are better women for the knowledge of humanity which our work has given us. May we not hope that humankind will be the better too, for our having wrought!" Dr. Elizabeth Blackwell continued as a pioneer in medical education for women in the United States and also in Britain, where in 1859 she was the first woman to "have her name entered on the Medical Register of the United Kingdom." She died in 1910. Dr. Mary Blair-Moody became the fir t woma n member of the Erie County Medica l Society, a fellow of th e America n Association for th e Advancement of Science, and a fo under of the [Buffalo] Women's Educational and Industrial Union. The union later (in 1916) gave their building to house the new College of Arts and Sciences and provided an endowment for the university. When asked for her opinion about th e uses of the endowment, Dr. BlairMoody recomm ended the establishment of a Departm ent of Preventive Medicine, "wi th a yo ung, able, gifted , and enthusiastic person as leader. Sex should not bar anyo ne fro m this chair. " She died in 1919. Dr. Maude Frye taught briefly at UB, then went on to a large and successful medical practice in Buffa lo. From 1922 to 1940 she also served as Medi ca l Adviso r for Women at th e Uni versity of Buffalo. She died in 1946. Change is so metim es slow. In the co urse of co ll ecting materials for this paper, I checked th e Medentian, a magazine published by the students of medicine and dentistry at UB in the 1940s. I was looking to see if it might have carried an article on Dr. Frye's retirement. Though I didn't find one, there was a regular monthly column written by women in the medical school under the ti tie "Hen-Med. " The first issue of the 1939- 40 school yea r, some 50 yea rs after Dr. Frye ente red the medi cal school, ended with the following observation : "THE SLIGHTING FACT that none of the physical diagnosis instructors at a hospital (quote) wants a woman in his group (unquote) ... The unflattering fact that women are politely excused from certain clinical procedures. The unsurmountable fact that too many hospitals have doors closed to women interns. Take all this, give it a quick glance, and pretend to forget about it. "Pretend. But do your share to prove your worth. Remember that the emancipation of women is still a thing of the future. And here in this school, as liberal and open-minded in its attitude toward women as any school in the country, among a group of genuine good fellows who are learning to accept you in spite of the remnants of their traditional distrust of you, is your chance to play a part in the great emancipation." + Magnificent BUILDING LOTS Dear Colleague: As a former president of the University at Buffalo medical school Alumni Association and a practicing surgeon in Western ew York for many years, I've come to understand what members of our profession desire in a home site - privacy, tranquility, fresh air, and pristine surroundi ngs. The Summit at Scherff is a truly extraordinary residential developme nt, un rivaled in Weste rn New York. Nestled in the hills of Orchard Park, this magni fice nt 81-acres has been subdivided into 50 estate-sized buildi ng lots surrounded by Chestnut Ridge Park and euman Creek in a very private enclave. Specifical ly as an escape from the fast- paced everyday life we lead, it's features include: ' Spectacular panoramic views of the Canadian shores, Lake Erie, and the Bulialo skyline ' Mature woods and secluded ravines • Oversized lots for your dream bouse ' Quick and easy access to the freeway systems leading to Bulialo and the city's northern suburbs ' Privacy, seclusion, and exclusivity The Summit promises to be one of the premier areas in Western ew York to construct your luxu ry residence. I invi te you to take a stroll through this picturesq ue setting. For ou r detailed brochure or a private showi ng please call (716) 667-2237 or (716) 472-3790. Sincerely yours, Ed mond J. Gicewicz, M. D. Past President, UB Medical Alumni Association THE Orchard Park, New York CIJristoplt e1 Densmore is tlte University at Buffa lo arcll ivi .st. B u f f a l o Phy si SUMMIT AT SCHERFF c i an Autumn I 9 9 7 �ou and Community Blue - a partnership based on a mutual goal of excellence. Our commitment includes finding solutions to the challenges that we all face in the ever-changing health care arena, and listening to the needs of those we work with and serve. For members, Community Blue offers innovative health coverage that gives members more choices and more flexibility, plus greater and more affordable access to the care they need. PARTNERED FOR EXCELLENCE. Providers benefit from Community Blue's growing enrollment and from the streamlined systems and procedures we're introducing. For employers, we provide a 12-month rate lock that gives rate stability and coverage that matches their business cycle. At Community Blue, we're proud of all we stand for in health care ... our innovative programs, our quality coverage and our financial stability. Most of all, we're proud of the long-standing partnership of excellence we have with the Western ew York medical HMO community. Blue Cross & Blue Shield of Western New York For information, call 887-7921. E .... An loderxn<km LKtnstt of 1he Blue Cross and Blue "'htekl Assoo:.auon The HMO that gives you more Buffalo Phys icia n A utumn 1 9 9 7 ���. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . . . . . . . . . . [1] ~ I Mini med school ahit LAYPERSONS LEARN HOW EX C ITING AND UNDERSTANDABLE SCIENCE AND MEDICINE CAN BE tis 6:30 on an exquisitely beautiful summer evening in late july, and Butler Auditorium is already starting to fill. By 7:00, Alan Reynard, Ph.D., professor of pharmacology and toxicology, is well launched into his description of how R A polymerase forms mR A in order to copy D A. He is squeezing in the last few minutes of a lecture he began two weeks before, working his way to the consequences of mutation" ow, is a protein with an incorrectly placed amino acid a mutation? No." He presents clearly but quickly because Jerrold Winter, Ph.D., professor of pham1acology and toxicology, is waiting to present his scheduled lecture on the chemistry of the brain. Every UB medical school class for the past 30 years has sat in these seats and heard these lectures, although they have usually been given in more detail. But tonight the students are a retired electrician and his wife , a systems analyst, an office manager, a lawyer, 16-year-old Brandon Palumbo, whose grandfather wants him to get a taste of what studying medicine would be like, and 200 other men and women as unlike in their age and backgrounds as traditional medical school students are alike in theirs. This is the final night of the second six-week session of UB's Mini Medical School, developed by Harry Sultz, D.D .S., M.P.H., professor of social and preventive medicine and director of the medical school's Health Services Research Program. When he applied to UB's Office of Public Service and Urban Affairs for a start-up grant, Sultz knew that such programs had been successful elsewhere. The first was offered by the University of Colorado Health Sciences Center in Denver in 1990; since then, more than two dozen institutions have offered similar programs, including a four-week session for members of Congress sponsored by the ational Institutes of Health's Office of Science Education Policy. "The real question in our minds ," Sultz said recently, "was whether Buffalo , with its reputation for blue-collar interests, would respond the way other cities had. " a u f f a 1 o Buffalo and its environs responded. otice of the spring program consisted of one announcement on UB's FM radio station and an article in the Buffalo ews. More than 1,000 people called for the 287 seats. A second program was arranged for June and July to accommodate some of the overflow. A third program will run in September and October, supplemented by additional lectures-on alternative medicine, women's health , preventive medicine , and how to navigate the health-care system, among other topics-for those who have been through the basic course and want more. The curriculum for the basic course consists of two lectures each on the subjects of cardiology, neuroanatomy and neurosurgery , microbiology and infectious diseases , oncology, immunology, and pharmacological therapeutics of the mind. Sultz, who readily characterized the program as "pa rt lecture, part theater, " recruited a luminous faculty of volunteer lecturers . On the night of the last summer session, as Jerrold Winter describes Otto Loewi's discovery of the chemical transmission of impulses in the nerves, the Butler auditorium quiets to a dead hush . "The thing that surprises me the most," Sultz says, "is the interest the people have in pure science. They're fascinated by science, even if it doesn't have immediate practical application to their own health." Sultz set three goals when he proposed the program: to promote good relations between the community and the medical school, to make science and medicine more understandable and exciting to laypersons, and to increase participants' knowledge of health and disease so they could be more competent health-care consumers. Continued demand for the basic course and the interest of"graduates" in additional lectures suggests that he has Physician Autumn 1 9 9 7 �····································· ···· ·······.························· · ··· · ··········• · tM I I THE THING THAT SURPRISES ME THE MOST IS THE INTEREST THE PEOPLE HAVE IN PURE SCIENCE. THEY'RE FASCINATED BY SCIENCE , EVEN IF IT DOESN' T HAVE IMMEDIATE PRACTICAL APPLICATION TO THEIR OWN HEALTH. " met the first goal. "We have a number of science teachers taking the course," Sultz says, "and they've wanted to know if they can bring their students. So we're talking about creating a mini med school for science teachers and their students on a model developed by the University of orth Carolina." For Charles Gorder, a retired electrician from Clarence, NY, the evenings have been a taste of what might have been: "When I was a youngster, I worked as an assistant to a pharmacist. When I got drafted during the war, I hoped to be a corpsman but the avy made me an electrician. I've been an electrician all my life-and that's been good, don't get B u f f a l o me wrong. But I've always had the interest. I've learned more here in six hours than I did in my entire life in school. Look at tonight. Now I know that someone who's depressed may be suffering a chemical imbalance." Bill Kilinskas, a systems analyst from Amherst, Y, came because "at my age you start thinking about health. The knowledge of what a heart attack really is, what a stroke really is, is useful. " And the 16-year-old? "I think it's pretty interesting." During intermission, after Winter has finished diagramming receptors and explaining acetylcholinesterase, serotonin, dopamine, gamma-aminobutyric, and other features Physician Autumn 9 9 7 of brain chemistry, Palumbo buttonholes him at the back of the hall. After the first session, Sultz was approached by a local cable television system with an offer to tape and broadcast the lecture series, but he turned them down. "I don't want people to take this sitting in their living rooms. I want them to go to medical school." And he rounds out the experience with a mini graduation. Led by the traditional bagpiper, the robed faculty march to the well in Bu tier to close the sessions. Participants receive a certificate attesting to the completion of 12 hours of instruction in the medical sciences. + - J U D 5 0 N M E A D �• ·········································· · ···································· · ········ ~ I Paganelli named Distinguished Service Professor harles V. Paganelli, Ph.D., professor of physiology at the University at Buffalo, has been named a SU Y Distinguished Service Professor. A member of the UB faculty since 1958, Paganelli has served as interim chair of physiology since 1991, a position he also held from 1980 to 1982 and in 1986. In addition, he was associate chair of the department from 1976 to 1980 and from 1982 to 1991. Starting in 1970, Paganelli was named to several committees ofUB's Faculty of Health Sciences (made up of all five of the university's medical and health professions schools), in which capacity he helped shape the role of those schools in the university's mission. An active researcher, throughout his career Paganelli has brought more than $5.7 million in awards to the university. His research has taken him to locations that include the Marshall Islands , the Midway Islands , Alaska , and Hawaii. He has presented lectures in Denmark , France , Switzerland, Italy , Israel , Taiwan, Korea , and japan , as well as throughout the United State . Paganelli has published more than 70 articles in professional journals and is coeditor of the book Physiology Function in Special Environments. His professional memberships include the American Physiological Society and the Undersea Medical ociety. In 1995, he received the dean's award of the School of Medicine and Biomedical Sciences and the Student ational Medical Association Award. + try , and Rehabilitation Medicine, and the faculty of Social Sciences. Also participating is the Department of Veterans Affairs through the VA Western ew York Healthcare ystem. "T his award by the Cummings Foundation will allow us to continue mapping the critical pathways by which humans understand language ," says Lockwood. "By studying the links between sound and emotion centers in the brain , we may also be able to better understand hearing loss and disorders such as tinnitus or ringing in the ears, which is associated with adverse psychological symptoms like depression , ~ anxiety, and insomnia." a In addition, the study will examine ~ auditory attention systerns that require ~ more complex processing of aural information and will analyze how the brain handles language , including studies of reading, grammar, and syntax. Such tests have already proved useful in monitoring recovery from concussive brain injuries like the one suffered by former Buffalo Sabres player Pat LaFontaine. Using newly installed M Rl equipment and powerful computers in Buffalo's VA medical center, the researchers will combine the MRI and PET images to map the functions observed in the PET scans onto precise locations in the body indicated by the MRI images. Part of the funds provided by the Cummings Foundation grant will be used to upgrade the computer equipment and software to include this sophisticated image-fusion capability. The james H. Cummings Foundation , located in Buffalo, was established in 1962 through a bequest by james H. Cummings, who was a prominent manufacturer of pharmaceuticals with operations in Buffalo and Toronto, Ontario. The foundation has distributed more than $ 15 million in grants to further medical science, research, and education. + ~ UB medical school receives $107,000 grant from James H. Cummings Foundation he University at Buffalo has received a $107,000 grant from the james H. Cummings Foundation of Buffalo to fund a pioneering research project that will look at how the brain transforms the sounds we hear into information. This three-year study will combine images of brain activity formed using positron emission tomography (PET) scans with images of structures in the brain acquired through magnetic resonance imaging (MRI) to create a unique image that links neural activities to specific brain sites. Through the combined images, researchers hope to gain new insights into how sound relayed by the auditory system are understood. Directed by Alan Lockwood , M.D. , UB professor of neurology , the multidisciplinary project will involve the Departments of uclear Medicine and eurology, Communicative Disorders and Sciences, Linguistics , Psychia- - B u f f a I a Physician PAULA WITHERELL Autumn I 9 9 7 �HURWITZ & RNE, P.C. [ATTORNEYS AT LAW Put the best seat in the fwuse myourgarage. I Maggie Wright med school assistant dean,retires SERYICI G THE LEGAL aggie Saxon Wright, assistant dean for student affairs and director of minority affairs, retired in August 1997. She had served in the medical school's administration since 1981. Wright oversaw the academic and student affairs concerns of first- and second-year medical students and administered the core basic science program, including medical electives, the HLBI Summer Research Program, and the ational Medical Fellowship Program. She also provided support services to all medical student organizations and was advisor to the Minority Undergraduate Pre-health Organization. Active as director or advisor to many local and national programs, Wright has been honored both by medical educators and by the community as the recipient of, among other awards, the State of New York's United University Professions Excellence Award, the ational Medical Association Award, and the NAACP Medgar Evers Award. + NEEDS OF THE HEALTH Scm cEs COMMU ITY • Managed Care • Purchase & Sale of Practices • Business & Tax Planning • HCFA Safe Harbor Regulations and Physician Self-Referrals • Contracts with Private & Public Entities 1997 Buick Riviera • Employee Relations Please contact Robert P. Fine or Lawrence M. Ross at 716-849-8900 Riviera: the most sophisticated personal luxury car Buick has ever offered. It is designed to stir the spirit and excite the soul. We at Paul Batt Buick are proud to serve the people of Buffalo and its surrounding communities. For the last 43 years, we have offered the lowest prices possible, along with the very best in service. We value the professional and the hard working labor force in our community and will continue our efforts to maintain their loyalty. When you enter our showroom you will find helpful people, not pressure-so when you think of Buick sales and service, we know you'll think of us! Joseph R. Pera Paul V. Batt, Jr. 1300 Liberty Building 1717 Walden Ave. , Buffalo, NY Counseling • Fringe Benefit Programs • Representation Before Government Agencies on Audit & Business Issues • Facility Finance and Construction • Credentialing and By-Laws • Hospital/Medical Staff Issues 'ldut'!Jall7Jlliti Buffalo, 6 u f f a 1 o ew York Physician 891-5595 Autumn 1 9 9 7 �• ······························································· · ······ · ················· ~ I Key issues include relations between the medical school and the local medical community, relations between the BY ANDREW DANZO school and the university as a whole, and changes in patterns of medical practice and teaching. Underlying it all are the economic factors driving much of hey don't do it for the glory-the Dean's Advisory Council is the change-the decline of government a relatively unheralded group that prefers to meet outside the support, the rise of managed care. To preserve an atmosphere in which memspotlight. They certainly don't do it for the money-members bers speak freely, Wright hesitates to relate details of Advisory Council dispay their own way, even if they must take a cross-country cussions, but he will say that recent sessions have touched on such subjects flight to participate. as the importance to the school of its What they do for the chool of Medi- the council after having spent 24 years volunteer faculty and the planned mergcine and Biomedical Sciences, however, as chair of orthopedic surgery at UB. ers among institutions in Buffalo's teachis becoming increasingly valuable. With Bradley Aust, M.D., founding chair ing hospital consortium. a roster of senior alumni and faculty of the Department of Surgery at the Some Advisory Council members members, the Dean's Advisory Council University of Texas at San Antonio have already been through similar issues is helping the school position itself to and a member of the elsewhere. "They can maintain leadership in medical educa- UB Class of 1949, provide us with some DEAN 'S ADVISORY COUNCIL tion, biomedical research , and health- agrees: "We're happy of the scenarios and some of the things we care policy during a period of profound to try and be supJ. Bradley Aust, M.D. national change. need to pay allention Charles D. Bauer, M.D. portive in giving adMichael E. Cohen, M.D. "The Dean's Advisory Council is a vice. One of the to from the perspecS. Max Doubrava, M .D. tive of the medical forum to put forth provocative, poten- advantages of outJock C. Fisher, M.D. schoo I," Wright says. tially controversial ideas; to get a reac- side participation is James R. Konski Jr., M.D. "Experience is a wontion from individuals both inside and that we're at other Jerome P. Kossirer, M.D. outside this community," says interim universities and derful teacher. " (Con sultant ) dean and vice president for clinical af- medical schools: In February of Harry l. Metcalf, M.D. fairs John R. Wright, M.D. "I articulate There are some this year, the group Eugene R. Mindell, M.D. current issues facing the school, warts generic problems met in Boston at the Richard B. Norins, M.D. and all. I don't think I hold anything that cut across uniHoward Hughes Margaret W. Poroski, M.D. back ... and the Advisory Council is not versity boundaries, Medical Institute, Dorothy C. Rosinski-Gregory, M.D. reticent about providing advice." and we can tell [the where the Advisory Albert C. Rekote, M.D. Established two years ago by former dean] about our Robert N. Schnitzler, M.D. Council's honorary George W. Thorn, M.D. dean John P. a ugh ton, M.D., the coun- problems and how chair , UB Class (I lonon11y Clw ir) cil represents a broad range of experi- we solve them. " of 1929 member Philip B. Wels, M.D. ence. Members from the Buffalo area George W. Thorn, Wright sees the Franklin Zeplowitz, M.D. include faculty who are heavily involved council, M.D ., has served as which in the UB medical school and alumni meets three times a research director. who are active in the local medical com- year, as a combina"He talked about his munity. Other council members, many tion of expert panel and sounding board life," recalls Mindel!. "He gave us of whom hold distinguished academic to help the school grow stronger in an some suggestions about how our and research positions, are scallered unpredictable but rapidly evolving en- school can attract outstanding facaround the country. vironment. "It's a given that we're not ulty and how to pursue funding for "We would like to help the UB School going to stand still," he adds. "We're activities we're interested in. " of Medicine to move ahead," says Eu- going to have to think of different ways ext February council members will gene R. Mindel!, M.D., who serves on of doing things." travel to San Diego, where they will be Dean's Advisory Council ® B u f f o l o Physician .A. u t u m n I 9 9 7 �····················· · ·· · ··············· · ··· · ······· · ················· · ···· · ······ · ····· • I • ~ . I hosted by jack C. Fisher, M.D., a UB Class of 1962 member who is among the group's most active participants. A noted professor of surgery at the University of California at San Diego and former head of that school's Division of Plastic and Reconstructive Surgery, Fisher hopes to provide insight for developing strategies in Buffalo. "There are contrasts to what's happening in Buffalo with what I've experienced here in California," Fisher says. ''I'm planning to give [council members] the opportunity to meet with some of the administration from our medical chool and medical center to discuss how managed care has inOuenced our own graduate and undergraduate medical education. It's been hard. " Fisher, who devotes at least several days a year to Advisory Council meetings and preparation , sees it as a way of giving back to his alma mater. "Basically, I'm a graduate, and Buffalo is my home. I was honored to be asked, and I find it interesting." + Andrew Danzo , a Buffalo -based freelan ce writer, is a frcc1uent contributor to Buffalo Phys ician . INFINITI AUTO PLACE INFINITI 8129 MAIN ST., WILLIAMSVILLE 633-9585 East of Transit Rd., Near Eastern Hills Mall s u f f a 1 o UB first to complete Women's Health Initiative enrollment he University at Buffalo is the first of 40 sites in the nation to meet all its recruitment goals for the $625 million Women's Health Initiative (WHI), the largest clinical trial ever undertaken in the U.S. UB's Department of Social and Preventive Medicine was selected in 1993 to be one of the initiative's 16 Vanguard Clinical Centers. These sites established the study's design and developed the operating procedures for the remaining centers. A total of 4,000 women in Western ew York have volunteered to take part in this landmark study. The WHI's goal is to arrive at definitive answers concerning the relationship of hormone-replacement therapy and various aspects of diet on women's long-term health. A third aspect of the project, the observational study, involves tracking women over the 12year study period to determine lifestyle habits that are beneficial or harmful. Specifically, the study will seek to determine risk factors for heart disease, the largest killer of women; breast, colon, and endometrial cancers; osteoporosis; and Alzheimer's disease. The WHI eventually will involve 163,000 women nationally between the ages of 50 and 79. Karen Falkner, Ph.D., recruitment director for UB's Vanguard Clinical Center, says that being the first to reach its recruitment goals is a significant accomplishment for UB and a testament to the generosity and insight of the women in Western New York. "These volunteers are willing to devote a part of their lives for the next decade to helping improve the health of women for generations to come," she says. "They are part of a history-making adventure." The university's share of the grant forthe WHI study is $11 million spread over l2 years. Co-principal investigators on the trial are Maurizio Trevisan, M.D., professor and chair of the UB Department of Social and Preventive Medicine, andjean Wactawski-Wende, Ph .D. , UB assistant professor of gynecology and obstetrics. The university's recruitment success in this clinical trial will help make it a prime site for future investigations, Falkner says. + When the engineers at lnfiniti set out to create the new flagship Q45, they didn't ask each other, "What does a luxury car owner desire most in a luxury car?" They asked the luxury car owners themselves. In countless interviews, Infiniti asked questions like, "What catches your eye?", "What tickles your fancy?" and "What makes your heart pound?" The result? Styling that's the perfect blend of elegance and sportiness. Physician QX4 Autumn 1 9 9 7 I �• ························································································ Aword from the director of development BY LINDA J . CORDER. PH 0 .. C hanks to many generous medical graduates who celebrated a class reunion this past spring, the Medical School Reunion Giving Program for 1997 received a prestigious award from the SU Y Council on Advancement and Development. I had the felicitous responsibility of accepting this] udges' Citation on behalf of the school during the annual SU Y/CUAD Conference, held in Corning, Y, this pastjune. The entry of the School of Medicine and Biomedical ciences was one of 113 submitted for evaluation of excellence and improvement by a panel of experts. Of the programs or publications evaluated, there were eight recognized as "Best of Category" and 11 that received a "judges' Citation." Our program received a judges' Citation. Last fall , we analyzed the Medical chool Reunion Giving Program by the results it had obtained over the previous six years. The amount of reunion gifts given to the school during that time period wa slightly more than $575,000an average of 92,500 a year, or under $10,000 per class, per year. With the assistance of former dean Dr. john aughton, we recruited reunion gift cochairs for most of the classes celebrating reunions. As far as I have been able to a certain, this year was the first in which most class reunion chairs had a cochair to assist with their class gifts. We extended the definition of "reunion class" to include all living alumni who graduated in years ending in "2" and "7." This added four reunion classes within the "jubilee Emeritus" group. Two-the 55th and 60th year classes-took active roles in this year's reunion celebrations. ® We encouraged class members to make gifts to any fund that would benefit the School of Medicine and Biomedical Sciences. In the past, class members were asked to contribute to a specific reunion account, for a purpose decided by someone else. We also included a one-page survey in the initial mailing. This provided each class member with an opportunity to update the information on file in our office and that of the Medical Alumni Association, to rate their perceptions on various aspects of medical practice, and to s hare per onal information with their classmates. (A t press time, we are still working on the "class booklets" based on these survey . They will be finalized and mailed to each person who made a reunion gift, ca me to reunion weekend, B u f f o 1 o F . R E or took the time to complete and return the survey even if they could not come to the reunion or did not make a reunion gift.) These four program enhancements likely resulted in the increased reunion giving upon which the award was based. Several people made gifts based on Dr. aughton's suggestion of $100 for each year since graduation, and many additional individuals gave contributions of 1,000 or more that will result in their recognition as members of the james Platt White Society for 1997. Overall, reunion class members committed more than $136,000 to the school, with a participation rate of 33 percent. This amount is more than double the total of reunion gifts made in 1996 and it surpasses the average of the previous six years by $44,000-that's an increase of 48 percent!! Twelve additional reunion class members made pledges of unspecified amounts. Depending on the magnitude of these gifts, the percentage of increase may be even more significant. The reunion class with the highest gift total-more than $30,000-was the Class of 1942. This successful effort was led by Richard Ament, who established a Charitable Remainder Unitrust in honor of his 55th reunion . He designated the remainder amount for the Department of Anesthesiology. Two classes shared honors for the highest percentage of participation: More than half-58 percent--of the living class members of the Class of 1937 and the Class of 1947 made a reunion contribution. Above 40 percent were the Classes ofl967 and 1952, with 42 percent and 41 percent participation, respectively. Physician Autumn 1 9 9 7 �··· ··· ··· · ············· · · · ··· · · · ··· · ···· ·· · · · · ··· : ···· ··· ······ · · ···· ··········· · ·· ·· ··· · · · ~ I How does this compare with other academic medical centers? From one perspective, not very well. My evidence is anecdotal , primarily from UB graduates who completed their residencies elsewhere and receive anoth e r institution's alumni publications. A UB alumnus in Arizona told me of a friend from residency whose medical class made reunion gifts totaling more than a million dollars. nearly twice as much as all of our classes combined, over a sixyear period' However, that was a private institution, with a development program that is more than 100 years old. A California surgery professor, also a B alumnus , described a multimillion dollar annual philanthropic program at his university, of which the reunion gifts made up a significant percentage. Like UB , this is a publicly assisted institution , but with a much shorter history than UB's 150+ years. Yet that medical school was established with the knowledge of the need for-and expectation of-significant private contributions. So, what is the "right" perspective by which to assess our program7 For now, l come down on the side of the panel of judges for the SU Y/CUAD awards. We provide our own standard of comparison. In this first year of increased efforts and generosity, the classes celebrating reunions in 1997 made significant progress over previous results . Our improvement earned us a citation of merit. Our efforts this year will provide benchmarks for future years of this program. Over time, reunion gifts have the potential to transform the academic and clinical opportunities currently available to UB's medical students. Over time, more classmates will want to participate and to contribute at levels that will bring them increased personal recognition and enhance their alma mater in significant ways. Who knows? Within the next few years, the certificate earned this past spring may have a companion piecean award of excellence for best program in the development category! + Liuda j. Cordc1 is assist aut dcau aud dirccto1 of dcvclopmcuL Medical School Reunion Giving Program 1997 Class Year 6 u f Number in Class Number Who Gave Gift Amount Number Who Pledged Pledge Amount Total Number of Gifts and Pledges Total Dollar Amount 1937 '42 '47 12 32 48 6 9 26 $6,331 1,910 17,684 1 2 2 (l nspecijied) $28,625 550 7 11 28 $6,331 30,535 18,234 58% 34 58 '52 '57 49 56 19 17 13,735 3,400 1 4 1,650 700 20 21 15,385 4,100 41 38 '62 '67 58 95 20 31 11,343 9,830 2 9 8,650 1,645 22 40 19,993 11,475 38 42 '72 121 26 9,073 7 3,817 33 12,890 27 '77 125 28 5,830 10 1 245 38 7,075 30 '82 121 26 3,950 7 660 33 4,610 27 '87 111 21 3,172 12 1,900 33 5,072 30 '92 119 19 675 7 295 26 970 22 f a l o Phys i cian Class Participation Percentage (I inspecified) (2 Cnspecifled) (2 Cnspecijied) (2 lnspecifled) (2 { nspeci}ied) (I lnspecifled) (I lnspecifled) (I Cmpecijied) Autumn 1 9 9 7 I �.,, ,ar.l"'mllllll':'l '' l711 ~ 11 11~~ · · · · · · • · · · · · · · · • · · · · · · · · · • · · · · · · · · · · · • · · · · · · · · • · · · · · · · · · · · · • · · · · · · · · · · · · • · · • · • · • · • · · · · • · Mandeville's suggested transition-tointerview statement isn't terribly different from the one Dr. Manyon asked us to use in our preceptors' clinics: "So, what brings you to see the doctor today? " While Mandeville certainly doesn't give the patient room to expound upon his BY JUDITH TOSKI . CLASS OF 2 0 0 0 condition (Dr. Manyon would reprimand him for not using an open-ended question), it is noble that Mandeville tis the year 1300, and you are a provincial lord in France. You have and his contemporaries would even been coughing for days, ever since you somehow stumbled into speak to patients. There was little patient-doctor interaction in the earlier, some bad air while hunting your grounds. You send for the local pre-university Middle Ages. Prior to the physician. Along with your messenger you send a flask of your rise of the university system, physicians would instead receive the patient's urine, a you expect the doctor to have formulated an opinion urine and make a diagnosis from it alone, without ever seeing or speaking to regarding your prognosis before he arrives at your bedside. the patient. In medieval European iconography, versibly altered by the innovations of Other aspects of doctor-patient inthe urine flask was the universal science and technology, there is one teraction have also been retained symbol of medicine. It implied element of medical care that has not through the ages. The idea that the great understanding, much like changed quite as drastically: the art patient's trust in the physician is parathe long white coat suggests of doctor-patient interaction. mount is a concept that has been alive Henry de Mandeville, a physi- in some form since antiquity, when the medical expertise of A~~~!!~~ today's attending phycian and surgeon who Greek believers sought healing from sician. While the symwrote around 1315, de- the god Aesculapias. During the 14th bot has changed, the scribed a proper method century, Arabic texts from the early connotation has ofquestioningapatient- Middle Ages came into vogue in not. What imparted onewhich,inmanyways, Europe-including one by Qusta ibn power to the repremirrors the paradigm my Luqa, a writer on psychosomatic medisentation, both in the class was taught in cine. This treatise explained that magic Middle Ages and today, is Clinical Practice of spells and incantations cure illnesses the patient's belief that Medicine during our because patients want to believe in "this doctor is a person first year at UB. In them , and th e mind controls the body who can heal me. " The a descrip- to effect the remedy. The medical intion of the novators of 14th-century Europe took remedies of both eras refleet the scientific underp r o p e r this concep t one step further, indicatstanding of the time, and thus protocol for ing that physicians have the power to would be completely differentbringing in a cure because patients accept that they the provincial doctor would have consultant on have such power. In the absence of applied poultices of mustard and an ongoing case, extensive pharmacopoeia or advanced other materia medica to the lord's M o n d e vi I I e surgical techniques , the patient's beche t, while today's primary-care specified the lief in the ability of the physician to phy ician would most likely language that heal was essentially the only tool that auscultate his lungs and chashould be used with the doctors had available to them. Today, tise the lord for keeping up a patient. He recom- in spite of improvements in medical three-pack-a-day smoking habit. AI- mended that the patient be interviewed, technology and the wide range of drugs though aspects of the treatment and first saying: "Sir, I hope it will not offend available to physicians to help ameliophysical examination have been irre- you if I ask when your illness began?" rate disease, not every illness has been Doctor-Patient Interaction: Lessons from the Late Middle Ages ® B u f f a I o Physician A u t u m n I 9 9 7 �' =-----=---- ~-- --- ------- - ---- -- ----- --~ ------ ··············-·······························-········································· ~:m il Medicine has changed because the world around it has. Advances in scientific thought and innovations in technology have transformed how care is delivered in so many ways that it is inconceivable to us moderns that anything could have remained the same about it. And yet, some similarities do exist between our culture of physicianpatient interactions and that of the Middle Ages. The desire of the patient to have faith in the doctor and his cures has not been modified all that much, and the necessity of open communication between physician and patient is a concept that even today is being taught and reinforced in UB's medical curriculum-to our advantage as future physicians, and to the benefit of our current and future patients. + Details on medieval medical practices taken cured. In such cases we have the same tool available to us that Henry de Mandeville and h is contemporaries had: that is , our patient's belief that we will try to save him if it is at all within our power to do so. This is a skill that transcends wearing a white coat or schlepping a pager around. My mentor, Dr. julian Ambrus , taught me that trust must be earned and reinforced in each encounter with every patient. A physician can only obtain trust when he treats the patients with the honor he would accord a superior. from McVaugh, Michael R. "Bedside Manners in the Middle Ages." Bulletin of the History of Medicine, val. 71, no. 2, johns Hopkins UP, Baltimore, MD. judi tit Toshi It as a B.A. in history of medicine from Thcjoltns Hopllins University. NICHOLS MIDDLE SCHOOL • Challengi ng, innovative curriculum • Outstanding preparation for high school • Average class size of 14 students • Interscholastic sports • Comprehensive visual and performing arts program • Dedicated, caring faculty • Financial aid available For further information, call: HOOL, 175 Nornngham Terr. B u f f a l a Physi NICHOLS UPPER SCHOOL, 1250 Amher>t ci an A utumn L 875,8212 1 9 9 7 NICHOLS SCHOOL --~ �Tone Johnson J[ '75: Alum earns belated decoration for bravery "When 1 got back, the very people I thought 1 was defending didn't like me very well. And that had nothing to do with being black-it was any soldier who was in Vietnam." Johnson said he dealt with the adjustment by disappearing into the colBY VIVIENNE HEINES lege environment. After graduating from Grambling College, earning his M.D. from UB, and completing his residency, uring a three-day period in 1965, a 19-year-old U.S. Army he served two more years in the military private named Tonejohnson found himself in a Vietnam jungle, and two years with the U .. Public Health Service before entering civilian life as a surrounded by dead or dying companions and hostile orth family practitioner. ow married and the father of five, Vietnamese regulars. Johnson runs his own practice and has that it is not uncommon for soldiers to recently opened two drug treatment As the American came under inreceive awards many years after they centers. As a lieutenant colonel in the creasingly heavy mortar fire, they ran out of ammunition and nearly lost any served. Congress also expanded the U.S. Army Reserve Medical Corps, he eligibility hope of surviving. Most didn't. Of the 35 runs a comrules for commen in his unit,Johnson was one of five bat medical ""IT WOULD HAVE BEEN EASY TO JUST bat veterans who lived through what became one of training proGIVE UP. BUT ABOVE ALL. I BELIEVED the worst battles of the Vietnam Warto receive gram to teach THAT MY FELLOW TROOPS WERE GOING TO decorations la Drang Valley, ovember 14- 17, 1965. ordinary solCOME . AND THEY DID ."" in 1996. "We ran out of ammunition at about diers prin one in the morning. We were only saved Johnson ciples of first by what we fondly called 'Puff the Magic attributes the award to the research of war aid and emergency medical care in the Dragon' [rapid-firing gun hip aircraft] correspondentJoseph L. Galloway, who field of combat. and the Air Force," John on recalled. described the horrors of Ia Drang in We ln the la Drang Valley battle,Johnson An American plane arrived, fired nearly Were Soldiers Once ... and Young, the was wounded in several places. An exatop the soldiers, and dropped napalm 1992 book he coauthored with retired plosion gave him a concussion and around them. Lt. Gen. Harold G. Moore . knocked him unconscious. He woke up "That really cleared them out. l was Johnson , now a family practice doc- in the middle of the shooting to find a close enough that 1 could feel the heat tor in Corpus Christi, aid the award is orth Vietnamese soldier sitting on his significant to him. from the names, but it wasn't close chest and eating his C-rations, he once enough to actually burn me," Johnson "lt means my country cares. Above told an interviewer from the ueces all things, it means my country cares," Valley Medical Society newsletter. said. "Frankly, I was glad they did [drop he said. the napalm], because a little longer and "This ticked me off," he said. we would have been goners." Like many Vietnam veterans , WhenJohnson moved, he startled the In ovcmber 1996, the 51-year-old John on returned to an American pub- soldier, who jumped up and shot him in Johnson received the Bronze Star for lic that was neither appreciative nor the armpit before being killed in the meritorious achievement in recognition accepting of the horrors he had experi- intense fire that ensued. Johnson also of his efforts to repulse the enemy durenced. Because of his race, he felt the suffered injuries to the face and knee. ing the bloody battle at la Drang Valley. adjustment even more keen!)'· The scar on his face is barely visible The award was pre en ted at a ce remony "As a black person in the war, it was today, but shrapnel wounds cost him in the ational Guard Armory in Corkind of tortuous. At home , we were the peripheral vision in his right eye. pus Chri ti, T . undergoing racial conOict. Then , in the "As I took care of the other soldiers war, we were undergoing that kind of during the night, a few of them said, A spokeswoman for the Army Personnel Agency, in Alexandria, VA, said armed conOict," Johnson recalled . 'Let's just give up. We're all worn out, B u f f a I a Physician Autumn 1 9 9 7 �we don 't ha\c an\ thing. ' The) had been wounded , and some were blccchng quite badl) and were ma) be a liulc bit delirious," johnson recalled . johnson got through the night b) maimaining his faith in God and in his fellow soldiers. '"A ll I could thmk was, 'The} 'll be here. ' And through the night, as we prayed about it, I knC\\ the) 'cl be here . It would ha\ e been caS) to just give up . But aboYe all, I believed that 111) fcllO\\ troops \\ere going to come. And the) did. " johnson said he has goucn past his nightmares about the \\ar, but it has changed him in other ways. " People ~a) , ''r ou 're so calm.' I sa), 'If you\e been through hell once, it's easy B u f f a I o to li-,:c in America .' Lillie things don't bother me nO\\. " Reprinted b) pctnih>ionfmmtlicCotpus CI111Sli (Tnm) Caller- Times. + ~ 1998 SCD plans I Plans for the 1998 Reunion Weekend and Spring Clinical Day (April25, 1998) are already well under way. This year's program is chaired by Dr. John Bodkin. The following reunion chairs held their organizational meeting September 11 : the 50th Year Class of '48, Dr. Daniel Fahey and Dr. Harold Graff; the Class of '53, Dr. Michael Sullivan; the Class of '58, Dr. Alfred Stein and Dr. Michael Genco; the Class of '63, Dr. Anthony M. Foti; the Class of '68, Dr. Robert Milch and Dr. Thomas Cumbo; the 25th Year Class of '73, Dr. Michael Sansone and Dr. Arthur Mruczek; the Class of '78, Dr. David Marchetti; the Class of '83, Dr. Richard Collins; the Class of '88, Drs. Andrew and Helen Cappuccino; and the 5th Year Class of '93, Dr. Michael Aronica. Physician Autumn 1 9 9 7 0 �• ···· ·· ······· · ·· ·········· ········ ····· ···························· · ······················ I 1 9 4 0 s daring surgery. The idea was to increase the collateral circula- bany, Pensacola, FL, writes: "There's tion to the ischemic cardiac from chair of Dept. of ObGyn, nothing like a sentimental enco- muscle. After a couple of hours Albany Medical Center, after 16 mium to stir fond memories. So of holding retractors, one be- years. iL was when I read of the death of came lax. Dr. Stewart always had and chair the board of Maternal JOSEPH H. MELANT '43 , of M Y R ON G O R DO N '48 , of AI- the same poignant question: Infant etwork of the Capital Re- 4, 1996) in Buffalo Physician. 'Doctor, are you holding those gion, and chair the Committee on Fifty-five years ago I had the retractors, or are those retrac- Medical Schools and Graduate good fortune to assist this gifted tors holding you?' He was the Medical Education of MSS Y. man in the first open-heart sur- embodiment of integrity and the Looking forward to 50th next year. gery performed in Buffalo, at sui generis of his time. " Skip Zola, Bill Bloom , and Dan a senior in medica l school, thus I had the honor of being his fourth assistant (there wasn't room at the table for any more!). It was a period when opening the pericardia! sac and dusting some talcum powder into it was SAMUE L CASSARA Rochester, '44 , of versity of California at Irvine. 1 ow teach, office practice, Dr. John D. Stewart (September Meyer Memorial Hospital. I was (addiction medicine) at the Uni- Y, writes: "Stepped down 9 LANCE 6 s 0 FOGAN ' 65 , of Valencia, CA, writes: "!took full early retirement from the Southern California Permanente Medical Group on July 31, 1997. I spent my entire practice career at the Kaiser Permanente Medical Center in Panorama City, Miller were here in Albany in April CA, beginning in july 1971. My for our son Seta's bar mitzvah. " last 16 years I served as chief of Y, writes that he the eurology Department. I ex- retired May 30, 1997, after 48 MAX A . SCHNE I DER '49 , years of pediatric practice, at the Orange, CA, has been elected pect to pursue my many inter- chair of the board of the ests happily and full time." age of 78 years. ext? "I will of a- write an autobiography of my tiona! Council on Alcoholism life and times. " and Drug Dependence. He is a IRVING S . KOLIN '65 , recently appeared on Channel9 in Miami, clinical professor of psychiatry If you come loolting for a car, you'll be a\vfully disappointed. HOWEVER, there's little chance you'llleave tl1at way. BECAUSE at tl1e Land •, Rover Centre, we have tl1e world's most impressive 4x4s. AND people who can answer any of your questions about driving. A4x4, of course . Amherst A NORTHTOWN AUTOMOTIVE COMPANY 3560 Sheridan Drive Amherst, New York 14226 (716) 831-3100 • (716) 835 FAXX (3299) ® B u f f a l o P hysician A utumn 1 9 9 7 �-- ··················· · · ····· ··· ······· ·········· · ·········· · ···· · ············ ·· ········· ·· ··• • I FL, to discuss psychological trauma in victims of child kid- the Southern California Kaiser publications are Sexual Investi- Permanente Health Care Pro- gation (NYU Press, 1996); Sex, who joins jacqueline (7), Alex (5), and Eric (3). Marc is direc- napping, and ADHD and the Ritalin controversy. gram. The department has a staff Love, and Friendship (Rodop, 1997) ; The Philosophy of Sex thalmology at Florida Health ( Rowman, 1997); and The Pili- Care Plans in Daytona Beach, FL. JOHN E . SHIELDS '68, of Delhi, Y, writes that his son john JOHN E . KNIPP '72 , of Washingtonville, Y, is presi- losoph) of Sex and Love (Paragon House, 1997). JENNIFER L. CADIZ '87 writes: M. Shields has ajD/MBA degree dent and chief of staff of the with honors, and Gregory P. Cornwall Hospital, Cornwall, hields is a freshman at Univer- Y, and president-elect of the of 80 MDs and ER As. sity of Arizona. He adds that he is Orange County Medical Soci- at Russell Sage College in Albany. ety, Orange County, Y. He is in the private practice of internal 1 9 7 0 5 DONALD H . MARCUS '71 , of Sepulveda, CA, has been appointed chief of anesthesiology at the Kaiser Foundation Hospital in Los Angeles. The L.A. Hospital is the tertiary hospital for WNY's medicine and gastroenterology. ALAN S OBLE '72 (M.A. Pharmacology), of ew Orleans, LA, writes: "l have recently been promoted to full professor ( 1990) and to research professor (1994). Among my latest tor of the Department of Oph- ''I've moved to Harrisburg, PA, 1 9 8 0 5 to begin life as a civilian. I'll be practicing with one of the local KEVIN S . F ERENTZ '83 , of hematology/oncology groups." the Pikesville section ofBaltimore, MD, has been installed as the LA URA POST '87, of Saipan, 49th president of the Maryland has been appointed chair of the Academy of Family Physicians (MAFP). Department of Psyc hiatry at Commonwealth Health Center, in Saipan. Her first book, Back- MARC J . KOBLICK '84. of Ormond Beach, FL, and his wife, Helene, announce the birth of stage Pass: Interviews with Women in Music, has just been published by ew Victoria Publishers. their fourth c hild, Reid Jayson , - Exclusive - BMW Retailer THOSE LOOKING FOR MORE CONTROL IN THEIR LIFE CAN NOW FIND IT ON SLIPPERY PAVEMENT. THE ULTIMATE DRIVING MACHINE.® MSRP s64240 F. G. DOWNING Towne BMW 3030 Orchard Park Rd. Orchard Park, New York 14224 Phone: 675-2550 s&99 1998 BMW 740i While the road of life may throw you an occasional curve, at least our All Season Traction helps you handle the particularly slippery ones. 30 mo. Lease FREE SCHEDULED MAINTENANCE ALL SEASON TRACTION PMT based on 5500 cap cost reduction (or trade). 12,000 miles per year. 15 cents charge per mile lor excess miles. First and last PMT, taxes and plate fees due at inception Residual $43040 Service Loaners Available..• Minutes From Rich Stadium s u f f a l o Physician Autumn 1 9 9 7 ® �• ····························· · ···· ·· ····· . I THE ULTIMATE DRIVING MACHINE. JOHN AKER '88 , oflndianapo- ANTH ONY R . RICOTTONE lis, I . writes: "I finally finished '91 , of Cheektowaga. my plastic surgcl) fellowship at " "vly wife, Deborah, and I arc YU, and am now in private practice in Indianapolis. ) . \Hites: pleased to announce the birth of our daughter. Marisa. Our son Kathleen and I were recently Dommie recent!) turned 2. I ha\ e blessed by our second child, recently joined KeY in Barloc, Rt- Zachery Alexander." charJ Gilbcrt,andJohn Gri~wold at Buffalo Medical Group tn the of DEBRA M . OMIATEK '89 , Lewiston, practice of urolog\." Y, is celebrating her first year in private solo prac- CAROL ANN KILLIAN '94 ti ce. She is president of the THOMAS M . BURNETTE '94 , iagara County Chapter of Family Practice (AArP). of Sleep; Hollo"', 9 9 0 5 and GALE of Baltimore, PETEF<BLOOM '90 emergenc\ 111 MD, write that Peter has recently Westchester Count} , ni- Ann has accepted a JOb as an rD versity of Maryland; he i working on research on infectious County Medical Center and Tom dysentery at the Center for Vac- has begun working as an inter- 111 the \ Vestchcstcr cine Development in Baltimore. nist in the Mount Kisco Medtcal Gale just received her master's in Group. The; keep in close con- public health from The Johns tact with Barb Kearnq, \\ ho Hopkins School of Hygiene and married Paul Stcfantck tn '>ep- Johns Hopkins in a CD -funded is finishmg her patholog\ resi- sexuall y transmitted diseases. Gale spent this past spring in tiful bah) girl named South Africa, where she consulted rebruar) 1997. health services. atalt e low to mid 20's; leases starting at $299 per month. MIKE J . PELECHAGY JR . ' 94 , of Orchard Park, ) , \Hites: * According to the Insurance "\\ c've .Just accepted a fellowship position at Roswell Park 111 hema- GULATI '92 announce the birth tology/oncology , starting Juh l , of their son Suneel S. Ram on 1997. Also, '' e had another bah) Feb. 21 , 1997. Ragh u has joined girl, OliYia Paige. We're glad to he Kenmore Family Medicine, a back in the Buffalo area. r or those new group practice in Kenmore, on the Internet, look up m) nc\\ Y. Neeva is completing her rP [-mail address either at ..,,,Itch- niversity at board or 411. Institute for Highway Safety (IIHS), the Saab 9000 has the lowest fatality rate of any production car on the market. SOUTHTOWNS SAAB 3580 Southwestern Blvd (1 Mile east of Rich Stadium) 716) 662·8008 Buffalo this year. ® higher education level than any other car owner group. * Saab purchase prices starting NEEVA re idency at the f;'\d ~01.1r OW'\ road. * Fact: Saab owners have a 111 and RAGHU RAM '90 AND CALL ME IN THE MORNING! tember 1994. Thev continue to dency. Barb and Paul had a beau- develop ado lescent- friend!) TAKE TWO ... reside in Tonawanda while Barb position to conduct research on for a rural district to help them Your WNY Leasing Specialist Serving WNY proudly tor 33 years ) . Carol attending Public Health and is working at 836-2033 respccti\cly, at the L.,niYersit\ of joined the faculty of the Division of Gastroenterology at the 487 Kenmore Avenue Buffalo, NY 14223 medicine and mternalnu·dtctnc, Pittsburgh. The} hm·c mo,·ed back close to thetr families to BURSTEIN '90 , Sales and Service nte that the) ha,·e completed thetr three) car res1denctcs 1 '\J), ' ' and Checkpoint Foreign Car, Inc. B u f f o l o Physician Autumn 1 9 9 7 �... . ..... UBMICRO COMPUTER SALES www.ubmicro.buHalo.edu Call 645· 554 t ..............• 11 . g Out A Non-Profit University at Buffalo Se ice Program - ' OBITUARIES MARTI N A . ANGELO '36 , of Fort Lauder- dale, FL, died May 28, 1997. The retired Advertise in one of the finest publications in Western New York ... Buffalo neurosurgeon was 85. He was on the staff of most area hospitals until retiring in 1976 and moving to Florida. Born in Buffalo, he sold newspapers and shined shoes during the Depression to help support his Buffalo Physician family and pay for his education. In World War II, he was commanding officer of an ~ u~ ~ ~ l~ Army hospital train unit stationed in France. He was a member of the American Medical f" ~ ~ \ t \ "~ Association, the Harvey Cushing Society, the Congress of Neurological Surgeons, and the Baccelli Club of Buffalo. Angelo is sur- YOU ARE ELIGIBLE vived by hi wife of 55 years, Marie Ruth for academic pricing on••. SanFilippo Angelo; a daughter; two sons; a sister; and nine grandchildren. Acer • Adobe • Apple • Corel • Dell • Hewlett Packard • Microsoft • Texas Instruments &much more ... Delivery & Setup in your home or office available! HAROLD Williamsville, BERNHARD ' 49 , of Y, former chief of service and medical director for gastroenterology at Millard Fillmore Health System, died june 19, 1997, at his home. He was 70. He Give us a call: practiced gastroenterology for the past 45 (716) 645-6933 Computer Workshops years and was one of the first physicians here to introduce the technique of gas- Michael J. Baranski trointestinal endoscopy; he was also a clini- Marketms Representative cal associate professor of medicine at UB. Call 645-3560 to have a brochure mailed to you. He recently was named Master of the American College of Gastroenterology, one of the most prestigious awards in his field, in • On-Site Private Training available. • Scheduled workshops start at $59. • 1/2 day miniclasses target specialized topics. recognition of his medical expertise and service to the professional group. He served as a trustee and secretary of the American College of Gastroenterology, governor of the college's orthern ew York chapter, and president of both the GastrointestinalLiver Society of Western Western ew York and the ew York Society for Gastrointes- tinal Endoscopy. Bernhard is survived by his wife of 48 years, the former G loria Summer hours: Mon thru Fri I 1-5 ~~~-·~~.[111'[+] BARANSKI u f f a l o grandchildren. ADVERTISING A non-profit University program tor students_ faculty & staff The commons . North Campus • (1t6) 645· 3554 • Fox: 645-3884 B Grossman; two daughters; and three Physician Due to space collstmillts, some Class11otes recei\ eel forth is issue ofBuffalo Physician will appear i11the next issue. -Eel. 146 Stepping Stone Lane Orchard Park, NY 14127 Autumn 1 9 9 7 �To consult with someone truly concerned with your financial come to KEY PRIVATEBANK Key. Your Key Private Banker heads a team of professionals, who can help you achieve your financial goals with surgical precision. Call Marv Madison at 84 7-2341. It may be one of the most important appointments you make. We know medical professionals' financial needs like the dorsum of our metacarpus. <>-w Key. For a new America~ ® Buffalo Physician Autumn 1 9 9 7 �Who says there's nothing good on TV? As busy as they are, physicians and other health care providers always take the time to watch MLMIC's top-rated risk management education programs. • When they tune into high quality programming broadcast over our satellite network, viewers know what they see will help enhance patient safety and reduce injuries. They also appreciate the policyholder discounts available to participating physicians. MLMIC programming is sponsored by the largest Risk Management Department of any professional liability insurer in the state. Policyholders also enjoy the protection of one of the country's largest and most experienced professional liability Claims Departments. Most importantly, MLMIC has successfully defended more physicians than all other available insurers combined. These are some of the reasons why MLMIC is the only medical liability insurer approved by the Medical Society of the State of New York. • To find out more, call1-800-356-4056 in Upstate New York, or 1-800- ASK-MLMIC in the New York metropolitan area. Ask for free copies of our risk management MLM~C ~ \lt'IKal Uahtlil; \fuluallnsurani,. (ompany guide for office practices. • Our defense never rests. 2 Park Avenue New York, NY 10016 2 Clinton Square Syracuse, NY 13202 90 Merrick Avenue E. Meadow, NY 11554 C1996 MM ca .aPi ty 1nsursnu: Ccmpsny Mutua l �BUFFALO PHYSICIAN Non-Profit Org. STATE UNIVERSITY OF NEW YORK AT BUFFALO U.S. Postage PAID 3435 MAIN STREET Buffalo, NY B UFFALO NEW YORK 14214 Permit No. 311 ADDRESS CORRECTION REQUESTED Planned Giving to UB. Tax deduct,ons and on 1ncome for fe ore on'y port ;Jf the benefits you con recetve w th planned g1v1ng to the LB and B omediCOI sc,ences weo 1thy o a School of Med c ne Yot.. needn I be norc1o ger uo All you need s to make a gft And hove o de~ to he1p today s budd,ng gen ses mo e the wor o a better p oc.e n 50 years. For mo e nf Corder PhD mot or contact Ly~ CFRE of 716 8292773 or vo e-mo' of I]C.Order@ocsu buf a o.ed UNIVERSITY AT BUFFALO S!alt l "niz·eni{J' qf . \ i•zt· JiJd, � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Autumn 1997 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1997-Autumn Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician and biomedical scientist Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v31n04-1997-Autumn Table Of Contents A list of subunits of the resource. Research DNA on Ice Dr. Mahoney Becomes Dr. Mahoney "The Woman's Way of Seeing and Doing" Orientation '97 Medical School News Development A Student's Perspective Alumni News Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. 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Copyright 1997 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/04b0e3e59d8eb9c6dc6dd52b05eddd9f.pdf 878a086bb473a87802435ea1299cf63e PDF Text Text �Dear Alumni and Friends, BUFFALO PHYSICIAN \ olumr 31 '\umhcr 3 ASSOCIATE VICE PRESIDENT FOR UNIVERSITY SERVICES Dr ( ;.uolt "'mlth Pt•tro DIRECTOR OF PUBLICATIONS h.athn n \."a\\ ncr EDITOR Jr ...... ila \n<.:krr ART DIRECTOR \l,m J 1-;egkr PRODUCTION MANAGER \nn Ras::mann Bn)\\ n STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES Dr John R. \\ nght lntt:l rru Dnm wul 1·;" Prnulnli{<H Clu1iwl \ffw" EDITORIAL BOARD Dr Bcnram Portm Cha1r Dr Dr Dr Dr Dr Dr Dr Dr Dr Dr Dr \larun Brecher Harold Brod1 R1chard L Coll11" Lmda J. Corder .I ian J Dnnnan James Kansk1 Barhara \laJrrom Llizahrth Ohmtrd Ch.trlrs Paganelli Stephen Spauldmg BradiC\ T Trua"' Roy \ 'ongtama Dr I ranklm Zcplo11 liz THIS I''L r or Bt FHW P11n1c 1.\\ marks a significant change for the school. After nearly two years as editor of Buffalo Phvsician, jessica Ancker has accepted a new opportunity elsewhere. \\"e all wish her well and thank her for her many outstanding contributions to this publication. During our search for her successor. judson Mead, editorial manager of the lJB Publications Office. will sene as interim editor. On May 11 , 1997, we celebrated the medical school's l5lst commencement, graduating l-+6 men and women as doctors of medicine and 37 as doctors of philosophy; four received bo th degrees simultaneously. At the ceremon), an honorary doctor of science degree was awarded to Dr. james Holland. a distinguished former member of the Roswell Park Cancer Institute and of the university. Our incoming medical student class is now complete, and we look forward to greeting this group a few short months hence. \\"e are also welcoming new house officers. many of them our own recent graduates. The new chief residents also begin their final year of residency and, along with the ne\\ residents. will participate in comprehensive orientation programs orgamzed by the Graduate Medical Dental Education Consortium, a legacy of former dean john Naughton ably directed b) associate dean Dr. Roseanne Berger. The introductory programs pro\·ide incoming residents with the latest medical, legal, and administrative updates and teaching! evaluation skills, as well as basic and advanced life-support training. Much credit is due to Dr. Berger for her commitment and dedication to this effort. As we continue to struggle through the fiscal maze so commonplace in today's medical schools and universities, we arc deeply grateful to you, the alumni and friends of this uniwrsity·. for your generous sharing of time, energy, and yes, worldly goods, to this noble cause. Please accept this sincere thank-you for your help. /f John R. Wright, M.D. /ntaim Dean, School of .\lcdic111c and Biomedical Sncncrs lntnim Vice President for Clinical A/fails TEACHING HOSPITALS AND LI A ISONS The Buffalo (,rnrral llospllal \fulwd ~~~"'' The Children's llospnal of Buffalo Ene Counl\ \lrdtcal Center \lerCI llralth ''stem \Iiiiard 1 Hlmore llealth ~ystrm l·ranlz S£1HI '\iagara l·alls \lrmonal \lcd!cal Center Ro~wcll Park ( <.lnccr ln-,ttlutc Sisters of Charll\ llospllal Dntnis \frCatth\ \'eteran!-, .\.ff..l irs \\·estern ~ew York Hcahhcare '-,ystcm ([)The ~tate UniH·rslly of :'\e\\ York at Buffalo Buffalo PI"'""'" IS published quanerh h) the State Lmversilv of ~e" \ork at Buffalo School of \1cdicinc and Biomedical Sucnccs and the Off<ce of Puhhcat10ns. It " sent, free of charge, 10alumni. facultY . students. residents. and friends. The staff reserves the nghtto cdll all cop) and submtssiono.; accepted for publication . .:\ddress questions, comments. and subnu,;10ns to The E:dllor, Bt<{falo Phrskian, State Lmvcrsny of !'Jew York at Buffalo, Office of Puhhcat!Ons. 136 Crofts Hall. Buffalo. '\\ 1-+260 Send address changes Ia: Buffalo Plll\«i<lll 1-+6 CFS .\dduwn H35 Mam Street Buffalo,"' 1-+21-t Greetings! A., THL ~EI\ t 1 LUCTED PRE,IDE"'f of the Medical Alumni Association, I am honored, proud, and humbled when I consider the quality of the individuals this organization represents. The 60th annual alumni weekend and Spring Clinical Day was a resounding success, thanks in no small part to Richard L. Collins, M.D., who put together an outstanding program. New York State commissioner of health Barbara DeBuono, M.D., M.P.H., updated attendees on the political and legislative aspects of managed care in New York State. john Friedlander, president and CEO of CGF Health System, presented the case for mergers. Steven R. Peskin, M.D. , talked about the evolution of managed care across the country. Irene S. Snow, M.D., spoke about practicing medicine under managed care. As a recent past president of the Eric County Medical Society, she has a unique perspective. She emphasized her personal involvement with patients, associates, and local, state, and national medical and specialty societies. Highlighting the program was the induction of two honorary medical alumni-john '\Iaughton, M.D., our recently retired dean of 22 years, and john Richert, Ed. D., our recently retired associate dean for medical alumni affairs. Each of them played a major role in making the school and the alumni association what they are today. There are some special people who deserve recognition for their support of this association: Nancy Druar, our administrative assistant; Bertram Portin, M.D. , our new associate dean of medical alumni affairs; and jack F. Coyne, M.D., our past president. We also wish to thank our interim dean, john R. Wright, M.D., for his support and participation. With the continuing support of these individuals, I am looking forward to a successful and enjoyable year. Sincerely, ~,d::Mf'~ Pres1dcnt, \lediwl Alumni Assocwtion �- --- - -~- -~- -- - ---- - -- -----.--- - VOLUME - - 31, NUMBER 3 S UMMER 1 i i i j Sp~ing 2 Clinical Day THREE PRESENTATIONS LOOK AT DIFFERENT ASPECTS OF CHANGE IN HEALTH CARE. 8 UB's New Specialty Dental Clinics DENTAL MEDICINE AND MEDICINE OFTEN CONVERGE IN St;IUIRE HALL . 10 D~. Cong~essman DAVE WELDON ' 8 1 IN THE HOUSE I S SAYS LIFE LIKE BEING AN INTERN YEAR-ROUND. by Clare O'Shea by Rosemary E. Frei Medical School News MATCH DAY . TWO FORMER FACULTY REMEMBERED. NEW CHA I R OF PEDIATRICS. t-1AMES PLATT WHITE HONOR ROLL. Commencement '97 PIONEERIN G THE Alumni News CLINICAL CURRICULUM. THE PICTURES SAY IT ALL! NEW ALUMNI ASSOCIATION RESIDENCY SLOTS. OFFICERS. HONORS FO R AStudent's Perspective LE ARNING ABOUT ASTHMA FO UR. 60TH ALUMN I WEEKEND. AT STREET LEVEL. by Michael Kane, Class of 1998 Classnotes THE QUOTE ON THE <OVER is hom ·APhysicion'sOoth; odoptedfromonewrittenby louislnsogno, M.D., deon of the Sockler School of Groduote Biomedical Sciences ond deon for ocodemic offoirs of the Tufts University School of Medicine. As port of commencement exerc~es eoch yeor, groduotes of the UB School of Medicine ond Biomedical Sciences rise ond formally sweor to fulfill, to the best of their ability ond judgment, this covenant. In oddiHon, three yeors ogo onew tradition wos born ot the UB medicoIschool: On the first doy of orientoHon eoch yeor, the ooth is reod ond discussed with students os omeons of impressing upon them the full significance of the program they ore obout to undertake. The complete text of the ooth is featured in the Autumn 1996 issue of Buffalo Physician. s 5 J':J~l ~ �SPRING SI X T ANNUAL I ETH ALUMNI WEEKEND CLINICAL DAY'97 Health commissioner discusses state P9licy in B y JESSICA Stockton Kimball Lecture ANCKER are creating tensions between private conscience and public policy, and nowhere are those tensions more obvious than in the office of New York State commissioner of health Barbara A. DeBuono, M.D., M.PH. CHANGES IN AMERICA HEALTH CARE DeBuono, who delivered the annual Stockton Kimball Lecture as part of the 60th Spring Clinical Day on April26 at the Buffalo Marriott hotel , plays a pivotal role in the development of the state's health policy. That often puts her in a tough position, as she illustrated by describing a case that recently reached her desk in Albany, Y. A patient received a diagnosis that indicated a Whipple procedure (pancreaticoduodenectomy), DeBuono said. His insurer, a managed care organization, supplied the names of three surgeons in his city qualified to do the procedure. But the patient, seeking what he felt would be the best possible treatment , underwent surgery at Memorial SloanKettering Cancer Center. His HMO refused to pay the bill or even to cover what the approved doctors would have charged. The patient appealed to the state health commissioner. On the one hand , DeBuono points out, the patient broke the agreement he made when he enrolled in his HMO. That agreement allowed the insurer to control its costs (and his premiums) by controlling where he could seek medical care. On the other, the patient wanted the best possible care. "And why shouldn't he get the best? " DeBuono asked. But there's no concrete evidence that the procedure performed at Sloan-Kettering was of substantially better quality than what the local surgeon would have done. While it is PHOTOGRAPHY 0 universally accepted that surgeons who perform high volumes of cardiac surgery have better outcomes, there is no comparable body of research on Whipples. When it comes, DeBuono's decision may have broad economic and political ramifications. If she decides in the patient's favor , will millions of ew Yorkers get the message that they can go out of plan whenever they want? But if she decides in favor of the insurer, could that lead to further restrictions on care? And how will the patient at the core of the case pay his bill? This case was one of the manypublidprivate health-care issues DeBuono discussed at Spring Clinical Day. DeBuono received her M.D. at the University of Rochester and completed her residency at the ew England Deaconess Hospital in Boston. She then earned a master's degree in public health from Harvard University and served as a fellow in infectious diseases at Brown University Medical School before becoming director of health for the State of Rhode Island. DeBuono was named New York State commissioner of health by Governor George Pataki in 1995 , becoming the first woman to hold the job. During her address at Spring Clinical Day, DeBuono said that the state had balanced cost-cutting with social responsibility in its Health-Care Reform Act of 1996, which deregulated BY DON HEUPEL ---------------------------------------------------------------------------------------B u f f a 1 a Physician Summer 1 9 9 7 �----------------~----- SIXTIETH A NNUAL __ ---- -.-- - - - ALUMNI hospital rates and created unique funding pools for graduate medical education and charity care. However, she noted, there's a lot more for state government to accomplish. As a member of a Republican administration that is in principle dedicated to reducing state regulation, DeBuono sounded reluctant to draft legislation to deal with minute details of health-care delivery. But legislation to cope with the "growing pains" of managed care, such as denials of care and physicians being deselected from networks without good reason, seems inevitable, she said. DeBuono also cited examples of insurers delaying reimbursing hospitals for service worth millions of dollars until the Department of Health intervened. "I don't want to have to legislate that," she added. "I wish the industry would do it voluntarily." The goal is to make sure that medical decisions are made for medical reasons, not economic ones. "The more managed care and indemnity insurance take decisions out of the hands of providers, the more frustrating it is for doctors and patients," DeBuono said. "We've got to fix that problem." An important step, she said, was the state Managed Care Omnibus Act of 1996, which has been praised by the American Medical Association for protecting providers and patients. It bans gag orders; ensures that managed care plans disclose their coverage, referral, and emergency care policies; allows doctors to appeal deselection; and establishes a patient grievance procedure. Legislation alone is unlikely to solve all the problems. DeBuono's story about the Whipple procedure grievance shows that some of the toughest deci ions may continue to be made on a case-by-case basis. "I still haven't decided what to do ," DeBuono confessed about the case. "If anyone has any ideas, let me know." + B u f f a l o Physician summer , 9 9 7 0 ~ �SIXTIETH ANNUAL ALUMNI Practicing medicine under anaged he thoughts I share with you today are mainly personal, and are geared toward our responsibility in patient advocacy and the preservation of our profession in managed care. The failure of managed care When managed care first came into being, it is my understanding that it was supposed to give less expensive care to people who couldn't afford conventional insurance. It is hard to argue that the first goalless expensive care-has indeed been achieved. Health-care premiums have risen at or below the inflation rate for two years, but most industry experts predict more increases. The multifactorial reasons for this include: 1. the need ofHMOs to satisfy stockholders after delivery of low profits last year; 1. the consolidation of HMOs into fewer and larger entities, eliminating competition and allowing prices to rise; 3. more expensive technology and an aging population; 4. demand from consumers for more access to specialists and point-of-service plans; and S. federal and state legislation that make it difficult for managed care to control costs. Managed care has also been a resounding failure in providing coverage to the uninsured and the underinsured. It is estimated that by the year 2002, the number of uninsured will reach 45.6 million, up from 39.5 million in 1995. The health-care reform agenda empowered managed care, and managed care failed to deliver the goods. What is quality care? The most abused and misused phrase of the '90s, in my opinion, has been "quality care." What exactly is quality care? Ask any of the four players in health care-employers, insurers, providers, or patients. Instantly, we have a problem. Patients and health professionals tend to think differently about what constitutes quality of care. Patients judge quality by very personal experiences, such as how long their proBY 0 IRENE B u f 5 f a . l care vider spends with them, how easy it is to access specialty care, and the range of health benefits provided. Professionals, on the other hand, tend to rely on populationbased performance measures, such as outcomes of cancer treatment over time. Employers concern themselves with such data as cost, time lost from work, and employee satisfaction as demonstrated by complaints to their human resources departments. Insurers declare their own quality measures. The ational Committee for Quality Assurance ( CQA) , the organization set up to measure quality of care given by managed care plans, has come under attack for not being independent enough. As of 1996, CQA got 40 percent of its funding from HMOs. The Health Plan Employer Data and Information Set (HEDIS) that CQA uses has been widely criticized by physicians for tallying up easy-to-administer tests rather than getting at core issues of what constitutes quality medical care. HEDIS doesn't measure quality: It measures the number of Pap smears or immunizations given. To confuse this picture even further, the development of quality measures has proven to be philosophically contentious, technically difficult, and politically delicate. Physicians must act Finally, some answers. This is a perfect place for physicians to take a leading-edge position by demanding relevance, objective research, and appropriate application. Physicians and managed care organizations need to work together to establish treatment guidelines patients can trust. Wide-ranging collaborative efforts led by academic researchers would be the most promising in outcomes research and treatment guidelines. And we must be at the table either individually or through our subspecialty societies when outcomes data is analyzed and implemented. just as we must be willing to accept report cards on our performance, we must demand more in-depth surveys of HMOs. Physicians should push for public disclosure and comparisons of HMOs regarding their performance in treating serious or chronic illnesses, how often and why out-ofplan referrals are denied, and ease of access to specialty care, among other things. SNOW o WEEKEND . Phys M . D ici . " 80 an Summer 1 9 9 7 �-~-- - - ----- - - - - - - - -- - - - SIXTIETH ANNUAL --- - --- -- ALUMNI I must admit that when I think of managed care, I feel like Albert Finney in the movie Network when he opens his window and shouts out, "I'm mad as hell and I'm not going to take it anymore!" In my more rational moments, however, I do believe that doctors who fight managed care at every turn will find themselves in a losing battle. We should take the lead in health-care delivery by admitting that we are dealing with finite resources. But physicians need to be a blaring trumpet section in our argument that we are better at making medical decisions and more compassionate than utilization review clerks. Doctors must take a stand against economics driving ethics and insist that ethics drive the economics. While accepting the principlesofpracticingcosteffective medicine , we must be able to challenge certain managed care rules that we feel compromise patient care. While on the topic of ethics and economics, I am philosophically opposed to the concept of capitated agreements. Simply stated, I just wasn't raised to be rewarded for work I haven't done. Under capitation, if you manage patients efficiently and effectively you stand to gain. The potential abuse of this system is glaringly obvious and extremely frightening. As patient advocates, we should not allow a system that poses this kind of potential threat to patient care to gain momentum. Capitation places providers-already in need of tort reform-in legally indefensible positions. In potential errors of omission, it will not take a Perry Mason to ask, "So, Dr. X, did you stand to gain financially by not ordering testY? " Yet capitation is here, thriving, and soon I will find myself practicing within it. However, I hope its prognosis is poor! Capitation in its pure form, without adequate oversight and regulation, is a consumer activist's next cause, and in my opinion, rightfully so. Hold HMOs responsible We must encourage regulators, employers, and consumers to insist on greater public disclosure of HMO financial results. - - - WEEKEND George Anders, a Wall Street journal reporter, said it better than I can in his book Health Against Wealth: HMOs and the Breakdown of Medical Trust. Anders commented that the big profits and compensation packages of some HMO industry executives can be seen as "uncomfortable hypocrisy for an industry that publicly preaches the virtues of austerity." o discussion of how physicians practice in any environment would be complete without mentioning the need for tort reform. In this regard, I mean that HMOs need to be held accountable for their mistakes. HMOs need to be "I question how long I will be able in good conscience o practtce economically driven me 1c1ne." subjected to the same malpractice restitution methods that physicians and other professionals face. Perhaps it is time for us to renew our commitment to the professional oath, ethical principles, and ongoing education process of a vocation that has always been dedicated to the betterment of mankind. The practice of medicine is in a state of unrest, which has the potential to bring out the best or worst in our profession. We must have the courage to speak out against any system that jeopardizes our legal right and moral obligation to practice good medicine. When historians record how we responded to these challenging times, it is my hope that we will be remembered for our commitment to our patients, our colleagues, and our principles. + ~------------------------------------------------------------------------------------------------------~ B u f f a t o P hysician summer 1 9 9 7 0 ~ ��with all of tne diseases of. dentistry, bexond dental caries and tne cracl<s oetween aentistry ommunities extenaing Pennsylvania Alfredo Aaulrre of the Orel Madlall .. Cllnlo (top lettll ......_..A. utlunen of the TeiiiP......,._n......,.Dieor...,.. end OICifacaMI Pain Cllnlo (bottol8 lettll Leurle c.re.r of . . . Orel ..... Me Mai&DIIII Dl&gnaetlo . . . . . . . Cllnlo , ........... ,.,.,,. A d&ld81 X ...... {G&IIIIarltllat •U lllla..e atena&la ln . . . oa:o8d,_D ......... . ., a &Ia , ............ , arrtWWj. in the ��Specia cinic takes haitosis senousy "Some people have joked, 'Maybe you could sell gift certificates,"' says Mirdza Neiders, D.D.S., M.S., head of the Breath Disorders Clinic in UB's Department of Oral Diagnostic Sciences. "Because most of our patients are referred by another person, like their spouse." The Breath Disorders Clinic is one " The best of six Special Care Clinics that specialdetector ize in diagnosing and treating dental or medical difficulties that most pracis still the titioners don't usually treat. They fill human in the gray areas between medicine nose." and dentistry, including psychological and social concerns that affect many Americans. All kidding aside, halitosis is one such serious social problem, as evidenced by the millions of dollars spent in the U.S. and Canada on breath mints, toothpastes, and mouthwashes. Some people are so concerned about their breath that they build their lifestyles around avoiding people. They may be referred to the clinic by someone close to them, or else a physician or dentist. While some cases of halitosis are truly medical, many can be alleviated relatively easily. The first step for patients coming to the Breath Disorders Clinic is for the clinician to determine whether the person truly has bad breath and, if so, to track down the origin of the problem. "The best detector is still the human nose," admits eiders. "If the person does have bad breath, treatments can then be designed to tackle it. If they don't, I sometimes refer them to Dr. Gale to help them overcome their social inhibition." In most cases, bad breath is caused by anaerobic bacteria on the surface of the tongue; these bacteria can simply be scraped away with a flexible, dull object, such as the edge of a plastic spoon. Prescription antiseptic mouthwash can also be helpful in some cases. If the odor is being emitted by an infection under an old crown or between teeth, repair of these defects is the best medicine. + 1 9 9 7 0 �43-year-old physician takes leave for his other calling by CLARE O ' SHEA "Can you hold on a second? " DAVE WELDO '81 PUTS THE PHO E DOW and rushes off again. We had been discussing his neuroanatomy professor at UB, the intense summer he spent immersed in microbiology and pharmacology, the way the snow would settle on the evergreen outside his tiny apartment off Hertel Avenue. But those memories are 15 years old, and right now Weldon doesn't have much more than 15 minutes for nostalgia. Voices on the other end of the line are calling him to the floor of the U.S. House of Representatives. It's time to vote on public housing. ® Buffalo Physician Summer 1 9 9 7 �unruffled, quietly picking up where he left off and continuing his train of thought from the House cloakroom, his refuge between votes. In many ways he sounds less like a doctor than, well, a politicianbut Weldon finds a lot of similarities between the two vocations. "The general skills a physician has transfer well into the political arena," he says. "My background gave me a lot of experience in relating to people, solving problems, and explaining complex issues to people in terms they can understand." While Weldon has become comfortable on Capitol Hill, he remains committed to his first calling. "I don't see myself as a career politician," he says. When he was elected in 1994, he pledged to honor an eight-year term limit. "I definitely identify myself as a doctor-a doctor temporarily on leave to serve Congress." Being on leave has only meant shifting to a higher gear, however. life in Congress, says - - - - - - - - - - - - - - - - - - - - --t"lm--- Weldon, is "like These days Weldon is better known as "Honorable" than "Doctor." For the being an intern "The general skills a physician past three years Weldon, a 1981 graduyear-round." In a has transfer well into the political ate of the UB School of Medicine and sense, Weldon Biomedical Sciences, has been serving arena. My background gave me a lot of has been running as a Republican representative. Instead at that pace since experience in relating to people, oflooking after patients, he's been lookhe left his home ing after the needs of Florida's 15th on long Island solving problems, and explaining Congressional District. Instead of mediand enrolled in complex issues to people in cal cases, he's been caught up in welfare the accelerated reform, balancing the federal budget, terms they can understand." medical program and school-choice legislation. at UB. He had "Okay, now where was I? I was in the accelerated program planned to work his way through medical school, but when at UB, and ... ." We'll be interrupted five times by the end of he realized how demanding the program would be he applied our conversation, but the 43-year-old congressman remains for an Army Health Professions scholarship. Then he got s u f f a l a Physician Summer 1 9 9 7 �''I'm not expecting heaven on earth-there will still be a lot more worl< to do when I leave.'' Weldon also serves on the House Science Committee and engaged to ancy, whom he'd met when they were both the House Banking and Financial Services Committee. And students at the State University of New York at Stony Brook. his commitment to health-care issues has not been forgotten. "l went through this grueling summer curriculum, took my finals, then ran back to Long Island, got married , and went on "We did pass important health insurance reform in the last Congress that will restrict the ability of insurance companies my honeymoon, " he says. "It was a whirlwind, but those were wonderful years. I was newly married , studying like crazy, and to exclude people because of preexisting conditions," Weldon notes. "I was very pleased with that. But I think there's a lot working with some of the finest people I've ever known. " Weldon graduated from UB in 1981 and spent the next more that can be done to make insurance more accessible and three years at the Letterman Army Medical Center in San affordable. l'd also like to see medical malpractice reform, Francisco, where he completed his internship and residency although the President has been an adamant opponent of it. " Because Weldon in internal medicine. He and his family spend was then assigned to a part of every month three-year tour of duty at "I began to become concerned with what I in Washington , it is Winn Army Community saw as a bad direction that we were impossible for him to Hospital in Fort Stewart, GA. The highlight? Workhave regular patients. heading in as a nation. I was particularly ing with General orman But he continues to disturbed by the high degree of family Schwarzkopf. see patients at the "He was the division Melbourne medical breakdown and the general erosion commander when I got group 's Saturday of traditional values." there ," Weldon recalls , walk-in clinic. He "and I was his wife's also is on call on occasional weekends at a community hospital in Melbourne. doctor and a good friend of his aide-de-camp. " "l really did like practicing medicine, and I had reservaBy the end of his army duty in 1987, Weldon and his wife tions about giving it up. That played a strong role in my were in love with the South. They moved to Melbourne , FL, decision to serve only eight years. My plan is to return to where Weldon was in private practice only a few years when he started thinking seriously about getting involved in politics. private practice in 2002. !look forward to that. The pace is so "I began to become concerned with what I saw as a bad much slower than this-can you hold on a second'" direction that we were heading in as a nation ," he explains. "I Weldon puts the phone down again and goes off to cast his was particularly disturbed by the high degree of family breakvote against an amendment (proposed by Rep. joseph down and the general erosion of traditional values. And I Kennedy, D-Mass .) to a bill to repeal the United States thought it was terrible that our congressional leaders in WashHousing Act of 1937 and deregulate the public housing ington were just borrowing money year in and year out. " program. "These are amendments that usually just make it easier for people to get public housing, " Weldon says. "That's First he threw his support behind local candidates whose generally the trend. Mr. Kennedy has a vision that's very vision he shared. Then one day in 1993, a colleague suggested that Weldon would make a better congressman than any of much opposite to what the Republican majority vision is. " the candidates running for election the next year. Coupled Welfare reform and a savings of $50 billion in government with his concern about the Clinton health-care plan-like spending are among the initiatives that Weldon sees as signals of positive change since he went to Washington. ln the next many physicians, Weldon is skeptical about the federal five years, he hopes to contribute to a crackdown on crime and government's ability to run the health-care system drug abuse and to continue to push for a smaller federal efficiently-that suggestion "pushed me over the edge," government and lower levels of taxes. "The process of change he says. Weldon won the election in 1994 and was reelected has been slow," he says, "but I think we're making headway. " to a second term in 1996. And if the world hasn't changed enough by 2002, will Since his district includes the Kennedy Space Center, Weldon be able to give up politics? Weldon devotes substantial time to space issues. His medical ''I'm not expecting heaven on earth-there will still be a lot expertise has proved useful here, as well. "''m a big supporter more work to do when I leave," Weldon says. "But l don't of the space program," he says, "and there's a lot of exciting think l could totally walk away from politics after this. lt's science research that is performed on the shuttle, like gotten into my blood." + microgravity research. " B u f f a 1 a Physician Summer 1 9 9 7 �Sandra A. Block Internal Medicine, UB Graduate Medical Dental Education Consortium, Buffalo , Y Match Day 1997 Adrienne D. Bonham Obstetrics and Gynecology, University of wo-thirds ofUB's graduating medical students were placed Rochester/Strong Memorial Hospital , Rochester, Y in primary care residencies in this spring's Match Day. The Timothy P. Braatz Internal Medicine (prelim ), University of Maryland , Baltimore, MD; Radiology-Diagnostic , University of Maryland , Baltimore, MD ational Residency Matching Program results were announced March 19 by associate dean Dennis Angela M. Camasto Pediatrics, University Hospitals of Cleveland, ' Cleveland, OH adler. Eighty-six percent of the students got their first, second, or third choice of placements. Almost one-third will stay in Buffalo to train in the Graduate Medical Dental Education Consortium, while 48 percent will go out of state. In the primary care specialties, 28 students were placed in internal medicine, 2 7 in pediatrics, 21 in family medicine, and 7 in medicine-pediatrics. This is the first year that ew York State has considered obstetrics-gynecology one of the primary care specialties. Fourteen students were matched to OB-GY residencies. "We're very pleased with the outcome of the match, especially with respect to the number of students who chose residencies in primary care," adler said. "We've worked very hard to achieve this goal." Jared C. Barlow lntemal Medtcine (prelim ), ew Rochelle Hospital , New Rochelle , NY; Anesthesiology, Mount Sinai Hospital , ew York , NY Drew H. Barzman Psychiatry, Duke University Medical Center, Durham , NC Juan P. Abonla Pediatrics , UB Graduate Medical Dental Education Consortium, Buffalo, NY B u f f a l o p h y s c a S u m Edward L. Chan Pediatrics, UB Graduate Medical Dental Education Consortium, Buffalo, y Alexander W. Chen Medicine/ Pediatrics, Duke University Medical Center, Durham, C Kristen M. Chimileskl Pediatrics, University of Chicago Hospital, Chicago, IL Ronlka D. Choudhary Family Practi ce, Highland Hospital of Rochester, Rochester, NY Joseph L. Chow Family Practice, Highland Hospital of Rochester, Rochester, NY Gonzalo M. Bearman Intemal Medicine, UB Graduate Medical Dental Education Consortium, Buffalo, Y Ravl K. Desai Internal Medicine, UB Graduate Medical Dental Education Consortium , Buffalo, NY Terl Beers Obstetrics and Gyn ecology, UB Graduate Medical Gregory DIFrancesco Emergency Medicine, UB Graduate Medical Dental Education Consortium , Buffalo, Y Cassann N. Blake Surgery , SU Y Health Science Center, Brooklyn, y m Patricia A. Cawley Pediatrics, Morristown Memorial Hospital , Morristown , J Catherine C. Costello Pediatrics , Albert Einstein College of Medicine!Montefiore Medical Center, Bronx, NY Altagrace Belmar Pediatrics (primary), Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY Sharon Baratz Internal Medicine, George Washington University, Washington , DC Jason M. Andrus Psychiatry, University of Hawaii , Honolulu , HI y Kathleen M. Batt Family Practice, Halifax Medical Center, Daytona, FL Dental Education Consortium , Buffalo, NY Jean S. Bae Psychiatry, University of Wisconsin Hospital and Clinics, Madison , WI Jeffrey A. Cassidy Surgery (prelim), UB Graduate Medical Dental Education Consortium , Buffalo, Y; Orthopedics, UB Graduate Medical Dental Education Consortium, Buffalo, e 9 9 Andrew Dmytrljuk lttternal Medicine, George Washington University, Washington , DC Jacqueline A. Dombrowski Medicine/Pediatrics , UB Graduate Medical Dental Education Consortium, Buffalo, Y �Morris P. Elevado Internal Medicine, University of Massachusetts Medical Center, Worcester, MA Clarlsa R. Gracia Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA Paul J. Kerner Orthopedics, Allegheny University, Central City, PA Thomas R. Elmer Internal Matthew J. Gutierrez Internal Medicine (prelim), Alton Ochsner Medical Foundation, New Orleans, LA; Ophthalmology, Louisiana tate University Eye Center, ew Orleans, LA Medicine, University of Vermont! Fletcher Allen Health Care, Burlington, VT (prelim), University Hospital, Stony Brook, Y; Radiology-Diagnostic, SU Y Health Science Center, Brooklyn, Y Paul A. Guttuso Family Practice, Peter W . Kim Internal Medicine, St. Mary Hospital, Lubbock, TX Simone P. Elvey Internal Medicine Taj A. Hadee Pediatrics, Medical College of Virginia, Richmond, VA (prelim), UB Graduate Medical Dental Education Consortium, Buffalo, NY; Radiology-Diagnostic, University of Rochester/Strong Memorial Hospital, Rochester, NY Children's Memorial Hospital, Chicago, IL Peter S. Ercollno Pediatrics, Asra Khan Internal Medicine Randy S. Fagin Surgery (prelim), UB Graduate Medical Dental Education Consortium, Buffalo, Y Pamela R. Haefner Pediatrics, Electra C. Martin Emergency Mediciue, SUNY Health Science Center, yracuse, Y and Gynecology, UB Graduate Medical Dental Education Consortium, Buffalo, Y Andrew Klapper Plastic Surgery, Paul J. Mason Orthopedics, Henry Eric J. Hanauer Internal Medicine Benjamin 0 . Koenig Emergency Medicine, William Beaumont Hospital , Royal Oak, Ml Janine M. McAssy Internal Suchltra Koneru Family Practice, M. Angela Mclellan Obstetrics and Gynecology, UB Graduate Medical Dental Education Consortium, Buffalo, Y ew York University Medial Center, New York, Y Jennifer T. Hanauer Obstetrics (prelim), Albert Einstein College of Medicine!Montefiore Medical Center, Bronx, Y; eurosurgery, Albert Einstein College of Medicine!Montefiore Medical Center, Bronx, NY and Gynecology, Rochester General Hospital, Rochester, NY James B. Gaul Medicine/Pediatrics, University of Minnesota Hospital and Clinic, Minneapolis, M Agnes A. Gelder Family Practice, iagara Falls Memorial Medical Center, Niagara Falls, Y Jennifer P. Gennuso Pediatrics, Kathleen P. Gillan-Lundgren Pediatrics, Children's National Medical Center, Washington, DC Louisiana State University School of Medicine, Shreveport, LA Armond M. Lapine Internal Medicine, niversity of Utah Affiliated Hospitals, Salt Lake City, T Peter M. McNeela Family Practice, Hamot Medical Center, Erie, PA Peter S. McQulller Anesthesiology UB Graduate Medical Dental Education Consortium, Buffalo, NY Manal Hegazy Surgery, ew ew Rochelle, y Research, Buffalo, NY Lisa M . Mendonza Family Practice, UB Graduate Medical Dental Education Consortium Buffalo, NY Janice M . Lee Internal Medicine, Wenchun Hsu Emergency Mediciue, Emory University chool of Medicine, Atlanta, GA t. Louis University School of Medicine, t. Louis, MO Michael D. Merrill Internal Jeffrey M . Legrett Internal Medicine (primary), UB Graduate Medical Dental Education Consortium, Buffalo, NY Mediciue, UB Graduate Medical Dental Education Consortium, Buffalo, NY Daniel C. Metrick lntemal Medicine, Mount Auburn Ho pita!, Cambridge, MA Kenneth A. Levey Obstetrics and Gynecology, George Washington University, Washington, DC Claudia Jaramillo luternal Medicine (primary) , UB Graduate Medical Dental Education Consortium, Buffalo, Y Jennifer A. Meyer Pediatrics, Timothy N. Llesching Internal y Akron General Medical Center/ EOUCOM, Akron , OH; Ophthalmology, Case Western Reserve University, Cleveland, OH Joseph F. Lopes Surgery (prelim), Dartmouth-Hitchcock, Lebanon, NH; Urology, DartmouthHitchcock, Lebanon , NH Medicine, UB Graduate Medical Dental Education Consortium, Buffalo, NY Loren S. Kane Internal Medicine, Andre L. Lopez Family Practice, University of Medicine East Carolina-Pitt County Memorial Hospital , Greenville, C Stephan J. Mllback Family Practice, aval Hospital, Camp Pendleton , CA Medical University of South Carolina, Charleston, SC Jeannie Kao Physical Medicil1e and Rehabilitation, William Beaumont Hospital, Royal Oak, Ml 0 Alex Mompoint Internal Medicin e (prelim) , Sisters of Charity Hospital , Buffalo, Y; Physical Medicine and Rehabilitation, University of Texas outhwestern Medical Center, Dallas, TX UB Graduate Medical Dental Education Consortium, Buffalo, y Iuternal Medicine, UB Graduate Medical Dental Education Consortium, Buffalo, Y B Lori A . Michael Emergency Andrew J. Luisi Internal Mediciue, Brian M . Karaszewski B Graduate Medical Dental Education Consortium, Buffalo, Medicine, Deaconess Hospital, Boston, MA Thomas J. Joly Transitional, Y Mediciue, University Health Center, Pittsburgh, PA Frank M . Lee Emergency Medicine, Obstetrics and Gynecolog) , Our Lady of Mercy Medical Center, Bronx, NY (prelim), UB Graduate Medical Dental Education Consortium, Buffalo, NY UB Graduate Medical Dental Education Consortium, Buffalo, Thomas E. Hansen Orthopedics, Rochelle Hospital, Ford Health Science Center, Detroit, Ml University of Maryland, Baltimore, MD Ayanna Angela L. James Jennifer L. Geiger Surgery Pathology, UB Graduate Medical Dental Education Consortium, Buffalo, Y University of Wisconsin/St. Mary's Medical Center, Madison, WI Eric I. Finkelstein Surgery University of Rochester/Strong Memorial Hospital, Rochester, NY Dori R. Marshaii-Hobika Gregg E. Kissel Family Practice, Lorna Linda University, Lorna Linda, CA Medicine, UB Graduate Medical Dental Education Consortium, Buffalo, NY David R. Frels Internal Medicine, Pediatrics, University Health Center, Pittsburgh, PA Akron City HospitaVNEO COM, Akron, OH (prelim), University of Rochester/ Strong Memorial Hospital , Rochester, Y; Neurology, niversity of Rochester/Strong Memorial Hospital, Rochester, Y Michael A. Filice Emergency Alexander Marcus Regina Y. Kim Family Practice, Sabrina R. Hammett Obstetrics University of orth Carolina Hospital, Chapel Hill , C Paul M. Maggio Surgery, Rhode Island Hospi tall Brown University, Providence, Rl Cozzette Lyons Internal Medicine, University Hospitals of Cleveland, Cleveland, OH 0 p y 5 c o n 5 m m e 9 9 �Jonathan A. Morgan Internal Medicine (prelim), Long Island jewish Medical Center, ew Hyde Park, NY; Radiology-Diagnostic, Thomas jefferson University, Philadelphia, PA Christopher M. Pieczonka Surgery (prelim) , UB Graduate Medical Dental Education Consortium, Buffalo, NY; Urology, UB Graduate Medical Dental Education Consortium, Buffalo, Shrini T. Mukkamala Surgery (prelim), B Graduate Medical Dental Education Consortium, Buffalo, Y David M. Pllati Surgery, University of North Carolina Hospital, Chapel Hill , C Tracey L. O'Connor Intemal Medicine, University of Rochester/ Strong Memorial Hospital, Rochester, NY Mount Sinai, Flushing, NY Gina L. Parlato Family Practice, orth Colorado Medical Center, Greeley, CO Emmanuella Paul Family Practice, Emory University School of Medicine, Atlanta, GA Christian W. Rochoii intemal Medicine (prelim), niversity of Vermont/Fletcher Allen Health Care, Burlington, VT Philip S. Piasecki Intemal Medicine (prelim), Sisters of Paul Rosen Pediatrics (pri mmy), Mount Sinai Hospital, ew York, a a Y p Matthew Smith, D.D.S. Surgery (prelim), B Graduate Medical Dental Education Consortium, Buffalo, Y Gavin N. Somersel Obstetrics and Gynecology, Albany Medical Center y 5 c a n s u m Matthew Taberski Internal Medicine, Hospital of the niversity of Pennsylvania, Philadelphia, PA Evan S. Taragano Pediatrics, University Health Center, Pittsburgh, PA Andrea L. Torsone Obstetrics and Gynecolog), University of North Carolina Hospital, Chapel Hill, NC Meryl Y. Tucker Obstetrics and Gynecology, UB Graduate Medical Dental Education Consortium, Buffalo, NY Usha Vaidyanathan Internal Medicine, University Hospitals of Cleveland, Cleveland, OH Joseph H. Wandass Ill Medicine/ Pediatrics, UB Graduate Medical Dental Education Consortium, Buffalo, Y John J. Welch Pediatrics, Georgetown University Hospital, Washington, DC Dayo N. Wilson Medicine/ Pediatrics, B Graduate Medical Dental Education Consortium, Buffalo, Y Noelle M. Stevens Family Practice, SU Y Health Science Danielle A. Woodall Internal Medicine, Albert Einstein College of Center at Syracuse/St. joseph's Hospital Health Center, Syracuse, y Sarah K. Storm Pediatrics, North Shore University Hospital, Manhasset, Y Gary A. Styn Family Practice, B Graduate Medical Dental Education Consortium, Buffalo, NY m Julie A. Szumigala Obstetrics and Gynecology, UB Graduate Medical Dental Education Consortium, Buffalo, NY louise Z. Spierre Pediatrics, University of Cincinnati Hospital , Cincinnati, OH Y y h Nicole L. Symons Family Practice, University of Medicine East Carolina-Pitt County Memorial Hospital , Greenville, C William M. Wind StJrgery (prelim), UB Graduate Medical Dental Education Consortium, Buffalo, Y; Orthopedics, UB Graduate Medical Dental Education Consortium, Buffalo, Y Hospital, Albany, Vitaly Raykhman Surgery (preli m), UB Graduate Medical Dental Education Consortium, Buffalo, Y; Umlog), B Graduate Medical Dental Education Consortium, Buffalo, Y Maryann M. Parietti-Scharf Family Practice, Highland Hospital of Rochester, Rochester, Y u Monica J. Simons Obstetrics and Gynecology, Queens Hospital! Pamela P. Rath Transitional, Hennepin County Medical Center, Minneapolis, M ; Ophthalmology, University of Minnesota, Minneapolis, M John Panagiotopoulos Intemal Medicine, Winthrop-University Hospital , Mineola, Y B Jimmy Y. Sim Pediatrics, Thomas jefferson University/Dupont Institute, Philadelphia, PA Jennifer M. Ragi Intemal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA lesley A. Orman Pediatrics, Eastern Virginia Medical School, orfolk, VA Charity Hospital , Buffalo, Charles M. Severin, Ph.D. faculty, Department of Anatomy and Cell Biology, UB Graduate Medical Dental Education Consortium, Buffalo, Y John C. Radford Emergency Medicine, UB Graduate Medical Dental Education Consortium, Buffalo, NY Medical Center, Merced , CA Jennifer F. Sussal, M.P.H. Pediatric Psychiatry, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, Y Craig M. Senzon Intenwl Medicine (prelim), Beth Israel Medical Center, New York, Y; Neurology, Albert Emstein Medical Center, Bronx, NY Bobbie l . Pustelny Surgery (preli m), University of California at Los Angeles, Los Angeles, CA Christopher M. Occhino Family Practice, Merced Community Noah D. Sabin Surgery (prelim), Abington Memorial Hospital, Abington, PA; RadiologyDiagnostic, Albert Einstein College of Medicine(Jacobi Medical Center, Bronx, Y y Catherine F. Przystal Medicine/ Pediatrics, University of Rochester/ Strong Memorial Hospital, Rochester, Y David J. Novak Internal Medicine (prelim), Georgetown University Hospital , Washington, DC Paniti Sukumvanich Obstetrics and Gynecology, niversity Health Center, Pittsburgh, PA Tami S. Seaman Family Practice, UB Graduate Medical Dental Education Consortium, Buffalo, Aisha K. Prim Pediatrics, Children's ational Medical Center, Washington, DC Manyan Ng Pediatrics, Thomas jefferson University/Dupont Institute, Philadelphia, PA James J. Runfola Family Practice, West jersey Health System, Trenton, J Patrick V. Scott, D.D.S. Surgery (prelim), UB G•aduate Medical Dental Education Consortium, Buffalo, Y V. Chowdry Pinnameneni Intemal Medicine (prelim), New York Methodist Hospital , Brooklyn. Y Gerardo Negron Internal Medicine, UB Graduate Medical Dental Education Consortium, Buffalo, Y Lisa S. Sufrin Pediatrics, University of Cincinnati Hospital , Cincinnati, OH Thomas E. Schenk Pediatrics, UB Graduate Medical Dental Education Consortium, Buffalo, Y y James P. Murray Medicine/ Pediatrics, University of Texas Medical School, Houston , TX Mary E. Ross Pediatrics, St. Louis Children's Hospital , St. Louis, MO e 9 9 7 Medicine(Jacobi Medical Center, Bronx, NY Denise C. Woodall Pediatrics, Eastern Virginia Medical School, orfolk , VA Carolyn M. Young Psychiatry, UB Graduate Medical Dental Education Consortium, Buffalo, Y �.. . . .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . . . [1] ~ I Rettred surgery professor dies BY WORTHINGTON G . SCHENK n September 4, 1996, surgery lost an outstanding leader with the death of john D. Stewart, M.D. Stewart earned a B.A. from the University of Virginia and graduated cum laude from Harvard Medical School in 1928. He and Henrietta Rhees were married in 1937 and had two daughters and one son. Their son, David, became a surgeon, but tragically, died quite young of undiagnosed overwhelming sepsis. Stewart completed an internship at the Huntington Memorial Hospital and a residency at Massachusetts General Hospital. He did research and further JR . , M . D . work at Massachusetts General and Harvard before being appointed professor of surgery at UB and chief of surgery at the E. ]. Meyer Hospital (now Erie County Medical Center). In 1943, he was commissioned a major in the U.S. Army Medical Corps and a year later was promoted to lieutenant colonel. He served on several national research committees, including the surgery section of the ationa! Institutes of Health. After serving a term on the American Board of Surgery, he became its chair in 1956. Stewart also Nobelist dies at 94 ir john Carew Eccles, a abel Prize-winning neuro- physiologist and a former member of the UB faculty, died in May at his home in Switzerland, the ew York Times has reported. He was 94. In 1963, Eccles shared the obel Prize for Medicine or Physiology with Alan Hodgkin and Andrew Huxley for describing the electrochemical communication system between nerve cells. Eccles showed that excited nerve cells release a substance (acetylcholine) that enlarges pores in a neighboring cell's membrane, allowing positively charged sodium ions to enter the cell, reverse the polarity of the electric charge in the cell, and transmit the nerve impulse. He also found that in other types of synapses, the excited nerve cell induces the neighboring cell to discharge potas- sium ions, which reinforces its existing polarity and inhibits the transmission of the nerve impulse. Eccles was the author of a number of books, including The Physiology of erve Cells (1957), The Inhibitory Pathways of the Central ervous System (1969) , The Understanding of the Brain (1973), and The Human Psyche (1980). Born in Melbourne, Australia , Eccles earned his bachelor's and medical degrees from Melbourne University, and his master's and doctorate from Oxford University under a Rhodes scholarship. B u f f a l o Phys i served as president of the American Surgical Association and was active in many other professional groups. His interests were not limited to surgery. The family kept cattle and working horses on ranches in South Carolina and Florida. In 1965,john retired from his medical school and hospital positions and moved to Boca Raton, Fl. During his professional career, he trained 20 surgeons, most of whom became chief surgeon at their institutions. Few surgeons made the breadth of contributions to the profession as did john D. Stewart. + Worthmgwn G. Schenh jr., trai ned with Dr. Stewart and later succeeded him as ch1ej of surgery at E.). Meyer Hosp1tal. He conducted the research that led to the obel in the 1950s while at the john Curtin School of Medical Research of the Australian ational University in Canberra. Eccles was knighted by Queen Elizabeth II in 1958. Other honors included membership in the Pontifical Academy of Sciences and a four-year term as president of the Australian Academy of Science. He and his first wife, Irene, had nine children. In 1966, Eccles came to the U.S. to head the American Medical Association's Institute for Biomedical Research in Chicago. Two years later, he moved to Buffalo to direct UB's Center for theStudyof eurobiology. He was named a SU Y Distinguished Professor in 1975. After his retirement in 1975, Eccles and his second wife, Helena, settled in Switzerland. + cian Summer 1 9 9 7 �- - - ------ -~-----~-~ ---- - ~~~- - -= ························································································•· Mlfl I I Morin appointed chair of pediatrics rederick C. Morin III, M.D., has been appointed chair of UB's Department of Pediatrics after serving as interim chair for a year. A UB professor of both pediatrics and physiology, Morin was also appointed pediatrician-in-chief at Children's Hospital of Buffalo. He has been chief of the hospital's Division ofNeonatalogy, which is internationally recognized for its research on treatments for lung failure, including surfactant replacement therapy, inhaled nitric oxide, and liquid ventilation. Morin succeeds F. Bruder Stapleton, M.D., who is now chair of pediatrics at the University of Washington. After earning his M.D. at Yale University, Morin completed his residency at Stanford University and held a research FREDERICK C MORIN Ill fellowship in neonatalogy at the Cardiovascular Research Institute of the University of California at San Francisco. He directed the Intensive Care ursery at the University of Rochester before joining the UB faculty in 1986. He is board certified in both pediatrics and peri nata 1/neona ta 1 medicine. + WNY's Largest Volume BMW Dealer THE ULTIMATE DRIVING MACHINE~ THOSE LOOKING FOR MORE CONTROL IN THEIR LIFE CAN NOW FIND IT ON SLIPPERY PAVEMENT. F. G. DOWNING s&99 1997 BMW 740i 27 mo. Lease Towne BMW 3030 Orchard Park Rd. Orchard Park, New York 14224 Phone: 675-2550 While the road of life may throw you an occasional curve, at least our All Season Traction helps you handle the particularly slippery ones. FREE SCHEDULED MAINTENANCE ALL SEASON TRACTION PMT based on 5000 cap cost reduction or trade, 10,000 miles per year. 15 cents charge per mile for excess miles. First and last PMT, taxes and plate fees due at inception. Service Loaners Available ... Minutes From Rich Stadium B u f f a 1 o Physician summer 1 9 9 7 �COMMENI 1 9 9 7 Commencement ceremony honors cancer researcher Internationally hnown cancer researcher James F. Holland, M.D., was awarded a State University of ew York honorary doctorate in science at the 151st commencement of the UB School of Medicine and Biomedical Sciences on May 11. Holland , whose work helped shape modern treatments for leukemia and other cancers , also delivered the annual D. W. Harrington Lecture on May 12, on the topic of "The Search for HMTV, Human Mammary Tumor Virus." Commencement ceremonies were held in the Center for the Arts on the UB orth Campus. SUNY Trustee Edward . elson conferred the honorary degree on Holland. One hundred forty-six students received their M.D.s during the ceremony, and 37 received Ph.D.s. Four received M.D./Ph.D.s. The ceremony served as the conclusion of the university's 18-month sesquicentennial celebration. Holland, CU Y Distinguished Professor and chief of the Division of eoplastic Diseases at Mount Sinai School of Medicine , served as chief of medicine at Roswell Park Cancer Institute for more than 20 years. A graduate of Princeton University and Columbia University College of Physicians and Surgeons, he spent a year at the ational Cancer Institute before coming to UB and Roswell Park Cancer Institute in 1954. He was named chief of medicine at Roswell in 1956, serving until 1973. During much of that time , he also served as director of Roswell's Cancer Clinical Research Center and became a research professor of medicine at UB. In 1972, Holland received the prestigious Lasker Award for his work in chemotherapy. + ® B u f f a l o p h y �-----~-- ---~- - -------- - -~-....--- - - liCE ME NT On with joy to new challenges: Twin sisters Drs. Danielle and Denise Woodall (center); Dr. joseph Lopes with daughter Olivia (top, page 18); UB President William Greiner hooding, then congratulating, Dr. james Holland (below, page 18); Interim Dean john Wright, presiding (top, page 19); Dr. Lisa Mendonza with family friends (above); Dr. Regina Kim signing the Book of Physicians (immediate left); and Class Speaker Dr. Charles Severin (below). ~ �• ··················································· · ···································· ~ I Aword from the director of development BY LINDA J . CORDER. PH . D. , C.F.R.E . n this issue of the Buffalo Physician, the school honors and thanks members of the james Platt White Society. Several times since becoming a development officer in the School of Medicine and Biomedical Sciences, I have been asked about the history and evolution of this honorary recognition organization. The short answer is, it provides a vehicle to thank those who generously contribute their personal resources to enhance and advance the School of Medicine and Biomedical Sciences. Each donor decides where his or her gift will go. Many give to the school's General Fund, which is disbursed at the discretion of the dean. It is not an exaggeration to say that the General Fund is the most important current gift fund. The caliber of our faculty continues to increase, in part, because of the flexibility this fund provides in support of searches and faculty dt.velopment. Other uses for the fund include recruiting promising students, supporting the minority high school research apprentice program, and underwriting the Medical Scientist Training Program seminar series. Some donors choose to designate their gifts for endowed funds, including endowed scholarships and endowed faculty chairs. Others make gifts to special projects, such as UB's euroanatomy Museum, or to departmental funds, which are disbursed at the discretion of the department chair for such uses as research seed money or student medical association activities. Gifts to any of these funds-as well as annuities, charitable trusts, or bequestsqualify a donor for membership in the james Platt White Society. The society offers two types of recognition: annual and lifetime. An annual gift of $1,000 or more results in a year's membership in the society. An individual or a couple is granted lifetime membership in the Founders' Circle of the society when cumulative contributions reach $50,000. Recognition in the james Platt White Society confers recognition in the University's President's Associates (annual) and University Founders (lifetime) honorary organizations. When the james Platt White Society was established in 1986, memberships went to ® B u f f a l o those who donated $10,000 payable over a period of ten years to any fund that benefited the school. Larger gifts guaranteed recognition for a specified number of years. A few "special members" are still recognized, due to those early agreements. Several years ago, the recognition categories were changed to the current annual and lifetime memberships. The category "Special Membership" is no longer offered, and will expire for current members at the end of 1999. The recognition category "In Memoriam" was added to recognize those whose thoughtful foresight included arranging major bequests or gifts from testamentary trusts for the school's enhancement. Individuals and couples who support the medical school at an outstanding level are seen as its closest friends, and so they receive additional information throughout the year, invitations to certain medical school and university events, and special recognition by the school. Best of all, this is an open and expanding group. The more "best friends" the school has, the more excellent it becomes. All are welcome to contribute and be recognized for their support. The entry level for the society has never been raised. In fact, it has actually been lowered for recent graduates. "Graduates of the Last Decade" (GOLD) are recognized for annual contributions of only $500 or more. The Executive Committee wants to encourage all medical alumni, and especially the GOLD graduates, to support their school at a level commensurate with their resources. We are deeply appreciative of all gifts to the medical school, especially those that have the potential to make a transforming difference in the quality of medical education and residency training offered at UB. I invite you to read through the roster of members that follows, and to thank your friends and colleagues listed there for their outstanding support. If you are not yet in this group, please consider increasing your contributions to the school. The executive committee would like to see this honorary group double in size by the end of the century.+ Linda). Corder became the direcror of development for the School of Med1cine and Biomedical Sciences this year. She had previously sen·cd the school as major gifts coordinaror. Physician Summer 1 9 9 7 �- -- --~-----~~~~-- -- - - ---- - - ~~-~ -- -= ·············· · ·········································································• · ~ I Dean ' s Circle james Generous gifts of $25,000 to $49,999 qualify individuals or couples as members of the Dean's Circle. Platt White Society Dr. Kenneth M. and Mrs. joan Alford Chair Buffalo, NY Dr. Charles D. and Mrs. Mary Bauer Byron A. Genner Ill, M.D. Williamsville, NY Potomac, MD I Founders ' Circle Individuals or couples whose cumulative lifetime contributions total $50,000, or whose irrevocable deferred gifts total $100,000 or more, are honored as permanent members of the Founders' Circle. Their names are also repeated in an annual category, at the appropriate level, in any year that they make a new gift to the School of Medicine and Biomedical Sciences. Dr. Elizabeth P. Olmsted Ross Buffalo, I Y Cheste1jield, MO Orchard Park, NY Dr. Orvan W. Hess Dr. Richard B. and Mrs. Ellen Narins North Haven, CT Dr. Richard B. and Mrs. Ellen B. arins Williamsville, NY Philip B. Wels, M.D., and Mrs. Elayne Wels Eggertsville, NY Buffalo, NY I Dr. George M. Ellis Jr. and Mrs. Kelly Ellis Connersville, IN Lakeview, NY Mrs. Catherine Fix Martinsburg, WV Dr. Thomas F. Frawley Chesterfield, MO p h Annual Members Individuals or couples whose annual gifts total $1,000 or more are honored in the year the gift is made, at the level indicated by the total amount of contributions made during the period specified. The following lists recognize this year's annual members, some of whom are also honored as members of the Founders' Circle. Mrs. Grant (Evelyn) Fisher y 5 c I a n 5 m Circle Gifts of $5,000 to $9,999 are given due recognition in the Professors' Circle. Central to a great university is a strong faculty. Likewise, central to the future of our school is the dedication of a cadre of supporters within the Professors' Circle. Miss Thelma Sanes Dr. Kenneth H. Eckhert Sr. and Mrs. Marjorie Eckhert Dr. Thomas]. Kufel Marilla, Y Dr. Charles]. McAllister Clearwater, FL Buffalo, NY I Scholars ' Circle One strength of an outstanding institution is the caliber of those who study there. Scholars within the james Platt White Society have made gifts to the school totaling $1,000 to $2,499 during the past year. These marked with an asterisk(*) are young scholars, graduates of the past decade who qualified with gifts of $500 to $999. Dr. Bruce M. Abramowitz Glenview, IL Dr. Kenneth Z. Altshuler Dallas, TX Dr. Richard Ament I Professors ' Buffalo, NY Providence, R1 o Longboat, FL Dr. Elizabeth P. Olmsted Ross Snyder, NY l Dr. Benjamin E. Obletz Hilton Head Island, SC Dr. Willard and Mrs. Clarice Bernhoft a East Aurora, NY Dr. Albert C. and Mrs. Linda Rekate Y Chairs ' Circle Dr. Thomas F. Frawley Richard]. Nagel, M.D. and Mrs. Florence Nagel Dr. joseph and Mrs. Helene Chazan Y just as a department chair earns recognition for leadership of an academic program, donors who make leadership gifts in the range of $10,000 to $24,999 are given special recognition by the james Platt White Society. East Aurora, NY Williamsville, Dr. joel M. Bernstein Dr. Richard W. Munschauer Dr. Eugene R. and Mrs. june A. Mindel! Dr. Charles D. and Mrs. Mary Bauer f Dr. Thomas]. and Mrs. Barbara L. Guttuso Mrs. GraceS. Mabie Orlando, FL Buffalo, NY f Buffalo, NY New York, NY Dr. Kenneth M. and Mrs. joan Alford u Buffalo, NY Mrs. Morris Lamer Williamsville, NY B Dr. Eugene R. and Mrs. June A. Mindel! East Amherst, NY Mrs. june M. Alker Circle Fellows within the school are recognized for the added depth they bring to postgraduate study. Within the james Platt White Society, fellows are honored for gifts made during any one year that total $2,500 to $4,999. Williamsville , NY Dr. and Mrs. Pasquale A. Greco Buffalo, I Fellows ' I Dr. William S. Andaloro Caledonia, NY Dr. George Bancroft Hamburg, NY Drs. Kevin and Elizabeth P. Barlog Dr. Willard H. and Mrs. Clarice Bernhoft Amherst, NY Snyder, NY Dr. jared C. and Mrs. Barbara A. Barlow Dr. Harold]. and Mrs. Arlyne Levy Grand Island, NY Amherst, NY Dr. Robert M. Barone Dr. Edward Shanbrom Santa Ana, CA Buffalo, NY e 9 La]olla, CA Dr. Paul D. Barry Dr. and Mrs. james]. White Jr. m Williamsville, NY 9 7 Aiea, HI �• ························································································ Dr. Ronald E. and Mrs. Kathleen Batt Lancaster, NY Dr. Mark and Mrs. Kathleen Comaratta East Amhnsl, ry Gerard T. Guerinot, M.D. , and Mrs. Geri Guerinot Dr. Edwin j. and Mrs. Phyllis E. Manning Rochester, Snyder, NY Y Dr. Ralph T . Behling Dr. Lyn Corder Dr. Eugene J. Hanavan Jr. Dr. Michelle j. Marinello San Mateo, CA Buffalo,, Y Blljfalo, 'Y Williamsville, Y Dr. Richard A. Berkson Dr. and Mrs. Daniel E. Curtin Mrs. Gilda L. Hansen Dr. William L. Marsh Rancho Palos Verdes, CA Orchmd Park, NY Williamsville, NY Bethesda, MD Dr. Theodore . Bistany Mrs. Joan D'A rrigo, in memory of Dr. Pete r . D'A rrigo Dr. Reid R. and Mrs. Elenora M. Heffner Dr. Don L. Maunz Buffalo, NY Dr. john . Bivona Jr. Newbu rgh, NY Dr. Willard H. Boardman Buffalo, Buffalo,, Y Bangor, ME Y Dr. Merrill L. Miller Dr. William j. Hewett Richard H. Daffncr, M.D., and Mrs. Alva K. Daffne r Hamilton, NY West Hartford, CT Mrs. Edwina Mincks in memory of Dr. Charles B. Mincks Jr. Robert M.jaeger, M.D. Winter Park, FL Ptllsbwgh, PA Dr. Dennis L. Bordan Port Washmgton, NY Dr. David R. and Mrs. Sherrye Dantzkcr Dr. Suzanne F. Bradley Roslyn, NY Whitmore Lake, ,\1/ Dr. RogerS . and Mrs. Roberta Dayer Dr. Charles A. joy Dean Mitchell , M.D. Bt;Jfalo, NY fairview, PA Cortla nd, Y Gerard]. Diesfeld , M.D. Dr. Stephen T. Joyce Dr. joseph F. Monte Arcade, NY Buffalo, \JY Buffalo, Dr. Thomas A. Donohue Dr. and Mrs. James R. KanskiJr. Dr. james]. Moran Lexington, KY Eggertsville, Santa Monica, CA Dr. Ronald l. Dozo retz Drs. Julian R. and Mayenne A. Karelitz Dr. Thomas W. Bradley Tonawanda, NY Dr. Martin Brecher Amherst, Y Dr. Harold and Mrs. Anne Brody Amherst, Y Dr. James B. Bronk Napa,CA Dr. Melvin M. and Mrs. Elaine S. Broth man Snyder, NY Dr. August A. Bruno Amherst, NY Dr. William M. Burleigh Rancho Mtrage, CA Dr. Washington Burns Ill Berkeley, CA Drs. Evan and Virginia Calkins Hamburg, l\Y icholas J. Capuana New Hartford, Y Dr. Dr. Nicholas C. Carosella Appleton, Y Dr. Yung C. C han Drapc1, VA Dr. Michael E. Cohen Williammlle, NY Dr. D. Jackson Coleman Ha worth, Nj Allenl01vn, PA Dr. Maynard H. MiresJr. Moun/am Lakes, Nj Norfolk, VA Georgetown, DE Y Dr. Thomas W . Morgan Dr. Robert B. Kaufman North Brunswick, Nj Ontano, Potomac, \tiD Dr. and Mrs. Kenneth K. Kim Roanoke, VA Clinton, Dr. jack C. Fisher Dr. Arthur C. Klein Lajolla, CA Los Angeles, CA Dr. Penny A. Gardner Dr. Robert A. Klocke Los Altos, CA Williamsville, NY Dr. Kenneth L. Gayles Dr. Paul S. Kruger Manhasset , , Y Y Dr. Arthur W Mruczek Sr. Medina, NY Dr. Richard L. Munk Sylvania, OH Dennis A. Dr. Lawrence H. Golden Dr. Paul A. C. Greenberg Y Dr. Kim Griswold Lockport, NY Ri chard]. agel, M.D. and Mrs. Florence agel Dr. Gordon R. Lang Orchard Park, Poestenkill, Dr. Masao 1 Y Eric, PA f f a l o akandakari Drs. Robert G. and Lillian V. jamestown, Carlisle, PA Dr. Robe rt T. Guelcher Y Honolulu, HI Dr. Stanley B. Lewin Fort Myns, FL adler, M.D.* Velvedccr- Tiburo, CA Dr. Andre D. Lascari Dr. Edward F. Gudgel a PaulL. Drs. joseph L. and Marie L. Kunz Chicago, IL Btiffalo, \'Y adler, M.D. East Amherst, NY Watertown, NY Eggertsville, NY Y Dr. John D. Mountain Dr. John A. and Mrs. Karen Feldcnzer Buffalo, NY Y Dr. Philip D. Morey Williams1·illc, Y Los Angeles, CA Dr. Robert Einhorn New York, Mukilteo, WA Dr. Kenneth L. and Mrs. Jane Jewel ey Y Dr. jack and Inez Lippes Dr. Thomas P. and Mrs. Sandy O'Connor Buffalo, Y East Amherst, Y p h y c a n S u m m e 9 9 7 �······················· · ······ · ································· · ······················· · ·' ~ I Mrs. Marguerite T. O'Gorman Dr. Joseph I. Schultz Dr. Bradley Truax Dr. Myron E. Williamsjr. Eden, NY San Pedro, CA Lewiston, Y Batavia, XY Dr. Rudolph Oehm Fred and Peggy Schwarz Dr. Alvin Volkman Dr. Richard G. Williams Walnut Creek, CA Williamsville, NY Greenville, NC Clearfield, PA Drs. Dean E. and Donna W. Orman Roy E. Seibel, M.D. and Mrs. Ruth H. Seibel Dr. Arnold Wax Dr. Lester E. Wolcott Henderson , V Lt1bbock, TX East Amherst, NY Eggertsville, NY Dr. JohnS. and Mrs. Dorris Parker Dr. Molly R. Seidenberg Dr. Harold J. Weinstein Gregory E. Young, M.D. Van Nuys, CA Holland, NY Dr. Arthur M. Seigel Drs. Charlotte C. and Hyman Weiss Ca nandaigua, NY Guilford, CT Highland Park, Dr. Elizabeth G. Serrage Dr. Paul H. Wierzbieniec Dr. Franklin and Mrs. Piera Zeplowitz Portland, ME Amherst, NY Buffalo, NY Dr. John B. Sheffer Dr. Gary J. Wilcox Williamsville, Carlsbad, CA Dr. David C. and Mrs. Susan D. Ziegler Rochester, NY Latrobe, PA Dr. Robert J. Patterson Snyder, NY Dr. Norman L. Paul Lexington, MA Dr. joel H. Paull Buffalo, NY Dr. Victor L. Pellicano Niagara Falls, NY Y Dr. Timothy S. Sievenpiper Dr. Charles E. Wiles East Aurora, NY Ha111es City, FL Dr. A. john Piccoli Drs. RobertJ. Smolinski and Claudia Fosket Fort Myers , FL Orchard Park, NY Dr. and Mrs. Herbert S. Pirson Dr. William L. Sperling Orchard Park, NY San Diego, CA Dr. Cary A. Presant Dr. John E. Spoor San Marino, CA Laurens, NY Dr. Bert W. Rappole JohnJ. Squadrito, M.D. jamestown, NY Troy, NY Dr. Frederic D. Regan Dr. William C. Sternfeld Staten Island, Y Sylvania, OH F. T. Riforgiato, M.D., and Mrs. Mary-Cecina W. Riforgiato Middleport, NY 8 Dr. David W. Butsch Montpelier, VT Eugene M. Sullivan Jr. , M.D. Dr. Richard R. Romanowski Ms. Janet F. Butsch Aurora, CO Boston, NY Williamsville, NY Dr. Michael A. Sullivan Dr. Charles H. Rosenberg Buffalo, NY Mr. Barry Swartz Dr. and Mrs. JeffreyS. Ross Dr. and Mrs. Marvin Z. Kurian Amherst, NY Albany, NY Willtamsville, NY Wayne C. Templer, M.D. Dr. Albert G. Rowe Harry L. Metcalf, M.D. , and KaarenJ. Metcalf, Ph.D. Corning, NY Tonawanda , NY Dr. David M. Rowland Dr. and Mrs. James C. Tibbetts Jr. East Aurora, Y Madison, WI Dr. Eric J. Russell Dr. Charles S. Tirone Chicago, IL Williamsville, NY Dr. Adolphe J. and Mrs. L. SchoepiTin Green Valley , AZ a l o Williamsville, Y Dr. john Naughton Buffalo, Y Mrs. Marvin (Helen) Winer Sarasota, FL Dr. George Toufexis ancy Williamsville, NY p h y 5 a n s In Memoriam - The following individuals left generous bequests or made arrangements for gifts from testamentary trusts to be given to the School of Medicine and Biomedical Sciences during the past year. Dr. Russell F. Brace Randolph, Y Dr. Richard J. Kenline Tonawanda, NY Dr. Thomas A. Rodenberg Hollywood, FL Dr. Mark W. Welch Rochester, :-JY Dr. John L. Butsch Williamsville, NY Stamford, CT ecial Members A few individuals and couples were granted multiyear memberships based on generous gifts made between 1989 and 1993. They will receive special recognition through December 1999. At that time all memberships in the society will be made on an annual basis, including ongoing recognition for Founders' Circle members as they reach 550,000 in cumulative gifts. Elizabeth A. Storch Buffalo, NY f Wa lnut Creek, CA Las Vegas, NV Hamburg, NY f ~ Dr. Wende W. Young Dr. Roger M. Simon Dr. Harry Petzing B I u m m e 9 9 We have made every effort to ensure accuracy in these lists. Please contact Dr. Linda) . Corder, Ms. Catherine Williams, or Mrs. janet Parker in the Medical School Development Office if we have made an error or if you would like your name(s) to be listed differently in fut ure recognition documents. Send mail to: Room 141 Biomedical Education Building, UB School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY 14214-3013. Phone: (716) 829-2773. Fax: ( 716) 829-3395. E-mail: <ljcorder@acsu.buffalo.ed u>. �• ········· · · · ··················································· · · ·· ···· · ··············· Clinical curriculum traces its roots to Buffalo BY S COTT T HOM A S t was half a lifetime ago, at the beginning of their careers . But for five pioneering medica l educators who came together once again to reminisce, the memories remain as sharp as a new scalpel. A "Celebration of Medical Education" honored the five former UB faculty members who created the Project in Medical Education, an innovative effort from 1955 to 1959 to expose beginning medical students to clinical experience and small-group teaching. The project was revolutionary for its time, and not without controversy. Previously, medical students had spent almost all of their first two years in the lecture hall. The Project "we should bring together medical educators and professional educators to see if there was something we could learn from them-and perhaps even they could learn from us." The idea evolved, Miller said, into a series of courses taught jointly by professors in medicine and education, and programs for visiting professors to spend time in both the School of Education and the medical school. 'The colonization began there, but in the course of the next few decades it has spread worldwide," he said. "All these schools have to acknowledge that the seeds of this movement began at the [then] University of Buffalo." Stephen Abrahamson, Ph.D., Ed.D., was on the School of Education faculty at the time; his career has since taken him to the University of Southern CaliLeft to right: Miller, Abrahamson, Rosinski, Jason, and Becker fornia, where he is now professor emeritus. He said he had one proviso when agreeing in Medical Education got them into hospitals and working with patients, an approach that to co-direct the Project in Medical Education: has become the standard for medical educa- " o gross anatomy, and no operating room. " Abrahamson noted the rise of "a bottomtion in the United States. At an April 24 presentation, the five pio- line mentality" with the advent of managed neers shared thoughts on why the project care; he also pointed with hope to the enorsucceeded so thoroughly, and where medical mous amounts of material now widely education might be going in the years ahead. available through the Internet. "In my 35 years of medical education," George E. Miller, M .D., co-director of the project, went on to the University of he added, "''ve tried to learn not a damn Illinois Medical School and is now professor thing about medicine. And the little I have learned has made me pray for health. " emeritus there. Edwin F. Rosinski, Ed.D., earned his docHe spoke of how Stockton Kimball, dean ofUB's medical school at the time, agreed that torate at UB while working on the project. B u f f a l o P Since then, his career has taken him to the Medical College of Virginia; the U.S. Department of Health, Education, and Welfare; the University of Connecticut; and the University of California at San Francisco, where he is now professor emeritus. Rosinski predicted a greater emphasis on outpatient and primary care-the latter a strength ofUB's medical school curriculum, which has become a national model. Hilliard Jason, M .D., Ed.D., earned his medical degree and his doctorate in education from UB. He now directs the Center for Instructional Support, in Boulder, CO, and is clinical professor of family medicine at the University of Colorado Medical School. jason recalled an initial disillusionment with medicine, due to a histology professor who "insisted that we spend hours peering through a microscope at tissues and putting dots on paper to match the shading of what we saw. " That changed with the Project in Medical Education. "I was so excited that there was somebody here who was challenging the status quo. There was this other side of the school that was enormously exciting and enriching." jason sees a plus side to managed care. "The arrival of the bottom-line mentality brings with it the notion of accountability. We have not had that in medical education. " Donald Raymond Becker, M.D., taught surgery at UB until1980, then went to the University of Connecticut at Hartford. ow emeritus there, he teaches at the University of California at Davis. "There have been so many changes in medicine in the past 40 years," he said. "Humanism courses and biomedical ethics committees; AIDS; more women and minorities in the profession. Some say medicine has become too cold, too remote, too impersonal, too unavailable, too money-hungry. "But when students today ask me if I would do it all over again, my answer is still: 'In a flash! ' Why should it matter to me who pays me or how much paperwork I have to do? There will always be the sick who need healing. " hysician + Summer l 9 9 7 B �Put tfze best seat in tfze fwuse myourgarage. ·······················································•· ~ I Residencyslotstobecut by 20 percent overfive years 1997 Buick Riviera Riviera: the most sophisticated personal luxury car Buick has ever offered. It is designed to stir the spirit and excite the soul. We at Paul Batt Buick are proud to serve the people of Buffalo and its surrounding communities. For the last 43 years, we have offered the lowest prices possible, along with the very best in service. We value the professional and the hard working labor force in our community and will continue our efforts to maintain their loyalty. When you enter our showroom you will find helpful people, not pressure-so when you think of Buick sales and service, we know you'll think of us! Joseph R. Pera Paul V. Batt, Jr. 'ldat'JJaff7lllll1 1717 Walden Ave., Buffalo, NY 891-5595 B u f f a l o he number of medical residents trained in Buffalo will be reduced by about 20 percent over the next five years in response to a Medicaid incentive program and cuts at the Veterans Administration. The Graduate Medical Dental Education Consortium of Buffalo had 687 Medicaid-funded residents in training in 1996. That number will be reduced to about 545 by the year 2001 , said Roseanne Berger, M.D., UB associate dean for graduate medical education. The cuts are part of an incentive program for ew York State hospitals offered by the federal Health Care Financing Administration, which runs Medicaid. During the five years of the cuts, HCFA will ease the transition by paying the participating hospitals a percentage of the money they would have received had they continued to train residents at 1996 levels. At the same time, the Veterans Administration is also cutting back on residency training. The Buffalo consortium now trains about 101 VA-funded residents; over five years, this figure will be cut to about 89, according to Gerald Logue, M.D., chief of staff at the Veterans Affairs Western ew York Healthcare System at Buffalo. The result will be a reduction in the number of Buffalo-area medical residents from 788 to 634. Also, a larger percentage of the remaining residencies will be in primary care areas. "Residencies are paid for with public money, so the numbers and types of residents should be driven by what the country needs," Logue said. Nationally, there is a concern that schools are training too many doctors, and specifically, too many specialists. There's also concern about the high cost of medical education, which contrib- Physician summer 1 9 9 7 I utes to the overall expense of health care. For example, federal budget officials have predicted that the Medicare Trust Fund, which is the source of much of the country's GME funding, will have a $600 billion deficit by 2002. As long as residency training provided income for hospitals, there was a strong incentive to create more residency positions and use the residents to take care of indigent patients. Sometimes, residents found themselves performing procedures not because they were required for board certification but because the hospital had no one else to do them. The trend has resulted in many more residency positions than can be filled by graduates of American medical schools, leading hospitals to recruit international medical graduates (IMGs). The changes are likely to start reducing the number of IMGs in the U.S., and Roseanne Berger residents may soon be able to select the types of hospital work they need in order to meet their own educational priorities rather than doing what is needed to care for patients. In addition to the changes in the two federal sources of GME funding, more changes are afoot at the state level due to the ew York State Health-Care Reform Act of 1996. Details remain to be worked out. However, Berger said these changes probably won't result in deeper cuts in Buffalo's programs. The changes provoke a variety of reactions at UB. Some feel that residents will end up better off: "I think this has the potential to strengthen many of our residency programs, " Berger said. "Many of our faculty see it as an opportunity." + - JESSICA ANCKER �_, ............ . . . .................................. . ..................................... . lEI Asthma in the urban community BY MICHAEL CLASS KANE , OF 1998 NOW I KNOW IT'S NOT THAT SIMPLE lenty of studies show that asthma is a growing concern of the inner city. The challenge that I am seeing early in my medical career is making the transition from textbooks, algorithms, and studies to actually helping people with asthma manage their condition outside the physician's office. Over the past two years, I have had the chance to see up close the environIn addition, I learned the importance the opportunity to work with Carlos ments in which Lower West Side asth- of being sensitive to the financial rejaen, M.D., and the Center for Urban matics live. sources of patients. Physicians often tell Research and Primary Care (CURE PC) Of the asthmatics we studied, 80 per- asthmatics to vacuum frequently to reon a comprehensive asthma study done cent were Hispanic, two-thirds received duce the level of dust, or to get rid of in Buffalo's Lower West Side. We iden- public assistance, and more than half cockroaches. But some patients can't tified asthmatics in the community and were exposed directly or indirectly to afford a vacuum cleaner, and they may gathered information about their medi- environmental tobacco smoke. Fewer have no choice but to live in cockroachcal management and knowledge of than half of the adults had a high school infested subsidized housing. asthma, their home environment, their education. More effort has to be put into smokexposure to environmental tobacco My eyes have been opened to many of ing prevention/cessation programs. smoke, and their socioeconomic status. the problems physicians face I joined the research team in per- when treating a chronic disease forming more than 800 home inter- in an urban community. One views in this poor, urban community. I of the most obvious problems became aware of the many sociopolitical was communication. I speak problems of this area, and of many asth- very little Spanish. Sitting in matics' poor understanding and man- patient interviews with a biagement of their condition. lingual researcher, I imagined The a tiona! Asthma Education Pro- what it must be like for a gram publishes guidelines for managing panish-speaking patient who asthma, ranging from the use of corti- enters an emergency room and costeroids, bronchodilators, and peak gets maybe 30 seconds of inflow meters, to the elimination of envi- struction for preventing the ronmental irritants, such as dust, pets, next acute asthma attack- in or tobacco smoke. English. When l first read those guidelines, I gained a better appreciathe management of asthma seemed easy tion of explaining things in enough. I thought that there was noth- plain language. Before I studied ing about asthma that couldn't be ex- asthma, I had no idea what a plained and brought under control after " nocturnal exacerbation " a few 15-minute visits to the clinic. was- it just sounded ow I know it's not that simple. Dr. serious. But that's the kind of term a Almost all the people we interviewed jaen tells his medical students, "In order doctor is Iikely to use when describing a knew that tobacco smoke can make to practice good medicine, you must night-time asthma attack. It's no won- asthma worse , but many still lived in a know the community in which you prac- der some patients-whether they speak smoke-filled environment. One home tice." My experience with him gave me English or not- don't understand. we visited had four children under the ® B u f f a 1 o Physician Summer 1 9 9 7 �UBMICRO COMPUTER SALES A Non-Profit University at Buffalo Se ice Program age of seven with asthma. one of the children were on any sort of treatment plan, and each of the parents smoked two packs of cigarettes a day. I asked what they did when their children had trouble breathing. The parents replied , "Take them to the emergency roomwhat else? " Besides the asthmatics who had no medications to take , there were others who took potentially harmful medications incorrectly. In one home , I interviewed a girl and her grandmother, both with asthma. During the interview , the girl began wheezing. She took an albuterol nebulizer treatment, and when that brought only partial relief, she went to her grandmother's medicine tray and took one of her grandmother's prescription 300 mg theophylline tablets. When I asked about it , the granddaughter explained that she some- Letter to the Editor times had to take her grandmother's medication because it was stronger. I took the opportunity to tell her that these medications-and others-can be dangerous iftaken inappropriately. I urged her to talk to their physician about a medicine review. But even though we both were speaking English , I suddenly got the feeling that I was speaking a foreign language. It is very easy to feel that these sorts of problems are out of the physician's hands, and that people will do whatever they want. However , after working on the CURE PC project, I know that I am going to try my best to confront many of these problems and work with patients for a better quality of life. That, after all , is what the patients really want. + Mi chael Kan e, who wi ll sLa rl hisfatmh yem of medi cal school this f all, is C0 11 sideri11g el!l cringfamil) medi cin e. Buffalo Phys ician received this letter in respo nse to Mike Merrill's www.ubmicro.l)uHalo.edu Call 645· 554 YOU ARE ELIGIBLE for academic pricing on... Acer • Adobe • Apple • Corel • Dell • Hewlett Packard • Microsoft • Texas Instruments & much more ... Delivery &Setup in your home or office available! "A Student's Perspective" column in our Winter 1997 issue. Computer Workshops May 6 , 1997 Call 645-3560 to have a brochure mailed to you. Dear Mike, • On-Site Private Training available. • Scheduled workshops start at $59. • 1/2 day miniclasses target specialized topics. 1 thought you 'd be interested that a guy as far away as Oklahoma really enjoyed your article "Medicine is a Game of Power" in Buffalo Physician. Thirty years ago, I took a watered-down version of the Oath of Hippocrates, which I suppose you will soon do. But keep in mind the spirit of the original . And the violations of it. In my opinion, in spite of "powerful enemies, " the intrinsic value of a good physician is tremendous and will prevail. Water finds its level. Third-party pay is inherently corrupt. You will be more valuable than you think. r Cordially, Summer hours: Mon thru Fri I 1-S Ed Ellis , M . D . Rowland Ellis Flatt Clinic Antlers, Oklahoma A non-profit UnivefSIIy program for students, faculty & staff The Commons • North Campus • (716) 645-3554 • Fax : 645-3884 B u f f a I o P hysician Summer 1 9 9 7 �• · · ··· · · · ·············· · ········ ··· ·· · ······· · ·· · · · ···· · ········ ·· ··· · ·· · ··· · · · ·········· New Alumni Association ollicers elected ared C. Barlow, M.D. , was elected president of the Medical Alumni Association at Spring Clinical Day on April 26. Barlow, an anesthesiologist, is medical director and administrator of the Millard Fillmore Surgery Center in Williamsville, Y, and serves as chair of anesthesiology for the Millard Fillmore Health System. A UB clinical associate professor of anes- Jared C. Barlow thesiology, he graduated from the medical school in 1966. Barlow was recently appointed to a three-year term on the New York State Committee on Quality Measurement, which develops quality measures and promotes research on clinical practice guidelines. He succeeds Jack F. Coyne, M.D ., as president of the Medical Alumni Association. Elizabeth L. Maher, M.D., becomes vice president of the Medical Alumni Association. Maher is a 1985 graduate of the medical school and a UB clinical instructor of medicine. A specialist in family medicine , she is an emergency department Elizabeth L. Moher attending physician at Medina Memorial Hospital. Richard Collins, M.D. , a primary care physician with the Buffalo Medical Group, is the new treasurer of the Medical Alumni Association. He also served as program director for Ri(hord Collins Spring Clinical Day. + Alumni Association honors four our prominent alumni were honored with Lifetime Achievement Awards from the Medical Alumni Association at Spring Clinical Day. Pictured below, from left to right, they are Jack Lippes '4 7, Eugene Marvin Sigman '52, Ross Markello '57, and Richard Ament '42. Of Lippes' research into reproduc- Left to right: Lippes, Sigmon, Morkello, and Ament tion and contraception, his best known work is the invention of the S-shaped intrauterine device known as the Lippes Loop. His biochemical studies of oviductal fluids have also been instrumental in developing treatments for infertility. A UB professor of gynecology and obstet- ® rics , Lippes has served as an international family-planning consultant to the World Health Organization, as well as numerous countries. He serves on the IUD committee of the International Planned Parenthood Federation. Sigman held positions in the Departments of Urology and Surgery at UB, Buffalo General Hospital, and Roswell Park Cancer Institute before moving to the University of Connecticut as professor of surgery and chair of urology. In 1985 , he became dean of the University of Connecticut School of Medicine, a position from which he recently retired. Markello , a former chair of anesthesiology at UB and E. J. Meyer Hospital (now Erie County Medical Center), recently retired as associate medical director of Independent Health of B u f f a I a Western ew York. He served UB as assistant dean for graduate medical education from 1978 to 1981. Markello has held a Sloan Fellowship through the Massachusetts Institute of Technology School of Management's Health Executive Development Program. Among numerous other professional honors and activities , Markello served from 1980 to 1981 as associate project director of the Love Canal Cooperative Health Study for the Centers for Disease Control and Prevention . Ament , a clinical professor of anesthesiology at UB , is a past president of both the American College of Anesthesiologists and the ew York State Society of Anesthesiologists. He also served on the executive committee of the World Federation of Societies of Anesthesiologists and as secretary of the Council of Medical Specialty Societies. An active member of the American Medical Association , he has testified on medical issues before Congress and the U.S. Justice Department. + -J.A. Physician Summer 1 9 9 7 �Reunions at 60th annual Alumni Weekend 1 9 4 7 First row (left to right): Ferdinand Paohm, Hallie Buchanan Mont, Peter Juhan, Robert Ehrenreich Second row (left to right): james Philhps, james Stagg, Arthur Schaefer, Daniel Curtin, Phihp ReitZ, Donald Nuwer, Ste\'en Cline, William Baker, Harold Pescovitz, David ichols, Elbert Hubbard Ill Third row (left to right): Robert jaeger, Robert Segal, Robert Dean, john Sheffer, Hans Kipping, Frederick Whiting, john Waite, john Weiksnar First row (left to right): Oli\·er Steiner, Burton tulberg, Bern1e Dm•1s, Phoebe aturen, Kurt Wegner, james Szabo Second row (left to right): eil Fuhr, Eugene Sigman, Donald Dohn, Victor Panaro, Ralph Obler, joseph Gene\~ich, Melvin Oyster, Alfred Lazarus, Wilbur Schwanz, S. Aaron Simpson, Robert Baumler, Donald Sprecker 1 9 5 7 First row: Roberta Gilbert Second row (left to right): George R. Tzetzo, David Carlson, Anthony Markello, joseph Armenia, Arnold Lubin Third row (left to right): jack Fisher, Sebastian Fasanello, Paul Loree, Owen Bossman, Robert Klocke, john Cudmore, Philip Morey First row (left to right): Charles O'Connor, Gregory Thorsell, Ben Celniker, Bronson Berghorn, Ross Markello, Richard Miller, Hilliard jason Second row (left to right): Bernard Wakefield, james Lasry, Robert Carpenter, Germante Boncaldo, john Parker B u f f a l o p y s c a n 5 u m m e 9 9 7 �[ll 1 9 6 7 First row (left to right): Thomas Augustine, Laird Quenzler, John Treanor Second row (left to right): Margaret Brown, Thomas Sheehan, John Menchini, Douglas Sirkin, Adele Gottschalk, Linda Young, Richard Young, John Anderson, Ronald Josephson, Barry Epstein Third row (left to right): Frank Perlroth, Rocco Venuto, Michael Phillips, William Burleigh, Trevor Robinson, Jonathan Ehrlich, Harvey Schwartz, Alan Saltzman, Arthur Sosis, Donald Miller, Thomas O'Connor, James Giambrone, David Fugazzotto, Anthony LoGalbo First row (left to right): Dennis Gross, Virginia Hawley, Robert Einhorn, Linda Kam, Joseph Oliver Second row (left to right): Alan Ast, Stuart Rubin, Robert Folman, Ian Frankfort, Martin Brecher, Murray Morphy, Richard Rivers, Russell Elwell First row (left to right): Eugene Paul, Thelma Caison-Sorey, lldiko Kondray, Antoinette Wozniak Second row (left to right): Alan Kuritzky, Howard Lippes, Albert Schlisserman, Steven Stone, Helen Marie Findlay, Kevin Greenidge, Nedra Harrison, Gregory Young, Janice Williams, John Norlund, Richard Terry, Michael Kressner First row (left to right): Gerald Harster, Michael Cesar, Joseph Leberer Second row (left to right): Timothy Gee ring, Joseph Gelormini, Mary ® B u a 0 Kelly, Elizabeth Barlog, Kevin Barlog, David Kurss, Michael Bartlett Third row (left to right): Joseph Gioia, R. Scott Crandall, Philip Stegeman, Benjamin Contessa, Joseph Wayne p y a s m m e 9 �First row (left to right): Beth Wutz, Elizabeth Conroy, Katharyne Sullivan, jack Hsrao, Patricia Reddin Vories, Marie Longo, E\·elyn Coggins, Stephanie Fretz Second row (left to right): Randall Loftus, Mark Swetz, Cynthia jensen, George Pancio, Mrchael Longo, Paul Paterson, Atle Skattebol (Identification not ava ilable befo re publication) If you come loolting for a car, you'll be a~vfully disappointed. HoWEVER, there's little chance you'llleave that way. BECAUSE at the Land Rover Centre, we have the world's most impressive 4x4s. AND people who can answer anyof your questions about driving. A4x4, of course . •, Amherst A NORTHTOWN AUTOMOTIVE COMPANY 3560 Sheridan Drive Amherst, New York 14226 (716) 831-3100 • (716) 835 FAXX (3299) B u f f a l o P hysic i an summer 1 9 9 7 �• ......................................... . THE ULTIMATEDRIVING MACHINE: • 9 1 3 0 5 ogy and was named McAllen's of "1996 Honoree. " Kuhl moved Y, writes, "From the to south Texas after complet- forgotten '30s: Last time 1 ing his residency in dermatol- HENRY H . Snyder, HAIN ES ' 33 , checked, there were ten M.D.s ogy and serving in the U .. from 1933. 1 sent a letter to all and was immediately informed Army and the Public Health Service. In addition to his prac- there were nine still alive. Some tice, Kuhl helped found a clinic are still healthy, one with a for Hansen 's disease and Checkpoint Foreign Car, Inc. Sales and Service 487 Kenmore Avenue Buffalo, NY 14223 stroke, me with two bypas es worked in the county venereal and cataracts, but still ambula- disease clinic. A past president tory. I'm still registered, for of the Texas Dermatological Society and a member of the 836-2033 etc.), but retired. 1 turned 90 City Health Authority, he year old on May 4." served as clinical associate pro- Your WNY Leasing Specialist Serving WNY proudly for 33 years convenience (prescriptions, fessor at the University of Texas 1 9 IV A N W. 4 0 K UHL ' 45 , 5 of McAllen , TX, recently retired from his practice of dermatol- Science Center for 17 years. With his wife, Ruth , he raised nine children, two of whom have become physicians. TAKE TWO~ -.. AND CALL ME IN THE MORNING! f;'\d )o ... r OW'\ roaE * Fact: Saab owners have a higher education level than any other car owner group. * Saab purchase prices starting low to mid 20's; leases starting at $299 per month. * According to the Insurance Institute for Highway Safety (IIHS), the Saab 9000 has the lowest fatality rate of any production car on the marl<et. ''The best m a de line in America" since 1913" 300 CRESCENT STREET • JAMESTOWN, N.Y. 716 664-5260 SOUTHTOWNS SAAB -Our Only Location- 3580 Southwestern Blvd (1 Mile east of Rich Stadium) Open Monday - Saturday 10-4 • MasterCard & Visa Accepted Take Thruway Exit 59, then Rt. 60 south to Jamestown. In Jamestown follow Rt. 394 east to Winsor Street; turn left on Crescent. Buy direct from our factory at wholesale prices. Save at least 50%. (?16) 662·800~ 8® 8 u f f 0 l 0 Physician Summer 1 9 9 7 �······································· · ··················································• HI ' 1 9 5 0 5 JAMES E . YOUKER '5 4 , of FRANKLIN ZEPLOWITZ '58 , in May. His new bride, of Buffalo, Margarita (whom he met in medicine.Iwillbeteachingstudents and residents in the ambulatory setting. Y, is the new Hartland, WI, received the president of the Bogota on Project World Gold Medal of the Association Medical Society Health), graduated in 1996. of University Radiologists at its of the County of They matched in Seattle for 45th annual meeting in Dallas, Erie. He suc- neurosurgery and family practice, respectively. David Sherer system chair of pediatrics for Atlantic Health System in annually to an outstanding ceeds Russell Bessette '76. '69 has been hospitality king radiologist for long-term Zeplowitz during the interviews." contributions to education, the TX. The honor is awarded is 1 9 7 0 cago, IL, has been elected vice and is chair of the radiology as a clinical instructor of sur- president of the American Soci- ERIC RUSSELL '74 , gery at UB. Lackawanna, classmate Rasinski julius Jr. '59, of Durango, CO, retired early in 1996 as a family practitioner. He had he will be re- of Chi- Sandra Fernbach, M.D., was el- Victor system chair, sponsible for merging all pediatric care un- ety of euroradiology. His wife, College of Wisconsin. 9 of ], has been named 5 director and chief of staff at 1 FELD '79 , J. As the first Our Lady of Victory Hospital in Lackawanna, NY, and serves of Y, writes: "Our Randolph, medical research, and patient care. DANIEL C . KOZERA '59 , LEONARD G . Florham Park, Youker practices at Froedtert Memorial Lutheran Hospital department at the Medical 6 0 5 evated to the executive council of the American Roentgen Ray WILLIAM E . ABRAMSON '60 , of Baltimore, MD, recently Society. KAREN tification in addiction medicine from the American Society of Addiction Medicine. der one department for the hospitals and the outpatient facilities. Atlantic Health System serves as a major teaching affiliate for both passed the examination forcer- been the team physician for GLASGOW '76 , of ew jersey Medical School and Co- Columbus, OH, writes, '·Re- lumbia University. Feld has been cently, I left a multidisciplinary chief of pediatric nephrology, director of the Children's Kid- group practice to become the the California Angels ever MOIRA J . of assistant program director of ney Center, and professor and since the team was founded. Tampa, FL, writes: "Two new internal medicine at Riverside vice chair of pediatrics at UB and He also served as team physi- physicians have been added to Methodist Hospital in Colum- the Children's Hospital of Buf- bus, where my husband, Pat Hayes '76, practices emergency falo since 1983. cian for the L.A. Rams." BURK E '69 , my family. My son, Brendan, graduates from medical school NICHOLS MIDDLE SCHOOL • Challenging, innovative curriculum • Outstanding preparation for high school • Average class si:e of 14 students • Interscholastic sports • Comprehensi,·e visual and performing arts program • Dedicated, caring faculty • Financial aid available For further information, call: 875--8212 B I u f f a l a p 1 c i a n 5 m m e �• •••••••••••••••••••••••• . HURWITZ & FINE, P.C. I [ 1 EDWARD 9 A. 8 TORIELLO 0 ATTOR EYS AT LAW I I N F I N IT I 5 S ERVICING '80, of Brooklyn, THE L EGAL NY, was appointed to the board of directors of the American Academy of Orthopaedic Surgeons at the organization's 64th annual N EEDS OF THE meeting in February in San Francisco. He is H EALTH S cm cEs chieJ of the Department of Orthopaedic Surgery at Wyckoff Heights Medical Center in Brooklyn, and is attending orthopaedic surgeon at St.john's Queens Hospital , Catholic C OMMU ITY Medical Center, in Queens. Toriello also serves on the board of directors of the New York State Orthopaedic Society and as a • Purchase & Sale of Practices The f ront-wheel Jrive lnj initi® 130n 1 • Managed Care • Business & Tax Planning delegate for the Medical Society of the State of ew York. An titterior more .•paciotM than a Roll• Royce Sil<•er Spur 11!. An e:rceptionally gmmllt.J li.<t of .<fanJard lu.-rury feature,<. A 190-hp V6 mpable 4 out-acceleratin,q many lu.mry v&•. AnJ of cour.<e, the ,</andard-,<elling performance and ,<erl'ict of lnfiniti. • HCFA Safe Harbor Regulations SJ99 mo. 56 mo. lean $999.00 dOII'n and Physician Self-Referrals LYNDA KARIG HOHMANN '81 , of Albany, Y, writes that she joined the Capital Dis- • Contracts with Private trict Physicians Health Plan as associate medical director. Prior to that, she had been & Public Entities medical director of a local addictions pro- • Employee Relations gram for four years. "Heather, my daughter, turns 21th is year and plans to go to medical Counseling school in another year." JANET • Fringe Benefit Programs '84 and JOHN '84 , of Morgantown, WV, WILL I AMS BARBACCIA • Representation Before Government Agencies on announce the birth of their fourth child, Nicholas Andrew. He joins Katie (5), Matthew (3), and Thomas (1).john is residency Audit & Business Issues • Facility Finance director for the Department of Anesthesiology at West Virginia University; janet is research director in the university's Department of Emergency Medicine. and Construction • Credentialing and By-Laws MARTHA PAVLAKIS ln t r ouu cing tbe a ll n ew 97' QX4® f r om SJ5,550. 00 in an lnfiniti® QX-1®, one of tbe fit-.<1 !bing.< you'll e,<cape 1~1 tbe mtmdane. Becau.1e !be QX-1 i.1 not your typical lu.-rury .<portuttlity l'tbicle. lflbi/.e it 1!{/erd all tbe l'tr.latility you e:rpect from a l'ebicle of it.< kint), tbe QX-1 offer.~ .Jome/ bin.9 you Jon 't e.~flecl: tbe lu.~·ury of an lnfiniti. '88 , of Stanford, CA, • Hospital/Medica l Staff Issues is an assistant professor of medicine (nephrology) at Stanford niversity Medical Center. "My clinical work is in kidney and pancreas transplantation, and my research Please contact Robert P. Fine or Lawrence M. Ross at 716-849-8900 interests are acute rejection and gene expression in transplant dysfunction. " I N F I N IT I AUTO PLACE INFINITI 8129 MAIN ST. , WILLIAMSVILLE 633-9585 '88 and MARY DAVITT Y, write, "We are proud to M ITCHELL TUB LIN '88 , of Albany, East of Transit Rd., Near Eastern Hills Mall announce the birth of our third son, Andrew james Tublin , on October 15 , 1996. Andrew joins Daniel (4) andjoshua (18 months) in ® 1300 Liberty Building Buffalo, New York B u f f a L o ( 130-$450). Bank fee + tax and license due at mception. 12,000 annual mileage. $.15 per m1le in excess. Physician Summer 1 9 9 7 �.........................................................• 11 ' Advertise in one of the finest publications in Western New York ... the Tublin gang! Mitch is assistant professor of radiology at Albany Medical Center; Mary state, and national levels." He had served for four years as the student representative to is practicing pediatrics, also at Albany Medical Center." the medical society's advisory council, and as student councillor to the ew York State Medical Society's governing council. He is CAROL V. R . DECOS T A ' 89 , of Brooklyn, NY, writes, "I was recently promoted to associate director of outpatient rehabilitation at the Staten Island Univer- Buffalo Physician sity Hospital. My practice also includes sports medicine. I was one of the physicians who covered the volleyball players during the Centennial Olympic Games in Atlanta last summer. " RUff"tU f"~S\[\"" 9 9 0 5 MARY RITA MURPHY '90, ofMarshalltown, lA, has moved from Tucson, AZ, to Iowa and will be in private practice with a partner starting in October. She writes that she is happily married and has three sons, ages 5112, Jih, and 18 months. (716) 645-6933 Michael J. Baranski Marketing Representative ADVERTISING 146 Stepping Stone Lane Orchard Park, NY 1412 7 a u t f o 1 o P hysic Levey is starting a residency in obstetrics and gynecology at George Washington University. RESIDENTS A . SWIANTEK ('73-'76), of Williamsville, Y, is in the process of pat- enting an instrument for prostate surgery called the ortech Sled. The instrument allows surgeons to perform electro-surgical vaporization for soft-tissue resection and desiccation. He writes that the procedure resects through soft tissue, prevents postoperative bleeding, and yields high-quality of Vienna, VA, tissue samples for pathological analysis. writes: "I have been appointed to one of the chief resident positions in the Georgetown OBITUARIES CRAIG CHEI FETZ ' 95 , Internal Medicine Program. I have recently won an award as a finalist at the Washington Regional American College of Physicians meeting for a poster presentation on Rhodococcus equi pulmonary infections. I have been elected to serve on the ACP Washington, DC, Regional Associates Council." REGINA Y. K I M '97 . of Akron, OH, is starting her family medicine residency program at Akron City Hospital!NEOUCOM . "I got married on October 12, 1996, in Rochester, NY, to Edward B. Yoon , M.D. , who is a fourth-year OB-GY resident at Akron City Hospital. We have a new yellow Labrador pup named Scout." BARANSKI also an alternate delegate from the AMA Medical Student Section to the American Medical Association's House of Delegates. PHILIP 1 Give us a call : I K E NN ETH L E V E Y '97 , ofBuffalo, Y, was honored by the Medical Society of the County of Erie at its annual meeting in May. He was recognized for "being an enthusiastic representative of organized medicine at the local, o n 5 m m e 9 9 7 ROBERT OEH L ER ' 38 , of Amherst, NY, died May 23 , 1997, after a long illness. The retired surgeon and veteran of World War II was 82. Born in Buffalo, he attended School 53 and was a graduate of East High School. After earning his medical degree, he completed his residency at Buffalo General Hospital. He entered the U.. Army in 1941 , serving until1946. His assignments during the war included duty on the Aleutian islands off Alaska. Oehler returned to Buffalo after the war to open his surgical practice and was on staff at Buffalo General Hospital and Children's Hospital until his retirement in 1979. He was a member of the American College of Surgeons, the American Medical Association, the Buffalo Surgical Society, and the Gross Medical Club. An avid fisherman and hunter, he was also a member of the Buffalo Athletic Club. He is survived by his wife of 4 7 years, the former jean Yeo. �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [1] Magnificent BUILDING LOTS . I of Williamsville, Y, died March 23, 1997. A pioneer in alcohol rehabilitation, he helped the American Urologic Association. Among his honors were election to fellowship in both the American and the Royal Canadian publicize the concept of alcoholi m as a di ease and a public health problem. In Colleges of urgery. He served as president of the iagara County Medical Society and 1948, he started and directed the first alcohol rehabilitation center in ew York State. He also worked with Alcoholics Anonymous in treating patients. Born in Buffalo, the Buffalo Urological Society, and was an enthusiastic teacher as an assistant profes- KENNETH GOLDSTEIN ' 39 , Goldstein was the 1932 Buffalo Evening ews city tennis champion and state doubles champion. After earning his M.D. , he completed a residency at the former E. j. Meyer Memorial Hospital , and served as a major in the Army Medical Corps during World War II. Goldstein practiced internal medicine and gastroenterology in Buffalo, teaching at UB as a clinical professor and serving on the staffs of Millard Fillmore Hospital and E.]. to Tucson . He was hired by THMEP to serve as chief of urology and director of the urology training program at the County and Kino Community Hospitals from 1975 to 1983. After a brief retirement, Baer served eight years as the first urologist of the Salt Lake City FHP Medical Group before re- Medical Alumni Association. He is survived oughly enjoyed his full life with his family, by his wife, Loraine, and a son, Harvey R. his varied medical practice experiences, and his love of golf, traveling, sailing, and skiing. He is survived by his wife of 50 years, Babette; his three children, David (of Pied- BAI SC H '45 , of La jolla, CA, died last year at the age of 74. A surgeon, he was certified by the American Board of Surgery and the American Board of Thoracic Surgery. The Summit at &herff is a truly extraordinary residential development, unrivaled in Western New York. estled in the hills of Orchard Park, this magnificent 81-acres has been subdivided into 50 estate-sized building lots surrounded by Chestnut Ridge Park and Neuman Creek in a very private enclave. turning again to Tucson to retire. ever the type to consider retirement an all-ornothing event, Baer then served as a cruise physician for Society Expeditions. He thor- BRUCE F O RDIN G As a former president of the University at Buffalo medical school Alumni Association and a practicing surgeon in Western ew York for many years, I've come to understand what members of our profession desire in a home site · privacy, tranquility, fresh air, and pristine surroundings. sor of surgery and urology at the University at Buffalo. In 1975 Baer and his wife moved Meyer. He was a past president of the UB Goldstein, M.D., UB Class of'77. Dear Colleague: Specifically as an escape from the fast-paced everyday life we lead, it's features include: • Spectacular panoramic views of the Canadian shores, Lake Erie, and the Buffalo skyline mont, CA), Laurence (of Laurel, MD), and janet Elisabeth (of Brookline, MA); and his • Mature woods and secluded ravines ten grandchildren; as well as by his brother, Howard (of Plant City, FL). • Quick and easy access to the freeway systems leading to Buffalo and the city's northern suburbs • Oversized lots for your dream house • Privacy, seclusion, and exclusivity R ICHARD A . BAE R '46 , of Saddlebrook, AZ, died March 26, 1997. He was born in iagara Falls, Y, on August 5, 1921. After graduating from the University of Michigan and the University at Buffalo medical school, he served a year's internship at Sisters of Charity Hospital in Buffalo before joining the U.S. Navy. He spent two years on the medical staff of the Great Lakes Training Center Hospital and then completed further training in surgery and urology at Mt. Sinai Hospital , Metropolitan Hospital, and Western Reserve University in Cleveland, OH. Baer then returned to iagara Falls, where he practiced urology for 22 years. He was a diplomate of the American Board ofUrology and a member of ® of Orlando, FL, died injanuary of cancer. Born in J O HN L AWR E N CE MU SSER ' 51 , The Summit promises to be one of the premier areas in Western New York to construct your ltLxury residence. 1 invite you to take a stroll through this picturesque setting. For our detailed brochure or a private shmving please call (716) 667-2237 or Buffalo, Musser served as a sergeant in the .S. Army from 1941 to 1945 in the orth African campaign of World War II before going to medical school. In 1958, he and his family moved to Hawaii , where he practiced (716) 472-3790. at the Hawaiian State Hospital in Paavilo Sincerely yours, and served as chief of psychiatry for Hilo Hospital and Institution of Mental Health. Musser also served in the Peace Corps. After returning to Western ew York in 1965, he Edmond J. Cicewicz, ~1.0. Past President, UB Nl.edical Alumni Association practiced psychiatry in Mayville, Y. He moved to central Florida in 1986 and worked for the Seminole County Public Health Department. He is survived by his wife, orma, THE SUMMIT AT SCHERFF and three daughters. 6 f f 0 l 0 O rcha rd Pa rk, New York p h y s I o n S u m m e 9 9 7 �Who says there's nothing good on TV? As busy as they are, physicians and other health care providers always take the time to watch MLMIC's top-rated risk management education programs. • When they tune into high quality programming broadcast over our satellite network, viewers know what they see will help enhance patient safety and reduce injuries. They also appreciate the policyholder discounts available to participating physicians. • MLMIC programming is sponsored by the largest Risk Management Department of any professional liability insurer in the state. Policyholders also enjoy the protection of one of the country's largest and most experienced professional liability Claims Departments. Most importantly, MLMIC has successfully defended more physicians than all other available insurers combined. • These are some of the reasons why MLMIC is the only medical liability insurer approved by the Medical Society of the State of New York. • To find out more, call1-800-356-4056 in Upstate New York, or 1- 800-ASK- MLMIC in the New York metropolitan area. Ask for free copies of our risk management MLM~C ~ledical ~ Uabinl\ \lutuallnsur.mi't> Company guide for office practices. • Our defense never rests. 2 Park Avenue New York, NY 10016 2 Clinton Square Syracuse, NY 13202 90 Merrick Avenue E. Meadow, NY 11554 @1996 Me :::.tl abi ty M tual M'!M.Inlr!G'- ..omp•ny �Non-Profit Org. BUFFALO PHYSICIAN U.S. Postage STATE UNIVERSITY OF NEW YORK AT BUFFALO PAID Buffalo, NY 3435 MAIN STREET BUFFALO NEW YORK 14214 Permit No. 311 ADDRESS CORRECTION REQUESTED Planned Giving to UB. Tax deductions and on ncome for l·fe ore only port of the benefits you con receive with planned g;v;ng to the UB School of Medic ne and Biomed·col Sciences. You needn't be wealthy, or a financial genius. All you need is to make a gift. And hove a desire to help today s budding geniuses make the wor 1d o beller place in 50 years For more information, contact Lyn Corder Ph D., CFRE, at (716) 829-2773, or v1o e-mail ot ljcorder@ocsu buffolo.edu. UNIVERSITY AT BUFFALO tate L"niwsity rf.\ ew l iJ1k � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Summer 1997 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1997-Summer Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician and biomedical scientist Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v31n03-1997-Summer Table Of Contents A list of subunits of the resource. Spring Clinical Day UB's New Specialty Dental Clinics Dr. Congressman Medical School News Commencement '97 A Student's Perspective Alumni News Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2019-01-09 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v31n03 Extent The size or duration of the resource. 40 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LB_HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1997 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/abe8d2d36bce3f6b3ca187a1f61c17d8.pdf cb90bb359762e6121c6a816e3fd32b20 PDF Text Text L �BUFFALO PHYS I CIAN Volume 31, Number 2 ASSOCIATE V ICE PRESIDENT FOR UN IVERSITY SERVICES Dr Carole Smith Petro DIRECTOR OF PUBLICATIONS Kathryn A. Sawner EDITOR jessica Ancker ART DIRECTOR/DESIGNER Alan]. Kegler PRODUCTION MANAGER Ann Raszmann Brown STATE UN IVERSITY OF NEW YORK A T BUFFAL O SCHOOL OF MEDIC INE AND B IOMEDICAL SC IENCES Dr john Wright, lntenm Dean, V1cc President for Clinical Affcurs EDITORIAL BOARD Dr Bertram Portin Dr Martin Brecher Dr. Harold Brody Dr. Richard L. Colhns Dr. Jack F. Coyne Dr. AlanJ Drinnan Brian Duffy Dr James Kanski Dr Barbara MaJeroni Dr. Ehzabeth Olmsted Dr. Charles Paganelh Dr. Stephen Spaulding Dr Bradley T. Truax Dr. Franklin Zeplowitz TEACHING HOSPITALS AND LIAISONS The Buffalo General Hospital .\1icharl Shaw The Children's Hospttal of Buffalo Erie County Medical Center Mercy Hospital Millard Fillmore Health System Franh Sam Niagara Falls Memorial Medtcal Center Roswell Park Cancer Institute Sisters of Charity Hospital Dear Alumni and Friends, THIS REPRESENTS MY FIRST OPPORTL,NITY as interim dean to communicate with you through the medium of the Buffalo Physician. During my tenure in this position, we will be presented with opportunities to build upon the many accomplishments fashioned in thejohn Naughton era, but we will also need to break new ground as we address new challenges. Managed care will, in whatever form it ultimately takes in Western New York, require significant changes and adaptations not only for the medical school but for the entire health-care delivery system in the Western New York region. Most of you are aware of the merger discussions between the Buffalo General, Children's, and Millard Fillmore Hospitals (see the Winter 1997 Buffalo Physician). As the reorganization unfolds, we may be presented with unique opportunities to reconfigure our programs at these institutions and elsewhere, and, in the process, maximize the distribution of faculty in a way that will enhance not only efficiency but also academic creativity. There is probably no single model that will address these needs. The process will not only be complex but likely driven by considerations beyond our control, and, in some instances, completely unanticipated. Provost Thomas Headrick recently circulated a major discussion document, "Planning UB's Academic Future: A Report to the UB Community," which outlines a number of bold new considerations for the university at large. The document is actually a "work in progress," and during the next few months, the provost and president William Greiner will be meeting with the faculties to discuss some of the concepts and proposals contained therein. Some of the suggestions for the medical school are new to this geographic region, but most are being considered or implemented in many other parts of the country. One of the most challenging ideas involves rethinking the traditional departmental structure and possibly reorganizing at least some of the faculty around interrelated disciplines. UB boasts 28 departments, significantly more than many other schools, including such icons of medical progress as johns Hopkins. Whether other configurations are right for Buffalo remains to be seen, but at the least, they merit our serious consideration and study. All in all, these will be challenging and exciting times. We will keep you updated through the Bllffalo Physician and through our meetings with faculty, alumni, and friends of the university through the months ahead . ~ W right, M.D. lntenm Dean, School of Medicine and Biomedical Sciences Interim Vice President for Clinical Affairs Dennis ivtcCarthy Veterans Affairs Western New York Healthcare System ©The State Uniwrsity of New York at Buffalo Buffalo Physician is published quarterly by the State Unl\-ersny of New York at Buffalo School of Medtcine and Biomedical Sciences and the Office of Puhhcations. It ts sent, free of charge. to alumni, faculty, students, residents and friends. The staff reserves the right to edn all copy and subm<ssions accepted for publication. Address questtons, comments and submisstons to: The Ednor, Buffalo Physician, State Lmversny of New York at Buffalo, Office of Publtcations. 136 Crofts Hall, Buffalo. N) H260 Send address changes to: Buffalo Physician, H6 CFS '\ddttion, 34 35 Main Street. Buffalo NY l42H Dear Fellow Alumni, As THE SNOW MELTS and the crocuses try to bloom, we find ourselves with new leadership at UB. A towering, gentle man, john Wright, M.D., serves as the interim dean of the School of Medicine and Biomedical Sciences. He is not only blessed with administrative skills, but is also an outstanding teacher. I met him when I was a second-year medical student, and found that he was one of the few teachers who could make medicine come alive. Like many in our class, I was rejuvenated. I wanted to get out there and cure the world, or at least, learn as much as possible now so we could someday make a difference. john generated this enthusiasm in many of us. It's because of role models such as john that UB offers outstanding programs like the Master Clinical Teaching Fellowship, developed by Diane G. Schwartz, Sheila Brodnick, and Richard Sarkin , M.D. As a graduate of this fellowship program, I am excited to share it with you in the pages of Buffalo Physician. l found it an immensely valuable experience for teaching students in my clinical practice. And thank you, Dr. Wright, for your inspiration as a teacher, researcher, and individual. We have exciting, challenging times before us, and no one better to lead us. Sincerely, ~y~DC'~ /'?~ President Med1ca/ Alumn1 Assooat:10n �VOLUME 31 , NUMBER 2 SPRING 8 Teaching on the Fly: US HELPS DOCTORS COMBINE TEACHING WITH 14 OB-GYN today PHYLLIS LEPPERT , M . D ., R . N. , PH . D ., IS THE PRACTICE DEPARTMENT'S INTERDISCI- by Nicole Peradotto PLINARY NEW CHAIR photos by Frank Cesario by Jessica Ancker 18 97 Amedical mission to Kathmandu by Donald P. Copley, M.D. '70 08-GYN yesterday RANDALL AND WINKLER REUNITED A DI V IDED DEPARTMENT New faculty by Ronald E. Batt, M.D. '58 VICTOR .JAMES HERNANDEZ , PH.D ., AND MARIA LAURA A V ANTAGGIATI , M.D. Research news TOSHIBA FOUNDS Astudent's perspective: STROKE RESEARCH MEDICINE IS A CENTER. MILD CONCUS - OF POWER SIONS CAUSE LASTING BY MICHAEL MERRILL , PROBLEMS . SURGERY REMAINS AN OPTION FOR GAME CLASS OF Medical school Alumni WPW SYNDROME. PARENTS ' 1 997 COUNCIL FRANKLYN KNOX SUPPORTS STUDENTS . Hospital news ROSWELL PARK FACES CHANGE. PAROSKI BECOMES ECMC MEDICAL DIRECTOR . HCP REORGANIZES. COMBINES RESEARCH BUCK AND WRIGHT WITH LEADERSHIP. RECEIVE HONORS. TWO HARRINGTON LECTURE ALUMNI GIFTS. NEW FOCUSES ON DEGREE OFFERED. MEL PHYSIOLOGY . DIEDRICK DIES . Classnotes �World-class stroke research center established at UB with $3.6 million gift of Toshiba imaging equipment esearchers are getting down to work in a new world-class stroke research center established at UB with a $3.6 million gift of equipment and services from Toshiba America Medical Systems. Toshiba has donated its most advanced cerebral angiography equipment to help researchers study stroke and perfect new minimally invasive neurovascular surgery techniques. "What's exciting about this center is that it provides researchers with the same kind of super-high-tech equipment that we're using in the hospitals," says L. Nelson Hopkins, M.D., director of the new center and chair of UB's Department of Neurosurgery. "So the research we're doing is only months away from use on patients-not years." Phase one of the project was completed in December with the installation of one of Toshiba's top-of-the-line angiographic x-ray machines in the center on the fourth floor of UB's Biomedical Research Building. The Toshiba machine can show blood vessels as small as a half a millimeter across, and can make video images at a rate of thirty frames per second (about the same speed as a standard video camera). In phase two, Toshiba will donate a model of its next generation of angiographic equipment, which will have three-dimensional capabilities and be able to take even faster images. "We'll have the first one in the world," says Hopkins. That means that UB researchers will be developing the techniques that will be used by physicians around the globe. Such equipment is necessary for some of the newest endovascular surgery techniques, which depend on maneuvering flexible microcatheters through the maze of cerebral blood vessels. The donated angiographic equipment includes positioners and focus tubes, cameras, digital video recorders and interfaces, generators, computer software, and workstations. "Minimally invasive procedures will dominate surgery in the 21st century," Hopkins says. "Tomorrow's neurovascular technology will be developed, tested, and perfected here. We know of no other research center with comparable equipment and capabilities." Installation of the equipment was aided by a grant from the Wendt Foundation, which helped offset the cost of essential structural alterations. Another grant from an anonymous donor will help cover operating expenses. A pioneer in endovascular surgery and chief of neurosurgery for the Millard Fillmore Health System, Hopkins was instrumental in developing the new partnership with Toshiba. He was recently a lead researcher in clinical trials of the Guglielmi Detachable Coil, the first product to receive approval from the U.S. Food and Drug B u f f a l a Phys i Administration for treating intracranial aneurysms considered too high risk for traditional surgery. UB'sstroke researchers at the Toshiba center will have three priorities. One, under the guidance of radiologist Stephen Rudin, Ph.D., is to achieve even better imaging with the lowest possible x-ray dosage. Rudin's new procedures should increase resolution capabilities from half a millimeter to a tenth of a millimeter, Hopkins says. In an unusual collaboration, Barry Lieber, Ph.D., an aerospace engineer who specializes in the dynamics of air cian S p r I n g l 9 9 7 �- ---- - ~-~- - ,~------ ······································ · ····· ·· ············ · ············ · ···· · ········· ··· · m . flow, is working with neurosurgeon Ajay Wakhloo, M.D. , Ph.D. The two scientists are combining their expertise to investigate the dynamics of blood flow, using full-scale models of cerebral blood vessels. Finally, Lee Guterman, M.D., Ph.D., is researching new techniques and de- viding funding to support graduate student stipends and an exchange program between japanese and American researchers. "Further, since any area of the body can be accessed through the vascular system, other departments, such as cardiology, surgery, and radiology, will have the option of conducting studies using the Toshiba angiographic equipment," u.w~ ..... . , . .................... Hopkins says. In addition to research, the center will provide unique educational opportunities. "We currently offer working courses in endovascular techniques for treatment of experimental aneurysms. The Toshiba Stroke Research Center will enable us to expand and diversify our offerings, attracting course participants from around the globe," Hopkins says. "The flow of personnel and information between the center and other international research centers in the U.S. and Asia will offer unique educational opportunities to UB students and faculty and the Western vices to treat and prevent stroke, espe- New York research comcially minimally invasive endovascular munity at large." Toshiba selected UB surgical procedures. Techniques used by UB 's neurosurgeons include because of "the clinical microcatheter injection of thrombolytic expertise, commitment, drugs to break up clots and stents to and research" of Hopprovide permanent support for nar- kins and his colleagues, says Jeffrey T. Dillon, rowed vessels. The Toshiba research facility will sales manager with also be used by researchers developing Toshiba America Medi new treatments for conditions other cal Systems. Toshiba America than stroke, and will serve as an educaMedical Systems, based tional center for students from UB and around the globe. Toshiba is also pro- in Tustin, California, is . _........" / B u f f a 1 a Physician 5 p r I n g 1 9 9 7 .. . .. a subsidiary of the international Toshiba Corp., one of the world's largest manufacturers of electrical and electronic equipment, with annual sales of more than $48 billion. Toshiba America Medical Systems' line of medical imaging systems includes diagnostic x-ray, xray computed tomography, diagnostic ultrasound, and magnetic resonance imaging. "This new stroke research center will capitalize on all the best strengths of UB's School of Medicine and Biomedical Sciences-pioneering research, outstanding clinical care, and exceptional teaching," says UB president William R. Greiner. "We are absolutely delighted to have Toshiba as a partner in this center. With an international corporate leader like Toshiba generously supporting the work of a first-class researcher and surgeon like Dr. Hopkins, we think that's a recipe for success. Most importantly, the creation of this center promises better health and fuller recovery for millions of people. And we think that's the real success." + - LOIS BAKER AND JESSICA ANCKER 0 �11 ............................................................... . . . . . . . . . .. . . . . . . . . . . . . . . . . ' I Surgery remains an option for some with WPW syndrome hree catheter ablations failed to correct Clayton Broussard's WolffParkinson-White syndrome, and he continued to suffer debilitating attacks of tachycardia. So his family brought fourteenyear-old Clayton from Louisiana to Buffalo where he could be operated on by Gerard M. Guiraudon, M.D., a pioneer in the treatment of cardiac arrhythmias and one of the few surgeons in the world who has remained an expert in epicardial surgery for Wolff-Parkinson-White syndrome. The operation was a complete success. "Even the best horse-drawn wagon had to be replaced with a motor car," Guiraudon says. "But once in a while, the horse still works better." In Guiraudon's metaphor, his epicardial surgical approach to arrhythmia is the horse cart, while the newer catheter ablation techniques are the motor cars. Surgery for Wolff-Parkinson-White syndrome was pioneered in 1968. But in the early 1980s, while at the University ofWestern Ontario in London, Ontario, way for a change in technology. By relying on Guiraudon's techniques to pinpoint the accessory pathways, surgeons were able to use catheter radio frequency ablation to fix most Wolff-ParkinsonWhite cases. Guiraudon himself helped train the new generation of catheter surgeons. Since 1990, catheter ablation has become the method of choice for treating Wolff-Parkinson-White syndrome. "I went from 120 of these patients a year to just five or ten," Guiraudon says. Today, he performs the surgery on patients like Clayton, who have undergone catheter ablations without success, or on patients who are scheduled to undergo open-heart surgery for other reasons. In a 1994 review article in the Annals of Thoracic Surgery, Guiraudon lightGuiraudon led an international team of heartedly focused a "retrospectroscope" surgeons in developing safer epicardial on the surgical treatment of Wolffsurgical techniques. Avoiding cardioParkinson-White syndrome. He conpulmonary bypass, they worked on the cluded that "a large body of scientific beating heart using surgical dissection, knowledge and skill was brought to cryoablation, or lasers. light by this experience and, of even For nearly ten years, Guiraudon's apmore importance, passed on for best use proach was the first choice for Wolffto the catheter surgeons." Parkinson-White patients. "Everybody But Guiraudon is not ready to retire visited this man and learned from him, yet. Born and trained in France, he was and everybody sent patients to see him," a professor of surgery in Paris before says Tomas Salerno, M.D., the director accepting a position at the University of of cardiothoracic surgery at the Buffalo Western Ontario and University HospiGeneral Hospital. "Getting Gerard tal in London, Ontario, at age fifty. Now, Guiraudon to come to Buffalo was like at sixty-five, he has become an immiputting a little hook in the ocean and grant again, moving to Buffalo to becatching a huge fish." An accomplished valve surgeon who come UB 's associate chief of developed what has become the stan- cardiothoracic surgery and the chief of dard approach to the mitral valve, cardiovascular and thoracic surgery at Guiraudon has also authored classic pa- Millard Fillmore Health System. His wife, pers on cardiac arrhythmias that are Corette M. Guiraudon, M.D. , remains referenced in such texts as Harrison's in London, Ontario, as the hospital's chief of pathology. Principles of Internal Medicine. "If you move, you do better," he says. Guiraudon and his colleagues also "You look at things in a new way, not in did extensive work in mapping the aca preconceived way. I moved to London cessory pathways that cause Wolffbecause I thought I could have a fruitful Parkinson-White syndrome. "Our goal collaboration with my colleagues there, was not just to do the surgery, but also and I did. Now, I hope I can do someto understand the pathophysiology." That new understanding paved the thing new here." + JESSICA 0 B u f f a l a Physician S p r I n ANCKER g l 9 9 7 �m ·························································································· m .. . ' . Mild concussions can cause lasting abnormalities in brain esearchers at UB have shown that a concussion results in abnormal brain activity that can last for months. This activity correlates with patient complaints of physical and emotional discomfort early on, and with various cognitive impairments later, the researchers found. Richard Linn, Ph.D., assistant professor of rehabilitation medicine, led a multidisciplinary research team which uncovered the abnormal brain activity in a small group of patients with recent concussions, using PET scans taken at the PET Center in the Buffalo Veterans Affairs medical center. The abnormalities were invisible to MRI. "In the first few weeks post-injury, some of these patients may experience headache, irritability, dizziness, or fuzzy thinking," Linn says. "They may have an MRI scan, which typically shows no abnormalities. Many may come away still feeling that their thinking isn't right, but they don't know why. "We now are able to show that these symptoms are related to a definite change in brain activity, and that these patients are not merely imagining their symptoms. The abnormalities in the brain reflected how well patients performed on cognitive tests. The greater the abnormality, the worse the patient's performance." Linn, program director of the UB T raumatic Brain Injury Rehabilitation System, is one of only a few researchers in the country who are using PET to study mild traumatic brain injury. Linn's research is funded by the National Institute of Disability and Rehabilitation Research. PET scans were administered to six victims of concussion two to three weeks after the injury and again three to four months later. The scans revealed small B u f f a I a but significant areas of increased glucose metabolism in the anterior cingulate, more pronounced in the right hemisphere than the left. All the patients had had normal MRis and showed few signs of injury. The increased use of glucose may be a sign that the cells are repairing themselves after injury, or that their ability to function is diminished and they need more energy to perform the same work, Linn says. In the early stages after injury, this abnormal activity correlated with patient complaints, such as headache, irritability, anxiety, depression, dizziness, and lack of concentration-symptoms collectively dubbed post-concussive syndrome. physician 5 p r I n g 9 9 7 ' . The studies showed that after three to four months, the areas of abnormal activity had enlarged somewhat and were correlated with impaired attention span, verbal memory, motor function, and information processing, but not with post-concussion symptoms. "Patients need to know they aren't going crazy, and that what they are experiencing may be a normal part of the recovery process," says Linn, who is now recruiting patients for a larger study. According to Linn, the only treatment for mild traumatic brain injury is patience. "People just have to wait it out. More than 50 percent of them are back to normal by six months; more than 95 percent are fully recovered in a year." + L o 5 B A K E R 0 �~············· · · · ····· · ······· · ···· · ······················ · ··· · ···························· ~ Roswell Park Cancer Institute faces change BY ANDREW DANZO s managed care's relentless expansion forces medical institutions to behave more like businesses, adaptation has become the watchword. At Buffalo's venerable Roswell Park Cancer Institute, however, change doesn't come easily. The 99-year-old institute is part of state government, and that, according to many people inside and outside the institution, has hobbled its ability to compete in the new healthcare marketplace. New York State officials have proposed spinning Roswell Park off as an independent non-profit entity. The plan is greeted enthusiastically by those who believe the institution will benefit from increased flexibility, but it has others worried that Roswell Park may jeopardize its tradition of groundbreaking cancer research in its rush to become self-supporting. Robert Hinckley, public affairs director for the state Health Department, points out that being a part of the state hampers Roswell Park in some of its everyday activities. "They can't develop networks, partnerships, mergers, et cetera, and react quickly to this changing health care environment," Hinkley says. "They can't do a lot of things that the Buffalo General Hospital can do. To get a $5,000 contract approved they have to go through this department, the Division ofBudget, and the Comptroller's Office. 0 CHANGE IF IT IS TO Buffalo General doesn't have to do that." Anderson Cancer Center at the UniverGov. George Pataki this year proposed sity of Texas in Houston. For example, that Roswell Park be allowed to change he would like greater flexibility to creits governance structure, possibly be- ate new types of positions. "We need coming a not-for-profit enterprise or af- managedcare specialists and case manfiliating with another health-care institu- agers," he explains. "The current systion. Approval is required from the state tem takes an enormous amount of time Legislature, and details remain to be and effort when we need to move worked out. One strong supporter of the quickly. This is an institution that needs plan is the institute's new president, David to reinvent itself." C. Hohn, M.D. He succeeds Thomas B. But Pataki's proposal for a governance Tomasi, M.D., who left last year after change has been greeted skeptically by running the institute for a decade. unions. "We think some of the cost "I think Roswell must change if it is to issues can be addressed within the conthrive and survive," says Hohn, who text of a public institution," says Richarrived in February from the M. D. ard E. Casagrande, executive director of B u f f a l a 5 p r I n g 1 9 9 7 �~ ---~== '~-~--- - - - ·································· · ······ · ··········································· · ···· [I I ] ' ' Lll] the Public Employees Federation, which represents 845 physicians, research scientists, nurses, and technicians at Roswell. "We see privatization as being really radical surgery. I think the primary gain, when you cut through the fluff and the sweet talk, is that they think that the public employees make too much." Hinckley says the plan is not an attempt to void state union contracts. "We've told them that we will abide by the collective bargaining agreements they have," he says. "Certainly, because of their expertise, any not-for-profit would need the vast majority of the employees." Some staff members worry nevertheless that Roswell could lose itself in the transition. "Roswell is not simply another hospital," says a senior scientist who asked not to be named. Without financial support from the state, he fears that Roswell will begin to lose research grants and become trapped in a downward spiral. "Roswell was never supposed to compete with a normal hospital, because it doesn't offer the same product," the researcher says. "You don't go to Roswell Park to get the same care as at Buffalo General. You go to Roswell Park because that's where we're developing new treatments that no one in their right mind is paying for." Through the Graduate Medical Dental Education Consortium, Roswell Park trains 26 UB residents. In its capacity as a UB graduate division, the institute also trains about 300 graduate students. The 25-acre Roswell Park campus is in the midst of a $245 million construction project. The institute's fortunes, however, have been slipping in the increasingly competitive health-care industry. Despite its National Cancer Institute designation as one of only 28 comprehensive cancer centers in the nation, Roswell has seen insurers steer many patients B u f f a l o elsewhere, and Buffalo General now handles a greater portion of the region's cancer cases. The institute's deficit is put at about $70 million, and it has been unable to join hospital systems being formed by Buffalo General, Millard Fillmore Health System, and other Western New York institutions. For his part, Hohn says he is dedicated to maintaining Roswell's status as a premier center for research and teaching, as well as for treatment and prevention. "I think acquisition is unlikely and probably not desirable," he adds. "This is not about unloading Roswell on someone else. I would not have come here if that was the intent. It is about the ability to affiliate, because health care is organizing into networks and systems. But the exact governance that would be put into effect has not been established." The governor's proposal also includes an additional $70 million for Roswell Park in each of the next three years. Some of that would be used to begin a 20-year plan to repay the state for the institute's deficit. Roswell Park's new president expects to become a familiar face in Albany over the coming months. ''I'm absolutely committed to building the case for ongoing state support for education and research," Hohn says. He also plans to step up the pursuit of grants and philanthropic support. "My vision of Roswell is for a growing and thriving institution," he adds. "I think we're really talking about building a brighter future." + HealthCarePlan reorganizes ealthCarePlan, Western New York's oldest HMO , is moving away from its roots as a staffmodel HMO. The 90 doctors who work for HealthCarePlan are leaving the HMO to form their own group, Medi- Physician 5 p r I n g 1 9 9 7 cal Partners of Western New York, which will continue to care for HCP's patients as a contractor. Patients will notice little or no change. The decision has been described by both sides as mutually amicable. Richard Battaglia, M.D., who will become medical director of Medical Partners, said the move will benefit the physicians because they will be able to accept payment from other insurers as well as from HCP. Medical Partners, which will be largely primary care doctors, is also exploring the possibility of merging with practices that contain more specialists, including the Buffalo Medical Group, he said. + UB alum appointed ECMC medical director argaret Paroski M.D . '80, of Buffalo, NY, has been appointed medical director of Erie County Medical Center. In this position, she oversees the medical operations of the ECMC Healthcare Network. The network includes the medical center, the Erie County Home, and a growing group of community health centers. Paroski is the former clinical director of ECMCs Department of Neurology. She is also a past president of the UB Medical Alumni Association. In addition to maintaining her Margaret Paroski, M.D. medical practice and her administrative roles, she continues to be an active researcher. + 0 �BY NICOLE PERADOTTO • In e UB HELPS DOCTORS COMBINE TEACHING WITH PRACTICE c E s "Teaching is about being a good role model. Inspiring people is a part of teaching." A R 0 - Pediatrician Richard Sarkin, M.D. 0 B uff al o P hy si cian Spring 1997 �IN THE MIDDLE AGES, teachers were known as "doctors ," a word derived from the Latin verb docere, to teach. By definition, then, a doctor is a teacher. And at clinics, offices, and hospitals around the world, many doctors take that definition very seriously B Take, for example, Kerryann Broderick, M.D., site residency director for emergency medicine at Erie County Medical Center. At 9:00a.m. one weekday, Broderick and fourth-year UB medical student jacqueline Dombrowski interpret a patient's chest x-rays for signs of tuberculosis. At and Biomedical Sciences. Ask students why, in addition to clinical courses, they shadow physicians in their scant free time , and they respond that there's no such thing as too much clinical exposure. Such learning allows them to leave the lecture hall, to leap 9:30, Broderick asks Dombrowski to help document a ninetynine-year-old woman's death, and then ushers her off to the quiet room to watch a resident break the news to the family . Half an hour later, the physician offers the student tips on how to debride a chemical burn and how to present a diabetic patient to the patient's primary care physician. Then Broderick listens to Dombrowski's presentation of a man complaining of intense pain in his left foot. Upon seeing the patient herself, Broderick congratulates her student for correctly diagnosing that the man did not in fact suffer from an infected toe naiL Welcome to "Teaching on the Fly 101 "-clinical instruction. Physicians find many ways of folding the education of students into their own practice of medicine. Under a physician's supervision, students can take histories , diagnose, and even treat patients. Clinical instruction represents more than half of the coursework at UB's School of Medicine from the hypothetical textbook case to a patient on a gurney. For many students, clinical experience helps determine specialties and build confidence. For the preceptors-many of whom volunteer their timethe benefits of teaching may not seem so obvious. Teaching takes time. Balancing patient care with student instruction can be exhausting. Being a preceptor can be demanding in other ways , too; students often expect teachers to serve as career counselors and personal advisors in addition to fulfilling their role as instructors. Yet those who teach insist that its rewards offset its demands. Teaching is as enlightening an experience for them as it is for their charges, and it makes them finer physicians. "Students require a lot of energy," says Broderick, assistant professor of emergency medicine. "They ask tons of questions and need a lot of supervision, especially early on. u f f a I a P hySICia n 5 p r I n g 1 9 9 7 0 �"More and more schools have been expanding their But I get challenged by them, and they're just so eager to learn clinical medicine offerings over the last couple of years and do small things. "They keep me really fresh, particularly at the basic because it is necessary," explains Dennis Nadler, M.D., science level. They'll ofassistant professor of ten ask, 'Why did you do clinical pediatrics and something that way?' associate dean at the "Spending a lot of time in lecture halls and That makes me question medical school. "Spendlaboratories can bring students down. Its why I chose that way and ing a lotoftimein lecture wonder, 'Is there another halls and laboratories can helpful for them to have (clinical) way? Is there a better bring students down. It's way?'" helpful for them to have exposure, to see whats coming down the In the emergency dethis exposure , to see partment, where time is what's coming down the line and to maintain their enthusiasm. " of the essence and line and to maintain their unpredictability is the - UB Associate Dean Dennis Nadler, M.D. enthusiasm." norm, Broderick is well At the clinical level, UB aware that persistent incounts 1,512 volunteer • quisitiveness can be too much of a good thing. In such instances she arms herself with options for students who threaten to slow the pace of operations. "Sometimes I try to sneak in to see a patient before a student does. Then I can come out and set things up that need to be done, like drawing blood. Sometimes, if I don't think they're quite ready to do a certain procedure, I say, 'You have to back off and watch what I do,' or I give them less acute tasks to perform." "You really have to learn how to switch gears very quickly. You have to assess a student's level, get to it, and then explain things at that level." faculty and 807 geographic, full-time faculty. Ehsan Afshani, M.D., clinical associate professor of radiology, falls intaA..he second category.In 1990 and again in 1996, Afshani received a louis A. and Ruth Siegel Teaching Award, an honor based on student nominations. Among the teaching duties Afshani considers most important is fostering critical thought. It's a skill that some students, dazzled by high-tech diagnostic tools and insecure of their own abilities, have a tendency to neglect. "In medicine you don't deal with x-rays alone , and students in radiology must be reminded of that. Sometimes students prefer just looking at x-rays and taking tests instead of what's so important: Talking with patients. Whenever they want to order a test, I say, 'Is it worth doing because it's going to help you come up with a diagnosisor because protocol tells you to do it? '" It's not just that Afshani appreciates the Socratic method. He wants his students to appreciate health-care costs, too. Clinical experience in the curriculum New to UB's curriculum this year is a two-year introductory clinical block that begins during the freshman year. Among the skills taught are history taking, diagnosing, cardiopulmonary recuscitation, and infection control. ® B u f f a l o Physician 5 p r 1 n g 1 9 9 7 �and throat. He organized his fourth-year schedule with a rotation in pediatrics at year's end, recognizing that it would provide him with ample opportunity to examine a host of sore throats, runny noses, and aching ears. "That four-week experience absolutely turned my life around. I had the most wonderful teacher (Mary Cruise, M.D., who is now retired), and she helped me realize that pediatrics was for me. There is no question in my mind that she, more than anybody else, was responsible for my decision. " And that's something preceptors must consider, as well, Nadler emphasizes . "Students take extra time, and at teaching sites, extra time is provided. But managed-care organizations don't want to pay a physician to see twenty patients a day when he or she can see thirty patients a day for the same amount of money. This is something we have to think about, and we'll be discussing it more in the future . And it's not just managed care. If there's a guy in a solo practice, his entire base is the number of patients he sees. But I don't know anyone who has made a conscious decision not to teach because of economics." That's often the case because physicians remember the teachers who nurtured them when they were students and residents, and they want to continue the tradition. When he was a medical student in 1970, Nadler planned to do a residency in surgery followed by one in ear, nose, 0 Consider you r goals and objectives, and communicate them to your learner. 0 Discover enthusiasm for your subject and for you r lea rners. 0 B u f 0 0 Take you r teach ing and their learning seri ously- plan, teach, reflect. 0 0 a l a 0 Get to know your learners as people, not just as learners. @ Promote self-directed learning. Provide frequent, timely, constructive feedback. Consider how you know if your learners are learn ing what you want them to be learning. Make your teaching and their learning fun . From "Sharpeni ng the Saw: Improving Preceptor Teac hing 0 Make you r learners as active as possible. f Becoming a good teacher Not every doctor is a good teacher. Even the best doctors can make simple mistakes when they start teaching. They may be disorganized. They may fail to give students feedback, or be unable to give clear descriptions of protocols and procedures. Some may take students' physician Skills," a handout written by Admit your own limitations. Re-learn how to say, " I don 't know." S p r I n g 1 9 Richard Sarkin, M.D. 9 7 �"The more approachable you are as a teacher, the more abilities for granted; others may underestimate students. comfortable students will be around you, and that's a positive As one doctor puts it, "There are a number of physicians them to learn in," says Sarkin. "I think there's atmosphere for I would want to treat my kid-but not to teach him. " In a very thin line beother words, even a tween a demanding physician esteemed teacher and a teacher by colleagues and "You really have to learn how to switch who intimidates, and liked by patients the latter model is may lack essential gears very quickly. You have to assess a pervasive in medical teaching skills. schools. UB has initiated student~ level, get to it, and then explain "Another problem several programs through the Priis that most people mary Care Resource think that when things at that level." Center to help docthey' re teaching , tors become better they're telling some- Emergency physician Kerryann Broderick, M.D. teachers. The cenbody something. But ter, directed by Riit's questionable chard Sarkin, M.D. , is a joint program of the Departments of Internal Medicine, Family Medicine, Pediatrics, Social and Preventive Medicine, and Obstetrics/Gynecology. One of the center's programs, the Master Clinical Teaching Fellowships, offers selected community physicians a stipend to attend an eight-month workshop series on clinical teaching. A second, the Teaching Effectiveness Program, offers faculty a choice of workshops on specific practical questions, such as, How does a preceptor handle a bright but condescending student? What's the best way to introduce students to patients? How can a preceptor criticize students without disheartening them? Sarkin, a clinical associate professor of pediatrics, teaches many of the workshops. A movie buff, he shows clips from such films as Footloose, Mr. Holland's Opus, and The Paper Chase when discussing the qualities of a capable teacher. ® B u f f a l o whether the person they're talking to is learning or not. We're trying to expand the whole notion that teaching is providing information. Teaching is about being a good role model. Inspiring people is a part of teaching. So is promoting self-directed learning, where students aren't so much provided information but motivated to learn on their own. " At the Children's Hospital Ambulatory Pediatric Clinic, doctors wear animal toys wrapped around stethoscopes, and patients stop by a drawer filled with stickers at the end of their visit. Here, Sarkin practices what he preaches. One afternoon he discusses a hypothetical patient suffering from persistent headaches with a handful of residents and a third-year medical student. Then the group turns their attention to a dozen or so real patients- youngsters sitting in the waiting room suffering from the flu , runny noses, or other winter ailments. After seeing his first patient of the day, medical student Phys icia n 5 p r I n 9 1 9 9 7 �Anand Singh talks with Sarkin. "His mother says he has cold symptoms that are coming and going. The cough is not producing anything, and he's tugging on his ears. I tried looking in his ears, but he started crying." "So, he looked sick and uncooperative?" "Yeah. He stuck his fingers in his ears when I tried to look in them." "Did you make him say 'Ah ?"' "Well, by that time he was crying." "That's an 'Ah,' isn't it?" Doctor and student discuss potential diagnoses and treatments before they walk down the brightly lit hall to room 7. There, a boy no taller than a kitchen stool sits glumly in his mother's lap. As Sarkin turns to address the toddler, his voice changes. Suddenly the fast-talking pediatrician paces his words extra slowly. His tone mellows; the pitch of his voice rises. He sounds like a narrator for a children's movie. "Are these your hands, Taylor? Oh, these are very nice hands. Can the nice doctor see your tummy?" At first the two-year-old doesn't protest when Sarkin pulls up his sweatshirt. When he starts whining, Sarkin encourages him to touch the stethoscope. This holds the boy's interest for a few seconds. Now it's time for the ears. "If I promise not to hurt your ears, can I look at them?" Taylor shakes his head. "OK," Sarkin says as he gently tugs the boy's fingers from his ears, peers inside them, and spots signs of a middle-ear infection. Singh raises his eyebrows and grins. He has learned a skill that no textbook-no matter how comprehensive-can teach. + UB provides support for clinical teaching Because more medical education today takes place in community physicians' offices, UB is placing a greater emphasis on helping doctors become good teachers. UB's Primary Care Resource Center offers a number of programs that promote effective teaching in different ways. Master Clinical Teaching Fellowships pay selected community physicians a stipend to attend an eight-month series of seminars on effective teaching practices. The program carries Category I Continuing Medical Education credits. The next "class" of fellows will start the program in September. The Teaching Effectiveness Program sponsors workshops to provide formal training in effective teaching techniques. These workshops, which generally attract UB's regular clinical faculty and residents, focus on specific teaching issues and carry Category I CME credits. The Master's Degree in Health Professions Education, designed for clinical instructors, combines Graduate School of Education courses with independent study. Community Academic Practice grants support independent medical practices that participate in graduate medical education. Among the activities eligible for funding by the grants: renovations to provide space for students, or the purchase ofjoumals or equipment for students. The program also provides each site with computers and access to electronic resources, such as Medline. For more information about any of these programs, contact the Primary Care Resource Center at (716) 829-3176. B u f f a l o physician S p r I n g l 9 9 7 + �Interdisciplinary Phyllis Leppe rt , R.N ., M.D., Ph.D., is the new department chair BY JESSICA ANCKER PHYLLIS LEPPERT FIGHTS a many-fronted war on behalf of maternal and child health. In the course of the battle, she has acquired an impressive array of academic credentials, published unique research, and worked to build a new ethic of collaboration among different types of health-care professionals. Mecca Cranley, Ph.D., dean of UB's School of Nursing, served on the search committee that recruited Leppert as the new chair of UB's Department of Gynecology and Obstetrics. "My agenda was to get someone committed to interdisciplinary education and practice," Cranley says. "I didn't realize we were going to find someone who was herself so interdisciplinary! That was a bonus." Leppert first trained as a nurse and then became a doctor. But instead of abandoning her first profession in favor of her more prestigious second one, she has worked to break down cultural barriers between the two. Leppert loves lab research and earned a Ph.D. while studying the physiology of the cervix. While committed to what she calls "bench research," she has also continued to work on such medical practice issues as raising health professionals' awareness of cultural differences. "It all comes together when you think that our goal is to reduce the number of low-birthweight babies and problems in pregnancy," Leppert says of her varied career. "We have to work on a number of fronts--biochemical, obstetrical, socialall at the same time." An interdisciplinary career Leppert earned her master's in nursing from Columbia University and practiced as a public health nurse in Harlem before receiving her midwifery certification in 1964. She studied at the Maternity Center Association in New York City, which offers one of the nation's oldest midwifery training programs. ® "I had wanted to be a physician since fifth grade, but it was a time when women weren't encouraged to do that," Leppert recalls. "But when I was in my thirties, I took a look at what I was doing and said, 'Why don't I just go to medical school?"' She did just that, earning her M.D. from Duke University School of Medicine in 1973. Leppert completed residencies in pediatrics and in obstetrics and gynecology and was a Robert Wood johnson Clinical Scholar at Duke before accepting a fellowship in maternal-fetal medicine at Columbia University's College of Physicians and Surgeons. She taught at Columbia for ten years. Though Leppert chose to pursue medicine, she has remained involved with midwifery training and practice and continues to value the knowledge and attitudes she learned as a midwife. For instance, she says, in normal births midwives favor a "high-touch" approach with minimal medical or surgical intervention. Obstetric education focuses on problems in pregnancy and delivery, an essential field of knowledge, but one which sometimes can bias obstetricians to favor a more high-tech, interventionist approach than is necessary for a given situation. "Both approaches are needed, but we're not always very good at figuring out which woman fits in which category," Leppert says. "We need to approach the question scientifically, deter- B u f f a I o mine who needs the interventions, and then make sure they get them." Firm grounding in research Leppert believes that all medical care must be firmly grounded in science-in both laboratory and epidemiological research. Her own love affair with research began in medical school. After a course in immunology, she worked in Duke's Laboratory of Pediatric Endocrinology under Stuart Handwerger. "That is something that really influenced my career," she says. She took advantage of her years at Columbia to do research on the role of cervical elastin in gestation and parturition, obtaining a Ph.D. from the Department of Pathology. She has continued to publish research on the physiology and endocrinology of the cervix and uterus. "It's essential that everyone in medi- Physician S p r I n g I 9 9 7 �cine have a strong grounding in science," Leppert says. "But in this country we have tended to put bench research on a pedestal and pooh-pooh community medicine. My experience has taught me that all of it is important. You can't break these areas apart-you have to be excellent in all areas. "That's one reason I think UB is such a good school-it has shown that primary care is important without neglecting research. " In Rochester, New York, Leppert held positions in obstetrics-gynecology, nursing, and community and preventive medicine at the University of Rochester, and was chief of obstetrics and gynecology at Rochester General Hospital. She has also served as a consultant to the federal Women's Health Initiative and recently completed a Robert Woodjohnson Foundation study aimed at reducing sociocultural barriers to health care. She co-edited a textbook, Primary Care for Women, published this year by Lippincott-Raven Publishers. ("I just had time to call them and change my title on the frontispiece from professor at Rochester to chair of the department at Buffalo! " she says.) The text is designed to provide information for any primary care practitioners who take care of women, including nurse-practitioners, physician-assistants, and physicians in different specialties. The book covers a variety of women's health issues, such as reproductive health, pregnancy and delivery , and menopause. It also provides an introduction to a wide range of primary care issues, such as cardiovascular disease, derma to logic disorders , and psychiatric problems, and describes how these conditions manifest in women and what impact they may have on pregnancy. Other chapters cover social issues, such as "cultural competency," the working knowledge of other cultures needed to care for a broad spectrum of patients. ing that way while they're in training, it might be easier to start working that way in practice. " There are other changes she would like to make. "We have to rethink residency education so it's not so rigid, and incorporate principles of adult learning. We have to do more animal labs and computer simulations and telecommunication. That way, by the time they get to the patient the residents are more polished and prepared." New ideas for medical education Collaborative practice While at Rochester General, Leppert brought together medical and midwifery education by putting student midwives in the same learning situations as medical students and residents. She also helped integrate midwives into the hospital's obstetrics practice. She has similar plans for Buffalo. She is bringing Children's Hospital's four nurse-midwives into University Gynecologists and Obstetricians, the UB practice plan incorporated last year. With Dean Cranley's support, she is also hoping to integrate the education of nursing students and medical students, and to award some of the midwives faculty appointments in the School of Nursing. LuAnne Brown, R.N., believes both doctors and nurses will benefit from Leppert's program. "Her idea is very good," says Brown, the nursing coordinator for maternalneonatal services at Children's Hospital. "It fosters the idea of teamwork. If you get doctors and nurses to start think- Leppert once worked in a neurology rehabilitation unit that provided what she calls an ideal example of collaborative practice. Each patient was cared for by a team of doctors, nurses, nutritionists, occupational therapists, and physical therapists. "The neurologist was about to discharge one patient when the occupational therapist pointed out that the man was still having trouble doing the kinds of everyday activities he would need to live independently. And the physician listened. " Building on this model, Leppert has been involved in collaborative obstetrical practices in which different professionals cooperate to supervise cases, and follow the leadership of whoever is most qualified for each case. High-risk situations may be supervised by a physician; lower-risk ones by a nurse-midwife. "It's sometimes hard for physicians to work this way. We've been taught that we're the king of the hill," she says. "That's an attitude I would like to see changed. We have to respect each other. "+ ...THE CHILDBEARING EXPERIENCE Is an intense, memorable event that lasts at least nine months. The health· care team must provide a nourishing relationship during this time, and because of complex knowledge and the different skills of various professions, a health-care team works best.... 1 believe that no one person should be the "captain" of the team. Leadership is dynamic and fluid and is based on expertise. For instance, in the case of a pregnant woman with Class C diabetes, the matemallfetal medicine specialist is the team leader; in a case of straightforward moderate preeclampsia, the leader might be a family practitioner; In the term twin delivery, the team would be led by an obstetrician; while in a normal birth the team leader could be the nurse-midwife. In the area of discharge planning, the social worker and family are the leaders. Different geographic regions of the U.S.A. could and should develop unique matemlty care Excerpt from "Developteams, just as women and their families should have the right to a team of their choice.... ing sound team relation1believe that the future of matemity care is in a team approach. It will succeed to the extent ships among maternity that we emphasize the positive aspects of the health-care team. Developing sound relation· care professionals," in Prelude to Action II: ships calls for mutual respect, openness, and an absolute refusal to carve out territory. The Reforming Maternity most important feature in the development of sound team relationships on the matemity care Care, 1995, a publication team is a focus on the patient. We always need to ask, "What is best for this particular woman the Maternity Center of and her family?" Only then are team relationships sound and the team approach a success. Association. B u f f a l o Physician 5 P r I n g 1 9 9 7 �OB-GYN yesterday RANDALL AND WINKLER REUNITED A DIVIDED DEPARTMENT AT BY R ON A L D E . BA TT , UB M . D . ' 58 N THE YEARS BEFORE WORLD WAR II, the University of Buffalo's Department of Gynecology and Obstetrics had become divided into an obstetrics department chaired by Francis Goldsborough and a gynecology department headed by James King. This academic division reflected tensions both within the department and within the medical community. But when the two rival chairmen stepped down in 1942, they left heirs who ushered in a new era of cooperation. Clyde L Randall and Edward G. Winkler served as ideal cochairmen of the Department of Gynecology and Obstetrics for eighteen years. They respected each other, and their interests were complementary, benefiting both the department and the practice of obstetrics and gynecology in Buffalo and Western New York. Winkler brings new surgical techniques Edward Godfrey Winkler (1901-1960) went to Georgetown Medical School and did residency training in obstetrics, gynecology, urology, breast surgery, and gynecologic oncology. After returning to his hometown, he honed his skills as a chief resident in obstetrics, gynecology, and urology for two years at the Buffalo City Hospital, under Goldsborough. The two became very close, almost like father and son. Winkler entered practice in 1932 at the depth of the Depression. He ® went to Chicago to learn the Heany technique of vaginal hysterectomy directly from H. P . Heany. He and Robert O'Connor worked night and day to build the obstetric-gynecologic service at Buffalo City Hospital. Winkler introduced low forceps and episiotomy for routine deliveries, and extraperitoneal cesarean section to replace classic cesarean section. Later, he introduced a low-flap- transverse procedure to replace extra peritoneal section, and finally low-segment-vertical cesarean section to reduce the chance of injury to the uterine vessels. Winkler was the first in Buffalo to do total abdominal hysterectomy and introduced the Heany technique of vaginal hysterectomy and repair. In contrast to the teachings of one of their influential predecessors (Irving W. Potter), Winkler and O'Connor taught that no internal podalic version and extraction should be performed until the cervix was fully dilated. 6 u f f 0 l 0 Recognizing the value of breast milk to the survival of premature infants, they introduced frozen breast milk. The breast milk was put into little cake tins, set on dry ice to freeze, and then stored in the refrigerator for use. They reduced premature infant loss from 60 to 10 percent. Randall focuses on research Clyde Lamb Randall (1905-1990) graduated from the University of Kansas Medical School and did residency training in gynecology, general surgery, and pathology. While working together in Buffalo, King and Randall formed a close relationship. Physician 5 p r I n g 1 9 9 7 �THE N "I think that the most important thing I learned from King was to try to be decent to people," Randall said. "He was exceedingly kind to his patients. He liked his patients and he treated them accordingly." However, King's insistence on strict routine irritated Randall. In 194 2, Winkler and Randall declined offers of full-time positions at Buffalo City Hospital and Buffalo General Hospital, respectively. Winkler succeeded Goldsborough as UB professor of obstetrics and gynecology, and Randall succeeded King as professor of gynecology. As co-chairs of the department, they alternated responsibilities on an annual basis. They developed similar but separate three-year residency programs which rotated through the gynecology, gastrointestinal surgery, and breast services at Roswell Park Memorial Institute. Both Randall and Winkler were excellent surgeons, with remarkable respect for tissues. City-wide cooperation During World War II , many physicians were called into the armed forces , and Winkler and Randall experienced huge growth in their clinical practices. They frequently met, often in the middle of the night, while attend- B u f f a I o A N D w _N 0 ing patients in labor. They also met socially in each other's homes to discuss academic matters and curriculum, but never once did they go to each other's hospitals. Out of these meetings they began to hold monthly combined meetings of their residents and attending surgeons at the Park Lane Restaurant on Gates Circle. Soon they added Herbert Burwig's service from the Deaconess Hospital and Louis Mclean's from the Millard Fillmore Hospital. Such collegiality greatly ameliorated the extremes that had marked recent obstetric practice (e.g., the conservative management of natural delivery promoted by Goldsborough, and the routine internal podalic version and extraction practiced by Potter) . The city-wide meetings led directly to the formation of the Buffalo Gynecologic and Obstetric Society in 1946. Different teaching styles Winkler gave medical students and interns a firm grounding in obstetrics and gynecology to prepare them for general practice. Robert Patterson observed: "Dr. Winkler was very demanding of the medical students. We had to sit with the patient during labor with our hand on the abdomen, and we really learned about labor. " Winkler trained his residents as general obstetrician-gynecologists, able to treat all problems encountered , including breast cancer. The large clinics that he and O'Connor had built up at Buffalo City Hospital during the Depression were invaluable for this education. The program was highly structured; residents learned one surgical technique to treat each condition encountered . After mastering the techniques , the residents were encouraged to broaden their experience. Winkler was directly responsible for training ___Q]:)stetrician-gynecologists and then physician 5 p r I n g I 9 9 7 placing the work in their hands by drawing up regulations to limit the privileges of general practitioners doing obstetrics. Randall's residency program was loosely structured. He allegedly never performed an operation the same way twice and encouraged individualized training of his residents so that they could develop and expand their special interests and talents. Complementary interests During the tenure of these men as co-chairmen of the department, the quality of medical education in obstetrics and gynecology for medical students, interns, and residents reached an extremely high level. For example, in the late 1950s, outside examiners of the residency program thought that the medical students were residents. During this period, the University of Buffalo graduated a higher percentage of students into obstetrics and gynecology training programs than most other nonsectarian medical schools in the country. Winkler concentrated on medical student education, standardized resident training, and local medical politics, whereas Randall focused on individualized resident training, the development of subspecialists, and leadership in the National Board of Obstetrics and Gynecology and the American College of Obstetricians and Gynecologists. Together they combined community and university resources for optimal patient care and teaching. When Winkler died in February 1960, Randall became UB's first full-time chairman of obstetrics and gynecology. He later served as the medical school's vice president for health sciences, acting dean, and executive officer, before moving to Maryland as director of education of the johns Hopkins Program in International Education for GynecologyObstetrics. + ® �" BACK IN FAMILIAR SURROUNDINGS, I'M STILL SEElNG THINGS THROUGH A NEPALI TINT ... I CATCH MYSELF PESTERING MY FRIENDS ABOUT HOW LUCKY WE ALL ARE, IN AND OUT OF MEDICINE, WITH SUCH A WEALTHY AND EFFICIENT CIVILIZATION TO GIVE US MORE THAN JUST SURVIVAL." Rmedical mission to BY DONALD P. COPLEY , M.D . ' 70 J l �T MY TWENTY-FIFTH medical school reunion last year, while trading boasts about conquests and crises, I wondered what, after all, is truly meaningful in this life. I turned to a favorite classmate, Brendan Thomson, now a pulmonologist in Phoenix, Arizona, and asked, "What is the most worthwhile thing you've done since graduation?" Without hesitation he answered, "NepaL" Of course I knew that Mount Everest is in Nepal-I'd even day-dreamed of someday seeing the world's tallest mountain-but beyond that I drew a blank. Brendan had traveled to Nepal six times since 1985 on a variety of medical missions. The country, which is the size and population of New York State, is strikingly beautiful from jungle to grand peak, mostly agrarian, and painfully poor. With an average yearly income of only $250 and a literacy rate of about one-third, Nepal needed lots of help, Brendan told me. On his first visit there, Brendan met a young Nepali physician named Buddha Basnyat who was intent on an internal medicine fellowship in the United States. Brendan placed Buddha at a Phoenix hospital and invited the young man to stay at his home during the three-year fellowship. The two have remained close, exchanging visits almost yearly. Since then, Brendan has acted as a travel agent for American students and doctors going to Nepal to study or teach, and he has helped Nepali doctors come to America to take board exams. And when Brendan visits Nepal, he takes other physicians along to teach and practice. ''I'd love to do something like that," I said , with visions of trekking in the Himalayas. "You know what?" said Brendan. "You can!" He needed a cardiologist for an advanced life-support course planned for the next visit. It wasn't long before I was dashing off a check for airfare to the other side of the world. Getting there It took thirty grueling hours for my wife, Andrea , and me to fly from Buffalo to Hong Kong, where we linked up with Brendan's small contingent of American doctors and nurses. After two days of orientation, we flew on to the burgeoning city of Kathmandu, 500,000 people nestled into a story-book valley turned deep green by the recent rainy season. As our jet banked over a shrine to land, I caught a glimpse of a giant figure of Buddha with its life-like tempera eyes squinting through the smog created by cheap Indian gasoline. We headed off in eighty-degree weather on a kamikaze taxi ride into the city, careening crazily on the British side of the road. We passed big-wheeled bicycles piled high with produce, smoky motorcycles buzzing by like mechanized mosquitoes, and little blue vans stuffed with people, like fraternity Volkswagens. The sweet smell of this sewerless city was intermittently obscured by clouds of dense diesel exhaust. At a roadside gutter, a woman washed her family's clothes near an array of fresh vegetables piled on the ground for sale. We were greeted everywhere with the Nepali gesture of "hamaste" (pronounced "hom-a-STAY"), palms together in a prayerful and humble pose, the height of the hands indicating the level of respect. A Nepali hospital About the size of a small community hospital in the U.S., Kathmandu's Patan Hospital was built a decade ago entirely from church donations , and it is still run by missionaries. Chief of Medicine Mark Zimmerman has been there since the day the hospital opened, when he arrived fresh from his U.S. residency. His work has been subsidized every year by a Methodist church in Syracuse, New York. He relishes what would be intolerable to most of us: a smothering rush of seriously ill patients who often arrive too late to be cured, sometimes even dying on the hospital's doorstep. He loves the challenge of functioning with ludicrously limited resources, for next to no pay, with little distinction between work and rest. Smiling and joking gently, he always looked calm and content amidst the hubbub. People, sometimes a thousand in a single day, walk for miles to queue up at an outpatient window. The sickest patients stay in one of Patan's 150 ward beds. We toured the hospital through corridors darkened by J �power outages. Although the hospital was fairly clean, the doors and windows were often left open, without screens, to let the breeze take care of necessary ventilation. Through a door open to an operating room, a smiling patient waved to me as his inguinal hernia was being repaired. Latex gloves , considered disposable in the U.S., were being washed and hung to dry on a large wooden rack, evidence that the Patan staff wastes nothing. The hospital survives on donated medical equipment. Much of it, such as the EKG machines and resuscitation equipment, came from Brendan and his colleagues. As we walked by one of Brendan's old cardiac defribrillators, he whispered, "Think of the lives we've saved by sending this over!" The medical wards bustled with patients and their relatives , the latter providing constant nursing care while the R.N.s attended to technical work. At Patan, the patient's family must purchase all drugs and supplies themselves from a nearby pharmacy. Tuberculosis is the number-one killer in Nepal; pollutioninduced lung disease is the most common non-infectious problem. Exotic infectious diseases abound: leishmaniasis, leprosy, rabies. Many Nepalis smoke-especially the youngsters , who idolize the American Marlboro image-which gives the cigarette industry a chance to "make a killing. " I saw more patients with rheumatic heart disease than with heart attacks , ® B u f f a l a but Nepali physicians expect that increased levels of smoking and urban stress will soon cause a coronary epidemic. Our students, twenty Nepali resident doctors and thirty nurses, were hungry for the critical-care knowledge we taught. We caused some consternation when we challenged traditional Nepali gender roles by putting male doctors and female nurses together in the same room and having them listen to our female nurse lecturers. We taught basic and advanced life support, the mechanics of chest compression and the Heimlich maneuver , cardiac diagnosis and EKG analysis, defibrillation, and drug treatment. Our students asked perceptive questions, the kind that come from people who have seen a lot. They beamed with pride when we handed out diplomas on the last day. Time for touring e made brief excursions into the countryside to learn about its beauty-and its poverty. On a 2,500-foot hike into the foothills of the Himalayas, we puffed like choo-choos while young children hurried past us up the paths, carrying cinder blocks in backpacks supported by forehead straps. Other youngsters begged us for American ballpoint pens to use at school. Finally, Mount Everest! A chartered plane took us northwest from Kathmandu , playing hide and seek with lowhanging clouds. Suddenly, there it was , fully visible from its tropical base at 2,500 feet to its snow-capped peak at 29,000 Physician S p r i n g 1 9 9 7 �The si&fttof a man perusing a newspaper 1s not common, as only about a durd of the Nepali population can read ThiS set of donated equipment 111 a fishing tackle box at Patan Hospital is not fancy, but it IS adequate to handle most emergencies. A father gneves at a child's funeral pyre. Doctors in Singapore work mostly in solo practice, without managed-care headaches, yet they still feel cost-containment pressures directly from their patients. For example, angioplasty is favored over coronary bypass surgery because it's cheaper, and patients are willing to return two or three times a year for repeat procedures. "For my patients, it's like going to the dentist," said one local cardiologist. I found Singapore doctors busy and independent, wealthy and content, with a touch of arrogance-similar in many respects to American doctors of a generation ago. Back in familiar surroundings, I'm still seeing things through a Nepali tint, or what's called "perspective." I catch myself pestering my friends about how lucky we all are, in and out of medicine, with such a wealthy and efficient civilization to give us more than just survival. Now I understand why Brendan keeps going back. He and I are sure to talk about Nepal at our next reunion dinner as we contrive another excuse to return. + ' feet. Microscopic villages were scattered at its toes like the patterns of a fine Tibetan rug. My cherished unlikely dream had become a reality, thanks to Brendan's perseverance. On the way home, we stopped in Singapore, an Oz-like city with gleaming skyscrapers and spotless, antiseptic streets. We had received an invitation from the U.S. Ambassador to Singapore, Timothy Chorba, whose younger brother, Terence, is a 1979 alumnus of UB's School of Medicine and Biomedical Sciences. In Singapore, per-capita income exceeds $16,000, and there is no unemployment. We lectured at Mount Elizabeth Hospital, which is about the same age as Patan Hospital but ages apart in appearance and technology. About the size of the Buffalo General Hospital, Mount Elizabeth sparkles from yearly renovations and is blinking with the latest medical machines and computers. Most patients pay out-of-pocket for their medical services, while those few with limited resources get a lesser level of care at a subsidized government facility. B u f f a l a physician 5 p r Donald P. Copley, M.D., practices cardiology and cardiac rehabilitation in Kenmore, New York. Brendan Thomson, M.D., practices pulmonary care in Phoenix, Arizona. Both are members of UB's Class of 1970. For more information about participating in a Nepal exchange, contact Thomson at 5251 West Campbell, Phoenix, Arizona 85031, (602) 247-7725. I n 9 9 9 7 �............. .. . .. ............. . . . ........ . ................ . ............... Tumor viruses and stressed-out bacterta B Y A N D R E W 0 A N Z 0 or the UB School of Medicine and for a pair of promising researchers at the National Institutes of Health, 1995 was a pivotal year. It was the year that the Lucille P. Markey Charitable Trust awarded $1 million to expand UB's young but already internationally recognized Center for Microbial Pathogenesis. And it was the year that Victor James Hernandez, Ph.D ., and Maria Laura Avantaggiati, M.D., crossed the Atlantic to take their wedding vows in Rome. This year, UB is using part of the Markey grant to bring the couple to Buffalo. "This is, from our point of view, a perfect package," says Microbiology chair Ian Hay, Ph.D. "They both bring to the group expertise that we need, and they're both superb. We consider ourselves very fortunate to have them here." The Center for Microbial Pathogenesis is an interdisciplinary unit with some two dozen investigators who come from both clinical and basic science backgrounds. Formed several years ago out of collaborative efforts that began in the early 1980s, the center has garnered widespread attention for its work in such areas as molecular parasitology, sexually transmitted diseases, and pediatric infectious diseases. Avantaggiati and Hernandez arrived in early February and promptly set up shop in UB's recently opened Biomedical Research Building, where they will continue work they were pursuing at the NIH. Avantaggiati is interested in tumor viruses and cell growth; Hernandez is studying stress response and adaptation in bacteria. "There is no drug that will work against bacteria forever. They will all become ineffective, " says Hernandez. "So our hope is to now find the next generation of antibiotics that will sustain us for the next fifty years. It's my premise that these stressresponse systems within bacteria will be very potent targets for future antibacterial chemotherapeutics." Hernandez, a native ofEl Paso, Texas, received his Ph.D. in cell and molecular biology from the University of Texas at Dallas in 1991. For the next five years, he worked as a postdoctoral fellow in the Laboratory of Molecular Genetics at the National Institute of Child Health and Human Development. Nearby, in the NIH's Laboratory of DNA Replication, Repair, and Mutagenesis, Avantaggiati was studying interactions between viral and cellular proteins. Born in Naples, Italy, she had come to Bethesda after three years as a postdoctoral fellow at the University of Rome, where she had already earned her M.D. "I wanted to do research, " she recalls. "In Italy, it's very good, but it's not the center. Certainly the most important things are going on here." For about three years, Avantaggiati and Hernandez would pass in the hall, exchange a polite hello, and go on to their respective labs. "It had always been a very formal relationship until one day I made a conscious choice to go in and talk to herandget to know her," recounts Hernandez. "We got to know each other better and began dating. It was a whirlwind romance." Onjune 1, 1995, they were married in Italy. "We had a grand party in Rome," Hernandez says. That same year, Avantaggiati moved to the National Cancer Institute, where she focused her work on cellular interactions that appear to have a role in tumor development. Hernandez pressed ahead with efforts to disrupt the ability of bacteria to adapt to stresses. UB, meanwhile, had already begun using the Markey grant to recruit new faculty to the Center for Microbial Pathogenesis. When UB used the grant to make an offer to the pair, they had already received other offers. But they selected UB because they were impressed by both the university and the city. "For us, things like crime are important, because we want to start a family," Hernandez says. Avantagiatti agrees. "The city's very nice. The people are very kind," she says. "The weather I still have to adjust to!" + Physician s p r I n g 1 9 9 7 , �.. . . ...... .. . .. ... .. . . . .. . .. . . . . . .. ... ... . .. . . . . . ......... ... .. . . . ... . ......... • ••••••• •• ~ I Germaine Buck, R.N., Ph.D. Epidemiologist appointed to board of national research agency , ermaine Buck, R.N ., Ph.D., associate professor of social and preventive medicine, has been appointed to a three-year term on the board of the Institute of Medicine's Medical Follow-up Agency, an arm of the National Academy of Sciences. The agency conducts epidemiologic research on the health status of veterans. Founded shortly after World War II to conduct follow-up studies of the wartime experience, the agency now bases its studies on records from the military and the Department of Veterans Affairs . The agency's board is composed of fourteen physicians and researchers from universities and research centers across the country. Buck has won national recognition for her epidemiologic research in human reproduction and fetal and earlychildhood health. In 1995 , she was appointed to a three-year term on the B u f f a 1 o National Research Council Committee on Toxicology , which provides expert advice to government agencies on toxicologic issues and problems. A prolific researcher, she holds a three-year fellowship from the Merck Company Foundation and the Society for Epidemiology Research to conduct a long-term study of the safety and effectiveness of tubal ligation. She holds master's and doctoral degrees in epidemiology from UB. She is a member of the American College of Epidemiology, the Society for Epidemiologic Research , and the Society for Pediatric Epidemiologic Research , and is a fellow of the American Academy of Cerebral Palsy and Developmental Medicine . + Wrtght honored for minortty education achievements aggieS. Wright, Ph.D., assistant dean for minority affairs , has received the Outstanding Contribution to Medical Education Award for 1996 from the National Association of Minority Medical Educators. Wright was assistant Physician 5 p r I n g 1 9 9 7 I dean for student affairs and director of minority programs for the medical school before assuming her current position. During her tenure, she has been director of the Minority High School Research Apprentice Program, the Science and Technology Enrichment Program for talented minority college students, and the Health Careers Opportunity Program. A former teacher, Wright earned master's and doctoral degrees in counseling from UB and worked at the University Counseling Center before taking her position at the medical school. Her recent honors include the Sojourner Truth Award from the National Association of Negro Business and Professional Women's Clubs; the award for leadership in meeting the challenges of children with special needs from the Robert Warner Rehabilitation Center Division of Human Genetics; the award from the Buffalo chapter of the National Medical Association for leadership, commitment, and service; and the award for outstanding contributions to medical minority education from the northeast region of the National Association of Minority Medical Education. + �,. In honor of John Naughton, M.D., the university has installed a bronze bust of the former dean in the Biomedi(al Researth Building. Shown here on the O((asion of its unveiling; UB President William Greiner, Houghton, S(ulptor Jeff Slomba, University Coundl (hair Philip B. Wels, and Provost Thomas E. Headri(k. Museum receives $50,000 gift $50,000 gift from an alumnus will help support UB's Neuroanatomy Museum. Willard H. Bernhoft, M.D. '35, and his wife, Clarice L. Bernhoft, made the gift in honor of Harold Brody, M.D., Ph.D., SUNY Distinguished Teaching Professor in the Department of Anatomy and Cell Biology, who helped establish the museum. "Dr. Brody is a sincere, hardworking gentleman who has been an inspiration to a lot of medical students and colleagues at UB," says Bernhoft, UB emeritus professor of colo rectal surgery. "He devoted much time to this project and even traveled to Denmark to learn how to create a neuroanatomy museum. " After earning his bachelor's and M.D. ® from UB, Bernhoft served from 1942 to will join him in supporting UB. 1946 as a neurosurgeon in the U.S. Army, "New York State doesn't provide the and traveled to the Philippines and Ja- financial resources needed by the unipan. When he returned to Buffalo, he versity. With the right impetus-that opened a private practice in colorectal being support from UB alumni and surgery, from which he retired last year. friends-the university can continue to The Bernhofts hope their gift will be one of the best in the country." + attract similar contributions by other medical alumni to help establish an endowed chair in anatomy in honor of Brody. Bernhoft, who has also been a strong supporter of UB's Willard Bernhoft and Carlo DeSantis Library of Anatomy, Cell Biology, and Neuroanatomy, says he hopes other alumni Clari(e L. Bernhoft and Willard H. Bernhoft, M.D. '35 B u f f a l o P hysician 5 p r I n g l 9 9 7 r �····· · ····· · ····· · ·········· ·· ····· · · · · ··· ················ · ··· ·· ····· · ········ · ··· · ····· • · ~ I ,. r Anesthesiology research to be funded by gift from alumnus Mefford Diedrick UB'sfirst medical illustrator, dies $50,000 gift from Richard]. Nagel, M.D. '53, has established the first endowed fund to support research in UB's Department of Anesthesiology. "Although the university offers excellent clinical experiences for its medical students studying anesthesiology, research in this area is something that I believe requires more attention," says Nagel, UB emeritus professor of anesthesiology. "Supporting research now will allow me to see some results from new UB studies, and it opens up many opportunities for students to Jearn from these experiences. I also hope my gift will encourage others to offer their support to this fund." Nagel joined the medical school faculty in 1955 and retired in 1995 . He also served for four years on the medical school admissions committee. He was chair of the Department of Anesthesiology at Mercy Hospital for fifteen years, and served as chair of anesthesiology at Our Lady of Victory Hospital in Lackawanna, New York. A retired lieutenant colonel of the U.S. Army Reserves, Nagel is the president of the South Towns Tennis Center in Orchard Park, New York. + elford D. Diedrick, UB's first trained medical illustrator , died on January 24, 1997, in Queenstown, Maryland, where he had lived since 1982. He was eighty-four. Diedrick, who was profiled in the fall1996 issue of Buffalo Physician, was the first director ofUB's Department of Medical Illustration. A native of Buffalo , he studied art at the Rochester Athenaeum and Mechanics Institute (now the Rochester Institute ofTechnology) in the early 1930s. Later , he studied at Johns Hopkins University under Max Broedel, who is considered the father of medical illustration in the United States. Upon returning to Buffalo, Diedrick worked in various capacities at area hospitals and at the B u f f a l o Physician 5 p r i n g 1 9 9 7 I medical school until he was hired by UB as a full-time illustrator. With his training in both art and anatomy, Diedrick produced innumerable illustrations for publications and teaching. He also illustrated medical stories for newspapers and television. Among his larger projects~e three surgical atlases. His last major project was the 11lustration o Surgery , by former UB faculty members David H. Nichols, M.D., and Clyde L. Randall , M.D., a text that is now in its fourth edition. Diedrick helped found the nationa l Association of Medical Illustrators in 1945, and served as its president in 1963. The association recently honored him with a Life time Achievement Award. Diedrick, whose wife, Bertha, died in 1995, is survived by his two sons, five grandchildren, and one great-grandson . His remains were donated for medical research. + �• ········································ · ······ · ···· · ·· · ····· · ··········· · ·· · ···· · ·· ···· ~ I Parents'Council aids medical students BY hey drove their children to Little League, checked their homework, and kept them in line. Now that their children have grown, some parents are still finding ways to remain active in their children's lives through the Medical Students Parents' Council, which raises money and provides unique support services to UB's medical students. Robert and Elaine Heichberger, the parents of third-year student Lisa Heichberger, are the council's copresidents. "We both have been teachers all our lives. When teaching is in your blood, this type of thing is a natural progression," Elaine Heichberger says. "We are interested in medical education, have a great deal of pride in UB, and have an interest in our daughter's education." They view the council as a support post for the students. "The support your children feel when you are involved with their medical education, even when they are married, means a great deal to them," Elaine Heichberger says. "That is discussed at the meeting on many occasions, and the students are very appreciative." The council has provided many things to make students' experiences at UB more pleasurable. The parents helped to renovate and furnish the student lounge, supplied the hardware for the electronic mail system, donated a fax machine and a copy machine, and created an annual grant of $5,000 for the computer laboratory. But their assistance is not limited to tangible items. According to associate dean Dennis Nadler, M.D., "the Parents' Council also VICTOR FILADORA provides support for educational missions and activities which benefit the student body as a whole." For example, the group sponsors student travel to national meetings, which Nadler believes has a ripple effect that strengthens the entire class. Also, during every holiday season, council members invite UB students who can't be with their own families into their homes for support and companionship. The council, which is unique among medical schools, was founded ten years ago by former dean john Naughton, M.D., as a way for parents to get involved in their children's education. One of the group's most popular activities is the annual Gala Dinner Dance for the graduating seniors on the evening before graduation. The council pays for dinner, dancing, a boutonniere or corsage, and a gift for each graduate. Parents are recruited during Parents' Weekend, and they receive a directory describing the responsibilities and priorities of the council. During the spring session, the school solicits donations from the members. Between $15,000 and $20,000 is donated annually; these funds go directly to student support. "Reinforcement from the home front gives students the backing they need so that they know they are not alone," says Elaine Heichberger. "The parents realize that it is the little things they can do which provide extras that students would otherwise have to do without. " Although correcting homework and carpooling to sports practices are no longer required, the emotional, educational, and financial support of parents still enriches each medical student's experience and makes medical school at UB much more enjoyable. + Victor Filadora is a fourth-year student at the School of Medicine and Biomedical Sciences. ROBERT AND ELAINE HEICHBERGER, THE PARENTS OF STUDENT LISA HEICHBERGER, ARE THE CQPRESIDENTS OF A UNIQUE PARENTS' GROUP AT UB. B u f f a I o S p r I n g 1 9 9 7 �.......... . .. . . .. ..... ............... ...................... ...... . ..... .. . . . .. . ..... . .. get in the way. But that periphery is made up of human souls, which have a bunch of that subterranean anger, and an agenda. And they are the people who BY M IKE M ERRILL , CLASS OF 1 9 97 pay us . They are trying to get into the examination room, trying to tell us that the ower, says the I Ching, must be fused with justice. same patients who want us to heal them "When one understands this," the 3,000-year-old Chi- also don't want their families hobbled by huge insurance premiums. These nese book says, "one understands the meaning of people are trying to tell us that we need to change the way we do things . everything that happens in heaven and on earth." We ignore them , or fight them , at It's quite a point for contemplation: worker bee in times of layoffs. our peril. They will shape our future , Then I went to medical school, or they will , I think, find someone else power exercised without justice can only lead to instability, in a government or a plunged into an environment of entitle- to do our work. business or a family . It leads in the ment and ego and suffering. The excesses and injustices of the powerless to a subterranean anger that I kept working partadministrative and may build to a destructive explosion. time at HCP, and I noinsurance systems, These thoughts bring a new light to ticed a change, a subtle "LITTLE ACTIONS just like those of evthe hospitals and clinics. It's easy to distance between me erything else, eventuAND WORDS CAN underestimate one's power: watch the and some of my old ally will be blunted patients at Erie County Medical Center acquaintances. I have and balanced. They RESONATE DOWN A deferentially get out of the way of the become one of the obare unstable and so white coats. Little actions and words jects that the anxiety will not last, as the I CHANNEL OF TIME IN can resonate down a channel of time in fixes upon. Ching says. UNFORESEEN WAYS. " But l think the unforeseen ways: one elderly patient I don't like it, but I physician's role will refused CTs because a doctor once said can't undo it. only remain powerful it would "make slices of the stomach." As a doctor, it might to the extent that we In a way, the I Ching is right. What we be easy to forget the learn to incorporate, see going on here in all of human life is fear of losing my job, in a dignified manner, the working out of the correct way to the worry about how the indirect financial to pay for groceries, the exercise power among humans. concerns of the paof unemhorrible maw Nowhere have I seen this so clearly as and the contients , at HealthCarePlan, where I have worked ployment, the anxiety cerns of the adminisof being without for six years. trative environs. I started there in 1991 as, basically, a health insurance. But Medicine now has high-level secretary, continuing as are- these are the fears of powerful enemies. my co-workers. When search assistant for a year, then entering It's the latest incartheir bosses get angry, medical school in 1993. nation of the same old and their world shakes I was of low rank in the Guaranty cycle: power concentrembles. When a secBuilding in downtown Buffalo that around justice, trates retary is fired, it breaks houses HCP's headquarters. I didn't even justice dissipates , and the leg of her family. need to wear a suit; it would have been I know the world of power leaves. + silly. The secretaries and clerks looked the patient will call me. on me as something of an equal, When I'm in the examination room, Mih e Merrill, afonnerj ournali sl, is a fourth-year though a bit of an anomaly. I made a wherever I end up, support staff and medical st udent at UB wlwsecolumns appear regulot of friends , heard the gossip , and insurance companies will seem merely larly in the Buffa lo News. He will begin a resishared the helpless anxiety of the peripheral entities that had better not dency in internal medicin e in Buffalo next year. Medicine is agame of power 8 u f f a 1 o P hysician 5 p r I n g 1 9 9 7 �Aleader in research and in academic administration FRANKLYN KNOX or many academics, stepping into administration means abandoning research. Not for Franklyn Knox. Internationally known for research on the physiology of the kidney (work that he began thirty-five years ago while still a graduate student in UB's Department of Physiology), Knox has also helped lead one of the nation's most highly respected medical institutions through a period of expansion and change. He is a recipient ofUB's Distinguished Medical Alumnus Award, and this February Knox was awarded an honorary degree from UB during the "Kidney Performs Under Pressure" symposium on renal physiology. A native of Rochester, New York, Knox earned his bachelor's degree in pharmacy from UB in 1959. In 1965, he became the first UB student to earn an M.D. and a Ph.D. concurrently. "I had entered medical school with the idea of a career in research and teaching, and it became evident to me that I needed further training in research, so I embarked on the Ph.D.," he recalls. "My decision to pursue renal physiology had more to do with my mentor, Don Rennie, M.D., than with the kidney itself. I first met him when he taught the medical school physiology course, and then I did research in his laboratory in the summers. "One of his many research interests was kidne y function . But under Hermann Rahn's leadership, the Department of Physiology largely focused on respiratory physiology. As a result, we studied respiration of the kidney." Knox worked for three years at the ® ,.. '65 , DISTINGUISHED INVESTIGATOR AT THE MAYO FOUNDATION accomplishment I point to with the greatest degree of pride," Knox says. Before 1982, the Mayo's medical and Ph.D. degrees were granted through the University of Minnesota. Under Knox's leadership, the Mayo became accredited to take full responsibility for both degree programs. "In some sense, the change was a 'truth-in-labeling' issue, because all the medical curriculum was being taught here at the Mayo anyway, " Knox points out. "The decision for us to independently grant Ph.D . degrees, as well as M.D.s, has resulted in much stronger basic science education here." He has also been involved in other major changes at the Mayo. The Mayo established full clinics in jacksonville, Florida, and Scottsdale, Arizona , in order to make its service and reputation more national in scope. It has also instituted a series of changes in response to National Heart Institute's Laboratory of Kidney and Electrolyte Metabolism, moving to the Department of Physiology at the University of Missouri School of Medicine in 1968. Two years later, he joined the Mayo Clinic and entered its Department of Physiology and Biophysics, which he later chaired. He was then appointed Dean of •= the Mayo Medical • School as well as director for education of the Mayo Foundation, with huuu hu responsibility for supervising undergraduate and resident medical education, the Ph.D. programs, and the health-related science programs, as well as continuing medical education. "The establishment of the Mayo as a degree-granting institution in its own right is the Interim medical school dean John Wright, M.D., with Franklyn Knox . B u f f a l a Physician 5 p r I n g 1 9 9 7 �················· · ······································································• James E. Springate; joey P. Granger, of the University ofMississippi; University of Alabama professor james A. Schafer, the president of the American Physiology Society; and the society's president-elect, Allen W. Cowley Jr., of the Medical College of Wisconsin. Knox spoke about his recent research on the kidney's natriuretic response to increased blood pressure. Two observations-that patients who take non-steroidal anti-inflammatory drugs ( SAIDs) over a long time increase their risk of hypertension, and that NSAIDs block prostaglandin synthesis-raised the question of how prostaglandin is involved in natriuresis, Knox said. He traced the sequence of events through which, in healthy individuals, increased blood pressure is reflected in increased renal interstitial pressure, which triggers pressure natriuresis to help lower blood pressure. In hypertension, a number of factors can interfere with this cascade. Knox's experiments showed that lanJESSICA ANCKER thanum ions crossed the epithelium of the proximal tubule via the tight junctions between the epithelial cells. Knox used these findings to argue that prostaglandin helps maintain the permeability of the tight junctions, and D. that this permeability accounts for a he kidney's regulation of blood substantial fraction of the transepithelial pressure relies on the paracellular transport of water and electrolytes. Thus, transport of water and sodium in he said, prostaglandin synthesis amplithe proximal tubules, Franklyn fies the natriuretic effect of increased Knox argued in February's D. W. blood pressure. The D.W. Harrington Lecture series Harrington Lecture. brings distinguished scientific speakers Knox's lecture was the cornerstone UB twice a year. The series is funded to of the "Kidney Performs Under Presendowment created by Harrington, by an sure" renal physiology symposium at a member of UB's class of 1871. + UB's Center for the Arts in February. -].A. The other speakers included UB's managed-care pressures, including developing its primary care network and affiliating with a network of hospitals and clinics. Knox credits the Mayo's strong administrative support structure with allowing him to continue being an active researcher throughout his administrative career. "Also, there's an expectation that administrative responsibilities will rotate, so people are encouraged to maintain their professional research roles throughout different administrative jobs." He now holds the title of Mayo Foundation Distinguished Investigator and Head of the Nephrology Research Unit of the Mayo Clinic and Foundation. He has served on numerous national and international editorial and advisory boards, and is a past president of the American Physiological Society and of the Federation of American Societies for Experimental Biology. His recent research focuses on the regulation of phosphate metabolism and the role of blood pressure in controlling electrolyte and water excretion. + 1kw Y• S Hwl COIIIIIIISSIOII 8arltara A. De8uono, H.D wl be the keylole speaker at DB's 60dl Annual $pMg OilicaJ Day OD April 26, ID a pni&IUI eatided "1lle blienillg of llealdl Care.. The pregnll at tile Buftalo Marriott IS designed to Dlfer physicials ilsigllts and answers to the prolllems ucl epportunltleS of medial practKe, aCtOnllng to program chair Richard Collins. H.D '83. 8 a.m. Welcome and Introduction Jadt f Coyle. H.D '85, presideat. "edial Alumni Association ~ L Wright. M.D., 111ten11 dean. Schoel of ltediCIIe ud lioiiHal Scieltes ' lidtanl L Colas. "0 '83, prop~ dlair Paracellular transport in the kidney: the W. Hanington Lecture B u f f o I o physic i an S p r I n g I 9 9 7 Fw more ln(onnotlon about Sprinc ClniaJI OCiy Gild ocher Alumni Weeltend Cldlwflies, , . _ coneoct die Medical AUnnl Alsodar.ton CJt 7111-129-2778 �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . [1] . HURWITZ & RNE, P.C. [ATTORNEYS AT LAW I I 1 S ERVICING T HE L EGAL N EEDS OF THE H EALTH S CIENCES C OMMUNITY • Managed Care 9 JOHN D. 4 s 0 WHITE '40 , of]acksonville, 1 FL, has moved with his wife, Dorothy, to Cypress Village, a retirement community next to the Mayo Clinic. He continues to be active in low-vision counseling and community affairs. He writes: "I would like to know why we don't have news of the '40s classes. I can't believe that they are all dormant. If you get to Florida, I'd like to see any of you!" • Purchase & Sale of Practices THEODORE W . KOSS '41 , of Smithville, • Business & Tax Planning • HCFA Safe Harbor Regulations and Physician Self-Referrals TN, has had a good recovery from both a total hip replacement and a coronary occlusion last fall. ''I'm doing exceptionally well, fishing and following the market." 9 6 s 0 MORTON PAUL KLEIN '62 , of Boynton Beach, FL, is retiring from ob/gyn after 28 years. He plans to travel through the United States and Canada in his new motor home. HARVEY LIEBESKIND '63 , of Jackson- ville, FL, writes: "Although I continue to practice psychiatry part-time in Jacksonville, most of my time over the past 20 years has been devoted to the thoroughbred horseracing and breeding industry as an owner. I attend all the major thoroughbred auctions and race principally in New York, Kentucky, and Florida. Two of my three sons are in the business with me. I'm looking forward to our 35-year reunion in 1998." • Contracts with Private & Public Entities • Employee Relations Counseling • Fringe Benefit Programs • Representation Before Government Agencies on Audit & Business Issues • Facility Finance and Construction • Credentialing and By-Laws • Hospital/Medical Staff Issues Please contact Robert P. Fine or Lawrence M. Ross at 716- 849- 8900 HAROLD PESCOVITZ '47 , of Cincinnati, OH, has retired from his practice of surgical oncology. "I winter in Boyton Beach, FL, and summer in Cincinnati, so 1see no snow." of Buffalo, NY, received the Senior Honor Award Cer- ARTHUR J . SCHAEFER '47 , tificate for his many years of service to the American Academy of Ophthalmology and its scientific and continuing education programs. The award was granted at the academy's 100th Anniversary Meeting in Chicago on Oct. 25, 1996. At the meeting, Schaefer was one of five past presidents of the American Society of Ophthalmic Plastic and Reconstructive Surgery who gave a three-hour instruction course, "Refinements in Surgical Techniques in the Treatment of Ptosis, Entropion, and Ectropion of the Eyelids." STEPHEN C . SCHEIBER ' 64 , MARC COEL '68 , of Kailua, HI, is chair of nuclear medicine at the University of Hawaii School of Medicine and director of nuclear medicine at Queens Medical Center. He writes: "I have had a nuclear medicine text (atlas) published by Saunders. 1 would be interested in hearing from members of the class of'68living in Hawaii. I live in Kailua, across the mountains from Honolulu, where I work ... a bit warmer than Buffalo this time of year." s . K. Bosu '69, of Anaheim, CA, has been C .J . PARKER '58, writes that he has moved from Detroit, MI, where he was an associate professor of biochemistry, to Hayes, VA. 1300 Liberty Building Buffalo, New York appointed director of the N.I.C.U. and clinical chief of pediatrics at Southern California Permanente Medical Group in Orange County. He was also recently elected to a two-year term as president of the Association of Nigerian Physicians in the Americas, a 2,000-member professional association. ® of Deerfield, lL, was elected chair of the Committee of Board Executives and Representatives of the American Board of Medical Specialties. He was also approved for membership in the Benjamin Rush Society and the University Club. Scheiber is secretary of the Group for the Advancement of Psychiatry and treasurer of the American College of Psychiatrists. B u a a p 5 c a 5 p n g 9 �.................................................................. I N FIN I T I 1 9 s 0 7 ARTHUR R . GOSH IN THOMAS ARNO '70, of Buffalo, NY, was selected by the Academy for International Health Studies to travel to jerusalem for a '78, of Meadville, PA, was awarded the 1996 D'Angelo Excellence in Heart Care Award by Hamot Medical Center. Arno is medical director and chief of cardiology at Meadville Medical Center. He was honored for improving cardiac care and week of study of the Israeli health-care system. He joined a delegation of 18 American health-care leaders that met with Israeli raising public awareness about heart disease. Among his accomplishments were adding new services at the hospital, writing medical columns for the local newspaper, Minister of Health joseph Matza; members of the Brookdale Institute; the mayor of Jerusalem; and the chair of the board of Israel's largest HMO, which has 3.4 million members. Goshin is president and CEO of Buffalo's oldest HMO, HealthCarePlan. He is also board chair and appearing on the radio to raise awareness of heart disease, and helping in the annual Heart Fund Drive. 1 9 8 s 0 '82, of Los Alamitos, CA, was recently advanced to fellowhip in the American College of Physicians and continues to practice pulmonary and critical care medicine in Orange County, CA. Having '74 , of Seattle, WA, writes: been promoted to the rank of commander in the Navy Reserve Medical Corps, he has attained qualification in surface warfare medicine on the U.S.S. Kitty Hawk and was recently awarded the Navy Commendation Medal. He and his wife, Pina Wong, M.D., have one daughter, Christen Marie, who is experiencing the 'terrible two's. ' "I have joined the Richmond Clinic and am starting an internal medicine practice. I will be living in North Seattle with my wife, Claudia, my daughter, Nicole, and my granddaughter, Samantha." RICHARD AL TESMAN '76 , of White Plains, NY, writes: "After 10 years in the private sector, I've returned to academia as director of the acute division of New York Hospital-Cornell Medical Center in Westchester County. I still maintain my psychiatric consulting practice." TAWNI ANN FRANK '76 ,ofCharlesCity, VA, writes: "After eight years working as a general practitioner and ER doc, I found my true calling in psychiatry. I am now an assistant professor in the Department of Child Psychiatry at the Medical College of Virginia in Richmond." MIKE NEANDER '76 , of Oneonta, NY, is practicing child, adolescent, and adult psychiatry in rural upstate New York, and works monthly in Washington, DC. He works with families with multiply behaviorally challenged children. e 0 0 p y c An interior more Jpaciou,l than a Ro//.1 Royce Silo•er Spur Ill. An e.-cceptionaffy generow liA of ,1tandard Lu.-wry featured. A 190-hp V6 capahle of out-acceleraltizg many Lnxury V8J. And of courJe, !he Jtandard-Jetting performance and Jervice oflnfiniti. $599 mo. 36 mo. LeaJe $999.00 down MARK CHUNG CEO of Vytra Healthcare, a HealthCarePlan subsidiary on Long Island. JOHN J . FIN A The fro nt-wheel drive I nfiniti® /50™ '82, of Grand Island, NY, is director of laboratories and chief of pathology at the Niagara Falls Memorial Medical Center. He has been granted voluntary recertification by the American Board of Pathology. Gioia is board-certified in anatomic and clinical pathology and is a clinical assistant professor at UB. JOSEPH F . GIOIA '83, of Memphis, TN, writes: "After a decade in academic medicine, including the last two years as chief of the division of geriatrics at the University of Tennessee at Memphis, I will begin a new adventure this year. I am joining St.j oseph's Hospital in Memphis to become the medical director of a MedWise Center. MedWise is run by GeriMed of America, a national company providing primary care for older adults throughout the continuum of care. " ROBERT BURNS o n 5 p n 9 9 9 I ntrouucing the all neov 9 7' QX4® from Sj5,550.00 In an ln/inili® QX4®, one of the firJt lhingJ you 'If eJcape iJ the mundane. Beca11Je the QX4 iJ not your typical La.xury .1porl utility l'e!Jicle. While it offet~' all the verJatility you e.-..:pect from a l'ehicle of it,, kino, I he QX4 offeN .wmething you don't e.-..:pect: the Lu.-..:ury of an infiniti. I N F I N IT I AUTO PLACE INFINITI 8129 MAIN ST. , WILLIAMSVILLE 633-9585 East of Transit Rd., Near Eastern Hills Mall ( 130-$450). Bank fee + tax and license due at inception. 12,000 annual mileage . $.15 per mile in excess. �& WILLIAM J . MAYER '83 , of Portage, MI, was recently appointed president and gen- THE ULTIMATE DRIVING MACHINE= eral manager of the Functional Foods Divi- Advertise in one of the finest publications in Western New York ... Buffalo Physician ~ Uf\"tj v"~ s \ [ \ "" Checkpoint Foreign Car, Inc. sion of Kellogg Company. He also served on an Institute of Medicine study committee that published Improving Health in the Community. He and his wife, Annie Fainsinger, have two sons, joshua (5) and Adam (2). EDWARD A . ZANE '84 , of ew Milford, CT, writes: "After serving as chairman of the Department of Anesthesiology, I have been elected to serve as president of the medical staff of ew Milford Hospital. Our three children-Alexandra (8), Erica (6) , and Mauhew (4)-bring endless joy to Debbie and me." OONNICA L. MOORE '86 , of Sales and Service eshanic Station, NJ, has been elected vice president for membership of the • American Medical Women 's Association. 487 Kenmore Avenue Buffalo, NY 14223 Moore, a gynecologist, has Give us a call: 836-2033 (716) 645-6933 • Michael J. Baranski Marketing Representative also been named president of Sapphire Women 's Health Group, which provides consulting services to companies and organizations interested in enhancing their position in women's Your WNY Leasing Specialist Serving WNY proudly for 33 years health. She will also serve as the program chair for the Fifth Annual Congress on Women's Health in Washington, DC, in june. She writes, "I hope to see many alumni there! " JOHN BARBACCIA '88 and JANET WILLIAMS '88, ofMorgantown, WV, announce the birth of their son, icholas Andrew, on Dec. 31, 1996. He joins three older siblings: Katie (5), Matthew (3), and Thomas (1). 1 BARANSKI ADVERTISING 146 Stepping Stone Lane Orchard Park, NY 14127 ® s u f f a l o P 9 9 s 0 PAMELA A . CLARKE '90, of Prospect, KY, writes: "I finished my pediatric endocrinology fellowship in june 1996 and accepted a position as assistant professor at the University of Louisville in the Division hysician 5 p r I n g 9 9 7 �················ · ······································ · · · ········ · ······················ • II ' of Pediatric Endocrinology. My husband, begin a two-year fellowship in pediatric oto- Mike, and I have been keeping busy build- laryngology at Emory University in Atlanta ing our dream home." this July. GLEN M . GINSBURG '90 , of Omaha, JONATHAN WEINSTEIN I '93, of Alexan- NE, was appointed assistant professor of dria, VA, writes: "I have finished my resi- pediatric orthopedic surgery and clinical dency in pediatrics at Children's director of the Motion Analysis Laboratory Medical Center in Washington, DC, and ational at the University of Nebraska Medical Cen- have joined a large practice in Fairfax ter after completing a fellowship in pediatric County, VA. I love living in this area and orthopedics at the University of Southern California. take advantage of the many sights and activities. I just finished my second Marine Corps Marathon-with my father! Ed Math LINDA D . LORENZANI - FRANCIS '91 , of Washington, NC, writes: "I finished my and I keep in touch frequently and occasionally I hear from Andy Corsello. " psychiatry residency at Sheppart Prall Hospital in Baltimore in 1995, and I've joined RESIDENTS the faculty at East Carolina University School of Medicine's Department of Psychiatric Medicine in Greenville, NC. " W I LLIAM A . PULLEN ( 1982- 85) , of Los Angeles, CA, was chosen as one of the best physicians in Los Angeles by Los-Ange- MATTHEW J . PHILLIPS '91 , of Snyder, NY, writes: "My wife, Toula, and I are proud les Magazine. Pullen is married to JoAnn C. Pullen '83. to announce the birth of our son, Mauhew John Phillips Jr., on Nov. 9, 1996. He joins his brothers James (3) and Michael (2). " of Amherst, NY, is completing the last year of her otolaryngology residency at UB and will PHILOMENA MUFALLI BEHAR '92 , MANDEEP KAUR RAI ( 1992-95), of Chagrin Falls, OH, was awarded an educational grant from the National Foundation for Infectious Diseases to attend the 1996 lnterscience Conference on Antimicrobial Agents and Chemotherapy last fall in ew Orleans. Rai is a fellow in infectious diseases at Prompt Care and the Cleveland Clinic Foundation. NICHOLS MIDDLE SCHOOL • Challenging, mnovative curriculum • Outstanding preparation for high school • Average class size of 14 students • Interscholastic sports • Comprehensive visual and performing arts program • Dedicated, caring faculty • Financial aid available For further information, call: NICHOLS MI DDLE SCHOOL, 175 Nottingham Terr. B f f 0 0 p h y s NICHOLS UPPER SCHOOL, 1250 Amherst St. c 0 5 p 9 875~8212 9 9 ® �• ·············· · ···· · ········· · ····· · ··········· · · · ···· · ············ · ·· · ········ · ······ · ··· I OBITUARIES STEVEN PIERI '36, of Fort Myers, FL, died on Dec. 18, 1996, after a long illness. After graduating from UB, he received further training from the People's Hospital in Akron, OH, and the Belmont Hospital in Chicago. In 1939, he started a group practice in Corning, Y, and worked there until his retirement in 1981. He was also a member of the staff at the Corning Hospital and was active in the Steuben County Medical Society. He is survived by his wife and classmate from UB, Doris Pieri '36. JOHN L. MUSSER '51 , of Orlando, FL, diedjan. 19. He had been battling cancer. He is survived by his wife, Norma. JEFFREY J . SEYMOUR '93 , of Ilion, NY, died jan. 6 as a result of injuries sus- tained in a car accident. He was 31. Seymour was completing his residency in emergency medicine at Albany Medical Center, where he had become chief resident. He earned his bachelor's degree from Cornell University after attending Herkimer County Community College. He graduated from UB School of Medicine and Biomedical Sciences with honors. In 1995, he married Pina Sanelli, UB Class of '94, who is now a resident in radiology at Albany Medi- This photo of Jeffrey Seymour and Pina Sanelli appeared in the 1993 Iris, UB' s medical student yearbook. cal Center. If you come loolring for a car, you'll be awfully disappointed. HoWEVER, there's little chance you'llleave that way. BECAUSE at the Land Rover Centre, we have the world's most impressive 4x4s. AND people who can answer anyof your questions about driving. A4x4, of course. 3560 Sheridan Drive Amherst, New York 14226 (716) 831-3100 • (716) 835 FAXX (3299) ® a f f a l a P h y s I a n 5 p n 9 9 9 �Put tfte best seat in tfte fwuse myourgarage. 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Doctor... f;'\d ~O<tr Information Insights Opinions Finances Stocks & Bonds Call in Listen In OW'\ ro(l[ * Fact: Saab owners have a higher education level than any other car owner group. * Saab purchase prices starting low to mid 20's; leases starting at $299 per month. * According to the Insurance Institute for Highway Safety (IIHS), the Saab 9000 has the lowest fatality rate of any production car on the market. WWKB, 1520 Saturdays 9:05 to 10:00 am SOUTHTOWNS SAAB @~P!2~~~11 3580 Southwestern Blvd (1 Mile east of Rich Stadium) Member: American Stock Exchange, NASD, SIPC (716) 662·8008 237 MAIN STREET Tel: 854-7541 WNY's Largest Volume BMW Dealer THE ULTIMATE DRIVING THOSE LOOKING FOR MORE CONTROL IN THEIR LIFE CAN NOW FIND IT ON SLIPPERY PAVEMENT. MACHINE~ F. G. DOWNING Sfi99 While the road of life may throw you an occasional curve, at least our All Season Traction 1997 BMW 740i helps you handle the particularly slippery ones. 27 mo. Lease Towne BMW 3030 Orchard Park Rd. 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U.S. Postage PAID Buffalo, NY Permit No. 311 BUFFALO PHYSICIAN STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 ADDRESS CORRECTION REQUESTED PLAN'l'ING A TREE UNDER WHICH You WILL NEVER Srr DR. DEVILLO W. HARRINGTON, class of 1871, knew how to make his money grow. In fact, this man who in 1905 provided $5,000 through his will for the University at Buffalo School of Medicine, is still supporting UB today through the endowment his bequest created. THIS PERMANENT endowment in Dr. Harrington's name has grown to over $300,000 and today it supports the famous Harrington lecture Series, which twice a year brings distinguished scientific speakers to the School of Medicine and Biomedical Sciences. DR. HARRINGTON'S LEGACY to UB is just one of many bequests which have established permanent and important endowed funds at the school. They enable UB to provide scholarships ·to outstanding students, enhance scientific research, support excellence in teaching and meet the ever-changing needs of the school. YOU TOO can provide the School of Medicine with a measure of permanence through a bequest. Proper estate planning helps you develop a smart financial plan. Acharitable bequest provides the satisfaction that comes from planting a tree under which you will never sit, but which will bear fruit for generations to come. FOR ACONfiDENTIAL consultation on making a bequest to the UB School of Medicine and Biomedical Sciences, or to receive materials to share with your attorney or estate planning advisor, please contact STEPHEN A. EBSARY, JR. I Assistant Dean and Director of Development, School of Medicine and Biomedical Sciences UNIVERSITY AT BUFFALO (716) 829-2773 UNIVI!ASITY AT BUFP'ALO SCHOOL OF MI£DICINII!: l50 I 5 0 Y £ A R S 18415-1998 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Spring 1997 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1997-Spring Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician and biomedical scientist Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v31n02-1997-Spring Table Of Contents A list of subunits of the resource. Teaching on the Fly OB-GYN today OB-GYN yesterday A medical mission to Kathmandu Research news Hospital news Medical school New faculty A student's perspective Alumni Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. 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Copyright 1997 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/036b61aa5ed92170adcc2621130b772d.pdf 6e9fd3da5c49d53bd021792690850f6a PDF Text Text State University of New York at Buffalo School of Medicine and Biomedical Sciences, Winter 1997 �BUFFALO PHYSICIAN Volume 31, umber l ASSOCIATE VICE PRESIDENT FOR UN IVERSITY SERVICES Dr. Carole Smith Petro DIRECTOR OF PUBLICAT IONS Kathryn A. Sawner EDITOR jessica Ancker ART DIRECTOR/DES IGNER Alan j. Kegler PRODUCTION MANAGER Ann Raszman n Brown STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MED IC I NE AND BIOMEDICAL SCIENCES Dr. john Wright, Interim Dean , Vice President for Clinical Affairs EDITORIAL BOARD Dr. Bertram Portin Dr. Martin Brecher Dr. Harold Brody Dr. Richard L. Collins Dr. jack F. Coyne Dr. Alanj. Drinnan Brian Duffy Dr. james Kanski Dr. Barbara Majeroni Dr. Elizabeth Olmsted Dr. Charles Paganelli Dr. Stephen Spaulding Dr. Bradley T. Truax Dr. Franklin Zeplowitz Dear Alumni and Friends, UB's SESQUICENTENNIAL EVENTS WILL END with the award by the SUNY Board of Trustees of an honorary doctor of science degree to Dr. james Holland at commencement on May 11, 1997. Dr. Holland, the Distinguished Professor of eo plastic Diseases and the director of the Cancer Center at the Mount Sinai School of Medicine and Hospital will also participate in teaching students in medicine, and will present a Harrington Lecture during the course of the weekend. Between now and the closing events of May 11, two additional special activities are planned. The first, on Feb. 21-22, 1997, will be held in connection with University Founders Day. Franklyn Knox, M.D. '65, Ph .D. '65, formerly dean of the Mayo Medical School and director for education of the Mayo Foundation, will be honored by a special symposium coordinated by the UB Department of Physiology. He will present a Harrington Lecture, entitled "The Kidney Performs Under Pressure." The SUNY Board of Trustees will also confer the honorary doctorate of science degree upon him as part of the sesquicentennial festivities. A very special event will focus on advances in medical education. It will be held on April25, 1997, the day before the annual Spring Clinical Day meeting. Four major leaders in medical education who had their roots at UB will return to join other faculty with whom they had worked, in addition to the current generation of medical education leaders at the medical school, to discuss the past, present, and future of medical education. The four are Dr. George Miller, Dr. Steven Abrahamson, Dr. Edwin Rosinski (Ed.D. '58), and Dr. Hilliardjason (M .D. '58, Ed.D. '62) . As the sesquicentennial activities draw to a close, it is my observation that each served to reconfirm the medical school's commitments to the intent of its founders and to provide excellence and leadership in education, research, patient care, and community service. As medical education and health care enter into a new, challenging era, UB stands ready to maintain its professional integrity, while preparing to make its contribution to the necessary growth in knowledge and needed advances that lie ahead. ~·'~.~ TEACHING HOSPITALS AND LIAISONS The Buffalo General Hospital Michael Shaw The Children's Hospital of Buffalo Erie County Medical Center Mercy Hospital Millard Fillmore Health System John Naughton , M.D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences Frank Sava Niagara Falls Memorial Medical Center Roswell Park Cancer Institute Sisters of Charity Hospital Dennis McCarthy Veterans Affairs Western Healthcare System ew York ©The State University of New York at Buffalo Buffalo Physician is published quarterly by the State University of New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. It is sent, free of charge, to alumni, faculty, students, residents and friends. The staff reserves the right to edit all copy and submissions accepted for publication. Address questions, comments and submissions to: The Editor, Buffalo Physician, State University of New York at Buffalo, Office of Publications, 136 Crofts Hall , Buffalo, NY 14260 Send address changes Ia: Buffalo Physician, 146 CFS Addition, 3435 Main Street, Buffalo, NY 14214 Dear Fellow Alumni, WELL, IT'S WI TER IN BUFFALO ONCE AGAIN. We brace ourselves for the cold weather ahead, and follow our Bills. But something is different. Things are not the same. Someone is not here. It is the individual who has directed and guided our medical school for the past 21 years, Dean john Naughton, M.D. When I was talking with him about some of his accomplishments, he quickly turned the discussion to one of h is favorite interestssearching his family tree. As he speaks of his travels through Ireland and the Northeast, you see a glimpse of the passion with which he engineered this medical school into the 21st century. He follows no model, but creates innovative ways to reach his goals. Hence, the reason why the Robert Woodjohnson Foundation has provided UBgrants fo r primary care, and why he currently chairs the New York State Council on Graduate Medical Education. His medical education interests have centered on reform of graduate medical education, medical student education, and collaborative and regionalized models of health care and education. It's hard to envision our future without Dr. aughton's leadership. He will be tru ly missed, but his legacy will live on in the students he has touched. Today's health care system has certainly benefited and will continue to benefit from his vision, passion, and dedication. Thank you, Dr. aughton! Cover photo by K.C. Krall Sincerely, ~cf2C'~~D Jack F. Coyne, M.D. President, Medical Alumni Association �VOLUME 31 , NUMBER 1 WINTER 4~~~~ ~,~~~~~~~"~.0. 8 C~unch ~me THE MANAGED CARE NAUGHTON DISCUSSES HIS REVOLUTION GOES INTO CAREER FROM SPORTS HIGH GEAR IN BUFFALO WRITER TO CARDIAC by Jessica Ancker 12 97 Making histo~y in the histo~y of medicine U 8'S TREASURES ON DISPLAY photos by K.C. Kratt RESEARCHER TO DEAN. II ..JOHN R. WRIGHT, M.D. NAMED INTERIM DEAN 2 Then and Now WHEN THE GERM THEORY WAS STILL A THEORY by George F. Haddad, M.D. '94 3 Research Alumni RADIOLOGIST WENDE W. LOGAN-YOUNG , GRANTS FOR BREAST GENOME RESEARCH. LIJ:¥UID VENTILATION . 2 Medical School News Astudent's perspective NEW BOSNIA PARTNERSHIP • A ..JOHN BORDER, M.D. IDEALISM INTO PRACTICE PRIMARY CARE EXTERNSHIPS. by Christopher J. DiMaio, Class ..JOHN KOLEGA, of 2000 PH.D. THE NPR CAREER OF US's MIRIAM SHUCHMAN, '61. ..JACK RICHERT RETIRES. CANCER AND HUMAN POLICE SUICIDES. M.D. M.D. CHANCE TO PUT 3 Classnotes �. . . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . . . .. . . . . . .. . . . . [1] I ' I " . $1.6 million funds study of alcohol and breast cancer an drinking alcoholic beverages increase the risk of developing breast cancer? If the answer is "yes," as many scientists suspect, what are the mechanisms involved, and are some women genetically more susceptible to the risk than others? University at Buffalo scientists will attempt to answer these and other questions about alcohol through a $1.6 million grant from the U.S. Army's special program for breast cancer research . The study was led by] o Freudenheim, Ph.D., UB associate professor of social and preventive medicine. "There is a fair amount of evidence that alcohol may be related to breast cancer, but most research has used inadequate measures of alcohol intake," Freudenheim explains. "We will be making careful measures of lifetime alcohol consumption, as well as collecting data on diet, physical activity, and reproductive history. The researchers also will assess genetic differences in the way individuals metabolize alcohol, and will compare breast cancer rates among "fast " and "slow" metabolizers . A specimen bank will be created to store blood samples for current and future research . The study group will be composed of 1 ,350 women from western New York with breast cancer and 2,030 randomly selected Jo Freudenheim, Ph.D 0 healthy women to serve as controls. Participants will be between the ages of 35 and 79. Researchers theorize that alcohol may influence the development of breast cancer by changing the body's steroid hormone levels or by increasing oxidation. These mechanisms are among those that will be investigated in subgroups of the study population. The research is an offshoot of an $8 million investigation of alcohol and its relationship to chronic diseases being carried out jointly by UB's Center for Preventive Medicine and the Research Institute on Addictions in Buffalo. + L o 5 B A K E R UB liquid ventilation study proves eiTectiveness artial liquid ventilation is safe and effective for premature infants, according to research from UB that appeared as the lead article in theSept.l2 , 1996, issue of the New England journal of Medicine . A five-center trial of partial liquid ventilation to treat lifethreatening respiratory distress syndrome in extremely premature infants has shown that the procedure is safe and effective , and that it improves lung function in some children who failed to respond to conventional treatment, increasing their chances of survival. Corrine Leach, M.D., UB assistant professor of pediatrics , headed the multi-center investiga- a u t t a t a P tion of the procedure, which was developed by Bradley Fuhrman, M.D ., UB professor of pediatrics. Both practice at Children's Hospital of Buffalo. Respiratory distress syndrome , the leading cause of death in premature infants, develops when the lungs of these tiny babies are unable to secrete surfactant to prevent the air sacs from collapsing. Partial liquid ventilation (PLV) involves introducing an oxygen-rich liquid called perflubron into the baby's lungs . The liquid allows the lungs to inflate and permits oxygen and carbon dioxide to pass through the air sacs and into the blood stream more easily and efficiently. "The successful introduction of liquid into the lung and the ability of infants to breathe with liquid allow us to ventilate the lung at lower pressure , which causes less damage ," Leach explains. "If we can decrease the amount of lung injury , we can greatly improve the patient's outcome and perhaps prevent chronic lung disease." The pilot study involved 13 infants born between 24 and 34 weeks of gestation. All had failed to respond to conventional therapy and were at risk of death . Carbon dioxide levels improved in all patients while on PL V; lung functioning improved in 11 infants. Seven of the 13 critically ill infants survived. Of those who died , three succumbed to their acute lung disease, and one to bronchopulmonary dysplasia. Two patients died of nonrespiratory complications of prematurity. Clinical trials using PL V to treat children and adults with severe respiratory distress syndrome are now under way. Results are promising, Leach says. + hysician o L W 5 1 n t 8 e r K A 1 E 9 R 9 7 �- - . - ~ -~ - - . ~. ~ --- ~- - - . .. - - - - -- - - Reorganizing the Human Genome Project Former trooper studies police suicide rates a pretty good indicator of what's going on out there ." Results appeared in the American]our- s part of a nationwide project to combat ethical and image problems with the Human Genome Project, the federal government has given Roswell Park Cancer Institute researchers a grant to build a new human gene library. The same Roswell Park research group , which is led by Pieter Dejong, Ph.D. , also won a grant to begin gene sequencing. They will share the $2 million Department of Energy pilot grant with a team at the University of TexasSouthwestern. The National Center for Human Genome Research decided there was a need for new gene libraries after finding problems with the way researchers had obtained DNA samples in the older libraries. The federal administrators found that most of the DNA in the four best gene libraries (including Dejong's) came from only four people, rather than from a diverse group of donors. They also found that some of the subjects may not have been fully informed of what their donation would be used for, and that several of the donors were known to the researchers and so were not anonymous. Under new ethics guidelines, researchers will recruit a larger pool of donors and follow procedures to ensure donors' anonymity and to obtain their informed consent. They will also follow additional rules to combat image problems. For instance, researchers may not donate their own DNA (because it might appear "elitist") or ask junior lab members to do so . They must also recruit a substantial number of women donors. According to Dejong, a UB associate research professor, sequencers will continue working on the old libraries during the two years it will take to create the new ones. + olice officers are eight times more likely to die by their own hand than by homicide, a study by University at Buffalo epidemiologists has shown. They also take their own lives at a much higher rate than other municipal employees, the findings indicated. The study is one of the few empirical analyses of police officers' risk of suicide, homicide , and accidental death, and the only study to compare their risk to that of other workers. "We are hoping this study will make the police community aware that suicide is a problem, not a myth , not something that should be shrugged aside, " says lead author john M. Violanti, Ph.D., a UB assistant clinical professor who is himself a 23-year veteran of the New York State Police. Violanti, along with john E. Vena , Ph.D. , and other colleagues from the UB Department of Social and Preventive Medicine, analyzed mortality data for the 138 Buffalo police officers and other municipal workers who died between 1950 and 1990 of external causes. According to Violanti, the Buffalo statistics mirror those of police departments around the country. "We looked at five other cities, and all five departments were higher in suicide than other occupations . I think this is The researchers identified a number of potential factors in the police suicide rate, including continuous exposure to human misery, an overbearing police bureaucracy, shift work, social strain, marital difficulties , inconsistencies in the criminal justice system, alcohol problems, physical illness, impending retirement, and lack of control over work and personal life. Easy access to handguns and the lack of confidential counseling may also be factors , says Violanti. "Police officers are even more hesitant than the average citizen to get help for emotional problems," he notes. "Because of their role and their job, they mistrust many things , and they especially mistrust mental health professionals. The other half of the problem is , confidential help isn't always readily available. "Departments should include some sort of suicide awareness training in their stress management program," Violanti adds. "The New York City Police Department has such a program and suicides went down after it was instituted. The Buffalo department now also has a program in place. " The research was supported by a grant from the National Institute of Mental Health. + -JESSICA B u f f a l a ANCKER Physician w 1 n t e r 1 9 9 nal of Industrial Medicine. - 7 L o s B A K E R 0 �Naughton discusses his career from sports writer to cardiac researcher to dean at UB As]OHN NAUGHTON, M.D., 63,stepsdownafter21 eventful years as dean of the medical school, he can be certain he's secured his place in UB history. Conversely, UB can be sure it has secured its place in Naughton's own eventful history, which began far from Buffalo or any other academic center. John Naughton grew up about 80 miles from Oklahoma City in Lawton, OK, at the time a town of 14,000 people. Lawton's business community, including the Naughton family's restaurants, depended on servicemen visiting from the nearby Fort Sill military post and training center. Young jack, as he was called, did well in school and also worked hard at a number of different jobs. Helping out at his father's restaurants , the Chuckwagon and jack's White House Cafe, "taught me just about everything there was to know in the restaurant business." He also worked part time as a sports and news writer for the Lawton Constitution. "I was a good writer-my strong point was writing lead sentences," he remembers with pride. Naughton earned an associate's degree from Cameron State College, a two-year school in Lawton where he was the editor of the student newspaper. But he had higher aspirations: he went on to St. Louis University to earn a B.S. in preparation for medical school. "My interest in medicine, I think, came from my mother. She had been a nurse before she was married, and always wanted to have a doctor in the family," Naughton says. "At the same time , my father , as an independent businessman who was very active in each community he lived in , gave me an appreciation of the importance of community service. That's something I consider to be part of medicine, too. " When he entered college, Naughton found that he was far behind some of his contemporaries in basic science education. "Lawton was a very small community, and we didn't have a lot of kids who went into academic fields. "Looking back on it, I appreciate Lawton, because I grew up among real people who sometimes academics and medical students don't have a chance to know," he says. bx !essica Ancker 0 B u f f o l o P Naughton earned his M.D. from the University of Oklahoma, did a mixed medical internship at George Washington University, and completed a residency and post-doctoral work at the University of Oklahoma Medical Center where he remained until 1968 as an assistant professor. While his early research interest was the effect of emotional stress on the heart, he soon began investigating the effects of physical stress and ways to rehabilitate patients after heart attacks. "In a time of national emphasis on fitness during John F. Kennedy's presidency, we were looking at broad national questions , not just the effects of hysician w I n t e r l 9 9 7 �-- --- tests on individuals. Our question was , in an unfit society, could unfit people be reconditioned and would it improve the quality of life? " a ugh ton then moved to the University of Illinois, where he became an associate professor and the director of the school's Rehabilitation Center. Later, at the George Washington University Medical Center, he became director of both the Division of Rehabilitation Medicine and the Regional Rehabilitation and Training Center. He also directed the ational Exercise and Heart Disease Project, a national study that he continued to head until its final report in 1983. It was at George Washington that B u f f a I a Phys i c - -- - --- Naughton got his first taste of administrative life , becoming dean of academic affairs in 1973. "Even though I loved being a researcher, I had also always been interested in teaching and in broader areas of medical education," he explains. Heremembers being trained to be a first-rate internist, with only secondary emphasis on developing a specialty. By the time he joined the University of Illinois, emphasis on the core of medical education was already disappearing in favor of training specialists. "That alerted me that there were interesting issues in medical education. My interest was in providing a medical Ia w I n t e r 1 9 9 7 - - �''I am lool<ing forward to education that served a broader need in society." Naughton accepted the deanship of UB's School of Medicine and Biomedical Sciences in 1975 at the age of 42. He was eager for the chance to lead a school, and he describes a mix of other reasons that made UB's offer intriguing. First, he says, he wanted to join a public university, with its commitment 0 to serving the people of its state. He also liked the fact that UB was an integral part of the Buffalo community. "Medical education should be serving the community in some way." Also, Naughton said he immediately felt that UB had never taken full advantage of the resources at its fingertips. For example, UB's outstanding faculty weren't getting recognition at the national level, and they were rarely invited to join state Health Department committees. "Things other people saw as disadvantages, I saw as opportunities. That probably comes from my rehabilitation career!" Coming on board at a time of sagging morale, low prestige, limited research funding, and uncertain priorities in the wake of the merger with SUNY, Naughton helped raise the school to national stature. One achievement that will always be linked with Naughton's name is the creation of the Graduate Medical Dental Education Consortium of Buffalo. More than just coordinating resident education, the consortium has become a symbol of the cooperation among the hospitals, which have reduced duplication, saved money, and concentrated their expertise by designating certain hospitals to develop into regional centers of specialty services. Interestingly, Naughton also counts as a success his hospital consolidation study, which stirred public controversy and was never implemented. He had been invited by Buffalo General Hospital, Children's Hospital of Buffalo, and the former E. ] . Meyer and Deaconess hospitals to head a study on the feasibility of mergers. The resulting report recommended a series of consolidations to cut down on unused beds and costly duplication of services. The plan failed by one vote to pass in the Erie County legislature, due to opposition from community groups, politicians, and some parts of the medical community. "However, that study served to create the image of the medical school as a B u f f a l a leader in Buffalo's medical community. It was also the first opportunity to bring people from the different hospitals together in a more cooperative way. It set the stage to found the consortium." Naughton is credited with many other accomplishments at UB, including beginning the Primary Care Resource Center, winning the Robert Wood johnson Generalist Physician Initiative grant, building and renovating university buildings, and establishing a strong affirmative-action policy. The dean is looking forward to returning to research, teaching, and men to ring new generations of students and doctors. "The things I came to UB to accomplish, I think I have accomplished. You get a certain thrill and high out of that," he says. "We now have a sense of institution. We have stature as a medical school, and it's not just dependent on one or two outstanding individuals. "I am looking forward to the next few years as an academic." + Physician w I n t e r 1 9 9 7 �INTERIM DEAN APPOINTED ohn Wright, M.D., will serve as interim dean and vice president for clinical affairs until a new dean is appointed. Wright, the chair of the Departments of Pathology at UB and Buffalo General Hospital, earned his M.D. at the University ofManitoba in 1959. He completed a residency at the Buffalo General Hospital and then held a National Institutes of Health fellowship in endocrinology there. Between 1965 and 1967 he held a Buswell Fellowship at UB. Wright taught at johns Hopkins University School of Medicine before joining the UB faculty in 1974. Among many other appointments, Wright has served as interim director of Roswell Park Cancer Institute and as director of the university pathology residency program. Wright says he hopes to continue john Naughton's initiatives in reorganizing the Faculty Practice Plan, reorienting medical education toward a primary care perspective, and providing support for the student body. He also hopes to keep the medical school involved in the merger negotiations between the Buffalo General, Children's, and Millard Fillmore hospitals. + B u f f o l o Physician w I n t e r 1 9 9 7 �BY JESSICA The managed care revolution goes into high gear in Buffalo lue Cross and Blue Shield of Western New York set off a firestorm of criticism last year when it introduced Community Blue Advantage, a plan that lets patients opt for lower copays and more services in return for a more limited selection of hospitals and doctors. In another city, this might have been accepted as just another insurance option. In Buffalo, it was considered outrageous. One state legislator accused the company of a "callousness" that was "frightening," and the county medical society at one point demanded an immediate halt to the plan's marketing campaign. Reaction might not have been so strong if doctors and hospitals hadn't already been feeling squeezed by fastmoving changes in Buffalo's health-care economy. Two factors here are compressing and accelerating a market evolution that is familiar to much of the rest of the country. First, a statewide Health-Care Reform Act is changing the playing field for New York State hospitals in 1997. New York had been one of two holdout states that still set hospital reimbursement rates for most insurers; now, all 0 insurers are free to negotiate these rates . Second, managed care is rapidly coming of age in Western New York. While about 30 percent of New York State's population is enrolled in managed care plans, the rate is almost 50 percent in Buffalo. The figures will increase, particularly because state officials hope to enroll 2.5 million Medicaid recipients in managed care in the second step of health-care reform. So the state has stripped hospitals of some protected rates at the same time that managed care is driving down hos- Buffalo ANCKER • pitalization rates. And looking ahead, both insurers and providers fear that for-profit companies will soon move into Western New York. These converging forces have produced a burst of competition in the health-care field . Patient care is rapidly moving out of the relatively expensive hospital setting, hospitals are facing low occupancy rates, and insurers are finding new ways to manage care and to share financial risk with doctors. "It took southern California 20 years to be changed by managed care. It took about eight years for Boston. We're going to do it in 18 months ," predicts jack M. Sieber, a health-care consultant at Ernst&: Young, LLP. "I think we're going to leapfrog some of the steps that other regions went through," agrees Robert V. Stanek, chief executive officer of Mercy Health System of Western New York. "That's a double-edged sword. On one hand, we learn from what's happened elsewhere. On the other, the rapidity of the change will be difficult. " These are some of the changes Buffalo will see in the near future : of? A wave of hospital mergers that could consolidate nearly half of the region's hospital beds into two systems; of? Reimbursement systems that split risks between insurers and providers; Physician W 1 n t e r 1 9 9 7 �-- - - - - - - - - - -- - - -- - - 7 Less money for residency training, which may translate into fewer residency slots; t" More interest by doctors in group practices and other sorts of cooperative arrangements that help them provide patient advocacy and negotiate better deals from payers. Stages of economic change The national health-care economy is changing in fits and starts, and it's different in every city. William L. Kissick, M.D., Dr.P.H. , has a unique perspective on the issue. The author of Medicine's Dilemmas: Infinite Needs versus Finite Resources, Kissick is a professor in the University of Pennsylvania Medical Center as well as Penn's Wharton School of Business. In the 1960s, he served as a staff member to the federal task force that created Medicare. In a recent lecture in Buffalo, Kissick outlined four stages of evolution in the health-care market. The first stage is the traditional system as many doctors fondly remember it. Doctors practiced independently or in small groups and were paid by insurers. There was not much push for lower costs on the part of employers. Kissick cites Syracuse, NY, as an example of a community that is still in this early stage of development. The second stage of market evolution begins when managed-care plans attract more enrollment, and hospitals therefore find themselves contending with lower rates of admission. Providers begin affiliating in loose networks, but are often still reimbursed on a discounted fee-for-service basis. According to Kissick, Buffalo is rushing into stage three. Managed-care providers have become larger, hospitals are merging, and integrated systems are beginning to link health-care financing with health-care delivery. Stage four , he predicts, will feature more highly managed care, fully integrated health-care delivery and finance systems, a high demand for primary care doctors, and leaner times for specialists. B u f f a 1 o - - - - ----- - - ---- Merging to save money Western New York's seven Catholic hospitals are well on their way to becoming an integrated system. They are likely to include Niagara Falls Memorial Hospital as an affiliate. In addition, Millard Fillmore Health System, the Buffalo General Hospital, and Children's Hospital of Buffalo are continuing talks toward a merger. They have released few details about the negotiations except to announce that john Friedlander has stepped down from his position as Buffalo General CEO in preparation for leading the new merged entity. "The health-care industry is going down the same path as the banking, railroads, and airline industries-we're undergoing consolidation to provide a better product from cost and quality standpoints," says Stanek, the Mercy Health System CEO. The mergers offer the potential to save money through consolidations and economies of scale. All the players agree that a considerable fraction of the 4,700 hospital beds in the Buffalo area are unnecessary, although estimates of the figure range from 15 to 35 percent. The mergers could also put hospitals in a stronger negotiating position with payers because insurers won't be able pit one hospital against another or ignore a system that serves a crucial geographic region. Erie County Medical Center is pursuing another strategy, expanding to form its own system with a network of community primary-care facilities to attract more insured patients. Creating a system (through mergers or through expansion into the community) puts hospitals in a better position because they can offer payers a full range of services, better geographic coverage, Physician w 1 n t e r 1 9 9 7 -- and more direct control of costs, according to Sieber. Some health-care experts also say that in the future, full-service healthcare systems may contract directly with large employers, bypassing insurers altogether. A more immediate incentive for mergers is a fear that New York State will drop its longstanding ban on for-profit hospitals. "There's a concern that if the law is changed, a big national provider could come in and scoop up whoever's not involved in a system," says Sieber. "Most people here would rather see community involvement and community control of the health-care system." In addition, for-profit insurers from New York City and from other states have been putting out feelers in the region. Increased competition on top of the state deregulation ofhospital rates would have prompted mergers in any case. The process is being speeded up by the fact that managed care in Buffalo is already so strong. "It's a big change, to take away that protection for hospitals at the same time that managed care is mature," says Arthur Goshin , M.D., president of Buffalo's oldest managed care group, HealthCarePlan. "In other states, either there was no regulated reimbursement, or managed care grew slowly." State law changes the rules New York's health-care reform package does more than just deregulate hospital rates. Among other things, it creates new funding pools for graduate medical education (GME) and for charity care. The changes are intended to stop the 0 �common practice of using GME dollars to help support a hospital's charity care and bad debt. They are also an attempt to reduce the number of residents trained in New York and bring the number closer to the national average of30 to 35 residents per 100,000 population. As a result, Western New York hospitals , which train 40 to 45 residents per 100,000 people, will face a $13.9 million loss in GME dollars, according to] ohn P. Naughton, M.D., who recently retired from his position as dean of the School of Medicine and Biomedical Sciences. While there is concern about how the reforms will affect the future of medical education, doctors are welcoming other parts of the health-care reform law that protect patients and doctors . Among the law's provisions: an absolute ban on "gag rules;" guarantees that qualified doctors will be involved in decisions about whether to cover specific procedures; and grievance procedures for patients denied care and for doctors dropped from insurance plans. Doctors share risk in new payment schemes Buffalo's managed care entities-mostly Independent Health Association , HealthCarePlan, and Community Bluetogether enroll almost 50 percent of the area's population (80 percent of the commercially insured population) . But until quite recently, Sieber says, most managed care companies in New York State have operated through discounted fee-for-service systems, so they weren't that different from indemnity companies. "We called it 'managed care lite."' "It's really been 'indemnity in drag,"' agrees UB's chair of family medicine, Thomas Rosenthal, M.D. As the market grows more competitive, managed care groups are altering theirreimbursement plans. For example, Independent Health Association, an independent practitioner association/managed care organization, has introduced a new system of modified capitation (prepayment on a per-patient basis). HealthCarePlan continues to reimburse physicians on a 'withhold' system, in which the insurer prepays doctors up ® to 85 percent of agreed-upon fees , but withholds the remaining 15 percent until the end of the fiscal year. Doctors who worked within their budgets then get the entire 15 percent; higher costs are deducted out of the withheld money. As an additional incentive, says president Arthur Goshin, physicians will be told the rates charged by hospitals. That will give doctors a reason to prefer hospitals where HCP has negotiated low rates. Blue Cross and Blue Shield negotiates different types of reimbursement with different providers, says Nora McGuire, the executive director of Community Blue, the insurer's HMO. Sieber says there is room for a variety of reimbursement systems. "Capitation is the buzz word today, but it's only one form of sharing risk. It's quite possible that no single method will dominate the market. " Companies are also creating new types of plans. HealthCarePlan, originally a staff-model HMO, recently added a preferred-provider network called Choice Care. But for many physicians, it was Blue Cross and Blue Shield's new HMO product that came to symbolize a threatening level of change. In essence, the company divided its HMO, Community Blue, into two parts. One is the traditional HMO in which patients are responsible for copays for a range of services. The alternative, Community Blue Advantage, offers additional dental, optical, and other services, lower copays, and medical care from a subset of the plan's doctors and hospitals. Patients can go to doctors outside the network for an additional fee . McGuire , the plan's executive director, says hospitals were chosen to participate in Advantage based on the rates they negotiated with the plan. The plan selected doctors based on factors that included cost, geographic distribution, and hospital affiliation. The plan resulted in complaints from hospitals and doctors not included in this abridged roster, although Community Blue managed to soften the criticism after adding ECMC to the Advantage plan and holding talks with the Medical Society of Erie County. B u 1 I a l o Best practices Insurers are also doing more to manage care by trying to standardize the way different doctors practice. In part, they do this by providing outcomes data and other research . Doctors and insurers both agree that doctors are eager to help set best-practice guidelines, and that, if they are convinced of the value of the guidelines, they willingly comply. The desire to better serve patients, as well as peer pressure from fellow doctors, can both play a role. "Doctors want to know the data because they want to use it in their decision making," says Gosh in, president of HealthCarePlan. "Physicians are scientists, and if we direct those energies into getting the best practices, we'll get the best outcomes," says Buffalo Medical Group medical director Richard M. Peer, M.D. "If it's imposed upon them, they will rebel. If they understand the process, and have input, they get enthused." But that doesn't mean that insurers and doctors will agree on what the best practices are. Doctors are concerned that insurance companies' business goals will win out over quality concerns. Insurers suspect that doctors don't appreciate the importance of controlling costs. In some cases, physician organizations can give doctors a greater say in how insurers regulate practice. And physician groups can also help doctors negotiate better deals . As a result, Buffalo's doctors are becoming more interested in cooperative arrangements, such as group practices , physicianhospital organizations, and independent practitioner associations. "Physicians in New York haven't been very organized, but we're starting to see more of that," Sieber says. One of the area's largest and oldest multi-specialty group practices is the Buffalo Medical Group. It was formed in 1946 as a way to pool resources and practice in an atmosphere of professional cooperation, but gradually its business role has become more important. The group now handles all billing, negotiates contracts with insurers, and scrutinizes contract language. Physician W I n t e r 1 9 9 7 �- - -~ ---- - -~-- - - ~- -- --~ - - "If we feel it is to our benefit and to care doctors and giving them a strong economy by realizing the possibility of our patients' advantage, we will partici- financial incentive not to use specialty cost savings in insurances. pate in an insurers' plan as an entire care, money is budgeted for primary In 1984, there were 33 hospitals in group," says Peer, a vascular surgeon care and for different types of specialty the Twin Cities. Within four years, eight who serves as the medical director. care based on usage of specialty services hospitals closed and most of the others A different type of physicians' orga- in past years. Additional financial and had merged into three systems. HMOs nization is the University Medical Group, professional incentives are intended to also merged and consolidated, and phyformed to organize UB's 400-plus physi- encourage specialists to follow certain sician groups grew larger in reaction. cian faculty members. Its chief adminis- practice guidelines and to underspend The result is a variety of networks of trative officer, Greg Brodnick, came to their pool's budget. physicians, HMOs, and clinics that have UB after a career with several Blue Cross ''I'm not suggesting this is the perfect shifted the provision of health care from and Blue Shield plans in New York and way to pay doctors, but we also know hospitals into community-based offices Pennsylvania. the pitfalls of the fee-for-service sysand clinics. A new state program, "I certainly know the other side's phi- tem," Tronolone says. "At this point in MinnesotaCare, provides coverage for losophy," says Brodnick. "That's what the health-care system, there is going to the uninsured. makes me valuable in this situation." be an economic policeman. The patients Buffalo may evolve along similar lines, The group's bargaining strength would be best served by having people or it may find its own solutions, Kissick comes from its diversity of generalists with medical knowledge do that, rather says. One of the critical factors is how and specialists. Also, many of the fac- than the 'bean counters."' doctors engage in the process. ulty practice in the downtown hospitals lawrence McCullough, Ph.D., a Baylor that care for most of Buffalo's Medicaid What nowt College ofMedicine professor who spoke patients. This makes the doctors more Minneapolis was one of the first regions at UB's symposium on ethics and values attractive to insurers who enter the Med- where the health-care economy began in health care, urged doctors to be more icaid managed care market, because the to change, and it's one of the few that has assertive in their response to managed insurers have to enroll enough doctors reached Kissick's fourth stage of ecocare. "I refuse to accept the victimology to care for their new subscribers. nomic evolution, managed competition. language. Physicians are the most pow"Whenever you have big numbers, The area has some similarities to erful, well-organized profession in the you have strength," Brodnick says. "Our Buffalo. Like New York State, Minnecountry. It's time to stop complaining goal is to get our doctors signed on with sota prohibits for-profit hospitals. Minand start acting." all the third-party payers. We can say, neapolis' population of 2.6 million is He told doctors to accept the fact that 'Either you take all of us, or you get none about twice that of the Buffalo-Niagara all payment schemes would include fiof us."' County region. However, unlike Bufnancial incentives, but urged them to Another sort of physician group is the falo, Minneapolis has a core of powerful fight to ensure that the incentives do not Independent Practitioners Association of Fortune 500 companies, which spurred cripple clinical judgment, that ethical Western ewYork, which comprises the much of the change in the health-care components are included in quality indoctors who work for Indicators, and that patients dependent Health. The are fully informed about IPA is so integrally contheir insurance plans. nected with Independent Kissick urges providHealth that the insurer ers and insurers to work essentially pays capitatogether to ensure such Carrie B. Frank has been appointed intion money to the docsocietal goods as conterim president and chief executive officer tors' organization, which sumer choice, low-cost of the Buffalo General Health System. then pays physicians. The care, and organized She succeeds John E. Friedlander, who IPA's president, Michael practice. has stepped down to lead the developTronolone, M.D.,says the "To manage or be ment of a merged health care system that IPA gives doctors a strong managed, that is the quesmay include Buffalo General, Children's voice in the plan. tion," he says. "Whether Hospital of Buffalo, and Millard Fillmore Tronolone says the 'tis nobler in the mind to Health System. doctors' group negotisuffer the slings and arFrank had been Buffalo General's exated a form of capitation rows of outrageous forecutive vice president and chief operating Carrie B. Frank that spreads financial tune, or to take up arms officer since March 1993. Before that, she risk among all types of against a sea of troubles, had served in a number of financial roles, including vice president practitioners. Instead of and by opposing end of finance and chief financial officer. capitating the primary them." + New CEO named for the Buffalo General Hospital a u f f a l a Physician w 1 n t e r t 9 9 7 �by Jess ca Ancker B photos u f f a l o P hysici by a n K.C. W Kratt I n t e r 1 9 9 7 �-- - - -- ----- ~ - - - - ·- -- - - - • ____n • the isto~ of medicine In UB\ RoBERT L. BROW\! HISTORY OF MEDICINE COLLECTION HAS BECO:YIE A LITTLE RICHER. A first edition of a 16th-century obstetrical text donated to the collection this fall became the University Libraries' 3 millionth volume. And a $500,000 endowment by the History of Medicine Collection's strongest supporter will enable the library to expand its unique collection. Volume number 3,000,000 is a 1554 first edition of Jakob Rueffs De GALEN PERGAMUM, 0 one of the most famous physicians of antiquity, practiced in Rome in the second century of the Christian era. His texts dominated medicine in Europe , Byzantium, and the Arab countries for more than 1,000 years. This book, Galeni Pergameni omnia, quae extant, in latinum sermonem con versa (The surviving writings of Galen ofPergamum, translated into Latin), is a compilation of his writings published in Basel in 1561. The detailed hand-coloring of the frontispiece evinces the respect accorded to Galen's name even at this date. B u f f a l o conceptu et generatione hominis. The Rueff book was presented to the University Libraries by George M. Ellis, M.D., class of 1945. It builds on the strengths of the collection, which was started by james Platt White, M.D. (1811-1881), a founder of the UB medical school and its first professor of obstetrics. White's collection of more than l ,000 medical texts was bequeathed to the university and became the nucleus of the History of Medicine Collection. The late Robert L. Brown, M.D. '44, was a strong supporter of the History of Medicine Collection throughout his 25-year career in the medical school. Brown, who at one point served as acting dean and later became the school's first associate dean, supervised the merger with the State University of New York. He also served as the medical school archivist, locating and preserving historical records that otherwise would have been lost. In 1985, the year of his retirement, the History of Medicine Collection was named after him. Brown's $500,000 endowment to the collection is one of the largest ever received by the library system. The 12,000-volume History of Medicine Collection already houses a trove of unique books, the oldest dating to 1493. In this issue of Buffalo Physician, we introduce a few of them to readers. Physician W I n t e r 1 9 9 7 �MAKING ANDREAS HISTORY THE HISTORY OF M E D ICI E VESALIUS of Brussels revolutionized the study of anatomy in the 16th century with detailed descriptions and illustrations drawn from his own dissections. He generally suspended his specimens from a pulley, so the organs and tissues in his illustrations often appear to be dangling from the cadaver. Because his observations updated and sometimes contradicted those of the ancient authority Galen, Vesalius came under fire from some critics who accused him of disregarding tradition. While the original sketches may have been made by Vesalius himself, the woodcuts, some of the most famous images in medical history, are thought to have been carved by assistants to the artist Titian. Two hundred seventy-seven wood blocks were created for the 1543 first edition of De Humani Corporis Fabrica (Of the structure of the human body) and an accompanying abridged edition called the Epitome. Some of the original illustrations were replaced by copies in later editions. UB's History of Medicine Collection owns one of these, a fourth edition (the closed book shown above). The original blocks were lost and rediscovered several times over the next few centuries as they passed through the hands of collectors , artists, and librarians. The New York Academy of Medicine and the Library of the University of Munich printed what would become the book' s fin al edition in 1934, a copy of which is shown above and at right. The blocks were destroyed in the Allied bombing of Munich in World War II. B u f f a l o Physi c la W I n t e r 1 9 9 7 �-- - - -- MAKI ~-- ~ - ~ THE G HISTORY DE c 0 N c E PT U ET GENERAT I 0 N E -- ~ ~- - - -- HISTORY OF MEDICI - E H 0 MIN Is (Of the conception and generation of men) was published by Swiss obstetrician Jakob Rueff in 1554. The book's Latin text covers contemporary knowledge about conception, fetal development, uterine anatomy, birth, and care of mother and infant. Rueff is believed to be the first author to recommend the use offorceps in live births . The woodcuts, although in many cases derived from illustrations by Andreas Vesalius, also correct some flaws in Vesalius' representations of the fema le reproductive organs. The woodcuts were carved by Jost Amman, who was also noted for his Biblical scenes. Shown here are depictions of abnormal presentations of the fetus. Presented to UB this year by George M. Ellis, M.D., UB class of 1945, De conceptu became UB 's 3 mill ionth library volume. B u f f o 0 p h y c o n w e 9 9 �MAKING THE HISTORY HISTORY OF MEDICINE SURGEON BRITISH William Cowper published the first edition of his popular Myotomia reformata, or an anatomical treatise on the muscles of the human body only three years after he entered the practice of medicine. The 1724 edition shown here, with its beautiful copperplate illustrations and capital letters, was published posthumously. During his career, Cowper identif ied the bulbourethral gland and the fascia pectinea ligament, both of which are now named after him . He also published other works on hardening of the arteries and surgery of the maxillar sinus. One of Cowper's publications, The Anatomy of Humane Bodies, became the focus of a plagiarism scandal. Scholars believe he bought the copperplates to Anatomia Humani Corporis, published in Amsterdam by Govert Bidloo, and republ ished them with his own English text and a new appendix. Lacking modern copyright protect ions, Bidloo retaliated by publishing a scathing attack calling Cowper a literary crimina l. ® B u f f o l o Phys i cian w I n t e r 1 9 9 7 �- -- -- - MAKI --- - -- G HISTORY WILLIAM HUNTER'S TheAnatomyof - -- - - -- - - - - TH E O F MED I C I erus ex eHum 1 - E ite! in figures reveals both his expertise in medicine and the value he placed on art. Hunter and his artists and engravers worked for 30 years to create this book, which was published in 177 4 by John Baskerville. Born in Scotland , Hunter practiced obstetrics and surgery in London . He opened his own School of Anatomy and lived on its premises , teaching and building his collections of anatomical specimens, rare books , coins , and paintings . B u f f a t o Phys l c l a W I n t e r 9 9 7 �MAKING "LET THERE BE A THE HISTORY T t STD UT ASS I STA HISTORY OF MEDICINE hold the pa ient's head firmly, and let others put their hands on his arms and knees." Such practical advice for surgery before the advent of anesthesia is found in Bell's Great Operations of Surgery, published in 1821 by the British surgeon Sir Charles Bell , who made a special study of the nervous system and was the first to describe Bell 's palsy. In his Great Operations, Bell detailed the tools and procedures used in such operations as trephining the skull, correcting hernias, amputating limbs, and removing bladder stones. An accomplished artist, he also illustrated his own book. In his advice to young surgeons, Bell draws on the experience he earned during his career in London and Edinburgh: "The extraction of the [bladder] stone most requires patience, and a disregard to what spectators are thinking of you, especially fools with watches in their hands." According to an inscription on the flyleaf, this copy of Bell was given to Roswell Park, M.D., in 1882 as a Christmas present. Park's own signature also appears on the title page. ~ I ® 6 u f f 0 l 0 Physlclo w I n t e r 1 9 9 7 �- --- - - ---- - - MAKI -- ~-- -- - - --- ~ G HISTORY - --- - a stonemason , was admitted to the hospital on March 20 , 1854, with debilitating faintness and lack of appetite. He died the next day. This hand-colored lithograph portrait of lveson in Thomas Addison 's 1855 book On the Constitutional and Local Effects of Disease of the Supra-Renal Capsule, illustrates the patient's overall pallor and some smoky skin discolorations on his face and chest. Addison was the first to link the discolorations, the faintness, and the weak pulse with autopsy findings of diseased supra-renal capsules (the adrenal glands). The disorder, called Addison's disease , is now known to occur when tuberculosis or autoimmune problems destroy the adrenal cortex and result in deficiencies of aldosterone and cortisol. This edition of Addison is exceptionally valuable because it was presented to the History of Medicine Collection by George M. Thorn, M.D. , UBclass of1929, who was one of the developers of the treatment for Addison 's disease. The book is inscribed to Thorn by " a grateful patient. " u f f a l a Physician -- - - ~ TH E HISTORY O F ME DI C I IVESDN, e - W i n t e r 9 9 7 - E �• ····· ·· ···························· ···· ······················ · ················ · ········· . I New faculty member is a regular voice on NPR hroughout her career, Miriam Shuchman, M.D., has drawn on her medical expertise to write articles for the popular press and to create broadcast commentaries and documentaries. Today Shuchman, a member of the psychiatry departments at UB and the Erie County Medical Center, is also a regular medical commentator on NPR's "Medical Rounds." A graduate of the University of Connecticut Medical School, she completed her residency in psychiatry at Massachusetts General Hospital and Harvard Medical School. Fellowships at Dartmouth-Hitchcock Medical Center inN ew Hampshire and the Robert Wood johnson Clinical Scholars Program at the University of California at San Francisco allowed her to pursue her interests in consultation psychiatry and medical ethics. She has also worked as a psychiatrist at San Francisco General Hospital. Since moving to Buffalo in 1995, Shuchman has been spending three days a week at ECMC and the rest of the week in Toronto with her husband, Don Redelmeier, a physician on the faculty of the University of Toronto, and their son, 2-year-old Daniel. Some of Shuchman's work for the popular media has been in collaboration with Michael Wilkes, M.D., Ph.D., one of her classmates from both high school and medical school who now teaches at University of California at Los Angeles Medical School. In their first collaboration, an article for the Hartford Courant newspaper written while they were in medical school, they discussed the medical school socialization process that helps turn a student into a doctor. Later, in regular columns for the Los Angeles Times and the New York Times, Shuchman and Wilkes educated readers about such medical issues as clinical depression, back pain, smoking cessation, and vaccines. Their writing caught the attention of a National Public Radio executive, who invited them to create their monthly program for Weekend Edition Sunday. Their close professional relationship shows in the smoothness of their fastpaced discussions on the radio program. One of them may begin an explanation of the day's topic, and hand it over to the other to complete, as in a well-rehearsed duet. They translate medical terms into simpler language that will be familiar to a lay audience. When they disagree, they do so politely but unapologetically. In the week before each broadcast, Shuchman, Wilkes, and NPR host Liane Hansen hold a telephone meeting to choose a headline-grabbing topic. Shuchman then prepares herself with a blitz of research. She combs through professional journals and news clippings and interviews experts around the country. She may ask professional societies, such as the American Psychi- B u f f a I o atricAssociation, to provide background material, or seek the help ofNPRstaffin collecting relevant news articles. On a recent "Medical Rounds ," Wilkes and Shuchman discussed nonsteroidal anti-inflammatory drugs such as Aleve. They pointed out that these drugs can cause serious side-effects, including ulcers. Hansen asked whether self-medication was dangerous. ''I'm not sure that medicating oneself when it's a matter of having pain is such a bad idea," Shuchman said. "You don't want to always have to call your doctor and say, 'I have this pain again, what do you think I should do?' It does make it easier for people that they can walk into the drug store and talk to the pharmacist and say, 'I know that there are a number of these drugs which are over the counter. What do you suggest?"' "I think I've got to disagree, Miriam," Wilkes responded. "I think that few people talk to the pharmacist when they buy over-the-counter drugs. I'm worried about how many people end up in the hospital with serious complications like ulcer disease, etc., and even death, as a result of taking too many of these drugs. " The pair said later that the issue was one on which they have long disagreed. "Michael tends to wear a public health hat, and I tend to wear an individual patient hat," Shuchman said. "I really think there's a limit to how much people want to be protected from thingswhether it's in medicine or in something else, like the speed limit on the highway. We know that a 55 mile-perhour speed limit is safer, but people want to drive faster. " Much of Shuchman's media work focuses on mental health, including such topics as the impact of violence on children who witness it and the value of talk therapy and medication in the treatment of depression. She is working on a radio documentary on schizophrenia for the Canadian Broadcasting Corporation to be aired in spring 1997. Physician W I n t e r 1 9 9 7 �Why Jtay home for the holUJayJ? Tbefront-wbeel orive Infinitt-® /30TM Miriam Shuchman, M.D. Shuchman won the 1996 Media Award from the Northern California Psychiatric Society. It's unusual to get such praise for her journalism work, Shuchman says. "Far more often, you get a letter from someone who disagrees with you or is offended by something you said." But, she says, she appreciates even these letters. She recalls one example, a "Medical Rounds" program on a Supreme Court ruling that protected patient-psychotherapist confidentiality. "It's a stigma for people to find out you've been in therapy. It can often prevent you from being promoted at your job," Shuchmansaid on the air. "So the court was recognizing that people have to know that what they say to a therapist will be confidential in order to feel that they can even go into therapy." Shuchman also pointed out that religious confessions are generally considered privileged, and she described the public outcry over an Oregon case in which prison officials secretly recorded a murder suspect's confession to a priest. Within hours of the broadcast, Weekend Edition Sunday received an e-mail from an Oregonian. "Dr. Shuchman pronounced the name of this beautiful state, Ore-gawn," he wrote. "As every Oregonian knows, and as every easterner who's never been here seems never to know, IT IS PRONOU CED ORYGUN!!! as in 'He may have a knife OR A GUN!! ' Incidentally, people in Eugene are often B u f f a 1 a offended when people say YOU-gene rather than the correct pronunciation: you-GE E. So, let's all say together, 'The taped Catholic confession happened in you-GE E, Orygun."' Although the letter may have been a bit embarrassing, it did turn out to be a learning experience. In a later "Medical Rounds," Shuchman discussed state measures on managed care, including a proposition on the Oregon ballot. "Listeners might not have agreed with me, but at least I pronounced the name of the state correctly! " She adds, "If I get letters that are very moving, where people share their personal stories or have been offended or hurt by something I said, I'll often call back or e-maiL" In one case, after a program on mastectomies and lumpectomies, she spent several hours on the phone with a listener who had lost his wife to breast cancer. Shuchman sees her two careers, medicine and journalism, as closely intertwined. Being a physician gives her the credibility to influence the public's understanding of medical issues. "I keep getting grabbed by stories, coming from my patients, or my students, or the ideas that come up in practice." + "Medical Rounds" is broadcast once a month as part of NPR's Weekend Edition Sunday, which is heard in Buffalo on Sundays from 8 a.m. to noon on WBFO-FM. Physician w I n t e r 1 9 9 7 An interior /TUJre Jpaciou.J than a Rnli.J Royce Sif.,er Spur Ill. An exceptionally genermu lut of JtaniJariJ fu:r:ury featuru A 190-hp V6 capable of out-accelerating mo.ny lu:r:ury V&l. AniJ of courJe, the JtaniJaru-utting performo.na and Javia of 1nfiniti. SJ99 mo. ]6 mo. feaJe 1999.00 dou•n Intro ducing tbe all n ew 97' QX4® f rom 1]5,550.00 In an lnfiniti® QX4®, one of the firJt thingJ you 'll eJcape i.J the mundane. BecaUJe the QX4 i.J not your typical lu.:-cury Jporl utiliiy vehicle. Whdt: it o/ferJ all the verJatility you e:r:pect from a vehicle of itJ l::iniJ, the QX4 offerJ Jomething you IJon 't e.:r:pect: the lu:r:ury of an I nfiniti. I N FIN IT I AUTO PLACE INFINITI 8129 MAIN ST., WILLIAMSVILLE 633-9585 East of Transit Rd ., Near Eastern Hills Mall ( 130-$450). Bank fee + tax and license due at inception. 12,000 annual mileage. s.15 per mile' in excess. �Trauma surgeon John R. Border dies ohn R. Border, M.D., an internationally known researcher whose pioneering work continues to save thousands of accident and injury victims from multiple-system organ failure, died on Monday, ov. 11, of a heart attack at his South Wales, NY, home. He was 70. Border, who joined the UB faculty in 1965 as a member of the Department of Surgery, was director of the trauma service at Erie County Medical Center and director of UB's Trauma Research Program from 1968 until his retirement in 1991. In the early I970s, he led nized and treated as soon as a team of UB researchers in possible after the original developing treatment plans trauma," he emphasized. to prevent the stress of seMuch of the lifesaving vere, multiple trauma from research over the years was producing a chain of biofunded through grants chemical events that, if not from the National Institreated with combination tute of General Medical protein and glucose therapy, Services. could lead to death. Although officially retired, Ina 1982 interview, BorBorder continued his work, both locally and internationder explained that when the John R. Border, MD . . body does not receive adally, to improve the treatequate amounts of protein to meet in- ment of trauma patients. Wearing his creased demands to maintain function trademark fire-engine-red suspenders, and begin repair of damaged tissue, it white shirt and tan slacks, he regularly draws on its own resources from muscle visited his office at ECMC. and other vital organs. The modest, soft-spoken Border "The fatal sequence-multiple- trained hundreds of UB medical stusystem organ failure-must be recog- dents and residents during his career, WNY's Largest Volume BMW Dealer THE ULTIMATE DRIVING IF BEING STARED AT MAKES YOU BLUSH, PLEASE CONSIDER YOUR CHOICE OF COLORS ACCORDINGLY. MACHINE~ F. G. DOWNING Towne BMW 3030 Orchard Park Rd . Orchard Park, New York 14224 Phone: 675-2550 $29 320 ' 1996BMWZ3 With a plethora of colors to choose from, you'll want to pick a roadster that goes with the crimson hue you 'll be sporting each time you take it for a spin . Service Loaners Available ... Minutes From Rich Stadium a u f f a l a Physician W I n t e r 1 9 9 7 �- - - --- -----~~- - - --~-- --- - - - HURWITZ & RNE, P.C. [ ATTOR EYS AT LAW I inspiring them by his example to not only be good surgeons, but to practice the art of the profession. It was not unusual for him to sleep overnight in his office at ECMC in case a patient he was especially concerned about needed him during the night. A 1956 graduate of Harvard Medical School, he did his undergraduate work at Harvard College and Indiana University. He served in the U.S. Navy Submarine Service from 1944-48. He and his wife, the former Donna Orvedahl, traveled on the Great Lakes and down the East Coast on their sailboat, Don]on II. + SERVICING THE LEGAL NEEDS OF THE HEALTH SCIENCES C OMMU ITY • Managed Care • Purchase & Sale of Practices • Business & Tax Planning • HCFA Safe Harbor Regulations and Physician Self-Referrals • Contracts with Private & Public Entities • Employee Relations Counseling • Fringe Benefit Programs "It's ok to ploy!" said Ringling Bros. clown John Lynch. Lynch, the son of on endocrinologist, discussed humor in medicine with students in Butler Auditorium while the circus was visiting Buffalo in November. • Representation Before Government Agencies on Audit & Business Issues • Facility Finance and Construction • Credentialing and By-Laws • Hospital/Medical Staff Issues Please contact Robert P. Fine or Lawrence M. Ross at 716-849-8900 Fourteen physicians have completed UB's first Master's Teaching Fellowships, which offer training in clinical teaching and precepting. Bock row: Thomas Scanlon; Michael Terranova; Jock Coyne; Richard Carlson; Joe Lanigan; Sanford Levy; Anthony Vetrano. Front row: Tim Siepel; Donald Robinson; Colleen Mottimore; C.V.P. Varma; David Novelli; Thomas Gerbasi. Not pictured: Richard Ruh. 6 u f f a l o Phys ician w I n t e r 1 9 9 1300 Liberty Building Buffalo, New York 7 �TAKE TWO. I I AND CALL ME IN THE MORNING! f;"\d ~o..,r OW"\ ro(l[ * Fact: Saab owners have a elebrate the higher education level than any other car owner group. * Saab purchase prices starting low to mid 20's; leases starting at $299 per month. • * According to the Insurance . lfl Marrtott Institute for Highway Safety {IIHS), the Saab 9000 has the lowest fatality rate of any production car on the market. SOUTHTOWNS SAAB tyle! 3580 Southwestern Blvd (1 Mile east of Rich Stadium) (716) 662·8008 From elegant parties to informal get-togethers, let the Buffalo Marriott host a celebration filled with warm fellowship and gracious hospitality. TheDollar Doctor... For Exceptional Entertaining ... Banquet rooms accommodating 10 to 1000 Superb catering with choice of packages Expert planning assistance For Your Office Festivities . .. Enjoy a special holiday luncheon or dinner with Panache Restaurant's delicious steaks, seafood and pasta. Information Insights Opinions Finances Stocks & Bonds Call in Listen In For Anytime Holiday Cheer! Stop in The Night Club Lounge for dancing and socializing with old friends and new! Book your holiday party today! Call the Catering Office at 689-6900 Ext. 61. BUFFALO.,\\arnott. 1340 Millersport Highway Amherst, NY 14221 (7 16) 689-6900 (800) 334-4040 FAX (7 16) 689-0483 WWKB, 1520 Saturdays 9:05 to 10:00 am ~~P!:,!:~~IJ Member: American Stock Exchange, NASD, SIPC 237 MAIN STREET Tel: 854 -7541 ® 6 u f f 0 l 0 Phys ici an W I n t e r 1 9 9 7 �·--- - - --~ ~ - - TRACING THE MOVEMENTS OF CELLS When walls between research disciplines break down, the change opens up new opportunities and new ways of looking at old problems, according to cell biologistjohn Kolega, Ph.D. B u f f a 1 o muscle cells; specifically, the migration of the endothelial cells that line blood vessels. These cells migrate during normal development when blood vessels are formed, and also during wound healing, tumor growth, and diabetic blindness caused by blood vessels forming in the retina. Kolega is attempting to establish how and when cells organize and distribute the motor protein myosin II, and how cells regulate the function of the protein. To watch cells move in three dimensions, Kolega places them in a collagen gel. Careful observations of moving cells are revealing how this molecule might act to move different parts of a cell as it crawls. A related project that examines how electrical stimuli affect the permeability of a sheet of cells may shed more light on cellular mechanisms of blood vessel leakage. Although some of the molecular structure and mechanisms are beginning to be understood, it's not known how they all work together. Visual imaging may provide some of the answers, Kolega says. For example, he uses fluorescent imaging to examine spe- Physician W I n t e r ~ cific proteins within living cells as they move. "One of the things that is exploding in my field is the imaging technology-the whole battery of different forms of microscopywhich is allowing us to visualize things in the cells that we could never see before. Things that were worked out by biochemists in test tubes are starting to be seen within the living cells. That is going to take the tremendous advances in molecular biology and translate them into real biological behaviors. We can now start to watch these things happening." New discoveries in the field are likely to be applicable to all cells, Kolega says. "I happen to be working on endothelial cells, in part because it's easier to get funding for something with clinical applications, but I like to think that my work will help answer the basic question of how non-muscle cells migrate." + John Kolega, Ph.D. Cell Biologist "It's no longer good enough to know everything about molecules or cells or organisms," he says. "The really interesting things are going on at the interfaces between the old disciplines, where you have people with different expertise looking at a system from different levels." Thanks to this new interdisciplinary emphasis in research and education, Kolega is now delivering human anatomy lectures to firstyear medical students, in addition to working with endothelial cells in the lab. Kolega, 38, earned his doctorate at Yale and held post-doctorate positions at the National Institutes of Health, New York University Medical Center, and Carnegie-Mellon University. Upon joining the Department of Anatomy and Cell Biology at UB, Kolega took a crash course in human anatomy so that he could share the responsibility of teaching basic preclinical courses. He spent virtually every day of his first year at UB in the anatomy lab. "I was just one step ahead of the students," he groans. When not lecturing or supervising dissections, Kolega continues his research into cell migration. His field is the locomotion of non- - - -JESSICA 1 9 9 7 ANCKER �• ............... . ... . ................ . . . ....... ~ I Extemships provide a taste of the real thing ven with today's emphasis on clinical experience in medical education , it's not every second-year student who gets to do an abdominal paracentesis or a flexible sigmoidoscopy. Clayton Polowy did. "I had some serious hands-on experience as far as procedures went," Polowy recalled of his 1996 experience in UB 's Primary Care Summer Externship program. "It's basically primary care medicine and preventive medicine at its highest degree ." Polowy, now a third-year student, was one of 7l first- and second-year students in the program last summer. The externship, which pays students to spend the summer working with a primary care doctor, was developed in 1993. Of the 55 externship participants who have graduated from medical school, more than two-thirds have gone on to residencies in primary care. "It's designed to give students a taste of reality in Geraldine Kelly, M.D., supervises as student extern Mark Oberlies terms of primary care mediexamines a patient. cine," said Kim Crooks, who coordinates the program at UB's Primary Care Resource Center. "A certain. The current budget comes from lot of programs are modeled after this one. a variety of sources, including the mediI get calls from all around the country." cal school, the Robert Wood johnson The six-week externship remains un- Foundation, and the state Department usual in the large number of students it of Health. The Independent Health enrolls and in the stipend it pays: $1 ,200 Foundation has also provided support for first-year students and $2,000 for since 1995, and it recently decided to those in their second year. That helps make a significant contribution for 1997. push the annual cost to $125 ,000, but it "The goal of the foundation is to immakes it possible for more students to prove the quality of health in the combenefit from the full-time externship ex- munity, and we feel strongly that if perience. ''I'm maxing out my loans," there is a large pool of primary care said Polowy. "It was nice to feel that I physicians in the area, we're going to be didn't have to work on top of doing that. " able to accomplish that," said joanne Because it has no guaranteed source Way, the executive director of the founof funding , the program's future is un- dation, which is connected with the ADMISSIONS TEST January 11 and February 8, Upper and Middle Schools March 8 and April 26, Middle School • Exceptional college placement record • Challenging curriculum with the most Advanced Placement courses in Western New York • Average class size of 14 students • More than 60 athletic teams • Comprehensive visual and performing arts program • Financial aid available For further information, call: 875~8212 ICHOLS MIDDLE SCHOOL, 175 Nott ingham Terr. NICHOLS SCHOOL NICHOLS UPPER SCHOOL, 1250 Amherst St. B u f f a l o P hysician w I n t e r 1 9 9 7 �- - - -- ~~-- -· - managed care company Independent Health Association. In addition, the Millard Fillmore Health System, the Millard Fillmore medical staff, and the Howard Wilding Memorial Fund of the Millard Fillmore Health Education and Research Foundation have made donations totaling $30,000. The externship is a way of introducing students to clinical medicine and the Buffalo medical community, said TimothyGabryel, M.D., vicechairmanofmedicine at Millard Fillmore. "It helps them to see that what they went to medical school for really exists," he explained. "The best feedback for us is when we see the enthusiasm in the students," said TonyBarthalomew, M.D., who with his partner, jay Bishop, M.D., has been an externship preceptor since the program started. It was at their Fredonia practice that Polowy got his experience. "In six weeks you really get to see a lot," Polowy said. "One time, I did a joint injection." He recalled how his preceptors would take the time to pull a book off the shelf before discussing a procedure, or would provide an immediate critique of the way he interviewed a patient or made a presentation. "I was always treated by the staff and the physicians as a colleague," the student said. Emily Calkins, another third-year student, was inspired by her 1996 externship with Deborah Richter, M.D. , in Buffalo's Geneva Scruggs and Mercy health centers. "She was just a great role model for me , which I needed during medical school," said Calkins. "You see so many social problems , and she handled them so well. For many of these patients she was the only place they could turn for help. I keep her in the back of my head at all times , wondering, 'What would Dr. Richter do? "' Mark Oberlies, a third-year student who has had two summer externship experiences, said he was already interested in primary care, but he had a nagging uncertainty about whether any B uffalo - - - physician could truly master the scope of practice encountered by generalists. "As a medical student you feel so utterly clueless when there's so much coming at you, " he said. "You just think, 'I've got to get to my little area of medicine and learn everything I can about it. ' At the same time you've got people telling you to be a famil y doc and take care of everything. I needed to see if I could do that. " Oberlies spent the first summer working with geriatric patients under June Chang, M.D., and the second summer with Geraldine Kelley, M.D., at Mercy Hospital. "I take a lot of comfort from the examples of these people," Oberlies concluded. "I have a lot of respect for the people I've met in both externships. The greatest success of the program for me was that it showed me that primary care is doable. People can do it, and do it well. " + - AN DREW D A N Z 0 - & THE ULTIMATE DRIVING MACHINE ~ Checkpoint Foreign Car, Inc. Sales and Service • 487 Kenmore Avenue Buffalo, NY 14223 UB and Buffalo General announce new partnership with Bosnia 836-2033 fficials from UB met at the White House on Oct. 2l for a ceremony to announce a partnership to help Bosnia rebuild its health-care system after years of war. Leaders from UB, the Buffalo General Hospital, and the city of Buffalo were guests of Hillary Rodham Clinton. Buffalo General has had an informal relationship with Tuzla Clinical Center for two years, through the efforts o[Jacob Bergsland, M.D. , a cardiothoracic surgeon and UB associate professor of surgery. The new project, funded by $2 million from the United States Agency for International Development, will offer educational programs and the exchange of clinical personnel. Nearly 120 healthcare professionals have already enrolled in the program at the clinical center in Bosnia-Herzogovina. + Your WNY Leasing Specialist Serving WNY proudly for 33 years Physician W I n t e r 1 9 9 7 • - • ~AR ® �THEN ~~AND~ N 0 W When the germ theory was still atheory BY GEORGE HADDAD, eorge Haddad, M.D. '94, is pursuing a doctorate in the Department of the History of Science and Medicine at Yale University. In his paper "Germ Theories, Scientific Medicine, and the Buffalo Medical Community," Haddad argues that there were numerous kinds of germ theories before Robert Koch's discovery of the tuberculosis bacillus, and that much of the local scientific debate was actually a "fixing of the meaning" of the phrase "germ theory." He also shows that scientific advances did not move, ready packaged,from European and American academic centers to peripheral communities like Buffalo. Instead, these smaller communities underwent their own periods of debate and upheaval before reaching consensus. The following excerpts from Haddad's work focus on the writings of one outspoken opponent to the germ theory. Haddad's full paper, along with other articles on western New York medical history, is being published in Medical History in Buffalo 1846-1996: Collected Essays, by the Friends of the Health Sciences Library and the University at Buffalo School of Medicine and Biomedical Sciences. Copies are available from History of Medicine curator Lilli Sentz at (716) 829-3024. Fighting the new theory F rederick R. Campbell was born in Niagara County in 1860. He graduated from the Buffalo Medical College at age 24 and later joined the medical department of Niagara University, where he taught "Hygiene" and "Materia Medica and Therapeutics." In addition to medical acumen, he had literary and historical interests, and his schol- M D arly output included a book entitled The into a certain lineage of medical theories, Campbell opened the germ theory Language of Medicine. In june of 1885, Campbell wrote an to criticism that other theories also faced. Two years after Robert Koch's discovarticle entitled "Chemical vs. Germ Theories of Disease" in which he offered ery of the tubercle bacillus, Campbell a historical account of the dialectic be- realized that the role of doctors in the new tween the "chemical-humoral" and germ theory world was about to change. "germ-parasitic" theories of disease. just "When the germ theory becomes an esas the history of philosophy had experi- tablished fact," he scoffed, "the true phyenced a dialectic between idealism and sician will become a mere manipulator of materialism, Campbell believed that germicides, and the pathologist a student of microscopic medicine, too , had botany." a specific sort of This did not dialectic between mean Campbell different theories of was opposed to an disease. He wrote: "There was a huideal of scientific progress in medimoral pathology of cine. On the conthe Ancients, estrary, he saw sentially a chemichemical theories cal theory of disof disease and orease, replaced by ganic chemistry as the vegetable parathe legitimate heirs sitic hypothesis of to the scientific traVallisneri, dition. He claimed Hauptmann, and that there were Linaeus. Then "many honest sciStahl proposed a entific men who purely chemical are unwilling to theory of disease, accept, in their but this has been Frederick R. Campbell, M.D., in a portrait present state, the followed by the published posthumously in the BuHalo Medical views of the germ theory, sug- and Surgical Journal. 'bacteriologists.'" gested by the revIn his comparison of chemical and elations of the microscope, and brought to its present stage of development by germ theories, Campbell exploited the such men as Virchow, Pasteur, Tyndall, optical limits of microscopy and offered and Koch. " a large number of well-articulated obBy placing the germ theory within a jections to a germ theory. For example, genealogy of medical theories, Campbell microscopes of the time could not disstressed the contingency and contro- tinguish between bacteria associated versial nature of a germ theory of dis- with very different diseases, and so, as ease. Moreover, by placing a germ theory far as Campbell knew, they were identi- B u f f a 1 o Phys ician w 1 n t e r 1 9 9 7 �- ~ -- - - ~--------, -- - - - - -- T H E N ..A'NDII N 0 w cal to each other. However, Campbell and antisepsis were mediated through thought it was nonsensical to blame chemical processes. The germ theo"identical" bacteria for varying diseases. rists, according to Campbell, had He also asserted that "bacteria and serendipitously, through erroneous theories, fallen micrococci are always found on the upon the proper surfaces of mucous methods of surmembranes and gical antisepsis. these organisms In a translation differ in no respect and commentary from those found in upon a French ardiseases." Moreticle published in over, he denied the the Buffalo Medical clayo al<l, •llowiloc 'I" ...... contagiousness of and Surgical jourtuberculosis and in- This laboratory sketch of cholera germs under the nal, Campbell exsisted that tubercu- microscope was published in the BuHalo Medical pressed his concern losis could be and Surgical Journal by George W. Lewis, M.D., about the social caused by a number a contemporary of Campbell's who defended costs of accepting of different, non- Koch's germ theory. At the time, it was rare for the germ theory of bacterial "irritating the journal to print any drawings or visual aids. disease: substances." "As to the social Campbell's "chemical theory," on the consequences, they have been seen in the other hand, explained infectious dis- recent epidemics in Italy and the south of ease by insisting that the introduction of France, where scenes of barbarism befit"some chemical substance" can result in ting another age were enacted. In Italy, it disease. He believed that chemical poi- appears proprietors demand that persons, just like drugs or bacteria, could sons suspected of having phthisis [tuberhave "selective powers." Moreover, culosis] shall vacate their property." In this piece, Campbell asserted that Campbell believed that chemical theories offered a "more rational basis of laboratory scientists do not do as much treatment than germ theories." Ulti- for practical medicine as "those who mately, Campbell believed that a chemi- pass their lives surrounded by diseases." cal theory of disease would be estab- Campbell's belief that he and the other lished as fact once scientists studied opponents of a germ theory were depathological chemistry as well as patho- fenders of "true clinical medicine" reflects the cleavage in medical identity logical anatomy. Campbell ended his diatribe against that the germ theory controversy progerm theories by rhetorically equating duced. Campbell drew a clear line bebacteriologists with alchemists. Bacteri- tween the practice of traditional bedside ologists "have already given the world medicine and the laboratory dabblings many valuable discoveries," he began. of the new medical scientists. In another Buffalo Medical and Surgi"] ust as the alchemists of old, while seeking the philosopher's stone and the elixir cal journal contribution, Campbell vitae, brought forth what was even more scoffed at bacteriologists for claiming valuable to mankind, modern chemistry, that they had discovered the true nature so the microscopists have paved the way of disease and reminded them that they, for the greatest discovery of modern medi- just as past believers in systems of medicine, were susceptible to new discovercine, surgical antisepsis." By this, Campbell did not suggest ies and revisions: "Were not the astrologists, the that antisepsis relied on a germ theory of disease. He firmly believed that sepsis humoralists, and the solidists of old ----...... ... ...................._ ""'..._·_ B u f f a 1 o PhUSICian W I n I e r 1 9 9 7 equally as certain as the modern bacteriologists, that they had discovered the true nature of diseases? Who can say that some writer in years to come will not ridicule those 19th century doctors who believed that microorganisms, like the demons of old, produced diseases in man?" A laudatory obituary of Campbell appeared in the same issue of the journal. His life ended at age 28. "He fell victim to typhoid fever, after a sickness of over a month," wrote the editors, who then tactfully commented, "Indeed it may be said that his death was the result of overwork enfeebling a physical system not robust and making it an easy prey to disease." Through modern hindsight, Campbell may appear hopelessly unprogressive, but he can also be cast in a sympathetic light. He did not study in Europe, and he, like most other American medical school graduates, did not have extensive training in microbiologic techniques. He saw a germ theory as a threat both to traditional medical practice and to his own sense of professional identity. His opinions did not fall along expected generational lines, nor did his opposition to a germ theory mean that he was against a scientific ideal in medicine. In fact, Campbell repeatedly made the claim that his "chemical theory" was the true heir to the scientific tradition. In addition to his theoretical and practical objections, Campbell saw a germ theory as a threat to traditional sources of professional identity. Campbell believed that true doctors spend their lives surrounded by the sick rather than peering into a microscope. His turn to the analysis of medical history may just have been an idiosyncrasy of his personality. However, it may reflect a greater tendency of physicians to make sense of changing values and meanings by turning to the study of medical history. + �I Achilllce to put idealism into practice BY CHRISTOPHER J. DIMAIO have wanted to become a doctor since I was a child. I did not have any life-altering experiences that led me to choose this career. I simply loved science and wanted to indulge myself in the highest level of science possible- human medicine. Thus I find myself in the middle of my first year of medical school, and I am loving it. But let's face it. My life is not as rosy as I may make it out to be. Ask any medical student, myself included, a seemingly harmless question like, "How's it going? " and you will find that you have just set yourself up for a formidable avalanche of complaints and frustrations about "how much work I have ," "how far behind I am, " and the ever-popular, "I need more sleep! " I can only compare the experience to trying to finish a plate of food only to have the waiter bring out another serving. just when you're wiping your mouth clean with the napkin, two more plates come out. And just when you thought you couldn't eat another crumb, the waiter decides to bring out the main course. Not hungry? Well , too bad, because the chef is just getting started. To be honest, I feel that all of the hard work and sacrifice is worth the effort. My experiences in the past four months have been unlike any others. Every day I get to ask the question , "How does the body work? " and every ® day I get another answer. My experiences go way beyond those in the classroom, though. I will never forget the rush of adrenaline I experienced when I made my first incision on a cadaver, or when I was firs tasked to do a physical examination on a patient. new cases, and how we should learn from the cases we have seen in the past. Most important, we are beginning to learn how to feel like doctors: how, when we are presented with a new case, we realize that this isn't simply patient #6578463, but rather Mr. Thomas O'Donnell who lives around the corner, has a wife and three children, and one day hopes to retire to Florida. The knowledge and information I will have gained from my years at UB will be with me for the rest of my life, and will allow me to carry on a tradition of treating those who are ill, and protecting those who are not. It is a dedication that will allow me to realize my noble thoughts of what a career in medicine should be. In each issue, Buffalo Physician invites a medical student to write a column about a topic of his or her own choice. A member of the Class of 2000, Christopher]. DiMaio is in the middle of his first year of medical school. It is exciting to know that this is only the beginning of my medical career, and that a lifetime of similar experiences awaits me. I stated my idealistic views of medicine in my application essay: "I truly enjoy helping people, and would like to have a career that allows me to make a difference in the lives of those who seek it." Today, my visions are being realized. We are learning how to think like physicians, how we should approach B u f f a l a Physician W I n t e r 1 9 9 7 I �Put tfze.best seat in tfze fwuse myourgarage. UB:MICRO CDMPUIERSALES A Non-Profit UNIVERSnY AT BUFFAIDS Yl PRoGRAM Advertise in one of the finest publications in Western New York ... Call 645-3554 www .computer-store. ubmicro.buffalo.edu Buffalo Physician YOUAREEUCJBTE ~Uff"lj for educationalpricing f " ~ s\ t \ " " DflL•COMPAQ•ZfNIIH APPlE•ACffi llXASINSIRUME\Tf Cl:l!:!!~ HEWIEIT9I(J(ARD - MICROSOFf•CORFl•ADOBFAND MUQI i\Om 1997 Buick Riviera Riviera: the most sophisticated personal luxury car Buick has ever offered. It is designed to stir the spirit and excite the soul. We at Paul Batt Buick are proud to serve the people of Buffalo and its surrounding communities. For the last 43 years, we have offered the lowest prices possible, along with the very best in service. We value the professional and the hard working labor force in our community and will continue our efforts to maintain their loyalty. When you enter our showroom you will find helpful people, not pressure-so when you think of Buick sales and service, we know you'll think of us! Joseph R. Pera Paul V. Batt, Jr. 'ldut7Jau-7Jtdd 1717 Walden Ave., Buffalo, NY Give us a call: (716) 645-6933 Phys APPLE ScHOOL REwARDS Michael J. Baranski Marketing Representative Pun:hase any qualifymg \lacintosh desktop computer, Apple display (if sold separately), and Apple printer through 1119/97 and earn poin~ for any school or your choice (to be redeemed for Apple products) IOMEGA REBATE OFFER Purchase an Iomega Zip Ori\'e, and recei\'e by mail either a $50 rebate, OR more than a $ISO >'alue "Game Pack-to-Go" Pun:hase an Iomega Zip Disk Ill-pack, and =i>< by mail eother a $20 rebaie, OR more than a $6o value "M Stuff Orpnizer". See Iomega maol-m renoCicate at l'BMocro for details. Rebate through 1/31/97. $so HP DEsK}ET 340 sERIEs REBA1EOFFER through 3/31197 See HP mail-on rertiOcaie at UB\Iocro for details CoMPUTER WORKSHOPS Call 645-3560 to have a brochure mailed to you. BARANSKI Open Mon thru Fri 11-5; Wed & T hurs 11-6:30 Coli for curr~nr priCin~ and Q\'(jifabilm·, Pnas subJ~Ct to dmnR~ witlwut noiiCt' ADVERTISING 891-5595 Buffalo Pun:hase any qualifymg Macintosh desktop computer. Apple display (if sold separately), and Apple printer through 1/19197 and rereire a $150 mail-in rebate. ician 146 Stepping Stone Lane Orchard Park, NY 1412 7 W I n I e r 1 9 A non-profit University program for students, faculty & staff The Commons • North Campus • (716) 645· 3554 • Fax: 645-3&84 9 7 �Aman who touched aenerations of students JACK RICHERT , ASSOC IATE DEAN FOR ALUMN I AFFAIRS , RETIRES ack Richert left many in the UB community with fond memories when he retired Nov. l from his position as associate dean for alumni affairs. It's no wonder, because he has touched the lives of hundreds of students- doing everything from helping them finance their education to keeping in touch after graduation. "I've met wonderful people in all my sions, student affairs , curriculum, medidifferentpositionsatUB," he says. "Now, cal school publications, and financial I can go to any major city and look in the aid. He also served as coordinator of Medical Alumni Directory and find post-graduate advisement and director people I know. It's a great feeling ." of the U.S. Foreign Medical Graduate He first came to UB to earn a master's program. In the latter capacity, he won in counseling psychology and a doctor- a $226,000 grant from the U.S . Departate in academic administration. The ment of Health, Education, and Welfare medical school hired him in 1970 as to create a pilot program for these transfer students. registrar and assistant to the dean. Former associate dean Leonard Katz, It was a time of rapid transitions. The dean who had hired him, Leroy A. Pesch, M.D., worked with Richert to bring stuM.D., left in 1971. Clyde L Randall, dent affairs and curriculum together in M.D., and F. CarterPannill, M.D. , served the new Office of Medical Education in as acting deans in quick succession. It 1975. "jack took the lead in student affairs ," Katz rewasnotuntil1975, members . "He with the arrival of was also extrajohn. P. Naughton, " IT'S BEEN GREAT TO SEE ordinary at arM.D ., that the SO MANY STUDENTS WHO school had a perranging events . CAME INTO MY OFFICE ON manent dean. For example, at Naughton credgraduation he THE FIRST DAY OF CLASS its Richert with added color with GROW AND MATURE AND BE helping to shore up a huge UB banthe administration ner , arranged for SUCCESSFUL ." music, and added during this period. other touches to "It was a very tough make ita wonderfew years, and jack was one of three ful pageant and a people who served as the 'glue' to hold great celebration." He took over the alumni affairs office services together for the students," he in 1984, and soon became associate dean says. In 1972, he was promoted to assis- and director of medical alumni affairs. tant dean. At various times in the folHe has had a profound impact on the lowing years , he led the offices of admis- Medical Alumni Association. When he B u f f a l a first became involved with the group , it sponsored only a few activities a year. I oday, as a result of innovations he introduced or facilitated , it is active yearround, offering events, lectures, awards , and educational programs for alumni and current students. He also helped expand the annual Spring Clinical Day program into an entire reunion weekend. The new Distinguished Alumni Awards and Alumni Achievement Awards recognize outstanding accomplishment. Receptions at national medical meetings make UB alumni feel welcome everywhere. The Medical Alumni Association has also become much more active in student life. The association donated money to furnish the medical student lounge, and it participates in student and resident orientations. It also sponsors scholarships, student travel to scientific meetings, and travel to work in developing countries. The association's Community Physician Program invites doctors to give luncheon talks to medical students about career choices, types of practice, and lifestyles. Richert also chaired the Buffalo Physician editorial board, where he helped the dean choose board members that represented the entire UB community, and was sensitive to readers' desires about the look of the magazine , according to fellow board member Bradley Truax, M.D. '74. "jack wanted to make this magazine something that the alumni would enjoy and look forward to getting rather than just throw in the wastebasket," Truax says. One of Richert's accomplishments was the creation of the james Platt White Society, which honors alumni who make annual gifts to the school of $1 ,000 or more. Philanthropy was not the only Physician w I n t e r l 9 9 7 �..L_ - -- - - - -- - - - - - - - - - . . .. .. . . . . . . . . . . . . . . .. -~ • goal of the organization. "My goal in creating the society was to help our alumni reconnect with UB ," he explains. "There had been something of a breach between the people who graduated from the private University of Buffalo and those who graduated from the public University at Buffalo (after the 1962 merger of the university with the SUNY system). We had graduates who lived nearby and had never been back to the school. We needed to bring them back, reconnect them with the school, and show them that they were still part of our community." "None of these good ideas would have come to fruition without jack," says alumni association past president Margaret Paroski, M.D. '80, who met Richert when she was a student and he was assistant dean for student affairs. "He has a real knack for persuading people to participate, take on responsibilities, and get things done, and he's always understood how important volunteerism is to the school and to medical teaching in general. " Richert's engaging manner , good memory for names and faces , and gift for B u f f a l o building friendships have been key to his success at UB---and will make him missed. "I was accepted just four days before school started, so I showed up with no idea about where to stay," recalls jack Coyne, M.D. '85 , Medical Alumni Association president. "jack put together a whole list of possibilities, and found ways for me to fund my education, too. Physician w I n t e r 1 9 9 7 He took a personal interest-it was more than just a job. " In retirement, Richert plans to catch up on reading and research ("There are a lot of libraries I have neglected for too long! ") , get involved with volunteer activities, work on his century-old house in Buffalo, and spend more time with his wife and their daughter. "As I retire, I think what a nice time it was. There were obviously peaks and valleys , but I think the peaks outnumbered the valleys ," he says. "It has been wonderful to watch the school move into national prominence. "I also think about the pleasure I've had in meeting so many fine people who have become my personal friends. And it's been great to see so many students who came into my office on the first day of class grow and mature and achieve and be successful." Recruited by admissions director Thomas]. Guttuso, M.D., Richert will also serve as a volunteer member of the medical admissions committee. And so , even in retirement, he will continue making connections with new members of the UB medical school community.+ -JESSICA A NCKER �Wende W. Logan-Young, M.D. '61 FOUNDER AND DIRECTOR OF THE ELIZABETH WENDE BREAST CLINIC BY ANDREW DANZO ack in the mid-l970s, a diagnostic radiologist had a radical idea. Armed with emerging breakthroughs in imaging technology, Wende W Logan-Young, M.D., felt that radiologists should move out from behind their x-ray viewboxes to play a more central role in the fight against breast cancer. In pursuit of this vision, Logan-Young founded the Elizabeth Wende Breast Clinic in Rochester, NY. Now radiologists at her clinic and similar ones in other cities are giving women more timely and compassionate answers to some of their most fearful questions and reducing the need for surgical biopsies. "Ours was the first clinic where the radiologist intervened and started doing more of what the surgeon did ," ® Logan-Young recalls. "Before, the traditional role of the radiologist was to sit down at the end of the day and look at the image made earlier by a technician. There was no patient contact. " Logan-Young named the clinic after her mother, who taught her the kind of compassion she tries to bring to her own work with patients. "She was my role model , just a fabulous person," Logan-Young says. B u f f a I o P Logan-Young has been a pioneer in the use of a multiprocedural approach that stresses the importance of taking a good patient history and conducting a thorough breast examination, in addition to utilizing ultrasound and 14-gauge needle gun biopsies. With her associate , Nancy Yanes Hoffman , M.S., she published Breast Cancer: A Practical Guide to Diagnosis in 1994. The book is to be the first ofthree volumes; she is currently working on the second. "The book is a distillation of 20 years of what worked best," Logan-Young says. Those years represent a second, perhaps third , career for Logan-Young, who is one of a long line of Buffalo physicians and UB alumni. During her time at UB, she was married to classmate] onathan Logan, M.D. '61, and was called Wende Logan. "It was a hell of a good school," Logan-Young recalls. "I still have very good feelings about the university. " She originally entered internal medicine. After having four children, however, she couldn't keep up with the demands of the practice and switched to radiology. She joined the University of Rochester School of Medicine faculty and got involved in testing new lowdose x-ray films. If it could be perfected, she realized, low-dose mammography could open new doors in breast cancer screening and diagnosis. She also noticed how grateful women were when she told them their results on the same day. "This was considered heresy in 1975," she said. At the time, and not uncommonly even today, radiologists were supposed to report only to the referring physician, a protocol that she said caused delay and anxiety. "It sounds like a small point, but it isn't, " she says. She became convinced that there was a need for radiological practices devoted to breast cancer. "I went around to every group in Rochester and begged them to take me hysician W I n t e r 1 9 9 7 �--- ----- - - - - - -- - - - -- -- - - - -- - "O~RS~IWAS~~ili HE!!IIF.IRSli C l.!! INIC!J,,W8ERE:!!,~ili 8E RADIOI!OGISlijiiiNliERVENED AND STARli ED)~DOING~IMORE O F.: WHAli il'~ili HE S~RGEONn EIDE W. loau·YOUIG, with that concept," she says. "They all said I was crazy. So I opened my own office." As she was setting up, she read an article about using an ophthalmic ultrasound scanner for breast exams. Researchers had reported promising results with ultrasound breast imaging since the 1950s, and by the mid-1970s several physicians around the country were using ultrasound for breast exams, but there was still no commercially available machine designed explicitly for that purpose. Logan-Young bought one of the ophthalmic units. "At that point," she says, "there wasn't a radiologist in the country who was combining ultrasound and radiology." By bringing the best tools for breast cancer detection- clinical examination, ultrasound, and mammography-under one roof, Logan-Young felt that the techniques could complement one another to more accurately identify real cancers and to reduce the number of surgical biopsies on masses that proved benign. But there were problems to be resolved with the low-dose film. LoganYoung organized national meetings on that and related issues at Roswell Park Cancer Institute in 1977 and 1979. "A lot of the equipment changes that came out resulted from those meetings," she recalls. Logan-Young continued publishing her results with low-dose mammography and ultrasound. She also traveled the country demonstrating techniques for clinical breast cancer diagnosis. Her practice, however, was slow to take off. "We spent a lot of time modifying the equipment," she says. B u f f o l o IDID ." M.D. Eventually it paid off. The Elizabeth Wende Breast Clinic now has a staff of 80 and sees 50,000 patients a year, some from as far as Watertown and Binghamton, NY. "They like the ambiance of the office and they like having the results the same day," explains Logan-Young, who took her current name after remarrying six years ago. A major part of her quest to expand the radiologist's role was fulfilled in 1993 when she acquired the first 14gauge needle biopsy unit in western New York. The needle biopsy technique was developed years earlier in Sweden, but it was only recently perfected by a Colorado radiologist who added a new - needle design and computerized guidance that yielded results comparable to surgical biopsy. "The development of the 14-gauge needle was the last step that the radiologist needed to prevent unnecessary surgery, to keep us from doing too many biopsies," Logan-Young says. Nationally, she added, only one out of every five surgical breast biopsies confirms a cancer, while the rate for her patients is one out of 1.3. Equipment and technique are not the entire equation. "This sounds real corny, but from the beginning we tried to make the office look more like a home than an office," Logan-Young says. "I always hated the sterile white jackets. We put in antique chairs and flowered wallpaper. " Three of the 14 chapters in her 1994 book are devoted to interacting with patients. "Once you become the one to make the diagnosis, you do a lot of the counseling that the surgeons would have done." + Grover Wende, Class of 1889 Wende Logan- Young's great-grandfather's brother wrote an early text on dermatology George H. Westinghouse, Class of 1896 Logan- Young's grandfather Walter David Westinghouse, Class of 1931 George Westinghouse's son was Logan- Young's fath er Wende Westinghouse Logan-Young, Class of 1961 Physician Walter David Westinghouse, Class of 1964 Her brother is a San Diego cardiologist Andrea Westinghouse, Class of 1989 Her sister entered medicine as a second career and is now a pediatrician in Eden, NY w I n t e r 1 9 9 7 �• · ··· ·· ···· · · ····· ··· · · · ·· · · · ·· ······ · · ·· ··· ·· · · ·· · ·· ······· ·· ··· · ···· · ···· · · ·· ···· ·· · · · · ·· I 1 9 5 0 s DONALD R . HAULER '57 , of Pensacola, FL, has retired from the U.S. Navy after more than 36 years of active duty. His rank at retirement was captain. He was awarded the Legion of Merit at a Washington Navy Yard retirement ceremony. He moved from McLean, VA, to Pensacola in In April 1997, Jason, along with Edwin Rosinski (Ed.D. '58) and former UB faculty members Stephen Abrahamson and George Miller, will be honored by the UB medical school for their pioneering work in medical education, which began while they were all at UB together. September. 1 JEROME P . KASSIRER '57 , of Weston, MA, was named Distinguished Internist of 1996 by the American Society oflnternal Medicine for contributions to the social and economic environment of the practice of medicine. A kidney specialist at the Tufts University School of Medicine and the New England Medical Center, Kassirer is the editor-in-chief of the New England journal of Medicine. HILLIARD JASON ' 58 , 9 6 s 0 RICHARD H . DAFFNER '67 , of Pittsburgh, PA, writes: "I have just published my fifth textbook, the second edition of Imaging Strong Memorial Hospital in Rochester, NY. He and his wife are both clinical professors of family medicine at the University of Colorado School ofMedicine.Jason is also co-director of the Center for Instructional Support and co-director for education for the Society of Laparoendoscopic Surgeons. ® also serves on the board of the New York State Department of Health's Office of Professional Medical Conduct. He and his wife, Sharon, have two daughters, Gretchen and Julie 1 of Vertebral Trauma . I am currently professor of radiologic sciences at MCP-Hahnemann School of Medicine at Allegheny University. I am based at Allegheny General Hospital in Pittsburgh." ED .D . '62, of Boulder, CO , and his wife, Jane Westberg, Ph.D ., recently published their sixth book, Fostering Learning in Small Groups. It is part of both the Springer Series on Medical Education and the Springer Series on Nursing Education. Jason earned his education doctorate while completing medical school and his residency at director of anesthesia services at Millard Fillmore Suburban Hospital in Buffalo. He is a member of the Millard Fillmore Health System board of directors and president-elect of the system's medical staff. A UB assistant professor, he is also chair of the school's quality assurance committee for anesthesia. Burdick 9 8 s 0 DAVID S . KOUNTZ '85 , of New Brunswick, NJ , has been named associate dean for postgraduate education and chief of the division of primary care at UMDNJ-Robert Wood Johnson Medical School. PEGGY ( MOREY) STAGER of Cleveland Heights, OH, writes that she and her husband, Richard, "announce the birth of our beautiful boy, Samuel Robert, on April 1, 1996." She is practicing adolescent medicine at MetroHealth Medical Center in Cleveland. '88 , 1 9 7 s 0 MICHAEL BARON '71 , of Bristol, TN , writes: "I have relocated to private practice in Bristol in pulmonary critical care medicine. The hospital is two and a half years old and is state of the art, and managed care is just beginning. I am an assistant clinical professor of medicine at East Tennessee State University School of Medicine." JAMES P . BURDICK '75 , of East Amherst, NY, was installed as president of the New York State Society of Anesthesiologists in December. Burdick is B u f f a l o U.S. ArmyinfantryinApril194l. On Dec. 7, when the Japanese attacked Pearl Harbor, Secrist was on guard duty on the island of Oahu, five miles away. In combat duty in Europe, Secrist was wounded in action and received the Purple Heart. He left the Army with the rank of first lieutenant after five years of service. Secrist returned to school on the GI Bill, earning a bachelor of arts degree from Columbia University in 1947 and his M.D. from UB in 1951. Secrist made house calls to patients all over Buffalo and developed a reputation for treating patients regardless of their ability to pay. A member of the Erie County and New York State Medical Societies and the American Medical Association, he was board-certified in internal medicine. He was a member of the American College of Chest Physicians. OBITUARY ROBERT SECRIST '51 , clini- cal associate professor emeritus at the School of Medicine and Biomedical Sciences, died Nov. 5 in his hometown of Lockport. He was 78. Secrist attended Cornell University for three years before leaving to work at Bethlehem Steel. He was drafted into the p h y 9 e a n w n I e 9 9 7 �Who says there's nothing good on TV? As busy as they are, physicians and other health care providers always take the time to watch MLMIC's top-rated risk management education programs. • When they tune into high quality programming broadcast over our satellite network, viewers know what they see will help enhance patient safety and reduce injuries. They also appreciate the policyholder discounts available to participating physicians. • MLMIC programming is sponsored by the largest Risk Management Department of any professional liability insurer in the state. Policyholders also enjoy the protection of one of the country's largest and most experienced professional liability Claims Departments. Most importantly, MLMIC has successfully defended more physicians than all other available insurers combined. These are some of the reasons why MLMIC is the only medical liability insurer approved by the Medical Society of the State of New York. • To find out more, call1-800-356- 4056 in Upstate New York, or 1- 800- ASK- MLMIC in the New York metropolitan area. Ask for free copies of our risk management MLM~C ~ledical ~ Liab1lity :-lutuallnsurance Company guide for office practices. • Our defense never rests. 2 Park Avenue New York, NY 10016 2 Clinton Square Syracuse. NY 13202 90 Merrick Avenue E. Meadow, NY 11554 el996 Ml"..d ..:.1 L at> ity Mutua! ln~r,gnc~ Company �BUFFALO PHYSICIAN Non-Profit Org. U.S. Postage PAID Buffalo, NY Permit No . 311 STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 21 4 'fED.LC L HISTO. IC~ ADDRESS CORRECTION REQUESTED PLAN'fiNG A \3 JT T LldR ~y TREE UNDER WHICH Ll w-~IHLS A Y D-~T You WILL NEVER SIT DR. DEVILLO W. HARRINGTON, class of 1871, knew how to make his money grow. In fact, this man who in 1905 provided $5,000 through his will for the University at Buffalo School of Medicine, is still supporting UB today through the endowment his bequest created. THIS PERMANENT endowment in Dr. Harrington's name has grown to over $300,000 and today it supports the famous Harrington Lecture Series, which twice a year brings distinguished scientific speakers to the School of Medicine and Biomedical Sciences. DR. HARRINGTON'S LEGACY to UB is just one of many bequests which have established permanent and important endowed funds at the school. They enable UB to provide scholarships to outstanding students, enhance scientific research, support excellence in teaching and meet the ever-changing needs of the school. YOU TOO can provide the School of Medicine with a measure of permanence through a bequest. Proper estate planning helps you develop a smart financial plan. Acharitable bequest provides the satisfaction that comes from planting a tree under which you will never sit, but which will bear fruit for generations to come. FOR ACONFIDENTIAL consultation on making a bequest to the UB School of Medicine and Biomedical Sciences, or to receive materials to share with your attorney or estate planning advisor, please contact: STEPHEN A. ESSARY, JR. I Assistant Dean and Director of Development, School of Medicine and Biomedical Sciences UNIVERSITY AT BUFFALO U N IVIE: R S I TY AT I!I UFFAl.O SC H OOL O F M ED I CI N E l5~ 1 5 0 YEARS (716) 829-2773 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Winter 1997 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1997-Winter Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician and biomedical scientist Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v31n01-1997-Winter Table Of Contents A list of subunits of the resource. John P. Naughton, M.D. Crunch Time Making history in the history of medicine Research Medical School News Then and Now A student's perspective Alumni Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2019-01-09 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v31n01 Extent The size or duration of the resource. 40 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1997 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/0f398d8e93b4093e754ecd5a751e5e2b.pdf fd716ff75fda5971dc3bbf631ad69b56 PDF Text Text State University of New York at Buffalo School of Medicine and Biomedical Sciences, Summer 1996 oes me 1c1ne deal with death? �BUFFALO PHYSICIAN \olume 30. Number 3 ASSOCIATE VICE PRESIDENT FOR UNIVERSITY SERVICES Dr Carole '>nuth Petro ACTING DIRECTOR OF PUBLICATIONS Kathryn \ Sawner EDITOR Je>SICa Ancker ART DIRECTOR \ian J Kegler ASSISTANT DESIGNER Julie Gmten PRODUCTION MANAGER \nn Raszm~1nn Brown STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES Dr John Naughton, Dean , \ ·"c Ptcsidcrll fo• Cliniwl A{f<111 s EDITORIAL BOARD Dr John A RIChert . Cluurmmt Dr Martm Brecher Dr llarold Brod) Dr. Rtchard L. Collms Dr. Jack f Co) ne Dr. Alan J Dnnnan Brian Dufh Dr James Kanskt Dr Barbara MaJerom Dr Elizabeth Olmsted Dr Charles Paganelli Dr Stephen Spaulding Dr BradiC\· T. Truax Dr r rankltn Zcplowttz Dear Alumni and Friends, THE SESQviCENTE:-o'\IAL E\E'\TS during the first two weeks of May truly rel1ected the commitment of the school's alumni, faculty, and friends to its missions and accomplishments. A major highlight was the opportunity to have Helen Ranney, M.D., deliver a stellar Harrington Lecture, receive an honorary Doctor of Science degree, and give very warm, well-directed remarks to the 1996 graduates. The commencement was also highlighted by the attendance of 29 members of the class of 1946, gowned and hooded and sitting on the stage with other faculty and distinguished guests. Spring Clinical Day was a resounding success in its own right. It drew probably the largest gathering of medical school alumni ever to attend this annual event. The session focused on issues related to preparation for death, the theme of this issue of Buffalo Physician. For me, it was amazing to experience the warmth and humaneness exhibited by a UB alumnus, Robert Milch, M.D., the medical director of Hospice Buffalo and an organizer of the session. He, with Ms. judith Skretny, set a tone which served to galvanize the audience into a cohesive, concerned, attentive group which ensured a successful learning experience for the entire day. The program was further highlighted and enriched by a singularly gifted presentation by the Stockton Kimball lecturer, Sherwin Nuland, M.D. As I rel1ect on the school's focus on its 150-year history, it is indeed rewarding and a pleasure to see a renewed awareness ofUB's successes and its willingness to commit itself to another 150 years of dedication to educate outstanding physicians and biomedical scientists. Sincerely, ~~. John Naughton, M.D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences TEACHING HOSPITALS AND LIAISONS fhe Buffalo (,eneral llospttal \ftdwd )lww I he Chtldren·s Hospttal of Buffalo [ne Count\· Medtcal Center Mercy llospttal 'vltllard fillmore llealth System Dear Distinguished Alumni, fnmll.Sa\'a Ntagara Falb Memonal Medtcal Center Ro"sell Park Cancer lnstilllte St>te" of Chanty lio>pnal DCillll\ \f<Cmllt) \eterans Aff.m> Western '-Oew York lleahhcare sy,tem © The State L·rmnSit) of '\ess York at Buffalo Buff<~lo Phnrcwn " publtshed quarterly b\ the !>late Lmve"nv of Ness York at Buffalo School of \.1cchunc and Biomcd1c.:al Science~ and the Offtle of Publtcallons It rs sent , free of charge.toalumm , faculty , student; , re;tdents and fnends. fhe staff r._enes the nghtto edn all cop) and submi.,c,lons accepted for puhltcallon. 4\ddrcss questions , comments and >ubmisstOns to: The [dnor, Buf{lllo Ph)-\itian. '-,tate Uni\·cr'-tll\. of r\e\\ York at Buffalo . Office ·o r Publt callon; , 136 (rafts I tall , Buffalo, '\1) 14260 Send address changes to: Buff<~ln Phl;t<illn, 1-!6 CFS Addnton , H35 \lam Street , Buffalo, 1\Y 1-!2 H (over Image: Scala/Art Re;ource. 1\Y Fdsard \lunch , Thr Dc<tth Chwnbcr , Munch Museum , Oc,lo, r\orway. THA'\K YOL FOR the opportunity to serve as the president of the Medical Alumni Board of Directors. Much gratitude is due to Margaret Paroski, M.D., whose shoes I need to fill-a task that will be hard to accomplish. She served with vision and commitment, and was an example to our students of a caring, effective teacher and clinician. Also, congratulations to Beth Maher, M.D., for an outstanding Spring Clinical Day program, "The End of Life: The QualityofDeath." The program attracted more than 300 physicians and was one of the best attended Spring Clinical Days ever. 1 It is with great pleasure that we continue the celebration of the sesquicentennial anniversary of our medical school with the Distinguished Medical Alumni Award, to be presented this Septemberto Elliott C. Lasser, M.D., class of 1946. Dr. Lasser's research in radiology has been the cornerstone of some of our present-day diagnostic techniques. This recognition is a source of pride for all our alumni. Plans for the 1997 Spring Clinical Day are already under way. Richard Collins, M.D. , is planning a program addressing the impact of managed care on the physician and the patient. The Alumni Association will also continue to sponsor a wide range of activities for medical students, including the community physician program, the senior reception, orientation events, and receptions at national medical meetings. As your new Alumni Association president, I look forward to this year, and I ask for your support and any ideas to better serve you and our future physicians. Sincerely, ~if C'~ /W:J Jack F. Coyne, M.D. President, Medical Alumni Association �V OL UME 30 , 3 NUMBER SUMMER Buffalo Hospice 5 A TEAM THAT CARES FOR DYING P ATIENTS TAKES ON A NEW ROLE: EDUCAT- 10 Physician-Assisted Suicide How FAR SHOUL D DOCTORS GO? by Jessica Ancker lNG YOUNG DOCTORS. 18 1996 The End of Life and the Quality of Death U S 'S S PRING CLINICAL DAY OPENS DISCUSSION ON CARING FOR THE by Andy Danzo TERMINALLY ILL. by Scott Thomas Research Medical School News BUFFALO GENERAL DISTINGUISHED GETS KUDOS. ALIENS AND ASTHMA . HELPER DOGS . PROFESSORS . ROBERT N. SPENGLER . EUGENE MINOELL. MATCH DAY . GIFTS TO UB . Alumni News LYNNETTE NIEMAN ' 7 8 OF THE History of Medicine NATIONAL INSTITUTES OF NATIONAL MEETINGS HELD HEALTH. THREE GENERA- IN TIONS AT UB . BUFFALO . AStudent's Perspective " I HAD NEVER KNOWN SO MUCH ABOUT ANYBODY. " BY CHRIS SCHAEFFER, CLASS OF 1 998 . Classnotes �! l··· ·· · ·· ······· · ········· · ·· · ··· · · ··· ······· · ··· ··· ········· · ·· ·················· · ········ Dogs can help people with impaired mobility ervice dogs promote independence and high self-esteem among individuals with impaired mobility, and they can also save money, according to UB researcher Karen Allen, Ph.D. The research by Allen and her colleague,Jim Blascovich, Ph.D., found specially trained dogs more cost-effective and useful at performing certain tasks for people with severe mobility problems than human helpers. They reported their findings in the April 3 issue of thejoumal of the American Medical Association. The ubjectsofthestudy suffered from muscular dystrophy, muscular sclerosis, spinal cord injury, or traumatic brain injury, and had used wheelchairs for mobility for at least two years before the study. The dogs were trained to pull wheelchairs, carry parcels, help with daily dressing, open and close doors, assist in getting in and out of cars, and pull people up from lying or sitting positions. They were even trained to pull their owner to safety in an emergency. Some canines have learned to assist with as many as 100 tasks, Allen said. Twenty-four of the individuals were given the trained animals one month after the study began. The other 24 received their canine helpers 13 months later. In both groups , the dogs' assistance cut the amount of time required by human helpers by approximately one half within six months. Also , the subjects' self-esteem scores nearly doubled in six months, and tripled by the end of the two-year study. The 0 individuals reported newfound independence, increased psychological well-being, and positive effects in other areas of their lives. At the end of the study, 40 out of the 48 subjects were able to get pan-time employment, and 18 of the subjects started school. A service dog costs about 5,000 to train and about $1 ,100 to maintain annually, far less than the cost of home health aides or other assistants , Allen said. While seeing-eye dogs are well-accepted and covered by many insurers, other types of service dogs are often not covered. However, the state of Montana is providing Medicaid coverage on a trial basis as a result of this study, Allen said. Allen , a member of the psychology department, is the former assistant director of UB's Center for Behavioral and Social Aspects of Health. + H E R 5 C H E L E M E L 5 0 N Buffalo General honored by national accreditation group he Buffalo General Hospital has been awarded a three-year accreditation with commendation by the joint Commission on Accreditation of Health Care Organizations for the first time in its history. Accreditation with commendation recognizes excellence and places Buffalo General in the top 12 percent of the 5,200 accredited hospitals in the country. joint Commission members reached their conclusion after spending about three weeks last December conducting surveys at Buffalo General, its Community a u f f o t o Mental Health Center, and its long-term care facility at the Deaconess Center. "Buffalo General is to be commended for its commitment to providing quality care to the people in its community and region," said Dennis S. O'Leary, M.D. , president of the joint Commission. "You have a lotto be proud of: superb people, excellent staff really doing a great job. It's clear they really care," said joint Commission surveyor Robert eher. "The quality of the programs really stands out. " + Aliens and asthma n innovative experiment involving a popular children's movie may have pinned down the neurological pathway by which unpleasant emotions constrict airways in asthmatic children. UB pediatric psychiatry researchers Bruce Miller, M.D., and Beatrice Wood, Ph.D. , reported their results at the annual meeting of the American Psychosomatic Society, March 7-10 , in Williamsburg, VA. The researchers invited 24 asthmatic children ages 8 to 18 to watch the video of "E.T.- The Extraterrestrial," while their heart rates , respiration rates , and blood oxygen saturation were monitored . Airway reactivity and pulmonary function were tested before and after the movie by spiro metry and methacholine challenge tests. The researchers were particularly interested in the children's physiological responses during a highly emotional scene in which the young hero , Eliot, talks to what appears to be the dead body of his friend , E.T. -then discovers that E.T. is alive. The mood shifts suddenly from hopelessness to relief and joy. Results showed that during the sad scene, heart rate and oxygen saturation became unstable, reflecting airway con- Physician Summer t 9 9 6 �··· · ···· · ······· · ······· · ·· · ··· · ····· · ··· · · · ·········· · · · ······· · ········ · ··· ·· ···· · · · ···· • . striction. During the happy scene, heart rate and blood oxygen stabilized , indicating open airways. In addition , the researchers noted that changes in activity of the vagus nerve , known to influence both heart rate and airway constriction, correlated closely with changes in the children's emotional responses . They believe the finding points to the vagus nerve as one pathway by which emotions affect asthma symptoms. "These findings are clinically important because they suggest that emotional conditions, such as depression and hopelessness, may be important triggers of airway constriction in asthmatic patients," Miller said. "Knowing that the vagus nerve is a specific pathway for inducing these psychophysiologic responses, we can now target this pathway for treatment intervention. " Miller suggested that antidepressant medications with strong anticholinergic properties may be the best choice for treating depression in asthmatic children. "These medications may have the dual effect of treating depression, while at the same time lessening vagal responsivity , which would directly improve asthmatic symptoms, " he said. "We need to point out to physicians that treating the depression can improve asthma symptoms , as well as mood. " The "E.T ." study is part of a long-term collaborative effort by Miller, the director of pediatric psychiatry at Children 's Hospital and a UB associate professor of psychiatry and pediatrics , and s u f f 0 l 0 P hys i Wood , the assistant director of the pediatric psychiatry department and a UB assistant professor. The two came to UB last year from the University of Rochester. An earlier study published by the two colleagues in 1994 found that children who experienced more intense physiological reactions and described their emotional experiences in more intense terms also experienced decreased pulmonary function and heightened airway reactivity. Miller and Wood believe that in this subgroup of asthmatic children, strong emotions activate a specific pathway in the autonomic nervous system that causes or aggravates asthma. In the long run, Miller and Wood hope their work will help bring the study of the body a little closer to the study of the mind. "We believe that's where medical education needs to go . It's stilted and artificial to practice psychiatry in a vacuum , or to practice medicine in a cian 1 9 9 6 '. vacuum ," Miller said. Wood adds that health care professionals must also include a concern for the patient's family and social setting. "It's no good to treat the child individually. It's important to engage the family , and see how that impacts the child's physiological functioning. " She hopes , too, to begin to develop a model for health , not just for illness. "We need to look more at the positive ways families impact on physiology, not just the negative ways. " Miller established his reputation in the field with a benchmark 1987 study on the links between depression and fatalities from asthma. He conducted in-depth interviews with families of asthmatic children who had died from their disease and with the families of others who had survived near-death experiences. He found that the children who had died were much more likely to have experienced psychological stress and family turmoil , such as a divorce or an impending separation . Also, around the time of their death , they were much more likely to have experienced feelings of despair and wishes to die. "My clinical practice had suggested this link long before, but this was the best-designed study to establish the link ," says Miller, who practiced family medicine for several years before specializing in psychiatry. Wood joined Miller's research after studying the impact of family stress on children with Crohn's disease . + -LOIS Summer .. . B AKER �nt How does medicine deal with death? DoES MEDICAL SCHOOL ADEQUATELY PREPARE DOCTORS to treat dying patients? Is it always possible .. .. to control pain, or to facilitate a dignified death? What should the law say about a dying patient who asks a doctor for a lethal dose of drugs? These are some of the topics brought up for discussion at UB's Spring C lin ical Day, held May I I on the topic of "The end of life: The quality of death." This issue of Buffalo Physician further explores these questions in several re lated articles. The first, "Hospice Buffalo," follows medical students and young doctors as they leam about palliative care in UB's new hospice education program. "Physician-assisted suicide: How far should doctors go?" explains recent developments in the legal and social debate about assisted suicide, and tries to put them in ethical perspective. Our Spring Clinical Day coverage includes excerpts from a panel discussion about dying patients, their families, and their doctors, and a story about the Stockton Kimball Lecture delivered by Sherwin Nuland, M.D., author of How We Die. In our new student column, third-year student Chris Schaeffer reflects on how death robbed him forever of the chance to know one fascinating and mysterious patient. We hope that this special issue will invite discussion and reflection on these difficult questions. -The Ed ito r 0 B uffalo P hysician Summer l 9 9 6 �• ICe by Andrew Danzo Photos by K.C. Kratt A team that cares for the dying takes on a new role: educating young doctors 0 CAR PIEDAD, M.D., was still getting used to people calling him "doctor" when he visited some old friends at Hospice Buffalo in late spring. At the nurse's station there were hugs for the young bear of a physician, freshly graduated and preparing to leave for a residency down south. Here he was still Oscar. Piedad looked at the Family Room, decorated with soothing pastels and simple, comfortable furnishings . He recalled the Christmas party there. The family pets that came for visits. The meetings with spouses and children to discuss final arrangements. He seemed "IT OPE:\lED M\ EYES TO Buffalo Physician A to miss it. \\'HOLE NE\\ C0:'KEPT OF MEDICINE," he explained. Summer l 9 9 6 0 �HOSPICE BUFFALO lN THC 18 'v10 HIS Physicians have a since Hospice Buffalo hard time saying became a clinical "enough," according training site for the UB to Thomas Raab, School of Medicine M.D., clinical assoand the Graduate ciate professor of Medical Dental EdumedicineatUB. "We cation Consortium of are trained to treat, Buffalo, some 70 residiagnose, and evalu- ____dent and lJ) medical ate; and if we don't students have shared know what's going an exposure to palliaon, we treat, diagtive medicine that is nose, and evaluate still relatively unsome more," he said. usual. They have "We must compaslearned about pain management, symptom sionately communicate to the dying patient management, and working in interdiscipliand the family when medical technology "You learn a nary teams. They have comforted dying padoesn't have any more to offer them and it's tients-some calm, some haunted by nighttime to stop. So many times, doctors don't lot of loving mares. They have made house calls. Overall, do that. " they have learned something about accepting the inevitability of death , and maximizHospice as Education and caring ing the quality of the life remaining. "Doctors just don't get good trammg in "There are a lot of life issue you have to caring for patients at the end of their lives," that before address," said Piedad. "For the family memsaid Raab. "It's sad what we do to some bers, too. The spouses and the children. people at the end of their lives. " They have to go through the dying process, The hospice educational program began you might too ... You learn a lot of loving and caring under the state-funded Indirect Medical Eduthat before you might only have shown to cation Demonstration Project. It now inonly have your own family." cludes lectures at the medical school and Advances in medical techniques and techconsortium hospitals by Hospice Buffalo nology have raised troubling questions about medical director Robert Milch, M.D., and shown to when efforts to save a life merely prolong a short- and long-term rotations for residents and medical students. painful death. The Robert Wood Johnson your own Foundation recently funded a study to deRotations include rounds of the inpatient termine whether better prognostic informaunit and home visits with a social worker or tion and patient-physician communication a clergy member. Students also work with family." would prevent overtreatment and pain at the the bereavement staff, who keep up with end of life. families for l3 months after a loved one's Dishearteningly, the "SUPPORT" study, reported death in order to provide support for the first-and in the ov. 22/29, 1995 issue of the Journal of the hardest-year of loss. American Medical Association, found that the interThe official hospice training program began in late ventions did little or nothing to improve care or 1994, but two students paved the way more than a year outcomes. The study documented that fewer than earlier. The first was Piedad, whose father , also named half of physic ians knew when their patients did not Oscar, is a retired general surgeon in Buffalo. want CPR,-cand half of conscio us patients were in The other was Maria Bruno, M.D., then a secondmoderate to severe pain before they died. The article year student. states that physicians "p rovide more extensive treat"I had some family members with cancer and bad ment to seriou ly ill patients than they would choose illnesses, and I knew people who just weren't satisfied for themselves." with the way they were treated. I wasn't sure if it was the 0 a u f f a 1 o Physician Summer 1 9 9 6 �HOSPICE physicians, or the system in general," said Bruno, who has just finished her internship in internal medicine in Buffalo. " ow I think it's the system in general." Bruno remembered her grandmother's death in the 1970s. "It was one of those situations where they opened her up , found cancer and closed her up without telling her ," she said. She thinks the doctors didn't want to upset her grandmother, but the result was sending her home without preparing her for the pain that would come. Bruno did a summer fellowship at Hospice Buffalo between her second and third years. Once the training program was up and running, Bruno returned for an elective rotation in her fourth year. She also researched the literature on physician-patient communication , and assembled a presentation that is still given to students and residents at the beginning of their hospice rotations. The presentation is entitled "Talking about Difficult Subjects: A Survival Guide for Giving and Getting Bad News. " "Medicine isn't all about science," Bruno said. "Hospice medicine is about the art of medicine as well as the science of medicine. " The training program got into full swing when Hospice Buffalo opened its Mitchell Campus, a complex of low cream-colored buildings in the Buffalo suburb of Cheektowaga. The campus includes a lObed unit for hospice patients in the final stage of disease, a lO-bed nursing unit for AIDS patients, and a 30-bed skilled-nursing residence for both hospice and non-hospice patients with advanced illness. It also includes a 220-seat auditorium for conferences and educational activities. UB residents in family medicine , internal medicine , and geriatrics now routinely visit Hospice Buffalo as part of their training, ac- B u f f a l o Physician BUFFALO "We must cording to Liora Ziv, R. ., Ed. D. , the organization's director of education. For other residents, the hospice rotation is available as an elective. Medical students can also choose hospice rotations as third- or fourthyear electives. compassionately communicate to the F r o m T h eo ry to P ra c ti ce Medical student oelle M. Stevens spent a week at Hospice Buffalo last summer. She remembers visiting a woman who had no family. The woman had put off seeing a doctor about the growing hardness in her breast, and by the time she did, the cancer had spread. "She wasn't going to benefit from chemotherapy, " Stevens recalled. "She was living alone in her apartment and wasn't even able to get up and go to the kitchen." The hospice team brought her back to the Mitchell Campus. Before the woman died, she confided to the student her surprise at the warmth of the Hospice staff. "She was one of the reasons why I would like to go into geriatrics, and why I would also like to continue working with Hospice in the future, " Stevens said. The opportunity came sooner than she had expected. During a hospital clerkship later in the year, Stevens became friendly with an elderly woman who had been admitted after a seizure. A CT scan and an MRI revealed that a cancer had metastasized to the brain, but its origin wasn't clear. "The medical team was really set on trying to figure out what the cancer was, " Stevens said. "They had a surgical consult coming in , and they were focused on trying to cure her. But they were not focused on what her wishes were." The woman, a retired nurse, insisted that she didn't want surgery or chemotherapy, and the family agreed. Stevens became the interme- dying patient and the family when medical technology doesn't have any more to offer them and it's time to stop. So many times, doctors don't do that." Summer 1 9 9 6 0 �HOSPICE BUFFALO diary between the patient and the medical team. Stevens advised the family to make their wishes known to the oncologist, and gave them the Hospice phone number. The woman ended up spending her last days at Buffalo Hospice. "I won't forget this lady," Stevens said. unsettling. You don't know where to sit ... You find yourself looking at disease in a totally different way. You look at the faded pictures on the wall. At the things on the coffee table. At the picture in the wedding dress. And then you see the patient in bed, and you see what the disease has done. " The Life Students are Hesitant Qua lit y of When the hospice lessons click, medical stuStudents and residents aren't exactly breakdents and residents no longer feel a sense of "When you go ing down the doors for hospice electives. futility in the face of serious illness. Instead, They often call for information, then call they have the skills and the desire to improve into a patient's back and say they've changed their mind. the quality of the life that remains. "In hosLauren Michalakes, M.D., isn't surprised. pice you don't have the expectation that people She remembers being an internal medicine are going to get better, so you don't have that home, you're resident a decade ago, intrigued by the techsense of failure that you have in a hospital," nology and intellectual challenge of the hossaid Robert Patterson, M.D. , who heads the on their turf. It pital. "We used to love intensive care," she lO-bed inpatient unit. recalled. "You'd feel like you were doing a Pain management is a key component of lot, and you'd write up these wonderful can be the hospice training. At the start of rotations, three-page reports. Being so busy technostudents and residents complete a 39-queslogically, you really didn't have to talk with tion test to assess knowledge and attitudes unsettling... the patient." about pain, drugs, and addiction. Clinical During five years of private practice, howpractice guidelines are also distributed. "In You find ever, her views changed. medical school you talk about 15 milligrams "In the hospital, people die in double of morphine as a therapeutic dose," said blaring rooms with strangers and with C Patterson. "Sometimes we use up to 4,000 yourself lookon the other TV," she said. "They die with milligrams of morphine a day to control pain, their clothes pulled off and hooked up to and the patients are still responsive; they can ing at disease things and all alone." talk. " Michalakes remembers sitting with an A former professor and associate chair of elderly woman at her home when she died. in a totally the OB/G department at UB, Patterson has "I just watched her in her big post bed with been volunteering at Hospice since retiring all her Ouffy pillows and her daughter and from obstetrical practice three years ago at age different way." husband and her poodle," Michalakes re70. Some days, after putting ina morning at the called. "What's wrong with that? I felt like I hospice inpatient unit, he goes home and spared her something. I felt a sense of accomplishment babysits his grandchildren and great-grandchildren. that I hadn't felt in medicine before. " "In my practice as an obstetrician, I dealt a lot with She now works full-time at Hospice Buffalo. families, " he said. "That was one of the joys of mediMichalakes thinks it's important for students to visit cine. Surprisingly, I feel the same about this .. .. It's two patients at home. "When you go into a patient's home, things that happen to all of us-we're born, and we die. you're on their turf," Michalakes explained. "It can be Hopefully, we can help at both ends." B u f f o l o Phys ician Summer 1 9 9 6 �HOSPICE BUFFALO A Sp iri t ual P la ce "You hydrate a healthy patient, you don't do it for a Buffalo Hospice medical director Robert Milch started dying patient," explained Ziv, the education director. "You his career as a general surgeon with a philosophical bent can really cause more suffering and pain in exchange for and a nagging discomfort about modern medicine. He's maybe prolonging for a few hours the life of the patient." been increasingly involved in Hospice Buffalo since it Tchernov said this aspect of hospice went against his original training. "In my Russian medical school, the started in 1978, and he gave up private practice several years ago to serve as its first full-time medical director. preserving of life as long as possible was the philosophy. We would never let a patient dehydrate." "There's something that hearkens to why you became a physician in doing this kind of work," Milch said. "It's Stude n ts F i nd Men t o r s not about dying. It's about how we live." During his recent visit to Hospice Buffalo, Piedad spotted Life and death are tightly interwoven at the hospice Patterson down the hall. He campus. After traversing a remembered the older brick walkway dotted with mephysician's manner, the way morial stones to former pahe touched and talked with tients, visitors arrive at an inis as much a philosophy as a facility gravely ill patients. "just his formation desk, where they voice, you could see them right can buy shirts, baseball caps, HosPICE BuFFALO ISBASED at the Mitchell Campus, a away calming down," Piedad and other souvenirs with the $6 m Ilion complex on 20 wooded acres, part of a hospice logo. There's a sunlit recalled. "I remember one pnvate nature preserve in Cheektowaga. chapel, usually the scene of time, a patient was very close But Hospice IS as much a philosophy as a facility. memorial services, but also the to the end. He went into the More than three-quarters of hospice pat1ents are place where a patient's daughand held her by the hand. room cared for 1n the1r own homes. Medical, nurstng, ter had her wedding this year. He told her not to be afraid." counseling, and pastoral serv1ces are prov1ded Then there's the bulletin board In a letter to the hospice through Hospice Buffalo and a networl< of affiliated outside Milch's office, where non-profrt agenoes under the umbrella of the Hosstaff after his rotation, Piedad someone has tacked up a dyp1ce Assooat1on. Serv1ces are also prov1ded in area wrote: "I was introduced to an nurs1ng homes and hosp1tals. ing patient's joke. aspect of patient care I had Medicare, Medica1d and maJor nsurance plans "They say the hearing is the never seen before. Pet therapy, will pay for hosp1ce care, and Hosp1ce Buffalo last thing to go. It's not. It's the music therapy, birthday paroffers a sliding payment scale for the uninsured. sex," the woman quipped. A ties, Christmas gifts, family According to med1cal director Robert Milch, dinners, decorated rooms, and few days later, she revised her M.D., bereavement serv1ces are an important part evaluation: "You know what I the list goes on. I began to of hospice care. "It doesn't stop when the mon1tor realize that the facility treated was saying about the hearing. stops. It goes on, and you've got to take care ofthe more than pain; their treatI think maybe I was wrong. " surv1vors." Bereavement care, wh1ch lasts 13 months Death itself, however, is ment involved quality of life, after a death, includes counseling and support groups. resolution of life, family innot trivialized. "It's a very spiritual place," said Andrei volvement, staff involvement, G. Tchernov, M.D. , who bereligious beliefs, personal life decisions, and bereavement ... I have never seen a team on lieves the hospice rotation he completed as a resident will help him in his family medicine practice. His a unit work so cohesively and with so much heart." experience also forced him to change his views on Piedad is now doing his residency in family medicine and sports medicine at Richland Memorial Hospital in practicing medicine. Columbia, SC. Shortly after his visit, Liora Ziv reflected For example, he learned that hospice professionals are on the impact of the educational program. "I don't think willing to withhold interventions that would postpone we can say yet that we've made a big difference," she an inevitable death. A hospice patient who suffered a concluded. "But I think we have made a dent in the stroke, for example, might use the physical therapy room surface if people like Oscar come back and say they'll at the Mitchell Campus to regain the ability to lift a fork. take what they learned here into their practice." + But patients near death and with no hope of recovery Buffalo j ournalist Andrew Danza, a frequent contributor to Buffa lo Physiwould be unlikely to receive antibiotics if they develop cian, also works as a writer for UB's Department of Family Medici ne and the pneumonia, or water if they become dehydrated. L_ _ _ _ _ _ __J ew Yorh Ru ral Health Research Center. e u t t a l o Physic i an Summer l 9 9 6 0 �Choices at the end o f Ii f e • • 1an Sl SSI How far shouldsdoctors go? COURT DECISIO S, SE SATIO AL CASES, STATE REFERENDA, and one-cause crusaders are dragging the intensely controversial issue of physician-assisted suicide out of the closet and into the public arena . ... Whether or not the nation's legal landscape is irrevocably altered as a result of the controversy, the public mind has already changed. A topic once taboo is now dissected on editorial pages and joked about on talk shows. Polls demonstrate increasing support for the idea of physician-assisted suicide during a terminal or unbearable illness. The new openness about DNR orders, health-care proxy appointments, and withdrawal of life-sustaining technologies may also be making it easier to discuss all sorts of end-of-life decisions. For the majority of Americans, the figure who has done more than any other to turn assisted suicide into a public issue is retired pathologist jack Kevorkian. By May of this year, Kevorkian had admitted auending 28 deaths, and had been acquiued in his third trial for assisting in a suicide. At about the same time, a nationwide Gallup poll showed that 75 percent of respondents favored allowing a doctor to end an incurably ill patient's life at the patient's request. "Public relations-wise, Kevorkian's done a tremendous job-he's converted a huge egment of the public," said rightto-die activist Derek Humphry, author of the how-to suicide book Final Exit. It's the kind of public relations most of the medical community would rather not have. Many doctors-even those who support physician-assisted suicide-believe Kevorkian is not qualified to perform it. They object that he had no experience treating patients during his career as a pathologist, and that he does not know BY P H 0 T 0 his clients well, does not try to manage their pain, and does not adequately screen them for clinical depression. In the end, what many doctors, nurses, and ethicists dislike the most about Kevorkian is that he does not appear to reflect at all about his individual cases. Because he believes so strongly that assisted suicide should be available, they say, he distributes his treatment without seeming to ask himself if this option is the right one for this person at this moment. "Physician-assisted suicide shouldn't be easy. It should always be a hard decision," said Timothy Quill, M.D., the Rochester, Y internist who opened a professional dialog on the subject in 1991 with an admission in the ew England journal of Medicine that he had prescribed a lethal dose of barbiturates to a dying patient. In his account of his eight-year relationship with "Diane," Quill described diagnosing her leukemia, discussing her desire for suicide, and asking her to consult her psychologist. Only when he was convinced that she was acting rationally on the basis of an unwavering wish, and only after wrestling with his own emotions, did he prescribe the drugs she requested. There is no consensus on the morality of physician-assisted suicide. While activists like Kevorkian and Humphry want to make the practice widely available on compassionate grounds, opponents argue that it is wrong under any circumstances to take a life. Many doctors also believe that their very mission prohibits assisting in death. "It's absolutely appalling that a doctor would take deliber- .JESSICA 8 S B u f y f F a l R o A ANCKER N K Phys CESARIO ici an Summer 1 9 9 6 �"A SUICIDE THREAT IS A CRY FOR HELP. OUR ANSWER MUST BE TO PROVIDE THAT HELP, NOT TO HELP THEM COMMIT SUICIDE. " Denise Hanlon, R.N., member, NYS Task Force on Life and the Law ate steps to end someone's life," said Evan Calkins, M.D., a member of the Buffalo Medical Group and UB professor emeritus. "It violates the Hippocratic oath to do no harm , and it weakens the ethical standing of the medical profession. We are a healing profession, not a killing profession." Other doctors take a middle view. They feel that before the American medical establishment considers assisted suicide , it should learn how to provide good end-of-life care for all dying patients. If assisted suicide is to be an option, they say, it should be decided as Quill and "Diane" decided it; not in the courts or on the editorial pages, but one case at a timecarefully, deliberately, and with anguish. Even some opponents respect Quill. "If all doctors were like Quill , then this wouldn't be a great concern," said Denise Hanlon, R.N. , an opponent of physician-assisted suicide who serves on the ew York State Task Force on Life and the Law. "Or if all patients were like 'Diane.' But they're not. " The l aw The courts and state legislatures are the current forums for debate about physician-assisted suicide. The 1994 Oregon "Death with Dignity" law is the first in the country to explicitly condone physician-assisted suicide, although legal challenges have so far prevented it from going into effect. In March 1996, the Ninth Circuit Court of Appeals, a federal court in San Francisco, overturned a State ofWashington law that banned assisting in a suicide. The plaintiffs were four physicians, three terminally ill patients who died before the ruling, and a non-profit organi- B u f f a l o P hysician zation called Compassion In Dying. The court broke new ground by determining that the U.S. Constitution guarantees a "right to die;" that is, to choose the manner and time of one's own death. Depriving patients of that right therefore violates the due process clause of the 14th Amendment. The court wrote that doctors should be able to prescribe life-ending medication for terminally ill, competent adult patients who want to hasten their own deaths. The judges said that their decision , in essence, removed them from the issue. "We are following the constitutional mandate to take such decisions out of the hands of the government, both state and federal , and to put them where they rightly belong, in the hands of the people. " The ruling has the potential to affect California , Washington , and Oregon, which all fall under the jurisdiction of the Ninth Circuit Court. In a similar ruling on April 2, the Second Circuit Court of Appeals, with jurisdiction over ew York, Vermont, and Connecticut, struck down part of ew York's ban on assisted suicide. The case was brought by three terminally ill patients and three doctors, one of whom was Quill. The patients all died before the ruling. The judges ruled that a doctor can prescribe drugs to hasten the death of a competent, terminally ill patient at the patient's request. They explained their decision in commonsense language: "What interest can the state possibly have in requiring the prolongation of a life that is all but ended? And what business is it of the state to require the continuation of agony when the result is imminent and inevitable?" legally, the rationale was more complicated. It was de- Summer 1 9 9 6 �"IF WE DON'T HAVE ANY LEGAL WAY TO DO TH I S, THEN IT TURNS INTO ONE DOCTOR MAKING THE HARDEST TREATMENT DECISION POSSIBLE IN A VACUUM - WITHOUT CONSULT I NG ANYBODY , WITH- OUT DISCUSSING IT . THAT TO ME IS NOT GOOD MEDICINE. " Timothy Quill , M.D., plaintiff in Quill v. Vacca cided that the ban violated the equal protection clause of the 14th Amendment. All patients already have the right to hasten their own death by refusing medical treatment. However, the argument goes , terminally ill patients who were not being kept alive through medical intervention had no comparable way to hasten their own death . lf patients can essentially commit suicide by refusing treatment,Justice Roger]. Miner wrote, "they should be free to do so by requesting appropriate medication to terminate life during the final stages of terminal illness. " Stil l a crime While these rulings are being appealed to the U.S. Supreme Court, and while Oregon's law remains entangled in the courts, it remains a crime for doctors to assist in suicides. Yet it's clear that they are doing it anyway. An anonymous survey recently published in the journal of the American Medical Assodation found that a small percentage of doctors in Washington state had helped terminal patients who wanted to die. A survey of Oregon doctors published in the N E]M in February showed that 7 percent of respondents had assisted in a suicide. Forty-six percent of the respondents said they might be willing to assist in suicides if the practice were legal, and 31 percent said they would refuse on moral grounds. "l think the issue at this point is how to respond to physician-assisted suicide , not whether it's going to happen ," said Stephen Wear, Ph.D ., co-director of UB's Center for Clinical Ethics and Humanities in Medicine. "Whether or not the legal situation allows it, it's happening, and in some jurisdictions it's likely to become legal. " B u f f a l a Does the law matter? Timothy Quill firmly believes that liberalizing the law is necessary to protect doctors like himself who choose to help patients die. But jack Freer, M.D. , chair of Millard Fillmore Hospital's ethics committee, uses Quill's case to prove that the law is already practically powerless to touch doctors. After Quill's E]M letter, prosecutors referred the matter to a grand jury, which refused to indict him. "They couldn't indict Quill. Kevorkian is unconvictable," Freer said. "lf that's the case, if you can't be convicted, then [the legal decisions] don't matter because you don't need extra protection. If a doctor acts in good faith, if it is clear that someone is suffering and asks for help, then that physician is unlikely to be prosecuted, anyway. "There would have to be a compelling need in order to justify such a sweeping change in the status quo. l don't see that need, especially when the change would jeopardize so many vulnerable people who have not availed themselves of good palliative treatment," Freer added. P u b lic debate? Quill and some other activists argue that since the practice is happening, it is important to discuss it. His purpose in writing the NE)M letter and joining the Second Circuit Court lawsuit was to open up discussion on what he felt was a widespread practice. "lf we don't have any legal way to do this, then it turns into one doctor making the hardest treatment decision possible in a vacuum-without consulting anybody, without discussing it. That to me is not good medicine," Quill said in a recent interview with the Buffalo Physician. Physician Summer 1 9 9 6 �Choices at the end o f "IT'S ABSOLUTELY APPALLING THAT A DOCTOR WOULD TAKE DELIBERATE STEPS TO END SOMEONE'S LIFE. WE ARE A PROFESSION, NOT A Iif e HEALING KILLING PROFESSION." Evan Calkins, M.D., UB professor emeritus ew Yo rk State Attorney General Dennis Vacco (UB Law School class of 1978) is leading the appeal because he feels allowing doctors to take life is wrong, and that vulnerable patients could be pressured into suicide for economic or other reasons. He also fears that ew York could become home to a sort of cottage industry of commercial death clinics. But even if he succeeds in getting the U.S. Supreme Court to uphold the ban on assisted suicide, Vacco does not plan to launch a drive to prosecute doctors- such as Quill- who have admitted doing it. "I don't think we need to change the prosecutorial scheme," he told this magazine. "No law can eliminate proscribed behavior, but the deterrent would discourage a sufficient number of professionals from engaging in this conduct. "I think that the system we had until this decision was working well. " Public po li cy Doctors, nurses , lawyers, ethicists, and members of the clergy from around ew York State meet once a month as part of the ew York State Task Force on Life and the Law to wrestle with some of the hardest questions in health care. Some of the task force's recommendations have led to ew York's health-care proxy law and the Family Care Bill, which has not yet been passed into law. The group's 1994 report When Death is Sought recommended against decriminalizing physician-assisted suicide. Some members of the task force felt that it was inherently wrong to take a life. Others felt that it was unethical for a doctor to do so. A third group felt that in some cases, providing a quick death for a terminal patient who asked for help would be B u f f a 1 o P hysici a n S compassionate and ethical. The task force was in agreement, however, in concluding that legalizing physician-assisted suicide would be dangerous public policy. The cost of health care and the perceived value of the patient could come to bear on who ends up committing suicide , they cautioned. They were also concerned that patients would not be properly referred for psychiatric or palliative care, and that attitudes about assisted suicide might become casual. "Over time, as the practices are incorporated into the standard arsenal of medical treatments, th e sense of gravity abo u t the practices would dissipate," the task force warned. Also opposed to physician-assisted suicide are professional medical societies, including the American Medical Association, which say that it violates a doctor's mission, and some religious groups. "It's a non-negotiable with us," said Sister Sally Maloney, a vice president at Mercy Health System of Western ew York, a Catholic hospital group. "It's completely opposed to our commitment to life. The ethical directives by the Catholic bishops are very clear on that. " Good end-of-l i fe care Since 1978, Hospice Buffalo has cared for more than 13 ,000 dying patients. Only one has committed suicide, according to medical director Robert Milch, M.D. "It's not unusual for us to go into a patient's home and hear that patient say, 'Look, doc, if things get too bad, I've got the ummer 1 9 9 6 �Choices at the end o f Ii f e usually they're looking forreassuram:e on rwo-points: one, that you can take care of their symptoms and their pain; two, that they will not be alone." "These fears are what drive people to consider suicide. lf you support patients and families, if you address their needs and fears, then the urge to do self-harm essentially disappears," he said. However, study after study has shown that doctors often fail to control patients' pain. "lf l make someone uncomfortable enough, put them in enough pain, l can convince them of anything," Milch said. "That is the principle of torture. "l would rather establish as a standard that the presence of unassessed, unmanaged pain is prima facie evidence of incompetence on the part of the physician," Milch continued. "lf physicians can't manage physical suffering, why would we give them the ability to do omething even bigger-end a life? " For Milch, and many other , physician-assisted suicide is at best a glamorous distraction from discussion of the real needs of terminal patients, and at worst a quick fix that society finds easier than spending the time, money, and emotional energy necessary for good care of the dying. "A suicide threat is a cry for help," said Hanlon, an adjunct professor at the UB School of ursing. "These people are in an impo iblesituation and they don't know what to do. They fear the unknown, and they fear that they won't get the help they need. Our answer must be to provide that help, not to help them commit suicide." But for Stephen Wear, the lack of good palliative care itself becomes an argument in favor of legalizing assisted suicide. "lf we can make people feel that they won't be needlessly overtreated and that their pain will be managed-and right now that is nota reasonable expectation, and people know it-then we should agree with Milch. lf we can't, then for compassion's sake we should be with Kevorkian and Humphry-and I loathe saying that," Wear said. "But it isn't enough to make philosophical arguments against assisted suicide. Doctors have to change their practice so assisted suicide is no longer the compassionate alternative." Even in the best scenario, where palliative care eases symptoms of terminal disease and hospice-type programs support patients and their families, many people believe that there will still be patients who cannot be helped by medicine. "ln most patients we can relieve their suffering, and we have to get better at doing that," Freer said. "But l also think it's clear- and most doctors agree-that there are people whose suffering cannot be relieved. There are people whose suffering can only be relieved by ending their lives." A s l i ppe r y slope The recent legal decisions on assisted suicide have made a distinction between helping a patient take his or her own life, and actively taking the life of a patient through euthanasia. But many fear that condoning one will lead to the otherand worse, to euthanasia of patients who are incapable of consent. ln the etherlands, euthanasia is illegal, but is not prosecuted if doctors demonstrate that the patient explicitly requested euthanasia, document their actions, and stay within other guidelines established by the national medical society. "IF PHYSICIANS CAN'T MANAGE PHYSICAL SUFFERING, WHY WOULD WE GIVE THEM THE ABILITY TO DO SOMETHING EVEN BIGGER-END A LIFE?" Robert Milch, M.D., med1cal director, Hospice Buffalo ® B u f f a l o Physician Summer 1 9 9 6 �"THE PROBLEM WITH THE PHYSICIAN-ASSISTED SUICIDE QUESTION IS THAT IT DISTRACTS FROM REAL ETHICAL DILEMMAS IN MEDICINE, AND COMPASSIONATE CARE OF DYING PEOPLE. " jack Freer, M.D., ethics committee chairman, M illard Fillmore Hospital Law might be the group that could provide leadership on the issue ," said Quill. Hanlon responded, "We will investigate any topic the governor tells us to, but we have already looked at this topic and come up with recommendations on it. " The task force's report warned that it would be impossible to draw up guidelines that could not be bent or broken. However, at least one study there has shown that more than one-fourth of euthanasia deaths occurred without a specific request from the patient. Many argue that this proves legalizing assisted death for consenting patients can lead to officially sanctioned euthanasia of patients who are incapable of consent. Also, Milch points out, "Nothing in medicine is a sure-fire bet. " If some physician-assisted suicide attempts fail to kill the patient, he asks, would that lead to sanctioned euthanasia? "Whose responsibility will it be to administer the coup de grace? " W h o w ill dec i de ? For the moment, the courts are making the decisions. If they decide to decriminalize physician-assisted suicide , the resulting legal void could open up more questions than it answers. The medical profession and American society as a whole will then have to decide how to handle the new freedom-to use it, abuse it, or reject it. "We're a complex society , a society of tensions, and there are not very many things that have a clear 'yes' or 'no' answer anymore, " Wear said. Also remaining to be solved is the issue of giving the proper care to dying patients-educating doctors and allocating resources. Whatever their opinion on physician-assisted suicide, observers believe that improving end-of-life care would drastically reduce the number of patients who find life so unbearable that they would choose suicide. "The problem with the physician-assisted suicide question is that it distracts from real ethical dilemmas in medicine , and compassionate care of dying people ," said Freer. "It's just such a simplistic way of dealing with such a small number of people, when the focus should be on the vast majority whose pain we just are not treating. " + jessica Andur is the editor of Buffalo Phy sician . T i me for gu i de li nes ? Some believe that the potential loosening of assisted-suicide laws means that it is time for medical professionals and patient advocacy organizations to cooperate in setting up guidelines to provide direction and protection for both groups. "We need guidelines and rules so people know that if they dot their i's and cross their t's, they can do this out in the open ," Quill said. His recommendations for safeguards include ensuring that a patient who elects suicide is terminally ill and not clinically depressed; that the patient is not pressured into the decision; that the wish to die is not a transient one; that there is proper access to palliative care; and that a second opinion is sought from an independent practitioner who has expertise in caring for dying patients. Quill's first concern is that palliative treatment and hospice care be extended to all who need it. "Hospice care must have failed , or not be acceptable to patients , before they should be able to choose assisted suicide. " He suggests that safeguards would have to be passed into law at the state level. "The state Task Force on Life and the B u f f a l a p h y c a 5 m m e 6 �Shades ofGr by Scott Thomas Four Buffalo doctors discuss the care of the dying BLACK A D WHITE aren't options for the physician caring for a patient in the final stage of life. All decisions are made in the gray zone in between. These shades of gray were the topics of a panel discussion, "Confronting Difficult Emotional and Ethical Issues in the Care of the Dying" at the 59th annual Spring Clinical Day, moderated by Elizabeth L. Maher, M.D. '85. The panelists were: Martin Brecher, M.D. '72, chairman of pediatrics at Roswell Park Cancer Institute and chief of hematology oncology at Children's Hospital. Jack P. Freer, M.D. '75, an internist and ethicist at Millard Fillmore Hospital who teaches at UB Medical School. Ross G. Hewitt, M.D., medical director and principal investigator for Erie County Medical Center's immunodeficiency services. Robert A. Milch, M.D. '68, medical director of Hospice Buffalo. Case No. I: A 36-year-old HIVpositive homosexual man. Following complications of AlDS, he began to develop memory loss . He made his partner his health care proxy and told his family in Wisconsin of his illness . When he was hospitalized for PCP pneumonia, his mother demanded that he be intubated for respiratory distress over the proxy 's objections. Hewitt: When the family is not aware of the diagnosis until much Buffalo Physician Summer 1 9 9 6 �Care of the dying later in the course of the disease, it puts patients and perhaps their significant others literally years ahead in terms of acceptance of the situation, coming to grips with their loss, the realities of having AIDS. They've gone through that process and are probably at a better stage to make health care proxy-related decisions on CPR and life support. So now the family is faced with going through all of those same processes that the patient has already been through years earlier. That very often leads to conOicts regarding care at the end of life. I think it's very possible in this particular case that the mother is still in shock and not able to listen to the facts that we might present in terms of what the prognosis is. Freer: This also points out the importance of a health care proxy, particularly in situations where there may be a number of different friends and family who may have conOicting views about what is best for the patient. This is in part because of the legal climate and the popular culture both presuming that people would want everything done to keep them alive as long as possible unless they've said otherwise . With that presumption, if you had somebody like the parent coming in and saying 'yes , you'd better intubate that person,' that is in keeping with this predominant view within the hospital culture and the courts, and there- B u f f o l 0 Physician fore it's important to have somebody who has the legal authorization to make decisions like this. Milch: Sometimes it's helpful to word things just a little bit differently. I've always been uncomfortable with defining ventilation and things like that as "life support." I think the connotation of discontinuing "life support" weighs heavily down the road, and if we redefine them as "function supports"-that's what we're doing with the ventilator is supporting the failed function-then perhaps that could be part of the first step over the bridge. Case No. 2: A 4-year-old boy with Stage 4 neuroblastoma. After chemotherapy, he had remission until age 6, and with a bone marrow transplant did well for another 18 months. At this point the mother requested no aggressive therapy. He was hospitalized for seizures, and required progressively larger doses of Phenobarbital to control them; hospital staff objected to giving such massive doses, and reported the case to administrators. Brecher: When a family faces potential loss of a child, perhaps this is the greatest tragedy that one can face in life. The family is really never the same thereafter. The parents are faced with this overwhelming tragedy in their lives; the siblings, who are sometimes forgotten elements in all of this , are profoundly affected by the parents' full attention on the sick child. The grandparents sometimes feel left out of the loop, and of course they're heavily emotionally involved. There's a tremendous impact on all the family. After the child dies , this family is going to have to live with what went on for many years to come and hopefully feel comfortable, not with the death of the child, but with what went on, that everything that should have been done was done correctly. There is such a loss of control when something dreadful happens to your child. After all, these are parents who used to decide what their kid would wear in the morning, what they would eat at lunch, Summer 1 9 9 6 �and suddenly it seems like everything has spun out of control and they have no impact at all on the course of their child's life. And to be able to bring that into the care-giving aspect of things , to have the child at home with as much support as they need , makes them feel that they have an important pan in this and gives them more comfort about a terminal situation. tain level , we relieve some of their bone pain, we improve their exercise tolerance or what have you. Brecher: The issue of the emotional impact on the care-givers is an important one. The longer you work with a child and a family , and the more you get to know them , the more they become a part of your life and the more difficult it is if there's suddenly a bad turn of events. Freer: Cases like thi also raise an important point for l think the after is important, too , sticking with the people involved in medical education. These are very family. I've had families tell me that not only was losing complex, difficult cases in terms of medical managethe child difficult, but they ment, in terms of commuhad devoted so much of their nication, in terms of settime and so much of their ting where the patient is life energies for months or going to be cared for. And years to the care of this child yet there is still that rem"I'VE HAD FAMILIES TELL ME that suddenly there was this nant of the old medical incredible void , when even education system where THAT NOT ONLY WAS LOSING though they might have cases like this are not inthree other kids, they didn't teresting, they're not good know what to get up for in teaching cases. l still get THE CHILD DIFFICULT , BUT the morning. infuriated when l see patients drop off the teach Milch: Even our choice of THEY HAD DEVOTED SO MUCH ing curve when they go to words is significant. On the hospice or a palliative care one hand we have "do not plan. These are very comOF THEIR TIME AND SO MUCH resuscitate, " on the other plicated management ishand we have "aggressive. " sues, and maybe we have Why would we refer to it as to emphasize this in trainOF THEIR LIFE ENERGIES FOR an aggression, rather than ing. trying to examine it as someMONTHS OR YEARS TO THE Milch: The issue of whether thing that may or may not a patient does or does not be appropriate to a certain have a do-not-resuscitate clinical setting7 l am as CARE OF THIS CHILD THAT order is but a small commuch troubled by standing orders of daily blood draws . ponent in his overall plan To what end? lt doesn' t imfor care, and should really SUDDENLY THERE WAS THIS pact our therapies. Then be kept to the side of deciperhaps it's appropriate to sion-making. The plan of INCREDIBLE VOID. " examine that. CAT scans, care is daily reassessed , MRls, other procedures ofeven hourly reassessed . ten do little more than docuYes , we would transfuse Martin Brecher, M.D. ment the natural progrespatients with metastatic sion of disease and do not prostate cancer, for example , if in getting their affect our decision-making hemoglobin up to a cerprocess. + e u f f a l o Physi c ian Summer l 9 9 6 �Care of the dying se in uland explains how we die by Scott Thomas OTHI G E~E," said Sherwin B. uland, M.D., "we should teach them that they must never let their patients lose hope." Hope-an elusive concept, and one that might seem to have more to do with poetry than with the science of medicine. Yet uland, who delivered the Stockton Kimball Memorial Lecture at the 59th annual Spring Clinical Day on May 11, told a large luncheon audience that hope is a most critical component of care at the end of a patient's life. As death approaches, he said, the role of healer and counselor is most important, not the science of T-cells and high-tech machines. Nuland, a clinical professor of surgery at the Yale University School of Medicine, is best known for his 1994 book How We Die, a frank and anecdotal account of life's last chapter as he has seen it played out in his family and his patients. The book won the ational Book Award for nonfiction and the Book Critics Circle Award, and was a finalist for the Pulitzer Prize. Though the ideas of hope and approaching death may seem irreconcilable, uland offered three ways in which a dying patient can be given the gift of hope. He was once asked, "What is the worst way to die?" His response was, "Alone"-whether physically alone or emotionally isolated. "Hope becomes a promise," he said, "that we will let no one die alone." Second, uland said, hope is the promise that no extraordinary measures will be taken that will make things worse. And finally, he said, physicians can impart the hope for immortality. "I don't believe in an afterlife," he said, "but I do believe in immortality. There are, for each of us, maybe one, maybe five people whose lives are dependent on what we are. We can share with them what their existence means for us. That's the kind of immortality that I would cherish." A person's actions and life affect loved ones for years and perhaps generations. Thus, a life well lived confers immortality. uland also quoted Czech President Vaclav Havel: "Hope is not the belief that things will turn out well. It is the belief '"lr \\ E TE \CH a u f f a 1 OLR qt_,DE TS o Physician that things will make some sense however they turn out." Nuland recounted the circumstances that led him to write How We Die-a persistent literary agent, a family history touched by many early deaths. "Death had been part of the lore of my family," he said. "Going to medical school meant learning to understand, to take part of the mystery away." In his practice he realized that most of his patients had no concept of what life's final stage was like, medically or emotionally. Romanticized Hollywood images of the family patriarch dispensing pithy wisdom from his deathbed, or the beautiful young woman going peacefully into that good night, are all we have to go on, he said. Hence his unflinching collection of stories about how real people die, sometimes easily and quietly, sometimes in pain or unable to resolve their life's unfinished business. uland pleaded for his fellow physicians to pay close attention to comfort care for their dying patients. "How did physicians forget that even more important than saving life is the duty to relieve pain?" he asked. "When did we begin converting every ethical and moral decision into a clinical decision? How have we begun to value triumphs of technique over triumphs of reason?" He traced the genesis of that attitude to the entrance of molecular biology into medicine. "We began teaching our students that one can learn more about a patient through the proper tests than by developing a real relationship with the patient. We moved farther and farther away from the fellow human beings who came to us for help, and before we knew it, we no longer knew who they were." But, uland argued, it benefits the practitioner as well as the patient to embrace a more human connection. "Among the greatest rewards we derive from medicine," he said, "are those we derive when we get emotionally involved with the people who come to us for healing." + Thomas, a frequent contributor to Buffalo Physician, is an editor and freelance writer with specialties in medicine, the arts, and religion. Summer l 9 9 6 �The historic context ot medicine Nationwide history of m edicine meetings draw scholars to Buffalo B Y JESSICA ANCKER for thousands of years, but in every age societal prejudices have colored their interpretations of th ose observations. H EALERS HAVE MADE ACCURATE MEDICAL OBSERVATIO S This lesson was a recurrent theme at the national meeting of the American Association for the History of Medicine, which was held in Buffalo May 9-12 in honor of UB's sesquicentennial. The event drew more than 400 scholars from around the country to the Hyatt Regency Buffalo. In the keynote address, Thomas Benedek, M.D., a rheumatologist and the president of the a sociation, discussed medical theories on the occurrence of gout in women. "The story of gouty women is an example of the interaction of science and the society in which it is practiced. It should not be considered unique," Benedek cautioned. "Despite our tremendous advances in science and technology, an unexpected stress makes us retreat to moralizing." Gout is caused by high levels of uric acid, which is produced by the metabolism of purine. The disease is characterized by sudden attacks of pain, swelling, and stiffness of the joints, often in the feet and legs. Inheritance, overeating, and alcohol can play a role in triggering the illness. Because estrogen help women excrete uric acid more efficiently than men, premenopausal women rarely suffer from gout. Ever since the 4th century B.C., Benedek said, healers have noticed that gout is rare among women. The earliest known pronouncement on the disease"A woman does not take the gout unless her menses be stopped"-is attributed to Hippocrates himself. The Roman writer Seneca blamed the disease on licentious and intemperate lifestyles. While these activities may have been regrettable in men, Benedek said, they were considered despicable in ® women. "Because of their vices, women have ceased to deserve the privilege of their sex; they have put off their womanly nature and are condemned to suffer the diseases of men ," Seneca wrote in a passage echoed by doctors for centuries. An 18th-century comic poem played on the alleged connection with lechery: "Where does one see a wife irate Because her spouse suffers gouty feet? In hot passion's embrace, as e\·e1yone /mows, Tl1 e gouty most often arc mighty heroes!" Doctors trying to explain gout in apparently blameless men and women offered alternate explanations. A few speculated that gout could be inherited from ancestors. Others held that gouty symptoms were not always gout. One doctor wrote that slender women with symptoms of gout were really suffering from hysteria. In the 18th century, the prestigious Philadelphia doctor Benjamin Rush absolved a respectable woman patient of the imputation of indelicate behavior by calling her gout rheumatism. "The cultural response to gout meant that women with gout were scorned: doctors often believed it was due to their unacceptable behavior," Benedek said. "The same thing happened when AIDS appeared. That shows how helpful it is for doctors to know something about the history of medicine-it helps them better analyze new problems that they encounter." The 69th annual meeting of the American Association for the History of Medicine drew 66 papers. The Society for Ancient Medicine, the AIDS History Group, the American Veterinary History Society, the American Association for the History of ursing, and seven other affiliated history societies also held their meetings in Buffalo the same weekend. Papers covered a multitude of topics, including fetal alcohol syndrome, the treatment of insanity in the 19th century, medical scholars in medieval Paris, traditional Korean medicine, the polio vaccine and public health policy, and dissections in the paintings of Rembrandt. + UB history professor Jomes Bono, Ph.D. (left), coordinated local affairs for the national meeting of the American Association for the History of Medicine, May 9-12 in Buffalo. Thomas Benedek, M.D. (right), of Pittsburgh, PA, is the association president. B u f f a l o Phys ici an Summer 1 9 9 6 �.......... . ............ . ............ . ........... . . . .. . .... . ...... .. .. . ... . ... •••••••••• ••• ~ I Dean Naughton to stay for additional six months ohn P. aughton, M.D. , the dean of the medical school and vice president for clinical affairs, has agreed to keep his current posts until the end of the year. aughton said he had planned to retire in June, but agreed to stay on for an additional ix months while the search for his successor continues. "As always, I appreciate your everwillingness to respond to the needs of the university," Provost Thomas Headrick told the dean. "UB greatly appreciates John's dedication and willingness to serve the university," UB President William Greiner said. After his retirement, aughton will John Naughton likely be as busy as ever. He plans to teach, do research in cardiology, and get involved in other educational projects. "''ve begun my transition by teaching a course in health care organization, and I'm continuing my activities in graduate medical education reform, and immunology and heart disease," he said. + Endowment established for scholarships and awards \ J director of admissions and the scholarship committee, I see the tremendous financial need of nearly 50 percent of the school's medical students. It made me realize how crucial financial assistance is to these students. " + ophthalmology. Recipients will be chosen on the basis of academic standing and financial need. "1 owe my success in medicine to UB, and 1 appreciate the opportunities I received when 1 was a student," saidGuttuso " ow, as Thomas Guttuso Registrar Dick Jones organizes the 1996 graduates in the Center for the Arts atrium. Twenty-nine members of the doss of 1946-who graduated during UB's centennial-returned to help the school celebrate its sesquicentennial. scholarship and award fund for UB medical students has been established through a gift of residential property from Thomas]. Guttuso, M.D. '60, the medical school's director of admissions, and his wife, Barbara. The Dr. Thomas ]. and Barbara L. Guttuso Scholarship and Award Fund will provide an annual scholarship for four medical students, as well as an award for a senior with an interest in B u f f a l a Physician Timothy Y. Jordon, M.D., was the class speaker at commencement. Summer 1 9 9 I 6 �• ································································ . I Match Day 1996 UST U DER HALF ofUB's graduatin g class ( 49 percent) were placed in primary care residencies in this spring's Match Day, putting the university within a hair of its 50 percent goal. The ational Residency Matching Program results were announced March 20 by associate dean Dennis adler at the Lord Amherst Motor Hotel. Eighty-two percent of the 136 graduating UB students got their first, second, or third choice of residency. Thirty-one percent will remain in Bu ffalo to train in UB's Graduate Medical Dental Education Consortium, while 53 percent will go out of state. JOHN l. BUTSCH, Stngfl), Rush- Presbyterian-St. Luke's Medical Center, Chicago, IL LAWRENCE R. CANFIELD, Famil) Practice, niversity of ew Mexico, School of Medicine, Albuquerque, M RICHARD E. CHARLES, lnccmal Medicine, The list below includes fou r additional students who were matched on UB Graduate Medical Dental Education Consortium, Buffalo, NY KATHERINE B. CHATIGNY, Psychiauy, Umversity of ew Mexico, School of Medicine, Albuquerque, NM Match Day but were not graduating seniors. Of the primary care specialties, 15 students went into internal medicine and four chose internal medicine-primary care. Twenty-two students chose BASIL CHERPELIS, Internal Medicine (P1clim.), orth Shore Universit) Hospital, Manhasset, Y KRISTEN M. CHRISTIAN, Pediatrics, S Y Y Health Science Center, Syracuse, pediatrics, 21 went into family medicine, and seven chose med!peds. EILEEN (Primal) Ca1c), Emory Universit)' School of Medicine, Atlanta, GA Universi ty of Michigan Hospitals, Ann Arbor, Ml SARAH BALLOW, Pediatrics, KIMBERLY M. BONISCH, Pediatrics, Graduate Medical Dental Education Consortium, Buffalo, NY Jo ANNE ARNOLD, Obstetrics & Gynecology, UB Graduate Medical Dental Education Consortium , Buffalo, NY PETER AUGUSTINOS, Surgery, St. Elizabeth's Medical Center, Boston, MA UB Graduate Medical Dental Educauon Consortium, Buffalo, Y JOHN P. BARRETT, Obstetrics & Education Consortium, Buffalo. Gynecology, Womens and Infants Hospital, Providence, Rl MARY(. BOPP, Pcdiauics, UB Graduate Medical Dental Education Consortium, Buffalo, Y RENIER J. BRENTJENS, lntcmal Medicine, University of Virginia, Charlouesville, VA MICHAEL BEECHER, Medicine/Pediatrics , UB Graduate Medical Dental Education Consortium, Buffalo, NY SUSAN E. BEHR, Pediatrics, Univer it)' of B u f f a l o TIMOTHY M. ComR, Diagnostic Radiology, Univcrsit) of Chicago Hospital, Chicago, IL HOLLY H. CROMWELL, TlansJtional, Cook County Hospital, Chicago, IL F. DAVIS, Internal Medicine, LOS Hospllal, Salt Lake Cit)', UT ALLEN GINA R. BRESCIA, lntcnwl Medicine, BRADLEY R. DAVIS, SurgCI), University of Yale- ew Haven Hospital, New Ha,·en, CT (P1immy Care), University of Rochester, Strong Memorial Medical Center, Rochester, NY SALVATORE BIANCO, Family Practice, Spartanburg Regional Medical Center, Spartanburg, SC Y Yale- ew Haven Hospital, ew Haven, CT PAUL C. BURNS, lntcnwl Medicine Texas Medical chool. Houston, TX Radiolog), Universit) of Rochester, Strong Memorial Hospital, Rochester, Y STEPHEN R. COOK, ,\fcdicinc/PcdJatrics, UB Graduate Medical Dental MATIHEW f. BARTELS, Pediatrics, DAVID ANDERSON, Surgery (P1elim.), UB M. BOBEK, Emergency MediciltC, ONEIL BAINS, lntcmal ,'1-fcdicine mversity Health Center, Piusburgh, PA JOSEPH E. CHRUSCICKI, Diagnostic Phys ici an Cincinnati Hospital, Cincinnati, OH JOSEPH S. DEJAMES, Family P1actice, UB Graduate Medical Dental Education Consortium, Buffalo. NY MANNY A. DELUCCA, Pediatrics, Medical College of Virginia, Richmond, VA Summe r 1 9 9 6 �········································•~ ··· I I ;; :.•> u ~ z Rhode Island Hospital, Prolidence, Rl (LARA E. KIM, lntemal Medicine, University of Nonh Carolina Hospital, Chapel Hill, NC MEEGHAN A. HART, Pediatrics, UB Graduate Medical Dental Education Consortium, Buffalo, Y ANDREW B. KLAFTER, Psychiatry, Thomas jefferson University, Philadelphia, PA STEVEN G. HEINTZ, Family Practice, ANTHONY J. LANGONE, lntemal Medicine, University of Vermont, College of Medicine, Milton, VI Baylor College of Medicine, Houston, IX JASON K. Ho, Family Practice, KEUNG W. LEE, In/ental Medicine, Yale- Glendale Adventist Medical Center, Glendale, CA MATTHIAS K. LEE, Psychiatry, Stanford BRIAN HANLON, lntemal Medicine, ROB L. DEMURO, lntmwl Medicine Dermatology, Stony Brook Teaching Hospitals, Stony Brook, NY (Primar) Care), Bassett Healthcare, Cooperstown, 'Y JAMES W. FOIT, Family Practice, UB DAVID J. D'SOUZA, Diagnostic Graduate Medical Dental Education Consortium, Buffalo, NY RadwlogJ, UniYersity of Texas Medical School, Houston, IX KATHLEEN M. DYSON, Pediatncs, UB RICHARD A. EDWARDS, Obstetncs & Gynecolog_1, UB Graduate Medical Dental Education Consoruum, Buffalo, NY LLEWELLYN A. FOULKE, Patlrologj, Hospital of the University of Pennsyh·ania, Philadelphia, PA UniYersity of Cincinnau Hospital, Cincinnati, OH MICHAEL J. ENDL, /rue mal ?lfedrcinc (Prelim.), Sisters of Charity Hospital, Buffalo, NY; and Dwgnostic Radiolog) , Duke Uniwrsil) Medical Center, Durham, C JOSHUA J. FISCHER, /ntemal Medicine, Universit) of Virgmia, Charlonesnlle, VA SAMUEL GOODLOE, Surgery• (Prelim.), UB Graduate Medical Dental Education Consortium, Buffalo, Y Gynecology, SU Y Health Science Center, Syracuse, NY THOMAS J. GUTTUSO, lntemal Medicine Einstein College of Medicine, Montefiore Medical Center, Bronx, y ERIK J. JENSEN, lntemal Medicine, UB Graduate Medical Dental Education Consortium, Buffalo, NY PATTI A. HAMERNIK, Pediatrics, UB TIMOTHY JORDEN, General Surger), GINA l. FLORES, Far111/; Practice, New STEPHANIE C. HAN, lrllcntal Medicine Hampshire-Dartmouth Famll) Practice, Hanover, H (Prelim.), UB Graduate Medical Dental Education Consortium, Buffalo, Y; and Radiation Oncolog), Yale- e\\ Haven Hospital, New HaYen, CT (Prelim.), Ston) Brook Teachmg Hospitals, Ston) Brook, Y; and B a 0 p y PAULY. JEE, lmemal Medicine, Alben (Prelim.), University of Rochester, trong Memorial Hospital, Rochester, NY; and 1 curolog), University of Rochester, trong Memorial Hospital, Rochester, Y Hospital at Queens, Flushing, NY SCOTT L. FLUGMAN, lmernal Med1cine BABAK JAHAN-PARWAR, Research Fellowship, Swgical Pa!holog), Roswell Park Cancer Institute, Buffalo, Y CHRISTOPHER JAYNE, Obstetrics & Graduate Medical Dental Education Consortium, Buffalo, 1Y DORNA E. FLASH, Transitional, New York Graduate Medical Dental Education Consortium, Buffalo, NY Graduate Medical Dental Education Consortium, Buffalo, NY Universil) of Virginia, Charlonesville, VA DAVID J. FIORELLA, lntcmal Medicine THOMAS F. HUGHES, Family Practice, UB MARK JAJKOWSKI, Surgery, UB THOMAS J. GENNOSA, Family Practice, (Prelim.), UB Graduate Medical Dental Education Consortium, Buffalo, NY; and Oplttlralrrwlog_\, Louisiana tate niYersity Eye Center, Ne" Orleans, LA MICHAEL S. LEONARD, Pediatrics, UB RAJIV K. JAIN, Medicine/Pediatrics, Duke UniYersity Medical Center, Durham, NC TIFFANY B. GENEWICK, Obstetrics (.-. Gy necoiOg)', UB Graduate Medical Dental Education Consortium, Buffalo, Y GARY J. ELKIN, /ntcnwl Medrcrne, Health Service, Stanford, CA Gynecologj, Temple University Hospital, Philadelphia, PA Louis University School of Medicine, St. Louis, MO (Prelim.), i ter of Charity Hospital, Buffalo, Y; and Diagnostic RadiologJ, johns Hopkins Hospnal, Baltimore, MD Graduate Medical Dental Education Consortium, Buffalo, NY JEAN(. HSIAO-WANG, Obstetrics c~ Yu-LUEN Hsu, lntenwl Medicine, St. BRIAN J. FORTMAN, /ntcnwl Medicine c a 5 m (Prelim.) Madigan Army Medical Center, Tacoma, WA WALTER J. KANTOR, Emergency Medicine, University Health Center, Pittsburgh, PA DAVID KAUFMAN, Pathology, Mt. Sinai Hospital, m New Haven Hospital, New Haven, CT e ew York, 9 9 Y Graduate Medical Dental Education Consortium, Buffalo, NY KWOK Ll, lntenwl Medicine (Prelim.), UB Graduate Medical Dental Education Consortium. Buffalo, Y; and Ophthalmology, Louisiana State University Eye Center, ew Orleans, LA DOMINIC R. LIPOME, ln!enwl Medicine (Primary Care), UB Graduate Medical Dental Education Consortillln, Buffalo, NY HAROLD I. LITT, lrHemal Medicine (Prelim.), Mt. Auburn Hospital, Cambridge, MA; and Diagnostic Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA CHENG H. Lo, Surgery, Stony Brook Teaching Hospital, Stony Brook, Y JIADE J. Lu, Internal Medicine (Prelim.), Sisters of Charity Hospital, Buffalo, Y; and Radiation Oncolog), jackson Memorial Hospital, Miami, FL BETH M. MACDONALD, Family Practice, Southwest Washington Medical Center, Bush Prairie, WA MICHAEL A. MANKA, Emergency Medich1e, UB Graduate Medical Dental Education Consortium, Buffalo, NY DEBORAH J. MANN, Emergency Medicine, UB Graduate Medical Dental Education Consortium, Buffalo, NY CHRISTOPHER (. MASCIA, Pediatrics, Medical College of Virginia, Richmond, VA �• ·········· ·· ··············· · ············ ~ I L. WALK, Family Practice, Highland Hospital Program, Rochester, NY PAULS. MAll, Pcdiatncs, Children's JOHN P. PATTI, \1rdiclllc/Pediatrics, UB KARIN A. SELVA, Graduate Medical Dental Education Consortium, Buffalo, NY Pcdtatrics, Uni,·ersity of ew Mexoco, School of Medocine, Albuquerque, M LISA Hospital of Pholadelphoa, Philadelphia, PA L. MCNALLY, Surgery (Prelim.), University of Rochester, Strong Memorial Hospital, Rochester, NY: and Urology, niversity of Rochester, Strong Mcmonal Hospital, Rochester, N'r OSCAR E. PIEDAD, Family PracL!cc, Richland Memorial Hospital, Columboa, SC EDWARD SILVERMAN, Obstctncs & G_\IICcolog_\, Mamwnodes Medical Center, Brooklyn, N'r JAMES G. WAXMONSKY, FREDERICK J. PIWKO, Fanlll) PnJctice, \\ olllamsport Hospital and Medocal Center, Wolliamsport, PA INDRANI SINHA, Pedtatrics, Unovers1ty of Florida, Shands Hospital, GameS\ille, rL KEE Y. WEE, KATHRYN A. MCVICAR, Pcdwtrics, JONATHAN W. SIRKIN, Psychiatl}, UB NAOMI D. WEINSTEIN, f.,Gynecology, Unl\erslt) of Rochester, Strong Memonal Hospotal, Rochester, NY STEVEN R. POSNER, urger\, Unoversit) of Michigan Hospitals, Ann Arbor, Ml JOHNS. PULVINO, Obstetrio & G) necology, Mmne Medical Center, KAREN A. SNELL, Obstetrics f.,Gynecology , Ba)'State Medical Center, Springfield, MA WILLIAM J. MEDWID, KAVITHA T. RAM, Obs!Cims MELANIE Presbytenan Ho pita!, Ne" York, Y THOMAS P. MEAD, Obslrtms Family Practice, Beverly Hospital, Danvers, MA PracL!ce, t.;B Graduate Medocal Dental Education Consortium, Buffalo, NY KIMBERLY E. METZ, Fanuly DAVID T. MILLER, Surge'} (Prclun.), UB Graduate Medocal Dental Education Consortium, Buffalo, Y: and Orthopedtcs, B Graduate Medocal Dental Education Consoruum, Buffalo, Y Emergency Medicine, Long Island jew1sh Medical Center, Long Island, NY PINAKI MUKHERJI, DWAYNE A. NARAYAN, Psychiatry, noverslty of Virgmia, Roanoke,\ A Obstru 1c; f_,Gynecology, noverslty of Texas Southwestern Medocal School, Dallas, TX EMMEKUNLA K. NYLANDER, NAYOMI E. OMURA, Internal Medicine (Prclun.), George Washmgton University, Washmgton, DC J. 0STEMPOWSKI, Orthopedics, Universit)' of Cincinnati Hospital, Cincinnati, OH MICHAEL CHRISTOPHER PACE, Urology, Unoversit) of Texas Southwestern Medical School, Dallas, TX Emngency Medtchtc, UB Graduate Med1cal Dental Education onsortlum, Buffalo, 'r PARAS PANDYA, Medtwoc, Unoversoty of Connecticut, Farmington, CT NEIL N. PATEl. Internal ® C" G\IICcolog_v, LB Graduate Medocal Dental Education Consortium, Buffalo, Y SUNG Y. SoN, Fwmlv TranstL!ollal, Evanston Hospital, Ch1cago, IL Graduate Medical Dental Education Consortium, Buffalo, Y J. RIEGEL, llllernal \trdicine, St. Elizabeth's Medical Center, Boston, MA KRISTIN A. STIEVATER, Psychiatt) , UB Fwnily Practice, UB Graduate Medocal Dental Education Consortium, Buffalo, N'r MICHAEL(. STONER, H. WILLIS, JR., i\eurosurgery, CleYeland Clinic Foundation, Cleveland, OH BYRON MARY M. WILSCH, Obstetrics & Gynecology, University of Rochester, Strong Memorial Hospital, Rochester, Y Graduate Medical Dental Education Consortium, Buffalo, NY KRISTEN M. ROBILLARD, ARLENE S. ROGACHEFSKY, Dw11a!Oiogy. Cle,·eland Clinic Foundation, Cleveland, OH JOSEPH(. WITIMANN, Pediatrics, UB Surgcty, Medical College of VIrginta, Richmond, VA Graduate Medical Dental Education Consoruum, Buffalo, Y Obstcutcs & G\nrcology, Albany Medical Center Hospital, Albany, NY TOVA R. STRAM, l. WRAZEN, Pedialt ICS, Oregon Health Sciences ni\-ersity, Portland, OR JENNIFER Medicine! Pechatms, Baystate Medical Center, pnngfield, MA SUSAN M. SZIMONISZ, Practice, LB Graduate \ted1cal Dental Education Consortium, Buffalo, Y MARY A. RYKERT, Fanul_1 Practice, Niagara Falls Memorial Hospital, Ntagara Falls, Y CHARLES YATES, FamilJ Pedtautcs, B Graduate Medical Dental Education Consortium, Buffalo, Y MAXINE E. SZUMIGALA, STARLEEN (. SCHAFFER, \lcdicine/ Pediatncs, Jackson Memonal Hosp1tal, Moamo, FL MARK R. ZAMBRON, Medicinc/Pediallics, UB Graduate Medical Dental Education Consortium, Buffalo, NY Emergency Mcdicme, UB Graduate Medical Dental Educauon Consortium, Buffalo, ) RENATE TREADWAY, DAVID F. SCHMITZ, Fcuml) Practice, Famoly Practice ResidenC) of Boise, Boise, ID Fanuly Practice, Niagara Falls Memonal Hospital, iagara Falls, Y DANIEL W. ZORICH, Obs!CIIics f., Gynecology, UB Graduate Medical Dental Education Consortium, Buffalo, NY MILLICENT H. TREVETT, J. SCHROT, Surget) (Prelim.), t. Louis niverslty chool of Medicine, St. Louis, MO RUDOLPH J. SCHUECKLER, Orthopedics, McGaw Medical Center, orthwestern Uni,·ersity, Chicago, IL JON UDWADIA, Pccliatr tcs, UB Graduate Med1cal Dental Education Consortium, Buffalo, N) EROL VEZNEDAROGLU, Surgcl) (Prelun .), Thomas jefferson UmverSll), Philadelphia, PA: and 1\eurosurget) , Thoma jefferson UmverS!l), Philadelphia, PA DOUGLAS A. SCHULTZ, 0 + Pediatrics, UB Graduate Medical Dental Education Consortium, Buffalo, NY OTTO 0 lntetnal Medicine (Prelim.), St. Mary's Medical Center, Long Beach, CA: and Radiation Oncology, Stanford University Hospital, tanford, CA Scan S. WILLIAMS, PATRICK J. STEIN, Psychiatl), UB BRIAN f Pediatrics, University of South Florida, College of Medicme, Tampa, FL Ptactice, Lancaster General Hospnal, Lancaster, PA EILEEN B. REILLY, u Dtagnostic Radiolog_\, Uni\·ersll\ Hospitals of Cleveland, Cleveland, OH Graduate Medocal Dental Education Consortmm, Buffalo, NY Portland, ME B Psychiall), UB Graduate Medical Dental Education Consortium, Buffalo, NY p s o n S u m m e 9 9 6 �··················································· ·· ···································• · · ~ •• New UB Chair honors professor HE U IVERSITY HAS HONORED a respected faculty member, Eugene R. Mindell, M.D., with the establishment of the Eugene R. Mindell M.D. Chair in orthopedic surgery. Mindell, UB professor emeritus and chair of the department of orthopedics from 1964 to 1988, conducts research in orthopedic oncology and bone pathology. Eugene Mindell He is particularly interested in new treatments that avoid total amputation. For example, Mindell takes pride in saving the arm of a 19-year-old woman with osteogenic sarcoma just above her wrist. After the cancer was removed, along with part of the radius, the patient's bone was reconstructed with bone from a bank. Ten years later, the patient has a good arm with an excellent grip, and no recurrence of disease. After interning at the Cincinnati General Hospital, Mindel! was stationed as a naval officer at the Veteran's Hospital in Columbia, SC. He completed his residency at the University of Chicago Clinics. Mindell met his wife of 50 years, june A. Mindell, while he was a medical student and she was an undergraduate at the University of Chicago. They have four children and three grandchildren. Robert Gillespie, M.D., chair of UB's Department of Orthopedic Surgery, said of Mindell: "He is a man of great charm and obvious integrity and leadership qualities. His greatest accomplishments are his dedication to the residency program and his work as a teacher. He is a true academic surgeon." The chair is funded by a charitable remainder trust commitment from Byron A. Genner III, M.D., UB class of 1954. Further gifts toward the chair are being sought. Genner's gift places $825,000 in real estate in trust for the medical school, while still generating income for Genner during his lifetime. The school will seek more money to bring the total funding for the chair to between $1 million and $1.5 million. "UB provided me with an outstanding undergraduate and medical education," said Genner. "This became evident during my internship and orthopedic surgery residency. It was satisfying being as well or better prepared than my peers in my academic endeavors." Genner spent 15 years on active duty in the U.S. Air Force, retiring as a lieutenant colonel. His career includes posts as associate clinical professor at George Washington University and assistant clinical professor at Georgetown University. He continues a part-time orthopedics practice, along with an active + medical-legal consulting service. -8 Y P A U L A W I T H E R E L L As part of UB's sesquicentennial celebration, these plaques were installed in downtown Buffalo to commemorate the first three homes of the medical school. B u f f a I a Physician Summer 1 9 9 6 �Robert N. Spengler, Ph.D. Neuroimmunologist WORKING AT THE INTERSECTION OF IMMUNOLOGY AND NEUROBIOLOGY IT' 5 o sEcRET that the mind has a profound effect on healing. Quantifying that relationship and examining it at the molecular level is the work of Robert Q) sity of Michigan, where he also did postdoctoral work in pathology. He joined UB as an assistant professor of pathology in 1989. His primary area of interest is cytokines, a class of immune system hom10nes that serve as cellto-cell communication signals. Once thought to be active only in the immune system, cytokines have been found to have many functions in the nervous system, as well. This has led researchers to believe that cytokines participate "We're looking for a better understanding of how the brain controls body functions , and the other way around-how cells associated with the immune system control neuronal functions," says Spengler, assistant professor of pathology. "Each system is interdependent on the other. " Spengler, 4l,isparticularlywell qualified to explore the fruitful intersection of immunology and _Eeurobiology. He earned his Ph.D. in pharmacology from the Univer- B U f f o . Spengler, Ph.D. l o Physician in neuro-immune communication and may even act as neurotransmitters in certain situations. Spengler is particularly interested in tumor necrosis factor. Like many other cytokines, it was first identified and named for its connection with an immune function (killing tumor cells). ow researchers believe it also has neurologic functions. Because the concentration of tumor necrosis factor often governs how it functions in different disease states, much of Spengler's work focuses on investigating how the body regulates the release of the substance. Another of Spengler's research areas is psychotropic drugs. He has investigated the biochemical activity of antidepressant drugs and how cytokines may be linked to depression. He also studies the use of antidepressant drugs to alleviate neurological pain, which occurs when a disorder such as arthritis causes chronic pain that creates a continuous circuit in the brain, causing the sensation of pain even without any further stimulus from the site of the disorder. Drugs that affect neural behavior may do so by regulating cytokine expression or sensitivity, according to Spengler. "We use drugs as a tool to understand a disease, " he explains. "Drugs are used because they work, not because we know how they work." Spengler is also beginning experiments on a second group of cytokines, the interleukins, which seem to perform many of the same functions as tumor necrosis factor. This redundancy, he theorizes, shows how important these functions are. "It's clearly the body's way of backing itself up," he says. + Summer 1 9 9 6 �·· · ··· · ········· · · · ·········· · ·········· · ··· ·· · · ···· · ··· · ········· ··· ·· · ···· · ···· · ··· · · ·• · · ~ I Two D~tinguished Professors named wo members of UB's medical fac- a department-wide commitment to upulty have been named to the rank holding the policy. It is largely through of Distinguished Professor, the his work that UB has been recognized highest rank in the State University as a national leader in recruiting and of ew York system, by the SU Y retaining students and facBoard of Trustees. ulty from traditionally James P. olan, M.D. , was named underrepresented groups. Distinguished Service Professor, awarded olan has been a memin recognition of extraordinary service to ber of the Governor's the community, state, or nation. Council on Graduate Perry Hogan, Ph.D., was named Perry Hogan Medical Education, and Distinguished Teaching Professor , has served as president of the ew York an equivalent honor that recognizes State chapter of the American College of outstanding teaching competence. Physicians. olan, who recently stepped down Hogan teaches cardiovascular physiafter 16 years as chairman of the Depart- ology, cell membrane phenomena, and ment of Medicine, is an internationally the electrophysiology of excitable cells. recognized expert in For many years he has taught cardiac liver function, liver and circulatory physiology to first-year disease and injury, medical and graduate students. and endotoxins. Hogan received the Louis A. and Ruth His efforts in the Siegel Award for Outstanding I eacher in 1970s led to a the Preclinical Sciences five times during full and fair affirma- a 16-year period. The award is given by tive action policy and medical students and fellow faculty. + James Nolan I UB microbiology professor dies at 76 ugene A. Gorzynski, Ph .D. '68, of Homburg, NY, a professor of microbiology and pathology at UB and chief of the microbiology section at the Buffalo VA Medical Center, died May 16 after a lengthy battle with cancer. He was 76. In 19 55, Gorzynski and the late Erwin Neier, an internationally known bacteriologist, were the first to describe enteropathogenic f. coli bacteria as a toxin producer that could cause severe diarrhea in infants and young children. Aveteran of World War II, Gorzynski served as director of bacteriology with the Army General Hospital in England. While there, he met his future wife, Ruth Repp, an Army nurse and Missouri native. She died in 1992. At different times, Gorzynski worked at the VA, Children's Hospital, and Roswell Pork Cancer Nielsen and Nolan Win Alumni Association Awards Institute, and served as an assistant director oft he ancy H. ielsen, M.D., a 1976 and serves as regional medical director graduate of the medical school for the Board of Professional Medical and a former member of the SU Y Conduct in the ew York State DepartBoard of Trustees, has been given ment of Health. A specialist in internal medicine the Samuel P. Capen Award , the and infectious disUB Alumni Association's most ease, she is a clinical prestigious award. assistant professor of The award recognizes alumni who medicine at UB. have made "notable and meritorious The Alumni Ascontributions to the university and its sociation also gave family ... influencing growth and imthe Walter P. Cooke provement of UB and stimulating othAward to James P. ers to give their active interest and olan , M.D. The material support to the university. " honor recognizes ielsen was the first woman to be exceptional service elected president ofThe Buffalo General to UB by a nonHospital medical staff. She is past presialumnus . + dent of the Erie County Medical Society Nancy Nielsen B u f f a I o P hysici a n Summer 1 9 9 6 Erie County Health Department. He hod taught at the UB School of Nursing and Erie Community College as well as at the UBmedical school. Amember of the UB-based Ernest Witebsky Center for Immunology, he served on the admissions committee of the School of Medicine and Biomedical Sciences. An amateur violinist, Gorzynski performed with the Amherst and Orchard Park Symphony orchestras for more than 30 years. He also was commanding officer of the 365th General Hospital for the U.S. Army Reserves in Amherst from 1966-69. He retired as a colonel in 1979. + ® �••••••••• • • 0 •••••••••• • ••••••••••••••• •• •• • • 0 ••••••••••••••• "I had never known so much about someone " ••• BY CHR I S SCHAEFFER , UB MEDICAL SCHOO L C LASS OF 1998 n the summer of 1995, after my first year of medical school, I spent six weeks at The Buffalo General Hospital's Outpatient Clinic. The story of that externship is the story of the 100 people I saw. I was fascinated by their stories, by their problems, by the factthatl was sitting in the room with them, wearing a white coat and writing it all down. Of all the stories that I came across that summer, one will always stay with me. Mr. R was a 54-year-old man, divorced, with one son. His face had the look of worn shoe leather. He was gaunt, with uncut white hair and skinny legs inside cowboy boots. In our first interview, during a checkup, Mr. R gave me the gist of his complaints. But what fascinated me was that his life had been so different from mine. He was poor, he had grown up without any of my advantages, and he had taken pleasure where he could find it. Later, my preceptor, Dr. Richard Schifeling, explained alcoholic cirrhosis and the attendant problems Mr. R was having-ascites and hemorrhoids, to name two. Mr. R returned the next week, before his scheduled appointment, complaining of pain and worsening ascites. I waved to him in the hall, oddly glad to see a familiar face in the crowd. ext week Mr. R was back. This time I asked to see him. In the sea of everchanging, ever-similar complaints, Mr. R seemed like a rock of certainty- ! already knew what was wrong with him. I talked to Mr. R about his belly and how things were going at home. Frankly, I was curious about how his life had come to this point. He could barely move himself around the examining room. I wanted to know, 'Who is this person who has done this to himself?' I put all of my empathy and listening skills to work, and for my efforts learned only that he lived with "a woman friend" and had just decided to give up drinking. Mr. R asked me to take off his boots becau e it hurt too much to bend over. That day, Dr. Schifeling recommended a transjugular intrahepatic ponosys-temic shunt, or TIPS, to bypass his failing liver. Mr. R looked at us, then looked away, and consented by saying, "Whatever you got to do.l just want to get this over with." When Mr. R was admitted, I thought, "Hah! He'll be here all the time-now he'll have to talk to me. " My increasing familiarity with his medical condition made my complete lack of understanding of him bother me more and more. When I visited, we chatted about nothing-the nurses, the food, the TVs remote control. What I really wanted to know was if he was nervous about the surgery, if he really had kept drinking even with his liver destroyed. I left without answers. Mr. R went from poor to worse. His kidneys began to fail , so he couldn't • •••••••••••••••••• • •••••••• have the surgery after all. Over the next two weeks I saw a myriad of people in the outpatient clinic, but every morning and evening I visited Mr. R. We tried everything we could to help, including multiple abdominal taps to relieve his ascites. One memorable day I stood with an attending, a resident, an intern, and a fourth-year student as the intern began an abdominal tap. After the initial excitement, everyone left except the intern and myself. The intern looked at me, considered his aching arms, and asked ifl would like to finish the tap. The next thing I knew, the intern had left, I was holding a needle somewhere inside Mr. R's belly, and Mr. R was talking on the telephone. All I could think was, "What is going on?? I hope nothing goes wrong! " Every day he was in the hospital, I saw his complete medical report, from his blood and urine to how he had slept the night before. I had never known so much about someone. In the final weeks of my externship it became clear to me (long after it had become clear to everyone else) that Mr. R was going to die, and die soon. Whenever I saw him, I waited quietly so he could bring up anything he wanted to talk about. I asked how he felt, I joked with him. Nothing changed. He still complained about his roommate, his girlfriend, his son. I never got to know Mr. Rduring our talks. He stayed private and separate from me. Knowing his prognosis, Mr. R decided to go home. He tried to cheer our blank faces by joking that he'd come to the clinic, "just like before." He left on Friday. When I got to work on Monday, Dr. Schifeling took me aside and told me that Mr. R had died over the weekend. + Chr-is Schaeffer, l-..ho will enrcr h1s !hird year a! L'B School of \.fed1cme and Biomedical Sciences 1h1s fall, is the secretan- of tht' \.1edical Studen! Polit\ s u f f a I o Phys i cian Summer t 9 9 6 �1996 reunion portraits en classes were honored at this year's Reunion Weekend festivities as they gathered in Buffalo to remember old times and renew acquaintances. FIRST ROW:john Crissey, Raymond Trudnowski, Stanley Cyran, William Walsh, Myron Williams, john Allen, Annabel Irons, Edward Gudgel, Donato Carbone. SECOND ROW:Lawrence Golden, William Marsh, orman om of, Harry Petzing, Fred Schwarz, Charles Bauer, Harold Levy, Herbert Pirson, Ross Imburgia, Thomas Morgan, R. joseph aples, Maynard Mires, Albert Rowe, Eugene Marks. THIRD ROW: Raymond Osgood, Richard Munschauer, Bernard Groh, Carllmpellitier, Willis Allen, Guy Hartman, Charles joy, W. William Tornow, Amo Piccoli, Frederick Musser. B u f f a l o P hysician FIRST ROW: Lester Wolcott, August Bruno, Donald Pinkel, Leonard Danzig. SECOND ROW: Alvin Volkman, james LoVerde, Allen Goldfarb, Milton Robinson, Eugene Leslie, Marvin Pleskow, Eugene Teich, Carl Conrad, Edward Shanbrom, Harold Krueger. Reunion Classes Continued on page 30 Summer l 9 9 6 �~ -········· ··· ·· · · · · · ························ · · ··· · · ··························· · ········· lEI FIRST ROW: Peter Goergen, Bernard Sklar, Helene Buerger, Sue McCutcheon,john Bartels, Robert Reisman, Fred Lee, Herman Schoene. SECOND ROW:john Hodson, joseph Kunz, Fred uessle, Robert Corretore, Paul Ronca, john Walters, Hugh 0' eill, Carl Schueler, jean Haar. THIRD ROW:Edmond Gicewicz, Mark Dentinger, Fred GoldsteinGretan, Erick Reeber, Dennis Heimback, George Christ. FIRST ROW: Eugene Cimino, Harold Brody, Michael Cohen, james Markello. SECOND ROW:joel Bernstein, William Hewett, A. Thomas Pulvino, Thomas Ciesla, Washington Burns Ill, Sylvia Kennedy, ]. Anthony Brown, Wende Young, Henry Goller, Edwin Manning,Jonathan Logan,joseph Fermaglich, Howard Wilinsky. FIRST ROW: Edwin jenis, Murray Yost, Robert Barone, jared Barlow, Cary Presant. SECOND ROW: Roger Seibel, jeffrey Kahler, Virginia Rubinstein, David Buchin, Rudolph Oehm, Ross Guarino , William Sperling, Frank Barbarossa, james Cuffe. THIRD ROW:Harold Grunert, David Wallack, Eugene Spiritus, H. john Rubinstein, Michael Weintraub, Louis Antonucci, Thomas Bradley, Wayne Fricke, Marcella Fierro, james Moran, john LaDuca. FIRST ROW: Colleen Livingston, Annie Terry English. SECOND ROW: Marvin Stein, Askold Mosijczuk, Dennis adler, Scott Kirsch, David Rowland, David Bloom, Sigmund Gould, Roy Oswaks, Allen Berliner, Robert Kaufman, Richard Manch, joel Paull. THIRD ROW:jay Harolds, Donald Marcus, David Hoffman, Martin Mango. FOURTH ROW:Manny Christakos,] ames McCoy,] ohnAntkowiak. FIFTH ROW: Charles Yeagle. B u f f a l o Physician Summer 1 9 9 6 �FIRST ROW: Gregg Broffman, Arnold Wax, Linda Wild, Susan Barde, Robin Lazar-Miller, Patrick Hayes, Karen Glasgow, Louise Isenberg-Dallaire, Stephan Levitt, Hartwig Boepple, Paul Schwach. SECOND ROW: Martin Barron, Grant Golden, Daniel Wild, Jon Yerby, Christopher Barde, Melvin Pohl. THIRD ROW: David Myers, Christopher Brandy, William Bishop, Dennis Pyszczynski, John Bodkin. FIRST ROW: Suzanne Bradley, Beth Heitzman Donahue, Betty Wells. SECOND ROW:George Bancroft, ToddJacobson, Pablo Rodriguez, Stanley Bukowski, Daniel Castellani, Pano Yeracaris. FIRST ROW (KNEELING AND SITTING): Carmen Todoro, Katrina Guest, Donnica Moore, Sanford Levy, Molly 0'6-orman, Paul Holmwood, Deborah Puckhaber, Mary Bennett. SECOND ROW: Megan Farrell, Shirley Anain, William Beneke, Andrew Giacobbe, Edward Stulik, Lance Besner, Riyaz Hassanali, Leonard Portocarrero, Karin Choy, Sean O'Brien, Mark Vickers, Deborah Richter. FIRST ROW: Alison Koehler, Kathylynn Southard, Susan Littler, Grace Alessi, Mary Bonafede, Rosalind Nolan Sulaiman, Elissa Bookner. SECOND ROW: Kinga Tibold, Joseph Barrocas, Joseph Bonafede, Steven Abbey, Richard Alessi, Jennifer Ferraro. B u f f a l o P hysician Summer 1 9 9 6 �Treating children from around the world LYNNETTE NIEMAN , '78, CLINICAL DIRECTOR OF THE NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT ynnette Kaye Nieman, M.D., values the knowledge and practical experience she carried from UB to her career at the National Institutes of Health (NIH). However, one thing she hasn't found a use for was an adage she was taught here: in medicine, if you hear hooves, it's more likely a horse than a zebra. "Around here, that just isn't true: hooves mean it's probably a zebra," explained ieman, 43, clinical director of the ational Institute of Child Health and Human Development, one of 16 component institutes at NIH. Nieman encounters the exotic and uncommon every day as she studies and treats afflicted children who come from throughout the world to the Institute's Bethesda, MD, clinic for treatment of rare endocrinological disorders. "Simply put," ieman explained, "we get to see weird things from all over the world." ieman oversee patient care, protocols, credentialing and medical education at the Institute , administering a 36bed inpatient unit and large outpatient clinic. More than 70 physicians, from fellows and trainees to experienced, board-certified experts , provide direct care through affiliation with the Institute. Young doctors who complete fellowships at the Institute are frequently recruited into academic medicine, the pharmaceutical industry or regulatory posts, including the Food and Drug Administration, A Buffalo native, ieman is board-certified in endocrinology and internal medicine. She obtained her undergraduate degree in molecular and cellular biology at Smith College and attended UB School of Medicine and Biomedical Sciences between 1974-78. She performed her residency in Buffalo as well , rotating between Buffalo General, the VA hospital, and what is now ECMC. She rose to chief resident during her third residency year. ieman served as an endocrine fellow in Buffalo for a year before joining IH explains ieman. Although the federal government has tightened its belt in recent years, ieman says that IH still enjoys relatively stable funding. Independence from constant grant-garnering enables IH clinicians and researchers to pursue "more high-risk research where there might not be a clear-cut payoff," explains ieman . Some of the work the Institute does in vaccine development is "really cutting edge," she added. Field trials take place all over the world , including current projects in Vietnam, Egypt and Israel. in 1982. ieman has authored more than 100 major journal articles and book chapters, most on Cushing's Syndrome or female reproductive anatomy. Cushing's Syndrome is a rather uncommon disease which ieman has researched , written about , and spoken on extensively. A natural overproduction of cortisone by the adrenal system, Cushing's comes in varying degrees of severity. Although relatively treatable, early Cushing's symptoms can be difficult to distinguish from more com- ® B u f f o l o Physician summer l 9 9 6 �Cushing's. In addition, she has examined other potential uses for the drug, which the FDA is now examining. "The drug seems to have potential for reducing fibroids and stalling endometriosis ," she explained. Thirty million women a year experience these problems, which are the most common reasons for hysterectomies, according to ieman. Dr. "Pepper" Davis, ieman's first attending physician in Buffalo, deserves credit for steering her toward endocrinology, she recalled. "I was mon ailments, ieman explains. "The early signs, such as weight gain, hypertension and interested in gynecology, but we talked a lot and he mood swings, are frequent even among the general popula- introduced me to the idea of medical endocrinology." ieman also credits UB medical school for showing tion," she said, "so we do a lot of work teaching clinicians how her how to examine philosophical and bio-ethical conto distinguish Cushing's from more common ailments." siderations during her training, tools Later stages of Cushing's, however, are which she has now revisited in dealing unmistakable. Patients will develop round, 11 with the RU 486 research. Simply put1 we reddened faces and weight gain in the center ieman, her husband and their two of the body, with purple stretch marks around children live in Bethesda. After years the midsection. Fully developed Cushing's get to see weird dedicated to the study of endocrinologican be fatal. Generally, victims succumb to cal change , ieman is occasionally ancillary problems including hypertension, tempted to "treat" her 13-year-old son infection, or adrenal cancer. things from all for puberty. "His mouth definitely went ieman's research into Cushing's has into puberty before the rest of him," says brought unique opportunities to study potenNieman. "There are those days, when I tial uses for RU 486, the controversial drug over the world." tell my husband , 'You know, I could used in other countries as an "abortion pill." cure this!"' ieman has found that RU 486 is an + effective cortisone blocker in treating B u f f a l a Physician Lynn ette Nieman, M.D. Summer 1 - 9 9 6 STEVE COX �SURF THE NET! Three generations of UB doctors he University at Buffalo's sesquicentennial celebration serves as a special milestone for the Levy family. It will mark the 50th anniversary of the graduation from B of Harold]. Levy, M.D., and the lOth anniversary of the graduation of his son, Sanford H. Levy, M.D. It will also be the Slst anniversary of the graduation of Harold's father, Sidney H. Levy, M.D., a radiologist who started the Levy line of UB physicians. Sidney, who died in 1945, received his M.D. in 1915 from the then-private nivcrsity of Buffalo, interned at the old Eric County Hospital, and then served as aU .. Army medical officcrduringWorld War 1. When idncy opened his practice in diagnostic radiology, he was only the second physician to render such services in post-World War I Buffalo. "When he started his practice, some hospital did not have radiologic equipment, o the patients were brought to my father's office in ambulances for such ser- vices," said Harold, a Buffalo psychiatrist. Harold graduated with honors from the UB medical school in 1946 at the young age of 21, and served for a short time in the U.S. Army Medical Corps. ln 1948, Harold was recalled to active duty and served as chief of psychiatry at army hospitals in Korea and Hawaii. Later, Harold entered the growing field of psychosomatic medicine. ow, at age 71, Harold, a life fellow of the American Psychiatric Association, continues his private practice at Psychiatric Associates of Western ew York and serves as a clinical associate professor at UB. Exactly 40 years after Harold received his medical degree, he watched his son, anford, graduate with highest honors. 'Tve wanted to be a doctor for as long as I can remember," recalled Sanford, an internist at Sisters Amherst Health Center. "Seeing my father working in medicine and the strong relationship he had with patient had a positive influence on me. Even today, my father continues to teach me." A fellow in the American College of Physicians, an ford is also an authority on alternative and complementary medicine. Following his father's lead, Sanford also teaches and mentors UB medical students and residents at Sisters Hospital. Harold is a member of the james Platt White ociety, a past president of the Medical Alumni Association , and reunion co-chair for the class of 1946. "I have an extreme sense of pride both as an alumnus ofUB and as a physician," he said. "Medicine is the highest calling and i one of the most commendable professions to enter. There is no greater sense of satisfaction and gratification than to serve your fellow man and improve his + quality of life. " The Levys ® • INTERNET SOFTWARE Many Titles!! PC Anywhere ENOR10N IOCANYWIIIll£ DOS ... 67 Windows... $69 • America Online \ lac & \\'indows...S21.-l9 • lnlcrncl Starter Kit Windo"~...$3-t49 \lac... 3-4.95 • Prodig) \lac & Windo"s... 15.95 • ~ctscar>e "~I' igator for \\ indows...$32 Can '1connect from home ll'ithout one! INTERNAL STARTING AT $84.95 EXTERNAL STARTING AT $94.95 Many Brands-' • Supra • US Robotics • Boca Modems • Practical Peripheral • Global Villiage BOOKS 20 % off Retail Using the Internet.............$15 The User-Friendly Reference Easy Internet................ $18.95 Using the Internet.............$29 Special Second Edition INTERNET WORKSHOP Learn How to Use the Internet! Feb 7 & 8 ......$99 CUSTOMIZED WORKSHOPS These private workshops are tailored to your needs. They are available and very affordable. Call 645-3560 for information! Prices sllmw1 iuclude a 2l1 discounl for cash payments Open .\1011. Tues, Fri 1/am-Spm. ned & Tlwrs llam-6pm (ij': l"". . . II~tel M .. . . .. A non-profit UnwefSJfy program for students faculty & staff The Commons • North Campus • (716) 645·3554 • Fax: 645-3884 P B u A f U f L a A l W o ITHERELL Phys i cian Summer 1 9 9 6 �........ . .. Reunion classes support UB his year's reunion classes made generous donations to the medical school during the annual Spring Clinical Day and Reunion Weekend festivities. In all, $130,030 was pledged to the medical school to be used for scholarships for worthy students. Following is a list of participating class members and class totals. Dr. Thomas]. Murphy Dr. Edward A. Penn CLASS OF 1946-$58,900 Dr. john G. Allen Dr. Charles D. Bauer Dr. Robert A. Brown Dr. Donald P. Pinkel Dr. Marvin j. Plcskow Dr. john T. Crissey Dr. Robert E. Ploss Dr. Stanley j. Cyran , Jr. Dr. Milton Robinson Dr. Maier M. Driver Dr. Lawrence H. Golden Dr. Gerard E. Schultz Dr. Edward Shanbrom Dr. Bernard F. Groh Dr. Edward F. Gudgel Dr. Eugene M. Teich Dr. Alvin Volkman Dr. Guy L. Hartman Dr. Lester E. Wolcott Dr. Charles A. joy CLASS OF 1956-$3,050 Dr. Elliott C. Lasser Dr. M. David Ben-Asher Dr. Harold J . Le,·y Dr. Robert B. Corretore Dr. Eugene M. Marks Dr. Joseph j. Darlak Dr. Dennis P. Heimback Dr. William L. Marsh Dr. Arthur T. Skarin Dr. Lawrence D. Lubow Dr. Donald H. Marcus Dr. Merrill L. Miller Dr. Elizabeth Donahue Dr. Paul D. Fadale Dr. jonathan Gewirtz Dr. Wende W . Young Dr. Richard L. Munk Dr. joanne G. Gutliph Dr. Denms A. Nadler Dr. LyndaM. KarigHohmann Dr. Todd A. jacobson CLASS OF 1966-$13,825 Dr. Paul M. Ness Dr. Louis]. Antonucci Dr. joel H. Paull Dr. Robert E. Kaplan Dr. Frank j. Barbarossa Dr. Dadd W. Potts Dr. Girard E. Robinson Dr. jared C. Barlow Dr. Douglas S. Richardson Dr. Daniel P. Schaefer Dr. Robert M. Barone Dr. Da,·id M. Rowland Dr. Anne Shain Dr. Thomas \V. Bradley Dr. Richard I. Staiman Dr. Evan B. Shap1ro Dr. james j. Cuffe . Jr. Dr. William C. Sternfeld Dr. Ross A. Sih erstein Dr. james D. Felsen Dr. Melvin f'ox Dr. Annie Terry-English Dr. Da,·id Small Dr. Harold Trief Dr. Lloyd D. Stahl Dr. Harold F. Grunert . Jr. Dr. Edwin H. jenis Dr. Francis j. Twarog Dr. Roberta C. Szczurek Dr. Stephen . . Vogel Dr. David M. Thomas Dr. jeffrey L. Kahler Dr. Bennett G. Zier Dr. Frederick L. Williams Dr. Georgianne ZigarowiCz Dr. KcnnethV. Klementowski CLASS OF 1976-$6,300 Dr. ~tichael L. Aaron Dr. Serafin C. Anderson CLASS OF 1986-$4,920 Dr. Laurel A. Bauer Dr. William j. Beneke Dr. Donald M. Pachuta Dr. Cary A. Presant Dr. Dr. Dr. Dr. Dr. Ben W. Rappole Dr. james F. Shaffer Dr. Michael R. Bye Dr. Anthony Camilli Dr. William L. Sperling Dr. John E. Spoor Dr. David Wallack Dr. Michael !. Weintraub Dr. Paul B. Cotter. Jr. Dr. David A. Della Porta Dr. Geraldme K. Kelley Dr. james Kern Dr. Sean T. O'Bnen Dr. Dr. Dr. Dr. R1chard j. Lederman Charles H. Michalko james]. Moran john j. O'Connor Dr. joseph L. Kunz Dr. Maynard H. Mires, Jr. Dr. Thomas W. Morgan • Dr. Paul Stanger Dr. Ronald H. Usiak, Sr. Dr. Martin E. Leber Dr. Annabel M. Irons - ~ Deborah Beller Marlene Bluestein Christopher f' . Brandy Soma Y. Burgher Dr. Michele]. Armenia Dr. Mary K. Bennett Dr. john H. Bloor Dr. Marsha E. Brooks Dr. Lucy A. Campbell Dr. Timothy E. Frey Dr. Katrina A. Guest Dr. Camille Hemlock Dr. Thomas]. Kufel Dr. Sanford H. Le,·y CLASS OF 1971-$17,225 Dr. Richard W . Munschauer Dr. Fred Lee Dr. Sue A. McCutcheon Dr. jennifer S. Kriegler Dr. john Y. Lambert Ill Dr. Micha Abeles Dr. Stephan M. Ledtt Dr. janice j. Pegels Dr. R. joseph Naples Dr. Frederick C. Dr. john M. Antkowiak Dr. Nancy H. Nielsen Dr. Roslyn R. Romanowski Dr. Norman Nomof Dr. Jordon S. Popper Dr. Michael B. Baron Dr. Christine Privitera Dr. Mark E. Schweitzer Dr. Raymond W . Osgood Dr. Paul D. Barry Dr. Denms R. Pyszczynski Dr. Rita R. Sloan Dr. Harry Petzing Dr. Paul C. Ronca Dr. Herman R. Schoene Dr. Allen I. Berliner Dr. Thomas L. Ritter Dr. joy D. Steinfeld Dr. Amo j. Piccoli Dr. Matthew W. Szawlowski Dr. David A. Bloom Dr. Paul Schwach Dr. William H. Stephan uessle Dr. Herbert S. Pi rson Dr. jerald A. Bovino Dr. Carole Shear Dr. Edward j. Stulik Dr. Alben G. Rowe CLASS OF 1961-$9,250 Dr. Barry G. Brotman Dr. \Varren Thau Dr. Carmen M. Todoro Dr. Fred S. Schwarz Dr. Richard H. Baker Dr. Kenneth A. Burling Dr. George Toufexis Dr. Michael \V . Wood Dr. W. William Tornow Dr. Nicholas j. Capuana Dr. Bernard M. Wagman Dr. Richard j. Valone Dr. Harold Brody Dr. Washington Burns Ill Dr. Kenneth j. Clark , Jr. Dr. Arnold Wax Dr. William P. Walsh Dr. Michael E. Cohen Dr. Manny E. Cristakos Dr. Linda Wild Dr. Myron E. Williams. Jr. Dr. H. Howard Goldstein Dr. Arthur C. Cronen Dr. Herbert S. Wolfe Dr. Henry F. Goller Dr. Lawrence]. DeAngelis CLASS OF 1981-$5,915 Dr. Paul L. Nadler Dr. Thomas G. DiSessa Dr. George Bancroft Dr. Anthony T. CLASS OF 1951-$9,645 Dr. William j. Hewett Dr. Howard M. Hochberg Dr. Pasquale D. Baratta Dr. Michael D. Plager CLASS OF 1991-$1,000 Dr. jennifer f. Hen kind Ferraro Dr. Colleen A. Mattimore g Dr. Carl R. Conrad Dr. Leonard S. Danzig Dr. Sylvia R. Kennedy Dr. Sigmund S. Gould Dr. Harvey Greenberg Dr. Andrea C. Bracikowski Dr. Philip j. Rados Dr. Seymour j. Liberman Dr. jay A. Harolds Dr. Suzanne F. Bradley Dr. Barry D. Shaktman Dr. Allen L. Goldfarb Dr. jonathan Logan Dr. Barbara I. Karpel Dr. james B. Bronk Dr. Mitchell K. Spinnell Dr. Mark E. Heerdt Dr. Edwin j. Manning Dr. Robert B. Kaufman Dr. Stanley L. Bukowski Dr. Harold P. Krueger Dr. Dave B. Olim Dr. Scott D. Kirsch Dr. Daniel A. Castellani Dr. Eugene V. Leslie Dr. Saar A. Porrath Dr. Stanley B. Lewin Dr. James j. Czymy Dr. james V. LoVerde Dr. A. Thomas Pulvino B a 0 p h y c a 5 u m m e 6 �~ -··································· · · · ··· · ············· · Why c~tay home for lEI the holiiJayc~ ? Medical Alumni Awards The front-wheel urive Infinitt-® I 50"' An interuw more .•paciow thana Rolf,, RL>yce Silm· Spur 11/. An e:>:ceptionally .fJetzerOild IL:•t of dtanJarJ lu.."l.·wy feat/ire.•. A 190-hp V6 capah!e ofout-acceleratin.lJ many lll.Ylli:J V&•. tlnd of cour.•e, the ,ltandarJ-,,etting pet:formance anJ .•erl'ice of lnfiniti. The Medical School Alumni Association presented three Lifetime Career Achievement Awards at Spring Clinical Day on May ll. The awards are given to alumni/alumnae in honor of lifelong achievements in important areas of medical Like e<'ery lnfiniti, llu G20 come.• ll'ith an e;t:/en,lil'e liA of .•tanJard !u.-wry feature,•; tl -1-year/ 60,000 mile Ba.•ic Nell' Vehicle Wtzrranty; 2-1-hour RoaJ.Jitle tl.•.•t:ttance Program Trip interruption Benefit.•; anJ our Free Serl'ti:e Loan Car Pro_qram. $3 ]9 mo. endeavor, such as teaching, research, 50 mo. !ea.Je $0 down practice, or community service. Michael E. Cohen, M.D. '61 (top left), is a neurology professor at UB. IN FIN IT I Robert E. Reisman, M.D. '56 (top right), is an allergist in Buffalo. Edward Shanbrom, M.D. '51 (bottom), is retired from his internal medicine AUTO PLACE INFINITI 8129 MAIN ST., WILLIAMSVILLE 633-9585 practice in Santa Ana, CA. All are pictured with Margaret Paroski, M.D., East of Transit Rd. , Near Eastern Hills Mall the outgoing president of the Medical Alumni Association. G20 42 moJ130 42 mo. lease with cash or trade equity down. (G20-$495) (130-$450). Bank fee + tax and license due at inception. 12,000 annual mileage. $.12 per mile 1n excess. ® B u f f a l a Phys ician Summer 1 9 9 6 �--~- -~ ---~- - - Spring Clinical Day and Reunion Weekend '96 SALE OR LEASE CONTEMPORARY MEDICAL OFFICES Spring Clinical Day (May 11) kicked off a lively reunion weekend. Alumni from the past SO years attended the Stockton Kimball lecture, CME panel discussions, and poster exhibits at the Buffalo Marriott. But the weekend's social events, receptions, and dinners also provided plenty of time for meeting old friends and making new ones. 4800 sq. ft. onNiagam.PallsBlv4.inAmhent Close to l-290 • Ample Parking • Handicapped Accessible Competitive Rent 3,000 sq.ft.Delaware Awnue a: \'irginillStreet Plenty of Parking • Can be divided or expanded ALANT.HASTINGS • 847-1100 • HXT.286 ~ ?~\~t?~ B u f f a t o P hysician Summer 1 9 9 6 �• ·························································· ; HURWITZ & RNE, PC. I I 1 9 3 0 5 CARLJ . STREICHER '35 , of Lake Havasu City, AZ, ha retired from his ophthalmology-otolaryngology practice. He writes, "After a direct experience with insertion of a stent into a coronary artery, I am now as active as a golrer rive days a week can be, and hope to continue in this career for some tune! " BERNARDS . STELL '36 , FRANKL. TABRAH '43, SERVICI G in the Department of Physiology at the Uni- THE LEGAL versity of Hawaii's School of Medicine, and H EALTH Straub Clinic and Hospital. recognized with a plaque from the Hidalgo• Managed Care Starr County Medical Alliance for his lifetime dedication to the citizen ofHidalgo and Starr • Purcha e & Sale of Practices • Business & Tax Planning 1 9 5 0 WILLIAM J . SULLIVAN '55 , 5 of los Angeles, CA, is self-employed in forensic psychiatry. will be memorable: in May will be the 60th anniversary of the granting of my M.D. de- He is president ofW.j. Sullivan, M.D., Inc. gree; the 50th anniversary of my having earned an Cd.M. degree from the Millard . of Buffalo; the 50th • HCFA Safe H arbor Regulations 1 9 6 HARRIS FAIGEL '60 , 0 5 of Waltham, MA, anniversary of my induction into Phi Delta Kappa, honorary education fraternity; and pediatrics at Tufts School of Medicine and the 50th anniversary of my membership in was elected to the boards of the American the American Psychiatric Association." College Health Foundation and the American College Health Association. One son, 9 4 5 Douglas, is Hnishing a GI fellowship and taking a position at the Portland (OR) VA '40, ofjacksonville, FL, was Hospital and Oregon Medical School; Faigel's awarded a special citation by the American other son, jordan, is a vice president at Association of Retired Persons in appreciation Paine Webber in New York City. JOHN D . WHITE 0 and Phys ician Self-Referrals • Contracts with Private was appointed associate clinical professor of 1 Scm CES CoMMU ITY of McAllen , TX, was ciety of America. Stell adds, "The year 1996 Fillmore College at N EEDS OF THE director of th e Baromedicine Center at the IVAN W . KUHL '45 , I of Honolulu, HI , of Sun Cit), AZ, the tereo Division of the Photographic So- AT LAW is emeritus professor of community health Counties through his medical practice. won the Master Stereographer Award from ATTORNEYS & Public Entities • Employee Relation Counseling • Fringe Benefit Programs • Representation Before Government Agencies on Audit & Bus iness Issues • Facility Finance and Construction of outstanding service to the community. of Pittsburgh , PA, was elected president of the Pennsylva- • Credentialing Hills, Ml , received the second annual Grad iva Award from the ational Association for the nia Academy of Ophthalmology at its an- and By-Laws Advancement of Psychoanalysis and the Biglan is director of ophthalmology at ALBERT W . BIGLAN '68 , ALEXANDER GRINSTEIN '42 , of Beverly nual meeting in Pittsburgh March 29-30. American Board of Accreditation in Psycho- Children's Hospital of Pittsburgh, and con- analysis for his book The Rcmwlwblc Bcatrix sults for the Neonatal Intensive Care Potter. The Gradiva Award, named for igmund Freud's 1907 work, Delusions and Dreams in jensen's "Gradiva," honors poets, ery at Magee-Women's Hospital , the Veteran'sAdministration Hospital , the West- artists, writers, and others who create works Rehabilitation Institute of Pittsburgh. urs- ern PA School for Blind Children, and the • H ospital/Medical Staff Issues Please contact Robert P. Fine or Lawrence M. Ross at 716-849 -8900 that advance psychoanalysis. Grinstein's of Orchard book won in the category of childhood- BERNARD C . MUSCATO '69 , related books. He was presented with the Park, NY, has been appointed chair of Mercy award on Apri l 20 at the annual Hospital's Department of Obstetrics and Gy- conference in ew York City. AAP necology. He is past president of Mercy 1300 Liberty Building Buffalo, New York Hospital's medical staff and is serving a six- ® B u f f a l o Ph ysician Summer 1 9 9 6 �••••••••••••••••••••••••• II 0 BARANSKI ADVERTISING • I THE ULTIMATE DRIVING MACHINE= year term on the hospital's board of directors. Since 1974, he has been in private p ractice at Hambu rg Gynecological and Obstetrical Group. 1 9 WILLIAM J. 7 0 5 was appointed FIDEN '70 , clinical director of Erie Countr Medical Center's Department of Familr Medicine. He also serves a clinical assistant professor at UB. A colonel in the ew York Air a- tiona! Guard, he is clinic commander of the 107th Medical Squadron in iagara Falls, Checkpoint Foreign Car, Inc. NY. He and his wife, Susan, live in Buffalo. Sales and Service Medical College of Wisconsin . His daughter Lisa, a sophomore at Duke University, will Your advertising presents your c o mp a ny image t o the public .. . and to prospective cli ents a nd c ust o me rs. 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CALL US TODAY REBECCA JACKSON SCHEITERLE '79 , (716) 645·6933 of Olean, Y, is doing full-time emergency medicine and is ER director at Olean General Hospital. She has four children: Stacy (18), Zachary (10), Jonathan (8), and MICHAEL J. BARANSKI Kathryn (7). She was remarried injuly 1995 to Rick Scheiterle. Marketing Representative 1 9 8 0 SU S AN STEPH E NS-GROFF '82 , P. S. We did this book! 5 of Phoe- nix, AZ, pediatrician for Maricopa County (AZ) Regional Schools, was honored as an outstanding healer by the YWCA ofMaricopa County at its third annual Tribute to Women B u f f o l 0 P hysician summer l 9 9 6 ® �• ···· · ··· · ······························· · ; Ifyou thought you knew us... do J.OU know I luncheon. She was chosen for her extensive efforts to provide medical services to the poor, especially her work running the clinic at the Thomas j. Pappas Regional counseled their parents about the limitations and possibilities of their children's conditions. She was the widow of RussellS. Kidder, M.D. Center for homeless children. ROBERT C . BAHN '4 7 diedApril 1 9 9 0 s 30, 1995,at his home in Rochester, M . He was 69. He was emeritus ROBERT P . P ITERA '90 , of Holbrook, Y, recently com- consultant in pathology and anatomy at the Mayo Clinic. He earned a Ph.D. in pathology from pleted a lecture series at the Beijing Hospital in the People's the University of Minnesota in 1953. He had a longterm interest Repub lic of China for the hospital's 75th anniversary. "My in the application of computers to medicine and belonged to the lectures focused on sports medicine with emphasis on diagnosis and treatment." The series drew over 100 physiatrists from all parts of China. Interested alumni Mathematics Association of America and the Association for Computing Machinery. Bahn also played trombone and tuba with local groups, including the Rochester can contact him at the Empire State Building, 350 Fifth Ave., Civic Music Concert Band and Suite 6606, New York, Y 10018 (212-293-7800), or at his home, what's NE.W? ~"~~ ., s~"s 'loJ· ._;;.~""'os"<'" • 14,000 sq. ft . of flexible ~~"~~ ~<:• 'b-~ e'-' meeung space on property ~ ~ 'o"<:PLUS direct access to an .,;::.f) {"~0 additional 250,000 sq. ft . 'r>" { 0~~ with state-of-the-art capabilities. "~(('X ;;."s;;. • Superb catering and innovative <1$"s~'~{ 'Q~s' theme dinners PLUS expert ~\'l ~ ~'l 0~ planning assistance from .,;::.f) ._~{;;.'<:pre-event through closing. <.0 Trombones Anonymous. His wife, Miriam Ruth Huer, died in 1992. 405 Sadd le Rock Road, Holbrook, NY 11741 (516-5638346). "It was great seeing everyoneatourfifth reunion. Keep in touch and keep smiling." And Your Choice To Stay In WNY! Buffalo Physician is on e-mail! OBITUARIES RUTH F . KRAUSS-KIDDER '4 3 , a respected member of the Children's Hospital staff and the UB faculty, died March 29, 1996, at the iagara Lutheran Home. She was 75. Before • A first-class hotel with outstanding amenities, comforts and conveniences - centrally located at the University at Buffalo Complex. Our new address for classnotes is Rooms bpnotes@pub.buHalo.edu. associate professor of pediatrics in UB's department of neurology. After graduation from UB's medical school, she interned at the former news about your fife, career, or famay. Don't forget to include your name, your home BUFFALO~affiOft address, and the year you E.]. Meyer Memorial Hospital. She joined Children's medical staff in earned your MD from UB. 1340 Millersport Highway, Amherst, Y 14221 (7 16) 689-6900 or (800) 334-4040 At the University at Buffalo Complex 1945. As a pediatric neurologist, she not only treated patients but ® B u f f a li.1r Congrarulations to The University at Buffalo School ofMedicine & Biomedical Studies on celebrating I 50years ofteaching, healing and research.' FromTN'f-~ Please send us the latest her retirement, she was director of electroencephalography at Children's Hospital and clinical ,t\'ail.tbl~: lJ B Alumni W~:~:k~:nd Oc.tob~:r ·1-6, I 'J'J6 l a P hysician Summer 1 9 9 6 �The jury is out. Your practice and assets are on the line. This is not the time to be second-guessing your choice of professional liability insurance companies. In a similar situation, a MLMIC policyholder remains confident, knowing he or she is protected by a company that already has successfully defended more physicians than all other available insurers combined. 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U.S. Postage PAID Buffalo, NY Permit No. 311 STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 ADDRESS CORRECTION REQUESTED 1 77 3 ri £ 1-1L l H ~C E CE S St:R LS Dt:PT B TT ti l I.,. r - PLANT'ING A TREE 'Z'S' ·= UNDER WHICH You WILL NEVER SIT OR. OEVILLO W. HARRINGTON, class of 1871, knew how to make his money grow. In fact, this man who in 1905 provided $5,000 through his will for the University at Buffalo School of Medicine, is still supporting UB today through the endowment his bequest created. THIS PERMANENT endowment in Or. Harrington's name has grown to over $300,000 and today it supports the famous Harrington Lecture Series, which twice a year brings distinguished scientific speakers to the School of Medicine and Biomedical Sciences. DR. HARRINGTON'S LEGACY to UB is just one of many bequests which have established permanent and important endowed funds at the school. They enable UB to provide scholarships to outstanding students, enhance scientific research, support excellence in teaching and meet the ever-changing needs of the school. YOU TOO can provide the School of Medicine with a measure of permanence through a bequest. Proper estate planning helps you develop a smart fi nancial plan. A charitable bequest provides the satisfaction that comes from planting a tree under which you will never sit, but which will bear fruit for generations to come. FOR A CONFIDENTIAL consultation on making a bequest to the UB School of Medicine and Biomedical Sciences, or to receive materials to share with your attorney or estate planning advisor, please contact: STEPHEN A. EBSARY, JR. Assistant Dean and Director of Development, School of Medicine and Biomedical Sciences UNIVERSITY AT BUFFALO (716) 829-2773 U N I V I!:IIISITV AT .UFFALO SCHOOL 01" MEDI C INI!: I li 0 1848 Y ll · A R 5 1998 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Summer 1996 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1996-Summer Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician and biomedical scientist Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v30n03-1996-Summer Table Of Contents A list of subunits of the resource. Buffalo Hospice Physician-Assisted Suicide The End of Life and the Quality of Death Research Medical School News History of Medicine A Student's Perspective Alumni News Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. 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Copyright 1996 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/f4209f935ca3475fdb4248c5ca161ddc.pdf f8f3e3241eb62160d7d97da33858a740 PDF Text Text State University of New York at Buffalo School of Medicine and Biomedical Sciences, Spring 1996 8 4 6 9 9 6 �BUFFALO PHYSICIAN Volume JO , Number 2 ASSOCIATE VICE PRESIDENT FOR UNIVERSITY SERVICES Dear Fellow Alumni, Dr C uole 5rnth Petro ACTING DIRECTOR OF PUBLICATIONS Kathryn A. ~"''ncr AS WI: CELEBRATE the University at Buffalo s sesqUiccntenmal this EDITOR many talented physicians and scientists who have contributed to that year, we reflect on the rich history of our med1cal school and the jesSica Ancker history. These indi\'Iduals were visionaries in their own era, lookmg ART DIRECTOR co~ld Alan J. Kegler into a future that others ASSOCIATE DESIGNER sesqlllcentenmal celebrate not only our school's past, but also our julrr c.rerten not sec. So it is fittmg that the vision for the future PRODUCTION MANAGER We have a tendency to thmk that the past was somehow a Ann Raszm;.mn Brown STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES Dr. john :-.jaughton, \'icc PreSident for Clmrcal Affarrs. Dccm kinder, simpler time, when doctors were unburdened by the complicated issues we face today, and inspiration and dedication were all that , \vas needed It seems unfair, somehow. Roswell Park did not have to spend two hours on the phone arguing to get an MRI approved . James Platt \Vhite did not have to pay outrageous malpractice premiums. Matthew Ma.nn did not have the quality-assurance police hounding hun about his C-scction rate. Austin flint EDITORIAL BOARD Dr John A RKhcn , Chairman Dr. Martrn Brecher Dr. Harold Brody Dr. Richard L. Collms Dr. Alan J. Drinnan Dr james Kanski Dr Barbara Marjcroni Dr, Elizabeth Olmsted Dr. Charles Pagand, Dr. Margaret W . Parosk1 Dr. Thomas Raab Dr. Stephen Spauldmg Dr. Bradley T Truax TEACHING HOSPITALS AND LIAISONS The Buffalo (,encralllosprtal ,\.ticlwd Shu11 The Children's llosprtal of Buffalo Erie Count\' Medrcal Center Mercy Hospital Jl,llllard fillmore llosprtals rrani~ Sm·a • N ragara ralls Memorial \1cdrcal Center Roswell Park Cancer lnsmute Sisters of Charity llosprtal Dnmis MrCcuthv \'rterans Affairs \Vrstcrn New York Hcalthcan· Svo.,tem did not have to worry about a \1edicaid audit. They didn't have to get CMI: credits, write triplicate scripts, or attend endless hospital committee meetings Things were so simple back then-if you call operatmg wnhout electric lights or antibiotics simple In real It}, each generation has its own umque problems to face Our common denominator is that we overcome the challenges and learn ways to solve our problems. Despite all the woes of modern medical practice, you?g people are applymg to our school in record numbers. \\'hy? One reason is that despite the stresses It bnngs, medicine still offers the intrinsic satisfaction of t._uring illness or helpmg people cope with what we cannot cure. The other reason is that we have a ternfic medical school. I may sound like a proud mother offering a somewhat biased opinion about how good-looking her children are but our med1cal school offers an excellent education at a reasonable cost hy any objective standards Our school has been acknowledged as an outstanding primary care/comprehensin' medical school by a national magazine (which arrived at that conclusion \V nhout any mput from me)! So how do we keep our medical school top notch m tough tunesl _Our Medical Alumni Association is a key player in that mission Since its mceptwn m 1875, the Medical Alumni Association has served to better the school in many ways. It allows us to stay in touch giving us the opportunity to network and exchange Ideas. A casual conversation at an alumni ©The State t niwrsrty of New York at Buffalo reception ca"n lead to a major project for the Medical Alumm Association. C.cneral class Buffalo Phv"rrun rs publrshcd students choose what field of medicine they want to pursue. quarterly by the State UnrvcrSlt)' of New York at Buffalo School of Medicine and BiomcdJCal 'icit:nu.·s and the Olfrce ol Publicatrons. It rs sent free of charge. toalumnr , fanrltv , students, rcsrdrnts and frrends. I he staff resn\'l's the rrght to edrt all copy and suhmisstons accepted for publicauon Address question.._, comments and submisSions to: The Edrtor Bu{julo Physificm, Statr l~ nivcrslt)' or New York at Buffalo , Offit-c of Puhlr callons 136 Crofts llall , Buffalo , New York 14260 Send address (hanges to: Buffalo Physician. 146 Cl'~ Addrtron , H35 Miun Street, Buffalo, New York 14 214 reunion gifts fund much-needed scholarships. The Coi~munity•Physi<.ians Program helps In treating a patient, any physician can tell you the difference a supportive familr makes family serves ro motivate, comfort, guide, and care for the patient. As medical alumni, we are the family of our school. As a family, we are proud of the 150 years of tradition this yearlong sesquicentennial celebratiOn marks, and the MediCal Alumm Association looks to its . , members for a \ tsion of the next 150 years. We also plan to have fun in the process. \Vannest regards, ~~ W. ?OA.o~, MD Margaret W . Paroski, MD. Prrsidcnt, l\.1cdical Alumni Association �v 0 5 p L . R 3 N 0 , o . N G 9 2 9 6 150 Preparing for the 21st Century -by john Naughton, M.D. UB's MEDICAL ScHOOL AT THE fOUNDlNG OF THE U 1\'ERSITY OF BUFFALO The stories of three of UB's founding father -by judson Mead BUFFALO's U !QUE NETWORK OF TEACHING HOSPITALS How the unusual relationship between the University at Buffalo and its teaching hospitals evolved. -by Ann Whitcher PHOTO ESSA'r: LIFE AT THE MEDICAL SCHOOL Two students bring us along during their daily routine. -photos by Don Heupel, story by jessica Ancker The medi cal faculty of the Uni versity of Buffa lo in 1861. PHOTO: UNIVE R SITY A RCHIVES . UNIVERS ITY AT BU FFALO _.J CoNTINuiNG A TRADITION or ExcELLENCE Profiles of some of UB's young faculty . m m MEDJCI'\J E or THE F UTURE Members of the UB community speculate on what is to come. C LASSNOTES �• ICa Preparing for the 21st Century This special issue of the Buffalo Physician celebrates UB's Sesquicentennial. The school's birthday is May 11, 1846, when New York State granted the charter to form the University ofBuffalo. Our Sesquicentennial Celebration parallels the events from early 1846 through mid-184 7, when the first class was graduated. The medical school was founded with strong community ties and a dedication to preparing excellent physicians committed to the highest quality of patient care and community service. At least three ofUB's first seven faculty members were unquestioned giants in medicine. Dr. james Platt White, one of UB's founders and a gynecologist-obstetrician, extended clinical teaching to include the demonstration of live birthing. Dr. Austin Flint was a peripatetic teacher, expert diagnostician, prolific writer, and editor. Dr. Frank Hastings Hamilton, a surgeon, introduced the use of ether as an anesthetic in BY JOHN the iagara Frontier. These three set the course for UB's medical school, consistent with Chancellor Millard Fillmore's dream that UB should be "eminently useful" to the citizens of Buffalo and western ew York. Like all institutions in the young nation, UB had its ups and its downs. A few of the high points: • The recruitment of Dr. Roswell Park from Chicago to head the Departments of Surgery in both UB and Buffalo General Hospital was a major accomplishment. Park was an internationally recognized surgeon with a broad range of interests and tremendous energy and foresight. His NAUGHTON , M . D . DEAN , SCHOOL OF MEDICINE AND BIOMEDICAL S CIENCES VICE PRESIDENT FOR CLINICAL AFFAIRS ••• a u a 0 p h y 5 c a n s p n g 9 9 �Buswell, and a UB alumnus, Dr. Harry Laforge, helped secure this bequest, which was shared between UB and the University of Rochester Medical School. • A group of local physicians (alumni and non-alumni) formed a fund-raising organization, the Annual Participating Fund for Medical Education (APFME). The first funds were used to recruit Dr. Hermann Rahn to become chairman of the Department of Physiology. Today, the funds are endowed and the revenues support Continuing Medical Education programs. Barbara Mierzwa serves as the APFME Director for CME. • The Medical Alumni Association supports the professional development of medical students, residents, and its other members. A major new initiative is the annual recognition of a Distinguished Medical Alumnus. • UB and its teaching hospitals established a nationally recognized model for graduate medical education. The Graduate Medical Dental Education Consortium of Buffalo has demonstrated the importance of shared gover- memory is honored through the cancer institute and the local society of surgeons that bear his name. • During the troubled years around UB's centennial, a leader emerged who served as dean for 12 years, Dr. Stockton Kimball. 1 regret that we never met. He is reputed to have been a warm person with a great deal of foresight, tenacity and fortitude who provided the leadership to broaden the medical school's missions and to relocate the school to the University Campus. • During World War 11, the school added two strongwilled, well established educators and scientists to its basic science faculty , Dr. Ernest Witebsky and Dr. Oliver P .Jones. These two , who helped establish UB's strength in fundamental biomedical research , were named Distinguished Professors by the SU Y Board of Trustees. • The school received its largest endowment from a Buffalo industrialist, Ralph Hochstetler, after his death in 1955. The revenues support physicians as they prepare to become clinical scientists and faculty committed to biomedical research. Hochstetler's brother-in-law, Dr. Henry s a 0 p h y 5 c CONTINUED a s p 9 9 ON PAGE 9 6 54 e �"For a long time the defects in the system of medical instruction in the neighboring colleges at Fairfield, Geneva, and Willoughby had been the subject of remark among my medical associates and myself It was on all hands agreed that the great desideratum, clinical instruction, could not be supplied in these rural schools. Without an opportunity to apply at the bedside the precepts inculcated in the lecture-room, the system of teaching by lectures can never be successful in making good practitioners. "Moved by these considerations, and influenced partly, no doubt, by the hope of personal professional advancement, ifthey could show they merited it, two or three young men, after careful deliberation, set about procuring a charter for a medical college. In this enterprise the older practitioners not only declined to participate but tried to discourage its undertaking. Nothing daunted by this opposition, aided by a few laymen, we proceeded in the winter of I 845-6 to procure a charter for a University. In the latter part of the same year we organized a medical department and appointed a corps of professors."- from remarks by Professor James P. White, M.D., at the inaugural dinner of the Alumni Association on Feb. 23, 1875. The "two or three young men" were White himself, Austin Flint, and Frank Hastings Hamilton, all then in their early or mid-30s, and all destined to make their marks on medicine and medical education in the United States. By B judson a Mead 0 p y s c a n 5 p g 9 6 �6 JAMES PLATT WHITE A pioneer in American obstet- rooms and laboratories for les- rics and gynecology and in the sons in practical anatomy and teaching of clinical obstetrics, chemistry. The faculty con- James Platt White may rightly be sisted of White, Flint, Hamil- considered first among equals in ton, Charles A. Lee, James Webster, Charles B. Coventry, the founding of the University of and George Hadley. Hamilton was Buffalo School of Medicine. a faculty member of the Geneva Of the three principal founders, Medical College but had taken up resi- White had lived in Buffalo longer than dence in Buffalo two years before; he re- Austin Flint and Frank Hastings Hamilton. cruited Lee, Webster, Coventry, and Hadley from White's father had moved the family from Austerlitz, Geneva. Y (near Albany), to the Buffalo area when White was five White cooperated in the founding of the city's first years old. He was educated in local schools and at hospital, the Buffalo Hospital of the Sisters of Charity, as Middlebury Academy in Vermont. White began his medical education in Buffalo in the well as in the establishment of Buffalo General and the office ofDr.Josiah Trowbridge in 1830 and then spent three Providence Asylum for the Insane. He was also instrumen- years attending medical lectures at the Fairfield Medical tal in the establishment of Buffalo State Hospital. College in Fairfield, Y. After receiving his medical degree On Jan. 18, 1850, White wrote a new chapter in Ameri- from Jefferson Medical College in Philadelphia in 1834 at can medical education when he conducted a clinical dem- the age of23, White set up a practice in Buffalo specializing onstration in obstetrics before 20 students in the new in the diseases of women and children. He also traveled to facility the university had built the previous year. The Europe to further his studies in Edinburgh, Paris, and students were permitted to perform a vaginal examination Vienna. According to one biographer, "he possessed of a woman in labor and then to witness her delivery. White, boundless physical energy which gave him a forceful , who knew this teaching method to be accepted in many aggressive personality." European medical schools, and who believed that medical students should witness a delivery before entering general The first class of the new University ofBuffalo met in the practice, called it "demonstrative midwifery." spring of 1847. The facility , a renovated Baptist church, included an amphitheater that could accommodate 200 The demonstration became a topic for vociferous public students and also served as a dispensary, as well as lecture discussion. Physicians who had opposed the founding of 8 a 0 p y c a 5 p n g 9 �the medical school were quick to attack White, while his nal of the Medical Sciences, published in Philadelphia, but students passed a resolution congratulating and thanking White was supported by medical journals in Louisville and him. The Buffalo Commercial Advertiser editorialized in Cincinnati. The Committee on Education of the American favor of his demonstration, but a few days later the Buffalo Medical Association reponed in 1851 that demonstrative Courier carried a highly charged editorial, signed "L," midwifery was entirely unnecessary. stating that "a precedent had been set for outrage indis- Clinical teaching in obstetrics was soon well established, criminate." In a letter to the Buffalo Medical journal, 17 nonetheless. Twenty-five years later White was pleased to Buffalo physicians called demonstrative midwifery unnec- remind an audience of medical school alumni that "this essary and "grossly offensive." When Dr. Horatio Loomis method of teaching has now been introduced, in some form had additional copies of the Courier editorial printed and or other, into all the leading institutions of the land, and in distributed, White sued him for libel. White was supported many, is made a prerequisite to graduation." at the trial by the testimony of Dr. Chandler Gilman, james Platt White was the only one of the three principal professor of obstetrics and disease of women and children founders of the medical school to spend his entire career in at the College ofPhysicians and Surgeons in New York City. Buffalo; however, he was far from parochial in his associations. Gilman stated that he had performed similar examinations He was a founder of the American Gynecological Society and, in while two or three students observed, and that he hoped to 1877, chairman of the section on obstetrics and gynecology and emulate White's demonstration of an actual delivery. vice president of the American Medical Association that had Loomis was acquitted, primarily inveighed against his clinical teaching because the jury ignored the judge's a quarter of a century before. He was Physicians who had charge; however, White felt that demonstrative midwifery had been also extremely active locally and was one of the founders of the Young opposed the founding of Men's Association, the Academy of vindicated. White's demonstration and Fine Arts, the Buffalo Historical Soci- the medical school were ety, and the Buffalo Club. At the time Gilman's testimony on his behalf quick to attack White, were the target of a vehement editorial by the influential American jour- of his death, he was for the second lime dean of the medical school he while his students passed a had brought into the world. resolution congratulating and thanking him. 0 B u a a p h c a n s p n g 9 �AUSTIN FLINT G In 1836, 24-year-old Austin Flint, during his eight-hour visit was with his wife and baby son, arrived enough to generate three papers, in Buffalo from published in 1845, 1852, and 1875 orthampton, MA, to set up a medical practice. (presented in 1873), on the com- Within five years he had pub- municability of typhoid. lished papers on rubeola, sudden The illness had struck 28 of the death, the use of quinine in intermit- 4 3 inhabitants of the village, killing 10 ting fever, and the connection between of them, a few weeks after a traveler from dyspepsia and the mind. By the time of his Massachusetts had fallen ill and died at the death in 1886, Flint had published more than 240 village inn. Flint discovered through correspon- articles on almost every aspect of internal medicine, as dence that the traveler had probably "left home with the well as several books and a widely adopted medical germicidal principal of typhoid in his body"; he con- textbook. He had also made significant contributions to cluded that "the subsequent cases were due to infection or the fields of physical diagnosis and epidemiology, served contagion introduced into the closely congregated com- as president of the American Medical Association, helped munity. " Although he noticed that three families who did found the University of Buffalo and another medical not drink from the village well escaped the disease, he college, and been a faculty member at four other schools. attributed their health to better nutrition because they Flint was the fourth generation in his family to practice were also wealthier. After diagnosing the disease and medicine (and he was followed in the profession by a son testing the well water, Flint dismissed an accusation from and grandson). He was educated at Amherst College and villagers that the epidemic had been caused by deliberate received his medical degree from Harvard College in poisoning of the well. 1833. Although he did not study abroad, Flint was well Flint's early papers on contagion were quoted by john acquainted through his Harvard teacher with the statis- Snow, a pioneer in epidemiology, in a famous oration in tical case recording methods advocated by the Parisian 1853. After that speech, Snow succeeded in stopping an clinician Pierre C. A. Louis. In 1843, Flint, who had been outbreak of cholera in London by taking the handle off a appointed health officer in Buffalo the year before, was pump to prevent people from drinking the contaminated called to the village of water. onh Boston, 18 miles away, to investigate an outbreak of severe illness. He diagnosed the Years later, after the transmission of typhoid fever illness as typhoid fever. The information he collected through contaminated water had been demonstrated, u a 0 p h y s c a n 5 p n g 9 9 6 0 �Flint revisited his North Boston findings and found that natural gift, nor does it accompany as a matter of course there had been a privy close enough to the public well to the acquisition of knowledge one acquires from reading or contaminate it with infected excreta from the first victim. didactic lectures. It is an art to be acquired." Flint was In his 1873 presentation to the American Public Health described as "a large man, with a full voice," always Association, Flint said, "It is perhaps the most remarkable solicitous of the comfort and feelings of his patients. experience on record as embracing a combination of In 1852 he left Buffalo to take a position at the University circumstances proving, in the first place, the communica- of Louisville. That year he received an American Medical bility of typhoid fever and, in the second place, rendering Association prize for his essay "Variations in Percussion vastly probable, if not certain, the communication by and Respiratory Sounds." Four years later Flint returned to means of a contagium contained in drinking water. " He Buffalo as professor of pathology and clinical medicine. His recommended sanitation precautions that, unfortunately, work on heart sounds resulted in a second AMA prize in went unheeded for another half-century. 1859. In 1862 he published a paper describing the particu- The reputation Flint had established through his early lar heart murmur that still bears his name. publications prompted an invitation in 1844 to teach at The characterization of the "Flint murmur" occurred at Rush Medical School in Chicago. He accepted, but soon Charity Hospital in New Orleans. The peripatetic Flint realized that he preferred living in Buffalo. Once resettled was by then dividing his time between Buffalo in the in Buffalo, he founded the Buffalo Medical]ournal, which summer and he edited for the next decade. ew Orleans in the winter. Flint left Buffalo permanently in 1860 to become professor In 1845, Flint attended the ational Medical Conven- of pathology and practical medicine at Long Island College tion in New York City as the delegate from the Buffalo Hospital. He helped establish Bellevue Hospital Medical Col- Medical Association. He was appointed to a committee lege and spent the rest of his life in New York City. charged with studying the requirements for granting medi- Flint's son Austin Flint Jr. described the variety of cal degrees. The committee's recommendations ultimately experiences that had made his father one of the great included extending the year's lecture period from four to six clinicians and teachers of his age: "During his professional months; requiring attendance for two years of lectures; career he encountered soldiers in camp and in barracks; requiring a total of three years of study, including three the rich and the poor; those afflicted with diseases inci- months of dissection; and requiring that all medical facul- dent to lives of ease and luxury and paupers in hospitals; ties have at least seven professors. the pioneers of western New York After helping to found the Uni- and the inhabitants of the metropo"The ability to observe versity of Buffalo, which held its first classes in 1847, Flint served as lis ... cases observed in the experience of a quarter century as a gen- is not a natural gift," the school's professor of medical eral practitioner, and of more than theory and practice for six years. He another quarter century as a con- Flint said. "It is an art shared james Platt White's belief in sulting physician, including epito be acquired." the utility of clinical teaching, say- demics which have occurred in this ing, "The ability to observe is not a 0 B a 0 country within the last 50 years." p h 5 a 5 p g 9 9 6 �FRANK HASTINGS HAMILTON 1813-1886 5 1 e Something of the single- growing city of Buffalo in or- mindedness of Frank Hastings der to have greater access to Hamilton, who once wrote (about surgical cases. He continued himselO that "a man whose busi- to teach at Geneva untill848. ness is in information rather than When the medical de- pleasure does best to travel alone," partment of the University of is evident in what he accomplished Buffalo enrolled its first class, r very early in his life. Entering Union e College as a sophomore at 14, he earned Hamilton was professor of principles and practice of surgery and his bachelor's degree three years later, then clinical surgery, a chair he held until studied anatomy in the office of Dr. John G. 1860. He was also the school's first dean. A contemporary described Hamilton as "rather cool and Morgan in Auburn, NY, for a year before attending medical .t lectures at the Fairfield Medical College in Fairfield, NY. He reserved to strangers, but open-hearted to trusted friends . 11 was licensed in 1833 by the Cayuga County Medical He could not conceal his utter abhorrence of the arro- ,, Censors; he earned a medical degree from the University gant. " .- of Pennsylvania in 1835. By then he was 22. ., Before the advent of anesthesia, surgery was performed As surgeon for the Auburn State Prison, Morgan could as rapidly as possible and the surgeon depended on a k obtain the bodies of prisoners who had died. Hamilton thorough knowledge of anatomy. In his first lecture at ,_ Was his demonstrator in anatomy untill834, when Mor- Geneva in 1840, Hamilton told his students, "You must gan was called to the faculty of the Geneva Medical persevere in penetrating and threading the windings of College. Hamilton returned to Auburn after his study in anatomy, and you must obtain complete mastery over 11 Philadelphia and taught anatomy and surgery in his pri- your nervous cords, that ... the keenest cry of suffering 1- vate office, mainly to students from the Theological Semi- shall not cause a thread to vibrate. " 1- nary at Auburn. In 1839, Hamilton was appointed profes- Hamilton was a preeminently skillful and inventive s sor of surgery at Fairfield Medical College; not quite two surgeon. In The History of Surge1y in the United States years later he succeeded his former teacher at Geneva 1775-1900, Ira M. Rutkow, M.D., calls him "one of the when Morgan left the schooL Hamilton traveled and most versatile of 19th-century American surgeons. " A studied in Europe during 1843-44, then moved natural mechanic, Hamilton invented a variety of surgical 6 9 u 0 0 p h 5 to c the 0 5 p n 9 9 9 �instruments, according to an article by Oliver P. Jones, the first battle of Manassas, he rapidly gained a wider Ph.D., M.D., for the 1973 Buffalo Physician. Jones also scope of responsibility as brigade surgeon, medical direc- said Hamilton was one of the first surgeons to excise the tor of a division, medical director of an army corps, and metatarsophalangeal joint for bunions and to remove the finally, in 1863, Medical Inspector of the United Stares central portion of the thyroid. To make joint amputations Army. He had published A Practical Treatise on Military more precise, Hamilton described what he called 'keys Surgery in 1861 and brought out a second, enlarged and guides' to the articulations. edition in 1865. During the war , he wrote to his wife that At the Buffalo Hospital of the Sisters of Mercy, in 1854, "it is no uncommon thing for a surgeon in the field to be Hamilton demonstrated the efficacy of closing old ulcers compelled to change his position once or twice during an by skin graft when he successfully transplanted a 7" x 4" operation, on account of a change in the direction or range flap of skin from the left leg of a patient to close an ulcer of the shots. " on the right leg. It was also in Buffalo that Hamilton wrote Hamilton resigned his commission late in 1863 and the preface to his influential book A Practical Treatise on returned to teaching at Bellevue. He was made professor Fractures and Dislocations , published in 1860. The first of the principles and practice of surgery and surgical American text to deal in depth with fractures , it was used pathology there in 1868. Four years later he published The throughout the country and appeared in seven editions, Principles and Practice of Surgery. He described its purpose the last in 1884. as "to supply within the compass of a single volume of Frank Hamilton and Austin Flint were both members moderate size, the instruction necessary to a full under- of the Long Island College Hospital's first faculty. Here standing of all the subjects belonging properly and exclu- Hamilton realized an ambition in clinical instruction that sively to surgery. " The volume went through three edi- he had harbored for 20 years: at the new college in tions , the last published shortly before Hamilton died in Brooklyn , students were able to 1886. In an address to the graduates pass directly from the lecture hall Hamilton was a surgeon in to the hospital wards for bedside of the University ofBuffalo in 1853, Hamilton gave them his final ad- teaching. the 3 I st Regiment of the A year after moving to Brooklyn, Hamilton became professor of monition as a teacher , urging them to study advances in medicine New York Volunteers in military surgery, fractures, and dis- during their careers. He warned the Civil War. His two sons locations, and professor of clinical that those who did not would , as surgery at Bellevue Medical Col- old men, " ... discover in their cruwere in the regiment and, lege. He volunteered as surgeon for the 31st Regiment of the New cibles some few scanty facts which , if they had looked to the experi- he wrote, "I wanted to be York Volunteers immediately after ence of others, they might have near my dear children in the outbreak of hostilities in the known at 30. It is quite as often, Civil War. His two sons had joined we fear , that they die wholly uncase they were wounded." the regiment and , he wrote , "I conscious that the science which wanted to be near my dear children they faithfully intended to prac- in case they were wounded. " In tice all their lives is a century or charge of a general field hospital at more ahead of them." B 0 0 p y 5 c a 5 p g + 9 9 �r i In 1953, the medical and dental school moved to this new building from its old High Street home next to Buffalo General Hospital. Samuel P. Capen Hall (renamed Sidney Farber Hall in 1974) became the nucleus of UB's South Campus. PHOTOS : UNIVERSITY ARCHIVES , UNIVERSITY AT BUFFALO ��BY ANN WHITCHER When the University of Buffalo opened in 1846, medicine was about to begin a half-century of dramatic advances, and the hospital Was about to change from a charity service for the poor to a pivOtalcommunityinStitution. ln the mid-19th century, mostmedicalpractitioners had little ~BUFFALO GENERAL HOSPITAL BEFORE THE TURN OF or no formal education; such primitive opened in 1858, it, too, became an affilimethods of therapy as bleeding, blister- a ted teaching hospital for the medical school. Medical school faculty had twice ing, and purging were still in use. Clinical training for physicians, too, been part of unsuccessful efforts to found Was extremely limited, owing to the a city hospital, in 1846 and 1854; with state of hospital care. A sojourn at even the establishment of Buffalo General, the best endowed of hospitals was sta- they finally succeeded. The association tistical!y riskier than home care, due to between the school and the birth of the the hygienic horrors of the time. Surgi- hospital inextricably linked the two in cal anesthesia was gradually introduced the public mind. When Buffalo General appointed its only after the late 1840s; asepsis was not Practiced until much later in the cen- first medical staff, most of the physitury. cians were associated with the univerNonetheless, hospitals were valuable sity, a pattern that still holds true today. Places for young doctors to see a variety By 1869, the medical school could asof patients and gain the kind of ex peri- sert that Buffalo General "will be open for clinical instruction . . . o hospital ence they would need in practice. . The University of Buffalo established fees are required; the Faculty having lts first relationship with a hospital when made arrangement for the admission of Sisters Hospital was opened in 1848 by all the members of the class without the Sisters of Charity. Frank Hastings charge." liamilton and Austin Flint, both faculty A rapid acceleration in medical unmembers at the medical school (then derstanding followed the introduction located a block away from the hospital of antisepsis in the 1870s and asepsis in at Main and Virginia streets) became, the 1880s. When the renowned German respectively, Sisters' attending surgeon surgeon Ernest Von Bergmann was asked and physician. When Niagara Univer- in 1882, "What's new in surgery?" he is Sity formed a medical school in 1883, said to have replied, "We wash our hands Sisters switched its primary affiliation; before we operate ratherthan afterward." however, Niagara's medical school was Actually, the surgeon of the 1880s iissolved 15 years later, and the UB- was likely to give a cursory wipe on the lsters connection was restored, al- sleeve to a dropped instrument, then though probably not with the intensity sanguinelycontinuewiththeprocedure. lt had once enjoyed. By the 1890s, however, aseptic surgery When Buffalo General Hospital became a more and more common hos- 0 0 p h 5 c 0 5 p pita! practice; there were now autoclaves, sterilized dressings, and rubber gloves. Knowledge of pathogenic microorganisms also played a major role in increasing ~ the public's trust in ~ hospital surgery be- --~ tween 1875 and ~ World War I. ~ When the ~ medical school re- 9 ~ cruited Roswell al THE CENTURY . Park from Chicago in 1883 to become professor of surgery, he quickly took on additional duties as attending surgeon at Buffalo General. A man of wide culture who had studied in Europe, Park "taught the value ofLister's approach, as well as aseptic methods," Evelyn Hawes wrote in her history of Buffalo General. "The faculty of the medical school was virtually the same as the attending staff of The Buffalo Genera! Hospital; medical students attended the hospital clinics, and observed procedures of their university professors at close hand." "The growth of the whole idea of residency-hospital training after medical school-really evolved from the mid1800s," says Roseanne Berger, M.D., UB associate dean for graduate medical education. "People graduated from medical school and didn't have sufficient medical training, so they sought apprenticeships in hospitals, but these experiences were highly variable." By 1890, the johns Hopkins Hospital had coined the term "resident" to describe individuals who had completed one year of hospital training, followed by specialized training provided by the medical school faculty. "What made it unique was that, up to then, such training was under the auspices of various hospitals," Berger says. "A teacher of residents may or may not have been affiliated with a medical school, or hold n 9 9 9 �Research Laboratory (forerunner of today's Roswell Park Cancer Institute) to be built on High Street, neighbor to both Buffalo General and the medical school, which had moved to a new building on High Street in 1893. In 1911, Gratwick became a state facility, initially known as the Institute for the Study of Malignant Diseases. A number of new hospitals and smaller clinics were established in Buffalo between 1870 and 1920, some run by specialists in rival schools of medicine. According to Another Era, thesesquicentennial pictorial history of the medical school , "competition among regular, homeopathic, and eclectic physicians intensified, culminating in the founding of the Buffalo Homeopathic Hospital (later Millard Fillmore) and Pierce's Invalids' Hotel. Ethnic and religious groups started their own hospitals, some of which became affiliated with the medical school while others have since closed or consolidated." Mercy Hospital, now one of the nine teaching hospitals, was opened by the Sisters of Mercy in 1904. A more clinically oriented medical education evolved throughout the country after 1910, when the Carnegie Foundation for the Advancement of Teaching published a harshly critical evalua- a faculty appointment. radical at the time to introduce this concept of organizing residency training-as opposed to medical school training-under the auspices of a medical school." By the 1890s, Buffalo General's medical staff included many distinguished practitioners; the close connection between the hospital and the university helped their efforts to integrate scientific medicine and hospital care. When Roswell Park became ill with diphtheria in 1893, he chose to recover in Kimberly Cottage, Buffalo General's facility for contagious patients-a clear endorsement of the therapeutic standards that had been achieved. The gesture must have been appreciated by the house staff and ward nurses. This was an age, after all, when those running the hospital were not often its patients, and when those with financial means usually preferred treatment at home. Forging another link in Buffalo's health-care network, Roswell Park and Buffalo Evening News publisher Edward H. Butler Sr. secured legislative funding in 1898 for a cancer research laboratory in the medical school. By 1900 the institute had outgrown its lab spac: of just a few rooms. A gift from the Gratwick family enabled the Gratwick a u 0 0 p 5 c o n tion of medical education, the Flexner Report. Charles E. Rosenberg says in his book, The Care of Strangers: The Rise of America's Hospital System , "That evolution grew out of an intricate symbiosis between hospitals constantly in search of staff, on the one hand, and on the other, physicians who sought clinical training and status. " By 1914, more than 75 percent of medical graduates in the country were taking an internship. "One of the things that grew out of the Flexner Report," says UB medical school dean John Naughton, "was that more and more medical schools did have an identifiable hospital or two that were, by perception anyway, controlled by them. That has never existed in Buffalo." By the time the Flexner Report came out, a number of other hospitals were also loosely affiliated with UB. One was the Children's Hospital of Buffalo, which had opened in 1892. Another was an institution devoted to tuberculosis that evolved into City Hospitalin 1918. Later renamed E.j. Meyer Hospital, the institution in 1946 became a county hospital that was the forerunner of Erie County Medical Center. UB's affiliations with Children's and City Hospital were informal by today's standards, but they made possible the variety of clinical settings enjoyed by medical students of the period. 5 p g 9 6 �A 1934 evaluation report from the C_ouncil on Medical Education and HosPitals lists clinical facilities for teaching ~t Buffalo City Hospital, Children's and . uffalo General. Heads of depanO.:ents In the me d'ICa] school held equivalent Positions m · t h e Bu ffalo City Hospital. Staff · appomtments, however, were reserved for the hospital's board of managers. Buffalo General and the medical school h d ha a no formal agreement, perps because of their long history of Wok' r mg together. "All visiting men are llJ.emb ers o f the faculty " the report noted A « · f , . · n m ormal agreement" also existed b Ch· etween the medical school and Ildren's. had lobbied for a new building on High Street. The Buffalo General Hospital had offered a block ofland on High Street for the new building; others saw what is now the university's South Campus as a more logical site. Some feared that put- l . By 1945, most of the medical school's k c Inical Wor was done at E.J. Meyer. All THE HOUSE STAFF OF MILLARD casesent . h FILLMORE HOSP ITA L, 1 93 1. enng t e hospital, including out. Pallent . ' were available for teaching. Buf- ting the new medical-dental facility near f 1 a o Gen l era treated all types of patients except" , Buffalo General would allow the hospi. mental, contagious and tubercu- tal to dominate it. In the end, the counIosis" . to an evaluation report cil approved the South Campus plan, rrollJ.' thaccordmg A , . c . e MAs Council on Medical Edu- and Samuel P. Capen Hall was opened allon and H . l ospita s and the Association in 1953 (it was renamed Sidney Farber of Am . encan Medical Colleges. Hall in 1974);Sherman followed in 1958. According to council minutes, UB P The relationship with Children's apeared t b h 194 . 0 e t e most solid, the AMA's Chancellor Samuel P. Capen displayed ·· h epresenceof his customary judiciousness and vision a 1. 5snetea msa1·d ,citmgt . laJson · th h commntee representing both in weighing the thorny matter. "He cited ""e ospital and the school that deter- the advantage of cooperation in every .,,Inect t ff w sa appointments. Although there possible way, not only with all the hosas still f th no ormal agreement between pitals with which the medical school llJ.ed· I e h lea sc h ool and the two general now cooperates, but probably also, as b ospitals, the report noted that "mem- time goes on, with a number of others. ers of th ff llJ. ct· e sta are also members of the As he saw it, medical education is just at e leal h 1 "" sc oo and the heads of depart- this moment at the beginning of a large '"ents at h h . te t e ospnal are on the commit- expansion into somethmg distinctly dif! es Which head the din ical departments. " ferent and more popular than it has n 1948 y , ground was broken for a new been in the past. There is an intensive eterans Ad .. Pin mmistration hospital, cap- drive in public interest in better and fo gByears of effort to secure a VA facility more extended medical care." r uffalo. ~~~~~~~~if.~ t What must have been a ense m . eetmg of the UniVersity C on J ounciltook place · une 10 , 1948 , [o IIowlog ct· a period of contentious lscuss· of h Ion on the location . ,s new h t e uni·versny d OllJ.e for its medical and ental schools which had l on · ' lii ~ smce outgrown the · g Street facility Many TH E ST AF F OF B UF F ALO GENERAL IN In the d. . me leal community B UI L DIN G AMPHITH E A TE R , C . 19 38. Medical school dean Stockton Kimball echoed these thoughts. No one hospital would be sufficient for the teaching needs of the university, he contended. Indeed, it was his view that the strength of the medical school lay in the large amount and variety of clinical material available at all the hospitals. By 1950, the medical school had teaching agreements with E.J Meyer, Buffalo General, Millard Fillmore Hospital, and Children's. While there was no formal agreement with Roswell Park, the two institutions were affiliated for teaching purposes. By 1956, extensive clinical facilities were available through agreements-now written-with Buffalo General, E.J Meyer, Children's, and Millard Fillmore, plus an "understanding" with Roswell Park. A 1965 report from a visiting team representing the AMA and the Association of American Medical Colleges noted that the school had since been given full accreditation, but repeated past concerns about "the basic hospital domination of the medical school and the need for strengthening the basic science areas." Following the university's merger with the State UniversityofNewYorkin 1962, there were new layers of complexity to be considered. For one thing, faculty communication was hampered, partly by "the geographic separation of clinical facilities," the 1965 evaluators commented. "''m sure the state did not have an understanding of all these relationships between the medical school and the hospitals," Naughton says. "There was the assumption, at least locally, that the state would build a medical center for UB." Various studies ensued "and a lot of money was spent on the planning ... Somewhere along the line, as I understand it, (UB) President (Martin) Meyerson and Governor Nelson Rockefeller decided that ~ the better place for this <~ medical center would be ~ i: the Amherst Campus and ~ not on the old campus." In g 196 7, plans were an- & g nounced to construct a ~ university hospital on the ~ Amherst Campus, but ll a 0 p y s a 5 p n g 9 �g ,~ . "0 these plans never materialized. "By the time I came here in 1975," Naughton says, "it was pretty clear that the state wasn't going to put another hospital in Buffalo, and therefore that if we were going to survive as a medical school in a teaching community, we needed to develop a different strategy." Paving the way to the modern hospital network were several key reports in the 1960s that urged institutional responsibility for graduate medical education. The 1966 Millis report of the AMA's Citizens Commission on Graduate Education ofPhysicians, for instance, said that teaching hospitals must demonstrate responsibility for medical education through the creation of a medical education committee. They also recommended that an agency be authorized to plan, review, and coordinate standards for graduate medical education. "The formation of the Graduate Medical Dental Education Consortium ofBuffalo in 1983 was really the culmination of an arrangement that had existed in Buffalo for a long time," UB's Roseanne Berger states. "Residency programs were based in hospitals throughout the city, because there was no single university hospitaL A single program actually shared the resources of multiple hospitals, and the oversight of that single residency program would be charged to a particular educator, a program director, but the financial arrangement-as to who would be responsible for supporting the program-became very complicated." By the early 1980s, there were new B u a 0 p requirements for accreditation under the auspices of the Accreditation Council for Graduate Medical Education. "That organization accredits the various residency programs and the various specialties and ensures that each program meets a set of standards that are established by a specialty-specific residency review committee," Berger explains. "In 1982, it required that each program identify a single sponsoring institution. In Buffalo-since the majority of programs were located at multiple hospitals-just deciding who that single sponsoring institution was became a problem. 'This became an opportunity to establish the consortium, and in so doing it pulled the hospitals together around one mission: graduate medical education. A governing structure was then established to create a formal process for the hospitals to work collaboratively for structur- Today'steaching hospitals: The Buffalo General Hospital The Children's Hospital of Buffalo Erie County Medical Center Mercy Hospital Millard Fillmore Hospitals Niagara Falls Memorial Medical Center Roswell Park Cancer Institute Sisters of Charity Hospital The Veterans Affairs Western New York Healthcare System y 5 c a s ing, reviewing, and thinking about issuE of resident training in the region." Today, the consortium plans and di rects all Accreditation Council residenc and fellowship training in Buffalo aill Western New York. Resident salarie and benefits are equal for each training year level throughout the region and ar paid by the consortium. A second initia tive, the Western New York Health Sci ences Consortium, formed in 1987, i directed toward improving the area' health-care delivery system. Michael Noe, M.D., vice presiden for professional affairs at Buffalo Gen eral, provided key leadership in orga nizing the consortium. "From the be ginning," Naughton says, "Mike and th1 residency training directors furthere1 the understanding of the strength, eco nomics, and improved training qualitj that could come from a single, coordi nated organization committed to share governance." Today, the Graduate Medical Denta Education Consortium coincides wit separate university agreements with th teaching hospitals. Resulting joint en terprises have produced more resideD cies in primary care, regional centers fo organ transplants and positron emi5 sion tomography imaging, and a rura health initiative. Medical school an consortium initiatives are flourishing i biomedicine, epidemiology, and clini cal trials, and the school has receive major funding to expand its generaliS medical education programs. Throughout its history, the medici! school has drawn on a network of affih' ated hospitals to advance its missiofl according to a ugh ton and joyce Vana Ph.D., clinical assistant professor of so cial and preventive medicine. The tW0 collaborated on a recent article in the: American Journal of Public Health. 'This arrangement," they wrote, "ha5 been sometimes divisive and always challenging, with conflicting loyalties an~ allegiances occasionally placing hosp1til service needs before medical educati011. However, mutual tolerance and depefl' dence have also developed. In Buffalo rhC need for collaboration in education, re' search, and service has proved stronger than the drive for autonomy." + p n 9 9 9 �These students were some of the last to study at the High Street university building. By 1949, when this picture was taken, the decision had already been made to move UB to Main Street. PHOTO: UNIVERSITY ARCHIVES , UNIVERSITY AT BUFFALO Old Alumni Hall was the lecture room in the High Street building. TIAN YEARBOOK, PHOTO : t947 MEDEN ERSITY AT BUFFALO L E R S I T Y ARCHIVES . UNIV �BY .JESSICA ANCKER THE PHOTOS BY DON LONG THING HOURS ELSE EVOLVES ABOUT NEVER CHANGE, MEDICAL CONSTANTLY TO BUT EDUCATION KEEP EVERY- UB AT ABREAST HEUPEL OF NEW TECHNOLOGIES, TREATMENTS AND ATTITUDES. TWO CUR- STUDENTS TYPICAL DAY TO KRISTEN BROUGHT PROVIDE A ANDRESEN, A US GLIMPSE 24-YEAR-OLO ALONG INTO WITH LIFE SECOND-YEAR AT THEM ON UB TODAY. STUDENT, WANTS PRIMARY CARE DOCTOR IN EITHER GENERAL MEDICINE OR PEDIATRICS . WHO GREW UP ON A LONG ISLAND FARM, WILLIAMSVILLE THAT OVERLOOKS A HAS RENTED A A TO BECOME A KRISTEN, SMALL HOUSE IN NEIGHBOR'S PASTURE, COMPLETE WITH HORSES. SHE DOESN'T HAVE MUCH TIME TO ADMIRE THE VIEW, THOUGH . ANY FREE TIME SHE CAN SNATCH FROM HER COURSES IS SPENT PREPARING FOR HER FIRST NATIONAL BOARD EXAMS IN ..JUNE. MOST OF KRISTEN'S DAYS ARE SPENT IN THE LECTURE HALL, AS HAS LONG BEEN TRADITIONAL FOR FIRST- AND SECOND - YEAR STUDENTS. BUT US IS INTRODUCING CLINICAL MATERIAL EARLIER AND EARLIER IN THE T H E �CURRICULUM. KRISTEN'S PATHOLOGY LECTURES, CORRELATIONS DISEASES IN WHICH STUDENTS ARE PRACTICING PHYSICIANS PRESENT RECENT EXAM. IN THE IT'S PROBLEM-SOLVING. THAT ILLUSTRATE THE CHANCE TO LEARN ABOUT PATIENT CARE BY SEEING PATIENTS AT BUFFALO 1 960S AND 1 970S, THIS "INTRODUCTION TO ONE-SEMESTER COURSE THAT TAUGHT STUDENTS HOW TO TAKE A PHYSICAL CASES BY CLINICAL LEARNING ABOUT. SHE'S ALSO GETTING A GENERAL HOSPITAL. FOR EXAMPLE, ARE ROUTINELY FOLLOWED NOW A INSTEAD PRECEPTOR FULL OF YEAR JUST COURSE, WITH LECTURING CHALLENGES HER TO HER TRY AN ON TO HISTORY AND ADMINISTER A EMPHASIS THE MEDICIN~ CLINfCA- c ON CASE-BASED PATIENTS EXPLAIN THEIR SHE COMPLETE LEARNING EXAMINES, SYMPTOMS WAS - A - AND KRISTEN'S AND ILLNESSES. HER EARLY EXPERIENCE WITH CASE-BASED LEARNING AND PROBLEM-SOLVING IS INTENDED TO INTRODUCE HER TO THE SKILLS SHE'LL BE DEPENDING ON IN HER THIRD AND FOURTH YEARS, TRADITIONALLY KNOWN AS THE "CLINICAL YEARS." KEN LEVEY, 24, A THIRD-YEAR STUDENT WHO PLANS TO GO INTO OBSTETRICS, INTRODUCES US TO A TYPICAL DAY IN THOSE "CLINICAL YEARS." KEN, IN THE MIDDLE OF A CLERKSHIP AT THE LUCKY TO HAVE FOUND CHILDREN'S A HOSPITAL OF BUFFALO, FIRST-FLOOR APARTMENT ON COUNTS HODGE HIMSELF STREET, WITHIN STROLLING DISTANCE OF THE HOSPITAL. HIS CLERKSHIP CONSISTS OF THE TRADITIONAL FOUR WEEKS ON A WARD. IN A RECENT INNOVATION, THE CLERKSHIP INCLUDES TWO ADDITIONAL WEEKS IN CHILDREN'S OUTPATIENT CLINIC. KEN IS ALSO PART OF ONLY THE THIRD CLASS WHO WILL SERVE A CLERKSHIP IN FAMILY MEDICINE. HEALTH PRIMARY CARE NOW INCLUDE CARE AND SOME COMMUNITY HEALTH OF THE FUTURE AMBULATORY PROBABLY SETTINGS, EXPERIENCE IN CENTERS. WILL CLINICS, SO DEPEND MOST PRIVATE OF US'S HEAVILY ON CLERKSHIPS DOCTORS' OFFICES OR KEN'S TIME IN THESE SETTINGS WILL PREPARE HIM TO WORK WITH RELATIVELY HEALTHY PATIENTS, IDENTIFY DISEASES EARLIER, AND EMPHASIZE PREVENTIVE HEALTH CARE. IN HIS FOURTH YEAR, AT LEAST ONE OF HIS ROTATIONS WILL BE SERVED ENTIRELY IN AN AMBULATORY SETTING. THESE NEW ASPECTS OF KEN AND KRISTEN'S EDUCATION ARE PART OF U B'S GENERAL PRACTICE INITIATIVE . THE SCHOOL IS IMPLEMENTING A NUMBER OF CURRICULUM CHANGES AS IT STRIVES TO GUIDE AT LEAST 50 PERCENT OF ITS GRADUATES INTO PRIMARY CARE FIELDS. "THE IDEAL FOUR-YEAR CURRICULUM INTEGRATES ALL ASPECTS OF MEDI- CINE, INSTEAD OF TEACHING THEM M.D., ASSOCIATE DEAN TO TEACH PROBLEMS, WANT TO STUDENTS INSTEAD PREPARE IN ISOLATION," SAID DENNIS A. FOR CURRICULAR AND ACADEMIC AFFAIRS. HOW OF TO MERELY STUDENTS ACCESS HOW TO FOR THE KNOWLEDGE MEMORIZE NATURE AND HOW "WE WANT TO INFORMATION. OF PRACTICE AS NADLER, WE IT IS SOLVE ALSO INFLU- ENCED BY AMBULATORY CARE AND MANAGED CARE. THESE ARE THE KINDS OF THINGS THEY'LL NEED TO KNOW AS r~ 0 DOCTORS." + w --------------------~ a 0 p y c a 5 p n g 9 6 �+- B: 1 1 A.M. KRISTEN ANDRESEN PACKS HER LUNCH BEFORE TAKING OFF FOR A FULL DAY OF LECTURES AND CLINICAL CLASSES. ~ 9 A.M. 1 1 :30 A.M. TODAY'S PHARMACOLOGY LECTURER , ..JERROLD WINTER , PH . D., COVERS A WIDE ARRAY OF TOPICS, INCLUDING NEUROLEPTICS AND THEIR SIDE EFFECTS, AND DRUG DEPENDENCE, TOLERANCE AND WITHDRAWAL. WINTER ALSO WARNS THEM ABOUT ILLICIT RECREATIONAL USE OF THE THERAPEUTIC DRUGS THEY WILL HAVE EASY ACCESS TO I N THEIR PROFESSIONAL LIVES. HE CITES THE CASE OF A DOCTOR WHO DIED AFTER A LOCAL SELF-ADMINISTERED OVERDOSE OF ANESTHETIC. "DOCTORS ARE MORE LIKELY TO GET IN TROUBLE WITH THESE KINDS OF DRUGS," HE SAYS. �i- l 1 :40 A.M. "iHe: ME:DICAL STUDE:NTS' COMPUTER ROOM IS C:ROWDe:D DURING THE LUNCH BREAK. FINDING A ~'"Re:e: TERMINAL, PRINTs OUT A KRISTEN QUICKLY EDITS AND REPORT ON THE HISTORY AND PHySICAL OF A PATIENT SHE EXAMINED LAST We:e:K. THE PAPER IS DUE TO BE HANDED IN THIS "'-~'"TE:RNOON. ~'"e:w HER WORK FINISHED, SHE TAKES A MINUTES TO SURF THROUGH HER E-MAIL. t 1 2 P.M. KRISTEN MEETS A GROUP OF OTHER SECOND-YEAR STUDENTS IN THE ATRIUM OF THE NEW BIOMEDICAL RESEARCH BUILDING TO PLAN BOARD REVIEW SESSIONS. THEY ARE CHECKING THROUGH A LIST OF PROFESSORS WHO MIGHT BE WILLING TO GIVE EVENING REVIEW LECTURES. "IT'S KIND OF TOUGH ON THEMTHEY HAVE TO TAKE THE STUFF WE'VE BEEN STUDYING OVER THE PAST YEAR AND SQUEEZE IT ALL INTO A TWO-HOUR LECTURE," KRISTEN POINTS OUT. t 1 2:30 P.M. KRISTEN TAKES HER LUNCH TO A QUIET CARREL AND EATS WHILE STUDYING FOR AN UPCOMING EXAM IN HUMAN BEHAVIOR. �t 3:35 P.M. -+ KRISTEN AND THREE CLASSMATES ARRIVE AT BUFFALO GENERAL HOSPITAL. IN THE OFFICE OF THEIR PRECEPTOR, TALAL BAKI, M.D., THEY DON THE SHORT WHITE COATS THAT MARK THEM AS STUDENTS. BAKI DESCRIBES ONE OF HIS CARDIAC PATIENTS, AND KRISTEN HAZARDS AN EXPLANATION OF WHAT THE PATIENT'S SYMPTOMS COULD MEAN AND HOW THE HEART TROUBLE MIGHT SHOW UP IN VARIOUS TESTS. "YOU HAVE 90 PER- CENT OF THE ANSWER. KEEP GOING, TELL ME THE REST," BAKI SAYS, ENCOURAGING HER TO COMPLETE HER IDEAS. �4:40 P.M. KRISTEN READS ALOUD THE CASE HISTORY SHE PRINTED OUT DURING HER LUNCH BREAK AND DISCUSSES IT WITH BAKI. EVERY TWO WEEKS, KRISTEN GETS A CHANCE TO TAKE A HISTORY AND PERFORM A ON A PHYSICAL BUFFALO GENERAL PATIENT WHo AGREES TO MEET WITH A MEDICAL STUDENT. ON ALTERNATE WEEKS, SHE PRESENTS THE CASE HISTORY TO BAKI, WHO SUGGESTS ~UESTIONS SHE MIGHT HAVE ASKED THE PATIENT, THEORIES ABOUT WHAT IS WRONG, OR BETTER WAYS TO WRITE UP THE REPORT . _, 6:40 P.M. KRISTEN HAS FINALLY ARRIVED HOME , WHERE SHE TAKES A MINUTES TO PLAY WITH HER BLACK LABRADOR , SHADOW, AND FIX DINNER. THEN SHE HEADS TO HER DESK FOR A STUDYING. SON I'M "I PREFER TO STUDY AT HOME. I'M A FEW NIGHT OF BOOK PER- I NEED TO HAVE ALL MY TEXTBOOKS AROUND ME WHEN STUDYING SO I CAN LOOK THINGS UP." + �+- :20 A.M. KEN LEVEY RISES EARLY DURING HIS CLERKSHIP AT CHILDREN'S HOSPITAL. "I GIVE MYSELF A MINIMUM OF FOUR HOURS OF SLEEP. I THINK THAT'S THE ABSOLUTE LEAST YOU CAN GET BY ON. WHEN GET SIX I FEEL GREAT." �6:50 A.M. -+ EARLY MORNING MIST WAFTS BY LEVEY THIS THURSDAY IN FEBRUARY AS HE WALKS TO THE HOSPITAL . HE'S ON HIS WAY TO ONE OF THE INFANT WARDS, WHERE HE'S SERVING A WEEK CLERKSHIP . FOUR- LATER, HE'LL SPEND ANOTHER TWO WEEKS IN ONE OF THE HOSPITAL'S CLINICS TO GET TRAINING IN AMBULATORY SETTINGS. 1 0:00 A.M. -+ MANY DOCTORS AT CHILDREN'S HANG TOYS FROM THEIR STETHOSCOPES OR WEAR GOOFY TIES WHEN THEY ' RE TREATING CHILDREN. "WE'RE TRYING TO DISTRACT THE KIDS FROM THE THINGS WE MIGHT HAVE TO DO TO THEM," ONE PHYSICIAN SAYS. �• • 0 •.40 AM -+ KEN ASKS INTERN THERESA WEGMAN, M.D., FOR SOME ADVICE. THERE'S ALWAYS THE SOUND OF ONE OR TWO BABIES WAILING ON THIS FLOOR, AS DOCTORS AND NURSES CATCH UP ON PAPERWORK AND ORDERLIES PUSH BROOMS AND LAUNDRY HAMPERS. ~ 1 1 A.M. ATTENDING PHYSICIAN FERDINAND YATES, M .D ., HOLDS AN IMPROMPTU LESSON ON DOWN'S SYNDROME FOR KEN AND HIS FELLOW STUDENTS, TIM LIESCHING AND LISA MENDONZA. AFTER CROWDING AROUND THE BED OF A SMALL DOWN'S SYNDROME PATIENT SUFFERING FROM A RESPIRA- TORY INFECTION, THEY RETREAT TO THE HALLWAY WHERE YATES TALKS ABOUT THE MEDICAL PROSLEMS OFTEN ASSOCIATED WITH DOWN'S. ~1 1:20 A.M. KEN TAKES A FINAL LOOK AT PATIENTS, BRITTNEY MOREY, lNG FROM RESPIRATORY ONE OF HIS TINY WHO IS RECOVER- SYNCYTIAL VIRUS !RSV) PNEUMONIA, ONE OF THE AILMENTS ON THE FLOOR. MOST COMMON BRITTNEY IS DOING FINE, AND CHECKS OUT LATER NOON. "WE WANT TO GET HER BEFORE SHE CATCHES OUT OF HERE SOMETHING REALLY BAD FROM ONE OF THE OTHER TO BRITTNEY'S MOM, THAT AFTER· KIDS," KEN EXPLAINS DAWN SMITH. �1 2:00 P.M. ~ KEN JOINS OTHER STUDENTS AND RESIDENTS IN A CONFERENCE ROOM OFF THE CAFETERIA FOR A LUNCHTIME LEC- TURE BY JEFFREY TUCKER, M.D., THE MEDICAL DIRECTOR OF THE HOSPITAL'S POISON CENTER. TUCKER APOLOGIZES FOR THE SUBJECT-INGESTION OF CAUSTIC SUBSTANCES. "IT PROBABLY ISN'T THE BEST LUNCH TOPIC!" BUT HIS LECTURE DOESN'T SEEM TO DULL ANYONE'S APPETITE. �/ 3:00 P.M. -+ A .., 7:1 s P.M. RADIOLOGY CONFERENCE GIVES "USUALLY I TAKE THURSDAY JAMES BACKSTROM , M.D . , THE NIGHT OFF TO WATCH 'FRIENDS,' DIRECTOR OF M Rl, THE OPPOR'ER,' AND 'SEINFELD,' BUT TUNITY TO SHOW STUDENTS HOW TOMORROW I HAVE TO DO A TO MAKE DIAGNOSES FROM PRESENTATION ON VARIOUS IMAGES . 'FAILURE TO HE SLAPS A THRIVE,"' KEN SAYS. HE CHEST X-RAY ON THE LIGHT SPENDS THE EVENING AT THE TABLE AND CALLS KEN TO THE HEALTH SCIENCES LIBRARY. + FRONT OF THE ROOM TO QUIZ HIM . KEN SCRUTINIZES THE IMAGE AND CAN'T FIND ANY PATHOLOGY . "ARE YOU TELLING ME I'D SHOW YOU A CHEST X-RAY? " NORMAL BACKSTROM ASKS . " NO, YOU WOULDN'T DO THAT ," KEN ANSWERS , PUZZLED . BUT THAT'S WHAT IT TURNS OUT TO BE. AFTER THE OTHER STUDENTS LAUGH , BACKSTROM POINTS OUT, "THAT ' S THE HARDEST THING OF ALL , TO HAVE THE CONFIDENCE TO SAY , 'THERE'S NOTHING WRONG WITH THIS PICTURE.' " �1916, WHEN HAROLD REIST WaS finishing his final year at the University of Buffalo, students were required to take one year of arts and sciences courses before entering medical school. Reist would have spent his first two years performing dissections and studying such standard scientific subjects as organic chemistry, physiology and bacteriology. In his third and fourth years, he would also have studied at Buffalo General and other hospitals. This photo was taken by a classmate, Victor Reinstein. BY PHOTO: DR. VICTOR REINSTEIN ALBUM , UNIVERSITY ARCHIVES . UNIVERSITY AT BUFFALO �WITHOUT ITS FACULTY, a school would be nothing more than an assemblage of buildings and labs~ microscopes and machines. The quality of UB's School of Medicine and Biomedical Sciences ultimately resides in the quality of the people who work, teach, and learn here. It was the innovative, forward-thinking doctors and scientists of the past, such as Austin Flint, Roswell Park, and ErnestWitebsky,who made UB a leader in medicine and research today. And it is the young doctors and scientists joining UB and its affiliated hospitals who will continue that tradition well into the 21st century. I. ~. .:.:I /.. _f;gJ . ••::1 we showcase a number of the ·~-- ~B uffalo In this issue of Buffalo Physician, lJlJ\ out~ standing young professionals on our Phys ician Spring 199 6 �faculty Some are practitioners who are turning their everyday experiences in treating disease into research that will benefit thousands of patients lg they will never see. Others are lab scientists whose patience at the bench may Pay off with undreamed-of drugs and therapies. Some are working on such )S, high-profile diseases as AIDS; others focus on problems that rarely touch )'s Americans, such as trypanosomiasis. In this issue, we can profile only a few of the e. innovative young men and women who have Joined our faculty in recent years. We plan to continue the series in future Issues with articles on new faculty to keep our readers in touch with the ever-changing medical school. We hope the articles on the next few ts Pages and in coming issues will demonstrate the range of talent and wide array of specialties that \!viii continue to provide UB's students with the best in medical education n, t~ for years to come. * Photographs J( by e K.C. Kratt 1 " f f a 1 o Physician 9 9 6 ED �in emergency medicine at the Medical College of Pennsylvania. Abrams is now an assistant professor ofemergency medicine at UB and the associate residency director at ECMC. Abrams helps train emergency department residents in fluoroscopy for quick diagnosis of injured extremities, and in telemedicine for long-distance communication. "Ultrasound and fluoroscopy aren't the kinds of things you'd use in every situation. But in some cases they can help you weed out what's serious from what's not," she says. "You take a look at an ultrasound and, boom! you find the bellyache iS caused by gallstones. That's not an emergency situation-you tell h1m he can go home. You st1ck someone's finger under a fluoroJ. scope and f1nd out it's not broken. Fine! That person can go home instead of waiting around for hours while you take care of all the gunshot wounds first." Abrams, who vollltlteered as an EMT while she was in medical school, continues to feel strongly A MAN WALKS INTO an emergency department complaining of about community service. She haS established a clinic for the homea vague back pain. Hours of tests reveal nothing, and soon the less at Buffalo's Friends of the N1ght pain itself disappears. As he dresses to go home, he collapses People shelter. A volunteer teafl'1 and dies of a ruptured aortic aneurysm. of nurses, medical students and doctors visits the shelter two eve"The suspicions we had weren't Ultrasounds are non-invasive, nings a month, providing routine high enough to bring in the radioloquick, cheap and portable, and have medical care to 15-20 people a gists and order up an ultrasound. no side effects. They night. Abrams But if we'd had an ultrasound maare particularly good hopes to enroll chine available in the emergency at picturing fluid build"If we'd had an more volunteers so department this wouldn't have hapup. All these factors she can offer the pened. That's unconscionable that ultrasound make them ideal for services more frehe died," says Barbara J. Abrams, quick diagnoses in quently. "It's a great machine available M.D. (known as Bobbie), as she certain life-threatenopportunity for the recalls the crisis from her residency ing situations, such as in the emergency medical students that led to her cunrent career as aneurysms, ectopic because they get 3 director of ultrasound education in department, this pregnancies, and carchance to take hisErie County Medical Center's emerdiac tamponades. tories and do physiwouldn't have gency department. Her latest research cal exams and start Abrams, 34, is bringing ultrashows that tilting a happened. That's doing some cofl'1sound technology into emergency trauma patient backmunity service. The departments around the country. In unconscionable wards in the T renpatients are also Incourses for the American College delenburg position credibly appreciathat he died." of Emergency Physicians, she trains can help doctors ditive." emergency physicians in ultrasound agnose injuries that Abrams orgause, develops protocols to help involve intraperitonized a similar cliniC them decide when the procedure is neal fluid build-up. atherlastpostin Philadelphia "I saidt0 appropriate, and tailors diagnostic Abrams received her M.D. from myselfthat wherever I go, ifthey need techniques for traumas. Brown University and did a residency a homeless clinic, I'll do it" -:J.A Barba r a Ab r ams , M. D . Adding to the ER's Diagnostic Arsenal * e s u a 0 p c a n s p g 9 �Bumpers , l . Harvey M. D . Ji~s :rJ- doctors and patients are slow to recognize the waming signs of cancer when they appear in younger patients, so the disease in these patients progresses further before it Creating New Models of Cancer in Mice HARVEY l. BUMPERS, M.D., HAS BEEN SO BUSY making breakthroughs Vvith animal models of cancer that he hasn't had time to begin a set of experiments he has been imagining for years-experiments ;e ~s :'s IS. ,d is Hl rn :k that he believes may hold the key to cancer. U .Bumpers, 40, a graduate of the n1versity of Rochester School of Medicine, completed his surgical Internship and residency at SUNY Stonybrook, where he was chief ~esident. He held surgical oncology ellowships at SUNY Stonybrook and Roswell Park Cancer Institute. An · U ass1stant prefessor of surgery at EB, he is an attending surgeon at [; CMe, the VA medical center, Bufpalo General Hospital, and Roswell ark as al ;ly 3.5 e- ;0 e Bumpers has succeeded in growIng human colon polyps in severe combined immunodeficient (SCI D) l'l'1lce. He has also implanted cancerous tissue in such a way that it con· p Slstently metastasizes to the liver. revious researchers treated cancerou s t.1ssue w1th . enzymes or chem·leas I 1n . order to get it to grow lf'lb sites under the skin or in the ae do men. Bumpers found, howVer, that pieces of solid tumor no special manipulation to needed g row· In the mice's gonad fat pads1 ~ fact, he believes that the tumors · ••etastas1ze · because their natural st n ructure and cell components are ot altered. perfonm genetic studies to compare precancerous polyps with cancer, and premetastatic cancers with metastatic ones. He also hopes to evaluate treatments in the mice with cancer. "This is all working so well, I haven't had time to get started on what I I 00 percent believe is the answer to cancer," Bumpers says. "I think the answer will be found in the adhesion proteins in cell membranes. But I have some other work to do before I can look into that." Bumpers has also done epidemiological studies of fisk factors in colo rectal cancer and breast cancer. In both, he found that younger patients had worse survival rates than older ones. He believes that both is diagnosed. A major in the U.S. Anmy Reserves, Bumpers recently created a unique reservist training program at the Buffalo VA medical center. He and several nurses in the Reserves arranged to perfonm surgery on Saturdays at the VA to fulfill the requirements of their drill duty. The arrangement allows reservists who are surgical scrub technicians to maintain their training by regularly helping in the surgery. It has also helped the VA reduce the length of time patients wait for non-emergency surgery. Bumpers also participates in public education on cancer through radio shows, workshops, and mailings organized by churches. "I feel strongly that if there is a possible solution, you should do your best to tell people what it is," he says. "Otherwise, they hear something on the news about cancer, and don't do anything about it." -J.A. * L. (I) u c: 8 In another breakthrough, t Umpers has used similartechniques a- s~lgow human breast cancer in able t mice. "No one has ever been 0 grow human breast cancer lf'l ,•. any animal before" he says "and •ve d ' ' ' th on t know exactly what it is that prevents it from growing. I lf'lklt'sb Call ecause breast cancertypi" y has a lot of fibrous tissue and ••Ot V ery many cells." · new exPe .His sue cess ·1n creat1ng ca nmental models for two kinds of Ofncer has provided him with a lot Pr · OJects to work on. He plans to 0 0 p h ctS u 5 c 0 5 p g 9 9 �A. M chaeI Ca I M. D . g ur Boosting the Immune System with lnterleukin-2 MICHAEL A CALIGIURI, M.D ., is researching new approaches to preventing cancer and controlling AIDS via the immune system. He is also part of an unusual team that develops treatments from the concept stage all the way through the laboratory bench to the patient's bedside. "It's incredibly satisfying to see our own observations translated into a treatment for a patient," says Caligiuri, 40, who is based at Roswell Park Cancer Institute. Caligiuri holds an M.D. from Stanford University and did his internship and residency at Harvard Medical School in Brigham and Women's Hospital in Boston. He did a fellowship in medicine at Harvard, and fellowships in oncology and bone marrow transplantation at the Dana-Farber Cancer Institute. Now a tenured associate professor of medicine at UB, he is a member of the department of hematologic oncology and bone marrow transplants. Caligiuri and colleagues including Zale Bernstein, M.D., recently studied a small sample ofHIV-positive patients and found that daily injections of interleukin-2 substantially boosted levels of natural killer cells, one of the types of immune cells that is decimated by the virus. As a result, none of the I 0 patients suffered opportunistic infections during the 90-day treatment period. The interleukins are part of a class of honmones called cytokines that regulate the growth of certain immune cells. According to Caligiuri, this was the first cytokine trial in AIDS patients. The findings raise the possibility that AIDS could be controlled with daily self-administered injections. The injections would boost the immune system to fight off fatal opportunistic infections, such as pneumonia and Kaposi's sarcoma. "Like diabetes, this would be hormone replacement therapy," says ED B u a 0 p Caligiuri, "but instead of sex hormones, we're working with the honmones of the immune system." Caligiuri is also studying the relationship between compromised immune systems and cancer. People with AIDS and other immune system problems suffer I 00 to I ,000 times as many lymphomas and sarcomas as the general population does. In research on severe combined immunodeficient (SCID) mice, Caligiuri and his colleagues have found that low doses ofinterleukin2 prevent certain lymphomas. The mice are bred to have severely inadequate immune systems, and h 5 c a s can be induced to develop a human-like immune system with injections of lymphocytes from human donors. Humans who are seropositive for Epstein-Barr virus are at high risk of a certain fatal lymphoma; mice who are injected with samples from these humans will be at risk for the same cancer. But with surprisingly small daily doses of interleukin-2, Caligiuri says, the mice were protected from the cancer. Caligiuri also led an international team that recently discovered a genetic defect linked with one common fonm of leukemia, acute myeloid leukemia. The defect was discovered on chromosome I I , and it was already known that many patients with acute myeloid leukem1a have three copies of chromosome I I. The researchers, who include UB oncology division chief Clara Bloomfield, M.D., say it is the first known molecular defect associated with a trisomy. Caligiuri predicts that more molecular defects will be identified and linked with different cancers, opening the way to gene therapies. Much of the research on leukemia. he says, may be performed at Roswell Park, which runs the world's largest leukemia bank. -J.A. * p n 9 9 �J1- J- ·e JS al ,d ~s Michael G. Ca t y' M. D. al a l- ysit ala 1e le Teaching Generalists as a Specialist ra st ~d tDUCATING GENERAL PRACTITIONERS IS A CHALLENGE for special- ists like Michael G . Caty, M. D ., a pediatric surgeon at the Children's Hospital of Buffalo . -s. ~s. a. at l's t.... "To provide them w1th a rTieaningful education, we apply our day-to-day work to their needs," Caty says. . Some of his students are pediatnc surgery fellows who have already ~eceived general surgerytraining and ave chosen pediatric surgery as thew subspecialty. These students need to be taught very specific details of pediatric surgery that will enable them to sue~eed in their newfield. Ut Caty also teaches general surgery residents, the majority of 'Nhom aren't likely to go on to pediatric sur~ery. These students, e explains, need to 1 earn basic surgery Pnnoples and only as much about pediatric surgery techn1ques . th as eymayneed in their Practice. th As the director of C eclin1cal clerkship at hildren's Hospital Caty also trains med 1 ~ cal h students who aven't yet decided on a 0 p h their future. They will leam enough about pediatric surgery to help them decide when to refer a patient to a specialist, and may also spend time in the division's clinic, where they'll see a variety of patients. "You can be a role model and a mentor even being in a different field," Caty says. Caty, 37, earned his M.D. from the University of Massachusetts, and did a general surgery residency at University of Michigan Hospitals, where he served as admlnistrative chief resident. He was a clinical fellow in surgery at Harvard Medical School in the Chiidren's Hospital of Boston. H1s field of pediatric surgery has given Caty a chance to develop a wide range of expertise, because although he specializes in one population, he doesn't limit himself 5 0 5 p to a single type of surgery. One of his specialties is laparoscopic splenectomies, performed on patients with spherocytosis. Because the disorder is hereditary. many of his patients' parents also underwent splenectomy operations when they were young. "The parents vividly recall having big incisions and being in the hospital for a month, and they're very appreciative when their children can have it done with laparoscopy," Caty says. Caty's research has centered on understanding and preventing organ damage caused by ischemia and reperfusion. lschemia/reperfusion damage is often linked with necrotizing enterocolitis, an intestinal infection among premature newborns. lschemia/reperfusion research can also be applied to transplant surgery, because organs can easily be damaged by the interruption in blood flow that occurs during a transplant. Caty's recent experiments on the intestine indicate that histamine produced by the body during ischemia/reperfusion events may contribute to organ damage. His research suggests that drug therapy against histamine could be an effective treatment to help prevent the -J.A. damage. * g 9 9 �Ke v n G b b n s 0 M D Going after Brain Tumors from a New Direction KEVIN GiBBONS , M.D., IS TAKING NEW APPROACHES to neurosurgery and head-injury management. Gibbons, 35, is the director of Millard Fillmore's neurosurgical intensive care unit. He holds an M.D. from Albany Medical College and did his internship and residency at UB. He also did a fellowship in surgical critical care at UB. Gibbons specializes in skull-base neurosurgery, particularly in novel exposure techniques for internal aneurysms, blood vessel malformations, and tumors once thought to be unresectable. These are often benign tumors; that is, in a different part of the body their slow growth and lack of metastases would pose few problems for the patient. But when they are situated deep within the brain, or in bone separating the brain from the face, their pressure on the brain, the cranial nerves, or the cerebrospinal fluid leads to debilitating symptoms or death. Traditionally, surgeons would open up a section of the cranium and push or pull aside the healthy brain to reach at least part of the tumor. But Gibbons says this procedure is often not successful in exposing the entire tumor and can injure healthy tissue, leading to complications such as hemorrhage. infection, stroke, and spinal fluid leakage. Instead, he and colleagues at Millard Fillmore and Roswell Park are entering the brain at the base of the skull or through the face. Using these newer approaches, surgeons are more likely to reach the entire tumor without disturbing or injuring the healthy parts of the brain. Gibbons twice a year teaches 3 . I national course on neurosurglca critical care sponsored by the American Association of Neurological Surgeons. He is working to popularize a change in treatment of traumatiC head injuries and aneurysms. Doctors typically treat strokes and an. ve eurysms by working to 1mpro blood flow to the brain. However. after a traumatic head injury, they' focus on controlling brain swelling by administering diuretics or other medications. According to Gibbons. these measures don't work for very" long, forcing repeated treatment after a day or so. The new guidelines recornmend increasing blood flow and perfusion to the injured brain: regardless of what caused the InJury'· Gibbons recommends ventilating · patients and increasmg cardiaC output through drugs to ·lncrea se blood flow. "The swelling problems may' be worse in the short term, but 1n the long term, they improve more rapidly," he explains. "It's the sarne experience with other organs whefl they are inJ·ured-they do better · st with better blood flow. It has JU taken us a while to realize that the brain should be treated the sarne way." 11 Gibbons was also a part of team that pioneered a new pal~ treatment in surgery for rupture discs. He and his colleagues lrl' serted a naturally degradable mor. 1 s ite phine sponge into the surglca and found that it provided longterm pain control. -J.A· * a 0 p y 5 c a s p n 9 9 9 �e r Carlos Jaen Roberto M.D., Ph.D. ' '/ g :r s. 1 ,t laking the Pulse of a Whole Community ''F AMILY PRACTICE IS LIKE TAKING CARE OF FRIENDS," says Carlos 1\oberto Jaen, M.D., Ph.D. "You have a chance to be close to People at so many important times in their lives. You form a Partnership with them to improve their health or their function . It's a challenge intellectually and at the level of your heart." fil ain -ed inor;ite ngJ.A· th Jaen has made many friends in l e Poor communities of Buffalo's tower West Side, where he prac~ces at the Niagara Family Health lJ enter and directs UB's Center for J ~an Research in Primary Care. ~n, 39, earned . his M.D. and a .D. 1n ep1dem1ology from UB, . ~,amlly . pract'and did h.IS res1.d ency 1n ~~e at University Hospitals of feveland. An assistant professor 0 both family medicine and social :nd preventive medicine, Jaen Perves on the New York State t' Ubi'IC Health Council and the na~onal Agency for Health Care ohcy and Research. Jaen has gained special insight 0 0 p h into the largely Puerto Rican community of the Lower West Side by supervising a comprehensive health survey of the area. The survey, conducted in 1993 and 1994, found high levels of asthma, diabetes, heart disease, hypertension, and other chronic conditions. The researchers also found high numbers ofsmokers-47 percent of the men and 32 percent of the women, compared with a national average of about 23 percent. In addition, they found that barriers such as language, distance, and lack of health insurance often prevented families from getting adequate health care. The researchers also y 5 c o n s p charted beliefs about HIV, use of preventive services, drug use, and experiences with crime. "One reason we were able to get such a high response rate is that our people were very persistent. They wouldn't take 'no' for an answer," he says. His group shared the research with community groups, who in turn shared their own insights and joined the efforts to solve the problems. "The community became empowered," he says. The survey has also spun off new projects for jaen and many of his students. Jaen has won a grant to reinterview the asthmatics in the study population. "Mortality from asthma has been increasing in poor urban communities over the past I0 years. Is it environmental exposure? Is it tobacco smoke? Is it lack of knowledge? Is it poverty? What is it that is causing this problem?" he asks. Jaen also writes columns for Panorama Hispano, a Spanish-language monthly that circulates in western New York. "I pride myself on my ability to make things that are very complex simple. I do that when I do direct patient education in my office, but also in a more public way when I do it in print," he says. "It makes me feel good when a patient comes into my office and says, 'I read your article about smoking.' It's a way of reaching more people than just the ones I can see in my office." One ofhis anti-smoking projects is a survey of how cigarette advertising and promotions are tailored to the inner city. Jaen says that although tobacco companies spent $6 billion on advertising last year, he is not intimidated by their strength. "I follow in the tradition of Don Quixote, I suppose. I have a picture of some windmills in my office that my mother got me when she went to Holland, and they inspire me. I just keep working in my circle of influence and see what happens. I think we have -J.A. right on our side.'' * n g 9 9 6 0 • !.. LL bO c: • �D a v d J a m e s M D task than they may have been Jed to believe." t In Canada, James points ou ' about 50 percent of me d .ICa1 stu- Specializing in Everything DAVID jAMES, M.D., is working to reintroduce a concept as old as professional medicine, and as new as 1990s health-care reform: the family doctor. "My father's family doctor took out his tonsils on the kitchen table, and amputated mygreat-uncle'sanm on that same kitchen table," James says. "The family doctor looked after you from birth and the cradle to the grave." A Toronto native, James, 37, earned his M.D. from the University ofToronto. In the Canadian system, James says, family practitioners are trained in all primary care areasobstetrics, pediatrics, and emergency and internal medicine. In his solo practice in a Toronto suburb, he saw patients in his office for about 44 hours a week, spent another 25 hours in emergency practice, and delivered two to four babies a week. "You're expected to have almost specialist knowledge in every area," James says. As an assistant professor of fam- dents become family practloners· d 11 Underthe country's publicly funde . health plans, pat1ents can 't get free . I.1st un less theY care from a spec1a are referred by their fam1 IYd0 ctor. . es "The family doctor superviS their care, acts as a curator. The . amount of money .It sav es iS remarkable," he says. d James welcomes the pu brIC an . private pressures t hat are driving d this country towar . eon agreaterre I1anc . general practl'tiO' ily medicine and the new medical director of Deaconess Center's family medicine center, James hopes to train a new generation of U.S. doctors in the same wide range of knowledge. He teaches family medicine, low-risk obstetrics, pediatrics, In Canada, about emergency medicine, and a wide range of other procedures. 50 percent of James is also an attending physician at medical students Deaconess and in Buffalo General's emergency and obbecome family stetrics departments. "Part of my job is to practitioners. show students that being a family physician is a much more broad, demanding ners. "General prac~ tice is not seen a being glamorous, the hours are irregular. and you don't rnak~ the same kind o dough, so students tend to go into sp ecialties. But I ber1e ve0 that in five to 1. years everybody iS going to earn a bout the same amounpS the health-care rn ar- ------ - -- ~-~--- e B a 0 p y s a s p n ket changes." * A - J.. g 9 �c. Shahrokh Ph. D. M. D., Khan Fighting Blindness through Surgery and Research SHAHROKH C. KHANI, M.D., PH.D., woRKS ON RETINAL degenerative disorders on two levels- the operating table and the laboratory bench. His primary research interest is in retinal gene therapy; currently, he is engaged in a search for the key to retinitis pigmentosa. Khani, 33, eamed his M.D. and a Ph.D. 1n biological chemistry from the University of Michigan. He was an · 1ntem at Saint Joseph Mercy Nosp1tal in Ann Arbor, Mich., and ~ a residency in ophthalmology at ash1ngton University. He also did fellowships at Harvard Medical ~hool and the Medical College of ISconsin before coming to UB. An assistant professor of ophthalmology and biochemistry, Khani teaches residents and biochemistry graduate students and is UB's director of retina services. Retinitis pigmentosa is a congenital disorder that interferes with the eye's ability to adaptto light and da.L . . Ioss o f '"' caus1ng progress1ve vision that can range from night blindness to total blindness. In young patients, whose only symptom may be night blindness, an electroretinogram can detect the functional problems that signal more severe problems to come. The disorder is also characterized by, and named for, the presence of extra, clumped pigmentation in the ret1na. Because the enzyme rhodopsin kinase helps photoreceptors to adapt to light by catalyzing the phosphorylation of the visual pigment rhodopsin, Khani believes that a mutation in rhodopsin kinase may be responsible for retinitis pigmentosa. As an initial, but substantial, step toward identifying the defect, Khani has succeeded in isolating and cloning the gene and identifying several mutations. Next, Khani's research team w ill try to express the mutant proteins in bacteria or cell cultures and analyze them, then introduce the mutation into a mouse and perform electroretinograms to see what effect it has on retinal response. "Retinal gene therapy is in its infancy. 1 th ink that more and more work wi ll be done in this area," says Khani. Although retinitis pigmentosa affects only a small number of people , Khani believes that the techniques he is establishing will have widespread applications. ''I'd like to find more genes responsible fo r retinal degenerative disorders-particularly age-related macular degeneration, which is the cause of blindness in about 2.2 percent of the population," he says. Even after genetic defects are identified In retinal degenerative disorders, the re are many hurd les that need to be overcome before gene therapy can be establ ished as routine, Khani explams. Unlike the cornea, the retina is re latively difficu lt to infect with the viruses that could be used to transfer genes, he says. Also, when researchers have succeeded In transferring genes to the retina, they have been d isappointed to find that the new genes are not functionally expressed. Because functional gene therapy is so far in the future, there is still plenty of demand for the retinal repairs Khani performs In the operating rooms at Erie County Med1cal Center and Millard Fillmore Hospital. As a vitreoretinal surgeon, Khani uses Iase r treatment to correct diabetic . retinopathy. He is also engaged In clinical trials on the use of high-density periluorocarbon liquids to reattach detached retinas in complex cases. Khani's trials compare the usefulness oftwo ofthe fluids, periluoron-octane and periluoro-n-octyl bromide. The high-density liquids are injected into the eye, where they settle under the fluid in the eye and gently press the retina into its proper place, stabilizing it while scar tissue is removed by lasers. The liquids can easily be removed after the opera- J.A. tion. * a 0 p h 5 c a n 5 p n g 9 9 6 i) �Ro b n S t e nhorn, H. M. D . neonatology department Nitric oxide, which is naturally produced in endothelial cells, was being used for the first time to relax the smooth muscle layer around the blood vessel, and enable an oxygen-deprived baby to breathe. For infants that do not respond to medication, she brought her expertise in heart-lung bypass surgery, which she calls a "safety net" and a "last-ditch effort." The complicated procedure of handing an infant's respiratory and cardiac functions over to machines for five to seven days requires 24-hour vigilance from two professionals, but gets positive results. Saving Newborns Who Can't Breathe RoBIN H. STEINHORN, M.D., HAs MADE A CAREER out of saving newborn infants who are literally blue from lack of oxygen. The window sill in her office at the Children's Hospital of Buffalo is filled with pictures of her now-thriving patients. Steinhom is fascinated by the moment when a baby takes its first breath of air. "Never at any time in anybody's life is there such a dramatic change with such rapidity," she says. In more than I in I,000 live births, that first breath can't oxygenate the baby's blood, and the infant is diagnosed with persistent pulmonary hypertension. These are the babies who are sick enough to qualify for the specialized treatment Steinhom can offer as medical director of Extracorporeal Life Support Services at Children's Hospital. Babies with persistent pulmonary hypertension are brought to Children's via helicopter from all over the state for treatment. Steinhom, 39, got her M.D. from Washington University and did a residency in obstetrics and gynecology at the Bames Hospital Group. She then swrtched fields, completing a resrdency rn pediatrics at the University of Minnesota, where she became an assistant professor of pediatrics. Steinhom also helped develop a program to train doctors, nurses, and technicians in heart-lung bypass while she was at the Variety Club Children's Hospital at the University ofMinnesota Hospital and Clinic in 1986. She brought the program to Children's Hospital of Buffalo. Her current area of research is cyclic guanosine monophosphate (cyclic GMP), a naturally occurring substance that relaxes blood vessels and works in concert with nitric oxide. She hopes that an understanding of how the cyclic GMP system develops naturally will help explain why it fails in some babies. Steinhom came to Buffalo four years ago because she was interested in the pioneering work being done wrth nrtnc oxide in the hospital's Steinhom prescribes passion for one's work. "Have some real excitement about what you are doing," she advises medical students. "I never go to the nursery without thinking about what I am doing in the lab, and I never go to the lab without thinking about the nursery." • She recalls her false start in obstetrics. ''After my first year of training I realized that I was more interested in the babies than the mothers." She was particularly intrigued by the blood vessels in infants' lungs. which can be manipulated in anumber of ways after they are bom. "It aroused the scientist in me," she says. Steinhom calls the examination of blood vessels and cyclic GMP her main contribution to medicine, and hopes the future holds not only a cure for persistent pulmonary hypertension but also a way to prevent it LL (]) .c. 1- * -BT a 0 p h c o n s p E !rN g I T. joHN 9 K ELL 1 9 �>(- Stephen in T e ach, J . M. D. Jr :h s!d lo Diagnosing Bacteremia in Febrile Children UP TO ·e IS PERCENT OF THE CHILDREN who come to a pediatric emergency department present with nothing more than a fever. But their diagnosis can be as innocuous as a cold, or as serious as meningitis. '0 ·e •P S, ;s b ric n ;- h n IC ill e )- s. 1t n b )- 1- 1- d 5, 1:' It e ,- c t J Polymerase chain reaction (PCR) technology, which has been used for years in laboratories to replicate DNA and create samples large enough to identify, will soon move into the hospital and become a speedy alternative to cultures, Teach predicts. PCR could identify a disease in 3 to 6 hours. "It will begin the molecular triage of sepsis," he says. PCR diagnosis will improve treatment by Doctors must quickly determine Which of the feverish children are suffenng from occult bacteremia, the bacterial infection in the blood that precedes and can blossom into a full-fiedged disease, such as a urinary tract infection or meningitis. Current culture techniques, wh1ch rely on watching the growth of bacterial colonies from a blood sample, can take from I 2 to 72 hours to diagnose bacteremia. Children who appear to be at risk are not only started on antibiotics but often hospitalized for the entire time 1t takes for the culture to Prov1de an answer. "The approach to that complaint hasn't really Changed in years, and I believe it is about to change," says pediatrician Stephen Teach, M.D., a clinical asSistant 1n pediatrics who specializes 1n ped1atric emergency medicine at the Children's Hospital of Buffalo. Teach, 40, earned an M.D. from Narvard University and a master's degree in public health from the University of California at Berkeley. l-ie did a residency in pediatrics at Children's Hospital of Boston, and Vvas a clinical fellow in pediatrics at Narvard Medical School before com1ngto UB as an assistant professor of pediatrics and emergency mediCine. accurately identifying the small percentage of feverish children who are suffering from a serious illness. It will also help hospitals cut down on costs by shortening the length of inpatient stay. Many hospitals are already building "short-stay" units designed for treatment ranging from a few hours to a full day. PCR will be particularly valuable in identifying bacteremia because the various organisms that cause bacteremia are well known. "You can't just screen for everything. You have to know what infections are epidemiologically likely to be present in this patient, and for bacteremia those bacteria are well described." PCR is already used at Children's Hospital to identify herpes, pertussis, HIV, Lyme disease, and some other diseases, Teach notes. "This will just be an expansion of an existing technology," he says. 'k - J.A. Teach's research into fever among children has shown how ~ifficult bacteremia is to identify. or example, in a 1995 paper, he demonstrated that one of the standard observation scales for classifying fevers 1s not very useful for children under three years old. "This is where I think we're go 1ng to see the world of molecular d1agn ost1cs · enter 1nto . the world of ambulatory pediatrics," Teach says. a 0 p h y s c o n 5 p g 9 6 6) • �their livestock, so that even if people do settle there, they can't support themselves. And then it kills the people as well," Williams says. T rypanosomes have a number of unique adaptations that make them particularly tough to kill or immunize against. They easily elude the human immune system because they change the glycoproteins. in their coat as antibodies recogntze them. The constantly changing coat makes it next to impossible for the immune system to recognize them as invaders. w No reen I I T rypanosomes also have an unusual genetic structure. The organism's genes are shorter than needed, so in order to express functional proteins, the trypanosome edits its own genes, spltctng togetherthe necessary components. a ms , p h. D. Williamsisfocusingherresteabr~ SLEEPING SICKNESS IS A DEVASTATING DISEASE endemic to Africa and on the organism's energy me a . Iism, which is also unusual. Leamtng more about what distinguishes trypanosomes' biochemistry from that of the cattle and humans it infects could lead to a drug that will target · h no efand kill the protozoan wtt Battling Parasites with Molecular Biology South America that saps strength and induces fatal comas in people and cattle. The key to fighting it may be to block the metabolism of the tricky parasite that causes it, according to microbiologist Noreen Williams, Ph.D. "It gives me some satisfaction to be working on this disease," she says. "It's a disease of developing countries, and so it hasn't been the focus of much research. The countries where it's endemic don't have many resources, but that doesn't make them any less cycle in the tsetse fly. It infects the insect's salivary glands and is injected into cows, antelope, or people as the fly bites them. The trypanosome thrives first in the bloodstream, then-over months or years-invades the lymph nodes, the heart, and the central nervous system. If important." Williams, 40, holds a Ph.D. in biochemistry and molecular bioiogy from New York University. She did postdoctoral work at The johns Hopkins University and was an assistant professorwith the Uniformed Services University of the Health Sciences before coming to UB in 1992. An assistant professor of microbiology, Williams is also the di- quickly identified, the disease can be cured by drugs. If not treated before it reaches the central nervous system, sleeping sickness leads to headaches, confusion, lassitude, coma, and death. An East African strain moves more quickly, often killing through congestiveheartfailurewithinweeks or months. A closely related illness in South and Central America is called Chagas' disease. rector for microbial genetics and "It's a severe problem in devel- physiology. The parasite that causes sleeping sickness, trypanosoma brucei, is a protozoan that lives part of its life oping countries. The tsetse fly breeds in water, meaning it lives in the parts of a country that would be good places for people to live. But it kills G B a 0 p 5 c a n 5 feet on the host. .. 1 "We're looking at the cnttca 't to enzymes that are necessary ~,or 1 survive. If you knock them out, you 'd knock out the organism," she says. Williams is particularly interested tn an ATP synthase that helps the trypanosome generate A TP for.''tS energy requirements. Compltcattng the research is the fact that trypa. rn nosomes change their metabo 1IS as they move between their insect and mammalian hosts. In a recent paper, Williams and her colleague~ identified an inhibitor pepttde tho apparently helps regulate ATPase function. "Modern biochemical approaches are new to parasitolog}'• · 1tg ht and they've helped .1t JUmp years in the past I 0 years," she says~ "It's a microcosm of what '.: hap pening in science in general. . Williams is also entering into t~ new collaboration to study plan that are chosen-apparently for medicinal purposes- by animals like chimpanzees and gonl.I as. Sh e Plans to help test substances firom thef plants on the "tryps" in the hopes 0 finding new leads to a cure. * -J.A· p n 9 9 �"The real lady is as much out of place in the practice of medicine as in a regiment of dragoons. " So ran an editorial in the Buffalo Medicaljournal in 1857. But by 1880, l3 regular medical colleges around the country admitted women. The University of Buffalo was one of them, having graduated its first woman, Mary Blair Moody, i.n 1876. By 1912, when these medical students were photographed in the library, it was not uncommon for women to make up about 10 percent ofUniversity ofBuffalo's graduating class. PHOTO : UNIVERSITY ARCHIVES , UNIVERSITY AT BUFFALO /cfcf:?l The university was also progressive in admitting black students. Early records do not list race, but a number of black students are known to have graduated in the 19th century. joseph Robert Love, class of 1880, is believed to have been the first. The second, Cornelius Nathaniel Dorsette, was rejected by the University Medical College of New York City because of his race before being accepted to the University of Buffalo. Pictured here wi.th his class in 1882, Dorsette became Booker T. Washington's doctor and a founder of the National Medical Association. PHOTO: UNIVERSITY ARCHIVES , UNIVERSITY AT BUFFALO �Medicine o t WHAT DOES THE FUTURE HOLD FOR MEDICINE? A procedure to lengthen life indefinitely?The eradication of disease? Genetic manipulation to create the perfect human being? Members of the UB community don't think so. Instead, they believe the next 50 years will bring little change in disease, and continuous progress in technology and treatments. What will change quickly and dramatically, they predict, is the profession of medicine as it is buffeted by social, political, and economic forces. Their speculations, which are presented on the following pages, were summed up by Gerald Logue, M.D., chief of staff at the Buffalo VA medical center. "If you look at the last 50 years in medicine, we've made enormous advances that you couldn't possibly have predicted. That's probably going to happen in the next 50 years as well. "Nevertheless, the diseases will always be there. We may alter . . . . some presentations, and there may be a few new viruses. But people 0 have a finite life span. Even if we eliminated cancer, it wouldn't extend 0 life span very much.There are factors that are age-related that aren't disease-related. m z < > ,0 ~ "Violence and war will probably still cause trauma and longlasting effects," he concluded."We're much more likely to look back in 50 years and be impressed with man's inhumanity to man than with nature's inhumanity to man." The top worry for all our respondents was the economy of health care-how it will be affected by spiraling costs, managed care, changes in Medicaid and Medicare, and politically driven systemic reform. Almost all of our experts predicted some type of universal health-care system, either public or private, in the near fui:tJre.Thomas Rosenthal, M.D., chairman of UB's Department of Family Medicine, 1 9 9 6 �uture ( PHOTOS BY FRANK CESARIO ) was optimistic that economic pressures would result in some improvements in care-a return to family medicine, for instance. But many of our respondents had more worries than hopes, fearing losses in doctors' traditional autonomy and in quality of care. Susan Regan, a prominent health-care attorney, summed up the topic of health-care financing for us, also touching on issues of market competition and tax reform. Another topic of concern was drug resistance in disease-causing organisms. jerome Schentag, Pharm. D., provided hope for the future in his discussion of the issue, pointing out that while discovering new drugs will help, changing the way doctors use existing drugs may do even more to fight the problem. Two bright views of the future were provided by David Ellis, M.D., who discussed the burgeoning field oftelemedicine,andAian Lockwood, M.D., who talked about the emerging possibilities of modern imaging technology. Both felt that their specialties have the potential to bring progress to medicine: imaging by discovering new information, and telemedicine by disseminating information. james Nolan, M.D., speculating on the future of medical training,thought that greater demand for primary care physicians may lead to a new system in which almost all medical school graduates enter generalist residencies. He also speculated that the cost of residency training may in the future be shouldered by the public sector: f Medical ethics specialist Stephen Wear, Ph.D., offered a thoughtful look at the moral ., aspects of medicine. He believes that it is poor communication between doctors and patients that causes many of today's ethical tussles. Although these may melt away as doctors change their attitudes, he anticipates that there will always be new problems. Finally, 5 Wear wasn't the only member of our panel who was concerned that cost considerations, rather than medical ones, might begin to constrain care. e u 1 1 a 1 o Ph ys l cla n 5 p r I n g l 9 9 6 �---- T ( H u T u - R 0 GERALD L . LOGUE , M . D . , ON MEDICINE . M D ----··- -- c - N ) The future will change how • practiced IS DISEASES OF THE FUTURE WON'T BE appreciably different from today's, but the practice of medicine will change radically, accordingto Dr. Gerald L. Logue's peek into the crystal ball. Logue says that because recent research has brought breakthroughs in understanding the genetic basis of cancer. breakthroughs in cancer therapy may be only a few years away. "We're going to see a tremendous reaping of benefits ofthat research in the next five to I 0 years.'' However, advances in treating other problems, such as cardiovascular disease, substance abuse, and environmentally triggered illnesses, will probably be incremental ratherthan revolutionary. 'We'll just keep chipping away." says Logue, chief of staff at the Buffalo VA medical center. What will change more radically. Logue predicts, is the way medicine is practiced. Burgeoning health-care costs and politically driven systemic reform will change how doctors pract1ce mediCine, and who pays for it. Obvious changes surround1ng the advent of managed care include more ambulatory care, and more control by payers and less by doctors. Logue also predicts greater cooperation between doctors and other health professionals, such as nurse practitioners, nurse-midwives, and physician assistants. primary care can be delivered by these other professionals, he notes. He also predicts a change in the way doctors use the tools of their trade. "We are slaves to our technology. Our technology is way beyond our ethics, or our methods of using it," he says. Because life-prolongmg technology IS available, doctors and families tend to use it on patients even when the patient's uality of life is poor and there's no hope of recovery. "It isn't !e right thing to do," Logue insists. "We're at the mercy of our ·::ome technology-we love it, we idolize it, we worship it." Logue hopes that this will change as doctors become more educated, and as more patients are urged to appoint health-care proxies and make advance-care directives. The change will be driven not only by concern for skyrocketing costs but also by a desire for better and more rational health care. "We will have to tum around our technology-driven health-care system," he says. "But we'll also have to be careful that we don't head back into a dark age of medicine where we don't offer that care to anyone." Even with federal aid, training residents drives up costs at hospitals. In an increasingly competitive market, hospitals may . . become unwilling to continue foot1ng the bill. In other countries, graduate medical education can be funded through a tax on health care, but America's political cl1mate makes that approach unlikely here. ''I'm not sure who 1s going to end up pay1ng for it," Logue admits. . Logue sees future research funding coming more from the pnvate sector and less from public sources. He also says that there's ~goo~ chance ther~.will be fewer students going into pure research. They re not dumb, he po1nts out. 'They look and they see that in the future, there's not going to be as much money." The "baby boom" demographic increase in the number of the elderly, plus rising costs and continuing fragmentation and mobility ~f fam11ies, ~ill cause a crisis in care for the elderly, Logue predicts. Everybody s go1ng to want to go into nursing homes and no body's going to want to pay for it," he states. "This is not really a medical problem, but s1nce 1t gets paid for out of the same pot, it will end up be1ng a problem for medicine." _ J.A . s p n g 9 9 6 �T u H T 0 R M N D DAVID G. ELLIS, M.D., ASSOCIATE DIRECTOR of the emergency department at Erie County Medical Center, is at the vanguard of sharing med1cal data, expertise, and protocols using personal computers and videoconferencing-an emerging technology called medical informatics, ortelemedicine. "Every specialty is going to look at this and apply it," he predicts. Computer- ( DAVID G. ELLIS, M.D., ON MEDICAL INFORMATION TECHNOLOGY ) ized protocols and video link-ups are the future as surely as managed care is, he believes; in fact, telemedicine will be inextri- Com put e r s w iII cably linked with managed care in the name of efficiency. The goal of informatics is to organize information so it can be shared by doctors and other medical staff in numerous, widely separated locations. The system will enable professionals to share information about specific patients, as well as protocols concerning entire classes of patients. Ellis hopes it will make treatment as efficient and uniform as possible in a manner cons1stent with the latest literature and practice, and in keeping w1th the goals of managed care. "The goal of the new medicine IS to keep people 1n the best health at the lowest cost, preferably at home," he says. Videoconferencing helps doctors and hospitals make scarce expertise and resources available over a larger geographic area. With a v1deo camera wired to a personal computer, doctors can examine a pat1ent and consult with each other even if they are miles apart. As an example of the possibilities, a new distance education room 1n the Health Sciences Library at UB's medical school allows nurse-practitioner students in the town of Olean to attend class in Buffalo without physically making the trip. Ellis is also pioneering the use oftelemedicine at the Erie County Holding Center and the Attica Conrectional Facility. T elemedicine makes its possible for doctors at ECMC to examine prisoners at Attica and consult with nurses at the prison without any of the financial, security, or time concerns that anse when prisoners are transported. The telemedical examination at the prison takes a few minutes, while the round trip from the hosp1tal would take several hours. And because the patient isn't taken out of the prison, there's no security risk. Even the prisoners like the new arrangement. Ellis has found that prisoners would rather get qu1ck emergency care in the prison than be taken to a public hosp1tal in shackles. Ellis's vision of the future includes doctors connecting to a medical Internet through their personal computers, or joining doctors from the community on virtual grand rounds without leaving thew respective hospitals. T elemedicine will keep doctors cunrent, curb feelings of isolation, and aid in the development of consistent clinical pathways and protocols, he believes. In his own field of emergency medicine, Ellis dreams of ultimately eliminating the Waiting room altogether, instead collecting registration and medical information through portable computers at the patients' bedsides While they are being treated. Ellis stresses that while technology will help establish consistency in practice, it willnever eliminatetne art of medicine. Medicine will always require flexibility because patients, diseases, and computers are not completely predictable. However, protocols can shorten e 0 0 p y 5 0 medical communication length of stay, reduce costs, and improve survival rates. Doctors should considertelemedicine a tool "just like a stethoscope," he says. "This technology is no longer a big deal. The real challenge now is relationships. This presents new ways for people to deal with each other." Technology will not replace primary care physrcians, either, he notes. It will merely enhance their capabilities. Consequently, Ellis is not worried that medical students win resist informatics. As an assistant professor at UB, he has found this generation of students computer-literate and cognizant of the value of technology. "Even doctors trained before the advent of personal computers are learning more about computers and reaping the rewards of more efficient practices," he says. - BY ERIN ST. jOHN KE L LY 5 p g 9 9 6 �u H T T u ( D M 0 R N Medical imaging will bring to medicine ALAN H. LOCKWOOD, M . D . , ON MEDICAL IMAGING NEW WAYS OF iNTEGRATING INFORMATION will make medica\ imaging nd new technologies will make 1t cheaper and more morepowe rfiul . a . 'bl d'cts Alan H Lockwood M.D., director of Pos1tron access1 e, pre I · ' Emission Tomography (PET) Operations for UB and the Buffalo VA medical center. . . . PET , one of the newest imaging technologies,. will be Invaluable .h in studying diseases and abnormalities-espeoally ones w1t out · tom·1cal manifestations-because 1t measures chang1ng 0 bV\OUS ana . · 1 · 1 processes such as blood flow and glucose metabolism. phys1o og1ca · f . ood explains in some cases o Intractable For exampIe, Lockw .' . ·1 magnetic resonance 1magmg (MRI) and computed ep1epsy, · · B 'd ·fy· reveal no anatomical abnormalitieS. y 1 ent1 1ng tomograp hY(CT) underactive regions of the brain, however, PET scans can find the locus without the hazards of more invasive methods. PET will also lead to steady progress 1n leam1ng about normal, · 1 av he believes Because 1t can measure blood flow I hy phys1o heat obt' · to various sections of the brain, PET is an ideal tool for finding out how the brain performs everyday yet still mysterious tasks, such as thinking and talking. Lockwood and his colleagues have already begun PET studies of people as they process language. "We'll begin to see the neuroanatomy of language production," he predicts. "One of the future developments in PET technolo'6f is going to be the fusion of physiological information with other sources of data," Lockwood says. Computer programs to integrate and superimpose PET scan information with MR\s already help doctors locate the site of a physiological abnormality with precision, he says. Further progress will be made by combining PET, which records events lasting about one minute, with electrophysiological methods that work on a fraction of that time scale. The combination will show how various brain regions work together to perform tasks such as talking and reading. Lockwood says it's unlikely that PET imaging itself will change much. ''I'd say we're pretty close to optimal in that technolo'6f." Instead, he believes, the invention of new radiopharmaceuticals will expand how PET is used and make PET technology more widely available. New tracers to study the brain, the heart, and the origin and spread of cancer are on the horizon. Lockwood also says less expensive tracers will be developed that will be widely distributed and used in existing primary care facilities. For example, a new generation of tracers can be used in Single Proton Emission Computed Tomography (SPECT) machines. These machines are often available in community hospitals and outpatient facilities that cannot afford PET systems. Regulatory barriers will also fall as a consequence of the work done in PET centers like the one in Buffalo, Lockwood predicts. Currently, the U.S. Food and Drug Administration classifies PET radiopharmaceuticals as experimental because their short half-life makes it impossible to subject them to the kinds of testing required for most drugs. Although PET studies are expensive, they are far less costly and hazardous than other alternatives such as exploratory surgery. That means PET can be used to help physicians decide on treatment options. Buffalo is the home of a unique committee made up of physioans. hospital administrators, and insurance companies that is establishing guidelines for the use of PET in the clinical setting. According to Lockwood, this makes Buffalo a leader in facing the challenge of determining how to use PET and other imaging technologies in ways that are sound both medically and economically. - J·A · B U a 0 p h y 5 a n 5 p n g 9 9 6 �T u H u T H 0 R D ( N ( JAMES P. NOLAN, M.D ., ON RESIDENCY EDUCATION ) Residency training will create more :1 tt s. s, tg .0 :Jf ys \. RESIDENCY MIGHT CHANGE SUBSTANTIALLY in the future, with most residents heading for a generalist education and a small number choosing super-specialties, according to James P. Nolan, M.D., immediate past chairman of the Department of Medicine. Residency training will need to reflect the medical community's increasing emphasis on primary care, says Nolan. Primary care skills will need to be taught from the first year of medical school, and residency training will need to develop into more of a continuation of medical training. It could even be that most young doctors will go through one generalist residency, instead of selecting specialties. T rain1ng will be very different for the m1nority who choose specialties, Nolan believes. "Those who do choose to enter the more technical aspects of med1cine probably will see their education differentiate in the third year of medical school, and they will go on to a highly specialized residency after that. he says. Specialist residencies will become much more focused and narrow, he believes. For example, radiologists could become wedded to one imaging technology. "We also will see changes in managed care and the way we've originated that system," says Nolan, who expects to see a universal health-care system like Great Britain's. Inpatient care will decrease as hospitals focus on the sickest patients. Most health care, Nolan predicts, will take place in ambulatory settings. And while there still will be a need for critical care doctors, Nolan said, residency training in the future will become more heavily oriented toward preventive care and wellness. "I think we also will see norms of treatment become similar for all physicians, and variations from treatment guidelines will have to be justified," he says. These care guidelines will be implemented to 8 0 0 p h 5 c a achieve efficiency, cost-effectiveness, and universality of care. The downside, he wams, is that physicians may have less discretion in terms of treatment. The roles of different types of health-care professionals will be undergoing a change, Nolan believes. "I think we will see a blurring of the roles of physicians, nurses, pharmacists and other health-care providers. I think we will see more working as a team, and blending certain aspects. For example, prevention and counseling will be emphasized across the board for all practitioners," he says. UB already is working to meet the needs Nolan sees developing. ''Moregeneralistskillswill be taught to students earlier, and that's what we're doing now," he notes. But medical educators will need to do even more to facilitate the changes he sees on the horizon. Medical schools, Nolan says, need to develop more ambulatory sites and clinics throughout the community that are staffed by university and clinical faculty. "We have not been able to use physicians' offices as much as we'd like. We still find that most tra1ning is in the inpatient setting. We've got to find the resources to move out into the community." Residency will likely become more a period of education and less a term of work. "The service component is decreasing now. Residents are not providing the same amount of service that they once were required to. The education of residents is being stressed much more than it has been in the past." That may lead to a change in the way residency training is funded. Residents are now generally on hospital payrolls, so their training is paid for by patients and thirdparty payers. If residency becomes more education-oriented, that cost may be picked up by the government, Nolan explains. - BY CHRISTINE VIDAL n 5 p n g 9 9 6 �~~~~~-- I u H T u -~·-·----~- - R 0 M D N the family doctor, a narrowing of the salary gap between specialists and generalists, and a smaller role for the hospital as more routine care is performed in ambulatory or home settings. Although she believes that managed care can bring new efficiency, she does not think it will miraculously erase the high cost of care. "Medicine is always going to be labor-intensive, and it's always going to take a long time to train doctors and other professionals,'' she explains. "And it's always going to take time for patients to respond to treatment ( SUSAN G. REGAN ON HEALTH CARE FINANCING ) Competition, not regulation, will and get better. No matter how much you pay the cellist, it takes the same amount of time to play the string quartet. "We will have to develop a better sense of distributive justice," Regan says, pointing to the current lack of service to the poor and to people in rural areas. "It's a form of rationing, but it's not based on any legitimate reasoning~ it's either how much you can pay, or the cost of health care THE COMING REVOLUTION IN AMERICAN health care will create a system that is vastly more efficient and, ideally, more fair than today's, says Susan G . Regan , a member of the New York State Public Health · · E · Council. Regan, who is also a member of UB's Center for Clin1cal th1cs and Humanities in Health Care, is an attorney who regularly lectures at the medical school. She heads the health law department at her firm of Magavern, Magavern & Grimm, which serves as counsel to a number of hospitals and health care prov1ders. . R Pred icts that the country will reshape 1ts health-care egan k "I h system through market forces, not government ta eover. n t e next 1 0 to 1 S years, we'll have a strong, deliberate movement toward competition in health care," she says, po1nt1ng out that a New York State government task force recently recommended that ·t 1 begin to negotiate reimbursement rates w1th all payers. h osp1 as · · b 11 Under this plan, not only health maintenance organ1zat1ons, ut a third-party payers~including Medicaid~would negot1ate payment rather than follow rates set by the state. These are the k1nds of measures that will likely begin to bring costs down, Regan bel1eves. "This will undoubtedly cause some problems, but overall 1t will lead us to greater efficiency. The days of the planned economy in health care are gone," Regan says. She does believe, however, that the nation'straditions of consumer protection will probably lead to some government supervision ofthe emerging system. "We may well dec1de that we need regulation a~ a balancing force, just as we discovered the need for ant1trust laws, she notes. "In the future, we will also reexamine how our tax policy contributes to our problems," she predicts. For example, current law subsidizes employer-provided health care by allowing employers to deduct the insurance they provide their workers; yet it does not force all employers to provide health insurance. The result is that people who get no insurance from their jobs indirectly subsidize those who do~the government collects the full amount of taxes from the uninsured, and uses that money, in part, to give a tax break to companies that provide health insurance for their workers. Regan agrees with the many observers who forecast a return to B 0 0 p h s whether in your town there happens to be an orthopedic surgeon." At the other end of the scale, she observes, a few people at the end of life receive far more care than they want or can benefit from. Concerns about cost and about good medical care will necessitate a more rational system of distributing care to those who need it. There is a serious risk that managers may try to save money by cutting back on needed services, or that doctors will be overly constrained by cost considerations. We have not yet found ways of avoiding those dangers, according to Regan, but it is essential to do so ifhealth-care reform is to succeed and make Americans better off "Our country is unique in that we have enormously creative thinking in the insurance industry and among health-care providers, so I can't help but think we'll come out of it with a better system," she states. ~J.A. c 0 5 p 9 9 9 �T u H T u 0 R M c 0 N ( THOMAS ROSENTHAL, M. D ., ON FAMILY MEDICINE ) M.D .. CHAIR oF UB's Department of Family MediCine, believes that the future of primary care is the future of medicine. "Primary care is going to reemerge as the base around which we build our health-care system, the same as it is now in every developed country with national health insurance," he states. "Family doctors have been managing the care of the family for centuries." Rosenthal himself practiced for eight years as a family physician in the farming community of Perry, NY. He became medical director of Buffalo General Hospital's Department of Family Medicine in 1986. He helped establish UB's DIVISIOn of Rural Health in Cuba, NY, and its residency program in rural health. Rosenthal was also the founding director of UB's Primary Care Resource Center. Managed care and the need to control costs are strong incentives to return to the model of the family doctor, Rosenthal explains. He expects to see health care move toward some sort of national insurance system within five years. As primary care becomes more important, Rosenthal says, schools will have to produce more generalists. "Medical schools will have to focus on producing 50 percent oftheir graduates who go into primary care careers. We will have to model primary care as the exc1t1ng career it can be." Rosenthal also predicts a move toward decentralization. "More medical education will have to occur in the communities, and less in hospitals,'' he says. Decentralization will make care more accessible. People will be able to see doctors in nearby clinics, or have phone consultations, or even receive home visits. The result will be earlier detection of disease, and better prevention and management of chronic illness. Hospitals will care foronlythe sickest patients. "If we improve the access to quality primary care, we'll see fewer admissions because THOMAS RosENTHAL, they will have their illnesses better managed in an outpatient setting. This has already been proven." Hospitals will therefore specialize in caring for advanced and complex disease processes, and incurable, terminal illnesses. Doctors will have to receive better training in pain management and end-of-life decisions, he says. "These are issues thatfamily practice residencies have always stressed,'' he adds. "We'll need at least as many hospital beds as there are today because the population will be larger, but we will need fewer beds per thousand people,'' he predicts. "However, the cost per day will probably go up." It is possible, Rosenthal says, to provide better and cheaper care without cutting back on the amount of care. "Managed care gets around rationing health care because you make wise decisions and treat people appropriately,'' he explains. "You make a decision based on a history and knowledge of a patient and their values, saving the lives of people with the potential to return to a reasonable state of well ness rather than prolonging the lives of people for more suffering." Technology presents its own set of problems, Rosenthal observes. Medical practitioners will have to decide whether technological advances are saving lives or merely prolonging suffering. "That's a real tricky, difficult question that we've put off answering." For example, imaging and advanced tests have made it possible to detect prostate cancer earlier than ever, but there's still no consensus on what to do with that knowledge. Surgery and other aggressive treatments may save some lives, but sometimes the treatment causes unwelcome side effects and does not prolong life. A second stage of research is needed to determine how best to treat prostate cancer, says Rosenthal. -BY CHRISTINE VIDAL The future . . of medicine IS In care B a 0 p h y c a 5 p g 9 9 6 �T u H u T R 0 M D ( N JEROME J. SCHENTAG , PHARM . D ., ON PHARMACEUTICS DISEASE ORGANISMS ARE BECOMING RESISTANT to drugs faster than drugs are being developed. In the next five to _1 0 years, doctors will see increasing numbers of patients dying from 1nfect1ous diseases such as pneumonia. But pharmaceutics professor Jerome j. Schentag, Pharm. D., he d oes n't believe this crisis spells the end of med1c1ne. .Instead, . believes that doctors will find better ways of using ex1stmg drugs, d that research will focus on boosting the immune system to an . . .. take over the fight against disease. "It's not a hopeless SJtuatJon, bugs were laying their strategy. They came back in force." Although the imminent crisis has spurred new research, experience shows that it takes an average of seven years for new drugs to progress from the test tube to the patient. 'There isn't anything in the pipeline now that looks like a miracle drug. We are getting new drugs, but they're mostly knock-offs of things we already have," Schentag says. Two classes of powerful broad-spectrum drugs developed in the 1980s together make up 50 percent of the antibiotics sold today. The third-generation cephalosporins attack bacteria by inhibiting key reactions in the cell walls, while the advanced fluoroquinolones interfere directly with bacterial DNA. "What we need, frankly, is another one of those advances," Schentag says. he says. . . "Five years ago, it looked like we were w1nn1ng. The bugs were on the run," says Schentag, who is also the director of Millard Fillmore's clinical pharmacokinetics lab. "The pharmaceutical industry pulled back a little, started investing in other areas. Meanwhile, the Hospitals are beginning to address the problem by finding better ways to use the antibiotics they have. Most hospitals save money by buying drugs in bulk and then using up their supply, but according to Schentag, using the same antibiotic over and over in the same setting helps breed resistant strains even more quickly. Instead, Millard Fillmore and other hospitals are beginning to rotate antibiotics every few months. They are also paying closer attention to dosing by testing patient cultures for resistance and boosting dosages in some cases to kill slightly resistant strains before they have a chance to develop higher resistance. In the long term, medical research will concentrate more on active and passive immunity, Schentag believes. That may include attempts to create immunoglobulins that are specific to certain diseases instead of the general ones in use now, as well as bacterial vaccines like the one against Hoemophilus in~uenzoe that helps prevent pneumonia and meningitis. In the short term, however, only changes in drug use can slow the development of drug-resistant bacteria. A simple thing like instant diagnostic tests could allow doctors to determine bacterial strains and prescribe very narrow-range drugs. More important, according to Schentag, is getting doctors to be more restrained in their use of drugs. "If we ever get to the point where we stop giving antibiotics to everybody with a cold, it would be the most revolutionary thing of all," he says. - J. A . The diseases are the drugs B u a 0 p h y s c a 5 p 9 9 �u H T u T H 0 R D ( N New ethical are on the horizon TouGH CHOICES IN MEDICINE will always involve ethical questions, but better communication between doctors and patients could someday resolve many of the day-to-day problems that require the intervention of ethicists like Stephen W ear, Ph.D. "I hope people who do what I do at the bedside won't be needed," says Wear, the co-director of UB's Center for Clinical Eth1cs and Humanities in Health Care. The author ofthe 199 3 book Informed Consent Patient Autonomy and Physician Beneficence in Clinical Med1one, Wear holds joint appointments in the departments of Medicine, Gynecology and Obstetrics, and Philosophy. He heads the ethics consultation team at the Buffalo VA medical center, where he is on call 24 hours a day, seven days a week. He is also a member of ethics committees at Hosp1ce Buffalo, Buffalo Mercy, Millard Fillmore, Children's Hospital, and the Erie County Medical Center. Wear is most often called to a hospital to resolve disputes between families, patients, and doctors on issues of clinical ethics such as informed consent. end-of-life decisions, and aggressiveness of treatment. Frequently, he says. the debates are caused by misunderstandings between doctors and families. He often clears up problems by simply helping physicians explain diseases and treatments, and by translat1ng "doctorese." Many of the issues around end-of-life decisions have already been charted out conceptually, says Wear, whose doctorate is in philosophy. What will hapSTEPHEN WEAR , PH . D . , ON MEDICAL ET HICS ) pen 1n the future, he predicts, is that doctors will do a better job of putting the theories there will be little need for bedside dispute resolution, Wear into practice by clearly informing patients about their disease, prognopredicts. However, new ethical questions are always cropping up. SIS, and choices. ·'One ofthe reasons people like me are around is that "We'll be going through a very ugly phase as issues of health care the profession has resisted internalizing these issues. financing are worked out," Wear believes. "We have to have this "A great deal of conceptual progress has been made in biomedicrisis because we have only so many resources to go around." cal eth1cs in the last 20 years," explains Wear. For example, at one Concern for cost may force insurers to limit treatment. Health point. refusing aggressive treatment was considered a suicidal act. maintenance organizations may prohibit doctors from prescribing Now, the concepts of informed consent and the right to refuse expensive dnugs or discussing effective treatments outside the treatment are widely accepted and have changed the terms of the network. ''I'm very nervous about that. My guess is, society w ill make debate. some poor choices along the way. I am hopeful that the right choices Wear says that institutions will probably be pressured to change will have been made in 50 years." as well. Hospitals now concentrate on trying to cure diseases, rather The emerging technologies of gene mapping and manipulation than on managing death. Each death is discussed in detail in hospitals' will raise new issues. The Human Genome Project, when completed, morbidity and mortality meetings. "Deaths have to be defended, could provide information about an individual's risk of illnessbecause there's always a suspicion that somebody m1ssed the boat. information that. in t he best case could be used to prevent disease, But 1n many cases, death is the only realistic outcome of a disease. or in the worst case to cut off insurance. Parents may get the power Why not focus the discussion on how the patient was treated, to select the qualities of their offspring. "It's a way of making choices whether pain was alleviated? Hospice has a lot to teach us," he says. regarding another individual," Wear cautions, "and whenever you As doctors and patients become better informed about ethical do that. you raise ethical questions." - J.A . questions of health care-and communicate better about them- c e u a a p h s c a s p n 9 9 9 �CONTINUED FROM PAGE 3 nance in resident and fellowship training. • The merger of the University at Buffalo with the SUNY system in 1962, of course, was the most significant event of these 150 years. The merger was traumatic but important, bringing an infusion of resources to make UB a major public institution. The period between 1962 and 1975 was characterized by confusion, instability, diminished institutional self-esteem, disillusionment, an uncertain direction, and little cohesion. The UB faculty had spent much effort in defining its dreams for a medical center comparable to those at Rochester, Stonybrook, and Syracuse, but found that those dreams were not shared in Albany. When the bubble burst, poor morale pervaded the school. This was reflected in critical accreditation reports in 1962, 1966, and 1972, a decline in academic productivity, and deterios v J OHN NA ration of the physical facilities. The situation improved in 1973 with the recruitment ofUB's first full-time vice president for health sciences, Dr. Fitzhugh Carter Pannill. I was recruited as UB's first full-time dean in 1975, and am forever grateful to Carter and to UB's president at that time, Dr. Robert Ketter, for offering me this exciting opportunity. Certain facts were apparent when I came: •UB and the community possessed a wealth of resources which included capable personnel, diverse hospitals, and a large population base. Those could provide the cohesiveness, ethos, and energy to develop a mature medical school. •Many of UB's best faculty had not received the national recognition they deserved. Now that UB's ability to compete with the best is established, this should never occur again. • Continued achievement of excellence required the acceptance that UB and the community were interdependent, and that meaningful programs were more likely to flourish through cooperation than competition. UB's medical school of 1996 is far different from thatof 1946. It has experienced five successful accreditation visits between 1976 and 1995. It has developed a core academic center with a world-class Health Science Library, magnificent educational facilities , a modem vivarium and biomedical research complex, and the schools of dental medicine, nursing and allied health professions. UB and its affiliated hospitals have defined both their individual missions and their shared ones. A strong volunteer faculty supplements UB's academic faculty. Most importantly, the medical school attracts academically competitive students, residents, and biomedical graduate students. Enough of the past and present. What of the next 150 years? In my opinion, the faculty, the university leadership, and the hospital and community leadership have positioned UB well for the future. For UB and all institutions of higher education, the new economy and social order will encourage sharing, collaboration, and interdisciplinary activity. There will be B a 0 p s increased emphasis on independent learning, increased use of technology, less classroom experience, and more attention to outcomes rather than to process and regimentation. Such change is already occurring at UB . Continued transformation will take another generation. But by building on past achievements and today's optimism, UB's medical school and its community partners will provide the best in education, health care and leadership. These assets will help us meet the challenges ahead: • The medical school has a core of educational and research facilities to sustain its mission well into the next century. • The new fiber optic network linking the campus and hospitals with other places in the state provides the infrastructure for distance learning, transmission of library information, and the continued development of the region's health system informaUGHTON , M . D . tion superhighway. • UB's biomedical research program generates more than $30 million annually. Together with a faculty practice plan that generates almost $80 million dollars a year and the complementary resources provided by New York State and the hospitals , the school will be able to educate physicians for the future. Two projects are planned in the next five years to help the school meet its obligations to its students andiacult.y: •The Comprehensive Health Education Center will be built in the old dental school building at the north end of Farber Hall. It is envisioned as an interdisciplinary center for community health education research, problem-based education, and the teaching of interview skills and physical diagnosis. The center will provide a modicum of patient care shared by the various health science faculties , and, we hope, a centralized autopsy facility coordinated among the teaching hospitals. •The second and third floors of historic Harriman Hall will become the locus of the medical school's administrative offices while its first floor continues to provide student support services. The building is connected to the Biomedical Research Building at the second floor level, uniting the South Campus health sciences core. As we celebrate UB's Sesquicentennial, there are many reasons for optimism. Future research, education and patient care will be interdisciplinary. Biomedical research will become more cooperative and collaborative. Education will be interdisciplinary, combined with more independent learning. Patient care will become more integrated and comprehensive. My dream for the year 2146 is that UB's leaders of the past, present, and future will meet in the great unknown to evaluate how each generation has remained faithful to the dreams of Millard Fillmore and UB's founders . Happy 150th B ir t h da y UB ! + c a n s p g 9 9 �\ ', - l HE UNIVERSITY AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES has a long and distinguished history-and you ore port of it_ In celebration of its Sesquicentennial, a beautifully illustrated pictorial history of the Medical School is available for your personal library or office_ This hardcover, 192-poge keepsake, Another Ero, contains 250 photos, including rare, historical photographs that will transport you to a time when___ Medical School tuition was $65 a year and "good board, with room, fuel and lights" could be found for $4_50 a week_ UB medical students were the first in the United States to witness a clinical demonstration of a live birth-which caused an outcry in newspapers nationwide! Retrace 150 years of achievement, trials and tribulations in this special limited volume, and toke pride in the Medical School's vision for its future_ To order Another Era by credit card call Wadsworth Publishing Company at 1-800-369-2646 exL 3339 $39_95 including shipping and handling. Gift cards available upon request. Charges will appear on your statement as Wadsworth Publishing. B u a 0 p y s c a n 5 p g 9 �• ······················································ I 9 0 3 5 ARTHURT . SKARIN ' 61 , ofNeedham,MA, E . GORMAN ' 36, of Hilton Head, SC, published the second edition of his Atlas of has been active at the Volunteers in Medicine Clinical Onco logy. Skarin is the chief of the Clinic on Hilton Head Island since 1993. The hematology laboratory and the medical di- FRED organization provides free medical service to rector of the thoracic oncology program at 6,000 to 8,000 people who have no other Dana-Farber Cancer Institute, and teaches at medical care. Harvard Medical School. The book is the first The State University of New York at Buffalo Department of Family Medicine is continuing to grow and expand. We are seeking BE/BC Family Practitioners to join us in varied urban and suburban settings throughout Buffalo and Western New York. The candidates we seek must have interest in OBI GYN and assume teaching responsibility for medical students and residents. Benefits include competitive salary, ample vacation, sick time, CME time, and licensure/board fees. If any of these opportunities sound of interest, your colleagues here at Family Medicine would welcome the chance to speak to you. of its kind to cover all aspects of oncologic 9 0 4 ALEXANDER GRINSTEIN '42 , tumors and malignancies. About half the 5 photos in the atlas come from Skarin's teach- of Beverly ing collection, gathered as part of his hobby Hills, MI, announces his most recent publi- of photography. Skarin's post-UB career be- cation, The Remarkable Beatrix Potter. His gan with a fellowship at Boston City Hospi- previous publications include Freud's Dreams, tal. Near the end of the Vietnam War, Skarin Freud at Crossroads, Conrad Ferdinand Meyer was drafted and spent two years in the U.S. and Freud, and Freud's Rules of Dream Inter- Air Force. After returning to Boston, he helped pretation. Alexander is president of the Dr. Sidney Farber develop a medical oncology Sigmund Freud archives. 9 program at the Children's Cancer Research 0 5 Foundation, which later became the Dana- 5 Farber Cancer Institute. Skarin says he some- of Dallas, TX, times reminisces about Buffalo with friend while chairman of psychiatry at the Univer- who is a daughter of longtime UB professor sity of Texas Southwestern Medical Center at Oliver P. Jones, Ph.D., M.D. KENNETH ALTSHULER ' 52 , Dallas, was named 1995 Professional of the E. of Delhi, NY, was Year by the Dallas Alliance for the Mentally JOHN Ill. The group honored Altshuler for helping selected a fellow of the American College of establish Mental Health Connections, a co- Physicians. He recently completed health- operative program ofUT Southwestern's De- care management training at the Kenan partment ofPsychiatry and the Dallas Mental Flagler School of Business, University of Health and Mental Retardation Center. North Carolina at Chapel Hill. SHIELDS '68, Altshuler, who holds the Stanton Sharp Dis- 9 tinguished Chair in Psychiatry at UT Southwestern, recently assumed the presidency of 7 0 JAMES J . MCCOY JR . '71 , 5 of Charleston, sc, is medical director of the Charleston the American BoardofPsychiatristsand Neurologists. Please contact Rebecca Brierley, Professional Affairs, Department of Family Medicine, 462 Grider Street, Buffalo, NY 14215 (716) 898-4797; Fax (716) 8984750. EOE/AA Surgery Center and a member of the Arthroscopy Association of North America, 9 6 0 5 and was recently installed as president of the of Waltham, MA, was South Carolina Orthopedic Association. He elected to the executive committee of the has seven children and soon will be a grandfather. HARRIS FAIGEL ' 60 , section on Ado lescent Health of the American Academy of Pediatrics and was appointed STEVE TUCKER '72 , chair of the finance committee of the Society of Anchorage, AK, is in solo practice in nephrology. He is gover- for Adolescent Medicine. His third grandchild (first grandson) arrived last June. His nor-elect of the ACP in Alaska and serves as wife, Frayda, is enrolled in the psychiatric director of the Alaska/Northern Alaska Kid- nursing track for a M.S.N. at Northeastern ney Center and chairman of the pharmacy University. and therapeutics committee. He has two We encourage the inquiries of women and minorities. adopted children, Jacob Ian, 5, who skates, B a 0 p h y s c a n s p n 9 9 9 6 �\ ......................................• II Ifyou thought ' you knew us... do J.OU know what's NE.W? ..;,~ ~ '<' skis, and plays soccer and hockey; jackie (5 1/2), Alex ( 4), and Eric and Alanna Elizabeth, 15 months. (19 months). JAMES P . o""e'( \ of BU R DICK '75, is the director of anesthesia ser- for an essay about lesbian battering entitled Strike One. Apractic- ban Hospital in Buffalo and a ing psychiatrist, she ha also pub- member of the board of directors and president-elect for the medi- lished features , es ays, fiction, and poetry in the U.S., Canada, cal staff of Millard Fillmore the United Kingdom, and Aus- Health System. He also serves on tralia. Her first book, a collection the board of the ew York State of interviews with female musi- Department of Health's Office of cians-including Marianne Professional Medical Conduct. Faithfull, joan Osborne, Laurie Lewis, and Grammy-winnerjanis of ment. He was also promoted to lieutenant colonel in the medical Ian-will be published this year. Post lives with her long-term partner, judith Avery, a psychiatric nurse. corps of the U.S. Air Force Re- 9 serves at Langley Air Force Base, where he serves as a gynecologist in the Women's Health Center. s 0 9 M ICHELLE SKRETNY SUSCO '91 , of Clifton, VA, is a board- certified pediatrician in a small of group practice in Manassas, VA. Washington, D.C. , has spent the She married joel Susco on Sept. 2, 1995. T ER EN C E CHORBA , '79 , past year helping improve disease surveillance systems in five OBITUARIES central Asian nations as a CDC epidemiologist in Kazakhstan. MARVIN N . W I NER , '39, of Sarasota, FL, died Dec. 27, 1995. Rooms .1vailahlc for UB Alumni Weekend October 4-6, 1996 9 Congrarularions to The University at Buffalo School ofMedicine & Biomedical Studies on celebrating I 50years ofteaching, healing and research! FromnNf-~ 8 0 S He was born in Buffalo, and after MAR K 5. B O R E R '80, of Dover, earni ng his M.D. , served three DE, was rated a "Top Doc" in the years in the U.S. Army Air Corps. state by 200 medical colleagues in the ovem ber 1995 issue of He practiced dermatology in Buf- Delaware Today. Mark is board- an instructor at UB. A Fellow of falo from 1946 to 1981 and was certified in psychiatry and child the American College of Physi- psychiatry. cians and of the American Medical Association, he was also a MARC BUFFALO~arrtoft 1340 Millersport Highway, Amherst, NY 14221 (716) 689-6900 or (800) 334-4040 At the Univers1ty at Buffalo Complex 0 STANLEY '78, of the Richmond Health Depart- • A first-class hotel with outstanding amenities, comforts and conveniences - centrally located at the University at Buffal o Complex. u L . Richmond, VA, is acting director And Your Choice To Stay In WNY! B CA, won first prize in the Ari- vices at Millard Fillmore Subur- COVIA ~ .("~ ~;:. ~ s~ of Oakland, zona Authors' Association ationa! Literary Contest in 1995 ;:.S· • 14,000 sq . ft. of flexible ~'b~~~ ~;:. . "/)~ e"\ meeung space on property ~ ~ 'o~;:. PLUS direct access to an -0-fJ ~~ ~0 additional 250,000 sq. ft. 'o~ 0~e;r. with state-of- the-art capabilities. ~ ~~~~~s~· s'~ .;;s' . and mnovauve . . • Super b catenng ~~s ~ 'o theme dinners PLUS expert ~\~ ~ 'b~o" planning assistance from -0-fJ ~~;:.';:. pre-event through closing. ~0 ~ LA U RA POS T '87, East Amherst, NY, is the president-elect of the ew York State Society of Anesthesiologists. He \ Oo ~~,o See Why ,:~'~~ ~;:.O~ e,C.\.~ \~ '( We're Your Ideal _,~~ s~~,,o<:'> ~~~~ . Fact·1·tty... \~ <i>'1~~s J. M eeung ~s ~o I 0 p h y J . K O B LICK '84, of Ormond Beach, FL, became a form er pre ident of the Central tales Dermatologic Society. He fellow of the American College was a member of the Landings of Surgeons. He and his wife, Racquet Club. He moved to Helene, have three children : Sarasota 10 years ago. He is sur- 0 n s p n g 9 9 6 �• •• • ••••••••••• • • • •• • • • HUR\VITZ & FINE, P.C. I I ATTO R NEYS AT LAW I THE ULTIMATE DRIVING MACHINE: S ERVICING THE L EGAL vived by his wife, Helen M.; his daughters, Beth Berenson of New York City, and Ellen N EEDS OF THE Litman of San Francisco; and four grandchildren. Memorial donations may be made to University of S. Florida Allergy Research, Account #25040, care of the Division of H EALTH S CIENCES COMMUNITY Allergy and Immunology, University of S. Florida College of Medicine, VA Hospital, 13000 Bruce B. Downs Blvd., Tampa, FL 33612. PAUL ROBERT MOYCE, • Managed Care • Purchase & Sale of Practices • Business & Tax Planning '70, of Mountain Checkpoint Foreign Car, Inc. View, CA, died peacefully Oct. 19, 1995 as the result of a severe head injury. He was surrounded by his loving family. Born in Buffalo, he graduated from the University of San Francisco in 1966. After earning his • HCFA Safe Harbor Regulations and Physician Self-Referrals Sales and Service • Contracts with Private • • Employee Relations & Public Entities M.D., he served in the U.S. Air Force as a flight surgeon. He was board-certified in anesthesia in 1977 and began his practice at Dominican Hospital in Santa Cruz. He vol- Counseling 487 Kenmore Avenue Buffalo, NY 14223 836-2033 unteered for the Santa Cruz Suicide Prevention program and Hospice. A growing interest in mental health led him to enter a residency in psychiatry at the University of California at Davis in Sacramento. He obtained his second board certification and began a private practice in psychiatry in Menlo Park, CA., in 1990. He enjoyed literature, travel, music, and the exploration of the spirit. An accomplished pianist and vocalist, he sang bass with the Cabrillo College • Fringe Benefit Programs • Representation Before Government Agencies on • Audit & Business Issues • Facility Finance Your WNY Leasing Specialist Serving WNY proudly for 33 years and Construction • Credentialing and By-Laws Slavonic Chorus and toured the Soviet Union with them in 1987. He is survived by his • Hospital/Medical Staff Issues wife, Kaki; his daughter, Audrey; and his son, Gregory, of Seattle, WA. Donations Please contact Robert P. Fine or Lawrence M. Ross at 716-849-8900 may be made to the Audrey Saxon Moyce Education Fund, care of David Moyce, trustee, P.O. Box 1883, El Grenada, CA 94018. We have more class notes than we could fit into this special issue. They will appear in the Summer 1996 issue.-The Editor 1300 Liberty Building Buffalo, New York ' j B a 0 p y 5 c o n s p g 9 9 6 �The jury is out. Your practice and assets are on the line. 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Bank fee + tax and hcense due at •nception. 12,000 annual mileage $12 per mtle m excess. · · a 5 p g 9 9 �.I • PLANTING A TREE UNDER WHICH You WILL NEVER SIT DR. DEVILLO W. HARRINGTON, class of 1871, knew how to make his money ' grow. In fact, this man who in 1905 provided $5,000 through his will for. the University at Buffalo School of Medicine, is still supporting UB today through the endowment his bequest created. THIS PERMANENT endowll)ent in Dr. Harrington's name has grown to over $300,000 and today it supports the famous Harrington Lecture Series, which twice a year brings distinguished scientific speakers to the School of Medicine and Biomedical Sciences. ) Uf he DR. HARRINGTON'S LEGACY to UB is just one of many bequests which have established permanent and important endowed funds at the school. They enable UB to prov1de scholarships to outstanding students, .ve At enhance scientific research, support excellence in teaching and meet the ever-changing needs of the scho,ol. YOU TOO can provide the School of Medicine with a measure of permanence through a bequest. Proper estate planning helps you deve I0 P a smart financ1al . plan. Acharitable bequest prov1des . the. sat1sfact1on . . that comes from PIantmg . a tree ere ure under which you will never sit, but which will bear fruit for generations to come. FOR ACONFIDENTIAL consultation on making a bequest to the UB School of Medicine and Biomedical Sciences, or to receive materials to share with your attorney or estate planning advisor, please contact: r STEPHEN A~EBSARY, JR. ~ - - - -- ~ Assistant Dean and Director of Development, School of Medicine and B1omedical Sciences UNIVERSITY AT BUFFALO (716) 829-2773 UNIVERSITY AT BUFFALO SCHOOL OF MEDICINE ISO YEARS •e•e · •••e a 0 'p h y 5 c o n 5 p n g 9 9 �·--- BUFFALO PHYSICIAN STATE UNIVERSITY OF NEW YORK AT"BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 ADDRESS CORRECTION REQUESTED -11 . .>.~.: l .,)TJ .!C ·- L Y .;TT L.i. .~ ><Y ,L, ... _ T ~ -- ~-- - Non-Profit Org. US Postage PAID Buffalo, NY Permit No. 311 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Spring 1996 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1996-Spring Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician and biomedical scientist Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v30n02-1996-Spring Table Of Contents A list of subunits of the resource. UB's Medical School at 150 The Founding of the University of Buffalo Buffalo's Unique Network of Teaching Hospitals Photo Essay: Life at the Medical School Continuing a Tradition or Excellence Medicine of the Future Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-12-20 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v30n02 Extent The size or duration of the resource. 64 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1996 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/334b5777f1ce947055f51673d3f1b7f0.pdf acc839f8ffcd24c4660cac3bc145a771 PDF Text Text State University of New York at Buffalo School of Medicine and Biomedical Sciences, Winter 1996 �BUFFALO PHYSIC I AN \olumc 30. '\umhcr I ASSOCIATE VICE PRESIDENT FOR UNIVERSITY SERVICES Dr Carole ~mnh Petro DIRECTOR OF PUBLICATIONS Timoth) j Conro\ INTERIM EDITOR judson \lead ART DIRECTOR \Ian j hcglcr ASSOCIATE ART DIRECTOR "'cott l:ri<.:kcr PRODUCTION MANAGER -\nn Raszmann Brown STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES Dr John '\:aughton \tee Pre>tdcnt for Clmical \[fat". Dean EDITORIAL BOARD Dr John \ Richert Chatrman Dr. \1artm Brecher Dr. Harold Brod\ Dr. Richard l Colltns Dr. Alan J Dnnnan Dr Timoth' Gabrwl Dr. James Kanskt · Dr. Charles \1a,;aro Dr. Charles Pagancllt Dr. Robert L. Rct>man Dr. Thomas Rosenthal Dr. Stephen ~pauldmg Dr Bradley T Truax Dear Alumni and Friends, N ineteen ninety-six has arrived; thanks to the dedication and hard work of the school's History CommiLLee, everything is in order to celebrate UB's and its medical school's sesquicentennial. The committee, chaired by Dr. Ronald Batt and Dr. Harold Brod) and ably assisted and supported by Dr. joyce Vana, has orchestrated a fine program of events. The initial opening activities will be held on February 22, 1996, when the newly completed Biomedical Research Building will be dedicated and the formerly undesignated Cary-Farber- herman Addition will be named the Biomedical Educatio n Building. These acth·ities will be conducted from 10:00 a.m. till noon. That afternoon, an academic convocation will be held in the elegant Austin Flint Reading Room of the Health Sciences Library. Thanks to the help of its director, Dr. Gary Byrd, and its excellent staff, the room will be available from 3:30 to 6:00p.m. The uNY Trustees and UB's president will confer an Honorary Doctor of Science degree on Dr. Saxon Graham, Professor Emeritus of Social and Preventive Medicine and the department's former chairman. This will be followed by a major Harrington Lecture by Dr. Steven A. Schroeder, president of the Robert Wood johnson Foundation. These activities are already complemented by the publication of the Medical Alumni Directory and by the publication of a special supplement in Business First dedicated to the medical school's sesquicentennial. In early April, the pictorial history compiled by all members of the History Committee and edited by Dr. Brody, Dr. Vana, and Dr. Richard Lee will be available for purchase. Thanks to the efforts of Ms. joyce Buchnowski, an im pressive flyer describing the book has been widely circulated. A series of other events are programmed throughout 1996 and up to mid-year 1997. We hope you will be able to participate in as many of the e,·ents as possible. \-tore important, all of us who have worked on preparing the sesquicentennial hope you will take the time to reflect on the significance of the school's past, its influence on you, and the pcomi>e' >nd '"P""'ibili''" 'h" will "~' <n ~"~ ' ....._, TEACHING HOSPITALS AND LIAISONS Batana \.\ \1edtcal Center Adem· Kclh The Buffalo (,cneral il<"pnal .\ ltdwd Slta" Buffalo \ .\ \1cdical Ccmcr The Children\ Hospnal of Buffalo Lric Count\ \1eclical Center \!ern Hospttal \1tllard Fillmore Hospnals fnmh Sma Roswell Park Cancer lnstnute '-,i~tCr"t or Charity llo~pital Dnuu~ \fc'Cwtln <0 The ~tate L 111\·crsll\. of :\cw York at Buffalo Bt4ffalo Ph\ \1(1<111 IS publtshcd quarterly b~ the State Lni\·cr..,it~· of :\e" York at Buffalo ~chool of \tcdtunc and Biomcdi<:al St:icnccs and the Office of PublicatiOns. It ts .,t.:nt free of charge. toalumm , facultY, students, re>tdents and fnends. The staff reserves the nghtto cdtt all COl" and ..,uhmi-,"otons at:ccptcd for puhliGttiOn . \ddrcss quc ... tions, comments and Eduor Bu(fcllo Ph)\icicm, State Lnin:-rsuy of '\"n, ... ubmission.., to : )ork at lluflalo . Unl\crstt\ Puhltcatll>t". I 3{> ( rofts llall,lluffal<i, '\c" York 1-+loO Send address thanges Ia: Buffalo Pin siw111. Ho (I~ \ddt! ton . 34 35 \lam ~treel. Buffalo. '\e" York 142 1-+ j ohn aughton, M. D. \!icc President for Clinical Affairs Dean, Sclwol of Medicine and Biomedical Sciences Dear Fellow Alumni: T he medical school's sesquicentennial celebration is well under way! We will keep you posted regarding the various e\'ents marking this historic m ilestone (there is a rou ndup on page 22). On February 22, 1996, we will ha\"C dedication ceremonies for the opening of the Biomedical Research Building and the designation of the CaryFarber-Sherman Addition as the Biomedical Education Building. In the ncar fu tu re, you wi ll be receiving a brief alumni sun-cy. The Board ofGo\'ernors tries hard to represent the alumni at large, but wedon'tgettosee many of you regularly, and we'd like to knO\\ what you're thinking. A variety of topics will be covered and we really hope that you'll find a few minutes to reply. If there arc any questions or topics you'd like covered in the survey, please let me kno\\. \Vhen I introduced Dr. 'laney Nielsen as a speaker at Spring Clinical Day in 1993, I was O\-cmhelmed by the list of her accomplishmenLs. Well, get ready for another line on her C.V. I Dr. :\!ielsen has been selected as this year·s recipient of the State University of New York at Buffalo's most prestigious alumni award, the Samuel P. Capen Award. Congratulations are also in order for Dr. james olan, who rcceml) retired as chairman of the Department of Medicine! Dr. "lolan will recci,·e the Walter P. Cooke Award, the university's award for notable and meritorious contributions to the uniYersity by a non-alumnus. I'm looking forward to seeing many of you at Spring Clinical Day in May. Warmest regards, ~... a. ~ . - ()a.JtJZX w. T ~sJt.,;. , MD Margaret W. Paroski, M. D. �V 0 w 3 L N T N 0 E R o 9 9 6 IJ Research II Hospital News II Treating Violence e ECMC's Trauma Center isn't finished working with the victims of violence when they are healed. The doctor's in. Page 26. m Sleep Without Rest e At the Sleep Disorder Center of Western ew York, patients may discover that what ails them during the day is the result of what they don' t know about their nights. Medical School · Then and Now , A Spoonful of Humor Alumni Treating violence with more than sutures. Page 6. 1 Classnotes *James ffiar~s. m.~. '?l ta~es t~e ~elm at What happens once you go to sleep? Poge 12. t~e ~~~~r~. rage{~. �weight-loss treatment programs showed that at 10 years, more than 20 percent of the children had maintained a 20 percent decrease in overweight, compared to fewer than 1 percent of the adults. "These results suggest that as a public health policy issue, it may be a better use of limited resources to focus on preventing obesity in children, instead of trying to reduce obesity after it is well established in adults," says lead researcher Leonard H. Epstein, professor of psychology, social and preventive medicine, and nutrition at the University at Buffalo. The study appeared in the September 1995 issue of Obesity Research. Epstein, who heads B's Behavioral Medicine Laboratory and has studied childhood obesity for more than 20 years, is now working with overweight children who participate in a four-month comprehensive, family-based weight-control program called the Stoplight Diet. The Stoplight Diet teaches children to ea t a nutritionally balanced diet by linking foods to the three signals on a traffic light: "red " high-calorie foods should be eaten rarely; "yellow" moderate-calorie foods can be ea ten in moderation; and "green" low-calo rie foods can be eaten freely. The program combines diet with exercise, behavior modification , and a maintenance program and is the only Dorn receives NIH "FIRST"grant treatment program in the country to document success in children over an extended period. In the current study, Epstein compared treatment results of children and parents from 113 families who had participated in behavioral weight-control programs conducted by his group. Children and parents in these programs were given similar diet, exercise, and behavior-change recommendations. At six months, about 40 percent of children and 20 percent of adults showed at least a 20 percent decrease in pounds overweight. While both children and parents regained weight after this initial drop, children's weight gain at five years stabilized at about 7 percent below baseline and remained there at10 years. But adults returned to their baseline weight by five years, and at10 years they weighed about 7 percent more than they did at the beginning of the study, results showed. Epstein cited several factors that could explain these results, including the nature of most adult treatment programs. "Typically, adults are treated by themselves, while children are treated within the family, which provides important support for habit changes and maintenance." Other reasons include the natural tendency of children to be more active, a difference in motivation in children and adults, children's fewer number of fat cells, and the fact that children's habits aren't as deeply ingrained. Epstein calls for more studies to replicate these findings and to better understand the mechanisms that may be responsible for the differences in effectiveness. The research was supported by grants from the ational Institutes ofHealth. + Leonard H. Epstein, Ph.D. (right}, meets with a CBS reporter. LOIS BAKER oan Dorn, Ph.D. , research instructor of social and preventive medicine at the University at Buffalo, has received a $350,000 five-year First Independent Research Support and Transition (FIRST) Award from the ational Institutes of Health. The FIRST award is given to new researchers to support their first independent research project and help them become competitive for traditional IH grants. Dorn's award is based on a research proposal to investigate the role of physical activity in disease prevention. he will conduct long-term follow-up and analysis of two epidemiological studies relating to this issue: a general population study conducted in Buffalo in the 1960s containing detailed health and lifestyle information collected from residents of that city; and a multi-center, randomized clinical trial conducted in Western ew York in the late 1970s as part of the ational Exercise and Heart Disease Project that was designed to study the effects of a regular, medically prescribed, supervised exercise program on the rehabilitation of survivors of a myocardial infarction. Dorn will determine the current status of all original participants and the cause of death of those who have died , and will analyze various health factors determined at one and three years and their relationship to long-term survival. + Kids better losers than parents he first study to compare weight loss and weight-loss maintenance in children and adults enrolled in the same treatment program ha shown that obese children take pounds off easier and keep them off longer than their obese parents. The follow-up study of participants in B 0 0 p h y o n w n e 9 9 6 �..•. .. . • . . . . . . . • . . . . . . . . . . . . . . . . . . . . • . . • . . . . • . . . . . . . . . • . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . • m . !lj , . ' . . '. Study points to new treatment for recurring UTis in women ings held even when several months tant professor of nuclear medicine and passed between recurrences. pharmacy, says about 10 percent of the "If our results are confirmed in fu- U.S. population experiences migraines , ture studies, they may have significant with women suffering the headaches n a study of 23 women with recur- therapeutic implicarent urinary tract infections , re- tions for women with searchers at the University at Buffalo recurrent UTis ," have found that most patients were Russo states. "Data being reinfected by the same strain from at least two preof E. coli bacteria that caused their vious treatment studinitial infection and not by different ies suggest that longstrains each time, as reponed previ- term remission can be ously. In addition , they found that the achieved with antimibacteria causing recurrences in most of crobials in some the women were harbored in the patient's women. We also own intestinal tract. know that certain anResults of the study were reported in tibiotics can eradicate the August 1995 issue of]ournal oflnfec- bacteria in the fecal tious Diseases. flora better than oth"These findings give us a new under- ers. Given these constanding of the mechanism of recurrent siderations, further urinary-tract infections," says Thomas data on the impact of A. Russo , M.D. , University at Buffalo different treatment Women suffer migraines three times more often than men. assistant professor of medicine and lead regimens on longinvestigator on the study. "It's possible term cure clearly are needed. " three times more often than men. that alternative approaches aimed at Migraines are thought to start with A specialist in infectious diseases , eradicating a persisting strain from the Russo began the research while with the a narrowing of blood vessels in the intestinal flora, and not just the urinary Bacterial Pathogenesis Unit of the NIH's brain , which decreases blood flow and tract , would result in a long-lasting, ational Institute of Allergy and Infec- can cause the flashes of light and dark permanent cure," Russo says. tious Disease. Also participating in the bar-like visual aura some migraine Urinary-tract infections in women ac- study were Ann Stapleton, M.D., Tho- sufferers experience, Bednarczyk says. count for an estimated 7 million office mas M. Hooton, M.D. , and Walter E. This vasoconstriction is thought to visits a year, at a cost of more than $1 Stamm, M.D. , of the UniversityofWash- be followed by a widening of the blood billion. About 20 percent of women ington-Seattle, and Suzanne Wenderoth vessels in the brain, or vasodilation , with an initial infection will develop of the ational Institutes of Health. + which causes the characteristic recurrences , some as many as 20 a year. pounding pain. B A K E R L 0 5 Previous studies concluded that o consistent relationship has been more than 75 percent of the recurestablished between migraine symptoms ring infections were caused by a new and cerebral blood flow , however , acstrain of bacteria from an outside cording to Bednarczyk. source. Using a genomic-analysis University at Buffalo researcher His study will attempt to show such a technique similar to D A fingerhas received a $114,000 two-year relationship by measuring cerebral blood printing unavailable to earlier regrant to study the mechanism flow at three intervals-during a headsearchers , Russo 's group found that underlying migraine headaches. ache episode, following treatment with 68 percent of recurring infections in The research is funded by the De- sumatriptan, and during a headachethe 23 young women were caused by partment of Defense, with funds free period-using positron emission the same strain of bacteria that made available through the Women's tomography, or PET scans, which are caused their first infection. The fig- Health Initiative. extremely sensitive and allow researchure was 76 percent among women Principal investigator Edward M. ers to monitor biological processes as with the most recurrences. The find- Bednarczyk, Pharm.D. , research assis- they occur. + Migraine study funded B a 0 p c a n w e 9 9 6 e �r r . : n · · · · · · · · · · · · · · · · ·· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · t!JJ UB dental school helps set up clinic for underserved children First pediatric heart transplant performed at Children's he School ofDental Medicine at UB is joining forces with Mercy Hospital and The Children's Hospital of Buffalo to establish a pediatric dental clinic expected to serve 4,0006,000 children who currently receive little or no dental care. The new clinic is expected to open in February in Mercy Hospital's Marian Professional Building. UB dentists project that they will serve 1,500 children covered by Medicaid the first year. "This project is a prime example of how a successful health consortium can work ," says Louis]. Goldberg, D.D.S. , Ph.D. , dean of the UB dental schooL The new pediatric dentistry clinic will be a six-chair expandable facility , managed jointly by the three participating institutions. The cost of the project (approximately $375,000, including equipment, computers, and furnishings) will be shared by the two hospitals. Dental students and residents will rotate through the clinic, with UB dental school faculty serving as attendings. Initially, only basic pediatric dentistry services will be offered; oral surgery and orthodontic services will be added as resources become available. "The Children's Hospital of Buffalo is very excited about the new partnership between Mercy , Children's, and the UB dental school," says Mary M. Ward, Ph. D. , vice president of clinical services at Children's Hospital. "O ur joint-venture pediatric dental clinic on the Mercy Hospital campus allows us to ensure that the children of our community have access to a pediatric dental network that is responsive to their unique needs. " Several other UB dental school outreach initiatives for underserved residents of Erie County and the Southern Tier are currently under way. + he Children's Hospital of Buffalo was designated the Upstate New York Regional Referral Center for Pediatric Heart and Lung Transplantation in june 1995 by the New York State Department of Health. Three months later, on September 27, CHOB successfully performed its first pediatric heart transplant. The patient , ten-week-old Evan Kentile , son of Mark and judy Kentile of Claysville, ew York (near Utica), was born in Syracuse on july 6 with a severe congenital cardiomyopathy. Immediately after birth he was transferred to CHOB's Level Ill eonatalintensive Care Unit, where his case was managed by neonatal and pediatric intensive care teams. Once his condition stabilized, he was approved for heart transplantation and his name was placed on the national organ donor list. A donor became available at The Children's Hospital of Buffalo on September 26. The heart was matched to Evan's specifications , and with the assistance of Upstate ew York Transplant Services, the donor's liver was sent to The Children's Hospital of Philadelphia for transplantation . Evan's heart transplant operation was -LUCY GARDNER CARSON performed by Eliot Rosenkranz , M.D., chief of the Division of Cardiovascular Surgery at The Children's Hospital ofBuffalo, with the assistance of orman Lewin , M.D. , a cardiothoracic surgeon from the Department of Surgery at Buffalo General Hospital. (T he transplantation program at Children's was developed in coopera- Eliot Rosenkranz, M.D., holds young transplant patient Evan Kentile. o L 0 B 5 8 A 0 K E 0 R p h o n tion with the adult-based transplant program at BGH .) "This initial transplant procedure demonstrated the benefit of having a transplant program at Children's Hospital equipped to deal with the most critically ill newborns, " says Rosenkranz. "This patient truly benefitted from the availability of all aspects of high-intensity care and teamwork that have been put together here ." Evan was discharged from The Children's Hospital of Buffalo on October 27. After remaining in the area for several weeks to allow for continued monitoring and regular follow-up examinations, he and his family returned home to Claysville. They visited Buffalo in December for a Christmas celebration at the Ronald McDonald House. "Evan is doing very well after receiving his new heart, and has not experienced any significant complications," Rosenkranz says. "His parents can now look forward to the opportunity to enjoy a long, healthy life together. " Before CHOB's designation as the Upstate ew York Regional Referral Center for Pediatric Heart and Lung Transplantation, such transplants in ew York State were primarily provided at adult healthcare systems in ew York City, or at out-ofarea pediatric medical centers in Boston, Pittsburgh, and Cleveland. + w n e 9 9 6 �······ · ············· · ···· · ···· · ··········· · · ·· · · ······························ · ········· · · [ i ] Western New York VA medical centers complete merger significant new partnership between the Veterans Affairs medical centers in Buffalo, Batavia, and Rochester became official in january, when the management structures of the three health care facilities completed their merger into one organizational unit. The Veterans Affairs medical centers are being integrated into a single healthcare system called the Department of Veterans Affairs Western ew York Healthcare System (YAW YHS) . Richard S. Droske, present director of the Veterans Affairs medical center in Buffalo, will serve as director of the new VAWNYHS. "Our goal is to make the best use of resources to give veterans the best health care possible," he says. Other goals of integration include providing a full continuum of care to patients, including primary care to every patient, expanded clinic hours, additional points of access for care, and decreased waiting times; better coordinating patient transfers and referrals; processing admissions in a more timely fashion; establishing one telephone number that veterans can call for care, information , and appointments; mak- B u 0 0 p ing patients' medical files available at any of the facilities in the integration; and reducing travel for veterans by transporting staff to provide specialized care at the facility closest to the veteran. The VAW YHS at Buffalo will continue to serve as the tertiary referral center for patients from throughout Upstate ew York and northern Pennsylvania, offering complete inpatient/ outpatient services and acute care. The VAW YHS at Batavia will specialize in comprehensive geriatric and long-term care, but will continue to offer limited outpatient and primary care services. Patients in need of acute care and hospitalization will be treated in Buffalo. Perhaps the greatest change will take place at the VAW YHS at Rochester, which presently consists of a small clinic in the downtown federal building whose space limitations preclude anything other than providing the most basic mental health and general medical outpatient services-to only 9 percent of Monroe County's 64,000 veterans. The Rochester outpatient clinic will soon be relocating to a new building dedicated solely to providing the area's veterans with more complete health care services. The goal of the VAW YHS at Rochester is to double its annual patient visits to 55,000 within the first year. Following national trends, all three medical centers (plus the VA's satellite center in Jamestown) will emphasize more ambulatory surgical procedures and outpatient care, and will expand the use of physician assistants and nurse 5 c 0 w practitioners whenever possible, in order to cut costs and streamline service. Cost savings realized through these measures, and through integrating the three medical centers into one management structure, will be reinvested into patient care and making more services accessible to more veterans. + - L UCY G A R D N ER CARSON Dawidson named transplantation services director at BGH he Buffalo General Hospital has named Ingemar Dawidson, M.D. , Ph.D., F.A.C.S., DirectorofTransplantation Services. Dawidson, whose clinical expertise is in kidney and pancreas transplantation and vascular access surgeries, earned his medical degree at the University of Gothenburg , in Gothenburg, Sweden. After completing his surgical residency at Sahlgren's Hospital in Gothenburg and his research fellowship in surgery at Tulane University, Dawidson underwent renal transplant training at the University of Gothenburg and earned his Ph.D. in surgical physiology at the University of Gothenburg Medical School. He then underwent liver transplant training at the University of ebraska Medical Center and pancreas transplant training at the University of Minnesota Medical Center. A prolific contributor to research and education (he has authored 123 abstracts and has been the selected speaker at more than 30 international lectures and symposia), Dawidson is a fellow in the American College of Surgeons, and a member of the American Society of Transplant Physicians, the American SocietyofTransplantSurgery, the American Council on Transplantation, and the Association of Academic Surgery. + n e 9 9 6 �BY JESSICA ANCKER Beepers sound in the corridors of Erie County Medical Center's trauma center. A paramedic is signaling to the doctors, nurses, and staff that his ambulance is bringing in a patient with stab wounds. Minutes later, the doors swing open and a young man is wheeled in, bleeding from scratches on his cheek and shoulder and from a third deceptively small spot in the left side of his chest. The two paramedics brief the doctors (" He says it was a six-inch knife"). The patient writhes and asks if he can get anything for the pain. "If we gave you something now, you'd just throw it up when you go into surgery," a resident says. PHOTOGRAPHY e u ffa lo BY Physic ROBERT 1 an WALION wInter 19 9 6 ��An unceasing thread of blood The program has its roots in the research of Simpkins, who found thatas he and other doctors had long suspected-assault victims were likely to come back to the hospital many times. "I kept noticing that I was operating on the same individuals," Simpkins says. His research in Washington , D.C. , and Baltimore found that 35 percent of the victims of violence in the emergency room had been to the hospital at least once before. Within five years , Simpkins found, 44 percent of these patients would return to the hospital after other violent episodes-and even worse, 20 percent would wind up dead. "I realized operating on them wasn't getting to the root of the problem," Simpkins says. In Buffalo , ECMC head of surgery Roger Seibel was noticing the same thing. During one two-year period, the number of gunshot wounds, stab wounds, and other violence injuries skyrocketed by 50 percent. Many patients were repeat victims. "It's a feeling of hopelessness just to patch them up and send them back out," Seibel says. >\T \1A~'t HO~PITAL':J , that would be the end of the Simpkins and Seibel teamed up with Karen Romano and story. But at Erie County Medical Center, it's where a new eville Francis to create the Violence and Victimization story begins. Prevention Program in March 1994. Before the patient leaves the hospital , social worker eville Their first step is to take advantage of the patient's pain Francis and surgeon Cuthbert Simpkins might come to chat. and confusion to urge him to rethink his life. And after the patient goes home, Francis will probably call to "The best time to intervene check in, and maybe suggest a is when that person is in the meeting. hospital ," Simpkins states . Those simple human con•PEOPI.£ T£ND TO B£ • "They've got a tube in their tacts are the beginning of the chest-that hurts. They've got hospital's aggressive follow-up a colostomy. They're scared. I for assault victims , called the try to make sure they're scared. Violence and Victimization PreI tell them 'You almost died ,' or vention Program. More than just 'You almost lost your leg."' stitching up wounds and set"People tend to be a little ting bones, ECMC's staff tries to more insightful when they realize they came close to dying," rescue patients from the kinds of violent lifestyles that could Francis agrees. "Coming close to death gives you a greater land them right back in the emergency room. "let's think of this as a demographic problem , rather appreciation for life. " They hope the pain and fear might be enough to make than something that just happens ," says Karen Romano , even the toughest young man or meekest woman wake up. ECMC's trauma nurse coordinator. winds down along his ribs as he is stripped, x-rayed , catheterized, questioned , reassured. An anesthesiologist takes the young man's hand and explains that the surgeons want to see if the knife has nicked his heart. "We're going to put you under and do what we call a pericardia! window, " she tells him. "How long will I be out' " he asks nervously. "It depends on what they find. More than likely it will be less than two hours, " she says. "But I'm asking your opinion," he insists. "lf there's something wrong, how long will it take? " She answers , "It's different for every person." He asks to make a call to his mother, and a young nurse takes the phone number and relays his message. An operating room is cleared, and the flock of doctors and nurses whisk the patient in. The operation finds no damage to the heart, and in a few hours he is stitched up and recovering from the anesthetic. 0 B u a 0 p h s a n w e 9 �If it does, they're ready to suggest help. For a drug dealer wounded in a street battle, that might mean substance abuse treatment, a trip to the welfare office, and job training. For a battered wife, it might mean shelter, and the emotional and legal assistance to help her get protection from her spouse. For many patients, it means help getting or keeping a job. "Unemployment is one of the risk factors for violence ," says Simpkins. That's when he began to lean on Francis for help in finding a new job , and sometimes just for comfort. "He's the best friend I have. Sometimes I feel like he's the only friend I have ,'' Truitt says. "He's got an understanding of me." With Truitt's good job history and six years of Army service, he was able to land another machining job. But after a few days , Truitt said, he couldn't handle the heavy pieces of steel with his weakened arm. His employer told him he could come back after his arm regained its strength, but when Truitt called after weeks of physical therapy, he found the job had been filled. ''I'm still looking, I don't give up. But it's tough. Whatever color you are ," says Truitt, who is black, "it's tough ." A natural optimist, Truitt will probably only need counseling and physical therapy to become one of eville Francis' success stories. But Francis deals with tougher cases every day, people who could spiral into poverty and end up as more grim statistics in ECMC's emergency room. The social worker's challenge is to find options for even the toughest cases: the young drug dealers who don't want to let down their macho street image, the battered women who are too scared to leave their spouses, the people who haven't held a steady job in years. Francis draws on his own varied experiences to connect with his clients. A native of Jamaica who emigrated to Toronto as a teenager , he worked in a factory for 12 years until the plant closed down and laid him off. "It was scary , and that's how I know how some of these people feel , " says Francis , a tall man who wears dreadlocks pulled into a ponytail above a casual jacket and tie . "I do identify with struggling people . I know the frustrations of being there. I know what it's like being on the outside looking in. " But he also knows that it's possible to take advantage of misfortune , a lesson he tries to impart to his clients. When he Bt.,FFA.LO RESIDE T GREG TRLITT was barely conscious under a turban of bandages when Francis first visited him. Two robbers had smashed his head with a board and grabbed his knapsack and wallet as he was walking home from a Fourth of July picnic. "I didn't even have any money in that wallet," says Truitt. At first, Truitt didn't think he had anything to talk to a social worker about. As soon as his head felt better, he was planning to go back to his good job, his girlfriend, and his two little children. But the next month, the manufacturing facility where Truitt had been doing lathe work went bankrupt. Also, Truitt realized his injury was worse than he had thought when he self-confidently checked out of the hospital against his doctor's advice. The head injury had left lasting nerve damage in his right arm and hand that robbed him of strength and made his hand clench up unexpectedly during work. He was also pursued by unexplained fears. "I was getting ready to cross the street and go between the cars, and I couldn't do it. My buddies were across the street, saying, 'Come on, man ,' and I just couldn't cross the street," recalls Truitt, a small, energetic 32-year-old who talks about his problems with a kind of exasperated wonder. "It's like being a kid all over again. Completely helpless." B u a 0 p h y 5 c a w e 9 �was laid off, Francis went to school, earning first a bachelor's degree and then a master's in social work from the University of Toronto. He conducted street workshops on AIDS and worked with the boys who accompanied their mothers to a battered women's shelter before joining ECMC in March 1995. Francis tries to approach every one of the 500 ECMC patients each year who are victims of violence, and tailor a unique approach for each. Some just need jobs, and the hospital's fledglingjob bank has provided housekeeping and cafeteria work at the hospital and at the University at Buffalo. But for someone who has been without work for a long time , job placement isn't enough. The social worker will talk about the responsibilities that work entails, such as showing up every day, and calling in sick rather than just staying home. Sometimes he even drives his clients to work. Francis recalls driving one client to her first day on a new job. She became very quiet in the car, and finally admitted that she was Cuthbert Simpkins. M.D. so nervous that she might never have made it alone. "We're talking about people doubting that they can live up to the experiences and responsibilities of working," Francis says. "But she ended up doing very well. " His job might also include visiting clients' homes and getting to know their families, visiting the welfare or unemployment office with them , or persuading an employer to hire someone with a prison record. lt also includes being patient. One man recovering from a drug-related shooting said he had no interest in talking to Franci . But two weeks later, he called and said, "What was that program you were talking about? " Francis was able to get him involved in drug rehabilitation , and hopes that he might be ready for a job soon. he tells how bigots bombed his family home when he was a child because his father was helping to register blacks to vote. Even before that horrific moment , which forced the family to leave their Louisiana hometown , he recalls that the library wouldn't let him in because he was black. These experiences , as well as his experiences with his patients, have helped convince him that American society is deeply violent. "There's a willingness at all levels of our society to use the tools of violence that are advantageous to them-whether it's the pen or the sword," he says. Middle-class families , he believes, are likely to express violence by sniping at their spouses, criticizing their children, or firing their employees. The poor tend to use guns, knives , and fists instead of just words , so they are more likely to land in the emergency room. Furthermore , Simpkins says, generations of oppression have forced disproportionate numbers of blacks into poverty and the violent lifestyles it can engender. As a first step to their overhaul of society, the staff of the violence prevention program created a videotape aimed at children. Filmed with the help of a local television station, the video traces four patients as they enter the emergency room, bloodied and battered; watches surgery in gory detail; and listens to the patients afterward as they talk about the violence and wish they had led different lives. Karen Romano and eville Francis, who take the film to the city's classrooms every week, say the patient that makes the biggest impression on kids is a young man who was crippled by a bullet and now must use a wheelchair. ln the long run, Simpkins wants the violence prevention program to launch the same type of peaceful revolution his father sought through voter registration. "l'd like to see the community organize itself. Register people to vote , take their fate in their own hands. Then l think we can see the community solve some of its own problems," he says quietly. "l don' t think we can really solve this problem until our entire country has a differ- r------------------------, THf C.RC\TORS OF THE \!OLE CL PRE\ E TIO program share a conviction that their work should be part of a greater overhaul of society. Simpkins, who is also black, doesn' t sound bitter when B 0 0 p h y s c o n w n e �FRANCIS TRIES • en t sense of interpersonal relations . I think we need a higher moral and ethical plane." eville Francis puts it more simply. "The problem is in the community, but the solution is also in the community." For now, the program's staff is taking it one patient at a time. "Let's say you get 400 patients who come in to the emergency room injured because of violence or a violent lifestyle. If you can getlO patients out of your 400 to change, that's something to start with," Karen Romano says. + Trauma Center - Life-saving teamwork The violence prevention program is just one example ofthe smoothly running support structure that underpins ECMC's trauma center. "We have a commitment from generalists and specialists to come in any time of the day or night to take care of trauma patients," says Karen Romano, the hospital's trauma nurse coordinator. The planning begins well before a patient is admitted. Paramedics or emergency medical technicians decide whether to bring a patient to ECMC based on state guidelines, including severity of injuries, extent of damage to the car in a car accident, and minutes away from the hospital. They then dial a number that reaches a network of beepers throughout ECMC. The beepers can display a simple message of what the injury is and how soon the patient will arrive. Incoming patients are brought to one of the trauma rooms, directly inside the emergency wing's doors. Each trauma room is equipped with portable x-rays and sonograms, lights, and surgical equipment. Once patients are diagnosed and stabilized, they con be sent to one of the operating rooms, intensive care units, radiology rooms, or other facilities clustered in the immediate area. Asurgical "pod," a corridor with nine small rooms branching off it, is available for patients whose injuries aren't as severe, and doctors in a similar medicol"pod" care for non-emergency illnesses. The emergency wing is designed to make it easy to get patients from one specialty area to another. Dr. Roger Seibel, who worked with the architects who built it, says it is being redesigned to make B u 0 0 p h s c movement even easier, and to add more space for outpatients and their families. The trauma system also provides services for recovering patients. Special outpatient rehabilitation areas provide such services as specialty dressings, water tub rehab, counseling, and occupational and physical therapy. Crucial to the center's work is its staff. All nurses have advanced training in trauma care and cardiac life-support. Residents receive onthe-job training from senior doctors, including many who have been in trauma care their entire careers. The staff evaluates cases in weekly and monthly morbidity and mortality meetings. Equally important, Karen Romano says, is the fact that they receive emotional support from one another. The ecstatic high of saving a life and the crushing disappointment of losing a patient create an atmosphere of both tension and camaraderie, she says. "It's very physically demanding and emotionally demanding to see, for instance, ayoung person permanently disabled," says Romano, who practiced critical care nursing before taking over as nurse coordinator. "It really does toke a special breed to practice in trauma." ECMC's 1,600 trauma patients come from all walks of life and have every conceivable injury and illness. The average age is 31 ; 75percent are men. While car accidents cause the greatest number of injuries (538 in 1994 ), assaults with guns, knives, fists, and other weapons come in a strong second with a total of 419. --::JA 0 w n e 9 9 6 �B u a a p h II 5 c a n w n e 9 9 6 �b y J u d s o n M e a THE HYPOTHETICAL truck driver, taking micro-naps at 65 miles per hour and headed for disaster, has thousands of very real counterparts on the road who are excessively sleepy because sleepdisordered breathing is waking them up hundreds of times every night-and they don't even know it. The ew England]ournal of Medicine editorial was prompted by publication in the same issue of findings from the largest population-based study of obstructive sleep apnea that had ever been conducted. Sleep studies of 602 employed men and women between the ages of 30 and 60 revealed that 4 percent of the women and 9 percent of the men in the group had a level of breathingrelated sleep disturbance that would warrant treatment. Edwin Manning, M.D., clinical professor of neurology and director of the Sleep Disorder Center of Western New York, says that sleep problems are still misdiagnosed or under-diagnosed, although awareness of them has increased greatly in the past 15 years. "There was a survey done at Stanford recently that found that in 1980 something like 80 percent of persons presenting a certain set of symptoms were diagnosed as depressed ," Manning says. "By 1985, physicians considered 50 percent of the persons presenting the same symptoms were depressed and 50 percent had some kind of sleep disorder. By 1990, it was recognized that only 5 percent of this population was actually depressed. " On a ovember afternoon, Manning explains obstructive sleep apnea in a small observation room as a technician monitors a patient sleeping in an adjacent bedroom. The patient is an overweight middle-aged man; the sleep study is run during the day because he is a shift worker. As far as the patient is concerned, he is asleep. But there are a number of signs that the sleep is not peaceful. The EEG readout crawling across the tee h n ician 's computer screen shows the tight amplitude of stage 2 sleep. His heart rate , audible from the EKG , is slowing noticeably; his blood oxygen level is dropping rapidly toward less than 70 per- d Anyone who sees a long-haul tractor-trailer driver nodding over the wheel as he barrels down the Interstate after ten years without a single restful night's sleep would call his situation , at the least, potentially catastrophic. But as Eliot Phillipson, M.D., pointed out in a 1993 editorial in the New England Journal of Medicine, "Ten to fifteen years ago, obstructive sleep apnea was considered to be a medical curiosity that was of little importance, and snoring was more a subject of humor than one of serious scientific curiosity. " Images B a 0 b y p h K . C . s K r a t t a w n e 9 6 �Sleep has an architecture that was only discovered beginning in the 1950s when a University of Chicago graduate student started running EEG tests on his eight-year-old son and found brain-wave activity that resembled a waking state during certain periods of sleep. These periods, coinciding with the eyes darting rapidly from side to side beneath closed lids, we now know are dreams; the sleep stage is REM, for rapid eye movement. The normal sleeper passes through four stages of increasingly deep non-REM sleep: stage 1 being a barely sleeping state of drowsiness, stage 4 being a profoundly deep sleep characterized by delta waves. During these four stages, the sleeper maintains muscle tone. After an hour to an hour and a half, the sleeper moves back to stage 2 and enters a first episode of REM sleep: brain activity increases dramatically; heart rate, respiration, and blood pressure all go up; but the muscular system is effectively paralyzed. As the night proceeds, the sleeper cycles through stages 2, 3, and 4 and REM sleep, with the lengths of REM sleep increasing while delta sleep decreases. Persons who suffer repeated arousals throughout the night never achieve stage The patient is in the sleep center cent. He is not breathing, but the instrumentation on his chest and abdomen because he reported to his physician that he is leepy all the time during record that he is trying to . Then a loud snort is broadcast into the day. Indeed , excessive daytime the observation room from a micro- sleepiness is one of the most comphone on the headboard. The EEG bursts mon presenting complaints related into activity, the heart rate shoots up to to sleep disorders. And such a com80, and the blood oxygen level begins to plaint is far from a triOing inconverise. The readout from a thermistor at- nience: a report prepared for the ational Commission on Sleep Distached under his nose shows that he is orders Research and published in breathing again. "He's awake now, but he doesn't know Sleep, in 1994, estimates that for the year 1988, the total cost of accidents it," Manning says. On the video monitor, the patient is lying on his side, head on an outstretched arm, his other hand tucked under his chin, apparently soun d asleep. Hi EEG quiet back to the relatively uneventful trail of stage 2 sleep. Then, after a few seconds, he stops breathing again. His heart rate and blood oxygen level start to drop. The cycle of arousal and return to sleep repea ts regularly about every 30 seconds. "His upper airway relaxes until it collapses completely after a few seconds of normal breathing. Then he tries unsuccessfully to breathe until the effort arouses him ," Man- Edwin Manning, M.D. ning says, watching another sudden related to sleepiness in the United burst of brain activity. "He may be States was between 43.1 billion and $56.02 billion. waking up 300 times a night. " "Wherefore to some, on being abed, they be taken to sleep, presently in arms and legs leapings and contractions of the tendons , and so great a restlessness and tossings of their members ensue that the diseased are no more able to sleep than if they were in a place of greatest tortu re. " B a a p h y 5 c a w n e 9 9 6 �"His upper a ir way relaxes until it collapses completely after a fe w seconds of normal breathing. Then he tries unsuccessful ly to brea t he until the effort arouses him, " Manning says, watching another sudden burst of brain activity. "He may be waking up 300 times a night. " 4 sleep. This deprivation is associated not only with sleepiness during the day, but also with diminished cognitive functioning and memory loss. "Obstructive sleep apnea is primarily a mechanical problem, so we use mechanical interventions to treat it, " Manning says. "Conservative treatment includes such things as weight loss, correcting posture, and smoking cessation. " A more aggressive intervention , for those who can tolerate it, is to splint the upper airway by the application of continuous positive airway pressure (CPAP) through a mask or nasal splint. A small com- Francis Gengo, Pharm.D. pressor is used to supply air at between 4 and 20 cc of pressure. located While such a device (which produces in the Dent eurologic Institute at the sensation of being slightly inflated) Millard Fillmore Hospital, runs approximight well bother a person not suffering mately 1,000 sleep studies a year, operobstructive sleep apnea, Manning says ating 24 hours a day with a technical that it can produce dramatic results for staff of eight. The center has four sleepsome of the patients he sees at the sleep ing rooms , outfitted with double beds and other furniture to be more homecenter. ''I've had patients who have been than hospital-like. Patients bring their chronically sleepy and lethargic for years own sleepwear. It is, naturally, a quiet wake up here after one night with CPAP work environment. For a typical overnight sleep study, intervention bursting with energy ," he says. "They tell me they've had their first the patient arrives in the evening, gives good night's sleep in years. " Surgery is a a brief history, changes into sleepwear, treatment option for a small group of and then is fitted with an array of electrodes on the scalp , beside each eye, and patients. The sleep center, B a 0 p s a n w on the chin, the chest, and both legs; a thermistor under the nose ; an oxymeter on one finger ; and belts around the chest and abdomen-these produce what is called a polysomnographic record. Although sleeping in a strange place and so thoroughly instrumented can cause what center technical director Thomas Maurer refers to as "first night effect, " getting patients to sleep is not a significant problem: after all, the reason most patients are there is that they are too sleepy . In the morning , patients complete a questionnaire that asks about such things as how long it took to get to sleep and the quality and duration of the night's sleep. "Some people have poor perception of their own sleep," Maurer says. "Some patients will report that it took two hours to get to sleep when the sleep study shows that it only took 10 minutes. " Technicians can monitor two studies simultaneously, watching data on a split computer screen and the sleepers on two video monitors. Data from a sleep study is scored later, with technicians paging through computer screens, each one of which shows 30 seconds of the study, to record arousals, oxygen levels , heart rate , and other pertinent condi- e 9 9 6 �"We ' r e one of j u s t a h and f u I of centers 1 n the co u ntry- and the on Iy one in New York-where the pharmacological studies look at both sleep a nd daytime effects , the real-world end-points of drugs that suppress the central nervous system, " Gengo says. tions; screens that show significant events can be printed out. The days of turning pages through thick sheaves of pen tracings ended when the center computerized its data management in 1992 after running both ystems in parallel for six months. ManningsaySthatsleepdis- (The sleep center has conducted clinical studies of the drug's effect on both sleep and next-day psychomotor performance-see box , facing page.) As for melatonin , which is enjoying a vogue as a sleep-inducer, Manning says that there is evidence that it has a role in directing the time relationships in sleep and that it can be of some help in controlling sleep problems related to jet lag orders fall into four broad categories: not being able to get to sleep or stay asleep, excessive daytime sleepiness, sleep-wake schedule disorders, and abnormal behavior and activity during sleep. Because everyone, at one time or another, has trouble falling asleep or staying asleep, a popular poll would probably name insomnia as the nation's number-one sleep problem. The aggre sive advertisement of overthe-counter sleep-inducing medications reinforces the belief. But the medical approach to insomnia is changing. "U ntil fairly recently, 15 percent of all prescriptions written were for Polysomnographic technician Pam sleeping pills," Manning says, "but Farina scores the digital record of a that's beginning to decline." sleep center patient's night. Manning, who lectures on sleep to first-year medical students at UB, tells them that 70 percent of insomnia prob- and other sleep phase disorders. But lems can be solved without medication Manning would discourage long-term by a regime of proper sleep hygiene. use of melatonin because its other acManning's first commandment for get- tivities in the body may interfere with ting to Jeep: "If you can't get to sleep, get reproduction and complicate heart disout of the bedroom." For transient ea e; another problem with the unreguinsomnias that need medication, Man- lated nostrum is that consumers can't ning favors the relatively new, rapid- be sure what they are buying. Excessive daytime sleepiness may be acting non-benzodiazepine zolpidem. 8 a 0 p h 5 a n w caused by various disturbances of a person's sleep, by chronic insufficient sleep, or by narcolepsy, the condition that causes a person to drop off to sleep suddenly during the day, sometimes directly into REM sleep; these episodes are often coincident with the experience of a strong emotion. A patient being tested for narcolepsy will spend a night at the sleep center for a regular sleep study, and then the following day undergo a Multiple Sleep Latency Test (MSLT) . This test consists of taking four or five 20-minute naps , two hours apart, to determine how quickly the patient goes to sleep and how quickly he or she moves into REM sleep. Achieving REM sleep during two of five naps indicates that the patient suffers from narcolepsy. The MSL T can show that a person is excessively sleepy-rapidly achieving stage 2 sleep in all four nap sessions but never REM sleep-indicating some factor other than narcolepsy. The abnormal behavior during sleep-or parasomnia-that Manning sees most frequently at the sleep center is sleep myoclonus, or periodic movements in sleep. In this disorder, the sleeper's legs jerk periodically during non-REM sleep, causing brief arousals from sleep and disturbing the normal sleep architecture by decreasing stage 4 sleep. The movements stop during REM sleep. Periodic movements in sleep are as- n e 9 9 6 l J �l 1 sociated in some cases with a condition called restless legs that particularly bedevils some persons before and during the onset of sleep. Manning likes to cite a description of the condition written in 1685 by the London physician Thomas Willis: "Wherefore to some, on being abed , they be taken themselves to sleep, presently in the arms and legs leapings and contractions of the tendons, and so great a restlessness and tossings of their members ensue that the diseased are no more able to sleep than if they were in a place of the greatest torture." Fortunately for its sufferers, the condition of restless legs responds to treatment with dopamine. The key to treating any of the many sleep disorders-from the sleep that won't come , to the sleep that gives no rest-is discovering that the problem exists. "There are many, many people suffering from sleep disorders who don't feel they can discuss them with their physicians, " Manning says. "People spend about one third of their lives asleep and for those who have problems with sleep there is often a remediable underlying cause. Physicians should be aware of sleep disorders and aware of the public health consquences of sleep disorders. " + Sleep Center Drug Research Cows mooing and dogs barking are not something one would expect to hear in the usually quiet corridor of the Sleep Disorder Center of Western New York. But they do occasionally disturb the center's morning peace as road hazards that test the alertness of volunteer subjects negotiating a virtual highway on a driving simulator. Gengo, who is the author of Drug Effects on Human In addition to diagnosing sleep disorders, the center maintains an active program of pharmacological research Functioning and numerous papers, has pioneered an ap- under the direction of Francis Gengo, Pharm.D. , associate proach to clinical studies that uses one drug as a marker professor in the departments of pharmacology and neurol- for evaluating another. Alcohol is an obvious marker for ogy and director of neuropharmacology at the Dent Neuro- comparative assessments of psychomotor impairment, logic Institute. Gengo's group is as interested in their and Genge's group has done extensive testing to establish subjects' waking state as in the contours of their sleep. the magnitude of effect of different blood alcohol levels. "We're one of just a handful of centers in the country- B "We can now say that the effects of a certain amount of and the only one in New York-where the ..,.....,.,..,._ benadryl are equivalent to the effects of a pharmacological studies look at both sleep certain amount of alcohol," he says. and daytime effects, the real-world end-points In current studies, Gengo is comparing the of drugs that suppress the central nervous effects of Zolpidem, Tamazepam, an over-the- system," Gengo says. counter antihistamine-based sleeping aid, and During sleep studies, Gengo 's research a placebo. Because the effects ofTamazepam group uses polysomnography to look at the have been fairly well studied, it serves as the effects of different drugs on such things as the time of sleep onset and the character of -·~------'- two nights, the first at home and the second in marker for Zolpidem. Subjects are treated for the ensuing sleep. In the morning, psychomotor tests the sleep center, and then undergo a battery of waking- reveal the subject's ability to think clearly and react state psychomotor tests. The over-the-counter sleep aid quickly. One such testing device is the driving simulator. causes the greatest morning-after impairment. Gengo has used it to establish baseline data that helps For studies of the effects of certain drugs not intended to to determine the relevance of psychomotor impairment. promote sleep--such as muscle relaxants or deconges- "There has been a lot of research that looked at the tants- Gengo' s group uses the Multiple Sleep Latency Test effect of a new drug against a placebo," Gengo says. "You (MSLT) and psychomotor assessments during a regime of find a statistical difference, but what is the functional scheduled naps for subjects taking regular doses of the significance or relevance of the difference?" medication (or placebo). u 0 0 p h s c a w n + e 9 9 �· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · [I] ~ ' tial for those types of resources to grow. We are considered a resource library, regionally and nationally, and we provide materials to other libraries for a fee. The fees actually cover the cost of those services and even generate a little bit of extra income that we can use to supplement other services and resources. "T he last initial impression I'd like to mention is the very strong support from the faculty community here on campus ....._....__ _ _ _....;..J From bound volumes to HUBNET GARY BYRD REFLECTS ON HIS FIRST YEAR AS DIRECTOR OF US'S HEALTH SCIENCES LIBRARY ary D. Byrd, director of the University at Buffalo's Health Sciences Library since january 1995 , came to Buffalo after nearly 12 years at the Health Sciences Library at the University of orth Carolina at Chapel Hill as Associate Director (198387) and Assistant Director for Finance, Planning, and Research (1987-94). He completed his doctorate in library science at that university in 1994. His first year at the helm ofUB's H L has confirmed his initial positive impressions. "First, this is a beautiful facility-it's one of the nicest facilities on the orth or outh Campus, in my estimation. This was the original Lockwood Library at the old private UB, and the main reading roomthe Austin Flint Reading Room-is a showplace for both campuses. "We have a very knowledgeable, service-oriented staff. They've gotten well-deserved service excellence awards from the university administration; they're well respected on campus and in the region and nationally , and that was one of the real attractions to me in this job-being able to work with such a highly motivated , competent staff. "Another obvious thing that impressed me right away was the information resources that have been gathered and made available under the heading of HUB ET [Hospital and University at Buffalo library resource ETwork]. B u a 0 p HUB ET is an array of bibliographic and full-text electronic information resources that have been gathered and made accessible over a wide-area network, so that health sciences faculty , students, and practitioners at the university and its affiliated teaching hospitals , as well as at other practice and teaching sites throughout Western ew York, can easily log on to this array of databases and search the medical literature-including full texts of many journals-and get an impressive amount of other information resources at their fingertips. This is a wonderful array of for this library, and the Friends of the information resources, and a model for Library organization that we have. Also, the way in which electronic inforI sensed in meetings with the deans , mation resources can and before l took this job, that they were also should be provided in very supportive of this library and that this kind of a setting. they were eager to support our resources "The gem of our and services. One demonstration of their collection is our commitment is that this year the deans History ofMedicine all agreed to help support the ongoing Collection, which I costs of the HUB NET system from their would call a worldown budget, as well as from the hospiclass history of tals' and the library budget, so that's a medicine collection. new source of support." It includes not only loByrd first became interested in inforcal medical history, but a mation resource management through very impressive assortment his work for Ship Hope in Tunisia in the of other historical materials illustrating late 1960s, when he was in the Peace the history of medicine and the health Corps. The mission of Ship Hope , a sciences. The School of Medicine is the volunteer project of American health oldest part of the university , and the professionals who refitted a World War sesquicentennial will be drawing pretty ll vessel as a floating hospital , was to significantly from those collections. dock at ports of developing countries "I was also impressed by the potenfor nine months to a year at a time, tial to strengthen resources in the seroffering modern medical services and vices despite budget constraints. Some training for local doctors. Byrd credits of our services actually generate income his experience as a volunteer assisting that helps us support those and other the ship's chief of staff with inspiring services, and I think we have the potenhim to pursue a fellowship in biomedi- h 5 c a n w e 9 6 �··················· · ······ · ············ · · · ·· · ······ · ·········· · ··· · ················· · ··· · · ~. ~ I future , we may not have a separate circulation department, for instance. We may be providing reference services in new locations and in different ways, and providing an increased array of reference services , such as more in-depth consulting." Byrd hopes to make better use of limited resources by restructuring the HSL and granting greater flexibility to the staff. He praises the experience and HSL director Gary Byrd in the library's Austin Flint Reading Room. dedication of not cal library science at the University of only the library's faculty and profesMinnesota in Minneapolis. sional employees but also the support One of Byrd's first projects upon ar- staff and clerical workers, and he pledges riving at UB was to work with his staff to to use these most valuable human recreate a vision statement of the long- sources more effectively: "We've got term goals and guiding principles of the many people with many years of service HSL. He would like to see the library to the university and to this library, and become more flexible and better able to my feeling is that we need to find ways respond to the health information needs to use their energy and creativity, and of both local and remote users. give them opportunities to use their "This library has had a fairly tradi- skills in new ways." tional organizational structure," he says, Byrd notes that the evolution of per"with public service units and technical sonal computers and the Internet has services units-cataloging, acquisitions , changed the way information resources and management of all our serial collec- are managed. "An increasing number of tions. ow we're in the process of re- our resources are available electronistructuring, somewhat. We're consoli- cally from computer terminals all over dating our technical services units into a campus, and at remote sites in our affilisingle collection management services ated hospitals and practice sites all over unit, and we're looking at possible new Western ew York, and even from models for organizing our public service people's homes. We have an increasing units and consolidating the way in which need for telephone support for remote we provide services from all of our public users. We need to use staff more flexibly service points-the places where the in ways that will allow them to go out public can approach the staff and ask for and work directly with users in their help or information, such as the circula- offices, or in their labs, or in classrooms. tion desk, or the reference desk. In the We need to strengthen the library's in- B u a a p h y 5 c a w I ternal computer and telecommunications infrastructure and its links to campus, regional, and worldwide electronic information networks. "The library is organized in many ways like an academic department: We have library faculty as well as professional and support staff. Our library faculty not only provide reference and other services, but they help instruct students, faculty, and staff on the effective use of information resources. And not only do we provide classes that we teach here in the library, but our faculty also go out and serve as guest lecturers and instructors in courses that are taught by other faculty. "I personally think there will be an increasing need in the future for courses that are actually taught by library faculty as part of the regular university curriculum. In some areas of the health sciences, especially, courses may really be needed on how best to manage information resources; how to use appropriate computer hardware and software to manage information, to browse the Internet, to use library resources, to understand the concept of effective search strategies, to understand how to use controlled vocabularies or Boolian logic or other strategies that make for effective use of the literature. "We still have a ways to go to strengthen and build on the resources that we have, but I think that we've gotten a strong commitment from everyone to work together to help make that possible. We don't have any magic bullets. I think the ammunition that we do have is our ability to demonstrate the value of the resources and services that we provide to the community, and then work collaboratively with the other parts of the university and with our affiliated hospitals to pull together the resources to turn those things into reality." + -LUCY e GARDNER CARSON 9 �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [1] ~ I BARANSKI ADVERTISING Your advertising presents your company image to the public ... and to prospective clients and cu tamers. At Baranski Advertising, we are proud to represent some of the finest publication in Western ew York, publications where your advertising message is sure to reach a quality audience. Medical students enjoy new lounge tudents in the School of Medicine and Biomedical Sciences have a new place to prop up their feet, thanks to the generosity of the Medical Alumni Association. Over the past two years the alumni group has donated approximately $4,000 to refurbish a former conference room in Cary Hall, which recently was outfitted with couches and a coffee table; a conference table; electronic equipment, including a television and VCR, a photocopier, and a microwave; a foosball table; and artwork. The purpose was to make the free time medical students have at lunch and between classes more CALL US TODAY enjoyable, according to Neha Sangwan, president of Medical School Polity. (716) 645·6933 "We wanted a little more of a social place than a study area. We wanted to get students to start to interact and to get to know people in different years, and to give them something to do," she said. "We greatly appreciate all the efforts and support of MICHAEL J. BARANSKI the Medical Alumni Association because it's helped to Marketing Representative bridge the gap between the first· and second·year students. This has provided a really comfortable P.S. We did this book! B u a atmosphere so we can get to know each other." 0 p y c a w e + 9 6 �················· · ································ · ·····································• ·· ~ •• ::» Percent and number of graduates from 1989-91 entering primary-care specialties-45th and 23rd, respectively; first among SU Y medical schools. (UB's total graduates for the three years, at 4 3 7, is larger than that of 70 percent of U.S. medical schools, a factor which lowers its percentage ranking compared "All medical schools share the broad to schools with fewer graduates. Also, and essential missions of education, re- the rankings in this category do not search, and patient care," Cohen said. reflect the success of the medical school's "However, within this context, individual Primary Care Initiative, begun in 1990, schools have different priorities and goals. which has raised the percentage of UB Because of this, a single ranking of medi- graduates entering primary care from cal schools is inappropriate and mislead- an average of 28 percent for 1989-91 to ing. The Institutional Goals Ranking 40 percent for the class of 1995. [In the Report is designed to provide medical AAMC survey, schools with 40 percent schools and the public with several scales of their 1989-91 graduates entering primary-care specialties by which they can mark ranked 5th.]) an institution's achievements in various areas." ::» Percent and numUB received its highest ber of 1995 graduates marks in the category of planning to practice inpercent and number of state-58th and 42nd, 1981-90 graduates who respectively; fourth are faculty, ranking 14th among SU Y schools in and 18th, respectively. percent, second in numAmongSU Yschools, UB bers. ranked first in percentage ::» Federal research and second in numbers. grants and contracts in aughton said UB's 1993-94-67th overall; second among SUNY high ranking in this category reflects the emphaschools. sis the school's faculty John P. Naughton, M.D. Naughton noted that places on teaching and education in its UB's listing doesn't include research fundbasic-science and clinical-training pro- ing administered by its affiliated cancer grams. research center, Roswell Park Cancer "Our graduates learn that as faculty Institute. Research funds attributable to members, they can play an important UB faculty working at Roswell Park torole in guiding the future of students taled $21,771,842. If these funds had and residents, can influence the future been included with those administered of medicine, and can enrich their per- directly by SU Y, UB's ranking would sonal and professional lives," he said. have been 36th instead of 67th. UB's rankings in the remaining cataughton said the report, prepared egories were: since 1990 but released to the public for ::»Percent and number of thefirsttimeinl995, isusefulforgaugunderrepresented minority graduates ing the medical school's progress in during 1990-94-27th and 23rd, re- important areas and for judging its perspectively; second in both listings among formance in comparison to medical SU Y schools. schools of similar size and scope. + UB ranks high as contributor to medical school faculties he University at Buffalo School of Medicine and Biomedical Sciences received high marks from the Association of American Medical Colleges (AAMC) in its 1995 Institutional Goals Ranking Report, released in late December. UB received its highest ranking14th among the nation's 125 U.S. medical schools-in the category of percent of graduates who are on the faculty of a medical school. UB was one of only two public universities in the top 15. In the remaining categories, UB placed in the top fifth to the top half in all listings but one, and was first or second among the State University of ew York's four medical centers in all listings but one. john P. aughton, M.D., UB vice president for clinical affairs and dean of the medical school, said he was very gratified by the results of the report. "These rankings indicate we have been able to achieve a successful balance between academic excellence and clinical relevance ," he noted. The AAM C report assessed the success of the nation's medical schools in meeting five goals considered important in today's medical climate: graduates entering primary-care specialties; graduates planning to practice in-state; graduates who are medical-school faculty; graduates who are underrepresented minorities; and total research grants and contracts. jordanj. Cohen, M.D., AAMC president, said the report is not intended to determine which medical school is "best," but should be used by medical schools and the public to evaluate these institutions in selected categories. B u a 0 p h y c a n w n e 9 6 �. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . .. . . . . [1] t, I sociation of the History of Medicine in Buffalo in honor of the medical school sesquicentennial (May 9-12 , 1996) >- Bestowal of honorary degrees at commencement in 1996 and 1997 >- Symposium on Epidemiology and Preventive Medicine (September 20-21 , Exhibits to highlight medical school's sesquicentennial year 1996) three-day national symposium on Ethics and Values in Medicine, the national meeting of the American Association of the History of Medicine, and a special opera performance will highlight the celebration of the 150th birthday of the University at Buffalo School of Medicine and Biomedical Sciences. Founded in 1846, the medical school was the first component of what is now the niversityatBuffalo, which is marking its sesquicentennial during an 18month period in 1996 and 1997. A 24-member commiuee composed of physicians, historians , archivists, scientists, and representatives from UB's teaching hospitals has spent the past three years planning special events to commemorate the medical school's century-and-a-half record of excellence in education, research, and service. Ronald E. Ball, M.D., clinical associate professor of gynecology and obstetrics, and Harold Brody, M.D., Ph.D., SU Y Distinguished Teaching Professor in the Department of Anatomy and Cell Biology, co-chair the committee. joyce Vana , Ph.D., clinical assistant professor of social and preventive medicine, serves as its coordinator and liaison to the dean of the medical school. For residents of Western ew York, the most visible sign of the medical school's sesquicentennial celebration will appear in january 1996, when 50 blue-and-gold commemorative banners will be installed along Main Street and Bailey Avenue on UB's South Campus, home of the medical school. The celebration will begin officially on February 22 , 1996-University Day-with the dedication of the medical chool's new $33 million biomedical research building, the awarding of an honorary degree, and the presentation of the 1996 D.W. Harrington Lecture. Events planned for 1996 and 1997 include: >- Publication of a pictorial history of the medical school (February 1996) >- ational symposium on Ethics and Values in Medicine (November 1416, 1996) >- One-day scientific colloquium and bestowal of an honorary degree (February 1997) >- Special performance by the Greater Buffalo Opera Company (Februwy 1997) >- Special exhibits at the Buffalo and Erie County Historical Society and the medical school's affiliated teaching hospitals + "How We Die"Author to Deliver Stockton-Kimball Lecture in May Dr. Sherwin B. Nuland, the author of National Book Award winner How We Die, will deliver the annual Stockton·Kimball Lecture at Spring Clinical Day on May 11. The tiNe of his talk will be "Death, the Doctor, and Hope." Nuland earned his M.D. from Yale University in 1955 and trained at Yale in general, cardiothoracic, and cardiovascular sur· >-Mounting of memorial plaques marking the three original medical school buildings in downtown Buffalo (May gery. Anoted speaker on medical topics, he has also written monographs on historical figures in medicine, such as Hippocrates and Napoleon's surgeon, Dominique Jean Larrey. In his 1994 book, How We Die: Reflections on Life's Final Chapter, he discusses haw modern doctors too 1996) often try desperately to save life, abandoning an >ational meeting of the American As- older mission to help people die with dignity. Sesqui(entennial banners now festoon the medi(al S(hool (ampus. a u 0 0 p y 5 c o n w e 9 9 �······································ ~ ~ I UB medical faculty appointed to national panels l 59th Annual Spring Clinical Day Cedric M. Smith, M.D., professor of pharmacology and toxi- Saturday, May 11, 1996 Buffalo Marriott cology at the University at Buffalo, has been appointed to a five-year term on the Expert Advisory Panel on Drug Information Science of the United States Pharmacopeia (USP) . The USP, founded in 1820, is a non-profit organization responsible for establishing public standards of strength, quality, purity, packaging, and labeling for drugs, medicines, and other healthcare devices and services. The standards are published in the USP- ational Formulary and are enforced by the U.S. Food and Drug Administration. The Expert Advisory Panel on Drug Information Science will be concerned primarily with expanding the USP drug and therapeutic-information database, which recently combined with the AMA Drug Evaluations database. Germaine Buck, Ph.D., associate professor of social and preventive medicine at the University at Buffalo, has been appointed to a three-year term on the ational Research Council's ( RC) Committee on Toxicology. The Committee on Toxicology, a component of the RC's Commission on Life Sciences, provides expert advice to government agencies on a broad spectrum of toxicologic issues and problems. Buck has won national recognition for her epidemiologic research in human reproduction and fetal and early-childhood health. + Medical Alumni Association State University of ew Yorh at Buffalo Continuing Medical Education End of Life/Quality of Death Death and the dying process hove traditionally been ignored by the treatment· and technologyoriented medical profession. Medical schools hove only recently begun to offer any curriculum in palliative medicine or death and dying. For many physicians the death of opatient is seen as opersonal failure. As oresult, dying patients and their families ohen feel shunned by and distanced from the physician at this critical moment. The advent of odvonced-<ore directives and heolthcore proxies has mode issues of dying o necessary topic for discussion between physician and patient. The objective of this conference is to help physicians become more comfortable with death and thereby be better equipped to help patients and their families through the dying process. Participants will be exposed to the basic concepts of palliative medicine, learn about end· of·life core resources in Western New York, and discover strategies for easing the transition from curative to palliative core. Principal Presentations "Dying Healed-The Nature of Care at the End of Life" Robert A. Milch, M.D. '68 "Delivering Bad News with Compassion and Hope" Judith Skretny, M.A. "Confronting Difficulr Emotional and Ethical Issues in the Care of the Dying" (panel discussion with case presentations) Martin Brecher, M.D. , )ach P. Freer, M.D., Ross G. Hewitt, M.D., Robert A. Milch, M.D. "Death, the Doctor, and Hope" Stockton-Kimball Memorial Lecture Sherwin, uland, M.D., F.A.C.S., author of How We Die The 1996 Spring Clinical Day will begin with registration at 7:30a.m. and welcoming remarks at 8:00 and conclude with the annual Medical Alumni Luncheon at noon, followed by the Stockton·Kimboll Memorial Lecture. UB chemistry professor Philip Coppens (right)was honored by the HauptmanWoodward Medical Research Institute with its first David Harker Award for outstanding contributions to the field of crystallography. Coppens received the prize at the dinner commemorating the 1Oth anniversary of the awarding of the Nobel Prize to Herbert Hauptman (left), institute president and UB research professor of computer science. B u a a p 5 The Accreditation Counci l for Continuing Medical Education designates this program for up to 4 hours of Catcgor) I credit toward the Physician's Recognition Award of the American Medical Association. This program has been reviewed and is acceptable for 4 prescribed hours by the American Academy of Family Physicians. a w n e 9 9 6 �Afriend called him "idealistic in apractical way" DR. ROSWELL PARK WAS A PIONEERING CANCER RESEARCHER AND " LIVING ENCYCLOPEDIA" WHOSE LEGACY LIVES ON IN TWO GREAT LAKES CITIES country, and was led by a well-known and well-respected his many achievements, founding the world's medical faculty. Park also relished the challenge of establishfirst cancer research institute in Buffalo in 1898 ing himself in a new city-and he was challenged. A piece is the one for which Dr. Roswell Park is probably published in the Buffalo Medicaljoumal commented on the best remembered. Rechristened the Roswell Park acquisition of Park by the university, questioning why a Memorial Institute in 1946 and known today as Buffalonian couldn't be found to fill the vacancy: "We fail to the Roswell Park Cancer Institute , this vital research and educational center was born out of Park's ascertain , after repeated inquiries in surgical circles, that the conviction that the increasing incidence of cancer around new appointee brings to this responsible position any ex tenthe turn of the century called for more immediate and sive experience or reputation. " It wasn't long, however, constant attention. Although the severity of his claims was before Park's indisputable character and aptitude won over the disgruntled columnist and the two achieved a friendly originally contested, he even went so far as to predict in 1904 that cancer deaths would one day outnumber deaths from relationship. tuberculosis. Park's concern about the increase of cancer In 1891, Rush Medical College tried to recapture Park by cases was as humane as it was scientific: He realized offering him the post of chairmanship of surgery-a that both professional and public attitudes toward tempting invitation that would have been an errorcancer patients during the nineteenth century mous promotion for Park. But a local group of were harsh, primitive, and counterproductive to influential medical professionals and public infinding a cure for the disease. dividuals coordinated a campaign to convince Park to stay in Buffalo, countering the Chicago Roswell Park was born in 1852 in Pomfret, offer with an offer of its own: Would Park be Connecticut, into the ninth generation of a prominent family that had arrived in America interested in a third building for the medical on the Mayflower (and had entered England school, on High Street, to be constructed to Park's specifications? Yes , Park would. with William the Conqueror). The first generation of Parks to venture from the East Coast, Park worked diligently and, aided by his many government and professional contacts, Roswell's family relocated to the Midwest when his father founded Racine College in Racine , Wislaunched an ambitious campaign to secure canconsin. After completing his B.A. and M.A. lr-=o=--R-= R-o_s _w_ E_L_L---:P:-A - R- K --,1 cer-research funding. In 1898, he and Edward degrees at Racine , Roswell Park earned his H. Butler Sr. , publisher of the Buffalo Evening M.D. at orthwestern University in 1876. After three years ews, won the world's first public-fund appropriation for cancer study. This 7,500 from the ew York State legislaas adjunct professor of anatomy at his alma mater, Park left to pursue his medical studies in Germany, France, and ture helped establish the ew York State Pathological LaboAustria. Indicative of his growing reputation , he was apratory of the University of Buffalo, the first lab in the world pointed lecturer of surgery at Chicago's Rush Medical Coldevoted exclusively to the full-time study of cancer. Within lege and an attending surgeon at Chicago's Michael Reese two years , the three small rooms the medical school had Hospital while still in Europe. Park did soon move to designated for laboratory use could no longer meet the Chicago, and it was there that he began what was to be a long demands of Park's research. Public donations and private and successful medical career in two Great Lakes cities. giving from Mrs. William Gratwick made it possible for land In 1883 Park left Chicago for the medical department at to be purchased for construction of the Gratwick Research the niversity of Buffalo, where he became professor of Laboratory at the University of Buffalo. Completed in 1901, surgery and later joined the new dentistry department. He it was , this time, the first lab in the world to be built and also worked as a surgeon at the Buffalo General Hospital. equipped solely for cancer research. Several things about the niversity of Buffalo appealed to Although by 1904 a ew York State grant annually Park: It had one of the oldest and best medical schools in the allotted the lab 15,000 for maintenance, it was not a state B a a p y a n w n e 9 6 �sidered among his most influential publications are the facility; that is , until19ll-thanks to the concerted efforts Mutter Lectures on Surgery, given in Philadelphia; the Lecof Park, along with the support of government officials and tures on Surgical Pathology; the Epitome of the History of the public. It was renamed the ew York State Institute for Medicine; Surgery by American Authors; and the Practice of the Study of Malignant Diseases, a title it retained until1946, Surgery, deemed when it was reby many his finest named after its iniwork. As a musitiator. cian , he was reFor thirty-one ported to be highly years until his skilled; he prideath, Park served vately published as a UB professor his musical pieces of surgery and Bufin a collection he falo General modestly titled A Hospital's chief Little Music. surgeon. Both inIt is not surprisstitutions would ing that one of feel Park's influPark's admirers ence for another called him a "livthirty-one years ing encyclopedia. " after his demise, as "When others each was led by his sought rest in novformer students. elty, gaiety, and Park's medical change," the friend expertise and reexplained , "Park assuring profescould be found sionalism earned Roswell Park (lacing the camera) operates before medical students and faculty, c. 1895-98. storing his splenhim the presidid mind with dency of the American Surgical Society, as well as American fresh material. " membership in the International Congress of Surgeons. As one ofBuffalo's most trusted and well-known surgeons, Park Rarely did Park slow down, even was appointed medical director of the Pan-American ExpoFrom its meoger three-room beginning in 1898, the as he got older sition of 1901, held in the city, and he was among the team Roswell Pork Concer Institute today spans twenty-five and intermitof physicians who attempted without success to save the life acres in downtown Buffalo, maintains osatellite tentlyill. Uncharof assassinated President William McKinley. acteristically, he research facility in Springville, New York, ond includes Park's achievements in medicine alone would guarantee made plans to go him a place among Buffalo's most successful citizens; howamong its fifteen buildings in Buffalo o 218-bed away and simply ever, he did not rest at the borders of his own profession. As hospital. The institute is currently undergoing o $241 relax in 1914, but a dedicated member ofUB's University Council, Park fought million renovation ond modernization of its facilities, died two days for the expansion of the university into the arts and sciences, slated to be completed in 1998, its centennial year. later on February prompting one colleague to describe him as "idealistic in a Cancer survival rates hove increased dramatically 15-almost cerpractical way. " His desire to be involved in creating a comfrom Pork's day, when being diagnosed with cancer tainly of heart plete university led to the establishment of the College of was virtually equivalent to odeath sentence. Only one failure-emArts and Sciences shortly before his death-and his son Dr. in five people survived the disease in the 1930s, one bodying perhaps julian Park would become its first dean, a position he would in four in the 1940s, and one in three oscore later. his favorite and hold for forty years. In men's social circles, Park was called Equally impressive is the fact that survival rates for often-quoted a "notorious mixer"; he held the presidencies of both the aphorism: "The those stricken with leukemia tripled between 19 50 Buffalo Club and the Liberal Club. As a scholar, he wrote 167 future reserves textbooks , articles , and monographs dealing not only with and 19 60- thanks, in no small port, to the for us repose medicine, but also with thanatology, student life in the early pioneering efforts of Dr. Roswell Pork. enough. " + Middle Ages, and sixteenth-century Italian philosophy. Con- Roswell Park'sButfalo Legacy s 0 0 p h 5 c o n w e 6 �A ,, Spoon f u I of Humor© gotten sick and they've called out over the P .A. for a doctor. There I am, resting comfortably in the middle seat with my knees in my eyes (I believe they call it the "chiropractor position"), when I hear the announcement: "If there is a doctor ACTUALLY , THE FIRST TIME I ANSWERED A CALL FOR on board, please make yourself known HELP , THIS PAST SUMMER , IT WAS A S ICK CHILD to the flight attendant." My first thought is, maybe they are looking for a date, or they have an Amway 111•111 his summer I made the deci- (Stamford, to be exact, but I still prefer on the side and are looking to business sion to move from the prom- to think of it as the ew York Metro ised land (California) to the area). Things are different here: obody bring doctors fleeing managed care into homeland ( ew York Metro has a sense of humor. For instance, the their group. The scary thing is, at this area). Perhaps it was the trickle- woman at the rental agency's name was point I might even be interested-espedown effect of managed care. I Anita Head. When I laughingly asked if cially if I begin as a Double-Diamond believe I reached my low point that was her real name, she retorted, Attending. Sometimes I am reluctant to respond when I was moonlighting in an occupa- "What's so funny about that?" I thought to these mid-air announcements. What tional medicine clinic (despite my train- to myself, "You not only need a head , if it's a situation I can't handle? This ing in pediatrics) and examining an but you need a sense of humor. " When I moved back East I needed to time, however, I literally jumped at the employee of Federal Express. The patient, a graduate student in finance , was fly one way, and there was only one opportunity, since l was trapped in the explaining the wonderful benefits pack- airline that would sell a one-way ticket. middle seat between two guys named Barry who were taking turns age offered to Fed Ex employpicking their teeth while disees who work as few as 20 cussing their favorite episode hours a week-a benefits of the Carney Wilson talk package that includes free I CHOSE THE SAME AIRLINE WHEN show ("Good-Samaritan Docflights to anywhere they fly. RETURNED TO CALIFORNIA FOR tors Who Get Sued While The only catch, he noted, i Helping Transsexual Patients that you have to be willing to VACATION DURING CHRISTMAS BREAK , with Kleinfelters"). You can sit in the "jump seat." ow, ON A " MANAGED-CARE VISA" (YOU see why I welcomed this opI'm not even sure what a jump portunity to get up and seat is, but I figure any seat KNOW , JUST ONE HOUR AND NOT A "work. " Anything to escape that includes the word the "dueling teethpickers." "jump" sounds like it has MINUTE LONGER ). Another reason l am usumore room than the average ally reluctant to get up and coach cage-! mean seat. assist in these situations is, I I even went so far as to jot down the name of the person in charge I don't want to name the airline, but let am a pediatrician. It's not very often that of personnel at FedEx (I still have her me just say it sounds like "terror air" kids get sick on planes, although l have number, in ca e l ever decide to move and leave it at that. lt is also the only considered supplementing my income back to California). Then it occurred to airline that has no frequent-flyer pro- by offering an impromptu pharmacy me that I may be overqualified: After all, gram (probably because it doesn't have service specializing in Benadryl and other I've written a book, and I am a pediatri- any frequent flyers-except me, that benign sedatives for children in the back cian ... maybe I could specialize in lift- is). I chose the same airline when l of the plane (I could make a killing on ing crates filled with children's books? returned to California for vacation dur- flights to Orlando and Anaheim). Actually, the first time I answered a As I said, that wa the low point. o ing Christmas break, on a "managedcall for help, this past summer, it was a care visa" (you know, just one hour and now l find myself in Connecticut, in the child-one who had had corrective sick middle of the "Blizzard of '96"-not not a minute longer). surgery for cyanotic heart disease two For some reason, every time l have unlike the Blizzard of '77 in Buffalo ('nuff said). I am living in Connecticut flown this airline (twice) someone has years earlier. A little oxygen did the ...adoctor on board?" B u a 0 p h y 5 c a n w n e 9 9 6 �Stu S i Ivers t e in, trick, and I was an instant hero. The second time it was a very un-pediatric problem: a 38-year-old with tingling and numbness down his arms and legs. He was only a couple of years older than me, so 1 knew there was no way he could in the back, I had to prove I was a doctor. Like somebody is going to try to take on that responsibility just to impress people: "Stand back! 1 am a doctor ... okay, I have a Ph.D. in political science, but you did ask for a doctor. " be suffering from a stroke or heart attack (could he?!). I quickly asked the usual questions: What did you eat? Do you have a past medical history? Taking any meds' (Are you a lawyer?) ow, believe it or not, before they would even let me touch this guy or open up the bag of equipment they keep As soon as I got over there and identified myself as an M.D., you could see the guy felt better right away, which just goes to show the importance of touch in medicine-and let's face it: touch is about all you can do on a plane. There is no CBC, no enzymes to measure, and no pulse oximeter. The guy's blood pressure B u a 0 p y 5 c a w M.D. and vitals were stable, and he improved with a little reassurance, so I concluded that he was most likely suffering from hypoxia coupled with flu symptoms. But just to be on the safe side, I decided to radio an internist on the ground, which meant that I got to take a trip to the cockpit. When I got there the pilot, co-pilot, and flight engineer all turned around to talk to me-and I'm thinking, "Who the hell is flying the plane?!" Automatic pilot or no automatic pilot, I want to tell you it is unnerving in the extreme to see these guys all looking backward while the plane is moving forwardkind of like riding in a ewYork City cab and having the driver climb into the back seat to chat while the car is going down Fifth Avenue at 45 miles an hour. (Come to think of it, that's probably not so unusual, ew York City cabbies being what they are.) Anyway, the pilot gave me his card (first time that's happened to me) and promised he would put in a word for me so I could get a free flight. So wouldn't you know it? I'm headed back to the East Coast from California (trip number three on "Terror Air"), minding my own business, and I hear that call for help on the P.A. again. This time it's a 33-year-old woman who has fainted in the back of the plane. I get up to answer the call to duty and the flight attendant says, " ot you again," which is precisely what I was thinking. So now I am three for three. Well, by now I am even ready to consider working for this airline instead of Federal Express, provided the benefits package is better. In these days of economic uncertainty, you have to find work wherever you can- even on cross-country flights. + Stu Silverstein, M.D., president of Standup Medicine Seminars of Son Francisco, California, and Stamford, Connecticut, lectures nationwide on humor in medicine. e 9 6 �~ -················································· · ······ · ·················· · ··········· lEI Promoting prevention at the CDC JAMES MARKS '73 IS THE NEW DIRECTOR OF THE NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION same pragmatic approach to the agency's long list of target issues: eeing one patient at a time isn't enough for James S. cancer, diabetes, heart disease, adolescent behavior, nutrition, Marks, M.D. '73: He prefers to take them in batches of physical exercise, community health, oral health, teen pregnancy, hundreds of thousands. family planning, reproductive health, infant mortality, and smokMarks is the new director of the ational Center for ing. Some current projects include monitoring mammogram rates, Chronic Disease Prevention and Health Promotion, a expanding state cancer registries , and helping redesign principal unit of the federal Centers for Disease Control school health curricula to emphasize prevention. The agency also and Prevention. puts out several hundred publications a year, including its famous "People don't realize that chronic disease causes 70 perSurgeon General's Report on Tobacco, an annual summary of cent of the deaths in the United States and 60 percent of the research on smoking and health. healthcare costs. We're having trouble paying for it already. "Our responsibility is to see that the findings of research That means either we are going to have to curtail care, or we'll about prevention are disseminated widely so that people have to reduce the incidence of these problems through know what to do to avoid chronic disease," Marks says. prevention. And we believe prevention is the only humane That entails distributing most of the agency's $400 milsolution," Marks says. lion budget in grants to state health departments , universiMarks was appointed director of the 550-person agency ties, schools, and other organizations to fund education, by CDCP Director David Satcher in June 1995, but long monitoring, and research programs. before that he had made a name for himself as an outspoken Marks grew up in Alden , near Buffalo, and majored in advocate of preventive health. His numerous publications psychology as an undergraduate at Williams College in include editorials for the journal of the American Medical Massachusetts. He earned his M.D. from UB in 1973 (where Association in which he applies science to social problems his father, Eugene, had earned his M.D. in 1946), and to come up with non-ideological, although not necessarily completed his internship and resinon-controversial, solutions. dency in pediatrics at the UniverIn a 1985 JAMA commentary, " THAT' S WHEN HABITS BEGIN , IN sity of California at San Francisco, he recommended creating a desigADOLESCENCE . WE' VE GOT TO SHOW where he also worked in a Planned nation called "fetal tobacco synTHEM THAT GOOD HEALTH HABITS Parenthood Teen Clinic. drome" to call attention to the "I realized while I was pracARE TO THEIR OWN BENEFIT , AND well-known correlations between ticing in San Francisco that the smoking and low birth weight and THAT THEY' RE NOT JUST problems I was seeing were pregnancy complications. An ediACCEPTABLE , BUT COOL. " broader problems than just the torial in 1987 advocated commuclinical ones," he says. Dispensnity-based sex education that ing antibiotics and vaccinations did nothing to remedy the would teach teens not only how to say "no " to sex-but also poor nutrition , teen motherhood, and other societal probhow to protect themselves if they said "yes." lems he saw day after day. "l got interested in the broader "Sexual messages pervade our lives-at home, in schools, community issues. " in media, in shopping centers, on airplanes , and even in He was hired by the Centers for Disease Control as an physicians' offices," began another JAMA editorial urging Epidemic Intelligence Service Officer in Ohio. On his universal sex education. His next sentence no doubt surfirst day at work, he was sent to Pennsylvania to help prised readers expecting disapproval of our sex-obsessed investigate what would become known as Legionnaires' society: "Rightly so, since being sexual is part of being Disease. "It was tremendously exciting, my first day on human." the job! " Marks remembers. He also investigated outAs head of the preventive health agency, Marks is applying the B a 0 p h y s c a w e 9 6 �························································································ ra~ . • breaks of measles and diarrhea , as well as complications from the swine flu vaccine, and was sent to Hawaii to monitor an outbreak of German measles in adults. With a growing conviction of the importance of epidemiology and public health, Marks left the CDC to earn a master's d eg re e in public health from Yale University, winning a Robert Wood Johnson Clinical Scholars fellowship. Toward the end of his studies, Marks served James Marks, M.D. '73, on the Centers for Disease Control and Prevention campus near Atlanta, Georgia. six months as "It's the leading cause of preventable mortality in this Connecticut's acting state epidemiologist. He also returned country," he says. "The tobacco companies have to deny to pediatric practice. "I just wasn't sure l wanted to stop what science is most clear on-the links between toseeing patients," he remembers. bacco and cancer and heart disease-every time we Marks rejoined the CDC in 1981. Since then, he has held publish the Surgeon General's Report on Tobacco. They a number of science policy appointments in various departhave to have 3,000 children start smoking every day ments, including the Birth Defects Branch and the utrition because 400,000 of their best customers die each year Division of the Epidemiology and Research Branch. Most and 600,000 quit." recently, he served for four years as the director of the However, the same issue has provided the most encourDivision of Reproductive Health, a subunit of the agency he aging example of the success of public health education, currently heads. Marks also teaches at Emory University he says. School of Public Health and has served as a consultant to the "When the Surgeon General's Report of 1964 came out, World Bank and the World Health Organization. which was the first to publicly state the risk of smoking, One of his goals for his agency in the coming years is to try nearly 50 percent of the adult population was smoking. Now harder to reach adolescents with the messages of preventive it's down to the low 20s. That's an incredible change and an health. "That's when habits begin, in adolescence. We've got incredible success." to show them that good health habits are to their own benefit, Marks, 47, lives in Atlanta with his wife, Judy (a 1968 and that they're not just acceptable, but cool." graduate of UB, where she was named "Outstanding FreshHe also hopes to begin attacking Americans' sedentary man Woman" and served as president of the Honor Society), way of life by promoting physical exercise, and to continue and his 16-year-old son, Adam. His 19-year-old daughter, to monitor the health problems of the uninsured. "We are the Amy, is at college, where she is tentatively pre-med. Alonly industrialized country that doesn't cover our entire though he has enjoyed living in Atlanta for many years, population. When we're designing programs for HMOs and Marks retains fond memories of his alma mater. insurers , we can't lose sight of the fact that they don't cover "l still miss the snow and the Bills," he says. + 20 percent of the population." One topic that never fails to get Marks' juices flowing is E 5 5 c A A N K J c E R tobacco. B u a a p h 5 c a n w e 9 9 6 �• ······························ · ······························· ·· · · · ·· ············ · ········ I BERNARD 5 . STELL '36 , of un City, Arizona, had l l slides-ofhis30 acceptedexhibited in imernational stereo photography exhibitions in 1994. 1 9 5 s 0 MORTON A . STENCH EVER '56, of Merler Island, Washington, continues to teach and practice after resigning as chair of the niversit)' ofWashingwn's DepanmenL of Obstetrics and Gynecology, a position he held for 19 years. He also serves as associate editor of Obstetrics and Gy necolog} , and has coauthored Comprehensive Gynecology and authored three books. He serves as treasurer of the American Board of Obstetrics and Thomas March '31 (arrow} at the 1966 reunion. Gynecology, and is a member of the OB/ GY 1 9 3 s 0 Residem Review Commiuee. He won the 1995 Wyeth/Association of Professional Gynecology and Obstetrics Annual Recog- THOMAS A . MARCH '31 , of Tacoma, Washington, writes: "As an ancient alumnus of the medical school class of '31, I am perplexed at the silence of other alumni from the class of'31. Perhaps it is because they feel 'too old.' nition Award. He and his wife, Diane, recently celebrated their fortieth wedding anniversary, and enjoy their three children and four grandchildren. 1 "A slwrt biography is perhaps indicated at this point: 9 WILLI AM "After internship at Toledo Hospital (Ohio), I attempted general practice in 6 s 0 E. ABRAMSON '60, of Baltimore, Maryland, teaches aCME course on substance-abuse education for primary care physicians at Maryland-area hospitals, four different locations in ew York State during the Depression of the '30s. sponsored by the state medical society. He "Economics forced me to tahe a staff appointment at Harlem Valley State Hospital. Before I knew it I became eligible for Psychiatric Boards, after continues his private psychiatry and addiction medicine practice at Sheppard PraLL Hospital in Townson, Maryland. I R V I N G 5 . KOLIN '61 , ofWinterPark, postgraduate courses at Columbia University. Florida, appeared as a guest of Ted David on "After service overseas in the Army Air Force in 1942 (as a Lieutenant Colonel; I resigned in 1945), I joined the staff of a VA Hospital. I became a recent edition of C BC-TV's Money/inc LO discuss the economic costs of substanceabuse disorders. The program was televised nationally. Hospital Director in VA, then continued in Veterans Administration as a J OH N J . LAMAR JR . '63, of Salem, director in two different locations. I retired in 1973 and had a private ew jersey, is happy to announce that he neuropsychiatric practice for about a year. will be retiring in 1996. His youngest daughter, Danine M. LaMar, who married Glendon "And now I am enjoying complete rest and retirement." grade at Quinton Elementary School. Lodge in 1994, will be teaching the third a a 0 p h y s c a n w n e 9 9 6 �...................................................... . .......... Orange, Connecticut, coedited with Hal ange County Medical Society. He and his wife, Colleen Mulligan (B.S.N . '79 , B. Jenson and 50 contributors a 1,600- D'Youville) , are raising their two "big boys": page text this summer entitled Pediatric Todd , 8 , and Trevor, 3. ROBERT 5 . BALTIMORE '68, of SURF THE NET! INTERNET SOFTWARE Many Titles!! Infectious Diseases: Principles and Practice, PABLO RODRiGUEZ '81 , ofWarwick, published by Appleton and Lauge. He is professor of pediatrics and epidemiology at Yale University School of Medicine, where his E-mail address PC Anywhere Rhode Island, has been appointed associate chief of OB/GY DOS ... $67 Windo"s... $69 at Women and Infants • .\merica Online ~lac & \Yindows...$11.-49 • Internet Starter Kit \Vindo\\s...$3-'.49 \lac...$3-'.95 • Prodig_' \lac & \\ indo\\s...$15.95 • '\etscapc :\a,·igator for\\ indows...$32 Hospital, the teaching hospital of Brown is University in Providence, Rhode Island. He baltimorrs®maspo3. mas. yale.ed u. has two children: Rafi, 6 , and Kika, -1-. 1 9 7 s 0 ROSLYN '86 , of ROMANOWSKI SUSAN A. BARDE '76, of Dayton, Snyder, Ohio, who is in private practice in allergy, Western wrote in to announce that her husband, Millard Fillmore Ho pita!. She returned to Christopher A. Barde '76, is chief of medi- the area in 199-t, and assumed her latest ew York, is thrilled to be back in ew York doing heme/one at cine at the Dayton VA Medical Center and position after working one year at Buffalo chair of gastroenterology at Wright State General Hospital. Can 't connect from home ll'ithout one' INTERNAL STARTING AT $84.95 EXTERNAL STARTING AT $94.95 niversity. They have two sons: Christian, ANNA KRISTINA ELISE HART '89, 13, and Andrew, ll. of Portsmouth, Virginia, has completed a 1 9 8 second tour of duty as flight surgeon in the s 0 Florida, is chief of the Department of Plastic cared for four squadrons and was head of Surgery at Florida Hospital in Orlando and a legislative committee member of the Or- UNIVERSITY AT BUFFALO S C HOOL OF M EDI C INE 150 I SO 1846 Y E - A RS 19 9 ManY Brands! • Supra • US Robotics • Boca Modems • Practical Peripheral • Global Villiage nited States avy, most recently at AS Whidbey Island, Washington, where she WALTER SIEMIAN '80,ofWindermere, CONTINUED ON PAGE 32 BOOKS 20% off Retail 150 Years of Medical School History Using the Internet............. $15 The User-Friendly Reference Easy Internet. ............... $18.95 Using the Internet............. $29 Special Second Edition INTERNET WORKSHOP In celebration of its sesquicentennial year, the School of Medicine and 6 Biomedical Sciences has published a 192-page history chronicling its accom- Learn How to Use the Internet! plishments and its everyday life over the past century and a half. 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Fri 1/am-Spm. ned & Thurs /lam-6pm C Order your copy today for delivery in March 1996. •r rrt n an r awlul'" Pnl'•• ·hJtltooiuo,f(l'"lll t 11<•tll' To place credit orders, call Walsworth Publishing Company at 1-800-369-2646, ext. 3339 A non-profit Umversity program for students faculty & staff The Commons • North Campus • (716) 645-3554 • Fox: 645-3884 6 u a 0 p h y 5 a w n e 9 6 �• ·························································· Why dtay home for the holidayd? I J e nni fe r (Broman) Moman, who is practicing pediatrics in Beaver, Pennsylvania, and is happily married to Dr. Moe Moman, a dentist. STEVEN P. HARRIS '91 ,ofPittsburgh, Pennsylvania, and his wife, jane, announce the birth oftheirson teven Phillip Jr., born September 1, 1995. The front-wheel drive lnfiniti®130"' MICHELLE PI ETZAK '92 , of Los An- ing her residency at Children's Hospital of Eln int~rt;>r 11/0t'l' ,•pact;>u,• than a Rolf,, Rove~ Si!..o· 5purlll. An ~.\-ceptulttal~v.tJm~mu,• o/ ,•tandard lu.rw:v f~atur~.•. 1! /90-hp 1'6 mpaM~ o/out-acal~ratti'.tJ many !u.\·w:v Jl<l:•. Elntl o/ <'tl/11".'~• th~ ,•tantlartl-,•ettin.tJ Los Angeles. Currently, she is in the first p~tj;>rlllilll<'~ anti ,•~r<'lt"e geles, California, married a fellow pediatrician, Derek Wong, in june 1995 after finish- year of a fellowship in gastroenterology at the niversity of outhern California. it;,, t>/ ln!i'niti. S.J 79 mo. -12 IIIli. lea.•e SO£11111'11 OBITUARY DONALD HALL '41 , of Buffalo, died Michelle Pietzak ' 92 january 7, 1996, after a brief illne s. He was a past presidentofthe Medical School Alumni the Aviation Medicine Department at the Association. After service in the Army during World War !I and residency at Buffalo hospital. During her two years at Whidbey Island, she spent much of the time traveling General Hospital and The Children's Hospi- and participating in training exercises both tal of Buffalo, Dr. Hall entered private prac- in the area and as far away as the East Coast. tice in obstetric and gynecology. He was an he attained the distinction of being the first assistant clinical profe sor at the medical female assigned to two aircraft carriers, and Achievement Medals for her accomplish- Blood Services and the Deaconess Center of Buffalo General Ho pita! Family Planning. Pro_qram. cine, working with several area medical or- ments while on her assignment. She reports ganizations, including American Red Cross that she mi se the days of nying while a night surgeon, but is enjoying being a resident in the world's largest and busiest naval 9 9 s 0 MICHELLE SKRETNY SUSCO '91 , Correction of Clifton, Virginia, is a board-certified pediatrician practicing in a four-pediatrician ELLEN GIAMPOLI '90 AND group practice in Manassas, Virginia, after CRAIG NARINS '90 were wed in completing three years of residency training Tarrytown, ewYork,onjune 10,1995. at Children's National Medical Center in Readers of the Autumn 1995 issue who Washington, D.C. She and her hu band , arc friends of the couple have noted joel, a CPA, who married in cptcmbcr 1995, will be living in their new home in The editors regret their error. ~.\·t~n.•il'~ a a -12 1110. !ea,•e SO tiown I N F I N IT I AUTOPLACE INFINITI 8129 MAIN ST., WILLIAMSVILLE 633-9585 East of Transit Rd., Near Eastern Hills Mall that we mi identified Dr. Giampoli. G20 42 mo. '130 42 mo. lease W<th cash or trade eqUity dawn. (G20-$495) (130-$450). Bank fee + tax and license due almcepbon. 12,000 annual m<leage. $.12 Clifton. Susco also provided an update on a an S2 79 IIIli. hospital. 1 Lit..-~ ~"ay !t~/i'nitl·, th~ (;]{!com~, , "•ith li.•t o/ ,•tandarti /u.\'111"1/ f~atur~.•: a -l-ymr/60,0£/0 mil~ Ba,•ic x~:,. l '~hic/~ ll'~u·ranty; 2-1- hour Roal/,,itl~ JJ.,,,[,•tana Pro_qram Trtp Interruption B~n~fi't,•; and our Fra Sal'ia f_,oan Car school until his retirement in 1983. After his retirement, Dr. Hall remained active in medi- most recently was awarded two Navy The front-wheel drive lnfiniti® G20'" per m1le p 5 a n w 1n excess. e 9 �The jury is out. Your practice and assets are on the line. This is not the time to be second-guessing your choice of professional liability insurance companies. 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MLM~C ~ \l<'li!Cal ljabilit) \lntuallnsuranct' Compan) Our defense never rests. 2 Park Avenue New York. NY 10 016 2 Cl'nton Square Syrac"e>e. NY 13202 9() Merrd Avenue E. Meadow. NY 11554 �BUFFALO PHYSICIAN Non-Profit Org. U.S. Postage PAID Buffalo, NY Permit No. 311 STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 ADDRESS CORRECTION REQUESTED PLANTING A TREE UNDER WHICH You WILL NEVER SIT DR. DEVILLO W. HARRINGTON, class of 1871, knew how to make his money grow. In fact, this man who in 1905 provided $5,000 through his will for the University at Buffalo School of Medicine, is still supporting UB today through the endowment his bequest created. THIS PERMANENT endowment in Dr. Harrington's name has grown to over $300,000 and today it supports the famous Harrington Lecture Series, which twice a year brings distinguished scientific speakers to the School of Medicine and Biomedical Sciences. DR. HARRINGTON'S LEGACY to UB is just one of many bequests which have established permanent and important endowed fu nds at the school. They enable UB to provide scholarships to outstanding students, enhance scientific research, support excellence in teaching and meet the ever-changing needs of the school. YOU TOO can provide the School of Medicine with a measure of permanence through a bequest. Proper estate planning helps you develop a smart financial plan. A charitable bequest provides the satisfaction that comes from planting a tree under which you will never sit, but which will bear fruit for generations to come. FOR A CONFIDENTIAL consultation on making a bequest to the UB School of Medicine and Biomedical Sciences, or to receive materials to share with your attorney or estate planning advisor, please contact: STEPHEN A. EBSARY, JR. Assistant Dean and Director of Development, School of Medicine and Biomedical Sciences UNIVERSITY AT BUFFALO (716) 829-2773 UNIVII!RSITY AT aUFFALO SCHOOL 0,. ME:DICINII! t5~ 150 YEARS � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Winter 1996 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1996-Winter Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician and biomedical scientist Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v30n01-1996-Winter Table Of Contents A list of subunits of the resource. Research Hospital News Treating Violence Sleep Without Rest Medical School Then and Now A Spoonful of Humor Alumni Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. 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Copyright 1996 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/6ad5c5c491ee4c72591c41beb85f0f08.pdf 5ad80e3fc2f2a5f1d081bbd5f459504f PDF Text Text State University of New York at Buffalo School of Medicine and Biomedical Sciences, Autumn 1995 FROM DARI<NESS TO DAYLIGHT UB's Traumatic Brain Injury Rehabilitation System repairs broken lives �BUFFALO PH Y S I CIAN Volume 29, umber 4 ASSOCI ATE VI C E PRESIDENT FOR UN IVERSITY SE RVICES Dr. Carole Smith Petro DIRECTOR OF PUBLICATIONS Timothy j. Conroy ED ITOR Nanette Tramont, R.N. ART DIRECTOR Alan J Kegler ASSOCIATE ART DIRECTOR Dav1d R1ley E DITO RIAL MANAGER judson Mead PRODUCTION MANAGER Ann Raszmann Brown Dear Alumni and Friends, T his issue of Buffalo Physician describes the Traumatic Brain Injury Rehabilitation System that has proven so successful in Buffalo. The story provides yet another example of how collaborative efforts among institutions can facilitate patient care, enhance the education of health professionals and promote meaningful clinical opportunities that can utilize the resources of other institutions to positive advantage. As importantly, the system has ensured that patients can be treated in Western New York rather than be transferred to service delivery sites in other parts of New York, or in other states. The latter actually provides an economic savings for the citizens of Western New York since such services are more costly, as well as inconvenient, when patients with head injury are treated in other states. We congratulate the medical, hospital and other leadership that worked to make this system a reality and a success. Sincerely, STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES Dr. john Naughton Vice PreSt den! for Cluucal Affairs j ohn Naughton, M.D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences Dean EDITORIAL BOARD Dr. john A. Richert, Chairman Dr. Marttn Brecher Dr. Harold Brody Dr. R1chard L. Collins Dr. Alanj. Dnnnan Dr. James Kanski Dr. Barbara Marjeroni Dr. Dr. Dr. Dr. Dr. Dr. Elizabeth Olmsted Charles Paganelli Margaret W. Paroski Thomas Raab Stephen Spauldtng Bradley T. Truax TEACH ING HOSPITALS AND LIAISONS The Buffalo General Hospital Michael Shaw Buffalo VA Medical Center Arlene Kelly The Children's Hospital of Buffalo Ene County Medical Center Mercy Hospital M1llard ftllmore Hosp1tals Frank Sava Roswell Park Cancer Institute Sisters of Chanty Hosp1tal Dennis McCarthy ©The State Umversity of New York at Buffalo Buffalo PhySician IS publtshed quarterly by the State University of New York at Buffalo School of Medicine and Bwmed1cal Sciences and the Office of Publications. It IS sent, free of charge, toalumm, faculty , students, residents and friends. The staff reserves the right to ed1t all copy and submissions accepted ror publicatiOn. Address questions, comments and subm1ssions to: Editor, Buffalo Physietatt, State Universny of New York at Buffalo , Universuy Publications, 136 Crofts Hall, Buffalo , New York 14260 Send address 1hanges Ia: Buffalo Physiciatt, 147 CFS Addition, 3435 Matn Street, Buffalo, New York 14 214 Dear Fellow Alumni, T his year is Oying by, and we are rapidly approaching the beginning of our Sesquicentennial. Numerous events have been planned to celebrate the 150th anniversary of our medical school, and we hope you will be able to join us for some or all of the festivities. As you know, this past year the Medical Alumni Association purchased furnishings for the medical student lounge. The students were most appreciative, and acknowledged our efforts with a reception and commemorative plaque. Our Alumni Association was also honored with representation on the newly formed Dean's Advisory Council, which held its first meeting October 25-26, 1995. The Council has broad geographic representation, and alumni traveled from as far as California to attend the meeting. The group toured the new Biomedical Research Building, which is a spectacular addition to our medical campus. Dr. Beth Maher informs me that plans for Spring Clinical Day are shaping up nicely. Dr. Sherwin Nuland, author of How We Die, will be the Stockton Kimball lecturer. His topic will be "Death, the Doctor and Hope." He wrote to Dr. Maher, "Your school is a place I have long admired, and the feeling is always enhanced by my visits." We hope you will enhance Spring Clinical Day with your presence, and I'll look forward to seeing you there on May ll, 1996. Enjoy, ~~ W. ?~~J Ml) Ma rga ret W. Paroski, M. D. '80 President, Medical Alumni Association �V A 0 2 L U T U M o N 9 9 N 4 9 5 II Resear(h II Hospital News GME Maelstrom e UB's graduate medical educaII The tion consortium girds itself for fundamental changes in financial support system. m Putting Ba(k the Pie(es e UB's Traumatic Brain Injury Rehabilitation System repairs broken lives. IIJ Medi(al S(hool EiJ Then and Now m m ASpoonful of Humor Flying the friendly skies. Page 21. Alumni m Classnotes * l~e meuical sc~ool' slon~ ~istor~ of e~ual o~~ortu­ UB' s teaching hospitals plan for the worst. Page 6. nit~. ra~e ~~. �.... . ......... . .................. . ....... . ............................. . ... . .............. UB biologists build better mouse model for Duchenne MD research mark absence of dystrophin and increased mast cell activity characteristic of the disease, it doesn't exhibit the progressive weakness that is a symptom of Duchenne muscular dystrophy. He said the mice exhibit a degree of muscle weakness and degeneration , but only after they are physically stressed by running on treadmills for periods of time or are injected with chemicals that induce mast cell activity. "We wanted a model that would express the full symptoms of the human disease ," Hudecki said. He and his colleagues bred mice with the dystrophin deficiency and the exaggerated activity of mast cells throughout the body. The findings show that not only does d ys trop hin-deficien t muscle contain a greater number of mast cells, but the muscle tissue also appears to be hypersensitive to mast cell products, he added. niversity at Buffalo biologists have developed a new mouse model of Duchenne muscular dystrophy that may more accurately simulate the progression of the disease than current models. The research, which should also provide an enhanced understanding of the - formed about pain management, and that this lack of knowledge interfered with the nurses' ability to provide adequate treatment. The study, which appeared in the May issue of the journal of Pain and Symptom Management, points to a problem with nursing and medical school curricula, according to lead author Kathleen G. Wallace, Ph.D., assistant professor of nursing and postdoctoral nurse fellow at Buffalo's Department of Veterans Affairs Medical Center. "Nurses and physicians are not taught enough about pain management," she said. "Schools have not made the commitment to teach it. ln the meantime, the knowledge base of pain management is exploding. " The pilot study involved 108 staff nurses selected from a random sample of hospitals in Georgia, Louisiana, ew York and Washington , D.C. Since staff nurses are usually the first on the scene when a patient is in pain, their sensitivity to, and skill in dealing with, pain problems is critical for effective pain management, Wallace said . Study participants were asked to rate themselves in several areas related to pain management-educational preparation, practice skills and knowledge of legal, financial, political and ethical issues - and to rate the importance of each area. They also listed the three most important problems of pain management in their facility. Undermedication surfaced as the most significant problem of pain management. This finding is a step forward , Wallace said, because previous reports have shown nurses and physicians generally did not believe patients were being undermedicated. The researchers found that most of the nurses interviewed thought their pain management skills were adequate, even though other studies repeatedly had found the opposite to be true. B Y ELLEN GOLDBAUM The new mouse could provide enhanced understanding of the disease. role mast cells play in the disease, was published in the july issue of the journal of Neurological Sciences. Michael S. Hudecki, Ph.D. , research associate professor ofbiological sciences, ndermedication is the most signifiis the senior author. Coauthors are jocant problem of pain management seph A. Granchelli, postdoctoral fellow , in hospitals, one of the first studies and Catherine M. Pollina, research asto investigate how nurses assess sociate. The work was funded by the their knowledge of pain and their Muscular Dystrophy Association. skill in alleviating it has shown. "There has not been a good model for The pilot study, conducted by UniDuchenne muscular dystrophy ," versity at Buffalo nursing researchHudecki said. "This specially bred mouse ers , also revealed that nurses think gives us a very good handle on studying they are adequately informed about the Duchenne disease. " managing pain, despite research Hudecki explained that while the pre- showing they aren' t. vailing animal model, a mouse deficient But the nurses interviewed believed it in dystrophin, closely simulates the hall- was the physicians who were ill-in- Nurses see undermedication as major pain management problem e B a 0 p 5 0 B A Y LOIS m B AKER 9 9 5 �···· · ·························· · ·········· · ················· · · · ·· · ··· · ·········· · ········· · · s . " ' '~ ..~.. . Rural AIDS cases increasing three Improved survival seen with new times faster than in urban areas head and neck cancer treatment IDS cases in rural areas appear to be increasing at a rate three times faster than in metropolitan areas, where health care facilities are better equipped to deal with the problem. Rural AIDS cases increased 9.4 percent from 1991 to 1992 - the last period for which comparable statistics are available- compared with 3.1 percent in major metropolitan areas , according to a review of scientific literature focusing on rural HIV/AIDS conducted by UB's ew York Rural Health Research Center. The review also found that unlike the typical urban AIDS patient, likely to be homosexual males, rural AIDS patients are more likely to be heterosexual females. "In terms of both total cases and research, rural AIDS remains dwarfed by the urban epidemic," said Robin Graham, Ph.D. , senior research scientist at the center and lead author of the study. "But our literature review indicates that AIDS is a serious rural problem, with growing numbers of patients requiring services from illequipped local health care systems." The studies reviewed revealed several distinct characteristics of the rural epidemic: <§> The rate of increase of AIDS cases in proportion to the population is much greater in rural areas. ©> Rural AIDS is distributed unevenly, with 30 percent of cases concentrated in the South Atlantic states. ©> Rates are particularly high among black women , adolescents , ative Americans and migrant workers. ©> A substantial portion of rural HlV patients have migrated to metropolitan areas , returning home to family exhibiting advanced cases of the disease. <§> Intravenous drug use and heterosexual contact are becoming significant modes of transmission of rural HlV. BY B u LOIS c p h .. chemotherapy shrunk it to 1/2 centimeter, we still took it out as if it were two centimeters," Lore states. Significantly, all the patients in the study were evaluated and treated by Lore , who resected the tumors to .5 to 2 centimeters beyond the point at which they had been marked by tattoos following diagrams , anatomical stamps and photographs. new treatment regimen for head and neck cancer developed at the Head and eck Center at Sisters of Charity Hospital could hold promise for some of the estimated 30,000 Americans who are diagnosed with the disease yearly. The new regimen, which combines preoperative chemotherapy with an innovative surgical technique , was pioesearchers and clinicians from neered by John M. Lore, M.D. , medical several UB departments are orgadirector of the center. Lore presented nizing a Group for Advanced Vihis research , scheduled for publication sion Research to bring together in the American journal of Surgery, at people working in the field to the annual meeting of the Society of collaborate on research , coordiHead and eck Surgeons last May. Lore demonstrated a five-year sur- nate funding efforts, share resources vival rate of 76 percent in one group of and enhance teaching. 93 patients with advanced squamous William Coles, M.D. , professor and cell carcinoma of the head and neck he chair of ophthalmology, is the group's treated over 15 years with one of two executive director. Malcolm Slaughter, preoperative chemotherapy protocols. Ph.D., associate professor of biophysical Previous survival rates , as demonstrated sciences and ophthalmology, has been by the ational Cancer Institute's 1987 named director of basic research , with Head and eck Contracts Program, av- James Reidy , M.D. , assistant professor of eraged 35 percent. ophthalmology, serving as director of The Head and eck Center's dramatic clinical research. 76 percent survival rate was seen in the 40 Researchers from the UB Departments patients who received cisplatin and 5-0uo- of Clinical Laboratory Science, Anatomy, rouracil preoperatively. Another 48 who Pediatrics, Biochemistry and Social and received preoperative Preventive Medicine have alcisplatin and bleomycin ready affiliated with the group. posted a five-year surCurrent members are conducting funded research 1n- - vival rate of 43 percent. (Five patients were diabetic retinopathy, noncompliant.) retinopathy of prematurity, The crux of Lore's age-related macular degenregimen is the strict aderation, corneal inOammaherence to preoperative tion, neuro-ophthalmology chemotherapy planand outcomes of surgical proning of ablative cedures in the developmenuncompromised surtally disabled. gery regardless of a fa- Angiogram displaying abnormal The group is organizing a vorable response to the retinal vascular pattern. research conference for 1996. chemotherapy. "If the tumor was 2 cen- Periodic grand rounds and continuing edutimeters prior to chemotherapy, and the cation seminars are also planned. UB researchers,clinicians form advanced vision research group BAKER 0 '· y c c m �Buffalo General and Buffalo Columbus finalize merger plans merger plan involving Buffalo Columbus Hospital; its parent organization, Buffalo Healthcare Corp.; and The Buffalo General Hospital has been finalized, hospital officials announced recently. The merger agreement, according to BHC board chair Vincent]. Muffoletto , represents "a major step toward providing vastly expanded services to our medically underserved community. " The Honorable joseph S. Mattina, chair of the board at Buffalo Columbus Hospital, observed that board members had "agonized" over the future of the institu- john E. Friedlander, Buffalo General's president and CEO , praised judge Mattina, Muffoletto , Garcia and members of the BC/BHC boards for exhibiting "extraordinary vision and determination. "Columbus represents a critical service provider for the community and specific patient populations, including the indigent, people who are HIV-positive , substance abusers, the chronically ill and people noting that Buffalo Columbus has a work force of 290 and Waterfront 200. "With approximately 500 staff, the campus will be a major employer on the WestSide." Sisters Hospital fights domestic ~olence with Crtsis Services he Safe Passage Program, Sisters of Charity Hospital's domestic violence program, has implemented an innovative working relationship with Crisis Services, a nonprofit human services agency that specializes in crisis response. The pilot collaborative effort between Sisters and Crisis Services will provide for the training of both crisis advocates from the agency and hospital staff, beginning with social workers , to serve as victim advocates. "We are training staff who will respond to victims' needs on a 24-hour basis," said Kathleen Slammon, M.S.W. , coordinator of the Safe Passage Program. Approximately 50 volunteers from Crisis Services' Advocate Program previously experienced in working with rape victims will receive additional training specific to domestic violence, including the dynamics of abusive relationships, standards of care for victims and community resources. The volunteers will supplement the services provided by Sisters Hospital social workers, who will also receive training specific to domestic violence. "The intent of this collaborative effort is to provide victims with consistent and comprehensive care," Slammon noted. Physicians, nurses and other hospital staff will be trained in domestic violence identification and intervention following the first phase of instruction for social workers and advocates. f tion for several years. "This agreement with Buffalo General will allow ~ us to mamtam our presence on the Lower West Side, provide better services than ever before, proceed with construction of a diagnostic and treatment center, and preserve as many jobs at this facility as humanly possible," Mattina explained. Earlier this year, the hospitals and BHC announced that discussions were under way to develop a merger plan in an effort to preserve, enhance and expand health care services for the city's West Side. Under the plan, the current Buffalo Columbus facility will be replaced with a diagnostic and treatment center. "Throughout the negotiations, the good of the community always came first ," remarked Andres Garcia , president and chief executive officer of Buffalo Columbus Hospital. "Our foremost responsibility is to the people of the Lower West Side, and our goal is to make this work so that they will have a community health care facility they can be proud of. " ?) with special needs ," Friedlander said. According to Friedlander, the merger plans include "the extension of new and existing services, while moving ahead with the process of developing a health care campus, including a diagnostic and treatment center at the site. " The 160-bed Waterfront Health Care Center, a residential health care facility operated by General Care Corp. , parent organization ofBuffalo General , has also been mentioned in the plans to create a health care campus. "Currently, we are exploring ways in which Waterfront and Buffalo Columbus can work together to create a West Side health care campus," Friedlander said, ;o. u m 9 9 �. . . . . . . ... . . . . . . . . ... . . . . . ... .. ... ... . ... .. ... ... . . ... . ... [1 "The entire hospital staff will be required to receive training. The extent of that training will depend on a person's position," Slammon added. The Safe Passage Program recently received a $10,000 Legislative Local Initiative Award from the New York State Department of Social Services. Funds from the award will be used to further develop the domestic violence program in the areas of intervention, advocacy and counseling services. Medical staff reappointments announced at Mercy Hospital hree UB physicians have been reappointed to key medical staff positions at Mercy Hospital of Buffalo. Saleela Suresh, M.D. , clinical assistant professor of rehabilitation medicine , has been reappointed as chair of rehabilitation medicine, a post she has held since 1979. She earned her bachelor's degree from the University of Calcutta, India , and her medical degree from the R. G. Kar Medical College in Calcutta. She served rotating internships in Calcutta and at the D.C. General Hospital in Washington, D.C. Suresh holds membership in the American Academy of Physical Medicine and Rehabilitation, the Medical Society of the County of Erie, the Medical Society of the State of New York and the American Association ofElectromyography and Electrodiagnosis. Noel Chiantella, M.D. , clinical assistant professor of radiology, has been reappointed as chair of Mercy's radiology department. He earned his bachelor's degree from Mount St. Mary's College in Emmitsburg, Md., and his medical degree from the University of Maryland Hospital. He served as a lieutenant, general medical officer, in the U.S. avy. John Fanelli, M.D. , has been appointed chief ofMercy's division of family practice, department of internal B u 0 0 p medicine. He earned his bachelor's degree from Niagara University and was an Army ROTC Distinguished Military Graduate. Fanelli earned his medical degree from UB , and served a rotating internship at the Ireland Army Hospital in Fort Knox , Ky. CHOB wins approval for acute pediatric inpatient rehab unit he ew York State Department of Health has approved The Children's Hospital of Buffalo's certificate of need to develop an acute pediatric inpatient rehabilitation unit. "There are no certified inpatient beds for acute pediatric rehabilitation in the Western ew York area, " said Joseph A. Ruffolo, president and CEO of Children's Hospital. "The acute needs of these patients are being met usually via transfer to acute inpatient rehab units outside of Western ew York and often outside of New York State. The gap in health care delivery results in fragmented and duplicative care for patients who require intensive rehabilitation services. Patient relocation forces temporary relocation for the family, which creates inconveniences and increased cost and stress," Ruffolo said. The inpatient rehabilitation unit will provide a multidisciplinary team approach for the treatment of brain dysfunction, traumatic spinal cord dysfunction, stroke, amputation of limbs, congenital deformities , neurological conditions , arthritis and other conditions. The treatment team will consist of the following medical disciplines: developmental pediatrics, education, occupational and physical therapy, social work, psychology, nutrition, rehabilitation nursing and speech therapy. "With a strong outpatient rehabilitation unit in place and numerous inpatient services providing referrals and direct clinical expertise, Children's Hospital demon- s c a A strates a strong commitment to provide a comprehensive continuum of care for this special population. A dedicated rehabilitation inpatient unit will ensure focus on functional outcome, so as to return each patient to the most independent setting possible," Ruffulo added. The Robert Warner Rehabilitation Center is the outpatient rehabilitation component of Children's Hospital. Grant named chief of pulmonary and critical care at VA center rydon Grant , M.D., has been named chief of pulmonary and critical care medicine at the Buffalo Department of Veterans Affairs Medical Center. A graduate of Charing Cross Hospital Medical School, London, Grant became interested in research during his residency and became a research fellow at the Royal Postgraduate Medical School in London. He continued his clinical training at Middlesex Hospital Medical School in London. ln 1977, Grant continued his research in pulmonary gas exchange and mathematical modeling at the University of California at San Diego. In 1979, he joined the faculty Brydon Grant, M.D. at the University of Michigan. He has been in Buffalo since 1983 as an attending physician at Erie County Medical Center in the pulmonary and critical care division, and as director ofECMC's pulmonary function lab since 1990. Grant has served on the editorial board of Respiratory Physiology and the American Review of Respiratory Disease. He recently completed a term as an associate editor of the American]oumal of Respiratory and Critical Care Medicine. u m n 5 0 �n interestin_ times THE ONLY CERTAINTY FOR ACADEMIC MEDICINE IS FUNDAMENTAL CHANGE t portrait photo s by Robert Walion EVERY ASPECT OF ACADEMIC MEDICINE WILL BE AFFECTED BY THE FlNA CIAL REFORMS BEING PLANNED FOR THE MEDICARE A D MEDICAID SYSTEMS - FROM THE NUMBER OF RESIDE CY SPOTS AVAILABLE TO NEW PHYSICIANS TO THE PRODUCTIVITY OF THE PROFESSORS WHO TEACH THEM . AT UB A D ITS AFFILIATED TEACHING HOSPITALS , THE MOOD IS OT HOPEFUL �by Andrew Danzo THE Fl A CIAL U DERPl Naughton describes the forces at work: the need for costtion are undergoing a fundamental reorganization. Medicontainment and a more rational approach to medical work care is being cut back and restructured. Medicaid, too. force policy; political promises of tax cuts; widening accepGrants are getting harder tance of business notions and harder to come by. of productivity. "These And in ew York, it's forces are going to collide anyone's guess what will here very shortly," happen when the system Naughton predicts, leanthat has regulated hospital ing forward during a disreimbursements for more cussion in the wedgethan a decade comes up shaped office that he will for renewal in several soon leave. He suggests a months. label: "Call it the GME "It's all under attack, evmaelstrom. " ery bit of it," says john Graduate medical eduaughton, M.D. , UB vice cation cost $3 billion in president for clinical afNew York State in 1994. fairs and dean of the School About a third of that came of Medicine and Biomedifrom Medicare hospital recal Sciences. imbursements, with most o one is sure exactly of the remainder from how it will play out. The Medicaid and non-governonly certainty is that ment insurers. The fundthings will be different , ing scheme is complex, to starting with teaching put it mildly. Medicare rehospitals and rippling outward. imbursements are driven by costs Among the hospital members in base years updated for inOa.JOHN NAUGHTON, M.D. tion, calculations of overhead atof the Graduate Medical Dental tributable to education, estimates Education Consortium of Bufof illness severity among teachfalo, there is talk of "integraing hospital patients and various tion " and "downsizing. " Fewer other factors. Reimbursements residency slots, perhaps. A testfrom Medicaid and other insuring of relationships among coners are determined by the New sortium members. Pressure on York Prospective Hospital Reimfaculty to find time for more bursement Methodology ( YPHRM), which adheres to clinical service. some parts of the Medicare formulas . "The CEOs know what's going on and know that something will have to give, but they are really unsure ," says Paul The average reimbursement per resident in 1994 ranged Candino, chief executive officer of Erie County Medical from more than $200,000 in the ew York metropolitan Center. "Once we see what the damage is, we'll be positionarea to about $149,000 in Western New York, a differing for redirecting our strategic initiatives. " ence that at least partly reOects regional variations in It may all end up producing something that is more health care costs. With 788 residents and fellows in the collaborative and attuned to the needs of a reorganized GMDECB, it is easy to see how changes in GME reimhealth care system, but the transition will not be painless. bursement could quickly translate into huge losses for ult' s all under attacl<, every bit B u 0 0 p c 0 of it. " A u u m 5 0 �ACADEMIC MEDICINE FINDS ITSELF IN INTERESTING TIMES affect medical education, but they are preparing for a individual hospitals. That could be compounded by major challenge. Asked what's at stake , Candino reother changes in Medicare, which covers nearly half the plies , "Everything. " patients in GMDECB institutions, and Medicaid. One obvious response would be reducing the number of Meanwhile, growing proportions of publicly and privately insured patients are residency slots, and some in managed care. HMO hospital executives say that can't be ruled out. "I penetration among those with non-government inthink the decisions will have to be what can we all surance in the metropoliafford from an educational tan Buffalo area is now about 60 percent, accordperspective as well as an ing to William D. Pike, operational one," says Ripresident of the Western chard Braun, vice presiew York Healthcare Asdent for finance and chief sociation. HMOs in Buffinancial officer of The falo have generally been Buffalo General Hospital. following the prevailing He says the consortium reimbursement rates set might also have to conunder NYPHRM, even sider consolidating some though they' re not reprograms, such as interquired to, Pike says. But nal medicine, which is the HMOs are beginning now split into two parts. to get more aggressive, he Naughton agrees that adds , pointing to one the government must get plan's recent exclusion of residencies under control hospital labs from a contract for nationally. In the three decades outpatient work. since Medicare began, training P A U L CANCINO programs and slots have prolifAs YPHRM approaches its june 30 renewal deadline , all erated. The knocks on the system are well known: public bets may be off. It is YPHRM funds helping to subsidize a surthat controls the bulk of hospiplus of specialists; geographic tal reimbursement for such maldistribution encouraged by "public goods " as graduate concentration of residencies in medical education and indigent a handful of states- New York care, and the insurance industry is already pushing to be realone has one-sixth of the leased from the dictates of diagnation's total; far more residents nosis-related groups , according than there are new American to jeannie H. Cross of the M.D.s , with programs sucking Healthcare Association of ew up young doctors from counn York State. "We're moving in tries where they are needed and the direction of a more marketmedical schools stymied in their oriented system ," Cross says. "The question is how fast. " efforts to rebalance the physician work force . GMDECB officials warn that there are still too "Obviously, the feds have a big job to do ," aughton many unknowns to predict exactly how all this will says. But Buffalo , he quickly adds , is not the place to do it. uThe CEOs l<now what's going on and l<now that something will have to give, but they are _really unsure. c a n m n 9 9 5 �ACADEMIC: MEDICINE FINDS ITSELF The GMDECB has been a national model since it adopted a self-imposed cap on residency slots several years ago. "We only have a few programs where we could say in the most rational sense of the word that we have a few excess residents," Naughton says. "We'd rather not lose any because we think the size is about right. " Final decisions on residency slots will be inOuenced by a variety of factors. For instance, disincentives for training graduates of foreign medical schools would be felt in the consortium, where about 45 percent of the slots are filled by international graduates. And even though the GMDECB is committed to training half of its residents in primary care (it's now at 43 percent), new disincentives for specialist training could pose difficulties. "We have a high surgical component at Buffalo WILLIAM General," says Braun, "and as you start to cut at that, you tear away at the whole system." To some degree, hospitals have already begun weaning themselves from their reliance on residents because the programs have been putting greater emphasis on the educational component of resident training. "They're not the slaves that they had been," says Roseanne C. Berger, M.D., associate dean for graduate medical education. Nevertheless, residents are still important. "Of our 21 clinical departments, 19 of them have relationships with graduate medical programs," says Michael F. Noe, executive vice president and medical IN INTERESTING TIMES director at Buffalo General. On average, the hospital has about 150 residents. "They are very much involved in patient care in the course of their learning experiences," Noe says. "Once they reach a certain level of competency, they directly provide patient care, particularly in urgent situations. If we did not have them here in the hospital, it would be very difficult to replace them. " Eventually, fewer residents could also mean fewer physicians in Western New York , Noe adds. "As there are fewer people in training, there will be fewer individuals familiar with the area who have developed a preference for this area as a place to practice ," he says. "lt could have an impact on the availability of people who go into practice. " Even if hospitals did cut back D. P I K E on residents, it wouldn't solve their problems. GME reimbursements have become intricately woven into teaching hospital budgets, supporting things that will continue to run up bills whether or not the residents are there. The largest part of the Medicare reimbursement goes not to direct costs - resident salaries and benefits range from about $20,000 to $60,000 in New York- but to compensate hospitals for the indirect, and somen what abstract, cost of being a teaching institution. Based on the ratio of residents and interns to beds, the indirect component is designed to pay for such educational costs as the greater number of tests that aWe have a very lean machine as far as health care delivery in Western New Yorl~. But we can do better, and we can do better by collaborating for shared services. B a a p h y s a n A u m 9 0 �ACADEMIC MEDICINE FINDS ITSELF residents tend to order, as well as for things like greater illness severity among teaching hospital patients. It is sometimes called an "add-on " to the direct Medicare reimbursement, which is paid according to diagnosis related group. "Our add-on is gigantic," says ECMC's Candino, who administers a hospital that is not only a major academic affiliate, but also has regional trauma and burn units and provides more than $20 million a year in indigent care. In New York, hospitals also receive indirect education reimbursements from Medicaid and nongovernment insurers through NYPHRM, which uses a formula that is similar to Medicare's but adjusted to encourage primary care residencies. The total indirect component is about 57 percent of the $3 billion in GME reimbursements in ew York. "A lot of it goes to the bottom line of the hospitals," says James RICHARD olan, M.D., director of medicine at ECMC and former chairman of medicine at UB. Likewise, other reimbursement streams help to indirectly support the educational mission of teaching hospitals. GMDECB officials say they will have to consider the potential revenue losses posed by overall changes in Medicare and Medicaid as they reassess their teaching activities. "If education stayed the same and you cut out $20 million of other funds , it's hard to say it would have no impact," says BGH's Braun. "The reality is, if someone cuts your budget by 10 or l3 percent, you have to react to it. The reaction IN INTERESTING TIMES has to be, what programs can we afford? " Teachers as well as residents are likely to feel the pinch. "This , of course, comes at a difficult time for faculty ," says Nolan. "There's been a decrease in state funding and hospital funding even without these cuts," he adds. "The hospitals have had to decrease the support they can give faculty. And grant support also has been decreasing." The combined effects of various revenue losses "are going to make it more difficult for full-time faculty to be financially supported," says oe. "In New York State in particular, our hospitals have operated very close to the margin. We have worked in a very heavily regulated environment for many years. The impact in New York State is going to be significantly greater than in other states." Berger sees that leading to some tough choices for adminisBRAUN trators and faculty. "I think there will be an increase in pressure for clinical activity, which may take them away more from the teaching endeavor," she says. That pressure had been growing already in recent years, and clinical practice now accounts forabout$75 million in UB medical school gross income. Berger says faculty could also be affected by financial pressure in the practice environn ment. "As managers begin observing the clinical productivity of faculty more closely, if there are no allowances for teaching time built in there , the standard will be maintained, whatever level is set for uTh e reality is, if someone cuts your budget by 10 or 13 percent, you have to react. The reaction has to be, what programs can _we afford? B u a a p y 5 c a A u u m 9 9 �ACADEMIC MEDICINE FINDS ITSELF seeing patients," she says. "You're not going to be able to teach as much while you're seeing patients if you're expected to see more patients." The coming year will be a crucial one for the GMDECB as it reacts not only to the federal changes, but to those at the state level as well. In addition to NYPHRM, New York's Medicaid managed care program is still taking shape, and another round of state budget cuts looms. "People are saying that next year is going to be a health care Super Bowl in New York," says Cross, the Healthcare Association spokesperson. "NYPHRM is a playoff game by itself." The situation could present some opportunities. For instance, the current system of GME reimbursement does not pay as much for ambulatory residencies as those in hospitals. Within the GMDECB, the salaries and benefits of ambulatory residents are covered, but RO SE ANN E C. there is no mechanism to pay the overhead costs. "Until there is real reform of financing, it's going to be hard to make the changes that are needed, shifting the locus from the hospital to the ambulatory setting," says Leonard A. Katz, M.D., director of research and education programs at Health Care Plan, which trains two internal medicine residents a year in the primary care: group practice!HMO track. The debate over such issues and the ongoing evolution of health care delivery are likely to put stress on relationships within the GMDECB. With managed care expanding and a continued push to replace DRGs with negotiated fees , hospitals that make teaching a part of their mission will IN INTERESTING TIMES have trouble competing unless there are adequate mechanisms to compensate them for their higher costs. "You have people at the consortium table collaborating for graduate medical education, but at the same time, these collaborators are competitors for patients," says Pike, of the Western New York Healthcare Association. "As competition heats up more and more, it's hard to sit down and say, 'let's work together."' But Pike and others say they expect the consortium toweatherthestorm. Ifanything, cooperative efforts will become more important. "The consortium is a good example of how the market is reacting in general," Pike says. "We have a very lean machine as far as health care delivery in Western ew York. But we can do better, and we can do better by collaborating for shared services." Examples of new partnerships are already emerging as hospitals form networks that unite B E R GER, M.D. a variety of providers and facilities to offer patients a "continuum of care" through a single organization. "l think you're going to see tremendous changes from a standalone hospital system to an integrated delivery systems environment," says Robert V. Stanek, chief operating officer of Mercy Health System, the network that now occupies the Mercy Hospital chair at the GMDECB table. Stanek says the n ew environment will pose challenges for clinical education . "Will it strain the mission? Sure it will," he says. "But in the long term, we're going to continue to provide services to the community, and as part of that, an educational mission needs to be maintained. " uYou' re not going to be able to teach as much while you're seeing patients if you're expected to see more patients." B u a 0 p h y 5 c a n A u m n 9 9 �PUTTING BACK THE PIECES US'S TRAUMATIC BRAIN INJURY REHA I ITATION SYSTEM REPAIRS BROKEN LIVES BY PHOTOS B u a BY SCOTT THOMAS COLLIGNON/JAROSZ 0 p h c a n ;o. u m n �-------- - HE ACCIDE T ITSELF, Anthony DeLabio doesn't much remember. He and a couple of friends were just fooling around. Too young to drink in ewYork State, they had walked across the Rainbow Bridge into Canada and spent the evening hitting the bars. Then they had walked back and were hanging around in the parking lot of the Rainbow Center mall. "We started horsing around by the edge of the parking lot," DeLabio, now 22, says of that fateful September night in 1992. "I leaned over ... and I fell. The next thing I knew, when I got percent of traumatic brain injuries are motor-vehicle-related. If you add in pedestrians who are hit by cars, it's closer to 60 or 70 percent. "And now, in some cities (though not Buffalo) , gunshot wounds are coming close to those numbers. " The medical school's Traumatic Brain Injury Rehabilitation System is a regional consortium that operates at three levels: ECMC, with its Level I trauma unit and acute-level rehabilitation; Our Lady of Victory Hospital in South Buffalo, for intermediate-term rehabilitation; and, until recently, the Deaconess Center ofBuffalo General Hospital, for long-term in-patient rehab. Labi says she and her colleagues are working with patients who , had they sustained such injuries 20 years ago , never would have survived - people with multiple body traumas Each year, an estimated half million people nationwide suffer a head injury; a significant proportion of them will require a course of rehabilitation. The medical school's Traumatic Brain Injury Rehabilitation System is a regional consortium that operates at three levels: acute-level, intermediate term and long-term, in-patient. from crashes, or horrific gunshot wounds. "In the past," she says, "most of them would have died of complications from their injuries. Now the emergency medical services are so much better. With the use of helicopters, patients are getting to trauma centers much more quickly. And the earlier we can treat them, the better. " But reckless drivers and trigger-happy gunmen aren't the only risks to gray matter. "just about anything can result in a head injury," Labi says, and she ticks off some examples: industrial accidents; falls , particularly among older people; blunt trauma , such as assault with a baseball bat. All can damage the brain and its delicate neural pathways - and forever alter the life of the victim. Anthony DeLabio says of his time on the eighth floor of ECMC, the head injury rehab unit: "I was totally confused. I had no idea what was going on. I remember that a couple my senses back, I was on the rehab floor (of the Erie County Medical Center)." He had been in a coma for five days before he opened his eyes. "The strangest thing was, for a while after the accident I had these dreams of people falling. ever me, always other people. And I'd say to them in the dream, 'Don't worry, you won't remember it."' DeLabio's story is in some ways typical of the events that conspire to injure the human brain. Each year, an estimated half-million people nationwide suffer a head injury; a significant proportion of them will require a course of rehabilitation. Most such patients are young, male - and have been around alcohol, automobiles or both. "We live in a fast world," says Maria L. C. Labi, M.D. , Ph.D., medical director of the University at Buffalo Traumatic Brain Injury Rehabilitation System. "More than 50 B u a 0 p y a u m 9 9 5 �of my friends came to see me; other than that, it was just very confusing. "But all the people, the doctors and nurses, were very nice to me. They calmed me down a lot of times, because I felt like I was caught in a whirlwind. I didn't know why I was in the hospital. They told me day after day that I fell, but I just couldn't make the association. I couldn't remember going out that night. " But slowly, in the nine-and-a-half weeks he was in the hospital , and throughout a long course of outpatient rehabilitation, Delabio made the connection. He worked with physical therapists to learn to walk again. Occupational therapists helped him relearn "the day-to-day things" showering, getting dressed. Speech therapists helped him learn to organize his thoughts and taught him strategies to course. The brain is a delicate and complex instrument, and damage may forever wipe out a lifetime of accumulated skills and memories. Labi, who is an assistant professor in UB medical school's department of rehabilitation medicine , makes the distinction between functional and neurologic recovery. It's not necessarily true , she says , that the central nervous system can 't regenerate itself: severed nerves sometimes reconnect through a process called sprouting. "lt's not always as efficient as it was before ," she says, "but even if the injured area does not recover , the brain has a lot of redundancy in it. Other parts can take over the function of the injured part. " Failing that, though, the goal is functional recovery. A patient may be paralyzed, for example, but if he can learn to PHYSICAL THERAPIST LESLIE MOREDOCK ASSISTS ROGER HOUSER. improve his memory. They also worked with him to relearn how to swallow and eat and talk. He worked painfully to regain coordination in his left hand that was impaired by the fall. He tried cooking. He passed his driver's test. Eventually, he got his life back. "I think that's one of the finest rehab centers around, " Delabio says now about the Buffalo TBl system. "Besides being great physicians and therapists, they have an empathy for the patient. They try to understand what the patient is going through. That's important." Delabio's remarkable recovery is the kind of outcome the rehabilitation teams hope for. It's not always possible, of B u a 0 p s live independently with the help of a wheelchair and maybe a part-time aide, he has made a functional recovery. "The system," Labi says, "is intended to make people as functional as they can be through excellent and cost-effective care. "It's very rewarding work," she says. "The perception of most people is that these patients are hopeless, that if they don't come out of it right away, they're never going to get better. But with good, appropriate, timely care, they do get better." Such as: {i;l The man in his 40s who was hit on the head by an 800pound weight at work. He was back on the job in six months. {i;l The patient in his late 30s who was run over by a train. 0 u m n 5 �"He pretty much broke every bone in his head," Labi notes. He, too, was recovered well enough to consider returning to work in six months. @ The lawyer in his late 20s who was in a car crash in California- back practicing law in a year-and-a-half. These cases, Labi says, are different from stroke, the other assault on the brain, because with trauma, the damage to the body is generally much more widespread. Patients come with fractures, blood clots, multiple traumas. Treating them, and rehabilitating them, means intervening early so their injuries don't snowball. "These cases are not typically one little problem you're working on," says Carolyn Teter, who administers the head trauma rehabilitation unit at Our Lady of Victory Hospital. "We're working on many problems at a time." they hadn't bargained for; they may have trouble accepting this changed person. One thing is for sure: The family will never be the same again. Richard T. Linn, Ph.D., an assistant professor in the department of rehabilitation medicine and program director of the UB Traumatic Brain Injury Rehabilitation System, says accepting what they've lost can be the most difficult part for head injury patients. "Most of these folks , when they're on the inpatient unit, are very confused and still showing quite a bit of disorientation," Linn says. "Many of them are not really ready for intensive supportive therapy. It's only when they get better and realize something of what they've lost that it really starts to sink in." Linn performs neuropsychological assessments of pa- "It's veryrewardingwork.The perception of most people 1s that these patients are hopeless, that if they don't come out of it right away, they're never going to get better. But with good, appropriate, timely care, they do get better." tients with head trauma, trying to establish a baseline level of functioning and then, later, to assess the patient's progress six months to a year after the injury. He also does some psychotherapy with these patients. "There aren't many psychologists in town who will do psychotherapy or supportive therapy for people with a brain injury," he says. "They may have memory problems, for example, and how can you do psychotherapy when they have to be reminded each time where we had progressed to? The answer is, you adapt your therapy to work more on reintegration issues: How do you get back to work? Isn't it frustrating not making as much money as you're used to? Maybe you can't drive, and that's dehumanizing. " Labi says the TBl system was conceived as a continuum of care- from the trauma intensive-care unit, through levels of in-patient rehabilitation, from acute to long-term and on to outpatient rehab. It's a system that makes sense economically as well as medically, says Glen Gresham, M.D. , professor and chairman of the medical school's department of rehabilitation medicine, and director of rehabilitation at ECMC. "For years patients were being sent out of state, all over the place, because there wasn't any coordinated system close For example, Teter says, if a patient is immobilized by his injuries, his joints can become tight and bent with muscle contractures, requiring surgery. And the whole range of skills that often is lost to a head injury takes time to relearn. That's why the TBI system employs a panoply of therapists, working as a team to decide how to work most effectively with a particular patient. They include occupational therapists, physical therapists, speech pathologists, recreational therapists , neuropsychologists, social workers, case managers and the attending physiatrist. And their work doesn't end at the hospital doors. "The shortest piece of a rehabilitation is the in-patient program," Labi says. That typically is followed by continuing outpatient therapy and monitoring. And the patient's family becomes deeply involved, whether or not he ends up living with them. Head injury happens not just to an individual, but to the family as well. The person they knew and loved may be irrevocably altered. They may have new care-giving duties B 0 0 p h s 0 u m 9 �OCCUPATIONAL THERAPIST SANDRA SEILER HELPS CHAD STUDLE Y IN THE K I TCHEN . to home," Gresham says. "It was just sort of a chaotic situation." with a lot less care on the outside. " The TBI rehabilitation system, he says, "put it all on the "We're working with the insurance companies and the basis of cooperation, so everyone could win. Particular hospigovernment to make this as efficient as possible," Labi adds. tals are guaranteed of a role; the health department (which "The financial climate in medicine with patients like this is very pays for many patients' head-injury rehab) is pleased because precarious. But our philosophy is that every patient deserves a patients are not sent out of state, which is much more costly; trial of rehabilitation regardless of their insurance source." and private insurers are pleased because they feel they can Sometimes that rehabilitation takes a turn even the best depend on the cost-effectiveness of the care, that this consortium is interested in good "The financial climate in medicine with patients like this care and not just interested in a big profit. "This is a model of regional 1s very precanous. But our philosophy 1s that every care that we're very proud of and that we think can be a model for the whole country." patient deserves a trial of rehabilitation regardless of their james A. Phillips, clinical instructor and administrator for the medical school's department of rehabilitation insurance source. " medicine, says having the Department of Health and private insurance carriers represented on the system's board of directors brings unity of therapist couldn't have predicted. Anthony Delabio, whose purpose instead of squabbling over fees. parking-lot fall put him into a coma, is back to the books at the "That's the cosmic glue that keeps things together," Phillips University at Buffalo. He had been studying environmental says. "At least we have reasons to communicate, which is not science, but now he wants to get into a different field: medicine. necessarily what's been happening elsewhere in health care. " Delabio, who lives with his parents in Niagara Falls, still He also notes , "The amount of money that we're spending has some impairment. "I get distracted easily," he says. "And in the hospital is only 20 percent of (a head-injury patient's) memory is a problem. " lifetime care cost. The real burden of care is when they leave But he's in great physical shape, having taken up body the hospital. The amount of care that the family has to give , building. He doesn't drink anymore: "I've been working so or an aide has to give , is really more substantial. We're trying hard on my rehab, I don't want to jeopardize it. " And the to make the community aware of alternatives: assisted living whole experience has changed him, not entirely for the worse. centers, for example. lf we can improve a patient's function"It's made me grow up a lot," he says. " ow I have ing by just a little bit, sometimes that means he can get by direction in my life .... I know what I want to do ." B u 0 0 p c o n u m 9 9 �TRAUMATIC BRAIN INJURY RESEARCH FOCUSES ON FUNCTIONAL OUTCOMES much care patients will need after they leave the hospital. " THE CLOSE ASSOCIATION between the medical school's Labi will report preliminary results from the study at a Department of Rehabilitation Medicine and the rehab proUB-sponsored international conference on head injury rehagrams in the Traumatic Brain Injury Rehabilitation System bilitation, to be held at iagaramakes possible some important reon-the-Lake, Ontario, in july 1996. search into an epidemic problem. • RichardT. Linn, Ph.D. , under a Two academic studies in grant from the ational Institute progress: on Disability and Rehabilitation • Dr. Maria Labi has a grant from Research , an ann of the U.S. Dethe federal Centers for Disease Conpartment of Education, is studying trol and Prevention, now entering individuals who have sustained its fourth year, to study head-injury mild head traumafor example, patients as they progress through who have lost consciousness those the rehabilitation system. Labi is for less than 30 minutes after a looking at the functional outcomes blow to the head. About 5 percent of head injury over a long period of of the people who suffer such ::1 follow-up care, and trying to idenconcussion, he says, continue to tify risk factors for complications have problems- attention deficit, from such injuries. headache, fatigue, depression , anxi"By having this regional system, etya year after the injury. by identifying all the patients comNow in the third year of the ing into the system, we've been able project, Linn is seeking a way to to collect data from the point of DR . MARIA LABI , JAMES PHILLIPS (LEFT) AND predict who will have such probimpact and follow them out for the RICHARD LINN , PH . D . (RIGHT). lems and who won't. Patients who rest of their lives," says james A. agree to participate undergo a positron emission tomography Phillips, clinical instructor and administrator for the mediscan within a couple of weeks of their injury, and Linn will cal school's Department of Rehabilitation Medicine. "That try to correlate the amount and areas of change in brain study will be a benchmark for the rest of the country. lt will function with later problems. also give back to insurance carriers information on how CUTHBERT SIMPKINS II , M.D . , {LEFT) ASSOCIATE PROFESSOR OF SURGERY AND DIRECTOR OF THE VIOLENCE AND VICTIMIZATION PROGRAM , WITH RESPIRATORY THERAPIST JOHN GUAGLIARDI . B u a 0 p h c a u m 9 9 �Michael Msall,M.D, receives 1995 Sir James Carreras Medical Award in care, clinical research, education and advocacy for children with neurodevelopmental disabilities. His efforts include team approaches, family supports and developmental interventions for children with Down's syndrome, cerebral palsy, spina bifida, congenital malformations, prematurity and related neurodevelopmental disabilities. His work was recently published in Clinical Pediatrics and the journal of Perinatology. Msall is a member of the Society for Pediatric Research. The Robert Warner Rehabilitation Center is a cooperative effort of families , rehabilitators and professional and voluntary not-for-profit community agencies, including Variety Club of Buffalo Tent #7 and The Children's Guild. The Sir james Carreras Award was established in 1986 and honors the name of Sir james Carreras, MBE, a former president of Variety Club International who still serves on its board. ichael E. Msall, M.D. , associate professor of pediatrics and rehabilitation medicine, has received the 1995 Sir james Carreras Medical Award. The award and an accompanying $10,000 prize are presented annually by Variety Club International to the physician who has done outstanding work in the field of pediatric medicine during the previous year. Msall was chosen to receive the award from among 60 physicians nominated from around the world. He is chief of the division of developmental disabilities and medical director of the Robert Warner Rehabilitation Center at The Children's Hospital of Buffalo. A UB faculty member since 1987, Msall received the award for his efforts UB medical student named to academic medicine fellowship niversity at Buffalo medical student Aisha Prim has been named an Academic Medicine Fellow by National Medical Fellowships, Inc. Prim is one of 35 minority medical students selected for the honor, funded by Bristol-Myers Squibb Co. , and established by The Commonwealth Fund, from among 90 students nominated by 58 medical schools. The $6,000 fellowship funded her participation in a summer research project at Roswell Park Cancer Institute to study how certain components of the immune response may help kill tumor cells. She worked with her mentor, Richard Bankert, V.M.D. , Ph.D., associate chief of Roswell's department of molecular immunology and professor of microbiology. Prim will present her research findings at a threeday symposium in january. Prim has received the Buffalo Urban League Youth Award and the medical school's Dean's Commendation Award for Academic Excellence. ln addition, she has received the Buffalo Foundation Award and the Special Merit Fellowship for 1993 to 1995, and is copresident of the UB Chapter of the Student ational Medical Association. Two former UB medical students , Andrea Williams, M.D. , and Yvette Vinson , M.D. , are previous recipients of the national award. -!11'1'"'--...,..------...... Michael E. Msall, M.D. B u a a p 5 c a ... u m n 9 9 �SUNY trustees namelJrouy-and-- -versrty~erecei~ed a doctorate from the , , , Umversny of Mmnesota. Hong distmgmshed professors suk Ki Hong, M.D. , Ph.D., uB professor of physiology, was named a distinguished professor in january in recognition of his reputation and contributions to research. A UB faculty member since 1975, Hong also serves as director of graduate studies in the department of physiology. Before coming to UB, he was professor and chair of physiology at the University of Hawaii. Hong's research interests lie in the areas of renal and environmental physiology. He has authored or co-authored wo School of Medicine and Biomedical Sciences faculty members have been awarded the rank of distinguished professor, the highest in the State University of ew York system, by the SUNY Board of Trustees. The rank is an order above full professorship and has three co-equal designations: distinguished professor, distinguished service professor and distinguished teaching professor. The rank of distinguished teaching professor was conferred upon Harold Brody, Ph.D., M.D., professor of anatomy and cell biology. The designation is awarded to persons who have demonstrated outstanding teaching competence at the graduate, undergraduate or professional level. Brody is a 1961 graduate of the medical school, and has been a faculty member for 40 years, serving for half of that time as chair of the department. He has done research and published widely in the field of neuroanatomy, and has served on several editorial boards, including that of Buffalo Physician. As a Fulbright scholar to Denmark in 1963, he helped establish that country's first cadaver donor program. He was one of the founding members of UB's Center for Aging and is past president of the Gerontological Society of America. He received the society's Robert W. Kleemeier Memorial Research Award for Outstanding Research in Gerontology in 1978. Brody left the anatomy department chairmanship in 1991 to continue teaching, do research and to fulfill a lifelong dream of establishing a MuseumofNeuroanatomy at UB. The museum, dedicated in january, has received national attention and is being used actively for education and research. A graduate of Western Reserve University, now Case Western Reserve Uni- B a a p nearly 190 articles for scholarly publications and more than 40 textbooks, monographs and book chapters He has earned numerous academic awards, including the Stockton Kimball Award from the medical school for excellence in research, education and service, and a special citation for distinguished service from the japanese Panel on Diving Physiology and Technology of the U.S.-japan Cooperative Program in Natural Resources. Hong received a medical degree from Yonsei University in Korea and a doctorate in physiology from the University of Rochester. 1995 Spring Clinical Day Awards given for research presentations T HIS YEAR'S FIRST- PLACE SPRING CLINICAL D AY AWARD WENT TO HANI ABDEL-NABI , M . D. , AND HIS TEAM FOR " CLINICAL APPLICA- TIONS OF W HOLE BODY PET FOG IN CANCER PATIENTS" ( R IGHT) ; SECOND PLACE WAS WON BY B IRGIT JURLANDER, M . D . AND HER TEAM FOR " CORON ARY A NGIOGRAPHY AND B IOCHEMICAL MARKERS IN UNSTABLE A NGINA PATIENTS" (BELOW) ; AND T H IRD PLACE WAS AWARDED TO H RATCH L. K ARAMANOUKIAN , M . D ., AND HIS TEAM FOR " D ECREASED P ULMONARY N ITRIC O XIDE S YNT H ASE A CTIVITY IN THE R AT M ODEL OF C DH" (R IG H T) . y 5 c a n A u u m 9 9 5 �THEN . . . . NOW Medical school enjoys rtch African-Amellcan herttage RECENT FOCUS ON UNDERREPRESENTED MINORITIES BUlL T ON A HISTORY OF_ " COLOR-BLIND" ADMISSIONS AND EDUCATION POLICIES FOR MEDICAL STUDENTS !though early records do not indicate race , it is University of Buffalo and completed his degree . clear that black students attended the University of Dorsette helped organize the ational Medical AssociaBuffalo School of Medicine before the turn tion for black physicians and was a trustee at Tuskegee of the century. Institute in Alabama, which Booker T. Washjoseph Robert Love was described ington built from a small normal school in a newspaper article about the into a nationally known institution with school's 1880 commencement as an 1,500 students. Episcopal clergyman who studied Other early black medical school medicine as "an auxiliary to his graduates include Frank L. ministerial calling," and was Watkins , who came to the Uniidentified then as the Univerversity of Buffalo from Montsity of Buffalo's first black gomery, Ala., graduated from graduate. His intention was the medical school in 1891 and "to undertake under Bishop died in Buffalo in 1921. Henry Holly of the island of Hayti, Harrison Lewis, who graduWest Indies, the introducated in 1918, was a member tions of the church in San of the university's first class Domingo ," according to in the College of Arts and the commencement arSciences before he transticle. Love's later writing ferred to the medical school. exerted an important inPerhaps best known locally was W. Yerby jones , a fluence on jamaican history, it was indicated. graduate of the medical Cornelius athaniel school's class of 1924, who Dorsette, a member of the lived in Buffalo for 50 years. class of 1882, was the second A prominent ophthalmologist, jones served as chief of African-American to receive a medical degree from UB. He was staff of the former E. ] . Meyer Memorial Hospital. BookerT. Washington's physician, and often was mentioned by WashMary B. Talbert, for whom the ington in speeches as an example of university's Talbert Hall is named , black perseverance and initiative. was a native of Ohio who graduated Born into slavery in onh Carolina , from Oberlin College in 1885 , married a Dorsette was separated from his mother at Buffalo bookkeeper and spent most of her life two months of age. He was raised by his grandin Buffalo. Active in local and national organizamother and graduated from the Hampton Institute in tions, she was chairman of the executive board and then 1878. Failing health forced him to president of the ational Association resign from the Medical College at of Colored Women , and vice president JOSEPH ROBERT LOVE Syracuse. After regaining his health of the ational Association of Colored and being rejected by the University Medical College of People. In 1922, a year before her death, she received the New York City because of his race , he came to the Springarn Medal from the AACP. 8 a 0 p c c u m n 9 �A Spoonful of he airline industry is in trouble. With utilization down , and many airlines cutting back on both personnel and flights , airline executives have looked to successful industries as models for their reorganization. Here's what might happen if airlines were run like the medical profession. Humor © Stu S i lverste i n , MANAGED CARE AIRLINES The terminal is neat and clean, the attendants courteous, the pilots capable. In the event of an emergency landing, M . D . HMO AIRLINES Passengers arrive eight hours before their flight after calling an "advice reservation desk" and then carry their seats out on the tarmac. They then take seats to the middle of the plane and flap their arms and hum "Anchors Aweigh. " Film: "Any Which Way But Up. " MEDICARE AIRLINES PEDIATRIC AIR They have the largest budget. Nobody can find the airport. There are three committees working around the clock to figure out how to make the airport more accessible. Problem is, the committee can't find the airport either. All seats will be first class, as soon as the seats are installed. Passengers walk out onto the runway, a short man with a bow tie hands them stickers in between answering advice calls and running to the back to help deliver the food . Every first-class seat is next to a colicky infant and breastfeeding mother. The movie: "Sophie's Choice: Augmentim" Complimentary drink : Pediatri c cocktail: amoxicillin and jack Daniels. PSYCHIATRY AIR First-class seats are couches. Coach passengers break up into small discussion groups. Flight destination is "wherever you want to go." Midway through the flight the pilot announces "I am experiencing some turbulence, but we aren't here to discuss me." The movie: "julia Child: Cooking with Lithium." SURGERY AIRWAYS The cashiers, flight attendants and pilots all wear shower caps and shoecovers, even though the flight isn't a sterile environment. Midwa y through the flight a steering wheel and earphone piece are thrown out of the cockpit, and you hear the pilot admonishing the crew, that "these aren't the ones I iike to use. " Th e movie: "A Broviac Runs Through It" The meal: Nobody has ever eaten it. B a a p h the pilot has to call an 800 number to get approval to lower the oxygen masks. They also have a fleet of Lear jets for the CEO of the airline. The crews receive lucrative incentives for talking passengers out of flying at all. s c a Stu Silverstein , M.D., pres ident of Standup Medicine Seminars of San Francisco, California, and Stamford, Connecticut , lect ures nationwide on humor and medicin e. He is also co-author of What About Me?, a booh on growing up with a develop- mentally di sabled sibling. u m n 5 �Fierro '66, inspiration for fictional, best seller M.E. AS THE REAL-LIFE VIRGINIA CHIEF MEDICAL EXAMINER , MARCELLA FARINELLI FIERRO SEES HER ROLE IN THE " KAY SCARPETTA" MYSTERIES AS "GREAT FUN" r. Kay Scarpetta and Dr. Marcella modest about her role as the model for Farinelli Fierro '66 are both bril- Kay Scarpetta. She is also quick to liant medical detectives, forensic point out that she doesn't physically pathologists who are among the resemble the fictional medical exambest in the business at unlocking iner. ''I'm definitely not 105 pounds the secrets of the dead and letting and five feet tall with blue eyes," she them tell the tales of how they lived and died. The fictional Dr. Scarpetta has gained worldwide fame as the heroine of Patricia Cornwell's best-selling mysteries. The latest, From Potter's Field, follows Scarpetta from Virginia, where she is chief medical examiner for the Commonwealth of Virginia, to ew York, where she confronts her principal adversary, psychopathic killer Temple Gault. While Scarpetta is fictional , she is, according to Cornwell, based on her mentor, Marcella Fierro, who is the real-life Virginia chief medical examiner. "1 consider her the best forensic pathologist in the world, and she has been a tremendous inspiration to me. " During an interview promoting her new book, Cornwell told a national audience how sur- Dr. Marcella Farinelli Fierro '66 prised she had been to discover a woman serving as a medical examiner says with a laugh. when she walked into the M.E.'s office She also doesn' t followthe lifestyle 10 years ago. Cornwell, a former news- of Scarpetta, who is divorced and enpaper reporter, ended up spending five joys affairs with FBI agents. Fierro and years working as a technical writer in her physician husband have two chilFierro's office and researching the op- dren , neither of whom is following erations of a real-life morgue for her their parents' medical career path, almurder mysteries. though their son is in law school and Fierro considers her role in the best- is interested in criminal law. Their selling mystery books "great fun" and is daughter is a legislative assistant to a s u 0 0 p h 5 o n A orth Carolina congresswoman. Fierro and Cornwell have become close friends, and she remains one of Cornwell's chief advisors, reading every manuscript for factual errors. Growing up in Buffalo, where she attended D'Youville College and the University of Buffalo School of Medicine and Biomedical Sciences, Fierro never dreamed of serving as a mystery book heroine , or even working as a pathologist. "While in medical school 1 was very interested in internal medicine, but once I did my pathology rotation I found this area of medicine fascinating," she recalls. "I was also inspired by the late Dr. Judith Lehotay (formerly Erie County's chief medical examiner), who was one of the first female forensic medical examiners." After medical school graduation in 1966, Fierro did her internship and additional training in Ottawa, Canada's capital, where her husband , Robert, was in training as an obstetrician-gynecologist. She had two more years of pathology training at the Cleveland Clinic, and another year of forensic pathology training at the Medical College of Virginia. She was certified in fo rensic pathology by the American Board of Pathology in 1975, becoming just the ninth woman certified by the ABP in forensic pathology. She served as Deputy Chief Medical Examiner for Central Virginia u m n 9 �············································· · ·········································· ~ for 17 years, followed by 18 months association's board of directors and as professor of pathology at East the executive committee. Fierro is a Carolina University School of Medi- fellow of the pathology-biology seccine, where she taught general and tion of the American Academy of Foforensic pathology. In 1994, Fierro rensic Sciences. She has also served as returned to Virginia to assume her a consultant to the FBI and on a panel current positions as chief medical studying gunshot wounds. She has examiner and chair of the depart- been published in professional jourment of legal medicine for the Com- nals and contributed chapters to sevmonwealth of Virginia, and profes- eral books, and is currently editing sor of pathology at the Medical Col- the second edition of a text on identification for the College lege of Virginia. of American "Forensic Patholopathologists. gists are reAlthough ally medical detectives an~M~nr a l1 o f who are helpcases ining the living volve dead by uncoverpeople, she is ing the causes philosophical of death," she about her work. explained. "lt all "There are a depends on million ways your focus. to look at difWithout the ferent cases, information and this field we have requires crelearn ed your focus. Without the ative thinkthrough paing and is information we have learned thology , for never borinstance, we ing." for through pathology, would never Testifying know what in criminal instance, we would never we know tocases is an day about important know what we know today child abuse part of a foand how to rensic about child abuse and how to recognize pathologthe signs of ist's job, and recognize the signs of abuse." abuse. We Fierro enjoys are saving the experi1 i v e s ence. through our work and that helps "I regard the court time as an opporus. We also owe it to the dead tunity to teach, to instruct the court," to find the cause of death and she explained. discover the killer in case of She is past president of the National Association of Medical Examin- homicide . " ers and presently serves on the - s v o E a o R A H w 1 L L 1 A M s B a 0 p h y s c a n A • Stephen Kimatian '92,is 1994 Air Force Flight Surgeon of the Year tephen]. Kimatian, M.D. '92, has been named 1994 Air Force Flight Surgeon of the Year. Kimatian, a flight surgeon with the 16th Operations Medical Flight, 16th Operations Group, at Hurlburt Field, Florida, competed against representatives from nine other major air commands to win the annual competition for the Malcolm C. Grow Award. Last year, Kimatian spent 189 days supporting joint special and national security operations in Bosnia, Somalia and Haiti. Kimatian was the first medical officer to reach the scene when an Air Force AC-l30H gunship crashed in the Indian Ocean in March. After triagingand treating the survivors, and transporting them to a avy vessel for further treatment, Kimatian returned to the crash site to coordinate mortuary affairs and collect information as part of the interim accident investigation board. Before activation of the 16th Operations Medical Flight, Kimatian evaluated the contents of medical rucksacks and medical Rapid Response Development Kits used during deployments. He served as a clinical instructor for medical technicians, advanced cardiac life support instructor and clinical advisor to joint medical planners preparing for training. Kimatian entered the Air Force after his graduation from the School of Medicine and Biomedical Sciences in 1992. He completed his internship at Wilford Hall Medical Center, Lack land Air Force Base, Texas; the USAF Hyperbaric Medicine Course, Global Medicine Course, Brooks Air Force Base; and Combat Casualty Care Course, Camp Bullis, Texas. He served with the 55th Special Operations Squadron at Hurlburt Field until activation of the 16th Medical Operations Flight in October 1994. u m n 9 �Arthur J. Schaefer, M.D. '47,wins Lucien Howe Award from 1954 to 1956 as chief of ophthalmology at hospitals in Korea and japan. He was named technical advisor to japan's first eye bank in 1955. A specialist in ophthalmic plastic and reconstructive surgery, Schaefer has maintained a private practice in Snyder since 1959. He has been a member of the medical school's teaching staff since 1952, and is a clinical professor of ophthalmology and a clinical assistant professor of otolaryngology. Schaefer has published widely in professional journals, and has been an invited guest lecturer in the United States and abroad. Active in professional organizations, he is past president of the American Society of Ophthalmic Plastic and Reconstructive Surgery. He is a fellow of the American College of Surgeons, the American Society of Ophthalmic Plastic and Reconstructive Surgery, the American Academy of Ophthalmology and the European Society of Ophthalmic Plastic and Reconstructive Surgery. In 1989, he was elected chairman of the advisory board of the American Society of Ophthalmic Plastic and Reconstructive Surgery. He has been a member of the editorial board of the journal Ophthalmic Plastic and Reconstructive Surgery since 1985. rthur J Schaefer, M.D. '47, anationally known ophthalmic plastic and reconstructive surgeon, has received the Lucien Howe Award for contributions to the field of ophthalmology. The award is presented jointly by the School of Medicine and Biomedical Sciences and the Buffalo Ophthalmology Society. Recipients are selected by a national committee. The award was first made in 1928 to Dr. Edmund B. Spaeth, director of ophthalmology at the Wills Eye Institute in Philadelphia. Schaefer is the 22nd recipient of the prestigious award, and the first Buffalonian. He received the award, a specially cast gold medal, in ceremonies held this past spring. Howe was a pioneering oph- Arthur J. Schaefer, M.D. thalmologist and researcher who practiced in Buffalo in the late 19th and early 20th centuries, and was a member of the UB medical school faculty. In 1926, he founded the Howe Laboratory of Ophthalmology at Harvard Medical School, known worldwide for its research. Schaefer graduated from Canisius College, took his medical internship and ophthalmology residency in Buffalo hospitals, and has spent most of his career in Western New York. He started the oculoplastic, lacrimal, orbital and reconstructive surgical clinic and service at the former E. j. Meyer Memorial Hospital in 1961. The service was the medical school's first subspecialty clinic. Schaefer served in the U.S. Army B u a a Paulette Smart '92,wins AMAI Burroughs-Welcome award aulette A. Smart, M.D. '92, has received the 1995 American Medical Association/Burroughs-Welcome Leadership Award for leadership in community service. A third-year resident in physical medicine at Ohio State University Medical Center when the award was made, she was one of 40 residents and fellows selected for the honor that allows them to participate in the Ameri- p h y s c a n ll. can Medical Association meetings for resident physicians. One of Smart's goals is to be a mentor to young people. She was active in the Big Brother/Big Sister program when she was a student at Pace University in Pleasantville, N.Y. , where she received her bachelor's degree in 1988. While in medical school, she taught physics on weekends to gifted high school students, and participated in musical groups that performed in nursing homes and children's units. She also spent five weeks in jamaica, West Indies, providing medical services to the less fortunate. Smart joined other resident physicians in session at the AMA's annual meeting in Chicago last june. She will also attend the group's interim meeting in Washington, D.C., in December. Seibel '66,honored for years of work at ECMC'strauma center he Erie County Medical Center Lifeline Foundation recently honored Roger W . Seibel, M.D. '66, at the foundation's annual black tie dinner dance. Seibel is ECMC's clinical director for the department of surgery and also serves as director of trauma services and the burn treatment center. Seibel, affiliated with the medical center since 1973, was influential in the establishment of one of the first trauma units in the country there. In 1989, the New York State Department of Health recognized the unit as the regional adult trauma center for the eight-county Western New York area. The unit treats over 1,600 trauma cases annually. Since 1989, Seibel has also been director of Western New York's regional burn treatment center at ECMC- the only one of its kind between Pittsburgh and Rochester. Seibel is a clinical professor of surgery u u m n 9 9 5 �and clinical associateprofessor of orthopaedics. He has published chapters in several books and authored articles in refereed journals. His article, "Blunt Multiple Roger W. Seibel, M.D. Trauma, Femur Traction and the Pulmonary Failure-Septic State," changed the way trauma patients are cared for. A 1966 graduate of the School of Medicine and Biomedical Sciences, Seibel began his residency program at the former E.j. Meyer Memorial Hospital in 1967, and was drafted by the United States Air Force in 1968. After a year in Texas and a year in Vietnam, he returned to Buffalo in 1970 to complete his residency. Franklin Zeplowitz '58, chief of staff and medical director of Our Lady of Victory Hospital, was honored recently for his distinguished service by hospital president and CEO Albert Candino (far left), chairman of the board, and retired Bishop of the Catholic Diocese of WNY Edward Head (center) and Bishop Robert C. Wurtz (far right). Irene Snow '80,among alumni elected to medical society posts The third woman physician to head the were Russell W. Bessette , M.D. , D.D.S. organization since its founding in 1821, ' 76 , president-elect; Franklin she succeeds David Scamurra, M.D. Zeplowitz , M.D. '58 , vice president; edraj. Harrison, M.D. '77 , secretaryeveral alumni of the School ofMedi- Snow is a diplomate of the American cine and Biomedical Sciences have Board of Internal Medicine, and is cer- treasurer. been elected officers of the Medical tified by the National Board of Medical Examiners. Society of the County of Erie. As a member of the county medical Irene S. Snow, M.D. '80 , clinisociety, she has served as president cal associate professor and chief elect, vice president, secretary-treaof general medicine for Buffalo Medical Group , was installed as president at the surer and as chair of the group's pubargaret Paroski , M.D. '80 , society's annual meeting held in June. lic health committee. She is also a president of the Medical member of the Alumni Association, has been Medical Society of elected a vice president of the State of ew Erie County Medical Center's York, the American lifeline Foundation , a notMedical Association, the American for-profit corporation that raises e sure to set aside time to celebrate the Sesquicentennial at Spring Clinical Day, May College of Physi- funds to develop programs and encians and the hance patient care at the medical 11 , 1996. Sherwin B. uland , M.D., author of "How Women Physicians center. Paroski is clinical director ofECMC's We Die ," will deliver the annual StocktonAssociation. department of neurology and an associAlso elected to Kimball lecture. ate professor of neurology. one-year terms Paroski '80,named vice president of ECMC'sLifeline Foundation Mark Your Calendars B a 0 p y s c a 1>. u m n �• ······ · · ····· ·········· ···· · · ····· ··· ··················· ····· · ··· ·· ····· ······· ···· ····· Sesquicentennial Reunion Weekend set EXT YEAR 'S REUNION WEEKEND AND SPRING CLINICAL DAY WILL COINCIDE WITH THE CELEBRATION OF THE MEDICAL SCHOOL'S SESQUICENTENNIAL ANNIVERSARY , WITH REUNION CELEBRATIONS ON FRIDAY , MAY 10 , AND THE STOCKTON KIMBALL LECTURE ON FOUNDERS' DAY , SATURDAY , MAY 11 . HAROLD J. LEVY, M.D. '46 Al ROWE, M.D. '46 MARVIN PLESKOW, M.D. '51 AllEN GOLDFARB, M.D. '51 JOSEPH KUNZ, M.D. '56 JOHN HODSON, M.D. '56 ROBERT REISMAN, M.D. '56 MIKE COHEN, M.D. '61 JARED BARLOW, M.D. '66 JOEL PAUll, M.D. '71 DENNIS NADLER, M.D. '71 JOHN BODKIN, M.D. '7 6 STANLEY BUKOWSKI, M.D. '81 BRIAN SAME, M.D. '81 PANO YERACARIS, M.D. '81 SANFORD LEVY, M.D. '86 PAUL HOLMWOOD, M.D. '86 SUSAN llnLER, M.D. '91 B 0 0 p h s o n m 9 9 �CLASS OF 1 946 CLASS OF 1981 CLASS OF 1 966 "Fifty years and still going strong! join us and celebrate. So many memories to share! " Harold J. levy "We would like to see you all back for the 30th reunion. Looking forward to reminiscing, renewing friendships and the fellowship. Please join us. " Chairman Jerry Barlow AI Rowe Chairman "It's been a rapid 15 years. Let's get together and try to catch up. Hope to see you in May '96! " CLASS OF 1 971 CLASS OF 1 951 Morv Pleskow Chairman AI Goldfarb Co-Chairman CLASS OF 1956 Stanley Bukowski Co-Chairman Co-Chairman "Can you believe it? Forty-five years! Our class reunion- May l l , 1996. Please, reserve this weekend! It's too important to pass up. It will be great fun to become reacquainted , renew old friendships, and enjoy the warm companionship we shared in the past. Do your best to join together for this very special celebration! " "Why wait five more years7 Come to Buffalo in the spring and relax with a few choice classmates! " "After 25 years it will be great to see one another. Looking forward to our Silver Reunion! " Brion Some Co-Chairman "Enough time has passed so that at least some of us will have grown up! Hope that as many as possible will be able to come and that all are well. " Joel Poull Co-Chairman Dennis Nadler Co-Chairman Pono Yerocoris Co-Chairman CLASS OF 1 976 "Class of 1976- can you believe 20 years have gone by?! Come back to your medical beginnings. There will be only one 20th-year reunion. Don't miss it! " "Come back and see how the medical school has changed and how all of us have changed in 10 years. " John Bodkin Sanford Levy Chairman Co-Chairman CLASS OF 1 986 "Forty years! It is time to celebrate! " Andrew Gage Paul Holmwood Joseph Kunz Co-Chairman Co-Chairman Co-Chairman John Hodson CLASS OF 1 991 Co-Chairman Robert Reisman "It's hard to believe that five years have passed since medical school and that some of us are still residents! I am looking forward to seeing all of you for a little wine , a few stories, laughs and baby pictures. " Co-Chairman CLASS OF 1961 "Set aside the time and help us celebrate the Sesquicentennial at the school and our 35th reunion in Buffalo, the weekend of May 10, 1996. " Susan littler Chairperson Mike Cohen Chairman Ed Manning Co-Chairman B u 0 0 p 5 a A u m �1995 Alumni Achievement Awards made IVE MEDICAL SCHOOL ALUMNI WERE THE RECIPIENTS OF THIS YEAR ' S ALUMNI ACHIEVEMENT AWARDS . ALL PICTURED WITH OUTGOING ALUMNI ASSOCIATION PRESIDENT RUSSELL BESSETTE '76 ARE : AT TOP LEFT , HARRY METCALF ' 60 ; AT BOTTOM LEFT , THOMAS GUTTUSO ' 60 ; AT TOP RIGHT , ROLAND AND SIDNEY ANTHONE '50 ; AND AT BOTTOM RIGHT , NORMAN CHASSIN ' 45 . HURWITZ & FiNE, P.C. I ATTORNEYS AT LAW I SERVICING THE LEGAL NEEDS OF THE HEALTH SCIENCES COMMUNITY Managed Care • Purchase&SaleofPractices • Business&Tax.Planning • HCFASafeHarborRegulations and Physician Self-Referrals • Contracts with Private & Public Entities • Employee Relations Counseling • Fringe Benefit Programs • Representation Before Government Agencies on Audit & Business Issues • Facility Finance and Construction • Credentialing and By-Laws • Hospital/Medical Staff Issues Please contact Robert P. Fine or Lawrence M. Ross at 716-849-8900 1300 Liberty Building • Buffalo, New York B 0 0 p h s c 0 m �Harold Brody, M.D. '61, professor of anatomy and cell biology and former chair of the department, received the 199S Distinguished Medical Alumnus Award from John Naughton, M.D., vice president of clinical affairs and dean of the School of Medicine and Biomedical Sciences. The award, a specially designed crystal bison, was presented at a dinner honoring Brody in October. ~niuersit~ at ~uffalo meaical ~lumni ~irector~ UNIVERSITY AT BUFFALO 1 B-MONTH SES~UICENTENNIAL C: DESK CALENDAR TIIE 1996 Universily al Buffalo Medical elebrate 150 years of tradition with the University at Buffalo 18-Month esguicentennial Desk Calendar, an elegantly designed calendar featuring illustrations culled fi·om University Archives. Each month's images-selected for their Alumni Directory has officially been released! character and umguenesschronicle UB's history. The calendar comes with a custommade lucite holder and stand, and is gift boxed. Medical Alumni. Dislribulion has already begun for Since Lhis is our Sesquicenlennial Edilion, you won'L want Lo miss oui. It is not too late to order your own copy of the directory. This comprehensive new volume is a compJation of tbe mosl current data avaJable on over 5,300 Lhose who reserved dreir copies early. If you wish to place an order or have any queslions about tbe directory, please contact our publisber directly at the (allowing address: CUSTOMER SERVIC E D E PARTMENT B E RN A RD C . HARRIS PUBLISHING Co., INC. 22 KO GE R C E NT E R NOR F OLK , VA To order, please call Stella Ryndak at (716) 645-6969. B u a a 23502 Or call t/1e Customer Service Department toll /ree at 1-800-877-6554 p h y 5 a n A u m n 9 �SPRING CLINICAL DAY Spring Clinical Day and Reunion Weekend '95 EDICAL SCHOOL ALUMNI AND OFFICIALS GATHERED AT THE BUFFALO MARRIOTT FOR THIS YEAR' S SUCCESSFUL SPRING CLINICAL DAY , FEATURING STOCKTON KIMBALL LECTURER RICHARD KRUGMAN , M . D . �AND REUNION WEEKEND REUNION CLASSES FROM THE PAST 50 YEARS CELEBRATED IN GRAND STYLE AS THESE PICTURES CLEARLY DEPICT . �• ················ · ·········· · ········ · ··· · ·········· · ······················ · ··········· · ··· . I November. In ad- 19505 E D W A R D of SHANBROM '51 , Santa Ana, California, received an honorary doctor of science degree from Allegheny College. THOMAS HAMILTON elected president of the Buffalo on March 8, 1995. He joins his Surgical Society and secretary- sister, Leah, 4 , and brother Paul, establishing an an- treasurer of the Medical Society 2 1/2. nual award in his name to honor fu- of the County of Erie. She also recently became a partner in the ture leaders in the formation of Delaware Surgical field of palliative Group, P.C.,agroupoffivegen- pain and symptom eral surgeons working at Millard WILBUR '69 , South and South west and Who's Who in the World. 6 9 IRVING KOLIN '65 , 0 5 of Winter Park, Florida, was invited to the and named professor of pediatrics and radiology and interim chair of radiology at the University of Iowa. He has six children and one grandchild. Governor's Institute in North Carolina to present recent re- 7 9 0 5 naltrexone in the treatment of alcoholism. Dr. Kolin also spoke at Duke University's department of psychiatry, where he addressed the topic of neurotransmitter systems and the use of medication in the treatment of alcoholism. JOAN G lAM POLl '90 and CRAI G were recently wed NARINS '90, in Scarsdale, New York. Or. Giampoli completed her resi- 8 9 0 DAVIDS . K OU NTZ '81 , 5 ofPhila- Strong Memorial Hospital, in ew York, where she Rochester, delphia, has moved from was chief resident in pathology. Hahnemann University Hospital to Temple University as asso- She is a fellow in surgical pathology and cytology at Strong. Dr. ciate professor of medicine and arins completed his residency director of ambulatory care at Duke University Hospital in there. He has two sons, David, 4, Durham, and Matthew, 18 months. cardiology fellow at Strong. SH I RA R UBINSTEIN '85 , search findings on the use of 5 dency at Vanderbilt Medical Center in ashville, Tennessee, and of Iowa City, tion of University Radiologists, 0 Fillmore Health System and St. SM I TH elected president of the Associa- 9 9 joseph Hospital. Iowa, has been new edition of Who's Who in the third child, Michael Nicholas, oring Dr. Milch by II ' 57 , oflasVegas,Nevada, Marvin A. McMillen '75 has been listed in the has been dition, CHI is hon- management. P . NEDRA HARR ISON '77 , directs orth Carolina. He is a R OSALIND N OLAN S U LAIMAN married of the Child and Adolescent Out- '91 , Wrentham, Massachusetts, has patient Psychiatry Clinic at M . D ., been appointed chief of internal Georgetown University, Wash- cember 1994. She is expecting a medicine at the Rehabilitation ington , D.C. She will present a baby this December. She is com- Hospital of Rhode Island. Or. paper at the American Academy pleting her med-peds residency at Sgalia currently practices inter- of Child and Ado- Baylor this year; her nal medicine and cardiology in lescent Psychiatry's husband is finish- Hopedale, Massachusetts. He has annual meeting in ing his ID fellow- A RTH UR C . S G A LI A '73 , A D E L S U LAIMAN , (Georgetown '90) in De- medical served on the faculty of the Uni- ew Orleans. She ship. They plan to director ofHospice Buffalo, clini- versity of Massachusetts Medi- cal professor of surgery and ad- cal School since 1978. writes that she and her husband love where his father is ROBERT A . M I LCH '68 , Washington, D.C. Elaine Ziavras '85, ambassador, for a has been named chief of surgery of she adds, is in the settling, probably Michael Reese Hospital in Chi- Georgetown on the East Coast. cago, Illinois, and professor of ophthalmology surgery and physiology at the department. junct clinical professor of family medicine at UB's School ofMedicine and Biomedical Sciences, has recently been named therecipient of the prestigious Award for Lifetime Achievement from Children's Hospice Interna- practice in Oman, MAR V IN A . M C M ILLE N '75, University of Illinois at Chicago. few years before NAVY L T. PAUL D . Rosalind Nolan Sulaiman '91 S EE MAN '93 , is currently halfway He has been program director in J EFFREY surgery at the Yale Affiliated Pro- STEI NIG '88 , commitment to children's hospice care. The award will be pre- gram at Bridgeport Hospital, director of the surgical intensive York, has completed a surgery ment to the Mediterranean and residency in Savannah , Georgia, Adriatic seas and has been serv- sented at a banquet during the care unit at the West Haven and is now a partner with ing off the coast of Bosnia- tional. Dr. Milch was recognized for his personal contribution and P . of Lancaster , New through a six-month deploy- 1995 CHI National Conference OVAMC and clinical associate South towns Surgical Associates. Herzegovina aboard the dock held in Washington, D.C. , in professor of surgery at Yale for He and his wife, Maria, had their landing ship USS Gunston Hall. the past eight years. B u a 0 p y a n m n 9 �The jury is out. Your practice and assets are on the line. This is not the time to be second-guessing your choice of professional liability insurance companies. In a similar situation, a MLMIC policyholder remains confident, knowing he or she is protected by a company that already has successfully defended more physicians than all other available insurers combined. Adding t,o the value of your MLMIC policy is one of the country's largest and most experienced professional liability Claims Departments, as well as the largest Risk Management Department of any professional liability insurer in the state. MLMIC also offers New York's only true peer review of claims experience. Only physician-owned and controlled MLMIC offers this high level of quality assurance and service. MLMIC also is the only medical liability insurer approved by the Medical Society of the State of New York. Find out more about the protection you'll receive from the 2 Park Avenue New York. NY 10016 2 Clinton Square Syracuse. NY 13202 90 Merrick Avenue E. Meadow. NY 11554 largest and most successful company of its kind in America. Call1-800-356-4056 in Upstate New York, or 1-800-ASK-MLMIC in the New York metropolitan area. Our defense never rests. Cl1994 M.-:d1call ab ty Mutulll lt1!:11Jrance Company �Non-Profit Org. U.S. Postage PAID Buffalo, NY Permit No . 311 BUFFALO PHYSICIAN STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 ADDRESS CORRECTION REQUESTED PLANTING A TREE UNDER WHICH You WILL NEVER Srr DR. DEVILLO W. HARRINGTON, class of 1871, knew how to make his money grow. In fact, this man who in 1905 provided $5,000 through his will for the University at Buffalo School of Medicine, is still supporting UB today through the endowment his bequest created. THIS PERMANENT endowment in Dr. Harrington's name has grown to over $300,000 and today it supports the famous Harrington Lecture Series, which twice a year brings distinguished scientific speakers to the School of Medicine and Biomedical Sciences. DR. HARRINGTON'S LEGACY to UB is just one of many bequests which have established permanent and important endowed funds at the school. They enable UB to provide scholarships to outstanding students, enhance scientific research, support excellence in teaching and meet the ever-changing needs of the school. YOU TOO can provide the School of Medicine with a measure of permanence through a bequest. Proper estate planning helps you develop a smart financial plan. A charitable bequest provides the satisfaction that comes from planting a tree under which you will never sit, but which will bear fruit for generations to come. FOR A CONFIDENTIAL consultation on making a bequest to the UB School of Medicine and Biomedical Sciences, or to receive materials to share with your attorney or estate planning advisor, please contact: STEPHEN A. EBSARY, JR. Assistant Dean and Director of Development, School of Medicine and Biomedical Sciences UNIVERSITY AT BUFFALO UNIVERSITY AT BUFFALO SCHOOL OF MEDICINE 150 V£AAS (716) 829-2773 ��SCHOOL OF BUFFALO MEDICINE AND PHYSICIAN CLASS OF 1 999 · BIOMEDICAL • �RENEE ABDERHALDEN BETTINA ACKERMANN DANIEL ALEXANDER MARTHA ALIWALAS University of New Hmnpshire Biochemistry Johns Hopkins University Biology University at Buffalo English Cornell University Biology MICHAEL AMENT .JOYCE ANDERSON LYNN-MARIE ARONICA .JORGE ARZOLA, .JR. Princeton University English University at Buffalo Anthrop:Jlogy University of Pennsylvania Biological Basis of Behavior University of Rochester Biology/ Psychology ROBERT BAIOCCHI LISA BALDUF FAYYAZ BARODAWALA University at Buffalo Biology Case Western Reserve University Colgate University Molecular Biology/ Economics STEPHANIE BABCOCK Hamilton College Biology Biomedical Engineering TODD BATTAGLIA KURT BENHAM ROBERT BENSON FLORENCE BERO Amherst College Psychology Rochester Institute of Technology Electrical Engineering Brighmn Young University Japanese Oarkson University Chemical Engineering ... 3 �SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES THOMAS BLACK .JASON BORTON WILLIAM BREEN DEIORE BROWN University of Michigan Cellular and Molecular Biology Niagara University Biology University at Buffalo Biology Canisius College Psychology SUZANNE BURKE BRIAN CAMBI CHRISTOPHER CARLSON ALBERT CHU St. John's University William and Mary College Biology SUNY College at Geneseo Biology Johns Hopkins University PATRICK D'ABBRACCI CHANTELL DALPE PATRICIA DANAHER Carusius College Biology Cornell University Industrial and Labor Relations Dartmouth College Psychology St. John Fisher College Biology ANN DENARDIN ANDREA DE ROSAS MELISSA DIIANNI ANDRE DICK Marist College University of Rochester Physics/Astronomy University at Buffalo Biology University at Buffalo Biochemical Pharmacology Medicine Public Health THOMAS CUMBO Biology ... 4 s �OF 1999 MICHAEL DOCHERTY BRIAN DUFFY NADINE DUHAN PHILIP EHRLICH Cornell University Biology Johns Hopkins University Biology University of Notre Dame Biology Duke University B1ology SUSAN ESPOSITO DOUGLAS EVANS ANDREW FAGELMAN TANYA FALKOWSKI Brown University Brain and Behavior SUNY at Binghamton Biology Muhlenberg College Natural Science Canisius College Biology BARBARA FARE VICTOR FILADORA II OREN FIX JAMES FLAHERTY SUNY at Binghamton Psychobiology Cornell University Biological Sciences University of Notre Dame JOHN FO.JTIK KAREN FOTI NATASHA FRANGOPOULOS ERIC FUNG Rensselaer Polytechnic Institute Biology Rochester Institute of TechnologyI University at Buffalo Photography/ Social Science Cornell University Hwnan Development; Family Studies Harvard University Biochemistry Cornell University Biology and Society • 5 Mathematics �SCHOOL OF MEDICINE KAREN GERBER .JENNIFER GRIFFITH Rochester Institute of Technology Biotechnology Cornell University Nutrition AND BIOMEDICAL .JOHN HANNIBAL IV University at Buffalo Biology SCIENCES s MOLLY HARRINGTON Cornell University Biochemistry , COREY HARRISON Allegheny College Chemistry MALCOLM HEAGLE LISA HAZARD II St. Lawrence University Biology Dartmouth College Biology BRANDY HELMINIAK SUNY College at Genesee Biology \ .J. CRAIG HENRY RENEE HERNANDEZ KEITH HERR .JONATHAN HERSHBERGER Houghton College Humanities Fordham University Chemistry University at Buffalo Biochemistry University of Rochester Biology/ Philosophy STEPHEN HESS ARAM HEZEL KELLY HOLES SHANNON HOWE Wake Forest University Biology Vassar College English Niagara University Biology University at Buffalo Biochemistry .... 6 �OF 1999 HARUKA ITAKURA AMY .JONES Cornell Uruversity Biology Stanford University Biology University of Rochester Neuroscience EDWARD KIM WON HEE KIM KRISTINE KLEIN MARGARET LAFFERTY SUNY at Cortland History/ Biology University ay Buffalo CheiTilStry St. Lawrence College Biology St. John Fisher College Biology WAYNE HWANG Johns Hopkins Biology LEENA ISAC \ Du LAM KAREN LEE HENRY LEE Harvard University Psychology SANDRA LEE Barnard College Psychology Columbia College Mathematics Uruvers1ty at Buffalo Biology .JUDI LETTMAN .JONATHAN LEVINE TINGTING Ll MICHAEL LIOUDIS Cornell University B1ology New York University Biology University of Rochester B1ology University at Buffalo Biology ... 7 �OF SCHOOL MEDICINE AND BIOMEDICAL SCIENCES I MICHAEL LIPKE STEFAN LUCAS PATRICIA LUGAR KELLY MARONEY SUNY at Binghamton Biology University of Michigan/ University at Buffalo Chemical Engineering/ Biophysics University at Buffalo Anthropology University of Rochester Health and Society BRETT MASCIA TALIA MCNAMARA CARRI - ANN MEGARGEL MICHAEL MELMAN University at Buffalo Biochemistry University at Buffalo Biology Lehigh University Behavioral Neuroscience Cornell University Biology DANIELE MERLIS SUSAN MILLER KATHRYN MONTGOMERY AMY MORROW Bowdoin College Biochemistry University at Buffalo Psychology Boston University Mathematics Smith College Chemistry KHADER MUl:;)TADIR ELANA NAPOLITANO HEIDI NARINS .JEFFREY NECHLEBA University at Buffalo Biological Sciences St. Johns Uruversity Biology Williams College Chemistry Yale University Economics A 8 s �OF 1999 DANIEL NOSEK University of Rochester Electrical Engineering .JOY NWACHUKWU Canisius College Biology MICHAEL O'BRIEN CHARLIE PAN Stonehill College Biology Massachusetts Institute of Technology Electrical Engineering/ Biology NATESH PARASHURAMA PARAG PARIKH RUPAL PATEL DAVID PAWLOWSKI Massachusetts Institute University at Buffalo Biology/ Political Science University at Buffalo Anthropology University at Buffalo Biochemistry ELIZABETH PELTON DANIEL PERREGAUX STEPHEN PRZYNOSCH Wheaton College Chemistry Middlebury College Biology/ Psychology Cornell University Biology MARY ROSE PUTHIYAMADAM MICHAEL RAUH MICHAEL REMINGTON KEVIN ROBILLARD University at Buffalo Early Childhood/ Health Sciences St. Bonaventure University Biochemistry University at Buffalo Biochemical Pharmacology Cornell University Natural Resources of Technology Chemical Engineering AMY PECK Wheaton College Biology ... g �SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES CHARLES ROCHE ARI RUBENFELD SAMUEL S' DOIA AHLAM SALEH University at Buffalo Biochemistry/ Pharmacology Cornell University Biological Sciences University at Buffalo Biophysics Ccmisius College Biology ANTHONY SANTILLI KIM SCHINDLER MARSILIA SEIWELL STEPHEN SELKIRK SUNY at Allxmy Mathematics Cornell University Biochemistry SUNY at Binghamton Biology Boston University Psychology ELLYN SELLERS SONIA SHAH SHAMS SHEIKH GREGORY SHIPKEY Hartwick College Biology Williams College Biology University of Rochester Chemical Engineering Canisius College Biology NATALIE SIKKA .JENNY SPERANZA BRIAN STOUT RENEE TAEFI Cornell University Human Development and Family Studies Rochester Institute of Technology Biology University at Buffalo Biological Sciences Ithaca College Physical Therapy .A 10 s �9 IVAI University at Buffalo Biology KA~HERINE TIMOSZ Cornell University Biology Lt EBNER ER A ~A. E A~ MYW AS Cornell University BiologJcal Sciences Boston University B1ology v T Uruversity at Buffalo Pharmacy and Pharmaceutics Tufts University International Relations z Hofstra University Cherrustry Individuals Not Pictured University of Pennsylvania History • H -Y Brown University Blomedical Engineering R C UE 0 1A Cornell University Anthmpology R AN University at Buffalo Biology �:c - . . ~ _L . - _A - S - -_ . - S . . - ~. , 0 .. -· - -- . - - - F . -__ ·_ _ --- - -- -_, . - - -· .....,.___ "- ~ ---- -------- - -. ...-~ ---- __.,.,.. :-_:-9=_-_:-__:~--=-~-9_::-_- ~; __-=:~_:g_-_-: ·: -------- ..... - · - -- ~-- ------ -~J � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Autumn 1995 Subject The topic of the resource State University of New York at Buffalo. 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Research Hospital News The GME Maelstrom Putting Back the Pieces Medical School Then and Now A Spoonful of Humor Alumni Classnotes Class of 1999 Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-12-18 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v29n04 Extent The size or duration of the resource. 48 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1995 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/1282444b30b5d092a8b57c3090a58fe9.pdf 19699087ba777d50ec61ac236db76802 PDF Text Text State University of New York at Buffalo School of Medicine and Biomedical Sciences, Spring 1995 �BUFFALO PHYSICIAN Volume 29, Number 2 ASSOCIATE VICE PRESIDENT FOR UNIVERSITY SERVICES Dr_ Carole ~milh Pctrl, Dear Alumni cnl Friends, I DIRECTOR OF PUBLICATIONS TunOih) ). Conroy EDITOR Nant'tlc Tramont. R. ART DIRECTOR Alan J. Kegler ASSOCIATE ART DIRECTOR D.mdj. Riley PUBLICATIONS MANAGER )ud,on Mead PRODUCTION MANAGER t\nn Raszm.,mn Brov.n STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES Dr. John augh1on. Vice President f"r Chnit:al Affa~rs. Drm1 EDITORIAL BOARD Dr. john A Richert, Chairman Dr. Rus.sdl Besseuc Dr. Martin Brecher Dr. Harold Brod) Dr. Richard L. CoUnts Mr. Ra,; Desai Dr. Alan]. Drinnan Dr. james Kanski Dr. Elizalxth Olmsted Or. Barbara Majeroni Or Charles Paganelli Da·. Thomas Raab Dr. Stephm Spauldmg Dr. Bradley T. Truax t's a tremendous pleasure to inform you that UB's medical school was among those institutions to receive one of the last gram awards to be funded by the Lucille P. Markey Foundation. The faculty leadershtp who led thts successful effort, Dr. lam Hay and Dr. Philip LoVerde in particular, deserve the institution's gratitude for the quality of the grant proposal submitted to compete successfully in this national arena. The timing of the award and its announcement could not be better. For example, this issue of Buffalo Ph~ ~ician emphasizes research activity in the school; the new biomedical research building opens this ~pring; and the Sesquicentennial activities are upon t•s. Although scientific merit was the primary criterion on which the I~ Foundation based its judgment. the school was certainly benefitted by ' . ~the enthusiastic support and hard work of the University's administrative officers; many of our alumni, especially Dr. Thomas Frawley, Dr. Virginia Weldon and Dr. Eugene Farber; and the many faculty who helped make this multidisciplinary effort a success. The funds from this award will be used to develop further the school's commitment to the area of molei:ular parasitology. It is a tremendous tribute to the school that the core of this program will be administered bv a basic science department that has had significant historical import to the school, Mi~robiology. Thus. the Center will serve to perpetuate the memory of Dr. Ernest Witebsky, the founder of the department at UB, and his protege who served the school so well, Dr. Felix Milgrom. Both of these outstanding scientists provide the ideal role models for their successors to emulate. All in all, the Markey Award designation to UB was a great event and marks UB's further commitment to pursue its scientific missions in the years ahead. ~·4-.~ john Naughton, M.D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences TEACHING HOSPITALS AND LIAISONS The Buffalo General Hospital Michael Shaw Buffalo VA Medtcal Center ArlawKclly The Children's Hospital or Buffalo Erie County Medical Center Mercy Hospital Millard Ftllmore Health System friDIItSava Roswell Park Cancer Institute Sisters or Charity Hospital Dennis McCardt.Y () The State Unlverllry of New York at Bullalo IJuffalo Physiclo is pu!Jhshed quanerly by the State Un.iverslry of ew York at Buffalo School of Medictne and Blomedial Sciences and ~ Office of Publications. It is sent, fret: ofcharge. to alumni, fill:ulty, students, tcildrnts and l'rlendi.. The staff reserves~ ri&htto edit aD. copy and •ubmisslons accepted for publication. Address questions. commmts and submisstons 10. Eduor. Bllffl&lo Physician, State Umversuy of New York at Buffalo, University Publicauons, 136 Crofts Hall, Buffalo. New York 14260; or by e-mail to notes@pub.buffalo.edu. s.-. ....., ..... tc Buffalo Physician, 147 CfS Addition, <05 MainStrttt.BulTalo,NewYork Iilli 0. Felew Alanlli, A s winter begins to fade and the first suggestions of spring appear, our attention can tum to the upcoming Spring Clinical Day. By this time, we on the Board sincerely hope that you have responded to the AlumniOfficeandarernakingplanstorenewfriendshipsandparticipateintheSpring Clinical Day program. The sub-committee of the Board has been reviewing files and several members from the class reunion years will be chosen for Achievement Awards. The senior medical student class will be honored at an upcoming cocktail reception and we look forward to officially recognizing these new members into the Alumni Association. Once again, we look forward to seeing you at Spring Clinical ay. If there are any matters which we can assist you with, do not hesitate to contact the Alumni Office. Russell W. Bessette, D.D.S., M.D. '76 Prnident. Medical Alumni Association �V 0 s 2 L p R 9 N N G 2 0 9 9 5 Research FDA chief David Kessler delivers Harrington Lecture. Page 20. Hospital News Building the Future of Research UB's new research building brings together researchers in a way designed to produce results far beyond what they can accomplish alone. Restructuring Research at UB The reorganization of scientists and clinicians promises synergistic results. Medical School Then and Now ASpoonful of Humor Alumni Classnotes Garden Spots ECMC' s roots. Then and Now. Page 24. �E J ·························································································· Landmark UB study shows major illness in West Side population esidents of Bqffalo's low-income, largely Hispanic Lower West Side are twice as sick as the U.S. population living in poverty, and face major barriers to receiving adequate health care, according to a comprehensive health survey conducted by the UB Center for Urban Research in Primary Care. The study is one of the first of the health status of a pocket of the urban poor in general, and of an urban Puerto Rican population in particular. The study is also one of the first of Puerto Ricans, who account for threefourths of Buffalo's Hispanics and comprise the major portion of Hispanic populations in ortheastern cities. "Most existing studies of Hispanics have been done with Mexican-Americans in the Southwest and West," said Carlos Roberto jaen, M.D., Ph.D., study project director and UB assistant professor of family medicine and social and preventive medicine. Demographics from the study show the population to be 54 percent Hispanic (three-quarters Puerto Ricanborn) , 29 percent non-Hispanic white and 17 percent African American. The number of men and women are nearly equal. Seventy percent are under 40. Smoking, alcohol consumption, asthma and diabetes are major problems in this population in which conventional written health information isn't very useful because more than a third of the residents did not complete high school. And when members of the Hispanic population go to a hospital or doctor's office in Buffalo, they often can't communicate with the English-speaking staff and physicians, the study noted. The results also indicate that, contrary to early assumptions, most residents of this low-income neighborhood have access to health care and are cov6 u 0 0 p Carlos Roberto Jaim, M.D., Ph.D., UB assistant professor and West Side study director. ered by some type of health insurance. Bilingual interviewers went door-todoor to gather data for the study, completing interviews at 826 households representing 1,873 individuals, for a response rate of about 78 percent. UB-Roswell researchers win $8.9 million in grants from NCI rants totaling $8,914,038 have been awarded by the ational Cancer Institute to UB and Roswell Park Cancer Institute researchers. john A. Blessing, Ph.D., UB adjunct assistant professor of statistics of the statistical office of the gynecology oncology group at Roswell, won a five-year $7,514,692 grant to fund that group's ongoing work of collecting and correlating data. Margot M. Ip, Ph.D., UB research professor in Roswell's department of experimental therapeutics, won a fouryear, 734,752 grant to investigate gene expression in normal mammary cells and try to determine the way this expression is disrupted by malignancy. h y s c 0 5 Enrico Mihich, M.D., of Roswell's department of experimental therapeutics, won a three-year, $342,763 grant to study cancer chemotherapy and immunologic effects. The research will expand previous in vitro work on Adriamycin and examine its effects in vivo. Thomas Shows, Ph.D., UB research professor from Roswell's department of human genetics, won a three-year, $321,831 grant to clone chromosome 11 genes. Questions raised about use of growth hormone for short stature ost short children are well-adjusted and have no serious social or emotional problems, despite assumptions by some physicians and parents, a study by researchers at UB and The Children's Hospital of Buffalo shows. The research hits at the heart of the controversy over whether to treat short children who are not deficient in humangrowth honnone. One rationale to treat was to improve psychosocial functioning. p n g 9 �······ · ····· ··· ····· ·· ········· · ····· · ·· ·········· · ····· · ······· ·· ······ · ··· · · ········· · ·· E : J "Shorter-than-normal children may be teased, and they may be treated as if they are younger than they are, but, despite that, they are doing pretty well," said David E. Sandberg, Ph.D. , assistant professor of psychiatry and pediatrics, B has won a new three-year, and lead study investigator. "Previous 600,000 grant from ASA to reports had led us to believe these chilstudy the physiological mechadren were quite bad off." nisms behind observed cardiovasThe study, published in last cular regulatory phenomenon in December's issue of Pediatrics, is based zero-gravity. on data from 258 children referred to a The award is based on research conpediatric endocrine clinic because of ducted on cardiovascular functioning shorter-than-normal stature. Parents and deconditioning in microgravity on completed a Child Behavior Checklist; two ASA Space Lab flights that found children 12 years of age and older com- blood pressure in flight is regulated by a pleted a comparable questionnaire them- decrease in vascular resistance in reselves. Responses were compared with sponse to an increase in cardiac output those from normal children and chil- induced by microgravity. dren referred for mental-health services. This phenomenon was first observed Earlier studies reported problems in UB research among children with moderate to severe short stature, including socialization based on height rather than age, stigmatization because of appearance, poor social skills, social isolation, low self-esteem and poor academic achievement. But these data were primarily from short children with conditions such as underactive pituitary or chromosomal anomalies. The UB study showed that parents rated boys somewhat less socially competent with somewhat more behavior problems than the normal sample, but without major ·~ psychosocial problems. The short boys ."~ were rated as functioning disor tinctly better than the group referred for mental-health services. Boys' ratings of themselves mirrored their parents on social activ: -~ ity, but they didn't report having more behavior problems. Short adolescent boys rated themselves better athletically than conducted on Space Lab l. Findings in the second study, conother boys their age. Short girls showed little difference in social functioning, be- ducted on Space Lab 2, also showed that havior problems and self-esteem and re- the ability of astronauts to perform work ported being better at athletics than the when they returned to Earth, as meacomparison group. UB wins $600,000 NASA grant to study BP regulation in space B a 0 p y 5 c 0 5 p sured by performance on a specific physical-exercise regimen, was decreased, and that there was a relationship between the ability to perform work and time spent in space. Astronauts on Space Lab 2, who were in flight for 15 days, performed less well upon their return to Earth and remained limited longer than their counterparts on Space Lab 1, in flight for nine days. Both in zero gravity and in readjusting to Earth's gravity, the astronauts' bodies regulated blood pressure by expanding or constricting blood vessels in the presence of increased cardiac output, the results showed, a phenomenon not observed prior to the two UB Space Lab experiments. The experiments and equipment used on both Space Lab experiments were designed by Leon E. Farhi, M.D., UB dis tin- · guished professor of physiology. The new experiments, Farhi said, will be conducted in simulated zerogravity environments. "If we find something interesting through these Earth-bound experiments," he added, "we will go back to ASA for another in-flight experiment." UB researchers involved in the project, in addition to Farhi were Barbara E. Shykoff, Ph.D.; Christopher Eisenhart; Richard Morin; Albert]. Olszowka, M.D.; David R. Pendergast, Ph.D., and Mary Ann Rokitka, Ph.D. n 9 0 �a ·· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · said, "john has demonstrated a remarkable ability to keep Buffalo General in a leadership position in today's increasingly complex health care scene. "With the advent of health care reform Kinnard and the need to develop integrated health care systems, John's business acumen and creativity will serve General Care Corp. and the hospital well in the years to come." Butfalo General'sKinnard and Friedlander assume new roles fter serving as president and chief executive officer of General Care Corporation since its founding in 1985, William V. Kinnard, M.D., has stepped down to devote more time to his role as president and chief executive officer of The Buffalo General Foundation. Succeeding Kinnard is john E. Friedlander, president and chief executive officer of The Buffalo General Hospital, the main entity within General Care. ln making the announcement, Thomas R. Beecher, Jr., chairman of the General Care Corp. board of directors said that Friedlander, a BGH executive since 1984, will maintain his responsibilities as the hospital's president and CEO. Beecher described Kinnard and Friedlander as "exceptional leaders whose vision and achievements have earned them the respect and admiration of their peers in the health care industry." Kinnard, who relinquished his General Care Corp. responsibilities last September, noted that the move had been planned for some time. Kinnard had served as BGH president and CEO from September 1975 until March 1990 when he was named the hospital's first fulltime board of trustees vice chairman. He will continue as chairman of the board of directors of Friedlander WestLink Corporation, a for-profit joint venture involving General Care and several other Western ew York health care providers. Commenting on Friedlander's appointment to lead General Care, Beecher B u a 0 work more closely with the most visible and respected provider of health care services in the West Side community. "This merger will enable Buffalo Columbus and Buffalo General to jointly develop a strategic direction toward providing a comprehensive array of primary ambulatory care services to address the major health problems in the Hispanic and non-Hispanic communities of the West Side," he added. BGH first WNY hospital to oiTer endoscopic ultrasonography he Buffalo General Hospital now performs endoscopic ultrasonography (EUS), a new diagnostic technique that detects Gl tract tumors with greater accuracy. The technique provides higher resolution images of tumors within the Gl tract and its adjacent structures. Buffalo General is the only hospital in Western ew York to offer the new technique, according to Siddhartha Shah, M.D. , UB clinical assistant professor of medicine. "With EUS , a detailed five-layer structure of the gastrointestinal tract wall can be easily visualized," Shah said. "GI tract tumors distort this normal five-layer structure and can be detected by this new technique , in detail. It allows us to visualize with great accuracy how far the tumor extends through and beyond the wall and whether it involves lymph nodes and adjacent structures. Shah said EUS is superior to CT scanning in staging GI malignancies, with EUS accurate in more than 85 to 90 percent of cases and CT accurate in about 50 percent. The procedure takes one to two hours and is performed in BGH's GI Laboratory, usually on an outpatient basis. Buffalo General and Columbus Hospital begin merger talks n a move designed to improve the delivery and expand the scope of health care services to Buffalo's West Side, the Buffalo Columbus Hospital, its parent organization, Buffalo Healthcare Corp., and The Buffalo General Hospital have agreed to engage in discussions that will result in a plan to merge. Buffalo Columbus president and chief executive officer Andres Garcia described the discussions as a "dynamic opportunity" for the hospital to strengthen its position as the "pre-eminent provider of primary, ambulatory care and substance abuse services for the Lower West Side. "Our aging facility and equipment have made it increasingly difficult for Buffalo Columbus and Buffalo Healthcare Corp. to provide the Hispanic community and all people on the Lower West Side with the health care services they expect and deserve," Garcia said. john E. Friedlander, Buffalo General president and chief executive officer, said BGH "welcomes the opportunity to p y 5 c a 5 p n g 9 9 �- · ·· ·· · -- - -~- - - ···· · ··············· · ····· · ·· · ········· · ·· · · · ·· · ····· · · ·· · · ····· · · · ········· · ECMC officials hope the new facility will provide simpler and faster services for outpatients using the hospital, including dedicated parking, decentralized, "point-of-service" registration and improved patient flow from one service to another. The facility would be funded through the sale of general obligation bonds, with ECMC contributing about $2 million, based on the level of surplus hospital officials expect for 1994. The twostory structure will be the first construction project at the medical center since it was built in 1978. Patients are given intravenous sedation. Routine endoscopy locates the tumor and the dedicated ultrasound endoscope examines the area. Feeley named associate director at Buffalo VA Medical Center illiam F. Feeley has been named associate director at the Buffalo VA Medical Center. He will be responsible for all administrative support services at the facility , including human resources, medical ad- .---------. ministration , fiscal and acquisition and rna teriel management. The position reports to medical center director Richard S. Droske. Prior to coming to Buffalo, Feeley held associate director positions at the VA Medical Centers in orthampton, Massachusetts, and Grand Junction, Colorado. Hospice Buffalo receives training grant to support its CHILD Project fficials at the Erie County Medical Center have announced plans to build a $14 million ambulatory care center r.ext to the hospital. The 80,000-square-foot building will house primary care, diagnostic and specialty outpatient services including family and internal medicine, OB-GYN , pediatrics, chronic dialysis, laboratory specimen collection stations and X-ray facilities. The hospital submitted a CO last December. a 0 p h ·· ···· · ~ ~ they support families in their communities. The CHILD Project team will define conditions of infants at risk and teach others to recognize these risk factors in order to appropriately refer or care for the infant. Project training will include the medical and psychosocial aspects of the problems of prematurity, cocaine exposure, HIV/AIDS, sickle cell anemia, developmental disabilities and failure to thrive. Buffalo General announces ED renovation and expansion project he Buffalo General Hospital has unveiled plans for a $5.6 million renovation and expansion of its he ew York State Department of department of emergency mediSocial Services has awarded Hoscine. pice Buffalo a $42,000 grant to John Friedlander, BGH presiprovide informational and educa- dent and chief executive officer, detional programs designed to im- scribed the project as the "most signifiprove the provision of services to cant construction program" for the hosdisabled infants with life-threatening pital since the mid-1980s when the new conditions. Hospice Buffalo is one of 16-story medical tower building was only two organizations in ew York completed. State to receive grant funding for this The project, to be accomplished in program. phases so as not to disrupt ED operaThe grant was awarded to Hospice's tions, is expected to be completed about CHILD Project, a special program intro- mid-1996 . duced in 1994 as part of a ew York The initial phase will involve conState Department of Social Service spon- struction of a two-story addition on the sored initiative to improve services to Ellicott Street side of the ED , including medically frail infants who are at risk of a new elevator to operate between the medical neglect. The grant will be ad- ground floor and the first floor of the ministered by The Life Transitions Cen- main hospital building. ter, an agency affiliated with Hospice Renovation of the first floor , previBuffalo that provides education, counously occupied by same day surgery, seling and support groups for children, will occur during the project's initial adults and families concerned about phase. In June or July of this year, ED grief, death and living with a serious or operations will move from the ground life-threatening illness. The program, floor to the first floor until renovations which began this month, will continue are complete. through February 1996. Temporary relocation will ensure The CHILD Project will assist and uninterrupted service for the more than support social services professionals as 3,000 patients who use the ED. ECMC submits CON to build $14 million outpatient care center B - - · - -·- - =-- - y s c a s p 9 9 �• • PHOTOS BY K.C . KRATT �UB's new research building brings together researchers in away designed to produce results far beyond what they can accomplish alone BY SCOTT THOMAS It looks sharp. It's built for speed -everything within ready reach, all the amenities for comfort and efficiency. It's roomier than you'd expect from the outside. You might say the new research building of the School of Medicine and Biomedical Sciences is a luxury vehicle perfect for the next stretch of the scientific highway. The new laboratories combine functionality with beauty in a classical design. �The new building features standard. institutional-quality materials used in an innovative and visually pleasing way. Light-reflective materials open up the interiors: maple casework makes the workspace bright and inviting. THE RESEARCH BUILD! G is in the final stages of completion, culminating a project more than five years in the making. The building provides for 60 wet laboratory units , each consisting of a main lab and two auxiliary labs; support facilities such as equipment rooms , utility rooms, darkrooms and "environmental chambers" for heated or chilled materials ; 60 offices for investigators; and six spacious conference areas. It's a significant advance for a school whose progress in research- one of the most significant factors in attracting and keeping high-quality faculty members - had been squeezed by a severe shortage of laboratory space. "It was essential that we make a sizable space readily accessible and functional very quickly ," says Bruce A. Holm, dean for research and graduate studies at the medical school. A faculty member throughout the time the building was being planned, Holm moved to the dean's office in 1993. joseph T. Spence , Ph.D. , Holm's predecessor as dean for research and graduate studies, was heavily involved in helping researchers, administrators and building planners reach a consensus on just what form the new structure should take. "We very much saw the building as a tool , just as any piece of equipment in the laboratories is a tool, " said Spence, who left UB in january 1993 to become head of the Beltsville Human utrition Research Center, a division of the U.S. Department of Agriculture's Agricultural Research Service. "We tried to be one step ahead of where we were today," Spence said. "We asked ourselves what people would be 0 B u 0 0 p 5 doing five, 10, 20 years down the road. And we were particularly interested in coming up with some design concepts that would make it as flexible as possible. " The existing labs in the Cary-Farber-Sherman (CFS) complex, Holm said , not only were inadequate for the number of researchers working , they needed major renovations to bring them up to state-of-the-art standards. "The problem with that," he says, "was that with the laws concerning asbestos abatement, it was incredibly costly to renovate those labs. We actually found that it was cheaper to build the new building. " The old labs will stay, he added , and "we will renovate them , but now we can do it in more of a piecemeal process. " After a competitive bidding procedure, the architectural firm Helmuth Obata Kassebaum was commissioned to design the building and supervise its construction. HOK is well-known in architectural circles - primarily for its sports facilities , including Baltimore's baseball stadium, Oriole Park at Camden Yards, Buffalo's Pilot Field and UB's University Stadium. Andy Wong, a principal at the ew York City office of HOK , served as the firm's project manager for the research building, leading a core team of three architects. He says the job involved drawing people out on what they wanted just as much as it did drawing lines on blueprints. "We understood that the mission of this project was to create more research space," Wong says. "The ability of the institution to attract research grants and talent is really tied c o n 5 p n g 9 �Maintenance-free materials were used to provide longevity as well as workability. Amenities include special flooring. Corian countertops. vinyl wall coverings and granite flooring and sculptured steel walls inthe main elevators. "Ultima tely, a lab bui lding is about the environment in into that. But that doesn't begin to define the goals of the the lab ," he says. "It's about the research environment that project, everything that's wrapped up in the warm fuzzy surrounds the investigator. It doesn't work from the outside stuff, the qualitative issues that need to be addressed. " in, it works from the inside out: how the benching works, In a series of dialogues with investigators and other how much wet space there is , how that relates to service faculty , school and campus administrators and State Univerrequirements ... sity of ew York representatives, the planners defined "We began to get a sense of the some of those qualitative issues. Says academic day there (among Wong: "They ranged from the researchers) , what the global - 'We have X numculture is there. We ber of dollars , get us the "THE MISSION of this project was to create more research discovered that most laboratories posspace. The ability of the institution to attract research grants and talent is really tied to people don' t really sible' - to the more spewant to hang around cific- 'We don't have a that But that doesn't begin to define the goals of the project. everything that's wrapped in a public space sq front door to this acaup in the warm fuzzy stuff. the qualitative issues that need to be addressed." much as have convedemic complex, and we nient access to their serwould like to create that. ' vice areas. They tend to spend "The end product, the building, more time in their research environthe attributes of the building- its modument than in the public rooms. The culture of research is larity, its flexibility- you just can't take that off the shelf and more that they need to be in their own spaces. But we built say, 'Here it is.' You have to tailor those generic approaches, and that includes siting, circulation , connectivity to the it to encourage interaction. For example, the conference existing campus, landscape issues, future connectivity. The rooms are in an area where there's a lot of circulation. " CFS complex is a pretty Byzantine maze of things. We didn't That kind of thinking is evident in the design of the want to aggravate the circulation issues, we wanted to clarify completed building. It's eight stories, including a ground them. " floor , six floors that house laboratory and office space, and a And primarily, Wong said , they talked about how to make penthouse floor with mechanical equipment for the buildthe building work best for the people whose work it was ing. The laboratory floors are laid out identically to each intended to further: the researchers themselves. other- labs , offices, support rooms and conference rooms a 0 0 p y 5 c o n 5 p 9 0 �Outside the laboratories, the floors are built for convenience and easy functionality. Support rooms and equipment rooms hold excess materials and equipment, freeing up space in the labs. Each floor has two darkrooms for developing photos and X-rays; the darkrooms are at one end of a long corridor, but an indicator light in the center of the hall shows whether the darkrooms are in use- saving busy researchers the long walk to find that out. In addition, dozens of small touches make the research building a comfortable place to work. "We had to use very maintenance-free materials, materials that have longevity," says architect Wong. "We were really challenged, because normally that grade of material is not one that the (construction materials) industry features or focuses on to try to come up with a lot of new colors or patterns. Our challenge was to use it in as innovative and visually pleasant a way as possible. "We did that by choosing very pleasing patterns on the floor, in the tiles. We took the standard, institutional-quality things and used them in a different way. We introduced daylight into the corridors by the placement of the windows. We chose to use as light-reflective materials as possible to all located in the same place, making it easy to find one's way around and easy to service the heating/cooling, electrical, water, waste, fiber optic and other supply and disposal lines. The labs themselves combine functionality with a large degree of beauty. Each laboratory unit consists of a large lab space (some with a center island) and two smaller adjacent labs where auxiliary or preparatory work can be done. There are the usual assortments of taps for purified water, natural gas and air. The countertops are a black epoxy resin, built to simulate the old slate tops that researchers have used for centuries. Fume hoods allow for work with materials that need to be vented to the outside. (ln addition, positive air pressure is maintained in the corridors, and negative in the rooms themselves, to prevent potentially hazardous airborne materials from escaping into common areas.) Solid maple cabinetry inset with glass windows gives a classical feeling to the rooms. Across the hall from each lab unit is an office space of about 14 by 15 feet; every office has a window, recessed over the attractive maple veneer that conceals the room's heating! cooling unit. The building completes a circuit with the Cary-Farber-Sherman complex and connects Squire and Harriman halls through tunnels and overhead walkways. The buildings now enclose a quadrangle of grass. ringed by sidewalks and crisscrossed with lights. B a a p h s c a n 5 p g 9 9 �- --- working with microbes or hazardous chemicals, but it can be open up the interiors. ln the labs, the maple casework was to costly in terms of heat loss. make it as bright and as inviting a space to be in as possible, To alleviate that costly loss, exhaust air passes over a because people spend a great part of their day there." series of pipes containing glycol; the heated glycol is then Thus, such amenities as chalkboards scattered throughrecirculated from the top floor down to the out the corridors for impromptu brainstormbasement, where it heats the incoming sessions, Corian countertops ing fresh air. "lt probably traps in the restrooms, vinyl wall one-third to half of the heat covering in a pattern of that would otherwise be "Ultimately. alab building is about the environment in the lab. It's about the tiny squares, special lost," Krygier says. flooring in the first-floor research environment that surrounds the investigator.lt doesn't work from the In addition , to save animal holding areas beelectricity, lights in the outside in. it works from the inside out how the benching works. how much cause it's continually building are controlled being washed down and wet space there is. how that relates to service requirements." motion sensors - no by beautiful granite flooring need to remember to flick and sculptured steel walls in the switch off when you leave. And the two main elevators add a sense of a sophisticated reverse osmosis water purification comfort and beauty as well as functionality. system treats tap water to remove sediments and bacteria by just as notable is the environmental consciousness that forcing it through a screen at high pressure, running it went into the building's design. through a charcoal filter and submitting it to ultraviolet rays. The air in the building is renewed nine times per hour, On the outside, the building completes a circuit with says Theodore R. Krygier, project coordinator for the the Cary-Farber-Sherman complex and connects Squire University's Office of Design and Construction. That's necand Harriman halls through tunnels and overhead walkessary for safety, in a building where investigators might be ways. (A passkey card system will secure the laboratory floors against intrusion from the common pedestrian corridor. ) The buildings now enclose a quadrangle of grass, ringed by sidewalks and crisscrossed with lights. Andback to the "warm, fuzzy" goals that were estabSchool of Medicine and Biomedical Sciences Research Building lished at the outset- serve as a front door to the medical school complex. Laboratory units ................................................. 60 "The materials that we chose were very quiet, so we attempted to give a lot of interest to the pattern and shapes" Equipment rooms ........ ............... .... .............. ...... 12 of the exterior, Wong says. "We chose the glass to be very harmonious with the brick. We attempted to create a diaUtility rooms ............................................... .. ...... 12 logue. The most prominent windows are for the office areas, and there are areas of large glass, such as the big vertical element at the corner of the building near the front entrance. Common work rooms .. .......... ......... .... ...... .. ......... 6 "In everything we did on the exterior, there was a very conscious effort to create an articulation of the exterior Darkrooms .. ... ... ... ...... .. .. .... ... ........ .... ... .... .. .... .. ... 12 walls. Shadow and play give this building a sense of scale. We chose to use as many of the given elements in as artistic a way Environmental chambers ................................. .. . 18 as possible. "We tried to create a sense of balance and harmony with Conference areas ............ ........... ................. .. ......... 6 the other elements that were pre-existing. The CFS complex had a fairly warm tone, and we attempted to borrow from that. The dental school had a palette that was a little more Offices ................................ .......... .. ..................... 60 rich. We tried to create a sense of harmony that would bridge all the elements that were there and at the same time create Laboratory space ....... .............. 110,000 square feet an identity distinctive to the medical school." An identity - but as yet, no name. Building .. .................... ... .. ... ... . 210,000 square feet "We do hope to name it," Bruce Holm says. "There have been some ideas. There are lots of people you can name About $54 million, funded by the State COST buildings after. " For the research building's new tenants, at least, the name University of ew Yorl? Construction Fund is excitement. B a a p h y c a n 5 p 9 9 9 �Rror~anization of scientists anrf rlinicians 111lomises srner~islic results t ��"The building is more than just a building," Holm said. "It's really meant to be a catalyst to put into effect an overall plan that's part of our mission for the next decade or two. It's allowed us to bring together people who wouldn't otherwise have come together. I'm very excited about it." Much of the school's research is performed at the hospitals of the Graduate Medical Dental Education Consortium of Buffalo, where many of the medical school's faculty both teach and practice. That hospital-based research will continue , Holm said ; the new research centers, or "affinity groups" as they are known, each comprising from 10 to 30 people, will do their work in the new building, and in renovated dry-lab space in the Cary-Farber-Sherman complex. "What we're moving are highly productive, highly thematic research groups, " he said. "They've actually in large measure self-formed. We left it to the investigators to find their own affinities, and some people are members of more than one group. " It's hoped that the new alignments will help continue a decade-long trend that has greatly strengthened the medical school's position among major medical research universities. Holm estimated that during the 199394 academic year, the school's faculty members brought in $30 million in grant money- excluding the approximately 200 faculty on the staff of Roswell Park Cancer Institute. Add in the grants to those Roswell Park researchers , and the figure climbs to $58 million. "It's dramatically on the increase ," Holm said. "My guess is that, 10 years ago , we were lucky if we were talking $10 million. "We've recruited new faculty members and initiated some new programs, and it's taken off in a big way. It's been a concerted effort to build up the research program in the school of medicine," he added. A thriving research program has two major benefits. Foremost, of course, it advances the frontiers of scientific knowledge and medical treatment. But it also gets the medical school's name out in front of the national scientific audience, making it much easier to attract the top-quality investigators and teachers who , in turn, create the best education for future physicians. Holm points out a third advantage, one that directly benefits medical students: "We have a variety of programs for the medical students centered around these research activities, that in fact teach them how to think. "When they go out into a world of medicine which is constantly changing, their education will be continuing for the next 30 or 40 years. "They need to be able to look at the literature and to be able to critically read journal articles and determine what is the best type of treatment for their patient. Having a strong research program means that we're imparting that creative thinking quality. " A comprehensive survey of research at the medical school would fill a book. But a quick overview gives a snapshot of the variety of projects being undertaken , both in basic medical science and in the clinical application of that science. Here, then , are some highlights of the medical school's research activity: Thomas]. Langan , M.D., associate professor of neurology and pediatrics and an attending neurologist at The Children's Hospital of Buffalo , coordinates an affinity group in Neurosciences focusing on the provocative idea that the brain, long thought to be unable to repair itself, "doesn't simply age and deteriorate but has a potential for a positive kind of change. " The eight members of the group , he says, are looking into such areas as how the visual system changes over time, and how it can regenerate and repair itself. Research on the cellular level, into such mechanisms as ion channels and protein secretions, seeks to discover how the nervous system changes with time and how clinicians might manipulate that. One member, a neurosurgeon , is investigating transplantation strategies to address conditions such as Parkinson's disease. Langan , whose own research concentrates on the plentiful brain cells called astrocytes , says formation of the new affinity groups can only help researchers' collaborations. "We don't talk enough to each other," he said of investigators in general. "The kind of exchange that most people find most productive is running into each other in the hall and talking things over. This will enhance that kind of day-to-day collaboration. " And Langan, who sees young patients with such brain insults as cerebral palsy, mental retardation and epilepsy, welcomes the alliances between basic scientists and clinicians. "Scientific illumination has to come before any attempt at treatment," he said. "The draw really was to try to understand some of these terrible brain syndromes, and by understanding them better, find out how to change things. " Robert Hard , Ph.D. , and his colleagues in the Imaging Center are accomplishing what was unimaginable before the invention of the microchip. Using powerful new technologies of video microscopy and computer methodology, they study tissues , cells- even individual molecules within cells. They accomplish that by using fluorescent markers to The new alignments continue adecade-long trend that has greatly strengthened the medical school's position among major medical research universities. B u a 0 p h c a 5 p n 9 9 �Bruce A. Holm. Ph.D. Associate Dean for Research and Graduate Studies Associate Professor of Neurology and Pediatrics �John A. Krasney. Ph.D. Professor of Physiology target molecules , attaching them covalently in a way that doesn't disturb the molecules' function , and then following them at low-light levels. The group has 16 members from five teaching departments. "There are people doing the same kinds of research in these different departments , and these interdisciplinary programs afford an opportunity for them to interact on a more formal basis than usually occurs," Hard , associate professor of anatomical sciences, said. Other sophisticated technology that the Imaging Center has in place or hopes to install: confocal microscopy , which enables the researcher to collect information in three dimensions and make 3-D computer models of cells; atomic force micro copy, so incredibly sensitive that it can measure forces between molecules; and laser tweezers , which use a laser beam to move parts of an individual cell around, even slicing chromosomes off a mitotic spindle. "The idea is to get everybody on a common Ooor and use (the Imaging Center) as a resource for the whole medical school, as well as promote more interactions on applying this technology to a variety of medical problems," Hard said. The Cardiopulmonary Center was initiated in 1990 to build on the medical school's diverse faculty interests in cardiovascular and pulmonary physiology. About 40 investigators are working in three major subgroups- cardiovascular medicine, pulmonary medicine and developmental biology. B u a 0 p h "Over the years here at Buffalo, one of the great research strengths of this university has been in cardiovascular and pulmonary research ," saidjohn A. Krasney, Ph.D., professor of physiology and liaison for the group. "The problem has been that we've been geographically separated. Many of the labs are at Erie County Medical Center and at other hospitals , and some of us who are doing basic science are here on the Main Street campus." ow, bringing together the affinity group can result in much more convenient and frequent interaction. "We're interested in the physiologic mechanisms that regulate and control the circulation in various situations," Krasney said. He gives as examples the problems of coronary artery disease, pulmonary disease , high blood pressure and changes in circulation that occur at birth. Cardiopulmonary Center investigators also are exploring how nutrients are carried in the blood to the body's organs and cells, and how that nutrient transfer is accomplished. One high-profile project under way is a ASA-supported study of how elevated carbon dioxide affects circulation to the brain. ln both the U.S. space shuttle and the Russian Mir space station, carbon dioxide levels have approached a very high 3 percent. "This can lead to problems in the ability of the astronauts and the cosmonauts to function, " Krasney said. One part of this study is being done in Cologne, Germany, in collaboration with scientists of that nation. c a 5 p n g 9 9 �---- -- - Robert Hard. Ph.D. Associate Professor of Anatomy and Cell Biology At the Center for Microbial Pathogenesis, researchers are looking at parasitic, bacterial and viral pathogens involving such projects as vaccine delivery systems and vaccine development, host-parasite interactions, the body's immune response to bacteria and how various viruses work in cells. One development being tested: a vac- .----.-------cine to prevent middle-ear infections in infants. The researchers point to four prevalent infectious diseases that have arisen in the past 15 years - AIDS, Lyme disease, Legionnaire's disease and toxic shock syndrome - as evidence of how much work remains to be done. This center in january announced that it has received a $1 million grant from the Lucille P. Markey Charitable Trust, which will be used primarily to hire additional researchers. Medical school officials hope that funds from this leading grant-giving organization for fundamental biological and medical research will contribute to the school's ability to attract new investigators. In announcing the award , UB President William R. Greiner said, "This important award indicates the Markey Trust's confidence in, and support for , UB's work in crucial areas of biomedical research. It will be the critical ingredient that supports major progress in the study of infectious disease." 'The Markey Trust's award will play a crucial role in the university's ability to seek matching funds for infectious disease research from other private and public foundations and agencies," said john aughton, M.D., vice president for clinical affairs and dean of the medical school. john Hay, Ph.D., professor and chair of the medical school's microbiology department and a principal investigator for the Markey award, noted, "This award will allow a marked expansion of the center's important disease investigations. It also will give a substantial boost to the national and international reputation of the center and UB. " Holm , also a principal investigator for the award, says the center developed from a collaboration initiated in 1981 by three scientists in different departments in the medical school. The center now includes 15 senior investigators , as well as support staff, and input from five departments. The pmgmms for the medical students centered around the school's research activities, in fact teach them how to think. B u a a p h y 5 c a n 5 p n g 9 9 5 �Other research efforts involve basic scientists and clinician scientists: The Metabolic Regulation Group studies how cells regulate their metabolism by hormones and other mechanisms. Investigators are looking at how cells use copper, the regulation of insulin secretion, the mechanisms governing obesity and the use of surfactants in treating lung disease in newborns. In the Molecular Mechanisms of Cell Regulation Center, researchers are investigating how proteins work in regulating cell processes and metabolic pathways, in addition to their function in such diseases as cancer, endocrine disorders and skin diseases. An overall goal of the group is to understand how these proteins affect expression of the genetic code in the body's development and aging, as well as its pathologies. Discovering the physical configuration of cells and their component molecules is the focus of the Structural Biology Center. Its investigators use X-ray crystallography and nuclear magnetic resonance imaging to discern molecular structures, including those of proteins, D A and RNA, carbohydrate and membranes. The Toxicology Research Center is in its seventh year of operation. Its focuses include developing in vitro methods of studying the body's reaction to foreign substances, in contrast to toxicology's traditional in vivo animal-based research. For example, in a study funded by the ational Institute of Environmental Health Sciences, researchers are seeking to develop biological markers that would indicate exposure to a particular substance. "The goal," says james Olson, M.D. , associate professor of pharmacology and liaison for the group, "is a simple test, like a blood test, to determine whether someone has been exposed to a substance or is susceptible to damage from exposure. " The investigators, he said, are looking for changes in molecules or cells, such as levels of enzymes or messenger R A. The group's other main focus, Olson says, is measuring levels of the chemicals themselves in the blood. For example, toxicologists have monitored the health of people who live along the Great Lakes and eat fish that may expose them to such contaminants as PCBs, dioxin and myrex. Excessive exposure may lead to reproductive and developmental problems. Initiatives in outcomes research and primary care constitute another major area of medical school investigation. Several new projects of the Rural Health Initiative study health policy and practice in the nation's rural areas. One, funded by the federal Office of Rural Health Policy, looks at the impact of managed care on rural communities throughout the United States, and the impact nurse practitioners have had on health care in rural areas. Another explores how the spread of AIDS has affected rural health care systems. A companion study looks at why immunization rates vary John Hay. Ph.D. Professor and chair of Microbiology �~~~- ~- -- -- ~ James Olson. M.D. Associate Professor of Pharmacology fighting coronary artery disease , osteoporosis and endometrial cancer; studying how a low-fat diet affects risk of cardiovascular disease and breast and colo rectal cancer; and investigating whether calcium and vitamin D supplements reduce the risk of osteoporosis, colorectal cancer, high blood pressure and breast cancer. Initiatives in Rehabilitation Medicine include the Uniform Data System, which is being developed into one of the largest databases in the world on issues in medicine , pediatrics and gynecology. "They're able to provide different subsets of this data to different people who need it for generating policy decisions, in the clinical management of patients, or to do outcomes research ," says Holm. Again , a brief survey only hits the highlights of the wideranging and growing research program at the medical school. Holm , for one, expects research to remain a strong part of the school's activity. "Our IH funding is growing, and it's as high as it's ever been," he said. "Realistically we're not going to be able to keep up this level of growth in the current (political) climate. But even if we were to plateau at the current level, I would not be unhappy. "I think it's a very exciting time ." greatly from county to county. Thomas Rosenthal, M.D. , chair of family medicine, says a new Department of Health grant will enable researchers to study how rural primary care physicians use the government's medical guidelines in treating the fast-growing illness of congestive heart failure. "We'll look how closely physicians in rural ew York State follow those guidelines, and if not, why not; and what kinds of things could be done to increase the use of those guidelines, if that's appropriate ," Rosenthal said. That's not specifically a rural issue, he acknowledged. "But there are differences in how medicine is organized in rural communities and in urban areas. We've developed a reputation for being able to look at these things in a rural environment. " Another initiative in outcomes research and primary care involve UB as one of 16 vanguard clinical centers nationwide that are part of the $635 million Women's Health Initiative , the largest clinical trial ever undertaken in the United States. Investigators are recruiting as many as 3,500 women from Western New York, and the study will include both clinical and observational components. Among the investigations: testing how effective hormone replacement therapy is in B a a p y s a 5 p n g 9 9 5 �a ······································ · ···· · ········· · ······················ · ··········· FDA chief David Kessler, M.D, J.D, delivers 1995 Harrington Lecture SAYS AGENCY HAS A RESPONSIBILITY TO DETERMINE THE POTENTIAL BENEFITS NEW DRUGS CAN BRING AS WELL AS THE POTENTIAL HARM THEY CAN BRING esponding to recent public criticisms that his agency moves too slowly in approving new drugs , Food and Drug Administration Commissioner David Kessler , M.D. , ].D. , told a standing-room only crowd at the medical school that the FDA has dramatically increased the access that patients with life-threatening diseases have to promising new drugs. Kessler delivered the D.W. Harrington Lecture February 9. He said the FDA has sped up the approval process for new drugs and increased patients' accessibility to new drugs that are still in the clinical stages of testing. Kessler, who was appointed by President George Bush in 1990, said the AIDS epidemic changed the way the FDA handles the approval process for B u 0 0 p new drugs offering potential treatments for patients with terminal diseases. He said in today's world , it is important for these patients to have the right to take a chance on a new drug when seemingly all other treatments have failed. "Experimental sources of therapy, such as new drugs , represent a rare source of hope for those people with conditions that have seemed to outsmart medical science," Kessler said. He said he realizes the FDA must address the unique problems facing those patients who have nothing to lose by trying experimental treatments. "In urgent cases where people are dying and no effective therapy exists, something more is required of the FDA," he added. The FDA has come under sharp criticism recently from conservative groups y s c o n 5 that believe the government over-regulates the pharmaceutical industry and hurts its ability to compete globally, as well as causes unnecessary deaths to people who could be helped by therapies awaiting FDA approval. Full-page ads in national newspapers trumpet, "If a murderer kills you, it's homicide. If the FDA kills you , it's just being cautious. " But Kessler points to widespread misconceptions about the length of time it takes for the FDA to approve a new drug. "For most drugs , the average approval length is l3 months, " he said, "not seven years or 10 years like most people think. " Sometimes the agency moves even quicker. Kessler, a graduate of Harvard Medical School and the University of Chicago Law School, said that in the past few years four new drugs- most notably the potential AIDS treatment, DDI - received approval in less then seven months. Kessler said this kind of fast-track approval is one of the best ways the FDA can address the needs of patients afflicted with life-threatening diseases. In 1992, he noted, the FDA also began granting conditional approval to certain drugs before final confirmation of direct evidence of their effectiveness is made. Drug manufacturers now can p g 9 �I ~- --- - ~- ---- -- · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·a I ' I I "The riskiest thing we can do is to not take risks. Especially since patients have said that they are willing to take the risks." said it is "not enough for the FDA just to get new potential therapies to people who need them. " lt is also its responsibility to "get answers" about the potential benefits a drug may bring as well as the potential harm it can cause. "The challenge," he said, "is to strike the right balance between access and answers. "One day we're going to make a mistake ," he said. "But the riskiest thing we can do is to not take risks. Especially since patients have said that they are willing to take the risks." The magnitude of these risks depends on the precision of the FDA approval process, which Kessler said "is only as good as the scientific research on which it is based. " Participation in the clinical trials phase of that research, he said, was closed to the most seriously ill patients - ironically, those who might benefit most from the experimental drugs being tested - until 1987 when the FDA opened the doors for tens of thousands of seriously ill people, mostly AIDS patients, to receive drugs free of charge while the drugs are in clinical trials Kessler said the FDA had to realize that while diseases such as AIDS "have no geographical boundaries, access to cuLLing-edge medical technology often does. " ln 1992, this program was expanded "Experimental sources of therapy, such as new drugs, represent a rare source of hope for those people with conditions that have seemed to outsmart medical science." apply for conditional approval if they prove a drug is "reasonably likely" to successfully treat a disease. Kessler said drugs receiving conditional approval are still held to the same standards as drugs receiving full approval and that manufacturers must conduct post-marketing studies to ensure efficacy. But, he said, "the less time a drug is in clinical trials, the less we will know about it and the more risks we will take when we make it available." Kessler B u a 0 p h y 5 a n 5 p to include even more patients. "Today, drugs that show promise are being made available to patients before they have received final approval from the FDA and before they are marketed to the public," said Kessler. The D.W. Harrington Lecture Series was established in 1896 by Devillo White Harrington, an 1861 graduate of the UB medical school and a professor of genitourinary and venereal diseases from 1886 to 1905. BY CHRIS SHEA Hershey appointed to Veterans Affairs Neurology AdrtsoryGroup inda A. Hershey, M.D., Ph.D., associate professor of neurology and chief of neurology service at the Buffalo VA Medical Center, has been appointed to membership on the Department of Veterans Affairs eurology Advisory Group. The appointment was made by john Booss, M.D., VA's director of neurology service for the 171-medical center system. The 11-member advisory group, composed of both VA and non-VA physicians, will serve as a policy advisory body for the nation's largest health care system. g 9 5 �a ························································································ Hauptman-Woodward Institute honors Kanski and Tomasi Nolan granted mastership in Amencan College of Physicians he Hauptman-Woodward Medical Research Institute, Inc. (HWl) honored two local physicians during its Fourth Annual Awards Luncheon held in january. james R. Kanski, M.D., clinical associate professor of medicine and a practicing physician with The Buffalo Medical Group, received the Helen Woodward Rivas Award for service to HWl. Thomas B. Tomasi, M.D., Ph.D., president and chief executive officer of Roswell Park Cancer Institute, received James Kanski, M.D. the George F. Koepf, M.D. Award for his contributions to the advancement of biomedical research. The awards were instituted in 1992 to honor the founders of HWl. Kanski received his medical degree in 1960 from UB's School of Medicine and Biomedical Sciences. A member of the HWI board of directors since 1975, he served as vice president and chairman of the nominating committee for most of his tenure. Kanski stepped down from the board in january after 20 years of service. He has also served as chief of the endocrine clinic of The Buffalo General HosThomas B. Tomasi, M.D. pital. Tomasi received his medical degree from the University of Vermont Medical School and his Ph.D. from Rockefeller University. The author of more than 300 publications and abstracts, he also serves as chairman of Roswell's department of molecular medicine. B a 0 p ames Nolan, M.D., professor and chair of medicine, has been granted mastership in the American College of Physicians by that body's board of regents. Masterships are given to fellows who have made distinguished contributions to the medical profession because of personal character, positions of honor and inOuence, eminence in practice or in medical research or other attainments in science or the art of medicine. olan received the award at the College's 76th Annual Session in Atlanta this month. Naughton receives honorary degree from Kosin University ohn aughton, M.D., vice president for clinical affairs and dean of the School of Medicine and Biomedical Sciences, received an honorary degree of doctor of medicine from the Kosin University in Pusan, Korea, last month. Naughton, dean of the school since 1975, is an acknowledged authority in the areas of exerci e physiology, exercise testing , cardiac rehabilitation, graduate medical education and regionalization of health care. His professional training is in internal medicine, cardiology and psychosomatic medicine. He holds fellowship status in the American College of Physicians, the American College of Cardiology and the American College of Sports Medicine. He has authored or co-authored over 120 peer-reviewed articles and two textbooks. He formerly directed the rehabilitation center at the University of Illinois School of Medicine in Chicago, h y a n 5 the Division of Rehabilitation Research and Training Center at the George Washington University Medical Center, Washington, D.C., and the ational Exercise and Heart Disease Project. Hui elected to fellowship by American Physical Society ek Wen Hui, Ph.D., research professor in the department of biophysics at Roswell Park Cancer Institute, as been elected a fellow by the American Physical Society. Each year the society's council elects members whose distinguished efforts have advanced physical science or its applications. Election to fellowship is limited to no more than half of one percent of the membership, or one in 200. Hui, a specialist in electron optics, was honored for his "innovative application of electron diffraction and other physical methods to elucidate membrane and liquid crystal structures, phase transition and membrane diffuse mechanisms." Sarkin named to chair pediatric association'seducation panel ichard Sarkin, M.D., clinical associate professor of pediatrics and attending physician at The Children's Hospital ofBuffalo, has been elected to the position of chair of the Ambulatory Pediatric Association's Special Interest Group on Medical Student Education. As chair, Sarkin is responsible for making recommendations on curricular structure and teaching methodologies for medical students across the country during their pediatric rotations. Sarkin is also a member of the executive committee of the council. p g 9 5 �I - -----~-~-- - ~-- - ~.- · · · · · · · · · · · · · · · · · · · · · · ·· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · o March Foundation'ssupport to school approaches $1 million loan fund to ensure help is available for students when unanticipated needs arise. lara March graduated from the University of Buffalo School of Medicine in 1907 and never treated a single patient. But she helped thousands of sick and injured people through her generous support of education for generations of physicians. At her death in 1967, the assets from March's estate were used to create a foundation for the medical school's benefit. Each year for nearly a quarter of a century, the Clara March Foundation has provided significant support for the school's students. Last year the foundation presented another generous gift of $65,000 for loans and scholarships, brining its total support to nearly $1 million. The foundation's annual gifts to the medical school provide 20 to 39 scholarships a year, in amounts from $1 ,000 to $10,000. A portion of the foundation's support is also set aside in an emergency illS elects RPCI researcher Joel Huberman,Ph.D, to rank of fellow oel Huberman, Ph.D., rese~rch professor at Roswell Park Cancer Institute and one of the nation's leading experts on D A replication, has been elected to the rank of fellow by the American Association for the Advancement of Science. Huberman, a cancer research scientist in the department of cellular and molecular biology at Roswell , was honored by the AAAS for his "pioneering studies of D A replication, particularly for his discovery and characterization of eukaryotic DNA replications origins. " Each year the AAAS elects members whose "efforts on behalf of the advancement of science or its applications are scientifically or socially distinguished. " Brodsky first woman officer of pediatric otolaryngology society inda S. Brodsy, M.D. , UB associate professor of otolaryngology and director of the pediatric otolaryngology department at The Children's Hospital of Buffalo, has been elected treasurer of the American Society ofPediatric Otolaryngology. She is the first woman officer elected to the organization. She has also been elected to the board of directors of the Society for Ear, ose and Throat Advances in Children, as well as the American Academy of Pediatrics, Section on Otolaryngology and Bronchoesophagology. At a reception for Clara March Foundation staff, trustees and recipients: from left, medical student and scholarship recipient, Aisha Prim; Foundation accountant M. Jane Dickman, C.P.A.; Foundation trustee Carmella DiPasquale; vice president of clinical affairs and dean of The School of Medicine and Biomedical Sciences John Naughton, M.D.; Foundation trustee Frank W. Warhus and his wife; and medical student and scholarship recipient James Murray Jr. B u a 0 p y 5 c o n s p n 9 9 9 - �One of the many gardens at the Buffalo City Hospital. Circa 1930. EtM~ built ~m ~e~ t~ peoJ~e mf its commmmity MEDICAL CENTER'S ROOTS DATE BACK TO AN OLD SCHOOL BUILDING REQUISITIONED IN 1909 TO DEAL WITH SCARLET FEVER EPIDEMIC rie County Medical Center had its roots in two Buffalo hospitals and an old , school building requisitioned in 1909 as a temporary contagious disease hospital by the then-commissioner of health Ernest Wende, M.D., and the mayor of the City of Buffalo,]. N. Adam. ~ B 1 ~ a 0 p y 5 a n 5 p n 9 9 5 �I -- - --- - -- - - - - THEN a 0 p A N D ~ N0 W In 1918, the new Buffalo City Hospital and opened in 1951. It was later named opened its doors; it was one of only 12 in the Donald C. O'Connor Memorial Wing the country that accepted all diseases for in honor of the hospital's third superintreatment. Later that year, the Erie County tendent. The last building added to the hosAlmshouse and Infirmary, located on the pital was the new School present site of the Univer84 for crippled children, sity at Buffalo's Main Street renamed the ComprehenCampus, burned to the sive Care Center for Chilground. Patients from the dren, which opened in Almshouse were moved to 1971. the new Buffalo City HospiGround was broken tal - abruptly and unexfor the present Erie County pectedly turning the new Medical Center on Octotuberculosis hospital into a ber 27, 1971, culminating public general hospital. 10 years of meetings, disThe original buildings of cussions, consultations the Buffalo City Hospital and planning. housed administrative ofThe new hospital fices and patient beds. In on Grider Street building 1922, more patient care became a reality because of the untiring space and the original urses Home were efforts of a group of civic-minded citiopened. One year later, communicable dis- zens led by then-county executive B. john Tutuska; Mrs. ease space was opened. And Mildred Campbell, chairin 1924, the Crippled woman of the Meyer HosChildren's School84, a day pital Advisory Board; and school for children with the Dr. Kenneth Eckert, presiresidual handicaps of polio dent of the Comprehenand other crippling diseases, sive Health Planning was opened. Council of Western ew The name of the Buffalo York. City Hospital was changed Designed by Gordon to the Edward J. Meyer MeFriesen Associates of morial Hospital in April Washington, D.C., the 1939 in honor of Edward]. new Erie County Medical Meyer, M.D., a prominent Above, Alpine Sun Lamps Center was one of the most were used in the treatment Buffalo surgeon who served of tuberculosis, rickets, modern and inefficient, as president of its board of scurvy and some skin novative hospital buildmanagers for 20 years. A diseases. Below, ings in the country when member of the University of fluoroscopy. Both pictures it opened its doors on july Buffalo School ofMedicine's circa 1930 from "Views of 9, 1978. class of 1891, Meyer also the Buffalo City Hospital." Today, it serves as one served as an instructor in of the medical school's afsurgery and adjunct profesfiliated teaching and resor of clinical surgery. Editor's note: Special thanks to Ed Leisner of Erie County In 1946, control of the search sites, as well as the Medical (enter's medica/library Edward]. Meyer Memorial area's designated Level I for his help in compiling this Hospital was transferred Trauma Center, burn article. from the City of Buffalo to treatment center, AIDS the County of Erie. unit and a host of other The last addition to the acute care and ambulatory Grider Street hospital was services available to the built for psychiatric patients community. n the winter of 1909, Buffalo was gripped by an epidemic of scarlet fever. With some 3,000 reponed cases and no contagious disease hospital facilities in the area, Wende and Adam, on February 19, 1909, urgently converted an abandoned school building on the corner ofBroadway and Spring streets into a temporary contagious disease hospital. The only other public hospital facility in Buffalo at the time was the Municipal Hospital at 770 East Ferry Street. Frequently referred to as the "pest house," it was operated by the Buffalo Health Department exclusively for the care of smallpox patients. In 1910, the city saw an alarming increase in the incidence of tuberculosis. That year, 561 tuberculosis deaths were reported, prompting the city fathers to plan a hospital for the treatment of tuberculosis patients. The 70-acre West Farm on Grider Street was purchased for $200,000 as the site of the new Buffalo City Hospital. It would cost another $3 million to build and equip it. In 1913, due to the rapid decline in the incidence of smallpox as a result of the gradual acceptance of the smallpox vaccine, Municipal Hospital was converted into a tuberculosis hospital to be used until the new hospital was erected on the Grider Street site. The high rate of tuberculosis in the city and the total lack of facilities to care for children with the disease attracted the attention of Edward H. Butler, Sr., the founder and publisher of the Buffalo Evening ews. As a result of Butler's efforts, a temporary tent hospital, large enough to accommodate 50 children, was erected on the Municipal Hospital grounds adjoining the original building. With the onset of a typically frigid Buffalo winter, the children were moved inside. Before the Buffalo City Hospital was completed, three separate units were added to the Municipal Hospital for the care of patients suffering from venereal diseases, alcoholism and psychiatric problems. B ------- y 5 a 5 p n 9 9 9 �A Spoonful of Humor© Stu Silverstein, ( BUT NOT QUITE AS MODEST AS SOME ithin the next few months we will once again have to face the ugly specter of the health care debate in the " ew Congress." As a physician, l feel it is my duty to give my congressman (whoever he is) my thoughts on the matter. l plan on making my own proposals. Here in California we witnessed the passing of Prop 187, "the illegal alien initiative. " lam currently collecting signatures in anticipation of getting the "Silverstein" initiative on the ballot: anyone in California who tries to start up another HMO or managed care company automatically qualifies as an illegal alien. Recycling is important in California, so my health care package will respect this by taking the 1,000-page plan that Clinton came up with and cuLLing it into 16th's to use as prescription pads. We can use half of them to prescribe sedatives for ewt Gingrich. (You know, if Elvis were alive today he'd be 60, and probably look something like ewt.) The guy is going wild , on the first day Congress was in session he climbed into Tom Foley's seat screaming like some kind of a rodeo clown running away from Richard Simmons. ewt is calling for us to sign on with his "contract with America. " Look , Democrat or Republican, you have to wonder about a guy who is willing to solve all your problems if you sign a contract with him. l suggest we shave his head and see if he's got three 6s tattooed on his skull. That might even explain the election results. "Network marketing" is big these days, especially among physicians try- B u a a p OF NEWT'S !) ing to augment their incomes to pay malpractice premiums. l think we should apply the concept to health care reform. For instance, if you are a patient having a spinal tap, you've still got your hands free , so you'd have the option of doing a spinal tap on the person in the next bed. Then you can bill him for your services, thus reducing your health care costs. He works on the person next to him and so on. The last person out just files for bankruptcy and even..-.--=~ tually nobody pays, and (almost) body gets hurt. My plan would inc I u de thing from warehouses. The Clinton plan requires that states set up large consumer groups called health alliances to collect premiums and bargain with health care providers. All companies with 5 ,000 emplo yees or fewer would have to buy coverage through an aliiLook, why don't they just hand over the job to WalMart? Pretty soon everyone will be employed by them anyway . We could call it "The Slice Club." You walk in to the shop, pick up a bag of Almond Joys, leg warmers and pick a urologist off the shelf to fine-tune your prostate. We could even have a driv ethrough out p a tientwindow .... that's where Ross Perot gets his hair cut and look what it's done for him. ... just to make sure it gets approved in the House and Senate, the definition of therapy will include chiropractic adjustments at clinics that charge $7 a drink. These days everyone is buying everyh 5 c a n M.D. Slll Si /rcrstci11, p•csidc111 of Sta11dup Mcdici11c Scmi11ars of Sa11 Fra11cisco, lect ures 11aliollwidc 0 11 5 humor ill mcdici11c. p 9 9 9 5 �- - -- . . . . . . . . . . .... ·. . . . . ... . . . . .... . . . ..... . ..... . . . ... E!j -- - -- - -- Stockton Kimball talk highlights annual symposium MEDICAL A L UMNI ASSOC IATION ' S 1995 SPR I NG CLINICAL DAY PRESENTATIONS FOCUS ON "THE PHYSIC IAN - hysicians are men and women of commitment, conscience and skill who face some of society's most challenging problems on a daily basis. Indeed , life and death issues are at the heart of medical practice , and so even private domestic relationships become part of a history and physical. The School ofMedicine and Biomedical Science's 58th Annual Spring Clinical Day, Saturday, April 29 , at the Buffalo Marriott, will address a variety of subjects encountered by physicians and other professionals concerned with the field of child sexual abuse, neglect, adolescent trauma and violence to the elderly. The conference, entitled , "The Physician- Healing the Abuse in Our F amily ," is intended to increase professional skills in prevention , recognition , assessment and treatment of all forms of maltreatment in the family system. The pres en lations will emphasize the awareness physicians need to recognize abuse in their patients and to encourage their roles as advocates for their patients. Specific approaches to these issues will be offered by the experts who have been carefully selected to speak at this year's program , designed to touch both the heart and the mind. The program has been designated for up to four hours of Category I Credit toward the Physician's Recognition Award of the American Medical Association and four prescribed hours by the American Academy of Family Physicians. B a 0 p h HEALING THE ABUSE I N OUR FAMILY" Faculty of this year's program inIntroduction clude: john F. Coyne, M.D. '85 "Amy" - Outreach Coordinator, Program Chairman PACT Clinic ofThe Children's Hospital of Buffalo Richard David Krugman, M.D. Landmarks in the Field of Child Abuse Dean and Professor of Pediatrics, School Stephen Lazoritz , M.D. of Medicine, University of Colorado , Denver, Colorado Stephen Lazoritz, M.D.- Medical Post Traumatic Stress in Abused Director , Child Advocacy Center , Children and Adolescents Children's Hospital of Wisconsin ; As- Susan V. McLeer, M.D . sistant Professor of Pediatrics, Section Head , Medical College of Wisconsin , Milwaukee, Wisconsin HIV: The Physician Can Make the Susan V. McLeer, M.D.- Professor Difference and Chairman, Department of Psychia- "A1ny" try, School of Medicine and Biomedical Sciences, University at Buffalo Kathleen G. Pharris, M.S.W. Coffee Break - Exhibit Reviews Director of Senior Day Center and Family Focus Program, Catholic Charities of Buffalo The Physician's Role as the Child Robert M. Reece , M.D.- Director, Advocate Institute for Professional Education , Robert M. Reece , M.D. Massachusetts Society for the Prevention of Cruelty to Children, Boston, Massachusetts The Tragedy That May Be Overlooked The agenda follows : Kathleen G. Pharris, M.S.W. Registration Business Meeting Welcoming Remarks Russell W. Besette, M.D. '76 President, Medical Alumni Association john aughton, M.D. Vice President for Clinical Affairs Dean, School of Medicin e and Biomedical Sciences 5 a n 5 p Annual Medical Alumni Luncheon and Stockton Kimball Memorial Lecture Child Abuse Prevention: Is It Too Little Too Late? Or Is It the Light at the End of the Tunnel? Richard D. Krugman , M.D. + g �~ ·········································· · ············································· Alumna dedicated her life to helping othe~ LISA BECHTEL '86 , PRACTICED WHAT SHE SAW AS THE IDEAL OF MEDICINE: A PATH OF SACRIFICE TO HELP THOSE WHO NEEDED IT MOST he lesson of Lisa Bechtel, M.D. '86, is one of humility. She died May 10, 1994, in Las Vegas, evada, where she made her home, conducted a private practice, managed a clinic and was in the process of raising three children. She and I palled around in medschool. What drew us together was what we saw as the ideal of medicine: a path of sacrifice to help those who needed it most. She went to Pittsburgh to do her family practice residency at Shadyside Hospital and I went to Rochester's Highland Hospital to do mine. Pressures of residency ate up time for both of us, and we drifted apart, losing touch. I married, adopted a child, and- the old storygot pregnant and had a second child. The majority of my family medical practice centered on inner city clinics in Buffalo. What I didn't know at the time was that in significant ways, Lisa's life was paralleling mine. She found a spouse, they adopted three children, and true to our ideals, she worked where people needed her most. From a alive American reservation in northern evada, she moved back to her home town, Las Vegas. By this time-Ilearned later, almost too late - her life and work had begun a new phase. This phase as much as anything defined the ideal of self-sacrifice - going beyond anything we had talked over so ardently back in med school, and the truth is, surpassing anything l had imagined for her or myself. Lisa was lesbian, so she was well B u a 0 p Lisa Bechtel, M.D. 5 c a 5 p n 9 9 9 5 �- --- - ---- . --- ························································ ~ ACADEMIC H ALTH PROFESSIO ALS I Insuring care for those who care Subscriber Owned • Organized • Governed PHYSICIANS • DE TISTS HEALTH PROFESSIONALS NURSES • RESIDENTS acquainted with the gay subculture, by then ravaged and haunted by the AIDS epidemic. She began working with AIDS patients, partly because of her innate sympathies, but largely because they weren't on top of doctors' lists. In fact, the Las Vegas AIDS clinic was unable to attract a medical director - low pay, very long hours, draining work, emotionally costly. The position was offered to Lisa. She took it. At once she became an indispensable figure of hope, charity, comfort and support, as well as medical attention. And it went further. Pediatricians asked her if she would see HIV -positive children who weren't getting the attention they needed. Way too few physicians knew how to treat them. She agreed. Her partner, Ann, a nurse practitioner who also worked at the AIDS clinic, was well aware of the need. Together they took another step. First they adopted an HIV-exposed baby, naming her Mariah. A year later she tested negative. Then they took in another unwanted baby - HIV-exposed in utero , plus various teratogens such as crack and alcohol. They not only kept her alive, but she thrived with them , and continues to as of this writing. Then a third baby, ate, was adopted. He was a year old last December. His HIV results are still inconclusive. Then, the wretched misstep occurred. Cleaning up in the clinic, depositing syringes in the dirty needle box, Lisa nicked herself. She filed a report and promptly forgot about it. That was in Aprill993. Six weeks later she developed a raging fever and viral syndrome. Her T cells fell so rapidly that within a few months she was diagnosed with full-blown AIDS. She grew too weak to carry on in medicine. In a little more than a year, she died. But not before the gay community rallied around her. By this time, we had renewed our contact after so many years, finding our friendship intact, reaffirming our beliefs. At a large, astonishing benefit in Las Vegas, the kind of celebration that snubs death , Lisa was honored . I attended and I don't think I've seen such an outpouring of gratitude and sympathy for one person. All good physicians dream of making a difference. Lisa Bechtel made a difference- a very, very big difference. Her example continues to make a difference in me, an object lesson that in this one profession whatever we think is enough, is never enough. All good physicians Superior policies for academic full-time and voluntary clinical faculty dream of making a ~ Competitive premiums ~ Rewarding educational programs ~ difference. Lisa Complete legal seiVice ~ Comprehensive coverage ~ Dividend opportunities Bechtel made a difference- a very, Academic Health Professionals Insurance Association is a subscriber owned and organized reciprocal licensed by the Insurance Department ofNew York State. Policy and programs ofthe Association are determined by a representative Board ofGovernors elected by subscribers at SUNY Health Science Centers. Enrollment open at all times. Transfers arranged \vithout loss. AcADEMIC HEALTH PROFESSIONALS INSURANCE AssociATION Empire State Building 350 Fifth Avenue, Suite #1512 ewYork, ewYork 10118 Ph. 212-947-4541 Fax 212-947-4572 B u a 0 p h very big difference. 5 c a n 5 p - BY n DEBORAH 9 9 RICHTER 9 5 �E ; ] ···················································· ·· ·· Four receive 1994 Lifetime Career Achievement Awards ifetime Career A hievement Awards were presented to four alumni last year. Andrew A. Gage , M.D ., '76, William R. Kinkel , M.D ., '5 4 , James F. Mohn, M.D. , '44 and Max A. Schneider , M.D., ' 49 , received the Medical Alumni Association's 1994 Lifetime Career Achievement Awards at last year 's pring Clinical Day and Reunion Weekend celebration. The awards are presented in recognition of conspicuous and outstanding career achievement. y ft \1~; Andrew A. Gage, M.D. William R. Kinkel, M.D. James F. Mohn, M.D. ~ Max A. Schneider, M.D. \.hi OFFICH uestionnaires for the special Sesquicentennial edition of the alumni directory have been sent out by the Harris Publishing Company. Please be sure to complete and return your directory Call UB questionnaire before the deadline indicated. cro to nqu~re' • Apple • IBM • Dell • Compaq • Panasonic • Hewlett Packard • TI • Sony • Software • Supplies • Accessories • Audio • Hands-on Workshops Prior to the publication date, the Harris Company will contact you after the data have been compiled to verify the information in your listing. B a 0 p 5 c a n s p n g 9 5 �"EJ ... .... ................. .. ......... ... .. . ........ . .................................. became board certified in critiof Johns Island, South Carolina, writes that after interning at Buffalo's Deaconess Hospital and HAROLD J . ELLIOTT '38 , cal care medicine in addition to internal medicine and pulmonary diseases. He is director of respiratory service and associ- orthern Westchester Hospital, he practiced medicine for six years in the mountains of Kentucky, eight years at orthern ate director of the sleep disor- igeria Mission Hospital, 18 years in southeast Minnesota and and living in Chicago. for the past 23 years in Johns Island, Charleston County, South Carolina, in a poor people's clinic in a church building. At age 80, he's still active ders lab - still actively practicing medicine, skiing and !ly fishing. His son, George, is married board certified examiner of the American Board of Forensic Examiners. '65 , of STANLEY L. OLINICK '40 , Winter Park, Florida, was certified in forensic psychiatry by points out a crowning irony of The American Board of Psychia- his career. In what may be his final (or nearly so) year of private practice of psychoanalysis, try and eurology after successfully completing the first exam given in the field last October. He has previous certification he has been included in the second edition of "Best Doctors in America." He continues to write papers for psychoanalytic journals, teach and enjoy his family, tennis, music and reading. LEONARD WOLIN '41 , of was appointed president and to professor of radiology at Northwestern University Medical School. He is director of chief executive officer of the Long neuroradiology and a member of Island Jewish Medical Center. the strategic planning committee -AS R. His is a senior partner at Kenmore Pedi- was atric Associates, P.C.; medical director for ight Call, an afterhours telephone triage service for elected president of the Chi- of JAN ARTHUR SCHWARTZ Westwood, Massachusetts, was elected president of the Massachusetts Academy of Dermatol- '75, is a pediatric anesthesiolo- ROBERT A . KUWIK '72 , of Johnson City, Tennessee, left private practice to accept a position as assistant professor of psychiatry at East Tennessee State University Quillen College of Medicine. His oldest son, Brian, is a Fulbright scholar in Cameroon, Africa, until October 1995; middle son, ick, is a junior at Florida State University. psychiatry since 1992 and is certified by the American Society of Addiction Medicine and the American Board of Quality Assurance and Utilization Review. Rhode Island. He wrote that he and his wife were expecting their Marrow and Blood Stem Cell Severin-Salzman. third child, a son, in January 1995. JOHN R . AND E R SON '67, RICHARD ofDepew, ewYork, was named medical director of the Brothers Sparks, PFOERTNER '60, of Boise, Idaho, recently B u a 0 BARNETT SALZMAN '65 , of Mercy ursing and Rehabilitation Center in Clarence, New p ARTHUR C . SGALIA '73 , of Wrentham, Massachusetts, was named chief of internal medicine at Rehabilitation Hospital of S. LEE '74 , of evada, was appointed chief of neurology and director of neurosciences of orthern Nevada Medical Center. 0 Society. 12; and Meredith, 7. of Bowling Green, Kentucky, was appointed medical director of the adult unit of Riverdell Psychiatric Hospital as well as a new member of the American Board of Forensic Examiners. He recently married Stacy Jean B. cal can Academy of Pediatrics. he's now "retired" but keeps up with his computer and the latest news, including the very latest from the Los Angeles Times, about his son, MAURICE J . WOLIN '84 , of Westlake Village, California, and his work for the Westlake Medical Center's Bone GEORGE cago RadiologiThey have two children: Gabrielle, ogy. He has two daughters. with added qualifications in geriatric psychiatry and addiction recently New York Chapter 1 of the Ameri- ALLEN BERLINGER '71 , Amherst, New York, writes that Transplant Center. K. Fernbach, physicians; and vice president of three days a week. KOLIN DAVID R. OANTZKER '67 , ROGER A . FORDEN '70, '65 , of Newton, Connecticut, recently became a diplomate and S. ERIC J . RUSSELL '74 , of Chicago, Illinois, was promoted wife, Dr. Sandra AUGUST J . D 'ALESSANDRO IRVING York, where he has been a staff physician for two years. 5 p gist at the Geisinger Clinic, in Danville, Pennsylvania. She recently spent three months as a visiting professor of pediatric anesthesiology at the department of anesthesia of Soroka Medical Center, Ben Gurian University of the egev, Beer-Sheva, Israel. DENNIS WHITEHEAD '75 , chief of emergency services for Dickinson County Memorial Hospital in Iron Mountain, Michigan, is serving a two-year term as speaker of the council of the American College of Emergency Physicians. He recently became the 36th person (and second physician) to climb the highest point in each of the 50 states. He writes that he's looking forward to his 20-year class reunion this spring. B E NNETT VOG E LMAN '78 , was appointed to the University of Wisconsin Teaching Academy and promoted to professor in 1994. g 9 9 5 �~ -··· ····· ··· ········· ······· ····· ·· ········· ······· ···· ······························ · ···· 1 9 8 KATHERINE DECARIA '80 , s 0 VINCENT JASNOSZ - of Murrysville, Pennsylvania , is a staff pathqlogist at Allegheny General Hospital in Pittsburgh. She has two children: Daniel, 5; and Anna, 4. of LOIS M . MCNALLY '82 , ew York City, was appointed director of medical student education for the ophthalmology department of the ew York Eye and Ear Infirmary where she JOSEPH 1 FASA - '86 , and his wife, NE LL O Donna, announce the birth of their second child, Diana Christine, on December 20, 1994. JESSIE JEAN -RUSH '86 , 9 9 s 0 of Cleveland Heights, Ohio, write ship at Naval Hospital in Jacksonville, Florida. He is now serv- that joe is currently a fourth-year ing as a general medical officer E T resident at the Cleveland Clinic. Mary completed her pe- on board the amphibious dock BONAFEDE '91 , MARY CAPPUCCINO '91 , Tucson, Arizona, is a general pediatrician and major in the U.S. Air Force at Davis MonthanAir Force Base. She has three diatrics residency at Children's landing ship the U.S.S. Gunston Hall, currently deployed to the Hospital of Philadelphia in 1994 Mediterranean Sea. and is currently doing a pediatric infectious disease fellowship at beautiful children: Kira, 10; Rainbow Babies Hospital in Eddie Jr., 8; and Kesha, 6. OBITUARIES BENNIE MECKLIN '35 , practiced family medicine in the Thousand Islands T I NA MARIE GARDNER '87 , practices ocular oncology and of Malone, attended by many classmates. A Watertown, ophthalmic pathology. ''I'm a family physician working great time was had by all. 46 years, died MARC KOBLICK '84 , and his wife, Helene, proudly announce the birth of their third child, EricJordan, born June 21, 1994. ern New York. We are teaching .P. students in our practice. My son jake is 4 of outdoorsman, with a strong in- Westlake Village, California, is terest in plants and trees and co-director of the Westlake gardening. I'm expecting my sec- Medical Center's Bone Marrow ond child next month. " of Stamford, Connecticut, joined ROBERT HESS a private practice group of six '37 , died ovember 8, 1994 in pediatricians there. She writes Oceanside, California. He was an assistant plant physician and and sends news about "lots of surgeon at Bethlehem Steel in babies Lackawanna, to our classmates: a baby girl, Ilana; has INGRID ew York, for 38 years before his retirement in 1972. has a baby girl, Natalie; PATRICK E . RYAN , JR . '87 , CRUSE is an associate professor at the COLLEEN of Bal- University Hospital in Syracuse, ZITTEL timore, Maryland, is director of KINGA the EMG Laboratory at Johns ew York, where he's been an in physician attending girl, Alexa. Hopkins Bayview Medical Cen- cardiothoracic surgery since last but a new house desperately in ter and an assistant professor of july. His \vife Denise, he writes, need of a new roof and paint job, neurology at Johns Hopkins is staying at home for now, tend- so lots to keep Joe and me busy." School of Medicine. Her son ing to their children: Sean, 5; Alexander was born March 6, Erin, 3; and Kieran james, 18 1994. She writes that classmates months. ROB I N CONWIT '85 , MEHNERT that she "is really enjoying it!" ELISSA JAFFE BOOKER and Blood Stem Cell Transplant Center. ovember 14, JENNIFER F . HENKIND '91 , years old and is quite an MAURICE J . WOLIN '84 , and ew York, area for 1994, at age 83. for the Mohawk Tribe in Northmedical, P.A. and who Cleveland. They were married on November 19, 1994 at a ceremony ew York, writes, com- and JOE of PAUL D . SEEMAN '93 , pleted his family practice intern- AND GREG have a boy, George; and TIBOLD has a baby o babies for me yet, MAT THEW J . PHILLIPS '91 , died july 14, 1992. CHARLES TANNER ~3 , a Buffalo cardiovascular surgeon and former president of Mercy Hospital, died December 7, 1994 after a long illness. WALTER A . OLZEWSKI '54 , ew York, and his assistant professor of neurology wife, Toula, announce the birth and clinical associate professor of of their second son, Michael of anatomy and cell biology, died Ventura, California, has been Nicholas, born December 12, February 23, 1994. and practicing internal medicine 1994. He joins his brother , are there since August 1992. She james, who turns 2 on April 7. expecting second babies this and her husband Thomas Alfano, AMY MILLER O 'DONNE LL had her third son, Michael , in February RE ICHARD of Snyder, VINCENT J . PARLANTE '42 , 1994; A L I S ON PETERSO N SARAH MURRAY WH ITE YASMIN PANAHY '89 , STEPHEN J . KIMATIAN '92 , who were married in December spring. ANDRE MIDGETTE ' 79 , drowned in Brazil in june 1994 of Navarre, Florida, writes that 1991, welcomed a son born September 15, 1994. while on vacation with his wife and daughter. he is a [light surgeon for the U.S. Air Force in Special Operations at Hurlburt field , Florida. a a 0 p h 5 c a n 5 p n g 9 5 �The jury is out. Your practice and assets are on the line. This is not the time to be second-guessing your choice of professional liability insurance companies. • In a similar situation, a MLMIC policyholder remains confident, knowing he or she is protected by a company that already has successfully defended more physicians than all other available insurers combined. • Adding t..o the value of your MLMIC policy is one of the country's largest and most experienced professional liability Claims Departments, as well as the largest Risk Management Department of any professional liability insurer in the state. MLMIC also offers New York's only true peer review of claims experience. • Only physician-owned and controlled MLMIC offers this high level of quality assurance and service. MLMIC also is the only medical liability insurer approved by the Medical Society of the State of New York. • Find out more about the protection you'll receive from the largest and most successful company of its kind in America. Call1-800- 356-4056 in Upstate New York, or 1-800-ASK-MLMIC in the New York metropolitan area.• MLM~C ~1edical ~ u ab1litr ~lutuallnsuranl't' Company Our defense never rests. 2 Park Avenue New York, NY 10016 2 Clinton Square Syracu5e, NY 13202 90 Merrick Avenue E. Meadow, NY 11554 �BUFFALO PHYSICIAN STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 ADDRESS CORRECTION REQUESTED Non-Profit Org. U.S. Postage PAID Buffalo, NY Permit No. 311 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Spring 1995 Subject The topic of the resource State University of New York at Buffalo. 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Research Hospital News Building the Future of Research Restructuring Research at UB Medical School Then and Now A Spoonful of Humor Alumni Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-12-18 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v29n02 Extent The size or duration of the resource. 36 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1995 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/2ebb0c0f48bdf05c396319ecd4f13792.pdf 1343078c3383bbf7f71de62773f2f9c7 PDF Text Text State University of New York at Buffalo School of Medicine and Biomedical Sciences, Summer 1995 �BUFFALO PHYSICIAN Volume 29, Number 3 STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES Dr. john a ugh ton, Vice President for Clinical AffalfS, Dean ASSOCIATE VICE PRESIDENT FOR UNIVERSITY SERVICES Dr. Carole Smtth Petro DIRECTOR OF PUBLICATIONS Timothy j. Conroy EDITOR Nanette Tramont, R. ART DIRECTOR Alan j. Kegler ASSOCIATE ART DIRECTOR DaVId j. Riley PUBLICATIONS MANAGER Dear Alumni and Friends, T his issue of Buffalo Physician highlights selected efforts in the national and international arena of volunteerism in which many faculty and students engage. You are probably already aware that foreign exchanges designed to enhance research and educational endeavors have long been a tradition for the school's faculty. Humanitarian efforts toward aiding the citizens of the global community take that tradition one step further. As the world becomes "smaller," it is even more important for UB's faculty to develop meaningful relationships that serve to enhance humanitarian efforts throughout the world. UB obviously offers a fine environment in which to train physicians and scientists from here and abroad, and its faculty and students have endeavored to "give back"- both to their local and global communities - a measure of what they have received. In all the exchanges, both the giver and the rec1pient benefit. We have many examples of successful exchanges in Europe and Asia, as well as in our own community. lam sure these will continue in the years ahead and that more will be added as national and international collaborations increase, and more physicians become aware of the needs for such humanitarian efforts. Sincerely, judson Mead PRODUCTION MANAGER Ann Raszmann Bro\vn EDITORIAL BOARD Dr. john A. Rtchert, Chairman Dr. Marttn Brecher Dr. Harold Brody Dr. Rtchard L Collins john aughton, M.D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences Mr. Ravi Desai Dr. Alanj. Drinnan Dr. james Kanskt Dr. Elizabeth Olmsted Dr. Barbara MaJeront Dr. Charles Paganelli Dr. Margaret W. Paroski Dr. Thomas Raab Dr. Robert E. ReiSman Dr. Stephen Spauldmg Dr. Bradley T. Truax TEACHING HOSPITALS AND LIAISONS The Buffalo General llospttal \fichael Shaw Buffalo VA Medical Center Arlene Kelly The Chtldren's Hospttal of Buffalo [ne County Medtcal Center Mercy Hospttal Mtllard Fillmore Hospttals Franll Sa\·a Roswell Park Cancer lnstttute Sisters of Charity llospttal Demus McCar·thy ©The State Umvcrstty of New York at Buffalo Bufftdo Physician is publtshed quarterly by the State University of 'lew York at Buffalo School of Medicme and BIOmedical Sctences and the Office of PublicatiOns. It is sent, free of charge, to alumni, faculty, students, residents and friends. The staff reserves the right to edtt all copy and submiSSIOns accepted for publication. Address questions, comments and submiSsions to: Editor, Buffalo Phystcian, State University of New York at Buffalo, UniverSity Publications, 136 CroftS Hall, Buffalo, cw York 14260 Send address changes to: Buffalo PltysiCian, 147 CFS Addttion, 3435 Matn Street, Buffalo, New York 14214 Dear Fellow Alumni, T hank you for the opportunity to serve as President of your Medical Alumni Board of Directors. My predecessor, Dr. Russell Bessette, did an outstanding job and will be a tough act to follow. This coming year, 1996, will mark the Sesquicentennial Anniversary of the medical school. Celebration of this event has already begun, with the conferral of an honorary degree to Dr. Gregory Thorn, one of our most distinguished alumni, at the medical school commencement this year. We will also be publishing an updated Medical Alumni Directory, which will include a brief history of our medical school. We hope you will take advantage of this directory to keep in touch with o ld friends. Plans for the 1996 Spring Clinical Day are already under way. Dr. Beth Maher is planning a promising program addressing issues on death and dying. The Alumni Association will continue to sponsor a wid e range of activities for the medical students, including the Community Physician Program, the Senior Reception and orientation events. This past year we donated funds to furnish the medical student lounge. We look forward to a busy and enjoyable year, and hope we can count on your support. We're always looking for new ways to serve our alumni and welcome your suggestions. Sincerely, Margaret W. Paroski , M.D. '80 �8 v 0 5 u 2 L . M M E 9 . o . N 9 R AUG 3 3 9 5 1 95 Research Hospital News Partial liquid ventilation. Page 12. Giving Back e UB's doctors volunteer their skills and themselves to communities throughout the world - including their own. m Breathing Life Through Liquid e The new technique of partial liquid ventilation developed at UB has the potential to revolutionize the treatment of respiratory failure. Medical School Then and Now , Alumni ASpoonful of Humor Classnotes * l~e ~lass of 1~~~. ra~e ~l Robert L. Brown, M.D. '44, dies after brief illness. Page 23. �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 / ' ' / . Study shows no increased breast cancer-electric blanket use risk re-menopausal women who sleep under electric blankets do not significantly increase their risk of developing breast cancer, a study conducted by UB researchers has shown. The research is a follow-up to an earlier UB study involving post-menopausal women that also found no increased risk of breast cancer as a result of electric blanket use. It was published in the December 1994 issue of the American journal of Epidemiology. In the current study, a team of researchers led by john Vena, Ph.D., professor of social and preventive medicine, investigated a possible breast cancer-electric blanket association by comparing electric blanket use in 290 premenopausal women who were newly diagnosed with breast cancer with a control group of 289 age-matched women without cancer. Results showed that among those who used electric blankets the most, the percentage of women with cancer and without was identical. In both groups, 8.3 percent said they had used a blanket daily in season and continuously throughout the night for the previous 10 years. "The bottom line," Vena said, "is if there is an effect, it is likely a weak one. Some researchers now think that the pineal-melatonin mechanism [one of the mechanisms suspected to increase breast cancer risk] may only operate for certain types of cancer tumors- those that are estrogen-receptor positive. The next phase in our research will be to look at electric blanket use and certain types of breast cancer." Also participating in the study werejo L. Freudenheim, Ph.D.; james R. Marshall, Ph.D.; Rosemary Laughlin, Ph.D.; Mya Swanson; and Saxon Graham, Ph.D., all of the department of social and preventive medicine. + B u a a p weren't recommending the back position despite the AAP recommendation. Parents were getting conflicting advice from nurses and doctors." Hudak designed the study to determine how physicians feltabout the issue and how their attitudes influenced what they told parents. The AAP recommends the tummy-up or side position. Reasons given most often for having reservations about the recommendation were the lack of published data on the connection between sleep position and SIDS in the U.S., and past experience. Also menUB study has shown that physi- tioned often was the possibility of aspiracians are reluctant to follow the tion after gastroesophageal reflux. + recommendation of the American Academy ofPediatrics and tell parents to put newborn babies on their backs to sleep to reduce the risk of Sudden Infant Death Syndrome. The recommendation, promulgated by the Academy in 1992, broke with University at Buffalo study- the what had been tradition since the 1930s first ever to assess the use of and abandoned the practice of placing assistive devices by elderly perinfants on their stomachs after studies sons with Alzheimer's disease and from Europe, Australia and ew Zealand other cognitive impairments- has showed a significant decline in SIDS found most existing devices for after physicians there urged parents to patients with dementia aren't designed put their infants to bed on their backs or to remain useful as mental health detesides. riorates. The UB study, reported in the january Results of the study, conducted by 1995 issue of Pediatrics, involved 121 researchers in UB's Rehabilitation Engiprimary care physicians. Only 24.4 per- neering Research Center on Aging, cent of them said they strongly agreed showed that elderly persons with cogniwith the AAP recommendation and only tive impairments living at home were 42 percent said they recommended the using fewer devices after one year than supine position to new parents. at the beginning of the study, even Principal author Bonnie B. Hudak, though their need for helpful devices M.D. , assistant professor of pediatrics, had increased due to declining health undertook the project as a result of her and cognitive status. own experience with her new daughter. "Obviously we are not making de"When I had my baby in 1993, no- vices that are as useful as they should body talked to me about sleep posi- be," said William C. Mann, Ph.D., direction," she said. "I began talking to other tor of the center, professor and chair of parents and learned that pediatricians the department of occupational therapy Physicians reluctant to heed ill adrtce about infant sleep position Alzheimer'simpairment outpaces dertces designed to aid patients y 5 a n 5 u m m e 9 9 �m ···· · · · · · · · · · · · · · · · · · ·· · · · · · · · · · ···· · ·· · ···· · · · · · · · · · · · · · · · · ·· · · · · · · · · · · · · · · · · · · · · · · · · · · · · m ' . . . and lead researcher of the study. "We need to develop more 'smart' devices and devices that will remain useful longer, as cognitive health declines. " Baseline data from the study, reported at a recent Gerontology Society of America meeting, came from a Consumer Assessments Study by center researchers that analyzed the types of assistive devices used by 90 elderly people and their caregivers. Mann and his colleagues based their current findings on a 31-person subset- all with cognitive impairments living in a home setting. Twenty-five of the 31 were diagnosed with Alzheimer's disease; the remainder were cognitively impaired. The researchers intend to follow this group for five years to provide direction for new device development and improvement of existing devices. + researchers say fractal geom- l etry may hold the key to ear- ~l lier detection of osteoporosis. The computational technique that tests and characa. Ill terizes bone deterioration more accurately than methods currently in use was developed by Raj S. Acharya, Ph.D. , associate professor of electrical and computer engineering. He explained that clinicians who look at X-ray images of bones have only been able to track deterioration in bone mass; deterioration in the honeycomb structure has been too subtle to see. But Acharya and his colleagues found a way to examine the fragile interconnections in this tissue , and to determine the level of deterioration. The technique lets them home in on each pixel in an X-ray or MRl and assign it a specific value called a fractal dimension. "With fractal dimensions , we can compute structural information," Acharya B u 0 0 p Genetic evidence of smoking and cancer rtsk shown by UB study said. "Together, mass and structural information give a much better indicator of bone condition. " Working with animal data obtained from Merck Corp. , Acharya and colleagues from the School ofDental Medicine used fractals to compare the trabecular tissue of the bones of normal rats with those of rats with osteoporosis induced through estrogen depletion or the immobilization of limbs. "ln both cases, when we computed the fractal dimension in these data, we found there was a significant difference between the values for normal bones and the values for bones with osteoporosis," he said. In the early stages of osteoporosis, Acharya said, "the honeycomb structure might actually be broken, which would weaken the bone, but because the mass might still be the same, a bone density test would not show anything abnormal. "The advantage of our approach is that if you can pick up signs of disintegration before the bone starts massive deterioration, then you can start therapy ," he said. "And if you can catch it at an early stage, there's a good chance that a deeper osteoporosis will not develop. " + Fractal geometry may aid in earlier detection of osteoporosis - B Y ELLEN esearch has yielded further evidence of a genetic link between cigarette smoking and breast cancer risk in humans. A study conducted by UB scientists has shown that female smokers who have the slow-acting genotype for -acetyl-transferase ( AT2) , an enzyme that detoxifies carcinogenic compounds in cigarette smoke, could have eight times the risk of developing breast cancer as women with the fast-acting NAT2 gene. The research provides new insight into why previous epidemiologic studies may have failed to show a consistent association between cigarette smoking and breast cancer in the face of evidence that tobacco smoke is a cancer risk factor at many other organ sites. Other research has shown that smokers with the slow-acetylation genotype for NA T2 had higher levels of tobacco's carcinogenic compounds in their bloodstream and were at increased risk of developing bladder cancer. The UB researchers - led by postdoctoral fellow Christine Ambrosone, Ph.D., of the department of social and preventive medicine - analyzed the characteristics of the AT2 gene in the DNA of 159 post-menopausal women with breast cancer and 203 cancer-free women in a control group. A strong association between smoking and breast cancer in slow acetylators was shown, with women who began smoking before age 18 at highest risk. Intensity of smoking at two, 10 and 20 years prior to the interview appeared more significant than duration of smoking. Slow acetylators showed a fivefold increase in risk. No significant associations between breast cancer risk and total years smoked, packs-per-average year or pack-years smoked were demonstrated among rapid acetylators. + GOLDBAUM Fractal dimension (FD) graphed for spine (above). e I'Moftsl FD " '-tWill 1.95 1.90 1.85 • 1.80 •••• • •••• 11 1.70 .., 1.65 1.60 1 - - - ' - - - ' - - - - - - _ ; _ - - - - 1 1 3 4 5 6 7 8 9 10 11 11 13 14 15 lime May 30, 1991 y 5 June6, 1991 a B Sept.16, 1991 n s '' m m Y e LOIS B AKER �The nation's first integrated hospice campus combines inpatient care facilities with a 40-bed residential facility containing a 10-bed AIDS unit. The lO-bed inpatient unit, which replaces Hospice Buffalo's former Alden facility, provides care for pain and symptom control, respite , and patients in the final stages of their disease process. The unit includes accommodations for family members to spend the night. Mitchell Campus also serves as a training site for medical and nursing students and allied health professionals and offers community programs on grief, loss and living with a life-threatening illness. + Hospice opens unique integrated residential-inpatient facility he nation's first integrated hospice campus combining residential and inpatient care facilities opened in Western New York last April. Located in Cheektowaga, Hospice Buffalo's Mitchell Campus was designed by the Hospice Association of Western New York to meet the growing need for services to help individuals and families facing advanced illness. The innovative campus includes Kresge Residence - the nation's first hospice-operated skilled nursing facility-a lO-bed inpatient unit, a 200-seat multidimensional educational center, non-denominational pastoral care facilities and centralized offices for Hospice home care and administrative staff. The 40-bed residential S F provides advanced care to those who have a skilled nursing need but a limited caregiving system, or no home in which to receive care. lt includes a lO-bed unit for AIDS patients - the only one in ew York State outside the ew York City metropolitan area. Kresge Residence features a comprehensive activities and recreation program, as well as physical therapy, occupational therapy, speech therapy, mental health services and pastoral care. Hospice support services include medical social work, volunteer support and bereavement counseling. 0 B u a 0 New book names Roswell one of North America'sbest hospitals oswell Park Cancer Institute is one of the "top-rated medical facilities in the United States and Canada," according to The Best Hospitals in America, a new book published by Visible lnk Press. Written by john Wright and Linda Sunshine, the book is a comprehensive guide to the services offered by the most prestigious medical institutions in orth America. Based on physician recommendations, and supported by information from government sources , professional and lay publications, patient satisfaction surveys and interviews with hospital officials, the book identifies for the public those hospitals whose reputation, personnel , basic and clinical research, treatment modalities and other special qualities have earned p h y s c a 5 them the highest standing in the medical community. According to the authors, "these are places to which physicians in other hospitals send their sickest patients - and with good reason." Roswell is the only facility in Western ew York and one of only 27 nationwide to hold the designation of comprehensive cancer center, awarded by the ational Cancer Institute. "We are pleased and proud that Roswell Park has once again been recognized for its exemplary leadership role in setting the national standards for cancer care, research and education," said Thomas B. Tomasi, M.D., Ph.D., president and CEO of Roswell Park. + Roswell opens dedicated HIVrelated malignancy center oswell Park Cancer Institute has opened its Center for HIV -Related Malignancies to meet the needs of patients who have cancer as a result of human immunodeficiency virus infection. The new center affords patients access to unique therapies, several of which have been pioneered at Roswell, said Zale Bernstein, M.D. , center director. "These patients require specialized care and unique approaches to help prevent and treat malignancies and opportunistic infections," Bernstein said. "As a major cancer center, Roswell Park m m e 5 �. . . . .... . . . . . . . . . . . . . . . .... . . .·. . . . . ... . . . . . . . . . ... . [1] has the facilities, resources and expertise to provide the intensive care these patients need. " A 1994 survey by U.S. News and World Report ranked Roswell among the best hospitals in the U.S. specializing in treating HIV-infected patients, based in part on the design , availability and preliminary successes of innovative treatment protocols the cancer center offers. Several current protocols use photodynamic therapy, pioneered at Roswell in the early 1970s. Others use Interleukin-2 in self-administered doses to attempt to ameliorate patients compromised immune systems. "We have recently completed a study which indicates that this therapy is easily administered with good comfort and compliance by the patient," explained Bernstein. In the patients studied to date, there have been no opportunistic infections reponed in over 40 months of accumulated observation. Bernstein added that Roswell is one of only three centers in the nation using monoclonal antibody therapy to treat malignant lymphoma in HIV-infected patients. "We have treated over 15 individuals with this therapy and have witnessed good results, " he said. "We encourage physicians and HIVinfected individuals to look to our treatment protocols as viable approaches to cancer care," Bernstein said. For more information on these and other protocols, call the centerat1-800-685-6825. + the ew York State Department of Health. The heart-lung transplant program completes and complements the alreadyestablished adult cardiac transplantation program in place at The Buffalo General Hospital, and is supported by the School of Medicine and Biomedical Sciences, as is BGH's. Buffalo General was designated the area's regional adult heart transplant center in 1986; its lung transplant program was developed in the early 1990s. Children's has maintained a working relationship with the adult program in an ad hoc role . Children's has had an active cardiac program for more than 30 years. The recent recruitment of Eliot Rosenkranz , M.D., from the Cleveland Clinic to head Children's division of cardiovascular surgery, has intensified the hospital's program. "The designation marks a new milestone in Children's Hospital's more than 103-year history," said joseph A. Ruffolo, president and CEO of Children's. "It's about saving lives ... providing the finest pediatric health care services well below the national cost level ... tapping new research doors that enable us to continue looking for better treatments and cures to heal our children ... and helping to establish new referral patterns from throughout New York State for other specialty pediatric services Children's offers. "One of the most pleasing aspects of this approval process was that Western ew York area hospitals, health insurers, civic leaders and health care stakeholders showed unconditional favor for our effort and participated as supporters," Ruffulo said. Children's filed its CON injuly 1994. At that time, pediatric heart and lung transplantation in New York State was primarily provided at adult health care systems in New York City, or at outof-area pediatric medical centers in Boston, Pittsburgh and Cleveland. + Children'swins DOH approval for heart-lung transplant center he Children's Hospital of Buffalo announced it has been designated Western ew York's regional center for pediatric heart-lung transplants with the approval of its certificate of need application by B 0 0 p y 5 c 0 S u BGH names Salerno chief of its division of cardiothoracic surgery he Buffalo General Hospital has named Tomas A. Salerno, M.D. , chief of the division of cardiothoracic surgery. Salerno is internationally known for his research and the development of the technique of warm heart surgery. He has been a visiting professor worldwide , including at BGH several times in the past. Salerno earned his medical degree at McGill University in Montreal, Quebec. He received his specia lty training at Montreal ' s Royal Victoria Hospital , where he became chief resident in general surgery and then chief resident in cardiovascular and thoracic surgery. Salerno served as professor and chairman of cardiothoracic surgery at the University of Toronto, Ontario, from 1987 until 1992, and head of the division of cardiovascular and thoracic surgery at St. Michael's Hospital in Toronto until1993. He was an honorary professor of cardiac surgery at the University of Chieti, Chieti, Italy, from 1993 until1994. ln addition, he has been on the surgical staffs of Kingston General Hospital, Kingston, Ontario; St. Mary's of the Lake Hospital, Kingston; Montreal Chest Hospital; Montreal Children's Hospital; The Toronto Hospital; and Sunnybrook Health Science Hospital, Toronto. He is a member of many national and international societies, and has published more than 500 papers and abstracts. He is the author of an upcoming book, Warm Heart Surgery. + m m e �-------------------------------------------------------------- . T II () \I .\ "IT IS BETTER TO LIGHT ONE CANDLE," says an old proverb, "than to curse the darkness." Peter, Paul and Mary made a song of that sentiment back in the glory days of social activism. But 1 volunteer service isn't consigned to the memory of the 1960s. Far from it. As dozens of University at 1 Buffalo medical school alumni, faculty and students demonstrate every day, pitching in with talent and energy always makes a real difference in people's lives. From the war-ravaged survivors of the Bosnian civil war, to the rebuilding economies of Vietnam : and the Ukraine, to the mean streets of our own poorest neighborhoods, volunteerism works. The darkness around us does seem deep, and there are many who would curse it. For these physicians, though, there just isn't time to lament the state of the world. There's work to be done. -------------------------------------------------------------- .. 0 B a 0 p h 5 a S u m m e 9 9 �-------------------------------------------------------------- .. From our own baekyard. to loealrs halfway around thr world. tlw nrrd for mrdieal hrlp is strong. 1 [B·s physieians proridr both din'<·t nwdieal earr for palirnts. and training. rrlirf and supplit>s for llH'<Ii<·al prrsomwl. IN TilE MIDST OF WAR some of whom, Hassanali notes, hadn't had a break in two years. Fifteen doctors were ready to make the trip in May 1994, but the on-again, off-again war broke out anew in Sarajevo. "The State Department strongly discouraged us from going," Hassanali said. "It became a dangerous situation to bring a big delegation." Hassanali decided to go alone. He went to Zagreb, Croatia, and joined the United Nations force there as part of a group of medics. But the fighting in Sarajevo was too fierce; the UN could get him into the city, but couldn't guarantee he'd ever make it out. He stayed in Zagreb, treating some of the nearly half-million refugees who fled to Croatia. Meanwhile, Bergs land, who holds dual orwegian and American citizenship, was able to enter Sarajevo with a medical company of the orwegian army. He was in Bosnia for three months, and spent four days in Sarajevo just after a major shelling of the city's central fruit market left 120 dead and scores injured . "To a large extent those patients had been treated already," Bergsland said. "We basically did more for the evacuation. President Clinton had sent a plane to take out Television images of the vicious civil war in the former Yugoslavia have horrified the world and sparked compassion for the innocent victims of the fighting. An initial effort in Buffalo to treat some of the wounds of war now has blossomed into a large-scale initiative for relief medicine and medical training for Bosnia's physicians. Called International Medical Relief of Western ew York Inc., the organization includes about 250 volunteer physicians and has a corporate office and a warehouse for supplies. Its president is jacob Bergsland, M.D., an assistant professor of surgery at UB medical school; its vice president is dermatologist Riyaz Hassanali , M.D. '86. Several other UB-connected physicians serve as officers or on an advisory board. The group began after Hassanali was introduced to the wife of Bosnia's vice president, herself a dermatologist, who was living in Buffalo with her children. After hearing her talk about the situation in her country, Hassanali organized a meeting of local physicians who wanted to find some way to help. They decided to solicit medical supplies and organize a trip to relieve the Bosnian doctors, ______________________________________________________________ .. B a a p h y c a n S u m m e 9 5 0 �r--------------------------------------------------------------., G [ I N I 1 B A 1 1 G K 1 1 1 1 lntt:>rnational Mt:>dital Rt:>lit:>f of Wt:>stt:>rn ~l:'w York providt:>s lwlp for war-torn Bosnia and Zagrt:>b. Croatia. some of the victims, and we had to get them from the hospital to the airport. " That was accomplished , he said, in armored ambulances accompanied by armed guards. He also practiced in his specialty, thoracic surgery, in the north-central Bosnian city ofTuzla. Now the contacts that both Bergsland and Hassanali made have grown into a continuing relationship with physicians at the Tuzla Medical Center. "We had decided that bringing humanitarian supplies was one thing, but the one group that has been completely ignored is the doctors and nurses, " Hassanali said. "Every other organization was helping the victims (of the war) . But we decided that our efforts would go toward the medical personnel. These are people who are really making sacrifices .... We started corresponding with some of the doctors , and found that they were hungry for knowledge. " So International Medical Relief started sending medical textbooks and journals, and put together a shipment of medical instruments. The group also began an exchange program, sponsoring Bosnian doctors and nurses to come to Buffalo for intensive training. The first group includes a cardiologist and a vascular surgeon, as well as three nurses , all training at The Buffalo General Hospital. "Bosnia is not a Third World country by any means ," Hassanali said. "But because of the war situation, they have been completely deprived of outside information and money to continue their research. You have a very educated group of individuals who are now just starving intellectually. " ln addition , teams of Buffalo physicians - one this summer, one in the fall- are heading for Tuzla to treat patients and conduct seminars. ln the past year, Hassanali said, about $100,000 in cash has been raised through two dinners and two medical conferences, and about $500 ,000 in equipment has been donated. "Our long-term goal," he said, "is to set up a 1 cardiac surgery center in Tuzla. " For Bergsland, pitching in is a matter of supporting what's right. "The legal government of Bosnia," he said, "has a policy that's similar to what we have in the United States: that people should be recognized as individuals and not as members of some ethnic or religious group. The Serbs have this terrible policy of ethnic cleansing and destruction of other people. Fifty years after the Nazis had similar policies in Germany, now we have it 400 miles to the south. This is something that we must do something about. " "l can completely identify with what they're going through ," said Hassanali, himself a refugee from Uganda. "Somebody was there to help me, to lend me a hand, and now it's my turn to pay back. ... I don't profess changing humanity. My goal is to make a difference for one person in this world. lf we all thought that way, the world would be so much better. " SEEING ACR<SS BORDERS lt was a bit of volunteer work on the Caribbean island of St. Lucia, back in 1976, that set Yale Solomon, M.D. '50, to thinking about the rest of the world. Said Solomon, an ophthalmologist in Bay Shore, .Y.: "Ophthalmology is the type of work that one can do on kind of a one-shot basis. l realized that you can go in , operate and see patients, and leave, and you don't leave a trail of half-finished work as you might, for example, in internal medicine. " A decade later, Solomon was inspired by a friend who had done similar work in India to go there. "I met the doctor in charge, and he was very happy to have the help ," Solomon said. "I realized that this could be some sort of ongoing arrangement, that they could use help beyond just me for a month. " That realization has grown into Volunteer Eye Surgeons International Ltd. (VESI) , a group of ophthalmologists who volunteer their expertise to serve month-long ______________________________________________________________ .. 0 B a a p h 5 a n 5 u m m e 9 9 5 �r··----------------------------------------------------------·-• I In Virtnam. tlw Voluntwr EyrSurwons Jntrrnational Ltd .. trains physitiansand pnwidPSsuppliPSand updatro nwditallitrratml'. 1 I Scott D. Perrapato , M.D., didn't know what to expect when he went to Vietnam for three weeks in February. What he found was both totally foreign - and oddly familiar. The Ho Chi Minh Medical School, he said, was built in the late 1960s by the American Medical Association, when that city was called Saigon. "It hasn't changed a bit since then," said Perrapato, who serves as an assistant professor of urology at the University at Buffalo medical school. "It was like being in a Southern U.S. medical school in that time. It's a neat place." Through the Friendship Foundation of American Vietnamese, an Ohio-based group, Perrapato joined a team of seven physicians on the trip. They made rounds from 7 a.m. to noon each day , then lectured to medical students all afternoon. "They have a 200-bed, 350-patient urology hospital," he said. "To work in that kind of environment is kind of a dream." The group also traveled to the provincial city of Nah Trang, where Perrapato worked with the staff urologists and saw patients. "''d never been in a place so destitute, " he said, "but the people showed no animosity (toward the Americans). From the street people to the government people, they were just gracious. I'm told the Vietnamese and Asian people have always been very open, and they're certainly not materialistic. . .. There, the families help give care in the hospitals; they're expected to, and they love doing it. And really , it's a big advantage to the patient." Now Perrapato is on the designing board for a new hospital in ah Trang, making suggestions for what the facility should include. He's making a return trip in February, this time with his wife, Tracy, who did her residency in family practice at UB. The hard part, Perrapato said, was the re-entry into American life. "The quality of the doctors and nurses was exceptional (in Vietnam) , but the constraints weren't B A I a 0 p h 5 c a 5 m m e 9 5 c K 1 1 -------------------------------------------------------------- .. u ~ 'KIND OF A DREAM' residencies in India, Thailand, Java, Liberia, the East African nation of Djibouti- and now Vietnam, to which the group has sent eight doctors in the past year, to see patients and train the staff physicians there. "We do not go for volume," Solomon said. "I learned in India that the doctors there are perfectly capable surgeons and physicians, and do an extraordinary amount of work. India has 6 million people with cataracts. "If we send a doctor there every six months , he's not going to make a dent in it. We teach some basic material and do operate, but primarily for demonstration purposes. "It's amazing how many ophthalmologists- both the young ones before they really start their practices and the ones in their later years - have an altruistic sense that they want to go and do something other than sit in their office and work for money," he said. "They feel they want to help and use their unique abilities , and here's an opportunity. " The Vietnam project includes bringing a young ophthalmologist from that country, a professor at Hanoi Medical School , to the New York Eye and Ear Infirmary for training. "He'll go back with books, supplies, and an awareness of new techniques that they just don't have ," Solomon said. "We're sending him back with a lot of books which he is going to translate into Vietnamese. They do not have any medical literature that dates after 1970." VESI makes it easy to volunteer, making all travel and living arrangements for ophthalmologists who agree to a month's service overseas. And the benefits work both ways. "It's very rewarding for the doctor who does the work ," said Solomon, who has cut his own practice in half to manage the organization. "You see cases and see things that you would never have experienced otherwise. The culture, the way people react to their physician - the whole atmosphere is so different. In a sense, this is really fun. " B (1 0 �r - - - - - • • • • • • • - - - • - - - - • - - • • • • - - • - - - • • - - - • • • • - - - - - - • - • - • - • • • • - • • - ., The program also involves bringing Ukrainian physicians to Buffalo for training, as well as an initiative to translate medical textbooks into Ukrainian. Organizers also are seeking to install a computer system in the central medical library in L'Viv, which would make it possible for physicians to teleconference with their colleagues worldwide. Sirkin's first trip to L'Viv was in june 1994; she took with her some donated diagnostic and surgical equipment and supplies. She taught techniques of anesthesia , cataract surgery and lens implant surgery, as well as such basics as how to use a microscope. In March of this year she returned to L'Viv. "They seem to be doing fairly well," she said. "They're starting to adopt some of the techniques and some of the equipment. "But it's very difficult, because you're fighting the political system within the hospital hierarchy , which is very patriarchal and hierarchical. Ophthalmology is almost entirely a female specialty there. But the administrators are all male, and the ophthalmologists don't always get their needs met. " there. There wasn't the paperwork and all the insurance overtures. I'd never been in that environment, where you could just practice medicine. " 1 X I (; I 8 A c K niiTI'IN(l CKRAINE GPTO DATE There's nothing wrong with Ukrainian medicine that about 25 years of scientific progress won't cure. That's what Sara R. Sirkin, M.D. '68, an adjunct professor of ophthalmology at the UB medical school, has found on two trips to the city of L'Viv in that former Soviet republic . "They're very competent people," the ophthalmologist said of her colleagues there. "The difficulty is , their medicine is still back in the late '60s. The facilities were built in the '50s and '60s and are very antiquated. They don't have access to modern medication or equipment, and they don't have the money to buy these things. "Much of their medical care, although adequate , is still very much Third World. We're trying the best we can to teach them modern techniques in surgery- in my case, cataract surgery and lens implants. And we're trying to upgrade their infectious disease control. "They're very eager to learn, and there's certainly nothing wrong with their intelligence. It's just that, under the Soviet system, they haven't had the opportunity to learn. " Sirkin went to L'Viv, an ancient city of 1.5 million people, as part of the American International Health Alliance, a joint U.S.-Ukraine effort to improve the medical conditions in the former Soviet republics. "There are churches that go back to the 13th century," she said. "It's a beautiful city. " The Buffalo connection was engineered by Myroslaw Hreshchyshyn, M.D. , chair of gynecology and obstetrics at UB medical school, through the Millard Fillmore Health System, for which Sirkin is chairman of the department of ophthalmology. ON TilE HOME FRONT It's not only in far-flung locales that the need for quality medical care is great. In Buffalo , two initiatives are directed at addressing the health needs of the city's poorest residents. At Friends of the Night People, a new medical clinic is open on alternate Tuesday nights for clients of the soup kitchen . Its proprietors are M. Steven Piver, M.D., clinical professor of gynecology and obstetrics and a longtime supporter of the organization, and Bobby]. Abrams, M.D. , an emergency physician who serves as a UB clinical assistant professor at Erie County Medical Center. The clinic sees about 20 patients a night, said Abrams , who had run a similar clinic in Philadelphia, where she Tlw eity of L'Vir in tlw l'krairw is plagu~l with antiquat~l fatilitit>s and latk of aeet>ss to tll(XIPrn nr~lieation and ~1uipnwnt. -------------------------------------------------------------B u 0 0 p c c n s u m m e 5 �r•••••••••••••••••••••••••••·-------------------------------·-·• morning clinic for men at Buffalo's City Mission. It's staffed by physicians from Sheehan Hospital, supported by volunteer medical students and nurses from the ursing Center for the Homeless, a project of the UB School of ursing. "We get a wide range of problems," she said. "In the winter there are a lot of colds and infections. Overall there are a lot of foot problems, a lot of athlete's foot, really poor hygiene. A lot of them are on their feet a lot and don't have good shoes." Bonham said about 60 medical students are involved on a rotating basis, doing initial intake, taking histories and vital signs. They also solicit donations of supplies from pharmaceutical companies. She said the clinic sees 15 or 20 people on an average winter morning, fewer in the summer. The clients, she said, are just people for whom life has taken a bad turn. "We had one man who came in, he told me he had a four-year degree. He was an accountant or something like that. He said he had been promised a job in Buffalo, but the job didn't pan out and he had gotten his wallet stolen. He had no ID, and he found himself on the street with no job and no place to live. He was very intelligent and well-spoken, and had all this luggage with him that he had to carry everywhere. "A lot of times you find people who've just had bad luck. The patients generally are quite grateful and very polite. It's actually surprising to some people. There are a lot of misconceptions about this population. For the most part, they're not what you might expect. They're younger than I had expected, for example. Some of the stories you hear will break your heart. "We may not have a lot of skills yet, but we do have time, so we talk to the patients. Often in an office setting you're on a time limit, but we tell them if they want to talk, we'll listen. Sometimes what they need most is a good listener." + served an emergency medicine residency. "As a physician you have to give back something to the community, and probably the best thing you can give back is your skills," Abrams said. "The minute I started this clinic, I can't tell you how many physicians came, asking if they could be a part of it. And the medical students are very eager to volunteer. We can offer them one-on-one teaching there, and it also exposes students to working in the community." Abrams and Piver, with the assistance of medical students, physician assistants and sometimes volunteer paramedics, see patients with such complaints as infections, coughs or colds, and perform routine physical exams. "We don't do anything invasive," she notes- no needles or scalpels - and they refer plenty of cases to hospital emergency departments. "There are whole families that are homeless," Abrams said. "A lot of my patients are a mother, a father and three kids. They have no way to get to a doctor and have basic things done. The kid may have a wound that's almost infected, but many of them are working people. To sit in the emergency room for three hours for a kid to be seenthey can't do it." Part of the job is building trust with patients. Abrams tells of one man who suffers with a seizure disorder that began when his father hit him in the head - with a hammer. The man was institutionalized for 40 years, she said, and "he was terrified, just terrified. Every time I saw him, his question was , 'Are you going to put me back in?' But now he'll come to me voluntarily, looking for help. "These people are really going out of their way to be good patients and help themselves," Abrams said. "And many of them have said: 'We know you don't have to be here. Thank you."' Adrienne D. Bonham is a second-year student at UB medical school who coordinates Hope Clinic, a Saturday HPrP in Buffalo. llw JXXlr and llw honwiPss swk medital altPntion at FriPnds of llw ~ight PP<lpiP and llw City Mission. -------------------------------------------------------------B u a 0 p h y 5 c a 5 m m e 9 v B A c K �DIA E ZwiREKI • lll • • 1 Ul PHoTOGRAPHY BY RoBERT CoLLIGNO THE EW TECHNIQUE VENTILATION DEVELOPED POTENTIAL TO TREATMENT OF 6 a 0 p 5 c OF a n 5 PARTIAL AT UB REVOLUTIO LIQUID HAS THE IZE THE RESPIRATORY FAILURE. m m e 9 9 �CORINNE LEACH, M . D ., PH.D., HOLDS FOUR-MONTH OLD KENNETH LA BARGE, ONE OF T H E BABIES WHOSE LIVES WERE SAVED BY PARTIAL LIQUID VENTILATION. B a 0 p y s c a 5 u m m e 5 �DuRING THE PAST DECADE, the University at Buffalo has grown strong among major medical research centers. Funding has increased, a state-of-the-art research center has recently been built, and the reputation of UB investigators continues to develop. But all this pales by comparison with the thousands of lives that will be saved as the work of these researchers becomes clinical reality. From the tiniest of premature infants to elderly victims of accidents and illness, society will reap the rewards as studies that originated in Buffalo reach fruition and are developed into clinical practice throughout the country, and the world. At UB and The Children's Hospital of Buffalo , along with four other centers nationwide, l3 premature babies who teetered on the brink of death from respiratory failure earlier this year were treated in the first clinical trial using partial liquid ventilation led by Corinne L. Leach, M.D. , Ph .D., assistant professor of pediatrics and attending neonatologist at Children's. This revolutionary technique was first described by Bradley P. Fuhrman, M.D., chief of pediatric critip LA T "THE I cal care at the hospital and a professor of pediatrics at UB. All of the infants responded with I S FUTURE TO improvement in their lung function, and seven ultimately survived . Known also as A CHILDREN perfluorocarbon-associated gas exchange, or PAGE, partial liquid ventilation could significantly enhance treatment for not only newborns, but older children and adults who suffer from lung disease. "Treatment is a way of taking advantage ofliquid to make a collapsed lung available for use ," explains Fuhrman. "It will be especially effective in situations where there is generalized lung collapse, such as acute respiratory distress syndrome and hyaline membrane disease . It showed very good effectiveness in the trial involving the l3 babies, all of B a 0 p h c whom were expected to die and had failed with all conventional forms of treatment, including surfactant. " PAGE also has been used to treat children with viral pneumonia and in patients with bacterial infections that cause lung collapse. "The plan in the near future is to do this in children and adults," as well as newborn babies, notes Fuhrman. "PAGE is a potentially major breakthrough," according to NEAR N THE Bruce A. Holm, Ph .D., dean for research and graduate studies at UB. "Its history lies in anD 0 I N T HI S other development: the development of surfactant. " The results of the D ADULTS " first clinical trials showing the efficacy of surfactant were published in Buffalo in 1985. A combination of phospholipids and proteins, surfactant is normally produced in the alveoli and secreted into the lung, where it is responsible for lowering surface tension. The initial production of surfactant in the laboratory, and later by commercial firms, has changed the standard of care for the treatment of respiratory distress syndrome. PAGE carries the basic concept behind surfactant a giant step forward. a 5 m m e 9 9 5 �R oge r Kais e r , M.D. in back g round , and Bhup e ndra Mepani , M . D. , view X-r ays from th e first clini ca l tri a ls . "It takes a patient who is unstable and poorly oxygenated and offers a more stable course," says Fuhrman. "We think we'll reduce the risk of having this kind of lung disease. " Leach, who collaborates with Fuhrman, and developed this technique in the treatment of respiratory distress syndrome, reported the results of the pioneer clinical trial at the May 10, 1995 meeting of the Society for Pediatric Research in California. Leach came to UB in 1988 from the University of Pennsylvania and the Children's Hospital of Philadelphia , having worked with Thomas Shaffer, Ph.D. , of Temple University, who designed an early liquid ventilator, and is considered the modern-day father of total liquid ventilation. In addition to Fuhrman and Leach , Erie County Medical Center's Roger Kaiser, M.D., clinical associate professor of anesthesiology and clinical assistant professor of surgery, has been instrumentally involved in studies using PAGE on adults . "Brad Fuhrman simplified the entire process of partial liquid ventilation and launched it into the clinical arena ," according to Leach. "While he was in Pittsburgh, he figured out that partial liquid ventilation could work; at the same time I was doing total liquid ventilation research here at UB. We got together, and I modified it to work in the sick premature lung. Since then , our team at UB , including Drs. Michelle Papo, David Steinhorn, Lynn Herman and Roger Kaiser, has developed PLV in the treatment of many dis- B a a p y 5 c eases, which has led to subsequent pediatric and adult clinical trials of PAGE. " And, as the landmark study of the l3 infants proves, it does work. Reaching this milestone took approximately 30 years, during which time one of the major barriers to clinical application was the fact that liquid breathing required a highly specialized ventilator. Fuhrman successfully leapt this hurdle. "PAGE requires the standard ventilator already used in hospitals ," he explains. "It doesn't require a shift in the way we do ventilation. It just makes existing methods work better. "We think it will make the lung more uniform and therefore more available for ventilation," he continues. "The spin-off could be quite large. There are 150,000 ARDS (Adult Respiratory Distress Syndrome) cases in the United States. In addition, many patients develop lung disease as a component of other problems. PAGE actually contributes to the treatment of many different diseases." Describing his role in the development of PAGE, Kaiser notes , "my role has been supportive of Fuhrman. Most of my work has been in sheep, utilizing an acid aspiration lung injury model. " Kaiser used sheep in his laboratory trials because initial work had been done on smaller animals. As a prelude to human adult trials , large animal trials were conducted. Much research has been funded by the Alliance Pharmaceutical Corporation, San Diego , which holds the patent on medicalgrade perflubron, the fluorocarbon commonly used in PAGE. a s u m m e 9 9 5 �"Brad Fuhrman first discussed PAGE in the july 1991 issue of Critical Care Medicine. Alliance contacted him immediately and matched Fuhrman with our chemical, perflubron," according to Hal W. DeLong, executive vice president of business development/marketing at Alliance. "One of the pleasant surprises has been that humans responded so similarly to animal models, which indicated the efficacy of the technique in treatment," adds DeLong. Kaiser notes that three human trials for PAGE- in neonates, pediatric patients and adults- have been initiated since 1993. "We are starting Phase II of trials in adults this summer," Kaiser says. "This will be a controlled study of two separate groups, one treated with PAGE and a control group treated with standard therapy. We will look at a number of different parameters to see how effective this therapy really is, whether it lowers the number of days spent on a ventilator, and whether it affects outcomes regarding mortality. Then, Phase Ill trials, which will be more broad, will be done. " Sites for this summer's adult trials include ECMC and BGH. Kaiser predicts that ifinvestigators' data work and the PAGE technique are shown to be of value, actual clinical application in adult patients could be implemented within the next two years. Perfluorocarbon is much less expensive to manufacture than its predecessor, surfactant. Other potential benefits to the patient include a shorter hospital stay and lower morbidity. And in years to come, the ultimate achieveBR AD L EY P. F u H R M AN, M.D. ment of PAGE researchers could be to prevent ARDS entirely. "Once we demonstrate that this is working the kinks effective therapy for out on that," says " I T TAKeS A PATIENT WHO IS UNSTABLE ARDS, the next step Leach. "Partial liqwould be to look uid ventilation will into its use prophybe one of the theralactically," predicts pies available in the AND POORLY OXYGENATED AND OFFERS Kaiser. "Preliminary '90s and in the fudata show that ture for the treatperfluorocarbon ment of lung dismay also minimize ease. We have a lot A MORE STABLE COURSE. " inflammatory reof data to show that sponse; therefore, other state-of-thewe could actually art therapies such as minimize lung damsurfactant have been shown to combine well with PAGE. This age before it happens. " gives us every reason to suspect we will use them in combinaCombining surfactant and partial liquid ventilation to comtion in the years to come," she concludes. + bat lung damage is also being investigated, although "we're still 6 u a 0 p y 5 a n S u m m e 5 �FuNDING CUTS RESEARCH IMPERIL look at research sites or the opportunity for investigators to visit Washington , D.C. , to present their cases. Furthermore, the effect of federal budget cuts is discouraging for researchers - new and experienced alike- whose applications are turned down by agencies such as NIH. "Because we have a larger number of investigators and a smaller number of grants being funded, more investigators tend to reapply. The work load on their part is tripled. This is demoralizing for young scientists. It has discouraged people from academic research," says Holm. "And , we're seeing senior investigators with 25 or more years' experience being turned down. The statistics are not flattering for anyone." UB , however, seems to be an exception to this national trend . During the past three years the university has seen a 20 percent growth in extramural grant funding into the School of Medicine and Biomedical Sciences. "We've managed to buck the system," concludes + Holm, "but how long can we keep it going? " Thrilling new developments in medical research have moved major centers like UB into the international limelight as the wombs , birthplaces and cradles of cure and prevention for such life-threatening conditions as lung disease . But how will federal funding cuts threaten to nip these pioneer efforts in the bud? The outlook is ominous, according to Bruce A. Holm, Ph.D. , UB dean for research and graduate studies. "The rate of growth for funding is not matching the rate of growth of the body of knowledge or the number of researchers ," notes Holm. The future work of the ational Institutes of Health, foremost agency among research funding in the United States, is severely jeopardized. "There have been dramatic cuts in-house at the IH. It's a matter of time before this impacts on productivity," says Holm. For instance, the NIH has completely eliminated research-related site visits as a means of cutting expenses. Review of applications for funding is now based solely on the written word, without a first-hand RESEARCH THAT CHANGES LIVES: A CHILDREN's HERITAGE with PKU in 19 58- one year before Guthrie discovered the test that screened Thirty-six years ago, Children's Hospital was the site of another life-saving for the disease and 10 years before newborn screening became standard research breakthrough when Robert Guthrie, M.D., who died this year on hospital practice. June 24 alter a long illness, changed the nature of newborn screening for mental PKU babies are born with normal intelligence, but become retarded if they retardation with his heel-prick blood test lor the presence of phenylketonuria follow a normal diet. Early detection and treatment with a specialized formula (PKU). are essential- and must become a lifelong habit. Today, efforts are focused Infants born with the disorder are unable to metabolize the essential amino on caring for older children and adults, as well as acid phenylaline, which builds to toxic levels and newborns, affected by PKU. "It's important to treat leads to mental retardation. If detected at birth, infants as early as possible to lower the level of children can lead normal lives if they follow a phenylketonuria. Within 10days to two weeks alter special diet that excludes foods containing large a child is born, the diet begins," notes Georgirene amounts of protein. Vladutiu, Ph.D., associate professor of pediatrics Guthrie's PKU test is now standard for newand neurology at UB and director of the Guthrie borns in all 50 states and 25 countries, and is laboratory. estimated to have spared 30,000 people worldwide At the laboratory, all PKU patients in from mental retardation. In Buffalo, his legacy Western New York- atleast1 00 at any given time continues through the efforts of the Robert Guthrie - ore monitored, and a nutritionist studies and Biochemical Genetics laboratory, located at modifies their diets as needed. Monitoring for paChildren's Hospital, the site of his original work. 5 Hospital in 1982 • Dr. Robert Guthrie at Children' tienls in North Dakota and parts of Ohio is also done Guthrie credited his son, John, and his niece, there. Margaret Doll, with being the inspiration for his research and campaign to get newborn testing widely accepted. John Guthrie, "Whenever a patient is pregnant, we monitor her PKU level weekly during who had non-PKU mental retardation, died earlier this year at age 47. Margaret the entire pregnancy. We also test the baby, of course. Most of the time, if the Doll is profoundly retarded and lives in a Minneapolis group home. She was born mother has followed her diet, the baby is line," Vladutiu says.+ B u 0 0 p y 0 5 u m m e 9 9 �• ... . ........................................... .. .......... ... .. . ....................... ~ I Naughton to step down as dean after 20 years WILL PURSUE TEACHING AND RESEARCH AT THE MEDICAL SCHOOL ohn P. augh ton, M.D., vice presi- the academic side, clinical practice and among the hospitals loosely affiliated dent for clinical affairs and dean of research . All three activities have devel- with the medical school; residency prothe school of medicine and bio- oped in a very significant way, testi- grams were administered and run by medical sciences for the last 20 mony to the fact that the medical school them , with little cohesion and consishas risen to become one of the top tency from hospital to hospital. years , will resign july 1, 1996. The community's health care sufaughton made the announce- medical schools in the country. " Naughton said he plans to stay at UB, fered for it, with competition between ment to a stunned group of colleagues and well-wishers gathered March 1 in the teaching undergraduate· and graduate the over-bedded hospitals resulting in atrium of Cary-Farber-Sherman to cel- medical students, pursuing his research splintered services, rising health care ebrate his 20th anniversary at the medical specialty- cardiac disease exercise re- costs and fiscal woes for all of them. aughton, in his role as vice president school. His retirement date coincides with habilitation - and working with the the school's sesquicentennial celebration. school's faculty on the evolution of an for clinical affairs, is widely credited with Naughton said he came to his decision interdisciplinary curriculum. Another helping to tum the situation around by to step down, "by realizing that 20 years is project, he adds, will be capturing his bringing the hospitals together in a coopa long time to be dean. The erative rather than comthings I'd planned to accompetitive arrangement that "For 20 years, he's demonstrated a unique and uncanny ability to get parties to the plish have been accomsaw them enter into a plished. It's time for the uniconsortia! agreement in table and work at consensus-building strategies among parties that otherwise would 1983 to respond to guideversity to evaluate the leadership of the school. " He lines promulgated by the credited the university for Liaison Committee on not. His ability to do this in this environment is going to be greatly missed." Graduate Medical Eduits continued "support for cation. the clinical changes made at - John E. Friedlander, president and CEO of The Buffalo General Hospital The Graduate Medithe medical school and its primary care initiatives." cal Dental Education William Greiner, president of UB, "unique experience in Buffalo of col- Consortium of Buffalo has served as a said, "john has led his school into the laboration and health care change." model for the nation and achieved sigAnd in his 20 years as dean of the nificant accomplishments , among them ranks of the nation's top 10 comprehensive medical schools. He has also re- medical school-12 of them also as vice the designation of The Buffalo General shaped the medical school's connec- president for clinical affairs for the univer- Hospital as the regional heart-lung transtions with the Western New York medi- sity- Naughton has seen a lot of change. plant center; the establishment of a single A nationally prominent cardiologist, division of neonatology in pediatrics to cal community at large. He helped to create extraordinary new relationships he came to UB as dean and professor of coordinate neonatal care, research and with UB's affiliated teaching hospitals, medicine from George Washington education; the establishment of a PET relying on a consortia! model that has University School of Medicine and center at the Buffalo VA Medical Center garnered national attention as a new ap- Health Sciences, where he served as and Millard Fillmore Hospital; and the proach to medical education." dean for academic affairs , in 1975. At designation of the regional Trauma-Bum john E. Friedlander, president and that time , UB's medical school was beset Center at Erie County Medical Center. CEO of The Buffalo General Hospital, by a lack of direction and leadership , The consortium also governs all resisaid, "He's dedicated himself to con- with both morale and research funding dency programs in Western ew York, tinuing in an outstanding way the medi- support low after the 1962 merger be- serving as the "institution of record" for cal mission here. Dr. aughton has a tween the once private University of graduate medical education, and is regreat deal of understanding of the three Buffalo and the public State University sponsible for standardizing residents' important aspects of medical school- ofN ew York. Clinical teaching was split salaries and managing their credentialing. B u a 0 p h 5 a 5 m m e 5 1 J �······················································ · ····· · ············· · ·············• · ~' ' 1 J medical staff president] ames P. alan, M.D., BGH president William V. Kinnard, M.D., and the immediate past president of the hospital's board of trustees, Robert S. Scheu, all of whom helped draft the plan with Naughton. Scheu and alan served as associate directors of the project; Kinnard chaired a task force that investigated the business and legal aspects of the proposed merger. The plan was eventually killed in the county legislature when that body failed to establish the nonprofit management corporation that would run the consolidated hospitals by one vote- l3 in favor, 7 against. Perhaps, ironically, many of the recommendations made in the report have been borne out by time - from the closing of the nursing schools, to the conJohn P. Naughton, M.D., vice president for clinical affairs and dean of the School of Medicine and Biomedical Sciences. version of the former Deaconess aughton was appointed vice presi- recommended that Children's be phased Hospital to a skilled nursing facility and dent of clinical affairs in 1984 after serving into a new nonprofit corporation that the area's decreased inpatient bed capacity. in that capacity as acting vice president of would manage it along with BGH, Deaa ugh ton accomplished much in his health sciences for a year. The position coness and Meyer in the county facility 20-year tenure, for both the medical gave him greater authority over clinical that was under construction at the time. school and its teaching hospitals. His teaching areas- at UB, without its own The merger plan proposed that acute watch saw the school garner significant medical center, the affiliated teaching care would be provided by the new research funding and prestigious grants, hospitals sites- and graduate as well as county hospital and BGH, with the em- among them the Robert Woodjohnson undergraduate medical education. phasis at BGH shifted from inpatient to Generalist Physician Initiative, the But aughton's tenure was not with- outpatient services. It also recommended Women's Health Initiative and the out controversy. Two years after com- that Deaconess Hospital be converted Markey Trust award. He was instruing to Buffalo, he was asked by officials into a nursing care facility, that the mental in making the School of Mediof The Buffalo General Hospital, The nursing schools at BGH and the county cine and Biomedical Sciences a leader in Children's Hospital of Buffalo and the be closed and that Columbus and the the push for primary care, and is also former E. ] . Meyer Memorial and Dea- now defunct lafayette General Hospital credited with unifying the-school's camconess hospitals to head a study into the move into the Children's facility. pus with the construction of the new Bolstered by support from a "Citizen's medical research building and the Caryfeasibility of merging those hospitals. The resulting report- portions of which Committee to Save Children's Hospital" Farber-Sherman complex, as well as inleaked to newspapers months before its that garnered over 200,000 signatures on stituting a consolidated computer netofficial release - set off a storm of a petition to keep the facility open and work among the hospitals and medical protest within both the medical com- independent, the hospital's medical staff school, now operated by the Health Sciand board of directors voted against the ences library and known as HUB ET. munity and the community at large. The report - citing the area's l3 consolidation, as did the medical staff at percent underutilized bed capacity Buffalo General in a sharp rebuke to Con~nued on page 20 6 a 0 p 5 c a n s m m e 9 9 �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . [1] ~ I Richard Krugman M.D~ delivers 1995 Stockton Kimball Lecture Naughton, Continued from page 19 Naughton also instituted UB's medical scientist training program for M.D.Ph.D. students and its successful early assurance program. His tenure saw steep increases in the quality of the university's medical students and an added focus on CHARGES MEDICAL PROFESSION TO MAKE CHILD minority medical education. He also ABUSE A PUBLIC HEALTH PROBLEM FOR PHYSICIANS spearheaded increased parental involvement in undergraduate medical education at UB with the formation of a parichard Krugman , M.D. , is a man nation's top childhood diseases. Child ents council and other programs. with a mission: to reinvent the abuse affects more than 2.5 percent of Naughton says, "the job for my suctreatment delivery system for vic- children nationwide each year. As a cessor will be to help provide creative tims of child abuse in our society. University of Colorado Medical School leadership in an ever difficult, con"We must change the focus of intern more than 30 years ago, Krugman strained environment" anticipated by child abuse from a social services worked with Dr. Henry Kemp , who conboth federal and state budget cuts. and law enforcement "There's an awful lot of uncertainty ," he mode to a public health remarks , "and we haven't seen all the approach concerned with fallout yet. preventive treatment ," "We've been done dirty in a way. We said Krugman, who shared were moving on pathways that looked his mission with a crowd more at regulation and coordination. of hundreds of UB mediAnd now we're caught in a social whirl cal school alumni on Sat- or maybe whirlpool - where we're urday, April 29 . uncertain of the changes fostered by Krugman delivered the competition and withdrawal of support. " keynote address at the Add to that, he says, the "reductions Medical Alumni Associafrom the hospitals in practice income tion 's Spring Clinical and research, and medical schools Day, held at the Marriott throughout the country will have to try Inn in Amherst. Although to re-sort things. We hope to maintain he is now dean of the Unithe emphasis on what we're all abou t - versity of Colorado Mediquality patient care, education and re- cal School in Denver , search. " Krugman still spends 10 At a Medical School Executive Com- to 20 percent of his time mittee meeting he attended last spring, speaking on and researchGreiner stated he intends to pursue the ing child abuse and neselection of a new dean and to separate glect, his passion since he that position from the post of vice presi- was a medical student. He dent of health sciences. A search com- is a former practicing pemittee will be formed soon to search the diatrician and worked vice president position. briefly as an advisor on In discussing his tenure, Naughton health care issues to Richard Krugman, M.D. said, "I think my biggest accomplishment former U.S. Senator David has to be bringing the hospitals and medi- Durenberger of Minnesota. ducted a pioneering study on battered cal school together to see that they could Krugman explained that child abuse children. "In 1960, we thought we had work for mutually cooperative goals." + is more prevalent than congenital heart uncovered the scope of the problem B Y NANETTE TRAM ONT defects or asthma, making it one of the when we found evidence of a few hun- B u a 0 p h y 5 c a s u m m e 9 9 �........................................................................................• .. · ~ I dred cases in Colorado," Krugman recalled, "and we thought it would be relatively easy to take care of." Today, more than three million reports of child abuse are filed each year. And 15 percent of all men, and 27 percent of all women now report some form of sexual abuse during their childhood, Krugman explained. Child abuse is finally recognized as a problem, said Krugman, but its root causes are not being adequately addressed. "As a society, we have attention deficit disorder," said Krugman. "We are quick to recognize a problem but long to cure it. We simply move on to another problem." Increased childhood and family stress, brought on by a lack of quality time as a nuclear family and events like divorce and out-of-wedlock births (both up 400% since the 1960s, Krugman points out), contribute to the high incidence of child abuse in our society, according to Krugman. "Kids face increasing isolation and stress," he said. "What we have is an emergency. We spend billions of dollars on the downstream effects of not treating child abuse early," he said, "but it is really quite extraordinary that, as a society, we are still in a basic stage of denial regarding this issue. " The impact of childhood abuse is lifelong, linked to an unusually high suicide rate among pre-pubertal children and contributing to such teenage and adult complications as eating disorders, developmental disabilities, even chronic headaches and moderate to severe chronic physical shaking, according to Krugman. To solve the dilemma, Krugman advocates a system of home health visits to sufferers of child abuse by trained medical professionals. Currently, abuse victims are dealt with by social service professionals , who, according to Krugman, are woefully overworked and undertrained to deal with the problem. "Many parts of the country require only B a a p means a system that makes it easy for a potential abuser to pick up the phone, reach a trained professional and say 'I need help ,"' said Krugman. Physician advocacy and market forces will create the environment needed for real reform in child abuse treatment, believes Krugman. The downstream costs of these medical issues will force the health care delivery market to begin making the types of adjustments it needs in order to provide preventive care to children and potential abusers, Krugman predicts. "Health care reform," he added, "is happening already. It is a market-driven force moving, like the weather, from west to east across the country." Krugman is not the first in his family to make a medical name for himself. His father, now retired in Florida, conducted extensive research which led to the first vaccine for hepatitis B. Seated next to UB's long-tenured medical school dean, john Naughton, M.D. , Krugman observed that being dean of his medical school is "not a unique opportunity. l am the ninth dean in twelve years." Looking over the list of past Stockton Kimball speakers, Krugman even noted that he was not even the first dean from the University of Colorado to be featured. Krugman also joked that, being from Denver, he shared Buffalo's pain each football season. Despite four appearances each, neither the Bills nor the Denver Broncos have ever won a Super Bowl. The luncheon's namesake, Stockton Kimball, served as dean of the University of Buffalo's School of Medicine from 1946 until his untimely death in 1958 at the age of 55. Kimball's tenure saw the medical school moved from its old home at Main and High Streets downtown to its current location at Main and Bailey, on the southeast corner of the South Campus. The move poised the medical school, which was still private, for its later merger with + the University ofBuffalo and SUNY. a high school diploma to become a case worker," said Krugman, "and their lack of knowledge is striking." Krugman believes money to finance the shift in emphasis in treating child abuse can be "squeezed out of the already shrinking health care delivery system. " He made an example of two friends of his from Denver, both doctors who owned their own HMOs and decided to merge. "Then another, larger HMO came in and bought them out. othing changed as far as service delivery was concerned, but my two friends split more than $6 million. "If the health care delivery field has enough money out there to make my two friends millionaires, there is money out there to fund child abuse treatment," chastised Krugman. He added that his home health visitation system would also reduce the number of inappropriate visits to emergency rooms, the most costly way to deliver public health services. Krugman praised the recent opening of a multidisciplinary Child Advocacy Center on Delaware Avenue in Buffalo. Though becoming more common in the west, it is the first center of its type in New York State, with the second due to open soon in Niagara County. The Child Advocacy Center is a cooperative effort of representatives from various area social service agencies designed to offer a single outlet for investigation, support, advocacy and medical treatment for sexually abused children and their families. The atmosphere is designed to minimize the amount of trauma involved to the children and perpetrators of abuse in seeking treatment. "Abusive parents love their children very much,just not very well," explained Krugman. Abuse is compounded because today's perpetrators were often abused as children, he added. Early intervention by trained professionals is the best treatment, he explained. "That's why I say that preventive treatment 5 c a 5 I BY m m e STEVE 9 COX �Sisters of Charity Hospital history reflects its mission BUFFALO'S FIRST HOSPITAL BUlLT ON SERVICE TO THE LEAST FORTUNATE he roots of Buffalo's first hospital Humboldt streets. The 30-acre site was to its present location, absorbing St. can be traced to the mid-19th cen- purchased from Austin Flint, M.D., the Louise de Marillac Maternity Hospital tury when the diocese's Bishop, first medical staff chief at Sisters Hospital. into its maternity unit and thus consolijohn Timon, traveled to Baltimore Land was also purchased at Main and dating all the Sisters of Charity health to request the services of the Sis- Delavan streets to help meet the grow- care services. ters of Charity to establish a hospi- ing medical needs of the city. A new Over the years, Sisters Hospital has tal for the Queen City of the Lakes, a hospital, accommodating 300 patients, undergone extensive additions, renovagrowing frontier on its way to becoming was completed in 1876. From 1877 to tion and modernization. The first addia major transportation center. 1882, some 4,420 patients were treated tion, built in 1948, housed the emergency Bishop Timon had purchased a brick there at a total expense of$19,000. About department, family health center, patient school house and adjoining cottage on half the patients were charity cases. rooms and outpatient treatment centers. Pearl Place in the city. The property, By 1884, four distinct Daughters of A five-story building added in 1965 which he turned over to the changed the face of the hossix sisters who traveled to pital, encompassing its adBuffalo to start the hospital, ministrative offices and rnabecame the first site of the ternity service, as well as Sisters of Charity Hospital in patient rooms, conference 1848. The Sisters of Charity areas, the medical records in America became known department and physician two years later as the Daughlounge. Another addition ters of Charity of St. Vincent constructed two years later \"JEW OF TUE llEDlC..!.L COLLEGE, ASD TUE llll:~~~~ll~S~_;-~~F::,T~~-~.o:=u:.:~._._ housed the pharmacy, cende Paul, officially joining with the order established in France in 1633. Charity hospitals filled specific needs in tral supply, diagnostic imaging and purWithin a year of its opening, Sisters the community - the newly opened chasing departments. Hospital was faced with its first test with Emergency Hospital at Pine and Eagle Inl974,theSetonProfessionalBuildthe outbreak of four cholera epidemics streets, Sisters Hospital for the sick at ing and St. Catherine Laboure Health in Western New York. Patients jammed Main and Delavan, St. Mary's Infant Center additions were completed- the the hospital; many recovered, but the Asylum and Maternity Hospital for or- Seton Building housing medical and epidemic would claim 900 lives before it phans and unwed mothers at Elmwood commercial offices along with hospital subsided. and Edward and Providence Retreat for extension offices, and the St. Catherine ln 1854, the Daughters of Charity the mentally ill at Main and Humboldt. facility housing a concentration of rehaexpanded their services to the City of Established originally as a downtown bilitative services including physical and Buffalo with the establishment of St. branch of Sisters Hospital, Emergency occupational therapy, social work and a Mary's Infant Asylum and Maternity Hospital was taken over by the Diocese skilled nursing facility. Hospital. The facility, which remained of Buffalo in 1954. lt is now known as Re-Vision 2000, Sisters Hospital's open for nearly a century at Elmwood Sheehan Memorial Hospital. major modernization project completed and Edward streets, cared for orphans Providence Retreat was closed in last year, added two more stories to the and unwed mothers. 1940. Two years later, Sisters Hospital main structure as well as new surgery, In 1860, Bishop Timon felt the dio- opened the St. Louise de Marillac Mater- coronary and intensive care units. The cese needed an institution dedicated to nity Hospital, which merged with St. project also included the construction the care of the mentally ill. The Daugh- Mary's Hospital in the Providence Re- of a new building named after Sr. Mary ters of Charity opened Providence Re- treat building. Charles Dever, former hospital presitreat the following year on the site of the Sisters Hospital remained at Main dent, to house the information systems present Sisters Hospital at Main and and Delavan untill948 when it moved and finance departments. a u a 0 p y 5 c a s m m e 9 9 5 �························································································• ·· · ~ I baton were designed served as director of the and constructed by Dr. Visiting Nurses AssociaBrown, as well as the tion from 1975 to 1978 case in which they are and was a member of the medical honor society, displayed, and he also Alpha Omega Alpha, the designed the school's Medical Foundation of academic gown, a Buffalo , the Faculty chandelier and doors Club, the Medical Hisin the complex to torical Society, the which he devoted his Albright-Knox Art Gallife. lery, the Museum of SciIn recognition of his ence, the Buffalo and Erie strong support of the County Historical Society Health Sciences Li- Robert L. Brown, M.D. , 44 and the Friends of the brary for 26 years, the historical and rare book collection was School of Architecture. He was also a long named the Robert L Brown History of standing member of the Buffalo Club. He is survived by his sister-in-law, Medicine Collection in 1985. Upon his retirement that same year, he was ap- Mrs. Donald (Virginia) Brown; a niece, pointed consultant to the University Li- LauraMehl;a nephew, Kenneth P. Brown; braries and continued his close associa- and his good friend , Donald]. Savage. tion with the History of Medicine Collec- Contributions may be made to the University at Buffalo Foundation, P.O. Box tion until his death. Dr. Brown received the Dean's Award 590, Buffalo, New York 14231-0590 for + in 1967 and 1973, and the Distinguished the History of Medicine Fund. Medical Alumni Award in 1974. He - B y L I L L I S E N T Z In addition to the facilities located on the hospital campus, Sisters has continually expanded its off-campus sites. In 1981, it opened the Alden Medical Center; in 1989, it opened an outpatient chemical dependency STAR unit in Amherst followed by a second a year later in West Seneca. In 1992, the hospital opened the St. Vincent Health Center on Buffalo's East Side and the St. Louise Health Center on the city's West Side. Sisters moved into the north suburbs with the opening two years ago of its Amherst Health Center. From its humble beginnings nearly 150 years ago, the history of Sisters Hospital is reflected in its services to Buffalo's poor, mentally ill and orphaned. The hospital has grown tremendously from its one-building roots to a network of health care facilities encompassing a full range of acute and long-term care as well as inpatient and outpatient services. + Robert L. Brown, M.D, former associate and acting dean,dies GRADUATION DAY 1995 It was a day for celebration and obert L. Brown, M.D. '44, former associate dean and acting dean of the University of Buffalo's School of Medicine, died April 5, 1995 after a brief illness. Dr. Brown's accomplishments and contributions to the medical school weremanyand varied. He was appointed assistant dean in 1959 and acting dean in 1960, when he directed the intensive planning for the university's merger into the State University of ew York system two years later. He was the first associate dean appointed to the School ofMedicine. In 1974, Brown became the medical school's archivist, beginning a systematic search for the historical records of the school that led to the categorization and preservation of many original records from the early years of the school. The medical school's mace and marshal's B a a p h I festivities as the School of Medicine and Biomedical Sciences graduated its 149th class of physicians and medical scientists this past May. y c a s m m e 9 9 �.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . [1] ~ I Match Day 1995: Success and Celebration UB'S GRADUATE MEDICAL DENTAL EDUCATION CONSORTIUM RESIDENCIES DRAW 35 PERCENT OF ITS GRADUATING MEDICAL STUDENTS THIS YEAR his year's doss of graduating medical students did well on the National Resident Matching Program, with 67 percent getting their first choice and 83 percent getting one of their first three choices. Of the 140 UB students participating in the NRMP, 35 percent will remain in Buffalo in Graduate Medical Dental Education Consortium residencies; 11 percent will stay in New York State, but outside Buffalo; and 51 percent will do their residencies out of state. Seven students were unmatched. Primary care residencies drew 40 percent of UB's graduating physicians, down from last year's 44.1 percent. Nationally, the program matched 17,858 of the nearly 23,000 students who competed for the 20,751 first-year residency positions available. More than half were matched in generalist residencies, including family practice (15.4 percent), internal medicine (24.5 percent) and pediatrics (11.1 percent). Omolora J. Akinbomi, Pediatncs, Children's Nauonal Medical Center, Washington, DC George J. Burnett, Psychiatry, Graduate Medtcal Dental Education Consortium, Buffalo, NY Mory J. Ciotoli, Emergency MediCine, Umverstty of Rochester/Strong Memorial Hospllal, Rochester, Y Trine B. Allen, Psychiatry, Duke Umverstty Medical Center, Durham, NC Timothy R. Byrnes, Internal MediCine (Prehm.), Ststers of Chanty Hospllal, Buffalo, NY Lori A. Cohen, Internal Medicine, Long Island jewish Medtcal Center, ew Hyde Park, NY Darren M. Coparoso, Family Pracuce, Graduate Medtcal Dental Educauon Consoruum, Buffalo, Y Richard J. DeAsla, Surgery, University of Rochester/Strong Memorial Hospllal, Rochester, NY Michael J. Carlson, Internal Medicine, Medtcal College of Virginia, Rtchmond, VA Tracie l. DiMarco, Family Practice, New York Medical College Mtd-Hudson Family Pracuce Serv1ces lnsmute, Kingston, NY lhuoma U. Alozie, Internal Medtcine (Prelim.), Hospllal of St. Raphael, New Haven, CT Andrew l. Altman, Urology, Case Western Reserve Umversity, Cleveland, OH Barry R. Armondi, Internal Medicine (Pnmary Care), Long Island jewish Medical Center, New Hyde Park, NY Brett D. Arnoldo, Surgery, Graduate Medical Dental Education Consorl!um, Buffalo, NY Robert A. Borroli, Emergency Medicine, Maricopa Medtcal Center, Phoemx, AZ Katherine A. Blum, Obstetncs and Gynecology, Graduate Medtcal Dental Educal!on Consortium, Buffalo, NY Miroslav P. Bobek, eurologtcal Surgery, Universlly of Mtchtgan Hospllals at Ann Arbor, Ann Arbor, Ml Maurits S. Boon, Surgery (Prelim.). Thomas jefferson UmverSily, Philadelphia, PA Otolaryngology, Thomas jefferson Umverslly, Philadelphia, PA Anthony J. Bartkowiak, Internal Medicine (Pnmary Care), Graduate Medical Dental Educauon Consortium, Buffalo, NY Maria D. Bruno, Internal Medicine (Prelim.), Graduate Medtcal Dental Educauon Consortium, Buffalo, NY Ophthalmology, Graduate Medical Dental Educauon Consortium, Buffalo, NY Ross J. Bellavia, RadiOlogy- Dtagnosuc, Umverslly Hospllals of Cleveland, Cleveland, OH Cheryl D. Buck, Medicine!Pedtatncs, Umverslly of Cincinnal! Hospital, Cincinnau, OH Scott J. Belote, Emergency Medicine, Graduate Medical Dental Educauon Consoruum, Buffalo, NY Tony T. Bui, Transitional Year, Wilson Memonal RegiOnal Medtcal Center (Unlled Health Services), johnson Clly, NY Physical Medicine and Rehabilllal!on, Universlly of Texas Southwestern Medical School, Dallas, TX Kathleen E. Bethin, Pediatrics. St. Loms Children's Hospllal, St. Louts, MO B u a Frank P. Carnevale, Pediatrics, Graduate Medical Dental Educauon Consoruum, Buffalo, NY 0 p h liang R. Chang, Obstetrics and Gynecology, Graduate Medical Dental Educauon Consorl!um, Buffalo, NY Craig E. Cheiltez, Internal Medicine, Georgetown UmverSily Hospllal, Washington, DC J~eph C. Dipirro, Pathology, Graduate Medtcal Dental Educauon Consoruum, Buffalo, NY Anthony M. Dirubbo, Medicine!Pediatncs, Umverstty of Rochester/Strong Memonal Hospllal, Rochester, NY Therese M. Duane, Surgery (Prehm.), Eastern Virginia Graduate School of Medicine, Norfolk, VA Karen A. Chojnacki, Surgery, Thomas jefferson Umverstty, Philadelphia, PA Karen E. Dull, Pediatrics, Umverstty Health Center of Plllsburgh, Plllsburgh, PA Christine M. Chruscicki, Psychiatry, Duke Umversity Medical Center, Durham, NC Christopher J. East, Internal Medicine (Prelim.), Ststers of Chanty Hospllal, Sebastian J. Ciancio, Surgery (Prehm.), Baylor Buffalo, Y College of Medicine at Houston, Anesthesiology, Duke Umverslly Houston, TX Medical Center, Durham, NC Urology, Baylor College of Medicine Affiliated Urology Program, Houston, TX Daryl R. Ehlenlield, Pediatrics, Graduate Medical Dental Education Consortium, Buffalo, Y c a 5 u m m e 9 5 �·········· · · · · · ·· · · · · ···· ··· · · · ······· · · · ·· · ·· · · ·· ·········· · ········ · · · ··· ··· ·· · ····· · ·• · tm I lynelle M. Emery, Famtly Pracuce, Famtly Practice Residency of Southwest Washtngton Medtcal Center, Vancouver, WA Cynthia E. Epstein, Pedtatncs, Medtcal College of Virgmta, Rtchmond, VA AndrewS. Feinberg, Transitional Year, Georgia Bapust Medtcal Center. Atlanta, GA Ophthalmology, Emol)' Umverslty School of Medtcme, Atlanta, GA Carole Y.Fenton, Emergency Medtcme, Graduate Medtcal Dental Educauon Consortium, Buffalo, NY Faith A. Heavens, Pediatrics, North Shore Umversity Hospital, ew York, NY Andrew D. Henry, Internal Medicine, Umverslty of South Flonda College of Medtcme at Tampa, Tampa, FL Nigel I. Henry, Obstetncs and Gynecology, Brooklyn Hospttal Center, Brooklyn, Y Aravind Herle, Internal Medtcme, The Umverslty of Chtcago Hospttals, Chicago, IL Huiiung Kim, Radiology- Dtagnosuc, George Washmgton Umverslty, Washmgton, DC Donielle S. Noteboert, Emergency Medtcine, Graduate Medtcal Dental Educauon Consoruum, Buffalo, NY Eric H. Kossoll, Pedtatrics, Eastern Virgtma Graduate School of Medtcine, Norfolk, VA David M. Odell, Famtly Pracuce, St. Joseph Hospttal, Denver, CO Shone C. Ferguson, Pedtatncs, Graduate Medtcal Dental Educauon Consoruum, Buffalo, Y Shown P. Ferguson, Pedtatncs, Graduate Medtcal Dental Educauon Consoruum, Buffalo, NY Peter Hertz, Surgery (Prehm.), Graduate Medical Dental Educauon Consoruum, Buffalo, NY Dono lim, Obstetrics and Gynecolog}', Universtty of Rochester/Strong Memorial Hospttal, Rochester, :-.JY Tyrone D. Fillyow, Psychiatry, Sheppard Prall Hospital, Baltimore, MD Douglas J. Hickox, Surgery (Prehm ), Graduate Medical Dental Educauon Consortium, Buffalo. NY Arlene D. lobo, Internal Medtcme, Cleveland Clmic Foundauon, Cleveland, OH Meghon A. Higman, Pedtatncs, Unl\·erslty Health Center at Pmsburgh, Ptusburgh, PA Martin C. Moloney, Famtly Medtcme, Graduate Medtcal Dental Educauon Consoruum, Buffalo, Y Evon Hirsch, Family Practice, University of Cahfornia at San Franctsco, Fresno, CA Michele M. Manko, Pedtatncs, Graduate Medtcal Dental Educauon Consoruum, Buffalo, NY Jeanne C. Fitzsimmons, Emergency Medicme, Graduate Medical Dental Education Consortium, Buffalo, NY Michelle Game, Pedtatncs, Eastern Virgtma Graduate School of Medtcme, Norfolk, VA Kathy M. Golding, Famtly Pracuce, Graduate Medtcal Dental Educauon Consortium, Buffalo, Y Randy J. Goldstein, Pedtatncs, Medtcal College of Virgmia, Richmond, VA JeffreyS. Grant, Internal Medicine (Prehm.), Ststers of Chanty Hospital, Buffalo, NY Physical Medtcme and Rehabtlltauon, SUNY Health Sciences Center, Syracuse, NY James C. Ho, Internal Medtcme (Pnmary Care), Long Island Jewish Medical Center, New Hyde Park, NY Toreq S. Horb, Internal :vtedtcine, Vanderbtlt Umverslty Medical School, Nashville, TN B a 0 c a Michele A. Potempa, Famtly Practice, Graduate Medtcal Dental Educauon Consoruum, Buffalo, NY Susan E. Potts, Pedtatncs, Duke Umverslty Medical Center, Durham, NC Kirk Puttlitz, Pathology, Emory Umversity School of Medicine, Atlanta, GA lrm R. Roio, Psychiatry, Umverslty Hospitals of Cle,·eland, Cleveland, OH Peter D. Roy, Surgery, Umverslty of Alabama Hospital, Montgomery, AL Susan M. Noselli, Internal Medtcme (Prehm.), Jewish Hospttal of St. Louts, St. LOUIS, MO Neurology, Washtngton Umverslty, St. Louis, MO Helen M. Kim, Psychtatry, Massachusetts General Hospital, Boston, MA y Natalie Poppito, Pathology, DartmouthHitchcock Medtcal Center, Lebanon, NH James G. Nalbone, Psychtatry, Albany Medtcal Center Hospital, Albany, NY Marie I. Kessler, Pedtatrics, Graduate Medtcal Dental Educauon Consortium, Buffalo, NY p Jesslyn l. Perry, Internal Medicme, Graduate Medical Dental Educauon Consortium, Buffalo, NY Brenden M. Miner, Surgery (Prehm.), Umverslty of Vermont, Burhngton. VT Heather M. Keene, Obstetncs and Gynecology, Provtdence Hospital, Southfield, Ml James S. Killius, Radiology- Dtagnosuc, Duke Unl\·erstty Medical Center, Durham, "iC Nancy Perez, Pedtatncs, Graduate Medtcal Dental Educauon Consortium, Buffalo, NY Gregory A. McDaniel, Medtcine/Pedtatrics, Western Reserve Care System/ NEOUCOM,Youngstown, OH Christina M. Keaney, Pathology, Graduate Medtcal Dental Educauon Consoruum. Buffalo, NY Thomas A. Honno, Famtly Pracuce, Guthrie/Robert Packer. Guthne, PA Tushar Patel, Ophthalmology, Scheie Eye Institute, Unl\·erslty of Pennsylvania, Phtladelphta, PA Madhulika Mathur, Pedtatncs, Graduate Medtcal Dental Education Consoruum, Buffalo, NY Jeoneo R. Hundley, Emergency Medtcme, Graduate Medtcal Dental Educauon Consoruum, Buffalo, NY Somir Khonior, Obstetncs and Gynecology, New Hanover Regwnal Medtcal Center, Wtlmmgton, NC Margaret E. Partridge, Pedtatncs, Umverslty of Rochester/Strong Memonal Hospital, Rochester, NY Philip l. Monzonero, Medtcme (Prelim.), St. Elizabeth's Hospital of Boston, Boston, MA Anesthesiology, Oregon Health SCience Umversity, Portland, OR David P. Hughes, Emergency Medtcme, Bowman Gray/North Carohna Bapust Hospital, Wmston-Salem, NC Kate l. Guernsey, Pediatrics. Umverslty of Colorado School of Medtcme at Denver, Denver, CO Thomas A. Owens, Medtcme/Pedtatncs. Duke UniverSit}' :vtedtcal Center, Durham, NC Patricio A. Krebs, Pathology, Baystate Medtcal Center, Spnngfield, MA Bryon R. lotzmon, Internal Medicme (Prehm,), Wmthrop-Umversity Hospttal, Mmeola, KY Neurology, Mt. Sinat School of Medtcme, New York, NY Albert B. Fiorello, Emergency Medtcme, University of Anzona Affthated Hospitals, Tucson, AZ Whitney l. Orman, Pedtatncs,Emory Unl\·ersity School of Medicme, Atlanta, GA Dovid P. Kowalski, Famtly Practice, Graduate Medical Dental Educauon Consoruum, Buffalo, NY Mitchell J. Herr, Internal Medtcme (Prehm.), Graduate Medtcal Dental Educauon Consoruum, Buffalo, Y Anestheswlogy. Umverslty of Cahforma at San Otego Medtcal Center, San Otego, CA Steven M. Finkelstein, Internal Medtcme (Prehm.), New England Medical Center, Boston, MA Anesthesiology, Brigham and Women's Hospital, Boston, MA I Neal T. Reich, Internal Medicme (Prehm ), Graduate Medtcal Dental Educauon Consoruum, Buffalo, Y AnesthesiOlogy, Graduate Medtcal Dental Educauon Consortium, Buffalo, NY Koren M. Roll, Pedtatrics, Hahnemann UmverSit)-, Phtladelphia, PA Renee F. Neely, Psychtatry, Graduate Medtcal Dental Education Consoruum, Buffalo, NY Germaine N. Rowe, Internal Medtcine (Prehm ), Graduate Medtcal Dental Education Consorttum, Buffalo, NY Physical Medtcme and Rehabthtation, Presbyterian Hospital, New York, NY Gory J. Nielan, Pedtalncs, Baystate Medical Center, Spnngfield, MA Amitobh P. Soha, Surgery, Flushmg Hospttal Medtcal Center, Flushmg, NY 5 m m e 9 �~ - . . . ... .. . . . . . . . . . . . . . El Theresa M. Sarafin, Pediatncs, Dartmouth-Hitchcock Medical Center, Lebanon, H Jeffrey Tessier, Internal Medicine, Portsmouth Naval Hospital, Portsmouth, VA Eva H. Sotell, Internal Medicine, Umversny Health Center at Pittsburgh, Pmsburgh, PA Edouord J. Trobulsi, Surgery (Prehm.), Thomas Jefferson Umversity, Pmsburgh, PA Urology, Thomas Jefferson Umversny, Pittsburgh, PA Philip Sauvageau, Medicine!Pediatncs, Graduate Medical Dental Education Consortium, Buffalo, NY Bertram Portin '53,to serve on Sisters Hospital board of directors Rolph P. Tufano, Otolaryngology, Umversny of Pennsylvama, Philadelphia, PA Bethonn Sthober, Pathology, Harbor-University of Cahforma at los Angeles Medical Center. los Angeles, CA Paul F. Updike , Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH Joel A. Shapiro, Orthopedics, McGaw Medical Center of Northwestern Umversity, Chicago, ll Felice Vobnitk, AnesthesiOlogy. Umversity of North Carolina Hospitals, Chapel Hill, NC Chondresh A. Shelot, Emergency Medicine, Mt. Sinai Medical Center, Cleveland, OH Timothy E. VanDuzer, Emergency Medicine, Graduate Medical Dental Education Consortium, Buffalo, NY Fronk Sindoni, Surgery (Prehm ), Graduate Medical Dental Education Consortium, Buffalo, NY Eileen Velez, Pathology, Graduate Medical Dental Education Consortium, Buffalo, NY Michael J. Singh, Surgery, Graduate Medical Dental Education Consortium, Buffalo, NY Andrew W. Worner, Internal Medicine, Graduate Medical Dental Education Consortium, Buffalo, Y Erik D. Skoog, Ophthalmology, Medical University of South Carohna, Charleston, SC Theresa M. Wegman, Pediatrics, Graduate Medical Dental Education C..onsorl!um, Buffalo, Y Romuold Sluyters, Surgery (Prehm.), Graduate Medical Dental Education Consortium, Buffalo, Y Orthopedics, Graduate Medical Dental Education Consortium, Buffalo, Y Dennis D. Weimer, Psychiatry, Umversity of Anzona Affiliated Hospitals, Tucson, AZ Denise K. Sokolofsky, Pediatrics, Graduate Medical Dental Education Consortium, Buffalo, NY Wendy l. Weinstein, Psychiatry, Graduate Medical Dental Education Consoruum, Buffalo, NY Stephen P. Sorrentino, Internal Medicine (Pnmary Care), North Shore University Hospnal, New York, NY Timothy P. Whelan, Internal Medicine, University of Colorado School of Medicine, Denver, CO Taro A. Soso, Internal MediCine (Prehm.), Graduate Medical Dental Education Consortium, Buffalo, Y Anesthesiology, Graduate Medical Dental Education Consortium, Buffalo, NY Ellen M. Whyte, Psychiatry, Umversity Hospnals of Cleveland, Cleveland, OH Attending Physicians Matthew Withiom-leitth, Obstetrics and Gynecology, Graduate Medical Dental Education Consortium, Buffalo, NY Peter F. Stengel, Internal Medicine, Umversny of Maryland, Baltimore, MD ertram A. Portin, M.D. '53, has been named to the Sisters Hospital board of directors . Certified by the American Board of Surgery and the American Board of Colon and Rectal Surgery, Portin is chairman of the hospital's division of colon/rectal surgery and a past president of the Sisters Hospital medical staff. "We are fortunate to have someone of Dr. Portin's leadership ability and insight join our board of directors ," said John] . Maher, president of Sisters Hospital. "Dr. Portin's presence on the board is important to further integrate physician expertise into governance and leadership at Sisters Hospital. " Portin is a member of the American College of Surgeons, the American Society of Colon and Rectal Surgeons, the American Medical Association and the Accreditation Council for Graduate Medical Education. + The award far best reunion class atten- William J. Wnuk, Medicine/Pediatrics, Graduate Medical Dental Education Consortium, Buffalo, Y dance this year goes to the 50-year Class Andrew N. Young, Pathology, Emory Umversity School of MediCine, Atlanta, GA of '45, which, under the stewardship of Thomas W. Stone, Internal Medicine (Prehm.), Graduate Medical Dental Education Consortium, Buffalo, NY Ophthalmology, Duke Umversity Medical Center, Durham, NC Brion K. Zebrowski, Surgery, Bridgeport Hospital, Bndgeport, CT class reunion choir Herbert Joyce, posted Erik J. Stumpf, Family Practice, Hahfax Medical Center, Daytona Beach, Fl Jeffrey l. Zondermon, Transmonal Year, Carney Hospnal, Boston, MA Ophthalmology, Tufts New England Eye Center, Boston, MA an approximate Royte R. Syracuse, Internal Medicine (Prehm.), Umversity of Maryland at Baltimore, Baltimore, MD Ophthalmology, Graduate Medical Dental Education Consortium, Buffalo, Y Jennifer M. Zubler, Pediatrics, Graduate Medical Dental Educauon Consortium, Buffalo, NY dance. Congratula- Keith A. Zu!!olo, Surgery. St. Elizabeth Hospital Medical tions to all on a job lisa l. Stephens, Obstetrics/Gynecology, Baystate Medical Center, Spnngfield, MA Eva M. Tokots-Dilorenzo, Obstetrics and Gynecology, Graduate Medical Dental Education Consortium, Buffalo, NY B a 0 Center/NEOUCOM, Youngstown, OH 78 percent atten- + + well done! p h y 5 a s m m e 5 �1995 reunion portraits: 50 years of medicine recalled en classes were honored at this year's Reunion Weekend celebration, and gathered in Buffalo to reminisce, remember old friends and good times, and renew acquaintances. CLASS OF 1945 CLASS OF 1950 FROM lEFT TO RIGHT: FIRST ROW: Richard Adler, Edward Forgrave , john FROM lEFT TO RIGHT: FIRST ROW: William Webster, Alfred Falcone, Robinson , Herbertjoyce,jacob Steinhart, Gilbert Tybring, Earl Robert Bergner , Roland Anthone SECOND ROW: Henry Pech, Sidney Anthone, Karl Manders, james Cantwell, Theodore jewett SECOND ROW: Paul Cotter, Eugene Morhous, William Andaloro, Dunn , Richard Leberer, Leo Manning, Roy Robinson Raymond Barry, Genevieve Howen, Vincent Capraro, Ivan Kuhl, THIRD ROW: Adelmo Dunghe, Eugene Zygaj , joseph Sheedy, William Loeser, William Mcintosh Robert Patterson THIRD ROW: Charles Wiles, john Fairbairn, Edward Valentine, john Hartman, Victor Lazarus, Hilton jacobson, john Long, orman Chassin, George George Ellis, Richard Greenwald, Thorngate, Vito Laglia , Adolphe Schoepflin, Leslie Osborn, Robert Schopp, Peter Terzian, joseph Tannenhaus, A. Arthur Grabau , Wayne Templer B a Reunion Classes Continued on page 28 0 p y c 0 5 m m e �~ ························ · ·· · ·········· •••••••••••••• • ••••• 0 •• • • • ••••••••••• • ••• w~ There· Med Eva H Cen Phili! Den Beth• Cal An! Joel No Chm Me fra1 CLASS OF 1955 CLASS OF 1965 De FROM lEFT TO RIGHT: FIRST ROW: Milton Alter, John Peterson, Leonard Mic Schaer, joseph LaMancusa Ed SECOND ROW: Bertrand Bell, Ray Schiferle, john Foley, john Baker, Eril Frank Gazzo, james unn, Michael Gianturco, Robert Dean, Robert Pittell, john Kent, james Stengel , john LeValley, Shedrick Moore Sc FROM lEFT TO RIGHT: FIRST ROW: Louis Trachtman, Kenneth Kim, joseph Cardamone, George Strauss SECOND ROW: Gary jeffery, W. Scott Walls, Elliott Larson, Antonio Catanzaro, George Moore, Robert Schuder Ro D• 0 c 01 E St 1'- CLASS OF 1960 CLASS OF 1970 FROM lEFT TO RIGHT: FIRST ROW: Harris Faigel, Edward Graber, Algirdas FROM lEFT TO RIGHT: FIRST ROW: Bruce Prenner, Michael Lippman, jeffrey Rothman, Bruce Sobin, Laurence Lesser SECOND ROW: Mary Clemens, Marilyn Kassirer, Roger Forden , William Balistreri, Allan Winzer, Arthur Goshin, Lynn Eckhert THIRD ROW: Dennis DuBois, Seth Craig, Donald Copley, Harold Vandersea, Brenden Thomson, Thomas O'Connor, Sebastian Conti, Allen Davidoff, Donald Gabel, Steven Weinstein, jan Novak, Alan Fink, Arthur Seigel, Shafic Twa!, Elliott Brender Gamziukas, joseph Antkowiak, Sylvia Sussman, Andre Lascari, William Abramson, Charles Riggio, Eugene Partridge SECOND ROW: Marshall Lichtman , Donald Hammel, joseph Chazan, Harry Metcalf, Donald Donius THIRD ROW: Harold Brody, james Kanski, Daniel Gianturco, William Stein, Franklin Glockner, Robert Malatesta, Harris Kenner, Gerard Diesfeld, Daniel Goldberg, Roger Dayer, Theodore Bistany, Thomas Guttuso B u 0 0 p h s c 0 5 m m e 9 9 5 �CLASS OF 1975 CLASS OF 1985 FROMLEFT TO RIGHT: FIRST ROW: Shirley Galucki , Barbara Brar , Elaine Schaaf, Erica Heit Remer, Lynda Stidham , Margaret Reidy, Roberta Moss, Elizabeth Maher, Lucie DiMaggio , Darlene Eldredge Fairchild, Amy Miller O'Donnell , C. Adrianna Alvarez, Donald Tingley, Graciela Desemone , Thomas Cowan SECOND ROW: David Forster, Carol Hammer Forster, Sabino Torre, Raymond Meeks, jack Coyne,jacques Hajjar, Susan Bates, Kenneth Romano, Thomas Szalkowski , jon Wardner, Victor Marino THIRD ROW: Michael Lahood , Michael ancollas, joseph Zizzi , john Leddy, Ira Handler, Blackford Middleton FROM LEFT TO RIGHT: FIRST ROW: Marvin McMillen , Sylvia Regalia, Leo liO Muido , Marguerite Dynski, Ben Echols, Lynne Hochberg-Pace, Alan Calhoun SECOND ROW: Marc Colman , Kenneth Anolik, William Cohen , Dennis Witehead, William Novak, Thomas Rosenthal , Henry Tomiak , jack Cukierman , Paul Trautman , john Stubenbord, Craig Blum, john Hedger, Michael Rade, Peter eumann , jack Freer, Eugene Hirsh CLASS OF 1980 CLASS OF 1990 FROM LEFTTO RIGHT: FIRST ROW: janice Errick , Alicia Stanton, Steven Howard , Suzzette Robinson , Stephen Panebianco , Valerie Vullo, Harriette Feier, Kimberly Blake, Dianne Jaeger Sutter SECOND ROW: Marc Klementowski, joseph Murphy, Mary Rita Murphy, Raymond Paolini , Robert Pitera , Mark agy , joyce Paterson FROM LEFT TO RIGHT: FIRST ROW: Thomas Dougherty, Archimedes Thomas, Edward Rockwood, john Shayne, Constance Lentz , Coral Surgeon, Theresa Stephan- Hains, Mary George, Lynn Steinbrenner SECONDROW: james Twist, Margaret Paroski , Gaspere Geraci , Mark Borer B 0 0 p s c 0 5 u m m e 9 9 �Porrath '61, pioneers integrated care for breast disease STUDY SHOWS THAT HIS MAMMOGRAPHY CENTERS FIND BREAST CANCERS EARLIER THAN THE AVERAGE FOR LOS ANGELES PATIENTS aar A. Porrath, M.D., has known since he was about four years old that he wanted to be a physician. "It was probably the influence of traveling with my father when he visited sick members of his congregation that influenced my early career choice," Porrath explained. His father was Rabbi Samuel Porrath, a long-time rabbi in iagara Falls and Amherst. Ironically, his inital decision to specialize in radiology was made because he thought he didn't want direct contact with patients. After graduating from the University of Buffalo's School of Medicine in 1961 , he served his internship and residency at Mt. Sinai Hospital in Cleveland. Following his military service as the chief of radiology service at Kenner Army Hospital in Fort lee, Virginia, he moved to California. "It was while I was in los Angeles that I started doing more and more mammograms and I found that I liked the patient contact," he recalled. By 1983, his transformation to direct patient clinical service was completed when he founded the Women's Breast Center in Santa Monica , which has pioneered an integrated care approach to breast disease and management. In 1990, he joined the Mammography Center in Burbank. Both centers are operated under the umbrella of the Women's Breast Center Group, which also operates the Mobile Mammography Center in the los Angeles area . Porrath also organized the Foundation for the Study and Prevention of Breast Disease, which sponsored a multitude of county-wide health fairs , attracting more than B u a 0 p 250,000 people over the two-year period from 1985 to 1987. The two breast centers are the largest providers of indigent breast health care outside of county facilities in los Angeles; the foundation has received grants to help cover the costs of treating indigent patients. "My book, A Multimodality Approach to Breast Imaging, published in 1986, was panned by some for being what was considered too clinical," explained Porrath, who is obviously in opposition to these critics. "Breast cancer is definitely increasing - basically for two reasons. About 60 percent of the increase is due to the aging of the population and the other explanation is that we are simply detecting a lot more cancers," Porrath said. He believes the current national controversy over the issue of mammogram screening guidelines for women under age 50 is largely related to cost issues. Porrath points out that of the approximately 180,000 women who will c a n S get breast cancer this year in the United States, nearly 30,000 will be in the 40 to 49-year-old age group. A total of 40,000 will be under age 50. "If we send a message to the American woman that screening has no validity, we will virtually wipe out the detection of all Stage 0 and Stage 1 breast cancers almost 20,000 women. There will be at least 6,000 women who would have lost the chance to prove that breast cancer is a curable disease. That is not including the vast number of people who will automatically jump at the chance of not having a mammogram because of their innate fears of breast cancer. " Porrath acknowledges that detection is more difficult in women under age 50, but points out that the lead time between detection and the spread of cancer is also less- making early detection all the more important. He stresses that breast cancer in the younger woman is a much more aggressive disease. u m m e 9 5 �"Breast centers such as ours are actually quite cost-effective because our statistics from more than 40,000 patients have demonstrated a significant reduction in unnecessary surgical biopsies. Of course this reduction also means less trauma for the patients." Five hundred of the center's approximately 40,000 patients have been diagnosed with breast cancer. But a study demonstrated that the cancers found at the center were smaller and were found earlier than those in other Los Angeles breast cancer patients. For all of Los Angeles County, 62 percent of the patients are Stage 1, I and II, compared to 90 percent of the Women's Breast Center cancer patients who were Stage 0, I and II. While he encourages breast self-examination, Porrath isn't optimistic that its usage will increase greatly. "Self-examination is based on a psychologically wrong principal- it offers a negative reward for a positive action by telling women that they can possibly find breast cancer by examining themselves," he explains. Porrath is well aware of the significant emotional issues involved in breast examination, mammography and breast cancer. His wife, Toni Bernay, Ph.D., is a psychologist and a consultant to the Women's Breast Center and the Mammography Center. Porrath has been elected a fellow of the American College of Radiology and is past president of The American Branch of the International Society for Study of Breast Disease, The National Consortium of Breast Centers and current vice president of the World Federation of Ultrasound. He has taught radiology technology training courses throughout the country, including Buffalo, and has lectured widely on breast cancer and detection issues throughout the U.S. and the world, including Canada, Mexico , Germany, Argentina, Brazil, Greece and Austria. + · B BY u DEBORAH a W a ILLIAMS p cated last September, has received national attention and is being used actively for education and research. A graduate of Western Reserve University, now Case Western Reserve University, he received a doctorate from the University of Minnesota. In receiving his Distinguished Medical Alumnus honor, Brody joins a list of renown School of Medicine and Biomedical Sciences graduates. He will receive the award at a dinner in his honor this October. The SUNY Board of Trustees also named Suk Ki Hong, M.D., Ph.D., UB professor of physiology, distinguished professor in january in recognition of his reputation and contributions to research. A UB faculty member since 1975, Hong also serves as director of graduate studies in the department of physiology. His research interests lie in the areas Harold Brody '61,garners two distinguished UB honors arold Brody, M.D., Ph.D., has been awarded the rank of distinguished professor - the highest in the State University of ew York system- and elected 1995 Distinguished Medical Alumnus. The designation of distinguished professor, made by theSU YBoardofTrustees, is an order above full professorship and has three co-equal designations: distinguished professor, distinguished service professor and distinguished teaching professor. Brody, professor of anatomy and cell biology, was named distinguished teachingprofessor. Thedesignationisawarded to persons who have demonstrated outstanding teaching competence at the graduate, undergraduate or professional level. Brody, who joined the ------·- =~ faculty in 1954, earned an M.D. from the medical school in 1961; for half of his 41 years at UB, he served as chair of the department. He has done research and published widely in the field of neuroanatomy, and has served on several editorial boards, including that of BufHarold Brody, M.D., Ph.D. falo Physician. As a Fulbright scholar to Denmark in 1963, he helped establish of renal and environmental physiology. Hong has authored or co-authored that country's first cadaver donor pronearly 190 articles for scholarly publigram. He was one of the founding members ofUB's Center for Aging and is past cations and more than 40 textbooks, president of the Gerontological Society monographs and book chapters, earned of America. He received the society's numerous academic awards, including Robert W. Kleemeier Memorial Research the Stockton Kimball Award from the Award for Outstanding Research in Ger- medical school for excellence in reontology in 1978. search, education and service, and a Brody left the anatomy department special citation for distinguished serchairmanship in 1992 to continue teach- vice from the japanese Panel on Diving ing, do research and to fulfill a lifelong Physiology and Technology of the U.S.dream of establishing a Museum ofNeu- Japan Cooperative Program in atural roanatomy at UB. The museum, dedi- Resources. + ...., 5 a n 5 u m m e 9 9 �A Spoonful of Humor© Stu Silverstein, M.D. e've all heard the old joke about the man who calls in a plumber and gets presented with a bill for $400. The customer says, "That's outrageous! What is your hourly rate?" "$200 an hour, plus travel And let's face it, men don't like calling for help to begin with, but when you are calling a plumber in, you are not only admitting that you are asking for help, but you are essentially saying that your intestines need to attend a 12-step group. That's not easy to admit to anyone, let alone a guy who shows up in overalls, no socks and asks to use your phone while spinning a monkey wrench around his pinkie (no l don't mean an orthopedist). Why are all plumbers overweight? Why do they all wear blue overalls. And even if they aren't overweight they always wear double extra large overalls. After jiggling the handle for 20 minutes time," answers the plumber. "$200 an hour!" the man replies, aghast. ''I'm a urologist. I went to medical school, residency, did a fellowship and I only charge $75 an hour." The plumber just shrugs his shoulders and says, "Hey, that's all I charged when I was a urologist." The disparity is even worse for pediatricians, and I went look. nobody hkes their job. That's why through a similar experience recently when I had to call in they call it a"'job." If they loved it, a plumber. Since I became a they'd call it something else, like "fun." homeowner, I can no longer just "I love my fun." But if It was fun call the landlord and order him you wouldn't get paid for it. over to the house when the bowl is stuffed up. B u a a p h s a 5 (billed through a lawyer's office) he tells me l will need to replace the toilet. A new toilet? ow that is something you never think about. How many folks have bought a new toilet- ever? And it's not that easy. The plumber doesn't just say, "Okay, just fetch me a toilet!" You have to choose one from a catalogue that he hauls in from his truck. A catalogue of toilets, now that's what l call bathroom reading. So now l have to choose between the flashy, efficient model, and the standard, family one. There you are having dinner with another couple, and the woman says, "You know, Myron and l are thinking about trading in our Lexus LS for a sporty LS 200. " "Yeah, l know what you mean. My wife and I are thinking about trading in our toilet for an intestinal evacuation system. You won't believe what they're showing in the catalogue." Of course everyone always complains that plumbers make too much. Even doctors complain. lf you break it down by the hour, the average plumber m m e �charges more than the average therapist. If I was a therapist and spent all those years in school, I would just go an extra six weeks and become a plumber. What the heck! Combine your fields! Put an ad in the yellow pages: "Purge your drain and your psyche for one low price. We'll even throw in the kitchen sink." "Copper pipes and crackpots - we fix 'em all. " "Whether you're anal-retentive or your toilet is- no job is too small. " "Unclog your drains and your brains - aH our plumbers are also licensed clinical psychologists. " It would be great the plumber shows up with a couch and you get to stretch out and free-associate. "So, how do you feel when your husband ignores you? ... hold on a second, damned tank won't release." I suppose that being a plumber isn't the greatest job in the world, but then again what job is? Everyone wants a job that they will like, so they go to school for 200 years, borrow $200,000 and then they realize that every morni'1g they still have to go to "work. " You can always tell when people hate their jobs, because theygooutoftheirway to tell you how much they like it. Look, nobody likes their job. That's why they call it a "job." If they loved it, they'd call it something else, like "fun ." "I love my fun. " But if it was fun you wouldn't get paid for it. "Sorry Mr. Yakman. You're enjoying your job too much. I'm afraid we're B a 0 p h AcADEMIC HEALTH PROFESSIONALS INSURANCE AssociATION gonna have to stop paying you. " When I tell people I am a pediatrician and they say it must be "fun " getting to "play with kids all day. " o! I don't get to play with kids all day. If you consider holding a kid down while he screams, spits and sees you as a human rest room with a white coat, then, come along - it's play time. Nobody gets to play with kids all day except other kids, and if you paid them Insuring care for those who care Subscriber Owned • Organized • Governed PHYSICIANS • DENTISTS HEALTH PROFESSIONALS NURSES • RESIDE TS Superior policies for academic full-time and voluntaty clinical faculty ~a. Competitive premiums ~ Rewarding educational progran1s ~ Complete legal service ~ Comprehensive coverage Dividend opportunities Academic Health Professionals Insurance Association is a subscriber owned and organized reciprocal licensed by the Insurance Department ofNew York State. Policy and programs ofthe Association are determined by a representative Board ofGovernors elected by subscribers at SUNY Health Science Centers. Enrollment open at all times. Transfers arranged without loss. AcADEMIC HEALTH PROFESSIONALS INSURANCE AssociATION to do it, eight hours a day and told them they can't leave, they would hate it too. In fact they would insist on going to work. + Empire State Building 350 Fifth Avenue, Suite #1512 New York, ew York 10118 Ph. 212-947-4541 Fax 212-947-4572 Stu Silverstein, M.D., president of Stondup Medkine Seminars of Son froncisw, Colifomio, lectures nationwide on humor inmedkine. He ~also c!Xluthor of What About Me?, o book oboot growing up with odeveklpmentol~ disabled ~bling. 5 a n s m m e 9 9 �[ IJ························································································· 1 9 THOMAS 3 MARCH s 0 ' 31 , of Tacoma, Washington, has, in his 43 years of practice, tried pri- vate practice in four locations in New York State. He also worked for ew York State and the VA before his retirement in 1973 at age 70. With eight grandchildren and 10 great grandchildren, he tells us he, at age 92, and his wife, at age 75, are well (relatively!). He'd love to hear more of his classmates from 1931. white photography since he was at 5 Country Club Lane, Route medicine in addition to internal 14. He got involved in stereo 11, photography about 22 years ago shire 03257. medicine and pulmonary diseases. He is director of respira- ew London, ew Hamp- and began specializing in pho- tory therapy services and associ- 1 tographic techniques that involve high-speed (l/50,000'h of 9 5 s 0 has been lab. Still actively practicing medi- a second) electronic flash as well as electronic sensors and elec- a professor of pediatrics at ortheastern Ohio Universities Col- cine, he enjoys skiing and fly fishing. He writes that his son, tronic components two years lege of Medicine since 1985. He George, is married and living in ago. Dr. Stell uses two single- KURT J . W E G N ER ' 52 , is director of the residency pro- Chicago and has blessed him lens cameras for his stereo work, gram in pediatrics at Tod with two grandchildren. rather than the Stereo Realist Children's Hospital in Youngstown, Ohio. Still active in pedi- camera produced some 40 years ago for that purpose. His spe- atric consultations in neonatol- cialization has paid off; he has ogy and genetics, he has three of Hol- won numerous awards for his sons, including one who is an lywood , Florida, is understand- stereograms, including the Best orthopedist, and two grand- HAR RY BERG MAN '34 , daughters. Ann B. Matasar, Amoco Distin- of Show medal from the Chicago Lighthouse International guished Professor of Interna- Exhibition of Stereo Photogra- WILLIAM ably proud of his daughter, Dr. ate director of a sleep disorders J. S U LLIVAN ' 55 , IRVI NG S . K OLI N '65 , of Winter Park, Florida, participated in a national meeting of clinical investigators working with Revia (naltrexone HCL) in the treatment of alcoholism. Revia is now approved by the FDA for the of treatment of alcohol dependence. Dr. Kolin served as co- tional Business at Roosevelt phy for his strobed photograph Los Angeles, California, is still University, Chicago, who has of a hummingbird at a feeder, working full-time in forensic investigator in the national been elected American treasurer the PSA Best Coniemporary psychiatry, focusing on medical study. He has also been ap- of the International Federation ofUniversityWomen Professors. medal from the Wichita International Exhibition of Photog- malpractice cases. He recently became a member of the execu- pointed to the advisory board of Dupont Pharmaceuticals for fur- She is that group's financial vice raphy for his high-speed stereo tive board, head of the psychia- ther study of the drug's use president, as well. Dr. Matasar slide of a golf ball landing in try section, of the American in the treatment of alcohol de- will visit Yokohama, japan, for water, and the Best of Show Board of Forensic Examiners. installation before visiting the group's official office in Geneva, Salon for his stereogram portrait Switzerland. Recently, the Uni- of a young woman. Dr. Stell re- versity of Paris- Sorbo nne, in- members that during his medi- an Innovation in Medical Man- creased her yearly tenure from cal school years, he and Ed agementaward from The Ameri- six weeks as professor of Eschner were the only photog- four to finance, and she received an invitation to serve as a visiting professor of finance at the University of Kiev, Ukraine, as well as one to lecture at the University of Vienna, Austria. medal from the Cordova Stereo Apter served as a resident ad- tography. Stell, who retired from junct professor at the oceano- private psychiatric practice in Eggertsville, New York, in 1975, graphic center of ova University in Ft. Lauderdale, Florida. has had an interest in black and He has now taken a well-de- has won ies of the entire record of their visit, which resulted in a reduction of health care costs due to a substantial and sustained drop cago and as a resource psychia- ous awards for his stereo pho- s patients were given written cop- turer at the University of Chi- City, Arizona, has won numer- 0 Health Services program. In it, practice, as a professorial lec- Center. From 1984 to 1995, Dr. 6 can College of Physician Executives for his Brandeis University tired in early 1984 from private trist at Michael Reese Medical 9 HARRIS C . FAIGEL '60, re- of Sun B ER NAR D S . S TELL '36 , 1 raphers in the class. N ATHANI E L S . APT ER '38 , u a a p h y 5 American College of Psychiatrists. The American College of Psychiatrists includes only 550 members elected from the 40,000 members of the American Psychiatric Association. Election to the College is based on peer recognition of accomplishments; elevation to fellowship - further recognition of work in psychiatry- is achieved by less than half of College members. in utilization of clinic services despite increases in student en- S AMUEL C . A RMSTRO N G ' 67 , rollment. is serving as chief of staff of GEO R GE B . P FO ERTNER ' 60 , Providence General Medical Center in Everett, Washington. of Boise, Idaho, was recently board certified in critical care served retirement and is living B pendence, and was recently elevated to fellowship in the c a n 5 m An internist, hematologist and oncologist, he has been with the m e 9 9 �··········· · ···· · ········· ·· ·· ········· ···················································• • ' Everell Clinic there for 21 years. JAMES L. CAVALIERI II '69 , was recently awarded the Buffalo Pediatric Society's "Pediatrician of the Year" award. He's Emory University. His son josh, Medicine in the Bronx, 16, is getting ready to apply to York. falo Pediatric Society, he is a member of the board of trustees of The Children's Hospital of Buffalo. in private practice in physical medicine and rehabilitation in is l2 and his daughter julie is 10. 1 1972. Past president of the Buf- 9 8 Annapolis, Maryland. She and her husband celebrated the birth s 0 of their second child, Margot of Dover, Leigh White, on April12, 1995. Delaware, was recently elected LiLLie Margot joins her older to a fellowship in the American brother, Cameron, who is 5. MARKS . BORER '80 , Psychiatric Association. MARITZA COTT0 '87 , of Dover, IAN M . SCHORR '69 , ew jersey, writes that his twoyear-old grandson, who lives in Chicago, forces him to take much-needed short vacations! 1 9 7 s 0 she is practicing cardiology at that he is moving back East to take a position in Columbus, Rochester Park Medical Group and Park Ridge Hospital in Roch- Ohio with Ross Products Division - Abbott Laboratories, as director of clinical research. ester, ewYork. She tells us that ANTHEA WOODLEY '87 , is also practicing card iology and CAMILLE BUONOCORE '87 , is KEVIN FERENTZ '83 , of Balti- more, Maryland, has a national Brookline, Massachusetts, was radio show heard on W EDAM in Buffalo and on 125 stations around the country. He also has a new son, number three, J. TWAROG '71 , listed in Best Doctors in America, 1994-95. He was also honored by the Asthma and Allergy Foundation of America ew England Chapter- for his contributions to asthma care in 1995. married and practicing endocrinology, and is the proud mother of daughter Corinne. GRETCHEN EBERHART '87 , Noah Samuel, born january 25, of Clearwater, Florida, has been appointed medical director of clinical affairs for Community Dialysis Center. He writes that although he has joined the ranks of physician executives, he still is able to enjoy a busy clinical practice. Community Dialysis Center operates 165 dialysis centers throughout the country. EUGENE HIRSH '75 , is a prac- ticinggastroenteroJogist in north Atlanta. Elected chief of the Gl section at St. joseph's Hospital there for 1995-96, he is an associate clinical professor of medi- 1994. is in private practice with Tri-City cine in digestive disorders at Anesthesiologists in Tempe, Arizona, where he enjoys his busy practice. He was recently board certified in pain management. He and his wife, jennifer, have 1 ' 84 , 9 9 finished his residency in psychiatry at Yale University and is now happily working in the Boca Raton Psychiatric Group in South Florida. His wife finished her Ph.D. in psychology at the University at Buffalo in 1993 and gave birth to their wonderful son , Mitchell , on january 14, of Westchester, ew York, is assistant director of psychiatric emergency services at Mon tefiore Hospital, the teaching hospital 0 0 p h y 5 c 0 n Claire Anita, on December 3, 1994. She joins her two brothers, Ryan, 2 1/2 and Connor, 1 1/2. KRISTA M . ( PRIGG) KOZACKI '91 , of Florence, South Caro- lina, wonders how everyone is doing in Buffalo. She writes that after she finished her fami ly medicine residency, she opened a private practice with another physician she went through residen cy with. They call the practice, "Pee Dee Regional Family Medicine." Business is great, she says, and the art and thrill of join them in September. Her family is doing wonderfully: her husband continues to practice with the same law firm , and their twins, Stefan and jacob, turned two February 18. They talk nonstop, climb the five-foot fence, play in the dirt and give wonderful hugs. Unique to her practice is a nursery built into the office of daughter, with a private nanny to care for the children. "It's the ew York and his wife, best part of medicine and moth- DOUGLAS P . PREVOST '90, of the Albert Einstein College of B Anita, had their third child , for her boys and her partner's 1995. Snyder, Stefan and Jacob Kozacki, 2 family medicine are even more fulfilling. A third physician will s 0 BRIAN FELDMAN '90, for a girl?? " jennifer sends her best regards to Dr. aughton. She was his secretary in 1983 and 1984. WEINST E IN is doing a fel- on january 27, 1995. four boys: Matthew, 7; Brendan, 5 1/2; justin, 4; and joey Jr., l. "Anyone have the secret formula CAROL PANKOW lowship in endocrino logy at Massachusells General Hospital in Boston. She and her husband celebrated the birth of their first child , Lindsay Grace Eberhart, JOSEPH D . CURLETTA '84 , CHARLES J. MCALLISTER '73 , writes that writes ROBERT SHALWITZ '80 , of FRANK is SARAH MURRAY WHITE '85, coaches basketball. His son Ben been in private practice in Williamsville, ew York, since I ew colleges and is in his third year of varsity swimming. He also . s m m e �• ....................................... . BACK TO SCHOOL SALE I erhood," Krista says. "Finally, it's very exciting to hear and read all about the growth and changes at UB med." CYNTHIA ( LEBER MAN) JENSON of Pittsburgh, Pennsylvania, writes that she and Mark '92 , had a baby girl, Alexandra Nicole, on March 8, 1995. She also tells us that jim and Laura Krug had a baby girl, Sarah Eliza- R ICHARD WARREN BR ITT ' 36 , died last ovember 4, in Deer Isle, Maine. Dr. Britt, a Tonawanda, ew York, native, was the son of Dr. W. Warren Britt. He began his medical career in practice with his father and brother, DR . ROBERT C . BRIT T ' 42 , in Tonawanda, and practiced there for 29 years, where he was a member of the medical staff of DeGraff Memo- beth. CATHY K . NAUGHTON '93 , and MICHAEL J . NAUGHTON '93 , are now second-year residents in the general surgery and internal medicine programs at Washington University/Barnes Hospital. Michael will pursue a fellowship in hematology/oncology and Cathy will continue at Washington University in the division of urological surgery. Cathy and Michael were married September 3, 1994, in St. Louis, Missouri, at the inth Street Abbey in historic Soulard. T O DD S C H LES ING E R ' 94 , is completing an internship in internal medicine and beginning one in dermatology this summer. J O HN OBITUARIES TIM OTHY SH E RWOO D recently completed an internship in internal medicine at johns Hopkins Hospital. He plans on making a career change to general surgery and will start an internship at University Hospitals of Cleveland, Ohio, this '94 , summer. He and classmate Debra Tarantino '94, will be married Performa 5200 CD Performa 636 CD rial Hospital, before moving to Maine in 1966. IRVI NG WEINER '37 , died May 6, 1994, at age 82. He had been in private practice in ewburgh, ew York, since 1938, before he retired after 50 years of practice. L EON A RD WOLIN ' 41 , PowerBook 520 of Buf- Power Macintosh 7100CD $1379 Performa 636 CD falo, died May8,1995. Dr. Wolin was the father of DR . MAU R ICE 8MB RAM, 500MB hard drive, CO-ROM drive, 15" color monitor, keyboard, mouse and lots of software. Performa 5200 CD $1819 8MB RAM, 800MB hard drive, CO-ROM drive, 15" color monitor, keyboard, mouse and lots of software. W OLI N '84 . Power Macintosh 71 00 CD $2029 8MB RAM, 700MB hard drive, CD-ROM dnve, 15" color monitor, keyboard, and mouse. died unexpectedly on Christmas Day while visiting his daughter in Colorado. THOMAS J . ENR IGHT '48 , WA L TER A. PowerBook 520 $1469 4MB RAM, 240MB hard drive. PENTIUM NOTEBOOK DELL Pentium NoteBook $4089 OLSZEWSK I ' 54 , died February 23, 1995. An assistant professor of neurology and clinical associate professor of anatomy and pathology at UB, Dr. Olszewski was board certified in neurology by the American Board of Psychiatry and eurology and neuropathology by the American Board of Pathology. He was a fellow of the Stroke Council of the American Heart Association and the American Academy of eurology. 16MB RAM, 810MB hard drive, 75MHz, 10.4" Dual Scan Color Display , Li ion extended life battery. BEST PRICE ON MICROSOFT OFFICE Microsoft Office is an integrated packal)e including Word, Excel, PowerPoint, a workstation l1cense for Mail & Access (professional version only}. $126 $134 $139 $158 • Microsoft Office for Macintosh Standard CD • Microsoft Office for Windows Standard • Microsoft Office for Macintosh Standard • Microsoft Office for Windows Professional .. ~ ,, \!~L ill.\\ - OFFICEI September 16. A non-profit University program for students, faculty & staff The Commons • North Campus • (716) 645-3554 • Fax: 645-3884 B u 0 0 p c a n 5 m m e �The jury is out. Your practice and assets are on the line. This is not the time to be second-guessing your choice of professional liability insurance companies. In a similar situation, a MLMIC policyholder remains confident, knowing he or she is protected by a company that already has successfully defended more physicians than all other available insurers combined. • Adding to the value of your MLMIC policy is one of the country's largest and most experienced professional liability Claims Departments, as well as the largest Risk Management Department of any professional liability insurer in the state. MLMIC also offers New York's only true peer review of claims experience. • Only physician-owned and controlled MLMIC offers this high level of quality assurance and service. MLMIC also is the only medical liability insurer approved by the Medical Society of the State of New York. Find out more about the protection you'll receive from the largest and most successful company of its kind in America. Ca111-::800-356-4056 in Upstate New York, or 1-800-ASK-MLMIC in the New York metropolitan area.• MLM~C ~ledical ~ Uability ~lutualln.<Urallef Company Our defense never rests. 2 Park Avenue New York, NY 10016 2 Clinton Square Syracuse, NY 13202 90 Merrick Avenue E. Meadow, NY 11554 01994 Med,cal Ual:111ty Mut.c.u~! ~ra11ee CompZiny �BUFFALO PHYSICIAN Non-Profit Org . U.S. Postage PAID Buffalo, NY Permit No. 311 STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 ADDRESS CORRECTION REQUESTED PLANTING TREE UNI)ER WI-ncH Yc)l WILIJ NE ER 7 Srt DR. Dr:Vn.LO W lhRRI <.IU • dass of 1871, knew how to make his monc) grow. In fact, this man who in 1905 prO\idcd $5.000 through his \\ill for Assrs n at Buffalo S<:hc r 150 y I • E <6 a A • I S ••• of \lcdicinc. is still supporting l'B � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Summer 1995 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1995-Summer Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician and biomedical scientist Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v29n03-1995-Summer Table Of Contents A list of subunits of the resource. Research Hospital News Giving Back Breathing Life Through Liquid Medical School Then and Now Alumni A Spoonful of Humor Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-12-18 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v29n03 Extent The size or duration of the resource. 40 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1995 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/61b2df99f11fd06ae6710c62febd72c6.pdf 18a2e61b4e50fe33e72286625e664e26 PDF Text Text State University of New York at Buffalo School of Medicine and Biomedical Sciences, Autumn 1994 UB'S FACULTY PRACTICE MANAGEMENT PLAN MAKES SENSE FOR ITS FACULTY MEMBERS AND THE PATIENTS AND STU DENTS THEY SERVE �BUFFALO PHYSICIAN Dear Alumni and Friends, \olume .!8, \iumber 4 T ASSOCIATE VICE PRESIDENT FOR UNIVERSITY ADVANCEMENT Dr C" ole ~m!lh Petro DIRECTOR OF PUBLICATIONS flmothv ). C mwv EDITOR ..1ne·te Ird.:-::.c~,: R l\1 ART DIRECTOR Ala,., I. Kcglr• ASSOCIATE ART DIRECTOR xonl rl(l er PRODUCTION MANAGER Ann R~\slm~mn Br..>wn STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES l'r 'vim aug; t.m. V 1ce Presd•nt for C •• meal Affd: cs. Dean EDITORIAL BOARD Dr john \ Riche t l h~"nn" Dr Russell \\ Bessette Dr \hnm Bul.bc: Dr ll n ld D:--)c.h· Dr \lr Dr Dr Dr Dr Dr Dr Dr 1 Rich.:d L ( .Ji ms Ra' i DrsJi \Ian : Dr""··m l.tmes Kntskt ~I 1zabet h Olmsted Ll·arlrs Pa~•. clli i ho"'as Ra.;~ hts tssuc of Buffalo Phvstcian reviews t\vO activllies of singular importance ~o L B\ medical ~chool- the proposed Academic Medtcal ( ollegmm and the lOth ann!\ ersarv of the operation vf the ~Lhool sF acuhy Practice Management Plan (F PMP, The latter was m:mdated b) the state legtslature to ensure that full-time and geographical full time chmca: faculty members met <.ducauonal and research responsibtliues to Slt Y ,md to dewlop a mechanism to employ talented fa<.ult) at competiuve compensatwn :evels. Such organizations are alwavs dtfficult to implement, It IL'ok t.B almost l 0) ears to wmplv with the legislauve in illative and the '>l ''t Trustees" pohc1es. But the FP\IIP has proven its potenual to cement the tnstltutional rclauon'>hip of a clmi...a' fa<.ulty dispersed throughout \\estern "\e\\ York The 1991 audn mdkates this decentralized plan ts functionmg well Of a tot.1l revenue ha'>t of approximately $70 mtlhon, almost half went 10 support f<~cult\ sala!"ics and $2 9 millio~t .md '>2.7 mil11on respeLt:\el) \\tre returned to the hospitals for overhead and to the school for academtc program developrrent. The \cad(:m1c MedKal (ollegmm represents a broader umverSil\ -cL>mmunlt) effort to mvolve the school, tea<.hiPg hospllals, cimical fac ultv ,md hospital ph\ st.:ian staffs m more cooper<~ the plannmg and work .ts the needs to meet the extgcnnes related to health care an<l medt<.al edu<.atlon reform becomt reality fhts orgamzatwn 1s working to defme its prmuples of orgamzation and w tll follow"' tth more speulk orgamzatlonal planmng. Gtvtn the su<.cec;s ol some ol l B sand the community s <.on~orual expenenees. this new c>rgamzauon could lorm a model from whkh !le\\ c:ooperatl\ e ventures de\ clop m \Ve'itern "le\\ 'r ork, and on-.e o.~g.:~in, .tn orgamzauon that wuld sene as a model for those vther aL.:~demicallv onented medtcal<vmmunmes that are struggling to deal with the c..omplex tssuec, of health care ard health edu<.ation refvrm. Smcerd), ~4---.~ ~lef!-c" <.pau'dt~(. J:c;~dlc) T ; r ax john "\aughton, \1.0. for Chmull \jfa:r~ Own ';c hool of \Jcdrcinr and Biomedtcal -'>ucnLn \'1< c Prc~ident TEACHING HOSPITALS AND LIAISONS fhc r 1iliO (.Je""IC'r"-. Hospll.ll \fi, had ~haw Buffa!<'\\ Vdi"" Center Dear Fellow Alumni, \~knr kt!~v Y The U1: ld:e:o s H•>Si>" !I of Buff. Ene Cvuntr ''~dh.~. Ccntc· "'er,) H"s"l:-Jl ~!tllarJ f til more llospuals frunl' 5m~ Ros\\elll'c.~t~t. Cc.JiiCt..r lnst.:~tc <.tstf'S of Chant~ Hosf>ttll D•.:nms Vc( ar•hv Tite "10:111... l mvers1rv uf "\ie\\ Y.... : k "' Buff,:c• C:uff,;lo PhvSidan i< pcbhs'>cJ qu:~rtc1~y b,· thr ..,Ute l nh~ r;:'"' ·>f !'.rw )ctk Jt Bulf.,Io School ct \1c<i.~ont:: anti F10medacal <;ocf\C("S and the Ltft h r ef i 'uf"'.l,cJtlons. h 1:::. SLnt free vi (hargc w.Ilumni, :.tt ultv Stude:1h, Tt.:.SilkntS .md fn·~"nJs. fhc 5taP rescn.ec;. the nJI'-t t.)edatall ... op) Jnd SlibtnJSstons a.ccpteJ fc.r publa.. Jta_ 11 \ddrcc;s q:~C">Ilons, ~o..cmmc~lh and s.ubmiSS~<)nS to: [d .. tor L:uf(ult, Ph)'')tl~un, ")LJ.tc l mvcrsuy of "l'"w )c•rk Jl Buflalo L'nl\crsttv PuhlcJtHll:S.I ~{>( r.·'t,llJll,U;.:!IJ:u. "'cv. )Jrk 142o(' orb~ .•. r-o~JI Jt notesu-'; >t: h. bu ff~lo.eue>. Send address <hanges to: flu/Jul.• Ph}llc>an. 14 ( l"> \ddittc•o l41j Mam ~t: ec! f.uffJic· "'cw h·rk d 2 I I our alumni board recently held tb mtd-<.ummer me~ting ..1nd pLm<. are well undt:rwav for the upLc'mt.ng medical <>chool year \Vekommg rec ~puons were held for !re'ihm.m and junior students ro1l0w mg form:d pre<;entaticms, the \lumm \s.,ouauon sponsort:d a c;octal event for stud~n•s I he SULLC~sful < ommumty Phv-.toans' Progr.tm w 11l be contmued fhe \t:Jr<. aclt\ 1· ues, '' hKh mclude mtroducing <>tudents to the dJtl) praw,e ol d1ffermt mediul-.peualt.e'>. '' :P be <.o-<.haired bv Dr<;. Roger Daver 'oO, .tnd Beth \tah.:r '85. fhe board arranged for the p""esident of the Mcdicai ">tudent Pol:t) h.> .:mend se\er.tl mectmgs, allowing for mort .:arrfulh C\aluated requesb and opponunitt.:s forLooperauon betwet:n the student bod\ and A.lumm AssL'Uatwn Plans for '>pnng (. hmcal Da) and Reumon Weektnd ,tre begmnmg to sohdify under the dtre.:tk>n of c hJtrperson Dr. j.:~ck ( m ne 8) ln '>epttmbu, \\ e pre~ented the D snnguished \kdical J\lumnus A'' ard to Dr '\Joel Rose '64 Hts achtevementc, are -nHmati<'nalh recognized: 11 IS an honor to have pre.,ented thts award to him ln'-.: ,tgain 'our '\lumm Assocuuon seeks to provide \\ays to a<.si<.t bt>th th nc.:nt and <ocnivr members. II you ha\ e <IllY 1dea<. that' ou \Hsh to sh..1re, plea~c d~' not hestt.tte to LOntact me Smcerelv. ~ c::::: Russell \V Be<;~ette, D D '>, \1 D. '76 P,-esrdmt, \lcdical Alumm As~L'< iatwn �V 0 u A II II II Where's the beef? Page 2. 2 L T u 8 M o N 9 N 4 9 4 Research Hospital News Practice Makes Perfect e After 10 years, UB's Faculty Practice Management Plan makes sense for its faculty members and the patients and students they serve. m Equal Time e The new Academic Medical Collegium gives its members an equal say in the future of health care in Buffalo. m m Medical School Then and Now m m Alumni Then and Now. Page 26. ASpoonful of Humor m Classnotes * l~e new ~cafiemic ffiefiical [ollegium ta~es s~a~e. rage lt �· · · · · · · · · · · · · · · · · · · · · · · ·· · · ·· · · · · · · · · · · · · · · · · · · · il] '' ' / 0 Roswell researchers arrest human cancer xenograft in scid mice B and Roswell Park Cancer Institute scientists have been able to arrest the growth of human lung cancer xenograft in severe combined immunodeficient (scid) mice by administering a long-circulating liposome formulation of doxorubicin known as Doxil. By doing so, Richard B. Bankert, Ph.D., D.V.M., associate research professor and principal investigator on the study, and colleagues, have reported the first direct evidence that antitumor drugs delivered in sterically stabilized liposomes are more effective at halting the growth of human tumors than more conventional systems. Bankert's research also establishes the scid mouse as a viable model in which to study novel chemotherapeutic approaches to treating human solid tumors. "The scid mouse appears to be an excellent model for in vivo testing the activity of anticancer agents on solid tumors due to its ability to produce tumors that retain the histological characteristics and metastatic potential of the original human specimen," Bankert said. Administering drugs in liposomes to reduce toxicity and target the drug to the tumor has been under investigation at Roswell for 20 years. The effectiveness of conventionalliposome preparations has been limited by their brief circulation time, as well as their susceptibility to uptake and clearance by the liver and spleen, and the binding of plasma components to their surface, causing the liposomes to break down and leak before reaching the tumor. Bankert and his team used sterically stabilized liposomes, which exhibit an enhanced ability to accumulate within B u a 0 p The fatty acid found in meats and dairy products may offer some protection against breast cancer. solid tumors in vivo. The researchers investigated the antitumor effects of Doxil, doxorubicin encapsulated in conventional liposomes ( C-DOX) and free doxorubicin against a human squamous cell carcinoma of the lung grown in scid mice. "Doxil completely arrested tumor growth in all of the mice tested , while free doxorubicin only slightly delayed tumor growth and C-DOX was ineffective at arresting tumor growth , although some decrease in growth rate was observed," Bankert said. Clinical trials for patients with lung cancer res is tan t to first -line chemotherapy are underway. + Where'sthe beef? esearchers at Roswell Park Cancer Institute have found that conjugated linoleic acid (CLA), a minor fatty acid found preferentially in meats and dairy products , offers some protection against breast cancer in animal models. "Unlike most fatty acids , CLA prevents rather than stimulates cancer development," said Clement Ip, Ph.D., UB assistant research professor from h c a A Roswell's division of breast surgery. Meat from ruminants contains more CLA than meat from other animals; bacteria from the ruminant's stomach can convert linoleic acid, an essential polyunsaturated fat, into CLA. "Dairy products and cheeses are also good sources of CLA," explained Ip, whose two recent studies provide strong evidence of the fatty acid's anticancer properties. Ip found that rats whose diets contained 0.1 percent CLA by weight - the equivalent of about four times the amount consumed in the everyday diet of the typical American- developed just twothirds as many breast cancers as rats given no CLA. In his paper published recently in Cancer Research, Ip further suggests that CLA may reduce the susceptibility of breast tissue to malignant changes. Of the large number of naturally occurring substances that have demonstrated anticancer activity, all but a handful are plant-derived. CLA is unique because it is present in food derived from animals, and its effectiveness is seen at dietary concentrations that are close to the levels consumed by humans. "We just do not know the impact that CLA alone has in the context of a high fat u m n 9 4 �·························· · ································ · ·············· · ·· · · · ·········· g] . ·~" '· ..• . illegal cigarette sales net state, federal governments big revenues orty-six states garnered $71 million in taxes from the illegal sale of cigarettes to minors in 1991, and the federal government took in an additional $51 million, according to a study led by UB researchers. California topped the states in illgotten tobacco revenues with an estimated $10.2 million, the data show, followed by Texas at $8.2 million, ew York at $7.2 million and Florida at $4.1 million. Louisiana, Missouri, Montana and ew Mexico were not included in the illegal tax-revenue statistics because these states had no law restricting the sale of tobacco to minors as of 1991. Since then, all 50 states and the District of Columbia have passed laws banning the sale of cigarettes to minors. The report, recently published in Are babies who are nursed protected later in life? Women breast-fed as infants may have lower risk of breast cancer ew research from UB indicates that women who were breast-fed as infants may experience a measure of protection against breast cancer later in life. The UB study, involving 1,130 women from two counties in Western ew York, indicated that women who were breast-fed had a 25 percent lower risk for developing breast cancer than women who were bottle-fed as babies. The study appeared in the May issue of Epidemiology. "There is growing interest in exposures in early life, including diet, and their relationship to breast cancer risk," said jo Freudenheim, Ph.D., associate professor of social and preventive medicine and the study's principal investigator. "There has to be some sort of environmental component to explain the geographical variation in breast cancer rates. American journal of Public Health, tracked the illegal sale of cigarettes to minors , by state, using a variety of national reports and studies. It was authored by K. Michael Cummings, Ph.D., associate research professor and senior research scientist at Roswell Park Cancer Institute; Terry Pachacek, Ph.D., associate research professor of social and preventive medicine; and Donald Shopland of the ational Cancer Institute. Other findings included: ~ Approximately 2. 7 million teenagu a 0 p .. ers smoked an estimated 516 million packs of cigarettes in 1991. ~ Federal and state governments collected a total of more than $240 million on the sale of cigarettes to teens 12-18 years old. ~ Cigarette companies earned $190 million in profit from sales to teenagers 94.8 million of it from illegal sales to minors. Cummings said the report was intended to send a message to state governments. "Despite laws prohibiting the sale of tobacco products to minors, it's clear teenage smokers can still buy cigarettes easily. Studies show that when these laws are enforced, illegal sales to minors can be reduced dramatically," Cummings said. + intake in humans," said Ip, who added that the challenge of future research will be to define the potential benefits of CLA in the human diet, to characterize its anticancer activities, to elucidate its mechanism of action at the subcellular level and to design new strategies for enriching foods with CLA. + B '· y 5 a n Risk factors relating to exposures in adulthood don't explain all the variation we see. This finding of a possible protective effect from having been breast-fed could be significant, and it is certainly worth looking at further. " Freudenheim and a team of researchers collected data on an array of potential risk factors from 528 women newly diagnosed with breast cancer and 602 women with no cancer who were randomly selected from the same population and matched for age. The women were between the ages of 40 and 85 during the time of the study, from 1986 to 1991. After controlling for age, education, age at menarche, age at first pregnancy, number of months they nursed their own children, number of pregnancies, family history of breast cancer, history of benign breast disease and body-mass index and height, the researchers found that one aspect of early nutrition - whether a woman had been breast-fed- was asso+ ciated with a decrease in risk. BY u m LOIS n BAKER 9 4 e �Buffalo General initiates third state lung transplant program he Buffalo General Hospital, in cooperation with the School of Medicine and Biomedical Sciences, has become the third hospital in ew York State to initiate a lung transplantation program. "This new service is an extension of our heart transplant program and its primary focus will be patients with endstage lung disease who reside in Upstate New York (west and north of Albany)," saidJoginder N. Bhayana, M.D., associate professor of surgery and director of BGH's Heart/Lung Transplant Program. In ew York State, only Columbia Presbyterian Medical Center and The Mount Sinai Medical Center in ew York City offer lung transplantation in addition to Buffalo General. oting that more than 80 heart transplants have been performed by BGH surgeons since 1984, Bhayana observed, "Our team has extensive transplantation experience and is well-prepared to perform lung transplants. " According to Bhayana, by late April , 28 people had already received preliminary evaluations for lung transplantation, and six were on the United etwork for Organ Sharing (U OS) list of patients awaiting donor organs. Bhayana said his transplant team hopes to perform six to eight procedures annually. "Obtaining lungs is more difficult than hearts because many potential donors are on respirators for several days prior to dying," he noted, adding that the chances of lung infection increase after a patient has been on a respirator for 48 hours. Unlike heart transplants, where organ rejection is the most critical postoperative factor, infection is the most 0 B u a 0 p serious concern after lung transplantation, he said. Bhayana observed that a multi-disciplinary team was developed to manage the evaluation, transplant surgery and post-transplant care in cooperation with the patient's primary care physician. The team consists of representatives in cardiothoracic surgery, pulmonary medicine, cardiology, infectious disease, psychiatry, nursing, pharmacy, pathology, rehabilitation medicine, nutritional + services and social work. edge and technology of genome science. "This very generous gift from the Palisano family will allow Roswell Park to endow its new program in cancer genetics and to use the interest the funds generate to support the research activities of its laboratory," said Thomas B. Tomasi, M.D. , Ph.D. , president and CEO ofRPCl. Roswell now houses several hereditary cancer registries, including the Gilda Radner Familial Ovarian Cancer Registry and the Familial Cancer Syndrome Registry, and has plans to add three new ones. + $1 million gift to Roswell will fund new cancer genetics laboratory Medical/Dental staff officers Buffalo family who lost six of its elected atteaching hospitals members to cancer has pledged $1 million to Roswell Park Cancer edical and dental staff officers Institute to establish a cancer gewere elected recently at several netics research laboratory. DB-affiliated teaching hospitals. The laboratory will be dedicated At Sisters Hospital, Daniel A. to the memory of John and Santa Castellani, M.D., clinical instrucPalisano, whose first born, Vincent, at tor in neurology, was elected age l3 started a delivery business with a president. Also elected were Edward horse and wagon that later spawned a Bartels, M.D., clinical instructor in gynumber of highly successful transporta- necology and obstetrics, president-elect; tion companies, including Boss Linco Kenneth]. Eckhert, Jr., M.D. , clinical Lines. assistant professor of surgery, secretary; Roswell received the gift from the and Nady Shehata, M.D. , treasurer. Charles and Charlotte Palisano family At The Buffalo General Hospital, Scott and from the Vincent and Harriet A. Tulman, M.D. , clinical assistant proPalisano Foundation. fessor of surgery, was elected president. "lt is both a privilege and an honor to Also elected were Daniel A. Mariniello, have a cancer research laboratory at M.D. , clinical associate professor of gyRoswell Park carry the name of my fam- necology and obstetrics, president-elect; ily, said Charles ]. Palisano, whose Nancy Nielsen , M.D., SUNY trustee and mother, Santa, three of his brothers, clinical assistant professor of microbiolVincent, Victor and Samuel, a sister, ogy and medicine, vice president; Daniel Virginia, and niece, Diane, died of can- S. Camara, M.D., secretary; and john cer. DeBerry, M.D. , assistant professor of The laboratory will be located within urology, treasurer. Roswell's new Cancer Genetics and Gene At The Children's Hospital of Buffalo, Therapy Program, established to capi- Daniel Peroni, M.D. , professor of peditalize on the explosive growth in know!- atrics, was elected president; Russell S. y 5 c a n A u m 9 9 4 �························ ··········· ···················································· ·· ·~ liJJ Vaughan, M.D., clinical assistant professor of pediatrics, was elected vice president; and Ehsan Afshani, M.D., professor of radiology and pediatrics, was elected secretary-treasurer. At Millard Fillmore Health System, Thomas Cumbo, M.D., clinical associate professor of medicine, was elected president. Also elected were Thomas Lombardo, M.D., clinical instructor in orthopaedics, president-elect; james Burdick, M.D., clinical instructor in anesthesiology, secretary; and Evan Evans, M.D., clinical instructor and Buswell fellow in surgery, treasurer. + Children'srecruits nationally renowned heart surgeon Eliot Rosenkronz, M.D. liot Rosenkranz, M.D., has joined The Children's Hospital of Buffalo to head its division of cardiovascular surgery. Rosenkranz, who was recruited from The Cleveland Clinic, holds the position ofUB associate professor of surgery. He will participate in clinical and laboratory cardiovascular research at both the medical school and Children's. "The successful recruitment of Eliot Rosenkranz is a coup for Children's Hospital," said joseph A. Ruffolo, the hospital's president and chief executive officer. "By leaving The Cleveland Clinic and joining the staff at Children's Hospital, Dr. Rosenkranz is making a strong statement as to his future investment and commitment to the success of the hospital." A native of Glen Clove, ew York, Rosenkranz is a graduate of the University of California at San Diego School of Medicine. He completed his general residency at the University of California and Los Angeles Medical Center. 6 0 0 p h Rosenkranz was the head of the section of congenital heart surgery at The Cleveland Clinic, responsible for pediatric and adult congenital heart surgery, pediatric heart transplants and arrhythmia surgery, as well as clinical and laboratory research. + NFMMC wins Preferred Prtmary Care Provider DOH designation iagara Falls Memorial Medical Center has recently been designated a Preferred Primary Care Provider by the ew York State Department of Health. lt is one of only two hospitals in the eight county Western ew York area Erie County Medical Center is the other- to have won the designation. Criteria to qualify for a Preferred Primary Care Provider include provisions for preventive and interventive health services, including immunizations and c 0 A cervicaVbreast/colon cancer screening, in addition to standard services such as radiology, pharmacy and clinical laboratory. The designation carries with it enhanced Medicaid reimbursement rates. DOH also mandates that each Preferred Primary Care Provider hospital establish a quality assurance program to determine patient satisfaction and continuity of care. The program includes development of an in-depth patient tracking and referral system, a 24-houra-day telephone service for patient health care inquiries and extended operational hours. The hospital 's primary care resources include its Hamilton B. Mizer Primary Care Center, which houses 18 programs, including Memorial Pediatrics, its family practice residency program, prenatal care assistance program and numerous specialty care clinics; the Summit Immediate Treatment Center; and the Tuscarora Health Center. + m n 9 9 �0 B a 0 p h y 5 0 n A u m 9 9 4 �,-------------------------------------~ I I I I I I I I PRACTICE MAKES PERFECT AFTER 10YEARS, US'S FACULTY PRACTICE MANAGEMENT PLAN MAKES SENSE FOR ITS FACULTY MEMBERS AND THE PATIENTS AND STUDENTS THEY SERVE I I I I I I I I y M A R w K A L L c A E I L _________ __ __________________________ Buff a loP h y sIc i an A u t u m n 1 9 9 4 ~ 0 �,------------------- - ------ - - ----------- Because so many different groups and individuals were involved, and because negotiations were so complex, it has taken a long time, much hard work and a great deal of cooperation to make the University at Buffalo Faculty Practice Management Plan into the efficient, cutting-edge system its proponents believed it could be. But a decade after its implementation, that's what the plan has become. Mandated be ew York State legislature in the midl970s and implemented on january l , 1984, the practice plan manages the income ofUB's widely varied and expert medical and dental faculty in 20 different departments, many of whom are widely dispersed at the school's affiliated teaching hospitals. "The plan has been extremely important to the development of the School ofMedicine and Biomedical Sciences," says] ohn aughton, M.D., vice president for clinical affairs, dean of the School of Medicine and Biomedical Sciences and chief administrative officer of the UB practice plan. PAUL C. HOLMWOOD, M.D., ASSISTANT PROFESSOR OF OPTHALMOLOGY , AT LEFT, WITH MEDICAL STUDENTS JOEL SHAPIRO (SITTING) AND ANDREW FEINBERG , AT MILLARD FILLMORE HEALTH SYSTEM ' S GATES CIRCLE EYE CENTER. AT RIGHT, I I I WITH RESIDENT ESTHER SANTOS, I I I M.D., DEMONSTRATING A PROCEDURE. L _______ __ _____________________ _ _________ _ 0 B u a a p y s c a n u m 9 9 4 �------ - ---- - - - -- - ---- - ---- - --------- ----, the medical school together. Given where we are in medicine right now, without the plan we would be completely disorganized , not knowing how to respond to many concerns," aughton says. The practice plan better defines the role of departmental chairs, creates common ground rules for faculty and provides funds both for the medical school and for hospital overhead, aughton says. "The practice plan brings about a more fairly shared enterprise," he says. The practice plan organizes, limits and audits the amount of money faculty physicians earn from clinical practice. Earning limits are based on faculty rank. Under the plan, physicians are allowed to earn no more than 250 percent, or in some cases 275 percent, of the maximum base salary allowed to a professor of their rank. Physicians also contribute to the fund of the chief administrative officer of the plan. SUNY Central sets a new salary cap every year. "The cap presents different concerns for different types of physicians," says ancy Glieco, assistant vice president of clinical affairs and administrative staff person to the plan since its implementation. "For instance, a family medicine doctor is not going to reach the salary cap, whereas for an orthopedic surgeon the cap may be an issue. " At the time of its implementation, the plan was highly controversial because it controlled physician incomes , Glieco says. o one is more aware of the complexity of the plan's history than William Dillon, M.D., an associate professor of gynecology/a bs tetrics located at The Children's Hospital of Buffalo . President UB's practice plan is its application of the State University of New York (SU Y) Faculty Practice Management Plan. Covered by Article 16 of the policies of the board of trustees of SU Y and negotiated by contract between the Union of University Professors and the Office of Employee Relations , the SU Y-wide plan includes all of the medical schools and dental schools in the SUNY system, as well as the School of Optometry. The plan mandates that all full-time and geographic full-time SU Y faculty (those based at affiliated hospitals) must be members. The plan is not required for volunteer or part-time faculty. At each SUNY institution with a medical faculty, the plan is administered by a governing board of that faculty . The fact that UB faculty do not work at only one nearby hospital, such as at SU Y-Stonybrook, but are dispersed among eight area hospitals, makes the management of UB's practice plan more complex than others in the SU Y system. "Without a centralized clinical faculty, and existing in various places in the Western ew York community as we do , the plan defined and brought together those who make up the full-time faculty ofUB.lt's the glue that holds I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I I I I I I I I I I I I I ------ -- ----------------------------------~ a a 0 p h y 5 a A u m n 9 �~-------- -- -- --- ---- ------ -- -- ----- - ------ 1 I I I I I I to have the honors and accolades associated with fulltime appointment to a medical school and the time to gain professionally and in administrative ability." According to Glieco, the plan has evolved significantly over the 10 years it has been operating at UB. "When we first started, we almost didn't know who all the people involved were," she says. "The organization was very loose - we collected money and patients however we could. "We've gone from being disorganized to being a department-centralized system with 20 departments and very few compliance problems," Glieco says. "The plan forces a member to have an organized practice, so we know who's doing what and where they're based," Glieco says. "Financing medical education has become a much more important issue in the last 10 years, and medical schools have changed from an unstructured environment to becoming a real business. We negotiate with teaching hospitals and each department, and this is the fifth year of the department-by-department audit. Here in the dean's office we think it's one of the best things to happen in medicine in the last decade. " of UB's Faculty Practice Management Plan governing board since 1986, Dillon has been on the board from its inception. "In the beginning, it took a lot of work by the governing board to educate faculty as to exactly what the practice plan was, to answer their concerns and objections and to work towards full compliance with the plan," Dillon says. "It was a learning process for the board also," Dillon says. "We needed to develop policies and procedures, certain guidelines under which the departments would function, and have the departments develop their own plans for the management of clinical income while seeing to it that those plans were consistent both with the overall UB plan and with Article 16. It was not an easy feat, and took a lot of talk and education over several years. " For Dillon, all the work has been necessary and significant because of the plan's importance. "As state employees in a university system, there must be an accounting of our income to the public," he says. "It's important that some limits are placed on the amount of income generated by one's private practice within the plan. Just as there are benefits for being a faculty member of the SUNY system, some of those benefits must be referred back to the school, and back to individual departments also. "The plan tries to allow SU Y faculty members to make competitive earning with other peers and yet do all the things a faculty member does which are not income generating," Dillon says. Although he admits that perceptions of the importance of being a UB faculty member may vary among physicians, for Dillon that importance seems clear. "I view my employment as a teacher, researcher and administrator of a medical school as a privilege," he says. "It's a profound responsibility - the privilege of seeing to it that a new generation of physicians are properly trained. With it comes the chance to be at the cutting edge of one's profession, L ________________________________________ _ B a 0 p h s c a ll. u u m 9 4 �-----------------------------------------, manner," he says. Currently, the plan gets good cooperation from the departments, Dillon says. There's more centralization within departments of their own finances , with reporting on a monthly basis to the office of clinical affairs flowing more freely and in a timely manner. The dean's tax computation, which provides money for the chief administrative officer of the plan, is done on a uniform basis, as is the computation for hospital overhead payment. Com- Beginning with a 1990 audit of 1989 earnings, audits have been done each year on a department-by-department basis by the accounting firm Levin and Associates. As the plan geared up for that first audit in 1990, there was a lot of concern about the cost of the audit procedure, and more effort and education needed to be provided to the departments, Dillon says. "Since that time , what we've seen is that the yearly audit process has become standardized, moves easily and is completed in a timely LEONARD FELD , ASSOCIATE M.D. , PROFESSOR OF PEDIATRICS , AT LEFT , WITH RESIDENTS ROB- ERT WORONIECKI , M.D ., ( LEFT ) AND RANDY CAN- TOS , M.D. , AT AN OUTPA- TIENT CLINICS CHILDREN ' S OF AT HOSPITAL BUFFALO, RIGHT, WITH I I I I I I I THE AND AT PATIENT ANI BAL LARACUENTE AT I I THE CLINIC. I I ---------- -- --- - ------------- - -- --- -- -- ---~ B u a a p h y 5 c a A u m n 9 �, ----- ----- ----- ------- ------- -------- ---- I I I I I I I pliance problems have decreased, and the vast majority of faculty now fund their retirement plans directly through the practice plan. Dean aughton says that the practice plan has defined much more clearly the role of department chairs from the standpoint of operating the various clinical sites of the medical school. "It gives department chairs the ability to manage their faculty," aughton says. "Before the plan, department chairs tended to have responsibility without much authority. The practice plan has helped them organize their faculty, and makes their position as department chair more secure." The plan has led to the formation of a number of facilitating organizations and legal entities to ensure its proper functioning. One such organization is University Medical Physicians Services (UMPS), which is the facilitator for the University Physician's Office, an ambulatory multi-group practice site that operates at two campus locations- the ground floor of the Cary-Farber-Sherman Annex and a sports medicine site in Farber Hall- as well as out of various offices in the teaching hospitals. Currently about 30 practice plan members see patients at the University Physicians Office. The office also provides UB medical students the opportunity to work directly with patients. UMPS received not-for-profit status in 1993, saving UB a great deal of money in state taxes. Most UB departments have become more formalized in their operations and have formed professional corporations, Dillon says. "Many of the more informal agreements between the hospitals and various departments or individuals have been done away with," he says. One department that has formed a professional corporation is the department of medicine, which currently has faculty at five affiliated teaching hospitals. The University Medicine Services Professional Corporation (UMSPC) is a departmentally centralized plan, with the same rules and goals for department faculty at all hospitals. Members of all hospitals, as well as representatives of all specialties, are represented on the department's practice plan governing board. The corporation is governed by the overall umbrella of the UB-wide and SU Y Faculty Practice Management Plan governing boards. The corporation has a ceiling less than the 250 percent mandated by the overall plan. With the exception of a small group of on-campus faculty, faculty in the department of medicine tend to be hospital-based at one area hospital, according to james olan, M.D. , president of the UMSPC, chair ofthe department of medicine and director of medicine at Erie County Medical Center. "Since I took over as chair of the department in 1978, an increasingly large percentage of salary dollars have needed to come from practice," olan says. L _________________________________________ · B u a 0 p y s c a n A u u m n 9 4 �-- --------------- - ------ -------- -----------~ want to say he had to be limited. If there's someone we can recruit who is going to help patients in Buffalo, we should work together to make sure the cap is not a stumbling block. I think people are coming to understand that. " Despite such issues, Feld agrees with Dillon that on the whole the plan has been a great success. "It's appropriate to have a plan that covers all departments, and this plan is individually tailored to meet the needs of various departments ," he says. "For all practical purposes it's worked pretty well. People will always have complaints, and no document is perfect for everyone. But if a majority like it, then it's been successful. "The practice plan provides a system that allows faculty members to supplement their incomes in the academic environment so we can be competitive and keep the people we want," Feld says. "In a university environment there have to be rules so that people can better work together. The practice plan gives UB a team approach , and that's what has made us so successful. " aughton agrees with Nolan that the issue of managed care will be a key challenge for the practice plan in the next decade. "As we experience changes in health care reform and financing, we will have to become more group-oriented," aughton says. "We will have to think as a group about how we interface with the changing financial environment. "We want to make sure the practice plan serves our mission of education and research , and generates the needed patient care activity," a ugh ton says. "The plan is in place, has matured and is functioning well. There are some real challenges out there , no doubt about it, but I + believe we can-face them. " "This has made it necessary for faculty to do a lot more practice, and has often put them in competition with the larger community for patients. "It's important to recognize that the practice plan only organizes income, and is not a plan for organizing the clinical practice of UB faculty, " olan says. "We do not have a university-wide group clinical practice. But having such a practice will be very important as we get into managed care, in which people will want to work with total care and not just particular departments. "Since UB faculty work at so many area hospitals, we have to be very attentive to the practice of our various hospitals , each of which has its own clinical culture ," olan sa y s. " Our department's faculty is spread out between competing institutions , and our faculty have to support the goals of their hospitals as well as [those] of UB." Although Dillon admits that a number of critically important issues still need to be dealt with, he believes the practice plan has come a long way. "Continuing issues will come up ," he says. "But we have a very good track record , and a responsive system that can deal with those issues. " Leonard Feld, M.D ., a member of the governing board from 1987 to 1990 and vice president of the board and chair of finance and policy from 1989 to 1990, says one of those key issues is how income limits will affect UB's ability to be competitive in recruiting physicians in certain fields . "There does need to be some flexibility on the limit," says Feld, who is an associate professor of pediatrics and physiology. "If UB wants to recruit certain individuals, income limits should not be a factor ," Feld says. "For instance, if we wanted to recruit a top transplant surgeon, we wouldn't I I I I I I I I I I I I -- - ------------ -- - -- - - ------- ---------- - - ~ B u a 0 p h y 5 c a A u m 9 9 4 �II THE NEW ACADEMIC MEDICAL COLLEGIUM GIVES ITS MEMBERS AN EQlJAL SAY IN THE FUTURE OF HEALTH CARE IN BUFFALO ANDREW T'S MORE THAN JUST ANOTHER institutional name. To people like Charles B. VanVorst, President of the Millard Fillmore Health System, "Academic Medical Collegium" * says a lot. "If you go back and look at Webster, the definition of 'collegium' is people sharing power on an equal basis." G) a u f f a l o P h y s I c I a n A u t u m n 1 9 9 4 �W LE IT'S STILL A WORK IN PROGRESS, the proposed Academic Medical Collegium holds the promise of creating a strong but flexible alliance among the University at Buffalo, its schools of Medicine and Biomedical Sciences and Dental Medicine and the eight area hospitals already affiliated with the university for graduate medical and dental education. There's also a seat at the table for medical staff and faculty in the novel organization, which proponents see as a vehicle for taking the region's health care and medical education systems into the next millennium. "We're trying to get up a step and do more for the community in a collaborative way," said Thomas R. Beecher Jr. , former Buffalo General Hospital chairman and a key player in the effort. Medical school dean john Naughton, M.D. , a prime mover behind the nascent organization, is optimistic. "There's been a broad foundation of principles to which most people have agreed," he said. "The good news," aughton added , "is everybody sees the appropriateness of moving toward cooperative interfaces in an era of reform directed at health care and health education that can be an overwhelming challenge to existing programs of quality." By incorporating broad representation from the university, hospitals and physicians, the Academic Medical Collegium hopes to build on the success of the existing Graduate Medical Dental Education Consortium, but to overcome the tensions that plagued a previous cooperative project, the Western ew York Health Sciences Consortium . If successful , the Collegium would enhance the region's medical education and health care systems to a point where Buffalo could become a national center of medical excellence. At the moment, the Collegium is more concept than concrete, but the concept is bold and its architects hope to move from artist's rendering to actual blueprints this autumn. The resulting structure would be something of a meeting hall from which members could launch collaborative efforts to enhance their academic and health care missions. "The question ," said VanVorst, "has got to be, how do you develop that forum with institutions that are not merged or economically linked to one another? I don't think it's a problem. I think it's a challenge. " Dean John Naughton, M.D., a prime mover behind the nascent organization, is optimistic it is •moving toward cooperative interfaces in an era of reform directed at health care and health education." B 0 0 p h s c o n u m 9 9 4 �Thomas R. Beecher, former Buffalo General Hospital chairman and a key player in the effort to build the Collegium, believes the organization could harness "a powerful force in the community" to meet the challenges that health core reform will bring. CCORDING TO THE Collegium's statement of m1sswn and principles, its focus would include everything from training and research to quality, cost and access to care. "There's a powerful force in the community if you take these eight institutions and the university medical complex to solve problems," Beecher said. It's too early for the Collegium to be planning any specific projects, but Beecher said there's no lack of possibilities. "If you put the weight of the university and all these hospitals into preventive medicine," he suggested, "a lot could be accomplished. " The Collegium would also serve as a communication forum for member institutions and practitioners, whether they be academic or community-based. And organizers want to keep the doors open for non-member institutions and practitioners to collaborate, too. "It's a very positive, almost ecumenical concept," said Gerald Sufrin, M.D., professor and chairman of urology and chairman of the medical school's Council of Clinical Department Chairpersons. "It's to improve health care delivery in a broader sense. Packed into that goes education and research, making young people the best they can be. " The organization would include the same institutions that make up UB's Graduate Medical Dental Education Consortium: the medical and dental schools, The Buffalo General Hospital, The Children's Hospital of Buffalo, Erie County Medical Center, Mercy Hospital, Millard Fillmore Health System, Roswell Park Cancer Institute, Sisters of Charity Hospital and the Buffalo VA Medical Center. aughton said plans call for the Collegium's board to include three people from each institution, including the chief executive officer or equivalent, the chief operating officer or designee and a medical staff or faculty representative. UB will be represented by its president and vice president for clinical affairs and chairman of the clinical council. Some see the Collegium as a natural next step in the development of cooperative efforts that began more than a B u 0 0 p h 5 c a n m n 9 4 �Charles B. Van Vorst, president of Millard Fillmore Health System, sees the Collegium as a forum from which member "institutions that are not merged or economically linked to one another" can launch collaborative efforts to enhance their academic and health care missions. decade ago with formation of the graduate medical education consortium, the organization that serves as the sponsoring institution for the numerous residency programs spread among UB's affiliated hospitals. While many had once viewed Buffalo's lack of a single university medical center as a drawback, the consortium has come to be seen as a model for other communities and a promising arrangement for implementing graduate medical education reforms , such as greater numbers of primary care slots. "It has drawn national attention," said William D. Pike, president of the Western ew York Hospital Association. The graduate consortium also got the university and the region's traditionally competitive hospitals used to working more closely together. In 1987, they formed a second alliance, the Western ew York Health Sciences Consortium. Its goal was to enhance the quality of health care in the region, and it was soon credited with several high-profile successes, including establishment of the Bone Marrow Transplant Center at Roswell Park, the Heart-Lung Transplant Center at Buffalo General and the Positron Emission Tomography center shared initially by UB and the Buffalo VA Medical Center, and now the Millard Fillmore Health System. Unlike the graduate consortium, the health sciences consortium was incorporated, giving it a more formal structure. And the Buffalo business community, interested in keeping health costs under control, played an important role in its formation and operation, so much so that the organization was headed by a bank executive. Despite its successes, the consortium ran into trouble. "There was always tension about how much involvement the business community should have in decisionmaking," recalled aughton. To make matters worse, physicians felt excluded. And hospitals, ever mindful of their own autonomy, were edgy about being absorbed into a de facto university medical center. Former UB President Steven B. Sample suggested that the consortium could solve some of its problems by putting the university in a stronger leadership position. The idea was seriously considered, but it didn't make nervous consortium members any more comfortable. "Eventually that organization went on the back burner," aughton said. "It hasn't been formally dissolved. But by gentleman's agreement, we decided to strike out in new directions to form a more mutually compatible organization." B a a p h c a n m 9 �LKS TOWARD THAT END have been going on at various levels for four years. UB's new president, William Greiner, also became involved, and by this summer the Collegium reached the point where everyone was preparing to sign off on a statement of mission and principles. It's an ambitious document that targets four areas: medical education; health care delivery; biomedical research; and the region's national standing. The document states that the Collegium would "Enhance the ability of its members to fulfill their respective academic roles, including those related to education of health care professionals .... " While it goes on to indicate that the Collegium would absorb the graduate education consortium, Beecher said that issue will remain uncertain until members get to work on specific operating plans. As for health care, the statement charges the Collegium with developing "organized approaches to meeting community health needs that strike a balance between collaboration and competition in addressing major health care issues, including quality, access and cost of care." Among other things, it says the Collegiu m would: facilitate availability of the best preventive, diagnostic and treatment modalities; foster efficient resource use and avoid unnecessary duplications; promote primary care access for underserved groups in the region; and encourage, where appropriate, resource sharing and joint support of activities. "I think this complements wherever health care reform takes us," said Robert Stanek, chief executive of Mercy Hospital. "But more importantly, it's good for the community." The mission and principles statement also says the Collegium would bolster biomedical research, partly by creating alliances of common interest that would "gain from clinical and organizational diversity among programs, departments and institutions." Such efforts might not only advance the body of health sciences knowledge, but could also help the area compete more successfully for research funds and establish it as a national biomedical research leader. The document also says the Collegium would encourage health services research into issues of quality, 6 u a 0 p h y 5 access, cost and appropriateness. In addition, the organization would develop collaborative information systems, which could also serve educational and administrative needs. "We can do very collaborative research among institutions," said Edwin Mirand, M.D., Roswell Park's vice president for educational affairs and dean of its graduate division of the UB medical school. "We can get greater numbers into the treatment schedules. You're always looking for patients to come into protocols, and one institution may not have one type of patient, but a group of institutions might. " Finally, the Collegium would work to advance the regional and national reputation of not only its members, but of the entire local health care community. In particular, it would identify collaborative opportunities to retain patients within the region and encourage "services of excellence." To answer physician concerns, Collegium planners added a section to the mission and principles statement in May that provides for proportional representation among institutions, medical and dental staff and UB faculty. "I think some of the nervousness between the volunteer faculty and the full-time faculty has been diminished because a representative voice has been assured," aughton said. Sufrin said the medical school's clinical department chairpersons were among the first to endorse the Collegium document. "In a sense, the faculty at large could be considered another institution," he said. "From our standpoint, we look upon the Collegium as an extraordinary opportunity to work with the other health care institutions in the system." The mission and principles statement also says, among c a n A u m 9 9 4 �Gerold Sufrin, M.D., professor and chairman of urology and chairman of the Council of Clinical Deportment Chairpersons, describes the Collegium as "a very positive, almost ecumenical concept" that will "improve health core delivery in a brooder sense." other things, that faculty appointments will not be universally required for medical and dental staff appointments to all teaching hospitals, and that the Collegium itself will not enter arrangements to provide patient care or other services unless all members and their staffs agree. "Keeping the physicians involved helps to round out the system," said Stanek. With Collegium participants concerned about their autonomy and everyone uncertain about the direction of health care reform, it hasn't been easy getting to this point. But many are optimistic. "I think it's good and it'll help health care delivery, research, education," said Mirand. "Yes, you'll lose some independence. But it'll also give us more opportunities. " "There's no question that people are looking out for their turf," said VanVorst. "But I do sense a broader winwin, a broader sense of community. I see a broader vision or need emerging. I think it's good, and I hope we find a way to build on that." If all goes according to expectations, Collegium organizers will work this fall on an organizational structure to carry out the lofty generalities of the mission and principles statement. Will the Collegium be incorporated? Will it absorb the graduate education consortium? What exactly will it do , and who will do it? It will probably be the most difficult part of the process, Beecher said. B u a 0 p h y s c VanVorst said he thinks the Collegium can avoid the tensions that troubled the Health Sciences Consortium. "I think it's a lesson," he said. "Also, that was several years ago .... The environment has changed, the leadership of most of the hospitals has changed. I see that as an opportunity. " The trick, he added, will be to move as quickly as possible "without fracturing the process or creating mistrust." Stanek said member institutions shouldn't feel threatened as long as the Collegium takes a "planned, rational approach." The organization may eventually try to reduce service duplications and encourage specialization among hospitals, but some of that is happening already, he said, pointing to developments like ECMC's traumaburn unit. Collegium or not, he added, downsizing is occurring, and the Collegium could help member institutions cope with it better. a ugh ton said he doesn't expect the Collegium to be finalized overnight. "We're in a preparatory phase," he said. "The actual formal organization may take another year or two. We're in a process of evolution." Still, he said, he sees the organization as being on the leading edge of a trend that will grow, especially if the basis of the Clinton health care plan is adopted. "I don't think there is any doubt that the managed competition theme will push every community to do more to develop + cooperative strategies for survival," he said. a n ll. u m n 9 9 4 �. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . . . .. . . . . . [1] I/ ;;;::::::_lJ 0 I Moncada gives Harrington Lecture INTERNATIONALLY RENOWN RESEARCHER FOCUSES ON CLINICAL APPLICATIONS OF NITRIC OXIDE RESEARCH alvador Moncada, M.D., who is internationally known for his pioneering studies of nitric oxide and its clinical applications, delivered the D.W. Harrington lecture, " itric Oxide: Physiology, Pathophysiology and Therapeutic Implications," discussing the history of nitric oxide research and some recent research on nitric oxide that suggests significant clinical possibilities. Paresh Dandona, M.D., UB professor of medicine, introduced Moncada, research director for the Wellcome Research laboratories in England since 1986. Dandona praised Moncada as "one of the most unique and creative minds of our time," saying his work "has inspired generations." While nitric oxide research was initially focused only on prostacyclin and related issues, Moncada helped expand nitric oxide research to all areas of the body, Dandona said. Moncada, a member of England's prestigious Royal Society who has received their gold medal, is credited with the discovery that nitric oxide is the endothelium-derived relaxing factor. The author of more than 550 publications on vascular physiology and pharmacology, including seminal work on modulation of prostaglandin release and action by blood vessels, platelets and endothelium, he is also a member of this country's ational Academy of the Sciences. Moncada said the determination that vascular endothelial cells generated nitric oxide was made in 1987. A year B a a p later, researchers determined brain synapses also generated nitric oxide, leading to the suggestion that the formation of nitric oxide from l-arginine, the synthetic precursor to nitric oxide, was a widespread pathway for the regulation of cell function and communication. It was determined that nitric oxide acts as MONCADA , A MEMBER O F ENGLAND'S PRESTIGIOUS ROY AL S OC IETY , IS CRED ITED W ITH THE DISC OVERY T HAT N ITRI C O XI DE IS T H E ENDOTHELIUM· DERIVED R ELA X ING FACTOR . h c a n an intermediary in such functions. The discovery that l-M A (methyl nitroso arginine - a derivative of larginine) was a selective and competitive inhibitor of the generation of nitric oxide proved the most important tool for the investigation of nitric oxide, Moncada said. l-MNA produces a longlasting hypertensive response and causes such effects as significant loss of blood flow. Such effects can be immediately reverted by the injection of larginine, Moncada said. The most interesting part of such a finding, Moncada said, is that l-M A does not increase blood pressure by inducing vascular construction, but by blocking the production of nitric oxide. Thus, in its normal physiological state, the cardiovascular system is in a state of active vasodilation, and a balanced system tends toward normal vasodilation. Such research shows nitric oxide is the endogenous dilator in the system, Moncada said. itro-vasodilators act the way they do because they are transformed into nitric oxide. itric oxide, he said, performs numerous functions within the body, interacting with prostacyclin and inhibiting platelet aggregation and white cell activation to regulate platelet and white cell activity within the vessel wall. Evidence is also growing to suggest that nitric oxide modulates vascular smooth muscle cell proliferation via a cyclic GMP-related mechanism , Moncada said. " itric oxide is a general regulator that plays many different roles, " Moncada said. "An interesting question is whether we can make compounds that might be different from normal vasodilators, which can lead to our selectively targeting specific vasodilators." itric oxide is widely distributed in u m 9 ] �. .. . . . .. .. ........... . . . . . ..... . ... .. .. . ... . .. . .... . .............. .. ......... .... .. ··· · ·~-· I in biological fluids may serve as a general marker of disease , Moncada said. "All these functions of nitric oxide are being established," Moncada said. "How could we have understood blood pressure before knowing this? Itnc oxide, which in the atmosphere is known as a pollutant, is also the first known gas to act as a biological mediator. Could it be that other gases also play a role in the nervous system, he said, where neurons are highly interconnected, and nitric oxide neurons are very resistant to processes of neurodegeneration. Moncada said this further suggests that nitric oxide may play a role in longterm potentiation - a major factor in memory. itric oxide may play many other roles in the central nervous system as well , Moncada suggested, including the regulation of cerebral spinal fluid. Research has discovered that white cells also release nitric oxide, Moncada said. Thus, while nitric oxide acts as a biological mediator for physiological purposes, when released by white cells it has defensive purposes. Nitric oxide is cytostatic and cytotoxic for tumor cells, bacteria, fungal cells and protozoan parasites, Moncada said, adding that activated white cells release nitric oxide for a very long time. At the moment, clinical applications of nitric oxide research are focused on the vessel wall area , Moncada said, where nitric oxide-mediated vascular relaxation can help regulate blood pressure. Also, it is clear that excessive nitric oxide production can produce hypertension in cases of septic shock. itric oxide synthase inhibitors can potentially manage such shock , Moncada said. "Whoever has been in an intensive care unit trying to reverse the effects of septic shock will agree this is very important," he said. Recent research has found an increase in nitric oxide production in all parts of the body during pregnancy, Moncada said. Such increased production could cause the decrease in vascular tone in pregnancy and other effects, as well as help prevent heart disease in pre-menopausal women. Other research has suggested that the breakdown products of nitric oxide a u a 0 p h I animal systems? " The Harrington Lecture is sponsored by the School of Medicine and Biomedical Sciences. The D. W. Harrington Lecture Fund was established in 1886 by Devillo White Harrington, M.D. , an 1861 graduate of the UB medical school and a professor genito-urinary and venereal diseases from 1886 to 1905. + B Y MARK WALLACE z Q ~ 3: . § 0 ~ Shirley Sampson, deputy director of Health Systems Agency, and Herbert Hauptman, Ph.D., president and scientific director of The Medical Foundation of Buffalo, speak at a health care reform forum sponsored by Rep. Jack Quinn, R-Hamburg, held at the medical school in May. Ebsary appointed assistant dean and director of development tephen Ebsary, Jr. , has been appointed assistant dean and director of development for the School of Medicine and Biomedical Sciences. He has served the university in various capacities since 1988, including as director of planned giving for the University at Buffalo Foundation, Inc. "Steve will help us continue to build on our y c a n strong base of philanthropic support," said john aughton, M.D. , vice president for clinical affairs and dean of the medical school. "We want to increase the school's endowments and unrestricted support so that we can continue to provide the excellent education for medical and graduate students that has earned us national prominence." Ebsary, a graduate ofMuskingum College in ew Concord, Ohio, is a native of East Aurora, ew York. Active in numerous fund-raising organizations, he is president of the Western ew York Planned Giving Consortium and chairman of the SUNY Task Force on Planned Giving. + m 9 9 4 �- • - ------ · · ··········· · ··· · ·· · ··· ·· ·········· · ·· · · · ····· · ········ ··· · · ············ ·· ··· ·· ·· · ····· z I 32 medical students receive awards at commencement don S. Ehrlich Award, the Mark S. Petrino Award and the American Academy of Family Physicians President's Award hirty-two UB medical students • Thomas Burnette, of Briarcliff were honored during the school's Manor: the Baccelli Award and the Bercommencement held on May 15. nard H. Smith Memorial Award in CliniAmong the recipients were cal eurology eight multiple award winners: • Karen Houck, of Snyder: the Dr. • Sean Perini, of Buffalo: the Cyrenius Chapin Award and the Hans Dr. George Alker Award, the Robin M. ]. Lowenstein Award in Obstetrics Bannerman Memorial Research Award, • Christopher Wood of Williamsthe Dr. Cyrenius Chapin Award and the ville: the Dr. Thomas]. Guttuso Award Upjohn Award and the E.]. Weisenheimer Award • Martha Bennett, of Cleveland, Ohio: Other graduates receiving awards the Charles Bauda Award, the Dr. were: Cyrenius Chapin Award and the Stephen • Diana Sanderson, of Tonawanda: ]. Paolini Award the Gilbert M. Beck Memorial Prize in • Steven Hammel, of Tonawanda: Psychiatry the Buffalo Pediatric Society Award, the • Katherine O'Donnell, of Buffalo: David K. Miller Prize in Medicine and the Buffalo Surgical Society Prize in the Morris and Sadie Stein Neuurgery roanatomy Award • joel Brenner, of Williamsville: the • Andrea Williams, of Buffalo: the Children's Hospital Prize Dean's Award, the orman Haber Me• Richard Kozak, of Buffalo: the Somorial Award and the ational Medical ciety for Academic Emergency MediAssociation Award cine Award • Kim Griswold, of Buffalo: the Gor• Todd Schlesinger, of Cleveland, B u 0 0 p h 5 c 0 n A Ohio: the Dr. Austin Flint Award • joseph Kay , of Amherst: the Bernhardt and Sophie B. Gottlieb Award • Michael Krabak, of Buffalo: the Francis]. Klocke Award • Debra Tarantino, ofBuffalo: the Dr. Heinrich Leonhardt Prize in Surgery • Elizabeth McClintick, of Buffalo: the Lierberman Award •j ennifer Tufariello, ofWilliamsville: the Maimonides Medical Society Award • joseph Valenti, ofBuffalo: the Medical Society of the State of New York Award • Michael Landi, ofBuffalo: the Medical Alumni Association Award • William Cecere, of Kenmore: the S. Robert arins Memorial Award • Douglas Golding, of Kenmore: the G. orris Miner Memorial Award • Glen Feltham, of Amherst: the Benjamin E. Obletz, M.D., Award • john Pryor, of Buffalo: thejohn R. Paine Award in Surgery • Madonna Tomani, of West Seneca: the Clyde L. Randall Society Award in Gynecology-Obstetrics • Mark Sheldon, ofBuffalo: the Emilie u u m n 9 �··························· · ··············· · · · ······· · ····· · ·························· · ·• · ~ I Lambert retires as Red Cross Blood Services principal officer nize those who donate six or more times per year. Under Lambert's direction, the Red Cross' Buffalo laboratory consistently eginald Lambert, Ph.D., has re- extracted the highest number of prodtired his position as principal of- ucts per donated unit of blood in the ficer of Blood Services, Buffalo Red Cross system. In 1993, the national Region after 21 years of service to component production average was 2.6 products per donated unit. The Buffalo the American Red Cross. Lambert, professor emeritus of Region amassed 3.6 products per unit microbiology, achieved many accom- average- enabling one unit of donated plishments during his tenure- among blood to assist up to four patients and them, the establishment of seven fixed fully maximizing each blood donor's blood collection sites throughout West- time and efforts. Also under Lambert's stewardship, ern New York. As a result, the Buffalo Region has consistently had the highest Buffalo was an early leader in the collecratio of donor per 100,000 population tion of platelets, pheresis in the early of any large region in the Red Cross 1970s and was the first Red Cross blood region to utilize a blood product irradiasystem. One of Lambert's proudest moments tor. Donald Dudley, an 18-year veteran came in the early 1970s when he led the Red Cross to adopt a "community re- of the American Red Cross, has been sponsibility" philosophy rather than the named Interim Principal Officer for the former "credit" system of blood dona- Buffalo Region. Dudley, who has served tion. Lambert also fully understood the in a variety of positions at both the strong personal commitment blood do- regional and national level, is currently nors feel to the program, and in 1986 he serving as Interim Principal Officer for established the "Sixer Club," to recog- the Rochester Blood Region as well. + Davis Rodenberg Memorial Award • Donna Stawasz, of Cheektowaga: the PhilipP. Sang Memorial Award • john Sherwood, of Buffalo: the john Watson Award in Medicine • john McArdle, ofYonkers: the john Watson Award in Medicine • Geoffrey Hobika, of Grand Island: the james Platt White Society Award • Michelle Penque, of Grand Island: the Frederick B. Wilkes Pediatric Award • Antonio Bird, ofBuffalo: the Farney R. Wurlitzer Award + SMILES ABOUND AS THE MEDICAL S C HOOL HELD ITS 148T H C OM· MENCEMENT I N MAY. FROM LEFT TO RIGHT , JEFFREY SEYMOUR , M . D ., ' 93 , CONGRATULATES NEW GRAD P I NA C . SANELLI , M . D .; J O S E PH J . FA LSON E. M . D ., MAKES HI S MOT HER MARYANNE PROUD ; AND BEHZAD TABIBIAN ( STANDING) AND MICHAEL LANDI ENJOY THE CEREMONIES . B u c 0 p h I y c c u m n 9 9 4 �• ·· · · · ····· · · · · · ···················· · ·· · ······· ·· ····· ·· ·············· · ··· · ·············· z I Kristen Schenck-Robillard Med student takes first place honors in AAFP research forum B medical student Kristen SchenckRobillard was the recipient of the First Place Research Forum Award at the ew York State Academy of Family Practice's annual meeting May 8, 1994, in Saratoga Springs, ew York. The title of Schenck-Robillard's research paper was "Predictors of First Contact Care in a Poor Urban Census Tract. " She competed against other medical and biomedical sciences students, as well as residents and attending physicians for the award. Carlosjaen, M.D., senior clinical investigator and clinical assistant professor of family medicine, is SchenckRobillard's research faculty leader, supervising her research endeavors. "If Kristen has expressed interest in becoming a family doctor, the specialty would be lucky to have her," jaen said. Schenck-Robillard, a native Buffalonian who attended Canisius College for her undergraduate education, is a member of the Class of 1996. She is expecting her first child in October. Schenck-Robillard will also present her paper to a national audience at the B a 0 p American Academy of Famil y Practice's scientific assembly held in September in Boston , Massachusetts. Two other UB medical students presented papers at the Saratoga Springs conference. jennifer Zubler, Class of 1995 , presented "Use of Ultrasonography." Patricia Krebs , also a member of the Class of 1995, presented "Violent Acts in Rural Settings. " Krebs will also present at the AAFP's scientific assembly in Boston. + - B Y R EBECCA B RIERLEY Rosenthal named chairman of family medicine department homas C. Rosenthal , M.D., associate professor of family medicine and a 1975 UB medical school graduate, has been named chair of the department of family medicine. Rosenthal has served as interim chair for the past year. A member of the department since 1978, he was instrumental in establishing the division of rural health, the medical school's rural health campus in Cuba , ew York, and its residency program in rural health, one of four in the country. Through his initiative, UB was named a ew York Rural Health Research Center in 1992, and one of five universities in the U.S. designated as national rural health research centers. He received the 1992 Distinguished Educator Award from the ational Rural Health Associah y 5 c a A tion for his work in expanding and improving rural health care. Rosenthal also is founding director ofUB's Primary Care Resource Center, headquarters for projects implemented through the school's primary-care initiative, a cooperative effort begun in 1992 to increase the number of medical school graduates entering primary-care practice. Rosenthal is project director of the Generalist Physician Initiative grant from the Robert Wood johnson Foundation. + Sarkin elected chair of pediatric association education group ichard Sarkin, M.D., clinical assistant professor of pediatrics, has been elected chair of the Ambulatory Pediatric Association's Special Interest Group for Medical Student Education. Sarkin also is a member of the executive committee of the council on medical student education in pediatrics. + Departmental name changes better reflect academic disciplines o better reflect the scope of their disciplines and missions , two medical school departments have recently undergone name changes. The department of pharmacology and therapeutics is now officially the department of pharmacology and toxicology, and the department of anatomical sciences is now officially the department of anatomy and cell biology. + u m 9 4 �ity, cost-effective, efficient care to all of the country's citizens in a larger variety of community-sited environments. This can be done only if more physicians are prepared to work in new settings and to focus on our many unmet needs. "UB is proud to be included among the schools that will provide the needed leadership for change in the years ahead," he added. The grant will support the following activities: • Recruiting underserved and rural students • Pairing promising high school students with primary care faculty during the summer • Restructuring some courses to include more emphasis on primary care clinical approaches, as well as developing new courses • Teaching information management skills to medical students • Training medical student in multidisciplinary teams with nurse practitioners, physician's assistants, therapists and social workers • Moving primary care medical clerkships out of hospitals and into clinics and doctors' offices in the community • Hiring a director of education development to help design new courses and programs, and a medical education specialist to train faculty to implement the initiatives "The Robert Wood johnson granl offers us a tremendous opportunity to unite the goals of the primary care departments and to produce high-quality clinical graduates who will be more likely to enter primary care," said Thomas Rosenthal, M.D., chair of the department of family medicine and the grant's project director. "Those who don't enter primary care will have a better understanding of the challenges patients face in our health care system." The medical school has set a goal of UB wins $60,000 Robert Wood Johnson Foundation grant he School of Medicine and Biomedical Sciences will receive approximately $600,000 over three years from the Robert Wood johnson Foundation to support the medical school's efforts to redesign its medical education curriculum and to increase the number of primary care physicians it graduates. In three years, after a successful evaluation, the foundation will continue to support UB's primary care education efforts through a non-competitive threeyear grant. UB is one of 14 U.S. schools to receive a Generalist Physician Initiative implementation grant. The money will allow the university to carry out recommendations developed during an 18month planning period, funded in 1992 through a $150,000 award from the foundation. The Generalist Physician Initiative grant will enable the medical school to begin its primary care recruitment efforts in high school, and to develop projects and programs that will give medical school students early hands-on experience in primary care. Studies have shown that early positive exposure can influence students to choose careers in primary care medicine . "The faculty and I are elated by the designation from the Robert Wood johnson Foundation to participate further in the Generalist Physician Initiative," saidjohn P. aughton, M.D., dean of the medical school and vice president for clinical affairs. "Medical schools and their teaching hospitals have done much since World War II to improve the quality of patient care and to eradicate curable diseases. Today, the challenge is to provide qual- B u 0 0 p h y c o n A u having 50 percent of its graduates eventually practicing in primary care fields. In September 1992, the school launched its own primary care initiative devoted to graduate medical education when it unveiled a $5 million demonstration project involving six Buffalo teaching hospitals, Medicaid, four private health care insurers and the ew York State Department of Health. That effort concentrates on recruiting medical school graduates into primary care residencies, improving faculty and resident teaching, setting up community academic practice sites and developing primary care research opportunities. The Robert Wood johnson Foundation, headquartered in Princeton, New jersey, is the nation's largest philanthropic organization devoted to improv+ ing health care. BY LOIS BAKER Ginsberg receives Triological Society Presidential Citation rwinA. Ginsberg, M.D. ,adjunctclinical professor, has been awarded the Presidential Citation of the American Laryngological, Rhinological and Otological Society. The founder and president of the Buffalo Oto laryngology Group received the award for his internationally recognized contributions to the research, diagnosis and treatment of hearing disorders. The Society, also known as the Triological Society, presented the citation at its annual conference in West Palm Beach, Florida. Ginsberg received the award for his pioneering research and practice in middle ear microsurgery and cochlear implants, as well as his work in the education of the deaf. + u m n 9 9 4 �Roswell Park Cancer Institute founded as part of UB NATIONAL CANCER INSTITUTE-DESIGNATED COMPREHENSIVE CANCER CENTER HAD ITS ROOTS AS A THREE-ROOM LABORATORY AT 24 HIGH STREET he first government-supported get into the business of disease research. cancer research laboratory in the But a year later when the bill was world had its beginnings in three passed a second time, he changed his rooms of the old University of mind and signed it. The state continued Buffalo building at 24 High Street. to support the laboratory until 1903 The laboratory, then known as when another governor, Benjamin B. the ew York State Pathological LaboOdell, faced with a shortage of funds, ratory of the University of Buffalo, had threatened to veto the appropriation. been set up under a grant of $7,500 from the state legislature in 1898. The enabling legislation specified that the money was to provide for "the equipment and maintenance of a laboratory devoted to an investigation into the causes, nature, mortality rate and treatment of cancer." Today, it is Roswell Park Cancer Institute, named for the UB professor who fought for its creation and served as Roswell Park Cancer Institute, circa 1935 its director for its first six years. Again, Butler exerted his considerable Park had come to Buffalo as profesinfluence until the bill was signed. State sor of surgery at the 4 7-year-old unisupport was never in doubt again, though the amount was sometimes in question. versity. One of the first things he noted In two years the laboratory outgrew was the greater incidence of cancer here than in Illinois, where he previously the medical school space. With money publicly raised, land was purchased on practiced and taught. He called the disease "the pathological mystery of the High Street across from The Buffalo ages. " Despite that, the University of General Hospital, and the first building in the world constructed solely for canBuffalo had no funds for cancer research, so Park turned to the state. cerresearch was opened in mid-1901.It He enlisted the support of Edward was named the Gratwick Research Laboratory of the University of Buffalo in H. Butler, editor and publisher of The Buffalo ews, who wielded consider- recognition of Mrs. William Gratwick, who underwrote it with a $25,000 grant. able influence with the legislature. In 1911, Roswell Park, no longer The legislature approved a grant, but Governor FrankS. Black vetoed the director but still actively interested in bill,questioningwhetherthestateshould the laboratory, led a move to have it B u a a p h y s c a A taken over by the state and it became the ew York State Institute for the Study of Malignant Diseases. In 1946, its name was changed to the Roswell Park Memorial Institute, in honor of its founder. During its early UB years, the laboratory had a staff of l 2 - five of them professionals. In 1903, they published five scientific papers. The laboratory maintaineda colonyof3,000 mice and 300 rats for research in spontaneous and transplantable tumors, and studied antibodies in mice recovering from experimental tumors. George ] . A. Clowes, M.D. , a member of the early staff, introduced experimental drugs in the treatment of cancer for the first time in the U.S. Later, working for Eli Lilly & Co., he helped develop methods for the commercial manufacture and use of insulin, for which he received the Banting Medal of the American Diabetes Association. Because of his work, four of his former faculty associates at UB were among the first to get insulin for their patients. Today, Roswell Park Cancer Institute is no longer officially a part of UB, although they are both ew York State public institutions. The institute serves as a teaching arm of the university the RPCI Graduate Division; students rotate through it for experience in treating patients with cancer. It was recently designated a Comprehensive Cancer Center by the ational Cancer Institute. + - BY u MILDRED u m n SANES 9 �Spring Clinical Day and Reunion Weekend held April29 and 30 At left, University at Buffalo president William R. Greiner, and below, John M. Canty, M.D., ' 79, associate professor of medicine, address the gathering. his year's Spring Clinical Day and Reunion Weekend, held April29 and 30, was a resounding success that saw friends and colleagues come together to reminisce and renew friendships. As these photographs of the events attest, a good time was had by all! + At left, this year's Reunion Classes enjoying the festivities. Above, outgoing Medical Alumni Association president Robert Reisman, M.D.,' 56, presents an Alumni Achievement Award to James F. Mohn, M.D., '44, as Jerome P. Kassirer, M.D.' 57, editor of the New England Journal of Medicine, looks on. Other Alumni Achievement Award winners were Andrew A. Gage, M.D., '44; William R. Kinkel, M.D., '54; and Max Schneider, M.D., '49. At right, Paula L. Stillman, M.D., former provost and dean of Eastern Virginia Medical School, speaks to participants at the program. e u a a p h y c a u m 9 9 �Reunion Portraits: Pictures of 55 Years of Success ere, Buffalo Physician presents the 10 classes that were honored at this year's Reunion Weekend, including the Class of 1939, which met informally to celebrate + 55 years of medicine. LEFT TORIGHT- FIRST ROW: Frank T. Riforgiato, Elizabeth Olmsted Ross SECONDROW: Anthony V. Postoloff, Roy E. eibel, George C. Brady, john H. Geckler LEFTTO RIGHT- FIRST ROW: Richard Egan, Paul Weygandt, Sidney chaer,james F. Mohn , Irwin Ginsberg SECOND ROW: Anthony Aquilina, Willard Boardman, Raymond Hudson, Frank H. Long, Jr. , Herman Edelberg, Howard Barnett, Helmut Mueller, Sam Cassara, Newland Fountain, Francis Marchetta, Casimir Pietraczek THIRD ROW: Clinton Strong, Raymond Bondi, Frank T. Frost, james Sullivan, Robert G. Wilkinson, Jr. , Theodore Prentice, William Potts, Thomas Frawley, Andrew A. Gage, Edmund Collins, William Nowill LEFT TO RIGHT- FIRST ROW: Carmelo Armenia, jacqueline Paroski, julia M. Cullen, joseph Bradley Aust, Jr. SECONDROW: Ralph S. Canter, Richard Schwanz, james Werick, George Erickson, Paul T. Buerger,john T. Sharp, Pierce Weinstein, Max Schneider, Harold Bernhard THIRD ROW: Charles Bathrick, Philip C. Dennen B u a 0 p y 5 c 0 A u m 9 9 �I - ~ --~ _-- ········· · · ························· · ···· · ············· ~ • lEFT TO RIGHT- FIRST ROW: Edward Wenzlaff, Charles Marino, Allen Lesswing, Paul Weinmann, Robert M. Oshrin, icholas Carosella, Donald Murray SECOND ROW: jacob Lemann, Jr., Donald Wilson, Byron Genner, William Howard, orbert Kuberka, john L. Conboy, Robert Miller THIRD ROW: Richard Mayer, William Kinkel, Edward Rayhill , Alfred Wolfsohn lEFT TO RIGHT - FIRST ROW: Daniel Kozera, Elton M. Rock, andra Wilt e Leininger, Eli M. Isaacs SECOND ROW: Constantine]. G. Cretekos,johnj. McMahon, William Blaisdell, joseph F. Monte, George Baeumler, Thomas Doeblin, james M. Cole, Richard A. Falls, Daniel Ninburg lEFT TO RIGHT- FIRSTROW: joseph DiPoala, Anthony Ferrari SECOND ROW: james Tibbetts, Jr., David Weinstein, john A. Manzari, Elizabeth Serrage, Michael Goldhamer, Charles LaDoulis, Gerald Goldstein THIRD ROW: George Glowacki, Stephen P. Katz, Irving Sterman,]. Frederick Painton, Jr. , Marvin Z. Kurian , Richard Wolin , Bela F. Ballo, David A. Leff, Michael Feinstein, Lawrence Casazza B u a 0 p h s c a n A u m n 9 4 �~- - LEFT TO RIGHT- FIRST ROW: Dorothea Downey, Penny A. Gardner, Moira J. Burke, Marion Wind-Pisick, David M. Sherer, Evelyn Hirschorn Roisman, Madeline White, Barry Weinstein SECOND ROW: Joel B. Bowers, Robert]. Gibson, Michael Pugliese, Michael Pisick, Hachiro akamura, Robert Hartog, louis Hevizy, Gerald Stinziano, James Cavalieri, Samuel Weissman, Bernard Muscato THIRD ROW: David F. Hayes, Timothy Harrington, Daniel Mandelbaum, Hanley Horwitz, James Patterson, Douglas Roberts, Thomas Scanlon,James White LEFT TO RIGHT- FIRST ROW: Lawrence Oufiero, Diane Matuszak SECOND ROW:James A. Smith, Paul Wierzbieniec, Stephen Yerkovich,John H. Clark, Richard]. Buckley, Jr., James l. Budny, Joseph P. Lemmer, Bruce Middendorf, Bradley T. Truax, Roy E. Seibel,Jr. , Thomas l. Walsh, Edward Valentine LEFTTO RIGHT- FIRST ROW: Peter E. Shields, Sonia L. Wornum, Ivonne Cellino, Robin H. Adair SECOND ROW;John Canry, Donald Armenia, Joh n Corbelli , Arth ur Rosiello, joseph Buran, Jr., Michael Cellino, Charles Francemone, Walter A. Balon, Ramon]. Pabalan, Andrew ]. Majka, John W . Crofts B u a 0 f' h c 0 n u u m n 9 9 4 �··· ·· · ·· ·· ·· ·· · ···· ·· ······· ·· ·· · · ··· ·· ·· ·· · ·· · · ··· · ··· · · ···· ·· · · · · ····· · ··· ·· ······ · ··· • ij LEFT TO RIGHT- FIRST ROW: Benson Zoghlin. Michael McMullen, Andrew LEnTO RIGHT -FIRSTROW: Amy R. Jeffery, KaraM. Kelly, Diane M. Cicatello, Knoll, David Pfalzer, Laurajo Booth, Raymond Chan SECOND ROW: Susan Rodney j. Voisine, Mary Schamann, LoriAnn Fraas-Burns, Richard E. Abbott, Evelyn Hurvitz, MoritzaAlvarado, Amy Schueckler, Mark Billinson Ferguson, Debra M. Omiatek, Carolyn]. Piver, Lee R. Guterman SECOND THIRD ROW: Fitzroy Dawkins,john McLaughlin,julie Dressloch, Mina Ohm, ROW: David R. Bloom , Kristina E. Han, Andrea L. Messina, Douglas Sillart, ora Meaney-Elman, Madeline Lalia, Kevin Rosteing, Paul Greenberg, Pamela D. Reed, Dawn A. Gais, Mark Pundt, Thomas Grimald i THIRD Seth Matarasso, William Healy FOURTH ROW: Thomas Mahl, Douglas Bates, ROW:Kevin M. Senn, Raul Vazquez, Michael Licata, Wayne A. Forde, Leonid Kenton Forte, Marc ]. Kublick,John A. Brach , Herbert Shkolnik, Paul]. Lecat, Eric R. Southard, Henry M. Stachura ewton,John G. Dyster,john Lupiano, Paul Misthos, And rew Tanner, Randall A. Solomon Donate $20 to Ronald McDonald House®and Get a Free Phone* From Cellular One® A vailable to all State, RF, UBF and FSA employees. Special airtime rates $12 Monthly fee and 22¢ per minute. I f you've been wondering if or when you'll buy a cellular phone... here's an offer that'll make you feel good about owning one. The program is called Hear The Call, Help The Children, and here's how it works. Your contribution of at least $20 helps fund Pl iO phone from Cellular One. Simple as that. ow, owning a cellular phone from Cellular One never felt so good. To contribute to the Ronald McDonald House* and get your free cellular phone, visit any Cellular One store or participating dealer or call 861-9680. But hurry, Buffalo's Ronald McDonald though. This offer expires September 30, 1994. '-l.~ff.~;;;;~~o..1J House*, one of 160 facilitie CELLUlAR ONE. around the world, each providing a seriously ill children being treated at local hospitals. At the same time, your donation also gets you a free NEC 861--9680 contact Paula Omicioli Make your check payable to: Ronald McDonald House• • Offer conun,amt upon new acovauon, equtpmmt contract and cm:ltt approval w1th Cellular~ m the aevm-county Westttn Nc.- Yorit area. Cellular c::>nt reserves the rteht to substitute equ1pmem. A one-t~ acovaoon fee apphes. EqUipment conmcu and rate plans vary. Certam temu and c.ondiUON apply. �~ -· · · ······· · · · ··· · ········ ·· ····· · ······· · ··· · ···· · ······ · · ·· ·· ·· · · ······ · ·············· 1181 Eugene Farber '43, focused his career on integrating clinical specialty of dermatology with basic science B UFFALO NATIVE SPENT 37 YEARS AT STANFORD AS A C LI NICIAN , EDUCATOR AND ADMINISTRATOR , AND FOUNDED T HE PSORIASIS R ESEARCH INSTIT UTE uring a guest lecture at the Central Research Institute of Dermatology in Soviet Georgia in 1977, Eugene Farber, M.D., attempted to inject some humor into his presentation by projecting pictures of California, his adopted home. One by one, Farber held up pictures of famous West Coast attractions: Fishermen's Wharf, Chinatown, the giant redwood trees. "My interpreter repeated that the redwood trees are so tall that when Sputnik flew over it almost hit the top of the trees," Farber recalled. " obody laughed." It was probably the only "bomb" dropped in Cold War history. Although Eugene Farber may not ever be recognized for his stage presence, the accomplished physician-researcher can be credited with helping to transform dermatology from a clinical specialty to a discipline with a close integration with basic science. A native of Buffalo, ew York, Farber received a B.A. degree from Oberlin College in 1939, his M.D. degree from the University ofBuffalo in March, 1943, his M.S. degree from the University of Minnesota in 1946 and served his residency at the Mayo Clinic from 1944 to 1948. From 1949 to 1986, Farber served at the Stanford University School of Medicine as a clinician, educator, research investigator and administrator. He completed his career at Stanford as a profesB u a 0 p sor of dermatology and chairman of the department of dermatology, a position he held from 1959 to 1986. It was at Stanford where Farber began to pioneer independent departmental status for dermatology. "In order for dermatology to grow as a specialty, with its own individuality and greater room for development, I believed it was necessary to have equal status with other clinical disciplines," Farber said. This desire for independence can be considered the landmark in the evolution of dermatologic research on both the basic science and applied levels, specifically in the study of psoriasis. Until well into the 20th century, published knowledge of this disease was almost entirely descriptive. From the genesis of his career, Farber linked clinical observations with laboratory studies. "I enjoyed teaching the longer I was in it. My professorship at Stanford included teaching combined with patient care and research. When I visited my patients, I would always have three or four students with me. It was important for them to actually see patients and to get first-hand experience with different maladies," Farber said. "The research part occupied my nights and weekends. I worked at least 60 hours per week during my career, but I enjoyed it." It was his desire for expanded knowledge and increased research that led to the First International Symposium on Psoriasis, held in 1971. Three more were h w " c a n A to follow at five-year intervals. Throughout his career, Farber has lectured in 44 different countries and has received honorary memberships and awards from more than 26 foreign dermatology societies. He is the author of several hundred scientific publications and four books. He recalls that one of his most memorable collaborations was in ewfoundland, British Columbia, where Farber teamed up with Dr. Wayne Gulliver, a professor of dermatology at St. John's University. Farber and Gulliver were investigating a five percent prevalence of psoriasis in a population that was considered to be a closed community. "There was a very low rate of divorce and most of the people living there are married within the community," Farber said. "We had an excellent opportunity to undertake genetic analysis of entire families," Farber said. "Evidence pointed to the sixth and seventeenth chromosomes, which demonstrated linkages in the family studies." Upon his "retirement" from Stanford, Farber co-founded the Psoriasis Research Institute, a non-profit foundation in Palo Alto. Originally established with a skin biology unit specializing in psoriasis, the institute expanded in 1989, adding a clinical-pharmacology division and a psoriasis medical treatment center. Although the main emphasis of the institute's work is research, Farber said that patients receive treatment daily at the facility. u u m n 9 9 4 �---------- - --~----=----=-=--~~~---_--- ···· ··· ··· · ··· ··· · ·· ···· · ······ · ················· · ·· · ·· · ······················ ·· · ·······~ • "We have a large program in Farber also recalled Abraham Aaron, psychoneuroimmunology, a field of M.D. , a professor of gastro-neurological great pertinence to people who have medicine, whose strict style of teaching diseases of the skin," Farber said. "We was respected and admired by the stuare investigating biochemical and im- dents. munological mechanisms which account "We were afraid of him, but his discifor the so-called mind-body relation- pline as a physician was exemplary," ships. Farber added. "Seventy-five percent of psoriasis is In 1993, Farber returned to Buffalo stress-related. We are, therefore, look- to attend his 50th class reunion. "I could ing at the sensory nervous system of the hardly believe how old we had become," skin with particular attention to neu- he quipped. ropeptides," Farber said. Theresearch, he said, is aimed at identifying antagonists to the neuropeptides, the suspected trigger of psoriasis and other skin diseases, in an effort to block their release and prevent the occurrence of the skin condition. The Institute also provides a total care program to individuals suffering from skin disorders. Farber believes it is important for patients and family members to learn about their disease. The total care concept includes access to educational materials and conventional and non-traditional Eugene Farber, M.D. treatment, such as auto-hypnosis, re"I was pleased to know what fine careers my classmates had. When I laxation techniques and diet. "After a period of total care, the need graduated from Buffalo and went to the for aggressive skin treatment is less- Mayo Clinic, I found that what Buffalo ened," Farber said. taught allowed me to compete successThroughout his career Farber has fully with students from the top medical assumedleadershippositionsinnumer- schools in the country," Farber said. ous dermatologic societies and organiLooking back to his early days as a zations. He is past president of the Soci- medical student, Farber observed draety for Investigative Dermatology, the matic changes in the way medicine is Pacific Dermatology Association and the taught today. "Medical school faculties Association of University Professors. He have advanced beyond having their stuis an honorary member of the Buffalo dentssimply memorizeGray'sAnatomy, for example." Chapter of AOA. Farber credits his initial interest in "There is much more practical applidermatology to Earl Osborne, M.D., a cation in the teaching of medicine toUniversity ofBuffaloprofessor, who was day," he said. Yet for all the progress in "dynamic and exciting in his teaching of medicine and medical schools, Farber dermatology." laments the "tough choices" facing the B u a a p h y s c a n " u medical students of today. "Medical students are faced with paying off huge debt. This shortens their career expectations because they can't hang on to specializing. It's just too expensive," Farber said. "The coming government requirements on how many specialists can be permitted to enter any particular field will also affect career choices and the possibly the quality of medical care. "The government wants medical schools to produce more family doctors, but medicine is too complicated today, and we need specialists. You can't be a jackof-all-trades," Farber said. Many UB stude nts and alumni will recognize Farber Hall on the University's South Campus. The building, however, is named after the late Dr. Sydney Farber, the noted dermatologist's brother, who, after graduating from the University of Buffalo, taught at the Harvard University School of Medicine for 4 1 years and founded the Dana Farber Cancer Center. There is a long association between the Farber family and UB.Jason Farber, M.D., was clinical researcher of chest medicine at University of Buffalo, while Marvin Farber, Ph.D., headed the university's philosophy department. Another brother, Seymour Farber, served as vice president for graduate education at the University of California in San Francisco. These days, Eugene Farber has reduced his work schedule to five days a week, devoting more time to leisurely reading and other pursuits. "I will take early retirement when I am 100," Farber said. However, there's no sign of the + good doctor slowing down. - BY u m PETER n SIGURDSON 9 9 4 �~ ·········· · ·· ·· · ·· ·············· · ········ · · ·· ·· · ·· ··· ··· ·· ·············· · ···· · ·· ········ ml 48 UB alumni listed in "Best Doctors in Amertca" orty-eight alumni from the School of Medicine and Biomedical Sciences have been named in the second edition of The Best Doctors in America, a directory of the best in the profession as chosen by their peers. Best Doctors lists 7,200 physicians in more than 50 specialties - approximately 2 percent of the nation's 350,000 practicing physicians. UB has 28 faculty members in the listing, compiled from interviews with thousands o f specialis ts throughout the country who were asked to rate the clinical ability of their peers. UB alumni included in Best Doctors are: Bernard S. Alpert, M.D. , ' 74 , Reco n structive and Microsurgery, San Francisco, Ca.; Kenneth Z. Altshuler, M.D., '52, General Psychiatry/Psychoanalysis, Dallas, Tx.; Joel M. Andres, M.D., '68 , Pediatric Gastroenterology, Gainesville, Fl.; William Balistreri, M.D., '70, Pediatric Gastroenterology, Cincinnati, Oh.; Karl R. Beutner, M.D. , '79, Dermatology/Herpes Virus Infections, Vallejo, Ca.; DavidA. Bloom, M.D., '71 , Pediatric Urology, Ann Arbor , Mi. ; Marlene Bluestein, M.D., '76, Geriatric Medicine, Tucson,Az.; Philip A. Brunell, M.D., '57, Pedatric Infectious Disease, Los Angeles, Ca. ;Joseph Caprioli, M.D., '79, Ophthalmology/Glaucoma, ew Haven, Ct.; Antonino Catanzaro, M.D., '65, Pulmonary and Critical Care Medicine, San Diego, Ca.; Carl I. Cohen, M.D., '71 , Geriatric Psychiatry, Brooklyn , .Y.; David Cohen, M.D., '89, ephrology, ew York, .Y.; Michael B u a 0 p E. Cohen, M.D., '61, Pediatric eurooncology, Buffalo, .Y.; D. ]. Coleman, M.D., '60, OphthalmologyNitreo-Retinal Surgery, Haworth, .]. ; Bruce F. Connell, M.D., '52, Facial Aesthetic Surgery, Santa Ana, Ca.; David R. Dantzker, M.D. , '67, Pulmonary and Critical Care Medicine, Roslyn, .Y. Also, Raymond]. Dattwyler, M.D. , '73, Infectious Diseases/Clinical Immunology, Stony Brook, .Y.; Patricia Duffner, M.D., '72, Pediatric eurooncology, Buffalo, .Y.; Demetrius Ellis, M.D., '73, Pediatric ephrology, Pittsburgh, Pa.; Eugene S. Flamm, M.D., '62, Vascular eurosurgery, Philadelphia, Pa.; John F . Foley, M.D. , ' 55 , Medical Oncology/Hematology, Omaha, e.; Richard R. Gacek, M.D. , '56, Otology/ eurotology, Syracuse, .Y.; Robert E.Jordon, M.D., '65, Dermatology/Cutaneous Immunology, Houston, Tx.; Louis Kavoussi , M.D ., '83 , U rology/ Endourology, Baltimore, Md.; Douglas W . Klotch , M.D. , '71 , Head and eck Surgery, Tampa, Fl. ; Thomas ]. Lawley, M.D., '72, Dermatology/Cutaneous Immunology, Atlanta, Ga.; Richard ]. Lederman, M.D., '66, eurology/Electromyography, Cleveland, Oh.; Stephen R. Marder, M.D., '71 , Psychiatry/Psychopharmacology, Los Angeles, Ca.; James R. Miller, M.D., '79, eurology/ Infectious and Demyelinating Diseases, Skaneateles, .Y. Also, Stan ley L. Olinick, M.D., '40, Psychiatry/Psychoanalysis, Washington, D.C. ; Linda Paradowski, M.D., '80, Pulmonary and Critical Care Medicine, Chapel Hill, .C.; Donald Pinkel, M.D. , '51 , Pediatric Hematology/Oncology, Houston, Tx.;Anthony A. Portale, M.D., '74, Pediatric ephrology, San Fran- h ~ " c a n A cisco, Ca.; Cary Amet Present, M.D. , '66, Medical Oncology/Hematology, Los Angeles, Ca.; Linda Rabinowitz, M.D., '82, Pediatric Dermatology, Milwaukee, Wi.; Robert E. Reisman, M.D., '56, Allergy and Immunology, Williamsville, .Y.; Hugh A. Sampson, M.D. , '75, Allergy and Immunology, Baltimore, Md.; elson B. Schiller, M.D., '66, Cardiology, San Francisco, Ca.; John B. Schlaerth, M .D. , '68, Gynecologic Oncology, Los Angeles, Ca.; Max A. Schneider, M.D., '49, Addiction Medicine, Orange, Ca.; Arthur Skarin, M.D., '61 , Medical Oncology/Hematology , Boston, Ma.; Kenneth Solomon, M.D. , '71 , (deceased), Geriatric Psychiatry, St. Louis, Mo.; Paul Stanger, M.D. , '61 , Pediatric Cardiology, San Francisco, Ca.; Morton A. Stenchever, M.D. , '56, Reproductive Surgery, Seattle, W a.; Robert C. Stern, M .D., '82, Pediatric Pulmonology, Cleveland, Oh.; Virginia P. Sybert, M.D., '74, Pediatric Dermatology, Seattle, Wa.; Stanley]. Szefler, M.D., '75, Allergy and Immunology, Denver, Co. ; and Lawrence W . Way, M.D. , '59, Gastroenterologic Surgery, San Francisco, Ca. + Medical school receives gift to create student scholarship fund he School of Medicine and Biomedical Sciences has received a $508,000 gift from a trust created by Helen Hekimian. The gift will be used to fund scholarships for students demonstrating academic merit and financial need. Helen Hekimian was the daughter of the late W illiam Crosby, a prominent Buffalo businessman active in university affairs earlier in this century. She married Ivan Hekimian, M.D., a 1927 u u m n 9 9 4 �..... .... .. ...... .... .. .. .. .. .... ..... ..... ... ... .. ... ... .... .... . r-------------. NEW OPPORTUNITIES FOR FAMILY PRACTITIONERS Hassanali, who practices dermatologic cosmetic surgery, originally had planned to fly to Sarajevo, Bosnia/ Hercegovina, but was turned back. Instead, his group traveled to Zagreb, visiting the main hospitals and rehabilitation centers that house many refugees and war-injured patients. Hassanali, himself a refugee from Uganda, donated $30,000 worth of medical supplies to the Zagreb hospitals and rehabilitation centers. Hassanali plans to bring one 17-yearold patient to Buffalo for reconstructive surgery. The girl, injured in an explosion in which she lost both parents, suffered severe burns on her face and hands. + graduate of the medical school who founded the local Red Cross Regional Blood Program, taught at the medical school and maintained an active practice in Buffalo. + Time to renew James Platt White Society memberships r, he Jomes Plott While Society - ooiSiinguished leodersh~ orgonizotion bosed on the values ond principo~ of the former deon ond founder of the School of Medicine ond Biomedicol Sciences4 ~ is oleoding suppporter of the school'smission of providing the highest quorlly educofion, reseorch ond ~ lient core. Through its membels' generous, choritoble member· ship pledges, the School of Medicine ond BiomeOICol Sciences confinues its leodel5hip role os one of the premier medico! schoo~ in the counhy-one poised to reoctto the dxJIIenges of heolth core refonn ond the burgeoning technology revolution through the use of innovative educooonol ond orgonizofionol progroms !hot benefit the next generotion of both physicions ond their potients. nyou hoven'tolreody, pleose renew your membership pledge for this yeor.And fyou oren'tolreody omember, but would like to join the medico! school'sprincipol supporting orgonizotion, pleose coli Michoel E. Benzin, Director of the Annuol Appeol, ot (716) 64 5-3312. + ynette ieman, M.D., ' 78, has been appointed clinical director of the ational Institute of Child Health and Human Development. She has served as deputy clinical director of the agency since 1990, and more recently as acting clinical director. Board certified in internal medicine , endocrinology and metabolism, Nieman has served on the institute's IRB since 1988 and on a number of clinical center committees focused on issues of patient care. She has been an invited speaker at many symposia and grand rounds , and has offered testimony concerning RU 486 to Congress on a number of occasions. Nieman's research has focused on attempts to improve diagnostic precision in Cushing's syndrome , the evaluation ofluteal function and the uses of antiprogestins in the reproductive cycle. + iyaz Hassanali, M.D., '86, recently returned from a humanitarian mission to Zagreb, Croatia, he coordinated to bring medical supplies and drugs to refugees of the war in Bosnia. u 0 0 p h W e provide everything you need to build a successful practice, as well as an enriching work environment. Salary is highly competitive. Benefits include retirement plan , license fees, health and malpractice insurance, ample vacation and CME time, and research opportunities. Area is eligible for loan forgiveness programs. Call coverage is very good and is managed effectively. Managed care programs are already in place. Lynette Nieman '78,appointed clinical director of NICHD ftiyazHassanali '86,spearbeads humanitarian mission to Zagreb B BEIBC family practitioners needed to staff new family care sites to be opened by ECMC and SUNY at Buffalo Department of Family Medicine. y 5 c o n A u Responsibilities include clinical work and teaching of residents and medical students. Administrative duties are flexible. Physicians must be willing to perform obstetrics. (With in-house OB back-up.) Please contact Rebecca Brierley, Family Medicine Recruitment Coordinator, Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215, (7 16) 898-4797, fax (716) 898-4750. ERIE COUNTY ~fMEDICAL CENTER • u m n . A 9 9 " �A Spoon f u I MUSINGS ON THE WAY TO of © Humor L.A . finally bought myself a new car. First time! I had always avoided it for fear of having to bargain with the salespeople. But first, of course, you have to deal with the receptionist. I called and said, ''I'm looking for Michael," and she asked, "Is that a two-door or a four-door?" The salespeople always want to know your last name, so they can repeat it over and over to lure you into a feeling of false security. When I was looking I always told them my last name was" o Sale Today." "Will you be buying the car today, Mr. o Sale Today?" " o! And that's Dr. o Sale Today." That's not true. I would never tell these guys I'm a doctor. Then they'd see me as a six-foot chicken on a rotisserie. I decided to take a trip down to L.A. to break the car in and visit a friend . I had a lot of time during the drive to think about things, not the least of which were the present inhabitants of the White House - two lawyers. I liked it better when we had an actor, a diet pill addict and Frank Sinatra doing naked pushups in the Lincoln Bedroom. At least you knew what you were dealing with and they entertained you all the time. As I got closer to L.A. (you can always tell from the lovely red haze in the air) I called ahead to let my friend know that I would be there in a half hour. I was only two miles away, but this was L.A. B u a 0 p Great times we live in- to be able to make calls from the highway - and I'm thinking, "Wow! I'vegotacellularphone in the car," which means I no longer have to stop at a gas station to make phone calls. ow if they could come up with a cellular toilet, that would be great. Cellular phones are still somewhat affordable - especially if you only use them on weekends. I try to avoid the "airphones," though. On a recent flight they announced a contest: make a call on the airphone using your credit card, and you have a chance to win $50,000 -or spend $50,000 if you stay on more than 10 minutes. Before arriving at my friend's house I decided to pick up a bottle of wine. I handed the clerk a 20 bill and he placed it under the drawer. I thought, "Why do they place the $20 under the drawer?" That's the first place a hold-up artist is going to look ... unless he's stupid. What are we dealing with here - remedial criminals? "Gee, all I see are ones and pennies . . . where could the big bills possibly be?" h ~ 5 c a n A u u m n 9 9 4 �Stu S i Ivers t e in , M.D . I also glanced through People magaThat day, the headline of the newspaper (well not the newspaper - USA zine. They had a quiz titled "Are you a Today) said that Congress was hoping genius?" You can pretty much be sure to pass a bill that would ban all assault that if you're reading People magazine weapons. I thought, "well let's see, we've and taking that test - you're not ... got Uzis, AK 4 7s, HMOs and grenades." although I did score pretty high. When l finally got to LA. , one of the Kaiser Permanente is big in Sou them first things my friend and his wife asked California. I believe one-third of the me was how to choose the right doctor. insured population there is with Kaiser. This, in fact, is the model the govern- With the new government health plan ment is following. In order to keep pace looming on the horizon, many people, I heard that Kaiser is thinking of install- including your friends and relatives, ing an outpatient drive-thru window. will be asking you for the same advice. Having recently faced this many times First in the country, in fact. myself, I never know what to say, but do offer to tell people how not to choose the "wrong" doctor. I've even prepared a little handout. Feel free to copy it and do the same. Tips on Choosing Your Doctor • Do not choose a doctor whose office is on a Greyhound bus. • It is probably not a good sign if for every prescription of Prozac your docThe sports page announced that tor writes, he gets 100 frequent flyer Darryl Strawberry signed with the Gimiles. ants. Yeah, I suppose if he gets in shape • If he says, "OK, up on the table and he can lead the league in free-basing. take off my clothes." Stay away! !! And for you real couch potatoes who • Watch out if he keeps referring to his can't program a VCR, now there's a new stethoscope as Hector. device that allows you to command • Ladies, it is not good if there is a sign your VCR. You just lie there on the on the wall that reads, " o Shoes. No couch and say, "Tape Seinfeld. Channel Shirt. No Cervix." 4. 8:30." and it will do it for you. The • Be careful if the fish tank in the waitdeluxe version has an additional feature ing room is labeled "Exhibit A." that lets you say the words, "I have no • Most importantly, leave his office life," and it lifts your skull off and sucks immediately if he asks you to turn your out your brain and you become a huhead and pull his finger. + man futon. And apparently Bill Clinton cel- Stu Silverstein, M.D., president of Stondup Medicine Seminofl ci Son fmncisco, ebrated his SOOth day in office by gain- Colifomio, ledures notioowide on hun101 in med"Kine. He recently published his first book, What About Me?, about growing up with a developmentnDy ing his SOOth pound . tfiSObled sibling, c~H~Uthored with BfYTKI Siegel, Ph.D. B u a 0 p h y 5 c a n A u u m n 9 9 4 �• •• • • • • • • • • • • •• • • • • • •• • The Perfect AcADEMIC HEALTH PROFESSIONALS INSURANCE AssociATION I Prescription For Your Conference Needs Insuring care for those who care 1 9 4 s 0 Subscriber Owned • Organized • Governed teaches diabetic management in Beijing and anjing, Ch ina for two months each year. He is in private practice in South Carolina. EDWARD M . TRACY '43, GEORGE THORNGATE PHYSICIANS • DENTISTS HEALTH PROFESSIONALS NURSES • RESIDENTS IV, '44, of Pebble Beach, California , writes, "During the trimester break in June 1944, there was a significant number of my classma tes wh o became wedding bound. This was especially true for those of us in the Navy Y-12 program. ine months later our daughter was the first offspring, we think, to be born to the class. With our five daughters, eight Superior policies for academic full-time and voluntary clinical faculty ~ Competitive premiums 0 . LOESER Conference Planning Professionals 'i' Convenient Downtown Location Dividend opportunities 'i' Quick Metro R ide to Main Street Campus and Medical School 'i' Close to Buffalo G eneral, Roswell, ECMC and Children's Hospitals 'i' Y our Guests Can W alk to Theatre, Shops, Pilot Field, Restaurants, Entertainment Academic Health Professionals Insurance Association is a subscriber owned and organized reciprocal licensed by the Insurance Department ofNew York State. Policy and programs ofthe Association are determined by a representative Board ofGovernors elected by subscribers at SUNY Health Science Centers. ' 45 , 'i' CME Friendly 'i' Great Banquet Food Please Talk To Us AbDUt Preparing A Proposal So YDU Can Bring YDUr GrDUp's Next Convention To Buffalo Enrollment open at all times. Tran fers arranged \vithout loss. (71 6) 856-1234 EXTENSION 6142 ACADEMIC HEALTH PROFESSIONALS INsURANCE AssociATION has been elected president of the William A. Little Obstetrical and Gynecological ociety, the association of faculty and alumni of the Department of OB-GYN at the University of Miami(Jackson Memorial Medical Center. It is of a 'i' Complete legal service ~ RAPHAEL 5 . GOOD '48, u of Meeting Space ~ ~ writes, "Five years after closing my private practice, I am again retiring, this time as medical director of a preferred provider organization. Our plans are to spend more time with children and grandchildren, distributed on the east and west coasts, but Youngstown, ew York remains our home." B 18,000 Square F eet Comprehensive coverage grandchildren and one greatgrandchild, Helen (Tweet) and I are looking forward to celebrating our Golden Wedding Anniversary, both of us in good health. We hope the other newlyweds of June 1944 will celebrate their anniversary with joy also." WILLIAM ~ Rewarding educational programs HYATT. WE'VE THOUGHT OF EVERYTHING~ Empire State Building 350 Fifth Avenue, Suite #1512 ew York, ew York 10118 Ph. 212-947-4541 Fax 212-947-4572 0 p h ~ 5 c o n A u u m n 9 9 4 �······· ·· ·· · · · · · ······· · · · · ··· · ·· ·· · ···· ··· · · ·· ····· ···· · ··· · · · ·· · ·· · · · ··· ·· · · ·· ·· · · ·· · · · · · ~- -~- ' particular note that Dr. Good is a past president of the South He is a fellow of the American Florida Psychiatric Society. president of the Georgia Psychi- I Psychiatric Association and past atric Physicians Association. Dr. 9 5 0 '51 , Haberman is clinical associate professor of psychiatry at Emory received the degree of Doctor of Science, Honoris Causa on May and Morehouse University 1 EDWARD SHANBROM 5 University School of Medicine School of Medicine. 22, 1994, from Allegheny College. Dr. Shanbrom has published over 100 scientific articles D IANE and is the author or co-author of over 20 patents. In the 1960s he collaborated with Dr. Kenneth Brinkhous to establish a technique that allowed concentration and purification of factor VIII. Besides funding scientific endeavors, Dr. Shanbrom and his wife, Helen, have also been supporters of the arts and education in their Orange County, California community. HILLIARD JASON ' 58 , has hosted, co-written, and produced more than 50 educational videos in the field of medical education for national distribution. Springer Publishing Company has recently released a new book written by Dr. Jason and his wife (Jane Westberg, Ph.D.) titled: Teaching Creatively with Video: Fostering Reflection, Communication and Other Clinical Skills. Both this new book and a prior book, Collaborative Clinical Education: The Foundation of Eff ective Health Care, are part of the Springer Series on Medical Education. is now retired, after practicing general surgery in ew Mexico since deputy director, Community Health Surveillance within the Maryland Department of Health and Mental Hygiene. Earned my MPH at Johns Hopkins University School of Hygiene and Public Health and am board certified in general preventive medi- Hilt.ard Jason '58 1971. Dr. Wilbee was recently appointed to membership on the State Board of Medical Examiners. He is a former president of the State Medical Society and past president of the ew Mexico chapter of the American College of Surgeons. 1 9 JOHN 6 0 JOHN C . S T UBENBORD '75, has been practicing internal medicine and family medicine in East Aurora for 10 years. He 5 was appointed a fellow of the Royal Society of Medicine, London, in July 1992. He has three boys, Derek, 6, jess, 3 and Wesley, l. SHIELDS '68, of ew York, is medical E. Delphi, director of Bassett Health Care of Stamford-Delhi. Dr. Shields is a member of the American College of Physician Executives. 1 7 9 0 5 GEORGE Y . LOHMANN , JR. '72 , is listed in Compton- Connally Guide to Best Doctors in ew York Metro Area, Who's Who in the East, Science and Engineering and World, Business and Finance. His daughter, orelle Christa Victoria, was born October 15, 1991. u a 0 MICHAE L A . HABERMAN 73, u 5 c a 9 8 0 5 ROBERT J . BRACO '80, of Springfield, Missouri, has joined the Springfield Clinic to do in- PAB LO RODR I G UEZ ' 81 , writes, "I have been awarded the 'Community Service Award' by the AMA young physician section for my work with the Minority Health Advisory Committee to the Rhode Island Department of Health. I have two boys, ages 3 and 5; my wife and I have become avid windsurfers." University and is practicing with term. His 7-year-old son, Keith, Kaiser in Fontana, California. She won first place in the National Radiant Peace Foundation's essay contest for the Midwest region. Besides a cash award, his is an associate GI fellowship director and assistant clinical professor of medicine at Lorna linda University. She and her husband, essay will be considered for publication in a book about children and their contribution to world peace. Chiayu Chen, have a daughter, Katherine, born January 17, 1993. Medical Association of Atlanta. h 1 RONALD A . V IDAL 77, was elected president of the medical staff of Samaritan Health System of Clinton, Iowa, for the '94-'95 was installed as president of the p Ronald A. Vidal '77 dustrial consulting. cine and public health." ROBERT H . WILBEE '59, B L. MAT USZAK '74 , writes, "Recently appointed n u u m PAT RICIA HSIA '85, completed a GI fellowship at Georgetown NIC HOLAS D 'A V ANZ O '86, is practicing pediatrics in a [ourman group in Raleigh, orth n 9 9 4 �• . .. .. . ... . ... . .......................... . ....... . ... .. .... I Peggy Morey Stager '88, was married October 30th to Richard Stager. Carolina. He and his wife have two children, Stephen icholas, 10 months and a 3 V2-year-old daughter. 1 9 9 s 0 FAITH F R ANK E L '91 , completed apediatric residency at Georgetown University Hospital and is now in private practice in Virgm ta. She and her husband, Douglas '88, was married October 30th to Richard Stager. Friends PEGGY MOREY STAGER Power Mac 7100 includes: • 15" Color Monitor • ClarisWorks • CD ROM Bonus: Microsoft Bookshelf Frankel, M.D., have a 1-year-old son, Maxwell Shane Frankel. from near and far joined the special celebration at the Buffalo Hyatt Regency. Mary Davitt and Mitch Tublin arrived from Pittsburgh, Nancy Lisch cruised in from Cleveland, and Cindy and Tom Bellomo road tripped from Milwaukee. The local attendees included Lori and Frank Luzi, Lisa Benson and Lee Guterman ('89) and Helen and Andy Cappucino. A fantastic time was had by all! The newlyweds reside in Cleveland Heights, Ohio. Peggy is an adolescent medicine attending at MetroHealth Medical Center. C Y N T H I A 66 MHz, PowerPC 601 RISC-based processor, 8MB RAM, 250MB hard drive. Macintosh Color 15" display, AppleDesign keyboard, built-in Ethernet, at:ive ClarisWorks 2.1, and the Apple Student Resoun:e Set which includes: The Macintosh Writing Companion; Student Assist; The Internet; Microsoft Bookshelf; The Voyager Offer (a coupon offer to pun:hase interactive CD ROM discs for just $9.95 (normally sold for $24.95 to $79.95)). ( LEBER MAN ) JENSON ' 92 , writes, "Curren tly co mple ting fi rst year of anesthesiology residency at the University of Pittsburgh . Mark and I are celebrating our one year anniversary, May 15, 1994." MI.L. $2358 • 15" Color Monitor • Pentium Upgradeable THOMA S GRIMAL DI '89, writes, ''I'm com- OBITUARIES pleting urology training at the University of Michigan and plan on joining the UB Urology faculty at the Buffalo VA Medical Center. My 1-year-old daughter, Sarah, and I are coping with the death of my wife, Ester Ponce Grimaldi '89. Thank you classmates for all the support. Ester died suddenly in an automobile accident injanuary 1994. A medical school graduation award is being established in her name, to recognize a compassionate and positive approach to clinical medicine." 8 u a 0 66 MHz 486DX processor, 8MB RAM, 340MB hard drive, SVGA 15" color monitor, 3.5" floppy drive, full size keyboard, DELL System mouse, DOS 6.2 . Windows 3.1, and 1 year next business day on-site service. died on March 23, 1994, in Buffalo. Before retiring in 1985, he practiced internal medicine and was associated with Millard Fillmore Hospital. After retiring, he and his wife, Lois, spent winters in Florida, where he enjoyed fishing and golfing. RUSSELLS. K I DDER '41 , KENNET H SOLOMON '7 1 , • Apple • IBM • Dell • Compaq • Panasonic • Hewlett Packard • TI • Sony • Software • Supplies • Accessories • Audio • Hands-on Workshops died unex- pectedly last spring. p h " c a n A u u m n 9 9 4 �BUFFALO PHYSICIAN STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 Non-Profit Org. U.S. Postage PAID Buffalo, NY Permit No. 311 ADDRESS CORRECTI O N REQUESTED 1773 EALTH SCIE CES SE LS DEPT ABBOTT HALL CAMPUS IL 4 The only liability coverage with this seal of approvaL Medical Liability Mutual Insurance Company (MLMIC) is the only professional liability insurer approved by the Medical Society of the State of ew York. Since its founding in 1975, the phy icianowned and managed company has successfully defended more physicians than all other available insurers combined. Additionally, MLMIC has the largest and most experienced professional liability claims department in the country, the large t risk management department of any ew York State professional liability insurer, and the state's only true peer review of claims experience. Call1-800-ASK-MLMIC (metro) or 1-800-356-4056 (upstate) for more information and an application. MLM~C ~ Medical Liability Mutual Insurance Company Our defense never rests. 2 Park Ave., New York, NY 10016 2 Clinton Sq., Syracuse, NY 13202 90 Merrick Ave., East Meadow, NY 11554 tO 1993 Medical Liability Mutual Insurance Company --Oo<- M--Oo< ��\ \ �/ / I ~ach I I / I I I I / year, the University at Buffalo School of Medicine and Biomedical Sciences ad, mits 135 new students. I Over the next four years, I I I I I 1 I 1 I they will learn both the art and science of medicine as they realize their calling and form lasting relationships that will enrich their lives. J I I Here, Buffalo Physician pre, I I I I I \ I \ sents the Class of 1998 and wishes them well on this, the beginning of their four,year journey to become physicians. \ \ \ \ \ \ \ �nHOOl Of MfOI[INf ANO ~IOUfOI[Al ~WNtf~ KRISTEN ANDRESON C 'rnelllJnt\·erslt\ Ammal Sczences LUNA BAilEY LESliE BARR Duke Uniwrsity L:nn·ersity 1t Bufralo Bzology/Chemmry Psychology Bwlo~· LORI BOWMAN SU. 'r J.t Geneseo RICHARD BREMER Clarkson UniversitY Bwlogy BwloJf.i YVONNE BOBEK Cornell Uni\·ersit~ • · · · ·· · · · · · ·· ·· · · · · · · · ·· · · · · ·· · · ERIC BONENBERGER orth Carolma State University Bzology :oology STEPHEN BEKANICH ,j Scranton Lnn·Lrsit~ ~' / ll'·:·. · ···' ,\- "'• JENNIFER BUlGER lJ I at Fred, ma Biology ROBERT BURNS TERRI CAliGIURI EMilY CAlKINS Gannon Umver>~t\ Gannon lJmveut~ UniversitY at Buffalo Biology Biology Anthropology APRil CAMPBEll JOHN CARTER CAROl CHEN Princeton Lmversity SU Y at Plattsburgh Johns Hopkim University CONNIE CHEN Cooper Union History Biology Biology Elecmcal Engmeering 3 �BONNIE CHENG ew York Universtty PETER COBB Davidson College SETH COHEN Yeshiva Umversity JEANINE COOLEY Umversity at Buffalo Biology Biology Biology Health Sc1ences PAM CROWELL Mercyhurst College Sports Med1cme MICHAEL CUMMINGS Cornell Umversity GUL DADLANI Umversity at Buffalo JONATHAN DANIELS University at Buffalo Nurririon Biology Psychology CHRIS DEAKIN Umversity at Buffalo MARYANN DEAN West Liberty State College BARBARA DEGUISEPPE Saint Francis College CLAUOIA DEYOUNG Northeastern University Busmess Art/Psychology Biology Mechanical Engineering = = = = ' PAMELA DIAMANTIS New York Umversity STACEY DIMARTINO Universit} of Rochetser VAMIL DIVAN University of Pennsylvania JANE DOPKINS Harvard-Radel iffe Policies Bwlogy Health Care Management and Policy Women's Studies 4 �HHOOl Of MfOI~INl ANO ~IOMfOI~Al ~WUf~ • · · · · ·· · · · · · · ·· ·· · · · ·· · · ·· · · · ·· · lYNN DUNHAM CRYSTAL DYER JASON EHRLICH ANDREW ESCH Colgate University CUNY City College Umvemty at Buffalo Universitv at Buffalo Bwlogy History Busmess Admmistranon eurosCience JOHN FANTON TODD FEHNIGER CHARLES FETTERMAN MELISSA GARDNER SU Y at Binghamton Uni,·ers1ty at Buffalo Cams1us College Hartwick College Philosophy and Bwlogy Bwlogy Biology Psychology RICHARD GAYlE JENNIFER GEORGE THOMAS GERGEL ROBERT GERSTENBLUTH Cams1us College Fordham Univer ity University at Buffalo Biology Chemistry Biology U Y at Binghamton Bwlogy YOUSSEF GHAL Y HARI GOPAL CHRISTINE GORDON LISA GREEN CU Y Queens College Cornell Umvemty CUNY Lehman UniverSlty of Rochester Bwlogy B1ology Anthropology Cell and Developmental Biology 5 �AlEJANDRO GRUNEIRD L verstt) at Butt:.tlo Btochenust') BRYAN HANYPSIAK LniH:rsi \ MICHAEl HASSETT 01 cr •. :1 C. I qe Bwlogy Flu t o Bwlogy liSA HEICHBERGER U. Y ~t Fred mia Bwlogy/Medtcal Technolog) = = = MICHAEl HERBDWY AARON HOFFMAN Umn:rsny at Buttalo lJni• n College Bwlogtcal Sc~ences Hi.I!OT) = STEVEN HORN UNY 1t Bin,!h~mton Bwlogy ARIEl HOTCHKISS Weslq: n lJnin:rslt\ Psycholoif.i CAlOGERO IPPOliTO PETER JANES THERESA JARMUZ LAWRENCE KANNER ( m1 IUs College SL. ·y ·n Genesco Bost<•n Lmtversit) Bwloi(}/Ps..,cholo!;} Bwchemistn Psychology Han .1rJ universtty Bwlog)' SANJIV KA YASTHA JUDY KIM Ydie Univcrsit) Bwlogy PAUlA KOCIAlSKI LORI KWAN Camstus (., lkgt Lniverstty at BuHalo Biolo10 Btology· c •rnell untn:rsttv A>tan Sttultes 6 �HHOOl Of UfOit!Nf ANO ~IOUfOitAl HlfHf~ • · ·· · · · · · · ·· ··· ·· · · ·· ·· · · · · ·· · ·· • ~JENNIFER lEE DAVID liN NEIL LIPKE CornelllJmn:rslty Cornell Lmvemty Umverstty at Bufhlo Cell Bwlog-y Bwlog) Spwal Studtes PATRICK MAHAR 't Bonaventure lJmvcrsity Bwlug-y TOM MALINICH MICHELLE MANG Bucknell University H·umlton College Mechamcal E"'lgtnee-rmg Bwlug)" AMY MCGARRY H, h Cwss Rus>tan JOSE MACEOA U1 tversi\ RuL 'lLskr Bwlug> JEFFREY MARCHANT lJn H:TSI •t Bu(fal l Health Sctences \ ) 7 J MICHAEl MARKAM PENELOPE MARTIN SlJ"JY at Plattsburgh Untvcrstty ot Rochester Ps,-cholog-y • euroscience THOMAS MCTERNAN Buth<L :->t· L C liege Bwlog-y SUMIT MEHTA GEORGE MOYNIHAN BENNETT MYERS BRETTON NEWMAN ) ale l.Jni\·ermv Ltberal Studtes \ illanova University Economtcs Cornell UntnNt\ Colgate University BwlogJ 7 J eurosLrence �= = = = MARK 0BERLIES JENNY OH lYlE OSTROW TAMERA PACZOS Univers1ty or Notre Dame Tufts University Johns Hopkms Umverstty University at Buffalo Business Administranon Psychology Biology Physical Anthropology PRASHANT PARASHURAMA Cornell Umvers1ty Phys1cs VIRESH PATEl Umvers1ty at Buffalo NICOlE PAZZAGLINI Umvemty at Buffalo Anthropology Johns Hopkms Un1versity Chemical Engineering ACHINI PERERA Biology ClAYTON POlOWY COLIN POWERS JOSEPH REBHAN JAMES REUTHER M1am1 Univer-ity of Ohw Cams1u College SU Y at Plattsburgh M1ch1gan State Biology Biology Biochemistry Physwlogy/ Anthropology ANNE MARIE REYNOlDS t. Lawrence University Biology ANTHONY RICE JEFFREY RICHMAN MARK RICHMAN Cams1us College Worcester Polytechmc Institute Wesleyan Umverstty Bwchem1stry Biology Chemistry B �~~H~~l ~f Ml~I~IU AN~ ~I~Ml~I~Al nllNtl~ • · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · JAYSON ROLAND Queen's University ZULMA ROSADO UniYersity at Buffalo Boston Umverstty Life Sctences Biology Biomedical Engineering JENNIFER SCAROZZA Canisius College Biochemistry CHRISTOPHER SCHAEFFER Harvard Umversity Psychology University at Buffalo ANGELA SCHOEP St. Olaf College Psychology Bwlogy MARY SCOTT Miami University ofOhw Mtchtgan tate Univer ity JOEL SEBASTIEN D'Youville College CARL SEON Umverslty of Mtchtgan Zoology Physiology Biology Classical Archeology DAVID SERRA University at Buffalo MACDUFF SHEEHY Brown Umverstty Umversity of Rochester ANAND SINGH Lehigh University Psychology Aquanc Biology Biology Biology MATTHEW SCOZZARO FRANK SALAMONE MICHAEL SCHARF DAWN SIMON NEHA SANGWAN Michigan State Untverslty Engmeenng �KENNETH SNYDER Cath iL L n vt s1tv , AmcnL B10med1cal Engrnemr. > JOSEPH STOWEll lt Bin {h ,unton Biology SGN! = J. WILLIAM SPARKS .3nl.! Bwlogy Un;ver It\ ut \L SUNIL SRIVASTAVA HANS STELMACH C rrell Ln \t:Nty k.t:ub College Economics Pswhology SOPHIA STREETE GARIN TOMASZEWSKI HANNAH lOON Bufr.1lo '>tate College Unt\'f.Tstt\ at Buftalo Rochestu Institute of Techno log~ Bwlogy Chemmn and Anthropology Btology THOMAS TREVETT CHRISTOPHER TROJAN DORIS VANDERPOOL ANTHONY VILLANI 11, >lv Cn"' C ollc,;e Cnrndl Umverstt\ U'1tverstt' at Butfalo How 1rd University BwloRY Bwchemtstry Health and Human Sciences Btology MICHELE WATSON New Y )Tk Universtty Psychology JEFFREY VISCO KEITH VOLMAR ANDREW WAGNER C ·ndl Untverslt~ Bwlogy lth, c.1 C liege Bostun University Phystcs Biomedtcal Engmeenn~; 10 �~[~OOl Of M!OI[IU UO ~IOM!OitAl ni!H!~ • · 0 0 • • • • • • • • • • • • • • • • • • • • • • t;.{ •.· ·-_ .:~---~ ~---/_ ? ~~-:-:_...:, .·:' . ·, . . ' ......, • r . ' . COllEEN WEBER L nin~r,lt\· '. Rc•Lhestu MARK WEIRICH lmn:r'lt\ c ~I d En~;h.lh/Bwlogy 1\ lrcrtJhwlog:y TAHSINA YASMIN liNDA VAN Y.1le LmvcrsltV Bwlogy m L 111 St John ' L GORDON WINGARD er,,t~ 't R(lLhL 't.:r (ell Bwlog) DANIEl YAWMAN 11\ erslt~ Ln1ver'lt\ Jl ,)tre Oame Hiswn/Prc-~1t?d Bl(,/( .If\ MICHAEl ZIONTS C.uneglv:-..1ell< •n L 111Hrs1ty \kchamcal Engmeenn~ Photographs by S tmon Tong OttJCe of Publ1cau n-., Dln~H.> n of Uni\er Augu•t 1994 C 1037 94 lt'l Sen ICC!l>. . '.·-~'., -.- MEl Yo WONG (_ Pr'1ell L ntYLr,ity Biology lY ZENG Buftalo Broluf!:'IPs)cholol:) Unl\-er>~tv lt 0 0 • • • • �� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Autumn 1994 Subject The topic of the resource State University of New York at Buffalo. 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For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/21b95c23bbdc6cd130acca62600fe6d3.pdf 1d066aa11bc0b3e94864028a5fe62997 PDF Text Text State University of New York at Buffalo School of Medicine and Biomedical Sciences, Summer 1994 �BUFFALO PHYSIC I AN Volume 28, Number 3 ASSOCIATE VICE PRESIDENT FOR UNIVERSITY ADVANCEMENT Dr Carole Smith Petro DIRECTOR OF PUBLICATIONS Timothy j Conroy EDITOR Nanette Tramont, R.N. ART DIRECTOR Alan j. Kegler ASSOCIATE ART D IRECTOR Scott Fricker PRODUCTION MANAGER Ann Raszmann Brown STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MED ICINE AND B IOMEDICAL SCIENCES Dr. john Naughton, Vice President for Clinical Affairs, Dean EDITORIAL BOARD Dr. john A. Richert, Chairman Dr. Martin Brecher Dr. Harold Brody Dr. Richard L. Collins Dr. Alan J. Drinnan Dr Timothy Gabryel Dr. james Kanski Dr. Charles Massaro Ms. Melanie McNally Dr. Charles Paganelli Dr. Robert E. Reisman Dr. Thomas Rosenthal Dr. Stephen Spaulding Dr Bradley T. Truax TEACHING HOSPITALS AND LIAISONS The Buffalo General Hospital Michael Shaw Buffalo VA Medical Center The Children's Hospital of Buffalo Erie County Medical Center Mercy Hospital Millard Fillmore Hospitals Frank Sava Roswell Park Cancer Institute Sisters of Charity Hospital Dennis McCarthy ©The State University of New York at Buffalo Buffalo Physician is published quarterly by the State Umversity of New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. It is sent, free of charge, to alumni, faculty, students, residents and friends. The staff reserves the right to edit all copy and submissions accepted for publication. Address questions, comments and submisstons to· Editor, Buffalo Physician, State Universtty of New York at Buffalo , University Publications, l36 Crofts Hall, Buffalo, New York 14260 Dear Alumni and Friends, C oncerns about the cost of health care in the United States also must include concerns about the cost of educating medical students. The SUNY system has sought to maintain tuitions that ensure students from all socioeconomic backgrounds access. Despite this, the base annual tuition for New York State residents exceeds $8,000, and most students require, seek and obtain major levels of financial assistance. UB's medical school has addressed its commitment to alleviate students' financial pressures by encouragingscholarship support for meritorious and needy students. Thanks to the generosity of many alumni. and friends, direct scholarship support approximates $200,000 each year. But these funds provide only 3 percent of the financial support required by UB's medical students. For example, in the 1992-93 academic year, 88 percent of UB's 555 medical students received some level of financial support from scholarships, grants or loans. Total financial aid from all sources approximated$ 7.5 million. In the 1993 graduating class, 25 students had amassed accumulated debts of $50,000 or higher and one amassed a debt that exceeded $80,000. The average debt for the class neared $30,000. This year's Class Reunion Campaign dedicated its donations to the Medical Alumni Scholarship Fund, as will the next three campaigns. It is anticipated that over five years, a principal of $500,000 will exist; its annual revenues will be used to enrich existing scholarship support. The 1993 campaign provided a fine beginning to this goal with total contributions of about $90,000. These funds not only recognize academic merit and financial need, but reduce our students' debt burdens considerably. The students, faculty and I are thankful for your continued interest in UB and in the well-being of its medical student body. ~ Sincerely, (. J 0 ~, ~ j ohn Naughton, M.D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences Dear Fellow Alumni, W ith the beginning of a new academic year, your Medical Alumni Board looks forward to providing experiences that enrich our medical students, house officers and alumni. Recently, we welcomed the incoming residents and the freshman medical class. During the year, we hope to impart to these physicians and physicians-in-training a sense of camaraderie and a feeling of trust for one another that will help the profession go forward. Activities such as the community physician program and career presentations to freshman and sophomore students offer guidance by established physicians in the difficult choice of career planning. We plan another January reception for senior students, as well as a Match Day celebration for seniors, along with out-of-town receptions for alumni in other cities and at major medical meetings. The 1994 Distinguished Alumnus Award will be presented in September to Dr. Noel Rose. Dr. Rose's achievements in immunology have been the cornerstone of many techniques and developments utilized in daily clinical practice. His recognition is a source of pride for all our alumni. The flagship event of our alumni year is Spring Clinical Day and your board is busy putting together another informative event that will also give us an opportunity to renew old friendships. Again on this day, Alumni Achievement Awards will be presented. As your new Alumni Association president, I look forward to this year and I ask for your support in our endeavors. Please feel free to contact me with any of your suggestions. Sincerely, ~ Send address changes to: Buffalo Physrcian, 146 CFS Addiuon, 3435 Main Street, Buffalo, New York l4214 < ===- Russell W. Bessette '76 �V s 0 u a 2 L M M E N o 9 R 3 9 4 Research Hospital News II An Investment in the Future • UB's medical scholarships benefit the students, their benefactors and the profession. m Going Beyond the Curriculum e Today's medical students focus their free time on research and community service. E!J ASpoonful of Humor Using spare time wisely. Page 14. m Alumni EZJ Medical School IJ Classnotes * ~n t~e ~ouer: ffiilnren ~anes ann t~e first ~anes ~c~olar. ~arnara ~earne~. Mat'h Day '94: It was a very gaad year! Page 38. �.. . . . . . . .. . . .. . . . . . . .. . . . . . .. . .. . . .. . . . .. . . .. . . . . . . . . . .. . . . . . . [1] , ' _. I . Buffalo General Hospital to join in national stroke research study he Buffalo General Hospital's neurology department is participating in nationwide research comparing the effectiveness of aspirin with the anticoagulant Coumadin in preventing strokes among patients who have already suffered them. "The data should give doctors clearer scientific guidance about which treatment will best protect patients from a second stroke," said Patrick Pullicino, M.D., the study's principal investigator. The study will last two years and will enroll 2,000 patients in more than 30 centers throughout the United States. The Buffalo General Hospital study team, which includes collaborating investigator Frederick Munschauer, M.D., and study coordinator Margaret Hens , R.N., Buffalo General stroke projects coordinator, hopes to enroll about 60 patients. Patients eligible for the study must have had a stroke within 30 days and be between the ages of 30 and 85. Patients with cerebral hemorrhage, or who are unable to take Coumadin, are not eligible to participate. For further information, contact Pullicino at 845-3703. + New anesthesia regime reduces high-rtsk cardiac complications hanging the type and method of administering anesthesia and pain medication to high-risk surgery patients can dramatically reduce the risk of postoperative cardiac abnormalities and possibly lessen the chance of a heart attack, University at Buffalo researchers have found . A team of anesthesiologists led by Oscar de Leon-Casasola, M.D., UB asB u 0 0 p The study will compare the effectiveness of aspirin with Coumadin to prevent second strokes. sistant professor of anesthesiology, followed the surgery and early recovery of 198 patients admitted during one year to Roswell Park Cancer Institute for upper abdominal cancer surgery. One group of 88 patients received standard general anesthesia during surgery and morphine for pain after surgery, self-administered through an intravenous line. Another group of 110 patients received combined anesthesia therapy using bupivacaine and morphine via epidural. After the operation, the same two drugs, adjusted to pain control, continued to be administered by epidural. All patients had an electrocardiogram every 12 hours for three days following surgery to detect cardiac abnormalities. Results showed that patients in the epidural group had 51 percent fewer incidents of tachycardia (15 versus 58) , 12 percent fewer episodes of ischemia (five versus 15) and suffered no heart attacks. Three heart attacks were reh s c a n 5 ported in the general group; none was fatal. De Leon-Casasola said about 40 percent ofhigh-risk patients suffer ischemia after surgery; 8 to 20 percent suffer heart attacks. When surgeons at Roswell reported a significant drop in heart attacks following major cancer surgeries, a team of anesthesiologists began to investigate why. "We had been using combination therapy for about five years ," de LeonCasasola said, "and there was much data suggesting that patients receiving a combination of anesthesia agents via epidural had better outcomes. So we decided to take a look at that issue." Researchers theorize that the epidural anesthesia dilates the coronary blood vessels to help prevent ischemia and the morphine better controls pain to prevent nervous system stimulation. + B Y LOIS BAKER Smokers at rtsk for pertodontal disease,separate UB studies find making may be a key risk factor in periodontal disease , University at Buffalo researchers have concluded. Results of separate studies by Joseph Zambon, D.D.S. , Ph.D ., and Robert ]. Genco , D.D .S., Ph.D ., found that smokers experienced less attachment of tooth to bone and more bone loss around teeth than non-smokers. In a study of 1,426 adults ages 25 to 74, Zambon found that the loss offiber attachment of tooth to bone was three times greater among current smokers - 12.03 percent vs. 4.28 percent compared to non-smokers. Zambon, professor of periodontics, also reported a 120 percent increased risk of infection with bacteria that cause periodontal disease for every step in levels u m m e 9 9 4 �··· · · · · · ········· ·· ··· ·· · · · · ··················································· · ········· · • .. . . from light to heavy smoking. He reported current smokers had higher levels of Actinomyces actinomy-cetemcomitans, Bacteriodes forsythus and Porphyromonas gingival is- all of which cause periodontal disease- than non-smokers. Genco, chair of oral biology, studied 1,361 adults ages 25 to 74. He found that smoking increased bone loss around teeth, a risk that increased from 3.34 to 7.35 times from light to heavy smokers. Researchers included Sara Grossi, D.D.S., senior research scientist; E. E. Machtei, D.M.D., visiting associate professor; Alex W. Ho, research support specialist; Robert Dunford, senior scientific programmer; and Ernest Hausmann, D.M.D., Ph.D., all with the + department of oral biology. - B Y M ARY BET H S "We are making new versions of human hemoglobin by growing the pro- _ tein in bacteria and doing site-directed mutagenesis," he explained. "We can change any amino acid in a protein into any other amino acid we choose. In this way, we hope ultimately to design a molecule that will function optimally as a blood substitute." + - BY a l. o p h II l The grant will allow UB researchers to continue developing a synthetic form of hemoglobin. that will function outside a red cell, explained that when hemoglobin is removed from red cells it binds oxygen so tightly "a person could have a generous supply of oxygen and still suffocate because the oxygen wouldn't be released to the tissues." Noble's approach involves manipulating the amino acid sequence of the hemoglobin molecule and observing how its structure affects its function . y 5 BAKER multi-center study in which UB researchers from The Children's Hospital of Buffalo participated, has found that high-dose intravenous respiratory syncytial virus immune globulin is a safe and effective means to reduce the severity of the disease in children. The three-year study involved 249 highrisk children in Buffalo, Rochester, Boston, Washington, D.C. and Denver. Debra A. Tristram, M.D., and Robert C. Welliver, M.D., of the center for infectious diseases at Children's, were supporting investigators for the study, published late last year in The New England journal of Medicine. Tristram said between 35 and 40 children have been treated with RSV immune globulin at Children's. "Overall, the treatments had good benefits for the children in the study. They had less respiratory ailments and were less likely to acquire severe RSV," Tristram said. The new treatment compound uses antibodies extracted from the blood of volunteers such as pediatric nurses who have been exposed to RSV and have high RSV antibody levels. "Children were hospitalized less often and required less intensive care treatment than· children without the infusions," Welliver added. + UB receives $1.1 million grant to continue hemoglobin research B LOIS New treatment compound found eiTective in reducing RSV severity PINA esearchers at UB have received a $1.1 million grant to continue developing a synthetic form of hemoglobin, joining researchers from five other institutions participating in the $6 million, fiveyear study funded by theN ational Heart, Lung and Blood Institution. Robert Noble, Ph.D., professor of medicine and chief of the laboratory of protein chemistry at the Buffalo VA Medical Center, is principal investigator on the UB project. The new funding will allow the team to continue research begun with a $1.3 million grant in 1988. "We are trying to obtain the fundamental knowledge that will enable us to design a molecule that will serve better as a blood substitute than normal hemoglobin," Noble said. Noble, whose team is concentrating on developing a form of hemoglobin ' . c a S u m m e 9 9 4 0 �"Chemo Coach"program begins in Western New York hospitals RPCI opens area'sfirst regional Brain Tumor Treatment Center he American Cancer Society's "Chemo Coach" program, which matches chemotherapy patients with one-year post-chemo patients for support, has begun in Western New York hospitals. The program, developed by ACS's Erie County Unit, recently won the society's award for being the most innovative program in the nation. "The program is based on the belief that someone who has 'been there' will encourage and empower the patient. Healing and wellness is promoted by motivation, encouragement , caring and support," said Hillary Ruchlin, director of patient services for the Erie County Unit of the ACS. All coaches are trained not to dispense any medical information or advice and have completed volunteer training. The program, begun last August after nearly two and a half years of development , has served 275 patients to date. It will be introduced nationwide this year. "We match patients and coaches according to age and type and location of cancer. The coaches then meet the needs of the patients by providing information and support and showing them that there is life after chemo," Ruchlin added. Seventy-five chemo coaches have been trained and are available through the Erie County ACS office. The program is available through patient or physician referral. For more information, call689-6981. + n recognition of the somewhat higher incidence of brain tumors in Western New York than in the nation, Roswell Park Cancer Institute has opened a Brain Tumor Treatment Center- the area's first major regional referral center for the multidisciplinary management of patients with brain tumors. B u a 0 p national Chemo Coach program was developed by the ACS' s Erie County Unit. "The Brain Tumor Treatment Center will provide for comprehensive treatment of all types of brain tumors in adults at one centralized location in Western New York," said Kyu H. Shin, M.D., professor and chairman of radiation oncology at UB and chairman of the department of radiation medicine at Roswell. Shin is one of the founders of the new center. h y 5 c a S The center - headed by neurooncologist Laszlo Mechtler, M.D. , clinical assistant instructor and assistant professor of neurology- is a collaborative effort between Roswell, The Buffalo General Hospital, The Children's Hospital of Buffalo, Millard Fillmore Health System and Erie County Medical Center. "By combining these resources and expertise, the scope of care provided goes far beyond what is available in community hospitals and at other regional teaching centers," noted Shin. The center provides diagnostic, treatment and surgical services in multi-specialty areas. In neuro-oncology, under the direction of Mechtler, neuroimaging, chemotherapy (including intra-arterial and intrathecal), neuro-oncological care and neurooncologic pain management are offered. In neurology and neuroimmunology, under the direction of Steven Greenberg, M.D., assistant professor of neurology, microbiology and immunology and chairman of the department of neurology at Roswell, services offered include neurological care, molecular diagnosis and a tumor tissue repository. In neurosurgery, under the direction of Walter Grand, M.D., clinical professor of neurosurgery, and Charles R. West, associate professor of neurosurgery and chairman of neurosurgery at Roswell, services offered include stereotactic biopsy and surgery, both invasive and superselective neuroradiology and photodynamic therapy. In radiation medicine, under the direction of Shin, services offered include radiosurgery, interstitial brachytherapy of brain tumors, photodynamic therapy, u m m e 9 9 4 �intracavitary radiation therapy and cerebral spinal axis radiation. Patients may be referred to the Brain Tumor Treatment Center by calling the Patient Referral Office at 1-800ROSWELL. + must be screened and cleared by their physicians," Ward noted. Since the startup of Western New York's only lithotripsy service in December 1986, urologists have performed nearly 7,000 non-invasive treatments on kidney stone patients at The Buffalo + General Hospital. Memorial Pediatrics provides wellchild care, sick care, immunizations, sports and school physicals, lead testing, birth control, teenage counseling, supportive services for physical and sexual abuse and 24-hour emergency coverage. + iagara Falls Memorial Medical Center has opened a pediatric primary care center. Formerly known as the "Kid's Clinic," Memorial Pediatrics, at 501 TenthStreetinNiagaraFalls, has evolved from a part-time clinic to a full-time pediatric service to improve the quality and continuity of care for families living in the Niagara Falls area. "Our goal is to serve the people in this community who don't currently have physicians," saidjack Coyne, M.D., the program's medical director. "We're here to offer comprehensive, quality health care for families in a pleasant, sensitive atmosphere." appointed president of the medicaVdental staff at Buffalo Columbus Hospital. A native of Cuba, Perez-Bode earned his doctorate of dental surgery at the University of Havana's School of Dentistry. After coming to the United States as a refugee in 1968, he received his New York State dental degree from the University at Buffalo School of Dentistry. He has been on the staff of Columbus Hospital since 1989. A member of the Cuban Dental Association in Exile, he served as vice president of the medicaV dental staff at Columbus before his appointment as president. + Buffalo General introduces new "waterless"lithotripsy technology Niagara Falls Memorial Medical Perez-Bode named president of Columbus Hospital medical staff he Buffalo General Hospital, which Center opens Memorial Pediatrics pioneered the use of extra-corpoene Perez-Bode, D.D.S. , has been real shock wave lithotripsy in Western ew York, has added waterless technology to the water bath lithrotripsy it introduced more than seven years ago. The move is expected to reduce a patient's length of stay to less than one day in most cases and minimize the pain associated with the procedure. During a "dry" lithotripsy procedure, a gel-like substance is applied to the patient's back, which is then positioned against a small water-filled cushion. "Because there is less pain associated with the new technology, the need for general anesthesia is eliminated in most cases. An intravenous sedation is used instead, allowing the patient to return home the same day," said Phyllis Ward, nurse coordinator of lithotripsy services at BGH. "Since the patient is no longer immersed in water, the visualization of the kidney stone by X-ray equipment is dramatically improved and the length of time to localize the stone also is decreased," Ward added. Ward also said that a patient's sizean important consideration in water bath lithotripsy - is no longer an issue. Even with the new technology, she noted, some of the previous eligibility criteria still apply. "Pregnant women still are not candidates for the procedure, and people with cardiac problems e u a 0 p h Memorial Pediatrics will provide full-time pediatric services to families in the Niagara Falls area. y s c a n s m m e 9 9 4 �Investing in the U:U'8 med:ieft;I 8ehoift;:r8h:ip8 p8;y d:i-v:ideii.d8 :ro:r ~he 8~-...deii.~8, ~he:i:r beii.e:rft;e~o:r8 ft;II.d ~he p:ro:re88:iOII. In the 0 ffices of the University at Buffalo Foundation, there is a list. On the list are a couple of dozen names. And on those names hangs the educational fate of a great many future physicians. O 6 u ffo lo Ph ~stcton S u m m e r I 9 9 4 �Pho"to8 b y Do-..g;Ia-8 Le-vere B u a 0 p s c a n s m m e 9 9 4 �~~Themo. .e y ~O-S a-ya-i_In-b i e ft-II_di -tho-..g;h-t;, ~ha--t's -the bes-t; -..se i_-t;!' I o~ deei_ded -t;hn--t;, 0--t; ~o:r Ien-s-t pa-:r-t; I -the gn-Ye -t;o -the medi_en-I sehooi, I ~a-.._-ted -t;o hn-Ye some-t;hi_.._g pe:rmn-.._e.._-t;. EYe.._ a-:1:-t;e:r I ' m go.._e i_-t; ~••• s-t;i_II b e -there.'' 'T'I•cl ma, ~a..-.e~ .~ 0 B u f f a 0 p h y 5 c a n 5 m m e 9 9 4 �It's the listofpeople who have made a commitment to the next generation of healers: they've endowed scholarships for students learning their craft at the UB School of Medicine and Biomedical Sciences. Some are alumni of the medical school, giving back a token of what their education has made it possible for them to earn. Some are former faculty members who've seen firsthand the bright, committed young people who continue to enter the profession. Some are just interested citizens who know that, despite UB's relatively reasonable tuition costs, some students would not be able to make their dreams happen without significant financial aid. And some who have endowed these scholarships, it must be said, are no longer with us. It's an irony of charitable giving that so often a gift is made in the form of a bequest - a provision in one's will. Such support, of course, can be vitally important in building up the endowment funds that are the basis for the medical school's scholarship programs. But other donors have found that there's nothing so satisfying as actually watching your money go to work, seeing the good that you can do in individual lives. Ask Thelma Sanes. A handful of years ago, Sanes established the Harold Sanes and Thelma Sanes Medical Scholarship with a major donation to the school. The scholarship- named for Thelma and her late brother Harold- was in recognition and memory of their late brother Samuel, professor of pathology at the medical school for many years and head of pathology at the former Meyer Memorial Hospital (now Erie County Medical Center). B 0 0 p 0 5 m m e 9 9 0 �Harold Sanes had passed away in 1986. ButThelmaSanes can watch with pride the results of their living gift to the future of the medical profession their brother loved so much and gave so much to . This year, the first of the "Sanes Scholars" graduated from the medical school; at any one time, four such students receive aid from the Sanes B u a 0 p grant. The scholarships, which nearly cover the school's $8 ,450 annual tuition, are renewable for each year of a student's education. "I had written up how I wanted the scholarships to be paid," Sanes said. "They're given every year, but the students who get them, get them for four years. I felt that anybody who met the criteria of the scholarship is someone 5 c a S who is in need , and I didn't want to dump them after freshman year. " The scholars have a genuine affection for their benefactress. "Most of the winners have written me letters of appreciation," Sanes said. "Occasionally I even get a Christmas card from one of them. They're very nice people. " There's an annual luncheon as well, she said, at which donors and scholar- u m m e 9 9 4 �ship winners can meet. Sanes said she has made provision in her will, as well, for an additional donation- "to cover inflation." "I figured, there's going to be enough left. Part of it should go where it will do some good." That it has. The first Sanes Scholar, Barbara P. Kearney, graduated on May 15, having had the scholarship for all four years of her medical education. "It was wonderful," Kearney said of the day she learned she had won the scholarship. By invitation, she had written a brief essay about her accomplishments and stated the case for her financial needs. The good news came in a phone call from Thomas ] . Guttuso, M.D., assistant dean for admissions. Between then and graduation, of course, were the strenuous four years that begin to turn scholars into physicians. But through all the work that those years entailed, Kearney said, she knew that the endowed scholarship - in her case, $5,500 annually -was there to help make it possible. A lot of her fellow students, she pointed out, will leave UB medical school with crushing debt burdens. "I still have some loans that I've taken out," she said. "I had to buy a car, and there are the books. But it's only about half of what I would have had to take out." What that means, she said, is flexibility in choosing a field of practice. (New residents who are tens of thousands of dollars in debt can feel pushed into a high-paying specialization.) Kearney began her residency in pathology with the Graduate Medical Dental Education Consortium of Buffalo onjune 12. "A lot of my friends have parents and relatives who've helped them along through school," she said. "But that's not possible for everyone. 8 0 0 p "Any scholarship or any kind of grant that can be made available, I strongly encourage (potential donors) to do that." Even gifts of smaller scope can make a significant difference in the scholarship aid the school can distribute, said Guttuso. By pooling smaller gifts, the medical school can assemble scholarships for those in need. Right now, he said, about 35 students are benefiting from scholarships that total around $60,000 annually. "It's our hope," Guttuso said, "that we can build a scholarship fund that will enable us to help close to half the class each year." Each class of the medical school has 135 students. Guttuso said students are considered for aid based both on their academic promise and on their financial need. Twenty "scholar incentive awards" are given to applicants solely on their academic promise, he said"we're trying to attract the most intelligent students to come to our institution." But for all other scholarships, need is a factor in the decision. Each spring, Guttuso said, his five-person scholarship committee sits down and sifts through the applicants for aid. It's a wrenching process. "It's kind of tough sometimes, when you get down to 50 or 45 students," he said. "To eliminate some is hard, because they all really need it. That's why we're hoping that we can expand the program to help a greater proportion of the students." Except for the minimal Regents Scholarships, New York State provides no money for scholarships, notedjohn A. Richert, Ed.D. , associate dean for alumni affairs at the medical school. "Monies are few and far between," he said. One major initiative to expand scholarship assistance is the establish- 5 a 5 scope cn..IJ.. d i ffe:reiJ..ce schoo1 cn..IJ.. ASSISTANT DEAN FOR ADMISSIONS m m e 9 9 4 �ment of Medical Alumni Scholarships, to be funded by those who know best how expensive it can be to go through medical school - the alumni themselves. Dr. Donald P. Copley, a cardiologist who was president of the Medical Alumni Association last year when this plan took shape, explains. "Last vear when we began organizing for the reunion class spring session, I brought this idea up to all the (class reunion) chairmen at the same time," he said. "The question I posed was, if we pull together and all of the classes got together quite a few thousand dollars, and the (Medical) Alumni Association promised to retain an identity for everybody involved- that is, identify particular students and maybe associate them with particular classes and link up person-to-person - would the chairmen and their constituencies be interested? "It turned out there was a pretty universal enthusiasm for the idea." So for the '93 class reunions, again this year and for the next three years, alumni class gifts to the school will be funneled into what promises to become a major scholarship endowment. (The five-year cycle was established to give members of every class the opportunity to contribute. Some individual classes, notably the Classes of 1957 and 1973, already have established scholarship funds; but this is the first time all the classes together have the opportunity to contribute to a combined fund.) Class gifts to the school have averaged around $100,000 each year, Copley said, and planners of the Medi- B a 0 p cal Alumni Scholarships hope to ex- books," says Claudia Jaramillo, anpand on those figures . "We're shoot- other alumni scholarship recipient. ing for $1 million," he said, "but at "That's usually what it comes to for a this point it's awfully hard to tell year (of books). (whether that goal is attainable). If we "The budget usually fora (UB) medigot to $500,000 or $600,000, we'd cal student is about $20,000 a year, still be quite happy about it." especially if you're not living at home. There was some controversy, he But still, anything you can get, espenoted, over whether recipients of the cially $1,000, is definitely helpful." scholarships should be chosen on acaFellow recipient] eannie Kao notes demic merit or simply on need. "Half that her student loan was reduced by the people I talked to thought that the amount of the alumni scholarneed should be a major consideration, ship, "and to have that be $1,000 less so that people who had no resources is really nice." With interest, of course, or very little resources would be the loan repayment can be much greater ones who were offered the scholar- than the principal borrowed, so a ships," Copley said. "An equal num- $4,000 reduction (the scholarships ber of my constituency thought that are for all four years) is a major benefit merit should be the only criterion." down the road. The outcome: a time-honored com"As a medical student," says scholpromise, in which academic merit arship recipient Frank M. Lee, "you will be the primary focus in half the really don't have the time to take on a scholarships, financial need the de- job except in the summertime. The termining factor in the other half. scholarship does cover my books at "The idea," Copley said, "is to carry least, which is nice. each of these individuals through four "Since UB is not really that expenyears of school." He noted that john sive to start off with, you do come out P. aughton, M.D., dean of the medi- with a debt, it's not in the hundreds of cal school, has supported the alumni thousands but still it's something you initiative with some discretionary have to think about. The scholarship money he has available. "Dean makes more of a difference in a school Naughton was particularly enthusi- like ours," because it represents a astic and helpful," Copley said. greater portion of the cost of medical Already the Medical Alumni Schol- education. For those with the means to make arships are providing significant support to first-year students. "It's a great a major gift of scholarship money, UB feeling to pick up that $500 check at offers two possibilities: an annual the start of each semester," says one scholarship or an endowed scholarsuch student,]ason M. Andrus. "It's a ship, both of which can be established couple months' rent. It's a terrific through the Office of University Defeeling to think that your school thinks velopment. An annual scholarship is a gift of that you're unique and they're going out of their way to assist you like about $8,000 or more for one year, or that. " annually for several years, to support "Definitely it helps, especially with a student's educational expenses for s c o n 5 m m e 9 �those years. By contrast, an endowed scholarship is a gift of at least $150,000 that is then permanently invested and the income used as scholarship assistance. It's a gift that continues beyond the donor's lifetime. Michael E. Benzin, associate director of special, annual and regional giving for the University at Buffalo Foundation, noted that the foundation has experience in handling gifts of all sizes. The endowment managed by the foundation for the university is now $40 million. (Donations earmarked for the medical school are managed by the B 0 0 p h foundation, but the school itself decides who is to receive the scholarship money they generate.) Unrestricted gifts are encouraged, because they afford the most flexibility in meeting students' scholarship needs. But major donors , Benzin said, can structure their gifts in any number of ways. For example, if a surgeon wants to endow a scholarship that would go only to students who aspire to surgery, that's entirely possible. Or, he said, "if (the donor) worked his way through medical school and would like to assist a student who's in that situation, you can do that, too ." s c a S u Benzin said endowment money is invested conservatively and that a part of the interest is channeled back into the principal so that its "buying power" isn't eroded by inflation. And he reminded potential donors about the james Platt White Society, founded in 1986 to honor donors to the medical school of$1,000 or more. Named after a founder of the school, the society has about 200 members. As Barbara Kearney , the new pathology resident, said of her Sanes scholarship: "There's just so many people out there who could benefit from something like this. " + m m e 9 4 ��o ree time is a scarce commodity for medical students. But one Saturday morning this spring, Amy Ferry was spending some of hers with a homeless man in Buffalo's City Mission. The pain in his feet and knees had gotten so bad he was having trouble walking. And he was feeling run down and depressed. "Any drugs?" asked Ferry, who was completing her fourth year at the UB School of Medicine and Biomedical Sciences. Not any mor_e, the man said, but he still drank. "Do you see your drinking as a problem?" Ferry asked. "I see me as a problem, period," the man replied. After the man had been referred for further treatment, Ferry reflected on why she was devoting this morning to Project Hope, the weekly City Mission clinic run by student volunteers from the UB medical school. "Doctors are expected to be involved in the community," she said simply It's the same reason she spent last summer on Capitol Hill, lobbying over tobacco and mammographies. "It's part of learning to be a doctor," she added. Ferry is among the large number of medical students who take it upon themselves to extend their educations beyond the curriculum requirements. Some work in clinics with underserved populations. Some teach health lessons to school children. Others spend long hours in the laboratory helping to carry out research. They do it to varying degrees and for a variety of reasons: a sense of social responsibility, intellectual curiosity, clinical experience, diversion, career advancement or just the challenge. e a 0 p h y 5 c a n S u m m e 9 9 4 �~ ~ese are talented kids in many respects, and they do a lot of things, " said Richard] ones, Ph.D., medical school registrar . No one keeps tabs on exactly how many students take part in activities that aren't required but are professionally relevant. Thomas Flanagan, Ph.D ., chairman of the Student Research Committee, said that at last count, several years ago , more than 300 UB medical students were involved in research. Recent projects include investigations into DNA, the epidemiology of neuroblastoma in New York State, alcohol-related injuries in children and adolescents and the exposure of medical students to blood and body fluids . And student leaders estimate that half to three-quarters of their classmates get involved in some type of voluntary service activity, from medical clubs to clinic work. Among the larger student initiatives are Project Hope and a pair of programs that put medical students into the schools to teach children about AIDS and healthy diet. "Most students will get involved even at a peripheral level in something," said Melanie McNally, 1993-94 president of Polity, the medical school's student government council. Those who do get involved may spend less than an hour a week on outside activities. Research, however, can easily take several hours a week. And some students find themselves with the equivalent of a part-time job. "I think a lot of it depends on how you handle your own stresses," said Eileen Killackey, a Project Hope volunteer who is going into her third year. "I think it depends on what you're most concerned about doing while you're in medical school. .. . In a way, it's something to keep you going. It gets you out of the classroom and in touch with what you're actually going to be doing at the end of four years. It's like light at the end of the tunnel. " But getting involved at more than a peripheral level can force students to make tough choices. "Your grades can reflect it," said B u a 0 ence on match day. "If you're visible , it does go down in your dean's letter," said McNally. "Right now, that's the only non-personal benefit you get out of it. " But it's the personal benefits that often matter most. It's not uncommon for students to describe their volunteer work in terms of social and professional responsibility. Many see the work as a way of helping others while preparing themselves to become better physicians. "It's definitely a two-way street," said Sarah Ballow, a Project Hope volunteer going into her third year. "Most of the people who get involved in these activities have a desire to do something," said McNally. "That's why they got into medical school in the first place - because they wanted to do something for their community." Flanagan said that while many student researchers take on their projects with an eye toward honors and residencies, a good number do it out of simple intellectual curiosity. "Some have a specific disease interest that they want to pursue," he said. "Some kids have had no research experience and just want to see what it is. " The research projects cover a broad spectrum, from laboratory "bench" research, to clinical investigations and even health policy work. Every year, the medical school supports about 20 students in its 10-week Summer Research Fellowship program. Applicants must submit detailed proposals, and only about half are accepted, said Flanagan. But in most cases, student researchers get started simply by talking to a professor and signing on to projects already under way. Many do it in the summer after their first or second year, when there's a little more time. And if there's a grant supporting the project and some money to spare, there may be a stipend in it for the student. Tom Guttuso,jr. , said that when he started medical school he didn't plan to become a researcher, but he became engrossed in the laboratory after his first year and the experience has "completely changed" his medical education. Guttuso received a summer research fellowship in 1992 to work with physi- Michael Landi, M.D., a Class of 1994 member who conducted several research projects. "I know my first-year and second-year grades were probably a little bit lower because of the time I put into research ." McNally said her student government work has forced her to manage time better - to a degree. "You make the time, you really do ," she said. "Then you go and beg your professors to have mercy. " Dennis A. Nadler, M.D., associate dean for academic and curricular affairs, said UB encourages students to go beyond the classroom. "Our university," he said, "stands on a three-legged stool -academics, research and service." Official encouragement, however, has been somewhat uneven. Some students who participate in research can garner extra points toward Latin graduation honors . But no points are awarded for those who participate in community or university service, such as volunteering at a clinic or serving as a student representative on a university committee. That may be changing. Nadler recommended last year that service activities be rewarded with graduation honors, and as early as this fall- depending on the outcome of a faculty council meeting in late May- a revised honors system could take effect. Under it, new categories of diploma honors would be created for research and volunteer service. Latin honors would revert to the traditional system, in which they are bestowed strictly for academic achievement. "We really feel that we have a commitment to serve the community as a medical school, and that extends all the way down to the students," said Nadler. "What we haven't had in the past was an adequate way of rewarding the students." Even without honors, extracurricular work can mean career benefits. "So many residency programs are interested in whether students have done any research," said Flanagan, a microbiology professor who oversees the medical school's Research Forum and Summer Research Fellowship programs. In some cases, community and university service could also make a differ- p h 6 c a n 5 u m m e 9 9 4 �ology professor Susan Udin, Ph.D., on visual plasticity in frogs. "We were working on basically trying to get the visual nervous system to reorganize and heal after it's been damaged and I just kind of fell in love with it. "I ended up really digging it so much that I did it through the second year of medical school - before classes, after classes, during some of the more boring classes." Then he took off the 1993-94 academic year, which would have been his third, for full-time study of the hormone melatonin with a $23,000 grant from the Howard Hughes Medical Institute. Guttuso was unable to prove an effect on frog visual systems, so he switched gears to pursue his theory that melatonin could prevent or slow the development of Parkinson's Disease. "It's been a lot of work to get this model up and running," he said. But, he added, the results could be much more clinically relevant than his original line of inquiry. His results, unfortunately, have been "inconclusive," but because of a design flaw in the experiment rather than his theory. Guttuso "hopes to do it again this summer." Ultimately, Guttuso said he would like to make research part of his career, mixing it with clinical practice, possibly in neurology. "It's put the thought into my head that I'm going to do something that I never expected to do when I entered medical school," he said. "Once a student gets involved in research, they very frequently will continue," said Flanagan. "They will do it in B u 0 0 f' h gery residency at Mercy Hospital in Buffalo this year, has been involved in several research projects, including a study into the exposure of medical students to patient blood and body fluids. He said he found that about 30 percent ofUB's class of 1993 was exposed through needle sticks, mucous membrane splashes and other means during third-year rotations. "That's pretty consistent with the class of 1994, too," he added. The study began when Landi read a letter in the medical school newspaper from a former student who had contracted hepatitis during her rotations. A snafu left the woman unaware for several weeks that she had tested positive for hepatitis, prompting Landi to look into student exposure rates and the policies for dealing with such cases. "It was just because I was kind of offended," he said. Landi, who is submitting the UB study for publication, is still reviewing results from a larger subsequent survey he conducted with another UB student of exposure rates at seven medical schools across New York State. He also helped develop a comprehensive policy for UB's consortium of teaching hospitals to handle student exposure cases. Previously, there was no consortium-wide policy. Landi never calculated how much time he put into his research, but he remembers spending a lot of evenings and weekends with it. "I wouldsayit'sagood parttime job," he said. "It gets kind of labor intensive when paper writing comes around. " Students who take on significant extracurricular responsibilities say it forces their free time during the school year. They don't have a lot of time, but they make time." Under the graduation honors policy in effect in recent years, students could earn Latin honors points if their work was accepted for presentation at the annual Research Forum, and their supervisor approved. "A lot of the work is very good and leads to publication," Flanagan added. The medical school encourages re- search, partly to make students aware of the career possibilities, but also to turn out more rounded clinical physicians. "It's one thing to read the outcome of research and another thing to actually conduct it, to confront the solving of problems, to be frustrated by things that don't come out the way you expect them to," Flanagan said. Landi, who is beginning a neurosur- y s c o n S u m m e 9 9 4 �them to set prionttes. "Some people manage to pull off the top grades even with this, but most of us are in the B range," said McNally, the Polity leader. Many students describe their extracurricular activities as a good way to experience a broader world that will be relevant to their professional futures. McNally said that in being responsible for the $88,000 in student activity funds distributed by Polity, she's learned something about accounting. "I have become very interested in the administrative side of medicine," she added. "I've found that I'm very good at this, and I'm hoping to make it part of my career." At Project Hope, students deal with unteers how to take histories and talk with the homeless patients. "I've always been interested in serving underserved populations ," said Ballow, who worked in a soup kitchen during her high school years in Connecticut. This summer, she will conduct US-sponsored research at a Navaho reservation in Arizona. She has also managed to keep up a relationship with her boyfriend, who lives four hours away in Pittsburgh. ''I'm a very organized person," she said with a smile. Project Hope began several years ago as an outgrowth of a City Mission clinic run by the School of Nursing. "We just wanted to do more outside the classroom, to use what we were learning," said Joe Kay, M.D., who graduated this year to begin a residency in internal medicine and pediatrics. Kay said he enjoyed his time with the clinic. "You're doing it because you want to, rather than being evaluated all the time," he said. "It's a different atmosphere than the hospital. It gives you an idea of the problems with the health care system, too ." Many students involved with Project Hope agree that the experience has affected them. "I always find that talking to the patient is a very humbling experience," said Killackey. "Medically speaking right now, I don't know how best to help people because I don't have the clinical skills. But with situations they might not see on hospi- these community projects, you find out that your just being attentive and listental wards. "If someone comes in with a simple ing to these men and women can make foot fungus, you tell them to clean their a big difference." There are limits, howfoot and change their socks," said Cook. ever, to how much students can take on. "Then you find out they only have Ferry, who will begin her residency this one pair of socks." year in obstetrics and gynecology, served About 60 students are involved in two years as regional student co-coordiProject Hope, according to Ballow, who nator for the American Medical Women's helps administer the program. Each of Association. "They wanted me to run those students spends at least one Satur- for national co-coordinator," she reday morning at the clinic. Ballow is called. "I said not while I'm an internthere once a month, showing new vol- no way, no how." + "0 think there is definitely a trade-off," said Stephen Cook, who in his first two years has been involved in Project Hope, a pair of Buffalo pediatric clinics and the Primary Care Club. Recently, he also initiated an undergraduate clinic for Niagara University students interested in medicine. "I enjoy doing these things," he said. "It's time I could spend learning gross anatomy or biochemistry, but that's the type of person I am. I'm a more humanistic person. I like dealing with people." Noah Sabin, a 30-yearold attorney who just finished his first year at UB medical school, has been adding to his list of responsibilities. During his first year, Sabin was elected vice president of the American Medical StudentAssociation chapter. He also signed on to a national AMSA task force on tort reform, and will work on environmental health issues with Rep. David Obey, DWisconsin, in Washington this summer as an AMSA fellow. In addition, Sabin said he tries making time to exercise and keep up on his nonmedical reading and current affairs. He described time management as something that's subject to amendment as exam results come back. "I sort of have a sense from looking back at law school of how much those grades really meant in the long run," he added. "They meant a lot if you're looking for a certain amount of prestige in a certain field . ... (But) the people defining what's most prestigious have spent their entire lives in those environments, and they don't really know what else is out there." B u a 0 p h 5 c a n 5 m m e 9 4 �M edical school makes a lot of demands, but it doesn't demand that students volunteer their time for research or public service. Yet many do . Here are some of the things they're involved with: RESEARCH "The student research at UB takes a number of faces, " said Luther Robinson , M.D. , assistant dean of student affairs. Student work ranges from basic biology to the genetic basis of cancer. "The spectrum of research in medicine contributes to the intellectual climate in medical school," Robinson added. Students most frequently get involved by approaching a professor already carrying out a research project. Some departments have grants to sponsor research opportunities, as well. And each year the university supports about 20 students in its Summer Research Fellowship program. Applicants must submit detailed proposals to a faculty committee for the full-time, IO-week program. In addition, student researchers can apply to present their work at the annual Research Forum. At the last forum, in December, more than 70 students made presentations. "This is not the science fair ," said Thomas Flanagan, Ph.D. , chairman of the Student Research Committee. "This is real research. " PROJECT HOPE About 60 students are involved in this Buffalo City Mission clinic, a u 0 0 p American Medical Student Association, the AIDS-prevention program began at UB last year. Since then it's reached nearly 10,000 students in Buffalo-area junior high and high schools. About 55 first- and second-year medical students take part. "We talk about the biological aspects of AIDS- transmission and prevention," said Beth MacDonald, who just finished her second year and is STATS coordinator. "The questions are usually very specific and very explicit," she added. "The questions show that the kids obviously need to learn." which is an expansion of a clinic started earlier by UB's School of Nursing. Each Saturday morning, four or five first- , second- and fourthyear medical students attend. They are joined by a nurse and physician. The first- and second-year students take histories and vital signs, then observe as the fourth-year student conducts an examination. They present their findings to the physician, who then conducts a final examination. Among the administrative problems faced by student organizers has been a lack of insurance for physicians who volunteered to attend. Recently, Project Hope became affiliated with Sheehan Memorial Hospital, which has been rotating physicians to the clinic every other week. "The credit goes to the medical students," said Raul Vazquez, M.D., of Sheehan's Family Care Center, who was attending the clinic one day this spring. Vazquez, a member ofUB's Class of 1989, said that while students were interested in such volunteer work when he was in medical school , programs like Project Hope didn't yet exist. GET HEART SMART In this four-year-old program, medical students visit local fifthgrade classes in teams of four or five to deliver presentations on avoiding heart disease. The 70 participating students, mostly in their first year, reach several thousand 10and 11-year-olds annually. "That's the age to get them, when they're still impressionable and don't have any heart disease," said Brad Davis, who ran the program i.n 199293. "We really consider it the purest form of preventive medicine." PEDIATRIC CLINICS STATS Teen-agers don't like listening to those they see as adults. But if they're told something by another student, particularly if that student is wearing jeans and a t-shirt, the message might get through. That's the theory behind Students Teaching AIDS To Students. Launched several years ago by the s c a S u About 20 to 30 students per semester attend pediatric clinics at the Roberto Clemente and jesse E. Nash health centers in Buffalo. They're mostly in their first and second years, and they help the health center staff with growth charts and sometimes with immunizations. + m m e 9 9 �A Spoon f u I of Humor© ADVICE FROM SOMEONE WHO ' S BEEN THERE ince this issue of Buffalo Phy sician features topics on medical school, I started thinking back to those days. Despite their complications, intricacies, similarities and differences, professors can basically be divided into five categories: tf . MIGHTY FAMOUS BIG SHOT ~ - THE DISDAINFUl EGGHEAD Advantages: His course includes attach- Advantages: Draws in grant money B u a 0 p and monolith residents to the department. Disadvantages: Speaks with a difficult-tounderstand South African accent, despite having spent all his life in a suburb of Cleveland. Choice in clothing qualifies him as legally blind. Warning: May be hazardous to your health. ing state-of-the-art electrodes to the lacrimal glands of domestically raised coyotes, making for interesting chit-chat at family gatherings. Disadvantages: Hates M.D.s and considers them technicians. Warning: Sit in the back row and avoid making eye contact. A ·THE NOVICE DRONER Advantages: Meticulously organized ~.PROFESSOR IN TRUCK DRIVER OUTFIT Advantages: Chain-smoking genius. Car- handouts make going to class very unnecessary. Disadvantages: Includes material that nobody ever heard of, including the people she is citing. Includes material nobody cares about. Warning: This is what the boards and cocktail parties are like. ries lecture notes in a Metallica lunchpail. Disadvantages: Cyanotic mouth breather, occasionally desaturates while lecturing. 5 c a n s /!; . PSYCHIATRIST FROM liCHTENSTEIN Advantages: His three lectures can be u m m e 9 9 4 · �Stu S i Ivers t e in M . D. ~ The social worker making rounds spontaneously combusts from boredom. ~ The patient loses patience and presents hmself to the housestaff. ~ The attending asks you to pull his finger. ~ Alfred Hitchcock walks through the group. ~ The team breaks up into small discussion groups in the stairwell. + FOR THOSE OF YOU who have friends or relatives about to attend medical school, here are some basic rules for success: summed up in one sentence: People who are terminally ill often get depressed. Disadvantages: See above. Warning: When you get depressed you will wait in line with your classmates to see him. , ~ Avoid lecture halls. on rounds, start each sentence with "According to the literature, occurs in 5% (or 95%) of the cases." ~ ever say, "I didn't get the lab results." It's always, "They're not back yet." ~ Begin rounds by handing out articles , nobody will read them anyway, so just randomly photocopy them. ~ Grow a beard with no mustache and nod your head up and down like a toy dog. (Males only please.) ~ Keep repeating, "great case, good pathology," until somebody notices you're naked from the waist up. ~ Offer to look at the smear several times during rounds while staring at the lab reports. ~ ~eep referring to your stethoscope as your pal Hector. ~ When Stu Silverstein, M.D., president of Standup Medicine Seminars of San Francisco, California, lectures nationwide on humor in SIGNS THATYOU ARE BORING ON ROUNDS: ~ You are a medical student. ~ Twenty minutes into your presentation the attending says, "how old was that patient? " ~ The patient asks you to leave the bedside because everyone else left for GI rounds 20 minutes ago. ~ When you present the lab results, the intern punches a bunch of numbers into his pocket calculator, looks up and asks if you also get expensive phone bills. ~ The chief resident pulls you aside to tell you you're too intense, relax or he'll give you a wedgie. B a 0 p h ~ 9 c a n 5 m m e 9 9 4 �Mixing medicine and business VIRGINIA WELDON '62, USES BOTH HER MEDICAL EDUCATION AND CORPORATE EXPERIENCE AS SENIOR VP FOR PUBLIC POLICY FOR MONSANTO COMPANY fter listening to a description of her assignments at the Monsanto Company, one of the nation's largest multi-billion dollar enterprises, you might think Virginia V. Weldon possesses degrees in chemical engineering, international diplomacy and marketing rather than a doctorate in medicine from UB. "I'm expecting a phone call from the FDA during the interview. If the call comes, I've got to take it, but I will call you right back." Indeed, Virginia Weldon is a busy person. As senior vice president, public policy, for the St. Louis-based company, the class of '62 alumna is responsible for corporate communications and government affairs, devoting most of her hectic schedule to opening new markets and winning government approval and public acceptance for emerging technologies and products. "Monsanto markets its products worldwide, and I have the responsibility to help sell our products and to get new products approved for sale by the government," Weldon explains. The Monsanto Company manufactures and markets agricultural and chemical products and pharmaceutical and food ingredients. Some of its best known products include Roundup herbicide, Ortho lawn and garden products and NutraSweet. Weldon never saw herself abandoning the operating room for the corporate boardroom. "When I went to medical B u a 0 school, I was thinking about being a practicing physician. I loved surgery. I really enjoyed surgery in my junior year at the E.]. Meyer Memorial Hospital," Weldon said. "And we had wonderful people teaching physiology. I remember going to parties and on picnics with Dr. john Boylan and with other faculty and students. It was a wonderful time. The four best years of my life," she adds. Following an internship and residencyin pediatrics at The johns Hopkins Hospital in Baltimore, Weldon completed a three-year fellowship in pediatric endocrinology at The johns Hopkins University School of Medicine. Shortly thereafter, Weldon joined the faculty of the School of Medicine at Washington University in the department of pediatrics. It was there that her interests in medicine began to shift to matters of public policy. "I became involved with public affairs as a member of the Endocrine Society and the Society for Pediatric Research with issues concerning funding for research and the ethical treatment of human subjects," Weldon says. After serving as co-director of the division of pediatric endocrinology and metabolism, Weldon was appointed assistant to the vice chancellor of medical affairs. The metamorphosis from physician to businesswoman was well underway. Weldon was named deputy vice chancellor for medical affairs and vice president of the medical center at Washington University School of Medicine and p s c a n S Medical Center in 1967. She joined Monsanto as vice president, scientific affairs and was quickly promoted to vice president, public policy, serving in that capacity from August 1989 to October 22, 1993, when she began her present position with Monsanto. One of the greatest challenges facing Monsanto, Weldon says, is to build public trust. "Science-based companies like Monsanto have a responsibility to assure the public that the science on which new products are based is of the highest caliber. It is imperative that our science and assessment procedures are beyond reproach in order to be credible and trusted." Weldon's education and experience as both a physician and corporate executive have helped shape her views regarding health care and, in particular, with the congressional debate regarding health care reform. "It's a very complicated subject, partly because of the size and complexity of the health care system, the entrepreneurial spirit of our country and the public's expectation for continual improvement of medical care." It will be very hard, she adds, to reform the nation's health care system in "one fell swoop." Instead, Weldon said attention should be paid to aspects of the system that are "broken." "We need portability of insurance coverage and we need to provide insurance for those who don't have coverage. And it must be affordable," she maintains. u m m e 9 9 4 J J �l J 1 J "One of the issues being overlooked in this debate is the jobs involved with health care services. No one is considering the consequences to the academic medical centers, pharmaceutical companies and insurance companies," Weldon says. When asked specifically about regulatory delays that affect the timely approval of new pharmaceuticals, Weldon said, "One way to help this country maintain its competitive edge in pharmaceutical discovery is to provide the FDA with enough funds to work efficiently and effectively, to give them resources to hire the scientists they need to evaluate new drug petitions, and to make sure the agency is free from political influence." But, she added, "Our congressional leaders have not seen fit to provide the additional funds the FDA needs. There are numerous, geographically separate facilities for the FDA in Washington, many of them antiquated. There is certainly a need for more resources." As a spokesperson and policymaker for a major international company, Weldon has become, by default and not by design, a high profile example of a successful businesswoman and she has strong opinions regarding opportunities afforded to all individuals within corporate America and within her own company. "What happens to you, whether you succeed or fail, depends upon you as an individual. "I don't believe that women who become militant about their role can contribute effectively. Women who make positive contributions make it easier for other women who will come after them," Weldon said. "My guess is that women who employ 'sharp elbows' in an attempt to further their careers actually make B a 0 p " SCIENCE-BASED COMPANIES LIKE MONSANTO HAVE A RESPONSIBILITY TO ASSURE THE PUBLIC THAT THE SCIENCE ON WHICH NEW PRODUCTS ARE BASED IS VIRGINIA WELDON OF THE HIGHEST CALIBER. " that was purposeful- it happened because, historically, medicine was dominated for so long by men." ot surprisingly, Weldon has taken an active role in promoting the national effort on women's health issues and, in 1993, was appointed by the National Institutes of Health to serve as Chairman of the Women's Health Initiative Program Advisory Committee. UB is one of 16 vanguard clinical centers participating in NIH's landmark things harder ," Weldon continued. "Monsanto is trying to find qualified women and minorities in order to achieve a diverse work force and to provide an opportunity for everyone to succeed. Monsanto is very serious about diversity. " But Weldon also acknowledged the difficult role many women face in advancing their careers. " ... probably every woman in any kind of job that is viewed as non-traditional has felt marginalized or overlooked .. .. we must work very hard to change the culture in our (nation's) businesses and institutions, but it takes a long time." An area in which Weldon sees steady progress, however, is in women's health initiatives. "Women's health has been neglected for a long time. I don't think 5 c a n s studyofwomen~h~hh . As for the future, Weldon says she is constantly challenged in her job at Monsanto and is not thinking about any more career changes. "Someday," she said wistfully, "''d like a little more time + for golf and travel. " - m BY m PETER H . SIGURDSON �~-··········· · ··········································································· IE Kasstrer '53, delivers Stockton Kimball Lecture 1991 DISTINGUISHED MEDICAL ALUMNUS RETURNS FOR SPRING CLINICAL DAY TO SPEAK ON " CLINICAL REASONING : TEACH I NG I T AND LEARN I NG IT" " espite or perhaps because of all sorts of technological advancements, our cognitive skills remain the preeminent part of our work as physicians,"] erome P. Kassirer, M.D., editor-in-chief of The New England journal of Medicine, told the audience gathered to hear him give the annual Stockton Kimball Memorial Lecture at this year's Spring Clinical Day, held April 30 at the Buffalo Marriott. "But despite the importance of the diagnostic process, we spend precious little time trying to understand it," he said. Kassirer's talk, "Clinical Reasoning: Teaching It and Learning It," focused on what he called "the mental process that physicians use when they perform the task of diagnosis." Robert Reisman, M.D., president of the UB Medical Alumni Association and a longtime friend and schoolmate of Kassirer, introduced Kassirer and praised him as "everything a physician should be- a clinician, teacher and researcher who is dedicated to medicine. He's an excellent physician, often referred to in those most admirable of terms as a 'physician's physician,"' Reisman told the more than 300 people, including UB B u 0 0 President William Greiner, who attended. Kassirer, a 1953 UB alumnus who earned his medical degree from the UB School of Medicine and Biomedical Sciences in 1957, began by pointing out that he felt it was a great privilege to be giving the Stockton Kimball Memorial Lecture partly because Kimball was dean of UB's medical school when Kassirer had been a student there. Kassirer praised UB and the Buffalo area, saying "I treasured my experience in medical school and the two years I spent at Buffalo General Hospital." Regarding the diagnostic process, Kassirer said, "The more we study it, the less likely we are to make errors. I want to explain how the process goes, as well as the faults that affect even the best of us." Kassirer pointed out that while phy- p h 5 c o n s sicians often think of themselves as the only people who use diagnosis, nothing could be further from the truth. Diagnosis is a process used by all sorts of people, from politicians to mechanics, Kassirer said. The diagnostic process involves, first of all, inferences that are made from observable facts about the nature of a system malfunction, Kassirer said. Such inferences yield "a series of provisional approximations that are revised continually," he said. But he added that it was important to pay attention to the distinction between a perception and an inference, and to note how much inference goes on in any act of perception. "As an example, if you see a ball bounce into the street, that perception may cause you to immediately slow down your car because of your inference that the ball could be followed by a child," Kassirer said. Kassirer pointed out that there are two basic types of problem-solving methods, which he termed "weak" methods and "strong" methods. Weak methods are general problem-solving methods that do not depend on a particular domain of expertise, are widely applicable across different problem areas and m m e 9 9 4 �·· ····················· ···· ·············· · ················ · ········ · ·· ·· ····· · ···· ·· · · ·· • are characteristic of novice rather than normal and abnormal findings. The com- ciples for teaching clinical problem-solvexpert behavior, Kassirer said. Strong peting hypotheses also have to be proved ing, which included using case presenmethods, he said, are methods used by false at this stage, Kassirer said. tations and giving students data in domain experts and involve rapid recResearch on the diagnostic process "chunks" that allows them to particiognition of patterns and efficient for- has a number of important uses in edu- pate in the diagnostic process. Kassirer mulation of problems in "semantically cation, Kassirer said. It enables better stressed the importance of using real meaningful chunks." Such methods go teaching of that process, and helps stu- cases in order to reflect what he called directly toward the solution of particu- dents learn how to recognize clusters of "the messiness of clinical medicine." lar problems and are domain-depen- cues at the beginning of the process. Other basic principles included stressdent and narrowly applicable, Kassirer Research on diagnostics also helps ex- ing causal relations when possible, and said. plain the rationale behind the tradi- identifying for students the reasoning Kassirer said four basic components tional routine "workup" with which strategies employed, as well as potential comprise the diagnostic process: hy- physicians prepare for every diagnosis, errors in reasoning. pothesis generation, context formula- Kassirer said. It is essential, Kassirer said, to teach tion, hypothesis refinement and hypothBut research on diagnostics also helps by example. Students learn reasoning esis verification. teach students that in certain cases it by seeing others reason, he said. Generating the initial hypotheses and may be appropriate to skip around, to The clinical reasoning process can formulating a context for those hypoth- start from laboratory data, or, in the help minimize errors at all points in eses provide a model for gathering more case of urgent problems, to interrupt diagnosis, and can help avoid such coninformation about the problem, Kassirer normal processes of information, sequences of error as delays in treatsaid. Often based on minimal cues that Kassirer said. ment, unnecessary exposure of patients come in clusters, these initial hypothFurther, students can be taught to to various tests, inappropriate treatment eses "can range from the general to the avoid certain heuristics that can lead to and the anxiety that results from each of specific," Kassirer said. "At this stage, error. Teaching the quantitative ap- these consequences, Kassirer said. hypotheses are intermingled in a pecu- proach to combining clinical data, as "All this will hopefully lead us to a liar sort of way." well as the use of pre-compiled, condi- general model of problem-solving that After developing a context for un- tion-action pairs, can also be improved can help us identify good or bad reasonderstanding why one has come to these by research on diagnostics, Kassirer said. ing," Kassirer said. + initial hypotheses, the problem solver Kassirer listed a number of basic prinBY MARK W ALLACE enters the stage of hypothesis refinement, Kassirer said. At this stage, various hypotheses are deleted, added or made more specific. This phase is dominated by probabilistic reasoning as the problem solver tries to determine which of the generating hypotheses are most likely correct, Kassirer said. By using pre-compiled rules and information about the source of various problems, the problem solver tries to achieve a hypothesis that has near certainty, he said. When one hypothesis clearly begins to dominate, the problem solver has reached the stage of hypothesis verificaThis year's senior medical students were honored by the Alumni Association and President and tion, Kassirer said. The hypothesis has Mrs. William Greiner at the annual Senior Reception last february 26 at the Buffalo Hilton. to be tested for coherence and accuracy, and to see whether it explains both B u a 0 p h y s c a n s m m e 9 9 4 �• ·············· · ······························· · ············ ····· ··········· · ·· · ·· · ······ . I • A test of the effectiveness of hormone-replacement therapy in reducing the risk of heart disease and osteoporosis. • A study of the effect of a low-fat diet on the risk of cardiovascular disease and breast and colorectal cancer. • An investigation of the effectiveness of calcium and vitamin D supplements in reducing osteoporosis and colorectal cancer. In Western New York, 14,000women will be recruited over three years to take part in the clinical trials. The observational study will follow women over eight to 12 years to try to determine physiological and lifestyle factors that can affect health. Participants in this phase - about 2,200 of them in Western New York - initially will give detailed medical histories and then will be contacted every three years to update their information. Women interested in volunteering for the study should call the Women's Health Initiative clinical center at (716)829-3128. + Women's Health Initiative begins MEDICAL SCHOOL AMONG 16 VANGUARD CENTERS TO PARTICIPATE IN LANDMARK STUDY OF WOMEN Trevisan. "We will be taking part in a history-making study that will answer very important questions regarding the well-being of women. "In addition, information we gain from the central study will be the seed for other studies that will contribute to the knowledge of women's health. It is also creating a number of new jobs, and more jobs will be created as other studies are generated. "This is a massive undertaking," he added, "and we will need the cooperation of many people, particularly the women volunteers, to make the study a success." The study itself will be conducted in two parts- clinical and observational. The clinical component will involve three investigations: esearchers at UB kicked off the major recruitment drive for the Buffalo portion of the $625 million Women's Health Initiative with the February 25 grand opening of the new women's clinical center. The Women's Health Initiative, funded by the National Institutes of Health, is the largest clinical health study ever undertaken in the United States. Approximately 160,000 women between the ages of 50 and 79 at 45 centers will take part in identical studies designed to investigate the causes of heart disease, breast and colorectal cancers and osteoporosis in older women and test the effectiveness of various treatments. UB, selected as one of the 16 lead research centers in the 12-year study, will receive $11 million over the life of the project. Headquarters for the UB clinical trials is a newly renovated 5,700-squarefoot clinical center in Farber Hall on the South Campus. The grand opening featured a ribbon-cutting ceremony with UB provost Aaron N. Bloch; John Naughton, M.D., vice president for clinical affairs and dean of the School of Medicine and Biomedical Sciences; Mauriz\_9 Trevisan, M.D., principal investigator for the UB portion of the study ana chair of the Department of Social and Preventive Medicine; Jean Wactawski-Wende, Ph.D., professor of social and preventive medicine and one of the UB investigators; and Congressman Jack Quinn, R-Hamburg. "This is a wonderful opportunity for Western New York and UB," said B a a B Y LOIS B AKER Women's Health Initiative MaurizioTrevisan,M.D.,andJeanWadawski-Wende,Ph.D.,atthenewdinicalcenter. p h y 5 a n S u m m e 9 9 4 �. . . . . .. .. . . ... . .. . .. . . .... ...... .. .. . . . . ... . ... . ... . ..... . .. .... .... . . . . • • • • • • • • • • • • • • • •• ~ I Dean honored by Asian Amertcan Physicians'Association recently avid C. Dean, M.D., clinical professor of medicine , received the Asian American Physicians' Association's first "Friend of the Asian American Physicians' Association" award at a dinner held last fall. Dean, who is also chief of cardiac rehabilitationatBuffalo VA Medical Center and co-medical director of the cardiac rehabilitation unit at The Buffalo General Hospital, is a fellow of the American College of Physicians, the American College of Cardiology and the College of Chest Physicians. + Lockwood assumes new PSR post he board of directors of Physicians for Social Responsibility (PSR) has named Alan H. Lockwood, M.D., UB professor of neurology and director of the Buffalo VA Medical Center's Center for Positron Emission Tomography, its 1994 president. Founded in 1961, PSR is a leading national organization of more than 20,000 health professionals and supporters working in 90 chapters across the country for the elimination of nuclear and other weapons of mass destruction, the achievement of a sustainable environment and the reduction of violence and its causes. PSR is the U.S. affiliate of International Physicians for the Prevention of Nuclear War, recipient of the 1985 Nobel Peace Prize. B u 0 0 p h I Lockwood has been a member of PSR for over a decade , serving in its house of delegates from 1986 to 1989, and as chair of that body from 1987 to 1989. He was elected to the national board of directors in 1989 and served as its treasurer for two years before being selected as president-elect in 1993 . Lockwood also serves on the editorial board of The journal of Medicine and Global Survival. Lockwood has been a leading PSR spokesman against the Strategic Defense Initiative. He has also been instrumental in the development of PSR's programs to address environmental health + threats. Curtis Mettlin, Ph.D., (left) receives award fram Irvin Fleming, M.D., ACS president. Curtis Mettlin receives prestigious ACS Volunteer Leadership Award urtis ]. Mettlin, Ph.D., chief of epidemiologic research and director of the department of cancer control at Roswell Park Cancer Institute, received the National Volunteer Leadership Award from the American Cancer Society (ACS) . The award is given annually to ACS volunteers whose service to the national organization has been long and distinguished. Mettlin has written more than 180 articles, chapters and books on cancer. He was the principal investigator of the ACS's multi-institutional study that found the use of ultrasound and the prostate-specific antigen blood test in conjunction with digital rectal exam significantly increases the detection rate for prostate cancer. Mettlin has served on many national ACS committees and task forces dealing with issues as diverse as cancer detection and treatment, public and professional cancer education and developing strategies for all Americans to gain access to + cancer treatment and prevention. Carl Granger wins Frank Krusen Award for rehabilitation medicine arl V. Granger , M.D., associate chairman of the department of rehabilitation medicine, has been awarded the Frank H. Krusen Award for outstanding contribution to the field of rehabilitation medicine by the American Academy of Physical Medicine and Rehabilitation. Granger, who is also director ofUB's Center for Functional Assessment Research and co-director of the Multiple Sclerosis Center, was presented the award at the academy's annual meeting last November. The award was established nearly 25 years ago to honor one of the academy's founding fathers. Granger served as president of the academy from 1975 to 1976. He is the author of more than 90 publications and co-developer of the Functional Independence Measure and the Uniform Data System for Medical Rehabilita+ tion. 5 c a n S u m m e 9 9 4 �developed a powerful system that mimics many types of brain damage ." Langan observes that the close resemblance of the cultures to damaged $534 ,000 WILL FUND RESEARCH INTO ASTROCYTE brain was "a fortunate surprise. " GROWTH AND RECOVERY FROM BRAIN DAMAGE But his lab's efforts to sort out the biochemical controls were even more niversity at Buffalo neurologist percent of all approved grants, resulting surprising. Studying a class of cell-signaling proteins known as G proteins, Thomas]. Langan, M.D., has re- in five years of funding. The NIH reviewers described the researchers discovered that the modiceived a $534,000 National Institutes of Health grant to explore Langan's application as a "very strong fication of these proteins by by-prodthe link between astrocyte growth proposal which emphasizes a very im- ucts of cholesterol metabolism deterand recovery from brain damage. portant aspect of astrocyte cell biology. " mines whether the astrocytes divide or Studies by others have shown that differentiate. "One of the most satisfying (and rare) "We showed that this modification, things that can happen in biomedical newborn astrocytes in culture divide on called isoprenylation, determines research is for a focused area of labora- the normal developmental schedule, whether the astrocytes commit to divide tory work to rapidly provide clues to which in the intact brain is the main several important clinical problems," reason for the growth of the brain after or assume a more differentiated shape. In other words, there seems to be a Langan, associate professor of neurol- birth. common biochemical control mechaLangan discovered that the cultured ogy and pediatrics and an attending nism for these two critineurologist at The cal aspects of astrocyte Children's Hospital of function. " Buffalo , said. The NIH grant will Langan's research foallow Langan and felcuses on astrocytes, the low UB researchers star-like brain cells that Commitment RPoint Ronald Berezney, Ph.D. , "are by far the most nuStart Glls professorofbiology,and merous cells in the brain, Robert]. Plunkett, M.D. , even though their funcassistant professor of Flat, tions were mysterious Stellate, Proliferating Arrested neurosurgery , to study Astrocyte until around 20 years Astrocyte this mechanism and to ago. Modification of the cell-signaling proteins determines whether the astrocytes divide. determine how it ap"During the last deplies to the problem of cade in particular ," brain injury and recovery. Langan explains, "there has been in- astrocytes further resemble their counThe significance of the apparent link creasing evidence that astrocytes may terparts in the intact brain by maintainbetween the role of isoprenylation in be involved in controlling the fate of ing the capacity to divide again for many and differentiation , cell division control neurons , both in terms of normal devel- months. Langan says, "lies in the potential to opment and response to injury. " He also found that when the cultured But, he notes, very little is known astrocytes are stimulated to divide later, manipulate the astrocyte responses once about what coordinates the complex they act exactly as cells that respond to the control mechanisms have been defined. behaviors of astrocytes themselves many types of brain injury. "Since astrocytes play a key role in an area where Langan's recent findings "When stimulated," Langan says, responses of human brain to many types lie that has drawn interest from the "these cultured astrocytes express the of injury, ranging from trauma and mulationalinstitute of eurologic Disor- same proteins on the same time schedtiple sclerosis to Parkinson's Disease, the ders and Stroke. At a review meeting last ule as the cells in intact brain that are autumn , the NIH branch ranked involved in reactive gliosis, the hall- ability to control their actions could + Langan's grant application in the top 4 mark of brain injury. Therefore, we have have immense practical benefit." UB neurologist wins NIH grant B a 0 p h y 5 a n 5 m m e 9 4 �························································································• ·· ~ I I UB has 28 faculty physicians listed in this year'sedition of "Best Doctors in America" wenty-eight faculty members at the School of Medicine and Biomedical Sciences have been included in the second edition of The Best Doctors in America, a directory of the "best and brightest" in the medical profession. Best Doctors lists 7,200 physicians in more than 50 specialties - approximately 2 percent of the nation's 350,000 practicing physicians. The listing is compiled from interviews with thousands of specialists throughout the country who were asked to rate the clinical ability of their peers. UB faculty members who are included in Best Doctors are Mark Ballow, M.D., professor of pediatrics and chief of the division of allergy and immunology; David W. Bentley, M.D., former professor of medicine, director of the Multidisciplinary Center on Aging and director of the division of geriatrics; Clara D. Bloomfield, M.D., professor of medicine; Lawrence B. Bone, M.D., associate professor of orthopaedic surgery; Edward L Bradley, Ill, M.D., professor and vice chair of surgery; Linda S. Brodsky, M.D., associate professor of otolaryngology and pediatrics; Michael E. Cohen, M.D. , professor and chair of neurology; Patrick Creaven, M.D., associate research professor of pharmacology; Patricia Kresse! Duffner, M.D. , professor of neurology and pediatrics; Bradley P. Fuhrman, M.D., professor of pediatrics. Also, Robert Gillespie, M.D. , professor and chair of orthopaedic surgery; Marion Zucker Goldstein, M.D., clinical associate professor of psychiatry; Daniel Green, M.D., professor of pediat- B 0 0 p h Bone Bradley Brodsky Duffner Fuhrman Gillespie Goldstein Greenfield Herzig Hopkins Jacobs Middleton Min dell Nemoto Pincus Reisman Rossi Stapleton Voorhess Ballow Bentley Cohen Creaven Green MacGillivray orthopaedics; Takuma emoto, M.D., research associate professor of surgery; Stephanie Pincus, M.D., professor and chair of dermatology; Derek Raghavan, M.D., professor of medicine; Robert Reisman, M.D., clinical professor of medicine and pediatrics; Thomas M. Rossi, M.D., associate professor of pediatrics; F. Bruder Stapleton, M.D., A. Conger Goodyear professor and chair of pediatrics; and Mary Louise Voorhess, M.D., + professor emeritus of pediatrics. rics; Saul P. Greenfield, M.D. , associate professor of urology; Geoffrey P. Herzig, M.D., professor of medicine; L elson Hopkins, M.D., professor and chair of neurosurgery; Lawrence D.jacobs, M.D., professor of neurology; Kenneth A. Krackow, M.D., professor of orthopaedics; Margaret MacGillivray, M.D., professor of pediatrics. Also, Elliott Middleton, Jr., M.D., professor of medicine and pediatrics; Eugene R. Mindel!, M.D., professor of s o n 5 Raghavan m m e 9 9 �• ··· ··· ······ · ·· · ············ ·· · ·· ·· · ·· ···· ··· · ··· · ········· ·· ······· · · · ···· · ··· ··· ······ . I Judah Folkman, M.D, delivers 1994 Harrington Lecture NOTED RESEARCHER DISCUSSES GROUNDBREAKING THEORY OF ANGIOGENESIS AS WELL AS CLINICAL BREAKTHROUGHS USING ANGIOGENESIS INHIBITORS udah Folkman, M.D. , whose research led to the development of the theory of angiogenesis, delivered the 1994 D.W. Harrington Lecture, "Clinical Applications of Angiogenesis Research," discussing the history of his work with angiogenesis, as well as some recent clinical breakthroughs that saved the lives of children with tumors which, in the past, would have been fatal. Charles Paganelli, Ph.D., interim chair of the UB Department of Physiology, introduced Folkman, who is the julia Dyckman Andrus professor of pediatric surgery at Harvard Med1cal School. Paganelli praised Folkman's interest and achievement in a wide range of areas, including not only the theory of angiogenesis but also development of the contraceptive Norplant and of implantable cardiac pacemakers. Paganelli further praised Folkman for offering fundamental insights into the growth of capillary networks. Folkman, who is also professor of anatomy and cell biology at Harvard, is credited with discovering the mechanisms of angiogenesis, a concept that holds that solid tumor cancers may develop as a result of chemical signals released by tumor cells that cause the blood vessels in surrounding tissue to grow. Research is under way worldwide investigating angiogenesis and its relation to cancer and many other diseases. The theory of angiogenesis has been guided by two central questions , Folkman said. "First is the question of how angiogenesis, or blood vessel growth, is turned off in many physi- B u a 0 Judah Folkman, M.D. ological states," he said. "Then there's the opposite question: why is it not turned off in many pathological states, and why does it persist to the detriment of its host?" In attempting to answer these questions, angiogenesis research has focused on three basic areas, Folkman said: what cancer would be like in the absence of angiogenesis, what would human tissue be like without it and what would happen if all communication between tumor cells in the human body could be stopped, Folkman said. Folkman began his research into angiogenesis in the 1960s while serving a two-year term in the U.S. Navy at the Bethesda National Naval Medical Center. After completing an experiment to study hemoglobin solutions by infusing the thyroid glands of rabbits with those solutions and then measuring thyroid function, Folkman and his colleagues began to ask whether isolated glands p h y 5 c o n S could support growth, he said. That research led Folkman and his colleagues to publish the hypothesis that tumor growth was angiogenesisdependant, Folkman said. In simplest terms, he said, that hypothesis stated that after a tumor exists, every further increase in tumor mass must be preceded by the proliferation of new capillary blood vessels that converge upon the tumor. "Our hypothesis led to many experiments, and the field has now moved in a number of basic directions," Folkman said. In the 1970s, Folkman began to work on isolating a variety of angiogenesis factors. After some years of failed work, Folkman finally managed to compile a list of those basic factors . "The list had great transformative pow ers for angiogenesis research," Folkman said. "It transformed my critics into my competitors." But it wasn't until1990 that researchers finally gained direct evidence that tumor growth was angiogenesisdependant, Folkman said. "Only four years ago did our many years of lab research begin to be translated to clinical trials," he said. Recent clinical trials have fallen into three basic categories, Folkman said: trials of angiogenic peptides that accelerate angiogenesis, the administration of angiogenesis inhibitors for patients with tumors and trials that attempt to understand the principles of prognostic tests in cancer. The discovery of angiogenesis inhibitors has taken place "primarily under weird circumstances," Folkman said, u m m e 9 9 4 �· ····· · ···· ·· · ·· ···· ··· ·· · ·· ·· · · · ·· ···· ··· ··· ·· ··· ···· · · ··· · · · · · · · · ·· · ···· ··· · · · · · ·· · ···[ i ] , ~ I - B BY u M A R K a WA 0 tion is a not-for-profit organization that brings together medical education and research, health care providers, health care manufacturers and health care-related businesses to explore issues facing the industry. + Health Care Industries Association presents Awards for Excellence suggesting that many inhibitors were discovered by accident rather than by controlled experiment. 1989 saw the first successful treatment of universally fatal pulmonary hemangioma by the angiogenesis inhibitor alpha-interferon. On hearing the news, Folkman and others were understandably skeptical, he said, but further investigation proved the treatment was valid. The administration of alpha-interferon has already saved 53 people, mostly children, who otherwise would have died of their tumors , Folkman said. "A whole series of tumors can now be held to dormancy by angiogenesis inhibitors," he said. "We're beginning to think that in the near future cancer patients, on their first biopsy, will have angiogenesis profiles perfomed," Folkman said. "They will also have long-term angiogenesis treatment to extend the dormancy of their cancer. " Folkman served as surgeon-in-chief at Children's Medical Center in Boston for 14 years before resigning in 1981 to conduct research full- time after his 1980 appointment to Harvard. A member of the National Academy of Sciences, Folkman counts among his many honors a 10-year Merit Award from the National Cancer Institute in 1989, the American Cancer Society's Medal of Honor for basic science, Israel's Wolf Prize in Medicine and the Christopher Columbus Award in Biomedical Research from the National Institutes of Health. The Harrington Lecture is sponsored by the School of Medicine and Biomedical Sciences. The D.W. Harrington Lecture Fund was established in 1886 by Devillo White Harrington, M.D., an 1861 graduate of the UB medical school and a professor of genito-urinary and vene+ real diseases from 1886 to 1905. oswell Park Cancer Institute , Herbert Hauptman, Ph.D., and Wilson Greatbatch were among the individuals and institutions recognized by the Health Care Industries Association's first Annual Awards for Excellence. The Economic Impact Award for Excellence was awarded to Roswell Park Cancer Institute. The award was cosponsored by the Western New York Economic Development Corporation. Special President's Awards were presented to Nobel Laureate Hauptman, UB research professor of biophysical sciences, and Greatbatch, adjunct professor of electrical and computer engineering, for their dedication to the Health Care Industries Association and their overall contributions to the health care industries of Western New York. UB President William Greiner delivered the keynote address. The Health Care Industries Associa- Nolan named chair of College of Physicians Board of Regents ames P. Nolan , M.D. , professor and chair of the Department of Medicine has been elected to a one-year term as chair of the American College ofPhysicians Board of Regents. Nolan has served on the 26member board since 1989 and was vice chair in 1993. Prior to joining the board, he was the society's governor for New York State for four years , winning the Governor of the Year Award in 1988. He also served as president of the New York State chapter from 1987 through 1988. In addition to his UB appointments, Nolan serves as director of medicine at Erie County Medical School. + At left, Herbert Hauptman, Ph.D., and Wilson Greatbatch receive Health Care Industries awards. LLACE p h y 5 c a n S u I m m e 9 9 4 �• ··················································································· · ···· . I UB signs unique clinical psychiatry agreement BUFFALO PSYCHIATRIC CENTER , WESTERN NEW YORK CHILDREN'S PSYCHIATRIC CENTER JOIN THE UNIVERSITY'S MULTIDISCIPLINARY CLINICAL TEACHING SITES the state Office of Mental Health; john Naughton, M.D., vice president for clinical affairs and dean of the School of Medicine and Biomedical Sciences; George Molnar, M.D., UB associate professor of psychiatry and executive director of the Buffalo Psychiatric Center; and Allen R. Morganstein, M.D., clinical director of the Western ew York Children's Psychiatric Center. UB, ~rimarily through its department of psychiatry, has used the two facilities to train students and residents for some time, but never had a formal working agreement with them. As a result of the agreement, a 10-member committee from the three institutions will be formed to oversee the educational and research programs the facilities operate. he Buffalo Psychiatric Center and the Western New York Children's Psychiatric Center became formal UB clinical teaching sites in a contract-signing ceremony held in March. The five-year renewable agreement between UB and the New York State Office of Mental Health opens new teaching and multidisciplinary research opportunities at the centers for UB faculty, students and medical residents, and provides the centers' physicians and staff access to UB's faculty and research facilities. Participating in the signing were UB President William R. Greiner; Philip B. Wels, M.D., chair of the UB Council; Richard Surles, Ph.D., commissioner of From left: William Greiner; Ri(hard Surles, Ph.D.; John Naughton, M.D.; Philip Wels, M.D.; Allen Morganstein, M.D.; and George Molnar, M.D., at the March signing (eremony. B a a p h s c a n s The new contract opens the centers' doors to the UB schools of dental medicine, nursing, pharmacy and health related professions, as well as to faculty and graduate and undergraduate students in clinical psychology and social work. The centers will provide equipment, lecture rooms and laboratories, in addition to faculty, for teaching and joint clinical research activities. "Collaboration with local providers has already proven to be an outstanding model for clinical training in UB's School of Medicine and Biomedical Sciences," Greiner stated. "We are delighted that the Buffalo Psychiatric Center and the Western New York Children's Psychiatric Center will join UB's group of clinical affiliates. Greiner praised Surles for his support, adding, "This sort of joint effort of the state, local providers and the university can do much both to enrich UB's education and training programs and to enhance care delivery for our fellow Western New Yorkers." Naughton, who will be UB's primary liaison with the centers and was instrumental in negotiating the agreement, said the relationship is a welcome step in the university's efforts to expand opportunities for clinical teaching and research for its students and faculty. "This contract confirms that these two psychiatric centers are very important facilities in our community," Naughton said. "The opportunities the agreement presents for interdisciplinary research and innovative learning are enormous. The inclusion of these facilities in the university family will add u m m e 9 9 �The images assist in pre-operative planning of the implant site, direct visualization of how well the implant will fit and ascertain the need for building up bone tissue before implantation. DelBalso is currently president of the American Board of Oral and Maxillofacial Radiology. He is the only physician in the U.S. who is board certified in both medical diagnostic radiology and oral maxillofacial radiology. + significantly to our educational opportunities, particularly in the areas of pediatric psychiatry and in the care of the chronically ill. " The affiliation offers a model that deserves replication in other areas of the state, Surles noted. "This agreement not only creates outstanding educational and research opportunities for university students and the psychiatric centers' staffs, it provides the agency with a formal role in academic training - a first for the state Office ofMental Health." Molnar praised the mutually beneficial agreement. "Our expectations are high ," he said, "and our enthusiasm is great. We look forward to many new opportunities for joint teaching andresearch activities , and to increased collaboration with the university's schools and departments. " Morganstein said, "The agreement will be beneficial to the university, as well as to the Western New York Children's Psychiatric Center, in providing opportunities for professional growth of staff. Ultimately, this will filter down to the community by providing enhanced clinical services." + B Y L OIS B AKE - 0 0 p 'i( Convenient Downtown Location Quick Metro Ride to Main Street Campus and Medical School 'i( Close to Buffalo General, Roswell, ECMC and Children's Hospitals tephen B. Edge, M.D. , chief of the breast division of the department of surgical oncology at Roswell Park Cancer Institute , has been appointed to a panel of health care experts and consumers to evaluate breast cancer treatment in New York State. The new Breast Cancer Treatment Quality Advisory Panel will gather data on treatment strategies, measure the quality of breast cancer treatment in New York and recommend ways to improve its effectiveness. Edge, the only Western New Yorker appointed to the advisory panel, has served as chief of RPCI's breast division since 1992. He is an investigator with the National Surgical Adjuvant Breast and Bowel Project. A fellow of the American College of Surgeons, Edge is a member of the American Society of Clinical Oncology and the Society of Surgical Oncology. + R h 'i( Conference Planning Professionals Stephen Edge named to state breast cancer advisory panel ngelo M. DelBalso, M.D., D.D.S. , interim chairman of the department of radiology, recently addressed the Third International Congress of the Dutch Society of Oralimplantology. DelBalso, clinical director of Erie County Medical Center's department of radiology, explained how readily available computer software can be used for three dimensional imaging in connection with permanent tooth replacements. u 18,000 Square Feet of Meeting Space 'i( DelBalso addresses Dutch Society of Oral lmplantology Congress B The Perfect Prescription For Your Conference Needs y s o n S u 'i( Your Guests Can Walk to Theatre, Shops, Pilot Field, Restaurants, Entertainment 'i( CME Friendly 'i( Great Banquet Food Please Talk T o Us A bou t Preparing A Proposal So You Can Bring Your Group's Next Convention To Buffalo (716) 856-1234 6142 EXTENSION HYATI. WE'VE THOUGHT OF EVERYTHING ~M H~Y--A--T"T REGENCY BUFFALO m m e 9 9 4 �• ··················· · ·· · ···················· · ················ ·· · · ··········· ·· ····· · ····· . I UB wins federal rehabilitation research grant $2 .4 MILLION WILL FUND NATION'S FIRST CENTER TO DEVELOP OBJECTIVE STANDARDS TO MEASURE DISABILITY AND ITS EFFECTS he University at Buffalo has received a $2.4 million federal grant to establish the nation's first center charged with developing objective standards to measure disability and its effects, and to assess the effectiveness of rehabilitation programs designed to treat disabilities and improve function. The new Rehabilitation Research and Training Center on Functional Assessment and Evaluation of Rehabilitation Outcomes will fund seven research projects over the next four years. The work will involve faculty from UB's department of rehabilitation medicine and its schools of nursing, health related professions and architecture and planning. The new center will also collaborate with five other academic rehabilitation centers - Craig Hospital in Englewood, Colorado; Rehabilitation Institute of Chicago; Kessler Institute for Rehabilitation, Inc., West Orange, New jersey; The Ohio State University; and Brown University. D'Youville College in Buffalo will work with the UB center to develop a curriculum in functional assessment studies. "Our charge is to introduce a more scientific approach to measuring the abilities and limitations of people living with handicaps," said Glen E. Gresham, M.D., professor and chair of the department of rehabilitation medicine and the grant's project director. "We hope to develop uniform standards for measuring disability and the methods disabled people use to adapt that everyone accepts and understands." B u 0 0 Glen Gresham, M.D. Currently, there is no system to classify disabilities according to severity, or to a standard rehabilitation regimen based on severity, Gresham said. "In this era of health care reform," he noted, "the field of rehabilitation medicine must be able to prove the value of its services. Research conducted through this new center will enable us to define disabilities clearly, tell which rehabilitation approaches are most valuable and will allow rehabilitation workers across the country to use a common language to describe patients and their problems." The center's seven research projects and the academic rehabilitation centers involved are: • Handicap assessment - to improve the classification of handicaps (UB and p h y 5 c 0 S Craig Hospital). • Relationship of treatment to outcomes- to determine how much rehabilitation programs help patients (UB, Rehabilitation Institute of Chicago and Kessler Institute for Rehabilitation) . • Measuring handicapping environments - to identify barriers that produce handicaps and measure the extent of their effect (UB). • Characteristics of effective, efficient medical rehabilitation programs - to determine why one program works better than another (UB, Rehabilitation Institute of Chicago and Kessler Institute for Rehabilitation). • Determining which functional assessment measure can best be applied to persons with traumatic brain injury (UB u m m e 9 9 4 �Msall elected to membership in Society for Pediatric Research and The Ohio State University). • Validity of telephone interview versus personal interview for completing the Functional Independence Measure, a score used to follow a patient's progress and measure the outcomes of a rehabilitation program (UB). • Determining whether social support enhances rehabilitation outcomes (UB , Kessler Institute for Rehabilitation and Brown University) . The grant also calls for developing a curriculum in functional assessment studies, which will be offered initially by UB and D'Youville College; writing a training manual on using functional assessment instruments; and hosting a national conference on functional assessment to be held in conjunction with the International Rehabilitation Medicine Association's annual meeting. UB has been in the forefront of medical rehabilitation for the past decade. UB researchers have led a national effort to develop the Uniform Data System for Medical Rehabilitation that includes the Functional Assessment Measure - a standard now employed nationally and internationally by facilities treating severely disabled people to define ability to perform common tasks. UB's department of rehabilitation medicine also established a national database that currently holds more than 400,000 patient records. Byron Hamilton, M.D., clinical associate professor of rehabilitation medicine, is principal investigator on the grant. Nadine Fisher, Ed.D., clinical assistant professor, is program coordinator and james A. Phillips, clinical instructor, is fiscal manager. The new research and training center will function within the framework of the UB Center on Functional Assessment Research, directed by Carl Granger, M.D., professor of rehabilitation medicine. + B B u Y L OIS a B 0 ichael Msall , M.D. , associate professor of pediatrics and rehabilitation medicine, has been elected to membership in the Society for Pediatric Research. Membership in the national organization is based on research record, sponsorship by members in one's specialty area and a vote by the full membership. Msall's research has focused on the problems and consequences of extreme prematurity and functional independence in children with Down 's syndrome, cerebral palsy and neurodevelopmental disabilities. His work was published recently in Clinical Pediatrics and appeared in the February issue of the journal of Perinatology. + • Apple • IBM • Dell • Insight • Panasonic • Canon • TI • Software • Supplies • Accessories • Audio • Hands-on Workshops ATeam Effort -In March, New York State Assemblyman Sam Hoyt presented Dean Naughton with the pen Governor Mario Cuomo used to execute legislation Hoyt co-sponsored that enabled the University Medical Practice Services to be classified as not-for-profit, and therefore, tax-exempt in New York State. lml ,Dllltlri A non-profit University program for students. faculty & The Commons • North Campus • (7 16) 645 -3554 • Fa x: AKER p h y 5 c a n 5 m m e 9 9 �THEN&IiiiiNOW Traditions and training varied for first med students TWO LECTURE COURSES REQUIRED FOR GRADUATION FROM FIRST CLASS OF UNIVERSITY OF BUFFALO SCHOOL OF MEDICINE • ' first medical students differed from their counterparts of today in just about every way: I their demographics , ._ 1i their age , their premedical school training and their medical school training. Sixty-seven students comprised the first class of the University of Buffalo School of Medicine. Students then were required to be at least 15 years old, although the majority of the class were 18 to 21. All 67 students were white males and many were already apprenticed to a "competent physician licensed by a county medical society." Three years of such apprenticeship were required before the degree of doctor of medicine was awarded. Like students now, students then paid fees-$2 for matriculation, $5 for graduation and $10 each to six of the seven professors who gave lectures or demonstrations. The professor of chemistry was paid $12 from each student because they used his equipment. But unlike today, UB had "no provision for gratuitous aid" - no scholarships. The school's first classes were held in a wooden building (formerly the First Baptist Church) on the corner of Seneca and Washington Streets in downtown Buffalo. Sold by the church in 1836, the building was used successively since then as a customs house, post office and police court. The university paid $700 to renovate the church for its use. The yearly rent came to $300. A library of 519 volumes ~ J B ~ a 0 The school's first classes were held in a wooden building (formerly the First Baptist Church) on the corner of Seneca and Washington Streets in downtown Buffalo. was valued at $829.96; its museum of anatomical, pathological and surgical preparations and drawings cost $250. An amphitheater accommodated 200. Instruction nearly 150 years ago was primarily by "lectures, demonstrations , clinical illustrations and recitations." Students weren't required to take notes , but that method of learning was highly recommended. Lecture courses lasted 16 weeks. Two such courses were required for graduation. Students often audited the same course twice. Most clinical experience was gained through apprenticeships in the dispensary of the school and the county p h y s c a S u m m e 9 4 �THENI!IiEIN 0 W .............................. r:_-· .. ./":,·~········· -~· .----on ..._ free to indigent patients and others willing to be observed by students. Students were allowed into the wards of the almshouse at no charge "at such hour of each day as the several medical officers are in attendance." And students then not only had to meet the school's academic standards, they had to be "of good moral character" to qualify for a diploma. The council of the university's first report to the Regents of the State of New York notes that the faculty can "exercise the power of expulsion for crimes of immoral conduct." But, it added, "no occasion for the exercise of this power occurred during the last year." Three weeks before the close of the lecture term, students in the university's first class delivered to the dean or registrar a dissertation "on some medical subject which must be examined and approved by the faculty previous to the examination for the degree" before they could receive their diplomas. Diplomas then were licenses to practice. It was required, however, that they were deposited on file with the Erie County Clerk. Specialists, of course, didn't exist nearly 150 years ago and most students set up their own offices or went into joint practice with an older, experienced physician. Surgery then was confined largely to emergency procedures. In his centennial address in 1946, George W. Thorn, M.D., a UB alumnus, pointed out that 100 years earlier only seven specific medications existed for disease - digitalis or foxglove for heart disease, quinine for malaria, cowpox vaccination for smallpox, vermifuges for intestinal parasites, mercury for syphilis, iron for hypochromic anemia and iodine, which had proved important in preventing goiter. + I ·~;t1 Ill 01 \tf •. ~·- :.·#. ­ :-: -- ......... --- -~ e -u a a p h 5 c a - n 5 u m BY m e MILDRED 9 SANES 9 4 �• ···················· · ······ · · · ········· · ········· · ···· ·· ···· ·· · · ·· · ······· · ····· · ·· · ··· · . I Francis P. Alcedo , Internal Medicine, Yale-New Haven Hospital, New Haven, Connecticut Class of '94 wins big in Match Day Robin] . Arent, Pediatrics, Eastern Virginia Graduate School of Medicine, Norfolk, Virginia 87 PERCENT OF US'S GRADUATING MEDICAL SCHOOL Kenneth] . Baker , Obstetrics and Gynecology, St. Barnabas Medical Center, Livingston, New jersey SENIORS GET ONE OF THEIR FIRST THREE CHOICES Daniel] . Barbero, Medicine/Pediatrics, Ohio State University Hospitals, Columbus, Ohio raduating seniors from UB's medical school fared well in this year's national match for residencies. A full 87 percent of the students who participated in the program were matched with one of their first three choices for residency programs, and 67 percent of them got their first choice, according to Dennis Nadler, associate dean for curricular and academic affairs. Forty-four percent of the class will pursue a residency in one of the primary care specialties: 10 in family practice, 32 in internal medicine, 18 in pediatrics and seven in combined medicine/pediatrics. Thirty-four percent of UB's graduating seniors will stay in the Buffalo area and 14 percent will remain elsewhere in the state to pursue their residencies. Fifty-two percent will pursue residencies out of state. Following is a list of students from the Class of '94 and their matches. p T 0 H 0 y B 5 5 M 0 T N N 0 Chad L. Beatty, Surgery (Prelim), University at Buffalo Graduate Medical Dental Consortium Martha I. Bennett, Family Practice, University Hospitals of Cleveland, Cleveland, Ohio Paula A. Bennett, Family Practice, University of Maryland-Baltimore, Baltimore, Maryland Jennifer J . Bergoine, Pathology, Medical College of Virginia, Richmond, Virginia Antonio M. Bird, Psychiatry, University of North Carolina Hospital, Chapel Hill, North Carolina Joel S. Brenner, Pediatrics, Eastern Virginia Graduate School of Medicine, Norfo lk, Virginia G Brian P. Brett, Medicine/Pediatrics , Morristown Memorial Hospital , Morristown , New jersey Tracy L. Brobyn, Family Practice, Mountainside Hospital , Verona, New jersey Daphine A. Brown, Internal Medicine, Oakwood Hospital , Dearborn, Michigan Gregory M. Bugaj , Internal Medicine, Mt. Zion Medical Center of the University of California at San Francisco, San Francisco, California Thomas M. Burnette, Internal Medicine, University Health Center-Pittsburgh, Pittsburgh, Pennsylvania Enrico Caiola, Medicine/Pediatrics, Baystate Medical Center, Springfield, Massachusetts Maria T. Cartagena, Surgery (Prelim), University at Buffalo Graduate Medical Dental Consortium, Uro logy, University at Buffalo Graduate Medical Dental Consortium William L. Cecere, Surgery (Prelim), University at Buffalo Graduate Medical Denta l Consortium james F. Chmiel, Surgery (Prelim), University Hospitals of Cleveland, Cleveland, Ohio Scott P. Cholewinski, Internal Medicine (Preli m), University at Buffalo Graduate Medical Denta l Consortium , Radiology - Diagnostic, Strong Memorial Hospital, Rochester, New York James Chmiel is congratulated by assistant dean Frank Schimpfhauser. B u a 0 p h y s c a n 5 u m m e 9 9 4 �................................ Below, Charles Rocci looks on as Christian DeFazio and his fiancee, Elizabeth Olson, open his match. Left, DeFazio, who will study emergency medicine at the University of Illinois, is congratulated by Olson and Falsone. Dennis B. Chugh, Internal Medicine, St. joseph's Hospital and Medical Center, Phoenix, Arizona Lynn M. Cieslak, Internal Medicine, St. joseph's Hospital and Medical Center, Phoenix, Arizona Kelli A. Cooney, Pediatrics, All Children's Hospital, St. Petersburg, Florida Devin A. Coppola, Family Practice, St. joseph's Hospital Health Center, Syracuse, New York Edwardj. Cosgrove, Internal Medicine University at Buffalo Graduate Medical ~ental Consortium Kirsta Leale Craig, Family Practice, Southside Hospital, Bay Shore, New York Joseph P. Cronin, Medicine/Pediatrics University at Buffalo Graduate Medical,Dental Consortium Ketan C. Dave, Surgery, Providence Hospital, Southfield, Michigan Maria L. Davis, Emergency Medicine, HarborUniversity of California at Los Angeles Medical Center, Los Angeles, California Christian R. DeFazio, Emergency Medicine, University of Illinois College of Medicine at Chicago, Chicago, Illinois Glen T. Feltham, Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, Tracey I. Demino, Surgery (Prelim), North Shore University Hospital, Manhasset, New York Ohio Nita K. Divan, Physical Medicine and Rehabilitation, University at Buffalo Graduate Medical Dental Consortium Amy E. Ferry, Obstetrics and Gynecology, St. Luke's Hospital of Bethlehem, Bethlehem, Pennsylvania Todd A. Dorfman, Surgery, Maine Medical Sarah G. Finnegan-Sloan, Internal Medicine (Prelim) , University at Buffalo Graduate Medical Dental Consortium, Neurology, University at Buffalo Graduate Medical Dental Consortium Center, Portland, Maine Winston G. Douglas, Internal Medicine, University at Buffalo Graduate Medical Dental Consortium Mark D. Fisher, Internal Medicine (Prelim), University at Buffalo Graduate Medical Dental Consortium , Anesthesiology, University at Buffalo Graduate Medical Dental Consortium Brian C. Dowdell, Internal Medicine (Prelim), Sisters of Charity Hospital, Buffalo, New York, Physical Medicine and Rehabilitation, Stanford University Hospital, Palo Alto, California Lorna K. Fitzpatrick, Pediatrics, St. Louis Children's Hospital at Washington University Medical Center, St. Louis, Missouri john L. D'Souza, Internal Medicine (Preli m), Strong Memorial Hospital, Rochester, New York, Radiology- Diagnostic, Rochester General David S. Foley, Surgery, Bowman Gray School of Medicine/North Carolina Baptist Hospital, Winston-Salem, North Carolina Hospital, Rochester, New York Darlene A. Durkin, Pediatrics, University at Buffalo Graduate Medica l Dental Consortium Maura P. Foley, Internal Medicine, University of Virginia, Charlottesville, Virginia joseph M. Falsone, Internal Medicine, University at Buffalo Graduate Medical Dental Deborah L. Delozier, Obstetrics and Gynecology, Strong Memorial Hospital, Rochester, New York Patricia A. Geil, Pediatrics, University at Buffalo Graduate Medical Dental Consortium Consortium Maureen A. Fay, Internal Medicine, University of Connecticut, Farmington, Connecticut Petros Ghermay, Psychiatry, University of California at San Francisco, Fresno, California Gloria M. del Valle, Pediatrics, University at Buffalo Graduate Medical Dental Consortium e u a a p h 5 c a n 5 u m m e 9 9 4 �Michael T. Giovanniello, Physical Medicine Presbyterian-St. Luke's Medical Center, Denver, Albany Medical Center Hospital , Albany, New and Rehabilitation, Ohio State University Colorado, Radiology- Diagnostic, University of York , Radiology- Diagnostic, Albany Medical Hospitals , Columbus, Ohio Co lorado, School of Medicine, Denver, Colorado Center Hospital , Albany, New York Douglas J. Golding, Family Practice, University Horacio Gutierrez, Internal Medicine (Prelim), Diane R. Heimback Morrison, Obstetrics and at Buffalo Graduate Medical Dental Consortium Sisters of Charity Hospital, Buffalo, New York, Radiology - Diagnostic, University of Colorado Gynecology, University at Buffalo Graduate Mabel P. Gong, Obstetrics and Gynecology, New Medical Dental Consortium School of Medicine, Denver, Colorado York Downtown Hospital , New York, New York Idalia M. Gonzalez, Pediatrics, University at Buffalo Graduate Medical Dental Consortium james D. Gould, Internal Medicine (Pre lim), Geoffrey G. Hobika , Internal Medicine, Sandra M. Gutierrez, Surgery , The Brooklyn University at Buffalo Graduate Medical Dental Hospital Center, Brooklyn, New York Consortium George E. Haddad , Internal Medicine, Karen L. Houck, Obstetrics and Gynecology, University at Buffalo Graduate Medical Dental Consortium, Anesthesiology, Duke University University at Buffalo Graduate Medical Dental University at Buffalo Graduate Medical Dental Consortium Consortium Medical Center, Durham, North Carolina Tegest F. Hailu, Family Practice, University of Carline T. Hyppolite, Internal Medicine Theodore S. Grabow, Transitional Year, California at San Francisco, Fresno, California (Prelim), North Shore University Hospital, Manhasset, New York Hennepin County Medical Center, Minneapolis, Minnesota, Anesthesiology, The University of Medical Center of Eastern Carolina, Greenville, Patricia E. Allen Iheke, Obstetrics and Chicago Hospitals, Chicago, Illinois North Ca roli na Gynecology, University at Buffalo Graduate Kim S. Griswold , Family Practice, University at Christian H. Hansen, Pathology, Georgetown Buffalo G raduate Medical Dental Consortium University Hospital, Washington, D.C. Geoffrey M. Gullo, Tra nsitional Year, George]. Hatsios, Interna l Medicine (Pre lim), Steven D. Hammel, Pediatrics, University Medical Dental Consorti um Gregory T. jehrio, Internal Medicine, Mary Imogene Bassett Hospital, Cooperstown , New York B a a p h 5 c a 5 m m e 9 9 4 �.. . ...... . . .. .... . . . ..... . .. .. . . ...... . . .. ..... . ... .. .. . . . .. . . . ....... . ... . ...... . ... • ~ Above, Todd Schlesinger, left, and Atif Zafar get the good news. At left, Charles Rocci, Stephen Machnicki, Michael Giovaniello, Joseph Falsone and Glen Feltham celebrate. Andrew D. jenis, Surgery, University at Buffalo Graduate Medical Dental Consortium Jeffrey W . Kanski, Internal Medicine (Prelim), Roger Williams Hospital, Providence, Rhode Island Joseph D. Kay, Medicine/Pediatrics, University of Michigan Hospitals, Ann Arbor, Michigan Barbara P. Kearney, Pathology, University at Buffalo Graduate Medical Dental Consortium Glenn E. Kershen, Surgery (Prelim), Temple University Hospital, Philadelphia, Pennsylvania, Urology, Temple University, Philadelphia, Pennsylvania Carol Ann Killian, Emergency Medicine, University Health Center of Pittsburgh, Pittsburgh, Pennsylvania Richardj . Kozak, Emergency Medicine, Oregon Health Sciences University , Portland, Oregon Michaelj . Krabak, Internal Medicine, Barnes Hospital, St. Louis, Missouri David G. Kupkowski, Internal Medicine, United States Naval Medical Center, Portsmouth, Virginia Michael K. Landi, Surgery (Prelim), University at Buffalo Graduate Medical Dental Consortium , Neurological Surgery , University at Buffalo Graduate Medical Dental Consortium Timothy J. Larosa, Psychiatry, University Hospitals of Cleveland, Cleveland, Ohio Christian D. Lates, Pathology, University at Buffalo Graduate Medical Dental Consortium s u a 0 p janet M. Lawrence, Medicine/Pediatrics, University at Buffalo Graduate Medical Dental Lauraj. Nicholson, Internal Medicine, Strong Memorial Hospital, Rochester, New York Consortium Paulj . Lee, Internal Medicine, Albert Einstein Affiliated Hospitals, Bronx, New York Michael P. O'Neill, Radiology- Diagnostic, University of South Florida College of Medicine, Tampa, Florida Wendy L. Leffel, Family Practice, Forbes Health System , Pittsburgh, Pennsylvania juliana S. Paik, Pediatrics, University of California at San Fra ncisco, Fresno, California Chien H. Lin , Surgery, Nassau County Medical Center, East Meadow, New York Michaelj. Pelechaty, Jr. , Internal Medicine, Guthrie Healthcare System/Robert Packer Hospital, Sayre, Pennsylvania Stephen C. Machnicki, Internal Medicine (Prelim) , Winthrop-University Hospital, Mineola , New York, Radiology- Diagnostic, Lenox Hill Hospital , New York, New York Michelle D. Penque, Pediatrics, University at Buffalo Graduate Medical Dental Consortium Sean Perini, Internal Medicine (Prelim), University of Washington, Seattle, Was hington, Radiology - Diagnostic, University of California at San Francisco, San Francisco, California Andres M. Madissoo , Surgery (Prelim) , University at Buffalo Graduate Medical Dental Consortium , Urology , University at Buffalo Graduate Medical Dental Consortium Richard G. Pinckney, Internal Medicine, Medical Center Hospital of Vermont, Burlington, Stacey A. Madoff, Obstetrics and Gynecology, George Washington University, Washington, D.C. Vermont john Pollina, Surgery , University at Buffa lo Graduate Medical Dental Consorti um Rita M. Malvaso , Internal Medicine (Prelim) , Baylor University Medical Center, Dallas, Texas, Physical Medicine and Rehabilitation, University of Texas Southwestern Medical School , Dallas, Ulka Prakash, Internal Medici ne (Prelim), University of Mary land School of Medicine, Baltimore, Mary land, Anesthesiology, johns Hopkins Hospital , Baltimore, Mary land Texas Frankj . Mascaro, Internal Medicine, University at Buffalo Graduate Medical Dental Consortium john Pryor, Surgery, University at Buffa lo Graduate Medical Dental Consorti um john R. McArdle, Internal Medicine, Yale-New Haven Hospital , New Haven, Connecticut Nasser Razack, Surgery (Preli m), No rth Shore University Hospita l, Manhasset , New York Elizabeth A. McClintick, Internal Medicine (Prelim), University at Buffalo Graduate Medical Dental Consortium , Anesthesiology, University at Buffalo Graduate Medical Dental Consortium Edward D. Reidy, Internal Medici ne (Preli m), Sisters of Charity Hospital, Physical Medicine and Rehabilitation , New England Med ical Center, Boston, Massachusetts Lisa L. Miller, Pediatrics, Rhode Is land Hospital , Providence, Rhode Island Stephanie C. Mitchell, Internal Medicine, Overlook Hospital, Summit, New jersey Cindy D. Repicci, Physical Medicine and Rehabili tation, Univers ity at Buffalo Graduate Medical Dental Consortium Paulj . Mus tacchia, Internal Medicine (Prelim), Presbyterian Hospital, New York, New York Charles A. Rocci, Emergency Medici ne, Albany Medical Center Hospi tal, Albany, New York Erns t Nanor, Internal Medicine (Preli m), Norwalk Hospital , Norwalk , Connecticut, Anesthesiology, Tula ne University School of Medicine, New Orleans, Louisiana Thomas Romanelli, Internal Medici ne (Preli m), University Hospitals, SUNY at Stony Brook, Stony Brook, New York , Anesthesio logy, University at Buffalo Graduate Medical Dental Consortium Michael A. Nasiak, Internal Medicine, University at Buffalo Graduate Medica l Dental Consortium Paul J. Sagerman, Pediatrics, St. joseph's Hospital, Phoenix, Arizona Tung V. Nguyen, Internal Medicine, Kaiser Foundation Hospital, San Francisco, California Diana R. Sanderson, Psychiatry, University at Buffa lo Graduate Medical Denta l Conso rtium 5 c a n s u m m e 9 9 4 �• ·············· · ····· · ············ ·· ················ · ··········· · ··· · ········ · ···· ·· ····· ~ I jennifer M. Thompson, Obstetrics and Gynecology,]ersey Shore Medical Center, Neptune, New jersey Gregory V. Tobias, Internal Medicine (Prelim), University at Buffalo Graduate Medical Dental Consortium, Anesthesiology, University at Buffalo Graduate Medical Dental Consortium Madonna R. Tomani, Obstetrics and Gynecology, University at Buffalo Graduate Medical Dental Consortium jennifer M. Tufariello, Obstetrics and Gynecology, Ohio State University Hospitals, Columbus, Ohio joseph S. Valenti, Obstetrics and Gynecology, University at Buffalo Graduate Medical Dental Consortium Yvette M. Vinson, Surgery (Prelim), Strong Memorial Hospital, Rochester, New York, Otolaryngology, University of Rochester, Rochester, New York From left, Carhne Hyppohte, Paula Bennett, Andrea Withams, Gloria Del Valle, Jennifer Thompson and Patrida lheke share their joy. Pina C. Sanelli, Anesthesiology, Albany Medical Center Hospitals, Albany, New York james W. Spain, Radiology -Diagnostic, Milton S. Hershey Medical Center of Pennsylvania State University, Hershey, Pennsylvania Paul Sansone, Internal Medicine, DartmouthHitchcock Medical Center, Lebanon, New Hampshire Michael Stanton, Internal Medicine, University of Michigan Hospitals, Ann Arbor, Michigan, Neurology, University of Michigan Hospitals, Ann Arbor, Michigan Mark W. Sheldon, Internal Medicine, Hospital of the University of Pennsy lvania, Philadelphia, Pennsy lvania Donna M. Stawasz, Medicine/Pediatrics, University at Buffalo Graduate Medical Dental Consortium john T. Sherwood, Internal Medicine, johns Hopkins Hospital, Baltimore, Maryland Donna G. Sinensky, Transitional, Mercy Catholic Medical Center, Darby, Pennsy lvania, Physical Medicine and Rehabilitation, New England Medical Center, Boston, Massachusetts Gregory H. Stiller, Surgery (Prelim), University of Colorado School of Medicine, Denver, Colorado Mary E. Stock, Internal Medicine, University at Buffalo Graduate Medical Dental Consortium Donald M. Slate, Pathology, University at Buffalo Graduate Medical Dental Consortium Sisters of Charity Hospital, Buffalo, New York, Anesthesiology, McGaw Medical Center of Northwestern University, Chicago, Illinois Sharon A. Szukala, Pathology, Duke University Medical Center, Durham, North Carolina Wendy I. Snyder , Pediatrics, University at Buffalo Graduate Medical Dental Consortium Behzad Tabibian,Internal Medicine, CedarsSinai Medical Center, Los Angeles, California Kenneth A. Sobel, Pediatrics, University at Buffalo Graduate Medical Dental Consortium a a h • c a n Amy L White, Pediatrics, University at Buffalo Graduate Medical Dental Consortium Andrea M. Williams, Surgery, University at Buffalo Graduate Medical Dental Consortium Douglas W. Wisor, Transitional, Reading Hospital and Medical Center, Reading, Pennsylvania, Physical Medicine and Rehabilitation, Medical College of Virginia, Richmond, Virginia Theodros Yohannes, Surgery, University of Louisville School of Medicine, Louisville, Kentucky, Urology, University of Louisville School of Medicine, Louisville, Kentucky Atif Zafar, Internal Medicine, University of + Cincinnati Hospital, Cincinnati, Ohio Debra R. Tarantino, Surgery, University Hospitals of Cleveland, Cleveland, Ohio p Christina G. Weston, Psychiatry, United States Air Force Medical Center (Wright-Patterson), Dayton, Ohio Christopher F. Wood, Internal Medicine (Prelim), Strong Memorial Hospital, Rochester, New York, Ophthalmology, Loyola University Hines VA Hospital, Maywood, Illinois Thaddeus E. Szarzanowicz, Surgery (Prelim), University at Buffalo Graduate Medical Dental Consortium, Orthopaedic Surgery, University at Buffalo Graduate Medical Dental Consortium J. Paul Sla venas,Internal Medicine (Prelim), u jennifer C. Wargula, Pediatrics, University Health Center of Pittsburgh, Pittsburgh, Pennsylvania Maya D. Srivastava, Pediatrics, Cleveland Clinic Foundation, Cleveland, Ohio Todd E. Schlesinger, Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio B lauren j . Vriesenga, Family Practice, Riverside Regional Medical Center, Newport News, Virginia 6 u m m e 9 9 4 �········ ··· ··· · · ·· ······ ·· · ······ ···· · ·· · · ·· · · · · ·· ··· · · · ·· ·· ··· ··· ··· · · ··· · ··· ··· ·· ····· · ·• 11 ' is free from Boehringer Ingelheim Pharmaceutical representatives. Dr. Bianco and his wife, Joan, have a new addition, Regina-Marie, born August 1, 1993. She joins David, 12, and John-Michael, 8. "We're all fantastic!! " tinguished Alumnus Award in 1989, received the award as part of the Sixteenth Annual Meeting of the St. Louis Metropolitan Medical Society. 1 9 5 0 s was reelected treasurer of the Minnesota Medical Association last September. ERICK REESER '56, MICHAEL A . SANSONE '73, JOHN R . ANDERSON '57, was Thomas F. Frawley '44 1 9 s 0 4 gives seminars on "Living With Low Vision" as part of the Mariners Hospital Community Lecture Series. Dr. White has low vision and his experience provides the visually impaired with techniques to increase their independence. His program includes a presentation on closed caption TV enlargers and talking books. In March Dr. White received certificates of appreciation from Florida's Department of Elder Affairs and the Alliance for Aging for his volunteer service. named medical director of the Brothers of Mercy Nursing and Rehabilitation Center, Clarence, New York. Frankhn Zeplowitz '58 by the Buffalo News in its 45th Annual Awards for Outstanding Community Service. JOHN WHITE '40, THOMAS F. FRAWLEY '44, chairman of graduate medical education at St. John's Mercy Medical Center, St. Louis, Missouri, was awarded the Robert E. Schlueter Award for "demonstrating excellence in clinical practice, promoting advocacy for patient care in socioeconomic and political matters and for representing the medical profession in community service." Dr. Frawley, who received UB's Dis- B u a 0 FRANKLIN ZEPLOWITZ '58, was elected chief of staff of Our Lady of Victory Hospital, for 1994-96. He is an attending surgeon at the Lackawanna hospital and a past president of its medical staff. He is a UB clinical instructor of surgery. 1 9 6 1 HARVEY LIEBESKIND '63, writes, "Hoping to retire this year, move to California, travel with my mate, buy and sell thoroughbred horses for a living. My oldest son, Louis, trains horses, middle son, Neil re- • c 5 LAWRENCE ZEROLNICK '72, atrics to join Kaiser Permanente in Baltimore. He and his wife, Barbara, announce the birth of their son, Matthew, on November 8, 1993. of Washington, D.C. , just completed a book for patients with arrhythmia entitled, You Can Live With It! This 66-page book ROBERT DIBIANCO '72, cal director of Hospice Buffalo, was named a Citizen of the Year II 0 has left private practice in pedi- ROBERT A. MILCH '68, medi- h 7 recently was honored by theN ew York State Ophthalmological Society for "leadership and commitment to organized ophthalmology in New York State." He is a past president of the state society and has been a member of the Federal Economic Committee, which advises Medicare on health-care reform. Sansone is chairman of the New York State Managed Care Committee. JOHN KEYES '75, is secretary- treasurer of the medical staff at Lake Shore Hospital in Irving, New York. married attorney Carol Siravo in Cranston, Rhode Island, in April. ALAN PERL '77, 1 9 8 0 s JOSEPHT. WAYNE'82, is pro- searches horse pedigrees, youngest son, Stuart, is a movie stuntman and bartender. Lee Baumel '63, moved to Hawaii in 1993. Paul Lessler '63 retired and is doing financial consulting work." p 9 MICHAEL BARON '71 , writes, "I have recently had two positive events occur in my career which I would like to share with the Alumni. I received the Inpatient Teacher-of-the-Year Award, 1992-1993, from the Family Practice Residency Program of the University of Massachusetts Medical Center. In addition, I am now a diplomate in critical care medicine." s 0 I a n 9 u m m e gram director of the combined internal medicine-pediatrics training program at St. Louis University. He announces the birth of his son, Gregory Joseph, on January 9 , 1994. HERBERT NEWTON '84, is assistant professor of neurology and director of the division of neuro-oncology, Department of Neurology at Ohio State University Medical Center. 9 9 4 �• ······· · ······ · ··· · · · ···· · ··· · ···· ··· ············ ··· ··············· · ···· · ···· ·· ···· · ······ I my general surgery internship in Denver, I spent two years as a brigade surgeon at Ft. Bragg, North Carolina, 82nd Airborne Division. We moved back to Buffalo,july 1993, at which time I started my orthopaedic residency. I married Anita Pantera in August 1991. We were introduced by our fellow classmate Virginia Beerel Campion '90. She and my wife went to high school together. We have two beautiful sons, Ryan Douglas, 20 months, and Connor Matthew, 6 months. MICHAELS. WATSON'87,an anesthesiologist, is vice president of the medical staff at Lake Shore Hospital in Irving, New York. Brian Moore Bernard ROBIN CONWIT '85, has moved to Baltimore and is now an assistant professor at johns Hopkins and director of the EMG Lab at the Francis Scott Key Medical Center. MICHAEL SANSANO JR. '85, has opened his own practice in ophthalmology at 515 Abbott Road, Buffalo, New York. He and his wife, Claudia, have four daughters. HELEN CAPPUCCINO '88, has opened an office in Lockport, New York for the practice of general, thoracic and laparo-scopic surgery. Andrew Cappuccino '88, is completing a spine fellowship with Paul McAfee at johns Hopkins and will be practicing in Amherst and Lockport injuly. The Cappuccinos are the proud parents of four children: Jacqueline, 13; Mac, 5;jake, 2; and Nicholas, 1. M DAVID I. KOLE '90, of Santa Maria, California is in private prac- tice and is chief of pediatrics at DAVID R. BLOOM '89, is now a partner of Beach Physicians and Surgeons Medical Group, Inc., Huntington Beach, California. He is also the team physician at Orange Coast College. "Doug Sillart '89, is a travelling anesthesiologist extraordinaire. Marian Medical Center. He has two children, Ben, 6, and Emily, 4. KRISTA M. (PRIGG) KOZACKI '91 of Florence, South Carolina, is finishing a family medicine residency in 1994 and is considering private practice or a faculty position opportunity. She is the recipient of the McLeod Regional Medical Center Merit Award. Her twin sons, Stefan jerome and jacob Scott, were born on February 18, 1993. M DONNICA L. MOORE '86, and her husband, Stan Bernard, M.D., M.B.A., are delighted to announce the birth of their son, Brian Moore Bernard, on Labor Day, 1993. As is obvious from this photo, he is eager to follow in Mommy's and Daddy's footsteps, although with the directions their careers have takenDonnica is associate director, professional relations at Sandoz Pharmaceuticals and Stan is director, pharmacoeconomics at Bristol Myers Squibb Company - a briefcase might be a more appropriate prop! B u a 1 9 9 0 5 MARK A. FLANZENBAUM '90, is completing a residency in combined internal medicine and pediatrics at the Medical College ofVirginia. He has accepted a position as attending physician in emergency medicine beginning in August 1994. Flanzenbaum is engaged to be married inN ovember to Christie R. Boyd, a neonatal intensive care nurse at the Medical College of Virginia. RICHARD G. BENNETT '92, is a second-year psychiatry resident at Case Western University Hospitals. He married Dawna Lynch on july 9, 1993. p h II • CURZON CADY FERRIS, JR . '46, died in july, 1993. He was 71 years old. Dr. Ferris retired from the Hendrick Medical Center in Abilene, Texas, in 1988. LINDA SHRIRO SCHENCK '77, an adjunct professor at the University of Minnesota's School of Public Health, died of complications from an autoimmune disease in December 1993. ESTER MARIE PONCE GRIMALDI '89, was killed on January 18, 1994, when the car she was driving hit a patch of ice, and slid over an embankment. She was six months pregnant with her second child. Dr. Grimaldi had just completed her residency in pediatrics and was working for a health maintenance organization in Michigan. Besides her husband Thomas Grimaldi '89, she is survived by her daughter, Sarah Marie. Buffalo Physician Goes Electronic Now you use the Internet to send classnotes or other information to Buffalo Physician. Our address is: OBITUARIES HOWARD CRAIG KEYES '28, died in Bellingham, Washington, July 8, 1993, three days short of his ninetieth birthday. Until his retirement in 1974, DoUGLAS PATRICK PREVOST '90, writes, "After completing a Dr. Keyes practiced at the Keyes Clinic, consisting of a father and three sons, all of whom graduated from the University of Buffalo Medical School- William Chauncey Keyes in 1896, Roswell Park Keyes in 1926 and Donald Keyes in 1928. c a n 5 u m Notes@pub.buffalo.edu We'd love to hear from you via e-mail or snail mail! m e 9 9 4 ��BUFFALO PHYSICIAN STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 2194 ADDRESS CORRECTION REQUESTED ME DICAL HISTORICAL LI 3RARY ABBOTT LI BRARY SERIALS DEPT CA PUS MAil. The only liability coverage with this seal of approval. Medical Liability Mutual Insurance Company (MLMIC) is the only professional liability insurer approved by the Medical Society of the State of New York. Since its founding in 1975, the physicianowned and managed company has successfully defended more physicians than all other available insurers combined. Additionally, MLMIC has the largest and most experienced professional liability claims department in the country, the largest risk management department of any New York State professional liability insurer, and the state's only true peer review of claims experience. Call1-800-ASK-MLMIC (metro) or 1-800-356-4056 (upstate) for more information and an application. MLM~C ~ Medical liability Mutual Insurance Company Our defense never rests. 2 Park Ave., New York, NY 10016 2 Clinton Sq., Syracuse, NY 13202 90 Merrick Ave., East Meadow, NY 11554 «:> 1993 Medical liability Mutual Insurance Company Non-Profit Org. U.S. Postage PAID Buffalo, NY Permit No. 311 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. 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Buffal~ School of Medicine and Biomedi~al Sciences, Spri.ng 199.4 �BUFFALO PHYSICIAN Volume 28, Number 2 ASSOC IATE VICE PRES I DENT FOR UN IVERS ITY ADVANCEMENT Dr. Carole Smith Petro DIRECTOR OF PUBLICATIONS Timothy j Conroy EDITOR Nanette Tramont Kollig, R.N. ART DIRECTOR Alan j Kegler ASSOCIATE ART DIRECTOR Scott Fricker PRODUCTION MANAGER Ann Raszmann Brown STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDIC I NE AND B IOMED ICAL SCIENCES Dr john Kaughton , Vice President for Clinical Affairs, Dean EDITORIAL BOARD Dr. john A. Rtchert, Chairman Dr. Martm Brecher Dr. Harold Brody Dr. Richard L. Collins Dr. Alan j. Dnnnan Dr. Timothy Gabryel Dr. james Kanski Dr. Charles Massaro Dr. Charles Paganelli Dr. Robert E. Reisman Dr. Thomas Rosenthal Dr. Stephen Spaulding Dr. Bradley T Truax Dear Friends, C hanges in medical education and health care are occurring at breakneck speed! UB's medical school and its affiliated teaching hospitals fortunately began developing a strategy for coping with the anticipated adaptations in the mid-l980s. Some of the required efforts were made possible through the development of a demonstration project that served to modify the priorities and directions of the graduate medical education programs. This has been largely accomplished through the Graduate Medical Dental Education Consortium of Buffalo. In the late 1980s, the school's faculty agreed to pilot a comprehensive two-month ambulatory clerkship in the fourth year. During the past two years, the Curriculum Committee has begun its re-evaluation of course offerings to ensure that future graduates will be properly prepared for national health care reform. This effort has been enhanced by the planning grant received from the Robert Wood Johnson Foundation and the school has submitted its final proposal to the foundation in the hope that UB will be among the l2 finalists to receive its support over the course of the next five years. These funds will be directed to assist the faculty in making the required changes in curriculum offerings and to assist in the adaptations in educational technique and support that must be forthcoming. Already, some significant changes are occurring. For example, beginning this fall, a formal clerkship will be offered in family medicine; the departments of medicine and surgery will modify their clerkships so that each department will offer new one-month courses in the fourth year. The Curriculum Committee, faculty and students have initiated their evaluation of years one and two, and obviously new innovations and designs should be forthcoming for these academic calendars in the years ahead. We hope to be able to position the school and its affiliates so they can respond positively to the changes that lie ahead and to maintain our commitment to excellence in teaching, research and patient care. Sincerely, John aughton , M. D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences TEACHING HOSPITALS AND LIAISONS Batavia VA Medical Center Arlene Kelly The Buffalo General Hospital Michael Shaw Buffalo VA Medical Center The Children's Hospital of Buffalo Erie County Medical Center Mercy Hospital Millard Fillmore Health System Frank Sava Roswell Park Cancer Institute Sisters of Charity Hospital Dennis McCarthy «:>The State University of New York at Buffalo Buffalo Physician is published quarterly by the State University of New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications . It is sent, free of charge, to alumni , faculty , students, residents and friends. The staff reserves the right to edit all copy and submissions accepted for publication. Address questions, comments and submissions to: Editor, Buffalo Physician, State University of New York at Buffalo, University Publications, 136 Crofts Hall, Buffalo , New York 14260 Dear Fellow Alumni, T he 57th Annual Spring Clinical Day, the traditional highlight of the Medical Alumni Association's activities, will take place on April30 at the Buffalo Marriott Hotel. The general reception for all Reunion Classes will be held on Friday evening, April 29, at the Center for Tomorrow. The five-year class reunion chairs have planned their Saturday evening receptions, a unique and ever more meaningful time to renew "old" close acquaintances and rehash unforgettable memories. This year, we have a most exciting and innovative program, addressing current and future issues in medical education- a subject that should be interesting and appealing to all attendees. The complete program can be found on the Alumni Section pages of this issue. The morning presentations set the basis for the Stockton Kimball Lecture, which will be presented by Jerome P. Kassirer, M.D., '57 , editor of The New England journal of Medicine, and a premier medical teacher and educator. His topic will be "Clinical Reasoning: Teaching it and Learning it. " As a personal note, I thank Dr. Kassirer for accepting this invitation. He is a past recipient of our Distinguished Alumnus Award and holds one of the most prestigious positions in American medicine. Thi• •hou\d b• '" ou~<anding w"~ Send address thanges to: Buffalo Physician, 147 CFS Addition , 3435 Main Street, Buffalo, New York 14214 Robert E. Reisman, M.D., '56 �v 5 2 L 0 p R 8 N N G 2 0 9 9 4 ~n tne [ouef: Five of the six new Consortium hospital CEOs. From left, Robert V. Stanek, Charles Van Vorst, Lynn Brown, Joseph Ruffolo and Paul Candino. Research Hospital News Leading Buffalo's Changing Health Care Scene e Six Dr. Roswell Park performs surgery. From The Pictorial History of the Medical School collection. Page 25. of the nine affiliated teaching hospitals have new CEOs. What will the changes mean? Changing the Face of Medical Education e The School of Medicine and Biomedical Sciences is moving steadily toward a new way of teaching that stresses analysis over memorization and patient interaction over crowded lectures. Medical School Alumni ASpoonful of Humor Graduate Education Classnotes Going home. Page 34. Alum Jack Coyne blends two callings. Page 30. �.... . .. . . .. . .. . .. . .. .. .. . . . ... . . ... . .. . ..... . . .. ... ... . .. ... . .. .. . . ...... ... .. . . ... .. . .. . . .' . UB research continues on NASA's Spacelab Life Sciences 2mission B research done on the first Spacelab Life Sciences mission that showed the body regulates the cardiovascular system in a novel way, continued on last October's Spacelab life Sciences 2 mission with three more astronauts over a longer period of time. The research was designed by a team of scientists headed by leon E. Farhi, M.D., distinguished professor of physiology. Results from the first mission showed that during space flight the cardiovascular system adjusts vascular tone to maintain blood pressure in the face of elevated cardiac output. "This type of regulation ofblood pressure was completely unexpected, " Far hi says. "The system's failure to reduce cardiac output surprised us." Earthbound research in simulated weightlessness has shown that when gravity is eliminated, the heart pumps more blood initially, but the body eventually reduces total blood volume by eliminating blood plasma through urine to maintain normal blood pressure. Astronauts on the Spacelab missions used special equipment designed by UB technicians to determine how the heart and lungs perform in and adapt to the weightless environment of space during exercise and at rest and how that adaptation affects the astronauts' readjustment to gravity. Results from the initial study found that astronauts did not regain normal cardiovascular balance and could not perform the experiment's exercises fully for at least seven days. UB researchers speculate that even five more days of weightlessness in space could cause more pronounced and longer-lasting effects on the heart and lungs. The experiment was one of three studies conducted during the mission that focused on the astronauts' cardiovascular functioning in zero gravity. Astronauts David Wolf, M.D. , Shannon lucid, Ph.D., and Martin Fettman, Ph.D. , trained for more thana year a tUB and the johnson Space Center in Houston to learn how to conduct the experimets in the confines of the Space Shuttle Columbia. - B y L 0 I 5 B A K E R Highest sepsis mortality rates found from respiratory infections lderly patients who develop sepsis from respiratory infections while hospitalized have higher mortality rates than patients who develop sepsis from all other infection groups , according to a study by UB's Center for Pharmacoepidemiology Research. Sepsis is the most common cause of death in intensive care units, according to Thaddeus H. Grasela , Pharm. D., assistant professor of pharmacy and director of the Center. Grasela was the principal investigator on the I, 758-patient study that revealed mortality rates that varied widely depending on the source of the sepsis infection. Patients with sepsis acquired from respiratory tract infections had the highest mortality rate at 59.3 percent. The lowest mortality rate was reported in patients who developed sepsis from a community-acquired urinary tract infection. Mortality rates for patients who acquired sepsis from other infections were: • 46.4 percent for hospital-acquired urinary tract infections. • 45 .8 percent for patients with abdominal infections. • 36.7 percent for patients with skin infections. • 35 .9 percent for gram-negative bacteremia inclusive of all sources. • 28.3 percent for respiratory tract infections acquired in a nursing home. • 24.6 percent for urinary tract infections acquired in a nursing home . The multi-center study followed patients receiving antibiotics for suspected or documented cases of gram negative infections that can lead to sepsis from the beginning of their treatment until their discharge from the hospital or death. + - B Y E LLEN G OLD B AUM Liposomes curb taxol's toxicity sing liposomes to deliver taxol has allowed researchers to control resistant tumor growth in animals with doses of the drug that would be lethal if delivered traditionally. UB and Roswell Park Cancer Institute scientists reported in the December 15, I993 issue of Cancer Research that the liposome delivery system may overcome some of the major obstacles to the more effective use of taxol in fighting cancer. "Taxol has two problems," said Robert Straubinger, Ph.D., assistant professor of pharmaceutics and lead author of the study, "The drug itself is toxic and �·············· · ············································· · · · ······················ · ····~ the solvent in which it is administered is also toxic." Straubinger's experiments showed that the use of liposomes to deliver taxol allowed it to be administered rapidly and in doses between two and seven times larger than those the animals would have been able to tolerate as free drug. "We're quite encouraged, " said Straubinger. "By encapsulating taxol in liposomes, we have caused a marked decrease in toxicity and increased the drug's potency. "Right now," he added, "patients who take taxol have to be treated heavily with antihistamines and steroids. That controls the side effects, but some of these supplementary drugs may interfere with the same systems that transport or metabolize taxol within the body." Liposomes, he explained, although they are essentially fat-soluble, are also very stable in water and thus provide a way to dissolve fat-soluble drugs such as taxol in the body. "Liposomes are particles with an oily core, and a fat-soluble drug like taxol tends to stay with them," Straubinger said. "As a result, we have reduced the massive wave of free drug that causes some of the side effects." The UB researchers compared the conventional delivery of taxol against taxol in liposomes in animals with colon cancer, even though the drug has not shown to be effective in controlling colon cancer growth. "We were able to see control of tumor growth in animals given multiple injections of liposomes containing 40 milligrams of taxol per kilogram of body weight," Straubinger said. "If you gave that amount as free drug, it would have killed the animals. But in liposomes, it didn't. It just controlled the tumors nicely." - B B Y ELLEN a GOLDBAUM 0 p UB'sDrug Surveillance Network tracks drug reactions nationwide he University at Buffalo's Drug Surveillance Network (DS ) is the only network of hospital pharmacists in the U.S. designed to rapidly track and share information about how patients react to drugs. Established by UB's Center for Pharmacoepidemiology Research with grants from pharmaceutical companies, and supported with a grant from the Food and Drug Administration, the DS includes more than 1,100 clinical pharmacists in 522 acute-care hospitals. "We have the unique ability to get a peek at what goes on in hospitals across the country," said Thaddeus H. Grasela, Pharm. D., director of the center and assistant professor of pharmacy. The network places Grasela virtually at the bedside of patients in hospitals from ~ :• -• The network of hospital pharmacists tracks and shares information about adverse drug reactions. 5 c a n s p Miami, Florida, to Anchorage, Alaska. Currently, clinical pharmacists from six UB teaching hospitals- Mercy Hospital, The Children's Hospital of Buffalo, Erie County Medical Center, Roswell Park Cancer Institute, The Buffalo General Hospital and Millard Fillmore Suburban Hospital- participate in the network. According to Grasela, one or two cases of adverse effects from a drug over a period of months or years in a single hospital may not attract concern. By combining information from hundreds of hospitals, however, the DSN provides a much faster way to spot problems with specific pharmaceuticals. - BY ELLEN GOLDBAUM UB scientists awarded $1.5 million in Veterans Affairs grant funding our UB researchers at the Buffalo VA Medical Center have received Department of Veterans Affairs grants totaling $1.5 million. John Canty, M.D., associate professor of medicine , received $606,600 to explore how nitric oxide affects coronary artery blood flow in conditions of underperfusion. Alan Lesse, M.D., assistant professor of medicine and pharmacology, received $174,100 to explore how changes in a surface protein on Haemophilus influenzae affect its virulence. Jeffrey Mador, M.D., assistant professor of medicine, received $175,600 to investigate the causes of respiratory fatigue. Timothy Murphy, M.D., professor of medicine and microbiology, received $533,700 to explore the causes of exacerbations of chronic obstructive pulmonary disease. He will also establish a Chronic Bronchitis Study Clinic to follow patients before, during and after exacerbations. n g 9 9 4 �~ -··· · ··· · · · ···· · ·· ·· · · ·· · · · ···· · ···· · ······ · ··· ···· ········ · ··· · ·· · ········· · · · ···· · ···· · · ~ Holmlund treats about 60 patients in Western ew York. The treatment, done on an outpatient basis, involves injecting the toxin directly into the overactive muscle , Holmlund says. The toxin, he explains, blocks the nerve impulse to effectively relax the muscle. "The nice thing about it," he notes, "is that we can grade the weakness" to tailor the response to each patient. The effects ofbotulinum toxin are transient, lasting several months - about three each in laryngeal dysphonia and spasmodic torticollis treatments and about six months for blepharospasms , Holmlund adds. "It has been a truly wonderful experience to help patients with disorders we previously could not help. We can finally do something positive for them," he says. In addition to facilities in Albany, Rochester and New York City, the treatment is only available at about 20 to 30 centers nationwide, Holmlund says. vices there. She holds a master's degree in health systems administration from the University ofLouisville in Kentucky, as well as both bachelor's and master's wo new CEOs have been ap- degrees in English from orth Texas pointed at University at Buffalo State University in Denton, Texas, and a medical school affiliated teaching bachelor's degree in nursing from Spalding hospitals. College in Louisville, Kentucky. Joseph A. Ruffolo has been appointed president and chief executive officer of The Children's Hospital of Buffalo and Evelynn G. Brown has been appointed as the new vice president and chief executive officer for hysicians at Millard Fillmore Millard Fillmore Suburban Hospital. Health System's Dent Neurologic (For more changes at the teaching hospiGroup are one of only four groups tals, see the cover story on Page 6.) in New York State using botuliRuffolo previously served as vice presinum toxin to treat patients with dent of corporate finance for Millard dystonias. Fillmore Hospitals, where he was reTomas Holmlund, M.D. , assistantprosponsible for financial leadership of fessor of neurology and an attending Millard and its affiliated health care subat the Dent, has been using physician sidiaries, including corporate restructuring, medical staff development, merg- botulinum toxin successfully in patients ers and acquisitions, programmatic de- with blepharospasms , spasmodic velopment and expansion as well as torticollis and laryngeal dysphonia since 1991. fiscal operations. New CEOs appointed to head two UB affiliated teaching hospitals Dent physicians use botulinum toxin successfully for dystonias Ruffolo was credited with playing a significant role in Millard's financial turnaround. The organization had lost over $20 million in operations over 13 years before Ruffolo joined it in 1984 and enjoyed operating surpluses in nine consecutive years after that. Brown most recently held the position of senior vice president and senior administrator for Eastern Maine Medical Center in Bangor, Maine. She also served as senior vice president for corporate services at North Colorado Medical Center, Inc., in Greeley, Colorado as well as director of professional and technical services and director of nursing and patient care ser- B a Mercy Hospital'striplehead nuclear camera is first in WNY area ercy Hospital of Buffalo has recently acquired Western New York's first triple-head nuclear imaging camera. The new camera provides superior quality images in shorter scan times and offers enhanced computer capabilities to address difficult processing demands. Compared to single-head, conventional nuclear medicine cameras, Botulinum toxin, injeded diredly into the muscle, blocks the nerve impulse. the triple-head is more effi- 0 p h y 5 c a n s p n g 9 9 4 �·· ······· · · ·· · · ·· ···· ··· ···· · ·· · · · ··· ·· ·· · · ······ ········ ···· · · · · · ··· ·· · ···· · ·· ······ ·· ·· · a cient, acquires three times the amount of information in the same amount of time and offers superior image resolution. "The recent acquisition of the triple-head camera will allow Mercy Hospital to provide our patients with the latest in nuclear medicine imaging techniques, " said Fazalur C. Rehman, M.B.B.S., clinical associate professor and chairman of Mercy's department of nuclear medicine. The flexibility of the triple-head camera allows it to handle all types of planar and SPECT studies as well. Suburban completes Suburban's new additions will add approximatelylOO,OOO square feet of space to the ISO,OOO-square-foot facility. phase one of its $60 will feature a dedicated X-ray room , two cystography rooms and an exam code room and 20 exam rooms when room . An additional six ambulatory surmillion modernization project illard Fillmore Suburban Hospital has completed the first phase of its $60 million modernization project, which broke ground in September 1992, with the opening of its orth and East additions. The new additions, which add approximately 100,000 square feet to the 150,000-square-foot facility, house a 20bed critical care unit, a 32-bed medicalsurgical unit, expanded emergency and radiology departments , new cardiology and respiratory therapy services and a new medical library, medical records and medical staff lounge. Suburban's new emergency department - with 50 percent more space than its busy 30,000-plus-visit ER - B a 0 p h renovation of the original, adjacent ER space is complete. The 151-bed hospital's radiology department, now doubled in size, accommodates nuclear medicine, fluoroscopy and the addition of angiography. The department features two dedicated mammography units, two ultrasound rooms and two SPECT cameras. The 20-bed critical care unit, with 10 each CCU and ICU beds, consolidates the hospital's four intensive care beds, four coronary care beds, a satellite pharmacy and a satellite laboratory. The new 32-bed medical-surgical unit includes 16-patient telemetry capabilities. The new construction also adds an additional OR room to Suburban's four , and three more recovery beds to its original six. The OR suite also features s c a s p gery beds have also been added to Suburban's original six. "The expansion and renovation project will help Suburban Hospital to meet the health care needs of Williamsville, Amherst, Clarence and surrounding communities well into the future . This also provides our physicians, nurses and other medical professionals with state-of-the-art facilities to care for their patients," said Lynn G. Brown, vice president and chief executive officer of Millard Fillmore Suburban Hospital. Renovation work continues on the original building, constructed in 1974. The $60 million project is the most extensive modernization project in Millard Fillmore Health System's 121-year history. n g 9 4 0 �--------------------------------------------------------------------. B y 5 0 C T T T H 0 M A S LEADING ' NOTHING IS CERTAIN BUT CHANGE- ESPECIALLY, IT SEEMS, IN HEALTH CARE. IN THESE TIMES OF SHIFTING POLITICAL SANDS AND AN EXPLOSION OF KNOWLEDGE ABOUT THE HUMAN BODY AND ITS SYSTEMS, THE EDUCATION OF FUTURE PHYSICIANS IS NEVER STATIC. THAT'S TRUE, TOO, OF THE INSTITUTIONS WHERE THOSE FUTURE PHYSICIANS PUT INTO PRACTICE THEIR RIGOROUS EDUCATION. SIX OF THE NINE HOSPITALS THAT ARE PART OF THE GRADUATE MEDICAL DENTAL EDUCATION CONSORTIUM OF BUFFALO - THE TRAINING GROUND FOR ABOUT 700 MEDICAL RESIDENTS - HAVE NEW CHI EF EXECUTIVE OFFICERS, ALL WITHIN THE PAST 15 MONTHS. P H 0 T 0 S E' v M A K R D ~ L L A s --------------------------------------------------------------------. 0 B u a 0 p h y 5 c a n 5 p g 9 9 4 �·-------------------------------------------------------------------~ • -- B a 0 p h y 5 c a n s p g 9 4 0 �e're living in an era where both medical education and health care will change considerably," said John P. Naughton, M.D., vice president for clinical affairs and dean of the University at Buffalo School ofMedicine and Biomedical Sciences. "The people coming in new will bring some new ideas, and if those ideas are worth testing, we'll probably test them.I think they'll contribute to positive change." The new CEOs have come to Buffalo from areas as diverse as Virginia and Indiana, Texas and Maine. Their backgrounds as businesspeople and health care administrators provide a wealth of experience that becomes a further resource for the education consortium. "It's something of an added learning curve for them," Dean Naughton said. "After all , they came here primarily to manage their hospitals, and now they find out that they have to work with each other. .. . It's been a learning process in the past six months, but I think it's been going very well. " Buffalo Physician caught up with these six newly appointed chief executives to ask about medical education, running a hospital and the unique demands that New York State places on the challenge of providing medical care. To a person, they were enthusiastic about the consortium's work in training medical residents. And they see more change ahead as the hospitals and the school - cope with a new era in health care. sity hospital , but that structure may turn out to be a long-term positive. The key to it is how well we work together. There's a tremendous give-and-take. ''I'm extremely supportive of the affiliation and want to continue to strengthen it. It's a real opportunity for practicing physicians, hospitals and the university to continue to come together in a cooperative way." VanVorst sees Millard Fillmore as a hospital system in a good position to adapt to the trend toward decentralized and outpatient care. "We need to continue to position Millard as an integrated delivery system," he said. "If you want to cling to the anchor of the past, this is a very troubling time. If you see it as a bridge into transforming our industry into even more of a positive force for society, it's a very exciting time. It's white-knuckle at times, but you just have to have faith that it will all come out appropriately." with sparking a dramatic turnaround in Buffalo's second-largest hospital system. Under his leadership , the formerly money-losing system ran consistently in the black. In addition, jennings formalized the hospitals' relationship with the university and many of the residency programs it operates. He left Buffalo last year to become president of the Children's Memorial Medical Center in Chicago. VanVorst came to Millard Fillmore in May from San Antonio, Texas, where he headed the multi-hospital Santa Rosa Health Care Corp. At Santa Rosa , he developed a long-range strategic plan and a quality management plan. His previous positions included president and CEO of the Carle Foundation, in Illinois, a not-for-profit health care holding company with hospitals and other facilities, and vice president of operations at Methodist Hospital of Indiana. Van Vorst has received the World Health Organization Fellowship and was appointed to the National Advisory Council on Public Health Training. His master's of business administration in health care administration is from George Washington University, in Washington, D.C. "New York is a much more regulated state" than hts previous locations, Van Vorst said. "It has unique nuances in terms of how health care is delivered." And the medical school's relationship with its consortium of hospitals, he said, also is unusual in American health care. "What is exciting and, frankly, I think is avant-garde about Buffalo, is the fact that there is a pluralistic approach many hospitals working with the university, a joining together of community resources. I think it may be a structure that's ahead of its time. "It starts from a level of collaboration and coordination that we have to do, because there is no (single) univer- Charles B. Van Vorst is the new president and chief executive officer of the Millard Fillmore Health System, which comprises the 443-bed Gates Circle and 151-bed Millard Fillmore Suburban hospitals. His predecessor,] an] ennings, served for a decade starting in 1983. Active in the community, Jennings is credited Lynn G. Brown joined Millard Fillmore Suburban Hospital on Nov. 3 as vice president and chief executive officer. She succeeds Albert L. Fritz, whose two years at the Amherst hospital ended when he returned to his hometown Baltimore to establish a health care consulting firm. During Fritz's tenure, the suburban hospital embarked on a major expansion necessitated by its burgeoning business in delivering babies as well as increased services, patient visits and occupancy that consistently approaches 100 percent. Millard Fillmore Suburban handles more than 3,000 obstetrical cases each year, reflecting its location in the youthful and populous Town of Amherst. Fritz redefined the hospital's approach to providing a "quality life experience" to couples at the birth of -------------------------------------------------------------------0 B u 0 0 p y s 0 s p g 9 4 �-------------------------------------------------------------------· B a 0 p y s c a 5 p g 9 9 4 �------------------------ --------------------------------------------- practice residency programs are the core of Millard Fillmore Suburban's role in the consortium, Brown said. The coordination of several teaching hospitals , she said, "certainly adds a layer of complexity. On the other hand , I believe there is tremendous value for a hospital to be affiliated with the medical school. It kind of forces everybody to stay on the cutting edge. "If you're there teaching residents and have residents in the building, it says that everybody there has to stay on their toes. It's a very positive growth experience, and really sets the stage for people to stay current in the field. " Brown said Eastern Maine Medical Center has affiliations with Tufts University, for the teaching of pediatric medicine, and the University of New England, an osteopathic program. "It's a very similar situation here ," she said. "Obviously, the more residencies you have, the more complicated it gets. "It's verymucha balancing act, too, " their children, instituting a wider spectrum of before- and after-delivery educational classes for new parents. Lynn G. Brown comes to the hospital from Eastern Maine Medical Center in Bangor, Maine, where she was senior vice president and senior administrator. During four years there, she implemented a total quality management program , brought 17 patient response teams on line and established a management development program. Previously, Brown worked for eight years at North Colorado Medical Center in Greeley, Colorado, serving as senior vice president for corporate services as well as director of professional and technical services and director of nursing and patient care services. Her master's degree in health systems administration is from the University of Louisville, Kentucky. She also holds a bachelor's degree in nursing from Spalding College in Louisville. Obstetrics/gynecology and family she said. "When you commit to being a teaching hospital, it is more work. A lot of times it would be faster to just do (some procedure) yourself rather than teaching someone. But it's really the questions, the answers and the interaction that helps us to grow. The patient, in the long run , will benefit because they are the recipient of having a well-attuned medical staff." Recognizing the hospital's "very attractive" suburban location, Brown says, "We're all looking toward becoming a more integrated health care system. As health care changes and evolves, a lot more emphasis is being placed on primary care. Family practice and obstetrics are both generally regarded as primary care practices. "We have a very strong focus on the health care of the future . Basically, we're a full-service community hospital. We want to look at more preventive medicine and the community's health in general. " -------------------------------------------------------------------- · B 0 0 p y 5 c 0 n s p n g 9 9 4 �-- --------------------------- ---------------------------------------- last October ,Joseph A. Ruffolo simply altered his daily commute. He had served as vice president of corporate finance at Millard Fillmore Hospitals since 1984. His predecessor at Children's, john P. Davanzo, saw the hospital come increasingly to handle high-risk deliveries; it also dominates the Buffalo market in pediatrics. During his two years at the helm of the West Side hospital, he grappled with a decrease in Children's patient load attributed to the population shift to the suburbs and severe competition for the obstetric market from other hospitals - most notably, Sisters and Millard Suburban. The resulting financial problems forced the layoffs of about 60 employees in 1992. At Millard Fillmore, Ruffolo played a significant role in that system's return to profitability. He also worked with the medical school to establish a Department of Rehabilitative Medicine. His previous health care administration experience includes positions at Sheehan Emergency Hospital and iagara Falls Memorial Medical Center. In 1990 he won the Cain, Shattuck Co. Award, a prestigious national award that provides the winner a fellowship in corporate financial management at Harvard University. Now, Children's financial picture has improved, and Ruffolo says the hospital's 125 residents in all specialties of pediatric medicine are keeping physicians up on the latest methods of caring for the tiniest of patients. "What (the consortium) enables us to do is to really stay on the cutting edge of new technologies and treatment modalities," he said. "Participating in these teaching programs allows you to develop protocols that can monitor behaviors much more effectively than if you were trying to do that using When he became president and chief community hospital physicians. " executive officer of Children's Hospital Ruffolo says he wants Children's Hos- regulated health care environment challenging. Here, "providers operate under a much more regulated environment," Maher said. "The options on what you can strategically do tend to be much more limited." He also cited the difficulties an administrator faces in a state that tightly regulates the fees hospitals can charge. "It's created a system where hospitals have a difficult time maintaining financial solvency," he said. "It makes it much more difficult for hospitals to have the capital to restructure and retool for the future. " About the medical school consortium, though, the new CEO is nothing but positive. "For a hospital like Sisters, it really opens up a lot of avenues for being able to work with the university," he said. "If you think about hospitals that are outside the opportunities a consortium provides, they're not able to access the educational resources that we're able to access. The consortium, for us, provides that opportunity, that avenue to benefit from resources that, without the consortium, frankly, we wouldn't have. " Sisters has about 48 residents in such programs as internal medicine, obstetrics/gynecology, otolaryngology and family practice. The Main Street hospital's future , Maher said, will be "very much involved in trying to not simply take care of the patients that arrive at our front door, but rather reaching out to the community and enhancing the health status of the community. It's something we can't do by ourselves, but only by working collaborativelywith other providers. " john]. Maher, Sisters Hospital president and chief executive officer, last April became the first lay president in the hospital's 145-year history. The hospital, part of the Daughters of Charity ational Health System, had been administered for the six years before that by Sister Angela Bontempo. Taking office at a time when the hospital needed renovation and was facing pressing financial problems, Sister Bontempo helped increase the hospital foundation's assets to more than $3 million, and directed the establishment of new women's services, chemical dependency centers and satellite primary care offices throughout Buffalo. She also was the force behind the hospital's $42 million modernization project. Sister Bontempo left to take on other duties in her religious order, the Daughters of Charity of St. Vincent de Paul. Maher previously was executive vice president of the St. Vincent Hospital and Health Care Center, in Indianapolis, also a part of the Daughters of Charity hospital system. There he was responsible for day-to-day operations at the hospital's three acute-care facilities, a regional referral center, a smaller community hospital and a mental health facility. He also managed a $100 million construction program and helped institute a program in which nurses and other staff members play a more active role in defining their care units - a program that cut costs, increased satisfaction among patients, physicians and staff and improved patient outcomes. Prior to his six years in Indianapolis, Maher worked in health care administration in Tacoma, Washington; Richmond, Virginia; and Chicago. He has master's degrees in business and in hospital administration from Ohio State University. He, too, finds NewYorkState's highly - ••••••••••••••••••••••••••••••••••••• B u a 0 p ., y s c 1 1 1 --------------------------------~ I a n s p n g 9 9 4 �--------------------------------------------------------------------· ficulties occasioned by stiff competition, fewer admissions and an increase in the average length of time patients stayed in the hospital. Mercy's financial picture improved after 81 positions were eliminated late in 1991. In Virginia, Stanek was responsible for all hospital operations, including finance and marketing. His previous experience included serving as executive vice president and chief operating officer of Good Samaritan Hospital, in Pottsville, Pennsylvania. His master's in business administration and administrative management is from St. joseph's University, in Philadelphia. His original training was in pharmacy, at the Philadelphia College of Pharmacy and Science, and in chemistry, at East Stroudsburg University, East Stroudsburg, Pennsylvania. Stanek says Eastern Virginia Medical School worked with DePaul Medical Center in much the same way the UB Medical School works with the hospitals in its teaching consortium. "It really is a major medical school," he said of UB. "The residents have the ability to experi~nce different environments. They pital to reach out to the community, "moving toward ambulatory settings so that residents have more exposure to ambulatory medicine. And we are beginning to develop more outreach initiatives in preventive medicine." Ruffolo says Children's seeks to encourage residents to choose primary care as a specialization, recognizing that primary care is increasingly essential to an integrated health care system. "I want to build Children's Hospital as more of a regional and statewide tertiary center for cardiovascular, thoracic and neurosurgery, hematology and oncology," he said. MERCY HOSPITAL Robert V. Stanek comes to Buffalo from orfolk, Virginia, where he was executive vice president and chief operating officer at DePaul Medical Center. He succeeds Sister Sheila Marie Walsh, who had been administrator of the South Buffalo hospital since 1976. Sister Walsh, like many local hospital executives, struggled with financial dif- also have exposure to not only full-time faculty members, but also with volunteer and part-time faculty members (at the hospitals). There's a richness and diversity there, and that's a major advantage that this type of consortium approach brings to the table." About34 residents, Stanek said, serve in the internal medicine, physical medicine and pediatrics programs at Mercy Hospital. ew York, he agreed, is a unique environment for the health care administrator. "It's driven to a large degree by this being a very regulated state health care environment. In Virginia it was very deregulated. Here, reimbursement rates are very regulated by the State of New York; in Virginia, it's much more a competitive situation, similar to the Clinton managed care environment. "I find the hospital providers in Buffalo to be very collaborative in nature, and I find that very helpful. The level of collaboration can help achieve a better quality of care for the people we serve. It becomes more cost-effective over time." In South Buffalo, Stanek said, "our -------------------------------------------------------------------- ~ B a 0 p h s c a n s p n g 9 9 4 �~ -------------------------------------------------------------------~ overall direction is to make sure that we are meeting the needs of the community. We try to make a commitment to servicing employees, patients, physicians-- we look at all of those as people whose needs we are challenged to meet." He points to gall bladder surgery as an example of how new technology is radically changing the way hospitals do business. "A few years back, you'd be in the hospital10 days to two weeks. Now it's laparoscopic; patients stay for a day or two. "We're watching the transition from care being provided in an inpatient setting evolving to outpatient settings. It's less expensive that way. "And there's a very strong evolution in the health care environment to really deal very heavily with preventive medicine rather than just the traditional delivery of health care. We want to develop an integrated, seamless delivery system. We want you to have the ability to get into the system and have your health care needs met." Wyoming County Community Hospital , where as CEO he guided the 102bed hospital to its first years in the black since its founding. Hired in 1990 - a year in which the hospital lost $2.3 million- he led it to profitable years in 1991, 1992 and 1993, with no financial assistance from the county. At ECMC, Candino said, his mission will be to bring the medical center into similar financial stability, while at the same time developing long-range plans for the way it delivers health care. "I think that ECMC and all the consortium hospitals have to begin looking at the overall delivery system and the health care community in the Buffalo and Western ew York area, " Candino said. "It's difficult to do, because there are all sorts of pressures on hospitals right now- reimbursement pressures, health care reform pressures. "It would be very easy for the CEO to continually focus on what's going on within the internal operations of the hospital he's in charge of, but if that's all the CEO does, then the overall world will change, and where the medical center fits into that will be up to someone other than the CEO. He has to make decisions for what makes sense for the community. "I think we have to work together and start making some decisions , not only what makes sense for our particular hospital, but what makes sense for the community." The appointment of ECMC's new chief executive officer was fraught with political controversy as the hospital's board rejected County Executive Dennis Gorski's candidate. The board has the sole authority to hire the county hospital's chief executive officer, but since the county executive appoints 10 of the board's l3 members, Gorski had argued he should have a voice in the selection process. With the selection process narrowed to three candidates, Gorski had sup- Paul Candino began work on February 14 as chief executive officer of the Erie County Medical Center, succeeding George H. McCoy, who had led the Grider Street facility since 1986. McCoy resigned effective April 1 to take a position with the government of St. Croix, in the U.S. Virgin Islands. As chief executive officer of St. Croix Hospital, he will oversee the rebuilding of the hospital, severely damaged by Hurricane Hugo in 1989. During his tenure, ECMC was named a regional center for the care of trauma, burns and AIDS. McCoy also is credited with buttressing the hospital's troubled cardiovascular surgery service and finances as it entered the 1990s. Nevertheless, it remains beset by financial and political troubles. Candino comes to ECMC from the ported Sushil C. Sharma, head of Buffalo's Columbus Hospital, over the other two, one from Washington, D.C., and one from Ohio . The board rejected Sharma, saying his experience at the helm of tiny Columbus Hospital didn't qualify him to lead giant ECMC. That decision set off a firestorm of protest, as supporters of Sharma pointed to his exemplary record at Columbus and his strong credentials. Candino maintains a firmer financial footing for ECMC will ease some of its political pressures. "We have to gain, as an institution, any efficiencies we can gain," he said. "Once we do that, a lot happens and a lot of opportunities will be presented. All of a sudden government is not as interested in the day-to-day operations of the medical center. As long as government is footing the bill in terms of a large subsidy, then they're going to want to have a say. That's their job. They're elected to serve the taxpayers' interests. "But once we can get beyond that, once we can generate a gain or a breakeven situation without a county subsidy, then we'll be able to look at the long-term picture of delivery of health care in the Western New York area , and work in more of a collegial environment with the other hospitals, work toward some mutual goals." OfECMC's part in graduate medical education, Candino said that's "a part of our overall mission. "In addition to providing high-quality care at the lowest cost possible, it's also a medical center that has the responsibility to provide teaching and research for the overall good of medicine," he said. "Somebody has to supply physicians to the community, especially the Western ew York community and especially primary care physicians, in the future. And somebody has to do the research and look into cures for the future. "I look at it as a challenge. " + -·------------------------------------------------------------------B u 0 0 p y s c o n 5 p n g 9 4 �HANGING FACE THE OF ED I CAL DUCATION UB'S REVAMPED CURRICULUM WITH THE BY BLENDS BEST ANDREW OF THE THE BEST OF THE OLD NEW DANZO It used to be fairly cut and dried. Two years of basic science. Two years of clinical experience. Then the M.D. Those days are over. The UB School of Medicine and Biomedical Sciences is moving steadily toward a new way of teaching -one that stresses analysis over memorization and patient interaction over crowded lectures. Proponents hope it will bring the art and science of medicine into more meaningful focus, providing future physicians with cutting-edge computer skills while re-emphasizing the people skills of old-fashioned doctoring. Many changes are being implemented or planned, but the central ones involve a problem-solving emphasis in basic science courses, earlier introduction to clinical skills, the creation of a clerkship in family medicine and a shift to ambulatory settings for other clerkships. B a a p 5 c a n s p g 9 9 4 �PHOTOS BY ROBERT basic science faculty, which he described as "excellent." "It's a difficult line we're walking here," said Loonsk, a 1986 UB medical school graduate. "By no means are we trying to imply that what they're doing is not superior." The proposals not only would make changes in the way the basic sciences are taught, but they would also establish a closer link to the clinical training that is the core of the second two years. "One of the ideas put forward is to focus the curriculum in the first two years around clinical education and experiences," said Dennis A. Nadler, M.D., associate dean for curricular and academic affairs. adler declined to predict the final outcome. He did say, however, that the ideas under discussion would "drastically" change the way medicine is taught at UB. Bone said it would be a "significantly" different education than the one he received when he attended the medical school more than 20 years ago. "We had no clinical correlation," said Bone, who graduated in 1973. "We had no interdisciplinary approach and we didn't see patients , except for an occasional visit with a preceptor, until the third year." The new proposals include an earlier introduction to clinical courses and improvements to the first-year preceptorship program. "The experiences the students had with the preceptor program vary, and that's a concern," said Loonsk, explaining that some students haven't had enough contact with their preceptor. One idea is to have students follow a single patient or family all the way through medical school. "That's a difficult one," Loonsk admitted. Nadler said the second-year family medicine course might The new approach is not so much a single effort as a group of ideas that have evolved independently in recent years. But many of those ideas are now coalescing under the umbrella of the medical school's primary care initiative. "The reason is that the forces of health care reform and national need are such that we don't need larger numbers of specialists, we need larger numbers of generalist physicians," said dean and vice president for clinical affairs john aughton, M.D. The medical school hopes to be chosen by the Robert Wood johnson Foundation in late spring for a $3 million grant to help implement the changes. If it wins the grant, and administration officials are optimistic, the funds could speed the changes, though no one has yet put a precise timetable on them. Naughton said UB isn't the only school making such efforts, but it's at the forefront. "We've moved a little faster than certainly most of the eastern schools have," he said. UB already has made some of the changes. It has started moving medical clerkships, for instance, from hospital bedsides to ambulatory settings, such as physician offices and clinics. It also has introduced a family medicine clerkship for third-year students. And some basic science classes have begun introducing problem-solving and clinical-correlation approaches. "The whole idea of medical school is to become a doctor and take care of patients," said Lawrence Bone, M.D., cochairman of the school's Curriculum Committee. "That's what we're trying to do , make doctors." Many of the changes that are still in the proposal stage focus on the first two years, where students traditionally have been immersed in basic sciences. john Loonsk, M.D. , the other Curriculum Committee cochairman, said that while the changes are significant, they are meant simply as improvements, not criticism of UB's B a 0 p s c WA LI ON 0 5 p g 9 9 4 �CHANGING THE FACE OF u a 0 p h 5 EDUCATION techniques almost to the exclusion of traditional didactic teaching. UB doesn't intend to go that far. "We hope to strive for a balance ," he said. "We believe both are important teaching tools , and we hope to achieve a balance. " Rosenthal said the techniques already have been introduced as a "clinical correlations " component in some courses, particularly microbiology and biochemistry. The teaching often is done in a team , with a clinical faculty member on hand to present the case, say, of a patient who has walked into a doctor's office with fever and chills. What might have been a purely scientific discourse on bacteria is transformed into a give-and-take exercise. Instead of- or in addition to - simply listening to a lecture, the students find themselves pondering the patient's chest X-ray. "What we hope to do is give the student the opportunity to recognize the relevance of what's being taught and give them the discipline to ask their own questions ," Rosenthal said. The teaching techniques would most likely take final shape around an "interdisciplinary medicine" course, a twoyear track that would integrate related aspects of basic science courses now taught separately. Among the many details still to be resolved are just which course components to move , and where. Rosenthal said there is no single model for what UB wants to do with its curriculum, but medical school officials have been exchanging ideas for several years with representatives of five other schools, including Harvard. "This has been an evolutionary process that comes into focus in 1994 with the Robert Wood johnson Initiative," he said. be expanded into the first year , using many of the same sites, as well as some additional ones, now used in the second-year preceptorships. Students might spend one or two half-days a week at the same site, following patients and seeing how a generalist practices, Nadler said. The second-year clinical introduction course also might be shifted to teach first-year students interviewing and diagnostic skills , said Thomas Rosenthal , M.D. , project director of the Robert Wood ] ohnson Generalist Initiative. Ideally, said Rosenthal, "by the time they hit the third year, they have some of these basic clinical skills developed and are able to take better advantage of the clinical experiences." While clinical experience would be accelerated and expanded under the proposals, the approach to teaching basic sciences also is in for some revision. Nadler said the catch-all phrase for the change is "self-directed learning," a central element of Harvard's New Pathway program. Essentially, it makes the student a more active participant. "The traditional curriculum at this school is a very didactic one," Nadler said. "Students go to lectures and laboratories and are taught." Self-directed learning is based on two techniques , casebased and problem-based teaching, which are similar. In problem-based teaching, basic science students are presented with a question that relates to a common medical problem, such as diabetes or cerebral palsy. The students break up into groups, decide what they must do, research the issue, discuss it, then present their findings . It's similar to a seminar. In case-based teaching, the process is about the same, but instead of being presented with an abstract problem, students are faced with a patient case. Nadler said Harvard's New Pathway program uses the B MEDICAL c a s p n g 9 9 4 �CHANGING THE FACE OF MEDICAL EDUCATION find the1r own UB was one of 18 medical schools that received answers rather Robert Wood johnson grants several years ago to than be told . search for ways of turning out more primary care Smith, who physicians. attends many Rosenthal said that the original Robert Wood Curriculum johnson grant of $150,000 expires in May. If UB is Committee among the l2 medical schools that win new $3 meetings but is million grants from the foundation~ , U~B~w~ou~ld!!h!av~e:._~~~~~.J._L___ 1w~..,.; not a member, "the resources to accomplish said the combiin a couple years what would nation of stu(otherwise) take us a much dent-based longer time ." learning and earlier clinical It would also elevate UB's exposure should give stunational stature, dents a greater appreciation not only among for what medicine is all schools emphaabout. "The students will sizing primary perceive from early in their care, but among careers the relevance of what those breaking they're learning to medical new ground in care," he said. "Some stumedical curricudents always understood lum innovation. why they were learning what While the package of prothey were learning. Other posed changes has come unstudents did not. " der the primary care umpart of the apA key brella, there's a broader raproach is research, not the tionale as well. scientific laboratory kind, "What is being proposed but the sort that's traditionwill be good for all doctors ," ally done in libraries. Exsaid Cedric Smith, M.D ., a cept now it's done more readily by computer and it's often professor in the department of pharmacology and therapeureferred to as "accessing information." tics . Bone sees it in terms of fostering a "lifelong pursuit of "There are many reasons ," said Nadler. "But maybe the knowledge. most important reason is we have discovered that students "As a physician, you don't stop learning the day you who know how to think, how to solve problems and access graduate from medical school," he said. "It's the obligation of information are more effective physicians than the ones who the school of medicine to help students develop those skills just memorize." ... in this day and age , the use of computers as a tool as well Murray Ettinger, Ph.D. and distinguished teaching proas an instrument for learning is very important." fessor of biochemistry, agreed. Already, vast amounts of information are available in "One goal is to try to give students a chance to learn more computer data bases, many of which can be tapped through on their own and to tie things together more on their own," said Ettinger, a member of the Curriculum Committee. "Up the HUBNET system operated by the medical school and its consortium hospitals. And electronic medical records will to now, a lot of medical school education in this school and most schools is an awful lot like undergraduate education, become more common, replacing traditional written records . "The electronic medical record is going to have terrific where people just go to lectures and take exams." The new curriculum may be more like traditional graduramifications in patient care," said Loonsk, who is the medical school's director of medical computing. ate education, where students are expected to conduct their Some proponents envision storing a patient's full medical own research , then present their findings and argue their history, right down to the X-rays , in computer data bases conclusions in seminar discussions. In short, students would B u a 0 p y 5 c a n 5 p g 9 9 4 �CHANGING T HE FACE OF from which the information can be easily retrieved and transferred. That could also have tremendous implications for clinical researchers, who currently must go to hospital record rooms and wade through stacks of patient charts. UB has been trying to familiarize medical students with computers and make them aware of the machines' potential since 1986, Loonsk said. It is one of the few schools that require computer training, though that's done now as a component of biophysics in the second year. One of the curriculum proposals now under discussion would create a first year, first semester course devoted to medical computing. "Actually, here at Buffalo, we're way ahead of the game compared to many schools because of the HUB NET system," said Loonsk. Through HUBNET, students and faculty can get into data bases like MEDLINE, where they will find information pertinent to both clinical care and research. Many of the data bases contain complete articles, and even textbooks are available on-line. "One of the problems with medicine for a long time was that it was becoming increasingly specialized, partly because there is so much information, it was difficult for the generalist physician to stay current in all these areas," Loonsk noted. Not any longer. "The implication to medical school," added Loonsk, "is that we should teach people how to access the information well." Specialists, of course, will always be needed. And physicians will always have to carry a lot around in their heads. But with medical knowledge expanding daily, some medical educators have come to the conclusion that it's better to stress thinking over memorization, because physicians who are well-versed in the principles can now more readily look up the detailed information they need for a specific case. And B u a 0 p h y 5 M EDICAL E DUCATION that information will be more current than something they learned years ago. "In the past we taught students much more to memorize," said Susan Schwartz, M.D., a Curriculum Committeemember. "Butit'simpossible to define anymore a body of knowledge they should have by the time they leave medical school." With problem-solving and research skills, she said, "they can become experts." The 25-member Curriculum Committee has been discussing many of the changes for several years and is just beginning to take the broad themes to the faculty at large. Before implementation, proposals must be approved by the Faculty Council, then go to course coordinators for more detailed development. Loonsk said they probably would not take effect until the 1995-96 academic year, at the earliest. Some significant related changes already have occurred, however. The biggest is the family medicine clerkship for third-year students. A major part of the Robert Wood johnson Generalist Initiative, it was approved by the Faculty Council in 1993 and will be instituted with the 1994-95 academic year. At the same time, the traditional clerkships are shifting away from hospitals toward ambulatory settings. "In medicine, the big change that we introduced over the past year was a four-week block of ambulatory medicine," said Schwartz, who is clerkship director for medicine. There are related goals. As medicine in general has shifted toward more ambulatory care, the educational experience for students in hospitals has narrowed. They've been meeting only the sickest patients, limiting their bedside interactions with patient and physician alike. c a n s p n g 9 9 4 �CHANGING THE FACE OF u a 0 p 5 c EDUCATION solution, she added , means that many students will take part two of their boards in senior year before finishing the full medicine and surgery clerkships. "That may be a problem," she said. The shift to ambulatory settings also has some students worried. "It's not a concern on my part, but for the students I think it seems a lot more intensive in the hospital setting, and they need to be reassured that they're learning as much in the ambulatory setting," Schwartz said. When the first group of students in the new ambulatory medicine rotation took their exam last fall, they did as well as previous groups, she noted . The ambulatory emphasis also means lining up new training sites and more community-based volunteer faculty . "That type of educational experience is basically one-onone," said Rosenthal. "It does represent a challenge to the departments of pediatrics and medicine to develop that volunteer faculty. " Other challenges lie ahead. For one thing, curriculum planners must decide which components of basic science courses should be integrated into the new interdisciplinary and problem-based approaches, and which should be left separate. There is consensus on the concepts - "We're trying to teach the science basic to medicine, rather than teaching basic science," said adler- but the devil is in the details. Also, some faculty members are uneasy with the uncertainty of the whole situation and the implication that the old ways were a failure . Naughton said that while UB is at the forefront of medical curriculum innovation, "most medical schools are going to make these same kinds of changes in the next few years ." "It will require a lot of faculty cooperation," he added. It is possible the new teaching approaches could take time from faculty who already are stretched between classes and their own research. Then again, the approaches could be easier to teach, since they delegate more of the responsibility for learning to the students. Either way, things are changing. "It will put a lot more stress on the primary care facultythey'll have to participate in courses they never thought about participating in before," said Rosenthal. "It will put the basic science faculty in a position where they'll have to interact more with clinical faculty ... it'll require change on both our parts, and change is stress." Ettinger agreed that faculty will be affected. "It's a different kind of teaching," he said. But, he added , "I think it may be less painful than people think." "The student wasn't getting a chance to do their own personal history and physical the way they were supposed to," said Schwartz. In a doctor's office or a clinic, Rosenthal said, students encounter patients "who present earlier in the disease process and with a condition that is not acutely life-threatening. So your diagnostic work-up is done not only at a different pace, but it's done with a different approach." Besides encouraging more students to choose primary care, he added, it will give future specialists more exposure to generalist physicians, which can only help interactions between the two groups. As faculty members ponder curriculum, some administrators have been thinking about the admissions side of things . adler said there have been efforts to identify demographic characteristics of medical school applicants most likely to choose primary care careers. "There is some literature on the subject, though it's pretty scarce," he said. "There is a sense that people from rural backgrounds are more likely to choose generalist medicine and return to rural areas ." But Thomas]. Guttuso, M.D., assistant dean for admissions, said the effort is limited. "We're looking for those people who have the personal qualities that we think will make them become outstanding practicing physicians," he said. "If it fits primary care, fine. But it doesn't have to be primary care." Meanwhile, said Guttuso , the number of applicants has increased from a low of about 2,250 in 1988 and 1989 to about 3 ,600 for the 1994-95 class. "There's definitely been an increase in the number of people applying who don't have pure scientific backgrounds," he said. "But still, the vast majority of the pool is scientifically oriented." While there is a sense of enthusiasm about all the changes, a lot of dust is still to settle. "These things come at a price, and they don't come easily," said Naughton, noting that introduction of the new family medicine clerkship resulted in scaled back third-year clerkships for medicine and surgery. The family medicine clerkship will be seven weeks, while medicine and surgery are being reduced to eight weeks from the previous 11 weeks. To compensate, students will take four weeks of a new Medicine 2 and Surgery 2 in the fourth year . "I was not happy about it," said Schwartz. "Not at all." She said planners considered a "screw everyone" solution that would have cut a week off all clerkships, but that would have disrupted the system of teaming students up with residents and interns on four-week rotations . "It was really a fierce battle for a year," Schwartz said. The B MEDICAL a 5 p n g 9 9 4 �a ············ · ··· · ·············· · · · ···· · ········· · ·· ·· ···· · · ·· · · · ··· ····· · ······ ·· · · · · · · · $7.5 million establishes new center ENTERPRISE WILL CONCENTRATE ON DEVELOPING AND MANUFACTURING REHABILITATIVE ASSISTIVE DEVICES he University at Buffalo has re- ogy Evaluation and Transfer "expands Assistive Technology and project direcceived a five-year, $7.5 million significantly the capabilities of the Cen- tor of the new initiative. The co-direcgrant from the National Institute ter for Assistive Technology, already a tors of the project are William C. Mann, on Disabilities and Rehabilitation visible leader in the field. professor and chair of the UB DepartResearch to establish the first na"It promises to increase our collabo- ment of Occupational Therapy and ditional center for advancing new ration with consumer-based agencies rector of the Center for Assistive Techassistive devices from the inventor's and private businesses in the commu- nology, and Kenneth ]. Ottenbacher, workshop to the manufacturer's assem- nity and nationally. It offers a promising professor of occupational therapy and new model of cooperation between uni- associate dean of the School of Health bly line. The Rehabilitation Engineering Re- versity, business and public interests." Related Professions. search Center on Technology EvaluaThe new center will help close the Five to 10 devices per year- items tion and Transfer is a collaboration be- - supply-demand gap in assistive devices that likely would not reach the public tween the Independent Living Center of existing nationwide, notes joseph Lane, otherwise - are expected to become Western New York, an agency that as- associate director of the Center for available to people with disabilities as a sists people with disabilities; result of the center's work. the Western New York Tech"We plan to bring into the nology Development Center, marketplace products that Inc. (TDC), a corporation that will make a difference in helps create, expand and dipeople's lives," Lane adds. versify technology-related "We hope to reach the inbusiness in Western New ventor working in the family York; and UB's Center for garage, as well as the estabAssistive Technology, a lished designer. multidisciplinary group that "Really helpful products provides research, education often never see the light of and service in the field of day because many designers assistive technology. and inventors don't have reThe center, which began sources to develop their ideas operating last fall, screens and make them marketable, prototypes for new assistive Above, Steve Bauer, director of research and development for the center, and don't know how to link works on an electronic data acquisition system. Below, Dale Johnson, design devices from across the up with the manufacturer," engineer associate, works on a powered mobility simulator. United States, selects those he said. "On the other hand, with the most market potential, evalumanufacturers often lack knowledge ates and refines them and establishes about consumer needs and product repartnerships with commercial firms to quirements. Our new center will promanufacture and market the products. vide the resources and become that missG. Alan Stull, dean of the UB School ing link." of Health Related Professions, in which Lane notes that the "military research the Center for Assistive Technology is and development of the past decade housed, says the Rehabilitation Engigenerated a wealth of new technologies neering Research Center on Techno!that are pending declassification. They B u 0 0 p s c o n 5 p n g 9 9 4 J } �············································ ····· ················ ·· ·········· · ·········· a · ~ I hold great promise for assistive technology applications. "The facilities now at UB, along with resources in Toronto, Rochester, Pittsburgh and Cleveland, make this region uniquely positioned to become the national center for research and manufacturing in assistive technology. We are definitely the leading region in the field." The Center for Assistive Technology currently houses the national Rehabilitation Engineering Research Center on Aging, which develops and evaluates assistive devices for disabled older adults. The Center for Assistive Technology also encompasses the Developmental Disabilities Assistive Technology Institute, which designs and produces lowdemand assistive products; Project LINK, a national clearinghouse that connects consumers who need assistive products with appropriate device manufacturers; Rehabilitation Technology Services, which designs and builds customized seating and positioning devices, plus a wide array of services for people with sensory, physical and cognitive impairments. The new center uses a five-stage evaluation process to ensure resources are expended on products with market value. Prototypes are analyzed by technical, user and marketing groups at each stage, and are either withdrawn or advanced, depending on the results of the collaborative evaluations. Organizers expect the center to be self-sufficient within five years, generating future operating funds through a percentage of the revenues from sales of devices licensed to manufacturers, partial ownership of some patents and fees for services charged to some inventors and corporations. A new not-for-profit company will eventually take over the center's technology evaluation and transfer functions. B a 0 p h I Above, Johnson welding in a lab at the center. The UB Center for Assistive Technology will continue new device research and development as well as grant procurement to fund the manufacture of "orphan" products- devices that would substantially enhance the lives of those who could use them, but that have little y 5 c a n 5 p commercial value to manufacturers. A 10-member board of directors with representatives from national consumer associations, private corporations, research centers and technology-transfer agencies oversees the work of the new center. - B v n L g 0 I 8 5 9 A 9 K 4 E R �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 l I UB begins joint study of addiction that 75 to 90 percent of the alcoholic population never enter an alcohol treatment program," Blane explains. "Thus, UB JOINS WITH RESEARCH INSTITUTE ON ADDICTIONS there is a strong need for populationbased studies like the ones we will conTO ESTABLISH ALCOHOL RESEARCH CENTER duct." RIA will conduct a study of why he School of Medicine and BioThe grant will create approximately some alcoholics seek treatment while others do not, and why some alcoholics medical Sciences and the Buffalo- 30 new jobs. "This is the first NIAAA Alcohol Re- appear to recover without treatment. based Research Institute on AdTrevisan notes the grant offers a dictions (RIA) have received a joint search Center dedicated to studying the $8 million grant from the National clinical and medical epidemiology of unique opportunity for alcohol researchInstitute on Alcohol Abuse and alcoholism. The new center adds an ers and clinical epidemiologists to work Alcoholism to establish the nation's first important, substantive direction to al- together to conduct research into Center for the Clinical and Medical Epi- cohol research in this country," Blane alcohol's relationship to chronic dissays. "These studies will significantly ease. demiology of Alcohol. "The study concentrating on coroHoward T. Blane, Ph.D., RIA direc- expand our knowledge of the natural tor, will direct the new center and Marcia history of alcoholism and the relation- nary heart disease will look in detail at Russell, Ph.D., RIA senior research sci- ship between alcohol use and health drinking patterns- not just the amount, but the way people consume alcohol entist, will serve as scientific director. disorders. "Most of what we know about alco- as possible risk factors," he adds. "We Maurizio Trevisan, M.D., chair of social and preventive medicine, will direct re- holism is based on studies of alcoholics will also look at the interaction between in treatment, but it has been estimated alcohol and other nutritional factors." search conducted at UB. The UB study on alcohol and The grant will fund three major ~!l!!fJ~IF~~;;;~II!I'I-,~Itll!!~ lung cancer will be the first to conresearch studies and one pilot protrol for possible confounders such as gram that will run concurrently over the next five years. The renutritional status and passive smoking - a particularly important facsearch programs will study the epitor to consider, Trevisan notes, since demiology oftreated and untreated alcoholism, the epidemiology of a great deal of alcohol is consumed alcohol and coronary heart disease in smoky bars. and the epidemiology of alcohol Other UB researchers involved in and lung cancer. The pilot prothe project includejo Freudenheim, gram will involve the development Ph .D.; james Marshall, Ph.D .; of a computer-based geographic inManavela M. Desu, Ph.D.; jeffrey S. formation system on alcohol conSchwartz, M.D.; Donald Armstrong, Ph.D.; Elisa V. Bandera, M.D.; Terry sumption to serve as a basis for Pechacek, Ph.D.;johnE. Vena, Ph.D.; further epidemiological study. The Lucy Campbell, Ph.D., and Paula grant also provides funds for a naMuti, M.D. tional conference on alcohol epiAdditional RIA researchers indemiology to be held in its fourth year and the establishment ofa blood cludeGerardj. Connors, Ph.D.; Kenand specimen bank that will allow neth E. Leonard, Ph.D., and Michael ~ ~ future researchers to explore the role R. Frone, Ph.D. ~ j of genetic markers and individual RIA is a research institute affiliated ~ susceptibility and to assess the interwith the New York State Office of u action between alcohol consump- The NIAAA Alcohol Research Center will be the first to study Alcoholism and Substance Abuse Sertion and these markers. vices. the clinical and medical epidemiology of alcoholism. B u a 0 p h s c a s p n 9 9 9 4 �···-·--·-·--·---·-------------·----------------·-·---------- ----··----·-·-·············· a · ~ I 1993 is strongest yeM ever for school's James Platt White Society he James Platt White Society capped its strongest membership drive ever last October with a special reception at the Park Country Club. Membership in the organization, which recognizes donors to the School ofMedicine and Biomedical Sciences of $1,000 or more, rose to more than 180 alumni, faculty and friends. Organized in 1986 on the medical school's 140th anniversary, theJames Platt White Society is a distinguished leadership organization based on the values and principles of James Platt White, M.D., one of the founders and a former dean of the medical school and a pioneer in the field of obstetrics. White's vision, intellectual vigor and moral courage represent the qualities of the society's membership and leaders. Gifts to the medical school by members of the society have helped fund biomedical and clinical research, provide scholarships, purchase stateof-the-art laboratory equipment and maintain innovative programming. Members of theJames Platt White Society for 1993 include: Dr. Bruce Abramowitz Dr. Kenneth Alford B a 0 Dr. Kenneth Z. Altshuler Dr. Richard Ament Dr. William S. Andaloro Drs. Kevin and Elizabeth Barlog Dr. jared C. Barlow Dr. Ronald E. Batt Dr. Ralph T. Behling Dr. David A. Berkson Dr. Richard A. Berkson Dr. and Mrs. Willard H. Bernhoft Dr. Theodore Bistany Dr. john C. Bivona, Jr. Dr. Willard H. Boardman Dr. Martin Brecher Dr. and Mrs. Harold Brody Dr. Melvin M. Brothman Dr. Robert L. Brown Dr. August A. Bruno Dr. Elaine M. Bukowski Dr. Ivan L. Bunnell Dr. David W. Butsch Ms. janet F. Butsch Dr. john L. Butsch Mr. David N. Campbell Dr. icholas]. Capuana Dr. Peter A. Casagrande (deceased) Dr. and Mrs. Norman Chassin Dr. and Mrs. joseph A. Chazan Dr. Michael E. Cohen Dr. Robert]. Collins Dr. Donald P. Copley Dr. and Mrs. William R. Cromwell Dr. Daniel E. Curtin Dr. Richard Daffner Dr. Peter S. D'Arrigo Dr. Roger S. Dayer Mrs. Carlo E. DeSantis Dr. Edward Diao Dr. Stuart L. Dorfman Dr. Sterling M. Doubrava Dr. Ronald I. Dozoretz Dr. George L. Druger Dr. Kenneth H. Eckhert Dr. Robert Einhorn Dr. and Mrs. George M. Ellis Dr. Alfred S. Evans Dr. john A. Feldenzer Dr. Donald M. Fisher Dr. jack C. Fisher Dr. john W . Float Dr. Thomas F. Frawley Dr. Vincent]. Fuselli Dr. Richard R. Gacek Dr. B. joseph Galdys Dr. Ronald F. Garvey Dr. john W . Gibbs Dr. Gerard Guerinot Dr. Thomas]. Guttuso Dr. Ralph R. Hallac Dr. joseph V. Hammel Mrs. Gilda L. Hansen Dr. Reid R. Heffner, Jr. Dr. Orvan W. Hess Dr. William J. Hewett Dr. joseph M. Hill p y 5 c Dr. Fredric Hirsh Dr. john M. Hodson Dr. Robert M. jaeger Dr. Kenneth L. jewel Dr. Stephen T. joyce Dr. james R. Kanski, Jr. Dr. julian R. Karelitz Dr. john P. Kelly Dr. Kenneth Kim Dr. and Mrs. Paul S. Kruger Dr. Marie Leyden Kunz Dr. and Mrs. Marvin Z. Kurlan Dr. Francis]. La Luna Dr. RobertS. LaMantia Dr. Gordon R. Lang Dr. Andre D. Lascari Dr. Dana P. Launer Dr. Won Yub Lee Dr. Sanford Leff Dr. Eugene V. Leslie Dr. Laurence M. Lesser Dr. Paul A. Lessler Dr. and Mrs. Harold]. Levy Dr. jack Lippes Dr. Hing-Har Lo Dr. Thomas A. Lombardo, Jr. Mrs. GraceS. Mabie Dr. Milford S. Maloney Dr. David L. Marchetti Dr. Don L. Maunz Dr. Michael A. Mazza Dr. Margaret McAloon Dr. Charles]. McAllister Dr. Margaret P. McDonnell Dr. Harry L. Metcalf Dr. Francis C. Mezzadri Dr. Merrill L. Miller Dr. Eugene R. Mindel! Dr. joseph F. Monte Dr. john D. Mountain Dr. Arthur W. Mruczek, Sr. Dr. Richard L. Munk Dr. Richard]. Nagel Dr. Masao Nakandakari Dr. Richard B. Narins Dr. john Naughton Drs. Robert and Lillian Ney Dr. Charles R. Niles Dr. john D. Norlund Dr. Benjamin E. Obletz Dr. Patrick L. O'Connor Dr. Thomas P. O'Connor Dr. Carrie P. Ogorek Dr. Yasuyo Ohta Dr. Elizabeth Olmsted Drs. Dean and Donna Orman Dr. johnS. Parker Dr. and Mrs. Robert]. Patterson Dr. orman L. Paul Dr. Clayton A. Peimer Dr. Victor L. Pellicano Dr. james F. Phillips Dr. Daniel A. Pietro Mr. R. Willis Post Dr. Richard A. Rahner a s p I Dr. Bert W. Rappole Dr. Albert C. Rekate Dr. Frank R. Riforgiato Dr. Charles j . Riggio Dr. Richard R. Romanowski Dr. and Mrs. Charles H. Rosenberg Drs. Robert Smolinski and Claudia Fosket Dr. Albert G. Rowe Dr. jacob D. Rozbruch Dr. Eric]. Russell Miss Thelma Sanes Dr. Michael A. Sansone Dr. Robert N. Schnitzler Dr. David S. Schreiber Dr. joseph I. Schultz Dr. Roy E. Seibel Dr. Molly Seidenberg Dr. Elizabeth G. Serrage Dr. john B. Sheffer Dr. john E. Shields Dr. Timothy S. Sievenpiper Dr. Roger M. Simon Miss Alice Simpson Dr. Arthur C. Sgalia, Jr. Dr. Raymond M. Smith, Jr. Dr. Morton Spivak Dr. john E. Spoor Dr. john]. Squadrito Dr. Richard J . Sternberg Dr. William Sternfeld Dr. Eugene M. Sullivan Dr. Michael A. Sullivan Dr. MichaelS. Taxier Dr. Charles S. Tirone Dr. john P. Visco Dr. Franklin E. Waters The estate of Mrs. Pauline E. Watson Dr. and Mrs. Arnold Wax Dr. and Mrs. Harold F. Wherley Dr. james]. White, Jr. Dr. Gary]. Wilcox Dr. james S. Williams Dr. Richard G. Williams Dr. and Mrs. Marvin Winer Dr. john R. Wright Dr. Gregory E. Young Dr. Wende W . Logan-Young Dr. Syeda F. Zafar Dr. Franklin Zeplowitz Dr. and Mrs. David C. Ziegler Editor's Note: While every effort is made to ensure the accuracy of this listing, omissions and misprints may occur. This report lists all members between October 24, 1992 and October 22, 1993. If you have any questions, comments or concerns, please call Michael E. Benzin, Acting Director of Annual Giving, at (716) 645-3312. Thank you. 9 9 9 �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 ~ I Sesquicentennial committee begins events planning MEDICAL SCHOOL FOUNDING ALMOST 150 YEARS AGO MARKS UNIVERSITY AT BUFFALO'S BEGINNING ith a little more than two years before the University at Buffalo and its School of Medicine and Biomedical Sciences celebrate the 150th anniversary of its founding, the History of the Medical School Committee is already busy planning celebrations and events to commemorate the historic occasion. Composed of representatives from both the medical school and the university at large, the committee meets monthly as a whole; its task forces focus on specific aspects of the Sesquicentennial Celebration. In the planning stages are a symposium series, the medical school's annual Spring Clinical Day, various medical school and community-wide exhibits featuring medical school memorabilia, a special sesquicentennial logo and the Annual Meeting of the American Association for the History of Medicine, scheduled from May 8 to May 12, 1996. The group is also working on anumber of special publications, including A Medical History in Buffalo 1846-1996: Collected Essays, A Pictorial History of the Medical School, Selected Writings of Austin Flint and an alumni directory. Douglas Bacon, M.D. SCHOOL OF MEDICINE a 0 E y 8 Committee members include: Harold Brody, Ph.D., M.D., Co-chair Professor, Department of Anatomical Sciences Ronald E. Batt, M.D., Co-chair Clinical Associate Professor, Department of Gynecology-Obstetrics joyce Vana, Ph.D., Secretary Clinical Assistant Professor, Social and Preventive Medicine B Assistant Professor, Department of Anesthesiology James Bono, Ph.D. Assistant Professor, Department of History Ivan Bunnell, M.D. Clinical Professor Emeritus, Department of Medicine Leon Farhi, M.D. Distinguished Professor, Department of Physiology Shonnie Finnegan University Archivist David Gerber, Ph.D. Professor, Department of History Nanette Tramont Kollig Editor, Buffalo Physician Richard Lee, M.D. UNIVERSITY AT BUFFALO 4 A 6 R S 9 9 6 Professor of Medicine, Pediatrics and Obstetrics john Naughton, M.D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences Carole Smith Petro, Ph.D. Associate Vice President for University Advancement Office of the Vice President for University Advancement and Development jack Richert, Ph.D. Associate Dean for Alumni Affairs Mildred Sanes Lilli Sentz Curator, History of Medicine Collection Library of Anatomy and Cell Biology Dedicated -John Naughton, M.D., vice president of clinical affairs and dean of the School of Medicine and Biomedical Sciences, speaks at the dedication of the school's anatomy and cell biology library last October. At left, Irene DeSantis, widow of Carlo DeSantis, Clarice Bernhoft and Dr. Willard Bernhoft, after whom the library is dedicated, look on. p 5 c a n s p g 9 9 • �............................................................ . . · · · · ··· · · · · · · · ·a Medical school memorabilia sought for pictorial history o celebrate the l50th anniversary ofits founding, the medical school will publish a pictorial history. Already being compiled, the history will feature articles and memorabilia about the school, its students and the historical events that have made it what it is. Connie Oswald Stofko, former Buffalo Physician editor, who will edit and compile the publication, asks for help from anyone who might have a contribution to it: "We need pictures, lots and lots of pictures, to make our pictorial history shine. We're looking for anything visual: photos, paintings, drawings, commencement programs, award certificates, perhaps even an antique that we could photograph. We need pictures from every time period , but we expect we'll have the hardest time finding things from the 1800s. Don't send any original! We'd hate for an heirloom to get lost in the mail. Describe to us what you have, or perhaps photocopy it. Please include the names of people in the picture, the date, wh ere it was taken and any other information you have. If you can't identify the picture, maybe we can help. Send the information about your picture to: Connie Oswald Stofko Editor, Pictorial History of the Medical School History of Medicine Collection Health Sciences Library South Campus 3435 Main Street Buffalo, New York 14214 Please remember to include your name, address and telephone number so we can contact you . B u a 0 p h Items already from the Pictorial History of Medicine Collection, to be published for the Sesquicentennial Celebration in 1996. Above, Dr. Roswell Park performing surgery, circa 1898. At left, the University of Buffalo's 1894 football team. Pictu re guidelines: Photographs: Any size, color and shape is fine. We can have a print made from a slide. Photos from programs and other publications could be copied. Photos from old newspapers might work. Paintings, drawings: Oil paintings, charcoal sketches, pen and ink drawings, pastels and other artwork are all possibilities. Maybe you have artwork 5 c a n 5 p of an old building or a sketch of a piece of equipment or the readout of some pioneering piece of equipment. Other: Look for programs from lectures, commencements or other ceremonies; award certificates; pins or buttons, or perhaps early items used in your field. Thanks, but we don't need yearbooks. We've got those." g 9 9 4 �THEN-NOW Anesthesiology at the University at Butfalo: FROM ITS ROOTS IN 1913 TO TODAY , US'S DEPARTMENT OF ANESTHESIOLOGY HAS MADE NOTEWORTHY CONTRIBUTIONS TO THE SPECIALTY was a pivotal year in the history of medicine both locally and nationally. On May l l , 1846 the University of Buffalo School of Medicine was founded. Almost five months later, on October 14, 1846, William Thomas Green Morton used the vapors of sulfuric ether to anesthetize Gilbert Abbott for the removal of a jaw tumor in the first public demonstration of surgical anesthesia. One hundred forty-eight years later, Paul R. Knight, Ill , M.D. , Ph.D., chairman ofUB's Department of Anesthesiology, oversees a branch of the medical school with more than 80 faculty members. The anesthesiology department supports 52 residents and fellows in six clinical sites scattered across the Buffalo metropolitan area, administers anesthetics , cares for patients with pain and manages critical care. Its anesthesiologists actively investigate problems in basic science and clinical and historical research, as well as give lectures in basic science and clinical demonstrations for the medical students. The Department of Anesthesiology has not always been so substantial. It originally was part of the Department of Surgery; its first appointment, John Henry Evans , was nominated in 1913 by the world renowned surgeon, Roswell Park, as an assistant in anesthetics. Over the next 40 years, Evans would bring anesthesiology in Western New York and the University of Buffalo to international prominence as he developed the country's first department and residency B a a training program . While remaining in active clinical practice all his professionallife, Evans also published 29 papers over the length of his career in the leading journals of his day . John Henry Evans was born on September 24, 1876 to Welsh immigrant parents in the Southern Tier community of Freedom, New York. He learned English at the age of 10 when his family moved to Machias and his father established a general store. He attended the Ten Broek Academy in Franklinville and graduated from Ithaca High School. Evans spent six years in the Merchant Marine before resettling in Western New York and enrolling in the University of Buffalo School of Medicine. After graduating with honors in 1908 at the "advanced" age of 32, Evans spent four years at The Buffalo General Hospital as a house officer, giving anesthetics as part of his duties . Evans returned to Machias in 1912 to set up a general practice. But he returned to Buffalo within a year after his brother was killed in a train accident. Evans' interest in the administration of anesthetics and his work with Roswell Park during his days as a house officer led to his faculty appointment. From then until the First World War, he was paid $2 per student for teaching anesthesiology. On May 15, 1917, the chairman of surgery promoted Evans to instructor in anesthetics. p y s c a n The First World War interrupted his academic career, when he was commissioned as a captain in the United States Army Medical Corp . He returned to Buffalo after his discharge in 1919 and began to resurrect both his academic and political career by becoming active in the organizations of the specialty. During the 1920s, Evans helped establish two societies devoted to advancing the then-fledgling specialty of anesthesiology. In 1922, he was elected president of the Board of Governors of the International Anesthesia Research Society, an organization over which he would preside for the next 20 years. The group's mission was to promote scientific inquiry into anesthesiology across the world. In 1923, the Eastern Society of Anesthetists was founded by Evans and two nationally prominent ew York City anesthesiologists,] ames Gwathmey and Adolf Erdmann , to promote anesthesiology along the Eastern seaboard. Evans presented a paper at the ftrst meeting of the society entitled "Blood Pressure Guides and Safety in Anesthesia. " In 1927, he was elected president of the Associated Anesthetists of the United States and Canada, the only national anesthesiology organization at the time . The July 1927 issueoftheBritishjoumal of Anesthesia was dedicated to Evans and listed his many accomplishments. In 1928, Evans was elected as the Eastern Society's president and helped present a bust of Morton commemorating the first public demonstration of ether anesthesia to the Massachusetts General Hospital. Photographs of the event were published in Current Re- 5 p 9 9 4 �THEN-NOW his career. Convinced that oxygen injected subcutaneously could improve wound healing and eliminate arthritic pain and improve function, Evans spent long hours testing his theories. Years after, former medical students still remember Evans' demonstration of the technique. In addition to pain management, Evans was embroiled in a scientific debate over how much oxygen could safely be used to treat pneumonia. Evans advocated the use of a high enough inspired oxygen concentration to abolish cyanosis - a radical thought for the day. Many others felt that permanent lung damage would occur when oxygen was inspired in concentrations greater than 60 percent. Evans clearly demonstrated this was not the case, and developed an apparatus for oxygen administration by face mask that today would be recognized as continuous positive airway pressure ( CP AP). When Boston's Coconut Grove Night Club burned in 1942, Evans was called in as a consultant to administer supplemental oxygen to the victims of that fire. The University of Buffalo should be proud of its long tradition in anesthesiology and its first chairman,] ohn Henry Evans. His attitude and his efforts have made possible much of what has become routine academic practice in the 81 years since Roswell Park made his initial appointment. Above, Evans, shown ot left ot his office in Mochios, New York. Below, the University of Buffalo medical school classes of 1907 through 1911. Evans is the first person in the second row at left. - searches in Anesthesia and Analgesia, the Department of Anesthesia; full recognition of anesthesiology as a medical specialty had materialized in Buffalo. Residency training in the field was initiated that year when Rose Lenahan accepted a position as hospital assistant in anesthetics (the equivalent of resident today) at The Buffalo General Hospital. Research into the effects of oxygen captivated Evans for the last 20 years of only American medical journal devoted to the field at the time, and Evans was pictured among the leaders in the field . In 1932, he was appointed professor of anesthetics. Four years later, a publication of Evans' originated at the Department of Anesthesia. The 1938 edition of the University of Buffalo Bulletin cited Evans as professor and head of the B u a 0 p y 5 c a 5 p BY DOUGLAS BACON , M.D . About the author: Douglas Bacon, M.D., is an assistant professor in the department of anesthesiology and director of resident education at Roswell Park Cancer Institute. The author would like to thank Chris Densmore and Shonnie Finnegan of the University at Buffalo Archives, Alfred S. Evans, M.D. and Ann Stewart (Dr. Evans' children), Richard N. Terry and Patrick Sim of the Wood Library-Museum of Anesthesiology fo r their help in preparing this manuscript. n g 9 4 �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 ' I I Members of the IH study sections are selected on the basis of their demonstrated competence and achievements within their scientific fields. Achievements taken into consideration include the quality of research accomplishments, publications in scientific journals, achievements and honors. UB professor authors several sections for the Merck Manual ames B. Lee, M.D., UB professor of medicine has updated the prostaglandins, thromboxanes and leukotrienes sections for the recently published 16th edition of The Merck Manual of Diagnosis and Therapy. Lee, who is an alumnus of]efferson Medical College in Philadelphia, is director of the Erie County Medical Center's hypertension program. Lee is one of 300 scholars and specialists who have contributed to The Merck Manual. Schimpthauser elected to head medical education research group rank Schimpfhauser, Ph.D., UB assistant dean and director of educational evaluation and research, has been elected president-elect of the Society of Directors of Research in Medical Education. The Society of Directors of Research in Medical Education, which conducts and promotes medical education research and acts as liaison and consultant to other medical groups, is composed of professionals in the field from U.S. and Canadian medical schools. Schimpfhauser, a 1965 UB graduate, has been active in the society for nearly two decades, serving as membership committee chair in 1991 and treasurer in 1992. Schimpfhauser's research in medical education has included topics on Frank Schimpfhauser, Ph.D. Murphy chairs NIH subcommittee imothy F. Murphy, M.D., professor of medicine and microbiology, has been appointed chair of the Bacteriology and Mycology Study Section, Subcommittee 2, Division of Research Grants for the National Institutes of Health. Murphy is chief of the infectious diseases divisions of the medical school, the Buffalo VA Medical School and Erie County Medical Center. He co-developed a vaccine with the potential to provide immunity against middle ear infections and was recognized as Niagara Frontier Inventor of the Year for 1992 by the Technical Societies Council of the Niagara and iagara Frontier Patent Law Association. Director of the UB microbial pathogenesis graduate group, Murphy heads two five-year projects totaling $2.5 million in funding from the National Institute of Allergy and Infectious Diseases to study organisms that cause childhood middle ear infections and adult lung infections. B u 0 0 p h y 5 c o n s cancer education, student career choice and decision making and most recently, on the use of standardized patients for the assessment of clinical competence. An associate professor of social and preventive medicine, he holds master's and doctoral degrees from Ohio State University. He administers program evaluation activities for the School of Medicine and Biomedical Sciences and is the coordinator of the third and fourth year academic programs. He also chairs the Association of American Medical Colleges' mini-workshop program and is a member of that organization's national planning committee. He has published more than two dozen articles in professional journals and has made presentations at more than 30 conferences in the U.S. and abroad. p n g 9 9 4 �...... . ................. ····················· · ················ · ··· · ·····················[!] lii'J Spring Clinical Day agenda set AGENDA he Medical Alumni Association has set the agenda for its 57th Annual Spring Clinical Day, to be held Saturday, April 30, at the Buffalo Marriott. This year's program - Medical Education Into the Next Centuryfeatures Jerome P. Kassirer, M.D., '57, as its keynote speaker. Kassirer, who received the Distinguished Medical Alumnus Award in 1992, is editor-in-chief of The New England journal of Medicine and professor of medicine at Tufts University School of Medicine. He also lectures at Harvard University. Kassirer will deliver the Stockton Kimball Memorial Lecture, "Clinical Reasoning: Teaching It and Learning It." The program, designated for up to 3.5 hours of category credit toward the Physician's Recognition Award of the American Medical Association and 3.5 prescribed hours by the American Academy of Family Practice, will present new approaches to the teaching of medicine. Faculty will explore ways to improve patient-physician communication and investigate its impact on the practice of medicine. Medical informatics and its effect on medical education will also be discussed, as well as the use of standardized patients in medical education. In addition to Kassirer, the faculty includes John W. Loonsk, M.D., '86, UB's director of the office of medical computing and assistant professor of biophysical sciences; RichardT. Sarkin, M.D., coordinator of UB's teaching effectiveness program and director of pediatric medical student education; and Paul::; L. Stillman, M.D., provost and dean of the Medical College of Hampton Roads, Eastern Virginia Medical School, Norfolk, Virginia. B 0 0 p h 7:30a.m. Registration and continental breakfast 8:15a.m. Welcoming Remarks Robert Reisman, M.D., '56 President, Medical Alumni Association John Naughton, M.D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences 8:25 a.m. Introduction to the day's interactive program Frank T. Schreck, M.D. '79 Program Chairman 8:30 a.m. "The Science of Listening" RichardT. Sarkin, M.D. 9:15a.m. "Information at Clinical Fingertips: Moving Beyond the Promise of Medical Informatics" John W. Loonsk, M.D. , '86 10 a.m. Coffee break and exhibit review 10:30 a.m. "The Use of Standardized Patients for Teaching and Assessment" Paula L. Stillman, M.D. 11:30 a.m. Business meeting Noon Annual Medical Alumni Luncheon and Stockton Kimball Memorial Lecture "Clinical Reasoning: Teaching It and Learning It" Jerome P. Kassirer, M.D. , '57 Andersen '47,and Zizzi '58, lauded by UB and ECMC urray N. Andersen, M.D., '47, and Joseph A. Zizzi, M.D ., '58, were honored for their long-time work at Erie County Medical Center. Officials from the School of Medicine and Biomedical Sciences as well as county and hospital officials, cited the physicians last year at the hospital's annual Springfest dinner dance. The event is held to benefit employee education. Andersen is former chief of thoracic 5 c 0 5 p and cardiovascular surgery at ECMC. He also served two years as president of the medical-dental staff at the former E.]. Meyer Memorial Hospital. Zizzi is director of clinical cardiology. He has also served as assistant medical director, acting medical director, medical director and deputy medical director at the hospital. Celebri-tees- Stephan Commins '74, and Jan Nathanson '74, at last October's Walt Disney World's Pro-Am Golf Classic. LincoiT '88,authors JAMA article orah Lincoff, M.D. , is one of the co-authors of a "Letter from Havana - 'Outbreak' of Optic and Peripheral Neuropathy in Cuba?" published in the July 28, 1993 edition of the journal ofthe American Medical Association. The article concerns a disorder first recorded by Cuban physicians in January 1992 and subsequently spread throughout Cuba. Lincoff and fellow authors Jeffrey G. Odel, M.D. , and Michio Hiano , M.D., of the College of Physicians and Surgeons of Columbia University, studied 20 patients ranging in age from 19 to 63 years afflicted by the disorder, the symptoms of which include decreased vision and sensory symptoms (paresthesia, burning and dysesthesia) predominantly in the feet. Lincoff currently is a neuro-ophthalmologist at Buffalo General Hospital. g 9 9 4 �~ ····························································· _ ····· _ ······_ ······· _ ······_ ··· Q to Grenada and then I got accepted to UB," he says. Deciding to pursue pediatrics, he trained at The Children's Hospital of Buffalo and eventually accepted the position of medical director of the hospital's Roberto Clemente Health Center on Buffalo's West Side. Prior to his arrival, a physician would spend three hours a day seeing patients at the center. "My idea was to offer continuity in a full-time position there and set up a system where we could have a nutritionist and social worker and build up the community so that our kids could stay out of the hospital emergency room," Coyne explains. The effort was a success. When he started at the center in 1988, patient visits averaged 4,000 per year. By the time he left last September, the annual total had grown to 22,000. Last fall, Coyne accepted a position with Niagara Falls Memorial Medical Center, taking on much the same challenge he did at Clemente. He was put in charge of the Kids Clinic at the Hamilton B. Mizer Primary Care Center- a place where a physician came in three or four days a week for three hours at a time. Coyne quickly added two full-time physicians, a nurse practitioner and a social worker. He credits Memorial Medical Center President Timothy J. Finan for taking the initiative in extending continuity of care at the primary care site that has just opened 10 new pediatric rooms and has since been renamed Memorial Pediatrics. "Forty-seven percent of the community in Niagara Falls is on public assistance. Most of those children do not have a physician. Tim Finan felt that was not appropriate and that we needed to do something different," explains Coyne. Services provided by Memorial Pedi- Prtest doctor, advocate for the poor FROM NORTHERN KENYA TO NIAGARA FALLS , JACK COYNE '85 , TREATS THE UNDERPRIVILEGED ost people follow one vocation at a time. Not Jack F. Coyne, M.D. He is both pediatrician and priest. The 1985 graduate of the School ofMedicine and Biomedical Sciences, however, considers himself primarily in social work. "There are those who feel that the priesthood is more sacramental. I honestly believe that the role of the priest is to be a social worker," he says. This view proved to be a renegade attitude with the Church in St. Louis where he was a graduate student in the late 1960s. So Coyne became part of a small group of fellow seminarians who decided to start a new religious community. "There was a full-page article in Newsweek when we made the break in 1968 for doing things differently- not dealing with the liturgy so much as dealing with inner city problems," Coyne recalls. Coyne added another vocation at the time as the group used music to express its work in the inner city, forming a folk-rock quintet known as "The Mission" that made appearances on national TV talk shows hosted by Dick Cavett, Steve Allen and Mike Douglas. The quintet also made an album for Warner Brothers Records with Mary Travers of "Peter, Paul and Mary." In 1981 - 10 years after he was ordained a priest- experiences in Cambodia, Haiti and Borneo convinced Coyne that he needed a knowledge of medicine to continue his work with the poor. "Because of those experiences, I applied to medical school and I got lucky. I had my airplane ticket set to go Jatk Cayne, M.D., and two very satisfied patients, Jeremy and Harvey Brundidge. B u a 0 p 5 c a 5 p 9 9 9 4 �· · · · · · · ·· · · · · ······ · · ·· ·············· ·· · · · · ······ · ··········· · ··· · · · ····· · · · ··· ··· ······ ~ ~ In 1984, Coyne switched from the Roman to Eastern rites, joining the Greek Orthodox Church. Coyne observes, adding, "To get the right mental health services, to get the right counseling, to get a child who's eight or nine through the system now and get the help he or she needs will help prevent them from becoming a painful survivor at 30. This is really a goal of mine and something that child advocacy is dedicated to as well. " Coyne added yet another vocation in 1987 when he became a husband and then a father. Having a continuing problem with the church law of celibacy, he switched from the Roman to Eastern rites in 1984, joining the Greek Orthodox church, which allows priests to be married. "There is no relationship in my mind between priesthood, service and celi- atrics include well child care, sick care, immunizations, sports and school physicals, lead testing, birth control, teenage counseling, 24-hour emergency coverage and supportive services for physical and sexual abuse. In fact , Coyne is the medical director of child advocacy teams in Erie and Niagara counties that investigate sexual abuse. "We see about three children a week who are sexually abused ," he says. He is pleased with Erie County's commitment to revamp a floor of the Prudential Building at Delaware Avenue and Allen Street as an advocacy center for young sexual abuse victims. "I find that a real expression of pediatrics because many of these children are forgotten - not just medically," B 0 0 p y s c o n 5 p bacy. I still think that might change in the Catholic church but I'll probably be long gone when that happens. That brought me to where I am today - to keep my priesthood but be able to get married and have a family," he states. Two years ago , Coyne fulfilled a lifelong dream and journeyed to Africa to set up a clinic in the bush of Northern Kenya for the nomads . "We did some HIV testing and worked with the (missionary) nuns there to create some medical services that could be performed on a regular basis ," he explains. It was a brief visit before his return to Buffalo. "I always thought I would eventually stay in Africa to work but as I grew up and had more responsibilities, such as a family , going to Africa wasn't as easy. My way of expressing the same need was to work in the inner city here, " Coyne declares . It has truly been a multi-vocational road for this Long Island native with a lifelong commitment to working with the poor. "I always wanted to be a priest but I didn't want to be in a parish," he concludes. Instead of administering in a parish, jack Coyne has acted as a shepherd of health care continuity in communities where such enrichment has been rare. And that's good for both the body and soul. - B y j I M B I S C CORRECTION In the last issue of Buffalo Physician, Dr. Franklin Zeplowitz' name was inadvertently omitted from the 1993 Reunion Class donors. Dr. Zeplowitz should have been included with his 1958 graduating class. Our sincerest apologies! n g 9 9 4 0 �! l ······················· . .................. .......... . . . . it is about the only occupation for the people. A coffee picker may earn 11 quetzales ($1.70) a day," Schaefer said. Approximately 2,500 people live in the village, with about 25,000 more in surrounding villages and coffee plantations, Schaefer said. Transportation is difficult in the mountainous region. "Patients often have to walk many hours or days to reach the hospital," he added. The Hospital de la Familia receives surgical patients from all parts of Guatemala and the surrounding areas of southern Mexico, El Salvador and Honduras. Schaefer said the most prevalent diseases there are malnutrition, respiratory ailments, gastrointestinal infections, congenital malformations and traumatic injuries. The region's infant mortality rate is approximately 80 percent, although a substantial improvement in that figure has been reported over the past five to 10 years in the area served by the Hospital de la Familia. Schaefer was accompanied by operating room nurse Karen Kumar and operating room technician Geraldine McGuire. During their two-week stay in Nuevo Progresso, they performed 140 eye surgeries. The ophthalmology team was part of a larger medical group that covered a variety of specialists, including otolaryngologists, general surgeons, OBI GYN and general plastic surgeons. This was Schaefer's second visit. Carolyn Bessette, M.D., in NASA's zero-gravity simulator. surgeries as well as defibrillation and mechanical ventilation. Bessette has completed a flight surgeon's training course offered at the johnson Space Center and is currently pursuing an aerospace medicine residency. Carolyn Bessette completes NASA aerospace medicine fellowship arolyn Bessette, M.D., a recent medical school graduate, recently completed a NASA aerospace medicine fellowship at the johnson Space Center in Houston. She was one of four senior medical students selected to participate. The four-week intensive program included lectures on topics such as cardiovascular reflex responses to microgravity, pharmacodynamics in zero-gravity, controlled ecological life support systems aboard a space station, the mechanisms of decompression sickness, vestibular adaptation to space flight and muscular atrophy and adaptation to microgravity. The fellowship also included zerogravity simulation flights as well as visits to NASA's Space Station Freedom mock-up's medical operations module. The unit is equipped to perform minor B u a 0 Daniel Schaefer '81, volunteers in Guatemala with medical team aniel P. Schaefer, M.D., '81, director of the ophthalmology section at St. joseph Hospital, was a member of a volunteer medical team that traveled to the Hospital de la Familia in Guatemala last spring to administer services to the poor. About 2,500 people live in the Nuevo Progresso, a mountain village about 170 miles northwest of Guatemala City. "The town lies at an altitude of about 2,500 feet in a nearly impenetrable rain forest. This is a coffee growing area and p h s c a . . . ...................... . ..... The Strasenburgh Planetarium, in Rochester, New York, was the site for a recent Medical Alumni Association reception. s p n 9 9 9 4 �Dear Colleague, Donnica Moore '86, honored by Amertcan medical women'sgroup he American Medical Women's Association (AMW A) honored Donnica L. Moore, M.D., '86, at last year's 78th annual meeting, "Women Promoting Women's Health: Prevention Through Research and Education." Moore was presented with the Calcium Education Nutrition Award, sponsored by Proctor and Gamble Pharmaceutical Company. The award is presented annually to the AMWA member who has done the most to educate physicians , medical students and the lay public about the importance of osteoporosis and treatment. Moore is currently the director of medical education at Sandoz Pharmaceuticals. She has spearheaded development of the Sandoz osteoporosis computer education program, a comprehensive, state-of-the-art, multimedia self-directed learning program designed for medical students. She has also been involved in developing AMWA's master faculty training program in osteoporosis and in establishing the Sandoz postdoctoral fellowship in bone metabolism. The AMWA event also marked the first time the association featured a UB School of Medicine and Biomedical Sciences alumni reception at its annual meeting. Moore, who is also AMWA regional governor for New York and New] ersey, organized the reception. B u a 0 p h The Perfect Prescription For Your Conference Needs We are pleased to inform you of your eligibility to purchase microcomputer and information technology products at special educational prices at UBMicro, the University at Buffalo's non-profit computer resale program. Consulting and pricing information is available weekdays 9:30am to 5pm, and until 7pm on Wednesdays and Thursdays. UBMicro is located in The Commons on the north campus at 645-3554. 18,000 Square Feet of Meeting Space "i' Conference Planning Professionals "i' Convenient Downtown Location "i' Quick Metro R ide to Main Street Campus and Medical School "i' __ Close to Buffalo General, Roswell, ECMC and Children's Hospitals "i' Your Guests Can Walk to Theatre, Shops, Pilot Field, Restaurants, Entertainment _.__ "i' CME Friendly "i' Great Banquet Food Please Talk To Us About Preparing A Proposal So You Can Bring Your Group's Next Convention To Buffalo (716) 856-1234 6142 • Apple • IBM • Dell • Insight • Panasonic • Canon • Tl • Software • Supplies • Accessories • Audio • Hands-on Workshops ml Dllllr+l EXTENSION HYATT. WE'VE THOUGHT OF EVERYTHING~M H~Y--A--T,T RE A non·profit University program for students. faculty & staff The Commons • North Campus • (7T6)645·3554 • Fox: 645·3884 c a n 5 p B n U 9 G f E"' C Y A , 0 • 9 9 �----A---- S P-, o o . ·.;n f . u , I" f o H u m o r; THEY SAY YOU NEVER CAN - B U T IT'S STILL FUN TO TRY sis my tradition, I returned to my roots in New York City for New Year's. I never enjoy the ew Year's rituals, since traditionally by 12:45 a.m., you've been asleep for 10 minutes with a pointy noisemaker protruding from your pocket. For the past 10 years, my friends from med school and I have always celebrated the "Third Alternative" party (the first alternative is the usual New Year activity and the second is to stay home or go camping in Central Park) . At this particular party , watches are checked at the door and we have random countdowns on the dance floor and show a video loop of the ball dropping throughout the evening (from 1961, of course, since Dick Clark had the same formaldehyde look then he has today). The goal is to avoid the mechanized rituals of the holiday and still have fun . A trip toN ew York is never complete without a trip to the old neighborhood. People there still know me because I went to medical school. The first person I see is the man B 0 0 across the street with the clever mustache and stretch pants with bass and treble control. "Hi, how's it going in CaliF AWNYA? Are you still interning?" He doesn't ask if I'm an intern, but if I'm still interning. I believe the verb In thi.s old, entrenched, working-class jewish neighborhood, everyone has a doctor who is the ,,best" in their field. "intern" means to confine or impound, especially during a war- which, come to think of it, is not unlike what it feels like to be an intern and go three and a half years without sleep. This guy (for the life of me I have no idea who he is or how he knows me) p h 5 c o n 5 next says to me, "Tell me something ... " (Already I know I'm in trouble.) "My wife sprained her ankle. What's good for it? Dr. Marvin Schanker on the radio says milk is good for this sort of thing. " I'm thinking Dr. Schanker certainly should know since he learned so much about medicine while earning his Ph.D. in communications. Against my better judgment, I continued this conversation and told him milk will help a broken bone but not a sprain. He broke in with, "Oh, what do you know. Dr. Schanker has been around a long time- you're young yet." Dr. Schanker may have been around a long time, but so has Charles Manson and I don't usually ask him for advice on ethics cases. Maybe it's time for Dr. Schanker to be interned. In order to gain brownie points with me , everyone from the old neighborhood tells me about the doctors they know. "My daughter-in-law's brother is married to a doctor. He is doing very well as a plumonologist"- which I believe is either a French expert on ball-point pens or an author- p n g 9 9 4 �jewish neighborhood, everyone has a doctor who is the "best" in their field. When pressed as to why their doctor is the best, they tell you, "everyone says so," and, "he's so busy you have to make an appointment to make an appointment. He's the best 'eye man' in Brooklyn. " The truth is, nobody knows how well their doctor did in medical school. How many even look to see where the doctor went to school. Does anybody actually know how well their doctor did in biochemistry? obody looks! I have a friend, a podiatrist, who actually hangs his dog's pedigree on the wall. For his patients, he's the best "foot man" in Bensonhurst. I even went back to the hospital where 10 years ago I spent my first days on the ward. I recalled my first time in the hospital wearing my white coat that came out of the package five minutes earlier with eight other things, including two stethoscopes, an eye chart and a rectal thermometer key chain. I looked more like a roofer on the way to an insurance inspection. At this point, I don't know anyone who carries that much equipment. But when you're a student and you don't feel like a doctor, you need to at least look like one (orTrapperjohn). I recall standing there with all this equipment on while residents whirled by picking off stethoscopes and eye charts saying 'can I borrow this , can I borrow that?' I felt like a gingerbread man Christmas morning. Of course they never returned any of the equipment, so after a half hour I was picked clean down to my boxer shorts ready to see my first patient. I felt so awkward. I was 22 years old. I wasn't shaving yet, and here I was doing procedures on people, examining patients. You can never say touching or feeling in the medical profession; they teach you very early on it is always "examining, probing, palpating," never "touching." That's too offensive. But it felt good to see old friends and colleagues and to see that I'm not the only one unbuttoning my pants while sitting down to dinner because my pants are shrinking. Happy ew Year. Stu Silverstein, M.D., president of Stondup Medicine Seminars of Son Francisco, California, lectures nationwide on humor in medicine. ILLUSTRATION BY JAY LINCOLN B u a 0 p c a 5 p g 9 9 �a · ····· ····· · ··· · · · · · ············· · · · ···· · ······· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ········ · · search fellow at the Buffalo Institute of Fetal Therapy. Karamanoukian received the award , presented last summer at the society's annual international meeting in Washington, D.C. , for his research combining nitric oxide and surfactant for the treatment of diaphragmatic hernias in newborns. Last year marked the first time ever the Society of Pediatric Research presented the award to a surgeon. Karamanoukian's research suggests combining nitric oxide with surfactant may lower the mortality of newborns with diaphragmatic hernias and significantly decrease morbidity. Further prospective clinical trials to examine the effect of the combined modality are planned. Karamanoukian is working in the laboratory of Philip Glick, M.D., assistant professor of surgery and Children's pediatric surgeon. Frances Nesti, M.D. Children'sfellow wins crttical care medicine research training award he Society of Critical Care Medicine In Training Award has been awarded to Frances Nesti, M.D., a fellow in critical care medicine at The Children's Hospital of Buffalo and UB's department of pediatrics. The award recognizes excellence in critical care research. Nesti was chosen specifically for her research presentation in the area of perfluorcarbon liquid ventilation. Nesti received an engraved plaque and $2,000. Annual Incoming Residents Week set for June 13 -18 The School of Medicine and Biomedical Sciences will hold its annual Incoming Residents Week Monday through Saturday, June 13- 18. Approximately 150 residents will participate in the program about communication skills, teaching skills and issues in medicine such as advanced directives , documentation and medical records. The residents will also receive life support and advanced life support training. Nitric oxide/surtactant research garners national research award he 1993 National Residency Research Award , presented by the Society of Pediatric Research, has been awarded to Hratch Karamanoukian, M.D ., a general surgical resident of the department of pediatric surgery at UB and The Children's Hospital of Buffalo and re- B a 0 p h y s c a n 5 Lalley,Ph.D~ '74,tapped to head HIT student center for the deaf eter Lalley, Ph.D., has been selected to head the Center for Baccalaureate and Graduate Studies at the ational Technical Institute for the Deaf ( TID), a college of Rochester Institute of Technology in Rochester, New York. Lalley, a 1974 graduate of the school of medicine's doctoral program in human genetics, was named to the position last]une. The recently established center is a comprehensive, student-oriented service that offers such programs and services as academic advising, tutoring, notetaking and interpreting as well as pre-baccalaureate discipline-related courses. A geneticist, Lalley has achieved national and international prominence. From 1985 to 1991, he was chairperson of the International Committee on Comparative Gene Mapping. He has served on numerous national and international advisory panels and has written more than 80 research journal articles. He is on the editorial board of Clinical Biotechnology and has been subject area editor of Genomics. He is a former editorial board member of the journal of Experimental Zoology and Cytogenetics and Cell Genetics as well as a reviewer for numerous other publications. The NTID is the world's largest technological college for deaf students. It was created by Congress and is funded primarily by the U.S. Department of Education. NTID represents the first effort to educate large numbers of deaf students within a college campus planned principally for hearing students. More than 1,100 deaf students from across the United States and other countries study and live there. p n g 9 9 4 �·························································································[! ] Rehabilitation Center in Clarence, New York, where he served as medical director. His portrait will be displayed in the center to honor his many years of dedicated service. Dr. Paolini was instrumental in the creation of the Broth- ROSARIE BENDER ' 20, is retired and living in Fort Lauderdale, Florida. Dr. Bender, who was one of the first women plastic surgeons, practiced plastic and reconstructive surgery for 50 years. She is the only living member of her class. ers of Mercy's 40-bed rehabilitation unit. He plans to enjoy retirement with his wife, Emily, eight children and three grandsons. writes, "Surviving: two bypasses, cataracts. Keeping busy, would like to see more entries from my class. Where are you? How are you?" David S. Ba[hman '47 BERNARD S . STELL '46, of Sun City, Arizona, informs us retired surgeon, is a columnist for several newspapers, and the author of a recently published book, Thoughts and Musings of an Arkansas Country Doctor. He also co-authored the book , MAX A. SCHNEIDER '49, received the Silver Key Award from the National Council on Alcoholism and Drug Dependence for "outstanding service in the field of addiction medicine." HENRY H . HAINES '33, that his article "Stereomacrography - The Water Droplet Lens" appeared in the December 1993 issue of Stereoscopy, published by the International Stereoscopic Union. DAVID S . BACHMAN '47 , a with his family and three little grandsons. HERBERT W . SiMPK INS ' 53 , of West Orange, New jersey, retired from practice in December. PAUL L. of Tarzana, California, retired last]uly after 38 years of practice in internal medicine. Breaking the Smoking Habit. informs us he is now fully retired and plans on spending more time BURTON STULBERG ' 52 , FERDINAND A. PAOLINI '47, retired in December from the Brothers of Mercy Nursing and HERBERT A . '55 , LEONHARDT of Florham Park, New jer- sey, informs us that he retired in 1993. He has six grandchildren. J . SULLIVAN '55 , writes, "Still working full time with my practice restricted to forensic psychiatry. My wife, Carol, and I recently purchased a new, large motor home; we are enjoying traveling throughout the West, Canada and Mexico in it." Finally, a Real Retirement Planning Breakthrough for Doctors, Attorneys, and Professional Entrepreneurs... The Tax-Free "Private" Pension V 100% Tax-Free Compounding of All Interest, Dividends and Capital Gains V No Income Tax or Tax Consequences on Withdrawals V Unlimited Contributions V 100% Tax-Free Fund Transfer and Switching V 100% Income Tax and Probate-Free Life Insurance Benefit V o 10% IRS Penalty On Withdrawals Before Age 59-1/2 V o Forced Distributions At Age 70- 112 V Flexibility To Fit Your Changing eeds B a 0 p s c a 5 p ' 54 , lished in the Fall1993 PHAROS (the AO medical honor society magazine). His paper explains the 10 biblical plagues. WILLIAM DAVID HERTZ '52 , WEINMANN wrote a paper, "The Tenth Plague -Deathofthe ewborn? " pub- g 9 9 4 �l! l· ···· ··················· ·· ········· ······· ·· ·· ··········· ····· ······ ···· ······· ······· ··· was re- CAPTAIN ELIAS ROSENBLATT director of clinical services in elected to a second term as treasurer of the Minnesota Medical Association. '68 , writes , "I have been living the department of radiology at the University of Iowa. He has six children and one grandchild. ERICK REESER ' 56 , in Potomac, Maryland for almost 10 years now, long enough to appreciate some of the better parts of the Washington, D.C. , area, and to avoid all the rest. My wife, Ruth, is administrative director of physical medicine and orthopaedics at Suburban Hospital in Bethesda. Our son , Jeremy, is in his junior year at the Bullis School. Our daughter , Alison, graduated from there a year ago and is a sophomore at Kenyon College. Their brother, Michael, graduated from Cornell in 1991 and is now working in the hotel appraisal business in Miami. I'm a captain in the Navy medical corps , currently assigned as the director of the Naval Medical Doctrine Center on the Marine Corps Base at Quantico, Virginia. This assignment followed my graduating from the Naval War College. The center develops, analyzes and tests the doctrine of the utilization of medical assets in support of Naval, joint and combined (i.e., NATO) operations. It's very WILLIAM E . ABRAMSON '60 , writes, "On July 31 , 1992, Iretired after 28 years as a staff psychiatrist at Sheppard Pratt Hospital in Towson , Maryland. I have remained in private practice , with my office in the hospital , and on the courtesy staff. I love my new boss !" presented papers on attention deficit disorder in young adults at the University of Massachusetts MediHARRIS FAIGEL '60 , cal Center, American College Health Association. He is president-elect of the New England Chapter of the Society for Adolescent Medicine. His granddaughter, Madeline, was born January 10, 1993. RONALD S . MUKAMAL '64 , retired from private practice and moved to Baltimore, where he works part time. writes, "Although I returned to Ghana in 1968, I have tried to keep in touch with a few classmates over the years. Notable among these are Charles Ladoulis , Michael Taylor and Steve Scheib~r. From 1968 to 1978, I taught epidemiology and control of tropical endemic diseases in the Department of Community Health of the Ghana Medical School. I joined the World Health Organization in 1978 and served as a senior epidemiologist at the FRED K . WURAPA ' 64 , B u a Irving S. Kolin '65 Tropical Disease Research and Training Centre in Ndola, Zambia. Since 1986, I have been reassigned to the WHO Regional Office as the Regional Adviser on Control of Parasitic Diseases." AUGUST J . D ' ALESSANDRO ' 65 , retired in 1992 from the state of Connecticut after 25 years. He is medical director of Catholic Family Services in Danbury, Connecticut, and a psychiatrist with the New York State Department of Mental Retardation . IRVING S . KOLIN ' 65 , successfully completed the examination of the American Board of Adolescent Psychiatry for certification in adolescent psychiatry last May 20. Dr. Kolin is board certified by the American Board of Psychiatry and eurology and in the past year has also successfully completed examination for added qualifications in geriatric and addiction psychiatry. He is also certified by the American Society of Addiction Medicine and the American Board of Quality Assurance and Utilization Review. 0 p h 5 exciting work. Not only are my clinical and operational experiences utilized , but so are the academic and communication skills learned in undergraduate and prep school years. " IAN M . SCHORR ' 69 , of Englewood , New Jersey , announces a new grandson , born February 4, 1993. is professor of radiology and pediatrics and vice chairperson and WILBUR L. SMITH ' 69 , c a 5 p RONALD H. BLUM '70, was appointed deputy director of NYU's Kaplan Cancer Center. His wife, Diane, is executive director of Cancer Care , Inc. ROBERT DIBIANCO '72 , and his wife, Joan, announce a new addition, Regina Marie DiBianco, born August 1, 1993. The family now consists of David , l2;JohnMichael, 8; Regina Marie, 1/2! DR . ROBERT KROOPNICK was elected a fellow of the American College of Physicians in January 1993. Board certified in both internal medicine and '72 , geriatric medicine, he practices in Randallstown , Maryland. is director of the Englewood Hospital hemodialysis unit. He has a 12-year-old son and two collegeage sons; one attends the University of Vermont and one attends the University of Arizona. RALPH R . HALLAC '73 , RICHARD LEE '74 , writes he has been named medical director of Sierra Summit Rehabilitation, an outpatient facility in Reno, Nevada. A fellow of the American Academy of Neurology and certified by the American Academy of Pain Management, he was recently appointed a fellow of the Royal Society of Medicine, London , U.K. Dr. Lee has also been involved in locum tenens work for the past three years in clinical neurology. g 9 4 �····················· ·· ···································································l ! - ! n ' ton and his wife, Katie, are the R ICHARD I A. WOLF '82 , writes, proud parents of a son, James "still in cardiology at Grand Cody, born in October 1992. Forks Clinic in Grand Forks, North Dakota." He wonders if anyone knows where Rob MARK 5 . BORER '80 , is presi- Dudek, Roger Beneitone and dent of the Psychiatric Society of Ivan Baumel! are? Delaware and co-founder and PATRICK E . RYAN , JR ., '83 , medical director ofMeadowwood is currently in fellowship in Intensive Treatment Options. GASPERE Barlow Lynch '77 C . cardiothoracic surgery at SUNY GERAC I '80 , Syracuse. He is married with writes that he is currently em- three children: 4 l/2 years, 21 ployed by Capital Health Sys- months and 4 months. tem as medical director of pri- NORA MEANEY-ELMAN '84 , mary and urgent care. He reBARLOW LY N CH '77 , is presi- dent-elect of the Washington Urological Society. Dr. Lynch is a clinical assistant professor of urology at Georgetown and cently received board certification in medical management in addition to board certifications in family practice and emergency medicine. George Washington University. He lives in Silver Spring, Mary- JAMES B . BRONK '81 , has land, with his wife, Pauline, and been installed as the 67th presi- son, jason. dent of the Solano County Medical Society. He is a partner in a ORESTES G . ROSABAL '77 , is the Southern Medical Association's state councilor for and Vacaville, California. Florida. In October, he attended the association's 87th Annual Scientific Assembly in New Orleans. Dr. Rosabal maintains a private practice in orthopaedic surgery in Hialeah, Florida. TERENCE CHORBA ' 79 , writes, "I received an M.P.A. from Harvard's JFK School of Government in June before returning to the National Center ' 81 , an had a great time in Cambridge. " BRUCE J . NA U GHTON '79 , is returning to Buffalo as chief of the division of geriatrics at The Buffalo General Hospital. Dr. Naugh- B u a 0 Electrodiagnostic Medicine Megan Elizabeth, on June 25 , meeting. Robin is a neurologist 1993. She continually amazes us, as well as her brothers, Daniel in Pittsburgh; Sarah, Maria and I and Ryan." Arbor, respectively. " is as- practice-in D.C.,Buffalo,and Ann DE I DRE GREENE '86 , writes , sistant director of psychiatric "Accepted a part -time faculty po- emergency services at Montefiore Hospital, Bronx, New York. sition with Egleston Children's was Atlanta. We celebrated the birth elected chairperson of the Chesa- of our third child, Timothy Elvis peake Bay Alcohol and Substance Dixon, in August 1993. " Abuse Program Advisory Board. CARLOS M . ophthalmologist in Amherst, Hospital at Emory University in ISADA '86 , re- com- cently joined the staff of the Cleve- new company, Energy Systems Associates, specializing in elec- pleted a five-year general surgery residency at St. Luke's- land Clinic Foundation in the de- tromagnetic medicine and bio- Roosevelt Hospital in Manhat- His wife, Loretta Isada, is in pri- FRANK New York, recently founded a LACQUA '85 , partment of infectious diseases. logical hazards consultations. He tan and a one-year colon-rectal vate practice in Akron, Ohio, as and his wife, Diane, announce the surgical fellowship in Houston, a noninvasive cardiologist. birth of their son, Michael) oseph, Texas. He is in private practice GLENN on May 29, 1993. He joins proud in Brooklyn and Staten Island, Lithonia, Georgia, and his wife, sisters, Erica and Sarah. New York. He has married Eva Carla Hackett Paris, announce for Injury Prevention and Control at CDC. My family came and at the American Association of DENISE M . DAVIS '85 , ology group based in Fairfield DAV ID J . RODMA N writes, "My husband, Richard Elman '78, and I had a daughter, CAROL W E INSTE IN '84 , private practice diagnostic radi- James B. Bronk '81 GERALD HARSTER '82 , was PARRIS '87 , of Acosta and resides in Brooklyn. the birth of a daughter, Stephanie writes , Delyse Parris, on September 17, JON M . WARDNER '85 , appointed director of laborato- R. ries at jeannette District Memo- "There was an impromptu Class 1993. Dr. Parris is a rheuma- rial Hospital, near Pittsburgh, of '85 mini-reunion in Pennsylvania. He has two sons, leans this October. I enjoyed run- tologist in private practice at the Gwinett Arthritis Center; his Ryan, 10, and jesse, 6. ning into Maria Labi, Robin wife is administrator at Grady Con wit and Sarah Murray White Hospital. p h y s c a 5 p ew Or- n g 9 9 4 �[! ] ·············································· ····································· · ···· and his wife, Marcia, announce the birth of a daughter, Rachel, in DAVID ROSENBLUM '87 , December 1993. She joins her brother, Daniel, 4. Dr. Rosenblum is chief of medical staff at Gaylord Hospital in Connecticut and codirector of its spinal cord injury unit. Active in clinical research, including clinical trials in multiple sclerosis, he also holds appointments at Yale and Columbia-Presbyterian Medical Center. will R ICHARD GILBERT '88, M ICHAEL HALLETT '89 , was recently appointed associate medical director for adult psy- CARLOS C . ALDE N '39, died January 14, 1994. The Army's most decorated surgeon, he was a senior psychiatrist at Buffalo Psychiatric Center for more than a decade before his retirement in 1976. chiatry at Brylin Hospitals. Dr. Hallett completed his psychiatric residency at Erie County Medical Center. He also maintains consulting privileges with Millard Fillmore Health Systems and has established a private practice. In addition to general adult psychiatry, his interests include obsessive/compulsive disorders, mood disorders, anxi- NAT HAN I EL J . P U LVER '48 , Lidia Palcan '90 join the Buffalo Medical Group after completing a urology residency at Georgetown Medical ety disorders, dual diagnosis and schizophrenia. Center in June. He has three children: Ricky, 4; Chelsea, 3; and Alexis, 2 months. pleting a residency in otolaryngology at the University of Pennsylvania. He and his wife, Michelle, WILLIAM PALM ER , JR ., '90, completed a residency at Duke University in proudly announce the birth of a son, Michaeljoseph, on April22, 1993. They have a daughter, Molly Bess, born May 19, 1991. was appointed chief resident of physical medicine and rehabilitation at the University of Pittsburgh. DAVID KATZ '88 , neurology and a fellowship in neuro-ophthalmology at the University of Michigan at Ann Arbor. In july 1993, he joined a group of neurologists in private practice as a junior partner with the subspecialty of neuro-ophthalmology. an ophthalmologist, is a member of the medical staff at ColumbiaGreene Medical Center in Hudson, New York. Dr. Kraus has joined the practice ofSanford Ullman '38. WAYN E Z I MMER ' 89 , Hopkins Hospital. Her husband is an orthopaedic surgery resident, also atjohns Hopkins Hospital. is com- is a third-year resident pursuing a dual certification in internal medicine and pediatrics at University and Children's Hospitals, Cincinnati, Ohio. JOSEPH BARROCAS , ' 91 , finished residency at The Children's Hospital of Buffalo and joined the Delaware Pediatric Group in Buffalo. HARR IET TE F EIE R ' 90 , writes, "I am completing a residency in neurology at UCLA with an eye toward an academic career in neuroimaging. I married Lorain DIANE KRAU S '88 , ANT H O NY L. CAPOCELLI, JR., completed a neurosurgery fellowship at Long Island jewish Memorial Hospital in june 1992. He and his wife, Christy, announce the birth of a son, Bryce Anthony, born September 14, 1992. ' 89 , B a ROHIT BA K S HI '91 , JONAT HAN O ' BRIEN ' 90 , completed internal medicine residency and started a gastroenterology fellowship at Albany Medical Center in july 1993. He has five children: Nathana, 5; William, 4; Shoshana 3; Rebecca, 2; and Eli, born july 21. Baeumler, R.N., daughter ofUB med school alumnus George R. Baeumler '59, on july 17, 1993 in Delaware Park - what a catch! " LI DIA PALCAN '90, announces her marriage to james Wenz, M.D., in Baltimore, Maryland, on June 5, 1993. Lidia is currently a fellow in child and adolescent psychiatry at johns 0 p h y s JOSE P H M . ACCURSO ' 92 , recently reported for duty with Naval Support Force Antarctica in Port Hueneme, California. c a 5 p died last March in Cincinnati, Ohio, of coronary heart disease. Dr. Pulver was in the private practice of pediatrics in White Plains, ew York, for 20 years before moving to Israel, where he managed the health care of children in the development town of Hazor. He practiced pediatrics with the Group Health Cooperative in Madison, Wisconsin after returning to the U .5. A long-standing member of the Academy of Pediatrics, he retired in 1989. R OY J . THURN ' 52 , died on September 12, 1993. His wife writes, "Roy loved medicine and finally retired at age 71 so we could do some traveling, etc., that his commitment to medi- cine postponed. He retired on April 2 as medical director at Bethesda Hospital, St. Paul, Minnesota, and on April 7 was diagnosed with inoperable small cell cancer of the left lung. We attended his class reunions and were looking forward to the next one." D EAN ALLE N LES HER ~2 , of Newark, died oflungand heart failure on August 12, 1993. Before retiring in 1992, he was a researcher at the Ciba-Geigy Corporation where he spearheaded the development of Lopressor. g 9 9 4 ��BUFFALO PHYSICIAN STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 ADDRESS COR~ECTIOf'j R The only with thi~ Medical Lial Company (ML liability insurer Society of the S Since its fou owned and mar fully defended 1 other available Additionally, and most exper ity claims depaJ largest risk rna: any ew York~ insurer, and th( review of claim Calll-800-A 1-800-356-4056 mation and an < Our def€ 2 Park Ave., Nev. 2 Clinton Sq., S~ 90 Merrick Ave. © 1993 Medical Liabili~ �Non-Profit Org . U.S. Postage PAID Buffalo, NY Permit No. 311 ' REQUESTED S C I EI'; C E~ ri.\L L ~: L ly liability coverage is seal of approval. jability Mutual Insurance [LMIC) is the only professional rer approved by the Medical eState of New York. :ounding in 1975, the physicianaanaged company has success~d more physicians than all 1le insurers combined. lly, MLMIC has the largest perienced professionalliabilpartment in the country, the nanagement department of ·k State professional liability the state's only true peer .ims experience. )-ASK-MLMIC (metro) or )56 (upstate) for more inforn application. MLM~C ~ Medical Liability Mutua! Insurance Company fense never rests. few York, Y 10016 , Syracuse, NY 13202 we., East Meadow, NY 11554 bility Mutual insurance Company �B U FFALO PHYS ICIAN STATE UN IV E RS ITY OF NEW YORK AT BUFFALO 3435 MAI N STREET BUFFALO NEW YORK 14214 ADDRESS CORRECTION REQUESTED The only liability coverage with this seal of approval. Medical Liability Mutual Insurance Company (MLMIC) is the only professional liability insurer approved by the Medical Society of the State of ew York. Since its founding in 1975, the physicianowned and managed company has successfully defended more physicians than all other available insurers combined. Additionally, MLMIC has the largest and most experienced professional liability claims department in the country, the largest risk management department of any New York State professional liability insurer, and the state's only true peer review of claims experience. Call1-800-ASK-MLMIC (metro) or 1-800-356-4056 (upstate) for more information and an application. MLM~C ~ Medical Liability Mutual Insurance Company Our defense never rests. 2 Park Ave., New York, NY 10016 2 Clinton Sq., Syracuse, NY 13202 90 Merrick Ave., East Meadow, NY 11554 © 1993 Medical Liability Mutual Insurance Company Non-Profit Org. U.S. Postage PAID Buffalo, NY Permit No. 31 1 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Spring 1994 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1994-Spring Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician and biomedical scientist Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v28n02-1994-Spring Table Of Contents A list of subunits of the resource. Research Hospital News Leading Buffalo's Changing Health Care Scene Changing the Face of Medical Education Medical School Alumni A Spoonful of Humor Graduate Education Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo physician, Spring 1994 Buffalo medical review Buffalo physician and biomedical scientist Date Created Date of creation of the resource. 2018-12-18 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v28n02 Extent The size or duration of the resource. 46 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1994 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/4268a956ed09e8732e83b20afff9bf8c.pdf f8f9e2c3529adfe0820340d25c3b8491 PDF Text Text Biomedical Sciences, Autumn 1993 �BUFFALO PHYSICIAN Volume 27, Number 4 ASSOCIATE VICE PRESIDENT FOR UNIVERSITY ADVANCEMENT Dr Carole Smith Petro DIRECTOR OF PUBLICATIONS Timothy J Conroy EDITOR anette Tramont Kollig, R.N. ART DIRECTOR Alan J. Kegler ASSOCIATE ART DIRECTOR Scoll Fncker PRODUCTION MANAGER Ann Raszmann Brown STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES Dr John Naughton, Vice President for Clinical Affairs, Dean EDITORIAL BOARD Dr John A. Richert, Chairman Dr Martin Brecher Dr. Harold Brody Dr Richard L. Collins Dr. AlanJ. Drinnan Dr. Timothy Gabryel Dr. James Kanski Dr. Charles Massaro Dr Charles Paganelli Dr Robert E. Retsman Dr Thomas Rosenthal Dr Stephen Spauldmg Dr Bradley T Truax Dear Friends, T wo major milestones are reported in this issue of Buffalo Physician. The first relates to the dedication of the Center for Positron Emission Tomography that occurred m mid-May. That dedication served to culminate several years of effort between the Department of Veterans Affairs and UB with the installation of the area's first PET camera. The Buffalo VAMC and the Cummings Foundation were included in the activities. The latter provided a $1 million grant that served to ensure the success of the project. Dr. Joseph Prezio provided exemplary leadership for this project and organized an outstanding scientific symposium. The second event was the celebration of the lOth anniversary of the Graduate Medical Dental Education Consortium of Buffalo (GMDECB). The organization has become the institution for governance of graduate medical education in Western ew York and it is membered by ll participating institutions- the medical and dental schools and nine affiliated teaching hospitals. The GMDECB has been instrumental in providing stronger training programs and in developing new direction and new emphasis for graduate medical education. The organization has committed to achieve a 50 percent distribution of trainees to the primary care specialties of family medicine, internal medicine and pediatrics over the next few years. It has also become a model that might serve to provide some guidance to national health care leaders as new initiatives in health care reform develop. Dr. Michael oe, executive vice president and medical director at The Buffalo General Hospital and program director of the preventive medicine training program, in particular, has provided extraordinary leadership to the GMDECB effort. Sincerely, John aughton, M.D. Vice President for Clinical Affairs TEACHING HOSPITALS AND LIAISONS Batavia VA Medical Center Arlene Kelly The Buffalo General Hospaal Michael Shaw Buffalo VA Medical Center The Children's Hospital of Buffalo Erie County Medical Center Mercy Hospital Millard Fillmore Hospitals Fran I• Sava Roswell Park Cancer Institute Sisters of Charity Hospital Dennis McCarthy ~ The State University of ew York at Buffalo Buffalo Physician IS published quarterly by the State University of New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. It 1ssent, free of charge, to alumm, faculty, students, residents and friends. The staff reserves the nght to edit all copy and submissions accepted for publication. Address questions, comments and submissions to : Editor, Buffalo Physician, State University of ewYork at Buffalo, Umversity Pubhcauons, 136 Crofts Hall, Buffalo, New York 14260 Send address changes to: Buffalo Physician, 146 CFS Addition, 3435 Mam Street, Buffalo, New York 14214 Dear Fellow Alumni, T he beginning of anew academic year brings another cycle of activities for the Medical Alumm AssocJatwn, with the goal of enriching the experiences of medical students, house officers and alumni. We have greeted the incoming house staff and will shortly sponsor another one-day session on "Prep for Practice," a practical practice management introduction (recognizing the current uncertainties of future practice). We have welcomed the entering freshman medical class and during the academic year will continue our support for a variety of student projects. In particular, the Alumm Association will continue to organize three sessions, with presentations by community physicians devoted to differing types of medical practice. In September, the annual award honoring an outstanding alumnus was presented to Dr. William Balistreri, Class of 1970. Dr. Balistreri is professor of pediatrics and medicine at the University of Cincinnati College of Medicine and is an internationally recognized pediatric hepatologist. We are especially pleased that Dr. Balistreri participated in the teaching program at Children's Hospital; his participation provided a wonderful opportunity for our medical students, house officers and faculty to benefit from his presence. Alumni receptions have been planned in neighboring Rochester and at several national medical meetings. Local alumni again will be guests at our annual reception. Your support for these most worthwhile activities is needed and appreciated. .,,,,,.,,d,, ~ (aver: The photograph of Dr. Joseph Prez10 was created by Collignot0arosz LTD. Robert E. Reisman, M.D. '5 6 �V 0 u A 2 L T u N 7 M N o 9 4 9 3 H OCT 1993 IJ Research IJ Hospital News IJ The Center for Positron Emission Tomography e "Then and Now" heralds the Sesquicentennial. Page 29. Dedicated to patient care, research and education. m 10 Years of Cooperation over Competition e The Graduate Medical Dental Education Consortium of Buffalo celebrates a decade of progress. m m m m m Alumni Graduate Education Medical School Classnotes ASpoonful of Humor 11 Shake and Bake." Page 3. * [~il~ren' s ~ospital ~egins ~W uaccine trials. ~agel. 11 ln Sickness and in Health." Page 28. �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 ' .... ' Study subjects must have well-documented HIV infection but no symptoms of HIV disease other than swollen lymph glands or a mildly swollen liver or spleen. Subjects also cannot have received any anti-retroviral or immune-regulating drugs within one month before their entry into the study. The Centers for Disease Control and Prevention estimates 10,000 children in the U .5. are infected with HIV. By the end of the decade, the World Health Organization projects 10 million children will be infected worldwide. For more information about trial sites or eligibility for enrollment, call the AID Clinical Trials Information Service at 1800-TRIALSA, or call the PACT program + at Children's Hospital at 878-7908. Children'sHospital selected for experimental HIV vaccine trials he Parents and Children's Together (PACT) program at The Children's Hospital of Buffalo is one of 12 sites nationwide coordinating the ationallnstitutes' of Health first trial of experimental HlV vaccines for children. "This trial is the first step in developing a vaccine thatmaypreventordelaydisease progression in children with HIV," notes Cynthia zelc Kelly, M.D., director of the pediatric AIDS program at Children's. The study, which will compare the safety of three experimental vaccines in 90 children, will enroll children between the ages of one month and 12 years. At least half of the children in the nationwide trial will be two years of age or younger to enable a comparison of the immune responses of the younger and older participants. Tying cholesterol testing to being overweight may miss many at risk Children's Hospital will help (Oordinate HIV va((ine trials. B u 0 0 p electing patients for cholesterol testing merely because they are overweight is a poor practice and may cause primary care physicians to miss many high-risk people, a University at Buffalo study has found. Neither weight nor body mass index is associated with high cholesterol levels, suggesting that screening should be offered without regard to weight, the study by Barbara A. Majeroni,M.D., UBclinical assistant professor of family medicine, determined. The study was reported in The journal of Family Practice. Majeroni reviewed the charts of 604 patients selected randomly from her group practice; 196 of the patients had had their cholesterol levels determined. Results showed a trend toward less screening of people with a low y 5 c 0 A Neither weight nor body mass index is assodated with high (holesterol, the study found. body mass index and more screening of persons with a higher body mass index. But the overweight people were no more likely to have high cholesterol levels than + patients who weren't overweight. BY LOIS BAKER Nitric oxide treatment used for persistent pulmonary hypertension esearch at The Children's Hospital of Buffalo with nitric oxide ( 0) may pave the way for breakthroughs in the treatment of persistent pulmonary hypertension in newborns. " itric oxide research and therapy may be the biggest step yet in the treatment of persistent pulmonary hypertension," said Frederick Morin, M.D., UB associate professor of pediatrics and division chief of neonatology at Children's Hospital. Treatment with 0 selectively dilates the vessels to the lungs-increasing blood u m 9 3 �............... .. ......... . ........... .. ................................... ........ m m ~~ ' flow to the lungs and oxygen in the blood within minutes - to stabilize the newborn. Preliminary indications show that 0 treatment may be a much less expensive and less risky treatment than extracorporeal membrane oxygenation - a fairly new treatment form itself. itric oxide treatment is being conducted on a trial basis for persistent pulmonary hypertension at Children's Hospital and four other medical centers across + the country. New software will allow rapid solution of complex molecules cientists who design new drugs will soon have at their disposal an extremely fast software package that solves complex molecular structures on a workstation, sometimes in minutes or hours. The new software, called "Shake and Bake," was developed by researchers at the University at Buffalo and the Medical Foundation ofBuffalo, and has developed from basic research to viable product in less than one year. Led by obel Laureate Herbert Hauptman, the research team invited researchers doing rational drug design and other work involving complex molecular structures to sign up for an initial test phase of the package during the summer. General distribution is scheduled for the fall. "'Shake and Bake' will solve structures that no one's been able to solve,'' said Russ Miller, Ph.D., UB computer science professor and a member of the research team. The software is the first that can routinely solve structures of up to 300 to 400 atoms if high-quality X-ray data are available. The user-friendly, menu-driven package has taken only hours or days to solve B u a 0 p h Bake" can solve complex molecular structures in minutes or hours. very complicated structures, including structures that previously took more than a decade to solve using other methods, and others that had previously been unsolved. Two versions of the software are available: one that runs on aU IX workstation and one on a massively parallel Thinking Machines CM-5 supercomputer. + - B Y ELLEN G OLDBAUM Method for synthesizing promising new cancer treatment developed niversity at Buffalo scientists have removed a major obstacle to the synthesis of an extremely promising cancer treatment that would inhibit uncontrolled cell division. A paper that describes the new approach to synthesizing potential protein kinase inhibitors, which is orders of magnitude faster than previous ones, was published in the May issue of The journal of Biological Chemistry. s c a '' "This will allow scientists to survey a much wider range of candidate inhibitors in a much shorter amount of time, including compounds that were just not synthetically accessible before," said David Lawrence, Ph.D., UB associate professor of chemistry, who led the research team. Protein kinase inhibitors, which inhibit the formation of the enzyme kinase that signals cells to divide, are generally recognized as potentially "a very novel family of chemotherapeutic agents," Lawrence said. Synthesizing such compounds in the lab, however, has been a difficult hurdle for scientists to overcome. Because of this, the UB scientists focused on developing protein kinase substrates rather than inhibitors. Both substances bind to their target enzymes substrates temporarily and inhibitors permanently - to inactivate the enzyme. Lawrence explained that focusing on substrates enabled the team to rapidly determine the types of chemical structures the enzyme would recognize. Lawrence said that both substrates and inhibitors must contain a specific amino acid within a peptide- a string of amino acids - that is recognized by the target enzyme, to be effective. He added it was generally accepted that the key amino acid had to be contained within the string, rather than on the end because this was observed in natural proteins. "Because the critical component is often very chemically sensitive, the process of attaching other amino acids to it often triggers unwanted chemical reactions which can ruin the critical compound,'; Lawrence said. In what he described as "an act of desperation," the UB team attached the key component at the very end of the chain of amino acids. "To our amazement, we found that such compounds served as extremely efficient substrates for enzymes,'' he said. + - BY u m ELLEN GOLDBAUM 9 3 0 �[ll . . . ............. .. ......... . . . ..... . .. . .............. . ....... . ....... . .... . able, as well. The program is closely affiliated with Roswell Park Cancer Institute and The Children's Hospital of Buffalo as well as other area health care facilities that offer pediatric services. It is one of only a few pediatric z hospice programs in 3 ~ the country that main§ tains swing beds in an ~ acute care hospital. Hospice Buffalo begins its home-based, comprehensive pediatric service. For more information or patient referral, call838-4438, Ext. 219. + . Comprehensive pediatric service established by Hospice Buffalo ECMC achieves lowest trauma mortality in New York State ECMC had 3,386 trauma admissions over the past 18 months with a total mortality rate under 2 percent- the lowest mortality rate in the state for a regional trauma center. For treatment of adolescents 10 to 15 years old admitted for trauma, the hospital achieved a 0 percent mortality rate. " o one component of the trauma system, whether it be police, fire, medical care or pre-hospital community care, can exist separately," said ECMC administrator Thomas Faith. "The truly regional and comprehensive nature of theW estern ew York Trauma System is a model that everyone who is associated with it can be proud of." + Buffalo General'sLancaster Alcoholism Clinic extends hours ospice Buffalo has established "The Carousel Program for Children and Families," a comprehensive pediatrie County Medical Center's Regional he Buffalo General Hospital's ric service for children and adolesTrauma Center has the lowest reLancaster outpatient alcoholism cents with life-threatening illnesses gional mortality statistics in the state, clinic has extended its hours of opand their families. and with the exception of the region eration. The interdisciplinary home-based prothat encompasses ew York City Alcoholism Outpatient Services, gram provides coordinated, comprehenand Long Island, the most trauma 11 West Main Street, Lancaster, is sive care under the direction of the child's patients. open from 9 a.m. to 8 p.m., Monday physician, according to Eva Rubinstein, According to statistics compiled by the through Thursday, and from 9 a.m. to 5 R. . , J.D., director of pediatrics for Hosew York State Department of Health, p.m. on Friday. pice Buffalo. Caregivers work closely with Services include Robert Milch, M.D., Hospice medical di- ~ assessment to derector, other area physicians, nurses and ~ termine if an alcoallied health care professionals to meet the * hol or drug probphysical, psycho-social and emotional ~ lem exists; indineeds of children and their families. Chilvidual, group and dren are not required to give up curative family counseling; therapy or have a limited prognosis to be education and readmitted into the program. lapse intervention The Carousel Program offers homecounseling, as well based pediatric skilled nurses, medical as services for adult social workers, child life specialists, art children ofalcoholspecialists, music therapists, speech theraics. pists, occupational therapists, pastoral For more inforcaregivers, volunteers, bereavement counmation, call 681selors, dietitians and home health aides. 4957. + High-tech home care services are avail- ECMC's Trauma Center mortality rate was less than 2 percent. 0 B a a p h 5 c a u m n 9 �. . . . . . . . . . . . . ... . ... . . . . . . . . . . .... .. . . . .. . . . ... . . .. [1] I . Buffalo General opens East Side adult ambulatmy care program Amsterdam named director of laboratory medicine at ECMC aniel Amsterdam, Ph.D., professor of microbiology and associate professor of medicine, has been appointed director of the department oflaboratorymedicineat Erie County Medical Center. Previously, he was director of clinical microbiolgy and im..... munology there. Amsterdam earned his doctorate ,.,,;)!'• .. .. ·.'...:·' from ewYorkUni"'~ versity. Before joiningECMC,heheaded the human cell biology program at the euroscience Center of the Kingsbrook jewish Medical Center and was on the faculties of Long Island University and the Mount Sinai School of Medicine. Amsterdam is a member of the American Association for the Advancement of Science, the American Association of Pathologists, the American Society for Cell Biology, the American Society for Microbiology and a fellow of the American Academy of Microbiology, the American Association for the Advancement of Science and the Infectious Diseases Society of America. + Children'sHospital appoints new director of pediatric surgery ~ ,. ~ ichard Azizkhan, M.D., has been appointed surgeon-in-chief and director of the department of pediatric surgery at The Children's Hospital of Buffalo and professor of surgery and pediatrics at the School of Medicine and Biomedical Sciences. Azizkhan was formerly associate professor of surgery and chief of pediatric surgery at the University of orth Carolina at Chapel Hill School of Medicine. He earned his medical degree from the Milton S. Hershey Center of Pennsylvania State University College of Medicine and completed a residency in general surgery at the University of Virginia Medical Center. Azizkhan did his pediatric surgical training at johns Hopkins University. Board certified by the American Board of Surgery in general surgery, pediatric surgery and surgical critical care, Azizkhan is a member of the American College of B u a 0 p h ~ ~-'!fl'~ 0 y 5 ' [IJ Surgeons, the American Pediatric Surgical Association, the Association for Academic Surgery, the Society of University Surgeons, the American Association for Surgery of Trauma, the American Medical Association and the American Academy of Pediatrics. + he Buffalo General Hospital has opened an adult primary care center on Buffalo's East Side. The 1490 jefferson Health Services at 1490 jefferson Avenue will offer general medical care, health screenings, podiatry care, nutritional counseling, health education and wellness programs and social work counseling for people who require referrals to social and human service agencies. The new facility includes five examination rooms on the first l1oor of the 1490 Enterprises Community Center, where it is housed. All private insurance as well as Medicaid and Medicare are accepted. + • c a A Chairman of pathology appointed at Roswell Park Cancer Institute ohn]. Brooks, M.D., has been appointed chairman of the department of pathology at Roswell Park Cancer Institute and professor and vice chairman of the department of pathology at UB. A graduate of jefferson Medical College, Thomas jefferson University, Philadelphia, Brooks completed his residency in pathology at the Hospital of the University of _Pennsylvania School of Medicine, where he was chief resident and assistant instructor of pathology. He was associate director of the section of surgical pathology, director of the immunohistochemistry laboratory and professor of pathology and laboratory medicine at the Hospital and School of Medicine at the University ofPennsylvania, Philadelphia. In 1987, he served as a visiting professor with honorary clinical status at the Royal Marsden Hospital and Institute for Cancer Research, London and Surrey, England. Brooks also has subspecialty training in hematopathology, soft tissue pathology, immunohistochemistry, in situ hybridization and the ultrastructure, cytogenetics and growth of soft tissue tumors. The author of more than 100 original scientific papers and 50 scientific abstracts, editorials, reviews, book chapters and letters, Brooks holds editorial positions on the journals Surgical Pathology, Modem Pathology and Applied Immunohistopathology. He is a reviewer for the journals Cancer, Ameri- can journal of Pathology, Cancer Research and the European journal of Cancer Research and Clinical Oncology. + u m n 9 9 3 0 �. Cooperative efforts between UB and the Department of Veterans Affairs become a reality O au tfa I a Ph y sl c 1 an A u t u m n 1 9 9 3 �On May 14, 1993, the University at Buffalo joined a select group not awarded its $3.4 million federal funding package until1988. "We didn't get it in the first round, but we did in the second," of nuclear medicine centers of excellence when it formally dedicated its $12 million Center for Positron Emission aughton says of the VA grants awarded on an annual basis. The Tomography- one of the most advanced in the country and grant was one of only four high-technology projects the federal one of the few with clinical, research and educational applicabody awarded that fiscal year. But with minimum PET startup costs estimated at between tions. The multidisciplinary center, which integrates medical spe$7 and $10 million, the federal grant was only a start for UB's cialties and subspecialties within its three functions , has been ambitious project. the result of collaborative efforts between the federal and state Funding ultimately came from diverse sources: $1.6 million governments and private foundations and corporations since its from UB itself, 6 million from ew York State, $1 million from the james H. Cummings Foundation in the form of a contribuinception. Indeed, even physically, the center consists of two distinct entities- UB's Parker Hall, the site of the cyclotron, and tion to the University at Buffalo Foundation's "Pathways to Greatness Campaign" and the VA award. the Buffalo VA Medical Center, 3,000 feet across the street, PET technology is considered one of the most advanced in where the PET scanner itself is housed - connected by an underground pneumatic tube system. medical imaging, distilled from a number of scientific disciThe center's origins date back to the mid-1980s, \l ucE sMA plines. It enables the visualization and quantification VI 11 LL . . . when congressional legislation made it possible c:, \\\ Q(J.f of complex physwlogiCal processes on a chemifor certain grants to be used to fund both ...,~'\ -+')'/'l cal level. The technology uses short-lived Department ofVeterans Affairs facilities and ,$'• ~ physiologically compatible positron-emitthe communities they serve to develop and ~ ~.,., ting radionuclides synthesized into phar~ maceutical drugs that are administered share scarce medical resources. The UB- ~ VA PET center accepts both veterans and : ~ to patients and read by a scanner. The non-veterans. ~ ~ infonnation the scanner reads is then "The VA was instrumental in the de- "' ~ fed into a computer to produce three%! velopment of this technology," says john ~ ~ dimensional images of physiological proaughton, M.D., vice president for clini- ~ cesses. cal affairs and dean ofUB's School ofMedi- ~ ~ PET technology uses radioactive nu?' cine and Biomedical Sciences. "There are ,; c, elides of elements commonly found in the several PETS in the country located in VAs. " body, such as oxygen, nitrogen and carbon, The PET center now serves four to six patients that are administered to the patient. Because they each week. "A fair number of those referrals are from are physiologically compatible, the PET radionuclides Rochester," aughton says. actually follow true physiological and metabolic processes, Cooperation between the different entities that comprise rather than mimic biological pathways as other nuclear mediUB's PET center has been the byword from the start of the cine imaging technology tracers do. PET imaging produces images of the functioning of the body, project. augh ton praised the joint relationship between the univerrather than its structure, as more traditional forms of medical sity and the Buffalo VAMC in both the ownership and manageimaging technology- CT scanning, for instance- do. The technology, which can afford physicians a cellular view ment of the PET facility. "The cooperative venture allows the VA to do something it of biochemical processes, shows promise in a number of disciplines and applications, among them, cardiology, neurology, couldn't do itself and the SU Y system to do something it couldn't do by itself," says Alan Lockwood, M.D. , director of psychiatry and oncology. The key to UB's successful PET center, according to aughton, PET center operations for the VA and UB professor of neurology and nuclear medicine. "This is a very rich intellectual environwas "developing the cyclotron"- the specially designed electromagnetic device that accelerates charged particles or ionized ment for something like this to take place in. UB is the flagship atoms to very high velocities. The high-speed particles then institution of the SU Y system and the Buffalo VA Medical collide into targets - physiologic elements- to produce the Center is one of the major VA hospitals in the country." radionuclides. "There was no space at the VA for the cyclotron," aughton says of the arrangement. "So we used a bay in Parker Hall to UB's cyclotron is one of the more advanced in the country. Manufactured by the Belgian firm , Ion Beams Application, it is house it. "Parker Hall not only houses the cyclotron now, but it serves the largest and most powerful of its type manufactured today. as a base for the nuclear medicine department. The arrangement From its specially designed bay in Parker Hall, it manufactures has enabled us to centralize that department. " radionuclides that are converted to radiopharmaceuticals by the UB entered the competition for PET grants in 1987, but was chemistry function of the nuclear medicine department in $ B u a 0 p s c a m n 9 9 8 �Parker and then transported via pneumatic tubes to the PET scanner suite at the VA. It takes the radio pharmaceuticals- many with a half-life of slightly more than two minutes, according to Lockwood- 80 to 90 seconds to travel the 3,000-foot distance. The scanner portion of the center has been in operation since October 1991; before UB's cyclotron went on-line during the summer, the center purchased radionuclides from Hamilton, Ontario, a ugh ton says. ow, the university is in a position to supply some of the "longer" short-lived radionuclides to other PET centers, he adds. UB's PET center is the only one within a 150-mile radius; it is one of only four in the state and one of two approved for use in patient care. PET technology has been in existence since the mid-1970s, according to joseph Prezio, M.D., chair of UB's department of nuclear medicine, director of the PET center and one of the driving forces behind the university's entree into PET technology. "But it was so technically poor and cumbersome and atrociously expensive, no one could get involved except for a few well-financed research centers," he explains. "As the equipment matured," he continues, "the cost, though still prohibitive, got a little better. "And," he explains, "there were clinical reasons to continue." Those clinical reasons include hopes for improved treatment outcomes and better understanding of a number of diseases and conditions, including epilepsy, coronary artery disease, schizophrenia, Alzheimer's disease, Parkinsonism, brain tumors and cancer. PET imaging in cardiology detects coronary artery disease earlier and with greater sensitivity than more traditional diagnostic procedures, often precluding the need for cardiac catheterization and other procedures that involve patient risk. At the VA Medical Center, patients with ischemic coronary artery diseases- about 100 so far- are scanned to determine whether an area of the heart with poor blood flow is still alive and capable of benefiting from certain treatments or dead and not capable, Lockwood says. "Current tests available primarily measure flow . We help sort out the difference between low-flow live muscle and low-flow An underground pneumatic tube connects the cyclotron boy in Porker Hall to the PET scanner suite at the Buffalo VA Medical Center. The tube system provides high-speed transfer of rodiophormoceuticols for use in medical imaging. The rodiophormoceuticols- some with a half-life of just over two minutes - travel the 3,000-foot route in 80 to 90 seconds. PET Scanner Suite Buffalo VA Medical Center 0 B u c 0 p h y s c n A u m 9 9 3 �dead muscle to determine the best candidates for bypass or angioplasty and to avoid expensive and risky procedures," he adds. The technology is revolutionizing the way patients are chosen for angioplasty and coronary bypass surgery or medical treatment. The technology is also revolutionizing oncology treatment decisions-enablingphysicians to evaluate the effectiveness of chemotherapy within a matter of days rather than months. At the VA, it is also being used to successfully pinpoint the site of electrical outbursts in the brains of epileptics as part of presurgical evaluations to determine whether seizures emanate from a single spot in the brain. "Around half the patients are seizure-free after surgery," Lockwood says. "And a substantial portion of the other half get substantial improvement. lt makes an enormous positive impact on the patient's life. " And although there are no clinical applications in psychiatry yet, UB's center already has garnered research awards with strong clinical applications, among them , grants to look at brain injury after minimal trauma and study brain pattern abnormalities after severe liver disease. The minimal brain trauma study, Lockwood says, involves collaborative work between the VA and UB's departments of psychiatry, neurology, internal medicine, nuclear medicine and emergency medicine at Erie County Medical Center. Lockwood says the PET center is beginning clinical studies of patients with colorectal cancer to detect recurrences. Other research involves collaborations with the university's linguistics department to try to determine which areas of the brain are involved with specific functions of speech. In addition to its clinical and research applications, UB's PET center is the first comprehensive training center for PET imaging in the United States, thanks to a three-year, $450,000 grant from Siemens H. G. , a major supplier of nuclear imaging equipment. The center is equipped to train the range of personnel needed to operate a fully functioning PET center - from the technicians who assist the chemists to the physicians who specialize in nuclear medicine. It is organized around four Winspear Ave. ~I Cyclotron Facility Porker Hall University at Buffalo South Com us I. B 0 0 p h y s c Buffalo VA Medical Center Parker Hall .,; > < University at Buffalo South Campus >- ~ ·;:; = 0 A u m n 3 0 �J~~~~~ ~r~li~. m.L ~~~~~~ ~~~~rtm~~t ~f ~~~ ~~r m~~~~~~~ w~ ~~~~r~~~~ r~ ~ major training groups: technicians, radiochemists, nuclear physicists and physicians. "The problem throughout the U.S. and, probably the world," Prezio says, "is that training for PET has not been organized appropriately, or in enough depth, so that you can end someone to one site and have them come back seasoned and trained. Siemens liked what we were doing here. They were looking for someone willing to put the effort into it. "Our goal from the beginning, in addition to establishing the PET imaging center for research and clinical use, was to set up a national educational program that would be unrivaled in the United States." In addition to that Siemens grant, the Buffalo VA Medical Center will receive more than $150,000 from the corporation to develop computer software for the PET scanner. Two new software modules will be developed: one, with both research and clinical care applications, will compute blood flow; the other will describe metabolism in the brain using mathematical modeling of biochemical reactions. "Right now there is no software in our computer system that enables a user to measure blood flow ," says Lockwood. 'This will expand the capability for existing and future PET systems," he adds. The grant was developed through a Cooperative Research and Development Agreement. The agreement, which falls under the auspices of the federal Technology Transfer Act of 1986, allows both federal and private corporations to work together to develop new technology.It is only the second time in VA history such an agreement has been reached. "This is an example of a new trend in funding of medical research where there's cooperation between public and private sectors," Lockwood says. "This will be an increasingly important aspect to funding future research of all types. " On the downside, "PET studies are expensive [currently running over $2,000 per procedure] and not generally covered by health insurance in this country. In Buffalo, however," aughton says, "payment arrangements are made on a case-bycase basis. Many of the area's major third-party payers have negotiated rates to cover the studies." To ensure coverage, Lockwood says that patients at the PET center are carefully screened to meet certain criteria. "We study patients only with specific indications for the procedure, rather than as an open-ended diagnostic procedure. "This is a very deliberate step we've taken because of our commiunent to provide cost-effective services to the public," he notes. "We request reimbursements only for procedures judged likely to be cost-effective. And because of this, we've had good relationships with insurers in this area. "After all, insurance companies will want to pay $2,400 for a study if it will save them $40,000 down the road." And although neither Medicaid nor Medicare reimburse for PET scans, national efforts are underway to change that. + B u a 0 p h y PET center dedication culminates two decades of planning and development for the future oe Prezio, M.D.'s singular vision of making the University at Buffalo a major force in nuclear imaging became a reality on May 14, 1993, when the University formally dedicated its Center for Positron Emission Tomography (PET) that is one of the most advanced in the country. It was a vision that began in the mid-1960s and took root two decades later when congressional legislation made it possible to award grants that would aid both federal Veterans Affairs hospitals and the local communities they served. And it was a vision that Prezio -as both chairman since 1985 and professor of nuclear medicine - is largely responsible for nurturing. According to john Naughton, M.D. , vice president for clinical affairs and dean of the School of Medicine and Biomedical Sciences, Prezio has helped build a department "always strong in the research arena and with a fine clinical presence." Prezio came to UB first as an internal medicine resident in 1959 and then as a clinical assistant professor and assistant director for medical education at Mercy Hospital in 1964. Over the next nearly 30 years he has served the university, he has seen both the department of nuclear medicine and the specialty itself grow and expand at the undergraduate and graduate levels as well as in its clinical and research functions. Prezio's love of nuclear medicine and the city in which he's realized his dream began rather circuitously with a rotating internship in internal medicine at Mercy Hospital. The Georgetown University Medical School cum laude graduate's strong interest in endocrinology- he eventually completed both a clinical and research fellowship in the field at Georgetown - developed into an even stronger interest in nuclear medicine as Prezio used radioactive iodine to treat thyroid patients. c a m n 9 �programs filled by international medical school graduates is about 60. Since 1985, UB's national graduate enrollment average has been greater than 90 percent. Part of what makes UB's nuclear medicine residency programs so attractive is that some combine nuclear medicine with another specialty- such as internal medicine and radiology- to allow graduates to get both boards in a shorter period of time than they would if they completed two separate residencies. "The programs are so successful," Prezio says, "that we're now offering a five-year program with the PET and neurology and psychiatry. That's five years versus six or seven years. And both the job market potential and academic career potential are outstanding. "We're the only university in the country offering the combined programs- except for a smaller, not-as-mature program at the University of orth Carolina." Prezio has also focused on major educational programs to increase community awareness and extend the university's concerns about the quality of nuclear medicine. "We want to expand our educational services beyond Western New York to become a national training site- not only for conventional nuclear medicine, but especially for PET training. "We've just completed a training program for endocrinologists to familiarize themselves with radiation safety techniques in their practice. We want to expand on that. " The PET center figures heavily in Prezio's plans for the future- he wants to establish it as a major research center, and is well on the way to accomplishing that goal already with the acquisition of grants to use PET technology to look at brain injury after minimal trauma and brain pattern abnormalities with severe liver disease. Prezio also wants to develop and enhance the department's attractiveness to industry. "I want to use the PET center and department as a resource and evaluation site for new drugs. " Taward this end, Prezio is recruiting an expert in nuclear pharmacokinetics. Prezio's final goal- at least for the present- is to further expand the multidisciplinary approach the department of nuclear medicine has taken in the past 10 years. "We want to continue to work closely with neurology and psychiatry to assist in research where PET technology can be applied. We want to bring all these research activities into this department. " Prezio credits Michael Cohen, M.D. and Murray Morphy, M.D. -chairs of neurology and psychiatry respectivelyfor spearheading the effort and for the successes they have already achieved. "They took a 'what's good for everybody' attitude rather than 'what's good for me' attitude and they deserve a lot of credit. + "We led the way in these jawboning techniques,'' he says. "That's how it all started," he relates. In fact , Prezio merged those interests when he started the clinical radioisotope program at the South Buffalo hospital nearly three decades ago. At that time, nuclear medicine was in its infancy- its first identification as a specialty, in fact, was in the late 1950sbefore the technology revolution that saw its knowledge base expand almost exponentially. "As the field became more complex, with the development of new imaging technology and new radiopharmaceuticals, it came into its own," Prezio said. "The idea to start a separate specialty," he adds, "was born in Buffalo, with Dr. Merrill Beader at Roswell Park Cancer Institute. He worked feverishly and with considerable aplomb to establish a forn1al residency program in 1971. It was the first in the country. In 1972 the boards were offered for the first time. " In 1972, nuclear medicine's technology consisted pretty much of a "scanner device and early scintillation gamma camera,'' according to Prezio. Applications consisted of lung, bone, thyroid and brain- the cardiac applications that are a mainstay today had not yet become a reality. And at the time, both the technology and its applications were directed at in1aging. "The direction today,'' Prezio explains, "is not just imaging, but the functional analysis of actual biochemical processes. "The next step is the cellular processes. We can look at these with the PET." And with UB's sophisticated new PET center- one of the few in the country with the capacity for both patient care and research- the department of nuclear medicine is positioned to become a national leader in both. Under Prezio's stewardship, the department has accomplished several goals. "The major thing," Prezio says, "is the centralization of the department from Diefendorf Annex. " Its recent consolidation to Parker Hall "is the first time in its history that it is totally centralized in one place. "All major educational activities for training medical students, technicians, nuclear medicine residents , are all here in Parker Hall. "Our grand rounds," he adds, "draw 90 people. They are always very well attended. We draw physicians and technicians from Rochester, Hamilton- the whole Western ew York area. It [the centralization and resulting consolidation] is an outstanding success. "And psychologically, it's better," he says, noting "neutral territory. " Making the nuclear medicine programs more attractive to American graduates has been another accomplishment. ationally, the percentage of nuclear medicine residency NANETTE B u a 0 p h y 5 a n u TRAMONT m KOLLI 9 9 3 G �.. B a 0 p a u m 9 9 �The Consortium's structure emphasizes the goal of improving educational quality, not meddling in the member hospitals' operations, and giving the members on equal voice in decisions. B u f f a l o P h ys icI an A u t u m n 1 9 9 3 �c 0 0 p ITED BY COMMO E R A NECESSITY, THE UNIVER- SITY AT BUFFALO MEDICAL SCHOOL A D ITS TEACH I G HOSPITALS ARE Fl A WELL AS CELEBRATE THE lOTH AI ATIO AL RECOG DI G STRE GTH lTJO AS THEY JVERSARY OF THEIR I STITUTIONAL ALLIANCE. Through the Graduate Medical Dental tion of American Medical Colleges. "People are coming and looking at Education Consortium of Buffalo, the assortment of residency programs scattered what we're doing with the Consortium," among area hospitals has been brought said William D. Pike, president of the under an organizational umbrella, giving Western ew York Hospital Association. the university greater control over gradu- "It is unique and something we should be ate medical education without threaten- proud of." aughton is ing hospital auclearly proud of the tonomy. The arrangeconsortium he was ment has fostered instrumental in greater cooperation at "If I had to describe it in forming 10 years a time of increasingly ago. "We're probstrained finances, and a word, I'd say ably the most soit has taken on some phisticated and of the thornier policy 'consensusbuilding .' I complex consorquestions in health tium that exists in care, such as the need would say no one has lost the country," he to tum out more prisaid. "I don't know mary care physicians. "There have been that we necessarily any autonomy." a lot of positive are the model, but outcomes ," john we are a model." Richard Braun, vice aughton , M.D. , asSitting back in sociate vice president shirt-sleeves behind president of finance and for clinical services his wide desk, and dean of the mediaughton recalled chief financial officer of cal school, said simthat it wasn't always ply. easy. Some resiAnd witl1 the nadencyprograms had The Buffalo General tion bracing for major to be reorganized, upheavals in health with responsibilHospital care and medical eduities and resources cation, the Consorshifted among diftium is also being ferent hospitals. viewed as a model. And, he notes, bu"When people talk about GME con- reaucratic turf battles haven't been comsortia, they all talk about Buffalo," said pletely relegated to history. joyce Kelly, Ph.D., associate vice presi"It'll lead to some testiness from time to dent for clinical services with the Associa- time," he said. "It'll lead to some issues. T 0 N But it works out." In fact, Naughton said, he was surprised there weren't more problems in bringing the university's teaching hospitals together. "Amazingly enough, given the magnitude of it, the difficulties were relatively modest," he said. "The main difficulties were in visualizing the needs and in bringing everybody into it so they filled their proper roles. " The goals behind the Consortium are better education for residents and better coordination among the participating institutions. "Most university medical centers are single centers that report back to one university," said Richard Braun, vice president of finance and chief financial officer of The Buffalo General Hospital. "What we have is a consortium of eight hospitals that divvy up the teaching." The idea for the Consortium came in the early 1980s when the Accreditation Council for Graduate Medical Education issued new guidelines requiring greater institutional management of residency programs. At the time there was little coordination between the Buffalo programs, with some controlled by the university and some by the hospitals - The Buffalo General Hospital, The Children's Hospital ofBuffalo, Millard Fillmore Hospitals, Erie County Medical Center, Sisters of Charity Hospital, Buffalo VA Medical Center, Mercy Hospital and Roswell Park Cancer Institute. UB was not the only medical school in the nation without its own medical center. But even among schools relying on community hospitals, the UB-affiliated residency programs were notably scattered, said Michael F. oe, M.D. ,BGH executive vice president and medical director. "We did not have the university or a university hospital identified as the sponsor of the programs," recalled oe, who worked with Naughton to forn1 the Consortium. "We had multiple hospitals identified as the sponsor of individual programs." . C 0 0 P E R A T I 0 N ti �.. oe described the situation as "fragmentation to the extreme." In some cases, he said, program directors found themselvesjuggling the conflicting interests of several hospitals involved in the same program. "The hospitals each had their own house staff, their own payroll and benefit package for the residents. There was no uniformityeveninthatarea," headded. " ordid we have any common operating policies that applied across the entire system." David M. Crossland, M.D. , chairman of the Consortium's residents committee, agreed. "There was no organization. They competed with one another and didn't trust one another," he said of the hospitals. "Residency programs were as good or as bad as the institution had them be." Said aughton: "We had had prior to that time a fair amount of problems with the various accrediting bodies." When the new ACGMErulescamealong, "We had to respond," aughton said. One of the first signs that the Consortium would workcameearlyon, during seemingly mundane discussions about designing a letterhead for Consortium stationery. "There was always a little tension in the communityaboutownershipoftheseresidencies," aughton recalled. "The question was, having made that bigjump, how would we identify ourselves." The dean said he was sure the hospitals would balk at putting the medical school's name anywhere prominent. He was happily mistaken. "It was pretty clear that the hospital directors thought the university should have the lead in it," he said. aughton credits several factors for the Consortium's success, including its design as a voluntary membership organization rather than a formal entity like a corporation. The structure emphasized the goal of improving educational quality, not meddling in the member hospitals' operations, and giving the members an equal voice in decisions. "We weren't merging anything," aughton said. "Ev- ery institution was going to maintain its integrity." oe agreed. "I think our success in establishment, as well as in the continued operation of the [organizational] model we decided upon, was first of all that it was a fully participatory governance process," he said. "You still have the individual tension, obviously," Naughton said. "But the decisions are made collaboratively, not by any single institution." Members meet regularly and lines of communication are kept open. The Consortium has three committees: administration, which includes deans, hospital �heads and hospital medical directors; program directors, which includes university department heads as well as the directors of each residency program, and residents, composed of elected representatives from each program. In addition, each committee elects a representative to sit on the other two C 0 0 committees. "All of our dealings are public within the organization," oe said. Program directors retain responsibility over the residencies, and medical school graduates still apply to individual residencies rather than the Consortium. But the Consortium is the sponsoring institution, and application forms and many other PER facets of the programs are now standardized. "What we did was to externalize the governance of all those programs from all those hospitals to a central body," oe said. Buffalo General CFO Braun said that while the Consortium's course is clearly set by aughton and the chief executive officers of the member hospitals, its decisions are group efforts. "If I had to describe it in a word, I'd say 'consensusbuilding,"' he said. "I would say no one has lost any autonomy. " Consortium members point to a number of achievements, including: • Centralized record-keeping Resident records were previously kept by the individual teaching hospitals. Bringing them under one roof is more efficient and has saved money, aughton said. • Resident salaries In the past, residents received different salaries and benefits depending on which program and hospital they were in. "Before there were different arrangements between hospitals ," aughton said. Even residents in the same program could receive different salaries if the program was spread over more than one hospital, oe said. Consortium members spent a number of years working on the problem. Along the way they encountered complications caused by the fact that some member hospitals- the VA and Erie County Medical Center - are run by government, oe said. "There were also union issues," he added. Two years ago the Consortium finally succeeded in forming two independent corporations to administer compensation packages for medical and dental residents. The corporations pool funds from the member hospitals and have eliminated most of the variations in resident salaries and benefits. • Orientation There is now a single week-long orientation program for residents, which in- AT I 0 l N ! �eludes training in bedside manner and certification in advanced life support. • Grievance procedure The establishment of a Consortium procedure for appealing disciplinary actions has been a major stride for residents, according to Crossland. "We've got much better due process in place now," he said. • Program reviews The Consortium itself reviews residency programs for potential accreditation problems before the ACGME arrives for its triennial checkup. "They do just as good a job as the outside body," said M. Luther Musselman, M.D., director of medical education at Millard Fillmore Hospitals. any of the Consortium's initiatives, such as pooling salaries and creating a combined orientation program, represent efficiency gains, said Diane Linskey-Hauser, executive director of the New York State Council on Graduate Medical Education. "There are lots of economic reasons for doing this," she said. Crossland said the Consortium also has worked to improve residency programs. Residents traditionally have been burdened with heavy workloads that cut into their time for study and research, he said, adding, "That's beginning to change and I'm impressed that they're serious about it." But some feel the Consortium's greatest achievement has been its willingness to tackle wider medical issues, such as the need for more primary care physicians. "It's really seeking to address some of these broader policy goals, well beyond these day-to-day operational issues," said Kelly. The emphasis on turning out more primary care physicians has become one of the Consortium's top priorities. It has set a goal of increasing the proportion of 13,000 residents, more than any other residents in primary care specialties to half state and nearly double the number in the total number of residents, and it has California. Buffalo itself has slightly more also pledged to cap the resident popula- residents than does all of Kansas. Buffalo's is neither the only nor the first tion at 750 medical and 32 dental, roughly teaching hospital consortium in the nathe present number. "That probably would be much more tion. The Association of American Medidifficult without some sort of consortia! cal Colleges tried to find out more about them this year by sending questionnaires effort," Braun said. Any proposal to start a new residency to about 400 teaching hospitals, accordprogram in a field outside primary care is ing to Kelly. The survey identified about met with heated debate at Consortium 40 different consortia around the country, though Kelly said meetings, he added. there are more, exMembers of the plaining that the Consortium are survey's purpose was presently involved to learn about the orin a demonstration "We're probably the most not to ganizations, project aimed at count them. boosting the numsophisticated and complex "Our preliminary ber of residents in findings suggest that the primary care spefor the most part the consortium that exists in cialties, the number consortia outside New of minority physiYork State do not share cians and the numthe country. of producing the goal ber of physicians in more generalist phyunderserved geoI don't know that w e sicians, more minorgraphic areas. ity physicians and Because of its efnecessarily ore more physicians servforts, the Buffalo ing underserved arConsortium is ateas," Kelly said. the model, but tracting national atThose other contention. "There are a sortia are geared more lot of organizations we ore a model." toward issues like resithat are interested in dent recruitment and trying to reform John Naughton, M.D., coordinating benefits, medical education," she said. "Buffalo is said Kelly. "Right vice president fo r clinical way ahead of everynowit'skindofheatbodyelse," she added. ing up because as The Buffalo Conaffairs and dean of the folks are thinking of sortium has taken its medical reform , cue on the broader they're also thinking School of Medicine and social issues from the ofmedical education state, which has been reform." Biomedical Sciences advocating greater use ew York State of consortia to implays a unique role prove medical trainin graduate medical ing since the report of education because the state Commission it has more than L �c 0 0 p E R A on Graduate Medical care, underserved Education in 1986. populations and miThe Commission's nority recruitment. "We did not hove the work led to creation Another consorof the state Council tium has been on Graduate Medical university or o university formed around AlEducation, which has bany Medical Colcontinued to push the lege and Albany hospital identified as the consortium idea. Medical Center, but "The advantages while its plan was apsponsor of the [residency] would be that it alproved by the state lows the opportunity Council on GME programs. We hod multiple for regional planning three years ago, the and looking at sociorganization has hospitals identified as the etal needs rather than been hampered by fiwhat the department nancial problems of medicine needs in and it continues to sponsor of individual tenns ofstaffing," said exist mostly on paLinskey-Hauser. per. programs. It was In its Fourth AnAs time goes on, nual Report, the Counhowever, and there fragmentation to the cil states: "Through is more pressure for consortia, medical changes in medical extreme. In some cases, schools, their affilieducation and the ated hospitals, and health care system, other teaching sites there will be more program directors found can jointly define the need for consortia. educational needs of "The point is that themselves juggling the residents and coordimedical schools and nate the development their teaching hospiconflicting interests of of core curricula, tals are going to have placement of resito network better," several hospitals involved dents and allocation said aughton. of educational re"A lot of coordisources in a way that nation is going to be in the some program." is both efficient and required among the responsive to the medical schools and Mi(hael F. Noe, M.D., needs of society." the affiliated hospiSo far , the only tals," agreed Linskeyexecutive vice president other operating conHauser. "Right now, sortium in the tate is Buffalo is a very clear and medical director of The one organized by model for how conew York Medical sortia might be modCollege and nine afeled." Buffalo General Hospital filiated hospitals in Kelly said there the late 1980s. In adhave been consortia dition to fostering around since the quality education, that consortium's goals 1960s and '70s, but now "they are being also include more emphasis on primary created at an increasing rate." C 0 0 PER T I 0 "The most common model for consortia is not the way it operates in Buffalo," she added. Most consortia now follow the "integrated program" model, Kelly said. These consortia are typically corporations set up to take over the residency programs. The member institutions give up their right to sponsor programs, and instead, the corporation becomes the sponsor. Kelly pointed to McGaw Medical Center at the orthwestern University School of Medicine. Contrary to what the name implies, McGraw Medical Center is not itself a hospital, but a consortium covering several member hospitals. Buffalo's consortium is an "independent" model, a less rigidly structured umbrella organization that lets member institutions retain a significant role in the residency programs. "There is no dominant hospital," said Musselman. "That's probably the biggest difference between Buffalo and other consortia." elly said that neither structure is particularly better suited than the other to pursue the widersocietalgoals for which consortia will be needed, but the Buffalo model makes it easier to get hospitals together in the first place. "It means you can maintain your independence," she said. One manifestation of that independence is in internal medicine, which is split into two programs within the Consortium. "Program A," with about 140 positions, is based at Buffalo General Hospital, Erie County Medical Center and the Buffalo VA Medical Center. The smaller "Program B," with about 40 slots, is based at Millard Fillmore. Even though Millard Fillmore was a Consortium member, it was reluctant to give up its own internal medicine pro- AT I 0 N �gram. "We didn't think it was good for residents to have two months in five different hospitals," Musselman said. "They finally agreed with us and allowed us to keep our program." Crossland said the Consortium's voluntary nature can be a disadvantage, limiting its ability to make changes. "It takes a lot of time and persuasion," he said. In general, however, the Consortium has fostered greater cooperation among its members. "I think we generally feel now that in a sense we have equal input into a decisionmaking process, that the unilateral decision-making that is sometimes not in the best interest of the educational objectives isnolongeraproblem," said oe. "Weare equal participants in a planning process that helps us assure the stability of our educational relationships. There is no question that sometimes decisions that are made don't go the way of one or more hospitals, but on balance I think everyone would agree the procedures set up have brought more advantages than disadvantages, more wins than losses." The primary care demonstration project i one of the more notable examples of cooperation through the Consortium. Under the project- initiated by the Consortium and the medical school, six of the 1 Consortium hospitals, the ew York State Department of Health, four private insurers and Medicaid- the hospitals involved pool about 15 percent of the indirect medical education reimbursements they receive from the government and insurers. The reimbursements are meant to help , compensate the hospitals for the costs of their teaching programs, and the 15 percent they are pooling is money that would otherwise have gone into the hospitals' general budgets, Braun said. The Consortium redistributes the pooled funds , which amounted to about 750,000 last year, to the hospitals for use in primary care training and other programs consistent with the demonstration c 0 project's goals. The Consortium also makes it easier for member institutions to respond to changes, as they did several years ago with a new state requirement involving resident credentialing. The Consortium brought the proper people together to establish a credentialing process, which now includes a system for forwarding records from one hospital to the next as residents rotate, aughton said. Crossland said that from the perspective of the residents themselves, the Consortium has been a "mixed bag." He said it has helped by making salaries and benefits more unifom1, but he adds quickly �c c o E 1 v c c that salaries should be higher. "Overall in the ortheast, we're in the lower 25 percent," he said. l n general, however,Crossland said he is pleased with the Consortium's goals and believes its members are making a good faith effort to improve educational programs. But he said he worries that financial problem could be an obstacle. "The hospitals, I can't overemphasize how much pressure they're under," he said. Last year wasn't a good one for the Consortium's hospitals. "ln total, the six hospitals that reported unaudited numbers showed a substantial loss, $8 million, I think," Braun said. "It's indicative of the environment and the problems we read about in the papers every day. It has nothing to do in a direct sense with the Consortium, but it influences people's ability to participate and the needs that they have." Braun said it hasn't kept the consortium from undertaking any new programs so far, but, "It's a consideration every time we sit around the table and talk about what new and innovative programs can be tried." Crossland said the hospitals are hampered by low reimbursement rates for graduate education. "Some of the reimbursement is going to have to be improved," he said. aughton agrees that the financial situation is serious. But he remains optimistic about the Consortium . "I think the threat is less if we continue to share resources as we do," he said. "l think the Consortium is a pretty good response to the economic climate." + f c c C 0 0 0 0 p E A R T I 0 "There is no dominant hospital. That's probably the biggest difference between Buffalo and other consortia." PER Luther Musselman, M.D., director of medical education for Millard Fillmore Hospitals AT I 0 N �-PAYING OFF FOR THE FUTURE, TOO Y ears ago, hospitals in Buffalo and less serious now," said Andrew J. Rudnick, president ''There's always been a little bit of disquiet elsewhere tended to look on other of the local business group called the Greater Buffalo Partnership. about it," he added. Now work is underway to form a new organi- health care institutions as rivals. They were motivated more by their own selfinterest than by what was best for the region. While the Graduate Medical Dental Education The business community pushed for creation of zation to replace the WNYHSC with a consortium the WNYHSC because it was concerned that local more directly under the control of the university hospitals were duplicating services and spreading and local medical community. The new consortium Consortium of Buffalo didn't set out to solve that some specialties too thinly over multiple institutions. would include the GMDECB, which would continue problem directly, it did help set the stage for anew As a result, there were inefficiencies and some pa- to operate without significant changes. After several years of the WNYHSC, Rudnick way of thinking and a new era of cooperation. tients were traveling to other cities for treatment they said, cooperative efforts have become institution"It helped to provide the mechanism for an should have been able to get in Buffalo. Through the WNYHSC, UB and the area hospitals alized and business leaders no longer feel a need evaluation," said medical school Dean John Naughton, M.D. now engage in more joint planning. Among other to be involved in the process. "We're not academic "Getting the parties to the table served as a things, Naughton and others credit the Consortium medical people," he said. ''We're not clinicians. springboard toward dealing with alarger agenda," with bringing a Trauma-Burn Center to Erie County We're not researchers. Ultimately it's got to be agreed Michael F. Noe, M.D., executive vice president and medical director at The Buffalo General Hospital. "Out of that, in 1987, the Western New Medical Center, a Heart-lung Transplant Center to turned over to them." In addition to encouraging cooperation, the The Buffalo General Hospital and a Bone Marrow Transplant Center to Roswell Park Cancer Institute. new consortium will also focus on issues such as York Health Sciences Consortium was formed." Forming the WNYHSC proved more difficult than new information systems and closer collaboration The Health Sciences Consortium took the the GMDECB because medical people were uneasy betweentheuniversityandcommunityphysicians, GMDECB concept one step further, going beyond with the central role played by the business commu- Noe said. the focus on training to look at the broader issue nity. "It was a little bit more controversial because it of providing quality care at low cost. was threatening to physicians and faculty as well," will be in place by the end of the year. Traditional hospital rivalries "seem to be far Naughton said. Naughton said he hopes the new consortium -A NDREW + DANZO �., ~·· ·· ······· ·· · · ··· · ······· · ··· · ················· · ····· · ······ ··· ··· · ·· ·· ·· · · · ············· · · · ··· Spring Clinical Day and Reunion Weekend '93 successfully staged his year's Spring Clinical Day and Reunion Weekend, held on April 30 and May 1, marked a time to reminisce, renew friendships and review health care practices today. lt was, as always, a rousing + success. From left to right- First row: Ronald E. Martin, Victor Guarneri, Richard]. Buckley, r. , Gertrude Swarthout Second row: Walter R. Peterson, Kenneth Bone, Alfred S. Evans, Duncan K. Macleod, Eugene M. Farber, athan P. egel From left to right- First row: Thomas Grayson, Morris Unher, Anthony Marano Second row: Thomas Heineman, B. joseph Galdys, Marvin Bloom, Harold Feldman, jane Freiberg, George Heus, William Keenan, Paul Wolfgruber, Ivan Bunnell, Ralph Behling, Edward Crohn, Richard jones Third row: Louis Ciola, Edward Tracy, Charles Tanner,john Ninfo From left to right- First row: Harold Graff, Daniel Fahey, Vernon Lubs Second row: Edward Heckman, Raphael Good, Myron Gordon , Daniel Miller, Robert Hall CLASS OF B a 0 p y 5 c a n A u 1948 u m 9 9 3 �CLASS OF 1 953 From left to right- First row: David Batt, jacob Shammash, Richard agel, joseph Ruh, Marvin Wadler, Donald Ehrenreich, Thomas Geoghegan Second row: Herbert Constantine, john Strachan, Reinhold Ullrich, james Coleman, Molly Seidenberg Panner, Thomas Comerford, Howard Smith, john Volunan, Milford Maloney, james Orr, Ronald Garvey Third row: Harley Lindquist, Curtis johnson, Stanley Cohen, Donald Rachow, john Handel, Bertram Portin, Raymond Smith, Michael Sullivan, Sander Fogel, Herbert Simpkins,john Fenger CLASS OF 1 958 From left to right- First row: Melvin Brothman, Richard Rahner, Thomas Cummiskey, Richard Wasson Second row: Richard Romanowski , John Armenia, Marie Leyden Kunz , Lucien Potenza, Michael Mazza,joseph Bellanti, jason Reder Third row: William Glazier,john Float, Michael Genco, Carl Contino, Donald Ginsberg, jacques Lipson , Domonic Falsetti, Robert Dickson, Bernice Comfort, Ronald Batt, Franklin Zeplowitz, Franklyn Campagna, Joseph Zizzi, Samuel Shatkin, Alfred Stein, Eugene Friedberg, Leo Kane, Richard Boyle, Robert Perez, Gerard Guerinot Fourth row:David Koretz, Morton Spivack, William Deverell, Gary Cohen, Gaspare Alfano , Reinhardt Wende,John Giardino, Elroy Anderson CLASS OF 1963 8 u a a p h c a A u m 9 3 �CLASS OF 1 968 i From left to right- First row: john hields, Gary Karch, jeffrey Stoff Second row: Bruce Gesson, Katherine Dowling Schlaerth, Barbara Blase Sayres, Sara Gerstman Sirkin, Thomas Cumbo, Ronald Friedman, Morris Stambler, Leonard Argentine Third row: Lawrence Baker, Gerald Daigler, Robert Baltimore, Albert Biglan, Robert White, Lesbia Fernandez Smith, Robert Rodner, john chlaerth, Geoffrey Clark, Elias Rosenblatt, Harold Kulman Fourth row: Bruce Rabin, jonathan Reynhout, Brianjoseph, Lawrence Dobmeier, julian Karelitz,john Bivona, Robert Rosen,julian Offsay, Robert Milch, Paul Murphy, Robert Dickman, William Clack From left to right- First row: David Breen, Frederic Buchwald, Robert Lamantia, Lynda Young, Sharon Kuritsky, Paul Kuritsky, Thomas Wasser, William Ackerman Second row: Frederick Beck, Michael Haberman, john Klimas, Michael Sansone, Charles McAllister, Arthur Mruczek Third row: jacob Rozbruch, john Przylucki, Dana Launer, Daniel McMahon, Andre Raszynski, Charles Wiles, Raymond Dattwyler, Arnold Scherz, Demetrius Ellis, Thomas Dwyer CLASS OF 1973 From left to right- First row: Michael Blume, Ronald Somogyi, Elizabeth Doherty,judith Baron-Stone, Richard Elman Second row: Stuart Dorfman, Kenneth Glick, Matthew O'Brien, Stephen Gawronski Third row: teven Kaplan, Paul Wopperer, Stewart Altmayer B u a 0 p h s c a " u m 9 9 3 �CLASS OF 1 983 From left to right - First row: Robert Smolinski, eal Smith, Richard Collins Second row: Melinda Cameron, Mary Lee, Suzzanne Tanbakuchi, Deborah Korwin, Younghee Limb, Gwen ichols, Andrea Manyon-Wild, Patricia Flanagan Third row: Ephraim Back, Kenneth Zimmerman, James Koness, Daniel Murak, Robert Rosen,jonathan Graff, Gregory Zuccaro, Borys Loza, Michael Chaskes, Kenneth Roth, Victor Chehebar, Therese Giglia , Peter Accetta Fourth row: Ross Greenberg, Lonny Behar, Robert Stall, Carl Grant, James Corasanti, Galvin Anderson, William Hanavan, Kevin Ferentz, Mark Schwager Fifth row: Charles iles, icholas Aquino, Frank Mezzadri, Frederick McAdam, James Wild, Mark Venditti, Allen Rosen SPRING CLINICAL DAY From left to right - First row: Judith Hays, Lisa Benson-Guterman, Stephanie Christenson, Ellen Adler-Weinberg, Janet Williams-Barbaccia, Norah Lincoff, Ann Marie Levine, Margaret Morey Second row: Kathleen O'Leary, Robert Mennella, Paul Shields, Helen HessCappuccino, Lori Guttuso-Luzi,John Barbaccia, Constance Greene-Klocke, Lisette D'Eon , Ralph Pothel, Thomas Bellomo Third row: Charles Everett, Lisa Guttuso-Klenk, Stephen Hughes, Andrew Cappuccino, Wayne Waz , Frank Luzi, Dawn Hrab, Mark Klocke Winners of the class with the highest percentage of attendees pose for a picture. The AMA's Dr. James Todd lectures on health care reform. Orvan Hess '31, wins an Alumni Achievement award. B u c 0 p y s a n A u m n 9 �~·· · ········································· · ············· · ·· · ··················· · ············ · · lEI Kathleen A. Lillis, M.D. Lillis '87,appointed attending physician in emergency medicine athleen A. Lillis, M.D. , '87, was recently appointed attending physician to the division of emergency medicine at The Children's Hospital of Buffalo. Her responsibilities include supervising resident and medical student teaching in addition to overseeing all incoming patients. Lillis is also medical director of the stabilization and transport team, as well as a child abuse and toxicology consultant for the hospital and medical director of Mercy Flight. + Frawley establishes endowment for residency research fellowship homas F. Frawley, M.D., '44, chairman of Graduate Medical Education at St. John's Medical Center and Emeritus Professor of Medicine at St. Louis University School ofMedicine, has established a charitable remainder unitrust through a gift of securities valued at $50,000 to the University at Buffalo. The unitrust will establish the Thomas F. Frawley, M.D. Residency Research Fellowship in the School of Medicine and Biomedical Sciences. The endowment will B a a p provide a stipend for a resident to perform r search for one year before deciding to follow primarily a medical re earch career or elect to go into clinical practice. Frawley received the Distinguished Medical Alumnus Award in 1989 and served as chairman of the medical school's annual fund drive in 1992. He served as president of the American College of Physicians from 1981 to 1982 and recently was the 1993 recipient of the Alfred Stengel Memorial Award presented to a Master of the College who has exhibited "unusual loyalty and exceptional contributions to the aims and purposes of the College as well as outstanding influence in maintaining and advancing the best standards of medical education, medical practice and clinical research." + Two annual awards endowed for graduating medical students enjamin E. Obletz, M.D. , '32, retired Buffalo surgeon, and his wife, Lila, have established the Dr. Benjamin and Lila Obletz Fund to support a prize in orthopaedic surgery to be awarded annually to a graduating senior. Obletz received both his undergraduate and medical degrees from the University at Buffalo and has served as a clinical professor of orthopaedic surgery from 1956 until the present. Mrs. june Alker has endowed a fund in memory of her husband, George]. Alker, M.D., '56, chairman of the department of radiology at UB from 1985 to 1991. The fund will provide an annual award at commencement to an outstanding student in the area of neuroradiology. Dr. Alker, who died December 31, 1991, was born in Budapest, Hungary, and immigrated to the United States in 1949 as a refugee. He was director of radiology at y 5 c a n A Erie County Medical Center and a member of the American Society of euroradiology. + Lillian Ney'64,named diplomate of medical management board illian Vitanza ey, M.D., '64, vice president for medical affairs and medical director ofW.C.A. Hospital in jamestown, ew York, has been designated a diplomate of the American Board of Medical Management, the national certifying agency for physician executives. ey, who has been with W.C.A. Hospital for 19 years, is board certified in internal medicine and cardiovascular disease. She is a fellow with the American College of Physicians, the American College of Cardiology and the Council of Clinical Cardiology of the American Heart Association. She is also a member of the American College of Physician Executives. + Reisman '56,named master in American College of Physicians obert Reisman, M.D. , '56, has been named a master in the AmericanCollege of Physicians. Reisman, UB clinical professor of pediatrics, is currently President of the Medical Alumni Association. + u m 9 3 �··· · ···· ······ ·· ···· · · ·· · ··· ····· · ·· · ·· · ····· ···· ··· ··· ·· ·· · ·· · ··· · · ·········· ·· ·········· ·· ····· · 1 ·. . II I • I Innovative palliative care training program begins at Hospice Buffalo or the first time, fellows from the Graduate Medical Dental Education Consortium of Buffalo are receiving training in palliative care at Hospice Buffalo. The eight-week rotation, under the auspices ofUB and the ational Institutes of Health Summer Program, emphasizes attitude, knowledge and skill. Under the leadership of Robert Milch, M.D ., medical director of Hospice Buffalo, the fellows examine the interdisciplinary approach of palliative care and how the therapeutic process involves more than diagnosing and attempting to revert advanced disease. Emphasis is placed on interventions as they relate to the patient's needs , desires and beliefs, and assuring patients have as much control as possible over decisions that affect them. The fellows are also involved in discussions on the ethical aspects of caregiving, including euthanasia , resuscitation , paternalism, aggressive versus palliative interventional therapy, incompetent patients, fairness in the health care system and strategies for resolving ethical issues. The curriculum covers common symptoms in patients with advanced chronic disease along with suggestions of appropriate techniques to combat them. Elements of grief reactions and preventive techniques for adverse reactions are also addressed. The rotation identifies various organizational arrangements for the delivery of palliative care and their relationship to the health care system, including community resources available to patients with advanced illnesses and their families . The fellows rotate through each clinical discipline of hospice care, examine methods used in nursing homes and accompany counselors on social work and bereavement visits. + B 0 0 p h The training follows an interdisciplinary approa(h to palliative (Ore that re(o.gnizes the therapeuti( pro(ess involves more than diagnosing and attempting to revert advan(ed d1sease. Pediatrtc fellow receives research award from national association elawati Yuwono , M.D., a fellow in the division of pediatric gastroenterology/nutrition at The Children's Hospital of Buffalo has received a Glaxo Fellow award for her abstract, the "Role of Promoter and Suppressor Genes During Adnomidis Polyp Development in Familial Polyposis Coli." Yuwono presented her data at the annual meeting of the American Gastroenterological + Association. "Membership in the consortium strenothens and improves the quality of b Memorial's family practice residency program through increased coordination with the State University of ew York at Buffalo's medical and dental schools and other area teaching hospitals," Memorial president Timothy]. Finan said. "Our participation will cement an effective working relationship and improve communication to the benefit of our resident physicians, the hospital and the community. " + Niagara Falls Memortal Medical Center joins Buffalo Consortium iagara Falls Memorial Medical Center has joined the Graduate Medical Dental Education Consortium of Buffalo to strengthen and enhance its family practice residency program. y c 0 n Resident training at Niagara Falls Memorial Medi(al Center will be enhan(ed. m n 9 9 �• ················· · ··· · ······························· ·· ·········· · ···················· · ··· · ····· ~ I "In Sickness and in Health" chronicles the plight of Alzheimer's disease victims he Western ew York Chapter of Alzheimer's Disease and Related Disorders Association has found an unusual way to raise money for its support services and promote awareness of the disease. lt has hired Buffalo Ensemble Theatre, a downtown professional company, to produce In Sickness and in Health, a new play about a family struggling to cope with the advancement of the disease. The play, by Donna Marie Vaughan, will be presented ovember 4, 5, 6 and 7 at Lancaster Opera House. All proceeds will benefit the local chapter. In Sickness and In Health, which is expected to receive national coverage, opens with Cecilia, a mother of four now in her late 50s, rummaging for her mislaid checkbook, which her husband, Emmet, eventually finds in the icebox. As the play progresses, Cecilia's condition steadily deteriorates, and Emmet alternates between shielding the severity of the disease from the children and visitors and grappling with the temptation to give his wife up to professional care. "Losing a person so gradually is more painful than death," said Marion Goldstein, M.D. , UB principal investigator of psychiatry who sits on the Alzheimer's Disease Association's Board ofDirectors. ''I've known a lot of people [who have] run away from it. But living to the fullest with a partial mind is something we should all know and share in - it enriches us." In Siclmess and In Health throws an unusual and sensitive spotlight on the other victims of the disease that afflicts four million Americans: their families. lt is the hope of the Alzheimer's Disease s u a 0 p Association's Western ew York chapter that the play will heighten awareness of both the severity of the disease and of the day-to-day struggles of the husbands, wives, children and friends- "caregivers" -who also live with it. "Donna came to us with the script in 1991 and consulted with our education director," said Sharon Ross, the chapter's executive director. "We've been looking for ways to produce it ever since. "What we're excited about is the opportunity for an innovative way of entertaining and educating people about Alzheimer's through the medium of theatre. " Ross said that she would be bringing the actors into contact with Alzheimer's sufferers so that they could stud) the symptoms o the disease. The local Alzheimer's Disease Association is one of 215 chapters working to alleviate the burden of the disease on victims and their families. Western New York's Chapter is armed by 100 volunteers who serve Allegany, Chautauqua, Erie, Genesee, iagara, Orleans and Wyoming counties. h s 0 A The support groups reflect a national web of interest and research that provides assistance for both those suffering from the disease and the next of kin who must continue to provide care as the disease takes its confusing and frequently devastating toll on daily life. The Western ew York Chapter's newsletter, for example, carries the advice, "You never win an argument with an Alzheimer's patient," from the Association's San Francisco chapter; the Greater Washington chapter offers tips "On Hiding Things." The association has also developed a program called "Safe Return," which helps locate patients who have wandered off alone (59 percent of sufferers are afflicted with what can be life-threatening wandering, and 70 percent of patients surveyed indicated wandering was a frightening factor in their lives.) The program, the impetus for which was the death of a wandering Buffalo patient in October of last year, enrolls patients in a national database and issues identity tags and brace- u m 9 9 3 �······ ··· ········ ·· ··· · ·· ·· · · ····· · · · ········ · ····· ·· ····················· ·· ··· ·· ············ r g l§JJ lets for a small fee. It also trains those who may not have had contact with the disease - and especially police and emergency crew members - in recognizing and responding to its symptoms. Information on Alzheimer's Association Western ew York support groups and its "Safe Return" program may be obtained by calling (716) 873-1335 or 1800-273-6737; information on purchasing tickets for In Siclmess and In Health may be obtained by calling (716) 8731335 or (716) 855-2225 . + - B Y R O B ERT W AT ERH OU SE PranikoiT elected asecretary of Amertcan Urological Association "Then and Now"will chronicle 150 years of medical school history evin Pranikoff, M.D., associate professor and vice chair of urology, has been elected secretary of the Northeastern Section of the American Urological Association for a five-year term. As secretary to the association, Pranikoff will coordinate its affairs as well as sit on its executive committee. He is the first urologist from the Buffalo area to be elected to the position. + n 1996, the University at Buffalo- and its founding School of Medicine and Biomedical Sciences- will celebrate 150 years of service. Beginning with its next issue, Buffalo Physician will commemorate the Sesquicentennial with the inauguration of o special series called "Then and Now," which will look at various aspects of what the medical school was like over the post 150 years. The series will toke both o historical perspective and o personal one with articles about what life was like for early medical students, clinicol "firsts," personol "firsts" and the history of the affiliated hospitals. In addition, Buffalo Physicianwill excerpt articles from The Buffalo Medical Journal, first published in 1845, and keep its readers abreast of the various events and exhibits scheduled to celebrate the Sesquicentennial. Stapleton appointed chair of pediattic nephrology sub-board Bruder Stapleton, M.D. , A. Conger Goodyear professor and chair of the Department of Pediatrics, has been named chair of the sub-board of pediatric nephrology of the Ameri1can Board of Pediatrics for 1993. The six-member board is responsible for certifying pediatric kidney specialists in the United States. Pediatrician-in-chief at The Children's B u a 0 p h Examiners, a member of the American Pediatric Society and sits on the executive councils of the Eastern Society for Pediatric Research and the American Society of Pediat+ ric Nephrology. Hospital ofBuffalo, Stapleton recently was named assistant secretary general of the International Pediatric ephrology Association. A fellow of the American Academy of Pediatrics, he is certified by the American Board of Pediatrics and its sub-board of pediatric nephrology. He is also a diplomate of the American Board of Medical y 5 a n A m n 9 �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [1] ~ I Two UB professors elected to Amertcan Pediatric Society aniel Green, M.D., and Bradley Fuhrman, M.D., UB professors of pediatrics, have been elected to the American Pediatric ociety for outstanding contributions to the field of pediatrics. Green, professor of pediatrics in the division of hematology/oncology, is chief of the oncology section in the department of pediatrics at Roswell Park Cancer Institute. He is also a member of the Scientific Committee of the International Society of Pediatric Oncology and the Society of Pediatric Research. Fuhrman heads the divisions of critical care medicine at The Children's Hospital of Buffalo and in the department of pediatrics at the medical school. He is a member of theNorthwestPecliatricSociety, the American Academy ofPediatrics and the Society of + Critical Care Medicine. Congratulations abounded as the S(hool of Medidne and Biomedkal Sden(es' Class of 199 3 attended its (Ommen(e· ment (eremonies in May. editorial board of thejoumal of Urology. Mark Ballow, M.D., professor of pediatrics and chief of the division of allergy/ immunology at The Children's Hospital of Buffalo, has been appointed to the editorial board of the ]oumal of Clinical Immunology. Donald Opila, M.D. , clinical assistant professor of medicine, received the "Young Internist of the Year" award from the American Society of Internal Medicine at + their recent national meeting. chair of medicine and microbiology and chief of the division of infectious diseases at UB untillastjanuary. The vaccine was judged the most promising invention among 40 entrants selected from more than 300 inventions receiving patents in 1992 in Western ew York. If it proves effective in humans, the vaccine will be a major medical breakthrough in the treatment of ear infections. The vaccine may also be effective against + lung infections in adults. B UB researcher Murphy named Inventor of the Year for 1992 wo researchers who developed a vaccine with the potential to provide immunity against middle ear infections were selected iagara Frontier Inventor of the Year for 1992 by the Technical ocieties Council of the iagara Frontier and the iagara Frontier Patent Law Association. Timothy Murphy, M.D. , UB professor of medicine and microbiology and director of its microbial pathogenesis graduate group, and Michael Apicella, M.D., professor and chair of the department of microbiology at the University of Iowa College of Medicine, were honored for their work. Apicella was professor and Bradley Fuhrman, M.D. UB physicians honored by award and journal board appointments hree UB physicians have been honored for their expertise in their repective fields. Gerald Sufrin, M D., professor and chairman of the department of urology, has been appointed to the B u a 0 p c a A Y LOIS B AKER Life Technologies donates labware for use in cell culture research abware valued at $45,000 for use in cell culture research recently was donated to the medical school b y GIBCO Life Technologies, Inc. Life Technologies, headquartered in Niagara Falls, ew York, develops, manufactures and sells molecular biology products and cell culture products under the BRL and GIBCO brand + names. u u m 9 3 �··························································································• II . - ' 1 9 4 0 director of the Delhi and Stam- structive pelvic surgery. George A. Gentner '41, of Phoe- '85, is presently a fellow in neonatology at the SU Y HSC. ford offices of the Mary Imogene nix, Arizona writes, "I have been retired for several years now and enjoy coastal cruising on a sailboat off southern California." John E. Shields '68, is medical particularly in the field of recon- s I Raymond Moffitt '48, retired in Bassett Hospital of Cooperstown, 1989 as chief emeritus of gastroenterologyatSt.Joseph's Hospital New York. Jeffrey G. Straus '84, writes, "I am a contributing author to the text Ophthalmic Anesthesia (Slack, in Providence, Rhode Island. He Sogba K. Bosu '69, is a pediatri- Inc., 1993); thechapterisonStraus William D. Loeser '45, of Young- now enjoys golf and working part- cian/neonatologist with the Retrobulbar stown, Ohio, closed his practice time elderly in Southern California Permanente nique, U.S. Patent#4,759,746." arragansett, Rhode Island, and Medical Group, Orange County, in 1989; he is currently medical director of a preferred provider with the California, assistant chief of pediatrics and director ofNicu-Kaiser Sarasota, Florida. organization. 1 9 5 0 Hospital, Anaheim, and chairman s Robert A. Benninger '50, of Cape of the pediatrics department, West Coral, Florida, informs us that he Anaheim Medical Center. Allyn, are expecting a second child in September. Paula Rothman '85, has joined a 1 9 7 0 s orthopaedic surgery and is cur- Maxine Hayes '73, is assistant rently helping to build a church. secretary of health for Washington State. She is president elect for tice in Birmingham, Alabama. Michael]. Bartiss '87, has joined the Carolina Eye Associates in the Association of Maternal Child Southern Pines/Pinehurst, of radiology at the Medical Col- Health Programs. Hayes received her MPH from Harvard Univer- Carolina, as a pediatric ophthal- lege ofWisconsin, has been elected sity School of Public Health in to the board of trustees of the American Board ofRadiology. His 1977. James E. Youker '54, professor and chairman of the department six-yearterm beganJuly l. Youker practices at the Milwaukee County 1 Medical Complex and Froedtert Memorial Lutheran Hospital, ichols '47, chief of where he specializes in chest radi- gynecologic pelvic surgery at Mas- ology, cardiac radiology and sachusetts General Hospital, was mammography. David H. Kevin M. Miller '85, ofWoodland Hills, California, and his wife, reproductive endocrinology prac- sold his airplane but still has a sailing sloop. He retired from David H. Ni(hols eedle and Tech- 1 9 6 0 mologist. MarkS. Courey '87, has joined the faculty of Vanderbilt Univer- 9 8 0 s sity, ashville, Tennessee, after completing a fellowship in voice George C. Geraci '80, is now board disorders and care of the profes- certified in medical management, sional voice. emergency medicine and family named Outstanding Surgeon of the Year at the annual meeting of orth s practice. Geraci is medical direc- Robert H. Goldklang'87, received tor of primary and urgent care for Capital Health System in Harris- a Clinical Research Award from burg, Pennsylvania. Health in 1992 and was selected the Glaxo Institute of Digestive to receive a renewal of the grant in the Society of Gynecologic Sur- Alan L. Pohl '62, informs us that Andrew M. Knoll '84, having suc- 1993. Goldklang is a junior fac- geons, held in PhoenLx. his son, Andrew, graduated from cessfully delayed his residency ulty member in the department of internal medicine at the Univer- ichols, formerly a professor and chair- the University ofWisconsin Medi- until the enactment of Section man of obstetrics and gynecology cal School and is a radiology resi- 405, is completing his final year of sity of California at San Diego at Brown University, is currently a dent at Michael Reese Hospital in training as chief resident in inter- School of Medicine/San Diego VA visiting professor at Harvard Medi- Chicago. nal medicine at the SUNY HSC in Medical Center. Currently, he is a cal School and Massachusetts Syracuse. He has accepted a posi- General Hospital. He is known for William M. Burleigh '67, of tion as attending physician in the his innovative surgical contribu- Rancho Mirage, California, in- Emergency Department at St. tions to the health care of women, forms us his daughter, Jennifer, Joseph's Medical Center in Syra- was born March 11, 1992. cuse. His wife, Maritza Alvarado 6 u 0 0 p y 0 n m trainee member of the American Gastroenterological Association and a member of the American College of Physicians. �• ····························· ······ ········ ··· · ········ ·· ································· . ' Deborah Shalder '87, writes, "I won a fir t place in watercolor at the annual exhibit of the American Physician AnA ociation held in San Antonio, ovember 1992." joseph Aferzon '89, announces the birth ofRacheljessicaAferzon onjanuary 11 , 1993. Aferzon is a third year neurosurgery resident at Hartford Hospital, University Stephanie is now Child Care Director at the YMCA." Scott Svitek '90, is chief resident in pediatrics at Long Island jew- of Connecticut. Ronald A. Alberico '90, was picked as one of the 40 best sec- ish Hospital. Debra M. Omiatek '89, is currently employed as clinical director at the Tuscarora Indian Health Center. ond-year radiology residents in the country. He has two children: Zachary Ryan, two, and Karissa icole, 11 months. Matthew]. Phillips '91, and his wife, Toula, announce the birth of Stuart Varon '89, has been appointed chief resident of child and Ronald Palazzo and Ellis Gomez Palazzo '90, announce "our new Richard G. Bennett '92, is cur- adolescent psychiatry at the West- addition, Ana-Maria Elaina, was psychiatry at Case Western Re- born September 17, 1992. Both of serve University Hospitals in Cleveland, Ohio. David]. Pochatko '88, completed an orthopaedic surgery re idency injune and began a foot and ankle fellowship at Emory Univer ity. Pochatko plans on practicing in us completed family practice residencies in june." very helpful bigsisterjanee.Janee was three years old in February. theirson,JamesMatthew,onApril 7, 1993. Buffalo. Helen Cappuccino '88, a general surgeon, and Andrew Cappuccino '88, an orthopaedic surgeon, proudly announce the birth of their fourth child, Nicholas An- em Psychiatric Institute and Clinic of the University of Pittsburgh, Pennsylvania, for 1993-1994. rently in the residency program in thony. 1 9 9 0 Ranjan Bhayana '90, announces the birth of his second daughter, Brittney Paulina, on March 4, 1993. Bhayana has relocated to the Buffalo area. Daniel F. Klee '90, began a cardiology residency at Good Samaritan Hospital in Phoenix in july. Pierre]. Moeser '90, of Chesterfield, Missouri, writes, "I will be in the citizen ambassador program rheumatology delegation to Russia and the Czech Republic in October 1993." Anna Kristina E. Hart Anna Kri tina E. Hart '89, writes, "I am still on active duty in the navy as a flight surgeon, currently in Pensacola, Florida. In earlyJune I'll be transferred to Whidbey Is- land, Washington , for one additional year before resuming re idency." B a William F. Balistreri '70, has been named the recipient of the Distinguished Medical Alumnus Award for 1993. 5 Ronald Alberico '90, is chief resident in radiology at Long Island 0 BIT U ARIES Evelyn Heath Jacobsen '24, died April 12, 1993, after a long illness. She worked for almost 50 years at The Children's Hospital of Buffalo, both full-time and part-time, until her retirement at age 70. The jacobsen Ambulatory Care Center at Children's Hospital was named for her and her husband, the late A. Wilmotjacobsen, M.D. Arthur C. Hassenfratz '28, died December 13, 1992. Hassenfratz was in private practice in Buffalo for 52 years. Rutherford S. Gilfallan '41, died in Dillon Beach, California, ovember 27, 1992, after a long illness. jewish Hospital. john F. Perry'S!, died December 25,1992, in Gilroy, California. William Palmer, Jr., '90, writes, James M. Garvey '55, died of emphysema at his home in Olean, "My wife, Stephanie, and I an- New York, March 8, 1993. nounce the birth of our second daughter, jilian, on October 11, 1992. She joins her proud and a p y 5 james]. Freeman '74, of Medford, New York, died of a heart attack April 18, 1993. Dr. Freeman worked for the assau County Health Department. a n A u u m n 9 9 �A Spoonful of Humor © Stu Silverstein , M.D . Future Perfect? THE TIMES THEY ARE A 'CHANGIN FOR HEALTH CARE eligious friends of mine tell me that we are living in the Messianic Era. With the scores of changes occurring recently, I remain open to this possibility, for these are indeed strange times. It's either that, or virtual reality scientists are playing a clever trick on all of us. Recently, we have seen the almost unthinkable - the death of Superman, and over the summer Charlie Brown finally hit that elusive home run after years ~f striking out. A colleague of mine just informed me that john Bradshawemperor of the dysfunctional family, admiral of the good ship healthy functioning- is getting a divorce (which sort of begs the question, "who gets custody of his inner child?"). The changes are particularly frightening for those of us in health care. And if all these changes aren't enough, we are facing the specter of two lawyers determining the economics of health care for the coming century -one lawyer who spent $200 at~~=-~~Z airport for a haircut and one, it seems, who spent 2 at the supercut drive-thru window. I am waiting for Hillary to actually bill us for 35,064 hours of service in 1996. Indeed, I am hoping that she doesn't expand the concept to "drive-thru" short-stay surgery to cut down on health care costs. When I decided to become a pediatrician, I did so despite warnings that I Would end up standing at the entrance to U.S. l 0 l holding a "Will do LPs for food" sign to make ends meet and pay off my student loans. At times I've thought about it, but resisted the temptation (primarily because there is barely room with all those unem~loyed lawyers holding up signs expresstug their willingness to litigate for the same). ow it seems that those who decried my going into primary care - my colleagues who chose careers in radiology and dermatology Will soon find that the real prestige will rest with those of us who chose primary care. According to Hillary Rodham Clinton, we're going to be the darlings of the new health care plan they're generating. At last I'll never again be asked to sit at the kiddie table during staff meetings, or play miniature golf to match my miniature salary. The possibilities are excitmg. We could soon see orthopaedists ordering "total" malleus, incus and stapes replacements to treat chronic otitis media, or perhaps general surgeons performing below-the-cochlea amputations for the same ... call it the van Gogh procedure- CPT code number 9990. Pathologists will prove what most of us suspected all along -that they know it all and this time they won't arrive when it is too late. Yet, this is perhaps what is awaiting us under the "managed competition" now being proposed by the Clinton administratio::,n~.-~~"" Managed competition is one of those oxymorons we've seen over the years, like "military intelligence," "government help" and "Super Bowl champion Buffalo Bills." What is managed competition anyway? I envision patients comparison-shopping from city to city, and hospitals setting up cubicles like those seen at car dealers. "OK Mr. Goodname. We'll throw in the epidural and the appendectomy, but the vasectomy will take me below cost - might have to call in a urologist, or even a plumber if you're willing to pay the difference. Let me check with my manager first!" President Clinton has promised us universal health coverage with acceptable quality, but he didn't mention that he will be using virtual reality technology to do it. This may not be such a bad idea, and actually may be the way to obtain not only universal health care coverage, but universal satisfac' tion in life-disgruntled postal workers could express their dissatisfaction while firingvirtualreality guns, Ross Perot could fulfill his megalomaniacal fantasies and actually become CEO of the country if not the universe in the privacy of his own home while leaving the rest of us alone. And maybe through the wonders of virtual reality technology, we can even see the unthinkable- the Bills winning a Super Bowl. Well, some things even in these times remain virtually + unrealistic. Stu Silve~tem, M.D., president of Stoooup Medicine Semino~ of Son fmocill:o, Colifom~. lectures nationwide on humor rn medi<ine. �BUFFALO PHYSICIAN STATE UNIVERSITY OF NEW YORK AT BUFFALO Non-Profit Org. U.S. Postage 3435 MAIN STREET PA ID BUFFALO NEW YORK 14214 Buffalo, NY Perm it No. 311 ADDRESS CORRECTION REQUESTED The only liability coverage with this seal of approval. Medical Liability Mutual Insurance Company (MLMIC) is the only professional liability insurer approved by the Medical Society of the State of ew York. Since its founding in 1975, the physicianowned and managed company has successfully defended more physician than all other available insurers combined. Additionally, MLMIC has the large t and most experienced professional liability claim department in the country, the largest risk management department of any ew York tate professional liability insurer, and the state's only true peer review of claims experience. Call1-800-ASK-MLMIC (metro) or 1-800-356-4056 (upstate) for more information and an application. MLM~C ~ Medical Liability Mutual Insurance Company Our defense never rests. 2 Park Ave., ew York, NY 10016 250 Harrison St., Syracuse, NY 13202 90 Merrick Ave., East Meadow, NY 11554 ' 1993 ~l edical Uability Mutual Insurance Company �I C s AND s B•OME... 0 9 1 F S C f [ N c.; E.G 9 7 I N L. �\ ~ 9 s > 0 1/J Ul EACH YEAR, THE UNIVERSITY AT BUFFALO'S SCHOOL OF IOMEDICAL SCIEN MEDICAL STU RS, THEY WILJ ES ADMITS ENTS. IN THE REALIZE THEIR :Y: WILL ENRICH FULFILLING YEARS OF THEIR LIVES. �s s J. Pablo Abonia I Jared Barlow ...,t h ' I II n \t:r [[!"1 9 > I l 1 Gonzalo Bearman Kathleen Batt tf B d • Angela Camasto l. orndl l n crs1t Timothy Braatz rf 1'1 l 1 \) Jeffrey Cassidy \, R Sandra Block Cassann Blake u t 9 Jean Bae Jason Andrus n ornu B 1 • Drew Barzman ri\ l ... F Mana! Abu Hegazy !u vc 0 c f, I B Edward Chan Alexander Chen ,, \u tf.mul 2 13'""' 111 lo llopk n' l lr 1 1\l Kristen Chimileski r tv R ,! c ter r;,, ,. �A \.. 0 5 5 F 1 9 9 > Joseph Chow l Catherine Costello Adrienne Deyo I FI II R Gregory DiFrancesco Bt f I Jacqueline Dombrowski \; !1 f I -., F Thomas Elmer. Jr. Eric Finkelstein 1 B 1 falo Ronika Dua Morris Elevado ~ <{ u rll I) r c otr , I Peter Ercolino otrc I J rrc 111 II ~ t Randy Fagin Bt f d' Michael Filicl! B ,tf ( n cr 1t t 1-{L I' B !. " David Fries ,, R k ' James Gaul Jennifer Geiger l IIV 3 t 1\ b!. </ f ) lk �A \.. 1 F 1 • : 9 9 > Carrie Greenberg Clarisa Gracia Kathleen Gillan Jennifer Gennuso l 0 5 5 II l B Matthew Gutierrez Rachna Gupta Taj Hadee Paul Guttuso 1 v b Pamela Haefner Sabrina Hammett I ::-l 't B, B I ) t B 1 1- l Bn 1 F F 4 1 n 't 1 Jennifer Hensen Scott Helsley Orlando Hayle Thomas Hansen Eric Hanauer , 11 Donald Higgs '! on l I t r 'o, �A \.. s s II \1r 1 r lie 9 9 > Claudia Jaramillo l Jeannie Kao 1 Brian Karaszewski ~ I 'I p I ll 1 l Michael Kane I Loren Kane F Dana Jandzinski Angela-Ayanna James Wen Hsu I 0 Peter Kim Asra Khan Paul Kerner Regina Kim r 1 , c F Gregg Kissel r B 1 Benjamin Koenig l Suchitra Koneru 1 I 5 Armond LaPine �\.. J 1 Frank Lee A s s 0 F f 9 9 > Janice Lee Jeffrey LeGrett Sandra Leni Timothy Liesching Joseph Lopes Andre Lopez Alexander Marcus Paul Mason Janine McAssey Lisa Mendonza Daniel Metrick B Kenneth Levey ! \ J Andrew Luisi. Jr. l. r H J I Angela Mclellan Peter McNeela 6 �A 1\ s 0 PI 1 I Manny Ng Christopher Occhino 9 9 > r David Novak David Nielsen 1 I 1 rf l E b Gregory Nagel F Jonathan Morgan Stephen Milback Jennifer Meyer l s B f I '-' t I I Tracey O'Connor I, Molly Parietti lesley Orman th II r Gina Parlato Emmanuella Paul Alka Patel 1 0 r ~ t 8 Philip Piasecki l I t a fl faio 1 " 7 f11 �A \.. Christopher Pieczonka 0 5 5 loll l 1.." c F 'IU '" l !. JU Noah Sabin t Btf ) 9 > Christine Pluviose 1\l l'\\'1 Pamela Paczan Rath Jennifer Ragi 1.. omclll n t\l It <1 r-it li., B· m,J, /[ n'", ' I'Nll"!il) Psy.f r "~IT Vitaly Raykhman 9 F I Bobbie Pustelny Aisha Prim ' V. Chowdry Pinnamaneni l I B I David Pilati P. I F Christian Rocholl Sd 11"1 I p, B /,1 1 "l ) fiiLJ ex, I t l n , h tgh.l nt 1 f or :htt 1 l , v r 1lv t ,/. ,.,.,, Thomas Schenk Tami Seaman Craig Senzon 1.. l (. \f rL] l 11 \ Nit b''"" 8 t "FU James Runfola Paul Rosen v I'd pm:. 1 >r1l \( k �5 0 5 F f \.. lily Snyder Monica Simons Jimmy Sim 9 9 > Gavin Somersel ! Noelle Stevens lisa Sufrin Gary Styn, Jr. Sarah Storm l l 0 lie l I Paniti Sukumvanich Jennifer Sussal Nicole Symons Matthew Taberski l It Evan Taragano ) I fl p Andrea Torsone ! 9 B' B '"' Usha Vaidyanathan Andrea Walter �A \.. ~..-r ( Ill th .. F f I H P .. 1 "/c.l l 1 1 P t:f Il 1 Carolyn Young Louise Zador 1/ \u' h .. • H I I .. ' ' I 1 l jf, Denise Woodall orPdll 1 cr 1t ~,.n, fulo p l f Lt111 9 Danielle Woodall William Wind Dayo Wilson f Lf "/l 9 > Joseph Wandass 1 0 5 5 0 by SimonTon~ . Pholo~raph,- of metli..:al instmments by Robert \Y' a! ion. J l\1 ... ,.. \ 9 f ;, l ~ Photo~raph,- of ,-tmlenb lL 11 u 1/) Ul d. > ..) 9 > �UN IV E R ~, f T BUFF-ALO L A s s 0 F 9 ENCE"S 9 7 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Autumn 1993 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1993-Autumn Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. 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You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/5100bb6f7d6df56d3ae4d288f1f6f4c0.pdf 6d18a66fe9ae26c576d782d37b48e9bd PDF Text Text State University of New York at Buffalo School of Medicine and Biomedical Sciences, Summer 1993 �Dear Friends, BUFFALO PHYSICIAN Volume 27, Number 3 ASSOC I ATE V ICE PRESIDENT FOR UNIVERSITY ADVANCEMENT Dr Carole mtth Petro D IRECTOR OF PUBLICATIONS Timothy J. Conro) EDITOR anette Tramont Kollig, R.N. ART D IRECTOR Alan J. Kegler ASSOC IATE ART D l RECTOR Scott Fricker PRODUCT ION MANAGER Ann Raszmann Brown STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND B IOMEDICAL SCIENCES Dr john Naughton, Vice Prestdent for Chmcal Affans, Dean EDITORIAL BOARD Dr. john A Rtchert, Chatnnan Dr. Martm Brecher Dr Harold Brody Dr. Rtchard L. Collins Dr. Alan j. Dnnnan Dr Timothy Gabryel Dr james Kanskt Dr Charles Massaro Dr. Charles Paganelh Dr Robert E. Retsman Dr Thomas Rosenthal Dr Stephen Spauldmg Dr Bradley T Truax TEACHING HOSP ITALS AND LIAISONS Batavia VA Medtcal Center Arlene Kelly Buffalo General Hospttal Mtchacl Shaw Buffalo VA Medtcal Center Chtldren's Hospttal of Buffalo Ene County Medtcal Center Mercy Hospttal Mtllard Fillmore Hospttals Franl1 Sava Roswell Park Cancer Institute Ststers of Chanty Hospnal Dennis McCarthy ©The State Umversity ofr\ew York at Buffalo Buffalo Phys1c1an IS published quarterly b)' the State Umverstty of f\,;ew York at Buffalo School of Med1cmc and BiomediCal SCiences and the Orfice of Publications. It is sent, free of charge, to alumni, faculty , students, resadents and fnends. The staff reserves the right to edit all copy and submissaons accepted for publication. Address quesuons , comments and I n july, a very concrete example of the benefits of Buffalo's consortia! efforts will be realized. The University, its Health Sciences Schools, the Health Sciences Library, and seven of the eight teaching hospitals will upgrade the availability of reference materials for students, residents and physicians who are based in or who use these faClhlles. This project will be jointly funded by UB and the hospitals and will bring the total MEDline reference system plus other biological reference systems directly to each hospital. In addition, a large number of actual text materials and graphics can be transmitted to the end-users or consumers. Because it is a joint venture of all of these partners, common equipment will be used across the educational system and the costs of adding to existing computer information capacities, while not insignificant, are much less than if developed in another manner. The services will improve education and information availability at all levels - undergraduate, graduate and continuing medical education. My office is grateful for the leadership provided by individuals such as john Hammond,john Loonsk and jerry Wilson, to name just a few of the many people involved, and for the cooperative input among the many units of UB and the teaching hospital system, which helped make this important project a reality. Literally everyone involved in medical and health education in all these institutions will benefit directly from this effort. At this time, l would like to take this opportunity to announce that Buffalo Physician magazine will begin accepting advertisements in our next issue. We are pleased to be able to offer our readers this additional benefit of informing them of various services and products that might be useful to them. Sincerely, john Naughton , M. D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences Dear Fellow Alumni, T he Medical Alumni Association had a most successful1992-1993 year. Congratulations and sincere thanks to Don Copley, who guided the organization with wisdom, tact and boundless energy. The basic goals were met- addressing many of the needs of the medical students, alumni and medical school. In addition, the Medical Alumni Board, under Don's leadership, established new alumni recognition awards, first presented at the 1993 Spring Clinical Day, and a new medical school scholarship fund, which should serve as an acceptable and appropriate conduit for reunion class contributions to the medical school. Spring Clinical Day, as usual, was educationally enlightening and socially, a warm pleasurable event particularly for those celebrating five-year reunions. We are indebted to Margaret Paroski, Class of 1980, for her direction and organization of this superb program. With the help of an enthusiastic, dedicated Medical Alumni Governing Board, I hope to continue to support the standards set by my predecessors. I hope you will continue to support the Medical Alumni Association which provides very special services, particularly to the medical students. Best regards, submtss10ns 10 Editor , Buffalo Physician, Stale Umversity o[New York at Buffalo, Umversity Publications, 136 Crofts Hall, Buffalo, ew York 14260 Send address changes to: Buffalo Physician, 146 CFS Add1t1on , 3435 Mam Street, Buffalo, l'ew York 14214 Robert E. Reisman, M. D., '56 �v 5 2 L 0 u M M N 7 E R 3 0 9 9 3 II Research II Hospital News He captured my heart in a way that patients aren't D supposed to." • Doctors affect patients every 11 Health care reform it's no joke. Page 42. day. But sometimes, patients profoundly affect their physicians. IIJ Managed Care e Containing health care costs or physicians' autonomy? EJ Medical School ~~ Graduate Education Social and Preventive Medicine's Maurizio Trevisan studies dietary habits. Page 22. IJ Alumni IIJ ASpoonful of Humor m Classnotes *managing rnanageo care. rage lt Med student Andrea Williams wins National Medical Fellowships award. Page 33. �11 ............................................ . ..... . ......... ... .... . ............ . ......... § " ~ ~ • :t u Skin cancer is the target of NIH's $5 million grant to Roswell Park Cancer Institute. Roswell gets $5 million NIH grant to study photodynamic therapy esearchers at Roswell Park Cancer Institute have received a $5 million grant from the ational Institutes of Health to conduct in-depth clinical and basic science studies of photodynamic therapy and skin cancer. Pioneered at RPCI in the 1970s by chemist Thomas Dougherty, Ph.D., photodynamic therapy (PDT) has been shown in clinical trials conducted in the United States and abroad to shrink or eradicate certain solid tumors, especially those of the bladder, breast, brain, lung and head and neck. PDT has also become an option for thousands ofcancer patients for whom surgery is not possible or who cannot tolerate additional chemotherapy and radiation. A large percentage ofPDT "cures" have been skin cancer patients. "An epidemic of 600,000 new cases of skin cancer are reported in the United States each year," said Allan R. Oseroff, M.D., chief of Roswell's Department of B u 0 0 p Dermatology and principal investigator of the IH study. "For large skin tumors, especially those appearing on the face, surgical removal may result in extensive reconstruction and in some cases, disfigurement. Chemotherapy and radiation may have a cumulative toxic effect." PDT virtually eliminates the drawbacks associated with more conventional treatments, without toppling the cure rates. Over the next five years, the Roswell researchers will assess the effectiveness of PDT against the most common type of skin cancer and scrutinize the mechanisms and dynamics of PDT as they explore strategies to perfect the treatment. + Selenium-enriched garlic is just one of the "designer foods" being tested as a cancer preventative by Clement Ip, Ph.D., a breast cancer researcher in Roswell Park Cancer Institute's Division of Breast Surgery. These days, Ip's laboratory smells like an Italian restaurant. In one recent study, Ip discovered that garlic- enriched by the anticancer agent selenium - protected animals against breast tumors. Selenium - a non-metallic element that resembles sulfur - has been Ip's major research interest for the last 15 years. "My studies and those of others, have shown that selenium protects against breast cancer. My goal has been to find the best ways to incorporate sufficient quantities of selenium safely into foods. " His choice of garlic is a natural, since the vegetable is abundantly rich in sulfur and has moderate anticancer activity. "Plants convert inorganic selenium in soil to organic selenium analogs of naturally occurring sulfur compounds," Ip said. "By substituting sulfur with selenium, we had hoped to produce more powerful anticancer agents in garlic." Ip compared garlic grown in seleniumenriched soil to garlic grown in normal soil. The selenium-enriched garlic was far superior to regular garlic in suppressing breast cancer in experimental rats treated with a carcinogen to induce breast tumors. "Designer foods"being tested as cancer preventatives at RPCI picures may call it the "stinking rose," but garlic by any other name will still carry that heady aroma potent enough to keep vampires, and perhaps even a disease or two, at bay. h s c o n s Garlic by any other name will still carry that heady aroma. u m m e 9 9 3 �m ····· · ·· · ··· · ································ ··· · · ·· ·· ··· ·· · · ··· ·· ··········· · ····· ·· ····· • .. . ' "Our research shows that by incorporating selenium into a plant that is already rich in sulfur, the potential for cancer protection is significantly enhanced," lp said. + Agrowing population of children may be at risk for long-term school problems. Half of veiY premature infants need special education services alf of extremely premature infants who survive into childhood may need special education services when they enter kindergarten. Another 15 percent are on the verge of needing special help, a study conducted by UB researchers has found. And children whose families had limited resources were seven times more likely to need help than those in more affluent households. Being non-white or male each increased the risk two and onehalf times. The study, headed by Michael E. Msall, M.D., associate professor of pediatrics and rehabilitation medicine, was published in the American journal of Diseases of Children. The research constitutes one of the first school-readiness studies of children born extremely prematurely during the 1980s and treated with calf-lung surfactant extract to prevent respiratory distress syn- B u a 0 p h The study, headed by Carl V. Granger, M.D. , professor of rehabilitation medicine, appeared in the journal Stroke. Granger speculated that older patients may be discharged from rehabilitation earlier because they reach a plateau sooner or because other medical problems may limit their ability to participate vigorously in rehabilitation. He also raised the possibility of a bias against older patients on the part ofyounger care providers, who may speed up discharge because they feel older patients + have less potential to benefit. drome. The treatment has dramatically increased the survival rates of extremely low birth weight infants. With more children surviving prematurely, especially those weighing under three pounds, Msall said, researchers have speculated there is a growing population of children at risk for long-term physical problems and school difficulty. Msall and his research team set out to assess the kindergarten readiness of children who survived extremely premature births to determine factors that identify children who might need extra help. The cohort of 149 children born at 23 to 28 weeks gestation were between four and five years old at the time of the study. Of the 149 children, 35 percent were observed to be ready for regular public school kindergarten. Fifteen percent were considered at risk of requiring special education resources, 4 2 percent were classified as requiring modified classrooms and 9 percent as needing extensive rehabilitative therapies and special education resources. Low socioeconomic status was the most significant predictor of the need for special education help among the children studied, followed by being non-white or male. + B Y L OIS BA ' ' KER Older stroke patients fare worse than younger ones,UB study finds lder stroke patients don't recover as well as younger ones and spend less time in rehabilitation than do the younger patients, according to a UB study of the rehabilitation history of 7,905 stroke patients. 5 c a 5 u Other health problems may limit the recovery of older stroke patients. m m e 9 9 �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . [1 '' ' "' . aspirin bind to the same receptor in the platelet. "But aspirin can't produce its effects if ibuprofen is already there," Gengo said. "If both drugs are taken together, the patient will get the temporary effect of the ibuprofen, rather than the permanent effect of the aspirin. " The researchers are now expanding their study to include older subjects taking both aspirin and ibuprofen for several + weeks. - B Y ELLEN G OLDBAUM Ibuprofen and aspirin don't mix. UB team uses DNA to recreate key Ibuprofen may diminish aspirtn's proteins to prevent tooth decay beneficial eftects on platelets B scientists have used recombinant eople who take aspirin regularly to prevent stroke and heart attack may need to be careful about how- and especially when - they take ibuprofen, according to a UB study. Published in the journal of Clinical Phannacology, the study demonstrated that in healthy, young volunteers who took a single dose of ibuprofen and then took an aspirin an hour later, the ibuprofen markedly shortened the duration of aspirin's effect on blood platelets. But the ibuprofen did not have the same effect on blood platelets if taken after the aspirin. "Both ibuprofen and aspirin inhibit platelet activity," said Terence Fullerton, Pharm. D., UB clinical instructor of pharmacy and director of the study conducted at Millard Fillmore Hospital. "But aspirin does so irreversibly for the life of a platelet - about seven to 10 days - while ibuprofen does so for only four or five hours." According to Francis M. Gengo, Pharm. D., UB associate professor of pharmacy, director of neuropharmacology at Millard Fillmore and co-director of the study, the working hypothesis is that ibuprofen and 0 B u a 0 p called mucins, that lubricate the mouth and tooth surfaces, minimize the abrasion of enamel and provide a moisture-rich environment that discourages the proliferation of harmful bacteria and fungi. Histatin possesses antifungal and antibacterial properties, Levine said, attacking the outer membrane of fungi or bacteria. While Levine said the mechanism of cystatin is not yet clear, it also possesses antibacterial and antiviral properties and halts the proliferation of microorganisms. Both proteins can help prevent the decay of tooth enamel, as well as infections that eat away at soft tissue and bone. Although future mou thrinses and toothpastes containing these proteins will not replace chemical antibacterial drugs, which, in tandem with the body's immune system, attack colonies of several types of microorganisms, "they'll be important in preventing or fighting the growth of these + microorganisms," Levine said. D A techniques to recreate key proteins in human saliva that help fight bacteria, possibly paving the way for over-the-counter products that - B Y would help prevent tooth decay. "Inexpensive products containing these salivary proteins will be used in toothpastes, mouthrinses and oral sprays by the turn of the century," predicted Michael j . Levine, D.D.S. , UB professor of periodontics. The two proteins in saliva recreated by the UB team - cystatin and histatin - inhibit the reproduction of microbes or interfere with their activity, which contributes to oral diseases. The team also is working to recreate two glycoproteins, Using DNA to fight tooth de<ay. h 5 c a 5 m MARY BETH S PINA ,z ~ " m e 9 9 3 �. . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . ... . . ... . . . . [1] Tucker appointed director of WNY Regional Poison Control Center r effrey R. Tucker, M.D., has been appointed medical director of theWestem ew York Regional Poison Control Center at The Children's Hospital of Buffalo. Tucker is a staff member at CHOB in its emergency medicine department and has been the associatedirector for the Poison Control Center. Tucker's responsibilities include providing medical advice to the poison specialists at the Center and educating residents and medical students about toxicology. Tucker is currently involved in several research projects, including a study of Albuterol- the medicine commonly used to relieve wheezing in children. Tucker graduated from Boston University School of Medicine and completed his residency at Boston City Hospital. He completed fellowship training in pediatric emergency medicine in Brown University's program at Rhode Island Hospital. + radiation over a 40- to 60-hour time period. Radiation from the pellets remains essentially confined to the tumor area, sparing the surrounding healthy tissue. Roswell Park's first patient to receive low-dose radiation using the new remote afterloading system was diagnosed with stage IlA cervical cancer. She had been treated with conventional external radiation prior to this treatment. Conventional intracavitary brachy~ therapy- the use of which was pioneered "'~ for gynecological cancers at Roswell to achieve the highest cure rate in the country following hysterectomy- carries with it certain risks for those treating the paLast year's record loss exceeded $29 million. tient. "Any persons having contact with the patient during treatment are exposed to be the most difficult in recent years, the - although briefly - to the radiation report said. The overall operating loss of source," said Kyu Shin, M.D., chairman of $7.9 million was posted in 1989; that loss the Department of Radiation Medicine. grew by 68 percent to $13.3 million in "The risk," he added, "is minimal, almost 1990 and increased by 30 percent to $17.3 inconsequential, but our new method million in 1991. eliminates any potential risk of exposure." The current loss of $29 million repreA computer-controlled robotic system sents an increase of 68 percent over the loads and unloads the radiation sources. previous year. Proposed ew York State "Before a person enters the patient's room, budget cuts for 1993 would mean an addi- the robot will remove the radiation imtional revenue loss of$41.4 million, while plant and place it into a vault. When the proposed Medicare cuts would result in a visitor leaves the room , the radiation further revenue loss of over $20 million to sources are replaced in the patient." Western New York hospitals. Combined Shin and his colleagues are currently with the 1992 operating loss, the pro- using the new procedure on patients with posed Medicare and Medicaid cuts could gynecologic cancers. account for a collective loss of$93 million For more information on brachytherapy in 1993. + or to refer a patient, call Roswell Park Cancer Institute's Department of Radiation Medicine at 845-3172. + Western New York hospitals post record-high operating loss for '92 RPCI oiTers computer-controlled estern ew York Hospital Asso- low-dose radiation therapy ciation member hospitals posted a record-high operating loss of $29,023,000 for 1992, resulting in 759layoffs in 1992, according to a report by the Western ew York Hospital Association. The financial performance of Western ew York's hospitals has been declining over the past four years, and 1992 appears B u a 0 p h oswell Park Cancer Institute is now offering computer-controlled lowdose brachytherapy - a safer, more efficient way to deliver low-dose radiation directly to tumors. The procedure uses robotics to implant radioactive pellets directly on or near the tumor to deliver low doses of y s c a 5 z ..: Asafer way to deliver low-dose radiation. m m e 9 3 0 �. .. ................ . . . ..................... . ........................ . ........ . ... . ........ psychiatric beds at BGH to 107, including 4 7 in the main hospital building and 60 in the hospital's Community Mental Health Center (CMHC). Buffalo General now operates 74 2 beds. Philip C. oe, assistant vice president and CMHC administrator, said the hospital has also opened two new specialty units, one for senior adults and the other for mentally ill chemical abuse patients. Each unit contains 20 beds. "Putting the 22 psychiatric beds in the tower will help maintain a close affiliation with medical units in the hospital," oe said. Additional multidisciplinary staff have been hired, including nurses, social workers and occupational and recreational therapists. Opening of the new units completes the final phase of a project begun in 1989. The first phase, a lO-bed medical psychiatric acute care unit, was completed in 1990; the second phase, a 15-bed affective disor+ ders unit, was opened in 1991. Sisters Hospital opens new lobby and 10-unit surgical department isters of Charity Hospital is heading for the three-quarter mark of its 28month, $42 million modernization project with the opening of its new operating rooms and lobby. The new 10-suite surgical department, which opened in March, is located on the hospital's fifth floor next to its recently opened intensive care unit. "It's quite an exciting change from the old area, which was built in 1948," said Gino Pazzaglini, executive vice president at Sisters. "The new space provides us with a modern, efficient area which will allow our surgeons and nurses to offer the best and safest possible care to our surgical patients." The new rooms are larger and equipped with the latest in surgical support systems. The new lobby, with its heavy emphasis on glass architecture and natural lighting, features stained glass artwork, high ceilings and banners carrying pastoral themes of hope, peace and joy. "From the beginning we felt the lobby should be seen as a special place to greet the general public, a place where they will be made to feel comfortable and at ease," + Pazzaglini said. 0 B a 0 Van Vorst named new Millard Fillmore Hospitals president Sisters Hospital nears <ampletion of its $4 2 million modernization proje<t. BGH opens 22 psychiatric beds to complete $1.6 million project he Buffalo General Hospital has completed the final phase of a $1.6 million project with the opening of 22 psychiatric beds in its medicaVsurgical tower. The new beds increase the total of p h y 5 a n S illard Fillmore Hospitals' ChairmanoftheBoard, Edward T. Hunt, announced that Charles B. Van Vorst has been appointed the new hospital president and chief executive officer. He succeeds jan R. jennings, who was recently named president and chief executive officer of the Chicago Children's Memorial Medical Center. VanVorst most recently held the position of president and chief executive officer of the Santa Rosa Health Care Corporation of San Antonio, Texas. The corporation is a regional, notfor-profitmulti-hospi- u m m e 9 3 �. . . . . . . . . . . . . . ... . . . . . . ...... . ... . ... . . . . . . . . . . . .... [1] tal system consisting of seven hospitals with 1,166 licensed beds. During his tenure at Santa Rosa, Van Vorst's accomplishments included the development of a new long-range strategic plan and the implementation of a total quality management structure. "We are extremely pleased that Mr. Van Vorst will be leading our hospitals and look forward to his contributions toward the continued success of our health care delivery system," Hunt said. "While his philosophies are very similar to those of the hospitals' board, we anticipate that he will add a new dimension which can only serve to further enhance the level of care we currently provide," he added. Prior to his position at Santa Rosa, Van Vorstspent l l yearsaspresidentandchief executive officer of The Carle Foundation in Urbana, Illinois, a not-for-profit health care-related holding company that owns and manages a number of health care entities including two hospitals, a nursing home and retirement center. Additionally, he held the position of vice president for operations for Methodist Hospital of Indiana for seven years. "I look forward to the opportunity to continue the momentum set forth by Mr. jennings and lead Millard Fillmore Hospitals to even greater heights and national prominence," VanVorst said. + MFH' s Hertel-Elmwood Internal Medicine Center. diagnostic services. Thomas Small, M.D., has been appointed medical director of the center. The center will operate under a preventive medicine philosophy, administering immunizations and vaccinations and providing information on health maintenance. A major goal of the center is to avoid major health problems in its patients through + early and ongoing intervention. New technique for liquid breathing discovered by UB research team simplified technique for liquid breathing discovered by a team ofUB researchers could significantly improve treatment of premature infants, children and adults with lung diseases. It could also help cut this country's annual $5 billion price tag for treating adult respiratory distress syndrome. Bradley P. Fuhrman, M.D., UB professor ofpediatrics and the team's chiefinvestigator, has pioneered an inexpensive way to enable the body to "breathe" perfluorocarbon. The technique is known as perfluorocarbon-associated gas exchange, or PAGE. Liquid ventilation shows great promise for treating premature babies with hyaline membrane disease and other patients with adult respiratory syndrome. Widespread testing of liquid breathing in humans has been impossible in the past, Fuhrman said, because a suitable, high-purity, me- he medically underserved community of Black Rock/Riverside is the location of a new primary care center run by Millard Fillmore Hospitals in conjunction with UB's School of Medicine and Biomedical Sciences. The Hertel-Elmwood Internal Medicine Center offers patients 16 years and older convenient access to medical care and a 0 p + ~ns. B MFH opens primary care center in medically underserved community 6 dicinal grade of perfluorocarbon did not exist and the procedure required special equipment. Fuhrman's technique uses a standard respirator, rather than a specially designed liquid ventilator. In PAGE , the perfluorocarbon remains in the lung while the respirator delivers breaths of oxygen. In standard liquid ventilation , perfluorocarbon is cycled into and out of the lungs using a specially designed liquid ventilator, which oxygenates the liquid and purges it of carbon dioxide. When his liquid ventilator broke down in the midst of research on piglets, Fuhrman decided to hook up an animal with a perfluorocarbon-filled lung to a standard respirator. "When I saw it worked," Fuhrman said, "I was exhilarated." PAGE is significantly less expensive than other methods of liquid ventilation since it uses readily available equipment. It is also kinder to damaged lungs because it is effective at lower pressure and may allow the use of lower oxygen concentra- y s c a n 5 m Y LOIS B AKER re nhalation halation Liquid breathing technique holds great promise for treating children and adults with lung disease. m e 9 9 3 0 �"He captu my heart in a way that patients aren t SUptxJSed to." • 1 tors affect patients every day. But sometimes, patients profoundly affect their physicians. Here are their stories. 0 Buffalo Ph y sl c I a n summer 1993 �Illustrations by Glyn B u a a p h y s c a s Sweeney 5 u m m e 9 3 0 �11 -rII remember my patientstheir grace, dignity and humor and triumph over adversity. Their stories are legion and what we have to do is train ourselves to listen and see. They're all out there and each has a moral of its own." -r- __e ,s - ... and they couldn't come to visit him. He was all by himself. "So the nurses and physicians who took care of him became his parents. "The barriers of how I was going to deal with this little boy were quickly broken. He captured my heart in a way that patients aren't supposed to. "He always wanted people to stay with him and although he was in a lot of pain, he rarely, if ever, cried. "We were constantly trying to figure out ways to try to relieve Rodney's pain. We tried everything. "We used to just carry him around. He always wanted to be carried, so we would just take turns carrying him. "Once he wanted to know why I had to leave- I remember this very vividly. "He finally died and we all cried together about his death. "That child made a very big impression on me. He was always upbeat, always happy to see you and always asking to go on a trip around the ward. And he could always con one of us into carrying him around. "He's probably the first patient who I knew intimately who died. And I did grieve for him. I have lost other patients, and I think I remember the names of all of them - a little bit of you dies with them each time- but this boy taught me there are ways you can comfort patients and make their time more meaningful." probably the first patient vvho I k.ne\v intimately Bob Milch, M.D., '68, was talking about his patients who have changed him. "You know what the definition of a minor procedure is?" he asked. "It's a procedure that's done on someone else. "Stories not memorable to the physician are to the patient. That's what it's all about - minor procedures and memorable stories." The physician-patient relationship is a complex one -and by its very nature, one in which it is the patient whose life is most affected. But sometimes, it is the physician who is changed by a patient who shows remarkable courage, or humor, or strength, or spirit, or pure force of will in the face of illness and adversity. And different patients affect their physicians in different ways- changing the way they see or practice medicine, or changing the way they see themselves. These are the patients whose stories are chronicled here. \vho died. And I did grieve for him. I have lost other patients, and I think I remember the names of all of them - a little bit of you dies \vith them each tin1e -but this boy taught n'1e there are vvays you can Virginia Weldon, M.D., '62, con1fort patients and make their vice president for public pol icy at Monsanto. "He was a little boy about two. I was an intern atjohns Hopkins Hospital. He had a neuroblastoma and it had metastasized to his orbits and his face had become deformed. "I knew I was going to be on the service he was on and i was worried about how I was going to take care of this little boy. "His parents lived in rural Maryland B u a 0 p Donald P. Copley, M.D., '70, past president ofUB's Medical Alumni Board of Directors. "I first saw KathyFreerin May ofl989. The last time I saw her was April 13. She was a young teacher who had had an extremely bad heart attack in May of '89. I never thought she'd leave the hospital, let alone go back to teaching. We did an echocardiogram on her which showed an ejection fraction of 15 percent, which is about as low as I've ever seen in anyone time more rneaningfu l. " h y s c a n S u m m e 9 3 �who's alive. "She had a prolonged hospitalization -at least 10 days - and I sent her home with trepidation. Her echo was slightly improved when she went home but still very bad. "We did a stress test, at least we tried, and she did poorly - she couldn't walk very far at all. "She had been a busy, active teacher, with no prior medical findings - no smoking, a family history of coronary disease, but not remarkably bad. "But she may be the type that goes with blood clots rather than atherosclerosis. We did an angiogram just before she went home and found a single occluded artery. My best guess is she had an atherosclerotic plaque that produced a clot that closed the vessel rather abruptly. "She went home and went into a rehab program that lasted a long time- at least six months. She started slowly and we weren't optimistic. "I had thought she was close to dying in the hospital - maybe a 50-50 risk - and I had told her husband things were grim. "But she is a very positive, jocular, bubbly person. In fact, she's been accused of being kind of cavalier- cracking jokes about dying early. People who don't know her accuse her of being flip. "She has what I would call an extreme form of an optimistic attitude. Whenever I would describe to her the possible outcomes, she would focus on the positive. She always passed over the negative. "And that's the way she was in rehab, too. She was very helpful to the other patients. She was even ready to get on with her life, without going back to work, which was always very important to her. And she was always very well-liked by the kidsshe taught middle school- and also very highly regarded by her peers. "She is very energetic- a Type A, an intense coronary factor- but with none of the hostility you associate with Type As. B u a 0 p "It was a full year before she could consider going back to work full time. And her echo is not normal now, it still shows the scar clearly. Her ejection fraction is doubled what it was when she was in the hospital and she still has a rather dilated heart. But she's found ways to cope with the disability." one had ever done exercise testing after a John aughton, M .D., vicepresident for clinical affairs and dean of UB's School ofMedicine and Biomedical Sciences. "I had one patient, Mr. Douglas Cordon, during my residency and fellowship training at the University of Oklahoma, who was the first to undergo exercise testing and training after a heart attack. It was because of him that we [Bruno Balke, Francis agle, Michael Lategola and aughton] developed a strategy for exercise testing and physical reconditioning for cardiac patients. "In 1964, Mr. Cordon indicated to me he wanted to get into some physical activity after his heart attack. He was 54 at the time. Two months earlier he had wanted to enter a physical therapy program- he had high blood pressure-and was one of a group of healthy volunteers we were studying. So we had the data on him before his MI. And so two weeks post-MI we first did an exercise test and measured the loss. We put him on a training program. He had a higher capacity after the training program. His work capacity increased. "He lived another 15 years after that and always kept fit. " o one had ever done exercise testing after a heart attack. We had him walking on a treadmill, and as we got more comfortable with him, we increased to 50 patients. It's an example of how you make a change by studying one individual patient, and then adding groups of patients. "My efforts grew from studying Mr. Cordon well to the development of group programs for heart attack patients and heart attack. vVe had him \·valking on a treadmilt and as vve got n1ore comfortable \ vith him , \veincreased to 50 patients. It's an exan1ple ofho\v you make a change by studying one individual patient, and then adding groups of patients." y s c a n 5 m m e 9 9 3 �then to the development , implementation and completion of the ational Exercise and Heart Disease Project. ln essence, he because l don't think she looks at it as changed my whole world. " terminal. "She faces the future with a realistic, yet Roseanne Berger, M.D., associ- optimistic point of view. She's very calm ate dean for graduate medical education. and brave and even at times when she is "Her name is Frieda Bair, and l remem- uncomfortable or in the hospital. ber her for a number of reasons. She is an "l have to feel her attitude is certainly accomplished poet. She is an elegant, ar- contributing in a lot of ways to the way she ticulate, very attractive elderly woman is coping with a very serious illness . who has a terminal disease ... rather, Even when she is in the hospital, she cancer ... l don't want to say terminal, has the ability to reach out to other B u a 0 p h y s c a n 5 people e v e n though she has a very good reason to be introspective and self-centered. But despite all that she's interested in and concerned with other people. Whenever l see her, before l even have a chance to say a word, she asks me how I am. And it's not just me- she's like that with other people. "She's always been an observer of life. She has these inspirations, or muses ... "l first saw her about two years ago. She was diagnosed with cancer [pancreatic] that first visit. But her illness is only a small part of this woman - her creativity and u m m e 9 9 3 �11 -relegance are central to her. "She has always been a teacher, formally, and she has allowed me to share her story with fourth-year medical students, so her case has been examined in detail by several seminars of medical students and she has been more than willing to allow me to do that- and has always been very gracious about allowing them to examine her and ask her about what she was feeling and what was happening with her life. "Her poetry has given me an insight into this person. She writes about very tangible things that people can relate to easily, like home. And she has a lovely little poem about red mittens ... the Buffalo Blizzard ... pollution ... and this one that I use for the medical students. "She is very much at peace with herself, and has that calm and confidence that comes from having led a full life. She is at ease and peaceful with what is happening. She is ready to accept death if it happens, but she's not just going to give up. She wants to live every day as well as she can." Ji first sa\v her about t\vo years ago. She \vas diagnosed \ vith cancer [pancreatic] that first "risit. But her illness is Robert Milch, M.D., '68, medical director of Hospice Buffalo. "There are so many patients in my line of work who are recollected for different reasons. And it's good that we try to recollect as many as possible - each of them is part of the fabric of us. "I remember a patient with cancer of the pancreas who was referred to us after discharge from one of our teaching hospitals. His wife was given a prescription for demerol and syringes to inject him with. "And we were told that he was a 'troubled patient' because at the height of one of his pain episodes, he bent the siderails ofa bed. We got him offinjectables to a more appropriate medication and he lived a comfortable and pain-free life for the remainder of his five months. "His gratitude was matched only by ours. "I remember seeing patients who point B a 0 p out just how fallible all the things we learned in medical school are regarding the use of pain medication. "I remembera39-year-old woman with cancer of the pancreas. As her disease progressed, she would take four grams of morphine every four hours. Do you know what the normal dose is? "We brought her into the hospital and gave her an epidural of morphine of just four milligrams. And all her pain disappeared. "We had to actually convince her to take small amounts of morphine to prevent withdrawal. "All the things we learned about addiction and dosing are not always applicable. "I remember a young man of 28 who was dying of Hodgkin's. Every day I came in to see him he was wearing a different t-shirt- whether it was U2, Jefferson Airplane, The Who - he always had some t -shirt from a rock group. As he got thinner and thinner, one day he was wearing one that said 'Hoots and the Geraltones.' So I said, 'Who are these guys?' "And he said, 'We got you!' He was Hoots and his wife was Geraldine and they just had one made up because they finally ran out. "I remember a man who was 50 and dying of cancer of the thyroid. When he and his wife had gotten married they had been very poor together for a long time. By dint of hard work, their marriage had worked out successfully - their children were healthy, they had sacrificed a lot in their early years. "The one thing she had wanted, but never had got, was a pair of diamond earrings. He was going to die before their next anniversary, and did, in fact, die about six months before. "But on the day before that anniversary, he had delivered to her a pair of diamond earrings." + only a small part of this \voman - her creativity and elegance are central to her. " y s c 0 5 u m m e 9 9 3 �By 0 Andrew an z o There was a time when organized medicine didn't think much of managed care. In fact, it tried desperately to stamp out, or at least contain, the health maintenance organizations that were spreadingfrom the west coast. Managed care won. 4D a u f f a I a P h y s I c I a n 5 u m m e r 1 9 9 3 ��ne in five insuredAmericans now belongs to an HMO . At least half the nation's physicians are believed to be affiliated with HMOs and related entities, and the majority at some point encounter utilization review, part of managed care's widening spectrum. The American Medical Association last year went so far as to acknowledge the "legitimacy" of HMOs. ow, organized medicine is even getting into the game- the Medical Society of the State of ew York is forming a statewide physician network to compete on the managed care field as early as this year. Health care reform will only accelerate the trend. While details remain to be hammered out in Congress, the Clinton administration's reform plan relies heavily on managed care to deliver health services. In New York State, Gov. Mario Cuomo is also pushing a reform initiative emphasizing managed care principles. Once the dust settles, several trends are obvious: greater demand for primary-care physicians, the backbone of managed care plans; a continued erosion of the solo practice as more physicians are pushed into groups, and further diminution of the ~~FOR THE autonomy physicians have traditionally enjoyed. "For the individual physician, I think it's a very disquieting time," said UB School ofMedicine and Biomedical Sciences Dean john aughton,M.D. "We'vehadthroughout the history of medicine in the United States the fee-for-service system and the solo practice. Clearly the forces are to encourage physicians to practice more in groups than in the past." In 1980, 4 7 percent of ew York State physicians were in solo practice. By 1988, the latest year for which figures were available, the percentage had dropped to 41 percent overall and to only 27 percent of doctors under 40 years old. Only 2 percent of New York doctors listed HMOs as their primary practice in 1988. But many more are affiliated with non-staff HMOs and similar plans, the fastest-growing segment of the managed care sector. o one knows exactly how many, but nationally it's estimated to be at least half of practicing physicians. "In some communities, every doctor is involved," said Kathryn Allen, executive director of the New York State HMO Council. And HMOs are scooping up more and more patients. During the 1980s, national HMO enrollment nearly quadrupled to 40 million. In ew York State it tripled and now stands at about 3.5 million. Health care reforms are expected to drive the numbers up dramatically, though ew York State Health Commissioner Mark Chassin, M.D., said that if federal rules permit, he favors a flexible approach based on the needs and resources of different regions of the state. " etworksandhealthplansandHMOs are part of the solution, but forcing consumers into one of the health plans, forcing physicians and hospitals into one of the health plans is not what we want to do," he said. However reforms play out, there will be greater emphasis on primary care physicians. "It can't be successful unless there is a larger pool of generalists available," said UB's Naughton. About one-third of the approximately 56,700 practicing doctors in New York are in primary care. It's the same proportion nationally, and the exact opposite of the generalist-specialist ratio in most other nations. Since managed care programs rely on primary care physicians to coordinate and control patient treatment, it's estimated that at least half of all physicians should practice the primary care specialties to make the programs work effectively. In ew York's inner cities and rural areas, there aren't enough physicians now, said Richard Kirsch, chairman of the ew York State Health Care Campaign, a coalition of groups pushing reform. "The INDIVIDUAL PHYSICIAN, I THINK IT'S A VERY DISQUIETING TIME." 6 u 0 Dean John Naughton, M.D. 0 p h s c 0 5 u m m e 9 9 3 �said aughton. Last year UB, in consultation with its consortium of teaching hospitals, set a goal of getting half its residents into primary care by 1995. However, aughton noted, even if all the nation's residency programs went to the 50 percent goal, the proportion of practicing generalists wouldn't reach 50 percent until the year 2035. In the meantime, some specialists might find themselves in the same boat as the laid-off factory worker. "People for the first time in recent months have been talking about the issue of retraining," said Edward Salsberg, director of the ew York State Department of Health's Bureau of Health Resources Development. "If you have a large supply of specialists and managed care comes into place and the use of specialists is decreased, then the demand and need for specialists should be dropping. In a specialist-rich state like New York, there's the question of what they will do. " Psychiatrists are already feeling the managed care crunch. Faced with premium complaints from employers, the Blue Cross and Blue Shield HMO in Buffalo , Community Blue, last year hired an outside health management company to oversee its mental health-substance abuse benefits. The company revised Community Blue's provider list, cutting the number of psychiatrists from 99 to 31. lt also reduced the number of Ph.D. psychologists from 141 to 93. The number of master's-level psychologists, social workers, psychiatric nurses and addiction counselors rose from 94 to 166. "They cover a broader range and there is not as heavy a concentration of psychiatrists," said Lynn Sidare, Community Blue spokeswoman. "We felt there were other specialties in mental health that could provide good, effective treatment." She said anyone who was seeing a psychiatrist removed from the list was given a grace period to wrap up treatment main thing New York needs to be doing is building up its capacity to provide primary care to its citizens," he said. Cuomo's initiative acknowledges that -proposing incentives to steer more medical students to primary care and financial help to open primary care practices. "l think we're a school that has been looking at the problem for quite some time, " B a 0 p h 5 c a n 5 m m e 9 9 3 �and make the switch. "The medical community obviously thinks this is very wrong," said H. John Rubinstein, M.D., president of the Medical Society of the County of Erie and a 1966 UB medical graduate. The society protested to the state, which ruled that Community Blue was within its rights. The tate, in fact, did the same thing last year with its own insurance plan, farming out management ofmental healthsubstance abuse benefits for 395,000 state and local government employees. "On an annualized basis, the program has saved us $30 million," said Priscilla Feinberg of the governor's Office of Employee Relations. any physicians are frustrated and angry, feeling that while the profession bears some responsibility, they've been made the scapegoat for a health care system that is far too expensive and far too inequitable. They agree that some kind of change is needed, but worry about the details. "My fear is we'll be left with even more administration and more micromanagement than we have now," said Amy P. Early, M.D., an associate clinical professor in UB's oncology division. The Medical Society of the State of ew York is hoping to maintain more control for physicians by taking a lesson from the labor movement and organizing, not as a union, but as a network of doctors who can negotiate from a position of strength in the expanding world of managed care. "Like it or not, the pressures faced by private practicing physicians in their efforts to compete effectively in the health care arena will be overwhelming and many physicians will lose the struggle to main- a u a 0 p tain their private practices," ancy H. Nielsen, M.D., SU Ytrusteeand the plan's coordinator, wrote in a report to the medical society's house of delegates this year. "When these challenges are added to the growing problems of a crushing bureaucracy and significantly decreased payments, it is evident that for the physicians of ew York State, 'business as usual' is no longer possible." The MSSNY Physician Network would provide medical services for insurers, employers and HMOs, with the state medical society negotiating statewide contracts and local medical societies handling local contracts. The network, which would have its own utilization review and quality assurance programs, would require an unspecified financial commitment from members. "It is clear that if these initiatives are uniformly implemented, physicians will gain immeasurably in their ability to compete effectively in the future managed care market," ielsen wrote. The medical society is also fonning a second network to compete in New York's Medicaid Managed Care Program, which seeks to get half the state Medicaid population into managed care by 1996. By and large, physicians have come to accept HMOs and managed care arrangements as part of the health care landscape. Early, an oncologist with the Buffalo Medical Group, said she has had occasional problems getting HMO approval for specialized cancer treatments in facilities outside the area. But overall, she feels she has a good relationship with her group's HMOs. "If I, as the primary doctor, have a problem or recognize that my patient has a special need, I can call someone," she said. "I may not always get approval, but I have a line of communication open." The real hassles, she said, are with the long-distance utilization reviewers. "For me to call an 800 number to someone in Indiana whose credentials I don't have a s c a S clue about to seek hospital admission for my desperately ill patient is ludicrous," she said. Chassin, who was most recently senior vice president of a utilization review company before becoming New York's health commissioner, agreed that there is both good and bad under the managed care umbrella. "In its best incarnation it can be a very effective way to maintain quality or improve quality at the same time costs are being controlled," he said. "But it's not always implemented that way. In other implementations it is micromanagement and throwing obstacles in the way of physicians trying to provide quality care for their patients." Chassin favors a flexible approach to reform in ew York, one that allows a variety of arrangements for health care delivery and compensation. He wants the state's rate-setting power expanded to physicians so there will be more uniformity and fewer inequities, like Medicaid reimbursements that discourage doctors from serving poor neighborhoods. But he would like different cities and regions to use the payment system that works best for them, whether it be salary, capitation or fee-for-service. "We want to have a statewide approach that encourages diversity," he said. John Rodat, an Albany health care consultant who has served in a variety of state positions, said perhaps the biggest trick in reform will be finding a way to accommodate the organizational impulses of the reformers and the independent nature of medicine. "The knowledge and skills and temperament and perspective that good physicians can and should have are ones which cause them to focus totally on the individual patient and not to see the organizational context around them," Rodat said. "These are not folks in gray flannel suits, and they should not be." u m m e 9 9 3 �But those traits, he said, have made the medical community slow to deal with restructuring, to see it as someone else's problem. "My very strong fear is that those who are going to impose reform, because they've B y nan age when care is "managed" and physicians are "providers," everyone complains about the bureaucracy. But to Robert A. Milch, M.D., it was something a little more unsettling. It was the feeling that medicine was surrendering its humanity to a cold ethic of efficiency. He wanted out. Unlike many frustrated physicians, the 1968 UB medical graduate didn't retire early. But he did give up his surgical practice to become medical director of Hospice Buffalo on january l. He's much happier now. "What I found was, I think, a microcosm of the best that medicine has to offer, which is humane, appropriate, cost-effective care," Milch said. It's unclear how many physicians are fed up and making a change. "At this point it's still primarily anecdotal," said Edward Salsberg, director of the ew York State Department of Health's Bureau of Health Resources Development. In 1990, the latest year for which figures were available, only 52,722 of ew York's 70,080 licensed physicians were active in patient care, but B u a 0 p h make things worse for many folks .... To do it right, it seems to me we have to have some kind of common language for solving the problem." Will that happen? "I think it's possible," he said. + grown impatient and the public has grown impatient, have a completely different set of perspectives," he added. "Even though they also may be perfectly wellintentioned, it is my great fear that their organizational perspectives are going to A N D R E D W A N Z 0 to specialized treatment. "What a terrible word," Rodat said. "What's terrible about it is that it is, in fact, descriptive of what the role is.. .. This is somebody whose primary role is to decide whether or not you go on, and if so, what price you pay. Wait a minute! " For Milch it was seemingly small things that added up. Like the surgery schedules that left residents little time to interact with patients, to gain some understanding of their hopes and fears before the anesthesiologist arrived. "This system conspires against humanity in the name of perceived efficiency," he said. He blames insurance companies. But he also blames medicine itself. "You've got to recognize truth when it's staring you in the eye," he said. "We have so many problems with health care delivery. So many of them are societal and the practitioner is the convenient whipping boy. But so mu.c h of the criticism is well-deserved. We have abdicated so many of our responsibilities. We have closed our eyes to questionable practices. Once you lose your deserved stance of moral rectitude, you can't be surprised when those who you should be serving tum on you." + the proportion doesn't seem notably different from past years, Salsberg said. Still, everyone seems to know someone who couldn't take it anymore. "I have seen some people who have just gotten out of practice and taken administrative jobs because the bureaucratic morass has gotten so bad," said H. john Rubinstein, president of the Erie County medical society. "I think it's fair to say that practicing medicine is probably not as much fun as it once was, when there wasn't a lot of regulation," said john aughton, M.D., UB medical school dean. "I think most physicians are very well motivated and committed to providing good care and dedicated to the needs of patients. But the emphasis on more external review and documentation of what we do, those are hard habits to take on. It does create a climate of distrust between physicians and patients, and vice versa. " john Rodat, a health care consultant in Albany, thinks the lexicon of contemporary health care tells a lot about it. Take, for instance, "gatekeeper," the term managed care plans use for primary care physicians, who control their patients' access s c a n S u m m e 9 9 �• ········· · ··················· · · ····· · ·· ··············· ·· ·· ·· ····· · ·· · ··· · · · ····· ·· ·· · · ··· ···· ··· ~ I tiative. "In addition to benefiting women living in Western ew York," he said, "this program will accelerate the role of the school's Department of Social and Preventive Medicine in epidemiology, preventive medicine and community medicine. Italso will complement the medical school's efforts to train a larger number of primary care providers." The UB Women's Health Initiative will be headquartered in Farber Hall on the UB South Campus. A 24-hour hot line will be established later this summer to answer questions about the study and to take the names of women who wish to participate. Trevisan said he is convinced that one of the major reasons UB was selected to participate in the study is because the UB selected as vanguard center for national Women's Health Initiative Maurizio Trevisan, M.D ., chair of sohe University at Buffalo has been selected to be a lead research center cial and preventive medicine, is UB's primary investigator. in the $635 million Women's Health "This is a wonderful occasion for UB Initiative- the largest clinical trial and Western ew York," Trevisan said. ever undertaken in the United States. "This was a very tough competition and UB will aetas one of 16 vanguard clinical centers; its share of the project will UB fared very well. " john P. aughton, UB vice president total about $11 million over 12 years. The Women's Health Initiative is being for clinical affairs and dean of the medical undertaken to learn how to reduce the risk school, said, "UB is very pleased to be of coronary heart disease , breast and among the institutions selected to be vancolo rectal cancers and osteoporosis in older guard centers in the Women's Health Iniwomen. Approximately 160 ,000 postmenopausal women between the ages of 50 and 79 will be recruited by the 45 research centers throughout the country participating in the study. A pproxi rna tel y 3,500 women will be recruited from Western ewYork. As a vanguard center, UB will help design the study and establish operating procedures that other centers will follow . Clinical trials are expected to begin at the vanguard centers this fall. The remaining 39 clinical centers are expected to be anJean Wactawski-Wende, M.D., dinical assistant prafessar of Gynecology and Obstetrics, and Maurizio Trevisan, M.D., chair of nounced this fall. Social and Preventive Medicine, at a news conference announcing UB' s vanguard center designation. B a a p h y 5 c a n 5 u m m e �··········································································· ··············· · ····· • ·· ~ I entire community supports the effort. Ph.D. , and Terry Pechacek, Ph.D., all from "We were able to offer a package not the UB Department of Social and Prevenmany institutions could match," he said. tive Medicine. "This effort involved the departments of Also participating are Myroslaw gynecology and obstetrics, medicine and Hreshchyshyn, M.D., chair, and jean medical technology. We had the support Wactawski-Wende, M.D., from the Deof the deans of the medical school and the partment of Gynecology and Obstetrics; School of Health Related Professions and Robert Kohn, M.D., Susan Graham, M.D., the UB provost. We had the support of the June Chang, M.D. and Paresh Dandona, medical community, the political commu- M.D., from the Department of Medicine, nity, the health-care providers and civic and Donald Armstrong, Ed. D., chair of the and religious organizations. Department of Medical Technology. + "This is a very complex study, involvB Y LOIS B AKER ing recruiting volunteers, retaining them and arranging for reimbursement," Trevisan said. "Because everyone was behind us, we were able to address all of these issues." The study itself will be conducted in two parts - clinical and observational. he United State's first comprehenThe clinical component will involve three sive training center for nuclear iminvestigations: aging has been established • A test of the effectiveness of hormone at the Univerreplacement therapy in reducing the risk sity at Buffalo, of coronary heart disease, osteoporosis funded by a and endometrial cancer. • A study of the effect of a low-fat diet $450,000, three-year on the risk of cardiovascular disease and grant from Siemens H.G. breast and colorectal cancer. The grant is the re• An investigation of the effectiveness of calcium and vitamin D supplements in sult of two years of reducing osteoporosis, colorectal cancer, discussions between UB and Siemens, an blood pressure and breast cancer. The trials will begin in August or Sep- international contember in Western New York. The obser- glomerate headquarvational study will follow about 2,200 tered in Germany and a women from 12 to 17 years of age to try to major supplier of determine physiological and lifestyle fac- nuclear imaging equiptors that can affect the health of women. ment worldwide. Under the grant, Participants in this phase initially will give detailed medical histories and then will be the training center- to be headquartered contacted every three years to update their in the medical school's department of nuclear medicine- will concentrate on information. Co-principal investigator on the study positron emission tomography (PET). "We're in the process of organizing a is james Marshall, Ph.D., UB professor of core curriculum to train everyone from social and preventive medicine. Otherinvestigatorsarejo Freudenheim, the PET technician who assists the chemPh.D.; Alma Blake, Ph.D.; Diane Hayes, ists, through all of the higher levels of science right up to a director of PET operations," said joseph A. Prezio, M.D., UB chair of nuclear medicine. " o one is doing that anywhere in the United States. " Siemens needed a center that could train its people in depth in this new field, Prezio said, and UB already had a wellregarded program in nuclear medicine and is establishing a major PET facility in conjunction with the Buffalo VA Medical Center. The new facility will be one of the most advanced PET imaging centers in the world. 'The problem throughout the U.S. and, probably the world, is that training for PET has not been organized appropriately, or in enough depth, so that you can send someone to one site and have them come back seasoned and trained," Prezio said. "Siemens liked what we were doing here. They were looking for someone willing to put the effort into it. "Our goal from the beginning," he added, "in addition UB establishes comprehensive nuclear imaging training center B u 0 0 p y s c 0 S u I valed in the United States," Preziostated. The center will be organized around four major training groups -technicians, radiochemists, nuclear physicists and physicians, according to Prezio. Training of PET technicians began this spring. Other programs will accept enrollees when curriculums are finalized. Training periods will vary from a month for technicians to two years for physicians being trained to + interpret PET images. B m m Y e LOIS B 9 AKER 9 3 �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [1] ~ I Maurizio Trevisan is poised to expand SPM's role in both scope and breadth he first thing that struck Maurizio Trevisan, M.D. about this country after he came here from his native aples, Italy, was Americans' penchant for eating large breakfasts with meat every day. "My parents used to have a cup of coffee- maybe toast and jelly- but no meat," he recalls. ow, the chair ofUB's Department of Social and Preventive Medicine (SPM) is putting that observation - and many more about the American lifestyle - to work, studying dietary habits with an eye toward reducing the incidence of the number one and two killers of Americans, cardiovascular disease and cancer. Trevisan believes that the key to changing the bad habits that contribute to the deaths of over 1.2 million Americans each year is "to focus more on societal problems. The largest impact will come not so much from focusing on the individual, but by influencing the market for foodby lowering fat, eating leaner meats. "And the market," he notes, "has responded to consumer demand. The largest impact will be the change in labeling," soon to be phased in by the Food and Drug Administration. "Increased awareness has created a change in consumer awareness that has resulted in producers changing their packaging." Trevisan, who originally came to this country in 1979 to study at orthwestern University, talks about his former boss in Chicago, a leading authority on diet and heart disease. "He shows slides of two meat cows - one from years ago and one from now. There is a huge difference in B a 0 p the sizes. And now the one that wins the competitions is leaner. People used to look for the steak with all the marbling. ow they're looking for the leaner meat. "We tend to consume what's available," he notes, adding, "I was lucky enough to grow up in a place where you didn't use butter on your bread and you didn't eat meat every day. We would only eat meat once a week. "Lunch was the major meal, and always with pasta. I'm still not used to a cold lunch," even after eight years. In 1982, Trevisan returned to the University of aples, where he obtained his medical degree, before coming to UB as an assistant professor in 1985. He notes that since he's lived in the United States, "dietary habits have changed tremendously," resulting in decreased incidence since 1970 in heart disease and stroke. "And they're still changing for the better." And that is his ultimate goal, of course - to be able to influence peoples' habits and lifestyles to improve the quality of their lives. To that end, Trevisan and Social and Preventive Medicine are carrying on the work of Saxon Graham, emeritus professor and former chair of the department. Graham and his groundbreaking work in epidemiology and diet and disease were key to Trevisan's decision to come to UB. He was, at the time, being wooed by two other institutions. "One of the reasons I came here," he recalls, "was I fell in love with Saxon Graham. I thought he had tremendous vision for the department. 'Td like to continue what Saxon started. I want to maintain and continue to strengthen the department in the field of diet and chronic disease. And I'd like to expand it and continue to include environmental and occupational research. " Another ofTrevisan's goals is to make SPM more clinical. "My background," he explains, "is in internal medicine. Trevisan moved closer to this goal last March when UB was named a vanguard center in the ationalinstitutes' ofHealth landmark Women's Health Initiative. UB, under the auspices of SPM, along with the Departments of Obstetrics and Gynecology and Medicine, will look at a number of factors affecting women's health. Among those to be investigated in the observational study that will look at over 100,000 postmenopausal women are diet, physical activity, smoking, estrogen replacement therapy, alcohol use and psychosocial factors, including social networks, personality, depression and role satisfaction. "At some time, I'd like to expand our definition of Social and Preventive Medicine by being more closely in contact with the community I don't want to be an Ivory Tower scientist. We need to participate more and be more aware of the needs of the community" h y 5 c a n 5 m m e 9 �········· · ··· · ·············· · ················· · · · ············ · ·············· · ··············· · ···• · ~ I I ) J Maurizio Trevisan, M.D. UB will also participate in the initiative's clinical trials to determine whether ERT for postmenopausal women is ultimately beneficial or not. [See the previous story in this section for more information on the Women's Health Initiative.] Trevisan acknowledges the chairs of the other departments involved for their support and involvement in obtaining the prestigious IH designation, as well as that of john Naughton, M.D., vice president for clinical affairs and dean of the School of Medicine and Biomedical Sciences. "The IH people said, 'It's the first time we've ever seen a dean so involved.' If we 8 a 0 p h his department is relatively small, it is thriving under the medical school's primary care recruitment and women's health initiatives and poised to enjoy an even larger role in the future. "At some time, I'd like to expand our definition of Social and Preventive Medicine by being more closely in contact with the community. The medical school has a responsibility for the health of its community. "I don't want to be an Ivory Tower scientist. We need to participate more and be more aware of the needs of the community." + make it, it's a great end to the efforts of many people involved," Trevisan said, referring to one of the IH's last site visits before awarding the vanguard clinical center designation to UB. Naughton has similar praise for Trevisan. "Maurizio is a very broad thinker. He is committed to epidemiologic and clinical research, and is a good leader of the faculty. His strong leadership, particularly in the area of primary care and interaction with other departments, make us fortunate to have him here." Trevisan officially took over SPM on january l after serving as interim chair after Saxon Graham retired. And although y 5 a n S u - m BY N ANETTE TRAMONT m e KOLLIG �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [1] ~ I Suraj A. Acharya Family Practice, UniversityofCalifornia-San Diego Medical Center, San Diego, California Match Day '93 aresounding success for UB'sgraduating medical students Shabi na Ahmad Gynecology/Obstetrics, University at Buffalo Graduate Medical/Dental Consortium, Buffalo, ew York atch Day went well for UB's medical students this year- with 84 percent of the graduating seniors accepted into one of their top three residency program choices. Dennis Nadler, M.D., associate deanfor curricular and academic affairs, said that this year saw 63 percent of UB's medical students accepted by their first choice of residency programs, 11 percent by their second choice and 10 percent by their third choice. In the highly competitive surgical specialties, 10 of 11 UB students who applied were accepted. "The usual match in these specialties is 50 percent," Nadler said. "So to get 10 out of 11 is excellent." Nearly one-third of the students will remain in Buffalo to continue their training- an increase of7 percent over last year. Twenty percent will go to other New York State programs, while about half were matched with out-ofFollowing is a list of the medical school's Class of '93 matches. u 0 0 ancy A. Allen Gynecology/Obstetrics, University at Buffalo Graduate Medical/Dental Consortium, Buffalo, ew York Jewel D. Alleyne Surgery, University at Buffalo Graduate Medical/ Dental Consortium, Buffalo, ew York Matthew E. Alter Surgery, University at Buffalo Graduate Medical/ Dental Consortium, Buffalo, ew Yorlz Pavan Anand Anesthesiology, Albany Medical Center, Albany, ew York Gregory A. Andrews Obstetrics/Gynecology, Sisters ofCharity Hospital, Buffalo, ew York Michael]. Aronica Med!Peds, University at Buffalo Graduate Medical/ Dental Consortium, Buffalo, ew York Behnam Asgharian Surgery (Prelim), University of Louisville, Louisville, KentucJzy Hisla A. Bates Intemal Medicine (Primary), Yale-New Haven Hospital, ew Haven, Connecticut Ophthalmology, Yale University, ew Haven, Connecticut Andrew J. Bauer Pediatrics, Madigan Army Medical Center, Tacoma, Washington Elyssa A. Blissenbach Intemal Medicine, Medical University of South Carolina, Charleston, South Carolina John S. Brebbia Surgery, University at Buffalo Graduate Medical! Dental Consortium, Buffalo, ew York state residency programs. B Elizabeth A. Allen Gynecology/Obstetrics, University at Buffalo Graduate Medical/Dental Consortium, Buffalo, ew York p h s c 0 5 Jon M. Bruce Surgery, University at Buffalo Graduate Medical! Dental Consortium, Buffalo, ew York m m e 9 9 �................................................ .... ............................ . . . . ... . . . . . . . . .•. ·. ' ~ ' ' AnneM. Comi Pediatrics, University at Buffalo Graduate MedicaV Dental Consortium, Buffalo, New York Thomas A. Coppola Internal Medicine, University at Buffalo Graduate MedicaVDental Consortium, Buffalo, New York Andrew C. Corsello Internal Medicine, Strong Memorial Hospital, Rochester, New York Vanessa L. Crothers Obstetrics/Gynecology, Ohio State University Hospitals, Columbus, Ohio Joan C. Davis Obstetrics/Gynecology, Baystate Medical Center, Springfield, Massachusetts Michael L. DuBartell Family Practice, Middlesex Hospital, Middletown, Connecticut Karen M. Duguid Obstetrics/Gynecology, Strong Memorial Hospital, Rochester, ew York John A. Dzik Pediatrics, University at Buffalo Graduate MedicaV Dental Consortium, Buffalo, New York Congratulations abound as over 60 percent of the class members are accepted into their top choice. Tricia L. Eisenstein Surgery (Prelim), Mt. Sinai Hospital, New York, ew York Julene 0. Evansmurage Obstetrics/Gynecology, Maimonides Medical Center, ew York, New York Lisa A. Cardamone Surgery (Prelim), University at Buffalo Graduate ALL PHOTOS BY SIM ON TONG Thomas G. Burke Internal Medicine (Prelim), St. joseph Hospital, Denver, Colorado Emergency Medicine, Denver General Hospital, Denver, Colorado Craig]. Burrows Family Practice, St. Vincent Health Center, Erie, Pennsylvania Heather R. Campbell Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Jean M. Cange Family Medicine, University at Buffalo Graduate MedicaVDental Consortium, Buffalo, ew York Rodney Capiro Obstetrics/Gynecology, Harlem Hospital, ew York, New York B a 0 p h MedicaVDental Consortium, Buffalo, ew York Orthopaedic Surgery, University at Buffalo Graduate MedicaVDental Consortium, Buffalo, ew York Gil M. Farkash Obstetrics/Gynecology, University at Buffalo Graduate MedicaVDental Consortium, Buffalo, ew York Richard M. Chemelli Pediatrics, University at Buffalo Graduate MedicaV Dental Consortium, Buffalo, New York Paul Favorito Surgery (Prelim), UniversityofMinnesota Hospital and Clinic, Minneapolis, Minnesota Elaine H. Cheon Obstetrics/Gynecology, Strong Memorial Hospital, Rochester, ew Yorl1 Ilana L. Feinerman Otolaryngology, Tufts ew England Medical Center, Boston, Massachusetts William F. Chlosta Surgery, St. Mary's Hospital, Waterbury , Michael S. Ferguson Emergency Medicine, University of Massachusetts Coordinated Programs, Worcester, Massachusetts Connecticut Josephine Cho Internal Medicine (Prelim), Staten Island University Hospital, New York, New York Radiology - Diagnostic, Einstein Affiliated Hospital, ew York, New York David M. Fisher Surgery, University at Buffalo Graduate MedicaV Dental Consortium, Buffalo, ew York David K. Frey Psychiatry, SUNY Health Science Center at Syracuse, Syracuse, ew York Judine C. Coggins Obstetrics/Gynecology, Sisters ofCharity Hospital, Buffalo, ew York 5 c a n s m m e 9 9 �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [1] ~ I Allen Friedland Med!Peds, University of Cincinnati Hospital, Cincinnati, Ohio Timothy D. Haley Surgery, Medical College of Pennsylvania, Philadelphia, Pennsylvania Wallace E. Johnson Internal Medicine, Strong Memorial Hospital, Rochester, ew York Myron L. Glick Family Practice, Lancaster General Hospital, Lancaster, Pennsylvania John D. Hall Obstetrics/Gynecology, University at Buffalo Graduate Medical/Dental Consortium, Buffalo, New York Saidat T. Kashimawo Psychiatry, Beth Israel Medical Center, New Yorh, ew Yorh Charles R. Gray Psycl1iatry, Thomas jefferson Philadelphia, Pennsylvania Hospital , Betty B. Gregoire Psychiatry, University at Buffalo Graduate Medical! Dental Consortium, Buffalo, ew York Kathleen T. Grimm Med!Peds, University at Buffalo Graduate Medical! Dental Consortium, Buffalo, New York B u 0 0 p Richard E. Hall Surgery (Prelim), University at Buffalo Graduate Medical/Dental Consortium, Buffalo, ew York Honora M. Heffner Patholog,, University of Minnesota Hospital and Clinic, Minneapolis, Minnesota James M. lsemia Internal Medicine, Healtheast Teaching Hospital, Allen10wn, Pennsylvania h y 5 c 0 n 5 Robin M. Kass Internal Medicine (Prelim), Faulhner Hospital, Boswn, Massachuseus eurology, Columbia University, New York, ew York Lisa F. Keicher Pediatrics, Hershey, Pennsylvania State, Hershey, Pennsylvania Kevin J. Kelleher Family Practice, Franklin Square Hospital, Baltimore, Maryland m m e �· ········ ··· ···················· ·· ······· ············· · ···· ····· · ······· ········· ········· ······• · · ~ I I Theodore J. Kolias Internal Medicine, Hershey, Pennsylvania State, Hershey, Pennsylvania Joseph M. Kowalski Surge1y (Prelim), University at Buffalo Graduate MedicaUDental Consortium, Buffalo, New York Paul M. Kozlowski Surgery (Prelim), Strong Memorial Hospital, Rochester, New Yorlz Urology, Strong Memorial Hospital ofthe University of Rochester, Rochester, ew York UB' s graduating medical students getting the good news: 84 percent were accepted into one of their top three choices for residency programs in this year's Match Day. Brian J. Krabak Internal Medicine (Prelim), Sinai Hospital, Baltimore, Maryland Physical Medicine and Rehabilitation, New England Medical Center, Boston, Massachusetts Jonathan R. Kemp Internal Medicine (Prelim), University at Buffalo Graduate MedicaUDental Consortium, Buffalo, ew York Ophthalmology, Louisiana State University Eye Center, ew Orleans, Louisiana J . Christopher Kuhn Pediatrics, University at Buffalo Graduate MedicaU Dental Consortium, Buffalo, New Yorlz Cathy Kim Surgery (Prelim), Barnes Hospital, St. Louis, Missouri Urology, Washington University, St. Louis, Missouri Tracy]. Lathrop Internal Medicine (Prelim), Einstein Affiliated Hospitals, New York, ew Yorlz Elizabeth H. Kim Internal Medicine (Preli m), St. Vincent's Hospital, ew Yorlz, ew York Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts David]. Lee Transitional Year, Presbyterian/St. Luke's Medical Center, Denver, Colorado Anesthesiology, Dartmouth-Hitchcoclz, Lebanon, New Hampshire Jeffrey 5. Kingsbury Surgery (Prelim), University at Buffalo Graduate MedicaUDental Consortium, Buffalo, ew York Kewjung Lee Family Practice, orthwestern University/St. joseph Hospital, Chicago, Illinois Ricardo A. Knight Physical Medicine and Rehabilitation, Temple University Hospital, Philadelphia, Pennsylvania B u 0 0 p s c 0 n 5 Charles H. Lieu Internal Medicine, Barnes Hospital, St. Louis, Missouri m m e 9 9 3 �• ··············································· .................... .... .... ...... .......... ..... An ebullient Jon Brute reteives tongratulations from his tolleagues. Jeffrey R. Parnell Internal Medicine (Primary), University at Buffalo Graduate Medical/Dental Consortium, Buffalo, ew Yorh Ophthalmology, University of California-Los Angeles, Los Angeles, California Vikram . Patel Surgery (Prelim), McGaw Medical Center, orthwestern University, Chicago, Illinois Otolaryngology, orthwestern University, Chicago, Illinois Francis R. Pallerson Orthopaedic Surgery, SUNY Health Science Center at Syracuse, Syracuse, ew York Kristen L. Paulus Internal Medicine, Georgetown University Hospital, Washington, D.C. Randall J. Loftus uclear Medicine, University at Buffalo Graduate MedicaVDental Consortium, Buffalo, ew York Andrew C. Michel Emergency Medicine, Geisinger Medical Center, Danville, Pennsylvania Karen M. Maier Family Practice, Harrisburg Hospital, Harrisburg, Pennsylvania Rogena L. Miller Pediatrics, Emory University School of Medicine, Atlanta, Georgia James K. Mantone Orthopaedic Surgery, Grace Hospital, Detroit, Michigan David A. Milling Internal Medicine, University at Buffalo Graduate MedicaVDental Consortittm, Buffalo, ew York Gina M. Marrero Pediatrics, Yale- ew Haven Hospital, ew Haven, Connecticut Lomelle B. Mills Internal Medicine, George Washington University, Washington, D.C. Bruce B. Marshall Emergency Medicine, Carolinas Medical Center, Charlotte, orth Carolina Daniel]. Mollin Internal Medicine, University of orth Carolina, Chapel Hill, orth Carolina Christina L. Master Pediatrics, Children's Hospital , Philadelphia, Pennsylvania Michael]. a ugh ton Internal Medicine, Barnes Hospital, St. Louis, Edward F. Math Internal Medicine (Prelim), University of California-Irvine, Irvine, California Radiology-Diagnostic, Duke University Medical Center, Durham, orth Carolina Jennifer A. ordby Pediatrics, University at Buffalo Graduate MedicaV Dental Consortium, Buffalo, ew York Fiona A. McConnell Pediatrics, University of Colorado, School of Medicine, Denver, Colorado Kevin C. McMahon Family Practice, St. Vincent Health Center, Erie, Pennsylvania Claudia F. Michalek Psychiatry, University at Buffalo Graduate MedicaV Dental Cons01iium, Buffalo, ew York B u 0 0 p Missouri Katherine A. O'Donnell Surgery, University at Buffalo Graduate MedicaV Dental Consortium, Buffalo, ew York Sanjay R. Ogra Internal Medicine (Primary), University at Buffalo Graduate MedicaVDental Consortium, Buffalo, ew Yorh William E. Ottowitz Internal Medicine (Prelim), University at Buffalo Graduate Medical/Dental Consortium, Buffalo, New York h y s 0 n s Laura]. Pierce Med!Peds, Strong Memorial Hospital, Rochester, ew York James D. Pile Obstetrics/Gynecology, University at Buffalo Graduate Medical/Dental Consortium, Buffalo, ew Yorh Michael D. Rabice Pediatrics, University at Buffalo Graduate MedicaV Dental Consortium, Buffalo, New York Arlene E. Ricardo Surgery, University of Texas Medical School, Houston, Texas Gloria Richards Internal Medicine C., Georgia Baptist Medical Center, Atlanta, Georgia Marcus R. Romanowski Surgery (Prelim), University at Buffalo Graduate MedicaVDental Consortium, Buffalo, New Yorh Orthopaedic Surgery, University at Buffalo Graduate Medical/Dental Consortium, Buffalo, ew York Leon Ronen Family Practice, aval Hospital Charleston, Charleston, South Carolina Paul B. Rosenthal Family Practice, UniversityofCalifornia-San Diego Medical Center, San Diego, California Mark A. Runfola Surgery, Good Samaritan Regional Medical Center, Phoenix, Arizona Richard S. Safeer Family Practice, Franklin Square Hospital Center, Baltimore, Maryland u m m e 9 9 �······························································· ···· ·········· ··· ········· ·· ····· • ·· · ~ I Diane M. Sanfilippo Obstetrics/Gynecology, University at Buffalo Graduate Medical/Dental Consortium, Buffalo, New York Frank M. Scappaticci Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Eric]. Schneider Family Practice, University of VirginiaCharlottesville, Charlottesville, Virginia Jeffrey A. Senall Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan Jeffrey Seymour Surgery (Prelim), University at Buffalo Graduate Medical/Dental Consortium, Buffalo, New York Peter U. Shen Internal Medicine, The York, ew York 1 ew Yorh Hospital, ew Andrew L. Sherman Physical Medicine and Rehabilitation, University of Washington Affiliated Hospitals, Seattle, Washington Julie M. Sicilia Transitional Year, Mary Imogene Bassett Hospital, Cooperstown, New York Patricia Sticca Pediatrics, University at Buffalo Graduate Medical! Dental Consortium, Buffalo, 1 ew York Michel E. Wild Obstetrics/Gynecology, ew Yorh Downtown Hospital, ew Yorh, ew Yorh Michael F. Sweeney Obstetrics/Gynecology, Akron City Hospital, Akron, Ohio Kelly A. Wood Internal Medicine, Barnes Hospital, St. Louis, Missouri Brian Szymanski Physical Medicine and Rehabilitation, University at Buffalo Graduate Medical/Dental Consortium, Buffalo, New York Thomas]. Yacovella Medicine C, University of Minnesota Hospital and avy + Clinic, Minneapolis, Minnesota aval Heather Campbell phones home. Courtenay C. Watt Emergency Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania Samiris Sostre Psychiatry, Einstein Affiliated Hospitals, ew York, ew York Michelle A. Webb Internal Medicine, Medical College of Virginia, Richmond, Virginia Anthony M. Spina Surgery (Prelim), University at Buffalo Graduate Medical/Dental Consortium, Buffalo, New York h Edward R. Stephenson Surgery, Hershey, Pennsylvania State, Philadelphia, Pennsylvania Christopher R. White Internal Medicine (Prelim), Sisters of Charity Hospital, Buffalo, New Yorl1 Radiology-Diagnostic, University Health Center of Pittsburgh, Pittsburgh, Pennsylvania Anil K. Vaidian Internal Medicine, Montefiore Medical Center, Bronx, ew York Michael K Soeder Med!Peds, Baystate Medical Center, Springfield, Massachusetts p Thomas C. Wheatley Pediatrics, University Hospital of Cleveland, Cleveland, Ohio Mary C. Totten Otolaryngology, Loyola University, Chicago, Illinois Christina A. Smith Psychiatry, University Health CenterofPittsburgh, Pittsburgh, Pennsylvania 0 Judy A. Wesolowski Obstetrics/Gynecology, SU Y Health Science Center at Syracuse, Syracuse, ew Yorh Kristine L. Tenebruso Internal Medicine (Primary), Rhode Island Hospital, Providence, Rhode Island Gail H. Smallen Pediatrics, University at Buffalo Graduate Medical! Dental Consortium, Buffalo, ew York a icho\as A. Stathopoulos Internal Medicine (Prelim), St. Mary's Hospital, Rochester, ew York Ophthalmology, Pennsylvania State University, Hershey, Pennsylvania Guy A. Taylor Internal Medicine (Prelim), University at Buffalo Graduate Medical/Dental Consortium, Buffalo, ew York Anesthesiology, Presbyterian Hospital, New York, New Yorh Alissa M. Shulman Surgery, University of Texas Medical School, Houston, Texas u Jonathan I. Weinstein Pediatrics, Children's Hospital National Medical Center, Washington, D.C. Robert W . Tahara Family Medicine, United States Hospital, jacksonville, Florida Mansour V. Shirbacheh Surgery, assau County Medical Center, East Meadow, ew York e Christopher D. Sprowl Family Practice, St. joseph Hospital, Denver, Colorado Irwin C. Steinberg Obstetrics/Gynecology, Winthrop Universi ty Hospital, Mineola, New York Paul D. Seeman Family Practice, United States avy aval Hospital, jacksonville, Florida y I s a 5 u m m e 9 9 �- - ········· ··· · ······· ········· ····· ··· ··· ·· ······· ······· . . .. . .. ... .. .. . ... ..... ......... ... • Maria New, M.D~ thanks her patients as she delivers 1993 D. WHarrington Lecture common symptom of the disorder) aggravated by stress. In her study of this disorder, ew identified its "nonclassical" form- a late onset hyperplasia in which the patient acquires the symptoms of the disease after HLA-TYPING LED TO DISCOVERY OF NONCLASSICAL birth, rather than in utero. ew became FORM OF CONGENITAL ADRENAL HYPERPLASIA aware of this form using HLA-typing to identify carriers in a specific family. Up to this point in herresearch, HLA-typing had en owned pediatric endocrinologist and then a male until adulthood, when the predicted every outcome in her patients. Maria I. ew, M.D., delivered the victim fell in love with and tried to marry "It was all fine until we hit this family, " 1993 D. W. Harrington Lecture, a maid. "The maid was dismayed and ran where ew noted that the deficiency wasn't away," when the unfortunate patient pro"Congenital Adrenal Hyperplasia: being passed on the way it was predicted From the Laboratory to the Bed- duced a birth certificate that was for a baby to . girl rather than a boy. Although it was ' ~ side," recounting her research on "We were very disappointed in the believed "he died of a broken heart," in the nonclassical form of the disorder. nonconcordance of the HLA prediction." Alexander Brownie, Ph.D., UB profes- fact, she said, he died of salt-wasting (a ew discovered one particular family sor and research professor in pathology, member - a male with a mild deficiency introduced ew, chair of pediatrics at on one of the sixth chromosome pair and Cornell Medical College. A friend of ew's a major deficiency on the other. She defor over 20 years, Brownie described her scribed the man's son "like no patient I dedication to the field of pediatric endohave ever seen," noting that the son should crinology, recounting how she always have had the deficiency at birth but in fact wanted to have a positive impact on childid not, nor did his sister who had the dren suffering from endocrine disorders. same HLA gene type. ew thanked many for their help in her Symptoms of the nonclassical form inresearch , but she made a special point to clude infertility and rapid growth. One of 100 thank her patients, "some of whom I have the most common symptoms is frontal followed from the time they were born hair loss. Treatment can help eliminate until they were parents." many of these symptoms. Pediatrician-in-chief and director of Statistics show that the severe classical the pediatric metabolism clinic at The disorder occurs in one in 14 ,554live births, ew York Hospital, ew has concenalthough there are some geographic variatrated her studies on the 21-hydroxylase tions; Alaska's Yupik Eskimos show the deficiency, which along with the 11-hyhighest frequency of the classical form. droxylase defect, is one of the most comew described how she "never exmon forms. The deficiency causes an inpected what I got" when she tested the creased secretion from the adrenal gland genetic axiom that mild disorders occur of cortisol precursors and androgens, remore frequent than severe ones. She said sulting in masculinization of the female she expected the frequency of the mild external genitalia during intrauterine life. deficiency of congenital adrenal First described in 1854, the disorder hyperplasia to be somewhere around one can lead to female infants being sexually in 13,000 live births, and was shocked misassigned at birth, as well as precocious when she realized it was much higher. A sexual maturation in boys. New told the 11 test on Eastern Europeanjewsshowed the story of that case, in which an Italian frequency to be one in 27 and a test on patient- raised as a female until age four, Hispanics in New York showed a fre- ~I Overall, the frequency average of congenital adrenal hyperplasia is one in who shows symptoms, while one in seven is a carrier, making it the most common autosomal recessive defect. New called for universal testing, but lamented the fact that only states have mandated it thus Jar. a a a p s c a n 5 u m m e 9 �quency of one in 40. Overall the frequency average of congenital adrenal hyperplasia is one in 100 who shows symptoms, while one in seven is a carrier, making it "the most common autosomal recessive defect. " ew called for universal testing, but lamented the fact that only 11 states have mandated it thus far. Treatment begins in the womb as fetal cells are Hl.A-typed. "When you get a diagnosis by amniocentesis, it's already too late," ew said. Dexamethasone is used to treat the fetus at risk even before the gender has been determined. If it is later found the fetus is a male, treatment is ended; females are treated until term. ew said treatment can lead to recovered fertility and the lessening of other symptoms "without causing complications. "It's still a very experimental procedure," explained ew, "but I am very respectful of human life." The author of more than 400 research papers on abnormalities of the adrenal gland, New is immediate past presidentof the Endocrine Society. In 1988, she received the society's Robert H. Williams Distinguished leadership Award in Endocrinology. She has received the New YorkAcademyofMedicineMedalofAward and the Due Case award from the Office of the Governor of ew York. She was elected a fellow of the American Academy of Arts and Sciences in 1991. The Harrington lecture is sponsored by the School of Medicine and Biomedical Sciences. As Harrington visiting professor, ew spent two days meeting with faculty and medical students in hospital grand rounds, at clinics and in informal discussion groups. The D. W. Harrington lecture Fund was established in 1886 by Devillo White Harrington, M.D. , an 1861 graduate of the UB medical school and a professor of genito-urinary and venereal diseases from 1886 to 1905. + r' Maria New, M.D. B s 0 0 p h y s c 0 5 u m m Y e M ARK P 9 OLLIO �• ································································································ ~ I The aim of both initiatives is to provide cooperative patient care networks for diverse specialty services to residents of the West Side close to their homes as well as to develop cost-effective access to University-affiliated tertiary care services to medically underserved communities. Prenatal services will be provided at the Buffalo Columbus' Family Care Center by clinical faculty of the department of gynecology and obstetrics. Women receiving prenatal care at the Buffalo Columbus facility will be referred primarily to CHOB for deliveries, as well as for any specialized pregnancy-related care. Additionally, women seen for gynecological services at the Family Care Center will be referred to either Children's or Erie County Medical Center. The agreement was forged through the joint efforts of john P. BlFFALO COL.lMIUS HOSPITAL UB-Columbus agreement provides cooperative patient-care services for West Side residents. UB-Columbus Hospital linkage to provide prenatal care services new agreement to enhance access to women's health and AIDS services to residents of Buffalo's West Side community has been inked between the School of Medicine and Biomedical Sciences, The Children's Hospital of Buffalo, Erie County Medical Center and the Buffalo Columbus Hospital. The agreement, which establishes a primary-tertiary care network to provide comprehensive women's services, includes provisions for delivering early prenatal care to an area with some of New York State's highest infant mortality rates. The agreement also provides for the training of local medical and nursing staff by specialists ofECMCS AIDS program to administer routine primary medical and specialized ambulatory care to AIDS and HIVpositive patients. B u 0 0 p president for clinical affairs and dean of the medical school, and the hospitals. At a press conference and luncheon announcing its es- II h c 0 UB oiTers GRATEFUL MED through National Library of Medicine grant B's Health Sciences Library has been awarded a 15-month outreach contract to promote library services to 75,000 health care professionals throughout Western and Central ew York. The library will do this through its Western New York Outreach Program, which began in August1992 and will run through this October, funded by a $159,699 ational Library of Medicine (NLM) contract awarded through the ew York Academy of Medicine. The program will introduce its audience to GRATEFUL MED, a software package that offers desktop access to biomedical information and will link unaffiliated health professionals to library services. Cynthia Bertuca, head of information dissemination services for the Health Sciences Library, said the program currently targets more than 10,000 pharmacists and dentists in a 25-county area. The counties involved are the eight counties ofWestern ew York, plus Steuben, Livingston, Mon- GRATEFUL MED reaches out. 5 tablishment, Naughton was lauded by Columbus Hospital board members for his community service and efforts on behalf + of Buffalo's West Side. 5 u m m e 9 3 �. .. . . . .. ... ..... .... . .. .... . . . .... . .... ... ...... .... ......... . . ..... . ... . ..... ... . . . . .. .... ••• ••~ ••• • I roe, Ontario, Wayne, Cayuga, Yates, Seneca, Schuyler, Chemung, Tompkins, + Cortland and Tioga. New plan turns private practices into formal classrooms in WNY the memory of the associate professor of medicine at New York University School of Medicine who served as a member of MF's board from 195 2 until his death in 1979. + The Graef Memorial Scholarship was established by the ational Medical Fellowships (NMF) board of directors and endowed through a gift from the Irving Graef Medical Fund. The award honors our doctors' offices, an inner-city health clinic and an HMO in Western ew York are becoming the nation's first private medical practices to function as formal training sites for medical students and resident physicians studying to become primary care physicians. The program is called the Community Action Practice (CAP) project, a cooperativeventure of the Graduate Medical Dental Education Consortium ofBuffalo. CAP is part of a $5 million primary care initiative unveiled by the Consortium last fall , designed to increase the number of resident physicians training in primary care from 35 to 50 percent by 1994. The new program will allow aspiring doctors to study primary care medicine where it is practiced- in doctors' private offices and walk-in clinics rather than in hospitals, the traditional training ground for all fields of medicine. Computer software and hardware will also be provided on-site as part of the new program. + UB medical student wins Irving Graef Memorial National Medical Fellowships scholar award ndrea Williams, a University at Buffalo medical student, has been chosen as the 1992-93 Irving Graef Memorial Scholar. As the Graef Scholar, Williams will receive $2,000 during her senior year. B u a 0 p h Andrea Williams 5 a n 5 I m m e 9 �. . . . . • ••••••••••••••••• •••••••••• . . . . .... . . . . . . . . . . . . . . . .. . . . UB'sOffice of Graduate Medical Education is key to excellence in Consortium residency training oseanne Berger, M.D., UB's new associate dean for graduate medical education has her capable hands full. Her office - the Office of Graduate Medical Education and House Staff Affairs - is charged with overseeing not only the education of over 700 resident physicians, but the many functions associated with coordinating their education through the school's Graduate Medical Dental Education Consortium of Buffalo (GMDECB). Founded 10 years ago in an effort to respond to new guidelines issued by the Liaison Committee on Graduate Medical Education, the GMDECB consists of the School of Dental Medicine, the School of Medicine and Biomedical Sciences and its nine affiliated teaching hospitals, all residency training program directors and one resident from each program. Before her office was established last October, Berger says "graduate medical education was spread among the hospitals, with some residents sent to multiple hospitals without any coordination between them. One resident may have gotten a salary from one hospital and rotated to three hospitals and his or her colleague might have received a different salary from another hospital and essentially do the same thing. And benefits were a problem, too." In addition, Berger adds, the accrediting body for graduate medical education "required an institution of record to hold responsible for ensuring the quality of the programs. In Buffalo, we had eight hospitals - and who was responsible for the quality? "That function is now focused out of this office." B a 0 p Roseanne Berger, M.D. The office also serves as a clearinghouse for Consortium residency program directors to learn about accreditation information and other issues affectinggraduate medical education. "For example," Berger explains, "the impact health care reform being anticipated from Washington will have on graduate medical education- that type of effort comes out of this office." Issues common to all residency programs are coordinated through the medical school's graduate medical education department. "Because there are multiple residency programs, there are certain issues common to all programs that are managed more efficiently if coordinated through one office," Berger says, and cites the Consortium's one-week residency program orientation as an example. 'The residents learn about communication skills, teaching skills, issues in medicine such as advanced directives, documentation, medical records, and also receive training in life support and advanced life support- all issues common y s c a n s .................................... to all programs and important for the new house staff to know. " As the medical school's chief liaison to the Consortium, Berger's office is poised to take an even broader role, given the current climate of health care reform that is likely to touch not only practicing physicians, but both graduate and undergraduate medical education as well. That climate, Berger notes, will probably result in striking changes in the way physicians- particularly resident physicians- are trained in this country. And UB and its Consortium- having committed to achieving 50 percent of its residency positions in primary care "are on the forefront of change because we are a Consortium and in the future graduate medical education will look toward developing more. We are the oldest and we are looked at as a model for the nation, having worked collaboratively with the hospitals. " The 50 percent primary care residency goal is only one objective of a three-year ew York State Department of Health demonstration project Berger's office also has responsibility for. That demonstration project is aimed at easing the nation's current and projected shortage of primary care physicians. "We've made a commitment to make changes in graduate medical education in exchange for more favorable reimbursement rates. This is a key reason why this office was established," Berger said. "We have to demonstrate we're making the changes we've committed to making. And these are exactly the kind of changes the government and health care planners feel need to be made in this country in terms of health care delivery and medical education. "We have a leg up on things because we've already committed to making these kinds of changes." + - BY m NANETTE m e TRAMONT KOLLIG 9 9 3 �. .... . ... . ....................... ... ...... .... ........ ... ...................... . ............... II lell Listing of Consortium residency programs demonstrates expanded specialty scope as well as focus on primary care he Graduate Medical Dental Education Consortium of Buffalo is responsible for the education of over 700 resident physicians. Following is a listing of the programs the Consortium runs, including the affiliated hospitals, program directors and number of positions in each program. ALLERGY AND IMMUNOLOGY Hospitals Buffalo General Hospital The Children's Hospital of Buffalo Erie County Medical Center Program Director Dr. Mark Ballow umber of Positions - 4 ANESTHESIOLOGY Hospitals Buffalo General Hospital The Children's Hospital of Buffalo Erie County Medical Center Millard Fillmore Hospitals Roswell Park Cancer Institute VA Medical Center Program Director Dr. Richard Ament Number of Positions - 52 VA Medical Center Program Director Dr. Clara Bloomfield E DOCRINOLOGY AND METABOLISM Hospital Erie County Medical Center Program Director Dr. Stephen Spaulding EPHROLOGY Hospital Erie County Medical Center Program Director Dr. Rocco Venuto GASTROENTEROLOGY Hospital Erie County Medical Center Program Director Dr. Milton M. Weiser INTERNAL MEDICINE PROGRAM A Hospitals Buffalo General Hospital The Children's Hospital of Buffalo Erie County Medical Center VA Medical Center Program Director Dr. Robert Scheig Number of Positions- 156 (iJicludi,gfellowships ) Programs CARDIOVASCUlAR DISEASE Hospital Erie County Medical Center Program Director Dr. Avery K. Ellis PULMONARY DISEASES Hospital Erie County Medical Center Program Director Dr. Alan R. Saltzman HEMATOLOGY-MEDICI E Hospital Erie County Medical Center Program Director Dr. Gerald Logue RHEUMATOLOGY Hospital Erie County Medical Center Program Director Dr. Floyd A. Green INFECTIOUS DISEASES Hospital Erie County Medical Center Program Director Dr. Timothy Murphy INTERNAL MEDICINEPROGRAM B MEDICAL ONCOLOGY Hospitals Buffalo General Hospital Roswell Park Cancer Institute Hospital Millard Fillmore Hospitals Program Director Dr. joseph lzzo umber of Positions- 3 7 DERMATOLOGY Hospitals Buffalo General Hospital The Children's Hospi tal of Buffalo Erie County Medical Center Roswell Park Cancer Institute VA Medical Center Program Director Dr. Stephanie Pincus umber of Positions- 10 FAMILY PRACTICE Hospitals Buffalo General Hospital Cuba Memorial Hospital Erie County Medical Center Millard Fillmore Hospitals Olean General Hospital Program Director Dr. Daniel Morelli umber of Positions - 52 B a a p h y s c a n 5 m m e 9 9 �• ••••••••••• I VA Medical Center Program Director Dr. George Simpson Number of Positions - PSYCHIATRY Hospitals Buffalo General Hospital The Children's Hospital of Buffalo Ene County Medical Center VA Medical Center Program Director Dr. Seung-Kyoon Park Number of Positions - 26 12 PATHOLOGYANATOMICAL CLINICAL Hospitals Buffalo General Hospital Erie County Medical Center Roswell Park Cancer lnslllute VA Medical Center Program Director Dr. Reid Heffner umber of Positions - 19 CHILD PSYCHIATRY PEDIATRICS NEUROLOGICAL SURGERY Hospitals Buffalo General Hospital The Children's Hospital of Buffalo Erie County Medical Center Program Director Dr. L. Nick Hopkm Number of Positions - 7 NEUROLOGY Hospitals The Children's Hospnal of Buffalo Buffalo General Hospnal Erie County Medical Center Millard Fillmore Hospnals VA Medical Center Program Director Dr. Michael Cohen Number of Positions- 16 CHILD NEUROLOGY Hospitals The Children's Ho pnal of Buffalo Erie County Medical Center VA Medical Center Program Director Dr. Michael Cohen NUCLEAR MEDICINE Hospitals Buffalo General Hospnal Mercy Hospital Roswell Park Cancer lnslllute VA Medical Center Program Director Dr. joseph Prez10 umber of Positions - 6 Program Director Dr. Myroslaw Hreshchyshyn umber of Positions - 40 OPHTHALMOLOGY Hospitals Buffalo General Hospital The Children's Hospital of Buffalo Ene County Medical Center VA Medical Center Program Director Dr. William Coles umber of Positions - 12 ORTHOPAEDIC SURGERY Hospitals Buffalo General Hospital The Children's Hospital of Buffalo Ene County Medical Center Mercy Hospital VA Medical Center Program Director Dr. Lawrence Bone umber of Positions - 16 Programs HA D SURGERY Hospitals Millard Fillmore Hospitals Erie County Medical Center Program Director Dr. Clayton Peimer umber of Po it ions 3 PEDIATRIC ORTHOPAEDICS Hospital The Children's Hospital of Buffalo Program Director Dr. Robert Gillespie umber of Positions- 1 GYNECOLOGY AND OBSTETRICS Hospitals Buffalo General Hospnal The Children's Hospnal of Buffalo Erie County Medical Center Millard Fillmore Hospitals Roswell Park Cancer Institute 6 u a OTOLARYNGOLOGY Hospitals The Children's Hospital of Buffalo Ene County Medical Center SISters of Charity Hospital 0 p h y 5 Hospitals The Children's Hospital of Buffalo Erie County Medical Center Mercy Hospital Roswell Park Cancer lnslllute Program Director Dr. Gerald Daigler Number of Positions - 71 (includi ngfellowships) Programs EO ATAUPERJ ATAL MEDICI E Hospital The Children's Hospital ofBuffalo Program Director Dr. Frederick Morin PEDIATRIC EPHROLOGY Hospital The Children's Hospital ofBuffalo Program Director Dr. Leonard Feld PEDIATRIC HEMATOLOGYONCOLOGY Hospitals The Children's Hospital ofBuffalo Roswell Park Cancer Institute Program Director Dr. Martin Brecher PEDIATRIC ENDOCRINOLOGY Hospital The Children's Hospital ofBuffalo Program Director Dr. Margaret MacGillivray PHYSICAL MEDICINE AND REHABILITATION Hospitals Buffalo General Hospital The Children's Hospital of Buffalo Ene County Medical Center Mercy Hospital Sisters of Charity Hospital VA Medical Center Program Director Dr. Kyu Ha Lee Number of Positions - 13 a n 5 u m Hospitals The Children's Hospital of Buffalo Western New York Children's Psychiatric Center Program Director Dr. David Kaye umber of Positions - 6 RADIOLOGY Hospitals Buffalo General Hospital The Children's Hospital of Buffalo Erie County Medical Center Millard Fillmore Hospitals VA Medical Center Program Director Dr. Angelo De!Balso umber of Positions- 18 Programs PEDIATRIC RADIOLOGY Hospital The Children's Hospital of Buffalo Program Director Dr. jerald Kuhn SOCIAL AND PREVENTIVE MEDICINE Hospitals Buffalo General Hospital Program Director Dr. Michael oe Number of Positions - 7 SURGERY Hospitals Buffalo General Hospital Erie County Medical Center Millard Fillmore Hospitals VA Medical Center Program Director Dr. Eddie Hoover Number of Positions - 72 Programs COLO AND RECTAL SURGERY Hospital Buffalo General Hospital Program Director Dr. Bertram Portin umber of Positions - 1 PEDIATRIC SURGERY Hospital The Children's Hospital of Buffalo m e 9 9 �··············· ····························•··· Bl I Program Director Dr. james Allen Number of Positions - 2 Erie Count)' Medical Center VA Medical Center Program Director Dr. joseph Margarone Number of Positions - 8 VASCUlAR SURGERY Hospitals Buffalo General Hospital Millard Fillmore Hospitals VA Medical Center Number of Positions - 2 PEDODO TICS Hospital The Children's Hospital of Buffalo Program Director Dr. joseph Bernat umber of Positions- 4 THORACIC SURGERY Hospitals Buffalo General Hospital The Children's Hospital of Buffalo Millard Fillmore Hospitals Roswell Park Cancer Institute VA Medical Center Program Director Dr. Eddie Hoover umber of Positions - 4 UROLOGY Hospitals Buffalo General Hospital The Children's Hospital of Buffalo Millard Fillmore Hospitals Roswell Park Cancer Institute VA Medical Center Program Director Dr. Gerald Sufrin umber of Positions - 9 AFFILIATED PROGRAMS MERCY HOSPITAL Program Internal Medicine Program Director Dr. Thomas Raab umber of Positions - 23 NIAGARA FALLS MEMORIAL HOSPITAL Program Family Practice Program Director Dr. M. Oyster umber of Positions - 12 Program Gynecology and Obstetrics Program Director Dr. Michael Ray umber of Positions- 8 SISTERS OF CHARITY HOSPITAL Program Internal Medicine Program Director Dr. elson Torre Number of Positions- 20 DENTAL PROGRAMS GENERALPRACTICE DE TISTRY Hospital Buffalo General Hospital Program Director Dr. Alan Drinnan umber of Positions - 6 GENERALPRACTICE DE TISTRY Hospital Erie County Medical Center Program Director Dr. Stuart Fischman umber of Positions - 6 GENERALPRACTICEDE TISTRY Hospital VA Medical Center Program Director Dr. Gene lnneo Number of Positions- 5 GE ERALPRACTICEDENTISTRY Hospital Millard Fillmore Hospital Program Director Dr. Sanford usbaum umber of Positions - 3 ORAL AND MAXILLOFACIAL SURGERY Hospitals Buffalo General Hospital B 0 0 • p h y 5 c 0 s m m e 9 9 I �"The Name of the Game" in health care reform today is reasonable change JAMES TODD , M .D. , GIVES STOCKTON KIMBALL LECTURE s he spoke in sports analogies and anecdotes,] ames Todd, M.D.'s message was clear: any change in the American health care system will have to be "slow and reasonable. " Executive vice president of the American Medical Association, Todd delivered the Stockton Kimball Memorial Lecture- "The arne of the Game" - at this year's Spring Clinical Day, held May 1. Margaret Paroski, M.D. , '80, assistant professor of neurology and Spring Clinical Day chairperson, introduced Todd to an audience of about 300. "If you read Time or Newsweek , I don't need to introduce you to Dr. Todd, because every time you hear anything about Hillary Clinton dealing with theAMA,you'llsee Dr. Todd's name." Todd explained how he sees health care as a game, with "rules, regulations, goals, winners and losers. Meanwhile, we and our patients are out on the playing court, fighting our way to a goal that sometimes seems only we continue to see. But unlike any other endeavor, there are also some rules, in this case called antitrust, that prevent doctors from working out their own team game plan. " Todd called UB "a grand example of how you can coordinate the education of students, the needs of the community and become a very cooperative activity to teach and advance the art and science of medicine." He lauded Stockton Kimball by saying, "Dr. Kimball was noted for many different achievements: for his knowledge of tropical disease, for his dedication to improving the physical facilities of your campus, for his concern for the people and commuB u 0 0 p nity of ew York State. "His involvement, his brand of humanitarianism, his genuine caring, personify the characteristics, the kind of personal concern which draws us all when we think about going to medical school." Todd said he saw a connection between Kimball's work and the theme of this year's Spring Clinical Day lecture, noting that in 1950 Kimball chaired a special AMA committee to study medical training in times of war and crisis called the joint Committee on Medical Educa- y s c 0 s tion at the Time of National Emergency. "How appropriate that is. And how very germane that is to my being with you this afternoon. Because if there was ever a time of national emergency in health care, we're facing it today. " The crisis is so compelling, Todd said, that "Mrs. Clinton has assembled a committee of 500 to find a solution. I'm not telling you it's a professional emergency -although it is that- nor is it a patient emergency- but it is that, too. The state of health care in this country is a national emergency-one that touches every single citizen of the United States," Todd said. "It touches the 87 percent for whom the current system has essentially been working pretty well. And it especially touches the 3 7 million people who are denied access to the system because of insurance regulations, loss of jobs or a dozen other quirks and loopholes. "These have rendered the basics of health care out of reach for too many for too long. And it is not a secret to anyone anymore that the present system is unsustainable. " either patients nor doctors can stand too much more of our present system. " Todd explained how he thought that the "future in the medical sciences will be limited only by our imaginations. Indeed, if the Clinton administration does the job that all of America hopes they'll do, I think we will have a lot to look forward to as far as returning to the goals that motivated us as physicians. " Todd warned of the dangers of mixing politics and medicine. "If Clinton and Clinton get stuck in the thicket m m e 9 �of political and practical miscalculations, we will all suffer-especially our patients. "The stakes are even higher than our own professional standing. And the name of the game I am talking about is patient care. Rules are being written even as we speak," Todd said. "Well, I'm no slam-dunker myself, but I do know this: there's not a coach in the world who doesn't try to improve on player performance." Todd noted that various strategies for rescuing the American health care system have already been proposed, adding that the AMA was one of the first organizations to put forth a plan. "We put a plan on the table known as Health Access America. It is the American way to reform the health care system. It seeks to bring to patients an essential set of benefits, universal access, cost containment, equity - while at the same time working to bring doctors relief from regulations." Todd believes the key to reforming the health care system is "not just change, but reasonable change. "Responsible change is the winning strategy. Today, patients are sent into a system so wrapped up in red tape they can hardly maneuver. Doctors half the time are playing with one hand tied behind our backs. We are coming under scrutiny that seeks to punish and not to educate, sending us racing full-tilt into the shelter of defensive medicine, so we don't get sued or worse," Todd said. ''I'm sure all of you would welcome a world in which you could follow your best clinical judgment and return the profession to the ability to discipline itself." But change will not occur, Todd said, unless "we show restraint in our behavior in what's going on around us. We have to focus on responsibility to our nation. We cannot afford to think of medicine as a spectator sport. We have to have active participation." + BY B u CARRIE a Calls for membership in the James Platt White Society went out from medical ~chool ~lumni during a special membership drive held last April. From left are: Albert G. Rowe, M.D., 61; R1chard R. Romanowski, M.D., '58; Michael A. Sansone, M.D., '85; Angelo M. DeiBalso, M.D., '78; Lawr~nce E. Mervine, assistant dean and senior development officer with the University at Buffalo Foundation; Arthur W. Mruczek, Sr., M.D., '73, and Elizabeth P. Olmsted, M.D., '39. Frawley '44 receives prestigious Alfred Stengel Memorial award homas F. Frawley, M.D., '44, has been awarded the 1993 Alfred Stengel Memorial Award. The American College of Physicians award, established in 1947, is given to a Master of the College who has exhibited "unusual loyalty and exceptional contributions to the aims and purposes of the College as well as outstanding influence in maintaining and advancing the best standards of medical education, medical practice and clinical research." Frawley, the 1989 recipient of UB's Distinguished Medical Alumnus Award, is a professor emeritus and chairman of the Department of Graduate Medical Education of St.john's Mercy Medical Center, St. Louis, Missouri. A governor of the American College of Physicians, he served as that group's president from 1981 to 1982. Frawley , who has been active on research and evaluation committees of the ationallnstitutes ofHealth, the ational Academy of Sciences and the American Medical Association, received his award in March at the American College of Physicians' Convocation held in + Washington, D.C. LIBERANTE 0 p h y 5 c a 5 m m e 9 9 3 �hkhert Kenneth Eckhert M.D~ Sr~ lauded by Niagara Lutheran Home he iagara Lutheran Home Foundation presented Dr. Kenneth Eckert, M.D., '35, with its 1993 Humanitarian Award at a special dinner in his honor last April. Eckhert, a lifelong Buffalo resident, played a key role in the establishment of the Health Service Agency- the first of its kind in Buffalo and the first to receive federal funding. Eckhen served as president of that agency, which was a forerunner of today's Health Systems Agency. Eckhert and his long-time friend, the Reverend Dr. Ralph Loew, were instrumental in the establishment of Trinity Tower, a senior citizen residence developed in conjunction with Holy Trinity Lutheran Church. Eckhert is a member of the board of trustees of the Niagara Lutheran Home Foundation and currently serves on a number of boards and medically related associations. He served as chiefof surgery, chief of staff and president of the executive committee of the fomer Deaconess Hospital. + B u 0 0 p American Academy of Family Physicians honors UB physician Harrts Directory begins survey of UB medical school alumni arlos Roberto jaen, M.D., '89, UB assistant professor of family medicine, was one of eight physicians honored recently by the American Academy of Family Physicians for their contributions to medicine and public health. Jaen received the Academy's McNeil Clinical Research Award for his work, "Symptoms Associated with Middle Ear Effusion in Children: A Basis for Quantifying Clinical]udgment." jaen came to the University at Buffalo in October 1992 after completing a fellowship and residency in family practice at University Hospitals of Cleveland, affiliated with Case Western Reserve University. He holds a doctorate in epidemiology and a medical degree from the UB School of Medicineand Biomedical Sciences. He completed his undergraduate and master's degree work at iagara University. jaen's research on tobacco dependence and bladder and colorectal cancer has been published in various scientific journals. + Carlos Roberto Jaen, M.D. s preparation for publishing an extensive medical school alumni directory, the Harris Company will begin sending questionnaires to all alumni with current addresses. Please be sure to complete and return your directory questionnaire as soon as possible to help make the School of Medicine and Biomedical Sciences' new directory as complete as possible. Alumni who fail to return their questionnaires may be inadvertently omitted from the directory. + y 5 c o n s m m e 9 9 3 �A Spoonful of Humor © Stu Silverstein, M.D. Health Care Reform It's No Joke • • • Stu Sil\'erswn, M.D., prrs1drnl of Slandup Med1c1ne Unless You Make It One Srm1nars of San Franmco, Califorma, lee lures nal!onw1de on humor in medicine In the previous issue of Buffalo Physician we talked about the technique of revamping old jokes with medical themes for appropriate use when addressing medical audiences. Here are a few jokes and anecdotes about an issue that seems to be appearing everywhere- in the news, on these pages, in our nation~ capital, and maybe even in our practices-the managed care movement in health care reform. • Recently, I was sitting in the doctors' lounge, reading the AMA ews and Buffalo Physician. I spotted a friend reading a government report on health care reform. I asked him why he was wasting his time reading that crap. He looked at the AMA News I was reading and said, "What are you reading about in there? How medicine is changing for the worse- managed care is placing unrealistic restrictions on us, our incomes will be going down, we won't be able to practice the way we used to. "You read that and get all depressed. I read this and find out we're all millionaires, play golf on Wednesdays and will continue to get rich despite health care reform." • I'm not sure ifl feel so good about two lawyers revamping the health care system in this country. Do you get the feeling that after four years in office we're going to get a bill for 35,000 hours for Hillary's services? B a a p h ''Asking the government for advice on how to run health care is like asking Sylvester Stallone for acting lessons.'' • Asking the governmentforadviceonhow to run health care is like asking Sylvester Stallone for acting lessons. • Hillary Clinton reminds me of someone who takes your watch off to tell you what time it is. • I told my son that I wanted him to be a partner in my practice, but it seems the government will beat him to it. • When I played hockey in high school, I spent most of the time sitting on the bench. In the last game of the season, we were down by one goal with one minute to go and no time outs left. The coach called my name to send me in. I turned around to get my instructions and he said, "We're out of time outs and can't stop the clock. Go in there and get hurt. " As a doctor facing health care reform, I feel as if I'm reliving that experience. + 5 c a n 5 u m m e 9 9 �• . ........... ... ... ..... . .................... ... .. . . .. . .. . ......... . ......... . ......... medical practice, and clinical re- governor to the American College search ." Frawley served as presi- of Surgeons for North Carolina. dent of the College from 1981to EUGENE A . PAUL '77 , writes, 1982. "My time is divided between a 1 9 6 0 full-time position as chief of the 5 medical clinic at Harlem Hospital ROBERTA GILBERT '62 , in- and a private general internal forms us that the first printing of medicine practice in Jamaica, ew her new book, Extraordinary Re- York. " lationships: A ew Way of Thinking About Human Interaction, sold out; the publisher is already be- ORESETES G . ROSABAL '77 , Southern Medical Association's ginning the second printing. Bernard S. Stell 1 9 3 State Councilor for Florida, reScientific Assembly of the Asso- laboratory dire ctor at Coastal 0 5 BERNARD 5 . STELL '36, of cently attended the 86th Annual Mi(hael Rowland CALVIN MARANTZ '65 , is now ROBERT B . KROOPNICK '72 , Communities Hospital in Santa Ana, California. Sun City, Arizona, has received was elected to fellowship in the Rosabal, a specialist in orthopaedic American College of Physicians. and traumatic surgery, is in private practice in Hialeah, Florida. the Diamond Star Award in the DONALD J . WALDOWSKI '65 , Kroopnick is board certified in Stereo Division of The Photo- has a solo private pediatric prac- internal medicine with additional graphic Society of America. tice at850 West High Street, Lima, qualifications in geriatric medi- Ohio. cine. pediatrics in Troy, ew York. " 1 9 4 0 5 THOMAS F . FRAWLEY '44 , DOUGLAS H . MOFFAT '79 , recently assumed the position of chief of medicine at Buffalo Psy- WALTER Z. SCHWEBEL '83 , writes, "I am still in the practice of ciation held in San Antonio, Texas. ANTHONY B . SERFUSTINI '66 , RETA D. FLOYD'73,announces chiatric Center. is chairman of the department of the opening of a new office at 924 orthopaedic surgery at the Uni- Buena Vista, Suite 204, Duarte, versity Medical Center in Las Ve- California 91010. Outside of work, EDWARD ROCKWOOD '80 , gas, evada. Floyd is active in her church where practices ophthalmology at Cleve- she is a Sunday school teacher. land Clinic Foundation. He and 1 9 8 0 5 chairman of graduate medical JOHN E . SPOOR '66 , writes, "I She also is active in the Pasadena! education at St. John's Mercy his wife Joan (former Millard have been named the editor of the Altadena chapter of Links - Medical Center and emeritus pro- Fillmore Medical Education sec- Section on Rural Emergency Medi- women's civic organization. Floyd fessor of medicine at St. Louis cine Newsletter- ACEP." lives in Altadena with her hus- University School of Medicine, was the 1993 recipient of the Alfred Stengel Memorial Award presented by the American College of Physicians. The award is given periodically to a Master of the College who has exhibited "unusual loyalty and exceptional con- a DANIEL P . SCHAEFER '81 , a band and two children. 1 9 7 0 retary) have three daughters. UB clinical assistant professor, 5 ELLIOTT SCHULMAN '74, has RONALD H . BLUM '70 , has been appointed deputy director of the Kaplan Comprehensive Cancer Center at New York University Medical Center. been elected a fellow of the Ameri- attended the American Society of Ophthalmic and Plastic Recon- can College of Physicians. In ad- structive Surgery meeting in Dal- dition to lecturing extensively on las, Texas. A member of the Edu- headaches, he is co-director of the cation Committee, he assisted in Comprehensive Headache Cen- giving written and oral examina- tributions to the aims and pur- BRUCE M . PRENNER '70 , was ter at the Germantown Hospital tions to the candidates for mem- poses of the College as well as in Philadelphia, Pennsylvania. bership in the society. outstanding influences in main- invited to present clinical research on asthma before the European taining and advancing the best standards of medical education, Respiratory Society in Vienna , Austria, in August. MICHAEL ROWLAND '75 , of Pinehurst, orth Carolina, was elected to a three-year term as B 0 0 p h 5 c 0 n s u m m e �····· · ················· ··· ··························· ·· ················· · ·················• II • DEIRDRE GREENE '86 , Elliott Schulman writes, JEFFREY WASSERMAN '82 , writes, "Vickie and I now reside in doing pediatrics. My husband, Rob Dixon, and I now have two kids - Patrick,3, andAurora, 16 Rochester, ew York, with our two sons, Robb, age 6, and Steven, age 4. After my residency in anes- months." thesiology, I spent one year as an MICHAEL S . academic anesthesiologist at the University of Rochester's Strong MILLER '86 , writes, "I am an assistant profes- Memorial Hospital. I am now in sor of psychiatry and a full-time faculty member of the University private practice at Rochester General Hospital." of Texas Health Science Center at San Antonio. My wife, Pamela, MARGARET and I have two beautiful children writes, "I completed my pediatric - Laura L. Post Matthew, age 3, and Jeffrey, D . JENKINS a senior fellow in the Robert TINA GARDNER '87 , ROSLYN '86 , R. ROMANOWSKI sion of hematology/oncology and Washington, will receive her MPH in Epidemiology in June 1993. Harvard Medical School instructor, received a five-year Clinical SARAH MURRAY WHITE '85 , Investigator Development Award (CIDA) totaling $385,000 from the National Heart, Lung and writes, "I have recently joined an Washington, D.C., where I practice rehabilitation medicine and perform electrodiagnosis. We are at the Washington Hospital Center. My husband, Bill, son Cameron, two and one-half years old and I live in Annapolis, Maryland. I recently spoke with Gretchen Pankow '87, who will be doing an endocrine fellowship at Massachusetts General (unless she changes her mind)." KARIN E . CHOYS '86 , writes, ''I'm a practicing pediatrician with the Kaiser Permanente HMO in the Hartford, Connecticut area. I am also happily divorced and enjoying 'flying solo!"' address is St. Regis Mohawk Tribe Health Services, do Community Building, Hogansburg, ew York. LAURA L. POST '87 , SHAUGHNESSY '86 , writes, "I have moved back to Boston with my partner, Rick, and combine private practice, mental health center work and a teaching appointment at Harvard Medical School and McLean Hospital." RAY 800RADY '87, has been medical director of Operation Concern, a lesbian/gay community mental health and services agency in San Francisco. She is active in research on lesbian mental health in addition to having a prolific writing career in women's music and culture. Post and her partner, Judith Avery, R.N.C. , have two sons and one grandchild, Karen, who is 18 months Blood Institute to investigate the erythropoietin receptor - how red blood cells are produced. JAM E S writes, "I have moved to northern ew York and am working for the Mohawks. It's beautiful up here! " Her new a staff physician in the divi- Wood Johnson Clinical Scholars Program at the University of orthopaedic surgery group in old. currently chief of the psychiatry clinic at Massachusetts General Hospital, completed four years in youth psychiatry and will finish a two-year STEPH E N C . SORENSON '87 , informs us that he completed an emergency medicine residency in Louisville, Kentucky, and is pres- fellowship in psychiatry in June. He has accepted a two-year staff position at Harvard. Boorady re- ently in private practice. He marriedJudith Bellville on September 19, 1992, in Louisville. cently attended an international A . MOREY '88, residency at Rainbow Babies and Children's Hospital, Cleveland. After a much-needed hiking trip in New Zealand, I'm beginning a fellowship in adolescent and young adult medicine at the Children's Hospital in Boston." is now director of clinical and regulatory organogenesis in CamM ICHAE L SABOLI NSK I '88 , bridge, Massachusetts. PAUL SHIELDS '88, u a 0 p h y 5 c has a pri- vate practice in internal medicine in Naples, Florida. In October he joined the aples Medical Center, specializing in internal medicine. CHARLES S . P . J E N KI NS '89 , of Chapel Hill, North Carolina, informs us, "Got married. Doing well. Will be hearing the pitterpatteroflittle feet soon. Seeya'll." KENN ETH P . SUN '89 , is cur- rently an anesthesiology resident at St. Luke's Roosevelt Hospital Center, ew York. TRAC I TROUP '89 , has joined the department of family practice convention in Paris. e '87 , "Still in Allentown, Pennsylvania, age 17 months." LAURACINNIE I a 5 m m e 9 9 �• .. . . . . . ................................................................................... I at Group Health , Inc.'s St. Paul Medical &: Dental Center, in St. Paul , Minnesota. 1 9 9 0 ELI Z ABETH CONROY 5 '92 , and her husband jeff, announce the birth of their son, Dylan Reid, on january 8, 1993. She is currently in a dermatology residency at the Cleveland Clinic Foundation . OBITUARIES RUTHERFORD FORD 5 . RUTHER · '41 , died in Dillon Beach, California, ovember 27, 1992, after a long illness. Rutherford was chief of staff and founder of Marin General Hospital in 1955; founder of Marin Organ Bank and Marin County Heart Association. He was the author of over 100 scientific and medical papers. L L OYD M. LEHRER '79 , died February 22, 1993, due to the effects of Behcet's Syndrome. In Beginning with our Autumn 1993 issue, our readers will hove the opportunity to learn more about products and services of interest to them. We ore happy to provide advertisers the opportunity to shore their product information with our unique readership who number more than 10,000. For additional information, please contact our Advertising Manager. addition to his private practice in Houston , he served as an assistant clinical instructor of medicine at Baylor College of Medicine , chair- • man of the department of medicine at Bellaire General Hospital and chairman for public education for the American Cancer So- University ot Buffalo Publications Deportment ciety, where he was honored for his work by the State of Texas. He 136 Crofts Hall is survived by his wife, Susan, and his sons, Benjamin and Michael , Buffalo, New York 14260 of whom he was so proud. Phone: (716) 645-2626 FAX: (716) 645-2313 B a a p h s a n s m m e 9 9 3 ��BUFFALO PHYSICIAN STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 ADDRESS CORRECTION REQUESTED Non-Profit Org . U.S. Postage PAID Buffalo, NY Permit No. 311 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Summer 1993 Subject The topic of the resource State University of New York at Buffalo. 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Research Hospital News "He captured my heart in a way that patients aren't supposed to." Managed Care Medical School Graduate Education Alumni A Spoonful of Humor Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-12-18 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v27n03 Extent The size or duration of the resource. 48 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1993 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/d780fd2a03a80c9fed4f5662cb58735f.pdf 3aa09c9c1329e25bce74f2157eff2cd7 PDF Text Text State University of New York at Buffalo School of Medicine and Biomedical Sciences, Spring 1993 . '• B~~a~·se of it, 7,367 .Americans will die this year. �Dear Alumni and Supporters of the UB Medical School, BUFFALO PHYSICIAN \ olume ~7 1\ -be- T DIRECTOR OF PUBLICATIONS (ACTING! )- C m 'e ~m1th Pet o he facultv of the Department of Social and PreYentn·e \ledKme and Gynecolog) and Obstetri~s are pursuing the possihilit\· of bemg designated a \'anguard Center for the EDITOR -..anette Tramo;- r_, g, R ART DIRECTOR \!an ] Kegler ASSOCIATE ART DIRECTOR Soa R f rich. STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES 1 John "\~mg',~ );--. \ L ~: Prcslc ~nt fc r Climcal -\ffz s, D.· Jlt EDITORIAL BOARD )r )0hn \ Rich t C r• ..,.." • Wvmen s Health Initiati,·e Clinical Trial sponsored b' the :\atioroal Institutes of Health. This m1tiat1Ye ''as approYed by Congress and is designed to eYaluate the health status vf women and the effect of a selected number of interYentions important to the health of women. Dr. \laurizio Tre\isan and Dr. \lyrosla\\ Hreshchyshyn haw proYided excellent leadership for this important multidisciplinaf\ effort TwentY-four organi::ations are being site-Yisited and it is expected that 15 wtll recciYe the designation of a Vanguard Center UB 1s wn excited about th1s possibdn' because clinical trials arc an important component of our research portfoho, and thts trial in particular, serws to complement our other inil!al!Yes re:.ned to pnman health care, health promotion and d1sease preHntion The staff of the Buffalo Physic tan and 1 keep you abreast of our progress in this Important area ''ill Sincere!~, ~~- R charc de Asia Dr \lo t - r ec ·or !.)r HOl old Bn""~d\ D• R charL Lolhns !), Donald P (.>:>lev '"lr I !an J Dnnnan L>1 fi -"'C'l \ ual-rvc Dr Glen ( res',J-, ]a -es Kd. 1s"'i john ;'>.aughton, ~!.D. \'ice Prcstdcnt for Cli111cal 4.ffairs Dean, Sdwol of \fcdiCIIIL cwd Bio111cdical Sciences L)r harles \lassar ..l ( harles Poganelh L utrc Rc bnson T cmas Rcse ·hal "" Ia ~Lrc ,r Bra<llrv fP'lX s, phen Snaul<ung jerome\ •• .:s !)r ( ): ): ), · 11 ::Jr Dr Dr Dear Fellow Alumni, TEACHING HOSPITALS AND LIAISONS Bato\ ia \ \ \le~ ul (enter Buffa'o C.e •er~. • >Sf nal ~\fh. harl '\rlt n. Buffo o \ \ \le~ c II ( enter t .<lo Pcd'"' C hildren s Ho;m 1! vf Buffale> E'IC c uUnt\ V,Jical ( e ·t.r Me C\ tms;1u,tl Mill. d FIll more t. "rlt.IIs Fr..,"11l '\a\· RC'..,we \ .... k (ancer ns.Hute SISt"rs of C harm • "• nal Dcnn.s \~. ( arriJ, c: fhl ~tJte a· >1 "IIo l m,·cro;;it\ ,. '\._w \ )f c. ,{Ja'o P11, s •• In 1s pu~l sh d quanerh "' t .. State l mvers v < f ew \ ork a• f ff 1lc Sc ..lol of \teL c~ne ., d Dl~:ncc... c 11 '>lllnccs '" c. ·~e '-'f:- c~ vi Pubu... lt c ns. I • ) ~nt free vic Jtg". 1o::~ .,...ni, 1'li uh} 't .:tc --s. r,si<.~nts anc. fnends. frc stalfr~srrve<t e r ght t· e~ .allccp' 11 Jnc Sl. b ni<;.c;Jo 1!...t. hcai.IOn. S lCCe 'ted f H \ddr>ss <JU stions, wmments and submis'i<.."- ~ ~o F c! tor b.IJJ.l'~ Pin s.(.UHl State l nivercoih of t\,;.c'' ' ' k Jt BuffJIJ l nners;t. Pu.>i"cc...:io""'"' ~6\.. oftsHall,b1 J Jlu "C\\ \ 1: k l4l6ll Send address changes to: BuJ ,• PII) '" an 14f ( FS \J<.htwn. l h \1ain~t eet Puffalo,"'cw\or' 1+21+ Cover llluslrolion by Ted Pitts T he excitement mounts as we approach the focal pomt of our -\lumni war- our 56th annual Spring Clinical Day on \lay 1, 1993 at the Buffalo \Iamott. \\'e are expLcting ~arucularly good att.endance this ,·ear for our C\-cle of class reumons going back o\'er )0 years. As) ou h.n e come to expect, we w11l also be presentmg another proYocatl\ e and challengmg cducauonal program that this Year is entitled "Doctor Watchers." This program will highlight the Yarious agencies that monitor physiuan performance and suggest \\a\·s to aYoid unwarranted scrutin). Our energetic ch:urpcrson, Dr. \largaret Paroski, has obtained commitments from an outstanding group of knowledgeable speakers. From Rochester comes Dr. Charles\ acanti, who is presentlY ser\'lng as Chairman of the '\Je\\ York State Board of Professwnal Conduct. Another speaker wlll be '\Janq ' iclsen, \\ell-known Buffalo internist and currenth the Regional ~led !Cal Coordinator of the Office of Professional Conduct. Other local speakers will include Dr Ross Hewitt from the AIDS ser\'lce at Erie Count\ \ledical Center and Dr. \lichael Horan clinical mstructor in pediatrics at The Children's Hospital of Buffalo Our d,stinguished Stockton Kimball lecturer thisyearwill he the American Medical -\ssociation's Dr James Todd, talking about "The '-Jame of the Gaml" As alwaYs, thts program carries four hours of Category 1 C\IE credit. Be sure to look a gam this year at the full Yaricty of Spring Clinical Day poster displavs summari::ing much of the current medical research being done at the UniYersity. \\ e are also Yen· pleased this year to be presentmg for the first time a group of Alumm Achie\·ement Awards at the afternoon luncheon honoring alumni who haYe made outstandmg contnbutions in partJCular fields of medical endeaYor or communit) sCf\"lce And don't forget our popular fridav night reception April 30th at the Center 'or Tomorrow thM th1s year wdl recognize our Reunion Chamnen as thev present for the first time our \lumni Scholarship awards to desen·ing medical students. This Year"s Spring Clinical Da\ \\ill certain I) be memorable and I urge you all to attend. 'I ours truh, Don Caple). \I D .. '70 �0 L p 2 R N G 9 9 3 IJ Research IJ Hospital News II Cluster lllnessese UB med student wins American Public Health Association award. Page 22. Sorting through one of the most vexing phenomena in medicine. m The Waiting Game e Despite advances in transplant technology, one-fourth of the people waiting for organs will die because of a shortage of donors. Leaving them laughing using humor in talks and presentations. Page 25. m Medical School ASpoonful of Humor , Alumni Classnotes ~tanoaro antibiotic therap~ for ear infections calleo ineffectiue. rage ~. New Roswell Park testing helps ensure safety of donated tissue. Page 20. �· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · IJ ' / . girls, he points out, and bottle feeding blood flow, " said Alan Lockwood, M.D., appears to be associated with increased UB professor of neurology and nuclear medicine and director of PET operaotitis media with effusion. In addition, the earlier in life children tions at the Buffalo VA. "This will octors know that ear infections in develop ear infections, the greater their expand the capability for existing and children rise as the temperature falls. risk of suffering recurring infections future PET system," he added. + But what they don't know, says a UB throughout childhood. Other factors such researcher and physician, is how to as family history, allergic conditions and a effectively treat the condition, de- mother's cigarette smoking might increase spite decades of antibiotic use. the risk of otitis media. 'The very fact that otitis media ... in the The standard treatment for ear infecantibiotic era, has emerged as a disease of tions is successive doses of antibiotics, an overwhelming, epidemiologic importance, approach that has resulted in increasing he National Cancer Institute has awarded five multi-year grants totalmust indicate that the treatment of this populations of resistant bacteria, Bernstein ling$1,566,723, to UB-Roswell Park condition has been somewhat of a fail- notes. + BY LOIS BAKER Cancer Institute researchers. ure," saidjoel M. Bernstein, M.D., clinical Richard Bankert, an associate reassistant professor of otolaryngology and search professor from Roswell's depediatrics. Otitis media accounts for more pediatpartment of molecular immunology, received a fourric visits to doctors' offices than any other year, $572,764 infectious disease and is the most common cause of hearing loss in children, grant to assess he Buffalo VA Medical Center will Epstein-Barr ViBernstein writes in Hospital Formulary. receive more than $I50,000 to de- rus (EBV) vacciSome children have ear infections more velop software for its new Positron nation strategies than others- a result, he says, of characEmission Tomography (PET) scan- to determine their teristics or conditions that seem to predisner through a grant developed un- ability to induce pose certain children to the condition. der a cooperative research and de- immunity in laboBoys tend to be more susceptible than velopment agreement ratory mice from between the VA and SieEBV-induced disseminated lymphopromens Medical Systems. liferation. The three-year reBonnie B. Asch, Ph.D., an assistant research project, formed search professor from Roswell's experiunder the auspices of the mental pathology department, received a four-year, $421,795 grant to investigate federal Technology Transfer Act, will allow mammary cell markers in different stages the development of two of progression to malignancy. Carleton C. Stewart, Ph.D., a UB renew software modulesone to compute blood search assistant professor, received a fourflow and one to describe year, $239,499 grant to conduct a multiparameter flow cytometric analysis of metabolism in the brain solid tumors. Stewart, from Roswell's flow using mathematical cytometry facility, also received a threemodeling of biochemiyear, $158,574 grant to study the role of cal reactions. flow cytometryin molecularphenotyping. "Right now there is Thomas S. Mang, Ph.D., a research assono software in our computer system that enciate professor from Roswell's radiation ables a user to measure medicine department, received a three- Standard antibiotic treatment for ear infections labeled ineiTective NCI awards $1.5 million in grant money to UB-Roswell researchers VAMC receives cooperative grant to develop new PET software B a 0 p a n 5 p g 9 �····························································· · ·········· ·· ··············· · m ·~!lj '·' ~~"· '· , . women and 239 Italian women with relation to 16 symptoms during three phases- premenstrual (defined as the week before menstruation), menstrual and the remainder. Results showed that omen from different cultures, livAmerican and Italian ing vastly different lives, experiwomen experienced ence many of the same menstrual nearly the same amount and premenstrual symptoms, a of symptoms overall, State University of New York at while Bahrainian women Buffalo researcher has found. reported fewer symptoms. The study is the first large-scale, popuWomen's experiences lation-based comparison of menstrual across cultures were most cycle distress across cultures. similar during the men"Margaret Mead suggested cramps are strual phase, and least trans-cultural symptoms," said Lisa A. similar during the remainder phase. Monagle, Ph.D., clinical assistant profesSymptoms reported during the premensor of social and preventive medicine and strual phase were revealing, Monaglesaid, lead investigator in the research. "Our because they show that the condition study confirms this, and also suggests that known as premenstrual syndrome (PMS) other symptoms, such as water retention, is not, as some people have suggested, a emotional distress and decreased activity, media-created phenomenon. Premenare experienced trans-culturally as well." strual symptoms common to all three The study compares the experiences of cultures were fatigue, anxiety and cramps. 179 American women, 172 Bahrainian Generally, Monagle found as many differences as similarities between cultures in the prevalence ofindividualsymptoms, but found consistent symptom groups + across all three cultures. . ' . year, $174,091 grant to investigate the use of photodynamic therapy in the treatment of pancreatic cancer. + Menstrual symptoms experienced across cultures,UB study shows BY LOIS BAKER Tacrine found to reduce some early Alzheimer'ssymptoms UB researcher is one of six authors of a study published in the ovember 11, 1992 issue of the journal of theAmericanMedicalAssociation that shows the drug tacrine is effective in reducing some of the symptoms of early Alzheimer's disease. Linda A. Hershey, M.D., associate pro- B u a a p s c a n s p fessor of neurology and chiefof the Buffalo VA's neurology service, performed the study at the Buffalo VA Medical Center with Kerry Donnelly, Ph.D., assistant professor of psychology, and Karen Burch, R.N., clinical nurse specialist. The 20 patients in the Buffalo component of the study were among 468 Alzheimer's patients at 23 outpatient centers nationwide enrolled in the trial. The study involved men and women over 50 who were mildly to moderately impaired due to probable Alzheimer's disease, but otherwise in good health. During the 12-week trial, patients received either a placebo or a daily dose of tacrine. Tacrine-treated patients showed significantly more improvement in memory and language than those receiving a placebo. Physicians and caregivers also noted greater improvement in behavior in the tacrine-treated patients than those on placebo. Patients taking tacrine should be closely monitored for side effects, including liver toxicity, nausea and vomiting, diarrhea, abdominal pain, dyspepsia and rash, Hershey cautioned. + BY n LO 9 I S BAKER 9 9 0 �----- Deaconess establishes area'sfirst pediatrtc long-term care unit v a 0 - couraged to participate in formulating care plans, as appropriate. The 21 pediatric S F beds are being filledinstages,withoccupancyofthefirst two-thirds already completed and the last third anticipated by June. Jan Valencourt, R. ., is the unit coordinator. + he only long-term pediatric care unlt m upstate ew York opened late last year at The Deaconess Center, a division of The Buffalo General Hospital. The 21-bed unit will care for children with congenital defects, specialized medical problems and head trauma. It is the seventh such facility in ew York State. The pediatric unit is the final link in an $8 million renovation and construction project at Deaconess that began in 1989. An earlierphaseoftheprojectadded 38 geriatric beds to the facility, which now has 200 geriatric skilled nursing beds, 21 adult long-term care head trauma beds and the pediatric unit. "A serious shortage of skilled nursing beds for children in the state prompted Buffalo General to develop this specialized unit," said Marilyn ]. Gibbin, BGH vice president for long-term care. "Because of this scarcity, we anticipate referrals from local agencies, as well as downstate and out-ofstate," she added. Gibbin noted that The Children's Hospital of Buffalo served as an early catalyst for the project and trained the unit's nursing staff. Linda A. Kam, M.D., medical director for the new unit, has privileges at both hospitals. In addition to physicians and nurses, the unit's multidisciplinary team includes social workers, audiologists, leisure time activities and educational personnel, nutritional services staff and occupational, speech and respiratory therapists. Families, and the children themselves, are en- B -- sliding glass door to allow for both continuousobservationandquietprivacywhen desired. Each patient room also has a large window to allow for ample natural lighting." The new ICU connects directly to Sisters' new surgical unit, slated to open in March. A new on-call physician room adjacent to the unit has also been added. The renovated units feature time-elapse clocks in patient rooms and nursing stations to facilitate code and drug administration record-keeping, air mattresses with pumps, scales mounted directly onto the beds and hemodialysis hookups at each bed. + Edge appointed chief of Roswell Park breast surgery division tephen B. Edge, M.D., has been appointed head of the Division of Breast Surgery, Department of Surgica I Oncology, at Roswell Park Cancer Institute. Before assuming his position at Roswell last summer, Edge served as assistant professor of surgery at the University of Virginia at Charlottesville since 1986. He is a graduate of Case Western Reserve University Medical School and completed his internship and residency in general surgery at the University Hospitals of Cleveland. He served a threeyear fellowship in surgicaloncologyatthe ationa! Cancer Institute, Surgery Branch. Edge is a principal investigator with the a- Sisters of Chanty Hospital opens renovated critical care units s part of its $42 million renovation project, Sisters Hospital has opened its newly modernized 16-bed intensive care and eight-bed coronary care units. "Both new critical care units offer patients and staff a much larger area," said Sister Mary Kelley, vice president for asset management. " ursing observation stations with recessed lighting and large counter areas overlook generous patient care rooms. Each patient room has a p y s a 5 p g 9 9 3 �. . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .[1] 0 0 p h 111: II!Otlill~ Tue M :'l], Dec 15 l'.l'lZ ................ ... . ,.. _ ......,.,,..... ?& •• _ ?1.8 .. ?1.1_ ,."' .... 18, ';0 1?. 8 17.8_ fS + :~:~- s_ '"··12 .5_ u.8_ s_ ,. ..... ... ..."·'.. """ "'·' ,,. -tZ r• tteftt. 1.11 • ll"ltb't Wed 11 .51 . ...... 1993 , ,8_ BtUi_ 88. 5_ :n.s 39.5_ Jf>.5_ JS. O "'·' ~:1 ..... 2:1.8_ 21 . 8 ' Dlt:rTI:Jil:t .' A topographic corneal scan, showing (at right) an essentially normal eye with mild astigmatism and (at left) an eye with keratoconus (pre-corneal transplant). assigned to a certain power range to produce a color-coded contour map of the cornea. One of the main diagnostic advantages of the new analyzer, Reidy said, is its ability to confirm the presence of certain conditions that previously could only be speculated, such as early corneal abnormalities. Special software added to the $30,000 analyzer allows operators to produce computerized spheric or aspheric contact lens fittings for difficult-to-fit patients. Millard's Eye Department, which has been doing five to 10 exams a week since it obtained the analyzer about a year ago, takes referrals from eye care professionals throughout Western New York, Reidy added. + illard Fillmore Hospitals' Gates Circle facility has become the only facility in Western New York to offer topographic corneal scans using newly developed computerized technology. The hospital's corneal analyzer uses concentric rings of light focused on the cornea to map its shape. Used to determine the presence of certain corneal conditions such as keratoconus, astigmatism and post-corneal transplant torsion, as well as for contact lens fittings and preradial keratotomy mapping, the analyzer uses video technology to capture the rings of light reflected off the cornea and then digitizes the image to produce a full-color print out, according to James]. Reidy, M.D. , assistant professor of ophthalmology and director of the cornea service at Erie County Medical Center. A mathematical formula translates the distance between the individual rings and transforms those distances into corneal power. "The rings are traced by computer, as well as each space between each of the 15 rings along 270 different meridians, and translated into the corneal curvature," Reidy said. The results, he added, are u r.ueon. 050 Millard oiTers first topographic corneal scans in WNY area B .. .,._"' .·-·-_ tiona! Surgical Adjuvant Breast and Bowel Project- a group of cancer researchers that receives support from the ational Cancer Institute. A leader in breast cancer research, the group was a dominant force behind the widespread use of less extensive surgical procedures for breast cancer. A fellow of the American College of Surgeons, Edge is also a member of the American Society of Clinical Oncology, the American Federation of Clinical Research and the Southeastern Surgical Congress. + - B Y N ANETTE T RAMONT KOLLIG Buffalo General Hospital names new head of orthopaedic surgery enneth A. Krackow, M.D. , an orthopaedic surgeon who specializes in hip and knee replacements, has been named head of the Department of Orthopaedic Surgery at The Buffalo General Hospital. Krackow, also named professor of orthopaedic surgery at the University at Buffalo, succeeds Edward H. Simmons, y 5 c 0 n s p M.D. , who had served as head of BGH's orthopaedic surgery department since 1983 before retiring from the position late last year. He remains an active member of the orthopaedic surgery staff. Immediately prior to accepting his new position at BGH, Krackow was a professor, full-time faculty, Department of Orthopaedic Surgery at Johns Hopkins University Medical School. He was also a member of the active orthopaedic surgery staff at Good Samaritan Hospital, Children's Hospital and Union Memorial Hospital, all in Baltimore. Krackow has authored numerous journal articles for peer and non-peer review publications, written four books and chapters for many others. His 1990 book, The Technique of Total Knee Arthroplasty, is used by most of the nation's orthopaedic surgery residents. A member of the American Orthopaedic Association, he is also a diplomate of the ational Board of Medical Examiners, a member of the American Academy of Orthopaedic Surgery, the Orthopaedic Research Society, the Knee Society and the American Medical Association. He is board certified by the American Board of Orthopaedic Surgery. + n g 9 3 0 �() B a 0 p 5 c 0 5 p g 9 3 �Buffo Ia Phy sIcIanS p rl n g 19 9 3 0 �- ~ - --- -- , a British sur~Oil co es across a b~arre ildlioo tumor ilien tindS at ·t stri es wi in a o- e a e It Belt." Since the childhood diabetes cases a decade ago in Poland, researchers have found other outbreaks, and the World Health Organization now hopes that further study can identify environmental agents at work in the disease. But cluster investigations aren't easy, and for every one that adds to medical understanding, many, many more raise unanswered questions, hit dead ends or simply prove to be matters of coincidence. "The cluster phenomenon is very difficult to evaluate," said Alfred S. Evans, M.D. , a 1943 graduate of the UB medical school, winner of the school's 1992 Distinguished Medical Alumnus Award and Yale University professor emeritus of epidemiology. In the UB incident, there were 15 Hodgkin's disease cases among 5,708 faculty, staff and students who once used a building at 4230 Ridge lea Road in Amherst. The New York State health department labeled it a true cluster, noting that the cases occurred at more than four times the national rate. But it also found that the people with Hodgkin's had a number of demographic and medical char- ln midwest Poland, physicians notice an upsurge in childhood diabetes so striking that it looks for all the world like a communicable epidemic. In a building once used by the University at Buffalo, worried faculty and staff members tally the number of Hodgkin's disease cases among their colleagues, then call in the state Department of Health. Clusters of chronic disease are among the most vexing phenomena in medicine. Communicable diseases are by definition subject to outbreaks. But tumors? Multiple sclerosis? What is the small-town pediatrician to make of the third patient this month to be diagnosed with childhood leukemia? Chronic disease clusters are rare, but hardly unheard of. And in some cases, they can yield significant medical insights. After dogged field study, some good hunches and a little luck, the strange jaw tumors noticed in Africa by Denis P. Burkitt, M.D. , in the late 1950s contributed not only to the discovery of the Epstein-Barr virus, but also to theories on relationships between the virus , immunodepression and cancer. 0 B a 0 e Lvmp oma 7 ......... p y c a acteristics closely associated with the disease. ln essence, investigators said the cluster was one of risk factors and probably would have occurred if the same group of people came together anywhere. Unusual? Yes. Reason for alarm? o. ot everyone is satisfied. "I think it was kind of a pat on the head, you know, 'Don't worry,"' said Joel S. Rose, who once worked at 4 230 Ridge lea. "I have colleagues who worked in that building, and I'm concerned about their welfare. " The public in general has grown more concerned about clusters in recent years. Hardly a day goes by at many large public health agencies without a call from someone who's noticed that there's an awful lot of cancer in the neighborhood lately. Many in public health think people have every right to be concerned, and government has been devoting more resources to cluster investigations. But physicians and policymakersstillgrapple with how much to spend in light of other needs. "It's a very important question because the past experience has been that they (cluster investigations) tend to be 5 p g 9 3 �unrewarding," said Curtis Mettlin, Ph.D. , UB research associate professor and director of cancer control and epidemiology at Roswell Park Cancer Institute in Buffalo. "There have been very few instances where a cluster aha lysis has led to disease prevention or control. More often they end up unexplained. There are some cases historically, though, which turned out to be so rewarding. " Cluster investigations are nothing new to medicine. In fact, since john Snow noticed 139 years ago that a London cholera outbreak was concentrated suspiciouslyarounda public-water pump, clusters have been at the heart of epidemiology. And just as that case contributed to the understanding of infectious disease, researchers have long hoped cluster investigations could shed light on diseases like cancer. As far back as the late 19th century there was a cancer-cluster study in Buffalo; a map from it remains on display in the Roswell Park library, Mettlin said. Over the last two decades, cluster cases have jumped from the medical journals to newspapers and television. After the ational Cancer Institute showed with maps in the 1970s that clusters were present in the Northeast, the ew jersey Turnpike would forever be known as "Cancer Alley." In 1978, the ew York State health department found that people living next to iagara Falls' Love Canal appeared to be at heightened risk for miscarriages and birth defects and sent panic through the community when it recommended pregnant women and children under two years leave the area directly adjacent to the site. Residents subsequently did their own health surveys, and under the glare of network television lights successfully pushed for evacuation of the wider neighborhood. john E. Vena, Ph.D. , associate professor in the UB medical school's Department of Social and Preventive Medicine, began his epidemiological work at Love Canal. "It made people aware that there are problems out there that aren't figments of their imagination," he said. B u a 0 p h ." he anyone gets ow e reason or it;' saidK llyAnnBarixa 1v1. ., w o ~tu 1e Ri eLea ortheNew "Yc r S De arttnen Environme~ta a w11e ge s.o many c~ . . e enVIrol)ment 1S 1n e news lot. Rather an thin itS n act Of Go , 1 e ip .e old a, s, ey In .It '' I 5 a s p g 9 3 0 �cause, and the exposures are often high. In neighborhoods, however, the number of cases tends to be relatively small, people move in and out and exposure levels are much lower. "We feel people do have a right to know what's going on in their communities," said Philip C. asca, Ph.D. , director of the New York State health department's Bureau of Cancer Epidemiology. "But I will say this up front- it's very difficult with these methodologies to pinpoint an exposure. " With a five-decade-old cancer registry and cluster investigation units dating to the 1970s, New York is considered one of the leaders in the field. But efforts have been growing nationally.In 1989 the Centers for Disease Control and Prevention, the Association of State and Territorial Health Officials and the Agency for Toxic Substances and Disease Registry held a two-day conference on clusters. They followed up with a set of guidelines for health agencies, published in the CDC's july 27, 1990, Morbidity and Mortality Weekly Report supplement. According to the guidelines, clusters that might yield important findings share several characteristics: "Usually such a cluster has a definable health outcome, either new or rare; a potential exposure or agent is suspected, along with a connection between the exposure and the health event; the situation is highly unusual, and statistical testing confirms the investigator's impression; and the short-term public health impact is immediate and self-evident. " Few clusters make the grade. "More clusters are due to a chance occurrence of rare events, what I've heard some people call the 'expected unexpected,"' said Ward Cates, M.D., M.P.H. , director of training in the CDC's Epidemiology Program Office. "just by chance alone, these things are going to occur." Some initial cluster reports come from Frequently it is related to the environment, or at least to where people live. Many chronic diseases do follow geographic patterns. Multiple sclerosis is more common in temperate climes. So is Hodgkin's disease. But why? Is it something in the air? Better diagnosis and reporting of cases? Or something else? Burkitt found that his jaw tumors occurred only below a certain altitude, later realizing that temperature was the critical factor. He also found correlations with rainfall. Then someone suggested he compare his maps of tumor incidence with maps of intense malaria cases. Bingo. Eventually Burkitt came to believe that the Epstein-Barr virus, in the presence of immunodepression brought on by longterm malaria, could cause "Burkitt's lymphoma." Today, the relatively frequent clustering of diseases like multiple sclerosis and Hodgkin's have bolstered theories that viral agents are at work there, too. In many cluster cases, pollution is also a suspect. Animal tests have linked anumber of chemicals to cancer. And some studies have found a correlation between high cancer rates and proximity to chemical plants, hazardous waste sites or ground water contamination. "There's no question that clusters could occur with an appropriate exposure," Evans said. Proving it is another matter. To document an environmental connection to a cluster, he said investigators should show a relationship between incidence and the duration of and proximity to the suspected cause. They should also study a large, comparable area that is free of the suspected cause. All in all, he said, it's a daunting task. In occupational cases, particularly industrial ones, investigators can at least document how long a person has worked and been exposed to a suspected disease B u 0 0 p s c 0 n physicians, but the vast bulk are made by the general public. In New York State last year, the health department's Bureau of Cancer Epidemiology received 328 phone inquiries. "We've always sworn that right around Christmas time, when people get together at parties, we tend to get a lot," said Nasca, who earned his Ph.D. in epidemiology from UB's Department of Social and Preventive Medicine. Of the hundreds of cluster reports annually, asca said about three-quarters go no further than the initial call. The department has an ombudsman to handle the reports, many of which involve a variety of cancers. After asking some questions, the ombudsman is usually able to tell the caller that there's nothing unusual going on. "Lay people have the idea that no matterwhat the disease is, it must all be caused by the same thing," said Brix. "We have to do health education and explain to people that first of all, cancer is very common, unfortunately. One-third of Americans will get cancer at some point in their lives and one-fourth will die of cancer." If there does seem to be something unusual, the department will check its cancer registry, and that often resolves the issue. For instance, asca said, a report of four brain tumors on one block will raise eyebrows, but on checking the registry investigators may find that the tumors all metastasized from different sites, greatly reducing the likelihood of a true cluster. If the registry confirms the report and sometimes it reveals even more cases -the department calculates whether the number of cases really are more than would be expected. Nasca said investigators work with local citizens and health officials to draw boundaries for the study area, taking local concerns and scientific needs into consideration. "If it looks like nothing is going on, we write up a long report as well as a simpler 5 p g 9 �executive summary," he said. The reports go to local health officials and concerned citizens. When a study confirms there are more cases that expected, investigators interview the patients, asking about medical history as well as lifestyle, occupation and where else they have lived. In eight cases last year the department went at least as far as checking whether the observed cases were more than expected, and as of early this yearthere were 19 other such studies under way. "In some cases we have confirmed some excess," asca said. "The real problem is trying to confirm some etiology." Given that, resource allocation is one of the biggest issues facing cluster investigators. asca feels that as long as clusterinvestigation units carefully target their studies and help educate the public in cases that don't merit investigation, their cost is well worth it. But he notes that the state is also working on cancer research, intervention and prevention. "I would not want to see cluster investigations draw staff from those other important areas," he said. + B 0 0 p y 5 c 0 5 p n g 9 9 �- --- ---~- - ~----- ' I Questions still remain I B y a 0 N 0 R E W 0 A N Z 0 relations aspects of their task as well as the and indicators of pre-existing immunological problems, also risk factors. And scientific issues. At Ridge Lea, things got off to a bad several had family members with start. The investigation officially began in Hodgkin's. All were at risk for the disease 1989, but after two years little had hap- before ever setting foot in the building. pened. Two people with Hodgkin's died "We don't think there's anything in without being interviewed by the health that building that would make it unfit for department, Hastrup said. And people human occupancy," Brix said. "These who had used the building were not alerted people had a very high prevalence ofknown to seek early treatment if they had risk factors associated with Hodgkin's disease. I'll be honest, I was surprised at how Hodgkin's symptoms. After a letter from 50 faculty, staff and well they fit the pattern. " students and some pressure from the adHastrup doesn't buy it. 1f you had a ministration, the health department as- group with an unusually high rate ofbreast signed Brix to the case in 1991. cancer, she asks, would you be satisfied She documented 15 Hodgkin's cases simply to know that the victims were among the 5,708 faculty, staff and stu- women? She said the cluster can't be exdents who used the building the most plained by risk factors without knowing while it was part ofUB's temporary Amherst how common those factors were among campus from 1969 to 1986. The incidence everyone who used 4230 Ridge Lea. "I don't think the health department's was more than four times the rate for the nation as a whole and more than three explanation is sufficient," she said. "What they're basically asking us to do times the rate for upstate New York, where Hodgkin's is more prevalent than it is is a 45-minute interview on over 5,000 people," responded Brix. "It's an enornationally. The health department tested the build- mous use of state resources, and there's no ing for chemicals, ionizing radiation and scientific reason for it whatsoever. " Clifford B. Wilson, UB associate vice magnetic fields. It found nothing unusual. But, Brix said, she did find something president for student affairs, said he acunusual among the people with Hodgkin's. cepts Brix's conclusion. He said he would They were of higher than average socio- rest easier if there were something more economic status, which previous studies concrete than risk factors to explain the have found to be common in people with cluster. But, he added, ''I'm not sure what + the disease. Many had had mononucleosis more one does. " Overtheyears,janicel. Hastrup, Ph.D., sensed that something was wrong. In talking with other UB faculty, staff and students who used the temporary building at 4230 Ridge Lea Road in Amherst, Hastrup heard about four with Hodgkin's disease. It seemed like a lot. Then, in 1989, there were two more cases. Hastrup, an associate professor of psychology, called the ew York State Department of Health. Last summer the health department confirmed that there indeed had been a Hodgkin's disease cluster at 4230 Ridge Lea. But it said the cluster had more to do with the backgrounds of those who were sick than with the building they shared. UB accepts the findings. Hastrup and several others who used the building don't. "It's better to say you don't know than to say you've explained it when you haven't," she said. "We did a very thorough investigation both on the health side and the environmental side," countered Kelley Ann Brix, M.D. , of the health department's Bureau of Environmental and Occupational Epidemiology. Cluster investigations frequently fail to satisfy the people who requested them. Cover-up charges are so common that guidelines published by the Centers for Disease Control and Prevention suggest investigators be sensitive to the public B A p 5 a s p 9 9 �B u f f a l a P h y s I c I a n 5 p r 1 n g 1 9 9 3 6) �y I B I 5 c i r D u 0 s t 5 p n i a n g e 0 9 s �z r w y b T e e c i p d i k t s t It will be a deadly one for 7,3&7 of the 29,4&9 Americans waiting for organ transplants. B u a 0 p y s c a �odern medicine has come a long wa~ Docto~ but in this day of xe- nograft transplants from baboons and microscopic cookie cutters for replacing human corneas) a frustrating dichotomy exists. Under its end-stage renal disease program, the federal government spends $3.5 billion a year to treat patients who could be taken off dialysis if donor kidneys could be found. And, the average ICU patient awaiting a liver transplant runs up costs of between $1 ,000 and $2,000 a day. The donor shortage, according to kidney transplant surgeon Sidney Anthone, M.D., needs to be addressed from both an educational and a legislative point of view. Anthone chairs an ad hoc committee for the United etwork of Organ Sharing (U OS) - made up of the country's 75 regional organ sharing centers and their computer networks- which has among its goals the integration of the organ donation process into medical school curriculums. "Curriculums are crammed already," notes Anthone, professor of surgery at UB. "But a curriculum has been written by U OS for nurses, medical students and neurosurgeons. It is now a matter of putting it into the schools and promoting it, having somebody who will go around and stampede for it." Indeed, the organ procurement movement needs a P.R. boost. It's a life-anddeath matter for the 22,415 Americans who, as of]anuary 1993, were waiting for Tremendous diagnostic, surgical and treatment advances have brought organ transplantation into a new era. But the single biggest obstacle to hope for the nearly 30,000 Americans awaiting organ transplants is a shortage of healthy individuals willing to make the vital choice to donate such organs when they or their loved ones die. In the laboratory, enhanced tissue preservation media and immunosuppressive drugs are developed. Dramatic methodologies for accurately matching donor and recipient cells are devised. Twenty-first century surgical instruments and techniques are mastered. But in hospital intensive care and hemodialysis units, the number of patients whose survival depends on new organs swells by 5 percent each year. All the milestones and medical advances in the world simply don't work without organ donors. Transplant surgeons and organ procurement officials agree that despite required request laws and similar recentlyenacted measures, a critical donor shortage remains. The average wait for a kidney transplant increased from 126 days in 1988 to more than a year in 1991. Some potential kidney recipients wait more than five years for the right donor to surface. B u 0 0 p s 0 s donor kidneys, the 2,321 awaiting liver transplants and the 2,686 who needed new hearts. Add to these statistics 127 patients in need of a pancreas, 775 who needed joint kidney/pancreas procedures, 964 awaiting lung transplants and 181 who needed heart/lung procedures. The numbers are sobering, even more so when one considers that 25 percent of these patients will not live to realize a second chance at life. "The waiting lists are so long because individuals are being diagnosed more rapidly with end-stage organ disease," according to Elizabeth A. Me amara, R.N. , M.S.N. , director of procurement at The Upstate ew York Transplant Services, Inc. "More patients are coming in sicker and being diagnosed quicker. "Individuals waiting for heart, lung, liver and heart/lung transplants usually end up becoming very ill before their transplant. Sometimes, they're too ill to undergo the surgery," she adds. jacob Bergsland, M.D., assistant professor of surgery at UB, is a cardiac transplant surgeon affiliated with the Buffalo Heart Surgical Associates. He echoes Anthone's concerns about the donor shortage and elaborates on an added wrinkle for patients awaiting hearts instead of kidneys. p n 9 9 9 3 ' �; "The nature of the .. problem for cardiac patients is that, unlike dialysis for kidney patients, we don't really haveaback-upsystem, except for mechanical devices which are not perfected. Our patients tend to die within one or two years unless they're transplanted. Also, each donor has only one heart, versus two kidneys," says Bergsland. While Bergsland sees a "stagnation" in the number of potential heart donors, he adds that "the number on the waiting list slowly goes up, though it is limited due to the nature of heart disease." Further contributing to the problem, according to the cardiacsurgeon, has been the recent explosion in the number of heart transplant centers nationwide. Of the approximately 2,000 cardiac transplants perfomedannually, about 75 percent are done in the United States. As of December 1987, there were 114 heart transplant centers in the country, according to U OS. By 1988, the year the first ew York State-certified center was established at The Buffalo General Hospital, this number had grown to 135. Today, there are 158 cardiac transplant centers. "There are too many centers," emphasizes Bergsland. "Fifteen hundred transplants ... is not enough [per center] to keep people in shape to perform these operations. Also, the cost goes up with B 0 0 p fewer numbers, and it's more difficult to answer key scientific questions. For a successful clinical study, you need more patients per center. It is society's responsibility to make sure this is handled properly. Transplant centers can't be used for advertising or prestige purposes." The cloud hanging over progress in transplantation does, however, have a silver lining. Several of them, in fact, as illustrated by recent technological breakthroughs in such areas as tissue matching, surgical procedures, tissue and bone preservation and immunosuppressive y s c 0 5 p agents to battle organ rejection. Kathleen Polanski, a Buffalo-area school bus driver, was diagnosed with systemic Iu pus erythematosus at the age of 16. Within six years, her disease had caused kidney damage so severe that dialysis was the only answer. Standing in the way of a successful transplant was the fact that her lupus produced various antibodies that reacted not only with potential donor tissue, but with her own as well. Three times, positive crossmatches between Polanski and potential donors ruled out transplant surgery. Crossmatch procedures to manually and visually measure antibodyreactivity failed to distinguish between antibodies related to the patient's lupus and · those which could have caused rejection of a donor organ. The answer to this dilemma and an increasing number of perplexing cases-lies in flow cytometry, a process of tissue matching that uses laser beams to measure the light properties of various types of tissue cells. Only 12 facilities nationwide are accredited by the American Society for Histocompatibility and Immunogenetics to use flow cytometry as a predictive index in transplantation. One is at Buffalo's Erie County Medical Center and directed by Thomas C. Shanahan, Ph.D., associate professor of microbiology at UB. In addition to lupus patients in need of n 9 9 �ecause it offers this heightened degree of sensitivity in detecting immune responses and helps eliminate some candidates from unfair exclusion from organ transplants) flow cytometry is a giant step in addressing the organ donor shortage. techniques for pancreas implantation as the most promising area of development in his field. Utilizing a process known as the bladder drainage technique, in which the duodenum is anastomosed to the bladder, surgeons are now able to implant the pancreas along with a section of the duodenum. This has resulted in reduced rates of post-operative complications and improved chances of detecting early organ rejection. Kidney/pancreas transplants, performed routinely for only the past five years, are vital to approximately 4,000 Americans each year, most of whom have been diabetic since their youth. Breakthroughs in surgical technology have led to new promise for patients who need cornea transplants, as well. Transplant surgeon james]. Reidy, M.D., cites the example of the surgical microscope and the trephine blade, the latter of which is now used in 75 percent of cornea transplant cases. "The trephine blade is basically a hightech cookie cutter," explains Reidy, assistant professor of ophthalmology at UB. "It looks like a small, round cutter with a razor-blade edge, and it cuts a circular transplants, flow cytometry is effective in cases ofindividuals who take certain drugs, such as hydralazine for hypertension and procainamide for heart disease, which produce antibodies similar to those lupus patients produce. "Old methods [of tissue matching] couldn't distinguish between harmful and non-harmful antibodies. Therefore, some patients were unfairly excluded," explains Shanahan. "In some cases, patients' antibodies may react against tissue, but this may not rule out a transplant. These patients may produce antibodies which mimic rejection." Because it offers this heightened degree of sensitivity in detecting immune responses and helps eliminate some candidates from unfair exclusion from organ transplants, flow cytometry is a giant step forward in addressing the organ donor shortage. In Polanski's case, it allowed her surgeons to perform a successful kidney transplant in 1989. Rabie Stephan, M.D. , a transplant surgeon and clinical assistant instructor who is working to establish a kidney/pancreas center based at UB, sees new surgical B u a 0 p 5 c a n 5 hole in the cornea. It is used to cut out damaged corneas and replace them with donor corneas, which are sewn in with stitches one-third the diameter of a human hair. " The story of a patient who literally has a brighter outlook on life as the result of these amazing instruments is perhaps their best testimonial. Marilyn Foit, a suburban Buffalo woman in her mid-40s who is working toward a masters degree in special education, literally couldn't see to read the blackboard before Reidy transplanted her left cornea in 1987. Five years later, she underwent a transplant in her right eye. She had suffered since her childhood from keratoconus, a cornea disease that causes progressive astigmatism and had rendered her legally blind. Following the success of her first transplant, Foit returned to school. "I started school 20 years ago and I've finally been able to return," she says triumphantly. A year after the first transplant, when her cornea had sufficiently healed, Foit was fitted with a standard contact lens to replace the cumbersome, uncomfortable p n g 9 �"The donor situalens she had been tion is pretty good in forced to wear to corBuffalo," says Edward rect her vision. "I H. Simmons, M.D., UB looked in the mirror professor of orthopedic and started laughing surgery. "Thesupplyis and said to the techniapproaching the decian, 'I've aged 20 mand, within reason. years!' I could finally Once bone is tested, culsee! It was the same tured and frozen, it can What this country needs is more of a "can-do" attitude about feeling l had when getbe kept indefinitely. " tingglasses at age nine. organ and tissue donations. Misconceptions such as these are Bone allografts are typiAll of a sudden, life cally either frozen or a big part of the reason why nearly 30,000 Americans can only became easier," she freeze-dried, depending recalls. wait - and hope for a second chance at life: on whether or not the Fait's right eye is accompanying cartilage still healing; in her left MYTH: ''I'm too old to be a donor. " must be preserved. eye, she enjoys 20/20 FACT: Organ and tissue donors range in age from newborn to 70 Bone grafting is vision with a standard years. probably the oldest contact lens. form of transplantation, MYTH: "My loved one's body will be disfigured. " Compared to the according to Simmons. FACT: Skilled surgeons harvest organs and tissues in such a way that dire shortage of organs He notes that autothe body is in no way visually marred by the surgery. such as kidneys and genous spine fusion hearts, donor corneas MYTH: "He never signed a donor card, so we can't agree to give up his procedures were perare relatively easy to organs." formed in the United find. Because tissue FACT: Signing a donor card is important, but not necessary. ext of States as early as 1911. matching generally is kin have the final say regarding organ and tissue donation. "When bone graftnot required because ing was first being done, the cornea is avascuMYTH: "It's against my religion. " all grafts were autoglar and corneas may FACT: Today, every major U.S. religion supports the concept of organ enous, and a patient's be preserved for up to and tissue donation. own bone continues to two weeks after harbe the gold standard vesting, a generous MYTH: "Organ donation is expensive." against which all others number of eligible FACT: A donor bears no financial responsibility for the costs related are judged," notes Euto transplant surgery. -Diane Zwirecki donors exists. Each gene R. Mindell, M.D. , year, 40,000 corneas professor of orthoare transplanted in the plant patients is the fact that, although 10 paedics and director of UB's division of United States. "Corneas may be harvested up to six to 20 percent of patients suffer rejection orthopaedic oncology. "However, 20 to hours after death," Reidy says. He sees the episodes, 90 percent of these can be treated 30 years ago , it was discovered that the development of specialized preservation with topical eye drops that are not only sites from which grafts were taken somemedia as a milestone and describes this effective but inexpensive. The drops cost times had residual disease symptoms. And, media as "similar to that used by scientists between $5 and $30 for a month's supply there were situations oflarge defect where - compared, for instance, to immuno- much bone was needed. Then, surgeons to grow cells outside the body." Unlike organs that derive their nutri- suppressive agents for renal patients that began to use bone allografts. " Allografts are common in cases oflimb tion from the body's blood supply, cor- may cost in excess of$100 for 100 tablets. cancer, severe trauma and total joint failSupply and demand come close to a neas derive oxygen from the atmosphere balance for patients who need bone graft ure. "In order to save a tumorous limb, and glucose from inside the eye itself. It is this difference in makeup that makes this procedures to treat cancer, trauma, failed surgeons dissect 10 to l2 inches of that joints or similar orthopaedic problems, limb and fill the defect with cadaverous type of preservation possible. bone," explains Mindel!. "If a total hip or Also working in favor of cornea trans- according to UB surgeons in this field. Organ Donations ~e~un~ln~ t~e m~t~s B a a p s c a n 5 p g 9 �knee which has been in place for 10 to 15 years fails, reconstruction is done to avoid a shortened leg after joint removal. The use of allografts in these cases is increasingly common." Fresh-frozen grafts are necessary in cases where cartilage as well as bone must be preserved to ensure a successful transplant. lf cartilage is not needed, freezedried bone is sufficient. Approximately 25 bone banks nationwide provide both large bone and bone/ cartilage allografts. In Buffalo, Mindell performs a bone graft every one to two weeks, includingseverallimb-sparing procedures each year. Transplant surgeons in various disciplines agree that improved immunosuppressive agents, several of which have become available only during the past few years, have led to great strides in the success of organ transplantation procedures. Kidney recipients usually rely on one of three kinds of immunosuppressants: cyclosporine, steroids or imuran. A new weapon in the arsenal is known as OKT3 . "OKT3 is directed against cytotoxic lymphocytes, as opposed to other immunosuppressive agents which are non-specific to the lymphocytes that cause rejection," says Anthone. In the realm of cardiac transplants, a new drug known as FK 506 bears some similarity to cyclosporine, according to Bergsland, who notes "most patients have some type of rejection, usually during the early phases following a transplant." A single donor can help as many as 200 people in need of new organs and tissue. Technological history is made over and over via the introduction of new equipment, new drugs, new talent and new techniques. But for those who are waiting, the numbers and the scientific breakthroughs often don't add up to a healthy, hopeful future. Unless more people are willing to donate organs and promote the concept of organ donation, the waiting game for many potential organ and tissue recipients will be lost. + B a a p h y s a 5 p 9 9 9 3 �Roswell Park uses PCR diagnosis to help ensure the safety of potential organ donations n a first-of-its-kind agreement in New York State designed to ensure that transplanted organs and tissues are HIV-free, Roswell Park Cancer Institute has recently been commissioned by Upstate New York Transplant Services (U YTS) to perform polymerase chain reaction (PCR) diagnosis on all potential donor specimens. "Concerns about undisclosed HIV infection were underscored earher this year in reports published in the New England journal of Medicine and the journal Lancet, which documented cases of HIV -infected individuals who had tested negative on serological examination and who were inadvertently used as tissue or organ donors," according to Steven]. Greenberg, M.D., UB assistant professor of neurology and chairman of the Roswell's neurology department. Greenberg, who came to UB two years ago from the National Institutes ofHealth, says that with PCR testing, "basically, we can ask, 'Is there a retrovirus present?' Unfortunately, if an individual is HIVinfected, it can take up to six weeks before an antibody level can be detected by normal serological techniques. This is a more sensitive test which can be done rapidly with a turnaround time of only about eight hours." Steven J. Greenberg, M.D., in his lab at Buffalo's Roswell Park Cancer Center. B u 0 0 p h Greenberg attributes the relatively recent capability to test potential donor tissues and organs not on the PCR technique itself- which already existed and, in fact, is routinely used in forensic science to type blood products and semen - but rather, on "a rather ingenious application of existing methodologies and an existing understanding of how molecular engineers put things together. "What has helped to automate the process and make it more widespread," he adds, "have been the more recent developments. The technology had to play catch up. " Greenberg credited the development of the automated DNA thermal cyclerwhich runs the PCR based on a software program the investigator downloads and the cloning and production-scale availability of a thermal-stable polymerase enzyme. Consisting of three separate reactions "repeated ad nauseum ," according to Greenberg, PCR "allows one to take a needle in a haystackandamplifyit to make a haystack full of needles." The "haystack full of needles" is the amplified genetic material- be it virus, bacteria, fungus or protozoa- of whatever the investigators are testing for. In the first step of the reaction, performed at high temperatures , duplex strands of DNA are melted apart. The second - or annealing step - "allows primers to anneal with either strand of the DNA to , therefore, frame the genetic tar- 5 a n 5 p get of interest," according to Greenberg. The final step is the polymerization step, in which DNA is synthesized for the ends of both primers, using DNA as a template. The reaction doubles the amount of existing material, which then is synthesized exponentially. The amount of material- of "haystacks full of needles" depends on the amount of cycles the reaction is programmed for. For 30 cycles, for instance, the material- synthesized exponentially - is multiplied by one billion. "There are two main reasons for using this," Greenberg explains. "It is excruciatingly sensitive, and independent of a host immune response. " That independence from the host immune response will help eliminate the "window of vulnerability" between the time a person is actually infected and his immune response is activated that often exists in the screening process for donor organs and tissues. According to Eugene R. Mindel!, M.D. , director of UB's division of orthopaedic oncology, "the number-one question I hear from patients is 'will I get AIDS from my allograft?"' And though the safety of this and other transplant procedures has greatly increased, the AIDS question continues to permeate all aspects of medicine - transplantation being no exception. Answering this query can only help to enhance the overall success rate of organ and tissue donation. + - N AN ET TE TRAM O N T 9 9 9 K O LLIG �I - • ---------------- ·· ·· ··· ····· ····· ··· ··········· ······· ·· ····· ·· · ········ · ·· ······ ······ ······ · ············ ······ ~ I lie health professionals. Mahoney wrote his doctoral dissertation on temporal mortalitypattemsamong the Seneca Nation oflndians, the first such study to have been done wi.th the Senecas. The study compares the mortality rates among specific age groups within the Seneca Nation to the mortality rates of other New York State residents in the same age groups. The research found unusually high mortality rates among the Senecas, especially due to cancer. The study has lead to a refinement and refocusing of the Seneca ation's public health programs, pinpointing specific areas, such as cancer, which wi.ll receive Med student winsAmerican PublicHealth research award artin C. Mahoney, Ph.D. , has won the 1992JayS. DrotmanMemorial Award from the American Public Health Association for his work in public health. Mahoney, a member of the class ofl995, received the award and presented his research at the APHA's annual meeting last ovember in Washington, D.C. The award, established in 1979 by Peter Drotman in memory of his late brother, recognizes promising young pub- B a 0 p y a n 5 more attention and further research. Mahoney earned his master's and doctoral degrees from UB. He has been a research scientist with the New York State Department of Health Bureau of Cancer Epidemiology and director of the bureau's Cancer Surveillance Program. He is a founder and member of the steering committee of the ational Cancer Institute's Network for Cancer Control Research in American Indian and Alaska ative Populations, and has initiated a survey of state public health agencies' sponsorships of cancer prevention and control services for Native Americans. + p n g 9 9 �Donald Rennie,M.D, senior UB counselor and vice presideni dies onaldW. Rennie,M.D.,67, a former UB vice president and vice provost, died December 28, 1992, in Myrtle Beach, South Carolina, while on vacation. A senior counselor to UB President William R. Greiner, Rennie had served as a faculty member in the department of physiology at the medical school for 34 years. He was named vice president for research in 1980 and assumed the additional responsibilities of vice provost for research from 1990 until last December, when he was named a senior counselor in the areas of research and sponsored programs, a position of cabinet rank. Greiner described Rennie as "a wonderful, sensitive and wise person; a man who all of us really admired. Don was our senior counselor for the last 10 years, someone Steve Sample and I wanted at the table for his wisdom." Rennie joined the UB faculty as an assistant professor of physiology in 1958. He was promoted to associate professor in 1962 and named a professor in 1966. Rennie was a visiting professor at Laboratorio di Fisiologia at the University of Milan, Italy, from 1966 to 1967. In 1968, Rennie assumed the responsibilities of associate chairman of the UB physiology department, was named acting chairman in 1971 and served as department chairman from 1973 to 1980. While serving as a vice president and vice provost, Rennie continued to teach physiology. Rennie received his medical degree and a master's degree in physiology from the University e u 0 0 p h of Oregon School of Medicine. He did a postdoctoral fellowship there as well as at Harvard Medical School. A member of the editorial boards of the American journal of Physiology and journal of Applied Physiology, Rennie had served on the Porter Fellowship Committee of the American Physiological Society, Test Committee for Physiology of the ational Board of Medical Examiners and as an ex-officio member of the Educational Committee of the American Physiological Society. Donations in his memory can be made to the Donald W. Rennie Memorial Fund, in care of the University at Buffalo Foundation, and sent to the Department of Physiology, University at Buffalo, 122 Sherman Hall, Buffalo, NY 14214. + B Y ARTHUR PAGE needed for optimal function. A member of the American Institute of Nutrition, the American Association of Cancer Research and the American Heart Association's Basic Science Council, Spence joined the UB faculty in 1980. He was appointed associate dean in 1988 and held a joint appointment as research asso+ ciate professor of nutrition. Above, about 50 physicians attended the second annual "Prep for Practice," held last October. Below, about 200 students, staff and alumni attended this year's senior reception at the Marine Midland (enter. Spence leaves UB to head USDA research center in Maryland oseph T. Spence, Ph.D., former associate dean for research and graduate studies, has become the new director of the U.S. Department ofAgriculture's Beltsville, Maryland, Human utrition Research Center. Below, faculty and staff view the exhibits entered in the 12th annual Medical Student Research Forum. ter - one of five nutrition research centers operated by the USDA's Agriculture Research Service. He oversees nutrition studies ranging from how many calories are burned in today's lifestyle to how much of the ultra-trace elements chromium and selenium are y s c 0 s p n 9 9 �· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ll 1/ ~iJ ~ I UB wins Robert Wood Johnson Foundation planning grant B's School of Medicine and Biomedical Sciences has received a $150,000 grant from the Robert Woodjohnson Foundation to plan new ways to select and train students to become primary care physicians. UB is one of 18 medical schools, selected from 83 applicants, participating in the first phase of the foundation's Generalist Physician Initiative to increase the number of pediatricians, general internists and family practice specialists. As a recipient of a planning grant, UB is in a strong position to secure a $2.5 million implementation grant from the foundation. "UB's medical school and teaching hospital system are honored to be numbered among the 18 recipients of a Robert Wood johnson Generalist Physicians Grant," said B a a others about their use. joseph L. lzzo, Jr. , M.D., professor of medicine and pharmacology and program director, said specialists with a knowledge of drugs and drug interactions are in critically short supply. "The shortage of clinical pharmacologists is occurring at a time when the number of new drugs under development and the need for drug-related education are at an all-time high," lzzo said. The program - one of four nationwide - is expected to grant two or three fellowships for the first year. The fellowships are aimed primarily at physicians who would choose clinical pharmacology as a subspecialty, but qualified doctoral candidates also will be considered, lzzo said. The UB program offers two avenues of entry: a two-year certification program following a residency or other postdoctoral training, or a unique four-year program combining a residency in internal medicine with a clinical pharmacology + fellowship. john P. aughton, M.D., vice president for clinical affairs, dean of the medical school and director of the project. "The faculty is committed to developing an outstanding educational experience to help correct a major manpower deficiency in American health care. This grant will help develop throughout our region those programs necessary to encourage future medical students to become generalist physicians." The medical school launched its own primary care initiative in graduate medical education last September, unveiling a $5 million demonstration project involving six Buffalo teaching hospitals, Medicaid and four private health care insurers. The Robert Wood johnson initiative aims to reach students even earlier, starting at the high school, undergraduate and medical school levels. One project involves working with the 14 area hospitals to identify promising high school students to work during the summer with community physicians. Projects are also underway to increase the emphasis on primary care in the medical school curriculum and add more out-ofhospital teaching sites. The Robert Wood johnson Foundation, headquartered in Princeton, ew Jersey, is the nation's largest philanthropic organization dedicated to improving health + care in the United States. B Y L o 5 B Y LOIS B AKER BAKER UB receives clinical pharmacology grant to launch pilot program he University at Buffalo has received a $3 million grant from the U.S. Food and Drug Administration to establish a pilot program in clinical pharmacology aimed at relieving the shortage of specialists trained to develop and test new drugs and teach p s c a 5 p n 9 9 �A Spoonful of Humor © Stu Silverstein, M.D . Leaving them laughing Think back to the last conference you attended. That first lecturer, he watss~t~h~e;::::;::;::;:;;::;::::=; obel Laureate from ew Zealand .. you came to hear. His CV is recited in a British accent by the chairman of neurology (who was raised in Brooklyn) . This world-renowned speaker approaches the podium and begins to speak. You become intrigued by the stain on his jacket and obsessed with the phone bill you forgot to pay, or did you pay it ... or didn't you? The lights go out, the slides go up. You close your eyes for "just a second" because of the lead in your eyelids. It's now 11:30; the lecture ended 45 minutes ago. All you remember is his bowtie and your drool-covered collar. What went wrong? Why do some people grab the audience's attention from the start? Chances are they use humor in the form of appropriate, wellplaced jokes, anecdotes and asides. But most people claim they can't use humor in their talks for a number of reasons. Theoneihearmostis, ''I'm not funny ," or, "Ican'tcomeupwithmaterial." While it's true most people are not naturally funny, most don't know how to ice skate erence becomes naturally either (including members of How do you the Buffalo Sabres), but it is something make a small fortune in medical practice? that can be learned. And coming up with Start with a large one. the material is not as hard as you think. The same can be done with anecdotes. One of the easiest ways is to "switch" an Here is a switched joke to a medical theme. old joke and replace the details with mediAt the circus, a strongman takes a lemon cal references. The result is a new joke that and squeezes it. At first, the juice dribbles is essentially original. Comedy writers did out quickly, then slows down until not a this during the past four years, when Pol- single drop comes out. The ringmaster ish jokes were switched to Dan Quayle offers $200 to anyone who can squeeze jokes. Andbytheway, virtually all "ortho- even one more drop from the lemon. Two paedic" jokes are restructured Polish jokes. pumped-up bouncer types step up and Suppose you want to comment on the squeeze until they're red in the face. otheconomic hard times of medical practice ing comes out. "Does anyone else wish to today. Followingisanexampleofaswitched try," says the ringmaster. joke. The originalis from jewish Humor by A frail-looking man steps forward. The joseph Telushkin (Morrow 1992). crowd begins to snicker. He picks up the How do you make a small fortune in lemon, squeezes it and a cup ofjuice pours Israel? Come up with a large one ... with out. Stunned, the ringmaster asks, "Who B a 0 p y 5 c a n s p are you? What do you do? " "Arnold Mills, Blue Cross claims department. " If you were using this joke to begin a talk on collecting from third party payers, you could add, "Billing and collecting from third party payers is difficult and sometimes you have to be a little like Arnold Mills to make it in practice. Making it in medical practice in the '90s is what I'll talk about today. " When using a "funny story," it's best not to begin by saying, "Here's a joke." It's better to say, ''I'd like to start with a story." The joke you start with should relate to your topic. Following is a joke derived from old jokes and how to use this to lead into a serious talk. A young man walks into an internist's office, rushes up to the receptionist's desk and says, "I understand my father has owed you for an office visit for three years now. " The receptionist replies, "Yes, have you come to settle the account? " "No," says the man. "I've come to get health care on the same plan he has. " "The cost of health care- and paying for it - are uppermost on the minds of most Americans. Today, I'd like to discuss ways we can make it more affordable ... " Here's another joke with a medical theme. In hospitals in heaven, internists order the fluids , orthopods set the fractures, psychiatrists do the talking, gynecologists do the pelvics. In hospitals in hell, orthopods order the fluids , gynecologists set the fractures, internists do the talking, psychiatrists do the pelvics. If you look at every joke as an opportunity to come up with a funnier one with a better theme, you will soon have more jokes than you know what to do with. + References: A Funny Thing Happened on th e Way to th e Boardroom, Michaellapoce (Wiley 1988) Us ing Hum or f or Eff ecti ve Business Spealling, Ge ne Perrell (Sterling 1989) Stu Silverstein , M.D., president of Standup Medicine Seminars of San Francisco , California , lectures nationwide on humor in medicine. g 9 �Gianturco named chair of St Joseph department of surgery ichael]. Gianturco, M.D., a 1955 graduate of the School of Medicine and Biomedical Sciences, has been appointed Chairman of the St.Joseph Hospital Department of Surgery. A board certified general surgeon, Gianturco has been on staff at St. Joseph Hospital for 29 years and is currently medical staff president. He is a member of the Buffalo Surgical Society, Western New York Vascular Society, Baccelli Medical Club, Erie County Medical Society, ew York State Medical Society and American + Medical Association. Michael J. Gianturco, M.D.,'SS, in his Amherst restaurant, Michael's Plum. Wels, a clinical professor of surgery at UB and distinguished alumnus, was recently appointed chair of the University at Buffalo Council by Governor Mario M. Cuomo. Chairman of the department of surgery at Millard Fillmore Hospitals from 1987 until1989, Wels completed his residency in surgery at the former E.]. Meyer Memorial Hospital, Buffalo, New York. He received the Distinguished Alumnus Award in 1979 and the Samuel P. Capen Award in 1981. A trustee of the University from 1972 to 1976, he has been a trustee emeritus since 1979. Hess, director of the Perinatal Monitoring Program at Yale- ew Haven Hospital (Y NH), Yale University School of Medicine, completed his residency in surgery, gynecology and obstetrics at New Haven Hospital, ew Haven, Conn ecticut. He is also co-director of the Y HH Fetal Heart Institute and Fetal Cardio-Vascular Center. Hess is a diplomate of the ational Board of the American Medical Association, past-president and a member of the Connecticut State Medical Society, a fellow of the Ameri- Alumni Association announces first Achievement Award winners our UB physicians will receive the first annual Alumni Achievement Awards - one of them posthumously- at this year's Spring Clinical Day luncheon. The awards, which recognize a select group of UB medical alumni who have made their mark in a particular area of medical endeavor, will be given to Philip Wels, M.D., '41; Orvan Hess, M.D., '31; Kenneth Altshuler, M.D., '52, and posthumously to 0. P. Jones, M.D. ,'56. In establishing the awards, the Alumni Association wants to laud alumni who have distinguished themselves in areas such as research, teaching, technical innovation, private practice, community service and school administration, according to Donald P. Copley, M.D., '70, Alumni Association president. In each case this year, he added, the recipients have made outstanding contributions in one or more fields. B 0 0 p c o n 5 can Board of Obstetrics and Gynecology and the American College of Surgeons and a fellow of the American College of Obstetrics and Gynecology and pastchairman of that organization's Committee on Anesthesia and Analgesia. Altshuler, professor and chairman of the department of psychiatry at the University of Texas Southwestern Medical Center, completed residencies in psychiatry at the Bronx Veterans Administration Hospital, Bronx, New York, and the ew York Psychiatric Institute. A fellow of the American Association for the Advancement of Science, the American College of Psychoanalysts and the American College of Psychiatrists, Altshuler is also a member of the American Medical Association and a life fellow of the American Psychiatric Association. 0. P. Jones, UB professor emeritus of anatomyandassistantmedicalschooldean who died in 1989, was recognized as one of the world's experts on the morphology of red blood cells. He also received the Distinguished Research Award from the Buffalo Chapter of Sigma Chi for pioneer- p 9 9 �ing the use of advanced microscopic techniques in hematology. The awards will be given prior to the Stockton Kimball lecture on Saturday, + May l. Alumni Association establishes scholarship endowment fund o help further the medical school's goal to seek students of all means, the Medical Alumni Association has announced it is establishing an Alumni Scholars Endowment Fund out of donations received from reunion classes at Spring Clinical Day and Reunion Weekend. "This year's donations will be pooled together in one fund," explained Alumni Association President Donald P. Copley, M.D., '70. A goal of $1 million, to be collected over five years, has been set, Copley added; the interest would be used to fund 10 scholarship awards one made for each of the 10 reunion classes. "The size of the award would likely be $1,000 per year for four years," Copley said. "There would be 40 such awards at any one time- and we hope to continue them indefinitely," he added. The first awards will be given April30 at the Reunion Class Cocktail Receptions + held at the Center for Tommorow. Spring Clinical Day and Reunion Weekend set for April30, May 1 he Medical Alumni Assocation has set Saturday, May 1 for the 56th annual Spring Clinical Day. Mark your calendars and plan to attend! jamesS. Todd, M.D., executive vice president of the American Medical Association will deliver the keynote address, "The Name of the Game." Reunion classes of 1943, 1948, 1953, 1958,1963,1968,1973,1978, 1983and 1988 will meet for Cocktail Receptions on Friday, April 30, at UB's Center for Tomorrow, and on Saturday, May 1 for Reunion Dinners. Those classes will be vying for the Best Attendance Trophy, won last year by the Class of 1952. + 1992 Reunion Class Donations New med school alumni directory to be published in June 1994 Donations from last year's Reunion Classes totaled nearly $80,000. Following is a summary of the gifts. he Bernard C. Harris Publishing Company, Inc., will produce a new medical alumni directory. Scheduled for publication in june 1994, the directory will contain facts on over 5,200 medical school graduates, including their current names, addresses and telephone numbers as well as academic and career information. The Harris Company will begin mailing questionnaires to alumni in the near future; if you prefer not to be listed in the directory, please contact the Alumni Affairs Office in writing as soon as possible. + Class Year .. #in Class .. #of Dooors ...... Total Gifts 1942 .........41 ........... 18 ................. $8,077.13 1947 ......... 52 ........... 12 ................. $5,850.00 1952 ......... 54 ........... 26 ............... SI 0,225.25 1957 ......... 61 ........... 22 ................ $ 5,925.00 1962 ......... 66 ........... 19 ............... $13,875.00 1967 ......... 92 ........... 42 ............... S14,525.00 1972 ......... 117 ......... 31 ................ $ 9,425.00 1977 ......... 134 ......... II ................ $ 3,925.00 1982 ......... 138 ......... 18 ................ $ 4,625.00 s 1987 ········· 144 ......... 27 ................ 2,050.00 B u 0 0 p h y o n 5 p James S. Todd, M.D. AMA executive to deliver Spring Clinical Day keynote address ames S. Todd, M.D., executive vice president of the American Medical Association, will deliver the keynote address for this year's Spring Clinical Day lecture. A general surgeon from Ridgewood, New jersey, Todd joined the AMA in 1985. Before that, he was a member of the organization's board of trustees as well as a commissioner to the joint Commission on Accreditation of Hospitals. Todd graduated cum laude from Harvard Medical School and interned and served his residency at Columbia Presbyterian Medical Center. A diplomate of the American Board of Surgery and a fellow of the American College of Surgeons, he has been a director of the Institute of Society, Ethics, and the Life Sciences (Hastings Center) and has published numerous articles dealing with health care and professional liability. On May 1, he will talk about 'The Name of the Game" at Spring Clinical + Day. 9 9 3 �• ·························································································· I 1 9 3 s 0 won the APA's Newsletter of the Year in 1992. CARLJ . STREICHER '35 , is enjoying retirement in Lake Havasu City, Arizona. He plays golf five times a week and has a new home built on a golf course. BERNARDS . STELL '36 , a retired psychiatrist writes, "In three international photo salons sponsored by the Photographic Society of America, my stereo slides won awards. Because most of my photographs are close-ups, ARTHUR J . tion of the various mal positions of the eyelids. tronic flash units that I use are also synchronized at speeds up to DONALD practice in thoracic and cardiovascular surgery in Cincinnati, 1 9 5 s 0 F. DOHN '52 , reports that he is busy with coastal cruising (sailboat) , camping and travel after retiring from the practice of neurosurgery in july 1991. EDWARD W. HOHENSEE '54 , retired in June from the have a Diamond Star in PSA Competitions. ow I am accumulat- ogy. After a total hip replacement private practice of ophthalmol- HILLIARD 1 9 4 s 0 THEODOREW . KOSS '4 1 , writes, "I am comfortably retired nearCenterhillLake,Tennessee. " GILBERT B . TYBRING '45 ,edits the Wisconsin Psychia- trist, the Wisconsin Psychiatric Association's newsletter, which B a ' 58 , book co-authored with his wife, Jane Westberg, Ph.D., Collaborative Clinical Education: The Foun- died December 1, 1992. A tuberculosis researcher after his graduation from medical school, he did private practice in Buffalo for nearly half a century, retiring in the early 1980s. dation of Effective Health Care, published by Stringer Publishing Company in 1992. Jason is currently executive director of the died October 3, 1992. Slocum Center for Instructional Support (a non-profit educational service) system. Heleft Texas in 1952 and in September, he reports that he is enjoying retirement and visiting and clinical professor of family medicine at the UniversityofColo- his eight offspring. rado School of Medicine. ERNEST H . MEESE '54 , retired three years ago after 50 years of practice and is keeping busy sculpting and writing books. JASON announced the release of a new Stereographer I. " IRVING PERLSTEIN '39 , OBITUARIES CLYDE W . GEORGE '29 , Ohio. some out-of-the-way place to get unusual pictures. At present, I ing credits for the next PSA Stereo Division Award, Master Hilliard Jason '58 Ernest H. Meese '54 physiology and surgical correc- I do not use a stereo camera; I use two 35 mm single lens reflex cameras whose shutters are synchronized electronically. The elec- 1/SO,OOOofasecond. Iamover80 years old, so I find it easier to set up my photo equipment on our backyard patio than to travel to SCHAEFER '4 7 , a UB clinical associate professor, attended the Advisory Board meetings of the American Society of Ophthalmic, Plastic and Reconstructive Surgery and the American Academy of Ophthalmology, in Dallas, Texas, as a member of a team of physicians who gave a lecture on the patho- 1 was presented the 1993 Swords- 9 6 s 0 HARVEY C . SLOCUM '32 , was the first professor of anesthesiology in the University of Texas spent approximately 10 years in military service at Walter Reed Army Medical Center. Upon retirement from military service, he returned to the University of Texas; in 1979 he was named Professor Emeritus. man Award given by the American Cancer Society at the Annual Beverly Hills, California, writes, Swordsman Ball on January 16, "My associate in practice and I 1993. This prestigious award recognizes his outstanding service and leadership in the field of can- have scheduled 17 radiology technology courses for mammography EDMUND M . TEDEROUS techs around the country. " '43 , died December 19, 1992. SAAR PORRATH '61 , of cer for the past 30 years. He has beenontheBoardofTrusteesof the Ohio Division of the Ameri- STEPHEN can Cancer Society since 1979 and served as the Board's president in 1990. Meese has a private 0 p y 5 E . RICHARDJ . MILAZZ0 '42 , died October 26, 1992. LANGER GEORGE BISGEIER '50 , '67 , of Berkeley, California, has recently been named medical director of the Wellness International etwork. died of a brain tumor on ovember 5, 1992. DANIEL A . RAKOWSKI '60 , died December 8, 1992. c a 5 p g 9 ��BUFFALO PHYSICIAN STATE UNIVERSITY OF NEW YORK AT BUFFALO Non-Profit Org. U.S. Postage 3435 MAIN STREET PAID BUFFALO NEW YORK 14214 Buffalo, NY Permit No. 311 ADDRESS CORRECTION REQUESTED .. .. •' • . .. .• .. ;.. . ... . ... .~ .· . .. .. .. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. 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You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/e7c663ad05ea016a079396c1be013372.pdf 898cc1e3821d4eef7f43acda9552b44b PDF Text Text State University of New York at Buffalo School of Medicine and Biomedical Sciences, Winter 1993 Problem Patients 8 'A Thorny Issue �THE BUFFALO PHYSICIAN AND BIOMED I CAL SCIENT I ST \olume 27 -.;umber I DIRECTOR OF PUBLICAT IONS (A CT ING) Dr Carole Smith Petro EDITOR -.;anelte Tramont Kolhg. R.:\ ART D I RECTOR ~Ian J Kegler ASSOCIATE ART DIRECTOR Scott Fricker STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES Dr john -.;aughton \ice President for Chntcal Affa'"· Dran EDITORIAL BOARD Dr john ·\ Richert Chairman \lr Richard de Asia Dr \!arlin Brecher Dr Harold Brad\ Dr. RIChard L Colhns Dr. Donald P Copley Dr. Alan j . Dnnnan Dr. Ttmoth,· Gabryel Dr. Glen Gresham Dr. james Kanskt Dr. Charles \lassaro Dr. Charles Paganelli Dr. Luther Robmson Dr. Thomas Rosenthal Dr. Saleela Suresh Dr Bradlev T. Truax Dr Steph~n Spauldmg Dr jerome Yates TEACHING HOSPITALS AND LIAISONS Bata\la \A \ledtcal Center Buffalo General Hospital \fichacl Shah Buffalo\',\ \led teal Center Paula Prdmr Children's Hospital of Buffalo Ene Count\ \lediCal Center \lerC\· Hospital \hllard Fillmore Hospitals franl1 Sam Roswell Park Cancer Institute Sisters of Charity Hospttal Dmnis .\ lcCartln 'c The State Lnt,·erstty of""' York at Buffalo Buffalo PlnSICian IS published quarterly b' the State Lni,·ersity of -.;ew York at Buffalo School of \ledtcme and BIOmediCal Sctences and the Office of Publications. It IS sent free of charge, toalumnt, faculty, students, reSidents and fnends. The staff resen-cs the nghtto edtt all copy and subm1ssion~ accepted for pubhcauon \ddrcss quesuono; , comments and submiSSions to · Editor. Buffalo Physician. State Lni,·ersitv of "\c,, York at Buffalo, C~i\'CrSll\ Publications. 136 Crofts Hall, Buffa!~ , "o;ew York 1-+260 Send address changes to: Dear Alumni and Friends, D r. Elizabeth Olmstead, an alumna, class of '39, has established a significant endowment designed to support the school's educational efforts m the area of medical informatics. The endowment principal of$1.5 million will generate an annual income to support the continued development of computer-assisted learning for medical students and to deliver ongoing educational information to residents, faculty and practicing physicians in Western New York. We believe this is the first such endowment of its kind in the United States. Dr. Olmstead has been a loyal, dedicated volunteer faculty member of the school for man} years. She established this important gift to memorialize the memory of her late husband, Dr. Ira Ross, who was an engineer at Calspan and who served as its administrative leader from 1958 until his retirement in 1969. The medical school is committed to expanding Its role in this important area as part of its commitment to keeping all of its constituencies involved in ongoing, life-long learning. Under the capable leadership of Dr. John Loonsk, UB is on the cutting edge of this Important educational technology. Thanks to Dr. Olmstead, this program will be enriched and we will all benefit from her generosity and kindness. On behalf of the administration, faculty and alumni, I am pleased to express our heartfelt gratitude to Dr. Olmstead. Sincerely, J ohn aughton , M. D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences Dear Fellow Alumni: W e're all excited about a high profile idea that should put your Alumm AssoCiation in the spotlight again. We have begun accepting contributions to a $1 million Alumni Scholars Fund to support worthy medical school applicants. This is a way to consolidate our class gifts so we can all pull together for a highly visible objective. Dean Naughton has expressed his full support for this major endowment fund that will accumulate principal over a five-year cycle so that each class has a chance to participate. The admissions department will assist us in picking two or three students each year. The awards will be presented at our Spring Clinical Day reception. We intend to follow our Alumni Scholars through the school year and keep you informed of their progress. Another major innovation for 1993 will be our new Alumm Achievement Awards, to be presented to a select group ofUB medical alumni who, although perhaps not universally famous, have nevertheless made their mark in a particular area of medical endeavor such as research, teachmg, technical innovation, private practice, community service and school administration. We are soliciting nominations from all over the country including both rural and urban locales. These Achievement Awards will be presented at our Spring Clinical Day luncheon. We are also sponsoring a Visiting Alumni Lecture Program to encourage the return of qualified alumni to lecture to peers, residents and students. We will contribute an honorarium to defray travel expenses. We also plan informal receptions to allo"" the lecturers a chance to meet old and new friends. Yours truly, Buffalo Plnsician. 146 CF~ \ddnion, 3435 \lamStreet , Buffalo, :\c" York 14214 Don Copley, M. D., '70 �- 0 ...........r - :;,r- w N 2 ~ ., _ N 0 1 f 3 ' 7/. I T( E R 9 9 Hospital News I Problem'Patients e T:Pe experts sa managing them takes a :mu self- Xami ation as patient-exami ati9n. Taking the Stand e As the need for medical experts In courtrooms grows, and in the absence o( stand,ardiz-ed pro(essional guidelines-, testifying in court can be a contro ers~al practtce. ASpoonful of Humor Medi,al s,hool People Alumni NCI' s Breast Cancer Prevention Trial still open to area women. Poge 2. Classnotes fflillarn ann ~r~lin forge joint seruice agreement. New findings on electric blanket use and breast cancer. Page 2. rage~- �l~l .................................................................................... Overall, electric blanket use did not increase the risk of breast cancer, the study found. But there was a slightly elevated, although not statistically significant, risk associated with sleeping with the blanket on all night throughout the season, suggesting the need for further study. Vena continues to investigate the risks of electric blanket use among premenopausal women. Electric blankets do not increase breast cancer risk urling up under an electric blanket ward off winter's chill may not pose an increased cancer risk , according to UB researchers. john Vena, Ph.D., and colleagues in the Department of Social and Preventive Medicine have shown that using an electric blanket does not increase the risk of breast cancer in post-menopausal women, the population group most likely to develop the disease. The study was published in the Americanjournal of Epidemiology. The breast cancer investigation compared electric blanket use over 10 years in 382 post-menopausal women with the disease and 439 with no known cancer. Scientists have hypothesized that chronic exposure to electromagnetic fields , such as those produced by electric blankets, increase breast cancer risk by suppressing the normal nighttime rise in the level of . the hormone melatonin. Melatonin regulates the hormone prolactin , known to influence breast cell growth. to 6 u a 0 BY LOIS The study is designed to determine whether the drug tamoxifen is effective in preventing breast cancer in women at a high risk of developing it. Tamoxifen has been used for 20 years to treat patients with advanced breast cancer. Since 1985, it has also been recommended as an adjuvant therapy for early-stage breast cancer. "With the latest statistics showing that one in eight women will develop breast cancer at some time in her lifetime, the BAKER Breast cancer study open to WNY area women he Breast Cancer Prevention Trial announced last April by the ational Cancer Institute's ational Surgical Adjuvant Breast and Bowel Project is still accepting women in Western New York. p y 5 c a n w e 9 9 3 �... . .... . ................................................................. . .............. tamoxifen study could potentially mean the reversal of this frightening trend and the saving of thousands of women's lives," said Stephen Edge, M.D., chief of breast surgery at Roswell Park Cancer Institute's Breast Center. The study will involve 16,000 women who will be randomly assigned to either tamoxifen or a placebo. Women 60 years and older are eligible to participate in the study based on age alone. Women aged 35 to 59 arc eligible to participate if they have an increased risk for developing breast cancer based on certain factors. Western ew York women interested in participating in the study or obtaining further information should contact Roswell Park Cancer Institute at845-7667. opinion turned up first on the list. \ ommunities trying to attract family physicians may get better results if they woo the doctors' spouses rather than the doctors themselves, a UB researcher has found. ln a survey designed to determine the factors that influence a doctor's decision concerning where to practice, the spouse's u 0 0 p Personal income , on the other hand, ranked lOth . Results of the survey cond uctcd by Thomas Rosenthal , M.D. , associate professor of family medicine, were reported in the journal of the American Board of Family Spouse's opinion means most in practice location B ' ' h Practice. Family practice is one of the most heavily recruited specialties due to existing and projected shortages of primary care physicians, a diminishing number of medical school graduates entering these fields and a high turnover rate among those who do. To better understand why a family physician selects one community over an- y c a w .[! other , Rosenthal surveyed physicians who graduated from family practice residencies between 1970 and 1989. Data were analyzed collectively, as well a by year of graduation , community size and in-state versus out-of-state location. The survey asked respondents to rank 24 factors known to influence a physician's decision about where to practice. Spouse's opinion was rated "most important" or "important" by 86 percent, with little change across year of graduation, community size or other variables. "Public policies and medical school experiences can have an impact on physician specialty and distribution ," Rosenthal said , "but the ability of an individual community to attract physicians will rely on how well it can confront problems and take action." The next three factors receiving the highest percentage of importance were hospital-related - hospital consultants (73 percent), hospital services (71 percent) and colleague interaction (70 percent). umber five on the list was afterhours coverage with 70 percent. Other factors rated important or most important by a majority of doctors were: quality of schools (67 percent), proximity to hospital (6J percent), family health and education need (60 percent), personal income (59 percent), employment for spouse (56 percent) and cultural opportunities (53 percent). BY e LOIS BAKER 9 9 0 �a ··························································· · ······· · ··············· · · · ··· the hospital's ties with the School of Medicine and Biomedical Sciences, and forging an agreement that made Millard Fillmore Hospitals one of the medical school's major teaching affiliates, with 16 residency programs based there. jennings was also instrumental in establishing in 1987 the Western ew York Health Sciences Consortium - an association of representatives from the medical school and its affiliated teaching hospitals, business and government designed to emphasize the need for cooperation and enhance the quality ofhealth care in Westem ewYork. "One of the most rewarding aspects of my experience in Buffalo," jennings said, "has been working with the University at Buffalo School of Medicine and Biomedical Sciences in the formation of the Western ew York Health Sciences Consortium. "One of the best secrets in Western ew York is the quiet but measurable leadership of Dr. john Naughton. He has in this tenure taken the University's medical school to the top quartile of all U.S. medical schools. In several key areas of measurement, the UB medical school is clearly within the top lOin thecountry,"jennings said. "This achievement is directly related to Dean aughton's commitment to excellence and perseverance," he added. Under jennings' stewardship, Millard Fillmore Hospitals established five primary care sites in medically underserved areas, established its successful Sleep Disorders and Hand Center specialty services, forged an agreement between its 3,342-birth Suburban Hospital maternity service and The Children's Hospital of Buffalo for neonatal coverage, established its $4.5 million Baird MS research center and developed the nation's largest freestanding ambulatory care center. The hospital also recently broke ground for a $60-million expansion and renovation project. The project, one of the Jennings leaves Mnlard post for Chicago ChUdren's an R. jennings, president and chief executive officerofMillard Fillmore Hospitals for the last 10 years, was recently named president and chief executive officer of the Chicago Children's Memorial Medical Center. He took over his new post january 15, 1993. "Having securely positioned Millard Fillmore Hospitals to meet the health care needs of this community for many generations, the climate was appropriate to accept the position at the Chicago Children's Memorial Medical Center, considered the 'crown jewel' of the U.S. child advocacy movement," jennings said. "During my nine years as president of Millard Fillmore, we have achieved every strategic objective charted. Millard Fillmore Hospitals has become one of the leading health care facilities in ew York State," he said. "The numerous successes achieved by Millard Fillmore during these nine years could not have been accomplished without the cooperation and dedication of the hospitals' board of directors, medical and nursing staffs, administration, employees and volunteers," jennings added. jennings took over as president ofMillard Fillmore Hospitals in 1983. The twohospital system had, at the time, lost $20 million over the previous l3 years. With several additions to a newly built administrative team, jennings turned Millard's finances around, with it emerging as the only major teaching hospital in the state to have maintained a positive bottom line for the past eight consecutive years. jennings is credited with strengthening 0 B u a 0 p 5 c a largest in its history, includes the addition of 43 beds to Millard Fillmore Suburban Hospital and major renovations to both the Gates Circle and Suburban facilities. The Chicago Children's Memorial Medical Center, founded in 1882 for poor children and affiliated with orthwestem University Medical School, is a multicorporate entity with its 265-bed facility as its centerpiece. A national search to find a new presidentand chief executive officer for Millard Fillmore Hospitals is already underway. New surgery chief named at VA Medical Center illiam Lynn Weaver, M.D., has been appointed clinical associate professor of surgery and chief of surgery at Buffalo VA Medical Center. A native ofKnoxville, Tennessee, Weaver graduated from Howard University in Washington, D.C. , with a degree in pharmacy. He attended Me harry Medical College in ashville and completed his internship, residency and nine years in the Army. "I think this is a tremendous challenge because of the history of the surgical department of this VA and all it stands for ," Weaver said. "The important name that the Buffalo VA and University at Buffalo medical school have developed in the national medical community gives me the opportunity to work with some of the brightest minds in the country," he added. Weaver hopes to increase the visibility of the surgery department by highlighting some of its past accomplishments, including its leading role in the development of cardiovascular technology. w e 9 �.... . ................................................ Sisters Hospital announces change in leadership isters of Charity Hospital has announced that Sister Angela Bontempo, hospital president and chief executive officer, is leaving Sisters Hospital for other duties within her religious order, the Daughters of Charity of St. Vincent De Paul. With the change in Sister Bontempo's status effective in October, a search process for a new chief executive officer is now underway under the direction of the regional office of the Daughters of Charity National Health System. "Being missioned is part of life in our religious community," Sister Bontempo said. "I've been at Sisters Hospital for six years and that's probably about an average stay for sisters in our order. But whether it's six, 16 or 60, moving on is never easy," Sister Bontempo said. "I will carry Buffalo and its people in my heart, always. Like so many others who have come to this beautiful area, Buffalo has captured me and I'll always be a Buffalo booster." Sister Bontempo took over Sisters Hospital in December 1986. "When I came here," she said, "the hospital needed major work. We had an old facility that begged for attention and was dangerously close to slipping into financial disaster. " Sister Bontempo brought in a new administrative team and the hospital has finished every year of her tenure with a positive bottom line while its fund balance has doubled. Among her accomplishments have been the establishment of new women's services, satellite primary care and chemical B u a 0 p ························· ···········a In 1990, Gov. Mario Cuomo named Sister Bontempo to the ew York State Pubic Health Council. She was also named to the Board of Trustees of the Western ew York Public Broadcasting Association. dependency centers and the hospital's $42 million modernization project, slated for completion in 1994. The project includes a new emergency department, family care center, operating rooms, intensive and ----- I Mnlard and BryUn announce ioint service agreement illard Fillmore Hospitals and Brylin Hospitals recently announced the establishment ofa formal medical ser- vices exchange agreement and the appointment of a jointly recruited physician to head Millard's psychiatry department and serve as associate medical director at BryLin. The agreement provides psychiatric consultation services for all emergency room and inpatients at Millard's Gates Circle and Suburban facilities and inservice educational programs for the nursing and support staffs. It also will foster a more coordinated care effort for inpatients at Brylin who need acute medical care and treatment. Under th e agreement, Ellen S. Dickinson, M.D., clinical assistant professor of psychiatry, was named chairperson of Millard's psychiatry department and associate medical director at BryLin. Board certified in psychiatry and neurology, Dickinson was an assistant professor of psychiatry at Albert Einstein College ofMedicine, Yeshiva University, ew York. She also served as the unit chief of psychiatry at North Central Bronx Hospital in ew York. coronary care units, head and neck center, urology and ambulatory care areas as well as a new entrance way and lobby. Sister Bontempo was the first woman to serve on the board of directors of M&:T Bank and currently sits on the board of the bank's parent company, First Empire State Corporation. In 1987, she received the Clifton C. Thorne Award for outstanding achievement in health care and human services. She received the 1989 Brotherhood! Sisterhood Award in health care by the National Conference of Christians and jews. 5 c a w n e 9 0 �~ 1 \ L 0 L B u 5 T R a A T 0 0 N p h 5 B y w H a T n N w E y 5 H e E R M A 9 9 N �B Y S C 0 T T T H 0 M A S Problem Patients Every physician has themhere's how he patient, a some doctors woman, came to Suzanne K.W. Anderson, M.D., with a complaint beyond the l<en of any diagnostician. deal "I feel with "I just feel so empty." empty inside," she said. them. Then she came again. And again. Soon, the patient was seeing Anderson every couple of days. "She really glommed onto me," says Anderson, now a family phy~ician and a clinical assistant professor of family medicine at the UB medical school. "She told me I was the only doctor who would ever tal<e care of her, who would ever love her." Buff a loP h y s i c ion WIn I e r 19 9 3 0 �Anderson tried to set limits- and the young woman turned violent. She cut herself with razor blades, showing the doctor her scars as punishment for her "rejection. " She invented a wild story about being kidnapped and raped, saying the rapist had carved an obscenity into her abdomen. The word was there, all right, but it was the woman's own knife that had done the carving. "Over time we did manage to establish some limits and got her into counseling," Anderson says. "And she actually ended up having astable relationship with a man after a couple of years." Problem solved. But for physicians struggling to treat difficult patients, rarely is the solution so neat. From dependent, fawning persons to the hostile and delusional , problem patients are a continual source of frustration for the caring doctor. Treating them means negotiating a fine line between empathy and effectiveness. And, perhaps most difficult to acknowledge, problem patients can point up a physician's own subconscious prejudices and shortcomings. "In a way, every patient is potentially a problem patient," Anderson says. "If their problems aren't treated respectfully, they can be a problem." "Compassionate objectivity" is how Jamie Shiffner defines that line between getting too involved with a patient and staying too distant. Too close, he says, and the physician can get caught up in the patient's emotions and stresses. Too far , and it's impossible to treat a patient with the empathy essential to proper diagnosis. Shiffner, a psychologist with a doctoral degree, teaches a Behavioral Sciences Seminar in the medical school's Department of Family Medicine. As part of that seminar, he delivers an annual lecture on problem patients- who they are and how to cope with them. There are no easy answers; the lecture consists of a series of video clips of patients, followed by students' discussion 0 B u a a hysician A might have no problem with a patient Physician B finds highly annoying- a difference that's rooted in the doctor's own subconscious. "There are certain kinds of personalities that we have trouble with, just because they remind us of people we've had bad experiences with in our own lives. You can use your own response as a diagnostic tool." of how they might handle the situation. One thing he has discovered, Shiffner says, is that "Know thyselr' is the first rule for dealing with problem patients. "Rather than being focused outwardly, pay attention to yourself," he says. "Know when you need to excuse yourself and get a cup of coffee, then come back. ... Give yourself time and space. Often it feels like, 'I've got to do this now, in my office, this second.' But there are very few things other than a code that you have to do right people who are excessively concerned about why I'm prescribing this drug, and does it have side effects. I also have a problem with excessively dependent people, and I can use my own annoyance as a signal that this is a dependent person. You can use your own response as a diagnostic tool." One place where problem patients congregate is hospital emergency departments. Close to the street, often serving as primary care providers for people without a regular physician, ERs play host every day to a wide-ranging drama of human misery. "There are hundreds of different reasons that people have stress that may ultimately result in a visit to the emergency department," says Steve Lakomy, M.D., who practices in three Western ew York ERs - at St. joseph and Sisters hospitals and the Erie County Medical Center-and is a clinical assistant professor of emergency medicine at UB . "There now. " Anderson notes that Physician A might have no problem with a patient whom Physician B finds highly annoying - a difference, she says, that's roo ted in the doctor's own subconscious. "There are certain kinds of personalities that we have trouble with,just because they remind us of people we've had bad experiences wi th in ou r own lives," she says. "I tend to have a problem wi th people who challenge authority a lot - p y s c a w n e 9 �are people who come to the emergency department because they're depressed and have a physical manifestation. Or they have a lot of stress at home or on the job, and they come in with an ulcer or high blood pressure. "There are people who just have emotional insecurity and can't deal with their problems; they don't have the coping mechanisms. It's a very wide range of people, and a wide range of problems. We kind of lump all these people together as hypochondriacs, when in fact there are all sorts of reasons. " One problem endemic to emergency rooms is the drug-seeking person. 'Tve had a patient come in and complain of a crushing chest pain, and gave him morphine for what could have been heart attack pain," Lakomy says. "It turned out he was faking it. "Or you have people from out of town who present with pain and say they need Demerol. But most area little more tactful. They have a whole list of drugs they can't take because (they say) they have an allergic reaction. Basically, it narrows down to one or two narcotics that they can take. "Sometimes they walk out of the department when they realize you're not just going to give them medication. "Butl always try to err on the side of the patient. l would rather be fooled several times, and actually give narcotics to a patient who's not being honest, than send somebody home in pain." Then there are the characters - not too sick, not too crazy,just enough of both - who keep life in the ER interesting. Lakomy tells of one patient, an asthmatic man in his late 40s, who sometimes shows up every day for two weeks with an exacerbation of his condition. While he's being treated, he regales the staff with his intentions to marry famous exMouseketeer Annette Funicello - who, of course, knows nothing of the sort. But he has this plan, see ... The patient has refused psychiatric counseling, Lakomy says, "but he's still a very functional individual." B a 0 p " here~ a reporting system for doctors - if we commit a violation or have a lawsuit against us, it gets recorded and gets reported to the physician registry. But patients who have seen doctors multiple times or who have had multiple surgeries, and never had any positive findings - we don't know about those patients. We become their victims." Anxiety, in all its forms, surfaces again and again as an underlying cause of patients' problem behaviors. Anderson, the family physician, tells of a recent patient who imagined that his head was Ooating up to the ceiling, and that electric shocks were shooting from his head to his toes and out his anns. Such symptoms, she noted , don't correlate with any known organic illness. So she spent some time talking with the patient. lt turned out that he had recently emigrated from Cuba, had a big family to support, had no job and no health insurance. "The symptoms were all related to this tremendous anxiety he had," Anderson says. "The thing is, he had been to an internist who had put him through a whole lot of tests, and spent a lot of his personal money, without result. " ln such cases, she says, "it's really a challenge to get them to see they don't have a physical illness. You have to bring this on very slowly and carefully, not too abruptly. "Often, just the awareness (that the symptoms are anxiety-related) makes the symptoms disappear or become a nonconcern to the patient." a n w Dentists, especially, find fear and anxiety epidemic among their patients- often stemming from fear of the dentist himself. The effects can be crippling. SanfordL. Nusbaum, D.D.S. ,a l960graduate of the UB dental school, tells of one patient. "Open, please," Nusbaum said to the patient, who would not. "We talked about it. l said, 'Can you open7' '"Yes.' "'Do you want me to examine you and see what the problem is?' '"Yes.' '"Well , open.' '"I can't."' 'Tve seen patients that, when you start explaining to them what has to be done, they'll pass out just listening to it. There's all this psychological, emotional baggage they're carrying with them that makes it a problem.'' Despite the time pressures on every physician, Howard Lippes, M.D. , '77, a clinical assistant professor of medicine at B, says the doctor's time is what fearful patients need most. "If you can possibly spend the time to e 0 �ot all problem patients are in the wrong. There are " many problem patients who ought to be problem patients, because they're not given the information that the patient should be receiving." [I i I I II B II "If you can't find something physically patient on, you're almost acknowledging wrong with them, they're almost angry at the wrongs of the prior physician." you . And they'll go to another doctor. All this is moot, he says, if the patient is "There's a reporting system for doctors not physically ill. Abandonment is rarely - if we commit a violation or have a charged, he says, "but physicians worry lawsuit against us, it gets recorded and anyway." gets reported to the physician registry. But Also , Albert notes, "Not all problem patients who have seen doctors multiple patients are in the wrong. There are many times or who have had multiple admis- problem patients who ought to be probsions and multiple surgeries, and never lem patients, because they're not given the had any positive findings - we don't information that the patient should be know about those patients. We become receiving. " their victims. " And just because a patient presents sympCan a physician who finds a patient toms that have grown in the mind, endocriunbearable sever their professional rela- nologist Lippes notes that doesn't mean he tionship? The answer is yes, but the isn't sick in body anyway. He tells of a patient legalities can be dicey. he saw while an intern- "an elderly woman UB Law School Professor Lee A. Albert, who complained of chest pain on a daily a specialist in medical-related legal issues, basis. All the physicians who took care of her says ending a doctor-patient relationship were rather exasperated; her pains were atis legally risky when the patient is ill and tributed to depression. has nowhere else to go. "But one day she explained that her "A doctor may not deny services to that chest pain was really due to a heart attack. patient without being sure the patient has And it really was. The attending physician access to a substitute physician," Albert told me, 'Even the crocks get sick somesays. "If she does refuse services after a times.' The lesson being that even the patient-physician relationship is estab- hypochondriacal patients can get real illlished, without reasonable assurance that nesses. You really have to be tuned in." a substitute physician is available, that's Despite the frustrations , Campagna and called abandonment, and it's tortious con- other physicians say dealing with problem duct. The patient can sue for damages. " patients is just part of the territory in a But,Aibertsays, "reasonable assurance" human science like medicine. "If you is a gray area. "It's often not very easy to conquer the challenge and ultimately find a substitute. When you go to a new things turn out well for them , it's a victory doctor, he asks whom you've been treated and it's a wonderful feeling," she says. by and what happened. There's a kind of "But sometimes the pain of getting there is collegiality that says if you do take that more than you want to bear." sit down and explain to the patient what it is you're doing or what it is you think the patient has, you're most of the way there," Lippes says. "The more suspicious and anxious the person is, the more time it takes." But the physician can talk until he's three shades of blue, and he won't talk some patients into doing what's best for themselves. on-compliance, or nonadherence, is one of the thorniest issues confronting physicians with a sincere interest in their patients' well-being. Ida M. Campagna, M.D ., '79, apracticing OB/GYN who is a clinical assistant professor in UB medical school's Department of Gynecology and Obstetrics, cites the case of a young patient she has now: pregnant, diabetic, but who refuses to take insulin. "We're going to try to do some outreach to this girl," Campagna says. "Get on the horn, call her, see if we can convince her how serious this is. A lot of things can happen with this baby. You have to pull at the heartstrings of the mother and say, This is what's best for your baby.' "Sometimes you have to do what your mother did, which is to administer an oldfashioned dose of guilt." Campagna also says she is troubled by "doctor-shopping," where patients go to one physician after another in search of a diagnosis that fits their own idea of what's wrong. "There are people who are really delusional about their ailments," she says. u a 0 p h y 5 a n w e 9 3 �'A roster of difficult patients Jamie Shiffner, a psychologist with a doctoral degree who teaches a Behavioral Sciences Seminar in the UB medical school's Department of Family Medicine, delivers an annual lecture on problem patients- who they are and how to cope with them. Shiffner has summarized the range of problem patients - a range as broad as humanity itself - into a dozen categories. They're a laundry list of the people who can ruin a physician's day. Perhaps you've encountered: Overly dependent people who have trouble making decisions . "They're the ones who call up at 3 in the morning and say, Tve got a runny nose, do you think I should take an antihistamine?'" Shiffner says. Seductive patients, both those who approach a physician sexually and patients who wheedle and flatter the physician in order to obtain narcotics. Aggressive patients. "Some get B 0 0 p h downright nasty," Shiffner says. Threatening people, who know what they want- for the doctor to sign disability papers, for example - and threaten force to get it. Suicidal or self-mutilating patients. Antisocial personalities, whose problem behaviors include lying, cheating and stealing. One antisocial patient is the one who never pays his bill. Patients who withhold necessary information, out of distrust or shyness. "Sometimes," Shiffner says, "people expect that doctors should be magical, and figure out what's going on without any information." Those with psychotic delusions. Arguing logic with them gets the physician nowhere. Passive-aggressive persons - tho e who say yes but mean no. Into this category fall all those patients who say they'll take their medication , lose weight, whatever, but don't follow up. People who are disgusting for some reason. Their appearance may just pro- y s a n w voke strong emotion in the physician -or they may not have showered in weeks. "They can be lovely people," Shiffnersays, "but it's really hard if you can't sit there without passing out from the aroma." Extremely attractive people. "Feelings don't just go away because you're a doctor," Shiffner says. And finally, patients suffering from a borderline personality disorder, generally people who have been abused as children. These patients, Shiffner says, are both dependent and standoffish - a contradictory set of behaviors difficult to resolve. In addition, Shiffner mentions a seemingly innocuous behavior that can turn into a problem: the patient who's exceedingly nice. "Maybe they talk and talk," he says; "maybe it's hard to deliver difficult news to them. What if you have to talk to them about their drinking too much? That can be as difficult as the person who comes in and yells at you." n e 9 9 3 ��BY ANDREW DANZO he said he raped her. He said she consented. The physical evidence couldn't say who was telling the truth. Thats where Raphael S. Good, M.D., came in. "My testimony was that the way she described the event, rape was not possible - or at least entry was not possible," recalled the University at Buffalo medical school graduate. "That was the bottom line. " He never said in so many words that William Kennedy Smiths accuser was lying, but Good gave the jury in West Palm Beach, Florida, reason to doubt her. And in December 1991 , thefourwomenandtwomen found Smith innocent. I)hysicians (L' I ILLUSTRATION Buff a loP h y sic JJ( rt BY ian Witnt sscs TED w PITTS i n t e r 1 9 9 3 �Lastly, taking the stand isn't always fun. "It's very intimidating to be a witness," said Brian S. joseph, M.D., a psychiatrist who graduated from the UB medical school in 1968. "You're playing by different rules, and while they're always respectful, they don't always treat you like you know everything." But the American College of Physicians maintains testifying in court is part and parcel of a higher calling. In its 1990 statement, which accompanies guidelines for medical expert witnesses, the college said: "Physicians, as members of society and as professionals, have a duty to testify in court as expert witnesses . . .. Nonpartisan and scientifically valid expert testimony not only assists the deliberations in a particular case, but also can establish for the record applicable standards of care." Some physicians say an occasional court date can be a gratifying teaching experience that helps keep them sharp. Others say there are personal rewards, especially in medical malpractice cases where they can help weed out incompetents or come to the aid of a wrongfully accused colleague. And, while it's not for everyone, cross- be to get more physicians into the courtroom. "Small numbers of physicians should not spend disproportionate amounts of time testifying; rather, more physicians should try to be available to serve as experts as a component of their professional activities," the American College ofPhysicians proclaimed in a 1990 statement. How can practitioners obliger "They might make it known to their local medical societies," said Lois Snyder, ].D., manager of health and medical-legal policy development for the college. "Some societies are becoming interested in pulling together an information bank of people who could be experts." But, she added, "I don't know who is doing this with regularity. " Physicians have plenty of reasons for avoiding the courts. Many cite the time it takes from their already busy schedules. And things can get messy if arrangements with the lawyer aren't spelled out. In Buffalo, so many disputes over issues like fees and canceled court dates have arisen that the county medical society has been working with the local bar association to develop a model witness agreement for members. ood is among the large number of physicians who go into the courtroom as expert witnesses. Many more serve as experts in cases that never reach court, either because the cases are settled beforehand or because the physicians convince the lawyers that there really isn't a case. Many lawyers say their need for medical experts has grown, and with that growth has come controversy. Court rules for the use of medical experts are vague, and professional guidelines vary among different medical organizations. Some physicians turn up so frequently on the witness stand that they have little or no time to actually practice. Some of their colleagues refer to them as "hired guns," the medical equivalent of the ambulancechasing lawyer. The best way to reduce the reliance on experts with questionable expertise may "THE PEOPLE WHO TESTIFY FREQUENTLY, MANY OF US THINK OF THEM AS WHOREs.•• Rapna I(, t>d \1 D. B a a p h c a n w e 9 l �"YOU'RE PLAYING BY DIFFERENT RULES, AND WHILE THEY'RE ALWAYS RESPECTFUL,THEY DON'T ALWAYS TREAT YOU LIKE YOU KNOW EVERYTHING." -Bnanjoseplt, M.D. examination can be as invigorating as a good game of tennis. "Listen," said Good. "I don't do anything I don't enjoy. I've been around too long." Good, a member of the UB medical school's Class of 1948, said he was brought into the William Kennedy Smith case by defense attorneys seeking a rape expert. Board certified in OB-GY and psychiatry, both of which he teaches as a clinical professor at the University ofMiami medical school, Good helped establish one of the nation's first rape-treatment centers in Miami in the early 1970s. He also is coauthor of a book chapter on rape. But Good's testimony ended up centering on the physiology of sexual response, and for that he was also qualified as a former vice president of the American Association of Sex Educators, Counselors and Therapists, and as the organizer of a human sexuality course at the University of Miami. He also maintains a psychiatric practice in Miami. Before trial, he reviewed voluminous records, including the depositions, police statements and polygraph tests of Patricia Bowman, the woman who accused Smith. "I would guess the stack was close to two B u 0 0 p h feet high ," Good said. On the witness stand, he said, he was given a hypothetical situation mirroring the alleged circumstances- that the rape occurred even though the victim was fighting off the attacker, the victim was not sexually aroused and the attacker had only a partial erection. Good said it didn't add up. Under cross-examination, he said, the prosecuting attorney kept hammering away at the fact that there was semen in the woman's vagina, so there had to have been intercourse. "I kept saying that under the conditions described, she could not have had intercourse," Good said. "The prosecutor said intercourse did occur. 1 said, 'Well, there must be some discrepancy."' The physician said he enjoyed verbally dueling with the assistant prosecutor who questioned him. "She tried to downplay my clinical experience, saying 1 was busy reviewing journals and giving talks around the country, implying I was not clinically involved with patients," Good said. "1answered by saying, 'Yes, it's true I am a very busy doctor.' She was very frustrated. " For all his cool, Good had been on a y a w witness stand only twice before. Once he testified about behavioral responses to pornography in an obscenity trial, and another time about marital relationships in a case involving an abortion law's spousal-notification clause. Like many medical experts, Good has worked with attorneys much more frequentlyoutside the courtroom. He said he is often called upon to review records in medical malpractice and personal injury cases, but the cases are usually settled or dropped before court, based on his conclusions. Good emphasized, however, that it's only a sideline. "The people who testify frequently, many of us think of them as whores," he said. "It's not an unusual experience, the same people are testifying all the time. I'm not sure they are dishonest, but they may see things a little differently." Few formal restrictions, however, govern the use of expert medical witnesses. "Generally, the relevant guidelines are the federal rules that govern court proceedings, and they are very broad about who can testify," said the American College of Physicians' Snyder. "Physicians sometimes see that as a problem." e �Various medical organizations have their own guidelines. The American Association of eurological Surgeons, for instance, says members who testify should be practicing surgeons or those who "can demonstrate enough familiarity with present practices as warrant designation as an expert." The American College of Physicians suggests that witnesses "should be actively involved in the clinical practice of the specialty or the subject matter of the case for three of the previous five years at the time of the testimony." The Medical Society of the State of ew York says witnesses should be practicing in the specialty at issue, but if they are already retired, it shouldn't be for more than five years. Not only do guidelines vary, but there are also gaps. For example, one pediatrician wrote in a letter to the journal Pediatrics last year that he would like better criteria for testifying in medical malprac- "YOU CAN'T SURVIVE FOR VERY LONG AS AN EXPERT WITNESS IF YOU'RE A HIRED GUN, BECAUSE YOU'D BE EXPOSED." They don't teach "Expert Testimony" in medical school. Yet some believe more physicians should lend their expertise to the legal system as a matter of professional duty Here are some tips for those who get involved: GET IT IN WRITING Many physicians become expert witnesses on the basis of little more than a phone conversation. That's a mistake, because there is ample room for misunderstanding. The Medical Society of Erie County and the Erie County Bar Association have been working on a model document to use in drafting expert witness agreements. For more information on the model, contact the medical society at (716) 8521810. WHAT To CHARGE A general rule of thumb is, charge whatever the value of the time taken from your practice. B u a 0 p Keep in mind, the American College of Physicians and others consider it unethical for experts to take a fee contingent on the case's outcome. One physician, however, has proposed an interesting twist on the contingency fee. In a letter in the May 20, 1992, journal of the American Medical Association ,]. Terrence Coyle, M.D. , a physician who practices at the Eye Clinic ofBellevue, Washington, writes that when he is asked to review a medical malpractice case and finds no merit to it, he asks no payment as long as the case is dropped. That, he writes, "has saved several physicians unnecessary stress from unfounded malpractice suits." h s a w PRACTICE WHAT YOU PREACH One of the top criteria for a medical expert is clinical experience in the subject. The American College of Physicians, for instance, suggests active clinical practice for three of the previous five years. Consult your state medical society and your specialty organization -there's a good chance they also have guidelines. And once you take the stand: DON' T SPECULATE ln the William Kennedy Smith rape trial, Raphael S. Good, M.D. , testified that sexual intercourse could not have occurred under the circumstances de- e 9 9 3 �Lice cases. lt is unclear how many different professional guidelines have been issued. Only late last year did the American Medical Association survey specialty societies to get a handle on the patchwork of rules. ln the meantime, the classified pages of law journals are filled with ads for medical experts seeking work. One ad in a recent issue of the National Law joumal states: "Neurologist. On faculty of prestigious university. Head injury and other expertise. " The ad lists a Boston-area telephone number. There are also services that provide medical experts. ln another National Law ]oumal ad, the Medsearch etwork lnc. offers "Prompt initial case assessment$495" for medical malpractice attorneys. Medsearch advertises that "Our expert panel consists of 15,000 board certified medical specialists nationwide" who provide reports, depositions and testimony. scribed by the accuser. Good says the prosecuting attorney kept asking how that could be, since physical evidence showed that intercourse had occurred. "The prosecutor would have liked me to say she (the woman) must have been lying. Butthat's a trap. Once you say that, they ask you how do you know someone is lying," Good recounts. "When they asked how do you explain it, l said, 'Hey, there's some discrepancy."' \ ATTITUDE IS EVERYTHING "You can't be arrogant and you must understand where you are," advises Franklin Zcplowitz, M.D. "Many times they (lawyers) get after physicians that come into the courtroom with a hostile B u 0 0 p manner." A past president of the UB medical school alumni association (Class of'58), Zeplowitz is a Buffalo surgeon who has testified in the past as an expert and now testifies regularly as the treating physician when his patients pursue personal injury cases. BE CLEAR "lt's not unlike giving a lecture to a class, to the extent they can understand what you're saying," says psychiatrist Brian S. joseph, M.D., '68. "You'vegota lay jury," addsZeplowitz. "You've got to answer questions at their level so they can understand what you're talking about." s o n w o one suggests that such witnesses will say anything for a price. But some question the expertise of physicians who spend more time in court than at the bedside. Others point out that in court, it's not always what you say but how you say it, and some experts might be more willing than others to tailor the way they answer questions. Good said a close friend of his is an attorney who handles personal injury cases. Years ago the lawyer had Good review a worker's compensation case. "I told him my opinion," Good recalled. "He thought I could say ita different way. I did not feell could say it another way." The two have remained friends, but the lawyer has never again sought Good's medical expertise. Many attorneys, however, say the only thing they want from an expert is an honest, unslanted assessment. Lawyers are becoming more thorough in research- COACHING Lawyers won't tell you what to say (at least they shouldn't). But they may want you to emphasize some things and downplay others. The best way to deal with the gray areas is to stick to your notes. "You just bring the facts out as you see them," says Zeplowitz. DON ' T BE FOOLED Advises joseph: "When you go to court and the opposing attorney says, 'Good morning, doctor,' it's important to know he doesn't mean it. " - n A N 0 e R E W 0 9 A N Z 0 9 �-----------------~--~- ••H .. "OFTEN YOU ARE CONTACTED BY ATTORNEYS BY VIRTUE OF THE PAPERS YOU HAVE WRITTEN." -]ach Fisher, M.D. ing the history of their opponent's expert witnesses, and they will seize on anything that helps them paint the witness as a hired gun. A lawyer can raise questions in jurors' minds about a psychiatrist who always finds criminal defendants insane or an obstetrician who always testifies for malpractice plaintiffs but never for defendants. "You can't survive for very long as an expert witness if you're a hired gun, because you'd be exposed," said Charles P. Ewing, J.D. and Ph.D. , a UB professor of law and psychology who has testified as a forensic psychologist. "You want someone who is rigorous and fair," said Gregory Stamm, j.D., a Buffalo-area attorney who frequently represents physicians before government agencies and sometimes represents medical malpractice plaintiffs. "If you have a doctor who's willing to testify about gynecology one day and psychology the next day and internal medicine the next day, he's going to be exposed, so you haven't done yourself any favors hiring him," said Stamm, a 1971 UB law school graduate. Lawyers usually can find experts without resorting to the full-time professionals. B a 0 "Often you are contacted by attorneys by virtue of the papers you have written," said jack C. Fisher, M.D., head of the division of plastic surgery at the University of California, San Diego, Medical Center. Fisher, a 1962 UB medicalschoolgraduate, served as chairman of a Plastic Surgery Educational Foundation committee on silicone implants in the late 1980s. He later wrote about the issue in the New England journal of Medicine. ow he is working with several attorneys defending physicians against silicone breast implant lawsuits. "So when you put a summary of an issue in the New Englandjoumal of Medicine, there are a lot more eyes on that summary than just the subscribers to the journal," Fisher said. In cases involving quality of care, Stamm said lawyers first look for experts within the community who can address local standards. "If you're representing the physician, it's very easy to find someone," he said. It's much harder to find local experts willing to testify for plaintiffs against physicians, he added. lf no local physicians will testify, Stamm said a lawyer will look to nearby communities. "What you're looking for is an p y a n expert who at least practices in the same state as the defendant," he said. After a while, attorneys develop their own lists of experts who are willing to testify, though they try to avoid using the same ones over and over. Lawyers will occasionally give a colleague the name of one of their own experts as a professional favor. In the William Kennedy Smith case, Good said defense lawyers first enlisted a friend of his, a pathologist, in their search for a rape expert. The pathologist called around the country, unaware that his friend had a reputation in the field. "People said, 'Hey, there's somebody there in Miami,"' Good recalled. In the end, Good said, he felt his testimony carried a lot of weight with the jury. But, he added, "There were many other aspects of the case that resulted in the not guilty verdict, l'm sure." And Stamm noted that as important as experts are, they usually don't make or break a case by themselves. "Good cases will tend to win regardless of experts and bad cases will tend to lose regardless of experts," he said. "I've had jurors tell me they didn't listen to the experts." w e 9 9 �A Spoonful of Humor © Stu Silverstein, M.D . hou hts on avisit to our nation's ca ital Before addressing the physicians of the D.C. Medical Society, l got to see the happenings of Washington first hand. l was welcomed to the D.C. area by all of the soon-to-be-unemployed Republicans at the exit ramp holding their "Will forge passports for food" signs. After living the past few years in California and growing accustomed to its casual ew Age attire, like tie-dyed lab coats, l was overwhelmed by the sea of blue and gray suits - more than I saw during the entire 15 days of the PBS series on the Civil War. Aides say they are concerned with how Bush will adjust to just sitting around with no defined job or agenda doing nothing during the next few months. Cmonhe's been doing that for the past four years. Bush is getting ready to move out. Barbara is out house-hunting for a nice place in George's hometown ... just as soon as they figure out which state it is in. Secretary of State james Baker, who has always bolstered his career by associating with winners,justsigned on as the mascot of the '49ers (sorry, Bills fans!). The Democrats are taking over the city, and with President-elect Clinton's drive for ethics in government, startingjanuary 20th you could easily get pulled over for driving under the influence of a lobbyist. ow, Arkansas "chic" is in. (An oxymoron, like congressional ethics.) l caught an early sign of this when I saw a young civil servant drive by in a Chevy pickup with a wine rack on the back. Clinton says he will involve Americans from all sectors of society in his administration. He's considering giving Gennifer Flowers a position . .. as First Bimbo. Bill and Hillary's daughter, Chelsea, is back at school. Her principal said she will 6 u a 0 p be treated "just like any other student" ... ow that the Church of England is yeah, any student who has the bomb squad allowing female priests, l guess it's only a matter of time before we start seeing male opening her Cheese Doodles! AI Gore will supposedly have a more nuns at the airport. active role than he did at their first press And, of course, baseball player Steve conference where he looked like a cadaver Howe, who was thrown out ofbaseball18 on line at the ATM machine. times for using drugs, just signed with the Yankees. A spokesman for the We now have two women senaYankees said that despite his probtors from California. they were introduced to the Q~[~t\ !ems and difficulties, "gram for senate floor, Senator Bob gram" he's still one of the best PackwoodlMMEDIpitchers in baseball. ATELY Seems like someone forgot to tell Bill Clinton that he won the election because he's still on the campaign trail. Responding to the death of Superman, he claimed it could have been avoided if Bush had implemented humane health care reform . The election year brought some interesting issues to the ballot. ln Northern California there was the controversial "Doctor-Assisted Suicide" Bill and in Southern California, the "Police-Assisted Suicide" Bill. But most of all , we are probably going to face some kind of government-mandated health care reform , leaving a lot of doubt and uncertainty in the medical community. Many wish we could just run things involveour way. In this spirit, I would like to leave ment! To get some relief from politics, last you with the Top 10 Current Movies- if week l watched the Frank Sinatra and the AMA were in charge of Hollywood. Michael jackson specials back-to-back. l Malcolm XXY soon realized that they actually do have a In House Alone 2 lot in common - they both grab their A Broviac Runs Through lL crotches and are willing to have their Beauty and the Plastic Surgeon noses broken to further their careers! Th e Last of the Meconiwm Back home, I discovered that the City Bram Stol?er's Dracula's lnservice of San Francisco is now being sued by on Exchange Transfusions Tampa Bay because they didn't get the Of Murine and Men Giants. Several local law firms are going to Informed Consenting Adults donate $3 million worth of legal services, A La Leche League of Their Own which works out to about three hours of Three Ninjas On Rounds work. s a n w n e �a ································································································ "For his many scholarly contributions in genetics in general and to medical genetics in particular and for his many personal contributions through generations and generations of geneticists, young physicians and others, we honor today Victor A. McKusick with the bestowing of the D.W. Harrington Award. " McKusick was founding president of The Human Genome Organisation from 1988 to 1990 and a founding member of the American Board of Medical Genetics. "Through his writings, courses, conferences and his personal example through his relentless activities, he has organized and called attention to important genetic disorders that result from alterations in fundamental biological processes. He has been a major contributor to making possible the more recent applications of powerful molecular genetic technique to the human disorders," Erbe said. Editor-in-chief of Medicine and founding editor of Genomics, McKusick talked about the international effort to map and sequence the human genome. "Thegoalofthe human genome project is to locate all of these genes, to identify them and to discover upon which chromosome they are situated and where on that chromosome, and to determine the full sequence of nucleotides from one end of genome to the other," McKusick explained. "There was an influential editorial in Science in March of 1986 suggesting that the way to solve the problems of cancer is to complete the sequence of the human genome," he said in regard to the significance of the study of the genome. The ational Academy of Science committee recommended that a special project was warranted and that it should have add-on funding so there would be no "robbing of Peter to pay Paul." Estimates of funding necessary to complete the project approximate $200 billion The Human Genome Proiect: unraveling its implications VICTOR MCKUSICK DELIVERS HARRINGTON LECTURE he ~ddcning gap bt.>t~H.'etl Hhat ph_';si( ians kno1-v h(nv to diagnose and H· hat thn hnov~. haw to tnat ""'ill he inten~ified b1r the luto""' ledg£ gleaned front tlu I Iuntan (,enome Ptoject. ptedic ted 1enowned geneticist\ idot A. tvkKusic h. ~1.IJ., '>c. D., cL~ he delhCJrd the 1992 I).\\. Ilanington I ccttoe. "I he llunu.ut C1enonte PJV)CCt: Bachgnntnd, ~tat us, Ptosp£ cts and bnplic ations. ·· members , quickly and unanimously, reached a decision to give the award today to Victor A. McKusick." Erbe, who is director of the Division of Genetics at The Children's Hospital in Buffalo, chairs the study group that reviews all grant applications for proposals to study social and policy issues of the Human Genome Project. The massive project to codify the sequence of nucleotide bases that makes up the genes in each of the 23 chromosome pairs in the human body has allocated a generous 3 percent of its budget to fund the study of the ethical, legal and social implications of its results. Erbe lauded McKusick by saying, "Dr. McKusick is a name really synonymous with clinical genetics and ... a major figure in American medicine. McKusick referred to subjecting D A to study as the diagnostic biopsy of the gene- an approach that will be increasingly used to identify specific neoplasms and their dispositions. But the knowledge that comes from this study raises "ethical and social issues" such as privacy and confidentiality that are being given a great deal of attention, he said. And although some may try to make connections between the genome's "constitution" and issues such as criminality, McKusick said many of these associations will be "spurious." Richard Erbe M.D., UB professor of pediatrics and medicine and chair of the Harrington Lecture selection committee, introduced McKusick, saying that although few geneticists have been chosen for the Harrington award, "the committee B 0 0 p h 5 c o n w n e 9 9 3 �·········· · ··································································· ·· ················ a · I (m 1988 dollars). I Also codtfted ts a growing hst of dtseases anatomy. He explained that while three categories of genetic disorders ~~-~t~r' /,I feet. The first of these diseases, McKusick related, was Huntington's disease , which was f mapped on the short arm o Chro~'1.~~~., mosome 4 in 1983. "This type of mapping is useful because once one knows where the gene is on the chromosome, one can hope to design a diagnostic test," McKusick explained. Of the 2 million plus genes in the human genome - 2,600 have been mapped. The genes for diseases such as cystic fibrosis , one form of Alzheimer's and Duchenne muscular dystrophy have been identified. McKusick said genes express disease ·: · f> . B a a p h s a n w A graduate of Tufts University and johns Hopkins' School ofMedicine where he received his M.D. in 1946, McKusick is a professor of medical genetics at The johns Hopkins University. - s v c A R R 1E A . L 1a E R A N T E e 9 �a ·············································· Dean Naughton receives Distinguished Service Award from Sickle Cell Disease Association School of Medicine and Biomedical Sciences, the School of Social Work and the Institute for CBO Education and Training. ohn P. Naughton, M.D., vice president for clinical affairs and dean of the School of Medicine and Biomedical Sciences received a Distinguished Service Award along with the medical school from the iagara Frontier Association for Sickle Cell Disease at its twenty-fifth Anniversary Dinner held last September. Naughton was cited for "his notable contributions to, and support of, the agency's unique health service to promote and ensure the well-being of the sickle cell affected and at-risk populations ofWestern New York from 1981 to 1992." During that time, a ugh ton provided a quality of material assistance that substantially contributed to the association's survival, according to the citation he received. He was also lauded for his active involvement in the creation of the Sickle Cell Center of Western ew York at The Children's Hospital of Buffalo, as well as his "always available advice and counsel on programs and problems." The University was cited for "its invaluable contributions to, and support of, the agency's unique community service work." Individual units of the University that provided singular contributions were also cited. They include: the Student ational Medical Association, the Black Student Union, the Equal Opportunity Program, the Office of Urban Affairs, the B a a ........ . ................. . ........... . .. . ........ idly growing field of medical information into its curriculum, according to John aughton, M.D., vice president for clinical affairs and dean of the School of Medicine and Biomedical Sciences. "Ira was a visionary - always looking two decades ahead," Olmsted, his wife of 39 years, said. "With medical informatics the wave of the future, this chair, one of the first of its kind in the country, represents an appropriate tribute to him." The use of medical informatics is not far off for UB's teaching hospitals, which are working with the medical school to develop an Information Systems etwork to link health care facilities and physicians in Western ew York. The network will provide a national and international prototype for medical education and health care delivery, according to Thomas A. Riemenschneider, M.D. , chair of the Western ew York Health Sciences Consortium Information Systems Council and associate vice president for clinical affairs and associate dean of the medical school. "The new Information Systems Network will place Western ew York on the cutting edge of this medical technology. The Ross chair in Medical Informatics adds significantly to that impetus," said Dr. Riemenschneider. Medical informatics chair to be estabhshed with gift in honor of Ira Ross ne of the nation's first professorships in medical informatics has been established at the School ofMedicine and Biomedical Sciences through a $1.5 million gift in honor of the late Ira G. Ross by his widow Elizabeth Pierce Olmsted Ross, M.D., '39. Olmsted is a practicing ophthalmologist and UB clinical professor of ophthalmology. The endowed chair will be known as the Ira G. and Elizabeth Olmsted Ross Chair in Medical Informatics. Ross, a distinguished aeronautical engineer, former president of Cornell Aeronautical Laboratories (later known as Calspan) and a dedicated Buffalo community leader, died january 3, 1991. The chair in medical informatics will help the medical school integrate the rap- p h y s c a Correction Our sincerest apologies to Robert A. Klocke, M.D., for printing a photograph of Francis Klocke, M.D., (instead of Robert) in an article about the medical school's annual faculty meeting in the Summer 1992 issue. Robert Klocke, a professor of medicine and physiology and chief of the pulmonary division, received the Stockton Kimball Award for excellence in academic achievement. w n e 9 9 �····· ········ ············· ············· ·· ···· ··········· ········ ····························· ·· ·[ ! ] Lore honored for oncologic surgery contributions project progress reports, Fish received the 1985 Outstanding Teacher Award and the 1987 Francis V. Hanavan Outstanding Teacher Award from the SchoolofHealth Related Professions. In 1985 , 1987 and 1988 he received the Faculty Recognition Award from the University's physical therapy program. Fish is a member of the American Physical Therapy Association, a manuscript reviewer for Physical Therapy and Physical Therapy Practice and a member of the MedicaVProfessional Advisory Committee of the Visiting Nurses Association of Western New York ohn M. Lore , Jr. , M.D., professor and former chair of the Department of Otolaryngology, has received the Presidential Award of the American Society for Head and Neck Surgery, for "his leadership in raising the quality and measurement of fellowship training in Head and eck Oncology ... " He is also the recipient of a Special Recognition Award from The Society of Head and eck Surgeons for his "untiring service as chairman of the joint council for approval of advanced training in head and neck oncologic surgery." Lore, the author of An Atlas of Head and Nech Surgery, is a senior member of the Commission on Cancer and a fellow of the American College of Surgeons. He holds dual certification by the American Board of Otolaryngology and the American Board of Surgery. Bissonette re-elected head of UCPA of WNY board aymond P. Bissonette, Ph.D. , associate professor of family medicine at UB, has been re-elected president of the board of directors of the United Cerebral Palsy Association ofWestern ew York. Also re-elected to the board was Kathryn A. Sawner as vice president, executive assistant in the Office of the President and G. Alan Stull, dean ofHealth Related Professions at the University at Buffalo. The UCPA of W Y volunteer board of directors governs the policies and procedures of the agency which provides a comprehensive range of services locally to 1,200 adults and children with disabilities. Fish wUI head physical therapy/exercise science ale R. Fish, associate professor of physical therapy and exercise science, has been named to a threeyear term as chair of the Department of Physical Therapy and Exercise Science in the School of Health Related Professions. Fish has been a UB faculty member since 1974. He is also a clinical assistant professor in the Department of Anatomical Sciences. Author or co-author of numerous abstracts, book chapters,journal articles and B 0 0 p h y s o n w Roswell doctors named 11 best" cancer specio6sts ive physicians from UB and Roswell Park Cancer Institute were selected as among the 419 "best cancer specialists in the United States" in a survey conducted by Good Househeeping magazine. The results were published in the magazine's October 1992 issue. Over 350 department heads and section chiefs at 110 major hospitals and comprehensive cancer centers nationwide were asked to name doctors they considered "outstanding" in treating the most prevalent cancers. Cited by their peers were Roswell Park surgeon and research associate professor of surgery Harold Douglass, Jr. , M.D., for gastrointestinal cancer; surgeon and clinical professor of surgery Constantine Karakousis, M.D. , for melanoma; surgeon and clinical professor of gynecology and obstetrics M. Steven Piver, M.D. , for gynecologic cancer; medical oncologist/hematologist, chairman of Roswell's Department of Medicine and professor of medicine Clara D. Bloomfield, M.D. , for leukemia, and medical oncologist/hematologist and professor of medicine Geoffrey P. Herzig, M.D. GYN and OB managers nome local editor oni Canazzi has been named editor in chief of AMGO News - the newsletter of the Association of Managers of Gynecology and Obstetrics. Canazzi is a senior staff assistant in the Department of Gynecology and Obstetrics at The Children's Hospital of Buffalo. e 9 3 �~ - · ····· ······· ······ ············ · ··············· ·· ··· · ·· · ·········· · ··· · ················· · ······ Q Evans receives Distinguished Medical Alumnus Award cation that l got at the University at Buffalo and that my father got." He said he would have liked the award to have been given to his late father, a graduate of UB's medical school and professor of anesthesiology, whom he described as a "pioneer" who established the first anesthesia training program in the country. After graduating from UB medical school in 1943, Evans interned at Philadelphia University Hospitals, Philadelphia and Goldwater Hospital in New York City. He then served two tours of duty in the U.S. Army- the first as a post-World War 11 public health officer in japan and the second as chief of the Hepatitis Research Center in Munich, Germany. Evans was appointed deputy chief of preventive medicine and consultant in epidemiology to the Army Surgeon General after his discharge from the Army. In 1987, he received the john R. Seal Award from the Society of Medical Consultants to Armed Forces, that organization's highest tribute. In 1977, Evans, who majored in English as an undergraduate at the University of Michigan, received the Best Book award from the American Medical Writers Association for his textbook Viral Infections of Humans. The book is currently in its third printing. Evans has published more than 200 articles in professional journals and spent his 43-year career studying the relationship of viruses to cancer and other chronic diseases, focusing his interests on infectious mononucleosis and the Epstein-Barr virus. About80 people attended the dinnerto see Evans receive his award, a specially designed crystal bison, from Donald Copley M.D., president of the Medical Alumni Association. LAUDS HIS LATE FATHER IN ACCEPTING AWARD lfredS. Evans M.D., '43, consultant to ASA's Manned Space Program and an infectious diseases expert, received the School of Medicine and Biomedical Sciences' 1992 Distinguished Medical Alumnus Award on September 24 at a dinner in his honor at the Buffalo Club. "I am very proud to be the recipient of this distinguished award," Evans said. "You have a very distinguished group of medical alumni. I am happy to be among them. I am happy to be a member who has been trained by this fine medical school." Evans,john Rodman Paul professor of epidemiology at Yale University for 20 years, was professor and chair of the Department of Preventative Medicine at the University ofWisconsin until he retired in 1988. A fellow and past president of the American College of Epidemiology and past president of the American Epidemiology Society, Evans served as editor in chief of the Yale journal of Biology and Medicine for three years. On accepting his award, Evans said, "I appreciate very much the wonderful edu- - BY CARRIE A . LIBERANTE Alfred S. Evans, M.D., '43, (center) receives the 1992 Distinguished Medical Alumnus Aword, a specially designed crystal bison, from Donald P. Copley, M.D., '70 (left) and Dean John Naughton, M.D. B u a 0 p h y 5 c a n w e 9 9 3 �....................................................... . . . . . . . Annual James Platt White meeting held he james Piau White Societyof the School ofMedicine and Biomedical Sciences held its seventh annual meeting October 23. The event included a talk by joseph Prezio, Chairman of the Department of uclear Medicine, on the introduction of the medical school's new Positron Emission Tomography Center as well as a tour of the facility and the new cyclotron. A reception and dinner dance were held later that evening at The Saturn Club. The event honors members of the society, who make annual contributions of $1,000 or more to the medical school. The membersofthejames Piau White Society for 1992 are: Dr. Kenneth Z. Altshuler Dr. Richard Ament Dr. WilliamS. Andaloro Dr. jared S. Barlow Dr. Horace L. Banaglia Dr. Charles A. Bauda Dr. Barry Benisch Dr. Richard A. Berkson Dr. Willard Bcrnhoft Dr. Paul K. Birtch Dr. Theodore S. Bistany Dr. Dennis L. Bordan Dr. Willard H. Boardman Dr. Martin Brecher Dr. Harold Brody Dr. james B. Bronk Dr. Robert L. Brown Dr. Melvin M. Brothman Dr. August A. Bruno Dr. Elaine M. Bukowski Dr. Thomas S. Bumbalo Dr. William M. Burleigh Dr. David W. Butsch Ms. Janel F. Butsch Dr. john L. Butsch Mr. David N. Campbell Dr. Nicholas j. Capuana Dr. Ben Celniker Dr. and Mrs. joseph A. Chazan Dr. Michael E. Cohen Dr. Donald P. Copley Dr. Daniel E. Curtin Dr. Edward Diao Dr. PeterS. D'Arrigo Dr. Richard Daffner Dr. RogerS. Dayer Dr. Alfred H. Dobrak Dr. Stuart L. Dorfman Dr. Sterling M. Doubrava B u a a Dr. Ronald I. Dozorctz Dr. Patricia K. Duffner Dr. Kenneth H. Eckhen Dr. Robert Einhorn Dr. and Mrs. George M. Ellis Dr. Alfred S. Evans Dr. john A. Feldenzer Dr. Donald M. Fisher Dr. jack C. Fisher Dr. Eugene S. Flamm Dr. Thomas F. Frawley Dr. Richard Gacek Dr. Man A. Gajewski Dr. Penny A. Gardner Dr. Robert A. G1anfagna Dr. john W. Gibbs Dr. Mala Gupta Dr. Thomas Gunuso Dr. Theodore R. Hall Dr. Eugene Hanavan,jr. Mr. Edward Hansen Mrs. Edythe T. Harris Dr. Re1d R. Heffner,jr. Dr. Orvan W. Hess Dr. Williamj. Hewell Dr. joseph M. Hill Dr. Annabel M. Irons Dr. Stephen joyce Dr. james R. Kanski,jr. Dr. john P. Kelly Dr. Richard j. Ken line Dr. Kenneth Kim Dr. Hans F. Kipping Dr. Arthur C. Klein Mrs. jean L. Klein Dr. Monon P. Klein Dr. jacobS. Kriteman Dr. joseph L. Kunz Dr. Marvin Z. Kurian Dr. Gordon R. Lang Dr. Andre Lascari Dr. Eugene V. Leslie Dr. Lawrence M. Lesser Dr. Harold Levy Dr. Stanley B. Lewin Dr. jack Lippes Dr. Hing-Har Lo Dr. Gary H. Lyman Mrs. GraceS. Mabie Dr. Michael M. Madden Dr. Milford C. Maloney Dr. Boris L. Marmolya Dr. Don L. Maunz Dr. Robert C. McCormick Dr. Harry Metcalf Dr. Merrill L. M1ller Dr. Eugene R. Mindcll Dr. joseph F. Monte Dr. john D. Mounlam Dr. Arthur W. Mruczek, Sr. Dr. Richard L. Munk Dr. Richard j. Nagel Dr. Masao akandari Dr. Richard B. Narins Dr. and Mrs. john a ugh ton Dr. Robert ey Dr. john D. orlund Dr. Timolh)' T. Nostrant Dr. Ralph M. Obler Dr. Benpmin E. Obletz Dr. john j. O'Connor Dr. Thomas P. O'Connor Dr. Yasuyo Ohta Dr. Carrie P. Ogorek Dr. Elizabeth P. Olmsted p h y s . . . . . . ... . . ...... n w .. . . . . [!] Mrs. Rose Marie L. Wong Dr. john Wright Dr. HaJIIlla Yamabarashi Dr. Gregory [. Young Dr. Wende W. Young Dr. Syedc r. Zafar Dr. franklin Zeplowuz Dr. and Mr;. David C. Z1egler Dr. Dean E. Orman Dr. johnS. Parker Dr. Gerald E. Pancrson Dr. and Mrs. Robenj. Pallcrson Dr. Clayton A. Primer Dr. Victor L. Pellicano Dr. james F. Phillips Mr. R. Willis Post Dr. Linda Rabinowitz Dr. Ben Rappole Dr. Alben C. Rekate Dr. Frank T. RiforgialO Dr. Charles Riggio Dr. Richard R. Romanowski Dr. Charles Rosenberg Dr. Alben G. Rowe Dr. Eric j. Russell Miss Thelma Sanes Dr. DavidS. Schreiber Dr. joseph I. Schultz Dr. Roy E. Seibel Dr. Elizabeth Serrage Dr. Arthur j. Schaefer Dr. Robert N. Schnitzler Dr. Edward Shanbrom Dr. john B. Sheffer Miss Alice Simpson Dr. john [. Spoor Dr. William C. Sternfeld Dr. Eugene M. Sullivan, Jr. Dr. Michael A. Sulivan Dr. MichaelS. Taxier Dr. Charles S. Tirone Dr. Edward A. Toriello Dr. Anthony C. Trippi Mrs. johnnie Vinson Mrs. Yvelle Vinson Dr. john P. Visco Dr. Barbara Von Schmidt Dr. Franklin Waters Dr. Harold j. Weinstein Dr. Virginia Weldon Dr. Philip B. Wels Dr. and Mrs. llarold F. Wherley Dr. james j. While, j r. Dr. Gary j. Wilcox Dr. james S. Williams Dr. Richard G. Williams a . . . 1993 Spring Clinical Day and Reunion Weekend Set Mark your calendars and make plans to attend the 56th Annual Spring Clinical Day and Reunion Weekend. The program features cocktai I receptions for reunion classes on Friday, Apri130, and james S. Todd, M.D., executive vice president of theAMA, speaking on "The ame of the Game," and Reunion Dinners on Saturday, May l. e 9 9 �[!!····························· Brown pub6shes history of area medicine rom the natural medicine of the native Americans to the hightech practices of 20th centu!}'_ surgeons, KentL. Brown, M.D.y '42 , has chronicled the extensive history of medicine in the Westfield, ew York area. His recently released book , A Medical History of Westfield, New Yorh, not only recounts the history of nearly 100 doctors who practiced medicine in the area , but captures the striking evolution in the art of caring for the sick over the last two centuries. Brown's history , illustrated with the drawings of jane E. Nelson, is a record of those who tended the ill from the early 1800s when the Westfield area - then called Cross Roads - was first settled. The history begins with Westfield's first physicians and continues to the present. The book features an ex tensive on the Civil War brings to life the {). horror of that conflict. Not only has Brown captured the history of medicine in the Westfield area, but his chapters on what he believes was the first autopsy in Westfield, Prohibition Days, the !lu pandemic, the Lydia Warner atrocity and many other topics offer a unique microcosmic look at the growth of the medical profession in America. Brown practiced medicine for 38 years in Cleveland before retiring to his native Westfield. An assistant clinical professor of surgery at Case Western Reserve University Medical School, he has written and lectured extensively on medical-legal problems. He is the author of Medical Problems and the Law and The Medical Witness , as well as several scientific papers. subject index to help readers pinpoint specific people and topics. A detailed chapter on the remedies and practices of the native Americans includes a fascinating discussion on natural cures. Brown also includes intriguing chapters on root and herb doctors and homeopaths. A chapter z a z w w z < ~ Brown's Medical History of Westfield, New York is illustrated with the drawings of Jane E. Nelson. B 0 0 p y 5 c 0 n w e 9 9 �································· · ······························································[ ! ] Phrnp B. Wels, M.D. '41, named chair of UB CouncH hilip B. Wels, M.D., '41, has been appointed chair of the University at Buffalo Council by Governor Mario M. Cuomo. Wels, a clinical professor of surgery at UB and distinguished alumnus, has served on the council since 1980 and last year was named its vice chairman. He succeeds M. Robert Koren, who was chairman from 1981 until his death last March. "Dr. Wels has been a part of our university community for more than half a century. He knows UB inside and out, and has a great deal of insight into the university's relationship with the Western ew York community," said B President William R. Greiner. Wels holds a bachelor's, master's and medical degree from UB. A founder of UB's fencing team , Wels was a member of the United States Olympic fencing team in 1936 and served as coach of the UB team from 1938 to 1940. He was a member of the UB Athletic Council and an original inductee into the UB Athletic Hall of Fame in 1965. He received the Distinguished Alumnus Award in 1979 and the Samuel P. Capen Award in 1981. A trustee of the University from 1972to 1976, he has been a trustee emeritus since 1979. Wels, a founder of the UB fendng team and its coach from 1938 to 1940, was a member of the U.S. Olympic fencing team in 1936. ciated with Hospice Buffalo - and the hospice concept- since its inception in Buffalo in the mid-1970s. Acting as its first medical director on a voluntary basis, Milch was pan of the group of health care and commLtnity leaders that first introduced the concept to the area and focused the attention of an international American Cancer Society conference held here on it. Milch also worked to educate health care professionals as well as the community at large about the benefits of hospice to both patients and their families. Milch served as medical director of the Palliative Care Unit at Buffalo General Hospital, and has been a staunch advocate for Hospice Buffalo. On the national level , he has acted as co-founder of Milch appointed full-time medical director of Hospice Buffalo oben A. Milch , M.D., '68, has joined the medical staff of Hospice Buffalo as its full-time medical director. Milch , a clinical assistant professor of surgery, has been asso- B u 0 0 p y 0 w Children's Hospice International and is a member of that organization's scientific advisory board. In 1988, he was given the prestigious British Ambassador's Award for his service to dying children and their families. Medical Alumni Association estab&shes Achievement Awards he Medical Alumni Association announces the creation of Alumni Achievement Awards to honorthose physicians who have demonstrated uncommon dedication in research, teaching, technical innovation, private practice, community ervice and school administration. The newly created awards will be presented annually at the Spring Clinical Day luncheon . e �B l · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·· · · · · · b::J division of laparoscopic surgery, a retired psychiatrist writes, "In three international photo salons sponsored by the Photographic Society of America, my stereo slides won awards. Because most of my photographs are close-ups, I do not use a stereo camera; I use two 35mm single lens reflex cameras whose shutters are synchronized electronically. The electronic flash units that I use are also synchronized at speeds up to 1/50,000 of a second. lam over80 years old, so l find it easier to set up my photo equipment on our backyard patio than to travel to some out-of-the-way place to get unusual pictures. At present, l have a Diamond Star in PSA Competitions. owl am accumulating credits for the next PSA Stereo Division Award, Master Stereographer l." further development of the resi- BERNARD S . STELL '36 , ARTHUR J . SCHAE FER '47 , was a member of the faculty for dency training programs and enhancement of research activities. He is an avid sailor and serves as the Fleet Surgeon of the Knickerbocker Yacht Club in Port Washington, New York. ELLIOTT BRENDER '70 , ~ 11. Elliott Brender '70 American College of Surgeons. sor of surgery at the University of retired from active family prac- California at Irvine and chief of tice. He has been promoted to surgery at Garden Grove Hospi- clinical assistant professor at the ROY M . OSWAKS '71 , lege of Medicine and Dentistry. cal College of Hampton Roads. of KENNETH P . SUN '89 , informs us that he and his wife are Insurance expecting their fifth child. He is pital Center, Company DONALD SCH ERTZMAN '82 , and lntracorp. vania, had his fourth textbook, Clinical Radiology: The Essentials, published byWilliams&:Wilkins, ovember 1992. minutes south of jerusalem, Israel on a West Bank settlement. BURTON L. HERZ '67 , died May 9, 1987. lem. JOHN K . CU S ICK '57 , Schertzman's address is: orthern judean Desert, Israel. com- pleted three years in adult psy- been appointed Director of Sur- chiatry at Massachusetts General. gery at New Rochelle Hospital He is currently finishing a two- Medical Center. Herz is respon- chiatry at Massachusetts General. administration of the department 5 His wife is at 5080 Lemon Bay Drive, Venice, Florida 34293. ER IC ARNOU '91 , died in Ari- automobile accident. ued growth and expansion of the h children. zona on November 5, 1992, in an of surgery, including the contin- p Talbott Recovery Center. He is survived by his wife Pat and six year fellowship in children's psy- sible for the overall direction and a died August 27, 1992. Prior to his death he spent six months at the ROY J . BOORADY '87 , has RAY MONDW. M ITCH ELL'44 , He practices anesthesiology at Bikur Cholim Hospital, jerusaMaalie Amos #109, ptosis and acquired involutional a ew York. practicing family medicine 30 in September. Schaefer lectured B is currently an anesthesiology resident at St. Luke's Roosevelt Hos- Hospital in Lexington, Kentucky Association. is currently a pediat- for Health Care Compare and the Southwestern Division of Cigna a professor of radiologic sciences at the Medical College of Pennsyl- Minnesota, has been elected treasurer of the Minnesota Medical LYN '88 , ton, Texas. come the orthopaedic consultant presented by the Center for Advanced Eye Surgery at Humana ERI C K REE S E R '56 , ofBagley, M ICHELLE V . ANDERSON - rics emergency fellow in Hous- ew Mexico, has be- RICHARD H . DAFFNER '67 , ptosis." jor 'project.'" appointed assistant professor of the Sixth Biannual Multispecialty for the correction of congenital was clinical surgery at the Eastern Virginia Medical School of the Medi- Oculoplastic Surgery Symposium on "Levator aponeurotic surgery writes, "I am continuing as an urgent care physician in Miller now two-years-old and is my ma- ew jersey Col- BERT A. LIES JR . '64 , T I NA MARIE GARDNER '87 , Place, New York. My son jake is tal. Robert Wood johnson School of Santa Fe, Roy J. Boorady '87 He is an assistant clinical profes- BERNARD H . SKLAR '56, Medicine of the re- cently became a fellow of the c a n w n e 9 9 ��BUFFALO PHYSICIAN STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 ADDRESS CORRECTION REQUESTED Non-Profit Org. U.S. Postage PAID Buffalo, NY Permit No. 311 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. 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Copyright 1993 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/59a8520632c63aba138f00cb7eaf3b1c.pdf 0a12fc59c7855326d69a10762f093f6d PDF Text Text �BUFFALO PHYS I C I AN Volume 26, Number 4 EDITOR Nanette Tramont Kollig, R. N ART DIRECTOR Alan J. Kegler ASSOCIATE ART DIR E CTOR Scott Robert Fricker STATE UNIVERSITY O F NEW YORK AT BUFFALO SCHOOL OF M E DIC I NE AND B I OMED I CAL SC I ENCES Dr. John aughton, Vice President for Clinical Affairs, Dean ED I TOR I AL BOARD Dr. J ohn A. Rtchert, Chairman Mr Ric hard de Asia Dr Martm Brecher Dr Harold Brody Dr. Rtchard L. Colhns Dr. Donald P. Copley Dr. Alan J Dnnnan Dr. Ttmothy Gabryel Dr. Glen Gresham Dr. Charles Massa ro Dr. Charles Paganelh Dr. Luther Robmson Dr. Thomas Rosenthal Dr. Saleela Su resh Dr Bradley T Truax Dr. Ste phen Spauldmg Dr Jerome Yates TEACHING HOSPITALS AND LIAISONS Batavia VA Medtcal Center Buffalo General Hospttal Michael Shaw Buffalo VA Medical Center Paula Pedene Children's Hospttal of Buffalo Ene County Medical Center Mercy Hospital Millard Fillmore Hospitals Frank Sava Roswell Park Cancer Institute judith Rice Sisters of Charity Hospital Dennis McCarthy © The State Umversity of New York at Buffalo Buffalo Phvsicwn is pubhshed quarterly by the State UmversnyofNew York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. It is sent, free of charge , to alumni , faculty , students, reSidents and friends . The staff reserves the nght to edit all copy and submissions accepted for publication . Address questions, comments and submissiOns to: Edttor, Buffalo Phystcian, State University of New York at Buffalo, University Publications, 136 Crofts Hall , Buffalo, New York 14260 Send address changes to: Buffalo Physician, 146 CFSAddition , 3435 Mam Street , Buffalo, New York 14214 Dear Alumni and Supporters of the UB Medical School: T he medical school and its teaching hospitals together with the faculty have made a major commitment to promote the education and training of an increased number of generalists for Internal Medicine, Family Medicine and Pediatrics. Throughout the past year, significant changes and accomplishments have been made in the governance of the graduate medical education programs and a mandatory two-month long clerkship has been initiated in comprehensive ambulatory care education. Through the recently funded Reimbursement Demonstration Project, six coordinated projects in primary care were funded together with a major project in geriatrics and minority recruitment and retention. These changes have positioned the medical school to address needed reform in undergraduate medical education. While some changes are already planned, UB has applied for a major grant for the training of generalists from the Robert Wood johnson Foundation. The school was visited by an external review committee in july, and we hope to be membered among the 18 awardees when the Foundation announces its choices in mid-November. The next challenge will be to compete successfully to be one of the l2 schools funded for a period of five years commencing in mid-1994. These two initiatives are accompanied by another complementary award. Dr. Thomas Rosenthal of the Department of Family Medicine was a successful winner of a major five-year grant from Health Resources and Services Administration to study the ways in which to develop and promote primary care in rural areas. I hope you are pleased by the commitment to this needed part of medical education and care that UB has made. We will keep you posted on the school's progress in this important area in the years ahead. Sincerely, john aughton, M.D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences Dear Fellow Alumni: T his is the ~ear of Professor William Greiner's inauguration as the thirteenth president of the Umversny , an ausptc~ous event for those of us who support the continued growth and ~ttahty of our medtcal school. Prestdent Greiner has long been a friend of . the_ bwmedtcal soences and has been conststently vigorous in his support of our objectives. For example, Prestdent Gremer and Dean john Naughton recently announced a target of 50 percent pnmary care phystctans by the graduating class of 1995, thus placing us m the vanguard of Amencan medical schools in meeting our country's health care needs. Your Alumni Association has presented the Distinguished Medical Alumnus Award to Dr. Alfred Evans, Yale Emeritus Professor of Epidemiology and UB Class of 194 3. We have also met our Rochester alumni at the Richardson Canal House for an informal renewal of friendships. Support for our current medical residents has continued wtth another "Prep for Practice" seminar. Our Community Physician t. for series on career choices has reached many students p · c1· · 1D d . repara wns Spnng . t_mca ay an Reunion Weekend are well underway toward · n a hvely program abou t phystctan . . . . performance and competence . 0 ur c1ass reumo to organize spring reun d 1 ·ft chatrmen. have been workmg dthgently · 0 n d. 1 . . mners an c ass gt s. We cenamly have reason for pnde m our school and its successful alumni/ae! Yours truly, Don Copley, M.D., '70 �V 0 A 2 L u T u 6 N o 9 N 4 9 2 Research Hospital News The Graying of Medicine e Changing the practice of medicine to meet the challenges of a burgeoning elderly population. Rehabilitation Comes of Age e UB's new Center helps an aging population reclaim its lost abilities. UB' s new SS million demonstrotion project to eose the primary care shortage could become a model for the nation. Page 26. Conquering Ojos del Salado • UB's William Carl, D.D.S., on his mountain-climbing adventure in the Andes. UB medical students wm soon see patients who aren't really sick at all. Page 28. , Medical School People Alumni Classnotes *[limning t~e secono· ~ig~est eleuation int~e Western ~emisp~ere. Harold Brody steps down as chair of anatomical sciences after over two decades. Page 30. ~age 1~. �m ····················· ··········· • • ••••••• 0 •••••• 0. 0. 0 •••• 0 ••••••• • 0 •• • •••• •• 0 ••• • • • • 0 •••• 0 UB-NASA experiments yield unexpected results n experiments with potentially far-reaching ramifications for the U.S. space program, University at Buffalo scientists have found that the human body regulates the cardiovascular system in a totally unexpected manner in the weightless environment of space and takes at least a week to return to normal functioning after even short flights. The cardiovascular research, conducted on NASA's first Spacelab Life Sciences Mission last june, showed that astronauts could not perform some routine tasks at their full capacity for the first days after returning to Earth. And in what the researchers term the most surprising finding of the study, results showed that in space, the human body uses a previously unobserved mechanism to regulate the cardiovascular system. David R. Pendergast, Ed. D., professor of physiology and one of the investigators, presented the findings at a special two-day meeting on cardiovascular response to exercise sponsored by the American Heart Association in Chicago injune. The experiment, funded by a $2.3 million grant from ASA, was developed by Leon E. Farhi, UB distinguished professor of physiology. It was one of three studies on the mission focusing on astronauts' cardiovascular function in zero gravity and under normal gravitational forces once they return to Earth - the first comprehensive human cardiovascular experiments conducted in space. B u a a p "These results will change the way ASA isthinkingabouthumansurvivalinspace," Pendergast said. " ASA had thought man could adapt readily to problems of space flight. This research shows that some functions remain compromised to some extent for at least seven days after a short flight. "This was only a nine-day flight," Pendergast added. "On a much longer flight, the effects could be much more pronounced, or last considerably longer." The project was designed to determine how the heart and lungs perform during weightlessness, and after adjusting to that environment, how they function when resubjected to Earth's gravity or a stronger gravitational force. This knowledge is important, Pendergast . explamed because the success of future ' . depen d on the travelers' space travel Will . . . norma lly during travel ab1hty to funcuon . as well as when they reach their destma· anotherplanet tion-beitaspacestauon, or Earth. , mechanisms and neural "Our bo d ys d reflexes are esi·gned to control blood h y 5 c a A pressure at 1-G ," Pender-gast said. "One of the major concerns regarding the body's adaptation to space flight is that the adjustments the cardiovascular system makes during flight to maintain blood pressure in weightlessness may compromise its ability to readjust to gravity upon return." UB researchers, using equipment engineered by UB technicians Richard A. Morin (U.S. . ret.), Christopher G. Eisenhardt and Claude Miller, took readings of three astronauts' cardiac output, oxygen consumption, mean blood pressure and heart rate five times during the six months before the flight. They calculated stroke volume, total peripheral resistance and the amount of oxygen extracted from the blood. The astronauts conducted the same experiments during the nine-day space flight, and UB researchers took readings again on the first seven days after the astronauts returned, as well as on the 45th post-flight day. Cardiac output was expected to increase initially in space, and then drop to normal in the weightless environment, as it does in experiments conducted on Earth under simulated weightlessness. During space flight, however, cardiac output went up and stayed up. When cardiac output increases, the body u u m n 9 9 2 �··· · ······· · ····· ··· · ·· ·· · ··· ·· ········ · · · ············ ···· · · ·· · ······ · ······ ·· ········· · ·· • 1'3 .~ .. attempts to maintain blood pressure; previous experiments had suggested the body reduces the amount of plasma in the blood to regain cardiovascular balance, freeing up water from the plasma and eliminating it in the urine. But because cardiac output did not come down in space and blood pressure remained stable, the researchers speculated a previously unobserved adjustment mechanism was apparently at work. And, in fact, calculation of the other cardiovascular variables showed that in space, the body had maintained blood pressure through hyperperfusion- engorging organs and tissues with blood. "This type of regulation of blood pressure was completely unexpected ," Pendergast said. "The system's failure to reduce cardiac output and its ability to accept the hyperperfusion are hard to reconcile using current physiological thinking." The researchers now theorize that this phenomenon is at the crux of the cardiovascular difficulties astro- B u reentering gravity. It will be the central focus of their research on future space flights. Post-flight data showed the ability of astronauts to perform work was severely limited immediately after leaving the weightless state and reentering gravity. "On the day they returned, the cardiovascular system was very compromised," Pendergast said. "Stroke volume was low, heart rate was high. The system was trying to compensate for the stress of gravity, but it couldn't. "By post-flight day one, the astronauts were able to perform exercise, but the body was not stable. They could do 30 minutes of exercise but the body was stressed. They couldn't have done more." The astronauts' ability to respond to stress remained compromised for seven days. 5 c o n A u "This is a significant problem that needs to be corrected if we are serious about longer space flights," Pendergast said. "Some more creative thinking has to come into play." All readings were back to normal by the 45th day. Pendergast praised the astronauts for their skill in conducting the experiments under demanding conditions. 'The crew did a phenomenal job getting data," he said. "It's an incredible testament to what humans can do." UB researchers have already begun training more astronauts to perform the same experiments on a Space Shuttle mission tentatively scheduled for next summer. + - u m n B Y L OIS 9 9 B AKER 2 0 �• ································· Area's first ECMO opens at Children's Hospital . . . . . . . . . . . . . . . . . .. . mained on ECMO for six days and finished recovering in the hospital until he was able to go home several weeks later. As many as one in every 4,000 to 5,000 newborns could benefit from the treatment, according to Robin Steinhorn, M.D., director of the ECMO Center. "With the establishment of an ECMO Center here at Children's we're taking on the challenge of caring for these desperately ill babies. We hope to be a resource for the local community as well as the entire state," Steinhorn said. + he Children's Hospital of Buffalo has opened the area's first extra corporeal membrane oxygenation (ECMO) service. Open since late june, the ECMO Center is one of only two in the state (the other is at Columbia Presbyterian Medical Center in ew York City). The state-of-the-art heart-lung machine, used for infants and children with lifethreatening lung or heart failure, completely takes over heart and lung function, enabling the patient's heart and lungs to rest and recuperate on their own. Housed in its pediatric intensive care unit, Children's ECMO service is manS Senator Alfonse M. D'Amato · · aged by an interdisciplinary team consistrecently announcedthattheSening of an ECMO physician, coordinator, ate VAIHUD!lndependent Agen. . tions Subcommlttechnician, pediatric surgeons, attending cies Appropna tee has approved his request for physicians and pediatric intensive care . to renovate The nurses. The unit's first patient, a newborn $2 m1.11 wn . . of Buffalo's Regional 1 with sepsis, was placed on ECMO within Children's Hosplta . his first 18 hours of life. The infant re- Pediatric Intensive Care Umt. . . .. . . . . . . .. . . . . .. . . . . . . . . . . "Children's Hospital is a national leader of health care for our children, providing cutting-edge scientific discoveries and stateof-the-art medical treatments for seriously ill and injured children, regardless of their ability to pay," said D'Amato. "Our children deserve the very best health care available. These funds will ensure that the badly needed renovation of the PICU will go forward without delay to provide for the health care needs of the community's families." Work on the $8.7 million renovation is scheduled to begin next year, pending approval by the State Department ofHealth's Office of Health Systems Management and the completion of additional fundraising efforts. The project includes expanded space for each PICU bed, expanded isolation rooms, enhanced nurses' and physicians' stations, an on-site satellite pharmacy and laboratory and enhanced storage and ad+ ministrative space. $8.7 mORon renovations proceed at Children's B a 0 p y s a n A u m n 9 9 2 �· ·· · ····· ······ · · · · ··· · ··· · · ·· .· ···· ·· · · ··· · ···· ···· ··· ···· ··· ··· · · ·· · ··· · ··· ··· ········ · · · • Legislature authorizes funding for RPCI maior modernization proied tion of a pedestrian walkway system to unite the campus; replacement and modernization of inpatient beds; correction of life safety , health code and infrastructure deficiencies , and restoration of structured parking. he New York State Legislature last March passed legislation that would authorize bonding for a major modernization ofBuffalo's Roswell Park Cancer (RPCI) Institute. Thomas B. Tomasi, Ph.D., M.D., RPCI president, said he felt tremendous "relief, elation and gratitude" as he watched ew York State Governor Mario M. Cuomo sign the bill which would appropriate $241.5 million to rebuild the nation's oldest cancer center. "Relief," he said, "because we had won a long hard fight. Elation because we had taken a giant step toward accomplishing what we had set out to do. And gratitude to the many individuals whose response to "it can't be done" was always "it will be done." Roswell Park's current campus comprises 19 buildings with approximately one million square feet on 25 acres. The major modernization program calls for the construction of a new diagnostic and treatment center for radiation therapy, diagnostic imaging, nuclear medicine and surgery with its related post-anesthesia care unit and central sterile supply. Construction of the center will begin next year, with completion scheduled for early 1996. A new vivarium - which would centralize disparate animal facilities presently spread over five buildings on campus and two off campus - will be completed in 1995. The plan also calls for the construction of a new laboratory building and renovation of other laboratory space to remediate obsolete mechanical and electrical systems and to provide additional space to meet the needs of the institute's basic science programs. Other priorities include the construe- B 0 0 p h The legisla- Artist's rendering of Roswell Park Cancer Institute's major modernization. tive bill passed in March, which is the final legisla- delays in renovations required to repair tive approval required before the project its deteriorating infrastructure, correct can commence, also authorizes the estab- code deficiencies, support competitive lishment of a Roswell Park Practice Plan to programs and facilitate recruitment, were enable the institute to add 30 new physi- chipping away at the institute's oncecians over the next few years without solid reputation as a major national canincreasing state funding. It will also pro- cer center. vide opportunities to develop joint venCuomo made a commitment to reverse tures with other health care facilities , in- these trends and pledged in 1989 and cluded Roswell-owned and operated fa- again in 1991 to do "whatever it would cilities outside the Buffalo area. take" to modernize the Institute. Funding for the project, which took The major modernization formally beyears to obtain, began in 1984, when gan in 1989 when a team of architects, Cuomo appointed a Blue Ribbon Com- planners, engineers and market and fimittee to assess conditions at RoswelL nancial analysts headed by Bohm • BBJ The committee stressed the national im- was selected to conduct the planning portance of the institute's scientific and project. An interagency core committee clinical programs, but underscored the of key management from the Institute, critical need for capital improvements to the Department of Health, Office of Genthe physical plant it found fundamentally eral Services and the Dormitory Authorinefficient and dehumanizing. ity was established to review and approve In the past, Roswell Park- part of the the plan in progress. ew York State Department of Health The combined direct and indirect ecosince 1911 - received approximately 45 nomic impact of Roswell's major modpercent of its funding from the state. ernization program on Western New York Today, the institute receives less than 30 is estimated at $511 million, with over percent from ew York State. That, plus 5,000 new jobs expected to be created. + y a n A u m n 9 2 �0 B u f f a l a P h y sl cIa n A u t u m n 1 9 9 2 �A ~ C T A N E M 0 N D s the baby boomers age, a demographic tidal wave will reshape the structure and culture of medical care for the elderly Already, physicians are learning to care for an older populationsome of whom are astonishingly able while others are remarkably frail- that is relatively new on the planet. Human life expectancy at birth has virtually doubled since the mid-19th century from 40 years to near 80. In fact, since 1900, the number of Americans 65 years and older has grown tenfold, from 3.1 million to 31 million today By the year 2040,68 million people will be older than 65, an estimated 22.2 percent of the U.S. population at that time, as compared with 12.5 percent now. L B L U a 5 T 0 R p A h T 0 s N c ~ 5 a n Y A l AHA 5 m 9 N EY 2 �ere, more than 15 percent of the community is 65 years and older, A preview of the medical community's competitive grant process. The program emphasizes clinical trainresponse to the nation's aging population maybefoundinWestem ewYork. Here, ing, aughton says, because, "The most more than 15 percent of the community is effective part of our education is the in for65 years and older, approximating the ratio that will prevail in the country as a whole in another 15 years. Responding to the needs of this community, the University at Buffalo School of Medicine and Biomedical Sciences is taking a leadership role in training physicians to respond to the needs of older patients. This year the medical school initiated a three-year trial program, the Indirect Medical Education (I ME) Demonstration Project, through which the region's consortium of six teaching hospitals pools Graduate Medical Education (GME) payments from area medical insurers and redirects these funds to train more residents in geriatric care. Funds are also set aside to train residents in primary care and to recruit and retain more minority residents - a strategy recently cited in Hospitals, as a national model for promoting primary care and reshaping graduate medical education. "We're using this as as tim ulus to move us institutionally mal methodologies and patient demonto help in these missions, " says john P. strations. Changes in the curriculum reNaughton, M.D., vice president for clinical affairs and dean of the School of Medi- lated to the medical problems of an aging cine and Biomedical Sciences. During the population will occur as the faculty develnext three years, the IME will provide ops interests and integrates them into the between $4 million and $5 million for curriculum." Already, Susan H. Schwartz, M.D., diresident training in geriatric and primary care, disbursing funds through an internal rector of UB's third-year medicine clerk- 0 B u a 0 p h s c a ship and assistant head of medicine at Buffalo General Hospital, has altered the medicine rotation to include outpatient exposure to the elderly this year for the first time. "Compared to their current exposure, this will change medical students' attitudes tremendously," Schwartz says. "The in-hospital exposure to the elderly is an unfortunate one. For students on inhospitalrotation, the elderly are the people who are in the hospital to die. They [the patients] are at their worst in an acute setting, away from home, where they're disoriented. It can be very frustrating for students to deal with. " Next year, Schwartz says, four of the 11 weeks of the medicine rotation will beat outpatient sites such as nursing homes and day care centers for the elderly. "It's important for medical students to see older patients in outpatient settings where they're walking, talking older people who may have assorted medical problems but are still functioning," she says. "They will see being elderly does not mean being completely infirm, and that there is a reward, clearly, for dealing with the elderly. It's both an emotional reward of just interacting with older people, and it's also the reward that you can make people better, that there are curable or chronic illnesses you can modify if not totally cure. , The geriatric initiatives funded through the IME Demonstration Project also reflect the progress of physicians' understanding of the needs of the elderly - u m n 9 �approximating the ratio that will prevail in the country as a whole in another 15 years. emphasizing preventive and chronic medical care, outpatient care for ambulatory older patients and interdisciplinary geriatric teams. Until recently, many physicians assumed that increased physical frailty was inevitable as aging progresses. A more current approach, often referred to as "successful aging," in reference to the landmark article in Science, "Human Aging, Unusual and Successful" byjohn W. Rowe and Robert L. Kahn, is gaining credence as research indicates that a healthy lifestyle and prevention of conditions such as heart disease and osteoporosis that are often present in an older population lead to increased longevity and a higher quality of life in later years. john Feather, Ph.D., director of the Western ew York Geriatric Education Center, which serves as a regional resource for geriatric education, observes, "If you think of aging as an inevitable degenerative process, then what's the point of trying to help people? You should just try to make them as comfortable as possible. However, if the frailties associated with old age are really disease-specific, then you should aggressively treat disease at any age. The truth probably falls somewhere in the middle; even if you solve every disease, that person isn't going to live forever. " june I. Chang, M.D. , who coordinates the education and training programs in UB's Division of Geriatrics/Gerontology, concurs. "A middle ground might be described as progressive aging, making people as healthy as long as possible, but accepting that some physical changes are going to occur." These philosophic approaches to medi- 8 0 0 p h cal care of the elderly have real consequences, she says. For example, though there is some senescence in aging, Chang says, people shouldn't forget important things like their child's name or someone who is a close friend. She observes, 'Tve had patients with memory loss say there's nothing sume that some surgical procedures or aggressive treatments would not be appropriate; but in many of these instances, treatment might extend life by another 10 to 15 years. Typically, students may not be aware of the importance rehabilitative therapy or assistive devices could have in improving the quality of life for older patients, she says. And they often Number of c ertl·r·led Geriatricians aren't aware of how changes re40,000 lated to aging affect which medications should be prescribed. Even practicing physicians have ....---.~ 30,000 a tendency to misdiagnose the symptoms of older patients, frequently failing to diagnose the treat_ ____, 20, 000 able medical problems that affect the health of older persons, Chang says. Medicine's approach to older patients will clearly receive more and more attention in the decades to come due to the sheer numbers of patients living to their "golden years. " T. Franklin Williams, M.D., the immediate past director of the ational Institute that on Aging and a professor of medicine at can be the University of Rochester, says, "Bedone, that's cause of the rapidly increasing numbers of normal with ag- older people in our society and especially ing. But this symptom really should be the very old, there's no question but that looked into. It could be a problem with the predominant amount of medical pracmedication, depression, a stroke or tice in essentially every field will be with Alzheimer's disease. Likewise, sleeping olderpatients-orthopedics,generalsurproblems that patients typically attribute gery, urology, family practice, internal to age could be symptoms of congestive medicine and cardiology, and so on, heart failure which gets worse at night, through every medical specialty. depression, improper medication or uri"The team approach is the key direcnary problems." tion for geriatrics, and specifically for the Chang works closely with medical stu- most complicated patients," Williams dents to address common misconceptions says. "That's true because the most comabout older patients. She says medical mon situation is a relatively older patient students frequently have a mistaken im- who may have two or three different morpression that people in their 70s or 80s bid medical complications, and may have don't have long life expectancies, and as- depression, dementia, plus social prob- Jo,ooo 5 c 0 A u m n 2 0 �related to care of the elderly with practicfor Graduate Medical Education. lems and functional losses as a result. "These two settings will expose resiing physicians and medical educators in "This is not only recognized in acavirtually every specialty. dents to the practices and principals of demic circles, but many community hosChang concurs. "Our goal for geriatpitals recognize that they need geriatricall y geriatrics with an emphasis on continuity specialized physicians, or geriatricians, on of care for elderly patients. These are real rics in general should not be training experiences in alternative settings away geriatric physicians, but to accept a role staff. They also recognize that in order to be known in a community as the right from acute care facilities, " says David W. as teacher and distributor of information place to come if you're a frail older person Bentley, M.D., head of UB's Division of to our colleagues. " Part of this mission, Geriatrics/Gerontology and the project she adds, is to convince medical stuwith complicated problems, you've got to director for the Geriatric IME Demonstra- dents that care for the elderly is chalbe well-staffed." lenging. An integral element in the develPopulation in Millions, 65 "Attitudes are changing," opment of needed geriatric experand older 10 she says, "but they're changing tise at UB's affiliated teaching hospitals, the Indirect Medical Education very slowly." Demonstration Project this year proIn the absence of a single 60 vides $130,000 in funding from the university-affiliated teaching = seven-hospital consortium for two hospital - which elsewhere t-_ - ____ , new interdisciplinary team initiatives have been criticized as being -~ overrun by medical specialists to train UB residents in geriatric ~~£40 and isolated from their commucare: nities- six of the teaching hos• Beginning in October, 1993, a 30 pitals affiliated with the UB medinew, mobile geriatric assessment team will treat older persons who cal school produced the bluelive in the community at ambu20 print for this first three-year latory care sites at area hospitals. phase of the IME DemonstraThe team, composed of a geri- 19--~:::-:--k::: J0 tion Project. atrician , nurse practitioner and 90 2000 ~ k:: Based on the project's ansocial worker experienced in the care of 201 0 0 ticipated success, UB medical older persons, will provide consultauons 'n::AI{ 2030 ~ school was asked to make a 20 40 presentation to the U.S. Congressional as requested by;residents and their intertion Project. nist-preceptors. Resident training will be ationwide, the demand for geriatric- Commission on Health Care Financing. aughton and senior staff associate provided through these consultations, as trained physicians has already outpaced ancy Gleico represented UB at the hearwell as through team conferences and supply. The Alliance for Aging Research recently asserted that the U.S. , which now ings that explored ways to change the seminars for approximately 40 residents during the first year. has 4,084 physicians certified in geriat- direction of graduate medical education • A new Geriatric Evaluation and Manage- rics, falls far short of the 20,000 needed to for which the federal government spends ment Unit, located at the VA Medical deliver medical care to the nation's 30 $5 billion a year. "We're ahead of where the country Center, will provide rehabilitative assessmillion persons over 65. This Washingment and care for frail elderly patients. ton-basednon-profitorganizationprojects should be going," aughton says, adding Theinterdisciplinarymembersofthis unit that by the year 2030, when there will be that for UB and other medical schools will also provide consultations to the VA more than 65 million Americans over 65, "One of the challenges for physicians wili MedicalCenter'sacutehospitalunits,adult more than 36,000 geriatricians will be be to coordinate medical care with specialday health care program and the geriatric needed. ists from the allied health professions. However, it will not be possible to keep Another challenge will be to integrate care ambulatory clinic. This program is expected to train approximately 20 Departpace with this projected demand. Instead, and prevention. ment of Medicine residents next year in a Bentley, who is also director of UB's "As the reemphasis on developing more proposed, required geriatric module rec- Multidisciplinary Center on Aging, sug- generalists occurs, and we turn around ommended by the Accreditation Council gests that geriatricians should share data our specialty model, it can be done. " + - - so ~~[/ B a 0 p y 5 c a I )..) n A u m 9 9 2 �lRf~li~G l H[ flDfRl~ arion Z. Goldstein, M.D., receives equate severity to require treatment, and nearly two calls a week from nearly 63 percent of this group receive no women who are concerned about treatment. Among persons over 65 living the quality of medical care pro- in institutions, an estimated 65 percent of vided to their elderly mothers. older persons require mental health serOften, the calls come as a com- vices, yet 91 percent of them receive no plaint, says Goldstein, director of the UB treatment. medical school's division of geriatrics. "The Team care is well suited to older paprimary care physician has just relegated whatever symptom is presented as just 'old age' or 'confusion."' A board certified psychiatrist with added qualification in geriatric psychiatry, Goldstein describes the common scenario: "The physician sent the elderly and their families away, saying you're just getting confused, getting old- without making distinctions between what is treatable and what is related to getting old. The stereotyping is horrendous. It's a matter of perceiving treatable, potentially reversible conditions as normal when they could be treated." She notes, for example, that if the symptom is memory loss, physicians need to conduct a differential diagnosis of the nature of the memory loss to identify how severe it is, whether it's something the person needs to adapt to, whether it's progressive or whether the anxiety and depression associated with it are treatable. A complicating factor: older patients are also often reluctant to acknowledge mental health problems, she adds. "They often are unaware of treatable mental health issues or attach a great deal of stigma to it. There's a great deal of fear of the mental health field by this elderly group. They're afraid their independence will be taken away." Depression is by far the most common complaint among an older population. Other typical mental health problems among older persons include dementia, anxiety, paranoia and alcohol abuse. In fact, research indicates that 7.8 percent of adults over 65living in the community have psychological disorders of ad- 1111111• B a 0 p h y s c a ll. u RIG Hl tients, Goldstein observes. "We need to address the specific needs of each individual much more adequately than we have so far. Our whole society needs to do something about the fragmentation of care. Hopefully the next generation will find it much more easy to seek out and find services they need. " + u m 2 �p ~ H J y B E s 0 T 0 c 5 5 a y B a p R h y s N E T A c R E B 0 a n T w A A L M m n N 0 N 0 9 D 9 2 �ul G. Bulger, 68, was reading a report at work one day, rubbing his eyes, when suddenly a giant black blotch covered the right side of the paper. When he looked up, the dark spot remained in his right field of vision. Alarmed, the former president of Buffalo State College had an assistant rush him to his ophthalmologist. There he learned that the condition in his right eye, age-related macular degeneration, would soon affect his left eye as well. Two years later, in 1988, while relaxing with his family at a wilderness summer cottage near Albany, the prognosis came true. �hough laser treatment in his left eye preserved some peripheral vision , Bulger was now legally blind. His ophthalmologist told him nothing more could be done to restore his vision , and sent him on his way. Bulger, frightened by his loss of vision , soon resigned from his position as interim director of the Buffalo & Erie County Historical Society. He became increasingly irritable, dependent on others, and subject to depression. Anticipating the needs of a growing population of elderly disabled persons like Bulger, a group of clinical and research faculty at the University at Buffalo recently founded a rehabilitation , research and infom1ation center for me elderly known as the Rehabilitative Engineering Center on Assistive Technology and Environmental Interventions for Older Persons with Disabilities. The center is the first of 18 national rehabilitative engineering centers to focus exclusively on ilie needs of the aging. It officially opened in September 1991 wiili the initiation of a fiveyear, $2.5 million grant from the Department of Education's ationa! Institute on Disability and Rehabilitation Research. An additional $2.5 million in matching funds were provided by UB and oilier sources for the center. William C. Mann , Ph.D. , director of the center known informally as the REC on Aging, says, "We have a unique service orientation. The ultimate goal of the center is to improve me quality of life by helping people maintain independence in the face of the aging process. While the physician is more typically involved with disease and medical treatment, we are addressing issues of long-term disability, and providing solutions ilirough assistive devices and environmental interventions." Referred by his physician shortly after the REC on Aging received funding in 1991 , Bulger visited the center for a full diagnostic review. The age-related macular degeneration that he suffers from occurs among an estimated 17 percent of Americans who are 60 years and older, and 30 percent of those 75 and older. Specialists identified two devices that would be of use to Bulger: a portable reading device and a computer with voice playback software. Though he remembers his early days ofblindness as, "A low spot that was pretty rough on me, and on other people around me, especially mywife,"Bulgersays. "With these devices, there is a tremendous elevation of the psyche. I have relatively few days of depression anymore." The REC also helped Bulger apply for financial support for me new devices, and provided six weeks of instruction on the devices. Bulger hopes to establish a consulting business, and is already using a desktop device that enlarges print for reading and writing that the Blind Association of Westem New York helped him obtain in 1989. Emmett Turner used the center's services to obtain a wheelchair specially molded to his body. Turner was 58 years old when he fell down a flight of steel stairs on ilie ship he was working on and broke his back. The former construction firm owner and port authority foreman couldn't sit for long periods of time in his first wheelchair and found it painful to ride over bumps.' In ilie new wheelchair, Turner can sit " nstead ofpatients who need treatment, older persons should be viewed as consumers who B u a a p h 5 c a n m 9 9 2 �process, accidents, developmental disabilities or disease. Among the medical conditions typically associated with aging that predispose to disability are arthritis, Alzheimer's, osteoporosis, cancer, heart disease, the inability to regain balance and neurologic diseases such as Parkinson's. Another REC client, john See!, a 71year-old information systems specialist who became legally blind from macular degeneration in 1988 now uses a voice-activated, specialized software package for a new computer that the center helped him obtain and learn to use. See! says if he had known of the center when he was first diagnosed, "It would have made all the difference in the world." Using this equipment, See! works from his home as a computerized maintenance, inventory and purchasing specialist for area corporations. He works for the income, and also because, "I would have just dried up and blown away if I didn't have something to keep me active." One of the RECs goals is to bridge the divide between geriatric specialists and rehabilitative engineers. "The technology people are not focusing on aging, and the aging people are not focusing in on rehabilitative technology and the applications of assistive technology and environmental interventions," says Mann, a licensed occupational therapist. "Perhaps we can bring them together." The center's cross-disciplinary team includes UB faculty in the School of Medicine and Biomedical Sciences, the School of Engineering, the School of Architecture and Planning, the Department of Communicative Disorders and Sciences, the School of Health Related Professions' Department of Occupational Therapy and specialists from UB's teaching hospitals and numerous state and local service agencies. In conjunction with their research efforts, these varied specialists provide wideranging, individualized client services that for nearly l2 hours, and is comfortable riding over uneven surfaces. "I go more places, and stay longer," he says. "It makes me feel a lot better." The medical community is on the front lines as the aging of America takes its financial and emotional toll. Currently, one in five Americans is older than age 55, as compared to one in 10 in 1910. By the year 2050, Census Bureau projections indicate this ratio will be one in three. Physicians are accustomed to providing medical solutions to health problems. However, as the nation's elderly population grows, the medical community is becoming increasingly aware of the need for non-medical approaches to improving the quality of life for older patients, many of whom face disability or loss of function to one degree or another as they age. While advancing age isn't always accompanied by disability, there is a strong relationship between age and disability or the need for assistance with the basic activities of daily life. A U.S. Census survey of non-institutionalized people conducted in the mid1980s found that 9.3 percent of persons 65 to 69 years old needed assistance with one or more activities such as dressing, eating, personal hygiene, housework, keeping track of finances or getting around outside the home. This rate rises steadily with age to 10.9 percent of persons 70 to 75, 18.9 percent of persons 75 to 79, 23.6 percent of persons 80 to 85 and 45.4 percent of those 85 years and over. These rates were significantly higher among persons living in an institutional setting. The research and service activities of the REC on Aging focus on restoring a measure of independence to those older persons whose limitations to mobility, speech, vision, hearing, strength, coordination or mental acuity are caused by normal changes associated with the aging B a a p h y c a n �he ultimate goal of the center is to improve the quality of life by helping people include in-depth assessments of each client's functional abilities, limitations and goals; identification of technologies that meet clients' needs, and assistance coordinating third-party payments for purchasing and training on new devices. The center also features a full-scale interior design testing center where changes in the layout of a home or office are tested before expensive modifications are made. lt also boasts computer and device laboratories where clients choose devices that will be most useful. The research component of the REC focuses primarily on persons 60 years and older. Interviews with about 600 of the center's clients will be used to identify which assistive devices on the market are most u eful for older persons, whether new devices should be created to meet their needs and how to make their living and work space more functional. Based on this input, the REC on Aging B u 0 0 p will design devices that are not currently commercially available to disabled older persons. Items the REC has already invented include a "smart" microwave oven that reads cooking instructions off bar codes and a motorized wheelchair testing platform to which a conventional wheelchair is attached, providing a cost-effective means to evaluate different models of motorized wheelchairs. The survey will also be used to identify and meet the needs of the older disabled person's family members and professional care givers. Survey respondents will be interviewed over regular intervals during the the REC's five-year education department grant, enabling the center to evaluate the long-term effectiveness of its services and the usefulness ofspecific assistive devices and modifications in living and work space. In keeping with a national trend to- h y 5 c o n ward patient empowerment, joseph P. Lane, an associate director of the center, observes that, "Instead of patients who need treatment, older persons should be viewed as consumers who need information to make rational choices. They have a role to play in decision-making. " Glen E. Gresham, M.D., chairman of rehabilitative medicine at UB and medical director at Erie County Medical Center, shares this perspective. just as internists consult with a surgeon if they think a patient needs an operation, he recommends that physicians with older patients with disabilities should consult with rehabilitative and geriatric specialists as well as the REC on Aging. "If physicians have patients who have functional problems that are limiting their lives, they shouldn't just say, 'You have to live with it,"' says Gresham. "The focus should be to help people stay functioning and independent as long as possible." + m n 9 2 �maintain independence in the face of the aging process. to mobility, vision, speech and hearing to read, write, control their environment and communicate in person and over the phone. * Inspection of home and work settings, full-scale testing of recommended modifications such as the enlargement of doorways or installation of hand rails. * Assistance coordinating funding from state agencies, insurance companies and employers. (The REC on Aging's fee-based services are covered by many insurance plans.) And for service providers and care givers for older persons with disabilities, the center provides: *Training and informational seminars for rehabilitative engineers, occupational therapists and institutional care givers for the elderly. * Presentations to residents of nursing homes and self-help groups for the disabled. * Presentations to advocacy groups for the aging, hospitals and church groups aimed at attracting clients who may regain independence with the center's assistance. For more general information, contact information coordinator Thomas Burford, Ph.D., and forreferrals for services contact Peggy Strassheim, social worker, at (716) 831-3141. + he University at Buffalo's new Rehabilitative Engineering Center on Aging offers wide-ranging services. For the medical community, the REC on Aging provides: * A center to which patients may be referred for evaluation and assistance. * Information about the effectiveness of more than 20,000 assistive devices and modifications to home and work settings. *Training for rehabilitation medicine residents, participants in UB's geriatrics/gerontology fellowship program, nurses, counselors, social workers, engineers, occupational and physical therapists and speecManguage pathologists. Because the REC on Aging shares the facilities of the University at Buffalo's Center for Therapeutic Applications of Technology, the following services are available to disabled persons of all ages: * Free information and referrals. * In-depth evaluation of needs and abilities, including identification of helpful devices and environmental modifications and installation and training on new assistive devices. * Custom modification of wheelchairs. * Computer facilities where clients may sample hardware and software designed to help people with significant limitations B 0 0 p 5 c o n A u m 9 2 �• • '' • n the centennial a iversary of the founding of th Sch l of Dental Medicine and the 25 year since graduated from it, Ros ell Park Cancer Institutes William Carl, D.D.S., climbs Ojos del Salado, the second-highest eleva. in the Western Hemisphere. This is his story. xl &Photos By illlam Carl D.D.S. �• �he world looks warm and pleasant through the windows of the Restaurant Miramare in Caldera, Chile. In the harbor, pelicans dive for fish. Small boats sway gently in the water. Beyond the bay, small houses, painted white and green, with flat roofs, cling like aphids to the desert slopes. The sun warms my back and face and drives the last of the lingering cold out of my body. Forty-eight hours ago, I stood on the crater rim of Ojos del Salado and shivered in the summit wind and fog. But now the Atacama Desert and its high plains and mountains are memories of an adventure into a great and unique wilderness. The Atacama Desert in northern Chile is one of the driest deserts in the world. It begins along the Pacific coast as gentle, sandy slopes and terminates inland in snow and ice-covered mountains of more than 20,000 feet high. No rivers flow through this desert; no rain wets the parched earth. The merciless sun during the day, the ever blowing wind and the bitter cold of night, have reduced all life to a minimum. What does grow in that desert of sand plains, saline lagoons and dry salt basins hugs the sterile earth firmly as tufts of coarse yellow grass. B a 0 p y 5 c a n u m n 9 2 ��THE CLIMBERS ENJOYING A BATH IN THE LAGUNA VERDE HOT SPRINGS AT 15.000 FEET . he creatures that inhabit this barren, desolate region reflect its colors in their feathers or furs. The few Oamingos on the shores of the saline lagoons don't have the bright pink shades of their African relatives. The furs of the occasional guanacos blend in with the maize of the salt flat grass, and the small lizards here and there scurry like fleeting shadows over the gray and brown sand. But then there are the rare humans wearing bright blue and red Goretex clothing in this endless wilderness: miners and adventurers searching to fulfill their ambitions and explore where few have tread before. What brought me to this end of the world? Once a year I feel the urge to get away from it all, leave civilization behind and test myself against the adversities of nature. I had climbed Kilimanjaro, Aconcagua, Cotopaxi and Chimborazo. But all of these mountains had the marks of tourism on them. Probably half a million people had climbed Kilimanjaro by the time I did. On Aconcagua - the highest mountain in the Western Hemisphere - the base camps were cramped with climbers from around the world and littered with garbage. Cotopaxi and Chimborazo were covered with snow and ice. That made them a little le s attractive to the average amateur climber. This time I was looking for something different. When I contacted Greg Wilson, B u 0 0 p my guide from Aconcagua, he immediatelysent mea list ofout-of-the-wayplaces. I picked Ojos because at 22,000 feet, it is the second-highest mountain in the Westem Hemisphere. Fewer than 150 people have climbed it. Climbers like those credentials. Besides, in 1992, the School of Dental Medicine in Buffalo celebrates its 100th birthday. I promised Dean Feagans to take the banner of the school to the top. There were four of us, all veterans of many mountains, waiting anxiously in Miami in March for the flight to Santiago, Chile: Peter Spatt, an internist from Colorado; Thomas Sieben, a pharmacist from Connecticut; David Hersey, a psychiatrist from Michigan, and me, a dentist from Buffalo. We had a specialist for any potential physical and emotional problems. In addition, there was Greg Wilson, our guide from Idaho who had recently climbed Mt. Everest and met Fernando and Missal, our Chilean drivers and part-time guides. From Copiap6, we headed north-east into the plains and canyons of the Atacama desert with two, four-wheel drive vehicles, leaving civilization behind. Life on land seemed to die. Clouds of dust and endless sand flats and dunes surrounded us. On the eastern horizon, rugged mountains met the blue sky in sharp silhouettes. The sun was only a few inches above the far horizon as we reached the first saline lagoon. The few flamingos munching in the shallow water took off as soon as we approached the shore. By now we were 12,000 feet high and the cold crept in y 5 c 0 closer as the sun dipped. That first night was a restless one; I never sleep well at high altitudes. The heat already made the air shimmer over the salt flat as I opened the tent flap the next morning. In the east, the three crosses - snow-capped mountains of about 21,000 feet altitude - suddenly loomed on the horizon. The Argentinean border was not far away. We camped for three days at 14,000 feet altitude to acclimatize to the altitude and then moved up to 17,000 feet. The best insurance against altitude sickness and pulmonary edema is gradual adaptation. Because the mountain air is cold and dry, hydration is crucial. Our high camp was at 19,000 feet, immediately at the foot of Ojos del Salado. Everything around oozed barrenness and isolation. On one side was the mighty massif of Ojos; on the other and below stretched the magnificent Atacama Desert with its canyons, driedout riverbeds and endless chains of snow- , W ILLI AM C ARL . D .D .S .. DESCE N D ING F ROM HIGH CAMP A T 19 .000 FEET . u m n 9 9 2 �capped mountains. We had been at high altitude for more than a week and I was anxious to get to the top after a few hours of rest at high camp. But Greg decided to allow for another rest day before our ascent. Finally, March 21st arrived - the first day of autumn in the Southern Hemisphere and the day we made our first attempt for the summit. We had packed ropes, crampons, provisions, water bottles and extra clothes the evening before. The anticipation was palpable. At 4 a.m., there was something different about Ojos. The top had an ominous white cap with a tail pointing toward the east. The cloud lingered at first on the summit ridge and then enlarged. Still, in the silvery moonlight, we continued in countless switchbacks up the scree slope until we reached the lower edge of the glacier at 20,000 feet. With the rising sun came the first gusts of wind carrying crystals of ice and snow. Above, the mountain top melted into B 0 0 p dense, fast-drifting clouds. Reluctantly, we turned back to the refugio hut. Cold and miserable, we sat around and cursed the weather. "You pay for the summit in the currency of toil," Greg philosophized. But in this weather, you couldn't even see the summit, let alone toil for it. All day the wind rattled the hut and snow showers alternated with moments c 0 A u of brilliant sunshine. When night came, no silvery moonlight illuminated the slopes of Ojos; its head remained in the clouds and our dreams of the summit began to evaporate. But weather in the mountains is unpredictable. I fell asleep in the small hours of the night and dreamed I flew a small airplane from mountain range to mountain range. It was 4 a.m. again when Greg called, "The top is clear, the wind has died." We rolled out of our sleeping bags and in the narrow space between the bunks fum bled around for our climbing gear. At this altitude, any exertion, like putting on boots and gaiters, is torture. At 5 a.m. we started to retrace our steps up the mountain. By the time the sun was well up we had reached the level of the glacier where we had to cross it. We strapped on crampons and roped up. The surface broke in large slabs, the snow underneath the ice sheet was soft and deep, up to the knees. Lifting your legs for each step out of a hole just to advance another 10 or l2 inches is agony at this altitude. Soon I measured my progress in half-boot lengths. "Breathe harder," I heard someone yell from above. I tried to answer, but no sound came out of my mouth, only a cloud of vapor that warmed my face momentarily. I concentrated on pressure breathing; breathe in deeply and let the air out with an explosive burst. The slope ahead looked steeper than anything I had ever climbed before. I conjured up the image of the little airplane that took me so effortlessly to the mountain tops in my dream and struggled on. The pain in my legs and the continuous gasping for air eventually gave way to my renewed deter- u m n 9 9 2 �summit of Ojos del Salado. To climb it, some technical know-how with ropes, jumars and descenders was required. I did not have that skill; besides, being scared of heights, I did not want to dangle from a rope at that altitude. Twenty-two thousand feet is respectable. The descent was long and slow, almost as tiring as the ascent. We met the sun again at the upper edge of the snow field and I had a picture taken with the centennial banner of the School of Dental Medicine. We had climbed and descended from 5 a.m. to 5 p.m.- a full day's work. I squeezed a few drops of water out of my frozen bottle and then dropped into my sleeping bag. I left summit jubilation for thenextdayand the long trek back through the desert. Climbing a mountain like Ojos is more than just physical toil - you have to be prepared for conditions that are not on an ordinary day's schedule. One thing is cleanliness. If you are obsessed with it, forget an adventure like this. I didn't wash my hands, let alone the rest of me, for two weeks. There is sand everywhere - in your clothes, in your sleeping bag and between your teeth. The toilet is the far side of a designated big boulder. It offers privacy, plenty of sand and lots of ventilation. You have to bring your own toilet paper and shovel. ights can be difficult on high mountains. You wake up out of a half sleep and your tongue sticks to the roof of your mination. Mini-breaks, while I waited for the slack of the rope ahead of me to pick up, sometimes allowed me to catch two or three breaths before the next step. That was sheer luxury. he steady deep breathing, the exertion and the dry air of the high mountains made my tongue and throat raw and painful. A short break, only a short break to get a drink of water, kept racing through my head. We reached the end of the snow field by early afternoon. Willpower and physical strength shriveled down to two and three breaths for each step of progress for the last few hundred vertical feet to the crater. We struggled up the ridge toward this almost imaginary point, so close to the eye, yet so far for the tired and aching muscles and oxygen-starved lungs. And then suddenly the ground leveled and we were there, on top of our world. I knew from other summits that there would be no magic insight into man and nature, no voice from heaven at that moment. My only thought was: I have to climb no more. The sun was by now behind the clouds and fog rolled in. From the rim, the depression of the crater stretched beyond the rocky elevation that was the actual mouth. You fumble around for your water bottle that's not frozen and squeeze out a few drops. And then you have to visit the far side of the boulder. At first you think about not getting up and going out into the cold for a while, but then nature demands action. You crawl back into your sleeping bag and a little while later it starts all over again. Some nights I had to get up five or six times. That's the price of hydration on high mountains. Physical fitness is essential for climbing. For a couple of months before I left for Chile, I toted heavy loads up and down Omphelius and Pfamer Roads in the Boston Hills, collecting curious looks from people in passing cars. But Ojos del Salado is different from the Boston Hills. As you struggle higher and higher, your back- THE UNIVERSITY OF ATACAMA·s .. REFUGio·· HUT AT 17.000 FEET . B u a a p y 5 c a A u m 9 2 �The memories of the cold, the wind, the sand and the toil faded as the snow-covered peak of Oj os vanished on the horizon. But the memory and the glory of having made it to the top always linger for a long time. And since this was our centennial year at the School ofDental Medicine in Buffalo and a quarter of a century since I graduated from that school, the summit of Ojos was a particularly memorable experience for me. But this was really more than just a mountain climb. It was an adventure into pack feels as if it weighs a ton and the straps cut mercilessly into your shoulders. Every muscle aches; your lungs never seem to get enough oxygen. You want to get to the top, butgravitywants you down. It becomes a balancing act. And then you begin to wonder what you are doing here. If you have any quit in you, the mountain will find it. When you set one foot in front of the other for hours and hours, you need something to occupy your mind. I wrote a few acid letters to people I didn't like. I counted from one to 100 in three languages, then did the multiplication tables and recited poems I had learned in school many years ago. I always knew they would come in handy some time. We left the mountain in high spirits. B a 0 p y a n the unknown. Even Greg had not been to this part of the Andes before. For a directional guide he used an article someone had written a few years ago for a magazine. That's the kind of stuff great adventures + are made of. m n 9 9 2 �• ················································· ··· ················· · ·························· . ' Proied aims to ease shortage of primary care physicians MODEL PROGRAM ESTABLISHED AROUND CONSORTIUM $5 million demonstration project that could become a model for easing the nations current and projected shortage of primary care physicians is being initiated by the School of Medicine and Biomedical Sciences, six of its affiliated teaching hospitals, theNew York State Department of Health, Jour private health insurance payers and Medicaid. The unique project is organized around UBs Graduate Medical Dental Education Consortium ofBuffalo (GMDECB). "The Reimbursement Demonstration Project represents a major cooperative effort on the part of our teaching institutions and graduate medical education directors to respond to known problems that face medical education, the medical profession and health care," said john aughton, M.D., vice president for clinical affairs and dean of the medical school. aughton, who chairs the GMDECB, will direct the three-year project, which also could pave the way for the more efficient use of graduate medical education dollars paid to hospitals. The project will also address ew York State's press- B u 0 0 ing need for more physicians to care for its growing elderly population as well as increase its pool of minority physicians. "We will strive to increase our commitment to the educational preparation of more generalists, and to attract increased numbers of underrepresented graduates from minority and socio-economically disadvantaged populations," augh ton said. "This effort shows the importance of cooperation by a number of diverse constituencies, each of which is involved in graduate medical education in some way," he noted. "Each has a responsibility to provide the innovative leadership this p h y 5 c a n project represents," he added. William R. Greiner, UB president, said, "The project is a clear and exciting example of the way in which we at UB and we in Western ew York can lead in a time when extraordinary new steps and unprecedented collaborations are called for. "It's a network of partnerships within our academic community; it's a way to address critical needs here at home, as well as a model for efforts throughout ew York State and across the nation. It will serve as a template for all of us here at UB, too, as we focus our attention on developing such experiments and leadership throughout our university's endeavors," Greiner noted. Eight new health care initiatives - to begin this fall - form the centerpiece of the project, for which $1.13 million is budgeted for start-up. Funding for the remaining two years is set at $1.7 million and 2.27 million. The funding is provided by the six hospitals through reimbursement from the insurance payers. The hospitals, which currently are reimbursed directly for their indirect medical education costs, will receive increased reimbursement rates and contribute a portion of these reimbursements into a pool to support the eight initiatives. A primary goal of the demonstration project is to increase the number of residents enrolled in the primary care specialties to 50 percent of the GMDECB's total by 1994. Currently, 35 percent of the Consortium's residents are enrolled in family practice, pediatrics or internal medicine. A Primary Care Resource Center, to be located in Beck Hall on the South Campus, will house five health care initiatives aimed at making primary care medicine - historically not as attractive professionally or economically- more appealing to medical students. ationally, less than 20 percent of medical school graduates enter primary care - down from 50 percent in m n 9 2 �without walls"- is fairly atypical of most of the nation's medical schools, which generally run their own medical centers. The Graduate Medical Dental ten have longer ....~~~~~~~~~~~~~~. .r1~~~~"~~~~~~~~ Education Conand less predictsortium of Bufable hours. falo came into The Reimformal existbursement ence in 1983 Demonstration when the mediProject's prical school and its mary care initiateaching hospitives would seek tals entered into to increase the its first consorGMDECB'scadre tium. Consisting of primary care of all affiliated residents by: teaching hospi4 Recruiting tals, the Schools medical students of Medicine and into primary care Biomedical Sciresidencies ence and Den4 Developing tal Medicine, all community sites residency trainwhere medical ing program diresidents can rectors and one practice resident from 4 Developing a each program, medical school the Consortium curriculum track governs all resiaimed at training dency training primary care leadprograms ers through a se4 Designing a ries of comprogram to immittees. prove the teachThe unique ing of primary program has care faculty, and, ~ emphasized 0 4 Developing re~ cooperation search opportuni~ rather than ties and fund recompetition search fellowamong its ships in primary teaching hospicare. tals , many of Other aims of the which were once consentation in its residency programs is 9 demonstration project insidered competing institutions. + clude incorporating geriatrics and the care percent. UB's medical school teaching hospital of patients with chronic conditions into - BY NANETTE TRAMONT KOLLIG model itself- labeled a "medical center residency training as well as reaching and 1963. Primary care physicians currently earn about one-third to one-half the salary their specialist colleagues do. And primary care physicians of- maintaining an 11 percent minority representation in residency programs. UB's current minority repre- �• ..................... . ......... . ................... . ... . .... . ...... . ... . .. . .............. . ... . .. . I Ador'' patients to be used to test competency of medical students 11 B medical students \ soon will be , \ I \ I I seeing pa~, \ I \ f tients ' ' '• '' w h 0 ... won't besickatall. The patients will be faking - to test how compassionate, caring and competent medical students are. UB is joining Albany Medical College, the State University of ew York Health Sciences Center at Syracuse and the nursing program at Regents College in a pilot program to uses tandardized patients - healthy people trained to portray the symptoms and characteristics of real patients - to test medical students' skills. The project is funded by a two-year, $200,000 grant from thejosiah Macy,jr. Foundation. To carry it out, the schools have formed the Upstate ew York Clinical Competency Center, one of six such groups funded by the foundation nationwide, for a total of $1.5 million. Using standardized patients allows examiners to compare and rate performances of students as they diagnose and treat the same patients. Students know when they are being tested with standardized patients, but the encounters take place under true-to-life conditions. "Many of us in medical education have become increasingly concerned about the use of standardized pencil and paper tests I .. .. . as the primary, and at times, only measure of physician competence," said Dennis adler, M.D, associate dean and head of medical education at the UB medical school. "This grant will allow us to start developing tools to assess a much broader spectrum of attributes and skills a physician .. should have. Knowledge, critical thinking, f \ I \ sensitivity, social skills and the ability to communicate are just some of the many components of competence we hope to address in this new interactive manner." The program will begin in January 1993. By the end of the two-year grant period, all fourth-year students in the three medical schools will be required to pass this new performance-based examination by working with eight standardized patients. Albany Medical College will set up the patient training program during the first year of the grant. The program will ex- -- pand to the other campuses during the second year. The ational Board of Medical Examiners is expected to add a clinical skills exam to its licensing process in 1995. + BY LOIS BAKER Knight named chair of Anesthesiology Department au! R. Knight, M.D., professor in Department of Anesthesiology at the University of Michigan Medical Center, .. has been named chair and •• - - - professor of the medical , \ ' ' .. school's Department of Anesthesiology. A University of Michigan faculty member since 1977, Knight also served as assistant and associate professor in the department of anesthesiology and an assistant research scientist in the department of epidemiology there. Before going to the University ofMichigan, he completed a residency in the departments of anesthesiology and surgery at the Milton S. Hershey Medical Center in Pennsylvania. Knight did graduate fellowship training in the department of microbiology at the Pennsylvania State College of Medicine. Knight has authored numerous journal articles and has delivered many presentations. He is a reviewer for thejournal Anesthesiology. + - BY MARK POLLIO �· · ·· ·· ·· · ······ ·· ··· · ······· ·· ·· · ·· · ·· ·· ····· · ··· · ····· ·· ······· · ········· ·· · ·· ··· ·· ··· ·· ·· ·· ··· • · ~ I I UB app6es for maior Robert Wood Johnson Foundation grant he University at Buffalo School ofMedicine and Biomedical Sciences has applied for one of 18 Robert Wood johnson Foundation planning grants aimed at increasing the number of medical school graduates entering generalist physician residency programs and practicing generalist physicians. Under project director john aughton, M.D., vice president for clinical affairs and dean of the medical school, UB's proposal uses its unique Consortium teaching hospital structure to improve the quality and numbers of primary care physicians it produces by effecting long-term changes in recruitment, training and support of the generalist physician. The planning grant is for one and onehalf years. + ers to receive the award in 1992. Robert Adams of the IH's Cancer Training Branch said career development UB researcher studying diet and cancer Bnk wins NIH award o L Freudenheim, Ph.D., assistant professor of social and preventive medicine, has received a $325 ,000 Research Career Development Award from the National Institutes of Health to support her research during the next five years. Freudenheim is one of eight research- B a a p grants are awarded to promising young investigators who have established themselves in their fields. Freudenheim has published articles in professional journals on her research into diet and osteoporosis and diet and cancer. Her work over the duration of the grant will involve further investigations into the effects of diet on breast and endometrial cancers, as well as a study of diet in Italy and its relation to cardiovascular disease and cancer. A University at Buffalo faculty member since 1988, she received a bachelor's degree in human nutrition from the University of Michigan, master's degrees in nutritional sciences and epidemiology from the University of Wisconsin at Madison and a doctorate in nutritional sciences from the University of Wisconsin . + B Jo L Freudenheim, Ph.D s c a }l. u u m Y n LOIS 9 B 9 AKER 2 �Harold Brody steps down as chair of anatomical sciences When the war was over, Brody was assigned to a VA-type hospital on Staten Island, where he worked in the OR until he was discharged. From there, he returned to his hometown of Cleveland and entered Western Reserve University "while it was still pure," Brody jokes about WILL REMAIN ACTIVE IN MEDICAL SCHOOL TEACHING what is now Case Western Reserve University- to study biology. "While I was there," he says, "with my ot only is UB's Harold Brody tor, but Haynes told me that unless I knew probably the only chair of any the anatomy, I wouldn't be a help to him experience with the medical unit and all the studying - I had kind of fallen in love department of anatomical sci- ... and told me to leave the room. ences who was kicked out of an "From then on," Brody said, "I memo- with anatomy. I wanted to do something operating room for not knowing rized Gray's Anatomy at night until1 a.m. with it, so I finally decided to go fora Ph.D. anatomy, but he readily re- I would know what the [surgical] cases in anatomy," which he received from the counts the incident and fondly recalls it. would be the next day so I studied the University of Minnesota in 1953. In 1950, Brody went to the University In fact, he says, it is the catalyst that anatomy the night before." Haynes was began his passion for anatomy and led to pleased. "He had kind of expected it," of North Dakota to head the teaching program in neuroanatomy for 40 firsthis still-ongoing distinguished career as a Brody recalls. "Gradually, I became more and more year medical students. teacher and researcher in the field . While there, his reputation as a reknowledgeable. And I never got kicked Here is what happened. searcher and instructor spread, and with Itwas 1944and Brody was in the Army out of an OR again. " Brody eventually became so knowl- only one neurosurgeon in the state at that medical corps. His outfit was stationed in Southern England at one of a cluster of five edgeableand proficient that Haynes would time (and no neurologists) , he served as a general hospitals set up there in anticipa- assist him. "I did a couple of craniotomies source for general practitioners on infortion of the French invasion. Brody and for shrapnel in the brainandaboutadozen mation on the nervous system. "There was so much to learn," hereseven others had been working as surgical nerve repairs," he remembers. members, adding that he had a couple job technicians and were trained to assist in offersone from Buffalo after a "hallway and perform the closure of wounds, apinterview by Dr. 0 . P. jones" at a conferplying casts, passing instruments, etc. "At ence in Galveston. least from a mechanical point of view," "And so we came here," he says. Brody says, "the enlisted men could close That was in 1954, and Brody and his wounds as well as the surgeons." wife, Anne, had a one-year-old son, David, It was about the time the Allies broke now an attorney in Buffalo. Their second through in ormandy and the surgical son, Evan, who just completed his Ph.D. suites of the general hospital were busy, in exercise physiology, was born in 1957 handling as many as 50 cases a day. while Brody was in his first year as a "We were joined by a neurosurgeon medical student. A year earlier, Stockton from the University of Illinois - Walter Kimball, the dean of the medical school at Haynes. He was put in charge of developthe time, had asked Brody to consider ing a neurosurgical unit. " obtaining a medical degree. Haynes chose Brody as his assistant. Brody managed to complete his degree "The first time I scrubbed with him was five years- all the while teaching gross in for a sciatic nerve repair. He asked me if I anatomy and neuroanatomy and doing could describe the anatomy of the sciatic research. "I would teach when I had to nerve," Brody recalls. teach and attend class when I could." ''I'd never been expected to do anyChairman of UB's department of anathing but tie a knot fast and hold a retrac- "With my experience with the medical unit and all the studying- I kind of fell in love with anatomy. I wanted to do something with it." B u a 0 p h 5 c a n A u u m 9 9 2 �······ ·· ················· · ·············· · · · ······ · ······ · ·· · · · ·· · ······· · ····· · ··· · ······· ··· · · ·• · ~ I tomical sciences since 1971, Brody was marked by his ability to take it in new one of the first people john aughton, directions in response to the burgeoning M.D., vice president for clinical affairs and knowledge and changing aspects the field dean of the medical school, met when he has taken. "Anatomy was almost exclusively teaching, rather than research," visited Buffalo in 1974. "He was very warm, gracious and sen- Naughton recalls. "Brody recruited a fine sitive," Naughton says, adding that Brody's faculty- good researchers as well as fine tenure as chairman of the department was teachers. He has been a stalwart supporter B u 0 0 p h s c 0 A I of the University and the medical school as he continued his own scholarly interests. "He is well regarded as a teacher and committed to the needs of his students. His sense of humor and warmth have served him well. His students feel very good about the education they get in m n 9 9 2 �• · ··· ···· · ··················· ··· ········ ·· · ····· · ·· ·· · ·· ···· ···· ··· · ····· ·· ··· ·· · · ·· ·· · ···· ·· · ··· . ' n anatomy, you have a " very different and unique relationship with your students. You don't see them just in lecture. The faculty struggles through with them. You come to know your students much better over a dissecting table." determine whether there is an optimum number of cells necessary for activity to take place." With widely published journal articles and book chapters, Brody, former editorin-chief of the journal of Gerontology, is an editor of eurobiology of Aging and an editorial board member of five other journals. President of the Gerontological Society of America and a founding member of the ational Advisory Council of the ational Institute on Aging, he continues to be active in professional and community organizations, as well as on several medical school committees. He is also spearheading the development of an anatomy museum "where everything will be on display for the students to use. " Brody, who was aided by Dr. Chester Glomski, professor and vice chairman of anatomy during his tenure, sees more changes ahead- not the least of which is, he hopes, another name change that better anatomy, and," aughton adds, "it is not an easy set of courses to teach." Indeed, Brody's--relationship with his students has, in many ways, been shaped by the very nature of the anatomical sciences courses. "In anatomy," Brody says, "you have a verydifferentand unique relationship with your students. You don't see them just in lecture. The faculty struggles through with them. You come to know your students much better over a dissecting table and at the microscope." Brody's major research interest has been in studies of normal aging in the human central nervous system. He is presently working on the effects of aging and alcohol on the cerebellum, a study in which Dr. Roberta Pentney, interim chairman of anatomy, is the principal investigator. "I have always been interested in cell numbers," he says. "Ultimately, my interest is in trying to B u 0 0 p h y c o n reflects the scope of the activity the department engages in. "One of the first things I encouraged the department to do when I became chair was to change its name. We were responsible for teaching and research in several subjects; I got tired of people saying, 'Oh, you only have one course.' We had not only gross anatomy, but neuroanatomy, histology and embryology. "We've been the anatomical sciences since then." Brody has worked to change the department's name to "anatomy and cell biology" to reflect the additional focus of neurobiology, cell biology, reproductive biology, hematology and functional morphology. The change, suggested by Dr. Barry Eckert, associate professor of anatomy, and approved by the medical school, is stalled at higher levels, but Brody is hopeful it will move forward soon. + -BY NANETTE u m TRAMONT n KOLLIG 9 2 �....... . ... . ........... . ....... . ............. . ... . ....................... . .. . . . . . .... . ....... . . 1973 graduate appointed U of Connecticut Health Center interim chief eslie Cutler, who received his Ph.D. in pathology from the School of Medicine and Biomedical Sciences in 1973, has been named interim vice president and provost for health affairs and executive director of the Farmington facility , including john Dempsey Hospital, for the University of Connecticut Health Center. Cutler joined the University of Connecticut School of Dental Medicine's department of oral biology in 1973 and has been associate vice president and associate provost for health affairs since 1991. He previously served as associate vice president for administration and research. He is currently a professor of pathology in the School of Medicine and a professor of oral diagnosis in the School of Dental Medicine. Cutler is also on the attending + staff of john Dempsey Hospital. Cosgriff elected vice president of New York State medical society state delegate to the American Medical Association. He is a past president of the Medical Society of the County of Erie. An attending surgeon and chief of trauma services at Sisters of Charity Hospital, he has been active in numerous medical organizations locally and at the state and national levels. He is a fellow of the American College of Surgeons, a fellow of the American Association for the Surgery of Trauma, a member of the American College of Emergency Physicians, a founding member of the ew York State Society of Surgeons and a member of the Buffalo Surgical Society of which he is a past president. Cosgriff serves on the state medical society's professional medical liability insurance and defense board. He is also a member of the American Medical Association. A diplomate of the ational Board of Medical Examiners and the American Board of Surgery, Cosgriff was recently honored at a benefit dinner for Mercy Flight. He was recognized for his contributions and dedicated service toward the improvement of trauma care services in Western ew York. Cosgriff has served on the board of directors of Mercy Flight and is a past director of the American College of Surgeon's Advanced Trauma Life Support courses for ew York State. + New officers elected to M111ard Fillmore Hospitals ames H. Cosgriff, Jr., M.D., a UB clinical assistant professor of surgery, has been elected vice president of the Medical Society of the State of ew York. The election took place at the society's 186th annual meeting held in ew York City. Cosgriff had been serving as the state medical society's treasurer. He also served as assistant treasurer and is currently a B u a 0 p h ndrasj. Vari, M.D. , was recently elected as president of the medical staff for Millard Fillmore Hospitals. Vari, a clinical assistant professor of medicine, will serve a two-year term. y s c a A ll l Other newly elected officers include Thomas S. Cumbo, M.D., clinical assistant professor of medicine, president-elect; Thomas A. Lombardo, M.D., clinical instructor oforthopaedics, secretary; Sanford R. Hoffman, M.D., clinical assistant professor of otolaryngology, treasurer, and Robert M. Barone, M.D., clinical assistant professor ofsurgery, immediate past president. Each will serve a two-year term. + Taheri develops FDAapproved device to treat hardening of the arteries he Food and Drug Administration recently approved a new device to assist in the treatment of femoral artery occlusion. Called the Taheri valvulotome, the device was developed by Syde A. Taheri, M.D., clinical assistant professors of surgery at the University at Buffalo and a thoracic and vascular surgeon at Millard Fillmore Hospitals. One of the common treatments for symptomatic femoral artery occlusion is vein bypass surgery. The Taheri valvulotome allows surgeons to remove the valves inside the vein used to bypass the patient's femoral artery. The device also permits simultaneous measurement of the blood pressure through the bypassing vein, Taheri explained. "In addition to removing valves and measuring blood pressure, the Taheri valvulotome also allows for detection of any abnormal communication between the artery and vein, and can effectively locate valves inside the vein," said Taheri, who spent two years developing the instrument. He has performed more than 25 procedures using the new technique, all at Millard Fillmore Hospital. + �•[21 ·································································· · ··············· ············· · . UB researcher to head awision of prosthetic materials at Sisters nne E. Meyer, Ph.D., has be n named head of the division of prosthetic materials of the Head and Neck Center in the department ofotolaryngology/head and neck surgery at Sisters Hospital. Recently appointed research assistant professor in the School of Medicine and Biomedical Sciences, Meyer is renowned for her research in surface science. She received her undergraduate degree from the State University of New York at Potsdam and earned her Ph.D. in surface science, prosthetics, at Lund University, Sweden. She formerly served as section head of the surface science section at Calspan Advanced Technology Center. Meyer is also principal research scientist for UB's Industry/University Cooperative Research Center for Biosurfaces, as well as a graduate faculty member in the School of Dental Medicine's oral sciences program and a research assistant professor in the department of biophysical sci+ ences in the medical school. ology, will serve a two-year term as vice president. Pieroni is a professor of pediatrics at UB and has been with Children's since 1976. Ehsan Afshani, M.D. , director of education for radiology and a clinical associate professor of radiology and pediatrics, will serve a one-year term as secretary/ + treasurer. Sisters Hospital names chainnan of obstetricsI gynecology department Alumni named department heads at St. Joseph ruce]. Cusenz, M.D., has been appointed director of the plastic and reconstructive section of the department of surgery at St. joseph Hospital in Cheektowaga. A 1981 graduate of the School of Medicine and Biomedical Sciences, Cusenz is an adjunct assistant professor of surgery and dermatology at the University. Heisamember of the American Society of Plastic and Reconstructive Surgeons of Upstate ew York and the Buffalo Plastic Surgery Society. Gerald V. Schwartz, M.D. , has been named chairman of the department of radiology at the hospital. Schwartz, a 1961 graduate of the School of Medicine and Biomedical Sciences, has been a staff radiologist at St. joseph since 1968. Board certified by the American College of Radiology, he is a member of the Buffalo Radiologic Society. + ichael Ray, M.D., has been appointed chairman of the department of obstetrics/gynecology at Sisters Hospital. Ray had been acting chairman of the department since 1991 and vice chairman since 1986. He is director of the hospital's antepartum fetal testing laboratory. A clinical associate professor in gynecology and obstetrics, Ray is a graduate of Georgetown University and earned his medical degree from the School of Medicine and Biomedical Sciences at UB in 1965. He completed a fellowship in perinatal medicine at the University of Southern California and has done extensive post-graduate work specializing in obstetrical ultrasound and antepartum fetal testing. ormal]. Sfeir, M.D. , clinical asRay is a diplomat of the American Board of sistant professor of medicine, has ames E. Allen, M.D., a professor of Obstetrics and Gynecology, a member of the been installed as president of the surgery at UB's School of Medicine American College ofObstetricians and Gynemedical staff at Sisters Hospital. and Biomedical Sciences, has been cologists, the Erie County and ew York State Also installed were Paul Burstein, elected president of the medical staff medical societies, the Buffalo Gynecological M.D., clinical assistant professor and Obstetrical Society, the American Instiof The Children's Hospital of Buftute ofUltrasound in Medicine and the Ameriof gynecology and obstetrics, presidentfalo. Allen, acting head of Children's Hospital's Department of Pediatric Sur- can College of Physician Executives. ln addi- elect; Daniel Castellani, M.D., clinical ingery and an attending surgeon there for 27 tion, he is a site visitor for the ew York State structor in neurology, secretary, and EdDepartrnentofHealth/ACOG District II Com- ward Bartels, M.D., clinical instructor in years, will serve a two-year term. Daniel R. Pieroni, M.D., chief of cardi- mittee to Reduce Cesarean Section Rate. + gynecology and obstetrics, treasurer. + Medical staH officers elected at Children's Hospital of Buffalo B 0 Sisters Hosp_ital installs medical staH officers 0 p h 5 c 0 A u u m n 9 2 I �.. ... . . . ......... ............ . .. .... . .. ..... ........ .. ... ..... ........ ..... ................. . . [I] CLASS OF 1 953 "Can't believe it's 40 years! See you in May." M ICH A EL A . S ULLIVAN, M .D., CHAIRPERSON CLASS OF 1943 MARCH "Don't miss our 50th Year Reunion. Lookingforward to seeing you." D UNCAN K . M ACLEOD , M . D ., co-CHAIRPERSON CLASS OF 1 943 D E CEMBER "Please circle the weekend of May 1, 1993. Plan to celebrate our 50th graduation anniversary. Hope to see you there." MORRIS UNHER, M . D ., "Half a century - our 50th Reunion! A special time for all of us. We want to see you. Please try to make a special effort to attend." R ICHARD J. CO-CHAIRPERSON "]oinusforthecelebration!" IVAN L . BUNNELL, M . D ., CO-CHAIRPERSON CLASS OF 1948 "Don't miss our 45th. We need you to make it a success. Please come. We can promise a happy time. " HAROLD L. GRAFF, M .D. , CO-CHAIRPERSON "Two-thirds of us made it to the last reunion. Hopingfor 100 percent attendance at our Spring Reunion!" DANIEL J. FAHEY, M . D ., CO-CHAIRPERSON BUCKLEY, M . D ., co-CHAIRPERSON IN MEMORY Long-time Reunion Co-Chairperson of the March Class of 1943, William H. Georgi, M.D. , died last July after a long illness. CLASS OF 1958 "Our 35th Reunion will take place on May 1,1993. Mark your calendar, reserve the date; great plans are underway! We look forward to seeing you." M ICHAEL T . GENCO. M . D ., CO-CHAIRPERSON I ALFRED M . STEIN , M . D ., CO-CHAIRPERSON s 0 0 p c 0 m n 9 9 2 �• ··························· ·· ··································································· CLASS OF 1973 CLASS OF "It's hard to believe that 20 yeras have elapsed since we graduated. Now that we're all settled and 'huge successes,' let's get reacquainted at Spring Clinical Day this coming May." 1988 "May 1st- Our Five Year Reunion. Don't miss out on the fun for everyone!" FRANK A . LUZI , M .D ., CoCHAIRPERSON LORI GUTTUSO-LUZI , M.D. , CO-CHAIRPERSON MICHAEL A . SANSONE, M . D ., CHAIRPERSON CLASS OF 1963 1 968 CLASS OF "Put the routine aside for a weekend. Come back and enjoy the warm companionship and memories of your classmates and friends at our 30th Reunion. " "It's hard to believe that it's been25 years since we went our separate ways. We really would like to see a tremendous turnout on May 1,1993. Come together and relive some of the special times we all shared. Please try to join us and make this a truly memorable time for all of us." ANTHONY M . FOTI , M.D. , CO-CHAIRPERSON "Each reunion has been rewardingtoall who attended. Let's make our 30th the best yet! Reserve the weekend of May 1, 1963 and renew our friendships. Makeourday!" THOMAS J . CUMBO, M . D ., CO-CHAIRPERSON "We are lookingforward to seeing you for our Silver Anniversary!" JOHN R . FANELLI , M .D ., CO-CHAIRPERSON ROBERT A. MILCH , M .D ., CO-CHAIRPERSON CLASS OF 1983 "Let's get together and renew our friendships at our lOth year reunion." RICHARD L. COLLINS , M .D ., CO-CHAIRPERSON "/ am really lookingforward to getting together with those we have lost touch with. I hope you all make it!" JAMES G . CORASANTI , CLASS OF 1978 M .D ., CO-CHAIRPERSON "Medicine's changed a lot in the past 15 years. Let's get togetherfor Spring Clinical Day and see how much we've all changed. Looking forward to seeing all ofyou in May of'93!" STUART L. DORFMAN , M .D ., CHAIRPERSON a u a a p s a n u m 9 2 �································································································r a a • 172 19 Connecticut ••••...•••••••••.• 123 District of Columbia •••.•••• 19 he 4,924 graduates ofUB's School ofMeclicine Delaware ........................ 9 and Biomedical Sciences are scattered far and Florida ......................... 270 wide across the United States. Georgia •.•••••••••••••••••••.••• SS Here, Buffalo Physician lists its medical Hawaii .......................... IS school graduates state-by-state and in the Dis- Iowa ............................... 6 trict of Columbia and Puerto Rico. The ll Idaho .............................. ] alumni listed in the "Other" category represent physi- Illinois ........................... 63 cians in Canada, England, Africa and other countries. Indiana .......................... 22 Alaska ••••••••••••.••••••••.••••••• 2 Arizona ......................... 84 Kansas ............................ 8 Alabama ........................ I 0 California ••.••••.••••.••••••.. S02 Kentucky ....................... 20 Arkansas ••.••••.••••.•••••••••••• 4 Colorado ........................ 48 Louisiana ...........•••••••••••• 17 Mapping our medical alumni s a a p h y s a n A Massachusetts .•..••••••••• 172 Maryland ..................... 16S Maine ............................ 36 Michigan ........................ 6S Minnesota ••..••••••••.•••••••• 3S Missouri ••.•••••••••••••••••••.• 20 Mississippi ••••...••••••••••••••• 3 Montana .......................... ] North Carolina ••••••••••••••• 66 North Dakota ••••••••••••••••••• S Nebraska ......................... 3 Nevada ••••••••••••••••••••••••. 22 New Hampshire •••.••••••••• 26 New Jersey •••••••••.••••••• 119 New Mexico •••..••••••.•••••• 18 New York •••.••••••••.•••• 2,06S Ohio ............................ l36 Oklahoma •••••••••••••••••••••• II Oregon .......................... l2 Pennsylvania •••••..•••••••• 239 Puerto Rico •••.•••••••••••••••••• S u m 9 ~5 Rhode Island •.••••••••.••••••• 33 South Carolina •••.••••••••••• 29 South Dakota •••••••••••••••••• 1 Tennessee ••••••••••••••••••••• 19 Texas ............................ 91 Utah ••••••••••••••••••.•••••••••• 11 Virginia ••••••••••••••••••••••• II 0 Vermont ••••.•••.••••••••••••••• 13 Washington ••••.•••••••.•••••• SO Wisconsin •••••••••••••••••••••• 27 West Virginia ••••.••••••••••• II Wyoming •••••••••••••••••••••••• 4 Other ............................ 11 9 9 2 �• ............................ . ............. . . . ............................. . . . .. . .... . . .... I niversary with a cruise from IRA L . SALOM '77 , Venice to the Black ea and the june 1992, I received a Master of Mediterranean. " Science in Management from the writes, "In s Wagner Graduate School of Public Service, ew York University. an- I had been enrolled in the Ad- nounces his retirement after 30 vanced Management Program for 1 9 5 JOSEPH 5 . 0 DAVID '53 , years in practice at Children's Clinicians, a W. K. Kellogg Foun- Hospital in Orange, California, dation-sponsored program in where he served as chief of sur- health care policy and manage- gery and chief of staff. He now ment studies." resides in Sun Valley, Idaho. John Ambrusko '37 1 9 6 s 0 1 Harry L. Metcalf '60, 9 8 s 0 MICHAEL D . RUDN ICK '87 , of ew York, was fellows named by the College's completed a fellowship in Adoles- Board of Chancellors during their cent Health in 1991 and was ap- elected president of the American annual meeting held in Septem- pointed director of the Westside cepted an appointment as surgi- Academy of Family Physicians ber in Phoenix, Arizona. cal consultant for the Qualitative Foundation. HARRY L . MET CALF '60, 1 9 3 s 0 JOHN AMBRUSKO '37 , Williamsville, has ac- Assurance Program at Manatee Memorial Hospital in Bradenton, Florida. ROB E RT BARRYS. 5HULTZ '68, J O RDO N '65 , chairman of dermatology at The Ambrusko served as University of Texas Medical medical executive director of the School at Houston, was elected Manatee County Public Health chairman of the National Advi- Department from 1977 to 1990. ofWest Reading, Pennsylvania, has been elected president of the Urological Association of Pennsylvania . Shultz is chief executive officer of Genito-Urinary Associations, Ltd. sory Board for the National Insti- The Doctor john Ambrusko Public Health Complex is named in tute of Arthritis, Musculoskeletal his honor. From 1950 to 1977, Amrusko served as chief of surgery and chief consultant in surgery at Kenmore Mercy Hospital , Kenmore, E. Teen Clinic of Denver's Health ew York. 1 9 7 s 0 and Skin Diseases. Jordon also THO MAS serves on various commiuees and '71 , boards of such professional orga- profes or of pediatrics and ap- G E RALD DISESSA was recently promoted to and Hospital System. His wife, Ann Smith-Rudnick '87, is in private family practice. JOHN CLAUDE KRUSZ '83, is on the executive board of the orth Texas Multiple Sclerosis Society and has served as chairman of the Professional Advisory Commillee for three years. He has a private practice in neurology in Dallas. nizations as the ociety for Inves- pointed division chief of pediatric tigative Dermatology and the cardiology at the University of American Academy of Dermatol- Tennessee College of Medicine, writes, "Marc Levine '83 and I are DEBORAPH L. FELDHEIM '84 , FRANK T . RIFORGIATO '39 , ogy. He is also chief of dermatol- Memphis, Tennessee. DiSessa is celebrating our eighth wedding retired in january. He informs us ogy at Hermann Hospital and a medical director of the cardiac anniversary and have been living that he is the last of the Italian- consultant to The University of catheterization laboratory and the in the Washington, D.C., area. American physicians on Buffalo's West Side, saying, "there are none left." Texa M. D. Anderson Cancer Center and St. Luke's Episcopal non-invasive laboratory at LeBonheur Children's Medical and psychoanalysis in private Hospital. Center. We are both practicing psychiatry practice and are expecting our second child in October." 1 9 4 C HAR L ES J . S MITH '66 , ofBay s 0 Shore, ew York, has been named of West Palm Beach, Florida, writes, WILLIAM J . FOLLE TTE '42 , a fellow of the American College of Radiology. Smith, selected for "My wife, Della (Walters) , and I celebrated our 50th wedding an- 6 u a 0 is now chairman of the section of general Z I NA surgery at Scripps Memorial Hospital, La jolla, California. writes, "After five years in Iowa (where we had a DANA P . LAU N E R '73 , ( DM YTRIJUK) HAJ - DUCZO K '84 , his contributions to the field of son, Alex, born in May, 1989), radiology, was one of 144 new we're back in Buffalo. I am the p 5 a n u m n 9 2 �··· · ···· · ··· ·· ··················· · ··· · ··········· · ·· · ·············· · ·· · ·············· · ····• • ' new director of echocardiography MICHAELJ . 8ARTISS '87 ,com- 1991. Bhayana is currently a third retired in 1986 from X-Ray Associates, a private practice in iagara Falls. He practiced radiology at at Buffalo General Hospital and pleted a fellowship in pediatric year resident at Francis Scott Key was recently inducted as a fellow ophthalmology at Wills Eye Hos- Hospital. of the American College of Cardi- pital, Philadelphia, Pennsylvania, ology in Dallas in last March." I Children's Hospital and Sisters and has joined a private practice in Rochester, New York. ANDREW FR IEDMAN '85 , OBITUARIES Hospital in Buffalo and DeGraff CARL A. STETTENBENZ '35, Memorial Hospital in Kenmore. of Snyder, ew York, died in Feb- He is survived by his wife, the writes, "My wife, Susan, and I JOHN J . O'BR IEN '87 , has have two children: jacob, 3, and started a plastic and reconstruc- William, l. I started a hand fel- tive surgery fellowship in Hous- PAUL V. DOWNEY '36, died lowship at the University of Pitts- ton, Texas,aftercompletingagen- july 20, 1992, in his Kenmore WILLIAM H. GEORGI '43 , died burgh july 1, 1992." eral surgery residency in Buffalo. home after a long illness. in july after a long illness. AMY (MILLER) O 'DONNELL THOMAS P . SMITH , JR . '87 , '85 , writes, ''I'm moving back to announces the birth of Sean Buffalo from the University of Patrick on june 5, 1992. He is Michigan with my husband jack welcomed by his sister Megan, 7, and two children, Sara and jef- and brother, Tommy, 3 1/2. former Mary Agnew Cain, a son ruary, 1992. and six daughters. He Help us find your classmates frey, and will be on the staff in endocrinology at VA Medical Center. I hope to get back in touch with my classmates in Buffalo. " R ICHARD SCARFONE '87 , I rl writes, "Karen and I have recently veryone likes to read about relocated to Philadelphia and are expecting our first child in Octo- LISA BECHTEL '86 , writes, "Un- ber. In May, I was awarded the expectedly, I'm back in Las Vegas, Society for Pediatric Research's coordinating HIV ambulatory care Fellow's Research Award for the at the University Medical Center. study of the use of corticosteroids Most importantly, my spouse and to treat moderate to severe asthma I have two wonderful daughters, in the emergency room setting. " what their fmmer colleagues r JJ Scarfone is an associate professor Mariah and Rose. " Medicine at St. Christopher's Hos- accepted a position as chief of the pital for Children. classmates are doing. division of internal medicine and assistant director of the residency HOWARD CHANG '89 , informs program at Mt. Sinai Hospital in us that he has moved to Los Ange- Cleveland , Ohio. Pamies has a les with his new wife, Dawn, and faculty appointment with Case will be beginning a fellowship in Western Reserve Medical School. pulmonary/critical care medicine at UCLA Medical Center. If you orthopaedics in the department of orthopaedic surgery at the George Washington Medical Center. B u a 0 1 9 9 0 know. just use the attached post card s and we'll print the infonnation as RANJ AN BHAYANA '90, ofPerry Hall, Maryland, announces the soon as we can. birth of a daughter, Monisha Maria Bhayana, born November 27, p h know where they are and what they're doing - please let us JOHN K. STARR '86 , has been appointed assistant professor of Buffalo Physician better by telling us what you and your of Pediatric Emergency Room RUBENS J . PAM IES '86 , has Help us make are doing. 0 n u m n 9 9 2 �A Spoonful of Humor © Stu Silverstein, M.D . Top 10 things overheard in the OR afternational health care reform ') OK, let's close. Wait a minute ( , where's my watch? !J ] Do you have health insurance? I Look, I've got 6.02 X 10 23 more J cases. I'll be out of here in 36 -1 hours. Let's do lunch. I' There aren'tsupposed to be two ~J of these. (\ Insert tab A into slot B. u '( Oh my God, what's that? () Aren't there supposed to be two of these? U Yes doctor. I'll take a table near U • the w indow. l('U r) I've got a plane to catch in 15 minutes, let's get started. Sw Silverstein, M.D., president of Standup Medicine Seminars of San francisco , Californ ia, lecwres nationwide on the role of humor in medicine. B u 0 0 p h s c 0 u m 9 2 ��BUFFALO PHYSICIAN STATE' UNIVERSITY OF Non-Profit Org. U.S. Postage 3435 PAID AIN STREET BU FALO NEW YORK 1421"1 Buffalo NY Permit No. 311 �( l ~ ~ - ~ 0 . , f ij~IUfR~Il~ ~l 8ijff~l0 ~(HOfrl Of · ffifDI(I~f ~~D BIOffifDI(~l ~(lf~(f~ l 9 9 B u f f a t o P h y s I c l a n A u t u m n 1 9 9 2 EJ) �The Class of! 996. h learning, study and gro . train them and make th their four years at UB's . Biomedical Sciences, relationships · ~nd build c ~-------- ,---------~~~~~--~~--~ , ·to the medical school a cquire knowledge that · ~nd . contribute t~ their · lere; Buffalo Phy$ician 96 ·and wishes the.m well ·h e. medical school. tD B u f f a I o P h y s I c I a n A u t u m n 1 9 9 2 �. Jo.Attne Arnold tI Oneil Bains ( A · Sa"raJ. Ballow John Barrett Natthew Bartels 0 Susan Behr Gina Brescia · Kimberly Bonisch · Paul B.;ms Christine Bopp Tiffany Boquard Ronald Bremer John Butsch Russell Canfield· Katherine Catallo f 9. 6 �.( ' ff ~ l A Patricia Cawley Ricl~ard Cl~arles BasJ Cherpelis Melanie Christian Joseph Chruscicki Thomas Cimalo Stephen Cook Tim~thy Cotter Holly Crorriwell David D'Souza .o f r • .l 9 9 Josepl~ DcJames Bradley Davis · Allen Davis ~lanny DeLucca Rob DeHuro 6 B u a 0 p 5 c a n A u u m 9 9 2 �( l A Andrew Drnytrijuk Kathleen Dyson Richard Edwards Simone Elvey ~ -~ o,\lichacl Endl Joshua Fischer Gina Flores Scoll Flugman James Foit Brian Fortman Thomas Gennosa Patti Hamernik Chen Han Hccghan Hart f 6 �{ l . ~ Steven Heintz Jason Ilo Jean Ilsia9 . Tl10mas Hughes Babak Jahan-Parwar Rajiv J~in ,\lark Jajkowski Paul ]ee Erik Jensen Clara Kim Anthony Langome Matthias Lee ]ilmes Ida . 0 f 1 9 9. · Dionne K"rr Timot hy Jorden 6 B u a a p 5 c a A u m 9 9 �' ( ~\ a _ ~ '1k: l i_-_:_ __ J '} J Michael Leonard. Kwok Li Kristen Lukasik Beth MacDonald Dominic Lpomc Cheng' Lo Jiadc Lu ~lichael ~lanka Dori Marshall 1 l .. f l 1 1 9 Christopl1cr Mascia Paul Nab: Peter HcQuiller William ~Icdwid Kimberly Metz 9 6 �(. l· A· Alex ~loinpoint Davicl l\l.ilJcr ~ _Pinaki Hukbcrji Sluini Hukkarnala Dwayne Narayan Nncnna Okcrckc Nayomi Omura Hik~ Oslempowski John Patli • Oscar Piedad Frederick Piwko . ~- 0 f . . Sltarnantha 1 Tcsarajal1 I l 9 9 John Pana""iolopoulos Pa_ras Pandya 6 B a 0 p 5 c a u u m n 9 9 2 �( l John Pulvino Kavitha Ram Eileen Reilly Brian Riegel 0 Mary Rykert Starlecn Schaffer Kristen Schenk David Schmitz f 1 9 Rudolph Schrot Otto Schucckler Douglas Schultz . Karin Selva Lisa Shutt .9 6 �( Jo~athan Sirkin" lnclrani Sinha Sun~ Son Karen Snell Patrick Stein ) 0 f Kristin Stievater ~1ichael Stoner Tova Stram Maxine Szumigala Renate Treadway Millicent Trevett Susan Szimonisz" Julie Szumigala l 9 Meryl Tucker LisaWalk 6 B u a 0 p 5 c a u u m n 9 9 2 �( l .A Jim Wa'xm'onskv 111 c Kee Wee Byron Willis ol Naa'mi Weinstein 1h t HaryWilsch I; uf ~ I ~ 1 ~ .o . Emily Wong' Joseph Wittmann 'l 1 1 \1 ' \'a!, Buf'1Jo l ..t_r ·' · ,I!) I · Mark Zambron Clmck Yates ·.. Jennifer Wrazen 1t em 1 L \\ R;. I C R t .Jt f 1, t} lH[ f.OUOWI~G HUD[~H fROffi lH[ (lAH Of 1996 W[R[ ~OJ PHOJOGRAPHfD.· .Peter Augustino~: Christopher Jayne: ~ ·. Eileen KJlackey: Cozzette Lyons:' I.. Deborah ;\lann: ;l Thomas ;\lead: ::Andrew Stirling: I' " Davi~ Zinkin · Daniel Zorich 'n Bufhl· l 1 'Pil()lOS. ·::-r 10 TO l; 9 9 �qHI Uf R~ ll ~ Al Bq.f f Al 0 ~ ( H00l . o·f ffi f DI ( I Hf AHD BI 0 ffi f DHAl ~ ( I f.H( f ~ l. ~ au ffo t oP h y s I c I an ll.utu m n t 9 9 2 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician, Autumn 1992 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1992-Autumn Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. School of Medicine Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician and biomedical scientist Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v26n04-1992-Autumn Table Of Contents A list of subunits of the resource. Research Hospital News The Graying of Medicine Rehabilitation Comes of Age Conquering Ojos del Salado Medical School People Alumni Classnotes A Spoonful of Humor Class of 1996 Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-12-10 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v26n04 Extent The size or duration of the resource. 56 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1992 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/50c30866460c3a36ce2f7ab2fcff931f.pdf c5b96c6da6ebd5da36c8d5f2c9aaac4d PDF Text Text �THE BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST \c umc 2~ "" mhcr l r"'"'"'lld m the bst ts.sue of the P/1\~.n.:n that thl' propili>Cd nC\\ research bu1ldmg was DIRECTOR OF PUBUCATIONS "lancv T L .... EDITOR ""~ rue rr m >nt lolhg r.: "' ART DIRECTOR A An I &.cj:,' r r "kcr STATE; UNIV£RSITY OF NEW YORK AT BUFFALO <;chool of !'.lrd•<mr ~nd B•omrd~ral ~lfDCCS Dr 1.>!: 1 "'au~hton 'V ( hntc \I -'" f.'lr11r. Prt nt lor EDITORIAL BOARD Or J >h D D~ Dr Dr M• Dr D Dr D '\ R r, l h 'd ru BrH hu II rr I r r I) Ra , 1td ~ ol I" ~- ~ JplcR [' \ l \ _ J [l nn-n T1 >th) '' bnrl ~olen <r m !"'ot\\ 'tork C:.t..1tc o; buJgct Th(' offt tal grcundbreakmg a ma;L~r hLstoncal t:Bovent'i I ~6-)C.UCXISI('n<c \\.:sheldon 11.1ay.! IQQ1 Ihcfa~..tht) \\til pro' 1dc nC\\, st.:tc or th(' an rusK rC'K'".trch l.tbor.non('<; dcs1gned to be operated as a . non-d('panmcnt.Jih ilSSt ncd untl It \\Ill al,o serve to umte the Health as envtsioncd .Ls long ago ._, I CJ6l ""=--,....,....,.~,....;..-...., fhe buildmg wtll straddl(' the "p<:~e bel\\een the 'x.hool of Dental Medion(' and th· rnrd•tal o;chool'" Am mal f .1oim AdJmmng the wcc;t side of the lampu.:; \\ t'l beth(' clcgantllc.tlth C,Cicnce<> library and foster Hall, the dental c;lhool"s b.L>~c sctc.nlc fac1hty. On the ea.o.;t s1dc wtll be the med1ca: sdtool complex Hamm.m (Old Nonon) Hall wtll be rcnov.ard for the slhool c; .tdmmtstr.lllvc offu.:es later m th1s dcc.ade .md w:r.nt:ltcd to 1hc new fa~.1ht) When completed Hamman \\ill be bounded on each '>ide by qu.tdr.mgles, and h) 1')<)'), th(' campus w11l 1: \e ho•h pre• ntl' .md the l pacnv to conunuc lOntnhutmg toNe\\ York <.t.!le'" needs,., bH.mied~t~l n.'sl'"ar~h The £acuity and I appreciate L nt\t.T-.;ll\ admtnt ... tr.ttwn 'tl'~'r tl•est.:k slt..:Jcrshlpdnd the\\esteml\oew ,,..,, ........ , m d1d on ou~ bdmlf Thanks 'tmccn:l\', 0 ASSOCIATE ART DIRECTOR ''-C"h 1 l"''ltrt f and Supporters of the UB Medical School: 1 r. ~LJL-.~ a <I a 1.- '1 Jr.o 0• < nl.- P • ~ I Dr L uthc Rc ""' D• Th<' P r'lthal Dr ..,a t• .a ' u~• D <;trp r .,,,a ld n Dr <.'It\ T r X Dr )ncmc ~at John 'Iaughton. M.D. far ( lmu:al Afjatr~ Dca'l, <, h110l c( \ftd1une and BwmtdiCtJI ':lctrna•s \ ltC Prt~tdtnt rr TEACHING HOSPITALS AND LIAISONS ~· n u \ \ "tr , I ( cntr L' flak• t.cncr I It< i'' al M chad ~"-"" flu I' o \ \ \1rJ I ( c " ' ,,.,.u,emi, wheel comes round uga rr...ula l'cdtt ( 1;, Jrrn, lie< pi al <! u'i I< E nr ( o·ml\' \1cJ•c ( rntr• Marv ft.trlflttl \{<!<Y H<>Spll M1l arJ ~, I re llr>pll h t r.,rrk ~a>u f<os" rl J k l 1 rr Ins 11 1 juduh "" ~· tr•• d <t- ••II> II< p.t I Otnnt) \1 ( '' Burr.· \ddrcs~ t; t In "~m ol fl'c '' tr ·. "'w hrk c mmcr.· u d suh r ' em~ tr 1 ~ > rhr C.4J~' H1>~t1• and Btomt'dJ,al 5dmrw C.t.•, l mvcrsll) c£ Ill~ \ rk Bull• <' l , \CI>II) Pt:" Ull<'m I lt'lr,>fhll"' [_•, 1lo."'~ ~ 11, bnngmg wuh 11 u l'C\\ \1edtc.tl \lumm &ard of rm cnthus• ,u._ .tbout !>C'rvmg .h) our new pre< 1dcn• La'>t >car's Board under Hamson set the htghtst .,!a"ldards for us to emulate. In lQ92 1991 we will such pre\ wusl} "-UCl"l''i~£ul .1c uvmco; ,,., the ph~ stCtan c.trcer presentations to sophomon mcdKal sllld('nts, .md the onent.tuon scssrono; for freshman restdem doctor; \\ l pbn .mother )Jnuarv rcccpuon for c.cmor <;tudcnt<,, along Jar out of-tO\\ n rrccptiott- for alumm m oth::r c tlle<.. <.)ur C,pnng Chmcal Day promtses.t forum cl ...ontcmpon.tl)" medtc.tl cone em, mtxc:d \lo ith the pleasures old fnends Our I1tsrm1:m<.hed \1edKal Alumnu<> Award will he presented in '-",,,.,mh..dl:•n Yale Emcntu~ Profc-,.><>r Dr \!£red L,,m. <.urrc'lth \\c .1rc \\orkmg on some nt-v. tde.lS for the commg )car mdudmg.tn IPR<.) rmx k tnal '>t.lntnar and a M.tt< h Da\ <elcbration for scmor., \\ ( '' tll conunuc our ltat"><m \\ 1th the Mcchwl AdmissiOns ( ommlllrc to fL•IIO\\ our lf'J.'fiC.\ stud... nts In addiuon, \lof' f'xpcct to recogmze unsung hlll dl'>Cr"\'ll'J;alumm \lolth a ne\\ catcgorv of Alumm t\thtevement r\\\ards to be presented at a <:.pcctal spnng luncheon. We are seeking opponumucs to suppon and acknowledge our hardworkmg volunteer fawh~ \\care also cono;rdcnng a Medical Alumni Who's Who to help '>pread the \\ ord about our more promment da~mates fhc \car ahe.td prom o;cc; all the cxcuement and mnovauon together our far-flung medtcal school fam1ly. 1k '"""'·" <;end address change• w n.r llu[jalfiPh} siCtull and Bwmrdual ~nrnllsr. 14f\ ( f'> Addu'"" H\5 !l.tJm 'ltrru. Buffalo New Ycrk 14214 Don Copley, M.D., '70 D(JY\ oJ..d. P. ee, rtto, MD . �VOL26,No.3 5UMMER1992 II Research II Hospital News IJI Country Doctors C. K. Huang, diredor of the Healtll Sciences Library, re<eived the first John and Margaret Naughton Spe<ial Recognition Award at the meiKal school' s annual fCKulty meetilg. Page 22 Rural physicians see more patients, work longer hours and earn less money than their urban counterparts. So, why do they do it? Diane Zwirecki finds out. Dr. Muse In an age of scientific specialization, some physicians find inspiration and expression in the humanities. Mark Hammer examines the phenomenon. _..,m --.111 m ASpoonful of Humor Stu Silverstein, M.D., learns about political correctness. m MeaKal School * Buffalo Gueral Hospital sends badly needed meiKal suppttes to Third World nations. Poge 4. Aguide to pahtically corred medspeak. Page 18. The School of MeiKine and Biomedical S<iences graduates Its 146th dass. Page 25. �[1] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. Exercise no substitute for not smoking n a collaboranve effort to determine the connecuon between hfestyle habits and blood levels of htgh-density lipoprotein cholesterol, researchers at UB and the University of Naples have found that smokmg and intensive exercise affect HDL in the body, but with opposite results. Based on an analysis of the habits of797 men who participated m the Olivetu Heart Study in aples, Italy, they found that nonsmokers who paructpated in vtgorous sport acti\ity- at least four hours a week for nine months a year- expenenced an average lO percent increase m levels of HDL, the c;o-called Mgood cholesterol.M Smokers, however, showed no statisticall> relevant mcrease m HDL levels, no matter how hard the> exerciSed. Results of the study were recently published in Preventive Medicme. "From a prevention potnt of view, this clearly says that you cannot run and sttll do everything else you want, because physical activity will not be able to overcome other bad habits," satd Maurizio Tre\isan, M.D , intenm chair of the Umversit) at Buffalo Department ofSocial and Preventive Medicme and one of the pnnctpal authors of the StUd). It has been known for some time that smoking is an tmportant nsk factor for developtng heart diSeaSe and that smokers have lower levels of HDL tn their blood than non-smoker... Meanwhile, studies have shown that high-density lipoproteins help protect against heart disease and that vigorous f) BU~,ALO PHVStCIAN exercise mcreases HDL levels. ~It appears that smokmg and physical activity act on high-denSH) ltpoproteins by the same mechanism, but have opposite effects," Trevisan said. "Mostltkely, they affect a number of enzymes, primarily lipoprotein lipase, a key enzyme in HDL metabolism. Smoking may decrease its activity, while exercise may increase it." The Findings were part of a larger study of the effect of lifestyle habits on HDL levels. The UB-UniversityofNaplesstud) supported previous findmgs that smokmg and being overwetght decrease HDL levels. Moderate alcohol consumpuon and \igorottS, sustained exercise increase H D L while low and moderate levels of phystcal + activity have no effect. BY LOIS BAKER Internationa I rehabilitation assessment standard developed at UB he first international standard for measuring the effectiveness of medical rehabilitation, developed by a University at Buffalo research group, could launch international research in the field and lead to refonns in the way Medicare reimburses the multi-million dollar rehabilitation industry for its services. The Uniform Data System for Medical Rehabilitation was developed through a three-year, $330.000 grant from the , ationallnsutute for Disability and Rehabilitation Research. The keystone of the system, e11:plained Carl V. Granger, M.D., professor in the UB Department of Rehabilitation Medicine and one of its principal developers, is the functional independence measure, or FIM, an easy-to-use instrument that allows trained personnel to assign a numerical value to a patienl's ability to function based on the performance of 18 physical and mental tasks that are part of a typtcal daily routine. By assessing pattents throughout treatmem and after diSCharge, their progress, outcomes and cost of treatment can be measured. The method has been embraced enthusiastically: -.r More than 150,000 patients m 337 facilities in 47 states have been assessed since its introduction in 1987. ._;. FIM has been translated ~ into five languages. ~.;.. Twenty-five facilities in ~ Aust~alia and five in Canada arc ~ sendmg data to UB's Center for i ANI) BtO..-£DICAL, SCt&HTIST I lit lit 2 .. �·························································································· m r3 m Functional Assessment Research, with japan expected to come on-line next. .;. Seventy-five VA rehabilitation centers will jom the system shortly Data collected from participating facilities are fed into a spectally destgned database that generates reports for each facility to compare its performance with similar facilities regionally and nationally. In addition, UB has opened a new database to serve skilled nursing facilities, and another is being developed to process information from m-home therapy services. Researchers have also adapted and are currently tesung the assessment method for pediatnc application, calling it WeeFlM. + BY LOIS BAKER Muscle rehabilitation with non-aerobk exercise can improve aerobic fitness .. VB study that used persons with osteoarthritis of the knee as subjects has shown that strengthening weak knee muscles with nonaerobic exercise also improves cardtovascular fitness. adtne M. FISher, Ed. D.,and colleagues in the departments of rehabtlitative medicine and physiolog} tested the subjects' aerobic fitness before and after three months of ISOmetric and endurance knee f!exton and extenston exercises known as quantitauve progre$tve e.xerctSe rehabilitation. After the program, the participants gained 65 percent more aerobtc power and could walk faster and exercise longer than previously. The study showed that, for this populauon at least, muscle rehabilitation alone can improve aerobic fitness. The findings were reported recently + in Gerontologist. BY LOIS BAKER nme percent having it in at least one meal per week ._;. Those with a higher frequency of eatmg the fish tend to eat larger serving sizes at one meal. ._;. Blacks and Native Americans, along with anglers with fewer years of education and lower LOtal household income, reported the most frequent consumption of ~ fish from Lake Ontario. ~ ~There is still a large percentage of people S using thiS resource, despite the warnings,·· ~ said john E. Vena, Ph.D., principal invesugator and associate professor of social and prevenuve medicine at the Universll) at Buffalo. • • Funded by a grant from the Great Lakes Protection Fund, the study was based on questionnaires returned by 11.717 anglers bile more than 90 percent of who purchased fishing licenses in 16 upanglers in upstate ew York state counties from October 1990 to Febare aware of the state's health ruary 1991. For six counties that border Lake advisory warning that fish Ontario, more than 10 percent of the anin Lake Ontario are chemiglers reported consumption of fish from cally contaminated, most have not changed their fishing habits or Lake Ontario at least once a fish consumption, according to prelimi- week. Venahasbeenfunded nary results from the largest study ever conducted on the health impact of eating by the Great Lakes ftSh from the Great Lakes. The study of more than 11,000 anglers by UB researchers showed that less than half have changed their fiShing habits and only 20 percent have cut their consumption of Protection Fund fish from Lake Ontario, the most chemifor follow-up studies. incally contaminated of the Great Lakes. cluding those of birth outThe study also found that: comes m female anglers and wives of an._;. Sixty percent reported consummg about the same amount of ftSh from Lake glers, and a study that '.viii focus on 350 Ontario in the last year as m prevtous anglers in the responding group that will years, while 30 percent reported eating mvolve taking blood and hair samples to determine who much of the chemicals are less. + .._;. One-third reported consuming the being absorbed by their bodies. Eight out of 10 anglers 1gnore wam1ngs about Great Lakes fish fish in at least one meal per month, with B Y L OIS BAKER �s ······ · ···· · ··· · ······························ · ··············· · ··························· Buffalo General Hospital shi ppi~ bad~ needed medkal supplies overseas uffalo General Hospital has launched a project to ship badly needed medical supplies and equipment to hospitals in Guatemala and the Philippines. Known as the Overseas Medical Assistance PrOJCCt (OMAP), the program was orgamzed b) BGH surgeon F fero Sadeghian , M D , and NanC} E. \ltazuchowski, assiStant admmiStrator for professional affairs. ~While traveling in different pariS of the world, I found that so many countries are in dire need of the type of medtcal and surgical items that we discard," Sadeghian The St. Louise West Side Health Core Center, site of Sisters Hospital's new OB/ GYH cfini<. satd. As an example, the BGH surgeon explamed that once a package ofsutures is goal is to conunue sending these types of counsel. Mazuchowski said support for OMAP opened and parually used, New York State ttems, but also to provtde hosp1tals with larger equipment whtch is no longer in usc has come from several sources, including health department codes do not permit it here," she explained. the hospital's medical and dental staff to be resealed and used In addition to the two organiz- which donated money to cover shipping elsewhere. He noted ers, other BGH staff mvolved charges for medical and surgical that a disclatmer ac+ in OMAP include Lynne supplies. companies each package advising Blanchard, R.N., sterilization of the supplies, if appropriate. Linda Butterfass, R.N., Mal) Ann The OMAP commmee meetsquarterl) to evaluDannenhoffer, ate the proJect, explore Phann. D , Charles , \ ways to expand the Lakso. \thchael program and to \ ' F "oe. ~1 . 0.. prepare pack~ ~'~~.:;;.~....... 'vttchael H. ISters Hospital has opened an obages for shtp- ............_ • stetncs/gynecology clmic featurl ping. To date, mg a wtde range of women's health t threeshtpments · senices and a bilingual nursmg ~ have been sent - staff at 209 Niagara Srreet, Buffalo. to Roosevelt The clinic is located at the St. Louise Hospital, a Also on the West Side Health Care Center, one of the 2,000-bed facthty commtttee are Rtchard hospttal's satellite facilities. Moore and Susan Regan, in Guatemala, and "We serve women of all age categories several to St. Martin de who are providing pro bono with various needs, including teenagers, I Porres Charity Hospital in legal services in connection with menopausal women and geriatric pathe project. They represent Magavern tients," notes joyce D. Heath, M.S., comManila. "As we proceed with this project, our and Magavern, the hospital's general munity services coordinator. Sisters Hospital opens obIgyn servke on Buffalo's west side l . 0 8U,.P'AL0 PHYSICIAN AND BIOMI[O f CAL SC.I:HTIST 5U .... M£R 1882 .. �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [1] The clmic 1s also a site for the SISters Hospital Prenatal Care AssiStance Program. The center's staff includes an obstetrician/gynecologist, a registered nurse. a nurse practitioner, a social worker, a nutritionist and a financial advocate. The clinic also serves chemtcally dependent and high-risk pregnant women. + ment of radiation medtcme at Roswell, "It takes less than lO minutes, seems to be more effective, offers greater patient safety and convenience and significantly reduces length of hospitalization. And the potential uses of this treatment seem to be limited only by our imaginations." Shin and his colleagues arc currently administering brachytherapy to patients with recurrent, inoperable lung cancer, particularly those who have failed to respond to conventional radiation therapy. Patients with tumor obstructions in the esophagus may also benefit from this treatment, Shin said, as well as pauents with prostate, breast, head and neck, cervical and endometrial cancers. + Sisters Hospital plans to open ambulatory care center in Amherst Roswell Park Cancer Institute first to offer high-dose brachytherapy igh-dose brachytherapy-a new. more efficient method of delivering radiation d1rectly to tumors - is now being offered to area cancer patients at Roswell Park Cancer Institute Brachytherap). m which a radioacuve pellet is attached to a thin, fieXlble catheter and placed directly on or near the tumor. has man) advantages over convenuonal radtauon therapy The procedure allows the dehvery of a very htgh dose of radiation that rema1ns essenually confined to the LUmor area, sparing the surrounding healthy tissue. In convenuonal radiation therapy. radiation IS delivered indirectly from outside the paucnt's body. According to Kyu Shin, M.D., chair of radiation oncology and head of the depart- he Amherst Planning Board has approved a Sisters Hospital plan to open a fullservice ambulatory care center on Harlem Road at Sheridan Drn•e in Amherst. The Sisters Amherst "" Health Center will occupy approximately 15,000squarefeetof a four-story, 40.000square-foot medical ' office building planned by Ftrst Amherst Development Group. The center will provide mammography, X-ray and CT scanning, laboratory and blood draw station and a full range of outpatient primary•care services. The hospital's Corporate Health Ser- vices division will also be a part of the Amherst complex. as well as a medical reference materials room and conference/ classroom areas for medical meetings and seminars. Ststers Hospital medical staff will also maintain offices for specialties including 08/GYN, cardiology, orthopedics, internal medicine and family practice at the center. "The building of the Sisters hospital ambulatory care center results from the hospttal's need to bring many of its outpauent senices closer to the consumer. Our location will pro,ide easy and quick access from all the northern suburbs,~ said Sr Angela Bontempo. president of Sisters Hospttal. The remainder of the space in the medical office butlding , ...;JJ be leased to physiCians and other health care specialists whose practices are compatible \\.ith the Sisters Hospital facility. The medical office building will be located direclly at the Harlem-Sheridan Drive exit of the Youngmann Memorial Highway. It is scheduled to open this fall. Artist's rendering of Sisters Hospital's planned ambulatory care center. + ���• "Most of these people are my patients, if not friends, then acq11aintances. I just enjoy the rural setting, the people and the attitude. " Rural phvsrcrans sec more patients, work longer hours and cam less money than their counterpart~ m maJOr cities. The\ are more sevcrd) affected b\ shonagesof con~ultants, nu~es, thcraprsts and social support agcnw:., So, why do they do it? And why do other doctors opt for an urban practice? For many, the choiCe b based on their upbnngmg. For others, lb srmply a lifeume dream come true. Ask farmh pracuuoncr Wallace alter wh) he chose a rural practice and he's at a loss to answer- verbally. Instead, he'll rm,te you to hop m hrsjeep and maneuver through the 35 acres oft and he and his ,,;fe Debra O\\ n m the lulls of Boston, 1\Je,-. York. From therr mountainside home which ha~ the look and atmosphere of a ski chalet they overlook a breathtak- 0 8U,P'AL0 PHYSICIAN ing scene of foliage and wildlife. from lheir living room, you can sec the renovated 170-year-old farmhouse a quarter of a mile mva) which houses their JOint practice. Debora and\\ allacc. one of the the first husband-and-\\ife teams to complete residenc> trainmg at the State UmvcNl\ of '\ew York at Buffalo. clear!)' arc dchghtcd "ith thetr choice ofa practtcc locauon. In Wallace's opinion, they ha,·c the best of both worlds, ,,;th ready accc..,., to care m Buffalo. where ~children·s Hospnal 1s a 17-min.ute \-1edE,·ac awa} \\ c're luck) here." In Boston, '\e"' '\ ork, and the ncrghboring hamlet ofPatchin, C\'CT} bod) knO\vs evef}rbody else and adults and children alike are on first-name bases. An hourlong visit for breakfast at a local restaurant AND BIOMEDICAL brings in at least a half-dozen guests who stop and chat ''ith the doctors. Referring to the restaurant's clientele, Wallace Salter notes that "most of these people are In) pauents. if not friends, then acquaintances. I just enjO) the rural seuing. the people and the attitude... If the Boston hills are off the beaten path, then the Salters' ex'J)Crience as resrdents m Point Barro". Alaska, was downright Siberian. Point Barrow is a town of 4,000 located 330 miles north of the Arctic (rrclc Its people are mega-miles from the nearest Cit). m geographic location as well as in mind-set. '-:otes Debra Salter, "The) still have their medicine women ... The) still do things like cupping (placing heat cups on the back) and burning to remove bad sprrits." Both Debra and Wallace spent time in Alaska caring for the resi- SCIENTIST SUMNI:fll I 8 8 2 �dents of Point SarrO\\ and se,·en outlying \'Hlages \\ithin a 300-mtle rad1us Wallace made two mps from Buffalo to Pomt BarrO\\, Debra. one, accompamed on her venture b\ the1ro:.onjcremy, who was two year.; old at the ume. The family lived at the 14-bed hospital where the doctors worked and Jeremy burned off toddler steam by running in the corridor.; (At 70 degrees belO\\ zero. planng outdoor.; was out of the quesuon ) Many of the Salters· pauents were Alaskan p1peline workers and their famJI1es. Complex cases had to be transferred to Anchorage. 700 miles and two-and-a-half hours away by jet. Wallace Salter recalls treating a head injury on a pipeline worker: he was a1rlifted to the scene of the injury and mformed by his pilot that he had 11 minutes to disembark. suture h1s pauent and return to the plane before fuel ran out (at 70 degrees below zero. the temperature IS too cold to restart the plane) I accomplished ll m 13 minutes and ....-e made it back safclv,'' he recalls. Home for mam a Point Barrow family was a tarpaper shack. and basic necessities such as indoor plumbing often simplv were not available "\\ e·d treat a chtld \Vith an ear mfecuon and recommend a humidifier and the qucsuon wasn't, 'Do you have a humidifier?' The question was, 'Do you have runmng water or electricity?"' says Debra Salter. 'They melt icebergs for fresh water," adds Wallace. Tuberculosis, syphilis, hepatitis and other infections ran rampant man area where a sanitation truck visited homes datlv to empty out waste. In sharp con~t to the1r Alaskan e.'.-penence and ultimate choice of a rural practice, the Salters both have experience m urban mechcine, ha-.ing worked in \'arious Buffalo hospital emergenC\ departments. For eight years. they res1ded in the inner cil) and are convmced that their urban medicine counterparts could •keep ~anhattan,just give me that coumn'Slde" "It wasn't neccssanh the pauents as much as ll .... as the hfcstvle," explams Debra. "I JUSt never had the mner-cily attitude. Part of the d1fference for me was my upbringmg. I was ra1sed on a 6,000acre cattle ranch m ew Mex1co. I was just much more used to rural-type living in the first place." �Recent studies show that two trends related to phys1c1ans choices of a practice location arc similarity to their 0\\11 home town and spousal preference. In the Salters' case. both these theories appl). and their decision to open a practice in a country scuing ,.,.as mutual To sa\ thev are happ)''"ith their choice of both profession and lifestyle c, an understatement Ther speak enthus1asucally about every aspect of it, even cham sa\\ season "We have things that walk mto our office that I would nner get 1fl '"as practicing in the city... says \\ allace. "Last fall ''as chain saw season. 'HO\\ do) ou get those annoying blood stains out of vour chain saw?'~ Catherine Weeden. \t D also !)C~ her share of chain saw injuries. <l'> well as farmingaccidentsandsimilar mediCal miShaps. Weeden completed her famll~ practice training at UB in june 1992 and became medical director of the Unt\'Cr'>ity's Rural Health Campus in Cuba, 70 miles south of Buffalo. The campus was funded b\ a 1988legislative grant from 'iew York State. sponsored by the state's Corrurus'>IOn on Rural Resources. Physicians began seemg patients at the campus, located on the grounds of 26-bed Cuba Memorial Hospital. mjuly 1991. In less than a vear. '>taffed by a medical director and t\\."0 re'>idents. the campus has handled 4,000 patient ,;sits Thomas Rosenthal. M.D.. director of the rural campus, comments that "we're where we'd normally be after a couple of years an urban site." ''I'm not sure why I chose a rural practice,'' says Weeden. "I've just always dreamed of being a small-town country doctor." In contrast to Debra Salter. Weeden's upbringing does not mirror her choice of a rural area in which to live and work. She grew up in suburban Orlando. Florida, and attended the University of Tampa College of 'vtedicine. Her link to :-.le" 'r ork's heartland is her husband. M1chael. a minister in Olean- at 15 miles away the nearest Cit\ to Cuba. She describes her patients as ~farmers and small busmessmen. Animal bites, rabies vaccinauons and farm-related accidents are common," she notes, as are injuries to boaters on nearby Cuba Lake. Recently, Weeden treated "horrible lacerations" on a gentleman whose face was caught in a barbedwire fence. "It's not really very glamorous," she says. "He was wrestling with his dog." like her peers from UB, Weeden spent the ftrSt m·oyearsofherres1dency training at the Deaconess Family Medicme Center, an inner-city subsidiary of The Buffalo General Hospital. She sees hkenesses, as well as stark differences, bet\veen her urban and rural pauent experiences. ..Actually, they're very similar populations in some ways," she notes. "Both are largely Medic- I II II 2 �aid patient~. The difference 1s that here, moreofthcmarC\\OrkmgMcdicatdpcople. The) work hard. but don't cam enough to get med1calmsurance. Referring to her adopted rural hfestyle, Weeden says, "It's been a pleasant surprise working here. More and more, I can't go anywhere without ~omeone knO\\ing my name." Access to mcd1cal tcchnoloro , circa 1992. is nota problem. "In th1sage,you're not a.., isolated as you u..,cd to be," she commenLs. One of her colleague:, m Cuba. Kimberle\ \tarkowsk1. \-1 D , echoes \\'ecdcn ~ op1mon Dbtance hasn t Jeopardized an) cases, note'> \-tarkowski. "In an emergenC). v. hen atrtransport becomes necessary, any tunc seems to long. But in all reality. it's reasonable." Born in the tin\ communit) of~ewfane. t\ew York, and raised 111 the nearby to\m oflockport, Markowski d1dn't thmk t\\ice about JOinmg her husband Geoffrev in family pracuce and movtng to a spre;d of land that measured "257 acres, at last count." When they're not treating animal bites or gunshot wounds, the Markowskis raise three daughte~. 14 head of cattle, fi"e rabbits and a dog. Their work represents "famih practice in itsenuret)," <>avs Kimberlev Markowski. "The best place for famth pracucc IS m a rural setting, where there s more of a need than there is in the cit\ In the Cll), there are specialists for e'wythmg. Specialists tend to cluster in the cll~ where thev can be reimbursed for thc1r ~pecialue:, .. Rural or urban. canng for people. building relationships and '>culpting a hfest\·le rooted m personal cxpcnence is what choosmga practice locauon ult1m.11ely comes down to. And for some of toda) \recent medical school graduates, mral medicine is the right choice. 8U,,-ALO .. HYSICIAN AND t's a long, long way from modem medicine to Point Barrow. Traveling to this Alaskan outpost 330 miles above the Arctic Circle, Drs. Debra and Wallace Salter may as well have entered a time warp. Traditional native medicine in Point Barrow borders on the prehistoric; for many an Eskimo, the first line of care is a medicine woman who uses techniques such as burning the skin's surface with coins or metal cups to ward off evil spirits that are believed to bring disease. "The people there equated their medicine woman with a witch doctor. She was very highly regarded ," says Debra Salter. The Salters spent several weeks during their residency training living in and working from a 14-bed Point Barrow hospital. " If the traditional means of treatment provided by the medicine woman didn't work, then they'd seek us out for care." In a procedure commonly known as cupping, Eskimo medicine women heat BIOMEDICAL metal objects and place them on the back. "Evil spirits are associated with illness. If they can get the evil spirit to leave the body, they believe the illness will go with it," Debra Salter explains. The Salters saw four or five cases a month, many of whom were children, brought to the hospital only after such traditional native techniques had failed to cure fevers, ear infections and similar childhood maladies. But not all the natives' medical problems were minor. "Some of the disease processes in children and in the population in general were similar to those you'd find in a third-world country ... advanced tuberculosis, hepatitis B... it was amazing," says Debra Salter. Amazing, perhaps. to the physician educated in a major American university. Buttothe Eskimo bred in Alaska's most remote geographic comer, it was a simple matter of respecting timehonored traditions passed down through the generations. One man's witchcraft is another man's cure. Perhaps it's just a matter of what you believe in. SCtaNTIST + S U M M £ R 1992 CD �I; In an age of specialization, n1any p/,ysicians find inspiration /ronz tlze arts. By Mark Hammer ver the last 50 years or so, American cuilure has come to celebrate s pectahzauon, not only in medtcme, law and academic pursuits, but in virtuallr every arena of human acuvity from mortgage banking to cosmetologr, ,..·here an electroly:.ist can seldom give r ou a good pedicure. In the field of medicine, specializauon is eptdemtc Where once the GP tripped up and d own the statrways of our hves, humming a tunc of his own creation, painting a hulc on thcstde, writing poetry, perhaps doing an autopsy now and then, there now gallops a he rd of otolaryngologists, orthopedists (and orthopedic surgeons), neurologists (and neurosurgeons) , urinary incontinologists, endometrial samplers, comeaologists and investigators into the structural relationships of dihydorpyridine-l)'Pe calciUm channel antagonists. Perhaps because we cast individualism in a sacred light, Americans denve great comfort from the label ~expert." After all, who do you want to sew up your aorta? One way for practitioners to augment the narrow focus of thetr scienufic pursuit is to explore a different creative realm entirely, giving free reign to the intuitive process in a relief from the sctentific. We know the dogmas and strictures that define the realm of the mcdtcal expert can accommodate the errant muse, and have often enough. The world of medicine has yielded great poets, authors and compos- ers. And sometimes, the arts have yielded a physician or two. Anton Chekov (1860-1904), the Russian playwnght who wrote such dramatic masterpieces as The Seagull and The Cherry Orchard, was a (sporadically) practicing physician who lived a life devoted to the arts. He wrote his first short stories as a medical student at Moscow University to help pay off family debts. Although his reputation as an artist far exceeds his work m medicme, Chekov's writing continually encounters and questions the human spirit and the motivations which produce the emotional and physical environments within which the Russian people lived at the tum of the century. His characters continually face a moral struggle in finding their true selves, only to find that the I II II 2 �8 U P' P' A L 0 A N 0 8 IO M COICAt.. I II II 2 G �tragic aspects of life are often comed1c as well. Another example of a man of medicine who devoted his life to the arts ts the American poet W1lham Carlos Williams (1883-1963) 'low v1ewed as a major contributor to American moderniSt artistic ach1evement, \o\lilliarrJS was a general practitioner m Paterson, '\ie,... jerse}. for most ofh1s adult hfe He spumed the large city of New York, both arusucally and medically, in favor of a small commumty where he did everything from setting broken arms and treating chronic headaches CD eu,,.ALO ,-HYatctAN to perfonrung emergency appendectonues and making house calls to deliver babies And yet Williams produced a bo<h of work that includes over 1,000 pages of poetry, se,·eral plays, collections of short stories and books of essar:. and an autobiography. An annual poet!) contest, open to medical students around the country, is sponsored by the Human values m Medtcine program at Northeastern Oh10 University's College ofMedtcmc in honor of Williams. Williams was presented with an honorary Doctor of laws degree by UB during AND BIOt-t£.DICAL its centennial celebration in October 1946 (sees1debaron Williams). His sponsor for that degree, then-Dtrector of Universit) Libranes Charles D. Abbou. sa1d at the ume that Williams had encountered and celebrated ordinal)· American life both wtth his wnung and his medical practice. ~He has been able to see, understand and to express the larger unities of American hfe," Abbou said. '·Like the Universit}. whose hundredth year we celebrate, he too began in medicine, kept faith with all that it demands and sought beyond to that large store of knowledge that fits SCICNTIST SUMME:llt 18St2 �man's mind to grasp the ends of thought." Williams was also a celebrated participant 10 the Niagara Fronuer Convocation in Buffalo m 1951, whtch explored the possibilities of Amenca m the Iauer half of the 20th century A large collection of lus papers is owned by the Universny as well. Williams and Cheko", and numerous others like the Enghsh poet, dramaust and physictan Thomas Campion (1567-1620) and the Austnan doctor and composer understand a great deal of disparate information. -1 believe that doctors think in a way that is amagonistic to poetry," he says. ~because phystctans are often mflextble m their thinking. 'My Simple premLSe IS doctors aren't trained broad!}· m the liberal arts. Their educauon IS generali}' very specialized. Poetic thought goes 360 degrees. And the process of poeuc th10kmg brirlgs the poet mto other mtellectual ar- the physician, or the poet, to encounter new prirlciples that become universal, according to Charles Bernsteirl, a prominent American poet who holds the David Gray chatr ofPoetry· and Lettersat UB. Bernstern has wnuen and edited over 20 books of poell) and essays on language. As a ghost wn ter for 15 years, Bernstein wrote monographs for physicians for medical education publications and abstracts about new experimental drugs and procedures for '~ grounding in science alone won 't make anyone a doctor. There also needs to be an understanding of the intuition that tells us what the whole individual is." Peter Lichtenthal (1867-1924), spent a great deal of their hves pursuing artistic beauty while adhering to their calling in medicine. One reason for tlus lies m the process of commumcauon that underlies much of what an arust does, accordmg to Wilham Coles, M.D., chatrman of the depanment of ophthalmology at lJB's School of Medtcine and Btomedical Sciences. Coles is an accomplished poet published wide!> 10 Buffalo and in magazines around the country - who holds Wilharns as a maJor mfluence on lus 0\\-'11 writing. He 1S also a Jazz mustctan who bills himself as "Doctor jazz," specializing in heritage jazz and blues on the banjo and vocals. "I started writing creatively after Igraduated from medical school. I went imo poetry because 1 was very interested m idea transfer as an educator as well as a public speaker," explained Coles, who has also taught Life Workshops m poetry at UB and won the Callenwold Poetry prize in Atlanta. "Poetry 1S appeal10g because tt is made up of very• concentrated and well thought out tdeas. It's what 1 call the process of poetry, and u centers on communicauon. My medical school trammg left out that kind of process-onented thinking. Let's admu It, most doctors are not very communicauve." The poeuc process brirlgs the poet into various areas of thought, according to Coles, who has also taught poetry·at Emory University in Atlanta, Georgta. And it is through that kind of intellectual diversity that the poet is invested with the ability to BUP'Fo\ LO .. HVSICIAN eas continually. Poetry is the new sensitivity forme, the seventh sense, if you will, that also allows me to reach people across a universal spectrum." An intense attention to detail is what makes creative photography and surgery· complementary, according to NanC} Stubbe. M.D., a clinical physician at UB's University Health Services and a facult} member at the medical school "Wllh photography, you need to spend a great amount of attenuon to set up a good stillhfe scene, for example. If the least thing is wrong, the picture is ruined," she explained. "In that respect, it's very simtlar to medicine, where a physician must be very conscious of detail in her work. And with both, you must devote yourself entirely to the task at hand." Another parallel between med1cine and photography is in the intricate observation essential for both, said Stubbe, who regularly enters her photographs of nature in local photo competitions and has had some of her work published in a local medical newsletter, Medical News. "As a physician, you're taught how to observe a patient very· carefully. whether before, during or after treatment. The same goes for photography. But being a photographer made me learn how to observe without someone speaking about symptoms. In that way, photography has made me a better clinical observer." Changing focus, using the mformation from one field to shed light or bring new intellectual possibility to another, allows AND B IOMEDICAL pharmaceutical companies. He also edIted the Canadian edition of Modern Medicme and wrote and edited over 20 books of poetry and essays on language. •J loved the precision of the medical nomenclature in that it was very specific. But thewritingl was asked to do was often relatively dry·. and most of it was recycled mformauon. And that writing.~ he explamed, "earned a sense of neutral descnpuon, which is the exact oppostte of m} poetry~ Bernstein said he began to notice that his medical writing began toaffectlusown wnting and thinking. He maintair!S that medical writing both altered and expanded his perception of language. ~I found that the medical terminology, the phrasing, staned to creep into my creative work. For example, I wrote a piece about 'dysraphism,' which means the congenital mis-seanung of body parts. And that description seems to have caught on regarding what my creative work does, in general. It's like bad stitching. I'm generalh fascmated by any descnption of abnormality" It IS the large spectrum of feeling that gives doctors-as-writers their field of exploration, accordmg to Richard Seltzer, M.D ,a retired professorofsurgeryatYale Umverstty's School of Medicine and author of six books of shon fiction and essays. His most recent work, Down From Troy, a memoir about lus boyhood in Troy, NewYork,duringtheDepression, is forthcoming this summer from William Morrow Publishers. "I've worked very SCtlNTtaT SUMMIE" t882 G) �hard to transfer the feeling of surgery mto my writtng. And there is a strong similarity between the two for me Both are techniques, crafts." he c;rud won a very simple level, you have a scalpel that draws bloodandapenthatdraw.. mk ln\vnung. you're suturing words together and \\'lth surge[}. you resutunng together the body. I want to report, m the most compelling language that! can use,the suuauon of the human bod)." 11 Tommy Dorsey, Benny Goodman, Glenn Miller, and we do a few modem tunes as well." he said. WThe number one reason why we do thiS is for the fun of it. It gtves us a chance to do somethmg outside of medicine that we all enjoy" \Vhile Schiller finds music to be an escape from the daily rigors and pressures of being a ph)'sictan, a way to enJO}' the com pan) of his colleagues. the technical aspects ofbeing a musician resonate much Washmgton for a year. ~A grounding in sctence alone won't make anyone a doctor There also needs to be an understandmg of the mtUttion that tells us what the whole individual is.·· She also points to the technical expertise associated with both fields as bemg a point of convergence, although she admtts that the basic discipline she gained from studying music for most of her life has made her a better physician. MThere 1S 0n a t'ery simple let•el, you lzat'e a scalpel that draws blood and a pen that draws ink. In writing, you're suturing words together and with surgery, you're suturing togetlter the body." Seltzer, who didn't begm wnting until the age of 40 (he's now 64), satd that once he became entranced with language, his abthty to sense and empathtze with his patients mcreased dramaucally. "In making myself mto a writer, I became a better doctor I saw that! \\.'as much more in tune with my pauents as human bemgs," he explamed. "Because with things like compassion and pll), some people have it naturally and others get it b~ enduring thetr own suffering. I found ll through wntmg In his forthcommg memOir, Seltzer writes of his boyhood and the stress of having parents who had very dtfferent career choices in mind for their son; his father was a doctor and his mother was a singer. "My father wanted me to be a physician and my mother wanted me to be an artist. I guess at 64. I've finally satisfied both of them," he laughed. And satisfacuon, whether personal or otherwise, 1S often mouvauon enough lO want to create provocau"e prose or a prisune photograph, or mterpret a !)'tiCal ballad by Benny Goodman. says Sheldon Schtller, M.D., an ophthalmologtSt from LoutSvtlle. Kentuck), and the onginator of WThe Doctor's Band," a popular 25piece dance band there. He plays the saxophone "I started ll over 25 years ago," he satd. WThtS band allows us to do something wewouldn'totherwisedo. lt'sareleasefor our own stress, kmd of group therapy for us. We're a dance band. We play a lot of music from the big band era, people Like 4D 8U,I'AL0 ~HYSICIAN deeper while offering a sense of commuruty not found in the medical profess1on according to Deborah Shuster, M. D , a graduate of UB's School of Med1cme and Biomedical Sciences m Ma) 1992, and a pathology resident at Stanford liniverstt} She is an accomplished \iOilSt who has played in orchestras m New York and Italy and has a master's degree m mus1c from the Cruvers1ty of Colorado "There is definitely too much speclaltzation in medicme. As a pathologist. rm outside the realm of patient care, but it doesn't have to be that wa)," she explained. "There seems to be no conversauon between the primary care doctors and myself. 1 don't like that at all." Shuster said she wants to be a part of a working community of physicians that is similar to the community she enjors when plaring in a symphony. "Being an artist, marbe I bring a vision of the whole individual to m) work m pathology. Because what finall} makes someone an anist is thatthe) begm to trUSt an innate sense of intulllon when performing or creating." she sa1d ~And medicine is defmuel> more of an art than a sc1ence, because there needs to be a lot of intuition mvolved on the part of the physician. And a pathologiSt can't exist without other physicians, and a musician, at least m my case, can't exist without the rest of the orchestra. Each IS one pan of the whole," said Shuster, who has played in the prestigiousSpolctto Opera in Italy and the Spokane Symphony in ANO BIOMCO!CAL a large amount of minute attention needed to function in both fields. With pathology. I may spend hours looking at one or two cells in hopes of getting a better sense of the whole cause of death," she said. "In mus1c, there is a tremendous amount of practice, sometimes several hours on one series of notes, m order to be able to play a beautiful piece of music." Bemg able to perceive one's singular function wilhin a whole structure, mustcall)' or medtcall), is essential to understanding the entire structure, according to Harold Utt, a French hom player and currently a student in the M.D./Ph.D. program at UB. "To find the value of what you're doing means that you must understand how what you're doing fits in with the whole. "It's the same in art as in medicine," he explained. "When looking at a medical problem, it's very important to identify the underlying causes. And similarly, in order to understand the one part you're playing m a symphony. you must understand the whole p1ece of music." He stressed that there needs to be a dichotomy between the technique and the art of medtcme. "To be a great anist, you must do more than play all of the right notes. You must transcend the ordinary." said Liu, who studied classical music with members of the Philadelphia Philharmonic when he was a teenager. "And it's the same m medicine. A doctor needs to have compassion and an intuition regarding his patients, which leads to a transcendent understanding of the human animal." + SCt&NTIS'T SU,..NEit llil82 ) J �LJ'm '') OS ] ]'IS and the UB connection J J ' he lJnivers1ty at Buffalo"s sored Williams for the honorary doctorsupport and recognition ate he received from VB m 1946 at ItS of William Carlos Williams, Centennial Celebration. M.D.'s work as a creative artist is It was also a dose connection to the made clear by the University's University that enabled Williams to take massive holdings of Williams' papers. part in The Niagara Frontier ConvocaOver 20,000 documentS in the Williams tion in December 1951, when for two collection are housed in the University's days, hundreds of scholars and intellecPoetry/Rare Books Collectuals from across America descended tion, inupon BuiTalo to probe ~The Outlook cluding letFor Mankind in the Next Half ters, manuCentury." scripts, Williams working w a s a draftS of postrong ems, notes critic of and other mas o m e terials. The maAmeriterials span more than 30 years of Williams' career as a writer-from the \Y';//;am 1920s to the Carlos \fT;//;ams' poem 1950s. Williams re- "Lear," u•riften on ltis ceived his medi- prescription pad- part cal degree in 1906 o/ UB's collection. from the University ofPennsylvania. After an internship can artists in New York and graduate study in the ~Expatn­ pediatrics in Leipzig, he returned to his ates," such as Ezra Pound and Ernest hometOY.'Il of Paterson, New jersey, in Hemingway - who left their counl910,determined to care for those m his try to go to Europe during the 1920s own community. Here was a man, as and 1930s. ln his speech at the Convowriter and physictan, who had a strong cation titled ~will the ArtS Thrive or sense of responsibility to community Degenerate During the Next FiftyYearsr and country. He would focus his cre- Williams lamented that American wntaU\'e and medical talentS m Paterson for ers had too often harkened back to Euthe durauon of htS hfe. rope for enlightenment and knowledge, lt was Williams' close relationship instead of focusing on Amencan mtelwith Charles Abbott, the former direc- lectual and artistic achievementS. ~Our first comers, while their bodies tor of Umversity Ubraries for the thenUniversity of Buffalo, which brought went forward into the wilderness, turned much of the material to Buffalo in the back in their minds to Europe,M said 1940s. And it was Abbott who spon- Williams. "After the first burst of BU,.,AL..O flHY81CIAH ANO BIOMIIOICAL affirmation at the time of the Revoluuon, and as wealth increased and the spiritual and Intellectual gradations between individuals became more and more apparent, the trend of mind back to Erope and the past grew in appeal." The second half of the twentieth century could prove to be the period during wh1ch the American artistic genius would shed itS dependency on past European associations and become disunct and smgular, said Williams. The ume, he said, was ~now~ for transformation, for creating a distinctly American literature. "Fifty years is a small space of time. It wdl be hard to say whether we have gone forward or shpped back during that ume, but the way tS dearly indicated. I do not thmk that we shall fail.M Withams' reputation as a wnter has grown steadily since ..... his death in 1963 when he was posthumously awarded the Pulitzer Prize in poetry for his Pictures from Brueghel, and Other Poems. His struggle to propose and define a literature that would reflect at once both the s1mple and complex themes played out m the Amen can experience has been recognized and applauded by a new generation of American writers and scholars. His attitude of looking to the future to defme people's relationships to thetr country and itS history continues to compel and challenge American writers to observe and defme their country's + heritage. - Mark Hammer 5CtCNTl8'f SUMN£11t 1882 G �A Spoonful Po of Humor ically rrect Medical Terms for the Last week I was informed by one of my colleagues that I can no longer use lhe words "woman~ or "female~ because lhey contained lhe words "man~ and "male," which implied a subservient status. From now on she insisted on being referred to as a "Gyno-American." I said, "That would be fine, Dr. Zimmerman ... er, Dr. ZimmerPERSON." Welcome to lhe "Politically Correct (PC)" world of the '90s. PC "newspeak" is no longer just the domain of college campuses and the West Coast. I must learn it, or risk being seen as a "phallocenoist impenahst." For example, someone who is "smelly and dirty" is now considered "hrgterucally challenged." Someone who IS lazy is actually "motivationally dispossessed." If 1t hasn't already happened, we will need to rethink and rephrase medical jargon so as not to offend patients and politically aware colleagues alike. With this in mmd, we are proud to present a primer on "politically correct medspeak." In using these updated terms, you will be looked upon as an enlightened man ("testosterone poisoned human") or woman C[) 8 U , P' A L0 fii'H Y S ICI AN ANO 8 10 tolli: OIC A L. 5 Ct CNT I ST SUM ... C:IIt 1$$2 �I 1 Stu Silverstein, M.D . ..,.. dead :> metabolically challenged ..,.. preemie :> gestationally challenged newborn After trying to resusCitate ~ir. Da\ 1dson for over one hour, we declared h1m "metabolicall) challenged" and called off the code. TillS IS a 27-\"eek ..gescacionall.> challenged newborn," born to a 27-year-old G2 P2 "Gyno-American." ..,.. drug abuser :> recreational pharmacologist ..,.. psychotic C> neurotransmitically challenged Sub-acute bacterial endocarditis is common among "recreational phannacologists." The murderer's lawyer tried to get him offby claiming he was temporarily "neurotransmitically challenged." ..,.. fungus C> Fungo-American (a fungus that resides in the United States) ..,.. sociopath C> ethically diverse Coccidioides is the "Fungo-American" that causes San joaquin Valley fever. Charles Manson's swatisha tattoo on his forehead is a manifestation of his "ethical diversity" ..,.. hernatopoeisis C> he!shematopoeisis Her retic. count was up, indicating that "shematopoeisis" \Vas not impaired "L\tetabolkall_~ Challenged" ..,.. lice infestation C> pedicular enhanced The presence of nits on his halT shafts sug- gested that he '~as ..pedicularly enhanced " (~womyn M) and a role model for future ..,.. male pattern baldness C> reverse Mohawk generauons. On the left are the pohucall} mcorrect terms. On the right, the latest politically correct replacement terms. We have also included a sentence to illustrate proper usage. I don't know wh.> men are so self-consoous A "reYerse Mohawk" malles a man looll so ..,.. amnesia C> memory-tested, Reagano-centrist recollection ..,.. morbid obesity C> verticulohorizontally enhanced His "Reagano-centrist recollective" abilities suggested a worll-up for organic brain syndrome. 1 suggested that he was dangerously sexy. ..,.. menses C> femses Fill in your own sentence, please. "verticulo-horizontally enhanced" and ought to go on a diet. ..,.. autism C> ce.rebro-centricindividual Dustin Hoffman's portrayal of a "cerebrocentricindl~idual~wasmagnificent in "Rain Man ... W. hope this guide is helpful. Bring 1t with you to your next QA meeting or when you give a talk at your next conference. We also welcome additional political corrections. Author's Note: After this guide went to press, I was mformed that the term ~poliu­ cally correct" is no longer politically correct Therefore, when you receive this arucle, please cross out all references to PC and replace them with "multiculturally assessed. I apologize to those offended by my use of the term ~politically correct." ..,.. boring C> REM sleep enhancer That lecture on the '"or k-upfor slwrt stature ("vertically challenged~) children was sure an "R£\4 sleep enhancer " M ..,.. cocaine addict C> cocainist As a "cocainist," he was at risll for becoming REF Tilt Ojjat1al Polatuall~ Corrtct DICUon<U) and Hand!AA>. Htnl") Burd and Chns!oph<r Ccrf motivationally dispossessed Vallard Booi<s ..,.. colicky newborn C> infant of choler Stu Silverstein, M.D., president of Standup Medicine Seminars of San Francisco, California, lectures nationwide on the role of humor in medicine. No matter what we do, this kid will not stop crying. This "rnfant of choler" is driving me up the wall. 8U,,.ALO .. HYIICIAN " Recreational Pharmacologist" AHO BIOfro4110fCAL SC II HTIST SUMMEfl 1882. G> �-- n n ~ ~ '1he sky's the hmit" for UB and Roswell Park's 1 new radiation oncology department -- hen Kyu Shin, M.D., talks about 1nedicinc as his mission, lle stresses that he was "taught to be a good physician, not a just a good clinician." Th£ distinction, he says, is an imp01tant one. "Sometimes, tlte human factor is ~issing." For l.he chatrman of l.he deparLment of radiation oncology at a large medical school and maJOr cancer center, l.he disuncuon could eastly get lost in the technology. Not so for Shm. '" I regard medtcine as my mission not as my JOb," he says. "I like to use my expertise to help l.hcse unfortunate cancer patients. "A good physician looks after patients. It's not just 'nine to live' and then drop it. lt's important. That's why I chose to specialize. I always feel if there's a need I will be there." Shin, who was recruned by UB and Roswell Park Cancer Institute last year to estabhsh a radtauon oncology program, has filled such needs before - creatmg preeminent radiation oncology departments at such presugtous msutullons as the Cleveland Clinic and Lhe Tom Baker Cancer Center m Calgary . Alberta, Canada. He auns to do the same Lhmg for UB. Roswell and the other consortium hospitals - and is well on l.he way, having already introduced several innovauve treatments and applied for residency program accreditation. "This is really an exciting lime," Shin says. "So many positive things are happening here. This is exactly what Dr. (Tho- uons. Buffalo people always go elsewhere to learn Now, they are coming here." Part of Shin's efforts at establishing the radiation oncology program at UB includes building a residency program. "We began l.he recruionent process for a deparLment chair for radiation oncology as far back as 1987," saysjohn Naughton, M.D.. vice president for clinical affairs and dean of the medical school. The department is new to UB, established after the faculty council researched the program. "Radiation oncology is seen nationally as a separate residency program," Naughton explained. "Our policy is if a program has independent status, we consider establishing a deparunent. Obviously, wil.h Roswell Park here, we should take advantage of that." Shm and his deparunent are now drafting curriculums for Lhe three-year residency program, scheduled to begin in 1993. The consortium program will also train two post-graduate fellows. A clinical traineeship was established last fall. The department already provides major traming for Erie Community College's two-year radiation therapy technician program, and works with both medical and tugh school students during the summer. mas) Tomasi (director of RPCI) and the entire institute are trying to do - make Roswell a leader on an international level. ~we can achieve that by having quality programs, and we can actueve quality programs from a quality staff supported by clinical research, patient care and education. And that is exactly what we have here.~ Shin doesn't conceal his enthustasm, and it has spread throughout Roswell's revitalized radiation oncology deparLmenL. Since he arrived a year ago the department has tripled the number of patients it treats each day. last year, l.he radiaoon oncology department logged 16,525 pauent visits. The treatments offered are often the ~last resort" for some, proffered only after ol.her treatments have proven ineffective. One recent success, Shin notes, IS total electron skin radiation. ~Treating the entire skin only IS a techUndergraduate medical teaching (as a nical nighonare,~ Shin explatns. But with third-year student selective) has already Roswell's new low-dose, computer-con- begun. "We intend to go into first and trolled, after-loadmg system - the only fourth year selectives as we expand our one in Western NewYork-Shinand hiS staffing,~ Shin said. colleagues recently treated a patient from Roswell's radiation oncology departSyracuse with mycosis fungoides whose ment has three divisions-clinical, medi"lesions are now completely gone. One of cal physics and radiobiology. "We have the doctors from Syracuse came to team been able to recruit many new staff to the technique," Shin relates, adding "we implement many new programs," Shin have an obligation to teach other institu- says proudly. "The most important role "RGOOD PHYSICmn LOOHS RfTfR PRTifnTS. IT'S nOT JUST \nlflf TO fiVf' RnD THfn DROP IT. IT'S lfnPOfURnT.. �the University has played has been to allow us to recruit a first class staff." One of the most exciting new developments in the depanment is tts computer netv,rork system, scheduled to go on-line this fall. The program, which wHI be a first in New York and probably m the U.S., Shin says, will completely automate all patient record-keeping m the department - from the time patients are referred, through thetr treatment and to follow-up back to the referring physicians. The system will enable physicians to see patients, dictate findings to the computer and send the results to the referring physicians by fax automatically. "just imagine the dynamics of the referring doctors getting their mforrnation the same day," Shin marvels. "Iu s a dream come true." He envisions the system will eventually be hnked wuh the Umverstty's and other area hospttals' systems Another mnovauon Shm has brought to VB and Roswell tS stereotactic radiotherapy-"a prectSton bramsurgel') without a knife and without bleedmg," Shin explains. The procedure, which uses sophisticated digitized computer targeting and planning, "destroys the part of the brain already destroyed by the tumor without any significant side effects," Shin says. The noninvasive procedure, which can be performed on an outpatient basis, is used to treat a variety of benign and malignant lesions, including glioblastoma, arterio-venous malformations, acoustic neuroma, pituitary adenoma, craniopharyngioma, smgle metastatic malignant tumors and solitary. base-of-the-skull metastatic lesions. Most effective for the treatment of target areas up to three centimeters in maximum diameter, the procedure giVes access to deep-seated lesions which were formerly inoperable or reachable only by extensive surgery. Although many centers in New York State are gearing up to do the procedure, Roswell Park is the only one currently performing it. Shin is characteristically already looking ahead. "We're now looking one step further," he says, "using MR1 spectroscopic technology research to find out exactly what happens metabolically when 8U,.P'AL0 ~HY81CIAN "IRfGMO mfOICinf HS mY miSSIOn -noT HS mY JOB. IUHf TO USf mY fXPffiTISf TO ~flP T~fSf UnfORTUnHTf CHnCfR PHTifnTS.N Kyw Shill, M.D. patients are treated by means of megavoltage radiation therap} How does the tumor disappear? Can we predict the radiation response by monitonng the exact metabolic changes? For the first time ever," Shin says, "we may be able to explain why radiation works." Preliminary research, he adds, has already begun. Shin has a great deal of pride in his department, in the University and in Roswell Park Cancer 1nstitute. He is also AND BIONEDIC:At.. grateful for the support he has garnered from each. and mindful the accomplishments realized belong to the multidisciplinary environment that fosters innovation and quality patient care and education. "We are building a very nice department as a group and a family. And that is possible because of Dr. Tomasi and Dr. Naughton. This is an exciting time. The + sky is the limit." SCt&NTIST SU""'WII." 1882 fJ) �University at Buffalo med students win •• I1Cifiotd research awards hree Umversny at BufTalo medical students have won top national research awards. Arlene Lobo, a second-year student, was named a Howard Hughes Med•callnsutute Research Scholar at the National Institutes of Health from the Howard Hughes Medical Institute in Bethesda, Maryland Yvette Vinson and Andrea Williams, also both second-year students, were selected as fellows in Lhe Fellowship Pro- -=-,._..gram in Academic Medicme sponsored b} Bristol-Meyers Squibb Company and The Commonwealth Fund. The fellowships carry$6,000awards. Vinson received hers for her "lnvestigauon of Haemopllilus ducreyi" (memored by Michael A. Apicella, M.D., professor of med1cme and microbiology); Williams received hers for her "Nasopharyngeal colonizauon m otitis prone and non-otHIS prone children" (mentored by Howard Faden, \1.D., professor of pediatncs and co-director of the divisiOnofinfectiousd~SCaseS). + Alums rjve back with generous endowments oscph A. Chazan, M.D., '60,and hiS wife, Helen, have made a pledge to the ~hool of Medicine and Biomedical Sciences' Pathways to Greatness Campa1gn. Their g1ft will be used to endow the Dr. and Mrs. joseph A. Chazan Scholarsh1p Fund es- fl) 8U,,-A 1..0 ~HVS ICI AN tablished in 1985 to provide full tUition scholarships. Chazan is the 1991-92 national chairman ofUB'sAnnual Fund Drive He LS also a member of the medical school's Advisory Board. Paul K. Bin ch, M.D.;43, chmcal associate professor emeritus of gynecology and obstetrics, has made a gift of$1 00,000 to the medical school to endow the Paul Binch, M.D., Endowment Fund. The fund will provide general suppon for research, visiting speakers, equipment and scholarships in the field of reproducuve endocrinolog} . + C. K. Huang honored at annual medical school faculty meeting ix faculty members, e1ght r~1dem physicians and the director ofUB's Health Sciences Library were honored june 3 at the annual faculty meeting of the School of Medicine and Biomedical Sciences. C. K. Huang, director of the UB Health Sciences Library, received the first john and Margaret Naughton Special Recognition Award. Naughton, vice president of clinical affairs and dean of the med1cal school, and his wife established the award to recognize significant comnbuuons to the advancement of the medical sc hool by a staff person or member of the community. Huang, library director smce 1970, IS credited \\ith bringing nauonal recogmtion to the library for its mnovauons and SCT\'!ce. He is a fellow of the Upstate and Ontario Chapter of the Medical Ubral"} Association and a distinguished member of the Academy of Health Informauon Professionals. Robert A. Klocke, M.D., professor of medicine and physiology, rece1ved the AND B IO MCO IC AL ~ Stockton K1mball Award for excellence in academic achievement. The award recognizes contributions to research, teaching and service. Klocke, chief of UB's Pulmonary (. K. Huang Division, is also editor of American Review of Respiratory Diseases. He Vl-'ill deliver the Stockton Kimball lecture at next year's annual meeting. Milford C. Maloney . M 0 Robert A. Kladte, M.D. clinical professor of medicine, received the fourth annual Robert S. Berkson Memorial Award in theArtofMedicinc. The award recognizes excellence in patient care and teaching by volunteer faculty. Robert J. Ge11<o, D.D.S. Robert]. Genco, DDS., Ph D., distinguished professor and chair of oral biology in the School of Dental Medicine, was the first person outside the medical school to receive the Deans A\\ard for outstanding leadership and academic excellence. While noting Genco's numerous contributions to the health sciences at the univerSity, the dean lauded him in particular for assuming the mterim chair of the medical school's Department of Microbiolog} wh1le mainLaining his demal school responsibilities. Louis A. and Ruth Siegel Teaching Awards were presented in four categories: ' Q Q 2 �• pre-clinical, for basic sciences teaching; clinical, for in-hospital instruction; volumeer, for unpaid faculty, and house staff, for resident physicians. Winners were selected from nearly 200 faculry nominated by students. The recipients were: .,;. Alan Lessc, M.D., assistant professor of pharmacology and therapeutics, pre-clinical category. Lesse also won this award in 1990. -.r Fred Luchette, M.D., assistant professor of surgery, clinical category. Luchette also won this award in 1990. -.r Steven lana, M.D., clirucal assistant professor of pedtatncs, volunteer category. -.r Alon Coppens, M D., radiology; Kathylynn Pietak, M.D., med1cme; Ramanathapur Natesha, M.D., surgery; Bruce Solomon, D.O., neurology; Mattheos Falagas, M.D., medicine; Siddhartha Shah, M.D., medicine; Edgardo Salvador, M.D., medicine, and Dawn Hrab, M.D., med1cme, all received house staff awards. + B Y LOIS BA Thomas F. Frawley, M.D., "44, chairman of Graduate Med1cal Education. St John's Mercy Medical Center, Emeritus Professor of \fedicine. St. Louis University School of Medicine, St. Louts, Missouri, and national chairman of the UB medical school's 1991-92 Annual Fund, "''as inadvertently omiued from the list of members of the James Piau White Society in the Winter 1992 cd1tion of Buffalo Physician and Biomedical Scirnlisl. + KER Match Day 1992: most UB med students get their top choice atch Day - that nail-biting time when fourth-year medical students learn where they will spend the next three years as resident physicians- was overwhelmingly successful this year for UB's medical students as 84 percent of them received one of the1r top three choices. Sixry-eight percent of the 141 students who participated received the1r topch01ce. 10 percent received their second choice and 9 percent received their third cho1ce Eight percent were unmatched. In addition, six military matches were made Although a majority of the students (56 percem) will venture out of state for the•r residency training, a full 25 percent of UB's medical students will remain in Buffalo and take their training at the Graduate Medical Dental Education Consortium of Buffalo. + �[1] . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . ..... . .. . . . . . . ~ I Medical school alunri feted at receptions in Florida cnl Indiana he University at Buffalo's medical school recently honored its graduatesatalumnieventsheld in Florida and Indiana. Florida alumni were feted at two separate receptions in February. William Boardman, M.D., '44, and Barry Weiss, M.D., '67, hosted a reception in Tampa at the Westwood Hyatt whtle Thomas Rodenberg M D , '51 , and his wife, joan, hosted East Coast alumni at the Tower Club in Ft Lauderdale. Alumni from various classes attended, mcluding Thomas Bumbalo. MD . '31 , and hiS wife, Ednh Bumbalo's grandson, Thomas Bumbalo,jr., tS a member of the medical school's Class of 1992. Also in February, George Ellis, M.D., '45, hosted a luncheon at the Radisson Plaza Hotel in Indianapolis, Indiana. Thomas Riemenschneider, M.D., M.B.A. , associate vice president for clinical affairs and associate dean of the mcd1cal school , discussed the Western New York Health Sciences Consortium and the lnformaoon Network System that will soon lmk the medical school with its affiliate hospitals and rural health care sites. On hand at the events in Florida was john Naughton, M.D., dean of the medical school , who spoke about the many new developmentsand II programs currently underway at UB. 1 aughton told the groups about the construction of the new biomedical research complex to be completed in 1993 and the Western New York Health Sciences Consortium and its Information Network System. He also talked about the continued recruitment of some of New York State's most talented students and UB's unique uclassroom without walls" clinical training setting. + Medical school begins department chai' secl'ches earchesare underway for the cha1rs of two clinical departments and one basic sc1ence department m the School of Medicine and BIOmedical Sciences. Department heads are expected to be chosen toward the end of the summer for the departments of anesthesiology, radiology and biochemistry, accord- mg to john Naughton, vice president for clinical affairs and dean of the medical school. ~we have outstanding candidates for all posts," a ughton said, adding that UB has been able to attract well-recognized academics of national prominence vying for the positions. In addition, search committees have been formed to chose the city-wide head of cardiOvascular surgery and the director of the Dent Neurologic Institute. aughton said several prominent prospects are in the running for the cardiovascular post, wh1ch is expected to be filled by the fall. The post at the Dent will be filled next summer. + UB med student selected for Ameriam Meclcal Student Association felowslip hristopher Wood, a second-year medical student at UB, has been selected to participate in the American Medical Student Association Foundation's Washington Health Policy Fellowship Program (WHPFP). Wood isoneoflS medi cal students chosen for th1s summer's fellowship fromapoolof74cand!dates. The fellowship is associated with thiS summer's American College of Prevenuve Medicine. In its founh year, the Washington Health Policy Fellowship Program IS designed to introduce promising medical student leaders to the health policy process, current topics in health policy and their role as advocates. The program combines an orientation and weekly seminar <;f'ries with a field placement experience.+ �[I] ( 0 M M E N ( E M E N T I 9 2 he School of Medicme and Biomedical Sciences graduated Its 146th class during ceremonies held in May. Here, fnends and families celebrate with the graduates as they receive their degrees. The Class of 1992 includes 150 students- 146 who earned medical degrees and four who earned combmed M.DJ + Ph.D.s. 8U,.,.ALO .. HVSICIAN AND BIOMEDICAL SCtC:NTIST 5UMM£R 1 g g 2 0 �Alunri meet il Apri for Spri1g Ciicm Day cnl Reurion Weel(end he School of Medicme and Biomedical Sciences held tts Spnng Chmcal Day and Reunion Weekend on Apnl 25. The events, which included a day-long seminar and cocktail receptions, were well-received, as evidenced by thts photo montage. BU e BU,,.A\.0 PHYS ICI AN AND B IO MCOI C Al.. SCICHTIST SUMMER 1992 �A N A N 0 BIOMEDICAL SCIENTIST $ U M M E R 1 Sl Sl 2 El) �CLASS OF 1942 ~ First row, left to right: George L Eckhert, Richard Mnauo, Vincent Cotroneo, Howard Frederickson ~ Second row: Urban L Throm, Richard Ament, Boris Marmolya, Charles A. Baudo, Ivan Bunnell, J. Walter Knapp ~ Third row: Richard Jones, Kent L Brown, Francis Clifford, Vincent Parlante CLASS OF 1947 ~ First row, left to right: Frecleridt Whiting, Wilrtom S. Edgecomb, Robert M. Jaeger, Hans F. Kipping ~ Second row, Robert Ehrenreidt, Wil~am C. Baker, Wilrtam M. Bukowsk~ Arthur J. S<haefer, Ridlard J. Kenr.ne ~ Third row: Ferdinand Paor.n~ Robert J. Dean. Russell J. Sacco, John B. Sheffer, Carl J. Nicosia, HenryS. Gardner, Daniel R. Curtin. James F. Stagg, Peter J. Jurtan, Elbert Hubbard CLASS ~ OF 1952 First row, left to right: Colin C. Madead, Eugene Sigman. Kenneth Altshuler, Barbara G. Coriey, Burtoa Stulberg, Donald F. Doha ~ Second row: John J. Banas, Aaroa Simpson. Robert A. Baumler, Alvin J. Brown ~ Third row: Roy J. Thu111. Kurt J. WegDer, Oliver J. Steiner, Vidor Panaro ~ Fourth row: James N. Schmitt, Bernie P. Davis, Bruce F. Connell. Alfred Lmarus ~ Fifth row: Donald J. Spredter, Eugene W. Loeser, Wilbur S. Schwartz, John Y. Rllllchoff, Travers Robbins, Ralph M. Obler, Neal W. Fuhr �··········································································· · ···················· ~all • CLASS OF 1957 ..,. First row, left to right: Btn Celnilter, Robert B. Sussmcm, Sol Messinger, Arthur L Btdt, Ross Marltello, Frank J. Chafel ..,. Se<ond row: Herbert Metsch, Robert Carpenter, Donald R. Hauler, Sherman Woldmon, Joseph I. Schultz ..,. Third row: Paul Archambeau, Edward Welsenheimer, Bronson Berghorn, Charles F. O' Connor, Richard F. ~iller CLASS OF 1962 ..,. First row, left to right: Charles G. Adams, Ronald Dozoretz, Joseph P. Amenia, Josepla R. Gerbas~ Paul J. LorH ..,. Se<ond row: Robert G. Ney, Morton E. Wei<hsel. David E. Carlson, Phitlp D. Morey, George R. Tzetto, Sebastian FasaneUo ..,. Third row: Seth A. Resni<off, Owen G. Bossman, Alan L Pohl, Morlt Peter Heilbrun, Morton P. Klein, Melvin J. Steinhart, Joseph A. Cimino, Roberto J. Gnbert, Anthony Morkella, Robert Goldstein, Harold Brody ..,. fourth row: Jack C. fisher, Philip Weisinger, Gerald Patterson, Martin F. Abbert, Oscar Oberkircher CLASS OF 1967 ..,. First row, left to r¥rt: Jonathan ~ J. Brian Sheedy ..,. Second row: David C. Stephens, Barry M. fpstein, Barry M. ~ Thomas P. Sheehan, vn&c.n Burie9l, Lon C. Ouem:Jer, John P. Kely, Docdd l Mler ..,. T1Wd row: David FugcrnoHo, Jacob Kritemc~~~, Arthur C~ Ronald Josephson, John B. Keiser, Robert M. Benson, Douglas M. Sirlti1, Trevor Robinson, David R. Dantzker, James Gicrirone, Ridtard Judelsohn, Thomas Augustine, Robert J. Brown, George S. StilT .... Fourth row: F11111kln H. Splm, Arthur C. Sosis, David L Larson, Norman Berltowih, Anthony l.oGallo, Cart W. Ehmann, IInKe Etmger, Alan R. Salmnan, Rocco C. Vetwto, Thomas O'Comor, Douglas Gerstein, Arnold Z. Gold, John J. Teanor, Midtoel !'haps �CLASS OF 1972 ..,.. First row, left to right: Martin T. Hoffman, Steven J. Rosansky, George E. Lundgren. Ywginia F. Howley, lon M. Frankfort, Robert fmhorn ..,. Se<ond row: George Kotlewsk~ Ridlard S. Goldman. Martin Brecher, Edwin A. Salsitz, Richard A. Savage, Stephen J. levine, Murray A. Morphy CLASS OF 1977 ..,.. First row, left to right: AntoineHe Wozniak, Chem1 A. Thorpe, HelenS. fmdlay, Nedra J. Harrison. Undo L Benjamin ..,. Second row: Albert Sddisserman. Carl J. Schmi«, Thomas H. Botsford, Alan S. Kuritzky, Dirk H. Dugan. Richard P. Newman. Joseph Byleby~ Reginald B. Stdes, Eugene A. Paul CLASS OF 1982 .... frst row, left to r9rt: Men CJtuns. waam Schedrter, £Jon Healy, Pilip Steget~~C~~~n. tmo RIDnowitz, Bet+nin Confesso, Y~rginio Keane, Joseph P. leberer, Ancho Abati-Scon, Debbie L K~ fhabetla Bartog, Nancy Peters, Susan fasd!beck. Richard A. WoH, David I. Kuru, Joseph F. Gioia, Gen*l F. Ylfale ..,.. Second row: Jessial Roc:kwel, Robert ~ Stephen Donovan, Robert C. Thomas, Potridl T. Hurley ..,.. T1n row: Michele Leon, An«ew R. Hordes, Robert P. Dudek ..,. Fourth row: Marcia McAvoy, Gerold A. Hinter, Joseph Gelonnini ..,. fifth row: Mary ASce Kely, Kevil J. Bartog, Joseph T. Wayne ..,. Sixth row: Eliot Chartash, David Weldon, Michael A. Cesar, Ivan A. Bcalmwel, fmotlay Geemg �CLASS OF 1987 ..,. ftrst row, left to right: Camille Buonocore, Marina Cotto, Patrick Shaughnessy, Jennifer Cadiz, Bonnie Orzech-Mixon, Kevin Quinlivan ..,. Second row: BrU<e Mac:KeUcr, John O' Brien, Thomas Smith, Michael Rudnidt. JiB Koehler, Timothy Bukowski, Douglas Katz TWs sigaecl origillal of a po&tical Dr. &ush finally arrives YE:.S, I BELIE.\/~ IT IS A Rt.ct.SSION... c.tooa, •Dr. Bnh finaly arrives," donated to tlte medical school by Plllitzer Prizewinning Buffalo News cartooftist Tom Toles, was won by Robert Reisman 'S6 in a siletlt auctiall held d.ring spn.g Oilical Day. �• 1 ·························································································· - I 9 3 0 cology at the Umvef!>ll}' of Pillsburgh C.Chool of Medic me. 5 MAURICE B . FURLONG '35, of jame:.town, New \ork mforms us that hts book, How To Gtt rour Baby To 5/tep, ha!> JUSt been published. A VROM M . GREENBERG '36, of Tucson, Arizona. was named Phystctan of the Year by the Ptma County Medtcal Society. Hts hfe story. "Reflections of an Old Curmudgeon.~ was featured m the Februarv pubhcauon of the Societ\ . 1 9 4 0 5 W . WILLIAM TORNOW '4 6 , IS pre:.tdent of the Hobart Club of Buffalo and mus1c eduor of a weekly newspaper, "The Southtowns CitiZen." Tornow tS an assistant chnical profes.sor of medicine (pcdtatrics) at the Umversity at Buffalo School of 'vi edtcine and B10medtcal Sciences. 1 9 5 0 5 ROBERT E . PLOSS '5 1 , writes, "Iam ahve and well after the Oakland firestorm of October 20. 1991, that burned m~ home to the ground along \\ith 3,000other!>. I w1ll rebutld." ANTHONY P SANTOMAURO '56. was elected a delegate from the State ~ledtcal SoCiety to the house of delegate!> of the Amencan Medical As<,ocmuon A past pres•dent of the ~1edtcal Soctety of the County ofEne. he current!\ serves as a representative from Western ew York on the Council of the Mcdtcal SoCiety of the wntes, "After two \·ear!> of pcdiatnc residency at The Chtldren's llospttal of Buffalo, I transferred to a surgery residenc> at the Eastern Yirgmia Graduate School of "v1edtcme m Norfolk. Vtrgmta Presently I am a second year resident insurgef). I have JUSt matched for a plasuc surgerv restdenc} at the Pennsylvania State Umver!>llY beginmng in 1993. JOHN S . AKER '88, John S. Alter '88 State of '\ew York. He is a member of the board of directors of the .\.1edtcal Uability .\.1utual Insurance Company and IS a member of the State ~1edtcal Soctety'sState Legl!>lanon Commmee. He tS also an officer of the E•ghth OtStnct Branch "v1ed•cal Society which comprises the eight Western New York counues. 1 9 7 0 5 H UGH A . SAMPSON 75, was recently promoted to professor of pedtatrics at Johns Hopk•ns Universll) He is co-editor of the new JOUrnal, Pedimric Allerg> and lmmunolog>. and co-editor of a book. Food A/lug>. published by Black\\ell in 1991. 1 9 8 0 5 ARLENE ROSE CURRY '82, and her husband.john Hntes, are the proud parentS of a baby gtrl, Alyssa Rose, born Januaf) 20, 1992 CHERYL A . KUBISTY '86, tSan J!>ststant professor of medtcine in the Center for Clinical Pharma- A N 0 B tO M NARINDER SHALLA '88.15 now chtef restdent of mternal medicine at '\ew York Umver!>ll}'. He and hts wtfe. \1arva KaltSh. announce the bmh of a daughter. Son) a Shalla, on june 30. 1991. CLIFTON WOODFORD '88 , vmtes, "I've been in San Otego for two years takmg care of dtvers and submarmer<,. We (my wire Kelly and three chtldren) wtll be here ror tWO more years while I complete m\ medtcme restdency at the San Otego 'laval Hospttal " RusseU Van Coeveriag II, ' 77 OBITUARIES ROY E . REED '32, died sudden)} or a heart attack on Februaf}' 2. 1992. MELBOURNE LENT '4 3 , dted Apnl 11. 1992. after suffenng a heart attack. JOSEPH A . VALVO '4 3 , died on March 13. 1992. in Pinehurst, North Carolina. R OY S WARTOUT Ill '4 5 , died of cancer onjanuaf)' 1, 1992, m Temple City. California. RUSSELL VAN COEVERING II , 1 9 9 0 5 MATTHEW J . CYWINSKI '91 , '77. rued unexpectedh on May 2, 1992 rnamed Bonme Zmuda on Februaf} 29, 1992. He tS a general surgef)' hou!>C offtcer at Hen'} Ford Hospual. Dearborn , \11chtgan. Call for nominations Don·t forget to cumplete and matl the attached postcard for OtStmgUtshed Medical Alumnus/a Award. Nominations will be accepted unul March I, 1993. C:OICAL SCtlrHTtiT 1 9 g 2 �I : �Buffalo, NY Permit No. 311 1773 HEALTH SCIEf.tCES SERIALS DEPT ABBOTT HA-L CAMPUS f·A:L 4 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician and biomedical scientist, Summer 1992 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1992-Summer Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. School of Medicine Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v26n03-1992-Summer Table Of Contents A list of subunits of the resource. Research Hospital News Country Doctors Dr. Muse A Spoonful of Humor Medical School Alumni Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-12-10 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v26n03 Extent The size or duration of the resource. 36 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1992 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/0af5ee947c7835ea9a73c57959b897fc.pdf 724995e8ef322632a43de73bd2a29914 PDF Text Text �THE BUFFALO PHYS I CIAN AND BIOM E DICAL SCIENTIST Dear Alumni and Supporters of the UB Medical School: Volume 26, Number 2 N DIRECTOR OF PUBLICATIONS NancyTobm EDITOR Nanelte Tramont Kolhg, R.N. ART DIRECTOR Alan J. Kegler ASSOCIATE AR T D I RECTOR Scolt Robert fricker CONTRIBUTING EDITOR Arthur Page STATE UN I VERS I TY OF NEW Y ORK A T BU F FALO SCHOOL O F M E D I CINE AND BI OM E DICA L SC I ENCES Or John Naughton, V1ce President for Clmical Affairs, Dean EDITOR I AL BOARD Or John A Richert, Chairman Or Harold Brody Or. Glen Gresham Or. Nedra Hamson Or. Jame> Kansk1 Mr. Harold Llll Or. Charles Paganelh Or. Luther Robmson Or. Thomas Rosenthal Or. Saleela Suresh Or Burton Singerman Or. Stephen Spauldmg Or Nelson Torre Mr Edward Wenzke Or. Jerome Yates ineteen ninety-two is off to a busy and difficult start. The good news is that the demolition project of the back-end of Harriman Hall is almost completed and construction of the new 110,000-square-foot research building should be underway by April1. Already one can sense the "campus-like" quality that will exist once these projects are completed. Indeed, UB will have a core medical-health-science campus of which we all can be proud. The bad news is that New York State's fiscal crisis will take yet another toll on the level of available state operating revenues. The reductions for 1992-93 will approximate $1.5 million and 25 full-time equivalents. The cumulative reductions since 1990 will total almost $3.5 million by March 31, 1993. lt is very fortunate that we experienced necessary growth and program development throughout the 1980s. O nly through the mechanisms of increased private giving, an expanded research program and the institution of the faculty practice p lan ar~ we able to cope wtth such large reductions in state funding. Even wtth these resources we w1ll be hard pressed to maintain the pace that 1s needed to be a med1cal school of top-rank. We are committed to do our best. Your help and support will be even more important in th_e months and years ahead. The faculty, students and 1 know you w1ll contmue to prov1de tt. We commit ourselves to maintain educational quality and to strive to keep your medical school among the leaders in the country. Sincerely, j ohn Naughton, M. D. Vice President for Clinical Affairs Dean, School of Medicine and Biomedical Sciences T E A C HIN G HOSPI T ALS AND LI AI S ON S Batavia VA Medical Center Buffalo General Hospital Michael Shaw Buffalo VA Medical Center Paula Pcdene ChHdren's llosp11al of Buffalo Karen Dryja-Swiersh1 Eric County Med1cal Center Mary Northen Mercy Hospital MHiard f'Himore llosp1ta!s Frank Sava Roswell Park Cancer Institute judith Rice S1sters of Chanty llospnal Dennis McCarthy © The State University of 1\ew York at Buffalo The Buffalo Physician and Bwmed1cal Scientist IS published quarterly by the State Umversity of New York at Buffalo School of Med1cinc and Biomedical Sciences and the Office of Pubhcauons. ll "sent, free of charge, to alumm, faculty, students, residents and fncnds. The staff reserves the right to ed11 all copy and submisSions accepted for publication. Address questions, commenlS and submissions to: Editor, The Buffalo Physician and Biomedical Scienllsl, Stale University of New York at Buffalo, Umversity Pubhcallons, 136 Crofts Hall, Buffalo, New York 14260 Send address changes 10: The Buffalo Physician and Biomedical Scientist, 146 CFS Addition, 3435 Main Street, Buffalo, New York l4214 Dear Fellow Alumni: W ith an exciting and informative Spring Clinical Day and Reunion Weekend just pa~t, I would hke to thank all of the board members who made ita reality. Dr. Mary Altce Kelly, as Program Cha1r, Dr. Margaret Parowski as Exhibits Chair and all of the others, made this event a big success. ' I would like to thank all the alumni who supported the many activities of the Association. You helped not only the medical school, but many medical students in their educational pursuits. We are a strong and healthy Alumni Association because you have shown that you care. Best wishes for a wonderful and healthy summer! Sincerely, J ~~·~ Nedra ]. Harrison, M.D., '77 �VOL . 26 , No . 2 .......... . . . .. . ........ .. .. . . . . . . . . ............. . . ... . . ....... . . ... . ... .. . . . SPR ING 1992 ..... . . . . ..... . . . ..... II Research IJ Hospital News IJ Perspective on Healing e A pictorial feature on UB's Smokers who quit smoking after bypass surgery were more interested in saving money than their lives, according to UB researchers. Page 3. Robert L. Brown History of Medicine Collection. DJ ASpoonful of Humor m Charting the Secrets of Life e As part of the Human Genome Project, researchers at Roswell Park Cancer Institute are unraveling the mysteries of our genes. ~~ It Hurts to Be Beautiful e Once nearly exclusively the UB researchers see a relationship between lower blood pressure and people with extensive social networks. Page 2. province of women, cosmetic surgery is fast becoming an equal opportunity operation as more and more men flock to surgeons than ever before. m m Medical School People • An early 1900s gas X-ray tube from UB's History of Medicine Collection. Page 6. EZJ Classnotes After a fouryear hiatus to do standup comedy, a physician returns to residency. Page 14. * C 0 V E R Apottery phrenology bust, ca. 1855, from the Robert L. Brown History of Medicine Collection. �· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · & ' " . North American Symptomatic Carotid Endarterectomy Trial to determine if patients with 30 to 69 percent narrowing of the arteries would also benefit from surgery. + National Eye Institute funds UB retina research VA study shows vascular surgery may help prevent strokes Department of Veterans Affairs cooperative study concludes that carotid endarterectomy surgery should be performed on patients who are at high risk for stroke. Linda Hershey, M.D., chief of neurology at the Buffalo VA Medical Center and UB associate professor of neurology, is one of the authors of the report published in December in the journal of the American Medical Association. "This validates the usefulness of surgery in high-grade stenosis, which can lead to strokes," Hershey saicJ. She added the study results showed that half of the patients who were randomly selected and treated with surgery and aspirin therapy had fewer strokes than those who were receivingaspi rin therapy alone. Thirteen patients from the Buffalo VA Medical Centerwereenrolled in the study that included 189 patients nationwide. The Buffalo study group will join the 8 BUFFALO PHYSICIAN alcolm A. Slaughter, Ph.D., UB associate professor ofbiophysical science and ophthalmology, has received a $143,000 grant from the National Eye Institute to continue research into how the retina functions. Specifically, he will study how neurons in the retina interact with one another. "There have been a lot of advances in eye research in recent years," Slaughter said, "but when it comes down to understanding the retina, we are just getting some real questions answered." Slaughter and his colleagues have been studying retinal function for nearly a decade. One of their discoveries revealed that the eye sees a light going on and a light going off in different parts of theretiM. + Study finds relationship between social contad and lower blood pressure UB study of social interaction and its relationship to blood pressure shows that people with extensive social networks have lower blood pressure than people with little social contact. And while connections with others in general were associated with lower blood pressure, certain aspects in particularthe number of siblings for women and household size and club participation for men - appeared to affect blood AND BIOMEDICAL pressure more than others. The study was conducted by researchers in the University at Buffalo's Department of Social and Preventive Medicine, headed by Maurizio Trevisan, M.D., using data from the 1960 Buffalo Blood Pressure Study. Results of the research were published in the ovember-December issue of Psychosomatic Medicine. To assess the effect of social interaction on blood pressure, researchers selected five categories of social encounters - household size, number of siblings, participation in social clubs and meetings, religious service attendance and maritalstatus-andcompared them with adjusted mean blood pressure levels for the 656 men and 753 women in the study group. Among women, the only category that showed a significant relationship to blood pressure was number of siblings. Those with six or more brothers and sisters had significantly lower blood pressure than those having five or less. Among men, significant correlations with blood pressure showed up only with size of household - the larger the better - and club participation - the more active the better. The researchers were surprised to find no significant relationship between blood pressure and church attendance since other research has shown an asso~iation between attendance at religious services and longer life, less hypertension and better health in at least some segments of the populations studied. + By SCIENTIST LOIS BAKER SPRING 1 9 9 2 �. ... ........ . .... . ........... .. ..... .. .... . ... . . . ......... . .... . ........ . ...... . . Money more important in motivation to stop smoking quit smoking and 13 had not. The smokers listed lack of will power, having nothing to do with their hands and nervousness as the most important rea+ sons for resuming their habits. mokers who quit smoking after bypass surgery considered saving money, not improving their health, the most important reason for kicking the habit, researchers in the University at Buffalo School of Nursing have discovered. And patients who returned to smoking did so within the first three months, they reported in an article in the Journal of Cardiopu l m onary RehabilitaLion. The survey of 46 people taken five years after surgery to determine the perceived benefits and barriers to stopping smoking showed that being more healthy wasn't even the second most important reason for remaining smoke-free. "Feeling better emotionally" (no smoker's guilt) held that position. one of the other potential benefitsfreer breathing, less coughing, feeling better physically- were listed often enough to be statistically significant. Further, the severity of their disease had no effect on p·atients' smoking behavior after the operation. Thestudytracked 197 patients who had coronary bypass surgery at Buffalo General Hospital in 1985. Of that group, 112 were smokers when they entered the hospital. All participated in post-operative programs to help them stop. The smokers' group was resurveyed after five years to find out how many were still smoking and why. Of the 46 who returned the survey, 33 had successfully BUFFAL O PHYSI C IAN By LOIS BAKER Roswell Pen to concUt Plme II breast aner study oswell Park Cancer Institute will conduct a Phase ll clinical trial of liposome-encapsulateddoxorubicin (TLC D-99) to treat women with advanced breast cancer who have not had prior chemotherapy. Doxorubicin is a widely used anticancer drug that has proven effective in treating solid tumors- carcinomas of the breast, lung and bladder-as well as lymphomas , leukemias and soft tissue sarcomas. Although effective, doxorubicin has been limited by the side effects it can cause, particularly damage to the heart, which may be irreversible and can be fatal. "Since the first chemotherapeutic agents were introduced," according to Ellis Levine, M.D. , assistant professor of medicine and the principal investigator of the study, "their inability to differentiate between malignant cells and healthy cells has resulted in potentially life-threatening side effects that have limited the dose that A N 0 BIOMEDICAL S C [I] could be safely given to patients." Encapsulating the chemotherapeutic agent could reduce its toxicity and target the drug to the tumor, according to Patrick j. Creaven, M.D., Ph.D. , associate research professor, who was among the investigators completing Phase l clinical trials of TLC D-99 in 1990. Those trials demonstrated that the toxicity of doxorubicin was reduced to a point where it may be possible to expand its use. When TLC D-99 is administered, its liposomal structures shields the body against many of the toxicities of the enclosed doxorubicin. lt is thought that TLC D-99 accumulates at the sites of tumors and avoids damaging tissue. The liposome breaks down after it reaches the targeted sites and releases the + doxorubicin. I IENTIST SPRING �lfZil · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·· · · · · · · · · · · · · · · · · · · · · · · · · · ~ BuHmo Genetd flies pm1 i1 study to cid stroke victins issue plasminogen activator, tPA, the clot-dissolving agent that provides hope [or many heart attack victims, is now being studied at The Buffalo General Hospital for its effectiveness in offering similar results for stroke patients. Buffalo General is one of l3 facilities nationwide involved in the study to determine if t-PA can increase recovery chances for stroke patients. The purpose of the study is to investigate whether t-PA can improve recovery by opening blocked arteries from strokes caused by a clot in an artery leading to the brain. "The use of agents like t-PA in acute stroke represents a new exciting chapter in stroke therapy," said Patrick Pullicino, M.D. , UB assistant professor of neurology and chief neurologist for the local 0 BUFFALO PHYSICIAN arm of the study. "Until now , there has been no effective therapy for a stroke. T -PA promises to be the first drug that will reduce the amount of brain damage caused by a stroke. " To be effective, t-PA must be administered within six hours of the onset of stroke symptoms. Pullicino emphasized doctors' attitudes about stroke, as well as those of the general public, would have to change if drugs like t-PA are to be useful. "The lack of treatment for stroke in the past has meant a pessimistic attitude and usually a long delay from the time of stroke onset to the time of arrival at the hospital. " The first BGH patients in the study, sponsored by the California pharmaceutical firm , Genentech, have experienced positive results [rom the drug. + clothing items to first-time pregnant teenagers who receive regular checkups through the Prenatal Care Assistance Program (PCAP) or are in Medicaid assistance in the Sisters Hospital Outpatient Program. PCAP provides free prenatal care to women who have no health insurance. The new program provides a "credit" each time the patient visits the prenatal clinic at Sisters for her scheduled checkup. After eight visits, she qualifies to receive a layette package that includes a variety of baby clothing items, receiving blankets and a specially designed diaper bag. + VA Medical Center one of 14 to receive HUMOR Proiect grant he Buffalo VA Medical Center has been awarded a grant to establish a Humor Resource Center within the medical center The grant, awarded by the HUMOR Project in Saratoga Springs, New York, was one of 14 awarded nationwide from a total of over 100 applicants. According to Michael Ackerman, R.N. , Ph.D. , director of the medical center's grant-writing team , "The Humor Resource Center is part of a larger project at the VA aimed at instilling a sense of humor into the health care setting. These are very difficult times for health care centers, and we feel that by providing an avenue for humor and creativity , there can only be one benefit and that is improved patient care." An integral part of the program is the isters Hospital has begun a pro- use of a hospital-wide humor cart, gram to offer incentives for first- dubbed "The Chuckle Wagon, " which time pregnant teenagers to seek will make a variety of items, including prenatal care. books, videotapes , toys, puzzles, etc., Called "New Beginnings," the available to patients throughout the program provides basic infant medical center. + Sisters Hospital program offers incentives for early prenatal care AND BIOMEDICAL SCIENTIST SPRING 1 9 9 2 �. .. . . . . . . . . . . . . ... . . .... . . . . . . .. . ... ..... . . . . .... . [1] CHOB purchases area's first fully computerized obstetric management system ultrafast CT scanner - an !matron can screen for coronary artery disease by detecting calcifications in the arteries associated with atherosclerotic plaques. Imatron scanners are ultrafast, taking images in one-tenth of a second as opposed to the two seconds required for conventional CT imaging. Because it is so fast, !matron scanning freezes the action of the heart's beat, resulting in clear, precise images that show calcifications. Images taken by traditional CT scanning can be blurry. Studies have shown that when I matron scans show no calcification , the patient is free of coronary artery disease. The presence of calcifications, however, may indicate the presence of CAD. According to Alan S. Brody, M.D., director of the CT Section of the Department of Radiology at Children's and he Children's Hospital of Buffalo has become the first area hospital to offer a fully computerized obstetrical management system in its labor and delivery suites. Purchased with proceeds from its 1990 and 1991 Golf Classic, the hospital's new system provides the staff with vital information on both the maternity patient and her ::~ -~-=-=-= . ./ '_...,.- ~- . .~....ro<t"·-··-:'' baby. From a central station, the system allows ll patients to be monitored at the same time on a single screen display, providing an instant overview of each patient in the system with immediate warning of critical conditions. The hospital, the region's designated high-risk maternity center with 5,000 deliveries annually, also purchased a new technologically advanced ultrasound for labor and delivery. Lawrence Romano, chairman of the '91 Golf Classic, notes "The new computerized monitoring system will enable the hospital to continue offering the highest quality care to maternity patients throughout Western New York. The Golf Committee is very proud of the business community's commitment and support of Children's Hospital. " + assistant professor of radiology at UB , "The Imatron has probably had the very best results in early evaluation of coronary artery disease than anything that's been tried previously. "The !matron scan is a screening test. If the Imatron shows that you have calcifications, it doesn 't always mean that you have coronary artery disease; but if the I matron shows no calcifications, you do not have CAD. In cases where no calcifications are present, an invasive angiogram should not be necessary. " Brody added, "Children's shares its technology and expertise with the community. We have an adult medicine department, and can cure adults as well as children ." In addition to being much faster than traditional CT scanning, !matron scanning uses a much lower dose of radiation. + ChUdren'sHospital becomes first in state to oHer ultrafast a scanning he Children's Hospital of Buffalo has become the only hospital in ew York State to offer ultrafast CT scanning. Research being conducted nationally indicates that use of an BUFFALO PHYSICIAN A N 0 BIOMEDICAL SCIENTIST SPRING �' ' The Robert L. Brown History of Medicine Collection Housed in UB's Health Sciences Library, the Robert l. Brown Robert l. Brown, M.D., medical school archivist and professor History of Medicine Collection offers an unrivaled perspective of medicine emeritus. The collection has grown, and continues into the evolution of the art and practice of modem medicine. to grow, in both scope and breadth with acquisitions and From its pre-Civil War lithotomy instruments to its assortdonations each year. ment of rare books dating back nearly half a millennium, the The instruments collection includes a range of dental tools, collection chronicles the progress of medicine stethoscopes, surgical kits, bloodletting devices, through the tools of its practitioners. One of ..-microscopes, lithotomy tools, obstetrical inonly three formal history of medicine collec- _,.__.,..~------- _:Struments, splints and early X-ray tubes. The tions among medical schools in New York State, oldest instrument - a Roman surgical clampthq:ollection at UB was formally established in dates back to the first century A.D. In 1985, 1972. Annette Cravens established the Edgar R. Before that, it existed as an aggregation of McGuire Historical Medical Instrument Fund donations to the medical school and volumes in honor of her father, a 1900 medical school acquired for the school's library from 1846. alumnus and chair of surgery from 1914 to his One of the first donations was the 1 ,070-voldeath in 1931. The fund supports the purchase ume private library ofUniversity founder james of historical medical instruments. Platt White, M.D. The medical school also Here, The Buffalo Physician and Biomedical acquired Roswell Park, M.D.'s entire 3,000Scientist presents a sampling of items from the volume collection when he died in 1914. Robert L. Brown History of Medicine CollecIn 1986, the collection was named after tion. 0 BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST SPRING 1 9 9 2 �'A 19th century Staffordshire leech jar. cupping set and lancets. The practice of bloodletting reached a high point in the early 19th century . BUFFALO PHYSICIAN A N 0 * BIOMEDICAL SCIENTIST SPRING 1 9 9 2 0 �I' ,, I' II I. I~ I~ n II II I~ il !I II This Naval surgical kit . manufactured by w. and H . Hutchinson of Sheffield. contains a trephine. tooth keys and forceps. as well as an This Powell amputation and Lealand saw and "No. 1" stand surgical microscope. knives. Gift manufac- of Theodore tured in England in 1884. represents the height of microscope design and craftsmanship in the 19th century . Gift of William H . Merrilees. M.D. 0 * BUFFAL O PHYSI C IAN A N 0 B IO MEDI CAL SCI ENTIST SPRING 1 9 9 2 �I' r ,.,, II I, I~ II I! II II il II !I This un iden tified art ifact was made by Maw and Ca. of London . a med ical instrument manufactu r er. * •••• BUFFAL O PHY SICIAN A N D BI OMED I CAL SCIENTIST SPRING r 9 9 2 0 �I~ I' ,, I' BUFFALO II I, PHYSICIAN I~ A N 0 II BIOMEDICAL II II I~ SCIENTIST II II 5 F' R I N G !I 9 9 2 �I~ I' ,, I' II I, I~ II I~ II II William A set of Hunter' s lenses for the Anatomia Powell and I~ II II !I Lealand "No. Humani 1" stand Gravidi. microscope. originally * published in 1774. was donated by James Platt .. White. M.D. It is shown here with early 19th century obstetrical instruments. * This set of dental instruments with ivory handles (ca. 1850) is similar to a set made for the Great Exhibition of 1851. Gift of L .L . Mulcahy. Jr.. D .D.S. * B UFFALO PHYSICIAN A N 0 B IOMEDICAL SCIENTIST SPRING 1 9 9 2 (D �I' I' ,, I' II I. II II II I~ II !I II The staff of The Buffalo Phys1nan and Bwmedical Scientist gratefully acknowledges collecuon curator Lilli Sentz for her mvaluable help m producing this feature. 'A trephina- tion set (ca . 1760). 'A trephine was a circular saw used to remove a disc of bone Post mortem from the instruments skull. (ca. 1870). * This set was manufactured by Luer in Paris. * 41) B UFFALO PH YSICIAN A N 0 B IOMEDICAL S CIENTIST S PRING 1 9 9 2 �I, I' \J I~ IJ II II il II !I 'A homeo- pathic drug kit. Founded by Samuel Hahnemann in the early 19th century. homeopathy as a system of medicine was based on the doctrine that diseases can be cured by administering minute doses of a drug which in larger amounts cause the symptoms of the disease. * BUFFALO PHY SICIAN AND BI OMED I C AL SCIENTIST S PRI NG 1 9 9 2 G) �ASp I{}on't know how I got here, but I couldn't get up. I wa\, pinned to the asphalt of Market Street, my legs were moving but I w~sn't going anywhere. ThiswasMarket Street in San Francisco, so why was the Empire State Building looming in the horizon? It was all so strange. Vice President Dan Quayle was dressed in white culottes, playing the accordian. It was more than I could take. But as hard as I tried I couldn't get up. Suddenly I could hear the beeping of a dump truck backing up, heading right for me .. The beeping got louder and more piercing, and wouldn't stop. It was then that I woke up. I was in the Newborn Intensive Care Unit call room, my first night "on," after taking a four-year leave of absence to perform standup comedy. I glanced at my glow-in-the-dark watch (which retails for $295, according to my father. He picked it up for $39.95 and had the slashed sales slip to prove it). It was 7:15 a.m. I managed to sleep until 7:15 on my first night, on call? I thought, "not bad" until G) BUFFALO PHYSI CI AN o on f u I remember that I went to sleep at 6:45 a.m. Better call that number, see what's the problem. "Hello! This is Dr. Silver ... "MEC!!! OR3!!!" CLICK!! No good morning? MEC!!! What a great medical euphemism. Makes me glad I didn't become a plumber, which according to my father wasn't a "dignified job." You spend your life up to your elbows in ... 'mec!"' Fortunately I don't have to get dressed. I never intended to sleep. I just collapsed in my scrubs and shoes. So I just drag myself down the hall to OR 3, wearing what amounts to pajamas and slippers (no bathrobe, though). I'm still waiting for the day when someone will notice this and say, "Hey Stu, get out of those pajamas and put on some clothes. You're a doctor, for God's sake!" Of course before you enter the hallowed ground of the OR, you must cover your shoes with the "shoecovers." I must admit that I was never quite sure whether we do this to maintain sterile conditions or to protect our shoes from falling "mec." (Since surgeons and anesthesiologists wear these covers and their showercaps in the cafeteria, I've always assumed it was for the latter.) I must admit this was my first delivery alone in a long time and I am quite nervous, but just like in comedy one must "never let them see you sweat." At least there aren't any hecklers, but I AND B I OMEDICAL I of Humor still imagine the anesthesiologist yelling from behind the drape. "Hey Silverstein, YOU SUCK! " Where'd you get your medical license from? A raffle? Would you look at him intubate! I'm waiting for Alfred Hitchcock to walk through this scene!" Relieved that this probably won't happen in a medical setting (with the possible exception of quality assurance meetings) , I relax and enter the OR. I begin by casually checking out the equipment on the table as recommended by NAl.Scourseand realize that some things have indeed changed. The NBICU nurse who will serve as my assistant, informs me that we are no longer required to"' suck the meconium into our masks through a Krazy Strawlike apparatus. It is now done with wall suction. Finally we've entered the "safe mec" era in medicine. The delivery goes well. I'm tempted to say, "Thank you! Good night! Drive home safely and don't forget to tip your circulating nurses, they worked hard for you tonight." Luckily, I keep this one to myself. BackintheNursery, l(;~~a:;;Zf£{jjd it was the usual rounds: "This is hospital day 4 forT win A, who is now a five-cell morula, up from two cells yesterday, tolerating masked CPAP with good gases. Twin B SCIENT I ST SPRING 1 9 9 2 �© Stu Silverstein, M.D . .. is still a zygote and is dependent on hyperal. He took in l20cc/kilo/day, urine output 2 cc/kilo/hour and a surprising three runs batted in. " The day was relatively uneventful except when the post call intern desaturated into the '80s. Fortunately he came around with vigorous stimulation and some bagging. And so my final year of pediatric training was finally underway. Starting in the NBICU was my choice; I figured it was one of the tougher rotations, yet it was a "controlled environment," with a finite number of problems and finite number of solutions. On day one, I sounded like a veteran fielding questions from the nurses. "OK, just turn the ratedown,getagasandcall me with the results. Yea, just go up on the PIP and increase the rate and get a gas ... " Oh! "Sorry, didn't realize this was a bili baby. " Ina way,standupdid prepare me for this return appearance on theresidencystage. Here, too , we must p e r - BUFFA LO PHYSICIAN Perform procedures, perform on rounds, and, of course, perform for parents while examining their children to show that we take their concerns very seriously no matter how trivial they appear to us: "Yes, I realize that your son has had abdominal pain since birth, and I AM concerned, however, since your child is 35 years old, I'm going to refer him to a specialist. " I did, indeed, learn some lessons in the comedy world that would come in handy here. I realize that rounds aren't "ExConvict Night" at the local comedy club, and I won't be heckled by a cyanotic mouth breather with no neck. However, medicine does have its version of the heckler and heckling, i.e. , the attending and pimping. I learned in comedy that one must always be prepared for difficult situations in advance. We comedians do this by preparing what the unsuspecting audience perceives as "ad Jibs," i.e., if a couple in their sixties should walk out while I'm performing, I can't rely on luck. I must allow them to get within five feetoftheexit so everyone can see them and pause before saying, "Mom! Dad! You promised that THIS TIME you'd stay for the whole show! " Likewise the performer, I mean resident, must be prepared with "ad Jibs" for rounds. Standard comedian retorts like, "I like the haircut, didn't realize Supercuts AND BIOMEDICAL had a drive-thru window" probably won't work on rounds. Ad Jibs must be more subtle. For example, when discussing the incidence of various diseases, I bear in mind "LaCombe's Rule of Percentages" (Hospital Physician, 1971, 7(2);102), whichstates that the incidence of any disease is either 15 to 25 percent or 80 to 90 percent. Even if I'm wrong, I'll be right if I finish my answer with, "depending on the study. " There are many others, however, since I still have another six months to go and some of my attendings might be reading this, I will keep them to myself for now. And so I am the comedian returning to complete my medical training after starting and establishing my second career as a standup comedian. I couldn't have done it any other way. I feel the same toward comedy that William Carlos Williams felt toward poetry when asked how he reconciled such an unusual combination. They both require an understanding of what people are feeling and fearing in their lives. In both cases it is my job to relieve suffering, and in both medicine and comedy, timing is everything. And my time is up. Thank you! Good night! + Stu Silverstein, M.D., president of Standup Medicine Seminars of San Francisco, California , lectures nationwide on the role of humor in medicine. SCIENTIST / SPRING 1 9 9 2 G) �~ m ~ 0 ~ > " Q • ••• • • • •• • ••• • • •• •• BUFFALO PHYSICIAN A N 0 BIOMEDICAL SCIENTIST SPRING 9 9 2 �Roswell Park research team unravels the human oenome Like a kaleidoscope, the Human Genome Project looks a little different to everyone _ who spends some time observing it. The view depends on the spin thats put on it. B ~ BUFFALO S c PHYSICIAN o AND t t BIOMEDICAL T h SCIENTIST o m SPRING a 1992 s 4D �o physicians and genetic counsel- genes that, when altered through mutation, can cause disease. The lab has identified, among others on Chromosome 11, the genes that cause aniridia, a form of blindness resulting from a complete or partial absence of the iris; Wilms' tumor; diabetes, and albinism. Teams working on other chromosomes have met with similar success; a recent breakthrough was the discovery, on Chromosome 7, of the gene that causes cystic fibrosis. The physical mapping is a tedious process of chemically breaking the DNA into manageable pieces of 300,000 to 400,000 base pairs, then assembling the information into a continuous strand of information - a seemingly endless string of permutations of A, T, G and C. But even success at this gargantuan task, Shows says, will be only the beginning of understanding how genes work; it won't mean that every genetic disease can immediately be eliminated. "It should not be construed that once we know this sequence, this is the prescription of life," he says. "This is just the first step in the long process of understanding the information in the genome. "How they function, how they are.controlled- all these are questions that have to be taken up." Because the Roswell Park lab has the computer capabilities to maintain the physical map, Shows said, biologists - about 200 a year - often write to ask for help in situating a gene they've extracted. The Roswell Park researchers can analyze a sample, match it against the DNA sequence they've stored in the computer database and tell the correspondent that the gene is situated, say, in position l3 on the short arm of Chromosome 11. And so another bit of the human genome code is penciled in. "Here's what I can picture," says Shows, whose enthusiasm for the project is prodigious: "Once we get the physical map and know what genes there are and know what the characteristics of genes are, all of this will be stored on computers. The time will come when biology will be done sitting at a terminal, instead of in the laboratory. "The amountofinformation is astounding. After all, this genome we have sitting here is the product of the universe." Decoding that information doesn'tcome cheaply. It now costs about $5 to pin down each nucleotide base pair; if that figure ors, the project is rich with promise for endinghumanmiseryfromawiderange ofgenetic diseases. To philosophers and medical ethicists, it~fraught with perilous implications for social policy. To pharmaceutical companies, it~ a potential bonanza ofgene therapies, a whole new industry of genes as drugs. The goal of the Human Genome Project, of nucleotide bases. The average chromohowever, is not complex: working in teams some contains 120 million base pairs; the in laboratories throughout the United entire human genome contains 3 billion. States, scientists are seeking to codify the The project, begun in 1990 and expected sequence of nucleotide "bases" that makes to cost U.S. taxpayers $3 billion by the end of up the genes in each of the 23 chromosome its 15-year life, has been compared to taking a pairs in the human body. census ofeveryone on Earth -and getting all The structure of the human genetic their addresses right. code was discovered by James Watson and About 2 percent of the total number of Francis Crick in 1953 when they deter- human genes have been mapped thus far. mined the configuration of the DNA (de"You could argue, why do this? " says oxyribonucleic acid) molecule that is the Thomas B. Shows, Ph.D., an adjunct profundamental molecular unit of life. The fessor at the University at Buffalo School of molecule is a double helix- shaped like a Medicine and Biomedical Sciences and diladder that is twisted. The sides of the rector of the genetics department at Roswell ladder are composed of a sugar-phosphate- Park Cancer Institute. "But to me, it's out sugar-phosphate polymer. The rungs are there to be understood. And what a thrill made up of the four nucleotide bases it will be to understand the human getwo purines, adenine and guanine, and two nome. " pyrimidines, cytosine and thymine. Each Shows' 20-person lab at Roswell Park is rung is formed by one purine and one involved in two aspects of genetic mappyrimidine; adenine always pairs with thy- ping. First is functional mapping - idenmine (A-T) , and guanine always pairs with tifying chromosome sites where diseasecytosine (G-C). Each side of the DNA related genes are located. He said the lab ladder is complementary to the other. has mapped about 400 genes- more than The D A (about six feet of it) is located any other group in the world. in the 46 chromosomes that are found in And then there's physical mapping, the the nucleus of every cell in the body. A primary goal of the Human Genome Project. gene is a chromosome segment that con- Working with a computer database, the tains specific genetic information, such as Roswell Park lab has concentrated its efeye color or the expression of certain dis- forts on the physical map of Chromosome eases. The 23 chromosome pairs are esti- l l, which is estimated to contain 2,500 mated to contain 100,000 genes and each genes. gene contains from 2,000 to 200,000 pairs Chromosome 11, Shows says, is rich in 4I) BUFFAL O PHYSICIAN AND BI O MEDICAL S C I E NT I ST SPRIN G 1 9 9 2 �•• •• doesn't fall to less than 50 cents per base health care and health insurance; the pair, the comprehensive project could be • • effect of genetic testing on parent-child doomed since the amount of money origirelationships . nally allocated is not enough to decode all "We're now moving into the area of of the nucleotides at the present $5 per insurance and insurability," Erbe says. "A base pair cost. The Department of lot of people are very concerned about Energy and the ational Inemployment. But other than the stitutes of Health, the major occasional horrible case there government sponsors of the hasn't been much in the way of project, are counting on developpre-employment screening yet." ments in robotics and other technologiShows, at Roswell Park Cancer cal improvements to make the process Institute, says the concerns about ethical cheaper before the money runs out. • • and social issues, although valid, are Cost considerations aren't the only • overestimated. aspect of the Human Genome Project that • "I get a lot of calls from ethicists and • philosophers who want to know what's has observers worrying. What about the ethical and social implications of this newgoing to happen once the genome is found knowledge? Like the design for a sequenced," he says. "They're all connuclear weapon, the genetic code is somecerned that there's going to be a real probthing that, once discovered, can never be lem quickly. We don't have a real problem unlearned. The world will have to live with quickly. We have a lot of work to do. its effects. "There will eventually be a blood test Writers of science fiction and newspawhere your entire genome is analyzed. It per "think pieces" have found much grist won't be soon , but it will happen. for speculation in the possibilities of the "There's no question that my insurance genome project: company could look at that and, if I had What will it mean for the insurance indussusceptibility to asbestos dust or whatever, try, they ask, when it becomes possible to they could decide I'm uninsurable. You bet identify an apparently healthy person as carrythat's a genetic issue," Shows says. ing the gene for a deadly disease? "But to me, the ethical issues are not as Who will have the right to study an important as the risk/benefit ratio of getindividual's genome? ting that physical map of the genome and Can potential criminals be identified discovering how to treat all those diseases. " through a simple blood test? What does the Human Genome Project Will D A testing create a "genetic mean for the practicing physician? Evenunderclass," shunned in their search for tually, it may make all the difference. In a jobs and health insurance? book by Leon Jaroff, "The ew Genetics: Richard W. Erbe, M.D., a UB medical they would abort a fetus if tests showed the The Human Genome Project and Its Imschool adjunct professor and director of baby would be born with CF. pact on the Practice of Medicine," molecuthe Division of Genetics at The Children's These parents' attitudes, they say in a lar biologist Leroy Hood is quoted as deHospital of Buffalo, knows the range of paper published in the May 1992 American scribing an exacting new world of doctorquestions that are being raised. For two journal of Human Genetics, may be indica- patient relations. After an analysis of a years he has chaired the study group that tive of those of parents faced with similar patient's genome, he says, "the computer reviews all grant applications for proposals choices about bearing children with other will give you a printout of the potential life to study social-policy issues of the Human disorders. history of that individual. ... You'll also get Genome Project. ElSI project proposals range widely in a printout that says, 'You should avoid The project has allocated a generous 3 subject and originate both individually and overexposure to the sun, change your diet percent of its budget to fund the study of jointly from theologians, scientists, actuar- at age 13, etc.' The focus of medicine, the ethical, legal and social implications ies, historians and philosophers- groups basically, will be on keeping people well, (ElSI) of its results. As a result, Erbe finds with little or no experience working with on making predictions about the difficulhis group in an unusual position: it has each other and often little or no knowledge ties people will run into and then avoiding more money to fund research projects than of each others' fields. The concerns they those problems by manipulating their diet, there are research projects to fund. raise are just as diverse: such issues as their environment or their immune sys"In certain respects, the many real is- religious implications of genetic knowl- tems, or applying molecular pharmacolsues are no different for genetics now than edge; professional standards for the use of ogy." Until then, we can only watch as the they've been all along," Erbe says. "But D A typing in police work; the history of now the public awareness is huge, because how people with genetic disorders have pieces of the human genome, one by one, only one in seven of the fertile couples said been stigmatized; the problem of access to fall neatly and inexorably into place. + •• • BUFFALO PHYSICIAN A N 0 BIOM E DI C AL SCI E • NTIST SPRING 1 9 9 2 4D �IN AN 1\I'I'EMPT TO LOOK TIIEIR BEST, MORE AND MORE MEN ARE UNDERGOING COSMETIC SURGERY THAN EVER BEFORE a> B UFFALO PHYSICIAN AND B IOMEDICAL S CIENTIST S PRING 199 2 �lastic surgery, the equal opportunity operation, has come of age. Once the exclusive domain of women, it is becoming more and more popular among men as they flock to surgeons in record numbers for chin implants, facelifts, eyelid tucks and liposuctions. And although women still account for 90 percent of plastic surgeries performed, the increasing numbers of men who seek cosmetic surgery prove that women no longer have an exclusive right to vanity. After 17 years in the business, Hanley M. Horwitz, M.D., has witnessed a change in the type of patients coming into his Williamsville office seeking cosmetic surgery. Ten years ago, he said, 2 percent of his practice was male. Today men represent 33 percent of his patients. What drives a man to seek cosmetic surgery? "A very strong ego to start with," said Horwitz, a 1969 graduate of the State University of ew York at Buffalo School ofMedicine and Biomedical Sciences. "And they can't be easily embarrassed. They also must have an overwhelming desire to have something corrected." Women also are important factors. "Wives are significant," Horwitz said, "very frequently young wives. Men feel it's good for the relationship." With society's intense focus on youth, there is no mistaking that this, too, plays an important role in their decision to seek cosmetic surgery. But that influence, according to Horwitz, is vastly overplayed. "That's one way to look at it," he said, but overshadowing this search for youth is simply the fact that people want to look their best. "Males age better than females," Horwitz said. "They don't get those little crow's feet and spiders all over their faces because their skin is thicker. And they don't get all the wrinkles on their upper lip." A man and woman walk into his office, both seeking a facelift. "Most of the time, they don't need it. Most of the time, they need something done with their eyelids" to achieve the results they want, Horwitz explained, adding that most men are well into their 50s, possibly their early 60s, before they need facelifts. Women, he said, usually need face-lifts 10 or 15 years earlier in life than men , usually in their late 40s. Buffalo surgeon and 1981 UB medical school graduate Bruce J. Cusenz, M.D. , has noticed that in men seeking cosmetic surgery, the aging process, regardless of the age, is more advanced. "Eyelids tend to hang more in men," he said. jack Fisher, M.D., a 1962 UB medical school graduate and professor of plastic surgery at the University of California, San Diego, estimates lO to 15 percent of his patients are male. "Many more men are coming in who feel fine , but look awful with folds and bags of skin." Not everyone who enters a plastic surgeon's office ends up having surgery. Most surgeons have extensive screening systems to weed out potential problem patients who have unrealistic expectations about how plastic surgery will change their lives. Horwitz schedules three office visits for his patients before performing surgery. "The first time I talk," he said. "The second time I listen. I have to flush the type of person he is out. If he can't come in three times before surgery, I won'tdo the surgery, even if l'm doing a doctor- someone I know well." Based on the initial sessions, a good portion of the problem patients are weeded out. "If they had expectations beyond what I could do, I won't even consider performing surgery," Horwitz said. For men , he said, a frequent request is a face-lift that will help them "to get their wife back or they want a job promotion," liON A MALE, YOU WANT TO LEAVE TH:E FEATURES ON TH:E HEAVIER SIDE. FULLNESS GIVES AN IMPRESSION OF AUTH:ORI1Y, AND YOU WANT TO LEAVE SOME WRINKLES." BUFFAL O PHYSICIAN A N 0 BI he added. Overall, the most frequent reason for turning someone away is an unreasonable demand, like obese people wanting liposuction to shed unwanted pounds. "They want to be skinny," Horwitz said, "and you can't do that" with an obese person through liposuction. Enhancing the diagnostic techniques of some cosmetic surgeons is computer imagery, where a patient can actually visualize what he or she will look like after the surgery is completed. But Horwitz calls this method unfair. "If you're showing it to the patients, you're potentially implying a result. You're also giving them unrealistic expec- OMEDICAL SCIENTIST SPRING , 9 9 2 ED �tations. If you're using it to analyze things for yourself and not showing it to the patient, you probably don't need it." Horwitz further explained his aversion to the method. "You can take away the bump on their nose with a computer picture, but it isn't the way a nose is going to look, because you'll have scar tissue and contracture. It's not going to look like that anyway," he said. Women on the whole don't experience as much dissatisfaction as men do after cosmetic surgery. Again , the selectivity of the surgeons comes into play, as those patients with underlying psychological quirks are more apt to be dissatisfied. As a rule, patient satisfaction with plastic surgery is quite high, with more than half of Horwitz's patients returning for more. Both McKissack and Horwitz themselves have had eyelid surgery and are pleased with the results. And both men said they would have it again. But gender is an important factor , as more women than men seek further surgery. "It's much more prevalent in women," Horwitz said. "They have their eyelids done; a year goes by and their face is sagging. It's not unrealistic that they would return for more. "Men get something done, and they're done," he said. The kinds of operations Horwitz performs on his men and Bruce J. Cusenz m BUFFA LO PHYSI CIAN A N 0 women patients are basically the same - rhytidectomies (face-lifts), rhytidectomies with liposuctions, rhinoplasties -but the techniques employed on men and women differ. "On a male, you want to leave the features on the heavier side," he said. "Fullness gives an impression of authority, and you want to leave some wrinkles. On a female you want more of a sculptured look, and you want to remove every wrinkle." Horwitz shares a philosophy held by many plastic surgeons: because of differences in skin thickness and texture, and due to the increased presence of hair follicles, cosmetic surgery on men can bring a worthwhile improvement. On women the results can be spectacular. According to PaulK. McKissack, M.D., a '56 graduate of the University at Buffalo medical school, men are not as good candidates for plastic surgery as women, especially when it comes to facial surgery. "Men's facial skin is a lot thicker than women's because it's hair-bearing," he said. "They also have a stormier course because they bleed more" due to the increased vascularity of the hair-bearing skin, he added, explaining that because of this, control of blood pressure is particularly important in surgery on men. "Women are easier to do," he said. "Their bones aren't [hard] like marble." Men also pose challenges when it comes to hair placement and concealing scars. For example, a face-lift on a male could cause his hairline to migrate behind his ear. To avoid this, hair follicles are destroyed in some cases. Doctors point out that on men it is much more difficult to conceal scars after surgery because they don't wear makeup. Nose surgery differs among men and women, too. "If you overdo it on a man, you can make him look effeminate," McKissack said. Surgeons also cite personality glitches as another source of complication in male cosmetic surgery. "Men are impatient," said james Wells, M.D., chairman of the public education committee for the American Society of Plastic and Reconstructive Surgeons. "And from that BIOMEDICAL S CIENTIST SPRING 1 9 9 2 �Hanley M. Horowitz and female patients. "Men come in just as tentative as the women, and they take a little more time beating around the bush. It takes them longer to open up," Cusenz said, "but once they get going ... " McKissock, who practices in the Los Angeles suburb of Torrance, California, has experienced a marked increase in face-lifts among his male patients. "It used to be considered a feminine operation," he said, "but especially here in Los Angeles, it's quite common." Some procedures, McKissack added, such as pectoral implants for men, are a very small and insignificant pan of plastic surgery. They appeal, he said, to "a certain type of man," such as the body-builder type. "I wouldn't even know who to send a patient to who wanted them . It's a stupid operation," McKissack said. It's a fly-by-night thing, and it will come and go along with a lot of other dumb things because they're a male fad ." "It's frivolous, " he said, "and for a plastic surgeon to call something frivolous .. . but this really is." + standpoint, they are more difficult to deal with than women. "Women are much more attuned to the length of time it takes to recover. Men think they are indispensable," he said. "Before they get out of the recovery area, they have a phone screwed into their ear. " Horwitz described his typical male candidate as a business executive with limited time. "They look at it like this: 'I want to buy a new car. I want to buy a new suit. I want to have my eyes done.' It's just one of many things." And before surgery, Horwitz, said, men are more demanding. "The male comes in and says: 'I have three days off and I want this done.' I say, 'But it isn't what you need.' If he still wants it done, I won't do it. "The female comes in and says: Just do anything you can; I want to look better."' When the surgery is completed, Horwitz added, "males are the most cooperative and the least demanding." By contrast, Cusenz sees few differences between his male BUFFAL O PH Y SICIAN AND B IO M E DI C AL S C IENTIST SPRING , 9 9 2 ED �• ························ · · · ······· · ··········· · ···················· · ······ · · · ·· · · · ········ ~ I UB medical school ranks high in terms of minority graduates years." Many of the programs for minority students - such as the Federal Health Centers Opportunity Program, the Minority High School Student Research Apprentice Program and the summer enrichment programs - have been funded by grants received by Wright. + nderrepresented minority students represent a higher percentage of graduates of the School of Medicine and Biomedical SciB Y M ARY B ETH S PINA ences than at medical schools at Medical students learn how to set up a private or other public universities in ew group practice at UB' s Prep for Practice program. York, according to a survey conducted dents some sort of benchmark from by the American Association of Medical which to make decisions about things Colleges. The medical school ranked like where to geographically set up a 16th in the survey of the 126 accredited practice or buy into one, what some of medical schools in the U.S. Cornell raduating medical residents the facility requirements are for differUniversity's medical school, ranked have rarely received sound ent kinds of practices and how best to ninth, was the only one in New York practical management training handle their own personnel," Richert ranked higher. in how to set up a private or added. The survey showed that students in The program attempted to give resigroup practice once they leave this group made up 12.2 percent of the their residencies. But a new dents further options concerning join704 students graduating from the school from 1986 to 1990. During the period, program at UB, called Prep for Practice, ing an HMO as well , he said. "For the University at Buffalo medical school is helping to change that, according to example, a doctor doesn't have to worry graduated 86 students in the john Richert, associate dean for alumni about getting malpractice insurance if underrepresented category, consisting of relations in the School of Medicine and he works for an HMO. He's already covered. And he receives a guaranteed African Americans, mainland Puerto Biomedical Sciences. salary. I think it's important for a young "We've long been wanting to do someRicans, American Indians and Mexican thing for graduating residents. It's really physician to understand these types of Americans. Maggie S. Wright, Ph.D., assistant long overdue," he explained. "This pro- things." Richert gave an example of how imdean of student affairs, attributed UB's gram touches on things that are never outstanding ranking to a number of fac- taught in medical school about what it portant geographic placement of a pracmeans to begin a practice. This program tice is by pointing out that if a young tors. is practical preparation for someone doctor chose to begin a general practice "For the past decade," she said, "we who's not going into academic medi- near the site of a military base, where have built and maintained a highly succine. " most of the people in the community cessful and comprehensive pipeline for Richert said that the program, which would already be cared for by the base early identification of talented minority students in Western New York and en- took place last November at UB and was doctors, the new practice would unrichment programs for middle and high sponsored by the Medical Alumni Asso- doubtedly fail. "These young doctors school students as well as undergraduate ciation, is designed to help graduating want to be able to make a living. I think and pre-med and accepted medical stu- residents make intelligent decisions this program teaches them and also takes about criteria such as malpractice insur- some of the pressure off by giving them dents." Wright noted that "faculty have par- ance, establishing a market for a prac- options." While practical knowledge was ticipated in summer minority research tice, banking and financing and risk manprograms at the school and have been agement. It was a single-day, eight-hour stressed during the program, Richert extremely enthusiastic and cooperative seminar. "We (Medical Alumni Asso- said that another purpose of the seminar in working with minority student en- ciation) were working in concert with was to present a myriad of possibilities richment programs and projects over the Syntax Laboratories. It gave the resi- to the residents from which they could Prep for Practice program helps residents set up new practices fl) BUF F AL O PHYSI C IAN A N 0 BI O MEDI C AL S C IENTIS T SPRIN G 1 9 9 2 �· ·· ···· · · ·· ····················· · · ·· · · ···· · ··················· · ········ · ········· · ···· · · · • make decisions based upon their own needs and wants. "Do you want to practice alone? Do you have the start-up costs involved in a solo practice7 Or is an HMO the best way to begin? And where do you want to live? These are all important questions, " he said. Ninety residents attended the inaugural seminar last fall and there was nothing but praise for the program, according to Richert. "It really was a smashing success. All of the evaluations were very positive. lthink that anybody who wants to go into some son of private, non-academic practice should be exposed to a program like this before leaving medical school. " + -BY MARK HAMMER UB to estabHsh nation's first comprehensive nuclear imaging training center he State University of New York at Buffalo will establish the first comprehensive training center for nuclear imaging in the United States, funded by a three-year grant from Siemens H.G. The grant is the result of two years of discussions between UB and Siemens. The training center, to be headquartered in the Department of uclear Medicine, will concentrate on positive emission tomography. "We're in the process of organizing a core curriculum to train everyone from the PET technician who assists the chemists, through all of the higher levels of science right up to a director of PET operations," said JosephA. Prezio , M.D. , UB chair of nuclear medicine. " o one is doing that anywhere in the United States. " Siemens needed a center that could train its people in depth in this new BUFFAL O PHYSICIAN field, Prezio said, and UB already had a well-regarded program in nuclear medicine and is establishing a major PET facility. The University , in conjunction with the Buffalo VA Medical Center, will be operating one of the most advanced PET imaging centers in the world by 1993. "The problem throughout the U.S. , and probably the world, is that training for PET has not been organized appropriately, or in enough depth , so that you can send someone to one site and have them come back seasoned and trained, " Prezio said. "Our goal from the beginning," he added , "in addition to establishing the PET imaging center for research and clinical use, was to set up a national educational program that would be unrivaled in the United States. " The center will be organized around four major training groups - technicians, radiochemists, nuclear physicists and physicians. Training of PET technicians will begin this spring. Other programs will accept enrollees as the curriculum is finalized. Training periods will vary from a month for technicians to two years for physicians being trained to interpret PET images. + B Y LOIS B AKER Ri(hard Safeer, right, distusses his poster with Murray Murphy at the Researth Forum. AND BIOMEDICAL Congratulations to the winners of the 11 th annual Student Research Forum irst Honors Winners Richard Safeer: The effect of the "Get Heart Smart" curriculum on middle school students. Diana Sanderson: Urine sorbitol excretion reflects blood glucose level in diabetes mellitus. Second Honors Winners Keung Lee: Characterization of a eDNA clone that encodes a Schistosoma mansoni antigen that may play a role in immunity. Harold Lilt: An integrated physician workstation: Digital patient records and the medical desktop. Atif Zafar: The temporal dynamics of scoliosis: Visualization of spinal geometry. Ann Comi: Copper toxicity and the distribution of copper in normal and Menkes lymphoblasts. Third Honors Winners Shane Ferguson: A controlled comparison of four different surfactant preparations in surfactant-deficient preterm lambs. Andrew Michel and Myron Glick: Cardiovascular risk factor analysis of an old order Mennonite community. Gina Marrero: Effect of combination photochemotherapy and hyperthermia vs. rotenone on human squamous carcinoma. Kristine Tenebruso: ~ Knowledge, attitudes ~I and practices of := women over age 50 regarding breast cancer screening and breast cancer screening practices. + SCIENTIST SF>RING I 9 9 2. ED �. . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . .. . . . [1] ' . American Board of Pediatrics and its sub-board of pediatric nephrology. He is a diplomate of the American Board of Medical Examiners and a member of the American Pediatric Society and the executive councils of the American Society of Pediatric Nephrology and the Eastern Society for Pediatric Research. + Children's Hospital appoints Alon Co_ppens to Department of Radiology T he Children's Hospital of Buffalo has appointed Alon Coppens, M.D. , to a fellowship in its Department of Radiology. Coppens received his medical degree from the State University of New York at Buffalo School of Medicine and Biomedical Sciences. He received his postgraduate medical training at Mary Imogene Bassett Hospital in Cooperstown, New York, and completed his residency in diagnostic radiology at the University of Arizona School of Medicine. + -BY . F Bruder Stapleton, M.D. , A. Conger Goodyear professor and chair of the Department of Pediatrics, has been appointed by the executive board of the American Academy of Pediatrics to the academy's Council on Pediatric Research. Stapleton is also pediatrician-in-chief at The Children's Hospital of Buffalo. The Council on Pediatric Research was established to provide a forum on pediatric research; its objectives include promoting pediatric research through the identification of major researchable questions, recognition of important completed pediatric research and the development of statements or other publications on pediatric research. Stapleton, a fellow of the American Academy of Pediatrics, is certified by the BUFFALO PHYSI C PAGE Raghavan appointed division hea~ at Roswell Park Cancer Institute D Stapleton ap~ointed to councU on peCiiatric research 6) ARTHUR IAN erek Raghavan , M.D. , Ph.D. , has been appointed professor of medicine at UB and chief of the divisions of solid tumor oncology and investigational therapeutics in the Department ofMedicine at Roswell Park Cancer Institute. Raghavan earned his medical degree from the University of Sydney, Australia, and his doctoral degree in experimental pathology from the University of London, England. He completed his residency in general medicine at the Royal Prince Alfred Hospital and served a medical oncology fellowship at the Royal Marsden Hospital, Ludwig Institute for Cancer Research, Surrey, England , and a research fellowship in medical and urologic oncology at the University of Minnesota. Prior to taking the position at Roswell, Raghavan served as senior medical oncologist as well as research director of the Urological Cancer Research Unit, Royal Prince Alfred Hospital, Sydney, Australia. Raghavan has published over 150 articles in peer-reviewed journals and presented over 100 papers at national and international meetings. He serves on the editorial board of the journals The Prostate, The Breast and The European journal of Cancer. + AND BI O MEDICAL Head of rehabilitation medicine named at BGH G ary S. Clark, M.D ., a UB associate professor of rehabilitation medicine , has been appointed head of the Department of Rehabilitation Medicine at Buffalo General Hospital. Clark earned his medical degree at jefferson Medical College, Philadelphia, through a five-year premedicaVmedical accelerated program with Pennsylvania State University. He is a diplomate of the American Board of Electrodiagnostic Medicine. Most recently, he served as medical director of Rehabilitation Services at Park Ridge Hospital, Rochester. A fellow of the American Academy of Physical Medicine and Rehabilitation, Clark is also a member of the board of trustees of the Association of Academic Physiatrists.+ Chddren'sHospital names attending physician in otolaryngology department T he Children's Hospital of Buffalo hasnamedMichaelP. Pizzuto, M.D. , to the Department of Otolaryngology as an attending physician. Pizzuto will manage all aspects of pediatric otolaryngology with special interest in pediatric airway and voice. After receiving his medical degree from the State University of New York Upstate Medical Center, Pizzuto completed a residency in otorhinolaryngology at the UB Graduate Medical!Dental Education Consortium. He completed a fellowship in pediatric otolaryngology at Children's Hospital of Michigan. Pizzuto is a member of the American Board of Otolaryngology, Head and Neck Surgery and the American Medical Association. + SCIENTIST SPRING 1992 �·········· · ················· ···· ·························· · ······························ • 1 9 3 0 Hospital (Co rnell University 5 Medical College). WILLARD G . FISCHER'36, fully re- SEBASTIAN CONT I '70 , cine on July 1, 1991, after 54 years. 9 4 0 9 ROBERT 8 J. 0 5 BRACO '80, an- nounces that he is beginning a tired from the practice of medi- 1 1 5 has a private practice in vascular sur- new practice in occupational and environmental medicine in gery in Sacramento, California, Appleton, Wisconsin. Braco re- and is an associate clinical pro- ceived his M.P.H. in 1990. fessor at the University of Cali- JOHN D . WHITE '40, is serving on fornia at Davis. R ICHARD A. SMI T H '81 , has the boards of the Older Americans Council and the AARP in ELLIOTT BRENDER '70 , is as- moved to Boston (Jamaica Plain), Massachusetts, to become an at- Tavernier, Florida. sistant clinical professor in sur- tending pathologist at the gery at the University of Califor- Faulkner Hospital. FRANK A. PFALZER '46 , has David H. Nichols '47 nia at Irvine, and chief of surgery been retired since july 1989. He 1 9 6 0 5 at Garden Grove Hospital, Gar- HOWARD WALDMAN '81 , den Grove, California. his wife,jan, announce the birth of t h eir daughter, Alanna and now lives at 2 Laurel Oak, Amelia Island, Florida, and spends sum- ROBERTA M . GILBERT ' 62 , mers in Western Falls Church, Virginia, informs RETA D . FLOYD'73, announces Denbrook,onSeptember9, 1991. us that her book, "Extraordinary the opening of her new office for Waldman is director of the car- Relationships, A New Way of the practice of psychiatry at 924 Buena Vista, Duarte, California diac catheterization lab at Salem ew York and Muskoka, Canada. DAVID H . NICHOLS '47 , has of accepted an appointment as Vis- Thinking About Human Connectedness," will be published in iting Professor of Obstetrics, Gy- June 1992. Hospital. 91010. D O U G LA S MELVIN R . PRATTER '73 , necology and Reproductive Biol- is AN D PLESKOW '82 , RANDI announce that ogy at Harvard University School JEFFREY of head of the division of pulmo- Rebecca Danielle, born on Sep- of Medicine and Head of the Di- Brewester, New York, writes, "1 vision of Gynecologic Pelvic Surgery at the Massachusetts Gen- have achieved no positions of prominence, written no notewor- nary and critical care at the Robert Wood johnson School of Medicine, Camden, ew Jersey. tember 10,1991, has joined her sisters Sara, 5, and Heather, 2 V2. eral Hospital. thy medical articles and am di- S. CARR ' 64 , vorced. 1 am very happy. " 1 9 5 0 5 JOHN J . BIRD ' 65 , ofWilmette, BERNARD H . SKLAR ' 56 , Fair Lawn, of ew Jersey, retired from active practice October 31, lllinois, is an associate professor of ophthalmology at orthwest- ern University. 1991. ROSS E . MCRONALD ' 66 , BEN CELNIKER ' 56 and his wife, Ilene, announce the birth of was medicine at Rutgers University. 1 9 7 0 his wife Debbie have five chil- Community Hospital of Shore University in Lattingtown, li na, School of Medicine. of directors of the American Lung of D E NNI S L. B O RDAN '70 , was elected vice president of the board of directors of the Ameri- Port Washington , New York, was recently named associate chair- can Diabetes Association , Western ew York Chapter. man of the department of surgery at North Shore University PHYSICIAN A N D orth New York. R ICHARD L . C OLLINS '83 , has recently been elected to the board Association of Western New DAVID M . K E NTON '79 , and their second child, Michael An5 is a vas- cular surgeon at Glen Cove's dren ages 15, 14, 13, 12 and 6. Neuberg is an associate professorof pediatrics in the division of pediatric hematology-oncology at the University of South Caro- his wife announce the birth of CHARLES F . O ' CONNO R ' 57 , BuFFALO and recently named director of sports their son,Jared Brandon, on November 17, 1991. G E RARD VI T A LE '82 , RON W . NEU BE R G '77 , drew, on September 3, 1991. Kenton is a practicing cardiologist in Deerfield Beach, Florida. BIOMEDICAL York. Collins also recently joined Buffalo Medical Group. R E NATA WAJ S MAN '83 , writes, "We have just returned to the USA after spending a year and a half in Israel. Ourfirstson, Oren Sharabi, was born in Israel in SCIENTIST SPRING 1 9 9 2 til �•• ........................................................................................ OBITUARIES July 1991. I am now joining a V I NCEN T J . FASANEL LO '86 , group in Cainsville, Florida, in and his wife Donna proudly an- gastroenterology." nounce the birth of their son, died December 26, 1991 in St. Vincent John , on February 3, Paul , Minnesota. ROBERT LASEK ' 84 , and COLETT E ( PRUEFE R ) LASEK '84 , announce the birth of their BRINA KESSEL RICHTER ' 25 , 1992. Fasanello is a psychiatrist with Westfall Associates in Roch- JOHN J . CONNELLY '42 , ester, January 3, 1992, in Buffalo , New ew York. first child, Christopher Ryan Lasek, on December 10, 1991. died York. SANFORD LEVY '86 , writes, "After travelling the world for GEORGE J . ALKER , JR. , ' 56 , LINDA PETERSON MANDANAS two years, I have settled back in former chair of the Department was recently inducted as a Buffalo and have joined the Cleve- of Radiology, died December 31, fellow of the American Academy land Hill Medical Group, prac- of Family Practice at the annual ticing internal medicine." '84 , AAFP meeting in Washington , ART H UR WE ISSMAN '86 , D.C. GRACIELA has 1991 , in his home in Williams- George J. Alker, Jr., 'S6, ville, New York , following a burgh as assistant professor of lengthy illness. He was 62. radiation oncology. Alker, who worked actively to joined a private practice in gen- promote passage of ( CONSTANTIN O) era]surgeryinBuffa]o, ewYork, State's mandatory seat belt law, writes, "jim with jonathan Reynhout '68. DESEMONE ' 85 , 1 9 9 0 HEIDI DEBLOCK s '90 , and her and I have recentl y moved to the Weissman 's Berkshire, Massachuseus, area, Zachary Arthur, was born on husband announce the birth of but more importantly, our daugh- April 12, 1991. Elizabeth Wende DeBlock on second child, February 2, 1992. ter, Marcela Grace, was born SepJOHN tember 8, 1991. " E. ZVIJAC '86 , com- pleted an orthopaedic surgery of residency at the University of Norfolk, Virginia, has started a Miami's jackson Memorial Hos- plastic and reconstructive sur- pital in june 1991. He is cur- gery fellowship at Eastern Vir- rently doing a one-year fellow- ginia Medical School. ship in sports medicine at the MICHAEL JON DENK '86 , American Sports Medicine InstiANDREW GIACOBBE '86 , of tute in Birmingham, Alabama. was honored by Governor Mario Cuomo two years ago for his service on the Governor's Coalition on Traffic Safety. Alkerwas chair of the Department of Radiology from 1981 until he retired in September 1991. During the same period, he served as director of the Department of Radiology at Erie County Medical Center, where he was a neuroradiologist from 1963 until his retirement. He was honored last year as Richmond, Virginia, writes, "My wife, Laura, and I became the proud parents of our new baby ROBERT F . CAFARELL '87 , writes, "I have combined an aca- daughter, Cristina Maria, on No- demic practice in anesthesiology vember 20, 1991." Giacobbe is at the University of Rochester's currently a plastic surgery fellow Strong Memorial Hospital with at the Medical College ofVirginia. ew York Physician of the Year by Erie County and ECMC. private practice at Rochester General. My wife, Brenda, and I are DEIDRE GREENE '86 , of Allen- town, Pennsylvania , writes, "My expecting our first child in March 1992." husband, Rob Dixon , and I are thrilled to write of the birth of RUS S ELL FUHRER ' 87 , mar- our second child, a daughter, ried Nancy in January and has Aurora, born August 8, 1991." joined the University of Pius- ti) BUFFALO PHYSICIAN A N 0 BtOMEOICAL SCIENTIST SPRING 1 9 9 2 ��BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 ADDRESS CORRECTION REQUESTED Non-Profit Org . U.S. Postage PAID Buffalo, NY Permit No. 311 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician and biomedical scientist, Spring 1992 Subject The topic of the resource State University of New York at Buffalo. 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Research Perspective on Healing A Spoonful of Humor Charting the Secrets of Life It Hurts to Be Beautiful Medical School People Alumni Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-12-10 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v26n02 Extent The size or duration of the resource. 32 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1992 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/da3a4858834527e0e8e73b2501d593f5.pdf d57d8580b37d59ec8600eac8e8cc0544 PDF Text Text �THE BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST Volume 26. '\umhcr I DIRECTOR OF PUBLICATIONS Nancy Tobm EDITOR Nanette Trd::1l PI kolhg, R.. ART DIRECTOR Alan J k g1er ASSOCIATE ART DIRECTOR ~con Robert f rit ker STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES Dr john "'Jugl";;on, 'vice t'<r"de·" or ( hmcal \ffa1rs Dean EDITORIAL BOARD Dr Dr Dr Dr Dr ~lr Dr Dr Dr john A R.• hen Chs ma., liar >l<:l Brodv (,Jcn (Jresham '\cdr 1 Ha7nson james Ka~skt Harok L t ( har cs Pag~nelli Antui· cttc Pflc·s L~· her Rohmson Thomas RPsenthal Dr Dr 'iakda Dr Dr Dr :'>lr Dr Surr~r: Smgerman Stephen 'ipaulding '\elson Tc rr I dward \\"c-uke jerome )ates UlLrlO:l TEACHING HOSPITALS AND LIAISONS Ibtana \' ·\ \h:di ... a. Center Buffak• C.cner.>l Ho,pllal \lidwel Shaw Buffatc> \'A ~edicat Ccnte• ( h>ldrcn's lie spital of C:.. '·•lo K.:rrn Dryja-Swit'r\hl tnc Ccuntv ~Icc! .cal (enter .\fwv ,\'orthrrn \lercy HC'pitJI \Iillard fillmore llosp11als Dear Alumni and Supporters of the UBMedical School: P rogrammatJc mitt. a~ivcs often r~quirc an extended._Iead time before thetr values ~an be recognized and their opportumucs brought to frunwn Such IS the situation with the medical school's development of a centralized mformation system and computer assisted education <CAl). In the early 1980s, the school embarked on projects designed to meet ib operatwnalwmputer requirements and to become a leader m CAl. L ndcr the leadership of Dr Alan Reynard and Dr. john Loonsk, the gains hoped for have been rcahzed UB represents one of only a few medical schools that offers a required course m med1cal computmg to ib students and requires medical computer literacy for graduation. [hanks to Alan's and John's leadership we were prepared to computerize all medical student and resident credcntialing information within 18 months of implementation of New York State's new 405 Code requirements; LB IS no\\ considered a model for others to emulate. And we arc considered leaders at the forefront of CAl. I he foregoing developments and successes set the stage for even more exciting opportumues in tht commg years. During 1990 and the early part of 1991, the Graduate I:ducatton Consortium conducted a wnsultant study rcgardmg destrcd future directions for the school and the teaching hospitals. That report, conducted by a consultant staff from Coopers and Lybrand was completed and accepted by the Consortium in 1991. Soon after its acceptance, representatives of the Digital lqUipment Corporation learned of our progress and expressed an mtercst Ill using the Consortium as a model for developmg a truly community-wdc medical-educatton-health care communicatiOn system. Under Dr Thomas Riemenschneider's leadership, a planning program involvmg consortia! member~. D1g1tal, IBM. NY" EX and Siemens is now in place, and there is every reason to be opttm1stiL that UB and its consortia! members will become acttve participants in an adventure that can serve to move our efforts forward and to showcase Buffalo as a leader m these important areas It should enhance the quality of medical education and health care for years to come Both the Physician and I will keep you abreast of future dewlopmenls. '>mcercly, ~ (• 0J ~ 1"john i'.aughton, M.D . Vice Pres1drnr for Clinical Affairs Dean, School of Medicine and Biomedical Sciences I-rani< Sava Roswelll'a; k (anccr lnstitutt: juJ!Ih RICe "'''""of ( harit) llosptc 1l DrnniS \fcC arthv © I he ~tAte L ,.- ver,llv ol "Jew YJr'< "l Buffalo rhc Hu((.. :o Phvs.c <liWild BiomrdtC.II ~(ICII· liSt ts '?Ubltshcd quarterly hv t~c ''"" L mver>II\ cf "'ew Ycrk ll Bt:!' 1lo 'ic' c PI of Mcd ;ctnc and Biomedic~: ~cic,ces and the Office >I Puhhca•tn,s. It is sent 'rce of c'1Jrgl' tt" odumni, fac11 i 1v ... tuclcnts. rcsl· dePts "nl! !nerds fhc st~lf reserves ;.he rag; to edn 4lll c>pv 2.:-:d ~ubmiss..:;'l;:•;; J.c ccpted for ~L.~Iication Address quest .c·ns. {.,.)r;:T"' 1.cnts dnd sub,,-; 'i~lons to: l'ditl r. The Bu([ulo Phv<i.·can cmd Bilnnedical ')dtnt;st ...,t~uc l mver~;~v ol 'Jew Yo:k at Buffalo l nt\'crs··v •·ubh cat Lens, I ~t (rAts Hall BuffJio ...... wYcrk 14loO Send addrc" chan~c' t<>c rl1r lluJ]al·, Phy sloan antl Bwrm:dica! '\ocntisl. l tf. C P~ Ad<!. lion, H 15 Main S~rcct Buffalo. ~ew York 14!1 t Cover Illustration by Jay Lincoln Dear Fellow Alumni: D on't le.t the wmtcr doldrums get you down 1 The Alumm. Assouation is offering some warmmg and cheerful events. On january 18, 1992. we held the Senior Reception for our future alums. As in years past, It was greatly appreciated and enjoyed by the scmors alums and faculty The Chairpersons for the Reunion Classes arc busy making plans for an exctttng n:umon weekend in Buffalo on April 25. You will be heanng more from them during the commg weeks. \Ve have a lot to be proud of in our medtcal school and our strong and active Alumni Association This is due to the strong support from vou, our alums' ' If you have any questwns, please feel free to call me at my office. ':imcerely ~~· ~ Nedra]. Harrison, .\1.D., '77 �WIN T ER 1992 VOL. 26 , No . 1 ..... ........... . .. .. .......... . . . .. . .. . .... .. . . ..... . .. . ..... . . .. ...... . ......... . .. . .. . ...... . ... Research Hospital News Further Notes on 11 The Other Classroom" • The School of Medicine and Biomedical Sciences' dean,John Naughton, M.D. , looks at the advancement of the medical school's teaching hospital relationships. Journey to the Top of the M.D. Ladder • For women, UB researchers have developed a "smart pill" that knows where to go and what to do when it gets there. Page 3. according to some, it's a longer climb. ASpoonful of Humor • A West Coast pediatrician and University at Buffalo graduate prescribes it for his patients and peers alike. Medical School People Alumni Classnotes The neurologic problems of musicians and singers ore the subject of a lecture by neurologist Alan Lockwood, M.D. Page 2. Dean Naughton's further notes on "The Other Classroom." Page 6. * Millard Fillmore Hospitals opens its new podiatry clinic. Page 4. �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . .. . . . . . . . . . ' ' I ' Success of new biotech drugs depends on prescreening patients Lecture focuses on problems of musicians and singers eurologic problems that tend to strike singers and musicians were the main topics of an evening of medicine and music held in early December at UB's Baird Recital Hall. The combination lecture and recital featured performances of various instruments, followed by a brief presentation on the injuries that typically are found in matching performers. University at Buffalo neurologist Alan Lockwood, M.D., internationally known for his research and clinical treatment of musicians and vocalists who incur neurologic problems as work-related disorders, discussed clinical case studies. Lockwood is a professor of neurology and nuclear medicine. Edward]. Fine, M.D., clinical associate professor of neurology, explained the roles of electromyography and electroneurography in the diagnosis of music-related neurologic problems. An estimated one-third of professional singers and musicians likely will expe- 8 BUFFALO PHYSICIAN rience some neurologic problem related to their work at some point during their careers. While a large percentage of these involve peripheral nerves, others may be traced to the central nervous system. Although surgery is indicated in a small percentage of the cases, a greater number can be treated effectively with physical or occupational therapy. "Although most people are aware of work-related disorders that can occur in various occupational groups, those among musicians and singers are not as well understood in the general population," Lockwood said. UB faculty who performed included Stephen Manes, chair of the department of music, piano; Ronald Richards, a lecturer in the department of music, oboe; Deborah Chung, professor of mechanical and aerospace engineering and Niagara Mohawk Chair of Materials Research, piano and voice, and graduate student Patti Cudd, percussion. The event was co-sponsored by the Buffalo Chapter of Sigma Xi and the UB departments of music and neurology.+ - A BY N D MARY BETH he success of expensive new biotech drugs that are nearing government approval will depend in large part on identifying the patients most likely to benefit from them, according to a UB professor of pharmacy. Speaking at the annual meeting of the American Association of Pharmaceutical Scientists in November, jerome ]. Schentag, who is also director of the Clinical Pharmacokinetics Laboratory at Millard Fillmore Hospital, referred to E5 and Centoxin, both costly new treatments for the often fatal gram negative sepsis infection, as cases in point. "The challenge with these new products is going to be proving that they work and communicating to physicians ~hich patients will clearly benefit from the treatment," he said. "If given indiscriminately, the cost to the health care system for the sepsis drug alone would approach $1 billion. When you're talking about $4,000 to $5,000 for a single dose, you need to pick your patients carefully." Each year, gram negative sepsis infection strikes 500,000 patients, most of whom are already SPINA BIOMEDICAL SCIENTIST WINTER 1 9 9 z �···· · · ·· ··· ····· · · · ····· ·· ······· ···· · · ··· · · · · · · · ···· ·· ·· ·· · ·· · · · ··· · · · · ··· ·· ·· ·· ·· · · · · · · · · ·~ \ . ;... . ill with cancer, heart or liver disease or who have just had major surgery. New treatments for sepsis block the action of endotoxin, the product of bacteria that causes most of the injury. In some cass, the new biotech treatment has completely cured patients. But other patients have seen little or no improvement following treatment. According to Schentag, this discrepancy in how the new drug affects patients is what makes vigorous prescreening of patients so necessary. + - B Y ELLEN geting drugs in the GI tract involve intubation. In contrast, the new targeted capsule is swallowed and its progress monitored by use of a tracking ··' GOLDBAUM Smart pHI" knows where to go after it's swallowed 11 "smart capsule" that allows researchers to precisely direct nearly any medication to a specific place in the gastrointestinal tract has been developed by scientists and engineers at the State University of New York at Buffalo and Millard Fillmore Hospitals. Described at a meeting of the American Association of Pharmaceutical Scientists in Washington, D.C. , the ingestible capsule and its microelectronic technology have important implications for treating patients who require repeated delivery of a drug, such as insulin, to a small area of the intestine where it can be absorbed. David T. D'Andrea, director of the Engineering and Devices Laboratory of Millard Fillmore Hospitals, is co-investigator on the project. Schentag, who also directs Millard's Clinical Pharmacokinetics Laboratory, explained that current methods of tar- BUFFALO PHYSICIAN device worn as part of a vest. The vest houses a computer monitor about the size of a Walkman. As the capsule, which contains a tiny radiotransmitter, passes through the GI tract, it sends out a continuous radio signal as the computer monitor system computes the position of the capsule and triggers release of the drug when it gets to a predetermined spot in the intestinal tract. Schentag noted that the technology would allow for the intact delivery of drugs such as insulin and some of the new biotech drugs, which are large proteins that are usually degraded by the acid in the stomach or the enzymes in the intestine. + -BY AND BI ELLEN O MEDI GOLDBAUM C AL S C .. UB surgeon performs world's first splenectomy by laparoscopy at BGH .. ,. "· \ ,, surgical procedure known as a laparoscopic splenectomy was performed for the first time on October 10 when a University at Buffalo surgeon removed the spleen of a 24-year-old woman at Buffalo General Hospital. Scott A. Tulman, M.D., clinical assistant professor of surgery, says the clinically experimental technique was made possible by the development of new tools for advanced laparoscopic surgery by U.S. Surgical Co. According to Tulman, the woman was suffering from hereditary spherocytosis, a congenital condition that causes severe, hemolytic anemia. The woman's gallbladder was also removed during the surgery, which lasted two and one-half hours. "Although the condition is rarely fatal, it is extremely debilitating and requires numerous blood transfusions or removal of the spleen, depending upon the severity of the condition in the individual patient," Tulman said. During the laparascopic splenectomy, small, half-inch punctures were made in the patient's abdomen and the recently developed laparoscopic instruments were inserted. The surgery was performed with no complications. + IENTIST WINTER �-- - - - - - - - -- - - ----------- - · · · · · · · ·· · · · · · · · · · · · · · · · · · · · · · · · · · · · ·· · · · · ·· · · ·· · · [i] II MDiard Fillmore Hospitals podiatry clinic opens at Gates illard Fillmore Hospitals now offers specialized podiatric care in its newly opened Foot Clinic in its Gates Circle facility. The clinic offers routine podiatric services as well as preventive foot care for patients with diabetes and peripheral vascular disease, according to David M. Davidson, D.P.M., chief of the podiatry section at Millard Fillmore Hospitals. "In addition to meeting the community's growing need for podiatric services, the Foot Clinic helps contribute to the comprehensive, quality health care services at Millard Fillmore Hospitals," Davidson said. The Foot Clinic is staffed by American Board of Podiatric Surgery board certified podiatrists from the hospital's medical staff. + PET imaging center to bolster research and enhance patient care he opening of the new Positron Emission Tomography (PET) imaging facility at the Buffalo VA Medical Center marks completion of the first phase of a cooperative effort between the hospital and the University at Buffalo to bolster medical research and patient care in Western ew York. The center will be completed in 1993 with the opening of a cyclotron facility e BUFFAL O PHYSIC IAN that will manufacture radionuclides for use with the scanner. Work on the cyclotron facility, to be located in renovated space on UB's South Campus, began last summer. Until it is completed, materials used in scanning at the hospital will be provided by outside sources. Once the cyclotron is operating, underground pneumatic tubes connecting the hospital and Parker Hall will be used to transport radionuclides produced by the cyclotron facility for use with the PET scanner. Because of its unique ability to visualize and quantify complex physiological processes occurring in the human body, PET imaging has potential for important advances in the understanding and treatment of major ailments, including heart disease, stroke, cancer, epilepsy and A N 0 B IOMEDICAL S C Alzheimer's disease. The first one in Western New York, the PET scanner at the Buffalo VA Medical Center is one of only four in the state and one of two approved for use with patient care. While there are several dozen PET imaging centers in the U.S., the UB-VA center will have clinical and research capabilities shared by only a few PET imaging centers located at other major research institutions, according to john Naughton, M.D., UB vice president for clinical affairs and dean of the medical school. "This project will put the UB medical school at the very edge of a new frontier of diagnostic medicine," aughton said. While located at the Buffalo VA Medical Center, the PET scanner will be available to veterans and other patients throughout Western New York through a shared services agreement between the University at Buffalo and and VA Medical Center. The center is being funded through a $3.4 million federal grant from the Department of Veterans Affairs, with the balance of the $12 million cost of the center provided by UB, state grant support and private support. Funding includes a $1 million grant from the james H. Cummings Foundation in the form of a contribution to the University at Buffalo Fotmdation's "Pathways to Greatness Campaign." + - B Y IENTIST A R T H U R WINTER P A G 1 9 9 E 2 �First Stereotadic Radiation Therapy performed at Roswell Park Institute most effective for the treatment of target areas up to three cen56-year-old Tonawanda, New timeters in York, man became the first pamaximum ditient in Western New York to ameter. The be treated with Stereotactic Raprocedure diation Therapy of the Brain gives access to (SRTB) for a recurrent malig- deep-seated lesions which were formerly nant brain tumor. inoperable or could be reached only by The procedure, which uses sophisti- extensive surgery, according to West. cated digitized computer targeting, was "The precise, pinpoint accuracy of this performed by Kyu H. Shin, professor and procedure enables us to deliver a high chairman of the department of radiation dose of radiation in single or multiple medicine at UB's School of Medicine and doses to a well-defined, small intracraBiomedical Sciences and head of the de- nial area without delivering significant partment of radiation medicine at Roswell radiation to adjacent normal tissue," Shin and Charles R. West, M.D., research as- said. sociate professor of neurosurgery at UB SRTB requires a high degree of posiand head of the department of tional accuracy. CAT, MRI scans or neurosurgery at Roswell. Roswell Park angiographic studies are performed to Cancer Institute is one of 28 National determine the center and dimensions of Cancer Institute-designated Comprehen- the target and compute the isodose dissive Cancer Centers nationwide. tribution. Treatment is first simulated The patient, who was diagnosed with a to ensure accuracy. The procedure, highly malignant, very advanced which usually takes about one hour, is glioblastoma, had already undergone then performed using the photon beam surgery and conventional radiation which of the high energy linear accelerator. had failed, according to Shin. The suc"We couldn't be more pleased with cess of the new procedure, Shin said, will this first procedure," said West. "The not be known for several months until a dose of radiation was delivered to the repeat CAT scan is performed. "It takes tumor exactly as the computer had caltime to know," Shin explained. "The culated. The future for this therapy is mass is still there and there is no way of exciting and promising for patients. " + knowing whether it's dead or alive until we see no tumor on subsequent CAT scans. With highly malignant tumors , the response is somewhat quicker. " The noninvasive procedure, which can be performed on an outpatient basis, has been used in other centers to treat a variety of benign and malignant lesions, such as arterio-venous malformation , acoustic neuroma , pituitary adenoma, craniopharyngioma, single metastatic lesions and malignant brain tumors. It is BUFFAL O PHYSI C IAN BI O MEDICAL BGH and ECMC announce plans for computer services in a new ioint venture he Buffalo General Hospital and Erie County Medical Center have announced plans to join forces to develop and install a fully integrated computerized information system at the medical center. Under terms of the collaborative agreement , Buffalo General will provide ECMC with a variety of services, including the computer capability required to process ECMC data volumes and operational statistics; installation/systems development; staffing and services; training, and ongoing operational support as well as hardware, software, database and communications support. The ECMC system will be implemented in phases with the first "go live" date tentatively scheduled for early january. The final phase of the project is scheduled to be implemented in january 1994. Under the agreement, ECMC admissions, registration and patient accounting information will be stored in separate data banks at Buffalo General and transmitted to ECMC via a microwave connection. Hospital officials noted that it will be a controlled process to ensure total patient confidentiality between the two institutions. + SCIENTIST WINTER �The following is a continuation of Dean John Naughton's paper, "The Other Classroom," published in the Late Winter 1988-89 issue of Buffalo Physician and Biomedical Scientist • Copies of the earlier paper are available from the medical school. PHOTOS B 0 B BY WALl ON 0 I C A L �BY B U F F A L 0 P H Y 5 I C JOHN I A N A N 0 B I 0 NAUGHTON , M E 0 I C A L 5 C I E N T I S T W I N T M.D. E R 1 9 9 28 �~~ ·- ~---------~~~~-------~~-~------------ uring the Fall of 1988 a major retreat was held at the Buffalo General Hospital focused in its continuing relationships with the medical school. A number of perspectives were presented and positive communications developed considering existing and future relationships. My presentation concerning the development of cooperative arrangements through the formation of consortia, entitled "The Other Classroom," was printed in The Buffalo Physician and Biomedical Scientist. 1 A manuscript detailing the role ofUB's medical school in regional economic development is being published this winter in, Metropolitan Universities .2 This paper will expand on the earlier publication and present some more contemporary views abou t how the University at Biffalo and its affiliated institutions strengthened their relationships through cooperative planning and programmatic sharing. [urrent [onsortial ~trategies GRRDURTE HEDICRL DEHTRL EDUCRTIOH COHSORTIUH OF BUFFRLO The medical school and its teaching hospitals entered into their first consortium in 1983 to respond in an efficient and cohesive manner to the new guidelines promulgated by the Liaison Committee in Graduate Medical EducationJ A major leadership role was provided by Michael oe, M.D., senior vice president for professional affairs and medical director at Buffalo General Hospital; he has been an active leader throughout its development and evolution. This organization , the Graduate Medical Dental Education Consortium of Buffalo (GMDECB), governs all residency training programs in Western ew York. The organization's institutional members include the affiliated teaching hospitals, the schools of medicine and biomedical sciences and dental medicine, all residency training program directors and one resident representative from each program. The work is conducted through a series of committees, i.e., Administrative, Program Directors, Residents and Coordinating. Over the past eight years, the GMDECB has been developed as an alternative model for other medical schools and their affiliated institutions to consider when dealing with the need to change their approaches to managing graduate medical education (GME). The GMDECB is now positioned to deal institutionally with the many issues that 0 BUFFALO PHY SICIAN ono~~ue. m.~., t~e ~rfmf mrector for [ontinuin~ menical fnucation. ~rouinen t~e leaners~i~ for t~is im~ortant innouation. AND BI OMEDIC AL face the medical education and health delivery systems. For example, GMDECB responded rapidly to the new requirements imposed by ew York State imposing the credentialing of medical students and residents. The program directors worked cooperatively to develop the required programs and reporting mechanisms, and with support made available from the Information Service system under the leadership of Alan Reynard, Ph.D. , a computerized reporting system was operational systemwide on July 1, 1990. The total time between the announcement of the new requirements and implementation was about 18 months. Institutionally, GMDECB has moved forward to change the method of orienting new residents. The usual one- to three-day hospital orientation was replaced by a comprehensive week-long curriculum. Its course contents include the usual personnel issues; completion of the required history and physical examination at a single site; training and certification in advanced cardiac life support; learning and evaluation of bedside teaching skills and lectures and small group sessions dealing with medicolegal, record keeping and ethics. Glenda Donoghue, M.D. , theAPFME Director for Continuing Medical Education, provided the leadership for this important innovation. 4 A total of 125 individuals representing specialties in medicine, law, nursing, medical record librarians and hospital administration participate as faculty for this unique and SCIENTIST WIN TER 1992 �important function. The GMDECB responded to the initiatives of the YS Council on GMP·6 ·7 •8 by committing to a ratio of 50 percent distribution of resident positions to primary care (family medicine, internal medicine and pediatrics) by 1994; recruiting and retaining representation from minority and socially underrepresented representatives of at least 11 percent of the total pool , and evaluating and studying the strengths and weaknesses ofconsortia! governance. The Council's subcommittee in Consortia evaluated GMDECB's progress in 1989 and 1991 and reported to the Council that we were meeting its definition and criteria for an operational consortia. The GMDECB's most recent accomplishment was the pooling of resident salaries into a single organization. This has enabled the teaching hospitals to pay all residents across the system one equitable salary and common fringe benefit BUFFALO PHYSICIAN rates. The residents have a consortialwide annual dinner dance, and each receives a UB certificate upon graduation with all member institutions listed on it. These changes together with other attempts at standardization of the education programs are serving to confirm that GMDECB is indeed the "institution of record" for graduate medical education in Buffalo and Western ewYork. vices was formed in 1987. This organization, the Western New York Health Sciences Consortium (W YHSC), has a membership similar to thatof GMDECB. UJESTERH HEUJ YORK HEHLTH SCIENCES COHSORTIUH In addition there are those representatives from the business community and each board chairman of an affiliated hospital and the president ofUB. This organization is incorporated and is not a membership body as is GMDECB. A second consortium designed to emphasize the need to cooperate and to enhance the quality of health care ser- A N D BI OMEDICAL Above, Millard Fillmore i'-11!11111• Suburban Hospital's newborn nursery, now under the diredion of Children's Hospital's Division of Neonatalogy. Left, Buffalo General Hospital's designated Heart Transplant Center. SCIENTIST W I N T E R 1 9 9 20 �----- The formation ofWNYHSC was more difficult than was that of GMDECB because its focus affected more constituents. It originated at the institutional levels and was perceived as a "top-down" organization. The rapidity with which it formed and the breadth of the agenda caused a great deal of consternation for full-time and voluntary faculty alike. The approach taken to accomplish its --------------------------------~- constituents was high, and too little preparatory work was performed to decrease existing tensions and to facilitate the necessary work and leadership. evertheless, a number of significant and positive outcomes can be ascribed to W YHSC during the course of its short history. Among these were: (1) awarding of a Bone Marrow Transplant Center to Roswell Park Cancer Institute (RPCI); (2) completion of a clinical affiliation agreement and faculty contract between UB and the RPCI; (3) designation ofBGH as the Heart-Lung Transplant Center, (4) the formation of a single Division of Neonatology in Pediatrics to coordinate neonatal care at Children's Hospital of Buffalo (CHOB) , BGH, Sisters Hospital (SH) and Millard Fillmore Hospitals (MFH); (5) rationalization of an integrated psychiatry program; (6) securing of a shared agreement between the Buffalo VAMC and UB for a center in Positron Emission Tomography (PET)imaging, goals was to use task forces usually chaired by a UB clinical department chairman or a department's division chief. The composition of each task force included full-time and volunteer faculty, representatives of hospitals, the school and the business community. Most task forces proceeded to achieve their intended outcomes. Three others had more difficulty because tension among the Left, the VA Medical Center's new PET scanner will provide enhanced medical imaging for Western New York through a shared agreement between VAMC and the University ...____ _ --~-......-II!Ci::!!C;,;_:E::::::...::::::__ _ _~--_. at BuHalo. Above, Erie County Medical Center's designated Trauma-Burn Center. «<) BU F FA LO PHY S I CI AN A N 0 B IO MEDI C AL S C I E N T IS T WIN T ER 1992 �and (7) the designation of the regional Trauma-Burn Center at Erie County Medical Center (ECMC). lion dollars, and the scales of economy for BGH will be significant. UB's Health Sciences Library belongs to a regional health library consortium and services the Western New York region. The school has a major computerassisted educational capacity. lt is envisioned that these systems will be added to the other networking activities, thus bringing educational and informational services directly to the bedside and clinical settings in the years ahead. There is no doubt that Buffalo's willingness to enter into more and more cooperative planning has served to move the school and the community into a leadership role in these areas. IHFOJUtJlnOH HET\UORKIHG ll of the above activities serve to network the institutions around the mutual purposes which each shares. One of the beneficial byproducts has been the ability to develop a computer network which links the medical school with each department and each teaching hospital. This network has matured to the point that it is attracting national interest as a model which can be emulated in other regions of the country. Thomas Riemenschneider, M.D., associate vice president and associate dean for clinical affairs, is providing valuable and constructive leadership in this area. In 1990, theW YHSC received a consultant's report from Coopers and Lybrand which will serve as a blueprint to future planning and implementation of this network. Several commercial firms have indicated their interest in pursuing a partnership in moving this system forward since no comparable program with this potential exists in any other community in the United States at the present time. Since UB is also developing unique strategies for interactive computerized education under the leadershipof]ohn Loonsk, M.D., has a networked community-wide system in place and has an outstanding Health Sciences Library which serves medical students, residents, full-time and volunteer faculty and each hospital in Western ew York, the consortium is in a unique position to provide a model of delivery information to a broad range of constituencies in the region. Another example of cooperative planning is that Buffalo General Hospital and Erie County Medical Center (ECMC) are working collaboratively to establish a single computer mainframe for patient billing and medical record keeping. In this model the mainframe will be owned and operated by BGH and services will be purchased by ECMC. The potential savings to ECMC will total several mil- BUF FALO PHYSICIAN [urrent ~tatus ~iemensc~neiner. m.~ .. associ- ate uice presinent ann associate nean for clinical affairs. is prouining ualuaMe ann construehue leaners~ip to neuelop a computer networ~ lin~ing t~e menical sc~ool wit~ its teac~ing ~ospitals. A N 0 B IOMEDICAL While it is apparent that UB and its affiliated hospitals have taken steps to enhance cooperation and sharing, more needs to be accomplished to ensure quality medical education and patient care at a time when the health care system is undergoing rapid, sometimes unpredictable change. Since many constituencies must be represented in the decisionmaking process, yet some decisions must be made expediently, UB's former president, Steven B. Sample, recommended that the WNYHSC model be strengthened through a mechanism of increased centralized control with UB assuming a more authoritative role. This plan, the University ofBuffalo Health System, Inc. (UBHS), received considerable public discussion within UB and the State University of New York system, the New York State Department of Health and at each involved Buffalo institution. While considerable support for a strengthened consortia! model exists, it was clear that progressing toward a cooperative model in which each member enjoys a partnership role is preferred. To that end, UB's president, William Greiner, has offered an alternative plan, now identified as the University at Buffalo Affiliated Hospital, lnc. (UBAH). The affiliated hospital CEOs and the medical school leadership are engaged in developing a plan that SCIENTIST w I N T E R 1 9 9 2G �-- - - - · - - - - - - - - -- ----- ---------- - can be acceptable to SU Y, UB, hospital boards and the full-time and volunteer faculty. The tenets of common agreement and need are being developed; by late 1991 the process of muerging the two consortia into a single organization could begin. It appears that the medical education and health care communities which serve to form UB's other classroom, a "medical school without walls," are committed to increasing cooperative activity in an era of declining resources and changing patterns of rendering medical education and health care. If these institutions and constituencies continue on these vectors, then UB and its affiliates could provide important, necessary leadership for other sectors in New York State and the nation. [ondusions n important lesson learned from the various consortial experiences is that meeting the challenges that face our institutions requires the work of multiple constituencies coordinated by a responsible leadership group. The medical school and UB have an important, but not singular role in that process. Given the history of the medical school and its teaching hospitals, UB must be committed to achieving its major academic goals in an environment committed to taking advantage of diversity and through a philosophy of inclusion rather than exclusion. The GMDECB has served to demonstrate the value of cooperative management, planning and execution. WNYHSC served to demonstrate the need for institutional cooperation and sharing. Although the pressure to render decisions precisely and expeditiously will continue to occur, it appears that the cooperative, multiconstituent model will work more effectively than a strongly centralized, "top-down" organization. 1. Naughton,]. , The Other Classroom, The Buffalo Physician and Biomedical Scientist, Late Winter 1988-89. 2. Naughton, ]., "The Impact on Regional Health Care By A Medical School And Its Affiliated Teaching Institutions: A Potential Model For Other Academic Health Center," for publication in Metropolitan Universities late 1991. 4D BUFFALO PHYSICIAN 3. 1980-81 ACGME Guidelines, The Essentials of Accredited Residencies in Graduate Medical Education , Feb. 24, 1981. 4. Donoghue, G.D., Glieco, . Flint, L.M. , Naughton, ]. "A Core Curriculum for Entering Graduate Medicine Education Trainees" to be published in Teaching and Learning in Medicine later this year. 5. Report of the New York State Commission on Graduate Medical Education, Feb. First Reportofthe Council, Volume I, 1988. 7. ew York State Council on Graduate Medical Education, Second Annual Report, 1989. 8. ew York State Council on Graduate Medical Education, Third Annual Report, 1990. 9. Pristach , C. , Donoghue, G. , Sarkin, R., Wargula, C. , Doerr, R., Opila, D., Stern, M., Single, G. , "A Multidisciplinary Program To Improve The Teaching Skills Of Incoming Housestaff," Academic Medicine, 1991. 1986. 6. Council on Graduate Medical Education A N 0 B I OMEDICAL S C IENT I ST WIN T ER 1992 �The Burn Treatment Center at Erie County Medical Center, one of the significant achievements of the Western New York Health Sciences Consortium. 4. Report of the National Advisory Commission on Health Manpower, Washington, D.C.: Gov Printing Office, 1967. 5. Sickness and in Wealth, ewYork: Basic Books, 1989. 6. Caring for the Uninsured and Underinsured (several articles) , The journal of the American Medical Association, May 15, 1991 , Vol. 265 , No. 19, (pgs. 2491+ 2566). l. The New York State Council on Graduate Medical Education, First Annual Report, 1988. 2. Chapter on Consortia, ew York State Graduate Medical Education Councils' Third Annual Report, 1990 (In Press) . 3. Public Health Policy Forum, American Journal of Public Health, April 1991 , Vol. 81, o. 4 (pgs. 418-420). B UFFALO PHYSICIAN A N 0 BIOMEDICAL ECMC's designated Levell Trauma Center serves the eight county Western New York area. SCIENTIST W I N T E R 1 9 9 2 41) �- ---· - ---- -- ---·. .- - - --·----~~-- By Lois Baker When top administrators at the University of Iowa For women) Medical School met for a presentation on a new security system, the marketing representative turned to the group of distinguished profes- sionals, which included two longer climb women, and asked, "Why don't one of you girls come 0 41 B UFFALO P HYSICIAN up here and try this?" AND B IOMEDICAL S CIENTIST W INTE R 1992 �Mary Ann Bishara, M.D. medical establishment's upper echelons. Aschenbrener instead described her treatment throughout her career as a "day-today kind of minor assault," manifested in this instance by a boorish salesman's offthe cuff comment. The presence of Aschenbrener, Conley and a small number of other female physicians in the top ranks of the formerly all male medical establishment is a sign that women are breaking through societal barriers which in the past forced those inter- ne of the "girls" was neuropathologist Carol Aschenbrener, M.D ., the highest ranking women in academic medicine in the U.S. today. Aschenbrener, executive associate dean at the University of lowa Medical School, perhaps is lucky. She has not experienced the overt discrimination or sexual harassment, such as Stanford neurosurgeon Francis Conley, M.D., reported, during her climb into the BUFFAL O PHYSICIAN A N 0 81 0MEOIC,._L ested in healing the sick to become nurses, not doctors. But unlikejoshua fighting the battle of jerico, their assault on the medical status quo has not brought the walls of inequity tumbling down ; it has created only a small breach, leaving women physicians, after years of proving themselves accomplished, and often brilliant, still struggling for equal opportunity and respect in their profession. "l am troubled ," Aschenbrener said, SCIENTIST W I N T E R 1 9 9 2 4D �"by the persistence of subtle expressions, from men and women both, that indicate still an underlying belief that women are second class, and that yes, they can succeed, but their real place is in the home. I perceive this societal pressure as being more intense now, at least in the media ," she added, "than I did 20 years ago. " Statistics certainly do not paint a glowing picture: • A year ago there were three women deans in the nation's 127 medical schools. Today there is none. • A report published last fall by the American Medical Women's Association and the Feminist Majority Foundation showed that today women make up 36 percent of medical school students but hold only 2 percent of the department chairs. • In 1990, 20 percent of all medical school faculty were women - only a 7 percent increase in l3 years. "At that rate," the report stated, "women will not reach parity on medical school faculties until the year 2077. " Men also outnumber women in the higher faculty ranks. Statistics compiled by the Association of American Medical Colleges show that in 1991 nearly three times as many men than women were full professors. That gap can be attributed in part to women's later entry into the profession. But when the Association followed promotion records of full-time faculty first appointed in 1976, it found that by 1991 , more than twice as many men as women had been appointed full professor. Inequities follow through medical specialities - women are clustered in the lowest paying fields ; through wages- the American Medical Women's Association reports female physicians receive 62.8 cents for every dollar earned by their male counterparts; and through medical organizations- the American Medical Association finally put a women on its board in 1989. By many indications, male and female physicians in this country are not treated equally. The medical profession appears to feature a so-called glass ceiling that prevents women in substantial numbers from reaching the top. How could this situation persist in the enlightened 1990s? For Eileen McGrath, the answer is clear. "I think the only reason for a glass ceiling in any group would be discrimination, and I think discrimination exists because of ignorance." McGrath is executive director of the American Medical Women's Association. "It is clearly documented that a glass ceiling exists," she said, "particularly in academic, but in all aspects of medicine." Nancy E. Gary, M.D. 4D BUFFALO PHYSICIAN A N D BI O MEDI C AL iscrimination against women is partly deliberate, partly unconscious, she said. "Most of the injustices we see are probably the result of unconscious acceptance of values in which one group is privileged at the expense of another group , whether it's race or gender. But the effect is the same, so it is sort of immaterial. I've known very few intelligent men who could defend it logically. " Frances Conley at Stanford has become the standard bearer for women physicians who are frustrated by their treatment at the hands of male colleagues and the medical establishment. Conley's oped piece in the San Francisco Chronicle last june, following her resignation from Stanford Medical School's neurosurgery faculty, detailed years of indignities and sexual harassment, including male colleagues calling her "honey," running their hands up her leg in the operating room and commenting on her breasts. Her public statement shocked the campus and raised a furor in the national media. Conley eventually rescinded her resignation, electing to work within the medical school to bring about change. She continues to press for equal, dignified treatment for women at Stanford and elsewhere. ''I'm here as a conscience," Conley said. "To remind people every time they see my ugly mug that there's some unfinished business." Conley thinks wide spread bias against women exists in many occupations. "Our society has a mind-set," she said. "We've been taught ever since we were small children that women were not quite as good as men. The thing that is most depressing to me is the stereotypical response from institutions to women who make an issue of it. They get rid of them." As a tenured professor with a wellestablished reputation, Conley can't be "gotten rid of. " But she admits her future at Stanford Medical School is not bright. "Things are relatively hostile," she said. "What I did is not exactly an acceptable behavior pattern for women. My department will never forgive me I'm sure." Olgajonasson has not experienced the kind of sexual harassment Conley de- SCIENTIST WINTER 1 9 9 2 1 \ �scribes, but she believes it happened to Conley, and says similar things happen to women in medicine all the time. jonassonchairs the DepartmentofSurgery at Ohio State University College of Medicine, one of two women surgery department heads in the U.S., as of july 1991. She has held the position for four years. "I think it is just constantly part of daily living," jonasson said. "I don't believe women are given the credence that men get. We tend to be ignored, passed off." She has dealt with such treatment in the past by ignoring it, but for young women physicians today she has other advice. "In the past I would have said just swallow it and make do," she said. "I don't know that that is practical, possible or reasonable these days. We have to make it clear we won't put up with these things." "It is not possible as a woman to go through medical school without some discrimination," stated Paula Clayton, chair of the Department of Psychiatry at the University of Minnesota Medical School. Clayton, a specialist in mood disorders, is the only female currently heading a department of psychiatry in the U.S., although the field has been popular with women for some time. She describes her own experience with discrimination as "little things- more in whether you deserve the same office" but tells about the complaints of a friend, a top researcher at Yale. "She has had trouble getting promoted, so there must be some bias against promoting women." Not all women physicians agree that discrimination is a problem in medicine. Nancy Gary, a nephrologist, is former dean of Albany Medical School. She left that position 17 months ago to become senior medical advisor to the administrator of the federal Health Care Financing Administration. Gary said she does not think a maledominated medical establishment prevents women from advancing. She thinks women are underrepresented in the top ranks of medicine because they are latecomers to the profession. "It's a time-related aspect," Gary said. "Women have only been entering graduateschool in any significant numbers since the 1970s. Then you have to add three to BUFFALO PHYSICIAN Pat Duffner, M.D. seven years of training and getting started in the lower academic ranks. Only now do you have a significant number of women reaching the maturity in their profession to realize such opportunities as chair positions." If a glass ceiling exists, it is caused by personal choices, not by institutional discrimination, she feels. "I think there may be limitations on opportunities various people can achieve by virtue of their preparation, their willingness to take risks, their willingness to go on divergent paths to reach certain opportunities," Gary said. "So I think it is A N D BIOMEDICAL a very individualized pursuit of a career that determines whether there is a glass ceiling." Clayton agrees that the choices women make may contribute to their concentration in medicine's lower ranks. "I think we have to take some responsibility for not getting ourselves promoted, " Clayton said. "My experience as chairman, and even before becoming chairman, is you have to be a researcher to get promoted. I don't think women are as intense about their research as they should be. They tend to take care of people. They enjoy that role SCIENTIST WINTER 1 9 9 2 4D �-- - --~~~~~-- and it's instantly gratifying. things are good, you are not going to make to identify the unique barriers women face "The feedback in taking care of people it in academic medicine. in using the system, and find out how to is so much quicker than planning a re"You have to be comfortable with your- get leverage from women colleagues and search project, executing it, writing it up self," Duffner added. "I think if women sympathetic male colleagues." ·and getting it published, that we tend not would just relax to some extent and not Mentoring is indispensable for women to do those things," she said. fight it so hard, and feel comfortable in in medicine, Gary emphasized. "People Clayton speculated that women also their expertise, things would be better. are identified to move on because they've had their career shaped by someone in a may not be advancing as fast as they But that's easier said than done. " Clayton said that if women want to position to guide them and advise them. should because they are not as mobile as men . "There are many women associate advance they have to publish. "And not Then they need the contacts, so when an deans, but why those women aren't being just books," she emphasized. "It's easier opportunity becomes available, someone promoted, that's the disturbing question. to write a non-refereed book than to pub- thinks of them as a potential candidate. " Practical advice notwithstanding, mediSometimes it's tough to get promoted from lish in respected refereed journals. Women within. You have to be able to move. And also have to protect their time, so they can cine remains a demanding profession. For women may not be as flexible. I know of do the research necessary to publish, she many reasons the burden seems to be a woman whose husband greater for women. "I think one ought not told her when they got to have to be an exceedmarried: 'You can move once."' ingly strong person to On the other hand, succeed," Aschenbrener UB's School of Medicine and Biomedical Sciences women may simply be said, "but I think someranks 25th among the nation's 147 medical schools times with women that more particular about the in the number of -women in its student body. A study is the case. There are jobs they take. Jonassen conducted by the Association of American Medical Colleges in 1990 sho-wed that 41.5 percent of UB's still an awful lot of socisaid she has had several medical students -were female . etal factors that are baropportunities to be a canToday the percentage is even higher. This spring riers to women. They didate for a deanship, but 73 -women- 4& percent of the class- -will receive turned them down bestill have to do more medical degrees from UB. The follo-wing table cause the offers didn't work. They still have tracks female graduates for the past 10 years. come from the right place. responsibility for home and children." Clayton too said she has 50% ------------------------------------------;---Aschenbrener has been asked many times, but isn't interested in bethrived in a difficult ca40% ;---;---h ;---;---..... 7 coming dean. reer by following the ad14<-' "Being a dean is more vice of her grandfather - 30% 47 4,~ 4~ ~ ~ nurturing, and I don't - "Do whatever your want to take care of more task is as well as you can, 20% people," Clayton said. " ! and everything else will want to be involved with fall into place." To that 10% philosophy she adds psychiatry and research, some wisdom of her or something bigger than 0 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 dean ." own: develop strong values, stick to them and But statistics tell us that most women in medicine do not have said. "You can't be the token member of reflect on them often. Despite the difficulties women in medithese options. Many are strugglingjust to too many committees. You'll be asked to do that. You have to work the same kind cine face today, the future will be brighter, make it out of the lower ranks. What, then , should women physicians of hours that your peers work. If you have Aschenbrener predicts. "Things are definitely improving," she children, you have to have shared respondo to bring about change? said. "There are more male physicians in "You have to find an area you can excel sibilities." in and focus your interest," said Patricia McGrath, at the American Medical positions of power who are really making Duffner, chief of the medical staff at The Women's Association, said women need a great effort to help women along, who Children's Hospital of Buffalo. Duffner to learn how to use the system to their take delight in seeing women succeed. was one of the early specialists in pediatric advantage. "Doing a good job just isn't I've been very fortunate to have a number brain tumors. going to get you there. Women have to of very fine men assist me in ways I never "If you do good work in a focused area, look at the political mechanisms men use asked for and in ways I wasn't aware of. it's hard to be ignored," Duffner said. "If to get on committee, be appointed to And I've seen peopledoitforotherwomen. you do a lot of little things, even if the committee chairs, get visibility. They have That is very gratifying." + UB RANKED AMONG TOP FOR WOMEN GRAD~ ,,~ ;---- ~r- ~ 4D BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST WINTER 1 9 9 2 �WE~TERN NEW YORK WOMEN ~EE GAIN~ omen may be gaining power ancy ielsen, M.D., paved the way and influence in the medical for Western ew York's women physiprofession, if Western ew cians to be more involved in organized York is an indication. The medicine by becoming the first woman Erie County Medical Soci- president of the Erie County Medical Soety and the Eighth District ciety in 1989. ielsen is a specialist in Medical Society both are internal medicine and a clinical assistant headed by women. professor of microbiology at UB. She also Mary Ann Bishara, M.D., is associated with the Buffalo Medical was elected last May to represent physi- Group. cians in the eight Western New York "Once someone has been the first counties that make up the eighth district. woman to do anything, it's easier for othBefore that, Bishara was president of the ers coming behind," ielsen said. "I don't iagara County Medical Society for two have this load I carry around of blazing years. She is chief of anesthesia at Mount trails" - among her other accomplishSt. Mary's Hospital in Niagara Falls. Bishara said being a female has not hindered her advancement in her field. "I've always been accepted as an equal," she said. "I've never noticed any problems." As head of the eighth district, Bishara monitors problems that develop in the member counties, acts as liaison between the county societies and works with the state medical society. Amy Early, M.D., a specialist in oncology and a clinical associate professor in the Department of Medicine at UB, is -Amy Early, M.D. president of the county group. She practices with the Buffalo Medical Group. "If someone had told me 15 years ago I would be doing this," she said, "I wouldn't have believed them. " The local medical community is very receptive to women, Early said. " l think men for the most part have been very supportive. The two people who were most influential in my career have been men. They have gone out of their way to promote my career. " Early said the medical profession could be perceived by women as a large old boys network, which might make them reluctant to jump in. But that is changing, she said. "In medical organizations, men have gone out and recruited women. The American Medical Association is very interested in female members. " Amy Early, M.D. rrlf someone had told me 15 years ago I would be doing thisr I wouldnt have believed them.rr BUFFALO PHYSICIAN AND B I OMEDICAL ments, Nielsen was the first woman chief resident at Buffalo General Hospital. "But one thing I did do as president of the medical society was make sure young talented women physicians interested in the society had opportunities to sit on key committees. That's what it's all about. " Medical societies are still remarkably male dominated, ielsen said, but not necessarily because of conscious discrimination. "People in positions of power did not know there were women interested in being involved ," she said. "Once that barrier was broken, ina couple of years the executive board of our society was 50 percent female. That's how quickly it can change." Today, opportunities for women in medicine are wide open, in Nielsen's opinion. "Women have always gravitated toward specialities such as pediatrics, obstetrics/gynecology and psychiatry," she said. "But they are now going in to in temal medicine, family practice and the last bastion- surgery. The surgical ranks, even the traditionally male-dominated subspecialities such as colo-rectal and urology, have female residents. There has been enormous improvement compared to a few years ago. " + SCIENTIST WINTER 1 9 9 2 «> �BY ROBERT 5. WIEDER When Dr. Stu Silverstein is examining an undressed patient, he likes to save the balance test for last. ttAs they open their eyes, I tell them, 'You're fine- but somebody just stole your clothes.'" A Spoonful of Whensuturingminorlacerations. Humor he tries out standup comedy routines on his patients. ttThey can't walk out on me, and they don't dare heckle." Moretothepoint, theyusuallylaugh, and sail through the procedure before they know it. (We'll avoid any puns on ttkeeping them in stitches.") • EI!) BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST W INTER 1992 �BUFFALO PHYSICIAN A N 0 BIOMEDICAL SCIENTIST W I N T E R 9 9 2 �--------- --------------~-----~-- • aughter can play an important role in pain-control by distracting patients from pain and discomfort'," Univer_ _ _. . _ sity at Buffalo 1 graduate (1981) Silverstein says. In fact, as he wrote recently in California Physician, he believes that "in the appropriate doses and settings, humor can help in the healing process. It should be part of the plan." The role and application of humor in medicine has been widely discussed since publication of orman Cousins' "Anatomy Of An Illness" but Silverstein has taken it to heart as a practitioner, advocate, teacher - and comedian. A pediatrics resident at San Francisco's Children's Hospital, he is also a professional stand up comic, a regional winner of the 1990 Merit Comedy Competition. Physician-comedian may not be a traditional career combination like poet-musician or author-historian, but it has worked well for him , as a physician, a lecturer- he presents "Stand up Medicine Seminars" for physicians on the virtues and uses of humor in medicine -and an instructor, conducting workshops on comedy writing techniques for health care and other professionals. He also writes jokes tailored for medical personneL Silverstein represents an emerging school of thought whose principle hypothesis is that humor can be a beneficial tool for the healing arts in a variety of ways: ~ Humor can psychologically enhance the doctor-patient relationship and the efficacy of treatment; ~ Humor provides discernible physiological benefits to the patient in several clinical areas; ~ Humor is a mnemonic aid in giving instructions to patients and in imparting 0 BUFFAL O PHYSICIAN information to students and lecture audiences; ~ Humor can improve the outlook and productivity of medical staffs and, as an emotional release valve, help reduce stress overload among health professionals. Patient Morale And Cooperativeness Humor helps to alleviate the feelings of anxiety, apprehension and helplessness that patients experience in clinical and hospital settings. A laugh can ease tension and put a "serious" situation into perspective. Silverstein recalls one colleague who kidded patients as he handed them their dressing gowns by saying, "These quality designer gowns, if purchased from Macy's, would go for twice what we pay for them at the Men's Wearhouse, allowing us to pass the sav- A N 0 B IOMEDICAL ings on to you ... " Lightening the moment with obvious parody made it easier for patients to don this particularly grim and depersonalizinggarment, Silverstein notes. "Sharing a laugh also makes it easier for them to bring up their fears about more serious issues - such as the bill," he adds. Humor also works to "socialize the situation," by establishing the doctorpatient relationship in warmer, less formal terms. Given the current atmosphere of biotech medicine and industrialized health care, the healing process is probably more in need of humanizing than ever, and there is no more distinctively human activity than laughter. Nothing enhances a doctor-patient relationship, Silverstein suggests, like the ability to laugh together and kid one another. The end result, he feels, is SCIENTIST WINTER 1 9 9 2 �increasedpatientcomplianceandcooperation. To paraphrase Mary Poppins, "just a spoonful of silliness helps the me~~ci~~!~ ~~~e:~·, clinical treatment seems to be more effective when dispensed by someone the patient trusts, likes .and feels close to. .And almost mvanably, we are more mclmed to trust, like and feel close to persons who add laughtertoourlives. Humorthushelps establish a bond between previously unrelated individuals in circumstances where such a bond is most needed. As Victor Borge says, "A laugh is the closest distance between two people." A joke made at the expense of the clinical :ituation adds a "we're in this together camaradene to a settmg otherwise characterized by inequality and ~,:0~;:~:!:\',:"~~~n~~~;'.:~~~~~~:~:l BUFFALO PHYSICIAN Humor also works to "socialize the situation," by establishing the doctor-patient relationship in warmer, less formal terms. Given the current atmosphere of biotech medicine and industrialized health care, the healing proc e s s is p r 0 b a b l y m 0 r e d f h u man l.z l n nee 0 1• ng than ever and t h ere l•s n 0 m 0 r e dish 1 tl n c t l v e y u man a c ti vi ty than laughter. • 1 • AND • BIOMEDICAL SCIENTIST WINTER 1992 @) �Top 10 Oscarwinning movies if selected by the "Academy" of Pediatrics By Stu Silverstein, M.D. lQ I Indianna Jones and the Precipitous Delivery 9 8 7 6 Saturday ight Fever ... without Origin Dirty Harry in "Tell me that it's just the flu doctor and I'll blow your head clean off." Sophie's Choice ... Augmentin The Man Who Fell to Earth on Librium s ET makes a Child Protective Services referral 4 3 2 l Sally Field in "Not Without My ... Lawyer" King Kong Rules Out Sepsis Godzilla vs. Fecal Impaction Rosemary's Baby Gets a Psych Consult sphere, lending a note of easy familiarity to impersonal protocol. It leavens uneasiness with laughter. Humor can be a lighthearted acknowledgement of the loss of privacy and control that patients are subjected to by medical procedures. This isn't to suggest that practitioners incorporate handpuppets, novelty bow-ties or five minutes of bedpan gags into their exami- ~ BUFFALO PHYSI CIAN nations or instructions. It is to suggest deal" matters, especially when patient that the inclusion of banter, such as cooperation is essential. And when im"These jokes are free, but we do have a parting instructions for self-medication two-enema minimum," can bring a valu- and self-monitoring, a joke or two may able humanizing quality to an otherwise be an important mnemonic aid. A patient too disconcerted by the gravity of dreary medical context. the situation to remember specific proAfter all, underlying the increasing cedures might very well recall a joke corporate formality, esoteric technology and confusing protocol of modern medi- designed to remind him or her of those cine, the fundamental task of the healer procedures. For example, when prescribing mediremains to make the patient feel better. And few things accomplish this more cation that may impair the patient's motor immediately than the simple act oflaugh- functions, the warning "Don't operate any vehicle, machinery or sexual partter. ner over 300 pounds" - can engrave the PhysiologicalBenefits caveat into the patient's memory more Silverstein doesn't actually extol hu- deeply than a dry recitation of the stanmor as a clinical panacea, but if laughter dard precautions. Humor, in short, can were a pharmaceutical, he'd attract the put things in more engaging, and memoattention of the FDA. "For bedridden rable, terms. When it comes to delivering a progpatients, it can improve the circulation nosis, if the situation is not all that serialmost like an aerobic workout. It stimuhumor is the most immediate and ous, lates the diaphragm and can induce coughing, which is important to pneu- persuasive way to underscore that fact. monia-prone patients in stasis, and more Conversely, if the situation is serious, fun than a respiratory therapist. Muscle- humor can help soften the impact of that tension headaches often disappear after reality, can provide comic respite from laughing at comedy. Laughter can lower intense emotions and can be a vital tool blood pressure, improve digestion by for managing or minimizing the resultstimulating GI blood flow - important ant anxiety or despair. "At best, you'll when you're dealing with hospital food live a long and normal life. At worst, - and as a distraction from pain, can you'll have the satisfaction of making your health insurance salesman wish reduce the need for medications." he'd never met you ." Humor similarly helps to convey Instructional And boilerplate data and terminology to lisMnemonic Aid. teners during lectures, seminars and Humor can do wonders for doctorrounds, according to Silverstein, a vetpatient communication by getting the patient's attention, by helping to express eran of all three. "The professors, things in a more comprehensible way attendings and presenters who work and as a memory facilitator. Given that humor into their material are the ones the diagnosic interaction is often com- we usually remember best. They keep us plicated by the distraction of patient interested and attentive. ln fact, the apprehension, a lighthearted note can more serious the message, the more imalleviate patient misgivings, and thereby portant humor can be." make procedures and instructions less formidable. For instance, the declara- Stress Reduction For tion that, "We'll need samples of your Health Professionals stool, blood, semen and urine," can beMedicine's very intensity, Silverstein come far less stark and ominous an an- feels, makes humor a vital mechanism nouncement if followed by, "Gee, maybe for decreasing the stress inherent in its I should just take your underwear. " practice: "A sense of humor helps keep Humor can convert impersonal de- us from being swallowed up emotionmands made on the patient into "no big ally." The simple ability to joke about AND BI OMEDIC AL SCIENTIST WINTER 1 9 9 2 �- ---- - ---~~~ crisis situations, wo rkload pressures and bureaucratic frustrations can foresta ll burnout and discordant overreaction. Studies of hum or in non-medi cal workplaces show it boosts productivity, aids mental acuity and dimi nishes alienation , conflict and absenteeism. Most importantl y, it can make th e cl in ica l en- vironment less a source of dread and depression. There is, of course, so me antipathy among pro fessio nals toward compromising th e "serious business" of medicin e with "undignified" lightheartedness. But, Silverstein poi nts out, "Humor has always been part of our profes- ~ tu "Schrick Doc" Silverstein, M.D., a University at Buffalo grad (1981) , began doing comedy as a student here , back when medicine was still a gleam in his agenda. "I lived in Ellicot Complex, and I knew I'd need humor when they passed out Elavil along with the dorm keys. ln Ellicot, people would turn the sound down on the TV and have me do the dialogue. I did impressions of professors, Jimmy Carter, Menachem Begin, Mick Jagger. People said l should do comedy, so l went on at the Rathskeller in Squire Hall, which I think is now a dental school; somehow appropriate. I did mock press conferences, I did a lot of material about Buffalo- I was from Brooklyn and used to wonder what people meant by, 'Do you drive a kerr? '" Now a pediatrics resident and working comic, Silverstein has combined his two vocations into a flourishing enterprise, delivering what he calls Standup Medicine Seminars on "The Power of Humor in Medical Practice" to groups of medical professionals, often for Continuing Medical Education credits, and conducting workshops on comedy writing techniques for physicians wishing to integrate humor into their practices and presentations. His "seminar circuit" ranges from California to the east and midwest, and he has been featured in newspapers and magazines, and on ABC's World News Tonight. + e B UFFALO P HYSICIAN sional lives, and it's usually a welcome relief. " The "pro-humor" advocates might argue that it is precisely because medicine is both serious and a business that it stands to benefit fro m those humanizing, comforting and even tranquilizing qualities that "comic relief' so uniquely provides. + AND B IOMEDICAL S CIENTIST W INTER 1 9 9 2 6) �--- • ········································································ · ················· . I Buffalo Academy of Medicine presents Kart Haas OF MEDICINE , MUSIC AND THE HUMANTIES arl Haas, the radio host of the popular "Adventures in Good Music," must know that there always are doctors in the concert hall. And not just because he hears their beepers. Doctors are there because medicine and music have a common theme, which is healing. They are there too because to be effective physicians they must not shut themselves in a diagnostic world. "Medicine is life," Haas told an audience oflargely physicians who had come to his piano recital and lecture last October in UB's Katharine Cornell Theatre. "Medicine is life-healing," he said, expanding his theme. "So is music." Haas's appearance was the opening event in the Buffalo Academy of Medicine's Centennial Lecture Series, a series which this season is prescribing doses of the humanities. Haas' topic was "Medicine, Music and the Humanities." During the course of it he examined several of the great composers, and named a number of scientific and medical discoveries that were footnotes to his text of musical appreciation. "A musician is the poorer for going through life only as a musician," Haas said. "And physicians, too." The "kinship" of music and science, he said, is "creativity." "Medicine," he dared say, "is as much a matter of talent as music." Haas chose to begin his musical examination with Bach, the composer who lived from 1685 to 1750, whose music summed up the achievements of the baroque period in music, and who, as Haas fl) BUFFALO PHYSICIAN "Medicine is life. Medicine is life-healing. So is music. A musician is the poorer for going through life only as a musician. And physicians, too. The kinship of music and science is creativity. Medicine is as much a matter of talent as music." A N 0 BIOMEDICAL reminded, produced in addition to great contrapuntal works, 20 children. The piece he played by Bach was chosen for its "melodious beauty" rather than its intellectual rigor. The scientific achievement that Haas chose for his footnote to Bach was the first recorded attempt to measure the rate of the heartbeat- a very appropriate choice, for one of the notable characteristics of Bach's music is its strong and steady rhythmic pulse. During Bach's lifetime scientists were first envisioning a vaccine for smallpox. During the lifetime of Mozart they were discovering a way to fight dropsy. Mozart died mysteriously, perhaps as the result of an epidemic. He lived to be 35, and died 200 years ago. Since then, it might be argued, there has been more good medicine than good music. For Haas, Mozart represents a psychological advance in music. He played the D minor Fantasia by Mozart, in which he believes the composer bares his soul. "He wasn't a regular guy," Haas said, "and we can only understand him through his music." Haas remarked that each time he plays Mozart he discovers something new about the composer. And he suggested that a physician too should find something new each time he treats a patient. The other composers examined by Haas were Beethoven, Schumann, Gershwin and Debussy. Haas mentioned a few scientific discoveries during their lives. The vaccination against smallpox was discovered, and the stethoscope was invented, during the time of Beethoven, and penicillin was discovered during the lifetime of Gershwin. Beethoven was going deaf, and he was dejected, Haas said, when he wrote his last will in 1802. "Music was the refuge from all the tribulations that befell him," Haas said. He played the slow movement of the Pathetique Sonata, which SCIENTIST WINTER 1 9 9 2 �---- -- ..................... .. ......................................................... • • • • •••• • ~ I I Karl Haas presents uMedicine, Music and the Humanities" as the opening event of the Buffalo Academy of Medicine's Centennial lecture Series. romanticism: "There is no such thing as a creative mind working in a vacuum," Haas said. At the piano Haas did not venture beyond Gershwin, who died in 193 7 of a brain tumor. (He did, however, make passing praise of Leonard Bernstein and Aaron Copland, whom he called great, and he told especially of his admiration for Bernstein, who once impressed him at Tanglewood by being able to sing all the roles of Carmen during a class for conductors.) Haas played a piano blues by Gershwin, and he made it sound urgent. happens to be the theme he has used for his radio program, ever since it first aired in Detroit 32 years ago (one year for each of Beethoven's piano sonatas). Haas gave a heartfelt performance of an Arabesque for piano by Schumann, the great romantic composer who suffered from mental disorders. If you would understand Schumann, Haas suggested, you would best listen to the dual personality expressed in his music. Footnotes to Schumann were not scientific, but included fleeting references to other romantic artists, such as Delacroix, Hugo, Goethe and Schiller. They were all on to 8 U F F A L 0 PHYSICIAN ~ N 0 BIOMEDICAL The "vague chords" and impressionism of Debussy's Prelude from Pour le Piano concluded the musical part of the program, with wonderful washes of notes and harmonies. The harmonies of music do go far in making us whole, Haas suggested. At the close he told of a period of suffering in own life, when his sister was dying, and he found strength in the music of the slow movement of Beethoven's Emperor Concerto. It was for him a powerful example of the healing effect of musicof the composer as physician. + -BY SCIENTIST THOMAS W I N T E R PUTNAM I 9 9 2. $ �• ... . ............................ ... ............. .. .... . .......... . .............. .. ... ... . . . I SSOO,OOO grant received to estabfish supercomputing network for research Med school oHers unique medical computing course he practice of medicine, like nearly every other profession, has been revolutionized by computers. A dazzling array of computer programs is available to the physician at the touch of a keystroke, providing access to everything from full medical texts to electronic mail consultations with colleagues. Students at the School of Medicine and Biomedical Sciences are learning how to use this computer wizardry in a course unique to medical schools across the country. The course is distinctive in two ways: it is mandatory for students and it allows them to apply all the technical tools, interactively, to real-life cases. "What we're doing now is quite different from what most schools are doing," said john Loonsk, M.D. , director of academic computing. "There are some schools with electives in medical computing, and some schools that have mandatory computer literacy courses. But what we've been doing is requiring a course specifically oriented to the use of e BUFFALO PHYSICIAN computers in medicine." Each student is assigned a case to diagnose and treat using the full array of computer-based records and medical information systems that will be available in hospitals in the future. Students have access to the patient's computerized medical records and laboratory and drug reports, as well as computer images of X-rays or CAT scans. Students can use a medical expert system that helps interpret findings and make decisions; a data base of medical literature; full texts of reference books, clinical manuals and journal articles; the full Physicians' Desk Reference of drugs; a program that identifies interactions between food and drugs, and electronic mail for soliciting opinions from other physicians. Loonsk said the students respond well to the new technology. "The time spent on computers is definitely very beneficial," he said. Many come back to us and admit that they had to struggle some, but now that they're in a clinical setting and are seeing some of these tools at work, they're glad they had the experience." + - BY AND LOIS BI O BAKER MEDICAL S C he State University of New York at Buffalo has received a $500,000 grant to set up a supercomputing network that will place it at the vanguard of the emerging field of biomedical supercomputing. The funding comes as a $300,000 grant from the National Science Foundation and a $200,000 contribution from the University at Buffalo. The new system, which is 500 times faster than the current system, will allow faculty to intensify their work in two important research areas: biomedical imaging and the study of ion channels, tunnel-like structures that control the electrical behavior of cells. "Only a handful of medical schools have this kind of facility available for biomedical research," said Anthony L. Auerbach, professor of biophysics and director of the supercomputer project. "And I'm not aware of any other research university in the country having this level of research power available for ion channel studies." Knowledge of how ion channels work can provide new information on brain and muscle function and the causes of certain diseases. "This supercomputer will allow us to do experiments we could only dream of doing before," saidjoseph T. Spence, associate dean for research and graduate studies for the medical school. The supercomputer will support the work ofbiophysical sciences professor Frederick Sachs, physiology professor Donald S. Faber and Auerbach. + - BY IENTIST LOIS BAKER WINTER 1 9 9 2 �. .............. .. ........ . ............. . . . . . . . . . .... . ....... .. .. . ...... .. . . . . ......... ••••~• I UB's rural training track in famUy medicine accredited in rural areas, where the need for primary care physicians is great. The rural campus currently is staffed by two physicians and two resident physicians. It will eventually accommodate four physicians and resident physicians, plus a number of medical students who will rotate through the center. The practice will serve parts of two counties with a population of 21,000. Two private physicians, neither of whom offers prenatal care, currently practice in the area. By 1992, rural campus visits are expected to reach 18,000 per year. The Residency review Committee of the Accreditation Council on Medical Education has accredited similar programs at the University of Washington + and the University of ebraska. he rural training track in family medicine at UB has been accredited by the Residency Review Committee of the Accreditation Council on Medical Education, making it one of three universities in the country approved to train primary care physicians to be country doctors. The rural training program is part of a three-year program. Resident physicians spend the first year in Buffaloarea hospitals and clinics affiliated wit the medical school, and the remaining two years at UB's Rural Health Campus on the grounds of Cuba Memorial Hospital in Cuba, ew York. Cuba is a community of about 1,700 people 70 miles south of Buffalo in sparsely populated Allegany County. The resident physicians live and practice in the area, seeing patients at the rural campus and Cuba Memorial Hospital and Olean General Hospital, cosponsors of the project. "Residents tend to practice near the area where they did their training," said Thomas Rosenthal, M.D., clinical associate professor of family medicine and director of the project. "For the past 40 years, the American medical training system has focused on large urban institutions. " Rosenthal hopes exposing residents to a country practice will help reverse that trend and encourage them to settle BUFFALO PHYSICIAN - B Y LOIS B I This year's forum featured the work of 93 students, the largest field since the competition began. Projects ranged from a study of the effects of cocaine on the brain of a rat, to an analysis of heart disease risk factors in an old order Mennonite community. One student's research took him to Kenya, where he studied health and disease among the Rendille. Most participants conducted their research with the help of summer research fellowships, working at UB and other institutions. Forum particpants presented their research in poster form . UB faculty served as judges; each display was reviewed by three judges. More than 60 UB faculty took part in the judging. + AKER Research forum features wen of 93 medical students B medical students vyed for $500 prizes and the chance to take their research to a national competition during the 11th annual Medical Student Research Forum in early December. A N 0 BIOMEDICAL SC I Medical students present their research during the 11th annual Medical Student Research Farum. ENTIST W I NTER I 9 9 2 ED �rfi,iil".... ............ .... ..... ..... ................ ........................ .. ......... ... .... . ~ Fisher wins award for excellence in writing N adine Fisher, Ed.D. , a research scientist in rehabilitation medicine, recently received the 1990 Sidney Licht Award for Excellence in Scientific Writing from the American Congress of Rehabilitation Medicine. The award was presented in late October. Fisher received her doctorate last May ~ from the Department of Exercise Sci- ~ ence. Her research has been published v; Nadine Fisher, Ed.D. extensively in the Archives of Physical Medicine and Rehabilitation Medicine. Fisher received the award along with fellow authors professor David R. Pendergast, Ed. D., and professor emeriames H. Cosgriff, tus Evan C. Calkins, M.D. , for their Jr. , M.D. , was recarticle "Maximal Isometric Torque of ognized for his Knee Extension as a Function of Muscle contributions to Length in Subjects of Advancing Age ," trauma care at a published in the September 1990 issue dinner in November at + the Hyatt Regency Bufof Archives. falo. Nationally known trauma surgeon, James]. "Red" Duke, Jr. , M.D., delivered the keynote address on the effects of traumatic injuries and the ecoradley P. Fuhrman, M.D., was re- nomic factors of trauma care. Orgacently appointed chief of the divi- nized by the Medical Society of the sion of critical care at The County of Erie and co-sponsored by the Buffalo Medical Group and IndepenChildren's Hospital of Buffalo. Fuhrman, a UB medical school dent Health, the event was a fundraiser professor, is responsible for overseeing for Mercy Flight, Western ew York's clinical research and training programs emergency medical care helicopter serin the pediatric intensive care unit. He vice. Cosgriff, an assistant clinical professor will also participate in of surgery since 1962, has served as the modernization of director of Mercy Flight, chief of trauma the unit and impleservice at Sisters of Charity Hospital and ment new medical chairman of the New York State Commanagement promittee on Trauma. grams as well as build Duke, a Texas native, is a nationally a fellowship program. recognized authority on trauma care. Fuhrman was previously assistant director of the intensive care unit at Pitts- He established Houston's Hermann Hosburgh Children's Hospital. + pital Life Flight and help found the Cosgriff honored at Mercy Flight benefit J Fuhrman appointed chief of critical care at CHOB B BUFFALO PH Y SICIAN AND B I OMEDICAL American Trauma Society . A 1989 candidate for the position of Surgeon General of the United States , he was host of the PBS prog r a m Body watch . He currently serves as professor of surgery at the University of Texas Medical School at Houston. + Bettigole named Red Cross blood services director R ichard Bettigole, M.D., an associate professor of medicine and clinical associate professor of pathology , has been named medical director of the American Red Cross Blood Services Buffalo Region. Bettigole previously served as head of hematology laboratories, blood bank and clinical hematology at Erie County Medical Center. He is a graduate of Yale University and Columbia University Medical School. + John Naughton, M.D., right, dean of the medical school, receives an Award of Excellence at the 19th Annual Black Achievers Dinner held last October. SCIENTIST WINTER 1 9 9 2 �........................ . .. . ........................................ . ........ James Platt White Societr holds annua meeting embers of the james Platt White Society were honored at the society's sixth annual meeting held last October 18 at the Country Club of Buffalo. joseph T. Spence, Ph.D., associate dean for research and graduate studies, delivered a slide presentation on plans for the medical school's new biomedical sciences building. The dinner dance was held to honor society members, who have made annual contributions of $1,000 of more. The members of the james Platt White Society for 1991 are: Dr. Kenneth Alford Dr. William S. Andaloro Dr. Kenneth Z. Altshuler Dr. Amos Ar Drs. Kevin and Elizabeth Barlog Dr. jared Barlow Dr. Charles D. Bauer Dr. Richard A. Berkson Dr. Willard Bernhoft Dr. Russell W. Bessette Dr. Theodore Bistany Dr. Dennis L. Bordan Dr. and Mrs. Harold Brody Dr. Robert L. Brown Dr. August A. Bruno Dr. Elaine M. Bukowski Dr. and Mrs. Irwin Burstein Dr. David W. Butsch Ms. janet F. Butsch Dr. john L. Butsch Dr. Evan Calkins Dr. icholas]. Capuana BUFFALO Dr. Dr. Dr. Dr. Dr. Dr. Dr. .fl l Michael E. Cohen and Mrs. joseph A. Chazan George H. Christ Daniel E. Curtin Roger S. Dayer Carlo E. DeSantis PeterS. D'Arrigo Dr. Edward Diao Dr. Thomas A. Donohue Drs. Thomas C. Doolittle and Leslie Doolittle Dr. Kenneth H. Eckhert Dr. Robert Einhorn Dr. and Mrs. George M. Ellis Dr. Leon Farhi Dr. Daniel Fahey and Dr. Marie Runfola Dr. Donald M. Fisher Dr. Grant T. Fisher Dr. jack C. Fisher Dr. Richard R. Gacek Dr. Matthew A. Gajewski Dr. Kenneth L. Gayles Dr. john W. Gibbs, jr. Dr. Allen Goldfarb Dr. Seymour Grauer Dr. Harvey Greenberg Dr. Mala Gupta Dr. Thomas]. Guttuso Dr. Eugene Hanavan Mr. and Mrs. Edward Hansen Dr. and Mrs. Gerald Hardner Dr. Reid R. Heffner, Jr. Dr. Orvan W. Hess Dr. Takeshi Homma Dr. Bradley Hull Dr. Annabel M. Irons Dr. and Mrs. Kenneth L. jewel Dr. Charles Alexander joy Dr. Herbenjoyce Dr. Stephen T. joyce Dr. james R. Kanski Dr. Ivan W. Kuhl Dr. joseph L. Kunz Dr. Marvin Z. Kurian Dr. Andre Lascari Dr. Eugene V. Leslie Dr. Lawrence M. Lesser Dr. and Mrs. Harold]. Levy Dr. Stanley Lewin Dr. jack Lippes PHYSICIAN A N 0 The James Platt White Society's sixth annual meeting was held in October. Dr. Dr. Dr. Dr. Dr. Don L. Maunz Robert C. McCormick William . Mcintosh Harry L. Metcalf Merrill L. Miller Dr. Eugene R. Mindell Dr. joseph F. Monte Dr. john D. Mountain Dr. Richard L. Munk Dr. Arthur Mruczek Dr. Dennis adler Dr. Richard]. agel Dr. Masao akandakari Dr. Richard B. Narins Dr. and Mrs. john Naughton Dr. David H. ichols Dr. john]. O'Connor Dr. Benjamin E. Obletz Dr. Yasuyo Ohta Dr. Elizabeth P. Olmsted Dr. Arthur Otis Dr. Donald N. Pachuta Dr. and Mrs. Robert]. Patterson Dr. and Mrs. joel Paull Dr. Deming L. Payne Dr. Clayton A. Peimer Dr. Victor L. Pellicano Dr. james F. Phillips Dr. He rbert S. Pirson Dr. Dr. Dr. Dr. Dr. Dr. Ben Rappole Frederic D. Regan Albert C. Rekate Frank T. Riforgiato Alben G. Rowe Richard R. Romanowski BIOMEDICAL SCIENTIST Dr. and Mrs. Charles H. Rosenberg Miss Thelma Sanes Dr. Arthur]. Schaefer Dr. Robert . Schnitzler Dr. Roy E. Seibel Dr. joseph I. Schultz Dr. Elizabeth G. Serrage Dr. Edward Shanbrom Dr. and Mrs. Samuel Shatkin Dr. john B. Sheffer Miss Alice Simpson Dr. Richard A. Smith Dr. John E. Spoor Dr. William Sternfeld Dr. Gerald Sufrin Dr. Eugene M. Sullivan, Jr. Dr. Michael A. Sullivan Dr. Hiroshi Tazawa Dr. MichaelS. Taxier Dr. Charles S. Tirone Dr. W . William Tornow Dr. Anthony C. Trippi Dr. Ronald H. Usiak Dr. john P. Visco Dr. Barbara Von Schmidt Dr. Philip Wels Dr. Paul H. Wierzbieniec Dr. Gary]. Wilcox Dr. james S. Williams Dr. john R. Wright Dr. Hajima Yamabayashi Dr. Tetsuro Yokoyama Dr. Wende W . Young Dr. Franklin Zeplowitz Dr. and Mrs. David C. Ziegler WINTER 1992 ED �• ········ · · · · · ····· · ········ · ····· · ···· · ······ · ··· · ····················· ·· ······ · ········ ·· I 1 9 2 s 0 ROSARI E ROSSELL BENDER medical director of the Urgent Maryland. Theyhavefivedaughters (including five-year-old trip- '20 , of Ft. Lauderdale , Florida, is Care Department of the Western lets). JOHN published in 1991. 9 JOSEPH 3 R. 0 SAAB '34 , ANDERSON '67 , ew York Medical Park, was Board the author of Don't Say Goodbye 1 R . partment of Medicine at johns in 1989. Hopkins. 1 WALTER Z . SCHWEBEL '38 , is 9 7 0 s ROBERT P . GALE '70 , of Los Angeles, California, is a section from general practice and is living in Hamburg, New York editor of a new journal entitled Robert Gole, M.D. and is an instructor in the De- certified in emergency medicine s retired He is in private practice Cell Transplantation. JAMES A . SOLOMON '79 , is assistant clinical professor of dermatology and director of the International Centre for Applied Immunologic Principles at Tufts Medical School/Bay State Medical still active in pediatrics and is the Center. has MELVIN POHL '76 , has returned been appointed to the senior-acLive staff at the Memorial Hospital to Las Vegas as a family practitio- of Salem, New jersey (thisappoint- author of The Caregivers' jour- JANET M . WILLIAMS '88 , ment is only possible after 25 years ney, When you Love Someone With her husband john ]. Barbaccia of service to the hospital). Aids, published by Harpers. '88, announce the birth of their tired in 1982 and enjoys living in STEPHEN C . SCHE I BER '64 , ORESTES G . ROSABAL '77 , Jupiter, Florida for six months the executive vice-president of the who serves the Southern Medi- each year. liams is an attending in emer- American Board ofPsychiatry and cal Association as Councilor for gency medicine at Allegheny director of the Physically Handicapped Children's Program of Rennsselaer County, New York. 1 9 4 0 s A . ARTHUR GRABAU '45 , re- MYRON E . W ILLIAMS , JR . , '46 , tells us that he retired in july from Family Practice and Geriatrics. 1 9 5 0 s JOHN J . LAMAR , JR . , '63 , ner and addictionist. He is the 1 9 8 s 0 and daughter , Katherine Moore Barbaccia onjuly 17, 1991. Wil- Neurology, serves on the Edito- the State of Florida, attended their General Hospital; Barbaccia is rial Board of Academic Psychiatry 85th Annual Scientific Assembly chief resident in anesthesiology and is a member of the Board of in Atlanta , Georgia during at Mercy Hospital. Trustees for the Group for the November. Advancement of Psychiatry. JAN ICE DENISE W IL LI AMS '77 , OBITUARIES HENRY J . WISER '34 died in has a ROBERT M . TABACHNIKOFF private practice in neurology in '66 , was deployed inAugust1990, gynecology at the U.S. Naval Hos- Winter Park, Florida August 22 , Honolulu, Hawaii, and is doing while chief of the Obstetrics and pital in Patuxent River, Maryland. 1991. research in the epidemiology of stroke and Parkinson's Disease. Gynecology Departmental Keller Hospital, West Point, New York, R ICHARD F . BUSCH '78 , and served with the 46th Combat assistant clinical professor of sur- Harry 0. Westphal '58, of Palm Support Hospital in Saudi Arabia City, Florida, retiredjuly, 1991. until mid-Aprill99L gery (otolaryngology) at the University of California at San Di- JORDAN S . POPPER '56 , is an attending in obstetrics and ego, School of Medicine. 1 9 6 0 s MICHAEL I. WE I NTRAUB '66 , is His article "Intermaxillary Fixation THOMAS J . KAISER '43 died in May, 1991. diedjuly 15, 1991, at his home in JOHN WILLIAMS '43 , Cassadaga, New York, after a battle with cancer. com- co-edited a book with Arthur E. pleted the three-month Advanced Fass, M.D. ,onthecombinedmedi- with Intra Oral Cortical Bone Screws" was published in the Management Program at the cal disciplines of neurology and December 1991 issue of The july 11 , 1991 following a six- Harvard Business School in No- cardiology, Heart and Brain: In- Laryngoscope. year battle with lymphoma. vember, 1991. He is medical di- teractions of Cardiac and Neur·o- rector of Kaiser Permanente in logic Disease. Weintraub also co- KENNETH GLICK '78 , Orange County, California authored one of the book's chapters with Allan Rothman, M.D .. wife Sandy live in Baltimore, KENNETH E . BELL '61 , G BUFFALO PHYSICIAN A N 0 BIOMEDICAL HARVEY Z . KLEIN '57 , died on and his SCIENTIST WINTER 1 9 9 2 ��BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST STATE UNIVERSITY OF NEW YORK AT BUFFALO 3435 MAIN STREET BUFFALO NEW YORK 14214 ADDRESS CORRECTION REQUESTED Non-Profit Org. U.S. Postage PAID Buffalo, NY Permit No. 311 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician and biomedical scientist, Winter 1992 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1992-Winter Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. 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You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/3e0dce2ec1aeb6e1a08685b4933e8709.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource "The Four Noble Truths for Conscious & Creative Writers" Description An account of the resource Julia McCutchen, founder of the International Association of Conscious and Creative Writers interviews Gail Sher. "In this interview," writes Julia McCutchen, "Gail Sher will guide us through the framework of her Four Noble Truths for writers and lead us to understand how to: establish our writing environment, recognize our authentic writer's voice, troubleshoot obstacles that tend to trip us up, work with process as a key to unlocking our true potential, and cultivate and deepen our relationship with words, their inner silence and stillness." Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 2018 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Format The file format, physical medium, or dimensions of the resource audio/mp3 Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_140 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Subject The topic of the resource Sher, Gail, 1942- Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. 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Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource 1999 interview with Connie Platt on KDTV about One continuous mistake Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1999 Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 1999 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. 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Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Moving Image A series of visual representations that, when shown in succession, impart an impression of motion. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher reading at Niagara County Community College (1985): Discussion 3 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1985 Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 1985 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Format The file format, physical medium, or dimensions of the resource video/mp4 Type The nature or genre of the resource Video Identifier An unambiguous reference to the resource within a given context LIB-PC011_157 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Subject The topic of the resource Sher, Gail, 1942- Language A language of the resource eng Rights Information about rights held in and over the resource <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. 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Streaming server, YouTube, etc. Streaming server SherInterview https://digital.lib.buffalo.edu/files/original/76e8630e0dc1c441b14eb301c3cd3f2e.jpg f91b42616a4f700f7836870dca80ede5 https://digital.lib.buffalo.edu/files/original/995a3a3d69060a6af816aeea909d6324.txt 5ec8e8f4ebb5bdb06f76e3b91408850e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Moving Image A series of visual representations that, when shown in succession, impart an impression of motion. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher reading at Niagara County Community College (1985): Second reading of: : "(As) on thing which (headpiece) touches the Moslem Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1985 Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 1985 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Format The file format, physical medium, or dimensions of the resource video/mp4 Type The nature or genre of the resource Video Identifier An unambiguous reference to the resource within a given context LIB-PC011_156 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Rights Information about rights held in and over the resource <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_156 Video Type Encoding for the video; mp4, flv, mov, and so forth mp4 Video Source Source of video. Streaming server, YouTube, etc. Streaming server SherInterview https://digital.lib.buffalo.edu/files/original/c05a1152a89ac0803feccf3e56278047.jpg f91b42616a4f700f7836870dca80ede5 https://digital.lib.buffalo.edu/files/original/6ae09cb65be49771f01bd6aa1294f136.txt 4f00674b86b74714f2ba4fb0a04024bd Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Moving Image A series of visual representations that, when shown in succession, impart an impression of motion. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher reading at Niagara County Community College (1985): Discussion 2 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1985 Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 1985 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Format The file format, physical medium, or dimensions of the resource video/mp4 Type The nature or genre of the resource Video Identifier An unambiguous reference to the resource within a given context LIB-PC011_155 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Rights Information about rights held in and over the resource <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_155 Video Type Encoding for the video; mp4, flv, mov, and so forth mp4 Video Source Source of video. Streaming server, YouTube, etc. Streaming server SherInterview https://digital.lib.buffalo.edu/files/original/7ba806da636ba8e69d8ddccd90a8dcba.jpg f91b42616a4f700f7836870dca80ede5 https://digital.lib.buffalo.edu/files/original/c64df39321f5007d0209c21c37bd342f.txt 9bbddc26919c9c731a1048f53e0cc14d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Moving Image A series of visual representations that, when shown in succession, impart an impression of motion. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher reading at Niagara County Community College (1985): First reading of: : "(As) on thing which (headpiece) touches the Moslem Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1985 Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 1985 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Format The file format, physical medium, or dimensions of the resource video/mp4 Type The nature or genre of the resource Video Identifier An unambiguous reference to the resource within a given context LIB-PC011_154 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Rights Information about rights held in and over the resource <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_154 Video Type Encoding for the video; mp4, flv, mov, and so forth mp4 Video Source Source of video. Streaming server, YouTube, etc. Streaming server SherInterview https://digital.lib.buffalo.edu/files/original/869016d59cb63c65379619dd77e1a9ad.jpg f91b42616a4f700f7836870dca80ede5 https://digital.lib.buffalo.edu/files/original/ea902d4265aabbd0fb376aaeae16509d.txt 89894d01d4145f9c190846b0192e319b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Moving Image A series of visual representations that, when shown in succession, impart an impression of motion. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher reading at Niagara County Community College (1985): Discussion 1 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1985 Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 1985 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Format The file format, physical medium, or dimensions of the resource video/mp4 Type The nature or genre of the resource Video Identifier An unambiguous reference to the resource within a given context LIB-PC011_153 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Rights Information about rights held in and over the resource <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_153 Video Type Encoding for the video; mp4, flv, mov, and so forth mp4 Video Source Source of video. Streaming server, YouTube, etc. Streaming server SherInterview https://digital.lib.buffalo.edu/files/original/a8a02bad9189d6576fdf0f42cfaa42bd.jpg f91b42616a4f700f7836870dca80ede5 https://digital.lib.buffalo.edu/files/original/5babda61fafdd91db57238082884d5dd.txt 8494de51ae38e0ec4e018df56a930a74 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Moving Image A series of visual representations that, when shown in succession, impart an impression of motion. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher reading at Niagara County Community College (1985): Reading: "From another point of view the woman seems to be resting" Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1985 Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 1985 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Format The file format, physical medium, or dimensions of the resource video/mp4 Type The nature or genre of the resource Video Identifier An unambiguous reference to the resource within a given context LIB-PC011_152 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Rights Information about rights held in and over the resource <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_152 Video Type Encoding for the video; mp4, flv, mov, and so forth mp4 Video Source Source of video. Streaming server, YouTube, etc. Streaming server SherInterview https://digital.lib.buffalo.edu/files/original/6c35e30b76c731e591d9ea444dbb98cb.jpg f91b42616a4f700f7836870dca80ede5 https://digital.lib.buffalo.edu/files/original/43baec5d7bfad263533c2442c07f0675.txt b56f8cc6fa636f22f0038eb484910ef0 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Moving Image A series of visual representations that, when shown in succession, impart an impression of motion. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher reading at Niagara County Community College (1985): introductory remarks Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1985 Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 1985 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Format The file format, physical medium, or dimensions of the resource video/mp4 Type The nature or genre of the resource Video Identifier An unambiguous reference to the resource within a given context LIB-PC011_151 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Rights Information about rights held in and over the resource <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_151 Video Type Encoding for the video; mp4, flv, mov, and so forth mp4 Video Source Source of video. Streaming server, YouTube, etc. Streaming server SherInterview https://digital.lib.buffalo.edu/files/original/21854449c90436acf5b17f9e77eacbe3.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/38023f16503795e46ef6abcc974b4bc0.txt b387acb4d121b71d96477b076f2e33cb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Moving Image A series of visual representations that, when shown in succession, impart an impression of motion. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource 1986 reading of "The Lanyard" at Living Batch Bookstore, Albuquerque, New Mexico Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1986 Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 1986 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource audio/mp3 Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_160 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_160.mp3 Video Source Source of video. Streaming server, YouTube, etc. Streaming server Video Type Encoding for the video; mp4, flv, mov, and so forth mp4 SherInterview https://digital.lib.buffalo.edu/files/original/903f81ecf15506023787895a25e5a5b3.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/7d2e6eaac88531237d0e1d46c78aafc3.txt e6620c2e6bc8d02db5fc035149b295e9 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource 1986 reading of "For Bart" at Living Batch Bookstore, Albuquerque, New Mexico Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1986 Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 1986 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource audio/mp3 Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_159 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_159.mp3 SherInterview https://digital.lib.buffalo.edu/files/original/d5057be1186fa566d8b4ec1e9abc71d0.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/8395c307c594c949496b84a5c7dbf9fe.txt a42e9fd7029e00de422d54432fcac487 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource 1986 reading of "(As) on things which (headpiece) touches the Moslem" at Living Batch Bookstore, Albuquerque, New Mexico Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1986 Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 1986 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource audio/m4a Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_158 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_158.mp3 SherInterview https://digital.lib.buffalo.edu/files/original/5af154f18bd4c1c4a9d3b1a5ec6ecee9.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/a1375abbe5eb34813bdd01cfa9bec2e7.txt e644a321c8bcdecf32059af16aa92cc7 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher interviewed by James Maynard, Curator of the Poetry Collection at the University at Buffalo, Emeryville, California, March 19, 2018. Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2018 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2018 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Maynard, James, 1974- Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_150 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_150.mp3 SherInterview https://digital.lib.buffalo.edu/files/original/c06bbcc1fa98634100af0c87fd619ecd.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/c37cb912c348dd96680d2fe114066ea9.txt 301f133be07fb60b1c8a0d8bc9419d82 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Though actually it is the same earth Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2008 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2008 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource audio/mp3 Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_149 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_149.mp3 Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/e3c550a6d19b8484e601ab7e3a67ebf9.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/817647b965e65f82c6d0429bf8a6aa9f.txt 5a80efa6a342db0d325a8937988dd7e6 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The tethering of mind to its five permanent qualities Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2009 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2009 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource audio/mp3 Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_148 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_148.mp3 Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/30512fbc34ce2f0f81a3357a54cd1c6e.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/65d6e6aa29841cb67a6d0fd821a427c0.txt d48b337578867c23d6c59f70aa8ff6fb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Mother's warm breath Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2010 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2010 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource audio/mp3 Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_147 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_147.mp3 Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/44d2847d8755708243b5f46526a5a988.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/dff418bc61181014ce0f63d77e5bd08f.txt 5c91aaefb7d56d9b38353acb51982b18 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource White bird Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2010 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2010 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource audio/mp3 Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_146 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_146.mp3 Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/e6f40f24eacb5ab5a173b8a3dc8de2a9.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/5c23d39b0da56b67b1c34a108165d67b.txt d7537a562ac7528151290ad727e0b535 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Bardo books Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2011 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2011 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource audio/mp3 Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_145 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_145.mp3 LIB-PC011_145.mp3 LIB-PC011_145.mp3 Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/bcbd6359d090f90f7fdaa1af0a74ba59.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/89aa5272a593687a0838b4d550a89f28.txt 7f0abd345d48e91243a373f557214b8d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Figures in blue Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2012 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2012 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource audio/mp3 Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_144 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_144.mp3 Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/f5580e7447b07dd921b64e0c73cda531.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/eb3ef85d9c60c917519d67d103c5caa8.txt ea5e30808d6aecd482ea3852e77ac400 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Twelve Nidanas Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2012 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2012 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource audio/mp3 Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_143 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_143.mp3 Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/3feb0b24701075e5921e65e7244baf15.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/6014cea0e5080c6c33af0f4c4126a1c9.txt 9847f502c4e5c637d5c93dc11e8459ad Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Mingling the Threefold Sky Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2013 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2013 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource audio/mp3 Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_142 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_142.mp3 Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/7d1cc61c0a143912614c4015495f1f52.jpg 8fa9a78dab61ce65af4438e3a8e6d1e8 https://digital.lib.buffalo.edu/files/original/ab5a513395f8b89a7709bea708d10b61.txt c57d18e96a4e9c7b65f1fb783e083f5a Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Sound A resource whose content is primarily intended to be rendered as audio. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Selections from the Wisdom Mind Series : introduction Description An account of the resource Recorded May 11, 2017 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Date A point or period of time associated with an event in the lifecycle of the resource 2017 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2017 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource audio/mp3 Type The nature or genre of the resource Sound recording Identifier An unambiguous reference to the resource within a given context LIB-PC011_141 Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Language A language of the resource eng Streaming Video Elements needed for streaming video for the VideoStream Plugin Video Filename Actual filename of the video on the video source server LIB-PC011_141.mp3 Audio/Video Recordings SherInterview https://digital.lib.buffalo.edu/files/original/eb03b185a4639dcbe8dcfb14b6916f65.pdf 095f4fa7d400af2efa8b597ddb078d46 PDF Text Text ����������� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Broke aide [excerpt] Description An account of the resource From tramen 3, June 1985 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1985 Date Created Date of creation of the resource. 2018-11-16 Date Copyrighted Date of copyright. 1985 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_139 Extent The size or duration of the resource. 11 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng SherMagazine https://digital.lib.buffalo.edu/files/original/27c5079dd6e1c2b6d1f73575b9c59d12.pdf 20c16df46ebf3881319a202dd51a85d9 PDF Text Text �� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Chests in exact spiritual Description An account of the resource From tramen 2, 1984 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1984 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 1984 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_138 Extent The size or duration of the resource. 2 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng SherMagazine https://digital.lib.buffalo.edu/files/original/7f948441c5fd0257f3c2cbbc5555b944.pdf 13e2cdc25efba57662880c85b5ac946f PDF Text Text �� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Foal the water bush Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date Created Date of creation of the resource. 2018-10-30 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_137 Extent The size or duration of the resource. 2 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng SherMagazine https://digital.lib.buffalo.edu/files/original/b4cd1f4c7fb4ec0091cff083a9fdb43f.pdf 8eaf8cda7cd440c7cfaf9ecfbb963073 PDF Text Text ���� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource From Kuklos Description An account of the resource From Oblek: a journal of language arts, no. 6 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available The Garlic Press State University of New York at Buffalo. Poetry Collection. Date Created Date of creation of the resource. 2018-10-30 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_136 Extent The size or duration of the resource. 4 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng SherMagazine https://digital.lib.buffalo.edu/files/original/7d4c43c15fafc87ac410fcaff221a768.pdf 9e20ebe3780b8596d3479164fe82e4fb PDF Text Text ���� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Ocker marginalia Description An account of the resource From Jimmy and Lucy's House of "K", no. 6 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1986 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 1986 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_135 Extent The size or duration of the resource. 4 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng SherMagazine https://digital.lib.buffalo.edu/files/original/b250b524659a11352c09b1d99dd3792f.pdf 8020757fb9d06729f1250b50a6cca07b PDF Text Text ������� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Review of "Jailbait" by Brad Gooch Description An account of the resource From Jimmy and Lucy's House of "K", no. 3 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1985 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 1985 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_134 Extent The size or duration of the resource. 7 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng SherMagazine https://digital.lib.buffalo.edu/files/original/6c8f4731b52e4f37383f829c366a9241.pdf 1ef7cb09d74de9e9c88247e207f8a8d5 PDF Text Text ������ Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The poetics of emptiness Description An account of the resource From Jimmy and Lucy's House of "K", no. 9 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1987 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 1987 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). 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Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Aware of this as a social act Description An account of the resource From tramen 2 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1984-05 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 1984 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_132 Extent The size or duration of the resource. 3 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng SherMagazine https://digital.lib.buffalo.edu/files/original/1ce4904792205c69f38fd6af0ac75968.pdf e64f4d34c645ae0d4900488a52d45a14 PDF Text Text ���� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource An exorcism of representational language Description An account of the resource From the magazine L=A=N=G=U=A=G=E, January 1980, no. 11 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 1980-01 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 1980 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_131 Extent The size or duration of the resource. 4 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng SherMagazine https://digital.lib.buffalo.edu/files/original/c8068b1ae70a9a2cc37105c8bc41c7d6.pdf 978989a5dfec233c09e3634317feeae5 PDF Text Text Gail Sher interviewed by James Maynard, Curator of the Poetry Collection at the University at Buffalo, Emeryville, California, March 19, 2018 JM: Well, to begin today, this is Jim Maynard, Curator of the Poetry Collection at the University at Buffalo, home of the Gail Sher Collection, interviewing Gail Sher at her studio in Emeryville, California on Monday, March 19, 2018. Gail, we are having this conversation at what I think is a very interesting point in your writing career, in that you have recently been consciously reflecting on your development as a poet and reissuing some early work, while also, simultaneously, producing new writing, which I know you do on a daily basis. I think this provides us an excellent opportunity to talk about your poetry and poetics, as they may have changed over time to where you are today. After studying music for several years, followed by undergraduate and graduate work in English and Middle English, and then 11 years of practice between Tassajara and the San Francisco Zen Center, you made the conscious choice to focus your attention on writing. Your first published poems appeared in the magazine Credences in 1981, followed a year later by your first book, From another point of view the woman seems to be resting. Since then you have published a total of 37 books of poetry and several works of prose, including in 2016 Poetry, Zen, and the �Gail Sher-James Maynard Page 2 Linguistic Unconscious and Reading Gail Sher. Both of these, and especially the latter, provide your readers with a remarkably useful set of contexts for exploring your work and its “habitats,” as you say. And my questions here today in many ways depart from these two texts. In Reading Gail Sher you describe your work in retrospect as taking shape in four phases: Radical Language Experiments, 1982 to 1997, Asian-Influenced Work, 1997 to 2008, the Wisdom-Mind Collection, 2009 to 2013, and Late Work, 2014 to present. When discussing the first, you write that early on you realized that your “concerns” as a writer were “of a poet, not a novelist, short story writer, or essayist.” And that you “came to understand that [you were] a poet because [you thought] like a poet.” What I wanted to ask you first is, what does it mean to think like a poet? GS: Poets care about language. That may sound simple, but it's a life's preoccupation. So when I hear anything, even you reading that introduction, I hear the particular choices of words, like you used “depart” in an interesting way a few sentences ago. And there will be rhythms that are particular to who you are as a person and onomatopoetic inflections that typify who you are and where you're coming from. And that's what I hear. �Gail Sher-James Maynard Page 3 And then later I'll go back to the import of what you are saying, which is what most everybody else would hear. It's like a giraffe is oriented in the world in a very different way from a lion. And I'm like a giraffe, in the sense that I just don't function, I don't receive my experience in the same way as other people. And it's a constant problem. JM: Well, the word that keeps coming up for me, and I think I'll come back to a couple of times in these questions, is attention, which I can't hear the word attention without also hearing the word tension inside of it. So based upon what you just said, then, how would you say poetry, then, differs from prose or fiction or nonfiction? GS: Well, I can't speak for poetry in general because I don't think all poets come from the same place. And I'm not saying this place is a better place to come from. I'm saying I can't help it. It's just like who I am. But it differs in the sense of a novelist is thinking about character development and ethics and who is going to fall in love with whom, and who is going to reject whom, and how subtly all of these things take place in society. None of those things are my concern. In fact, in my poetry I have to bend over backwards to leave the story out so that people will pay attention to the language. �Gail Sher-James Maynard Page 4 JM: That brings me to my next question in terms of thinking about language, in hearing it first before understanding, as all good giraffes do. GS: Right. JM: I know from early on you were very actively engaged with music, having played piano and harpsichord and having studied music theory and composition. How do you think these experiences may have shaped this thinking about poetry and, in particular, your own reimagining of Eastern literary and musical forms from your Asianinfluenced work? GS: I actually formally gave up music when I was a Zen student at Tassajara, so that I could use all of my musical ability for writing. And I believe that I do do that. And it's only been in the last few months that I've taken up a musical instrument, but it's also only in the last few months that I've consciously ended my career as a poet. And in order to emphatically do that—because I did that once before and it didn't work; I ended up writing yet another poetry book—so I decided to write a novel. I used to hate poetry. And, in fact, I distinctly hated poetry and all I read was novels and literature that wasn't poetry. And so when I took up writing, my idea was to be a novelist. And I only had to learn later by default that my interests just weren't that of a novelist. �Gail Sher-James Maynard Page 5 And so now you're probably wondering, "How can I write a novel then?" Well I hired a tutor and I'm taking lessons. JM: So have you found yourself, then, inverting what you just said? GS: No. What I'm actually finding is that the lessons are completely boring, and I can't do anything that they're really asking. And I've got it down to sort of the way they've got it organized. And so I just flip to the back page and I read what the assignment is, and I hand them not the assignment, but I hand them what I've written already in between when they read my work the last time until I'm going to turn in this batch. They really want my next chapter and I'm really sending them an array of pieces that sporadically cover, basically, what this story is going to be about. It is not really a story, actually. JM: So how do you feel having so long tried to suppress that narrative in your radical language, to now be jumping in that side of the pool? GS: Here's what I really think. I think that the best novels are actually poetry anyway, but they're not language-based poetry. They're more maybe rhythm-based poetry or meaning-based poetry, which I have never written. So in a way, you could say I'm just writing a different type of poetry. But this is not my passion. I better stop and say something else. And this may be because you haven't gotten to the Wisdom Mind part yet. �Gail Sher-James Maynard Page 6 JM: My next question. GS: Okay. Well, I'm going to answer that question right now. That's really important. It's why I can stop. It's why I can officially say I've done everything I set out to do as a poet and I don't need to do it anymore. What I set out later to do as a poet, when I realized that it was my job and it kind of fell to me to do, uniquely, because of my, not only Zen background, but even more particularly Tibetan Buddhist background, I became aware that other languages like Tibetan and Sanskrit have the ability to convey wisdom in such a way that English can’t. For example, in Tibetan there are 15 words for love, and in English there's like one. So I set for myself the poetic task of enlarging English. So I feel like what I've accomplished as a poet, primarily, is stretching the English language. And the way I've done that is by leaving meaning out, but using language so that it implies a meaning, that it makes you think there's going to be one there any second. So if you sit with a very open mind, almost like a meditative mind, and read my Wisdom-Mind poems, you will find yourself going beyond the language into some other place. And that other place could be a wisdom-based place which is beyond language; whatever it is that's beyond language. And that's what I've strived to do. And �Gail Sher-James Maynard Page 7 by the time I got to The Twelve Nidanas, I felt like I had done that exponentially. The Twelve Nidanas takes place on about five different levels. And I felt like I was never going to do it any better than that. And there are a number of books leading up to The Twelve Nidanas, and there's one that follows it that's sort of a coda [Mingling the Threefold Sky]. I felt like I don't need to do this anymore. This is really, really hard. And the pitfalls are, since it doesn't quite make sense, it can also sound like nonsense, or it can sound silly or something like that. And that's not what I was after. So I had to toe this really careful line to neither be silly nor nonsensical, and also not quite make sense, so that the reader would make his own sense, but beyond language sense. JM: This always reminds me of, I think you find it in both Eastern and Western discourses that there is this long-time animosity between poetry and philosophy. That poetry makes a kind of experience possible. That philosophy wants to valorize and describe. GS: Yes, that's right. JM: But in describing it it cuts it off from its life force. GS: That's right. Because wisdom can't be described in language. Wisdom goes beyond language. So that's where my way of being a �Gail Sher-James Maynard Page 8 poet can do that. If you were like a novelist you wouldn't be able to do that, or if you were a regular poet who talked about anything. Really, I'm not talking about anything. I'm making something happen for the reader by the way I use the language. So I'm distinctly not talking about anything. So when I stopped writing that kind of poetry, the first thing I wrote was Sunny Day, Spring, which is way more prose-like. But what I loved about that book is that I said to my friends, "So it's 113 pages and it doesn't say anything." And so I was very happy about that. But then later I was still determined not to write poetry. And then I wrote Mary's Eyes, which, actually, I'm very fond of that poem, and it is a poem. And it took a year-and-a-half to write those 22 measly pages. But it's unique in a completely different way from my other poetry. JM: Just hearing you speak now I'm reminded, too, of the great Cage line, "I have nothing to say and I'm saying it." GS: Right, right. Yes. JM: This notion of interrupting the mind's habitual activities of sensemaking, that, for me, when I talk about that as a reader, both your attention and your use of tension, that's the tension. GS: That is the tension, right. �Gail Sher-James Maynard Page 9 JM: This demarcation between making sense, but deferring it, and kind of going back and forth. GS: Exactly. JM: So this space for wisdom that can be possible through language, do you think of it as a non-conceptual type of knowing? GS: Yes. JM: It's hard to talk about outside of its performance, but could you say a bit more about that space? GS: Well, that space, what got me started on that was the 12 years I spent, or 11 years or whatever it was at Zen Center sitting a lot of zazen and feeling at the end like, ugh, this is a total waste, basically. And then later I had a glimmer, actually. When I was at Zen Center I actually had a glimmer of, "Oh! I know what this is about. This is about the body. The body is what is understanding here. If there's anything to be understood you do it with your body." I had flickers of that when I was at Zen Center, but nothing like that was ever talked about, and so I never dwelt on it. But later I realized for absolute sure that it was the body that understood Zen practice, and that I actually had gotten everything. I actually had gotten everything. And I feel that was later confirmed, and I won't go into �Gail Sher-James Maynard Page 10 that story. You asked me how Zen practice and Tibetan Buddhist practice informed . . . JM: Uh-huh, and just to hear you talk more about this, what I think of as kind of a non-conceptual or non . . . GS: It's not conceptual. My first glimmer into non-conceptual came with the understanding that it was the body that got this kind of knowledge. And then my second, not just glimmer, but in depth round of it came with Tibetan Buddhist spiritual practice, which is very emphatically non-conceptual. And there's a huge portion of it that's just simply rote practice. Like to do the ngondro, which in Tibetan Buddhism you aren't even given your first anything until you complete what's called the ngondro. And each lineage has its own ngondro, so there are different ngondros. But the ngondro that I was given has five practices that you repeat 100,000 times. JM: Wow. GS: That's a lot. It took three-and-a-half years. These are called preliminary practices, before you even get to the first real practice. And so throughout all of that, and then also finally getting to the real practice, one gets a feel for where this wisdom lives. And it's that that I was working with in the Wisdom Mind series. �Gail Sher-James Maynard Page 11 JM: Do you think there is a connection in any way for yourself between writing and Buddhism and psychotherapy? Is that too much of a leap to make? GS: I would say the connection is there, but it goes from Buddhism to psychotherapy, and Buddhism to writing. I don't know that it goes full circle like that. Buddhism, definitely, informs my psychotherapy practice, absolutely 100 percent. More so than any theoretical model or this and that. It's informed me and I'm the tool for psychotherapy and that is how I work. And so not everybody likes me and so be it. But the people who do really do and their lives really change for the better, and I see it every day. And Buddhism informs writing in the way we've already talked about, like this whole Wisdom Mind thing. I don't know if there's like a circle there. JM: But it sounds like Buddhism is the key. GS: Buddhism is the key. But I've practiced Buddhism at least 40 years pretty intensely. So you can't be that intense about something and not have it be in your blood. It's the way I live, really. JM: That kind of study must re-hardwire your brain and your attention patterns. �Gail Sher-James Maynard Page 12 GS: It does, even to this day, when I'm not doing formal practice anymore. I made a conscious decision to just accept that writing was my way. And poetry is a Way with a capital W. And so I finally came to peace with that. JM: Thinking about poetry as a Way, I've heard many writers talk about their feelings, however sometimes vague, that all of their books, no matter how different they may be from one another, are somehow all part of an overall or overarching continuing project that they see taking shape through different parts or fragments. As we talk here today, do you have that sense of your own trajectory as a writer, or do you think of these four phases as distinctly separate periods of your work? GS: No. I definitely have the sense of them building, and then culminating with the Wisdom Mind series. And I feel like that book, The Twelve Nidanas, is the culmination of my writing practice, plus the one right after that [Mingling the Threefold Sky]. And from there, I decided to just have fun after that. The only book that I would put in a serious poetry category after that is Mary's Eyes. The others [“Late Work” 2014-2016] were just fun and I'm doing fun now. JM: I'm quite fond of Mary's Eyes. I think through the language there is a real construction of a space for contemplation in that book that I find quite powerful, actually. �Gail Sher-James Maynard Page 13 GS: Thank you. JM: Almost in an artistic sense, in that there is something almost dramatic about it. It's as if you're creating a stage for something to happen, for something to take place, a performance. GS: Yes, I was. That voice is different from all my previous work. And that's what I'm so pleased with, that it is distinct, and that I felt it was successful. But it took everything out of me, and so I'm writing a novel now. JM: And here's a question that I've actually wanted to ask you about for a long time. I've always been struck at how across your work these 37 years I keep coming back to use of parentheticals. And in Reading Gail Sher you say the “parentheses don't contain, they shield.” And then quote Kathleen Fraser on their ability to destabilize a text. Could you talk a little bit more about your use of these parentheticals in all of your work as both sheltering and disrupting something. GS: Correct. And, interestingly, for the very first time in my whole writing career, in my novel, I'm not using parentheticals at all. And every time I'm tempted to, I go, "No, no. It's not right." Isn't that interesting? It's interesting to me. I think parentheticals were right all the way from my very first work. I bet you, when we discover that first piece, whatever it is. �Gail Sher-James Maynard Page 14 JM: We'll track it down. GS: I bet you're going to find parentheticals there. JM: Well, I read them all so differently. Sometimes for me, as a reader, they give a multivoicedness to the text, as if there's a different voice speaking. Sometimes they have a tendency to shift the point of view from an interiority to an exteriority. GS: Yes, correct. JM: And sometimes they seem to shift things altogether in terms of register and tone and voice. GS: It does all of the above, yeah. I know. That's why I'm shocked it's not happening in this book that I'm writing now. It's not happening. JM: Well, I'll be curious to see how the novel ultimately ends up. In addition to always being interested in your use of parentheses, from the first time I read it my absolute favorite line of yours from Poetry, Zen and the Linguistic Unconscious is the following: "My biggest responsibility to myself as a poet is to remain in the realm of the unknown." GS: Yes. �Gail Sher-James Maynard Page 15 JM: "I don't write from an idea or concept or from any other analytical place. My writing arises, and I am constantly surprised by it." Now, I have to admit as a long-time reader and enthusiast of Robert Duncan's, this seems where you and Duncan are almost sitting in the same chair together. And this, certainly, I think, has many indications for thinking about the Buddhist element you've been talking about, as well as the psychotherapeutic, but could you talk about writing as a process of discovery? GS: Oh, yes. That is what it is, which adds another dimension to everything I said about the Wisdom Mind series because it is about the unknown. And even in doing it, you're dealing with that every single day. I don't have this difficulty anymore because I've been doing it for so long, I think. But I know for my students the hardest thing is to keep them not knowing because they want to know. "We have to have a plan for this and we need an outline and we need dada-da-." And then I tell them, "No, no. Just stay where you are and just see what happens." And they'll say yes, and then the next time they come in they'll forget they said yes and they'll go back to, "Well, but you know, I can't figure out . . ." But it takes place on a whole lot of levels. There's that level of what's going to happen next, so to speak. But there's also the level of just the mystery of language and your psyche and “allowing” in silence and allowing space for anything to happen. �Gail Sher-James Maynard Page 16 Not to mention, a skillset that's developed over many years. And then you put all that together in a set period of time on a regular basis and something does happen. Mary's Eyes just happened though it took a long time. Something does happen. I almost can say that it's just impatience at this point that keeps me from—I'm sort of almost tired of sitting there. And I'm still sitting there--and more is happening. JM: Duncan has a great line for it. He calls it the intellectual adventure of not knowing. GS: That's right. That's good. JM: But it's difficult. GS: It's very difficult. It's like the artist's blank page. JM: Well, I think of Dickinson’s “I dwell in possibility,” or Keats’s “negative capability.” GS: Yes, negative capabilities, exactly. JM: This is something that poets and artists come back to quite a bit. GS: Right. �Gail Sher-James Maynard Page 17 JM: I'm hoping we've got time for just a few more. I know we've been talking a lot about more theoretical considerations and your approaches to poetry and language. And I wanted to take a minute or two to talk about what your practice might have looked like in the past or now. You've talked a bit about exercises and activities as a way of preparing oneself to write. But for yourself, how does a poem begin? GS: Oh. It doesn't begin. The whole thing is a process and you just start wherever it happens to come out. And then it keeps coming out dayafter-day as you're sitting in your writing practice. And then you go back at a certain point with a different state of mind, with an editing state of mind. And you start finding where the energy is in the language. And then you throw everything else away that's not those parts that are marked with energy. And then from there, you start building a piece. And it's actually the writing that does the writing. The writing puts together the piece. The writing tells you, if you listen, "Oh, I don't need to come last. I need to come first." Like, "Oh! Really? Well, let's see." And then it either works or it doesn't. But usually it does if the language is saying so. And that's completely how I -- I never know what the piece is until it's the piece. I actually am the last to find out. JM: That sounds very different to me than other Buddhists' approaches, which I think sometimes put the emphasis on first word, best word. As if that extemporaneous outpouring is somehow purer. �Gail Sher-James Maynard Page 18 GS: Yeah, no. No. I totally disagree with that. In fact, I would go so far as to say that, unless it's crafted, it's not writing. Because who wants to read that kind of junk that just comes out? It's just junk that comes out. JM: My last question. I think we've been talking about this a couple of different ways, but I'll end with this. It's another line of yours that I really am quite fond of. You've written that poetry is dangerous. Do you want to say anything at the end here about the dangers of poetry for hapless readers like myself? GS: Well, I don't remember saying that. (I'm still back on the last thought, actually.) This idea of if it's not crafted it's not writing. The craft part of it is what identifies the voice. And so when I'm crafting, I don't even know when I first start what voice this poem is going to assume. And then as I'm crafting, the voice identifies itself, and then it takes over. And so then it tells you what's allowable to be in this piece and what isn't, and what's going to be first and last, and so forth. So the only danger would be forgetting to let the poem write itself. Then you could fall into the trap of thinking that you know what the poem is. And as soon as you do that, you fall into your mind. And regular mind is not as powerful as wisdom mind. This is my beef with academics. �Gail Sher-James Maynard Page 19 JM: Get in line. GS: Yeah, I'm sure. What's most important to know can't be known with the mind. And so it's all just chatter, really. So that's why I feel my poetry is so important, because I'm using language to get beyond language, which is where all the important stuff is. JM: The way I've interpreted that remark of yours, to go back to this notion of Wisdom Mind, and I think it's in Reading Gail Sher, you say, "Poetry is dangerous, after all.” It's our vulnerability before language. GS: Yes, exactly. JM: Language has the capacity to change us, or to become a transformative experience. It isn't premeditated; it can't be controlled. GS: It's raw, and it's really like being naked. And so that is vulnerable. JM: Well, Gail, thank you very much. This has been an absolute pleasure to speak with you today. And I can't thank you enough for your time and your generosity. GS: Well, thank you. It's been my pleasure, too. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher interviewed by James Maynard, Curator of the Poetry Collection at the University at Buffalo, Emeryville, California, March 19, 2018. Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2018 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2018 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Maynard, James, 1974- Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_130 Extent The size or duration of the resource. 19 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng SherInterview https://digital.lib.buffalo.edu/files/original/226f0cc85e4a7256ff5bcacf08714c94.pdf 50abf35af71a2bd58f9b0e6d942dde8c PDF Text Text Mary’s Eyes, a new voice in the radical language experiments Gail Sher has been exploring since 1981, joins the ancient passion of devotion to the cutting-edge linguistic so characteristic of her work. In addition to her poetry, Gail Sher is the author of One Continuous Mistake: Four Noble Truths for Writers (Penguin), the first of a widely-praised series of books on the craft of writing, informed, as is all her work, by the practice of Zen Buddhism, Tibetan Buddhism and Yoga. Her poetry is archived in the Poetry Collection of the University at Buffalo, library.buffalo.edu/collections/gail-sher. For more information and to read her poetry online, go to gailsher.com. Gail Sher Mary’s Eyes �Mary’s Eyes �Also by Gail Sher PROSE Reading Gail Sher Poetry, Zen and the Linguistic Unconscious One Continuous Mistake: Four Noble Truths for Writers The Intuitive Writer: Listening to Your Own Voice Writing the Fire: Yoga and the Art of Making Your Words Come Alive From a Baker’s Kitchen POETRY Elm Early Work Pale Sky Five Haiku Narratives Ezekiel Sunny Day, Spring Mingling the Threefold Sky The Twelve Nidānas Figures in Blue The Bardo Books White Bird Mother’s Warm Breath The Tethering of Mind to Its Five Permanent Qualities The Haiku Masters: Four Poetic Diaries though actually it is the same earth East Wind Melts the Ice The Copper Pheasant Ceases Its Call old dri’s lament Calliope Who, a Licchavi Watching Slow Flowers DOHA Birds of Celtic Twilight: A Novel in Verse redwind daylong daylong Once There Was Grass RAGA Look at That Dog All Dressed Out in Plum Blossoms The Moon of The Swaying Buds Marginalia la KUKLOS Cops Broke Aide Rouge to Beak Having Me (As) on things which (headpiece) touches the Moslem From another point of view the woman seems to be resting �Mary’s Eyes Gail Sher night crane press 2018 �Copyright 2018, Gail Sher gailsher.com All rights reserved Night Crane Press 1500 Park Avenue, Suite 435 Emeryville, California 94608 No part of this publication may be reproduced or transmitted in any form without permission in writing from the copyright owner and publisher. ISBN: 978-0-9978313-2-0 �For Brendan ��contents Mary’s Eyes 1 Sing 13 ��Mary’s Eyes ��i cold and snow. the sound of snow falling. the young novice’s eyes it’s (the) forgiveness that she notices (an old noticing) she feels thinks about Christ. will she marry him. she has already married him (she feels) asks if she is sure [bells sound in the background] figures appear. the clink of plates, spoons, hush of nuns eating the rule of the meal (omitting) the meal the weight of the prioress’s eyes readings turn to time (the word Mary repeated) verse empty of her suddenly 3 �ii a tall girl and her girl (their “astrology” of brotherhood) the eyes of one watching from a second-floor window what the watching girl is thinking versus the couple— walking, carrying books, talking loneliness and time. more loneliness and time “crippled time” she muses opening the sash for a better view as if time and her ribs—as if time stopped her ribs “see” she presses placing a hand on one a girl within the girl arrives behind the color orange “break it” she is yelling, throwing food at birds (she is always throwing food at birds) “grandpa fed the birds” she explains she says “the” as if the birds were his or always the same (or something) “the” (the article) making the thing “definite” pinning it down like a thumbtack 4 �orange and birds all curly like his hair mishmash of thoughts underneath grandpa’s car, intelligence, newspapers, noise the grinding of sound inside his head [inside her the smear of his aloneness or what must have been his aloneness] maybe he felt the birds would understand—if they would die or if HE would die “my feelings belong to sky they go up and are swallowed by sky” he would rail (being a person inside out or that his gravitational pull was wrong) as if words were too tight for his body or that he’d say, but instead of words there’d be sadness “the infant Jesus screams can’t you hear him screaming” he’d cry (actually I think I did hear) 5 �iii lines & squares, the enchantment of their honesty the certitude of straight untarnished by thought carves one on her thigh like a symbol of something important then forgets the thing that was important the mark (tattoo) is blue stands for Christ’s feet that eventually turned that color the turning of one color into a second color the brown of his feet still in Mary’s eyes the transmutation of space infected by what happens in it or the imbuing of a form with the means of a previous form touches a line forcing it to speak to say what she forgets (because she really can’t remember) the violence of gone (actually gone is impossible) what is its shape before it becomes its line or if the line is an amulet holding (probably-irrational) reverence beauty this thorough 6 �the image of his feet nailed to the sun its ball of red rising [here the landscape becomes an action that moves aggressively toward her] cups her ears so that it’s paused thinks of the letter F then E E and T summoning them to her so that she is not alone “with a letter I can be WHEREVER I want when I hold one in my mind I forget everything else” [the alchemy of WHERE versus the unawareness of a leg (for example) as if the leg were a mermaid’s rubbery tail (i.e.) a memory from the past trying to be from some other past] “maybe words are stars secretly” (she is thinking) turning one around (handling) it carefully because lightly let go a word suffers “words glitter and shine all by themselves in the middle of the night (seemingly) like a winter star all by itself (hanging by itself) seemingly” 7 �interlude alone in an open room water and wind (their) hardness in time wearing out time replaced she feels with time the freshness of wet blows around her lightly [her sense of the sea (awareness) of time (her presence in the room) co-adjacent with time] her dog too on the rug below one eye opening then closing (seemingly) content the sand covering its body and what the sand says about its life the dog’s ear and what the dog is noticing (waiting) for something to end sees the waves of the sea melt into sea its song vanishing to nothing the rhythm of the vanishing repetitive (prayerful) the earth (too) which the sea hears 8 �listens to sea (the sound of the sea breathing) the implacability of sea time its power and its blueness circling her like a tiger the tiger’s immaculate stealth 9 �iv blue late-April sky, sound of waves lashing the girl’s jaw remembering something ungraspable the sea itself ungraspable thin (soft) time which she dreads the coming of harm, ripening and then, moonlit coming to know (coming being its own naked color) “soon” she thinks but it’s vague the upshot of vague like a portion of a color notices sky, a shadow of a tree, the mind of the tree transferred to a form what the form may imply and whether or not she generalizes its significance reads the clothes for clues 10 �sees Jesus in his robes rising a little (bowing) toward her (slightly) sees herself seeing the vivid reality of his form the body of Christ (touching) it with sight (its) aperture and tone with regard to so much happening the event—Jesus rising—and then again rising— “toward her” had been there the first time (she is realizing) as if his life took place (in her mind a lion yawns) [but it’s clapping. someone is bowing to an act seemingly ended the impossibility of blue (since it stands for itself) ending] authority of blue (standing for itself) attentive (to) what we call color which may have taken place previous to time or even in some other time “what is my color before there was color” ransacks blue as if it were light instead 11 �she is what one is inside of drawn to what is known also sense of fallowness even her hair as if once it was some other color such that it’s cheap the slut factor of hips seeing the calling flammulated then, covered with feathers her name flying away away = coherence (as in food afterwards) the aura of a plate lingering there but in her mind it’s the girl’s blue-feathered shoulders “an owl at night, me the shrew” her shrew has no snout however 12 �Sing ��i a cow hangs toward the end of sky its green moo dead (a social cow) the archer thinks splotches of blood recede into sky his bow too recedes holds feelings of cow cordons off sky so that cow can rest “wipe the blood off ” someone says the cutting of time as if time comes in the slow tones of a woman the subterfuge of having it leans into seriousness (as if) time is a joke then “getting” the joke “what about eggs” someone says, pretending time is a koan 15 �“mind may eat without time mind may eat with neither food nor time” (as if food were time told by the throat making her have some) pleading YES as a motion citing this or that as others pass unnoticeable in her mind’s eye intends again, to eat (again) [a fool eats in slow-motion footage, reel continuous maybe something crawls out of tight dark space] the bag of her (she feels) socks in a silly pile burglars appear. what should she do is someone there. am I there police fence her yard barring her off, warning her probably. hoarding occurs probably + images of climbing—there’d be rain—without footholds, without grab-able bars 16 �reflected in (slight) convexity of ovary area (eating) off the knife, laughter off the knife the pregnancy of knives, cans wrapped in paper or things wrapped in whitish paper 17 �ii a bluebird’s song and then the sky afterwards propelled through time as if they were together blocked by shade, the shade carrying light anyway (its bullying white getting in anyway) its white versus ordinary white white releasing white such that the white of white is freed (white separate from “white”) releasing significance nonverbally white without releasing significance [having freed a color (separate from freeing) refers to alaya of existing like the black part of white such that snow exists for black also] scabs of snow on tree tip also the way it bunches on a branch, a bird in the branch if it moans (in the extreme heart of a woman) 18 �“the sound of snow could be air weeping” as if music were there but then it is over “over” as an idea turns into sky, the gray of mouths opening sings sky forward into treetops the method of sky, voice, snow in choral time no sound but sky the liturgy of sky (and before sky) mimes the One in a row silent canticles in a row 19 �iii moments of snow devolve into blue asleep to itself as if its brain were blue also slow (into the basket) slow into her (as if) trees are following her but the trees are narrowing up to her she will be a bird (she is saying) an ultra bird thought by one in pain one bird walks from shadow into shade tipping the balance slightly one bird versus no bird or if the bird doesn’t sing or fails to sing creates an absence of the bird loops of birds fight wears necklace of birds-in-a-row fighting wears necklace of birds-in-a-row dead 20 �an abstract bird clears in her mind [GEORGIE but her voice is slack] solemnly (solemnly) ice + the vague marrow of its bones “was there time” like a swan (leaves) its name in the air feathers & bones mute “lay dead, lay dead” snips time touching its feathers “poor Georgie” said (a bit bleak) sings in wind (adds it to the bird) 21 �iv [fades to black winter lake, swan (in it) swimming the midriff of the lake (its) hollowness in space] “look a crane” someone says taking out binoculars she turns to see the crane but SHE is the crane the hood of her head covered with snow offers condolences to her but SHE is the one offering condolences “cranes are always offering condolences” dancing in snow with their tracheas screeching bony rings rattling the emblem of her throat arched high in the full moon escutcheon of moon with medallion of her throat sings to moon which she feels is SO watching (hopes to hear the moon) 22 �the sound of a thumb presses back softly, the silence of a thumb in the pit of her stomach the sound moves to her throat its thumb speaks in her throat like a second throat aware of a thumb as a mouthpiece of pressure sees with her mind it being in a grave the lowering of the thumb (loaning color to earth) frill of snow covering it up [a drawing of the thumb: graphite on paper 1963 is written near the bottom the writing is cracked though] 23 �Mary’s Eyes is set in Minion, a typeface designed by Robert Slimbach in the spirit of the humanist typefaces of fifteenth-century Venice. Minion was originally issued in digital form by Adobe Systems in 1989. In 1991, Slimbach received the Charles Peignot Award from the Association Typographique Internationale for excellence in type design. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Mary's eyes Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2018 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2018 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_129 Extent The size or duration of the resource. 33 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng SherPublications https://digital.lib.buffalo.edu/files/original/e352da3b0f0f091d6be77062c6e000cd.pdf 7d3dc78118ecca6bbdce57da32d9774a PDF Text Text though actually it is the same earth Gail Sher Q night crane press 2008 �Tiger Dream Sun from behind the mountain falling on the threshers and reflecting from the lake gains depth from the sound of falling. The sound of water over stones at the lake’s edge is like a darting bird. If she wakes, she couldn’t say the bird disappears, but its breath dissolves, like an undertow at sea. How igneous (fiery) and lucid are the bodies of tigers, she muses. 21 �Commentary Each day the sun slips over the crest of the hill and lights the yellow grass. A cat climbs the hill as though dawn were in its head, entwining pieces (petals in branches). A day-moon slides below low tide. Fall-out from one’s skin protects it from further harm. Tide emits tide as she wanders down the coast, empty as a battered jug. 22 �A woman carries a jug dexterously embroidered on silk. The woman’s skin shines like the interior pink of a river. The dimensions of the jug’s magenta is implicit yet exacting. Out is not a direction but an aspect of conference around the jug’s battered aggregates. Bringing yellow out, where out is a structure of color and light, intensifies out, as if its DNA changes. 23 �There is an hour in which her memory will be there, where light falls in rain on a tiger’s flickering head. A stone woman prays, hearing sun in sun. (She dreams its precise nest.) A magenta flower glows so that I feel free at last. A magenta flower glows, disappearing in its skin. Light jumps back as if she has that person again. 24 �Death is color-added-to-color. Color learns color by touch, like the feel of rain from one’s bed. What if the occurrence of harm refers to the difficulties of offering the harm? In the broad space of an animal, a wound in a woman’s thumb feels like embroidery of jasmine and honeysuckle. The necessity of something and its form is the tiger sleeping, tail to tail, in tandem with something. 25 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Though actually it is the same earth Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2008 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2008 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_128 Extent The size or duration of the resource. 6 p Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/4c50546673596aea46a95b58702bd20f.2 2d23e4ead1d55271decf07d1bc2cfb7e PDF Text Text The Tethering of Mind To Its Five Permanent Qualities Gail Sher Q night crane press 2009 �ii A gull circles a wedge of water, marking the water with her eye. The memory of her skin is limitless, like the memory of her cry, before a kill or later for the sake of others. Wind, too, gains qualities by its forcefulness with things, its hand, say (a piece of sun cut off). A crack in light, like a painting of light. The palette of wind is gold, she mutters, the boundary of a man playing chess in light being the dead person. 65 �A flower emits voices behind falling sun. A flower is soft and the pain of soft reminds her of a sea of heads. As if her life dreams its own violence. If a bird disappears, she may have asked for this to happen. She begins to think that mountains wash out mountains. That the sea of heads form a land on which to walk, which she calls the isthmus of larks. 66 �So a bird flies flat and what is it about its sleek blue mind. Is a bird a bird or quality of place dawned by the bird? you mutter. You look at a chirp, though it could be surreal. A tree comes just at the point of sky. Phenomenology of the tree rides not so much on the stature of the tree but like the tap of a cane, where it goes after it is hidden. 67 �A sycamore branch in late light sheds, as if sun splashes scattered shards of larks through needles of light-fall. Time is little drops like from a spout drip-dropping the bough. Its stem is underground, someone says, and I have a memory of a double stream flowing deep beneath the earth. You tap on the stream to awaken the stream so that the leaves stop shaking their light out of it. 68 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The tethering of mind to its five permanent qualities Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2009 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2009 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_127.2 Extent The size or duration of the resource. 4 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/67125cd41265b840e85b745acd74ea9b.pdf 3f50323259074a698850aff1c2263a62 PDF Text Text Mother’s Warm Breath Gail Sher Q night crane press 2010 �ii My mother is a place. And a being from there having qualities, as if she is also from there. From the inside of her being her, gradually becoming her in the same taste as russet-pink. Russet-pink is a field carrying one’s pure essence, like a whiff, oh! that’s her! Maybe some pawmarks. Totems of her gaining belly from herself. 83 �A place is by chance (like pain is a guess). Like a lid with its definite jar, she’s attached to this, thinking maybe there’s no other jar. The lid has a slogan, which she wears and thinks it’s not right if her family does not. Like a birth word, say. Every person has one word. 84 �Held adrift by old old hearing. Don’t touch you! says her own face. (For she recognizes the previous resentment and its marks on her old face.) As if spring follows summer and we are already at the beginning. If my father is murdered, does that mean I am dead or (like one’s face in sound) about to be dead? 85 �A legacy of light is separate from reflection, like a legacy of dog only sees itself. So there is mourning but not knowing. She could be a dog thinking she’s a dog. Her formless growl cracks like a flower, like shards of voice but one hears only the thinnest outermost skin. I harbor myself in the familiarity of something, air, leaves, peacocks running across a field. 86 �People coming in like the last second of her knowing. As if she’d snapped her teeth. Stealing knowing, she becomes simple. In the interstices of a plan, like knowing skips to what’s there anyway. The value of her in the real actual sitting down, till she rests. 87 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Mother's warm breath Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2010 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2010 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_126 Extent The size or duration of the resource. 6 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/520af15a469240fbc4c25ff7ac9e7528.pdf e8c862c9b0558fbf6461a6da97af8005 PDF Text Text White Bird Gail Sher Q night crane press 2010 �1 A man wearing birds, sitting in birds, inside the birds’ flow. Together they’re called White Bird. White Bird grows tall. White Bird hugs his own legs back. The meditation of sky streams into his heart so there’s a passage of heart into which he may relax. White Bird relaxes back into his heart, breathing white, like the beauty of a seed or wind in a bird’s hair. A man sits in wind wearing few clothes, but the birds come and sit on him like clothes. 57 �White Bird stops. Summer light swarms his shell and the blue shell breaks. The beauty of his wing fills with sky. A gull too drags its sky. As if it were an ear gathering in sky. Beauty is sky. Beauty is rain in sky’s past sky. 58 �My mother’s arm is pure, its curve of sky seeping into structures. Then later someone says, That person is a dead person. So then I think, The beauty of sky’s color flows from her arm reminding me of her arm. I want to wear sky, I holler. (I am in tune with degrees of my mother hanging from death like a soft shoe.) Her yellow armpit sags, like old newspapers would be lying fallow as they do on distant fields. 59 �A man buys socks but it is really death lurking in sky. I want to dust sky out so that my limbs swallow themselves. He looks, passing by death, as if he is new, in sky now, as he puts it. O look at the birds! They’re combing each other’s hair! (He’s watching a bird gather its gorgeousness.) My mother is a line. Within the death-lines she is one. But a node on her blackens and then she is not my mother. 60 �I know a bird whose color is sky before the sky admits itself. Like the brain of a color if sky admits the bird. A mountain is visible inside the bird then. Its color dies then. A queen bird releases into sky. There’s the sky! someone says, as if there is sky, the location sky. That bird knows me well, I’m thinking, because the bird is mostly dead. 61 �Here is a corner of sky, mother says, fondling a dead bird wrapped up in her pocket. (The bird had lost sky. That’s why it died.) I am the oscillations of a flower, inside, like a flower’s brevity, she whispers. A tall bird tumbles through sky. The touch of its voice is like a raw egg folded into zero. My mother feeds me air, the tablature of air, doubling air, forcing it to become air to something. 62 �I dream of air (a box of air) because I conflate air with my dead mother. She could taste the flavor of the box and in her mind suck out the box. (Secretly she criticized people who didn’t suck.) Her feet swell in air. The ascending foot, like you could crawl inside the foot. Who is the end of my mother? Who is the end of my death? (I am organizing myself backwards.) Flowers fall, but mountains blossom in air. Born in air, I’m in air already, like a broken piece of air. 63 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource White bird Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2010 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2010 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_125 Extent The size or duration of the resource. 8 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/323a0537bfdf16a399f8bbd48e94c549.pdf fa4669ade19b0d7e0c88f0175920dbb3 PDF Text Text The Bardo Books Gail Sher night crane press 2011 �Bathing Suit �A woman begins, is the value of space, like a child in a pool, shuffling air in which hard wood is air. She breathes through wood, taking sharp quick breaths. I want the soft cloth of children, she’s saying. Her breath has height and the texture of children swimming, new swim, out and out, yet clearly touching the bottom. The mind of wood may rest itself to completion, she murmurs. Wood and air is swimming there, in the space of air filtered through a dark forgotten memory. 16 �She is complete air. She tucks herself in air, as in the taste of breath, the babysteps of breath. She is anterior to her air and tries to tie air like a ball. Someone gives me a ball and I tie up the ball. I feel certain that I want to tie the ball. She calls it air because it’s there like air, but actually it’s a kind of stupidity. 17 �Swimming is like a captivity in its body. Every minute in a row I am swimming everywhere and wanting to spend my time swimming swimming swimming. Because death, too, is an integer. I say ‘grass’ and it follows me into longevity. The absence of time, like grass without time, or a lizard in its skin but outside time so that its purity lay in its body. The brain of the sky snaps an instant to its purity because everything perceived is Buddha Vairochana. 18 �My mind vanishes then. Inside its skin it has its male and female aspects. A pool of mind is a passage of light, raw light, the membrane between the watery part of light. A person flows through wood and is the breath of a swimmer, like two dead people in love. Air in a heart is the same air resting there. 19 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Bardo books Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2011 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2011 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_124 Extent The size or duration of the resource. 6 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/f594c528e72f77d68f1245e3360857f1.pdf 638e846a857ad952c93309ac9fccd2f7 PDF Text Text Figures in Blue Gail Sher night crane press 2012 �DAFFODILS A woman alone at a large open window gazes at the sky. The soft flesh of her arm folds around a basket. If she is dead, the colors may be alive. Her soft flesh holds a premonition of her, calls its form within the form of its space in sky. She is miming sky with her body. Taming its color, like a double her of color. There is a sense of intense activity in the buildings and neighborhood, so familiar, yet her skin is not that. 1 �Angst from the street, but what prevails is the face of a person waiting. An agony of light chugs through her body. If she could roll out her body, like make a road of her body, there is the sense of that being all there is. As if her flesh were a habit, a woman stands in sky, catching it in the drape of her dress. 2 �As she rests in the bare window she is dead. I (am dead) she says. It stands like a point of view. A strip of death is on the woman’s arm. She wants the death eagerly, like time tucked in her arm. On the crest you can just touch death, she feels. She sees an arm (the boundless ordinary nature of her arm) in a gown, in the sky, wrapped in a column of the unsaid. 3 �Sky like sea, around a woman hugged by sea. A man is a response (like sky and a sea wall). The float of him sinks, then appears on the horizon. I am exempt from sky if I empty myself toward it. The flaccid man’s ribs absorb the thick musculature of her arm. Daffodils range, placated by time, but it is the habit of deep slumber. 4 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Figures in blue Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2012 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2012 Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. Poetry Collection. Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_123 Extent The size or duration of the resource. 5 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/72a7fd334c6fa7fc4a65a584b494d251.pdf 86d1ccd907607b31c9e237fa401d4c7d PDF Text Text The Twelve Nidānas Gail Sher night crane press 2012 �III I walk through trees, a series of squat willows, and see the space between the willows as time. Because it’s not the space, it’s the emptiness of mind (whose energy is grounded to its darkest possible color). Taking birth beneath a tree, I want to feel my longing for the tree, my deep thought of you in its disentangled precision of stillness. One bends, taking its time, a full earth of time. How do I wander into its leaf? 9 �Merely touching earth, gently touching the awareness of earth, like the beginning of day in earth. Leaves stretch to sun, the full breath of sun, but I am left gasping. My reference point is fading. The underleaf is blank. But blank itself catches me in a kind of double-take. A gap exists but she refuses to see it, which is a third sort of fuging, like the darkly yellow on the leaf ’s bottom. 10 �That yellow cala lily, earth and earth-consecutivewith-darkness, a coincidence of blood and dark and color, such a yellow, heavy and unknown. Indexed to light, this card of light folds around the sleeve of your body. We take shelter in abyss, which looks like a color, magenta calligraphed in a cala lily’s cup, deep in the cup, its fire. Color filters light is not the net color that the cala lily tells by way of its earth sign. 11 �IV Night is her skin, its pleats the quiet fold of her. Background and foreground are the memory of a skin wearing dynasties of her. A bird touches night and her skin moves as if it were tied to this. As if a mass accumulates in a narrative of space. Now preserves as a robin opening out of its capacity in me. I want to pet it. I want to cry. The intimacy of a word before it is a word, so that it’s now, in the interval, wears its own full body. 12 �How many tiers live in a word and the hues of the tiers in the space of the word’s awareness. I, the word, in the space of my form, imaging my form, like a lion in its death throes. I swallow you and emergence in a word. (The word’s shape is how death looks like this image.) A cold press of wind through a word’s tired body could be hell or a word separate from its word. 13 �To feel into a word, which may be neutral, but may be like an animal who gets the word, as if the word were a lesion in its body. The lesion could be freedom because a word has no location, like a break in the hills. (Mostly our words are skeletons of themselves.) One senses the transparent quality of its body, an unchangeable power that runs alongside its body. I am a word. I am the ultimate fearless word, beauty or sky so that there is nothing in the way. 14 �A word lands on her cheeks. Unspeakable is the word. Unspeakable is the crutch, the cane of the word, the transparency of the word that relates to her as a body. As how several letters cast a sense of time, like a painting casts depth, which is the image of death in a room. Then the dream of the word amalgamates. First there’s sky, then the full comportment of a body. Sky-swaddled words catch the light of death. I want to believe each word, like pray to the word, because you want to believe in its denial, forgiveness, everything. 15 �A word lay in snow. If you lift the snow and suspend your idea of the possible, it’s like space linking space to all constellations of that word. The sheer resplendence of a word, as how the daughter of a word, a whole lineage pouring out from its god-father. A child picks up a word. It’s the enjoyment of the word, the shape of all commodious expressions that the mind living in that word carries. In a tapestry of texts, I am in the moment of one, as if I had gone to sleep. 16 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Twelve Nidānas Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2012 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2012 Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_122 Extent The size or duration of the resource. 9 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/5cb166e182aa8612b5995a9138c5b0e8.pdf dda7142c8aeb7233df8fd5aa437ef6ed PDF Text Text Mingling the Threefold Sky Gail Sher night crane press 2013 �Y E L L OW 7 �A vein of sun hits a woman’s cheek. What is her face, she wonders, a blush of cheek beneath the long hair of her goldenness. How sunlight fills the sky is how the mind myelenates appearances to her. Whose milt is on the edges. It stands in front of sky such that all she sees is sky. The absolute knowing of sky, weather and sky, like a prerogative that’s said against which she may stroke her child. 8 �Though she sits facing away, as if it is in her, one feels the age of this away as her. The painter paints time locked away from its material, like her own personal face exiled from her face. As if away without location is the real time, the real completion, a recrement of sky, the other loneliness of sky. Rangjung dorge’s face. Its light is not what is in me that way. 9 �As the moon releases into sky, shedding yellow back to sky, you see a person’s face deep in the heart of the eye of one. Day walks out of day losing track of its intelligence, the part of day held back from day or the end of his life which is so heartbreaking. Sound at a distance extends from in front of him. The arc of his face leaks into shape. The space between her face, the moon’s display of face. (The features of her belie her apparent face.) 10 �* The color of day, two figures in a plain, as if two were possible outside of itself as a number. As if day were a point dabbed like paint onto the brief cortex of togetherness. A pattern of her in yellow, such that she too, though he, the he of how they came to be here forever. Where clouds are yellow and birds are yellow, a double portrait of her, which is them as who she is. 11 �It’s like these two things, the way light throws itself over land, them as a pulse, a stream of apposite colors. The metaphysics of grey within a yellow space, or closeness, the duo of her body coming to be the grey. For this she’d received an empowerment. A doleful space of air. A prosody of air. The belly of the mind leaks the containment of them, as how the painter lifts the them of them and simply puts it on a piece of paper. 12 �Waiting is the movement. Waiting is not resting because the aspect of pair, a person’s hat of hair, the tip of the world at the edge of his hair. The man is not. He is thinking about something else. His hat facing light holds the tension of his being there. The skirl of light obscures to fading light. A vague sense of waiting hangs over his elbow. Now he is home listening to its softness as if inside me I have finally found my bedfellow. 13 �* The fold of a tree over light on a road, if she is in the road, the sense that she would be there anyway. An old live tree, like the life of someone screaming, is the language of the tree pushed outside its form. What colors grow untouched in her, her and her, what she sees on the Paris streets. Old registers hard even in a bit of shade. 14 �What is it in a tree that seems to be erased, as if emotion were space, and the subtlety that is part of the tree, the great washing over of space. The way time holds light on the inside of her which is how color organizes itself toward a person. It makes me question whether sky is the same since movement is not limited (I begin to see sky as limited). Fifty three skies settle in my backyard may simply be sky pouring out sky. 15 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Mingling the Threefold Sky Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Publisher An entity responsible for making the resource available Night Crane Press State University of New York at Buffalo. Poetry Collection. Date A point or period of time associated with an event in the lifecycle of the resource 2013 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2013 Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_121 Extent The size or duration of the resource. 15 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng Audio/Video Recordings poetry SherInterview https://digital.lib.buffalo.edu/files/original/309fd2b415ac66de1778e2cee3cea5a5.pdf 5d8f530f9e067b5b683c7541997a7ea2 PDF Text Text Selections from the Wisdom Mind Series Read by Gail Sher (recorded 11 May 2017) Introduction: “Between 2009 and 2013 I wrote a series of eight books, beginning with The Tethering of Mind to Its Five Permanent Qualities, and culminating in The Twelve Nidanas and Mingling the Threefold Sky that are rooted in Tibetan Buddhist philosophy and dedicated to “stretching” English in order to create gaps so that Wisdom Mind might flow through to the reader. The idea in these poems is to not-quite-make-sense. The beauty (hopefully) of the surface language plus the strategy of “approaching narrative” first intrigues, then holds a reader, allowing, in stillness, the dawning of a new kind of intelligence. As a poet, I feel that this body of work is my most important.” Print source: Sher, Gail. Reading Gail Sher. Night Crane Press, 2016, pp. 3-4. File name: sher gail intro wisdom mind.mp3 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Gail Sher Collection Subject The topic of the resource Sher, Gail, 1942- Poetry -- United States Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Identifier An unambiguous reference to the resource within a given context LIB-PC011 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Selections from the Wisdom Mind Series : introduction Description An account of the resource Recorded May 11, 2017 Creator An entity primarily responsible for making the resource Sher, Gail, 1942- Date A point or period of time associated with an event in the lifecycle of the resource 2017 Date Created Date of creation of the resource. 2018-10-30 Date Copyrighted Date of copyright. 2017 Rights Information about rights held in and over the resource Copyright Gail Sher and used with permission. Contact the <a href="http://library.buffalo.edu/pl/">Poetry Collection</a> for more information. <a href="https://rightsstatements.org/vocab/InC/1.0/">IN COPYRIGHT</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). Format The file format, physical medium, or dimensions of the resource application/pdf Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context LIB-PC011_120 Extent The size or duration of the resource. 1 p. Is Part Of A related resource in which the described resource is physically or logically included. LIB-PC011 Gail Sher Collection Language A language of the resource eng Audio/Video Recordings SherInterview https://digital.lib.buffalo.edu/files/original/ea9203538521e2ddea354a4eecb3ca70.pdf 76d9e665fbe7bcc68b1dd07a99c7ea9a PDF Text Text �... DEARALUMNI ANDFRIENDS, BUFFAlD PtIY~I~!6N STAF F EXECUTIVE EDllOR UNIVERSITY PUBLICATIONS Ro~rt T. Marlett BUFFALO PHYSICIAN EDllOR Connie Oswald Stofko AR:r DIREClOR Alan ). Kegler ADVISORY BOARD Dr. John Naughton, Cluurman Dr. Harold Brody M, . Nancy Gheco Dr. James Kamk1 Dr. Charles Paganelli Mr. Gregory Zittel Or. Antoinette Peter-s Dr. Charle, Pruet Dr. Luther Robinson Dr. Thomas Rosenthal Or. Saleda Suresh Dr. Burton Sing~rman Or. Stephen Spaulding Dr. Nelson Torre Mr. Edward Wemke Dr. Paul W1er:b1en1ec Dr. )trome Yates T he school successfully completed its institutional selfstudy on schedule in mid-June in preparation for the November LCME survey visit. I am graceful to the department chairmen, faculty members, students, full-cime and voluntary faculty members, hospital directors, and board of trustee representatives who served on the Steering Committee and received the reports chat emanated from every aspect of the organization. This sixmonth effort served to establish the state of the medical school today and to develop an agenda of recommendations for casks which should be accomplished between 1988 and the next LCME visit in 1995. Indeed, I chink the process proved that the medical school is strong, the faculty and student body are committed co the achievement of scholarly excellence and meeting the needs of society, and chat each wants the school to improve even more in the years ahead. These are good signals chat the momentum developed over the past several years can be maintained. As has always been the tradition at the UB Medical School over the past 142 years, the multiple constituencies are committed to working harder to attain higher levels of excellence. This should bode well for the upcoming accreditation visit and for our future as we begin to think more earnestly and intently about medicine in the 21st Century. Sincerely, Joh n Naught on, M .D. Vice Presidentfor Clinical Affairs Dean, Schoolof Medicine and BiomedicalSciences WRITERS Li<a Josephson Clare O'Shea Mary Beth Spma David Snyderman Ann Whitcher ILL US TRATOR S M1chad Gelen Glyn,s Sweeny P H OTOG RAPH ERS Doug Levere Dan1d Morelli Ian Rcdmbaugh T EAC HI N G H OS PI TALS Batavia Veterans Admini~rrat1on Medical Center Buffalo General Buffalo VeteransAdmm1'-trat1on Medical Center Children's Enc County Medical Center Mercy Millard Fillmore Roswell Park Memorial lnsraute Sisters of Chamy Produced~ rhe Di<is,onof Um, en1h Relationsm as.<OCUUwn u:,rh,he Schoolof Medirine and BiomedicalSc,ence.s,Suu, Uni,m,r, of Nru Yorkat Buffalo. THE BUFFALO PHYSICIAN ANO BIOMEDICAL SCIENTIST (USPS 551-860) Autumn 1988, Volume 22, Number 3. Published five 11mes annually: Spring, Summer, Autumn, Early \\'inter, and Late Winter - by the School of Med,cine and Biomedical Sciences, Stare Univermy of 1':ew York a, Buffalo, 3435 Mam Street, Buffalo, New York 14214.Third class bulk postage pmd at Buffalo, New York. Send address changes to THE BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST. 146 C.F.S. Addiuon, 3435 Main Sm,et, Buffalo, New York 14214. Cove r Ph o to: Danit! Mon:11, DEAR FELLOW ALUMNI/ ALUMNAE: T his is the time of year when the Alumni Board develops the program for next year's Spring Clinical Day. Dr. Nedra Harrison is working with her committee on an excellent program for our scientific day, and Dr. Joseph Kunz is working with the reunion class chairmen to gee their plan5 set for their class reunions. Again this year, l will try to keep you abreast of the happenings on and about the Unive rsity through our newsletter, and I remain open to any suggestions you may have. In conjunction w1ch the dean's office, we are crying co establish an award for a distinguished alumnus of our University this year, and plans are being sec forth with the committee to select such an individual. If you have any suggestions as co a distinguished alumnus of our University, please forward the name with a brief biography of the person to myself, Dr. Jack Richert or the dean's office so that person can be brought into consideration. As this year seems to continue co slip by, I can only look forward co my 15th reunion this coming May, and I hope that the members of my class will be active and participate in this reunion celebration. Sincere/), Paul H . Wier zbieni ec, M .D. �Vol. 22, No. 3 Autumn 1988 Features 2 East Meets West. Emerging from years of isolation, China is reaching out to improve the medical care of its one billion inhabitants. Under a new exchange agreement, scholars from Beijing study Western techniques here while Buffalonians learn about Chinese techniques such as acupuncture. Page24 10 Medicineandthe Arts.The creativi ty of health-care professionals was the topic of a summer symposium organized by the UB Health Sciences Library. 14 TykeTrike . The colorful tricycle that six-year-old Sarah Tangelder rides has been modified by UB researchers to give electrical stimula­ tion therapy to her paralyzed legs. Departments Page 10 18 Research.The latest developments in organ transplantation and a new test to diagnose celiac disease were discussed at the 11th Inter­ national Convocation on Immunology sponsored by the Ernest Witebsky Center for Immunology. 21 Classnotes . MedicalSchool.Suk Ki Hong, M.D., discussed his "Thirty Years Underwater" when he gave the Stockton Kimball Lecture at the An­ nual Faculty Meeting. This year's winner of the Stockton Kimball Award was John R. Border, M.0. 24 31 People. Page22 32 Alumni . News of the reunions. 36 Events. �2 hinese B y CONNIE edicine OSWALD STOFKO raditional Chinese medicine has been largely ignored by the west, but seeing it practiced in Beijing has piqued the interest of a group from Buffalo who visited China in March. '~nything that's been going on for thousands of years must have some usefulness;' reasoned James M. Schlehr, a medical student who made the trip. Veronique James, another student, wou ld like to return to China to learn acupuncture after she finishes her residency in pediatrics. "It may be very useful in my practice;' she said. The two students were part of a group that spent a month in Beijing as a precursor to a new formal exchange agreement among UB, Millard Fillmore Hospital, and the Capital Institute of Medicine of Beijing. Other members of the delegation were Daniel Morelli, M.D., vice chairman of the Department of Family AUTUMN 1988 BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST ��4 Medicine at UB and director of the residency program at Millard Fillmore Hospital; William M. Healy, M.D., then a resident in internal medicine at Millard Fillmore Hospital, and medical students Ira Rock, Jerry Igoe, Charles Everett, and Wayne Waz. For treating chronic conditions like arthritis or curing the common cold, Chinese traditional medicine does as well as Western medicine, Waz said. He add­ ed chat there's a push in China to find which of the traditional techniques have a good scientific basis and which ones seem to work only because of a placebo effect. AUTUMN 1988 Waz has good feelings about one tradi­ tional technique, acupuncture. Because he once damaged the cartilage in his knee, it aches when he walks on it a lot. While in Beijing, he tried acupuncture and found it got rid of the pain for three or four hours. While it may offer good pain relief, acupuncture is no longer used in China as an anesthetic for surgery because it's not a good muscle relaxant, noted Hea­ ly, the resident. The herbal medicines hold promise, but even the Chinese admit that it's sometimes hard co get as true a dose with their herbal teas as we do with our pills, said Healy, who has long been interested in folk medicine. Sometimes a batch of tea will lower blood pressure well, but the next batch will not. Another traditional technique is cup­ ping. The group saw the treatment per­ formed on a woman with shoulder problems. A lighted alcohol wick is inserted in­ to what looks like a small, glass goldfish bowl. When the air inside the glass is heated, the wick is removed and the glass quickly placed on the patient's skin. A vacuum is formed and sucks the skin in­ to the glass, forming a nasty mark that can best be described as a giant hickey. BUFFALOPHYSICIANAND BIOMEDICALSClENTIST �hina's practice of med• icine is as distinctive as its architecture. Physicians con/ er over medical records penned in traditional Chinese characters, lef~ while a patient re• ceives acupuncture enhanced by elec • trical current, below. The technique is believed to draw harmful substances out of the body. Traditional Chinese massage uses manipulation to relieve pain and restore function. Massage is used for ailments such as arthritis. Because they were in China such a short time, the Buffalo visitors saw techniques being used, but don't know if they provided lasting results. But the patients generally reported feeling better initially, Healy said. B oth traditional and Western styles of medicine are used in the hospitals in Beijing, and patients don't see BUFFAID PHYSICIANAND BIOMEDICALSCIENTIST saving?" Healy questioned. The Chinese doctors read western medical journals and are up on the latest techniques. But they can't use many of those techniques because they just don't have the resources. Needles, syringes, IV tubes, and surgical gloves are washed and reused. Before surgery, doctors soak their hands in an alcohol bath because the water isn't free of parasites . Even photocopy machines are rare commodities. "They do a lot with so little," Morelli said. "They squeeze very hard on every resource." Because they don't have the equipment we have here, Chinese doctors rely almost completely on physical exams rather than lab tests to make diagnoses. The Chinese are very skilled, and the UB students learned a great deal about techniques such as palpating an a conflict in combining them, Morelli enlarged liver or spleen . noted. A patient may receive a Western Waz had hoped to talk with a Chinese pharmaceutical preparation while also faculty member who was an expert in receiving an herbal preparation. medical ethics . What he found was that In rural areas, people often seek out the the Chinese haven't developed ethics intraditional practitioner before they see a to an academic discipline as we have. Inphysician who practices Western stead, Waz noted, they use what you medicine. The traditional methods pro- might call "medical pragmatism." bably ease the symptoms, and the peoSince the Chinese don't have our ple seem satisfied with the treatment. Yet lavish resources, they don't have the the Buffalonians saw people whose thorny ethical issues chat go along with disease had progressed beyond any them. They don't have co decide whether medical care, but who might have been a very sick infant should get intensive helped if they had had surgery earlier. care; they simply don't have any such "I wonder how many people were care to offer. ultimately hurt because they kept going Yet Americans would consider the to the traditional practitioner, delaying Chinese lavish in hospitalization policies. treatment that might have been more life Many people who'd be treated as outpa- AlJfUMN 1988 5 �6 IJ'lat ~cian I!' left, a phy sid em onstrat es tradi- ,. tional Chin ese massage for a pa tient suf- /.../ , f ering low back pain and, at righ t, a wo man rece ives a cup p ing I treatm ent. Note the marks tha t remain on th e w om an 's s kin. A bo ve, bi cy cl es are a c omm o n for m of t ran spor tati o n , th ough the numb er of cars is in creasing. tiencs here are hospitalized in China. A nd once in the hospital, patients stay a long time. For instance, a patient who has a gall bladder removed in the United States might stay five to seven days; in China, he'd be in a few weeks, noted Morelli. T he result is that hospitals run out of beds. Families keep bringing sick relatives back day after day hoping they'll be admitted. The hospitals also run outpatient clin ics that are very heavily subsc ribed, More lli noted . The Buffalo visitors saw some medical cond itions that aren't common in the United States, such as rheumatic heart disease and hepatit is and liver diseases that aren't alcohol related. They got to hea r the heart murmurs AlJTUMN 1988 associated with mitral stenosis . In the United States, residents might see one or two classic cases a year, Hea ly said. In China, they saw six or seven a day. "Now I can say I really hear the classic sounds - just the way it's written in the textbooks. That was a real thrill;' he observed . It was hard to get a hand le on just how common certain diseases are in Ch ina, Healy said. The Chinese would claim that a disease was very rare, then show them 10 cases of it . Healy wasn't sure if they were trying to gloss over the situation or if there was simply confusion over use of the word "rare." Since no one in the Buffalo group could speak more than a few words of Chinese , commun ication was a problem . Medical termino logy, especially drug names, was hard to translate . Sometimes they'd just give up on a point, Healy said. T he Chinese have a six-day work week, but also tried to prov ide relaxation for their guests. "After six days in the hospital, on the seventh day we toured," Morelli said. They visited the Great Wall, the Palace Museum in the Forbidden City, and Mads Tomb. The imperial sites are very colorful, almost gaudy, but it was a welcome contrast to the gray and dingy city. Since most people burn coal in their homes, a brown haze hung over the city on still days, adding to the March gloom. "It's a hard life in China overall," Morell i said . "They do without a considerable amount of day-co-day things we cake for granted ." T his includes simp le things like prepared foods or larger things like the freedom we enjoy. BUFFALO PHYSICIA N AND BIO MEDICAL SCIENTIST �7 #1' eijing physi- ~ cians struggle to care for the city's 10 million in­ At left is the well-baby nursery at a bus, • district hospital. After the rigors habitants. of a six-day work week, the Americans were escorted to popular tions Great and tourist attrac- such as the Wall, above, the Forbidden City, right. "It's like they're black and white and we're color," Morelli said. But the peole seem happy and hopeful. A favorite sight of Waz's was the old men who take their pet birds for a walk to the park. They'd hang the cages in the trees while they chatted with their friends. High rise apartment buildings are sprouti ng up all over Beijing. Communism is loosening up; a lot of consumerism is starting . People in the street are selling things and are allowed to keep the profits. People can voice disagreement with goverment policies, though not very loudly. The thing that stands out most in Schlehr's mind was the time he met a Chinese army officer who had a copy of George Orwell's 1984. The novel, a parable of the evils of communism, was, in all likelihood, banned in China. For BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST the officer to even have a copy means "things are opening up a lot," Schlehr said . The Buffalonians were impressed by the red carpet treatment they received from the Chinese. Few people in Beijing own cars, but the Americans were driven around in a modern Toyota mini-bus, belonging to the Capital Institute. Though it was winter, the Chinese tried to find the best selection of vegetables for their guests. The Chinese took them to operas, concerts, and tourist attractions. They had dinner at the fancy Peking Duck Restaurant with heads of all the city's hospitals. The group was photographed and videotaped at every opportunity . The process always entailed a bit of seatshuffling because each person had to be seated in a place that reflected his pro- per status, Morelli explained. Even parties in Beijing are very structured. There's generally some chatting, followed by some speeches, then entertainment. Th e Buffalonians decided to throw a thank-you cocktail party, but the Chinese guests were very uncomfortable because they didn't know what to do in such an unstructured setting, Waz said. The Americans salvaged the affair by giving some speeches and singing "America the Beautiful," "Under the Boardwalk," and "Take Me Out to the Ball Game:' The Buffalonians say they want to go back to Beijing; some in a few years, some in a few decades. They fully expect that things will be different, though it's hard to say in what way. "So many things cou ld happen," said Waz. "They have to try to get the best of our ideas and avoid our problems'.' AUTUMN 1988 �eets 8 a nu Bu hosp speci equi medi acup 0 right year! yean for E "H big l est Buffalo and Beijing exchange scholars in new program By CONNIE OSWALD smFKO n tiom Ul with Hig~ ~ lectric acupuncture needles combine the old and the new, the East and the West. They're a symbol of China today . China is a country coping with change . le clings co the traditiona l Chinese medicine used since ancient times, using techniques such as acupuncture and herbal medicines. Bue after years of isolation, the most populous country in the world is eager to adopt the medical advances of industrialized nations. To accomplish that goal, leaders from the Capital Institute of Medicine of Beijing on June 7 signed a new exchange agreement with UB's School of Medicine and Biomedical Sciences and Millard Fillmore Hospital. The agreement allows three faculty members from Beijing to visit Buffalo. Two will visit for about two months and the third will visit for a year. In return, six senior medica l students from UB, as well as two residents, will observe medical care in Beijing for one month. The exchange is the result of the opening of China to the outside world, said Du ]inxiang, the acting president of the Capita l Institute of Medicine of Beijing. The Chinese wane to learn the advanced technology of the West in order co develop their own science and technology. "In the past, China was isolated, occluded from the world," explained Gao Tienxiang, professor of cell bio logy and microbiology at the Capital Institute. "It's '8' ALm.JMN 1988 l i ll' ~ Q i From left: Peter Ostrow, associate dean for curricular and academ ic affairs at VB; Jan Jennings , pres ident and chief execut ive officer of Millard Fillmore Hospital; Du Jinxiang; Gao Tienxiang, and John Naughton. a pressing prob lem we feel." Gao is also head of the Institute's laboratory of electron microscopy and the laboratory of cell biology. He acted as the translator for the Chinese dignitaries during their June visit to Buffalo. Du and Gao were accompanied by Li Hui, Gads wife, who is a professor of microbiology and immunology at the Capital Instirue and head of the Department of Microbiology at Shandong Medical University. that the Cap Ki fessc nice prov broa Roa< Tl were an e: Zhe1 grad who ince1 Tl oth~ SL The exchange agreement is important because of the increasing ties between the two countries, said John Naughton, vice president for clinical affairs and dean of the School of Medicine and Biomedical Sciences at UB. "As we go down the pike, the U.S. and China are going to have more intense relationships," Naughton said. "This exchange gives us an opportun ity to be part of it:' The Capital Institute was founded in 1960,said Du. Like UB, it's affiliated with jing dim a ne Mill Cap dela BUFFAW PHYSICIAN ANO BIOMEDICAL SCIENTIST BUFF/ 198i �number of hospita ls. But you'll find things in the Beijing ,spirals chat you don't see in Buffalo: ecialties in tropical disease, pharmacies uipped to fill prescript ions for edicinal teas, and departments of upuncture . Chinese students enter medical school :ht after high school and study for five ars, then work as residents for 5 to 10 ars. The Institute provides physicians r Beijing, which has 10 million people. "Health care for 10 million people is a g burden for us; Du noted . The Capital Institute also has affilia)nS in Rochester and Texas. UB already has a systemic agreement ith the Beijing Municipal System of igher Education . UB is the only university in the U.S. to have an agreement with the entire system, which is somewhat analogous to the City University of New York. O ther U.S. universities have exchange agreements with only one co llege in the system. About 100 students and faculty have traveled between China and Buffalo over the past seven years, studying such dive rse fields as music, education, engineering, physiology, and h istory. UB's Health Sciences Library is also setting up a cooperative relationship with China's nat ional medical library, which is part of the C hinese Academy of Medical Sciences and Peking Union Med ical College in Beijing. In anticipation of the new agreement with the Capital Institute, UB and Millard Fillmore Hospital sent a delegation to Beijing in March . In the delegation were Daniel Morelli, M.D., vice chairman of the Department of Family Medicine at U0 and dirt:ctur of the residency program at Millard Fillmore Hospital; William M . Healy, M.D. , who was then a resident in internal medicine at Millard Fillmore Hospital, and medical students Wayne Waz, James M. Schlehr, Ira Rock, Jerry Igoe, Veronique James, and Charles Everett. "This type of exchange buys us more goodwill than does military aid or other types of aid; said Morelli. "It would be a very productive thing for us as a nation to sponsor. It's a way of sharing the wealth we have in a way that goes beyond sharing money." UB mournstwo killed in trafficaccident By JIM McMUL LEN ~ Chinese professor and a UB staff 'II member were killed June l while driving home from a dinner party 1at celebrated the schedu led signing of 1e new exchange agreement with the :apical Institute of Medicine in Beijing. Killed were Sun Keji, an exchange prossor in anatomical sciences, and Berice Poss, execut ive assistant to the UB rovost, the driver . Thei r car was struck roadside by another veh icle on Maple oad in Amherst . Three othe r passengers in Poss's car ere injured. They are Yong-Huan Shen, :1exchange scholar in mathematics ; Yahen Gu, his wife, and Xijou Hou , a -aduate exchange student in education, ho had attended the dinner as an 1terpreter. The dr iver and a passenger in the rher car were also inju red. Sun, 57, had been at UB since August }87 under an agreement with the Bei:1gMunicipal System of Education . The inner party anticipated the sign ing of new three-yea r agreement among UB, 1illard Fillmore Hospital, and the :apital Institute . That formalization, elayed because of the accident, took JFFALO PHYS IC IAN A N D BIO MEDICAL SC IEN TIST Sun Keji place Jun e 7. Born in Sha nghai, Sun received his degree in medic ine in 1954. He served as cha irman of the Department of Histology and Embryology at the Capital Institute of Medicine, where he was recently promoted co full professor. Sun was considered the best teacher at the Institute . Here he was also valued as an excellent teacher, a meticulous researcher and a friend of rhis Universiry, said Harold Brody, chair of Anatomical Sciences . At UB, Sun conducted research on neuroendocrine control of liver regeneration. His work will be compiled and published later this year. He also taught in a medical and dental histology class. "His teaching in the lab was interesting," Brody said. "He had some difficulty in communicati ng because his command of English was not so good. But he was a kind, patient man, excellent at working one-on-one or with small groups of students." He voluntarily tutored several minority students in histo logy. As one stude nt said, "You couldn't help but like him." Sun was scheduled to return to Beijing in mid-August . A memorial service for Sun was held June 7. He is survived by a wife and two children. AUTU MN 1968 9 �MEDICINE AND THE ARTS 10 Many health-careprofessionalslead double lives. Not only do they work in the lab and treat the ill, they also write novels, sing, collect art and build crystal models of nature. Their creativity was the subject of a June 4 symposium on "Medicine and the Arts," sponsoredby the UB Health Sciences Library. ~, .,,-.....,""" -:-- -~""- .... . ~ Carh knew. itation S''. \ ~[ ( ~-~,--- w ~- ~ ~- :.. .. a cour out a most i .. C.. Easing Pain hat makes a musician? It is "neither nature nor nurture; said Karen Miller Allen, associate health sciences librarian and former principal clarinetist for the Mannheim Chamber Orchestra in West Germany. "Boch must be present before musical and other abilities can emerge." A UB doctoral candidate in health psychology, Allen lost the ability to read music after she suffered a head injury . She has long been interested in the psychological and physical aspects of music. "Twenty years ago it was possible only to speculate why music such as Bach's Massin B Minor makes most people feel a certain way. Now it is known that specific chemical changes are taking place, such as the production of endorphins and enkephalins. "Music's role in psychoneuroimmunology is just beginning to be explored, and it is being found that music can influence important changes in this area, too. In Germany, music often is used during anesthesia and during the post-operative period . It has been found that, especially when the patients pre-select their own music and hear it through headphones, that they require less medication, and report reduced pain levels." Alll1JMN 1988 Ci ly the, to writ into a Two U A: -· ·" Ye figure , tionab Notice earth. tanr a A1 gleane, (1896-l and se L "He As me disease TheS~ By CLARE O'SHEA & ANN WHITCHER .... ,.,..."'."r-'"3!!=~-~~,:,£' dent's A1 thur C detecti tives 61 \Yj W. Somerset Maugham mong the world's physician writers, few are as well known as W Somerset Maugham, whose writing reflects the "tremendous bitterness and pain in his life," said John Gaeta, chief of pathology at Roswell Park Memorial Institute and professor of pathology in the medical school. Throughout his life, Maugham was a man of sear ing ambivalence. Born in France of British parents, he was orphaned at IO,taken to England where he was raised by an uncle, and educated at King's School, Canterbury. As a youngster, Maugham stammered and endured the pain of being mocked by other children, said Gaeta. In fact, stammering was to be a lifelong affliction, so severe that the author avoided the telephone entirely, Gaeta said. In Heidelberg, Maugham learned German and acquired a "tremendous philosophical background ."He decided to study medicine and graduated from Sr . Thomas' Hospital medical school in London. His experiences as a young intern in obstetrics are reflected in his first novel, Lizaof Lambeth(1897), the modest success of which prompted him to abandon medicine. The author of novels, short stories and plays, Maugham is perh aps best known for his semi-autobiographical novel Of Human Bondage (1915),the story of a medical stu- BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST by Kat and d Unive A was b, his de; ed the and C them tice, J "1 medic tainec claim< Ir: tions, "P by pe1 and n work, rested ing. 1 interfi dri nk BUFFAU �r's painful maturation. Another famous physician writer, Gaeta said, was Sir Arr Conan Doyle, who created the personality of the ideal !Ctive in Sherlock Holmes. "The literature is full of detecs but none has had the popularity of Sherlock; said Gaeta . Yet Doyle created an interested counterweight to this re of Holmes, who is so smart that his humanity is ques1able, Gaeta noted . "Watson was created for balance. :ice that he's a doctor. He would bring Holmes down to :h. The personality of Sherlock Holmes is not so import as the balance between the two men:' Anoth er writer who infused his writing with observations ned from medicine was the Scottish physician A. J. Cronin >6-1981),who was educated at the University of Glasgow I served as a surgeon in the Royal Navy during World War :-leis an example of tenacity and optimism; said Gaeta. medical inspector of mines, Cronin studied occupational :asesin the coal industry. One of his many popular novels, · ScarsLook Doum, was set in the Welsh coal mining region. Cronin began a London practice in 1926 but quit shorthereafter because of ill healch . He then used his free time vrite his first novel, Hatter'sCastle (1931), which was made > a film, as were five other Cronin novels. Adventures in > Worlds is an account of his years in medicine. As a young man about to begin medical training, William fos Williams showed his poetry to an MIT professor he :w. "Stick to medicine; the professor told him. "Your imions of Keats are very good but you'll need co earn a living~ Williams did stick to medicine, and spent a lifetime in >untry doctor's practice. He also stuck to writing, turning a lifetime of work that would earn him the title of "the st influential American poet of the 20th century." Williams was the subject of the keynote address delivered (athryn Montgomery Hunter . Hunter is associate professor 1 director of the Division of Medical Humanities at the iversity of Rochester School of Medicine and Dentistry. A prolific writer of prose in addition to poetry, Williams : born in 1883 in Rutherford, N.J., and lived there until death in 1963. Later that year, he was posthumously awardthe Pulitzer Prize in poetry for his Picturesfrom Brueghel, ' Ocher Poems(1962). His poetry, which often concerned most ordinary of subjects, benefited from his medical prac·, Hunter said. "Throughout his life, Williams maintained that his :lical practice sustained his poetry and that his poetry sus1ed his daily practice of medicine," she said . "He always med he became a doctor in order to write." In his autobiography, published in 1967 by New Direc1s, Williams wrote: "As l say, often after I have gone into my office harassed :>ersonalperplexities of whatever sort, fatigued physically 1 mentally, after two hours of intense application to the :k, I came out at the finish completely rested (and I mean ed) ready to smile and to laugh as if the day were just start. That is why as a writer I have never felt that medicine :rfered with me but rather that it was my very food and 1k, the very thing which made it possible for me to write." 'ALO PHYSIC IAN AND BIO MEDICAL SCIENTIST Daily, close observation of the mundane and of the rhythms of ordinary American speech often provided the poet with the subject s and themes of his works, as well as the sounds transferred to the dialogue of his characters. And somehow Williams found time to gee it all down on 11 paper. That could mean jotting down poems on prescription pads (some of which are among the 20,000 pieces of Williams' writing stored in UB's Poetry/ Rare books collection). By keeping a sheet of paper rolled into his typewriter at all times, he could even snatch a few minutes of writing in between patient visits. Many important moments of his practice are captured in poems such as "Complaint" and 'The Last Words of My English Grandmother~ Bur it is Williams' first-person doctor stories, including the memorable "Use of Force; that were the most "medical" of his works, according to Hunter. These short stories, written in the '30s and recently collected in paperback, are often told from the point of view of"a crusty, curmudgeony pediatrician." Music Th erapy usic is an extremely personal yet totally universal experience;' said Jill Scott, a nurse who uses her voice and guitar to soothe the pain of the elderly and terminally ill. Interspersing her talk with performances, Scott said "music is a powerful tool char can leave one defenseless. One must respect a person's right to choose the type and amount of music, or even not to hear any music at all. "Some clients respond superficially, some emotionally; said Scott, on-site coordinator of the RN Satellite Program at Fredonia State College . For some it is an intellectual experience, in which the composer's style and technique are topics for discussion. For ochers, it is a physical sensation in which they beat time or move their bodies co the music. The music therapist, she says, "needs to trust music to perform the healing. When music is chosen carefully, words can become totally unnecessary~ In using music therapeutically, Scott first tries to "convey a sense of trust." She then attempts to help the patient express his or her needs and desires. Sometimes, of course, the music is just for fun . Lastly, Scott tries to help her clients find "self-fulfillment and some relief, to help them take care of unfinished business before they die." AUTU MN 1988 �... .., .. . 12 .... ~·,\"t :, cian. Ac Union College, he was a disc jockey, program director and general manager at the campus radio station. At one time, he even considered a broadcasting career . .·.::•-/:\: -: · i, ·, Singing aritone Brian Zunner, D.D.S., the recipient of a B.F.A. degree from UB, performed four songs by Brahms, accompanied by James M. Bigham. Zunner, who has been a soloist with the Buffalo Philharmonic, is in the Dental Residency Program at the Veterans Administration Medical Center of Buffalo. UB assistant professor of clinical pediatrics and otolaryngology Joel Bernstein presented a short recital of diverse works including three lieder by Schubert, arias by Mozart and Offenbach, and a Rodgers and Hammerstein song. He was accompanied by pianist Marjorie Lord. Bernstein is a lecturer and consultant to the Music Department. He has studied vocal performance for the last fifteen years and has performed throughout Western New York. Jan ichard (Dick) Judelsohn finds fulfillment in both jazz and the healing arts. The Buffalo pediatrician, who has hosted a jazz program on WBFO since 1976, seeks to educate the public on jazz from 1945-1965, the focus of his show. Whenever possible, he tries to include commentary about the artists, sidemen, and arrangers, in addition co the date of the recording. In shore, he looks for clues that will give his listeners "optimal enjoyment." Judelsohn, a 1967 graduate of the Medical School and associate UB professor of pediatrics, collects his knowledge through listening to jazz radio programs, talking co musicians, going to clubs and his own playing of the saxophone. Jazz has been his passionate interest since high school when he became interested in the art form as both a fan and a musi- Atm.J MN 1988 Herbert A. Hauptman (p/ q) (q/ p) = (left) (-1)1 /2 (p-l)xl/Z(q-1) he Law of Quadratic Reciprocity, a formula from number theory, is "the supreme example of the art of mathematics," according to Herbert A. Hauptman, UB professor of biophysical sciences. "Youcan see this beautiful formula has a great deal of symmetry just by looking at it. It is well-worth spending the two to three weeks it would cake to prove its validity:' Mathematics is an art, not a science, said Hauptman, who is also president and research director of the Medical Foundation of Buffalo and a recipient of the Nobel Prize in Chemistry. "The great 20th century philosopher and mathematician Bertrand Russell wrote: 'Mathematics possesses not only truth but supreme beauty, a beauty cold and austere, like chat of sculpture, sublimely pure and capable of a stern perfection, such as only the greatest art can show: " Unlike any ocher art, however, mathematics appeals not to the senses but to the intellect, Hauptman pointed out. le is also a more demanding art. "It requires nothing less from the viewer but chat he participate in the creative process itself because the act of understanding requires this participation. The demands on the viewer are great but the satisfactions and the pleasures are correspondingly great." Certain patterns found in the visual, literary, and musical arts, Hauptman said, which "almost always have a regular or repeating motif and show varying degrees of symmetry," are analogous to "the patterns of logical inference, the very essence of mathematics. "It is the recognition and appreciation of these patterns and these symmetries, as well as their significance, which gives pleasure when viewing a work of arc, listening co a musical composition or reading a poetic one, or comprehending usually after a great deal of effort - a mathematical exposition." Hauptman pointed to geometry as a more readily accessible area, combining the intellectual features of mathematics BUFFAlD PHYSIC IAN AND BIO MEDICAL SCIENTIST �and the visual appeal of art. "For many years I've been intrigued by the construction of these extremely beautiful, fascinating geometric solids; he said. "I first made them out of cardboard, then I learned co work with stained glass - using the colors to enhance the symmetry and beauty of the geometric forms. "Was it then only coincidence that my life's work as a scientist was concerned with crystals and their structures which often mimic their geometric counterparts in the world of mathematics?" Transparent models of crystal s created in rose and blue, pale green and white, were projected in slides during Haupt· man's speech. Several were also on display at the Health Sciences Library. 13 Art Collec ting ow does one build an art collection? In the case of Donald A. Lar son, UB's associate vice president for clinical affairs, it came after years of study, observation, and family consultation. Larson said his collection is varied in terms of media, artists, styles and origins. It runs the gamut from comfortably decorative works to tension-producing abstracts . In the view of Larson and his wife, Mimi, art serves to differentiate Ph ysician Wr iter o all those physicians leading double lives as artists, what does the artistic impu lse cost? It doesn't matter, according to Martin E. Plaut, novelist and UB professor of medicine . "le is still better to try than not to try; he said. "Many people who have somehow suppressed the artistic impulse have a feeling of loss, of what might have been. To me, the cost of not trying is greater." Plaut knows of what he speaks. He has published four novels, several under the pseudonym Paul Marttin (a scrambling of the letters of his name), including Cocoa Bll1fles, called "a stunning novel of love, sex, corruption ." He is also the author of The Doctor's Guide to You and Your Colon: A Candid, Helpful Guide to our #1 Hidden Healch Complaint. But he's known failure, too. "I sent off stories in manila envelopes for years; he said. "Editors handled submissions like they were samples of stool. "But there are those little epiphanies, coo; Plaut added. "Like when you walk into a library and find your book listed in the card cata logue." The artistic impulse is not limited co the printed word, Plaut emphasized - or co any of the so-called arts for that matter. "It may be an attempt to grow roses, or to describe a sunset after four days of clouds . Even if it's the way you tell stories or sing in the shower - if you possess it and ignore it, it will cost you more." BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST the spac e within their home. Accordingly, said Larson, "the collection should be controlled in its hanging to provide that differentiation which supports our various needs . Without this selectivity, there would be discordancy both for ourselves and our guests." From the beginning, the Larsons wanted theirs to be a teaching collection for their children . The Larson children would often return to college with a piece of art, bring it back a year later and take another painting or drawing . As a result, Larson joked, "we have a satellite collection in New York City, Austin and Chicago ." Occasionally, the Larsons' taste diverged, but they were able to find common ground nonetheless. "We have learned things about ourselves." Pho tos by Nus baum xhibitors in the Medicine and the Arts symposium were: lvan L. Bunnell, UB clinical professor of medicine and watercolor artist; Karen Flynn-Miller, dentist and mixedmedia artist; Herbert A. Hauptman, UB professor of biophysical sciences and glass sculptor; Anthony Keller, nurse and harpsichord builder; Sanford L. Nusbaum, UB clinical assistant professor of oral surgery and photographer; David ]. Triggle,dean of the UB Pharmacy School and photographer, and Peter L. Weinmann, UB clinical assistant professor of dermatology and photographer . • AUTUMN 1988 �14 TYKE TRIK E Patent,pending device makes paraplegic one of the gang AlITTJMN 1988 BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �.. he colorful tricycle chat perky six-year-old Sarah Tangelder rides around her suburban Clarence neighborhood looks similar co ocher "Big Wheels" popular with kids her age. But the dark-haired youngster in the purple sweatsuit quickly explains that her bike is different, special, one-of-a-kind . Equipped with a device based on a patent-pending concept developed at UB, the tricycle provides her with mobility while simultaneously delivering physical therapy for her legs, paralyzed by transverse myelitis. As she pedals around her driveway, she gets one hour of electrical stimulation to her leg muscles each day without having to set aside extra time for her therapy. Until the UB team, led by Frank Mendel, Ph.D., and physical therapist Dale Fish, Ph.D., designed the concept for Sarah, her mobility was limited to a wheelchair. "We felt it would be ideal if she could have therapy as she played; says Mendel, an associate professor of anaromica l sciences in the School of Medicine and Biomedical Sciences . lc's hoped che therapy will strengthen her muscles and cardiovascular system. Aided by health sciences instrument shop director William Tanski, Jr., and retired engineer Robert Kell, the team studied and modified a child's big-wheel tricycle . Handlebars were replaced by hand cranks, which are connected by chains ro the foot cranks, allowing Sarah co use her arms to propel the tricycle. Cams mounted on the common axle linking hand and foot cranks activate microswitches that in turn activate a pair of battery-powered po rtable electrica l stimulators which send electrical signals co selected muscles. Because the speed at which she turns the hand cranks controls the pedals and stimulation co her legs, she can increase or decrease the speed at which she trave ls, but her leg muscles will always be stimulated at the correct arcs of movement. Use of electrical stimulation for therapy is nor new. It's often recommend- BUFFALOPHYSICIAN AND BIOMEDI CAL SCIENTIST ed for individuals who, because of illness or injury, cannot independently exercise weakened or paralyzed muscles. As carefully controlled current flows from a stimulator via electrodes caped co skin, underlying muscle is activated. Although this is an effective form of therapy, it is often inconvenient for a patient to travel several times weekly to a hospital or rehabilitation center where such therapy is typically administered. Even if portable models are used at home, the individual usually reclines or sits during therapy. "The design can also help prevent pressure sores, which develop in chose who sit or lie in a single position for long periods of time," says Mendel. The sores, often referred co as "bedsores; occur IS when lack of body movement cues off blood supply and nourishment co areas of the skin. Sarah's parents, Jim and Melanie Tangelder, report that her neurologist, James Teter, M.D., has detected improvement in muscle strength and increased sensibility since the child began using her special Big Wheel this winter . When it's coo cold to ride outdoors, Sarah switches the tricycle ro a stationary mode, which allows her to ride in place while her muscles receive their alternating JO-revolution stimulation and JO-revolution rest cycles for an hour daily. The stimulation-rest cycles and selection of muscles co be stimu lated can be tailored to the individual's needs . As Sarah gains muscle endurance, the Sarah Tange lder and Frank Mende l, Ph.D. stimulation cycle will be increased . "Being able to connect the portable While Sarah uses her purp le padded stimulator to a mobile vehicle, which the wheelchair to get about much of the paraplegic individual can incorporate in- time, she's able to stand with the aid of to normal activity, encourages consistent specia l, sturdy braces. therapy; says Fish. The UB team estimates that the cost Because the Big Wheel is inappropriate to equip the Big Wheel, excluding labor, for older children and adults, the UB ranges from $1,200 to $1,500. The major team is working on application of their expenditure is for the portab le electrical design to wheelchairs . stimulacors priced from $500 to $800 "The hand cranks could be incor- each. porated near the area of the brake Fish and Mendel be lieve the patenthand les typically found on the pending concept might also benefit wheelchair; Mendel explains. The chair's others whose legs have become paraconventional footrest could be replaced lyzed or severely weakened by certain inwith pedals, which would be connected juries or one of a hose of neuromuscular co the handcranks and electrical disorders . stimulators much as they are on the Big As long as the nerves from the spinal cord co the muscle are intact and the Wheel. Fish notes the team is particularly en- muscles are healthy, electrical stimulation thusiastic about chis work because could be beneficia l. People with multiwheelchairs are the primary mode of ple sclerosis, stroke, or other neurologiclocomotion for many paralyzed people. ally induced paralyses may be candidates Thus, a wide variety of individuals could for this kind of program, they say. receive electrical stimulation while The team hopes there will be a way to engaged in their everyday activities . produce the design for manufacture so For the very young, an all-metal tri- it's easily available in the future for others cycle fitted with the UB design might be like Sarah. sturdier than the all-plastic Big Wheel. The concept was presented in a scienAs Sarah rides with sister Grace, 5, and tific session at the American Physical nine-year-old brother Tom, she's also ex- Therapy Association meeting in Las Vegas on June 14. ercising her cardiovascular system. AUTUMN 1988 �ONE STEP FURTHER 16 Electricalstimulationtechnology movesfrom rehabilitationsetting into the realmof everydaylife By MARY BETH SPINA computer specialist whose lower right leg was partially paralyzed as the result of a spinal inju ry 32 years ago is now able to walk more normally because of the efforts of a research team at UB. The team has adapted existing electrical stimu lation technology, bringing it from the rehab setting to everyday life, to benefit UB staffer Jay Leavitt. (The same team has enabled a para lyzed sixyear-old to ride a tricycle - see accompanying story .) Despite his spina l cord injury, which resulted from a freak tumbling accident in college, Leavitt has maintained an active lifestylebut was somewhat hampered by an inability to lift his right foot from floor surfaces as he walked. "Every 12 days, I had to have the sole of my right shoe replaced - sometimes more often if I walked a· great deal on rough surfaces," he relates. In addition to the cost of shoe repair, Leavitt, who trave ls a great deal in his work, grew impatient with the amount of time it required for him to cross a parking lot or a large carpeted area. UB anatomist Frank Mendel, Ph.D., and physical therapist Dale Fish, Ph.D., worked with Leavitt to reduce his AlJTUMN 1988 decades-old pro blem by electr ically stimulating various muscles in his partial ly para lyzed limb. "We reasoned that if stimulation could be activated by a heelswitch in his shoe that could cause his affected foot to clear the floor, he could walk more normally," said Fish. "And ... save a lot of shoe leather in the bargain," added Mende l. A lthough portable battery-powered electrical stimulators are availab le, they are typically used in clinics as individuals sit or recline during therapy. The team, which includes retired engineer Robert Kell and Leavitt himself, decided to modify a commercial functional electrical stimulation system (FES) called Respond II equipped with a heelswitch to activate stimulation duri ng the "swing phase" of gait wh ich occurs when the heel is not in contact with the floor. The heelswitch is connected to the electrical stimulator which is in tum connected to surface electrodes applied over leg muscles and the top of the foot. Electrical pulses cause the muscles to contract and help lift Leavitt's foot and leg during the "swing phase ." An associated goal is to improve con - BUFFALO PHYSICIAN AND BIO MEDICALSCIENTIST �venience and durability of the system, says Mendel. Ordinary modular telephone cables, equipped with standard snap cpnnectors, connect the stimulator to the electrodes. The cables 17 and connectors allow fast connection and disconnection to facilitate dressing and toileting. The cable system worn under Leavitt's trousers connects to the stimulator and eight AA nickel cadmium rechargeable batteries which are compactly stored in an ordinary camera shoulder case. This arrangement is more convenient than wearing the stimulator on the belt because it does not bind while sitting or block access to pockets. The team concedes there are still some "bugs" to be worked out with the durability of the heelswitch, which must be replaced every two months . Although the basic techno logy for th is system is readily available and used in clinics, few individuals use such systems on an everyday basis. "Companies which developed the FES did not have a person like Jay Leavitt in mind - an active person who will subject existing units to heavy-duty use day after day," says Mendel. The UB team notes that Leavitt is able to walk more normally without lurching and without his mechanical leg brace. Further, the stimulated muscles are becoming stronger and therefore will continue to improve his gait over time. Although his physician, James Teter, M.D., notes improvement in gait and muscle strength in the affected leg as a result of using the stimulator, Leavitt will continue to need the device in the future. Leavitt, who with his wife, Ginger, raises Morgan horses on a farm in Elma, outside of Buffalo, finds the use of electrical stimulation to be a tremendous improvement. "Before I began using the device; says Leavitt, "I was burdened with a heavy brace, and my foot wouldn't clear the ground . Walking was time- and energyconsuming." ~ This research was also presented by the l!I ~ UB team during the scientific sessions of ~ the American Physical Therapy Associa~ tion meeting in June. ! AUTU MN !988 �18 '' yclosporine isn't the end of the (transp lantation) story. The crusade goes on; according to Thomas E. Starzl, M.D., who is known for his work in human organ transplantation . Starzl addressed approximately 250 immunologists and scientists at the 11th International Convocation on Immunology on June 15, sponsored by the Ernest Witebsky Center for Immunology at UB. Delivering the Ernest Witebsky Memorial Lecture at the event, Starzl AUTUMN 1988 said that a new drug, FK 506, cou ld be an improved medication for maintaining the fine line of avoiding donor rejection of the organ without appreciable toxic side effects. Both cyclosporine, which is now given to organ recipients, and FK 506, discovered only a few years ago in Japan, are immunosuppressants . Cyclosporine, however, has severe side effects leading to kidney damage. But, Starzl said, cyclosporine and FK 506, used together, promise to be a significantly improved combination for treating patients who have undergone human organ transplants. FK 506 has not shown toxicity in most animal studies, including non-human primates. Starzl, a professor of surgery at the University of Pittsburgh, noted that one interesting thing about modem drugs is that interrelations with other drugs can be analyzed much faster because of modern techno logy. Thus a major breakthrough in the technique of assessing immunosuppressive potent ial of drugs was the development, by Starzl's collaborators, of a standardized system of employing cell cultures . Using this system, all information now available on FK 506 with cyclosporine A was acquired within six to eight weeks. Within the first year that liver transplant patients were given cyclosporine in combination with steroids, the survival rate doubled and then tripled. There were never any steps backward, said Starzl. "I th ink cyclosporine and FK 506 will be soul-mate drugs because of their synergism (the interaction of the drugs produces an improved effect over those found in each drug separately); he said . "The 64 dollar question is, is FK 506 toxic in humans?" Starzl said . According to Starzl, in rats and baboons it isn't, which leads scientists to believe it won't be toxic in humans . In vitro experiments strongly suggest that FK 506 in combination with cyclosporine A will allow use of both drugs in such low doses that toxicity is extremely unlikely . lmmunosuppression is the part of transplantation that gives this specialty a kind of peculiar identity all its own, ac- ORGAN TRA New drug, FK 5( for avoidin ''I think c and FK 50c because oft synergism,''1 explained. I 64 dollar qi is, is FK SC toxic in hun BUFFALOPHYSICIAN AN[ �cording to Starzl . There are two other areas essential for successful transplantation. One is tissue preservation and the other is tissue matching. Improved tissue preservation techniques have made it possible to preserve organs longer so that a possible matching recipient can be found, and the donor organ can be transported to the recipient. In 1959 scientists described an organ profusion technique (putting fluids through the organ) by which organs could be preserved for several hours . This process has been continually improved. Donor livers could survive for up to 10 hours in 1976, bur using a new profusion solution described in 1987, donor livers now can survive for 24 to 30 hours, allowing transportation between Europe, the U.S., Canada, and South America , as well as between South East Asia and Australia and New Zealand. "The whole conduct of liver transplantation was revolutionized because of this preservation process; said Starzl. "Although this is a truly revolutionary development in liver transplantation; he added, "it's not the end of the line because greed is everywhere . I mean greed in a nice way, beca use no one is ever satisfied. It should not be long before donor livers will surv ive for a week or more.'.' The th ird essential aspect of transp lantation is tissue matching . However, convent ional matching has gone to the back burne r with improved and powerful immunos uppressants, such as cyclosporine A. A cross-matched test in which the seru m of t he prospective recipient is tested with the donor's cells before transplantation is important in preventing a certain number of very early rejections. Starzl pointed out that Felix Milgrom, disti nguished professor of microbio logy at UB, contr ibuted significantly to identifying antibodies in the recipient as the cause for h yperacute rejection; this is rejection of the organ within a matter of minutes after grafting. Cyclosporine and FK 506, no matter how effective in cell-mediated rejection, cannot prevent hyperacute syndromes . There cross-matching seems essential. ~$PLANT ATION 506, shows promise ing rejection ~ 1---1 ---- "'fi -----.! ....;i ~ .., cyclosporine 06 will be drugs their question ,06 imans?'' /\ND BIOMEDICAL SCIENTIST T he final major po int Starzl made was that there is new hope that intestinal transplants will be a 19 reality some day. Prospects for intestinal transplantation include patients with sho rt bowel syndrome, in which uptake of nutrients is severely impaired or impossible because of lack of intestinal mucosa! surface (lining of intestines) . Altho ugh there have been no completely successful intestinal transplantations, Starz l and his team are working diligently to find out what the problems are and how to solve them . Last November Starzl transp lanted small intestines into a two-and -a-halfyear-old girl. The donor intestines, because of the large number of immu nologically reactive cells present in its tissues, were pretreated with monoclonal antibodies to T-cells. The transplant was accepted and was functioning. Then, about three months after the transplant, the child became sick and doctors discovered lesions in her liver. Upon biopsy, they found extended lymphomas, usually associated with the Epstein-Barr virus, a member of the herpes virus family. "We have no idea why the little girl developed the lymphomas in her liver or if it had any connection to the transp lant, but we intend to find our; said Starz l It was of interest that the cells of the lymphoma were of recipient origin . It could be that reactivity of donor lymphocytes to recipient cells facilitate development of lymphomas . T his child was the first one who lived over six months and had a fully functional intest ina l transplant. "Everyone loved this child and was very sad when she died; expressed Starzl. "Bur I feel at least an attempt was made.'.' What is the difference between the bus iness of medicine and the crusade, asked Sta rzl. Th e business of medicine is what successful transp lantation seemingly always becomes, he answered, and the crusade is what hasn't yet been achieved . Intestinal transplantat ion is currently one of the transplant surgeon's majo r crusades . AUTUMN 1988 �20 to have an allergic reaction to gluten and muse restrict it in their diets, they do not form the damaging antibodies which differentiates it from gluten sensitive enteropathy (celiac disease); Kumar explains. There may be many undiagnosed cases among adults who've never shown clinical symptoms of the disorder. "By using our test as a simple screening device, we may find celiac disease is more prevalent than previously believed; .,. __ ""'1 z Kumar adds . The test may also be used ., __ .. ~ to monitor effectiveness of dietary treac'----l j ment for diagnosed celiac patients. § Or. T P. Chorzelski of the Warsaw ~ Academy of Medicine in Poland and his lllliiiiiiiill .. ___ .,~ ~ colleagues initially identified the antibody which is triggered by gluten figures on incidence in the U.S. popula- intolerance. tion . Studies by others suggest it is more A long-time collaborator of Kumar prevalent among certain Israeli popula- and Ernest Beumer, Ph.D., of UB, tions and may be found in one of every Chorzelski found chat the antibody ap300 persons in Ireland . peared in the blood of 70 per cent of To confirm diagnosis, a biopsy is now those diagnosed with dermatitis taken of the mucosa lining the small herpetiformis, a rare skin condition bowel with another biopsy taken six associated with chis specific intolerance . months after the individual is placed on "Ou r research together on skin a gluten-free diet. Additional biopsies disorders with immune system commay be required. ponents led us to investigate the possibiliThe new test, on the other hand, uses ty the antibody would be detected in a small amount of drawn blood . Not on- blood of those with celiac disease as well," ly is it less painful than a biopsy, it is in- Kumar explains. expensive and less time-consuming. Blinded studies conducted in conjunc"With conventional biopsy techniques, tion with Buffalo Chi ldren's Hospita l alternated with dietary challenges of giv- showed the new test revealed the aning the patient gluten products, diagnosis tibodies in the b lood of two previously may take 18 months compared co a day diagnosed celiac patients in a group of or so using our blood test; Kumar 100 persons . Subsequent blood tests on explains . ocher groups with unfailing accuracy Treatment of celiac disease consists of identified diagnosed celiac patients in putting the patient on a gluten-free diet group studies which included patients which eliminates the offending protein . with a variety of other disorders. Those who do not have the autoimmune Also involved in the ongoing studies disorder, which appears co run in as well as refinements in the test are scientists at the School of Medi cine in families, do not make these antibodies. "While some people have been shown Haifa, Israel. TESTDEVELOPED FORCELIAC DISEASE By MARY BETH SPINA A safe, accurate, inexpensive blood test to diagnose celiac disease has been developed by a team of UB researchers in collaboration with colleagues in Poland and Israel. Find ings of studies conducted on the new test were presented by Vijay Kumar, Ph.D ., of UB's Departments of Microbiology and Dermatology, at the 11th International Convocation on Immunology June 16. The convocation was sponsored by the Ernest Witebsky Center for Immuno logy at UB. The test, which has been developed over the past three years, has been shown to be 100 per cent accurate and promises to replace intestinal biopsies (surgical procedures) now used to diagnose the disorder . Kumar says the immunofluorescence test is now being adapted so it can be marketed in convenient test kits in the future . The test is now available at a cost of $40 through UB and a few other medical centers. Test results are generally available within 24 hours, he said. Celiac disease, characterized by weight loss and diarrhea, causes changes in the small intestine due to a reaction to certain proteins called glutens found in wheat and other types of grain. 1n medical terms, the disease is known as a gluten sensitive enteropathy . The test detects antibodies formed in the small incesti!"}ein reaction to the gluten protein. The antibodies appear as cell-tale markers only in blood of celiac patients and those with a rare skin disease called dermatitis herpetiformis. Primarily a disorder found in infants and young children, celiac disease is considered rare, but there are no accurate AlTl1JMN 1988 BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST i �21 small general hospitals in rural communities. Or. Nelson is now living at 2734 Miradero Or. in Santa Barbara, Calif. 93105. Steven G. C line (M' 4 7) • of Atlanta, Ga., has retired after serving as chief of radiology at South Fulton Hospital for 25 years. M. Luther Musselman (M'3 7) John C. Inman (M'33) • writes, "I would enjoy news from classmates." Or. Inman retired in 1971due to a coronary. His winter address is 18 Palm Drive, Lake Worth, Fla. 33461. M. Luther Musselman (M'37) i • is president of the Medical Society of the County of Erie for a one-year term . He is also the president of the Buffalo Academy of Medicine. Dr. Musselman is director of medica l education at Millard Fillmore Hospital and an associate professor of Medicine at UB. Carl J. lmp e llitt er (M'46) • writes, "Following a 27-year thoracic surgical practice in Scottsdale, Ariz ., l have been invited to join the Mayo Clinic, Scottsdale, Department of Ca rdiovascular Thoracic Surgery." Linc o ln D . Ne lson (M'46) • has retired after serving 35 years as a medical missionary in the Philippines, where he was directly involved in establishing th ree Raphael S. Goo d (M'48) • was recently elected vice president of the South Florida Psychiatric Society. Or. Good is professor of psychiatry and obstetrics and gynecology at the University of Miami School of Medicine. Yale So lomon (M'50) • a New York ophthalmologist, periodically takes time off from his busy practice and his work at Southside Hospital, where he's chief of ophtha lmology, and his teaching at the State University of New York at Stony Brook Medical School, to go to India, Thailand, and the Caribbean, where, paying his own way and operating gratis, he has restored sight to hundreds of indigent people. Or. Solomon is the founder of a tax-exempt organization, Volunteer Eye Surgeons International (VESl) - with the express purpose of raising funds to cover the costs of travel and living expenses for eye surgeons on onemonth assignments to needy areas of the world. "VESl is unique among the large number of groups involved in providing eye care in developing countries in that it's the only one to cover volunteer expenses." For further information about Volunteer Eye Surgeons International, contact VESI, 375 East Main Street, Bayshore, New York 11706. BUFFALOPHYSICIAN AND BIOMEDICALSCIENTIST Stephen C. Scheiber (M'64) And rew Norr is (M'82) Myra R. Zinke (M'SO) • writes, "I am home on disability because professor of medicine in the University of Texas, San Antonio Family Practice Department. of cancer and would love to hear from friends and colleagues." Dr. Zinke resides at 4401 Roland Ave., Baltimore, Md . 21210. Andrew Nor ris (M'82) • of Stephen C. Scheibe r (M'64) • professor of clinical psychiatry at Northwestern Medical School, is president-elect of the Association of Academic Psychiatry . Or. Scheiber is also chairman of the APA Committee on the Impaired Physician, co-chairman of the Fellowship Committee of the 11linois Psychiatric Society, and has been elected a member of the Committee on the Study of Evaluation Procedures of the American Board of Medical Specialties . Fort Co llins, Colo., has published "Cyclotorsional Oiplopia Following Retinal Detachment Su rgery" in the journal Pediatric Ophthalmologyand Sirabismus. Jos eph Ke ith Miller (M'83) • writes, "I have completed a fellowship in EEG and epilepsy at the Un iversity of Illinois at Ch icago. I will be joining the Johnson Neurological Clinic in High Point, N.C. in June." Joseph P. Ri enzi (M'85) • writes that after three years of a genera l diagnostic radiology residency, he began a fellowship in nuclear radiology on July I at Yale-New Haven Hospital, Yale Univers ity School of Medicine. Kenneth Lee Gayles (M'73) • M ichael S. Mill er (M'86) • has been elected to fellowship in the American College of Cardiology. Or. Gayles is an assistant professor of medicine at UB. writes that he is a psychiatry resident at the Medical College of Virg in ia H ospitals . His wife Pamela has just received her master's degree in mental health nursing from the Medical College of Virgin ia. Tone Johnson, Jr.(M'75) • has been appointed clinica l assistant AUTUMN 1988 �22 R ''!:I q.._ pan ahe It's a , CPR, tor of fessio1 The Biornc suppo "It's reside, vance matte prepa1 T h, waso1 schoo' held i goes I: intub: body! heart Wh vance years: cy pro requir "It's quire UB "It ii noise The the ac best ~ "It I Mary "Yo, Pocha I!! ~ g ~ AlJl1JMN 19& BUFFALOPHYSICIANANO BIOMEDICALSCIENTIST BUFFAL �23 IBSIDENTS SUPPORT LIFE > Gettinghands-ontrainingin advanced cardiac life supportwasone of the best r 1rtsof a new orientationprogram,say UB residents i ~ UB placeditself one step 1ead of State regulation s by requiringthe trainingof all of its residents. ~ ·~ r r a common myth that all doctors know 'R, noted Glenda Donoghue, M.D., direcof continuing medical education and pro;ional development at UB. ~he UB School of Medicine and ,medical Sciences gives training in basic life )port skills, but not all medical schools do. It's our perception, and the State's, that idents should know not only basic, but ad1ced cardiac life support," she said . "No teer what your specialty is, you should be pared." ihac's why advanced cardiac life support , one of the topics covered by the medical ,ool's new orientation program for residents d in June . Advanced cardiac life support !S beyond CPR and uses methods such as ubacion, IVs, and medications to keep the :ly functioning for a prolonged period after m failure. XlhileUB's medical school has offered ad1ced cardiac life support for a number of 1rsand it has been required in some specialprograms, chis is che first time it has been 1uired of all residents in all programs. lt's virtually unheard of for a schoo l co reire it of all of its residents," Donoghue said. JB is getting a jump on Scace regulations. It isn't required by the State yet, but there's ise chat it will be," Donoghue explained . ihe new residents were enthusiastic about '. advanced cardiac training, calling it the ;c part of a fine orientation . It totally demystified a code," remarked 1ry Ann Millar, M.D. You definitely need it," added David :hatko, M.D. "I thought we needed it at FAI.O PHYSIC IAN AND BIOMEDICAL SCIENTIST the end of the second year" of medical school. The orientation was offered through the graduate medical education program, which operates under the auspices of the Graduate Medical-Deneal Education Consortium . ln order to attend, residents had co arrive for work a week early and the hospitals agreed to pay them for an extra week. "The hospitals are behind it 100per cent," Donoghue said. The purpose of the program was co prepare the residents for their work in the affiliated hospitals by educating them on the particular issues of practicing medicine in New York Seate, she explained. That includes: Creating a cohesiveness among the residents, who work in several different hospitals. "They're often confused about their relationship to the Un iversity," Donoghue explained. "They know intellectually they're in a University-related program, but they hardly ever see anything of che University." The program also aims co help the residents gee to know each other . Data suggests that if they' re brought into the hospitals as strangers, it takes a week or 10 days for them co function efficiently. If they know each ocher, they work in teams from day one, she explained. "That may be one of the biggest pluses," Donoghue noted. All of the residents from both halves of che orientation were invited to a picnic reception. It was a hot blustery day and the residents joked and mingled and noshed their way co peak efficiency. "It's a good way to get co know each other before you start the rigors of residency," Dennis Dejesus, M.D., a resident in general surgery, said of the orientation . Between sips of an icy drink, Constance G reene, M.D., a family medicine resident, noted that getting co know the other residents was especially helpful to her because she'll be working with so many of them from different departments . Teaching chem to be teachers. In the past, residents went from being students co being teachers overnight without any training. Now they get intensive training. The small-group teaching sessions and presentat ions on how co evaluate students were effective, said Jeff Sceinig, M .D., a resident in surgery. The orientation also videotaped the students to show them using good techniques and co point out flaws. Making su re the residents are aware of the regulatory climate in New York State. The Health Department regulations and credentialing requ irements may be much more stringent than in other states, Donoghue noted. "For a person from outside the country like me, the re was a lot of information," said Bharat Jain, M.D., who is from India. He found the discussion on defensive medicine versus cost control "very progressive." Even American students are unfam iliar with things like DRGs and cost containment . "The nurses would always yell at us about how much money we were running up with these tests,"said Millar. "Nobody ever cold us how much they cost . Now we know." AVTUMN 1988 �THIRTY YEARS UNDERWATER 24 By CONNIE OSWALD SlDFKO olding her breach, the woman plunges below the surface of the frigid ocean water, swimming deeper and deeper in search of abalone, snails, sea urchins, and seaweed. She is one of the Arna - the professional women divers who harvest the fruits of the seas that surround their homelands of Korea and Japan. They may dive as deep as 15 to 30 feet while holding their breach for as long as a minute. Bue what was fascinating co Suk Ki Hong, M.D., Ph.D., a professor of physiology at UB, was the Ama's indifference to cold. In the winter, the water is as cold as 50 degrees Fahrenheit, yet the Ama would wear only cotton bathing suits. About 25 years ago, Hong began co study the Ama . After a decade of research, he demonstrated that they had indeed become acclimatized to the cold, something that physiologi sts had doubted was possible. Hong discussed his findings on the Ama and his other research when he presented the Stockton Kimball Lecture at the Annual Faculty Meeting of the School of Medicine and Biomedical Sciences on May 25. There are 30,000 professional women divers called Arna in Japan and South Korea. The profession has existed for 2,000 years, Hong explained, showing a slide of an ancient Japanese print which depicts an Ama with an abalone knife AUTUMN 1988 clenched in her teeth. Just as their predecessors had done, the Ama studied initially by Hong wore no protective clothing, just cotton bathing suits. Even in the summer, the water never gets warmer than a cool 75 degrees Fahrenheit . "They're exposed to cold all year round," Hong noted. "I went in the water to measure the temperature. I wore a wet suit, but I still felt cold, though the women didn't seem bothered by it." Hong and his colleagues estimated the Ama's daily heat loss to be about 1,000 kilocalories a day. That's an enormous amount - about a third of their daily caloric intake. "This amount of voluntary heat loss is the largest ever measured in human subjects and provided strong rationale for our subsequent studies on human acclimatization to cold;' he explained . The women would voluntarily leave the water when their body temperatures reached about 95 degrees Fahrenheit, Hong said. If asked to stay in the water, they slowly lost consciousness. Hong measured the Ama's critical water temperature, that is, the lowest water temperature the subject can tolerate for three hours without shivering. In general, the fatter the subject, the lower the critical water temperature. Yet the critical water temperature of the Ama was low even if there wasn't a thick layer of fat under the skin, he found . Hong also found that the blood vessels in the divers' hands constricted more quickly in icy water and remained constricted longer than did the blood vessels of those in a control group . Another finding was that these divers had 30 per cent greater basal metabolism rate in winter than did non-divers. All of these factors created a pattern that indicated that it's possible to become acclimatized to the cold. But to be convinced, the researchers had to show that these unique deviations from the norm disappear when cold is removed. In 1977, the divers in Korea began wearing wet suits to insulate themselves BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �25 I Suk K i Hong, M.D., Ph.D. from the cold. This created the perfect laboratory for the second part of the experiment. Through a grant from the National Science Foundation, Hong stud ied the women again and found that by 1982 they had indeed lost their acclimatization. Hong dubbed his talk "Thirty Years Underwater." His career, devoted to studying humans' adaptation to life underwater, has divided itself rather neatly into decade-long segments. In the second decade, he examined the mechanism unde rl ying hyperbaric BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST diuresis, which is the increased urination that occurs when the body is subjected to high atmospheric pressure, as occurs underwate r, for long per iods . T hese experiments were conducted in highpressure chambers in Hawaii and Japan. The diuresis was puzzling because the divers didn't increase their fluid intake to make up for the increased urination, yet the total amount of body fluid remained the same. Hong fo u nd that the primary mechanism for chis diuresis is a suppression of the process called insensible water loss. Normally, peop le lose water vapor through their skin. Hong found chat at higher pressures, the divers lost less water vapor through their skin. His third decade of research centers on explaining, at the cellular level, how the mechanism causing hyperbar ic diuresis works . He and his colleagues at UB have constructed a specia l mini-hyperbaric chamber to study sodium transport in cells under high pressure. The experiments so far indicate that high pressure may indeed interfere with active sodium transport, Hong said. AUTUMN 1988 �26 ext year's Stockton Kimba ll Lecture will be delivered by this year's winner of the Stockton Kimba ll Award, John R. Border, M .D., who is acknow ledged as one of the fathers of modern trauma surgery. Border, a professor of surgery at UB, pioneered ground-breaking treatment methods that dramatically improve the chances of surviva l of patients who suffer severe multiple trauma, such as occurs in traffic accidents . "Few surgeons are recognized as having ch anged a n d imp roved their disciplines; said Lewis M . Flint, Jr., professor and chairman of surgery, as he presented the award. "Dr. Border has improved his discipline nationally and internat iona lly." Several other awards were presented during the annual meeting. Michael E Noe , M.D., clinical associate professor in social and preventive medicine and clinical assistant professor in medic ine and family medicine, received the Dean's Award for his leadership in the Graduate Medical-Deneal Educatio n Consort ium, for his leadership at Buffalo Genera l Hospital , and fo r h is teaching contributions . Distinguished Service Awards went to: Glor ia L. Roblin, Ph.D., clin ical professor of psychiatry; John W. Cudmore, M.D., clinica l associate professor of surgery; John E Moran, Ph.D., associate professor of bioc hemistry; and Peter Nickerson, Ph.D., professor of pathology . The first Robert S. Berkson Memor ial Award in the Art of Medicine was presented to James E Phill ips, clinical professor of medicine . T he award recognizes a volunteer faculty member for excellence in patient care and teach ing. AWARD-WINNING PROFESSORS By CONN IE OSWA LD STOFKO "Few surgeonsare recognized as having changed and improved their disciplines,"said Lewis M . Flint. "Dr. John Border has improved his discipline nationally and internationally." Border,a fat her of modem trauma surgery, received the Stockton Kimball Award at the annual Faculty meeting. AUTUMN 1988 BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �27 John R. Bord er, M.D. Phillips said he was very deeply honored to accept the award in the name of all the great teachers who went before him. he Louis A. and Ruth Siegel Teaching Awards were presented in four categories: The preclinical award went to John R. Wright, M.D., chairman and professor of the Department of Pathology. Commendation letters were given to Alexander C. Brownie, Ph.D., professor of biochemistry; Murray Ettinger, Ph.D., professor of biochem istry; Leon E. Farhi, M.D., professor of physiology, and T BUFFALOPHYSICIAN AND BIOMEDIC AL SCIENTIST Charles M . Severin, Ph.D., associate professor of anatomical sciences. The clinical award went to Margaret W. Paroski, M.D., assistant professor in neurology. Commendation letters were given to John A. Brach, M.D., clinical assistant professor of medicine; Ralph J. Doerr, M.D., assistant professor in surgery, and Frederick Munschauer Ill, M.D., research assistant professor m neurology . The volunteer award went to Thomas A. Raab, M.O., clinical assistant professor in medicine . A commendation letter was given to Takuma Nemoto, M.D., research associate professor in surgery. House staff and special awards went to Matthew Antalek, M.O., clinical assistant instructor in medicine; Jon B. Bishop, M.D., clinical assistant instructor in surgery; Robert A. Gianfagna, M.D., clinical assistant instructor in medicine, and Sathyazathi Reddy, M.D., clinical assistant instructor in medicine. Also at the meeting, Mrs . Char les Schen, president of the Auxi liary of the Erie County Medical Society, presented a $10,000 check to the school. The money was raised by the wome n's auxiliary for scho larships and unrestricted funds. AUTIJMN 1988 �28 'DEMYSTIFY SCIENCE: GRADUATES ARETOLD By DAVID M. SNYDERMAN B ecause physicians are the health scientists who most regularly come in contact with the lay population, the UB Medical Class of '88 must do their best to demystify science, according co the noted evolutionary geneticist Rebecca Cann. Cann, an assistant professor at the University of Hawaii, was part of the ream char formulated the "Eve Hypothesis~ the theory that claims that all humans share a common ancesror. She addressed the 142nd commencement of the School of Medicine and Biomedical Sciences on May 22. President Steven Sample also addressed the graduates, reminding them how much they are indebted to their parents for making their college and medical school educations possible. The class speaker was Stephen Hughes, who delivered a farewellco and from the class. Along with 140 doctor of medicine graduates, there were 25 doctor of philosophy degrees conferred. At the University's General Commencement, held earlier in the day, National Heart, Lung, and Blood Institute director Claude Lenfant received an honorary Doctor of Science degree. Lenfant, who received his M.D. in Paris, did postdocroral work at UB during the late 1950s. He did work on pulmonary physiology under Hermann Rahn, distinguished professor of physiology emeritus in the UB medical school. Commencement speaker Cann emphasized the need for physicians co be educators. This need exists, she said, because mosr Americans lack scientific knowledge. This knowledge gap is seen in the inability of many Americans co understand scientific theories, including Cann's own research on evolution. Cann recently was part of the team which "concluded that modern humans can trace the evolution of (mitochondrial) genes to a single female who lived in Africa around AlJfUMN 1988 200,000 years ago; she told the graduates. Known popularly as the "Eve Hypothesis~ the theory indicates that all mankind shares a common ancestor. Cann noted that "mitochondrial genes differ from classically defined genetic systems in that they are exclusively maternal in their mode of inheritance; meaning that all of an infant's mitochondria and their accompanying genetic material come from the mother. BUFFALOPHYSICIAN AND BIOMEDICALSCIENTIST �29 A bove, Rebec ca Cann, a memb er of the t ea m t hat f o rmulat e d the "E ve Hypot hesis," spoke at th e 142nd comm en cem en t of th e m edi cal sc hool. evidence of our own evolutionary history better known as biological certainty to the general public; Cann said . She also noted that specialists have developed different "jargons and a vocabu lary that provide an efficient mode of communication benveen peers but that also provide an effective barrier quite impenetrable" to understand ing the developments by non-specialists . Physicians "play an important role in the struggle for scientific literacy in the Ame rican public. Your daily activities will affirm the importance of science and techno logy on B human society today," Cann emphasized . ; She also noted that many college biology ~ students form their attitudes about science i very early in life. "These attitudes largely stem from their exposure to TV and their family physicia ns; she said . Cann instructed the graduates to "use your cited the Office of Technology Assessment's special ab ility and your everyday working report for the National Science Foundation know ledge of the human body to help foster that states that "somewhere between 43 and a bette r understanding of the biolog ical 45 per cent of high school-educated closeness which we humans share." Americans do not believe in human In order to help educate as many peop le as biological evolution and estimates that even possible, Cann urged the physicians to "read, about 25 per cent of college educated travel widely, and talk, not just to your colAmericans hold similar views." leagues but to community organizat ions, It is in light of this that physicians shou ld do everything possible to "make the physical school boards, polit icians, an d lawyers about i Mitochondrial genes "code for a small number of proteins that function in the production of energy for the cell."Cann said the importance of this is symbolized by biological essayist Lewis Thomas's statement that "you cou ldn't lift a finger or think a thought without those genes." However, Cann noted, much of America's population can't fully understand the implications of this type of scientific research. She BUFFALO PHYSIC IA N AND BIOMEDI C AL SCIENTIST AUTIJ MN 1988 �30 your informed (scient ific} opinions." Sample reminded the graduates of the large debt chey owe their parents for encourag ing them co pursue an education as well as seeing them through their schooling, both financially and emotionally. According co Sample, graduation "is an excellent time for you co express appreciation to the many individuals whose leadership, loyalty, and support have played such a significant role in helping you co reach your goals~ Sample feels chac it is imporcant to recognize thac "che individuals who are unquestionably rhe most important members of chis team, and who are deservedly the proudest of all on chis wonderful day are your parents, who throughout your lives and your lifetime educational process have provided direction and support." His sentiments were echoed by the dedication of the annual yearbook, The Iris, to "our parents" by rhe student body. The dedication was presented by yearbook co-editors Lisa Benson and David Brock and accepted on beha lf of all parents by Dr. and Mrs. Dav id Greene, rhe father and mother of a member of the graduating class. Brock said that the graduating class decided co dedicate the yearbook to parents "for instilling the values of caring and self-sacrifice and nurturing our love of learning; for pro• viding emotional and financial support and encouraging us when we needed it most, for giving of your selves so chat we could give to ochers and for just being the re." The class speaker, Stephen Hughes, suggested chat graduates shou ld link their alumni donations co pet causes. "For four years we have complained about our lack of power as medical school srudents; Hughes said. "Each of us has things in the curricu lum or about our education we would like co see improved. I am suggesting thac when you give - and I do encourage you co give - you make your suggestions known, and judge your futu re donations by che response to your suggestions." The graduates were welcomed into the alumn i association by Franklin Zeplowicz, president of the organization . AUTUMN 1988 The Hippocratic Oath was administered to t he new physicians by John Naughton, vice president for clinical affairs and dean of the School of Medicine and Biomedical Sciences. The 165 proud new graduates received their diplomas and joined the ranks of more than 4,500 alumni. "This bu ilding is impo rtant if we're going co continue to develop as a majo r biomedical research center; said John Naughcon, vice president for clinical affairs and dean of the medical school. "\Y/eneed facilities and equipment that will provide for ou r immediate needs for development and for a possibility of expansion over a 10-year period or so." SCHOOL PLANS NEWLABBUILDING T By LISA JOSEPHSON J use when you thought the sawdust had seeded, the UB School of Medicine and Biomedical Sciences is planning co build a $50 million research building that will contain approximately 150,000 nee square feet. The building will be 50 per cent larger than the Cary-Farber-She rman addition, which was completed in August 1986. Ir will be almost as large as UB's Recreation and Athletics Complex. The new building will consist primar ily of laboratory and research space. The building probably will be located somewhere co the south of the present medical school complex. It will connect to the Cary-Fa rber-Sherman complex, but there is almost no vacant land nearby, so exactly where to locate che new building poses some problems. Valdemar lnnus, UB associate vice president for resource planning, said the specific site will be decided by the architectural firm. Medical schoo l officials are currently in the process of developing an outline describ ing what activities will be housed there, said Innus . The Ca ry-Farber-Sherman addition, which cost $19 million, was said to be "the cornerstone of the medical schoo l's expansion program ." Alchough medical school officials had hoped che addit ion would satisfy che school's needs well into the 21st century, it does not have the facilities, equipment or space needed for the schoo l co become the major research institution that officialswant it to be. he University had planned a major renovation of the Cary-Farber-She rman complex, but the comp lex doesn't lend itself to the type of renovation requ ired, Innus said. For example, there isn't enough room between the ceiling and the floor for all of the pipes for electricity, gas, water, sewage, heating, cooling, and ventilat ion . Wee labs, which use special fume hoods and sinks, need mo re pipes than office buildings do. Officials want to hurry the building project along because there's a growing need for research space in the medical school. To speed up the process, they've set some guidelines for construction. One is chat the new building shou ld be designed co allow any space to be converted into wet lab space if needed . Another is there should be minimal finishes co provide flexibility. The planning process is expected co be completed sometime this fall, according co lnnus . Ac chat time an archi tectura l firm will be chosen. The schedu le for construction of the building depends on the complexity of the outline given to the architect. Usually co nstruction of a facility of chis type cakes about three co four years. Officials say the building could be completed in as sho re as four co five years or as long as eight years. "le really depends on how long we cake co design the building; said lnnus . "Our approach is co move as quickly as possible through the design process. We will sec ambitious timetables to make the building availab le as soon as possib le." "This is an exciting addition chat makes it possible for us to move forward on plans we've had for a number of years," remarked Naughton . BUFFAIDPHYSICIANAND BIOMEDICALSCIENTIST �31 Frank Schimpfhauser, Ph.D. , assistant dean and director of the Medical School's Education Development and Research Unit, received a 1988 Chancellor's Award for Excellence in Professional Service. A member of the UB staff since 1976, he has helped his faculty apply for federal grams, including several subsequently awarded for research in cancer education and cancer prevention. He served as Faculty Senate secretary for two years and chaired the senate's teaching quality committee for two terms. He also oversaw a review of the Gifted Math Program. Schimpfhauser has co-directed the summer development program for new and recently hired faculty for the past five years. He has published articles on medical education and evaluation and teache s two graduate courses through the Department of Social and Preventive Medicine, where he is associate professor. Schimpfhauser holds his Ph.D. and M.A. degrees from Ohio State University. He received his B.S. from UB in 1965. Russell W. Bessette, M.D., D .D.S., has been appointed head of the Division of Plastic Surgery at the Buffalo General Hospital and UB. A member of the Buffalo General medical staff since 1981, Bessette has broad clinical and research experience and an avid interest in re-establishing graduate education programs in plastic surgery. Bessette will continue his active role in UB's Health-care Instruments and Devices Institute (HID!) as director of the IDEA laboratory at Buffalo General. He also holds faculty appointments in the Department of Surgery and the Departments of Oral Medicine and Oral Pathology at the University. C h ar les F. Dewitz (M'14) • who practiced medicine until the age of 100, died June 29 at the age of 103. As a teenager, he worked for one of the doctors who assisted in treating President William McKin ley when he was shot in 1901, and who treated Mrs. Jefferson Davis, the wife of the president of the Confederacy, in 1903. Dewitz opened his own practice in 1921.He closed his office when he was 92, but continued to see a few patients for eight more years. He is survived by two sons, Charles S. and Robert G.; a daughter, Esthe r D. Eddy; nine grandchildren, and nine great-grandchildren . Frank Schimpfhauser, Ph.D. Peter T. Ost row, M.D. , was moderator for the 22nd annual John J. O'Brien, M.0., Research Symposium held at Mercy Hospital. He is associate dean for curricular and academic affairs and associate professor of pathology at UB. The patient medication information sheets written by sophomores Craig Na rin s and Laura Nic ho lso n were the top entries in the annual c,ompetition held in the spring by the Department of Pharmacology and Therapeutics. Eugene R. Mindell , M.D. , professor of orthopaedic surgery, was named president-elect of the Musculo skeletal Tumor Society at the society's recent annual meeting in Minneapolis . DEATHS Linda Hawkin s, M.D. , Ph.D. , assistant professor of psychiatry, received the 1988 Hyman L. Levin Award at the annual luncheon of the Mental Health Association of Erie County. She is a psychiatrist U and director of the Department of Psychiatry's Education and Training/Medically Ill Chemical Abuser s Program at the Buffalo Psychiatric Center. BUFFALOPHYSICIAN AND DIOMEDICALSCIENTIST Francis R. Daniels (M'24) • died suddenly Oct. 20, 11987,from a heart attack at his home in Sama Ana, Calif. Dr. Daniels practiced general surgery in Rochester, N.Y., until 1954. In 1955, he moved to Sama Ana, where he practiced until 1981. He is survived by his wife, Irma, a son, Dr. Mar cel F.Danie ls, and a daughter, Chantal. Mauri ce B. Gordon (M'34 ) • died on July 31, 1987, in Brunswick, Maine. He was superintendent of Cleveland State Hospital until 1951 when he became director of the Veterans Administration Mental Hygiene Clinic in Newark, N.J. Or. Gordon maintained a private practice and served as assistant director of social rehabilitation at the Postgraduate Center of Mental Health. He is survived by his wife, Ellen, and daughters, Marcia and Judith. Donald M. Secr ist (M'65) • died of cancer on Dec. 6, 1987. After serving as a captain in the U.S. Air Force, he began a private practice in gastroemerology in Aspen, Co lo., in 1973 and continued that practice until his death. Or. Secrist is survived by his wife, Maryellen; a son, Peter, and two daughters, Jennifer and Katie. Georg e W. Fugitt (M'45) • died May 30. The Kenmore urologist was on the staff of Kenmore Mercy and OeGraff Memorial hospitals and had served as president of the medical staffs of both facilities. F-orfive years he was chief of the medical staff at DeGraff and was a member of its board of trustees. Fugitt was chie f of urology at Kenmore Mercy. At UB he was a clinical associate professor of urology. H e is survived by his wife, Betty; two sons, Or. Robert G. Fugitt and David P. Fugitt; a daughter, Diane Fugitt Pugh; a broth er, Warren Fugitt, and two grandchildren. AUTIJMN 1988 �32 TOTAL 1988 AWMNI DONATIONS SPRING $77,980AT ANNUAL REUNION /CLASS DAY CLINICAL he class reunions are a high point of the annualSpringClinicalDay held each year by the School of Medicine 1928 Fromleft, seated: Thelma Brockand RaymondRick/off.Standing:Bmno and Biomedical Sciences. It's a time Schutkeker and Walter King. for chatting about family and mutual acquaintances; catching up on classmates'careers,and talking shop. It's also a time for the traditionalgifts. This year the anniversary classes generously donated $77,980. . $5,750 Class of 1938: ......... $11,460 Class of 1943: ......... $6,900 Class of 1948: .......... $10,930 Class of 1953: ......... $14,400 1938 Class of 1958: ......... seated:Eustace c. Phillies,Leo]. Doll, Walter z. Schwebel, $8,725 Fromleft,Lieberman, Class of 1963: .......... L. ]. Foit, and \\1/alter , ClarenceStraubingerNorman Samuel 5>·doriak.Standing:Charles Donatelli, Vincent L. Rutecki, Russell]. Cla5S Of 1968: · · · • · · · · • · $7, 575 Catalano,SanfordUllman,H. RobertOehler,Carl Hertz,JohnH. Geekier, Harry C. Law, CharlesF. Becker,William H. Tatem, Harold]. Elliott, RichardTerry. and $8,200 .......... Class of 1973: $3,525 Class of 1978: .......... $515 Class of 1983: ........... AUTUMN 1988 BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �33 1943 1953 Fromlefc,seated:Erwin R. Chillag,Kevin M. O'Gorman, Morris Unher, amd EdmundM. Tederous.Standing:Marvin L. Bloom,PaulJ. Wolfgruber, Ivan L. Bunnell, Joseph]. Ricotta,CharlesJ. Tanner,PaysonB. Jacobsen, JohnC. Ninfo,JohnR.Williams,AnthonyJ. Marano,and RobertW. Moyce. From lefc, seated: Herbert W. Simpkins, Marvin Wadler,JosephF. Ruh, Thomas E. Comerford,Molly SeidenbergPanner,Jack Gold, RichardJ. Nagel, and Donald L. Ehrenreich.Standing:Thomas G. Geoghegan,John N. Strachan, Curtis C. Johnson,John W. Handel, Milford C. Maloney, Howard C. Smith, Bertram A. Partin, Michael A. Sullivan, Robert A. Peacock,ReinholdA. Ullrich,RobertS. Sobocinski,StanleyL. Cohen,James M. Orr, James R. Coleman, FrancisT. Oliver, Donald 0. Rachow,Harley D. Lindquist, James W. Carlin, and Raymond M. Smith. 1948 From lefc, front row: Lester H. Schiff, Raphael S. Good, Norman Paul, Albert P.Sutton,Darwin D. Moore,EdgarC. Smith, and CliffordW. Gates. Secondrow:JamesG. Borman,Michael Dzubaty, Norman Minde, Judith B. Landau, Oliver P.Jones, Leon Graff, Mary Alice Smith, and David P. Buchanan.Third row: Warren L. Hollis, Cletus J. Regan, Vernon C. Lubs, FrancisPeisel,SeymourZola,Daniel J. Fahey,Robert]. Hall, Myron Gordon,Harry C. Essig,Glenn B. Doan, Ansel R. Marcin, RichardProplesch, B. Edward Heckmann, and Thomas J. Enright. BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST 1958 From left, front row: Richard Romanowski, Michael Mazza, Frederick Dischinger,GaspareAlfano, RichardRahner,RichardC. Boyle,and Joseph Bellanti.Secondrow: John W. Float,JohnArmenia,JerryWeisberg,Samuel Shatkin, Marie L. Kunz, Melvin Brothman,Jacques Lipson, and Roger M . Baretz.Third row:JosephZizzi, HaroldZimmerman,ReinhardtWende, Alfred Stein, Gerard Guerinot, Franklin Zeplowitz, Eugene Friedberg, RichardD. Wasson,John J. Giardino,Leo Kane, Dominic Falsetti,James S. Williams, RobertC. Dickson, ElroyE. Anderson,John P.Murphy, Lucien Potenza,and Lloyd H. Leve. Fourthrow: RobertJ. Perez,Franklyn Campagna, Thomas G. Cummiskey, BensonEisenberg,Morton Spivack, and Michael Genco. At.rrUMN 1988 �34 1963 1973 Fromleft, front row: JosephC. Tutton,John Schriver,Mike Sullivan,George Fromleft, seated:RobertLaMantia, PaulKuritzky,SharonKuritzky,Jeremy Lockie, and Joseph Herbstrict.Middle row: Albert Maggioli, Anita ]. Cole, and Stephen Nash. Standing: LeelandJones, RobertFugitt, Patrick Herbert,FrankV DeLaus,AnthonyFoti,CharlesS. Tirone,David Malinov, O'Connor, David H. Breen, and Joseph Mylotte. Robert8. Spielman,and Donald Levine.Back row: John LaMar, Richard B. Narins, William Heyden, LawrenceSobocinski,John R. Fanelli,John Wadsworth,Jason E. Rudisill, Stephen Joyce,and Ernest Fatta. 1968 1978 Fromleft, front row: RaymondMarlin, Thomas]. Cumbo, Sara R.Sirkin, RobertA. Milch, BruceGesson,and GeorgeCohen. Middle row: PaulS. Schulman,Kenneth Jewel, John Gold, Stephen Edelstein,Julian Karelitz, Harold Kulman, and Kenneth Eckhert. Back row: Peter A. Mansk)', Jonathan Reynhcut, Lawrence]. Dobmeier,Brian Joseph, Robert White, and Gerald Daigler. Fromleft, front row: PaulParoski,Mathew O'Brien, RonaldSomogyi,and John R. Valvo. Second row: Richard Elman, Gregory Roberts, Roberta Meltzer, Elizabeth Doherty, Lois Polatnick,Judith Baron-Stone,Franklin Gillig, and Covia L. Stanley. Third row: Gary Eggleston,Steven M. Seidman,]. Thomas Amo, Mario Santilli, FredH. Geisler,RichardSternberg, SimonShaham, PaulWopperer,and Nelson Isada.Back row: HarveyGutman, Stewart Altmayer, Stephen Gawronski, and Alan Koslow. AUTUMN 1988 BUFFALOPHYSICIANANO BIOMEDICALSCIENTIST �35 1983 From left, front row: Galvin Andmon, Borys Loza, JonathonA. Graff, ElaineHuber,Sue MeyersTanbakuchi,and FrankMezzadri. Secondrow: Gwen Nichols, PatriciaFlanagan,Jill Lindner, Andrea Manyon Wild, SharonAlger, YoungheeLimb, CatherineGood/ell.cw, and KarenHorowitz. Thirdrow: Mark Schwager,RichardAmiraian,MelindaS. Cameron,Robert Smolinski,Stephen Kinsman,James E. Wild, RobertStall, Kenneth Zimmerman, Neal Smith, RichardCollins, Michael Michotek, PeterAccetta, Kevin Ferentz,John Feldenzer,Carl Grant, Michael Cane, Marc Levine, and Ronald Marcus.Back row:Allen Rosen,Mark Venditti,and Frederick McAdam. NEWOFFICERS ELEOED TO MEDICAL AWMNI GROUP aul H. Wierzbieniec (M'74) ha s been elected to a one,year term as president of the UB M edical Alumni A ssociation. Other officers are Joseph L. Kunz (M'56), vice president, and Charl es S. Tirone (M'63), treasurer. Wierzbieniec, an orthopaedic surgeon , is clinical instructor of orthopaedics at UB . Kunz, a clinical assistant professor of medi cine at UB, is a specialist in interna l medicine with su bspecialties in gastro enterology and endoscopy. Tirone is a clinical assistant professor of radio logy at UB. BUFFALOPHYSICIANANO BIOMEDICAL SCIENTIST From left, Eugene Be l trami, Robert Patt e rson, and Harold Brod y . JAMESPLATTWHITESOCIETY FORMSEXECUTIVE COMMITTEE he James Platt White Society has formed an execut ive committee made up of society members . T he purpose of the comm ittee is to help guide the society in the nurturing of the medical school, both financially and emotionally. Dr . Robert Patt erson ha s been named chairman . He is joined by Dr . Eugene Beltrami, Dr . Harold Brody, Dr. Marvin Kurlan, Dr . Richard Narins, D r. Clayton Peimer, Dr. Richard Romanowski, and D r. Robert Bernot. Membership in th e society is open to those contrib uting $1,000 to the schoo l an, nually . Currently, ther e are 66 member s. Those interested in mo re information regarding the society can contact any board member . AlJfUMN 1988 �36 OCT.13 OCT.20 ................... T he H arrington Lecture will be held at 4 p.m. T hursday, Oct . 13, in Butler Audito rium . Edwin D. Kilbourne, M.D., Distinguished Service Professor of Microb iology at Mt . Sinai School of Medicine, will speak . Kilbou rn e is a member of the National Academy of Sciences . "Elevated Cho lesterol: A Public Health Crisis?" will be the topic of a conference sponsored by the UB Schoo l of Medicine and Biomedical Sciences. It will be held from 1 to 5 p.m. Thursday, Oct . 20, in Butler Aud itorium. Registration is at 12:30 p.m . For more information, call 831-3714. . AD IMPLIEDNO ENDORSEMENT he Buffalo Physician and Biomedical Scientist, Volume 21 #5, carried an advertisement for Ph ysicians for Social Respon, sibility that caused concern among some readers. While we have previously covered the activities of this group, to which a number of Medical School faculty belong, we had never before run an ad of thi s nature that invited membership . Did this constitute an endorsement of the group on the part of the University, we were asked? The answer to that, of course, is no. The ad was run through a misunderstanding on the part of the Director of University Publications who at that time was func, tioning as interim editor of the Physician. The ad was brought in by a faculty member and the interim editor assumed that since the professor has been referred by the Medical School Office that referral somehow indicated an approval to run it . This was an error because when the magazin e appeared, the dean was sur, prised to see it. In any case, the respon sibility is that of the in, terim editor and the appearance of the ad was not meant to state or imply an endorsement on behalf of the Univer sity or the School of Medicine and Biomedical Sciences. • T ��BUFFALO PtiX§!~~ State University of New York at Buffalo 3435 Main Street Buffa lo. New York 14214 c. K. HUANG BA 57 TREESROOKer. WILLIA SVILLE NY 14??1 -- Address Correction Requested Non-Prof U.S. Po" PAID Buffalo.l Fnm11 N �Profit Org. Postage lo, N.Y. , No. 3JJ � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician and biomedical scientist, Autumn 1988 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1988-Autumn Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. 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You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/8da3556d698c9e5d32463827512169d4.pdf 566020955cb0948d0fab04977a2bda6e PDF Text Text �--:--- I �VOL. 25 , NO. 4 ....................................... . .......................... . ........ . ....................... AUTUMN 1991 IJ Research II HospitalNews II TheResignationof NealRzepkowski.Forced out of Prescriptions for pain havechanged, andso havedoctors'attitudes aboutthis major patient complain t. Page20. Brooks Memorial Hospital in Dunkirk and caught in the storm of controversy that followed the release of the CDC's new guidelines governing HIV-infected health care workers, Neal Rzepkowski is a physician at peace with himself and his life. IEJInWhoseHands?The Patient Self-Determination Act should put patients more firmly in control of their own medical destinies. m Congratulations . YouHaveBeenAccepted! Getting into UB medical school is more com petitv e than ever. E3The Classof 199S. A special photo directory insert of the School of Medicine and Biomedical Sciences' entering class. E!J Ending the Agony• epidemic of pain. EJMedicalSchool EiJAlumni TheHopeClinic lets UB's medical studentsgive backlo their commu nity. Page24. ew techniques to treat the mPeople mClassnotes *TheJamesPlattWhite Neal Rzepkowski, M.D., speaks out onthecontroversythat cast himhis jab. Page 6. Societylavndtes its "'Thotsancl at a Thotsancl" campaign.Page28. �···· ··················· ··· ······ ············· ···•·· ········ ··············· ······· ·· 11 ., ' . Studyshowspetdogs aremorecalming thanclosefriends is that subjects with their pets presen t were apparently less psycho logically threaU!ned than were subjects with their friends present or subjects withou t a comp2mion," the researchers wrote. + he presence of man 's best friend - the four-legged variety - is a more calming influence during the performance of a stressful, evaluative task than , that of a close human friend, UB research ers have found. The researchers believe the resu lts of the study, published in a recent issue of the Journal of Personality MyFriend and Social Psychology,can be amibuted to the fact that dogs are seen as non-judgmental and non-evaluative, while friends are not. The study was conducted by Karen M. Allen, Ph.D., director of training for the Rehabilitation Research and Training Center on Community Integration of Persons with Traumatic Brain Injury; James J. Blascovich, Ph.D., director of the Center for the Study of Behavioral and Social Aspects of Health; graduate student Joe Tomaka, and Robert M. Kelsey, a post-doctoral fellow. The researchers measured autonomic responses of 45 women who reported close relationships with their pet dogs during two sessions in which the subjects performed stressful menta l arithmetic tasks. With pets present, participa nts' autonomic responses remained at baseline while performing the mental arit hmetic tasks. BULwith friends present , participants ' autonomic reactivity increased dramatically. "Our interpretation of these findings e B U FFA. L O PHYSIC I AN B Y SUE W U ETCHER UB1~esearcher receives gra11t fromACS UB researcher has received a $240,000 grant from theAmerican Cancer Society to study the relationship between diet and the development of cancer. ~ Jo Freudenheim , Ph.D., assistant professor of social and preventive mediC"ine, will conduct three studies under the two-year grant. One will examine the role of dietary intake in the development of premeno pausal breast cancer, endometrial cancer an,d pros tatic cancer by focusing on information on dietary intake and health and persona l factors collected in interviews with residents of Erie and Niagara counties with cance r and a group of matched controls. The sLUdywill look at the association betwe,~n the cancers and the intake of fat, calories, carotenoids, vitamins, fiber, zinc and cruciferous vegetables . A second study will focus on 58,000 older, llong-tenn New YorkState residents who completed a questionnaire in 1980 about their health and personal factors. "The group is being followed through the New York State Tumor Registry, " Freudenheim noted. "Sufficient cases have now occurred to allow for a prospective analysis of dietary factors in cancer of the lung, breast, colon, rectum, ovary ,endometrium and prostate. " The third study '<viiilook at data on controls from the first sLUdyto examine the correlation of factors such as energy expen ,diture, occupational time and lei- A.NO B I OMEDtCA L SC i sure time with dietary practices. Smoking, reproductive history and socioeconomic status also will be among the + factors to be studied . - BY A RTHUR PAGE Innovative technique usedto repairaneurysm eurosurgeons at the State University of New York at Buffalo used an innovativeendovascu lar procedure LO treat a cerebra l aneurysm in a mother of eight , eliminating the need for risky surgery and giving the woman a "second chance " at life. The neurosur geons , led by L. Nelson Hopkins, M.0., chair of the neurosurgery de partment at UB and chief of neurosurgery at Millard Fillmore Hospital, threaded a micro-catheter through the patient 's blood st ream and into the aneur ysm . A small coil of platinum wire was placed in the aneurysm and a low-voltage banery current passed through the coil , causing a clot to form and seal off the aneurysm. The coil was released within the aneurysm and left I EN TI ST A U TUMN 1 9 9 1 �····•·· ··········· ····················· · ··········································· · ······ m . WU .. low-up Clin ic and director of the oncology section at The Children 's Hospital of Buffalo. Also on the team were Michael A. Zevon, Ph.D., Geoffrey Lowrie, NinaSeigelstein and Brenda Hall. The study focused on 25 male and 35 female former cancer patients 18 or older who had been diagnosed with cancer five or more years earlier. Among the 39 children born to the male former patients, three had minor congenital anomalies. The frequency of BY ARTHUR PAGE single anomalies was 7.9 percent, compared with 13 percent for the general population, the researchers reponed. Congenital anomalies occurred in five of the 63 children born to the female former patients. The incidence of venuicular septa! defect as a single malfom1ation was 3.85 he use of chemotherapeutic agents per cent in female children of the white to treat children and adolescenLs with cancer does not appear to female formerpatients,ascompared with increase the frequency of con- 0.034 percent in white female infants in genital anomalies in their chil- the general population. The incidence of tetra logy of Fallot was 2. 78 percent dren, according to researchers among the male offspring of the white affiliated with UB and Roswell Park female former patients, compared with Cancer Institute. 0.024 among white male infants in the They report in the lead article in Lhe July 18 issue ofTlie New Englandjoumal general population. Both women who gave birth to a child of Medicine that with Lhe exception of one agent, dactinomycin, a higher inci- with a cardiac defect had received + dence of congenital anomalies was not dactinomycin in chemotherapy. BY ARTHUR PAGE found in a follow-up study of 60 former cance r patienLs. In the case of dactinomycin, structural congenital cardiac defects were found in 10 percent of the infants born to women treated with the drug compared with a 0.60 percent rate for infants in the general popu laLion. Daniel M. Green, M.D., professor of pediaLrics and chief of the oncology secLion in the department of pediatrics at Roswell is principal author of the study. Green also is director of Roswell's Long-Term Fol- behind to permanently seal off circula tion and protect against future hemorrhage. The neurosurgeons from UB and Millard Fillmore are only the founh group in LhenaLion to successfully perform the procedure on patients. "I feel like I'm lucky to be alive," says Jacqueline Talada, 49, who suffered from progressively severe headaches and seizures due to a "giant aneurysm" at the base of her brain. "I feel I got a second chance to be alive, Lhanks to Dr. Hopkins and th e medical field." Talada underwent the procedure July 29 at Millard Fillmore under local anesthesia. Discharged three days after the procedure, she has had no more seizures and her headaches have improved tremendously. The new procedure was developed in 1990 by Dr. Guido Guglielmi, M.D., and a team of neuro-radiologists at the University of California at Los Angeles. + SUE ~· ,. . BY ·~ sample ofBuffalo households. Also working with Trevisan, associate professor of social and preventive medicine and acting chair of the UB Department of Socia l and Preventive Medicine, were Vittorio Krogh, M.D., Linda Klimowski , Susan Bland and Warren + Winkelstein, M.D. Chemotherapy in childhood notshownto increase birthdefects ETCHER Lackof siblingsincreases riskof hypertension eing an only child increases your risk for high blood pressure, accordi ng to UB researchers. Ina study of 1,472 whiteadulLs, researchers found that the mean systolic and diastolic blood pressure and prevalence of hypertension were higher in those without siblings. In the case of systolic blood pressure and prevalence of high blood pressure in both sexes and diastolic blood pressure in men, the differences were statistically significant, Maurizio Trevisan, M. D., and colleagues reported in a letter in The New EnglandJoumal of Medicine. The UB study focused on 6 76 men and 796 women, age 20 to 70, who participated in a survey involving a random BU,.FALO PHYSICIAN ANO BIOMEDICAL S CIENTIST AUTUMN I SI 9 I 0 �1&n1·················· .... . ···· ~ SistersHospital begins modernization proiect ork began in mid-October on Sislers Hospital's $42 million modernizalion projecl. The 28-month project will provide enhanced patient treatment areas and improved seuings for visitors and employees. Major components of the project include new coronary and intensive care unilS, new operating rooms, ambulatory care wing, emergency depanment, head and neck center and a new lobby and elevator bank connecting corridors for easier access to all areas. The project will also address major code and safely issues along with increased cool ing capacity and air conditioning and medical gas systems. "Much of the work will be done within the existing structures so those passing by the hospital will not be aware of most of lhe work," said Timothy J. Finan, Sisters' executive vice president. The projecl will begin with lhe addition of lwo floors atop the hospital's skilled nursing facility to house a ..t;J ....,._I I new 16-bed ICU and eight-bed CCU. A ·' _! connecting corridor will allow for direct .;..W... access between the new intensive care units and operating suite to be constructed. Sisters will also consolidate its laboralories to the hospital's fourth floor. The present operating room space is slated for renovation to house pre-admission, urology , endoscopy and outpatient surgery. The project also includes construe- fl 0 BUf",.A.LO PHYSICIAN · ········································ · ············· tion of a 10, 760-square-foot building behind the hospital to accommodate the hospital's information systems and finance depanmenlS. Also scheduled for renovation and realignment is a significant portion of the hospital's first floor. A new main lobby will be constructed at the present location of the finance and information systems departments. Inpatients and visitors will pass directly through the new lobby to a new bank of elevators linking them directly with patient floors, surgery and critical care units. OutpatienlS will use the new entrance and connecting corridor to a completely remodeled ambulat0ry care wing which will incorporate the emergency department, outpatient department , women's services, corporate health services and satellite radiology and phlebotomy labs. The emergency department will also gain a new entrance to enhance traffic flow for walk-in patients. The project was designed by the Rochester firm of DeWolff Partnership, + Architects. ffi §~ ffl --,i~: Herzigto heodbone morrowtronsplontotion unitot Roswell eoffrey P. Herzig, M.D., has been appointed d irector of the Divisions of Hematologic Oncology and Bone Marrow Transplantation, Department of Medicine, at Roswell Park Cancer lnstitute. Former professor of medicine, division of hematology/oncology and head of the bone marrow transplantation program at Washington University School of Medicine in St. Louis, Herzig is an active member of many professional organizations, including the American Federation for Clinical Research, American Society for Clinical Oncology, American Association for Cancer Research and American Society of Hematology. He has written over 80 scholarly papers, monographs and book chapters. j:~:;!;~ ~-[ ~-___ .... ~-~r. W;~ 8 ►-- ~ ~~ ~ fj§ · ······· ell ~~ b f~~ ~o~ .Aili~~ Artist's rendering of Sisters Hospitol's newlobby. ANO 8tOMC:DICAL SCIENTIST AUTUMN 1 9 9 1 �- -------- ······ -- · ···· · ············ -- -- - -- · ················ A Phi Beta Kappa, Herzig received his medical degree in 1967 from Case Weslern Reserve Universily in Cleveland and his medical residency training at Bronx Municipal Hospirnl in New York. He also served as senior invesLigator, Pediatric Oncology Branch, at the National Cancer Institute. The bone marrow transplant program performs both autologous and allogenic transplantations and conducts research designed to improve long-term survival rates for transplant palients. The division of hematologic oncology treats pati en ts with leukemia , lymphoma, myeloma and other hematologic problems and studies the pharmacological and biological basis of disease progression and response. + BGHparticipates in JCOAH test proiect he Buffalo General Hospital has been selected to participate in the field testing of indicators , or "performance measures, " for theJoint Commission on Accreditation of Healthcare Organizations. The Lesting represents the firsl largescale evaluation of theJCOAH 's trauma care, oncology care, cardiovascular care, medication use and infection control indicators. The indicators are designed to support hospital efforts to assess and improve the quality of patient care. Buffalo General will participate in the testing of infection control indicators. Testing is expected to last about two years. The indicator development project is part of a JCAHO project begun in 1986 to modernize its accreditation process. The new process potentially uses both clinical and organizational performance data to measure an organization 's ability to deliver quality health care. BUF' F AL O PHYSICIAN - - -- ---- · ··· --- · ···· --- · ········ ·· ·· ···· BGH joins other test sites selected from volunteer accredited hospitals throughout the nation. Test site activities include evaluating hospitals ' ability to use computer systems to collect indicator data and to transmit the data electronically to the Joint Commission. A second activit y involves evaluating the reliabilit y and validity of the indicators to assess their potential usefulness to improve the quality of patient care and services. + ~ --- - - - ················· - -- • ·····lrBl - a primary physician. Referrals are based on patient need, geographic location and accessibility to follow-up treatment sites. Some of the benefits of the HIP program include early intervention and immediate response Lo potential problems while patients are still hospitalized, according to program counselor Kathleen McDonald, R.N. Early treatment of alcohol-related problems also reduces the chance of patients developing further physical or psychological complications , McDonald said. According to statewide data gathered since H!Ps were implemented in 1989, approximately 25 percent of patients admitted to hospitals have alcohol or drug-related conditions. + BGH adoptsalcohol intervention program uffalo General Hospital is one of 18 hospitals statewide to , developaHospitallnterven~ V tion Program (HIP) for pa- ,, ./. -~ tients with alcohol-re' lated problems . • f The new program , the first in Erie County , offers counseling , education and linkage and referral services based on inpatient screening on des~~~~ ignated units. Screenings con- , ~ :: ,. ff. ~ i~- ·~ff~ ~\\'- - sist ~f. a series of questions admm1stered by nursmg staff with the permission of a patient 's AND B I OM E DICA L · .~ .,;,..V $C1£NT I ST AUTUMN I 9 II I 0 �I eal Rzepkowski'.sstory is straightforward and only slightly bitter. The 40-year-old UB assistant professor of medicine spends his days in the Spiritua list haven of Lily Dale, New York, an oasis of tranquility amid the storms that have gripped his life. Diagnosed in 1985 as being infected with the human immunodeficiency virus the virus that causes AIDS Rzepkowski was thrust into the nationalspotlightlastsummer I �_I , ~-/ ~ r I I-:___/ _JJ_f I< · ~-- LlVin~ wltll tlleconsequences ofilieCDCsre~ulations new ~overnin~ HIV - osit ive pllysldans. �when he became the first physician lo disclose his HIV-positive status under new guidelines governing health care workers infected with the virus. The Centers for Disease Control issued the guidelines last July after months of delays and deliberations. As a result, Rzepkowski was forced lo resign his fulllime emergency room post al Brooks Memorial Hospital in Dunkirk amid a nurry of national press coverage. Rzepkowski does not, al this point, have AIDS, though he is realist ic about the likely outcome. The possibility of an early death, he says, "hangs over my head like the Sword of Damocles." Save for a half-day of work a week at the Immunodeficiency Clinic at Erie County Medical Center, Rzepkowski's practice is non-existent. "l suppose l could start a private practice. l know I would get a lot of I IIV-negative palienlS coming 10 see me. But a private practice and my past experience of having one means that you're on call with a full-time work week, on call al nighlS and up weekends." So Rzepkowski is careful to gua rd his resl and nutrilion. "I'm not going to have a private practice to prove a point." Monitoring and appropriate medical action, he knows, can delay the onset of AIDS. Rzepkowski iscoping with the stresses of sudden celebrity. He is perhaps a little weary of questions posed by yet another interviewer. His story has been reported by the national press, and further probed on talk shows by Oprah Winfrey and Jane Pauley in her "Real Life" series. Today, Rzepkowski feels fine though he's occasionally fatigued and does have hairy leukoplakia - a white, possibly precancerous, patch-on his tongue, "a sign of HIV-positivity/ he relates matter-of-factly. He is above all, an educator on the AIDS nightmare who doesn't shirk from the known faclS,even when they so impinge on the tranquility of the moment. There is no time for easy dissembling when his mission is the truth. "The average time between getting infected and becoming seropositive, and developing symptoms is 10years- that's the average time. Some people take a lot o eu,,.ALO PHYSICIAN longer. But it is thought that more than 90 percent of these people, eventually, given enough time, will go on to develop AIDS." Rzepkowski's own frank statistical analysis may mean he has only a few years left. So often, he notes, the public con fuses HIV positivity with having AIDS ilSelf. "l don't have AIDS. I have HIVpositive teslS. A lot of people confuse that. Like I say, you can be HIV-positive for 10 years before you have the end stage of that virus, which is AIDS." Rzepkowski has owned his small Lily Dale home for four years, living in the century-o ld community for metaphysical education for the last year and a half. He went to high school in Dunkirk, then moved to Troy where he began studying Spiritualism and earned his B.S. from Rensselaer Polytechnic lnsti tute in 1974. Then came medical school at what was then SUNY Upstate Medical Center in Syracuse (M.D., 1978), followed by a fam ily practice residency in Schenectady's SL Clare's Hospital and seven more years as director of the hospital's Family Health Center. ANO BIOMEDICAL SCllNTIST Board certified in Family Practice, Rzepkowski was drawn to Boston's Fenway Community Health Center in 1988, where he could care for AIDS pa tienlS in the sympathetic setting of a gay-run institution. Openly gay, he "wanted to go learn about the virus and care for these patients." In 1990, weary of high renlS and neighborhood crime, he returned to Lily Dale, where he could tend his garden and consider an uncertain future. By this time, of course, Rzepkowski knew he had the virus. "The odds are," he says, that he contracted it "in 1981 or 1982," before the human immunodeficiency virus was isolated and "safe sex" practices were advocated. Slowly he revealed the news to a circle of friends, and gradually lO professional people he thought should know. "In July 1985, I tested positive; the test first became available to the public that month. Wi thin a short time, I told the director of my program and the nurse epidemiologist at the hospital. They were the only ones who knew - at the time, they were the only appropriate people lO AUTU""N 1 9 9 I �----- - ---------- tell. I also had cared for HIV-positive patients ever since the test first came out. I shared the fact that they were not alone and that I was in their same boat. " This was the beginning of gradual disclosures that led to a front-page story in a New Hampshire paper and later, to blockbuster announcements in the local and national media last summer. "It was open, " Rzepkowski ins ists of the subject. "I also shared it \vith a few of my HIV-negative patients. When I applied for the position at the Fenway Community HealLh Center , I told them l was HIV-positive. " "At the end of 1988, I decided it was worth my while to educate the public in an even more direct fashion than I had. I had been giving lectures across the country on HIV-related topics, and had started to share with public groups that I, too, was an HIV-positive person and that peop le needed to put a face on this condition and see that human beings are walking around with this and are perfectly healthy. " Rzepkowski then took up a series of speaking engagements to public groups and medical assemblies, including the New York State Academy of Family Physicians lastJuly. "Just recentl y, I spoke to the Tennessee Academy of Medicine and the Tennessee Academy of Family Physicians. '' During these presentations, I would say, 'I am also HIV-positive.' In July of 1989, I gave a public forum in Keene, New Hampshire, sponsored by the American Red Cross, on AIDS, dealing \vith the blood supply and how you get the virus and how you don 't. There were news reporters there who asked if they could print this, and I said, 'I'm open about it,' and so I was on the front page of the Keene newspaper. "When appropriate, I put this information on my medical applications . The medical application doesn't ask specifically whether you're HIV-positive or not. So I didn't need to bother with that question. They do ask whether I'm capable of performing medical duties which I am. So that was put down. "LastJune , I went for a physical exam which doctors have to do as employees. I told the doctor in Buffalo that I saw, 'Look I'm HIV-positive and you should BU,-fl'ALO PHY SICIAN ANO -- - ~ - -- - --- know that..' When it was time to fill out my application for work, the question was, 'Are you capable of performing your duties medically ,' and he put yes. Asked for other comments, he said, 'You know doc, I have to put down that you're HIVpositive.' I said, 'That's fine."' Rzepkowski 's former employer, Joseph Gatewood, M.D., director of medical services for Spectrum Emergency Care of St. Louis, which sub-cont racts out to Brooks Memorial in Dunkirk to supply them with emergency room physicians, puts it this way: "This is a problem that goes beyond personal freedoms and rights to know. It's question of physicians and their capability of taking care of patients. The point is that the public is so frightened of this as an unknown fear that their demands to know whet her the doctor has a particular illness - when the statistical chance isso small - strikes me as an irrational reaction. It is much more dangerous to have a physician who's suffering a hangover from having had too much to drink the night before. " In applying for privileges at Brooks, Rzepkowski was asked whether he had been taking any medicine regularly. "Well, I had put 'no' on my original application last year. But this year, I am on AZT regularly. The next question is why, and I put down, 'because I'm immune deficient with HIV.' So that is when the administration knew , in April ~ Healtll Care Workers W'rthAIDS S ince the epidemi c ~egan . nearly a decade ago, the..CD C has reported AIDS in the Jol!owing fl.Umb ers of health care. wQrkei·s. ;J"h e numbers ofH IV~ positive het.ith care workers, which are not reported here, of course, .are greater. Nurses•···-·· ····· .. •··••···· 1,~ ;,- Health aides ......... ...... 1,101 Technicians •.•..•...•. .. ... ...1'41 Physicians ......... ........... . 703 ' Paramedics ......... ... ....... 116 Therapltrts ..... ..... .. ......... ~ 19' Dentists/hygienists ..••.•• 17 1 BIOME:DIC-'L SCI 4 ENTIST -- - - - -- of'91. The direct0r of ER and the appropria te doctors in the hospital knew Jor over ayear about this and had previously called the state health department, and had been reassured that, in fact, I was \vithin my rights to work, that I was not a danger to anyone. " Brooks Hospital Administrator Richa rd Ketcham acknowledges that Rzepkowski told the ER director of his condition shortly after he was granted privileges there in April of 1990. According to Ketcham , the administration knewofhiscondition when Rzepkowski completed his reappointment application in the spring of 1991. The piccure darkened, though, following the release of new CDC recommendat ions July 12. "I think the hospital administration became nervous at this point. According to the new recommendations, not law, but recommendations, HIV-positive health care workers should refrain from 'exposure-prone ' procedures. They ultimately left the definition of exposure-prone up to each individual hospital. At the time this came out, I was called by Dr. Joe Gatewood. He told me that umil we get this straightened out, I shouldn't work. 'We' re put ting you on administrative leave of absence.'" According to Rzepkowski , Gatewood requested input from Rzepkowski on what exactly constitutes "exposureprone " procedures, in view of his expertise on AIDS issues. He met with Ketcham, Gatewood and other officials at Dunkirk 's Sheraton Harborfront Inn . "I thought, this is nice, they're wanting my input on what 's 'expos ure-prone .' Well, I got to the breakfast meeting and they said, 'We've come up with a list of 35 exposure-prone procedures we feel you can't do; therefore you can't work in our emergency room. Therefore, wesuggesteitheryou voluntarily withdraw your privileges for an indefinite period of time, or we can dismiss you. But if we dismiss you, you'll have to put this on all your resumes and explain it all if you ever want to apply for privileges again. "'What is your decision, doctor? ' So, of course, my free will decision was to voluntarily withdraw. This looks nice in the paper- that 1voluntarily withdrew, AUTUMN I 9 9 I 0 �bm what would your choice be? 1f I didn 't voluntarily withdraw, I would have The possibility of an early deal gotten fired. " There is some anger in Rzepkowski's voice as he tells his story, but he claims to understand the "human emotions" that precipitated it. "Given the circumstance of a small hospital and their level of education about AIDS, and not having e)cpen input into the 35 exposure-prone procedures, it's understandable that they didn't want me to work there. " Asked to comment on Rzepkowski's story, Ketcham says, "It's a relatively accurate portrayal. I'd like to reiterate that Dr. Rzepkowski has handled (the matter) very well, superbly, in fact. He was honest and open with the hospital. We tried to be open with him. " The hospital 's list of 35 exposureprone procedures was not arrived at by which I'm afraid it is - then it's critical ln Ketcham 's view, the issue of inofficials at the Harborfront lnn meeting, that the needs of health care workers be formed consent is a compelling one in Ketcham states. Rather, they were deter- addressed. Because clearly the risks of the context of exposure-prone procemined before by members of an ad-hoc transmission of communicable disease dures. "Some ER patients are not in a committee appointed by the hospital 's from patient to health care worker are position to give informed consent. In medical executive committee. Members much greater than the other way around. other situations, if a patient chooses his represented "appropriate medical spe"I find it personally very distressing, or her private physician - and knowcialties" Ketcham said, who then pre- as does the board of trustees and the ingly chooses an HIV-positive physician sented their findings to the medical ex- medical staff involved in this issue, that - that is this person's choice. In ER, it is ecutive committee and later to the board HIV is not treated in a scientific manner. usually not a matter of choice. Thereof trustees for approval. Unlike any other disease , it is treated fore, we believe we owe an even higher In commenting, Spectrum's Gate- through the political process. This has obligation to the community in this rewood cited his own many years as an created a paranoia, hysteria, a level of spect." emergency physician. "It's not just a fear unlike that for any other disease. Of the 4,100 individuals who were business with me. My interpretation as Though much of this is unwarranted, sent letters alerting them to Rzepkowski 's an individual physician of the types of the reality is that hospitals must react to condition, 536 chose to be tested. None procedures that the CDC listed in their public perceptions as much , if not more tested positive, Ketcham reports. July document is that probably there are so, than scientific facts. Some may see In Rzepkowski 's view, the public up to five or six procedures that would this as ducking real issues , not being fair needs to be educated about the disease. be truly 'expos ure-prone ' by their defini- to the physician, but I also have an "It's transmitted in certain defined ways. tions, that an ER physician might do." obligation to the 18,000 ER patients who l think it's fearsome because it's ultiHe noted that he wasn 't criticizing were served by Brooks last year. mately so deadly. That's what people Brooks' list of the 35 procedures, nor the "We have tried to stress the educa- fear. But if you really think about it in process used in arriving at them. "I just tional aspects of this issue and the fact proper perspective , yeah, it's a deadly think that they 've listed some proce- that the risks are very small. The level of virus, but it's hard to transmit that deadly dures that , when beuer support and as- awareness is not what it should be. A virus." sistance is given to hospitals and there is much higher level of awareness is needed As he continues his battle for more better guidance from the speciality soci- ifan HIV-positive physician is to work in understanding of AIDS issues, eties and the CDC, some of the proce- an ER, particularly if he is the only ER Rzepkowski knows that "at any time I dures on the list would be taken off." physician on duty at any one time , as is could get sick. My allergies are acting For Ketcham , the dilemma posed by the case at Brooks." up. I ask myself , is this the allergies or do Rzepkowski'scondition has two aspects: And according to Gatewood, "Most I have pneumocystic pneumonia? ls this "First , there is the scientific approach, probably, of the 5,000 ERs in the coun- the end? Those kinds of things are alwhich would clearly indicate that the try, the vast majority have a single emer- ways lingering. But you have to deal with risks are so small as to not even exist. If gency room physician. An ER physician it and live one day at a time, live life to its the move is toward mandatory testingcan't limit himself to certain procedures." fullest." + «I!) BUFFALO PHYS1CIA.N ANO BIOMC:OICAL SCIENTIST AUTUMN 1991 �------------------ U~lli on·rue ·~.. l·leof · · H·· d• cl .·Too · • • 1 - _ · ,r:w • . - - · • IS • .. · • , ·' .,. 0 is What Do You TI1ink? The Buffalo Physician a11 d Biomedical Scientist wants LO know its readers' "Clearly,someth~•Speculiarwasgoing011in that office.'· Clarissa Cui111inghCl(11 , spohespcrsonfor t11e.AIDSAction Co1111cil,..refer1illgto Acer's,{a~/1 of w1ivetsalpreooutitl1L~ and sterilc·tecff11iq11c. -- · . , 11vFloridadentist.Ac~r. 011how s}iewould • "ILis 111ucl1 _mo1·edangerousta have <1'17hys'i-thaf .UP,'heldth~ Medical Center at cian wn~·ssufferinga l_1angover from having Princeton's policy requiring an HIV1nfected s~rgeoh to seek · informed had 100 m11cl1ta d~nk thci,ightbef~r'e."· JosephGatewood,M.D .. directorcf medical consent from his patients, effecscn•icesfarSpectrum£mergotcy Car~ofSt. .tively .-restricting his practice. Louis, which $1tlJ-comr0;c4· 11utt0 Brooks MemorialHospitalto supplythemwith emer- "The i11h ere11trilh1to know-forpaticn(a 11d e co,ifigency'ro~mphysicia1is,011the risks a pdr,ient doGtoralihe_: always bas ta SUPG{__Sed . facesfrom bei11gueatedbyan HIV-positive deniiality . •Tl1edoctordoc;sn't hal!e 10e11tup a signboard,but therehasto be inJonntd consent ph_y~ician .• ~le gai11gto do invasive proceduFcs. 'First'. "Unfortunatl!ly, this dentist ,did dono ha~· is the absolutebedrocnoJmedicine,. not use very strong aseptic techTIJeKimbei:lyBergalis~sof this~11 orlda,rovoidniques, 'did not use rubber gloves, ablc.·• SaiifordK1,vi1t,M.D.• vicr.cl1ainnan:of for in~ance." Louis _H .. Sulli .van, •the f'lational 'founclation.[or~1ifectious - Qis· Secretary of He.. h and Human ease~ Services, referri1'i to Florida de.ntist David J. Acer, who infected five of his patients with tflY before t dying of AIDS in Sel?tember 1990 .. - ~ .. . . · osure . ."'~ ,.... • • ,. --- tho ugh ts on the new CDC gu idelines on disclosure of HIV-posi tive heahh care workers under certain circum sta nces. Please take a few minutes to wr ite down your comments. We will publish selected responses in an upcomi ng issue. Please mail responses to: and BioEditor, The BiiffaloPhysicia11 medical Scientist, State Un iversity of New York at Buffalo, 136 Crofts Hall, Bu ffalo. New York l-+260. or fax the m 716-636-3765. ,;avefelt if herf1hysicianrejuseaLope1fon11 r;yesurgeryo11heraftershuo!Jliim$.hewas HIV-posi¥ve. Her pl1ysicialfdid ;heppera- "An exposure-prone procedure is one where- it Is likely, concpivable, possible that the doctor's blood will g~t into the patient's circulation. That ~n be through an open wound on the patie,;t, a sore on the patient, but the doctor has to bleed fresh blood ~f his into fhe patient, or get a~ instrument bloodied by himseff ;1ndthen, use it on the patient. Now whether you're wearing gloves or not, doctors don 't easil1 ble.ed when tfley're taking care of patients." N'e~I Rzepkowslti , M.D: " "Dcat.his going to catchme with my boo1~0 11. I'm ,wt going to,sitdown·a11a'dwindl~ away•:, 1 have a messageto pass on. The one 41ing thaL1 am 11otJoing,11owis the tbl11g1 lov~ most i11life and thµtis taking care ofpeople, b_fcaustmedicinehas 110placl.']or thosewho. our tale11.r." an; HIV t,ifcctep,regtirdlrss of,Y_ Aotm, M.D., o,; Baltimort carrliologisl'l\_cit, suffe1ingfi'omJull-blawnAIDS three years afier a rest tube full of HfV-contaminatcd bloodbroke and spilled qvel' his cutji,fgcr. Aoun sued after ad1>1inistr<1tors al the hospi· tal where /Je,was l[di11i1rg refusedco renew his ~ontract. The case was settledfor al!1111disclosed .s11m.· "Ethically and morally ; I think I. . , shouldtnot continue with my work without telling anybody." Dentist lll David J. Acer to a social worker during a hospitalization tor pneumonia a few weeks before selling ''Who do , I blame? l?,o I 'blame his lucrative practice ii:' the SU("~ • mys~lf? I sure don't. I never used • mer ot · 1989, but over .a year before telling his patients he had "Doctors .rre afraid. They want to IV drugs, neve~ slept ~ith anyone AIDS. A few days after telling · know the HIV status of their pa- and never h-?d a blood transfutients-, and doctors who work in slon. I blame Dr. Acer and every them 6y letter, Acer died . single _one of you bastards. Anysurgery ask us about it alfthe time. one that knew Dr. Acer was in"TIie lisFiclosely resembles Lhc-risli of n If we get the patient's permission, -~hicularfatalflJ' during transpoi'lationto . we give the information, oth~rwise : fected and had f~ll =blown "Jlu>S it's up to the surgeon to discover it and stood by not doing a' damn ' ahdfrom 1111 ;, hospital." Albert~Lowe,ifel , thing about it : You are-all just as .M.D.. of New Yorli'Mcdical College,calcu- on his, own. In many institutions, lating the risli of transmissionfrom ·a,1HI'v- blood is illegally and surreptitiously . guilty as he was. You've ruhted infe.:Ledsurgeo·11 t~ a patie11tat las(June's drawn on patients 1o find ou\ Jheir · ·· m]t . life and my .family's." Kiminte,:national~o,iference on AIDS held in status." Paul Rothman, M.D., presi- bedy Bergalis, the first patient to · dent -of Search Alliance, an Los An- contract AIDS from h.e( dentist, Plorcnce,Italy. • David Acer, in a letter to Florida geles . AIDS-res~arch organizatio& 11 :rhe ultimate risk to the \atient is be~lth officials. In a po,st script, tot~ll_va11dgo11e Berga I is also wrote, "If laws .are so abiiolute, so devastating, thfat "I 11ouldhm•e 1111derstot1d it ls unt'enable to argue against down to the AIDS clinic. A~d it_wouldn't ha;rc l\dt formed to provide protection, : inf~fll'led consent;' ; New ' Jersey botheredme at all to_go-dow11. I jusl gave him then .my ~uttering and death was \ Superior Court Judge Philip ·oicoption. Nobodygaveme the .option." Bar~, ..•~vain. Ca;at,man, in a· May 1991 ruling bara Wcbb~_aziotl1er patient infectedwith 1,;IIV "I'mdying guy,-. Goodbye.:t' • • . .. 8Ufl' F' A.LO P + • HYSICIAN A NO BIOMEDIC A L 5Clt::NTIST AUTUMN I 9 9 I G) �Dy Jess:i.e~ 8"te:i:n.. D:i.~moII.d. • ew legislalion may clarify lhe nation's debale over who makes medical decisions on behalf of lhe comalOse and lerminally ill, placing the power lO refuse or accepl lreatment more firmly in the hands of the patient. According to patients rights advocates, doctors, hospital administralOrs and auorneys, the Patient Self-Determinalion Acl, which Lakeseffect December 1, 1991 is likely to lead to more compassionate medical care by improving communicalion between patients and health care providers. Primarily an educational law, the PSDA mandales that federally funded health care providers publicize state laws on patient rights to patients and caregivers alike. But the PSDA also presents logistical, legal and educational hurdles for health care providers: specifically, how to educate and counsel patients so that their advance medical directives accurately reflect their unique circumstances and values. 4D BUFFALO PHYSICIAN A N D 8 1 0 M E O I c' A L S C I E N T I 5 T A U T U M N I 9 9 I ��L'sexcellent law from the perspective thaL more people will be infonned so they're able to make their own decisions, " says Daron Weber, former spokesperson for the national Concern for Dying and the Society for the Right LO Die. "The PSDA may lead to change by making people aware. The key factor is going to be compliance.just how much teeth does the law have." Although health care providers that receive Medicare and Medicaid funding must 11 comply with the PSDA Lo receive these monies, the circumstances under which money would be withdrawn have yet to be spelled out. Written into law as parL of the federal Omnibus ReconciliaLion Act of 1990, the PSDA mandates that health care providers give all patients written information about stale laws on living wills and their rights LO refuse or accept medical treatment. HealLh care providers must ask incoming patients for advance medical directives and place them in patients ' medical charts and also publicize their institution's policy on these state laws. For stales with few or no such laws on the books, the PSDA requires that health care institutions make this known. Simplifying these mandates, a spokesman for the Health Care Finance Administration (HCFA) recommended that health care providers develop clear statements of policies on advance directives, write detailed action plans for staff education and community outreach and decide logistically how LO enter patients' wishes into their medical records LOcomply with the PSDA. HCFA is responsible for writ- ing the terms of the law into regulations , In regulations scheduled to have been issued in October , HCFA was expected to specify how providers should comply,vith the law for patients who are unconscious at the time of admission as well as define exactly when hospitals should give patients information about patient rights laws - before a planned hospital admission, at the registration desk or at the patient's room. Other issues related to compliance with the law may be more difficult to solve. The PSDA spotlights the difficulties of obtaining truly tnfonned consent, says Susan Goldberg, ofMagavem & Magavem, medical treatment so it's harder for them to prove they're competent LO make a decision. There are an awful lot of people out there without the documentation and without families to speak on their behalf." In New York State, the Patient SelfDetermination Act will likely ensure that hospitals now routinely ask patients whether they have living wills LOenter into theu records. Buffalo area hospital administTators say they \viii continue and improve their ei,.,isting educational programs on patients rights for health care staff, incoming patients and the community at large. These educational efforts will focus mostly on two New York State laws: • The Do Not Resuscitate Act of 1988, referred LO the DNR law, which mandates that on admission all patients receive information on how to place their wishes regarding CPR and other "heroic measures " to resuscitate them in their medical records. • The Health Care Proxy Law, effective January 1991, which requires that all patients receive at the time of admission a form and explanation for how to designate a proi,.,-yor surrogate decisionmaker LO gu ide their medical care when they can no longer express their own wishes . These laws have already been gradually, a~d occasionally grudgingly, integrated imo hospital procedures. Peter D'Arrigo, M.D., vice president of medical affairs at Millard Fillmore Hospitals , recalls that when the DNR law took effect, doctors disliked discussing it with patients who needed sunple medical procedures such as having a mole removed. Some patients became alarmed that medical care would be withdrawn unnecessarily or that their health problems were more due than they believed. The proxy THE BURDENOFSUFFERING IN CERTAIN CIRCUMSTANCES APPEARS TO BESOGREAT THAT WITHDRAWAL OFTREATMENTAND WE'RENOTTALKING ABOUT ASSISTED SUICIDE- MAYSEEM TO BETHEONLYACCEPTABLE ALTERNATIVE'.' ~ eu,-FALO PHYSICI A. N legal counsel to Buffalo General Hospital. "There 's risk - particularly with living wills - that a person may sign a form entitled "living Will" and not have really understood what it might mean in a given situation. Sometimes a fonn may give duections that are ambiguous , and people should not sign them without first discussing the contents with their physicians. " Beaufort Williams, an attorney and director of Legal Services for the Elder ly in Buffalo, is frequently appointed to represent patients who cannot adequately express their wishes. He shares a similar concern . "Poor and uneducated people can't always articulate their objections to AND BIOMEDICAL SCIENTIST AUTUMN I 9 9 1 �law was more readily underst0od. But the burden of making medical choices can weigh heavily on prox'Ydecision-makers who now must make decisions on their own that were once made solely by physicians , observes Michael Noe, M.D., clinical assistant professor of medicine and social and preventive medicine and senior vice president of professional affairs and medical director of Buffalo General Hospital. "The burden of suffering in cenain circumstances appears to be so great that withdrawa l of treatment - and we're not talkingaboutassisted suicide- may seem to be the only acceptable alternative," he says. "Before proxy law, certain of these decisions could be handled by a doctor with perhaps a broader, more objective assessment of the medical issues." Hospital ethics committees often help proxy decision-makers who request additional legal, medical and ethical guidance. BGH's nursing, social work and medi- cal staffs are trained to discuss pro>..')' forms with patients. But the hospital strongly advises that patients discuss DNR forms, advance medical directives and living wills with their own physicians. "The types of decisions a patient has to make require an opportunity to have questions answered by a medical person familiar \vith their situation," says Noe. Medical professionals also mentioned a common misconception that educational efforts mandated by the PSDA may help correct: many patients don't realize that the living will is legally recognized in New York State most frequemly when it is accompanied by a proxy or DNR document, and it may not have a binding effect on a particular decision about medical treatment on its own. Stephen Wear, Ph.D., a UB professor who specializes in medical ethics, says, "The real issue people have to explore is the complexity of care for people with chronic degenerative diseases or critical Most medicalethicists believeNew York State's patients' rights laws, especially the health care proxy act, are best applied when physicians discuss them with patients as a matter of course, beforea hospitalization or crisis. Doing so can prevent the problems illustrated by the following recent casefrom a local fwspital. man in his 80s suffers a heart attack while watching a Bills game this fall. 911 is called and he is resuscitated at home and taken to the emergency __ ...___ ,,__ room of a local hospital where he is stabilized, placed on a ventilator and admitted to the intensive care unit. Subsequently it is found that the patient has suffered severe brain damage. Among other things, he cannot breathe for himself. When he is diagnosed in a persistent vegetative state, the patient 's ·wifeand adult children unanimously request that all treatment be stopped, including withdrawal of the ventilator. The physician asks the family whether the patient had made any prior statements while competent about what he wou ld or wouldn 't want in such a circumstance. They 8UFF'ALO PHYSICIAN ANO BIOMEDICAL illness. What does their remaining time look like, how should their care be managed?" Physicians should discuss with their patients exactly how the proxy, living will, DNR and advance medical directive forms are used in conjunction with each other and also how statements on these forms about specific medical procedures would shape the medical response to theirown specific situation, he notes. The PSDA, by tluowing the spotlight on state patient rights laws, is a strong indication , at least, that patients need no longer rely passively on the decisions of medical providers. Clearly, patient rights laws vary greatly from state to state. By providing patients with information about these laws, the PSDA takes a giant step toward helping patients retain control over their medical destinies - even in an era when medical technology has redefined the very nature of death and the process + of dying. respond that although he had never talked about it specifically, they are certain he wouldn't want aggressive medical intervention given his prognosis. The physician advises the family that without the patient's prior competent statements supporting the withdrawal of the ventilator and without an appointed health care proxy to make such decisions on his behalf, this couldn't legally be permitted. The family is aghast. The patient remains in the intensive care unit for several weeks and dies of a second cardiac arrest. Under two recent New York State laws, the Health Care Proxy law and the Do Not Resuscitate law, this patiem 's wishes, if clarified in advance, would have been protected. However, he had not appointed a health care proxy who could decide about treatment ifhe lost the ability to decide for himself. The prox y could have requested the removal of the ventilator. The Do Not Resuscitate law would have protected the family's right to decide whether ventilation could be used to resuscitate the hospitalized pati ent in an emergency but not whether ventilation could be used to keep the patiem alive. A UB professor of medical ethics who attends meetings of num ero us Buffalo hospital ethics committees says such heart-wrenching circumstances are not uncommon and that doctors are learning through these situations the importance of explaining these laws to their patients well in + advance of a medical crisis. SCll!:NTIST AUTUMN 1 9 9 1 4D �[ ~ Il ~ RH I ll1H I I ~ Il ~V~ llHHUf BffIlH[ [ fPI fIl... B R y H C R A D D y E Always prized, an acceptance from UB's School of Medicine and Biomedical Sciences is more sought after than ever by today 's medical school hopefuls. "The combination of the med school's growing national reputation and its affordability are making UB the school of first choice for most candidates we accept, " according to Thomas Guttuso, M.D. , assistant dean and director of medical admissions. "The class of l 995 's rate of 1.9 acceptan ­ ces per seat is the lowest since the early 70s when the medical school applicant pool peaked. That means that today more applicants accepted are saying yes to UB." 4D B U F FALO PHYS I CIAN ANO BI O MED ICAL 5C l £ NT IST A UTU M N 19 9 1 �Maria Bruno, a first-year medical student with a 8.5. in genetics from Purdue, has a long list of reasons for returning to her hometown to sLUdymedicine at UB. "I was impressed with a lot of the things SUNY Buffalo had to offer over higherranked schools," Bruno said. Guttusso points to favorable national rankings as one of the key factors that favorably disposes applicants toward UB. "We're rated the best of the SUNY med schools by The Gounnan Report , which is considered the leading independent 'authority ' evaluating American medical BUF'F ALO PHYSICIAN ANO schools. Nationally, Counnan ranks UB 30 out of 126 medical schools, pulling us in the top 25 percent of American med schoo ls." Guttusso also cites a recent ranking by the Association of American Medical Colleges (AAMC) placingUBas third among all U.S. medical schoo ls based on the AAMC's current institutional goals. Making UB even more attractive to prospective medical students is the school's track record in placing seniors in their preferred residencies. According to Guttusso, 90 percent of UB medi- 810M£0lCAL SC IENTIST cal school grads are currently placed in one of their first three choices, 15 percent to 20 percent above national averages. For first-year student Lew Foulke, a better chance at a prime residency was the deciding factor for coming to UB medical schoo l, despite the location of another school closer to his roots in Central New York. "Of the three schools I was seriously considering, UB's reputation and ranking were the best, which will give me an edge when applying for residencies in whatever my chosen spe- AUTUMN 1 9 g I 41) �cialty turns out to be." Cost, boLh from the standpoint of tuition and area cost of living, also gives a boost to UB's stature among medical school applicants. Tuition for in-slate residents is just over 57,100 which compares to a national average of about $16,000 for public and private medical schools; the most expensive schools charge over $20,000annually. Thecostconsciousness of most medical students has typically been raised by four years of undergraduate education, often at much more expensive private schools. Lara Akinbami, a Harvard University economics graduate is typical of this breed of student, but her career aspirations in medicine also moved her toward puuing even more emphasis on the cost of a medical education. "Having spent two years with the World Bank in Washington , D.C., my interests are in the public polic y of medicine , particularly in the areas of access and affordability," Akinbami said. "Since this isn't the most lucrative venue to take in the medical field, it made good sense to go with a very good school that was also affordable." Not surprisingly, being one of the country's best and most affordable medical schools is making the admission process for UB even more selective. Guuusso, who chairs the Admissions Committee noted, 'The Class of 1995 was the most difficult class to be accepted into in almost twenty years. 263 applicants were accepted this year; that 's the lowest number since 1974." About one in 10 applicants was accepted to the Class of 1995. Given the difficulty of geuing in , how does the Admissions Commiuee make its acceptance decisions? "Obviously, we're seeking people who are talented academically with ability demonstrated by both grades and MCAT scores," said GutLuso. "We also look for the personal qualities that are important for future physicians: awareness of problems in the profession, concern and empathy for their fellow man, the commitment to being a doctor. The final decisions are a balance of all these factors." The overall demographic composition of this year's first-year class hasn 't a, BUFFALO PHYSICIAN radically shifted since the mid-70s when the medical school first started tracking a wider range of student statistics. Women and minorities continue Lobe well-represented, renecting the University"s early commitment in this area. Over the years, the average age of the first year medical student has increased to 23.5 years from a low of 22.1 years in 1976. The class of 1995 has 22 people over 25 years old, indicative of a growing national trend for medical students to pursue other work and academic interests before entering medicine. Darren Caparaso,a 25-year-old Western New York native, who majored in VitalStatistics: Theclassof1995 ' Applicants ................................... 2693 S18 Interviewed.................................. Accepted ....................................... 263 ClassSize...............13SMedical School ................................... 4 MST Program Average Age............................... 23.S Men............................................... 79 Women ...........................................S6 Science Majors .............................. 100 Non-Sci enceMajors .........................3S business at UB as an undergraduate and completed a masters in biology from Buffalo Stale College, credits his work experience in a variety of hospital positions with his decision LO become a doctor. "Wor king in a hospital for several years helped me to focus in on medicine as a career. Being a first-hand observer of what goes on in a hospital environmem also gave me the confidence to know that medicine is the right choice for me. " Although academic performance as measured by GPAs and MCAT scores hasn 't changed significantly, one noteworthy change has been a marked increase in the number of non-science majors, 35 in this year's first-year class. ANO SIOMC:OtCAL SCIENTIST' Gullusso explained, "More than any one particular major, we're looking for demonstrated academic excellence along with leadership, compassion and exposure to the medical field. This gives students the opportunity to get a broader undergraduate education. Of course, to be admitted, non-science majors must fulfill core science requirements and perform well on the MCATs." Foulke, who studied the classics in college and worked in a hospital environment before medical school, explains the seeming discrepancy in his undergraduate and post-graduate fields of study. "I was drawn to medicine by an interest in the growing body of research showing a defin ite mind-body connection which affects personal hea lth. Because I was strong in the sciences during high school, I opted for a non-science major to improve and develop my verbal skills." Regardless of how favorably the Admissions Committee is impressed by the quality of candidates interviewed, the size of the first year class remains constant, having been set at 135 in 1971. Additionally, a maximum of five applicants are admitted to the Medical Scientist Training Program which prepares student for careers in academic medicine as well as medical practice. Guttusso, involved in UB medical school admissions for 16 years, noted that the number of applicants to medical schools has dropped dramatically from the early 70s at UB from a high of over 5,300 in 1974 to approximately 2,700 in 1990. "l think today 's applicants are very aware of the negatives affecting the general atmosphere in medicine: malpractice, government intervention and control over income and the AIDS crisis," Guuuso said. "Co nsequently, applications have fallen off from the early 70s, when.many students viewed medicine as a career for those smart in science to make a lot of money. I see this as a blessing because every applicant we're now evaluating is really com mined to being a doctor for all the right reasons. Ultimately, that 's a positive trend for the medical school and + the profession." AUT UMN I 9 9 1 �.c s s 0 \ l1 THE STATE;_ UNIVERSITY ' . OF NEW YORK SCHOOL AT OF BUFFALO MEDICINE ANO BIOMEDICAL SCIENCES �E ACH YEAR , THE YORK STATE AT BUFFALO BIOMEDICAL SCHOOL SCIENCES 135 ABOUT UNIVERSITY NEW OF NEW OF MEDICINE ACCEPTS STUDENTS AND TO BE AND TRAINS PHYSI- CIANS. T HEY FROM COME FROM SCHOOLS ALL ACROSS WALKS THE OF UFE COUNTRY. AND THEIR ,, DIVERSITY UNIVERSITY BER ADDS TO THEIR RICHNESS AND CONTRIBUTES OF THE TO TH El R CALI- AS PHYSICIANS. , H ERE , WE PRESENT WISH THE THEM WELL FOUR-YEAR THE ON THIS , THE JOURNEY. OF '95 AND BEGINNING OF CLASS �o OmolaroJeonAkinbomi AndrewLouisAllmon Economics Biology RobertAnlhonyBorroli• ScottJonolhonBelote CherylAnneBettigoie MiroslovPatrickBobek English Psychology Microbiology Biology HarvardUniversily SUNYCollege01 Hobartand William Universily at Buffalo YaleUniversily CornellUniversily Geneseo SmilhColleges A Blum Katherine AlbertJohnBonoIll e TrinaAden Biology BolomuroliAmboli Anthony Jomes BortkOWJO, IbrahimA Berhon Biology Biology Biology Biochemistry liberalStudies Vassar New YorkUniversily Universily ol Buffalo Universily al Buffalo IndianaUniversily al Universily of Pittsburgh Bloomington (t lhuomoUdoAlozie I BarryRussell Armondi,Jr Ross JosephBellavia Be1hBernell Biochemislry Biolog9 Biology Biology CUNYCily College Universily al Buffalo Syracuse Universi _ly UnionCollege I EricBlumon Biology MourilsSlevenBoon Biology Cornell UnionCollege ' I C a s s 0 f 9 9 5 �e J~,ief,nn Brounscheidel CherylDeniseBuck TimothyRaymondByrnes LiangRueyChong Biochemistry Biology Biology ChristineChruscicki LoriAnneCohen Biochemistry Biology/Psychology Biology University at Buffalo University at Buffalo University at Buffalo Uoiversity of Rochester SUNYat StonyBrook Carol ElizabethBrietzke TonyTruongBui DarrenMichael • Craig EvonCheifetz Sebastion James Ciancio DeniseKo\herineDoigler Humanities Caporoso Psyc_hofogy Biology Nursing Am~riconUniversity CornellUniversity NiagctroUniversi!{ RichardJosephDeAslo , University at Buffo!o e . Biology JohnsHopkinsUniversity SUNYat StonyBrook . \ Business ' . University al B1.1ffolo (t Mario DoloresBruno . GeorgeJosephBurnett FronkPeterCarnevale KorenAnnChojnod.i Mory LeeCi6toli Genetics Biology Pre-Professional Biology Biology PurdueUniversity Con,siusCollege University of Notre Sr LawrenceUniversity CornellUniversity . . " Dome 2 C a s s 0 f 9 9 Optics University of Rochester �; ' Tracielee Di/v\orco Che!11islry Therese /v\orieDuane Dory!RoyEhlenlield CoroleYerkovichFenlon TyroneDovidFillyaw AlbertBrunoFiorello 'Socio!Science Economics History B.!_ochemislry /v\orislCollege Cornell~niversity CoseWesternReserve University ot Buffalo PsychoLogy JohnsHopkinsUniversity University of Buffalo University ' KorenEileenDull JosepbChris.DiPirro Biology • CynlhioEstherEpstein .Biology AileghenyCollege ConisiusCollege Chemistry ~UNY al B,nghomton . Shone Grego,yFerguson StevenMore Finkelstein JeanneC. Fitzsimmons Biology_ Business' University al Buffalo Universi!Y ot Buffalo SUNYColtegeal Old Biology - \ "Westbury (t AnthonyMale~")DiRubbo ChrislopberJonEast Psychology CornellUniversity . • AndrewStevenFeipberg Sho~nPatrickFerguson DovidFiorello Biology· Chemistry Biology Civil Engineering Syracuse University DukeUniversi'Y._ SUNYCollegeal DornoEvertonFlash NaturalSciences University al Buffalo Ford~omUniversity Buffalo - I J . ' C a s s 0 ,. f 9 9 �e Llewellyn AllynFoulke RondyJasonGoldstein T~omos J Guttuso ToreqShehodehHarb Nigel Ion Henry DouglasJomesHickox Classics 'Chel]ltSlry Psychology Physics Medicol Technology Biology SUNY01 Binghamton SUNYat Binghamton CornellUniversity CornellUniversity CUNYCollegeof University of Rochester i StatenIsland ' MichelleAnn Gome Biology JeffreyScottGron! Lynette Haggerty faith Heavens ArovindHerle EvonHirsch Bidogy Biochemistry Biology English History PurdueUniversity Hobartand William NozorethCollege Oral RobertsUniversity DukeUniversity SUNYCollegeat \ SmithColleges (t KodionMorie Golding Biology B1Jffo10 KateLouiseGuernsey - Biology CUNYQueensCollege CornellUniversity ThomasAndrewHonno AndrewDoveHenry 'v\itchellJosepnHerr Biology Biology Chemistryand Biology Biology SUNYat Albany CUNYMedgor Evers University or Buffalo University of Chicago YuluenHsu College 4 C a s s 0 f .I 9 9 5 �-------- -- - - -- - - ]A l" I , 0 JeoneoReneeHundley SomirKhonjor HuijungKim Biology Biology NaturalSciences ConisiusCollege Corn.ellUniversity ofPennsylvania Universityof Rochester University KathyMtJssey PatricioAnn Krebs Biochemistry . Andrewlouden Philipl. Manzanero Biology Biology Swarthmore College University of Rochester AndrewBennettKlofter BryonRussell Lotzmon MortinC. Mdhoney Oemistry Physics Biology Psychobiology History P1~ FordhamUniversity Universityof Rochester SUNYot Binghamton SUNYat Binghamton CooisiusCollege Oral RobertsUniversity HelenMon Kim EricHeathKossoff Oono lim MicheleMlJrieMonka ModhuiikoMathur Electricol 'Engineering English NeuroS'cience Business Psychology Biology ClarksonUniversity CornellUniversity CornellUniversity CornellUniversity Ohio StoleUniversity TuhsUniversity (\) Christina Maureen Keaney JomesStephenKillius \ (t HeatherMicheleKeene ' ) ) C a s s 0 f 9 5 �19 e GregoryAlan NlcDoniel tv\ariaM.odico , Anthropology , 6iology RerieeNealy DavidMichaelOdell NaturalSciences Chemistry SUNYCollegeat BuffaloStateCollege Hobartand William tv\anhotton College Buffalo ' ' KathrynAnneNlcVicor Psychology University of Chicago NancyPerez Biology· ConisiusCollege Hobartand William SmithColleges SmithColleges· . JomesGory Nalbone GoryJohnNielon Psychology Fro~lin and tv\arshall MechanicalEngineeri~g Biology ':Jhitney.leeOrman Neil NileshPotel MicheleAnn Potempa Scienceand Non- Biology Umversity of·Rochester St LowrenceUniversity Science SUNYat Binghamton University at Buffalo_ Coll~ge (t Brendontv\aneyMiner tv\argoretE. Partridge , Biochemistry , . Susontv\a~reenNaselli Donielle Susan No:ebort . Biology Psy~hology Conis1us College Le!w;:,yneCoUege SusonEljzobethPolls Biology ThomasAndrewOwens TusharR.Patel Biology ' Chemistry Biology St Bonaventure University of Rochester SUNYat Albany CornellUniversity University ' fr C a ( s s 0 f 9 9 5 �I_ G - -- -- - - - -- -------- BethannSchober Chondresh Ajit Shelot ToroAlice Soso Biology PreMedicol ~iology BuffaloStateCollege University at Buffalo KirkMichaelPuttlitz Neal ToddReich life Science ln)egroted Health NaturalSciences. University at Buffalo Sciences JohnsHopkinsUniversity long lslo~dUniversity AmitobhProtimSoho - University at Buffalo ·e lrm RoqibRojo KorenMoy Roll Theresa/11\one Sarafin Morie lo~iseSchmitt NeurosciElnce Biology ColgateUniversity ·St.Bonaventure Biology I St. BonavJ~nlure Biochemistry NazarethCollegeof· • University Rochester ... University , ErikDole.Skoog • Psychology PeterFrancisStengel Bi_ochem1stry Dukeyniversity Canis1us College .' PeterDamionRoy (t Science and GermaineNoncyRowe EvaHolinoSotell Foreignlanguage Biology I Non-Science CornellUniversity Rutger~ University Physics StephenPeterSorrentino LisaLynnStephens Biology ComputerScience TuftsUn°iversity SUNYat Albany JoelAllenShapiro St. Bonaventure t BostonCollege UnlVersity ~ , --.. 7· C a s s. 0 f 9 9 5 �Q ThomesWilliom Stone Eva Tokocs·Dilorenzo Ed9t,1ord JohnTrobulsi Eilene Velez TheresaMorie Wegman TimothyPatrickWhelan History Art Bioche,mistry MolecularBiology Nutrition Dartmouth College HamiltonCollege Univer:sily of Rochester longIslandUniversity CornellUniversily Scienceand Non-Science lof?yelleCollege o ErikJonStumpf Chemistry Wng TsangTong Rolph!Patrick Tufano Chemistry Biology University al Buffsilo HamiltonCollege SUNYat Binghamton TimothyE.Von Duzer , Chemistry BrighamYoong DennisDorrWeimer, Jr. EllenMorie Whyte Biology Biochemistry ConisiusCollege Universilyof Chicago• Universily, / (9RoyceRosanoSyracuse JeffreyMichaelTessier PoulFrederickUpdike Andrew WilliomWorner Bi(?logy Biology Biology Music HofstraUniversily Wendy LynnWeinstein LorraineS. Williams Biology , Psychology CornellUniversily le Mc,,1ne College Universily of Buffalo SUNYat Binghamton 8 C a s s 0 f 9 9 5 Universily of Buffalo �e Bror>Krig Zebrowsk rMJ e , ffrcyleeZo:d man z~bier Ml t~ Alo~Zuccolo Bology SUN 01 on 01AnnArbor 00!')' Gcreseo MJ ,e E @ 81oclie":1stry N?zoref, Co ::,geof R SfynPerry An opology lJnivers~ at & a o 9 C a s s 0 f 9 9 5 �o ATH 0 f Hippoc~ATES I SOLEMNLY SERVICE , I ' WILL PLEDGE MYSELF TO CONSE~.RATE MY LIFE TO THE OF HUMANITY. GIVE TO MY TEACHERS WHICH IS THEIR ( WILL PRACTICE THE RESPECT AND GRATITUDE OUE; MY PROFESSION T HE HEAL TH OF MY PATIE'NT •I WILL RESPECT THE I WILL MAINTAlN BY ALL WITH WILL SECRETS CONSCIENCE BE MY FIRST WHICH AND DIGNI_TY; CONS!DERATION; ARE CONFIDED IN ME; ·, AND THE NOTABLE THE TRADITIONS MEANS IN MY POWER, .OF THE MEDICAL THE HONOR PROFESSION;· ' MYCOLLEAGUES IWILL NOT RACE, PARTY PERMIT BETWEEN I WILL THE . MAKE HONOR. POLITICS, MAINTAIN TIME BE MY BROTHERS CON .SIDERATIONS MY DUTY AND THE THESE PROMISES SISTERS; STANDING NATIONALITY, TO INTERVENE MY PATIENT; UTMOST KNOWLEDGE AND OF RELIGION, OR SOCIAL OF CONCEPTION; MY MEDICAL I WILL RESPECT EVEN UNDER CONTRARY SOLEMNLY, FOR HUMAN THREAT, TO THE FREELY, LAWS AND LIFE, I WILL FROM NOT USE OF HUMANITY. UPON MY �V~llll~f ~IillfIll[Hl~TllilE Ill HillE Rl[HfIlifR~llB o the best of his knowledge, which is considerable, Balamurali Ambati, age 14, is the youngest medical student in the history of American medical education. A memberof the Class of 1995, Ambati was accepted at 13 to the medical sc hool 's Medical Scientist Training Program (MSTP), which on completion simultaneously awards M.D. and Ph.D. degrees. In discussing the historic acceptance, Thomas Guttusso, M.D., who heads admissions for the medical school said, "We believe that Ambati is the youngest ever admitted anywhere, certainly at UB. His application came to us through normal channels and his credentials were excellt:nc. Actually, the academic record for MSTP applicants must be outstanding; admission standards are more rigorous than those for applicants only applying to the graduate or medical school." He added that the one major consideration given to age was that the MSTP program takes seven years which would make Ambati about 20 years old at graduation. But although Ambati's age makes him distinctive, Guuusso said he will receive no special support. "Because the medical school strives to give a high level of support to all students, I'd expect no more than we give other incoming students. His ability to graduate from college with honors in two years is an excellent indicator that no extra support will be needed." Ambati, who modestly acknowledges the recognition and nurturing of his talents he received at an early age, is also quick to point out that a lot of hard work has contr ibut ed to th e considerable BUF"l"ALO PHYSICIAN AND achievements of his short lifteime. A magna cum laude graduate in biology from New York University (NYU), Ambati was on the dean's list throughout his short tenure at NYUand made USAToday'sAllUSA Academic 2nd Team. He plans to pursue both research in neuroscience and a medical speciality in ophthalmology. In addition to his academic successes, Ambati has also coauthored AIDS: The TrueStory, a book primarily aimed at high B IOMEDICAL SCIENTIST school students, wh ich examines the epidemiology, treatment and ethics of the disease. His collaborator on this project was his brother ,Jayakrishna, who started medical school at 17 and is now in the fourth year of an M.D./Ph.D. program at another school. For hls pan, UB's Ambati, on an even faster track, is now on his way to becoming the youngest doctor in the United States. + D RICHARD AUTUMN 1991 Y E fI:) �.._, ~ . ?, r., ~ } L L BUFFALO U S T R A T PHYSICIAN 0 N A N S D B y AL AN SCIENTIST , ,.. ~ -- E. COB AUTUMN ER t 9 9 l �PRESCRIPTION FOR B Y 5 C O T T PAIN : T H O M A S f all the symptoms that physicians are presented with, pain is the one that troubles the most patients and can be the most perplexing to treat. ► Reliable estimates say that one in three Americans suffers from some form of chronic pain - pain that persists long after its useful function as a warning sign has passed. Half of them will become disabled for days, weeks or longer. B UF F ALO P HYS I CIAN ANO 8IOMIEOICAL SC I ENT I ST A UTU M N t 99 t fl> �f pain were a disease, it would be an epidemic. But, of course, it's a symptom with literally dozens of diagnoses. Headache and backache top the list of the most common complaints. Pain also intrudes in the lives of people with arthritis, sciatica, degenerative spine disease , peripheral nerve damage, stroke, shingles and whiplash. And people with cane.er must cope with managing pain which, if left unchecked in the disease 's advanced stages, can be the most excruciating agony known to mankind. Increasingly , physicians in all specializat ions are recognizing pain for what it is: an insidious invader that works in a thousand ways to not only destroy their patients ' quality of life, but affect their physical well-being as well. And throughout the medical field, there's a new awareness that pain, unlike its root causes, nearly always can be controlled. "Up unt il the last decade or so, doctors were more focused on cure rather than care," says Mark. J. Lema, M.D. , who directs the Department of Anesthesiology at Roswell Park Cancer Institute. Lema , an assistant professor at UB's School of Medicine and Biomedical Sciences, is director of anesthesia research for the school's Department of Anesthesiology. "The body 's nervous system is the last medical frontier to discover, " Lema says. "One engram [a nerve bundle in the brain that serves as a switching area for pain I is more complicated than the most complex microchip. " Increasing the difficulty of assessing and treating pain is the problem of measuring an individual's pain. By its very nature , pain is subjective; what one person feels as a minor irritant, another might experience as an agony. Factors as diverse as individual biochemistry and cultural differences all affect what pain feels like and how it is tolerated. "There 's a sociocultural aspect to it - how does one respond to pain? - that 's built up in the early stages of life/ says Romanth Waghmarae, M. D., assistant clinical professor at the medical school and director of pain management programs at Sheehan Memorial Hospital and Kenmore Mercy Hospital. "In certain cultures, children are taught to be stoic, to 'tough it out'; in others, it's considered acceptable to Cl)' and wail and really feel it." Research has shown that Americans of Mediterranean heritage feel pain more deeply than their neighbors whose ancestors were Northern European. And it's widely acknowledged that most women have a higher tolerance for pain than most men, perhaps a blessing that toughens them for childbirth. But individuals' pain tolerances vary widely, even within families. The reasons remain a mystery of biology . Pain specialists, or algologists, sometimes use a simple 10-pointscale, asking patients to rate theirown pain. Though this doesn't make it any easier tO compare the experiences of different patients , it helps in assessing an individual ED BUFFA LO PMVStCIAN ANO B10Mco1cAL patient's progress during treaunent. The biochemistry of pain is simple enough: injured nerve cells transmit a "pain signal" to the dorsal horn of the spinal column. The signal is then relayed through the spinal cord to the thalamus, the pan of the brain that recognizes the impulses as pain. For people suffering chronic pain, though , the ordeal goes far beyond chemistry. They may find themselves in a vicious circle of tension , anxiety and further pain. Waghmarae says pain works subtly to disrupt the fabric of relationships, avocations and habits that make up daily life. It becomes a constant, an uninvited companion that causes people to function on a lower level. It is always present; even sleep doesn't bring relief. "You suddenly become abnormal," Waghmarae explains. "That in itself works against you." People who become disabled may develop a whole range of sympt0ms related t0 the pain that put them out of work. These people may snap at their spouses and children partly from frusuation, partly from edginess related to the pain itself. They might go out less , insulating themselves from any activity that might increase their pain. Their relationships suffer. They become sedentary, causing even more med ical problems , increasing the pain. Depression follows - and so on and on. After a wh ile, pain is only one part of a complex of misery that it has caused. "It changes your life," says Vivian Schiferle, a Town of Tonawanda woman who suffered wiLh chronic pain after a back injury several years ago. "I couldn't think because of the pain. "It's the liule things that change. The way you dress. You have LO learn LO like low nat shoes. Even· to go out to dinner, we would go where the chairs were good. We wouldn't go where maybe the atmosphere was terrific, or to that new place that jusl opened. It was always where the chairs were comfortable." Schiferle's pain has been controlled for over a year now, Lhanks to severa l epidural injections of steroids, a relalively recent innovat ion in pain therapy generally used for cancer and other severe, debilitating pain . In this procedure , an analgesic mixture - most often narcotics or steroids - is injected into the epidural space in the spinal column, deadening Lhe sensation by blocking transmission of the pain impulses. In recognition of pain asa distinctentity , treatable in itself, physicians and hospitals have begun to establish pain management programs. The goal is not only to eliminate patients ' pain as much as possible, but to teach Lhem how Lohave full lives despite pain that won't go away. One such program is the pain managem~nt center at Buffalo General Hospital. 1ts medical director, Gerald L. Peer, M.D., is a clinical assistant professor in the medical school's Department of Anesthesiology. SctCNTIST AUTUMN 1991 �ln addition, there are physical benefits. It has been re"It's very individualized," Peer says of the Buffalo General ported that patients who use PCA after thoracic surgery or program and others like il. "We tailor-make the treatment for repair of broken ribs are more likely to breathe deeply each pat ien L" reducing the risk of pneumonia - because their chest pain Peer says such programs may involve not on ly physicians , is better comrolled. but also psychotherapists, occupational therapists, social "Pain and suffering is second only to incurability when workers and nurses who specialize in pain managemenl. people think of cancer," says Lema, whose practice deals "Many times, " he says, "we can tell a patient that the pain is largely with cancer pain. "It's not even the prospect of dying no longer a sign of ongoing physical damage . The:n we find that scares [patients] so much as the thought of suffering." the best ways we can to help him live with it. " The solutions With some cancers, such as leukemia, the patient's pain is may be as simple as help ing the patient to arrange for relatively mild. But Lema says tissue cancers often encroach ho usehold help, or adjusting his medications , or fining him on nerves and bone , sparking constant and debilitating pain. with a body brace to take the pressure off the afflicted area. In addition, he says, cancer treatments - chemotherapy, The multifaceted approach of pain management programs radiation therapy and surgery is being [eltat the medi - all bear their own costs in cal school as well, says severe pain. Robertj. Schuder, M.D., Epidural mJections, he interim chair and assosays, work "much of the ciate professor in the Detime ." But until repartment of Anesthes iolcently, physicians ogy. shied away from prescribing "We're a pan these opiates, fearing that of the team, " Schuder patients would become ., :says of anesthesiologists. addicted. ~ "We serve as a buffer be::::"'-.. ~,;:;~ For those in end-stage ~ -:.:::::: .:::, tween the an of medicine : ::: cancer, it's a moot point. -:.:.~ ' and the technology of But even for patients with ·• '· : medicine. less advanced cancer, or "And we bring some those with non-malignant humanity to it. You can chronic pain, studies have not on ly do [the job I, you shown that narcotics taken can empathize as well. " only to relieve pain are Schude r says residents highly unlikely to result in in anesthesiology deal with addiction. a variety of acute and "It's very awkward some,· ,: -- ..... •. -,. ..: .• ,, chronic pain situations in ' ...:.·/~/ ~/ times, because we have a ' ,,.,. - ..:--- ~ ; • - ~ 'l ·•,; their work at Western New • , , ... II\\' = ;~ 'l°l/~, i 'l(L war on drugs right now, " '.u.~-...J..:..::.:....:..:.. .~~=-~~~~ ...:J. !.....:!4....:!a. ..:!!:J ~...2~--t York's teaching ----+ Lema says. ''Peoplearesayhospitals. There, to drugs .' Well , there 's a small minority of us ing, '.just say no he says, they are often exposed to what has been ,called the who are saying, 'Let's say yes to drugs when it's appropriate. "' most exciting innovation in pain management in decades: All sons of alternative therapies are availab le as well, from patient-controlled analgesia, or PCA. the widely accepted to the marginal. Besides the holistic Patient-controlled analgesia is most often used for postremedies some sufferers swear by - hypnosis, massage and operative patients , people who otherwise would depend on acupuncture among them - one frequently prescribed treata nurse and a needle for relief of their acute pain. With PCA, ment is transcutaneous electrical nerve stimulation, or TENS. patients regulate their own pain. By pushing a button on a This hand-held device delivers a m ild electric shock directly specialized pump, they self-administer an analgesi,c through to the afflicted area, affording relief by interrupting the an intravenous line. nervou s system's "pain circuit.'' Studies have shown that patients on PCA use less pain "The fact that you have pain limits you," Waghmarae says . medication - and receive bener pain relief - than those "No matter how hard you ti)' to be normal, your behavior who must request a shot. Patient-controlled analgesia changes. " For the patient , he says, the questio n is simple: also gives patiems a greater feeling of autonomy and involve"How do you manag e?" The answer, as physicians know all mem in their recovery- invaluable psycho logical assets as + too well, takes a little mor e consideration. they heal. _,_ -s -;:., 8 uFFAl.O PM vs1c1AN AN O u10M £01c>.L sc1ENTI S T AU TUMN 199 1 6) �················· · ······· ·············· ····· ·················· ············ ······ ····· [i] . ' year, except for the major holidays, " he explained. "We really have an overabundance of student enthusiasm for the projecL." The attitude of the students is "fantastic" according to Juanita Hunter, pro fessor of undergraduate nurse education, project director for the Nursing Center for the Homeless and coordinator of the clinic. "It must be understood that the students generated the idea and did all the work to get it established," she explained. "This situation provides a great opportunity for the students to understand how health care should be provided to such less-fortunate groups Medstudents establsh "Hope Clinic" attheOtyMission STUDENTS JOIN NURSING CENTER group of enthusiastic UB medical students has joined with the University's Nursing Center for the Homeless to provide extended medical care for the less fortunate of Buffalo. The "Hope Clinic," which meets every Saturday EI) BU FFALO PHYSICIAN FOR THE H OMELESS morning at the City Mission, has met with great student enthusiasm, according to, Joseph D. Kay, a second year medical student and co-director of the medical student contingent of the clinic. "We're working on a rotating basis. Four of us work every Saturday during the ANO BIOMEDICAL S CIENTIST AUTUMN I 9 9 1 �· 11 ·························································································· ~ I in our society." The ursing Center for the Homeless, a federally funded non-profit organization, was established by Hunter in 1988 to provide free nursing care for the homeless. The medical students, she explained, began organizing two years ago under the direction of Kayand fourthyear student Geraldine Rubin, third-year students Alissa Shulman, Kristen Paulus and Anne Comi and second-year studentjennifer Wargula. They joined the clinic last June. "The advantage of having a medical clinic to go along with the nursing program is that if you have a person who needs to cons ult with someone who has greater medical expertise, you can refer them to the Hope Clinic." The results have been encouraging so far, but it wasn't easy getting all the pieces in place to make the operation a success, said Kay. ''Our major stumbling block was recruiting community doctors who would volunteer to work for a few hours on a Saturday morning," he exp lained. "We wouldn't be able to do what we do here without a licensed M.D. present." Kay explained that any physician who wants 10 be a part of the program simpl y needs to obtain an adjunct appointment from th e medical school. "And that 's not difficult to obtain. With that, the doctor is covered by UB insurance. " Anthony Bartholomew, a professor at UB's medical school, said that the camaraderie established between the stud ents will be beneficial to them in the future. "I give them a lot of credit. It's great to see first and second year medical students working with senior students to care for patients. They've really made this work." Fourth year medical student Patricia Reddin said that the clients at Hope Clinic present unique problems for the stude n ts and doctors. "You see a very different population here from week 10 .. BUF fl"ALO PHVStCJAN ANO I w e e k . There a re often immigrants who have Iit tie command of the language and that is difficu It," she said while preparing to question a 40 year-old woman from Somalia who had never seen a doctor in her life and was complaining of a non-stop headache. Kay said that the range of ailments exhibited by the patients who frequent the cliniic are numerous but often predictable, given the conditions in which they live. "There are a lot of skin problems, especially the feet and fingers, because a lot of these people are outside a good portion of the time. And of course we see substance abuse cases. We've even had a few cases of tuberculosis, which is really scary." Elizabeth Brown, who works for the Nursing Center for the Homeless, said that the program's success hinges on the cooperation and stamina of all who take part in it. "The students are really hungry 10 get some clinical expe rience to go along with the theory. For the Mission, it's simply something they've never had before. It's really needed. And the potential of the program is just now unfolding.· • Part of the cooperative process that underlies the clinic's success lies in the generosity of various agencies around the city according to Kay. "We have an agreement with the Washington Street Pharmacy where they provide the medication at wholesale, which makes it cheap for us. Millard Fillmore Hospital gives us a lot of supplies that are essential here as well.·· The Hope Clinic examines between seven and 10 patients every Saturday, according to Kay. "But this is as much a learning tool for us as it is a community service. If we can incorporate ourselves into the medical school as a program, they'll provide us with the stability we + need." - S IO M!:D IC A t.. SCtCNTaST SY MA AUTUMN RK HAMMER 1991 e �• ············· · ································· ·· ·· •· ···································•· ' I Dr.James F.Mohn Ends His Distinguished Career atUB A LONG TENURE O F TEACHING is faLher and grandfaLher were both opposed LoJames F. Moh n's choice of medicine as a career. "They Lhought I was a born Leacher buL ever since I was a smal l boy I wanted to be a physician. 1 just never planned that I would combine my medical career with Leaching and thaL iLwould Lum into Lhe longesL teaching span of a full-time faculLy member in the medical school's history - 45 years and nine months to Lhe day." Mohn relishes recalling the smallesL details. AfLer graduating from Fosdick Masten Park High School, he entered Lhe University of Buffalo - helping pay his way th rough school by work ing in The University's maintenance depanmenl. "I remember I was weeding the peony bed in front of Foster Hall when I heard that Germany had invaded Poland." After only two years of pre-med sLUdies, he was accepted into medical school and during his freshman year came under the inlluence of Professor of Bacter iology and Immunology Ernest Witebsky who had lled the Nazis and his German homeland in 1936, arriving in Buffalo three years later. "Witebsky was th e most famous person on the staff of the medica l school, a pioneer in immunology. He took me LO Buffalo General Hospital and had me ster ilize boules - he believed in learning about research from the ground up. 1 stayed with him until he died. " While still in medical school, Mohn contracted pulmonary tuberculosis - e BUFFALO PHYSICIAN "They thoughtI was a born teacherbut ever , RESEAR C H AND SER V ICE he says he still remembers the patient who was the source of his infection. His internship at Buffalo Gene ral was cut short and he entered th e Niagara Sani tarium. JusL before entering th e sanaLarium he took Lime out for his wedding to one of his med -tech sLudents. "We honeymooned on Lake Canandaigua and then 1 went into the sana tarium. It was warLimeand my wife was working at Buffalo General as Wite bsky's chief technolo gist," Mohn recalls. While recovering from TB he rebuilt the institution 's diagnostic laboratory. On Apri l 1, 1945, UB president Samuel Capen appointed Mohn instructor in bacteriology and immunology, officially beginn ing his teaching career. Mohn likes to joke that he "knew all the buildings at UB as people - Capen, O'Brian, Crofts." As his mentor, Witebsky imbued Mohn with the ideals that have stayed with him throughout his professional career wh ich is s till ongoing despite his retirement in January, 1991 from his position as professor of microbiology and directorof the Ernest Wi tebsky Center for Immunology. "WiLebsky believed in the troika teaching, research and service as a necessity for Lhe best teaching of medical sLUdent s," Mohn said. Mohn 's research has taken him to Walter Reed Army Center while on active service during Lhe Korean War and Cambridge Universi Ly where he work ed wiLh Professor Robin Coombs, inventor AND 810ME01C.t.L SCIENTIST sinceI was a smallboy I wantedto be a physician. Ijust never plannedthat I would combinemy medical careerwith teachingand that it would tum into the longestteaching span of afull-time faculty memberin the medicalschoolshistory." of th e Coombs test. His blood group research led him LO make numerous visits to Finland and LO Lhe discovery of a new blood group variant - AFinn· ln 1988 he received the Nevanlinna Medal from the Finnish Red Cross for his co ntr ibuLions LO blood transfusion services. Mohn's expertise has been sought ou t by state, naLional and international leaders. He was one of th e co-founders of the International Society of Hematology, started in Buffalo in 1948. In 1974 he was appointed by the Governor and confirmed by the state Sen ate Lo a council fonned to regulate statewide blood trans- AUTUMN 199 1 �. .. .... . .... .. ......... . ..... . .... . .... . .. . .. . ... .. ... ... . ... .... .. ... .. .... .. . . ...... . .. fusion practices. I le remains chairman of the State Council on Human Blood and Transfusion Services and director of Buffalo General Hospital's transfusion service, named in honor of Witebsky. His blood research led to an mntation to the etherlands to help celebrate the 25th anni\'ersary of the Red Cross BloodTransfus1onScrvicesCentral Laboraton . The court Iv and dapper Buffalo nati\'e took tea with Queen Juliana. who was less well -turned out than he - her slip was showing . But Mohn doesn't mind donning work clothes and working as a carpenter and Bu,-,.Al.0 PMYIICIAN fl] the other way. Ifwe didn't have regional center-,. we wouldn"t be doing transplants and cardiac su rgery." Hi!>long record of Red Cross ser"ice includes a term as Greater Buffalo Chapter chairman He is currenth chairman of the Red Cross Medical-Scientific Advisor) Committee and the chapter fitra\'el nancial development committee. He ,s proud of his -f6 years of \"OlunOf all his honors and awards. though, teer sen 1cc,, Hh the Red Cross In the \tohn sa,d the highest mbute he ever earl} days he ,,as opposed to the Red came when \Vitebskv praised Cross concept of regional blood ser- received him the as a teacher-calling abilit) nces. but soon realized the wi.sdom of his + known. ever had best teacher he the approach. "If you're an objective LLIAMS WI DEBORAH -BY scientist. vou ha, c to face facts . I swung painter to restore his 1851 Elma farmhouse,, here he and his wife raised four children. He collects antiques and art as well as wines and has been working throughout the rear on another pct project of h,s - the Red Cro-.s· \'intage Affair-an auction ofwmes, dmingand ANO &1O,-.iC0ICAL $CIC:HT t lT AUTUMN 1091 e �·······•· ······ ······························· ················· ·•···· ······· [i] . ' Firstannual Southern Tiersurgery meeting heldinOlean hysicians and professors from The Cleveland Clini c Founda tion, George Washington University, Hanneman University Hospital, Buffalo General Hospital, Olean General Hospital and the State University of New York at Buffalo School of Medicine and Biomedical Sciences convened for the First Annual Upda te in General Colon and Rectal Surgery in October. Working with chairman and program director Adil H. Al-Humadi, M.D., adj unct clinical assistant professor at UB and colon and rectal surgeon at Olean General Hospital, were Eddie Hoover, M.D., chairm an of the medical school's Department of Surgery and Bertram Portin, M.D., head of the Department of Co lon and Rectal Surgery, who moderated the symposium. Designed to apprise primary care physicians, internists, surgeons and health care professionals of the most recent developments in the diagnosis e BUFFAL O PHYSIC1AN and management of selected surgical problems including colon and rectal surgery and gall bladder disorders, the Update was the first conference in general colon and rectal surgery held in the Southern Tier area. The program was designed by the Department of Surgery as part of its Continuing Medical Education program. + James PlattWhite Society seeks1,000 donors he Schoo l of Medicine and Biomedical Sciences and the James Plan White Society have launched a "Th ousand at a Thousand" campaign to raise funds for biomedical and clinical research, scholar ships for needy and meritorious students, state -of-the-an laboratory equip11 ment, educational p rogrammin g and unrestr icted support for special needs ichard S. Safeer, a second-year and opportunities. medical student, has received an The campaig n award from the Regional Center was la un ched in for Clinical Nutrition Education September, accordof The New York Academy of ing to Eugene Beltrami , M.D. '54, Medicine for \\tt,'*/JJ, James Platt White a paper on cardio- ~\\! Society Chairman. vascular disease. ~The James Platt Jam es PlattWhite Safeer, who is~,,~ .: • ~ th eoriginatorand ~ § White Society was formed in 1986 on directorofthe"Get ~ ~ the 140th anniversary of the founding of Heart Smart" pro- ~/ ~ the medical school to recognize dedigram, won in the Comcated alumni and friends of the medical munity Work category. + schoo l who contribute $1,000 annually. The James Platt Wh ite Society provides vital financial resources to help the medical school attract the best students, retain top faculty and strengthen biomedical research, educational and clinical programs , Beltrami said. James Platt White was one of the founding members of the University at BuffaloSchool of Medicine and Biomedical Sciences. An obstetrician and gynecologist, Wh ite contributed important improvements in the practice and teaching of obstetrics, conducting the first clinical demonstrations in obstetrics in the United States and advocating anesthesia in childbirth. He was professor of obstetrics for 35 years and dean of the school at the time of his death in 1881.+ Safeerwinsawardfor GetHeartSmart" program fll~ ~ 'fl//m~~ AND BIOMEOICA- SCIENTIST AUTUMN 1991 �·············· · ······· · ·············· · ···· · ····· · ··· · ··········· ··· · · ············· · ····· · ·■ · mm I Medical schoolhonors its facuitymembers even faculty members and six resident physicians were honored at the annual faculty meeting of the School of Medicine and Biomedical Sciences. Michael A. Apicella, M.D., director of the Division of Infectious Diseases in the Department of Medicine, received the Stockton Kimball Award for excellence in academic achievement. Apicella, UB professor of medicine and microbio logy, also serves as co-director of the UB Center for Applied Molecular Biology and Immunology . He will deliver the Stockton Kimball Lecture at next year's ann ual mee ting. Jacob M. Steinhart , M.D., clinical associate professor of pediatrics, was named recipiem of the third annual Robert S. Berkson Memo rial Award in the Art of Medicine. The award recognizes excellence in patient care and teaching by volunteer faculty members. Mary Voorhess, M.D., professor of pediatrics, received the Dean's Award for service to the medical school and the University and outstanding research. Codirector of the Division of Endocrinology at The Children's Hosp ital of Buffalo, she has served on various committees of the medical school and its department of pediatrics. Louis A. and Ruth Siegel Teaching Awards for teaching excellence were presented in the following categories: pre-clinica l, Charles Severin, Ph.D., associate professor of anatom ical sciences; clinical, Bradley Truax, M.D., clinical associate professor of neurology, a nd volunteer , Christopher Valencia , M.D., clinica l instructor of medicine. House staff awards were presented to: Maritza Cotto, M.D., resident physicia n in medicine;John A. Leone, M.D., resi- HislaAngela Bates UBmedical student winsNIMH award isla Angela Bates, a third-year medical student, has been chosen one of six medical students in the U.S. to receive an American Academy of Child and Adolescent Psychiatry James Comer NlMH Minority Fellowship Award. She rece ived a $3,000 stipend to support participation in research in child and adolescent psychiatry last summer. Bates, under the direction of Gary Cohen , M.D., clinical associate professor of pediatr ics and psych iatry, David Kaye, M.D., clinical assistant professor of psychiatry and Richard Clopper, M.D., clinical assistant professor of psychology and psychiatry , was involved in the prospective psychosocial screeni ng of children referred to the Pediatric Endo crine Clinic at Chi ldren's Hospita l for evaluatio n of growth problems or newly diagnosed diabetes mellitus. The Comer Award is funded through a grant from the National Institute of + Mental Health . BUl"F' A LO PH Y SICIAN ANO BIOM£01 C AL SC I ENTIST I dent physician in medicine; Michael Denk , M.D., resident physician in sur gery; Frank Green, M.D., resident physician in medic ine; Nashat Rabadi, M.D., resident physician in medicine , and Joseph Cinderella, M.D., resident phys ician in medicine. A special award was presented post humously toJohn F. Moran, Ph.D., asso ciate professo r of biochemistry and former assistant to the dean for facilities + planning, who died in February. B y A R T H U R P A G E Schwartz headsUB cardiology division effrey S. Schwartz, M.D., has been named chief of the Division of Cardiology in the Department of Medicine. A professor of medicine at the University at Buffalo and faculty member since 1987, Schwartz is the head of the Division of Cardiology at The Buffalo General Hospital. Prior to coming to Buffalo, Schwartz was associate professor of medicine and di rector of the exercise laboratory at tlheUniversity of Minnesota Medical JeffreySchwartz , M.D. School. A graduate of Rutgers Univers ity, he received his medical degree in 1968 from Albert Einstein College of Medicine and did a cardiology fellows hip at the University of Chicago. He also did research on narrowi ng of the coro nary arteries under a National Institutes of Health Young [nvestigat0r Re+ search Award. B Y A R T H U R AVTU-MN I P 9 9 A G 1 E 6) �Kassirer receives -1991 full-time people who were extraordinary teachers and doctors. The environment was very carefu lly designed for the student. l'm sure it's even more so today . After l had begun my career, it was apparent to me that these great teachers and doctors had become role models for me." As an acknowledged specialist in nephrology and internal medicine, Kassirer has received national recogn ition for his work on diagnost ic reason ing and therapeutic decision-making . He is the Sara Murray Jordan Professor of Medicine and vice chair of the department of medicine at Tufts Universi ty School of Medicine, Boston, where he has been on the facu lty since 1961. Kassirer also is associate physicianin-chief at the New England Medical Center, Boston . Kassirer has over 100 publications on a varie ty of aspects of clinical medici ne. A Buffalo native, he auended UB as an undergraduate from 1950 to 1953, entering medical school following his junior year. While attending medical school, he was named to the Gibson Anatomical Society and Alpha Omega Alpha and received the C.V. Mosby Award and the Roswell Park Award in Surgery. He received his medical degree magna cum laude, and did his internship and served as assistant reside nt in medicine at The Buffalo General Hospital. Since 1986, he has served as a regiona l member of the governing board of the UB Medical Alumni Association. He said that his multi-faceted career was a key factor in his securing the editoria l duties at The New England Joumal. "The experiences I had in my early Distinguished Alumnus Award NEW ENGLAND MEDICAL J O URNAL EDIT O R PR A ISES UB SCHOOL erome P. Kassirer, M.D., editor-inchief of The New England Joumal of Medicine, received the 1991 Distinguished Medical Alumnus Award at a Past President's Dinner on September 19 at the Buffalo Club. Kassirer replaced Arnold S. Relman, M.D., last July as editor. He was named following an extensive worldwide search by a distingu ished panel of medical leaders. The New England journal is the oldest continuously pub lished medical journal in the world and is considered the nation's leading medical research journal. Kassirer said that a combination of research and teaching excellence makes UB's School of Medicine and Biomedical Sciences one of the great academ ic centers in the country. "Buffalo is obviously veryimportantto me. It was herethatI developedmy idealsand my knowledgein the field of medicine." "Buffalo is obviously very important to me. It was here that I developed my ideals and my knowledge in the field of medicine," he said. "When I was in medical school here, there was a group of Farleft: Thoma s Riemens chneide r, M.D. , associat e vice president for clinical affairsand associat e dean. left: James Weerick , M.D., Class of 1949 Eit> BUFFALO PHYSICIAN ANO BIOMEDICAL SCIENTIST AUTUMN I 9 9 I �Alumni of theMedical n, , '77, president withNedraHarrisoM.D. , celebrates of Medicine Journal , M.D.,'57, editorof 11,eNewEngland e .Kossirer JeromP . Award us ed the1991DistinguishAlumn , afterreceiving Association her going, it was what she hadn't done LS and said that the one fundamental men yet that kept her going. That reprcsentS career, includinga lot of teaching, helped should be held b>·all docthat al pnnc1p ph) ." set me up for the Job I haYe now. I tors is to perform services ,, h1ch arc very clearly my philoso Associauon prei Alumn al interMedic very The me believe those things made useful and good for people ~rmsull a allydcs1gned aspeci ith en, said. he Kassir sented esung to the search commntec, doctor. \1\ responsibility 1sto do good. tion ofh1s emora in comm in gjob crystal buffalo "I think that it is the most amazin This 1san unparalleled opportunity LOdo ues colleag and friends award. About 75 medicine that there 1s." good 11·sa bit awesome to me," he said + were on hand to honor him. Kassircr, who addres!>cd the 145th "Martha Graham, when she was 80, R E M H A M M A R K B Y commencement of the medical school in II wasn't the awards that kept that said Ma}, made light of his own achic\"e- BurP'A.LO PHY.IC I AN ANO e1oiw:CDtCAL SCICNTl•T AUTUMN �.......... . . .. ....................... . ............ . ............ . ........................ .. Spring Clinical Dayand Reunion Weekend set he MedicalAlumni Associationhas seLSaturday, April25, 1992,for its 55LhAnnual Spring Wilensky, ClinicalDay. KeynOLespeakerGail direcLOrof LheHealLhCare Finance Adminisrration,will address "High Technologyand CosLConLainrnenL in Lhe1990s." Reunion Classes of 1942, 1947, 1952, 1957, 1962, 1967, 1972, 1977, 1982 and 1987 will meeL on Friday, April 24 for CockLail RecepLionsand Saturday, April 25 for Reunion Dinners. Those classes will be vying for the Best Attendance Trophy, won lasLyear by the Class of 1941. CLASS OF 1942 "It's hard LO lx:lievethat 50 years have elapsedsince we graduated./.£r'smaizethis reunion as meaningful ro us as tl1c day we received our diplomas!" RICHARD AMENT, M . 0. , CHAIRPERSON CLASS OF 1957 "The more rhc merrier. It's ce11ai11ly tme for class reunions. Thoseof 11swho have a1te11ded previo11Sreunions /mowhow mud1fm1theyare. l l1opeall my classmatesare pla1111i11gcocomeroour35th , in April '92." SOL M.0 .. MESSINGER. CO -CHAIRPERSON CLASS OF 1947 "A long rime has passedsince we fought rl1ebattle of High Street. Let's relivethosedays and share new stories at rhe 45th classreunion." WILLIAM M . BUKOWSKI. M . D .• CHAIRPERSON CLASS OF 1 952 "Comebacl110see how Buffalo, the School and your classmates have changed in -f0years.We needyou LOmalie r!1isthe bestreunionof all." NEAL FUHR . M . 0 ., CO -CHAIRPERSON "Don'tyou thinli dra1after40 yew:s<ISphysiciansour whole classought LOget cogether011 April25, '92 bac/1in B1if{alo?" ROBERT BAUMLER "Dr. Sol Messingerand I are /oohingfonvard with great expectationsto our 35tl1reose union. We hope that 1/1 auend the 30th who did 1101 will 111al1e every effort to renewoldfriendshipsandshare with otherswhat's happened ro them over t/1eyears." RICHARD MILLER. M . 0 ., CO -CHAIRPERSON . M . 0 .. CO-CHAIRPERSON "Fony years. Ir's beena long rime and a greatprofessional " career.Comea,u/ celebrate! BURTON 5TULBERG . M . D .• CO-CHAIRPERSON e BUFFALO PHY S ICIAN A N 0 8t0MEOICAL SCIENTIST AUTUMN 1 9 9 1 �.. . .... .. .............. CLASS OF 1962 .............. ..... .... ....... .................... .. ............ "It's hard to believeihatfive years have gone by. Lei'sall gel togeiher and renew 1l1e friendships we had. We hope to seeyou ihis Spring." FASANELLO, M . 0. , CO-CHAIRPERSON JACK C . FISHER, CO-CHA OF 1 987 CLASS "Theseare ow·vintageyears. D011'1 miss your 30th." SEBASTIAN . M . 0., IRPERSON THOMAS SMITH . M . O .. CO-CHAIRPERSON ALAN BEITLER. M . O .. CO -CHAIRPERSON OF 1 972 CLASS CLASS OF 1977 CLASS OF 1982 "Be an activist again! Co11taC1 your f rie11ds from rhe classof '72 and meer them i11 Buffalo. the ci1y of chichen wings, beef 011 wec/1 and America's premier football ream!" "Fif1ee11 years liavejlow11by! /-loware our classmatesdoing? Come to the reunion on April 25th and find out for yourself" MAR TIN BRECHER. "Fifteenyears? It can'! be! ELIZABETH BARLOG. Lei'sge1 togeiherbeforea11y M.0 .. CO -CHAIRPERSON more lime passes.Nedraand I loolifonvard10secingyou." "A special grce1i11g10 all of my classmaresll'irh the hope GREGORY YOUNG. M . O ., co-CHAIRPERSON 1ha11992will seeyoubachin Buffalofor our 10-year reunion." M .0 .. CO -CHAIRPERSON PATRICIA OUFFNER . M . D .. co-CHAIRPERSON N EDRA HARRISON. CO-CHAIRPERSON M.0. , ''Tl1esepasi 10 years have go11eby sofast and so muc/1 has happened in our lives. Won't ii be grear 10 get 10gether with old friends and find 0111what's been going 011?See you all al our 10ycar reunion!" KEVIN BARLOG, M.D .. CO -CHAIRPERSON CLASS OF 1 967 "\Ve all have a date with history. I-lopeto see you all at our 25th re1111 io11011April 25th, 1992. Be there if you possibly ca11 !" JOHN P. KELLEY . M.O .. CO-CHAIRPERSON THOMAS P. SHEEHAN. M .0 ., CO-CHAIRPERSON PHYSICl A N A N D BIOMEDICAL SCIENTIST A U T U M N I II 9 I E!) �··············•····················· [I] ' . NoenamedSeniorVP at Buffalo General ichael F. Noe, M.D., M.P.H., has been appointed a senior vice president al The Buffalo Genera l Hospital. A clinical assistant professor of medicine and social and preventive medicine at UB and recipienL of the Dean's Award in recogni lion of ou tstanding service to the medical school, Noe most recently served as BGH's vice president for professional affairs. He will continue to be responsible for that deparlment whi le also serving as the hospital's medical director. "He has received this appointment in recognition of his continued outstanding contributions to this inslitution, particularly with regard to medical affairs, the University-hospital relationship and the improvement of quality assurance," according to John E. Friedlander, BGH's president and chief executive officer. + M JosephChazen M.D. namednational fund drivechairman oseph A. Chazen, M.D., has been named National Chairman of the University at Buffalo 1991-92 Annual Fund Drive. The UB Annual Fund seeks support from alumni and friends across the country for University-wide needs such as scholarships, fellowships , classroom and laboratory equipment, library acquisitions and unrestricted funds. J e, 8UFFALO PHYSICIAN Chazen received his undergraduate degree cum laude in pharmacy from the University at Buffalo and medical degree from the School of Medicine and Biomedical Sciences. Currently he is clinical professor of medicine at Brown University, Providence , Rhode Island, medica l director of the Artificial Kidney Center of Rhode Island and head of Nephrology Associates. He also is co-director of the Division ofRenal Diseases, Rhode Island + Hospital. Milgrom awarded an honorary sciencedegree elix Milgrom, M.D., distinguished professorof microbiology, has been awarded an honorary doctor of science degree from the University of Medicine and Dentistry of New Jersey in recognition of his pioneering work in basic and medical immunology. Among Milgrom 's major contributions is research in the strucLUre and function ofanLibodies related to rheumatoid arthritis and the mechanism of hyperacute rejection in kidney transplants. A native of Poland , Milgrom joined the UB faculty in 1958 and served as chair of the department of microbiology from 1967 to 1985. He was previously chair of the department of microbiology at Silesian University School of Medicine in Zabrze and professor and acting chair a t the University of F 4NO Bt OMEOIC A L SCIENTIST Wroclaw, both in Poland. Milgrom's scientific contributions have earned him the prestigious Paul Ehrlich Prize, the Alfred Jurzykowski Foundation Award and honorary degrees in medicine from the University of Vienna, University of Lund (Sweden), Unive rsity of Heidelberg and University + of Bergen (Norway). Schaefer succeeds father inSt.Jose~hHospital Ophthalmology post aniel P. Schaefer, M.D., will succeed his father, Arthur J. Schaefer M.D., as director of the department of ophthalmology at St. Joseph Hospital, Cheektowaga. The younger Schaefer, a UB medical school graduate, has been a member of the SL.Joseph Hospital medical staff since 1986. His father was director of ophthalmology there since the hospital opened its doors in 1960. Daniel Schaefer served his resident training in oph thalmology al the New York Eye and Ear Infirmary , New York City, and was appoin ted chief residem in his third year. He served a fellowship in ophthalmic plastic , reconstructive , orbital and lacrimal surgery at Wills Eye Hospital, Philadelphia. A fellow of the American College of Surgeons and the American Society of Ophthalmic Plastic and Reconstructive Surgery, Daniel Schaefer is a clinical associate professor of ophthalmology and assistant clinical professor of + otolaryngo logy. D AU TUMN 1991 �-- -------------------- ----- -- - -- ·· · ··· · ··················· · · • ················· · ···························· ··· ············■ • 9 1 2 s 0 '27 , of B . KUITE GEORGE I Conway, New Hampsh ire, is dis ab led due to a fracture of the spine two years ago. L. MAXWELL LOCKIE '29 , is retired and lives in Escondido, California, where he enjoys playing bridge and meeting new friends. 1 9 IRVING 3 B . PERLSTEIN Louisville, s 0 '39 , Kentucky, of retired from practice and teaching in 1989. 9 1 4 HAROLD 0 s K . PALANKER '40 , has been invited to become a founding member of the Albu- left to right:AndyandHelenCappuccino '88, WayneWaz'88, hiswifeMarijonePetruzzi '86, TomBellomo '88, his wife,Cynthia Loya , Loriluizi'88, Margar et Morey'88, FrankLuzi , '88, JamieMusiker '87, herhusband, Michael Nemirov '88. of ogy at the University of Texas for children with cancer in San Amhers t , New York, retired after Medica l School, Houston, edited Diego, which has now been du- N . LUBIN ARNOLD '62 , 25 1/2 years in the US Air Force the textbook /mmwrologic Dis- plicated and spread through- and is now Erie County Health Commissioner. eases of tlte Shin, Appleton and out California with at least six other camps having been formed. Lange, 1991. I look forward to coming back querque Academy ofSurgery. He ROBERTA has been retired since 1987. GI L BERT '62 , read two papers this year: ''Toward a PAUL M. GOLD F ARB '67 , for our next reunion and look forward to hearing about other D . WHITE '40 , has been Natural Systems View of Trans- writes from San Diego, Califor nia, that he will be taking over as appointed to the Monroe County, ference" at the Midwest Sympos ium on Family Theory and Therapy, Chicago Academy of Pres ident of the American Can cer Society for the State of Cali- Sciences, and "Freud, Transfer- American Cancer Society in the ence and Differentiation" at the an United States . Over the last 11 sor and cha irman of the depart- Symposium on Differentiation at Lawrence years, his practice has been lim- ment of obstetrics and gynecology at Albany Medical Center, the Georgetown Fami ly Center, Andover, Massachusetts, is an ited to doing surgical oncology. Washington D.C. He has been a member of a JOHN Florida, Alliance For the Aged Advisory Committee. MYRON GORDON '48 , profes- will be on sabba t ical from JanuEHRLI C H '63 , is now ary 1992 to June 1992 in Lon- FRANK don, England, at Kings College deputy chairman of the depart- Hospital. ment of surgery and director of the division of surgical critical 1 9 F LOYD 6 H. LIPPA 0 '61 , s was care and nutrition at the Graduate Hospital, Philadelphia , Pennsylvania. fornia, the largest division of the aviation medical examiner. He also nies antique aircraft. versity in San Diego. He is active specialist, is di rectorof the respi- COLE '73 , a ratory department and sleep dis- doing surveys of hospital cancer orders center at North ridge Hos- programs. "Of the things that l pital in proud ofis having started a camp PHYSIClAN at Hospital , with the College of Surgeons years, the one that I am most 0 surgeon General pulmonologist and critical care pro- L '72. JEREMY fessorand chairman of dermatol- A N . WARNOCK o rt hopedic s 0 tained affiliation with the Uni- ROBERT I"' RICHARD 7 fort he last 10 years and has main- pital, Dearborn, Michigan. F 9 mu ltispecia lty oncology group three-year term at Oakwood Hos- U 1 orthridge, California. have done over the last several elected chief of surge ry for a 8 members of my class ." E . JORDON A H D '65 , BIOMEDICA\. SC ENTIST C . S GALIA '73 , of Hopedale, Massachusetts, is cur- AR T HUR AUTUMN �■ ·························································································· I OBITUARIES rently vice president for medical affairs and president of the medi- in 1988 and became board certified in 1989. She i's now medical Center. I have just published 'On a Radical Lesbian MATTHEW L. CARDEN ·19 , cal staff at Milford Whitinsville direCIOr of the young adu lt t reat- Feminist While Training in Psychiatry' in Women and Therapy. died August 27, 1991 in Sarasota, Florida. Dr. Carden practiced LAWRENCE 0 . RAMUNNO'87 , 60 years before moving lO Florida. received an M.P.H. from Johns While in Buffalo he served as Regional Hospital. He maintains ment unit for resistant patients at a full practice in internal medi- Four cine/cardiology, and is a clinical ins tructor at the University of Westchester, New York. Massachusetts. JoHN W inds Hospital v . Sosso Remaining in medicine in Buffalo for more than '85 . of Hopkins and is now in private Blauvelt, New York writes, "Re- practice, "near a covered bridge," cently completed a fellowship in allergy/immunology at Scripps in Conway, New Hampshire. in Health Policy and Administra- RONALD DAVID '75 , a lecturer chief of staff as well as president of the staff of Mercy Hospita l. He headed the Eric County Medical Society in 1954. Survivors in- tion at Harvard writes, "'I am re- Clinic in La Jolla, California. SUSAN L. BEHEN '88 . a fourth- signing my post as Acting Secre- Longing for the East Coas t , re- year general surgery resident at tary of Health in Pennsylvania 10 turned to open 'Orangetown Al- Johns Hopkins Hospital writes, clude a son, Dr. Lawrence M. Carden of Sarasota. return 10 academia, write a few lergy and Asthma' in Rockland "I will be doing a six-month fel- JUL IUS T . books and critically reflect on County, ew York. My wife lowship at Oxford University at died May 26, 1991. Dr. Markovitz health and medical care in the Oanel Piscitelli-Bosso, M.D.) and John Radcliffe Hospital, Oxford, had a private practice in Nonh new millennia." I recently had our first child, England fromJanuary'92 toJune Tonawanda, New York until 1955 Lauren Catherine." '92. Any fellow alumni welcome when he moved 10 Lauderda le- to stop by, if you arc in the area by-the-Sea, Florida. DAVIDFORSTER '85 , and Carol Hammer Forster '85 write, "We traveling . Sorry 10have lost touch ticed in Florida until 1980. He is with my classmates survived by his wife, Bernice. friends." cology. arc proud to announce the birth of our first child, Chriswpher JAMES R . MILLER '79 , was re- IRA L. SALOM'77 , ofE!mhursL, New York, has passed the first examina tion given by the American Board of Clinical Pharma- elected president of the New York State Association of County Health Officials. He is Commis- and old MARKOVITZ '28 , He prac- CHARL ES R . LEONE '29 , died May 4, 1991, in San Amonio Brandon, on May 18, 1991. We will be moving back to Northern MAJOR J OHN G . CHR IST IE '88 was deployed LoSaudi Arabia/ while attending a mass for his Virginia in August after two fun Iraq/Kuwait with the 1st Infantry deceased wife. Dr. Leone was an years in California. Division during Desert Storm. auending Carol con- surgeon at Saint sionerofHealth for the Onondaga tinues her practice as pediatri- He is currently in the M.P.H. Vincent Hea lth Center in Erie, County Health Department. cian, and David will be practic- Program at Johns Hopkins and Pennsy lvania, for 40 years. He has been selected for promotion rank of Lieutenant Colonel. His main civic interest for more ing ophthalmology." 1 9 B s O MIC HAEL E LLIOT CAN E '83 , has a pri va Le p rac1 ice cardiothoracic lO surgery in in Bethlehem, Pennsylvania. T INA was president of the staff in 1955. than 40 years was the Boys and MAR IE GAR D N E R '87 , . writes, Girls Club ofErie. He was a mem- Jacob, born July 25, 1990. She is "A large group of UB Medical ber of the board of directors for nowdoingou1pa1ien1 urgent care School graduates met on the sunny shores of Redondo Beach over -+Oyears and in February 10 celebrate the wedding of Tom bership. He was honored in 1983 announces the birth of a son, in Stony Brook, New York. E . O STROV '83 , an assistant professor at the Hershey LAURA BAR BARA MARGAR ET MOR E Y '88 1990 was given a lifetime mem - Bellomo '88 10 Cynthia Loya. 11 with the prestigious Silver Me- Medical Center, Hershey, Penn- chiatrist for Operation Concern was a fantastic evening of cham- dallion by the National Boys Club sylvania, announces the birth of pagne, fresh oysters, stir-fried shrimp, while being serenaded of America. her daughter, Meredith Buckley, in Alameda, California, writes, "I completed my psychiatry resi- inJu ly 1990. dency at UCSF/Langley Porter by a Mariachi band. Enclosed is P OST '87 , a staff psy- Ins1itu1e, and started a position CAROL WEINSTEIN '84 . com- as staff psychiatrist at a Lesbian/ pleted a residency in psychiatry Gay Community Mental Health ~ BUFFALO PHYSICIAN A N D BIOMEDICAL a photo of all the Buffalo folks." ALI CE B E NNE TT EMMA MURRAY'37 ,diedjuly3l, 1989, in Phoenix Arizona. 5C1£NTIST A U T U M N 1 9 9 1 ��YORK AT BUFFALO Permit No.311 :c _ , 5--1 L• Ry ., €PT � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. 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For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician and biomedical scientist, Autumn 1991 Subject The topic of the resource State University of New York at Buffalo.- School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1991-Autumn Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. School of Medicine. 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[.., "- tc ,c<11 r \H>ulJ 1,e tr,1'1 •crrt- rri\ m \ r., ch, 1 Kil 1 n11\ H Ju, I, I' \\I t t~, '.[) t tI I nr r1L.Jt-}mc.rl re t.1• short ,'1,hJ.lumni,mdtn,r,l, ,dn1Ptr1bll' • \\h.tt ,, reqi.irt·d, l ~ 1s ,on,tct-r, l I Jcr , !I '1 ' rut- IC. 11 j .ii SL.h,k \ Ill l''l'\ldmg SL.hol,1="11r5SI ( OlC. l nJLr th< ,e l<tr~h1;,of['; Thon I VJtlU5u, A, M,lllt Dem ..1·111'.·ll r. r , • \.IT' 1 ·It n,, rnl ~ r,c hu r·cuuil, tLnds w 11,1,JrJeJ t. iudlnt, l nth, h-1 o 1 IT m, r nltd [ ,h w.ir th. sc h0<l •s,1bletl' Ix ncht < f n• m mix r I tl de nr, \XL hope th t the\ \\ 111h: < 1H1ucll'h •r He '.11 th It i, thvr l irn ' Pll '-.• '' '11.1. 1, 1J ,r, It 11 Ku, ll t,, •I),, ct',,rt \\,~,le n, .. ~1 ITt ',, .....I ' n 1 LL.kh ~,>''r, kr sr1<1tln11• ngn,thmthel9b0, 1 .irrmi- 1u1r But ,,«,r!L. thc,n 1e,,<\,1tposturl\\,1lchmgl hm:un t1J\, l l\,c, r 1111u.1cntt< mu," rhc \ 1• 11- rool, 1h<hol.1rsh1rrunJ"\a~..1 oli,J r I ·.1blihe 1 m ''1l < rl, , 4'< , \\ , 1 u n,,nrr 11, n J .,, I r h,"1-r1 I • (I J, I ,d, d It ml c ,di 1tr n,>\\ th n t ..: u ·t, Inc l1t l, 11, 11 n L ! I\ I I Ul rt " 1c dth, ,11,ltnt fll, Et Tl'K \'-,'-...'t ,Aft \U cl , RI • O rn. JL\dl Ix ch th< tK Tr I fr1, ne • the prton te ,IL,. then l t DearAlumni andSupporters of theUBMedical School, ~ l'-L L • M •~t \ \H Is, x,k (() h~lr tht \\lit II l n •t. tnel'lc.1' t r_.r; 1' f1 lrl p ,nrt r I~ ·t C. 1rcJ n•ht tdt.,ns,lcxrrc• of,, 1\\l,,\\nuJ.1kctl'sh1r~mth \er Ix r,garJs Ill \ IC lll T,, rh "lc.,11 llt.nc. 11r11.:c 111,t•t1t :11 pr rt\t<,k11,k1 I, .... «•I• necJ <L h -•-rr rt " m ,~, h ,r, i,, 'I ·1 'vi 11' I)\\,, <r '"\~ l > H \, 1-11'-.(,H ,.., ITA .., ,~ ·LI \IS{''-" I t \ \ \1e, 1( e • fi It I lll T'<F I . •t \hl f ' ), l 1 \ I 1 .•n ' ',f\ \! , l 1 ' r ! I' ,I l'r,, \ i, ·t I I \j, llc l John N.mghton, M.D. 1 • • r C 111 I \ff.1 r, ,1 l .! I< U.. 11 ~LI l t ' DearFellowAlumni/ Alumnae: \ M ,knr, I thL \I mn1 \, K 111 ,n 1, rn F< th ,n h It \ r 1hLfl m llnm m 1,1h, "d I ,1-r,Lt J ,c \lumn R,un, 11\Xuh11l ml1l,1r, runt.r..,1rm•l l1111,II 1 l\,111tth1, ,c ,r Ill, 1..11.1m 11n rhru,t I 1 ,, 1 t f "l , , 111th ,, 11 ru,n1t th< \lltk<n n It r ,, u. "' " 1 11,k, ,, u di 1 , mr11 " I ,nu l Ir lmun, the \lumn \, ,1111 n h.i k.l I rucpl n Irr, \X, h I I ,Im , ~l'\' ,n, n l' \\ c In I th 1 , < , ti, ,rud,nr, durm tic 1r m tn 111,11, n. l h, e 'l'lll , , t, r 1d1 I cir'-' me tr, ,, 111, rh, ,!11,, md \ ur L 11 ,n, I. \ur di rr, 11111 l l, 111"\\I t ,clt,,l I , 11'< 1, r, m, ,, mx1 1 f, r 1111h, tu ILnt, I I tun< u1 n r ..!11111ll. lll\t nunl r" trh <\I 1111111\ x:1111 1 TI1<\ I I\L K"-l" kn<.« I, ur\\ llm Ill" II -f I 1l1t rl11, ~" 1 II --1H, \• 11 hLIr ntr1h111 rill 11 '" 11111 "rnn th II l Im,< 11I k\ I.I I, r thl t !l 11 I 11 '1rr rt 1h II Ill 1h, "I\ Bertram .\. Portm, M.D., '5, �B UFFAlD P!JY§1~!6iN Srnni.: 1991 II Research II HospitalNews On art and medicme, page 18. II HealingtheSpiritIn sickness, more than just the physical side needs to be addre-.;sed. BJDaggersoftheMind:Shakespeare andNeurology Lance Fogan, M.D., '65, catalogs the Bard's knowledge of the field. m A Curefor Malpractice HeadachesFull-rime SUNY Hmpicalchap/amsare a ma/ pareof the healthcareteam, page6. faculty physicians and dentists form their own insurance company. DJTheChnkalPktureRichard V Lee, M.D., on the affinity between medicine and art. E!J FromShin Splintsto HipPointersUB's new Sports Medicine Institut e helps weekend and professional athlete':> alike. BJCharting theQuality of LifeHarrington Physicumsned a <W)' to quancihquabryof life issues,page 24. lecturer Alvan Feinstein, M.D., laments the inability of basic science to measure the qualit) of life. m m Medical School News Alumni EEJ Research m m m People MatchDay Shakespe,art.' on neurology, />age 13. Classnotes Dand W'.Bt'ntb, M.D . focmes chcmedicalschool on healthcare[or the agm(!, page26. �----:(]}---- ., E I\. ~ 2 ten by a one-year $15,689 grant from the STUDY TOSURVEY HEALTH Great Lakes Protection Fund, which will IMPACT OFEATING GREATfocus on how consumption of fish from the Great Lakes affects risk of malignant LAKES FISH and benign thyroid disease. B researchers chis spring will survey 30,000 New York State anglers anJ their spouses in the largest study ever conducted on the health impact of caring fish from the Great Lakes. The study, funded by the Great Lakes Protection Fund, will focus on the consumption of fish from lakes Ontario and Erie by residents of 16 counries, according to John E. Vena, Ph.D., princi pal investigator and University at Buffalo associate professor of social and preventive medicine. Vena said researchers want to determine the characteristics of the population that consumes fish from the lakes, how their perception of risk relates to their consumption and rhe health effects of that consumption. "There is a long overdue need for a large populationbased survey of anglers to establish a cohort of fish carers," Vena added. The study is funded by a one-year $157,800grant from the Great Lakes Protection Fund, the United States' only multistate environmental endowment. Vena also is the principal investigator on a second study, underwrir- U Vena said the survey of anglers and their spouseswill focuson a random sample of anglers between rhe ages of 18 and 40 who live in the 16 counties and were issued a fishing license in New York since October 1990. The self-aJministered questionnaire will be mailed in May, he added. The 16 counties are: Cayuga, Erie, Genesee, Jefferson, Lewis, Livingston, Monroe, Niagara, Oneida, Onondaga, Ontario, Orleans, Oswego, Sc. Lawrence, Seneca and Wayne. Despite advisories issued by New York State that certain species offish caught in Lake Ontario should not be eaten or consumed not more than once a monrh, Vena said it's estimated that at least 15 percent of anglers eat these fish as often as once a week. He added chat among the Great Lakes, Lake Onrario "has a unique contaminant profile with the highest documented levels in fish of contaminants including pestipol ych lor inated biphenyls (PCBs) and methyl mercury." Vena said that m o s t studies to dace of consumption of contaminated fish from the Great Lakes "have been based on small, convenient samples in ocher states. For New York Seate, there is a lot of data on how much fish is caught, but no data on how much is eaten . We want to know who are the fish eaters and how much they eat and what do they know about the advisories." Once chose who consume the fish are identified, Vena explained, researchers will be able ro look at the associat ion between past and current consumption of contaminated fish, whether consumption has added to their body burden of chemicals and how consumption affects their risk for health problems. Barbara Knuth, Ph.D., assistant professor of natural resources and policy management at Cornell University, will be co-investigator in the study. Also collaborating on the study will be Germaine Buck, Ph.D., Maria Zielezny, Ph.D.,James Marshall, Ph.D., and Jo Freudenheim, Ph.D., all of che the medical school's Department of Social and Preventive Medicine. In the study, Vena's co-investigaro rs will be John M. Lore, M.D., professor and former chair of the UB medical schoo l' s Department of Otolaryngology, and Manuel H. Castillo, M.D., UB assistant professor of otolaryngology. Their study of the consumption of contaminated fish from the Great Lakes as a risk factor for malignant and benign thyroid disease will look at lifetime fish consumption from the Great Lakes in 58 people with cancer of the thyroid and 237 people with endemic goiter not due to iodine deficiency and a matched number of controls. 'This study will be one of the first to systematically evaluate the hypothesis chat consumption offish from the Great Lakes is related to risk for either malignant or benign thyroid disease," Vena said. • - By Arrhur Page �- ---:(]):-- -- .,. E ~ ~ 3 LINK BETWEEN CANCER, ELECTRIC BLANKETS NEEDS MORE STUDY W hile there appears cobe no general increase in breast cancer risk among women who have used electric blankets for several years, there is a higher yet not statistically significant risk among women who use the blankets throughout the night, according to researchers in the UB Department of Social and Preventive Medicine. John E. Vena, Ph.D., and colleagues studied 382 postmenopausal women with breast cancer and 439 controls who were asked about electric blanket use in the previous lO years. The UB researchers say further studies must be done co obtain an accurate picture on the relationship between electric blanket use and breast cancer risk. It has been hypothesized chat chronic exposure to electromagnetic fields increases breast cancer risk by suppressing the normal nocturnal rise in pineal melatonin. • - By Arthur Page More than 500 scientific papers will be presented at the meeting sponsored by the medical school's Department of Social and Preventive Medicine. Graham will be honored at a reception and banquet at 6:30 p.m.,June 11, in the A lbright-Knox Art Gallery, Buffalo. The symposium honoring Graham will explore the directions chat research should cake to define the role of diet in the etiology of cancer. Registration is being handled by the Office of Conferences and Special Events at the University at Buffalo. • - By Arihur Page SYMPOSIUM TO HONOR SAXON GRAHAM A symposium on diet in the epidemiology of cancer will highlight the 24th annual meeting of the Society for Epidemiologic Research co be held June 11 to 14 at the BuffaloConvention Center. The meeting will include a "Symposium on Diec in the Epidemiology of Cancer: Future Directions" in honor of Saxon L. Graham, Ph.D., professor and chair of the Department of Social and Preventive Medicine, who will retire in May. BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST mal imaging equipment and accompanying computer software chat result in che simultaneous production of matching thermal and visual images. "The same electronics that generate the thennal imaging data also provide the visible imaging data," he notes. "The same optics that are used to generate the thermal imaging data are used co generate the visual imaging data." The computers used in today's thermal imagingequipment interpret the body's radiation patterns in terms of temperature, producing readouts of numbers, shades of gray or colors keyed co specific temperatures. Hejazi notes that the image produced is not a visual one, but a "picture" based solely on temperatures that muse be interpreted. Hejazi's electronic and optical equipment modifications result in simultaneous production of thermal and visual images that share a common perspective and size. He said further modifications may provide an ability co superimpose one image over cheoch~ • THERMAL IMAGING DRAWBACK OVERCOME A major drawback that occurs in interpreting the results of thermal imaging has been overcome with technology developed by a researcher at UB's medical school. Shahram Hejazi, Ph.D., has developed patented modifications to standard ther- - B)' Arthur Page SPRING 1991 �---------------------·ffi------------------+E 'll" 4 For most of the last l O years, the hospital's annual births hovered around the 2,400 mark. Births rose steadily over the psychiatric expertise for patients who canlast three years, from 2,472 in 1988, to 2,706 in 1989 and ove r 3,000 last year. nae be properly treated at the Community Sister Angela Bontempo, president of Meneal Health Center because of their Sisters Hospital, attributed the dramatic medical condition," or patients who canincrease to changing patterns in available noc "receive adequate psychiatric care on obstet ric services, a rise in area births, a a regular medical floor." The opening of the new facility increases strong OB residency teaching profile, dedco70 the number of beds operated by BuJfulo ication and hard work from nurses and General for patients with psychiatric illness- physicians and high-profile marketing. She noted that the hospital has been es. The other 60 beds are located in the working very hard over the years to Community Mental Health Center. • strengthen its residency progra m. "We have built up our residency program on obstetrics and gyneco logy," she said, addi ng, "we have improved our facilities and capab ilitie s, invested in people and let the physicians and public know about or the first time in recent history, Sis- what we have. Obviously, we are very proud of our obstetrica l service and are ters of Charity Hospital del ivered • commi tted to its future." 3,000 babies in a calendar year. The milestone delivery came down to the wire as the 3,000th baby arrived on New Year's Eve as I 990 drew to a close. problems," he added . SISTERSMAMMOGRAPHY Noe said the new facility "makes it posUNITACCREDITED BYA(R sible to integrate internal medicine and isters Hospital' s Mammography Unit has been accredited by the American College of Radiology. The unit, part of the hospital's Department of Diagnostic Imaging and located next to its Breast Care Center of Western New York, is one of 1,500 facilities chat have been accredited nationally. Requirements for the three-year accreditation include a peer review eva luation of the facility's staff qua Iifications, equipment, quality control and quality assurance programs, image quality and breast dose. Mammograms are recommended by the American College of Radiology,the American Cancer Society, the American Medical Association and nine other major medical organizations, every one to two years in conjunction with a physical breast exam every year for women between 40 and 49, and every year in conjunct ion with a physical breast exam for women over 50. • S SISTERS HOSPITAL RECORDS 3,000THBIRTH ONNEWYEAR'S EVE F ROSWELL PARK CANCER INSTITUTE RECEIVES NEWNCI DESIGNATION STATUS BGHOPENS 1O-BED MED-PSYCH UNIT B uffalo General Hospital has opened a new l 0-bed acute care medical-psych ia tric unit as part of a 47-bed expansion approved by the New York State Health Department. The new unit, located on the 12th floor of the hospital's 16-scory medical cower, began admitting patients late lase year. Philip C. Noe, administrator of BGH's Community Meneal Health Center (CMCH), said, "ll1e unit is among on ly 20 such facilities in the entire country. Currently, the Erie County Medical Center is the only ocher upstate New York hospital with an acute care unit dedicated to patients who are diagnosed as having both medical and psychiatric R ... . .. _,,.· srtmm 1'191 oswell Park Cancer Institute has been approved by the National Cancer Advisory Board for status as a National Cancer Institute-Des ignated Comp rehensi ve Cancer Center. One of the first three cancer centers co receive the designation under a dual-level eer review system and guidelines estab··hed injanuary 1990, Roswell wasfuvorly recommended for the comprehen·ive designation by NCI's Cancer .;:;:::. fi/ Support Grant peer review com•·. mittee. Fox Chase Cance r : Center in Philadelphia .) and Yale University ...... :-':" Comprehensive . �s Cancer Center in New Haven, Connecticut, are the other two. All three institutions had been NCI comprehensive care centers under designated guidelines issued in the early 1970s. "As one of the original three centers designated as comprehensive following the passage of the National Cancer Act in 1971, it is most gratifying that we are also one of the first centers ro receive redesignation under the new peer-review process," said Roswell direcror Thomas B. Tomasi, M.D., Ph.D. 'The mark of'comprehensive cancer center' is one that the Institute bears proudly." The new guidelines required each center to be judged in new redesignation criteria, including: • A strong core of basic laboratory research, • A viable mechanism for facilitating links between basic/clinical research and outside organizations, • A proven record of innovative clinical research trials, • A significant amount of cancer prevention and control research, • An effective research training and continuing education program, • A wide range of cancer infonuation services for patients, health professionals and the surrounding community and • A substantial commitment ro community service and outreach activities, especially those directed coward underserved populations or those with disproportionate cancer rates. • CHILDREN'S HOSPITAL ANNOUNCES ER APPOINTMENTS hildren's Hospital of Buffalo has announced the appointment of two physicians ro its Pediatric Emergency Room. C BUFFALO Pl IYSICIAN AND BIOMEDICAL SCIENTIST OTOLARYNGOLOGY RESIDENTS RESEARCH DAYSETFORJUNE T Eugene W.Yates,M.D. PaulaMa1ur-Ellis, M.D. Paula Mazur-Ellis,M.D., clinical assistant professor in the Department of Pediatrics, and Eugene W. Yates,M.D., clinical instrucror in the Department of Pediatrics, have been appointed attending physicians. They will be responsible for patient care and supervising the pediatric residents. Mazur-Ellis received her medical degree from the University of Pinsburgh and did her post graduate work at Mercy Hospital of Pittsburgh. She has had extensive training and education in various classifications of life support. Prior to her new position, she was an associate pediatrician in a private practice in Beaver, Pennsylvania and a college health physician at Duquesne University. Mazur-Ellis is a member of the American Academy of Pediatrics and has written articles and abstracts about intellectual development status postHaemophilus Influenza meningitus. Yates was an assistant attorney general for the South Carolina's Attorney General's office prior ro obtaining his medical degree from the University of South Carolina. He completed his pediatric residency at Richland Memorial Hospital in Columbus, North Carolina. A member of the American Academy of Pediatrics, Yates is the co-author of publications on child and adolescent psychiatry. • he Seventh Annual Residents Research Day for Otolaryngology/ head and neck surgery will be held Wednesday, June 5, from 8 a.m. to 3 p.m. in Palmer Hall at Sisters Hospital. The day will include presentation of otolaryngology residents' research papers and will feature visiting professor Guy M. Osoff, D.M.D., M.D., Guy M. Maness professor and chairman of the Department of Otolaryngology at Vanderbilt University Medical Center, who will speak on "The Role of Laser Technology in the Upper Airway 1991." • SISTERS HOSPITAL NAMES CHIEF OF DENTAL MEDICINE ayne C. Jarvis, D.D.S., has been appointed chief of dental medicine at Sisters Hospital. He previously was direcror of the hospital's division of oral and maxillofacial surgery. A graduate of the University of M ichigan and the University of Michigan School of Dentistry, Jarvis completed his residency in oral and maxillofacial surgery at UB's School of Dentistry. He is a faculty member at the Misch Institute for Advanced Implant Dentistry, Dearborn, Michigan, and the Implant Center of the University of Pittsburgh School of Dentistry, as well as UB. He was recently certified and awarded diplomat status by the American Board of Oral Implantology/ Implant Dentistry. • W ~PRING 1<191 �6 YLOIS ASTRAINED PROFESSIONALS , : SIMON TONG CHAPLAINS ARE PART OFTHE HOSPITAL TEAM SPRING 1991 BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST ��8 arher Richard Augusryn's first patient when he was a chaplain-in-training threw a bedpan at him. "I told my teacher, 'I only have one suit left,"' Father Richard said after returning home to change."[ can't afford this." Father Richard returned to the hospital and to the room to learn the reason behind the thrown bedpan. The patient, he discovered, had just been cold by a physician that she would need a double mastectomy. After delivering his report, the doctor had abruptly walked out. And the next person co enter the room a few minutes later received the patient's wrath. She apologized; the chaplain-intraining learned he hadn't done anything wrong; she is alive and well today. "That's the creative edge in pastoral care," said Father Richard relating the story years later. "You really don't know what the agenda is going to be." In a setting where most professional staff members have clearly defined duties, the job of hospital chaplain is an anomaly because it deals with the human and rhe spirimal rather than the scientific, and consequently defies easy definition. Local directors of pastoral care describe their work in spiritual overtones: "the soul of the hospital" and "the heartbeat of the hospital." Father Richard has been director of Buffalo General's Pastoral Care Department since it was formed in 1988, and was a volunteer chaplain for several years before char. With the help of a cadre of volunteers, he attempts to meet the spirimal needs of patients in that l,000-bed facility. "Yes, you have doctors; yes, you have nurses," says Father Richard in his tiny Buffalo General office. "You have all kinds of fancy technical things in a hospital. But in sickness there's more than just the technical char needs co be addressed, and chat's the human. "You have ro look at where people are coming from psychologically and spiritually. You cry co put all chose areas in sync, so the healing process becomes alive and real." In an attempt co define what hospital chaplains do, it is easier co state what they do not do. They do nor proselytize, preach, or attempt co convert. "We don't hand out rosaries," says Sister Lucille Socciarelli, director of pastoral care at Mercy Hospital in South Buffalo. "I can spend a whole visit and nor mention God." "I don't have a religious mission," says the Rev. Jackie Lewis, a Presbyterian minister and full-time chaplain at Children's Hospital. "We divorce ourselves from iniriaring the 'Jesus love~ me; Yes I know; For the Bible cells me so' sort of thing, because that's not where everyone is at," agrees Father RicharJ. Humans have cared for the sick since they Jevelnpcd the capacity for compassion, bur the position of professionally trained hospital chaplain is relatively new. As recently a~ the 1940s, ministering to the spiritual needs of Lhe hospitalized was a job often relegated to problem ministers anJ priests. That situation changed in 1951 when a group of Protestant denominations began training ministers for hospital work. The group was incorporated in 1967 as the Association of Clinical Pastoral Education. A similar Catholic organi:arion - the National Association of Catholic Chaplains - was incorporated in I 965. Today most hospital chaplains have at least one year of training and are certified by a board to practice in a hospital setting. Modern hospital chaplains are members of the treatment ream. They serve the needs of the patients, the staff and their families, rather than representing a particular congregation or denomination. They have access to patients' records, and as is the case at Children's, particularly in the Intensive Care Nursery, are encourageJ to record observations on patient charts. Chaplains serve on committees on ethics and institutional review. They receive referrals from physicians likeanyorherspecialisr. The main work of a hospital chaplain, however, is listening. "If nothing else, I'm company," says Eliot Marrus, rabbi at Temple Shaarey Zedek and a volunteer chaplain at Buffalo General. "Most of all, people wane someone co talk co. My role in the crnwersarion is almost negligible." His favorite story about listening involves a visit with an elderly woman in a wheelchair who had no family co visit her. "She looked exceedingly frail," relates Rabbi Marrus. "She J\UFFAL,1 PllYS!CtA:-.:.~Nil ll!OMElllC.~L '<'IE.'-JT!ST �Ina settingwheremast professional staff members havedearly 9 defined duties , thejob of hospital chaplain is ananomaly because ii dealswiththehuman andthespiritual rather thanthescientific, and consequently defies easydefinition. Atleft, Father Richard Augustyn. Atright,Rabbi Eliot Marrus. sort of put out her hand, I took it rather gently, and felt this viselike grip. She pulled me into the chair beside her and then maneuvered her wheelchair so that I couldn't stand up. I was her prisoner for the next 30 minutes while she gave me her autobiography." Rabbi Marrus's experience illustrates a basic tenet of the chaplain training program: lee the patient sec the agenda . 'That might mean being kicked out," says Father Richard. "That might mean listening to how the pastor of their church has raked them over the coals for something. That might mean being with someone who is dying and not saying anything." Father Richard has been a chap lain for 11 years. Ac Buffalo General he manages a staff of 10 trained volunteers. "The national average is one chaplain for every 40 pacients,"he said. "In light of that I shou ld have a staff of 42." His chaplains are assigned to particular floors in order to develop a relationship with staff and long-term patients. They go from door-to-door regardless of denomination. Most people receive him well, Father Richard says, but he has been ejected from rooms on occasion. He figures the negative reaction stems from preconceived notions about a chap lain's purpose. HosPITAL CHAPLAINSWHo PAYS? ospital chaplains are members of the hospital staff and are paid by the hospital. In add ition, many hospitals supplement their pastoral care staffs with trained volunteers. These chaplains are primarily interdenominational and serve the hospital staff and their families as well as patients. Ministers from specific congregations serve their own members as pare of their routine pastoral responsibilities. Father Richard Augustyn, director of pastoral care at Buffalo Genera l Hospital and president of the National Association of Catholic Chaplains, says all Buffalo-area hospitals had at least one full-time paid hospital chaplain as of April 1, 1990. Buffalo General established itsdepartmento nly two years ago. Since then, Erie County Medical Center has elim inated the salary of its director of pastoral care in an effort to cue its budget. He is staying on temporarily as a volunteer . Meanwhile, Millard Fillmore Hospital has just hired its first full-time director of pastoral care. "In Buffalo we're swimming upstream," says Father Richard . "Throughout the country they're cutting departments. All hospitals are feeling the crunch and we just don't know how it's going to pan out . ECMC'ssituation reflects the trend nationwide. "The bottom line is, pastoral care needs to be an integral part of the hospital. We're on the right track. That's what keeps us going." • - BUFFALO PHYSIC IAN AN D BIOMEDICAL SCIENTIST SPRING 1991 �"The concept of many people is that we're here 1roevangeenhance what is going on physically." lize, to slap their hands for not being a good Christian," he says. Chaplains at Mercy try to see all new admissions within 48 "The biggest egg to crack is to get beyond the hurt they bring hours. Currently they are not entitled to record observations with them concerning religion." on patients' charts, but hope to acquire that privilege. While hospital chaplains do not want to be seein as repre10 Sister Lucille said she is received well most of the time. senting a particular religion, Father Richard is of ten called "We always ask 'Is this a good rime?"'she said. "I've only been upon for priestly duties. One of his warmest memorie s as a tossed out of a couple of rooms. chaplain centers around performing last rites for a dying "Usually when people are sick, they are so vulnerable that woman. if anyone can help them, they grasp on to that straw." He had just returned home from the Stratford !Festival in She speaks of being called to visit with a 30-year-old Ontario, where he had seen A Streetcar Named Desire. One woman who had to have a double mastectomy; of comforting of the play's central characters is the unstable woman of a wife whose husband died of a heart attack after going out for questionable character - Blanche DuBois. a Friday night fish fry. Father Richard was in bed when he got a call saying that a Recently she stayed with an only child at the bedside of her Mary DuBois was dying. "I went to her room, krnelt down, dying mother. "The daughter just talked out loud to herself, anointed her and went through the whole thing call ing her and l was there," Sister Lucille said. Blanche," he said. "Her husband came up to me "Lots of times people tell us things they wouldn't afterward and asked if it made a difference that her tell anyone else. After being through something with name was Mary, not Blanche, and I was devastated. a patient, you can be closer than family." Oneof thegreatest "I got back down on my knees, and I'm apologizChildren's Hospital has had a Department of ing and explaining to this woman, who is extremely serviceschaplains can Pastoral Care for at least 20 years, now headed by thin and emaciated, why I cal led her Blanche, and al I Father Frank T uchols. offer is theirtime. of a sudden she got this very wide smile on her face Jackie Lewis, who has been a Presbyterian chaplain - and she died. there for a year, recalls that she was called "Sister" by Otherhospitalstaff "Now I've got all these guilt feelings. I apologized everyone, even when she was pregnant with her first mustrush off lo to her husband, but he put his arm around me and child. said 'Father, you've given me the best gift anyone According to Rev. Lewis, a chaplain's responsianother medical crisis ;a could give me. That's the first time I've seen my wife bilities at Children's can range from providing supchaplain canstay smile in six month s."' port for a woman experiencing a miscarriage, to At Mercy Hosp ital a pastoral care department performing a baptism in the intensive care nursery, to behind. has existed since 1975.Sister Lucille has directed the tending a small child so the parents can be with an Below , SislerLucille. injured sibling. full-time staff of two priests and four sisters for sil< years. The chaplains are part of what Sister Lucille She says that she is received well more often than Atright , Rev. Jack ie calls the "holistic hea lth care team." she would expect. lewis andherson. "[ believe so much in the ministry we are doing,'"' "When I first began as a chaplain, I thought 'Boy, she said "We try to reach people inside of themselve:s if some stranger walked in when I was having a crisis, - spiritually, psychologically, emotionally - to I'm not sure how I'd feel.' But people are very receptive." SPRING 1991 I\UFF.-\LO Pl IYSICI.-\N ANO BIOMEDICAL SCIENTIST �say hello. "A lot of the time I end up playing with the younger kids. While we're playing things come out . Adolescents can be really open and talk a lot, but some of them don't want to talk at all." Rev. Lewis says she loves her work. She could be speaking for all hospital chaplains when she explains why. "There is always a situation popping up that we hadn't dealt with before. That stretches us all the time, and it's exciting. We discover what we really believe about humandignicy, pain and the ultimate value of people's lives." • CHAPLAIN TRAINING ATSISTERS A isters Hospital currently offers the only hospital-based Her first call as a chaplain while doing her clinical training in the pediatric ward at Strong Memorial Hospital left a last- '' chaplain training program in Western New York designed for all religious affiliations. The program at Sisters, accredited by che Association of Clinical Pastoral Education, or ACPE, took in its first students in September 1990. Seven people have gone through the program to dace, and six more \ are enrolled for the summer. \, Sister Margaret Dougherty, directorof pastoral care at Sisters, supervises the program. Would-be students need ing impressionconcerning che nacureof che human response at least a year of theological background to enroll. Her to crisis. "The call was for a baby who had died in the intensive care unit," she says. "When l walked into the room, the doctor was sitting on the floor with the baby in his arms, the parents were sitting beside him, and they were all crying. "I walked in and told them who I was. The doctor handed me the baby and they made space for me in their circle. I could have fainted when he handed me the baby. I didn't expect that kind of hospitality at that moment." One of the greatest services chaplains can offer is their time. Other hospital staff must rush off to another medical crisis; a chaplain can stay behind. Rev. Lewis tells of being with a husband whose wife was killed instantly in an automobile accident. She mer him at the bedside of his 18-month-old child injured in the same accident. "At first he didn't say anything," she says. "Eventually he started to talk about his wife, about how long they had been married, about how the accident happened, about going to the morgue to identify her body - a lot of derails he needed to talk about. "I think he knew that because of my role, I'd be comfortable hearing his pain. All I really did was spend time with him." If there is time remaining after caring for emergencies, Rev. Lewis visits children on the floors. Often they don't know what to make of her. "I'm pretty low key with them," she says. "I tell them I'm not going to do anything to hurt them. That l just came in to students are an ecumenical lot, representing a wide range of experience . "So far we have had a priest, a Lutheran seminary student, an Episcopal deaconess, a Lutheran deaconess and three Catholic laymen," said Sister Margaret. "This summer we have an Assembly of God seminary student, two Baptist seminary students and two Daughters of Charity sisters." Trainees receive 400 hours of instruction per unit, with a minimum of cwo unit s required to become qualified as a hospital chaplain. Students spend 25 percent of their time in group work or individual supervision and the rest of their hours visiting patients. "Students learn about the process of illness, grief, coping, the role of emotions in illness, interpersonal relationships and give each ocher feedback," Sister Margaret said. "What's really exciting to us is chat along with ministering to acute patients, we have some students interning in the methadone clinic. They are really working on the spiritual dimensions of people in treatment. Ir's been a good experience for them." Chaplain training for Catholics is a lso offered through the National Association of Catholic Chaplains, or NACC. A multi-denominational parishbased program certified by ACPE is offered through Lutheran Social Services. • BUFFALOPHYSICIAN AND BIOMElllC -\L SCIENTIST SPRINO 1991 11 �FIG <MIV: SUl'OIK>' l'IIOffTAI. \ UN IMtl!IOII Fl'O'f f Al. GYII\/S ................ 1,AT(II.Al,..,. ~mi&l h~ ,, ./ • I • Ii, �Daggcern of theeMmJg ~ §kJkcespcearce ~ anJ Nce1Li1Jroliog 13 Pox and plague, double vision and dementia: Lance Fogan,M.D. , '65, hasstudiedthemall- throughthe eyes of William Shakespeare.<JIAn award~winning study written by the West Coast neurologistexamines the neurologicaldisordersdescribedin the dramatist's greatestplays. Among "Dr. Shakespeare's" diagnoses: tremors, the neurological complications of syphilis, encephalopathy, dementia, epilepsy, disturbances of srage IV sleep, cerebra l hypoperfusion, sciatica, pharyngeal abnormalities and cranial nerve lesions. "The plays of Shakespeare are the greatest mirror of mankind, reflecting all of our emotional and psychological complexity and diversity," Fogan says. "They give us the fullest possible picture of our nature. "Shakespeare was not only acquainted with the signs, symptoms and courses of diseases of the central and peripheral nervous systems," Fogan says, "but he also understood them well." Indeed, Fogan argues, "Shakespeare could have been a Renaissance neurologist." So careful and complete has been Fogan's research in support of chis contention that he has won widespread recognition from neurologists and Shakespeareans alike.His paper, "The Neurology in Shakespeare," won the American Academy of Neurology's j 32 7 Lawrence C. McHenry Prize in the hisrory of neurology. The study, which examines references ro neurology in32 of Shakespeare's 3 7 plays, not only impressed neurologists, but also attracted the attention of the Los Angeles Daily News, the Washington Post, the Chicago Tribune and KABC-TV in Los Angeles, which invited Fogan to appear on a health series. Fogan's work has also piqued the curiosity of the venerable Folger Shakespeare Library in Washington, D.C., which has expressed interest in having him make a presentation. "Shakespeareans from all over the country wrote co me. Even my mother read about it in Florida," Fogan says. Fogan attributes the widespread interest to the universal appeal Shakespeare holds and the endless curiosity about his life, his sources, his works and his influences. In the Los Angeles area, where Fogan lives, there aregroups of Shakespeare devotees - "geologists, newspaper critics, lay people," Fogan said, who meet to explore different approaches to reading him. While Fogan is pleased with the SPRING 1991 �14 reception to his paper, he is modest about chinking, ideas, motivations, fears. Anhis own contribution to Shakespearean thropology gives one a perception of how studies. There are over 700 references to all of chose facets of a human being demedicine and psychiatry in Shakespeare's velop. The knowledge of the body plays, Fogan says, and other researchers biology and anatomy - is one thing; but have gone over some of the terrain . He in making the person accept your diagnocites studies on Shakespeare's knowledge sis, your ideas about causes, testing and of chest diseases, obstetrics, gerontology, treatment, the physician needs to be able ped iacrics,rheumatology, orolaryngology, co understand the who le person. radiography and dentistry, plus countless "Shakespeare and literature heighten analyses by psychiatrists. But Fogan's study highlights a dimension of Shakespeare not fully recognized before - Shakespeare's breadth of knowledge of medicine, the accuracy of his observations of neurological signs, symptoms and diseases and the appropriate use of this knowledge co depict his characters. "The fullness and accuracy of Shakespeare's observations of behaviorcannot be overemphasized," says Fogan. Or overadmired, as the vo lume of Fogan's mail from Shakespeareans all over the country would seem to testify. Fogan's interest in Shakespeare, he expla ins, grew out of a life-time Lonee Fagan, M.D. , '65 interest in anthropology. "When I was an undergraduate at UB, I wanted to be broadly educated. I my awareness of certain aspects of human knew I cou ld meet the science require- nature and help me to recognize the huments for medica l school without having manity around me, giving me a new to major in a science. What I really wanted awareness of motivations and feelings and to study was mankind, so I decided to helping me to perceive, absorb and share what other people are feeling," Fogan major in anthropology." says. Though a pre-med student, Fogan Fogan became seriously interested in found encouragement for his interests from anthropology professors Henry Lee Shakespeare in the summer of 1977, when Smith Jr. and David Stout. The advisor to he spent a three-month study leave in London and was able co make weekend pre-med students, Roger Gracwick, thought his interest in anthropology co be visits to Stratford. Upon returning, he a fine, if unusual, foundation for medical enrolled in a night course on Shakespeare at the local community college - the studies. Looking back, Fogan values the for- College of the Canyons in Valencia, mative liberal arts education he received California - which offered a six-year course covering the complete plays and ::tsa UB undergraduate. "My backgrou nd in anthropology and poetry. Fogan faithfully attended for all linguistics served as an excellent founda- six years. "I started to notice the double vision, tion for me as a physician. A physician's primary responsibility is working with the dementia, the headaches occurring so people and trying to understand a person's frequently in the plays, and I began co SPRl1'G 1991 takenotes,"Fogansays. ln 1987,asoucgoing president of the Los Angeles Society of Neurology and Psychiatry, he used the occasion of his final address to present his research on Shakespeare. le was so well received that he expanded it into the prize-winning paper. Since that presentation, the paper has been published in The Archives of Neurology(August 1989) and in The New Scientist, the British equiva lent of ScientificAmerican, under the tide "The Neurologist of Avon" (January 1990). le was also presented for a medical benefit at the Old Globe Theater in San Diego (where Fogan appeared in Renaissance costume for the occasion), at the Institute of Neurology of the National Hospital, Queen Square, London and for the UB Medica l School's Department of Neurology in 1989, as part of the annual lecture series. In 1983, Fogan established the Edward Fogan Lectureship/Prize in Neu;!; rology at UB in honorofhis farher. 0 ~ Fogan enjoys balancing his lit< erary interests with his professional 0 responsibilities as chief of the Department of Neurology of Kaiser Permanente Medical Center in Panorama City, Ca lifornia, and assistant clinical professor of neurology at the UCLA School of Medicine . His research interests include cluster headaches and atypica l mycobacceria, a subject he studied for his M.P.H. (Unive rsity of Oklahoma School of Public Health, 1968). His other research in the history of neurology includes a study of John Cheyne, the lace 18th-century Scottish physician and one of the founders of child neurology . Among his many interests outside medicine Fogan includes windsurfing and cooking. But history and literature are his special loves. An<l what is he planning next? "Well, I've been reading Keats with special attention since my last visit to England. And then there's the Bible. I cook a course in literature and the Bible, and found a lot of passages of special interest co physicians there." • ! i BUFFALO PHY~ICIAN AND l\lOMEOICAL SCIENTIST �1\le Ji cali 01seiryaf i ons firom a R en&-issa irn.,c e l.\'lan "Shakespeare might have been a neurologisc. .. he was so good at ir ...His wonderful descriptions and delineations in this great field of our science shows that he had thoroughly mastered the subject in all its branches." The preceding quote is from O.W. Owen's 1893 medical journal "The Medicine in Shakespeare." And while this may have been the first word on "Shakespeare as Neurologist," certainly the current, dominant work on neurological references in Shakespeare belongs to UB alumnus Lance Fogan. His award-winning paper, "The Neurology in Shakespeare," supports Owen's recognition by noting and discussing the various observations, symptoms, signs and disease states of the nervous system that appear in Shakespea re's 37 plays and poetry. Fogan points out that "Shakespeare's works are replete with information and references of particular interest co physicians." The following has been excerpted from Fogan's masterwork: OntheNeurological Complications of Syphilis: The "pox," referring to the venereal disease, is mentioned in many of the works. It became known in Europe in about the year lSOOA.D."Timon of Athens,"which was written sometime between 1604 and 1609, contains many references cosyphilitic symptoms. Timon shows a marked personality change himself; he initially is a cultured and prominent Athenian leader. As the play proceeds his intellect pathologically weakens and at the conclusion he is angry and violent and as his steward Flavius cries out, "a ruinous man .. .full of decay ... " Evolution of a syphilitic into a pare tic clement, I offer in pointed speculation. I\UFF.-\LO PHY,ICl.-'.l--AND lllO MErnL AL S<.'18': Tl~ Of special interest, which again emphasizes Shakespeare's power of observation, are symptoms included in Timon's malignant tirade directed at two prostitutes. He encourages them to give them (men) diseases "and co cause lawyer's voices to 'crack."' Tertiary syphilis can cause aneurysms of the ascending thoracic aorta which can compress the left recurrent laryngeal nerve and paralyze the left vocal chord; this clinical entity is known as "prostitute whisper." Is this what the Bard described, or was it gummas of the larynx which could result in the ninth part of a sparrow." A locus for the foundations of memory appear in "Love's Labor's Lost" IV,2,66: "These are begot in the ventricle of memory, nourished in the womb of pia macer. .." Nearly 400 years later can we be that much more precise in "locating memory?" OnSciatica: One of the several references co this affliction is offered by the "deformed and scurrilous Greek" Thersites in "Troilus and Cressida" V,1,25, as he includes sciaticas as one of the "rotten diseases of the hakespeare was not only acquainted with the signs, symptoms and courses of diseases of the nervous system, but he understood them well. same symptoms? In IV,3,153: Timo n"...Crack the lawyer's voice,/ That he may never more false title plead/ Nor sound his quillets shrilly ..." Tabes dorsal is is the neuropathologic form of the disease responsible for the lightning-like pains in the extremities, and for impotency, which also did not elude the great author. In IV,3,152: Timon"...strike their sharp hins and mar men 'sspurring ...Plague all/That your activity may defeat and quell/The source of all erection ..." OnNeuroanatomy: Shakespeare shares with us his awareness of some neuroanatomy in mentioning pia mater, which in Eli:abechan England referred not only to the membrane covering the brain but also to the brain itself. In "Twelfth Night" 1,5,108 the clown says " ...whose skull Jove cram with brains, ...one of thy kin has a most weak pia mater." In "Troilus and Cressida" Il,l ,66 Thersites exclaims "I have bobbed his brain more than he has beat my bones ...an<lhis pia mater is not worth the south" (i.e., of the southern end of the body). Results of treatment of sciatica must have been frequently disappointing in Shakespeare's day, just as today, for Thersites expounds " ...sciaticas, limekilns i' the palm (or arthritic calcifications), incurable bone-ache ..." Again, in "Timon of Athens" IV,l,25: Timo n"...Thou cold sciatica,/ Cripple our senators, that their limbs may halt as lamely as their manners! ..." On"Extraordinary Measures'': How current his ideas are, even though they were written almost four centuries ago. In 1988, as we minister to our poly-intubated and venrilarory-assistcd patients in incensi,·e ca re units, as we sometimes agoni:e over the appropriateness of our life-prolonging activities, the Bard of Stratford-Upon-Avon admonishes us, as did Kent in "King Lear" V,3,314: "Vex not his ghost. 0, let him pass! He hates him/That would upon the rack of this tough world/ Stretch him out longer." • SPRING !WI �f.l FFALOMn, OAS A'-D Ill MEDICAL"'-""IL'-"Tl'• �• 17 or nearly 20 years, physicians in New York Scace have grappled with the problem of malpractice insurance. Now, chat is changing for full-time faculty physicians and dentists ac four SUNY Health Sciences Centers, thanks co an innovative new insurance company the faculty formed itself. The new company, the Academic Heal ch Professionals Insurance Association (AHPIA), is the only one of its kind now operating in che United Scates, according to its chairman, William P. Dillon, M.D., associate professor of gynecology-obstetrics at UB and chief of the division of maternal/fecal medicine at The Children's Hospital. AHPI/\ began issuing binders in January of chis year. Dillon, who was instrumental in spearheading the development of the company, noted that New York State's malpractice insurance crisis of 1973 began the chain of events that eventually led co the AHPIA's formation. The early 1980s saw malpractice insurance for New York State physicians targeted specifically at full-time University faculty. With their lower exposure and, as state employees, indemnification under Public Officers Law 17, full-time facu Icymade an attractive market, Dillon said. Indemnification under state law, however, has not been interpreted as such by the state's attorney general, leaving SUNY faculty physicians and dentists potentially at risk as the issue is tested and appealed in the courts. In 1986, as part of the United University Professions state contract negotiations, a Labor Management Committee was formed to investigate the availability and feasibility of self-insurance. "The labor-management group concluded it would be to the faculty's benefit co form our own captive insurance comBUFFALO PHYSIC IAN ANO BIOM EDICA L SCIENTI ST licensing of AHPIA. AnewSUNY programformal The company, in the short time it has operating, is doing very well. "More insuresfacuity been and more faculty are joining us. this company as safe or physicians & dentists safer"Wethanmade any other out there," Dillon said. "The New York State Insurance ACADEMIC HEALTH PROFESSIONALS Department is not going to license us if INSURANCE ASSOCIATION FACTS they think we're going to fail," he added AHPIA: • Isa reciprocal insurance company. • Is operated by a board of d ireccors made up of representatives of the medical centers, dental schools and United University Professions who are also subscribers. • Offers both occurrence and claimsmade policies. • Handles all claims occurring from private clinical practice as well as those occurring from a faculty member's employment. pan y," Dilion said, noting the group based its conclusions on two main premises: that the insurance be available only to full-time faculty in the practice plan and that those faculty who joined the company would benefit in the form of lower premiums and, in time and with the approval of the state insurance department, the realization of dividends. Through the efforts of a steering committee of dentists and physicians from the four medical schools and two dental schools and support from the deans, the initial capital was raised. Reinsurance by Lloyds of London, cogether with that raised capital, met all capital obligations under state regulations. "After that," Dillon said, "we submitted our application for a reciprocal insurance company to the Scace Insurance Department," in a process that would culminate over two years later with the In developing this company, he said "we made sure it has belts and suspenders." The Academic Health Professionals Insurance Association writes both occurrence and claims-made policies. Occurrence policies are those that cover incidents occurring during the policy year without regard to when a claim is filed and are available only to physicians and dentists currently holding them with their present company. Claims-made policiescoveronly incidents that arise and are reported during the policy year, but extend back to any incident since the inception of the insured's first claims-made policy (retroactive date). By law, physicians and dentiscs who now hold claims-made policies, as well as those subscribing for the first time in New York Seate, are required to purchase claims-made policies. Dillon stressed that besides the potential for dividends and the benefits offered by self-governance, AHPlA has selected specialist attorneys and would encourage subscribers in the same specialty from other SUNY sites to act as expert witnesses. Its philosophy is co work closely with SUNY Central, the faculty union and the state's attorney general co develop guidelines for the division of responsibility co defend and indemnify losses. "This is a company by and for the faculty," Dillon said, adding, "This is pioneering work. We're taking a problem and responding to it." • SPRING 1991 �Ediwr's Note: Followingare excerptsfrom an articleby RichardV. Lee, M.D. publishedi;ntheMay 1990Journal of Clinical Epidemiology. Lee, a professorof pediatrics and cwUunctprofessorof anthropology,is basedin theDepartmentof Medicineat The Chilclren'sHospira!of Buffalo. n exquisite Van Gogh painting is played at the Albright-Knox Art Gallery in Buffalo. The 0/cl Mill was completed in 1888, two years before the artist's death and over a century before the composition of chis essay. There is nothing medical about it; no earless, demented, bandaged or sick people; no hint of plague fears, no angst . Rather it is a welcoming, friendly landscape, full of warmth and color. It is about two feet square, a cozy painting, incense, arresting . 1am unable to walk along the gallery corridor in which it hangs without stopping. Dissecting my affection for Van Gogh':; painting, or any painting for that matter, probably seems clinically obscure for young modem physicians schooled in "hard science." Van Gogh, I admit, does appear a bit removed from biostatistics, magnetic resonance imaging, coronary angioplasty an<l DNA probes. Aesthetic sensibi1lity,however, ought not co be excluded from clinical medicine. Indeed, how doctors perceive and appreciate art is not merely significant. I maintain that a well-developed aesthetic sensitivity, an awareness of beauty and of ugly, is clinically essential. Physicians are caught not to regard their patients as beautiful creatures, but as creatures to be dissected, poked an<l observed with suspicion . The idea of the human bo<ly as a work of art smacks of religion; that the manifestations of illness might be considered aesthetic seems callous and disrespectful. Art can be triv iali:ed. Medicine is coo serious and too scient ific for such antics. Medicine is too real to be contaminated j $PRING 1991 •►lriiiMIP or distracted by the ethereality of arc. Still, the mythic "art of medicine" continues to circulate and to remind us of a more complete, perhaps humane, medicine. And medicine without aesthetic sensibility and sensitivity is transformed into a kind of neutral tinkering: routine, colorless, boring. Viewing Van Gogh is more than a dissection: individual brush strokes, individual colors combine into a comprehensible whole. The painting reaches out, sei:es my eye and captures my attention. There is immediate comprehension, instantaneous intuition, active awareness. Perhaps it is this intuitiveness that makes physician-scientists so suspicious about introducing notions of art in clinical activities. Yet my comprehension of the nature of a patient's misery is no less intuitive. Examining a patient, looking at a painting, listening co music, share a sense of being possessed, totally engaged, intuitively immersed in the object and the ace of observation. Clinical medicine and looking at a painting unavoidably include my personal interpretation of symbols and symptoms. Boch activities require a storyteller patient or storyteller artist, visual intimacy, time and me. The clinical picture is a unique blend of the patient and the physician: both acting as artist, observer and viewer. The pat ient 's description of che intensity of pain is colored by fear and anxiety, the hope chat this is "just something minor." The doctor's relation of the description and clinical interpr etation is colored by the "fit of the story;" does the pain I\UFFALOPHY~ICIANA"l() BIO~tEL11CAL --C:IENT!ST �19 has more to do with ways of knowing as opposed to ways of doing, with intuition not with technique, with episteme, not f t praxis. match the events and the findings on examination, is the patient asking for relief of something other than pain? Clinical truth, like a Van Gogh painting, is a composite. Master physicians do more than master the craft of medicine. They use it in waysthat inspire, that expand our knowledge and our vision. One connection between art and medicine is epistemologic. Both depend upon intuition, the nonquantitative apprehension and comprehension of beauty and of ugliness. Art proclaims its intuiti\'eness; modem medicine attempts to camouflage it. Van Gogh uses blues, yellows and greens to make a verdant, fecund sensual image. A patient tells me ofarthralgias, allergies, abortions, bruising and photosensitive skin chat has malar telangiectasia and atrophy. Even before the confirmatory laboratory tests have been taken I can tell her I have her clinical picture, a diagnosis. Van Gogh's Old Mill is stunning. My patient's lupus erythematosus is stunning. But different artists, different patients and different physicians can make different pictures of identical scenes and diseases. Our notion of disease and health is the same. The clinical expression oflupus erythematosus varies from patient to patient, the clinical picture is shaped by the powers of description and observation by patient and doctor, but we do not doubt that there is a fundamental biologic disorder that generates the disease, the clinical picture. So the affinity between me and Van Gogh, between my medicine and his art, Academic medicine devotes enormous amounts of energy, time and verbiage to the praxis of medicine: the design and statistical evaluation of experiments and experience, the performance of delicate surgery, obtaining and preserving anatomically precise, computer-enhanced images, the definition and imposition of what is called "quality control." The officiously objective burdens of utilization review and quality assurance ask only about technique and outcome. They do not ask about intuition or interpretation. Compassion and comfort, beauty and joy, are not concerns of "quality control." More importantly, those moments of exhilarating, humbling clinical intuition are not concerns of medical educators and administrators. Because it eludes measurement by standard scientific, statistical studies, clinical intuition is nor taught, or even talked about. We assume it is a gift, an endowment students bring to medicine, not something we teachers impart to them. Despite my lamentations, contemporary medical education works. Perfectly adequate doctors are produced ... never having attended a symphony concert or strolled through an art gallery. Why bother about Van Gogh's Old Mill or Lewis Thomas' LateNight Thoughtson Mahler's Ninth Symphony? Because without them medicine is ugly. And without intuition, and beauty and ugliness, without art, what I do wouldn't be medicine at all. Reprintedwichpemiissionfrom The Journal of Clinical Epidemiology, Volume43, RichardV. Lee,M. D. , TheClinicalPicwre,Co/J)'righr1990, PergamonPress, Inc. SPRING 19'11 ���sawacauliflower earinanybody -= I never --- butawrestler. Sore shoulders and elbows a.> '--' 22 cs a.> E common ailments inpitchers. c:s are ..... a.> -= a.> C:S> ---= -c:s = -= c:s E -= C ~ "There is no place like this in Western New York," says Edmond J.Gicewic:, M.O., of the 13,000square feet of space in Farber Hall that houses UB's new Sports Medicine Institute. The innovative program on the South Campus is designed for the specialized management and treatment of athletic injuries. A joint effort between the UB Medical School anJ the Division of Athletics, it operates under the aegis of the Department of Orthopaedics. Gicewic:, an assistant professor of orthopaedics at UB and the University's team physician for 25 years, says the lnstitute's mandate is three-fold - education, service and research. Its benefits, he adds, will extend to the Western New York community at large. The Institute brings an extra dimension to the practice of sports medicine in the region. Assembled under one roof are all the personnel and facilities necessary to treat athletic injuri es on the spoc: physicians experienced in sports medicine to examine and diagnose, X-ray and casting rooms, physical therapists to supervise recovery and $300,000 worth of rehabi Iitation equipment co help the athlete return co playing form, including a motion laboratory, a $52,000 Biodex machine that assesses range of motion via computer and whirlpools for partial and whole body hydrotherapy. It also offers the University's Athletics Division the quicker anJ more extensive care to its athletes it will require for the planned move m Division ]. As an educational facility, the Spores Medicine Institute is a training ground for students in various specialties who need experience treating athletic inju ries. "We have family practice residents come through so they will know how to handle these things if they are the only physicians in a small community . We hope to rotate our orthopaedic residents through as part of their training. We may have some surgical residents. We will have medical sru<lenrs, nursing students, physical therapy students, athletic trainers," Gicewic: notes, ad<ling, "Athletes sustain many ailments not seen in general me<licine. I never saw a cauliflower car in anybody but a wrestler. Sore shoulders and elbows are common ailments in pitchers, and there's jumper's knee in basketba ll." The lnstitutc's founders, which include Robert Gillespie, M.O., chairman of UB's Deparnncnr of Orthopaedic Su rgery, who pressed vigorous ly for the facility, hope to set up a fellowship in sports medicine to round out the teaching component . Service is the broa<lesr and most public of the lnstitute's mandates. Any person injured in any sporting activity- in competition or personal recreation may come to the Institute for care. Patients are charged a fee for service, as at any other clinic. Although treating people who get hurt participating in sports is not the lnstitute's sole reason for existing, tending coathletic injuries is the its most imme<liate mlc, and UB's athletes were the first to benefit. HeaJ athletic trainer Mike Rielly, who is also program coorJinator for the Institute, works with the athletes <laily. For him the Institute is a tremendous as·er. It provides professional care of the highest quality immc<liarely. During football season, for example, the Institute remained open much of the weekend to rend to high school and college players hurt during Friday anJ Saturday games. Time is critica l nor only for rhe athlete's comfort but for proper assessment of an injury, Rielly says. "If an injury is acute, the quicker it can be evaluated, the better the chance of proper diagnosis. Some signs can be masked if the injury is a llowed to sit for an exten<led perio<l." The Institute also conducts an outreach program for high school athletic trainers, and sponsors symposia for high school coaches in various sports. The research arm of the Institute will study new ways to treat certain ailments for which current treat- Rt.:FF:\LO PllY~ICl:\N :\N[) RIOMEnlC..\L SCIENTl~'T �23 ment is considered inadequate, and take on other projects. One of its most ambitious goals is to establish an injury registry for Western New York's young players. "Every h igh schoo l athlete who gets hurt will fill out a rather detailed form telling how the injury occurred, what the acti\'ity was, whether the field was wet or dry, whether it happened on Astroturf or grass, and when during the game it happened," notes Gicewic:. "We will put all this information into a data bank and study it so we can eventually draw some conclusions." Gicew ic: is pleased with the response the Institute has garnered so far since it opened last August. "We are getting patients from Barker, Medina, Jamestown, Ellicottville. We are seeing a lot of people from all age groups and all walks of life. I think the Institute will be really helpful to the Western New York community." • BUFFALO PHYSICIAN AN[) BIOMEDICAL SCIENTIST Assembled under oneroofareall thepersonnel andfacilities necessary lo treatathletic injuries onthe spot. SPRING l9<ll �24 • ua1 Alvan Feinstein callsfor the creation of a new basic science. By Laurie W Wo I f e hen patients arc diagnosed with a disease, they want to know how it will affect their lives. Will they be able to work, to drive, to parent the1rchildren?Will rhe pain stop? When? And patien~ aren't the only ones looking at chose kinds of questions. In this era of declining economic resources, with its concomitant soaring medical costs, economists and insurance companies are concerned with cost/risk/benefit ratios, noted Alvan R. Feinstein, M.D., when he delivered the 1990 W. D. Harrington Lecture lase October. The distinguished professor of Yale's Department of Medicine and director of its Clinical Epidemiology Unit noted chat if clinicians are co offer evitlence of benefits w the quality of life of their patients they must have a coherent way of describing, measuring and quantifying even simple things like "being able w breathe comfortably" or"beingable to walk without pain." A life may not have been s rRIN l, ! <NI extended by a procedure, but perhaps that life's quality has been measurably improved for the patient. "The current challenge," Feinstein noted, "is in mensuration and quantification. We need a language for drawing fair and relevant comparisons, for example, for the severity of an illness, for relief, for comfort. We must create models that fit the observed phenomena, rather than forcing clinical events into models chat may not be appropriate." Part machematic ian, part philosopher and part provocateur, Feinstein is renowned as thoughtful critic of the established doctrines and practices of clinical medicine. His capacity to "stir things up" was admiringly noted by James Nolan, M.D., professor and chair of the department of medicine, as he introduced Feinstein to an audience of UB faculty, alumni and students. Attending the University of Chicago, Feinstein earned a master's degree, and, in 1952, a medical degree. He trained in internal medicine at Yale and the Rockefeller Institute. After five years as a faculty member at New York University, Feinstein returned to Yale where he has remained except for a two-year visiting professorship at the 0eparcmencofClinical Epidemiology and Biostatistics at McMaster University, Montreal, Canada. Feinstein's lecture was peppered with humor and insight, focusing on the inadequacy of "basic science" to assist practicing physicians in making decisions about managing disease. He urged creative thinking to develop "an additional basic science for observing, quantifying and comparing clinical phenomena" to fill that gap. Feinstein noted that basic science presents two very different challenges: to explain phenomena and to intervene upon chem. The latter is the realm of the practicing physician, who predicts how to manage the phenomena . Feinstein predicted that the clinical observations of practicing physicians will become more important as medical care becomes more expensive and the competition for research dollars increases. While the last century has seen tremendous advances in technology and experimental methods that benefit explication, Feinstein said, "in general, clinicians have not developed a set of basic scientific strategies for making and eva luating managerial decisions" about the prevention and treatment of diseases. As a result, "controversies and doubts regarding the optimal usage, benefits, risks and costs of technology exist at BUFFALO PHY~ICIAN AND BIOMEDICAL SCIENTIST �2S u 5 t every level of clinical decision-making, from the care of a newborn to the care of the octogenarian, from the care of the common cold to the care of a patient with disseminating cancer." In the past, rhe biomedical paradigm has generally been the search for "hard data," obtained wirh a subject or specimen that is preservable (so as ro be reexamined). The results are usually expressed in dimensional terms, and the measurement procedures are objective and made preferably by machine. Absent from the literature on therapy arc what Feinstein referreJ to as "soft data," descriptions of human beings and human life made by natural observation in clinical practice. Soft data, he cautioned eloquently, have a great effect on good clinical decision-making. They are "the crucial harbingers of prognosis. Without soft data we cannot achieve scientific reducibility and identify the people under treatment. BUFFALO PHYSICIA1' AND BIOMEDICAL SCIENTIST a 0 n 5 8 "Does it matter if a congestive heart failure consists of some relatively mild peripheral edema, or whether the patient is gasping with pulmonary edema? Of course, it:does . And yer congestive heart failure, as one part of spectrum of coronary disease, is often described without those distinctions." In arnother example Feinstein remarked rhat cancer studies often fail to distinguish between patients labeled "inoperable .." The category may combine people who will not tolerate surgery and people wlhocould tolerate it, but refuse it. Feinstein challenged his audience to create indices and rating scales to identify clinical phenomena and, in effect, "harden" soft data. In need of indexing are such phenomena as different types of symptom.s within the spectrum of disease, rhe severity of those symptoms, rhe chronometry of the symptoms' manifestations, rhe auxometry (rate of progression of the ailment), rhe co-morbid asso- y T m L e e ciated ailments, rhe reasons for diagnostic or therapeutic decisions and the reasons for a patient's functional limitations. While praising the value of randomized clinical trials in remedial therapy, Feinstein stressed they are not adequate "in an era of burgeoning technology and unstable therapy." High costs, cumbersome logistics, lengthy study durations and the great number of subjects required make randomized trials impractical in prophylactic therapy, especially where the goal is to prevent the adverse progression of a present disease. "It is our job as clinicians - nor rhe mathematicians, statisticians or computer experts - but our job to develop an observational substitute for randomized experimental trials in cause and effect reasoning. If we don't do it, it won't be done, or it will be done badly by people who don't understand the problems." • Sl'Rl1'G 19~1 �---------------------- - ~ ~ ~ I ( ~~ ---------------------- .,. r /f 0 <) 26 The Greying of Medicine David W. Bentley, M.D. 's Mandatefor the 21st Century D avid W. Bentley, M.D., has set an ambitious goal for himself as the new head ofUB's Division of Geriatrics/ Gerontologyto help prepare the University community for the major health issue of the 21st century - health care for the aging. "Geriatrics and long term care is the name of the game in health care today," said Bentley. "TI1e next 25 years are going to be focused on these two domains. The typical health care community and university community have nor been interested in these two domains, ever." Since assuming his position September l, Bentley has sought to make UB an exception to that rule. One month into 1991, he and his colleagues had already submitted four major research granc proposals dealing with issues affecting the elderly. Two have already been funded. In addition to his position as profe ·sor and head of geriatrics, Bentley also serves as director of the University's Multidisciplinary Center on Aging, co-director of the Westem New York Geriatric Education Center and chief of the Geriatrics Service at Buffalo VA Medical Center. He was recruited to increase the research activities of a division already strong in clinical affairs and education. Even before moving into his offices in Beck Hall and the VA Medical Center, Bentley was busy convincing 19 senior faculty in several disciplines to gear their research in progress toward problems of the elderly and to accept postgraduate fellows in gemmology to work along with them. The effort culminated in a $259,200 grant proposal cothe National Institute on Aging which, if approved, would set the University on an ambitirn.1i; course of incorporating age-related research and education throughout the University's disciplines. Bentley came ro gerontology rather late in his career. A graduate of the University of Rochester Schtx)l of Medicine and Dentistry, he took his residency in internal medicine at Vanderbilt University Hospital and did postdoctoral work in infectious diseases at the University of Illinois. After a two-year appointment at the University of Manitoha, Bentley returned to Rochester in 1972 to head the infectious tliseases unit at Monroe Community Hospital, known intemationally for its work in geriatrics. He remained there until coming to UB. He was abo an associate professor of medicine at the University of Rochester's School of Medicine and Dentistry. Bentley became a specialist in geriatrics "by osmosis," he said . He worked closely with its medical director, D. Franklin Williams, now director of the National Institute on Aging. His expe riences at the Rochester hospital convinced him to change his career and hi~ research to focus on the elderly. When the first boards for certifica1ion in geriatrics were offered in I 987, he took them and passed. Bentley said the move into geriatrics was prompted by his own inclinat ions and a look into the future. "For anyone in healrh care, the demographics were very clear," he said. "The most rapidly growing segment of the United States is 85 years of age and older, and the population 65 and over is also growing very rapidly. The epidemic of Alzheimer's disease, for examp le, is much more serious, much larger and more costly than the epidemic of AIDS." Bentley and his sraffhave already scored some successes in steering the University toward the concerns of an aging population. One of his plans for the future is to attempt codevelop a cadre of researchers outside the Center who will apply for and receive funding from major grant-giving organizations such as the National Institute of Aging. "There are only a handful of people at the University now who have those types of awards," Bentley said. He credited the cooperation of his colleagues across the University for the accomplishments of the Division and the Center so far. "The problem chat one has in academics," he said, "is that you have to be good in teaching, good at research, you arc expected to beexemplary in patient care and to be a very good administrator. That is a very difficulr chore for the average person. Without so much support around me, we could nor have achieved all we have in these few months." • - B)' Lois Baker llUFF:\LO PHYSICIAN A:-.111 llll'MEl11CAL !'CIE.Vfl~ �----------------~@~ () ('" If Davidw.Bentley,M.D., (above): ... I ( ~~-- "' ---- -- -------- 0 "The epidemicof Alzheimer'sdisease' for example,is much moreserious,much largerand more costlythan the epidemicof AIDS." BL:FFALO PHYSICl.·\N ~ND BIOME[)IC.~L SCIENTIST SPRING 1'/<ll �--------------------- ~~~I C~ ~--------------------.,. .... (" II o I) 28 The High Expectations of Eddie Hoover New Surgery Chairman Plans for the Future <ldie L. Hoover, M.D., new chairman ofUB's Department of Surgery, credits two people with helping him get where he is today: a college professor who sent him on the right path and a surgeon who inspired him to follow it. "I didn't have any idea about becoming a surgeon," said Hoover, a native of Charlotte, N .C. "I went to college to get away from farming." Hoover chose pharmacy as his major when he enrolled at the University of North Carolina at Chapel Hill, because he knew what pharmacists did . A sophomore history teacher, seeing Hoover's grades, suggested medicine instead, and introduced him to the clean of Duke University Medical School. "My idea of a physician was ro go somewhere where you were needed, open an office and treat patients," sai<l Hoo\'er. "Even when I was looking into medical schools, there were no black specialists." But he eventua lly enrolled at Duke, where rhe emphasis was on turning out people who would stay at medical schools, teach and do research. There, Hoover lancle<lby accident under the tutelage of Paul Ebert, M.D., a dedicated surgeon who woulJ have a lasting influence on his life. "He operated on children's heart s," Htx)Versaid. "I thought that wa~the most exciting thing a per ·on could do in life. I decided I was going to do it if I had to beg, borrow or steal." E "I get fairly immediate gratificationfrom what I do. A person's appendix hurts , I take it out. I like the fix-it approach." As luck would have ir, surgery suited Hoover's personality nicely. "I get fairly immediate gratification from what I do," said Hoover. "A person's appendix hurcs, I take it out; a person has lung cancer, I cure them, rather than readjusting pills because somebody's blood pressure is out of control. 1 like the fixit approach." Hoover did his internship with Ebert at Duke University Medical Center, and when Ebert left Duke for Cornell University Medical Center, Hoover followed. He completed his residency and thoracic surgery training there and at MemorialSloan Kettering Cancer Institute. He went on to hold academic appointments at SUNY-Downstate Medical Center anJ Meharry Medical College in Nash\·ille, as well as Cornell. He has served on the surgical staff of New York Hospital, Kings County Hospital and State University Hospita l, all in New York City; VA Medical Centers in Brooklyn and Murfreesboro, Tennessee; Woodhull Medical and Mental Health Center in Brooklyn and G.W. Hubbard Hospital in Nashville. Hoover assumed his UB position and was named chief of surgery at ECMC on September I. He also is continuing his research, which currently centers around the role of prosraglandins in gall stone formation and hypertens ion and kidney damage in heart transplant patients. The new head of surgery has several goals for his department. "First, we must continue to provide the highest quality patient care, and make sure all the new technology that is safe and makes sense is available to people in Western New York," he said. "Second is resident education. We must provide the kind of training programs that allow us to attract the highest quality residents." His third goal is to make UB preeminent among major public universities, he said. "We need to rum out excel lent physicians and academicians, so we can hold our own in the scientific field." The drive char pressed Hoover onward to success as a surgeon surfaces when he speaks of his plans to move UB toward new surgical frontiers. BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �----------------------- ~e~ - I ( ~~ - .;, (' If ~ ------ ----------------- 0 29 EddieL Hoover , M.D. "We need ro start doing lung transplants," Hoover said. "We have approva l from the state but we haven't gotten it starred . We need to move into more laser applications in medicine. Ten years from now, a lot of what we do in surgery will be replaced by laser techniques." Preparing for that inevitability, Hoover lll.:FFALO PHYSICIAN AND BIO~!EDIC.-\L "l"IE.'1Tl!-T has established a study group with the physics and electrical engineering departmen ts to develop appropriate laser research projects. To improve the teaching of surgery, Hoover wants to incorporate the newest audio-\'isual techniques. "The new equipment is so good you can see a lot more watching a TV screen focused on the field than by standing at the operating table," he said. "Now, some students may stand there for six hours and hardly see anything. "We're going to start that by July," Hoover said. "All I need is $30,000. Somehow I'll get it. • - B)' Lois Baker ~l'RllsG 1991 �----------------------~@ - ~I r~~------------------- .,. r /( 0 - -- I:> 30 UB PHYSICIANS USENEW PROCEDURE ToSAVE GEORGIA POLICEMAN rill wearing an eye parch to stave off double vision, a Savannah, Georgia, police officer thanked God and "the doctors in Buffalo" for saving his life after he was shot in the head pursuing a shooting suspect in early March . G. Scan Freeman, 28, was investigating reports of domestic violence in Savannah when the shooting occurred . Fifteen days later, Freeman was airlifted co Buffalo to undergo an expe rimental procedu re in which "micro-bal loons" were placed in his internal carotid artery to keep him from bleeding co <leach. The procedure was performed by L. Ne lson Hopkins, M.D., chair of the Department of Neurosurgery and chief of neurosurgery at Millard Fillmore Hospital. Hopkins use<la micro-catheter co place the silicone micro-balloons co occlude a bu llet-damaged section of Freeman's left carotid artery. "The bullet tore open the left caroci<l artery ... and penetrace<l the upper part of the nasal cavity, where it came co rest" allowing blood co escape out the nose and th roat, Hopkins said. A clot surrounded by soft tissue formed, temporarily closing the com artery, but creating a potentially lifeth reatening situation. Usually, Hopkins said, "the clot will dissolve and the arte ry would again begin hemo rrhaging. If chat happened, I th ink he likely would have bled to death." Freeman's Georgia physic ian recalled that UB neurosurgeons were using to coronary a technique similar angioplasty co prevent an<l treat stroke. T he new technique, however, uses miniaturized catheters and balloons to ac- S srRINU19'11 Top,G.StanFreeman andhiswife,Nancy,lookat X·raysandangiograms of hisskull.Bottomleft,a leftlateralinternal carotid arteryangiogram showsshrapnel scattered adjacent to thetornarteryand thebulletlodgedinthesinus.Bottomright,a lateralskullX·rayal theballoono«lusionwitharrows marking thethreeballoo ns inthe internal carotid. commodate the finer vessels in the bra in. In a four-hour procedure guided by X-ray images, with Freeman totally awake, surgeons th readed a tiny catheter through his femoral artery to the carotid. Hopkins then inflate<l three micro-balloons one primary and two backup- to occlude the tear. They will be left in place and eventually will be walled off by the body. The permanent occlus ion of the blood supply through the carotid will not affect Freeman, Hopkins ad<le<l,exp laining he has sufficient collateral circulation. The bullet will be left in place . The UB team performs about 100 balloon occlusions each year at Mil lard Fillmore Hospital, most designed to prevent stroke and intracerebral hemorrhage from arceriovenous ma lformations an<l aneurysms. The procedure is also used as an adjunct to surgery to de liver chemotherapy to or tie off the blood supply of tumors. The procedure was developed by Grant Hieshcmia, M.D ., professor of ra<liologyat the University of Ca lifornia at San Francisco, and lnrerventional Therapeutics Corp. It was first used five years ago. Nationwide, about 1,000 such surgeries are performed each year. • Bl.JFF,\L,1 rllYSl<:IAN ANDRIOMEnlCAL SCIENTIST �IJ "' 31 KASSIRER TOHEAD JOURNAL NEWENGLAND OFMEDICINE erome P. Kassirer, M.D., a 1957 graduate of the University at BuffaloSchool of Medicine and Biomedical Sciences, has been named the new editor-in-chief of The New EnglandJournalof Medicine. Kassirer will take over the helm of the journal in July, succeeding Arnold S. Reiman, M.D., who has served as edicor-inchief since 1977. He was named on Jan. 29 following an extensive worldwidesearch by a distinguished panel of medical leaders. J The New EnglandJournalof Medicine, published by the Massachusetts Medical Society, is the oldest continuously published medical journal in the world and is considered the nation's leading journal of medical research and opinion. "l am deeply honored and pleased to accept this position," Kassirer said. "Some of the most illustrious names in American medicine have brought great distinction to the pages of The Journalduring their tenure as editor. I hope robe inspired by their examples, and am ready co meet the exciting challenges that lie ahead." A specialist in nephrology and internal medicine, Kassirer is Sara Murray Jordan Professor of Medicine and vice chair of the Department of Medicine at Tufts University School of Medicine, Boston, where he has been on the faculty since 1961. He also is associate physician-in-chief ac the New England Medical Center, Boston. A Buffalo native, he attended UB as an undergraduate from I 950 co 1953, entering its medical school following his junior year. He received his medical degree magnacum laude. Since 1986, he has served as a regional member of the governing board of the UB Medical Alumni Association. Kassirer received several honors while ac UB, including the Freshman Chemistry BLFFALOPHY~ICIANANO lllOMEDIC.ALSCIE?\TIST Jerome P.Kassirer , M.D. , '57 Award in 1953 and the Bausch and Lomb Science Award in 1953. While in medical school, he was named co the Gibson Anatomical Society and Alpha Omega Alpha and in 1957 he was recipient of the C.V. Mosby Award and the Roswell Park Award in Surgery. He did his internship and served as assistant resident in medicine at The Buffalo General Hospital from 1957 to 1959. Kassirer has received national recognition for his work on diagnostic reasoning and therapeutic decision-making. He is considered a national expert in many aspects of clinical medicine, especially kidney disorders. Board certified by the American Board oflncernal Medicine, Kassirer is a member of che board of governors of the American Board oflncemal Medicine and the board of regents of the American College of Physicians, which named him a master in 1990. A member of the editorial board of The New England Journal of Medicine from 1972 co 1975, Kassirer is editor-in-chief of Ciment Therapy in Internal Medicine (3rd edition) and co-editor of Clinical Forum. He ProblemSolvingand Nephrolog)' has authored or co-authored more than 100 editorials, scientific papers, book chapters or case studies on various aspects of clinical medicine. • - ByArthur Page About300 guestsattended theMedical Alumni reception inhonorof the seniormedical doss,held 12inthe January 38thFloor Restaurant of the Marine Midland Center. �__________________ ____ ,,, :z:---------- ----- ----- -- 1., 32 COLLINS LECTURE TOUCHES ON ETHICAL IMPLICATIONS OF GENETIC RESEARCH s researchers unravel the mysteries of human genetic makeup, society must start making decisions about how chat knowle<lge will he shared and app lied. That's the opinion of Francis S. Collins, M.D., Ph.D., associate professor oflncernal Medicine and Human Genetics and chief of the Division of Medical Genetics at the Howard Hughes Medical Institute, University of Michigan at Ann Arbor. Collins spoke to more than 100 physicians, researchers and others interested in genetics on March 26 at Buffalo's Hyatt Regency Hotel. Internationally known for his contributions to recombinant DNA technology. Collins was the inaugural speaker for Children's Hospital's Rose and Al Pastor Lecture Series. "DNA is an elegant scheme for storing information," he said. "Every genetic disordercan be traced tosomethingwrong in the DNA." Collins reiterated his work on isolating Lhe gene for ncurofibromatosb T ypc I a severe disorder of the nerves char affects one in every 3,000 people worldwide. He followed that with an explanation ofhow he isolated the gene for cystic fibrosis using a technique called "chromosome jumping" chat allows investigators co take "large steps across the vast expanbe of a chromosome." It is now possible rn screen for CF carriers, who number one in 25 in this country, he said. Carriers carry the gene A Francis S. Collins , M.D. , Ph.D. for CF but do not manifest the disease themselves. Each baby conceived by two carriers has a 25 percent chance of having the disease, a 50 percent chance of being a carrier and a 25 percent chance of being neither a carrier nor having the disease. "Genetics is not familiar territory to a lot of folks," he said, adding that a pilot counseling program of 2,000 people, such as the one undertaken by Richard W. Erbe, M.D., professor of pediatrics at UB, may give clues as rn how the issue should be approached. Collins suggests chac couples should be screened before a pregnancy is attempted. "The tricky part is that we have to be really careful when we Jo ·omething like this so that people really understand what the information means and there are all sorts of ways chat that information can get confused in people's minds," he said. "We could righc now start a screening program that would detect 85 per- cent of CF carriers," Collins said, but added that a program of this scope has to be carefully planned because it affects so many people and there aren't nearly enough trained counselors to impart the information. "People who are carriers may go away thinking that they are going to become sick themselves. And there are concerns about stigmatizing - that people will feel rhey are personally defective." Collins said he is afraid physicians might be pressured into offering the test if couples who have babies with CF sued rheir physicians, claiming their doctors were aware a test was available. Collins said he knows of an insurance carrier that sent a couple a letter after they tested rn be CF carriers that implied they would be "expected to use the information responsibly." Ir implies that if they had a child, the company wouldn't pay for medical expenses, he said. 'There arc areas where a lot of people get uncomfortable, includingmc,"Collins said. He included sex selection among them. "l do occasionally have people come in co my genetic clinic for just chat reason," Collins said, "and they look very surprised when l say I'm not going to participate. To me, it is an affront tO all the reason · I went into genetics ." He quoted from a Newsweeksurvey on "made coorder" babies chat showed chat I percent of couples would abort if the baby was rhe "wrong" sex; 5 percent would abort if the fetus had a predisposition to Alzheimer's disease (even if the onset was in old age) and 11 percent would abort if the child were predisposed co obesity. "Thar's when we have to ask where to draw the line," Collins said. "When you are looking at selection for traits rather than the elimination of disease. • - By PaulaVoe/I I\UFFr\Ll1 PIIYSltl-\N A1'D lllt)~IEl'IL'.-\l SCIEt-:TIST �---- •,ll ----0 y 33 Midd leton's internationally known research has included studies of the biochemical characteristics of allergic diseases, especially asthma and rhinitis; chemical mediators of allergic reactions; clinical assessment of new anti-allergic drugs, and effects of naturally occurring plant flavonoids on immunologic reactions. • - ByArthur Page MINDELL RECEIVES TwoHONORS ormer Chairman of the Department of Orthopaedics Eugene R. Mindell, M.O., received che Distinguished Service Award from the University of Chicago Medical Alumni Association last June. Mindell, currently professor and Director of Orthopaedic Oncology ar Buffalo General Hospital, was also elected a vice president of the American OrthopaeJic A sociation at its Boston, Massachusetts meeting the same month. • F NOENAMED TOHEAD DEGRAFF REHAB UNIT ohn E Noe, M.D., '84, has been named medical director ofDeGraff Hospical's new 20-bedmedical rehabilitation unit. The unit, which opened last December, is the first of its kind in Niagara County. leoffers an aggressiveapproach cothe rehabilitation of patients who suffer strokes, neuromuscular diseases such as multiple John F . Noe , M.D. , '84 lliott Middleton, Jr., M.D., received sclerosis, some spinal cord injuries or those the Distinguished Service AwarJ of with major joint replacements or amputhe American Academy of Allergy and tations, Noe notes. "Rather than emphaImmunology at the academy's annual si:ing their level of disability what meeting held in March in San Francisco. patients can't do for themselves we Middleton, professor of medicine and adopt strategies so they can do as much for pediatrics and director of the Allergy Divithemselves as they possibly can," he adds sion in the Department of Medicine The new unit, which occupies the ho received the award for lifelong contribupital's entire second floor, provides incense, tions to the academy. high ly focused therapy plus coordinated, A fellow of the American Academy of follow-up home and outpatient care. It Allergy and Immunology since 1961,he has cakes a multidisciplinary team approach, served as the academy's president, treasurer Noc explains, adding "Members of the and editor of its journal, TheJournalof Allerteam include a physiacrist, physical therHe is a member of the editorial ad,·isory gy and Clinical/mmunolog) '. He is also a board of the Journal of lmmunopharmacolapists, occupational therapists, speech clinical professor of pharmacy at UB. Director of the Allergy and Immunology ogyandClinicalAdvancesin the Trear:mem therapists, nurses, a psychologist and sometimes social workers." of AllergicDisorders and international adviDivision at The Buffalo General Hospital, sory board of the Asian Journalof Allergy The former director of the medical rehahe is a consultant in allergy at Children's bilitation unit at Sisters of Charity Hospital Hospital of Buffalo and Buffalo VA Med- and Immunology.He previously served on the editorial board of the Journalof Allergy. and clinical director of inpatienc services ical Center. Author or co-author of more than 190 at BuffaloGeneral Hospital, Noc is cert ified A fellow of the American College of by the American Board of Physical scientific articles and l 7 book chapters, Physicians, Middleton is a diplomate of the and Medicine and Rehabilitation and is a memAmericanBoardof InternalMedicineand the he is senior editorof Allergy:Principles AmericanBoardof Allergyand Immunology, Practice (C.V. Mosby Co. 1988), now in ber of the American AcaJemy of Physical Medicine and Rehabilitation. • its third edition. of which he was an original director . J MIDDLETON RECEIVES DISTINGUISHED SERVICE AWARD E Ratherthanemphasi zing theirdisabili ty...we adopt strategiesso theycan do as muchas theycan. BUFFALO PIIYSICI:\:- .~NP lll0~1EPI< AL SCIE~Tl:-T srRJN(o JQQI �-- --•- ~l--0 -- y 34 DanielM.Green , M.D. GREEN TOHEAD NATIONAL WILMS' TUMOR STUDY COMMITTEE aniel M. Green, M.D., UB medical school professor of pediatrics, has been e lected chair of the National Wilms' Tumor Study Committee. The committee determines what combination of therapies is best for treatment of all types and stages of Wilms' tumor, the most common form of kidney cancer in chi ldren. The committee's protocols are useJ by all hospitals participating in two national childhood cancer study groups, the Pediatric Oncology Group and the Ch ildren's Cancer Study Group. An international authority on the late effects of cancer th erapy in children, Green is chief of the oncology section in the Department of Pediatrics at Roswell Park Cance r Institute and director of the institute's Long-Term Follow-up Clin ic. D Board certified in pediatrics and pediatric lhematology/oncology, he has been a member of the UB medical school faculty since 1978. He also is directar of the Section of Oncology in the Division of He·matology-Oncology at Children's Hospiical. Green is a member of the Scientific Committee of the International Society of Pedliatric Oncology, Society of Pediatric Research, American Society of Hematology and American Society of Clinical Oncology. He has written more than 60 scienrific articles and two books on pediatric oncology. A graduate of Massachusetts Institute ofTechno logy,Green received his medical degree cum laude from St . Louis University School of Medicine in 1973. He did his residency in pediatrics at Boston (Mass.) City Hospital and then completed a fellowsh ip in pediatric oncology at Sidney Farber Cancer Institute, Boston; a fellowship in medicine-hematology/oncology at Child ren's Hospital Medical Center, Boston, and a fellowship in pediatrics at Harvard Medical School, Boston. • - By Arthur Page UB ALUMNI ASS ,OCIATION To UPDATE DIRECTORY h,e UB Alumni Association has contracted the Bernard C. Harris Publishirng Company to produce a comprehensive alumni directary. Scheduled for release at year en<l, the d irectory will inclu de current name, address and telephone number, class year and degree, plus business information (ifapplicable) bound in a library-quality e<lition. All alumni who completed an alumni directory questionnaire mailed earlier this year will be contacted by the Harris Com- T pany to verify the information and take book ordering information. If you prefer not to be listed in the directory, contact the A lumni Association in writing as soon as possible. • ALBINI NAMED FULBRIGHT SCHOLAR, To TEACH, Do RESEARCH INAUSTRIA oris Albini, M.D., professor of microbiology and research professor of medicine at UB, has been named a Fulbright Scholar. Under an awar<l from the Fulbright Scholar Program, Albini, began teaching and research in the Department of Experimental Pathology at the University of Innsbruck in Austr ia in March. He will collaborate with Austrian researchers on studies of immune responses to bacterial components and lymphocyte function in aging. Albini is one of936 academics, professionals and independent scholars from the Unite<l States who have received awards under the Fulbright Scholar Program to lecture, consult or conduct research abroad in I 990 and 1991. A member of the faculty of the UB School of Medicine and Biomedical Sciences since 1975,Albini was a BuswellFellow in the Department of Microbiology in 1975 and a Max Kade Fellow in thedepanmcnt in 1974. Before joining UB, he was a clinical assistant professorat the Institute for Genera l and Experimental Patho logy at the University of Vienna, Austria . A member of the medical school's admissions committees and its M.D./Ph.D. program, he is a member and former chair of the University's Laboratary Animal Care Committee and a member of the UB Faculty Senate. He has served on the orga- B BU~'FALOPHYSICIAN AND BIOME()ICAL !'CIENTIST �---- -~l----0 ' JS nizing committee for several of the biennia l international convocations on immunology sponsored by UB's Ernest Witebsky Center for Immunology, of which he isa member. Albini is president of the Buffalo Collegium oflmmunology. The author or co-author of more than 110 scientific articles, Albini isa member of the editorial board of Immunological Communicationsand /nr.ernationalArchives of Allergyand AppliedImmunologyand a fonner member of the editorial board of Clinical and ExperimenwlImmunology.• - B)' Arthur Page the Hisroryof Orolaryngology,he has been a consultant to the Gillette Corp. and the Ministry of Public Health for the State of Kuwait. In 1975 he served as chief of surgery and assistant hospital director at Yuka Hospital for Tuberculosis and Leprosy in Kalabo, Zambia. Author or co-author of more than 65 scientific articles,Simpson isthe author of texts on common problems,emergenciesand laser surgeryin otolaryngology.He has conducted extensive researchon lasersurgeryand laser interaction with tissue to deal with tumors and ocher disease processes. • - By Arthur Page SIMPSON NAMED (HAIR OFOTOLARYNGOLOGY eorge T.Simpson, II, M.D., has been named professor and chair of the medical school's Department ofOtolaryngology. He will also serve as chief of otolaryngology/head and neck surgery at Sisters Hospital. He previously was acting chair and associate professor in the department of otolaryngology at Boston University School of Medicine and instructor in ocolaryngology at Tufts University School of Medicine, Boston. He also was otolaryngologist-in-chief at Boston University Medical Center and director in the Department of Otolaryngology, Department of Health and Hospitals for the City of Boston and Boston City Hospital. Simpson is certified by the National Board of Medical Examiners, American Board of Otolaryngology and American Board of Laser Surgery. He isa founding fellow of the American Society for Pediatric Ocolaryngology and a fellow of the following organi:ations: American College of Surgeons, American Academy of Otolaryngology - Head and Neck Surgery, American Academy of Pediatrics, American Society for Head and G BUFFALOPHYSICIAN AND IIIOMEDICAL SCIENTI~ GeorgeT.Simpson, II,M.D. Neck Surgery, American Bronchoesophagological Association, American Academy of Facial Plastic and Reconstructive Surgery and American Academy of Cosmetic Surgery. He is a 1969 graduate of Loma Linda University, where he received his medical degree in 1973 and a master's degree in public health in 1975. Simpson completed an internship in general surgery at the University of Alabama Medical Center and residency in head and neck surgery at the University of California at Los Angeles. He was a fellow in pediatric otolaryngology at Boston University and Children's Hospital Medical Center and Harvard Medical School, a U.S. Public Health Service/Association of American Medical Colleges Fellow in Yugoslaviaand American Society of Anesthesiologists Fellow at the University of Alabama Medical Center. Former vice president and secretaryrreasurer of the International Society for TwoALUMNIELECTED TO ST.JOSEPH HOSPITAL MEDICAL STAFF ichael). Gianturco, M.D., '55, has been elected president of the medical staff of St. Joseph Hospital. Gianturco, a board certified genera l surgeon, has been a staff physician there for more than 27 yearsand served as vice president of the medical staff in 1989 and secretary in 1988. Also elected as vice president was Irving Sterman, M.D., '64. • M Michael J.Gionturco, M.D. srRINO 1991 �36 Match Day '9 1 saw the suspense end for fourth-year students as they found out where they will do their residency training. SPRING !'I'll BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �-- ---- 37 Thisstereogram of a humingbird in flightapproaching a feederhaswon severalmedals andhonorable in inter· mentions national competi· lions.Theoriginal colorphotograph S. is byBernard Stell, '36. 1930s Joseph R . Saab '34 ► writes, "still alive and looking forward to my 60th anniversary." Bern ard S. Stell , '36 ► has won several medals in international photo competitions. Stereo closeups are one his specia l interests . Information on his stereogram and its innovative technique will be published by the Internaciona l Stereoscopic Union. "According to my research, what I have accomplished in getting these multiple images in one picture has not been published before in any pare of the world." The reproduction of the stereogram containing three hummingbirds against a black background is really a stereo of a single bird with rapidly beating wings on a single approach to the feeder. Ic has been captured in three separate positions by three closely spaced bursts oflight from the flash units. Walte r Z. Schwebel ' 38 ► is still practicing pediatrics and is direccor of the Physically Handicapped Children's Program for Rensselaer County, New York. 1940s John D. Whit e '4 0 ► of Tavernier, Florida, presented a "Talking Book" project at the Mariners Hosp ital Health Fair in January. Frank A. P falzer ' 49 ► is retired and now living on Amelia Island Florida. He writes chat he is enjoying travel and several hobbies . Ra phael S. Good '48 ► a clinical professor of psychiatry and obstetrics and gynecology at the University of Miami Schoo l of Medicine, is president-elect of the South Florida Psychiatric Society. Dr. Good is a former president of the Miami Obstetrical and Gynecological Society . BUFFALO PHYSICIAN ,~ND BIOMEDICAL SCIENTI ST K e n n e th N i sw and e r ' 4 8 ► received an award for the best anicle in 1989 from rhe magazine Comem/)orary ObscemcsandGynecologyfor his article, "Neurologic Deficits on Trial: What Response." Dr. Niswander is professor of obstetrics and gynecology at the University of Ca lifornia at Davis. Law r en ce M . Ca rd e n ' 49 ► retired on Jan. I, 1990 and is now living in Sarasota, Fla. 1950s Fr ed Lee '56 ► of Ann Arbor, Michigan, was named a fellow of the American College of Radiology. Ge rmante L. Bonca ldo ' 5 7 ► is direccor of the Millard Fillmore Rhcumacology Center, Buffalo, New York, "an out-patient facility for rheumatology patients in a patient satisfying consulcaci ve atmosphere." Th omas P. H amilt on II '5 7 ► has been named Deputy Commander and Direccor of Medical Education ac the Brooke Army Medica l Center, Fort Sam Hous• ton, Texas. W a r r en E. Lev in so n ' 57 ► writes, "I was elected to the Mill Valley City Council in April 1990. and My book MedicalMicrobiology Immunology was published in August 1989." Levinson is professor of microbiology at the University of California, San Francisco. Ga ry Co h en '58 ► has been appointed chief of the Division of Chi ld and Ado lescent Psychiatry at Children's Hospital of Buffalo. A clinical associate professor of psychiatry and pediatrics ac UB, Dr. Cohen previously served I0 years as acting directo r of the divi• sion. John T. Korn ' 58 ► "Entered solo ob/gyn practice in Novato, California in 1964. Mary and I raised and educated four sons. Having accomplished that successful career, I closed my private practice in l 990 and am now enjoying an interim second career of OBG locums tenenswork. In a year or so I willbegin concentrating full time on all my other neglected lifetime goals, such as aviation, sailing, scuba diving, deep sea fishing and traveling. Mary, being relieved of children and household chores, enjoys her days in commercial retailing of ladies accessories." John W. Kosteck i '59 ► an associate clinical professor at UB, received certification in general vascular surgery from che American Board of Surgery. SPRING 1991 �----------------------- ::,,,. _::: --------------- -- - ------ s ll 38 Law rence E. Gra ss ' 63 ► was just elected chief of family practice at Phoenix Baptist Hospital for a two-year term. John J. LaMar '63 ► is senior attending pediatrician at the Memor ial Hospital of Salem, New Jersey, where he has been on staff for 2 5 years. John A. Schriv er '63 ► has been appointed head of the section of emergency medicine at Yale University and director of emergency services at Yale New Haven Hospital. Dorothy C.Rasinski , M.D., 'S9 William E.Abramson , M.D.'60 Do roth y C. Rasinski '5 9 ► will be a participant in the morning program on Spring Clinical Day in Buffalo on May 4. An internist, attorney, educator and author, she recently received a special recognition award from the American Society of Internal Medicine. TI1is award is presented to an internist who has made a significant contribution to the social and economic aspects of interna l medicine. Rasinski's flair for translating dry legal accounts of malpractice suits into interesting vignettes has made her "Legal Briefs"column one of the best-read pages in The lncemisi:HealrhPolicy in Practice.She has been an editor for the Journalof LegalMedicine, son has a private practice in psychiatry and is senior psychiatrist at the Sheppard Pratt Hospita l, Towson, Maryland. z. Ronald J. Kallen '60 ► is direccor ofthe Division of PediatricNephrology and Hypertension at Lutheran General Children's Medical Center in Park Ridge, Ill. Robe rt L. Malat esta ' 60 ► of Warren, New Jersey, has been appointed associate direccor of Drug Safety and Surveillance at the R. W.Johnson Pharmaceutical Research Institute. H arold L. Metca lf '6 0 ► is vice president of the American AcadeLegalAspectsof MedicalPractice, my of Family Physicians FoundaClinicalOiabeies, Journalof Clinical tion with headquarters in Kansas City, Mo. EihicsandHospical EthicsCommit- Willi am E. A br a mso n ' 60 ► "attended my first class reunion and Spring C linical Day in April 1990 and had a ball. Will :me nd in 1995, God willing." Abram- :-PRINUl'l'll Bert A. Lies, Jr. ' 64 ► of Santa Fe, New Mexico, continues to practice orthopaedic surgery with a special interest in disability evaluation aml rehabilitation. He is presently the orthopaedic consultant for the Aspen Ski Company, and is joining the Orthopaedic Associates of Aspen on a pare-time basis as a consultant in rehabilitation and disability evaluation. Saar A . Porrath '6 1 ► of Beverly Hills, Calif., \vaselected president of the National Consortium of Breast Centers . Murra y A. Yos t Jr. '66 ► has been elected vice chairman of the Buffalo Section of The American College of Obstetricians and Gynecologists. Yost is an associate clinical professor of obstet rics and gynecology and assistant clinical professor of psych iatry at the UB School of Medicine. J ohn L. Kiley ' 6 2 ► is medical director of Charter Hospital in Las Vegas, Nev. John E. Spoor '6 6 ► was named a fellow of the American College of Emergency Physicians, appoint- tee Forum. 1960s Mar vin Ku r ia n '6 4 ► has been named to membership on the Board of Governors of the American Biographical Institute Research Association . This prestigious board position carries with it the tide of Deputy Governor. ed assistant clinical professor of medicine at Columbia Un iversity and listed in Who'sWhoin rheEast. T homas P. O'C onn or '67 ► has returned to Western New York to become directo r of radiation therapy at Western New York Medical Park, a new facility in West Seneca . Paul S. Schu lman '68 ► of El Cajon, Cal ifornia, was named a fellow of the Ame rican College of Radiology. S.K. Bosu '69 ► has returned to the United States after serving as a consultant to the Lagos State Government in Nigeria. Da vid M. Sherer '69 ► writes, "Took a trip around Lake Erie last summer with my 13-year-old son, saw baseball in Cleveland, Detroit and Toro nt o and stopped in at Capen Hall. Had a brief reunion with professor Milgrom. Otherwise l'm involved in our Credit Union Board,ski patrol, Golf Club Board and have sung with the Seattle Opera. Am having fun with my wife Barbara and th ree chi ldren. I love Scanle." Sherer isdirecto r of Clinical Laboratories, Group Health Cooperative of Puget Sound. 1970s Elliott Brender '70 ► was elected chief of the depa rtment of surgery at Garden Grove Hospital, Garden Grove, California. Jam es M. Bak er '7 0 ► writes, "Besides a small town family practice, I am do ing phase Ill cli n ical studies for phannaceutical companies in development of new drugs. Miko, my wife, and two children are doing well." BUFFALOPHYSICIANAND BIOMEDICAL SCIENTIST �________________ _______,.... .... 39 I ra L. Salom '77 ► was elected a fellow of the American Co llege of Physicians and certified in geriatric medicine. Russell J. Van Coevering II '77 ► was elected president of the New York State Society of Obstetr icians and Gy neco logists. Salvalore A.DelPrete , M.D.,'78 Leela nd A. J ones '73 ► after completing a residency in psychiatry, Jones left his North Caro lina family practice to return to Buffalo, where he was named director of the medical-psychiatry unit at Buffalo General Hospital. Michael Rad e '75 ► has been elected to the Board of Governors of the American Co llege of Su r• gcons as a Governor-at-Large from Western New York. He is a clinical instructor in surgery at the UB School of Medicine and Biomedical Sc iences. Elaine S. Chirlin '77 ► has a private practice in chi ld, adolescent and adult psychiatry in Cincinnati, Ohio, where she also works in pub lic sector mental health. Ch irlin has three daughters. OrestesG. Rosabal '77 ► waschosen to represent the State of Florida as Co uncilor for the Southern Medical Association, a multi-specialty associat ion providing continuing medical education and practicerelated benefits for physicians. Salvatore A. DelP rete '78 ► of Fairfield, Connecticut, was the 1990 recipient of the Dr.Melville G . Magida Award, presented annually to a Fairfield Cou nt y physician fo r "demonstrated notable capability in patient rre-at• menr and care." 1980s Robe rt Brac o '80 ► is the occupatio nal medicine physician at the SW Center for Occupational Health and Safety of the University of Texas School of Public Health in Houston. William N. Capicotto '80 ► of Buffalo is a fellow of the Ame ri can Academy of Or th opaed ic Surgeo ns. Daniel Paul Schaefer '81 ► has written rwo chapters in che new Adas of Con t emporary Op h tha lmic Surge ry. He is an assistant clinical professor in the department of ophthalmology and assistant clinical professor in the department of ear, nose and throat at the State University of New York at Buffalo. Mark Ch ung '82 ► is in private practice as a pulmonologis t in Lo Alamitos, California. He is a lso a lieutenant commande r with the U.S. Naval Reserve Medical Co rps. BUFFALO PHYSICIAN ANO BIOMEDICAL SCIENTIST Mich elle D. Leon '82 ► is the new assistant program director of the integrated reside ncy in eme r• gency medicine currently being establis hed at the University of Co nn ecticut Medical Cente r. Paul N. Rosenberg '82 ► writes, ''Living happily in Rochester, New Yorkarea with my wifeSuzanne and d1ildren,Aaron, 6,andShelby,3. My practice is limited to oculoplascic, reconstructive and orbital surgery." Adolph Soto Jr. '83 ► of Bronx, New York, was recentl y appo inted unit chiefoflinco ln Hospital, the city's first bilingual, bicultu ra l, inpatient psychiatric program. R obe rt W. Lasek '84 and Colette ► arc living in Danville, Pennsy lva ni a. "Colette has com pieced her cardiology fellowship at Geisinger Medical Center and joined the staff, specializing in echocardiography, rransesophageal echocardiography and imraopcrative echocardiography. I comp leted a fellowship in medical educa t ion at the University ofTexas-Southwesrem Medical Cente r (sponsored by the Emergency Medicine Found ation and the American Co llege of Emergency Physicians). I am active ly involved in teaching eme rgency medicine at Geis inger Med ica l Cente r. We recently celebrated our fifth wedding ann iversary." R. (Pruefer) Lasek '84 Joh n J. Picano '84 ► has completed a two-year clinical fellowship in neuroradiology at Massachusetts General Hospital and is now in private practice in New Hartford, New York. He and his wife, Lynn, have rwo children, John, 3, and Cara, 1, and are expecting their third child in May Marc J. Koblick '84 ► moved to Daytona Beach, Florida after completing an opht halmology fellowship in New Orlea ns, Louisiana. He proudly annou nces th e birch of a daughter, Jacqueline Ann, born July 13, 1990. Andrew C . Friedman '85 ► finished a ge n eral surge ry res idency in Buffalo and has started a plastic surgery residency at Case Western Reserve. Mark Ross Comaratta '85 ► has return ed co Buffalo afte r comp let• ing a retina fellowship. He and his wife Kate have two childre n. Kevin L. Donovan '85 ► was appo inted chief of the anes th esiology serv ice at VA Hospi tal in Nashville, Tennessee. He and his wife, Shar, are expec tin g their fourth child in March 199 I. Nicholas D' Avanzo '86 ► is enjoyi ng private pediatric practice with two partners in the H amptons, N.Y. Jean Ann (Comaratta) Marfurt '86 ► proudly anno un ces the birth of her son, Ryan William, born on August 25, 1990. She is practicing pediatrics with two partners at 1630 Maple Road, Williamsville, New York. Debra Ann Gould '87 ► finished a family practice reside n cy in Rochester,New York, andhasaccepred a two-year position as National ResearchService Awa.rdprimarycare fellowwith the department of family medicine at the UniversityofWashington, Seatt le, Washington. Jill E. Koeh ler '87 ► ann ounces the birth of a daughter, Alaina Joy Moreno-Kochler, on December 17, SPRING 1991 �------------------------ ::,~ ,:.:---------------------- --- s 11 40 D avid R. Bl oo m '89 ► announces the birth of a baby son, Annunzio Joseph, 7 lbs. 6 oz. on November I , 1990. Bloom is an assistant clinical instn1ctor of family medicine and clinical assistant for undergraduate affair; at the University of California at Irvine. Ca rlos Robe rto Jaen '89 ► is senior clinica l instructor and resident in the department of family medicine at CaseWestern Reserve University School of Medicine. Donnico L Moore , M.D.,'78 1990, weight 7 lbs. 11 oz. Koehler 1san attending physician at Hurley Mec.licalCenter in Flint, Michigan. Do nn ica L. Moore '87 ► writes, "Robe rt Man ella '88 was recently hired by Sandoz Pharmaceuticals as an assistant director of medica l operations in rhe cardiovascular area - the fourth UB MD to be hired by Sane.lo: in three years! (Other;: Evan Dcmest ihas '87, now at Bristol-Meyers-Squibb; Michael Sabo linski '88, a=iate director, medica l operations am! myself). Perhap;, this rrcnJ has to do with the required Medical Care Organization courses we cook." Moore now heads a new Jepartmcnt within Sandoz Pharmaceuticab - The Medical Educmion Center. The Center will develop eJucarional programs for physicians and medical student;, on osteoporosis anJ rdatec.l metabolic bone disorders. "My husband (Stan Bernard, MD, MBA) ,me.I! have settled in central New York and love the rural lifestyle while being close to New York City and Phi ladelphia. Sec y'all at our Fifth Reunion!" SPRINt11991 D ebra M. Omi atek ' 89 ► transferred from the program at St. Elizabeth's in Utica to finish two years of family practice residency in Niagara Falls at the Niagara Falls Memorial Medical Center. C harles Eve rett '89 ► and his wife, S,mdra Everett '88, and their son Kristian, delight in announcing the new addition, Nicholas, horn, August I 7, 1990. Obituaries Fr ancis M. C rdge ' 19 ► of Santa Barbara, California, died October 17, 1989 at the age of 95. Au gustus ]. Tranella '39 ► died October 30, 1990 at his home in Greece, New York, after a long illness. An obstetrician, Tranel!a delivered more than 2,000 babies at Highland Hospital before his retirement in 1978. John F. Moran, Ph.D. , associate professor of biochemistry at UB, died Wednesday, Feb. 20, 1991 in hi; home in Snyder. He was 55. Moran served from 1983 co L988 a;, assistant to the dean for facilities planning at rhe medical schlx>I. In that capacity, he wa, the coordinator between the school's faculty and the architect on plans for renovation of existing facilities and the construction of a $30 million addition to the medical school, completed in 1988. A native of Cleveland, Moran joined the UB faculty in 1964 as a research associate in the Department of Biochemical Pharmacology in the School of Pharmacy. He was named an assistant professor in the medical schoo l's Department of Biochemistry in 1967 and associate professor in 1970. From 1975 to 1976, he w,1sa visiting associate professor in the Department of Physiology at the Case Western Reserve University choo! of Medicine. Moran was the recipient of a Chancellors Award for Excellence in Teaching, Distinguished Service Award from the UB medical school and a Siegel Award Commendation for excellence in teaching medical students. Murray J. Ettinger, acting chair of the UB Department of Biochemistry, noted that Moran "put endless hours, energy and empathy into coume lling students. He was the sta lwart of the undergraduate biochemistry program and, more recently, the advanced biochemistry course for medica l and graduate students. Whatever he did, he put his heart, soul and humor into it. His persona l efforts helped countless students over the years." Director of undergraduate studies in the UB Department of Biochemistry from 1968 to 1984, Moran haJ served on the UB Faculty Senate, the medical schoo l's Faculty Council, the steering committee of the UB Department of Biochemistry and the curriculum committee of the UB School of Pharmacy. Moran also was active at Christ JohnF.Moran , Ph.D. the King Church, Snyder, where he was head of the usher's organization, a post he held since the late 1970s, and a former officer of the Christ the King Schoo l Parents' Guild. He also was a former treasurer of the Parents Guild of Villa Maria Academy. A 1958 graduate of John Carroll University, Cleveland, Moran received a master of science degree magna cum laude from the Univers ity of Ottawa in 1961 anJ a doctorate in biochemistry from McGill University in Montreal in 1964. An expert in metabolic biochemistry, he was the co-author of more than 30 scientific articles . He is survived by his wife, the former Karin Yax; two sons, Kevin and Patrick, both of Snyder, a daughter, Megan, of Snyder; and a sister, Martha O'Donnell of Cleveland, Ohio. Contributions in Moran's memory may be made to the University at Buffalo Foundation, designated for the John F. Moran Memorial Fund in the UB Department of Biochemistry, or the South East Community \Xlork Center, I 81 Lincoln Road, Depew, N.Y. lll 'FFALO PHYSIC IAN AND BIOMEDICAL ~IENTIST ��BuffaloPhysicianand BiomedicalScientist StateUniversityof New Yorkat Buffalo 3435 Main Street Buffalo,New York 14214 Address Corre<tioa Reqwested 958 MR. CHUNG - KA! HUANG HEALTH 5CIENCc LI RAqy A880 TT HALL CAMP US ,r1AI L Non-l'ro hc Org. U.S. l'osc~e PAID Buffalo,NY Pcnmt No. 3I I � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician and biomedical scientist, Spring 1991 Subject The topic of the resource State University of New York at Buffalo. 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Research Hospital News Healing the Spirit Daggers of the Mind: Shakespeare and Neurology A Cure for Malpractice Headaches The Clinical Picture From Shin Splints to Hip Pointers Charting the Quality of Life Medical School News Alumni Research People Match Day Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-11-12 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v25n02 Extent The size or duration of the resource. 44 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1991 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/cc44c68c949906d40cb4e81db435df64.pdf f718e6a1097fa2829afb11d5b66d915f PDF Text Text Vol. 25, No. I �STAFF DIRECTOR OF PUBLICATIONS Nancy Tobm Dear Friends: EDITOR Connie Oswald Stofko s we enter 1991, concerns that previously required only speculation now reqUire appropriate attention and resolution. This transference will be accelerated because of increasing fiscal constraints from all of our usual sources of support and the changing world in which we hve. Chtef among those concerns are a need to foster more independence and self-responsibility among medical students and physiCians for their learning, continued development of a research environment which will ensure continued proJuctivtty of the scientific faculty well into the 21st century and the important need to guiJe clinical training programs to be more responstve to social needs without harming the tremendous contributions made to the age of specialization developed smce World War II. For a medical schcx1l faculty, these area' of concern, as well as a multitude of other problems which must be addressed, seem bxh overwhelming and contradictory. Nevertheless, each of this country's 126 medical sch(Xlls shares these issues and each must present options for solutions. Given the unique circumstances at UB, it seems that these areas of concern will receive our focus and attention throughout the current decade. The faculty are initiating curricular changes, and the school is providing the necessary technology and faciltties whtch will foster educational change; the plans for the construction of a modem research facility to be completed in 1994 are well underway, and a maJor tnstitutional commitment has been made to mcrease the emphasis on educating and training a larger cadre of primary care physicians while recruiting and returning an increased prop.1rtion of residents from minority and socially disadvantaged programs. Thus, while UB and its teaching affiliates will not be protected from the onslaught of constraints that will continue to rx:cur, we have initiated strategies to prepare and deal with the changing environment as we meet its challenges. Best wishes for a happy and successful 1991. ART DIRECTOR Alan j. Kegler WRITERS Peter Askew Lots Baker David Htmmelgreen judson Mead Arthur Page David Snyderman Laune Wolf PHOTOGRAPHERS Mark Dcllas Stmon Tong Robert Walion ILLUSTRATORS Thomas Hutchmson Thomas Rtxmey Dan Zakroc:emskt ADVISORY BOARD Dr. John Naughton, Chairman Dr. Harold Brody Ms. Nancy Glieco Dr. James Kanskt Dr. oseph L. Kunz Dr. Charles Paganelh Mr. Michael Arontca Dr. Antoinette Peters Dr. Charles Pruet Dr. Luther Robmson Dr. Thomas Rosenthal Dr. Saleela Suresh Dr. Burton Singerman Dr. Stephen Spaulding Dr. Nelson Torre Mr. Edward Wemke Dr. jerome Yates TEACHING HOSPITALS AND LIAISONS Batavia VA Medteal Center Buffalo General Hosrital, Mike Shaw Buffalo VA Medtcal Center, John Pulli Chtldren's Hospital, Karen Dn]a-Swterskt Ene County Medical Center Mercy Hospttal, Chuck Telesco Mtllard Ftllmore Hospttal, Joseph R. Ci{fa Roswell Park Cancer Institute, Judi Rtce Sisters Hospttal, Dennis McCarthy Produced by che Dim ton of UnivmiN Relanons m associati<m with the School of Medicme and Biomedical SCiences, Swte L'niverstty of New Yark at Buffalo. Eduorial office is m 136 Crofts Hall THE BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST (USPS 551--860) Winter 1991, Volume 25, Number I. Puh!tshed by the School of Medtctne and Bwmedtcal Sciences, State Untverstty of New York at Buffalo, 3435 Main Street, Buffalo, ew York 14214. Thtrd class hulk postage patd at Buffalo, New York. Send address changes to THE BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST, 146 CFS Addttton, 3435 Main Street, Buffalo, New York 14214. A ~L+-s: John Naughton, M.D. Vice President far Clinical Aff01rs Dean, School of Medicine and Biomedical ScierlCes Dear Fellow Alumni/Alumnae: I n September, we were happy to present the Second Annual Distinguished Alumnus/a Award to Dr. David Nichols '47. Professor and chairman of the Department of Obstetrics and Gynecology at Brown University, David is a world-recognized authority on female pelvic relaxation disorders and has been a prolific contributor to the literature in hts specialty. It's time to start thinking ahout next year'~ honoree. Please use the enclosed postcard for your nominations. Our programs for students are going well and we were well represented at the orientation sessions for the incoming University residents and for the freshman and )Untor classes. Mark May 4, 1991 on your calendar for Spring Climcal Day and Reunion Weekend. This year's program, "Bridgmg the Gap Between Medicine and Law," will be highlighted by the Stockton Kimball Lecture, given by Sol Wachtler, chief judge of the New York State Court of Appeals. It promises to be an exceptional program. Smcerely, D~ Bertram A. Portin, M.D. '53 �Vol. 25, o. 1 Winter 1991 In Praise of Housecalls Once a staple in medicine, the housecall is alive and well and making a comeback. New hours could hurt continuity of care, page 10. The resurgence of housecalls, page 4. Residents' Hours State~mandated changes haven't caused the havoc educators thought they would. Epidemiological findings need close examination, page 24. Making a Team for Michael The Craniofacial Center, a multi~disciplinary team of health care professionals, improves the quality of life for a six~ year~old boy and a host of other children. Danger in the Locker Room With illegal anabolic steroid use on the upswing, reliable investigation into its health risks is urgently needed. Thomas B. Tomasi, M.D., Ph.D ., receives Stockton Kimball Award, page 27. Do Bad Habits Breed Disease Saxon Graham, Ph.D., lectures at the 1990 Annual Faculty Meeting. Medical School News Alumni Classnotes Illegal anabolic steroid use is rampant, page 22. Craniofacial Center brings a smile , page 14. �- - - ---®:- - - .r E ~ '1- 2 INTERNATIONALLY KNOWN RESEARCHER TO SPEAK AT (HOB LECTURE STUDY LINKS BALDNESS, BLOOD PRESSURE LEVELS study of Italian factory workers has indicated an association between male-pattern baldness and higher cholesterol levels and diastolic blood pressure readings. Maurizio Trevisan, M.D., co-principal investigator and associate professor of social and preventive medicine at UB, cautions that although the study is the first showing an association between baldness pattern and risk factors for coronary heart disease, it doesn't indicate whether there's a link between baldness patterns and the disease itself nor does it reveal the reason for the elevat~ ed readings. Men with male-pattern baldne s had slightly higher levels of serum cholesterol and diastolic blood pressure (the pressure measured in blood vessels as the heart rests between beats) than those with either no hair loss or frontal baldness only. He said the differences reached statistical significance when the average readings for men with male-pattern baldness were compared with those for the men in the e other two groups combined. - By Arthur Page WINTER 1991 rancis S. Collins, M.D., Ph.D., associate professor of Internal Medicine and Human Genetics and associate investigator and chief of the Division of Medical Genetics at the Howard Hughes Medical Institute at the University of Michigan at Ann Arbor, has been chosen as the inaugural speaker for the Rose and Al Pastor Lecture Series. The lecture, scheduled for March 26 at the Hyatt Regency, is sponsored by The Children's Hospital of Buffalo. Internationally recognized, Collins' work in recombinant DNA technology has led to several important advances in the field, including the location and isolation of the genes for cystic fibrosis and neurofibromatosis type 1. The lecture series is an annual event that focuses on public health issues affecting the Western New York community. Collins is slated to speak from 4 p.m. to 6 p.m. A reception will follow. For more information, call the Public Relations Department at Children's Hospital at 878-7543. e space for about 34 physicians and researchers working on approximately $3 million worth of medical research grants. V AMC's medical research program includes a wide spectrum of both clinical and basic studies. Its proximity to the UB medical school has fostered collaborative investigations within a variety of specialties and departments. In addition to providing new research space, the project included the refurbishing and expansion of 25,000 square feet for clinical activities, outpatient care, and administration, plus an additional 10,000 square feet for animal research. SURVIVORS OF (ANCER IN CHILDHOOD (AN HAVE HEALTHY KIDS dult survivors of two forms of childhood cancer - Hodgkin's disease and Acute Lymphocytic Leukemia (ALL) -are capable of conceiving and giving birth to healthy children, according to the results of two recent studies conducted by Daniel M. Green, M.D., professor of pediatrics at UB and director of the Long-Term Follow-up Clinic at Roswell Park Cancer Institute. VAMC DEDICATES NEW RESEARCH (ENTER he Buffalo VA Medical Center last November formally dedicated its new Research Building as part of a $16.5 million expansion and refurbishing program. The new $13.1 million facility, located north of the medical center, provides BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �- - - ---CID:- - - .r t ~ ~ 3 In the study of former Hodgkin's disease patients, some male respondents reported medically-documented decreased sperm counts and some female respondent reported unusual menstrual cycles. But children born to respondents (who averaged 29 years of age) showed no more congenital defects than children born to parents with no history of the disease and none had been diagnosed with childhood cancer at the time of the study. The ALL study, although conducted among former patients who were younger than those in the Hodgkin's ~ study, showed the same results for ~ ~::; childbirth. "Our study suggest that children treated for Hodgkin's disease and ALL lead essentially normal lives after the disease is cured," Green says. The ultimate goal of these and future studies is to follow these patients and their offspring throughout their lives to determine whether there is a genetic risk involved with these types of cancer and whether these former patients develop other malignancies as they grow older. Counseling is an important part of the clinic's work. "Some women who have had these types of cancer as children are afraid to conceive and give birth because they believe they may have a sickly child or a child who will develop cancer," Green says. "We are able to reassure these patients." The studies were conducted with Michael A. Zevon, Ph.D., director of the Department of Psychology at Roswell Park and associate research profes or at UB, and Brenda Hall, R.N., P.N.P./0., Department of Pediatrics. The Hodgkin's disease study was reported in Pediatric Hematology and Oncology and the ALL study in Cancer. e BUFFALO PHYSICIAN AND 1\IOMEDI AL , GooD NEws, BAD NEws: BOTH LIVER AND BEER IMPLICATED IN CANCER IENTIST § matched controls, the researchers identified a "substantial increase in risk" related to the ingestion of vitamin A in the form of retinol from meat and dairy foods like milk and ice cream. On the other hand, the researchers found no risk associated with vitamin A derived from vegetables in the form of carotene. In fact, the study showed risk of esophageal cancer was lower for persons whose diets regularly included lettuce, other greens and tomatoes. e - By Arthur Page STATISTICS DEPARTMENT JOINS MEDICAL SCHOOL 1£ f you resented your mother's admonitions to "eat your liver," you'll find solace in a recent study out of the UB Department of Social and Preventive Medicine. Organ meats, like liver, head the list of foods that appear to increase the risk of cancer of the esophagus, according to the team headed by Saxon Graham, Ph.D., professor and department chair. On what others might consider the down side, beer (which also scored high in an earlier UB study of dietary factors increasing the risk of rectal cancer) also ranks right up there in terms of riskincreasing food fare. The study, reported in the American Journal of Epidemiology, also uncovered what appears to be the Jekyll-and-Hyde personality of vitamin A, which not long ago was being hailed by some scientists as a factor that would reduce cancer risk. As the result of an in-depth comparison of the diets of individuals with esophageal cancer and carefully he University's Statistics Department has joined the medical school, ending uncertainty about its fate. Now located at 2211 Main t., the Statistics Department is adjacent to the Department of Social and Preventive Medicine. This proximity is expected to enhance research and scholarship, school officials say, since the two departments have complementary interests. John Naughton, M.D., dean of the medical school and UB vice president of clinical affairs, says that the school will soon seek new department chairmen for both Statistics and ocial and Preventive Medicine. He calls this an opportunity to recruit chairs who can bring their departments clo er together. Associate Provost Kenneth Levy is currently acting chairman of Statistics. Saxon Graham, chairman of Social and Preventive Medicine, plans to retire. Levy said that no changes in Statistics Department courses or programs are anticipated in the near future but that a faculty position will be added. e WINTER 1991 ��s The physician housecall is alive and well in Western New York. After years of de . . cline, the popularity of the home visit may be on the upswing again, though it isn't the same as the housecall of the horse and buggy days. Instead of traveling miles to check out a bellyache, physicians now see mainly the chronically ill, newborns, and the frail elderly. "It's really a time..-saver to see homebound elderly folks right in their homes," said David Holden, M.D., professor and chairman of UB's De... partment of Family Medicine. "Frankly, it takes longer for them to get maneuvered out of their beds into wheelchairs, then into ambulances, out of the ambulances, back into the chairs, into the offices, and up onto examining tables - then repeating all these steps - than doing the home visit. "With newborns, I find it's nice to do the first visit in the home, where I can get a good look at the preparations the parents have made, and a better view of the baby's home environment. It's obviously a convenience for the family not to have to bring the baby out of the home when it's two to four weeks old." BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST The physician housecall "still has a very important WINTER 1991 �6 role in health care," agreed David A. Silverstein, M.D., assistant professor and director of undergraduate education in Family Medicine. "It's extraordinarily useful to see a patient's surroundings." For example, if an elderly patient falls frequently, a doctor on a housecall could observe that rooms are cluttered with potential booby traps to trip the forgetful resident. A medicine cabinet may reveal medications the patient doesn't bring to the office, but which may be contraindicated. "You're better able to make an informed decision as to whether a patient - despite what he or she tells you in the office - is comfortable and able to make it at home," concurred Daniel Lasser, M.D., M.P.H., clinical director of family medicine at the Erie County Medical Center and director of the Urban Family Medicine Program. Seeing one patient is useful, and visiting couples yields some extra benefits, noted Holden, who with his wife, Carol, a nurse practitioner, often visits couples in their 80s and 90s. "I gain as much information about how one (spouse) is doing by asking the one not being examined," Holden said. "You can really learn what type of support system surrounds the patient by seeing the home and talking to the people living with your patient, whether it's a spouse, another relative, or a friend. "For example, if you ask an elderly female if she's eating, the answer is almost always 'yes'. If you ask her daughter who's actually watching her eat, you may get a different, and more accurate, answer. Such added insight isn't often available in an office visit where a doctor's questions are directed only at the patient." Holden believes that housecall are becoming more common again now that doctors don't have to worry about whether they can fit all of their equipment into a little black bag - everything a doctor needs is a phone call away. During the last 10 years, the full range of services of practically all labs is availab le for dispatch to a patient's home on a physician's phone order. The services often are performed faster at WINTER 1991 Eugene A. Steinberg, M.D., feels house<aDs help redU<e the fear and isolation of many terminally mpatients. "You can really learn what type of support sy stern surrounds the patient by seeing the home and talking to the people living with . " your patrent. home than in a hospital. The physician also can arrange for physical therapy, occupational therapy, and intravenous therapy in the home. Lab work and therapy visits are covered by major in urance carriers, Medicare, and Medicaid. Home visits help make many people comfortable, and reduce the fear and isolation which many chronic or terminally ill patients face, said Eugene A. Steinberg, M.D., clinical assistant professor of medicine and family medicine and a member of UB's Division of Geriatrics and Gerontology. "We talk to people, listen to people, and deal with the fears that block the learning in the hospital," said Steinberg, who is also medical director of the Buffalo VA Medical Center's Hospital Based Home Care Program. The program at the VA is special because patients are seen in their homes not just by a doctor, but by a team that includes nurses, social workers, a dietitian and a physical therapist, Steinberg noted. Many of the patients the team sees have chronic illness and are stable, such as those who have suffered a stroke or multiple sclerosis. There's also a growing group of patients who are discharged from hospitals sicker and unstable and who are continually readmitted. The team finds that early intervention, such as making small changes in medication, often makes a big difference and can even keep the patient out of the hospital. This not only helps the patient, but saves the hospital money. The team works closely with the oncology unit at the VA Medical Center, providing compassionate posttreatment care for terminal patients, in areas such as pain control, psychological issues, and generally aiming to improve the quality of life. "It's a very different focus from acute care," Steinberg noted. Another group of patients seen by the VA team is those with multiple medical problems. BUFFALO PHYSICIAN A D BIOMEDICAL SCIENTIST �Assistant professor and director of faculty development and continuing education in the Department of Family Medicine, Roseanne C. Berger, M.D., prepares students 0 to determine exactly what they can learn from a housecall." "The housecall by the full team is extremely valuable in untangling confusing symptoms," Steinberg explained, "and in addition provides an excellent opportunity for effective one-to-one education with patients on their turf on how to watch their bodies." If housecalls seem like a well kept secret, it's because physicians haven't promoted or advertised that they make housecalls, said Robert A. Baumler, M.D., an internist, cardiologist, and clinical assistant professor of medicine at UB. That's because many people mistakenly think they can routinely call a physician to their house for whatever's wrong with them. Doctors can't make housecalls for everything because the travel time would consume their day. Another drawback to housecalls is that they may keep patients from getting much-needed activity - there is therapeutic value in getting dressed up for an office visit and getting out for some fresh air, some doctors assert. BU FFALO PHYSICIAN AN D BIOMEDICAL SCIENTIST Critics also argue that medical insurers, including Medicare, don't adequately acknowledge the value of housecalls. Reimbursement rates don't come close to covering costs. Marshall Clinton, M.D., emeritus clinical professor of internal medicine at UB, recalls he "used to make a lot of housecalls, and was trained to do so. You could do a lot for people at home that you couldn't do any other place." Although he still makes calls on selected longtime patients, Clinton says he's one of the physicians who is fed up PRESCRIBING HOUSECALLS House calls are best used when: e It's helpful to assess the home situation, especially for the elderly and newborns. e A patient's condition would be adversely affected by being transported to the office. e A terminal illness affects a longtime patient who may not require hospitalization, but may need a medication change or other support. e Transporting the patient for an office visit would be a hardship or impos- sibility for family members or friends. e It's more convenient for the physician. If a parent calls at 5 p.m. about a fairly well-defined condition in a child that's not likely to require extensive lab work, such as an earache, the doctor may find it easier to pay a house call than wait for the family to get to the office. -Thomas C . Rosenthal, M .D., clin- ical associate professor and director of residency education in family medicine at UB WINTER 1991 �8 Early intervention, often possible only through home visits, tan signifitantly improve outtomes. with government regulations and inadequate reimbursements. "I rather expect I'll be retired within a year," Clinton confided. Despite the drawbacks, the Family Medicine Department remains convinced that there is a place for the housecall. According to a survey by Roseanne C. Berger, M.D., 16 of 26 full-time faculty members in the department visited patients' homes during the past year. Starting this year, all new family medicine interns are receiving an orientation lecture on housecalls by Berger, who is assistant professor and director of faculty development and continuing medical education in the Department of Family Medicine. "We need to prepare (future) physicians to determine exactly what they can learn from a hou ecall," she said. WINTER 1991 "It's important to get students in their formative years to become familiar with what can be done for people in the home . " Some students in family medicine already accompany faculty members on housecalls, and Berger would like to see that opportunity extended to all medical students. "It's important to get students in their formative years to become familiar with what can be done for people in the home," she said. There are many resources available to provide care for people at home, such as visiting nurses or X-ray services, but "I don't think students appreciate it unless they see that in action," she said. Berger notes that doctors are trained in a very high- tech world, and may appreciate being exposed to the low-tech surroundings of a patient's home. Janet V. Johnson, a fourth-year medical student, said she "found it refreshing and mildly surprising to learn that BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �physicians - not just visiting nurses alone- actually make housecalls." She says she not only finds housecalls interesting and helpful, but after making just one call was firmly convinced they'll be an integral part of her own practice. "On my first visit," Johnson recalls, "we were going to see a 51-year-old bedridden man who was cared for by his 78-year-old aunt. When I saw her age in the written report, I was naturally concerned about her ability to function effectively at her age. "But when I saw the aunt at work in the home, my mind was immediately placed at ease because she seemed much younger than 78- and fully capable of handling things. Instead of her age being a concern, the visit put fears to rest." Johnson's evaluation of the home visit summarizes that of many practicing physicians: "I enjoy it, and you can learn a lot from it." e TIME-HONORED PRACTICE DESERVES TO MAKE A COMEBACK orman Chassin, M.D., '45, muchhonored senior statesman of the Western New York medical community, considers housecalls so valuable that when poor health robbed him of the vigor to continue them, he ceased practicing medicine altogether. "I never lost anything from going into a home, and I a lways gained immensely," Chassin said. "There is no questioning the rewards in terms of new information about the patient's lifestyle. This information is the cement that fills in the cracks of one's understanding of a patient." "The whole physician-patient relationship is fundamentally enhanced," he continued. "The physician has answered the patient's call totally, bodily. That is not the same as answering the phone or being in the office. The whole transfer phenomenon, the psychological aspect of the relationship, is benefited." Chassin is respected by patients and physicians alike. When he retired, his patients established the Norman BU FFALO PHYSICIAN A D BIOMEDICAL SCIENTIST "There is no question the housecall is a plus. The primary concern of the physician is problem--solving for the patient, and there is much that can be learned from the patient's setting. We are sometimes surprised with entirely new information that affects management of the patient's problem." Chassin Endowment Fund at the Erie County Medical Center, where Chassin spent more than 20 years as attending physician. The fund provides an annual stipend to the outstanding intern in internal medicine at the center. He holds the Kenmore Mercy Hospital Foundation's highest award for service to his patients and the community. James Nolan, M.D., director of medicine at ECMC and chairman of the Department of Medicine at UB, considers Chassin one of the leading clinicians in internal medicine in the Western New York area. Chassin was instrumental in forming the Committee on Human Values and Medical Ethics at UB, and with organizing the first meeting of clinical chiefs of medicine from area hospitals. Hundreds of medical students have benefited from Chassin's knowledge, which is imbued with extraordinary compass ion and concern for the patient's emotional, as well as physical, well being - an outgrowth of Chassin's long interest in psychiatry. He was headed for a career in the field when he switched at the last moment to internal medicine. Chassin believes that medical treatment should be personal, that ideally physicians should form long-term relationships with their patients, garnering as much information as possible about their lives. Rooted in this belief is his respect for the value of housecalls. "There is no question the housecall is a plus," Chassin said. "The primary concern of the physician is problemsolving for the patient, and there is much that can be learned from the patient's setting. We are sometimes surprised with ent irely new information that affects management of the patient's problem. "Physicians must be aware of the social factors- the patient's immediate family, as well as cultural, ethical, legal and economic constraints. Rarely can one attend a patient in just the physical sense." Making housecalls meshes w ith another Chass in opinion of h ow medicine should be practiced - slowly and patiently. "Nowadays new students and physic ians feel they n eed to do something quickly," he said. "I teach that certain diseases and illnesses take a basic natural course, and that time is an important element. Sometimes it is better not to jump in with aggressive therapy, but to wait for the appropriate moment. "And for many patients, home is a better, even safer, place to heal than the hospital," he said. "Considering all the risks of being in a hospital today - technology gone wild, infection running rampant - home can be better for certain given conditions. "Obvious benefits aside, if housecalls are returning to favor now," Chassin said, "the impetus is probably economic." "The government and other payors have realized that in certain instances, the home call will benefit the payor more than some sort of call in the doctor's office," he said. "If you make the econom ic rewards high enough, the housecall will return." e - By Lois Baker WINTER 1991 9 �10 n 1989, New York became the first state government to step in and tell medical hools and teaching hospitals how to run their residency programs. intervention- intrusion to some- came in the areas of work hours, supervision, and credentialing. (See box for details.) After living with the regulations for a year, the reaction ofUB faculty and residents is still mixed, depending in great part on specialty. But many concede that the regulations aren't as bad as they had feared. SURGEONS ARE STILL UPSET "What you see now is more attending staff working with more junior residents," Hassett said. "In the past, a third-year Surgery was- and is still- the medical service that is least comfortable with the regulations. resident might have helped a first-year resident, but now the When the regulations first-year resident is likely to be getting instruction from a 40were proposed, Lewis Flint, or 50-year-old attending physiM.D., who was chairman of cian who has far more experisurgery at UB, said that they ence. We might get an educawould damage surgical educational windfall out of that." tion so much that it would be But he is troubled by the better to close the program than overall effect of the regulation comply. Flint delivered himself on surgeons' education. from their restrictions by ac"There is a practical fivecepting a position at Tulane year limit on post-graduate University in New Orleans. education in surgery because "My sense is that most of coulf/ ~UtH! &~n U LOP.)P. you can't get anyone to pay for our residents are not happy with more," he said. "And if you cut them," says James Hassett Jr., ~a/~ 'o/,,& /io/bJ an> .;h~~ the amount of time available to M.D., associate professor and residents in those years, you cut chairman of the Task Force on clinical exposure." Graduate Medical Education According to Hassett, the in the Department of Surgery. BY JUDSON MEAD bottom line is how indepen"They don't like anything dently the resident can act when forced down their throats. They he or she is finished with the just want to operate and anyresidency. Hassett worries that some of a resident's education thing that restricts their chance to do that is perceived as a negative." may be shifted from residency to practice. "The essence of surgical education is repetition," Hassett Some residents simply ignore the rules, Hassett said. If said. "The important thing is how many complex procedures they aren't finished with their work, they stay beyond the time allowed, even though the new regulations have built in extra has a resident been exposed to and how many times a resident time for surgical residents. has repeated simple procedures." Surgical residents are allowed to be on call past the normal hours limit if they are "generally resting" with "infrequent" OTHER DEPARTMENTS ARE CONCERNED interruptions for patient care. The exceptions apply only if The view is generally more positive outside of surgery, but residents are on call no more than two time a week and have people's concerns haven't vanished. a 16-hour rest period after they go off duty. In the Department of Medicine, the move to an SO-hour In its attempt to comply with the new regulations, UB's week for residents was coming one way or another - its surgery program has created a patchwork of different rules in national accrediting body implemented the change nationdifferent hospitals, such as instituting a regimen of night wide shortly after the New York regulations were put in place. coverage. The side effect is that there are fewer residents on 'The house staff likes the changes," says Alan Saltzman, duty during the day, spreading them thinner. M.D., clinical associate professor of medicine at UB and Even if the hours requirement has surgeons steaming, clinical director of the Department of Medicine at the Erie some of the supervision requirements are viewed as positive. County Medical Center. "They've clearly been 'decompressed."' :7/ WINTER 1991 BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �In addition to giving residents a more humane schedule, the changes have "put more emphasis on the role of the attending physician, which is a benefit." But there are still worries about the effects on education and patient care. Gerald Logue, M.D., chief of staff at the Buffalo VA Medical Center, calls the regulations "a detriment to education." The problem Logue sees is with continuity: continuity of patient care and continuity of resident education. If a patient comes in at night, the night float (a resident who covers two or three different specialty services) does the workup, a different team sees the patient the next day, and yet another team sees the patient the next night. Because residents must take a whole day off every week, they often have to drop out of a patient's care, which decreases its educational value. "It's hard for residents to follow a case," Logue says, "and hopefully patient care doesn't suffer." Even if patient care hasn't suffered, there is no evidence that it has improved now that hours are reduced, notes Saltzman. Yet the state based its regulation of hours on the assumption that long hours were detrimental to patient care. A Minnesota study published in the November/December 1990 edition of the ]ournal of General Intemal Medicine showed that the outcomes for patients who were cared for by the admitting resident were the same as the outcomes for patients who were admitted by a night float and cared for by a different team of residents, Saltzman noted . However, disrupting continuity of care can be expensive, he added. The study found that patients who weren't treated by the admitting resident stayed in the hospital longer and received more lab tests. "It's hard to say whether we've gained as much as we've lost," Logue said. "We don't have people walking around who haven't slept for 36 or 48 hours. But the law encourages a shiftwork approach to medicine that is incompatible with what residents will encounter in practice in the real world." would be. "The mood is settling out," Naughton said. "The initial mood was that this would be disastrous for training, but this has not been borne out. "As far as education is concerned, I think the effects have not been adverse. In fact, what's happened has probably been positive." Whether the regulations are driving the best young doctors from choosing New York State residencies, as some had feared would happen, is difficult to tell, Naughton noted, because other factors also affect residents' choices. Downstate, for instance, the biggest problem in recruiting residents is the large number of AIDS cases. "My feeling is that recruiting for Buffalo has gone fairly well this year," Naughton said. INFLEXIBILITY IS A DRAWBACK In Obstetrics and Gynecology Myroslaw Hreshchyshyn, M.D., professor and chairman of the department, says that, on balance, the regulations have benefited resident training and patient care. However, there are drawbacks. "The negatives are cost, loss of flexibility in handling things as we (the departments) think best, and the creation of expectations that are not always reasonable," he said. Hreshchyshyn thinks the residents in his department are generally pleased with the regulations, but adds that he senses that they are coming to regard the limitation on hours as an entitlement. "The law takes away flexibility in terms of assignment and continuity of care," Hreshchyshyn said. "In this respect it is no different than any other work rule specifying when you can take a coffee break and so on." MOOD IS SETILING OUT Well before last year, Obstetrics and Gynecology was moving toward voluntarily providing supervision by faculty members at the level now mandated. When the regulations were implemented, Hreshchyshyn warned that the cost of requiring, rather than encouraging, the increased supervision would be a problem. His view is the same now. Summing up the situation, John Naughton, dean of the medical school and vice president for clinical affairs at UB, says most people think the regulations aren't as bad as they thought they "This is a costly proposition for the hospitals," he says. "With time it will become routine. The net result is that we have added a very costly component to hospital services." BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST WINTER 1991 11 �12 SUPERVISION, NOT HOURS, IS THE KEY Supervision, not the hours requirement, is the key part of the change, according to George Ennis, senior hospital administration consultant at the New York State Department of Health. "The hours-business got distorted out of proportion at the expense of the supervision issue," he said. Most hospitals in the state are working assiduously to comply with the regulations, Ennis said, and most residency programs have provided the funds needed for supervision. The department has received some complaints about non-compliance and has cited some programs. It is the consensus in Buffalo that local hospitals have had an easier time complying with the regulations than downstate hospitals. "Teaching hospitals in Buffalo have always had rather rigid standards," said Luther Musselman, M.D., director of medical education at Millard Fillmore Hospital and clinical associate professor of medicine. He thinks the changes have worked for the better elsewhere, especially with respect to tightening supervision downstate. HURRAH FOR CREDENTIALING Of the three components of the law, the one concerning credentialing has generated the most enthusiasm locally, even though it has also generated more paperwork. "The credentialing has been positive because it forces us to scrutinize more closely what residents can and can't do and how good they are," said Hreshchyshyn ofOB/GYN, adding that his department is now doing a better job of monitoring both residents and their supervisors. The department absorbs the extra cost this entails. In the Department of Family Medicine, which was already in compliance with the hours regulations, the credentialing requirements have caused the department to formalize what it was doing by keeping better records, noted Thomas Rosenthal, M.D., director of the family medicine residency at UB and clinical associate professor. The internal medicine program at Millard Fillmore Hospital developed an extensive credentialing protocol in 1988 before the new regulations appeared. It specified the criteria for gaining privileges for each procedure a resident encounters during training. WINTER 1991 The internal medicine protocol was then used by UB as a model for the rest of its departments in the Western New York Consortium for Graduate Medical/Dental Education, which coordinates all of UB's residencies at the various hospitals. Credentialing decisions are made by the director of each program. Among all of the training programs in Buffalo, there are 275 procedures which require credentials (for example, inserting an IV line). Keeping track of the credentials of the 615 residents has been streamlined by centralizing the information on computer. All consortium hospitals have access to that computer information. "What this has led to is the possibility of much more information exchange between members of the consortium," says Saltzman of ECMC. "But whether we're teaching better or just creating a better paper trail is a question." Musselman of Millard Fillmore says that the formalization is a good idea because credentialing in the past was more impressionistic. Now computerized data on procedures completed is forwarded to the chairman so he or she has better information on which to base a decision. COST IS A HURDLE While New York is still the only state to directly regulate residency training, others are watching. "The issue has to do with the whole structure of postgraduate medical education," said Ennis of the Department of Health. "The American College of Physicians, the American College of Surgeons, other states, and the federal government are all looking hard at what New York is doing." Indeed, the 80-hour limit on residents' work hours is either under legislative consideration or discussion in several states, including California, Pennsylvania, Illinois, Minnesota, Connecticut, and New Jersey. And in] une 1989, the AM A's House of Delegates passed a resolution by its Resident Physician Section endorsing the SO-hour limit. The biggest hurdle for the states is cost. About two-thirds of the expense the regulations impose on hospitals has been covered by increased reimbursements, either from the state or, in the case of the VA hospitals, the federal government. At the Erie County Medical Center, Assistant Adminis- BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �trator Thomas J. Faith says that at the moment money is not his chief concern. "The money is there to hire ancillary staff, but the problem is finding them," he said. Marcia Brierly, administrative director in the Department of Medical Education at Millard Fillmore, believes that the financial impact will show more clearly in the future. "It's dangerous that the hospital is absorbing so much of the cost of the regulations," she said. RESIDENTS' MORALE IS HIGH But Brierly has also observed a positive change on a human level. "The biggest impact of the regulations on residents is in their morale," she says. "I hear the same thing from people around the state: we didn't see the mid-winter depression we're accustomed to in residents." Lisa Benson, M.D., a thirdyear resident in internal medicine, credits the hours limit with some improvement in the quality of her life. "There's been a real difference - for the better," she said. "There may be a slight deficit in continuity of care, but I don't think it's been significant, and I don't think the change has had an adverse impact on education, either." While surgery residents complain that the regulations make their hours too short, some residents think it's still not short enough. Timothy Gundlach, M.D., who started his residency in surgery, moved to anesthesiology this year, a department that was already in compliance with the regulations before they took effect. There's a camaraderie among surgery residents that tends to minimize complaints about the long hours, he said, but that wasn't enough for him. With only 50 or 60 hours a week spent outside the hospital, there wasn't enough time left for reading or even to conduct a personal life. Gundlach noted that there's a general feeling that if more support staff, such as IV teams, could be hired, it would take the pressure off surgery residents. People are leaving because there's too much work. NashatRabadi, M.D., chief resident in medicine at ECMC, says of going home to bed after being on call: "That was a real pleasure." e BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST 13 HOURS Residents may be scheduled for no more than 80 hours a week, when averaged over four weeks. They may be scheduled forno more than 24 hours in a row. On-duty assignments must be separated by at least eight hours of non-working time. Residents must get 24 consecutive hours off each week. Hospitals must enforce policies that prohibit combined assigned hours and moonlighting hours from exceeding the limits on assigned hours. In certain departments that don't have a high volume of acutely ill patients and where the resident is able to get enough rest, there is more flexibility in scheduling. (Excluded from this clause are anesthesiology, family practice, medical, surgical, obstetrical, orpediatricservices.) Surgery residents can be on call past the hours limit if they are "generally resting" with "infrequent" interruptions for patient care. The exceptions apply only if residents are on call no more than two times a week and have a 16-hour rest period after they go off duty. ON-SITE SUPERVISION A sufficient number of supervising physicians must be present in the hospital 24 hours a day in the acute care specialties of anesthesiology, family practice, medicine, obstetrics, pediatrics, psychiatry, and surgery. Supervising physicians must be board certified or board admissible, or have completed a minimum of four years of postgraduate training. The supervising physician may be a resident in his final year of post-graduate training if the patient's physician can get to the hospital within 20 to 30 minutes of being called. CREDENTIALING The medical staff must provide written documentation of patient-care privileges granted to residents. e WINTER 1991 �14 B y D v A M H D M E L G R E E N ts beginnings were casual meetings in the halls and conversations in the OR lounge at Children's Hospital about five years ago. Sometimes the discussions were prompted by a special patient who had a disfigured face along with problems hearing, speaking, and eating. Other times, the physicians would talk about patients who had more common disorders involving the head and face, such as cleft lip and palate. The doctors were concerned because these patients were being shuttled from specialist to specialist almost unendingly and some of the older children were out of school for surgery more than they were in school. p H WINTER 1991 0 T 0 s B y s M 0 N T 0 N G BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST ��16 The disconnected conversations finally found a direction with the development of the Craniofacial Center of Western New York. The center, begun in 1988, maintains a unique interdisciplinary team approach to diagnosing and treating patients who have disfiguring and disabling conditions of the head and face . It is based at Children's Hospital and has ties throughout the University and community, according to Joseph Bernat, D.D.S., M.S., who heads the center's board of directors and is chairman of pediatric dentistry at the UB School of Dental Medicine. One of the patients who influenced Bernat and colleagues to start the center is six-year-old Michael Manthey, who has presented one of the center's most challenging cases. Many of the doctors now associated with the center have been treating him since his birth, and continued treating him when the center was organized. Michael was born with a rare genetic disorder known as Nager's syndrome. This disorder is characterized by severe underdevelopment of the lower face, hearing loss, and limb abnormalities, according to Robert Perry, M.D., clinical assistant professor of surgery (plastic), otolaryngology, and oral/maxillofacial surgery at the UB medical school and member of the Craniofacial Center's board of directors. Michael had almost no chin; his lower jaw was deformed and retrusive. His tongue is small, he has hearing problems, and he is missing fingers on each hand. His treatments aimed first to help him breathe and take nourishment. The later therapy helped him to communicate and to chew, as well as improve his appearance. When Michael was born he had to receive a tracheostomy to open an airway, as well as a gastrostomy so he could be fed using a tube that entered his stomach through the abdominal wall. He only needed the gastrostomy as an infant to ensure that he got adequate nutrition, but he may always need the tracheostomy. Since his birth, Michael has undergone multiple surgeries on his hands, and has WINTER 1991 been evaluated for laryngeal problems. "Last year we began to organize a treatment plan for reconstructing Michael's lower face," said Perry. Because Nager's syndrome is so rare, the team consulted specialists from craniofacial centers in New York, Toronto, and Dallas, he added. The first course of action was surgery to examine Michael's airway and expand his chin and neck tissue to make room for his new jaw. The next step was to begin expanding the jaw bone, Perry stated. The team used a technique known as the llizarov procedure, which was developed in the 1950s in the Soviet Union to stimulate bone growth. Until recently, this procedure was primarily used to lengthen limb bones. It uses an externally fitted apparatus that is placed over the area where bone growth is required. In 1987, two UB physicians, Monroe Strong, M.D. and Robert Gillespie, M.D., were the first in North America to use the MonticelliSpinelli External Fixation System to promote bone growth in a patient who had a badly infected broken leg. Michael wore a modified version of that device that was fitted over his head and face, said Bernat. It looks like a halo and is securely anchored to his skull. Surgeons cut through both sides of the lower jaw bone, creating fracture sites. The apparatus holds the fracture sites open. As in a broken bone, new bone grows BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �between the fracture sites. As new bone is laid down, the apparatus is adjusted daily to open the space slightly between the fractures, stimulating more bone growth. The result is that now Michael has a more fully developed lower jaw and chin. The next step will be to reconstruct his jaw joints in order to get his jaw to open wider. When the joints are reconstructed, he will be able to chew better. Michael also received help for his other related problems. He wears a hearing aid and communicates through a combination of speech, sign language, and a computerized speech board, noted Sanford Nusbaum, D.D.S., clinical associate professor of oral and maxillofacial surgery at UB's dental school and a board member at the Craniofacial Center. "He pushes a button and it says 'Hello Dr. Nusbaum,"' Nusbaum reported. In spite of his disabilities, Michael is attending regular first grade and doing quite well emotionally. Michael's family is a pillar of support and very much involved with the success of his treatment, the staff noted. Michael's case is one of the few times mandibular (jaw) bone elongation has been done on patients in the U.S., Perry said, noting that the success of Michael's treatment reflects just how important it is for specialists to combine their expertise and resources. This is what sets the Buffalo center apart from the others. "Most centers revolve around a single surgeon who does the majority of the work," Perry explained. Bernat said that this individual becomes "the dominant force, and then the team takes on the personality and flavor and the bent of that individual profession." "We wanted to get away from that model so that everybody's contributions are considered and nobody feels as if they're left out," Perry said. "You can see that in our conferences. Everybody's opinion is respected." "No one part of the team is more important than any other part of the team," Bernat added. "So, the psychologist is just as important as the surgeon." One of the most common congenital disorders treated at the center is cleft lip and palate (CLP). BUFFA LO PHYSIC IAN AN D BIOMEDICA L SCIENTIST Michael'S case is one of the few times mandibular bone elongation has been done on patients in the United States. The success of his treatment reflects just how important it is for specialists to combine their expertise and resources, and it is what sets the Buffalo center apart from the others. CLP, which arises during the embryological development of the fetus, results in the incomplete closure of the palate and an abnormal cleft between the upper lip and the nose. CLP occurs in about one in every 700 live births. The relatively high incidence of this birth defect accounts for about 61 new cases every year in Western New York. Some children with CLP also present other associated problems which could be overlooked and come back to haunt these children later, noted Linda Brodsky, M.D., who is associate professor of otolaryngology and pediatrics at the UB School of Medicine and Biomedical Sciences and is on the board of directors of the Craniofacial Center. For instance, some children born with CLP also suffer varying degrees of hearing loss which may affect their speech development. Many physicians and dentists may not be familiar with the subtleties of these syndromes, Brodsky commented, and they don't know about new treatments and procedures. The center serves as a repository for tried and tested treatments as well as for new technology and the sharing of seminal ideas. And in no better forum can the sharing of ideas and opinions be heard than during the monthly patient conferences, which are held at Children's and open to all individuals interested in craniofacial disorders, said Bernat. At each conference, a lecture on a specific topic is presented to the audi- ence. Then one or more cases are reviewed with the actual patients present. Any of the specialists can examine the patients and review their histories and charts. After the patients leave, the specialists begin their debate about the best plan for treatment. The goal is to get a variety of opinions from all the specialists. "We talk it out - sometimes fight it out," Brodsky said. In the end, everybody must be satisfied with the treatment plan, she explained. It's not enough for an oral surgeon to get up and say "I want to do a bone graft now." Not only does he have to convince other oral surgeons in the group that this is the right thing to do, he must convince the other specialists as well. Most children born with craniofacial disorders are seen by team members immediately- right in the delivery room at Children's Hospital. (Those born at other hospitals may be transferred to Children's if the condition is severe.) In the delivery room, the breathing of newborns with craniofacial disorders is checked. If there's a problem, an otolaryngologi t is called in and may perform a tracheotomy to open an airway in the neck. A few days later, once the physicians are sure the infant is breathing and feeding properly, Luther Robinson, M.D., examines the infant for possible genetic disorders. Robinson, director of Clinical Genetics and Dysmorphology WINTER 1991 17 �18 llizarov's Procedure, developed in the Soviet Union in the 19SOs to stimulate bone growth, was used to lengthen Michael's jaw through the use of an externally fitted device. in the Division of Human Genetics at Children's and assistant professor of pediatrics at UB, is also on the board of directors at the Craniofacial Center. Once this diagnosis is made, the team will have a better idea of how the disorder will behave and progress. From there the doctors are able to make a prognosis. Craniofacial patients generally require years of treatment. For example, patients with CLP may require between four and six surgeries to repair the lip and palate, and may also have to have their dental arches expanded through bone grafts. Treatment will last through their teen years, said Nusbaum, the maxillofacial surgeon. Many of these procedures are timed according to the eruption pattern of the permanent teeth, he added, and this stretches out the treatment period. ln addition, these children "have to be monitored for speech and often they need the help of a speech and language pathologist," commented Nusbaum. Because people are concerned about their looks, a person who has never looked right or sounded right or chewed right may need counseling, as may their families. Success for a patient may be measured in small victories, resulting in a great deal of stress. Older children and even adults are treated at the center, Nusbaum said, adding that the younger patients tend to respond somewhat better to treatment because they're still growing and WINTER 1991 I don't have to relearn speech habits. The coordination of the center's activities requires a monumental effort on the part of support staff. Two of the people who are responsible for keeping the center running smoothly are Deborah Green and Janice Rockwood, R.N. Green, who handles secretarial duties, is helping to set up a fee structure that should save patients money. Patients will be charged a flat fee for evaluations by the team, rather than being billed by individual specialists. The treatments themselves generally are covered by insurance, and patients with congenital deformities often are BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST \ �eligible for state assistance. Rockwood, a nurse at C hildren 's fo r 15 years who h as worked in just about every department, began working at the center last year. "I am a patient advocate," sh e sa id. "Th a t 's m y m a in jo b . I h ave th e responsibility of sch eduling pa tie nts for their appo intments and surge ries, t h e ir preo p e ra tiv e proc edures, a nd patient education ." Rockwood also gives invaluable advice on things such as referrals and payment, and acts on behalf of the patients when they see doctors who are not part of the center. Finally, Rockwood se rves as a sounding board for patients to air their frustrations, fears, and hopes. Because of their enthusiasm fo r the interdisciplinary approach , the team is lobbying lawmakers in Albany to find resources so that other craniofacial cen ters can be started up through out th e state, Perry said. In creating a state-wide network of centers, patient care will be enhanced, the number of surgeries reduced , and costs will come down, Brodsky added . The center has already taken on an international flavor. During June 1989, members of the craniofacial team spent two weeks in the Dominican Republic on an informational exchange miss ion . They spent time diagnosing patients and even operating on nine children . S ix footlockers of supplies and equip- ment , which were don ated by S isters H os pital a nd C hildre n 's H ospita l of Buffalo , we re delivered to C hildren's Hosp ital in the Dominican Republic, Perry said . 19 The team also tra ined some of the loca l phys ic ia ns on n ew techniqu es. Th e t ea m will b e returning t o th e Dominican Republic in N ovember to strengthen ties and share more of their information, he added. Future success of the C ra niofacial Center depends upon continued integration of the various fields of expertise. The team encourages those interested in treatment, education, or research of craniofacial disorders to get in to uch with the center at (716) 878-7149. e Craniofacial Center's Aim: lmproYing uality of Life W hen people usually think about a craniofacial treatment center, they think about corrective surgeries that change the way a person looks, noted Linda Brodsky, M.D., who is associate professor of otolaryngology and pediatrics at the UB School of Medicine and Biomedical Sciences and is on the board of directors of the Craniofacial Center. Here, the concern is not just with correcting deformities, but more importantly, making sure that the patient functions reasonably well, stated Brodsky, who is also a co-head of the Department of Otolaryngology at Children's Hospital. The aim is to improve the overall quality of life. "The center is multidisciplinary in that there are many disciplines involved, but it's also interdisciplinary in that all of the disciplines are intertwined," said Joseph Bernat, D.D.S., M.S., who heads the center's board of directors and is chairman of pediatric dentistry at the UB School of Dental Medicine . "We work very closely with one another, and that's something that we stressed from the very beginning." BUFFA LO PHYSICIAN AN D BIOMEDICAL SCIENTI ST More than 20 health care specialties ore represented in the Craniofacial (enter. In all, more than 20 health care specialties are represented in the Craniofacial Center, including genetics; pediatric dentistry; speech pathology; audiology; psychology, and plastic, oral and maxillofacial surgery. The center currently treats over 200 patients, most with congenital deformities. Treatment generally starts at birth and lasts through the teens, though some adults are also treated. The center also focuses on education for the team members and residents, and it's beginning an aggres- sive research program as well, added Robert Perry, M.D., clinical assistant professor of surgery (plastic), otolaryngology, and oral/maxillofacial surgery at the UB medical school and member of the Craniofacial Center's board of directors. The research program includes a new investigative project on the efficacy of various procedures to lengthen the jaw bone. Initially, researchers will use animal models to test these procedures. Eventually they hope to apply their findings to e humans. �:···················· • • ••••••... . .....•••••••••.•••.......•• • •............•••••...............•.•••••••••••••••.........•.••••••••••••.•........••••••••.•.........•• ! .. 20 .: E R H E I1D A N D N_ T - ;:· .:. --:--:.. : - .- - - .:. - ~- ::. --- ,_ - -~ - -' ( L 0 K ' - w - v. ~<._~- E R ILLUSTRATIONS: THOMAS HUTCHINSON R 0 0 M ........................................................................ ....................................... ..................................................................... I \ �S DE ~ B y LAURIE 0 WOLF 21 <:) """ n 18~year~old body builder takes several types of black market steroids and gains 130 pounds of lean muscle over the next three years. He also experiences fits of depression, violence and I \ delusions of grandeur. Convinced of his omnipotence, he drives his car into a wall at 30 mph, after enlisting a friend to videotape the crash. BUFFALO PHYSICIA AND BIOMEDICAL SCIENTIST WINTER 1991 �22 ................................................................................... These are just two examples of the increasing misuse of anabolic steroids and human growth hormone that have come to the attention of researchers W. J. Kraemer, Ph.D., director of research at Pennsylvania State University'sCenterfor Sports Medicine, and Karl Friedl, Ph.D., a research physiologist with the U.S. Army Institute of Environmental Medicine. Presenting a paper on the topic at last August's Congress of the International Society ofPsychoneuroendocrinology, which was co-sponsored by UB, the pair said that reliable investigation into the health risks of steroid use is urgently needed. Mere scare tactics in the media, Friedl noted, are unlikely to discourage athletes from pursuing a competitive edge with hormones. Instead, the negative publicity surrounding steroids undermines their legitimate applications and impedes scientific study. Kraemer, a member of the U.S. Olympic Committee and the National Strength and Conditioning Association, made a plea for increased drug testing, better role models in athletics, research into alternative training methods, and rehabilitation for athletes habituated to steroid abuse. Anabolic steroids are synthetic de- increased significantly among athletes, mostly male, and has even spread to nonathletes who want only to improve their appearance. Friedl cited a recent study of 12th-grade males in the United States that showed that almost 7 percent use or have used anabolic steroids. Sixteen percent of those were not involved in any competitive sports. In another study of steroid use among male high school seniors, 38 percent reported beginning anabolic steroid use at age 15 or less. Naturally, few steroid users are willing to talk openly. Among those who do admit to using steroids, few will accurately report the amounts, strengths and combinations taken. Anecdotal reports suggest athletes take doses that are from four to more than 100 times greater than those approved in therapeutic treatment. In fact, noted Kraemer, an underground subculture exists to share information on experimental combinations and strengths of different steroids. "Stacking," the taking of multiple steroids at once, is common. Eighty-five percent of these drugs are acquired from pharmacists, doctors and veterinarians. The remainder are mailordered black market drugs, smuggled, stolen or secretly manufactured products. M ere scare tactics in the media are unlikely to discourage athletes from pursuing a competitive edge with hormones. Instead, the negative publicity surrounding steroids undermines their legitimate applica, tions and impedes scientific study. ................................................................................... WINTER 1991 rivatives of the male hormone testosterone and are FDA-approved for treating a small number of diseases. Human growth hormone, somatotropin, comes from the pituitary gland and is sometimes prescribed for children who are not growing properly. But athletes use the substances more than doctors do: to promote muscle growth, to improve athletic performance, and to prevent or speed recovery from injury. Reportedly, the first use of anabolic steroids occurred during World War II, when they were given to German troops to increase strength and aggressiveness. Based on anecdotal reports, steroids were first used in athletics by the Russians in 1954, Friedl noted. Since then, the use of these drugs has BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �"In a controlled research setting, there's no way to study the superhigh doses these athletes are taking," says Kraemer. "It is simply not bioethical to administer the drugs in such massive doses." Hence, most of the information on the health risks of anabolic steroids comes from the treatment of patients who have taken comparatively smaller therapeutic doses, or from the observations of sports physicians. Friedl noted that one important area that needs more research is steroids' effect on the prostate gland. Because the prostate gland is a target for steroids, researchers suspect that repeated use might cause enlargement of the gland or even cancer. He sees many parallels between men's use of steroids and women's use of the contraceptive pill and predicts that it will take a long time for all of the effects of steroids to emerge. Not much is known about the effects of steroids on musculature and skeletal muscle growth. However, it is suspected that prepubescent children and adolescents who take steroids may be in \..l,~. danger of stunting their growth. There are some effects that are more well documented, Friedl said. Heavy users face an imbalance in high- and lowdensity lipoproteins, which may promote arteriosclerosis and heart disease. There have been everal case reports of strokes that seem associated with steroids. Orally administered steroids have been implicated in the development of benign tumors and blood-filled cysts of the liver. Reproductive function and sex characteristics are affected. Males may suffer from atrophy of the testes, low sperm count, and increased libido. These effects may gradually reverse when the drugs are stopped. However, gynecomastia, the enlargement of the breasts, may not. (To rid themselves of this feminizing effect, some body builders resort to surgical mastectomy, Friedl noted.) Females may exhibit increased hair growth on the face, enlargement of the clitoris, deepening of the voice, and loss of menstruation. Acne in users of both sexes is common. The use of human growth hormone is less prevalent than anabolic steroids, partly because it is less available on the black market. In adults, it causes acromegaly, a condition characterized by enlargement of the hands, feet and face. Another area that researchers don't I I \ know much about is the psychological effects of steroids. Kraemer noted that anabolic steroid users report increased energy, greater endurance to stress and a keener desire to compete that can lead to habituation. However, they also report various forms of psychoses: delusions of grandeur, paranoia, auditory hallucinations, depression and mania. Stopping the drugs usually brings an end to paranoia and mania, but may increase depression and apathy. "There is no question that steroids build up bodies," noted Kraemer, "but at what price? The young men and women taking these drugs don't appreciate the serious health risks they're taking, not the least of which is potential psychological damage. There hasn't been a careful ex- perimental study in this area, and one is badly needed. The people at this congress are in a position to take that next step." 23 DNTIERNATDCNAIL CON ff:IERIENCIE RIEFlllECTSS SSIHID ff:T ON SSIP>IECDAILTY "There's been a definite shift in the field of psychoneuroendocrinology ,"explained Uriel Halbreich, M.D., professor of psychiatry, research professor of gynecology/ obstetrics, and director of Biobehavioral Research at UB. Halbreich chaired the 21st Congress of the International Society of Psychone u roe ndoc r in o logy, which wasco-sponsored by UB. The congress brought almost 450 scientists and clinicians from around the world to Buffalo last August to address the theme ofhormonal modulation of the brain and behavior. Research during the past 10 years has spotlighted new mechanisms of brain function, Halbreich said. "We used to measure the peripheral hormones, for example, cortisol, to learn whatwasgoingon in the brain,"Halbreich said. "It was thought that the brain created hormonal changes which then influenced behavior. "But in the early 1980s we discovered receptors for hormones actually in the brain. Now we also study how the hormones, themselves, affect the brain and cause changes in behavior." This exciting shift has advanced the management of mood disorders. In studying this new mechanism of brain function and dysfunction, better drugs are being developed, along with more effective treatments. • WINTER I99I BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �DO BAD HABITS Sometimes, but beware of the correlations 24 pidemiology helps to answer some of society's questions, but its findings need to be closely and carefully examined. That was the message that Saxon Graham, Ph.D., professor and chair of the department of Social and Preventive Medicine, delivered as the Stockton Kimball Lecturer at the 1990 Annual Faculty Meeting last spring. y Graham is an epidemiologist who received the 1990 Distinguished Achievement Award of the American Society of Preventive Oncology for his pioneering research. He has developed most of the epidemiologic methods that are currently used to investigate the relationship between diet and cancer, and he and his group identified many of the foods and food components that increase or decrease the risk of cancer. Graham is the principal investigator of a $6 million, five-year study funded by the National Cancer Institute to investigate the link between diet and cancer. While obviously an advocate of the usefulness of epidemiology, Graham warned his audience to be cautious when dealing with epidemiological findings. WI TER 1991 BUFFALO PHYSICIAN A D BIOMEDICAL SCIENTIST �BREED DISEASE I you make, warns epidemiologist Saxon Graham. 2S "The most fundamental fact of epidemiology is that it is a very inexact science," he said. Physicians should be aware of the trouble spots that could make a study suspect, Graham explained: Too little replication of a result. Replication is especially important in epidemiology because this field is particularly prone to errors in observation, Graham said. These errors often occur in studies that rely upon reporting by patients themselves. Memories of past exposure or behaviors are suspect and "even patients' current observations are not made with the precise tools that clinicians and bench scientists are often able to use," Graham explained. e .,., 'Z ... Too few subjects in the test. "Individuals are so idiosyncratic that it is difficult to generalize a finding to humans as a group from only a small number of observa~ tions," he said. The element Of time. (CONT.PAGE26) W INT ER 199 1 BUFFALO PHYSICIAN AND BIOMEDICAL SCIE TIST �(CONTINUED FROM PAGE 2S) 26 t seems obvious that a study must allow enough time for a pathological effect to show up, but Graham said that this is frequently forgotten. In the case of Love Canal, for example, Graham said, "the convincing evidence probably will not be available for a good many years simply because the diseases these exposures might cause have such a long latency and such low incidence," When researchers do allow enough time, it's possible to make strong conclusions. For example, "one of epidemiology's major accomplishments was to show that cigarettes can kill people after many decades of smoking," Graham said. -{:{Lack of a "dose-response." In other words, risks should increase with higher dosages. -{:{ Inconsistent results. Several years ago, people became concerned over a study that linked saccharine with bladder cancer in one sex. Study after study failed to replicate that finding. Finally, "the most definitive study of the subject showed no relationship," Graham said. He also warned that although animal studies can be useful in corroborating effects found in humans, "what is true for animals is not necessarily so for people." Several studies have shown a relationship between tumors and alcohol in humans, but "so far as I know, the many attempts to cause tumors in animals with potable alcohol have been unsuccessful," he noted. In a case such as this, "where there is a strong association and many replications, I believe the prudent clinician would base his behavior on the epidemiology" instead of on the animal results, Graham said. -{:{ Potential confounders. Other factors can affect the results of a study, and must also be taken into account, Graham noted. For example, lower cancer mortality rates in the Los Alamos population does not necessarily mean that plutonium is good for you. A better explanation for this phenomenon is that Los Alamos residents are much more highly educated and probably have stopped WINTER 199 1 He warned t1uu aitnough animal studies can~ useful in corro"OOrating effects found in humans, "what is true for animals is not necessarily so for ~ople. '' smoking in larger numbers than the comparison populations, Graham said. Finally, Graham warned against throwing out a set of studies just because one or more members of the set has a weak conclu ion. An example is a study that looked at whether exercise can help prevent a second myocardial infarction (heart attack), conducted by John Naughton, M.D., dean of the medical school and vice president for clinical affairs at UB. Although the overall death rate and the death rate due to cardiovascular disease both decreased after exercise, they did so at a rate of "borderline statistical significance." However, Graham said that statistical significance should not be the only criterion applied to this study. "There has been replication of this finding in 22 studies," Graham said, "and the benefit of exercise under medical supervision probably outweighs any potential for harm. "Where there has been much replication of a given finding and all the findings are in the same direction, even though some of them are not quite statistically significant, that finding bears consideration." Thi is especially important when the proposed remedy isn't harmful. UB's epidemiologist isn't the first Graham to win fame for his theories on food. In 1839, the Reverend Sylvester Graham blamed red meats and refined flours as a cause for the rampant sexuality of his day. As a result, "Great-greatuncle Sylvester," as the epidemiologist jokingly called him, concocted his own type of flour, which is known today as graham flour. The idea of fiber as a nutritive additive has come up several times in the past century and a half. Although today you can "taste them again for the first time," as the slogan goes, back in 1888 you really could taste corn flakes for the first time. That was when "Dr. John Kellogg, also to cool the hot blood of Americans, advocated the replacement of white flour by whole grains and invented something close to what we know today as Kellogg's Corn Flakes," Graham said. Fiber has been more recently advocated as a preventive measure for colorectal cancer, but "epidemiologic research on fiber, per se, has been minimal and the results contradictory," Graham said. Fats are being linked to cancer, in· part because countries with high average dietary fat intake also have high colon cancer mortality rates. "But a simple correlation does not neces arily indicate a causal relationship," Graham cautioned. He pointed out that "a significant increase in the stork population in two counties in California paralleled an increase in the birth rate in those counties." The same nations that have a high fat intake also tend to be highly industrialized, Graham explained, and the increased risk could be due to the industrialized nature of the countries, rather than their high-fat diets. And there are possible confounders in the studies linking fat and cancer. "Thus, we need to study not only fats, but also high caloric intake, high body mass, and high energy expenditure through physical exercise in relation to a number of cancers," Graham noted. For the most part, epidemiologists can't make precise recommendations about diet, Graham explained. But epidemiology, through studies which are carefully conducted and interpreted, can "suggest clues for prevention of disease." e BUFFALO PHYSICIAN A D BIOMEDICAL SCIENTIST �-------------------------------------------~®~I~~- -------------------------------------------C .,. ~ (" If 0 27 Giving birth, rejecting a transplant: Torrwsi sees intriguing similarities By LAURIE WOLFE ould birth actually be a mother's immune system finally rejecting the fetus as it would, say, a skin graft? If so, what prevents rejection for nine months, and could that factor be useful in transplant acceptance? These are some of the current questions that intrigue Thomas B. Tomasi, M.D., Ph.D., director of the Roswell Park Cancer Institute. Known internationally for his landmark discovery of the mucosal immune system, Tomasi was given UB's Stockton Kimball Award in recognition of his 25 years of research in immunology and over 30 years of teaching. He will deliver the 1991 Stockton Kimball Lecture at the Annual Faculty Meeting in the spring. In addition to his administrative duties at Roswell Park, Tomasi is a professor of medicine and microbiology at UB and head of the Molecular Medicine and Immunology Division in the UB Department of Medicine. He maintains a busy and productive lab that is looking into several questions on immunology, including the riddle that has always puzzled scientists: How is it that the fetus survives inside the maternal womb in spite of the fact that it carries the foreign chromosomes of the father? Tomasi may have discovered the answer while looking at a different problem. Thomas B. Tomasi, M.D., Ph.D. "Infants of almost all species, including humans, are born without any antibodies on their respiratory and other mucosal tissues," said Tomasi. "Two of our current projects stem from the initial question , 'Why are newborn animals deficient in their mucosal immunity, and could this deficiency be due to a circulating factor?'" Tomasi and his fellow researchers suspected that the factor circulated in the blood . But, working with mice, it was too difficult to get enough fetal blood to proceed. Instead, the researchers used amniotic fluid because it is more plentiful and contains many fetal proteins. Sure enough, they found a substance in the amniotic fluid that suppressed WI TER 1991 BUFFALO PHYSICIAN AN D BIOMEDICAL SCIENTI ST �------------------------------------------- ~@~~~ -------------------------------------------.,. r I r It 0 ..... ~ 28 the immune response. This factor is either identical to or closely related to TGF-13 (transforming growth factorbeta.) Now that they knew what they were looking for, they were able to go back and identify the same factor in fetal serum. The findings were published recently in the Journal of Experimental Medicine. Using molecular techniques, Tomasi's lab has found that TGF-13 stays localized in the uterus. These discoveries led to the next question: Could the factor that makes babies deficient in their mucosal immunity be the same factor that keeps the mother's body from rejecting her fetus? "What we found was amazing-really exciting," Tomasi said. "This substance was present in the pregnant uterus and not in the normal uterus. It appeared at about the ninth day of a 20-day gestation period, reached a peak at 15 days, and then fell off rapidly as birth approached." He speculates that this may be the mechanism by which pregnancy is allowed to persist. "This has important implications," Tomasi said. "It's probably the hormones of pregnancy that are generating this suppressive factor in the uterus. We have found that this substance checks the expression of certain antigens controlled by paternal genes - the antigens that would normally stimulate the graft rejection phenomena. "Now we're wondering if birth actually is a rejection phenomenon. We're also wondering, if you lack enough of this substance, does a miscarriage occur? Up to now we could only speculate. But we're about to begin work with an antibody that will neutralize TGF-13, and this may give us an answer as to whether or not TGF-13 is involved in spontaneous abortion." Within a year, Tomasi hopes to take WINTER 1991 ~~what we found was amazing- really exciting. This substance was present in the pregnant uterus but not in the normal uterus. It appeared at about the ninth day of a 20-day gestation period, reached a peak at 15 days, and then fell off rapidly as birth approached." This may be the mechanism by which pregnancy is allowed to persist. this research further by seeing if TGF-13 is useful in preventing transplant rejection. Studies in his lab have already found that if a skin graft is performed between two incompatible st rains of mice, and the animal is treated with TGF-13, ordinary rejection of the graft is suppressed. "Naturally, this could have tremendous impact on the future of organ transplants," notes Tomasi. "We're just starting experiments with heart and kidney transplants." Interesting ly, in skin graft observations, Tomasi has found that the addition of TGF-13 can be stopped after a certain time without causing subsequent rejection. So once beyond an initial rejection stage, the suppressive agent is no longer necessary. "Of course, further studies have to be made into the toxicity associated with this naturally occurring immunosuppress ive factor," he noted. These experiments are bui lt on Tomas i's earlier ground-breaking work. He fo und that mucous membranes in the body produce antibodies that are distinct from the antibodies found in the bloodstream. T his mucosal immune system provides the body with a vital first line of defense against microorganisms that cause disease. The mucous membranes l ine the areas that come in con tact with the external envi ronment wh e re fo reign organisms can naturally and easi ly invade - the eyes, ears, nose, mouth, and gastro intestinal tract. Today hundreds of scient ists a re building on Tomasi's d iscove ry by research ing various aspects of the mucosal immunity mechanism, the structure of these particular antibod ies, how they are transported, and the mechanisms of vacc ination. Tomasi received his M.D., magna BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �-------------------------------------------:~:-------------------------------------------­ ~ It 0 29 cum laude, in 1954 from the University of Vermont. He then started working on his Ph.D. at Rockefeller University, where he began studies that led to his discovery of the mucosal immune system. As a profe sor of medicine and a research professor of microbiology at UB from 1965 to 1973, he further advanced his work. He left Buffalo to become chairman of immunology at the Mayo medical school, and returned to Buffalo to head Roswell in 1986. Tomasi will soon return to another area of research that he began at Mayo: the immunology of exercise. A casual remark by a friend, a physician associated with the Olympic Nordic Ski Team, was the catalyst that sparked Tomasi's interest. At any one time, the friend said, 20 percent of his cross-country skiers were out of commission with upper respiratory infections, whereas downhill skiers did not suffer the same setbacks. From his own experience as a competitive skier, Tomasi knew that cross-country skiing was far more exhausting than downhill, the equivalent of running a marathon as opposed to the 300 meters. Building on what he already knew about the mucosal immune system, Tomasi found that in athletes pushed to the limit, there is essentially a disappearance of antibodies on the mucous surfaces of the upper respiratory tract. He also saw changes in the circulating immune cells, the natural killer or "Nk cells" that are involved in resistance to cancer. Initially, there was a tremendous drop which then returned to a normal level in about 12 to 24 hours. So, in effect, severe physical stress caused a temporary immune deficiency. Conversely, if a person backed off on extreme exercise and did moderate workouts (this level was naturally different for each person), the person actually enhanced his or her immune response. This phenomenon could have considerable relevance in the treatment of chronic diseases. Of special interest to Tomasi is how physical and emotional stress affect the immune systems of cancer victims. After surgery and radiation, he wonders, why do node-negative breast cancer victims have a survival rate of 80 percent? Is there a mechanism that is damping the immune response of the other 20 percent, and could this be affected by stress? Tomasi is in the process of assembling a team of researchers to tackle these questions, and the many more that are sure to follow. e ANNUAL FACULTY MEETING HoNoRs ToP TEACHERS FoR 1990 he Annual Faculty Meeting held each spring provides an opportunity for the UB medical school to honor those who have made outstanding contributions. Honored in 1990: Roland Anthone, M.D., and Sidney Anthone, M.D., clinical professors of surgery, were named recipients of the third annual Robert S. Berkson Memorial Award in the Art of Medicine. The award recognizes excellence in patient care and teaching by volunteer faculty members. Bernard Eisenberg, M.D., clinical associate professor of pediatrics, received the Dean's Award for service to the medical school and the University and outstanding research. A longtime volunteer faculty member, Eisenberg is a member of the school's admissions committee. Evan Calkins, M.D., professor and head of the medical school's Division of Geriatrics/Gerontology, received a special award as founder of geriatric medicine at UB. A plaque in his honor that will hang in the medical school describes Calkins as "an energetic, imaginative leader with demonstrated qualities of humanitarianism, compassion and a fondness of learning and giving. A true role model for the medical leaders of the 21st century." Louis A. and Ruth Siegel Teaching Awards for teaching excellence were presented in four categories. The recipients were: Pre-clinical award: Alan Lesse, M.D., assistant professor of pharmacology and therapeutics. Clinical Award: Fred Luchette, M.D., assistant professor of surgery. Volunteer award: Thomas Westner, M.D., clinical assistant professor of medicine. House staff awards: Frederick Kohn, M.D., resident physician in obstetrics/gynecology; Robert Erickson, M.D., resident physician in family medicine; Maheswar Rao, M.D., resident physician in medicine; and Karen Drake, M.D., resident physician in obstetrics/gynecology. • CASSEL TO VISIT UB AS HARRINGTON PROFESSOR hristine Cas el, M.D., an expert in medical ethics and gerontology, will visit UB on May 29 and 30 as the second Harrington Visiting Professor. Cassel is one of two women regents of the American College of Physicians and chief of the section of genera l internal medicine at the University of Chicago School of Medicine. As the Harrington Visiting Professor, she will give several talks and seminars.e WINTER 1991 BUFFALO PHYSICIA AND BIOMEDICAL SCIENT IST �-------------------------------------------~@~I~~-------------------------------------------"' r C If 0 ~ 30 Cooperation, not Competition Thomas Riemenschneider strives to unify teaching hospitals around common goal By LOIS BAKER agging along after his father in rural Berea, Ohio, 50 years ago, Thomas Riemenschneider saw firsthand the tie between physician and community. Those early impressions grew into a love for medicine and a commitment to pushing his profession beyond its traditional boundaries, a dedication that Tom Riemenschneider, M.D., M.B.A., brings with him as the new associate vice president for clinical affairs and associate dean at UB Medical School. "Most medical schools will tell you their missions are teaching medical students, research, and patient care," he said. "As far as I'm concerned, there are four missions. That fourth mission is relating to the community -- identifying community health care needs and responding to those needs." His goal here is ambitious: To develop a unique model for delivering health care to the community. As liaison between the medical school and area hosp itals, his job is to convince everyone to work together through a cooperative consortium, for the benefit of all. That effort is already under way. The hospitals' CEOs are meeting to discuss common goals. Next will come meetings between medical directors and department heads. If the effort is successful, Western New York could serve as an example for other communities across the nation. WINTER 1991 "The degree of cooperation here is unique," he said. "Out of 128 medical schools in the country, only a few are close to the model we're looking at here." "The traditional model is one university hospital designated as the primary teaching hospital for students and residents," Riemenschneider said. "My own feeling is, that in recent years, that traditional model has become outmoded, in part because there is an ivory tower around it," he continued. Because the traditional model never existed here, he saw an unusual opportunity to move health care delivery and medical education into the community. In this approach, Riemenschneider has the full approval of John Naughton, M.D., dean of the medical school and vice president for clinical affairs at UB, who has championed a consortium for 15 years. "Riemenschneider comes highly regarded and is well versed in his field," Naughton said. "We think he is going to do a very fine job." Riemenschneider replaces Don Larson, M.D., whom Naughton credits with helping to organize the medical school's Office of Clinical Affairs, and with helping to implement its faculty practice plan. Larson has returned to teaching in the Department of Biology. Riemenschneider earned his bachelor's degree from Baldwin Wallace College and his medical degree from SUNY's Upstate Medical Center, now called the Health Science Center at Syracuse. Now a professor of pediatrics at UB, he developed an interest in pediatrics as a college student, watching his father deliver babies. To test his commitment to medicine, his father got him a job emptying bed pans, where he didn't like the work but loved the excitement of the hospital. At his father's urging, he took a summer job working for a cardiac surgeon. A chance meeting with a physician friend of his father led to a residency and three-year pediatric cardiology fellowship at the UCLA School of Medicine. At UCLA, the appeal of the diversity of practicing medicine in a university setting was obvious. "People had something different to do every day," he said. He was hooked. There he immersed himself in his particular research interest -- adaptation of the newborn heart to extrauterine life. After completing his fellowship and a two-year commitment as chief of pediatric cardiology at Scott Air Force Base in Illinois, he took his first job in academic medicine at the University of Utah Medical Center. He remained three years as assistant professor in the medical center's Pediatric Cardiology BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �------------------------------------------- ~@~ ' ~~-------------------------------------------r .r r If 0 .... <::. 31 Tom Riemens,hneider, M.D., M.B.A., asso,iate vi'e president for dini,al affairs and asso(iate dean at UB Medi,al s,hool. Division, and directed the center's pediatrics honors program. In 197 5 the University of California at Davis offered Riemenschneider the opportunity to become its chief of pediatric cardiology and set up a program in his specialty. He spent the next 15 years translating into action his ideas concerning a broader role for academic medicine. At UC Davis he built the program from scratch; then, to care for the needs of the largely rural population served by the medical center, he set up a network of clinics stretching to the Oregon border. In I982 he returned to his home turf to rebuild the pediatric cardiology program at Case Western Reserve's School of Medicine in Cleveland. During eight years there he made two important career decisions -- to earn an M.B.A., which he received from Baldwin Wallace in 1987, and to become a fulltime medical administrator. He was appointed associate dean of the medical school in 1986. At Case Western Reserve, with the aid of a $425,000 grant from the National Institutes of Health, he started a health education program in the Cleveland Public Schools, using medi- cal students as teachers. That initiative resulted in 17 health care modules being incorporated into the district's curriculum. The chance to build a better health care system that could reach throughout Western New York and beyond was too attractive to refuse. "Most places across the country are still in the old competition model," he said. "In Buffalo the eight CEOs are meeting in our conference rooms and talking collaboratively about what's best for the people of Western New York. Now we've got to bring the medical directors together, and encourage them to begin to talk collaboratively." One of Riemenschneider's major initiatives is to meet with department chairs scattered throughout the teaching hospitals to determine where UB medical school faculty should be placed to best meet community needs and to tackle specific community health problems. This is the kind of challenge that, for Riemenschneider, makes life interesting. He also enjoys spending time with his large extended family, playing tennis and golf, jogging, and country music. He delights in the fact his daughter Laura performs at Nashville's Opryland. He also has a daughter Karen, an art teacher, and a son Jim, a senior at Baldwin Wallace, in business. Riemenschneider admits he sometimes misses working with patients. Knowing he continues to touch patients' lives in a larger context, however, compensates for any sense of loss. "In a way I'm still involved with patients," he said, "but on a larger scale. If I'm able to help organize this consortium and this system of health care, think of all the patients I will have an impact on by providing a better health care environment." • WINTER 1991 BUFFALO PHYSICIAN AN D BIOMEDICAL SCIE TI ST �------------------------------------------- ~@~ I ~~-------------------------------------------C .J' (" .... <:) If 0 32 Dennis A. Nadler, M.D., '71 A mandate to develop a curriculum plan for the next decade By LOIS BAKER ennis A. Nadler, M.D., '71 looking relaxed in his shirt sleeves, glasses dangling from a cord around his neck, is talking with considerable passion about his work as new associate dean for curricular and academic affairs at the UB medical school. "I'm happy," he said. "I'm having fun. It's interesting, and I'm accomplishing things." If it weren't for his salt and pepper hair, parted boyishly down the middle, Nadler could, at 44, be mistaken for one of the medical students he is charged with supervising as head of UB's medical education program. He was appointed associate dean in January 1990, after serving in an interim capacity since the previous July. A pediatrician with a specialty in developmental difficulties, Nadler comes well-suited for the job. He is personable and ea y going, with an empathy for young children that transformed easily into an understanding and appreciation of young adults. The promise of daily contact with students was one reason he took the job. This enthusiasm was not lost on John Naughton, M.D., dean of the medical school and vice president for clinical affairs at UB, when he was searching for a replacement for Peter Ostrow, M.D. Ostrow left the associate deanship to return to teaching in the Department of WINTER 1991 Dennis A. Nadler, M.D., '71, associate dean for curricular and academic affairs. Pathology. ''Throughout his career, Dennis has had a long track record of interest in students and teaching," Naughton said. "I think he has gotten off to a very good start." Nadler said he was programmed since birth to be a physician. The son of a would-be doctor who turned to pharmacy because he couldn't afford mediBUFFALO PHY ICIA AND BIOMEDICA L SCIENT IST �-------------------------------------------~@~~~-------------------------------------------.,. .... I C r If 0 () 33 cal school, Nadler avidly followed the path his father relinquished. Medicine appealed to him and he never gave serious thought to anything else. A Buffalo native, Nadler earned his bachelor's degree in psychology from UB in 1967 and entered the UB medical school. He was headed for a career as an ear, nose and throat specialist until he spent the summer before his senior year in medical school in the pediatric outpatient clinic at Children's Hospital of Buffalo. He decided to become a pediatrician then and there. "There's just something special about children," he said, explaining his switch of specialties. A devoted father, Nadler spends as much time as possible with his sons Noah, 17, Jacob, 10, and Benjamin, 7, and his wife Susan. After completing his internship and residency at Children's, Nadler in 1974 accepted a position as pediatrician-inchief at the Jesse Nash Family Health Center in Buffalo, became an attending physician at Erie County Medical Center (ECMC) and joined the UB medical school's full-time faculty. He served as director of the Department of Pediatrics at ECMC from 1977 to 1988, when he stepped down to devote more time to the University. He had been serving as assistant dean for student affairs at the medical school since 1985. In addition to his current University post, Nadler is medical director for the United Cerebral Palsy Association, and an attending pediatrician at ECMC and Children's Hospital. As the medical school's associate dean for curricular and academic affairs, Nadler is responsible for everything that involves the education of medical students - from basic science and clinical education, to evaluation of teaching methods, to preparation of students for "Teaching students how to learn is at least as important as teaching them what to learn. " residencies, even to financial aid. He finds today's medical students more sophisticated and better educated than their counterparts of 20 years ago. Sophistication aside, he asserts that the basic motivation for becoming a physician remains the same - a wish to aid humanity. "I don't think the majority of students today gravitate to medicine because of the money or because of the prestige. I think they gravitate to medicine because they want to help people. "I came out of the '60s, and we were going to save the world," he said. "I think there is still a lot of that around." Nadler relinquished the rewards of caring daily for young patients for the chance to influence the training of the next generation of physicians. His mandate is to develop a curriculum plan for the medical school for the next 10 years. Toward that end, he has organized a task force to review all medical education - faculty development, student affairs, advising, and several other areas - in addition to curriculum. The task force will also assess the medical school's external resources, such as the area's teaching hospitals and health related professions. He brings to the job a strong conviction that medical schools must change the way they educate students. "The curriculum has always been very hospital-based, "Nadler said. "When I was a medical student that was just fine. I took care of all kinds of fascinating and mundane problems. "But today, people aren't admitted to the hospital unless they are in crisis or in some form of deteriorated condition. So what we're getting in the hospitals is a very skewed population of the extremely ill and extremely old . You can't give students a broad-based medical education anymore if you just put them in hospitals." Nadler favors placing students with volunteer faculty in their offices, and making better use of community-based clinics and hospital ambulatory programs, in addition to using the traditional hospital setting. He also advocates a new classroom approach: stressing creative problem solving over memorization. "Teaching students how to learn is at least as important as teaching them what to learn," he said. "Developing problemsolving skills, clinically based basic science education, reducing lecture time, and placing greater emphasis on independent learning- these are the challenges." Nadler concedes that not everyone views his mission in the same light. "Some think we should continue to be a very traditional medical school. Some think we should become a very innovative medical school. I suspect there is an appropriate balance to be struck," he said. "I hope I will be able to find that balance." • WINTER 1991 BUFFALO PHYSICIAN AN D BIOMEDICAL SCIE TI ST �---------------------------~~: --------------------------" \t- 34 LAW vs MEDICINE SPRING CLINICAL DAY TO Focus ON LEGAL IssuEs ridging the Gap Between Medicine and Law" will be the the theme of 1991's Spring Clinical Day and Reunion Weekend, which will be held the weekend of May 4. The unique Spring Clinical Day program, to be held May 4 in the Buffalo Marrio tt, was planned with the help of the Bar Association of Erie County. Topics will focus on the legal issues in the physician-patient relationship. "Striking a Balance Between the Rights of Patients, Doctors, and Society" will be the title of the Stockton Kimball Lecture, to be delivered by Sol Wachtler, the chief justice of the New York State Court of Appeals. The weekend opens with a reception for all reunion classes on Friday evening, May 3, in the Center for Tomorrow on UB's North (Amherst) Campus. Take the advice of the reunion class chairmen: Mark your calendars for May 4. e "50 years - one-half century. Let's all come to the reunion Saturday, May 4, 199 1." Donald Hall '41 "Old friendships renewed, old memories revived, reflections on life tracing back to our days on high. Come to our 45th reunion." Harold Levy '46 "40 -wow! Looking forward to seeing all of you again. We're not ge tting older, we're getting better." Marvin Pleskow '51 ALUMNI To HosT RECEPTION IN BosToN he UB Medical Alumni Association and the Department of Neurology will host a reception in Boston, Mass. on Monday, April 22 in conjunction with the American Academy of Neurology Meeting. All alumni/ae in the Boston area are invited. e WINTER 1991 I "Long time, no see! Come join your classmates for our 50th reunion." Gene Hanavan '41 "In the past 40 years, the world, the school, medicine have changed. Have we? Let's get together and find out at our reunion." Allen Goldfarb '51 BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �---------------------------~~:--------------------------- 35 "35 and still alive! Please return for classmate jive." Edmond Gicewicz '56 "A great time with a great bunch of people." Harold Brody '61 "The 20th was good, let's make the 25th great! Join us May 3-5 to renew old friendships and memo ries." Jared Barlow '66 "We are looking forward to seeing all the I5 -year alumni and renewing friendships." Russell Bessette '76 "Surprise! Five years have already slipped by. It 's time to touch base and catch up on what's happened. Look forward to seeing you in May." Jim Schlesinger '86 Carlo DeSantis '61 "20 years is a long time. Hope we can get together for a good time and to renew old friendships. " "Take a break after I 0 years! Shuffle back to Buffalo to share in the old and the new!" Joel Paull '71 Bruce Cusenz '81 WINTER 1991 BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �-------------------~~: ------------------- 36 DAVID H. NICHOLS '47 RECEIVES DISTINGUISHED ALUMNUS AWARD avid H. Nichols, M.D., internationally recognized expert in the field of reconstructive gynecologic surgery, received the second Distinguished Alumnus Award from the UB Medical School and Medical Alumni Association. A 194 7 graduate, Nichols is professor and chair of obstetrics and gynecology at Brown University. A lecturer in obstetrics and gynecology at Tufts University School of Medicine, he also is obstetrician and gynecologistin-chief at Women & Infants Hospital of Rhode Island, Providence, and surgeonin-chief in the Department of Gynecology and Obstetrics at Rhode Island Hospital, Providence. Nichols served on the faculty of the UB medical school from 1954 to 1980 before joining the faculty of Brown University. He was head of the Department of Obstetrics and Gynecology at The Buffalo General Hospital from 197 5 to 1980, chief of the Department of Obstetrics and Gynecology at Sisters Hospital from 1971 to 1974 and associate cancer research gynecologist at Roswell Park Cancer Institute from 1953 to 1960. He also was previously associated with the old E.]. Meyer Memorial Hospital, St. Francis Hospital, and the Veterans Administration Medical Center. Certified by the American Board of Obstetrics and Gynecology, Nichols is a fellow of the American College of Obstetricians and Gynecologists, American College of Surgeons, and International College of Surgeons. He is a past president of the Society of Gynecologic Surgeons, Buffalo Gynecologic and Obstetric Society, and Erie County Unit of the American Cancer Society. WINTER 1991 David H. Nichols, '47 (ALL FOR NOMINATIONS FOR ALUMNI AWARD arch 1 is the deadline for nominations for the third annual Distinguished Medical Alumnus/a Award. The award is presented to a graduate of the UB medical school who is distinguished nationally or internationally in the eyes of his or her peers and has made an outstanding contribution to medicine, the arts, or humanity. The award will be presented at a special dinner in September. Please forward the name of your nominee as soon as possible on the attached postcard. Your cooperation is vital if this is to be a true alumnus/a award. e DoNoRs HEAR TALE oF UB MED ScHooL fOUNDER edical professors of the early 1800s were restless folk who moved from town to town, noted Richard Lee, professor of medicine and pediatrics at UB. When the founding fathers left, the schools often went under. Few schools founded in that era exist today. Buffalo is an exception because one of the founding fathers of UB, James Platt White, was committed to the community and remained active here for almost 50 years. "James Platt White and Buffalo had a remarkable association," Lee said. "If anyone could claim the Buffalo medical school as his child, it was he." Lee spoke at the fifth annual meeting of the James Platt White Society in October honoring members who have made an annual contribution of $1,000 or more. The members of the James Platt White Society from Oct. 20, 1989 to Oct. 18, 1990 are: Dr. Richard H. Adler Dr. Kenneth M. Alford Dr. Kenneth Z. Altshuler Dr. William S. Andaloro Mrs. Rose Bakow Dr. & Mrs. Jared Barlow Dr. Alphonso L. Barragan Dr. Charles D. Bauer Dr. Eugene L. Beltrami Dr. Richard A. Berkson Dr. Willard H. Bernhoft Dr. Theodore Bistany Dr. Willard Boardman Dr. Dennis L. Bordan Mr. & Mrs. Leroy B. Bornhauser Dr. & Mrs. Harold Brody Dr. Robert L. Brown Dr. August A. Bruno Dr. Elaine M. Bukowski Dr. & Mrs. Irwin Burstein Dr. David W. Butsch Ms. Janet F. Butsch Dr. John L. Butsch Dr. & Mrs. Evan Calkins Dr. & Mrs. Joseph G. Cardamone Dr. & Mrs. Joseph A. Chazan Dr. Donald P. Copley Dr. Daniel E. Curtin Dr. James A. Curtin Dr. Peter S. D' Arrigo Dr. Roger Dayer Dr. Thomas A. Donohue Dr. Sterling Doubrava Dr. Kenneth H. Eckhert Dr. Robert Einhorn Dr. & Mrs. George M. Ellis BUFFALO PHYSIC IAN AND BIOMEDICAL SCIENTIST �------------------------------~~:------------------------------ 37 Dr. & Mrs. George M. Ellis Dr. Daniel Fahey & Dr. Maria Runfola Dr. Lucille M. Farrar Dr. Robert E. Fenzl Dr. Donald M. Fisher Dr. Jack C. Fisher Dr. Grant T. Fisher Dr. Edward Forgrave Dr. Thomas F. Frawley Dr. Matt A. Gajewski Dr. Kenneth L. Gayles Dr. John W. Gibbs Jr. Dr. Daniel Goldberg Dr. Seymour Grauer Mr. Wilson Greatbatch Dr. Thomas J. Guttuso Mrs. Marion B. Hague Dr. Martin E. Hale Dr. Eugene J. Hanavan Mr. & Mrs. Edward A. Hansen Dr. & Mrs. Gerald Hardner Dr. Thomas H. Hayden Dr. Reid R. Heffner Jr. Mr. John L. Hettrick Dr. Gary Jeffery Dr. & Mrs. Kenneth L. Jewel Dr. Stephen T. Joyce Dr. James R. Kanski Ms. Catherine Kresge Dr. Marvin Z. Kurian Dr. Vito P. Laglia Dr. Andre Lascari Dr. Eugene V. Leslie Dr. Lawrence M. Lesser Dr. & Mrs. Harold J. Levy Mrs. Ursula Lichtenstein Dr. Jack Lippes Dr. Hing Har Lo Dr. Fred A. Luchette Dr. Robert L. Malatesta Dr. Milford C. Maloney Dr. Don L. Maunz Dr. Harry L. Metcalf Dr. Merrill L. Miller Dr. Eugene R. Mindel! Dr. Joseph Monte Dr. Shedrick Moore Dr. Robert M. Moskowitz. Dr. John D. Mountain Dr. Arthur W. Mruczek Sr. Dr. Richard L. Munk Dr. Richard J. Nagel Dr. Masao Nakandakari Dr. Richard B. Narins Dr. & Mrs. John Naughton Dr. Benjamin Obletz Dr. Elizabeth Olmsted Dr. Dean E. Orman Dr. JohnS. Parker Dr. Jacqueline L. Paroski & Dr. Paul A. Paroski Dr. Margaret W. Paroski Miss Olga E. Paroski Dr. & Mrs. Robert J. Patterson Dr. Clayton A. Peimer Dr. Victor L. Pellicano Dr. James F. Phillips Dr. Frederic D. Regan Dr. Frank T. Riforgiato Dr. Charles Riggio Dr. Eugene Rivera Dr. Richard R. Romanowski Dr. & Mrs. Charles H. Rosenberg Dr. Albert Rowe Miss Thelma Sanes Dr. Arthur J. Schaefer Dr. Robert N. Schnitzler Dr. Joseph I. Schultz Dr. Roy Seibel Dr. Elizabeth Serrage Dr. & Mrs. Samuel Shatkin Dr. John B. Sheffer Miss Alice Simpson Dr. Richard A. Smith Dr. John J. Squad rita Dr. William Sternfeld Dr. Gerald Sufrin Dr. Eugene M. Sullivan Dr. Michael A. Sullivan Dr. Syde A. Taheri Dr. Joseph Tannenhaus Dr. MichaelS. Taxier Dr. JacobY. Terner Dr. Charles S. Tirone Dr. Anthony C. Trippi Dr. Stanley Urban Mrs. Victoria Van Coevering Dr. Barbara von Schmidt Dr. Coolidge S. Wakai Dr. Franklin E. Waters Dr. Paul Wierzbieniec Dr. Gary Wilcox Dr. Richard G. Williams Dr. John R. Wright Dr. Franklin Zeplowitz Dr. & Mrs. David C. Ziegler REUNION (LASSES' GIFTS HELP MEDICAL STUDENTS edical students will benefit in many ways from the generosity of the alumni. As of Sept. 11, the classes that marked their five-year reunions in 1990 donated $123,211 to the University. Class of 1940: Scholarship in the amount of$ 7,3 25 Class of 1945: Gift of $20,810 for the Vincent Capraro Lectureship Class of 1950: Scholarship in the amount of $7,750 Class of 1955: Scholarship in the amount of $6,700 Class of 1960: Unrestricted gift of $43,700 Class of 1965: Unrestricted gift of $8,975 Class of 1970: Unrestricted gift of $9,225 Class of 1975: Unrestricted gift of $4,925 Class of 1980: Gift of $12,251 for the John Paroski Memorial Scholarship Fund Class of 1985: Scholarship in the amount of $1,550 WI TER I991 BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �---------------~~:---------------­ }0._ J' S II () 38 Philip Goldstein '31 ~ in memory of Or. Goldstein, an annual memorial lectureship in hepatology and an award to a graduating resident have been established at Millard Fillmore Hospital. The Goldstein Award is given annually to the graduating resident "demonstrating the highest degree of humanitarian qualities in the approach to, and treatment of, patients." The lectureship and award were made possible by Kenneth Goldstein '39, Gerald Goldstein '64, Harvey R. Goldstein '77, Rabbi Brett Goldstein and Mrs. N. Stiller. Murray A. Yost '33 ~ received a certificate and a gold medallion when he was honored with lifetime membership/fellowship in the American Psychiatric As ociation. John M. Constantine '34 ~ of Oneonta, N.Y., retired from active practice in November 1989. Robert J. Krug '35 ~ writes from Tarpon Springs, Fla., "had a mild stroke, affecting left side, but I still get around OK without a cane." Bennie Mecklin '35 ~ writes "Why no news from the class of 1935? I am still lecturing, writing and enjoy traveling." Or. Mecklin resides at 6711 Starkeys Place, Lake Worth, Fla. 33467. Charles A. Bauda '42 ~ sent an article from the Palm Beach Post telling us that at the age of 74 he received a master's degree in WINTER 1991 Milton Alter, 'SS Donald W. Burkhardt '68 William K. Major '69 theology from St. Vincent de Paul Seminary. Dr. Bauda practiced family medicine in Buffalo for 40 years before moving to Boynton Beach, Fla. recurrent trokes. In I 989 he became editor-in-chief of the journal Neuroepidemiology. gy at the University of Southern Alabama. Arthur J. Schaefer '47 ~was a vtstttng professor at the University of Washington Medical School, Seattle, Wash., where he lectured on the pathophysiology and the surgical corrections of malpositions of the upper and lower eyelids. Victor Panaro '52 ~ of Amherst, N.Y., has been elected Councilor for the American College of Radiology. Milton Alter '55 ~ former chief of neurology at the Minneapolis Veteran's Hospital and former chairman of neurology at Temple University Hospital is now director of re idency training in neurology at the Medical College of Pennsylvania. He holds an NIH grant to study the epidemiology of strokes and a supplemental grant to study risk factors for William J. Sullivan '55 ~ is a diplomate of the American Board of Psychiatry and Neurology and is certified in psychiatry and psychoanalysis. He is now specializing in forensic psychiatry. Mary Ann Zavisca Bishara '59~ was appointed president of the medical staff at St. Mary's Hospital, Lewiston, N.Y., for 1990-1991 and continues as chief of anesthesiology at the hospital. Kenneth E. Bell '61 ~ was recently named clinical professor of obstetrics and gynecology at the University of California at Irvine. Or. Bell is medical director of the Kaiser Permanente Medical Center in Anaheim, Calif. F. Robert Weis Jr. '64 ~ was appointed a full professor and director of clinical anesthesiolo- David R. Dantzker '67 ~ is now chairman of internal medicine at Long Island Jewish Medical Center and professor of medicine at Albert Einstein College of Medicine. Donald W. Burkhardt '68 ~ retired from emergency medicine at Kenmore Mercy in Buffalo and moved to Morocco. He is living in a villa in the foothills of the Middle Atlas Mountains. His new address is Villa William & Ruth, 141 B.I.S. Route de Fes, Sefrou , Morocco. John E. Shields Jr. '68 ~ is medical director of the Seafield Center, an 80-bed alcohol and drug rehabilitation center in Hampton Bays, N .Y. Or. Shields was certified in addictionology in 1988. William K. Major '69 ~ a cardiothoracic surgeon, has been elected president of the Medical Society of the County of Erie. BUFFALO PHYSIC IAN AND BIOMEDICAL SCIENTIST �------------------------------~~:------------------------------~'C::l .f S II () 39 Edward J. Coleman '83 );>completed a fellowship in thoracic and cardiovascular surgery at UB in June and joined a practice in Green Bay, Wis. Melvin Pohl '76 );>- is the author of a book The Caregiver's journey: VVhen You Love Someone VVith AIDS, published by Hazelden. Dr. Pohl is chief of Clinical Services at the Pride Institute in Minneapolis, Minn. Russell J. Van Coevering 11'77 Russell J. Van Coevering II '77 );>- is president of the New York State Society of Obstetricians and Gynecologists, Inc. and serves on the board of directors of the Buffalo Civil War Roundtable. Dr. Van Coevering is a member of the President's Associates of the UB Foundation and the James Platt White Society of the medical school. Russell P. Massaro '70 );>- relocated to Albany, N.Y., where he is director of medical services for the New York State Office of Mental Health. Cliphane W. McLeod '77 );>writes, "Looking for a partner for a busy ob/gyn service." Dr. McCleod can be reached at 227 Topi Trail, Hinesville, Ga. 31313. Jay A. Harolds '71 );>- is chief of radiology and the radiology residency program of Baptist Medical Center of Oklahoma City and president of the Oklahoma State Radiological Society 1989-1990. Richard T. Irene '79 );>- of Columbus Ohio, was recently initiated a fellow of the American College of Surgeons. Donald H. Marcus '71 );>- of Sepu lveda, Ca lif., has been elected to a three-year term on the board of directors of the Southern California Permanente Medical Group. Roy M. Oswaks '71 );>- continues as chief of surgery at Bayside Hospital in Virginia Beach, Va. Joseph A. Dunn, Ph.D. '71 );>a senior research scientist at Eastman Kodak, has started a two-year sabbatical in the Biotechnology Center of Cornell University. Robert Braco '80 );>- writes, "Completed my MPH in May and started working for the University of Texas School of Public Health in Houston, looking after the health of employees of major petrochemical companies in the Houston area. It's great, I highly recommend it." Jonathan C. Felsher '80 );>- has a private practice in cardiology and is associated with the Crozer-Chester Medical Center and the Bryn Mawr Hospital. He and his wife, Lisa, have two children: Matthew, 2, and Marisa, 9 months. Renata Wajsman '83 );>- writes, "After working for a year as a gastroenterologist, I am moving on to Israel to take a full-time position in gastroenterology in Tel Aviv-lchilov Hospital." Robert Braco '80 Bruce J. Cusenz '81 );>-is a member of Buffalo Plastic Surgery, a practice specializing in cosmetic surgery as well as traumatic and reconstructive surgery. The practice has two offices: 2800 Main St., Buffalo and 1321 Millersport Highway, Williamsville. Helena Reichman '81 );>-former full-time member of the faculty at the University of Massachusetts Medical Center and private practitioner, is relocating to Brandon, Fla. to join a ob/gyn practice at Humana Hospital. Nora Meaney-Elman '84 );>- of Amherst, N.Y., writes, "Upon completion of residency, I am joining the Highgate Medical Group and practicing full-time in family medicine." Herbert B. Newton '84 );>writes that he finished at Memorial Sloan-Kettering Cancer Center in June , then became the neuro-oncologist for Ohio State's new cancer center in July. "Go Buckeyes!" John Picano '84 );>- completed a neuroradiology fellowship at Massachusetts General Hospital in June and moved to New Hartford, N.Y. to enter private practice. He and his wife, Lynn, have two children, John Daniel and Cara. Lloyd D. Stahl '81 );>- of Leawood, Kan. writes, "Jackie and I were in New Orleans when I was inducted as a fellow into the American College of Cardiology. We have three children: Michael, 8; Mara, 6, and Danny, 2. We are enjoying life in the midwest." Maritza Alvarado '85 );>- writes that she and her husband, Andrew Knoll '84, moved to Syracuse, N.Y. this summer. He began his residency in internal medicine and she started a fellowship in neonatology. Manuel L. Saint Martin '82 );>completed law school and psychiatric residency in Los Angeles simultaneously! He is now conducting a joint medical and legal consulting practice in Los Angeles and Forest Hills, N.Y. Timothy Wacker '85 );>- of Tonawanda, N.Y., has completed a fellowship in gastroenterology/hepatology at the University of Pittsburgh and is looking forward to starting a private practice in the Southtowns. WINTER 1991 BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �--------------- ~~~ --------------­ ~'0, s s " () 40 Douglas J. Floccare '86 Douglas J. Floccare '86 ,_.. has been appointed the aeromedical director of the state med-evac helicopter fleet operated by the Maryland State Po li ce. Dr. Floccare currently serves as fire surgeon for the Baltimore County Fire Department's Division of Emergency Medical Services, and co-medical director of the paramedic education program at University of Maryland at Baltimore County's Emergency Health Services Department. Clarence Durshordwe '23 ,_.. an anesthesiologist for more than 40 years in Buffalo, died Sept. 24, 1990. He had served in the U.S. Army during World War I. Joseph F. Kij Sr. '27 :;;;... died July 29, 1990. Dr. Kij treated five generations of patients as he became one of the patriarchs of Western New York's Polish-American community. His many community endeavors included helping to found the former St. Rita's Home for Children and serving on the Lackawanna School Board. He continued his private practice in Lackawanna until I 988. WINTER 1991 Ramsdell Gurney ' 29 ,_.. an organizer of the Buffalo Medical Group, died July 30, 1990. The group is now composed of 70 physicians. Dr. Gurney was an associate professor of medicine at UB. "He was an exceptiona l human being," said classmate Victor L. Cohen. "He was thoughtful, dignified, and devoted to his wife and family and to the art of medicine. His conduct lent dignity to the practice of medicine and to the associate he so skillfully chose." William G. Ford '31 ,_.. an internist for almost 50 years, died Oct. 14, 1990. He worked as a physician for Bethlehem Stee l and was in private practice in Buffalo. During World War II , he served as chief of medicine on the U.S. Army's first hospital ship as well as the USS Ernest Hines, a luxury liner remodeled as a hospital ship. He retired from private practice in 1978. Helen Toskov Wolfson '31 ,_.. a former Buffalo clinical pathologist, died April 10, 1990 in Ambler, Pa. Dr. Wolfson was the only woman in the C lass of 1931. She opened her own laboratory in 1933 and remained in practice in Buffalo until 1974. After retiring in 1974, she moved to West Palm Beach, Fla., where she lived until 1986, when she resettled in the Philadelphia area . Hugh J. McGee '32:;;;... a retired neurologist died, January 27, 1990 in jackson, Mich. Edward Shubert '39 ,_.. died May 18, 1990. William D. Dugan '39 ,_.. a retired orthopaedic surgeon, died April 15, 1990. He practiced medicine at Buffalo General, Children's and Mercy hospitals in Buffa lo and our Lady of Victory Hospital in Lackawanna. He was a member of the Ruffed Grouse Society and the Buffalo T ennis and Squash Club, where he was a champion. Maurice M. Maltinsky '44 ,_.. d ied Jan. 25, 1990. Vernon G . Smith '48 :;;;... a pathologist, died Ocr. 20, 1990. He founded and directed Western ew York Analytical Laboratories 1nc., with offices throughout Western New York. He had also been honored with a team of doctors for early research in cryogenics. Alfred Berl '49 :;;;... a psychiatrist and horsebreeder in Bu llvi lle, N.Y., died suddenly in Puerto Rico on May 9, 1990. Dr. Berl was a former teaching psychiatrist at Yale, former chief psychiatrist of the Manhattan House of Detention and, during the Korean War served as chief psychiatrist of the Far East Command. With a partner, Dr. Berl founded Excelsior Farms in Bullvi ll e in 1965, and bred many top pacing horses, including Fly Fly Solly, who earned over $700,000 and the former world champion pacing gelding Magna Bird. Until the time of his death, Dr. Berl served on the Advisory Counsel of Camp Blueberry Treatment Center for Autistic Children. Haluk Caglar '56 ,_.. assistant professor at UB and a specialist in gynecologic oncology, died june 30, 1990 after a lengthy illness. He was 45. Born in Turkey, he came to the United States in 1971 and attended the UB medical school and Georgetown University Medical School. He received many teaching awards at UB and wrote numerous chapters in medical textbooks. An artist, his paintings were exhibited in galleries in Toronto. David E. Pittman '64 :;;;... a member of the James Platt White Society and supporter of the University at Buffalo Foundation, died on October 26, 1989. He held a number of University appointments, including clinical assistant professor of Medicine at the University of Pittsburgh and the Medical College of Pennsylvania. He was a senior attending cardio logist and the associate director of the cardiovascular laboratory at Allegheny General Hospital and served on the Editorial Board of the Catheterization and Cardiovascular Diagnosis Journal and the Journal of Angiology. He authored 56 scientific papers. Lawrence J. Emrich, Ph.D. ,_.. associate research professor in biometry at UB and a biostatistician at the Roswell Park Cancer Institute, died June 23, 1990. He was 35. Emrich received his doctora l degree from UB in 1983 and was a consultant to the School of Dental Medicine's Ora l Biology Department and to the Department of Psychiatry. At Roswell Park, he headed the statistical consulting and statistical computing laboratories. He was also a statistician for the DineSystems Co. in Buffalo. BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST ��~- - ~- - Non-Profit O rg. U.S. Postage Buffalo Physician and Biomedical Scientist State University of New York at Buffalo 3435 Main Street Buffalo, New York 14214 PAID Buffalo, NY Permit No. 3ll Address Correction Requested 2194 ~EDICAL HISTORICAL LIB. ABBOTT LI3RARY, SERIALS DEPT. CA. PIJS IIIAIL � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. 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Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1991-Winter Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. School of Medicine Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician Buffalo physician Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v25n01-1991-Winter Table Of Contents A list of subunits of the resource. In Praise of Housecalls Residents' Hours Making a Team for Michael Danger in the Locker Room Do Bad Habits Breed Disease Medical School News Alumni Classnotes Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-11-12 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v25n01 Extent The size or duration of the resource. 44 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1991 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/c54c897a51f284ea0d7cb674f8718b11.pdf 5358dd230af28e29b828ec67532e163d PDF Text Text Vol. 24, No.2 and Biomedical Scientist The medical profession struggles with maternity leave �STAFF DIRECfOR OF PUBLICATIONS NancyTobm EDITOR Connie Oswald Stofko ART DIRECfOR Alan J Kegler WRITERS Joan Damig David Htmmelgreen Jeffery Jackson Arthur Page Mary Beth Spina JeffreyTrebb Sue Wuetcher PHOTOGRAPHERS Debbie Hill Antoinette Mucilh Stmon Tong Robert Walion ADVISORY BOARD Dr. John Naughton, Chairman Dr. Harold Brody Ms. NancyGlteco Dr. James Kanskt Dr. Joseph L. Kunz Dr. Charles Paganelli Mr. Michael Aronica Dr. Antoinette Peters Dr. Charles Pruet Dr. Luther Robinson Dr. Thomas Rosenthal Dr. Salecla Suresh Dr. Burton Smgerman Dr. Stephen Spauldmg Dr. Nelson Torre Mr. Edward Wenske Dr. Jerome Yates Dear Friends: T he.1989-90 academtc year was another busy and producttvf year for the medtcal school, as evtdenced by the flurry of spring activity. It began wtth Sprmg Clinical Day, sponsored by the Medical Alumni Association. The association's efforts culminated successfully with Dr. Arnold Reiman's keynote address at the Stockton Kimball Lectureship luncheon and an excellent fundraising effort on the part of the five-year reunion classes. The weekend was highlighted by the dedication of a wing in the department of Pathology in memory of Dr. Samuel Sanes by the Class of 1945 and the presentation of the first Samuel Sanes Scholarship Award, which was made possible by a generous gift from his SISter and brother, Thelma and Harold Sanes. We were fortunate and honored that hiS wtdow, Mildred, participated m the event. Graduation was highlighted by once agam conducting the Honors Convocation m the Austin Aint Reading Room of the Health Sciences Library. An eloquent commencement address was given by MorrtS Abram, United States Ambassador to the United Nations in Geneva. His remarks were enlightening because of his own experiences wtth acute leukemia in the mid-1970s. The third annual reception honoring and recognizing the many contributions of the volunteer faculty was held at the Albright-Knox Art Gallery. Approximately 200 faculty and their spouses attended. The second annual Graduate Medical Dental Education Consortium dinner· dance completed the Spring's activities on June 22. Each resident graduate received a set of bookends with the UB logo on one and the consortium's title on the other. We look forward to an even more exCiting and productive academic year m 1990-91. As always, the staff and faculty are grateful for the tremendous support provided by our alumni and friends. TEACHING HOSPITALS AND LIAISONS Batavia VA Medtcal Center Buffalo General H<l>'[Htal, Mike Shaw Buffalo VA Medical Center, John Pulli Children's Hospital, Karen Oryja-Swierski Ene County Medical Center Mercy Hospttal, Chuck Telesco Millard Fillmore Hospttal, Joseph R. Ciffa Roswell Park Cancer Institute, ]wl.y Rice Sisters Hospital, Dennis McCarthy Produced by the DitJisum of Unit'f'TSity Relations in association uith the SchOOl of Medicine and Biomedical Saences, ~rate Unit'f'TSity of New York al Buffalo. Editorial office is in 136 Crofts Half THE BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST (USPS 55I-860) Autumn 1990, Volume 24, Number 2. Published by the School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 3435 Main Street, Buffalo, New York 14214. Third class bulk postage paid at Buffalo, New York. Send address changes to THE BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST, 146 CFS Addition, 3435 Main Street, Buffalo, New York 14214. John N aughton, M.D. Vice President far Clinical Affairs Dean, School of Medicme and Biamedical ScienCes Dear Fellow Alumni/Alumnae: T he spring of 1990 marked the anniversary of the 53rd year of Spring Clinical Day. In my opinion, this event has been marked by ever-increlli>ing maturity and sophistication for which all alumni can be justifiably proud. The clini· cal and reunion weekend provtdes a major focus for your Alumni Association and this year's program was especially timely, informative, and prognostic. As your new president and on behalf of all medical alumni, I would like to express our appreciation publicly to Dr. Bob Reisman, Class of'S6, for assembling such a superb program. Our outgoing president, Dr. Joe Kunz, served his term with distinction and our gratitude goes to him as well. I would be most remiss if I didn't communicate to all of you how grateful we are to Dr. Jack Richert and to Nancy Druar of the Alumni Office. Without their help and guidance, this asso· ciation would be a far less healthy organization. I look forward to servmg as your prestdent and I hope to continue ro work actively with alumnt, medical students, faculty, and administration as we all work to support and strengthen our medical school. Sincerely, D~ Bertram A. Portin, M.D. Class of'53 �Autumn 1990 Vol. 24, No.2 IJ Research. A $4.5 million grant to study treatment of multiple sclerosis; AIDS fear and drop in blood transfusions; diving for science. II Mommy track? The number of women attending Cover: Photos by Robert Walion. Story starts on page 6. medical school has steadily increased, but is there room in the system for their babies, too? UB women discuss the problems and pressures they've faced balancing family and profession. IIJ Cutting red tape. American doctors have the power to change the medical delivery system in this country, said Arnold S. Relman, M.D., editor,in, chief of the New England Journal of Medicine. He spoke at UB's 53rd Annual Spring Clinical Day and Reunion Weekend. Ill Rubbish. From hypodermic needles to patients' Orientation follows gradWltion. Page 26. facial tissues, the amount of medical waste is growing daily, and it's getting harder to throw the stuff away. ~~ Medical school news. How a 19th,century anatomist got tangled up with couple of body snatchers was the topic of a lecture sponsored by Alpha Omega Alpha. At commencement, diplomat Morris Abram told graduates to "listen with heart." And Match Day was better than ever. m People. Marvin I. Herz, M.D., chair of psychiatry at UB, got a new perspective on the workings of Washington bureaucracy. America's ailing medical system. IIJ Classnotes. Page 13 . Trashing medical wastes. Page 20. �: -------------------------------------------- 2 UB Takes a $4.5 Million Shot at MS UB research pioneer heads team investigating treatment for disease that hits young adults BY ARTHUR PAGE 0 ne of the largest grants ever received by the UB medical school will study a promising treatment for multiple sclerosis, the most common crippling disease of young adults. The four-year, $4.5 million federal grant from the National Institute of Neurological Disorders and Stroke was announced in May. UB is the coordinating center of the multi-center study that will involve 288 patients at Millard Fillmore and Buffalo General hospitals in Buffalo, as well as hospitals in Washington, D.C.; Cleveland; Denver, and Portland, Ore. It will evaluate the effectiveness of intramuscular injections of beta interferon in the treatment of a form of multiple sclerosis characterized by alternating periods of flare-ups and inactivity. Results of the study could lead to the approval of the experimental treatment by the U.S. Food and Drug Administration, according to Lawrence D. Jacobs, M.D., principal investigator and UB professor of neurology. There currently is no effective treatment for multiple sclerosis, which affects an estimated 250,000 Americans. Jacobs has gained international recognition for pioneering work showing the effectiveness of beta interferon injected intrathecally, or into the spinal fluid, in treatment of multiple sclerosis patients with exacerbating-remitting disease. His AUTUMN 1990 co-investigator on the new study will be Frederick E. Munschauer Ill, M.D., UB assistant professor of neurology. The study will involve patients at the William C. Baird Multiple Sclerosis Research Center of Millard Fillmore Hospitals, of which Jacobs is chief, and the Buffalo General Hospital, where he is head of the department of neurology. Other participating centers include the Mellen Multiple Sclerosis Center of the Cleveland Clinic, Cleveland, Ohio; Walter Reed Army Medical Center, Washington, D.C.; University of Oregon Medical Center, Portland, Ore.; and University of Colorado Health Science Center, Denver. Carl V. Granger, M.D., UB professor of rehabilitation medicine, will serve as a consultant on the project. He also is co-director of the Bernard B. Hoffman Multiple Sclerosis Center at the Buffalo General Hospital and chief of rehabilitation medicine at Buffalo General. Data management and statistics will be coordinated by scientists at UB and Roswell Park Cancer Institute, under the direction of Diane Cookfair, Ph.D. Jacobs has been investigating the use of beta interferon to treat individuals with multiple sclerosis since the late 1970s. His work and that of others using beta and other forms of interferon - a substance produced by the human immune system to fight viral infections - is based on, and reinforces, a growing body of scientific evidence that multiple sclerosis is caused by a viral infection that is not effectively countered by an individual's immune system. In two earlier studies, Jacobs and colleagues showed that treatment with beta interferon given by spinal taps reduced or prevented exacerbations in patients with exacerbating-remitting multiple sclerosis. Follow-up analysis of the patients in the first study showed beneficial effects persisting in some patients for up to five years after treatment. The second study, in conjunction with BUFFALO PHYSICIAN A D BIOMEDICAL SCIENTIST �: ----------------------------------------------- 3 researchers at the University of Rochester Medical Center and at Walter Reed Army Medical Center, was considerably larger and double-blinded, with neither participants nor researchers knowing which patients received interferon or placebo treatment. At the end of the controlled study, the disease flare-ups of those who received beta interferon had been significantly reduced, compared to those in the control group receiving placebo treatment. The clinical condition of three-fourths of 69 patients who received interferon was improved or unchanged. In some cases, symptoms disappeared and patients regained lost functions. Jacobs said those studies focused on intrathecal administration of beta interferon because it was believed the substance did not cross the blood-brain barrier and that the only way to get it into the central nervous system was by injection directly into the spinal fluid. He said subsequent studies in animals have shown the same positive changes in the immune reactivity of the central nervous system whether beta interferon was administered BUFFALO PHYSICIA AND BIOM EDICAL SCIENTI ST by spinal tap or intramuscularly. As a result, his focus is now on intramuscular injections. "Even though the intrathecal injections worked and were well tolerated by patients, people don't want to undergo multiple spinal taps if they can avoid it," Jacobs added. Participants will be assigned randomly to two groups -- 144 will receive weekly intramuscular injections of interferon over two years, and 144 will receive intramuscular injections of a placebo once a week for two years. All participants will be followed for two years following their last injection. The study will be double-blinded. Researchers affiliated with a multi-center study at the University of Maryland are conducting a similar study with intramuscular injections of beta interferon. However, there are important differences in the studies. Participants in the Maryland-based study receive injections of larger doses of beta interferon three times per week, while those in the UB study will receive substantially lower doses only once a Lawrence D. Jacobs, M.D., principal investigator, is studying a treatment for MS. week. Jacobs noted that the UB study will utilize substantially lower doses of beta interferon based on a pilot study by his group that indicated the lower dose given once a week will produce the same immunological response as higher doses given thrice weekly. In addition to monitoring participants for exacerbations of their disease, the UB study also will assess progression of disease and disability. Jacobs noted that multiple sclerosis "most often affects individuals at or near the peak of their productivity and consumes substantial societal and health care resources. Fifty percent of patients with multiple sclerosis will be unable to walk or conduct normal work activities within 10 years of disease onset." In addition to previous support from the National Institutes of Health, Jacobs' earlier studies were supported locally by the Baird Foundation; William C. Baird Multiple Sclerosis Research Endowment AUTUMN 1990 �:-------------------------------------------- 4 of the Millard Fillmore Health, Education and Research Foundation; Millard Fillmore Hospitals; Delaware North Corp.; )arne H . Cummings Foundation; the Buffalo General Hospital and the Bernard B. Hoffman Foundation. The late t grant "underscores the commitment to excellence in clinical neuroscience of the UB medical school and its department of neurology," said Michael Cohen, M.D., UB professor and chair of neurology. "In granting this award, the NIH ha firmly recognized Buffalo as a center of excellence in neurologic research. John P. Naughton, M.D., UB vice pre ident for clinical affairs and dean of the medical school, said that while Jacob provided the initiative for the study, "the cooperation of Millard Fillmore and Buffalo General hospitals provided an impetus for getting this off the ground. It's an example of the kind of thing that the medical school can do with affiliated teaching hospitals in the community, with each maintaining its unique focus while coming together for common research projects." Care of people with multiple sclerosis in Western New York is coordinated through the University at Buffalo Multiple Sclerosis System, formed two years ago under the auspices of the UB Medical School and its departments of neurology and rehabilitation medicine. The program unifies the services of the William C. Baird Multiple Sclerosis Research Center of Millard Fillmore Hospitals, the Bernard B. Hoffman Multiple Sclerosis Center of Buffalo General Hospital and the Western New York Chapter of the National Multiple e Sclerosis Society. Arthur Page is associate director in the UB News Bureau and former medical reporter at the Buffalo News. AUTUM 1990 DROP IN TRANSFUSIONS LINKED To AIDS THREAT F ear of AID has decreased not only the amount of blood collected in the United States, but also the amount physicians use, researchers at UB and the Center for Blood Research have determined. The researchers, reporting in the June 7 issue of the New England journal of Medicine, found that blood transfusions have declined significantly since 1984, suggesting that physicians and surgeons are altering their practices. The findings of the research team, led by Edward L. Wallace, professor of management sy terns at UB, and Douglas M. Surgenor, M.D., senior investigator at the Center for Blood Research in Boston and former dean of the UB medical school, were based on national surveys of transfusing and blood-collecting activities in the United States in 1982, 1984, 1986, 1987, and 1988. The findings indicate that some transfusions performed in the past may have been unnecessary, particularly those single-unit transfusions that are given to patients to make them feel better, Wallace noted. Physicians and surgeons now seem to be weighing more carefully the risk of not giving a transfusion versus the risk of transfusing a patient with blood that may be infected with HIV or other transfusion-transmitted infections, he added. "Patients, blood donors and the public at large are apprehensive about the safety of the blood supply, about acquiring AIDS through blood transfusion and even about the safety of donating blood," the researchers said. "Physicians, increasingly aware of the risks of HIV and other transfusiontransmitted infections, are reconsidering the risks and benefits of transfusions, and are turning to alternatives to transfusion of homologous blood, including not transfusing at all." Transfusing fewer units of blood is one way of reducing the risk of contracting AIDS through transfusions, but the risk is already low, Wallace said. In the national surveys of blood transfusing and collecting activities, Wallace and Surgenor found that transfusions of whole blood and red cells peaked at 50.6 units per 1,000 population in 1984 and fell to 4 7.6 units per 1,000 in 1987. Collections of homologous blood (donated for use by other people) was growing rapidly until 1982, when the growth slowed. Collections peaked at 13.4 million units in 1986 and declined to 13.2 million units in 1987, the researchers found. Meanwhile, collections of autologous blood (blood to be used by the donor him elf) -- less than 30,000 units in 1982 -exploded to 397,000 units in 1987. That's equivalent to 3 percent of the homologous collections that year. The researchers concluded that the unprecedented decline in transfusions, coupled with the importation of packed red cells from Western Europe and the effect of autologous collections, forestalled serious shortages of blood due to the lackluster collections of homologous blood. Other re earchers contributing to the study were Steven H. S. Hao, M.B.A., of UB and Richard H. Chapman of the BUFFALO PHYSICIAN A D BIOMEDICAL SCIE TIST �------------------------------------------- - : -------------------------------------------- s Center for Blood Research. The research was funded by a grant from the National Heart, Lung and Blood Institute. The grant, in its fifth year, will be continued for another five e years, Wallace said. - By Sue Wuetcher DIVERS IN UB CHAMBER HOLD THEIR BREATH IN NAME OF RESEARCH W hen the Majorcas hold their breath, it's worth studying. The family team of deep breath-hold divers from Italy took part in tests at UB's Center for Research in Special Environments as part of a research project under the direction of Claes Lundgren, M.D., Ph.D., professor of physiology and director of the center. Data from tests in the chamber will provide scientists with information on changes that occur when the body is subjected to increased pressures in the BUFFA LO PHYSICIA AN D BIOMEDICAL SCIENTIST ocean's depths. That promises to improve water safety techniques for divers as well as benefit patients who have heart arrythmias and other heart-lung problems. Pressure on the body increases as divers go deeper. If a breath-hold diver stays down too deep for too long, he could lose consciousness and die. At greater depths for more than a minute, pressure can compress the lungs, forcing blood into the heart and lung capacity, causing internal bleeding and severe cardiac arrythmias. The Majorcas-- Enzo, 58, and his daughters Patrizia, 30, and Rossana, 32, are athletes who hold their breath for two or three minutes as they dive to depths of 150 feet or more in quest of world records. A sport in Italy since the 1930s, champions of early deep breath-hold diving contests claimed their prize money from an underwater cage placed by weights at a depth that proved a record-setting dive. Enzo Majorca, record-setting diver, floats in UB's hyperbaric chamber. Enzo still holds the record, set in 1976, for the deepest unassisted breath-hold dive of 197 feet. In "assisted dives," the athletes are lowered to the ocean's depths on a small platform. The divers use a lever to control their rate of descent, explained Massimo Ferrigno, M.D., who was instrumental in arranging for the Majorcas to be tested at UB. "They hold their breath only the two or three minutes it takes for them to enter the water, reach the desired pre-determined depth for a record and then ride the platform back to the surface," explained Ferrigno, an anesthesiologist and a former UB Buswell Fellow. The three divers' work at UB took place underwater in the environmental chamber, which has the widest pressure capacity of any in the western world, simulating the pressure of 5, 700 feet underwater to 100,000 feet in altitude. The divers were allowed to go only to the equivalent of 240 feet in the chamber for safety reasons, said Lundgren, and the Majorcas were in full control of their rate of descent. The research team also is studying how water depth relates to triggering of the mammalian diving reflex that has saved people who fell into icy waters. While the coldness of the water constricts peripheral blood vessels, diverting available blood supply to feed vital organs such as the brain or heart, there may be other changes which the pressure of the water may trigger. Italian scientists and physicians in Buffalo as part of the research team were Paolo Cerretelli, M.D., Guido Ferretti, M.D ., and Mario Costa, M.D. The research project with the Majorcas is funded by the National Oceanic and Atmospheric Administration through the New York Sea Grant Institute. e - By Mary Beth Spina AUTUMN 1990 �6 ~MMY~ACK IN MEDICAL SCHOOL? y years ago, few women's faces women in their prime childbearing looked out from med school year, years, medical schools and women books. Then, in the 1970s, barriers have had to face a difficult issue - to traditional male professions began time off for pregnancy and maternity to fall, and today women repre, leave. These stories look at sent more than a third of UB's the problems and pressures medical school classes. and how some UB women With the arrival of so many By AUTUM 1990 D ebo r a h have dealt with them. Willi a m s BUFFALO PHY !ClAN A D BIOMEDICAL SCIENTIST �7 Usa Benson, M.D. '88, spends some quiet time with daughter Eve Guterman. ult's a tough situation, 11 Benson says of maternity leave. ulosing a resident for any length of time can be difficult and we are sensitive to our peers and their work loads.11 Photos by Robert Walion BUFFALO PHYSICIA AND BIOMEDICAL SCIENTIST AUTUMN 1990 �9QUGH ~EING 9 HORT-STAFFED 8 t one time, Lisa Benson, M.D., a 1988 UB medical school graduate and third-year resident in medicine, considered ob-gyn. But because she wanted to combine a medical career with a family, he decided she didn't want those long hours. Benson, 28, had her first child in September and returned to her residency training in April. Her husband, Lee Guterman, M.D., is a resident in neurosurgery. "Initially I intended to only take six months, but there were complications with my pregnancy and my daughter was born early," she explained. "I never thought of only taking ix weeks off. It was an in tinctive thing with me. I just couldn't leave my daughter o soon. "As soon a I knew I was pregnant I let my director know so preparations could be made for my ab ence. When we are short-staffed because people are out on maternity leave there are comments from some residents. It's a tough situation - losing a resident for any length of time can be difficult and we are sensitive to our peers and their work loads. My training will take longer but ~ that's OK." g 'TRUGGLE IS Jf OTHING EW discrimination against women in obtaining residencies then, but with the war and the men, including my husband, being sent overseas, I got the residency." Henrich took 10 years off to have her children, but kept her hand in the field by doing some clinical work. 'W q?HILD ~ARE fZIFFICULTIES Mary Henrich, M.D., displays photos of her sons "I'll just stay right at the hospital and have my child and be back at work three weeks later. I wouldn't recommend . " zt. to my patzents. - Ortman--Nabi J/ he problems women doctor face trying to combine family and career are nothing new. Mary Henrich, M.D., struggled with them half a century ago. A 1941 UB medical school graduate, she was one of only four women in her class. She met her husband, the late Daniel Bot ford, M.D., in medical school, and wanted to have a family. "I very cold -bloodedly chose ophthalmology as my specialty because I decided I could control the hours and it would combinr well with raising a family," explained Henrich, 74. "Then I faced the problem of getting a residency in the field. There was definite AUTUM 1990 Judy Ortman·Nabi, M.D., and her daughter, Jasmine udy Ortman-Nabi, M.D., 34, who has struggled with a system that didn't work for her, supports the call for changes. She is a second-year resident in obstetrics-gynecology and a 1989 graduate of the UB medical school. She was a first-year medical student in Ohio when she had her daughter. Her husband, Hani Nabi, M.D., was living in Seattle. "It actually worked out fairly well because at least I had the summer off, but it was difficult going back to school and caring for my daughter with my hu band so far away," Ortman-Nabi recalls. "Then my daughter had to be hospitalized for respiratory problems." Family members, including one who is a nurse, were able to help care for the child, but that meant the girl had to be taken to their homes, a four-hour drive. "My husband took her the next year, but he had a great deal of difficulty with child care," Ortman- abi said. "It was very complicated and I ended up taking a year off from school. We moved to Buffalo where I fini hed medical school. I've continued to have problems finding reliable child care and my husband travels about one week out of every month." As Ortman-Nabi related her experiences, she was busy arranging for interviews for someone to care for her second child, who was expected shortly. "I'm doing my rotation at Children's right now and I'll just stay right here at the hospital and have my child and hopefully be back at work three weeks later," she said. "It's not something I would recommend to my patients. I'm just taking vacation time. The program that I'm in really isn't flexible. The system definitely needs to change." ~ BUFFALO PHY !CIA AND BIOMEDI AL IENTIST �- 9 UPPORTIVE q?OLLEAGUES [7?ELPED or Heidi DeBlock, 27, who graduated from the UB medical school this spring, life as a medical student and new mother worked out a lot better than she had expected. Despite taking six weeks off during her pregnancy and three months after her daughter was born a year ago, she graduated only a month late. "I had some extremely supportive and kind attendings who helped," she said, "except for one who asked me whether my pregnancy wasn't all a big mistake. I was quite sick during my pregnancy and even had to be hospitalized. "My husband is a pastoral counselor in area hospitals and a minister in Rochester. He commutes there several days a week but he's off on Monday and watches her then, and the other days she's in day care. I nursed her for quite a long period and during days when I was on a surgery rotation from 6 a.m. to 9 or 10 at night my husband would bring her to the hospital or sometimes I would go to her." DeBlock plans to specialize in internal medicine and spent May working at the Johnson Space Center. She took her daughter with her and her husband joined them for a couple of weeks. She wants three or four children and is planning the next one at the end of her third year of residency. "I think it would be too difficult to be pregnant earlier, especially if I am sick again," DeBlock said. "I thought about picking a specialty that would work out well with a family but I decided I had to go with what I liked. Hopefully, there will be part-time positions for me." ~ Heidi DeBlock, M.D., with daughter Alexandria "I have been able to combine medical training and motherhood. I don't have any free time, but it can be done if you want to. " -Brown q lD 9 URGERY AT 'llTH :JCOUR' essica Brown, M.D., 35, an orthopedic surgeon who graduated from the UB medical school in 1984, was doing surgery right up to three weeks before her daughter was born three years ago. It's still relatively rare for women to BUFFALO PHYSICIAN AND BIOMEDICAL SCIE TIST Jessica Brown, M.D., and her daughter (orina enter the field of orthopedic surgery and ra rer yet for a resident in orthopedic surgery to be pregnant. Brown was able to do both because of the support she got from Robert Gillespie, M.D., chairman of orthopedics, she said, adding, "I think I had an easy pregnancy and delivery because I'm a jogger and also lift weights, which l continue to do whenever I can." Brown said she didn't consider the specialty's effects on raising a family; she chose orthopedics because she liked it. "I didn't want to compromise my career," she said. "But once I'm in private practice my hours will be more controlled since many orthopedic surgeries are elective and scheduled. "l took eight weeks off when my daughter was born, and with the support of a good babysitter and my husband, who is a Marine recruiter, I have been able to combine training and motherhood. I certainly don't have any free time, but it can be ~ done if you want to." q/(AITED10 ~VE ~HILDREN rucy Borowitz, M.D., 36, clinical assistant professor at UB, said she waited to have children until after her residency because she felt it was just too hard to combine both. "I've had a zigzagging career which has included study and work in various cities around the country," she said. "But I've always worked part time including when I was in private practice. Right now I am supposedly working 80 percent time, although it is probably more than that." Borowitz is director of the Cystic Fibrosis Center at Children's Hospital, mother of two children, ages four and six, and wife of Philip Glick, M.D. "This is a creative country and certainly programs could be developed to accommodate the needs of physicians and their families," said Borowitz. "It's unlikely that l will climb the academic ladder, but that has been my choice. Medicine is really a wonderful profession and I have been able to combine my family with intellectually stimulating work." ~ AUTUMN I990 9 �10 Susan Graham, M.D., holds her son Peter ._qRAYS A .c71AzARD IN d'JREGNANCY S usan P. Graham, M.D., 36, assistant professor of medicine at UB an~ director of the Coronary Care Umt at Buffalo General Hospital, faced the problem of protecting herself against X-ray exposure during her pregnancy. "I was pregnant and in my third year of a fellowship in cardiology and the official policy was that pregnant women were not to be anywhere near X-rays," she explained. "But I was working with angiograms, so I took extra precautions. I wore extra lead shields and wore a radiation badge to detect any radiation." Graham had her first child last summer soon after coming to Buffalo. Her husband, Jon Kucera, M.D., is an internist on the staff of Health Care Plan. "I worked up to the day I delivered. In fact, it was a Saturday morning and I was AUTUM 1990 making rounds. I was feeling pains and went home and waited for my husband who had also been making rounds. I ended up arriving at the hospital just an hour before I delivered my son. I took off six weeks after he was born." Graham says she feels under pressure to do research and publish to advance her academic career, but right now research has to have the lowest priority in her life. She will continue teaching as a clinical professor if she finds it's just not possible to advance on the traditional academic ladder. "Hopefully, I will find the time to do research, but there are limits to the day and one's energy," Graham said. e qHE f?'YSTEM IS fNHOSPITABLE 1D ~(OMEN ANDdfABIES Ill he system (of medical education) has failed to adequately address the needs of women physicians who also want to raise a family," said Linda Brodsky, M.D., assistant professor at UB and co-director of pediatric otolaryngology at Children's Hospital. "Women face the real issues of their biological clock and a system that really hasn't been able to accommodate their needs." The system's many critics argue that it hinders women who want to combine a medical career with family. Obstacles include a lack of flexibility in training programs, long hours which make breast-feeding difficult, rigid timetables in academic medicine, difficulty in finding part-time positions, and a general shortage of reliable day care. Nationally, women make up more than a third of medical school students and nearly a third of residents, according to Anne E. Bernstein, M.D., director for members-in-training of the American Medical Women's Association and professor of clinical psychiatry at the Columbia University College of Physicians and Surgeons. Two-thirds of practicing women physicians have children. Half of them had their first child during residency training and one-quarter had their second child during that period. Bernstein added that few women reduced their working hours during pregnancy. Women physicians have been struggling for a long time with the issue of maternity leave policies, said Glenda Donoghue, M.D., APFME director of Continuing Medical Education and Professional Development at UB and a director of the National Council on Women in Medicine. "There are certain limitations inherent in the education system," explained Donoghue, who is also co-chair of the Committee on Academia of the American Medical Women's Association and served as chairman of the Committee on Women in Medicine of the Medical Society of the County of Erie. "Residents must work for a set period of time before they can sit for their boards and there is a similar limitation in medical school. Thus eight weeks is probably the outside limit (for maternity leaves) without extending the training period." At UB, the majority of women medi- BUFFALO PHYSICIA AND BIOMEDICAL SCIENTIST �cal students and residents who choose to have a baby during training are able to take time off and get back on track within a year, according to Maggie S. Wright, Ph.D., assistant dean for student affairs at UB medical school. Most request eight weeks off, although some take less time and others more. That agrees with the national statistics, according to Bernstein, who said women take an average of between two and eight weeks. While schools should have written leave policies, Bernstein wrote in the 11 Journal of the American Women's Medical Association, there aren't enough facts to decide how long that leave should be. The data does suggest that a maternity leave of six weeks is recommended for recuperation from noncomplicated pregnancy and delivery, she noted. "We also feel strongly that while maternity or child care leave is not a disability unless there are medical or surgical complications, the housestaff member taking a sanctioned leave is entitled to reimbursement just as if she had sustained a fractured leg," Bernstein said. But residents who seek leaves because of pregnancy create real problems with scheduling and with other residents, noted Margaret McAloon, M.D., clinical associate professor of medicine at UB and medical director of the University Medical Practice Services P.C. "Someone has to pick up the work and it's natural (for other residents) to resent having to work harder," McAloon said. "Right now there aren't any part-time programs that could accommodate pregnancy and child rearing more easily. Pregnancies during residencies definitely play havoc with schedules, especially when three or four women are pregnant at the same time." The system still has its problems, but McAloon notes that some attitudes toward women physicians and their families have improved over the years. "When I was applying for residency programs in the late '60s, I actually was asked about what form of birth control I was using," she recalled. "Of course, I dismissed applying for those programs after I was asked those questions. No one would dare ask anything like that today." BUFFALO PHYSICIA AND BIOMEDICAL SCIE TIST Undo Brodsky, M.D. with her children Jeremy, left; Dana, right, and Rebecca, foreground A number of suggestions have been offered to help physician-mothers. These include part-time and shared residency programs, longer parental leave programs, a flexible approach to the tenure clock, and improved day care options. "I think the idea of the 'mommy or daddy track' is a great one," said Brodsky, a 3 7-year-old mother of three children, ages seven, five and two years. "By this I mean a more flexible system that would be available to all physicians who want to have more time for their families and still pursue academic careers." She decried the "arbitrary timetables" that exist in academic medicine and believes academic medicine imposes the greatest demands on physician-mothers. "I was very lucky with each of my children - uncomplicated pregnancies," Brodsky said. "I took a month off for each and breast-fed for six weeks, but all women pay a great price. They are often constantly tired and worn-out." Brodsky, whose husband, Saul Greenfield, M.D., is head of pediatric urology at Children's Hospital, said she has been able to balance the conflicting demands of her many roles only with reliable full-time live-in household help, plus two part-time assistants at home. Writing in a November 1989 New England Journal of Medicine essay, Carola Eisenberg, M.D., a Harvard Medical School psychiatrist, argued for more choices for both women and men. She supports parental leave and day care programs throughout medical school, residency training and employment. She also calls for stopping or slowing the tenure clock in academic medicine while doctor-parents take off to bear and rear children. "Women will bring into academic medicine a greater emphasis on the importance of the physician's family life," she wrote. "The beneficiaries of this concern will be men as well as women .... Restructuring medical careers to recognize the legitimate needs of physicians' families will be to the advantage of all."'i' AUTUMN 1990 �~· ·~ . · .....,. , ;;..«. : �for America's Ailing Medieal System 8\' CO,~lE OSW.\LD ~OFKO Today's doctoring is no Norman Rockwell scene Their hands may be tied with red tape, but American doctors have the power to break those binds by helping to change the medical delivery system in this country. That was the common thread weaving through talks at the 53rd annual Spring Clinical Day • -.. sponsored by UB's Medical Alumni Association. -- theme of the session held April 28 in the Buffalo - • I "Changing Aspects of Medical Practice" was the Marriott Hotel. �'PAYORS' REVOLT' SPAWNED RED TAPE I I D octors are right in perceiving that there are increasingly intrusive and harassing restrictive conditions being put on the freedom to practice," affirmed Arnold S. Reiman, M.D., editor-in-chief of the New England Journal of Medicine and considered by some to be America's most powerful doctor. Despite the red tape that makes doctors' lives miserable, "medicine doesn't need more micromanagement," said Reiman, who advised his colleagues "to recognize the problem and participate in the solution." Physicians need to work actively toward a system that lowers costs, regains the public's trust, and delivers care to all citizens. "Let's stop fighting managed care and quality assurance," said Reiman, who advised doctors to enforce quality control, rather than fight it. That would get the malpractice monkey off doctors' backs, he said. The seeds for the restrictive climate were sown after World War II, Reiman said, when medical facilities expanded rapidly and specialties became more sophisticated. As health care became more available and more expensive, third-party indemnity-type insurance became popular. By the late 1960s, roughly 85 percent of American had some kind of health insurance, usually through their employers or through Medicare and Medicaid. Businessmen could build hospitals, make it attractive for doctors to practice there, accept only the in ured, and charge what the market would bear. There were no incentives for consumers to keep costs down, and there were enormous incentives for doctors to provide services, the]oumal editor said. "You had the inevitable ingredients for enormous inflation," Reiman said. This led to the revolt of the payors. "When Mr. Iacocca (the head of Chrysler) has to pay $700 per car that he manufactures to pay for his workers' health care coverage, he's not happy; he doesn't like that; he didn't choose to do ~.:~~· .-,.JSJ), . ·~ ·~· ~ "It's a thinly disguised, sanitized version of the kickback. It's an example of what's happening in the conversion of health care from a social service to a commodity. " that," Reiman said. "He was taken kicking and screaming into that arrangement." Uncle Sam is just as unhappy to pay approximately 8 percent more each year for physician services for Part B Medicare, Reiman added. In addition, the public has doubts about the quality and necessity of the tests and procedures doctor are performing. All of this is driving payors to insist on more and more regulations to control costs and increase effectiveness, said Reiman. Doctors are responding by seeing themselves as businessmen: doctors making extra profit by dispensing drugs in their offices; ophthalmologists buying a certain brand of lenses at a discount and charging the insurance company full price; doctors investing in facilities to which they refer their patients- the more patients they refer, the bigger their profit. "It's a thinly disguised, sanitized variation of the kickback," Reiman said. "It's an example of what's happening in the conversion of health care from a social service to a commodity, and doctors accepting that philosophy." Despite the emphasis on commercialism and a free market economy, costs aren't going down because health care is not an industry, Reiman said. "Doctors should support and enforce ethical codes that make it clear that they aren't businessmen," he urged. He suggested several other things doctors can do to remedy the restrictive climate in American medicine. First, every doctor should join organized medicine, become active and vote- in the public interest. "Don't vote the way the longshoremen's union would, or the electrical workers - everybody else be damned, we're going to take care of our own," Reiman said. He added that while doctors should be concerned about the millions of people who are uninsured and should push for more access to health care, they must also help figure out ways to pay for it. Reiman noted that despite today's restrictive climate, doctors still enjoy a monopoly, much independence, the ability to self-regulate, a virtual guarantee of a good living, and enormous power. Their education is subsidized, research for the new techniques doctors use was paid for by somebody else, and hospital-based physicians don't have to pay for the technology that they use, he said. In exchange for all of that, Reiman said, doctors have the obligation to erve the public's interest. They must accept that they have a moral contract with society. Physicians must help find a better system "regardless of whether it's in our particular economic interest or not," he �said. "And if we do, we'll make out very well." Society is happy to pay its experts and heroes - doctors should have no problem getting compensation. Another suggestion is to let young people experiment with group arrangements - they're not going to be lazy because they're salaried, he said. Fee-for-service practice will remain an option, but it won't be the main method of payment because it's impossibly expensive. Specialists shouldn't be paid ten times as much as primary care physicians. He also urged doctors to push for no-fault insurance. "We can afford health care if we make the system efficient and rational," Reiman concluded. "We doctors have to play a role. We'll either help with the solution e or be judged a part of the problem." SCRAP THE SYSTEM T he United States should start over and re-create its medical system, using the best points of the Canadian setup, suggested Robert L. Dickman, director of the Department of Family Medicine at Mt. Sinai Medical Center in Cleveland. In Canada, the government runs the insurance and physicians have great clinical freedom and less paperwork. I ~ ~~ .··~· That's what we're spending our money on now. I think we can do better." Medical care isn't a commodity to be dispersed by doctors the way a baker sells bread, Dickman said. Advertising is fine for hamburgers, but many people find promotions for medical care questionable. He cited the "Baby Grand" program in which a Cleveland hospital gave mothers $1,000 to deliver their babies there. He also noted that in a free market system, McDonald's doesn't wring its hands over the millions of people who can't afford a Big Mac. "If we believe that health care is a commodity, it makes no sense to even talk about the 30 million or 40 million uninsured," Dickman said. "Why worry - unless, of course, there's something special about health care. "If you don't think we're in the business of selling used cars, if you think there's something noble and special about our profession, maybe we ought to think about the possibility of starting over so that we don't find ourselves dealing with patients over and over again about their insurance requirements. "It is my belief that the only way to solve our problems in American medicine is to develop some kind of unitary system that preserves the doctor-patient relationship." Physicians should lead the way, he said, noting that there is already a growing organization called Physicians for a National Health Program. e GRouP PRACTICE Is THE BEST CHOICE I.G . .i Their system can't be transplanted wholesale, Dickman said, but "I believe we can take the best of it and make it work for us. "About 10 percent of our budget in health care is to pay insurance companies so they can build those big buildings in downtown Cleveland and Buffalo. roup practice is, if not the best, one of the best choices for us to deal with complex technology and the incredible pressure on cost of care we face in this next decade," said Edward J. Marine, M.D. Marine is medical director of Health Care Plan of Western New York, a health maintenance organization, and served as associate dean of the UB medical school. Society won't add more resources for health care; it will simply reallocate the resources we have now, he predicted. By the turn of the century, Marine believes, most doctors will find themselves involved in the managed care system. We need managed care; that is, managed costs, Marine said. Managed care refers to any health-care financing plan that attempts to manage costs through controls and influences on services and on payments for services. He pointed out that more than 30 million Americans have no health insurance, and 30 million to 50 million are underinsured. "Everyone agrees that something must be done," Marine said. "Everyone also agrees that someone else should pay for it." The prevailing view in the medical profession is that doctors should ignore the cost of care, Marine said. Instead, he suggested, the push toward lower costs in health care should be led by a group of well-trained physicians dedicated to the best values of the profession who are prepared to apply the best principles of management to medical care. e DISCIPLINING DocToRs T he current system of handling complaints against doctors is not working, said Peter J. Millock, general counsel, New York State Department of Health. It's time-consuming, it addresses too few physicians, it wastes money, and it's so complicated it's unintelligible to patients and doctors. The average case lasts 20 months, Millock noted, and almost all physicians, including those whose licenses �are ultimate ly suspended or revoked, remain in practice during this time. In 1989, there were 67 such cases. The state is now examin ing way to streamline the system. M illock also sees oth er sources of change for the physician discipline system. There may be new ways to identify substandard physicians, including recredentialing. Standards of care may become more precise, he said, and deviations from those standards easier to e tablish. But a member of the audience took exception to the idea of tightening standards of care. "What bothers me is that standards are going to be set and your performance is going to be monitored by how many inches you deviate from the standard. As an individual, that's the most disturbing thing for me. If I wanted to be a robot, I'd be a robot." The comments were greeted by applause. Millock urged the speaker to work his concerns into the changing system. • MALPRACTICE CRISIS T he next malpractice crisis will come in 1995, predicted Donald W. Aaronson, M.D., an allergist who is also an attorney. Though he's not sure what will cause it, Aaronson said it will be child's play compared to the 1975 crisis, when doctors wondered whether insurance would be available, or the 1985 crisis, when prices skyrocketed. Aaronson offered up another depressing tidbit: physicians in general have a 3 7 percent chance of being sued for malpractice during their lifetime; those in ob/gyn have a 57 percent chance. However, there are several things doctors can do to avoid getting sued, said Aaronson, who is also clinical Quality of care soon "I don't believe the old a rt of medicine is lost," Aaronson said. "We care about our patients, but often we don't know how to show it." e may be judged by how Connie Oswald Stofko is editor of the far a doctor deviates from precise standards. One physician's comment: "If I wanted to be a robot, I'd be a robot. " assistant professor of internal medicine at the University of Illinois College of Medicine and editor of Medica l Malpractice Prevention. They include: e Reduce patient injury. This can be done by raising the skills of incompetent doctors. Training programs should retain the physicians' dignity, but bring them up to the level they should be, he said. e Share responsibility. Doctors shouldn't make decisions for the patient. Instead, they should spend time presenting the alternatives. Doctors should also listen to other health professionals, such as nurses and pharmacists. e Keep good records. For instance, carry paper at all times and record phone prescriptions, he suggested. e Improve communication. Patients complain that doctors are concerned only with disease, they don't listen, they don't explain things, and they're inaccessible. Buffalo Phys ician and Biomedical Scientist. PATHOLOGY WING DEDICATED To SANES T he Class of 1945 dedicated the pathology wing in the Cary-Farber-Sherman Addition to the memory of the late Samuel Sanes, M .D., a much-admired professor, during the Spring Clinical Day and Reunion Weekend. The plaque marking the wing paid tribute to Sanes, who died in 1978, as a physician, acting chairman of pathology, and community leader, as well as an outstanding teacher. It contains a quote from Hippocrates: "To hold him who has taught me this art as equal to my parents and to live my life in partnership with him." Those attending the ceremon y included Mildred Spencer Sanes, his widow; Thelma Sanes, his sister; other members of the Sanes family; about 15 members of the Class of 1945, and Barbara Kearney, the first recipient of the Harold S. and Thelma Sanes Scholarship. The cholarship was established by Sanes' brother and sister for students with academic promise and financial need. e �WELCOME BACK G etting together with old friends ts always a highlight of the annual Spring Clinical Day and Reunion Weekend. A reception to welcome return, ing alumni was held Friday, April 2 7 in UB's Center for Tomorrow, followed the next day by the alumni luncheon at the Marriott. The trophy for the reunion class with the highest percentage in attendance went to the Class of 1960, whose chairmen were RogerS. Dayer, M.D., and James R. Kanski, M.D. Special recognition was given to mem, bers of the 50,year reunion class, who wore festive straw hats to mark the occasion. Reunions were also held for graduates of the Classes of 1945, 1950, 1955, 1965, 1970, 1975, 1980 and 1985. Mark your calendars now for next year's celebration. The reunion weekend starts Friday, May 3, 1991. From left, seated: Henry Severson. Morshall Ointon. John Benny, Stanley Urban. Bernard Juveher, James Schaus. Standing: Warren Montgomery, MaHhew O'Brien. Norbert Roberts, Charles Mincks, Robert Hubbard, Wilham Hndebrand, Fritz Guenter, Evan Molyneux, Albert Rekate, Harold Polanker. 1940 From left, on floor: Jacob Steinhart, Ivan Kuh~ Herbert Joyce, Wilham Mcintosh, Robert Schopp. Seated: Raymond Barry, Wilr10111 Loeser, Gearge Thorngate, Wilham Andaloro, Richard Adler, Edward Fargrave, Earl Cantwell. Standing: Donald Groft, Joseph Sheedy, George Elhs, Wayne Templer, Hnton Jacobson. Charles Wiles, Wilham Taylor, Joseph Tannenhaus, Norman Chassin. Theodore JeweH, Albert Rosso, John Hartman. Edward Valentine, John Ouinhvan. John Robinson. Vito Lagr10. 1945 �From left, seated: William Webster, Robert Kling, Helen Sikorski, Richard Leberer, Bob Patterson, Leo Manning, Joseph Mattimore. Standing: Roland Anthone, Henry Pech, John Graf, Robert Bergner, Richard Lyons, James Curtin, James Brandl, Robert Benninger, Vincent Scamurra, Del Dunghe, Roy Robinson, Sidney Anthone. From left, on floor: Franklin Glockner, Francis Klocke, Gerard Diesfeld, Thomas Guttuso. Seated: John Lauria, Robert Malatesta, James Kanski, Roger Dayer, Naomi Leiter, Harold Brody, Marshall Lichtman. Standing: Harry MetcaH, Daniel Rakowski, Donald Donius, Joseph Antkowiak, Algirdas Gamziukas, Andre Lascar~ John Tuyn, Joseph Chazan, Robert Sauer, Eugene Rivera, Harris Faigel, William Abramson, Edwin Lamm, William Stein, Donald Hammel. From left, seated: Robert Martin, John Peterson, John Winter, James Nunn, Richard Carlson, Winifred Mernan, John Baker. Standing: James Garvey, Ray Schiferle Jr., John Foley, Albert Franco, John Kent, Larry Beahan, Robert Pittell, Frank Guzzo, Shedrick Moore, Eugene Whitney. From left, seated: Wilt.am Adler, Patrick Houston, Louis Trachtman, Joseph Cardamone, George Moore, Robert Schultz, Michael Feinberg. Second row: Harry Yerby, Barry Feinblatt, Kenneth Kim, Steven Berman, Calvin Marantz, Ralph D'Amore, Ira Hinden, Jerald Giller, George Strauss. Third row: Gary Jeffery, W. Scott Walls, H. Elt.ott Larson, Wilt.am Bucher. 1950 1955 1960 1965 �From left, seoted: Wilr.om Fiden, Robert Ungerer. Second row: Michael Uppmann, Laurence Lesser, David Rossman, Agnes Szekeres, Roger Forden, Dennis Krauss, Robert E. Lee, Alan Fink. Third row: Jan Novak, Ronald Zmyslinski, Donald Capley, Sebastian (anti, JeHrey Ross, Dennis Dubois, Shafic Twal, Arthur Goshin, Arthur Seigel. Not pictured: Donald Gabel, Neil Garroway. From left, on floor: Mark Borer, James Twist, George Tremiti. Second row: Theresa Stephan-Hains, Barbara Hirsch, Ellen Tedaldi, Michael Grant, Morgoret Paroski, Harvey Arbesman, Constance Lentz. Third row: Nancy Colligan, Maryanne Kiernan, Katherine Jasnosz, Cynthia Parlato, Donald Switzer, Paul Trainer, Donna Oehman, Lynn Steinbrenner, Irene Snow, James Conway, Vivian Fasula, Timothy McCullough. Fourth row: Mark Gilbert, Thomas Masten, Robert Shalwitz, Thaddeus Wojcik, Martin Hale, Eric Tenbrock. From left, seated: Marguerite Dynski, Wilr.am Cohen, Mary Lou Meyers. Second row: Jack Cukierman, James Burdick, Henri Woodman, John Stubenbard. From left, on floor: Sabino Torre, Jack Coyne, Kevin Donovan, John Fudyma, Joseph Zizzi. Second row: Shirley Galuck~ Lynda Stidham, Wendy Delaney, Thomas Cowan, Claudia Fosket, Thomas Medige, Lucie DiMaggio, Adriana Alvarez. Third row: Michael Lahood, Timothy Wacker, Donald Flemming, Ira Handler, Thomas Szalkowsk~ Margaret Reidy, Er.zabeth Maher, Barbara Deuell, Carl Turissini, Amy O'Donnell, Edward Cheslow, Margaret Ubby, Donald Tingley, John Leddy. 1970 1975 1980 1985 ��21 a nurse gives a vac~ cination, a lab technictan uses a Petri dish, or a patient discards a tissue. Medical waste is created. And it's not just hospitals that generate medical waste. Physicians' and dentists' offices make it, and so do laboratories. Finding safe and economical ways to dispose of medical waste is a growing concern for health care providers, research institutions, and universities, as well as for government agencies charged with guarding the public from exposure to potentially toxic substances. Getting rid of such waste isn't as easy as it used to be. Most experts agree that there's more of it, thanks to the proliferation of disposables and single~service items such as disposable syringes, bedding, IV bot~ des, and other supplies. And the percentage of waste requiring special handling has climbed dramatically since 1985. The public's concern about medical waste heightened after medical~ ly related material washed up on beaches during the summers of 1987 and 1988. In addition to aesthetic concerns, fear of AIDS contributed heavily to the public's anxiety regarding medical waste, according to a report from the Agency for Toxic Substances and Disease Registry. However, only a small fraction of persons infected with HIV (the AIDS virus) are hospitalized. At any given time, more than 99 percent of all potentially infectious HIV~infected persons are living in their homes in the community. Thus, body fluid waste eliminated by persons with infec~ tious conditions is primarily being discarded from private homes, accord~ ing to a 1988 Oregon Department of Human Resources study. HANDLE It's getting harder to throw away By Paula Voell CARE �22 Only five year ago, according to 1985 Centers for Disea e Control guidelines, less than 10 percent of total hospital waste needed to be treated as infectious. Today, the percentage varies, depending on whose parameters are used. "Three or four years ago the medical waste given pecial handling was mainly from people in isolation," said William D. Pike, vice president of the Western New York Hospital Association. "They may have had an open wound, hepatitis, pneumonia, AIDS. Now we're handling almost all patient care waste as medical waste." This can account for as much as 50 to 80 percent of total hospital waste if Centers for Disease Control universal precautions guidelines are followed, said Lawrence G. Doucet, a professional engineer with Doucet and Mainka, hospital management consultants in Peekskill, N.Y. Categorizing the wa te ha also become more complex. The terms "infectious," "medical," and "hospital" waste often are interchanged inappropriately. Hospital waste is the broadest category and includes all solid waste. Medical wa te describes materials such as soiled dre sing and intravenous tubes. Infectious waste is that portion of medical waste that could transmit an infectious disease. About 15 percent of ho pita! waste is estimated to be infectious by Environmental Protection Agency (EPA) definition. Experts tress the importance of viewing infectious waste in its proper perspective. All waste, including that from homes, may contain pathogenic organisms. Hospitals in the eight Western New York Counties produce about 60 tons of solid waste daily - that includes the potato peels from the kitchens and the memos circulated throughout the facility. Of that, about 16 tons is treated as infectious waste, according to William Pike. Many of the larger hospitals and the University incinerate their waste, but smaller hospitals use private haulers. David Balbierz, vice president of BFI Waste Systems, says his business has steadily increased. BFI is a private hauler with 80 medical waste disposal sites in the United States. Private physicians and other small hazardous waste generators (less than 50 pounds of waste a month) have also had to change their disposal habits. "You can't put it in the trash any more," said Balbierz. "For a long time this stuff was going out to the curb, into dumpsters or into the sewer." Now physicians, dentist , veterinarians and others must register with the state, fill out tracking forms and submit annual reports. The waste has to be packaged and marked with the generator's name and addres . As the waste travels to its final disposal, the form goes with it. "The tracking system is intended to work as a burglar alarm, alerting EPA and state officials whenever waste has not reached its intended destination and leaving a paper trail that will lead to the violators," according to discussions in the Congressional Record. "THREE OR FOUR YEARS AGO THE MEDICAL WASTE GIVEN SPECIAL HANDLING WAS MAINLY FROM PEOPLE IN ISOLATION. NOW WE'RE HANDLING ALMOST ALL PATIENT CARE WASTE AS MEDICAL WASTE." As regulations become more tringent, skyrocketing costs of disposal take a bigger bite out of hospital and university budgets. A study by the management and technology consulting firm of Arthur D. Little in Cambridge, Mass. notes that nation-wide, disposal costs could rise from $3.7 billion in 1988 to $10.7 billion in 1991. To complicate the problem further, hrinking storage capacity in landfills puts more emphasis on incineration of wastes. "As we approach 1992 and there is less available (storage) capacity in the marketplace, prices will jump considerably for a period of time as new incinerators come on line," said Melissa Forgione, vice president of Medical Waste Services, a Buffalo waste disposal firm. "Then I think prices will decline, and stabilize." In the Buffalo area, almost all hospitals burn waste, said William Pike of the Western New York Hospital Association. Before the waste is incinerated, regulations state that it must be handled with caution. At Buffalo General Hospital, for example, waste is placed in red plastic bags that are transported to a holding room on each floor in a large cart that is eventually rolled to the incinerator. A bracket system on the bottom of the cart allows it to be latched onto the incinerator. "We have a pretty unique system," aid Richard Kerling, director of plant operations at Buffalo General. "Once the waste is in those containers, it's not handled again." The hospital burns six tons of solid waste a day, everything from garbage to paper, at an estimated co t of $240,000 for 1990, according to Kerling. Before the incinerator was operative, it cost the hospital 60-65 cents per pound to have its waste hauled to a landfill in South Carolina. "Since the incinerator went into operation in September 1988, to be conservative, - - - - - - - - - the hospital has saved a quarter of a million dollars in medical waste disposal costs," Kerling said. Despite such savings, Buffalo General and other local hospitals are facing a crunch because the Department of Environmental Conservation has tightened regulations on incinerator emis- �sions. By January of 1992 even hospitals such as Buffalo General, which has one of the newest incinerators, won't meet the new code without costly modifications. "Our incinerator is just a year old, but we'll have to upgrade it to meet the standards," said C. J. Urlaub, Buffalo General's vice president of operations. Installing a scrubber 23 (a device placed on an incinerator to remove air contaminants with water) may cost the hospital as much as $800,000. Other hospitals will pay from $1 million to $3 million for new incinerators, depending on size, Pike said. Adding to the cost is the sophistication of the new machines, which need expensive stack monitoring and engineers to run them. "You can't have the housekeeper light a machine and throw the bags in," Pike said. Hospital administrators are exploring the option of joining with other facilities to cut costs. "If 14 hospitals are spending $70 million, it would be far cheaper to have a few larger sites," Pike said. Some environmental officials favor such a regional approach because it means there are fewer incinerators to operate and monitor, but public outcry has been intense against accepting waste from outside the community. The ot In My Back Yard ( IMBY) cry has become so strident, some wonder if it's turned to NOPENot On Planet Earth. Recently, Medical Waste Services was negotiating to build an incinerator to handle waste from several hospitals, nursing homes and physicians' offices in the southern part of the state. The project was defeated because of citizen outcry. Medical Waste Services picks up 10,000 pounds of waste each week from small generators as well as from Our Lady of Victory and Columbus Hospitals, facilities which do not have their own incinerators. "We provide the packing, permitted hauler and insurance," said Forgione, the company's vice president. Boxes for waste storage and disposal provided to its clients by Medical Waste Services come in three sizes and include a three-millimeter liner. A box 18 by 18 by 24 inches that holds 30 pounds costs $27 for disposal. On average, private physicians produce one box of infectious waste every two weeks, according to Forgione. BFI workers who pick up medical waste are given extensive training in how to handle the waste and what protective clothing to wear, said Balbierz. "Actually, the people who pick up regular (curbside) trash are less protected because they don't know what's in it," he said. Waste haulers point out that ordinary garbage from private homes can include needles (it is estimated that one billion needles are discarded by diabetics annually), as well as waste from infectious di eases such a hepatitis. Misconceptions about treatment of hospital waste abound, despite increasing amounts of attention to the problem, Pike said. "I think people assume that hepatitis will be coming out of stacks and that hundreds of trucks will come to a property and that's just not true," he said. �HOW UB HANDLES MEDIC 24 The University produces about 35,000 pounds of medical waste annually from its 60 laboratories, mainly utensils containing culture media from labs in the schools of medicine, dentistry, and nursing. "The state regulation in relation to the University seem very stringent," said Robert E. Hunt, director of Environmental Health and Safety at UB, which has an incinerator on the South Campus. "For a long time the state regulations said that once infectious waste was autoclaved (sterilized with steam) it could be treated as trash and go to a sanitary landfill. That was no problem for us except for a few labs who had to find a way to autoclave. "But recently a sentence was added to the regulations to require that all regulated medical waste has to be made nonrecognizable, so it has to be incinerated or ground up. We are using incineration but it's causing considerable problems because a big share in poundage is plastic - flask tubes, pipettes and Petri dishes. That's extremely difficult to incinerate efficiently, to bum up at high temperatures efficiently enough so you don't get a lot of byproducts in the air." To cut down on the amount that has to be incinerated at UB, labs are advised to put all clean glass and plas:~m~ tics in special containers 'glass,' Hunt says. These are collected puncture- Balbierz estimates t h at only two to five percen t of waste is pat h o l ogica l waste, but con cedes t h at t h e public has a different perspective. "Th ey h ave t h e misconception that o ur AU11JM 1990 resistant cartons to be disposed of in permitted landfills. Hunt doesn't think the health industry will revert to reusable supplies. "I've thought about it, but there's just so much expense involved with the handling, cleaning and storage of glassware that maybe a lot of researchers would find it impossible to continue." William Pike, vice president of the Western New York Hospital Association, agrees it's unlikely that hospitals will go back to reusables. "The reason we use disposables is sterility. If there was a fault in the autoclave, would you want a needle reused? "And I think that there would be a concern for infection with blood products if we switched from the use of throwaway plastic bags." Pike said that hospitals are more likely to look for ways to cut down on disposable items and encourage recycling in areas other than patient care. "There are other things hospitals could do in such things as packaging for food - eliminating the use of Styrofoam, for example," he said. trucks are filled with body parts, when actually most of our waste is rubber gloves, disposable gowns, the paper used on examinating tables, masks and tongue depressors." Before all the dust settles on how best to dispose of hazardous waste, Melissa Forgione says, people will have to become better informed. Paula Voell is a reporter for the Buffalo News. BUFFALO PHYSICIAN AND BIOM EDICAL SCIENTIST • �... ----------------------------------/f 0 25 The Body Snatchers Elwood lecturer tells how grave robbing and murder charges ensnared a famous anatomist BY JEFFREY TREBB A • 19th century anatomist whose illustrious career was destroyed by charges of grave robbing was the subject of the Charles L. Elwood Memorial Lecture in March. The lecture was delivered by Sherwin B. Nuland, associate professor of surgery at Yale School of Medicine, whose visit to Buffalo was sponsored by the Alpha Omega Alpha national medical honorary society. According to Nuland, it was only stubborn self-assurance that allowed the Scottish anatomist Robert Knox to become implicated in a series of murders committed to furnish specimens for dissection. In his lecture, "Goodness Tainted: Robert Knox and the Anatomy Murders," Nuland told his audience: "Robert Knox (1791-1862) was a paladin destroyed by his own code of honor, for although his drive and talent seemed to promise a glorious academic future, his destiny became his downfall when he was scapegoated for a series of crimes instigated by the medical science of his time. "By confusing egotism with purity of conscience, by believing compromise signifies cowardice and by equating pragmatism with weakness, Knox sacrificed great achievement on the altar of vanity," Nuland said. The actual "scoundrels" were two navy workers on the Union Canal between Edinburgh and Glasgow, William Hare and William Burke. Nuland called both "familiar with all BUFFALO PHYSICIAN A 0 BIOMEDICAL SCIENTIST Detail from "The Anatomy Lesson of Dr. Tulp," Rembrandt, 1632 In 1828, corpses of murder victims were sold for about seven British pounds apiece. the woe, wretchedness, guilt and pollution" life contains and said they embarked on a spree of killings shortly after Hare filled an already-dead neighbor's coffin with tanner's bark and sold the man's corpse to the medical college, becoming quite impressed with the simplicity of the deed. All colleges in Great Britain early in the 19th century were facing an increased need for corpses owing to the growth of surgery with its new emphasis on detail, and also to the higher standards of care legislated by government. AUTUMN 1990 �... If ----------------------------------------- 0 26 And procuring bodies for dissection, Nuland pointed out, usually meant resorting to illegal measures of some variety since the two legal sources, the bodies of executed criminals and those of the unclaimed dead in hospitals, never approached the demand. "The need was insatiable. You just couldn't teach without corpses," he said. Grave robbers, or "resurrectionists," supplied what they could, but eventually graves became clo ely watched over by relatives of the deceased, said Nuland. So Burke and Hare turned to murder. Burke even gave his name to a style of suffocation: To "burke" someone meant strangling him while sitting atop his chest. In all, Burke and Hare killed about 30 persons in 1828, netting about seven British pounds per body. The pair brought suspicion upon themselves after murdering several well-known prostitutes. An elderly woman they brought home from a tea shop, plied with gin, and killed after an evening of dancing and singing, was their last victim. Unfortunately for Knox, the body, purchased by assistants, was found in his dissection cell. Nuland described Knox as a "man of solitary self-regard, endowed with an air of authority, possessed of charm, cultivating distinctiveness." He had studied in Paris with Georges Cuvier, the French zoologist and statesman, who established the sciences of comparative anatomy and paleontology. Shortly after returning to Edinburgh in 1822, Knox established a museum of comparative anatomy at the Royal College of Surgeons in Edinburgh. "Knox's enviable command of language and his showman hip drew students in huge numbers; not only anatomists but artists and divinity students. He was a tourist attraction for AUTUM 1990 cultivated travelers and at the threshold of an illustrious career," aid Nuland. "The greatest anatomy teacher of his day, he was also skilled in paleontology and comparative morphology." But because the body was found in his room, Knox "faced all the frustration built up by a century of grave robbing. He was scolded for every sin ever committed in every aspect of medical science," said Nuland. The press derided him, he was burned in effigy, he was forced to walk through creaming crowds to give his lectures. A folk song closed with "Burke's the butcher, Hare's the thief, Knox is the boy who buys the beef." Few colleagues came to his defense. Even his admiring students left his side. This despite the fact that he was acquitted in court late in 1828, according to Nuland. (Burke was found guilty on Hare's testimony and hanged before 20,000 onlookers. His dead body was sent to the anatomy school for dissection.) Nuland claimed the anatomist was brought low by pride and vanity: "Knox cast ridicule on the opinions and men of the time and flaunted his talents, inviting bombardment. He believed it beneath his dignity to respond to the charges, and the reverberations followed him the rest of his life." Knox lost his job as curator of the anatomy museum and was forced to resign from the University of Edinburgh. He rambled about the country barely surviving by lecturing on anatomy and fishing and writing for magazines in London. He was expelled from the Royal Society of Edinburgh for non-payment of dues. This career as a perennial free-lancer was relieved by only one respectable position as a fellow of the Ethnological Society of London. In 1862, long after his wife and all his children were dead, Knox e died of a stroke. BUFFALO PHYSICIAN AND BIOMEDICAL IE TIST �27 MILGROM OUTLINES WoRK ON ANTIANTIBODIES A t one time, it was believed that the body's immune system could not make antibodies that would be destructive to the host's own tissue. But Felix Milgrom, a distinguished professor of microbiology at UB, helped to prove that theory wrong through his work with antiantibodies. Milgrom delivered the 20th Annual Ernest Witebsky Memorial Lecture in May at the Center for Tomorrow on UB's North (Amherst) Campus. "The theme of antiantibodies is something that I have been pursuing for 44 years," Milgrom said, outlining his research career. "It is something that I have been pursuing from the very beginning of my research." In outlining his research, Milgrom Felix MUgrom, M.D. BUFFALO PHYSICIAN A D BIOMEDICAL SCIENTIST issued a caveat to his capacity audience. "The lecture," he said, "was not designed to be a comprehensive treatment of this topic." Milgrom noted that the audience would require a graduate seminar in advanced microbiology if they wanted to really understand what the topic encompassed. Milgrom worked at UB from the 1950s through the mid-1960s with the late Ernest Witebsky, whom Milgrom called "the world's most brilliant immunologist." Their work made great strides toward disproving the old theory about autoimmunity. Another "first" for Milgrom was demonstrating in the laboratory that some forms of kidney graft rejection are caused by antibodies present in the circulation of presensitized recipients. That was an important piece of information in 1968 when the field of human organ transplantation was new. His research also clarified the structure of rheumatoid factor, an antibody. Milgrom noted that over the years, UB's Department of Microbiology has attracted hundreds of students. About 40 or 50 now head departments or institutes focusing on immunology in the U.S. and abroad. A native of Poland, Milgrom was chair of the Department of Microbiology at Silesian University School of Medicine in Zabrze, Poland, and a professor and acting chair at the University of Wroclaw in Poland, before coming to UB. Milgram has authored about 600 professional articles and has served as editor for several books. He was awarded the Paul Ehrlich Prize in 1986 in recognition of his distinguished service in the fields of immunology and chemotherapy. After Milgram's lecture, the Ernest Witebsky Memorial Awards for proficiency in microbiology were given to Seth Dewey, a medical student; Jennifer Kuracina, a dental student, and Haiping Mei and Ai Shih, both graduate students in microbiology. e AUTUMN 1990 �28 LISTEN WITH HEART, ABRAM TELLS GRADS A very personal message came with this year's commencement speech to the School of Medicine and Biomedical Sciences. The 145 medical students, 25 doctoral tudents and their familie and friends heard diplomat Morris Abram advise graduates to "shorten your stethoscopes to hear what patients are saying and feeling." Abram, the U.S. representative to the European Office of the United ations and Other International Organizations, Geneva, and former Diplomat Morris Abram addresses graduates. president of Brandeis University, keyed his address to the relationship between doctor and patient. But it was more years, had shortened the listening tube than a theoretical overview from a sani- of his stethoscope. tized ivory tower. Abram shared his per"One day a young resident came up anal experiences with the graduates, to thi wise old man and said, 'Doc, talking about hi own bout with why do you use such a short stetholeukemia that lasted five years. scope? Did you buy it that way?' He "The relationship between doctor and said, ' o son, I just had to keep cutting patient is one of extraordinary psycho- it off.' He was a man who paid very litlogical and emotional interplay," Abram tle attention to technology and a great said, reflecting on the sometimes-anx- deal of attention to what he was hearious encounters with hi own team of ing," Abram said. physicians during chemotherapy. In looking at patients this way, Anguish, frustration, and reverence are Abram said, physicians will be able to all felt by the patient toward his physi- determine how much information they cian, he said, pointing out that, in time, can give the patient, whether or not especially with diagnosis of a disease that the patient has the "instinct and will to can be fatal, patients begin to scrutinize fight to survive," and if the patient is the doctor's every word and nuance. realistically facing the severity of his ill"I remember the anxiety of sitting by ness, he added. the phone waiting to hear the results of The historical and technological my bone marrow from my hematologi t. changes that have taken place in I would sit by the phone and think, medicine since 1846, when the UB 'Why hasn't he called? What's wrong?' medical school was established, have Finally he called and he said, 'The bone affected the doctor-patient relationmarrow looks good.' I said, 'What does ship, Abram said. that mean? Does it mean it doe n't look The first hundred years were marked great?'" Abram added with emotion. by a small arsenal of treatments, and The speaker recounted the story of a bedside manner was sometimes the best learned physician, who, through the medicine, Abram said. Technology has AUTUMN 1990 moved ahead in leaps and bounds, but to orne extent it has caused the physician to focus on body parts rather than look at the whole human being. Abram referred to some of the frustrations today's physicians face - the increasing risk of malpractice, bureaucratic red tape, immense amounts of information to be absorbed - all of which result in le time for patient interaction. There is precious little time for "rumination about the symbiosis between the healer and healed" in the cour e of medical training today and among practicing doctors, Abram said. But he urged the new physicians to listen and study their patients, not just from a biomedical standpoint, but also from an emotional one. Abram told the audience that during hi bout with leukemia, he was under the care of James E Holland, M.D., former chief of medicine at Roswell Park Memorial Institute and former director of Roswell Park's Cancer Clinical Research Center. Holland, who wa also research professor of medicine at UB, is now at Mt. Sinai School of Medicine and Hospital in New York City where BUFFALO PHYSICIA AND BIOMEDICAL SCIENTIST �29 he is professor of medicine, chief of the Division of Medical Oncology, and director of the Cancer Center. A lawyer by training, Abram is a man of many accomplishmen ts, said John Naughton, M.D., vice president for clinical affairs and dean of the UB medical school, who introduced the speaker. Abram is a Rhodes scholar, a former president of the United Jewish Appeal, and has served on state, local, and in ternational commissions including a presidential-appo in ted committee examining medical ethics. This year's commencement was highlighted by the graduation of the medical school's first M.D./Ph.D candidate, Edwin Heidelberger. The first graduates of UB's Early Assurance Prog ram, which allows qualified students to apply early, also crossed the threshold from e student to resident. - By David Himmelgreen Richard Condit, Ph.D., associate professor of biochemistry, listens thoughtfully. Dennis Nadler, M.D., associate dean, witnesses the signing of the Book of Physicians by Constantine Petrochko. BUFFALO PHYSICIA AND BIOMEDICAL SCIENTIST AUTUMN 1990 �30 a Martha Pierre, left, shares her exciting news with Shiau-Wen Pien and Jase Rivera. 89°/o GET ToP CHOICE AT 'BEST' MATCH DAY T hey streamed through the doors of Butler Auditorium like the ancient Hebrews making their way through the parted waters of the Red Sea. Some had bottles of champagne, others had babies and spouses. They were all buddies who just completed four years of training in quest of becoming fine physicians. And now they were about to embark on another journey. March 21 was Match Day, the annual event held at medical schools across the country where fourth-year students find out where they'll spend their residencies. The UB students had to wait through the announcements - yearbooks, graduation speaker, and in tructions on how to sign the alumni scroll - before they would get those coveted envelopes telling them where they would be going. AUTUM 1990 Then they waited some more as Dennis Nadler, associate dean for curricular and academic affairs for the medical school and director of the office of medical education, reported on the statistics. The tension was mounting. There were 141 students who participared in this year's match, said Nadler. It was the best year since 1979, when Nadler first began keeping records. This year 67 percent of the students got their first choice, up 2 percent from last year, said Nadler. And another record was broken with a whopping 89 percent of the students getting one of their top three choices. (Five students didn't enter the match: one was a military match, one was a student in the Medical Scientist Training Program who began a residency in January, one chose graduate study in physiology, one accepted a part-time position in Vermont, and one got a position after the match.) The applause thundered through the auditorium as the students realized just how good a class they were. UB students are going to some of the best and most highly competitive residency programs in the country. Nadler exclaimed that UB finally cracked the prestigious residency program at Massachusetts General in Boston. He added that UB is also sending students to other top-notch programs such as Duke and Johns Hopkins. But Nadler had to make the students squirm just a little more. As he clenched the envelopes that would tell them of their fate, he said with a grin, "I made an effort to randomize them." The students booed as if they just saw a Bills player drop a pass. Then, one-by-one, they came up, some with trepidation, but many with beaming smiles splashed across their faces, to get the sacred envelopes. Cheers broke out and champagne corks flew through the air. There were plenty of hugs, smiles, and celebrations. "I got my first choice - Syracuse," said Anthony Navone, a medical student, who added that "after five years and $75,000 it was all worth it." Heidi DeBlock, another student, who brought along her husband Scott and daughter Alexandra, was ecstatic that she was going to Rochester, her first choice. Ralph Augustini, who's a glutton for cold weather, will be spending the next several years at the University of Michigan. He was full of good cheer and drenched with champagne and kisses from well-wishers. "I just want to congratulate all of my classmates," he said. Nadler summed it up: "We have a strong class. We did well, exceptionally w~ll. It was an impressive result especially because the competition is getting tighter every year." e - By David Himmelgreen BUFFALO PHYSICIA A D BIOMEDICAL SCIE TIST �0 " 31 Dr. Herz Goes to Washington UB psychiatry chair tightens up mental health grants BY LOIS BAKER A stint as a senior science advisor at the National Institute of Mental Health (NIMH) has given a UB professor new perspective on the workings of Washington bureaucracy. Marvin I. Herz, M.D., professor and chair of the Department of Psychiatry at UB's School of Medicine and Biomedical Sciences, spent September through December at the NIMH as advisor to the director, Lewis Judd. He found the work in Washington interesting, but prefers to be closer to the front lines. "I got a close look at how the federal bureaucracy works," said Herz, "and I enjoyed meeting people and exchanging ideas. But it's much more rewarding to be in a setting where you can actually work with patients, actively direct their care, and do the research. "These people administer programs that other people do. They don't work with patients, students or faculty. They are far away from where the action is." Herz was invited to NIMH headquarters in Washington, D.C., for work with the Division of Education and Service Systems Liaison because of his expertise. He is one of the few physicians in the United States who has devoted his career to researching new treatments for schizophrenia and other serious mental illnesses. BUFFALO PHYSIC IA AND BIOMEDICAL SCIE TIST "I got a close look at how the federal bureaucracy works , but it's much more rewarding to be in a setting where you can actually work with patients. " Herz's mission was to bring a more scientific orientation to the division's projects.The largest task of this division is to fund clinical trials that try to find more effective ways to treat seriously mentally ill children and adults. The funding is channeled through state Departments of Mental Health. "The problem in the past with these demonstration projects has been that they were never scientific enough to be reported in the literature so they could be replicated," said Herz. One grant that Herz reviewed was an extension of some of his own previous work. It proposed to study schizophrenic patients and the benefits of intervening in their treatment at the first signs of relapse. Herz said that traditionally, professionals treating schizophrenics tum to crisis counseling for the family and an increase in medication for the patient only after the patient has suffered a full relapse which usually sends the patient to the hospital. "When early signs of relapse appear, several days or a week usually pass before the episode progresses to full relapse," Herz said. "By intervening early we expect a decrease in hospitalization as well as less family burden and improved functioning of the patient." Herz said, "My job was to tighten up the demonstration grants - define the population, give a clear description of the grant's intention, make sure they were using randomized control studies, if possible, and valid and reliable instruments to register change. "In the past they couldn't describe what was actually done because the results weren't clear." He also advised the demonstration project staff on ways to treat seriously mentally ill patients, and helped sharpAUTUMN 1990 �0 v 32 PoRTIN Is PRESIDENT OF MEDICAL ALUMNI B ertram A. Portin, M.D. '53, has been elected to a one-year term as president of the UB Medical Alumni Association. edra J. Harrison, M.D. '77, was elected vice president, and Donald P. Copley, M.D. '70, was elected treasurer. Portin, a colon and rectal surgeon, is a UB clinical professor of surgery and chairman of the division of colon and rectal surgery in the Department of Surgery. Certified by the American Board of Surgery and American Board of Colon and Rectal Surgery, Portin is an attending surgeon and chair of the Division of Colon and Rectal Surgery at Buffalo General Hospital. Harrison, a general surgeon, is a clinical instructor of surgery at UB. Copley is a clinical professor of medicine in UB's Department of Cardiology. e Robert M. Barone, M.D., a general surgeon, has been elected president of Millard Fillmore Hospitals' voting medi~ cal staff for 1990-92. Barone is a clinical ~ assistant professor of surgery at UB. e § Q Sister Angela Bontempo, pre ident of Marvin I. Herz, M.D. en the focus of training programs for psychiatrist , social workers and other mental health professionals. He continue to serve a a consultant to the institute. Herz developed an interest in treating serious mental illness during his directorship of the inpatient unit of New York City's Montefiore Hospital from 1961-1963. He later spent 12 years as director of community p ychiatric programs at Columbia College of Physicians and Surgeon and New York ::W.iiiiiiliiiiiiiiiiiiliiiiiiiiiiliiol State Psychiatric Institute. In addition to his UB position, Herz currently i director of psychiatry at the Erie County Medical Center and Buffalo General Hospital, as well as consultant at the VA Medical Center. He was elected recently to the Board of Regents of the American College of Psychiatry. Herz's research has earned accolades in the past. In 1988 he received the American Psychiatric Association's Psychiatric Institute of America Foundation Award for Hospital Research. e ~ Sisters Hospital, has been appointed to the state's Public Health Council. The 14-member council advises the State Commissioner of Health and considers matters relating to the preservation and improvement of public health. e Gregory Branch was one of 10 medical students nation -wide to receive a Metropolitan Life Foundation Award for academic excellence in medicine. The honor includes a 2,500 tipend. He· is now a fourth-year student. e Kandala Chary, M.D., has been elected pre ident of the Sisters Hospital medi- AUTUMN 1990 BUFFALO PHYSICIA AND BIOMEDICAL SCIENTIST �0 ' 33 cal staff. Chary is a clinical instructor in medicine and otolaryngology at UB and has served as president of the Asian American Physicians Association. e 1918fLU EPIDEMICGRAD WAS THERE Thomas J. Dougherty, Ph.D., director of radiation biology at Roswell Park Cancer Institute and associate professor of pathology and radiobiology at UB, received the Gustavus John Esselsen Award for Chemistry in the Public Interest. Dougherty was recognized for his research leading to the development of photodynamic therapy (PDT), a potential new approach to the treatment of certain types of cancer. The award was presented at the annual meeting of the American Chemical Society in April. e Leonard G. Feld, M.D., Ph.D, associate professor of pediatrics and physiology at UB, has been elected to the American Physiological Society. Feld is also chief of the Division of Nephrology at Children's Hospital and director of the Children's Kidney Center of Buffalo, which is located at the hospital. He recently received a $96,600 grant from the Juvenile Diabetes Foundation International to study the long-term effect of the drug aminoguanidine, which will be used to prevent glucose from damaging the membranes within the kidney. e John Naughton, M.D., dean of the medical school and vice president for clinical affairs at UB, has been named Physician of the Year in Academic Medicine by the alumni association of the University of Oklahoma College of Medicine, where he received his medical degree in 1958. aughton was cited for "outstanding contributions and leadership in furthering scholarship, administration and research." e BUFFALO PHYSICIA AND BIOMEDICAL SCIE TIST John D. Pigott, M.D. John D. Pigott, M.D., a specialist in congenital cardiac surgery, has been appointed chief of the Division of Cardiovascular Surgery at Children's Hospital and associate professor of surgery at UB. With this appointment, Buffalo is now offering state-of-the-art heart therapy for children that is not available elsewhere in the state. Pigott had been a cardiac surgeon at the Children's Hospital of Philadelphia. e James J. Reidy, M.D., has been named director and chief-of-service for the cornea service in the Department of Ophthalmology at UB. e John P. Visco, M.D., a cardiologist at Buffalo General Hospital, has been elected president of the hospital's medical staff for 1990. Visco is also a clinical assistant professor of medicine at UB. e Gentlemen: Thank you, sincerely, for publishing the article, "Flu," written by Deborah Brunch Bucki, R.N., M.S. It sure brought back many memories of my early life in Buffalo. 'I was there,' so to speak. In the fall of 1918, I was a member of the senior class, South Park High School. I became ill at school and was excused. I walked home a distance of one-half mile. On arrival home, my mother took my temperature - it was 104. It was diagnosed as influenza and I recovered after one week- no complications. I graduated from the University of Buffalo Medical School in 1925 interned at the Buffalo City Hospitai and remained there 20 years (1925-194 5), except for a two-year period in the mid-1930s when I attended the Johns Hopkins School of Public Health where I was granted the degree of Doctor of Public Health (D.P.H.). I succeeded Dr. Walter S. Goodale on his death in 1941 as superintendent of the City Hospital and professor and head of the Department of Preventive Medicine at the University of Buffalo. All of the doctors mentioned in the article: Goodale, Fronczak, Gram, Cott, Meyer, Sherman and Jacobson, were friends of mine - great men, all of them. I departed from Buffalo in 1945 and for the next 21 years served as superintendent of the New York State Masonic Home and Hospital, in Utica, N.Y. I retired in 1966 and since then have lived in "God's Country," the foothills of the Adirondacks at Woodgate, N.Y. I was 89 years of age in August and enjoy good health. William T. Clark, M.D., D.P.H. AUTUMN 1990 �0 ' 34 most advanced in the world. It features a unique environmental chamber which simulates the equivalent of depths of 5,600 feet beneath the sea or 100,000 feet in altitude. It also includes a centrifuge capable of simulating up to 10 "Gs" or gravities and a submersion basin which provides underwater observation of subjects against specified rates of currents. HERMANN RAHN DIES; PHYSIOLOGY PIONEER LooKED To SKIES, SEAS H ermann Rahn, Ph.D., whose pioneering research in environmental physiology helped provide the foundation for today's aerospace and undersea medicine, died June 23 after a brief illness. He was 77. Leon Farhi, M.D., chairman of UB's Department of Physiology, has noted that while environmental physiology was on the books for a long time, it really blossomed in the early 1940s when Hermann Rahn made his contributions to the field. Rahn, distinguished professor of physiology at UB, served as chairman of the Department of Physiology at the medical school from 1956 to 1973. A native of Michigan, Rahn received an A.B. degree from Cornell in 1933 and a Ph.D. degree from the University of Rochester five years later. Joining the UR faculty after teaching briefly at the University of Wyoming and spending a year as a fellow at Harvard, Rahn, with his colleagues, conducted research which benefited Allied pilots and soldiers in World War II. The Rochester team assisted the U.S. Army in determining the amount of water and other essentials needed for desert survival prior to the landing of U.S. troops in North Africa. Later, the researchers used a converted brewery tank as a primitive altitude chamber to study hypoxia, which caused pilots to lose consciousness at high altitudes. Although he officially retired in 1985, Rahn continued to put in six-day workweeks in his lab until shortly before his death. His research in comparative respiratory physiology involved work with eggs ranging from those of the ostrich to the hummingbird. During 15 years of research in this field, he served as a consultant to the poultry indu try and to those interested in the field he founded, incubation physiology. AUTUM 1990 Hermann Rahn, Ph.D. Although Rahn's scientific interests spanned a range of subjects within biology, his primary interests were comparative physiology and pulmonary physiology, in which man or animals adapt and interact with different environments. Basic knowledge he provided in this area advanced the understanding of lung dysfunction in patients with pulmonary diseases. For this work, he received the American Lung Association's prestigious Trudeau Medal. A device he invented led to development of the self-guided cardiac catheter used today in diagnosis of cardiovascular problems. Rahn's vision, enthusiasm and determination helped build UB's Department of Physiology into an international center for environmental physiology. The Hermann Rahn Laboratory, housed in the UB Center for Research in Special Environments, is one of the Rahn's research earned him many honors, including the U.S. Air Force's Meritorious Civilian Service Award, the highest given a civilian; election to the prestigious National Academy of Sciences and the American Academy of Arts and Sciences; and honorary degrees from the Universities of Rochester, Bern (Switzerland), Paris, and Seoul (Korea). He was the first recipient of the Under-Sea Medical Society's top honor, the Benke Award. During his career, Rahn had been a visiting professor at several institutes abroad and was a president of the American Physiological Society and vice president of the International Union of Physiological Sciences. He was the author of more than 200 scientific articles and four major texts. A dedicated teacher as well as a researcher, Rahn inspired many graduate students and fellows who studied with him at UB to follow successful careers in physiology. A Hermann Rahn Memorial Fund has been established and contributions may be sent to the Department of Physiology, 124 Sherman Hall, University at Buffalo, Buffalo, N.Y. 14214. e BUFFALO PHYSICIAN A 0 BIOMEDICAL SCIENTIST �35 1940., Stanley L. Olinick '40 :l> writes that his busy schedule includes a half-time practice, teaching, writing, friends, tennis and music. Anthony M. Aquilina '44 :l> of Amherst, N .Y., was elected president of the Baccilli Medical Club for 1990. William D. Loeser '45 :l> is now retired from private practice. "! work part time for a nursing home ... love it!" Albert J. Rosso '45 :l> writes, "My wife of 41 years and I have eight wonderful children and 16 fine grandchildren." David J. Shaheen '45 )> retired in 1986 and is now living in Titusville, Fla. Jacob M. Steinhart '45 :l> of Clarence, N.Y., writes, "Still enjoying the private practice of pediatrics, but in a six-man group!" Gilbert B. Tybring '45 :l> who has been retired for five years, edits the Wisconsin Psychiatrist. Vernon G. mith '48 :l> of Orchard Park, N.Y., retired from his private practice in pathology in 1987 due to a severe fracture of the right femur. Max A . Schneider '49 :l> who is known internationally for his work in the field of addiction medicine, was recently appointed an associate clinical professor of psychiatry at the University of California College of Medicine at Irvine. Henry A. Thiede '49 :l> appears in the videotape "The History of Certification in Emergency Medicine" produced by the American Board of Emergency Medicine. This tape was made to celebrate the recognition of emergency medicine as a specialty and to commemorate the individuals involved in the history of certification. Robert Benninger '50 :l> is now retired and enjoying life in Cape Coral, Fla. George P. Bisgeier '50 :l> former medical director of New Jersey Bell, is semi-retired and doing part-time occupational medicine. Karl L. Manders '50 :l> of Indianapolis, Ind., recently published "Indications for Surgery in Back Pain" in Seminars in Neurology. In addition to his practice in neurosurgery, he continues as medical director of the Community Hospital Rehabilitation Center for Pain. Dr. Manders is currently president of the Midwest Pain Society. Ernest H. Meese '54 :l> was elected president of the board of trustees of the American Cancer Society Ohio Division. He has been a volunteer with the Cancer Society for 26 years. Dr. Meese has a private practice of thoracic and cardiovascular surgery in Cincinnati and is an assistant clinical professor of surgery at the University of Cincinnati Medical Center. Milton Alter '55 :l> left his position as chairman of neurology at Temple University and is now professor of neurology and director of the residency training program at the Medical College of Pennsylvania. He holds an NIH grant to study the epidemiology of strokes and was BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST recently awarded a supplemental grant to study risk factors for recurrent strokes. George L. Mye Jr. '55 :l> of Yelm, Wash., retired in July from general surgery and a partnership in a Southern California Permanente Medical Group. David L. Palmerton '55 :l> of Clarence, N.Y., writes, "! retired six years ago, but I am into starting up home health care agencies in Florida and Virginia." Jerome P. Kassirer '57 :l> the Sara Murray Jordan Professor of Medicine at Tufts University School of Medicine in Boston, has been elected to the Board of Regents of the American College of Physicians. He began a threeyear term in April. Daniel C. Kozera '59 :l> a clinical assistant professor at UB, is acting chief of ob/gyn at Mercy Hospital and a consultant for ob/gyn to the Erie County and New York State Health Departments. 1960.\ Franklin Glockner '60 :l> is now working full time in the Division of Orthopaedic Surgery at Albany Medical College and is chief of orthopaedic surgery at the VA Hospital. Edwin R . Lamm '60 )> was elected president of the medical staff at Lakeland Regional Medical Center in Lakeland, Fla. Eugene T. Partridge '60 :l> of Buffalo has 12 grandchildren and is expecting more. Joseph A. Chazan '60 :l> director of the Division of Renal Diseases at Rhode Island Hospital and associate clinical professor of medicine at Brown University, took office in April as governor for the Rhode Island chapter of the American College of Physicians. Jeffrey E. Lindenbaum '66 :l> has been appointed clinical director of a new joint venture adolescent medicine program with Children's Hospital and Medical Center in Seattle, Wash. Stephen E. Langer '67 )> of Berkeley, Calif., is medical editor of the National Examiner. His column reaches 6 million people per week. Dr. Langer is currently president of the American Nutritional Medical Association. John E. Shields '68 :l> is a consultant at the Seafield Alcohol Treatment Center in Westhampton Beach, N.Y. 1970s Jan Novak '70 :l> has been reelected president of the medicaldental staff of the Erie County Medical Center. He is an attending in medicine and heads the gastroenterology unit of the hospital. Kenneth Solomon '71 :l> associate professor in the Division of Geriatric Psychiatry at St. Louis University School of Medicine, presented at the Department of Psychiatry Grand Rounds at the Erie County Medical Center and the VA Medical Center in Buffalo April 20. Patricia K. Duffner '72 :l> has been elected president of Children's Hospital medical staff, the first woman elected to AUTUMN 1990 �36 the post. A professor of neurology and associate professor of pediatrics at UB, she has coauthored a book with Michael Cohen, M.D., on brain tumors in children. past 11/z years she has also been involved in public sector work. Dr. Turner has 2 sons, 5 1/z years and 2 years. Her husband, Alan, is a member of the Dallas Symphony. Arthur W. Mruczek '73 > has been appointed director of the contact lens service at the Erie County Medical Center. The service will include therapeutic as well as co metic contact len es. Mark Chung '82 > writes, "I am a practicing pulmonologist at Los Alamitos, Calif., having graduated from Harbor-UCLA training program, and have been appointed lieutenant commander with the U. . Naval Reserve." Nancy H . Nielsen '76 > has been named to the State University of New York Board of Trustees. A clinical assistant professor of medicine at UB, Niel en practices medicine with the Buffalo Medical Group. She is a medical consultant to the bacteriology laboratory of the Buffalo General Hospital and is a delegate to the New York State Medical Society. Niel en wa the first woman president of the Erie County Medical Society. A member of the board for Professional Medical Conduct, ew York tate Department of Health, Niel en i a longstanding volunteer for the Buffalo and Erie County YMCA. 1n 198 7, she received the Outstanding Achievement Award from UB's Community Advisory Council. Angelo Del Bal o '78 > is the author of an 800-page text for physicians and dentists called Maxillofacial Imaging. It describes imaging techniques used to detect and identify diseases and di orders of the head and neck area. An associate professor in UB's Department of Radiology, Del Balso is also the author of Panoramic Radiography, published Ia t year. AUTUMN 1990 Patricia K. DuHner '72 1980.~ Mark . Borer '80 > is starting a new organization "P.E.A.C.H.," People Educating and Advocating for Children. Robert Braco '80 > will receive an M.P.H. degree in May from the University of Texa School of Public Health in an Antonio. Katherine Jasnosz DeCaria '80 > write "My hu band Anthony and I are the proud parents of Daniel Joseph, born on Sept. 15, 1989." Dr. DeCaria is a forensic pathologist with the Allegheny (Pennsylvania) County Coroner's Office. Walter iemian '80 > is certified by the American Board of Pia tic Surgery, and is now an active member of the American Society of Pia tic and Reconstructive urgeons. Sylvia Turner '80 > of Dallas has a private practice in child and infant p ychiatry. For the Albert Speach '82 > is currently assistant professor in the division of otolaryngology at the University of Kentucky. Jo Ann Pravata Pullen '83 > and her husband, William Pullen, M.D., are the proud parents of William icolas Pullen, born Oct. 14, 1989. William is in private practice in internal medicine and endocrinology in Santa Monica, Calif.; Jo Ann practices medicine at Cigna Health Plans in Los Angeles. Mark C. Steckel '84 > is a clinical instructor in ophthalmology at New York Medical College, and director of pediatric ophthalmology and strabismus at the Metropolitan Hospital of New York, N.Y. In addition to his academic positions, he has a practice in adult and pediatric ophthalmology at 4699 Main Sr. in Bridgeport, Conn. Deidre J. Greene '86 > of Pennsylvania writes, "My husband, Rob Dixon, and I jojned ABC Pediatrics last July in Allentown. We also now have a beautiful son, Patrick, born in October." Janice J. Pegels '86 > write , "Married James Jewell, M.D. on June 10, 1989; enjoying the lake and mountain view from our home in Seattle." James J. Shaughnessy '86 > writes, "I'm living in rural Massachusetts and commuting to Providence for a two-year fellowship in child and adolescent psychiatry. Dale Radka '86 is in the same program." Jill E. Koehler '87 > announces the birth of her son, Alejandro Daniel MarenoKoehler. Dr. Koehler is chief pediatric resident at Hurley Medical Center in Flint, Mich. Obituaries Mitchell!. Rubin, M.D., a kidney specialist instrumental in the development of Children's Hospital as a modem medical center, died April11, 1990 in Charleston, S.C. after a long illness. Rubin, 88, a teacher, clinician, re earcher and pediatrician, was well known for his work in pediatric nephrology. He was a professor and former chairman of the Department of Pediatrics at UB. Pediatrician-in-chief for Children's, he retired in 1972 after 27 years of service. After retirement, he returned to his native Charleston, joining the Medical University of South Carolina, where he established the Division of Pediatric Nephrology. The author of Pediatric Nephrology, Rubin published more than 70 articles in professional journals. He belonged to 14 professional societies. BUFFALO PHYSICIA AND BIOMEDICAL SCIE TIST ��Buffalo Physician and Biomedical Scientist State University of New York at Buffalo 3435 Main Street Buffalo, New York 14214 Address Corredion Requested Non-Profir Org. U.S. Posrage PAID Buffalo, NY Permir No. 311 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. 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School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1990-Autumn Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. School of Medicine Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v24n02-1990-Autumn Table Of Contents A list of subunits of the resource. Research. Mommy track? 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Copyright 1990 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/a14d1a5b2686ae6df94b63e41b3a9872.pdf 34b832c7ebf16b2c680afb2b1ec4d17a PDF Text Text \ol. 24, !'-:u.I PINS & . NEEDLES / ._ NEEDLES & PINS· · .: ___,e----- • • • • . . ' . . ,. . . .. .,_ . �::,,,\I I ()IRH'TOROF rt llUl <\TillN', DearFriends: Nann Tol•n T he current ,.,,,uc of the Ph'ljs1cranmc.luJcs ,m .,mdc det,111 mi: the <,1rccr ,uu:e,~ ot three ,1lumnt ,, ho ,ire me<l1c.,1l <c.hool de n<. M mh 111A. Ltc.hrm n, M D '60 at the Um, er,11\ of Rol.hNtcr, Eui:n1e M '-1i:m m. M () •i;z at tht· Um,ersll\ of Conncd1cu1, ,md F-r.mklyn G. Knox, M.n., Ph.D. '65 di rlw M,1\0 Ml.'d1, ,I -.;._hool L'B l'rNrdcm "11.'H'll R. unplc h.i, rbccJ .i m 11orcmph "' on reuunment , t faLuh, ,, uh rec.ord, , f Mgnthc.mt ,Khre\C mcm Also., p,m of 1h.11t,ISk is the de,elupmt'nt 111mdr\"lduab who rcpn·wm Buftal1),II ,>1hcrqualny m,111u1101iThe thrtt mdr, ,duals pr. filed m<lccJ rc.-presem the be,1 m tC"rm<uf J'C'r.<n 1I md pr< fc ,ron 1I , ,luL,, wrecr pr,>ducu, II\ ,md ,1ch1e,cmC"nt,.mJ (,....,1du,h1pskill-. Oi each \\C"<hould not only take i:re,11pndC",hur IH' should cxpre.,,, to th C"m,iur hc.rrt• tel1 gramudc tor commntmi: their hH"li tu purp<™-"li "c ,1l1hold so dear EPIT\ R C.inn1c (.),,.JIJ 'I ,tl ART DIRECTOR AbnJ Kr,:lcr \\ RITI RS D.i, iJ I limmcli:rttro Anhur r'I:'" Jdtm. Tr,M, "U<'\luctchn r1tun X,RAl'I lERS l'ld·hcHu >- n l..,. Rot...-rt'iJ. 10n AO\'J-.;()RY BO .\RD Dr John N ,u •hhm, l h.:unnan Dr II ,IJ Br~ ~b. """''(,I«' Dr J K.nd, Dr J,...,,h L Kur Dr Ch irk r, mdl, M• I Jul () l'dl<n<•n Dr !\nt It< rcren Dr ( hark, rnrr Dr Luther R >hn ,n Dr Tl1011u,Ru,cnth.il Dr :,,.,Jccb"ur<>h Dr Run n "•~nn.m Dr "r<f'hm "f<'ulJ, John :-.au ght on, ~t.D . Dr l'-cl "' Tom, Mr EJ,. rJ 'iJ.cn,lc \'rec l'rts1d..•mfarClinu-alAffa," Dean, Schoolof i\fofu.11\t' ,md B1omcdic.1/S,,cncts Dr J.-r.....,YJ10 T~\ C lll:-.;G Hl ) '-l'ITA ~ ,\:,;() l.lc\l~O:-;s BarI\ ,a\ A Medic.ii Center Buffilo Umcral lfo,rn l \like \hau Buff k \ !\ ~lahc.il C.cnm I Pu l1i IJrm H..--..rirI K4r Ory '>t. E.rc C ty McJ I ( .enter Manon"-lamnou-,,_, M, rev llo,pnal, C.hu.k r,bw M,llarJ f, !more II r11al,J ""f'h R uffa R ,.,. II r: rl C: nccr In lute /,J,, /uo:c, m Ht,,r11al M.{.anfn Pr .lu«J i....w f\nuan of l 111h-ntt'f Rd.:J k11M>R141rh W XMuf of \ltd, ..mt nd IU,r\S ffl "-"'" l'nil ~ "' Tl II' Bl ff ALO rHhlC.1AN A?-.l) BIO MEDICAL SCIENTIST (USPS m MO) SrrinK 1990, \, 1 umc 24 Numl,cr I PuM ,hcJ '"" tum, nnu;,11, '-rnlll: Summer Atrt n. Luh- \l mr.-r, ,mJ Late \l ,nrcr I') rhc Sc -. I 111M<J1emc anJ B1omcd1ol x,cnc , S1,1c l nl\et>II) f Ne,. ,.,,l II llufl I. • l4}5 M 1nSrr«r Rull lo, Ne,. h-.,l 14214 ThuJ hull r< 1 raiJ II Bufr lo, c• Yorl s.-nJ ,Jdu ,hant< 1 THE BLFFAl(l rmsll lAN AN[) BIOMEOIC'AL S<.1 D.'Tl'-T, 146<~ AJ.lmon. 1415~bin "-trn-t Buff rt l ◄Zl4 cu i-;..,.,' DearColleagues: I I \\ould lakC"to ,h re "uh }OU ex1..crp1, from I IC"ttfr "c r«cl\cd from I m1.'tll~r, t the i:raJuJtmg c.Li, th,mkmi: us tor the -.cnrur rcc1.-p11on "Dc,t r nwmhi:r, ,if tlw ,1!11111111 .i,,oc 1,1t1110 "As stu<l1.·nt,,... 11e le 1mmg th 11 1p1rt from the obi IOU' furu:.11n,, f kecpmi: tr.id, ,,t waJua1~ md org.m,:mg reunion< our ,1lumnt ,ire trul\ mtcrcstcJ m the ,tud1.-nL, mJ the ,;chool 11,clt ~I.mi ,1lumrn ,1ss,x1,111o n, 1h,11111.• h,11·e ,,h,cn c<l m rhC" p,1 I nnohe them,,che, m m.11m.11nmi:the rcput 1110nof 1hc1r alma m llt'1' h\ m ,kmi: ml•ne1,11; Jon 1110n, to the ~hool md c-.1,1hlt,hmi: ,m 'olJ h.,) ncl\\Ork' for gr,1duates. \Vh1le 1he-e ue clfecme mJ o.ll.'-ept.IMCmethoJs, " our lumm h,tH dim.en to h.• more J1redh 1mohl..J. "Through the -.enior rccepttun, the ~pnng Clmrc. ,I n.i, an,1 m,m\ oth,•r ,1lumnt ,1ff 1rs, \OU h,1H· set ,m ex mple for u, ot hlm our ,,lumnr .1ssoc1a11unc.m be "hen 11c..ircs to go furthl·r th1n tht· 1r,1d111on,1,ICU\ I 11,e,. 'wur J<.11\CpnJc ,md concern c.h1llenge, u< to hcconw 11:u,e ,1lun1111 .md contmuc 10 ,!um the s..hool .md the communn, \,h.11 "1mport,mt 10 rh,,1u.in, ,,ho gr Juatc from 1hr, s..hool" ( !,'UCSS thts ~1y, II .ill &-...1",~hes to the ( •1.1.,,, ol '90 .ind to ,111rhc ,1lumnt/,1c .ir,· ,/ <.·ordialh u~LK ::.u Pusidenr, 1',itdirolAlmmuAssoc1a1on �Vol. 24, No. I Srrmg 1990 Research briefs.Sodium and stomach cancer; elderly blacks need more health care; soaking in the tub; healthy wheelchair ; active endothelium. Onpinsandneedles.It's not until everything else Pinpointingpain relief, page6. has failed to relieve their pain that patients tum to acupuncture and UB's June Oh, M.D. Theboywholiveda miracle . No one had ever recovered from such an injury. But Brian Fitzpatrick, a 1986 graduate of the UB medical school who helped treat the boy, was able to see him walk out of the hospital. Microscopes to microchips. From practicing diagnoses The caseof ihe "miracleboy," page 12. to recognizing heart murmurs, computers have emerged as the UB medical schoo l's newest teaching tool. Moreresearch . A major study suggests that olive oil is more "heart smart" than butter and another project investigates temporary shelters for the homeless made of corrugated cardboard. Talentintriplicate. UB boasts three alumni who are currently medical school deans. Take a glimpse at their careers and their recollections of UB. Alumni. A member of the Class of 1971 honors a teacher through a gift to the UB medical school and two members of the Class of 1930 are remembered through gifts. Computers:the UB medical school'snewest teaching tool, page 18. Classnotes . Cover:Illustration by John Ripa UB boasts three alumni who are medicalschooldeans, page26. �--- :® :---.r E t. ~ 2 ·,., •...,1t1;':-ii SODIUM INTHEDIET MAYINCREASE THERISK OFSTOMACH CANCER t's prohably not good fnr your heart, and now 1t looks like higher levels of sodium m the diet mcrease the risk of gastric, or stomach, cancer, according to a ~tudy by researchers al UB. They found a dose-response increase in risk for men and women related to sodium, as well as related to fat and retinol, a form of Vitamin A. Puhlbhed in Nutrition and Cancer, the study of diet in the ep idemiology of gastric cancer was conducted by Saxon Graham, Ph.D., professor and chair of the UB Department of Social and Preventive Medicine, and colleagues. Based on extensive interviews with 293 patients with gastric cancer and carefully-malched controls, It showed "suhstantial reductions in ri,k were associated w1th 111gest1on of carotene ... as well as with increased use of low-temrerature food storage." Vegetables, some nf them rich 1n carotene, identified by the UB researchers as decreasing nsk were celery, cucumhers, carrots, green peprers, tomatoes and oniom. Noting that the incidence of gastric cancer has dropped "drastically" in recent yean., the re-earchers sa1J "the promulgation nf preventive medicine recommendation.-,is less urgent than formerly. "Certamly, however, limiting caloric intake, especially fat, limiting sodium, and increasing intake of vegetables, particularly those containing carotene, are suggested as steps in the direction of inhihiting nsk of stomach cancer. The same may be said for use of refrigeration . "A number of other cancers, such as cancer of the colon and lung, as well as cardmvascular pathok1gies, might also be controlled by these dietary suggestions." The UB researchers found a doseresponse increase in nsk with increases in ingestion of total number of calories, as well as total carbohydrates, fats and protein. "Consistent wnh our finding of increased risk associated with fats and protem, was an incrt::ase in risk associated wirh increai-es in ingestion of meats," they said. The researchers also noted "a numher of high-search foods were associated with increased mk of gastric cancer, including potatoes, potato chips, french fries, pe;u;, nee and pasta." Graham said improvements in the refrigeration of food since the early 1900s may be a maior factor in the drop m gastric cancer. "Both refrigeration and carotene could inhibit oxidation products which could act as carcinogens 111 the stomach," the researchers noted. Other UB researchers participating in the study were Brenda P. Haughey, Ph.D.; James R. Marshall, Ph.D.; John R. Brasure; Maria A. Ziele:ny, Ph.D.; Jo L. Freudenheim, Ph.D., and James P. Nolan, M.D. Also authors of the paper were Dee West of the Bay Area Resource for Cancer Control in Alameda, Calif., and Gregg Wilkinson of the University of Texas School of Medicme at Gah·estnn. - B)· Anhur Page ELDERLY BLACKS HAVE GREATER NEEDS Bur GETLESS HEALTH CARE he elderly black residents of New York State receive far fewer health and social services than elderly whites, even though the blacks' needs are much greater, according to a landmark study by UB's Mult1disc1plinary Center on Aging. Conducted hy Arthur Cryns, Ph.D., professor of soCial work and senior research professor with the center, and Kevin M. Gorey, research assistant professor, the study was the first comprehensive attempt co examine the health and social needs of blacks acr~ the state. The researchers found: Black elderly people arc 4.5 times more "vulnerable" than elderly in the general population, with vulnerahility defined as having three or more unmet health or social service needs. Gorey said needs were simply the "necessit1es of daily living, ranging from transportation, housekeeping and food preparation among the social services, to the health care provided by a physician, hospital or nursmg home." 13.9 percent of elderly blacks are health care "dependent," compared to 8 percent of the elderly in the general population. The proportion of elderly blacks considered self-sufficient is less than one-half that found among the elderly �3 in the general population. Elderly blacks have only half of their social services needs met. Economic reasons were listed as the most potent factors explaining the variation in services among the elderly. "Medicaid does essennally what it was designed to do, but that means nothing for the near-poor, those severely impoverished but unable to meet the criteria for aid," Gorey explained. "Forty-six percent of tho e surveyed lived under the U.S. povert) line. Unfortunately, 26 percent are very close to the po\'erty line and can't meet expenses from their pocket." The study was funded by the New York African-American Institute, a component of the State University of New York established in 1986 to initiate, conduct and coordinate applied and historical research on blacks, especially New York State resi<lents. Japhet M. Zwana, Ph.D., director of research and special proiect for the institute, termed the study ""ery important" and hoped it would be applied co policy decisions addressing the disparity in ser\'ices. The study "demonstrates the magniwJe of the problem and confirms our worst fears," said Arthur Eve, deputy speaker of the New York State Assembly, who added chat he planned to hold public hearings on the issue. "The existing institutions are making a concerted effort. bur the minority community must <levclop our own support network," Eve said. "We must be empowered." He acknowledged the need for more black doctors within the black community, recommending more ,cholarsh1p money to thb end. "Above all, we need more resources and stronger institutiom," E"e said. "It's an unequal system." The study was based on responses to a lengthy questionnaire by 1,542 elderly blacks, 1,057in New York City and 485 in the upstate cities of Buffalo, Rochester, Syracuse, Albany and Binghamton. In most cases, the upstate participants were found to have greater unmet needs than those in New York City, a trend that may reflect the fact that more services are in place in the latter. - By JeffreyTrebb the body to excrete large amounts of water and salt and could he useful in treating people who have fluid retention disorders. For instance, in pregnant women with rnxemia, immersion has been found to lower blood pressure significantly and increase the excretion of salt and water without drugs that coul<l harm the fetus. 'That's the nice thing about immersion- 1r's not a pharmacological treatment," Krasney pointed out. As a person sits in a tub of water, the water preswre squeezes the blood from the legs up into the chest, until the volume of blood in the heart and lungs is coo high. How does the body adjust? It eventually tries to reduce the blood volume by getting rid of fluid through urination. "Water immersion produces a very profound and sustained diuresis," Krasney said. "If we didn't have kidneys, when we sat in water, our blood volume m the body would ri,e enormously." Da\'id Pendergast, Ed.D., professor of physiology, has shown that the response of the kidneys is reduced in athletes, particularly in swimmers, though it's not clear why. The body excretes fluid not only from the blood, bur from cells as well, Krasney belte,·es. A subject immersed for six hours excretes so much fluid, he'd have very little plasma left if all of the tluid came from the blood. Another indication that water is shifted from cells is the fact that people's skin gets wrinkled m water, he said, though the wrinkling coul<l be caused hy the temperature of the water or other reasons that aren't clear. "Our major area of interest i, why chi,; major fluid shift occurs and what implications H has for therapy," Krasney explained. SOAKING INA BATH WARMSPHYSIOLOGIST TOITSBENEFITS ince ancient Rome, people have touted the curative powers of a long, relaxing soak in the tuh. Now scientists are taking a second look at the medicinal properties of the bath in treating high blooJ pressure, inflammation of the kidney, cirrhosis of the liver, and toxemia during pregnancy. Data resulting from this renewed interest in "head-out water immersion," as scientists call 1t, was reviewed in September at the first international symposium on the topic. John Krasney, profe.ssorof physiology at UB, delivered the keynote lecture. Scientists are interested in heaJ-out water immersion, Krasney explained, because soaking in a rub of water causes �--- :(]}---.,. E ._ \. 4 There are probably ma1or shifo in blood flow patterns from one part of the body to another, he added. Krasney's immersion scudtes are pare of a program project from the National Institutes of Health called "Environment and Oxygenation: Delivery, 0iffw,ion, and Toxicity." The principal investigator is Suk Ki Hong, M.D., Ph.D., professor of physiology. The Physiology Department at UB abo uses water immersion in ocher ways: As a t0t)l for studying temperature regulat ion. As a way to study the effects of increased blood volume without actua lly adding fluid to the blood. § To simulate the weightlessness t JosephC.Moll endor f, Ph.D encountered by astronauts. Water immersion is also used in I physical therapy, Krasney noted, and more work should he done to understand how it may affect blood flow to injured muscles. II ealchy" wheelchairs chat do a "The whole area is exploding clinilot more than provide a cally," said Krasney. There are only means of mobility are the goal about 30 researchers in the world study- of UB researchers. ing head-out water immersion now, but Incorporating a patented system they he expects that there will be many developed that enabled a young paramore when a second symposium on the plegic to ride a tricycle, che prototype topic b held in Italy in 1991. wheelchairs being developed by the At the September symposium, researchers would exercise the muscles Krasney received an honorary life mem- of users' legs as well as strengthen their bership in the Doctor Richard Bright heart and lungs. Society, the group formed to perpetuate Wheelchair modifications being research in kidney disease that sponinvestigated by the UB team include :;ored the symposium. the addition of hand cranks and Ironically, the symposium was held in replacement of conventional footrests Bristol, England, co honor Bright, the with pedals. The wheelchair~ would be father of renal medicine. But Bright moved by a combination of the user didn't think very high ly of water operating the hand cranks and his feet immen,ion, noted Krasney. pushing on the pedals as a result of electrical stimulation of muscles in his legs. - By Connie OswaldStofko "This is a new concept to incorrorate exercise inw the normal daily activities of the wheelchair-hound person," ! I explained Frank C. Mendel, Ph.D., associate professor of anatomical sciences and founder of the UB Spinal Cord Injury Research Interest Group. "It would allow the paralyzed or weakened lower limbs to be exercised on a regular and habitual basis," he added. "Every time users move che wheelchairs, they would exercise their lower limbs. This would pump blood pooled in their lower legs upstream so the re would be less swelling of the legs. It also would move their joints so there would be less likelihood of decubitus ulcers forming." Turning the hand cranks and movement of the legs also would provide aerobic exercise strengthening the heart and lungs. Wh ile wheelchair users currently may derive such benefits from costly exercise devices, usually limited co hospitals or clinics, the system proposed by the UB researcher~ would provide them dunng routine activities in the home, at work and elsewhere. The work dates back to a discussion between Mendel and his accountant, father of a then 6-year-old girl who was confined to a wheelchair after her legs were paralyzed at age 3 . With hopes that she someday will walk again, her parents wanted co mamtain the integrity of the girl's leg muscles. The UB researchers' solution also provided a means to strengthen rhe youngster's heart and lungs and, literally, a vehicle for joining her siblings and friends for a spin around the block. They replaced the Big Wheel's handlebars with hand cranks synchronized with the tricycle's pedals using chains and cams. The trike was propelled by a combination of the youngster moving the hand cranks and her feet, held in stirrups, pushing on its pedals as a result HEALTHY' WHEELCHAIRS REALLY GETLEGS MOVING BLFF:\LO PHYSICIAi-.::\1'D lllL1\{Ei'IC\L !-CIE!-.Tlq �--- :CE} ---J'E,.q. s of electrical stimulation of two secs of muscles in the thigh of each leg. Electrical stimulation of the users' leg muscles is a key factor in the benefits derived from the modified trike and the wheelchairs envisioned by the UB researchers. "If we don't stimulate them, che lower limbs would simply go for a ride," Mendel explained. "They would get no exercise." ln addition to Mendel, members of che team are Dale R. Fish, Ph.D., U B associate professor of physical therapy and exercise science; William Tanski Jr., director of the UB Health Sciences Instrument a nd Fabrication Shop; Robert Kell, retired electrical engineer formerly with Calspan Corp.; Joseph C. Mollendorf, Ph.D., UB professor of mechanical and aerospace engi neering and Darold C. Wobschall, Ph.D., UB associate professor of electrical and computer engineering. The work is funded by grants from the New York Stare Science and Technology Foundation, Gaymar indust ries Inc. and Index Electronics Inc. - ByArchur Page Endothelium can respondto variousstimuli, notonlyas the productofinjury,as we havealwaysthought, but:alsoby undergoing 'activatwn . . ,' says RarnziS. Cotran, M .D. endoithelium. BLOOD VESSELS' LINING of Cocran is the Frank Burr DOESN 'TJUSTSITTHERE Professor of Pathology at the he endothelium isn't just a coat for the blood vessels, but is a very active protagonist, according to Ramzi S. Cocran, M.D., who delivered the fall Harrington Lecture at UB. Cocran is a recognized leader in the study of endothelium, which is the lining of the cavities of the heart, the blood vessels, lymph vessels, and other organs. With Guido Majno, M.D., he did pioneering studies on the structu re lll:FFALl ) rHY~lCl:\N ASD 810 \IEDI CAL :;... :tESTl~T Mallory Harvard Medical School and chairman of the Department of Pathology at Brigham and Women's Hospital, Boston. He and hi colleagues found that ''the endothelium must be doing something more than just sitting there as a passive bystander as was previously thought," Cocran said. Endothelium can respond to various stimuli, not only as the product of injury, as we ha\'e always thought, bur also by 1Jndergoing "activation." Endothelial acti\'ation means there are quantitati\'e changes in specific gene products which endow the endothelial cells with new o r altered capacities co perform specific functions. This is significant because the activated endothe lium can express new molecules that weren't expressed before on the surface. These newly expressed molecu les can influence: coagulation adhesion of blood cells co the organs, which can produce inflammation new antigens, especially antigens that can influence rejection in transplanted organs This endothelial activation occurs in the boJy as well as in cell cultures and may lead to vascular inju ry, Cocran said. Endothelial cells can be activated by cytokines, which are stimulating factors (such as for growth) that are released by cells in the immune system (such as lymphocytes) or by endothelial cells. Cocran focused on the cycokines interleukin- I, tumor necrosis factor (TNF), and gamma interferon. A member of the Institute of Medicine of the National Academy of Sciences, Cocran also is a past president of the American As:.ociation of Pathologists and on rhe board of trustees of the American Board of Pathology . He serves on the editorial boards of several medical journals, including the American Journal of Pathology. Dedicated co medical education as well as being a researcher, he is coauthor of a very popular medical pathology book, Pathologic Basis of Disease,which is used at UB and other medical bchools. - By Connie OswaldScofko FormoreResearch • seepage23 �6 and feeingnopain BY ANTHONY Cl I A'-if. ,rn1~(, 1990 c.:upunc111rl•\ ad\'1K·,11e, m,1,1 1hat 11 ,me rt.·ali:6 that nw,t of thc:,e patiench,1, bencfitted b11l1on, ,m1.e It \\a, ~cek Oh\ hdp onl} a, a la t rc-.ort. mtrl,duccd mnre th,1114,000 \e,1r, ago. "The,e pafll'llt ha\·e often heen to \Vhy, tlh·n, Jo "1 m,1ny A llll'ric.in man) doctor,," c:xpla1m Oh. "They'n• ph},ic1,m, remain shpt1c,1l of 11? "~1a}bcthe} feel that other science, h,1\"Cmm1.•de,n-cut prooh l>I hm\ thq work," ,uggc,ted Ju1\l' (Joung R,1) Oh, ~1.D. On the other hand, ,he ob-.:r. e,, "Once ( pl ,1c1 1 ) h,1\ e rcicrred a p.1t1ent, ,1nJ ,een g110J re,ult,, thq h:coml' nh1re c.:onhdult." Oh, as I tant professor of rl.'hab1l1ta• t n • 1.•d11. me at UB and ,mending phy,1cnn m rehah1l11,111onml·d1cine ,1t the Erie Count\' ~kd1c.1l C1.·ntl·r, h.1, CIIJO}cd t,trtlmg re ulb u,mg thl' tedt• nique 1111r1.',II a d1\as1.· r,mcc ,111.hmnu.: p,11n:bur,111, lo\\ l'r b.1d: ,tr,un, t ngem• m,11neur,1lg1,1,m1gr,111w he,1d,1dw, neck and ,h11ulller [Min, Bell\ p,il,), had ph\,1cal thl·r<1p\ and nothing h,1p• o,tco.utlmt 1,, te111H dbm\ ,md e\ l.'n pened; med1c,1wm, and \Ct the problem Mnu, hcacbchc. ,nil per,1,red. The\ come 111 de,1,craIn De1.l'lllher, EC MC opem·d .1 nl'\\' t 1011,\\ 111 mg to g1,·e anyth mg ,\ try." ,11.upun1.tur1.· center, the onh ,ud1 cen• P,111enr,m·I\ come co hl•r 111 de,pcr,1• ter in ,1 \Vcstem Ne\\ York ho,pnal. Oh tlOn, I t the u,uall\· lc,t\ C harr}, able rt. •r1' h.11 5 percent of her patient, to funcuon better, ffillre cncrgeuc, and there l'XPl"rienn· g,111dr1.",t1lt-. The: in ,ome tnsl,lll<.:l'' ahl1.• to return to t 1t1,tH. 1 e,peci,1lh impre~,l\'t.• \\ hc:n wnrk for the tir,1 tune m ,1gc:,. llU!FAI0Pll\'1<1AN A~lll\l \IIDI c\L~lf~TIST �7 / JuneOh, M.D. , left, an assistantprofessorof reh1abilitationmedicine at UB , is oneof the fewM.D.s in the Buffalo areawho usesacupuncture. Aboveis oneherpatients , a 6!;-year-oldwomanwithosteoarth ritis. P n 0 t OS BUFFALO PHY~ICIAS A~O BlmlEDIC.-\L ~IE.'-:Tl~T b 'Y b 0 b \\ a 0 n :SPRISG1990 �8 Torelievekneeandanklepaincausedbyosteoarthritis, needlesareinsertedintothewoman 's legs, above,andhands , right. "My specialty here (at ECMC) is neuromuscular problems," says Oh. "Multiple sclerosis, strokes. Pain resulting from car accidents, whiplash, amputatiom. Anything dealing with muscles or neuroproblems. "I see occupationally related pain X-ray technicians who do a lot of lifting, those who lift a lot of patients they have pain in the shoulder blade, and yet the X-ray shows e, •erything to be O.K. Nobody can find anything, but '<PRISGIWJ acupuncture relieves the pain. I do see a lot of that." "Acupuncture is a respectable, safe approach to chronic pain," said Glen E. Gresham, professor and chairman of rehabilitation medicine at UB and director of rehabilitation medicine at ECMC. Acupuncture is Just one of many different therapies, ranging from drugs to electrical stimulation, that are a\'ailable to doctors to treat pain, and no ~ingle therapy worb for everyone. "Acupuncture is an accepted and respected alternative in this array of approaches," Gresham said. The technique, notes Oh, is almost painless. A number of very fine needles are inserted at designated points that are mapped out on a chart in Oh' s office. (In Chinese, the points have names; in English, they have numbers.) Most people find the acupuncture treatment very relaxing; some of them even fall asleep. �ECMC. She joined the staff of the hospital m 1972 as an assistant attending physician. le wasn't until Oh had lived in Buffalo for several years that she decided to study acupuncture. In a search for alternatives for patients who did not respond to available treatment, she embarked on a specialized 300-hour course in acupuncture at UCLA in California. That course allowed her to become licensed last year to use the procedure in New York Scace. The pink licensing certificate is proudly displayed on her office wall. "Ir took three years to get that paper," she exclaimed. Today, acupuncture constitutes between 30 and 40 percent of Oh's practice. Western physicians do not yet trust acupuncture completely and imurance doesn't co\'er the technique. Perhaps it's not accepted because it's not clear how it works. "No one knows exactly how acupuncture blocks pain," Oh confirms, but ventures a theory. "Pain appears to involve multiple systems including peripheral nerve endings, brain stem, midbrain reticular formation, thalamus, and prefronral cortex. "When I insert needles and manipulate and twist with my fingers, there ts an area that stimulates the pain pathway to I A native of Korea, Oh grew up in a culture that accepted acupuncture. When she was a child, her parents took her to an acupuncturist for successful treatment of stomach pains. She studied medicine in Korea, graduating from the Ewha Women's Medical School in Seoul. Then she completed an internship at the Bronx Lebanon Hospital in New York City before coming to Buffalo to do a residency in rehabilitation medicine at BUFF,-\Ll) r t-n~l(' I -\~ \!',;l) RIOMEPICA I. :;(: l~ Tl'-T Ele<trocles are oftenattached to theacupunctureneedles.In thiscase, Dr.Oh said,thepatient• wasableto get around without herwalker , walkfaster , and evengo shop· pingaftera few treatments. the middle brain and the spinal cord. The concentration of certain naturally occurring hormones (such as endorphin) is increased and the pain is controlled." Successful acupuncture, notes Oh, depends on the integrity of nerve function. About half of all known acupuncture points are in some way directly related to the peripheral nerve, and more than 35 percent are located close to the peripheral nerve. This is not the first time an acupuncture clinic has been housed at ECMC. An earlier clinic was started at the hospital in 1974, back when it was known as the E.J. Meyer Memorial Hospital. The clinic closed after a little more than a year when the initial high demand for acupuncture slacked off, said Ross Markello, M.D., who headed the anesthesiology departments at the ho pital and UB. There were also some doubts about the effectiveness of the treatments, noted Markello, who is now an emeritus professor at UB and an associate medical director at Independent Health, an HMO. A review by psychiatrist~ showed that 33 percent of the patients felt they had some improvement - exactly what you'd expect from a placebo. Oh bristles slightly at the suggestion that acupuncture might be a kind of hypnosis or a placebo. 9 �10 I Inanotherpatientsufferingmusclespasmsandpainafter backsurgery , acupuncture needleswereinserteddirectlyintotheback. Thepatientreportedfeelingwarmandrelaxedafter thetreatmentandthe spasmsstopped. �"It's not a placebo effect at all," she states matter-of-factly. "You can see in China where surgery is performed on alert patients using acupunctu re that's no placebo. "In Western New York it's not as common as it is on the West Coast," adds Oh. "In California, a great deal of acupuncture is practiced, not only by Chinese acupunctu rists, but by physicians as well. Western New York is more conservative, anJ nor as accepting of acupuncture as a medical treatment. "Since I started here at ECMC, and the patients who have come here have had good results, word of mouth has been good. In fact, a neurosurgeon at ECMC has begun to send patients who still have back pain after surgery to me." Doctors' relatives and doctors themselves also go to Oh for treatment. She was able co relieve the "tennis elbow" pain from which one doctor's wife had suffered for more than a year. A physician sought her help for Bell's Palsy, a disorder that leaves one side of the face weakened - the face becomes asymmetrical as one side droops. After six treatments his face is balanced again. Although behavior moJificacion is not really in her lme, Oh has even been able to assist the efforts of hospital employees to quit smoking. "Somehow, acupuncture b very effective to help people quit smoking," says Oh. "People have been able to quit smoking after 30 years!" When acupuncture needles are manipulated in the patient's ear, body chemistry is altered and the desire to smoke is diminished. she said. "Once people start smoking again, they're back in the habit," warned Oh, "but the technique works beautifully. I did it for cwo patients who are employees of the hospital. "I did it reluctantly, because l am not exclusively an acupuncturist. I am a physician who uses acupuncture as a tool in her practice. My practice at ECMC is a medical practice. Thirty or 40 percent of my practice is acupuncture, as indicated when these patients need pain control." Those who are exclusively acupuncturists and do not hold an M.D. or D.D.S. travel a different route ro ger licensed in New York Scace, according to T homas J. Monahan, executive secretary of the State Medical Board. They muse already have an acceptab le acupuncture license from another state or country, along with appropriate training in acupuncture and 10 years of experience outside New York Stace. Because of the way the statute is written, most acupuncturists licensed by New York were trained m Easr Asia , Monahan noted. Licensed acupuncturists outnumber physicians who use the technique in Western New York - Oh has heard of only one besides herself. But perhaps one Jay it won't be so rare. "Acupuncture is not yet completely accepted in the medical profession, bur pretty soon it will be," she predicts. Anthony Chase is the coordinawrof Academic Services for the Educauonal Opponumt)' Programat BuffaloState Collegeand a prolific free-lancewriter HowMANYDIFFERENT WAYS(AN You SPELL RELIEF? cupunctu re 1s 1us t one alternat1\'e for treating pain. While no single method can claun to be JOOpercent effect1\'e, "a ll of these th ings work \'ery well for some people," noted Glen E. Gresham, professor and c h airman of rehabil1tation medicine at UB and director of rehahd1tat1on med1c111e at ECMC. Dru g th e rap y co m b in ed with ph ys ical th era py. This 1s the most common methoJ, according to June (Joung Ra) Oh, M.D., assistant professor of rehabdnation medicine at UB anJ attending physician m rehabilitation med1c111e at the Erie Count) Medical Center. TEN S - tran sc utan eo us el ec tri c al n e rve s timulati o n. An electrode 1s pasted on the skm which deliver, a low-\'oltage current. "A Im of people gee relief from this method," noted Gresham. "l think there's a physiologically similar mechamsm to acupuncture." Tri gge r-po int inj ec ti o ns . "This 1s \'ery fashionable for people who ache all over," noted Gre:;ham. If a physician can find a pomt on the skin that cause:. this allO\'er achines, when pressed, he can inject the point with a local anesthetic or corticoscero1d, or both. The trigger pomts mav coincide with acupuncture point~. Freez ing. Freezing the area \\ ith a \'apocoolant spray bricth frec:cs and numbs the spot. The muscle can be stretched to relca:ie ,1spasm. ., 11 �Timmy Mathias'mother,Kerry,talksto herson as he recuperates. �13 BY EDWARD J.SYLVESTER Noonehadeverrecovered fromsuchan iniury. Theboy'sheadwasattachedto his bodybyonlyhisspinalcord,a fewmuscles, andskin,andhisbrainstemwasdamaged. Butthanksto theworkofa UBalumnus andotherneurosurgeons inPhoenix, the boyeventually walkedoutof thehospital, smiling and talkingto reporters. ... Timmy Mathias 'mangled bicycle �Spnng had arnved in Phoenix, Ari:ona, and the weather on April 26, 1989, was sunny and inviting. But neurosurgery resident Brian Fitzpat rick didn't have 14 time to notice. It was 8 a.m. and he was already in the middle of his bu,y morning rounds at St. Joseph's Hospital when he was ,ummoned to the emergency room: A young boy on a bike has been hit hy a pickup truck and had JUH been airevaced from the accident sm: m suburban Phoenix. In the emergency room, the trauma ream, paramedics, and nursing staff worked on the unconsc10us 10-yearold hoy who was strapped to a hack board and protected by a cervical co llar. X-rays indicated that the boy had suffered ltfe-rhreatening internal injuries and needed to be rushed into general surgery. Fit:patnck, a 1986 graduate of the UB med ical school on a pediatric neurosurgery rotation with Barrow Neurological lnstttute m Phoenix, was called co check for spine and neck injuries, and he began the first medical workup of the case that would dub his patient "the miracle child." At first, doctors had only hmt:, to the extent of the injuries suffered l,y Timothy I. Mathias Jr. From the X-rays 111 the emergency room, taken Fit:patrick and spine specialist Steven Papadopoulos, M.O., saw evidence of a !X)tentially lethal separation of the boy's neck vercehra from his skull. Timmy was sent for CT scam, which offer a much finer resolution than ordinary X-rays. From chose, the doctors suspected somethtng even worse: a fa111tshadow suggested blood on the hmm stem. A, Fit:patr1ck accompanied the unconscious hoy's gurney, rushing from the emergency mom to the CT scan to general surgery, the hoy's condition worsened. He didn't blink when hts eyes were toucheJ anJ his pupils didn't contract m respome to light, a sign of hram stem miury. In genera l surgery, physicians were able to sa\'C moM of the hoy's ruptured spleen, mended his li\'er and kidney, and stopped hi, internal bleeding. was rushingX-rays and CT scans among the specialistsof Barrow's neurosurgery team, but he was deliveringincreasingl y bad news. "It becameapparentthat Timmy's headhadbeen separatedfrom his spine," Fitzpatrickrecalls, "and that the brainstem hadbeen damaged as well." A review of the medicalliterature confirmed what everyone now suspected: No one ever recovered from such an injury. Meanwhile, Fit:patrick was rushing X-rays and CT scans among the specialists of Barrow\ neurosurgery team, but he wa.....deli\'ering increasingly bad news. "It liecame apparent that his heaJ had been separated from his spine," Fitzpatrick recalls, "and that the brain stem had heen damaged as well." A review of the medical ltterature confirmed what everyone now suspected: Of thme accident victims whose skulls had broken loo,e from their spines, a tmy proport ion suffered no bram stem injury; if immobi lized quickly, the, recovered. But of those who suffered any bram trauma what oever, none reco\'ered, no marter how quickly they were immob1li:ed. All either died or remained vegetative. Timmy haJ pulled through general surgery, but Fitzpatrick and his colleagues still faced a challenge. They needed to know precisely where the suspected brain stem inJUI)' was located. There 1s no such thing as exploratory brain surgery, Fit:patnck pointed out later in an interview; the neurosurgeun mu,r know exactly where he is headed tiefore he starts surgery. Only a magnetic resonance image (MRI) would disclme the 1nJury plainly enough for surgery, but the powerful magnet required to take such a scan would disrupt the respi rator, killing the boy. "Our fin,t break was in having a new, experimental MRI scanner," Fit:patrick explained. "This was a low-field scanner, Jes1gned not to interfere with a respirator. The question was, would it work?" It d,d, enabling Fitzpatrick and Papadopoulos to rush a set of cryscalclear scam to the viewing screen. But as each MRI scan was placed m the light in the early afternoon, recalls Harold Rekate, M.O., the pediatric neurosurgeon under whom Fitzpatrick Web working, "the news got worse. We were shocked," he says, a word not frequently heard among neurosurgeons. The separation of Timmy's neck from his skull was more severe than any of them had ever seen, and a walnut-si:ed blood clot pressed against the front of the boy's brain stem. By m1d-afcernoon, a growmg ream huddled around the MRI scam on the lighted wall panels. There was Robert Spet:ler, Barrow's chief, who is known for his aggressive and successful treatment of aneurysms and stroke; Volker Sonntag, the spine surgeon who had in\'ented an implantab le pin that would be used to reconnect the boy's spine to his skull; Rekate, chief of pediatric neurosurgery; Fmparrick, and Papadopoulos. �IS Thethinblackarrowsshowhowthe skullwas separatedfromthe spine.Thefat whitearrowindicatesthe bloodclotpushingonthe spinalcord. RL'FFALOrHYsJCI-\'\ A'\ll f\l0\1ElllC-\l ~-IE'\Tl'-T �16 "Granted, there is little chance we can save him," Spetder told the group. "Bue 1f we do nothing, he will surely die. If we do these things, we're going to lose mo,c of the t11ne.Bur if we don't do chem, we'll lose all the time. "What are we waittng for?" To Fitzpatrick, ,uch a moment marked one of the intangihle values of his residency. "le is reall, that accicude at Barrow that's important," Fir:patnck sar. "And that's Sperzlcr's attitude. He b very aggressive. If there's a chance of saving someone, you take it. "There were three things chat made the surgery possible. First, the aggressive workup as soon as the boy was admmed, mcluding the lo,\,-field MRI scan. There was the assumption that the worst might be true, hut we still might save him. "Second, the aggressive approach Barrow rakes in brain inJttry ,·icttms, especially children." And the third ingredient chat was needed co make the surger,· succcl-sful,of course, was expertise. "Especially Sonnrag's and Spetzler's," Fitzpatrick said. Timmy's head had been immobilized in a cervical collar and a backboard at the accident scene, and 1n the late afternoon Fttzpatrick and Papadopoulos labored to fit him into a halo brace. The halo hrace resembles a medieval torture instrument, with a steel halo chat encircles the head, held by pins screwed into the bone. Four rods ristng from a tight leather vest run through loops 111the halo. Fitzpatrick and Papadopoulos had co make sure they didn't Jar Timmy's head or spine, or they would destro~ the unprotected delicate fihers of the brain stem. Nothmg held Timmy's head on but his spmal cord, a few mw,cles, and skin. And the sp111alcord, to a neural expert, is simply spidery filaments of hra in ttssue. Fit:patrick noted that the location of Timmy's clot was a further complication. Ar the from of the brain stem, tt lay directly hehmd the mouth cavity, and the normal approach for surgery would have heen through the mouth. Bur raking that route would rhk infecttng the brain w1ch mouth hacteria, Above,Brian Fitzpatrick, a 1986graduate of which would certainly be fatal. Spet:ler had developed a technique theUBmedical school, checked Timmy's progress dailyandsawradical improvement. for reaching previously inoperable aneurysms through an approach from Within theconfines of hishalobraceanda the back of the neck. That meant legcast, nmmywasableto laughandplay likeany10-year-oldandeventually walked Fit:patrick and the ochers had co roll the boy onto his stomach hefore outof thehospital. surgery, another reason why the halo brace was critical. It was nearly 5 p.m. as Fitzpatrick and Papadopoulos wheeled Timmy into Operating Room 2 and scrubbed in. Across the hall, Spetzler was completing eight hours of delicate surgery, clamping off a blee<lmg aneurysm deep within a 64-year-old man's brain during a procedure known as a "scambtill" - a complete cardiac arrest in which the bram is drained of blood and chilled to hring metabolic activity below the normal threshold of life. Spetzler scrubbed out, crossed the hall, scrubbed in and hegan again. The doctors cue down to the spme, parred rhe neck muscles, and worked around to the front of the bram stem. Fmally, the clot could be seen. The only hopeful sign they found was that there had heen no new bleedmg. The clot was drained and the doctors began the arduous task of reattaching Timmy's skull and spine with Sonnrag's V-shaped pin. The open ends of the "V" were wired to the vertebrae and the �the surgery, Timmy was essentially Fitzpatrick's patient. "He began to show signs that his paralysiswas improving almost immediately," Fitzpatricksaid. "But the really 1 l big moment came severalweeks later when we asked him to show us two fingers, and suddenly two fingerspopped up. That was the first time we knew he was awake. " "V" point was fastened to the skull with wires looped through tiny holes drilled through the bone. The surgery took about five hours. It was well after midnight, 16 hours after Timmy was brought in, by the time Rekate and Fitzpatrick met with Timmy's parents. They had been told there was only a 1-in-20 chance chat Timmy would survive. Now it appeared he had beaten those odds. Bue how far he would come back was completely unknown. Timmy was now essentially Fitzpatrick's patient, on Rekate's pediatric neurosurgery service. "He began to show signs that his paralysis was improving almost immediately," F1t:patrick says. The morning after the operation, Timmy began moving, though he was too dee p in a coma to follow commands. Timmy's movement was amaz ing enough. "Bue the really big moment came several weeks later when we asked him to show us two fingers, and suddenly two fingers popped up. That was che first time we knew he was awake." Fitzpatrick visited Timmy twice a day on rounds and saw radical improvements day by day. In mid-May, a press conference was scheduled to discuss Timmy's condition. The story of Timmy':, rema rkable surgery had already been told in newspapers and magazines and on television around che world. Speeder had even been inte rviewed by Tass, the Soviet news agency. Tim my was pictu re d , while sti ll comatose and in halo brace, on the cover of Stern, Germany's major news magazine. Tho ugh cheered by Timmy's progress, Fitzpatrick still was as surprised as the rest of the medical staff when Spetzler confidently said at the news conference, "Timmy will walk out of here." Within a month after the accident, Timmy was acting like any I 0-year-old, chatting and laughing. He moved as much as he could while wearing the restrictive halo brace and a leg case, which had been applied a few days after the accident to mend his broken leg. Because several vertebrae are fused with the V-shaped pin, Timmy will always move his head as if he has a stiff neck, but there doesn't appear to be any permanent brain damage. Speczler's prediction was correct, and Timmy finally walked out of the hospital on June 23. Reflecting on that surprising forecast, Fit:patric k finds a lesson for neurosurgeons. "Timmy had a le:,ion we could see, that we removed. That tell you that a more aggressive workup may show a hopeless problem to be treatable, in some cases even curable," Fitzpatrick said. Neurosurgery has appealed to Fitzpatrick since his first year of medical school at UB when he conducted research at Millard Fillmore Hospital with Nick Hopkins, M.D., now chairman of the Depa r tment of Neurosurgery at UB, and James Budny, M.D., vice chairman of the department. "Working with them was very exciting," he said. "It showed me the direction to take." His decision to become a doctor goes back even farther; way back to Amherst Central Junior H igh. His biology class had shown him for the first time "new insights instead of just a continuity, a new way of looking at the world," he said. The son of Robert C. Fitzpatrick, director of research developme nt in the UB School of Dental Medicine, Fit:patrick the n majored in neurobiology at Cornell. After graduation, he did his required year of general residency at Millard Fillmore. Fitzpatrick chose to continue his neurosu rg ica I training at Barrow Neurological Institu t e in Phoenix, A riz., because he wanted a bu y neurosurgica l service. And, he had heard, unlike Barrow, many better-known institutions don't allow residents to perform surgery until their final year. Another drawing card was Robert Spet: ler, Barrow's chief, o n e of t he world's leaders in vascu lar neurosurgery, the area in which Fitzpatrick was most interested. "The staff was young and aggressive, and they were up on the latest technology," Fitzpatrick says. "And technology proved important" in Timmy's case. Soon after Timmy was re leased, Fitzpatrick finished his pediatrics rotation in neurosurgery at St. Joseph's Hospital in Phoen ix and began a sixmonth rotation at trauma-hea\'y Maricopa County Hospital in Arizona. He is now chief neurosurg ical resident at University Hospital in Tucson. Then it will be back to Phoenix and Barrow again, and three more years to complete one of medicine's lengthiest apprenticeships. EdwardJ. Sylt•ester,a memberof the Naaonal Associationof ScienceWriters,is the authorof The Gene Age: Genetic Engineermg and theNext lnduscnal Revolution, «:ith Dr. Lynn C. Kloc;:,and Target: Cancer. 17 �18 STETHOSCOPES TO MICROSCOPES TO MICROCHIPS Computers emerge as medicalschool's newest teaching tool BY DAVID HIMMELGREEN he three-pound preemie is suffering from respiratory distress syndrome. Her breathing is lahored and her skin casts a bluish tint. She's hooked up to a res-ptrator,but the monitor shows that her viral signs are not gO(.xl. This is the medical student's first experience with life-or-Jeach decisions in the intensive care nur ery. Hands sweating and heart racing, the stress 1s almosl unbearable. The student must choose the right course of action. Fortunately, even a bad decision has no fatal comequences. This babv is made not of tlesh and blood, but bits and bytes and pixels - she exists imide a comrucer program. The student types in an instruction to pass a rube down the computer bahy's air passage. The computer responds, mdicaung that oxygen 1s l:,eing delivered to the lungs, and che baby's respiration is returning to normal. The student also breaches easier. Other complication., anse for the preemie, and tomorrow's physician contmues to make decisions, typing in further imrruct1ons. This "dialogue" between student and computer contmut:s for p.:rhaps an hour, simulating four days in the baby's life. Both a confidence builder and valuable experience for the future, this program 1s just one example of the cools now available co UB medical student!\ in the wake of the computer revolution of the lace '70s and early '80s. Today, even computer novices can use powerful software programs to assist them in medical education, research and administration. said John Loonsk, M.D., director of academic computing for the medical school. ILLUSTRATIONS compu· tersimulat ion allowsstudents to honetheir diagnostic skills andevenmake mistakes without endangering a human life. BY Computers can simulate patients and have the potential tl> cut down on the number of animals used in teaching. They can look at X-rays or slide~ 111 new \\ ays and access large amount~ of information, almost instantaneously. And computers are becoming sophisticated enough to help come up with soluc1ons to problem:.. Personal computers (PCs), which are more accessible and user-friendly than mainframe computers, are popping up everywhere in hosritals and cl1111cal practices. AnJ the software programs are relanvely easy to use and more powerful lhan ever. Physicians of the 21st century will be faced with a field of medicme thac 1s more and more complex and speciali:ed. Computers will help them wade through the mass of information and paperwork that they'll encounter, Loonsk predicts. "Future rhysicians are going to need to be computer capable," he said. The UB medical school has been usmg computer, to assist in pre-clinical coursei., ,uch as physiology and biophysics, since the 1970,. During those early days, computers were loaded on rumbling cam anJ wheeled down the hallowed halls to labs and lecture rooms. Today, the medical school has a computer lah, now 111 ib third year of operation, located in the Cary-Farber-Sherman Addition on the South (~fain Street) Campus. Loonsk, who graduated from the UB medical school 111 1986, b director of the lab and the newly appointed chairman of the medical school computer mstruccion committee. The computer lab 1s a multtpurpose facility that uses and de\'elops computer programs. It offers LI SA HANEY I\CHA LO f'HY•ICI ·I' .-1'.'\11BI0 \1f.()ICAL :,c 1E:-.'ll q �computer-aided instruction tn many subjects, teaches "computer literacy," and teaches how to use computers in medicine. "Our students arrive with very wide and varied backgrounds in computers," stressed Loonsk. The objecttve is to bring student:, up to speed on the computers and then introduce them to the power of computers in educat ion, research, and adminbtration. One of the biggest benefits of computers is the way they can manipulate the pictures thal medicine already uses, such ai, rhotos, slides or X-rays. Using a 51bill, Loonsk demonstrated a machine called a digiti:er, which scam. rictures and convens them into informanon that the computer understands. After scanning the bill, the computer presented a super-high quality image of George Washington's face on rhe monitor. The digitizer enhances the image and can :oom in on minute details that may not be seen b, the rhysician at first glance. Currently, Loomk and lrn, colleagues are busy digitizing images that will eventually be used by facully to teach students about things such as the identification oi kidney stones anJ what different tyres of bacterial infections look like. Studenls and faculty ah.o have acces:, to four ,·iden-disk players that interface with computers. Recently, the Medica l Students' Parent:, Council, a group of parents of medical students that conheUnitributes time anJ money to a wide variety of medversityplansto ical school activitie~, donated an lBM eventuaUy tinkthe lnfowindows worbtation with video-disk rlayer, computers computer and touchscreen monitor to the comthroughout the medical schooland puter lab. Medical students use the lnfowindows touchbeammultimedia screen system in their introduction to clinical imagesrightinto meJicine course to study different types of heart classrooms and laboratories. Gone sounds and the cardiovascular system, said Loonsk. A video of real patients being examined 1splayed arethedaysof heftingequipment through the video-disk rlayer. Students can also request images of the heart anatomy simply by oncartsand couching the menu that's disrlayed on the monitor. wheeling it down When the students touch the heart on the thehalls. screen in different spots, the computer plays the different heart sounds that emanate from those areas. Students can abo request graphs of heart sound cycles, Loonsk said. Students also have access to seven CD-ROM players, which are similar to CD-music players found at home. Instead of reading disks that have captured the sounds of Verdi or the Beatles, they read disks that contain computer data. Like the video-disk plaver, CD-ROM players use lasers to read information. But CD-ROM players tend tO be more text-based and rely less on images, though that may change in the future. One use of the CD player is to provide a textbook on a disk, Loonsk said. Scientific American now offers its consult textbook of medicine on compact disc. This CD is regularly updated so that students can get the most recent medical informa- omputerscanenhance an image , whether it's theportrait of George Washingtonona dollarbill oranX-rayof a tibia . Dodorscan thenmanipulate theseclear images , zooming inandetailsthey mightotherw ise havemissed. 19 �tudents canfistentocfdfer· entheartsounds bytouching the various areasof theheartshown onthecomputer screen.Thisis one useof an lnfowindows workstation, whichwas donated bythe Medical Students ' Parents Council. 20 tion with high-rel>Olution images almost instantaneously on the computer. There are also a number of medical Journals publishing on CDs so that access to current rel;earch is becoming easier than ever, Loonsk explained. The computer lab offers a numher of databases, including the Physician's Desk Reference (PDR). Loonsk pointed out that it is important to expose students to the PDR program because It provides them wtth a wealth of information on brand name and generic medications and drug interactions. Medical students are given a worksheet with items about a patient's medical history, such a~ age, sex, symptoms and lab results. After reading the information, the students must consult the PDR to determine drug interactions and decide which medications are best suited to the patient. Students then write down their diagnosis and therapeutic regimen on the worksheet for evaluation by faculty. Loonsk envisions a time when patient medical histories are integrated w1ch many different programs like the PDR.Information from many different oources could then be brought up on the screen at the same time, without having to make cumbersome conversions herween different programs. In the future, the miniaturization of computer hardware may provide the physician with almost .instantaneous access to medical information. "Hypothetically, there are devices chat flip over one eye and allow you to view data as it's projected directly on your retina," Loonsk mentioned. Perhaps one day a physician will be able to use this device to view a patient's medical hi. cory, lab tests, and refer to the PDR in one fell swoop while the patient is on the exammmg table. tudents cangaineasy accessto huge amounts of information using databases suchas thecomputer versionof the Physician 's Desk Reference. There is also a program that reaches UB students how to call up patient lab data from the computer system of the Erie County Medical Center. Soon students may get the opportunity to work on various local hospital computer systems before they begin their clinical rotations, Loonsk added, making the student's transition co real-life medical situations easier. Another clinical database program available co students and faculty 1s MEDLOG, which allows a physician to examine specific charactemcics of his patient pool. For instance, if a physician wants to test a new blood pressure drug on patients with specific characteristics, he can use MEDLOG co find the names of the most suitable patients for chis drug. After the test 1s done, the program can also be used to analyze whether the drug was able to effectively lower blood pressure for the sample of patients, Loonsk said. Another tool used in academic computing and within l>Omemedical schoob is known as "multimedia." Multimedia integrates images, animation, sound, and text on a screen using multiple windows. At UB, multimedia projects will llSecommercially available sofcv:areprograms and reshape them for an individuali:ed solution to a specific problem. One problem is visualizing anatomic relationships. The meandering route of the cranial nerves, for instance, is as confusing as a New York City �ersonol computers con helpdoctors send a letterorcon suggesta possible diagnosis ina porticulor case. road map. Traditional textbook descriptions, illustrations, and the dissection of cadavers all help, but still some students struggle. Now, imagine a multimedia program where a student can view a high-quality three-dimensional rotating image of the cranial nerves, along with a text description, while conducting a dissection with classmates. While chat's in UB's more-distant future, a simpler version of multimedia is expected to be in use at UB by the fall. A eady Loonsk and his colleagues are using the digitizer to create images. For example, images of cirrhotic livers incorporated with text descriptions will be useJto teach students about liver disease. These images and text can easily be manipulated so that students can scan variations in the disease process and compare images to different types of liver disease, all on the screen at the same time. Another plan for the UB medical computer lab is the eventual linkage with computers throughout the medical school complex. Faculty will be able co utilize the lab's resources from classrooms and laboratories in the building. Addmonally, a video distribution network will beam multimedia images and descriptions of things such as disease pathologies and anatomical structures to students while they are in lectures or <lomg laboratory work. Using even simple PCs, the sky's the limit to what students and faculty can do in the medical school computer lab. The lab maintains more than 35 IBM-compatible and Apple computers ypotheticolly , there couldbedevices thatflipoverone eye andallowa personto view dataas it's projected directly ontheretina . and a wide variety of software applications. One program teaches about human heart sounds. Students can choo e to listen to specific preprogrammed heart murmur with the "patient" lying down, sitting up, and breathing in or out. A drawing of a patient's chest appears on the monitor. The computer simulates the sounds a physician would normally hear if he or she were to place a stethoscope on different anatomical points outside the chest. Another helpful tool for students 1sa problemoriented program called Quick Medical Reference (QMR) that'~ run on an IBM-compatible personal computer. Like the systems in banking that decide whether or not a customer is a suitable loan risk, QMR makes decisions about medical diagnoses based on specific clinical findings. "lt (QMR) allows you to look at medical information in a totally different way than if you were to read a textbook or other resource," Loonsk said. "We can put up a disease and then sort the clinical findings in many different ways. "For instance, we can determine the most frequently cited symptom in a large group of patients or the finding that would most strongly indicate that srecific disease." For example, a -rudent can plug in the clinical findings for a pregnant woman who is over 30 years old, obese, and experiencing high blood sugar, excessi\'e urination, and acidosis. Then the student requests the QMR program to make a diagnosis. QMR will interpret these findings and suggest gestational diabetes mellitus (diabetes in pregnancy) 21 �a potential Jiagnos1s, a,, well as lbt other d1sea:,e:, from which the patient might be suffering. The computer lab also offers tools for medical anJ health related research. One project, still in its embryonic stages, is the Scoliosis Tempora l Imaging Project, which bassociateJ with the work of Robert Gillesp ie, M.D., professor anJ chairman of the Department of Orthopaedics. The goal in this pro1ect is co demonsuate, through three-dimensional images, the progression of scoliosb (a curYature of the spine) through time. Even ordinary software used in business offices can be helpful to physicians, though many aren't yet familiar with what's available. "We have word processing, Jesktop publishing, databases, spreaJsheets, and graphics programs," Loonsk said, a,, well as electronic mail. Combined, these programs can help a physician set up long-term appointment schedules, present well-written and concise consults, monitor illness trends within a patient pool, and keep track of billing and payments. In the long term, Looru.k hopes that computers will assist in the nuts and bolts of medicine by quickly retrieving the most pertinent information the physician needs to help a patient. A big complaint in rneJicine today is that physic ians are so specialized and medicine is so technological char there is little time for physicians to per,onally interact with their patients. Loonsk hopes that in the future compurers will free more time for physicians to spend with their patients. a,, 22 WHATS ON THE l\1ENU 7 I f you can't cell the hardware from the software without a scorecard, take a look at this lbt of items being served up at the UB medical school'~ computer lab. Di git izer. This machine scans photos, slides or X-rays and converts them into information that the computer under~ranJs. Then a superhigh quality image appears on the monitor. The d1git1:er can manipulate the image in many ways, :,uch a~ enlarging a portion of rhe image for cloi.er inspection. Tou ch screen monito r. This 1s similar to the monitors found in grocery scores that shoppers can press to finJ in which aisle the anchm y p1::as are located. Vid eo -di s k playe r. V 1Jeo-d1sk players use lasers co read informauon from a disk anJ send moving image, to a television-like monitor and hecomputerlaboffers toolsformedico! researchers and clinicians alike. Byhelping physi· ciansquickly retrieveinformation, computers mayenablethem to spendmore timewiththeir patients . send sound to a speaker. They can also score thousand, of ,nil 35 mm slides. They allow users to see moving images of real people, or a computer-generated image, and move easily between the two. CD -ROM playe r. Compact disk read-only memory players are similar to CD-music players found at home, but imteaJ of reading disks that have captured the sounJ~ of VerJi or the Beatles, they read Jisks that contain computer data. Like the video-disk player, CD-ROM players use laser, to read information. But CD-ROM players today tend to be more text based and rely less on images. Multimedia. Multimedia integrates images, animation, sound, anJ text, and can use multiple windows. Dat·1d Hnnmelgreen, tl'ho i, comple1inghis Ph.D. m anthropoloff'.\' at UB, has done researchon numuon and food habits in Lesothoand Kashmirand plam w remm to Africaw completehisdisseriacion m chefall. �---- :(]}---.; E J. ~ 23 TEMPORARY SHELTER f OR HOMELESS ATUB TESTED portable shelter Jesigned ro prov1Je temporary protection from the elements for homeless persons passed its first fielJ test with flying colors in January, according to physiologists at UB. The device could be used by hnmele:.s person., who refuse to go to a formal shelter or cannot find room m one on cold winter nights. "We certainly con · ider something like this as a la;,t resort," said Tom Harmon, who came up with the idea. Harmon was a street person for three years and is now executive director of the Friends of the Night People shelter for the homeb,. Researchers ,aid that whether it can provide adequate shelter when the tempera tu re drops to near zero Jegrees Fahrenheit and pre\·ent hypothermia - a precipitous drop in core body temperature - remains to be determined in additional testmg. Suk Ki Hong, M.0., Ph.D., professor of physiology at UB, anJ four colleagues monitored Harmon, who \'olunteered for the tesl, for sign, of hypl)thermia. Not only Jid Harmon's core body temperature remain normal. but the temperature wiLhin the two-piece corrugated "pup tent" never dropped below 50 degrees Fahrenheit. The low temperature during the all-night test was 30 degrees Fahrenheit. The idea for the temporary shelter originated with Harmon. He proposeJ a corrugated shelter based on his own experience: One of the hest night's sleep he had while homeless, he recalled, was in a discarded corrugated cardboard box that had been used for shipping a hot-water tank. The corru- gated material is insulating and holds in the warm air. The "Harmon Hotel" being tested by UB physiologists resulted from discussions between Harmon and Peter Pellegrino, sales manager for Great Lakes Container Corp. of Lockport, N.Y., a \'Olunteer at Friends of the Night People, during the bmer cold snap that hit most of the nation in December. The prototype is a two-piece tube that folds flat anJ is easily carried. When a confining band is cut, the tube "almost self-erects," resembling a triangular pup tent. The two telescoping poruons of the tube adjust to the height of the user. Although the user is completely enclosed in the tube, he or she can get out of the tube easily. TomHonmon stayedwormthrough one of Buff ollo' s winternightsinsidethe "Hormo1~ Hotel. " Although the tubes are biodegradable and Harmon envisions using them only once or twice, they can be reused and can be carried after the metal band 1scut. Harmon said he e1wi:iions carrying a suprly of the corrugated pup tents in the trunk of his car and handing them out to homeless people who need chem. He also would like to make chem available to police, fire and ambulance personnel, as well as ocher shelters and soup kitchens. Great Lakes Container designed and developed the prototype at no charge, Pellegrino said. A charge will be assessed if the company eventually manufactures it, he said, adding chat Friends of the Night People will receive part of any profits obtained if the device is sold co any group other than the Buffalo shelter. Assisting Hong in the first field test were Richard A. Morin, director of facilities for the UB Physiology Department; Donald R. Wilson, senior lab equipment designer; Walter S. Marshall, lab equipment designer, and Donald R. Rennie, UB professor of physiology who also 1sa UB vice president and vice provost for research and graduate education. M. Steven Piver, M.D., UB clinical professor of gynecology-obstetrics, sen·ed as medical director for the testing. Chief of gynecologic oncology at Roswell Park Cancer Institute, Piver also serves as vice president of the board of directors of Friends of the Night People. Piver said that during the night Harmon spent in the corrugated shelter in a courtyard on the UB South (Main Street) Campus, "his body stayed as warm ru; if he was in his own bed." For his night tn the corrugated pup tent, Harmon bundled up in a manner he ~aid reflects that of home le ' S persons spending a cold winter night outdoors. He wore two pairs of pant:,, two ,hires, a sweatshirt, two pairs of socks, a coat, gloves, and a pair of heavy boots. - By Sue W111etcher �--- :(]}---J'EJ.q. 24 GOODBYE BUTTER, HELLO OLIVE OIL UB researcherssuggestthe switch could lower the risk of heart disease mericans intent on lowering their risk of cardiovascular disease would be wise co use olive oil instead of butter or margarine, according co a major study by researchers at the UB medical school. The study, repo rt ed in the Feb. 2 issue of the Journal of the American Medical Association, represents a major contribution to the scientific literature. le indicates chat use of o live oil in the diet in lieu of butte r and margarine not only co rrelates with lower blood cholesterol levels, but appears to lower blood pressure and blood glucose levels. The UB study is che first large-population examination of the association between consumption of mono-unsaturated fats like olive oil and risk factors BY ART HUR PAGE for corona ry heart disease, according co Mauri:io Trevisan, M.D., principal author and associate professor of social and preventive medicine. Oche r UB researchers participating in the study were Vittorio Krogh, M.D., Jo Freudenheim, Ph.D., and Alma Blake, Ph.D. The Italian researchers included Paola Muri, M.D., Sal\'atore Panico, M.D., Eduardo Farinaro, M.D., Mario Mancini, M.D., Alessandro Menotti, M.D. and Gio rgio Ricci, M.D. The study has received national attent ion, in part because of the growing interest among the public in hearthealthy eating, but also because the public relations office at JAMA christened it the prestigious journal's storyof-the-week. A film crew from the AMA spent a day in Buffalo, interviewing Trevisan and filming at local restaurants and scores to prepare a video chat was distributed co JOO television stations. On cop of that, the JAMA public relations office distributed a news release about the UB study to about 3,000 people. The landmark study was conducted in conjunction with Italian researchers affiliated with the Italian Nine Communities Study of risk factors for atherosclerosis. The data, collected by the Itali an study, was analyzed by the UB researchers. Resu Its were based on a n a Iyses of BUFFALOPHYSICIAS A)',;[) BIOMEl'IC'.Al ~IE.''TIST �--- :®: ---J' t ~ ~ 2S data derived from dietary interviews and physical examinations conducted with 4,903 Italian adults ages 20 to 59. The subjects included 2,365 men and 2,538 women. Trevisan explained that conducting the same study focusing on the eating habits of a similar number of Americans would have been impossible on two counts. First, very little olive oil is consumed by Americans, although sales have increased in recent years following reports on its lmk with reduced cholesterol levels. Second, Trevisan said, there is very little regional difference between the use of fats m the diet of Americans. In Italy, on the other hand, the researchers were able to compare data for those living in the northern portion of the country where butter use is widespread and little olive oil is consumed - with that for those living in the south - where olive oil is used almost exclusively. "Because of this variation," the authors wrote in JAMA, "we were able to find relatively strong associations despite a relatively crude measurement of dietary intake." They added, however, that "the cross-sectional nature of this study needs co be taken into account in analysis of the e findings. While the results are suggestive of a protective role for unsaturated fats for cardilwascular risk factors, other unmeasured confounders may be the actual etiologic agents." Trevisan said that in their analyses, the re earchers attempted to identify such an influence by taking into consideration confounding effect· of other risk factors for cardiovascular disease, such as age, body-mass index, alcohol intake, moking and consumption of fatty foods. RCFf-\LO PH)SICI.-\S -\Sl1 BIO\IEl'ICAL ~IESTls. Maurizio Trevisan, M.D. The study found that "in both sexes, higher consumption of butter and margarine was associated with increased systolic and diastolic blood pressures and increased serum cholesterol levels." Those associations reached statistical significance only in men. "In both sexes, higher frequency of consumpnon of butter and margarine was associated with significantly higher levels of blood glucose," the researchers said. Increased consumption of olive oil, they wrote, was associated with significantly lower leveb of systolic blood pressure, blood glucose and blood choles terol in both sexes. In men but not in women, diastolic pressure was significantly neganvely associated with olive oil consumption. While the study found that consumption of polyunsaturated fats, such as vegetable oil, correlated with consistent and statistically significant lower cholestero l and blood glucose levels, the association was not consistent for blood pressure. Arthur Page is associate director in che UB News Bureau and farmer medicalreporter at cheBuffaloNeu·s. �--- ·,®~--// ~ 26 Talent in Triplicate UB alumni are at the helm of threemedicalschools BY JUDITH B. HERMAN "I would say there is no highercal/in~1han ministering to the sick. But it is useful, and occasionally importanl, for someone to be a dean." - MarshallA. Lichtman, M.D. orientation and programs for Jevelopmg faculty to <lo research m academic settings {some of whom may well become deans), the cltmate m the '50s and '60s was different, Naughton explained. "At the time these three graduated, Sandberg at Roswell Park. Lichtman wanted to set up an assay for aldosterone, a hormone that had recently been discovered to play some role in hypertension. Referred co Sandberg, a hematologist also trained ith the recent appointment of the school \\ ' ab very small and pnmanly in endocrinology,he then began to get Marshall A. Lichtman, M.O. '60 as <lean of the University of Rochester School of Medicine and Dentistry, the UB medical schlx1l now boasts three deans among its graduates. The other two are Eugene M. Sigman, M.D. '52, Jean of the Univen,ity of Connecticut School of Medicine smce 1985, and Franklyn G. Knox, M.D., Ph.D, '65, who has heen director for education of rhe Mayo Foundation and dean of the ~layo Medical School m Rochester, Minn., since 1983. UB graduate~ achieve dist1nct1on m many areas. Is it so noteworthy to find three of them heading medical schools? John Naughton, dean of the medical school and vice president for clinical affairs at UB, thinks it is. "There arc only 126 medical school <leans at any one time," Naughton said. "Prohably most of them come from the older medical schoob. For Buffalo ro have three of irs graduates at that level of recognition 1snoteworthy mdeeJ." While today UB has a strong research clinically oriented, with comparatively lmle facility and faculty to support a big research endeavor," he said. "Then it was a matter of bright, motivated people somehow finding the right connections and bemg stimulated to do things. "All in all, there have been a lot of things done to enlarge opportunities and create a nourishing atmosphere for UB students to pursue careers 111 research and rbe to positions of leadership in academic medicine," Naughton said. "Sigman, Knox and Lichtman stand as forerunners and models." invol"e<l in some of Sandberg's hemologic clinical work. Sandberg was a major influence and launched Lichtman's career m hematology, hut Lichtman has tributes for a numher of UB faculty members. "l recall with respect and affection nor only Sandberg, but Oliver P. Jones, chair of anatomy, who was very actively involved with students; Douglas Riggs, chair of pharmacology, one of the best teachers I ever encountered; Ernest Wttebsky, Herman Rahn, and Cornell Terplan, all very distinguished teachers who developed outstanding departments which provided rich environments for students in terms of research opportunities," Lichtman said. Lichtman is the author of research papers on various aspects of blood cell biochemistry and physiology and has been engaged in NIH-supported research on blood diseases since 1967. He 1s editor or co-editor of three textbooks of hematology, including the recent fourth edition of Hematology published by McGraw-Hill. MARSHALL LICHTMAN n internationally recognized authority on blood dbeases and the new dean of the Universit) of Rochester Medical School, Marshall A. Lichtman, '60 got his first opportunity to conduct re~earch when he was a student 111 the UB medical school. After his first year, he worked as a summer research fellow under Avery IICFMLO r m~K IAS AS I) 111 0 ~1F.l l1CALSCIENTI:-., �------- :®: -------27 Marshall A.Lichtman , M.D. '60 A scholar of the Leukemia Society of America from 1969 to 1974 and immediate past president of the American Society of Hematology, he is currently chair of the National American Red Cross Biomedical Research Program Scientific Council. Lichtman's training as a physician anJ his activity as a teacher, together with his work in both basic science and clinical departments, have been important preparation for his new 106. "My experience means that I can he comfortable, say, working with molecular biologists on our molecular medicine Rlc ff.-\L O PHY'-ll lAS AS[ ) Rl<JME[)I C AL ~ IESTl~T programs, as well as with physicians in general medicine on the issues that are important to them," he explained. "It's helpful to have had actual experience in all the areas and among all the various constituencies that look to you for leadership. It's helpful to have been in all the trenches." Licht:man joined the faculty of Rochester Medical School in 1965. "I chose to pursue an academic career because I developed an early interest in research as well as in patient-care and teaching," he noted. Dean of the medical school in Rochester since January, Lichtman finds the challenges of his new position are as varied as the satisfactions are great. "As dean, I oversee the school's mission in regard to education, research, and the patient-care activities of our faculty," he said. "A dean has to set priorities among the different departments and programs, establish standards for appointments and promotions and adjudicate various disputes. "But I also have to be a fund-raiser, a cheerleader and then some kmd of role model for the faculty." What makes it so worth while? "I �--------- :®:--------{/ \t- 28 "I went to medical schoolto pursue a careerin research, not necessarilyto become a dean," saidFranklyn G. Knox. Franklyn G. Knox , M.D ., Ph.D'65 enjoy sccmg to other people," Lichtman explaineJ. "I thmk that h an important charactern,t1c of anyone who rakes on any kmd of leadership position." FRANK LYN G.KNOX went to medical school to pursue a career m research, not necessanly to hecome a Jean," said Franklyn G. Knox, since 1983director for education ot the Mayo Foundamm and dean of Mayo Medical School. "My undertaking an M.D.-Ph.D. program, hecommg department chairman and then Jean - none of that was laid out 111 some sort of master plan at the hcgmnmg. There was just a general inclinamm in that direcuon. It JepcnJeJ on hooking up wnh a sympathetic mentor and the em ·1ronmenr making 1t possible for those inclmations w tum mto something." II excretion, rena l phosphate handling and renal hemodynamics - Knox has served on the scientific advisory board of the National Kidney FounJation and the board of directors for the American One of Knox's first mentors as a UB Heart Association and as president of for underii:raJuate was Gerhard Levy, a pro- the Federation of American Sl">Cieties Experimental Biology. fessor of pharmacology. As a UB mediHe has served in numerous capacical stu1dent, Knox workeJ summers in the lab of DonalJ Rennie, now profes- ties with scientific organizations sor of physiology and vice pro\'ost for national and international - and is currently on the Nationa l Research researc:h and graduate education. "I sQ much enjoyed that kind of Council, U.S. National Committee for acti\'1ty," Knox recalls. "I said to myself, the International Union of Physiological Sciences. 'If there's any place you'd like to he, Being dean uf Mayo Medical School where 1, 1t!' The amwer was the lab." Undler Rennie's guidance, Knox pur- 1s not the largest of Knox's current responsibilities. As director for educasued a Ph.D. 111 physiology, as well as an M.D. The Cllmbined Jegree was neces- tion of the Mayo Foundation, he also sary, Knox felt, 111order to be able to do oversees the programs and activities of the Mayo graduate schools in health basic iresearch m disease-related areas sciences and medicine. and ce:ach in a medical school. Despite his administrative responsiKnox joined the Mayo Medical Schcx)l faculty in 1971after doing basic rt"l>earch bilities, Knox is able to continue teachmg as he has every year in the medical at the Natmnal Heart Institute and ,chool for the last 19 years. And, more reaching at the Univer..1ryof Missouri. unusual for someone m his position, he A ditstingubhed anJ highly productive researcher m the field of renal physiology is able to spend half his time on - particularly the regulation of sodium research supported by the National �------- f!J--------29 Institutes of Health. Knox's career is something of a balancing act, perhaps, but he is good at it. "Everything is arrange<l in such a way that I have been able to maintain the research and teaching activit ies as well as carry out my administrative responsibilities, although at any one time any of these could be all-consuming," he said. "So it's a matter of organizing and delegating things so everything comes out even." EUGENE M.SIGMAN // had no aspirations to go into administration or to join a fulltime faculty. I just wanted to be like the rest of the pack, a physician of one kind or another in private practice," said Eugene Sigman, dean of the Uni,·ersity of Connecticut Medical School since 1985. Eugene M. Sigman , M.D . 'S2 Afteir Sigman finished his residency and began m practice urology at Buffalo Genera I Hospital, however, he became involve·d in research and in 1961joined che faculty of the UB medical school m urology. He was awarded Buswell Fcllows,hips tn 1963and 1964 to pursue research in urology and nuclear medici ,ne and was recruited by the University of Connecticut m 1969, a year after the school opened, to head its urology department. "I backed into academia from practice," Sigman said. "But l was deeply interes1ted in medical education, more than anything else, and that's what drew me back." As a new school, Connecticut offered opportunities to develop innovative approaches to educat10n, Sigman said. Courses were multi-discipli narv, based on an organ-syHem approa,ch, with 10 to 12 faculc} members te:achmg a course. The curriculum also included courses in the social and beha\'ioral ~c1ences. Although Sigman has done important work and written numerous papers tn urology and nuclear medicine, his chief interest 1s education. He is a meml;,er of the Association of American Medical Colleges, the AAMC Council of Deans, the AAMCAMA Liaison Committee on Medical Education Site Visit Team and the AAMC-AMA Oversight Committee on Me<lical Education. Sigman traces his own commitment to educatton to the influence of the committed faculty and practicing physicians he studied with at UB, including John H. Talbot, chair of the UB Department of Medicine and chief of medicine at BGH; the late Oliver P. Jones, professor of anatomy, and George Miller, professor of medicine. "My own education at UB led me to appreciate the value of education. The commitment that [ saw - department heads taught the basic science courses - very much impressed me. "In the clinical years, there was only a very small full-time faculty. Instead, practtcing physicians provided free time for educating medical students. That really struck me. In spite of their very busy schedules, they were able to find time to give to students. "I took my residency in the same system. I came to see chat what you got out of the system you had to pay back by contributing to the education of the students who followed you. That's probably what impressed me more than anything else about UB. Plus there are a lot of nice people there." ]11dichB. Hennan is a B1,ffalouriter wah a special interest m medzcme. She has been a 1niter-ediwr w1th the Western Neu York HealrhS~swmsAgency. �--- -/tJ---IJ \t, 30 ALUMNUS' GIFTTOUB HONORS FORMER TEACHER "I will give to my teachersthe respectand gratitwlewhich is theirdue." - Oath of Hippocrates emember chat spec ial teacher who recognized your potential, wh o encouraged your best efforts, and who, through h is or her interest and influence, left a last ing effect upon your life? One way co show your respect and gratit ude is through a gift co the UB Foundation in honor of that special teacher and friend. Jerald A. Bovino '71 recently gave a $500 gift to the UB Foundation in honor of his former teache r, Philip Weis '41. Weis, a clinical professor of surgery, is a general surgeon in private practice, a member of the University Council, and chis year's annual fund chairman. Bovino wrote: DearDr. Weis, I was pleasedto receiveyour recent letter for support for the Unit•ersity at Buffalo Foundation. I would like w tell you why your letter has personal significance. On a cold and snowy autumn day 23 years ago, I flew to Buffalo for my medical school inten,•iew.Like so many of the applicants, I was apprehensii•eabout m)' prospects for acceptance to a school of medicine. My undergraduategrades were good but not outstanding, but my MCAT scores, especially in the sciences, were very high. I was mten·iewed by three members of chef acult:y,but I specificallyremembermy interniew with you. I felt that you u•ere warm and sincere,and you made me «•ant to aLtend the Unit·ersit)' at Buffalo. Analumnus remembers thewarmthandsincerity shownto himbya teacherat UB. �--------- ~®:--------// tt. 31 Although I was subsequentlyacceptedto ocher medical schools, ( many of them more prestigious), I chose to attend UB largely on the basis of our personalcontact. . .. A check is enclosedwhich l would Likeyou to submitfor me in your honor. Warmestpersonalregards from a gratefulstudent, JeraldA. Bovina, M.D. Bovino rece ived nume rous Mosby and Lange awards for outsta nding performance while at UB, and was elected to Alp ha Omega Alpha. C urrently, he is in a vitreoretinal surgical tertiary care hospital-based practice in Toledo, Ohio; has published extensively on the subject of retinal surgery; has se rved as vice president, president and secretary of the Vitreous Society (a professional group), and is an associate clinica l professor of surge ry a t the Medical College of Oh10 at Toledo . ship fund will be used for UB medical studen ts who show academic promise and have financial need. "Both my brothe r, Harold, am l myself ne,·er married or had an y child ren," Miss Sanes explained. "We wanted to do something to he lp others and to show that we had walked across this earth. Since our brother taught at UB, we thought it would be nice to do something for the Uni\'en,ity." The late Winfield Louts Butsch '30 is remembered through an endowed lecture fund established in his memory by h is children, John L. Butsch, M.D., David W. Butsch, M.D. and Janet F. Butsch, and various friends and relatives. Butsch, a prominent Buffalo surgeon and clinical professo r of surgery at UB, died Oct. 24. The gift will be used to sponsor an annual lecture series in clinical surgery. IT'SLAST CALL FOR WORKOF1930GRADS AWARD NOMINATIONS GOES ONTHROUGH GIFTS wo graduates of the Class of 1930 who cherished their work with medica l students are remembered by gifts that will he lp continue that work through a scholarship fund and a lecture series. The late Samuel Sanes '30, a noted physician and professor of pathology at the UB medical school for mo re than 30 years, won numerous awards for his service and contributions to the field of teaching. He is remembered through a scho lan,hip fund in the names of his brother and sister, Harold S. and Thelma, set up through a gift of $100,000 from Miss Sanes. The permanently endowed scholar- here's just a little nme left to make n ominations for the second annual Distinguished Medical Alumnus/a Award. June 1 is the deadline to suggest a name of a graduate of the UB medical school who has made an outsta nding contribution to medicine, the arts, or humani ty during his or her career. The selection will be made during the summer and the award will be presented in the fall at a special dinner. There's a postcard at the front of the magazine for your nominatio n. Hurry! ERRATUM Editor: In the Early Winter 1989 issue, you have a picture and a short note on a classmate of mine, Dr. Har\'ey C. Slocum. You have it labeled class of '36. This is incorrect as he graduated with me m 1932. He is a renred professor of anesthesia m Texas. While in the service at Walter Reed General Hosp ital, he gave the anesthesia to President Eisenhower durmg his surgery for ileitis. - Elmer Friedland , M.D. , F.A.C.P. The Buffalo Physician and Biomedical Scienast welcomes letters from its readers. Address chem to Buffalo Physician and Biomedical Scientist, 136 Crofts Hall. Unit1ersity at Buffalo, Buffalo N.Y. 14260. From leh, Nedra Harrison, M.D.'77, treasurer of the MectKal Alumni Association, chats withShawnCotton andEllen Giampofi oftheOassof 1990at a re<eption inJanuary forthe graduating doss. About 250people attended. �32 1960. Paul J Loree '62 - recent!) 1lwrrad1u' "-:,,,ml •""-x1:ttl,I 111 ,,t ,1phth.1l1rniloi:vw11h Kcnncth Amhonc, M I) m Tort.'lwand,1. fr,1nl E. Ehrl1d, '61 - 1, ,lin·uor ,,t the di\ 1,10n ,,ftr.Ill• m I md prof,,, or of urger) .it Uni\ er 1q in Hahnemann rhit.1,ldpht.1 . D 1\ 1d Ci. l'ublo\\ '65 .- ,, pre 1clcnr-dect ,11 rhc ;,,.e" 1l 1m1hire Onhop-Jt.•,fa::X>Cll'I) Lmu,nle A. Gol,lschl,1gcr'65 .1, board ll"rt1hcd in cma.cenq ml-d1-.mcan<l \\,IS cb:1,-d 11 (cl. lo" , t 1he Amcncan Collct;c of Ellll'f)!l"lll\Ph) ll 1,111'. E.Jordon 't 5 mi:: 11 text book, Dm:,1sc,oJth<' km Ro~'fl t.-dulogic Roger \X'. Sc1hel '66 .- ha been named m1er11n clm1-.al ,l1rnrnr ,-it ,urgcn ,It thl· Eric ( ,1111\1\!1.lcJ1l,1ICcnll'r. Dr. " I •I 1, an ltlcndmg trauma • •1 I and director of state 11 thl• ho,pttal. pra,on 'l'r\lll' ,md ,, c11rrcntl, 1clm1c.1I,l,'<X 1• ,Ill' prof, ,,,,rof both ,urger) and nt UB or1hClp.1C<l1,, J,1u1h D. R,,:hrud, 'i l .- 1, the I\C\\ ,h1cf of orrhop 1cd1c ,uri::cr, Jt Docior, Ho,p1111, lkth l,r.1d !l.1,d1,.il cl'llll'f, fork. ~l'\\ 1 1 Jame M. L,·\\ 1 ' 5 .pri,,ltl' peJ1.1m, pr llflll' ,111h.1 ,pl'll 11mrcr,·,t III dHnllll l lrl'. Dr I t \\ 1., ha, four lh1ldren A 11orld tnl\ cll·r, skillc,I pho• to.gr11lll'r ,mJ ,1 p.11ron of thc an,, Jlcoh,en Jomcd an,lther ,\ \V1lmo1Jacob.--cn,M I) , 1 doctor on an .ucheologac,tl I rot,-.,-orol r,·d 1,llrll s ,II U fl "' w ,1n·mntc rcg11>1\ t,ir m,1n, ,c,1r, ,,h,"c ,.1r1,·,I cxpcd111lln II\ 195". ~1cXICll m1cre,1, m luJed mro1cal,111.!1<"' of the de 11hof Prcs1dem\V1lh1m 1ed ~hron J. D)hich ' McKmlq, d1,.J D« .. Ii, 19"9, 1989, m ::-dll'ncl.1.1<1\ Ou.lo, .1ftcr,1hnd 1llnc". lll·\,,is91 . afrl·r a I, ng I IIn,·~ . Attn recl.'I\mg ht, h.1chdor's md mcd1c,1lJq::reo from John, \ irgmia Pa" lak '36 - \\ ho Hopl..m, Un1\l:r,11), he ,,·i',d pr,tl t 1< ,·d medll 11\l'undcr hcr Ill the u.~ Arn\\ d11rmc\Vnrl,I m.11,I,11 n,1me of R1.:hrcr. d1l•d \Vir I tor I\\O ,car, . Atll'r th,· Jm I , 1990, m Cl ircn ...e. ~ Y, " ir, he 1rnmc<lan mcd1cmc anJ J airer il loni: tllnc,, pcd1atr1l.,a1 John, Hopkm,. , M.D. A. WilmotJacobsen sl11.•111.11nta1mdhl·r rr1, lie In 1926, Jncoh,,·n c.11nl·to c tor 2i \l 1rsunul 19hl, rrat11 Huttilo r., ,..,1,1hh,hin outra11cm she bc.:ame d1re.:1or of "hen dcronmmr ,11Oul,hn'.. llc,,pnal d1n1l 1<1rthe E11l l., mtq In JQ~~. hl' rn,1mcd fael)n '-he also I o a peda uric 1an. Health Dl'partmn Hench, I H •art 1aui::h1 ar sic honorl,I rhc ....I _,.. ,I St.,,[Jnt Children's I ln.i-p11.1l Ste\ l'll T, 11,:h Acndl'lll). thc hr t• n.unmc h, 19:-4 p,11rm ,11Ohio ,urcln of profr"or '-tare UntHr•tt) ,111da11,•nJmg tloor ou1p.111en1 d1111l th, rd Harold MC)cr, ·5-; " ph1,11.:1anm the [)q,;1rtmen1 of Jacob-1.'n•Hcath Ambulatoq ocmx. An:, a P.")l.h1am1, l lime. Ped1a1r1csurgcr) m Columbus 3, 1991.l J1l d J,111. In thl• I 92l',, J,1.:,,h,cn ,,,1, l 'luklrcn\ 11.,,pttal. crcd1tl..J,1uh m1xmi:ii druc from Tamm) J Lm<ncr - a lir•t• German, 10cure a )OUngBuff1lo P 1ulm, A Wall, ' I - 1 )C3r mro11.:al,1udem, wa, \ailed OO)"11h memng1115", h1ch ,, as M,,orkmi: hard" m her prl\ ate m ,1l,lr ,Kc1Jcm I\:·.:. 21 \\ lllll• 1h,,ught 1<1Ix- t.11,11ll"0 l'l'rH·111 (~1l1t..m1a, pr.1lt1u• mt ).1kl.111,l. 'O 1,111nchl·r fam1h m Cicne..... , ol thl· time ni.11 drug 1urncdout ed 1 8.A m rcccl\ Lm,ner to he an earl) f. nn ot ,ulfa drugs, Jt:ftrq j . !Moua ' 2 - ha, m 19-.9 from chem, tr) the hN an11b1011, upcnl'J .1 pr,1cr11.l' an Terre Cnlll'J.:l', I. H.1m\l, ll.111tc,ln,h11M, ,pl'l11lt:mg m In 19H, hl• "'" till· hr,t tn At 1lw UB ml....11,.il"hc,,I, ,t,, g t,tr,ll'ntl'mln1.1 ,mJ cndo:,cop1. rnogn1:c ,md Jc,,nl-,c I num• cl '"mate, El 1mc Cheon 10111('(1 bcrof J1Hr,c ')ndromc a, real• Campbell m pl m Hcathcr and cnttt\ Onl' 7 -- ,a,, I) bdon,:ani: rn Roh·rt GolJl IJn!! ...._ l'\IUl,non pro• outread, an nmg that \,h,n he lim,he, Im rc-1Jcn• \,hi.:h h,· call,·,1 hl·rcd11aq mJ horn,·• mJ1c,n1 the tnr Jcl.! . The q m mtl'm 11ml.J1c1ne m June, o teochondro,h,tropln 1:e l'tnpha "ill that le" g d1sca,e " 1, uh-equcntl) nanwd 1990. hl· \\Ill he con1m11111h,, Ir'-..calk-d . m<' meJ1 prcHm1,c . honor h,, m Ja«>h,en\ d1,,a,c 1r,1mmg\\1th a 1dlo\\,h1p 1n g:i-• which ,rand, tor \ 1!?orou e, en at the age of H E.A I I ~.G., II'()(ntl.'l'Ok,i:,i.llthl· Um, cNt) cl n, and Leamu~ Edlll.-a.111 lll-ahh. 91, Jal.oh,cn mamt 11neJ othle at '-m Dil.1,'<l ( 1hfom1::i Gm,\lh ~I.'" lmoh-mc ll(lur, ,1x d,1)' .1\\cek Till' ,111,lcnti:r,,up I\1ht1 \\Ill J.1«1kcn wa.~ m l.''\l'(n ,m the Pd,M,1h t\. \Vh1tl' 'f-.7 - ol a plaque, "rnc,, ~ ..) commH-n.) OH'I' whether medical pl mt a tree, rnarh-d h\ Tona\\cmd.i, ""holJr A I) mem ner'led 10 1he death ot m Lm J \'( hue and 1ncomptctl."I\Cc "Chri,tophcr .11',1 ha, menH>r\ her 111 ,hip l1eh,ir,1h t\. \\'hire ,11\11<,un.:e l'rl·,1d1.:nt~1d(mlc) ,liter hi.' l\,h 1d: 11.irl\l 11 up ,c1 h.:'l'I\ 1 1'111• thl• •hot m 1 hll at rh,· h1rth ,,t ,1 ,on, \ndre\1 <'.ollct;e Ruffalo E.xposmonm 19 6, \mencan ~i't ,n Fr:m1.:1,, Ohituarics I9SC1- 0 ��I( Buffalo Physician and Biomedical Scientist State University of New York at Buffalo 3435 Main Street Buffalo, New York 14214 3581 I d n Requeste Correctio Address II II II I LOCKIE DR L. MAXWELL 92.;i DELEWAREAVE ~UFFALO NY 14209 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician and biomedical scientist, Spring 1990 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1990-Spring Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. School of Medicine Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v24n01-1990-Spring Table Of Contents A list of subunits of the resource. Research briefs On pins and needles The boy who lived a miracle Microscopes to microchips More research Talent in triplicate Alumni. Classnotes. Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-11-12 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v24n01 Extent The size or duration of the resource. 36 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1990 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/29271f84e7bc25fb0e525fabe21b5ced.pdf a287a68baa3b329da1143dd9ccdf4527 PDF Text Text E.rly Wmrer1989 \bl 23, :-<o.i ---• - ····- . ..:::--; .. ; : :: : : \t\fi ~: ; '. ff ·; =-;-!_: ~:~::·~-:- I I I ......... _____ _ ••• ;•. I t • ' ~--u&; :e;;;' ~=f~~:::-; ~-~=~ --------- 1Ile Class of '45 and Its Tn,e Humorists ·.·:·r ' �STAPF OIREC1Ult Of PlJIUCAT1oNS N-yli,bin ..-w l'H'tSICIAN mm:,o "-°"'"""""' ARTDIRECIOll Alan).~ ADVl80RY BOARD Dr J,,hn N...... , 0.- .,.. ........ r,....... Ma. NMKy 01i«o , T he August II, 1989 issue of Tone nuipunc publilhcJ an lmpoftllntanicle de.ling with the cumnr and posa1blefuture 1tMU1 of dx medicalpro(aaion. Not 111rprilinawerethe n111ny a>nc:emcdand nepave pen:ep, bOnL Thfflt ol the moet distftaina: poina arr the public's pcrcq,- tion that physicians no °' """" ''""' Dr,Ku.Ir., 11,o.... kmaclisten r to patients. CONiflcntlv run la, and laU<o ecplam what they arr Dr. J-ph l. K11ru Dr a..ta Pap,,.lli Mr l'auJ.D"-""" Or. O..lo.PN "-Dr. ,,,,'-" Or. U11ha Ran..,.. Dr a.-nduil n-n. .... .... ... 0........ .., .... .... _., "'-"' ..... _ o. 0. -.... °""" warreu -M~~ .......... W...ll'r.,tor.M.Jl :=.":i~ ILLUll'Mmll8 dometo patients. Of all the mucs. these an: the chanca:riat1cs which rhc rnemben ol the prolnaion md1vidually and collectively can corffCt at l1nlcpmonal and cconomtc COit. A:non ally, I find rl\em so intrirwcally fundammtal to the 1ntqrr1ty of a physici an, reprdlca of ipeciaky identification. that I would think thar wouktwant ro dimnwe fflCICconcmu, 81 ei:pedlnowly as posaihlwe c. The b.inh major con«m rdated ro the percepaon of over· cluraing ior ICl"VICa. Fortunately, our 10e1tty supports the con• that-phyadam ahowd be adequately compmsated for rhcir tltttlsand talentLHowever, It II becomina:1nctta111alv col'K:ffllN with the lnc:artsuitv whichelCIIU betwem the kwb of compe:n· NIIDD ftC:doled anclthe pc.abed wtthdrwal of physiciana from czpt dealina'WMhpahmtt Ir -.. of modest co ltmlfN means. obviousrhM:medical,chook, their ttaduna: hoepitab. and the pro(euton at larsc must deal with the1e four llSUCS in a ditect, t'ordlriaht, consuuctive mannn if dw pasunllhC p,ctuttofered In Jmv 1& to be ff'VC!'Sed. • at l.J8"amedical school contin~ to commH ounclves preparlna phystc1ans wellpounded 1n the fundamentals of Klflldftcmedicalpracoce and dedicated to the neelB ol all pat"ac nu. '° ~ (}i-_~~~: ftM:HINGAND John Naup,.,.,, M.D. Va PmidaacforOmamlA//mn 0-,Sdloola(....,.,,,,..., -- ... ~pilll• ..W- .... ~ Nwbk.Sftlll THE BUPl'ALO PHYSICIANAND BIOMEDICAL ......... IICIEHl1ST. c.,, ................ .. eo.liallv, �BUFFAlD \ol. P tJX-?i l~~ n. ~"-4 Earl1 Winter 191N Features fl Top teachers,Page23 II PETScanner . Buffalo is getting state-of-the-art imaging equipment that shows not how the body looks, but how it works. A joint project of the UB medical school and the VA Medical Center, the $12 million center for Positron Emission Tomography should be fully operational by the end of 1991. Meet the chairmen.UB has created a new Department of Emergency Medicine and has placed one of the field's pioneers at its helm. Meet him and five other new chairmen who have visions of new ways to bring UB to the forefront in research and teaching. m Thoughtson a nasty day. William R. Taylor, Class of '45, reflects on three classmates who understood the importance of humor in their profession and their lives. IEJPhoto directory. Here's an introduction students in the basic sciences. to the Departments I] fl Antique treasures,Page30 fl I] Neu· image, Page2 Ill Alumni au:ard, Page26 Cowerlllurnotion:JosephTh,d People. Keep your teaching fresh, even offbeat. That's the advice of award-winning professors Murray Ettinger and Charles Severin. Research.A product called INFASURF significantly reduces respiratory problems in premature infants, according to a national study coordinated by UB researcher Edmund A. Egan lll. Alumni.George W. Thorn, Class of '29, a pioneer in endocrinology, organ transplantation, and kidney dialysis in the United States, received the first Distinguished Alumnus Award from UB. MedicalSchoolNews.Two antique chandeliers have been restored to their original luster thanks to a donation from Robert L. Brown, Class of '44. The pair now graces UB's Health Sciences Library. Classnotes. �2 PlEI s <e<r1lIl1lIl1l<eJr With plans to build $12 millioncenter, Buffalo is poised at a new frontier uffalo is approaching a new frontier in diagnostic medicine with plans to build one of the most ad; vanced Positron Emission Tomography (PET) imaging centers in the world. PET imaging, the latest in com; puter scanning techniques, has the unique ability to visualize and quantify complex physiological pro; cesses occurring in the human body. It has potential for important advances in the understanding and treatment of major ailments, in; eluding heart disease, stroke, cancer, epilepsy, and Alzheimer's disease. EARLYWINTER 1989 BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �3 Joseph A. Preiio, M.D., Jayakumari M. Gona, M.D., and Robert E. Ackerhalt, Ph.D. A joint project of the UB School of Medicine and Biomedical Sciences and the Buffalo VA Medical Center, the $12 million center will serve the entire community, including non-veterans. Funding of $3.4 million for the project has been awarded by the federal Department of Veterans Affairs. UB has committed $1.6 million. The balance will be provided by state grants and private support. The James H. Cummings Foundation already has committed $1 million - the largest grant in the charitable, nonprofit BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST PET centers m the nation bave tbe capabilities proposed for tbe Buffalo site. corporation's 26-year history - to the project. The center will be the first PET imaging center in the SUNY system and the only one of four in New York State that's located upstate. There are some two dozen PET imaging centers in the U.S.,but only a handful have clinical and research capabilities on the scale being proposed for Buffalo, noted John Naughton, M.D., dean of the medical school and vice president for clinical affairs at UB. Naughton said the PET imaging center EARLYWINTER 1989 �4 "will be significant not only co this region, but co the entire northeastern United States. This project will put the UB medical school at the very edge of a new frontier of diagnostic medicine." "We will be offering an imaging technology not available in most big teaching centers in the United States; added Joseph A. Prezio, M.O., chair of the UB Department of Nuclear Medicine who will serve as the cenrer's director. "It will also add significantly to the services we offer our patients:• The center will have two major components: a PET scanner facility located at the Buffalo VA Medical Center and a cyclotron facility housed in Parker Hall on the adjacent UB South Campus. The cyclotron facility will produce radionuclides, low-level radioactive materials, to be used by the PET scanner. Underground pneumatic rubes connecting the hospital and Parker Hall will transport the radionuclides. The cyclotron is a specially designed electromagnetic device that will permit researchers to accelerate charged particles or ionized atoms to very high velocities. The particles collide with targets composed of various elements, compounds, or gases, producing the low-level radioactive materials. Most radionuclides produced by the cyclotron will totally decay to a stable element within a few hours to a few days, Prezio noted. The hospital-based PET scanner is expected to be operational by September 1990 and the UB-based cyclotron by the end of 1991, Prezio said. It's anticipated that other local hospitals and private medical practices will decide to buy scanners and use radiopharmaceuticals produced by the UB cyclotron. Millard Fillmore Hospital has indicated that it will open a diagnostic imaging center with a PET scanner, and Buffalo General and other area hospitals have also expressed interest in getting PET scanners. The chief of the PET scanner facility at Veterans will be Jayakumari M. Gona, M.O., chief of nuclear medicine at Veterans and UB clinical assistant professor of nuclear medicine. The director of the EARLY WINTER 198Q cyclotron facility will be Robert E. Ackerhalr, Ph.D., vice chairman of the UB Department of Nuclear Medicine and research associate professor of nuclear medicine. The project has received enthusiastic support from the Western New York Health Sciences Consortium. (That consortium is composed of area hospitals, the UB medical school, and the Greater Buffalo Development Foundation.) In a 15-month child uncontroHeJ ( top anJ normal. old with seizures, center) appear Howevc-r, on the PET image (bottom), the- dark area epileptic event 1s page occurring. is a view of the PET e<Juipment, A PET scan will cost about $1,500, which is comparable to the cost associated with a study using CT scanning or magnetic resonance imaging. lt is less than many invasive studies used to evaluate cardiac, neurologic, and oncological problems, bur without the increased risk of morbidity or mortality associated with them. It's anticipated that soon third-party carriers will provide reimbursement for a PET scan. PET scanning is the newest computer imaging technique to arrive in Western New York. The first CT scanner in all of New York State arrived at the Dent Neurologic Institute at Millard Fillmore Hospital in 1973. It was the fifth in North America. The Dent also got Western New York's first working magnetic resonance imaging scanner in December 1982. For the first two years, it was used only for research. UB President Steven B. Sample noted that Buffalo's PET center "is part of the effort of the University and its affiliated teaching hospitals co establish 'centers of excellence' in healrh care and enhance the regional and national reputation of the high-quality health care delivery system in Western New York. Its establishment also is in keeping with our goal of moving the University into the ranks of the top 10 public research universities in the country." Richard S. Droske, director of the VA Medical Center, said the cooperative effort that led to designation of the new center is another example of how the VA Medical Center and the University work together co benefit the community. "The PET Imaging Center; he predicted, "will lead co quantum leaps in our clinicalcare and research abilities in such fields as cardiology, neurology, and oncology." • BUFFALO PHYSICIAN AND BIOMEDICAL SCLENTIST �To get a better idea of what Positron Emission Tomograpy (PET) imaging is, it's helpful co compare it to the more familiar X-ray computed tomography (CT) scanning. Boch are noninvasive and provide glimpses into the human body. There is a significant difference, however, noted Joseph A. Prezio, M.D., chair of the UB Department of Nuclear Medicine who will serve as the director of Buffalo's new PET imaging center. While CT scanning shows anatomic structures in the body, PET scanning visualizes and quantifies information about physiological and chemical pro­ cesses occurring in body organs. Put another way, CT scanning reveals how organs look, while PET scanning tells how well they function. Because it detects disease-triggered chemical changes in the body that are precursors to anatomic changes and physical symptoms, PET scanning already has shown its value in early detection and treatment of disease. In coronary artery disease, for exam­ ple, PET scanning can help physicians tell the difference between viable and dead heart muscle. PET scanning has potential for major advances in the understanding and treatments of ailments such as stroke, cancer, epilepsy, and Alzheimer's disease, noted Prezio. It also will allow physicians co evaluate the effectiveness of chemotherapy programs in cancer treat­ ment within one day, rather than several months. Pharmaceutical companies will use PET to accurately determine effective drug dosages. Prezio noted that PET scanning has also been used co successfully pinpoint the sire of electrical outbursts in rhe brains of epileptics chat set off seizures, BUFFALOPHYSICIAN AND BIOMEDICAL SCIENTIST and to advance medical understanding of brain tumors. Another difference between PET and CT scanning is the manner in which the images are produced. In CT scanning, low-level X-rays are produced by the scanner unit and pass through the part of the body being studied. A computer generates a three­ dimensional image based on readings that result from the X-rays. With PET scanning, trace amounts of radioactive biological compounds called radiopharmaceuticals are introduced into the patient's body. These radiophar­ maceuticals emit positrons, a positively charged electron. A computer generates three-dimensional images based on the pattern of X-rays emitted by the positrons. Radionuclides, the low-level radioac­ cive materials contained in the radiopharmacuecicals, will be produced in the cyclotron facility at UB. • EARLYWINTER 1989 �6 N ew names,new faces,new directions. Six new chairmen are among the 19 to lead departments in UB's Schoolof Medicineand BiomedicalSciences. Just created is a Department of EmergencyMedicine, which will be headed by G. Richard Braen, M.D. The other new chairmen areStephanieH. Pincus,M.D., dermatology;L. Nelson Hopkins, M .D., neurosurgery; Robert Gillespie, M.D., Ch.B., orthopaedics;F.BruderStapleton, M.D., pediatrics,and Ron­ ald P. Rubin, Ph.D., pharmacology and therapeutics. They have outlinedplans to bring to their departmentsnationaland internationalreputations for excellence. Severalchairmenhave also been reappointed: • JosephA. Prezio,M.D., De- partment of Nuclear Medicine • Myroslaw Hreshchyshyn, M.D., Department of Gynecology and Obstetrics • George Alker Jr., M.D ., Department of Radiology • James P. Nolan, M.D., Department of Medicine • Leon E. Farhi, M.D., Department of Physiology • Saxon L. Graham, Ph.D., Department of Social and Preventive Medicine • Harold Brody, M.D., Ph.D., Anatomy • William H. Coles, M.D., Ophthalmology • Glen E. Gresham, M.D., Rehabilitation Medicine • David Holden,M.D., Family Medicine • John I. Lauria, M.D., Anesthesiology • John R. Wright, M.D., Pathology • John M. Lore Jr., M.D., Otolaryngology PHOTOS : EARLYWINTER 1989 BOBWALION BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �EMERGENCY MEDICINE G. Richard Braen, M.D., has been named chairman of the new Department of Emergency Medicine at UB. He is also head of the Department of Emergency Medicine at Buffalo General Hospital. "Dr. Braen is one of the new breed of emergency medicine specialists," said John Naughton, dean of the medical school and vice president for clinical affairs at UB. "He's been in the discipline since its inception. He's regarded as an academic leader for the discipline and is helping to set the foundation of what the discipline is." Braen is residency-trained and board-certified in emergency medicine. He ran the residency program at the University of Kentucky for several years. He came to UB from his post as assistant professor at Harvard Medical School. The autho r of spiral-bound manuals for medical students and residents, his popular Clinician's Pocket Referenceis in its sixth edition. Braen is working on the third edition of EmergencyMedicine: Conceptsand Clinical Practice. Bl.ifFALD PHYSICIAN A:S:D BIOMEDICAL SCIENTIST G. RichardBraen, M.D., a pioneer in the field of emergency medicine,is chairmanof the medical school'snewest department. Along with a UB medical student, he's working on another spiral-bound emergency medicine manual. 7 He also wrote Managementof the Physicallyand Emotionally Abused: Early Assessment, Interventionand Counseling. Getting a brand-new department off the ground takes quite a bit of work. "Our major goal is education, initially," said Braen. "We'll get into research as time goes by." The department will be very communityoriented, Braen said. It will work with pre-hospital personnel such as ambulance staff and emergency medical technicians. Within the school, the new department will work with medical students at various levels. le will expand the offerings for emergency medicine rotations and offer services to existing cou rses that want to include emergency medicine topics. The three-year residency program will train IO emergency medicine residents a year. Emergency medicine is one of the most competitive residencies, he added. UB's program will be based at two main hospitals, Buffalo General and Erie County Medical Center, with Millard Fillmore and Children's hospitals supplementing the program. Most emergency medicine residency programs use more than one hospital, Braen noted. He hopes to have the residency program in place by July 1991. "The big job in starting a residency program is getting the board-certified emergency medical physicians," Braen said. "In the greater Buffalo area, I can count all of them on two hands, maybe one hand." Nation-wide, there are on ly about 7,0CXJ certified emergency medicine physicians available to fill 30,000 available positions, he noted. Since most of the training programs are in the midwest and west they can't keep up with the need in the east. ' Because UB's training program is located in the east and is at a university, "we1Ibe very competitive and in very high demand, and we'll get very good, qualified residents in the program; Braen predicted. The residents in tum can teach the students. "The key is the people," he said . Ten years down the road, Braen hopes the department will have a fully credentialed residency program that will be supplying residency graduates to area hospitals, that there's an appropriate interest in emergency medicine from medical students, and that there's a well-established research component in areas such as shock and trauma. • (Fordetails on the new department, see page 8.) EARLY WINTER 1989 �8 DERMATOLOGY Stephanie H. Pincus, M.D., has been named professor and chair of the Department of Dermatology ac UB. Pincus also serves as head of the Department of Dermatology at Buffalo General Hospital. Board-certified in both internal medicine and dermatology, she specializes in care of skin problems chat are unique to women. Her research is in a type of cell called an eosinophil, which participates in allergic and parasitic disease. It's found in large numbers in skin disease. Pincus, who is highly regarded nationally as a teacher, comes to UB from a post as associate professor of dermatology and medicine and vice chair of the Dermatology Department at Tufts University School of Medicine, Boston . She was also associate dermatologist-in-chief and director of the phototherapy unit at New England Medical Center, Boston. Re-establishing the national image of the dermatology department is one of Pincus's major goals. Dermatology has a tradition of being strong in Buffalo, she said. In view of the many changes chat have raken place in dermatology in America in the lase few years, it was time for re-evaluation of the residency program. One change was to integrate che department SKILLED PHYSICIANS NEEDED AT 'FRONTLINES'OFMEDICINE ''You never know what's coming in," said G. Richard Braen, M.D. That's the challenge of emergency medicine - it's the front lines in the fight against the trauma of major injury. And because the emergency room is the first stop for many kinds of cases, emergency medicine physicians need skills that cut across many disciplines - surgery, obstetrics, pediatrics, psychiatry, and community relations. Braen, a pioneer tn this relatively new specialty area, has been named chair of UB's newly created Department of Emergency Medicine. "l've been practicing since 1976, and I don't know of a day tha t's gone by when I didn't see something I'd never seen before; said Braen. "l like the variety." Braen remembers the time he was working an evening shift in Lexington, Kentucky. A call came in over the radio to expect five people burned in a car accident. le turned out that all five were deaf and mute. Because their hands were burned, communication was a challenge - they couldn't speak, couldn't write, couldn't use sign language. "We had to do the best we could; Braen said. Ac one time, the emergency room was a kind of Siberia where the hospital's least qualified physicians were sent, or the ER was staffed by interns. "Then it was realized that this was where the most qualified people were needed," Braen noted. Emergency medicine is an important new field, said John Naughton, dean of the medical school and vice president for clinical affairs at UB, because as the technology of caring for patients becomes more sophisticated, people who used to die from major injuries can now be saved. An important part of emergency medicine is the integration with the rest of the pre-hospital system, such as ambulance staff and emergency medical technicians, Braen explained. "We want to make sure the initial care is high so when EARLY WINTER 1989 they come to us they are salvageable;' he said. Many emergency room cases are not true emergencies, Braen noted. Emergency medicine physicians also cake care of minor medical problems at odd hours when the patient's regular doctor might not be in his office. Making sure char patients are properlyreferred so they get needed care, but avoid elaborate services that aren't necessary, is part of the job of the emergency medicine physician, Naughton noted. "There's a lot of emphasis nationally on improving emergency room care - where a lot of mistakes used to be made," he added. It was just a little over 10 years ago that emergency medicine was recognized as a specialty by the American Board of Medical Specialties. UB is one of the few medical schools with a department in this field. "I could probably hold a meeting of all of the chairmen of the academic departments of emergency medicine right in my office; Braen noted, glancing around the room. "There are only about seven or eight, so this is a relatively uncommon position to hold." UB decided to create a freestandtng department rather than a division within surgery because emergency medicine is a more defined specialty than it once was, explained Naughton. It also cuts across many disciplines. A freestanding academic department will be a big attraction to residents, Braen predicted. And, since this is an area where many mistakes can be made, having a freestanding department puts fewer people in the chain of command and makes residents more directly accountable, Naughton noted. The freestanding department was recommended by a special committee appointed by the dean. The hospital directors unanimously supported the plan, and it was in turn approved by the Faculty Council of the medical school, the provost, and the president. • BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �more closely with other hospital departments. Dermatology's administrative and clinical offices were mo\'ed right tnto Buffalo General Hospital. The department also will emphasize more basic resean.:h to educate residents in the pachophys1ology of dermatological diseasl' and its relation to other basic science. "The res1dencs have, in large part, responded very positively, and there's very good esprit de corps; she noted. The next goal is thl· recruitment of more dermatology faculty memhcrs for the Erie County Medical Center and Buffalo General Hospital. ~1orc physician, are needed becau,e new regulations mandate that every patient who is seen by a resident must also be seen by an attending physician. Research is also an important part of the department. "Ulcimatelv, we want to develop a very strong re"Can..h program to further the development of the specialty," Pincus said. She also envisions that dermawlogy will plav an important role in an increasingly busy outpatient practice in the hmpitals. Another aim of the department is to strengthen the faculcv clinical pranicc plan, which provides private care on a fee-for-service basis. "I want to provide good care and use the fiscal rewards for departStephanieff. mental development," she said. Pincus, \Vhen asked about her accomplishment,, Pincus points to photos of her children, ages 17, 13, M.D.,has and I. integratedthe "I'd like to convev to women medical ,cudents Dermatology that it's not easy, but possible, to have a personal and professional life," Pincus said. Department In her quest for an administrative position, Pinmoreclosely cus was happy to find a city where both she and her husband, Allan Oseroff, M.O., Ph.D., who is withother also an academic dermatologl',t, could work. Oseroff is chief of dermatology research at Roswell hospital Park Cancer lnsntute. Roswell'ss1mulrnneous affiliadepartments. tion with, yet independence from, UB allows the couple to work wgecher,with(?ut one spouse working for the ocher. A graduate of Reed College in Portland, Ore., Pincus received her medical degree cum laudc from Harvard Medi cal School in 1968. Pincus served her internship at Boston City Hospital and her residency in medicine at the Umversity of \X'ashingron Affiliated Hospitals, Seattle. She served as senior fellow in dermatology at the University of \X'ashington and resean..h folio\\ BlJFFALO PHYSICIA~ A,'\;0 BIOMEDICAL SCIE?--.'TIST 9 in dermatology at Harvard Medical Sl hool. From 1987-88,she was a visiting scientist at Biogen Research Corp. m Cambridge, Mass. She is a fellow of the American Academy of Dermatology and a member of the Souetv of Investigative Dermatology. · Pincus 1sthe author or co-author of more than 60 articles and abstracts and nine book chapters. • NEUROSURGERY L. ~el,on Hopkms, M.D., has heen named chair• man of the Department of Neurosurgery at UB. He is also Lhairman of the departments of neurosurgery at Buffalo General Hospital, Millard Fillmore Hospital, Children's Hm,pital, and the Eric County Medical Center. A local product, born and raised in Buffalo, Hopkins comes to the chairmanship directly from private practice. His natural interest in arndemic neurosurgery led him co publish a book, several hook c.hapters, and more than 40 ahstracts and papers. He has lectured widely and sponsored national seminars in Buffalo on the management of aneurysms. EARLY 'IX'J!\TER l9bQ �Because of his energetic work as a teacher and IO clinician, several people suggested that he consider lhe chairmanship at UB even though he was a clinical associate professor, not a full-time academician. Re-establishing the reputation of the residency program, which was on probation, was his major goal when he started in January 1989. "A year ago, all but one resident failed the boards, and he was borderline; Hopkins said. "Now, all the residents have passed, and they did well. "In one year, we've turned around the teaching program, and that's largely because of Jim Budny (vice chairman of the department) ." In order to concentrate resources and avoid duplication of services, Hopkins aims co develop subspecialry centers of excellence at different University hospitals. Neurovascular surgery and neurosurgery of the spine would be located at Millard Fillmore Hospital; neuro-oncology, Buffalo General Hospital and Roswell Park Cancer Institute; trauma, Erie County Medical Center, and pediatric neurosurgery, Children's Hospital. Millard Fillmore Hospital is building a lab for spine research, as well as a multidiscip linary back institute for care of patients with back problems in conjunction with the medical school's Department of Rehabilitation Medicine. An exciting area that's being developed at Millard Fillmore is endovascu lar neurosurgery, Hopkins said, which can sometimes eliminate the need for open surgery or make surgery much safer. For example, a tiny catheter could be inserted at the groin and moved through the artery up to the head. Then doctors can inject fluid through the catheter into a tumor or vascular abnormality to take away its blood supply. This procedure could cut the hospital stay from 10 days co just a day or two in some cases. The department also is concentrating on neurologic diseases of the spine and has recruited two outstanding young surgeons who are experts in treatment of patients with spine disorders. "Back pain is the most common cause of disability in the U.S. besides the common cold; Hopkins noted. The department is also trying to develop a program for care of brain tumor~ with Buffalo General Hospital and Roswell Park Cancer Institute. Hopkins received his bache lor's degree from Rutgers University and graduated cum Laudefrom Albany Medical College in 1969. He served his internship in surgery at Case Western Reserve, then served as a resident in EARLYWINTER 1989 L. NelsonHopkins , M.D., aims to develop subspecialty centers of excellence at various University hospitals. neurology and neurosurgery at UB. He is certified bv the American Board of Neurological Surgery. Active with the Congress of Neurological Surgeons, he is general chairman for this year's annual meeting and last year was scientific program chairman. Hopkins is the chairman of a computer subcommittee of a joint committee on education for the two national neurosurgical organizations. He also chaired a subcommittee on drugs and devices for the two organizations. He's a member of the executive committee of the Congress of Neurologica l Su rgeons and has served as a member of the editorial staff of Neurosurgery,rhe group's journal. • ORTHOPAEDICS Robert Gillespie, M.0., Ch.B., who had been acting chairman of the Department of Orthopaedics at UB, has been appointed chairman . A member of the faculty of the UB medica l school since 1985, Gillespie is a professor of orthopaedics . He is also director of orthopaedics ac Children's Hospital of Buffalo. BUFFALOPHYSICIANANO BIOMEDICALSCIENTIST �Establishing a coordinated research program and an organized sports medicine component are two of Gillespie's goals for the department. "I want ro establish a vigorous research base," he explained. Central laborarory facilities for all aspects of orthopaedic research will be located in renovated space in Farber Hall, the old dental school building, probably by June 1990. He also plans to establish a clinical research office with computer linkages throughout affiliated hospitals. Gillespie is working to recruit an established leader in orthopaedic research. Recruiting is also under way for a new scate-ofthe-art sports medicine center . The center, for patient care and research, will be established in conjunction with the Family Medicine Department, che Division of Athletics, and other departments at UB. le will provide overall health care for UB's varsity and intramural sports reams, students who want to gee fie and stay fie, and other residents of Western New York. One of the strengths of the Department of Orthopaedics is its strong teaching program that offers excellent, well-rounded training for residents, especially in spine and hand surgery, trauma, and pediatrics. The residents have a very high success rate on the orthopaedic board exams, Gillespie said. "And we are optimistic that we can move our training program - which is already well respected - to a level where it is regarded as one of the major orthopaedic programs in the country," he said. "Part of that process is to enla rge our research fellowship program co facilitate our research capability and to be able to build a stronger and more complete research experience into the residency training program itself. "We hope to build and strengthen our contacts with other departments th roughout the University, especially Engineering, Physiology, and Health Related Professions." Before coming to Buffalo, Gillespie was an assistant professor in the Department of Surgery, University of Toronto and an orthopaedic surgeon at Toronto's Hospital for Sick Children. He also was a consulting orthopaedic surgeon and clinic chief of the amputee service at Ontario Crippled Children's Center in Toronto and on the staff of the Department of Orthopaedic Surgery, Orthopaedic and Arthritic Hospital, Toronto. Gillespie is an orthopaedic consultant to the Pediatric Institute of Krakow, Poland, which operates under the auspices of Project HOPE . BUFFAl.O PHYSICIAN AND BIOMEDICAL SCIENTIST RobertGillespie, M.D., Ch.B.,plans to establish Since 1970, he has been active in the research into the problem of children with spinal deformities 11 and congenital limb deformities. The author of multip le publications and book chapters on these topics, he has also been an invited guest speaker in many major centers around the world . He received bachelor of medicine and surgery degrees from Sc. Andrew's University, Sc. Andrew's, Scotland, in 1959. He was named a fellow of the Royal College of Surgeons of Edinburgh in 1965and a fellow of the Royal College of Surgeons of Canada in 1969. Gillespie has served for the past four years on che board of directors of the Scoliosis Research Society of North America. • a coordinated research programand an organized sports medicine componentin orthopaedics. PEDIATRICS F. Bruder Stapleton, M.D., has been appointed chair of the Department of Pediatrics and the A. Conger Goodyear Professor of Pediatrics at UB. He also serves as pediatrician-in-chief and chair of the Department of Pediatrics at Children's Hospital of Buffalo. A nationally recognized pediatric nephrologist, EARLY WINTER 1989 �12 i Stapleton previously was professor of pediatrics and chief of pediatric ncphrology at the University of Tennessee Center for the Health Sciences in Memphis. The first step toward developing a nationally recognized academic department is to strengthen its already fine faculty by recruiting talented scientists who can also provide the state-of-the-art clinical skills in pediatrics, Stapleton said. The lack of a research building to show candidates is an impediment to recruiting, he noted. UB's planned research building will help, and there arc plans for Children's Hospital co gee additional research space in the next five years. Another recruitment hurdle is the limited number of people going into academic pediatrics. But UB's Department of Pediatrics has several points in its favor, Stapleton pointed out. It's affiliated with Children's Hospital of Buffalo, a strong pediatric hospital with a unique feature: it's the only children's hospital in the continental United States with a high-risk delivery service and a strong neonatology program. Children's Hospital enjoys a great deal of community support and there's a very close relationship between the hospital and the University. The EARLY WINTER 1989 F. BruderStapleton, M.D., is recruiting talented scientists to strengthen the fine faculty in the Department of Pediatrics. hospital is clearly oriented to support the move to national recognition for academics, Stapleton added. Because UB has a system of affiliated hospitals rather than a single medical center, faculty in pediatrics can draw upon the other hospitals, such as che Roswell Park Cancer Institute. The drawback, though, is that Children's Hospital is geographically separate from the core of scientific activity at UB. Because researchers have to travel between sites, "it takes tremendous commitment to meet patients' needs and conduct research; he noted. Stapleton received his medical degree in 1972 from the University of Kansas Medical Center in Kansas City, where he also served as chief pediatric resident and a fellow in pediatric nephrology. Before joining the University of Tennessee, he was on the faculty in pediatrics at the University of California at San Diego and the University of Kansas Medical Center in Kansas City. He also served as co-associate director of the Clinical Research Center at the University of Tennessee and medical director of its Pediatric Unit and as direccor of research for the department of pediatrics at LcBonheur Children's Medical Center in Memphis. Author or co-author of 88 scientific papers, Stapleton has done extensive research in urinary and kidney problems in children. He participated last year in the development of a consensus doscument prepared under the auspices of the National Institutes of Health chat focused on a long-rage plan to combat kidney and urological disorders. A fellow of the American Academy of Pediatrics, Stapleton is certified in pediatric nephrology. He was recently elected a member of the American Pediatric Society in recognition of his accomplishments in pediatric research. Stapleton also was elected co the executive council of the American Society of Pediatric Nephrology. He is a member of the executive council of the Internacional Pediatric Nephrology Association and the national executive board of the American Board of Pediatric Nephrology. • PHARMACOLOGY Ronald P. Rubin, Ph.D., has been appointed professor and chair of the Department of Pharmacology and Therapeutics. BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �___ -_-_ ___ --~- ---- - ---~ Rubin previously was professor of pharmacology at the Medical College of Virginia, where he had been a member of the faculty since 1974. Before chat he was on the faculty of Downstate Medical Center and Hunter College. After receiving his undergraduate degree in biochemistry from Harvard College, Rubin attended dental school at Harvard University, then switched gears and obtained his master's degree in teaching from Harvard. He taught high school science for a year before he decided co go into pharmacology. In 1963, he received his doctorate in pharmacology from the Albert Einstein College of Medicine. Rubin's goal is to build a department of national and international repute. He emphasizes chat he is seeking quality, not quantity. "Quality begets qualicy; he noted. "People build reputations individually. We're not dealing with a numbers game. When I retire, I want to be remembered for having built a good department; nor a large department. He's crying to recruit a "critical mass" of faculty with world-class reputations. In the next four or five years, he wants to see the faculty invited to national and international meetings. "If you have a good department, several faculty members should go on co be chairmen of their own departments; Rubin added. "We've identified a couple who could be in the next few years." One of che strengths of the department is its good young research faculty. Rubin has recruited a colleague from che Medical College of Virginia, Suzanne Laychock, Ph.D., and he's looking for two additional people. John Naughton, dean of the medical school and vice president for clinical affairs at UB, has been very supportive and understands the need to bring in outside people, Rubin said. Having chis critical mass of fine faculty members will in turn attract fine pre- and pose-doctoral trainees, Rubin added. It's important co have an active graduate program with approximately one student per faculty member. You need that blend of pre-doctoral trainees, post-doctoral trainees, and faculty for an optimal intellectual environment, he said. To strengthen che department's teaching program even more, Rubin plans co interact more close1y with the Department of Biochemical Pharmacology in UB's School of Pharmacy. Research is an important part of the department, and Rubin expects the faculty to be productive. However, he stresses that grants are only a BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST - 13 RonaldP. Rubin, Ph.D., emphasizes that he is seeking quality,not quantity,for the Departmentof Pharmacology and Therapeutics. means to an end. He'd be satisfied with a productive faculty member who had one grant. And if a faculty member had two grants and wanted a third Rubin would want to make sure the faculty membc; could handle it. "My goals are productivity. My goals arc quality, not quantity," Rubin stressed. "I think this department as a group feels that. "I'm not against grants; I'm against making grantgetting the goal of your work." Rubin studies secretory mechanisms, also called signal transduction. He focuses on calcium as a mediator of secretion. The author or co-author of more than 80 scientific articles, 19 book chapters, 2 monographs, and numerous abstracts, he also serves as field editor for cellular pharmacology with the Journalof Phar­ macologyand Experimental Therapeutics. He won the faculty member of the year award for excellence in research from the Medical College of Virginia. A member of the American Pharmacology Society and the Endocrine Society, Rubin was on the Public Information Committee of the Federation of the American Society of Experimental Biology. • EARLY WINTER 1989 �14 Bv WILLIAM R. TAYlDR, ~1.D. n the second day of January, the weather in California was so cold and nasty chat it reminded me of Buffalo. I began watching two large gray squirrels playing tn a naked oak tree. They were running at top speed, alternating the lead, up and down branches, then jumping many feet co another tree. All this was 50 feet above the ground, on wet footing and in the rain. Their obvious joy and pure fun broke me out of my slowly developing depression, and changed my thinking to happy thoughts from 45 years earlier. A great day in the history of medicine was Jan. 2, 1944. On that d:w penicillin was released for u,e on the general population and memhers of the Class of 1945 were assigned their first live patients. We were designated a, "junior clinical clerks" and called "Doctor" bv thl· knowing nur,es. That day was also cold and wet in Buffalo. We were herded mto a large room where we met Abe Aaron, full professor of medicine, in charge of converting us "masters of ac.adem1c theory" into "dinicians" - Ill ahout one hour. The most memorable subject covered bv Dr. Aaron chat day wa, the role of humor in the pracm:e of mediune. He proposed char etery disease inflicts a secondary effect on the psyche of the patient and that chis ranges from simple worrv to depre~sion. It is also similar among their kinfolk, if not worse. He assured us that the presence of the physician could etther lift or further depress the mood of the sick room and we Jl/uslralions EARLY WINTER IQ~q must never forget chis potential. He used the word "humor." This must never be of a flippant type, hut a "discreet and appropriate" type; when the doctor leaves the room, ewryone involved with the disease should foci better. This is espt.•dallytrue in those cases where ,pccific therapy \\ ill not cure the primary disease. Abe Aaron then proiected ro our future and promised us that a good sense of humor would be necessary if we were to survive 111 the potennally depressing career environment of disease. Meditating on the above leads me to update three inadequate t)bituarv notices. While our Class of '45 mav not he the most outstanding in every category, we certainly had the greatest collection of True Humori.,ts. It is a sad reality that our three greatest humorists have re,encly died. The ohicuary notices 111 chis UB alumni journal missed their real greatness when they factually reported: Mamn Downe',', Jr. ane,thesiolog1st; Joseph Rutecki-surgeon and anatomist; George Fuggm-urologist. I would like to introduce you to these three outstanding members of my c.lassand offer a few thoughts concerning their true greacnes:s.Furthermore, should they (Xlssess that elusive nbility co read this from their position in the Great Beyond, I would like them to know how much I admired themthen and now. I met Joe Rutecki fir~t because we both went to R1vcrs1deHigh Sthool, where I was a vear ahead of Joe. Accordingly, I did not t'/ JoseplJiie/ BUFFALO PHYSICIAN ASD BIOMEDICAL SCIENTIST �. ----------+~-:j ____________ ::::::-1:➔ ••••-••-~.f•• '' ••••••••••• II 11 I ;.,....... : I t I I , I I I , I I .... - . - :: t - - • - ••••.::: I I I - --- ---------- .. I I I I I I I I I I I I ,-............ - _.,. ~ •' I I I 0 I .. ---_-_-:___ --_- ----•• I ,,' .:L ... I ' ,-----==-- II I I"• I . -------- ----- --- :,I I 1 I ••••• �16 know Joe very well, after all, he was only che laseof a long line of Ruceckis. Joe was known co be unusually smart, bur nor as flamboyant as his older brother. We all knew him as a nice kid. We didn't know che term "humble; but he was that coo. I next met Joe in anatomy lab on the morning of July 5, 1942, the day our class started med school. I was with him every day for the next three years. I had the only car going from Riverside to med school and I drove Joe to and from every day. There was a constant attitude of humor that grew more inescapable as time went on. This was every day in the car, in the classes, and in our frequent bull sessions which were often about a very real WW II, which was not always going well for us. Joe had a specific type of humor we all noticed: he never extracted humor ac the expense of any other person. We identified Joe's humor as "benign humor." I think of the humor of Red Skelton as "benign humor" and that of Don Rickles as "malignant humor." I cannot separate Joe's humor from his sharp and quick mind, which may explain why he made med school after only three years at Canisius College. Joe very rapidly changed from "just another Rutecki." Since he was "Ru" and I was "Ta"in the alphabet, we spent both years of our clinical clerkship not only at the same hospitals, but in the same small groups. It was in the clinical setting chat we saw him use the type of humor char Abe Aaron called "discreet and appropriate." He was often with a patient in the desperate throes of a terminal illness, but I could not help noticing how his innate humor spilled over co make the patient somehow feel better. This was not a phony act just because Aaron had cold us to inject a dose of humor; this was the real Joe who had chis quality from rhe cradle on. Another word we muse use is "sincerity; which he had in full measure. Among his colleagues, Joe was noted for coining nicknames and propagating, if not originating, "rumors." When the med school was between deans, he wanted to start a rumor campaign to get our most eligible classmate appointed. Norm Chassin was not elected, bur he EARLYWINTER IQ8Q ,~..-...._. . .,_,,,_,,~._~......,._,.~, '! rn Jle I courl jesler ' ' anJ a Jarn root! i sluJenl, j 300 pounJs-pfus , I, I i 'e was II . I I' ' J ' of Jumor anJ fun,· i I, I I:, I' ' i: . 'i ii nol an ounce meanness '- ..... • ,n of /, • tm. I' i I I . i' I I' , ~~ ........ ~...... ,- ,~ ·•- •1 - ,,-!: was a dandy. When I lase saw Joe Rutecki it was at our 1985 class reunion. Several of us were in a conversation when Joe joined the group. A classmate said: "Here comes Joe ... now we will all scare laughing." I don't remember che derails of the conversation, but the laugh titre went sky high. As his special "benign" humor went to work on his beloved classmates, he was personally carcinomatosis, bur concealed the grim fact. He was a great guy for me co have known. C hronologically, the next one I met was George Fuggin. This was in September, 1938 when we both scarred pre-med on campus. We met more literally when we both went out for frosh foot• ball. On the first day he played defensive nose tackle and I played offensive center. We bashed each ocher all afternoon. My mother ended my career when she refused to sign the parental consent to play. I don't know if George's mother scuttled him in a like manner, but I was sure he would not make the team. He was 300 pounds-plus of humor and fun; not an ounce of meanness in him. Through countless encounters, four years on cam- pus and then three more in med school, George Fuggitt was always the "court jester" and a dam good student, coo. In med school he was in all my preclinical classes, but he was "Fu" in contrast to my "Ta" so we were on opposite sides of most rooms. George met Gene Morehouse in med school and their chemistry hit it off. They had a running pseudo-feud chat injected humor into every situation. Since George was over six feet call and always on the upper side of 300 pounds, he was dramatically bigger than Gene, who played the straight man. This pair we called our "Laurel and Hardy." Their humor was not necessarily classic benign, but it was also never malignant. At the 1980 reunion party, George was the master of ceremonies. His spontaneous and continuous humor further underlined the rumor (possibly started by Rutecki?) chat George was the only doctor who had his patient laughing during a prostate massage. It is good that George chose urology, where humor is so appropriate. I last saw George at the 1985 reunion. He couldn't be the MC because the ravages of his rumor diminished his ability - but not his beautiful smile. His humor fit well in his huge countenance. The last of our trio was Marty Downey. He sat two stools co my right in histology lab and we met for the first rime on the afternoon of July 5, 1942. At that time l evaluated him as a quiet, incelleccual type. ln those days he started no conversations, but always joined in with comments on all subjects. His comments were always very appropriate and usually raised the level of conversation. He was more a Catholic philosopher than a humorist. As the freshman year progressed, he became more relaxed and the humor began co show. It was especially effective because of his original reputation as an intellectual. Marty Downey and George Fuggitt contrasted in many ways: George was at all times a gross extrovert; George was the biggest man in the class and Marty was probably the smallest; George was not a football payer and Marry was. But both were equal in the quality of their humor. BUFFALOPHYSICIAN AND BIOMEDICALSCIENTIST �,.. . .·J • : ~ · .-- .... .~ ... ,,,,,,.... ..- ••:•. • ~•• 0 •• : ... A ., --~...... .. _ ,.,,....,.- .~ • . """' ·-. ··. ~.- : } . : ..~ ~;·.:. ....,...io!!_j~;;\. ··- \-.-~ -·· .. :l ..___:' ..' ' ·.~l ·:·:. . ' ...:--- ----:-::. ~ ·,'··............ ' . ...._.... . ~ ,. ..;,,,,.. .:·....:,:,,: __,,,,,,,,,,, . ,( { .. ·::__ ... . By October, 1942, we had spent three full months with the freshmen dentists. While we spent every afternoon in labs, they were having a series of picnics with endless beer and spectacular couch football games. The lace afternoon lab schedule was aggravating enough, but their arrogance abouc their games was building our resentment to hatred. We finally arranged a showdown game. On the team were several former college star players, but chose Dents were pros. They beat us 35 to 7. Marcy Downey was our entire offensive threat and they identified him immediately. He was so fast and shifty that he was the only one co gain ground all day. The Denes would frequently cackle Marty because they were afraid a mere touch might miss this dancer. Each time Marty would bounce up in testimony to his great physical conditioning, and each time he would make a snide remark about the rough game, but in a manner chat both sides had co laugh. By the end of the game he was both our M.V.P. and top humorist. We arrival. They were not disappointed at the plight of this terribly proper bronchoscopist. We were convulsed ar rhe retelling. ln my medication on the theme, l am somewhat disappointed that Marry Downey chose anesthesiology for his life's work. It is regrettable chat so many of his patients were sleeping rhrough his humor . Bue, to remember the second admonition of Abe Aaron, the physician needs a good sense of humor to survive a career in chis potentially depressing environment of ours. all had to use humo r co accept chat terrible beating, but Marcy was the best. The last time I saw or heard Marty Downey was on the occasion of our 35th reunion. In a small group setting, Marry reviewed a case which he had not been forewarned about. The first inkling that it was co be a sex change operation was when the surgeon in charge made his initial bold incision, actually excision, to change a boy into a girl. This surprised the anesthesiologist, who was attempting to sec up a very proper chart. He gave a resume of the surgery and the comments in the O.R. by all of the various members of the O.R. ream. Marty convulsed chis audience, which led him into a discussion of the gastrocolic reflex of Herman Boser. It seems chat at 9 a.m. his urge to respond to the reflex would have to be answered. Ac 8:45 a.m., Marty set up a phony occupant in each of the two toilet booths in the doctors' lounge at Buffalo General Hospital. He then locked the doors and climbed out over the partition. Then the boys all sat back and awaited the urgent BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST <T here is one more unique circumstance that involved all three: ASTP. ln July, 1943 the military took over all the approved medical schools with a program called "Army Specialized Training Program." Our three heroes were all soldiers, first as privates and later promoted to Pfc.The olive drab uniforms were wool, which can get hot and itchy. Mass formation each 0800 our in High Street was awful as witnessed by us Navy men wacchin~ them from the comfort of inside. Worst of all was the military protocol, which demanded that these privates behave as subordinates to the corporals, sergeants, and most especially the major, who constituted the staff. All the above stimulated the funny bone of our class instead of breaking their spirit. There were many other classmates who were humorists in this regimented lifestyle,but none greater than our Big Three. These were three great men who have left a hole in the remnants of the Class of '45. The level of humor will be lower. If we allow these three men to die and fill an obscure niche in a stack of obituaries, the cause of humor in medicine will be offended. [ hope there is some professor of medicine at UB who repeats the message of Abe Aaron, and impresses the budding doctors chat humor should be a big part of their careers in medicine. I am quire sure each class will have potential Ruteckis, Fuggitts, and Downeys, and they should be officially encouraged in this beautiful line of therapeutics. Can you now see why l love these three men? • J EARLYWINTER 1989 J7 �Graduate Students he scientist values research by the size of its contribu, tion to that huge, logically articulated structure of '' ideas which is already, though not yet half built, the most glorious accomplishment of mankind?' - Sir Peter Brian Medawar (who won a Nobel Prize for his work in immunology). The grandest of goals is shared by the graduate students who are entering the University at Buffalo School of Medicine and Biomedica l Sciences. As it did in the last issue for the medical students, the Buffalo Physicianand Biomedical Scientist now presents a photo directory of the new graduate students. Their biographies inc lude undergraduate major and degree, unde rgraduate institu, tion, and current department. �Graduate )tudents 19 Susan Lynn Dagenais, Peter Augustinos , B,ologyB.A., Hofstra Unitermy, Pacholoin-1 u:,sh co gam more knou:ledgeabouc the human bod,. Kathleen E. Bethin , Bux:hem1s1ryB.S., Unlt'ers11y at Buffalo, Biochemistn. l am a jomt M.D. ·. Ph.D. student. Reva Bhushan , BiologyB.S. and Chemistry B.S.. Si. FrancisCollege, MicrobioloJ::,'. 1 ha,e a ma.1ter'sdegreefrom Rhode Island m B,ologv. 1 am 1nten-s1ed m research,oil pam1mg and baiik. Manja H.E.M. Bouman , Biochemistry Engineer,Hogeschoolf nterstudie,Biochemistry. I'm from rhe Nerherlands.l pla, Korfbal. Margaret Christine Grabb, Bwlogv B.S., Un1<ers11y at Buffalo, M, fa,orue Physiolog:,·. sporesare u>lle-balland basketball. David A. Judd , B,otechnologv,RlT, B,ochemistn. l u·ould ratherbe d~mkmg. Chong-Hyun Kim , Microb,oloi('iB.S., Seoul Nauonal Uni,emiv, Physiology.M, fawrite spori is bou·lmg. Won-Ki Kim , PharJungsook Cho Lee, 1rtac\ B.S. and M.S., Pharma" B.S., Seoul Seo,;!Na11onalUn1te~,- l\'auonal Unn.ersH~. t), Pharmacolog:,. l like Pharmacnlog,.I came plavmg iennis l am a from Korea. neu· Ph.D. studenl in pharmacolog,. Laura Jane Nicho lson, B,olog:, B.A., l.lni,·erm, of · Delauare, Micmbwlogv. l came 10 Buffalo from· ~for.land and for UB's .\1.0. • PhD. program. Xin Sun, B,ochemism B.S., Fudan Uni,·e"uy: ShanghaiProunce, B,ochemistr..;'..h faiher is a professorm • biochemiscr..1 ihmk I'll uork on biomedical Miriam Helene Tiktinsky , Phy1ical Theraf1\B.S., Washmi:conUni,m11y, Pms,olo![).Afier eight w,m as a P.T.,I'm gomg back co school10 do research. Meng-Hang Xia , Tox1cologv B.S., ShanghaiMedical Unn ern1,, Pharmacolog,:I'm from Chma. 1 am a Ph.D. Meiheng Yang, B1ochemmr.B.S., Sichuan Uni, mu,, B,ochemmr.. l came here on July 26. Zhaohui Yang, Biochem,sm·B.Sc., Pe- science. 1ruden1no-.,·.I u·ill enjO\ B,ochenmrnB.S.,Norih• em M,ch1gan Unit·mir,, Parholog:,. I ha,·e an M.A. m biolog,. I ha,e an miere.<tm research. Shih-Ping Yang, M.D., NarionalDefense Medical Cenrer, Physiolog:,. l am a graduaresrudentof rhe departmentof pms,ology Yuan Gao, Medicine B.S.C. PekingUnion Medical College, B,ochemmr.. I chose UB becauseu's a famou~umt'ersuy. king Un1ternr,, Bioch,mmr.. I am onginalh from Chma. 10te l.!B. If. Photoswere unavailablefor: John Delyani , Physiolog:, Haiping Mei , M icro&iolog,. �People 20 Offbeatand Proudof It Ettinger will do anything to spark students' interest "1 try to convey in an emotional way, what's exciting about the subject. I do a lot of 'offbeat' things to stimulate excitement and interest; Murray Ettinger, professor of biochemistry, said from his laboratory. "I have no pride. I'll do anything to create interest and understanding." Ettinger was describing some of his offbeat methods of reaching. "[ meet people ten years lacer and one of rhe first things they mention is collagen superstar~ Ettinge r said a former student gave him this title. "I go overboard crying to get people to understand why collagen (a structural protein) is so exciting," he said. But collagen isn't the only subject to get Ettingcr's unusual treatment. "There is a concept of how enzymes work called induced fit. I used a thinly disguised analogy ro mutually happy sex." Bur Emnger's offbeat approach isn't limited to a single class. "I taught an advanced graduate course and I decided nor to give any exams. Then I found out what rhe great motivator is: a berter motivator than grades ... • Ettinger paused with a twinkle in his eye. "I said, 'Put your hand on the buzzer as soon as you chink you have the answer. Whoever understands it first will get a dozen doughnuts:" Pastries, apparently, motivate students better than finals. These methods apparently are working. SUNY Central recently named him a distinguished teaching professor, one of the highest honors in the system. This is not the first rime that Ettinger's EARLYWINTER 1989 By DAVID M. SNYDERMAN teaching excellence has been recognized. He has received two Louis A. and Ruch Siegel Teaching Awards and many letters of commendation. "Put your hand on the buzzer as soon as you think you have the answer. Whoever understands it first will get a dozen doughnuts," Ettinger told his students. Pastries, apparently, motivate students better than finals. T he medical school class of 1979 dedicated its yearbook to him and he received the S.N.M.A. Award for Service co Minority Students in 1988. "I really felt good about that because I have spent a lot of rime trying co help minority students; Ettinger commented. Ettinger has serious accomplishments co his credit. He has developed several classes, one of which is an elective honors biochemistry course for medical students. "Several students said they were just bored with the first year of medical school. "It's an informal, graduate level course where the students learn from each other. Two co four students identify a disease that they arc interested in. I help chem a licdc bit finding papers about the disease," explained Ettinger . The class has examined such diseases as Down's Syndrome, sickle cell anemia , systematic lupus, Parkinson's, diabetes, muscular dystrophy, and schizophrenia. "lc'swhatever the student wanes. Everybody in the class reads the papers. All that the people who choose the diseases do is lead the discussion. They learn by informal conversation about what they read. And then the following week, we get together with a physician and a patient." This helps the students get a better understanding of the disease, Ettinge r noted. "I've (also) organized a summer program for people who have failed biochemist ry. The objective is not only to learn and pass biochemistry but to learn an approach to understanding any subject," he said. Ettinger teaches methods of learning in this biochemistry course. Students are told they should take the lectures and then, "paraphrase BUFFALOPHYSICIANAND BIOMEDICALSC!ENTIST �People 21 1nternah:c 1t, ~ct II mto vour m, n word . Iii he a good ,tudent, vou have to lome up \\ 1th your O\\ n 'ICU point. \\'hnt a good tcachcr dOC! 1s ,umul tc you to do chat. •t \\ould like p,.:opll' t<> undcr,t.md what I'm t.ilking .,bout ,o that tlll'y rnuld solve a rnrn• plctch nc-., problem• 11, or Emnger, tead11ng add, 'Pile to life. "I like the \'ancty of mv Job. I enJO) my I would go re5c:mh but 1f I did Ju t r=rch, half hall), Teaching gl\cs me rnntan \\1th F people." "1th111 a teach mg exist Et unger' order to "In hO\\L'\er. frame-.,ork of rc,,carch, get a J1 t 111guished te,1<hmg pmtc sor,h1p, fir<t of nil \'<)U han· to hen prof<'S50ran<l vou can't he a profo-or "1thout being a uccessful researcher." Trained ,1, n protl'III < hem1,t, l:tt111~crmm \\Orb "11 h rnecalocn:ymc,, •pc-c1ficallvtopper o:1:idasc. "I'm intl'f('!,tcd m the role of copper m h1ology," lw ,,ud. "Sumulatcd h, quCl>t1on, from m\ O\\ n graduate cudcm,, our work in recent ~car has dnhl·d towards H'llular hmchem1<trv ol ,oppcr; th,ll 1,, how cdl move nroun<l and use copper, and mhcmcd d1,-ca~ of copfl<.'1' b1ochcm1 try (,uch a \X'1l,-0n'sdt l-a,e). "\\'c u,l' the d1,ea,l' ,1s :- rool," he ,ay,. "If not only rnn we cure figure out the d1!-<:asc, the d1~. se, but \\C find out 50me1hmg tm portant about hm, normal cells u e copp~:r." EmngL·r\ n>mmllrnl'lll ro re<l'.lr<h makes lum a be Iler m,cruc1or, he said. "The old a~~c that tcachmg and research complt:mcm <':I<h 01 her 1~ true." Hi, 1ead1111gmetho,.h ure ha L'd on mak• ing an 1mprcss1on, Emngcr ,aid One of his former student, rold Emngcr that one of the pmfc,,or's 5ta1cmcnt ,ihuuc "ho\\ ,Hw1h111g that can r,lllonallv happen probahh \\tll be bsencd in 50mc Lanett <)<tern• had become the ha~• for that phys1c1an's pracucc ol 0 med1eine. "It reall) madc me feelgood." § for Ettmscr,teaching rs a =pons1b1ht~ n t R t,) fic takl·n lightly. "I'm t hL·onl' \\ ho 1< ,urn• lt 111,m:mgI he wholc ,rnw of knowk<lgc about the ,uhJcct. \XO\\! That' rcalh a prl\'llcgc: • ,,c I \furra~ Ettinger, Ph.D. BUI!'AID PHYSICIA~ A~D lll0\1EDICAI SCJE:-:TIST EARLYIX'ISTER198'1 �People 22 Keep It Fresh Severin wins Chancellor's Award for Excellence in Teaching //E ach student has his limitations. You have co adjust your teaching to the student," says Charles Severin, associate professor of Anacomical Sciences. His willingness co adjust, along with his excellent teaching methods, have won him a Chancellor's Award for Excellence in Teaching. One of rhese adjusrmenr, occurred wirh the student of a colleague. Severin, who teaches gross anatomy (primarily to medical and dencal students), was asked for suggestions by Judith Tamburlin, clinical instruccor in anatomy, who teaches the undergraduate gross anatomy class. "A couple of years ago, she had a blind student enroll in a class," Severin began. "Anacomy is a visual subJect; there are areas in anacomy that are cough for a sighted student to understand. "After finding that there weren't any teaching aids at this level for her, we designed this for her." "This" is a braille, raised relief, gross anatomy textbook made especially for Lisa Hoffman, Tamburlin's student. Accompanying the raised drawings are explanations both in braille and on tape. Severin and Tamburlin recently received a two-year, $154,000 gram from the National Science Foundation to develop and assess a similar book for high school students. Writing the accompanying texts was a task that beneficed his regular teaching duties. "Ofren the descriptions we used co teach her, we now use co teach the sighted because they were clear and concise," Severin said. EARLYWINTER 1989 By DAVID M. SNYDERMAN Bue Severin maintains his efforts co help students day in and day out and doesn't limit those efforts to an occasional pupil. Because medical scudenrs have long, unusually inflexible schedules, Severin found it difficult to find office hours agreeable co everyone involved. As a result, he now meets most of his students by appointment. 'I've met with students at seven in the morning, eight at night, and on weekends, if they need help,"he explained. "Some people would call it great lengths, but I Just consider it pare of my job. "I try co make my hours as flexible as possible; I cry co help students as much as I can.• S everin said he has found the students extremely dedicated, once they have come co him for help. "I would make appointments for seven in the morning. I would get here sometimes at ten minutes to seven and I never bear the students here." Severin cakes the special insights he received as a student and passes them along to his pupils. "I try to present co the students little rricks and techniques that I use co remember the subject," he said. One of the "tricks" is co draw the anacomical structures from memory. In fact, Severin asked Lisa Hoffman co cry to draw the pictures that he and Tamburlin had transcribed for her. Hoffman walked up to the blackboard and drew the structure, he said. "There was lots of overlap," Severin said, "but she could do it." Another trick that Severin suggests is "to place chem in the body. You can sit there and memorize rhe conrenrs of the anacomy text, but it's just words." So, he asks students co imagine chat they are inside the body, telling them to look around at the structures that arc there. "Anatomy allows you to do that because it's basically a visual subject." This technique, he said, help, students to remember the anacomy long past the final exam. To Severin, it is important that they "remember it ten years from now~ One of his teaching practices has been to revise a lecture every year - even if he was happy the way it went the previous year. Severin said he was taught not co teach like some professors, who use the same lecture year after year. "After doing that for five or six years, they're bored - you can cell they're bored - and the students are going to sense that as well; he said. Severin said he respected the efforts put in by one of his own professors when he was a student. "He spent a minimum of two hours preparing each lecture after IS years." As for professors who just read a prepared text, Severin says, "that's not teaching. There is no sense in coming co an 8 a.m. lecture if the guy is just going co stand up there and read. "We both know it's readable. The object is to try and get the student to remember it." Often, after the lectures in which he presents his tricks, Severin finds that students present him with approaches they've devised to learn the material. "In effect, they are teaching me ways of teaching." • BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �People :!J sc1plinary He ,~ d1rc1.tor of 1hc ~1ul11d1 and coUB ,II Agmg of I~ Stu the for Cenrer d1rcctor of r '" \\ cm :-:c:."\\'rink Genamc • Educauon Ccmcr :it the Um\.-rsny. M.D ., ho, lx·cn Lebenthal, :-.:anonal ,ttc:. ,. [n,mute of Child Health and Human De ,dopmcnt rhat \\ 111re, tcw grant ,1pplicar1011s involvmg nutm1onal therapy (or inborn errors of mctahoh m. Profc sor of pedrnm at UB, l..ebcmhal LS ..rologv and , h1cfof 1ht•Ol\1,1011nt Gastroc:·111 :-.:um11011,tt ChtlJn·n's Hosp11al ,md J1rc:.'C• tor of !IS lmernauonal ln,mu1c of lnfa111 :-.:um11on and Ga tromrestmal D1sca,c. • Emanuel hc r ry Leitch , a S<.'tond-vearuuJrm. won a n·lkl\\sh1p 1ha1 Tr.IV lcr Gcnamcs Rl.'5Carch • S3,000. of award carries an Trevor Litchmore , a third-year •tude111, \\<>nan American Ht·art A<so,1111on\ Stu• Jent S.:holar,h1p m Ccrcbrova,cular Oisca c • thnt came,. an award of $1,'it"lO. Edwin A. Mirand, Ph.D., J rc-ctor of the Dcparrmcnt of Ec.lut,1t1onanJ dc;in of the of UB, re• Ro,\\cll Park Graduate D1v1s1011 A,,_,-ardm \\ehr H. 1lh \X Dr. CCl\t-d the M tr~h tor h1<conmhuuom to Roswell Park • Memorial Im.mute. Chc1rlt•\ Set•erin, Ph D Ph .D ., meal mmucJudith Tamburlin, tll<< , ,,on I L1llv St anntomKal ror ol n-llo"•h1p for her mno\'amc "hanJ,-on" tt-achmg mcthcxh. In a prQgr.!m mlcJ •Undcrgrnduate Human An.11omv Dcmo11s1ra11on Lahormory and RclmcJ Tt-achmg ~latcrial<~ Tamhurhn ,, ne:umg ,pcc1al materials for lnhorator\' Jcmon<1ramms h) prc,cn mg human 11--uc, ,uch a, hcan and lung , m a hfchke •cate. This 1sdone chrough pla,1mauon, the prote,s o( rt·plauni: dw "acer Ill 11'-U<"'"II h a • ,iliu1111ypc ma1cri,1I. 0 0 John Acquavella, a Ph.D. tudcm m the of Social and Pn:vcnnvc Department McJ1c me, rccc1vcJ the award for the best pa~ pri:5ented on a di<scrcauon m the :-:n- BCHAI.O PHYSICIAS ,\SD lllOMEDICAI uonal Compc:uuon of the Ep1dcmiolog1t Rc~earth. S. ty for • Ra)'mond P. Bissonette , Ph.D .. soc1me tam1lv mcd1c11 ,c l B, was ,..._r of the hoarJ oi dm."ttor, ol idem pre dt-ctcd 1he Un11cd CerchrJI l'al y A ,oc1auon ot • 'ri1rk, Inc. \\b1crn :,.:<"'' ob-,or and heaJ of faan Calkin,, M.D., , anJ Gcromologv n of Jcr ch D, :it UB, h,1, h,cn nanwd ,t ma,1.:r of the American Colkgc of l'h\sitian,. C-.alkms, chief of the Gcromolog~ cc11on nt the \r\ Mcd1cal Cemer, wa, urcd for pron mcJ1<:al '1dmg d1rcc11on and 111<p1ra11oco ,rnJcncs and residents and for hi, le;1Jcr,h1p and '>t!n,cc m rhe field of genamcs. SCIESTISI e prt..,.1dem for John '\aughton, \1 0.. t c mcd1cal school rs and d cln a1 UB, h," hct•n n.11ned pre,1dt·nt of I ht Amcman Heart A~soc1,1tion,:,.:t"\I ); rk S1,1tt ,\ffihatc. ~aughcon ha, puhhsht-d c"renmdv on ex t-rCN' and phy,1cal acuvnv m the prevcn• • 110n "' c,,ronarv ht-:irt disease. Tracy Perapato, 0.0., a th1rJ-vcar family t Buffalo Gencr1I med nt rc,1dcnt Ho•pnal, 'J.On the annual ~c" ); rk Statt Atadcmy of Family Prarnce Rcstdent A-1~arJ • for Rt.,.carth. cudcm, won arac , a fourth-war Timur !-1.'(lmdpn~e for h1~po,.tcr prt'!-1.'lllattona1 the E,1,tcrn Srudenc Rest•;trch Forum 111 Florida m :',.1r h • EARLYWINTER l<l~<l �Research 24 Surfactant Helps Tiniest Preemies UB researcher coordinates national study on IN FASURF By ARTHUR PAGE A single dose of calf lung surfactant extract. inJ_ected into their lungs ~t bmh s1gmficanrly reduces the incidence and sevemy of respiratory distress syndrome in premature and low-birthweight infants, according to a national study coordinated by a UB researcher. Involving 2,506 newborns eighr weeks or more premature treated at 13 medical centers, 1t showed that the infants responded favorably to a form of calf lung surfactant extract called INFASURF. The most dramatic results were in the smallest and most premature newborns, those at greatest risk of developing problems. Edmund A. Egan 11, UB professor of pediatrics and physiology, said chat among premature infants born 12 or more weeks early, INFASURF significantly decreased che respiratory death race, incidence and severtty of acute lung disease and chronic lung problems. For example, the study included 712 infants born 12 co 15weeks early, average birthweight 2 pounds, who received 100 milligrams of INFASURF at birth, and 96 infants who did not. The incidence of severe respiratory disease and respiratory death were halved in the treated group. Among the treated infants, 16 percent developed severe respiratory disease and 8 percent died from respiratory failure, compared to a 33 percent incidence of severe respiratory disease in the untreated infants and a 19 percent death rate from respiratory failure. "Current modification of the continuing EARLYWINTER 1989 The ONY Company was created to make the surfactant available even if it isn't patentable. study incorporates more than one dose oflNFASURF if a premature infant develops respiratory disease even with treatment at birch. This 'rescue' approach promises to further improve the outcome for these premature infants; Egan said. Respiratory distress syndrome, also known as hyaline membrane disease, is a leading cause of death and disability among premature infants. le is estimated to occur in 50,000 of the approximately 250,000 infants born prematurely each year 111 the U.S., k1ling about 5,000 of them. The third child of President John F.Kennedy died of respiratory distress syndrome in 1963. Because of their prematurity, the lungs of affected infants do not produce natural surfactant, a substance that coats the insides of che lungs, preventing them from collapsing when the baby exhales. INFASURF is one of several surfactants granted invescigational new drug (IND) status by the U.S. Food and Drug Administration and is being studied in medical centers across the U.S. The FDA in July approved making one of these surfactants, a synthetic form manufactured by Burroughs Wellcome Co., available for wide use prior co its receiving approval for marketing because of surfactant's potential benefit to infants born with respiratory distress syndrome. INFASURF and ocher surfactant macertals arc still classified as INDs and cheir use is limited to specific study centers. However, their sponsors also arc seeking approval from the FDA for wider use. Egan and UB colleagues in the Division of NL'Onatology at Children's Hospital of Buffalo and Goren Enhorning, M.D. and colleagues at Women's College Hospital in Toronto first used calf lung surfactant extract in the early 1980s. Carefully controlled studies, reported in medical journals, showed that injection of che calf lung surfactant extract protected tiny premature infants from respiratory failure. The 13-center study conducted under the FDA's designation of INFASURF as an IND involves 2,506 infants to date. INFASURF is produced by ONY Inc., a Buffalo-based company of which Egan is president. le wa~ incorporated in 1985 to seek FDA approval for calf lung surfactant extract for treatment of infants at risk for respiratory distress syndrome because, according co Egan, major pharmaceutical companies were not BUFFALOPHYSICIANANO BIOMEDICALSCIENTIST �Research 25 willing to sponsor ir because 1r was not patentable. "The pharmaceutical industry basically has two issues in its product development or selection," Egan said. "One is that a product or drug offer some benefit to people and the other is char it make money for the company. ONY was created to make this surfactant extract available to children, even if it isn't patentable, because we believe it's the most cffecti ve." ONY is a "graduate" of the University at Buffalo roundarion Inc. "incubator." The incubator was created to encourage development of small businesses in high-tech areas. Its offices are located in Baird Research Park, adjacent to the UB North (Amherst) Campus. Both the incubator and rhe research park are managed by the Western New York Technology Development Center. • RESEARCHERS STUDY COMPOUNDTHAT Aas LIKEINSULIN I nsulin can be used co treat diabetes, but how docs it work? UB scientists are trying to unlock that secret by studying a compound called vanadate. To many researchers' surprbe, vanadate, an oxygen-vanadium anion, has been shown to mimic insulin's acnons both in cells and in diabetic rats. Insulin is a hormone rhat causes body cells co take in glucose (a sugar) for energy production and storage. "When you have something that everyone describes as insulin mimetic, it naturally leads you to examine diabetes," explained Gail Willsky, associate professor of biochemistry at UB. She recently received a grant from the American Diabetes Association to investigate vanadium's properties as an insulin ,mitaror, yet Willsky's field of research is nor diabetes. "I'm a vanadium person; she explained. "I'm using rhe diabetes, in a sense, ro understand how the vanadium compounds affect metabolism." The similarity between vanadium's actions stimulating a rt.-ceptoron the outside of a cell. They act in much rhe same way as a key opening a lock. Only a similar key will acnvate chat same receptor. Once the receptor is activated, it will cause certain other things to happen, like increasing glucose transport. lnsulin is a long molecule, while vanadate 0 is much smaller. As a result, vanadacc can't ~ - fit in the same "keyhole" as insulin. Instead it seems as if vanadate acts on a different Ioca'. cion of the receptor. •One hypothesis is thac it is stimulating the ~ protein kinase that's part of the insulin rccepcor inside the cell. Where insulin 1s binding "' ac the extracellular, vanadium effects would be intracellular: Willsky explained. Vanadium would he tripping an internal latch of the lock, while insulin opens the door from the and insulin's came as a surprise LO medical outside. researchers. Willsky said she is looking closely at how "They not1ced in cell culture systems that vanadium alleviates cardiac symptoms of vanadace had an insulin mimetic activity, diabetes in rats. such as stimulating glucose transport; Willsky "The heart, the kidney and the eye are the said. maJOr target tissues of diabetes," Willsky said. Eventually, vanadate was med in animal "I'm working in che heart w1th Robert J. systems. "Ir wasn't until it was realized that Mentzer (professor of surgery and physiology). it had a lot of multiple hormone effects rhar "With James Lohr (assistant professor of it was tried m diabetic rats." medicine) and Margaret Acara (associate proInsulin must be inJeCted, while vanadium fessor of pharmacology and therapeutics), can be ingested orally. Will vanadate ever we're also studying how vanadium treatment supplant insulin? Not likely, Willsky said. alleviates kidney symptoms associated with "I don't envision this in any way replacing diabetes." insulm. Since insulin 1s the body's natural Currently, no drug company 1sinvestigating answer to diabetes, 1t 1s the drug of choice:' vanadium as an insulin substitute "due co the Vanadate might be used to treat diabetics face rhat it is so expensive" to meet Federal who don't respond to insulin treatments, but Drug Administration (FDA) guidelines for that would be many years down the road. drug approval, Willsky said. "My efforts are focused on this very basic science, the result of which could be used in "The problem is the vanadium structure is so ~,mple that they don't see how they can a clinical setting," Willsky said. The vanadium compounds may cause maintain their rights to 1cafter they've gone stomach problems and may make people who for FDA approval. That's what I was told by are hypertensive (prone to high blood research and development people in the drug pressure) even more hypertensive. companies." As a result, Willsky said that the "We're a long way from being able co predict drug companies are afraid that they would how a diabcnc would react to chis drug," not be able ro recoup their research and Willsky said. "I think its higher potential is, development expenditures. However, there if you can really understand how insulin arc companies that are looking at vanadium works, you might be able to eliminate as a tool ro investigate insulin's activity, she said. • diabetes some other way." Hormones, such as insulin, act by -By David M. Smderman BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST § f ! EARLYWINTER 1989 �Alumni 26 Medical Pioneer Alumni Associationhonorsone of its own A m1.'Cl1cal pioneer whose achievements as clinician, scienrist and teacher have spanned 60 years, George W. Thom, M.D., was honored Sept. 21 as the first recipient of the Distinguished Alumnus Award given by the UB School of Medicine and Biomedical Sciences. A 1929 graduate of the UB School of Medicine, Thom 1scredited with establishing the foundations of modem endocrinology and metabolism and with pioneering what 1s believed co be the world's first organ transplant as well as bringing kidney dialysis to the United Scates. Thorn al'-0 initiated one of the first "health plans,• a forerunner of today's group practices and health maintenance organizations. Thom received the award ar a dinner in the Buffalo Club. Joseph L. Kunz, M.D., president of the Alumni Association, made the presentation of a specially designed crystal buffalo. Thom was introduced by John P. Naughton, UB vice president for clinical affairs and dean of the medical school. A professor emeritus at Harvard, Thom is chairman of the Howard Hughes Medical Institute, which he founded with the late Howard Hughes in 1953.The institute has "expanded tremendously," Thom says, and has developed a strong research program "in 40 medical centers throughout the country." Thom is vice president of MIT's Whitaker Health Sciences Fund and chairman of the Whitaker Foundation's Scientific Review board. A member of several visiting commit• EARLYWINTER 1989 By JOAN DANZIG A specially designed crystal buffalo was presented to George W. Thorn, M.D. tees at MIT, he is a life member of the corporation. A Buffalo native, Thom's career as ~ researcher began while he was anending the UB medical school. As early as his second year, he began assisting Dr. Frank A. Hartman in the preparation of adrenal extracts, developing the first workable assay for adrenal cortical extract activity. Thom looks to his work in Buffalo as the start of one of his most significant achievements, "the excitement of developing the use of corcin for treatment of Addison's disease which was an extension of my work with Dr. Hartman at Buffalo.• After graduation, he remained in Buffalo for five years, first as a house officer at Millard Fillmore Hospital and chen as assistant in the departments of physiology and medicine at the medical school. In 1934, Thom was offered a Rockefeller Fellowship, which cook him to Harvard Medical School and Ohio Stace University, where he rejoined Professor Hartman for one year before leaving for Johns Hopkins Medical School. Thom became an associate professor of medicine at Johns Hopkins in 1938.In 1942, after service as a major in the Johns Hopkins Medical Unit of the U.S. Army, Thom accepted an appointment as Hersey Professor of the Theory and Practice of Physic at Har• vard Medical School and became Physicianin-Ch1ef at the Peter Bent Brigham Hospital. His life-long interest in renal disease brought the pioneering dialysis techniques developed by Kolffin the Netherlands to Peter Bent Brigham, where, under his leadership, the now world-wide standa rd procedure of dialysis was put into use. His successful work cleared the way for the development of a program of kidney transplantation. High on his list of lifetime achievements, Thom says, is "the unique experience of developing the artificial kidney for kidney dialysis.• He was appointed Samuel A. Levine Professor of Medicine at Harvard in 1969. At Harvard, Thom initiated the Harvard-MIT Program in Health Sciences and Technology, which culminated in the Whitaker College of Health Sciences. BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �Alumni 27 A recipient of many national and international awards, Dr. Thorn received the American Medical Association's Gold Medal in 1932 for his work with Professor Hartman on cortin and again in 1939 for his studies on desoxcorticosterone and pellet implantation. In 1946, UB Chancellor Samuel Capen paid tribute to Thorn as a "leader ... master of the arr and science of medicine" in awarding him UB's Chancellor's Medal for "eminent services in the alleviation of human suffering which have won for you high personal distinction, and through you, have dignified Buffalo in the eyes of the world." A teacher of distinction, Thorn has had a major influence on medical education, particularly during his years at Johns Hopkins and Harvard, \\'here he trained more than 5,000 medical students. Most medical students "know" Thorn, though they may not have mer him, sweating CALLFORNOMINATIONS J Immediately above, Dean John Naughton, left, and Alumni President Joseph Kunz, right, congratulate Dr. Thorn at the dinner. their way through the "Bible of Medicine," Harri.Ion'sPrinciplesof lncemalMedicine, which Thorn edited for 31 years. One of its original editors in 1946, he served as chief editor of the 1977 edition. • BUFFALDPHYSICIANAND BIOMEDICALSCIENTIST unc I is the deadline for nominations for the second annual Distinguished Medical Alumnus/a Award. The award is presented to a graduate of the UB medical school who has distinguished himself or herself nationally or internationally in the eyes of his or her peers and has made an oursranding contribution to medicine, the arts, or humanity during his or her career. The selection will be made during the summer and the award will be presented in the fall at a special dinner. Please forward the name of your nominee as soon as possible on the attached postcard. Your cooperation is viral if this is to be a true alumnus / a award. The 1989 winner is George W. Thorn, M.D., a medical pioneer whose achievements as a clinician, scientist and teacher have spanned 60 years. • EARLYWINTER 1989 �Alumni 28 SPRINGCLINICALDAYAND REUNION WEEKEND T he graduates of the UB medical school have won their share of local, national, and international awards for achievement, but it took an enormous amount of effort, toil, and sweat. Wouldn't it be nice if, just once, someone gave an award for something easy, like going to a party? The Medical Alumni Association is doing that for the first time at its reunion weekend. The reunion class with the highest percentage of attendees will win a trophy engraved with irs class year, which will be displayed in the medical school. Now, don't let the daces throw you. The next Spring Clinical Day and Reunion Weekend will be held in April, not May. It starts off with a cocktai l party Fri• day evening, April 27. Spring Clinica l Day will be held Saturday, Ap ril 28. Arnold Reiman, editor of the Neu: EnglandJournal of Medicine, will deliver the Stockton Kimball Memoria l Lecture. The theme for Spring Clinical Day is "Changing Aspects of Medical Practice~ • Class of 1940 Class of 1945 Class o 1955 "Saturday,April 28, 1990, the evening we hat·e all waited 50 )'earsfor. Let u.s make it our best reuniondetails lacer." William Hildebrand , Jr. "45 )ears! Tempus fugit. Time co renew, time co refreshold friendshipsand memories from the most significantyearsin our lit·es - the Class of '45." Herbert E. Joyce "We are lookingfor a big turnout for our 35th reunion. Plan now to meet with your classmates." James R. Nunn Class o 1950 John A. Winter "Togetherwe canmake our 40th a real winner. Lookingforu:ardto seeing)Ou all in April." Ro bert J. Patter so n EARLY WINTER 1989 BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �Alumni 29 Class o 1960 Class o 1965 Class o 1970 Class o 1980 Class o 1985 "It is with a great deal of pleasure and anticipation chatwe lookforu:ardcoour 30th reunion. Near coca! parcicipacionu:ouldbe an added bonus." Roger S. Da yer "Come cosee hou· we, the school, and Bt1ffalohat·e changed in 25 "ears. \\1/e u:ot1ldl0t·e co hat·e :,ou in Buffalo." Joseph G. Cardamone "You can't ignore20 :ears. Step back into the pascand reneu·friendshipsfrom chat hapP) ume. Duse off ,ot1r memoriesand bnng chem along. Come back co reminisceand share some lat1ghs." Donald P. Copley "BAMMO! Ten:-a:11:1 hate gone Ir:,·.Let's gee together and .1eeif che chemiscryis the same." "Lee'sget rogecher and auch up on uhac'shappenedin che lase/ite )el!TS." John E Coyne Margaret Paroski I Jame s R. Kanski Robert M. Moskowitz Class o 1975 Theresa Stephan Hains Joseph A. Zi.zzi "I 0-:,earreunion «:asgreac. 15 will be et·en better. See )'OU acSpringClinicalDa:, m Buffalo." Jack Cukierman BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST EARLYWINTER 1989 �Medical School 30 LIGHTINGUPIN STYLE: LIBRARY CHANDELIERS AREANTIQUETREASURE 0 nee they glittered above nights of music-making in a fabled Buffalo house. Now they shine above studems and researchers poring over books in the Health Sciences Library. Located in rhe HSL:s main reading room, the restored twin antique chandeliers are believed co dare from the 18-¼0s.Robert L. Brown, M.D., associate professor of medicine emencus and a member of the medical school's class of 1944, made the restoration possible through a donation to the UB Foundation. The silver-placed fixtures came to che HSL as pare of the original furnishings of che old Lockwood Library, which was opened in 1935 and was designed by Edward B. Green, also the architect for the John J. Albright house, a huge Tudor mansion on West Ferry Street. These chandeliers once dominated the Albrights' music room, but were moved in the 1930s when che Albright estate was broken up, after the family suffered financial reversals. Originally candle chandeliers, they were electrified when brought ro the old Lockwood. The mansion, built at the cum of the century, was torn down in the 1930s. Albright, a pioneer in the development of electric power and automobile manufacture, gave more than $1 million for the construction of the Albright Art Gallery. While hardly a Morgan, he was, in che words of his grandson, "symbolic of the day~ of the city's greatness." A donation from Robert L. Brown (M'44) made the restoration possible. buildings, was responsible for moving the chandeliers out here; said Brown. He added chat when the old Lockwood Library was rehabili1tated as part of che Health Sciences Library project, "there was no provision for che restoration of the chandeliers. There was even a question whether they would rehang chem, 01rif they did, whether they would electrify chem. By chat time, they were black from age:' Brown, who 1salso che medical school's archivist, wanted to preserve these elegant reminders of the old Lockwood. "After· the library occupied the space, I started making inquiries about having chem restored, but che problem was chat no placer had facilicies co cakc care of :.uch large pieces; he explained. "We also would have had difficulty lnnding someone who would do the rest of the restoration. "Bue as a result of the restoration of the Bueler Mansion downtown, I called the man n 1934, a reporter for rhe Buffalo faening who did their major chandelier. I also located Neu,~described the house's sad end: "l..cav- Marlette Placing, a local firm chat does coming the house, the visitor carries with him a mercial plating." Finding Marlette was a big reverence which is as melancholy as the place advantage since the firm, headed by Edward itself in the face of rhe dissolution it is Marlette, had the large placing baths needed undergoing .... He (Albright) gathered the for the job. beautiful things of rhe world around him and his aestheticism overflowed to give the dry orne idea of the chandeliers' value can be 1rs noted temple of arc." surmised from the pre-restoration ap"We assume that Green, who designed both praisal. I S EARLYWINTER 1989 "Wewanted insurance when che chandeliers were being taken down; said Brown, "while they were off che premises, until they were put back up, that is, for che duration of rhe restoration. They were appraised at $25,000 apiece."The value, of course, "is way up now." Beyond moneta ry considerations, however, was a reverence for the University's past. "We were all concerned about preserving as much as possible of the old Lockwood, which was really an elegant building, the best the University has ever built. The craftsmanship couldn't be equaled today and it would be unaffordable if it could be," Brown said. "Our concern was co preserve as much as we could, and the chandeliers were a significant part of chat main reading room. I wanted to restore them co a scare chat they were ongmally in." In a charming comc1dence, the mother of Edward Marlene's wife, Norma, was the longtime assistant ro Charles D. Abbott, director of University Libraries from 1934 to 1960. Her name was lvah P. Sweeney. The restoration work was done by Jack Kiener, a highly-regarded craftsman who has been restoring antique lamps for 17years and is the owner of Antique Lighting in Clarence. "I'm quite sure these chandeliers are English; said Kiener. He noted, coo, chat the chandeliers have hcen kept together from the beginning, an unusual occurrence in the chandelier world. He explained: "Every piece chat's removable is numbered . Every arm has its spot to fir in. Each piece was made by hand and made for its O\\'n counterpart. "When we disassembled the fixture, there were 20 arms. On che number I arm, for instance, we have a bobeche, a candle cup, and some finials. All are numbered so that they fie back on number I. The numbers are scamped m. Whoever made the fixture numbered them in; this is the mark of a good craftsman. Nothing is interchangeable:' The arms on one chandelier are numbered I through 20; the arms on the ocher are numbered 21 through 40. "Sosince the 1840s, the fixtures have stayed together all chis time; he said. "This is very unusual." It cook Kiener "close ro 90 days" to com- BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �;\fedical School 31 - --- ..---= ------- -=- unrestnued endowment to help meet uncx• peered financial needs and opportunities. Accordmg to Prc,1Jenr Stewn B. Sample. "The S5Z million \qll enable L'B to meet needs char have been identified a, cr1ucal ro the growth of rhe Untvcrsiry, hut for which t.lte funds arc limacd or una\ailable. "State budgetarv Imes cannot meet all rhe needs of the University, nor can they provide the flex1h1hrvchat i, ahsolutcly csscnrial for rhe U111vcr,1rvto rhnvc. Joining pm·atc support w1ch~rate dollars will permit the Umvers1tv at Buffalo ro achieve its go,11of bccommg one of the nation•~mp ten public rl"5Carlh uni\'er--iucs bv the end of the ccnturv." The St hod of Mcd1e1nc and Biomedical Soence, ha, received some of the largest gift, co the campaign rhus far. Ont of the mo,1 rl'CCntwa, a $1 million l;,mmitmlnt from the The chandelien once graced the ,\lbnght Mamion. James H. Cummmg, Foundation, Inc. ro rhe of assist m the funding of a Positron Emis.,ion dav, glorv the n:calling One writer, plerc rhe work on the first chandelier. "This (PEn lrnagmg Cc111cr,a joint Tomographv the remembered mansion, Alhright involved preparmg ir for plating and med1<al slhool and the VA thi: of project her m husr to l1h-d Albright Mr;. •mu"lalc,," reassembling 1r, ,rraighremng all the arm,, Medical Center. This 1,1ranris the largest ever mu,1c room. This was rhe "golden age" of the rewiring it, lacquering it. Also, because 1t wa, awarded m rhe 26-\·ear hi<torv of the Cumhouse, he ,aid. a candle chandelier, we had ro devise ,ome mmgs fuundar1on. ch.mdcl1er,, rhc,e that One like,. ll) chmk way of holdmg the ~ker, m and \\e handOcher significant rnnmbutions mdude a renewed found ha\'e shadow,, the in so long shaved wooden plug, to fit mro the candle of ,ecurmcs valued at nearly 53 million gift • home. UB their in glory socket,." a ml'OI<11school alumnus who wishes from \\"h11chcr Ann B, --ctfor "wa, chandelier \1an,1on The Burler anonvmou<. This i, the larJ:esr gift remain co elecrric1rv." Kiener commented. "At l.iB, \\e md1\1dunl ever rcn·1\·ed in the l1v111g a from had ro put the wire on the outside of rhe fixU111\'er,1tv.both a, a private the of h1,rorv er ,1h wa, that ture. Ir's a solid c:<1,tfixture according to Jo,eph msnruuon, puhhc and w1rcwav,." no \\ere e plart.-d.Ther the Uni\crsirv at of president J. \lansficlJ, fur the expcriencl-d Kiener, the UB proJclt he used to will It Foundation. Buffalo brought its own reward,. "le\ inspiring when to help endowment unrestricted an e,tablish wnR-d vou on rake ~mething frc.,munre,.to he. Unt\'er,1rv ar Buffalo Foundano .n's nc\\ rl-cru1t ,cholar,hips. ,rudenc pro\'1de has \\a< It ampaign black. pach wa, GR'3tnl.._s•C le ro 1t. fim,h "Pathwav< and dinon rcchno)Ojly high purcha,e mcmbcrs, faculty million Ill gift, ratscd more than ..,z1.z nor taken care of hccau,e of how high tt wa,; equipment and support various needs of the and pledges as of Sept. 15, according to no one could keep it up, and it was ht·avily R. Knox. national campaign medical ,-chool for wh1lh other funds arc coated with lacquer and ~arni,h (applied) 111 ~onhrup limited or una\'a1lablc. ,av would 1c.I . prescne cha1rpcr-,on Knox, who 1sLhairman ui rhe hopes char thi, \\OUIJ Another anonvmou, SI million !!!ft ro hoard of !lilarinc Midland Bank, ,aid this that 40 of the hours were ,pent just ,mp' Pathw;w, to Greatness' C-impmgn was the represents more than 40 percent of chc ramping the lacquer off the 20 arms." for rhe Slhtol of ~fodK1ne. dc,11:natt.-d goal. m1lhon pa1gn'<five-year, 552 The refurbished chandeliers alR-adv arc colthe ded1~Jt1on and lcaJcr~h1p of "Through Lampa1gn the ,1fter 19~i. day next 0-.robcr m very "The Launched leccmg rave review,. and members of rhe Cam• Knox Northrup ,eeks ro increa,c permanent endowment the first chandelier was inscalll-<l;said Histtiry we an· well on Commmee, xecutl\'C E pn11,?n funds for the U111\'ers1tvtO pro\'ide pmfc,'-Or• of \fod1cmc Librarian Lilli Sent:, "one of the uhiect1\'es," our achic~mg tL wav our (cllowsh1p,, po,tgraduarc ,1nJ ,h1~. graduate mamtenancc men who hod been 1molvcd re is snll much co be noct.-d."The :-.tansfield grantsarhlcti< holar,h1p,, s, e sra1r,, undergraduat the up running came w1chthe hanging, Jone, bur we arc confident of attninmg our 111-a1J.fine an, programming, aJJ1riom to saying, 'I've got to see that chandelier: Th,tt • and has been the reaction of the ,cudcnt,. roo." library and pocrrv/rare hook collccnons. TOGREATNESS' 'PATHWAYS TOPS$21.2 MILLION T BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �Medical School 32 VAN RIDESFASTTRACK FORCANCER EDUCATION W hile black and Hispanic women have a lower incidence of breast cancer than white women, they are more likely to die from the disease, according to Noma Roberson, director of community in• rervention and research at Roswell Park Cancer ln,tirute. One reason for the higher death rate among these women is that "they tend to get into the health care setting only at a very late stage of the disease," she explained. To get minority women into this semng sooner, Roberson has developed a mobile health care program. It operates from a 34-foot recreational vehicle which has been renovated to include examination and counseling rooms, along with a library and classroom. The transformed RV, which has been named the "Health Express," travels around Erie County bringing health education and disease-detection services into poor and minority communities. Roberson, who received a Ph.D. in experimental pathology with an emphasis in epidemiology from UB in 1985, said she has been interested since early graduate school in "women who are underserved (by the health care system), women who are hard to reach." Her doctoral research at UB focused on the specifics needed in breast cancer programs to reach minoriry women. After graduate school, Roberson continued to be preoccupied with the problem of how to reach poor and minority women who might be at risk for breast cancer. "Over the years,"said Roberson, "we've had a number of programs chat have involved major recruitment efforts to get people to come in to use the health care services at Roswell Park. Yet while we've been successful, we have not been as successful as I would like." And then one day, "out of the blue," Roberson came up with the idea of a mobile van. While there are other mobile health care units in the country, the "Health Express• is unique. "Most mobile units are geared to providing EARLY WINTER 1989 Developer Noma Roberson meets the press at the opening of the Health Express. X-rays,"said Roberson; "this one will not (pro• vide them). Instead, it will provide the first step - education and clinical breast examination. "\Y/ewill emphasize the importance of early detection. The women will come in for a 45-minute to an hour program. They will listen coa brief presentation and then actually work with the breast models on a one-to-one basis. They'll learn how to find a lump, see what a lump looks like, what it feels like." Besides learning how to examine their own breasts, the women will also be able to receive clinical breast exams in the examination room of the mobile health care unit. According to Roberson, "a nurse will check the woman's breasts thoroughly to see if there are any problems. If there are, the woman will be referred to Roswell Park or a physician of her chokc.• At Roswell Park, Roberson continued, "a physician will examine the woman even more thoroughly and will make a recommendation if there is a need for X-rays and further examination." All of these services, the classes, the examinations in the van and at Roswell Park, as well as Pap cests, are free, Roberson noted. In addition, she said, the program will provide free mammographies for women who lack insurance. These women who fall through the cracks, a situation which is more and more common, merely must prove that they are needy and that they are at least 50 years old. She added that free mammographies mighc also be provided for younger women, depending on the case. "A 30-year-old woman whose mother died of breast cancer, whose sister died of breast cancer, and who now has suspicious findings on her breast would probably be a candidate; Roberson said. Finally, to help women who have been diagnosed as having either breast or uterine cancer survive "the devastating rehabilitative phase," Roberson said there will be a support group and counseling program. To gee the women to use the van, field workers introduce rhe program to directors of neighborhood centers or schools, then work with the directors to publicize the van's arrival. The "Health Express" has been financed by a grant of $205,190 for two years from the New York State Department of Health. The grant is part of a $1 million fund that was set aside by the stare last year to develop brea,t cancer detection programs. "The intent for chat money; Roberson explained, "was to service the state by developing model programs that would focus on the early <leccction of breast cancer and that could be used in the future across the state." Of the eight programs awarded grants by the Department of Health, Roberson said hers is the only one that uses a mobile unit. In addition to the grant from the Health Department, Roberson has received services from Roswell Park, and from various community agencies, including the Erie County Health Department, Sheehan Memorial Hospital, the American Cancer Society, the Medical Society of Erie County, and rhe Geneva B. Scruggs Health Care Center. "As I add up the contributions of all these agencies, including my own institution, we're talking about a program that is really about a $400,000 program, which we've done for about $200,000. "And that," Roberson concluded, "is just a demonstration of the importance of community coalition for these kinds of health care projects." • - By ElisabethSheffield BUFFALOPHYSICIANANO BIOMEDICALSCIENTIST �Briefs 33 SEMINARS SET ON THEAGING A series of faculty development seminars will be held by the Western New York Geriatric Education Center and the Multidisciplinary Center on Aging from ~bruary to April m Beck Hall on UB's South (Main Street) Campus. Continuing Medical Education credit of category I (CME) will be given for each seminar attended. For more information, contact Patricia M. Krupp, Beck Hall, 831-3176. i MFH OPENSCENTER FOR AMBULATORY SURGERY M illard Fillmore Hospital has opened the first multi-spccialcy, freestanding ambulatory surgery center in Western New York. It's one of the first of its kind in the State. Located m Amherst, the center is designed to accommodate most types of nonemergent, uncomplicated elective surgeries. le has the capacity to perform more than 7,000 procedures a year, including ophthalmologic surgery, breast biopsies, arthroscopic surgery, plastic surgery, hernia repairs, pediatric procedures, and oral and nasal surgery, among other types of minor surgeries. "le is estimated char by the mid-l990s, -15 to 50 per cent of all ,urgical procedures will be performed on an ambulatory basis," said Jared C. Bario", M.D., president and medical director of the center. • ~ A~lllllll~lf should not only be checked by doctors and nurses at the operating room door, hut removed before the surgical scrub, according to Thomas S. Beam, M.O., associate professor of medicine and microbiology at UB. Whtie such mfccnons invariably arc caused by bacteria colomzing the patient, rhc source of infection of a wound may be questionL-d if surgical gloves tear during an operation. Stressing the payoff of an ounce of prevention and noting chat removing a rmg is a mammal inconvenience for most people, Beam wrote in the Journal of the American .'vledicalAssocwtionrhac the most prudent approach i, not to wear jewelry in the operating room. • AN ONLYCHILD OPERATING ROOMIS MAYHAVEHIGHER No PLACEFORJEWELRYBLOODPRESSURE Add co the long list of potential sources of nosocomial infections chat band of gold on a surgeon's ring finger. Because it may harbor bacteria char can trigger a postoperative infection, jewelry BUFFALO PHYSICIAN At-:D BIOMEDICAL SCIENTIST A dulcs who were only-children are more likely to have higher blood p_ressure than those who grew up with siblings, according to a study conducted at UB. The researchers found chat adults who were iii ~ 6 only-children had significantly higher mean systolic and diastolic blood pressures than those with brothers and sisters, regardless of number of siblings. The results were presented at the fourth scientific meeting of the American Socierv of Hvpertension held in New York Cicv. Maurizio Trevisan, M.D., associate professor of social and preventive medicine, said the higher blood pressure found among adults who were only-children could be responsible in part for the finding ma ,eparate srudy of a higher incidence of coronary heart disease deaths among adults without siblings. He postulated thar the higher blood pressure m adults who were only-children may be a consequence of stress resulting from inLreased expectations placed on an onlv ,hild and/or growing up m a limited social network due ro the lack of siblings. The UB researchers investigated the rela• tionship of birch order to blood pressure in 676 white males and 796 white females, aged 20 to 70 years, participating in che Buffalo Blood Pressure Study. • § ECMCOPENSCENTER FORBURNTREATMENT T he Regional Burn Treatment Center of Western New York opened in March ac che Erie County Medical Center. This is the culmination of a two-year planning process berween ECMC and Sheehan Memorial Hospital, which closed its burn service. The medical director of the new burn center is Jorge Rodriguez, M.D., who received his training in the management of critically ill patients at Columbia University and the University of Louisville. The center has eight beds: six for critical care and two for intermediate care. The unit includes cwo hydrotherapy rooms and scareof-the-art monitoring equipment, as well as staff and family conference areas and administrative space. Construction and renovation for the center cost about $1 million. • EARLY WINTER 1989 �Classnotcs 34 held in Hyderabad, India. Harold F. Wherley (M'36) • of Stone Creek, Ohio, writes chat his grandson Rob, (son of Benjamin J. Wherle y, M'65 } 1s starting medicine at the Univer• my of Cincinnati. Albert P. Sutton (M'48 ) • pre;idenc of the New York Section of che American Uro logical Association, organized the Annual ~ieeting held in Lausanne, Switzerland, on Occobcr 22-29. Matt A. Gajewski (M'39) • wa>honored by t he Erit: County L..-i::i,laturewhen tht:v named the Human Scn1c1.:,Center on Buffalo\ East Side the "Dr. ~1att A. St:n ices GaJewsk1 Human Center." Harte) C. Slocum '36 1920's L. Maxw ell Lockie , Ph.G . (M'29 ) • profe"or <.memu, of therapeuttc, at UB, ha, been named to the prestigious rank of "ma<rer•bv the American Colk,gc ofRheumatology. P:iruallvrenred, he now serves as a consultant m rheummology at t he Erie Counry Med1Cal Centl"r, Buffalo General and ~1illard Fillmore hosp1ral,, and Children\ Hospital of Buffalo, where he founded one of chi, country\ first clinic, for children with arthriu,. During hi, medical career he developed method, of diagno,rs and treat• menr for arthrms now used world-wide. 1940's EARLYWINTER !<13Q Andreu• A. Ga~e '44 Edward G. Forgra ve (M '45 ) • informs us I hat he remed from acm·e practice m 1985,but i, still doing somr UR work of the Phi Lambda Kappa Mc<l1rnlFraternity, he was ell-cted to the po,ition of \'ice chairman of the board of the two orizani:anons. Dr. Levy is currently m the Geo rge A. Poda (M'45 ) • private practice of psychiatry m reured aftt:r 381/z years as m1.-dical Buffalo, chairman of che Depart• of Du Pone's ,uperintcndent ment of Psvch1atrv at the ~1illard Savannah River Plant. He i<no\\ Fillmore Hosp1tab, and a clmical teaching at Oak Ridge A,,ouated associate professor of psychiatry Universine, and doing contract at the UB medical school. work for the Department of Energy - "th1, 1s fun!" Andrew A. Gage (M'44) • one C arl J. lmp e lliti e r (M '46 ) • a thoracJC 'C\ surgeon, Joined the scaffof the M.iyo Clime in Scorudale. An:. 'Grear wav co cut back on a surgical pranice. Heare and hand arc still steady!" Annabel Miller Iron s (M'46 ) • of Chevenr e, \\ vo., rctm.J 'rom the Veteran, Adm1ni,trat1on Joseph R. Saab (M'34 ) • of Hospital and 1s now doing Hamburiz, N.Y., celebrated h15 \'olunrecr medical work in the 80th birthday m August. Dr. Veteran, Admm1stracion\ Nur~Saab rccentlv attended hi< ;sch mg Home. Dr. Irons 1, pre,1dent class reunion . of the Woman's Club of Cheyenne, the oldest (201 years) Harvey C. Slocum (M '36 ) • 1s federated cluh in Wvommi:;. profe5sor emeritus of the University of Texas Medical Branch and Harold J. Levy (M '46 ) • Afte r a Colonel (Ret.) in the U.S. ,ervmg as president of the Army. Dr. Slocum live, in San Medical Student Aid Society, Antonio, Texas. which 1sthe ph1lanthro1 < hranch 1930's Paul T. Buerger (M'49) • of Young,cown, ~ .Y.,writes, "I have jomed the Anthropology Depart· ment of SUNY as a graduate stu• dent." of the developer, of the implantable cardiac pacemaker, rClcnrly received two awards. Gage was honored in March at the annual meenng of the American Society of Contemporary Medicine and Surgery in Florida. In April, he was honored during the s<.'<.ond annual Thoracic Surgical Teachmg Days program, co-sponso red by UB and Buffalo Genera l Hospital. Gage is che deputy director of the Roswell Park Cancer Institute and a profc,,or of surgery at UB. Arthur J. Schaefer (M '47) • delivered the fir,t Dr. P. Ramchander Memonal Oration at the Annual Ophthalmolog ical Meet• ing given by che Kanchan Eve Hospital and &-search Cente r 1950's H e r b e rt L. Berman (M'SO ) • has retired from the active practice of plastic and reconstructivc surgery and is now r~iding in Scocc,dale, Ariz. Vict o r A . Panaro (M'52) • was elected to the board of director, of Blue Shield of W1.-scernNew York and Community Blue and serve, as a counci lor for the American Coll~e of Radiology. Roy J. Thurn (M'52 ) • wmes "As a captain in the USP HS Ready Reserve, I recently com pieced a two week ,horc tour of ducy at the Crownpomc, N .M., Indian Health Facility on the NavaJo Indian Reservatton. It was a very rewarding experience." 11 P. Hamilton Thomas (M'S?) • was recalled to active duty by the Unaed Scares A rmy in 1984 as deputy commander, Center, Army Aeromedical followed by an assignment in Saudi Arabia. He is currently chief of the Preventive Medical Service at Brooke Armv Medical Center m San Antonio, Texas. John B. Ander son , Jr. (M'58 ) • medical director for Centerior BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �Classnoces 35 pleasure: patients and che opportunity for flight time again. Also appointt-d to che admissions committee, School of Medicine, uni· formed Services University of the Health Sciences." Energy Corporation, ha, been clencd president of the hoard of trustees for the Andrew, School, an independent girls' boarding and day school in Willoughby, Ohio. 1960's Je rro ld D. Canto r (M'69) • \\as ek"<.tedchief of the medical ,raff , t C:ia,ral Communttil-,, Hospital, Santa Ana, Calif. Algirda s Gamziuk as (M'60) • has been appointed ass0<.iaceadministrator for medical affairs at St. Joseph Ho,pital in Check• towaga. 1970'., Seba stian Co nti (M'70) • has Rob e rta M . G ilb e r t (M '6 2) • was named ml-d1cald1rt-ccorof che Georgetown University Family Center. Dr. Gilbert presented a Add1ltion,: Put pap.:r "lat~cn ting the Patient m Charge" at the Midwest Family Theory Sympo,1um in Chicago. Harold J. Le,,y '46 Rob e rt W. Hamilt o n (M' 63) • ha, moved co Tc,k-do,Ohio, where he 1, professor of mt•1.hcineand chief of the ncphrology division of the MedJl'll Coll~l' of OhK England area in chc fall of 1989 after serving a, chief of the ob/gyn department, Supreme Allied Powers Headquarters, Europe (S.H.A.PE.). Belgium. of both the American Lung Associauon ofWC!SternNew York and the ~ev. York Trudeau Sociery. Jeffr ey S. Ro ss (M '70) • \rntes Ro be rt M . Tabac hn ikoff "I have rl"\.Cnth·t-,.-ln apooinwd (M'66) • returned co the :-,.:ew professor and chairman of the Steph en C. Sc heiber (M'64) • R a n da ll A nd e r so n John ha, been ele1.1edto Who'i Whom (M '67) • wa, rt<. nclv bo'lrd certhe \\'orld. He ,en·es a, eXl"CUtl\"C in cmergcn1.y med1unc. He secretary of the Ameman Board of Psychiatry and Neurology and president of the As.soc1auon for Academic P,y<hiacry. Dr. Scheiber 1, also a member of the Award, Committee of the American College of P,ych1atri,ts. Al an Saltzm an (M'66) • has been named clinical director of the Department of Medicine at the Erie County Medical Center. He is chief of the pulmonary disease section and associate chief of mc.-dtcal-.er-viceat the Buffalo \½ Medical Center. Dr. 5almnan serves on che board of che Amencan Lung Association of ~ew York Scatt and is president a pnv,ire practice ,11(:cializin~in \"ascular surgcr\' and IS an associate clmie.tl professor of ,urgerv at the Umvcr,uy of California at Davi,. tified i, a clinical assistant pmfc,,or of familv medicine at UB. D av id Fuga zzo tt o (M '6 7) • is part Jf a group pral CJ<e in ped1atr1t, in Birmingham, Ala. Dr. Fugazmcco w;i, elected to the executive committee at the ;\1ed1calCenter Ea,c Ho,paal. Capt. Elias Rose nblatt (M'68) • write!',"Just completed a tour as director of medical services and executive officer of the Naval Medical Clime in Washm~on, D.C. and have begun a clinical position with the Naval Air Facil• icyat Andrews Air Force Ba<e.A BUFFALO PHYSICIA:-: A~D BIO~EDICAL SCIESTIST Department of Pathology at the Alban\' ;\1t-dicalCenter Ho,p1tal and Albanv Medical Colk-ge, Albanv, N.Y." Roy M. Oswa ks (M'7 l ) • was elected c h1cf of surgery ac Bayside, Hospnll Humana V1rgm1a Beach, Va. W illi am Hru shes ky (M'73) • wnres, "Aftu a do.en years, t the University ofMmnesota m MPIS, I haw returned co ~cw York and profe"<Jr of am currently medicine and m1lrobiologyltm• munobiologv at Albany }..1ed1cal College of Union Lim\er,1tv. While in Mmnc,oca I captured a :--=orwegian Amencan pr~ncc,s, Pamc1a A. \'food, \1.D., Ph.D., and we have recently had our first M.uie Cassandra daughtl·r, :-,.:1Cole.• Melvin R. Pratter (M'7 3) • is head of ch division of pulmonarv John B. Anderson, Jr. '58 and cmical care and profe,,or of Rohen medicine ,11 UMDNJ Sl hool of \"food Johnson ;\1cd1cmeat Camden. Dr. Praucr has two children, Chtusen, age IO, and David, age 6. Michael Row land (M'75) • is president clelt of the North of the Chapter Carolina Amcncan College of Surgeom and was also clccced into of the ~orth membcr,hip Carolina ':,urg1calA"oc1ation, a group limited to a maximum membcr,hip of 100,urgcons. Dr. as chair• Rowland currently scrv<.-s Commmee man of the Cancer and Outr, atienc Commmee at Hospnal. Regional ~loJre Pinehurst, N.C. Na n cy H .• ie lsc n (M '76) • a 'fX"(talisc111 internal ml-dicincand infcccious d1sc3ses, is the new president of the ;\icd1cal Societv of the Countv of Eric She is the first woman 10 lead the organtza1 'on in 1t, 165-vear history. Kev in C. Gree nidg e (M'77 ) • 1s currently an associate professor of clinical ophchalmologv at the ~e\~ York Medical College and lhtef of the Department of Ophthalmologv and director of EARLY Wlt-:TER JQ8Q �Classnotes & Deaths 36 from che NIH in support of my research on hepatic glucose metabolism. Paula and I now have cwo children, Isaiah, 8, and Steven, 3." He served four years in the U.S. Army, entering as lieutenant and bemg discharged as major. He spent 28 years as an instructor for surgical technicians and served with the 96th Field Hospital in India and China. Walter R. Siemien (M'80) • of Winter Park, Fla., is certified hv che American Board of Plastic Surgery. Thoma s J. Sy racuse (M'33) • James F. Twist (M 'SO) • has moved his office for the practice to 2156 of ophthalmology Sheridan Dr., Kenmore, 1'!.Y. Nancy H. Nielsen '76 Jack Hajjar '85 D eni se M. Goo dman (M'83) • glaucoma services ac Metropolitan Hospital Cencer in New York. He recently had a book chapter, "Head Pain Associated with the Eye,"published in Managemencof Facial, Head and Neck Pam, published by W.B. Saunders Company, Philadelphia, 1989. wrnes, "After completing pediatrics at CHMC Cincinnati and a critical care fellowship in Pittsburgh, I am now assistant professor of pediatric critical care at the University of Minnesota, and I practice at the University Hospical." Jo n ath an H. Woo dcoc k (M '77) • has been appointed Eri c P. W ittkug el (M' 83) • has completed his training in pediatrics, anesthesiology, pediatric ancschesiology, and cncical care at che University of Pennsylvania and the Children's Hospital of Philadelphia. He is currently an assistant professor of clinical anesthesiology and pcdiamcs at the University ofCincinnaci and the Cincinnati Children's Hospital. medical director and clinical leader of the Neurobchavioral Inscicuceof che Rockies in Louisville, Colo. Roge r Kaiser (M'7 9) • has been named clinic:JI director of anesthesiology at the Eric Coun• ty Medical Center. 1980's Eric Ten Broc k (M'SO) • has been appointed director of Pulmonary Funccion and Blood Gas at Buffalo General Hospital. He is also director of the Medical Intensive Care Unit at BGH and assistant professor of medicine for the Division of Pulmonary and Critical Care at UB. Robe rt Sha lwitz (M'SO) • of Creve Coeur, Mo. writes, "I was recently awarded a FIRST grant EARLYWINTER1989 Jack Hajjar (M'85) • writes, "On Dec. 13, 1988, I left for the earchquake-devascaced region in Soviec Armenia wich an ICU team from Montefiore Medical Center (where I am doing my fellowship in anesthesia) sponsored by the State Department. The team participated in rescue efforts and worked at the Republic Hospital, the largest in Soviet Armenia. We equipped their ICU with $1 million worth of equipment donated by several industries." He went back to Armenia in April co scare a longterm training and exchange program in order to establish a fully equipped ICU Departmenc at the Republic Hospital. a member of the UB Athletic Hall of Fame, died Feb. 26. He was 79. As an undergraduate at UB, he was a member of the undefeated 1930-31basketball team. He lacer cook up golf, winning the Erie County Medical Society championship. Three years ago, he retired after practicing medicine for more than 50 years. Syracuse was a member of the UB Bison Head Society and Erie County Medical Society. Abrah am S. Lem:ner (M '41) • Deaths Marvin A. Bloc k (M'25) • a retired clinical assistant professor of medicine at UB who was a pioneer in persuading physicians to treat alcoholism as a disease, died Feb.28 in Buffalo at the age of 86. Block wrote widely on alcohol abuse and addressed groups throughout the world. His efforts led co the 1956 vote by the AMA House of Delegates co declare alcoholism an "illness" and to urge doctors to treat its "victims." Ronald Walt er Steub e (M' 3 l ) • died July 9, in Naples, Fla. Jo hn Ca lvin Inman (M '33) • died July I, 1989. He was on the staff of Mercy Hospital, Lake City, Md., for 40 years, serving as chief of surgery and chief of staff. died in June 1989 of heart failure. He served in World War II from 1942 to 1946 as a lieutenant commander, MCUSNR in the Pacific Theater. first as a Seahce, then aboard LSTs. He received eight major campaign scars and a Purple Heare. He was adjunct professor of clinical psychiatry at the Dartmouth Medical School, a member of the psychiatric staff at Mc. Ascucney Hospital and Health Center and served on the Commiccec on Aging of the Vermont Scace Medical Society. In addinon to his pnvate practice in psychiatry, he devoted suhscantial voluntary time locally and nationally to the growth and development of psychiatry. A pioneer in methods of outpatient care and the treatment of psychosomatic illnesses, Lenzner was a Life Fellow of the American Psychiatric Association. BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST ��~oo-Prof1 Ori; L, Po.ta Buffalo Physic ian & Biomedica l Scientist PAID Buffalo,NY 1\-rm t =-- lll State Untvers,ty of New York at Buffalo 3435 Main Street Buffalo, New York 14214 Address CorrKtlon Requested 3 581 DR L. MAXWELLLOCKIE 925 DELEWAREAVE BUFFALO NY 142 0 9 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. 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Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/aa8f7d2b89af658c8b73ddbb1e980eae.pdf 37ff1706a44303ab813d74a0693eed5a PDF Text Text Vol. ~J. So. l Autumn 1989 �STAFF EXECUTIVE EDITOR LJJ\:l\'ERSITY Pt..:BLIC"ATIONS Robert T Marlen BUFFALOPHYSICIAN EDITOR Conme Os"ald Stofko ART DIRECTDR Al J. 1-:e er ADVISORY BOARD Dr. John :\aught• · . mnan Dr Harold llroJ,, !\Is. :--;ancy Gh..-co Dr. James Kanska Dr )o<cph L. 1-:un: Dr Charles Pagane1!1 !1,1r.Paul D. Pat«scn Dr Antoinette Pecers Dr. Charles Pru<1 Dr. Lu, her Robon;,:,n Dr. Thomas Rosenthal Dr. Saleda Surcsh Or. Burtl>rl Smgc-rman Dr. Stephen Spaulding Dr Ndsc,n Torre \1r Edward \Ven:ke Dr J1n ,rr Y,r, WRITERS M ,rk \1.ir ,~ [; [)· J !1,1.';urllcrman ILLUSTRATOR L H. PHOTOGRAPHERS ~ancr J. Paroso DearAlumniandSupporters of the UBmedicalschool: T he 1933-39 academic year was a stellar one for the school's faculty \'i,'c were honored that the SUNY Board of Trustee, and the chancellor singled ouc three faculty memhcrs for special recognition. Dr. Leon Farh1, professor and chairman of phys1ology, was awarded the title of Oiscmgu1shed Professor. This is pcrhap, the most ~igrnficant award char can be given to a SUNY facultv member since its bestowmenc indicates significant achievement in all phases of academic life and extraordinary evaluatiom by peers world-wide. Dr. Murray Ettinger, profc,sor of h1ochemistry, wa, awarded a Discmgutshed Teaching Professorship. :\1urray, an accomplished academician in all re,pe..:ts, has always excelled as a dedicated teacher of medical, dental, and graduate students. His LOmm1rmcnc to teaching is well known and he is fully deserving of thb spcual rccogmrion. The third farnlty mcmher, Dr. Charle, Severin, assoLiatc profc,,or of anatomical science,, was awarded the ChanLellor\ \fedal for excellence in reaching. Chuck Severin has provided superb leadership smce coming to Buffalo, and together with Dr. Farh1 and Dr. Ettinger, is alway, regarded a, among the ,crongest of the fine cadre of teachers and cducators we have in the medkal school. I am sure chat ca..:hof you Join me m congratulating cl1L-se three fo.:ulcymemhcrs 111their indindual and colk'Cnve accomplishments, and in rendering our thanks for their efforts on the schtx)l's hchalt. Simon Tong Bob\\ 1,n___, Li TEACHING HOSPITALS A'SD LIAISO!'.S Bauv.a \r.:•.:r.i.:~ Adm:. -·r . \ 1ed,cnl Center Buffalo General Hosp1tal, M,l, \hau John Naughton, M.D. Vice Pro~sulenr 1nr Clmical Affain Dean, S.hool of .\lediunr and Riomedical \cienc·cs Buffalo Veterans AJmm1strauon !\1cJ,cal Center, John Po,ll, ( h!Jrt·n's Hospotal, Karrn Dr,Ju \u oenk Enc Count-,: \1cd1Cal( t1.c1.:•". \!anon \forwnousb !\lerq Hos~,11al,Ch,.,k Tele«o \l,llard hllmorc Hc,spn ,!, Debo-rahFenn Roswell Park !\1cmoroal lnsraute, Jud,Ru., S1,1ers Hosp11al,D,-nnrs McC.mll) Pmdw:,db-, rh, Dn mon of l,noi-mm Rela "'"" ,n =ocu,uon u, ch ch.-S..hoolf .\l,,du. nc urul Bo•medocal'i.:1ence,.Stace l nn t'NI) of :\,u )O'fk at B1<jjolo. THE! Bl FFALO PHYSICIA:S: A'\D 810~IEDICAL SCIE:S:T!Sr (U:,PS 5>l•ll601 Summer !OS<), \\,lume '\uml--er 2 P bli-.hc.:dfi\'c umt.~ i.1IJt1ual1v: Spring, ~ummcr, Autumn. Earlv \'C.'tnt(!'r, :id L.::ttl• \Xm«r h 1he School oi !l,l,d,une and B1omc.~1cal X1cnces, State l mvcrstty vf ~""' Y.1rkat Buffalo. IH> !\hon S1ree1, Buffalo, ~c"' fork 14214.Third das 1"ulk rosu~e paid at B"ffalo, :--.;ev. York. Send address changes 10 THE BlA'fAIJ..) PHYSICIA'\ A:--.;D BI0!\1EDICAL SCIE:--.;TJ$T,140 CFS. AJJ,1,on, HJ5 !\bm Sir«c Buffalo. New )c,.k 14214 n. Dear FellowAlumni/Alumnae: T he first D1stingu1,hcd Alum nu., ha, hcen chosen hv che Ad Hoc Commim:c for l9SQ, The m1ard will be presented co Dr. Gt•orge \\'. Thorn, cerrnmly a worthy cho1Ce of one whose ,ntcrnanonal reputation ha, brought muLh h,mor to our medical ,,hool. \X'carc msmuting a program for alumni mtcnicws of pm,pcctlve candidates for medical school admission in distant cities, designed for students who find it difficult to come to Buffalo for their 1nterv1e11.\\'ould you be interested in bcmg of ,ervice in vour cit\, 1fsuch a situation arises? f.:indly contact Dr. John Richert at the Alumnt Offi.:e. \\'c would be most grateful for your help. Please mark Apnl 28, 1990 nn your calendar for next vcar\ Spring Clinical Dav and Alumni Reunion \X'i:ckend. Weare planning a great smnulacmg program. :\-1orc about chis later. Through your support, we ha,·e reached an all-ume mcmbcr• ship high ,,f 1,474 ducs-paying mcmhcrs, mcluding 53 Life \kmbcr ,uhscrihers. It is an honor to serve you as president for the 1939-1990term. Please contact us with any problems or suggestions you may have. ~ ~ 0' - Sia.~,,,, Joseph L. Kunz, M.D. President �BUFFAID \ ol. 21, ~ o. 3 PW-§!~l6N l Autumn 19t!9 Features II ~ ~r/4 The history of trauma care, Page 18 IJ Notjustbecauseit's there.Growing up in the shadow of the Alb orz Mountains in Tehran, Fero Sadeghian, M.0., developed an early interest in mountain climbing that lasted throughout his adult years. He climb s not "just because it's there;' but because of the challenge. "It becomes us against the mountain." His mo st recent challenge: the remote and trea cherous east face of Mt. Everest . Likerubbingsnowon frost bite. A popular treatment for "acute mountain sickness" may actually make matters worse, according to John Krasney, professor of physiology at UB. We'renot hurtinganimals.The scientific community must come together and convey this message to the public: we're not hurting animals, we're saving human lives, medical researchers are told at a campus conference. Mountain medicine, Page 10 Departments MedicalSchool News. From rags to stitches: John Border gives a history of trauma care in the 1989 Stockton Kimball Lecture. School graduates its 143rd class. Pull out all the stops in treating patients, a noted pediatri c surgeon advises. 143rd commencement, Page 20 ■ Specialsection. Meet the Class of 1993 - a directory of this year's incoming class begins after page 24. Thi s year's reunion classes generously pledgFDedAlumni. a total of $102,220. All IOclasses sat for portraits that are featured on pages 26-29. Mountain cl1mbmg, Page 2 �2 Fero Sadeghian to mountain the beauty By MARK is drawn climbing by & challenge MARABELLA up in the shadow of the Alborz Mountains in Tehran, Fero Sadeghian, M.D., 53, developed an early interest in mountain climbing that lasted throughout his adult years. Sadeghian, a clinical assistant professor of surgery at UB, has climbed the Alborz Mountains in Iran, Mont Blanc in France, Kilimanjaroin Africa, Growing AUTUMN IQ89 ~.- the Andes in South America, and even a small peak on the southwest face of the legendary Mount Everest - the highest mountain in the world. Unnamed peak In Himalaya chain. However, Sadeghian's highest and BUFFALO PHYSICIAl-: Al-:D BIOMEDICAL SCIEl-:TIST �most exciting climb u·as in Ma)·, 1988, when he revmted Eierest and climbed its remote and treacherouseast face. There, completelyby chance,he met up with another smaller expedition that BUl+Al.O PHYSICIAN AND lllOMl·DICAI. 5'( ll:1'TIST u·as one of only tu:oexpeditions in his, tor)' to reach Everest'ssummit by way of the eastface. Sadeghian'smedicalex, pcrtise played a key role in the safe return of these historic climbers. Photos: Fero Sade&hlan ,\l l l \11" 1•1~<1 �(From top to bottom) Potala, The once the home of the Dalai lama; climbers three the drove days before transferrin g equipment to yaks ; frostbitten foot of a member of the Americ a n / British expedition a a . a • wile Sadeghian himself did nor set out to attain Everest's summit of 29,028 feet, he trekked ro the h ighest altitude in his climbing career-22,000 feet . Th e callesr peaks Sadeghian had previously visited ranged from 15,000 to 19,500 feet. (The Hima layas are so high chat peaks be low 24,000 feet don't even gee named there .) "To attempt the peak of Everest, a climber must devote a great deal of time co its pur:-uit . It may even be the culmination of a lifetime of preparation;· Sadeghian asserted . "I wish I cou ld make an actcmpt, but I'm a surgeon by profession and find it difficult co make time for ~uch a \'Cnture. Bl FFALO PHY:c-lCIA:S: A'D Bl0~1EDICAL SCIE:S:TIST �5 "Bue still, I've always found mountain climbing co be an exhi larating way co recharge one's batterv from the day-to-day monotony that everyone muse endure;' he observed. "The attraction is not merely because 'It is there'. The mountain attracts a certain breed of people those who seek natural beauty chat is both isolating and challenging. There is a unifying camaraderie among mountain climbers that transcends race, religion, and politics . le becomes us against the mountain ." Certainly, Everest - called Chomolungma hy the locals, meaning "Goddess Mocher of the Earth" BL"FFAL.0PHYSICIA:-.:A:--:O BI0:'-1EDICAL SCIE:-;TJST - represents what Sadeghian seeks in his mountain pilgrimages. Everest separates Nepal from Tihet and has three faces: north, cast, and southwest. The southwest face can be seen from Nepal and is the conventional way of climbing Everest . This face was the first path co the summit con4ucred by the New Zcalander Sir Edmund Hillary, with the Tibetan Sherpa, Tenzing Norgay, in 1953. In 1975, Sadeghian climbed co Everest's southwc!:>t base camp with a small group t h at inc.lude<l two other individuals from UB's medical school - David Greene, M .D., professor emeritus Members of Sadeghi a n's group with members of the American /Brit­ ish expedition. Sadeghlan is third from right. no ace• �of medicine, and Winfield Butsch, M.D., clinical professor emeritus of surgery. Sadeghian always dreamed of one day revisiting Everest. "On my previous climb of Everest my group went through Nepal (where the southwest face base camp is located). But this route has become coo commercialized, busy, and Lrowded," he recalled. The north and case faces are approachable only through Tibet and attempts along chese routes have been scarce. "The cast face base camp in Tibet is more remote and less traveled and I always wanted to sec Tibet," Sadeghian said. "fur many decades the ease face was closed because of poor political conditions in Tibet due to its relations with the Chinese; now with what has recentlv happened in China it is unlikely anyone will be climbing there for some time to come:' The east face provides a significant challenge because it takes days of trekking over high passes to reach its isolated base camp. Sadeghian's month-long trip co Tibet, highlighted by his three-week ascent on Everest's case face, was the culmination of many months of preparation. Sadeghian first contacted the Mountain Travel organi:arion m Albany, Calif., eight months before rhe trip to express his interest in dimbing Everest. The organization then assembled a group of nine climbers who expressed the same interest, secured the necessary mountain climbing permits from the Chinese government, and provided the group with the supplies needed to trek in the Himalayas. All expenses were paid by the climbers. Six months before the climb, Sadcghian started a rigorous workout schedule running six miles, four times a week, with aerobic exercises in between, to im:rease his !'-trengrh and stamina for the challenge of Everest. Sadeghian was appointed the phy~ician for the group and was responsible for carrving antibiotics, sutures, bandages, pain medicine (morphine and Demerol), intravenous and ~urg1calequipment, and a supply of oxygen. He was 101ned by his friend, Nas Efrckhar, M.D., an orthopaedk surgeon at Columbia University. The group of nine was forrunate because it is rare to have two doctors on such a small expedition. 6 Sadeghian and Eftekhar fle\\ into Beijing, China, where they mer the other people with whom they would spend the next four weeb. The appointed leader of the climb was Bruce Klepinger, a full-ume mountaineer. Other members of the group included SI-year-old Jeffrey Davis from Canada; 47-year-old Steven Ncgler, a retired U.S. Air Force officer from Urah; 57-year-old Peter Anson from Minneapolis; 32-year-old Minnie Chin from California, and John and Carol Goodman, AUTUMI\ IY84 married and in their early 20s, from Texas. From Beijing, the climbers spent several days driving over narrow dirt roads along steep valleys and climbing up 17,000-foot passes before they reached Shigacse, the Tibetan town located closest to the east face of Everest. There they transferred their equipment from their truck and three jeeps onto the backs of 17 yaks. Each yak was loaded with approximately 150 to 200 pounds of equipment. The equipment included five double tents, three larger rents, gas-burning stoves and lanterns, and plenty of canned food. Here they were joined by five Sherpas who were in charge of the yaks. Sherpas are Himalayan residents who, due to their climbing experience, are hired to carry supplies and assist rhe climbers on their trek. The group was also joined by several Chinese who were hired co cook, guide, and maintain an established base camp. The mix of the English, Chinese, and Tibetan languages proved cumbersome. The translator for rhe Tibetans was Mr. Chin, a well-respected mountaineer who had been a member of a Chinese expedition to Everest and had lose part of his nose and right hand to frostbite. Another man, named Mr. Jin, translated for the English-speaking climbers. To communicate with the Tibetan yak drivers, the climbers spoke m English co Mr. Jin, who spoke Chinese to Mr. Chin, who spoke Tibetan to the yak drivers. The group traveled by yak for nine days and set up a base camp. Then, carrying 35-pound day packs, they set out to ascend Kangshung Glacier. Climbing along lateral moraines, where an immense glacier had deposited large amounts of rock and debris from its gradual movement down the moumian, Sadeghian and the others could see and hear the thunderous avalanches of the east face. The cast face of Everest is accessible only through the Kama Valley, near Shigatse, which is ,urrounded by mountain passes averaging 18,000 feet. The terrain varies significantly. At lower almudes, it's lush green dotted with wild roses, rail poinsettia bushes, and turquoise lakes. However, the terrain near the passes is cold. barren, and snow covered. When they had climbed to approximately 20,000 feet, the group split up. Five of the climbers, who chose to rest their weary lungs and muscles, visited a base camp char was established for the group that reached the cop. Sadeghian and three others continued climbing until they reached a rocky spur at 22,000 feet. Herc Sadeghian's small group rested for some rime and gazed at the impressive Everest, raking rare photos from che ease face. BCFFALO PHYSICIAK Al\D BIOMEDICAL SCIE:-.:TIST �7 l \ " "These mountain climbing trips always bring tremendous pleasure for me," Sadeghian reflected with a smile. "Not only is the natural scenery and landscape unparalleled, but the variety of people one meets is always so diverse. "During the day we share the dangers, frustrations, and unpredictabilities of the climb," he continued, "and at night around the fire we discuss the day's events and plan the next day's goals. This is the best part of the trip because it brings everyone together like a family." Meanwhile, the other half of Sadeghian's group at the American/British base camp discovered several climbers who were in desperately feeble condition. "What happened was that these climbers got stuck near the top without oxygen, food, or tents," explained Sadeghian. "They were unable to return to their base camp at first because the weather and their weakened reflexes prevented a speedy descent~ Returning from the small peak, Sadeghian's group joined the other climbers at the American/British base camp. It was here that Sadeghian first met the American/British group that managed co put one man on the top without rhe use of oxygen. Only 15 individuals have ever managed to go to the top without oxygen and none before had accomBUFFAI.D PHYSICIAN AND BIOMEDICAL SCIENTIST (From top to bottom) Sadeghian and companions received warm welcomes from natives; Sadeghlan in front of Rongbuk monastery near the north face of Everest; Camp Frost on the way to Everest. a es a s a AUTUMN l'l!\9 �8 (Top) Framed against the Himalayan peaks, the 1,000 •room Potala r ises 1,000 feet above the valley and can be se e n for miles; (bottom ) Sadeghi an watches drivers dinner . yak cook plished ic from che treacherous Getting to the Everest summit face had been accomplished only \\'as done by an American group \'arJ in 1983. east face. by way of the east once before. That led by Andy Har- In chc 1988 attempt, the man who reached the top, Stc\'C Venables of Britain, made headlines across Europe as the first European to reach rhe summit from the cast face. And he accomplished his feat on the 35th anniversary of Hillary's ascent. But the attempt was not without its coses. All of the climbers suffered frostbite to a \'arving degree. One of them, Ed Webster, described his group's traumatic events in a Januarv 1989 Sportsllluscraied arricle. \X'cbster was malnourished, extremely dehydrated, dcmorali:cd, and consramly in tears. He was abo suffering from severe frostbite with black toes and fingers . Another climber, Robert Anderson, was also suffering from frostbite on his fingers and toes, but co a lesser degree. Venables, who reached the top, suffered severe frostbice on his toes and nose. For several hours, Sadcghian and Eftekhar cared the best they could for the climbers' injuries, us- ing medications and bandages chat Sadeghian was rnrrying on his back. "\X'hac they really needed more than anything else;• explained Sadeghian, "were some words of reassuran<.e and some idea as to what to expect as far as prognosis was concerned. At the time, I choughc chac they mighc lose portions of their fingers, toes, and nose, buc I tried co remain as positive as I possibly could." Both Webscer and Venables had to be carried down the rest of the mountain by cheir Sherpas on improvised litters. \X1hen they returned to the BLFFAI.() PHYSICIA;\ A:S:D 810.\tEDICAL SCIE:--:TIST �(Top to bottom) Tibetans friendly are and maintain serene a nature ; 9 two Sherpa children whom the climbers encountered in the T ibetan / Everest region; John Goodman (foreground) Sadeghian the foothills and In of the Himalayas. ed very little, if any, medical treatment. Only a few of the climbers suffered from cerebral edema and required some oxygen, which is no rmal." Sadeghian and his group returned safely down the mountain, hiking over to the north face upon their descent. From the north face the group traveled to Nepal, abandoning their yaks for some wheels before eventually flying back ro the States . One precious souvenir that Sadeghian brought back from h is trek on Everest was a note, written by Miriam Zieman, the medica l advisor from the American/British camp. It was sent to Sadeghian's camp via a Chinese runner and gave thanks for the surgeon's treatment . "May 20t h- 8:00 p.m. - Everest base ca mp " "Endless thanks for your support and encouragement today . It was quite an unbelievable vision to see your companions this morning after three months of isolated company, but to find out that two surgeons were on thei r way down (from a peak just above our base camp) was very reassuring for both the climbers and myself. "It was very gene rous of you to help and advise me. T he past few days were exasperating and it was a great relief for me to have you here . Needless to say, the climbers enjoyed your care and expertise and felt better after your consulta tion." United States, Webster had ro have all the fingertips on his left hand amputated, as well as three on his right hand and pares of three roes on his left foot. Venables lost three and a half toes on his left foot . "Fortunately," noted Sadeghian, "my group need- BUFFALO PHYSICIA1' AND BIOMEDICAL SCIENTIST "One thing I enjoy about being a physician," Sadcghian commenced, "is that, regardless of politics or language barriers, doctors are always well received by people . Closed doors always are opened for physicians." • ALJfUMN 1989 ��LIKE RUBBING SNOW FRO! i I BITE ~ ~ ON By CONNIE OSWALD S1DFKO ike rubbing snow on frostbite, a popular treatment for "acute mountain sickness" may actually make matters worse, according to John Krasney, Ph.D., professor of physiology at UB. Acute mouncain sickness affects lowlanders who travel to high altitudes where the air is thinner. "The symptoms are terrible," said Krasney, who suffered from the condition when he attended a conference in Snowmass, Col., which is 11,000feet above sea level. Acute mountain sickness is marked by a severe headache, along with nausea, irritability, lethargy, severe fatigue, and trouble eating and sleeping. In the past few years, mountaineers have been teaching climbers to treat the condition by breathing into a paper bag . But that makes matters worse and could actually prove lethal, Krasney contends . His findings are important as more and more people ski and hike at high altitudes. Bur, Krasney emphasized, his research also has implications for peop le with heart and lung diseases that inhibit oxygen intake. The idea of breathing into a paper bag has been promoted by neurologist Marcus Raichle of Washington University in St. Louis. Both Raichle and Krasney agree that the trigger for acute mountain sickness is a decrease in the oxygen supply to the b rain. Raichle contends that breathing into a paper bag increases the person's intake of carbon dioxide, which dilates (widens) the blood vessels in the brain. That allows more blood flow, and therefore, more oxygen, to reach the brain. But this dilation of blood vessels is the problem, not a solution, Krasney explained in a paper presented earlier this year during a symposium sponsored by the International Society for Mountain Medicine in Lake Louise, Alberta . ILLU Bl.:FFALO PHYSICIAN AND BIOMEDICAL SCIENTIST S TRATION S: LI SA H A N EY II �THE MESSAGE FOR PERSONS PLANNING This dilation of blood vessels in the brain ele,·ates pressure in the capillaries (the tiny blood 12 vessels that connect larger blood vessels to tissues). That causes a mild form of high altitude cerebral edema - the brain tissues fill with fluid. "Our data says there's already roo much vasodilation" caused by rhe low oxygen level at high altitude, Krasney explained. "If you increase carbon dioxide, you make the situation worse. "Normally, when you go to a high altitude, you hyperventilate. You bring in more oxygen and exhale more carbon dioxide. Thar's a normal response. And we think that has something to do with the eventual resolution of mountain sickness - we think it's the decline of carbon dioxide'.' Krasney says he's upset that Raichlc didn't publish his data in scientific journals before his theory was presented in lay magazines such as Discover. "I think it's a good example of something that could be very dangerous getting into the popular literature." Krasncy said. While acute mountain sickness is a condition that has plagued man for centuries (Marco Polo described traveling over the "Big Headache Mountains" in China), we haven't made much progress in treating it. Theoretically, administering oxygen should help, but it doesn't help immediately, Krasney noted. One option is to simply let the condition run its course. Without treatment, most people recover from acute mountain sickness in a few days or weeks as they become acclimati:cd to the high altitude. However, the condition can develop into a lethal form of high altitude cerebral edema or high altitude pulmonary edema. Then the only thing that can be done is to get the patient to a lower altitude. One treatment that mountaineers arc trying now is the Gamow Bag, named after Igor Gamow of the University of Colorado. The patient's entire body from head co toe is placed in the portable fabric bag, making him resemble a mummy. Then the bag is inflated using a foot pump. Thar increases the pressure in the bag, which increases the oxygen saturation. In many cases, the oxygen saturation is increased enough to begin resolving the edema, Krasney said. It's easier to prevent acute mountain sickness than to treat it. The symptoms are brought on by the failure of people to acclimatize themselves properly to high altitudes, Krasney explained. Once a person reache~ 10,000 feet, he should take a full day to ascend another 3,000 feet. AL'Tl,MN ICl8Q GO TO TO HIGH ALTITUOES IS THAT THEY SHOULOTAKE CARE TO ACCLIMATIZE PROPERLY ANO GO SLOWLY. UP (By comparison, skiing areas in Western New York arc only about 900 feet above sea level.) The minimum altitude to get acute mountain sickness is 8,000 feet - that's the height of Mexico City. The condition can be lethal at 9,000 feet, Krasney noted. Some people with underlying lung problems could probably experience symptoms in Denver, which is only a mile high. He also pointed our that the cabin in a jet aircraft isn't pressuri:ed to sea level, only to the equivalent of 7,000 or 8,000 feet. So passengers arc mildly hypoxic, that is, their tissues aren't getting enough oxygen. "So if you get a headache flying from Buffalo to California, there might be more reasons for 1t than the wine you drank;' Krasney said. "Thar's another aspect - acute mountain sickness or hypoxia can really intensify the effects of alcohol. If skiers make the bar the first stop, they can be quite violencly ill." Exercise can also exacerbate the condition, Krasney and his colleagues believe, because circulation is severely altered at high altitudes. As blood pressure goes up, it may produce an undesirable increa~e in brain blood flow, which causes a marked elevation of pressure in capillaries. Thar can cause a rupture in the blood-brain barrier. "The message for persons contemplating going to high altitudes is char they should rake care to acclimatize properly and go up slowly; Krasney said. "If they can't, they should certainly take ir easy for the first few days at altitude." Certain drugs to prevent acute mountain sickness can be taken before traveling to a high altitude. The standard drug is acctazoleamide, which is distributed under the brand name Oiamox, Krasney explained. Ir works well if taken four to five days before going ro a high altitude, and helps to a variable extent after symproms have developed. "No one has any idea how Oiamox works; he added. Another drug, a steroid called dexamethosone, can also be effective when used prophylaccically. The problem with dexamethosone is chat if you lose your pills or stop raking chem, the symptoms of acute mountain sickness can be amplified in a nasty way. How these drugs work and what ocher therapies could he useful are other areas the UB researchers wane to investigate. "Clearly, anything we develop here is going to have tremendous benefits for people with lung disease who suffer from oxygen lack at sea level; Krasney said. BL,FFALD PHYSICIAJ\. A1'D BIOMEDICAL SCIE:-..TJST .. �TMIS KINOOF RESEARCH FALLS UNCER A BRANCH OF MEDICINE .. CALLEO 'MOUNTAIN MEOICINEt THAT ONLY FIVE YEARS CLO. his kind of research falls under a branch of medicine called "mountain medicine" chat's only about five years old, Krasney said. It looks ac physiological problems caused by high altitude. Krasney performed his research with Douglas Curran-Everett, who was a Ph.D. student at UB and is now at the University of Colorado, and Jun Iwamoto, M.D., Ph.D., a Japanese neonatologisc who is working at UB on a Buswell Fellowship. Iwamoto is from the University of Occupational and Environmental Health in Kitakyushu, which has become one of UB's sister institutions. The reseachers conducted a fairly simple experiment. Sheep were placed in a low-oxygen chamber for four days, which produces the effects of being at high altitude - comparable to about 15,000feet. The real stress of being at high altitudes is the lack of oxygen, not the low pressure, Krasney believes, so using a cumbersome low-pressure chamber with air locks isn't necessary. This experiment lasted much longer than those conducted by ocher researchers which subjected animals or people to low oxygen levels for only an hour or two. The longer time span enabled the UB researchers to better follow che course of the sickness, which generally cakes a few hours co develop, Krasney noted. In the experiment, the researchers used radiolabeled microsphercs - tiny plastic beads only IS microns in diameter. These beads were injected into the left ventricle of the sheep's heart where they mixed with the blood and were d1stributec.l throughout the body in proportion to [i BvFFALO PHYSICIAN AND BIOMEDICAL SCIEl'-'TlST IS ABOUT the blood flow. This is a very high-resolution indicator of the blood flow co a region, in this case, the brain. "In fact, radiolabeled microsphem, have become the 'gold standard' for the measurement of cerebral blood flow,"Krasney explained. "This is the method against which everybody judges the more indirect clinical methods." After four days, the sheep brain was removed and studied. The researchers found signs of cerebral edema. "It appears that edema 1smore prominent in the white matter, but we don't know why; Krasney added. Now that they've studied high altitude cerebral edema, the investigators plan to look at the related problem of high altitude pulmonary edema, where the lung tissue fills with water. The UB researchers also plan to continue collaborations with researcher,. in other parts of the country. They've worked with a group of Army per· sonnel at Triplcr Medical Center in Hawaii who have a lab at 14,000feet on Mauna Kea, an extinct volcano that offers the only snow skiing in Hawaii. The Army is interested in acute mountain sickness because when two armies are fighting at high altitudes, the one that gets acute mountain sickness is the one that loses, Krasney pointed out. Much of the clinical data we have today came from the 1967 Indian-Chinese War. The sickness devastated the Chinese Army during battles in Tiber. Krasney also has startcJ a collaboration with Peter Hackett, M.D., of Anchorage. An emergency critical care physician and a mountain climber, Hackett was one of the two physicians who attained the summit of Mount Everest in 1981with the American Medical Research Expedition. Hackett has established a laboratory at 14,000 feet on the west buttress of Mount McKinley or Denali, which they prefer to call it. "It's probably one of the more hostile environments on che planer;• Krasney noted. Crevasses suddenly open up and people disappear. Hackett and his colleagues have sec up an emergency aid station during the climbing season. Climbing has become so popular, probably 1,000 climbers a year try to get to the summit. A great number will get quite ill and have to be treated or evacuated. They've been able to try some innovative therapies - the climbers are not only ill, but they make very useful research subjects, Krasney pointed out. Control stuJics done at sea level in Buffalo will AUTUMN l'l!N 13 �be coupled with high-altitude studies on Denali, 1-l which has a very well equipped laboratory. This winter, Krasney will cake a course in ice climbing and winter mountaineering in order co go up on the mountain himself. "My interest is co work with the human patients who are suffering from acute mountain sickness and high altitude cerebral edema. I wane to gee some further insights co cake back co the laboratory and attempt to work out the more fundamental issues in experimental animals," Krasney said. "Ir's a nice example of how we can go back and forth from the experimental animal laboratory to the field situation where people arc actually suffering." • Environmental Research Unites The Several Disciplines in Physiology //'An interest in abnormal environments unites the different disciplines in the Department of Physiology," said Leon Farhi, M.D., distinguished professor and chairman of physiology. "Environmental research has always been the core of the department." The researchers wane to know how biological systems reacr co extremes in gravity, temperature, air pressure, and gas density. This research is applied to a wide range of interests, including circulatory and lung disease in newborns, space travel, and deep sea diving. The work goes back co World War II and the respiratory studies of Hermann Rahn, distinguished professor of physiology who is known as one of the fathers of aerospace medicine. He and his colleagues clamped themselves into low-pressure chambers to conduce experiments that had direct application to fighter pilots. "Almost the entire subject of respiratory physiology came out of chose very early studies," noted John Krasney, Ph.D., professor of physiology at UB. "So, in a way, we're still studying things that Dr. Rahn began investigating 40 years ago." In the 1960s, UB was selecred as the site for a federal center of excellence in special environments. The government decided to set up a number of these centers in varied fields such as biology, linguistics, and mathematics. Ir grew out of a desire co enhance the country's research potential in case of an emergency, said Farhi. The government had learned a lesson during AUTUM:--:198Q World War 11,he explained. When the military had co land troops in North Africa, it was discovered that nobody knew how the desert affects humans, nor did anyone know where to find the experts who could study the problem. The centers of excellence were set up with no specific mission - they would simply be available if needed. Teamwork was co be a key element of the centers and UB had already assembled experts in altitude and gravity, temperature regulation, diving, and other fields. With the center "we got a nice pot of money for equipment," Farhi added. "It paid for the big BLiFFALOPHYSICIA:>:A:>:DBIOMEDICALSCIE:>:TIST �ments ar UB came in 1985 when rhe University established an interdisciplinary research center. The Center for Research in Special Environments serves as a resource for researchers in academia and industry who need equipment, technical support, and access ro scientists in environmental physiology and human engineering, explained Claes Lundgren, M.D., Ph.D., professor of physiology and director of the center. "Imagine how difficult it would be if a researcher needed to conduct an experiment with a highgravity load and didn't have rhe equipment," said Lundgren. Nor many agencies are willing ro give a grant for a $5 million centrifuge or a $2.5 million pressure chamber, he noted. And who would have the rime co plan and build rhe equipment, then hire and train personnel? "We're here and available; Lundgren said. The maker of a diagnostic device for eye disease is one company that took advantage of the center's services. It had to test the device to ensure it would function at high altitudes, such as in Denver. The center is working on several projects for the aerospace industry, Lundgren said. It's looking at ways to protect crews against high-gravity loads, such as when a plane makes a sharp turn. Another project looks at the body's reaction to explosive decompression, which could occur when a cargo door blows off. Still another project with local industry involves a mathematical model for a pressure regulator valve that has applications for pilots. Other experiments examine ways to prevent .....decompression sickness, better known as "the bends;" how to swim using a minimum of energy, and how to build a better breathing apparatus for §it use underwater or in hostile gaseous environments. To aid this research, UB's equipment has been improved, Lundgren noted. The deans of the schools of medicine and engineering gave a $250,000 grant for a technical upgrading of the saturation diving system that allows people to live in the pressure chamber for extended periods. Through a grant from the medical school, the pool was clad with stainless steel to reduce upkeep. An upgrading of the human centrifuge from a capability of 7G to 9G or more is expected to be completed this fall. "There have been a lot of improvements to the equipment, reflecting the commitment of the University to this unique facility; Lundgren noted.• I j pressure chamber, the human centrifuge, the swimming tank, and lots of lab equipment." The equipment is housed in the Hermann Rahn Laboratory on UB's South Campus. Once the government provided the equipment, the researchers were on their own to support their research. They've gotten grants from NASA, the Air Force, the Navy, and the National lnstitures of Health. (No classified research may be done at UB.) As well as lab work, field expeditions have been conducted underwater in Korea and Australia, as well as high on mountaintops in the Alps. Another boost to the study of special environ- BL'FFALO PHYSICIAN Als:D BIOMEDICAL SCIENTIST CLAES LUNDGREN DIRECTOR THE FOR IS CF CENTER RESEARCH IN SPECIAL ENVIRON­ MENTS. -B, Connie Oswald Scofko AUTUMN 1989 15 �' l6 ~Y lonni~ ~~wal~ ~rntko he scientific community must band together and convey this message to the public: we're not hurting animals, we're saving human lives. That was one of the points brought out during a day-long $UNY-wide conference on animal rights held at UB in June. The conference was attended by public relations staff, researchers, veterinarians, and administrators from several SUNY campuses and Buffalo hospitals. John Deats, director of public relations at New York University, told the group that when one researcher at NYU was targeted in protest by an animal rights group, the whole university got involved with the matter. At NYU, "we developed a consensus among the faculty: no researcher can stand alone," he said. Deats also emphasized that universities must open their labs - not to animal rights activists, but to representatives of the public, that is, to the media. That suggestion was echoed by Charles (Bud) Middleton, director of the Division of Lab Animal Resources at Stony Brook. It's important to show that the animals are perceiving no pain and that there is a compelling reason for the ~ research, he explained. "But you can't give a partial tour," he warned. "It has to be all or none." The problem with opening all of the labs is that a number of investigators have received death threats, Middleton noted. They fear for their safety and the safety of their families, as well as for the animals and University property. At Cornell, one researcher was the target of months of protests, said Fred Quimby, director of the Center for Research Animals at Cornell. One day she received a phone call ac l a.m. in which an unidentified caller told her char if she didn't drop her research with cats, he would kill her children and kill her. The next morning she dropped her work. Cornell wants to make sure that doesn't happen to one of its researchers again, Quimby said. It has developed a "proactive" faculty committee to stress che point that animal research has greatly benefited both human and animal health. The panel involves representatives from research, teaching, wildlife conservation, and agriculture. "I think this lies at the crux of what we all have to do," he said. "The time of looking at che issues as they relate to our use of animals, with a narrow focus on • AUTUMN 1989 BL'FFALOPHYSICIA:-S A),.;DBIOMEDICALSCIE:-.:TIST �- ~ Q z 0 ::E vi 17 § .i Charles (Bud) Middleton, director of the Division of Lab Animal Resources at Stony Brook, says that it's important to show that the animals are perceiving no pain and that there is a compelling reason for the research. education or research is over. "Standing alone is the way that we're going to be split up and the way that eventually we'll lose this battle. I, for one, feel that we all have the same vested interest and we're all going to approach this in a solidified manner." SUNY is bringing its researchers and administrators together through a new committee on animal research. The purpose of the committee is to share i,deas among campuses on how to protect' the welfare of animals and how to conform to rapidly changing State and federal regulations. One mission of the committee will be to tell the researchers' side of the story - how animal research helps human BUFFALOPHYSICIAN AND BIOMEDIC AL SCIE:S:TI ST welfare. "We're all interested in animal welfare, but that's different than animal rights; explained SUNY Provost Joseph C. Burke. "Animal rights, if carried to an extreme, would make it difficult or impossible to conduct research on animals. Neither our society nor our University can accept that." • AUTCMN JQS9 �Medical Scudencs 18 From Rags to Stitches John Border gives a history of trauma care By DAVID M. SNYDERMAN .000-year-old . mummy was discovered vith an open fracture (where both km and bone are broken). John ~ Border, M.D., pointed out that there were no signs of healing and rhm rhe broken femur was the cause of death. "This is an ancient problem; explained Border, an expert in trauma care. "The results of trauma care were absolutely dreadful. The mortality rate for any significant injury (penetrating wounds of abdomen or chest, or open fracture of the femur) was 50 to 80 per cent. Those who did survhe were permanently disabled. "This began to change for open fractures !are in World War I but did not change for other injuries until the mid '4(}.; and early '50,. "Since rhen the results of care have progressively improved as our knowledge of rhe basic sciences of physiology, biochemistry, and cell biology has improved." Border is a professor of surgery and orthopaedics and a research professor of biophysics at UB. As the recipient of la,t year's Stockton Kimball Award, he delivered the 1989 Stockton Kimball Lecture ac rhe annual faculty meeting this spring. He acquainted his audience with ~ome of the historical developments in trauma care. Border knows of these improvements firsthand because he has played a large role in developing them. The methods that Border has pioneered have decreased mortalitv rate, length of hospital stays, and the amount of permanent disability in patients treated in this manner. Referred ro as •one of the fathers of modern trauma surgery," Border is an advocate of aggressive treatment of trauma patients, which includes performing surgery immediately. AUTl.'M1': 198<1 "Ir is quite clear that our old belief that rhe average of 1,819 days; Border said. In addipatient was too sick to he operated on the tion, "70-100per cent had some degree of pernight of the inJury was wrong; Border noted. manent disability and 20 per cent of these "Such patients get sicker with the passage of were so disabled they never worked again." Today, a simple femur fracture usually rime. They do not get better. They need comcauses three to six months of lose \\'Ork and plete surgical care the night of the injury to help them get rapidly better." no significant permanent disability. Border, who is the director of the trauma "This is a dramatic reduction m time even service at Enc Countv Medical Center from rhe '60s and '70s; according ro Border. (ECMC), reccntlv received the Roswell Park owever, as damaging as \\'Ounds were to Medal from rhe Buffalo Surgical Society and soldiers, there was a \\'Orse enemy stalkwas honored by ECMC for his contributions mg the fighters on the field of battle. co trauma care. "The major problem, in all armies, was nor Border drew the material for hi, lecture death from wounds," Border explained. "The from his new book titled Blum :--111/tiplemaJor problem was dcarh from disease. For Trauma: Comprehensite Paihoph,·s1olog;; and every soldier in rhe American Civil War who Care.Ir is a guide ro the understanding and died of wounds, cwo died of disease. These treatment of blunt multiple trauma cases, for were communicable diseases of childhood, rhe instance, auto accidents. diseases of filth, and problems such as H Border said that for hundreds of years up through part of World War I, open fractures were treated by amputation. In fact, the army field hospitals "were usually marked by huge piles of amputated limbs and dead bodies." As a result, he said, rhc hospitals "were usually quite easy to find." The amputations \\'ere performed in under three mmuces and required up ro six strong men to restrain the patient. The military surgt.'OnDominique-Jean Larrey "at the Barrie of Borodino did 200 amputations m 24 hours," Border noted. \Vhen patients managed co keep borh their li\'es and limbs, "they lost years our of work" and , for the most part, "were permanenrlv and severe!y disabled; he said. "According to Lorenz Bohler (a modern surgeon who "'as an expert m the treatment of fractures), prior to World War I a simple femur fracture kept you out of work an malaria." In fact, it was nor until World War I that disease and wounds had similar mortality rates and not until World War II that wounds passed disease as a cause of death. "These ad\'ances depended on vaccination, ~anitation, and antibiorics," he said. Border remarked that poor sanitary practices of the day horh in and our of the hospital helped co aggra\'ate the disease situation. Sanitation was, m fact, one of the primary problems of medical care until rh1s century, Border said. Wounds were washed \\'ith pieces of non-sterile doth rinsed in a communal "pus bucker." "These rags came from an international rag marker, or were discarded linens; Border explained. "They were later found co be a major carrier of bacterial disease from place to place." BL'FFAI.OPHYSICIA:>.A:S:DBIO~IEDICALSCIE:S:TIST �Medical Students 19 Conditions in the operanng room were little better, Border said, giving the example of a Viennese surgeon from the last century. "This is Theodor Billroth operating in Vienna," Border said, explaining a particular shde. "Notice no hats, no gowns, no gloves. The huge audience is breaching on the wound." Many of the improvements in sanicac1on can be traced co Florence Nightingale's reform of hospitals during the last half of che 19th century. The care during the Crimean War was so bad and so well publicized that the Briti,h government hired a group of young women to go with Nightingale - these were the fir,c paid nurses. The mortality rate at the hospital where Nightingale worked during the war dropped from -l2 per cent before she arrived to 2 per cent while she was there. She later repeated thb performance at a second hospital. As a result, Border said, Nightingale is credited as the founder of nursing as a profession. One of her decisions, although seeminglv simple, was extremely important. "An absolutely valuable change here," Border said, "was doing the laundry with hoc water. It was not until much later that ic was proved that laundry with cold water did not change the bacterial content at all, whereas laundry with hot water did." Another invaluable change that Nightingale made ro patient care was an insistence on accurate patient records and statistical summanes of the patient care. "One has to give her credit for creating modern scientifk medicine," Border concluded. "Pnor to Florence Nightingale there were no hospital records." 0 ne of the next great advances in surgery and patient care, Border said, was the use of anesthesia. Anesthesia entered the scene in 1846. "Bue no doctors could make a living ac it, so there were very few doctors who gave anesthesia, and the tradition was chat the surgeon called on whatever docror walked down the hall; Border said. "No measurements were made of vital signs or blood loss and no intravenous fluids were given during surgery. try of both toxins and bacteria? This is an enormous change in viewpoint. Granted, the basic hiology involvL-dapplies co most ~ritically ill patients and not just to the trauma patient." The care of trauma patients, Border said, has improved "primarily because of a large amount of basic science research, which allows us co understand metabolism, cardiopulmonary physiology, the whole thing that goes wrong with the trauma patient." Florence Nightingale: she improt·ed hospital sanitation. "There was no real professional anesthesia until World War II. At chat time, the armb trained and designated anesthetists. "There was another very important change at chis time and chat is that the anesthetiM should nor only be an echcrizer buc a rcsuscicacionisc; he noted. "This required an enormous development in biochemistry and physiology to know whar to do. "John D. Stewart, a former professor and chairman at the department of surgery, made the major contribution co chis advance." The latest and probably greate<\Cadvance in trauma care i, the realization that we were looking at the problem of infection complccely wrong, Border said. To fight infection, stronger and more numerous antibiotics were used. Bue because che critical illness and infections came from toxins and bacteria in the gut, annbiotics actually encouraged infection by destroying beneficial bacteria which kept detrimental bacteria in check. This allowed the detrimen• cal bacteria to multiply and enter the rest of the body. "The annbiotics we administered to treat infection undoubtedly caused infection; explained Border. "The correct way of looking at chis problem is undoubtedly, how do we support growth of the good bacteria in the gut and how do we support the gut mucosa as a barrier to en• BI.JFl'Al.O PHYSICIAN AJ\:D BIOMEDICAL 5CIENTIST Despite public belief to the contrary, Border said, the total cost of health care has accually gone down because modern medical care has been able to get people on their feet and hack to work sooner. This has more than offset increased hospital and doLtor bills. "You have to understand chat, of rhc total cost of accidental injuries today, only some place between 13 and 15 per cent goe,, for doctor and hospital bills; he said. "Eighty-five per cent of the cost is in temporary and permanent disability and death. "Of this, the dominant portion is temporary or permanent disability. This is where the real cost is." He explained that the net effect of all changes in modern care has been to shift coses from the disability/death category inro the hospital care dassiftcation. "The per diem cost has gone up even more rapidly because of the reduction in the length of hospital stay," Border ~aid. "This trend began in the '40s because it resulted in better care. John D. Stewart also contributed to thb advance. "Unfortunately," he continued, "our political leaders look only at hospital costs and do not look at rhe effect of the changes in care (reflected in hospital coses) on the length of temporary disability, the numbers of cases, and degree of permanent disablity or the mortality rate both in and out of the hospital. "The essence of all changes in modern care that have occurred has been to reduce outof-hospital costs by increasing hospital coses~ A, a result, he concluded, the total cost of health care, when both hospital and ouc-ofhospical costs are caken into account, has "dramatically" decreased "in total coses for many dbease problems, including trauma."• AUTUMN 191!9 �Medical Students 20 \ J THEHEADBONEIS CONNECTED TO. . . F or the 143rd time, the University at Buffalo School of Medicine and Biomedical Sciences has injected new physicians into the practice of medicine. On May 21, during a ceremony held in Alumni Arena on the University's North (Amherst) Campus, 140doctor of medicine degrees were conferred, along with 26 Ph.D.s, and six master's degrees. As proud parents and families looked on, the new doctors strolled down the aisle to receive their hoods and diplomas in a ceremony that featured vocal music hv the 0ermatones, an a cappella group of medical students. John Naughton, vice president for clinical affairs and dean of the medical school, commended the graduate, for the concern they showed for a classmate, John Robin, who contracted cancer during the sophomore year and died in September of 1987. The medical students memorialized Robin in their yearbook, the Iris. Robin's untimely death, Naughton said, "was a tragedy that we all felt," and the medical students' compassion toward their classmate "shows that you are ready to become physicians." The class speaker, Paul Lccat, looked back on the four years the new physitians had spent together. "As I look around the room, I can only think of one four-lccter word that I picked up in New Orleans to describe all of you, and chat is 'fine;" Lccat said. The 1989 yearbook, che Iris, was dedicated co the art of medicine. Loriann Fraas and Diane C1cacel10,co-editors, presented a copy of the yearbook to Lilh Sentz, history of medicine librarian. C ommencement speaker Harry L. Metcalf, M.D., former president of the AmerJCan Academy of Family Physicians and associate clinical professor of family medicine, warned students who were leaving Buffalo that "in about two months you will have acute withdrawal symptoms for chicken wings and Bocce pizza." On a more serious note, he left the class with three things to remember. "First and foremost, you owe a very large deht of gratitude to your parents and family,"Metcalf said. "J\.:evcrforget char many years of struggle, support, and sacrifice went into allowing you to realize your dream." He also urged graduate, to support their medical school and to live up to their responsihilities to help their communities. "\'('hen you arc setrled into your career, give something back to the community in which you serve," he urged. "Participate in your specialty organizanons, the PTA, your church or ,ynagogue, or whatever charitable way you <:hoose. But please, don't he Just a taker~ He concluded with a short anatomy lesson. "There's one more thing you can learn about the body that only a non-doctor would cell vou; Metcalf said. "I hope you'll always remember this: The head bone is connected to the heart bone and don't let them come apart." • BlJFFALD PHYSICIAN AND BIOMEDICAL SCIE:S:TJST �Medical Students \ J BlJFFALO PHYSICIA~ AND BIOMEDICAL SCIENTIST AUTUMN 1989 �Medical Students 22 Pull Out All the Stops Go as Far as Possiblein Treating Patients, Advises Noted Pediatric Neurosurgeon By DAVID M. SNYDERMAN P ediatric surgeons who work with brain damaged and potentially brain damaged children face difficult ethical problems, Benjamin Carson, M.D., told a group of medical students recently. "The whole issue becomes one of how much time do you put into the care of individuals like chat?" he asked, advising the future doctors chat they should, wherever possible, "pull out all the scops" in the treatment of their patients. Ca rson, the director of pediatric neurosurgery at Johns Hopkins Medical School, made the comments at UB May 5 in the first annual Progress in Medicine Lecture sponsored by che Student National Medical Associanon. Carson is known for his separation of a pair of Siamese twins. He illustrated some of the ethical questions confronting physicians by detailing case histories. "I remember a case of a young girl - four years old - who had Ix-en hit by an ice cream truck and suffered a very severe head injury," he said. The girl was brought in over the weekend and Carson did nor sec her until Monday morning. He was told chat "the only function she had at chat point was pupillary reacrivicy." However, when he examined her, her pupils were fixed and dilated, implying severe head trauma . He decided to operate. "T-vo weeks later, she was awake, talking, and responding co commands," Carson said AL,TIJMl\ I98Q Benjamin Carson, M.D., gave the first Progress in Medicine Lecture . with a smile. After two more weeks, "she walked home and was neurologically normal." Many people, he noted, would have argued early on char surgery was a waste of resources, chat the girl's case was hopeless , and chat it would be best to just let her die. "If we had done that, we would have lost someone who was subsequemly normal," he said. In another, similar case, a young boy was seriously injured and the mother wished to pull him off che respirator. Carson talked the woman imo allowing him to treat the boy. "We wem ahead with it, and he subsquently walked; the neurosurgeon said. Although the boy did have some neurological impairments, Carson said, che mother was oveqoyed to have her son alive. Then there was the case of a man injured m a car accident . The patient was in control of his mental faculties despite being depen- dent upon a respirator. "He made a request to us bv sign language chat we disconnect the respirator and allow him to die; Carson said. Boch his family and clergyman accempted to calk him out of it, "but no one could convince him otherwise. After several days we removed che respiracor." Thar brings up the question of what should be done for children in similar circumstances who do not have che experience and know ledge co make similar requests. "How can you make such a dc.-cision(rcmoving a respirator) for someone who hasn't experienced life?"Carson questioned. "That's one of the biggest ethical problems." Carson gave another case history concerning a girl who had been seen by several cop specialists around the country . When he saw her at Johns Hopkins, he felt surgery was in order. However, a well-known neurologist disagreed and attempted co get the hospital to intercede to keep the girl out of surgery. But the neurologist "then made a big mistake; Carson said. "He went to Rome for a conference, and I realized this would be a good time co do it." Carson said the girl has made excellent progress, thanks to the surgery. F inally, Carson told of his experience in the separation of a set of Siamese twins. Traditionally, such twins were either left together or one was sacnficed so the other could live. BUFFALO PHYSICIAN A1'D BIOMEDICAL SCIENTIST �Medical Students 23 However, m the case of the seven-monthold twins brought to him, "the mother didn't want to choose which one would survive and which one would be sacrificed." So Carson embarked on a procedure to separate the twins in such a way that both would be able to live. "We thought the chances were no greater than 50-50," he recalled. After a grueling surgical marathon, in which a total of 70 people were involved, the twins were separated. During their recovery, "they suffered just about every complication known to man but they subsequently began making a significant amount of progress, and eventually went home." The enti re action of separating and caring for the twins cost about $2 million, Carson said, of which the hospital paid half. But no hospital can afford that kind of expenditure on a regular basis. "The way you solve that problem,' he noted, "is you share the wealth. You don't require one institution to perform all of these procedures." • Academi1cLadder; she told her audience that it's important to set goals. Academic promotions - the rungs of the acaderni,c ladder - arc just benchmarks of our succ,ess, not goals m themselves, Behrens emphasized. We must always remember the larger goals - helping asthmatic children or finding a cure for cancer. While setting goals, you can dream big dreams, but the dreams have to be focused through the small end of the telescope of reality, Behnms said. You must also realize that your goals can change. As a teen, Behrens wanted to help with health care in Third World countries, but didn't plan to be a dean. She diid become a dean and her plan to practice in the Third World was deferred, though not abandoned. As a dean, she facilitate:sThird \Xlorldprograms through her school. Still, the pediatrician plans to someday practice medicine in the Third World. Using your personal time carefully is as important as using your professional time carefully, Behrens added. "It took me a number of years to realize that other people can cook and clean, but I'm the only one who can listen to my husband and put psychological Band-Aids on my hurting children," Behrens said. She also discovered that when juggling many roles, it's easy to forget to set aside time for one important person. "] had left out one person - me," Behrens said. "I was giving so much, there was nothing left for me." She learned that she had to attend to her own emotional and spimual wellbeing before she could focus on her goals. There's no room for coasting, Behrens added. "You must develop as a professional and a person for the rest of your life,"she urged. • B:, Connie Osu:ald Stofko CLIMBINGTHE ACADEMICLADDER A t one point m her career, she felt as if she was living in a pressure cooker. She was on 20 cornrnirree:sand trying to juggle her roles as clinician, researcher, teacher, administrator, spouse, and parent. With so many deadlines, it was hard to get through the day, said 8. Lyn Behrens, M.B., B.S. She eventually learned that prioritizing one's goals makes it easier to say "no." Drawing from her own experiences, Behrens, the dean of the School of Medicine at Lorna Linda University and one of only three female deans of medical schools in chis country, took parr in a four-day program on academic achievement. This spring's OW. Harrington Visiting Professor, Behrens is gaining a nauonal reputa• tion for her presentations on faculty development. As part of a session on "Climbing th c B. Lyn Behrens, BUFFALO PHYSICIAN A:-.:D B10:l.1ED!CAL SCIE:-.:TJST one of only three female med school deans in the U.S. AUn..:M:-.: 1'189 �,. Medical Students 24 OUTSTANDING FACULTY HONORED AT ANNUAL MEETING T he 1989 Annual Faculty Meeting witnessed the presentation of many awards for teachmg excellence, research, and service to the school and communitv. This year's Stockton Kimball Award for excellence in academic achievement was given to Saxon Graham, Ph.D., who will deliver next year's Stockton Kimball Lecture. Graham, an epidemiologbt, is a preeminent member and chair of the Department of Social and Preventive ML'Clicine.His work has been primarily m linking diet to various diseases and suggesting dietary modifications ro help prevent the onset of these maladies. His best known qud1es involve colon and breast cancers . Graham has linked dietary fats ro a high risk of cancer of the colon, lung, and stomach. Equally important, he has reported a potential protective effect of carotene in combatting cancers of the mouth, lung, esophagus, and stomach. Graham has also suggested that women who arc m high-risk categories for breast cancer limit their alcoho l mtake. This year's Stockton Kimball Lecture was delivered by John Border, who 1sprofessor of surgery and orthopaedics and a research professor of biophysics at UB, as well as director of the trauma service at Eric County ML-dical Center (see accompall)mg amcle). The Dean's Award was given to No rman Solkoff, Ph.D., a probsor in the Department of Psychiatry, for his service tO both the medical school and the University as a whole, and outstanding research. Special recognition went to Murray Ettinger, professor of biochemistry, and Charles Severin, associate professor of anatomical sciences. Ettinger was recently named a Distinguished Teachmg Professor by the SUNY Board of Trustees and Severin received the Chancellor's Medal for Excellence m Teaching. The second annual Robert S. Berkson AUTUM:-..'19R'I I Saxon Graham Memorial Award in the Art of Medicmc was given to Robert Reisman, clinical professor of medicine and pediatrics. The purpose of this award is to recognize excellence in patient care and teaching by a volunteer faculty member. The Louis A. and Ruth Siegel Teaching awards, which recognize teaching excellence, were presented in four categones: ■ Steven Gutman, M.D., assistant professor of pathology, received the Pre-Clinical Award . Letters of commendation were given to Edward Car r, M.D ., professor of pharmacology and therapeutics; Perry Hogan, Ph.D ., professor of physiology; Alan Lcssc, M.D., assistant professor of pharmacology and therapeutics as well as medicine; Charles Severin, Ph.D., associate professor of anatomical sciences, and John Wright, M.D., chair and professor of pathology. ■ Ralph Doerr, M.D., assistant professor of surgery, received the Clinical Award. Letters of commendation went to Paul Davis, M.D., professor of medicine; Margaret Paroski, M.D., assistant professor of neurology and physiology; Luther Robinson, M.D., assis- tant professor of pediatrics, and lnsook Shin, M.D., clinical assistant professor of neurology. ■ Joel Paull, M.D., clinical assistant professor of surgery, won the Volunteer Award. A letter of commendation was awarded to John Treanor, M.D., clinical assistant pro• fessor of psychiatry. ■ Edward Co leman, M.D., clinical as:;istant insrructor of surgery, was given the House Staff and Special Award . Letters of commendation were given to Donna Desmone, M.D., clinical assistant instructor of medicine, and Deborah White, M.D., clinical assistant instructor of medicine. Also at the meeting, Nancy H. Nielsen, M.0., Ph.D., the new president of the Medical Society of the County of Eric, introduced Charlene Cortese, New York State Medical Society Auxiliary, American Medical Association-Education and Research Foundation (AMA-ERF) chairperson, and Phyllis Caputi, president of the Medical Society of the County of Erie Auxiliary. They presented checks totaling $8,004 to the medical school.• - 8,· Dal•idM. Sm·derman BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST .. ��Medical Students Suraj Arthur Acharva, French LitcralllreB .A , Lniwrnr) of Califonua S.C I am mr,·rc,1edm ,ntL~uumnalmedicine, ch,1mb..>r mu,i,, and arr Kawh Ali:adch, BwloJ<., B.A.. Ctmiell Unn-ernty. Bnrr! Eli:abcth Ann Allen, Trina Bernadette B1ochcmi,1n B S , Allen, BwloJ?Y B.A., Unit a,rr, at Buffalo. I \' assar Colle[!.eI like l(J(Jk foru·ard w sf>,mdmg hiking, mm ies, and caung <'hce.,ecake cnwtht.-r four ,·ears m . .\led sch,-,1fu, m /i.ruwn Buffalo. :--:ancv A. AllenRichard, Bi.. :hemistry B.S , Sl';'\JYat Sum, Brook I h,ll'e 11great st1f>f>or111 c Jamily and Jewel Damita Alleyne, Bwchcmmry, Hof,1ra. I like w ,mg, I lo,e w tratel. I chose lJB becauseof the re.,earch. I'm gladw Ii. m Buffalo. hmm,. Matthe,- Evan Alt.,,, Chcmisrr, B A., \eu YorkL'nn-ernry I cho,e l'B bern111eof rhewe,11 Rmh:·rs. Elvs,a Anne Blissenbach, Bwk,J<., B \ , Fairfidd L nn ,'TS1fy.,\h jat<>me pasume" figure ,karmf!.. Gre~ory A. Andre",, Got<"Tltmenr A. B, Michael Jo,eph Aronica, Bwlos::,B.A., Harmrd L'nm:rsuy. I cho,e L'B med sch(J(JI h.!causc! of Its ow,tand1111! rcpuumon Uml'L'T'ilt)· of Rochl!stc:r. Mike "a t,prcal med srudcnru-hoha1cs l1brarr.:.1 and Ime, w parry Renier Jo,eph Brcntjcn,, / fowry B A., Darnison Jon Michael Bruce, Bwlogy BS. Chemmry B.S , L'nin>rm:,at Buffalo and ,'\Jia[!.ara Una·er,11y.Hello B11ffal11! Colle[!.,'.1 um born ,n Ams1erd,1m,The Nethc'Tland.,. and like \(lllmf!., Behnam A,~harian, B10.:hcm111nB <;_, L'n11m1t)·at Buffalo I look foru·ard w med schml and cnio:,,/i.mf!.a1 L'B Andre" Jacob Bam,r, Bu><:h,·mNry B A., Thoma, Gerard Burke, Mc<·hamcal EnRtneeringB S., Notre Dame Ir's fun to come homefor schoolm rhe,c Crai~ H. Burrow,, B.,,r,,!?Y B.S . Ho11ghton Collt>gc.I enim the an of pantomime curmu_, ume.o;. Carolvn L. Be""1te, Bioloi:yB.A , Camsrm Collef!.e.I <1lsc, Unnc'TSII)of Roche,ier. lune degreesm la1t•, Lookmgfonmrd to music, d..'!lusrry,and medicalsch,.,I. Enj<>y elecm.:alengmeenng. playm,irhe1·1olmand cycling. Heather R. Campbell, Bioloi:yB.S, Cornell L'n11ernr,.I like being uurdoon and bakmgnut necessonl~ · m the ~me ume. �Medical Students Rodnn Cap,ro, P,:«·ho/og,B A , Xcu r,,rk Um1s'T"':· Becominga ph,.\lcklll has />.:ena lifelong ambmun. Ann" Mari" Comi, B,o/og, B.A . f/oly Cm". I reallyrhmk the.,t!qut.1.,rlmt,an.• ab,urd so I'll JIN keep :mu folksgun\lng Li,a Ann Cardamone, 810l01?:B A . Lrmh·nil'\ vfRo,·hesct:r I am tloconh a sc:,:unJ. gencrarum 1>h,"c1<1n /,ur aho a u·c,i:htl,frcr. Andre" C. Cor,dlo, Chcm1Srry13.A.. C,m1dl L'1mernr, I ,d\11hatc J,·,grccs111ltm· and m1Nc. I mincedw round offm~-c.•Jucawm I,:.gomg co mcd1,,1I "h,.,I. T ridJ L. Ei~~n..,tctn, John Alt,xander D:ik, ,\1cchamcalEng111ccr111Jl 81mndK<1lEn.~anccrmg 13.S.. L'n11crnr,lH Buffalo. I cnJm pki,ml! ra,:q1«1ball anJ bmdmg. B.S E Duk,· l 1m a<1r,. I l,ke w f), />kmc,- I'm a ,ucdcnr 1,1101. \!aria T er1!,a Cartai:cna, B,olog, ll S. L'mwrsit) at Buffalo. 11,,w dorhc, Richard Mark Chcmdli, Bwlog, B.A, Comdl Unn•c.>f\!l'.''· h\ nnr JU\( ll pro/1.!s,1,m. 1t', cm Elaine Hee-Young Ch,.,on, lliolo.~",md ~,..-1e1,B -\,. C,,rndl l '1111 <"T\11\ 11,ke ,kuni: and 101111\. William F. Chlo,ta, Biulo.~"B S Ca.,.: \\.'t'.Slt."ntRc:,c..'n 1..: l Hll'~T\ll),' I ~1110: ,k11ni:.,,ulmi:, remm, ,md<1rt.I'm l,x,kmg fi,rn ,ird ro m,·d,ch,x,I \1ichacl La" rencc DuBartcll, Bwlogy 13.A , l 'nn,'T\lt, at /l11ffa/u.A/1,:r _gr,id11a11011 I 1m111Jl,k.: 10 praruct.' /1..uml) m,:Jii.-mc.·. Karen M. Dui:uid, (1t.lt·i:1UUTt.." \'ane"a L. Crother,, Win,ton G. Oou1,:la,, Cherm,rn and llw,:hcnmrn 13~-, l',y,hology ll .A , l 'nn.:rnl\ of Ro,hc,r,'T I U.dtU to ht!-u doctor,o /'II h,:,,bk w (rttm~,: healthfare m necd.:d. Ru/,..-rr,\\'.'csle,an (•oil..:~.:.Fmu ~\'t.'<ir, /rom nou I hope w/,..-<1 ph,"cr,m. Julene Op1al,.,neE,an,, ,\ f ,rr.,/>wl,J!i:'.' /l S. Cumdl L'mwrnr, I ,ho,c L B hl?f,111,c I urn,IJlike w twrk j,,r ih,· \\'.'orlJ I kalrh Gil Michael Farka,h, Hu._hemhtn B-~., L nn cT\11\ dl llujji,lo I ( >r.s,:c1rn,aw,111 m Kl'n)·a n.·r~·~.,cm:Jahuut ,mendingm.:di.al,,hwl <II LB. ,,nnc:dtl\· c.'HJO)' ,1 Jnt."nH, oj ,pc,rb md,«Jml!1cmm, ,kun)(. andu:orklll,1!out I ,m1 Paul Jo,eph Fa,orito, P"chohwlol!", H,mulwn Coll,:g,· I um ,:a~erlo hcgmmed ,, h,.,1 and I hk.:m pl," ,..,,w,h \ kd1,11ITe(hn,,/o~" 13S l '1111,·Nryof \ l1,h1ga11. I ,un <1 <'<Yllfi.:d Sign kmi:11,1~,: m1t:rt>r1.'rc.·r. I Cdn r U.'(UI 10 ,wn ! Ilana L. Fcincrman, B,,..-h,·m"'" 13.S l"nn.:rnr, ,u B11/f<1lo. I thmk 13ujf<1lo " " ~.,..:,u pla..·c<111</Im 11/,ul111/,,_, bt,,kJi,rfour mor,: )'t?(JT\, �Medical Students \1ich,,cl '-cott D,1\IJ K. he,, Bio!oi:y B.S . L'nu ernry ar Buffalo. I'm an early assurance mukm. I'm from N ia1;araFailsand enJO)golf Orn·ego I chose Buffalo ~cau..\l'of ns gtc!at weather. Gloria \1. Gladk,m,ki, Bwlol(Y B A., L'nii·,.,._m::,,ai Buffalo. I trnrkcd in a hmp,caiJoreight :,cars as a medicalsecretllr. and nou am dum)(ini:role,. '-.indr., \I. Gutierre:, Timoth, Danah, H·,ln, Chemmr. BS., Honora \f. Heffner, En1;!i,hB.A , Colgac.t St. Lawrence Lnu·,.,._my.I'm ured.• l,'mtt'l'SII). / «ill he a ihirdgmaarwn Fl·r ~U..,llO, 810ch1;.~mrscry,' B.S.. SL,\ Y ac Biochenmcr:,B.A.. Neu York Un1tcrnry I pia, the drnm sec. I I,ke compwer \Clenc~, and l u,li bea firn gcnt'l'amm phys1cu111 ph::,,s,c1an and I like w piay ciannet. Charle, R. Gr.w, Health SciencesB S .. Beu, B. Grc~oirc, Speechand Drama, K1thl~cn T. Grimm, Canis,us,/Y}'mm!k. I lJnncNI) at Buffalo. I am final/:,a firn,ycar med suukm SL \IY at Gt>neseo./ ha,, a ma.,1ds m library haw a B S. m med wch and aL,oa BS;-.. Jame, \I. hernia, B11smess;<v1an,1J?emcnr B.S, Cornell L'nn-asuy Fr,mhali mJ11nesfurcedme to be the paucm. Nou I i:ct to ,~«! tht>accwnjrom Ute! Wallace E. John,on, Philosophyand Theatre B A. , Yale. I look foruard to leamin.~ ~cicnce,tu.•ochildrt!n. and like w readand sail Robm \i. """• Psycho!oi:yB A , Varonouch. Phowwaphy and owd,.,r s[><ms ahaw B11ffab,. mht.,."ck. Li,a F. Kci,her, BwlogyB.A., Camsn,s College.I, a capuon ri.?all~ · nrce~.\ll~·! Kt·vin J. Kelleher, B,olol(YB A , Camsn1s College. Ba.,kechali, wlle,hall, and rcnm, arc my font' (hueI rau!y use chat,wrd) Jonathan Robert Kemp, Brrx:hem1,cr:, B.A , Neu· Yark Linu ,.,.m, / u·i,h m)' brmht'l'George u·a., here. PEACE. Cath\ Kim, Biology B.S , \1/T Llfe" temporaryso fin~if to the fullesc· u•,,rkhard and piay cwn lu1rdcr: Eli:abeth H. Kim, Bro!ol(Y B A . Camm" Co/le1;eI u-ar11to be /urch~r young! Ricardo Alfon:o Knight, Ph"iail Thera{)yB.S .. Uniwrncy at Buffalo. I ihmk bemg a docc,,rrs the ea,u:.~t u·a-\ to achie,eall charI can be �Medical Students T cd J. Kolia,, Bwloi," BS. , L nn .:mi,· of \fa:hr.i:,m I en}o) pla:m.i:ha,keiroll. .,occcr, anJ the pram,. Paul \t. Ko:1,m,ki, Bwlolt' B .A . C,mrsrus Collei:e I u·an1 w reach hikingrn 1hel'hrlippmes. Brian J. Krah.ik, Elecmcal En.i,ne<.'1111 .~ BS., Comdl L·nriern1, I like playmi: the /nano ari,l .101.n-r, neuh.:rof wh,.-h I' II h,a e wne for Da, id J. Lee, Biolo.i::,/ .'-.·curoKrcnccB.A .. Oh..-r/111 College I'm on Kcuni: Wai Lee, Kc\\•Juni: Lee, Brochemr,1ryB.S , SL',\') <11Hinghamwn l\ycholo.l!)B.A., Comdl Uniwr,11,. I dm«J11111.: u hen I ,ki on /me />kl'lll/? ,o,.-er. lrke ,um1ming lx1-'ke1h,II,1runnmi:. f><11d.:r Julie A. Madcj,ki, Bwchcm1<1r.· B. S . l ·nrt.·Nt) at Buffalo Can' 1 u·au w i:ei S1<1rted on rhrs1,.:11· ewurng (><rrr of m, lrfe Karen \1. Maier, l're;\ieJ B \. . ,\' orre D<1me I Ion! l\·ntrc Durn<? {tH!lNII Jerald Chri,tophcr Timoth, J,1,· L,R,"a, Kuhn, Enl!/i,h B.A , Biolo.l!)B.A .. flamrlwn Collei:e I am l 'mt ..·r,H~' of Rocht',ll'T an attd .\liilor, ,u1dcnJo-:,. · I hale cmds.,<1<.'latl.''srn the heaimful mnny u·eaiherrn Bu//<1/0. appliedscrence111 hro..-he11m1r,, Charle, Hoonjani: Lieu, Chem1>1r.B .A Comd/ Unncrsu, .\fohular Bro/ol:'AB , Tammy J. Linsner, Chcm,,m B.A., Princeton L·1111c·rsr1). I U.'ant w Sl'rtt.' (;od ch a Harru-rckCollq,:e I am lookmi:f"nmrd IO med ph,srcran.' ,chMI Bruce B. \farshall, Bu<me,.1.\fona.11,,,nent, Comd/ Um,crnr,. I Ed"ard F. .\lath, Biololt' B A., Branders \\'.'hLnclo~!.'i orn·ntauon .. i!nd! Jame, Kcillh Mantc.>ne, Gina M. Marrero, Bu><:hernr.\lry BS, ;\11crnhrol".I!) BS, C,mid/ L'nncrnl\ I am /,.,km~ fonmrJ w " ,cry SL;-,:y,11Bmi:hamron I u'll.SIn mg r.a/iprlyrm ,1 beachrn Ca~rfomta,then mmn and ,uul mademe come here. Tr.in !-Idem· Lathrop Chcmr.m, B.A ~l i':Y m Brn1:h<11mon r~uardin,J.? t' xpc:rrence at LB Christina Lc,lie Lin, hate hem a ieach~rf,rr four JCars I like m(),t ,f><,m Un11crn1,· I rhme w be a ph~srcwnh.:came I enJ") pressureand tcn~ion �Medical Students Fiona A. McConnell, Kc,·in Christopher B1ol111;V B A . \\:'11!1,11111Md-,,{ahon, (,oternCollege.I likehangmg ment B.A , f-larrnrd out I hop.:to mdke flm<' L"nlt'c..'n:lly /"d like to hate u praftice in duringmed ,ch,,ol to do sport.'i.makt.·mu~,l, anJ Cha11ta11<1ua Count, 1omcda,. lune fun . frrnfe~_,ion of medirmt.' becau,c I lm·e 1mrk111i: Daniel J.Mollin, BA . P"<"hoh,,,loRY ?\'eu· Yurk L"nrtern!) . I dcoded w i:o ro med on />a.1r ,chwl h<1,ed u uh p.:ople. exf>t!TICUO! Lorncllc B. Mill,, Bwlol!)B S . ,--:cl< fork l 'n,urnr, I cho,e the Claudia F ranee, Michalek,, Nurnni: B.S , D'Yrnml/e I hate a dt.'grt!r 1n nt4rsmg. Michael John Naughtor,, Philosophy B.A.. \',:'il/1am1College I rnn ,p.:ll,\;1ct,.<ehc Andre" Charle, Michel, Bio,:hcm"try B.S . .\f11/m11lk L'mn.>rstt~·1tnJ'" Jly fi.,hmg.and crm,country skiing. I look fonrnrd to s(h<H,I . Tuni: V. Nguyen, Biuengmuring BS , L'C (II B,.,-keh I trill he a third,i:cner<1t1on ph,sic1an. Rogena Leonila Miller, Bwlol!JB.A , Talladega I chme med <ehmlhecau.seI'm mt,.,.e,ted111the medical profernon and helpml( mhcr,. Jennifer Ann Nordby, BiologyB.A . Corne// L"m1,,,.1uy . M>·greatgrandfathergraduated from UB medicalm David A. Milling, .s.' B Unn,.,..m, at Buffalo. I PhdTTMC;i haw a B.S m pharman I c?nJo) racquethalland rcnms. Katherine Anne O'Donnell, Bu..:hem11try B.S . SL'NYat Bmgh.1mwn.I hate <111 ,\1 S m pharmacoloio. 1901! Sanjay R., Ogra, Biolol(;iB. ~ • Cornd1 l'mtcrnt:,. From r,,day. 1am a doctor (,umd><,d) ') . wld me rh,,r ycsterciay Mia Pappagallo, Bwlol()B.A P,ycholol:;i B.A., Lnnernry of Rochc,u:r .\1y p,mport phoro" heucr than mi,!' Jeffrey Richard Parnell, Bwlo);VB S , L'nncr.ll!y Ill Buffalo There" no heltercaret'l' ch.anmed,cme! Vikram N. Patd, Bmchcml\lr\ B S.. SUNY at Swny BrcxJk.I choseLB became I l,ke huffalne.1. �Medical Students Frand, R. Patterson, Bwloif.<BS \1/T I like pla)mg ,porr, and arn,·mcs . ocheroWlUH>r 1':a"er Ra,ack, Neurobwloif.<• Archaeoloifi·.L'nncr,u:, of M1Chiga11 . I decu.ledw p,o w med ,chwl m Bufjal,, b.?rnu,eI Inc Kri,tcn Loui,c Paulus, B,olog, B.S , Come!/ L·mwn1r, I hope clwcu e all b.?wme chet:,·peof ph,,icum char u·e m,ncliL', u"<rnltl. like wgr,w . playmg tennis, dancmg, and oh so much more. Jame, D. Pile, B,o!,,in B.S., L'nrt,·rnc, m ~tichad D. Rabicc, :\1ach13S I /ohm Buf[<lit, . Uymnd\UC:\ , College So m1Khfor children, mtd med ,,h11<>I math and mu,1c - on w are 111,fllratim1al tnl'dtclllt.' '\'ita K. Ram, Chcmicc1IF.ngmccrmg 8 S . t ·1111crnc, 111 Buffalo I like pl,rnnl( t.:nni_,, cookmf!, l'atm~. and l>cmgk:, Arlene I:. R,carJo, :\larcu, Med Te< ·h BS . Sl ,-.;y at Alba1n \\'.'hm I grad,uueI 1nm1 w hate ,m officerm rn:,:,a<·hrm 1heCaril>ne<1n . Romanow!<.ki, Richard llwloi:kal E!a.sr,of Bchmror B .A , Leon Ronco, \lmhcmau.:, B A , 'iLSY at Bmgh<1111wn. I likeco tn.nd lo furt:11,!tl Umtcr.,m ,,f Pcnm,ltanra I'm i:l,~Iw l>cba,:k m Buffalo. mtd mn h,km)( Joruard to ,uu.l,mg m L'B med. countries . I l'nJo)· plaw11(1cnn1, und Eric Joseph Paul Davi ,d Seeman, Schneider, Biology B.A., We.deyan Um,oermy.I enjoy the outdoorsand athleucs. Psychologyand Zoology B S .. Du~• Um,oersity. l l,ke to pla:y golf, cennis, and j(O ,ai/i,ng. Jeffrey A. Senall, B10/og:,• B A , Cams1u.s hi:r!! Richard Scott Safeer, NucnuonalScience B.S . , Camell Unwersicy I relax by Laura J. Pierce, Bioloin B A , l ·111, ernry ac Buffalo. I CllJo' runruin.~and pl,1ymgtenm, . "'"chill College.H,, how are ya, mce to ,ee ya! I enjoy sportsand lookforu:ard to an easy four years. Ju.stlikeei,eryonesays 11 u:,Ube, yeah. righr. Paul Brian Ro,cnthal, Ernnoml(\ BA .. r \l'' ac Bmghamwn lott.' ro rr£ztd.tkmct.' , ,mJ plm ,fx,m . Mark Anthon, Runfola, Prr/•mfr,"'"'"1/Ecrmr,m10B.A., .,otrr Dame . Im h,kmg fonrnrd w lunch. �Medical Students Jdfrn J. <,.,ymour, General S111d1e, B.S.. Cornell L'mwrnry I enJO)tl'eiihr l,frmi, skimg, and music Peter U-Fu Shen, Chemi.,rry B.A.. t.:m,ernry of Chicago. I JOI(for fun Chri,rma Ann Smith, BiologyB.A .. Comdl UmH'TSU). I cho.<e UB becau.,eI low mmhml' Michael K. Soeder, BiologyB.A . lin11ern1yat Buffalo.A pic111re 1sunrrh a thousand,wrck and rho,eBuffalo beachc.,. Andre\\ L. Sherman, BmmessMana;:ement, Cornell l ·111wr1it,. Alu<1yslookmgfor a good game of balland decent road trips. Samiri, So,trc, Laun Amencan L11erawreB10loi::,B.A.. Neu• YorkU1mermy I hope w do some mlunceer unrk m .\iex1co. !1-fan,our \'. Sh1rbachch, Biochemist') BS. CSU-Las Angele.,. I read now ls. Chri,tophcr D. 5prtrn I, Biochemistry B.S, L'm«'TSII) at Buffalo. I am concerned for our enuronmcnt. !min C. Srcinbcriz, Biolo,:;;B.S . SL'NYac Bmghamwn. I cho.<e t.:B becauseof the lackof sun. Ali-sa \iaric Shulman, Farmand F11ncnonB.A., L'mwrsuy a1 Buffalo. I am an ani<1 of che human bod:,and would like w 111e1heseialent< m medicine. '\; 1chola, A. Stathopoulo,, Bio,:hemiscryB.S . t.:nn ,.,.<It:,of Rochester. /' m frnm Rochesterand l,ick checreauwy w fill rh" 1~mow Ed"ard R. Stcphcn,on, Bwlogy B.A .. Fordham lfmwrsicy. l mjoy all rypesof spam and hope w parucipateac l.JB. Gail H. Smallen, BiologyB.A.. Brandeis L'm,ersicy. I plan w go w Honduras. l enjoy playing/Jureand piano. Donna \laric Sia\\ a,:, Bioloir.,B.S. Chemmry s B A. ' )1'0CIISC L'mt·erm,. I don'r always l,ke 1h1s!! 1;,k Patrkia Sticca, Bwlol(Y B.A. Psy·choloit> B A., lJmwrncy· of Rochester. l u·illbe the firn person m my family w auend medical school. �Medical Students \{i(had F. S"<·cnc), Anthmpolo,r.,,Ca,e \l;!e,tem Re.,.:ne L:nnersu\ . .\1d1.:n1e ,hould ~· m1cnll.ltlfJJU1I. Roh•rt \\ . Tahara, P,),hulo,r.,fl.A .. l 'n11,>r"I)m B11Jjalo "' ot onl) am I a c.:rti{it:'d ,cub<,,her, hm I al.", make m) 01m ~,.,. L,,okm!,!fomt1rdto a Kristine L. Tl·nchru,o, ,\.'euTl,,. .1ocii:nl't:', l nit't..'ntt)· of R,x:h.:,t,:r.l lik.: to pl,_,~ tennis but most of all ,:o 01<1 u·uh friend, anJ Ii.a e fim \ idr, C. T ,,11,·n, Life Science, B.S , L 111,ernl\ at Bu!Jalu. I l,k,·ch..-Bill, and hope the1 do JtN a, udl or 1->c?ucr thi, 1..-ar Jo-<·rh S. \',1lcnti, C,,urtcna, Bml,,,r.,/l',~chol"J.::i B.A . Can""" Coll~gc Biolo.i::;B.S L urn Colkge of \\racu,e I hof>c! to combmt! m)· gncH(thwuc rc:~c:arch ba,kgrmmd uuh m) ,p.nt (. ra1i:\\'.111, rhc f><Nrnu ~-l'an u:urkinRm a mol.:rnlar /,wlo/.!)l,_,h mt!d1calt.'ducauun n.-tn1rdin.l? cart..'l."T in rraumd sur.(!t:>n·. JuJ, ,\. \\'c,,,l,m,ki, \ kJicin,,/ C:h.:mMn ll S. L 1111,:rnl\ m 1311/Ja/,,. I'm ,,amng w Thoma, Charle, Wh,·atlc,, BioL,~ /l A. , Cornell L'nnc:nu~ I \.'njo)· Chri,tophcr R. \\'lute, Ch,·mmr) ~li,had B.A . Add1,h, Stmt:, Brmk I um Ann \\',,.xi, 1310/0,r., B.A , C,m""'' Colle/,!<'I cnJo:, trmdmg th.:C<l\) ,t11/l / l,k..B11fft1/o u in.i:,. 1mrk, and u.:t1th.-r b.:gm a r,:1n1rdmg nir,:,:r runmnJ!and am m m1.·Jrcmt' mh.'TC:1ilL'tf m ~diatrrC\ from SL .\'Y ,u Sr""' Brmk. fh,,ma, J. YJnwdla, P"choloi,')B.A , L 111wrnl\ <lt Buffalo I 1,k..ha,k.:1/,,.1/1. l lun,: a Che,.:u..-.I J,J not 11mk th" ,wnm..-rand I h.1te the 1'rd,, nd.:. Atif Zaf.1r, /l1olol:) BA . .\lath BA , L nnenu,· tit ll1<Jfalo. I'm " /11l,;t I .:nio:,/1/e l na, ail,1bl,· tor l'hot<>s: Paul,, A Bcnn,·u, D,n,d ,\1 Fl\ha l,,:ojfr,·) (;. Hoh1k.1)u,cph .\1 1'um1hk1,,mJ liu: Ta\lor. Jona1han I. \\'cin,tcin. Bu,lol!) 13..-\.,Cornell Un11ernt) So much for mightbe a fl,~ht ,urgeon at ,\'AS.-\ t ·111,crnt\ (,ra,/ de.i:rcc E. \\ ilJ, BwloJ.::i B.S SL.\Y ,u Kdh h,kmg J,,ru,1rdw u and tt'~t'c.m..·h I'm cht,llcngmg careerm excncd medKmc. ,chool. .,,-.,,.t med 1t?n ��,, • Medical Swdent.s 25 by che UB Medical Alumni Association. They also received a "welcome to Buffalo package" \\'Ith maps and hints on things co do, provided by the Medical Society of the County of Eric. The orientation also gi\'es the hospitals the ability co sign the residents on co 1hc payroll and perform pre-employment physicals . Approximately half of the residents are graduates of the UB medical school. • SCHOOL HONORS VOLUNTEER FACULTY A reception thanking the volunteer faculty of the medical school for the many hours thev have devoted to the school was held May 12 in the sculpture court of the Albright-Knox Art Gallery. "The volunteer faculty make an extremely important contribution ro the School of Medicine and Biomedical SuencC!-; said John Naughcon, dean of the school and vice president for clinical affairs. "Historically, they've served as role models to students and enriLhed the eJucarional experience in ways chat otherwise would not he possible." • ) I ,. 0. P. JONESDIES; WASDISTINGUISHED PROFESSOR OFANATOMY ORIENTATION EASES RESIDENTS' TRANSITION E sw- asing rhe transition from medica.l dent to resident is a prohlem heing tackleJ by the UB medical school through irs second annual resident orientation. Two separate one-week sessions were hclJ st;ircing June 19. Ahout I50 students parnnparcd. One of the maJor goals of the orientation ts to lcr the rc,idents "gee to know one another," according to Glenda Donoghue, M.D., director of continuing medical education anJ professional development ar UB. The orientatton consisted of lecrure copies caLh day with informarion char the residncts will find u;cful throughout rhc1r rnrecrs, Donoghue said. lndudl-<l were presentauons on organ procurement, rhc new credentialing process, the prevention of malpralti,e, knowing rhe patients' rights, cost conrninment, and advanced cardiac life supporr. Also presented was a program ro teach residents how to reaLh. The first half-day co\'cred the skill, of hedside teaching and the second dealt w1rh the skills of evaluating. A luncheon for the residents was sponsored Jones received his Ph.D. from rhe Univer• ,ity ofMinne,ota m 1935 and his M.D. degree from UB in 1956. He Joined the medical school faculty in 1937 as an assistant professor. In 1943, he was named an associate professor. Lacer that vear, he was promoted co professor and chairman of the Anatomy Department, a position he held until 1971. He was assistant dean of the medical school from 1946 to 1954. Jone, wm,al,o a v1s1t111g professor at several institutions, including Baylor University and National University in Mexico. In 1%4, he was a distinguishL-d IClturer at Tulane University School of Medicine. A member of 15 profc,,,ional societies, Jones was program secretary of the American Association of Anarom1sts from 1954 to 1966. He served on the advisory councils of both che American Society of Hematology (1962-67) and the Continental Associatton of Funeral and Memorial Societies (1954-1971). He ,,·a, accive in the International Society of Hematology, ,.:rving as its vice president from 1958 ro 1962. He was a director of the , ational Society of Medical Research from 1956 to 1961, and president of the Society of Experimental Biology and Medicine, Western New York Section, from 1951-52. Jonl'!<was assoctatc L-ditorof The A11awm1cal R..:cord (1955-1968),and served on the ediconal hoards of Blood (1946-1955), and Folta Haemawlo~1ca of Lcip:1g, Germany (1937-1949). The 1954 edition of Meden1ia11, the joint yearbook of the medirnl and dental schools, was dedicated co him. His other honors include the 1964 Dean's Award from rhe U111versity,and rhe l9il Silver Medal from the medical school. He was a member of Alpha Omega Alpha, the national medical honor society. He was the husband oft he late Dr. Cathryn M. Jones. He is survived by three daughters, Helen Jones of Maynard, Mass., Carolyn Gurney of Asheville, N.C., and Ann Davidson of West Yarmouth, Mass.; a son, Oliver, of Columbus, Ohio; two sisters, Ann An near of Abs(.'(On, N.J., and Evelyn rord of Pleasantville, N.J., and IO grandchildren. Concributions may be made to a fund to he established in his name ar the University. • Dr. Oliver P.Jones (M'56), di,ringuished professor emeritus in the medical school and a leading figure in hematology, dieJ June 18 in his home in Buffalo. He was 83. A native of West Chester, Pa., Jones caught gross :macomy in the medical school from l93i until 19il, when he was named distinguished profC!-sorof anaromy. His scientifil accomplishments were many and worldrcnowned, and his work was said to contain rhe hcst descriptions of hone marrow changes. He was a pioneer in the use of the clcuron microscope in morphological studies of blood. "Not only were his contributions in teaching and research of critirnl importance~ said Harold Brody, chairman of the Deparcml'.nt of Anatomical Sciences, "but the roles rhat he played m helping to Jevclop the organizations and professional journals in hematology were primary from an mtcrnanonal point of view. "Above all, the loyalty and concern for his students were maior facets of his c:haracter and arc rcmemhered by graduates of the Schoob of Med1Cine and Demiscry, as well as hy graduate students during his years of tenure~ During his later year, as chairman and ,tnLC 191I, Jones de\·◊ted himself co examining the early h1scorv of the medical school in addition co the scory of its founders. These ummbution, ,,ere published in national journals as well a, m che Buffalo Phwcian. BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST AUTUMJ\! 1989 �Alumni 26 MED SCHOOL REUNIONCLASSES PLEDGE $102,220 TO UNIVERSITY Reminiscingabout theirUB dayswas a greatpastimefor alumni duringthe SpringClinicalDay/ ReunionWeekend, heldtheweekendof May 6. The alumni not only rememberedwhat UB gave 1934 .. . . .. ....... . ... . .. . . . From left, seated:John V. Andmon, Maria N. Samo, Charles E. May, to them, they also took the time to and Max B. Weiner.Standing:JosephR. Saab, EarleG. Ridall, Nicholas Linderman, John M. Constantine, and Harry Bergman. give somethingback to the University. This year'sreunionclassesgenerously pledgeda total of $102,220. Class of Class of Class of Class of Class of Class of Class of Class of Class of Class of AlJTUMN 1989 1939 .......... $18,400 1944 . .... . .... $ 6,725 1949 . ... ...... $ 7,125 1954 .......... $ 8,000 1959 .......... $15,450 1964 .......... $16,255 1969 .......... $ 9,500 1939 ... . .. . .. . ....... . . .. . . left, seated:CarlosC. Alden, William Dugan, Elizabeth Olmsted, 1974 .... . ..... $10,500 From Ruth C. Burton, Marvin Siegel, George C. Brady, and Henry V. Middle row: Kenneth Goldstein, John J. Squadrito,John H. 1979 . . . . . . . . . . $ 8,220 Morelewicz. Remington,John H. Geekier,Lloyd A. Clarke, RoyE. Seibel, and Frank T. Riforgiato.Back row: Alfred H. Dobrak, Frederic Hertzmark, James 1984 .......... $ 2,045 ). Creighton,and A. V. Posto/off. BUFFALD PHYSICIAN AND BIOMEDICAL SCIENTIST • �I Alumni Reunion 27 1944 ...................... . 1954 ...................... . Fromlefc,seated:L.~diafutmcain,Mrs. Strong,IdaSchaer,S)lda Ginsberg, Charloue Fros[ Ph.llis \'(/i/kinson,Jean Boardman,~fo. Sulli,an, Mrs. Momani, Santd M~riaCassara,Jean Bamecc,HelenHudson, Mrs. Gage, and Ka:,,Weygandc.Standing: Mary Lou Bondi, Raymond G. Bondi, Willard H. Boardman,Newland W. Fountain, Anchony M. Aquilina, Clinton H. Strong,Andreu A Gage, Sidney M. Schaer,Fmnk T Frost, Carrol].Shater, RobertG. Wilkinson,JamesR. Su/Iii-an,FrankH. Long, Samuel Cassara,Howard R. Bamecc,Ra)mond A Hudson, Helmw A. Mueller,PaulWeygandt,JamesF.Mohn, /ruin A Ginsberg,Mrs. Mohn, and Casimir F. Piecraszek. From lefc,seaced:John A. KutT)bala,l\'orberc]. Kuberka, EugeneC. Hyz), Sylda G. Lislot·s,Allen L. Less1,1,mg, :S•.1icholas C. Carosella,and CharlesH. Manno. Secondro1t·:Walter A. Olszett·ski,Jacob Lemann, PaulL. Weinmann,Edtmrd F.Wenz/a//,HarryT Olil'er, RobertD. fuley, and Donald]. Murray.Third row:£mesc H. Meese, William R. Kinkel, Eugene L. Belcrami,James £. Youker, Richard F. Mayer, \'(/il/iam]. Hou-ard,Lows C. Cloucier,and RobercH. Miller. Fo1mhroil': ByronA. Genner,£du·ard A. Rayhill, John L. ConbO),Donald M. \X'ilson,and HerbercH. Benson. 1949 . . . . . . . . . . . . . . . . . . . . ... 1959 ... From lefc,seaced:FredShalu-it,, Julia M. Cullen, and Joseph£. Griffin. Standing:Edtmrd W. Rosner,J.B.Ausc,John Sharp,PaulT Buerger,Max A. Schneider,Carmelo S. Armenia, Laurence M. Carden, and James A. Werick. From lefc, seaced:RobercJ. Brennen, Daniel C. Kozera, George R. Baeumler,Sandra\'(lilcse,DorocltyC. Rasinski,Mary Ann Bishara,Joseph F. Monce, £/con M. Rock, and Dadd E. Den,el. Scanding:JosephA. Ferfoi,Julius\I. Rasinski,John]. McMahon,ScerlingM. Doubrata,Logan A. Griffin, Alf M. Tannenberg,Morron H. Heafic,, Jason H. Scetens, James R. Do::-le,Thomas D. Doeblin, and Selbert A. Chemila. BLFFAI.O rHYSICIA:S- A:-.:D BIO~IEDICAL SCIE:--:TIST . . .. . . . . . . . . . . . . . . . . �Alumni Reunion 28 1964 ......... 1974 ...................... . . From lefc, seated: Bela F. Ballo, Gerald B. Goldstein, Lillian V. Ney, ElizabechG. Serrage,William Fleming,Da11idZiegler,and JosephA. DiPoala.Secondrow: Paul Sussman, Stephen P. Katz, Jeffrey S. Carr, Michael Feinstein,Michael A. Judd, RichardWolin,John F. Reilly,Anthony Ferrari,and Charles Ladoulis. Third row: lroing Scerman, ). FrederickPainton,ScephenScheiber,Da11idA. Leff, Marl.'inZ. Kurian, and James C. Tibbem. Fromlefc,firscrow:ElaineMarie Bukowski, Suzanne A11ery,Gordon L. Avery,JudyOufiero,and LawrenceA. Oufiero.Secondrow: Alan G. Bur• scein, Sharon Burscein,and Stephen A. Yerkovich.Third row: Sandy Piecraszek,James C. Piecraszek,Roseanne Berger-Morelli,Daniel J. Morelli,James L. Budny, Pam Budny, Conrad F. Wolfrum, BradleyT. Truax,ElizabethTruax,RichardJ. Buckley,Judy Buckley,Bruce F.Middendorf, Mimi Middendorf, Paul H. Wierzbieniec,Ellen Wierzbieniec, James A. Smith, and Beverly Smith. 1969 ...................... 1984 ...................... . Fromleft, seated:Madeline). White, Moira ). Burke, Evelyn Roisman, Marion Wind, DorocheaA. Downey,and PennyA. Gardner.Secondrow: Hanley M. Horwicz,Gerald D. Scinziano,Louis He111ZY, IsraelKogan, Roberc). Gibson, James L. Ca11alieri,Michael N. Pisick, Han:ey I. Weinberg,TimochyV Siepel,and BernardC. Muscaro.Third row: Thomas S. Scanlon, James J. Whice, William K. Major, David S. Schreiber, Timothy F. Harringcon,Douglas L. Robercs,and Carl ). DePaula. AUTUMN 1989 . Fromleft, seated:HeleneSurowiec,CherylMiller,ElaineSchaafGergelis, Maria Billinson,Maritza Alvarado, Amy SchuecklerRosceing,Jennifer Curletta, Lynn Picano,RoseDeAnwnis, and )ill Pfa/zer.Scanding:Roberc W Lasek, Man: ). Koblick, Herbert B. Newwn, RichardE. Gergelis, Mark Billinson,Andrew M. Knoll, Ke11inP.Rosteing,JosephD. Curletta, John ). Picano,John F. Noe, and Dal •id F. Pfalzer. BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �Alumni Reunion 29 JUSTWHATIs THEUB FOUNDATION? H 1979.......... .. .......... . From left, seared:Tunde Kashimawo,BarbaraE. Klein, Letitia R. Clark, IvonneS. Cellino, Andrea C. Bracikowski,Norma Creighton,Kathleen Buran,Jody Spooner,Ellen Balon,Donna Irene,LindaA. Cardone,Gale A. Barg,Christine A. Marino, Connie Shields, Marilyn Armenia, and Kay Baron.Secondrow: Robin H. Adair, Ann Canty, Michael Schneider, Susan Lehrer,BarbaraEames,FrederickA. Eames,Katlty Hall, Theodore R. Hall, Walter A. Balon, Peter Condro, Bruce J. Naughton, Thomas L. Mahoney, Thomas McKeever, Mary PacSchreck,Robert L. Baron, Cindy Kaiser, and MargaretNaughton. Third row: Jason Dunn, John M. Canty, Myra N. Rubyci, Michael Cellino, RichardT Irene,James P. Bracikowski,JosephE. Buran, Ted H. Spooner,Donald ]. Armenia, JamesJ. Creighcon, Peter E. Shields,John Naughcon,Jim Cardone,Roger E. Kaiser,and John W. Crofts.Fourthrow: GeorgeBoyar,MichaelCamp, bell, TajudeenA. Kashimawo, Andrew T Costarino,James R. Miller, LIO)·dM. Lehrer,and Frank T Schreck. ave you ever wondered why your gift to the School of Medicine and Biomedical Sciences is acknowledged by the University at Buffalo Foundation? Simply because the University at Buffalo Foundation is the chief administrator of all gifts to the Univer• sity. As a non-profit organization, the UB Foundation seeks, manages, and invests private gift support on behalf of the University. The Foundation was established in 1962 when the private UB join• ed the Scace system to ensure that gifts for the University would re• main at UB and not be dispersed throughout the State. Since its founding, the Foundation has generated more than $140 million in private support. 1988 revenues totaled almost $23 million, of which more than $7 million was earmarked for the School of Medicine and Biomedica l Sciences. Donors can designate thei r gifts to the medical school, a depart· ment, a specific research project, a schola rship or even a new com· purer. No matter what the final designation, the gift is made through the University at Buffalo Foundation. Just as donors make many d ifferent kinds of gifts, the University shows its appreciation in many ways. Individuals who contribute $1,000 or more annually to the medical ~chool receive membership in the James Platt White Society. In add i• tion, for persons who make a commitment of $10,000 or more payable at the rate of $1,000 annually, recognition is given through the Presi• dent's Associates program of the University. For more information about the James Platt White Society or gifts to the School of Medicine and Biomedical Sciences, contact rhe Qf. fice of the Dean (831-2775) or Mary Greene at the UB Foundation (636-3315). • A NUMBER OFPEOPLE MADEMEMORIAL GIFTS: MEDICAL ALUMNI ASSOCIATION ELECTS KUNZPRESIDENT Clas s of ' 39 Gift Fund: • Dr. WillardH. Bernhoft- in memo1)of his brother,Frederick,a member of the Class of '39, who passed away in his lasr year of medical school. • Anna L. Bleich- in memory of her husband, La Moyne. • James Marinello - in memory of his brother, Carlo. • Connie Plummer Miller - in memory of her sisrer, Lois. • Dr. Ann Rudmgerand David Rudinger- in memory of che1rmother, Ellen. • Berry Storms - in memory of her husband, Rober!. • Harriet E. Wesp - in memo') of her husband, Et·erert. Class of '44 Gift Fund: • Dororh) Kennedy- in memory of her husband, Sidney. Class of '49 Gift Fund: • Victoria Van Coevering- in memory of her husband, Russell. Class of '64 Gift Fund: • Dr.and Mrs. David C. Ziegler- in mem07) of Dr. Ziegler'sclassmare and friend, Dr. Sheldon Roth/leisch. oseph L. Kunz (M'56) has bee n named to a one-year term as presi• dent of the UB Medical Alumni Association. A lso elected were Bertram A. Porrin (M '53), vice president, and Nedra J. Harrison (M'77), treasurer. A clinical assistant professor of medicine at UB, Kunz is a specialist in internal medicine with subspecialties in gastroentero logy and endoscopy. Kunz is an attending physician at Buffalo General Hospital and a staff physician at the Oute r East Side Clinic sponsored by the Erie County Health Department. He formerly was a consulting gastroemerologist at St. Francis Hospital. Portin, a colon and rectal surgeon, is a clinical professor of surgery and chairman of the division of colon and recta l surgery in UB's Department of Surgery . Harrison, a general surgeon, is a clinical instruc tor of surgery at the University at Buffalo. • BUFFAI.O PHYSICIAN AND BIOMEDICAL SCIENTIST J AUTUMN 1989 �Alttmni 30 175 ATTEND1STREUNIONRECEPTION he first annual reception to honor the members of the reunion classes at the Spring Clinical Day/ Re'union Weekendwas held May 5 in the Center for Tomorrowon UB's North Campus. More than 175 alums attended the reception sponsored by the UB Medical Alumni Association. The gala event providedan opportunity for all of the returning classes to mingle and it set a warm and friendly atmospherefor the rest of the weekend's activities. We hope that next year's returning classeswill plan to attend our second annual reception on Friday evening, April 27, 1990. (1-r) Mrs. Raymond Bond, Raymond Bond '44, Helmut Mueller '44, Mrs. Paul Weygandt, Paul Weygandt '44. The 50,year reunion class. (1,r) Sandra Wiltse Logan Gr iffin '59. Leininger '59, Daniel Kozera '59, The 25,year reunion class. BL"FFALO PHYSICIA:S: A:-;D BI0~1EDICAL SCIE1'TIST ��Buffalo Physician & Biomedical Scientist State University of New York at Buffalo 3435 Main Street Buffalo, New York 14214 N,n l <; PAIi) flu Pu Address Correction Requested 998 MR. CHUNG-KAIHUANG HEALTHSCIENCE LIBRARY ABBOTTHALL CAMPUSMAIL �•Profit Org. i/"""g,, f.10, NY. mit No. lll � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician and biomedical scientist, Autumn 1989 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1989-Autumn Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. School of Medicine Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v23n03-1989-Autumn Table Of Contents A list of subunits of the resource. Not just because it's there Like rubbing snow on frost bite We're not hurting animals Medical School News Special section Alumni. Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-11-12 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v23n03 Extent The size or duration of the resource. 45 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1989 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/3a41cae185ffc27558085f42c817f643.pdf e41be51c1198e075933af57621de8e9b PDF Text Text �STAFF DearAlumniand Friendsof the school: EXECLTnVE EDITOR Ul's'IVERSITY PUBLICATIONS Rob,,,, 0 T Marlen Bl!FfALO PHYSICIA!\ EDITOR Conni• C.1-v.-ald Stoflo AITTDIRECTOR Alan stlllln from che fine l"Jirorsh1p of Bob McGranahan to the leadership provideJ first hy Bruce Kershner and no\\' Connie Os,vald Stofko, every auempt has been made for its contents to n:fleccmore fully the life of 1he total m<-.:lica!Khoo] in Buffalo as ·xs·mplificdthrough its multiple constituencies, i.c::.,students, fa,;u!• ty, alumni, parents, and affiliated huspitak The compo,ition of the Advisory Boardwas stn:ngthenc,.I and its functions increased. The n:wurces of the University's publications and public relations staff h,ivc added significantly once-missing support and participation. I am plea5e.,Jthat these efforb have borne 1heir fruit. The publication ll'as n."Cognizedfor its excellence when awardt.-da gold m<-dalin thi, year\ rnmpetition sponoored by the Council for Ad· vancemem and Support of Education (CASE), This organization 1• compo5Cd of representatives from the major colleges and universities located throughou t the United States and Canada, and represems profel<sionalsin the areas of publications, alumni rda· tiom, puhlic n:lation~, and fund rai~ing. Of the 82 publications ,·ith whkh the Buffalo Plry~icianand Biomedical Sc1cn1is1was evaluated, there wen: three go!J medals, three silver medals, and chree hmn:e ml-dais awan.k,J. Alan Kegler, the art direnor; Mrs. Stofko, anJ all of those in• vnlved with this publication ~hould he justifhbly prouJ of this r, >gnit1vn. Thl"y have ,,mrked harJ to bring tn our s(.mstituen • cies a timl·ly, informati\'e puh!ication designed to reflect :111aspects of this medical and hiomedirn! edu.:;1tional enterprise. I hope ~·ou arc as pleased as I am about their success. I look forv,ard to their rnmimR.J innovation~ and contributions in the years ;1head. J. Mo(l,r ADV ISORY BOARD f>r.John Naughton. C~ ,.,...,~ D, Harold Brody l.!.. ~&r><:Y C Dr. J..,,,.,,!-:an,. Dr. ]Okf'h L. Kun1 1),-, CharlN l'aRandli M,. P:aul O P:ner,on Dr. An1rn1m~ l't,1,:n Dt Chorln Ptu<1 Dr. L.nhn- Rol,n,..,n Dr. Thon1;10 Jl.,ocnthal Dr. Sal... la Su,...h Dr. Burton S1¥frn•n Dr. S.,ph.n Spaulding Dr. Ndson Tom Mr. EJ,.·arJ \t', :k Dr. Jero Ya,~ WR ITl::RS ),.hrk Marahdla A<thur P~ Da 1d M. S, ,-Jtrma ILLUSTRAroRS Thomas Roonty Jooq,h Thd P HOTOGRA P HERS M•rk Lrw, la , RalinN di - ,..on To" B,,h \J:'abon TE.ACHING H OSP ITALS AN O LIA ISONS !L,.,,·,a \',,,.,_,,,. ,1 I. /'. f'1--~~-' AJmini1tratim McJ1-.,:, ..,,,,., Ruffalo G,,,~r:,I H,,.pu.-.l, .\t,kc Sn.n.., Buffalo V.-,,,,,.ns AJmm1>1rat1on Modk•I C.enu,r, Joh~l'wH Ch,lJ,en·, H,,,;pit.,I. i,.:_. D,,..,.,.,,._,,.,k, Eue Coun,y \\«h, al C4'n1e \l~,;,,,, ""'""""""'' M=v Ho,p,ul, Clu,d Trlr Dm:m,~ m,.. ~ • 1wD11, "' _,..,,a,..,... .... d Elion, N,,. \D"- S< IJ -,;i ___:, R""' r. :1,.,,...:,,11oo1'l(.\t.C.::>< S,.,- l.1n11rntt;,>I PKn, &./fa o. TIIE BUFFALOPHYSIC!A:,./AMl flll). MEDICAL SCJESTIST tLN'S ". -&::• ··-·· ·"" 191:P, \\,h,mc .: l, :-.:umi-... f'yt, .,hed f,.·e t!meo ,rnn«allv, Sprn,K, Summer, ,\.,,u,nn, l:arlv Wn>t,"T, 11,J La,e ll'1n1er . l'T1he S.hool ol McJi<m<"and ~ .....:!,calSc1en<e,, Su!< lln1<·<1'"1,1< of y N..,. Yotk a< Buffalo, Hl> Main Srr,:c1, Buffalo.:,i,.., York 14214.Third cb~• bulk ""''"F~,J •t Buffa!c,,Nrw Yo,. S.-r,~ aJJ,.,.. changes 10 TIIE BUfFAlO i'HYSICIA1' A1'O 1110.\IEDIC.-\L ::;.c:iE:-.:nsr. 146c.F.s.AJJ"""'· HJ" Mmr, Sm,.,. Buffalo, Ncw York H214. Smmdy, --.. Jo hn N aught on , M .D . \· r~si.Jmt j<H C/m,",! Affair, Dean, Schoolof ~lt-dicineand BiomedicalSciences M,llard F,lln1or,: lfo,pna\, R,..,,,,,~ll P:.rk Mm"'t»l ln,t,tule, J, . Si,,c,; H°'p,t.11, D"""" M,-C.nlr, vcr th_ccou_rse~f the past several year~.the Buffalo Ph;11ician and 81om,:d1cal SciffliLJt has ,;hanged <.:ons,Jerab]y.In its mm• Dear FellowAlumni/Alumnae: I \\'ou!d like to wckome th, · rec, m gradu.1te to th, )\.ledical Alumni A"5Ck.1ati,in.'fou an: . .i' ,,__: m· . :-s >IoJr group l'J also like m extcnJ a warm and ~lnlere invita110n to 1he new m,·mhers nf the Uni\'<c'TsityRe~1Jency Program t,, bccom, a= - :.uc· memh.--, Re:.idcm.smay join even if ihc"Yarc n,1t graJuatrs of the L,11ven11v Jt Buffak S,·hoc: of !l.ledi im and Bio1"1ed1c:il 5' icnce We ,ire your <1rganizationand our sole purpose is 10 wrve you ,nd our medical ochool. 'i\'c- art."very im=reJ in anything VOJ wam to hring to our attemion for aJvice, help, or ~urpon. Be 5Url.Jthat any n,mmunication will be prompdv :onsiderl-d and am,nJeJ to within the bt·s1 ,,four ,1hilities. On annther note, l'-e arc gratified hy thc ,·mhusiast1, l\.">,pon~ to the rail for n,,minet'S for 1he Di~tinguishcd Alumnus Award, This emirwm graduat<c'll'il! be announced anJ ho11oredin the fall. I .· 0- ~ ----;, J o se ph L. Kunz , M .D . �BUFFAlD Ptoc§L~~ Vol. 23, No. 2 Summer 1989 Features II Boonorbane?Nobody wants residents to overwork, but will new State regulations that limit residents' hours help or harm medical education? The debate rages on in Buffalo. II SpringClinicalDay.One speaker urged physicians to take a hand in shaping health care policy, while another said that grapefruit pectin may lower cholesterol. The theme of the alumni-sponsored event was "Nutrition in the '90s." Page32: Polio's Aftermath Departments Page 18: Nutrition fl MedicalSchool News. Lectures and conferences covered topics ranging from microbial pathogenesis to the question of whether we have enough doctors in this country . And UB's Match Day was better than ever. I.DJHospitalNews.Treating the fetus as a patient is the focus of the new Buffalo Institute of Fetal Therapy at Children's Hospital. Over at the Erie County Medical Center, they're struggling with post-polio syndrome . Page 2 7: Match Day IJ People.Leon Farhi, chairman of physiology, has been named a distinguished professor by the State University of New York. He was honored for his years of work in human lung gas exchange and the human circulatory system. Page25: Milk & Sleep IJl Research.Routine ultrasound screening of infants could pick up "silent" urinary problems, say UB researchers. ImClassnotes.Find out what your former classmates are doing nowadays. Cover Photo: &b Walion Page 26: Luc Montagnier �2 Boon or Bane? Debate ragesover new regulationsfor residents BY CO~"\IE OS\\ ',\LD STOFKO ependingon whom you talk to, new regulations on residents' hours and supervision are improvingor destroyinggraduate medical educationin the State. They're saving or jeopardizingpatients' lives.There will or won't be enough money and staff to implement the changes. One chairmansaid the potentialfor harm in his residencyis so great, he'd rathershut down his pro­ gram than beforcedto limit hisresidentsto working only 80 hours a week. Another chairmansayshis specialty is already in compliance. PIIOTOS BY BOB \\'J\L I O ' �3 .· ·11 1 1·2' ·10 3. ·9 .8 l l ~ s. 4• 6:01 a.m. Monaa1 Holx-n OriSC'OII.ll:ft. chief surgical residen1. s1ans his 37-hour day ai Buffalo General 1 1osp i1al. ,\ day 111 the lif e of a resident. as chro ni cled in 111 ese p ll otos. would change under nc-w Staw wgulations. BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST SUMMER 1989 �ne student chose an out-ofState residency because he says rhe regulations will damage education, while another stayed in New York because he says the regulations are humanizing medicine. The changes limit residents to working no more than an average of 80 hours a week, with 24 consecutive hours off each week. They also mandate increased supervision of residents. Other changes in the code mandate more formal credentialing of residents' skills and limit residents in emergency rooms to 12-hour shifts. (See box for derails). The 1984 death in a New York City teaching hospital of Libby Zion, 18,the daughter of a well known journalistlawyer, led ro a grand jury investigation. Though rhere were no indictments in the case, the grand jury made several recommendations concerning emergency room staffing, the supervision of residents, and residents' working hours. Then the New YorkState Department of Health appointed an Ad Hoc Advisory Committee on Emergency Services, chaired by Bertrand M. Bell, M.D., a 1955 graduate of UB's medical school. The committee recommended derailed policies on which the new regulations are based. The starring dace for the regulations on residents' hours and supervision was ro have been July 1, but that was uncertain at press time because the Hospital Association of New York Scace filed litigation in State and federal courts to have the regulations deferred. The hospital association proposed that if the regulations are deferred, hospitals and medical schools should develop policies to meet the intent of the regulations. . There's vociferous disagreement on Just about every part of the regulations, but one thing char everybody agrees upon is that the intent is good. The purpose of the changes is ro improve patient care by making su~c t~at residents don't work when they re improperly supervised or sleep-deprived. The changes also try to regain a balance between education and service residents are employed by hospitals, but they're there to learn. 0 4 SUMMER 1%9 A second point of agreement is that the regulations present a number of hurdles. It means a rethinking of the educational system. "We'renot saying it's going to be a piece of cake; conceded a spokesman for the State Department of Health. W cent are we interfering with the educational process and how do we plan co compenate?" In surgery, the regulations are interfering to a great extent and there's no way around it, shore of shuning down the residency program, according to Lewis M. Flint, M.D., professor and chairman of surgery ac UB. If the surgery program is forced to obey the letter of the law, it will damage surgical education so much that it would be better to stop training surgical residents. "I'm quire sincere about ir; he said. Ocher specialties have been able to meet the regulations by reducing the number of patients they see, Flint said. But each surgical resident must perform a minimum of 600 surgeries with in 55 months of training co meet national standards, and UB e..xpectsresidents to perform 800 surgeries. Flint complai ned that the figure of 80 hours a week was chosen almost at random. He doesn't see how residents can work less than 96 hours a week. The program trains residents co act like surgeons, he explained. A surgeon cares for the patient before, during, and after an operation. "Ifa resident operates on a patient, the resident is given as much responsibility for care of the patient as he's capable of shou ldering; Flint said . That includes staying with a patient whds having tro~ble, no matter how many hours the resident has already worked. "If we asked a resident to leave at the end of his shift, he would say 'no; no matter what the health department said; Flint asserted. "They like taking care of their patients and they rake their obligations co patient care very serious ly." hile several other states are examining these conce rns, New York is the first to impose new regulations. Many people question whether these regulations, as written, are the best way to meet these lofty intentions. "Are we improving services co patients? Arc we improving education?" asked Michael F. Noe, clinical associate professor of social and preventive medicine. "There arc a lot of suppositions here that haven't been tested. I'm not sure we have rhc answers co chose questions . "If you decrease the number of hours of experience in the clinical arena by re• quiring residents to work an a~e:3ge_of 80 hours a week, arc you depriving individuals of a certain number of decision-making experiences that are crucial? Will you have to increase the length of training? That question is unanswered; stated Noe, who is also chai rman of the coordinating board and the administrative commince of che Graduate Medical-Dental Education Consortium as well as vice president of he problem could be solved by adding professional affairs at Buffalo General a year co the residency program. Hospital. "There are 100 good reasons for "The fact of the matter is, patient care lengthening the training program, but is a critically important clement in that's nor one of them; Flint said. "A betgraduate education. By decreasing the ter alternative would be to close the pronumber of experiences, you're abgram." breviating the educational process. He criticized the health department for "I'm certain ly not advocating that peomaking wholesale changes in the educaple work in a sleep-deprived state, or that tional system without any evidence chat we should put people through an exrhe changes will work. perience chat is physically or Referring to the death of Libby Zion, psychologically harmful. Bue to what exFlint said, "The incident that precipitated t BLIFFALO PHYSICIA!s AND BIOMEDICAL SCIENTIST �1v ~ c-1I',-- 5 '- this hysteria - and that's what it is, hysteria - happened on an internal medicine teach ing service. "It can't happen on a university surgical teaching service. A jun ior resident is not left alone to make a life-and-death decision ." Junio r residents are supervised by senior residents, who have usually been out of medical school for six years that's longer than some residency programs in other specialties. A major operation is almost never performed without the attending physician in the building, Flint added. There's no data stating chat residents are making poo r judgements because of sleep deprivation, he said . The only data t hat exists says that surgeons get grumpy after being up for 36 hours . Flint expects that the new regulations will be modified . "If they're not, then we're going to have a lot of trouble in surgery; he said . At the othe r end of the spectrum is family medicine, wh ich is already in comp liance with all aspects of the regulations. The maximum workweek for family BUFFALO PHYSIClAN AND BIOMEDICAL SCIENTIST 6:30 a.m . Mo n day Oppos ite page. s urgica l reside rns discuss cases befo re rou nds. 6:44 a.m. Monday Above. Drisco ll sees pa licni s ,n irnc nsive care. 7: 17 a .m. Monday 1.. ef 1. studc rns and rcside rns go 10 a m ee1ing. 10.2 1 a.m. Mo nday Bonom lef1. Drisco ll prepa res fo r surgery. medicine residents is 75 hours, noted Thomas C. Rosentha l, M.D., director of the family medicine residency at UB and clinical associate professor . For years family medicine has used a system of supervision that meets the new requirements. "The faculty is active in patient practice," said Rosenthal, who is also director of the Office of Rural Health. "We utilize, but don't rely, on residents for care." Family medicine is an outpatient specialty, Rosenthal noted . Forty per cent SUMMER 19S9 �6 ·, V 2. ·10 ·9 .8 ~ l ~ 3· 4. 5. ' I.! o:; p 111 \/0111 I, 11 ,\IXM'. l>n."',~I Ix·11onns d ....1gmrncl ( ol<'( IOlll) umlcr 1lw w,111t1ful n 1· or ..,urg,·on lt~ph ( ,HU,Hld J .io p 111 \/011d,1\ OPIX)",llt' p.ag(' I1111",lllllg Ill<' -.,urger) .i 20 pm \/()ll(/d .\ Bdow IJn',!·oll hrt'cll-..., tor lunch w11h S11·,1· S( .ahd. a -.urgw.il r, ·..,1clt·111. 111<'11 ",f wncl..,IIW t'\t'llllls;l Ill lllt'('lings , 111<1I 'Xillllll1111A ;,;.r,l\ 'S . • of residents' time is spent in outpatient care. Ocher specialties fall somewhere between surgery and family medicine. For instance, overall, residents in gynecology and obstetrics work 80 hours a week, but "overall" is the key word, noted Myroslaw M. Hreshchyshyn, M.D., professor and chairman of gynecology and obstetrics at UB. At Children's, which is UB's main and busy - obstetrical site, a resident works in labor and delivery the entire time he is on call. At ECMC, che resi- llLFFAIO PHY~IUAN AND BIOMEDICAL SCIENTIST �dent works in gynecology and may have to attend patients in the emergency room or occasionally perform emerge ncy surgery at night . Otherwise, he can sleep. During a rotation at Children's, a resident may average 90 or 100 hou rs a week, but at ECMC, average only 65 or 70, Hreshchyshyn said. The regulations force the program to distribute work more equally, but Hreshchyshyn doesn't anticipate a problem. He sees more difficulty with the supervision requi rement. The program has BUFFALOPHYSICIAN AND BIOMEDICAL SCIENTIST been working toward providing better supervision for residents already, but che law makes it inflexible and costly, he said. Five years ago, full-rime faculty members started caking turns spending one or two nights a week at Child ren's Hospital co supervise residents - free of charge. "I sold them on the idea because it was good practice, it was good for the patient, and it was good for the resident," Hreshchyshyn said. Little by little he was introducing the idea to each hospital. About a year and a half ago, full-rime and volunteer faculty members at Buffalo General Hospital started spending nights at the hospital. Bur because it was prompted in part by a shortage of residents, the faculty members asked co be paid, Hreshchyshyn noted. Since the supervision at UB's hospitals is being mandated, rather chan performed by faculty of their own volition they too will want to be paid: Hreshchyshyn predicted . Ultimately, his department will find ways to adjust within constraints of the law, he added . Flexibleor inflexible? t he inflexibility of the regulations is the big drawback, agreed Gerald Logue, M.D., chief of staff at the Buffalo Veterans Administ ration Medica l Ce nter. He is professor of medicine and head of the Division of Hemato logy in the Department of Medicine at UB. "The point needed to be made that the re should be a ba lance between education and service , but the point is being made with a nuclear weapon," Logue said. "There are ocher ways co make sure residents are awake and alert chat still allow you educational opportunities . "If these regulations were less driven by hours, it would be better . The hou r thing limits your flexibility." Because che regulations are so rigid, the continuity of care is disrupted, Logue said. Residents can be on call any night of the week, buc outpatient clinics are scheduled only on certain days. If a resident works at night, he has to miss the clinic the next day. Yeea very important need in medical education is co have residents see more ambulatory patients . And residents teach medical students. If the residents aren't around , the education of the students will suffer, Logue said. Because of the invasiveness and intrusiveness of governmental regulations, New York State is the worst place in che country co practice medicine, Logue complai ned . "The regulatory climate is going co drive good people out of New York Stace; he said. Vicki Zeldin, a spokespe rson for the health department, countered chat che regulations are indeed flexible. The rules say chat residents shouldn't work more than an average of 80 hours a week, she pointed out . Some weeks they can work more. "We're not going to be there scopwacch in hand," Zeldin said. "The bottom line is, if someone is coo tired co serve patients adequately, chat patient's life is in jeopardy ." She said chat the position of David Axelrod, M.D., the Scace commissioner of health, is chat "if these regulations didn't go into effect, patients would die. They're very important to the quality of care. "Personally," Zeldin said, "if 1 had the choice between being treated by the same doctor who had been up for hours SUMMER 1989 7 �8 n r 8.20 /l Ill. Monda_, . Driscoll. top lctt. explains 10 a patien t the de tmc1emen1 he'll perform w11I) caruana 8 :32 p m Monday Top ngh1. DriS<"0II helps transport l.>illient 10 surgery 9 pill . .\1011( /cl_\' Lower left. surgery conunues un11I 10:so p.m. .\lidnig/11 At lower right. DriS<"oll discusses a case wilh 01her residents . so I could have continuity of care, or getting a fresh doctor, I'd choose a fresh doctor." Residents rend to resent patients near the end of an exhausting 36-hour-day, she added, and these regulations are necessary to remove some of chat resentment. "Frankly, these are new regulations," SUMMER 1989 Zeldin said. "If we find that physicians all over the State are saying that they can't spend enough rime with patients, we would listen." Nobody is ever comfortable with changing from the familiar way of doing things, she pointed out, and that may account for some of the concerns people are expressing. Residents themselves view the regulations as benign, said James Woytash, D.D.S., M.D., chairman of the House Scaff Committee of the Graduate Medical-Dental Education Consortium. The new regulations "provide the best of both worlds. "They give residents time to spend with patients, and they give them time to keep up with the medical literature and have time for a personal life,"said Woycash, a fourth-year resident in pathology at the Erie County Medical Center. "It looks very promising." Residents in some specialties, especially surgery, are worried about seeing their cases through to completion, he said. They're also concerned that if there's nor enough money to hire all of the needed ancillary staff, patient care will suffer. While residents weren't demanding the changes, no one has left UB because of them. "The doomsday prophets were saying it was going to drive people away from New York State in all areas of medicine," said Woytash. But looking at the latest Match Day results, "the great exodus out of New York Seate hasn't occurred:' For UB medical students, the percentages of people choosing to stay in New York State are about the same as in previous years. From 1985 to 1988, between 56 per cent and 66 per cent of the class stayed in New York. This year, 62 per cent stayed . Anecdotal information from fourthyear medical students at UB, however, indicates mixed feelings about the regulations. John Osborn feels that the regulations will damage the training program in New York, so he accepted a pediatric residency at the University of BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �Washington in Seaccle. Classmate Doug Sillarc, on che ocher hand, says che regulations are "making medicine more human ." He chose a residency in internal medicine ac Millard Fillmore Hospital in Buffalo. Ocher students were confident that, no matter what specialty they chose, the regulations will have no effect on them. "l doubt it's going to affect surgeons; said Joseph Ciac ci, who accepted a surgery residency at Mt . Sinai in New York City . "It wasn't designed around surgery residents. The system for surgery is okay as it is. I really think I'll be working just as hard as residents did in the past." Some students who chose out-of-Scace residencies noted char those states are looking at similar regulations, but they aren't expected co be as drastic as New York's. 9 B:50 a. 111. Tlicsdm• Mi er ge 11 111ga • r ha n,e 10 slccp tro m abo u1 1-30 a rn 10 6a m .. 1tw n ro ndu,li ng rou nds and see ing pa 11 e111 s. Drisc:oll rt' \'l t' W S 1cx 1s 111p rcpara 11 on fo r vascu lar surgny Is it practical? e ven if you agree that we shouldimplement these new regulations, many people ask, "can we implement them?" The two biggest concerns are whether there will be enough money and staff. "We believe that the changes to the code carry a very important message; said Thomas J. Faith, assistant administrator ac the Erie County Medica l Center. "They establish a daily menu for che quality of care. I believe that with all my heart . "But being able to do it is another matter." But when push comes to shove, ECMC won't cut back on services, he emphasized. The hospital administrators interviewed agreed that, somehow, they will comp ly with the changes. Bue it won't be easy. "Down the line it might be bette r, but the transition will be wicked; noted Marcia A. Brierly, administrative director in the Department of Medical Education at Millard Fillmore Hospital. The health department says that funding for the changes is available, though the hospitals wonder . Private hospitals, and even the Erie County Medical Center, get most of their funding through third-party payers BUFFA ID PHYSICIA N A ND BIO MEDICAL SCIENTIST ,. Illa..: SUMMER 1989 ��(such as private insurance companies or the Stace's Medicaid program). The State regulates the rates that hospitals can charge third-parry payers. In July, the rates are being increased and the hospitals in the State will receive an extra $270 million to cover the coses of the changes, said Zeldin of the health department. Since an outside consultant had estimated the changes would cost between $200 million and $300 million, chat amount is in the ball park, she noted. Bue since the regulations are so new and haven't been implemented yet, "there's a concern as to whether anyone knows what the financial impact will be," countered Brierly of Millard Fillmore. "It's difficult co know whether chis will cover everything." Finan cially, the Batavia and Buffalo Veterans Administration Medical Centers operate a bit differently from the ocher teaching hospitals. Their funding comes from the federal Veterans Administration, noted Logue. So far, the VA hasn't promised any new money for its hospitals in New York State co meet the code changes, but Logue predicted chat the federal agency may allocate extra funds as other states adopt similar regulations. In the meantime, the Buffalo VA Medical Center will spread its resources more thinly. "It'll be macaroni and cheese instead of steak," said Logue. Cutting back on che number of hours a resident can work is creating a manpower shortage, hospital representatives agree. "The bottom line is there'll be less work done by residents, so there has co be some other way co take care of patients," said Logue. Hospitals are adding more staff, with nurse practitioners and physician's assistants most in demand. Bue since the regulations have created a new demand, they've become hard co recruit, noted Logue. t he health department's position is that it may be difficult, but it's doable. "Our belief is that, except for isolated incidents, hospitals will be able co find BUFFALOPHYSICIAN AND BIOMEDICALSCIENTIST II I the staff; said Zeldin. "They should be able co find the ancillary staff and use attendiings without having to hire a lot of extra people. We're not saying it's going to be a piece of cake." The health department isn't going to be counting heads on Day One of these regulations; it just expects a good-faith effort from the hospitals, she said . Hospitals are also looking at adding more registered nurses, phlebotomists, IV teams, and transport people. Logue said that the cost for additional staff at the Buffalo VA Medical Center is approaching half a million dollars. Bue he conceded that it's hard to sort out which changes are being made simply co meet these new regulations. 1p m . -niesda.1 ,\ l>O\' C , Drisco ll :,a w m o re paueni s ,-md 100 k a s h o n brea k l.>e fore \ 'lt' Win g X-rays Wllh Jo hn HIC-Olld. , ·.i:,cu la r s urg eo n opp os i1e pa ge. Orisco ll sc nil , s up lor a \'C'in by pass ~rail SUMMER 1969 �12 "We probably would have had to add an IV team anyway," Logue pointed out. "There was too much service and not eno ugh education going on. If these regulations hadn't come a long, something else would have forced us co do this." To meet the staffing crunch, hospitals would like co hire more residents. Bur the number of residents a hospital may hire is limited by the accrediting bodies, explained M. Luther Musselman, M.O., director of medical education for Millard Fillmore Hospital and clinica l associate professor of medicine. Besides, it would be expensive and difficult to find enough qualified residents to fill some slots. One hospital chat is adding more residents chis summe r is Sisters Hospital. Five new residents from osteopathic schools will start in a program that was begun independently of the health code changes, said A. Charles Massaro, M.O., vice president for medical affairs at Sisters and clinica l assistant professor in medicine and family medicine at UB. Fortunately, the timing is convenient. Sisters also plans to spread hours a bit more evenly between junior and senior residents. Normally, as a resident advances, he spends less and less time on call, Massaro explained. "But (senior residents) are going to have to, much to their chagrin, work more on call; he said. "It was a nice little perk they had, but we can't do it any more. I don't blame them for not liking . " It. While hiring ancillary staff is the hospitals' main strategy, it's only a stopgap measure because "it only helps solve the problem with hours; it doesn't solve the supervision prob lem; said Brierly of Millard Fillmore. In the past, attending physicians or the patient's doctor were on call and could be reached by phone if a resident had questions at night. The supervising physicians had to be able to get to the hospital within 20 or 30 minutes. Now, supervising physicians in seven acute care areas - internal medicine, family practice, surgery, anesthesiology, obstetrics, psychiatry, and pediatrics must be at the hospital 24 hours a day. A resident who has completed four years, or is in his last year, of his residenSUMMER 1989 BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �13 cy may supervise ocher residents. To solve chis problem, hospitals have several choices: • Require fellows in subspeciaky training to work at night. • Use senior residents to supervise ocher residents. • Hire attending physicians and pay them per hour to stay in the hospital at night. • Require full-time faculty to periodically spend a night in the hospital. Each of these solutions has its drawbacks. Fellows in subspecialty training won't be attracted to the idea of overnight shifts and it may interfere with their education, said Noe. The problem with hiring senior residents is that there are few of them and, like all residents, they're limited to working no more than 80 hours a week. When it comes to hiring attending physicians, money and availability are the two big drawbacks. BUFFAID PHYSICIAN AND BIOMEDICALSCIENTIST "Physicians are just not out there to hire," said Faith of ECMC. And even if you can find them, you have to be able to pay chem competitive wages. 1:50 p.m mesdm Top ld1 . Hicoua · and Driscoll make rinal prepara11ons 10 1he pa11cnrs leg before ;,urger~ 2 pm nwscfm Bollom 1cr1. suriery Noe estimates chat it would cost at least $350,000 to $400,000 a year to provide 24-hour coverage in one specialty in a single hospital. And what happens to the attending physician who takes care of his practice all day, supervises at the hospital all night, and sees his private patients again the next day? asked Brierly of Millard Fillmore. Another twist to this dilemma is that making night shift work lucrative in order to make it appealing to physicians could work too well. Some doctors may decide to work only nights, she said. Musselman added that with so many of these night positions opening, we may run into a shortage of physicians in the nexc few years . "We'recreating a monster in a different area," Mu sselman predicted. lxgins. 3.10 p.m nwsc/c11· they · prepare 111evein 10 1\!)0ve. l)(> gral1ecf a nocher option is to require UB faculty members to stay overnight in the hospital. "Historically, the residency training experience was chis opportunity to have as intense and as emergent training in patient care as possible," explained John Naughton, UB's vice president for clinical affairs and dean of the medical school. "Residents providing coverage in hospitals around the clock goes back to the cum of the century. The supervising physician can usually go home at night, permitting the resident co fill the gap." Bue that is changing and will be extremely difficult for physicians living in large SUMMER 1<189 �I urban areas such as New York City. Each medical director, with each director of service, is working out what faculty 14 doctors have to be at the hospital overnight, the dean said. The department faculty are involved in the decision. Bue the definition of who may be a supervisor poses a problem, Noe pointed our. Supervisors in certain areas must be board-certified or board-admissible physicians. Bur there are fully qualified physicians who may have chosen co skip the adding char the question may end up being settled in court . If the attending is held responsible for any mistake a resident makes, attendings may view the supervision of residents as a high-risk enterprise they'd rather avoid, predicted Faith of ECMC. Eventually, there might not be enough attendings to supervise residents and the number of people in graduate education could decline. Noe also questioned whether teaching hospitals are being asked to meet a higher standa rd than community hospitals char aren't required to have a full array of specialists on site. "Presumably, the management of patient care at those hospitals can be provided by somebody who can be called from home," he said. ''.A.rewe defining a different, higher level of patient care in teaching hospitals than in other community hospitals?" Otherregulations a certification test and, because a certain time period has elapsed, are no longer eligible to become board certified. "So does a program director have to make a distinction between his faculty?" Noe asked. "It's causing some uncertainty among program directors." Conversely, he pointed out, a physician who is board certified and, by definition, is qualified to supervise residents, may be a subspecialist who finds it difficult to supervise a broad array of problems. Still another problem with on-site supervision of residents is the question of liability of the supervising physician. Can one attending physician be available to perhaps 5 to 10 residents, each of whom is responsible for IOto 20 patients? "Can the attending physician carry that responsibility and meet the intent of the standard? It's uncertain; Noe said, norher portion of the code called for more formal credentialing of residents' skills and for limitations on residents' hours in the emergency room . Generally, those have been easier to meet. For UB, it was a challenge to invent a system that could be shared by its nine different reaching hospitals. A task force of the Graduate MedicalDental Education Consortium, headed by James M. Hassett, Jr., M.D., associate professor of surgery, set up the system. He is also assistant professor of biophysics and anesthesiology . Before the changes, when a supervising physician deemed a resident had shown he was able to perform a procedure satisfactorily, the supervisor gave the resident permission to perform the procedure on his own . The documentation wasn't structured and there wasn't communication between the hospitals. Now the faculty in each specialty have defined uniform criteria char residents must meet before they're allowed co do a procedure on their own. A computer is used to record the number and types of procedures residents do under supervision. Looking at a resident' s record, the chairman decides whether to grant privileges to the resident. When residents move between hospitals, their records move with them. While chis is probably rhe easiest and cheapest of all of the code changes, administrators at Millard Fillmore Hospital noted chat the start-up costs alone at their hospital ran $45,000 . Still another change in the code, in place since October, requires that residents and attending physicians in emergency rooms be scheduled for no more than 12 consecutive hours. The atrendings in rhe emergency room can't be the same ones cover ing the rest of the hospital. Again, cost and manpower are the issues. Faith of ECMC estimates that it will cost about $1 million a year just for physician coverage at his hospital. Rural hospitals probably have the toughest time recruiting physicians, bm city hospitals are scrambling, too. "We're recruiting nationally to staff our emergency rooms and we're just making it," said Musselman of Millard Fillmore, though his hospital was one of several Buffalo hospitals chat had mer the regulations before they went into effect. Noe pointed out that the medical school is planning to establish a residency training program in emergency medicine for 30 residents . "As the program develops it will go a long way to relieve the manpower problems, particularly upstate," he said. Also easing the problem is the fact that people in internal and family medicine are showing more interest in emergency medicine. "I don't think there's any doubt that (the changes to the code) are burdensome," said Naughton. "It's seen as adversaria l rather than as a positive thing. "Bur for us as a medical school, the changes create an awareness that we need to do a better job of supervising our srudents and residents and of credentia ling them. It makes good pedagogical sense. "Sometimes we don't solve a problem without a crisis. In the short haul, it may be tough. But in the long haul, we • should be able to do it." BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �SUMMARY HOURS Effecnw:JwlyI, /989 • Residents may be scheduled for no more than 80 hours a week, when averaged over four weeks. • They may be scheduled for no more than 24 hours in a row. • On-duty assignments must be separated by at least eight hours of non-working time. • Residents must get 24 consecutive hours off each week. • Hospitals must enforce policies that prohibit combined assigned hours and moonlighting hours from exceeding the limits on assigned hours. • In certain departments that don't have a high volume of acutely ill patients and where the resident is able to get enough rest, there JS more flexibility in scheduling. (Ex eluded from this clause are anesthesiology, family practice, medical, surgical, obstetrica l, or pediatric services.) ... •,i t',· /10 :9 ·.8 lil. 2· 3: -, 4.- .7 .? _s•. s p.m . Tuesday Opposite page. finishing surgery 6:50 p.m . Tuesday TOp. Driscoll confers with or . M. carlin and Dave 1tarshman. a surgical resident. 6:57 p.m . Tuesday center. Driscoll examines a patient. 7:05 p .m . Tuesday Driscoll and photograph er BOb Walion end their workday . ON-SmSUPERVISION Eff«aw:1111, 1 989 • A sufficientnumber of supervising physicians must be present tn the hospital 24 hours a day m the acute care specialties of anesthesiology, family practice, mediane, obstetrics, pediatrics, psychiatr¥ and surgery. • Supervising physicians mustbe. board certified or board adm1ss1ble, or have completed a minimum oJ four years of postgraduate tramingi • The supervising physician may be a resident in his final year ofpost graduate training if the padeJj physician can get to the hosp within 20 to 30 minutes of beliDRP called. CREDENTIALING E/f«tiwJan.1 1989 • The medical staff must written documentation o care privileges granted to EMERGENCY ROOM Eff«tiw • Residents and attending ph cians can be scheduled for no mote than 12 consecutive hours. SUMMER 1989 15 �I 16 Samuel 0 . Thi e r �Spring Clinical Day 17 Doctorsurged to shape national policies l 1 l BY CONNlE OSWALD SlDFKO = ~ f physicians don't take a hand in shaping this :::: country's health care ::: policy, they're shirking their responsibilities, according co Samuel _.._-_ ~ 0. Thier, M.D., president of the Institute of Medicine of the Nationa l Academy of Sciences . Physicians should be key players in deciding today's tough health care issues, but "the silence from the medical community is deafening," said Thier, who gave the annua l Stockton Kimball Memorial Lecture at chis year's Spring Clinical Day on May 6. The United States leads rhe world, but we're at a point of instability, said Thier, who is also visiting professor of medicine ac che Johns Hopkins University School of Medicine and clinical professor of medicine ac the George Washington University School of Medicine. It's rime to choose whether we will evolve and remain leaders, or give up chat leadership to some ocher group . Ideas for evolution are desperately needed and they have to bubble up from the medical community. "I don't see a sense chat we're engaging the issue," Thie r said. "What will replace chis? We have the responsibility co chink about what we want next." The policy makers in Washington view the medical community "as apologisesfor the status quo" rather than an active - BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST Physiciansshould be key players in deciding today'stough health careissues,but "the silencefrom the medicalcommunity is deafening,'' said Samuel 0 . Thier, M.D. of the National Academy of Sciences. force for change, Thier noted. One of the issues facing physicians today is access co care. There are 35 to 40 million people in this country with no hea lth insurance at least pare of the year. One to two million are turned away from care, and the rest don't seek care as often. When Thier was a resident at Massachusetts General, physicians who wanted hospital privileges had to contribute time to care for the indigent . Now, some physicians feel that if they're not reimbursed for care, they don't have to provide it. "I believe chat's an abrogation of our social contract," Thier said. Some social problems, such as teenage pregnancy, the indigent, and aging, aren't dealt with adequately because physicians cry co force the issues into a medical model, T hier said. Picture the elderly person who lives in poor housing: he or she becomes depressed, doesn't eat much, and gees pneumonia . The physician successfully treats the pneumonia and sends the person back to the same house. Rather than just treat the pneumonia, we need co keep people functional, Thier pointed out. He noted that in Japan, they tail off the money they spend for medical care for the elderly and spend it instead on housing and fo.od. In this country, we need to create some kind of a plan chat uses preventive strategies and somehow moves from a medical model to a social model, he indicated . We made a mistake 50 or 60 years ago when we separated schools of medicine from schools of public health. "If we simply watch the scene evolve, we won't have met our professional responsibilities," he concluded. • SUMMER 1989 �Spring Clinical Day 18 PECTIN It thickens jelly, but can it thin arteries? �Spring Clinical Day 19 WR:R:T TJE N JBY CON ][JE ((})§W A JLD §TO>FKO utrition in the '90s" was the theme of the 52nd annual Spring Clinical Day, held May 6. The event, which also ) included the class reunions, was sponsored by the UB ) Medical Alumni Association. The topics of the scientific sessions were nutritional of cholesterol; epidemiology of nutrition management and cancer; recent advances in characterizing and managing obesity; new fuels for the gut, and normal nutritional requirements. CHOLESTEROL I II chink we can lower plasma cholesterol and LDL (which is connec ted to an increased risk of heart disease) with _ , .,..v.,a grapefruit pectin and no change in diet," said James J. Cerda, M.D., professor and associate chairman of the Department of 1 , ,I"' 0 • Medicine at the University of Florida at(: ~ Gainesville . According to studies performed by Cerda and his colleagues, grapefruit pectin appears to lower cholesterol. (Pectin , is a water-soluble fiber that binds adjacent cell walls in plants . It's used by homemakers in preparing jellies and jams .) will actually reduce atherosclerosis once In experiments with pigs, Cerda found it forms. That's an important question that even when fed a high-fat diet, the because most of us already have atheropigs' cholesterol decreased when they sclerosis, Cerda reminded his audience. were also fed pectin . The pectin also apThe researchers also conducted a peared to prevent atherosclerosis, the double-blind trial of people with high plaque buildup that results in narrowing cholestero l who couldn't or wouldn't of the arteries. change their lifestyles. He noted that it The next question the researchers wasn't hard to find subjects. would like to look at is whether pectin r. ) ) ][JLJLU§TRAT][O) BUFFALOPHYSIC IAN AND BIO MEDICAL SCIENTIST BY The researchers found that pectin was ,statistically significant in reducing ·cholesterol. One-third of the subjects had at least a 10 per cent decrease in cho lesterol while taking pectin. Cerda emphasized chat he's not suggesting that people rely only on pectin to lower their cholesterol. They should also eat a good diet and get exercise. Since it's important for physicians to advise patients about diet, medical schools shou ld prepare them by teaching nutrition as part of the curriculum, Cerda added, and physicians should also rely on dieticians more than they do. CANCER W hen it comes to reducing the risk of cancer, fiber - but not just any fiber - may be beneficial, according to Saxon Graham, Ph.D., professor and chairman of Social and Preventive Medicine at UB. Vegetable fiber, but not fiber from grains, is helpful in reducing the risk of Jr({))§JEJP>H THIEJL SUMMER 1989 �Spring Clinical Day I zo rectal cancer, according to a study by Jo Freudenheim, assistant professor in Social and Preventive Medicine at UB. Graham pointed out that that's not the fiber the National Cancer Institute cold us to eat. Vitamin A may reduce the incidence of cancer of the mouth, larynx, esophagus, bladder, lung, and cervix, he said. As well as searching for foods char prevent cancer, researchers are also on the lookout for ones chat cause cancer. There's epidemiological evidence eying the amount of far in one's diet co both colorecral and breast cancer, Graham said, but he cautioned that it's a leap in logic to say fats cause chose cancers. He also observed chat closely associated with fats are obesity and the coral calories ingested. These interrelated factors could be connected co cancer of the colon and rectum. And since physical exercise can reduce obesity, exercise may also be associated with decreased risk. Ir is also possible chat exercise by itself may reduce the risk of colon and breast cancer. While the ocher recent, well-publicized recommendations of the National Research Council seem well-founded, there's little epidemiological evidence to support its advice co decrease the protein SUMMER 1989 in our diets or to increase grains or calcium, Graham said. The first strategyin dealing with obesity should be prevention. Physiciansshould recognizethe family at risk - whereone or both parents are obese. OBESITY T he first strategy in dea ling with obesity should be prevention, said Lyn J. Howard, B.M., B.Ch., ER.C.P., head of the Division of Clinical Nutrition at Albany Medical College. Physicians should recognize the family at risk - where one or both parents are obese, said Howard, who is also a professor of medicine and associate professor of pediatrics. Children shouldn't cross over their growth curves, even if the children are at the correct weight for their height. Also at risk of obesity are people with a low resting metabolic rare. Those at risk should hold down their calorie intake, particularly during periods of rapid growth, such as during the fetus' last eight weeks of gestation, early infancy, adolescence, and during pregnancy for women, she recommended. Physicians must advise patients about the fat in their diets. The percentage of fat in the diet, rather than coca! calorie intake, is a big contributor co obesity, Howard explained. Because the sympathetic nervous system regulates the mechanisms that tell the body chat it has had enough co eat or chat it needs to burn up calories, anything that turns on the sympathetic nervous system is beneficial. The best thing is exercise. "Diec is not the first thing, but exercise is," she emphasized . "Exercise has to be a forever commitment." Another thing that cums on the sym- BUFFALOPHYSICIAN ANO BIOMEDICAL SCIENTIST �Sprmg Clinical Da:,· 21 pathetic nervous system is the carbohydrate content in the dier, so people should use carbohydrates as their chief calorie source. For people who have become obese ro a point where it's affecting lifo expectan· cy and health, strong consideration has robe given ro the possibility of performing surgery, Howard noted. 1'\·o pro· cedurcs, gastric bypass and vertical banded gasrroplasty, restrict food intake and ro some extent impair food digestion. They have a 60 ro 70 per cent success rare. However, gastric balloons haven't proved safe or effective, she pointed our. Howard mentioned rhar some new drugs to aid weight loss may be available in the next decade. They will be aimed at increasing rhe mobili:arion of far, mimicking satiety, and delaying gastric emptying. FORTHEGUT FUELS I n certain conditions where the intestines aren't working properly, it may help ro feed the intestines certain fuels that their mucosa use best, said John L. Rombeau, M.O., director of the Nucri• tional Support Service at Philadelphia Bl.:FFAW PHYSICIAN AND BIOMEDICAL SCIENTIST Medical Administration Veterans Center. Patients with intestinal malfunctions are often placed on a regimen of "bowel rest" and fed in a way (such as intravenously) that attempts to bypass the intestines. Bue bowel rest has side effects, noted Rombeau, who is also associate professor of surgery at the University of Pennsylvania School of Medicine. The gut begins to arrophv and the muscous lin• ing of the intestines begins ro function poorly. Studies show that in selected conditions, it may be preferable to feed the intestines certain fuels char the mucosa use best. For example, glucamine, a non-essen• nal amino acid, is seen as the preferred fuel for the enterocytes, the cells that line the small intestine, he explained. Shorr-chain fatty acids are rhe preferred fuels for the colon, with soluble fiber, such as pectin, as a precursor. When part of the intestine is removed, the addition of pectin to a liquid diet improved adaptability of the remaining portion of the intestine, Rombeau explained. Pectin also decreased diarrhea. The shore-chain fatty acids improved the strength of the colon. EMENTS L NORMAREQUIR I t's difficult to establish nutritional requirements, noted Jorge E. Albina, M.O., associate director of the Nutritional Support Service of Rhode Island Hospital. Minimum requirements arc defined as the minimum intake that will maintain adequate function and health, explained Albina, who is also assistant professor of surgery at Brown University. But adequate for what, he asked. ls the goal to reduce dietary diseases such as scurvy? To maintain good health? To reduce the risk of other diseases such as cancer? For hundreds of years, we've been try• ing to figure out what kinds of foods and how much food people require. The first recorded nutritional allowance was written in 1753 when British sailors were told to drink an ounce of lemon juice a day to prevent scurvy. Recommendations have changed over the years, and today different dietary boards disagree on minimum nutritional requirements. "If we try to answer the same question: 'How much food does man require?; I chink we still don't know, but we're learn• ing pretty fast," Albina concluded. SUMMER 1%~ �Medical School 22 Health Manpower Will we have enough doctors? How many is enough? BY CONNIE OSWALD smFKO W ill we have enough do ctors in the future ? That's a hard question to answer since no one has yet decided how many doctors we need, according ro George E Sheldon, M.D., professor and chairman of the Department of Surgery at the University of North Carolina at Chapel Hill. And the kind of doctors we'll need in rhe future changes with every scientific breakthrough. Sheldon discussed "Health Manpower the Future Challenge" March 23 ac the indu ction ceremony of the UB chapter of Alpha Omega Alpha, the national medical honor society. He is a regent of the American College of Surgeons and chairman-elect of the American Board of Surgery. "Nobody has ever decided how many doctors we need,"said Sheldon, a trauma surgeon. "There's no question we've got more than we did 25 years ago, but we didn't have enough then." There was a time when medical schools were turning out large numbers of doctors. Back at the turn of che century, standards were so low chat anybody who could pay the tuition could enter medical school. Then, the Flexncr Report, which urged reform in medical education, was published in 1910.Standards were raised, closing down some schools and causing a shortage of do ctors. Between 1920 and 1950, there were less than 120 physicians for every 100,000 Ameri cans, Sheldon said. SUMMER 1989 "Nobody has ever decided how many doctorswe need," said Sheldon, a trauma surgeon. "There's no question we 've got more than we did 25 yearsago, but we didn't have enough then." Now there arc 200 physicians per 100,000 Americans, but that's only a few more than we had at the turn of the century, he pointed out. If we assume tha t we have enough doctors today, we're pretty good at predicting the numbers we need. But we don't fare as well in predicting what specialties will be in demand. Sheldon described a 1978 study by the Graduate Medical Education National Advisory Committee, which was an extensive and expensive project that projected the kinds of doctors we'll need by 1990. The study was right on target in predicting the number of physicians we'd have - about half a million, he noted . "But it was off by a mile on all the specialties," Sheldon said, because medicine is changing so rapidly. Back in 1978, no one predicted the importance that organ transplantation would have today because cyclosporine, the drug that greatly improved the success of transplanta• tion, wasn't around yet, he said. And no one had heard of AIDS. AIDS is becoming a problem today, but we have to keep it in perspective, he cautioned. More people die on the nation's highways each year than have died from AIDS since it was identified . in the futu re, She ldon noted, the aging populatio n in this country will create new demands for certain types of physicians. And BUFFALOPHYSICIAN AND BIOMEDICALSCIENTIST �Medical School 23 there may be a greater demand for sports physicians. He also outlined ocher trends: ■ Before the 1970s, health care was a "corcage industry." Doctors ope raced fee-for-service solo practices. This was coupled with voluntary hospitals. Now, the trend is toward group practices, Sheldon explained, and hospitals have become very fragile economic entities. During Texas' recent oil problems, hospitals closed because they are very dependent on che overall economy of an area. ■ Most doctors work 60 to 70 hours per week, though females tend to work fewer hours, he said. The number of women is increasing, which could mean that the total number of hours worked by physicians will decrease. BUFFALOPHYSICIANAND BIO~IEDICALSCIENTIST "Bur I think that women have kept the quality of heal ch care up; Sheldon said. "As the number of applicants (to medical schools) dipped down, if we didn't have the interest of rhe women, quality would have gone down." ■ The retirement age of physicians, driven by high malpractice insurance rates, has dipped below 60 years old. ■ Medical school enrollment has plateaued . No new schools are being built. An important aspect of the medical manpower question is how much society is willing to spend for health care. The U.S. now spends 12 per cent of its gross national product on health care, while Brirain spends only six per cent, Sheldon noted. But he pointed out that 86 per cent of what Britain spends comes from the government while less than half of what rhe U.S. spends comes from the government. And in Britain, patients wait 28 months ro get a hip replacement or 26 monchs to have a hernia fixed, he added. "These are choices we make in sociery; Sheldon said. "Health care is not going to get less expensive as technology increases. \Y/e have co decide how we'll spend our money." Quoting Rashi Fein, Ph.D., a Harvard economist, Sheldon said, "If we become comfortable with a culture char tells us that health care is analogous to selling shoes, and that the level of health spending and major allocation decisions are to be determined by marker forces, rather than by a political or social consensus, we will be comfortable with rationing." • SUMMER 1989 �Medical School 24 Timothy Murphy, M.D. of diseases caused by microbes (such as BUFFALO IS EMERGING bacteria, viruses, and protozoa), provides vital AS LEADER IN STUDYOF research that contributes to vaccine development and to the control and understanding MICROBIAL PATHOGENESIS of diseases. B uffalo is emerging as a major center in the study of microbial pachogenesis, researchers here report. That prominence is highlighted by a national conference held here in March that was sponsored by the UB Microbial Pathogenesis Graduate Group. "We attracted many heavyweights in the field ro the first Buffalo Conference on Microbial Pathogenesis; said Timothy Murphy, M.D., associate professor of medicine and microbiology and direcror of the graduate group. "This attests to the nationa l respect chat Buffalo has in the field, as well as to the need to collaborate our efforts." Microbial pathogenesis, which is che study SUMMER 1989 Barbara H. lglewski, Ph.D., and Stanley Falkow, Ph.D., national leaders in the field were among rhe six speakers at the March event. lglewski is professor and chairman of the Department of Microbiology and Immunology at the University of Rochester and president of the 15,000-member American Society of Microbiology. She has contributed groundbreaking research in using molecular techniques for studying bacteria. Falkow is professor of microbio logy, immunology, and medicine at Stanford University School of Medicine. He is known for his pioneering work in the field using genetic techniques in order to understand how a microbe adheres to and invades a cell. "Basically, there is a lot of pathogenesis research going on in Buffalo and all over the country," says Mu rphy. UB's new graduare group, as well as the con• ference, offers opportunities for researchers scattered among several departments at UB to organize and communicate with their colleagues. The UB Microbial Pathogenesis Graduate Group includes 25 graduate students and 33 faculty members from the Departments of Medicine and Pediatrics (Divisions of Infectious Diseases), Microbiology, Biochemistry, Oral Biology, and Surgery. "Tom Flanagan (Ph.D., chairman of che Department of Microbiology) was instrumental in recognizing the need for such a group; explained Murphy. "le was formed in order to foster the exchange of ideas and technology among faculty members in different departments who have interest and expertise in the study of molecular biological aspects of infectious diseases." While many of the researchers in the various departments study different types of organisms such as bacteria, viruses, protozoa, and other parasites, they ask similar fundamental questions ('What are the factors in microbes chat enable them co cause diseases?') and use many of the same techn iques regarding pathogenesis. Interaction among departments has facilitated the development of a vaccine for the disease called Haemophilusinfluenzae a bacterial disease, unrelated to the flu, which preys mainly on preschool ch ild ren and causes bacterial meningitis, pneumonia, and ocher serious conditions. "This development is a potentially significant one," explained Bud Nelson, a postdoctoral research associate in microbiology and biochemistry. "Previous vaccines were ineffective in children under two years because their immune systems did nor recognize the vaccine and produce the necessary antibodies. Currently there is a pha rmaceutical firm interested in resting the vaccine." T hrough this interaction among departments, Michael Apicella, M.D., professor BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �Medical School 25 of medicine and microbiology, steered Nelson to David Rekosh, Ph.D., associate professor of microbiology and biochemistry. Under Rekosh's direction, Nelson learned a gene sequencing and cloning technique used in Rekosh's lab in order to characterize the specific protein for the new vaccine. "It took about eight months to learn the technique; said Nelson, "but once I had, l rook what I had learned back ro the infectious disease labs at the Erie County Medical Center and continued the studies ." The technique of genetic engineering is a powerful molecular biologica l tool that has revolutionized the study of infectious diseases in the past decade. Since the faculry using these techniques are located throughout different departments, the graduate group allows collaboration for research projects. This collaboration, together with the conference, are examples of the type of interaction needed wirhin the field, both at the University and nationally, Murphy said. • - By Mark Marabella A GLASS OFMILKMAYHELP S leep disorders in che elderly are usually complications of other problems and are too complex ro be whisked away with prescription drugs, said Troy L. Thompson U, M.D., professor and chairman of the Department of Psychiatry at Jefferson Medical College. Thompson made his remarks during the second annual conference on "Current Issues in Geriatric Psychiatry," co-sponsored by the Division of Geriatric Psychiatry, Department of Psychiatry, and rhe Western New York Geriatric Education Center at UB. His was one of five talks presented at the April conference in the Ramada Renaissance Hotel in Cheektowaga . "Conservative estimates indicate chat about 5 million elderly patients in this country have a severe sleep disorder," Thompson said . "For unknown reasons, the death rare among people who 'often' use sleeping pills is 1.5 times higher than that among marched subjects who have never used sleep- BUFFAlD PHYSICIANAND BIOMEDICALSCIENTIST ing pills." Thompson maintains char sleep disorders, such as the common insomnia, are too complex co be whisked away by the hasty prescription of sedative-hypnotics or benzodiazepines. He emphasized rhar, especially in older individuals, insomnia is usually secondary in nature and arises as an aspect or complication of psychiatric, medical, environmental or pharmacological events. "Many sleep disorders, such as insomnia, are merely a secondary symptom of a complexity of factors; explained Thompson . "A patient's complaint of a sleeping problem should trigger a comprehensive review which includes that patient's medical history, family background, and current lifestyle." Many times, remedies for sleeping difficulties need not come from the medicine cabinet or a doctor, Thompson pointed out. An adequate dose of L-Tryptophan, an essential amino acid which is sometimes recommended as a hypnotic, can be obtained by drinking a glass of milk. However, if a sedative-hypnotic medication is chronically needed to maintain adequate sleep, the physician should regularly reevaluate the initial diagnosis, reconsidering such possibilities as depression, anx iety or one of a dozen ocher primary sleep disorders, Thompson cautioned. "Judicious use of sedative-hypnotics in the elderly requires an understanding of drug metabolism in the aged, as well as knowledge of the differential diagnosis of distu rbed sleep; he said, adding that "the clinician should be familiar with the changes in sleep patterns and sleep architecture that are seen in the healthy elderly person." • - By Mark Marabella SUMMER 1989 �Medical School 26 -- Luc Montagnier, M.D. SUMMER 1989 FOCUS ON BASIC AIDSRESEARCH, SAYSMONTAGNIER "we should put our research efforts first in basic research; said Luc Montagnier, M.D., the noted French AIDS researcher, "because we still don't know many things about the virus and how it causes disease. It's very difficult to design new treatments and also to design a vaccine" without this knowledge. Montagnier, a professor at the Pasteur Institute in Paris who identified the HIV virus associated with AIDS, spoke April 12 at the 19th Annual Ernest Wicebsky Memoria l l..e<:cure in Bueler Auditorium. The lecture is sponsored by the Ernest Witebsky Center for Immunology and the Department of Microbiology. According to Montagnier, AIDS is not caused, but only triggered, by HIV (the human immunodeficiency virus). He contends that the virus causes autoimmunity, in which the body becomes immune to itself. The virus hides from the immune system by mimicking che configuration of a human cellular structure so that the immune system can't discriminate between itself and the virus. HIV alone, in sufficient amounts, is enough to induce the disease in susceptible humans, Montagnier says. However, when the virus dose is low, and thi s is probably the case in sexual contact, then some co-factors may play a role. It's important to understand the basic workings of the virus, but "at the same time, of course, we have to deal with the disease in patients and we should try anything that works, even in an empirical way; Montagnier said, referring to treatments that seem to work but haven't yet undergone thorough study. "If something works, we should cry it." In all parts of the world the treatments are the same, he said, and the best we've got is an antiviral drug called AZT (azidothymidine). While it may be beneficial to a patient for months or even years, it's not a cure. Many other compounds are under Phase BUFFALOPHYSICIAN AND BIO MEDICAL SCIENTIST �Medical School 27 I trials, Moncagnier added. The Ernest Wicebsky Memorial Awards for proficiency in microbiology were given co Alison Koehler, a medical student; Kevin G. Cleary, a dental student, and Sam Jayanch Samuel, a graduate student. • BETTER THANEVER l ooking like a contestant on The Priceis Right, Paul Lecat, amid applause and cheers from his friends, ran down the steps of Butler Auditorium to the podium. He received an envelope, tore it open, and jubilancly yelled out che good news - "Akron, yeah!" Lecac had just found out he got the residency he wanted in medicine and pediatrics at Children's Hospital of Akron in Ohio. The occasion was March Day, che annual event where lase-year medical students find out where they'll spend their residencies. About 65 per cent of che medical students got the best news they could have hoped for - chey got their first choice of residency. And a whopping 87 per cent got one of their cop three choices. Students aimed high and were placed in some of che more competitive residency pro• grams, such as Yale, Cornell, Columbia Presbyterian, Strong Memorial, and Johns Hopkins. "le was a very impressive match overall~said Dennis Nadler, M.D., assistant dean of student affairs in the medical school. "It's going • to be very difficulc to cop." Scott Bookner congratulates Joan Murray. Peter Ostrow, associate dean, prepares for a second champagne shower . ./ Doug Sillart and David Bloom BUFFALOPHYSICIAN AND BIOMEDIC AL SCIENTIST Charlene Vita le and Kristina Hart share their happy news. SUMMER 1989 �Medical School 28 NOBEL PRIZE-WINNER EXPLAINS WORK G erald M . Edelman, M.0 ., Ph.D., D.Sc., winner of the 1972 Nobel Prize in Medicine and Physiology,delivered the annua l Edward Fogan Lecture in Neurology on March 16 in the Albright- Knox Arc Gallery . The lecture was sponsored by UB's Department of Neurology. Edelman discussed "Cell Adhesion Molecules in Morphogenesis and Neural Development." In recent years, Edelman has worked in neuroscience. He is the proponent of a theory explaining development and organization of the human brain, which is outlined in his book Neural Darwinism: The Theory of NeuronalGroup Selec1ion. Before that, he worked in immunology. Edelman received his Nobel Prize for his discoveries of the molecu lar configurations of the immunoglobulin molecule. This work led Edelman to consider questions of how ou r immune system develops specificity in recognizing objects chat are foreign to the body. This ana logy has been adapted co che nervous system. Cell adhesion molecules, first described by Edelman in 1977, are markers on the surface of cells chat provide a framework by which the billions of cells in the nervous system are able co relate co one another. These molecules provide the structure by which the nervous system differentiates itself from an immatu re mass at birth, incapable of sensing its environment, to che more mature nervous system able to respond to the intricacies of its environment. Edelman suggests chat cell adhesion molecules provide the matrix by which cells relate co one another, thereby creating specific neurona l differentiation . By chis means, he suggests a mechanis m by which selective parts of the nervous system develop specificity for vision, pain, temperature, memory or fine motor coordination, etc. Related to chis work is Edelman's theory of neu rona l Darwinism. Just as adaptation co the environment is the foundation of Dar- SUMMER 1989 Gerald M. Ede lman, M.D., Ph.D. , D.Sc. win's theory of evolution of species, Edelman's theory proposes that brain development is based upon competition for survival among neural cells and response co stimuli in the environment. Those that are used survive while unused ones do not . Cell adhesion molecules provide che structure that allows cells chat are to be programmed for a specific function to relate to one another. Those areas that do not develop affinities for one another do not survive. This theory of how cells relate to one anothe r and how they differentiate is so important that some people speculate chat Edelman may be in line for a second Nobel Prize. Edelman is the Vincent Astor Professor at the Rockefeller University and director of the Rockefeller University Neurosciences Institute. He is also scientific chairman of the university's neurosciences research program. • - 8)' Michael £. Cohen, M.D. BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �Medical School 29 Tai-Hwang M. Fan, a fourth-year student, represented UB at the eighth annual Medical Student Research Atvards Program sponsored b-v the Associated Medi cal Schools of New York. The May event was held in Buffalo for the first time. Judith Tamburlin, cl inical instructor, right, explains her work on an anatom::, atlas for the blind to Stephanie lovino, a graduat e student. The di spla::, was part of the medical sc hool's first Faculty Research Day held April 25. BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST SL:MMER1989 �Hospital News 30 Decked out in a frill:>•hairband and sucking on her pacifier, Carley Mallon is cuddled by her parents, Peter and Diane. Treating the Fetus as a Patient S cace-of-the-arc diagnostic and treatment methods have introduced a new concept in medicine - treating che fetus as a patient. That's the focus of the new Buffalo Institute of Fetal Therapy, formed by che Perinatal Center of Children's Hospital of Buffalo and the UB medical school. The program is the first of its type in New York Scace. "The traditional field of fecal and maternal medicine knows how co treat the mother and normal pregnancies, and how co treat an abnormal pregnancy when it affects the mother; explained Philip L. Glick, M.D., co-director BUFFALOPHYSICIANAND BIOMEDICALSCIE1''11ST of the program, "but it doesn't know how co treat the fetus:' In the recent past, a physician might be able to predict chat a fetus would be born with an ailment, but there was little he could do about it. Now he can cake some action, explained Glick, who is also an assistant professor of surgery at UB and a pediatric surgeon at Children's. Sometimes physicians can treat a fetus surgically or medically while it is still in the womb. A more common action is co plan rhe rime, place, and mode of delivery, and have experts ready when the baby is born. The ocher co-directors of the program are Luther K. Robinson, M.0., director of clinical generics at Children's and UB assistant pro• fessor of pediatrics, and Amel S. Lele, M.D., director of the Women's Clinic at Children's and UB clinical associate professor of gynecology/obstetrics. Glick said a wide range of fecal abnormalities can be identified using ultrasound and rests that sample amniotic fluid, maternal blood, and fetal cells and tissue. Among che problems chat can be detected chis way are urinary tract obstruction, thoracic masses, congenital diaphragmatic SUMMER 1989 �Hospital News 31 hernia, abdominal wall defects, and spina bifida. Some are best corrected after a full-term delivery, others may require a cesarean delivery, and still others may require induced prererm delivery for early correction outside of the uterus. Some may require medical therapy before birth and some may require in-utero surgery. The Buffalo program, Glick explained, rakes a multidisciplinary team approach to the unborn patient. The program has assembled a team of experts consisting of perinacologists, neonatologists, radiologists, cardiologists, anesthesiologists, geneticists, ethicists, clergy, and pediatric surgeons with various subspecialries. Rather than usurp the role of the community physician, the team members act as consultants, Glick said. The results can be very gratifying. I II fit wasn't for you people at Children's Hospital, we wouldn't have our baby today," said Peter Mallon, gazing at his fourmonth-old daughter Carley. Peter and his wife, Diane, 35, were thrilled co find out she was finally pregnant. Their joy turned to shock when doctors discovered through an ukrasound test that the baby girl Diane was carrying had a congenital diaphragmatic hernia. In this condition, the diaphragm (the muscle chat separates rhe chest from the abdomen) hasn't developed properly. Carley's abdominal organs were in the chesc. Her intestines compressed her lungs, resulting in small and abnormal lungs. Although many babies with chis condition also have other abnormalities, a cest called amniocentesis and a thorough feral ulcrasound confirmed that Carley had no ocher birth defects. The doctors discussed the options with the Mallons and they chose surfactant replacement and surgery after birth. When the pregnancy was full term, labor was induced and the baby was delivered vaginally. Surfactant, che soapy coating that prevents the lungs from collapsing in between breaths SUMMER 1989 Philip L. Glick, M.D. and makes the lungs more pliable, was placed in the baby's lungs before she rook her first breath. Surfactant replacement is an accepted therapy for premature babies, Glick explained, but it's a new approach for babies with diaphragmatic hernias. Babies with that condition have lungs that appear similar ro rhe small and sriff lungs of premature infants. It apparently worked. Now the physicians will go back to rhe laboratory and examine whether rhe surfactant really did help Carley and whether they can recommend it for other children. After Carley was treated with the surfactant, she was rushed off ro surgery where all of her abdominal organs were removed from her chest and placed back in her abdominal cavity. Her diaphragm was repaired with a piece of plastic. That indicates how risky her condition was, Glick noted. When plastic is needed co repair the diaphragm, the mortality rate is almost 100 per cent. After six weeks, the baby was discharged from che hospital and sent home without respiracory or feeding difficulcies. "She's coming along real good - she's real alert," Diane said. "She's lifting herself from che crib and crying ro roll over a little bit." "As far as we can tell, she's absolutely normal," Glick confirmed, and Carley's future looks bright. "She will be an absolutely normal five-year-oldon the playground with normal lung capacity." He stressed that it took team work. Work- ing on Carley's case were Diane's obstetrician, ultrasonographers and technicians in radiology, perinatologists and neonatologiscs, geneticists, pediatric surgeons, a developmental pediatrician, house staff, operating room and intensive care nurses, and the hospital chaplain. The Buffalo Institute of Feral Therapy is modeled on a handful of similar programs across che country, including the pioneering effort of Michael R. Harrison, M.D., ac the University of California at San Francisco, where Glick did his general residency in surgery and a fellowship in fetal surgery. The Buffalo program was founded in conjunction wich the deparrments of pediatrics, gynecology/ obstetrics, radiology and surgery at UB and Children's. Its work, Glick noted, is facilitated by che fact that Children's Hospital of Buffalo is che only free-standing children's hospital in the continental U.S. with an in-house maternity division. J.E. "Ted" Sribbards, Ph.D., president of Children's, noced that pediatricians used to wait as long as five years co carry our some corrective procedures that are now carried our in the first few days of life. Glick's work pulls back chat riming even further. John P.Naughton, M.D., UB vice president for clinical affairs and dean of the medical school, said rhe new program "represents an important clinical addition to the Perinatal Center chat has existed at Children's Hospital for the past three years. "It will provide added and needed services for unborn children with feral abnormalities and will stimulate research designed to prevent such abnormalities from occurring and co treat those chat are not preventable." "The future of fetal therapy is inspiring; according co Glick. "As our understanding of the fetal immune system progresses, the possibility of in-utero transplantation of stem cells and whole organs looms as a distinct reality. If che secrets of fecal wound healing can be unraveled, the scarless healing of the fetus may usher in a new era for plastic surgeons. ln-utero fetal nutrition may lessen the mortality and mor• bidity of intrauterine growth retardation. "The list just goes on and on." • BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �Hospital Neivs 32 Struggling with Polio's Aftermath BY MARK MARABELLA H en ry Bauld, 78, was struck with polio as an infant in 1912. Although he successfully thwarted this potentially crippling disease, in his 50s he began to experience extreme fatigue and pains in his shoulders. He couldn't walk any distances without becoming exhausted. When he consulted his physician about what was happening to him, his doctor chalked it up to "oldage." It wasn't until last year, when he first consulted the Erie County Medical Center's PostPolio Center of Western New York, chat Bauld learned he wasn't alone in his affliction . Bauld signed up for an appointment with Frederick McAdam, M.O., director of the center and clinical instructor in UB's Department of Rehabilitation Medicine. Following Bauld's initial examination and evaluation, McAdam and the center's specialists prescribed individualized daily exercises and vitamin supplements. Bauld soon discovered that he had renewed energy that he hadn't felt in 25 years. Sudden ly, his formerly diagnosed "old-age" was seemingly in remission. People who had polio as youths are now suffering in their lacer years from chronic muscle and joint pain, fatigue, weakness, and breaching difficulties. They are being diagnosed as having "phantom pain" or symptoms of "old-age," according to McAdam. Because the number of post-polio patients with these symptoms has steadily increased, physicians have begun co realize chat polio may indeed have effects that linger well after a patient's initial onset and rehabilitation. Over the past decade, more physicians and researchers have turned their attention to this syndrome. McAdam began the ECMC clinic in Oc- SUMMER1989 suffering from post-polio syndrome or poliomyelitis. McAdam stresses that the main objective of the clinic is co help a patient mentally and physically cope with this synd rome; there is no miracle cure . The clinic emphasizes the teaching of energy conservation and establishing functional limits for patients. With correct diagnosis and treatment, there is improved quality of life. "Many patients who come to the clinic are wiped out just from getting out of the car and walking into our office,"McAdam noted. "So what we try to do is help them to function more efficiencly in everyday life." P Frederick McAdam, M.D. tober 1987 with two Department of Rehabilitation compatriots, Carl Granger, M.0., professor, and Byron Hamilton, M.O., Ph.D., clinical associate professor. The clinic is now a division of the Neuromuscular Diseases Clinic and Laboratories of UB. At first, the clinic was held one afternoon a month with two to three patients at the most. However, starting in July, it will take place biweekly (then weekly some time thereafter) so that it can better meet the growing need for special post-polio medical care. "The response to the center has been overwhelming," McAdam noted . Since its establishment, the Post-Polio Clinic of Western New York has remained the on ly facility in the area which provides both clinical care and valuable research for people rescribed treatments vary with each patient . While in Bauld's case a vitamin deficiency was recognized, vitamin supplements aren't a common aid. Anaerobic and stretching exercises also vary with a patient's co nditi on and needs. The specialises at the clinic may even recommend orth otic devices - canes, braces, and walkers - to help conserve the energy of the patient . There is already a lengthy waiting list for treatment at the center. It is difficult co handle the high demand because the initial evaluation and treatment is so time consuming and labor intensive . A physiatrisc, neurologist, clinical nurse specialist, physical therapist, occupational therapist, and social worker may all work together on a single case. Once a patient contacts the Pose-Polio Center, a questionnaire is sent asking for the patient's symptoms and medical history. Then McAdam meets with each patient to assess his or her problem using var ious tests, including X-rays, CT scans (computerized tomography), videoflu roscopy (barium swallowing and monitoring), and ocher lab BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �33 Henry Bauld work. Following this, McAdam and his staff establish a specified program for each patient. Most of the time, these programs are designed co endure for the duration of the patient's life. Overall, McAdam is pleased with the clinic's effectiveness and patient satisfaction. "We'remaking a difference in most people's lives, and chat's what's important," McAdam emphasized . McAdam also pointed out chat while one function of the clinic is to help sufferers cope with this debilitating condition, the other function is to gather and evaluate valuable evidence concerning the syndrome . At this time, there is very little known about post- BUFFALOPHYSICIAN AND BIOMEDICALSCIENTIST polio an ,d there is no specified cure for the syndrome. The March of Dimes estimates from polio records ,chat there are somewhere in the neighborhood of 500 post-polio sufferers in the West,ern New York area alone. However, McAdam believes there are probably twice chat number because many with this affliction still think it's just aches and pains from old age. This is why educating che pub lic is another important function of the clinic. Donald O'Conner, president of the Polio Survivor Support Group of Western New York, maiintains a symbiotic relationship with McAdams and the Post-Polio Center at ECMC. O'Connor's group helps educate and inform potential patients - as it did with Bauld - of the center's availability. In cum, McAdam recommends that patients join the support group. The condition of most patients affected by post-polio syndrome usually isn't life threatening, says McAdam. However, those patients who had previously been afflicted with Bulbar Polio - polio which affects the diaphragm, incercostal muscles (voluntary muscles between the ribs), or the muscles involved in swallowing - can be affected more seriously by post-polio syndrome. They may experience respiratory disorders and difficulty with breathing which can indeed be life threatening . • SUMMER 1989 �People 34 LEONFARHIJOINS RANKS OFTHEELITE L eon Farhi, chairman of physiology, has been named a distinguished professor by the State University of New York for his years of work in human lung gas exchange and the human circularory system. The prefix of distinguished professor is considered to be the highest academic title in the SUNY system and is held by only about 50 professors. Farhi joins the ranks of poet and literary critic Leslie Fiedler, Gerhard Levy of pharmaceutics, Felix Milgrom of microbiology, Hermann Rahn of physiology, and Eli Ruckenstein of engineering, among others, as UB faculty who are distinguished professors. The honor "recognizes his tremendous contributions to both the scientific world and the University," noted John Naughton, vice president for clinical affairs and dean of UB's medical school. "We feel honored that he was so recognized and it indicates that the efforts he has made and chat the school has made have been recognized." Farhi joined the medical school more than 30 years ago. "I was offered a job here in '58 and have been here ever since; he said with a content smile. "I have always been interested in the heart and the lungs and also in the effect of gravity on the heart and lungs." Sitting in his office, Farhi swiveled in his chair and pointed out the window on his back wall. "See that?" he asked, as he pointed to a cylinder on a circular track, surrounded by a moat of calm water which in turn was circumscribed by a running track. "That's a human centrifuge. We are the only University in the free world ro have one." Farhi explained chat cest subjects sit inside the capsule as it revolves. Centripetal acceleration from the revolution mimics high gravity situations, up to the equivalent of seven times the earth's gravitational field. What Farhi is currently working coward is a June 1990 shuttle launch. He will be studying blood flow in the astronauts before, during, and after their flight. Sound cumber• some? Needles and blood samples sticking out SUMMER 1989 Leon Farhi, M.D. everywhere? Not quite. "We have developed a technique chat allows us to measure the amount of blood the heart pumps out without putting any needles into the subject," he said. Farhi's technique requires the subject co breathe into a bag. "We have developed a sec of mathematical formulas that allow us to use the rate at which CO 2 accumulates in the bag to calculate the amount of blood that brings it there," Farhi said. "If I know how much CO 2 reaches the lungs every minute, I can calculate the amount of blood going through the lungs ." The amount of blood going through the lungs, he said, is the same as the amount that the heart is pumping out. The experiment itself, Farhi ex'])lained,consists of looking at the heart's output under different amounts of stress while the astronauts are in space and comparing that ro their cardiac output on earth both before the flight and after it. "The heart is an organ which is supposed ro regulate itself. In order ro find whether it is acting adequately or not, we look at subjects at different levels of exercise and determine whether cardiac output is appropriate for that level," Farhi said. "We look at the cardiac output as a function of the power output of the subject." The subjects work out on an exercise bicycle hooked up to a power generator. On earth, each subject is tested ro determine maximum power output. In space, they will be tested at 30, 60, and 90 per cent of maximum, he explained. "Out technique looks at an astronaut before flight as a baseline, then follows up on him or her every day in flight, and provides special emphasis after the return to earch; he said. T he problem that Farhi is looking into is known as cardiovascular deconditioning. What it involves is the heart's adjustment to zero gravity and its subsequent readjustment to earth's gravitation. Problems resulting from cardiovascular deconditioning affect the astronauts after they return ro earth. They have to do with the body's ability co return blood ro the heart from its tissues, especially the legs. "Man has developed a mechanism which allows us ro make blood come back against gravity," Farhi said. In space, he explained, there is no gravity and so the body's methods of pulling blood back up from the legs in to the heart are "unlearned." "It's like riding the tiger," Farhi explained. "As long as you keep riding, you're all right." But "if the astronauts stand up without chose mechanisms once they are back on earth, the blood accumulates in the lower part of their bodies. If it's down there, then the heart doesn't pump it back and the brain doesn't get the right amount of blood." BU FFALO PHYSICIAN AND BIO MEDICAL SCIENTIST �People& Research 35 Farhi said chat chis can lead to fainting in asrronaucs after chey return to earch. "That rums out to be a rather important problem for NASA because it amounts to a loss of che inborn ability to cope with the effects of gravity." Five astronauts, three payload specialises, and two mission specialises have been training for this flight since 1984, when they visited UB to gee a chance to use Farhi's equipment. Two of che payload specialists and both mission specialists will fly on the summer 1990 flight while che ocher payload specialise will fly at some time in the future. The experiment was supposed co be conducted on a summer 1986 shuttle flight but was postponed, due to che disaster which befell the Challenger, on which UB alumnus Gregory Jarvis was flying. Along with preparing for the NASA flight, Farhi is conducting other lines of inquiry. "We've been involved recently with the problem of rediscriburion of blood in che lung; he explained. "If you have an area of the lungs char is not breaching properly, che body shunts blood away from rhose pares to the healthier parts of the lung."This happens in emphysema and pneumonia, among ocher diseases, Farhi said. The equipment in Farhi's facility was paid for by che Department of Defense almost 20 years ago. Besides the centrifuge, which is used for studying the effects of gravity and pressure on man, there is a swimming tank chat is used co investigate man's reaction co temperature. Near the centrifuge and swimming tank, there is a diving tank which is being used by Claes Lundgren, also of physiology, co study the consequences of pressure on man. "ln the late '60s; Farhi said, "the Depart· ment of Defense decided it would be a good idea if there were a few centers across the country char could be mobilized in case of a national emergency. Thar was Project Themis. "Our project was environmental physiology. We proposed to study how various environ menta I factors, such as gravity, temperature, pressure, oxygen levels, etc., affect man and his performance." He said che only Defense Department in- BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST volvement was to help scare the program. The agency provided the start-up coses for the facility so chat in case of national emergency, the Defense Department would be able to turn co Farhi's group for specialized research. lnicially, he had a grant with the Air Force. Currently, he is being supported by the National Heart and Lung Institute. Farhi said he has never done classified research. Farhi's well-traveled career has carried him far from his native Cairo, Egypt. He attended college and medical school in Beirut, Lebanon. He was a postdoctoral fellow at the Trudeau Sanacorium, in Trudeau, N.Y.. 1952-53; che University of Rochester department of physiology, 1953-54, and the Johns Hopkins University, 1954-55. Farhi was also an instructor at the Hebrew Universicy-Hadassah Medical Center in Jerusalem immediately before arriving in Buffalo. In 1983, Farhi was named the Western New York Heart Association "Man of the Year" and in 1978 received the medical school's Stockcon Kimball Award for teaching, research, and service. Chairman of physiology since 1982, he was recently appointed co his third term. • - By David M. Snyderman DETEOING 'SILENT' AILMENTS IN INFANTS R outine ultrasound screening of infants could lead co earlier diagnosis and treatment of significant, yet "silent; urinary tract problems in more than 47,000 infants born annually in the U.S., according co researchers at UB. The projection is based on the investigators' identification by ultrasound of significant kidney problems in six of a group of 437 apparently healthy infants participating in a study reported in Pediatrics. The UB researchers said chat if ocher studies show similar results, the medical profession should consider recommending chat che use of ultrasound co check infants for urinary trace problems become a routine pediatric screening procedure. The cost of the rest, which can be done in less than IO minutes, is about $35. The researchers, led by Jacob M. Steinhart, M.D., UB clinical associate professor of pediatrics, turned co ultrasound to dececc a group of problems chat account for the highest incidence of human birch defects. An estimated IOper cent of all humans are born with some form of genitourinary problem. Despite chac prevalence, the researchers said that in private practice they continued co encounter "significant numbers of children in whom renal disease had escaped diagnosis until an acute illness, perhaps unrelated, prompted investigation of the urinary trace." They added, "\Viedecided co undertake chis study to determine whether it would be feasible and cost effective to screen apparently healthy infants with ultrasound in an effort to diagnose renal abnormalities that might be helped by early treatment." The researchers concluded chat "there are a significant number of infants harboring silent urinary trace abnormalities chat can be dececced by ultrasound at a relatively low cost." Referring co the six infants in whom significant problems were identified, chey added: "le seems likely rhac che monetary cost as well as the morbidity would have been greater had these infants' problems not been diagnosed until they had become infected and/or progressed to varying degrees of renal insufficiency." Referring co the incidence of significant problems of l in 73 in their study, they said "one could extrapolate chat, of the approximately 3.5 million babies born in che Uniced Scates each year, more than 47,000 would have significant urinary tract pathologic conditions." Also participating in che study were Jerald P.Kuhn, M.D., UB professor of radiology and associate professor of pediatrics; Bernard Eisenberg, M.D., clinical associate professor of pediatrics; and three clinical assistant professors of pediatrics: Russell L. Vaughan, M.D., Albert J. Maggioli, M.D., and Thomas F. Cozza, M.D. Kuhn also is head of che Radiology Department at Children's Hospital of Buffalo. • - By Arthur Page SUMMER 19S9 �Classnoces 36 for his efforts on behalf of the care of physically deformed children by organizing voluntary surgical reams willing ro rravel into rural Mexican communities . 1930s Richard C . Batt (M'36) • a retired radiologist, writes, "The past three years of my retirement have been successful as a volunteer in helping to rehabilitate selected brain-damaged patients through computer usage." Bernard St e ll (M '36) • a retired psychiatrist, keep s active by teaching photo amateurs at a community college and by creating phoro slides char bring him honors. "I won an honorable mention ribbon in an internationa l stereo exhibition for my stereogram, 'Thar's My Tongue: Ir is a high-speed sequence (three figures) of a hummingbird in flight with its tongue sticking our. In rhe PSA International Traveling Exhibition, I was awarded a second place ribbon for my srereogram, 'Red Lipped Clown' a 3x magnification of a water droplet with an image of a clown . A water droplet acts like a lens; it projects an image of a clown that is about 12 inches behind the water droplet." Dr. Stell also won, for the second year in a row, first place in the December 1988 contest for the Sun Cities home decorating contest. 1940s Richard J. Buckley, Sr. (M'43) • has recently been elected president of rhe New Voice Club of the Niagara Frontier, a support group for laryngectomees . A lfred S. Evans (M'43) • was elected vice president (president• elect) of the American College of Epidemiology . His busy schedu le includes a paper at a Scientific Conference on Epidemiology in SUMMER IQ89 Ernest A. Fatta (M'63) • of Woodland, Calif., is president of the California Affiliate of rhe American Heart Association for 1988-1989. Richard C. Batt '36 Beijing, China, in April; being a visiting professor ar rhe University of Valencia School of Public Health in Valencia, Spain in June and teaching the Graduate Summer Program in Epidemiology at rhe University of Michigan in July. "In August I will fish." Dr. Evans is the John Rodman Paul Professor of Epidemiology, Emeritus at Yale University. The third edition of Viral fn/eccions of Humans:Epidemiology and Control, (A.S. Evans, Ed.) was published in March by Plenum Press, New York, N.Y. Clifford W. Gates (M'48) • former ch ief of radiology services and chief of outpatient services at the Long Beach Naval Hospital, is retired and living in Fountain Valley, Calif. 1960s Jack C. Fisher (M'62) • has been selected by the San Diego County Medical Society as Physician/Cit izen of the Yca·r. The society cited Dr. Fisher's contributions roward establishing a higher regard for the medical school by community physicians, and also Jeffrey Kahler (M'66) • was recently elected to serve a oneyear term as president of the medical sraff ar Sr. Joseph Hospital, Cheekrowaga, N.Y. Dr. Kahler is rhe director of the hospital's orthopaedic surgery section. 1970s Denni s E. Stemp ien (M'73) • was appointed associate company medical direcror of clinical medicine at the General Electric Company in Fairfield, Conn. Melvin Pohl (M'76) • of St . Louis Park, Minn., is medical director of rhe Pride Institute and co-chairman of AMSAODD' s Third National Forum on AIDS and Chemical Dependency. Barlow S. Lynch (M'77) • has a private urology practice in Washington, D.C.,and is an assistant professor in the Deparrmenr of Urology at George Washington University, Georgetown University, and Howard University. Ira L . Sa lom (M'77 ) • writes, "I am enrolled in rhe J.L. Kellogg Foundation Sponsored Advanced Management Program for Clinicians at the NYU Graduate School of Public Administration." Pete r E. Shields (M'79) • is a fellow of the American Academy of Orthopaedic Surgeons. 1980s Thomas J. Lane (M'81) • writes from Bristol, Conn., that his research interest is in chronic fatigue syndrome. Dr. Lane is an assistant professor of medicine at the Universiry of Connecricut Health Center. Richard L. Co llin s (M'83) • has been named medical director at the Northwest Buffalo Community Hea lth Center, a federally funded medical center for the medically underserved . Kenneth Ja y Ru th (M'83) • writes, "I am in solo pracrice in internal medicine in a San Diego beach community. My practice is growing rapid ly and I'd be most interested in having a fellow UB grad as an associate. Please call (619) 226-4524." His address is 5825 Caminito Del Estio, La Jolla, Calif., 92037. Brian Gale (M'87) • writes, "I am a nuclear medicine resident at the Albert Einstein College of Medicine and will begin a radiology residency at New York Medical College in July 1990. I will marry lawyer Marla Kirsh in Augusr '89." Tina Marie Gardne r (M'87) • writes from Fairfield, Maine, "We moved from New York City to Maine; we love the fresh air and free parking. This program is much berrer too?' Dr . Gardner is a resident physician in the MaineDarr mou rh Family Practice Residency Program at the Kennebec Valley Medica l Center. BUFFALOPHYSICIANAND BIOMEDICAL SCIENTIST ��CAMPUSMAIL 998 MR. CHUNG•KAI HUANG HEALTHSCIENCE LIBRARY ABBOTTHALL CA...,PUSMAIL � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. 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Copyright 1989 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/e75df90ccdda2d8d51acc53ae4a881d8.pdf 4d453869241aa240ad70c4d0932ac018 PDF Text Text Vol. 23, No. I Spnng 1989 and Biomedical Scientist ~ Procedurecan save lives­ but donor organs are needed �STAFF EX[ Cl 'TIVE E[)ffilR UN vl'RSITY PL RLIC'ATK'NS Rehcr1 T M irlcr 6t'rFALO ffi'r<;IC IA1\ l'[)ffi)R C ( l'OIC ()s, 1ld S10110 ART o: {fC'Tl 'R A, in I Kcgl.r Dear Alumniand Friends: 0 n Feb. l, President Stc\en B. Sample announced that the L'nhersity at Buffalo had h,ecn ,m1t<.-dto jom thc_prest1g1?us Assoc.1at1onof AmL'T!<.an Gmversmc-s (AAUl. Tlus orgaruzallon, founded in JQOO , has 5o members, .1 rcprt-s<.:nt,ltlonof tw0 per cent or less of all American umvcr,mes . Sigmfkant in this v~-ar'sadmissions 11asthe fact char rno p:1bhc inst1tut1ons, both from the East, rather than one publ1<.and one private in,titution, each w<:reasked to JOlll. The Uruversity at Buf• falo 1s rhe first public institution from either ~ew York St.tte or New England Jdmirred w th<: organi:arion. The other invitee is Rutgers University. The other member institutions from Ne11 York StJte <1reColumbia, Cornell, ~ew York University, Syracuse, and the Umvers1ty of Rochester. Our acceptance into this important organi:ation signifies the growth and academK maturity that has resulted in the short period of 25 years smcc the merger of UB with the SUNY system. Tod av, Buffalo's l.Jnivcrsity rep resents a comprehensive unit committed to excellence in research and teaching, and to servicing a broad public mission. Special recognition and congratulations are due President Sample, who set this achievement as a major goal from the beginning of his presidency seven years ago. There is little doubt that all of us who current'.y associare oursdves with this academic eN<-rprise and those who J0tn and follow us will benefit enormously in the years ahead. \X'e owe the fTes1dem ,:md Sl.JNY a great debt of gratitude. I hope ) ou are as pleased as we are. ADVISORY BOARD Dr John :--=au~hton,rli.:,rman Dr. H .old Brody ?\ts. N1n1.y GI C\.O Dr. James Knrua, Dr t harl~ P O ,ncll· \.tr. G~•>:"',' Zinc: Dr Antoinette Pctcr-s Dr. l harlc Pru, • Dr. l ,1>i., Rob·.,-;on r>r. rhor RiY.-tnt•11 Dr. S.k•d, Sures [)r b1..rron ')in.ge--man Dr :01erhcn '>1 ulJinc Dr ?\:cl.on rorrc Mr. EJ,.. ird \'<,.,:kc nr f'.:.._ I \\ 1cr; 1 lcr 'l""[)r Jerernc:-Yates WRITERS M \IJ,-,bdi UK l Ar(I _ !'a~t: ILi USTRATORS L1 H~ncy ), re Mir k~ P ul '-•p,ko" k l\.t1kc: ~- ,Iosc1 , c , D ,-, l ,kroc:.·msk, l'HOTOl:RAPHERS ~-L 1-"' \l.•k ' rn:~~LJ Jo hn Na ughton, M.D. \'ice Prc"de'll for Climcal AJfa,rs Dean, School of \ Lhme and Bwmed".al Sciences &,\-, \'( ''"' H.ACHl:S:G HOSPITALS AND LIAIS01'S o· • \ \ ..tcranir. AJn, \'c._:'P.uft 1 .,.r••no: '-crrc Buff..!o Gcn\.r,. 1n1 V \h •• AJrr r · 11 ,nrc 'ohn I ill \kd, ,t , ( b,IJ,,,-, Ho II • l\.an:n Fr. ( um1 \1 l, ,I l n· r, \f'- 0 \1 0 'tl .._,,. nn"'~u ' \1rn Dear FellowAlumni/Alumnae: l➔l h:nn .> \ Ho rt 1 • '- hui.. k, r.u:<(: M,llord F 'lmon- .!, pu ,I, !) l'l J,'rlfl I r ... \1i me. 1al : ' K. " 'i r H< r . I),. nn tit . . .. I-ct \~ -< .artlr- Rt!~ j n .. r'!, ~I JUlo<~~ ~l~ n.; fli' >l Ff \:....l PHY-,ICIAN A \l[) BIL' \lEl11l \~ ,( IEl',,rt,r ,L ,f"i "t> r ,,, '5( \I \dune. ~ ,,1 'luo •er I fu,.,1 1-\ h\c: t mL ~•· · u~ 11\· "'ip..m~ "-lu1 11Y.r, \ ·u1 r--, f. r v \X.mtcr, 1nJ ii..u W t • 1-- th 'i<hoc•I.,. \.kJ1o n, mJ Bmri.l-Ju.. ,1 Sl1cm.1. . ~t.: • l .1 ,er ·\ c•f i\ic.\ Yn·k lt B -,11 l•f\C. \1am '"itrcc·, Buffa!~ 1', , for. I,!•; flu-J , ulk pl . [ p11' f bL.""1 l, ~ "- Yul Send JJrc c mg, '" n:E BL Fl'\.ll PH) -,I( I\ \l AN[' AIL)Mfl:',C \L 'ip ~u_~•:~: IE1';T'>f, 16 ( F 5. AdJ,· " '-t t Buff lo 1', " Y,·l I t .s hard ro heltl'\L rh.H my year as pn ..,tdLnt Jf thl' Alumm Assocaoon 1s .1lrcady ~oming tC',1n end The Sprin~ Cl ,mc.ill Dav k'Stl\ ttK>s,induding the educ anona, sesstC'ns,ind •he gal,1 e\ent for the reunion c.'as,e,, ,!Tl'Sl't for the \\cekend of Mav 6. 1h,s \e,lf the :-.1edtlJI Alumm Assnc.,ation will stirt a nc\\ award for , medic.ii ,tudent or students \\'1th the highest .ic.ademK achkvemcnt in their first and se<.ond \cars. It has heLn noted b\ our board th.it studc:tts rc:c.e1vcs,hul,ir,lups upon <:ntmnce to ,choul, but altu rh.,t the: highest 1-h1e\l'rs .tren't honored before the third year. It is our attempt to recognm: those students. As mentioned in prtvious \Hl'!ngs, the Distinguished Ahmnu,1A:umna A\1,:,.rd, sponsored 1:-ythe A:umm Assouatt('!'l, will he presc:mcd rh1s fall Ad nner honormg th·s person will be held Ill c.Onjun,tton \I 1th our Pa,t Pre,id<.'nts' Dmner. \Xt will h·ep vou po<ted .1, to rhe winner, .Jnd \1·eexrend an opt:n mva.,tion to ill! .,!urns to attend the dmner. In .:losm!l, note thJt 111 the <.<'!"11111!!y~.1r.the Medical Alumn· \I uh the flepartmenrs of Surgerv Assoc1anon will c.o-ho,,trc.-ccpt1011s .,n..l Ant:<tht:si,1 ,,t their 11.it1unalmeetmgs. \Vt: 1m ,te alumm in the .trca, 0( the nauon.il meetings to .JttcnJ. 1 •l t IZl4 cJ?d/V ~~ Paul H . \\'icr:bicn ic c, M.D. �Vol. 23, No. I SPRING 1989 Features 0 Theelusive miracle.Heart transplantation El A hot new field. Thermography, which maps the can be a lifesaving miracle, but the shortage of donor organs keeps this miracle out of the reach of many. various skin temperatures on the body, has great potential in the diagnosis of circulatory and neurological disorders, say UB researchers. ffl Earthquake. UB physicians offer medical assistance to victims of Armenia's December quake. Page 2 lffl BoneGrower.Munro Strong, M.D., associate professor of orthopaedics, pioneered the use in North America of a revolutionary apparatus for people with limb deformities and severe fractures . Page 25 Departments '1'1 Research. Testing "clot busters," cutting costs in trauma cases, and exercises for arthritis of the knees are subjects of UB researchers. ffi1 MedicalSchoolNews. You could call them the unsung heros of the school. They're the voluntary faculty who receive no pay but provide a vital service to the school. Page 21 Page 12 ml HospitalNews. iDJ People.The focus is on Thomas R . Beam, Jr., M.D., who's looking at ways to speed up the FDA's drugapproval process, and Peter Ostrow, M.D., Buffalo's only physician/TV reporter . Spotlight . The watercolor work of cardiologist Ivan L. Bunnell, M.D., Class of 1943, is featured in our premiere of this department. In each issue, we'll take a look at the artistic work of one of our alumni, students, or faculty . Classnotes. Cover lllurtnrtion: Mike Wolruchinow ��3 FORMANY, HEART TRANSPLANTATION REMAINS A DREAM By CONNIE OSWA LD S1DFKO harles Hilton knew he was going to die soon. Though they didn't tell him, his doctorsthought he'd die that night. He couldn't eat, couldn'tbreathe,couldn'twalk. His anginacausedconstantpain. His only hope was to get a heart transplant."I had nothing to lose,"Charles said. "Anything would have been an improvement- even death." Charles was one of the lucky ones. He got a heart in time. That's the life-saving miracle of heart transplants. Bue ochers aren't so lucky. Across the country, 20 co 25 per cent of heart transplant candidates die while waiting for a donor organ, according co Robert M. Mentzer, M.D., director of UB's Heart Transplant Program and a professor of surgery. "It's a very serious prob lem," agreed J. N. Bhayana, M.D., co-director of the program . "We're losing patients ." In Buffalo, heart transplants have been performed since 1984, first at the Veterans Administration Medical Center and now at Buffalo General Hospita l as well. In chat time, 23 transplants were performed. Five people died while waiting for a heart, and, as of February, there were more than iO more patients waiting. Another 15 are being evaluated as possible recipients . SPRING 1989 The UB program has excellent facilities, a top-notch staff, and plenty of willing patients . There's only one shortcoming : the number of available donor hearts. One reason for the shortage is that as heart transplantation lost its experimental status, more and more new centers opened . In 1984, there were only 32 centers in the United States. Now there are 135 and counting . That's causing keener competition for the organs. Another major problem is that people just don't understand about heart transplants . "People don't even realize organs can be transplanted, or they don't know which organs can, or they never thought about donating organs; said Elizabeth A. McNamara, M.S.N., R.N., che transplant coordinator for the Organ Procurement Agency of Western New York. "Then they're faced with the sudden, tragic loss of a loved BUFFALOPHYSICIAN AND BIOMEDICALSCIENTIST �4 obert M. Mentzer, M.D., director of UB's Heart Trans, plant Program: "We have to try to think in terms of not wasting organs." one, and when they' re asked if they want to donate his organs, they may say 'nd because they're not ready to deal with it." McNamara pointed out that the best organ donors, especially for hearts, tend to be young, healthy people who suddenly suffer brain death. It's the guy whose motorcycle spun out of control. Or the one who fell during a fist fight and hie his head on the sidewalk. Or the child who walked out between two parked cars. "That's the rub~ she said. "These aren't predictable deaths. The family has just lose a loved one they may have been speaking to a few hours earlier." And the idea of brain death is difficult for families. "It's rough for the family to accept chat their beloved one has died," said Bhayana, associate professor of surgery at UB. "But if they wait too long, the heart may stop or there might be an infection of the lungs. Then the person is no longer a candidate for donation ." "Even within medicine and nursing, you'd be amazed at the number of people who are nor comfortable with the term 'brain deach:" added McNamara . "They chink, 'Well, maybe the person's not reallydead .'" Exacerbating the problem is the fact chat there's no Scace-wide criteria. Instead, the Stace has empowered each hospital co decide how many flat EEGs and ocher evaluations constitute brain death . Because chis is such a trying moment, hospital staff members are often reluctant to approach che family about SPRING 1989 possibly donating organs . "Some of the professional staff take it on themselves not to ask the family, chinking the family won't be able to handle the emotional strain," McNamara said. "Bue chat's nor fair to chem-we need to give chem rhe opportunity to say 'yes' or 'no? "In the IS years I've been in nursing, it's the hardest thing I've ever done. But there's also a redeeming aspect. le helps them go through the grieving process. And it helps chem build a kind of memorial co their loved one to know chat he or she has given three or four people a second chance at life (if several organs are recovered). "I just spoke with a mom whose daughter died in a car accident. She calls every so often to talk . The daughter was an only child and chis was the parents' first Christmas without her . They got through it because they thought of the people who could go on living. They were very happy they gave consent." Boch the Scace and federal governments have now passed laws chat mandate chat families of suitable organ donors muse be given the opportunity co donate, McNamara noted . Every hospital has designated a key person who will be the one co approach the family when brain death is imminent . While a person is still well, he can sign a donor card pledging his organs at his death, or sign che special space on the back of the New York State driver's license. These are considered legally binding . BUFFAID PHYSICIANAND BIOMEDICALSCIENTIST �5 N. Bhayana, M.D. , codirectorof UB's Heart Transplant Program: • "It's a very seriousprob­ lem. We're losing patients." But the most important thing he shou ld do is let his family know his wishes, said McNamara, because the agency won't accept an organ without the family's consent . "Ir's great to carry the donor card around with you, but if your family doesn't know anything about your decision, it's worthless," she said. Because of the high level of emotion that may be involved, the agency won't accept the donor if there is overwhelming family disparity . "We don't want to cause a permanent emotional rift in the family," she explained . In addition, the bad feelings it would generate would work against the agency. "If you turn off one member of one family, and that person tells the story to 50 or 100 people, it turns all of them off; McNamara said. If there is no known next of kin, the agency won't accept the donor . Some people are reluctant to give consent because they hold misconceptions . The agency tries to overcome this problem by assuring the family that donating organs won't cost them any money, that it won't mutilate the person, that they can still have an open casket funeral, and that major religious denominations allow organ donation . Still another reason for the shortage of donor hearts is the small geographic area from which they can be drawn . The average maximum ischemia time is four to five hours; that is, the donor heart can be without blood flow for only four BUFFALO PHYSICIAN AND BIO~EDICAL SCIENTIST to five hours from the time it is removed until it is transplanted . That limits the distance the transplant team can travel to recover a heart . Another factor that may aggravate-or alleviate-the shortage of donor hearts is a new distribution system that started in January . Those involved agree that it's still too early to tell how it will affect Buffalo's program . Under the new system, if a heart is available in Buffalo, the Organ Procurement Agency of Western New York contacts the University transplant program . If there is a suitable recipient at Buffalo General or the VA, the organ stays in the area. (fhe donor heart must be compatible in a number of ways, including size and blood group.) If the Buffalo program can't use the heart, the local procurement agency contacts the United Network for Organ Sharing (UNOS), a national network . That group runs a computer match to find a recipient within a 500-mile radius of Buffalo. Out of all of the suitab le candidates, the person who has been waiting the longest gets the organ . But what happens if a donor heart is available in Rochester or Syracuse or Albany, cities which don't have their own transplant programs? Under the old system, a candidate first would be sought within New York State, so Buffalo would have a good chance of getting the organ . Under the new system, however, the organ goes to the candidate within a 500-mile radius who has been waiting the longest . Ir's feared by some that out-of-State centers will get srrui-o 1989 �Say 6 lizabeth A. McN a~ mara, M.S.N., R.N.: Hospital staffs often ......... are reluctant to ap~ proachfamiliesabout donating organs. many of the hearts that, under the old system, would have been sent to Buffalo. People are also concerned chat these centers won't reciprocate and send hearts ro Buffalo because these ocher centers are larger and able to use every heart that becomes available in their local areas. "Because the system is changing-we hope it's changing for the better-we're not sure how these changes are going to affect our programs;' said Mentzer. "But we all share the same goal, which is to gee as many donor organs to as many patients as possible, no matter where they live. "We're always talking about the patient, but equally important is protecting the donor supply. We have to cry to think in terms of not wasting organs, and placing the donor organ in an environment that has the best chance of being successful, because there is such a demand." Still anothe r factor contributing to the shortage may be the sheer newness of everything surrounding heart transplants. Western New York has had a system for procuring hearts since only 1983, Bhayana pointed our . Before chat, each hospital acted on its own. And since the University program is so new, it doesn't yet have rhe community awareness and support that other, more established programs have, Mentzer added. Predicting the future of organ procurement is difficult . New problems may crop up. For instance, the spread of AIDS may cut into the supply of donor organs in the future, Bhayana and Mentzer speculate. SPRING 1989 For now, a number of solutions to the shortage are being examined. Researchers are looking for ways to increase rhe length of time rhe donor heart can be without blood flow, as has been done with livers. Livers once had to be transplanted within eight hours, but now a perfusion solution has expanded that time frame to 24 hours, allowing chem to be distributed all over the country, McNamara said. Also, the maximum allowable age for heart donors has increased, Mentzer pointed out. It's now 40 years old for males and 45 years old for females. Organs from older people aren't accepted because it raises the chance of implanting a heart with coronary artery disease. The key solution to the shortage, Mentzer, McNamara, and Bhayana agree, is education of both medical staff and lay people. Ir's important to educate the smaller, rural communities around Buffalo, said Bhayana, such as Jamestown, Olean, and Warsaw. "Thar's where we're going to have our donors;' he predicted. "We're trying to get a foothold into the community, especially into the minority community, through the clergy who deal with death and dying every day;' McNamara said. Many minority people have strong religious beliefs, she noted, and if their minister stands up in the pulpit and endorses organ donation, the efforts will trickle down . The organ procurement agency also conduces free BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �7 harles Hilton pends on a suitcasefull of medication, but he and hisfamily see his transplantas "a gift of life and God's miracle." workshops and seminars, and will make presentations to clubs and "anyone who's willing to listen," she said. "We're always in need of additional media attention." "I want to emphasize chat the media has to help us educate peop le," Bhayana added. "If someone is brain dead, his family owes it ro society at large to use his organs ro save somebody else. Thar's what will he lp us." Mentzer pointed out that it's important to get across the idea that organ donations have the potential to save a life. "As long as we can continue to emphasize how important organ donation is, and what the benefit is, we can separate the tragedy of the death from the goodness of the gift," he said. "It's a gift of life and it's God's miracle,"says Martha Hilton, Charles' wife. "There are miracles." Sept. 2, 1986 was Charles' 54th birthday. And it was a birthday in the true sense of the word because that was the day he receiveda new heart at the VA and a new chance for life. Charles' heart camefrom a 17--year-old killed in an all-terrain vehicle accident. "That was the one sad part-that someone had to die to let my husband live," Martha said. The desperatelyill patients waiting for transplantspray for hearts, Charles said; not hoping that someonewill die, but hoping that if someonedoesdie, the heartcomesin time to save their lives. It's difficult for them to wait day after day wonderingif they'll BUFFALOPHYSICIAN AND BIOMEDICALSCIENTIST survive long enough to receivea heart. One fellow Charles knew waited three years without getting a heart. A couple of his friends have been waiting six months. Charles had an unusually short wait-only a week. It's been about three years since his transplant at the VA, and Charles,a retiredapartmentsuperintendent,sayshe feelsgreat. He walks a couple of miles a day in the winter and 10 miles a day in the summer. A new endeavoralso keeps him busy. Knowing how difficult it was for his family to commute almost three hours from his daughter'shome in Naples, N.Y., to the VA,Charles hasambitious plans to open a housein Buffalowherefamiliesof out-of-townheart transplantpatientscan stay at no cost. He speaks to veteransgroups lookingfor donations,which can be sent to him at 18 Mark Circle, Naples, N.Y., 14512. Gratefulfor the secondchancehe got, Charlesalsodoespublic speaking on behalf of the Organ ProcurementAgency of Western New York. Through the agency, the Hiltons sent a letter to the family of the teenagedonor, thanking them for chisextraordinary gift. "Everytime my husbandhasa birthday, their son hasa birthday, too," Martha said. • Editor's ::-..'ote: For more infonnac1onon che Organ Procurement Agenof Wbtcm ::-..'ca)ork, Inc., call I-800-227--1771. For more information on ihe UB!Bujfa/o General Heart TransplantCenter, call 1-800-2-12 00-15. C\' SPRING 1989 �8 SPRING 1qgq BUFFALOPHYSICIANAND BI0~1EDICALSCIENTIST �THERMOGRAPHY: A HOf NEW FIELD By CONNIE OSWALD STOFKO he patient's image appearson the computer screenas blotchesof garish reds, blues, and greens,lookinglike a wild paint-by-numbers . The facial features are indistinct, but that doesn't matter. This picture is more like a map than a portrait. The picture was created using a technique called thermography,which maps the various skin temperatures on the surface of the body. This data on distribution of skin temperatures has great potential in the diagnosisof circulatory and neurologicaldisorders,say UB researchers. And they're ready to take the lead in the new and growing field of thermography. "Currently, we are the most active center for thermographyresearchin the country and are expanding rapidly," said Michael Anbar, M.D., chairmanof the Departmentof BiophysicalSciences at UB. "We've got cameras matched by nobody. We've got software matched by nobody-because we developed it. "We want to make Buffalo the national center for thermographyresearch." BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST SPRING 1989 9 �T hermography is a relatively simple technique. "It's ve r y much like taking a 10 photographic image-the re's a camera , it looks at you, it takes your picture. You can even smile if you want to," Anbar quipped. The camera is a rectangular , black metal box about two feet long. A spinning mirror located in a recess of the box picks up the light reflected from the surface of the subject . The light is reflected to another mir ror inside the box, and then to a third. Finally, the lighr is reflected inside the box onto a detector rhar's sensitive to infrared light. (Everyone emits infrared light. Broadly, it can be said that the intensity of the infrared light depends on the temperature of the subject.) The detector changes its resistance depending on the temperature char falls upon it. If a photo detector were used in place of this infrared detector, you'd get a photographic image, Anbar noted . Using the thermographic camera, vivid color images that show the distribution of skin temperatures are produced on a computer screen, displayed in colors ranging from hot red to cold blue. Since skin temperature is a function of the pe rfusion (or blood flow) under the skin, hot and cold spots can indicate problems wirh blood vesselssuch as clogging of the arte ries, thrombosis, or an inadequate blood supp ly to the feet of diabetics. "Whenever you have a perfusion problem, thermography is ideal because it's non-contact, non-invasive to the extreme, it doesn't hurt, you can repeat it as many rimes as you like, and you can quant icace the resulrs; said Anbar . "I feel we haven't scratched the surface of its potential:' Changes in skin tempe rature and blood flow can indicate more than circu latory problems. Since blood vessels can constrict or dilate depending on signals from nerves, we can learn about the behavior of nerves by watching the behavior of blood vessels, Anbar explained. Thermography cou ld be used to flag a pinched nerve or a disorder of the sympathetic nervous system . Thermography can also be used to SPRING 1959 "visualize" pain. That's because when a nerve sends a signal to the brain that registers as pain, it's often associated with a change in blood flow. If the affected area of the body shows a change in temperature, it might indicate that the patient feels pain . However, even if nothing unusual shows up on the thermographic image, the perception of pain can't be ruled out. While this technique can be very helpful in rehabilitation medicine, it also can be abused, Anbar pointed out . Lawyers like to use it when they suspect that a litigant is faking an injury in order to collect money after an accident. "T he r mography has fa llen into disrepute because it has been used so much by the legal profession as a kind of lie detector for pain," Anbar noted. While thermography is now used most- ly in non-surgical procedures, it has great potential for use during surgery, Anbar believes. le could be used in all surgical procedures where perfusion is critical, such as during organ transplants . "Here's a non-contact technique char tells you whether perfusion is uniform, and it could be performed du ring surgery," Anbar said. T he University researchers are investigating ways that thermography can be used to assess irritation to the cornea and to try to prevent the rejection of corneal transplants . Thermography could also be used to check on the healing of skin grafts. The researchers are developing new computer hardware and software for thermography, as well developing better diagnostic tests. 0 EGREES CENTIGRADE 32.4 32.0 31..7 .. 31..4 .. 31..0 30 • I ''ffjl •' 7 .4 ·1 :~ . ~..... 30 ~~, ii. BUFFALO PHYSICIAN �They want to take the subjectivity out of thermography. Instead of simply looking at a thermographic image and making judgments about "hot" and "cold" spots on the body, the researchers want to be able to assign number values to the data . "We're focusing on quantitation of rhermographic information;' Anbar noted . "Ar the moment, we're the only ones in the count ry doing this." The researchers also are crying to develop "normative data; chat is, data from healchy people to provide a baseline for comparison co different pathologies. They hope to use rhermography as a model for diagnostic imaging in general. T he data they're developing may be applicable to any diagnostic imaging problem, from X-rays to ultrasound. "An image is an image, no matter how it's generated," Anbar noted. The UB team is an interdisciplinary group char includes : • Robert A. Spangle r, M.D., Ph.D., associate professor of biophysical sciences at UB • John Loonsk, M.O., instructor in biophysical sciences at UB • James Montoro, biomedical engineer in biophysical sciences at UB who is developing quantitative techniques • Kyu-Ha Lee, M.D., associate professor of rehabilitation medicine and director of the residency program in physical medicine and rehabilitation at UB as well as chief of rehabilitation medicine at the Veterans Administration Medical Center • Linda A. Hershey , M.D., Ph.D., associate professor of neu rology at UB and chief of neurology services at the VA • Steven M . Steinberg, M.D., assistant professor of surgery at UB and chief of the surgical service at the VA • William H . Coles, M.D., M.S., professor and chairman of ophthalmo logy at UB and clinical director of ophtha lmology at the Erie County Medical Cen ter. A relatively new field, computerized rhermography has existed for only about IO years. Buffalo's first rhermography camera arrived at the Veterans Administration Medical Center less than three years ago. Buffalo now has three such cameras-two at the Veterans Administration Medical Center and one in the Department of Biophysical Sciences at UB . By 1992, Anbar hopes to have seven or eight in the area. The Department of Biophysical Sciences decided to put a great deal of effort into thermography because it's a problem researchers here can attack with relatively inexpensive equipment, Anbar said. For example, an MRI (magnetic resonance imaging) machine costs about $2 million to buy and $1 million to run. Thermography equipment costs about $100,000. T hese gra:,•-sca le th e rm og raphi c im ages show th e hand s of a pa ti ent s uff e rin g f ro m a neur olog ica l di so rder. T he han d at left is co ld er . than th e on e a t ·; right. A NO BIOMEDICA L SCIENTIST "We cannot easily become leaders in areas which require larger investmentsand we should be leaders; Anbar said. "With chermograp hy, it's not a 'me-tod situation . Thermography is one of those areas where we have an advantage over anywhere else in the coun tr y." Hardly a bargain-basement techniq ue, thermography can do things that other techniques can't . Thermography looks at the functions of the body, while othe r techniques, such as X-rays and MRI, look at the structure of organs or tissues. The rmography assesses the surface of the body, while the ochers look inside the body . All of the tech niques operate differently and the information each provides comp lement one other. "Thermography is not a substitute and it's not a competitor to these ocher techn iques ; Anbar emphasized. "They're very different. "Thermography can identify physiological phenomena that can't be identified by other means . T here's no simpler, more direct way to measure" some of the functioning of the nervous system. • SPRIN G I9S9 11 ��FromDestruction to Recovery B y M A The Armenian R K MARABELLA rom their devastated homeland in the moun- earthquakein tainous region of Armenia, 10 young earth- December devastated quake victims arrived at snowy Buffalo cities and International killed 50,000 Airport in February for treat- people. But for ment at Children's Hospital of Buffalo and survivorslike MartinMekret- Millard Fillmore Hospital-two major chian, left, life goes on-with help from hosp itals affiliated with UB's Schoo l of Medicine and Biomedical Sciences. some UB physicians. Children's treating youngsters, seven H ospital is Armenian more than any other American hospital. The children range in age from 5 to 14. UB physicians affiliated with the Hand Center of Western New York at Millard Fillmore are treating a 17-year-old and two Armenians in their early 20s. BUFFAW PHYSICIANAND BIOMEDICALSCIENTIST SPRI!'< G 1989 13 �14 Munro Strong, M.D., associate professor in orthopaedics at UB and orthopaedic surgeon at Children's Hospital, was one of a team of 10 American medical personnel who traveled co Armenia for the difficult cask of choosing which patients were co be airlifted to the U.S. for continuing medical treatment. During his nine-day stay in Armenia, he and physicians from Syracuse, Boscon, Philadelphia, and Chicago, in cooperat ion with Armenian officials, selected a coral of 37 patients for treatment in 10 American hospitals . The Armenians were chosen for medical treatment in the U.S. if their injuries were liferhrearening, infected, or healed improperly, according to Strong . Many will receive prostheses and rehabilitation during their stay. "Ideally, you would like co help all of the children and bring them all back co the U.S.," acknowledged St rong . "Unfortunately, we can only directly assist relative ly few of these kids, but these kids we help will gee excellent medical care here." An est imated 3,000 to 4,000 Armenian chi ldren are suffering from serious injuries including broken spinal cords, crushed pelvises and limbs, and infected SPRING 1989 fractures . The earthquake, which hit two and a half weeks before Christmas, claimed the lives of more than 50,000 men, women, and children . Those who have survived or sustained injuries have lose others in the catastrophe . "The children who made th is trip are extremely frightened; Strong emphasized . 'They have been through a great deal. Most of chem in face have lost one or both of their parents. Many of their parents were never even found. Many who came co the U.S. were accompanied by an older sibling, an aunt, o r a grandparent as their guardian ." Buffalo became involved in treating the Armenians through Robert Gillespie, M.D ., acting chair of orthopaedics at UB and chief of orthopaedi cs at Children's . On Christmas Eve he received a phone call from officials of Project HOPE, an independent, nonprofit, international, health education foundation lilit Ermand- based in the U.S. Both G illespie and Strong had worked with Projian, S, left, ject HOPE as orthopaedic consultants to the Pediatric Institute of Krakow, Poland for the past two years. The radiates suninstitute is the largest hospital for children in the world shine. Below: and is affiliated with Project HOPE's continuing education of Polish and Soviet medical personnel. ArevikToroProject HOPE had been contacted by cop White House officials following Soviet Premier Mikhail Gorsian, 13, and bachev's request for aid from the U.S. SonjyPangoian, Strong emphasized char the airlift and treatment of the Armenian child ren is merely an initial gesture 17, are mesfrom Project HOPE, which negotiated a more enduring relief initiative with the Soviets and their Ministry merizedby of Health. The long-term project includes plans co Americansoap develop a rehabilitation facility in Yerevan (the capital of Armenia located 3 7 miles from rhe site of the operas. catastrophe) in cooperation with Armenian authorities . Initially, the facility will provide services co earthquake victims requiring continuing treatment for their injuries. Children fitted with prosthetic devices in the United States will need co have them mod ified as they grow. The project will include training technicians co operate the Yerevan facility and establishing an or- BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �chopaedic and plastic surgery exchange program with American hospitals and universities. "There is no ability co make prosthetics or rehabilitate people with upper-extremity loss in Armenia," noted Strong. "All of the children who had injuries of upper or lower limbs were left unsplinted, so chat the patients we found who had upper extremity nerve injuries had their joints contracted in one (contorted) position or another." There is a great dea l lacking in the medical expertise of the Soviet Bloc as well as the Eastern nations in general, Strong said. He reported that he did not see one spline of any kind the entire time he was in Armenia . "Many concepts considered basic to medical care are not known or regarded there-such as the need for splines or removal of infected bone without the need for amputation," Strong pointed out . Nevertheless, he emphasized chat the Armenians, given the available facilities, did a "remarkable and massive job caking care of the hundreds of thousands of injuries chat literally came into Yerevan within the first several days." It's hard to envision the devastation of the quake . In Leninakan, a town with approximately 200,000 inhabitants, officials blew up unsafe buildings every day at 4 p.m. and dragged the rubble outside of town,. In Spicak, a town of 30,000 chat was very close to the epicenter of the quake, 50 per cent of the buildiings were destroyed and the other ha lf were unsafe . T hose who survived had to be evacuated . "In a small village of about 2,000," Strong sob1~rly recalled, "the entire place was leveled. Not a single structure was left standing. There was simply a pile of rubble for about two miles along the highway . ''Any medical system, no matter where it might be located, would be overwhelmed by such an event. The people there worked night and day in order co save BUFFALO PHYSICIAN AND BIO MEDICAL SCIENTIST few were as 15 lucky as Artem Horontyunian, below, who traveled to Buffalowith his mother.The girls at right check out Polaroidsof themselves. lives." Strong urges people, particularly in ArmenianAmerica n communities, to continue opening their hearts and responding to the needs of the Armenians. Buffalo's Ronald McDonald House, which affordab ly houses our-of-town families of patients who have traveled co Buffalo for medical treacmenc, has graciously opened its doors co the parents and guardians of the Armenian victims. Moreover, all of the hospital services, equipment, and the medical attention given by the Americans have been donated without charge to the victims or their government . "le is a tribute to the quality of medical care available in Buffalo,"noted John P. Naughton, UB vice president for clinical affairs and dean of the medical school, "chat UB physicians working at two of our major affiliated hospitals will treat the largest number of children-IO-airlifted from Armenia . "It is also a tribute co Buffalo's reputation as The City of Good Neighbors' chat it will play host to the families and guardians of these young patients?' UB President Steven B. Sample commented that, "shortly after the Dec. 7 catastrophe, the University at Buffalo was able to lend engineering and technical expertise to the people of Armenia through our National Center for Earthquake Engineering Research. We are pleased to be able to continue this international commitment through our participation in Project HOPE's humanitarian program?' • SPRING 1989 �16 BO GRO R This one device can lengthen or straighten a limb. It can grow strong, healthy bone in the gap left by the removal of infectedbone. And it can do it better and faster than other treatments, says the UB orthopaedist who pioneered its use in North America. By MARK MARABELLA lthough its appearance may resemble a gruesome medieval torture device, nothing could be further from the truth . Called the Monticelli-Spinelli External Fixation System, this apparatus of stainless steel wires, nuts, and rods is a revolutionary system which has given new hope to patients with limb deformities and severe fractures. "The European company that manufactures this device didn't realize the importance of what they had: asserted Munro Strong, M .D., an associate professor of orthopaedics at UB. "I had a difficult time convincing them to increase its production and distribution for use in the States. "This one device can be used to correctangular deformity and limb length, abnormal growth, and rotationa l adjustment." A • SPRING 1989 Ant hony H int o n It has been used for patients who need to lengthen one leg that is shorter than the orher, to straighten a leg that is crooked due to abnormal growth, or to grow healthy bone in the gap left by the removal of an infected bone segment . Ocher devices aren't able ro perform so many diverse functions, Strong noted. Furthermore, they require more extensive surgery and often require rhe use of plates or grafting, which result in weak BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �17 and britcle bones that are more susceptible to fractures. The Monticelli-Spinelli device requires a shorter treatment period than other devices, with only a brief stay in the hospital when the device is initially attached. The device is monitored and cleaned by the patient daily, requiring only intermittent examinations by the attending physician. Furthermore, the device allows the patient to put weight BUFFALOPHYSICIANANO BIOMEDICALSCIENTIST on the limb with only limited restri,ctions. "The most impressive feature of this devic,e is its ability to develop new strong and healthy bone, with few postoperative complications; emphasized Stronig, who is also an orthopaedic surgeon at Children's Hospital of Buffalo. Once Strong convinced the manufacturers of the device's importance, he and Robetrt Gillespie, M.D., acting chair of orthopaedics at UB and ch ief of orthopaedics at Children's, were the first surgeons in North America to implement the device in October 1987. Children's Hospital was chosen as one of four initial North American sites to be study centers for the instrument, manufactured by Jaquet Orthopaedic, S.A., in Geneva, Switzerland, a subsidiary of the Howmedica Company. Just two years later, there are 43 centers SPRING 1989 �18 across the U.S. and Canada, and more than 200 patients have benefited from the system-IS alone have been treated at Children's Hospital. For Anthony Hinton it meant that not only could he avoid the amputation of his bad ly ipfected leg, but he can also look forward to a full recovery. "This device is one of the greatest inventions I know," declared an enthusiastic Hinton . "I didn't think this thing was going to work, but now I'm happy to see that it really has ." Hinton suffered a bad ly broken tibia (the thicker of the two bones in his lower leg) when the tractor trailer he was driving flipped over and pinned him inside the cab. A lthough his leg was set and placed in a cast, he developed an infection within the fracture of his bone several weeks later. This meant that Hinton had to undergo surgery to remove the portion of infected bone . In the recent past, this type of operation meant that the patient might lose the full use of the limb or would have to have it amputated . But that's not the case with the Monticelli-Spinelli device. The stainless steel device is composed of two or three concent ric rings which encircle the limb, stabilized by three vertical rods which look like long bolts. Wires, attached to the rings, hold the severed bone in place and provide che necessary traction tension . Nuts are attached to the rods. As the patient tightens the nuts, the device, and in turn the leg, is stretched . Strong used the device in a technique called proxima l corticotomy in Hinton's case. Once the infected portion in Hinton's lower tibia was removed, a cut was made in the proximal metaphysis (the growth plate in the tibia closest to the knee). Within this incision, a hematoma (a blood-filled swelling) formed, which in time changed to fibrous tissue, and then SPRINC 1989 Hinton had lost about 1112centimeters (.6 inches) due to bone absorption in addition to the 4 centimeters (1.6 inches) of infected bone removed by Strong. So Hinton had his leg lengthened almost 6 centimeters (almost 2.4 inches) co compensate for the bone he lost. Hinton was required to tighten the nuts only a quarter millimeter (about .01 inches) four times a day for six months . This he lped to stretch the healing bone tissue gradually. To prevent infection, which is common in such cases, each day Hinton had to carefully clean the wires which pierce the skin . "I didn't think this thing was goingto work, but now I'm happy to see that it reallyhas,"said Anthony Hinton. "The pain was minor compared to the benefitsI received.Even thoughI couldn'twork, I could still get aroundand put T he device is most often used on younger patients because of their ability to heal and regenerate new bone faster. However, Hinton, at 28, is the oldest patient in North America to have used the device thus far. "The doctor cold me that I was the oldest patient, but that didn't bother me; recalled Hinton . "The pain was minor compared to the benefit s I received from this thing . The only pain involved was when I had to tighten (the nut s) or if I bumped it by mistake. The cold weather during the winter wasn't too pleasant either, but I got used to it. "Even though I couldn't work, I could still get around and put weight on it," Hinton added. "My mother made me a special pair of pants to wear for the winter, and I slept with pillows under my leg." Although Hinton stopped tightening the nuts after six months, he continued co wear the device for two and a half more months to give the new bone, muscles, and tissues in his leg a chance to strengthen. Now that the wires are removed, he will wear a cast for about six to eight months, according to Strong. "There was some inconvenience, buc • now my leg is fixed," said Hinton. weight on it. There . . was some inconvenience, but now my leg is fixed.'' into solid bone. As the incision in the metaphysis gradually began to regenerate new bone, Hinton tightened the nuts . That increased the length of the growing upper tibia and moved it toward the lower portion of the tibia. Eventually, the gap caused by the removal of the infected bone became narrower . Finally, the upper and lower port ions of tibia met, fused together, and became solid . BUFFA LO PHYSICI A N A ND BIOM EDICAL SCIENTIST 1 �Alumni & Et•ents 19 AWMNISETAWARD FORTOPSTUDENTS he Medical Alumni Association Academic Achievement Award has been established ro honor the third-year student or students who have achieved the highest academic standing during their first two years of medical school. The Medical Alumni Association began the award because it was felt that while many awards and scholarships are offered to students when they enter medical school, based on their undergraduate records, nothing is done to recognize the top scholars before their third year of medical school. The achievement award will be presented for the first time during the school's annual awards ceremony for students in August . • T REHAB MEDICINE sm SYMPOSIUM he Department of Rehabilitation Medicine at UB is sponsoring a symposium on "Functional Assessment in Rehabilitation Medicine" to be held July 8-9 at the Marriott Hotel in Amherst . The conference will discuss measurement of the disability of patients in rehabilitation programs and how this scaling is developed and used, said Carl V. Granger, M.D., professor of rehabilitation medicine at UB and head of rehabilitation medicine at Buffalo General Hospital. Ocher topics will include the implications of medical ethics, the implications of financing, and the implications of research. The symposium is geared to physicians, nurses, therapists, social workers, psychologists, and administrators involved with chronic health care services or medical rehabilitation health care services. The cost of the symposium is $195. For more information, write to Granger at the Department of Rehabilitation Medicine, Buffalo General Hospital, 100 High St., Buffalo, N.Y~14203. • T 'l ticipated in the famous Framingham Study. Lasting almost 30 years, it is the longest continvovs swdyof c;:an;liovascular disease. Much of what we know about strokes has come from this study. Speakers from UB are Linda Hershey, M.D., Ph.D., associate professor of neurology, and William Kinkel, M.D., professor of neurology. Organizers of the symposium arc Glen E. Gresham, M.D., professor and chairman of rehabilitation medicine at UB; Carl V. Granger, M.D., professor of rehabilitation medicine at UB, and John V. Basmajian, M.0., professor emeritus of medicine and anatomy at McMaster University in Hamilton, Ontario. The conference is funded through a grant from the National Institute on Disability and Rehabilitation Research, part of the U.S. · Department of Education. Ir's a feather in the cap of the University to be chosen to host this international symposium, said Gresham, who noted that UB's research in chis field is strong. • REMEMBERING YESTERYEAR emember what it was like when you were at UB-the classes, the parties, the friends? The Alumni Association wants to capture a bit of chat feeling through a collection of memorabilia to be housed in a locked display case in the LippschuczConference Room in the medical school. The association is looking for alumni to lend or donate items for display. Items might include pictures, small medical equipment, programs, pennants, buttons, or other souvenirs that remind you of your academic and extracurricular activities. Send items to Dr. John Richert, Alumni Affairs Office, 146Cary-Farber-Sherman Addition, State University of New York at Buffalo, 3435 Main Street, Buffalo, N.Y. 14214.• R CALLFORNOMINATIONS our president and Board of Go vernors has, over the past several years, received many requests for Alumni / ae to establish a Distinguished Medical Alumnus / a Award. Therefore, your president and board are seeking nomination s for thi s award to be presented annually beginning thi s year. The award will be presenced to a graduate who has distinguished himself/ her self nationally or internationally in the eyes of his/ her peers and has made an outstanding contribution to medicine, the arts, or humanity during his/ her career. The selection will be made during the summer and the award will be presented in the fall at a special award dinner. Please forward the name of your nominee as soon as possible on rhe atta ched card. A June 30 deadline has been established for the receipt of all nomination s. Your cooperation is absolutely viral if this is co be a true alumnus / a award. Y WORLD EXPERTS TOMEET ATUB TODISCUSS STROKE any of the world's experts in stroke outcome research will gather in UB's Center for Tomorrow July 10-12for an international symposium on "Methodologic Issues in Stroke Outcome Research~ Attendance at the symposium is by invitation only. The proceedings will be published by the American Heart Association as a supplement to Stroke: A Journal of CerebralCircularion. The speakers will come from the United States, Canada, Australia, Japan, Israel, and Great Britain. They will include two who par- M SPRING 1989 BUFFAID PHYSIC IAN AND BIO MEDICAL SC IENTIST - ---- -------- ��I Research 21 Testing 'Clot Busters' Simple blood test may do the trick ' By ARTHUR PAGE simple blood ccscmay provide an alcernacive co immediate coronary arceriography when it comes co determining whether medications have successfully dissolved blood clots in coronary arteries following a heart attack, according to researchers at UB. The researchers showed chat the test, which measures proteins released into the bloodstream by cells in damaged heart muscle, was 88 per cent accurate. While the test was already available commercially, the researchers were the first co use it for this purpose. It's essential co determine whether rhe blocked arteries have re-opened in order co plan a patient's treacmenc. That determination now relies on coronary arteriography, an expensive and invasive procedure nor available in all hospitals nor at certain times even in chose with cardiac cathecerizacion laboratories. Unlike coronary arteriography, the commercially-available blood test is inexpensive, noninvasive, and relatively risk free. Results of the research, conducted in con• junction with scientists at Emory University, were reported in che December issue of Circulation, the scientific publication of the American Heart Association. Avery K. Ellis, M.D., Ph .D., UB assistant professor of medicine, was principal investigator for the study, funded by the Veterans Administration and American Heart Association. Ellis is chief of cardiology at Buffalo Veterans Administration Medical Center. His UB co-investigato rs were Francis J. Klocke, M.D., who is the Albert and Elizabeth Rekatc Professor of Medicine as well as chief of cardiology at UB and che Erie A . BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST Unlike coronary arteriography, the in a cardiac cachecerization lab. He noted, however, chat "most of the patients chat have infarcts are in hospitals where cathecerizacion labs are not available. Even if they are in a hospital with a cachecerizacion laboratory, you could not logistically make immediate cathecerizacion routine wichouc greatly expanding the facilities and personnel." On the other hand, che blood cescused by the UB and Emory researchers can be used in all hospitals. The researchers are the first co focus on measuring myoglobin, an oxygen-carrying protein essential to the heart's normal functioning, co gauge che success of thrombolycic therapy, according to Ellis. They focused on the myoglobin level in blood samples taken from 42 patients at the time they received a thrombolytic drug and at regular intervals thereafter. The subjects also underwent cardiac cathete rizacion co assess the success of chrombolycic therapy. There was a rapid rise in blood myoglobin levels in patients in whom the drugs resulted in reperfusion. In contrast, che levels rose slowly in those in whom the attempt co open the artery was unsuccessful. The researchers found that a co mparison of myoglobin levels in a blood sample taken ac che time medication was given and one taken two hours lacer corre lated with the resulcs of reperfusion attempts, as confirmed by coronary arreriography, 88 per cent of the time. "The need co develop a non-invasive marker of reperfusion is important in view of the large number of patients in whom intravenous thrombolysis is now likely to be used and in whom subsequent triage becomes an important issue; they said. • commercially~available blood test is inexpensive, noninvasive,and relativelyrisk free. County Medical Center, and A.R. Zaki Masud, M.D., clinical assistant professor of medicine. n the shore time since their approval by che U.S. Food and Drug Administration, thrombolycic drugs have been hailed as a major development in efforts to reduce deaths from heart attack. Experts project that an estimated 150,000 Americans a year who experience a type of heart arrack known as an acute transmural myocardial infarction are candidates for thrombolytic therapy. When successful, it results in reperfusion, oc reopening of che blocked corona ry artery, potentially reducing heart-muscle damage and saving lives. To be effective, the medications must be administered within four to six hours of onset of chest pain. Klocke said corona ry arteriography has been che 'gold standard" for assessing whether a thrombolytic drug has worked on a patient. Coronary arceriography muse be performed I SPRING 1989 ��Research 23 Early Surgery Cuts Cost, Hospital Stay in Trauma Cases By ARTHUR PAGE arly operative stabilization of thigh-_bone fractures in trauma panents drasncally cuts the length and cost of their hospicalizacion, according to a study coor• dinated by a UB researcher. In the most seriously injured patients, the study showed chat even a short delay of only 24 hours increased che average length of hospital stay by nine days and the cost of hospitalization by more than $13,000. Lawrence B. Bone, M.D., assistant professor of orthopaedic and general surgery, said the study is rhe first prospective examination of the benefits of early versus delayed fracture stabilization. The results, scheduled to be reported in the Journal of Bone and Joint Surgery, have been presented before the American Academy of Orthopaedic Surgery and American Orthopaedic Association. Bone was principal investigator for rhe study, which involved patients at Parkland Memorial Hospital in Dallas, where he did his residency in orthopaedics in conjunction with the University of Texas Southwestern Medical Center at Dallas. He is now direc• tor of the musculoskelecal rrauma service in the Department of Orthopaedics at the Erie County Medical Center. The study compared che medical course of parients whose rhigh-bone fractures were stabilized operatively within the first 24 hours after injury with that of patients whose fractured femurs were placed in traction and not stabilized for more than 48 hours. Bone noted that in hospitals without a trauma service the delay in stabilizing fractures in trauma patients may stretch into days. He said the results confirm both che experience of major trauma centers where frac- E BUFFALO PHYSICIAN ANO BIOMEDICAL SCIENTIST cures in multiply-injured patients are stabilized as soon as possible and studies based on review of patient records from trauma centers. B one said che study shows chat immediate stabilization of fractures, whether they be of che femur, pelvis, or other bones, should be a focus of medical efforts to treat trauma patients. "The patients are in the best shape they are going to be in when they first arrive; he added. "There is very little reason nor to stabilize rhe fracture when rhey first come in, regardless of their ocher injuries, and that includes head injuries. "]f a hospital doesn't have the facilities or capabilities co do this, the patient should be transferred to a trauma center chat does chis routinely because it not only saves lives, but is cost effective. By reducing the incidence of complications, we were able to reduce hospitalization costs by nearly half in our study." The study was designed co evaluate the impact of early versus late stabilization of leg fractures on the incidence and severity of pulmonary complications and the occurrence of adult respiratory distress syndrome (ARDS) in patients. A pattern of progressive respiratory failure, the syndrome has a 50 per cent mortality rate, according to Bone. The 177 patients in the study were random• ly assigned co early and delayed stabilization groups, which were subdivided into two groups: the less severely injured and chose with multiple injuries. All emergent and urgent surgical procedures were performed on each patient according co his specific injuries. Only the fracture of the femur was random• ized to early or delayed treatment. Early stabilization had a positive impact among chose with multiple injurie s, with the syndrome developing in only I of 45 patients whose fractures were stabilized early, com• pared co 5 of 37 of chose in chelate stabilization group. ARDS did not develop in any of rhe less-severely injured patients. Bone said significant pulmonary complications developed in 14 of the 37 patients with multiple trauma and delayed fracture stabilization. On the ocher hand, only one of the 45 patients with multiple injuries and early fracture stabilization developed any significant pulmonary complications. Among the most seriously injured patients, chose in the early stabilization group had average hospital stays of 17.5 days at a coca! cost of $19,492, compared to an average of 26.6 days ac $32,915 for those whose fractures were stabilized after 48 hours. In chose who were less severely injured, the average time of hospitalization was 7.3 days for the early stabilization group and 10.2 days for chose whose fracture was stabilized after 48 hours. The cost of hospitalization averaged $5,235 for the early group and $6,929 for the late group. None of the less severely injured patients needed co be placed on a respirator or in an intensive care unit. Among chose with multiple injuries, 18 of 42 stabilized early and 24 of 37 stabilized late required intubation and admission co an intensive care unit. The early group spent an average of 2.4 days on a ventilator and 2. 7 days in the ICU, while in the lace group there was an average 6.9 days on a ventilator and 7.6 days in an [CU. • SPRING 1989 �:!!'''' ' ~ f ~ ~ ~ '! ''' i1, I I: t 11 ~ -' ~ ,i ;~ ~ -. .. .•~ - ~ ~-- . • _,'!. ., :·,, ~ ~ -·--) ~ - -~ ··~ .. .,,~ �Research 25 Exercises Promise Relief From Arthritis in Knees By ARTHUR PAGE new exercise program chat has promise to improve the mobility of millions of Americans with arthritis of the knees is being evaluated by researchers at UB. In earlier studies, the researchers showed chat Progressive Quantitative Exercise (PQE) increased the strength of some patients' leg muscles fivefold, dramatically improved functioning of their knees and their mobility, and decreased pain. Subjects were able to walk better, stand longer, and get out of a chair more easily. One man, an avid fisherman who previously had to pay someone to carry his day's catch up a river bank, now boasts of being able co scale the slope while carrying his fish. The UB researchers, led by co-principal investigators David R. Pendergast, Ed.D., and Glen E. Gresham, M.D., will study the effects of PQE on leg muscles under a $501,597grant from the National Institute on Disability and Rehabilitation Research of the U.S. Depart• ment of Education. Gresham, UB professor and chair of rehabilitation medicine, is also director of rehabilitation medicine at the Erie County Medical Center, where the study will be conducted . Gresham noted that while arthritis of the knees may occur at any age, it affects an estimated one-third of the elderly. When it is severe-with resultant pain, stiffness, decreased range of motion and muscle weakness-it limits the ability to use stairs, get up from a chair, stand comfortably and, eventually, to walk. The UB researchers A BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST The study showed that subjects were able to tvalk better, stand longer,and get out of a chair more easily. The exercisesincreased strength, dramatically improved mobility and functioning of the knees, and decreasedpain. believe chat's due in large part co accompanying weakness of the quadriceps muscle that controls extension of the knee. The goal of PQE is to strengthen the quadriceps muscle by gradually and precisely increasing the amount of work it is required to perform over a three-month period. le involves isometric exercise, focusing on contracting leg muscles without moving the knee, and isotonic exercise, which includes extension of the knee. While their preliminary studies showed PQE cased the symptoms and limitations, che researchers do not believe it affects progression of the arthritis. Subjects' progress will be monitored based on pioneering work in quantitating muscle strength conducted by Pendergast, UB professor of physiology, and Nadine M. Fisher, Ed.M., UB clinical instructor of rehabilitation medicine, who is project director. They showed that not only is there a norm for leg-muscle function at a given age, but that function and strength of the quadriceps muscle decreases dramatically past age 55. Gresham noted chat while the work focuses on arthritis of che knees, che researchers are interested in "improving the rehabilitation of people with a wide variety of musculoskeletal impairments, particularly those affecting the frail elderly." Ocher UB faculty members involved in the study are Judy Cameron-Ruh, RPT, M.S., adjunct instru cto r of physical therapy and exercise science who is physical therapy supervisor at ECMC; Evan Calkins, M.D., professor of medicine and head of the UB Division of Geriatrics/Gerontology; Beverly Bishop, Ph.D., professor of physiology; Carl V. Granger, M.D., professor of rehabilitation medicine, and Theodore Papademecriou, M.D., clinical professor of orthopaedics. • SPRll',:G 1989 �,\ led1calSchool 26 VOWNTARY FACULTY: THESCHOOL'S UNSUNG HEROS ou could call them the unsung heroes of the medical school. Though they receive no pay, voluntary faculry generously give their time and expertise to the medical school. "Voluntary physicians collectively and as individuals receive far too little credit and recognition for their contributions to medical education and to the advances in medical care,"said John Naughron, vice president for clinical affairs and dean of the School of Medicine and Biomedical Sciences at UB. Voluntary faculty members serve on school committees, teach courses, represent the school in national and Stace societies, and play an important role at affiliated hospitals . "This information serves ro confirm that there is a role for the voluntary physician, and chat the school has not excluded that role," Naughron said. "There's a need for coexistence and involvement of a strong fulltime and voluntary staff in the years ro come While UB still doesn't do enough co recognize its voluntary faculty members, it is ahead of other medical schools, the dean noted. The long-standing Siegel Teaching Award and the annual reception for voluntary faculty are a couple of examples. A new award, the Robert S. Berkson, M.0. Memorial Award in the Art of Medicine, will be given for che second time in May. The award goes to a voluntary faculty member who exhibits skill in patient care and teaching and who combines the features of scholarship and compassion that elevate medicine in its best sense from a science to an arc. The award is named for Berkson, who was a respected solo practitioner of internal medicine and served on the voluntary faculty from 1949 until his death in 1966. "His devotion ro patients was his greatest attribute," said Philip Weis, M.D., clinical professor of surgery and a member of the UB Council. Weis met Berkson when they were undergraduates ar UB. They continued Y SPRING 198'1 through the UB medical school rogether, graduating in 1941. "He was an excellent student and was interested in people," Wels recalls. "The outstanding thing about Dr. Berkson in his practice was that he was extremely, extremely devoted co his patients. He gave all the time they required. His humanitarianism is unsurpassed to this day. He would spend time with the patient beyond the normal role, and would discuss things again and again with the family in a repetitive way that most physicians would nor tolerate. "He was an ardent reader and always kept up with che newer modalities in medicine . "Dr. Berkson liked to reach, and his students liked and respected him because of his concern and his abilities ." Berkson served as a captain in the Army Medical Corps during World War U. After his discharge, he underwent four years of training in internal medicine, then began private practice. He was on staff at Buffalo General Hospital, Sisters Hospital, Millard Fillmore Hospital, the Veterans Administration Medical Center and the former E. J. Meyer Hospital. He was a fellow of che Ame rican Board of Internal Medicine, a diplomate of the National Board of Medical Examiners, and belonged co local and national medical societies. He loved his community and was active in several Jewish groups. A family man and very devoted father, Berkson encouraged his cwo children, Weis noted. His son, Richard, is now a physician. Berkson was a voluntary physician on the staff of David K. Miller, M.0. "I admired him and he did a good job," Miller said. Years ago, all faculty members were voluntary, he remembers . In 1937, Miller became the first full-time faculty member in the medical school. At that time there were a great number of "service patients" who didn't have a private physician. Times have changed and the number of full-rime faculty continues to grow, buc Miller hopes chat we won't see an end co voluntary faculty. "I think certain people have a great deal to offer in teaching residents and interns, as well Robert S. Berkson, center front, abot ie, enjoys the 1956 reunion with his colleagues from the class of 1941. Also pictured at left, he is the namesake of an atvard for voluntary faculty. as medical students," Miller said. His personal convictions are reflected in his actions. Miller left UB in 1974, but is now a voluntary faculty member with the University of California. BUFFAIO PHYSICIAN AND BIOMEDICAL SCIENTIST �>.!edical School 27 T he first person co receive the Berkson Award was James F.Phillips, M.D., clinical professor of medicine. A specialist in internal medicine with a subspecialty in gastroencerology, Phillips teaches students, interns, and residents at Buffalo General Hospital and in his office. Every year he takes a month-long teaching service. He works with an assistant resident, a couple of interns, and a few students for about one and a half hours a day, five days a week. Sometimes a fourth-year student will spend a month with Phillips, working at his elbow from 7 a.m. to 9 p.m. as he makes hospital rounds and sees patients in the office. Every year Phillips takes on a seven-week preceptorship, meeting with students for one and a half hours, three times a week, to discuss patients. Once or twice a year, he cakes a monthlong service in gastroencerology, supervising the training of a fellow. Phillips meets with the fellow for an hour a few times a week. Every day he meets with the residents and interns who arc assigned to his patients in Buffalo General Hospital. Occasional! y Phillips will lecture. All of this is time consuming work for which Phillips receives no pay. Yee he does it gladly. "I enjoy teaching," he said. !e's a great way co keep up on the latest developments in medicine, he noted. "I learn from my students and they learn from me," Phillips said . As modern medicine races ahead, it's difficult co keep up with every new advance. A student may have access co new information in a field outside of gastroencerology that is helpful to Phillips. Teaching also stimulates a physician co keep on his toes-he doesn't wane to appear uninformed to his students . There's also a certain amount of prestige that comes from teaching, Phillips said. "Physicians respect someone who teaches in the medical school," he said. "Everyone wants to be respected among his peers, no matter what the business. "It's self-gratifying, I enjoy it, so I do it." But he also feels an obligation to teach. As outlined in the Hippocratic Oath and elsewhere, all physicians have the responsibility co take care of the sick, to conduce research, and to teach, he said. The role of the voluntary faculty member will always be here, Phillips predicted. "More and more medicine is being practiced outside the hospical; he explained. "Insurance people wane it chat way, the government wanes it that way, and magical modern medicine allows it. People who work only in hospitals can get a skewed viewpoint. They see only the patients who are critically, terribly ill." But the real world of medicine isn't filled SPRING 1%9 BUFFAW PHYSIC IAN AND BIOMEDICAL SCIENTIST - ---- --- -- �Medical School & Hospital News 28 with intensive care units, he asserts. Instead, it's marked by sore throats and belly aches and diarrhea. The voluntary faculty present rhe world "as it really is,"Phillips said. "The full-rime faculry don't have rhar privilege." A challenge facing medical education roday is how to allow students to spend more time in "the real world" of medicine-offices and clinics, he noted. In his reaching, Phillips tries to inform students about a disease and to convey rhe things he's learned through experience. But he also tries to be a role model and impart the qualities of compassion, kindness, gentleness, and friendliness. Disease doesn't exist on its own; it's affecting a human being and that person's family, he pointed our. "The best way to teach people how to be a good human being is by being a good human being; he noted. When Phillips accepted the Berkson Award, he did so in rhe names of all the great teachers who went before him, especially William Lipp, Elmer Milch, and Clayton Green. "I learned everything from chem," he said. "My name is on it, but rhe award is for all those great people who taught me my trade and taught me rhe love of teaching." • SURFACE SCIENCE IS TOPICOF CENTER acuity from the UB School of Medicine and Biomedical Sciences will participate in a new Biological Surface Science Center established at UB. The research at the center will focus on the interaction of biological materials with another material at the molecular level. For instance, a dental implant should stay securely in rhc jaw. However, a company making chewing gum docs not wane gum that sticks to rhe reech. Surface science can determine why dental implants stick to gums, as well as why chewing gum will nor stick to reech. The co-directors of the center are Robert E. Baier, Ph.D., a research professor of biophysical sciences at UB and director of rhe F SPRING 1989 Health-care Instruments and Devices lnsrirure (HlDl), and Joseph A. Gardella Jr., Ph.D., an associate professor of chemistry. The National Science Foundation (NSF) gave UB a $25,000 planning grant to start rhe center. The center will be funded with annual grants of $75,000 from the NSF and about $200,000 from HIDI, a New York Scare Center for Advanced Technology. Faculty from rhe School of Dental Medicine, the Faculty of Natural Sciences and Mathematics, and the Faculty of Engineering and Applied Sciences, are also involved in the center. • STUDENTS HONOR ENTIRE DEPARTMENT he UB dental class of 1992 has presented an award co rhe gross anatomy faculty and staff in the School of Medicine and Biological Sciences for their outstanding service and dedication. "This is che first time chat an entire class has collectively recognized the efforts of an entire depamnent," said Harold Brody, M.D., Ph.D., chairman of the Department of Anatomy. "I chink chis award exemplifies the sense of cohesiveness that exists between the students (both medical and dental) and the staff within UB's medical school." • T CAPLIFTED FOR NON-RESIDENTS he UB medical school has rescinded its cap on the number of out-of-Stare applicants that can be admitted. However, the medical school will continue to give preference to New York Stare residents. Ir was decided that the cap of 4 per cent of the class, that is, five our-of-State students, was too restrictive. The declining pool of applicants ro medical schools may make it necessary for UB to accept more out-of-State students, bur the cap discouraged them from applying, it was argued. • T SISTERS EXPANDS HEAD,NECKPROGRAM S isters Hospital, in conjunction with the UB School of Medicine and Biomedical Sciences, is developing a "commitment to excellence"in otolaryngology and head and neck surgery. The project is spearheaded by John M. Lore Jr., M.D., chairman of the Department of Otolaryngology and Head and Neck Surgery at Sisters as well as professor and chairman of the Department of Orolaryngology at UB. Sisters has 12 years of experience in treating cancer patients in a special unit. In addition, UB's Department of Otolaryngology has a fellowship in Advanced Head and Neck Oncologic Surgery, which is centered at Sisters and the Veterans Administration Medical Center. Established in 1979, the fellowship is one of the first five to be developed and is one of only 16such programs in the United Scares and Canada. Plans for the center include: • Expanding facilities, equipment, and programs. • Expanding research and establishing a program to develop new biomedical instruments. • Improving medical education for professionals as well as improving educational pro• grams for the public. • Contributing ro and utilizing the National Cancer lnstirure's database on patient treatment and outcomes. • Funding the new position of Chaired Professor of Otolaryngology / Head and Neck Surgery and filling it with a nationally recognized head and neck oncologic surgeon. • Developing an endowment to fund a scientist conducting basic research. • Developing a head and neck tumor registry. • Evaluating treatments, including surgery, radiotherapy, chemotherapy, and irnrnunocherapy. The University's Department of Otolaryngology will continue to work closely with che other UB affiliates, including Roswell Park Memorial Institute, Buffalo'sdesignated corn- BUFFALO PHYSIC IAN AND BIOMEDICA L SC IENll sr �Hospiwl ;-,7c.:H'S 29 BGHNURSING HOME ADDING 80 BEDS uffalo General Hospital is adding 80 skilled nursing beds to one of its nursing facilities and has announced an affiliation with another nursing home. Buffalo General's Deaconess Skilled Nursing Facility is adding a 21-bed pediatric unit, a 21-bed unit dedicated to head trauma patients, and 38 conventional skilled nursing beds. The $7 million project includes renovation and modernization of the current 162-bed facility and is expected to be completed in mid-1990. The Downtown Nursing Home, an 80-bed skilled nursing facility on Buffalo'slower West Side, has affiliated with the General Care Corp., parent company of the Buffalo General Hospital. Both nursing facilities provide services primarily co disadvantaged persons in Western New York. The affiliation is expected to reduce costs for both facilities. • B CATHETERIZATION LAB STARTED ATMERCY Jo hn M. Lore Jr., M .D. prehensive cancer center. Both Sisters and Roswell are members of the Western New York Health Sciences Consortium. • NEWRULES TOCUT RESIDENTS' HOURS c looks like the recommendations of the Bell Commission Report are becoming reality. New Seate regulations that limit the number of hours residents are allowed co work are slated to go into effect July I. Under the new rules: • Residents may work no more than 80 hours a week when averaged over four weeks, and no more than 24 hours in a row. • On-duty assignments must be separated by at least eight hours of non-working time and residents muse get 24 consecutive hours off each week. I BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST • Hospitals must enforce policies that prohibit combined assigned hours and moonlighting hours from exceeding the limits on assigned hours. Buffalo hospitals are still gearing up to meet these requirements. Regulations for emergency rooms went into effect in October. They include: • Limiting assignments for residents and attending physicians to 12 consecutive hours. • Requiring that residents be supervised 24 hours a day. This requirement can be met by a resident in his last year of training if the attending physician is within a reasonable distance of the hospital, explained James P. Nolan, chairman and professor of medicine. The Graduate Medical-Deneal Education Consortium is also developing a formal system to credential residents. This would replace the informal system of documentation of skills chat exists now. • ercy Hospital is now equipped with a Cardiac Cachcterization Laboratory, the first of its type to be constructed distinct from a cardiac surgical center in Western New York. The lab has been fully operational since early October. "Diagnosis and early treatment are critical factors in preventing cardiovascular disease from seriously afflicting chose at risk," stated Anthony Bonner, M.D., chief, Division of Cardiology, Department of Medicine. "A cardiac catheterization procedure is one of the best diagnostic cools available co pinpoint the disease state in those at risk, as well as a tool to develop the proper regimen of treatment." While the laboratory cost approximately $594,000, this expense will be offset by eliminating transportation costs and the time spent waiting to transport patients to another laboratory, noted Mary Ann Gottstine, assis• cant administrator. M SPRING 19$9 �People 30 SPEEDING UP THEFDA T homas R. Beam, Jr., M.D., associate professor of medicine and microbiology at UB, has been named director of a new project that will explore ways to speed up che U.S. Food and Drug Adminisrracion's drugapproval process. The two-year projecr also will develop recommendations for improving the federal agency's monicoring of drugs already on the market for early warnings of serious adverse reactions in patients. The project will be conducted under a $280,550 contract between the FDA and the Infectious Diseases Society of America (IDSA). While the project will focus specifically on antibiotics, ics recommendations are likely to be applied co drug groups across the board, said Beam, an expert in infectious diseases. He is also associate chief of scaff for education and former chief of infectious disease at Buffalo Veterans Administration Medical Center . He praised the IDSA for initiating the project and the FDA for welcoming the cooperative effort between the professional society and federal agency. "To their credit, they recognize that the system is flawed," Beam added . He said problems have been highlighted in recent years by complaints that che FDA drug-approval process unnecessarily delays the approval of new drugs, some of which already are available in othe r countries. Critics of the process calling for reforms have ranged from AIDS activists co officials at the National Cancer Institute. Despite the lengthy process designed to assure the safety and efficacy of new drugs, Beam noted chat some medications approved by the FDA still have been implicated in serious adverse reactions and patient deaths. "The regulatory process chat now takes 10 co 12 years no longer guarantees safety; according co Beam. "At issue is whether the compounding of regulations benefits anyone; he added . "Ir delays the entry of good drugs into the marketplace, creates tremendous costs for the SPRING IQSQ Thoma s R. Beam , Jr., M.D. pharmaceutical industry, is costly to the FDA and means the Ame rican public does nor get access r,o drugs as quickly as people in Europe, Japan and che rest of che world." The classic example cited to defend the FDA's ,conse rvative approach on drug approval iis that of thalidomide, which caused major birth defects in the children of pregnant women who used it in the late 1950sand early 1960s. The drug was not approved for clinical use in the U.S. when che birch defects appeared in children born in West Germany and Great Britain, where it was already available. Whil,e the layers of regulations built into che reviiew process since then have stretched out the drug-approval protocol in the name of safety, Beam noced char "the recent history of drug development has not been one of sue- cessful protection of the American public." He cited the examp le of benaxoporfen (Oraflex), an anti-inflammatory drug for the treatment of arthritis that won the FDA's scamp of approval, yet later was associated with serious complications and the deaths of several patients. Also of recent vintage, he added, were the cases of ticrynafen (Selacryn), a diuretic shown to be associated with irreversible liver damage and patient deaths after it was approved for marketing, and moxalaccam (Moxam), an antibiotic that caused severe interna l bleeding in some patients . While the FDA subsequently ordered benaxoprofen and ticrynafen pulled from the market, moxalactam is still available, although "the physician community has essentially stopped prescribing the drug BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �People 31 because its toxicity outweighs its benefits; according to Beam. He said the examples underscore the need for a "scheme of monitoring that relatively quickly identifies serious side effects and brings them to the attention of the FDA so that physicians can ultimately limit their use of a drug or it is pulled from che marker, if necessary." Beam, who will work ac the federal agency in Rockville, Md., until midsummer, was selected from more than 30 members of the 1,600-member IDSA who applied to head the project. He will collaborate with FDA officials, representatives of che Pharmaceutical Manufacturers Association, national leaders in academic medicine, and approximately 50 members of the IDSA who will serve on pro• • jeer subcommittees. - By Arthur Page HEAIRSALLTHENEWS THATKEEPS YOUFIT s the lights go up on the WIVB news set, Peter Ostrow, M.0., Ph.D., straightens his notes and peers con• fidently into the red-lighted camera which will broadcast his health / medical report to thousands of Western New York viewers. "I used to be nervous at first; admitted Ostrow, associate dean and professor of pathology at UB's School of Medicine and Biomedical Sciences. "But, a year of experience, and doing up to six hours of research for my two-minute segment gives me confide nce chat my report will be accurate and informative." Ostrow was chose n for the three-year position with WIVB over seven other hopefulssome who previously had broadcasting ex• perience. However, with his expertise in the field of medicine, his 14 years of experience in medical education, and his commi tment to UB and the surrounding area, the native Buffalonian had some definite advantages over the others. "I cold the producers at the station chat my idea was to showcase the cutting-edge medical A Peter Ostrow, M.D., left, confers with Jacq11ie \Valker on the news set. research and health care that is going on at the University and area hospitals, which is among the nation's most advanced; explained Ostrow. "And they loved che idea." John Naughton, dean of the School of Medicine and Biomedical Sciences, views Ostrow's position as "an honor to the medical school" which helps to create a positive relationship between the University and the community. W hen Ostrow landed a seat next to anchors Bob Koop and Jacquie Walker, he became, and still is, Buffalo's only physician• reporter. His segments appear live on \'(,'JVB's news broadcast ac II p.m. on Tuesdays and Thursdays and are rebroadcast on Wednesdays and Fridays ac noon. Ostrow's topics have ranged from antibiotics and influenza, co smoking and cancer, to medical history. One of the biggest viewer reponses co an Ostrow report concerned a new drug called ciprofloxacin which helps heal hand and foot infections in diabetics. The clinical research which proved this drug's effectiveness was conducted by Tom Beam, M.D., associate professor of medicine and microbiolog y, and Jerome Schentag, Pharm.D., professor of pharmaceutics, noted Ostrow. This is an im- porcant development because diabetics otherwise have a difficult time fighting peripheral circu latory infections. WIVB and Ostrow received phone calls from Rochester, Pennsylvania, and Canada. However, Ostrow noted char not all viewer response has been enthusiastic. "Once when my topic was syphilis; he recalled, "I had mentioned in my report char Christopher Columbus and his crew brought the disease to the New World. The next day the station received a phone call from an irate viewer who happened to be the man who was almost single-handed ly responsible for having Columbus Day declared a national holiday. He threatened to call the FCC and bring charges against the station, but nothing more came of it. "I feel that if something is true, then it's worth saying; emphasized Ostrow. "The peo• pie at the station aren't only concerned with ratings but with quality and integrity as well." A lth ough Ostrow enjoys working as a television reporter and has learned a great deal from the experience, his primary interests remain in neuropathology and in medical education. Ostrow received nine awards in reaching excellence from his students at the University of Texas at Houston where he was SPRING 19$9 BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST -- -- - -~- -- ---------- �Peot>le 32 the director of neuropathology before returning to UB as an administrator in 1984. Ost row began his academic career as an undergraduate at UB in 1962. "Unlike other health / medical reporters, I am responsible for my own material because medicine is my field of authority. My reputation as a doctor and an educator depends upon the accuracy of what I say; Ostrow pointed out. "I have to prepare a lesson plan just as if I were in the classroom. I research the topic and conduct interviews with other medical experts. I don't just report the story-I explain it. "Television is a powerful medium and I see chis job as a great opporrunity co educate and inform the general public about recent advances in medicine." Ostrow's uncompromising pursuit of accurate and informative topics has meant sacrificing many early evenings at home and saying goodnight to his three children . He was also asked to shave his beard and mustache, which he had worn for 18 years, because the producers thought it was a "sinister" and "less than trustworthy" image for a doctor to have. His children, however, thought just the opposite. "My children, the oldest of whom was 15 at the time, had never seen me without a beard: Ostrow remembered vividly. "My youngest child, Rachel, threatened to run away from home if I shaved my beard off. So I let her shave it. I held a basin under my chin and the 10-year-old first trimmed it with scissors and finished it off with an electric razor. "Now that my family ha s gotten used to me without a beard, they like it better." Although Ostrow has appeared on television for over a year, he hasn't gotten used to basking in the limelight. He still gees embar• rassed when he is recognized at the supermarket or at a souveni r booth at Rich Stadium . "I just can't get used to being recognized by strangers; Ostrow admitted . "However, their comments are usually very complimenta ry, which is reassuring. le lets me know that people out there are listening to what l have to say." • - By Mark Marabella SPRING 198'1 of psychiatry at the Erie County Medical ~nre~ • Francis J. Klo c ke, M.D. , the Albert and Elizabeth Rekate Professor of Medicine, has been appointed to the National Heart, Lung, and Blood Advisory Council of the Nationa l Institutes of Health. He is also the chief of cardiology at UB and the Erie County Medical Center. • John M. Lor e Jr ., M.D. , professor and chairman of the Department of Otolaryngology at UB, has completed his third edition of An Atlas of Head and Neck Surgery.Originally published in 1962 and up• dated in 1973,the text is considered to be one of the most complete works relating to techniques in surgery of che head and neck. Lore is also chairman of the Department of Otolaryngology and Head and Neck Surgery at Sisters Hospital • Gerald Sufrin , M.D. , professor and chairman of the Department of U rology, has been appointed to the lntersociety Council for Research of the Kidney and Urinary Tract.• Mark Flanz enbaum , a third-year medical student ac UB, cook first place in che medical school's eighth annual Student Research Forum. He won for his presentation on his basic research on oncogenes. Second place went to Janice Errick , a third-year student. In a three-way tie for third place were Kevin Osterhoudt , a second-year student; Gar y C ro ghan , a third-year student, and John Klemper e r, a third-year student . • Marvin I. Herz, M.D. , professor and chair of the Department of Psychiatry at UB, has been elected president of the Western New York Psychoanalytic Society. He is director Rohit Bak shi , a second-year student at UB's School of Medicine and Biomedical Sciences, received the Saul R. Korey Essay Award in Experimental Neurology, sponsored by the American Academy of Neurology. An abstract of his essay, "N-Mechyl-D-Aspartate antagonist Dexrrorphan limits dinorphin induced paralysis in racs; will be published in the AAN annual abstract issue of the jour• nal Neurology. 1'vo UB medical students have been elected to positions with the American Medical Student Association . Th omas R. Piazza has been named chapter president and Richard S. Musialowski is recruitment coordinator.• Mary Ann e Rokitka , Ph.D. assistant professor of physiology at UB, has been elected vice president of the Undersea and Hyper• baric Medical Society. • SPOTLIGHT SHINES ON ARTWORK earring with chis issue, the Buffalo Physicianand BiomedicalScientistwill regularly feature the artistic work of one of the UB medical school's alumni, students, or faculty. The work could be in painting, photography, sculpture, poetry, fiction, or ocher media. If you'd like co be featured, send us a photo of your artwork, or even a photocopy, so we can see if it will reproduce in black and white. Feel free to send shoes of several pieces. lf we decide co use your work, we'll make arrangements to rake a good, clear photo . If you submit literary work, please send a photocopy. We'd hate co see artwork lose or damaged, so don't send us the original artwork . Please include your address and phone number, and tell us if you're a student, alumnus, alumna, or faculty member. Address submissions to Connie Oswald Stofko, 136Crofts Hall, University at Buffalo, Buffalo,N.Y. 14260. • S BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �"I have been doingwacercolors for more chan25 years. ... Many paincingshavebeeninspiredby nacureobservedduring20 )-etlTS of joggingaround Williamsville. Paincingis a good way w sharpenyour eye, co see more beaucyaround." Ivan L. Bunn e ll, M.D . (M'43), Ca rdiologist, Director of the Buffalo General Hospita l Angiology Laboratory from 1960-1982 BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST SPRING 1989 �Clmsnotes 34 1960s Edwin R. Lamm (M'60) • of Lakeland, Fla., is president of the medical staff of the Lakeland Regional Medical Center and also secretary-treasurer of the Independent Physicians Association of Lakeland . G eo rg e B. Kuit e (M'Z 7) • has been disabled since 1970. His address is: lntervalc Rd., Box 1457, North Conway, N.H. 03860. 1930s Or van W. H ess (M '3 I ) • is clinical professor (emeritus) of the Yale University School of Medicine . H arr y Bergman (M'3 4) • received a gold medal in March from Phi Lambda Kappa Medical Fraternity for his contribution to the advancement of medicine and the medical sciences, and particularly for his work in the field of urology. The Bergman's Sign, along with a short biography of Bergman, was included in the 27th edition of Dorland'sMedical Diccionary.The author of several books, Bergman is clinical professor of urology at rhe University of Miami Medical School and New York Medical College. Harry Bergma11 '34 founded and it is in chis spirit char the recipient of the award is honored . 1940s Burton L. O lmsted (M'41) • writes, "Enjoying retirement after 37 years in the practice of plastic and reconsrruccive surgery in Portland and South Portland, Maine?' 1950s John Ambru sko (M '3 7) • is the namesake of the new $3 million public health building in Manatee County, Fla. Ambrusko is retiring after 11 years as medical executive director of the county's health department. In addition, Ambrusko found time for occasional stints as the physician on cruise ships. James E. Youker (M'S4) • will receive the Distinguished Service Award from the Medical College of Wisconsin at the May commencement. Youker is professor and chairman of rhe Department of Radiology and is currently serving as chairman of rhe Residency Review Committee for Radiology. Maxwell Rosenblatt (M'38) • The Maxwell Rosenblatt Commemorative Award has been established by the Public Health Foundation of Los Angeles Coun• ty. It was through Rosenblatt's vision and persistence that the Public Health Foundation was Robert A. Bren ne r (M'59) • gave up private practice to take a full-time position at the Veterans Administration Medical Center in Syracuse. SPRING 1%'1 Tarik E lib ol (M '62 ) • assistant professor of medicine ar rhe UB Schoo l of Medicine, has been elected chief of medicine at DeG raff Memorial Hospital. Virgin ia V. We ldon (M'62 ) • has been named vice president of scientific affairs for the Monsanto Company . She will advise the company on public policy issues in science and medicine . Weldon is also deputy vice chancellor for medical affairs at the Washington University School of Medicine in St. Louis. Marvin Z. Kur ia n {M'64) • has been elected to Who's Who in America and is a lifetime member of Fellows' Leadership Society of the American College of Surgeons. Kurian is a clinical instructo r of surgery at UB. David E. Pittman {M'64) • has been invited to serve on the editorial board of t he Journalof Angiology.Dr. Pittman is associate director of the Cardiovascu lar Laboratory at Allegheny General Hosp ital and a clinical assistant professional of medicine at the University of Pinsburgh School of Medicine . Calv in Ma rantz (M'65) • writes from Santa Ana, Calif., where he is a pathologist / dermatopathologist, that he is now serving as co-director of Laboratory Coastal Communities Hosp ital. Virgin ia V. Weldon '62 Daniel S. Sc hubert (M'65) • of Shake r Heights, Ohio, is currently the edito r of rhe lncernacional Journalof Ps)'chiatryin Medicine. August J. D'Alessandro {M'65) • of Newtown, Conn ., is supervis ing psychiatrist at the Fairfield Hills Hospital and consultant psychiat rist to the Co nnecticut Department of Mental Retardation and Region #4 PGM Review Committee member. Jared C. Ba rlow {M'66) • is president of the New York State Soc iety of Anest hesiologists for the 1989 ter m. Barlow is medical di rector and chairman of anesthesia at Millard Fillmore Surgery Cente r, and associate professor of anesthesiology at UB. John R. Fisk {M'69) • was elected president of t he Association of Child ren's Prosthetic and Onho t ic Clinics - a U.S. and Canadian organization of clinic personnel. D r. Fisk is ch ief of the Child Amputee Clinic at the Chicago Shrinc rs Hosp ital. BU FFALO PHYSIC IA N AND BIO MEDI CAL SCIENTIST �C/assnotc, 35 presented four papers at the 7th Medical Command Radiology Conference, both in Heidelberg, Germany. 1970s Jan M. Novak (M'70) • has been elected president of th e medical-dental staff of the Erie County Medical Center where he is director of the gastroenterology division. Mark Glassman (M'78) • was promoted to associate professor in the Division of Pediat ri c Gastroentero logy at the New York Medical Center. Roy M. Oswaks (M'71) • of Virginia Beach, Va., was recertified in general surgery by the American Board of Surgery. Larr y Zemel (M'73) • married Jesse Stoner in June, 1987. They have a son, Michael, born in April, 1988. Zemel is director of pediatric rheumatology at Newington Children's Hospital, Newington, Conn . Howard R. Goldstein (M'74) • joined the Urological Professional Association in Cherry Hill, N .)., where he lives with his wife, Judy, and three child ren, Lee, Lauren and Daniel. Mic h ael L. Stei n fe ld (M'75) • is clinical assistant professor of cardio logy at the University of Pittsburgh and president of the medical staff at Forbes Health System. Jane K. Dorval (M'76) • was recently appointed medical director of Moss Rehabilitation Ho spital, a 144-bed freestanding, not-for-profit hospital with an affiliation with Temple University's PMR Residency Program. Dr. Dorval is a boa rd -certified physiarrist. Nora 8. W ilcox (M'76) • writes, "I have decided to make a career of the Navy and have been selected for promotion to the rank of comma nd er. Also this summer l was appo int ed head of the Jared C. Barlow '66 Department of Aviation Medicine and senior flight surgeon at the Naval Air Station, \'Vhidbey lsland, \Y/ash." Cliphane W. McCleod (M'77) • reports char he is the only obstetrician in Hin esville, Ga., where he has a solo practice. His wife, Joan, is his office manager and nurse. The McCleods have five children : Cliphane II, 13; Lucien, IO; twins Travis and Nice!, 7, and Natacha, 4. Richard R. Curran (M'78) • an internist with Buffalo Internal Medicine Associates, P.C., has been appointed rhe new medical director for the Alden Medical Center . Angelo M. DelBalso (M'78) • and an alumnus of the Deneal School (72) writes chat in 1988he presented a continuing education cou rse sponsored by the School of Deneal Medicine in lxcapa, Mexico. He also presented continuing education lectures to the 89th Medical Detachment and BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST Mark E. Brenner (M'79) • writes, "Recently completed hand and microsurgery fellowship in Louisville, Ky., and am relocating to Pinehurst, N .C. to establish a practice in hand/orthopaedics/ microsurgery ." Joseph Caprioli (M'79) • of Hamden, Conn., was recently promoted to associate professor of ophthalmology and visual science at Yale University School of Medicine . David M. Kenton (M'79) • writes, "presently practicing cardiology in Deerfield Beach, Fla.,-would like to hear from Mark Brenner and Alan Schimmel." His add ress is: 5580 G Coach House Circle, Boca Raton. William J.Lawrence (M'79) • is vice president of Associated Healthcare in Buffalo. 1980s Jain Avanindra (M'80) • is an assistant professor of medicine and cardiology at the University of North Carolina at Chapel Hill. He and his wife, Diane, have a two-year-old son, Brian. Jan A. Koenig (M'81) • writes, "Completed a fellowship in joint replacement surgery of hip and Jan M. Novak '70 knee. Now in private orthopaedic surgery practice in Long Island, N .Y. Expecting first child (a boy) March 1989." Brett C. Shu lman (M'81) • recently married Amy Libenson, an attorney, of \Y/ilkes-Barre,Pa. Shulman has a solo practice in dermatology and dermatologic surgery in Rochester, N.Y. Arlene Rose Curry (M'82) • of \Y/oodside, N .Y., writes, "\Y/illbe married coJohn Patrick Hynes on May 28, 1989. Unfortunately, my father, Howard Curry, will not be with us - he died March 7, 1988." Richard L Collins (M'83) • writes, "I recently accepted the position of medical director at the Northwest Buffalo Community Health Center . I rook this position in October, 1988. This is a federally funded multi-specialty health center." Mary M. Lee (M'83) • is a research fellow at Massachusetts General Hospital, Boston . Adolph Soto (M'83) • is currencly working as a psychiatric attending at Lincoln Hospital in the Bronx on a special bilingual/ SPRING 1989 �Classnotes 36 bicultural inpatient unit . Soto was married on May 29, 1988. Raymond Graber (M'84) • writes, "l recently married che former Mary Kowalczyk of Amhe rst, Ohio . We hope to start on our 10 kids soon." Graber is director of anesthesia at che Veterans Administration Medical Center, Cleveland, Ohio. M ichele Kaufman Koleszar (M'84) • joined a women's medical group in Bridgeport, Conn., in the practice of obstet rics and gynecology. She marr ied Miklos P. Koleszar in May 1988. David J. Forster (M '85) and Carol A. Hammer (M '85) • were married in Buffalo in July. Dr. Hammer is practicing pediatrics in the Washington, D.C. area and Dr. Forster is associate chief resident in the Department of Ophthalmo logy at Georgetown University Hospital. He will be going co USC / Estelle Doheny Eye Center in Los Angeles in July for a fellowship in uveitis and ocu lar immunology. Lesley Burton-lwinski (M'85) • Finished a residency in June 1988 and is now a clinical instructor in che Department of Family Medicine at the Medical College of Georg ia. Jon M. Wardner (M '85) • who is a resident in P.M.&R. at the University of Michigan writes, "Blackford Middleton (M'85) and his wife Ursula King visited on June 28 en rouce co Palo Alco from Hartford . Enjoyed their company and an evening of gourmet beer casting. To Jim Esse r (M'85 ), we say 'ouzo' ." SPRING 1989 Chr istopher S. Walsh (M'85 ) • presented "Control of Neck Disease in Carcinoma of Waldeyer's Ring" at the October 1988 meering of the American Society ofTherapeuric Radiology and Oncology. Walsh is chief resident in the Department of Radiation Medicine at Massachusercs General Hospital. M. Miles Braun (M'86) • has joined the Internacional Activities Office of AIDS Program in Atlanta, Ga . N icholas D 'Avanzo (M'86 ) • will be completing his pediatric residency in 1989 and plans co open a private pediatric practice in Connecticut. Donnica L. Moore (M'86) • writes "I am well on my way coward recovery from my spinal fusion surgery, enjoying married life, and love my switch from ob/ gyn co family practice." Jos e ph A. Pierro (M '86) • is the first author wich Ors. Berens and Crawford of che Clinical Manual of Radiology,which was released in March. Ros ylyn R. Romanowski (M'86) • has scarced a fellowship in hemacology/ oncology at New England Deaconess Hospital. Evan D emestiha s (M'87 ) • is assistant medical director for Sandoz Pharmaceuticals in Hanover, N.J. He is responsible for products in the neuro-endocrine-metabolic cherapeu tic area including Parlodel (bromocripcine), Sandostatin (occreocide), and Tavist (clemanstine). moor Psychiatric Center, Queens Village. He began his career with the Scace Department of Mcneal Hygiene in 1935 ac Harlem Valley Psychiatric Center, Wingdale. During World War II, Haigh t served in the Army Medical Corps for nearly five years, seeing action in the Pacific. He rose to the rank of lieutenant colonel. He retired from the Army Reserve in 1967 with the rank of colonel. M ichele Kauf man Kole.1:.C1r'84 Brian D. Gal e (M'87 ) • has started his residency in nuclear medicine at Albert Einstein Hospital, Bronx, New York. R h onald 0. Hyndman (M '8 7) • informs us that he is still single. Jill E. K oe hl e r (M '87 ) • announces her marriage co Edilberco A. Mo reno, M.D. of Puerto Rico on April 10, 1988. Dr. Kochler is a pediatric resident at the Hurley Medical Center in Flint, Mich. Thomas P. Smith Jr. (M '87) • announces the birth of a son, Thomas Patrick 111,born on Dec. 25, 1988. Smith has a daughter, Megan Elizabeth, age 3. Deaths J. Roth ery Haight (M'3 4) • retired director of Gowanda Psychiatric Center, died Dec. 9. H e was 81. In New York Seate service for 42 years, Haight was director of the St. Lawrence Psychiatric Center, Ogdensburg; assistant director of the Kings Park and Utica psychiatric centers, and supervising psychiatrist of Creed- John D. Persse (M'42 ) • chief of surgery at Mercy Hospital from 1951 through 1971, died in Sarasota, Ra. He had joined Mercy's staff in 1948 and retired in 1981. Buffalo-born George Hatem, 78, the doctor credited with eradicating veneral disease, opium addiction, prostitution, smallpox, trachoma and filiarisis in China, died October 2 in Beijing. He had hoped co eliminate leprosy in that nation by the year 2000. He was known in China as Ma Hai-ceh, a name chat means "virtue from overseas." Harem received an honorary degree from UB in September 1987 and spoke ar the medical school's Spring Clinical Day in Ju• ly 1986. He is survived by his wife, two children, a sister, and two grandchildren. Former director of Child ren's Hospital Mo ir P. Tanner died August JI, 1988. He was 88. He held the position of director for 30 years - longer than any ocher administrator of his era. When he retired in 1967, a 10-story addition co the hospital was named for Tanner, who was known as "Mr. Chi ldren's Hospital." He also was very active in community and religious organizations . He is survived by a son, Duncan C., five grandchildren, and four great-grandchildren . • BUFFAID PHYSIC IAN AND BIO MEDICAL SC IENTIST ��Buffalo Physician & Biomedical Scientist State University of New York at Buffalo 3435 Ma in Street Buffalo. New York 14214 Address Correction Requested :S:on-Profi,Oll:U.S. Po,tage PAID Buffalo, '-.Y Perma :So. l 11 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician and biomedical scientist, Spring 1989 Subject The topic of the resource State University of New York at Buffalo. School of Medicine -- Periodicals Medical colleges -- New York (State) -- Buffalo -- Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Date A point or period of time associated with an event in the lifecycle of the resource 1989-Spring Contributor An entity responsible for making contributions to the resource State University of New York at Buffalo. School of Medicine Relation A related resource MIcFilm LD701 .B42 M5 no. 268-271, Buffalo physician Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Identifier An unambiguous reference to the resource within a given context LIB-HSL008_v23n01-1989-Spring Table Of Contents A list of subunits of the resource. The elusive miracle A hot new field Earthquake. 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Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1989 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/b9e7d5bc38e6182e6a53b6b4a90ded40.pdf 176af84cc28a3d0cd5088c01ed804b1f PDF Text Text Vol 22, No ~ �Dear Alumniand Friends: STAPF EXfC l '11\ f EC'ffi)R Lil's!\ ER'iITT Pl 3llt ATI->!'>IS R.:bcrt T \hr 6l fh\1.0 PIH~!( Al'<EDr,DR 1d Cor: c l)s" u d /1 =cdia.l ~ tr:mr m· hdd l l.ide,; :i shortl'ned \l'rs :Jn of m\ rem 1•k$to •he rctMlt tees Tro of Board nd n, 1s1r,m• .idm11, ft, t, h, the med1, I •o uixl.i•c i;ned Jc•, rrtre h1< p11,1IT Ho l,rneml Buffalo rh "' 1 1hc !,_.,spit I, 11\ 1hc 1he1r L 111,mLeiu.Jc Lbou1 de\dopml'nts ln~11tutc, "a< ried1c I chool, and JI 1hc Ro wet: P.ir:.. Memon I Thl. hosp11al (l.-sslul s1, .,..i1te \\a OUnt ~•1.1el. well atlendcJ ,md h', C'ndJct .ich , Ii> b c.onpr.itul •l-d fn IJkm .. \ luJblc t me 1,1.. , sul'S m ,111mlorm..illH' •l' nn lOlllcrnm~ rr ,1Jor c,)ntt.wporar\t.-du , >n .md h 'th <,ire. n ,J .-sJrc nd As vou "111 glt'ln from m\- rem.irks. m,1Jor d1..ingt to "• I Nnr llX,11ly, tc\\1dc anJ n.mon.illy "h1 h w1I rH· I med the lxrneen tt.d cx1 ,c h 1hat ps h ch,m :, the rcfauon fhcsc ,hangcs cdu, 110n'-""llll'llll ty anJ ~h, p 111t•ntcJrt· sy•ttm 1hat h.ivc 111tcr.1C11ons \\ill oltcn be tro·1bk-wm • .i1 that 1hc um'iuc 1 dNUPll.-d as 'llOrc .ind r x1stt·d m th, husp t I em ronn, nt "1 1 be mt-d m ,lm riore mt.-d1, I studc111 .md re d nt cdu.a".;>n 1spcdor of tht l.ilrrtnt hul:itor', md ...om'll m ty l'!l\ .ronm,llls, ,mJ mu h tc Urtl-S ot "ork {'C'l'IOrlT',J h\ res1dc111s ~ urned h.., altcrn ht.11th manpowu. ,mpc:nJ ng ,h,mges m thc mmner Ill wh1lh Di,-.;p1te th~ .te'l' w1'I med .ii edu,.1•1on 1sconJul.tcd, thn teach ng hosp1rn: sy '- ·re pJUcnt ,md fl.h, • r<." uon. c<lu.. f ull be. maJur 1n:!fU"TIC'l'o .1 tc,Jlh•ngl.m,1y for the .,, Je'll' lly ,mcntl.-d I, ulty ,rd thr rctrt ll ,>ricnlt'd pFl t1 mg phy,K,JII commun11y Hopctulh. ot us for dc11I ;cr\N 10 reinforce th t cont.er• JnJ tu pr,p,1rc .ill "1th m the mr wuh the rl·,1l11eswh1t.h we ,ire .md "rll he f,1,t·d J. he ye r T h 1< 1c C)frh B11/fle, Pin l<W ~mil,:, ART Dliu.C'TPR AJ,c J K,glcr ADVISORY BOARD [)r )o, I l',; IL n, • tl1<11m: Or H • ,Id Broov ' ( " lf .., :::>r.; .'" 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WRITI:RS \!ark Marc'i.,lla hn "'•ugh· I: •sabcth % fhc J "ue 'll'uctchr ILLUSTRATORS CiiTg B, hop &m F•.:gm'J P l l(mlG R1\ Plll:RS Tong 'i.m Bo "- on Jm· 1 rrat n John n 8 Na u ghto n , M.D. Prc,.Jert/0"'Clrm<.i!IAIJa,r, v•.._.._ u & ...... l. - TE.ACHINGIIOSPITALS ANI> LIAISONS of M, I, me u· 1 Bron: t,c..11'x .,,.e, D.m '><.ho<f l t , A Dear FellowAlumni: "M llarc.lFllh, ore llo-p1·al, Clan•, 1: Day, Bo..ird, A'umm thl' H~CJ. 6, MJy 1,dJ to wh,,h pie , j 10 1 mount. th it the pn:y,rJm h • hu:n cl 11,r1hc pe 1ker, w111 Jay A J, ,11n-; 11 h -<lfJl •1h of l<X1 11' :l nauon 11 "•~ ri,1h• .i'T'r J, i.. •~urmon 1r th '4! •I•• ou• ~ pc 1h,111' ret.r,1011 ,la 1he1r nJ . ,rn p·ogr th1 tt•nd lo ., cvl"-•·rrrd dfort l hh hm l't of Th Alur m· Bo rJ I. t<•t pn t I th nu:·bo ,rd r llHrl·ntl. 01,1m 'J hed Ml-d ,JA ,urr r,u 'A"JrJ. , • p col th1 p 1hlll. I th )r, C. .urJ (-C~ mp n ·n r, , :t< f0r tin ., po t,1rl' "l;. 1d (ard nJ • t nom1nt tkttm,; • 1 <rlter. th n n I' I..)ffi'\lumm the.· ro for -t.l'd 1, \'Ol r n0m1n,ltlon p 1 )· r '-<' ti ,J th1 t th r,nuur. I hi-e I 1. I\',""" Lr.. .r, ti, l11<1or','of ,r 'llt-n':-t yang p thl· l,rg~ I c.·nrol'n,t1,t ••I J~. \'\' on the bo rJ Pixnn. 1,41, l' 1 \ 'I A11•n" I \1cJ ~h lur. 1d wot, J 1cn•lxr r ir • rrori , 10i.:. for" ,rd t '< >flti"'l'H: ! JP"''"' • r~ I,, '1\ ,nc In• ti, It l fl• \1c ·nhcr ' p •n .i• '"l'J"'I; 1 tr t po , t>·••~.pll' <' rc~po,,I f v ~.1bl, •o ,.1 rr, , re 11011 1 the ~.rr, 1<rro\\ Ill's ntJrc r to our Spnll Bl•) \ r C l Pl > " l , C , • A, Ju [' \/T [ j 16 ( f "''.,.. ' . 'l , II h11'1,r, \1 .:... /~//1./~k Paul If. Wicrzbicnicc, M. D. Pre .Jer.1 . I! I l �Vo l. 22, No. 5 Features The best is yet to come. Donald S. Faber, Ph.D ., received the prestigious Javits Neuroscience Investigator Award for his work that has helped change the way we think about the nervous system . I lucky13. For alumnus Larry Schreiber and his wife, Carol, ten adopted children plus three children by birth add up to one big happy family. Cholesterol.Can you trust laboratory measurements of cholesterol levels?An October conference looked at that and other question s pertaining to cholesterol. I Passivevaccine.Edwin D. Kilbourne, M .D., one of the world's leading experts on influenza, is working on an influenza vaccine that actually allows a virus to invade the body . He described his research in the fall Harrington Lecture . Airwaves.Three students find that jobs as radio disc jockeys ease the tension of medical school. ~ Handpicked . The students entering UB's medical school are talented and diverse. Departments HospitalNews.The board of managers at the Erie County Medical Center has more power over the day-to-day operations of the hospital, thanks to a new law that was effective Jan. l. Classnotesand alumninews. A new annual award will honor a Distinguished Medica l Alumnus/a . Cover P hoto: Bob Walion ��3 It's More Than Electrical Wiring Faber gets ]avits Award for researchon nervous system i f ver the last 14 years, Donald S. Faber, Ph.D. has he lped change the way we think about the nervous system . In recogn ition of that fruitful work, and in anticipation of more to come, the UB professor of physiology has been given the prestigious Javits Neuroscience Investigator Award by the National Institute of Ne u rologica l and Communicative Disorders and Stroke . The award, named for the late Sen . Jacob K. Javits of New York, is given to investigators who have a distinguished record of substantia l contrib utions in neurologica l or comm u nicative sciences and who can be expected to be highly productive over the next seven years. The award grants Faber an extra two years of funding for his new NIH grant, bringing it to a total of $1.2 million over seven years. Since the 1970s, Faber and the members of his laboratory have collaborated closely with a group of researchers, led by Henri Korn, M.0., Ph.D., at the Pasteur Institute in France . "The award is the result of our collaborative efforts;' Faber said . This grant, as well as h is previous work, focuses on synaptic interactions in the central nervous system. Faber and his colleagues work with the Mauthner cell in the brain of a goldfish, BUFFALOPHYSIC IAN AND BIOMEDICALSCIENTIST which he finds to be a better experimenta l mode l than mammals or invertebrates. "Ic's a very beautiful system for a number of reasons," Faber said . "The cell is identif ied-you can give it a name . That's not common in other systems. "There are just two of these Mauthner cells, one on each side of the brain . And the cells are large." The job of the Mauthner cell is to trigger the fish's escape mechanism-when you tap the aquarium, the fish swims away. Different kinds of sensory input trigger the cell and trigger it reliably. How does this trigger work? Using microelectrodes, the researchers recorded the Maut hn er cell's responses to inputs from sensory cells and from inhibito ry interneurons (the cells that "talk" to the Mauthner cell). These inhibitory cells are part of the network that controls when an escape occurs. Injecting dyes into the inhibitory intemeu ron, the researchers were able to look at the structu res of the synapses using the light microscope and electron microscope . "By combining physiology and structure, and statistical ana lysis of responses of the Mauthne r cell to inhibitory intemeurons, we have developed a mode l at the microscopic level for synaptic transmission in the central nervous LATE WINTER 1988-89 �4 Does one synapse influence another? "We're excited about the question of cross talk because it opens up a number of possiblr ua)S of thinking about hou the nervous s, stem i0orks." 1 LATE WINTER 1988-89 system; Faber said. "This mode l is common not just to fish, but to most neural connections!' ne aspect of the model is related co the fact that the endings of nerve cells release chemical transmitters in a "probabi listic" way, Faber said . 'There's a degree of uncertainty in the way the connections work ." We often think of the nervous system as a wiring diagram . If you flick a switch, a light bulb goes on. But Faber pictures it this way: You've got 10 light bulbs . When you flick the switch, sometimes all 10 bu lbs light up. Another time just four light up, or none come on at all. Though the stimulus is the same, the message that the cells receive is different each time. This probabilist ic feature also provides the basis, in some systems, for forms of "plasticity" where, with experience, synaptic connections become reinforced . For example, if you stimu late a nerve cell repeatedly, there's a greater chance that subsequen tly all 10 bu lbs will switch on . Faber likes to use the term "plasticity" co describe this phenomenon, preferring that word over "learning" or "memory~ That, in capsule form, is what Faber has been working on for 14 years. About four years ago, Faber and his colleagues began to think about the u nity of a synapse-not on ly how the chemical trigger is released, but how the Mauthne r cell responds . They've developed computer models of how that works, tak ing into account the diffusion of the chemical transmitter in the synaptic cleft (the very small space between the inh ibitory interneuron and the Mauthner cell) and how the Mauthner cell responds to that transmitter . T his mode l prompted the researchers to become interested in new questions, including : Are the adjacent synapses isolated from each othe r or does one synapse influence another? The re are indeed mechanisms for cross talk between adjacent synapses, Faber and Korn wrote in a November 1988 article in the Proceedingsof the National Academy of Science.This work becomes the focus of the Javits Award, Faber explained. "We're excited about the question of cross talk because it opens up a numbe r of possible ways of thinking about how the nervous system works:• he said . The genera l notion about a synapse is chat a chemical neurot ransmitter is released, diffuses over the synapt ic cleft, binds to specific receptors on the other side, and is quickly deactivated when Pac-Man-like proteins gobble it up or carry it away. But Faber has found that instead of being active ly carted away, the chemical transm itter slowly diffuses away. While the chemical lingers, its effect can be compounded . For instance, if two adja- BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �5 Faber thinks a chemical transmitter can change an adjacent receptor site. "If iue're right, we have a tremendous mechanism for modulation of synapses that use even different transmz.tters.'' cent inhibitory incemeurons transmit glycine, the effect is greater than the two individua l effects added up. "The fun thing we want to do in the next few years is expand chat concept;' Faber said. Suppose two adjacent nerve endings, called A and B, release different chemica l transmitters onto one cell. In the old way of thinking, chose nerve endings are isolated from each ocher. Chemical A affects receptor site A and Chemica l B affects receptor site B. Then the chemica ls are quickly deactivated. But Faber thinks it's possible that chemical A may affect not only receptor site A, but diffuse over to receptor site B and change it as well. "If we're right, we have a tremendous mechanism for modulation of synapses that use even different transmitters;' he said . This adds a level of sophisitication to our thinking that's left out of the "wiring diagram" view of the nervous system. He noted that a lot of experimenta l models for plasticity in the nervous system on ly work when groups of cells are active, not when a sing le cell is active . Faber's postulation "is one type of mechanism that explains chat, we hope . We'll try to find our:• aber received his S.B. in electrical engineering from the Massachusetts Institute of Technology and his Ph .D. in physiology from UB in 1968. For cwo BUFFALO PHYSICIAN AND BIO MEDICAL SCIENTIST years he worked ac UB as a postdoctora l research fellow supported by an NIH grant . He left UB to become a visiting research associate at the Max Planck Institute for Brain Research in West Germany, chen moved on to a similar position ac the Universice de Paris. From 1972 to 1974 he was an assistant professor of physio logy at the University of Cincinnati. Faber moved back co Buffalo co cake a position as a research scientist with the Research Institute on Alcoho lism. In 1975 he joined che faculty at UB and in 1978 became director of the Division of Neurobiology, a pose he held until 1986. A prolific writer, Faber has published 82 papers and one book. In addition, he holds numerous positions with faculty committees. Awards are nothing new to Faber. He was an exchange scholar with the Capital Institute of Medicine in Beijing in 1986, a fellow of the Neuroscience Institute in New York City in 1984, a fellow of the Claude Bernard Association in Paris in 1972, and a Grass Foundation fellow at the Marine Bio logical Laboratory in Woods Hole, Mass. in 1969. About the Javics Award, Faber says modestly, "It's a nice feeling to be recognized . le says my colleagues like what we've been doing:' • LATE WINTER 1988-89 �0 Il.§ 6 LATEWINTER1988-<W 0 ceil.Ir BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �7 Larry and Carol Schreiber, the jay of adoption has evolved into a lifetime pursuit. They have adopted 10 children- nine in seven years - in addition to their three children by birth. In the rural town of San Cristobal, New Mexico, population 200, the Schreibers and their 13 children comprise 5.5 per cent of the total population. Their experiences have been so good, they have formed a non-profit organizationcalledChild-RiteIncorporated to help place other children with special needs. The couple's interest in adoption began in Buffalo in 1971 while Larry Schreiber, a UB medical schoolalumnus (M'72), was on his senior pediatric rotation at Buffalo Children's Hospital and Carol was there as a recreationaltherapist. It was there that they met Lawrence, a 17-year-oldhemophiliac. or BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST LATE WINTER 1988-89 �8 awrence "was having various medical, financial, and family problems at the time and cou ldn't return home to his family in New York City. He needed a temporary place to stay while he was being treated in Buffalo;' Schreiber explains. "Carol and 1,having worked extensively with him during his treatment ar the hospital, were concerned for him. So, we offered him our place to stay:' After 10 months he was able co return successfully to his own family. Now 29, Lawrence resides in Buffalo with his wife and three children. Sho rtl y following Schreiber's graduation from medical school, the coup le moved to New Mexico where Schreiber began his summer internship at the University of New Mexico-affiliated hospital in Albuquerque. Working primarily in the pediatric ward, Schreiber met a four-year-old boy named Matthew who had lived in five foster homes after being abandoned by his mother when he was only a year old . Since Matthew had no home or family waiting for him, the Sch reibers yearned to give him a loving and permanent home, something he had never yet experienced in his young life. ln response co Matthew's needs and cheir unwavering emotions, the Schreibers adopted Matthew in December 1972. He was their first child. Only one month later, Sch reiber helped Carol deliver Jordan, the first of three children born to the couple. Lucas, their second son, was born in July of 1974, and their daughter, Gabrielle, was born in November 1978. le was not until 1980 chat the Schreibers considered adoption again. Schreiber was working as a volunteer for the International Red Cross Committee on the Thai-Cambodian border when he met Michael in a refugee camp. Michael was an II-year-old Cambodian orphan who was subjected to horror of watching his family of four die at the hands of the Khmer Rouge. He had been surviving on his own in the war-torn country for several years. Schreiber was moved by Michael's circumstances during his three-month stay in the refugee camp. Having inadequate medical facilities to treat a cleft palace from which Michael was suffering, LATE WINTER 1988-89 Schreiber wrote to his wife suggesting Michael's adoption and treatment in the U.S. Caro l agreed and the Sch reibers applied for Michael's adoption immediately through the United Nations, but there was extensive polit ical and bureaucratic red tape. "The political climate in that region of the world was very unstable ar rhe rime; Schreiber recalls, "so Carol and I were extremely worried that Michae l wasn't going to be released from rhe country ." ;\1tcha l arni eel at L A. International Airport not knoi i g an'\ En lish, Just tearing a tag around hii; neck that identifze his famzh and destination Wzthin u eek,, bab'\/ Yo Ri chaperoned tu o from Korea, arrned zn the U.S. Feeling frustrated and helpless, the couple sought advice and emotional support from Friends of Children of Various Nations, an adoption agency based in Denver. Here they became interested in a nine-month-old girl from Korea named Yo Ri. The Schre ibers were first introduced co Yo Ri through "exchange books" that contain a phorograph and an extensive case history of each child . The Korean infant was also suffering from a cleft palate . However, un like Michael's situation, Korea was politically stable enough co have her released for che Schreibers' adoption. While they were awaiting Yo Ri's arrival, much co the relief of the worrystr icken Schreibers, Michael was finally released from Cambodia . He arr ived in June 1981 at L.A. International Airport, not knowing any English, just wearing a cag around his neck chat identified his family and destination in New Mexico. Within two weeks of Michael's homecoming, baby Yo Ri, chaperoned from Korea, also arrived in the U.S. "June 1981 was a very excit ing month for us with the addition of both Yo Ri and Michael within such a short time;' recalls Schreiber. "After such elation, Carol and I had very few reservations about adoption." In 1983 che Schreibers again adopted two children at one time. Eight-year-old Kevin and his IO-year-old sister, Mary, came to the Schreibers from southern New Mexico . The two black children had only each olher as family after experiencing child-neglect and then several temporary homes through the foster-care system . They were a welcomed addition co the growing Schreiber clan . Next, in 1986 came Gina - all the way from Calcutta, Indi a. Gina, on ly eight years o ld and suffering from polio, was abandoned because her mother cou ldn't care for Gina's special needs while caring for Gina 's six sisters. The Schreibers were informed of Gina's situation through an Albuquerque adoption agency called Rainbow House. Since joining the Schreibers, Gina has had back and leg surgery and is able to walk with the help of braces. When Schreiber flew co Calcutta co escort Gina back to New Mexico, he met Gina's good friend Champa . Champa was co be adopted by a family in another region of New Mexico. In November 1987, Rainbow House called che Schreibers to tell chem chat Champa's adoption didn't work out with her prospective family and chat she was going to return to India. Once again the Schreibers opened their hearts and their home and took Champa in. All of their children are now thriving. Matthew, 20, from New Mexico, is currently a sophomore at Eastern New Mexico University. Michael, from Cambodia, is 19 and attends Pitzer College in California. Jordan, 15, attends Taos County High School. Champa, from In- BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �9 Hen•'s tht whole clan Larn <1nd Mattheu art st<1nclmg m bad,. ln the m1clcllerow, from left ar~ Mary, C hamf>a· Michael; Re) na1clo bemJ:'hl'lcl 1,..,( arol; I 1cas; Jordan and Ket m. Th girls m front ar Yo Rr, Lorena, Gabriell huJ:'grngC 1ela and Gma dia, is now 14. After studying English and the equivalent of eight years of school in merely three years, she attends junior high with Lucas, 14, and Mary, IS, one of the black siblings. Mary's natural brother, Kevin, 13, attends Taos Middle School with Gabrielle, 10, and Gina, 10, from India. And Yo Ri from Korea, 7, attends Taos Elementary. chreiber acknowledges that all has nor been smooth sailing with such a large and diverse family. Problems often arise when another child is added to the family, especially when a newly adopted child is the same age as a child already there. "It is sometimes a difficult adjustment for a child who has already been through BUFFALOPHYSICIAN AND BIOMEDICAL SCIENTIST four or five foster homes; Schreiber added. "It takes a little bit of time for a child to figure out how he fits into the new environment. But that's only natural. All the kids have fit in just beautifully. "We have family meetings all of the time, so that grievances and growing pains are aired before they become too large to handle. We keep the lines of communication open. When we are considering another adoption we discuss it among rhe whole family. If anyone is uncomfortable with an addition at a certain time, then we decide against it. When we do decide to adopt a child, it is a family decision." The latest additions to the Schreiber brood came in the beginning of 1988 with little hesitation from the family. They are Lorena, 4; Ciela, 3, and Reynaldo, 2 - three Hispanic siblings from southern New Mexico. They are now the youngest of the Schreiber children . "Carol and I had never really planned to adopt ten children, but the addition of each individual child, with his or her own diversity of unique personal and cultural backgrounds, has helped all of us grow immeasurably closer and stronger as a family. The tribulations seem minimal by comparison. We have found adoption to be the most splendid thing in our lives; Schreiber emphasized. The Schreibers say they are now at "capacity; but their enthusiasm for adoption hasn't waned . They've steered their efforts coward Child-Rite Incorporated, a non-profit organization they formed in LATE WINTER 1988-89 �---: 10 �h hut II un J hi orgar z ati Ri n th t I he co plt t mp li m~ pro oft often n 1986 to help place "special needs chi ldren" in permanent residences. "Special needs children" is a term given by the government for children in state institutions or foster care who are older (9 years and up), are in sibling groups, have minority backgrounds, or have exceptional physica l, mental, and emotional needs. Most special needs children are placed in state custody or foster care as a result of child abuse, neglect, or abandonment. ... II of the Schreibers' adopted children were considered "special needs children" by the state . The couple emphasizes that their family is living proof of the overwhelming joy chat these often-neg lected children can add to a family. They point out chat the wait to adopt a special needs infant is usually less than a year, which is much shorter than the usual three-year wait for healthy white infants . Also, it is not only possible, but common, for loving single parents to adopt a special needs child. To families who decide to adopt special needs children, the state may pay a stipend depending on the family's income and the specific needs of the child, Schreiber pointed out, but laws vary BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST l from state to state . There are also other subsidies such as food stamps and Medicare, which may include both medical and psychiatric treatment for the adopted children . Child-Rite has placement and referral services that are national in scope. It will refer prospective parents to other agencies and organizations which may better fulfill the parents' needs. Schreiber stressed that Child-Rite does not charge for consultation or referral. Its funding depends so lely upon private taxdeductible donations. Child-Rite works closely with Bob DeBolt and Aid for Adoption of Special Kids (AASK). DeBolt established AASK in 1976 to place special needs children in permanent residences after his family reached adoptive capacity at 20 children. Other Child-Rite board members include Carol Schreiber, who is completing her M.A . in social work at the University of New Mexico, prominent regiona l artist Veley Vigil, and author John Nichols, who wrote The MilagroBeanfield Wars, which Robert Redford recently brought to the screen. For more information concerning adoptions or donations, write to the Schreibers at Child-Rite Inc., P.O.Box 42, San Cristobal, New Mexico 87564, or call (505) 776-8158. • LATEWINTER 1988-89 �12 TRUSTWOR 7• Cholesterol tests yield dubious results hen I was in medical school, I thought if I sent a sample to the lab, I could rely on the values," said Philip L. Green land , MD. "I don't think we feel that's entirely true any more, especially in relation to cholesterol testing." Greenland, an associate professor of medicine and preventive medicine and director of preventive cardiology at the University of Rochester, spoke at UB in Octobe r during a conference on "Elevated Cholesterol: A Public Health Crisis?" sponsored by the UB medical school. The medical literature points out that laboratory measurements for cholesterol around the country aren't very good, Green land said. He noted that 240 mg/di of cholesterol is considered the cut off for high risk. But if a blood sample that has a value of 240 is sent to a lab it might come back with a result ranging anywhere from 226 ro 254. "In other words, you might see a patient today whose true value is 240 and it comes back 254,"he said. "You might see him tomorrow and you measure it again and it comes back 226, and nothing's happened to the patient; it's simply the laboratory variability!' Using the instruments and chemicals they have today, the laboratory people don't think they can get more precise than that, he added. In a 1986study, blood samples were sent to 5,000 labs in the United States. While the true value of the specimens was 262,95 per cent of the lab results ranged from 210to 3IO. That's when peop le started getting excited and the Wall Street Journal ran an article about it on the front page, Green land noted. The problem is with reference materials supplied by the manufacturer that laboratories use to calibrate their resting systems. The best reference material would be blood, but that's coo expensive co use. Manufacturers are trying to come up with better references and have improved their products in LATE WINTER 1988-89 the last several years, Greenland noted . That resulted in some inadequate tests being pulled off the market. Another problem with cholesterol testing is that several methods are used, but the results aren't comparable. One method might give a result of 225 while another yields a value of 240. "Laboratory directors are aware of this problem now and by and large are correcting for it," he said. G reenland indicated that labs shou ld use a system that's comparable with one used by the Centers for Disease Control. While the CDC standardizes systems, it doesn't have enough resources to standardize labs, except for labs conducting NIH-sponsored research. "To my knowledge, between Rochester and C leveland, there is no CDC-standardized laboratory," Greenland said. "Thank goodness we're in New York because the State Health Department is developing a reference lab so that laboratories in the State can send samples to Albany and assure themselves that they are giving answers traceable back to the CDC. "ls that happening now? No. The best thing you can do is ask your lab director if he's using a system traceable back to the CDC." Also ask the lab director for data on the precision and accuracy of his lab, Greenland suggested. While there are a lot of problems with cholesterol testing, testing for components of cholesterol is even worse, Greenland said . There are several components to cholesterol. One, called low density lipoprotein or LDL, is connected with a higher risk of heart disease. But another, high density lipoprocein or HDL, protects people from heart disease. While it might be beneficial to know rhe levels of various components, today's tests don't tell you much, Greenland said. Cho lesterol testing "has problems, but it's getting better," he said. He predicted char we'llsee more specific tests in the future. The cholesterol levels of most of the people in BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST .... �... -.. ' •• , • • •• Bad Food s: • • ••••••• •• •••• cream ► sour cream ► ice cream ► cheeses ► butter ► eggs ► red meat ► sausages ► organ meats ► palm and coconut oil ► �14 "lf somebody enjoys drinking, I might allow him two drinks a night . But I wouldn't recommend it as therapy for a ceecocaler." There's a whole list of drugs chat can lower cholesterol, bur all have drawbacks, Kohn said. Each drug has its own sec of possible side effects. For instance, Nicotinic Acid can cause flushing, gastritis, nausea and malaise. You'll feel lousy for a week, Kohn promised, then these side efects generally disappear . Nicotinic Acid can also cause abnormal results on tests of liver function. The cost can be another drawback. Prescriptions may run $100 a month. And after a while, a single drug may be no longer effective and the doctor may tum to a combination of drugs . "But when you consider what this costs, the patient may be taking $200 or $300 worth of drugs," Kohn noted . "lf the pat ient also happens co have hypertension or something else, he has $200 more of that medication. The patient must be very rich, indeed. "When you're dealing with real patients, you've got to be aware of the costs of all these medications you're ordering or you won't have a very big practice very long." Kohn says he hopes that new cholesterol drugs will spark enough competition among drug companies to bring the price down. "If patients are concerned about the price of drugs, the only alternative we can offer is diet, and they will have to modify their behavior and stick to that diet the rest of their lives," he noted . But this diet is nor well accepted by Americans, he added. His point was illustrated by a 27-yearold woman in the audience. Her mother had had oods to watch out for, Kohn said, include dairy a stroke, she explained, and she was concerned foods, eggs, palm and coconut oil, red meats, about her own cholesterol levels. Ac what point organ meats, and anythingin a sausage casing. Good would Kohn prescribe medication, she asked, adfoods include poultry, fish, cereals, legumes, com ding chat she's not going to give up pizza and oil margarine, sunflower oil, and low-cholesterol chicken wings for the rest of her life. products like Egg Beaters . "That's one of your choices," Kohn said. "You Pasta is good, but be careful of the sauce, he know the risks, and you've got to be willing to acwarned . Fish oils are fine if you use chem instead cept them ." of saturated fats in your diet. If you supplementyour When co prescribe d rugs is a very individualdiet with these oils, he emphasized, it's only going ized thing, Kohn said, and strongly recommended to make you fat. a rigid diet for the woman. He pointed out that Shellfish have some cholesterol, but they also if she planned to get pregnant, she should avoid have a lot of unsaturated fat . So they're fine, but medication since we don't know the effects on rhe watch the drawn butter, he added . developing fetus. Kohn suggested chat two drinks a day can Physicians tend to overlook the contributions elevate rhe levels of HDL, the beneficial cholesterol. co-professionals such as nutritionists can play in Bue more than two d rinks a day can pose ocher getting somebody to alter his or her diet, Kohn problems. remarked in answer to a question . "I don't know if (it helps reduce the risk of heart Yeagle also pointed out that there is a whole disease) because it increases HDL or because it's a family of risk faccors for heart disease, including socially accepted tranquilizer that makes you feel family history, age, sex, smoking, and exercise. better;' Kohn said. Cholesterol levels can't be considered in isolation. • the moderate to high-risk range can be modified by diet, said Philip L. Yeagle, Ph.D ., associate professor of biochemistry at UB who has done research in the basic role of cholesterol in cell membranes . "Five years ago I wouldn't have believed it," he added . At the high range, more than strict diet is needed. A one per cent decrease in serum cholesterol leads to a two per cent decrease in risk, Yeagle added. "Youcan have a very interesting diet and reduce your cholesterol," said Robert M . Kohn, M.D., clinical professor of medicine at UB and medical director oflndependent Health. "However, in order to reduce your cholesterol and keep it down, you have co stick co the diet . If you go off the diet even two days a week, you're not going to have a significant reduction in your cholesterol." Heart-smart refreshments were served during the break at rhe conference . There was plenty of dip and lots of celery sticks, bur not a chicken wing in sight. Instead, participants were treated to fresh fruits and vegetables with low-fat dips, soda pop, and tangy "Red Satin Punch" made from apple and cranberry juice . LATE WINTER 1988-89 BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �I ::: .. r . ~:H4,,.I . /ii!!~ ....,,;:-~· ~.. ~,·:: .• !/~.IJJ;f!. I I' 'I I , Jj1,, j:1:: /. [.:: ,·"' :.: I ....-:, ':°/ l ff::::': ; I • I''/!::: !' I I ., ·1, :·:.:; , .. :: ~ .rlJ(v·. .aL.•• I . • . '.:. : : I • • • -.r- .. •, ' : . j . ~ •i : ·:,, ·; ,' ..... . . .,. ..; •I:• ' ,,, ' . • • • 't .. ' • : : t . . . •1 ' ' ' ' ' , '1 I \ . \ I• .' • I ' C t t . I • I \ • \ 11, , • .f f '\.:,:1,•·, • I I I 'r.','•. . ' ,I I I C ' .' 't I' , j : ' I ; PI . I; I Good . . . . . . . . .Food ... . . . . s: . poultry ► f ish ► cereals ► legumes ► pasta ► corn oil margarine ► sunflower oil ► Egg Beaters �. ..: -', .."..··1.. ...-•-::\•..·..... . ...·. :~~ -· . . .•. .. . -~ _:(FP: ·:i}_:/ ::,-. ~·-. . -' - .- ·.. ..·:,,.. .-:t~ ~ ..\ -: . ...-'.' • . . ...-- .···.·:t'':'; . · .. .- . ·' . ~~ . . • . .:•..:,....!-.: • ., ~ . • ·• . .~ . , . ..,.~·. ~· • r;. • - ;::·•~):: ·: . .. ~ I • ~ ,--; •, I :, _.:: ::·., :T:~•/\.~ ; •• . ..... _ �17 Vaccine Lets Virus Invade-On Purpose By CONNIE OSWALD he soldiers stand ready ar battle stations, prepared to annihilate rhe enemy. Their duty is to make sure none of the attackers get into the fortress alive. That's how conventional vaccines work. Made from a weakened or nonvirulent form of the virus, the vaccine stimulates antibodies-the soldiers that fight off infection. But Edwin D. Kilbourne, M.D., one of the world's leading experts on influenza, is working on an influenza vaccine that would actually allow the attacking virus to invade the body. Kilbourne, a distinguished scientist both in microbiology and preventive medicine, offered a glimpse into his work during the medical school's Harrington Lecture in October. One of the founding chairmen of the Mount Sinai School of Medicine, he's a distinguished professor there and is a member of the National Academy of Sciences. Kilbourne's vaccine uses a single, purfied protein of the virus, a technique that other researchers arc crying as well. But what's really different about Kilbourne's vaccine has co do with the antibodies chat are produced . Instead of standing with guns poised to fend off any invaders, these antibod ies allow the attack ing virus into the body. But once the attacking virus gets inside, the antibodies prevent it from duplicating a great deal. By keeping the quantity of virus low, disease is prevented, yet new antibod ies are induced by the viral attack. The vaccine would allow the enemy within the gates, then suppress the enemy's activities, explained Kilbourne . A study by UB's Pearay L. Ogra, M.D. showed chat such an infection-permissive approach could work, Kilbourne said. Ogra is professor of microbiology and pediatri cs at UB and chief of the Division of Infectious Diseases at Children's Hospital. In Ogra's study, Buffalo schoolchi ldren were given a vaccine similar to the one Kilbourne is working on. "Disease was prevented, though not as well as with a conventiona l vaccine: Kilbourne said. BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST S1DFKO "But it showed the approach is feasible. That's the lesson I took away~ The use of a single purified protein, in this case neuraminidase, is a technique rhat wasn't available when Ogra's study was done about IO years ago. It's something char may help overcome some of the drawbacks of rhe earlier vaccine, Kilbourne noted. All of Kilbourne's work with the single purfied protein has been done in mice. The next step is to begin studies in humans. It may be two, or more realistically, three years before a vaccine is on the market, he emphasized . "We've had encouraging preliminary results, but it's not for tomorrow's use in man; he cautioned . Influenza is a highly significant disease, Kilbourne explained, because it paves the way for pneumonia which can prove fatal. Even when it's not fatal, influenza causes fever, aches and pains, and lands people in bed. "Ir cou ld tic up a whole community; he said. "Ir has a high attack rate-it can be devastating econom ically.• The influenza virus produces widespread pandemics of disease in cycles, every 10 to 30 years. Episodes occur when the antigens change so much that they confront the whole global population as new viruses. 'So we all become children again in front of these new viruses,• he said. "We have essentially no past experience with the antigens ~ One advantage to Kilbournc's vaccine is chat since the protein used changes less frequently, we may be able to go for a longer period without having ro change rhe vaccine. Kilbourne is hopeful that his approach will provide a better vaccine for young children. With the present vaccine, child ren under two years old have about a 25 per cent change of developing untoward reactions; that is, developing flu symproms from the shoe. If you give them only a single purified protein, there's less chance of having a reaction. "That's a long way from being proved, but we think that giving one protein is better than giving seven-which is what you have with an intact virus; he said. • LATE WINTER 1988-89 �18 Students on , These three found f their love of mus By MARK M, hey close themselves inside a foampadded room on a regular basis co escape the pressures of their hectic schedu les. No, they're not asylum inmates, bur some may call them neurotic when it comes co thei r passion for music. David Blaustein, Tony Capocelli, and Rohic "Rob" Bakshi are medical students at UB and all have pursued their musical interests as disc jockeys on the FM airwaves. Bakshi, a third-year student, is working at KYUU-FM in San Francisco. He's caking a leave of absence from UB in order co participate in neural research at the LATE WINTER 1988-89 University of California at San Francisco. Capocelli and Blaustein, both fourthyear med students, currently co-host ThursdayNight Jazz on UB's radio station, WBFO, 88.8 FM. Although their styles and musical formats at the stations differ, all of the aspiring M.D.s agree that the air time provides them much-needed relief from the tedium and discipline of their rigorous med school studies. Capocelliand Blaustein Tony Capocelli and David Blaustein, both self-professed "jazz junkies," have been voicing their musical addiction across the airwaves at WBFO for the past thr ee and a half years. "I love jazz and I love neural regeneration research," the 24-year-old Capocelli professed . "If I had to choose an ideal goal right now, it would be to head a groundbreaking team of neural regeneration researchers and have a jazz band on the side. "Even if I never end up running a research lab, I know I'll always be playing jazz." Capocelli and his partner in jazz, Blaustein, met three and a half years ago through their mutual love for jazz. "I had just begun med schoo l and was blowing off a little frustration by jam ming on my alto (saxophone)," explained Blaustein. "I was in the student lounge at about 10 o'clock at night, so the place was pretty empty . Tony, who I didn't know at the time, was corning back from the library and heard me playing . So he brought his acoustic guitar down from his room and started jamming with me. We had a really good session ." Shortly after that, Blaustein and Capoce lli each began their l-to-6-a.m. "graveyard shifts" on WBFO-Blaustein on Satu rdays and Capocelli on Sundays . Although the positions were volunteer, BUFFALOPHYSICIAN AND BIOMEDICALSCIENTIST l J �19 the Airwaves P way to harmonize 1sic and medicine MARABELLA l J the early morning shifts gave the young jazz enthusiasts an opportunity to develop their formats, styles, and selections . The collection of jazz albums in the extensive WBFO library tops 20,000 records, so it took them both some time to distinguish their own repertoire of music for their shows. "They (management) don't give us any specific record lists. As long as we stay within the spectrum of jazz-which is pretty broad-we can pretty much play anyone we want to," said Capocelli. During the year and a half that both endured the graveyard shift, Blaustein and Capoce lli started their own jazz/blues band called Code Bluenamed for their mutual interest in both music and medicine. Code Blue is an "allclear" signal given in one hospital after a Code Red, which is the emergency or cardiac arrest signal. It also represents.the band's own brand of cool blues music which alleviates the "Code Red" pressures of med school. The six members of Code Blue include Capocelli on electric guitar; Blaustein on the alto saxophone; classmates Dave Vogel on electric violin, Esther Ponce on synthesizer, and Tom Grimaldi on bass, and Tom's younger brother Chris on the drums . Whi le the two-year-old band has BUFFALOPHYSIC IAN AND BIOMEDICAL SCIENTIST made no local appearances yet, Capocelli and Blaustein are hoping to play sometime on open jazz night at some of the Buffalo jazz clubs. Capocelli has been playing the guitar and working as a disc jockey since his days as a junior at Windsor Plainsboro High School in Princeton Junction, New Jersey. The high school station had a rock format, so Capocelli didn't develop an interest in jazz until he worked two years at WRUR-a jazz station at the University of Rochester . After completing his undergraduate degree in neurobiology there, Capocelli came to UB to specialize in neurosurgery as well as to pursue his interest in neuralregeneration research. Since WBFO is Blaustein's first experience in radio, it took rhe ZS-year-old native Long Islander a little while before he felt comfortab le behind the microphone . "It (the graveyard shift) was a learning experience," Blaustein admits. "Sometimes I thought that I was the only one listening. On the nights that no one called during my show, it was sometimes cough to stay awake even after drinking a six-pack of caffeine-saturated LATE WINTER 1988-89 �20 Mountain Dew. But after a while both of us established a fairly faithfu l latenight following. We would get the same peop le calling the stat ion at the same time week after week.n Although it was time-consuming, the station helped him tremendously in coping with med schoo l. "The first couple of years of med school were the hardest for me because of the constant studying and lab work . I don't think that I was exactly ready for the work because after I graduated from Emory University (in Atlanta), I traveled around the Un ited States for a year with my buddy . We were proverb ial 'freespirits' -picking up odd jobs here and there as we needed money. So when I started med school, 1 wasn't used to the schedule or the pressure '.' laustein's primary interests in the field of medicine include rehabil itation medic ine and functiona l orthopaedics . Because he majored in psychology and minored in English as an unde rgraduate, he developed a strong interest in the humanities . "I'm more concerned with the human aspect of medicine-like how a patient is going to function in society after a traumatic operation. My job will be to help patients after neurosurgeons, like Tony, get through cutting them up," he quipped . While Blaustein and Capocelli may one day professionally comp lement each other, they are current ly combining their talents on their own jazz show on Thursday nights from 9 p.m. to I a.m. and have done so for the past two years. They have also added a jazz/ fusion hour from midn ight to 1 a.m. Tuning into WBFO on Thursday evenings, one might hear Pac Metheny, Jon Scofield, Chic Corea, or The Yellow Jackets. "Even though some of the old-time LATE WINTER 1988-89 'jazz-purist' listeners take exception to the newer jazz/fusion, overall our listeners have exceptionally increased since ou r days on the graveyard:' Capocelli estimated . Blaustein and Capocelli are currently the on ly student disc jockeys on the air at WBFO. "Sometimes I thought I was the only one listening. But after a while both of us established a fairly faithful late~night following. We would get the same people calling week after week.'' Bakshi While Rohit "Rob" Bakshi began both his medical career and radio career in Western New York, his recent endeavors have taken him across the country to the West Coast . After completing his second year of med school at UB in May, he took a one-year leave of absence in order co pursue neu ral research with Alan Faden, M .D., at the University of California at San Francisco. However, Bakshi has also cont inued performing as a DJ at KYUU-FM, a "top-40" station in San Francisco . Although Bakshi is no stranger to top-40 commercial radio, he was forced to start from the bottom on the "graveyardshift" at the west coast station . Nevertheless, the Bay Area currently has the fourth largest popu lation area for radio in the country, so Bakshi's show is listened to by thousands of people even at the wee hours of the morning . Bakshi developed his interest in radio when he was a senior at Cornell University. There he entered a disc jockey competition for new ta lent for WVBR, the Cornell -owned-and-operated top-40 commercial radio station. Bakshi entered the competition with a field of 75 ocher hopefuls. "1 d idn't really think that I had a chance because I had never worked in radio before. But I worked pretty hard on my demo-tapes whenever I cou ld'.' "Demo-tapes" are demonstration tapes used in the music industry to screen prospective DJs for a job. Bakshi was one of the first of three chosen for the air. Shortly after, he acquired his FCC / FM license and began his nine-month stint at WVBR. After he received his bachelor's degree in biology, Bakshi started medical school at UB and made his local radio debut on the now-defunct top-40 station, WNYSFM 104. He worked the weekend "graveyard shift" for four months until the station was sold {it's now Classic Hits 104.1). Soon after, Bakshi appeared briefly again; this time playing top-40 on the weekend graveyards on the popular WPHD-FM 103.3. Then in the summer of 1987 Bakshi was hired at WKSE (KISS 98.5 FM) for its radio prime-time weekend daytime BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �Medical School 21 Rohit "Rob" Bakshi shows. "It was a big break to get the numberone sloe on the number-one local top-40 station;' Bakshi recalled. "l guess they must have really liked my demo-tapes:' During his one-year seine at KISS 98.5, the radio station became Buffalds highest raced top-40 radio station (for 18- to 34-year-old listenership). Moreover, during the 1987 winter rating period, Bakshi's Saturday show from 3 to 8 p.m. was rated number one in Western New York. Bakshi, alias "Rob Miller" on the air, had to follow strict formatting, but still BUFFALOPHYSICIANANO BIOMEDICALSCIENTIST introduced several creative features on his show that made it distinct in Western New York. He created call-in comedy spots for such characters as "Pee Wee Herman" (played by Greg Sambuchi) and "The Jammin' Grandma" (played by Bakshi's girlfriend Lorraine Baeum ler). One phone call in particular brings back pleasant memories for Bakshi . "On Mother's Day I called my mother and put her on the air live. le was pretty funny be,cause she didn't realize that she was on clhe air and said some pretty embar rassin1g things ." As hiis mother, Deebika Bakshi remembers, Rohic wasn't even going to apply for the job because he was sure he wouldn't get it . She encouraged him to app ly and "the number-one DJ had to thank his mother on the air." Rohit's parents have been a prime influence in his life. The 23-year-old was raised in the Buffalo area where his father, Suraj Bakshi, M.D., a specialist in nuclear medicine, works at Roswell Park Memorial Institute . Although Bakshi spends weekends working as a professional top-40 disc jockey, his medical studies have not suffered. This past summer he secured fellowship grants from the prestigious Alpha Omega Alpha Medical Honor Society and from the Ame rican Heart Association in support of his work with neuro logist A lan Faden, founder and directo r of the Center for Neural Injury at the University of California at San Francisco . Bakshi is one of the few pregrad investigators working on Faden's research team . More specifically, Bakshi's research encompasses central nervous system injury and neural-regeneration, focusing primarily upon the endogenous excitotoxins, opioids, and their receptors. Faden's research has been instrumental in the development of naloxone, which has recently been approved by the FDA for testing on acute spinal cord-injured patients. "I really love working as a DJ, but my main objective is to become a doctor. I don't think I will continue working at a radio station when I return to Buffalo in September because my third and fourth years of medical school are critica l years in my medica l education . But after I'm through with my medical training and have established myself in academ ic medicine, I would really like to gee involved with radio again," Bakshi emphasized. • LATEWINTER 1988-89 �\ 22 Handpicked Ne w student s are talent ed and diver se By CONNIE OSWALD STOFKO espire the gloom and doom predictions about the shrinking nation-wide pool of applicants to medical schools, UB had no prob lem finding talented people to fill its 1988-89 first-year class. In fact, it sent out only 301 offers of admission to fill its 135 spaces, noted Thomas J.Guttuso, M.D., assistant dean and director of medical student admissions for UB's School of Medicine and Biomedical Sciences. This is the lowest number of offers UB has sent out since 1974, and UB has the lowest turnover rate of the 12 medical schools in New York State, Guttuso added. While UB accepted only 2.2 students for every one who actually enrolled, some fine medica l schools have had to accept five students to enroll one, he said. "Our school is more popular; Gutruso said . "Our reputation is improving and there's less turnover ." He explained that medical schools across the country send out acceptance letters in different months. Students may accept at one school, then withdraw that acceptance when they hear from their first-choice institution . "Obviously, we're becoming number one for more people if they stay with us," he noted. According to John Naughton, vice president for clinical affairs and dean of the School of Medicine and Biomedical Sciences at UB, this popularity can be LATEWINTER1988-89 attributed to the school's improved facilities, stronger faculty, the diversity of the program, and economics-the low tuition and low cost of living in Buffalo. The warm atmosphere of the school is another factor, said Guttuso. He noted that many applicants are offered free overnight lodging with students when they come to town to interview. Students eat lunch with the applicants, and performances by the Dermarones, the student singing group, break the ice. "Faculty are very warm and supportive of students, and students are that way with applicants; Guttuso said. "It's the general atmosphere in the school." "It's an environment rhar stresses achievement and excellence, bur not a frenzied environment of competition," added Naughton. Students play a strong role in the life of che school. There's even a new group chat organizes parents into a support group for the school, he noted. "The number of applications is down, but the quality is nor down-not here," said Guttuso. "In spite of all the negative news about medicine, there are still plenty of people applying" to UB's medica l school. Negative publicity about medicine has eroded the profession's patina of glamor. What was once seen as a lucrative and prestigious profession is now viewed as one filled with long hours and huge malpractice insurance payments . People seriously weigh their decision to become a physician, Guttuso noted, and those who finally do choose medicine are usually very dedicated . "I th ink we'll have excellent physicians from these classes we have now; he said . The numbers bear him out. The class's average underg raduate GPA (grade point average) is 3.43. The mean MCAT is 55.92, above the national average of 54. Three of the new students have Ph.D.s and 15 have master's degrees. "In genera l, we've been getting very good classes;• said Naughton . "T he feeling is that the current classes are really outstanding ." The students come from a wide range of academic and social backgrounds . About 80 per cent majored in the sciences, with about 46 per cent majoring in biology, 10 per cent in chemistry, and 7 per cent in biochemistry. There are a total of 27 majors outside the sciences. About 13 per cent of students majored in the humanities and social sciences and 5 per cent majored in health-related fields. Falling into none of these categories are one student who majored in German literature, psychology, and biological sciences; another who majored in fashion design, and a third who majored in life sciences. The adm issions committee tr ies very hard ro make sure no group is discriminated against, noted Naughton. "This is a very representative class, made up of d iverse people of diverse BUFFALO PHYSIC IAN AND BIOMEDICAL SCIENTIST �23 backgrounds;' he said . "The proof of rhe puddin g is in the class,• Gurruso added . The class contains a record-setting proportion of females-48 per cent. There are 10 black students, four Puerto Ricans, and one Chicano. The oldest member of rhe class is 40 years old, and 25 students are 26 or older. There is one handicapped student . The largest number of students-70comes from the 8th Judicial District (the area surround ing Buffalo). Another 37 come from downstate, 17 from the extended Western New York Area, 6 from upstate, and 5 from out of stare . Because UB is a State school, it must favor applicants from New York State, and some preference is given to students from Western New York. Bur in order to show that rhe school is responsive ro its alumni, children of out-of-state alumni are now cons idered as local residents. BUFFALOPHYSICIANANO BIOMEDICALSCIENTIST They, of course, must have compet itive credentials. "The number of children of alumni from our of state who matriculate is low; Naughton said, "bur we want them to know we welcome their applications ." • Focusedon a goal usic has always been special to D,eborah Shuste r of New York C ity. She received her bache lor's and master's degrees in music, then played viola professionally for five years. Yet she always felt a pull from the field of medidne. "My dad's a doctor," Shuster explained . "I've always loved science and I've always been fascinated by medicine . "As a child, I was encouraged to play music- I got a chance my parents didn't have. So I pursued music. It seemed the thing co, do at the rime." Shuster, now 29, performed with the Spokane Symphony Orchestra in Washington, played with professional orchestras in Italy and South America, and free-lanced in New York City with her own quartet as well as with small orchestras, ballet companies, and opera companies. "But it wasn't intellectually stimulating eno ugh;' she said . "I needed to use the other part of my brain." Shuste r attended a special program at Columb ia University for two years to pick up the science courses she needed, free-lancing on viola in her spare time. When it came time to choose a medical schoo l, she chose UB for several reasons, including the affordable price and its location . Her husband, a guitarist, teaches in Syracuse, so she wanted to stay upstate . Being a cad older than most of the other students is an advantage as she emLATE WINTER 1988-89 �;\, J l I' I 24 barks on her medical career, Shuster says. "I've seen a loc, dealc with people a lot, and that'll make my job easier; she noted . "I'm more focused and I know what I wane." • During his Early Assurance interview , he noted chat some people feel pressure co become a physician because they have a relative who's a physician. But Adams told the interviewer, "My father's not a doctor . My mother's not a doctor . The reason I'm here is because I wane co be here ." His inte rviewer cold Adams that, with his record, he could probab ly go to any medica l school he wanted . But Adams decided o n UB beca use it's inexpensive and he can get a good education here . He noted that since the facilities have just been refurbished, he's among the first to use the new labs. And he likes the staff. "It's a grind, bur I really enjoy medica l schoo l; he said . "It's like one big family. A lot of peop le have different interests, but we're all in the same boat, trying to become doctors." • Creative and dedicated fo.ld Servingothers odd Adams, 22, of Grand Island chose medicine as a career because "I couldn't picture myself doing anything else. I couldn't just sit behind a desk. I wane co work with peop le and help people:' Adams entered medical school through the Early Assurance Program, which allows qualified students to apply early. A biochemistry major at UB, he had a 4.0 average and had taken part in research . He also volunteered in the emergency room at Millard Fillmore Suburban Hospital, belonged to academic organizations, and enjoyed skiing, golfing, and playing basketba ll. LATE WINTER 1988-89 felt a real need to help peop le, as cliched as that sounds," said Hisla Bates, a first-year medical student at UB. A successful fashion designer, she abandoned that lucrative career to pursue her childhood dream of becoming a doctor. Born in the West Indies, Bates lived in Guyana unti l she was six, then moved with her family co the New York City area . In junior high school and high school, her arc teachers cold her she was very talented . "I got so much enco u ragement in arc, I decided to cry ic; she said. "It seemed a very exciting career, I was using my talent, and I felc confident. In science, I didn't get that kind of encouragement, though I was a very good student:' Bates attended the Parson School of Design in Manhattan , majoring in fashion design . After graduation, she worked her way up co become head designer for Herman Geist and did a licensee line for Stanley Blacker. "I traveled extensively thro ughout Europe and th e Orient; ' Bates said . "I started to make lots of money, but it still wasn't satisfying." After three years as a fashion designer, she spent four years as an undergraduate at Hunter College in the City University of New York to pick up her required science courses . She also d id research in the Marine Biological Laboratory in Woods Ho le and at Rockefe lle r University . "I'm glad I did it chis way; said Bates, 29. She's seen much of the world and has developed the confidence chat comes with success. Ac che same time, it was hard to give up a $40,000 a year job where she managed several assistants . But it shows one thing . "I really wane co do this," she said . • f·hsla Bates BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �\[ ",l ( I 25 GROUPSTRENGTHENS FAMILYTIESTO SCHOOL he notion is very simple;' said Peter Ostrow, M.D., Ph.D., associate dean for curricular and academic affairs. "Even though your son or daughter has become an adult and graduated from college, their need for su ppor t from their parents doesn't stop . It may even be greater because medical school is such a stressfu l time." Ostrow, along with a group of inspired parents, spearheaded the establishment of the UB Medical Student Parents Council chis past fall. The organization was form ed in o rder to strengthen ties between the medical school and parents . "(The council) is simi lar to the PTA in grammar school, only it's on a higher level;' explained Ost row. "Most families want to be more involved with what's going on in their son's, daughter's, or spouse's medical education above and beyond Family Day, which takes place on ly once a year." The deve lopment of the council was spurred by the huge success of Family Day, an event initiated in 1981by John Naug ht on, dean of the Schoo l of Medicine and Biomedical Sciences. The day allows families to interact with the medical school's faculty and other students, and stim ulates interest in the school and its activities. Families of freshmen and sophomores v1s1t classrooms and meet facu lty who can answe r quest ions about courses and teachin g methods, while families of juni ors and seniors visit US -affiliated hospitals where those students conduct practical rotations. Naughton introduced the idea of a parents cou ncil as early as 1981,but it wasn't until 1986,when attendance at Family Day surpassed 500, chat the BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST medical school decided the time was ripe to develop such an organization . When Ostrow presented the idea last summer to parents of UB medica l students, he met wirh overwhelming ly positive response. Gail Pitterman, one of the founding parents and a member of the council, spoke about the new organization at the opening presentation for first- and second-year students ar the most recent Family Day. "The primary goal of the Medical Student Parents Council is to give moral and financia l support to students and the ir schoo l;' noted Pitterman. Pitterman said the council is looking for volunteers in various cities co ace as hose families for UB students who need a place co stay when interviewing for residency programs. Local hose families are also needed to accommodate students interviewing for entrance into the UB medical school and to provide hospitality during holidays for chose unable to return home. The council is also inviting parents to work with student organizations and the UB Foundatio n to plan social, educational , or fund-raising events, and to gee involved with publicity for the school. Cu rrently, the council is helping to raise funds co support the medical school's Computer-Assisted Int eractive Video Teaching Aids. Since the counci l's inception, membership has grown from 14 parents to about 50, most from New York State . Some parents who find it d ifficult to attend meetings at UB are consider ing organizing a New York City chapter as well. "We encourage parents and any othe r family members to get involved, make suggestions, or offer their services if they're interested;' Ostrow remarked . "There was a very similar program at the University of Houston where I previously taught that proved to be very successful and popula r with the school and the families of the students . "What's unique about a Medica l Student Parents Council is that it provides people with more info rmed support and activity that isn't always after the pocketbook . "We wane our students' families co know that they haven't lost a ch ild but have gained a med school;' Ostrow said . Th ose who are interested in the council can call (716) 831-2802for more infor• macion. -By Mark Marabella LATE WINTER !988-89 �26 ~ The Other Classroom Buffala hospitals maintain a key role in medical education By JOHN NAUGHTON, !though numbered among the oldest of America's medical schools, UB is one of the few which has maintained the status of a "community-based" medical school for such a long time. Medical historians note that of the northeastern medical schools that survived the 1910 Flexner Report, LATEWINTER 1988-89 M .D. two, namely UB and Albany Medical College, chose to distinguish themselves primarily as centers of clinical training in which our network of teaching hospitals was and is a key element . The merger of the private UB with the public SUNY system did not treat the medical schoo l kindly during the early years of trans ition . It threatened the bonds between the old UB and its already existent faculty and hospital system . The university medical center that was proposed for the Main Street Campus or the future Amherst Campus probably never had any real chance for success. BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST �27 We are still, and will continue to be for the foreseeable future, a communitybased medical school working with a group of affiliated ho spitals . The major differences between now and 1962 are that we have forged through the partnership with the SUNY system a much larger, stronger, and more secu re funding base which has enabled the University and its hospital community co raise their sights and to become compet itive with major medical centers throughout the Stace and the nation . The cha llenge that the hospitals and medica l schoo l share is ro develop the interrelationships necessary to use the investment of the citizens of New York Scace and to make it benefit each of us as individuals, institutions, and communities . I chink we are on char course, and, hopefully, when chis century closes, each of us can look back on the efforts put forth with a sense of satisfaction and accomplishment. The hospitals' principal co ncern in medical education relates co the role of residents in the hospital system and the future of loca l graduate medical education . There are three things we should keep in mind: First, reform of graduate medica l education is upon us. Second, the public policy priorities for graduate medical education at the federal and Scace level are ar variance with much of what occurs in the nation's 127 medical schools . Third, funding mechanisms for support of graduate medica l education will change . Given the above assumptions, we shouldn't dwell so lely on the quality of the graduate medical education programs in Buffalo. We know char the q ualit y is good and it will continue to improve. In stead, we should dwell on any incongruities char exist between institutiona l and recommended pub lic policy, BUFFAW PHYSICIAN AND BIOMEDICAL SCIENTIST "We are still, and will continue to be for the foreseeablefuture, a community~based medical school working with a group of affiliated hospitals." and how these issues might be addressed and resolved. simplified statement of contemporary public policy is char we shou ld prepare more generalists, fewer specialists, and more physicians from minority and underrepresented populations. In reviewing the Buffalo scene, it is apparent chat we are not much different than the other medical schools in the United Stares . It appears that almost half of ou r residents arc in so-called prima ry care programs, i.e., internal medicine, pediatrics, and family medicine . Bue of the 120 residency positions funded for internal medicine and pediatrics, the number used co train genera lises is about the same as che number assigned co fellowships. Since fellows usually come from an existing residency base, we aren't in accord with existing Scace guidelines or developing federal guide lines. To deal with chis situation, it is clear that the faculty and the governance structure of the Graduate MedicalDental Education Consortium will have co develop strategies for change . Th ese strategies might include: • A more formal emphasis on the value of being a generalise and a proper reward system for primary-care faculty . • Transfer of funding for fellows from the reimbursement system co ocher resources. • Increased emphasis on recrumng fellows whose commitment is broader than char of achieving specialized skills for che practice of medicine . • Transfer or reallocation of a large portion of a resident's education from the highly technologically oriented tertiary care center to ambulatory care and community activ ity. You can see why the school has spent a certain amount of its energy over the past few years in reordering its community and hospita l relationships to ensure a new and needed variety of educational opportunities . For in stance, fami ly medicine has been very successf ul in incorporating a suburban and rural network designed to complement its urban base located at the Deaconess Center. Pediatrics complements its tertiary base with o utr each activities ac the Erie County Medical Center and Buffalo Mercy Hospital. Medical students and residents in nonsurgical and non-hospital-based specialties will need educational opportunities in environments othe r than hospitals, and both full-time and voluntary faculty will be needed co facilitate and implement the changes . Two oche r areas of concern are the distribution of future physicians and the extension of ou r affirmati ve action program to resident recruitment and training . The former is being addressed by LATE WINTER JQSS-89 �\I cl t 28 diversification among the primary care departments, especially in areas such as family medicine and geriatrics. The school now has educationa l relationships in these two areas tied directly to the major reaching hospital system . The combination of these organizations has permitted the development of a balanced program designed to ensure opportunities in urban, suburban, small community, and rural environments . As part of the LCME self-study (see Early Winter 1988 edition of Buffalo Physicianand Biomedical Scientist), the clinical chairmen reviewed their performances in recruiting residents from minority and underrepresented backgrounds. Ir was evident chat the medical schoo l's commitment was not adequately incorporated into its graduate medical education mission. The chairs affirmed a commitment to give a priority to chis important public policy issue. They will have to consciously prevent the current matching system from interfering with this priority . le is premature to address the issue of funding graduate medical education, except to state chat New York Stace's new Council on Graduate Medical Education has proposed that all graduate medical education funds provided through the reimbursement funds be placed into a centralized governance under control of consortia. There is a need to deve lop new training programs as well as to modify the manner in which some programs are operated. The Graduate Medical-Dental Education Consortium of Buffalo has recommended the development of programs in emergency medicine, radiation oncology, and plastic surgery over the next three to five years. Soon we will cons ider developing another program in preventive medicine. It is obv ious that even without the LATEWINTER1988-89 future constraints imposed by the Bell Commission, major changes in the conduct of graduate medical education, especially in the primary care specialries, will be forthcoming. More emphasis will be directed toward educational prepararion, less coward service, and more diversity of educational experiences will be required. • ADSMAYSWAY VIEWS OF BIRTHCONTROL elevision and radio commercials advocating birth control may help reduce the high race of pregnancies and abortions in New York State, according co a UB study. The study by the Health Services Research Program of the UB School of Medicine and Biomedical Sciences found that after exposure to a limited media campaign, women were more aware of birth control methods and the risk of pregnancy without birth control, and less likely to believe chat birth contro l spoils the spontaneity of sex and chat it gives men a false impression of the woman's availability. The media campaign, which ran in Buffalo and New York City in the summer and fall of 1987, used paid commercials, not public service announcements, said Harry A. Sultz, head of the Health Services Research Program and professor of social and preventive medicine. Researchers also interviewed women in a contro l city, Syracuse. The "media messages" were developed by a New York City advertising agency as part of a five-year plan by a coalition of family planning agencies and clin ics to reduce the high rates of unintended pregnancy and abortion in New York State, Sultz said. The New York State Family Planning Media Consortium has 23 members from across the state. The Buffalo-area members arc UB, Planned Parenthood of Buffalo and Erie County, Deaconess Center, and Planned Parenthood of Niagara County. The four messages in the campaign's (Ml 5IC THROIJGHOL 11 SONG· Lon.[!er than there't c been fishes m the ocean, l11gher than uny bird 0111;er t'll r flen, thun BUFFAID PHYSICIANAND BIOMEDICALSCIENTIST �29 30-scconcl radio and television spots, underscored with music by singer Dan rogclberg, were: • Birth control: from saving no co takmg rhc Pill, you're coo smart not co use it. • Four out of five young women who don't u,e birth control get pregnant before chev want co. • Boch young men and young women in a caring relationship arc concerned about having children at che right tame. (Young, obviously carmg, couples arc featured in the celcv1s1onspots). • Call 0ocal telephone number) or look under "Binh Control" in the yellow pages. "The intcrt.'Stmg thing is, nowhere, in either Buffalo or New York, wa, there a negative reaction," Sulc: noted. "They didn't get any letters, they didn't get any complamcs. In face, the ads in New York City had the New York Cn~ Health Department's Health Lmc telephone number on them, and there was an immediate Jump in the number of calls to the Health Linc asking for information." The spot wa, aired during prime time on two network-affiliated television ,rations m Buffalo and on rwo Spanish-language television scackms in New York, Sulcz said . Howt.·ver,the maior telC\'l'IOn,rations in Nt.'\\ York said che ,pot was coo controvcrnal and wouldn't nJn the ad. The same mformauon then was placed on 12-foot placards on 500 New York City buses, on carcards on all sub\\ay Imes in the city, and on six radio srat1on,. Once the evaluation of the media campaign wa, completed, the family plannmg consortium placed the television ad m prime t1me m all nine maJor media markets around the Mate, Sult: ,ay,. WWOR-TV, one of New York City's independent television stattons, then approved the ad and aired tt m prime time, he n,oced. The scud, offer, proof that birth control is ,1 way of life for the maJ0rtt\ of young women, Sultz sm<l.Overall, two-rh1rds of sex• ually active women reported they always uSt.--d birth control. A little more than 16 per cent ne\er used birth control, while 16 per cent said they sometimes used contraception. These fig,urcshelp researchers pinpoint rhe population at risk for unintended prcgnan- Bt..FFALO PHYSICIANA:-.;OIIIOMWICALSCIENTIST cy and abortions: those women who never use birch contro l or arc haphazard about its U!'C, about a third of the sample, Sult: says.• - B) S11e\\½,etcher CALIFORNIA DEAN IN APRILWill DISCUSS CAREEDEVEL R OPMENT Lyn Behrens, M.D ., dean of the S(hool of Medicine at Loma Linda e University, will give presentations on professional development as che first Harrmgton Visiting Profe,'\Or at UB. The program will run from April 25-28. Bchrcm is becoming recognized nationally as an expert on profc,,1onal development. One of only three female deans o( medical schools 111 the country, she 1, active in AAMC, especially m programs on advancing the car~-ersof \\Omen. Topics for the introductory program include advancement in ncn<lemia, policies of academic institutions, and professional growth. There will be a short program on UB's servKt.'Sfor rt.-,,earchers. A whole day will focus on research planning, including the characteristics of producttve researchers, the nuh and bolts of research design, and the Loma Lmda faculty model. A management workshop will al,o be held for a small number of people. The program will include the Annual Faculty Research Day, whe re faculty will display posters summarmng their research. Behrens will be available co addrc<< small groups of faculty . The Harrington V1s1tingProfessorship is an expansion of the spnng Harrington Lecture. The new format allow, the v1s1tmg scholar m spend more time at UB developing a topic. The school will continue co sponsor its fall Harrmgcon Lecture. For more information, call Glenda Donoghue, APFME director of Continuing Medical Educat ion and Professional Development, at 831-3714. • LATE WINThR 19!18-89 �30 WE BID FAREWELL TO LOISLEWIS ired in September 1959 when UB was still a private institution, Lois Lewis has worked in the dean's office at the medical school through four University presidents, five med school deans, and explosive student riots. She has also watched the progress of the Amherst Campus from its meager beginnings as a swampy flood plain. "I've seen a lot of changes in UB and the med school during my 28 years working here," Lewis recalled, "and even though I'm happy co be retired, I'm going co miss the University and the med school very much." In late September, John Naughton, dean of UB's School of Medicine and Biomedical Sciences , held a buffet reception in the new lobby of the med school to honor Lewis, who had served as his senior staff administrative director since Naughton joined UB 13½ years ago. More than 100of Lewis' friends and colleagues came to the reception where Naughton presented Lewis with a captain's chair inscribed with the UB seal for her 28 years of contributions and dedication to UB. "She is missed already and will be difficult to replace," Naughton remarked. "She cook pride in everything she did. She paid attention co every detail and always wore a smile. We all wish her the best in her retirement because she deserves ic.• "If Lois Lewis couldn't find something char was requested, then it wasn't findable," Peter Ostrow, associate dean of the med school, said. "She was dedicated and personally involved in the life of the school. She was always a pleasure co deal with and made me feel at home when I first came to UB in 1984.• However, working at UB has nor always meant good rimes and parties. Lewis remembers vividly when student riots erupted on the Main Street Campus in 1969-70 and police occupied the troubled University at che request of Martin Meyerson, president of the University at the rime. "We were evacuated from our offices several times because of smoke bombs and the general threat of violence," Lewis recalled. "The students were protesting (federa l) LATEWINTER19SS-69 government contracts with UB. At the time there was hyperbaric research (the study of rhe physiological effects of high pressure) going on in Capen (now Farber) which was contracted with rhe Navy. They were protesting right in front of our building, so we could see them demonstrating from our windows. It was difficult to enter or leave the building without being harassed by all the people from rhe 'sicins: Ac one point our staff was locked into the office for our own protection. It was a scary time." evercheless, che campus soon became less explosive as talk of a new campus in Amherst spurred the imagination s and expectations of everyone involved with UB. "Originally the med school was planning ro be relocated into Hochstetter Hall on rhe Amherst Campus, but they decided lacer that Main Street was the best location because of its close proximity to the hospitals in Buffalo," Lewis recollected. "It didn't really bother me, though, because I like the Main Street Campus better anyway. It seems more endearing and the city location gives it some character . The Amherst Campus is coo cold and isolating, bur I guess I'm partial," Lewis commenced . "When I first came to UB in 1959, the med school was part of a small private college and graduated a total of only 60 students. Now the med school is a State school with one of the largest budgets for research in the University. The size of the graduating classes have more than doubled while the faculty has tripled." Lewis, a 30-year member of the Professional Secretaries Association, enjoyed the work she did for the University. Working as the BUFFALOPHYSI CIAN AND O!OMEDICALSCIENTIST �31 manager of the dean's office always kept her busy, she says. "There was never a dull moment at the University. There was always something happening-a lot of action," Lewis remembered. "The dean's office was always a busy place, especially since Or. Naughton arrived in 1975. He is one doctor who doesn't play golf on Wednesdays. He doesn't even rake a lunch break." Lewis plans to spend her retirement traveling and visiting her friends. Although she will miss the day-co-day pace of the medical school, when asked what she would miss most about the University, she stated simply, "All of the people." • -By Mark Marabella SCHOOL EXPANDS EARLY ASSURANCE he UB School of Medicine and Biomedical Sciences has expanded its Early Assurance Program to qualified undergraduates at any college, and now offers Early Assurance in the M.0./Ph.O. program. Previously, the program was open only to undergraduates at UB and Canisius College who wished to pursue an M.0. here. Students who are accepted into the Early Assurance Program know in their junio r year of college chat there'll be a spot waiting for them in the medical schoo l, explained Thomas J.Guttuso, assistant dean and director of admissions for the UB medical school. The purpose of the program is co attract highly intelligent students and allow them to pursue a broader range of classes in their last two undergraduate years, Guttuso explained. Students often feel chat they must rake certain science courses that will look good on medical school applications, leaving little time to explore the humanities, he said. In addition, many juniors reduce their courseloads to study for the MCAT, further limiting the variety of courses they take. Since they don't have to rake the MCAT and the pressure of getting admitted to medical school is off, Early Admission BUFFALOPHYSICIANANO BIOMEDICALSCIENTIST students can broaden their backgrounds beyond science, making chem well-rounded individuals. Students need about a 3.5 average in science and non-science subjects and must have completed half of the courses required by the UB Medical School before they can apply, Gurruso said. They must be residents of New York Stace. After they're accepted, students enroll in a clinical preceptorship to see how medicine should be practiced. For local students, preceptorships are arranged at UB. For those living outside of the Buffalo area, arrangements are made with a UB alumnus. Students in the M.0./Ph.O. program are expected to have conducted research before applying to the program. After acceptance, they are encouraged to continue their research at their own college or at UB. Other medical schoo ls in New York State have established early assurance programs and are considering expanding them. • THIERTO SPEAK AT SPRINGCLINICAL DAY r. Samuel 0. Thier, M.0., president of the Institute of Medicine, National Academy of Sciences, will be the Stockton Kimball lecturer at the annual Spring Clinical Day and Reunion Weekend. Thier will speak during the scientific session on Saturday, May 6. The theme for the session is "Nutrition in the '90 s." The weekend will begin with an evening reception for the reunion classes on Friday, May 5. For more information, call the medical alumni office at (716) 831-2778. • MERRILEE$ DONATES ANTIQUEMICROSCOPE n antique microscope valued at $6,500 was donated to the Health Sciences Library's History of Medicine Collection by William H. Merr ilees, M.0., C.M., associate professor of obstetrics and gynecology at UB. A gift from his father, William Merrilees, Ph.D., upon Merrilees's acceptance into medical school in 1936, the Powell and Lcaland No. I microscope was hand-built in England in 1884. It marked the summ it of microscope design and manufacture in England for over 50 years. This microscope was renowned in its time for its innovatively designed stage, which could be rotated 360 degrees, and its steadying stand, which singly required at least 600 man-hours of production. It also introduced the unique ability to be converted to a binocular device by simply unscrewing its monocular eyepiece and replacing it with a binocular eyepiece. Merrilees has also donated 21 titles of medical monographs from the turn of the century. • LATE WINTER 1988-89 �\ VOTERS GIVEMORE POWER TOECMC'S BOARD OFMANAGERS The board now can deal with issues in a timely and businesslike fashion, with less political influence, says the chairman. he board of managers of the Erie County Medica l Center has more power over the day-to-day operations of the hospital, thanks to a new law that was effective Jan . I. The legislation allows the board to deal with issues in a timely and businesslike fashion . "We felt it was very critical because in the eyes of the New York State Health Department, we had the responsibility, but not the authority co ace; said Kevin I. Sullivan, chairman of ECMC's board of managers. The law, passed by referendum in November, "allows us to be more responsive, reduces delays in acting, and reduces political influence over the day-to-day actions of the hospital," he said. Sullivan noted that the county legislature retaii:is certain powers. The board of managers must report to the legislature before programs or services are curtailed. The county still bargains with unions, and the county decides how large a subsidy it will give the medical center. In 1988, the county supplied $5.9 million LATE WINTER 1988-89 K 11 l ~11ll1 m d,c 1rma11 of E( MC\ board of mcma LTS BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �33 of ECMC's $117 million annual budget. For 1989, the county subsidy is $6.9 million . The county subsidy, along with some Scace money, goes toward care of the indigent. Mose of the ocher money in ECMC's budget is received through fees for service, including third-party payments, Sullivan said. The move co governance by a board of managers was prompted by a fiscal crisis in the early 1980s. The county's subsidy co che medical center zoomed up co $24 million in 1984. In 1985, the hospita l superintendent resigned and the firm of Ernst and Whinney was hired to provide interim management. Lacer that year, the board of managers was created co govern the hospital. A cask force sec up by the county identified five long-rerm objectives: Keep ECMC open. Reduce operating costs and financial losses. Continue co serve the community with special attention co the indigent. Operate the facility in a businesslike and cost-effective manner . Continue a leadership role in medical education. Also, in 1985, che county reduced its subsidy co $7.7 million. In 1986, the Vitalnet Group, an independent management firm, was retained to manage the hospital. The goals of its two-year contract were to improve the hospital's operation, ease its drain on county taxpayers, and separate it from political influence. The county further reduced ECMC's subsidy to $6.6 million . In 1987, the medical center repaid co the county $10 million for loans it received during its fiscal crisis. Lase year, the Vicalnet Group decided co let its management contract expire and the referendum was held. Now the board of directors, through a chief executive officer and financial officer, is empowered to operate the hospital on a day-to-day basis. The law also provides two new board members, one appointed by the majority of the legislature and che ocher by the minority. That brings the board to 13 members, all BUFFALOPHYSICIA N AND BIOMEDICALSCIENTIST of whom are voluntary and receive no fee, Sullivan noted. • DEACONESS STARTS GERIATRIC CLINIC he Deaconess Center of Buffalo General Hospital has begun a series of geriatric clinics to help families with assessing and coordinating care of the elderly. During the weekly sessions, the clinic staff primarily provides consultation to caregivers, though some primary care services will also be provided, said June Chang, M.D., director of the clinic. Chang is also an assistant professor of medicine at UB. The clinic directs families co appropriate services and helps with concerns that arise when the patient is under the care of several specialists or takes mu ltiple medications. • NURSING FACILITY NAMESLEVITT acqueline Levitt, M.D., was recently ap• pointed medical director for rhe Sisters of Charity Hospital Skilled Nursing Facility. A geriatrician, she is on the faculty of the Geriatric Division of the Department of Medicine at UB. Levitt is also associate director of the Division of Geriatrics/Gerontology at Buffalo Veterans Administration Medical Center, medical direccor of the Odd Fellow and Rebekah Nursing Home in Lockport, and associate medical director of both the Amherst Presbyterian Nursing Home and the Rosa Coplon Nursing Home. A graduate of the University of Chicago, Levitt received her medical degree from the University of Illinois and completed a residency in internal medicine at UB. She is a diplomace of the American Board of Internal Medicine and the American Academy of Family Practice. In addition co professional memberships in the American College of Physicians, American Geriatrics Society, Maimonides Medica l Society and the Network on Aging, she is on the advisory boards of the Alzheimer's Disease Association and the Carer's Association. • NEWMEDICAL STAFF ELECTED AT MFH orman E. Hornung, M.D., EA.CS ., clinical assistant professor of urology at UB, has been elected president of the medical staff at Millard Fillmore Hospitals. Hornung is a practicing surgeon in rhe Department of Urology at the hospitals and has been a member of the hospitals' medical staff for the past 20 years. He received the American Medical Association's Physician's Recognition Award for the past seven years. Ocher elected medical staff officers include Robert Barone, M.D., clinical assistant professor in surgery, the new president-e lect, a member of MFHs' Department of Genera l Surgery; Andras Vari, M.D., clinical assistant professor in medicine, secretary, medical codirector of the Western New York Sleep Disorder Center, and Thomas Cumbo, M.D., clinical assistant professor in medicine, treasurer, chief of Infectious Diseases with the hospitals' Department of Internal Medicine. • CORRECTION " lease note chat in the Buffalo Physician and BiomedicalScientist, Vol. 22, No. 3, page 7, the edifice you identify as the 'Forbidden City' is in fact 'The Hall of Prayer for Good Harvest' in Tiancan Park, commonly known as the Temple of Heaven Park! This important site is sou ch of the Forbidden City but linked co it ceremonially since the ancient emperors of China paraded in majestic style from the imperial palace co the Temple of Heaven at the time of the winter solstice to invoke the gods!" - Marshall A. Lichtman, M.D. LATE WINTER 1938-89 �34 Vic tor Panaro (M'52) • was elected councilor of the American College of Radiology and member of the Board of Directors of the New York State Radiological Society. Harold K. Palanker (M'40) • of Albuquerque, N .M., was invited by the chief of surgery of the University of New Mexico to be a founding member of the Albuquerque Surgical Society. John D. White (M'40) • was honored for over IO years of meritorious service as a consultant to the Florida Health Professional Services, Inc. Abraham S. Lenzner (M'41) • who has a private practice in psychiatry in Norwich, Vt., was appointed a fellow of che Academy of Psychosomatic Medicine and is now an attending at Mc. Ascurney Hospital and Health Center. Gilbert B. Tybring (M'45) • informs us chat he had coronary bypass surgery in 1988. Dr. Tybring, who is retired, is editor of che newsletter of the Wisconsin Psychiatric Association, Wisconsin Psychiatrist. Reinhold Ullrich (M'53) • is president of the 10,000-member Los Angeles County Medical Association for a one-year term. Dr. Ullrich has a private practice in obstetrics and gynecology in Torrance, Calif. Joseph P. Armenia (M'62) retired from active practice as a specialist in Internal Medicine with the Kaiser-Permanente Medical Care Program in Harbor City, Calif. During my 33 years with Kaiser, 1 served as chief of the Department of Medicine, medical director of the Harbor City Medical Center, and for the last 11years in clinical practice as a general internist." Edward Sha nbrom (M'Sl) • who was among the first to recognize the potential of detergent treatment co inactivate viruses in blood produces, has Geo rge H. Mix (M'47) • in- assigned his patents co the New York Blood Center . Dr. Shanforms us he is retired and living in Summerland Keys, Fla.; "Life brom, senior consultant in che Lindsley E Kimball Research Inin che Keys is great." stitute of the blood center, will Philip C. Dennen (M'49) • of participate in pilot studies co be conducted jointly at Alpha Middlebury, Conn., is che author of the textbook Dennen's Forceps Therapeutics and the blood co improve so lDeliveries,Third Edirion, published center venc/decergcnt technology. in lace 1988by EA. Davis ComResearch has resulted in a new pany. The forward co the book procedure which uses a special was written by Kenneth organic solvent cogecher with Niswander (M'48). detergent to inactivate viruses that can contaminate blood produces. The success of che method was demonstrated in a clinical Jay B. Belsky (M'S 1) • writes study of the blood center's antihemophilic factor concentrate. from San Pedro, Calif., "I have LATE\\~NTER 1988-89 Milton Alter (M'SS) • of Philadelphia, writes, "In September 1987,I stepped down as chairman of neurology at Tem• ple Univers ity Hospital (after 11 years - 1975-1987)." William J. Sullivan (M'SS) • of Los Angeles, Calif., is a diplomate of the American Board of Psychiatry and Neurology. He is certified in psychoanalysis and is now specializing in forensic psychiat ry. Philip A. Brunell (M'57) • is president of the Society for Pediatric Infant Disease and editor-in-chief of PediatricInfant Disease News. Dr. Brunell is associate director for academic affairs and chief of pediatric infant disease at Cedars-Sinai Medical Center, Los Angeles. Edwin R. Lamm (M'60) • is president-elect of th e medical staff of Lakeland Regional Medical Center, Lakeland, Fla. Kenneth Be ll (M'61) • has been appointed associate medical director for Kaiser Permanente in Orange County, Calif. As chief of staff for the medical center located in Anaheim, he is responsible for selecting physicians, setting medical policy, planning new programs, and administering budgets. Dr. Bell is an associate clinical professor of obstetr ics and gynecology at the Unive rsity of California (Irvine) School of Medicine. Joseph P. Armenia (M'62) • received the 1988Citizen of the Year Award from the Western New York Chapter of the American Diabetes Association on May 25. Armenia is a clinical associate professor of medicine at UB and chief of the Division of Endocrinology at Mercy Hospital. During the past 20 years, he has been instrumental in the organization an d development of the local chapter of the diabetes group. He served as its president for many years and is currently chai rm an of the board. Jr. K e nn et h H. Eckhert, (M'68) • has been appointed chairman of Sisters Hospital Department of Surgery. Eckhert is medica l d irector of che hospital's Breast Care Center and is ch ief of surgery at St. Francis Hospital. Maxine Hayes (M'73) • of Bellevue, Wash., has been named director of the Bureau of ParentChild Health Services wich che Department of Social and Health Services. Dr. Hayes is serving an executive session four-year term with the John E Kennedy School of Government's (H arvard University) Center for Health and Human ResourcesPolicy.She has also been selected as che Har- BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST �35 D ouglas Pl eskow (M'8 2) • writes chat he and his wife Ran• di Ples kow (M'82 ) completed a vard School of Medicine's Fae Golden Kass Lecturer for 1989. Israel J. Ja co bo wit z (M '73) • of Brooklyn, N.Y., has been appointed director of the Cardiovascular and Thoracic Division of the Maimonides Medical Center. GI fellowship last year. "Randi and I have a two-year-old daughter named Sara. Randi is an assistant professor of pediatrics at Tufts Medical School and I am an instructor of medicine at Harvard Medical School." Larry R. John so n (Ph .D. '73) • is project coordinator of rhe Oregon Health Sciences University Lung Health Study in Portland. He is partly responsible for spirometry quality control at 10 study sites and consults on Chinese and Japanese spiromerry longitudinal studies. Steve n J. Morri s (M'73) • received a J.D. degree from Georgia Stare College of Law in 1988 and is a member of the Georgia Bar. Dr. Morris has a private practice of gastroenterology in Atlanta and is a clinical associate at Emory University. He is president of rhe Georgia Gastroenterologic Society. Dr. Morris is married and has four children. Michael Rowland (M'75) • of Pinehurst, N .C., is general surgeon of the Pinehurst Surgical Clinic and vice president of the Norrh Carolina chapter of the American College of Surgeons and chairman of the Cancer Committee of Moore Regional Hospital. Bess Mill e r (M'77 ) • a medical epidemiologist, division of tuberculosis control at rhe Centers for Disease Control, writes, "The job is great-and if that doesn't keep me busy, my husband and I have two little boys: David, 4 years, and Matthew, 11/2 years-who do keep us busy!" Paul A. Gree nb erg (M'84 ) • Mi chael Row land (M '7 5) writes, "After doing rwo years of surgery and three years of medicine, I'm on my way to do a medical oncology fellowship at MD Anderson Tumor Institute in Houston." Tumor Institute. He helped found the Head and Neck Surgical Society, the James Ewing Society (now Society of Surgical Oncology) and the Radium Society and was president of each. James D . Tyner (M'29) • died on April 29, 1988in Newark, N.Y. He was a past president of che Wayne County Medical Society and a founding member of the American Academy of Family Practice . Ric hard Taylo r (M'30) • a others, Leah and H:adass. Ir's because I became a certified mohel." B o n n ie Ri c hard so n (M '85) • announces that she is scarring a private practice in family medicine in Hudson Valley, N.Y. Dr. Richardson's daughter, Emily Fjaellen Thompson was born in August 198i. M a rk S. B ore r (M'80) • is staff child psychiacrisc and director of the Dover Day Ho:spical for Troubled Youth, Dover, Del. David Stein (M'87) • is a resident in medicine at the Massachusens Medical Center in Worcester, Mass . general practitioner in Blasdell for 51 years, died Oct. 24 following a long illness. He was 82. Born and raised in Hamburg, Taylor served as the town's health officer from 1935co 1975.He also served as the physician for the Blasdell and Frontier Central schoo ls, for the Blasdell Fire Company, and for the Eric County Fair and Exposition. He was active in many UB fund drives. Taylor is survived by his wife, three sons, 12grandchildren, and a great-grandchild. Anth ony S. U ng er (M'8 0) • a Bruce R. Saran (M'88) • mar- Charles F. Banas (M'37) • chief clinical instructor a't George Washington University Medical Center, recently published "Total Ankle Arthopla sty" in Operaci1:e Orchopaedicsedited by M. Chapman, M.D. ried Robin I. Kauffman in Occober 1988.Dr. Saran is a resident at the Medical Center of Delaware, Dover, Del. of scaff at Mercy Hospital from 1966to 1986,died September 13, 1988. He was 75. Born and raised in Buffalo, Banas joined Mercy Hospital in 1938 as a family practitioner. From 1942 to 1946 he served in the Army Air Force-Air Transport Command, Medical Corps . In 1952 he instituted the Allergy Clinic at Mercy Hospital and served as its director for 30 years. He also helped co-organize the General Practice Section and served as its first president. Banas served as the first chief of the Genera l Practice Department from 1956 until his appointment as chief of scaff in 1966. Wes ley S. Bl ank 1(M'80) • writes, "Nan and 1 ha,d another baby girl, Rebecca, to join our rwo Joe l Fiedler (M'81) "' is clinical assistant professor of pediatrics at Sc. Christopher's Children's Hospital in Philadelphia, Pa., and an allergy consultant for rhe North Jersey Medical Group. Mark M. Chun g (M '82) • writes, "I am a practicing pulmonologist in Ora nge County, Calif., and a member of the pr'ofessional staff of UCLA." BUFFALOPHYSICIANAND BIOMEDICALSCIENTIST W illi am S. Mac Co mb (M'2 7) • died at his home in Walnut Creek, Calif., Sept. JI, 1988. He is survived by his wife, Janet, three sons and a daughter. Dr. MacComb lived in Houston from 1952 to 1974. He developed and was chief of rhe Head and Neck Service and was professor of surgery at the University of Texas, M.D. Anderson Hospita l and LATE ll.1r<TIR IQ~ �AlHmm 36 CALLFORNOMINATIONS our president and Board of Governors has, over the past several years, received many requests for Alumni/ae to establish a Distinguished Medical Alumnu s/a Award. Therefore, your president and board arc seeking nominations for this award to be presented annually beginning this year. The award will be presented to a graduate who has distinguished himself/herself nationally or internationally in the eyes of his/ her peers and has made an outstanding contribution to medicine, the arts, or humanity during his/her career. The selecltion will be made during the summer and the award will be presented in the fall at a special award dinner. Please forward the name of your nominee as soon as possible on the attached card. A June 30 deadline has been established for the receipt of all nominations. Your cooperation is absolutely viral if this is to be a true alumnus /a award. our way of showing ou r appreciation to the members for their past suppo rt of the school. Preparation is under way for the 1989 meeting of the society. The James Platt White Society is named for one of the founders of the medical school who was in private practice in Buffalo from 1835-1875. A founder of the American Gynecological Society and one of the founders of several Buffalo hospitals, he made important contributions to the practice and teaching of obstetrics. • GUTTUSO GIFT CREATES TWOAWARDS wo new annua l student awards have been created, thanks to a fund established by Thomas J. Guttuso (M'60), director of admissions for the UB Medical School. One award will go to a senior medical student who has contributed most significantly to research in ophthalmology or who has demonstrated significant concern for patient care while in ophthalmology service. The oth er award will go to a resident who has contributed most significantly to ophtha lmology overall. Guttuso has a private practice in Lockport. He is a member of the James Platt White Society (the school's highest gift recognition group) and the President's Associates (the University's highest gift recognition group).• JAMES PLATT WHITE SOCIETY TOURS NEWFACILITIES DURINGANNUALMEETING he third annual meeting of the James Platt White Society, a group of major annual contributors to the medical school, rook place on Friday, Oct. 21, in the Lippschutz Room of the school. In addition to a tour of the new medical school facilities, the members and their spouses and guests were treated to an excellent afternoon program. The topics ranged from cardiology in Buffalo to bioengineering in anatomy to biotechnology and the human side of AIDS. The topics were excellently presented by facu Icy, not on Iy from the School of Medicine and Biomedical Sciences, but from nursing and physiotherapy. The capstone for the day's meeting was a cocktail reception and dinner in the Center for Tomorrow on the Amherst Campus. All members of the society received an engraved Jeffersonian pewter cup. The cup is LATEWINTER 1988-89 DIRECTORIES SLATED FORMAY DELIVERY he UB Schoo l of Medicine and Biomedical Sciences Directory is coming soon! This comprehensive new volume is a compilation of the most current data on more than 4,655 medical school alumni/ae. Now chat the editing, proofreading, and printing are almost finished, the distribution of this impressive edition will scare. All alumni/ae who reserved a copy shou ld receive it around May 5. If you have a question on your order or wish to place an order, contact the cuscomer service department of Bernard C. Harris Publishing Co., Inc., 3 Barker Ave., White Plains, N.Y. 10601. The phone number is (914) 428-8921. • HERE'S ONEMORE hen we ran one photo of each reunion year in our Autumn 1988edition, we thought we had all of the bases covered. Bue there were two graduating classes in 1943 and we inadvertently left out the spring graduates. Here they are, with our apo logies: Front row: Harold P. Graser, Gertrude S. Swarthout, Kenneth W. Bone, and William H . Georgi. Back row: Duncan K. Macleod, Richard S. Fletcher, Richard J. Buckley, Charles C.B. Richards, Alfred S. Evans, and Joseph H. Melant. BUFFAW PHYSICIAN AND BIOMEDICAL SCIENTIST �,, �MEDICALHISTORICAL ~1~, KIMBALLTOwER, SERIALS DEPT, MAIN ST., CA"1PUS c-/ BUFFALO NY 14214 ff1Jfrl � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. Brown History of Medicine Collection Format The file format, physical medium, or dimensions of the resource application/pdf Language A language of the resource eng Type The nature or genre of the resource Text Still Image Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Buffalo physician and biomedical scientist, Late Winter 1988-1989 Subject The topic of the resource State University of New York at Buffalo. 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Passive vaccine Airwaves. Handpicked. Hospital News Classnotes and alumni news Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Buffalo medical review Date Created Date of creation of the resource. 2018-11-08 Is Version Of A related resource of which the described resource is a version, edition, or adaptation. Changes in version imply substantive changes in content rather than differences in format. v22n05 Extent The size or duration of the resource. 40 p. Spatial Coverage Spatial characteristics of the resource. New York (State) -- Buffalo Is Format Of A related resource that is substantially the same as the described resource, but in another format. Journals and magazines (periodicals) Is Part Of A related resource in which the described resource is physically or logically included. Buffalo Physician Magazine LIB-HSL008 Rights Holder A person or organization owning or managing rights over the resource. Copyright 1988 University at Buffalo, State University of New York Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/77748a01ec55afafcc2f48fa6ec5306b.pdf ad6ae51514747afafbd5808acf1aac8b PDF Text Text Volume 21, Number 5 I and Biomedical Scientist Study lryDr. Lau,renceBone demonstratesneed for aggressivesurgeryin trauma cases Lace Winter 1988 �Dear Alumni, Alumnae and Friends: STAFF EXECUTIVEEDITOR UNIVERSITY PUBLICATIONS Robert T. Marlett BUFFALOPHYSICIAN EDITOR Connie Oswald Stofko ART DIRECTOR Alan J. Kegler PHOTOGRAPHY DouglasLevere EdNowak Ian Redinbaugh Simon Tong ADVISORYBOARD Dr. John Naughton, Chairman Dr. Harold Brody Mr. Kevin Craig Ms. Karen Oryja Ms. Nancy Olieco Dr. James Kanski Ms. Marion Marionowski Dr. Daniel Morelli Dr. Charles Paganelli Mr. James Phillips Mr. John Pulli Dr. Robert Scheig Mr. Mike Shaw Mr. Steve Shivinsky Mr. Raul Velasquez Dr. Mary Voorfiess Dr. John Wright Dr. MaggieWright Dr. Franklin Zeplowit:z Dr. Joseph Zizzi,Jr. TEACHINGHOSPITALS BuffaloGeneral Children's Erie County MedicalCenter Mercy Millard Fillmore RoswellPark Memorial Institute Sisters of Charity Veterans Administration Medical Center Producedlry ihe Divisionof University Relatumsin associationwith ihe School of Medicine,State Universityof New Yorkat Buffalo. THE BUFFALO PHYSICIAN (USPS 551-860) Late Winter 1988, Volume 21, Number 5. Publishedfive times annually: Late Winter, Spring, Summer, Fall and Early Winter - by the School of Medicine, State University of New York at Buffalo, 3435 Main Street, Buffalo, New York 14214. Third class bulk postage paid at Buffalo, New York. Send address changes to THE BUFFALOPHYSICIAN, 146 C.F.S. Addition, 3435 Main Street, Buffalo, New York 14214. Cover Photo: Dr. Lawren ce Bone,photographedb:,Rob McElroy. T he medical school has embarked on its second Institutional Self-Study in preparation for the accreditation visit by the Liaison Committee on Medical Education (LCME) Survey Team scheduled for November of this year. The first self-study was condurn:d in 1980. We have set an ambitious time-table in that all committee work is scheduled tO be completed during the first six months of 1988 so that a final document can be edited and collated for submission to the LCME by September. Just as was done in 1980, a large steering committee has been assembled with representation of University administration, hospital board members and administrators, department chairmen, faculty and students, alumni, practicing physicians and members of my staff. In contrast tO 1980 , the established commim:es of the Faculty Council are serving as the working committee for the various areas to be reviewed. External representatives have been added to the membership of each committee to ensure that as much communication and cross-fertilization as possible can be and is facilitated. When the task is completed this summer, we will have an appreciation of the progress made since 1980, the current status of the medical education enterprise in Buffalo, and an agenda of tasks to be accomplished bt::tween now and 1995. These outcomes will be summarized in a future issue of the Physician. As I had indicated in an earlier letter, the timing for this study is fortuitous since it comes during the 25th anniversary year of the merger ofUB with SUNY. The process should be helpful to the life and vigor of the institution and in preparing us for a successful accreditation visit next fall. Sincerely, John Na ughton , M.D. Vice Presidentfor Clmrcal Affairs Dean, School of Medrcine Medical Alumni President's Message I t gives me a great deal of pleasure to announce that the recipient of the Stockton Kimball Memorial Award for 1988 will be Dr. Robert Gale of the University of California at Los Angeles - UCLA. Dr. Gale is a 1970 graduate of the University at Buffalo School of Medicine and has distinguished himself in the field of bone marrow transplantation. His prominent role in leading the American effort in aiding the Soviet Union after the world's worst nuclear disaster is, I am sure, well known to all of you. His involvement in this endeavor as well as his consu lt ant role in other nuclear accident incidents continues. His timely and info rm ative lecture at the luncheon will be a highlight of an outstanding program at "Spring Clinical Day and Reunion Weekend" - May 7, 1988. The morning scientific program will be devoted to Controversies and Treatment of AIDS, Breast Cancer, and Coronary Arte r y Disease with national and local experts . Mark your calenda rs now so that we can welcome as many of you as possible from around the count ry and the Western New York area to this program and to your five-yea r reunions. Your A lu mni Association continues co play a prominent role in Medical School affairs, with you r President being a member of the Executive Committee of t he School and a member of the Steering Committee and Executive Committee of the "Liaison Committee for Medical Education" - LCME which is self-evaluating the School prio r to the acc reditation survey in the fall of 1988. If you have not become an Active or Life Member of the Medical Alumni Association, please do so now, so that you can help us continue and expand all the activities I mentioned in the last Newsletter. - Sincerely, Franklin Zeplowit~, M.D. '58 �BUFFAlD Volume 21, Number 5 PtIX§l~~ Late Wint er 1988 2 Lead Poisoning. Screening children for lead poisoning should be a routine part of medical care, Public Health Official urges. 7 Black Monday. One man lost his shirt in the market crash and shot his stockbroker; others shrugged it off. Why the difference? 8 Premenstrual Syndome. Dr. Uriel Halbreich, head of a new Life~ Cycle Center, finds the term premenstrual changes or PMC more accurate. 11 Leeches. What do leeches and microsurgery have in common? Plenty if you ask Dr. Kulwant Bhangoo. 14 Lawrence Bone M.D. Thousands of lives lost following auto accidents and other causes of severe trauma co uld be saved, this orthopaedic surgeon has found, if a new surgical approach is adopted. Departments Page8 Page 14 17 Research. Unique Roswell case report was the key to a breakthrough genetic study published recently by British scientists. 21 Medical School News. The Buffalo General Hospital, a major UB teaching hospital, is establishing the State's second heart transplant center. 30 Classnotes . Two Med School graduates are the co~founders of the Comprehensive Headache Center at The Germantown Hospital and Medical Center in Philadelphia. News of the classes. 35 Hospital News. The Batavia Veterans Administration Center becomes UB's ninth affiliated hospital. 36 Deaths. Medical �POISONING Samephysicianssay it isn't a problemin theirareas becausethey haven'tseena casein 20 years. But many childrenshowno overtsymptoms,healthofficialwarns BY CONNIE OSW ALO STOFKO S creening children for lead poisoning should be a routine part of medical care, recommends Jane S. Lin-Fu, M.D., whose research was instrumental in the federal legislation that banned lead from household paint. Some physicians say that lead poisoning isn't a problem in their area because they haven't seen a case in 20 years. But many children with lead poisoning show no overt symptoms, Lin-Fu cautioned. Even when there are overt symptoms, they're so vague that they're often misdiagnosed, she noted. It's nearly impossible to detect lead poisoning without a blood test. It's also a myth that lead poisoning affects only inner-city children, she added. It's a ''Yuppie" problem, too, especially for those who move into older homes and do the renovat ion themselves. in-Fu is acting chief of the genetics services branch of the Health Resources and Services Administration. That's pa rt of the U.S. Public Health Services. She recently gave a lecture sponsored by the Research Center for Child ren and Youth, one of UB's eight organized research centers. In the United States, Lin-Fu estimates, tens of thousands of children are affected by this condition, which can lead to retardation and even death. While it can affect adults, children are more prone to lead poisoning for many reasons, including the fact that child ren have greate r L Late Winter '8 8 intestinal absorption and retention and their organs are more immature. Routine screening is important because there's convincing evidence that undue lead absorpt ion in early life may be associated with neuropsychological deficiencies and behavioral disorders, leading to learning disabilities. This happens before there are any overt symptoms, Lin-Fu said. And even when it gets to the point of overt symptoms, there's no guarantee that lead poisoning will be detected without a blood test, she noted. The symptoms are vague: irritability, refusal to play, apathy, poor appetite, occas ional vom iting, sleep disturbances, stomach aches, and constipation. Lin-F u , who has three children of her own, noted that these symptoms are common to "no rm al" children. "You have to be very astute to pick it up as lead poisoning," she said. "You can't rely on signs and symptoms to diagnose it." Those are the relatively early symptoms, she said. If nothing is done, the child can experience developmental delays and regressions . A child may stop making sentences or stop jumping. The child may have protracted vomiting, ataxia, or convulsions, or even die. Even when the condition gets to the convulsions stage, lead poisoning can be misdiagnosed. A two-year-old with lead poisoning was operated on twice because it was thought she had a brain tumor, Lin-Fu said. The test for lead poisoning, eryth r ocyte protoporphyrin (E P), is cheap, she said, and has the added advantage of picking up iron deficiencies.Just a small amount of blood from a finger prick is needed. The equipment, a hematofluorometer, costs about $4,000 and is cheap enough to be purchased by a clinic, she pointed out. Because it gives an instantaneous d igital readout, follow-up tests can be performed while the child is still in the office. There's no loss of follow-up. But how much lead is too much lead? The answer has been changing in the last two decades, Lin-Fu noted. Unlike calcium, zinc, or iron, which the body needs in certain amounts, the body doesn't need any lead at all. But researchers forgot that fact when they tried to define "normal" lead levels, she said. "They started studying the 'normal' population, not realizing that the 'no rmal' population was contaminated." In 1970, the accepted level of lead in the blood was a whopping 60 micrograms . Lin -Fu fought a tough battle to get it lowered to 40 micrograms. Today, even 40 is considered much too high, she noted . Various agencies in the past few years have recommended 25, 20, or even 10.S. Lin-Fu said she doesn't know whether the accepted limit should be dropped to zero . She noted that people in the Himalayas were tested and even they had 3 micrograms of lead. There is disagreement ove r when treatment should begin , she noted. The treatment is painful. It Buffalo Physician and Biomedical Scientist �can also be dangerous because it removes vital zinc and forces some of the lead to the brain. Even if the physician decides not to treat the condition, it's important to look for lead in the environment, Lin-Fu said. 3 A major culprit is lead paint on walls. Th e ban on lead in household paint didn't go into effect until 1978, she noted. Lead abatement must be done carefully. If done improperly, scraping the paint off the walls can actually do more harm because it creates fine particles which can be more easily absorbed, she explained. Once the particles get into the rugs and curtains, a regular vacuum cleaner won't pick them up. During lead abatement, it's important to get everyone out of the house, remove all belongings that can be moved, cover everything that remains, and clean up carefully. Disposal of the lead is a problem, too. She noted that when people remove lead from their houses, they just put it in plastic bags and take it to a dump. But it doesn't change into some other substance when burned; the problem is just recycled. ead paint isn't the only source of lead poisoning, Lin-Fu said. "We pay a price" for living in this modern world, she said. "Lead is in the air you breathe, the food you eat, and the water you drink." The elevated lead levels of most children aren't caused by eating paint chips, as was once thought, Lin-Fu pointed out. Small children put their hands in their mouths a lot and ingest the lead from household dust and soil they pick up while playing. Another source of lead is water that sits overnight in pipes soldered with lead. "New houses, including the one I moved into two years ago, have copper pipes with lead solde r ," she noted. People are advised to run their water each morning to get rid of the stagnant water. L Buffalo Physician and Biomedical Scientist Late Winter '88 �4 Othe r sources of lead include industrial emissions, burning at city dumps, storage batteries, ammunition, improperly glazed dinnerware, burning old wood that's covered with lead paint, arts and crafts supplies, colo red ink for newspaper, smoking, some alcohol, and cosmetics such as Grecian Formula. Some folk remedies contain lead as well. "Health care providers must remem- ber this is a land of immigrants," Lin-Fu said, and that people bring these remedies with them. A couple of sources of lead are on the decrease. Leaded gasoline has been banned for newer cars. In the four yea rs since the ban, blood lead levels have decreased 30 per cent. Lin-Fu is convinced the ban should get the credit. "Nothing else could explain such a dramatic drop," she explained. Lead solder for food cans is also on the wane. In 1979, 90 per cent contained lead solder. In 1986, only 28 per cent did. Lead poisoning is still a problem, even though we've known since early in this century that it's preventable, Lin-Fu pointed out. "Here we are 70 years later still talking about lead poisoning," she remarked. • Two UB units working on lead study T wo UB units are working together to compare lead levels in the umbilical cords of newborns to medical and socio-economic data, with an eye to how that information may be related to developmental disabilities. The two units are the interdisciplinary Research Center for Children and Youth and the Division of Developmental and Behavioral Neurosciences of the Department of Neu ro logy in UB's School of Medicine and Biomedical Sciences. During pregnancy, lead is mobilized just as calcium is and may go to the fetus, explained David Shucard, Ph.D., professor of neurology and pediatrics and director o f the Divisio n of Developmental and Behavioral Neurosciences. No one knows what levels oflead are toxic, Shucard noted . The other researchers o n th e project include: • Janet Shuca rd, instructor in neurology at UB • Matthew Lanighan, Ph .D., clinical instructo r in medical technology at UB and assistant director of public health for the Erie County Public Health Laboratory • Robert J . Patterson, M.D., clinica l associate professor ofGYN-OB at UB and clinical chief in the depa rtme nt of GYN-0B at Child ren's Hospital • Robe rt Gu thr ie, Ph.D., M.D., professor emeritus in pediatrics and neurobiology In February, the researchers expected to finish collecting abou t 1,200 blood samples from births at Children's Hospital. The blood is taken routinely Late Winter '88 for other tests, Shucard noted. The researchers also collected medical and socioeconomic data from the mothers' and babies' charts . The informa t ion included the baby's gestational age, b irt h weight, Apgar scores, sex, and order of birth in the family. Information on the mother included hemoglobin level ( there may be a relationship between lead and anemia, Shucard explained), any complications during pregnancy, age, education, and where she lives. Where the women live may show if certa in local areas have higher lead levels than others, he noted. Unlike toddlers, the mothers aren't eating paint chips. The researchers have been looking for fund ing to pay salaries of a gr aduate student and clerical help to analyze the data. State money is available for screening, Shucard noted, but this project doesn't co unt as screening because there are no existing guidelines o n what levels oflead are considered high for u mbilical blood. T here have been very few stud ies in this count r y on the lead levels in umb ilical cord blood, Shucard said . Work is generally done with toddlers, not newborns. A large scale study is planned with federa l support. It will include more of the preventive and socia l aspects of lead poisoning, which are of major interest to Anthony M. Graziano, Ph.D., and Murray Levine, J.D . , Ph .D., the co-directors of the Research Ce nter for Child ren and Youth. • Buffalo Physician and Biomedical Scientist �Yes,I want to help PSRpreventnuclear war. D Pleasesend me more information. D I would like to host a PSRspeakerin my home/c ommunitygroup. D I want to makea tax deductiblecontribution of $____ to further PSR'swork. Name_ ____________ _______ ____ Street Address____________________ City,State, Zip ________ _ _ _ _ __ _ _ _ ~ hone____ PSR.1601ConnecticutAvenue, NW., Suite 800, Washington.D.C. 20009 _ �:I . :!' 1 l ', 5 t 5 ,.. - ,j .. 3 ;:- <,. (. ~. :.: . "! 7 i 9 , 8 8 t, , I_,";> •" • 9 0 7 7 I I • d s s ... ~ ~ S ;;- () l (, 0 9~ G . , 1 1 1i l 1 - . z 1., .... . ... l I - n ' <; ,, :, J - .) ~ ~ ,. ,. ., •... ;:. 1 ~ 2 '/ ,, :,. , . 'i .. i: : 6 0 ' .., .. 1 : "1 • -: 7 ·, I 1 I 7 -• I 7 t• _.. :"-.; s , a 1' ? ti s-s e a a ., -. .. • -l -~ i 9 { I .. £ 9 9 ~ J ~ t. S d , 9 ·-· "' "' :. C. <, r 0 ~ 11.G.(. 0 ·o' :. ( ~ ..... , (. J 7 ~ .... i..; 1t· 1 · • ".I 9 '• -1 1 J O " l 0 1 .,.s4.s4. 'L6 I 5 5 I\ ' '- - , _ , 6,6 J.., "-.' ' _-7· .,. ,.:''H•~,aa •C'9 •• • " ,rq•_t !f9 O ) �1 BIACKMONDAY Someinvestorsshrugged;otherspanicked.Why? BY CONNIE OSW ALO STOFKO 0 ne man lost his shirt on "Black Monday" and shot his stockbroker. Other investors lost just as much -or even more - in October's stock market crash and simply shrugged it off. Why ar e there such different reactions to the same event? It has a lot to do with both the individual's history and the significance of the loss, explained George Molnar, M.D., associate professor and vice chairman in the Department of Psychiatry at UB. Molnar has an interest in stress-related disorders. As a psychiatrist with the U.S. Army Reserve, he looks at the concept of stress and stress reaction to extreme situations. The stock market crash was a stressful situation and could be experienced by some individuals in the same way they would experience other extreme situations, such as a car accident, combat, or the loss of a parent, Molnar explained. These situations have different meanings for different people at different stages in life. T he significance of the loss to the individual is an important factor in how the person will react, Molnar said. Where the loss of $2,000 may break one investor, even a $1 million loss may be dismissed by another as just a "paper loss." The person's reaction also depends on his vulnerability, social supports, the intensity of stress, and how he deals with anger. Alcohol and other drugs can disinhib it behavior, such as violence, that's normally inhibited, Molnar said. One case of violence was the incident in Miami where a man incurred heavy losses and killed his stockbroker. But, according to newspaper accounts, the man apparently had a complicated life history, Molnar pointed ou _t. He was in the government's protected witness program. He may have been an unbalanced individual, prone to impulsive actions, particularly precipitated by events such as his sudden loss in the market. "So in addition to looking at the immediate stress, he was probably predisposed to acting this way," he pointed out. "It didn't come out of the blue." Buffalo Ph ysic ian and Biomdica l Scientist Indiffer enc e and homicidal anger are the two extremes, Molnar said. Many reactions fall in th e middle and can occur long after the crash or other traumatic event. Anxiety disorders, depressive disorders, or adjustment disorders are other means of response and reaction to such events. In some extrem e cases, ther e can be a brief reactive psychosis, Molnar said. Psychosomatic conditions such as hypertension, peptic ulcers, migraine headaches, and irritable bowel may also come into play. Some people just become irritable, angry, or depress ed and begin to self-medicate with alcohol. These feelings can add to ongoing marital conflicts. Stress over the course of the stock market doesn't affect just investors. People who work in the market, such as brokers and secretaries, feel it, too, Molnar pointed out. They find their jobs are more precarious, and their workdays are filled with pressure and angry clients. Often their self-esteem rides with their success in the stock market. "S everal individual s no doubt committ ed suicide, from what I read," Molnar said. Even people who don't have money in the market can feel anxious and alarmed when hearing news reports about the economic situation. S tress-related conditions are eminently treatable, Molnar said. If there are no previous complicating disorders, brief psychotherapy and medication should be sufficient. Treatment will diminish the severity of or remove symptoms and keep the condition from getting chronic. There shouldn't be excessive use of medication, Molnar pointed out; usually a single agent should be used. Molnar noted that most people haven't become ill from the stock market crash. "The great majority of individuals went about the normal business of their lives,'' he said. ''They weren't pleased with the loss of money, even if it was only a paper loss, but they took it in stride. They accepted it as part of doing business." • La tt: \Vintcr '88 �8 PREMENSTRUAL CHANGESARETHE FOCUSOFA NEW LIFE--CYCLE CENTER BY CLARE O'SHEA 0 n two different Friday nights, Jane goes to parties. On Friday night numbe r one,Jane and her boyfriend have three or four drinks and feel equally tipsy. The nex t Friday night, they go to another party and drink the same amount of alcohol. Jane 's boyfriend is no more tipsy than he was last week. But Jane is more impulsive, her concen tration is a little off, her memory's not as sharp as usual. This week, Jane is tipsier. She's also expecting her period. Such an effect of alcohol on women in the premenstrual phase is just one of many possible characteristics of the condition known as premenstrual syndrome, or PMS. Uriel Halbreich, psychiatry professor and director ofbiobehavioral research at UB, rejects the popular PMS label, however, in favor of PMC, or premenstrual changes. PMC is the more accurate term, Halbr eich believes, for a couple of reasons. The term syndrome implies more than one symptom; it is possible, though, to have just one change premenstrually. In addition , research has shown that positive as well as negative changes can be associated with the premenstrual phase . Lare Winter '88 T he study of premenstrual changes as a phenomena is relatively new. "There has been a tendency in the past for the problems associated with PMS to be minimized or simply dismissed by some physicians," Halbreich said. "Often the patient's complaints were not taken seriously or it was implied that he r symptoms were 'all in her head.' 11 PMC research has not been without controversy, either. For example, the theory that women usually are more sensitive to alcohol premenstrually than at other phases of the cycle, and in comparison to their male counterparts, can be a touchy one, ripe for accusations of male chauvinism, Halbriech pointed out. And, indeed, he said, certain preconceptions or biases, perhaps gender-related, may influence such research. A definition of the phenomena of premenstrual changes is still being worked out. According to Halbreich, symptom or symptoms are considered as PMC if: They reoccur cyclically, du ring the premenstrual phase ( that is, the late luteal phase, one to seven days prior to menstrual bleeding); they are significantly changed in severity compared to other times in the cycle; they subside shortly after the onset of menstrual bleeding. Without eve r having heard of PMS, many women recognize changes in the way they feel or behave just befo re the beginning of their periods. Some women are depressed, or go through rapid mood swings; others lack control, are aggressive or compulsive; still others might have an increase in sexual drive, in appetite or in sleep. Halbreich has found that some women consciously alter their behavior during this time - they drink less, for example, or try not to take complicated, high-performance tests. It's difficult to say , he added, just how many women have premenstrual changes. Although the symptoms are quite consistent in one woman, they can vary widely between women. Some women have symptoms for only one day; others for 14 days , the entire luteal phase. "If one defines PMC as including any noticeable changes, some people say up to 80 per cent of women are affected," Halbreich said. "If you count only women who seek treatment and in whom the premenstrual disorder is confirmed , it wou ld be somewhere between two to eight per cent of the normal women's population . 11 The premenstrual changes are conside red a disorder if there is an impaired function , socially or occupat ionally, Halbreich explained. "It also depends on how you do your research - on what group you study, for example," he continued. "We surveyed nursing students and over 90 pe r cent ( reported PMC). Among women executives or highly successful professionals, not even one ( of 23) reported premenstrual changes .'' H albreich has been studying PMC for more than 10 years. Before coming to UB in 1985, he was on the faculty of Albert Einstein College of Medicine in New York City. He was previously a faculty member at the medical schools of Columbia Univers ity and Buffalo Physician and Biomedi cal Scie ntist �lllUSTRATlON : GLYNISS'M:ENV �10 Hebrew University in Israel. Biological aspects of PMC were the focus ofHalbreich's initial studies of the condition. He soon realized, however, that certain methodological issues needed to be addressed first. For example, the groups of women under study were not homogeneous; they did not necessarily reflect the diversity of types of premenstrual changes. A reliable procedure for the clinical and research assessments of premenstrual phenomena did not exist. The Premenstrual Assessment Form, subsequently developed by Halbreich and his assoc iates , uses 95 different items to measure changes in mood, behavior, and physical condition during the premenstrual period. Rather than following the common practice of viewing PMC as a single entity, the form reflects the wide variability of PMC. "While there are more than 200 symptoms associated with PMS, the major ones are depression, anxiety, and diversified discomforts states, 11 Halbrei ch said. responsive to external stimuli. If taken to a party, they can be cheered up. Symptoms of atypical depression are quite similar to those of premenstrual depression. A women with premenstrual depression can also be cheered up at a party, for example. But there are differences, Halbreich pointed out. Premenstrual changes can last just one or two days. A woman would have to be depressed for at least two weeks, however, before she could be diagnosed as having a major depressive disorder. In addition, unlike atypical depression, premenstrual depression by definition is exclusive to one phase of the menstrual cycle, and the depression is usually not as severe. That leaves premenstrual depression out of the category of major depressive disorders. Interestingly, research has suggested that those women who have dysphoric PMC are more likely to develop more depressive disorders in the future than those who do not have dysphoric PMC, Halbreich said. A I s one of the most common of premenstrual changes, depression has undergone especial scrutiny. It has been suggested, by Halbreich and others, that there may be an association between dysphoric PMC ( characterized by abnormal moods, especially depression) and more severe depressive disorders, and that PMC can be studied as a model for such disorders. Among the several types of depressive disorders are atypical depression and endogenous depression, or melancholia, Halbreich said. Melancholia is associated with a variety of biological symptoms including decreased sleep, weight loss, severe depression, guilt feelings, and suicidal ideations. People with melancholia are miserable; if taken to a party, Halbr eich offered as example, they will not be cheered up. Atypical depression, although possible in both men and women, is more prevalent among women, he noted. There's an increase in appetite and sleep and a decrease in energy. People with this form of depressive order are very Late Winter '88 n recent months, his work has taken a multidisciplinary and practical approach in the form of a research and service clinic which evaluates and treats women suffering from negative PMC. The Life-Cycle Center at Millard Fillmore Hospitals, directed by Halbreich, is staffed by two physicians, two gynecologic nurse practitioners, a psychiatric nurse clinician, and a clinical social worker. "We very thoroughly evaluate each patient - though you can't really call them patients because we are dealing with normal women who have symptoms only a short time during their menstrual cycles, 11 Halbreich explained. "We are giving treatment which is aimed mostly at the elimination of the fluctuations of the gonadal hormones." It takes about six weeks to fully evaluate each patient at the Life-Cycle Center. Treatment primarily takes the form of medication - patients are given tablets that influence the production of estrogen and progesterone, usually eliminating ovulation. Hormonal patterns are examined through blood studies. Group therapy and nutritional consultation will be offered in the future. "We schedule patients for two visits, at specific times of the menstrual cycle - once during the phase when they are not expecting the symptoms and once during the luteal phase when they're supposedly having the symptoms," Halbr eich said . "Between the first visit and the second, the patient monitors her symptoms daily so that we can see if these symptoms are exclusive to the premenstrual phase and if there is a change in fluctuations. "We know that for about 70 per cent of the women, the treatment is effective," he added. "We don't yet know why it is not effective for the other 30 per cent, however, or why one drug is effective and another isn't." Studies will be conducted at the center to evaluate the efficacy of new treatments and test medications currently used for other conditions but which may relieve PMC symptoms. Last November, a few weeks after the center opened, patients were coming in at a rate of about one per day, Halbreich said. The center's capacity is two new patients per day. If the PMC studies Halbreich and his associates carried out at Albert Einstein College and Columb ia University are any indication, the Life-Cycle Center should have no trouble finding patients. "Many times family physicians or gynecologists just don't have time ( for PMC patients), but there is quite a lot of demand," Halbreich said. "In New York City, we ( evaluated and treated) close to 800 women over the years. We had more potential participants than we could handle." Women should seek treatment for negative PMC , according to Halbreich, when "the severity is such that there is an impairment of social or individual functioning to a degree that is clearly significant to the women and/or those around her." The Life-Cycle Center is located at Millard Fillmore Hospital, 3 Gates Circle, Buffalo. Appointments can be made by calling 887-4444. • Buffa lo Physician and Biomedical Scientist �LEECHES 11 Theirusewas an important aid in a successful microsurgical reattachmentof a severedear Dr. Bhangoo examines successfullyreattachedear. BY LISA JOSEPHSON W hat do leeches and microsurgery have in common? Plenty, if you ask Dr. Kulwant Bhangoo, Mercy Hospital's ch ief of plastic surgery and clinical assistant professor of plastic surgery at UB. Dr. Bhangoo is the first surgeon in the Buffalo and Western New York area to use leeches as an adjunct in a successful microsurgical reattachme nt of a severed ear. During the early hours of June 2, 1987, a SO-year-old white male patient, Frank lin Dye, was rushed into the emergency room of Mercy Hospita l with Buffalo Physician and Biomedical Scientist severe facial lacerations, including amputation of his right ear. During emergency surgery, Dr. Bhangoo used microsurgical techniques to reattach the ear. Unde r the magnification of the operating microscope, he found a transected artery in the ear and its corresponding stump on the scalp of the patient . The diameter of the small artery was less than 5 millimeters. Using the extremely delicate technique of microsurgery, the two cut ends of the artery were anastomosed using sutures that are barely visible to the naked eye. With the repair of the arte ry , it was possible to get blood flow- ing into the ear. However, Dr. Bhangoo notes, in order to have a successful microvascular reimplantation of an amputated part, it is als0 necessary to anastomose veins in addition to the arteries; this allows the blood brought into the part by the reconstructed arteries to d rain back out into the body's circulatory mainstream. Conventionally it has been extremely difficult to find and anastomose veins in reimplantation of the ear because the veins in that structure are extremely small; in th is particular case, they were cru shed and irreparable. Late Winter '88 �12 l i,, 0 i .____ ___ 0 Dr. Bhangoo(le/!) with patient Franklin Dye. Soon after the surgery, the ear had blood flowing into it, bearing testimony to the successful arterial anastomosis. Howeve r , a few hours later, the ear started to turn blue and became engorged with blood, indicating that there was inadequate outflow of venous blood from the ear. Dr. Bhangoo knew that there was no other surgica l technique that could salvage the ear from succumbing to venous strangulation. He left the hospital k nowing that the only way to save the ear would be to somehow gently rid the reattached part Lace Winter '88 of the stagnant veno u s blood until natural healing of the veins could take place. That takes about five to seven days in a circumstance such as this case. In the past, in simila r situations, surgeons had made small incisions in the reattached parts in hopes of causing sustai ned oozing that would allow for decompression. Howeve r , Dr . Bhangoo said, such small incisions soon clot, even when an ticoagulants are applied topically or given int r avenous ly. Large cuts wou ld mak e the re att ached pa rt suscep tible to in fection . As Dr. Bhangoo walked from th e hospital to his nearby office, it suddenly occur red to him that here was an ideal sit u ation to use medicinal leeches to salvage the failing reattached ear. Medicinal leeches had been u sed very effectively in the past for draini ng blood from patie nts. The leeches attach th emselves wit h microscopic bites infl icted by a row of teeth in their circular jaws which mak es a triradiate incisio n into the sk in. This wound in the sk in remains ope n because of its clever des ign. T he leech, Dr . Bhangoo notes, secretes Buffalo Physician and Biomedical Scientist �in its saliva, three pharmacologically potent substances. A local anesthetic similar to novocaine makes the bite painless, a fact not relevant in amputated parts that are insensitive co pain because of severed nerves. The second su bscance is a potent vasodilator which opens up the blood vessels and enhances the local blood flow. The third and most important substance is a locally acting long lasting anticoagulant which prevents the blood at the bite marks from clotting and allows for small amounts to ooze continually from these sites for between 24-48 hours. This prolonged oozing facilitates removal of stagnant blood in situations such as in Mr. Dye's reattached ear. After making several phone calls, Dr. Bhangoo found that medici nal leeches could be obtained from a company in Westbury, New York, called Leeches, USA, which is a subsidiary of Accurate Su rgical and Scientific Instruments, a co rporation dealing with instruments and supplies for microsurgical procedures. Dr . Bhangoo presented the option of using leeches to Mr. Dye . Faced with the possibility of losing the reattached ear, the patient readily agreed. In fact, Dr . Bhangoo recalled, Mr. Dye was surp risingly nonchalant and very receptive to the idea. "It won't be the first time," he said about the leeches. "I pulled one off my leg as a child after play ing in a pond many years ago." Over the ensuing five days, three leeches were applied to the ear daily. The response was quite dramatic- "nothing short of amazing," D r . Bhangoo no tes. "The dark, plum colored ear would become less swollen and pink in short order with each application." The leech attaches itself co feed and stays on for a period of from 15-45 minutes . Mr. Dye remarked that diffe rent leeches fed at differe nt speeds. "Some engorged themselves with blood and d ropped off within 15 minutes, while othe rs fed more leisurely and took u p to one hour ." Dr . Bhangoo is not sure what causes the animals to stop feeding. It is Buffalo Physician and Biomedical Scientist conceivable, he said, that the increases in the animal's weight may be a facto r, or possibly there may be a built-in mechanism telling it when to quit. With one feeding, the animals are able to susta in themselves for from six co 12 monchs. In order to prevent infection and cross contamination, these leeches, which cost about $6 apiece, are used only once and then discarded. npe.ople think these thingsmust bite you likea king crab,but theyjust go on like a suctioncupand then it is all over. Youdon't even know they are there. The hardestpart is lyingstill so as not to disturbthem.'' Mr . Dye remarked that "people t hink these things must bite you like a king crab, but they just go on like a suction cup and then it is all over. You don't even know they are there. The ha rdest part is lying still so as not to disturb them." Mr. Dye's ear has healed completely and is one of only a very few successful ear reimplants in the world literature, D r. Bhangoo notes. T here are fewer than six documented cases of successful microvascular ear reimplants, he says. T he leeches used are not the ordinary pond variety animals. The supplying fir m obtains them from a leech farm in Wales, United Kingdom. This species ofleeches is called "Hirudo-medicinals;" they are farmed at Biopharm in Swansea, Wales, and then shipped to the U n ited States via air freight . They are maintained in sterile, cool, damp containers for shipment. The organization in Wales, Dr. Bhangoo says, is at the center of the resurgence of medicinal leeches. Currently, apart from their use in salvaging failing reimplants in situations similar to that of Mr. Dye's or as adjuncts in microvascular reattachment of ears, noses, lips, avulsed scalps, digits, and limbs, they are finding wider use in o t her surgical procedures. These include correction of venous engorgement in transposed microvascular free flaps, or pedicle flaps. Leeches over the years have also been used quite effective ly in decreasing swelling following trauma, such as in treating black eyes and hematomas. The idea of us ing leeches medicinally stemmed from the anc ient belief that disease was caused by an excess of corrupt blood. The principle used today is similarly aimed at removing stagnant and unwanted blood from parts of the body . The earliest written reference to the medieval use of leeches was by a Greek in the second century B.C. However, medicinal leeching originated much earlier in India . The French also used leeches. They applied up to SOat a time to "blood patients" and found accidentally that leeches helped pulmonary edema, cardiac failure, and hypertension. Ho wever, pat ients who did not have these ailments were often made wo rse. This was particularly so in conditions such as obesity. Use of the leeches often caused anem ia and blood loss and sometimes lead to death. By the early twentieth century the practice of using them for bleeding had almost died out. Dr. Bhangoo anticipates a widespread readoption of the technique as an adjunct in microvascular reimplantation and also in plastic and reconst ru ctive surgery. But he cautioned that it has to be used judiciously and discrimi nately. When asked whether he will use the technique again, he said, "If the situations are righ t and if the patient is willing, then we will do it again." • Late Wimer '88 13 �14 CE ♦ BY BRUCE S. KERSHNER T housands of lives lost following auto accidents and ocher causes of severe trauma could be saved if a new surgical approach is adopted . This is the finding of a just completed research study by UB orthopaedic surgeon Lawrence Bone, M .D. His study demonstrates that aggressive immediate surgery for multiple long bone fractures significantly reduces irreversible respiratory failure and markedly reduces morbidity rates. In addition, he has found that hospital costs could be halved by the rarely used surgical approach. Nationwide, the primary approach is to surgically stab ilize long bone fractures , such as occur in an auto accident, several days later. Dr. Bone's findings provide convincing evidence that this traditional surgical approach is a major factor in increa sed morbidiry and prolonged hospitalization for the multiply-injured patient with fractures. "Surgeons can no longer ignore the implications of delaying fracture stabil ization," Dr. Bone states. The study provides the "smoking gun" against continued use of the traditional surgical approach, Dr. Bone maintains, "because it is the first published prospective random ized study on the subject, and the results are statistically significant ." While several previous retrospective studies reached the same conclusions, retr ospect ive studies lack a control, unlike prospective studies . "Because the retrospective reviews of patients were uncontrolled studies, their findings made little headway in con- Late Winter '88 Dr. Lawrence Bone (left) with Dr. Steven Lasser. vincing most of the American medical community," he commented. This skepticism has prevented the adopt ion of the new surgical approach to trauma, and probably less than a dozen hospitals around the nation currently use the new approach. "Our findings were that 12 of 28 trauma patients that had traditional delayed surgery developed respiratory failure. However, only one of 30 such patients with prompt surgery developed respiratory failure. That one patient (who was struck by a train) was so injured that we expect he would have died of his multiple, severe injuries anyway," noted the assistant professor of Buffalo Physician and Biomedical Scientist �15 orthopaedic surgery. r. Bone emphasized that it is an economic breakthrough, not just a medical breakthrough . While medical advances often tend co increase hospital coses, chis advance would result in reduced coses if adopted. "le is nearly twice as expensive co delay someone's operation by 48 hours ," he explains . "Thi s is not just because of an additiona l ten days ofhospicalizacion but also because oflonger treatment in the Intensive Care Unit. "Based on our study, it will cost half as much co treat multiple D Buffalo Physician and Biomedical Scientist trauma patients with early fracture stabilization." Bone's interest in the subject was sparked by che work of Dr. John Border, who is acknowledged as one of the fathers of modern trauma surgery. Dr. Bone was trained in trauma medicine under Dr. Border who is a UB professor of surgery based at Erie County Medical Center. Border helped pioneer the new creacmenc methods that enable dramat ic improvement in che survival of patients with severe mult iple trauma. Dr. Border developed the "Total System Approach" co trauma pat ients. It involves six basic techniques, including aggressive Late Winter '88 �16 immediate bone surgery {the one Or. Bone focused on), as well as aggressive cardiopulmonary treatment, massive protein nutritional support, and continuous ventilation of the patient, among others. Where adopted, Border's approach has reduced the mortality rate for severe multiple trauma from 30 per cent to 3 per cent or less. "Dr. Border's studies have focused on a broader range of trauma medicine concerns while mine focused only on orthopaedic surgery," Dr. Bone -----.--remarked. Dr. Border's research, while it demonstrated the importance of aggressive bone surgery, relied on retrospective studies only. This is one of several reasons why this approach is still rarely used. It is also the reason that Dr. Bone decided to undertake this study in 1984. "! saw a need for a study that would definitively establish the role of early fixation in the trauma patient. Because the approach was viewed with skepticism by the medical community, I saw chat this kind of study could change this skepticism," he related. While chief orthopaedic resident at Parkland Hospital, University of Texas-Dallas (1984 to 1986), he became project director for the study. It was funded by a $64,000 grant from the Orthopaedic Research and Education Foundation. Dr. Kenneth Johnson, University of Texas associate professor of orthopaedic surgery, served as co-investigator. Dr. Bone's prospective randomized study compared 125 trauma patients who had femur fractures. They were separated into two groups, one which had early stabilization of bone fractures and one which had de layed stabilization. These two groups were in turn divided by level of injury, whether moderate or severe. In the group with moderate inju r y levels, those with delayed su rgery showed 2.6 times greater levels of abnormal arterial blood gases than those with immediate surgery. Pulmonary emboli occurred in 3.3 per cent of the delayed group, but none in the immediate group had this difficulty. For the group with severe injuries, differences were much more dramatic. Ventilation support and admission to the ICU were required for mo re than twice as many in the delayed surgery group as in the immediate surgery group; amount of time spent in the ICU was almost three times greater in the Late Winter '88 delayed group; major pulmonary failure was 13 times greater ( 42.9 per cent vs. 3.3 per cent) for the delayed vs. the immediate surgery group. The reason pulmonary failure occurs from the multiple bone fractures has to do with the reaction of the body following severe trauma. It appears, Or. Bone states, "that fat from the fracture site, from the liver and from adipose tissue form emboli and other vascular cellular elements that lodge in the lung, ---, mechanically occluding or constricting smaller capillaries." This results in an irreversible reduction in oxygen for the lung. Dr. Bone has presented his findings at the American Academy of Orthopaedic Surgeons meeting in San Francisco, at the American Orthopaedics Association in Washington, D.C., and at the World Surgical Conference in Australia this fall. "I have received a very, very positive reaction from fellow surgeons so far," he says. He expects to pub-lish his results in a primary orthopaedic journal. Or. Bone returned to Buffalo in 1986 after he was invited to join UB's faculty. But his connections to the area are not just career-related. He is a Buffalo native, his family lives in Western New York, and both he and his father are UB medical alumni. Besides receiving his M.O. and completing his surgical residency at UB, Or. Bone has participated in fellowships in Switzerland, Germany, and Texas. He is both director of the Musculoskeletal Trauma Service at Erie County Medical Center and acting chief of the Division of Orthopaedics at Buffalo Veterans Hospital. He has other staff positions at Buffalo General and Children's hospitals . Dr. Bone is unusual because he is one of only several physicians nationw ide who is board certified in both orthopaedic surgery and general surgery. This year, Dr. Bone was honored with the American Orthopaedic Association Traveling Fellowship. He is the author of 15 publications. He hopes his findings will spark interest in the new approach to trauma so that the advances will become standard techniques. Regarding his uniquely fitting last name, the bone surgeon remarks, "I get a little bit of ribbing from my fellow physicians once in a while. On the other hand, none of my patients ever forgets my name." • Buffalo Physician and Biomedical Scientist �17 ROSWELL REPORT WASKEY TOGENETIC BREAKTHROUGH BY COLLEEN M. KARUZA A unique case report of a Roswell Park patient was the key to a breakthrough genetic study published recently by British scientists. Sir Walter Bod mer, of the Imperial Cancer Research Fund, in London, and his colleagues have provided compelling evidence demonstrating that the genetic defect responsible for familial adenomatous polyposis - a premalignant condition leading primarily to colorectal cancer - resides in the long arm of chromosome 5. Their study was published in the August 13 issue of Nature, a well-known British journal. In an article published on the same date in the New York Times, Sir Walter acknowledged that his group's research was triggered by a 1986 published case report from Roswell Park involving a mentally retarded patient with colorectal cancer, extensive adenomatous polyposis and several unusual chromosomal anomalies. This brief report, which appeared in the American Journal of Medical Genetics,was written by Lemuel Herrera, M.D., FACS, director of the Familial Adenomatous Polyposis Registry of Western New York, and several members of Roswell Park's Genetics & Endocrinology Department. Or. Herrera is an assistant professor of surgery at UB. Familial adenomatous polyposis is an autosomal dominant, premalignant condition. If one parent carries the gene for this condition, 50 per cent of the offspring will inherit the gene. "If an offspring develops colon polyps," said Or. Herrera, "there is a 99 per cent chance that he or she will develop cancer by age 35." Moreover, only those affected may transmit the genetic defect to their children. Because familial polyposis is premalignant primarily for colorectal cancer, it is, according to Dr. Herrea, "the classic prototype for studying the genetic back- Buffalo Physician and Biomedical Scientist ground of the number two cancer killer in both the U.S. and Great Britain." Of the 140,000 new cases diagnosed in the United States in l 987, it is estimated that 25 per cent to 40 per cent may be linked to a genetic defect. The human genome has been calculated to have l 00,000 genes distributed in 23 pairs of chromosomes. Chromosomes can be compared to sentences that contain an individual's genetic blueprint, while the genes are the words. The chemical bases that make up these genes are the letters that spell out an individual's inheritance. In the report, Dr. Herrera, who is also a clinician in Roswell Park's Surgical Oncology Department, evaluated a mentally retarded male patient who had undergone a proctocolectomy for a colon carpeted with adenomatous polyps. The resected specimen contained two well-differentiated colorectal cancers. Four years later, the patient developed a large mass which occupied the entire abdominal cavity and was ultimately responsible for his death. An autopsy revealed an enormous desmoid tumor and other congenital anomalies, including a horseshoe kidney, a liver consisting only of the right lobe, absence of the gallbladder, rounded configuration of the heart, and deformed feet. Subsequent cytogenetic studies showed that the patient's mother had normal chromosomes, while the father had an enlarged satellite area on chromosome 22. A similar assessment of the patient revealed that a portion of chromosome 5 was missing; and that the same enlarged satellite area appeared on chromosome 22. Although the family had no known history of colorcctal cancer or adenomatous polyposis, Dr. Herrea and his colleagues believed that the combination of colonic adenomatous polyps, cancer and the desmoid tumor represented a mutant of familial polyposis often labelled as Gardner's syndrome. G ardner's syndrome is characterized by several abnormal growths caused by a single dominant gene, with the colon being the central tumor site. Familial polyposis has been claimed to involve just colon cancer, and not the other anomalies associated with Gardner's syndrome. Recently, there has been evidence to suggest that Gardner's syndrome is the full-blown phenotypic manifestation of the familial polyposis gene. Only five cases of abnormalities on chromosome 5 had been reported previously in the literature, with Roswell Park being the first and only research institute to describe a constitutional chromosome anomaly in a patient with Gardner's syndrome and colorectal cancer. Despite several decades of intensive research, this was the first time that a cytogenetic finding led to the discovery of a recessive genetic effect in one of the most common types of cancer. "At that point, however," said Or. Herrera, "more cases needed to be studied to establish the possible significance of this cyrogeneric abnormality in familial polyposis." Prompted by the Roswell Park report, the British research team studied several families with adenomatous polyposis syndrome from the St. Mark's Hospital Registry in London. For those individuals who later developed colorectal cancer, variants in the generic material were disclosed by ONA recombinant techniques. This indicated a gene deletion on chromosome 5. The British team not only corroborated rhe results of Dr. Herrera's research that indicated that the defect was in bands 2 l and 22 of the long arm of chromosome S, but they also established an Lare Winter '88 �18 assoc1at1on for the gene deletion in both inherited and sporadic forms of colon cance r. With these findings, Sir Walter contends chat teams currently working on this project should be able co sequence the chemical bases of the gene within the next few years. If the promise of the new studies is borne out, periodic blood tests will be available to detect the defective gene in individuals at greatest risk for colorectal cance r; and knowing the gene sequence may lead to more effective treatments. As Dr. Herrera explains, "This research will provide the basis for presymptomatic or prenatal diagnosis of familial polyposis as well as the early detection of a significant percentage of colorectal cancers chat are often associated with the presence of adenomatous polyps in the general population.11 Dr. Herrera's collaborators on the report were Surabhi Kakati, Ph.D.; L. Gibas, Gen Pietrzak, and Avery A, Sandberg, M.D. • Epidemiologist finds link between SIDS & retarded fetal growth N ew evidence linking Sudden Infant Death Syndrome (SIDS) with retarded growth of the fetus during pregnancy has been reported by a UB epidemiologist. According to the study conducted by Germaine Buck, Ph.D., babies who die of SIDS typically, at birth, weigh less than five pounds and five ounces, measure less than 20 inches long, and are delivered earlier than 3 7 weeks gestation. Buck's findings were presented lastJune at the meeting of the Society for Epidemiologic Research in Amherst, Mass. The study, conducted by Buck as a doctorial candidate in UB's Department of Social and Preventive Medicine, also won the Society's prestigious Abraham Lilienfeld Award for best student research. She is currently a clinical assistant professor in the department. SIDS, which swiftly and without warning kills, usually within the first six months after birth, has no known cause. Late Winter '88 SIDS babies are typically normal, healthy infants who are found dead, usually in their cribs. This killer of infants gives no signs, no symptoms, and it strikes rich and poor alike. "Diagnosis of SIDS at autopsy is always a diagnosis of exclusion; it remains as the likeliest cause of death when all other diseases and disorders have been excluded," says Buck. The UB researcher says reduction in birth weight and birth length, called proportional growth retardation, which the SIDS infants share, may be related to insults which occur to the fetus early in the pregnancy. These insults include the mother's consumption of alcohol; consumption of drugs - illegal, prescription, or over-the-counter; inadequate nutrition, and exposure to chemicals or other substances in the environment which can affect fetal growth. These may be particularly criticaI in the earliest weeks and months of pregnancy, Buck believes. "We know, for instance, the fetus achieves about 75 per cent of its birth length by the end of the second trimester of pregnancy," she points out. Therefore, it may be during this time that insults which would slow the growth involving length could occur. I n general, risk of SIDS decreases with increase in infant size. SIDS, which was formally recognized during the early 1960s, occurs in two to three live births pe r thousand in the population of developed nations around the world, a rate which remains unc hanged after two decades. It is extremely difficult, says Buck, to estimate the figures for SIDS in developing nations because infant s there are likely to die within the first year oflife from a variety of diseases and problems connected with nutrition and environment. Buck's study examined birth weight, birth length, head circumference and length of time in uterofor all babies born in New York State in 1974, excluding New Dr. Gennaine Buck York City. She then examined identical factors for infant deaths in New York State for 1974 and 1975. A total of 148autopsyconfirmed cases of SIDS, 114 infant deaths from all other causes including trauma, and 355 living infants who had reached their first birthday were compared in the study. "Even when I examined factors such as education levels and occupations of the parents of the babies in the three groups, none of these data suggested that socioeconomic , educational or health status of the parents affected the SIDS risk," Buck points out. The only factors, she says, which the SIDS babies had in common were birth weight of less than five pounds, five ounces, birth length ofless than 20 inch es and a gestation period of less than 37 weeks. "This is not to say that all babies which fit this pattern will die of SIDS," she emphasizes, "it only suggests that these factors which are the result of delayed development which occurs in pregnancy put them at higher risk than average." Buffalo Physician and Biomedical Scientist \ J �19 Roswell skin cancer study enters second year of tests R oswell Park is entering its second year in a nationwide research study designed to test the vitamin A derivative, isotretinoin, as a prophy lactic against basal cell carcinoma. This five-year study was made possible through a $500,000 research grant from the National Cancer Institute (NCI) . ~ Basal cell carcinoma, a disorderly growth of cells near the skin's surface, is the most common - and most commonly cured - human ~ malignancy. Although cure is virtua lly guaran6 teed with early detection and treatment, persons who have had basal cell carcinomas in the ... past are likely to see new skin lesions developing in the future. The first tumor may appear on the face; the next one on the neck. Cur rently, ased on the results of her study, Buck there is no way to prevent new basal cell carsays it wou ld appear that the earlier cinomas from forming. the mothe r-to-be r eceives prenatal counThe NCI has been investigating drugs that seling and examination, the better for the would arrest or disrupt this regeneration. In a infant. pilot study conducted by the NCI, a synthetic derivative of vitamin A called isotrecinoin "Many women may believe that it's not effectively slowed the development of new skin important to check in with the doctor o r cancers in a small group of patients treated for clinic until they 'show' weight gain. Othbasal cell carcinomas. ers may not believe they are pregnant in Basedon this preliminary evidence, the NCI the first two months, especially if they launched an intensive five-year clinical study of have a history of irregula r menstrual pe r ilow-dose isocrecinoin as a prophylactic against ods," Buc k points out . And some physibasal cell carcinoma . Eight study sires around cians have suggested women not schedule the U.S., including Roswell Park, were sethei r first prenatal visit u ntil after they 've lected to conduct the cooperative clinical trimissed two periods. als. Currently, more than 800 patients nationwide are enrolled in the study. ''The study suggests, howeve r , t h at the At the Roswell Park study site, Dr. Howard earlier the mother-to-be gets adequate nuL. Stoll, director of the Dermatology Section trition, abstains from alcohol and tobacco and clinical associate professor of dermatology, and other chemicals including illegal is the principal investigator; and Ors. B. Dale drugs as well as medications, the less lik ely Wilson and Corne lie Jones, clinical assistant she may be to r un the risk of the baby dying professor of dermatology, are co-investigators; later from SIDS," Buck surmises . Barbara Slusarski, R. N., M.S., is the study Buck's study was conducted with grant coordinator. monies from the National SIDS FoundaThe Roswell Park study began in the spring tion and assistance from the New York of 1986,with 68 skin cancer patients volunteerSt ate Health Depa r tment . • ing as subjects. "The patient s have been ran-Mary Beth Spina domly assigned to one of two groups," said Mrs. i i --------- ~----------- B \ j Buffalo Physician and Biomedical Scientist i Slusarski. "One receives a placebo; the other group, the isotretinoin." The study is "doubleblinded," which means that neither the patient nor the physician knows which agent is being administered. Each patient is required to take two fivemilligram capsules each day and make regular visits co the Roswell Park Dermatology Clin ic. After three years, study researchers will compare che groups to see if the isocretinoin group had fewer basal cell carcinomas . Although they will stop taking the capsules after the third year, patients will still return to the clinic for routine follow-up visits every six months for II patients have been intwo more years. ''.A. formed that should we find proof chat the isotretinoin is effective, the 'blind code' will be broken, and the drug will be prescribed for all study participants," explained Mrs. Slusarski. Conversely, if the drug proves harmful at an y time, the study will be abruptly discontinued. And how safe is isotretinoin? "Physicians have successfully treated more than 1,000 acne pat ients with isotretinoin at doses three to ten times higher than the 10 milligram daily dose in our study," said Mrs. Slusarski. ''.l\swith any medication, side-effects can occur; however, we feel that, because of the low dosage, any side-effects that do occur are very unlikely to be dangerous." Some of the possible side-effects are chapped lips, mild nosebleeds, and tired or irritated eyes. This may occur because isotrecinoin has a drying effect. Unlike vitamin A, isocrecinoin appears to have no deleterious effects on the liver or kidney. "However, if eithe r organ malfunctions, the body may be unable to break down che compound," said Mrs. Slusarski. "We routinely test patients' blood to ensure that these viral organs work normally." Ac che end of the trial, patients will be notified of any significant results, but chat isn't the only benefit they'll derive for their participation . During the five years of the study, patients receive free dermatological care, including check-ups and treatment. • Late Winter '88 �20 Dental researchersJoseph Margarone (left) and Charles Liebow demonstratehow laserwill be used for surgery. LASERUSEDTOTREATSOFT TISSUELESIONS IN MOUTH BY MARY BETH SPINA P ioneering research in the UB School of Dental Medicine shows that soft tissue lesions in the mouth can be successfully biopsied or removed on an outpatient basis with a pulsing carbon dioxide laser beam. Although the laser "light knife" has been used to treat a var iety of medical problems, its use in the oral cavity has been largely limited to experimental surgery under general anesthetic. Charles Liebow, D.M.D., Ph.D., told the Society of Optical and Quantum Electronics in Lake Tahoe, Nevada, in December that a UB team has successfully used the laser to treat some 15 patients. Four had fibrotic outgrowths or "callouses"; four ochers had hemangiomas; two were diagnosed with the potentially precancerous lesion leukoplakia; and five had papillary hyperplasia. The pulsing rather than continuous laser beam has dis t inct advantages in the oral cavity, said Lie bow, an associate professor of oral Late Winter '88 surgery here. The continuous beam can produce inflammation in healthy tissue adjacent to the lesion being removed . "Patients who underwent treatment with the pulsing laser experienced no post operative bleeding and little, if any, discomfort compared to what would be expected using traditional surgical procedures," he emphasized. Since the laser energy source, which literally boils and vaporizes tissue, can deliver a pulsing beam in l / 100,000th of a second in an area as small as one-tenth of a millimeter, small amounts of tissue can be lased. "Microscopic capabilities combined with the laser gives the oral surgeon a great deal of control in a precise manner that may not always be possible with traditional surgery methods," Liebow adds. Deep lesions can be lased in layers; intact biopsy samples can be removed by using the laser to cut around and under tissue in a pie-shaped wedge. "While the carbon dioxide laser has proved itself successful as a surgeon's tool in the oral cavity, I don't anticipate every oral surgeon will use it," he predicted. He believes cases which can benefit most from the laser will be referred to tertiary dental centers where clinicians specially tr ained in its use will perform the procedure. Laser treatment does not appear applicable for oral surgery involving bone no r may it be recommended fo r certain other procedures in the mouth, Liebow said. The UB team has, however, used the carbon dioxide laser to treat one case of periodontal disease with good results. Liebow said that the researchers in the Department of Oral Surgery are involved in other ongoing research which may expand applications of laser technology. Others involved in the study include Robert E. Braun, D.D.S., Joseph Natiella, D.D.S.,Joseph Margarone, D.D.S. and Laurie Hartman, D.D.S ., all faculty in the UB School of Dental Medicine. • Buffalo Physician and Biomedical Scientist �21 e Buffalo General Hospital, a major eaching hospital of the State University of New York at Buffalo, is establishing the State's second heart transplant center. Among institutions which also submitted proposals for the heart transplant center were Mt. Sinai Hospital and Montefiore Medical Center in New York City and Strong Memorial Hospital in Rochester. The State's only established center is at ColumbiaPresbyterian Medical Center in New York. The new heart transplant center at Buffalo General will be directed by Robert M. Mentzer Jr., M .D ., head of the Division of Cardiothoracic Surgery at the UB School of Medicine and Biomedical Sciences and chief of Buffalo General's Department of Surgery. The center will be heavily oriented toward research aspects of cardiovascular surgery, including follow-up studies of transplant patients and the development of bioengineering devices such as artificial hearts and support systems for surgery, Mentzer said. "The Cardiac Transplant Center is an important step forward in the development of Buffalo as a national center of excellence for health care," UB President Steven B. Sample commented. "The establishmen t of the center is the result of cooperation among the University's eight teaching hospitals, including Roswell Park Memorial Institute , the strong support of the community, and our faculty's experience in heart transplantation at the Buffalo Veterans Administration Medical Center, where 12 heart transplants have already been performed." "The Cardiac Transplant Center will enhance the Medical School's academic program in cardiovascular surgery," said John Naughton, M.D., vice president for clinical affairs and dean of UB's School of Medicine and Biomedical Sciences. He also emphasized the cooperative effort among the University's eight teach ing hospitals and the involvement of the Western New York Health Sciences Consortium in developing and supporting Buffalo's program in heart transplantation. Fourteen heart transplants are projected during the first year of operation with an average of 25 each year after that, Mentzer said. The Organ Procurement Agency of Buffalo Physician and Biomedical Scientist STATE'S 2ND HEART TRANSPLANT CENTER ESTABLISHED HERE BY LINDA GRACE-KOBA$ THEBUFFALO ENl:RAL HOSPITAL .," -~n. ... BUFFALO GENERAL HOSPITAL I z i5 ~ i Q :.,__ _ ________________ __J ~ President Sam/1le at podium d111·ingheart trans/1lan1 /Jrcss conference. Western New York will handle organ location and procurement. Mentzer noted that no additional hospital construction or equipment is required before the program's start-up and that two operating rooms, intensive care units, and a newly created stepdown unit on the 13th floor in a new medical tower building will easily accommodate the cardiac transplant procedures. Mentzer, with Joginder Bhayana, M.D., will co-direct a cardiac transplant team con- sisting of University at Buffalo facu lty surgeons from Buffalo Children's Hospira!, Buffalo Veterans Administration Medical Center and Buffalo General. In addition to Mentzer and Bhayana, team members include Jacob Bergsland, M.D., Thomas Lajos, M.D., A. Norman Lewin, M.D., Gary Lofland, M.D., Syed T. Raza, M.D., and Theodore Spooner, M.D. Since 1984, this team has performed a total of 14 cardiac transplants in Buffalo. Late Winter '88 �22 Also involved in the heart transplant program are Francis J. Klocke, M.D., SUNYBuffalo professor of psysiology and medicine, who this year serves as president of the American College of Cardiology, and Lewis M. Flint, M .D., chairman of the U niversity' s Department of Surgery. All persons involved in the Buffalo Cardiac Transplant Center emphasize the cooperative effort that resulted in its approval by the State. Other principals in the program's development include William V. Kinnard Jr., M.D., president and chief executive officer of Buffalo General Hospital; John E. Friedlander, Buffalo General's executive vice president, and Andrew J. Rudnick, president of the Greater Buffalo Development Foundation, Inc. Mentzer said the comprehensive nature of Buffalo's program in cardiovascular surgery could not be achieved by a single institution. Officials at Buffalo's renowned cancer research institute, Roswell Park Memorial Institute, have supported efforts to establish transplantation programs for heart and bone marrow transplants, he said. Pediatric cardiovascular surgery and research studies have been under way at Buffalo Children's Hospital, while researchers at the Buffalo VA medical center have developed a highly regarded program in heart transplants and cardiovascular surgery . He also cited Klocke's reputation as a leader in the study of coronary blood flow in humans who has performed important studies in that discipline. Klocke will initiate new coronary blood flow studies in transplant patients, Mentzer said, particularly in the area of atherosclerosis. Other research studies to be performed within the new center will be a systematic investigation of coronary blood flow in transplant patients. Leon Farhi, M.D., chairman of the University's Department of Physiology, is a leader in respiratory physiology who will participate actively in clinical studies investigating changes in blood circulation after a patient undergoes a heart transplant. "Most heart transplant cente rs are not prepared to study changes in the body after transplants in as comprehensive a manner as we are able to because we have the involvement of so many University departments and teaching hospitals," Mentzer said. "In extensive follow-up studies, we will be looking at Late Winter '88 Governor Cuomo visits heart 1:rnnsplan1 cenwr following announ cement of its cstablishmcnL ways to help patients after their heart transplants through Buffalo General's Cardiovascular Life Sciences Program." Another unique aspect of the Buffalo Cardiac Transplant Center is the University's commitment to biotechnology, Mentzer noted. "We are also going to investigate support systems to maintain patients and the furthe r development of cardiovascular technology," he said. "We are prepared to look at the experimental development of artificial hearts over the next several years. We have associations w~th bioengineering experts at the University and with its Health-care Instruments and Devices Institute. "Most other cardiac transplant programs in the country do not have as well rounded a research base to expand their programs as we do in Buffalo. Our goal is to establish ourselves as a transplantation center as good as any in the country." Mentzer was recruited by the University at Buffalo to head its Cardiac Transplant Program from the University of Virginia, where he established a reputation as one of the leading young researchers in cardiovascular surgery in the country, University officials said. His awards include a National Institutes of Health Research Career Development Award and two Public Health Service Awards. • Buffalo Physician and Biomedical Scientist �23 Consortium wi ll focu s on marrow tran splan ts B one marrow transplants are the initial focus of the new consortium formed by three medical institutions: UB School of Medicine and Biomedical Sciences, Roswell Park Memorial Institute, and the University of Rochester Medical Center and School of Medicine and Dentistry. The purpose of the consortium is to share resources in transplantation medicine in the areas of patient care, research, and medical education. The consortium is also exploring the possibility of sharing resources outside trans- Buffalo Physician and Biomedical Scientist plant medicine. "This cooperative agreement is a good indicator of further inter-institutional cooperation in the two communities of Buffalo and Rochester," said John Naughton, M.D., UB's vice president for clinical affairs and dean of the medical school. "Sharing of our expertise in bone marrow transplantation is a sign of more things to come." "The consortium is unique in that it br ings together in a single program the resources of a nationally designated Comprehensive Cancer Center and two university teaching hospitals recognized for thei r excellence, for the benefits of patients throughout Upstate, Central and Western New York." said Thomas B. Tomasi, M.D., Ph.D., director of Roswell Park Memorial Institute (RPMI). "Each institution will bring unique strengths to the program." "We're looking at an era where cooperative use of resources will be crucial if expensive and complex medical technology is to serve the public efficiently," said Paul F. Griner, M.D., director of the Medical Center at the University of Rochester. The cooperative agreement will establish interactions among researchers on a formal basis, Tomasi said. "The three institutions will work toward sharing common interests," Naughton said, adding that the agreement will include cooperation and exchange in research and education. At first, the interchange will involve faculty visiting neighboring institutions to work on joint research, according to Naughton. Later, the exchange could involve the exchange of senior residents and special fellows from the two medical schools. It is proposed in the consortium agreement that a joint program for bone marrow transplantation be established at Roswell Park Memorial Institute and Strong Memorial Hospital of the University of Rochester Medical Center, enabling physicians to perform allogeneic (donated) bone marrow transplants for patients suffering from leukemia, aplastic anemia and related diseases. The bone marrow transplantation program at RPM! and Strong Memorial will serve patients in Western New York as well as the Finger Lakes and Central New York. Tomasi said RPMI currently offers autologous bone marrow transplants in its clinic. (Autologous transplants involve drawing marrow fluid from the patient, treating the fluid, then returning the marrow to the patient.} This procedure is less complicated than allogeneic transplants, which require special facilities. "Research is needed in the bone marrow transplant area, including gene thereapy," Tomasi said, adding that gene therapy, now an experimental procedure, entails inserting genetic material into the cells to replace missing genes. Tomasi's research team is also studying the reasons why organs are rejected when transplanted to a patient. This research may result in improved methods of transplanting organs, such as the heart or liver. • Late Winter '88 �24 JOHNNAUGHTON : DEAN& VICEPRESIDENT BY CONNIE OSW ALO STOFKO I t's not easy to tell where one of John Naughton's jobs stops and the other starts. Naughton is vice president for clinical affairs. He's also dean of the School of Medicine and Biomedical Sciences. When he's wearing his vice presidential hat, he reports to President Steven Sample. In his role of dean, he reports to Provost William Greiner. "Often I report to both together because you can't separate the roles out," Naughton noted. As dean of the medical school, he takes care of the school's academic needs. As vice president, his job is to work with the local hospital system. Clinical education is different in Buffalo than it is in other places because UB uses a system of affiliated hospitals instead of a single teaching hospital as is the case with most others. "To make the system work in Buffalo, we need the cooperation of the hospitals and the school," Naughton said. "To develop the system was the job of the vice president for clinical affairs. To keep it going is the dean's job." Since about 1983, his duties as vice president have remained stable, he indicated. "My job is to be the University's representative and officer to the teaching hospitals in Buffalo," Naughton said. It's his job to represent not only the medical school, but the other schools and departments that have programs in the local hospitals. However, Naughton isn't placed Late Winter '88 over the other deans. "l have oversight in relation to affiliation needs, but not over programs," he explained. The affiliation agreements with hospitals are now cent ralized in rhe Office of the Vice President for Clinical Affairs. Originally, they were in the office of Edward W. Doty, vice president for finance and management. Any department that sends students to work in a hospital must have an affiliation agreement, Naughton said. Each school pretty much works out the relationships with the hospitals itself. Units with affiliation agreements include the School of Dental Medicine, School of Nursing, School of Health Related Professions, Department of Communica tive Disorders and Diseases, Psychology Department, and School of Social Work. A s vice president, Naughton also oversees lease agreements with the hospitals. UB pays hospitals for space it uses at their facilities. He is also responsible for the clinical practice plans for both the medical school and dental school. Another of his vice presidential duties calls for Naughton to oversee programmatic issues concerned with clinical practice. For instance, he has been working on the attempt to get a heart transplant center in Buffalo. That is, in large part, a patient care issue, but it requires a strong academic presence, he pointed out. But even this example is one of the areas that overlaps with his role as dean, he pointed out. Coordinating the residency programs is another example of the mixture of his roles, he said. Residents are paid by the hospital, so they're agents of the hospital. But they're there for an education, which falls into his role as dean, he explained. The residency program is operated by the Unive rsity faculty who are chairmen of the clinical departments. Invariably, they're also chiefs of the same clinical areas at the hospitals. Naughton's position as vice president differs from the other vice presidencies in one big way - it's a staff position rather than a line position, he explained. That means that although he reports to President Sample as the other vice presidents do, he has no control over resources when wearing his vice presidential hat. • Editor's Note: The Reporter, ihe campus' weekly newspaper, has been running a series of articles on the University's organizational srructure, explaining how each vice presidential area is set up and how it functions. This article on chevice president for clinical affairs attempts to delineate the differences and complementary relationships between John Naughwn's two administrative roles as both vice president for clinical affairs and dean of medicine and biomedical sciences. Buffalo Physician and Biomedical Scientist �25 PHOTODOUG LEVERE �26 It'searthshaking,but rwt anotherPlague,Mohnsays BY MARY BETH SPINA U B immunologist James F. Mohn, M.D., describes the AIDS crisis as "the most earthshaking infection of this century," but cautions against comparing it with The Plague - The Black Death which killed about one-fourth of Europe around the 14th century. Speaking at a seminar organized by the Depa rtm ent of Microbiology on AIDS and other venereal diseases, Mohn noted that unlike The Plague, which in its pneumonic form spread rapidly through casual contact, the AIDS virus is transmitted only in blood and semen and by intimate sexual contact. Transmission appears to be primarily by means of unprotected intercourse with an infected partner, contaminated needles shared by IV drug abusers, transplancental exchange during pregnancy from an infected woman to her fetus, and - much less frequently t0day - transfusion of blood products. Very rare instances have been reported where health workers, in no other high risk group for AIDS, accidentally received the virus from an infected patient through a needle prick, or through infected blood entering an open sore or scratch. Mohn noted that while there's no cure for the virus - HIV 1,2,3 - great strides have been made since the syndrome was first recognized a half-dozen years ago. Not only has the virus been identified, but screening tests sensitive to and specific for HIV antibodies have been developed to minimize its spread through the human blood supply. In addition, there are continuing efforts to educate health workers as well as the general public about methods they should Late Winter '88 employ to prevent the spread of AIDS. "All we have going for us now is prevention through essentially personal hygiene methods," said Mohn, director ofUB's Ernest Witebsky Center for Immunology. He also serves as chairman of the New York State Council on Human Blood and Transfusion Services which Gov. Mario Cuomo charged to be responsible for insuring safety of the blood supply. Mohn said that although there is some promise for AZT, the drug currently approved for treatment of AIDS patients, it has t0xic side effects. The best hope, he believes, is for an effective vaccine to be developed. The lethal effects of the retrovirus HIV can be blamed on the type of cells it recognizes and attacks as well as on the fact that it can remain latent or inactive but alive for an undetermined number of years in the human body, said Thomas Flanagan, Ph.D., a virologist and chairman of the Department of Microbiology. While other viruses have a particular attraction for certain types of human cells, HIV is especially deadly because it recognizes and infects primarily T4 helper cells and, to a lesser extent, certain types of cells in brain tissue. Because the virus attacks, infiltrates, and renders impotent these important T helper cells, the AIDS patient falls victim to a number of organisms found normally in the body and normally held in check by cellular immunity. Among these are the parasite Pneumocystis carinii. S ince the humoral immune system is compromised to a lesser degree than the cellular Buffalo Physicianand BiomedicalScientist ��28 one, it is more unusual for AIDS patients to die from exposure to infectious agents for which they have developed antibodies in the past. Flanagan noted that, compared to other viruses, HIV appears relatively "inefficient" in its transmission. Hepatitis B, for instance, which may also be spread by infected blood, is considerably more efficient in producing active disease than · HIV. This difference, Flanagan hypothesized, may lie in the amount of the virus which may be transmitted per occurrence. Especially of concern are babies born to HlV positive mothers. "Fifty per cent of these infants are born HIV positive with a certain number going on to develop active cases of AIDS," Flanagan said. But among those born HIV negative to positive mothers, it cannot be determined how many will undergo seroconversion or how many years could elapse before this might occur. T imothy Murphy, M.D., a faculty member in the Department of Medicine, told the audience that physicians can estimate the individual AIDS patient's expected survival rate from time of diagnosis to death based upon the syndrome's initial manifestations. "Patients who first present with Kaposi's sarcoma will live about 125 weeks after diagnosis, compared to 35 weeks for those initially presenting with Pneumocysciscarinii pneumonia and 18 weeks for those first affected by other opportunistic infections or disease," Murphy said. In addition to opportunistic infections, some patients develop certain types of brain tumors typically found only in AIDS patients. Murphy's case presentations showed the abstract term "fatal" takes on a more tragic picture: most patients with AIDS will die within three years of diagnosis. Although laboratory screening tests for HIV antibodies can assist the physician in confirming a suspected diagnosis of AIDS, they are more important as a means of screening the human blood supply, according to Roger Cunningham, Ph.D., associate Late Winter '88 professor of microbiology. Screening at blood banks features an initial ELISA (Enzyme Linked Immunosassay). A test sensitive for HIV antibodies, ELISA is repeated twice if the first result is positive. "False positives can result from antibodies in the blood which are not anti-HIV, reacting with material from the cell culture used in growing the virus for use in the test," said Cunningham. If the prospective donor has two positive ELISA results, the blood is tested using the electrophoretic Western Blot, which while as sensitive as ELISA, is more specific. "If the donor is repeatedly ELISA positive or positive on the Western Blot, he or she is barred from blood donations but still may not develop an active infection from HIV," he added. There is no guarantee that those who are HIV negative on these tests are not incubating the virus and might not convert to positive at a later time. But, Cunningham noted, "all that can be done is being done" to protect the human blood supply. "The time required from exposure to the virus co a positive test result is something we still don't know," he explained. Asked later about a recent finding by Johns Hopkins researchers that suggests that some patients who are seropositive for HIV later may convert to a negative test result, Cunningham said this discovery may indicate HIV "acts just like other viruses" in certain aspects of its behavior. "What these researchers have found is what we might suspect could happen," he added. I n addition to scientific questions about HlV and the AIDS syndrome, there are legal and ethical considerations which confront the physician and society, said Cheryl Nohejl, M.D., a UB pediatrician. Among these, she said, are allocation of available resources, maintenance of confidentiality, privacy for the patient, and duty co warn third parties. Some of these issues, notably allocation of resources, figure prominently in controversies involving other types of disease states, Nohejl pointed out. In addition to AIDS, Janek Patel, M.D., and Joseph Mylotte, M.D., discussed other sexually transmitted diseases, notably herpes and gonorrhea. Use of oral contraceptives, the IUD, and changes in sexual behavior since World War n have led to incr~ases in certain venereal diseases such as gonorrhea, genital warts, and genital herpes, they noted. Patel told the audience that the drug, acyclovir (Zovirax), has proved useful as a treatment for patients who suffer from initial outbreaks and recurrences of genital herpes caused by either Type l or Type II herpes simplex virus. The drug, he cautioned, should be given for no more than six months at a time in chronic cases. Daniel Amsterdam, Ph.D., a faculty member in the Department of Medicine and the Department of Microbiology who is based at the Erie County Laboratory, discussed laboracory diagnostic methods for various sexually transmitted diseases. Also included in the seminar, which was offered as part of the coursework for Microbiology 600 and 51 I, were Joseph Kite Jr., Ph.D., and Boris Albini, M.D., Department of Microbiology. • $200 ,000 bequest will provi de scholarship s M re than $200,000 will go toward cholarships for VB medical stuents under the terms of a trust fund established by a Medical School alumnus. The University at Buffalo Foundation Inc. recently received $205,229 from the estate of Vivian Sampson of Chicago, the widow ofW alter Sampson, a nephew of the late UB alumnus Walters. Barnes, M.D. Barnes had established a trust fund for his nephew. The terms of the trust stipulated that the principal would reve rt to the Medical School upon the Sampsons' death if their marriage produced no children. The UB Foundation has used the money co establish an endowed account, the income of which will be used for the scholarships. Buffalo Physician and Biomedical Scientist �29 Barnes, an 1892 graduate of UB, left the University $211,000 upon his death in 1958 at age 89. That money was used to upgrade facilities in Sherman Hall, and a plaque commemorating Barnes was unveiled in Sherman in 1962. A native of England, Barnes came to the United States with his parents in 1877. He had been affiliated with Mercy Hospital in Chicago for mor e than 65 years, and had served as a professor at the Northwestern University Medical School. • ADDEO PROT!,;CTI O!I OF' FAE E. RAO!Ct,L AH •. ERS OJHt •.RECOVER - l"BALI .Y lSCHE :-\IC RAT m : ;,P.T MTSP student wins national scholarship D avid J. Altman, a Medical Scientist Training Program (MSTP) student at UB, was one of thr ee M. O./Ph. D. students nationally awarded a Medical Scientist Scholarship worth $14,000 per year and renewable up to five years. Mr. Altman, an alumnus of Harvard University, received a letter of commendation for academic excellence for the 1984-85 year. In addition to his fine scholarship, he has also been involved in student affairs and in the orientation program for enter ing students. MSTP students are different from other medical students in that they can work coward a M. D./Ph. D. simultaneously, completing both in six co seven years. This program, started in 1982, was designed to narrow the gap of knowledge and understanding that often separates highly specia lized scientists from practicing physicians. • Psychiatry unit changes its name T he School of Medicine and Biomedical Sciences is not the only medical unit at UB that has undergone a name change. The Department of Psychiatry has been renamed the Department of Psychiatry and Behavioral Sciences. The ratio nale for this is that the department Buffalo Physicianand BiomedicalScientist :,: I i----1 ___ ~ ._l ~ I Q ;&Ii i..._ ______ __ ___ _____. Peter Bloom was one of the exhibi tors in UB's seventh annual Medical Student Research Forum held in Decembe r . is the principal unit in the Medical School responsible for teaching and research in the behavioral sciences. Three required courses in behavioral sciences during the preclinical years are offered, and psychiatry is taught in the clinica l years. The faculty consists of both psychiatrists and psychologists with some individuals, especially the psychologists, primarily responsible for teaching courses in the behavioral sciences. Fur thermore, research interest of faculty include such areas as behavioral aspects of health and illness, neuroendocrine effects on behavior, and prevention of mental retardation and mental illness. Dr. Marvin Herz, chairman of the renamed department, points out that 23 other medical school psychiatry departments have already adopted the new names. These include Stanford, George Washington, Johns Hopkins, SUNY Stony Brook, and Univers ity of Texas. • Minority students win Regents awards T wo UB minority medical students have received Regents Health Care Scholarships in Medicine. The two students are Lisa King and John W Smith. The Regents scholarship program is aimed at reducing the critical shortage of physicians in certain areas of New YorkState. It also aims to expand medical educational opportunities for underrepresented minority students and economically disadvantaged students. Scholarship holders receive up to $10,000 a year during their four years of approved study. After completion of their professional studies, they are required to practice in underserved areas of New York State. The UB students represent two of the 40 medical students selected Statewide. • Late Winter '88 ~ �30 HEADACHES ARE THEIRSPECIALTIES The information in chis scorywas compiled by Clare O'Shea from interviews wich Elliott Schulman and Greg Tramuca, brochure information and articles on the Comprehensive Headache Center, and nor.es by Bonnie Schulman and by Bruce Kershner. W hile at UB in the mid-60's, a couple of undergraduates met playing pinochle in the old Norton Hall. Twenty-five years later, they're meeting regularly again. But this time, it's to talk about headaches. Elliott A. Schulman, a neurologist, and G regory J. Tramuta, a psychiatrist, are cofounde rs of the Comprehensive Headache Cente r at The Germantown Hospital and Medical Center in Philadelphia. The center diagnoses and treats patients suffering from one of mankind's most common ailments. The shift from a pinochle team to a headache team was not exactly planned. Schulman and Tramuta were buddies all the way t hrough medical school unt il their graduat ion in 1974. But then Schulman moved to Pittsburgh, Tramu t a moved to Philadelphia, and eight years went by without any contact between them . Then came the day Tramuta was making h is rounds at Philadelph ia's Germantown Hosp ital. It just happened to be the same day and the same hospital in which Schu lman was making rounds, covering for another doctor. "It was totally serendipitous," said Tram uta, now chief of psychiatry at Germantown and a clinical assistant professor at Temp le University Medical School. " Here was someone out of my past - I had not heard from Elliott in years. I was very surprised." ln the years since he had last seen Schulman, T r amuta had completed postgraduate training and a residency at the Albe rt Ein- Lare Winter '88 stein Medical Center. He had held various positions including assistant professor of psychiat ry at the Medical College of Pennsylvania, psychiatric consultant at Germantown and at Wissahic kon Hospital, and psychiatrist at the Fox Chase Cance r Center, where he worked with terminally ill patients and their families. It was at Fox Chase, where he served as chairman of the pain management committee, that Tramuta became interes ted in chronic pain. He began discussing wit h Ge rmantown's chief of neurology, Stephen D. Silberstein, the idea of developing a center where patients with chronic pain could receive multidisciplinary treatment. Schulman arrived in Philadelphia by way of Pittsburgh and Washington, D .C. Afte r an internship at Montefiore Hospital, an affiliate of the University of Pittsburgh, Schulman served as a resident at Georgetown Univeristy School of Medicine and a fellow at the National Institutes of Health. He was subsequently appointed staff neurologist at Temple University Hospital and assistant professor at Temple Univers ity School of Medicine. Currently, Schulman is an attending neurologist at Germantown and is in private practice with Silberstein. T he pain cente r idea surfaced again when Schulman and Tramu t a began p r ivate practices. Because of the overlap between neurology and psychiatry, the two friends were t reating some of the same pat ients, shuffling them back and forth between their offices, then discussing them by mail. Rather than tryi ng to provide service for the whole spectrum of chronic pain problems, however, Tramuta and Schulman decided to establish a multidisciplina ry cente r focusi ng on a manageable segment of pain sufferers. In 1982, the two medical school friends . Buffalo Physicianand BiomedicalScientist �31 along with Silbe rstein and two psychologists, Ronald Kaiser and Joseph Primavera Ill, founded the Comprehensive Headache Center. The center, which meets once a week at Germantown, now includes a social worker and three nurse practitioners. "We knew that we could handle the head and facial pain populations within our disciplines," Tramuta explained. "We think we do a lot better than the primary sole practitioner can for patients with chronic pain problems." "This is a comprehensive approach," Schulman added. "Now that we are working side by side, we can address the problems as they come. We don't have to communicate by mail." The center is able to treat patients more effectively and efficiently because of the accumulated experience and expertise of the staff. In addition, opportunities for specialized research are made easier in such a setting. There are about 15 such centers in the United States. Of these, the Comprehensive Headache Center is one of only three with an inpatient unit, according to Schulman. It remains the only center of its kind in the tri-state area of Pennsylvania, New Jersey, and Delaware. The medical team cannot promise miracle cures, but they can in many cases help reduce the frequency and intensity of their patients' headaches, the two US-educated physicians agree. "ln the past, headache sufferers were never taken seriously," Schulman said. "It was the classic case of'take two aspirins and call me in the morning.' We now know there are treatment plans that really work." W hen the headache sufferer first contacts the center for help, he or she is given an extensive questionnaire to complete and bring to the initial appointment. The patient is given a complete medical exam and is seen by a psychologist or psychiatrist. A psychological profile of the patient is created using the information provided on the headache history along with psychological tests . That profile is given to a staff neurologist. A t reatment p rogr am tailored to the Buffalo Physician and Biomedical Scientist individual headache patient is then designed by the medical team. Treatment will vary, but it may include a change in diet, medication, behavior modification, biofeedback, and psychological and physical therapies. Some of the newer medicines used by the headache center include calcium channel blockers, various antidepressants, beta-blockers and DHE ( dihydroergotamine), an ergot preparation. The center has been involved in testing a nonsteroidal anti-inflammatory agent, and a new selective beta-blocker, Schulman said, and has experimented with low doses of anaprox, a motrin-relative . Those patients in need of inpatient evaluation are taken off all unnecessary medications and, in some cases, given a prophylactic medicine during a five- or six-day hospital stay. Classes are given on headache types, drug therapy, and the social ramifications of headaches. A social worker meets with the patient and family several times during the hospital stay. M any headache patients have suffered every day for years without finding relief from pain. "lt would not be unusual for us to treat a person who has suffered with headaches for over 25 years, often on a daily basis," Schulman noted. "These patients commonly ingest l Oto 12 aspirin or Tylenol daily, along with an assortment of narcotics and ergot preparations." "Because we're really a referral center, we tend to see people with more severe problems," Tramuta added. "These are people with severe headaches, people who daily are taking large amounts of analgesics, tranquilizers, sleeping pills, or specific migraine medications. They're a wide mix of personalities; some are depressed or neurotic, others are not.'' The physical pain frequently affects other aspects of the patient's life. "Severe depression is a common manifestation," Schulman pointed out. "Patients miss school or work, have problems with their families, don't go out.'' ' 'T hey are socially isolated because of their Late Winter '88 �32 headaches," T ramuta added. "Chronic headache pain wears people down. They feel depressed in response to the pain, and frustrated because they can't get rid of it and don't understand why they get it. The pain and the depression can feed on themselves it's a vicious cycle." J ust as there is no one patient that is typical, there is no such thing as a typical headache, Schulman and T ramuta point out. There are many misconceptions about the cause of headache pain. Some people blame their sinus problems. Although sinuses can ache, the headache in the area of the sinuses described by most people is rarely caused by congested or inflamed sinuses. It is more often the pain of a tension or migraine headache. Neither are headaches usually a sign of high blood pressure, allergies, dental problems, or eye problems, according to Schulman. Some sufferers of severe or chronic headaches fear the possibility of a brain tumor. Actually, fewer than 10 per cent of chronic recurring headaches have such a serious underlying cause as brain tumor, blood clot, infection, or hemorrhage, he said. It is now believed that many headaches may result from a biochemical imbalance in the brain, according to Schulman. This involves the compound serotonin which may lead to inflammation of the blood vessels and irritation of the nerves, resulting in a headache. The imbalance can be triggered or aggravated by many agents, including head injury, emotional or physical stress, hormonal changes, drugs, sleep disturbances, noise, bright lights, weather changes, odors ( including certain perfumes), menstruation, lack of adequate exercise, alcohol (especially red wine), large amounts of caffeine, and certain foods such as bananas, nuts, aged cheeses, chocolate, smoked or pickled meats, pickled herring or chicken livers. "Not every headache problem is headacheinduced," Tramuta pointed out. "People should take a close look at their environments.'' The most common Lare-Wimer '88 types of headaches treated at the center are migraine, tension, cluster, and rebound. Migraine and tension are the two major types of benign chronic recurring headaches. Since symptoms of each can overlap, however, it has been suggested that migraine and tension are not two distinct headache types but rather exist at opposite ends of the same spectrum. A bout 20 per cent of the population suffer from chronic, recurring headaches, Schulman said, although almost everyone suffers a headache at some time in his or her life. "More women than men get headaches," he added. "And while more women get migraines, more men get cluster headaches." The tension headache is typically a dull, constant ache which usually affects the whole head. Sufferers often describe the pain as a tight band around the head, often accompanied by a tightness in the neck, dizziness or nausea. Aspirin or acetaminophen often quickly relieves the pain, although it may last for hours or even days. The common migraine pain is usually throbbing, periodic, and one-sided, although it can be bilateral. Often there is a family history of this type of headache, which also can last for hours or days. Nausea or vomiting, sensitivity to light and loud noises, abdominal pain, anxiety, and fever are possible symptoms. The classic migraine may bring the same symptoms, plus it may be signaled by flashing bright lights before the eyes lasting as long as 20 minutes. In rare cases, weakness or numbness in parts of the body or blackout in a part of the visual field accompanies the migraine. Interestingly, a headache need not be part of the symptoms of a migraine. If taken early enough, aspirin or acetaminophen or other prescription drugs can sometimes relieve migraine pain. Drug therapy may be necessary, however, if the migraine is chronic. The cluster headache occurs in bunches from one to five times a day over a period of days or weeks, followed by a remission of six months to a year or longer. Attacks last from 15 to 90 minutes, and recur at approximately the same time every day, often interrupting Buffalo Physician and Biomedical Scientist �33 the person's sleep. The pain always affects one side of the head, is located around the eye, and is described as a severe, boring sensation, like a hot poker is being pushed into the eye. Nasal stuffiness and eye tearing on the same side as the pain are usual symptoms. There are no warning signs associated with the cluster headache, although alcohol frequently brings on che attacks. Cluster headaches are not inherited. The analgesic rebound is a newly described form of headache. The first thing many people do when a headache hits is to reach for the aspirin bottle, or maybe a strong cup of coffee. And they keep reaching, perhaps taking more than 14 tablets a week or more than 100 a month. It has been shown that such abuse of analgesics can perpetuate and worsen the headache pain. And when the medication is withdrawn, the result is a rebound headache which increases in intensity and lasts from four days to one or two weeks. Finally, there is the headache which com- Stress seen as primary cause of children's headaches S tress brought on by social or family pressure is the cause of the vast majority of all headaches experienced by child ren and adolescents. "Headaches are very common throughout all pediatric age groups," said Michael E. Cohen, M.D., speaking at the Annual Meeting of the American Academy of Pediatrics (AAP) in November. Dr. Cohen added, though, that toddlers and children between the ages of 5 and 15 years have the greatest incidence of headaches. Peer pressure, school phobia and family problems such as d ivorce are some of the env ironmental facto rs that can cause stressrel ated headaches in children, Dr. Cohen said. Tension headaches also may develop, he said, as a result of difficulties with sibli ngs or when children have problems achieving their parents' expectations. Buffalo Physician and Biomedical Scientist manly occurs as part of the post-traumatic syndrome chat follows a head injury. Such a headache can have one or several of the symptoms of either migraine or tension headaches. M ore than 300 headache sufferers have been treated at the Comprehensive Headache Center since it opened its doors. The success rate has been about 80 per cent, Schu lm an said, due in large part to drug therapy and the addressing of psychological issues. "We have treated patients as far away as Florida and the Midwest," Schulman said. ''Our youngest patient was 12; the oldest was 80." "We'll get people who sometimes have had headaches for years, who feel wretched, miserable, hopeless," T ramuta said. "They've been told they have to live with this pa in which has disrupted thei r who le lives. It's very gratifying to see people walk out the door feeling a new optimism about life." • Dr. Cohen, professor of neurology and pediatrics at UB, and director of child! neurology, Children's Hospital of Buffalo, explained that stress-related headaches are non-migrainous and can occur frequently or infrequently. He estimated that about 40 per cent of all children have expe rienced such headaches by age seven and about 70 per cent of all children experience th em by adolescence. Medication may help reduce some of the symptoms of a non-migrainous headache; however, Dr. Cohen said that counseling with a pediatrician, child neurologist, or child psychiatrist may be a better alternative. "Counseling of the parents can also be quite helpful," he added. Dr. Cohen estimated that the minority of childhood headaches are caused by physiological problems, such as chronic infections, brain tumors, or blood vessel abnorma liti es. He also noted that sinus problems, visual difficulties and sensitivity to chemicals in certa in foods are often suspected but seldom proven as causes of chronic headaches. • Dr. John \V. Cudmore John W. Cudmore (M'62 ), a physician with Health Care Plan's (HCP) group practice, was recently promoted to Brigadier General, Army National Guard. He is a clinical associate professor of surgery at UB. Cudmore, who received his first commission in the National Guard in 1963, is in charge of 6,500 troops throughout New York Sta te. "What is unusual about my assignment," Cudmore said, " is that a medical officer has been given command of general service troops." During his years of military service, Cudmore has given many more hours than the standard two weeks per year and one weekend per month required for reserve service personnel. He has been called in to assist with floods and blizzards and the prison uprising at Attica Sate Penitentiary and to command Military Medical Support to the 1980 Winter Olympic Games in Lake Placid. "l wouldn't do this ifl didn't really enjoy it," the general said. In his new command, Cudmore will oversee the training of New York State's National Guard and will be responsible for the level of readiness sustained among his troops. The National Guard maintains a force that is prepared to respond to any state or federal emergency that should arise. Cudmore, who has been a full-time member of Health Care Plan's physician staff for five years, is a genera l surgeon and a staff member of Buffalo General Hospital. • Late Winter '88 �34 William S. Edgecomb '47 1940's William S. Edgecomb (M' 47 ) • has been appointed a life fellow of the American Psychiatric Association in honor of his long-time contribution to the medical and general community. Dr. Edgecomb has a private practice in Orchard Park, N. Y., and is currently an assistant clinical professor in the UB Psychiatry Department and president of the medical staff ac Bry-Lin Hospitals. 1950's Patri cia A. Meyer (M'50) • writes, "I would like t0 cell you of my good fortune. I entered the February comest of the Monthly Prescribing Reference and was the winner of a trip to London on che Concorde. Along with the trip, there is a gift of $1,500 for other expenses." 1960's Loui s Trachtman ( M'65 ) • has been elected president of Eta Chapter (Tu lane University) of the Delta Omega Society, a national public health honorary Late Winter '88 soc iety . Dr. T rachtman is comedical director of the State Office of Preventive and Public Health Services and a clinical instructor at Louisiana State University School of Medicine. He is also continuing as assistant adjunct professor ac Tulan e University School of Public Health and Tropical Medicine and has a pare-time pediatric practice. Dr. Trachtman has published numerous articles in che]ournal of the Louisiana Seate Medical Society. Raymond A. Martin (M '68 ) • writing from Houston, Texas, tells us that he is president of the Texas Neurological Society for 1987-1988. He is an instructor in neurology at the University of Texas . 1970's Ar thu r M. Seigel (M'7 0) • assistant clinical professor of neurology and pediatrics at Yale University School of Medicine, writes that in 1987 he published "The Neurological Examination" in PhysicalDiagnosis.Dr. Seigel is a member of the Board of Directors, New Haven Individual Practice Association. Richard J. Goldberg (M'74) • was appointed chief of psychiatry at Rhode Island Hospital and Women's and Infant's Hospital in Providence. Dr. Goldberg is an associate professor in the Department of Psychiatry and Human Behavior at Brown University. Richard S. Elman (M'78) • has been named medical director of the emergency department at Sisters of Charity Hospital. Dr. Elman, who assumed years of practice in general internal medicine at Harvard Community Health Plan, Dr. RockwelI is now a firsc-yearfellow in endocrinology at Beth Israel Hospital, Boston, Mass. Dr. Jederlinic is an assistant professor of medicine: critical care, pulmonary and occupational medicine, at the University of Massachusetts-Worcester. Richard S. Elman '78 his duties on September 1, is the only board certified emergency medicine physician in the Buffalo area. A magna cum laude graduate of Case Western Reserve University, Dr. Elman, after receiving his UB med ical degree, completed an internship in family practice at University of Arizona Affiliated Hospitals. Prior to joining the Sisters staff he was director of emergency services at Lockport Memorial Hospital. Paul Summ ergrad (M'78) • writes, "I have been appointed director of che inpatient psychiatric service at Massachusetts General Hospital. where I completed my psychiatric residency in 1985. I also completed a residency in internal medicine at Boston City Hospital in 1981. I am board certified in internal medicine and psychiatry." 1980's Peter Jederlin ic (M' 79) and his wife Jessica Rockwell (M'82) • inform us that they have two children: Nicole Sarah and Alex Michael. After completing cwo Robert A. Herman (M' 83) • recently completed his residency in psychiatry ac NYU School of Medicine and opened his private office for the practice of psychiatry at 35 West 90th Street, Suite lA, New York, N. Y. 10024. He has been accepted as a candidate at the Columbia University Center for Psychoanalytic Training and Research. Dr. Herman is a clinical instructor at NYU and is assistant clinical psychiatrist ac Bellevue Hospital. Patricia Flanagan (M'83) and Mark Schwager, (M'83) • of Cumberland, R.I., joyously announce their new arrival, Zachary Alexander, born July 8, 1987. Herbert B. Newton (M'84) • informs us chat he has been accepted for a fellowship in neurooncology at Memorial Sloan-Kettering Cancer Center in New YorkCity. He is planning to publish a paper on che effects of cisplatin in che treatment of malignant brain tumors. Blackford Middleton (M' 8 5) • writes, "Mose exciting news is of marriage co Ursula G. King in September. After chat I am happy co report that I marched for my first choice fellowship position which will be at Stanford Unive rsity as a fellow in General Medicine and Medical Informatics!" Buffalo Physician and Biomedical Scientist �35 The Batavia VAMC Batavia VAMC joins UB affiliate group A s if eight affiliated teaching hospitals weren't enough, the UB Medical School has added one more : the Batavia Veterans Administration Medical Center (V AMC). The addition extends UB's educational mission not only to Batavia, 30 miles east ofBuffalo, but into Rochester as well. This is because Batavia V AMC has an outpatient clinic in Rochester. Batavia V AMC is UB's first teaching hospital outside Erie County. "We are pleased at the opportunity to extend our work with the Veterans Administration to facilitate development of education and research in geriatrics and rehabilitation," Vice President and DeanJ ohn Naughton comments. "We see Batavia VAMC as accelerating the school's ability to strengthen its role as a national leader in geriatrics and rehabilitation." Specifically, the new affiliation provides an alternative environment for training students, residents, and fellows in geriat rics and rehabilitation medicine. It will also stimulate resea rch activity in these disciplines as well as in long-term care and home care. For the hospital, it will provide a more focused mission in these areas. It will also help Buffalo Physician and Biomedical Scientist the care of veterans by bringing the University in contact with the hosptial, and enabling the staff to be enriched. All hospital appointments in the future will become UB appointments. Batavia V AMC previously had an educational linkage with the University of Rocheste r. That affiliation was dropped after a review indicated chat the hospital's interests complemented UB's strengths. The reporting relationship of veterans hospitals in Batavia and Buffalo will remain independent. Neither one will have a subordinate role regarding UB and both will sit on the same dean's committees. • State proposal would limit residents' hours A proposal before State Health Commissioner David Axel r od would limit resident physicians throughout the State to working no more than 80 hours a week. The report from the Ad Hoc Adviso ry Commit tee on Emergency Services, chaired by Dr . Bertrand M. Bell, also recommends that non-emergency room residents be scheduled to work for no more than 24 hou rs in a row. They must be off for one 24-hour period a week. An ear lier proposal had recommended that residents work no more than 16 hours in a row. Residents in emergency rooms would be limited to working 12 hours in a row, which is already standard practice, said John Naugh ton, dean of the UB School of Medicine and Biomedica l Sciences and vice president for clinical affiars. An individual who has worked the maximum number of hours as a resident won't be allowed to work additional hours as a physician in another hospital. The proposal also requires that hospitals provide more ancillary care to make up for the decreased workload of house officers . Hospitals must have sufficient IV services, phlebotomy services, and messenger/transporter services to meet the new demands, the committee's report says. All of the recommendations are based on the understanding chat the Department of Health will provide the necessary funds to implement the recommendations; according to the report. • U.S. Army contract at Roswell Park T he United States Army and Roswell Park Memorial Institute have entered into a th ree-year, $488,379 contra ct co develop and test more effective, less toxic interferon inducers to prevent and treat viral diseases. The contract was announced by Dr. David Axelrod, New York State commissione r of health, and Dr. Thomas B. Tomasi, director of Roswell Park. Interferon is a natural protein that cells produce when attacked by a virus in order to "interfere" with the reproduction ~f the virus in the body. Interferon inducers are synthetic mate• rials chat are injected into the patient to scimu• lace che body to produce its own interferon. Dr. Judith A. O'Malley, director of biological resources, and Dr. Jake Bello, principal cancer research scientist in che Roswell Biophysics Department, are the co-principal investigators on the contract. • Late Winter '88 �36 Dr. Ko rn el Lud wig Terplan • 93, former chairman of the pathology department at the University of Buffalo School of Medicine, died Nov. 21 ar his new home in Sonoma, Calif. He taught two generations of medical students and was renowned for his studies of children's brain development. Dr. Terplan, a native of what then was the Austro-Hungarian Empire, had lived in Buffalo from 1930 to last June and had continued his brain research and part-time teaching until last year. A tall man described as formal and private, but noble, by one of his former students, Dr. Terplan was said to have been an inspiring teacher as well as a renowned medical researcher. His description, released in 1932, of body changes during insulin shock is said to have been the first report of its kind. His pediatric brain collection, called one of the world's best, was transferred last year to the UB School of Medicine, where it is used in reaching medical students. He lectured widely on pathology ro medical groups. Born in Aranyosmaror, Hungary, Dr. Terplan was raised in Schessburg, a German Lutheran enclave in the Transylvania part of Hungary. He studied medicine in Budapest and Prague and served during World War l as a medical officer in the Austro-Hungarian Army. He graduated in 1919 from the German University of Prague and did research there until 1930 when he was asked co come to the UB School of Medicine and Buffalo General Hospital. He began here as a research professor in pathology and in 1934 was appointed the department chairman. He is credited with developing UB's modern pathology department. After he retired from UB in 1960 and was appointed professor emeritus, Dr. Terplan continued his research under grants from the National Institutes of Health. He maintained an office in Children's Hospital until shortly before he moved to California. He belonged to the Buffalo Athletic Club, where he regularly swam until about a year ago. Survivors include his wife, lnge; three Late Winter '88 sons, Dr. Martin of Sausalito, Calif., Dr. Peter of Los Angeles and Dr. Fritz of San Francisco, and three grandchildren. (Reprinted from the BUFFALONEWS) Frank Chambers (M'40) of Plant City, Florida, died July 13, 1987. Dr. Chambers had a family practice in Plant City for 36 years. He was a member of the American Family Practitioners and a Federal Aviation Authority medical examiner. He was a veteran of WW II, having served in the Navy as a pilot. He is survived by his wife Elizabeth Bateman Chambers; two daughters, Mrs. Pamela McGinnes and Mrs. Sherrie Mueller, and a son, Dr. Step• hen F. Chambers, all of Plant City. Milton A. Palmer (M'27) of Lancaster, New York, died March 30, 1987. Dr. Palmer was a life member, incorporator, and charter member of the board of directors of the Bufflao EyeBank and Research Society. He was chairman of its executive committee for 10 years, president for 21 years, and was president emeritus . Dr. Palmer was a life member of the Eye-Bank Association of America, and in 1983 he received the Rudy Spitzer Memorial Award for Sight Preservation and Dedicated Participation in the Buffalo Eye-Bank and Research Society. He is survived by his wife, Doris Wheeler Palmer, and a son, William W. • Walter Stafford, Jr. (M'44), a UB physician who once also served as a special assistant to the acting president ofUB, died August 12, 1987, at age 67. He held several faculty titles, includ ing clinical associate professor of neurology, clinical associate in anatomy, and a former title with the Pathology Department. He was a neurologist on staff at BuffaloGeneral Hospital for more than 30 years. Dr. Stafford served with the U.S. Navy in the Philippines during World War II. An accomplished pilot, he once conducted research at Cornell into the effects of high speed flight on the human body. • Dr. John Charles Robin, 38, a second-year student at the UB School of Medicine, died September 2, 1987. A lifelong Buffalo resident, Robin had suffered leukemia for about two months. He held a degree in psychology, a master's degree in natural sciences and a doctorate in pathology, all from UB. Robin was a member of the Erie County Historic Preservation Board, the Allentown Association and the University Club. Survivors include his parents and four brothers. • Norman S. Ellerstei n (M'71), known for his work on the detection and prevention of child abuse, died August 25, 1987 in Amherst after a long illness. He held various positions at Children's Hospital and was an assistant professor of pediatrics at UB's Medical School. Born in Akron, Ohio, Dr. Ellerstein was raised in Buffalo. He earned his undergraduate and medical degrees at UB. Dr. Ellerscein was a full-time staff member and held several administrative positions at Children's Hospital. He was director of the Child Abuse and Neglect Program, run jointly by UB and the hospital, and was director of the hospita l's Child Protection Clinic and of the pediatric house staff program. A fellow of che American Academy of Pediatrics, Dr. Ellerstein wrote many articles and books on pediatric medicine and child abuse and neglect. He was an editorial consultant to many professional and medical journals. Surviving are his wife, a son, and his mother. • A lfre d Mi tchell (M'38) • died on June 20, 1987, in Elmira, New York . Or. Mitchell practiced internal medicine in Elmira, from 1940 co 1987. He was a Diplomat of the Board of Internal Medicine. Elme r G r ob e n (M'4 1) • died Septembe r 5, 1987, after an extended illness. He practiced medicine in Columbus Junction from 194 7 co 1970 when he moved to Iowa City where he practiced until 1983. Or. Groben was an associate professor in family practice at the University of Lowa College of Medicine. He is survived by his wife Martha and two sons and cwo daughters. Robert Wa rd ( M'47) • died on November 25, 1987, in Miami, Florida. Buffalo Physicianand Biomedical Scientist �SPRING CLINICAL DAY AND REUNION WEEKEND May 7, 1988 Buffalo Marri ott 8: 15 , Morning Scientific Session 12:30: CONTROVERS IES AND TREATMENT OF AIDS, BREAST CANCER AND CORONARY ARTERY DISEASE 1 :00: Stockton Kimball Memorial Luncheon and Lecture Honored Leaurer ROBERT P. GALE, M.D. '70 Associate Professor of Medicine, UCLA Medical School Dr. Roberr Gale --~--------------------------------------------------------------NO POSTAGE STAMP NECESSARY IF MAILED IN THE UNITEDSTATES BUSINESS REPLYMAIL FIRSTCLASS PERMITNO 2210 BUFFALO. N.Y. POSTAGEWILL BE PAIDBY ADDRESSEE 146 C.F.S. Addit ion State University of New York at Buffalo Buffalo, New York 14214-9980 I,,,II,I111,, I,I,,,II,I,,II,I,,I,I,,I,,I,II11111 I,II �BUFFAlD Non-Profit Org. U.S. Postage PAID Buffalo, N .Y. 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Title A name given to the resource Buffalo Physician Magazine Description An account of the resource <em>The Buffalo Physician</em> (formerly the <em>Buffalo Medical Review</em>) was published quarterly by the State University at New York at Buffalo School of Medicine and Biomedical Sciences and the Office of Publications. The magazine informed its alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in our region. Identifier An unambiguous reference to the resource within a given context LIB-HSL008 Subject The topic of the resource State University of New York at Buffalo. School of Medicine--Periodicals Medical colleges--New York (State)--Buffalo--Periodicals Publisher An entity responsible for making the resource available State University of New York at Buffalo. School of Medicine Robert L. 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For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Beer shampoo poster Description An account of the resource Residents of the Czech Republic consume more beer per capita than any other country in the world. Beer finds its way into other consumer products as well. Creator An entity primarily responsible for making the resource Welch, Claude Emerson Publisher An entity responsible for making the resource available State University of New York at Buffalo Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Format The file format, physical medium, or dimensions of the resource image/jpeg Language A language of the resource en Type The nature or genre of the resource Image Identifier An unambiguous reference to the resource within a given context psc001_psc3167 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Czech Prague (Czech Republic) Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/13308bd09afd46241f9cbba009bd3737.JPG 939593059fb933fc971721eb34c4ec08 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3182 Title A name given to the resource Ladies' room graphic sign Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Prepared in the spirit of Hundertwasser, this sign conveys its message quickly and clearly. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Wittenberg Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/2c97a65e1b239d47eb456388fad4555b.JPG 405b1175636c866b7f2d5131df4620e7 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3181 Title A name given to the resource English-language poster touting Berlin as city of the future Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Future office and commercial sites can be found in Berlin, the German text indicates. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Berlin (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Language A language of the resource en Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/fdd34257908c3aff6d99585bc9870174.JPG 08e99f16b5ade3ad82f6b7397f905206 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3180 Title A name given to the resource Stylized theater sign, Magdeburg, Germany Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Designed in the style of Hundertwasser, this sign directs patrons to the "Green Citadel" Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Magdeburg (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Language A language of the resource de Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/2611f2fc6428ad3df8aac326eed5237b.JPG 4234dfd94e45ee5b48771df963f80d6e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3179 Title A name given to the resource Old or new Town Hall? Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Wittenberg has both maintained its former town hall and built a new one, as the sign indicates. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Wittenberg (Germany : Landkreis) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Language A language of the resource de Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/f5235bb7394053f4c5fa139348036d30.JPG 7c72f0b29add802f9c7a8ef8840970c4 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3178 Title A name given to the resource Ads for knight's festival near Berlin Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Drawing on romanticism for the Middle Ages, these posters advertise a 'knight's festival,' to be held at a Berlin-area estate. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Berlin (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Language A language of the resource de Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/b9346049fc802407de3096818844a090.JPG b4f24b39888f8bd9e65005ac207a52a6 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3177 Title A name given to the resource Display ad for German child-oriented "Jump City" Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource The poster advertises trampolines and illustrates other child-oriented activities at a special club. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Berlin (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Language A language of the resource de Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/7d996102c546de4f01463c3458b31839.JPG a214c4e1a108e423fda6aa245dae825a Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3176 Title A name given to the resource "To the musketeer" sign Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource The Königstein fortress, nearly 800 feet above the Elbe, no longer serves a defensive purpose. It has become a significant tourist attraction, complete with restaurants with a martial theme. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Koenigstein im Taunus (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Language A language of the resource de Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/08981f2bb7484f16059c3070967192fe.JPG 4a99dba65550db2168ac2de1636ee452 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3175 Title A name given to the resource Men's room graphic designed by Hundertwasser Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource 20th-century Austrian architect Friedensreich Regentag Dunkelbunt Hundertwasser is known for his intriguing, highly colorful designs. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Magdeburg (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/2fde230a2451bc627498889848f2bd0a.JPG d0b6a88462d129e025836653a1020b67 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3174 Title A name given to the resource Hundertwasser-designed entries to men's and ladies' restrooms Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource 20th-century Austrian architect Friedensreich Regentag Dunkelbunt Hundertwasser is known for his bright colors and dislike of straight lines. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Magdeburg (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/0360ac8bc03d9af3973bf26df541809e.JPG 5f4dd29348da44c9926d0a2d9a87b198 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3173 Title A name given to the resource Poster advertising Christian art highlights, Wittenberg, Germany Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource "Because through love, man becomes better," the poster proclaims. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German/Christian Wittenberg (Germany : Landkreis) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Language A language of the resource de Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/d09a06140e6276d77c426d3d6b3bc9bd.JPG f22d04adc76001275264902e03a2e89f Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3172 Title A name given to the resource Multi-advertisement kiosk Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Advertisements on a large pole Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Magdeburg (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Language A language of the resource de Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/9fcf9ca2bb5fc2053e277f8bbff42472.JPG 6b648a46d6961588ad0b22eb2861bd07 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3171 Title A name given to the resource Poster advertising French film festival in Saxony-Anhalt cities Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Films from France carry significant cultural cachet throughout Europe. Three German cities in the state of Saxony-Anhalt showed several of these movies in April 2018. The poster reads: "Französische Filmwoche Sachsen-Anhalt Dessau Halle Magdeburg," or, "French Film Week Saxony-Anhalt Dessau Halle Magdeburg" Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Magdeburg (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Language A language of the resource de Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/efccf2f9bebfe8db1df8d37fe8ab4a3d.JPG a52fc4f63a87f30fedc04119c44fad9a Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3170 Title A name given to the resource Special water supply for dogs, atop mountain Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource The Königstein fortress lies nearly 800 feet above the Elbe, dominating a major curve. The fortress is one of Saxony's major tourist attractions. Visitors sometimes hike to the top with their dogs, who can risk dehydration. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Koenigstein im Taunus (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/a938434c0ea1f390245a24ae75078edb.JPG 75aca3a97b33285afab9770cab195ace Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3169 Title A name given to the resource Medieval coats of arms, Prague armory museum Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Numerous small political entities existed within the Holy Roman Empire, including several in the current Czech Republic. These are typical coats of arms from that period. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Czech Prague (Czech Republic) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/a110b591438f71d01961bf8d3bbf3dd6.JPG 6259669517221b779756d5d6b248d8e3 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3168 Title A name given to the resource 1949 political parties campaign posters Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Dating from 1949, when West Germany held its first election, both the poster for the SPD [the Socialist Party of Germany] and the CDU [Christian Democratic Union] emphasize, in words and by maps, that post-WW2 occupation must end and that the country should be reunified. The posters are displayed inside the transparent dome of the Reichstag, Germany's parliament. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Berlin (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Language A language of the resource de Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/99d5fd30d44192f7e640b50b602734cd.JPG a5c39fe840a8b06e480ffe12fec5be30 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3166 Title A name given to the resource Sexually explicit ad for Magdeburg strip club. Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource "Flim-flam in a shitstorm," the ad promises. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Magdeburg (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Language A language of the resource de Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/7d761624d349ff63b3732a6b529c7977.JPG 5991e6280f23dae0b0b795a16a20b813 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3165 Title A name given to the resource Sign for "The Commanders" restaurant Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Visitors to Königstein Fortress can dine on its grounds, which stands over 750 feet above the Elbe River. More than 50 buildings lie within the Fortress grounds. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant German Koenigstein im Taunus (Germany) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Language A language of the resource de Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/0530f70818ff918942fe013f66c4cc91.JPG e9305ee2de7dc17733d8e45f3e25d708 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3164 Title A name given to the resource Whimsical statue of Franz Kafka Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource This statue captures the disturbing nature of Kafka's writing, especially his quirky combinations of realism and fantasy Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Czech Prague (Czech Republic) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/bfa24d9d8a928ee346f9e85fb3d99f08.JPG d0aebc632100e50e3c0dbc040e854f22 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3163 Title A name given to the resource Art nouveau wood panels, Muncipal Hall Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Prague's Municipal Hall is an excellent example of art nouveau, which flourished late 19th-early 20th c. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Czech Prague (Czech Republic) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/47f10a5822efa477f661341d6189ba62.JPG f21156960eca3713a43495ccdf65cd1b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3162 Title A name given to the resource Vineyard near Prague Castle Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Prague's relatively mild climate permits cultivation of grapes. Few parts of the Czech Republic outside sections of Bohemia are equally suitable. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Czech Prague (Czech Republic) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/446df97096a1ee5d6d936d0be632127f.JPG c667aadc7d35ebd3b485a0ba9503a511 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3161 Title A name given to the resource Vineyard near Prague Castle Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Prague's relatively mild climate permits cultivation of grapes. Few parts of the Czech Republic outside sections of Bohemia are equally suitable. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Czech Prague (Czech Republic) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/380d36c3863006ced83a258a715a53f8.JPG dfe25499a7ce872176497cdfe297dfbc Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3160 Title A name given to the resource View from Prague Castle toward cathedral tower Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource The Castle and various public buildings dominate the heights of Prague's Old City. This shows a church tower in ithe distance. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Czech Prague (Czech Republic) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/2c379cd9b73728b9d1576a21fa000e3f.JPG 1d0b001bb147d57ec3e1525c59ddf848 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3159 Title A name given to the resource Typical 18th c. kitchen implements, old street in Prague Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource Household equipment from earlier centuries, Prague Old City Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Czech Prague (Czech Republic) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). https://digital.lib.buffalo.edu/files/original/b20738f120e48a540f91351163e6f5e3.JPG 1404faf5a7bdf0cb22149eb4e87b12bf Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Welch-Ludwig Collection Description An account of the resource The images in this collection come from 35 mm. Kodachrome slides or .jpg pictures taken by Claude Welch, SUNY Distinguished Professor in the Department of Political Science. He started his teaching career in 1964, directly after completing his doctoral work at Oxford. The images reflect a wide span of his interests and continents, with particular strength in sub-Saharan Africa, Western Europe, India and China. The addition of metadata to this collection is an ongoing project. Identifier An unambiguous reference to the resource within a given context PC001 Still Image A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context psc001_psc3158 Title A name given to the resource St. Vitus towers from side Date A point or period of time associated with an event in the lifecycle of the resource 2018-04 Description An account of the resource The Cathedral of St. Vitus is an excellent example of Gothic style, with its lofty pointed spires (each nearly 400' high) and fine stained glass Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Czech Prague (Czech Republic) Creator An entity primarily responsible for making the resource Welch, Claude Emerson Type The nature or genre of the resource Image Format The file format, physical medium, or dimensions of the resource image/jpeg Is Part Of A related resource in which the described resource is physically or logically included. Welch-Ludwig Collection PSC001 Publisher An entity responsible for making the resource available State University of New York at Buffalo Rights Information about rights held in and over the resource <a href="http://rightsstatements.org/vocab/InC-EDU/1.0/">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>. This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s).