AUTUMN 2009 CJfLy^-^^eya^^Z^ ^ Science, Seance, and Skullduggery 1 ALUMNI BULLETIN y , wpp^ •^^tjStP -«, IC ., 4- B^^^^l w .^E - If c > °^*^ t ^Sk For decades the owners of this daguerreotype hod assumed that it showed a whaler posing with his harpoon. Earlier this year, though, the owners contacted the Warren Anatomical Museum to help prove its true subject: Phineas Gage holding the tamping iron that had so famously rocketed through his skull in 1848. This photograph is one of the few extant images of the medical celebrity. AUTUMN 2009 • VOLUME 82, NUMBER 3 v^lA^LLjUJ- Vj I 1 JL C^ DEPARTMENTS Letters 3 Pulse 5 HMS graduates head to Washington while faculty members receive top honors I Editorial 10 I How worried should we be about health g care reform efforts? hy Timothy G. Ferris o I President's Report 12 < by Steven E. Weinberger I Bookshelf 13 o i Thinking Zebra 14 § Organ failures leave a young man perplexed 1 and in pain, by Ann Marie Menting I Benchmarks 16 5 Ancient proteins, a role for leptin in S diabetes, human heart stem cells, and 5 clinical and molecular discoveries z § Class Notes 52 o ^ In Memoriam 57 § Daniel C. Tosteson I Obituaries 58 I Endnotes ...64 g Athletes and the journalists who cover 2 their stories make valuable assists to - doctors, by Sachin H.Jain SPECIAL REPORT: SKELETONS IN THE CLOSET 20 22 28 Skeleton in the Closet The schools first dean demonstrated both a dying and undying devotion to the education of medical students. IVlldniQrlt rlUnder To acquire the human cadavers needed for their dissections, early doctors hoped for the executed but depended on the resurrected. ANN MARIE MENTING I he Illusionist Harvard, Houdini, and high society tangled with a surgeon's wife, who nearly fooled them all. fc^jEssicA cerretani o4 MeOd Loses Phlneas Gage wasn't the only nineteenth- century worker with a blast to the brain — and a connection to Harvard Medical School. Jj^william ira bennett 36 jCtlOOl tor jCOndOl corpses plucked from graves, murder conducted by mail, chivalry gone awry — ^what 227'year'old institution doesn't have a few skeletons clattering in its closets? Test your wits on these shocking stories from Harvard Medical School's history, hy paula byron FEATURES ■'^ The Flirtatious Feline and Other Medical Mysteries what caused a boy's eye to dilate suddenly? A kindergartner to start bumping into furniture? And a banker's lung cancer to disappear? An emergency physician turns to the case files to depict doctors as detectives. b}' JONATHAN A. EDLOW 46 Catalyst tor Change a game-changing Harvard program sparks collaborations among disparate researchers. Ij^jessica cerretani Co\er ^h.oto'Shxitratxon of]ohn Collins Warren: Marc Yankus Harv^^rrl Medirni A L U M N U L L E T I N In This Issue UKDER, MAYHEM, AND MORTUARY — EACH HGURED LARGE IN THE NINETEENTH- century edition of Harvard Medical School. The murder of physician George Parkman on School premises in 1849 filled the newspapers of the time, as did the mayhem of medical students collecting anatomical speci- mens from freshly dug graves. Yet a more positive focus on mortuary balanced these morbid facts: the tradition of the dead teaching the living through the Warren Anatomical Museum. Most of medicine — and much of this institution — has been transformed since those early days. Today's students, for example, can learn anatomy without having to pilfer corpses from cemeteries. And today's patients need not endure the bloodletting practices and questionable tonics of their physicians; instead they can benefit from a dizzying array of medical advances, many the legacy of knowledge gained by generations of avid anatomists. Some HMS traditions do endure, certainly; one of those has been the Harvard Medical Alumni Bulletin, with its rich, 82-year history. That history is taking on a new chapter, and this issue marks the beginning of several transitions for the magazine. As Steven Weinberger '73 mentions in his President's Report, the next issue will bear noticeable alterations, including a redesign, color through- out, and even a new title. Harvard Medicine. Those changes are exciting. One change we regret to report, though, is the stepping down in June of William Bennett '68 after five three-year terms as editor-in-chief. When Daniel Federman '53, then director of alunmi relations, asked him to take on the role fifteen years ago. Bill, like other HMS graduates who cannot bear to deny a request from Dan, accepted. BiU was perfect for the role. He had inter- rupted his residency to launch a medical writing and editing career. In addition to coauthoring a book on the physiological factors controlling weight, he wrote numerous articles on health, taught science writing, and served as editor for sci- ence and medicine at Harvard University Press and as editor of the Harvard Health Letter. By the time he returned to clinical medicine — undertaking a residency in psychiatry in the 1990s — he possessed a wealth of hfe experiences to inform his work as a doctor. He remains a sought-after psychiatrist. Bill has an extraordinary gift for leavening science with Uterature to bring fresh meaning to medicine. His introductory columns and his occasional arti- cles in this magazine — including one in this issue — provide evidence of his lyrically deft touch. And his intelligent stewardship of the Bulletin helped make it a magazine that truly celebrates the School and its graduates; as our ambas- sador, he served with distinction. We are indeed in his debt. />Lc<n,cl- C - f:^riuJ>0uuJ^ ACTING EDITOR-IN-CHIEF George E. Thibault '69 EDITOR Paula Brewer Byron ASSOCIATE EDITOR Ann Marie Mencing ASSISTANT EDITOR Jessica Cerretani EDITORIAL INTERNS Sarah Daniels Elizabech Purest Ariana Hakim BOOK REVIEW EDITOR Elissa Ely '88 EDITORIAL BOARD Judy Ann Bigby '78 Rafael Campo '92 Elissa Ely '88 Daniel D. Federman '53 Timothy G. Ferris '92 Ahce Flaherty '94 Atul Gawande '94 Robert M. Goldwyn '56 Sachin H. Jain '06 Perri Klass '86 Victoria McEvoy '75 James J. O'Connell '82 Nancy E. Oriol '79 Anthony S. Patton '58 Mitchell T. Rabkin '55 Jason Sanders '08 Eleanor Shore '55 DESIGN DIRECTOR Laura McFadden ASSOCIATION OFFICERS Steven E. Weinberger '73, president Gilbert S. Omerm '65, president-elect 1 Phyllis I. Gardner '76, president-elect 2 Kenneth Offit '81, vice president Neil R. Powe '80, secretary Deborah C. German '76, treasurer COUNCILLORS H. Thomas Aretz '76 Judy Ann Bigby '78 Rosa M. Crum '85 Laurie Ghmcher '76 Elizabeth Petri Henske '85 Katherine Janeway '00 Jim Yong Kim '86 Triste N. Lieteau '98 EQeen Reynolds '90 Michael Rosenblatt '73 David H. Sachs '68 Rahul Sakhuja '03 CHAIR OF ALUMNI RELATIONS A. W. Karchmer '64 ^H^r HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 REPRESENTATIVE TO THE HARVARD ALUMNI ASSOCIATION Joseph K. Hurd, Jr. '64 The Harvard Medical Alumni Bulletin is published three times a year at 25 Shattuck Street, Boston, MA 02115 c Harvard Medical Alumni Association Phone: 617-432-7878 • Fax: 617-432-0089 Email: email@example.com Third class postage paid at Boston, Massachusetts. Postmaster, send form 3579 to 25 Shattuck Street, Boston, MA 02115 ISSN 0191-7757 • Printed in the U.S.A. SECOND OPINIONS FROM OUR READERS | T.ETTEKS^ films, these HaiA'ard doccors al\va)'s have an audience. H ^|^| H^l H ^H H^P^K ^^^ A short man standing a few feet away fixed me in his gaze. I nodded. He nodded. Then he stepped up to me and barked, "You a producer?" When I rephed that I wasn't, he abrupt- ly turned and raced away, in search of the real thing. Walk of Fame Your Hollywood issue recalls my own experience with "the industry." No, I'm not an actor, nor am I a consultant to the dream factory. From 1976 to 1991 1 was chief of radiology at Hollywood Presby- terian Medical Center, one of the first hospitals in Los Angeles and for a time the hospital to the stars. Many old-time actors and movie people maintained a connection to the center. I'll resist the temptation to drop names, but very nice people, all of them. One of my patients, an actor who had played a key role in ThcManchurian Candi- date, gave my wife, Morelle, and me a membership into The Academy of Sci- ence Fiction, Fantasy & Horror Films — a lovely gesture. And so we attended the Saturn Awards, held at the Screen Actors Guild, then on Sunset Boulevard. It was a grand, star-studded event — heady company for a mere physician. At one point I was standing in the lobby among faces familiar from movies and television. A short man NORMAN D. LEVINE '56 Standing a few feet away fixed me in his gaze. I nodded. He nodded. Then he Stepped up to me and barked, "You a producer?" When I rephed that I wasn't, he abruptly turned and raced away, in search of the real thing. Any illusions I may have had of status in that crowd thudded to the floor. I thought about calling after him, "But I'm a doctor!" to recover some sense of importance. But that would have only compounded the deflation. Then another Hollywood moment changed my view You may remember a TV series called Trapper John, MD, a spin- off of M*A*S*H. For several years our parking lot and office building served as the shooting location for the series one day a week. The crew would arrive very early and often shoot for hours. The activ- ity provided us onlookers with much entertainment, especially the sight of the many attractive young women carry- ing chpboards and trying to look busy. Most of the action, in fact, consisted of people running around doing tasks that no one seemed able to explain. One evening I watched a scene being shot that consisted of Trapper John emerging from our generic -looking office building and walking about 20 feet to his funky, graffiti- covered van. The director had the poor guy repeat what looked to me like the identical walk at least a dozen times. The lesson I learned from Trapper John, MD is this: Pretending to be a doctor is boring. Actually being one is anything but. NORMAN D. LEVINE '56 BRENTWOOD, CALIFORNIA Quality Time Congratulations on the Spring 2009 issue, a classy and interesting edition of the Bulletin. I was intrigued by the comments of some of your readers in the Letters to the Editor section on the new realities in the practice of medicine. While I agree with the need for more general practitioners, we are not likely to see a significant change in the numbers until reimbursements from government agencies and insurance companies rec- ognize the value of these doctors' time as equally as they recognize the value of procedures. The new reality that comes under the heading of "quality of care" will affect all doctors, particularly surgeons. We have already seen a parade of health- care-quality agencies, quality improve- ment organizations, and, most recently, the P4P, or pay for performance, move- ment. While they all sound good and may prove beneficial, they're merely additional layers of reporting and con- straint on doctors' judgment and deci- sion-making. They also offer further mechanisms for reducing doctors' incomes, which are already threatened. Before my retirement, I always worked long and hard to give the best care and obtain the best results, but sometimes failure is inevitable. ARMAND LEFEMINE '52 CENTERVILLE, MASSACHUSETTS AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN TETTERS I SECOND OPINIONS FROM OUR READERS THE BEAUTY OF THE BEAST The article "Design For Life" in your Spring 2009 issue cited the promise some endangered species carry in offering potential clues to curing human diseases. By inference many other "helpers" may one day benefit people. The author, Eric Chivian '68, makes the case for preventing these animals' extinction by appealing to our narcissism: How can humans benefit from these creatures? To accept his appeal means turning our attention to the future. Alas, there's the rub: "Me, now" is more than a slogan. It describes a mindset, one that must be changed. The language of "later" is neither widely understood nor widely valued. Nor, to my knowledge, is it taught. Which leads me to inquire about medical ethics, present and future. Is this subject discussed in the context of a population that's going on 7 billion? Is there any obligation to keep humans alive to senility and beyond? How do assisted reproductive technologies that lead to multiple births factor in? Where does ethical thought take us when illnesses drain family finances and society's resources? Do, please, consider shining light on these issues by presenting an arti- cle on the status and reach of medical ethics. LENORE C. FRAZIER (WIDOW OF HOWARD S. FRAZIER '53) WINCHESTER, MASSACHUSETTS Affair to Remember The letters in recent issues from Massad Joseph '77 and Mark Klausner 11, two school chums from HMS, jogged my memory of the Great Grade Boycott of 1973. Despite Mark's having little rec- ollection of the events, there very much was a grade boycott. I confess I was one of the former radicals who orga- nized it. (Don't forget that many of us were products of the sixties and the anti-war movement.) My recollections of the events jibe with Massad's memories. I also recall the class meeting in which Dean Robert Ebert informed us that we could be replaced. One classmate stood up and retorted that we were a "national resource" and not easily replaced. My proof of the boycott is the old three-ring binder labeled "Boycott" that I saved from my medical school days; the code number 137 is written on the inside cover. Those of us who took part in the boycott pledged to sign our tests using only our code numbers, and the keeper of the codes would divulge only the identities of those who had failed the test. All others agreed to accept a "pass" grade, regardless of how they had performed. Although it seemed Kke most of us talked about joining in, or at least that's what we said to each other in pubhc, our class was politically diverse and perhaps not everyone participated. That might explain why some people earned a real grade rather than pass or fail — if the School knew their identities. I dorit think the impetus for the boy- cott lasted long, and I think the honors/ pass/fail system was implemented for us the following year. But I have less recol- lection of the second-year experience, aside from our Second Year Show, "The Effects of a Six-Day Week on Ebert Coli." (I did keep a script and playbills from our Fourth Year Show — "Ship of Tools" — which was a sequel to the sec- ond-year production.) JAY H. HERMAN '77 GLENSIDE, PENNSYLVANIA HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 MAKING THE ROUNDS AT HMS t Dr. Smith Goes to Washington ITH HEALTH CARE REFORM L%^nfl topping the must-do agenda k^^H of the nation's leader, the Obama administration has enhsted several HMS alumni to help transform the way this country dehvers medical care. Here's a roster of some of those graduates. David Blumenthal 74 National Coordinator for Health Infor- mation Technology, U.S. Department of Health and Human Services. Blumenthal, who has taken a sabbatical from his HMS position as the Samuel O. Thier Professor of Medicine in the Institute for Health Care Policy at Massachusetts General Hospital, was the senior health advisor to the Obama for America cam- paign in 2008. Ezekiel Emanuel '85 Special Advisor for Health Policy to the Director of the White House Office of Management and Budget. To serve in this new position, Emanuel has taken an extended leave from his role as head of the Department of Bioethics at the Clinical Center of the National Insti- tutes of Health. A widely respected researcher and scholar on bioethics, Emanuel has served on the National Bioethics Advisory Commission. He was a member of President Clinton's Health Care Task Force. Margaret Hamburg '83 Commissioner of the U.S. Food and Drug Administration. Hamburg assumed her new position after nearly nine years of service at the Nuclear Threat Initia- tive, a foundation dedicated to reducing the threat that nuclear, chemical, and biological weapons pose to public safe- ty. Her previous positions include assis- tant secretary for policy and evaluation in the U.S. Department of Health and Human Services and New York City's health commissioner. Sachinjain '06 Special Assistant to the National Coor- dinator for Health Information Technol- ogy, U.S. Department of Health and Human Services. A medical resident at Brigham and Women's Hospital, Jain is a member of the faculty of the Institute for Strategy and Competitiveness of Harvard Business School. As a medical student, Jain helped found Improve- HealthCare, an international organiza- tion that aims to educate physicians about health care systems. Joshua Sharfstein '96 Principal Deputy Commissioner of the U.S. Food and Drug Administration. Sharfstein had most recently served as health commissioner for the City of Bal- timore in Maryland. While there, he won recognition for innovative pro- grams that sought to expand literacy efforts in pediatric primary care, increase influenza vaccination of health care workers, and enhance access to treatments for opioid addiction. Yvette Roubideaux '89 Director of the Indian Health Service in the U.S. Department of Health and Human Services. Roubideaux, a former assistant professor of family and com- munity medicine at the University of Arizona College of Medicine, has con- ducted extensive research on American Indian health policy and health issues, especially diabetes. While in Arizona, she also co-directed the Special Dia- betes Program for Indians Demonstra- tion Projects, an effort that involved dozens of American Indian and Alaska Native communities. ■ AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN i^.r PTIT.SK I MAKING THE ROUNDS AT HMS Second Sight B LOYD M. AIELLO REMEMBERS A time in the 1960s when half his patients went bhnd every year. Mostly young adults, they suffered from a complication of diabetes in which weak, leaky blood vessels proliferate in the retina, leading to hemorrhage and vision loss. Today the vast majority of patients with this disease — diabetic retinopa- thy — retain their vision, thanks to a treat- ment Aiello, an ophthalmologist, pio- neered with his father-in-law, the late William Beetham, in 1967. AieUo received the Warren Alpert Foundation Prize for that work during a ceremony at the Joslin Diabetes Center in September. Retinopathy develops when blood flow slows in the retina, compromising vessel walls. As a result, blood leaks and pools in the tissue instead of reaching its destination. Deprived of blood flow and nutrients, other regions of the retina release factors that stimulate the growth of new vessels, which also are weak and leaky, perpetuating the problem. By studying thousands of retinas, Aiello and Beetham observed something curious; Patients with extensive retinal scarring from other diseases did not go blind as quickly as their peers. This finding provided the first major clue about how to stop this vicious cycle. "We decided to mimic the scarring observed in these patients to halt the proliferation of blood vessels in other persons with diabetes without signifi- cantly compromising the visual field," says Aiello, now a clinical professor of ophthalmology at Joshn. In 1967, the team took advantage of new laser technology to create scars in the retinas of young women and men without destroying the entire eye. Work- ing in a small room at Joslin that doubled as a broom closet, the researchers devel- oped a way to focus a parallel beam of light on each patient's retina, creating several hundred lesions on tiny regions of tissue. The patients remained awake for this laser surgery. After presenting preliminary results at a major diabetes conference, Aiello helped organize the Diabetic Retinopathy Study, a multicenter chnical trial for the National Eye Institute, in the late 1960s and 1970s, to rigorously test his technique, knov.Ti as scatter or panretinal photocoagulation. The success of the project spawned addi- tional clinical trials, which allowed Aiello and others to refine the method — and set a new standard for diabetes care. According to the World Health Orga- nization, diabetes is projected to affect 366 miUion people by 2030. As incidence rises across the globe, Aiello is working to ensure that patients everywhere have access to the latest diagnostic tools and treatments in the future. He collaborated with Beetham Eye Institute colleague Sven-Erik Bursell to start the Joslin Vision Network, which brings advanced medical care to people with diabetes — including those in remote regions — through digital imaging. The images are sent to Joslin or Joslin- certified reading centers for analysis and, based on the resulting report, health care providers at the remote sites dispense advice and treatment to their patients. "Our only hope for handling the impending diabetes pandemic is telemed- icine — remote-site imaging and dehvery of treatment to patients wherever they happen to Uve," says AieUo. "We're devel- oping and automating this model." ■ Alyssa Kndler is a senior multimedia specialist at Harvard Medical School. HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 Eyes on the Prize STRING OF FINDINGS ABOUT some of nature's tiniest struc- tures has resulted in what many consider the scientific community's biggest honor. In October, Jack Szostak, HMS professor of genetics at Massachusetts General Hospital, won the 2009 Nobel Prize in Physiology or Medicine. Szostak, who shares the prize with Elizabeth Blackburn of the Univer- sity of California, San Francisco and Carol Greider of Johns Hopkins Univer- sity School of Medicine, was recognized for the discovery of how chromosomes are protected by telomeres and the enzyme telomerase. Some 70 years ago, scientists hypothe- sized that the ends of chromosomes had protective caps that prevented them from fusing together inappropriately, yet the theory had never been tested. By 1980 Blackburn had discovered that these caps, called telomeres, were made up of DNA sequences in a single-cell proto- zoan but didn't know whether this fea- ture occurred in other organisms. After meeting at a research conference that year, she and Szostak teamed up to deter- mine whether the same sequence was present in yeast cells. It was. Further research by the investigators and Greider, then a graduate student, showed that cells must be able to replen- ish telomeres to function properly. Although they didn't know it then, such END ZONES: Jack Szostak, >vho >von the Nobel Prize for the discovery of ho^f/ telomeres and the enzyme telomerase protect chromosomes, has since turned his research attention to the molecular origins of life. findings have since played an important role in helping researchers understand the processes behind cancer and aging. Szostak, who is also an investigator at the Howard Hughes Medical Institute, has since turned his research focus to the mol- ecular origins of life. Szostak's award brings the number of Nobel prizes won by HMS faculty members to 13. His work, says HMS Dean Jeffrey Flier, "showcases the fun- damental importance of basic science and how it can open up an entire field of investigation." ■ Leading Lights Paul Farmer '90 (near left), the Maude and Lillian Presley Professor of Social Medicine at HMS, v^as recently named the new chair of the Department of Global Health and Social Medicine. He succeeds Jim Yong Kim '86, >vho became president of Dartmouth College in July. "As an international leader in global health and social medicine and an outstanding researcher, teacher, and clinician," says HMS Dean Jeffrey Flier, "Paul is uniquely suited to lead this department." AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN ptit.se MAKING THE ROUNDS AT HMS Story Core writing. OME AUTHORS HAVE BEEN composing stories since they could hold a pencil, so natural and insistent is their gift for Others — the literary late bloomers — may take decades to uncover their talent. For Jerome Groopman, that moment came in his early 40s v/hen he found himself, inexphcably, on the brink of a midlife crisis. "I was desperately in love with my wife. And I had no interest in sports cars," said Groopman, the Dtna and Raphael Recanati Professor of Medicine at HMS and Beth Israel Deaconess Medical Cen- ter, speaking in June at the Alumni Day Symposium, "Doctors as Writers." Rejecting the usual alternatives, Groop- There is a special thrill in hearing the story behind a writer's stories. The nearly 200 attendees at the symposium, held beneath an enormous tent on the Quad lawn, were thoroughly engaged as they heard Groopman and three other well-known physician-authors — Perri Klass '86, Elissa Ely '88, and Stephen Bergman '73 (also known as Samuel Shem) — recount how they got their start as writers. What was striking, as George Thibault '69, symposium orga- nizer and president and CEO of the Josiah Macy, Jr. Foundation, noted in his introduction, was their variety. "I got my start as a writer growing up in a household with a mother who thought everyone should be a writer," said man decided to write. Sitting at his kitchen table in the dusky hours before dawn, he banged out three stories that, after much reworking, would appear in his first book. The Measure of Our Days. One of them, a tale about a wealthy cancer- ridden patient, would so impress the then editor of The New Yorker that she offered him a regular gig as staff writer. "Tina Brown said my story was hot," Groopman said. Klass, who has two siblings, both writers. In fact, aU three would turn their mother's love of stories to their advantage. "You could always get out of waUdng the dog," Klass explained, "by saying, 'Mom, I just had an idea I need to write down.' " Ely was also deeply influenced by her family and in particular her father, who died when he was 35 and she was 5. "He disappeared into Memorial Sloan-Ketter- ing and never came out," Ely said, adding that this loss, and her quest to understand it, haunted her early stories and still drives her writing. "After 46 years, I'm still writing about my father," said Ely, a psy- chiatrist and a regular contributor to The Boston Globe and National Pubhc Radio. It was later in life, during a Rhodes scholarship at Oxford that had him working in a laboratory studying cock- roaches, that Bergman decided he wanted to be a writer. When he told the labora- tory director of his decision, the man, with characteristic British aplomb, responded, "Well then, have a sherry." Despite the writers' diverse begin- nings, common themes ran through the tales. Several of the speakers described in agonizing and amusing detail their early disappointments. Klass, now a professor of journahsm and medicine at New York University, received multiple rejection notes before pubHshing her first article. Groopman described making the rounds of New York editors to sell his first book. One — an older woman with a bouffant and red nails who looked, according to Groopman, as if she had just flown in from a canasta game in West Palm Beach — said, "Doctor? I'm sure you're a very good doctor." She then went on to teU hun what was wrong with his stories, namely that their characters did not demonstrate the proper number of epiphanies. Ironically, the story that so impressed The 'New Yorker editor was a tale about an arrogant cancer patient who has a remission only to realize how empty his life is. "It really was an epiphany that didn't end happily," Groopman said. Doctors hear and hve out stories like that every day, which is why Klass said she prefers writing fiction to nonfiction. "When you write fiction you can choose the ending," she said. "The hardest thing about medicine is that you cannot always choose the ending." ■ Misia Landau was a science writer for Focus from 1994 to 2009. HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 On the Road HEN UNINSURED AND UNDERINSURED PATIENTS CAN'T MAKE IT TO A k M vM physician's office for basic preventive counseling and screening k^^^l tests, a group of health care pro\dders hits the road — and brings those services to them. That's the premise of Family Van, a mobile health clinic that has been providing health care to medically disenfranchised Bostonians since 1992. Now a study by Nancy Oriol '79 and other HMS researchers shows that the Family Van doesn't just have the potential to save hves — it saves money, too. "People talk about the value of preventive measures all the time, but no one has ever really captured the important contribution of nontraditional prevention- based programs like the Family Van," says Oriol, who is the program's cofounder, the HMS dean for students, and an HMS associate professor of anesthesia at Beth Israel Deaconess Medical Center. "This value is underscored by the unique role that mobile health plays in reducing disparities in health outcomes, increasing access to care, and enhancing our ability to reach out to particularly vulnerable, at-risk communities." The Family Van provides screening, testing, and education for nutrition, weight management, diabetes, heart disease, pregnancy, sexually transmitted diseases, and other health concerns. To better quantify its cost- effectiveness, Oriol and her team used published data from the National Commission on Prevention Priorities, which assigns values to a broad array of preventive practices, as well as published data on the cost savings of preventing avoidable emergency department visits, to develop an algorithm that calculates a return-on-investment ratio. The results, published in the June 2 issue o[ BMC Medicine, were impressive: For 2008, the Family Van had an estimated return-on-investment of $36 for every dol- lar spent. These numbers reveal not only the cost- effectiveness of the Family Van, but also provide a model for other preventive-services programs. Researchers hope to have the calculator used in the study available online within a year. ■ Web Resources Alumni Association. The Harvard Medical Alumni Association has revamped its website to include addi- tional alumni news, information about events, links to alumni benefits, and opportunities for social networking. Visit alumni.hms.harvard.edu; for links to class pages and social networking groups, click on "Community." Conflict of Interest. HMS Dean Jeffrey Flier has written a white paper exploring conflicts of interest in acade- mic medicine. The report is one part of the School's Integrity in Academic Medicine Web, a collection of policies, information, committee statements, and news. To access the website, visit hms.harvard.edu/public/coi; to read the report, visit hms.harvard.edu/ public/coi/dean. Match Day. In March, nearly half of the members of the HMS Class of 2009 learned they would be staying in Massachusetts for at least part of their training. The largest percentage of the class — 24 percent — matched in internal medicine, followed by dermatology, general surgery, pediatrics, and radiol- ogy. To learn where recent graduates are undertaking their residencies, visit alumnibulletin.med.harvard.edu/ connect/matchday/2009.php. Obituaries. The Bulletin's reduced production schedule has swelled its list of alumni obituaries awaiting publica- tion. To view recent obituaries as well as longer versions of previously printed notices, visit alumnibulletin.med. harvard.edu/obituaries.php. ■ Jl>C 3. IjrUlCliriff OL3.r The Bulletin will be undergoing notable changes to its format beginning with the next issue, and we hope you will participate in the magazine's continued evolution by joining our new Readers' Panel. As a member, you will be asked to engage in periodic online surveys about the magazine, to offer feedback, and to suggest content. To learn more and to sign up for the panel, visit alumnibulletin.med.harvard.edu/readerspanel.php or contact the Bulletin's editor, Paula Byron, at 617-432-7762 or firstname.lastname@example.org. ■ AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN KDTTORTAT. I PRESCRIPTIONS FOR A NEW MEDICINE Clean Bill of Health Dear Dad, It was great seeing you and Mom last week at her birthday party. The kids loved playing with you. I know the pain from your hernia slowed you down a bit, but I'm confident the operation next week will go well. I'm writing to foUow up on your questions about Obama's health care reform. Sorry I couldn't give better answers at the time. What good is having a doctor and a health pohcy wonk for a son if he can't help you understand health care reform? Looking back on that moment, I think I was tripped up by the diffi- culty of laying out what I see as the core issues without boring you with the details. And of course you've read so much already. What could I add? But I failed to appreciate at the time that you weren't expecting me to recount the facts on insurance cover- age or the causes of the impending bankruptcy of Medicare. You wanted to know whether you should be wor- ried about the coming changes if the reform legislation passes. So I thought I'd try again. And a good place to start might be: What should we be most afraid of? What's the worst that could happen? The worst that could happen is that we could lose the services that repaired Mom's pinched spinal nerves, stopped your bleeding ulcer, cured your cancer, saved your pre- mature grandchild, removed your cataracts, and slowed the progression of your sister's Parkin- son's disease. Actually, when you think back on how much our family has benefited from health care, we have much to be thankful for. So when Obama proposes to reform health care, we have plenty to be concerned about. Even though our family's experiences with the most impor- tant parts of health care — saving life and hmb — have been ter- rific, many people say that, overall, health care in this country is mediocre. Of course you've seen those report cards ranking U.S. health care lowest in the developed world. Having worked on some of those report cards myself — and having seen the care in other developed countries — I think those report cards exem statistics." I know all too well how those grades can be manip- ulated to produce the rankings that their creators preordained. This country's health care could certainly be better, but our family has direct benefited from truly remarkable health care. So, should we be worried? Perhaps vigilant would be a better word. I'U tell you why I beheve we can take heart. Health reform wiU increase the number of Americans who have health insurance. With two of your sons potentially bene- fiting, you obviously agree this is a good thing. Jeff now chooses to be uninsured rather than devote A half his income to pay for individual f health insurance, and Peter doesn't ' know what he'U do if he can't find a new job before his COBRA runs out. The uninsured have no insur- ance because they cannot afford it. So regardless of whether the plan is a pubhc one, taxpayers must fund the new insurance. Spending more public funds means adding to the national debt or increasing taxes. You made sure I understood before the age of ten that neither option was good. And even though I now recognize why we don't want either one, I'm also convinced that our country must increase health insurance coverage in order to stay competitive and support social stability. We'll need to do the hard work to find ways to pay for this, but .in the long run, our country will be stronger. But of course the term "pubhc plan" has become code for an insur- ance plan operated by the government. Our Reagan-era dinner conversations introduced me to your disdain for the American tendency to oversimplify government as good or evil. Nothing I've learned since has changed my view that government agen- cies can be incredibly inefficient and yet, at the same time, they're the only organizations that can be entrusted with truly pubhc responsibihties. It's not about government as good or bad but about haxong government that works. So whether the new insurance plan is actually adminis- tered by the government isn't important to me; I can see advantages and disadvantages either way. On this point most doctors disagree with me. They're afraid that a government- phfy what Mark Twain referred to as "hes, damned hes, and run plan will pay too little. This may be true, but on balance 10 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 I'd rather see my tax dollars spent on health care services than go into the coffers of private insurance companies. And pressure from patients and doctors will ensure that payment rates remain adequate. If this were aU that Obama's reform had in store for us — higher national debt and petty arguments over who adminis- ters the benefit — then, as a current Medicare recipient, you would have nothing to worry about when it comes to health care reform. But there's more. The other part of health care reform is cost containment. Health care costs are chmbing at an astounding rate, and the reform includes provisions that try to contain those costs. On this score you should be more worried about what is not in the legislation than what is in the legislation. The legislation has no sweeping changes in how Medicare is structured. Instead the legislation gives Medicare permission to try some cost- on 10 percent of the population, so improving care coordi- nation for the high-risk, high-cost patients must be part of the answer. Chances are that we will all be in that high- cost 10 percent at some point in our hves, and more than likely it v^l be near the end of our lives. But deciding what is necessary isn't straightforward. And simply cutting the fees paid to physicians and hospi- tals doesn't help; it uses a sledgehammer to remove the tumor of overuse. The health care you've come to expect depends not only on payments to hospitals and doctors but also on investments in training programs, innovation at academic medical centers, and a biotechnology industry that pushes the envelope of what is possible. The proposed experiments would compel doctors and hospitals to work together to try to address the cost problem, and that's cer- tainly good for your care. Deciding what is necessary isn't straightforward. And simply cutting the fees paid to physicians and hospitals doesn't help; it uses a sledgehammer to remove the tumor of overuse. Mil containment experiments. Ln other words, the legislators have proceeded cautiously. No dramatic changes to your Medicare. Why is this experimentation worth worrying about? Well, in the near term, of course, it's fine. The people who wrote the legislation understood correctly that we don't know exactly how to contain costs without disrupting people's health care. So they moved slowly in some promising directions. The problem is that if costs keep rising then something much more dramatic will need to happen. And any dramatic action will certainly affect your health care. What if Medicare cuts its rates? Most health care costs are spent on the salaries of people working in the field. Rate cuts to hos- pitals would mean higher unemployment and fewer nurses on the floor when you get admitted; fewer nurses would mean compromised care. Rate cuts to doctors would mean less access to services. Given the magnitude of the cost crisis, such dramatic cuts may be necessary. Precipitous rate cuts are what you should be worried about. The key to cutting costs without reducing access to the services you need is to cut payments for unnecessary ser- vices. Few people realize that 70 percent of costs are spent From a high-level perspective, the health-reform effort has been a remarkable example of democracy at work; a motivat- ed president, an engaged electorate, and a legislature hound- ed by special interests. Given the complexities of the issues and the pohtics, the sausage they have made looks pretty darned good. So, to answer your question, you can relax; Your benefits won't change, and your health care won't change. I support Obama's health care plan because it gives more Americans health insurance but doesn't threaten what you and Mom have for health care. Managing the debt will be important, but investing in the health of the population is worth that effort. Love to you and Mom, Tim Timothy G. Ferris '92 is an HMS associate professor of medicine and pediatrics, medical director of the Massachusetts General Physicians Organization, and a senior scientist at the Institute for Health Policy at Massachusetts General Hospital. His brothers names have been changed. AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN PRESTDENT^S REPORT Trading Places D N THIS ISSUE, I'D LIKE TO HIGHLIGHT SEVERAL CHANGES TO both the Harvard Medical Alumni Association and the HarvardMedical Alumni Bulletin. Such transitions provide us with an opportunity to celebrate past accomplish- ments and the people responsible for them while also intro- ducing new people and looking forward to new plans. In the Spring 2009 issue of the Bulletin, we announced that George Thibault '69 would be stepping down as chair of alum- ni relations. It is impossible to capture in a few words the scope of George's contributions to the School and its affiliated hospi- tals. Before moving to New York City to take his current posi- tion as president of the Josiah Macy, Jr. Foundation, George spent several decades serving HMS through major chnical and educational leadership roles at Massachusetts General Hospi- tal, the Brockton/West Roxbury VA Medical Center, Brigham and Women's Hospital, and Partners HealthCare. coness Hospital and eventually at Beth Israel Deaconess Med- ical Center. A. W. is deeply committed not just to HMS but to its alumni as well, having served on the HMS Alumni Council from 2004 to 2008 and as president of the Harvard Medical Alumni Association for the 2006-07 term. We are indeed dehghted that A. W has accepted the position of chair of alum- ni relations, continuing a legacy of truly outstanding individu- als who have served HMS in that role. This is also an important transition time for this award-win- ning publication, as the current issue will be the last to carry the title Harvard Medical Alumni Bulletin. Future issues vdll be pubhshed under the name Harvard Medicine, providing recogni- tion of the quahty and impact of this pubhcation that extends beyond the community of HMS alumni, faculty, and students. As the pubhcation unfolds with its new title and appearance, we look forward to recei\'ing feedback from our readers — both I We are delighted that A. W. Karchmer has accepted the position of chair of alumni relations, continuing i: a legacy of truly outstanding individuals in that role. At the School itself, George has left his fingerprints every- where — on countless committees and initiatives that he has led; on the Academy at Harvard Medical School, of which he was the founding director; and, of course, on alumni activities, as president of the Harvard Medical Alumni Association from 1998 to 1999 and as director and then chair of alumni relations from 2005 until this October. On behalf of all HMS alumni, I want to thank George for his significant contributions and the impact he has had on the School, its students, and its alumni. On a personal level, I con- sider it a privilege to have worked with George during my tenure as Alumni Association president and during the many years we worked closely together as colleagues on the HMS faculty. Following a search process coordinated by a committee composed of several Alumni Council members and a Dean's Office representative, we were pleased to select an outstanding alumnus and career-long HMS faculty member as the new chair of alumni relations — ^A. W Karchmer '64. An internation- ally renowned speciahst in Infectious diseases and an HMS professor of medicine, A. W also served for many years as chief of the Infectious Diseases Division at the New England Dea- individually and through a new Readers' Panel — about how we can make the magazine as engaging as possible. Finally, I wish to recognize the enormous contributions of Wilham Bennett '68, who stepped down in June after 15 years as editor-in-chief of the Bulletin. I want to express my personal gratitude for all Bill has done to make the pubhcation such an outstanding one. His wonderful writing skills and his ablhty to weave together the world of medicine with the worlds of hter- ature, the arts, and history have allowed him to jom with the editor, Paula Byron, in shaping the Bulletin mto the exceptional pubhcation it has become. ■ Steven E. Weinberger 73 is senior vice president for medical education at the American College of Physicians in Philadelphia. He can he reached at sMemail@example.com. HMS alumni, faculty, students, and friends are encouraged to join the Bulletin's new Readers' Panel, an informal advisory group to the magazine. To learn more, visit alumnihulletin.med.harvard.edu/ readerspanel.php or contact the Bulletin's editor, Paula Byron, at 617 '432-7762 or firstname.lastname@example.org. 12 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 BOOKS BY OUR ALUMNI [ ROOKSHETF _E Hdi/ie^ tat 2)edd" ODD BHIVtBD HEOICIL SCHOOL ^ MAN OUT Testosterone for Life r Turning Blood Red The Fight for Life in Cookys Anemia, by Arthur Bank '60 (World Scientific, 2009) Written by a world-recognized expert on Cooley's anemia, a potentially fatal blood disease, this book provides new insights into the condition, which may lead to new therapies. A multidiscipli- nary guide that covers several fields, including hematology and pediatrics, it also details how Cooley's anemia serves as a model for understanding other human diseases. Bank further describes the emotional and medical impact of the disease on patients and their famihes. Dancing at the River's Edge A Patient and Her Doctor Negotiate Life with Chronic Illness, by Ahda Brill and Michael D. Lockshin '63 (Schaffner Press, 2009) This collaboration between a doctor and his longtime patient chronicles their experiences as they negotiate treatment for her chronic autoimmune disease. The dual memoir presents both a dialogue and a personal journey toward a new understanding of the chronically ill and those who treat and are touched by them, including family, friends, and colleagues. Retired, Not Dead Thoughts Plastic Surgical and Otherwise, by Robert M. Goldwyn '56 (Artnik Books, reflections on his career in medicine and life in general. With wit and wisdom, he offers his thoughts on topics as diverse as hospital politics, the Registry of Motor Vehicles, and shoe shopping. The author also holds forth on the plastic surgery field and his retirement from it. Unstucl< Your Guide to the Seven-Stage Journey Out of Depression, by James S. Gordon '66 (Penguin, 2008) This practical, easy-to-use guide is designed to help patients overcome depression without the use of antide- pressants. The author, a psychiatrist, focuses on the benefits of food, nutri- tional supplements, meditation, exer- cise, Chinese medicine, and other inte- grative approaches, concluding each chapter with a carefully designed "Pre- scription for Self-Care." He also includes dramatic and inspiring exam- ples from his own patients. Odd Man Out A Year on the Mound with a Minor League Misfit, by Matt McCarthy '08 (Viking Adult, 2009) In this wide-ranging collection of brief essays, Goldwyn shares his engaging A former college baseball player, the author was drafted by the Anaheim Angels in 2002. Here, he recounts his grueling year as a pitcher with that team's minor league affiliate, the Provo Angels, and shares the often bizarre — and sometimes controversial — details of what goes on behind the scenes of our national pastime, from the dugout to the locker room. Testosterone for Life Recharge Your Vitality, Sex Drive, Muscle Mass & Overall Health, by Abraham Morgentaler '82 (McGraw-Hill, 2009) This authoritative, up-to-date guide helps male readers determine whether they have low testosterone, a common but frequent- ly underdiagnosed problem in middle- aged men. Morgentaler, a urologist and expert in sexual and reproductive medi- cine, also details the potential benefits of testosterone therapy for men, including increased vitality and virility, improved muscle mass, and better general health. Try to Remember Psychiatry's Clash Over Meaning, Memory, and Mind, by Paul R. McHugh '56 (Dana Press, 2008) Written in response to the loss of public confidence in psychotherapy resulting from the trend in what the author con- siders false "recovered memories," this book examines what went wrong and what must be done to restore psy- chotherapy as an honored therapeutic approach. McHugh presents patients, families, and mental health providers with insight and guidance on how to work together. He outlines the best practices in psychiatry, shows readers how coherent therapy functions, and provides a clear approach to accurate diagnosis and effective treatment. AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN Si. THTNKTNO ZERRA DIAGNOSIS OF A DIFFERENT HOOFBEAT Internal Conflict E KNEW HIS ORGANS MIGHT ONE DAY FAIL. HE JUST didn't expect them to begin failing during his mid-twenties — especially after simply carrying a basket of laundry to the car. Yet on a late winter day in 2001, this young man, whom we will call Craig Hud- son, was performing just such a task when he was stricken. "I got this sudden pain in my throat," says Hudson, "then in my chest. Then I found it hard to breathe." He bolted up the dozen stairs to his apartment and for three days tried to catch his breath. But it wasn't just breathlessness; curious sloshing sounds were audible in his chest whenever he moved. Could it be pneumonia? A trip to the doctor brought puzzled looks from the examining physician. "He kept asking me if I felt okay" says Hudson. "Then he ordered a chest x-ray." The image showed that Hudson's right "He talked with me frankly," says Hudson. "He told me my symptoms and history put me beyond the scope of his hospi- tal. But there was someone in Philadelphia he thought I should see." There, a physician at the Hospital of the Univer- sity of Pennsylvania considered Hudson's history and quick- ly referred him to Reed Pyeritz '75. Throughout the years and the confusion of symptoms, Hudson had researched each physiological calamity that had befallen him. He had investigated the treatments and diag- noses he had received, and he had studied the specialties of the doctors who had cared for him. Now he was scheduled to see Pyeritz. His research found that Pyeritz was the chief of the Division of Medical Genetics in the hospital's Perehnan Center for Advanced Medicine and that he was an expert in diagnos- ing and treating heritable diseases of coimective tissue. This, The litany of medical problems grew, as did the number of perplexed physicians. Rounds of hospitalizations ensued, bringing a lung biopsy, more tests, and more uncertainty. Finally his surgeon could do no more. lung was 80 percent collapsed, seemingly without any direct cause. Re-inflation proved difficult and recovery long. An unexplained shoulder dislocation and a bout with Bell's palsy joined the hst of mysteries. The palsy had been particular- ly unsettling — "I thought I was having a stroke," Hudson says — but a short course of steroids set him back on track. Then, two years later, another organ began to fail. "I was mowing the lawn," Hudson says, "when I felt what seemed hke a stomach cramp. Soon I was blinded by pain." This time doctors found that a spontaneous dissection of the artery to his left kidney had caused some tissue death. The litany of medical problems grew, as did the number of perplexed physicians. A month-long tussle with a bad cough that produced blood-tinged sputum led Hudson to the emer- gency department of his local hospital. Imaging revealed more lung problems, this time in the left lung; decreased air capacity, a fluid-filled cavity in the lower region of the lung, and another, smaller collapse. In addition, nodules and some areas of opacity were visible on images of Hudson's lungs. Surgery removed the nodules, and tests showed them to be cancer free. A few months later, though, Hudson was again gripped by intensive coughing with more blood-laced spu- tum. And new nodules. Rounds of hospitalizations ensued, bringing a lung biopsy, more tests, and more uncertainty. Finally his surgeon could do no more. Hudson thought, may be where I get my answer; this may be where I find out why my body parts keep gi^'tng out. Tissue of Cries Barbara Bernhardt, a member of Pyeritz's close-knit team, remembers her impressions of Hudson on his first visit to the clinic. "He seemed frightened," she says, "but determined. We began to talk." Bernhardt, a genetic counselor, helps guide Pyeritz's patients through questions of fanuly and future. And she helps them develop strategies for incorporating a genetic disorder into their Hves, including ways they can present their medical story to others to help normalize their daily routines. "He was quiet," Bernhardt recalls, "but clearly knowledge- able, relating all that had led to his referral to our office. Then he said what I beUeve had been on his mind since learning he was to see Dr. Pyeritz: He was concerned he may have Ehlers- Danlos. And he was worried it might be the nasty kind.' " Ehlers-Danlos syndrome is a constellation of gene-based disorders that ravage connective tissue, the biological scaffold- ing that helps give the body's skin, organs, and vessels their integrity and shape. For centuries before it gained its dual eponym, the syndrome was described only as a curious collec- tion of symptoms. Around 1900, though, patient cases separate- 14 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 ly presented by physicians Edvard Ehlers and Henri-Alexandre Danlos to members of the Paris Society of Syphilology and Der- matology served to estabhsh the syndrome in the Hterature and to usher in efforts to fully characterize it. The disease was first described by physical manifestations; velvety, hyperelastic skin; hypermobile joints; and poor wound healing. But physicians soon were able to list other symptoms, including the development of calcified cysts under the skin and of "cigarette-paper scars," areas of mild trauma that imperfectly heal to resemble thin paper. The syndrome's prevalence among populations with European ancestry and occurrences in families helped estab- lish it as a heritable one that can take at least six distinctive forms. Each form brings hurdles to those with the syndrome, such as weak muscle tone, chronic joint dislocations, severe spinal curvatures, and, in the vascular form — the type that Hudson's research had him worried about — heightened risk of organ rupture and internal bleeding. Each form appears with differing frequencies. The most common one occurs in 1 in 10,000 to 15,000 people. The vascular form, however, sur- faces a tenth as often. Diagnosing the syndrome — and pinpointing its form — involves genetic testing of a sample of a patient's tissue. Pyeritz would need to carry out such a procedure for Hudson. But first, he would need to talk with him and examine him. "When the patient was referred, I reviewed his medical history," Pyeritz says. "His extracellular matrix seemed to have a fundamental defect. Much of the evidence pointed to Ehlers-Danlos and, from my reading, the rare vascular form. So I began the exam realizing I had a bias, but I soon saw many of the signs I was expecting." Pyeritz performed a skin biopsy. The results confirmed his suspicion: Hudson had the vascu- lar form of Ehlers-Danlos. Ballooning Problem Pyeritz remembers well the first patient he saw with the vas- cular form of Ehlers-Danlos. It was in the late 1970s, while Pyeritz was a senior resident at the Johns Hopkins School of Medicine. He was working in the medical genetics clinic of Victor McKusick, a cardiologist whose interest in gene-based diseases led him to help found the field of medical genetics. To Pyeritz, he also was the godfather of heritable disorders of connective tissue. It was, in fact, while Pyeritz was at Hopkins that McKusick's group found the genetic trigger to the vascular form of the syn- drome. Later, mutations to the gene COL3AI, which directs the production of a collagen precursor, were identified as the fundamental cause. This genetic misdirection causes skin hyperelasticity but also leads to severe compromises to the strength of internal organs and blood vessels. "The boy was 12 or 13 years old," says Pyeritz of the patient he greeted that day at Hopkins. "I was examining some unusual scarring on his skin, when he said, 'Look, doc, what I can do.' The boy then held his breath and bore down. Out popped this mass above his clavicle. At first, I thought it was his lung." But tests showed it was a pseudoaneurysm. With a touch of amazement still in his voice these many years later, Pyeritz recalls, "The boy had actually ruptured his subclavian artery and survived." Life Redone With a firm diagnosis in hand, Pyeritz and his team are work- ing with Hudson to help him deal with his disease. And Hudson, with an answer to his years of questions, now hves with a diagnosis that is sobering but oddly Hberating. "Most people don't have to hve with their own mortality," he says. "I now try to live a bit more, to make every moment of hfe worth it." Pyeritz believes his ability to diagnosis Hudson's condi- tion rests in large part on a dictum that he and his colleagues follow. "We assume that uncommon events have a common linkage," he says, "and that patients don't tend to suffer an array of rare, unrelated conditions." ■ Ann Marie Mcnting is associate editor of the Harvard Medical Alumni Bulletin. "Thinking Zebra" refers to advice many medical students receive when learning the art of diagnosis: "When you hear hoofhcats, think horse, not zebra." AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN RENCHMARKS DISCOVERY AT HMS Relative Perspectives IGHTY MILLION OR SO YEARS AGO, during an ordinary day in the Cretaceous period, the genes of a Brachyhphosaurus produced some collagen proteins inside the dinosaur's bones. When the plant- munching giant died, its corpse was entombed in the sediment of a river that ran through today's Montana. Now, researchers have identified eight frag- ments of the proteins clinging to one of those aged bones — millions of years after the proteins were expressed from the dinosaur's DNA. The proteins, found on a three-foot- long femur of a Brachyhphosaurus canaden- sis, are the oldest to be extracted from a fossil, say the HMS and North Carolina State University researchers who report- ed the study in the May 1 issue of Science. The fragments show that the 30-foot- long Brachyhphosaurus, which means short-crested lizard, is more closely related to a chicken than to a lizard on the evolutionary tree. The findings build upon an earlier study, in which the team found similar results in a 68-milhon-year-old Tyran- nosaurus rex. "This helps verify that our first discovery was not a one-hit won- der," says John Asara, who coauthored the studies on the T. rex and B. canadensis. Asara is an instructor in medicine at HMS and director of the Mass Spec- trometry Core at Beth Israel Deaconess Medical Center. Location, Location, Location Many in the paleontology community consider the study's findings unsettling not for their reconfiguration of evolu- tionary relationships but because of the material relied upon for that reconfigura- tion. Current models say that soft tissue, DNA, proteins, and other biological material are replaced by minerals during fossilization, especially in fossils dating back more than a milhon years. ^^^jVlAf^^Jw^^^^^^^' vO FOR THE BIRDS: Fragments of collagen proteins found on Brachylophosaurus bones suggest the creature is more closely related to a chicken than to a lizard. Although the study team cannot explain how the proteins they found on the ancient bone remained intact through the ages, they are relatively cer- tain the protein fragments did not come from other, nondinosaur sources; all their contamination controls were clean. An explanation for the proteins' presence could lie where the femur was found; the bone was buried 20 feet deep in sandstone along the side of a washed- out ridge at Montana's Judith River For- mation, one of the largest fossil sites in the United States. The scientists beheve the sandstone may have softened any wearing on the bone during the millions of years of aging. Feathered Friends Once the fossUs were extracted and cleaned of minerals, the North Carolina researchers analyzed them microscopi- cally and found what appeared to be ves- tiges of bone cells, blood cells, and blood vessels within a fibrous structure that resembled collagen, a protein that makes up to 90 percent of the bone in many mammals. Further analyses with anti- bodies confirmed the presence of colla- gen as well as other proteins within the fibrous structures. The samples were then sent to Asara, who usually uses mass spectrometry to ferret out low levels of signaling proteins in cancer cells. He scanned the material and isolated the eight collagen fragments. The protein sequences were only 149 amino acids long — less than 10 percent that of a full-length collagen sequence — but were sufficient to allow the team to compare the fragments to collagen from 21 hving species and to collagen found in the fossils of the T rex and those of a 300,000-year-old mastodon. The sequences from the B. canadensis fell within the group of archosaurs, an ancient group of land vertebrates whose members were more genetically akin to today's chickens and ostriches than to alligators and lizards. The B. canadensis and T rex data pro\ide the first molecular proof of the well-estabhshed theory that birds evolved from dinosaurs, says Asara. Asara hopes the data alter paleonto- logical thought on the resilience of pro- teinaceous material: "This should help convince the skeptics," he says. He hopes that as sequencing techniques become more precise, more details on dinosaurs and other extinct species will be extracted from larger pieces of collagen and other proteins. Such stud- ies could usher in a new discipline that Asara and colleagues have dubbed fossilomics. ■ Nuno Dominguczwas an intern at Focus. HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 Course Change Receptive Audience m ORMONAL THERAPY FOR MEN with prostate cancer may increase their risk of death if they have coro- nary artery disease and have had congestive heart failure or a heart attack. This unsetthng finding is reported by researchers at Brigham and Women's Hospital and the Dana-Farber Cancer Institute in the August 26 issue of The Journal of the American Medical Association. Previous research shows that hor- monal therapy, when used with radi- ation therapy to treat localized, unfa- vorable-risk prostate cancer, increas- es survival rates in men with no or minimal comorbidity but not in men with moderate to severe comorbidity. "Until now, we were unsure which additional health risks might limit this well-established survival benefit," says lead author Akash Nanda, an HMS clinical fellow in radiation oncology at Brigham and Women's. So the scientists conduct- ed a retrospective study of more than 5,000 men who had received either hormonal and radiation thera- py or radiation therapy alone. They found the addition of hormonal therapy increased the mortality risk only in men with coronary artery disease-induced congestive heart failure or heart attack. But it did not appear to increase mortahty risk in men who had only one risk factor for the disease, such as diabetes, high blood pressure, or high cholesterol. "This study highlights the need," says senior author Anthony D'Amico, an HMS professor of radiation oncology at Brigham and Women's and Dana-Farber, "for a careful discussion of the potential risks and benefits of hormonal therapy with men whose coronary heart disease has caused a heart attack or heart failure." ■ CAN A SINGLE HORMONE, ACTING ON a tiny region of the brain, normalize blood glucose levels and increase physical activity in diabetic and obese patients? It can in mice, says a team of researchers at HMS and Beth Israel Deaconess Medical Center. Writing in the June 3 issue of Cell Metabolism, the team, led by Lihong Huo, a research fellov/ at the medical center, found that restoring leptin receptors to a particular group of neu- rons in the hypothalamuses of mice cured the animals' severe diabetes and doubled their activity levels. "This discovery suggests a new therapeutic pathway for drugs to treat insulin-resistant diabetes in humans with severe obesity and pos- sibly even to stimulate their urge to exercise," says senior author Christ- ian Bj0rbaek, an associate professor of medicine at HMS. First identified in 1 994 as an appetite- and weight-regulation hor- mone, leptin plays a role in energy homeostasis. Research has pinpointed the arcuate nucleus in the brain's hypo- thalamus as one key area in which leptin exerts an influence. Within this nucleus, scientists have identified two types of neurons that are respon- sive to leptin: the Agouti-related peptide neurons, which stimulate appetite, and the pro-opiome- lanocortin, or POMC, neurons, which curb appetite. Other studies have indicated that leptin's action on the arcu- ate nucleus helps control blood-sugar levels as well as activity levels. In designing their study, Bj0rbaek says, "We hypothesized that, in both cases, the POMC neurons were involved." The scientists began their inquiry by measuring the appetite and body weight of mice whose neurons were genet- ically deficient in receptors for leptin. These mice presented the characteris- tics associated with such a deficiency: extreme obesity, hypoactivity, and severe diabetes. The researchers used a technique that allowed them to genetically and selectively re-express leptin receptors in the POMC neurons. When leptin activity was restored only to those neurons, the mice became slightly less obese. More importantly, they became twice as physically active, and their blood glucose levels decreased to normal. So although replenishing leptin activity in the POMC neurons did not cure obesity, it did spur the mice to exercise more and it effectively halted the diabetes. "The fact that normal glucose levels were restored independent of food or weight changes suggests that it is pos- sible to normalize blood glucose even without weight loss," says Bj0rbaek. These findings may offer potential tar- gets for future drugs that alleviate dia- betes or increase the will to exercise in obese and diabetic patients. ■ ]ue Wang, a former intern for Focus, contributed to this article. APPETITE FOR LIFE: In mice, the hormone leptin appears to promote exercise and v^eight loss — and to prevent diabetes. • # :>-j-aBSS*;.v-3---':' kUiMM iirrrTriiff- AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 17 RKNCHMARKS I DISCOVERY AT HMS Matters of the Heart HE HEARTS OF THOSE WITHIN THE community of cardiovascular scientists and clinicians may have skipped a beat when news of the discovery came their way. HMS researchers announced they had found the mother of all heart cells known as the master human heart stem cell, a cell that can differentiate to form all parts of the heart, including contracting and smooth muscles and blood vessels. And this dis- covery was coupled with another; Har- vard Stem Cell Institute researchers at Massachusetts General Hospital also found these \Ttal progenitor cells resided in regions of the heart known to be hot spots for congenital heart disease. The research team was led by Kenneth Chien, director of the institute's cardio- vascular disease program and the hospi- tal's cardiovascular research center. Its discoveries, pubhshed in the July 2 issue of feature, provide scientists with a vital cell standard for use in their investiga- tions of human heart development and the genetic diseases of the cardiovascu- lar system, particularly those known to cause heart disease in children. Identify- ing and manipulating the pathways along which these progenitor cells grow and differentiate could allow researchers to significantly influence congenital heart disease by converting severe forms of the disease to those with a better prognosis or even by preventing the disease in fetal and newborn hearts. The researchers do not, however, see these cells as playing a role in the regen- eration of the fully developed adult heart. For one thing, such cells are extremely rare in the adult heart. And the cause of morbidity in adults with heart disease differs from that for children; adults most often suffer from impaired function rather than structural abnormahties. A Growing Notion For their study the team focused on deter- mining how the human heart develops. At birth, the human heart is more than a thou- sand times larger than the adult mouse heart, yet embryonic human hearts differ Htde in size from those of mouse embryos. How, the researchers wondered, does the human heart achieve that level of growth? The team found two possible answers to that question. The first was straight- forward; Structural change drives the growth — that is, valves, muscles, and all other parts of the heart develop from their \'arious independent ceU lineages. Then the cells in those structures reph- cate and the heart's size increases. But the researchers speculated that the reason might rest elsewhere, in what Chien describes as a stem-ceU paradigm. In this line of thought, a single form of progenitor cell replicates, massively expands the pool of heart-cell precur- sors, and then differentiates into the var- ious cardiac structures. The researchers chose to investigate this paradigm by genetically tagging progenitor cells derived from a human embryonic stem-cell line and then tracking their dispersal in heart tissue. When they analyzed the developing tis- sue, they were astonished to discover that HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 large numbers of the progenitor cells per- sisted and were dispersed throughout the heart tissue. The highest concentration of the cells was in the aortic outflow track, a spot associated with congenital heart dis- ease. The team also observed a large num- ber of the distinctive intermediate cell types that give rise to all parts of the heart. These findings indicate the stem cells were capable of replicating and expanding their numbers before they diEerentiated in any specialized cell type in the heart. Since the findings show that heart expansion rehes on a stem-cell-mediated process, particularly in regions affected by congenital heart disease, the researchers consider the progenitor cells to be impli- cated in the underdevelopment or incor- rect development of heart structures. Core Group The team is currently studying three types of disease that affect children: Duchenne muscular dystrophy; specific chromoso- mal disorders, such as DiGeorge and Down syndromes; and rare, genetically based congenital heart diseases. For each disease type, Chien says, mouse models are not enough; "They are not likely to fully recapitulate the human disease." For Chien and his colleagues, this study also underscores the importance of human embryonic stem cells to the research enterprise, rather than relying on induced pluripotent stem cell lines that are created in the lab by forced gene expression. "Induced pluripotent stem cells are going to be good for research into certain diseases, but I'm not sure they wUl be good for research on heart diseases," says Chien. "The degree of variation in the induced lines is significant, so how do you even compare this cell to itself? But by targeting specific genes and manipu- lating them in human embryonic stem cells, you can create human models of human disease directly in a simplified format: human embryonic stem cells." ■ Research Digest llll^ WAYFINDER ALERT When determining the risk for heart attack in patients who have had coronary-artery bypass grafting, it may be wise to look beyond present standards, say researchers at Massachusetts General Hospital. Physicians often check levels of the biomarker cardiac troponin to determine the likelihood of an attack in such patients. But scien- tists led by James Januzzi, director of MGH's Cardiac Intensive Care Unit, report that consen- sus cut-points for troponin use in post-CABG patients are too low for routine application, resulting in over-diagnosis of post- CAGB heart attack. In their paper in the September 8 issue of Circulation, the researchers note that troponin remains an excellent predictor of death when its levels measure ten times higher than those currently acceptable. llli^ IN THE ZONE Travel that chases the sun across time zones is exciting, even invigorating — until jet lag hits. But an anti-lag aid may be on the way. In the June 1 9 issue of PLoS Computational Biology, researchers at Brigham and Women's Hospital and the University of Michigan report the development of software that uses various measures such as light levels and sleep schedules to calculate the countermea- sures needed to reset the body's inner clock. Team leaders Elizabeth Klerman '86, an HMS associate professor of medicine at Brigham and Women's Hospital, and Dennis Dean, a computational research associate in the hospital's Division of Sleep Medicine, believe their math-enhanced intervention could halve the numbers of days a traveler would need to adjust to a new time zone. 111^ PROVISIONAL RESOURCES Nascent cancer cells seem to need community to thrive. If isolated during the early stages of tumor formation, such cells kill themselves, an action called apoptosis. Scientists had thought apoptosis was the sole way these homeless cells perished. But researchers working with Joan Brugge, the Louise Foote Pfeiffer Professor of Cell Biology at HMS, discovered another cause: starva- tion. In the September 3 issue of Nature, the scientists report discovering that cells that had been genetically altered to become precancerous lost their abil- ity to transport glucose, their primary energy source. When treated with antioxidants, however, the cells survived, opting to use fatty acids for their energy needs. By better defining the metabolism of precancerous cells, the research provides a fresh approach to new tumor-killing drugs. llll^ TRAIL MARKER Diagnosing acute appendicitis in children can be a bit like finding a particular tree in a forest: its symptoms resemble those of other conditions, and few diag- nostic markers are specific to the disease. A study by researchers at Children's Hospital Boston, reported in the June 25 online issue of the Annals of Emer- gency Medicine, has identified one such biomarker: leucine-rich alpha-2-gly- coprotein. The team was led by Richard Bachur, chief of emergency medi- cine at the hospital. AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN The cadaver lying before them came with its own set of instructions. "Let the body be injected with arsenic after death, soon," John Collins Warren, the first dean of Harvard Medical School, had written. The body, Warren continued, should be examined or dissected as appropriate, with the "morbid parts" carefully preserved and particular attention paid "to the heart, spleen, and prostate gland." Over the course of his long surgical career, Warren took the same detailed care in assembling an extraordinary col- lection of anatomical and pathological specimens, which he presented to Har- vard in 1847, along with a gift of $5,000 to create the Warren Anatomical Muse- um. But no donation was more remark- able than the one he bequeathed nine years later; his own body as specimen. His bones, Warren had written in the same set of instructions, should be "carefully preserved, whitened, articu- lated, and placed in the lecture-room of the Medical College, near my bust; affording, as I hope, a lesson useful, at the same time, to morahty and science." Four days after Warren's death, J. B. S. Jackson — the School's first professor of pathological anatomy, the Warren Muse- um's first curator, and a member of the Class of 1829 — followed those instructions for preparing Warren's corporeal bequest. When the family later restricted the view- ing of Warren's remains to his descen- dants, his bones were placed in storage. And so John Collins Warren became a literal skeleton in a Harvard Medical School closet, thwarted in his intention of embodying the anatomists' motto of mor- tui vivos docait: the dead teach the hving. ■ HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 X .^J" '' ■M SNOOZE CONTROL: His devotion to anatomical study afforded John Collins Warren speed and surety in the surgical theater. Such expertise was critical for patients of the time, who had to remain dwake during their operations. So ,4, when the chance arose to V limit surgical pain, Warren ieized it and, at Massachu-' f^ setts General Hospital in I 1846, performed the first * surgery to successfully |: incorporate anesthesia. 5 Afterward, he famously concluded, "Gentlemen, fkic ic nn|iumbug!" fUJ^Je ^ CT •■" ^ ! : 3 ■ " , S 1 1 m ntt*" ' 1 '^ 9L ^M 1 iKf st ::-fx^,;^^^^^§^;^^ illlilliiis^jf-^^^^ Ij-H To acquire the human cadavers needed for their dissections, early doctors hoped for the executed but depended on the resurrectec. BY ANN MARIE MENTING The group operated clandestinely. Even its name remained unwritten. Correspondence from one member to another would merely contain discreet references to the Sp rs Club. Nothing else needed to be stated. But the group of young men undoubtedly had a home, a safe haven for the imple- ments so necessary to its gatherings. Perhaps it was simply a room that boasted a table, long but Kkely lean, as its furnishing. Around this fixture, the club members would gather, intent as one of their number separated skin from fascia, muscle from bone, and organ from cavity Small animals, even the occasional larger creature, were sacrificed, opened, and studied by the group. AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 23 students of medicine often took it upon themselves to procure a candidate for dissection either by hijacking a body between deathbed and grave or by extracting one from its earthy resting place. Had the club members restricted their explorations to four-legged species these activities would not, in themselves, have necessitated such dis- cretion. But it was their other endeav- or — the anatomical study of the human body — that demanded their secrecy. During this nation's formative years, the practice of human dissection struck equal measures of fear, loathing, and curiosity in the hearts of nearly every man and woman. And these attitudes were compounded by the knowledge that the fathers, daughters, grandmoth- ers, and uncles whose bodies graced those cutting boards were most likely resurrected during midnight raids on local graveyards. This fact made the actions of these young men — these young Harvard medical men — daring, dangerous, and possibly, even demonic. Like Father, Like Son The group of young anatomists, known without ehsion as the Spunkers Club, is one such story. Founded in the late 1760s by a group of Harvard students, the club featured several future luminaries, including John Warren, who would be a founder of today's Harvard Medical School, and William Eustis, a future gov- ernor of Massachusetts, U.S. Congres- sional representative, and secretary of war for President James Madison. They and their comrades studied general med- icine, surgery, and anatomy in the home of John's brother, Joseph, a noted physi- cian, teacher, and Revolutionary War hero. It is speculated that Joseph, abetted by John, was the club's instigator. The club was a response to the times; In the late eighteenth and early nineteenth SNATCHIN' STIFFS: Eighteenth-century caricaturists ^vere not coy about mocking the doctors who participated in grave robbing, as in this etching of a fleeing William Hunter, the physician >vho introduced the use of cadavers to medical education in Great Britain. centuries, a knowledge of human anato- my and skills in the surgical dissection of the human body were increasiagly considered critical to the education of young men who wished to practice medicine. Coupled with this demand was the burgeoning number of medical colleges in the colonies. Yet crucial components to such an education — human cadavers — were nearly nonexistent. Reasonable legal mechanisms for procuring a steady sup- ply of bodies wouldn't appear until the late 1800s. So any physician, teacher, or student who sought to learn the internal byways of the human body was forced to be inventive. The more daring of stu- dents often took it upon themselves to procure a candidate for dissection either by hijacking a body between deathbed and grave or by extracting one from its earthy resting place. This exercise was not unknown to young John Collins Warren, a future founder of Massachusetts Gener- al Hospital. He reported that in 1796, while a student at Harvard College, he "began the business of getting subjects" for anatomical study. And quite the busi- ness it was, to read one of his accounts. "We reached the spot at ten o'clock at night . . . [and] proceeded rapidly, uncov- ering the .coffin by breaking it open. We took out the body of a stout young man, put it in a bag, and carried it to the bury- ing-group wall." The theft was not to be that simple, though, for at the wall, the troop found a man walking along, smok- ing. The lads were forced to improvise. "One of the company . . . affected to be intoxicated, while he contrived to get into a quarrel with the stranger," War- ren recalled. "After he succeeded in doing this, another of the party, approaching, pretended to side with the stranger, and ordered the other to go about his business. Taking the stranger by the arm, he led him off in a different direction " The body was whisked off 24 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 ope Ttl^S The opposition that colonial America held for the practice of dissection made it fertile ground for the body trade and the skills of the grave robber. Yet even in nations where dissection was accepted, the notion of cutting into a human body has rarely been taken lightly. For ages, in fact, it carried the possibility of divine disapproval. Early Egyptians believed the gods were displeased if a corpse was cut, even if the cutting was in preparation for embalming, burial, and the next life. To sidestep godly wrath, the ancient undertakers would press an elderly man into service. Armed with a sharp stone, the scapegoat would quickly slash into the abdomen of the corpse, then flee. The undertakers would further emphasize their noncompli- ance — and ensure the gods had the right man should they wish to exact revenge — by pelting the scurrying fellow with rocks. Greeks, too, avoided opening their venerated dead, but felt no compunction over peering into the bodies of those they conquered. Comparative anatomy provided many learned populations with the opportunity to gain knowledge of the mechanisms that sustained life and movement. The Romans were active as comparative anatomists; Galen, the second-century Roman physician and philosopher, appar- ently used apes as dissection models. Medieval Arabs, abiding by a doctrine that held human dissection as unclean, also investigated anatomy through the dissection of pigs and other animals. Although early Christians may have inherited the Romans' repul- sion toward dissection, indications are that attitudes changed; the death in 1410 of Pope Alexander V was followed by an autopsy. And despite a papal bull denouncing a gruesome practice of the Cru- saders — who dismembered, boiled, and macerated the flesh of fallen comrades so as to more efficiently package their remains for ship- ment home — there are few prohibitions on autopsy and dissection in Catholic or Protestant writings. In fact, in regions in which the Catholic Church traditionally held sway, dissection was legalized dur- ing the Middle Ages: From the end of the thirteenth century through the middle of the fourteenth, the countries now known as Spain, Germany, and Italy each had laws that legalized the science. This wave of legalization helped lift much of the stigma associated with the dissection of humans while also boosting the sources for bod- ies and body parts that could be used by those seeking to advance medical knowledge. Ultimately, this international change of opinion altered U.S. laws governing anatomy, leading to an expansion of academic instruction and research in the discipline and a shuttering of the activities of those who specialized in resurrecting the dead. ■ to Cambridge while the young Warren stayed behind, working until dawn to refill the grave and gather the tools. At the day's first class, he faced his teacher, John Warren, the School's first profes- sor of anatomy and surgery, former Spunker — and his father. "When my father came in the morn- ing to lecture," the younger Warren wrote, "and found that I had been engaged in this scrape, he was very much alarmed; but when the body was uncovered, and he saw what a fine, healthy subject it was, he seemed to be as much pleased as I ever saw him." The acorn, it seems, had not fallen far from the oak. The Company One Keeps While it was often the responsibility of the students to provide the specimens they would dissect in class, it was more usual for the professor to shoulder the duty of ensuring an adequate supply of cadavers. For centuries in England and its North American colonies, the sole sanc- tioned source of bodies was criminals. especially those whose crimes were so heinous that the judge added further insult to the death sentence by ordering the body "anatomized." In 1784, Massachusetts added duelists convicted of killing an oppo- nent to the list of candidates for the dissection table, and by 1824 the Com- monwealth had augmented that supply with the bodies of convicts who died while in prison. The numbers remained woefuUy inad- equate, however. Estimations of supply and demand in Vermont, for instance. AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 25 THE THRILL OF THE GRILL: To foil body snatchers, families sometimes erected iron grills around the grove of a loved one, as shown at right. And while resurrectionists avoided being seen with the bodies they snatched, later generations of medical students were proud of their anatomy work and often took group photos v/ith their cadavers, such as the one Harvard medical students had taken in 1905 at far right. indicated that betvs^een 1820 and 1840, nearly 1,600 students attended medical schools in that state, and each student was expected to perform a dissection alone, with a preceptor, or as a member of a small group. Conser\'ative talhes placed the number of bodies needed to serve Vermont's medical students at about 400. Yet records indicate a mere 40 corpses would have been available legally. If one extrapolated Vermont's situa- tion to the nation at that time, supply estimates grew to about 5,000 bodies, again far exceeding the number legally obtainable. Preceptors and physicians were forced to think along lines that usu- ally placed them in league with grisly ven- dors known variously as resurrectionists, sack 'em up men, exhumators, body snatchers, or grave robbers. Stock in Trade Although this form of commerce was not an above-board sort of business, there is a rich record of diaries, epistles, and news- paper accounts of grave robbers' exploits. These documents reveal the risky and lucrative nature of the business. An 1820 bill to the London surgeon and anatomist Sir Astley Cooper, who kept more than a few resurrectionists busy, parsed one dehvery into such costs as transport and the hiring of carriage and coachmen for a total of 13 pounds, 12 shillings. In 2008, in the United States, that sum would have translated to roughly $1,300. Such pricing was not exclusive to England's com- merce; one early-nineteenth-century Ohio-based exhumator charged medical schools $30 per corpse, or approximately $409 in 2008 dollars. His business was said to have been brisk. The trade was also seasonal. Medical colleges held sessions from early Septem- ber through May. This calendar had olfac- tory benefits as it avoided the steamy months of June, July, and August when bodies, in this time before embalming, could become quite ripe quite quickly. Methods for raising and transporting the corpses were as varied as the person- ahties and talents of the robbers who employed them. For the standard grave robbery, however, a party of three was considered effective — two to dig the body out and one to drive the getaway wagon. Since resurrections were best undertaken at night, daytime reconnais- sance was ^dtal, not only to triangulate the grave against easy-to-locate land- marks but also to observe and map any traps the family may have set to thwart the very act the robbers were planning. Some deterrents were simple telltales — cleverly strewn flowers, perhaps, or a patterning of stones or shells — others, such as tripwires attached to loaded, cocked guns, were dangerous and direct. For the task, the minimum equipment was a shaded lantern, tarpaulins, an auger for preparing the coffin hd to be pried open, and one or two wooden spades — wood did not ring out as metal would when it hit a rock or other hard surface. In addition to these tools, the digging duo often had one of two items specially crafted for puUing the body from its crypt. One, a simple harness, could be shpped under the arms of the deceased; an attached rope allowed the robbers to tug the body free. Another device — the hook — may indeed have had its genesis among butchers. This tool, forged from a long iron bar, had one end curled to form a short, blunt hook. By snagging the hook under the corpse's chin, the diggers could puU the body up and out. Time from start to finish? Most sack 'em uppers bragged one hour flat. Amateur Hour Sometimes anatomists and physicians of the do-it-yourself stripe would attempt to resurrect bodies for their ovvTi use. Such endeavors could be per- ilous, as Thomas Sewall, Class of 1812, learned. Sewall lived in Chebacco, a sec- tion of Ipswich, Massachusetts. There he married and set up practice. And it was there, in the fall of 1819, that Sewall was found guUty of possession of disin- terred bodies. The events that led to this outcome began on a wintry night a year earlier when residents near the town's grave- yard noticed glimmers of hght coming from its grounds. Worries were kindled and within days townspeople were in the graveyard with picks and sho\'els. One family found a distinctive hair chp next to the recent grave of their daugh- ter — ^yet her body, and the hair once moored by the chp, no longer lay in the grave. Others excavated the graves of their departed. A total of eight graves, some dating back to 1811, were found to be unoccupied. Suspicion quickly cen- tered on Sewall — he was known to teach dissection to students in his home — and when identifiable parts of three different bodies were found on his premises, he was indicted for what newspapers of the time called a "most daring and sacrilegious robbery." In No\'ember, Sewall, and his attor- ney, Daniel Webster, were handed the 26 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 Some deterrents were simple telltales— cleverly strewn flowers or a patterning of stones- others, such as tripwires attached to loaded, cocked guns, were dangerous and direct. guilty verdict. Sewall was fined $800, possibly the largest fee assessed for pos- session of an unsanctioned corpse — a body other than that of a criminal's — in the country. No longer comfortable as a member of the Chebacco community, Sewall accepted Webster's invitation to move to Washington, DC. There, Sewall was professionally reborn, helping to found and lead the Medical Department of The Columbian College, which is today the medical school for George Washington University. By the Book The SewaU affair higUights some of the confounding legal aspects of grave rob- bing. By and large, the taking of bodies from graves was not illegal — a dead body was not considered property in EngHsh, and therefore in early colonial, law. Yet the clothing and ornaments buried vidth the dead were protected; their theft was actionable. To honor this fine hne, most grave robbers stripped the bodies they appropriated of all physical goods; their only worry then became the ire of towns- folk who might catch them at their labors. Physicians and medical schools were not exempt from the public's anger, for the anatomists' patronage of the body snatchers fueled an industry that preyed upon their departed neighbors, friends, and famihes. In Massachusetts, an effort to clear the legal ambiguity over the procure- ment of bodies began in earnest in 1815 when the Commonwealth passed a law — the one that led to Sewall's dis- grace and fine — making it a felony to disturb a grave or to receive a body obtained in such a fashion. Punish- ments included a one-year imprison- ment or a fine of up to $1,000. Within two decades, the issue driving the trade — the meager supply of bodies for study — was taken up by Abel Lawrence Peirson, Class of 1816, a member of the Massachusetts Medical Society. Like many of his colleagues, Peirson, a Salem surgeon, was mortified by surgery's association with the grave- robbing industry. In February 1829, he formed a committee to petition the legis- lature to "modify the existing laws which operate to forbid the procuring of subjects for anatomical dissection." By January 1830, a bill had been introduced, but it went nowhere. So Peirsoris com- mittee began the nineteenth- century version of a media campaign — complete with pamphlets, op-ed pieces, and pub- hc debates — that aimed to educate the pubhc on the proposal's merits. Their tactics worked. In early Febru- ary 1831, the legislature requested that a member of the society address the pro- posal at a joint session; John CoUins War- ren, who since his grave-robbing days had become a widely respected surgeon — and the first dean of Harvard Medical School — was tapped to tackle the task. By the end of that month, an act protect- ing the "sepulchres of the dead" and legal- izing the study of anatomy, the first to do so in the United States, had been passed. The rule permitted ci\Tl officials to sur- render any corpse that would have other- wise been slated for burial at public expense, thereby increasing the supply of bodies for study and undermining the resurrectionist trade. The law also helped sever the hnk between dissection and crime that exist- ed in the pubhc mind. Gone was the cen- turies-old judicial fiat for treating dissec- tion and anatomical study as insults to be added to the execution sentences of those guilty of such major crimes as mur- der. And for famihes that for generations had associated the actions of anatomists with the theft and desecration of their loved ones, gone was their need to pat- tern the ground above their departed. ■ Ann Mark Mcnting is associate editor of the Harvard Medical Alumni Bulletin. AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 27 Harvard, Houdini, and ligh society tangled with a surgeoris wife, who nearly fooled them all. BY JESSICA CERRETANI It began, for Mina, as a lark. She sat with her husband and their guests in the dark spring night, holding hands around the table. The air was thick with quiet anticipation, and she giggled nervously. Then, sud- denly, the table began to tilt. ~ The seance had been the brainchild of Mina's husband, Le Roi Goddard Crandon, Class of 1898. Earlier that week, in May 1923, the surgeon had read an account of a paranormal occurrence called table tipping, and he wanted to see whether he could replicate it. He built a table exactly to the specifications in the book and invited friends to a party at the couple's Beacon Hill townhouse. ~ Now, against all logic, the table was rocking back and forth. In an GIVING UP THE GHOST: Mina and Le Roi Crandon conjure the face of a spirit above their heads in this publicity photo. 1^ % / # SOUL SEARCHERS: Mina Crandon poses with members of the Scientific American committee, from left: O. D. Munn, J. Malcolm Bird, and a highly skeptical Harry Houdini. n .JLJ- effort to determine who might be the medium through which the spirits were working, each person left the table; finally, only Mina remained. The table continued to move until she left. The doctor's wife, it seemed, had hidden talents. Until that evening, Crandon had been the more renowned of the couple, having earned the moniker Button Hole Cran- don for his iimovation of an appendectomy technique per- formed through a patient's navel. It may have been this proce- dure, in fact, that brought Crandon and Mina together: The HMS surgery instructor had allegedly met his new trophy vvdfe — number three, for those keeping count — at a Boston hospital when he treated her for appendicitis. Not long after that encounter, Mina divorced her first husband, a grocer, and promptly married the good doctor. She had, no doubt, traded up: A Boston Brahmin who could trace his lineage to one of the original Mayflower passen- gers, Crandon was educated and wealthy. But he was also nearly twenty years her senior, described as arrogant and antisocial. An unfortunate scandal, which stemmed from his misdiagnosis of appendicitis in a patient, had reportedly almost cost him his job. His resulting midlife crisis — during which he married Mina and bought a yacht — combined with his obsession with death, had spurred his new interest in Spiritualism. The movement, based on the belief that mediums can com- municate with the dead, had flourished during the nineteenth century but was still attracting followers in the 1920s. Sir 30 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 Arthur Conan Doyle was the most visible proponent of Spiri- tualism at the time. "I consider the psychic question," the cre- ator of Sherlock Holmes declared, "to be infinitely the most important in the world." With this in mind, Crandon began a correspondence with Doyle, detaihng Mina's apparent powers. Since that first evening, the couple had held regular seances at their home at 10 Lime Street in Boston, and with each one, Mina's abihties seemed to grow stronger: Whatever new phenomena Cran- don happened to read about — abrupt flashes of hght, ghostly music, the appearance of a hve pigeon — his wife was now able to conjure. Her mystical prowess reached new heights one evening, when she charmeled the spirit of Walter, her long-dead brother. Intrigued, Doyle invited the pair to his London home, where Mina so impressed the writer that he deemed her "a very powerful medium" whose psychic gifts were "beyond all question." Before long, Mina had caught the attention of the editor of: Scientific American, J. Malcolm Bird, who extolled her powers in a series of articles for the magazine, concealing her identity with the pseudonym Margery. A year earher. Scientific American had offered a $2,500 prize to any medium who was proved legitimate. Mina seemed a perfect candidate. It didn't hurt that her husband was a prominent Harvard surgeon. Surely a man of science and medicine — presumably interests that tend toward a natural skepticism — would only seek and promote the truth. Siiilu OF'I'i^lf CONDirCTCD her seances dad only in a negligee and silk stockings, but not before her husbanc. had proudly displayed photographs of her communicating — in varying stages of undress — ^with the Great Beyond. Tempting Fate At first glance, Mina Crandon hardly seemed to fit the stereo- type of a medium. The daughter of a Canadian farmer, she had moved to Boston to live with her older brother, Walter, until he was killed in a locomotive accident. Described as "too attractive for her own good," Mina had worked as a secretary, an actress, and even an ambulance driver before marrying Crandon. She often conducted her seances clad only in a neg- ligee and silk stockings, but not before her husband had piqued the interest of their guests by displaying photographs of her com- municating — in varying stages of undress — ^with the Great Beyond. Perhaps it was this very atmos- phere that initially convinced Sckn- tific American's prize committee of her talents. In fact, the group — which included Bird; William McDougall of Harvard University; Daniel Comstock of MIT; Walter Franklin Prince of the Society for Psychical Research; and Hereward Carrington, a psychic researcher — found the Crandons so welcoming that several members took up resi- dence at 10 Lime Street, living and dining with the couple even as they investigated Mina's veracity. This relationship was particular- ly dubious in light of the fact that Carrington had borrowed money from the couple. The editor's objec- tivity may also have been blurred: "Mr. Bird, if he wishes to achieve the authority in psychical research which I invoke for him," advised Prince, "must hereafter avoid faUing in love with the medium." The committee was poised to present Mina with the prize when Harry Houdini heard the news. The magician — who had begun debunking mediums as a side project — ^was a member of the committee but was unaware of the group's investigation. Peeved, he fired off a letter to Bird, demanding to be included. Houdini, aheady skeptical of Mina's abilities, called Bird's arti- cles about her "the worst piffle I ever read." When pushed by Houdini to judge the medium's authenticity. Bird responded, "Why, yes, she is genuine. She does resort to trickery at times, but I beheve she is fifty or sixty percent genuine." A month later, in July 1924, Houdini, accompanied by O. D. Munn, the magazine's owner, arrived in Boston to decide for himself. The Burden of Proof TRICK OR TREAT: Mina Crandon claimed to be able to communicate >vith the dead. That night, Houdini and Munn gathered at Lime Street with other members of the committee to witness Mina's abihties. The hghts were dimmed and the sitters clasped hands and touched their feet together, a method of control that presumably kept the medium from manipulating the table or other objects herself. Soon, the show began. As had occurred at prior seances, the spirit, "Walter," rang a beU attached to a box on the floor. Then he knocked over Mina's cabinet, the three-sided wood- en screen that surrounded her. Finally, he announced he was holding a mega- phone that had been sitting at Mina's feet. At Houdini's request, Walter threw it to him. The other sitters were impressed. Not so Houdini. Mina's performance was, he wrote, "the slickest ruse I have ever detected." He explained the trickery to his colleagues and, later, to the pubhc in a pamphlet entitled 'Margery" the Medium Exposed. The day of the seance, he had worn a rubber ban- dage around his calf, which allegedly rendered his leg painfully tender, allowing him more sensitivity in the limb. This, he claimed, made it easier for him to detect the movements of Mina's own foot when it was pressed against his during control: "I could distinctly feel her ankle slowly and spasmodically sliding as it pressed against mine while she gained space to raise her foot off the floor and touch the top of the box" to ring the bell, he said. Houdini also had explanations for the crashing cabinet and megaphone. Bird had briefly broken control with Mina and left the room, during which time she was able to topple the cabinet with her foot and pick up the megaphone with her free hand. She placed the megaphone on her head like a dunce cap, then jerked forward, tossing it at Houdini's feet. Despite Houdini's claims, the committee continued to investigate the Crandons. The result was aU-out war: Houdini strived to expose Mina as a fraud, while the medium sought AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 31 '■YOU WANT TO KNl# w WH^i it feds like to be a witch? That's what they would have called me in Boston ^50 years ago . . . now they send committees of professors from Harvard to study me. That represents progress, doesn't it?" to make him look foolish. In his quest to prove the hoax, Houdini buUt a large wooden box to constrain Mina, with holes for only her head and hands to remain free. The over- the-top "Margery Box" didn't help either party's case. Mina entered it, but complained that the wood blocked her com- munication with the spirits. Then Walter piped up, accusing the magician of planting a ruler in the box to make it look like Mina had secreted it there to help her move objects. (Houdini had previously accused Mina of holding a stick in her mouth to manipulate objects while her hands and feet were controlled.) Houdini denied planting the ruler — in fact, he charged the Crandons with placing it in the box to make him look bad — but the damage was done. As for Walter, the irritable spirit was incensed by the suspicions of his sister. "Houdini, you goddamned son of a bitch!" he bellowed. "Get the hell out of here and never come back." Houdini did return for one last seance that August. Com- pared to earher sittings, it was uneventful, save for one exchange between the magician and the medium. Houdini had shared with the Crandons his plans to denounce Mina as a hoax at a Boston theater; he had recently added reenactments of tricks used by various defrauded mediums to his traveling stage show. If he misrepresented her, she warned, her friends would give him a good beating. Blithe Spirit All threats aside, what happened next was rather anticlimac- tic — at least at first. Scientific American refused to grant Mina the prize, a disappointment that likely hurt her ego more than her purse; the Crandons had planned to donate the money to Spiritualist causes. Bird resigned from the magazine and began promoting the Crandons. Houdini continued with his stage shows. In January 1925, Doyle published an article in the Boston Herald criticizing Houdini and defending Mina, whom he termed "a most charming and cultivated lady." For her part, Mina went on with her seances, adding new elements — including ectoplasm, a phosphorescent material that seemed to pour from her orifices during spirit commu- nication — to the mix. It was this ectoplasm that attracted the attention of other psychic experts. The English researcher Eric Dingwall attended a seance with Mina dur- ing which the ectoplasm appeared. At first an excited believ- er, Dingwall soon turned skeptic: The Crandons never allowed the ectoplasm to be viewed in full light, it didrit move unless Mina threw it, and, upon further study, it "strongly resembled the cartilaginous rings found in the mammalian trachea" — a substance that Crandon could easi- ly obtain in his work as a surgeon. Later that spring, a group of faculty members from Harvard — including HMS pathology professor S. Burt Wolbach, Class of 1903 — visited Lime Street to observe the medium in action. The group took part in six seances and at the time mentioned no apparent trickery. Yet they revealed their true findings in an article pubhshed in the November 1925 issue of The Atlantic, including the observation that Mina had at one point freed both her hands from control and removed objects from "the region of her lap." StiLl, they noted, an "internal search of the medium has never been permitted." The faculty members' final conclusion was that "trickery accounted for all the phenomena" they had witnessed. That finding, though, was of httle concern to Mina. "You want to know what it feels Kke to be a witch?" she asked. "You know that's what they would have called me in Boston 150 years ago . . . now they send committees of professors from Harvard to study me. That represents progress, doesn't it?" Dead Reckoning In the midst of these investigations, a curious thing hap- pened; Houdini died. The athletic magician had been punched repeatedly in the stomach by a college student whom he had dared to test his abdominal muscles. A few days later, on Halloween 1926, Houdini died at the age of 52. The cause of death was a ruptured appendix. The death came as a shock — to almost everyone. Two years earher, Houdini's friend-turned-nemesis Doyle had predicted that he would "get his just desserts very exactly meted out," while Walter himself had announced at a recent seance that the magician would be dead within the year. Houdini, Cran- don later concluded, "had been dealt with by the spirits for activities against the movement." Threats are one thing, forensic proof is quite another, par- ticularly when a maris death certificate notes the location of his appendix as his left, not right, side. In 2007, an effort — since aborted — began to exhume Houdini, sparked by theories that he had been poisoned. The chief suspects? The Crandons. The Myth of Fingerprints He may have died, but Houdini's suspicions about the Cran- dons li^'ed on. Subsequent im'estigations came to similar con- clusions as those of the Scientific American and Harvard groups, including a report by Joseph Banks Rhine, who would later found Duke University's Parapsychology Lab. Rhine was convinced Mina was a fraud, suggesting that "it is e\'idently of very great advantage to a medium, especially if fraudulent, to be personally attractive; it aids in the 'fly- catching busi- 32 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 GHOST IN THE MACHINE: Houdini's "Margery Box," meant to prevent the medium from moving during seances, only served to fuel the controversy surrounding the Crandons. "tifM ness.' " Doyle, still a staunch supporter of the Crandons, fired back by purchasing advertising space in the Boston papers, in which he simply stated, "J. B. Rhine is an Ass." Mina paid no heed. By 1928, she had a new psychic talent to promote; Walter now claimed he could leave a fingerprint in wax to prove his presence. Indeed, following a seance, two prints appeared in a basin of dental wax in the room. Refusing to take the prints at face value, Crandon called on John Fife, an acquaintance he identified as the chief of police at the Charlestown Navy Yard and an expert on fingerprints. Fife confirmed that thumbprints found on the dead maris razor matched perfectly the prints in the wax. Emboldened by the findings, Crandon enlisted another friend, E. E. Dudley, to catalog all prints left by Walter in future seances. Dudley obhged, but took it upon himself to collect prints from all the sitters at Mtna's seances as well, to disprove critics' claims that the prints had been left by a living person. There was just one problem: They had been. To his surprise, Dudley realized that "Walter's" prints were identical to those of one Frederick Caldwell — Mina's dentist and friend. The apparently unwitting man had given the medium an imprint of his thumb as an example when he showed her how to use the dental wax he provided. Mina, it appeared, had then made a mold of the print and used it to create her dead brother's supposed prints. Later investigation of Fife revealed that no one in the poHce department had ever heard of him. This time, the evi- dence of fraud was clear. Unhappy Medium Mina's downfall was as sudden as her meteoric rise had been. Although she continued her seances for some time after the fingerprint fiasco, when her husband died in 1939 she became depressed and alcoholic. She even attempted to jump off the roof of her house. Her distress, perhaps, was root- ed in the fact that she'd lost her best audience: Crandon himself. " 'Margery' might take a chance and confess if Crandon did not firmly believe," W S. Griscom, a Boston Herald reporter and mutual acquaintance of the Crandons , _. and Houdini, once wrote to the magi- cian. "She knows it would end all their relations and she doesn't dare do it." While Crandoris interactions with Fife suggest he was com- phcit in the scheme, Griscom wasn't the only one who was con- vinced the surgeon wanted to beUeve in his wife; the Harvard investigators and other researchers posed similar theories. The couple, they suspected, had engaged in a sort oi folic ci deux that benefited them both in very different ways: The seances dis- tracted Crandon from his preoccupation with his own death, played to his sense of discovery, and bolstered his ego. And they made Mina a star, transporting her from mere hausfrau to Spiritualist celebrity — and likely kept her husband's eye from wandering to potential trophy wife number four. That star had faded by her final days: one visitor described her as a "dumpy little woman," hardly the neg- ligee-clad beauty of decades earlier. Yet Mina's air of mys- tique remained intact. On her deathbed in 1941, the medium was encouraged by yet another psychic researcher to finally confess and divulge the tricks she had used during the seances. After first suggesting that the questioner go to hell, she blithely added, "Why don't you guess? You'll all be guessing — for the rest of your lives." ■ Jessica Ccrretani is assistant editor of the Harvard Medical Alumni Bulletin. AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 33 4<Ste«, X ■**«;«;#■ ..::JW ^ Phincas Gage wiisn t the only nineteenth eentury worker with a blast to the brain — and a connection to HarMirc xMec leal School. - by william ira bennett 34 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 Every Harvard medical graduate knows the story: In 1848 Phineas Gage was tamping explosive powder into a rock in Vermont. The powder exploded prematurely and blasted an iron tamping rod out of Gage's hands and through his forehead. The railroad construction foreman famously survived this primitive lobotomy, with some possible deterioration of his per- sonality to become one of the great medical curiosities of his day. Harvard Medical School's Warren Anatomical Museum, which was only a year old when the accident occurred, soon acquired a plaster cast of Gage's head. In 1867, seven years after his death. Gage's mother was prevailed upon to give her son's skull and the tamping rod to the physician who had treated him. The doctor donated the skull and the rod to the museum as teaching tools for medical students, creat- ing the museum's most famous exhibit. Yet for several days in 1868, M. Jewett, an Ohio physician, attempted to upstage the Phineas Gage exhibit. That year, some- where near Akron, a coal miner named Noel Lenn suffered a similar accident. A gas pipe was driven through two thicknesses of his cap in front, his right forehead, the front part of his brain, then back out of his skull a bit forward of his left ear, and finally through a third thickness of cap. With great presence of mind, and considerable strength, Lenris mate extracted the bent pipe and got the injured man home. In the ensuing days the doctors caring for Lenn removed a good deal of "coagulated blood and broken up brain" from the site of the wound — and incidentally purged him of a I7-foot-long tapeworm. The miner, who had studied for the priesthood in his native France, survived, but his faculties were slow to recover. "He holds no conversation either in French or Enghsh," Jewett wrote to Henry Jacob Bigelow, Class of 1841, a prominent surgeon and HMS professor who had studied Gage and other cases of brain trauma. "To my request that he go home with me and work in my garden he rephed, 'No sir-ee,' the largest number of words I have heard him connect since the injury." Jewett facetious- ly added that Lenn "could not realize any- thing from the sale of any books." Leim was by then "physically as well as ever but very averse to labor." He was, therefore, something of a burden to the community where he was hving. And this was what prompted Jewett to contact Bigelow. What is remarkable about the correspondence between the two is its very matter-of-factness. "What think you," Jewett asked Bigelow, "of the idea of taking him to Boston for a permanent residence in a museum? Have you any Barnum?" Jewett proceeded to offer Lenn to Bigelow for study, proposing that the man be installed in the museum as a living exhibit, his mea- ger needs to be supphed by revenue from the curious public and, perhaps, from physi- cians with a commitment to learning. The animate component of the exhibit would be accompanied by cap, gas pipe, and, as an added attraction, the preserved tape- worm. If the Harvard people weren't interested, Jewett cagUy suggested, "per- haps the faculty in Paris would be glad to take him in charge." Bigelow hastened to reply that the eco- nomics of displaying Lenn in a museum were utterly unfavorable. If anyone could have made a hving at it, Bigelow wrote, it would have been Gage, "a shrewd and intel- hgent man and quite disposed to do any- thing of that sort to turn an honest permy," who had "tried it for a short time at New York at Barnum's" but failed to support himself. "As for the Paris faculty collective- ly or singly," he added, "money appears to be the one thing in least abundance and in most demand among them." Bigelow then made a counterproposal: If Jewett would bring Lenn to Boston, Bigelow would arrange for the man to be kept at an appropriate institution. Bigelow would attend to any financial obhgations that might arise, in return for which he would have the exclusive right to study Lenn at his leisure. This arrangement was, of course, to be kept confidential. Jewett quickly assent- ed, though he noted that Ohio had a law against bringing paupers into the state or taking them out. But in this case he thought there should be no diEiculty. In due course Jewett arrived with Lerm for a meeting of the medical society. The Warren Museum eventually acquired exhibits 952 (a cast of Lenris head) and 3107 (the gas pipe). Lerm himself was deposited in the Taunton Lunatic Hospital for several years, then transferred to the Tewksbury State Almshouse, from which he absconded in 1874 with his skull still inside his head. He was not heard from again. ■ William Ira Bennett '68, a psychiatrist in private practice in Cambridge, Massachusetts, served as editor-in-chief of the Harvard Medical Alumni Bulletin from 1995 until earlier this year This account was excerpted, adapted, and reprinted with permission from an article Bennett published in the July-August 1987 issue o/ Harvard Magazine. sdmsRh Corpses plucked from graves, murder conducted by mail, chivalry gone aw^ry — ^w^hat 227-year-old institution doesrit have a fev/ skeletons clattering in its closets? Test your w^its on these shocking stories from Harvard Medical School's history BY PAULA BYRON Webster Murder Most Foul George Parkman's prominent chin had always given him an air of determination. But as the gaunt, nearly skeletal physician climbed the steps of Harvard's medical college on the morning of November 23, 1849, the thrust of his jaw was more pronounced than usual: He was hellbent on collecting a long-standing debt from Professor John White Webster. Sadly, Parkman failed in his mission. He also failed to leave the building alive. For weeks Boston's citizens scoured the neighborhood for signs of the missing doctor. Finally, at the prompting of a suspicious janitor, authorities recovered Parkman's remains from Webster's chemistry laboratory. Upon his arrest, Webster, a member of the Class of 1815, swallowed a strychnine pill. He went on to survive his suicide attempt only to endure, in March 1850, one of the more sensational murder trials of the nineteenth century. His feUow professors provided the forensic evidence needed to convict him. In the weeks before his death by hanging, Webster confessed, at the urging of a local minister, to having fatally struck Parkman during a heat- ed quarrel over the debt. ^ ^ After that, Webster stat- ed, "All I could see was the need to conceal Dr. Parkman's body in order to avoid the blackest disgrace." 1. Where in the laboratory was Parkman's body found? A. The hole beneath Webster's privy B. A large wooden tea chest C. The furnace D. All of the above 36 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 Nursed to Death Apart from her penchant for poisoning patients, Jane Toppan was, by most accounts, an excellent nurse. Her tender ministrations, astonishing efficiency, and ebullient personality kept "Jolly Jane" in constant demand as a private nurse in Cambridge, Massachu- setts, during the late nineteenth century. These wel- come traits, however, masked a dark, considerably less convivial one — ingenuity in administering morphine and atropine in varying lethal doses. This sinister twist on caregiving enabled Toppan to murder dozens of people and yet remain undetected for 16 years. Despite her outward joviality, Toppan nursed grudges. She resented her foster mother, who had abused her, and her foster sister, whose life seemed charmed. No doubt irked that the mother died of natural causes, Toppan dispatched the sister by slipping her a morphine-spiked tonic. But hostihty was not Topparis only motive. She mur- dered one friend because she coveted the friend's job, a landlord because he had grown "feeble and fussy," and countless patients because she wanted to see how their nervous systems would respond to different poisons. Others she murdered for the sexual thrill — or "voluptuous delight" — she felt in the presence of the dying. Dispensing poison, she would later confess, had simply become a habit. With each murder, Toppan grew bolder and more reckless. In 1901, she killed a dear friend, then the friend's grown daughter. "I went to the funeral and felt as jolly as could be," she exulted, after the second death. "And nobody suspected me in the least." But when Toppan went on to murder the friend's husband and other daughter just weeks later, suspicious family members requested toxicology tests. That's when Top- pan attracted the attention of Harvard Medical School. Harvard was not a new presence in Toppan's life; she had received her advanced training at an affiliated hospital. Yet supervisors at Massachusetts General Hospital had discharged her from the nursing school — amid rumors of falsified charts, petty thefts, and out- landish lies — and had refused to issue her a Ucense. Now, more than ten years later, an HMS professor, 0- Edward Wood, found the evidence needed to indict her, and four HMS graduates helped ensure her incar- ceration, first in jail, then in a mental institution. "Something comes over me," she once told one of those graduates, Henry Rust Stedman, the psychia- trist who diagnosed her "moral insanity." "I don't know what it is. I have an uncontrollable desire to give poison wdthout regard to the consequences." After confessing, in gleeful detail, to 31 murders and vaunting her ambition to have "killed more people — helpless people — than any other man or woman who ever lived," Toppan was committed to the Taunton Lunatic Hospital for life. There she died, decades later, snow^ haired, docile, and unrepentant. In the early years, though, Toppan had proved a difficult patient: At mealtimes her attendants had needed to resort to placing her in a straitjacket and force- feeding her. 2. Why did Nurse Toppan refuse to eat? A. She was convinced someone was trying to poison her B. A strict dietician with her own patients, she refused to eat the unwholesome hospital fare C. She wanted to lose the 50 pounds she had gained in jail D. She was staging a hunger strike in hopes that the hospital warden would agree to let her join the nursing staff AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 37 A Fine Delicacy when Elizabeth Blackwell, the first woman to earn a medical degree in the United States, enrolled in New York's Geneva Medical College in 1 847, she was, according to a Boston Medical and Surgical Journal editorial, "a pretty little specimen of the feminine gender." She would arrive in the classroom with great composure, remove her bonnet ("exposing a fine phrenology"), and take assiduous notes. "The effect on the class has been good," the editorial concluded, "and great decorum is preserved while she is present." Emboldened by Blackwell's example, hlorriot Kezio hlunt applied to hiarvard Medical School that same year, including with her application a copy of the editorial. But Harvard found the idea of a woman settling into medical studies too unsettling. Sixty-five years after the School's founding, the fHarvard Corporation concluded that it would be imprudent to begin enrolling women. Three years later, encouraged by Blackwell's graduation, hlunt again applied to the School. The faculty voted to admit her, and the Corporation affirmed that vote. But this time the medical students protested, citing possible "feminine interference" with their studies. No woman of true delicacy would be willing to attend medical lectures with men, they declared, adding that they were loath to mix with any woman who had so "unsexed" herself and "sac- „. ^ rificed her modesty." Threats against hlunt ended only after faculty leaders convinced her not to attend. During the ensuing decades, appli- cations from other women met with rejection. Donations as high OS $50,000 were offered as sweeteners; those too were rebuffed. It was only when a world calamity caused grave staff shortages in Harvard's teaching hospitals that women were at lost allowed to attend the School. What world calamity finally prompted Harvard Medical School to begin admitting women to its student ranks? A. World War I B. The 1918 flu pandemic C. The Great Depression D. World War II 11 Evasion of the Body Snatchers Harvard medical students of the early nineteenth century were expected to further their education by taking lecture notes, undergoing an apprenticeship, and — in the predawn hours — unearthing corpses from freshly dug graves. John CoUins Warren, the first dean of the medical college, encouraged his students to supplement the insti- tution's meager supply of cadavers — and emulate his own youthful example — by staging night raids on ceme- teries. In one escapade, two students watched the burial of an almshouse resident, then marked the grave. Soon after midnight, they returned to the cemetery to disinter the body. But just as they were about to load their plun- der onto a wagon, several guards sprang upon them. In another grim caper, a student celebrated for his talent in procuring bodies returned to the grave he'd marked earlier only to find himself in the hostile clutches of ceme- tery watchmen. 4. What did these three medical students do to escape prosecution? A. Drove about until morning, then returned to town with an air of innocence B. Fled, then hid under a pile of wood shavings C. Met the charges with great indignation and insisted that the watchmen were conspiring to extort money D. All of the above 38 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 Message in a Bottle Josephine Barnaby agreed that the whiskey was vile, peeled the flypaper from his cell ceiling, soaked the yet she sipped it anyway. Within minutes, she was strips, and ingested the arsenic -tainted residue. gasping in agony. Within days, she was dead Barnaby had received the arsenic-laced whiskey while on vacation in Denver in April 1891. The package carried a Boston postmark; the bottle's label bore an unsigned greeting. "Wish you a Happy New Year," it read. "Please accept this fine old whiskey from your friend in the woods." As she lay dying Barnaby tried to imagine who would want to kill her. Finally, she voiced the unthinkable. "Can it be possible," she whispered to the friends gathered around her, "that Dr. Graves could do such a thing?" Thomas Thatcher Graves, Class of 1871, had a talent for ehxirs — and a predilection for wealthy dowagers with nervous conditions. In Barnaby he had found his ideal patient, and he soon made himself indispensable. When her husband died leaving her a pittance, Graves helped her challenge the will and gain a handsome settlement. She named him a beneficiary in her new will, and he promptly took over her financial affairs. His ever-tightening control made her balk, though, so he threatened to place her in an asylum. She in turn made plans to change her will. And then the mysterious package arrived. Colorado authorities didn't take long to name Graves their chief suspect in the widow's murder. After a sting involving a Pinkerton detective, he was imprisoned, tried, and comdcted. But before he could be hanged, the state supreme court set aside the ver- dict on technicahties and ordered a new trial. Graves had found the first trial harrowing, and he could not bear the thought of a second one. So, on September 2, 1893, his jailers later reported, he Near his lifeless body was a suicide note dated, oddly, months earlier. "Please don't hold any autopsy upon my remains," Graves had written to the coroner. "The cause of death may be rendered as follows: 'Died from persecution — worn out — exhausted.'" A second letter to the public protested his innocence. Indeed, not everyone was persuad- ed of the doctor's guilt. Other sus- pects abounded — Barnaby's vengeful and violent son-in-law, her quarrel- some friend, her conniving secretary, even the doctor's mentally unstable wife. And not everyone remained convinced of Graves's death. The following year several newspapers printed the rumor that he had absconded to Brazil, leaving a wax double of himself on his cell cot and bribes in the pockets of his jailers. Other clues fueled that speculation: his widow's refusal to allow his remains to be embalmed, her later disappearance, and witnesses' claims that his casket, when opened at the gravesite against his widow's protests, did not contain his corpse. 5. What, according to this rumor, did Graves's coffin hold instead? A. The body of a fellow inmate wfio'd had the misfortune to resemble him B. Three hefty sandbags C. A pine log D. A wax replica of the doctor, complete with mustache and beard D S- QV QZ V 2 a L :Xs>| JSMsuy AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 39 the flirtatious - and other medical mysteries ~ BY JONATHAN A. EDLOW What caused a boy's eye to dilate suddenly? A kindergartner to start bumping into furniture? And a banker's lung cancer to disappear? An emergency physician turns to the case files to depict doctors as detectives. 40 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 ^^. Wl •^^^P .-^'^-' M4 M ■// yfi I <■ »i ^''^'^ "^^"•^Sk^ r»«w#/ ,594i3««crj-^ V:^ >J?- ^J«^!' /, %W- '"^X , i f/4^ it IfS- - / / '^', t^ljpi^V; '^t.'*.;!**?*"' .-- '^^^■ ^dlK— rv:;^^^' J-**^^;- %! — ». -"^iiit^***, ; '. '7/,'' ■■■■'■'' Saif' HAT *> c •V- -a%^-«i«».. ■; > 'i fil i«l^^ ;^-^ -''-^•flri^j^ i»i^ iSCT'^ L'5^-^ #r- 0>3^:r-^ .--^ v> :.^* ;/'• '^ ny mediiMillP9Sf§(ries are easily solved: A man shovels iieavy vv^et snow, develops chest pams, and rushes to an emer- gency department, w^here an electrocardiogram shows a heart attack. Sometimes, though, doctors face far trickier dilemmas. Clues lead to dead ends. A failed treatment proves a presumptive diagnosis false. Or the diagnosis is definitive, but the cause remains elusive. In the following stories. Harvard doctors reveal how they cracked challenging cases. UNDER PRESSURE Five-year-old tuisa Alvarez Ruiz arrived at the emergency depart- ment of Children's Hospital Boston with a persistent headache. She had some nausea and sensitivity to light, but no vomiting. Her parents couldn't identify any triggers for the headache, and they insisted that she wasn't taking any med- ications. The pain, they said, seemed to wax and wane over the course of the day. Their daughter had no history of head trauma, no recent illnesses, and no family history of headaches. But lately her parents had noticed that Luisa, who lived with her grandmother every other month, had grown clumsy and was bumping into things. The standard tests revealed nothing worrisome, and Luisa's physical exami- nation was normal. But her headache had persisted for several months, so the emergency pediatricians ordered a neu- rological consult. "That was the point where I became involved," says David Urion, a pediatric neurologist at Childreris Hospital Boston and an HMS associate professor of neurol- ogy. His examination of Luisa uncovered only one unexpected finding: He couldn't detect the normal pulsations of her reti- nal veins. Yet without papilledema — a swelling of the optic nerves caused by increased intracranial pressure — he couldn't teU whether the absence of those pulsations indicated a problem. It did sug- gest, however, that Luisa's pain was not a minor, primary headache disorder. And her history of bumping into things made Urion worry about the possibihty of an infiltrating tumor. So he ordered an MRI. "The initial report showed 'something funny,' " Urion says. "The neuroradiolo- gists huddled around her scans as if in Tahnudic discussion." That "something funny" turned out to be a strange bright- ening of both optic nerves. After requesting an ophthalmology consult, Urion received a stunning find- ing: Luisa was almost blind. Her \dsual acuity was 20/400 in her left eye; in her right eye, she had barely any vision. 42 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 It didn't take the mage nurse long to make notations in Shawn Matthews's chart: The ten-year-old had been playing in his room when he was seized by a sudden headache and blurred vision. His vital signs were normal, but his left pupil was markedly dilated. "Before I even stepped away from the chart rack," recalls Gary Setnik, chair- man of the Department of Emergency Medicine at Mount Auburn Hospital, "I was considering all the possible causes of headache and dilated pupH. Most of them were bad." Shawn was sitting on the examination table with his parents and a younger sis- ter clustered around him. Like the triage nurse, Setnik instantly noticed that the boy's left pupil filled the iris. Yet Shawn's parents reported that their son had always been in excellent health. He had never had an eye injury, he took no medications, and he hadn't used eye drops. So Setnik turned his attention to the boy's nervous system, concerned that a cerebral artery aneurysm could be to blame. He checked Shawn's sensation, strength, and balance. He placed his stethoscope on the child's head to check for bruits — whooshing sounds that would indicate a tangle of abnormal cere- bral blood vessels. He peered into Shawn's retinas to look for signs of brain swelling or bleeding. He checked Shawn's neck for stiffness, an indicator of inflammation in the subarachnoid space, where the cerebrospinal fluid resides. All the tests were normal. "I was struck by how well he looked," Setnik says. "It was just my gut feeling that he wasn't sick." Then Setnik realized that Shawn's lop- sided gaze looked familiar. Five years ear- her, a graduate student had come into the hospital with one dilated pupil. While working in a chemistry laboratory, he had accidentally spiUed atropine on his finger, then absentmindedly rubbed his eye. "Somehow," Setnik says, "the two cases linked up in my mind." Atropine is an alkaloid extracted from the Solanaceae family of flowering plants, whose most infamous member, Atropa belladonna, or deadly nightshade, has a long history of use as a medicine, a poi- son, and a cosmetic. Itahan for "beautiful lady," the species name, belladonna, derives from a popular practice during the Renaissance, when women would dab the juice of the berry into their eyes, knowing the chemical would dilate their pupHs — and hoping it would increase their allure. "In medicine, we feel about 80 per- cent of diagnoses can usually be made by the history alone," says Setnik. "So I started over." Was there any possible way, he asked Shawn's parents, that the boy could have gotten something into his eye? Was anyone else in the family using eye drops? Were there any old medications in the house? Suddenly Shawn's mother looked up and said, "Oh, my God! What are we putting in Fluffy's eyes?" "It turns out," Setnik says, "that Fluffy was the cat, and she had some type of eye problem that the veterinarian was treat- ing with an ointment." Then Shawn remembered: Right before developing his headache. Fluffy had rubbed up against him and demanded to be petted. "I hterally said, 'That's it!' " Setnik says. He asked Shawn's mother to retrieve the cat's medication. A half hour later, she returned with an aluminum tube whose label read "1 percent atropine." Like the absentminded graduate student, Shawn had touched his eye, transferring traces of the ointment from the cat's fur. "I told the family that Shawn's pupil would likely stay dilated for seven to ten days but that his eye would ultimately be completely normal," Setnik says. What had seemed like a medical crisis was nothing more than a brush with an affectionate pet. ■ wmi^'k:^^c>i>::i Now Urion ordered a lumbar punc- ture, and the results gave him the clue he needed. Luisa's cerebrospinal fluid was clear. The protein and glucose levels were normal, and there were no abnormal cells or bacteria. But the pressure in her skuU was two and a half times the normal level. "Now we had a diagnosis — pseudo- tumor cerebri, which occurs when intracranial pressure increases for no obvious reason," says Urion. "But it was a diagnosis that only raised another series of questions. To have that diagnosis in a skinny five-year-old was pretty unusual in itself." Also known as idiopathic intracranial hypertension, pseudotumor cerebri, a rare condition, is most often seen in overweight adult women. Urion quizzed Luisa's parents again. Were they sure she took no medications? Did she have access to the medicine of other household members? "The family took a Uttle umbrage at our repeated questions," Urion says. Finally the family asked what could cause the con- dition, and Urion gave them a hst. They stopped at the word vitamins and asked, "Could fish oil have these vitamins?" The next day, Luisa's grandmother brought in a bottle of Smith's Fish Emul- sion. Every other month, for more than a year, the grandmother had poured Luisa a tablespoon of the fish oil, giving her the recommended daily dose — for an adult — of vitamin A, supplementing what Luisa already received in her normal diet. The child had acute vitamin A toxicity. Luisa underwent multiple lumbar punctures and took diuretics to reduce the pressure. Not only was further loss of vision halted, but Luisa also recovered some of her eyesight. She stiU has occa- sional headaches. What the case taught him, Urion says, is the importance of teasing out medical histories. "Four of us, all good doctors, had asked about medication ingestion," he says. "But none of us had asked the question the right way. The family finally helped us out by asking us directly, 'what are you worried about?' That helped us to be more direct with our questions and to get the right answer." ■ AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN THE CASE OF THE DISAPPEARING CANCER The doctor pulled Phillip Bradford's wife into the hospital corridor to dehver the news: The odd nodules on her husband's chest x-ray suggested lung cancer. He needed a thoracotomy — the surgeons would open his chest up like a clamshell — so the suspicious tissue could be biopsied. But when he learned the diagnosis, the SS-year-old patient wasn't frightened. "I simply didn't believe that's what I had," he says. "I was healthy and a non- smoker. I wanted a second opinion." Earle Wilkins, Jr. '44, then a senior thoracic surgeon at Massachusetts Gener- al Hospital, remembers the case clearly, despite the passage of three decades. "I was struck by two things," he says. "First, if this was metastatic cancer to the lung, I could detect no primary site. And second, one of the nodules on the latest . . jais*efiigKye.g5^vai,m3ias^^ij£L&SKM:iL^i^ ■^Mj^&ijmmmmmmmjsmgsissimimssiiaaif^smL 44 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 x-ray seemed slightly smaller than it had been on the previous film. If that was true, a cancer would be unlikely." The thoracotomy was cancelled. Bradford improved and remained well for almost a year. But then he started coughing and ruiming a fever, displaying all the symptoms that had first brought him to the doctors' attention. Once again, his chest x-ray blossomed with ominous nodules; several weeks later, as with the previous episode, his symptoms mysteri- ously vanished. This time, Wilkins sent Bradford to Robert Rubin '66, then an infectious dis- ease speciahst at Massachusetts General Hospital and now associate director of the Division of Infectious Disease at Brigham and Women's Hospital. Rubin reasoned that if the nodules that appeared on the x-rays were always in the same location, a chronic structural or anatomical lesion within the lungs would be the likeliest cause. Each x-ray showed, however, that different episodes affected different parts of the lungs, sug- gesting an environmental trigger. "And because none of the multiple tests had revealed the presence of a microbe that might have been the culprit," Rubin says, "the question of hypersensitivity pneu- monia immediately arose." Hypersensitivity pneumonia occurs when a lung becomes inflamed after breathing air that contains organic dusts laden with such biologic stow- aways as mold, fungi, bacteria, or spores. Although these substances are not nec- essarily as toxic or invasive as the virus- es and bacteria that cause typical infec- tious pneumonia, the immune system still perceives them as foreign invaders. Within hours of being exposed to these dusts, people with hypersensitivity pneumonia often develop symptoms — including fever, chills, headaches, cough, and shortness of breath — that can be easily misdiagnosed as flu, bronchitis, another kind of pneumonia, or, in rare cases, lung cancer. Among the more important agents of biological decay are thermophihc actino- mycetes, the primary decomposers of such tough plant materials as bark, leaves, and stems. Exposure to spores from these bacteria place farmers, pigeon breeders, and parakeet fanciers at H lis chest x-ray blossomed with ominous nodules; several weeks later, his symptoms mysteriously vanished. elevated risk for hypersensitivity pneu- monia. People who harvest sugarcane and coffee beans, cure tobacco, or work with wood dust, cheese, maple bark, mushrooms, soybean feed, or barley can develop the syndrome as well. Bradford, though, did not farm, breed pigeons, or harvest sugarcane. He worked as an executive in a banking firm. "I questioned Bradford at length about humidifiers, his home heating sys- tem, and hobbies," Rubin says. "But I couldn't come up with any exposures that would account for his symptoms." Finally, Rubin's extensive questioning uncovered a clue: The symptoms had begun shortly after Bradford's firm had moved into new office space. The theory, though, had at least two glaring problems. Bradford went into the office every day during the workweek. Why would the symptoms be intermit- tent? And why weren't his colleagues get- ting sick? 'When Rubin checked the mainte- nance records of the office building's HVAC system, he found that the air ducts had been blown clean twice. And the schedule jibed perfectly with the appearance of Bradford's symptoms. Rubin's next step was to send a sample of Bradford's blood for analysis. He ordered a precipitin test to determine whether any antibodies in the blood would clump — or precipitate — ^with an antigen from the bacteria. The blood test was negative. But Rubin persisted. "I didn't have much faith in the test," he says. "If it's positive, great, but if it's negative, that doesn't necessarily mean anything." So he checked the ducts himself. "I put on work clothes and climbed up a ladder," he says. "I took samples and swabs from many areas, especially wet ones." Next, Rubin smeared the material onto culture plates. Within days, ther- mophihc actinomycetes were thriving in the culture. Every sample, from every site tested, produced them. During this phase of the investiga- tion, Bradford inadvertently inhaled another dose of air from the ducts and promptly developed mild symptoms again. Another set of x-rays showed a reappearance of the same ominous nod- ules, clinching the diagnosis. But Rubin had one last mystery. Why hadn't Bradford's fellow office workers also become sick? The full answer to this question remains elusive, but other building-related clusters of hypersensi- tivity pneumonia have shown the same phenomenon, suggesting that an indi- vidual's degree of exposure and genetic predisposition both play roles in deter- mining who gets sick. After Rubin's investigation, the build- ing's ducts were thoroughly cleaned. And Bradford, who worked in the buHding for four more years, never had another bout of the pneumonia. "If I get any credit as the patient's first physician," said Wilkins during a clinical case conference later held at Massachusetts General Hospital, "it is for picking a detective as well as a physician to take over this diagnostic problem." ■ Jonathan A. Edlow, UD, FACP, is vice chair- man of emergency medicine at Beth Israel Dea- coness Medical Center and an associate profes- sor of medicine at Harvard Medical School. These stories were adapted with permission from his most recent hook. The Deadly Dinner Party & Other Medical Detective Stories (Yale University Press, 2009). Edlow is also the author of Bull's Eye: Unraveling the Medical Mystery of Lyme Disease (Yale University Press, 2003). The names of the patients in these stories are pseudonyms. AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 45 A game- changing Harvard program sparks collaborations among disparate researchers. BY Jessica Cerretani ^Hw!" Despite their ties, Harvard-affiliated hospitals have historically competed with one another — for faculty, patients, and fiaancial support. This sense of rivalry has meant that the thousands of researchers throughout the School and its hos- pitals felt not just a physical separation but a symboUc one, and they had little motivation to interact with one another. That culture has been changing, however, and in the past two years, a compeUing new force has helped unite investigators around one crucial com- mon goal: to cure human illness by translating basic laboratory research into patient care. The Harvard Clinical and Translational Science Center, better known as Harvard Catalyst, 46 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 now sparks innovative collaborations among researchers — not just among scientists at HMS and its seventeen affiliated hospitals and institutions, but also throughout Harvard Universi- ty's eleven schools. It's a stunning achievement, but one that HMS Dean Jeffrey Flier believes comes naturally to investigators. "We operate on the belief," Flier says, "that the people here want to come together because they really want to make those discoveries that save lives." In a test of that conviction, Flier approached Harvard's affiliates in 2007 to persuade them to collaborate with the shared purpose of advancing clinical research. In truth, the affiliates didn't have a choice; The National Institutes of Health (NIH) had announced that it would be phasing out the individual clinical research grants historically awarded to Harvard's teaching hospi- tals. Instead, Harvard would have to apply for a five-year, $117.5-million award to be shared by HMS and its affiliates. Faced with the prospect of The team coined an inspired name for the clinical and translational science center: Harvard Catalyst. The new title evokes images of laboratories, energy, and innovation — and that's no accident. losing tens of millions of research dol- lars, this competitive community had to come together. The University and its affiliates would need to cede con- trol of the grant money — and therefore of publicly funded clinical research — to HMS. "We needed unprecedented support from the University and the hospitals," says Flier. "And we got it." HMS also got the grant — no small feat, considering that the team, spear- headed by Lee Nadler 73, dean for clin- ical and translational research at HMS, had just a hundred days to craft the proposal. But getting the grant meant the real challenges had just begun. "The grant was approved on a Thurs- day," Nadler says. "That Sunday morn- ing I got a call from the NIH telling me, 'Okay, you're funded. Start spending.'" Bright Ideas It was a massive undertaking, but one that HMS was eager to tackle. This spir- it of collaboration and discovery drove the School's approach to the new Har- vard Clinical and Translational Science Center — admittedly not the catchiest of titles. "During our first few weeks of funding, it was hard to explain to people what the center actually was," says Nadler. So the team coined an inspired name for it: Harvard Catalyst. The new title evokes images of laboratories, ener- gy, and innovation — and that's no acci- dent. "All the components necessary to make an impact on human iUness already exist at Harvard," Nadler explains, refer- ring to the more than 17,000 investigators at the University and its partnering institutions. "Unfortunately, few of those components have been in the same 'reaction vessel,' leaving our potential wtually untapped." The solution was clear: encourage researchers to forge novel alliances by eliminating obstacles to such collabo- rations — in short, unite those researchers in one large reaction vessel. Key to this process has been the cre- ation of Harvard Catalyst's website, which connects researchers and facili- tates teamwork by detailing investiga- written in th l»TARS Most people approach the prospect of an MRI exam with o sense of dread. The coffin-sized quarters and timpani-like racket of the machine conspire to create an environment that can make even the least claustrophobic patient uncomfortable. Now, an innovation by Ronald Walsworth and his group at the Harvard-Smithsonian Center for Astrophysics in Cambridge, Mass- achusetts, has the potential to make the process more tolerable — and accessible. Their open-access, walk-in, low-magnetic field MRI system lets patients be scanned while sitting, standing, or lying down, a modification that not only promises to ease nerves but also allows for more precise imaging of blood flow and airflow, which depend on posture. The idea for the scanner came to Walsworth, a senior lecturer on physics at Harvard and senior physicist at the Smithsonian Insti- tution, some 15 years ago when he was developing atomic clocks, which use noble gases like helium and xenon to provide precise measurements of time and frequency. For Walsworth — whose other 48 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 ^n&„. MAN WITH A PLAN: J Lee Nadler leads the | Harvard Catalyst teqlini^! '^ research interests include Einstein's theory of relativity and the detection of new planets — the link to medical imaging made per- fect sense. "You can easily detect helium and xenon in the body if they're magnetized with a laser beforehand and then inhaled or injected," he explains. (Standard MRI scanners produce images by detecting the body's water and fat within a magnetic field.) "Because the gas magnetization is long-lived and done ahead of time, it doesn't require the large magnetic fields of conventional scanners. You can create an open, walk-in imaging system that doesn't affect pacemakers and medical implants, and allows imag- ing for all body postures. It's a great spin-off from physics to med- ical imaging." For several years, Walsworth built and refined the scanner as a side project. His available funding, however, could only take him so for. "It's hard to get money for things that are transitioning between physics and biomedical imaging," he says. "Not many programs fund them." Then he learned about Harvard Catalyst. If other Catalyst grants have helped connect disparate researchers with common goals, Walsworth's award has helped him take his invention to the next level by putting it in the hands of physicians. The Catalyst grant has paid for the scanner's move from Walsworth's lab to Massachusetts General Hospital's Martinos Center in Chorlestown, installation of tile flooring in its new home, and tweaks to the machine to make it technically optimal. "These are grungy, non-sexy things," Walsworth says, but they are changes that lay the groundwork — literally — for future clinical research. In fact, he recently learned that he will receive funding from the National Institutes of Health for pilot lung imaging studies with the scanner, thanks in part to the scanner's relocation. While frustrating, gaps in funding like those that have stalled his progress also present opportunities, soys Walsworth. "We've got these well-financed lobs, but it's difficult to bridge to other researchers. That's what Catalyst is doing, and I'm very grateful for it." ■ AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 49 WALK thi IS way With obesity at epidemic proportions, it's clear that physical activity is crucial for good health. But what will spur confirmed couch potatoes to put down the remote and get moving? Massa- chusetts General Hospital internist and pediatrician Nicolas Oreskovic has an inspired suggestion: Create envi- ronments that encourage people to walk more. Oreskovic, also an HMS instructor in pediatrics, has previously researched the effects of the built environment — the layout and location of buildings, walk- ways, and roadways — on childhood obesity. His findings have been intrigu- ing, if not surprising. In a study pub- lished in the July 2009 issue of Clinical Pediatrics, for example, he and his team found an association between children's body-mass indexes and the distances from their homes to schools and subway stations, as well as the amount of nearby open space. STARTING OFF ON THE RIGHT FOOT: Researchers hope to identify architectural and design elements that inspire physical activity. Now Oreskovic is taking his research one step further. Working in collaboration with colleagues at MGH and at the Harvard University Gradu- ate School of Design — and funded by a pilot grant from Harvard Catalyst — he is using functional MRI neuroimaging technology to pinpoint just how the human brain responds to particular architectural and design elements. "We're trying to crack the nut of the human subconscious by determining what promotes the desire to walk," says Oreskovic. "If our theory is cor- rect, the areas of the brain associated with motor function and emotion should react positively when a person views certain architectural environments." The idea of reaching out to researchers in seemingly unrelated fields isn't new to Oreskovic, who met some of his co-investigators when he took courses at the design school while pursuing his master's degree in public health. Still, he acknowledges that such connections aren't forged so easily for many of his peers. "In medical research we tend to work in our own little silos," he explains. "Yet there's such a wealth of knowledge out there that we could draw from." Oreskovic hopes that harnessing this knowledge will help guide the develop- ment of novel ways to address the obesi- ty epidemic, with the ultimate goal of using architecture and design to improve human health. In the meantime, he's thankful for Harvard Catalyst's support of this study. "The infrastructure of Har- vard Catalyst is what's made this work possible — it's been easy and painless for me to connect with other researchers," he says. "That's unimaginable at many other institutions." ■ tors' expertise and latest discoveries. An updated search engine scours the site's pages, applications, and databas- es to help visitors locate people, publi- cations, clinical trials, and core facili- ties affiliated with Harvard. This September, a new apphcation was added that helps investigators find and secure funding by giving them col- laborative. Web-based tools for identify- ing opportunities, building project teams, and developing proposals. The apphcation, called Grant Central, con- tinues Harvard Catalyst's mission of removing barriers to research by stream- lining the grant process. Even more func- tions for the site are being planned. Such cutting- edge technology is impressive, but the real test of Harvard Catalyst will be its abihty to dehver clin- ical and translational science. Judging by its performance so far, that goal is in sight. In the first round of one-year pilot grants this past spring, 218 investigators from 23 Harvard schools and hospitals received a total of 62 grants of $50,000 each; a second round of pilot grants announced this fall will underwrite an additional 65 projects. These diverse research teams include neonatologists and microbiologists, informatics experts and endocrinolo- gists, and cancer vaccine speciahsts and polymer engineers. Together, these and other speciahsts are making bench-to- bedside advances: One basic scientist who discovered an anticoagulant protein in the E coli bacterium, for example, has joined v\dth clinicians to explore devel- oping that protein into a new class of blood-thinning drugs. When it comes to Harvard Catalyst, however, game-changing collaborations Mice these are just the start. Plans to teach and assist researchers are also in the works. "We're revolutionizing our education program by integrating the School's master's programs and oEering more courses to help investigators apply laboratory research to human subjects," say Elliott Antman, director of the Har- vard Catalyst Postgraduate Education Program. "We want young researchers to come in with a baseline of knowledge and leave with the comprehensive knowledge needed to succeed as a clini- cal investigator." Harvard Catalyst wlU also support researchers by pro\'iding access to what 50 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 Nadler calls a "dream team" of biostatis- ticians and other experts who will help design, execute, and analyze studies; to shared laboratory space; and to pro- fessional staff, such as nurses. "This approach," says Nadler, "is how you help clinical investigators succeed." Through Harvard Catalyst, HMS is also part of a group of nine institutions that recently received a two-year, $15- million stimulus grant. The grant will fund a new national research resource discovery program called the eagle-i Consortium, which aims to help inves- tigators across the country share scien- tific resources critical to advancing clinical and translational research. "This project is about linking scientists nationally to resources, technologies, and opportunities," says Nadler, "and about making invisible resources visible to the researchers who need them." For Flier, though, such achievements are just the beginning. "These are the next generations of researchers we're helping train and connect," he says. "This work will be transformative." ■ Jessica Cerretani is assistant editor of the Harvard Medical Alumni Bulletin. For more information about Harvard Catalyst, visit http://catalyst.harvard.edu. •mtlQtlhi rum Laws are meant to protect a community, but when it comes to immigrants, fears about enforcement policies may be haz- ardous to their health. That's the theory posed by Karen Hacker, executive director of the Institute for Community Health and an HMS assistant professor of medicine. In her work as a physician at the Cambridge Health Alliance, Hacker has observed firsthand the effects of those fears on her patients: missed appointments, unfilled prescriptions, and other forms of health care under-utilization that she suspects stem from patients' concerns that their immigrant status — whether documented or undocumented — might be exposed. "What's so amazing about this project in particular," Hacker says, "is that members of the community we're studying — Everett, Massachusetts — had similar concerns and approached me to work with them on this issue. Everett has undergone a huge demographic shift in a short period of time." Hacker cites the city's influx of for- eign-born residents, including Brazilians, Haitians, and Moroccans. Harvard Catalyst provided Hacker with the perfect opportunity to reach out to community partners, local representatives of immi- grant communities, and other researchers interested in the study. "The academic environment doesn't always provide the resources for collaboration," she explains. "And this particular area of study doesn't fit within mainstream research." Armed with a Harvard Catalyst pilot grant, Hacker has been able to build those connections and conduct a community-based participatory research project. Working with community co-investi- gators and investigators at the Harvard School of Public Health, the Harvard Kennedy School, and Tufts University, she has assem- bled a team of community and academic investigators to explore this issue. Their first step was to conduct focus groups of Everett residents to discuss the challenges faced by the community. She is also planning an electronic survey of some 300 local physicians to evaluate their experiences and to seek solutions. FEAR FACTOR: Concerns about immigration policies may keep patients away from health care providers. "We hope to determine what else we can do to assuage unfounded fears among immigrants so they take care of their health," Hacker says. "We also need to figure out how to help the community adjust to demographic changes and heal." Although Hacker's ultimate objective is to establish enough pre- liminary data to attract funding for larger studies of other commu- nities, she's quick to recognize the promise of her current work with Harvard Catalyst. "If it turns out that we don't get more fund- ing, but Everett has a healthier community," she muses, "have we not achieved our goal?" ■ AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 51 CT.ASS NOTES NEWS ABOUT ALUMNI F.dmund Meadows 1 944 "rm living with the after- effects of bladder cancer, but longevity — for more than 88 years — has been my strong suit. My grandson Jeffrey is currently a pediatric interven- tional cardiologist." Martin Tuhin 1 945 "In collaboration with my son Adam, I have published a new strategy for treating many tumors, such as lung and pan- creatic cancer, glioblastoma, melanoma, mesothehoma, osteosarcoma, soft-tissue sar- coma, and T-cell acute lym- phoblastic leukemia. Our paper on the topic appeared online in FLoS ONE on May 29. An abstract of our recent mouse studies was presented this past April at the annual meeting of the American Asso- ciation for Cancer Research. We now hope to find major funding to support extensive animal testing, and we wel- come suggestions for obtain- ing funding quickly." William Owen 1 949 "Margaret and I continue to be in good health, although I have a touch of chronic obstructive pulmonary disease, which slows down my ability to play tennis and golf. Sorry to have missed the 60th reunion. I plan to catch the 65th, God willing." Herbert Ausubel dren. Ian and his fiancee are plarming their wedding. "My greatest joys have been seeing our children become productive members of society and h\'ing to see the next gen- eration. The love of medicine keeps me in active practice, and having my son working with me is something special. The Almighty has blessed Stephanie and me with health sufficient to maintain an active lifestyle — to travel through the Andes mountains, to talk to students at a univer- sity in an Islamic country on Israel and the Arab world, to visit Vietnam and observe the changes that have taken place in that country. By nature, I am an optimist and so I wall not dwell on the negatives. Instead, I will focus on my prayer for true peace in the Middle East. "And now my second task the completion — and pubUca- tion — of the six -book series on the ancestors of our children, which will serve as a micro- cosm of the history of the Jew- ish people over three mOlennia." Ralph Heising 1955 "My beloved wife of 54 years, Nancy, died on December 11, 1954 "I remain in active practice with my son. Dr. Ian Ausubel, and two other associates. My daughter. Dr. Lara Ausubel, has moved from the Brigham in Boston to the City of Hope in Duarte to continue her research, necessitating trips to California to see our grandclul- HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 2008, of respiratory failure. She is sorely missed." John Laszlo "I'm happy to say that all goes well with our family. I'm still playing tennis, despite my artificial knees, and am glad to be active. Pat and I had a wonderful trip through II national parks in Utah and Arizona. I am currently engaged in interesting con- sulting work on DNA vac- cines and electroporation." Ernest Picard "I continue to serve in a vol- unteer job with the Serving the Health Information Needs of Elders (SHINE) program and am staying out of trouble. Joyce and I had our 55th anniversary this year!" Mitchell Rabkin recently coauthored an opin- ion piece on health care reform, which was pubhshed on the website of the Ameri- can Academy of Arts and Sci- ences, where he is a fellow. John Grnver 1 956' "Plullipa and I are well (fin- gers crossed at the moment) and are awaiting results of dehberations by President Obama and Congress on health care. We should worry less about government's role in health care and more about the power of health Arnold Katz "I am now an HMS visiting professor of medicine, as I gave three lectures on cardiac physiology and heart failure as part of the second-year core curriculum. Looking up ^^ iiii i i I i Pill at where I sat 55 years ago was spooky." John Ross "I recently headed up a group of professors at the Universi- ty of Florida to create a com- munity-based, free educa- tional seminar called 'What Parents and Adolescents Need to Know About Health and Competitive Sports,' which attracted more than 500 attendees." Mark Perlroth 1 960 "I am acclimating to retire- ment. I am busier than I thought I would be and con- tinue to attend the same weekly conferences at Stan- ford as before. I see Rex Jamison '60 regularly at Grand Rounds and I try to communicate — mostly by email — ^with some of our classmates. My health is good and Karen and the kids are well and busy." Herbert Eenson 1 96 1 was named the 2009 recipient of the Mani Bhaumik Award by the Cousins Center for Psychoneuroimmunology at the University of California, Los Angeles. The award is presented each year to an individual who advances understanding of the mind's role in health and healing. Norman Cohen "This spring, our daughter Celine gave birth to a baby boy, William Heath Stum- bles, in Sydney, Australia. In addition, I was chosen to receive the Kaiser Award for Excellence in Teaching by the volunteer clinical faculty at the University of Califor- nia, San Francisco Medical School. I teach at the San Francisco VA Medical Center in the hematology-oncology clinic once a week." Yeu-Tsu Lee "Aloha to my classmates! Since my retirement in 1999, I have kept busy by traveling to Taiwan three times a year to teach medical students and train surgical residents. I have also made medical missions to Honduras, Laos, and the Philippines. See you at our 50th reunion in 2011!" James Reck John Mills 1 963 "My wife, Susan S. Beck, JD, HLS '68, died March 7 after a long illness. We have posted photos of Susan and a record- ing of the funeral service to the Web. If you would like the Web address, please write me at email@example.com." David Sachar dehvered both the keynote and concluding addresses at the Third International Sym- posium on Biomolecular Tech- nology at Shahid Beheshti University of Medical Sciences in Tehran, Iran, in May. Frank WiHiams 1 964 "I continue to practice med- ical and surgical ophthalmol- ogy in Clearwater, Florida, and do volunteer medical teaching and eye surgery in Bhutan twice yearly. A high point of my visit there in November 2008 was attend- ing the coronation of the fifth king of Bhutan as a guest of the royal family. Jackie and I also visited Zambia and Botswana that summer." 1965 "I'm enjoying my work in many different environ- ments — medical practice, virology research, diagnostic lab services, and biotechnolo- gy. My wife and I traveled to Laos in July where we partic- ipated in an HIV training course with our daughter, Christina, who has worked in a pediatric hospital there for a few months." James Nelson "My retirement is spiced up by my work as a partner in a small biomedical venture capital firm. I developed a new catheter design and have a new MRI contrast media grant in progress. Working on the NIH Challenge Grants provided a little Ught reading this summer!" Harold Sox is retiring as editor of the Annals of Internal Medicine after eight years in the position. He is considered a leader in the field of health policy. David Bergman 1 966 "I recently started a new position as medical director of Casa Pahnera, a residential treatment center in Del Mar, California, that specializes in the care of people with addiction, eating, mood, and chronic pain disorders. Although I am retired from office practice, I continue to teach at the University of San Diego Medical School, where I'm an associate chnical pro- fessor of psychiatry." Wilham Shipley is a co-recipient of the 2009 ASTRO (American Society for AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN CLASS NOTES NEWS ABOUT ALUMNI Radiation Oncology) Gold Medal Award, presented annu- ally to two individuals for achievement in the field of therapeutic radiology and oncology. Shipley is chair of the genitourinary oncology unit at Massachusetts General Hospital and is the Andres Soriano Professor of Radiation Oncology at HMS. Thomas GutheH 1 967 "After two years as president of the International Academy of Law and Mental Health (the international forensic psychiatric organization), I turned over the job to my suc- cessor at the organization's annual congress in New York in June. I was then honored by the estabhshment of the Prix Thomas Gutheil, to be award- ed every two years for high achievement in the area of chnical forensic practice and given this year to Jacques Tal- bot, a forensic psychiatrist at the Institut Philippe-Pinel de Montreal in Quebec, Canada." Eric Chivian Library journal. Chivian directs the HMS Center for Health and the Global Environment. Stephanie Pincus was recently named to the Board of Directors for the Center for Exploratory and Perceptual Art in Buffalo, New York. She is also the founding director of the RAISE Project, which aims to ensure that notable women are nominated for national awards in science, medicine, and engineering. Ralph Steinman was one of three doctors to be awarded the 2009 Albany Medical Center Prize in Medicine and Biomedical Research, the largest national award in medicine. Steinman, who received the award for his groundbreaking work in immunology, is the Henry G. Kunkel Professor of Cellular Physiology and Immunology at Rockefeller University in New York City. Martin Crane authority in the field of med- ical regulation. Crane is the former chair of the Massachu- setts Board of Registration in Medicine. Harvey V. Fineberg 1971 was honored in June with the Harvard Medal, which recog- nizes extraordinary service to the University. Fineberg is a former dean of the Harvard School of Pubhc Health and the current president of the Institute of Medicine. Joel Greenberger "Our first-born, Rachel, is now in medical school. Emily begins her second year at Dartmouth, Josh is at the University of Pittsburgh School of Pharmacy, and Ben is a junior in pre-med at Har- vard. I continue to research new anti-radiation drugs and stem- cell transplantation for irradiation injury. I am begin- ning year 17 of my chairman- ship in radiation oncology at the University of Pittsburgh School of Medicine." 1 968 had his book, Smtaming Life. How Human Health Depends on Biodiversity, named one of the best biology books of 2008 by 1 969 has assumed chairmanship of the Federation of State Med- ical Boards, a nonprofit orga- nization that is the national Peter Rowley 1972 was recently awarded a grant from the Angehnan Syndrome Foundation. His research will HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 focus on identifying the sub- strates and pathways for the neuronal pathogenesis under- lying Angelman Syndrome, a neurogenetic disorder. James Kirklin 1 973 was elected president of the International Society for Heart and Lung Transplanta- tion, a multidisciplinary pro- fessional organization dedi- cated to improving the care of patients with advanced heart or lung disease through research, education, and advocacy for transplantation, mechanical support, and innovative therapies. Kirklin is currently director of the University of Alabama at Birmingham's Division of Cardiothoracic Surgery. David Mauritson 1 974 "I graduated from the J. D. Birmingham School of Law in May 2008 and am currently a partner in the law firm of Grammer and Mauritson in Northport, Alabama. Lve kept my day job in cardiology because my daughter decid- ed — at age 30 — to go to med- ical school. I also remain an active flight instructor in air- planes, helicopters, gliders, and gyroplanes." Christopher Rose "Randi and I are sorry we missed the reunion. I am still trying to demonstrate the utility of electronic medical records to analyze the processes and outcomes of a large radiation oncology prac- tice. I hope this will help identify best practices and improve cancer care incre- mentally. We welcome visits from classmates who are in Southern California." Frank Valone was named chief medical oEi- cer of FibroGen, Inc., a San Francisco, CaMornia-based company that researches treatments for such conditions as tissue-fiber disorders and diabetic complications. JudyAnn Bigby 1 978 received the 2009 Ruth M. Batson Social Justice Award from the HMS Office for Diver- sity and Community Partner- ship. Bigby is the Massachu- setts secretary of health and human services. Before accepting that position, she was director of community health programs at Brigham and Women's Hospital. William Frist has joined Aegis Sciences Corp., a Nashville, Teimessee- based forensic chemical and drug-testing laboratory, as a health care advisor. Daniel Podolsky is the recipient of the Ameri- can Gastroenterological Asso- ciation's 2009 Juhus Frieden- wald Medal for Distinguished Service in the field of gastro- enterology. He is currently the president of the University of Texas Southwestern Medical Center in Dallas. John Kelly 1 979 has been named chief medical officer of lifechnic Internation- al, where he develops strategies to improve the health and well- ness of those who use the com- pany's blood pressure moni- tors, health stations, and health management systems. Samuel Stanley, J r. 1 980 is the new president of Stony Brook University in New York. He was previously the vice chancellor of research at Washington University in St. Louis, Missouri. Jame.s O'ConneH 1 982 was named the J. H. Kanter Prize Laureate in August, hon- oring his work in health care dehvery for low- income and homeless people around Boston. The prize provides $100,000 to allow O'Connell to continue his work. Robin Avery 1985 "The transplant programs at the Cleveland Clinic are rapid- ly expanding, which keeps me busy. My husband, Mike Lauer, is now a division director at the National Heart, Lung and Blood Institute and commutes from Cleveland, Ohio, to Washing- ton, DC. Our sons, Nathan and Danny, are 17 and 15." Jim Yong Kim 1986 became president of Dartmouth College in July. Kim was pre- viously the chair of the HMS Department of Global Health and Social Medicine, HMS professor of global health and social medicine, and the Frangois-Xavier Bagnoud Professor of Health and Human Rights at the Harvard School of Pubhc Health. AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN CT.ASS NOTES I NEWS ABOUT ALUMNI Malcolm Reid 1987 "I was recently appointed to serve on the New York State Hospital Re\iew and Planning Council. I am the chairman of the Department of Rehabihta- tion Medicine and an associate medical director at St. Luke's Roosevelt Hospital Center in New York City." Laurence Ronan received the 2008 Lifetime Achievement Award from the HMS Office for Diversity and Community Partnership for his work as director of the Thomas S. Durant, MD, Fellowship for Refugee Medicine program. Ronan is an HMS instructor in medicine at Massachusetts General Hospital. Richard Waldmann "I am enjoying family life in Milton, Massachusetts, with my wife, Janet, and our two children, Jonathan (age 5) and Clarissa (age 7). I work in a neonatal intensive care unit with a sideline in equi- ties trading." Paul Farmer 1 990 was awarded the Lois Pope LIFE International Achieve- ment Award in February. The award honors his work in treating infectious diseases in impoverished nations. Farmer also succeeds Jim Yong Kim '86 as chair of the HMS Department of Global Health and Social Medicine. John Nash "Susan and I are enjoying rais- ing our six children, ranging from a toddler to teenagers. My work is very rewarding despite being very busy. I work in medical administra- tion in my 'spare' time." Robert Friedlander 1991 was named HMS professor of neurosurgery in 2008. He is vice chairman of the Depart- ment of Neurosurgery at Brigham and Women's Hospi- tal and was recently appoint- ed to the National Advisory Council of the National Insti- tute of Neurological Disor- ders and Stroke. Andrew Sussman was recently appointed the president/chief operating offi- cer of CVS MtnuteClinic and senior vice president/associate chief medical officer of CVS Caremark. Rafael Campo 1 992 received the 2009 Nicholas E. Davies Memorial Scholar Award for humanism in med- icine from the American Col- lege of Physicians. In July, he was also appointed director of the Office of Multicultural Affairs at Beth Israel Deaconess Medical Center, where he is an HMS associate professor of medicine. Pratik Multani has become vice president of chnical development at Fate Therapeutics, Inc., where he is leading upcoming chnical tri- als of stem cell modulators, small molecules, and biologies that guide cell fate for thera- peutic purposes. Lisa Clark Pickett 1 994 was recently appointed chief medical officer of Durham Regional Hospital in Durham, North Carolina. She is also co- director of the Critical Care Unit, chief of the Division of General Surgery, and graduate education medical director for surgery at that hospital. B. Price Kerfoot 1 996 developed a new learning technology platform, "Spaced Education," or SpaceEd, which Harvard recently adopted. Kerfoot is an HMS associate professor of surgery. Deborah Hung 1997 received the 2009 American Society for Microbiology Merck Irving S. Sigal Memor- ial Award for her work in the microbiology of common infectious diseases. Howard Chang 1 999 was named an Early Career Scientist by the Howard Hughes Medical Institute. Chang, a dermatologist at the Stanford University School of Medicine, v^dll receive a six- year appointment to the insti- tute as well as a $1.5-million research budget. Glenda Callender 2000 "I finished my general surgery residency at the University of Chicago Hospital in 2007 and am currently completing fel- lowships in surgical oncology and endocrine surgery at the M. D. Anderson Cancer Cen- ter in Houston, Texas." M artin Burke 2002 was named an Early Career Scientist by the Howard Hughes Medical Institute. He is a chemical biologist at the University of Illinois at Urbana-Champaign. Oni Blackstock 2004 was one of two physicians awarded the 2009 Minority Clinical Fellowship Award by the HIV Medicine Associa- tion. She is a resident at Montefiore Medical Center in Bronx, New York. ■ HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 DANIEL C. TOSTESON, 1925-2009 | TN MEMORTA S DEAN OF HARVARD MEDICAL SCHOOL, DANIEL Tosteson '48 had an overarching ambition: to smooth the paths its students and facuky walked. Dan succeeded in paving estabhshed routes for the HMS community during his tM'o decades in the post, from 1977 to 1997 He also created some nev^ paths on his own. Dan died at the age of 84 on May 27, 2009 at his home in Boston after a brave struggle with Parkinson's disease. He is best known for bringing about radical changes to the School's approach to medical education — which carried the cognomen New Pathways. Its purpose was to create a hfelong love for learn- ing medicine and to prepare the School's students for the changes in medical practice they would surely encounter. Dan built the medical education center that now bears his name to house this curricular reform. It included student societies that became centers for student-faculty exchange; rooms for student-dri- ven case- analysis sessions that were intrinsic to the educational process; and new and updated classrooms and lecture haUs. A passionate supporter of the sciences basic to medicine, Dan strengthened the HMS Quad- rangle departments by recruit- ing eminent scholars as depart- ment heads, increasing the scope and size of the faculty, and providing faculty researchers with new laboratory spaces. He promoted an organization of departments that reflected the thrust of contemporary biomedical research as opposed to a reca- pitulation of a list of obsolete course titles. He also pro- vided for an increasing number of graduate students in the Division of Medical Sciences and a more coherent framework for their courses of study. Dan estabhshed two departments that helped acknowl- edge the importance of the social sciences to medicine: the Department of Social Medicine, since renamed Global Health and Social Medicine, and the Department of Health Care Pohcy And he founded the Department of Ambulato- ry Care and Prevention (now Population Medicine), which underscored how important it was for medical education to include experience with non-hospitalized patients. Dan beheved in sharing the lessons learned at HMS with the broader medical and scientific community. This attitude led to several national and international initiatives, includ- ing the Harvard Macy Institute for medical educators and the Giovanni Armenise-Harvard Foundation for promoting collaboration v/ith scientists at leading institutions in Italy. Despite his many accomphshments, Dan had his share of frustrations and unfulfilled wishes. He had hoped that the student societies would serve as a source for curricular inno- vation, yet, except for contributions by the Harvard-MIT Division of Health Sciences and Technology (now the London Society), this did not happen. Fear- ing an unhealthy competition for patients, Dan also sought to build a plan for cooperative activity among the School's affiliated hospitals. This initiative too was blunted. His interest in the natural and life sciences was early and intense. During college and medical school, Dan was intrigued by salt and water homeostasis and took a year off from his medical school studies to work with the cardio- vascular physiologist Eugene Landis. During his residency at The Presbyterian Hospital in New York City, Dan became curious about red-blood-ceU transport, a focus that led to an enduring interest in general physiology and, in particular, membrane biology. He continued to work with arti- ficial and red-blood- cell mem- branes during his fellowships in Brookhaven and Cambridge and at the National Institutes of Health and, subsequently, during faculty stays at Wash- ington and Duke universities. He brought that interest, one he shared with his wife, Magdalena, to HMS when he returned as its dean. Dan loved to talk about biomedical science, and his enthusiasm for discovery was infectious. He was a great advocate for HMS; he took its causes seriously and wanted his hsteners to feel them also. This sincerity is what made him such an effective spokesperson and fundraiser; under his stewardship the School's endowment burgeoned. Dan is survived by his wife; a brother, Thomas; his sons. Tor and Joshua; his daughters, Ingrid, Zoe, Heather, and Carrie; and five grandchildren. They are joined by many others in mourning the loss of his company. ■ S. James Adchtdn '53, the Paul C. Cabot Distinguished Professor of Medical Biophysics at Harvard Medical School, served as executive dean for academic programs under Daniel Tosteson. AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 57 ^ OBTTTJARTES I COMMEMORATING DISTINGUISHED LIVES Emerson Day 1938 Died October 21, 2008, at the age of 95, in WiLmette, Illi' nois. Day served as a flight surgeon for the U.S. Army Air Forces' Air Transport Com- mand during World War II. He was director of the Strang Cancer Prevention Clinic from 1950 to 1963 and chief of the preventive medicine divi- sion at the Sloan-Kettertng Institute from 1954 to 1964, both in New York City. Day was also a professor of medi- cine at Northwestern Univer- sity and an attending and vis- iting physician at Northwest- ern Memorial Hospital in Chicago. Day was predeceased by his first vvdfe, Ruth. He is survived by his second wife, Gerry; five children. Tad, Bob, Nancy, Bonnie, and Shery; thirteen grandchildren; and four great-grandchildren. Laurence G. Wesson 1 942 Died September 2, 2008, at the age of 90, in Scarborough, Maine. A leading authority on kidney physiology. Wesson was also an expert in ento- mology. During World War II, he was an artillery battalion surgeon v^dth the rank of cap- tain in the U.S. Army. He was among the first Americans to hberate the Dachau concen- tration camp. After leaving the Army Wesson held various teaching positions at New York University College of Medicine. In 1962 he accepted an appointment as a professor of medicine to create the Divi- sion of Nephrology at Jeffer- son Medical College in Philadelphia. He pubhshed the standard textbook Physiol- ogy of the Human Kidney in 1969, and he retired in 1987. Wesson is survived by his wife of 60 years, Eleanor; four children, Laurence, Anne, Robert, and John; and eight grandchildren. Douglas R. Morton 1 944 Died September 9, 2008, at the age of 88, in Elgin, Illinois. Board certified in general, thoracic, and cardiovascular surgeries, Morton ran a pri- vate general surgical practice in Elgin. He served in the U.S. Army and was chief of surgery at Eort George Wright in Spokane, Washing- ton. He is survived by his v/ife of nearly 65 years, Mary; their children, Douglas, Jr., Carol Eletcher, Sarah Semich, and Bruce; nine grandchildren; and four great-grandchildren. H. Stanley Bennett 1945 Died October 4, 2008, at the age of 87, in Lake Oswego, Oregon, of a ruptured abdomi- nal aortic aneurysm. Bennett served two years with the U.S. Army Medical Corps in post- World War II Germany. In 1953 he helped form Associat- ed Physicians, a multispecialty clinic. After retiring in 1986, Bennett and his wife moved to Togo, where, as a Peace Corps doctor, he oversaw health care for volunteers in Togo, Benin, and Ghana. After moving to Lake Oswego in 1988, he con- tinued his volunteer service at the Old Town Chnic in Port- land, Oregon. Bennett was predeceased by a son, James. He is survived by his wife of 65 years, Mildred; a son, David; a daughter, Barbara Berger; five grandchildren; and one great-grandchild. D. Carleton Gajdusek 1 946 Died December 12, 2008, at the age of 85, in Tromso, Nor- way. Gajdusek won the 1976 Nobel Prize in medicine for his work on what are now known as prion diseases. In 1951, Gajdusek was drafted into the U.S. Army and was sent to the Walter Reed Army Medical Service Graduate School as a research virolo- gist, spending time at the Institut Pasteur in Tehran. He later traveled to Austraha, where he performed postdoc- toral work at the Walter and Eliza Hall Institute of Med- ical Research. It was on his way home from that trip that Gajdusek learned of the Fore tribe of New Guinea, which was slowly being wiped out by kuru, a degenerative brain disease. In 1957, he identified the tribe's custom of eating the infected bodies and brains of deceased members as the cause of kuru, a discovery that won him the Nobel Prize 19 years later. Gajdusek led the brain studies laboratory at the National Institute of Neurological Disorders and Stroke from 1970 untiil 1997 He is survived by many adopted sons and daughters and two nephews. John M. R. Rruner 1 949 Died May 28, 2008, at the age of 82, in Groton, Massachu- setts, of pancreatic cancer. Bruner served as a medical officer in the U.S. Navy during the Korean War before set- tling in Groton, where he practiced medicine for ten years. He specialized in anes- thesiology at what was then Peter Bent Brigham Hospital. He was later on the Massa- chusetts General Hospital staff and taught at HMS. Bruner is survived by his wife of 58 years, Barbara; three children. Temple Bruner 58 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 Staples, John, and Bradford; and six grandchildren. Robert Byron Giles, Jr . 1 949 Died December 16, 2008, at the age of 87, in Dallas, Texas. Giles was the former chief of staff at Presbyterian Hospital in Dallas and a former assistant professor of medicine at the University of Texas Southwestern Medical School. During World War II, he did research in the nuclear physics department at the Massachusetts Institute of Technology for the War Man- power Commission. He served as a first lieutenant in the 8228th MASH unit during the Korean War; he received a com- mendation for his work in the unit's hemorrhagic fever center. Giles later had a private internal medicine practice in Dallas for 40 years. Giles was predeceased by his first wife, Patricia, in 1992. He is survived by his sec- ond wife, Ann; four children, Caroline Banks, Ben, Richard, and Phoebe; five grandchildren; and three great-grandchildren. Albert R Hendler 1 949 Died November 17, 2008, at the age of 82, in Dallas, Texas. Hendler's internship and resi- dency were interrupted by his two years of service in the U.S. Army Medical Corps. He later spent one year at the Dallas Vet- erans Administration Medical Center before opening a private internal medicine practice in Casa linda. Hendler was the pri- mary medical support for the first open heart surgery per- formed at Baylor Hospital in Dal- las. He was a clinical professor of medicine at the University of Texas Southwestern Medical School from 1970 until his retirement in 1999. Hendler was predeceased by his son Charles in 2006. He is survived by his wife of 60 years, Pauhne; seven children, Robert, Richard, Katherine Huske, Gloria, Thomas, Sarah Feagin, and Pauhne Pagel; and 19 grandchildren. T-ewis Rloomingdale 1950 Died December 8, 2008, at the age of 89, in Norwood, Massa- chusetts, of an intestinal obstruction. Bloomingdale was a psychiatrist whose grandfather founded the Bloomingdale's department store chain. He served as a chemical engineer with the U.S. Army in the Pacific the- ater during World War II. Bloomingdale had a private practice in Scarsdale, New York, with his wife, Eileen, a clinical psychologist. He retired in 1998. Bloomingdale was also president of the Psy- chiatric Society of Westchester and taught on the faculty of New York Medical College for many years. His major research interest was atten- tion deficit hyperactivity dis- order, which he traveled to four other continents to study. Bloomingdale was prede- ceased by his wife in 2000. He is survived by a son, Kerry '77; three grandchildren; and a great- granddaughter. Thomas B. Hayes 1950 Died August 24, 2008, at the age of 86, in North Andover, Massa- chusetts. Hayes served as a pharmacist mate and neuropsy- chology technician in the U.S. Navy during World War II and as a post surgeon in the U.S. Army in Japan during the Kore- an War. Hayes was chief of surgery at Lawrence General Hospital from 1965 to 1968 and president of Bon Secours Hospi- tal in Methuen, Massachusetts, from 1971 to 1973. He also served as that hospital's director of emergency medical services. Hayes is survived by his wife, Loretta Spires; his daughters, Judi Mancini, Mary Beth Hayes Rentschler, and Cathy Hayes Lee; his sons, Thomas, Jr., Michael, Kevin, John, Daniel, Brian, and Patrick; fourteen grandchildren; and six great- grandchildren. Federico Mora 1950 Died October 9, 2008, at the age of 82, in Albuquerque, New Mexico. Mora received training in general surgery and neurolo- gy at Massachusetts General Hospital before serving two years in the U.S. Air Force as a neurosurgeon. He ran a private neurosurgery practice in Albu- querque from 1959 until 1995. Mora held staff appointments at BernahHo County Indian Hos- pital, BernahUo County Medical Center, and the Albuquerque Veterans Administration Med- ical Center. After closing his practice. Mora participated in neurosurgical missions to Guatemala, his birthplace, sponsored by Healing the Chil- dren. He also dedicated many hours to preparing paleontolog- ical specimens for the New Mexico Museum of Natural History and Science. Mora is survived by his vwfe of 57 years, Virginia; his children, Federico III, Clara Luz Nixon, Ana Maria Waller, Claudia Riciputi, and Juan; nine grandchildren; and one great-grandchild. Fvelyn Waitzkin 1 950 Died October 21, 2008, at the age of 90. A psychiatrist, Waitzkin was a member of the second class of female stu- dents at HMS. She was prede- AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 59 ORTTTIARTES I COMMEMORATING DISTINGUISHED LIVES ceased by her husband, Leo. Waitzkin is sur\ived by three daughters, Ellen, Carol, and Susan; and five grandchildren. Christopher C Fordham TIT 1951 Died August 14, 2008, at the age of 81, in Chapel Hill, North Carolina. Fordham was a former chancellor of the University of North Caroli- na-Chapel Hill. He joined that university's medical school in 1958 and became its dean in 1971. As chancellor from 1980 to 1988, he helped create the Area Health Educa- tion Centers program, a col- lection of rural medical cen- ters across North Carolina. He also oversaw a major under- graduate curriculum revision and a renewed focus on pri- vate giving. Fordham is sur- \Tived by his wife, Barbara; three daughters, Pam Ford- ham Richey, Susan Fordham CroweU, and Betsy Fordham Templeton; six grandchildren; and seven great-grandchildren. H. Douglas Collins 1952 Died October 14, 2008, at the age of 80, in Hanover, New Hampshire, of Alzheimer's disease. After a public health service stint in Anchorage, Alaska, he established a pri- vate practice in Caribou, Maine. From 1975 to 1980, he directed the Central Maine-Dartmouth Family Practice Residency in Augus- ta. Collins was predeceased by his first wife, Helen. He is survived by his second wife, Mary; his children, Herschel, Gordon, and Linda; his stepchildren, Thomas Dress- er, Peter Dresser, and Jane Howe; eight grandchildren; six step-grandchildren; and one great-grandchild. Thomas F. Dolan, J r. 1953 Died September 28, 2008, at the age of 80, in Madison, Connecticut, after a prolonged iUness. Dolan completed his medical training at Children's Hospital Boston and at the National Institutes of Health in Bethesda, Maryland. He spent 40 years on the active faculty of the Yale School of Medicine and as an attending physician at Yale-New Haven Hospital in Connecticut. He was also director of Yale's cys- tic fibrosis clinic for 25 years. He was a past president of the American Academy of Pedi- atrics. Dolan was prede- ceased by his wife, Margaret, and a son, Christopher. He is survived by three daughters, Karen Garner, Maureen, and Evelyn; a son, Kevin; and four grandchildren. Jay Katz Sally and Amy Goldminz; two stepdaughters, Mary Whit- field and Emily Whitfield; and four grandchildren. Robert Katzman 1953 Died November 17 2008, at the age of 86, in New Haven, Connecticut, of heart failure. A physician who focused on medical ethics, Katz taught psychiatry at Yale School of Medicine and was assistant professor of psychiatry and law at Yale Law School untH his retirement in 1993; he con- tinued to teach as an emeritus professor. In 1972, Katz was named to a federal panel to investigate the 1932 Tuskegee Syphihs Study. The panel described the study as "ethi- cally unjustified," yet Katz beheved the report didn't go far enough, stating that study participants had been "exploited, manipulated, and deceived." Katz was prede- ceased by his first wife, Esta, in 1987 He is surw'ed by his second wife, Marilyn Arthur; his son, Dan; two daughters, 1953 Died September 16, 2008, at the age of 82, at his home in La JoUa, California, after a long iUness. An internationally known leader in Alzheimer's disease research, Katzman served as the chair of neurolo- gy at the Albert Einstein Col- lege of Medicine in the Bronx from 1964 to 1984, when he helped estabhsh the Shiley- Marcos Alzheimer's Disease Research Center at the Uni- versity of California, San Diego. Katzman held the Flo- rence Riford Chair for Research in Alzheimer's Dis- ease there from 1984 until his retirement in 1995. He co-edit- ed Basic 'Neurochemistr}' in 1972. Four years later, his landmark editorial in Archives ofNcuwlogy was the first to state the prevalence and severity of Alzheimer's disease. He was also a founder of the national Alzheimer's Association and served as president of the American Neurological Asso- ciation in 1985. Katzman is survived by his wife, Nancy; two sons, David and Daniel; and one grandson. Donald P. Zangwill 1 953 Died October 7 2008, at the age of 80, in Mt. Lebanon, Pennsylvania, of mesothelioma. Zangwill worked in private practice in internal medicine for 35 years before retiring in 2000. He was a frequent seek- er of adventures around the world. Zangwill was prede- ceased by his first wife, Estelle. He is survived by his lo\'ing companion and best friend. 60 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 Carol Boll; his former wife, Grace; his children, Andrew, Rhonda, Kenneth, and Leonard; and three grandchildren. James A. GlKson 1 954 Died September 15, 2008, at the age of 83, at his home in Hinsdale, Illinois. Gibson was a co-founder of the Institute of Family Therapy in Chicago and had a private practice in Hins- dale. Gibson was predeceased by two daughters, Mary Ellen and Lisa Erin. He is survived by his wife of 49 years, Bar- bara; three daughters, Suzanne, Gina Eielder, and Julie; and three granddaughters. Edward D. Holyoke 1954 Died September 30, 2008, at the age of 79, at his home in Sandy Pond, New York. Holyoke served in the U.S. Army from 1956 to 1958 in Kyoto, Japan, retiring as a colonel in the Army Medical Reserves. Holyoke was chief of surgical oncology at Roswell Park Memorial Insti- tute in Buffalo, New York, where he studied the use of interferon as a cancer treat- ment. In I99I, he joined the Vet- erans Administration in Togus, Maine, where he served as chief of staff. He was later chief of staff for the Veterans Adminis- tration Hospital in Syracuse, New York, and continued to work there as a research grant consultant until several months before his death. Holyoke is survived by his wife, Judith; four daughters, Amanda Neal, Rebecca Sumner, Melissa Gartz, and Cassandra Bluff; two sons, John and Edward; and nine grandchildren. Eugene Nobles, Jr 1954 Died December 22, 2008, at the age of 79, in Memphis, Ten- nessee. Nobles served as a cap- tain in the U.S. Army during the Korean War and as chief of surgery for the 44th MASH unit. He joined the Department of Surgery at Baptist Memorial Hospital in Memphis, where he worked for 38 years. Nobles was the chairman of that hospi- tal's Department of Surgery and Accreditation Committee, as well as president of its medical staff. He also served as presi- dent of the Memphis Surgical Society and of the Southern Surgeons Club. He was an avid inventor and held three patents. He is survived by his wife of 47 years, Gloria; two daughters, Helen Bird and Lil Rudd; and five grandchildren. Parvin S. Farmanfarmaian 1 956 Died April 22, 2009, at the age of n, at her home in Princeton, New Jersey, of pancreatic can- cer. Earmanfarmaian was among the first cadre of faculty to join Rutgers Medical School, now called the Robert Wood John- son Medical School, in Prince- ton in 1968. As fellowship director for the hematology and oncology program at that school, Farmanfarmaian trained scores of hematology and oncol- ogy speciahsts during the past four decades. She developed the New Jersey Regional Hemophil- ia Program and served as its director starting in 1976. Ear- manfarmaian is survived by her husband of 50 years, Allahverdi Farmanfarmaian; two daugh- ters, Lara Terry and Kimya Har- ris; and four grandchildren. Malcolm H. Moss 1 956 Died October 17, 2008, at the age of 11, at his home in Tampa, Florida. Moss served as a cap- tain in the U.S. Air Force, sta- tioned in Japan. He practiced pediatrics in Englewood, New Jersey, for 30 years and was chief of pediatrics at Engle- wood Hospital from 1979 to 1989. After closing his practice, he became a medical director at Cigna Healthcare in New Jersey. He transferred to Flori- da in 1994. Moss is survived by his wffe of 45 years, Sylvia; sons Andrew and Jonathan; and four grandchildren. Geoffrey R. Paul 1956 Died October 28, 2008, at the age of 79, in San Francisco, Cali- fornia. Born in Sydney, Aus- traha, Paul founded the Anzac Peace Prize and the Anzac of the Year national awards, annu- al prizes given to ordinary Aus- trahans for efforts toward glob- al peace, in 1976. Paul was also a physician at Kaiser Permanente in San Francisco for 25 years. He is survived by his wife, Sharon. Charles W. Fairfax II 1957 Died December 9, 2008, at the age of 11, in South Dartmouth, Massachusetts. Fairfax worked as a radiologist at St. Luke's Hospital in New Bedford, Massachusetts, for 31 years, including many years as chief of radiology, until his retirement in 1995. He helped establish that hospital's School of X-Ray Technology and was a member of several professional organiza- tions, including the American College of Radiology, which named him as a feUow in 1978. Fairfax is survived by his wife of 50 years, Eleanor ("Sue"); five children, Diana Fairfax Miller, Laura Fairfax McDonough, Christopher, Peter, and Josh; and twelve grandchildren. Robert W. Shavelson 1958 Diedjune8, 2009,attheageof 75, at his home in New Jersey. AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 61 ORTTTJARTES I COMMEMORATING DISTINGUISHED LIVES Shavelson practiced internal medicine and served in Viet- nam. He was predeceased by his wife of 43 years, Sonia, in 1998. Shavelson is survived by his three children, Pamela, Patti, and Robert, Jr.; and two grandchildren. David V. Heisterkamp 1 964 Died January 26, 2009, at the age of 69, in Denver, Colorado, in his sleep. Heisterkamp trained in anesthesia at the University of Pennsylvania before serving as a heutenant commander in the U.S. Navy from 1968 to 1970. He moved to Denver in 1970 and prac- ticed anesthesia, first at the University of Colorado Med- ical Center, then with the Metz Group and with Col- orado Anesthesia Consultants. He retired in 2005 to spend more time with his family. Heisterkamp is survived by his wife, Roberta; his five children, David, Wendy Wiehardt, Rebecca, Christo- pher, and Charles; and four grandchildren. Gerald r.nlman 1 966 Died December 26, 2008, at the age of 68, at his home in Albany, New York. Coknan had been a lieutenant com- mander in the U.S. Navy and the officer in charge at the South Vietnamese Provincial Hospital in Quang Tri from 1969 to 1971. His service earned him the Vietnamese Service Medal, the Repubhc of Vietnam Medal of Honor, the Cross of Gallantry, and the Pubhc Health Medal. In later years, he made several trips back to Vietnam — as well as to China, Russia, and the Philippines — as part of Operation Smile, performing surgery on children with cleft palates and cleft lips. Colman was chief of plastic surgery at the former Child's Hospital and St. Peter's Hospital, both in Albany, and taught as an associate professor at Albany Medical Center. He practiced with the Plastic Surgery Group in Albany for more than 30 years. He also served on the Board of Trustees of the Albany Jewish Commu- nity Center, which recently honored him with a Pillars Award. Colman is survived by his wife, Ruth; five chil- dren, David, Jonathan, Adam, Benjamin, and Rachel; and one grandson. James F.dw^ard Mclennan 1 967 Died September 30, 2008, at the age of 68, in Providence, Rhode Island. McLennan completed his residency in neurosurgery at Brigham and Women's Hospital and Chil- dren's Hospital Boston. He had been a physician at Miriam Hospital and Roger Wilhams Hospital in Providence since 1981. He also served as a clini- cal associate professor at the Warren Alpert Medical School of Brown University. McLen- nan is survived by his wife, Karen Jacobsen, and two daughters, JiU and Jenny. Richard Alan Kaiser 1 969 Died November F, 2008, at the age of 63, in West Orange, New Jersey. Beginning in 1971, Kaiser served several years in the U.S. Navy and rose to the rank of heutenant comman- der aboard the nuclear sub- marine the U.S.S. Will Rogers. He maintained a private prac- tice in general and pediatric surgery in Montclair, New Jersey, retiring in 2004. Kaiser is survived by his wife of 40 years, Debra; a daughter, Hilary Grove; a son, David; and two grandchildren. Barbara Ma llinrWrnd t Osborne 1 969 Died March 29, 2009, at the age of 65, at her home in Hous- ton, Texas, after living with Alzheimer's disease for many years. Osborne completed her training at Massachusetts General Hospital and Beth Israel Deaconess Medical Cen- ter in Boston, and chose a career in pathology, specializ- ing in lymphomas. In 1975, she moved to Houston, where she practiced pathology and hematopathology for nearly 20 years. She is survived by her children, Jonathan and Bizet Siegel, and four grandchildren. Donald Michael Vickery 1 969 Died November 22, 2008, at the age of 64, in Evergreen, Colorado, of lung cancer. A pioneer in the self- care and wellness movement, Vickery, a nonsmoker, was also a life- long crusader against tobac- co. He founded the nonprofit Center for Consumer Health Education, now known as the Self-Care Institute, in Evergreen. In 1984, he started the Center for Corporate Health in Reston, Virginia. Vickery wrote and co-wrote numerous books about well- ness, and he founded Health Decisions International, a self-diagnosing software tool for doctors and patients. In 2003 he received the Ameri- can College of Preventive Medicine Lifetime Achieve- ment Award. Vickery is sur- vived by his wife, Carol; a daughter, Meredith; two sons, Andrew and Michael; and two grandsons. 62 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 John Richardson 1 970 Died November 13, 2008, at the age of 64, in Little Rock, Arkansas, after an extended battle with cancer. Following his medical training, Richard- son joined the U.S. Public Health Service and was sta- tioned in Galveston, Texas. He later joined the National Insti- tutes of Health, where he con- ducted research on cholesterol. He eventually returned to Texas, where he taught at the University of Texas Health Sci- ence Center in San Antonio and practiced medicine at Cen- tral Texas Nephrology Associ- ates in Waco. Richardson is survived by his wife, Martha. ■SiiyannpRigg.s 1 972 Died April 28, 2009, at the age of 62, in Providence, Rhode Island, after a battle with cancer com- plicated by kidney disease. Riggs spent six months studying in Colombia before completing her residency in pediatrics and a fel- lowship in adolescent medicine at Childreris Hospital Boston. She was a physician at Harvard University Health Services and at Childreris, where she founded the Young Parents Program. She later moved to the Brown Uni- versity School of Medicine in Providence to start its Division of Adolescent Medicine. She became professor of pediatrics at that school and served as medical director of clinical ser- vices at the Rhode Island Train- ing School for more than 20 years. Riggs was known nation- ally for her work in the eating disorders field. Riggs is survived by her children. Amy Hennessy, Rob Lewis, and Jane Lewis. Mirrhpll R May Pittsburgh, Pennsylvania. His death was ruled a suicide. A neurologist and authority on the genetic basis of pain. Max was a senior investigator with the Center for Pain Research at the University of Pittsburgh Medical Center. He had previ- ously been a researcher at the National Institutes of Health, where he directed the Pain Research Clinic, and a captain in the U.S. Pubhc Health Ser- vice. Max is survived by his wife of 23 years, Lisa, and two daughters, Rachel and Laura. Andrpw Hanna.s 1 976 Died September 24, 2009, at the age of 58, in his home in Lafayette, Indiana, from injuries suffered in a fall. Hannas worked for the Kansas State Department of Health and taught Enghsh, Latin, and Greek at Purdue University. Hannas was prede- ceased by a sister, Margaret. He is survived by brothers Mike and Jacob and sisters Molly and Polly Silverman. Peter Finstein 1 974 Died October 22, 2008, at the age of 59, at his second home in 1 978 Died suddenly September 22, 2008, at the age of 59, in St. Louis, Missouri. A pediatric cardiac surgeon and unmunolo- gist, Einstein founded the Trans- position Study Group, where he pioneered an innovative training model for pediatric cardiac surgery. He also founded the Childreris Heart Project Interna- tional, which made resources available for childreris heart svirg- eries in the developing world. Einstein is survived by his wife, Kim Rosenfield, and his chil- dren, Jesse, Eric, Tracy, and Lisa. Rrure Van Bnerkel 1 978 Died February 6, 2009, at the age of 56, in Greenfield, Massa- chusetts, following a four- month bout with cancer. Van Boeckel did a residency in internal medicine at George Washington University Hos- pital before moving to West- ern Massachusetts, where he was employed by the Sisters of Providence at Farren Memorial Hospital, hi 1990, Van Boeckel and his partners formed Con- necticut River Internists in Turners Falls, Massachusetts. He worked there until his retirement in 2001. In 2004, he helped found the Hospice of Franklin County and served as its medical director until his death. He was a strong believer in paUiative care, and during his illness he became a beneficiary of the hospice he had helped create. Van Boeckel is sur\'ived by his wife of 25 years, Terry. FHward R. Rrnrnfielrl 1983 Died May 10, 2009, at the age of 58, in Newton, Massachusetts. A recognized expert in the field of epilepsy, Bromfield was an HMS associate professor of neurology and chief of the Divi- sion of EEG, Epilepsy, and Sleep Neurology at Brigham and Women's Hospital. He joined the HMS faculty in 1993 after undertaking a two-year fellow- ship in epilepsy and EEG at the National Institute of Neurolog- ical Disorders and Stroke in Bethesda, Maryland. The Ameri- can Epilepsy Society honored him with the 2007 J. Kiffin Penry Award for Excellence in Epilepsy Care. In 1999, Bromfield helped found Camp Wee-Kan-Tu, the first overnight summer camp program in New England solely for children with epilepsy; he served as the camp's medical director. Bromfield is survived by his wife, Terry, and his sons, Daniel and Benjamin. ■ AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN 63 ENDNOTES SOME FINAL THOUGHTS Game Plan Y THE TIME THE PATIENT WAS ADMITTED TO THE hospital, his creatinine level was ten times higher than normal. He was now paying the costly price of a long history of uncontrolled hypertension. His kidneys were shot, and he faced a certain future on dialysis. The wrinkle in the story was that the patient — I'll call him Fred — ^was refusing surgery to create an arteriovenous fistula that would allow us to filter his blood. Psychiatrists had ruled Fred com- petent to make his own decisions, and he was now testing our team's negotiation skills. A daily parade of doctors at every level of training — kidney speciahsts, general medicine doctors, fellows, residents, and, me, the medical student — ^would visit with him and repeat variations on a theme: He might feel fine now, but kidney failure would Idll him unless he went on dialysis. He would respond to us all in the same way: "I feel fine. I don't need dialysis, and I don't need surgery." Fred was at once frustrating and perplexing. Each day we debated hypotheses about the reasons for his refusal. Was he suspicious of our motives? Our competence? Our judg- ment? Was he afraid of surgery? Tired of hving? Our debate continued until one morning, when our team of doc- tors approached him during rounds. "I want dialysis," Fred said, "and I'll meet with the surgeons." Why the sudden change? "I was thinking about a picture I saw in Sports Illustrated of Hank Gathers," Fred told us. "He just collapsed and died on the court. I don't want that to be me. His death was so awful for people to watch. I don't want to be another Hank Gathers or Reggie Lewis." None of the other members of my team knew who these basketball giants were — and they didn't care. They couldn't afford to let the patient change his mind again, so they scheduled an immediate surgical consult. As an avid sports fan, I knew that Gathers was a college- basketball phenom who had died suddenly during a champi- onship playoff game, and that Lewis was the young Boston FINAL SHOT: Hank Gathers, a basketball star for Loyola Marymount University, collapsed and died during a tournament game. An autopsy revealed that he suffered from hyper- trophic cardiomyopathy, a heart-muscle disorder. Celtics star who had coUapsed and died one day during prac- tice. From the grave. Gathers and Lewis were accomplishing what doctors alone could not: saving Fred's Me. Fred's sudden change in thinking underscored for me the incredible influence that athletes have in shaping the way we think about our health. As icons of extreme physical well- being, professional athletes remind us of the pinnacles of human perfor- mance, but also of our own frailty. While they express the virtues of human perseverance and intense training, they can also bring to hght the egahtarian quahty of disease — striking anyone, even optimally conditioned professional athletes, at any tune. In doing so, they help patients like Fred understand dis- ease, feel less alone with their diag- noses, and persist in treatment when they feel like giving up. While athletes Kke Gathers and Lewis remind us of our mortahty, others call attention to our body's innate capacity to cope with disease and to heal. When Magic Johnson returned to the basketball court after announcing he had HIV, he helped destigmatize the disease, eased our fears of infectivity, and made us realize that those testing positive for the virus could stiU lead vigorous lives. When Red Sox pitcher Jon Lester pubhcly faced a Iffe-threatening cancer diagnosis and fought back to return to top form, he allowed us the reahstic hope that we, too, might recover and hve normally. Sports journalists, by chronicling the stories of the ill- nesses of athletes, and professional athletes, by sharing those stories with us, perform an invaluable pubhc health service. They help us understand and cope with disease in ways that caution, reassure, and inspire us. ■ Sachin H. ]ain '06, a resident in internal medicine at Brigham and Women's Hospital, was recently named special assistant to David Blumcnthal 74, national coordinator for health information technolo- gy at the U.S. Department of Health and Human Services. 64 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009 ,wy?lJ^u»at«^<^''JRSh««fiWliv*^-*A»-* W i iiit l ilM i iW i iliM^^ :cf I 1 to — m iBi. ft JPs f^ "^ -*~ f A97^>. ^ ^^ ^HWii^ ^ mmm k ■ife* ii ^c-l i"**! .<==> />< 1 V '^^i Xi j^^ PSp^I < RVll r]i MEDIC. SCHOOX" 11,758 STUDENTS, FACULTY, RESEARCHERS, AND STAFF DEDICATED TO ALLEVJtf HUMAN SUFFERING CAUSED BY DISEASE. At Harvard Medical School, the world's largest group of world-class researchers working on human genetics is on the brinl< of a revolution: personalized patient care based on one's individual genonne. This approach to individualized ^ treatment is the future. It will be possible because of the breakthroughs in human genetics happening here. INVEST IN DISCOVERY Support this vital work. Visit www.hms.harvard.edu or contact Mary Moran Perry at 800-922-1782, 617-384-8449, or mperryOhms.harvard.edu. GIFT PLANNING: CHARITABLE TRUSTS • GIFT ANNUITIES • REAL ESTATE • RETIREMENT PLAN ASSETS • BEQUESTS Harvard Medical Alumni Association 25 Shattuck Street Boston, Massachusetts 02115 Change Service Requested Non-Profit Organization U.S. Postage PAID Permit No. 52420 Boston, MA HOLMES, SWEET HOLMES: Oliver Wendell Holmes, Class of 1 836, was far from the retiring, measured stereotype so commonly conjured for the Victorian era. His lively, inquir- ing mind led him to provide engaging discourses on such topics as the contagiousness of puerperal fever, the impor- tance of the U.S.S. Constitution ("Old Ironsides"), and the provincial view of those in his hometown — his belief that Bostonians considered their State House the hub of the solar system led to the city's nickname, _"the Hub." Holmes was a man of science, a man of letters, and, according to a recent symposium at the Francis A. Counlway Library of Medicine, a man of questions. Organized to commemorate the two-hundredth anniversary of the birth of the former Harvard Medical School dean, "Oliver Wendell Holmes and the Spirit of Skepticism" celebrated his life, his accomplishments, and the continuing relevance of his literary and scientific contributions. To view videos of the symposium, visit alumnibulletin. med.harvard.edu/history/people/holmes.php.