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AUTUMN 2009

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Science, Seance,
and Skullduggery

ALUMNI BULLETIN

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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

I President's Report 12

< by Steven E. Weinberger

I Bookshelf 13

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

§ Class Notes 52

^ 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

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: bulletin@hms.harvard.edu

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

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

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 paula_byron@hms.harvard.edu. ■

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

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

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 sM'einhcrger@acponline.org.

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 paula_hyron@hms.harvard.cdu.

HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009

BOOKS BY OUR ALUMNI [

ROOKSHETF

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-

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^^^^^^^'

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

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.

•

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AUTUMN 2009 • HARVARD MEDICAL ALUMNI BULLETIN

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

.^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!"

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iKf

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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

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

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.

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.

.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

4<Ste«,

■**«;«;#■

..::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

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,

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

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

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.

HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009

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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.

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

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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

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

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,

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

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

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

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 jbeckl@partners.org."

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, Jr.

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."

Martin 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

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

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

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, Jr.

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.

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

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 MallinrWrndt 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.

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

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.

HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2009

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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.

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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.

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