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Full text of "Harvard medical alumni bulletin"

SPRING 2009 




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ALUMNI BULLETIN 







DI^jz- 11 






If you want to be happy, 
resolutely turn the spot- 
light off yourself. Forget 
your own self-importance, 
your aches and pains, your 
feelings and fears. Instead, 
get busy. The world is wic 
and fascinating, and it 




SPRING 2009 • VOLUME 82, NUMBER 2 



CnNTW 




DEPARTMENTS 



Letters 3 

Pulse 6 

Harvard Medical School students take 
to the stage while alumni take to the 
small screen 

President's Report 8 

by Steven E. Weinberger 

Bookshelf 9 

Benchmarks 10 

Promising research on a topical treatment 
for herpes and a surgical safety checklist 

Class Notes 64 

InMemoriam 67 

Thomas H. Weller 

Obituaries 68 





Design 



for Life 54 

From sharks to snails, bears to snakes, 
% frogs to bacteria, Earth's biodiversity 
° holds medical treasures waiting to 
< be discovered — and crying out to be 

1 conserved, by Eric Chivian 

I Doctor Who? 60 

2 Test your wits on the wisdom of centuries 
- of Harvard doctors, by Fred R. Shapiro 



SPECIAL REPORT: THE HOLLYWOOD ISSUE 



12 Special EtteCtS What can the dramatic arts teach doctors about 
improving their performances? t> alice flaherty 

lo rlOyinCJ UOClOr Television physicians have devolved from saints to 
sinners — without sacrificing ratings, by allan j. Hamilton 

24 I he LOSt World A former classmate reflects on Michael Crichtoris 
years at Harvard Medical School — and celebrates his life and work. 

by WILLIAM IRA BENNETT 

Zo Idles UUT 0l jChOOl Listening to patients' stories makes for good 

doctoring — and sharing those stories makes for good TV. by neal baer 

34 Cinema Veritas A blonde bombshell, a death on the dunes, and a 
handsome leading man are all part of Harvard Medical School's 
celluloid history, by massad Gregory joseph 

DO bCript UOClOrS Whether penning lines for House, MD or producing 
independent films, these Harvard doctors always have an audience. 

by JESSICA CERRETANI 

44 We're Ready for Our Close-Up one believes he s God; another 

performs exorcisms. One commits murder, while another merely hurls 
cats in fits of pique. Meet the fictional graduates of Harvard Medical 

School, ty PAULA BYRON 

52 Watch and Leam Hollywood has long offered a range of medical role 
models. From which screen doctors should you take your cues? 

72 Changing Channels When you've worked all day as a doctor, some- 
times the last thing you need is more medical drama in your living room. 

1)) VICTORIA MCEVOY 

The cover photoillustration by Stephen Webster features the 1978 movie Coma, based on a novel by a former 
faculty member of Harvard Medical School, Robin Cook, and directed by an alumnus, Michael Crichton. 



Harvard M edical 



ALUMNI BULLETIN 




In This Issue 

ARVARD HAS ITS HISTRIONIC STREAK. THE HASTY PUDDING CLUB, HOME OF 

drag theatricals and currently Hollywood's most durable and publi- 
cized fan club, was founded only a dozen years after Harvard Medical 
School. The School's Second Year Show has been running since 1907, and the 
tradition has outlasted much of what was taught in the classrooms and clinics 
of that era. For that matter, the Second Year Show is older than Hollywood, 
which hosted its first movie production in 1910. 

None of this would lead me to say that Harvard has anything more than its 
first and last letters in common with Hollywood, except that it does — if only 
only for its keen sense of the value of branding. Given their shared dramatic 
traditions and mastery of publicity, it is hardly surprising that the two institu- 
tions have developed a symbiosis. In "Hollywood, the dream factory," as anthro- 
pologist Hortense Powdermaker called the American movie business, Harvard 
has a rather special role. 

Real HMS alumni do not have much of an on-screen presence — except for 
the long-running cast of NOVA's documentary series that began with "Can We 
Make a Better Doctor?" in 1988. Mostly, our screen graduates are fictional, and 
any resemblance to persons living or dead is purely coincidental. One living 
alumna, however, came very close to being resembled, not at all coincidentally, 
in a television series whose pilot was filmed but not aired, and she tells the 
story in this issue. 

Harvard graduates with diplomas do go to Hollywood, however, as writers 
for and consultants to the industry's many doctor dramas. To say that there are 
"droves" of HMS alumni in Tinseltown may be a shade expansive, but "pack" or 
"pride" seems fair enough. Many of the medical series of the past 20 years have 
drawn on the experience and skill of an HMS alumnus or faculty member, most 
notably ER, which was conceived by the late Michael Crichton '69 soon after he 
graduated, although it didn't debut until 1994. In this issue, we offer a sampling 
of the ways that HMS doctors have participated in what Hortense Powdermaker 
called the "mass production of prefabricated daydreams." 



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&H 1/lA 




EDITOR-IN-CHIEF 

William Ira Bennett '68 

EDITOR 

Paula Brewer Byron 

ASSOCIATE EDITOR 

Ann Marie Menting 

ASSISTANT EDITOR 

Jessica Cerretani 

EDITORIAL INTERN 

Ryann Burnett 

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 

Alice Flaherty '94 

Atul Gawande '94 

Robert M. Goldwyn '56 

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 

JudyAnn Bigby 78, president-elect 1 

Gilbert Omenn '65, president-elect 2 

Ken Offit '81, vice president 

Neil R Powe '80, secretary 

Douglas G Kelling 72, treasurer 

COUNCILLORS 

H. Thomas Aretz 76 
Rosa M. Crum '85 

Laurie Glimcher 76 
Jim Yong Kim '86 

Triste N. Lieteau '98 

Eileen Reynolds '90 

Michael Rosenblatt 73 

Rahul Sakhuja '03 

John D. Stoeckle '47 

CHAIR OF ALUMNI RELATIONS 

George E. Thibault '69 



REPRESENTATIVES TO THE 
HARVARD ALUMNI ASSOCIATION 

Joseph K.Hurd, Jr. '64 
John D. Stoeckle '47 

The Harvard Medical Alumni Bulletin is 

published three times a year 

at 25 Shattuck Street, Boston, MA 02115 

* 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 01917757 • Printed in the U.S.A. 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 



SECOND OPINIONS FROM OUR READERS 



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All Aboard 

A hearty welcome to the search Daniel 
Federman '53 conducted in the Spring 
2008 issue of the Bulletin, using a nauti- 
cal metaphor, for a system of universal 
health care that has long been in place in 
every other developed country. Actually, 
we may be closer to Dan's "clear sailing" 
than his metaphor suggests. Two major 
initiatives will be crucial to the success 
of national health insurance. 

First, for-profit insurance companies 
must get out of health care. Hundreds 
of billions would be saved, as their 
overhead of 25 to 30 percent could be 
reduced to Medicare's efficient 2 to 3 
percent. No more advertising. No more 
administrative efforts to reduce bene- 
fits, and no more profit. Medicare for all 
is the aim of the United States National 
Health Insurance Act, or H.R. 676, 
which has more than 60 cosponsors in 
the U.S. House of Representatives. Dan 
doesn't have to look far for first-rate 
scholars and advocates for such a solu- 
tion. Several are HMS faculty members. 



Second, for national health insurance 
to succeed, we must bolster primary care, 
which has been attracting fewer young 
physicians every year. In successful sys- 
tems around the world, two-thirds of doc- 
tors are in primary care. In this country, 
the ratio is less than one-third. Specialty 
care, with its emphasis on diagnostic and 
therapeutic procedures, is inherently 
expensive. This is partly why the United 
States spends twice as much per capita 
as other countries. To make primary care 
more attractive, Drs. Arnold Relman and 
Marcia Angell have called for a major over- 
haul of physician reimbursement. 

While the Bulletin has visited the 
issue in articles and letters since 1999, 
the gap between outstanding care at 
great centers like Harvard and the 
diminishing number of people it reaches 
has become more and more unaccept- 
able. Now is the time for the Harvard 
Medical School family to get on board 
the good ship Federman and set course 
to a brighter future. 

JAMES S. BERNSTEIN '52 
NEW YORK, NEW YORK 



Navigational Aids 

Daniel Federmarfs thoughtful and cogent 
piece about the problems facing medicine 
makes a strong case that HMS students 
and graduates should be agents for 
change in reforming our present dysfunc- 
tional health care system. Indeed, a num- 
ber of HMS graduates, such as Donald 
Berwick 72, have played prominent roles 
in this area, despite its overall dominance 
by lobbyists, health economists, and large 
corporate health care purchasers. 

Dr. Federman's proposal to apply 
the standards of medical education to the 
problems of health care needs to be put 
into context, however. Any change in our 
health care system will, of necessity, 
involve government participation and 
action to a major extent. As someone who 
spent eight years working full-time in the 
U.S. Senate on health issues, I can attest 
that the concepts of logic and evidence 
that dominate medical education are gen- 
erally subordinate factors — and some- 
times only minor annoyances — in a world 
of government policy in which political 
agendas and personal relationships 
reign supreme. Our future agents of 
change must be specifically taught how 
to operate in this very different world if 
they want to succeed; "evidence-based 
politics" is a wish for the future, if not 
an outright oxymoron. 

Similarly, HMS graduates must prac- 
tice medicine in a world where, at least 
for the foreseeable future, the rules that 
govern such practice are not set by HMS. 
In particular, Dr. Federman's admonition 
that HMS graduates should "change the 
world" if they are unable to practice as 
they were taught seems a bit glib. Until 
the HMS agents of change can succeed, 
the School's graduates will be carrying 
out their profession in a world where 
non-physicians decide what constitutes 
performance in a world increasingly 
dominated by pay for performance; 
where others determine how physicians 
should balance dedication to the individ- 
ual patient with a need to husband limit- 
ed medical resources; in short, where the 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



^> 



LETTERS 



SECOND OPINIONS FROM OUR READERS 



SHELF EXAM 

In this poem, I offer a reaction to what appears to be our pernicious and 
inexorable slide toward judgment of each other and our students through 
multiple choice exams. 

1 . A doubtful man, bemused by paper-green pictures of presidents (metal 
coins are more convincing), has job and car and house and wife fading 
toward transparence. He can feed: 

a. the diabetes and the cat 

b. the copay and the cold pain 

c. Timmy's faded teachers 

d. tides of tax 

e. none 

2. A doubtful doc reaches each station asymptotically — almost, nearly — 
but never, in these winding days, the tight fit of ligand and ligandee. A 
foot pointed where. His jagged REM is colored by: 

a. paper people and carnal lab slips 

b. a beeper at an orgasm 

c. the electronic medical rectum 

d. wrong third-grade answer recalled 

e. no one 

3. A doubtful copy of the educator class, crazed quantifiliac, lately 
cloning influence to see if the number of numbers will surpass the macro- 
electronic storage crates. Escaping enumeration is (are): 

a. mother's heartcramps 

b. the stars in disguise 

c. primes between ten and a lot 

d. the shelf in the self 

e. not one 

EDWARD R. WOLPOW '63 
BROOKLINE, MASSACHUSETTS 




rules of the game are not set by the play- 
ers. HMS has an obligation to teach its 
students how to practice the art and 
craft of medicine successfully within the 
confines of a health care system that is 
ultimately designed by the citizenry at 
large and not just by physicians. 

To extend Dr. Federman's sailing 
metaphor, no amount of maneuvering will 
help you navigate well in the dark of night 
through a channel loaded with mines 
unless you have the proper equipment 
and maps. It is the obligation of HMS to 
make sure its graduates know how to 
find and use the tools they will need to 
complete their journeys successfully. 



ALLAN R. GLASS '7 1 
BETHESDA, MARYLAND 



Transcript of Events 

I enjoyed very much reading the letter 
Massad Joseph 77 wrote in the Spring 
2008 issue in which he recounts a boy- 
cott by the Class of 1977 protesting a 
grading system with more categories 
than the pass or fail we had been expect- 
ing. I was troubled to realize, though, 
that I had no recollection of a pass/fail 
system, a boycott, or Dean Robert Ebert's 
warning that we were all easily replace- 
able if we dared execute a protest. 

I do remember, however, that our 
class, much to the chagrin of this then- 
poor boy, refused to accept stethoscopes 
from a pharmaceutical company (I 
believe it was Eh Lilly) in an advanced 
statement of protest against the pharma- 
ceutical industry (of which I subsequent- 
ly became and remain a member). I also 
was perplexed as to how we could have 
created a system whereby each student 
was assigned a number, how we recruit- 
ed a faculty member to assist us in these 
endeavors, and whether any student 
actually, as part of the proposed honor 
system, turned himself or herself in as a 
"failee" of the physiology course. Last, 
wouldn't such a system have required 
100-percent participation and how 
would a boycotter of the boycott have 
been treated? 



4 HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 



I scurried to my files and found my 
four-year transcript, which, in black on 
white, provided several clues suggesting 
that Massad was mistaken. The tran- 
script contained a legend at the bottom 
with the categories of E (excellent), S 
(satisfactory) and U (unsatisfactory). 
My grades fell into three categories: S, E, 
and "-". Fortunately I didn't receive any 
grades of U, though one might argue 
that I might have during my psychiatry 
rotation, as the residents and attending 
criticized me for refusing to accept the 
teachings of Freud. What, though, did 
the "-" represent? 

I do recall that our class was either 
the first or one of the first to be told we 
wouldn't receive class rankings. Perhaps 
that's what Massad was recalling; my 
transcript doesn't show any ranking. 

I do hope that this provides some 
clarification about the reported boycott. 
I still have questions. Did we in fact 
reject the free stethoscopes, and was it 
Lilly that made the offer we turned 
down? And can someone please tell me 
what a grade of "-" means? 

MARK A. KLAUSNER 'JJ 
PRINCETON, NEW JERSEY 

Semiformal 

Early in my medical school career, I was 
sent, along with several students, to 
Boston City Hospital for a conference 
with William Castle '21, a pioneer in 
hematology. Upon our arrival, we found 
the professor in overalls; he had been 
repairing the hospital elevator. He start- 
ed his lecture by complaining that the 
repairmen had had the audacity to want 
to charge the hospital five dollars per 
hour for their repair work. 

Toward the end of my fourth year, 
my wife and I received an unusual tele- 
phone call. The caller announced that 
she was Mrs. William Castle, and she 
invited us to a Sunday dinner at her 
home. At first I thought it was a prank 
call; my classmates were always putting 
some woman up to call me, claiming to 
be from the dean's office and informing 



'During the dinner, 
Mrs. Castle served a 
homemade chicken 
potpie. 'What, no liver?' 
I shouted. The professor 
broke into a profound 
laughter. He explained 
that he would not eat 
liver, even if he were 
starving to death." 

MURRAY STROBER '51 



me I'd failed physiology. Mrs. Castle 
must have thought that I was mentally 
disturbed, as I repeatedly challenged 
the veracity of her call. The next day I 
overheard another student claiming 
that he and his wife were invited to the 
same dinner. Surely, I thought, this invi- 
tation must be a prelude to a final 
examination to determine whether I 
could graduate from the Medical 
School. I immediately began reading up 
on Dr. Castle's research, such as his dis- 
covery of the gastric intrinsic factor. 

The next dilemma occurred on the 
day of the dinner, when my wife and I 
couldn't decide how to dress. I had my 
suit pressed and my shoes shined. My 
wife donned her finest dress, adding a 
hat and white cotton gloves. When we 
arrived at the designated address, I real- 
ized the invitation had indeed been 
authentic. In the driveway was Dr. Cas- 
tle's 1933 Model T Ford. Dr. Castle 
responded to my ringing the doorbell. 
He was wearing an open shirt, dunga- 
rees, and sneakers, and he had a glass of 
beer in his hand. With his melodious 
bass voice he welcomed us. 

During the dinner, Mrs. Castle served 
a homemade chicken potpie. "What, no 
liver?" I shouted. The professor broke 
into profound laughter. He explained 
that he would not eat liver, even if he 
were starving to death. I later explained 
my confusion with Mrs. Castle's tele- 




phone call, describing the pranks that 
had been played on me. When I added 
the story about preparing for the visit 
by boning up on his research, Dr. Castle 
broke into thunderous laughter. 

At the end of the evening, Dr. Castle 
declared that he and his wife had had a 
wonderful time. He planned to make this 
type of dinner an annual event. 

After graduation I started my intern- 
ship on the Downstate University Ser- 
vice at King County Hospital in Brook- 
lyn, New York. One day, a rumor was 
circulated that Dr. Castle was at the 
hospital to see his old friend, William 
Dock, who had been a house officer at 
Peter Bent Brigham Hospital in 1923. 
Apparently, Dr. Castle asked Dr. Dock 
whether I was an intern on his service. 
While making rounds on one of the 
wards, Dr. Castle saw me and rushed 
over to embrace me warmly and inquire 
about my wife. I was the topic of hospi- 
tal gossip for some time — and my 
appointment to the next year's residen- 
cy program was assured. 

MURRAY STROBER '51 
PASSAIC, NEW JERSEY 

The Bulletin welcomes letters to the editor. 
Please send letters by mail (Harvard Medical 
Alumni Bulletin, 25 Shattuck Street, Boston, 
Massachusetts 02115); fax (617-432-0089); or 
email (hulletin@hms.harvard.edu). Letters may 
he edited for length or clarity. 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



PTIT.SK 



MAKING THE ROUNDS AT HMS 



Ready for Prime Time Players 



D 



HE UNTHINKABLE HAS HAPPENED: 

HMS has dropped to number 
two in the medical school 
rankings, losing out to some 
school in Baltimore. What is a dean of 
medical education to do? In the 102nd 
Second Year Show, Jules Dienstag sets out 
to restore HMS to its former glory by 
crafting the new, new, new curriculum. 

He's Got Curriculum, directed by Paul- 
valery Roulette and Ibrahim Khansa, 
takes much of its inspiration from televi- 
sion. Dienstag gives a group of professors 
one last chance to reconfigure their 
courses and help bring HMS back to the 
top spot in the rankings. Each professor's 
new (but not-so-improved) course is pre- 
sented via a spoof on a television show, 
after which he or she must enter the 
boardroom and receive Dienstag's verdict. 
Chris DeSesa's turn as Dienstag makes 
the show. Part Dr. Evil, part Donald 
Trump, DeSesa's Dienstag gleefully 
insults and then fires each and every 
instructor, with impecca- 
ble comic timing. An 
unabashed blowhard 
who "eats success 
for breakfast," he 
tells course direc- 
tor Kate Treadway 
(Katherine Walker) 
that her introductory 
course needs "a little 
less Introduction and a 
little more Profession." 
No wonder Trudy Van 
Houten (Regan Bergmark) 
calls him "Dr. Mean- 
stag." Dienstag's buf- 
foonery is further 
enabled by his adorable 
assistant Evan, played 
by Jordan Strom, 
who eagerly caters 
to Dienstag's every 
whim Strom's acting 
chops were evident, 
since despite his lack 





PLAYING IT COOL: The Class of 201 1 devotes its Second Year Show to poking fun at 
the new curriculum. 



of a speaking part, his antics as Evan 
frequently had the audience in stitches. 

In between send-ups like "MCM 
Bachelor," a Dating Game-style show in 
which cell biologist Randy King (Adam 
Donnell) must find his biochemistry 
queen, the audience was treated to com- 
mercials for faux pharmaceuticals like 
Gunnopril (for the treatment of idio- 
pathic gunner syndrome) and Geico 
Dental Insurance ("So easy, even a Dental 
can do it!"). Those hankering for dancing 
got an occasional fix. 

Several musicians from the Class of 
2011 stood out. Chinyere Obimba, who 
served as the production's music direc- 
tor, got the show off to a strong start 
with "Study, Study, Study," set to the 
tune of "For the Love of Money" by the 
O'Jays, and later stole the scene during 
"Physiology Magic School Bus." Nadia 
Farjo's vocal talent was kept under 
wraps until the end, when, dressed as an 
ob/ob mouse in tribute to HMS Dean 
Jeffrey Flier's obesity research, she mas- 



terfully delivered the concluding song, 
"This Is How We Do It (HMS and 
HSDM Style)." Another musical high- 
light was Sherman Jia's violin accompa- 
niment to a reading of the children's book 
Ferdinand the Bull during intermission. 

It would not have been the Second 
Year Show without searing parodies of 
everything HMS holds dear. Referring 
to Patient-Doctor I, a student asks, 
"Why do we have to take a class to 
learn to pretend like we care?" HST 
students, as hopelessly nerdy and 
socially inept as ever, demand to be 
known by their new culturally sensi- 
tive name: the London Society. Even 
Sarah Palin is skewered. 

As usual, the breadth of talent was 
impressive. If the second-years want 
HMS to regain its top ranking, they might 
consider challenging those students in 
Baltimore to a talent competition. ■ 

< 

Emily Lieherman is the editorial assistant 
for Focus. 



Linked In 




HAT DO URBAN PLANNING AND 

neuroimaging have in com- 
mon? What about smog and 
kidney disease, or cancer 
vaccines and polymers? These are just a 
few of the intriguing research collabora- 
tions to receive grant funding from 
Harvard Catalyst, the Harvard Clinical 
and Translational Science Center. 

The first round of 62 pilot grant recipi- 
ents, announced this spring, connects 218 
investigators from 23 Harvard schools 
and academic health care centers with the 
shared goal of addressing important issues 
in human health. The urban planning and 
neuroimaging collaboration, for example, 



will unite researchers from the Harvard 
University Graduate School of Design and 
Massachusetts General Hospital. The Har- 
vard School of Public Health and Brigham 
and Women's Hospital will join forces to 
study the effects of air pollution on kidney 
disease. And the Dana-Farber Cancer 
Institute and the Harvard School of Engi- 
neering and Applied Sciences will collabo- 
rate on the role of polymers in vaccinations. 
With these one -year, $50,000 grants, 
Harvard Catalyst aims to stimulate clini- 
cal and translational research in three 
ways. First, the grants enable researchers 
to jointly address important scientific 
questions. Second, they provide the 



means to generate the preliminary data 
needed to apply for long-term funding. 
Lastly, the grants help focus scientific 
resources and expertise on high-risk, 
high-impact areas of research. 

"The pilot grants of Harvard Catalyst 
demonstrate the drive among the faculty 
to collaborate on unique problems," says 
Jeffrey Flier, dean of HMS. "Watching this 
process unfold has confirmed my deep 
conviction that we can most effectively 
impact human health by encouraging peo- 
ple from across Harvard who have never 
worked face to face to work together." 

For more information, visit http:// 
catalyst.harvard.edu. ■ 



Reel Medicine 



D 



N I987, THE CREW OF THE 

television program NOVA arrived 
on the HMS campus to begin 
shooting what would become 
700 hours of footage of seven first-year 
students. The resulting documentary 
series — "Can We Make A Better 
Doctor?" — aired in 1988 and portrayed 
the stress, drama, and rewards of med- 
ical school. Subsequent episodes 
detailed the doctors' residencies and 
early years of practice. 

This spring, a two-part installment 
called Doctors' Diaries catches up with 
the physicians for an update that is, at 
times, poignant: One doctor no longer 
sees patients; others have faced chal- 
lenges with their health or personal 
relationships. Still, these alumni have 
few regrets. "In my years of practice, I 
have seen all the ranges of extreme 
tragedy, extreme joy," says Tom Tarter 
'91 of his experience. "I can't think of 
anything that has grounded me so 
much in my life as being a doctor." 

To learn more, visit www.pbs.org/ 
wgbh/nova/doctors. ■ 



Making His Move 



GEORGE THIBAULT '69 HAS ANNOUNCED 

his plan to step down as HMS chair of 
alumni relations in October. Thibault, the 
former director of The Academy Center for 
Teaching and Learning at Harvard Medical 
School, has spent most of his medical 
career at HMS and its affiliated hospitals. 
He has served as chief medical officer at 
Brigham and Women's Hospital and as 
vice president of clinical affairs at Partners 
HealthCare. A cardiologist by training, 
Thibault has been president of the Josiah 
Macy, Jr. Foundation since January 2008. 

In anticipation of the change, Alumni 
Council President Steven Weinberger '73 
has convened a nominating committee 
to begin the 
search process 
for Thibault's 

successor. "George's recent tenure as chair of alumni 

relations has capped off a long and distinguished record 

of contributions to HMS," Weinberger says. "Throughout 

his career, he has exemplified the 'quadruple threat' 

through excellence in patient care, teaching, research, 

and administration." ■ 




Leadership Sought 

TO NOMINATE YOURSELF OR ANOTHER 

HMS graduate to take on the role 
of chair of alumni relations, contact 
Debra Metcalfe, director of alumni 
relations, at 617-384-8518 or 
debra metcalfe@hms.harvard.edu. 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



PRESIDENT'S REPORT 



Course Adjustments 



m 



EALTH CARE FACES TRULY DAUNTING ISSUES AS WE 

approach the second decade of the twenty-first 
century: 47 million uninsured Americans; Medicare 
expenses that consume 16 percent of the federal bud- 
get and are projected to grow to 20 percent by 2016; physician 
shortages, particularly in primary care; and a health care system 
that achieves stunningly poor outcomes despite staggering 
costs. At the same time, the medical education community con- 
fronts a widening array of challenges in training tomorrow's 
physicians, challenges that affect both undergraduate and grad- 
uate medical education and are often related to changes in 
health care and in the training environment. 

Given my local and national perspectives on medical edu- 
cation — gathered during more than twenty-five years as a 
clinician-teacher and medical educator at HMS, and, more 



rience and professional development. As a consequence, the 
outpatient setting must play a greater role in training future 
physicians and must assume a focus on prevention and on bet- 
ter management of chronic illness to avoid hospitalization. 

Limitations on duty hours. In recent years, regulatory bodies 
have imposed restrictions on resident work hours, with the 
intent of reducing resident fatigue and improving patient safe- 
ty. The subsequent increase in physician-to-physician hand- 
offs has led, however, to concerns about diminished continu- 
ity and the potential for decreased quality of care. Reconciling 
these concerns necessitates creative approaches to scheduling 
and patient coverage that balance and best meet the needs of 
both trainees and patients. 

Pressures on teaching faculty. Faculty members need time and 
support for the responsibilities that are critical to the profes- 




Students and trainees must understand the 
importance of assessing and continually 
improving the quality of care they provide. 



recently, five years directing medical education at the Ameri- 
can College of Physicians — I decided to use this column to 
discuss four major environmental changes affecting health 
care and medical education. 

Emphasis on quality of care. Catalyzed by the Institute of Medi- 
cine's Crossing the Quality Chasm report, physicians are now 
judged not only by what they know, but more importantly by 
what they do when caring for patients — that is, the quality of 
care they provide. Students and trainees must be educated in 
an environment in which quality of care is a core value, and 
they must also understand the importance of assessing and 
continually improving the quality of care they provide. Faculty 
who supervise these students must embrace a culture of quali- 
ty, commit to teaching the principles of quality improvement 
and the delivery of high-quality care, and serve as role models 
for the implementation of such improvement and care. 

Change in the nature of inpatient care. For several years now, the 
inpatient setting is no longer an ideal place for trainees to learn 
how to diagnose acute illness, follow the course of acute dis- 
ease, and take primary responsibility for patient care. Instead, 
preadmission diagnoses, shortened inpatient stays that focus 
on throughput, and the delegation of decisions to attending 
physicians and consultants all detract from the student's expe- 



sional development of students and trainees: evaluation through 
direct observation, frequent and high-quality feedback, mentor- 
ship, and role modeling. Yet faculty members are under increas- 
ing pressure to generate more revenue through either clinical 
productivity or grant funding. As teaching activities do not gen- 
erate revenue, clinical institutions require clinician-teachers to 
see a greater number of patients, a move that lowers the priori- 
ty placed on their teaching responsibilities. Fortunately, many 
institutions have acknowledged the need to support teaching 
faculty by remunerating their educational duties and emphasiz- 
ing quality and quantity of teaching in criteria for promotion. 

These four areas do not capture all the changes affecting 
medical education; notably absent are the pressures accompa- 
nying the current economic downturn. They do, however, rep- 
resent areas over which medical schools, teaching hospitals, and 
educational leaders have some control. How well institutions 
address these challenges will determine how well they can meet 
the educational needs of students and trainees and the clinical 
needs of patients. ■ 

Steven E. Weinberger 73 is senior vice president for medical education at 
the American College of Physicians in Philadelphia. He can be reached 
at sweinberger@acponline.org. 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 



BOOKS BY OUR ALUMNI 



BOOKSHELF 



M^ 



A Doctor 
in Galilee 



Uncle Sani's 
f"^ Shame 





Rhinosinusitis 



Worried . 
^Sick U 





A Doctor in Galilee 

The Life and Struggle of a Palestinian in Israel, 
by Hatim Kanaaneh '68 (Pluto Press, 2008) 



A native of Galilee born before the cre- 
ation of the state of Israel, the author 
founded the Galilee Society, a non- 
governmental organization aimed at 
achieving adequate health, environmen- 
tal, and socioeconomic conditions for 
Palestinian Arabs in Israel. In this, his 
memoir, Kanaaneh describes the forma- 
tion of his grassroots organization and 
describes how he fought for the basic 
human rights of his patients. 

Uncle Sam's Shame 

Inside Our Broken Veterans Administration, 
by Martin Kantor '58 (Praeger Security 
International, 2008) 



The author, a psychiatrist, reveals how 
everyone involved in veterans' medical 
care — from the nation's capital, to doc- 
tors, to the veterans themselves — is 
responsible for the breakdown of the 
system. He pinpoints how common ill- 
nesses that veterans suffer are misman- 
aged, and he offers his ideas for meaning- 
ful reforms to the current system. 

The Iodine Trail 

Exploring Iodine Deficiency and Its Prevention 
Around the World, by John B. Stanbury '39 
(Oxford University Press, 2008) 



and Africa as it details the author's 
travels during his decades-long study 
of iodine deficiency disorders. Filled 
with tales of harrowing encounters with 
mountain gorillas, venomous snakes, 
and callous dictators, it also offers an 
introduction to the field of iodine defi- 
ciency and an insider's account of scien- 
tific collaboration. 

Rhinosinusitis 

A Guide for Diagnosis and Management, 
edited by Erica Thaler '90 and David W. 
Kennedy (Springer, 2008) 



This guide discusses the medical, surgi- 
cal, and pharmacological management of 
rhinosinusitis. Pediatric considerations 
and the role of allergies, asthma, and sys- 
temic diseases are detailed. The editors 
devote a special chapter to alternative 
medicine, review surgical therapies, and 
include information about diagnostic 
imaging techniques. 

Worried Sick 

A Prescription for Health in an Overtreated 
America, by Nortin M. Hadler '68 
(University of North Carolina Press, 2008) 



This book takes medical research out of 
the laboratory and into South America 



Hadler argues that access should not be 
the only issue in the current debate about 
health care: the amount of care available 
should also be on the table. He urges read- 
ers to educate themselves so they can 
make informed decisions about what care 
is truly necessary. Each chapter addresses 
the uses and abuses of a particular proce- 
dure or treatment, such as mammography 



and coronary stents. Accompanying source 
chapters provide references that help 
inform Hadler's critique. 

The Infertility Assistant 

A Practical Planner to Help You Through Your 
Infertility Journey by Chantal Caviness '93 
and Ann Montalvo-Guillerman 
(SOS Publishing, 2C. 



A pediatrician, Caviness underwent six 
years of infertility testing and treatments 
before having twins by surrogacy. This 
guide is designed to help women and 
couples track information involved in the 
diagnosis and treatment of infertility 
while maintaining a sense of control. The 
book includes sections on choosing a 
doctor, medical evaluation, self-care, 
financial and insurance-related concerns, 
and treatments such as intrauterine 
insemination and in-vitro fertilization. 

How to Use Herbs, Nutrients & 
Yoga in Mental Health Care 

by Richard P. Brown, Patricia L. 
Gerbarg 75, and Philip R. Muskin 
(W. W. Norton, 2009) 



This guide covers major categories of 
mental health — mood disorders, cognitive 
decline, substance abuse — and presents a 
range of complementary and alternative 
treatments found to be helpful for those 
conditions. The use of herbs, vitamins, 
hormones, and mind-body practices is 
discussed with a focus on methods that 
are practical and easy to administer and 
that have few side effects. 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



RENCHMAKKS 



DISCOVERY AT HMS 



Rites of Passage 




HETHER THROUGH CONDOMS 

k m « I or abstinence, most meth- 

\ t± Vi | ods to prevent the spread 
of sexually transmitted 
diseases have a common logic: keep the 
pathogen out of the body altogether. 
Although reasonable, that approach 
does not help countless people who 
have little or no control over their sexu- 
al circumstances. 

Now, Judy Lieberman '81, an HMS 
professor of pediatrics at Children's 
Hospital Boston and a senior investiga- 
tor at the Immune Disease Institute, has 
overseen the development of a topical 
treatment that, in mice, disables genes 
necessary to herpesvirus transmis- 
sion. The treatment uses the intracellu- 
lar mechanism called RNA interference 
(RNAi) to deal the virus a molecular 
one-two punch that knocks out both 
the bug's ability to replicate 
and the host cell's capacity 
to take up the virus. 

The treatment is just as 
effective when applied from 
one week before to a few 
hours after exposure to the 
virus. So the basic biology of 
the prophylactic is respon- 
sive to real-world demands. 

The findings appear in the 
January 22 issue of Cell Host 
and Microbe. 

Now and Then 



If we can reproduce these results in people, 
use of this microbicide could have a pow- 
erful impact on preventing transmission." 

According to the World Health Orga- 
nization, approximately 536 million 
people worldwide are infected with her- 
pes simplex virus type 2 (HSV-2), the 
most common strain of the herpesvirus. 
Women are disproportionately affected, 
with potentially serious consequences. 
The virus can pass easily from mother to 
newborn during delivery, and untreated 
infants risk brain damage and even 
death. While HSV-2 alone is not life 
threatening for adults, infection does 
increase a person's vulnerability to other 
viruses such as HIV. 

In order for the herpesvirus to infect 
a host cell, two conditions must be met. 
First, the virus must enter and take over 
the cell. Second, the virus must repro- 



duce itself. Liebermaris topical treatment 
uses RNAi to foil both events. 

Method Acting 

RNAi, a biological process identified 
barely a decade ago, has transformed the 
field of biological research. This process, 
which occurs naturally in the cells of all 
multicellular organisms, regulates the 
translation of genetic information into 
proteins. By introducing tiny RNA mole- 
cules into ceUs, researchers can target a 
gene and block its ability to build protein 
molecules, essentially disabling the gene. 
While RNAi has profoundly improved 
scientists' ability to probe and interro- 
gate cells in Petri dishes, therapeutic 
breakthroughs using the process have 
proved elusive. Researchers have had dif- 
ficulty targeting the delivery of the tiny 



"People have been trying to 
make a topical agent that can 
prevent transmission for many 
years," says Lieberman. "But 
one of the main obstacles to 
this goal is compliance. One of 
the attractive features of the 
compound we developed is 
that it creates in the tissue a 
state that's resistant to infec- 
tion, even if applied up to a 
week before sexual exposure. 




10 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 



No Sponge Left Behind 



RNA molecules into selected cells and 
tissues in a living organism. 

For this study, Lieberman and her team 
modified a delivery technique they had 
previously developed so as to treat murine 
cells with strands of RNA that could block 
certain genes from producing proteins key 
to the herpesvirus infection process. The 
technique allowed the researchers to fuse 
the RNA strands to cholesterol molecules, 
which helped chaperone the RNA mole- 
cules through the cell membranes. When 
applied as a topical solution, the RNA mol- 
ecules could be fully absorbed into the 
vaginal tissue, protecting the mice against 
a lethal dose of administered virus. 

One RNA molecule in the topical solu- 
tion targeted the herpes gene UL29, a gene 
the virus uses in its replication process. 
Another RNA molecule targeted the 
actions of Nectin-1, a surface protein on 
cells in the vaginal tissue. Nectin-1 binds 
to extracellular substances, including 
herpesvirus, and ushers them into the 
cell. By shutting down Nectin-1, the virus 
cannot get into the cells. 

The actions of either RNA molecule 
would be sufficient to block the virus. But 
delivered together in this RNAi cocktail, 
they prompt the host cell to block the 
virus's entrance and to implement a back- 
up scheme that wipes out the invader's 
ability to multiply if it does enter the cell. 

'As far as we could tell," says Lieberman, 
"the treatment caused no adverse effects, 
such as inflammation or any kind of 
autoimmune response. And while knock- 
ing out a host gene can certainly be risky, 
we didn't see any indication that tem- 
porarily disabling Nectin-1 interfered with 
normal cellular function." Lieberman 
recently received a grant for work with a 
corporate partner on a topical microbicide 
suitable for human use. In addition, she is 
investigating how the study's approach 
might be used to treat HIV. ■ 

David Cameron is associate director for media 
relations at Harvard Medical School. 



WHAT DO PILOTING AN AIRPLANE AND PERFORMING SURGERY HAVE IN COMMON? 

A simple safety checklist that can improve performance. According to a 
Harvard-led study, surgical teams that reviewed a safety checklist before 
and after major operations cut their rates of deaths and complications. 

The checklist, used orally to confirm such items as the safe delivery of anes- 
thesia, the patient's identity, the site and type of operation, appropriate antibi- 
otic use, and the names and 
roles of surgical team mem- 
bers, reduced post-surgery 
complications and deaths by 
one-third in the eight hospitals 
that participated in the inter- 
national study. Overall, the 
rate of complications went 
from 1 1 percent to 7 percent 
while the inpatient death rate 
fell by more than 40 percent. 

"The checklist reduced com- 
plications by double digits in 
every hospital we put it in," 
says Atul Gawande '94, the 
team's leader and an HMS 
associate professor of surgery 
at Brigham and Women's 
Hospital. "With 234 million 
operations performed world- 
wide every year, universal use 
of this checklist could save 
hundreds of thousands of 
lives." Gawande and his sur- 
gical team at Brigham and 
Women's Hospital have used 
the checklist for almost a year. 

Gawande's research team 
screened complications and 
death rates after surgery in 

urban hospitals in Canada, England, India, Jordan, New Zealand, the 
Philippines, Tanzania, and the United States. Outcomes for more than 
7,600 patients were analyzed 30 days following their surgeries and includ- 
ed a near-even split in the number of patients with surgeries before and 
after the checklist was introduced. 

As a result of the study's findings, Ireland, Jordan, the Philippines, and 
the United Kingdom plan to implement the checklist in operating rooms 
nationwide. In the United States, hospital associations in New York, North 
Carolina, South Carolina, and Washington State have committed to using 
it. "Our goal," says Gawande, "is to get surgical teams worldwide to try it 
and make it a part of their practice." 

The study was part of the World Health Organization's Safe Surgery 
Saves Lives campaign and appeared in the January 29 issue of the New 
England Journal of Medicine, u 

Nuno Dominguez is an intern with Focus. 




SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



11 



by Alice Flaherty 



TEST PILOT: The life of neurologist Alice 
Flaherty formed the basis for a proposed 
television series, The Madness of Jane. 
Ever Carradine (far right) was cast in 
the lead role. Also pictured are, from 
left, Erick Avari, Jeff Bryan Davis, and 
Brittany Ishibashi. 




What can the dramatic arts teach doctors 
about improving their performances? 





SEVERAL YEARS AGO, my husband 
and I were eating breakfast with our 
friend Rob LaZebnik, a Hollywood 
scriptwriter, when my husband asked 
Rob whether he was working on a new 
pilot. Rob blushed. "I've been meaning to 
ask you two. . . " he said. "Well, if this is 
in any way disturbing. . . I want to write 
a doctor show whose lead character is 
based on Alice. You know, a hypergraphic 
neurologist at a Boston teaching hospital 
who's a bit crazy. Kind of House meets 
AllyMcBcalr 

My first thought was, Oh no, poor Rob, 
what a bad idea. It's true what he said the other 
day, that comedy writers over 40 are dog meat. 
My second thought was, A TV show all 
about me} Wheel My husband's first and 
second reactions were identical: dismay. 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



13 



RETURN ON INVESTMENT: Actress Ever 

Carradine cyberstalked Alice Flaherty 

to study her mannerisms and prepare 

for the role. To Flaherty's relief, 

Carradine avoided becoming an 

"authentically wooden neurologist" 

and instead cultivated fluent gestures. 






My eagerness trumped my husband's 
wisdom, and I soon found myself helping 
with the script, inventing neurological 
cases for the brilliant protagonist to 
solve. I also tried to cut down on unnec- 
essary medical jargon that crept into the 
dialogue, such as not saying "upper 
extremity" when "arm" would do. Rob 
resisted my editing. "People love the jar- 
gon," he said. "That's the lesson Holly- 
wood learned from ER." I later realized 
that the actors liked using the jargon for 
the same reason medical students do: it 
makes them sound like real doctors. 

Rob had warned me that most pitches 
never turn into scripts, most scripts are 
never sold, and most purchased scripts 
are never filmed. So I was surprised to 
find myself having to ask my department 
chair, during my yearly review, to hold her 
thought; my agent and my entertainment 
lawyer were on the line to discuss how 
much to ask for the rights to my life story. 

During the process of casting "me," the 
producers reviewed dozens of audition 
tapes. One woman both looked and acted 





What can science tell us about acting? More each year. Psychologist 
Paul Ekman, for instance, has demonstrated that there are six basic 
facial expressions that people from every culture understand innately. 
Although we can't rely on expressions like winking, the meaning of 
which varies across cultures, when we're in China, we can be sure 
that native Chinese will understand our frowns, smiles, pouts, raised 
eyebrows, sneers, and wrinkled noses to mean anger, happiness, 
sadness, surprise, contempt, and disgust. 

Maude Mitchell, a stage and film actress, once asked me 
why, when she was starring as Nora in an adaptation of A Doll's 
House, her mascara ran down the left side of her face long before 
it did on the right. I told her this response reflects the fact that the 
right side of the brain controls negative emotions more than the left 
one does. Because the right brain controls the left body, the left 
side of the face tends to express sadness more than the right side 



does. Maude seemed amused by my explanation and said that 
from then on she would play her most tragic scenes with her left 
profile toward the audience. 

To learn more about expressions of sadness, I turned to colleagues 
in psychiatry. Although there has been recent debate over whether 
tears are cathartic, or only make you feel worse, most psychothera- 
pists are strong believers in the purgative effect of tears. One psy- 
chotherapist told me with a faint pride that, on average, patients cry 
in nearly a third of their sessions with her. "Some don't feel they get 
their money's worth if they don't cry each time," she told me. 

The hall leading to her office seemed graphic testimony to her 
effectiveness; its walls were lined with towers of boxes of facial 
tissues. When I mentioned that, she burst out laughing. 

"Those aren't my tissues," she said. "Those are the realtors' in 
the next suite. You know what housing prices are like in Boston." ■ 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 



What was sobering about the show was 

not the ways in which it was less than real, but the 
ways in which it was more than real. 












remarkably like a neurologist — remark- 
ably like me, in fact, in a suitably dry per- 
formance. I was relieved when the casting 
agents chose someone less authentic. 

Several colleagues have asked me 
whether it felt degrading to be played by a 
tall blonde with legs from here to tomor- 
row. Maybe if I hadn't been so lucky with 
this particular actress, Ever Carradine, it 
would have been. Instead, I learned from 
her. At first I learned how to act like a 
good doctor; in the end, I learned how to 
be a better one. 

Charm School 



The Madness of Jane featured the fictional 
Jane Conway, a quirky neurologist who 
festooned her office with Post-It notes, 
built odd contraptions to help her 
patients, and diagnosed rare diseases 
based on only a few symptoms. The show 
was neither a soap opera nor a sitcom, 
but a serious exploration of the person- 
al foibles of doctors. Ever, a member of 
the Carradine acting dynasty, brought 
special insight to the role. Not only are 
her in-laws doctors, but a family mem- 
ber's serious illness had recently exposed 
her to a range of doctors' performances. 

Before I met Ever, Rob called with a 
warning. "I don't want to freak you out," 
he said, "but Ever's been cyberstalking 
you, watching clips of documentaries 
where you were a talking head, to pick up 
your mannerisms." That was bad. What if 
she succeeded and turned herself into an 
authentically wooden neurologist? Luck- 
ily, she merely grafted some of my more 
harmless traits, like toe walking, onto her 
own set of more expressive behaviors. 

Ironically, I had already been trying 
to incorporate Ever's mannerisms into 
my encounters with patients. In her 
audition tape, to convey therapeutic 
concern, she had used gestures more 
fluent than any I had in my own reper- 
toire. Her smile when a treatment 



worked, for instance, looked pleased 
for the patient, not just pleased at her 
professional skill. I began to try it out 
on the wards, with good effect. Life 
imitating art imitating life. 

During the filming, my role resembled 
that of a neurology attending: I showed 
"residents" how to hold their brain stim- 
ulators properly, and I corrected their 
jargon. ("'Subthalamic,' not 'subthalamic,' 
darling.") Life-and-death decisions, 
though, were left to the director. 

Life and art blurred further in that the 
filming took place in a real hospital that 
turned artificial each weekend: a Veter- 
ans Administration outpatient center 
that emptied itself out to rent to dozens 
of medical shows. When I saw extras sit- 
ting in the clinic waiting room for then- 
next scene, I kept mistaking them for real 
patients. Oh, poor woman, I thought when 
I spied one middle-aged woman in a bad 
wig, she must be getting chemo. An instant 
later, I remembered, Duh. She's an extra. 
Another instant later, noticing that the 
other extras' wigs were skillful enough 
to look real, I realized that her bad wig 
was intentional — she was meant to look 
like a woman with a bad chemo wig. Art 
imitating art imitating life. 

In the pilot's main medical plot, a 
Vermont maple sugar farmer's brain 
stimulator was reset after he was 
shocked while trying to dive under an 
electrified fence on his farm. A typically 
unrealistic Hollywood storyline, except 
that it had really happened to one of my 
patients. The television version ended 
up less bizarre than the true version. 

What was sobering about the show 
was not the ways in which it was less 
than real, but the ways in which it was 
more than real. In particular, the actors 
playing doctors had notably better bed- 
side manners than many real doctors. 
They made eye contact with their 
patients, spoke at a comfortable pace, 
and, when the patients complained of 



pain, focused on the complaint rather 
than changing the subject. 

Also revealing was the director's 
custom of shooting important scenes as 
many as twenty times in a row. While 
some of the actors duplicated their lines 
and gestures as accurately as automatons 
for each take, the better actors tried 
something new each time. I thought 
about my own limited repertoire. During 
initial patient visits, for example, I made 
the same joke every time I pulled out my 
reflex hammer; my flexibility extended 
only so far as to ensure I never repeated 
that joke on follow-up visits. 

Get Your Act Together 

The good actors' ability to modify their 
behavior contrasted sharply with an 
event on my neurological service that 
happened soon after the show's pilot 
was shot. One of my senior residents was 
giving a death talk to the family of an 
elderly woman with multiorgan failure. 
The family members were dramatically 
upset. Earlier, when we had told them 
that the woman's prognosis was poor, 
one daughter had fainted and another 
had begun dry retching over a trash can. 
The resident's obvious discomfort was 
natural, but it wasn't helping. 

He folded his arms tightly and 
drummed his fingers against his chest as 
he gazed over the family members' heads 
toward the door. The daughters asked 
more insistently whether we had done all 
we could — a natural response to a doctor 
who was signaling that all he wanted was 
to be done with them. Finally I couldn't 
resist his signals either, and I sent him off 
on an errand. He shot out the door, and 
the family members relaxed almost 
immediately. They were not, fundamen- 
tally, upset with us. They were just upset. 

Afterward I discussed the room's 
heightened drama with the resident. I 
suggested, in what I hoped was in a 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



IS 



Quoting dialogue from an episode of 

House, MD doesn't produce the same air of gravitas 
as quoting passages from a Walker Percy novel. 



non- confrontational way, that in future 
situations he might avoid crossing his 
arms and drumming his fingers. He 
seemed to find my advice reasonable, but 
added, "I could never do that, though. 
When I'm nervous, I cross my arms." 

I showed him a simple alternative, sit- 
ting with his palms held loosely open on 
the table. That gesture, the universal 
human "Look! No weapons!" signal of 
non-aggression, works as well when 
dealing with angry patients as it does 
with your boss. "Oh, I wouldn't feel com- 
fortable doing that!" he said. "I have to 
cross my arms." 

Mirror, Mirror 

In medical school, doctor-patient courses 
that teach the art of medicine often use 
the literary arts as a model. Lecturers 
hope that by assigning, say, Tolstoy's short 
story "The Death of Ivan Ilyich," they can 
teach students to read a patient like a 
book. Perceptiveness doesn't inevitably 
lead to altruistic action, though. Indeed, 
feeling a patient's suffering too much can 
make an empathic person want to flee 
rather than to stay and help. And even the 
most polished phrases of compassion lose 
their power when a doctor recites them 
rapidly while gazing at a computer screen. 

Instead, the true art of medicine is 
more dramatic than literary, as the dis- 
proportionate number of doctor shows 
suggests. Real medicine's use of ritual- 
ized lines and gestures, operating the- 
aters, and costumes — the scrubs and the 
johnnies — are much more than conven- 
tions. Their dramatic symbolism can give 
doctor-patient contact an emotional 
meaning that transcends the notion of 
cure. Their ceremonial quality, by shap- 
ing the patient's expectations, can even 
be part of that cure. 

Doctors don't like to think of medicine 
as theater, though. Drama's status as a 
low art, overly emotional and deceptive, 
can discomfort the academic psychia- 



trists who tend to teach the bedside- 
manner courses. Quoting dialogue from 
an episode of House, MD doesn't produce 
the same air of gravitas as quoting pas- 
sages from a Walker Percy novel. 

A major force that keeps doctors from 
acting well is that we like to think we are 
above acting. Historically, as academic 
medicine became a scientific pursuit and 
doctors wanted to distinguish them- 
selves from the quacks who cured with 
their flamboyant bedside manner alone, 
physicians in the academies adopted an 
undramatic aloofness that has persisted 
to this day. 

When medical ethicists talk about 
deficits in bedside manner, they often 
present them as manifestations of the 
pressures on doctors' time or of the pain 
that an empathic bond with a patient can 
inflict. But we sometimes choose to act 
brusquely because that's how brilliant, 
scientifically driven diagnosticians are 
supposed to act. Subconsciously, many of 
us believe that empathy is the nurses' job, 
or we save it for terminal patients for 
whom we have nothing more potent. 

Yet science can now demonstrate the 
benefits that warmer doctor-patient 
interactions can bring. The placebo 
effect that can be achieved, for instance, 
when doctors' behavior makes patients 
expect to get better, is nearly as helpful 
as the workings of many of the most 
expensive drugs. Sympathetic human 
interaction produces real changes in the 
subcortical regions of adult brains and 
causes permanent changes in the DNA 
transcription of children. 

Television medical dramas, despite 
their often soapy quality, have real-world 
relevance: They reflect and shape how 
patients play the sick role and how they 
expect doctors to behave. An episode 
of ER, for example, stressed the role of 
physicians as patient advocates when 
surgeon Peter Benton fought a colleague 
over the importance of following a safe 
surgery checklist; his insistence on using 



it ended up saving his one-time protege 
John Carter from kidney failure. 

Teaching students the art of medicine 
as drama has another problem besides 
our fear of the theatrical as false. Acting 
skills are difficult to teach. Performance 
gives introverted premeds stage fright, 
whereas literary contemplation of anoth- 
er's suffering can be done in the privacy of 
one's own head. Neither working doctors 
nor trainees receive much visual expo- 
sure to good role models of empathic 
action. Feedback about behavior is even 
rarer and generally comes long after the 
patient has left the room. 

The actors on Rob's show, unlike my 
residents, received immediate feedback 
after each shoot. The director would call 
out advice such as, "Too weepy! This isn't 
Beaches." After the next take, "Too dry! 
Too Helen Mirren in The Queen." Or: "Hey! 
We're not doing Flatliners here." 

The Science of the Art 



Recently though, actors have been giving 
medical students feedback about how to 
become better doctors. The Objective 
Structured Clinical Examinations, or 
OSCEs, use actors as standardized 
patients to help assess the clinical per- 
formances of fourth-year medical stu- 
dents. These tools are popular with both 
students and faculty. By presenting com- 
munication skills as concrete abilities 
that can be tested, these exams make 
even the most hard-nosed students take 
bedside manner more seriously than doc- 
tor-patient courses — with their empha- 
sis on emotional exchanges between 
doctors and patients — have done. And 
the actors, many of whom have by now 
observed hundreds of students, are per- 
ceptive in their feedback. 

In the hierarchical world of medicine, 
though, students focus more on what 
faculty examiners say. The "patient's" 
words are given about the same weight 
as the opinions of real patients. The 



16 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 




emphasis of these exams is not on train- 
ing but on testing students' abilities. 
And they occur only a few times a year, 
as actors are expensive. 

Less cumbersome help with the art of 
acting well may come from unexpected 
sources, the very forces that bedside man- 
ner is traditionally meant to combat — 
science and technology. The explosion of 
social neuroscience research is starting to 
provide a bottom-up approach to playing 
doctor that complements art's top-down 
one. Studies of the facial expressions of 
emotions have turned the ability to pro- 
duce a smile that looks real rather than 
ingratiating from an art to a science. 
(It's all about activation of the orbicu- 
laris oculi. Social smiles involve only the 
mouth; emotional ones crinkle the eyes 
as well.) 

Medical education has made increas- 
ing use of high-tech simulations to teach 
skills learned best by performance, such 
as putting in central lines. The logical 
next step would be to construct multi- 
modal simulations of human interaction 
that will allow students to learn how not 
to hurt patients' feelings by a technique 
other than learning from their mistakes. 

Human-interaction simulators are 
already in use with populations that 
range from Asperger's patients who need 
to understand how their disquisitions 
affect their listeners, to police officers 
who want to detect lying, to shy people 



who wish to speak more comfortably in 
public. The simulations that Asperger's 
patients use allow concentrated practice 
and feedback. Likewise, doctors could 
learn to reinforce such basic communica- 
tion skills as maintaining eye contact, 
pausing to allow patients to ask ques- 
tions, and avoiding jargon. 

Medical students are eager to use clini- 
cal simulators. Doctors, however, are not. 
They don't want to take time away from 
their real patients to play doctor to fake 
ones. And now they may not need to: 
Recent developments allow the rapid feed- 
back about performance that simulations 
can provide — but in the real world, with- 
out slowing actual clinical encounters. 

The MIT Media Lab has developed a 
number of such devices. One is a beeper- 
sized box called the Monologue Monitor 
that analyzes the wearer's speech pat- 
terns. Speakers who drone on without 
interruption get a discreet zap from their 
monitor, prompting them to pause so 
their listener can respond. Another 
device analyzes the listener's face for 
signs of puzzlement or negative emotion 
and signals any such sign to the speaker. 

It's tempting to think that while these 
machines may help awkward computer 
scientists, they have nothing to offer 
socially sophisticated physicians. Surely 
we can recognize boredom when it stares 
us in the face. Perhaps that's true — but 
many of us have learned not to look. 



While rapid behavioral feedback 
devices lack the subtlety of literary 
analysis, the empathic errors that we 
doctors make are often equally unsubtle 
ones of haste and habit. A number of 
studies show that doctors lose rather 
than gain empathic sensitivity during 
their training. In one study, for example, 
researchers used functional MRI to 
show that after two years of training, 
doctors had lost the activation in brain 
empathy areas that was seen in the 
healthy controls. Their medical educa- 
tion had helped them achieve dispas- 
sionate brain activity similar to that 
seen in people with Asperger's. 

Prompt, Please 

Our adventure with the TV pilot had a 
happy ending, if not quite a Hollywood 
ending. As Rob had predicted, the pilot 
wasn't picked up. He returned to his job 
on The Simpsons, where he makes ten times 
more money than he would have made 
from the new show. Ever has a job with 
another TV series, filmed in Boston. And 
I was saved from the temptation of turn- 
ing my office into the equivalent of the 
"real" Cheers bar, where I would have 
likely sold reflex hammers that played 
the show's theme song whenever you 
rapped someone's knee with them. I kept 
my job and perhaps gained some wisdom. 

How much wiser am I? I learned a lit' 
tie about the art of acting well — and 
about the reasons doctors often choose 
not to behave artfully. Hollywood also 
taught me that medical shows can't 
teach doctors everything they need to 
know about acting well. Those shows 
are, after all, trying to model themselves 
on the worst of our manners as well as 
the best — as the protagonist of House 
demonstrates so vividly. 

Science itself may soon help us 
improve the art of medicine. Advances in 
behavioral therapies are starting to help 
people with Asperger's interact with 
others more effectively; perhaps they can 
help doctors do so as well. In learning to 
help those who struggle with how to feel 
and act, we may end up learning how to 
heal ourselves. ■ 

Alice Flaherty '94, PhD, is an HUS assistant 
professor of neurology at Massachusetts Gen- 
eral Hospital. 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



Television physicians have devolved from 
saints to sinners — without sacrificing ratings. 



by Allan J. Hamilton 




IT WAS ONLY ONE SENTENCE, A MERE TEN 

words: "I'm not a doctor, but I play one on TV." With those 
words, uttered in a 1986 commercial, Peter Bergman parlayed 
his role as a physician on the soap opera All My Children into an 
endorsement for Vicks Formula 44 cough syrup. In delivering 
what would become an iconic statement, he blurred for the first 
time the distinction between the dramatic portrayal of medicine 
on television and medicine in real life. 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



19 






20 



CLINICAL CASE: The producers of 
Medic, one of television's earliest 
medical shows, tried to capture the 
life of doctors and the tempo of 
clinical care by filming the series in 
Los Angeles hospitals. Richard 
Boone, right, played physician 
Konrad Styner from 1 954 to 1 956. 






Two decades later, Robert Jarvik, the 
inventor of an artificial heart and the 
holder of a real medical degree, appeared 
in a series of commercials extolling the 
virtues of Lipitor to help lower choles- 
terol. One advertisement used a stunt 
double to illustrate Jarvik's devotion to 
exercise as a complement to his medica- 
tion regimen. The metamorphosis was 
now complete: Actors had become doc- 
tors and doctors had evolved into actors. 

The dramatization of medicine has 
long seemed a natural fit for television. 
"One of the vivid examples of the tactile 
quality of the TV image occurs in med- 
ical experience," wrote media critic 
Marshall McLuhan in his landmark 
1964 book, Understanding Media. "The 
sudden emergence of the TV medico 
and the hospital ward as a program to 
rival the western is perfectly natural." 
From the earliest days of television, the 
leaders of the country's professional 
medical societies grasped the tremen- 
dous attraction the medium held for 
viewers and the enormous power that 
television could have in shaping the 
public's perceptions about doctors and 
the care they deliver. 

But Hollywood can be notoriously 
fickle. Rather than serving up flattering 
images, medical dramas on television 
have reflected society's larger issues by 
offering increasingly complex — and 
often troubling — portrayals of doctors. 

Strong Medicine 

In the 1950s, the images of the bloody 
carnage of both World War II and the 
Korean War remained fresh in the 
minds of many Americans. The first sig- 
nificant medical show on television was 
Medic, which debuted in 1954. The show 
aimed for an admirably high level of 
realism: Writers spent more than two 
years shadowing doctors around hospi- 
tals in the Los Angeles area to capture 
the routines of the physicians and the 
ambience of the institutions. Each 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 




episode opened with the narrator 
reminding the audience that the doctor 
was "the guardian of birth, the healer of 
the sick, and comforter of the aged." 

The show's budget was so small the 
producers couldn't afford to build a for- 
mal set, opting instead to film the series 
inside the same hospitals in which the 
writers had conducted their research. By 
contractual obligation, a designated rep- 
resentative of the Los Angeles County 
American Medical Association scruti- 
nized and evaluated each half-hour 
episode to ensure its portrayals corre- 
sponded with the organization's public 
relations strategy and maintained a rea- 
sonable level of medical accuracy. Once 
the medical association endorsed the 
script, the televised episode displayed 
the organization's seal of approval. Inter- 
estingly, the association deemed one 
episode — one that depicted an African 
American physician character — to be 
racially alarming; it never aired. 

By the 1960s the country's mood was 
changing. U.S. society was awed by the 
sheer breadth and power of technologies: 
atom bombs, jet airplanes, satellites. 
Antibiotics and vaccines appeared limit- 



less in their power to conquer diseases 
that had threatened humanity for thou- 
sands of years. John Kennedy was in the 
White House, and his administration's 
New Frontier program, with its zest and 
enthusiasm — from the Peace Corps to 
the space program — had seized the pub- 
he's imagination. 

Two new medical dramas on televi- 
sion, Dr. Kildare and Ben Casey, emerged in 
1961. These shows, whose scripts the 
American Medical Association reviewed, 
were as interesting in their similarities 
as they were in their differences. Each 
focused not on experienced physicians 
but instead on doctors in training. The 
first was Dr. Kildare, loosely based on a 
1930s film character of the same name. 
Played by Richard Chamberlain, Kildare 
was boyishly handsome and exhibited a 
zealous innocence in his devotion to 
medicine as a calling. His personal needs 
always yielded to his patients' concerns. 
Issues of income, love, and marriage were 
noticeably absent in the plots. Kildare 
lived like a medical monk whose vows 
required him to cloister himself within 
the confines of the fictitious Blair Gen- 
eral Hospital. 



Television during the 1960s brought 

medicine into a raw, confident light. The best medicine 
was the boldest; the swiftest action, the wisest. 



While Kildare labored toward the 
divine light of sainthood, Ben Casey was a 
darker character. Actor Vince Edwards 
portrayed him as an arrogant, forceful, and 
headstrong neurosurgeon who was rushed 
and irritable from an operative schedule 
punctuated by innumerable trauma cases. 
While Kildare was caring, solicitous, and 
gentle, Casey was gruff, disdainful, and 
prone to tell his patients what was right 
for them — or wrong with them. His med- 
ical authority seemed to extend far beyond 
his neurosurgical expertise and allowed 
him to opine at will on any aspect of his 
patients' lives, from the state of their mar- 
riages to their psychological weaknesses. 

Casey's approach to disease tended to 
consist of aggressive, high-risk surgeries, 
usually experimental in nature, with a 
premium placed on procedures that had 
never been attempted. Almost all his 
actions took place in open defiance of hos- 
pital administrators and with disdain for 
government regulations. This no-holds- 
barred picture of "real medicine" even sur- 
faced in the more sedate Dr. Kildare, when 
Leonard Gillespie, Kildare's senior facul- 




ty supervisor, declared in one episode: 
"There are always risks, unforeseeable 
risks, but risks that must be taken. Med- 
icine isn't worth practicing if I have to 
stop myself because of legal risks. Until I 
am free to proceed on the basis of my 
knowledge and skill, I am not a doctor. 
I am a slave to outmoded laws." 

Television during the 1960s brought 
medicine — especially surgery — into a 
raw, confident light, tinged with enor- 
mous faith in the technology now avail- 
able to both bedside and operating 
room. Doctors were portrayed as glam- 
orous, heroic, self-sacrificing, and will- 
ing to dare risky procedures. The best 
medicine was the boldest; the swiftest 
action, the wisest. But these characters 
also had rebellious, defiant streaks, 
reflecting the emergent political and 
social attitudes of a new generation ris- 
ing up against the traditions of the past. 

The Dr. Kildare and Ben Casey storylines 
also introduced a new yet important 
theme: that of the powerful and profound 
relationship between a younger protege 
and an older, wiser mentor. Kildare had 
his Gillespie while Casey was under the 
mentorship of the sage yet short-fused 
chief of surgery, David Zorba. Since the 
1960s, the theme of the mentor-appren- 
tice relationship at the heart of medical 
training has been a staple of every med- 
ical drama. 

Father Time 



DR. KILDARE 



OPPOSING FORCES: Dr. Kildare, portrayed 
by Richard Chamberlain, was caring, 
solicitous, and gentle, while Ben Casey 
(Vince Edwards) was arrogant, forceful, 
and headstrong. 



Just as the Vietnam War split the coun- 
try into widely divergent political 
camps, the portrayal of doctors on televi- 
sion exposed new professional divisions 
as well. The main character of Marcus 
Welby, MD, which ran from 1969 through 
1976 and starred Robert Young, seemed 
to epitomize the silent majority, with its 
trust in law and order and in the wisdom 
of seasoned leadership. In keeping with 
the times, Welby dished out paternal 
counsel to guide and restrain his 
younger, more radical partner. 




Marcus Welby, MD received the endorse- 
ment of the American Academy of Family 
Physicians, an indication of the ascendan- 
cy of primary care on the U.S. health care 
landscape. By then the American Medical 
Association had abandoned its policy 
of overseeing and approving television 
programs. The association's leadership 
instead was becoming concerned that 
television dramas were raising the pub- 
lic's expectations beyond anything real- 
life practitioners could deliver. Television 
was depicting a success rate in resuscita- 
tions of greater than 85 percent, when the 
actual survival rate was well below 15 
percent. The wise Welby proved able to 
resolve familial conflicts in 95 percent of 
the television episodes while tending to 
the medical problems of his patient, singu- 
lar; his practice seemed to allow him the 
luxury of having to treat, along with the 
help of his younger partner, only one 
patient at a time. 

The 1970s also brought us M*A*S*H. 
Although the setting for the drama was 
the Korean War, it was a thinly veiled 
allusion to the ongoing conflict in Viet- 
nam. The drama satirized military and 
political authority as well as religious 
mores. It underscored the inherent para- 
dox of doctors trying to save lives in the 
midst of a war in which body counts were 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



21 



22 



St. Elsewhere took place in a grimy and 

under-funded inner- city teaching hospital. 
The physician characters now had quirks and issues. 



the measure of military success. M*A*S*H 
also brought a dramatic shift in the focus 
of the storylines. The physician charac- 
ters became almost the exclusive focus of 
the drama. The patients and their grue- 
some injuries began to serve as a macabre 
backdrop to the main action occurring 
among the doctors. 

Alan Alda portrayed one of the main 
characters, Hawkeye Pierce, as sarcastic, 



cynical, and sadly disillusioned. His 
drinking habits often verged on outright 
alcoholism. He was an inveterate wom- 
anizer and showed nothing but defiance 
and disregard for almost any form of mil- 
itary protocol or etiquette. 

A new kind of physician also 
appeared in this series: Frank Burns. 
Burns was a buEoon — a plodding physi- 
cian who rigidly abided by rules and reg- 



ulations. He was often depicted as 
greedy, stupid, and envious of his col- 
leagues. M*A*S*H showed us a world of 
medicine in which masterful doctors 
worked alongside witless ones, with all 
at risk of having their efforts rendered 
futile by the larger political context. 

The early 1980s brought us St. Elsewhere, 
notable for featuring women and African 
Americans among the main physician 




GROUP THERAPY: Decades of television 
doctoring produced the quiet, calm 
family practitioner (Marcus Welby, MD); 
the zany, pressured warrior physician 
(M'A'S'H); and the idealistic, young, 
urban health professional (St. Elsewhere). 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 



M*A*S*H 




BUMPY RIDE: Gregory House, 
the lead physician character on 
House, MD, is portrayed as a cyni- 
cal yet brilliant doctor who battles 
both colleagues and such personal 
demons as narcotics addiction. 






characters in the cast. St. Elsewhere took 
place in a grimy and under-funded inner- 
city teaching hospital. The physician 
characters now had quirks and issues, 
ranging from bulimia to domestic vio- 
lence, from sexual deviancy to suicidal 
depression. Another new, somber note 
entered into the storylines. Patients could 
not always be saved. Many were routinely 
lost, and some even died as a result of 
physician error and incompetence. 

House Calls 



The twentieth century closed out with 
ER, in which physicians were forced to 
deliver care in a system on the brink of 
collapse and patients received merciless 
triage out of sheer necessity. The crisis in 
health care delivery was viewed against a 
chaotic, dysfunctional backdrop. A twist 
that began with St. Elsewhere intensified, 
as some episodes explored the physician 
characters themselves succumbing to 
medical mishap and disease. A sense of 
mutual vulnerability emerged: physicians 
and patients alike seemed at risk of 
falling victim to a health care system that 
was running amok. Ironically, the same 
month ER debuted, the Clinton adminis- 
tration's bid to establish national health 
care reform was declared dead on the 
floor of the U.S. Senate. 

The twenty-first century added Grey's 
Anatomy and House, MD to ER as hit med- 
ical dramas. Grey's Anatomy follows a 



HOUSE, MD 



cohort of residents and attendings in a 
large, fictitious teaching hospital called 
Seattle Grace. As a medical script consul- 
tant for the show for the past three 
seasons, I've worked with the show's 
writers as they develop storylines around 
neurosurgical problems as esoteric as 
neurocystercicosis and as mundane as an 
epidural hematoma. Doctors are depict- 
ed not just as clinicians who treat disease 
but also as patients who occasionally fall 
prey to it. In Grey's Anatomy, physician 
characters have struggled with every- 
thing from Parkinsonian tremor to post- 
traumatic stress syndrome to metastatic 
melanoma. More than ever, the world of 
medicine seems slightly out of focus, with 
a blurred boundary between physician 
and patient that suggests that doctors are 
far less heroic than human. 

House debuted in 2004, with Hugh 
Laurie playing the main character, Gre- 
gory House — a misanthropic, cynical, 
and brilliant physician at the fictional 
Princeton Plainsboro Teaching Hospital. 
There House routinely insults, belittles, 
and ignores his residents and fellows on 
clinical rounds. Various episodes depict 
him physically assaulting patients, their 
family members, and even the occasional 
colleague. He performs surgical proce- 
dures for which he has neither creden- 
tials nor privileges. He administers 
medications to patients without their 
consent, and when he deems a surgery 
on another doctor's patient to be mis- 






guided, he wheels that patient right out 
of the operating room. He steals hospital 
records, bullies patients into signing 
consent forms, and even treats children 
against their parents' wishes. 

House adds personal foibles to his 
professional transgressions. He breaks 
into the hospital pharmacy to feed his 
addiction to pain medication, writes 
prescriptions for himself, and occasion- 
ally faces arrest for drug possession. Yet 
we root for House. He's a genius and a 
sociopath — a Sherlock Holmes who 
solves the crime but never seems able to 
see the victim. 

Reality TV 

Doctors, so often noble icons during the 
early and mid-twentieth century, have 
thudded to Earth, and television has 
reflected this descent. The earlier ideal- 
istic depictions of physicians slowly 
eroded as the health care system became 
more harried, intrusive, and over- 
whelming. Medical dramas on televi- 
sion no longer portray physicians as 
saints but instead delve into multidi- 
mensional physician characters who 
often display a rebellious and some- 
times even sociopathic defiance of the 
medical establishment. 

As their portrayal has become increas- 
ingly more human over the decades, doc- 
tors have also become more accessible to 
the viewing audience. The public's fasci- 
nation with the real drama inherent in 
medicine has not seemed to have faded 
for more than a half century. Instead, 
television series have evolved to place 
medical challenges in the larger context 
of real societal issues, propelled by the 
uncanny ability of scriptwriters to take 
the pulse of their audiences. ■ 

Allan ]. Hamilton '82, EACS, is a professor 
of neurosurgery at the University of Arizona. 
He also serves as a medical script consultant 
to two television shows, Grey's Anatomy and 
Private Practice. 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



DOUBLE EXPOSURE: 
Jurassic Park, the 1 993 
movie based on the 
bestselling book by 
Michael Crichton, led to 
an explosion of dino- 
mania — and an epony- 
mous name for a new 
ankylosaurus species, 
Crichtonsaurus bohlini. 




Adept 

nysician, 

'.ic 
riter, 

Master or 

Hollvwood 

Micjiai 

, n Grichton 

1942-2008 

by William Ira Bennett 




MICHAEL CRICHTON '69 was preparing to apply a 
cast to my right ankle, and I was taking off my shoe and sock so 
he could accomplish the task. There, in the bright light of a cast- 
ing room, with my glasses on and my leg extended on a table, I 
could see to my horror that my ankle had the grubby patina of a 
six-year-old's at bedtime. Excuses were beside the point, but 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



25 



DRAMATIC LICENSE: For more than three 
decades, Michael Crichton wrote the 
books, crafted the screenplays, and 
even directed the movies that enter- 
tained millions. And in some cases, as 
with the 1 979 movie The Great Train 
Robbery, he was a triple threat, serving 
as author, screenwriter, and director. 




I muttered them: that my small shower 
had poor lighting and that I was near- 
sighted, sleep- deprived, and so tall that 
my eyes were a long way from my 
ankles. The "tall" part was particularly 
unpersuasive, as Michael topped me by 
six inches. 

We had become foxhole buddies on 
our neurology rotation. All was quiet 
on the neurology front at Boston City 
Hospital that month in 1968, however, 
and there was little of the incipient 
neurologist in either of us. We became 
each other's willing accomplice, slipping 
away for a late afternoon beer and con- 
versation. The friendship continued as 
we moved on to orthopedics. 

Briefly Michael's "patient," I could 
easily imagine him as an academic 
physician, the sort exemplified by the 
chiefs of service in Harvard hospitals. 
His manner was self-contained but not 
aloof. Rather, his style was affably 
imperturbable. He shrugged off my 
embarrassment, put the ankle where he 
wanted it, and, following our instruc- 
tor's directions, covered it, grime and 
all, with a light, tidy cast. He was a 
quick study. 

Nevertheless, I didn't think it likely 
that he would go on to a career in acad- 
emic medicine. He was already a writer. 
While in college, under the nom deplume 
John Lange, he had written three or four 
fast-paced thrillers. Published as small 
paperbacks, they were easy to slip into 
one's pocket and read during afternoon 




lectures. There was nothing ambiguous 
about the intention of these books; they 
were designed to become movies along 
the lines of To Catch a Thief or Topkapi. 

Although I didn't know it, Michael 
had already written the book that would 
become his first movie. The Andromeda 
Strain had two sources of inspiration — 
Harvard Medical School's second-year 
bacteriology course and H. G. Wells's 
The War of the Worlds. Much of this book 
was, indeed, written while Michael was 
taking the bacteriology course. He went 
on to write two other books during med- 
ical school, and both of them stand up to 
rereading 40 years later. 

For A Case of Wed, Michael, who had 
joked about his height with "John 
Lange," now borrowed the name of a 
knighted dwarf, Jeffrey Hudson, who 
was in the court of Henrietta Maria, 
the queen of Charles I. Michael often 
made small jokes about his height. I 
wasn't surprised that he would know 
about seventeenth-century royalty; 
I always took for granted how much he 
knew. It would have been overwhelm- 
ing to ask him where he had gleaned 
the tidbits that were regular and enter- 
taining parts of his conversations. 
Although he had a gift for fiction, his 
delight often seemed to be in small facts, 
which peppered his writing much as 
they did his talk. 

Like the first novels, A Case of Need was 
an exercise in a standard form — that of a 
mystery in which a bystander is thrust 
by circumstances into the job of detec- 
tion, competing with misguided police 
to identify the real culprit. The crime in 
question is an illegal abortion resulting 
in the death of a prominent surgeon's 



daughter. The accidental detective is a 
pathologist who has for years helped 
a gynecologist colleague conceal the fact 
that he has safely and carefully per- 
formed abortions in the hospital. The 
book is a farrago of medical stereotypes: 
a surgeon arrogant to the point of 
sociopathy, a principled gynecologist, a 
street-smart nurse, an opera-loving 
homosexual psychiatrist, a mild-man- 
nered and diligent pathologist. It is easy 
to read and often quite wry. 

It is also, despite the cover of a pseudo- 
nym, quite a brave book. A Case of Need, 
published five years before the U.S. 
Supreme Court's decision in Roe v. Wade, 
straightforwardly addresses the distor- 
tion of values and relationships in med- 
icine and society as a result of the nearly 
universal criminalization of abortion. 
The fact that abortions were relatively 
safe, Michael argued, was what made 
possible the large criminal market for 
them. Many more women were muti- 
lated, made gravely ill, or killed by 
criminalized abortionists than by 
physicians performing the few termi- 
nations that were either legally sanc- 
tioned or disguised as another proce- 
dure. But the reality was that the sub- 
stantial majority of women survived 
the illegal process. Thus, the black mar- 
ket for abortions thrived. 

Although A Case of Need is written to 
a formula, it is not a morally simplistic 
book. The tangle of relationships that it 
portrays, the painful reasons for seeking 
an abortion, the horrible consequences 
of secrecy and deception, the dangers of 
breaking the law, and the potential dam- 
age of enforcing it are all handled with an 
authority that is remarkable when you 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 







consider that Michael was 25 years old 
when he wrote the book. 

His next book, Five Patients: The Hospital 
Explained, was published in 1970 as a 
work of journalism. The five patients of 
the title were all people brought to 
Massachusetts General Hospital for 
treatment: a man who has suffered car- 
diac arrest, another with a fever of 
unknown origin, a third who has almost 
lost his hand in a crush injury, a woman 
with chest pain, another with a rare pre- 
sentation of lupus. The patients' stories 
serve as five remarkable essays not only 
about MGH itself, but also about the role 
of the modern hospital as a technologi- 
cal, economic, and social institution. 

In certain details Five Patients is dated. 
The man with fever of unknown origin 
spent a month at the hospital and 
incurred a bill of $6,172.55. (No, I didn't 
move a decimal point.) Another quaint 
feature of the book is the author's habit 
of referring to physicians only as men; no 
woman doctor appears in the book and 
no note is taken of the possibility that 
women would come to play a significant 
role in medicine. 

Michael spent much of that year at 
MGH as a participant and an observer 
in the life of the hospital. He listened 
in on such legendary physicians as 
Alexander Leaf and Daniel Federman '53 
as they made recommendations for diag- 
nosis and treatment. He interviewed 
many of the most interesting and active 
leaders at the hospital. And he read very, 
very widely. The resulting book remains 
readable, informative, and formidably 
intelligent. One has the sense that 
Michael got what the hospital was 




about and had an uncanny sense of 
where it was headed. 

Perhaps one of the more striking fea- 
tures of Five Patients is the security of its 
tone. Here is a fourth-year medical stu- 
dent giving opinions with a self-assur- 
ance bordering on the magisterial. And 
he gets away with it. Four decades on, I 
mostly don't mind being guided in my 
thinking about hospitals and medicine 
by a 27-year-old. 

When writing a new preface to the 
book in 1994, Michael had little reason 
to change his conclusions or his tone. 
He wrote, "This country must finally 
adopt some form of national health 
insurance. . . other industrialized nations 
spend less on health care and get more 
for their money. At the moment, our 
national debate on health care is in the 
phase of blame and recrimination. . . . But 
the truth is that everyone works within 
the constraints of the present system — 
and it is the system itself that must be 
changed." The same year, his television 
series, ER, premiered. It was to be, of 
course, a hugely successful drama of peo- 
ple living and working within the con- 
straints of the current system. 

Looking back on his career, it seems 
inevitable that Michael would have cho- 
sen fiction and film over the convention- 
al practice of medicine. When we were 
students together, however, I think the 
choice was less clear. He did not take an 
internship, but if he had I think he would 
have been successful — if chafing at his 
loss of writing time. I did not see him 
again after graduation and have only 
now, after his death, returned to thinking 
about his relationship with medicine. In 
rereading his books from that time, I 
noticed two clues, in addition to the 
obvious ones, as to why he left medicine 
as a career. 

In A Case of Need and Five Patients the 
most painful moments come at the 
beginning. Both scenes are set in emer- 
gency departments — one as fiction, the 
other as reporting of a real event. In both, 




a young patient has unexpectedly died, 
and the physician must tell the family. 
The agony of the moment, in both books, 
is intense and, to my reading, heartfelt. 
Whether Michael privately dreaded this 
aspect of medical practice I can't say. Nor 
can I say that in turning to medical fic- 
tion he also had a didactic intention. But 
at the very end of Five Patients — having 
written at length about hospitals and 
doctors, having looked at the history of 
medical technology and institutions, 
and having made some predictions as 
to where they would go — he wrote, 
"...patients are more knowledgeable 
about medicine than ever before. Only 
the most insecure and unintelligent 
physicians wish to keep patients from 
becoming even more knowledgeable." 

Michael then goes on to emphasize 
the importance of a knowledgeable pub- 
he to medical institutions. "Hospitals are 
now changing," he wrote. "They will 
change more, and faster, in the future. 
Much of that change will be a response 
to social pressure, a demand for services 
and facilities. It is vital that this demand 
be intelligent, and informed." In ER 
Michael not only created one of the 
longest-running entertainments in 
the history of U.S. television, but he also 
built a bully pulpit from which to 
instruct about the triumphs, failures, 
and horrors of medical practice. ■ 

William Ira Bennett '68, a psychiatrist in private 
practice, is also editor-in-chief of the Harvard 
Medical Alumni Bulletin. Michael Crichtoris 
obituary appears on page 71 of this issue. 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



27 



Listening to patients' stories 
makes for good doctoring — 
and sharing those stories 
makes for good TV. 



BY NEAL BAER 



THE FINAL GURNEY HAS 

crashed through the doors of Chicago's 
County General Hospital. We'll see no 
more zaps with the defibrillator, no more 
emergency tracheotomies, no more pace 
and pathos. After 15 years, ER, the televi- 
sion series set in that fictional hospital, has 
ended — and Thursday nights will never be 
the same for me. 






SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 29 



^ about patients' stories as 

unfolding narratives made me a better doctor. My search 
for the nuances in those stories made me more empathetic. 



I was a fourth-year medical student 
planning on doing a residency in pedi- 
atrics at Children's Hospital Boston 
when I received a script that Michael 
Crichton '69 had written while a Har- 
vard medical student. The document 
had lain buried in a file cabinet for near- 
ly a quarter century until a member of 
Steven Spielberg's production team 
rediscovered it. Spielberg, who remem- 
bered it fondly as a movie script he once 
considered directing, decided it would 
make a great television show. John 
Wells, a childhood friend of mine who 
had hired me to write an episode of China 
Beach before I had enrolled at HMS, was 
slated to produce the script. He sent it to 
me to find out whether it still reflected 
life in the emergency room. 

Crichton had indeed captured the 
essence of the drama of an ER. At any 
moment anyone can burst through the 
doors with any sort of calamity: a teen 
with a gunshot wound; a pregnant 
woman with a distressed fetus; a man 
with a pole plunged through his chest. I 
immediately called Wells and said, "This 
is my life!" Although we no longer used 
glass IV bottles or chloramphenicol, 
Crichton had gotten it right. So I left 
Boston for what I thought would be two 
months to break stories with the new 
team of writers on ER. 

Doctors as Storytellers 

I soon found that my experience at 
Harvard had prepared me for television 
writing in unexpected ways. During my 
student years the curriculum was the 
New Pathway, which emphasized prob- 
lem-based analyses of real patient cases, 
the doctor-patient relationship, and the 
social context of medicine. To make a 
proper diagnosis, I learned to poke and 
prod for the narrative thread of a 
patient's complaint and to examine 
that patient's habits, history, and hopes. 
I learned to appreciate the complexity 
of the doctor-patient dynamic. And I 




learned to anticipate the thorny ethical 
issues that can arise suddenly to compli- 
cate treatment. 

Thinking about patients' stories as 
unfolding narratives helped me become 
a better doctor. My search for the 
nuances in those stories made me more 
empathetic. And telling my patients' 
stories — even by writing notes in their 
charts — helped me understand those 
patients more deeply. 

Refining my storytelling skills as 
a doctor also helped me improve as a 
writer — and provided me with stories 
to tell. In fact, many of the stories I 
wrote for television were inspired by the 
patients, medical students, and attend- 
ings I met at Harvard. I had arrived at 
Warner Bros. Studios in Burbank, Cali- 
fornia, armed with more than a hundred 
stories based on my life as a medical stu- 
dent — some humorous, some odd, oth- 



ers tragic. Those became the sources for 
ER episodes. I quickly learned, though, 
that they weren't enough; we would 
burn through at least half a dozen sto- 
ries each week. 

In one early episode, for example, 
Noah Wyle's character, John Carter, was 
challenged by his attending to name 
the capital of what was then known as 
Zaire. He did and was allowed to join the 
surgeons at the operating table. But that 
wasn't enough. The chief of surgery then 
quizzed him: "What are the borders of 
the Triangle of Calot?" And Carter 
replied, "Cystic duct, common duct, and 
the liver." Impressed, the chief of surgery 
allowed Carter to hold the retractor. 

Both moments were rooted in the 
real-life experiences of classmates at 
Harvard's teaching hospitals. In fact, a 
certain surgical attending at one of the 
Harvard- affiliated hospitals always asked 



30 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 




SERIOUS CONDITION: The writers of ER 
regularly touched on the gravity and 
pressures of the world of medicine, as 
evidenced here by the facial expressions 
of several major characters, clockwise 
from far left, Mark Greene (Anthony 
Edwards), John Carter (Noah Wyle), 
Peter Benton (Eriq LaSalle), and Elizabeth 
Corday (Alex Kingston). 

that question. On the show, one of the 
attendings prepped Carter before he 
entered the OR, telling him to remember 
three things: cystic duct, common duct, 
and the liver. Carter didn't understand 
the significance of her advice at the time, 
but he appreciated her coaching when it 
came in handy. Details like this one 
transformed the audience from mere 
viewers to insiders who shared the joke. 

Another show during ER's first season 
provides details only someone trained as 
a doctor would know: When Carter per- 
forms his first lumbar puncture, the 
nurse tells him that his resident will give 
him a bottle of champagne if the tap is 
clear. Carter nervously inserts the nee- 
dle; later, when the lab results come 
back, he is elated to learn that the tap 
had no red blood cells — and he gets his 
bottle of bubbly. 

Stories like these opened a window 
onto the culture of becoming a doctor 
and became integral to the show's suc- 
cess. Before ER, staff writers of medical 
shows would use consultants to salt the 
scripts with occasional clinical details. 
ER changed that. Crichtoris training 
had helped him set the stage for a show 
that would take us into the lives of doc- 
tors as no show had done before. And 
executive producer John Wells decided 
the best way to realize that concept 
would be to employ real doctors as 
writers for the show — a television first, 
to my knowledge. 

It's an approach I call anthropological 
television. To write the kinds of stories 
ER presented, to provide the cultural 
minutiae that go into making a physi- 
cian, one would have to be an ethnogra- 
pher living among medical students and 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



doctors. Or one would simply need to be 
a doctor. Wells chose the latter. 

Not only was I one of the first two 
doctors to write on a television drama, 
but I was also the first — and likely the 
only — medical student. To help ensure 
the show's veracity, we had emergency 
physicians working on the set of every 
episode; they taught the actors Noah 
Wyle and Eriq LaSalle how to suture by 
having them practice on chicken parts, 
pigs' feet, and eventually prosthetic 
devices. The actors' suturing skills 
eventually surpassed mine. 

This approach to scripting a televi- 
sion show not only gave viewers a fresh 
take on the world of medicine, but it also 
had lasting effects on other television 
shows. Today, few medical shows on 
television are without a doctor-writer 
on staff. House, MD is a wonderful exam- 
ple. My closest friend in medical school, 
David Foster '95, is the show's doc- 
tor-writer, the creative force behind 
those rare cases we loved learning about, 
but seldom saw, as medical students. 

But the trend toward enlisting the 
help of experts isn't limited to medical 
dramas. CSl: Crime Scene Investigation and 
its offshoots have forensic experts writ- 
ing on their shows, just as legal shows 
now employ lawyers. Audiences have 
learned to crave authenticity. 

Programming Notes 

It quickly became clear that viewers 
weren't watching ER just for its enter- 
tainment value. During the two years I 
finished my last clerkships, I shuttled 




INTENSIVE CARE: ER explored the intense, long-term relationships that can form 
between medical professionals in its storyline involving nurse Carol Hathaway 
(played by Julianna Margulies) and pediatrician Doug Ross (George Clooney). 



between coasts, in Boston when ER was 
on hiatus and in Los Angeles when the 
show was filming. It was while I was in 
Boston that I witnessed the strong 
effect ER was having on medical stu- 
dents. Thursday night viewing clubs 
had formed; medical students would 
gather to watch the show and test 
themselves by trying to make diagnoses 
before ER's physicians could. The expe- 
rience may have even influenced their 
career paths; studies show that applica- 
tions to emergency medicine residency 
programs increased after ER came on 
the air. 

ER was popular with the public, too. 
One episode — in which Doug Ross, the 
dedicated yet emotionally flawed pedi- 
atrician played by George Clooney, 



saved a boy trapped in a storm drain — 
drew a 45 share, meaning that 45 per- 
cent of the television sets in use in the 
nation were tuned in to ER. Today's 
top-rated American Idol draws numbers 
that pale in comparison. 

But people didn't simply watch ER — 
they learned from it. For a Kaiser Family 
Foundation study published in Health 
Affairs in 2001, we surveyed a random 
sample of ER viewers about an upcoming 
episode on human papilloma virus and 
cervical cancer. Before the show aired, 
9 percent of the study participants knew 
the virus caused cervical cancer; a week 
after the show aired, 28 percent could 
correctly state that relationship. Back 
then, 30 to 40 million viewers were 
watching ER, which translates into at 



ER Through the Years 




BOTTLE OPENER: Actual 
tales from medical 
school gave a high 
degree of realism to 
the television show ER. 
In its opening season, 
John Carter, a third- 
year medical student, 
performed a red-cell- 
free lumbar puncture — 
a champagne tap — 
earning him a bottle 
of bubbly and the 
cheers of colleagues. 



PRIVATE PRACTICE: ER 
took a prime-time leap 
when Jeanie Boulet, a 
physician assistant on 
the show, tested posi- 
tive for HIV. Like many 
real people who were 
then living with the 
virus, Boulet sought 
treatment privately, 
fearful of coworker 
reactions and career- 
ending workplace 
repercussions. 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 




Our approach to scripting £J? not only 

§ave viewers a fresh take on the world of medicine, 
ut it also had lasting effects on other television shows. 






least 8 million people learning about 
human papilloma virus — the first step 
toward prevention. The Health Affairs 
study also showed that about one in 
seven viewers had contacted a doctor or 
other health care provider about a health 
problem after seeing an episode of ER. 

The ER scriptwriters took the Health 
Affairs findings seriously. In fact, during 
the show's infancy a New Englandjoumal of 
Medicine article had taken us to task for 
showing unusually high rates of success 
in cardiopulmonary resuscitation. In 
reality CPR works infrequently, and, 
when it succeeds, it's often accompanied 
by serious sequelae. After that article 
was published, we tried to make the 
show as accurate as possible, although 
we continued to take dramatic license 
with the time it takes to get lab results. 

ER also educated viewers on social 
issues. We delved into many of the con- 
troversies surrounding medicine today: 
cost, privacy issues, access, the impact 
of new technologies. And we were the 
first prime-time television show to pre- 
sent a main character with HIV, Jeanie 
Boulet, portrayed by Gloria Reuben. 
Before ER, diagnoses of HIV infection 
were presented as death sentences; we 
showed that someone with the virus 
could lead a full life. 



My work on ER taught me how pow- 
erful doctors' stories can be, how they 
move people to tears — and even to 
action. I've been lucky to be able to take 
personal stories that have challenged 
my way of thinking, angered me, or 
shaken me to my core and use them as 
inspiration for ER and for the show I 
now write and produce, Law & Order: 
Special Victims Unit. 

I've witnessed, for instance, too many 
children rushed to emergency rooms 
with gunshot wounds. My role as a 
writer has allowed me to transform this 
personal experience into a public story: 
I've written several episodes of ER and 
SVU about gun violence. I know such 
stories have had an impact, not only from 
the studies we've done, but also from the 
many times people have told me that a 
story from ER or SVU made them see the 
world differently or compelled them to 
consider another point of view. 

Live It, Write It, Share It 

All doctors have stories from our prac- 
tice of medicine that we just can't shake. 
But we don't need to be television writ- 
ers to bring those stories to the public. 
Outlets for storytelling are legion. We 
can write op-ed pieces, present on grand 



rounds, testify before legislatures, host 
blogs, teach, compose poetry. 

I have, in fact, turned to the Internet 
to share another story that has moved me 
deeply: the crisis of 15 to 20 million chil- 
dren orphaned by AIDS in Africa. With 
partners from Venice Arts, a nonprofit 
organization that introduces children 
to photography and filmmaking, I've 
visited Africa several times to teach 
photography to HIV-infected mothers 
in Cape Town, South Africa, and to AIDS 
orphans in Maputo, Mozambique. 

We post their photographs online so 
the women and children can share their 
stories with people worldwide. And we 
present this work to policymakers and to 
college students to stimulate action. I 
believe I have a responsibility as a physi- 
cian to alert people to the orphans' plight. 

But it isn't my responsibility alone. And 
it isn't my opportunity alone. Each of us 
has stories to tell. And when we share 
them, we can begin to change the world. ■ 

Neal Baer '96 has been executive producer of 
Law & Order: Special Victims Unit since 
2000. Before that, he served as a staff writer and 
eventually as an executive producer of ER. To 
learn more about his photography project in 
Africa, The House Is Small but the Welcome Is 
Big, visit www.thchouseissmall.org. 



NO DO-OVERS: The 
specter of medical mis- 
takes ran throughout 
the series. In one story, 
Elizabeth Corday, a 
British surgeon who 
repeated her intern- 
ship so as to earn her 
U.S. license, worked a 
36-hour shift. In her 
sleep-deprived state, 
she miscalculated the 
dosage of an injection 
given to a patient. 



COPING MECHANISM: 
The toll that the prac- 
tice of medicine takes 
on individuals was 
threaded throughout 
the storylines. In the 
final season, John 
Carter and Abby 
Lockhart, a nurse who 
later earned her med- 
ical degree, coinci- 
dently attended the 
same Alcoholics 
Anonymous meeting. 



WISHFUL THINKING: 
The pressure of life- 
and-death decisions 
occupied the final 
season of ER. Neela 
Rasgotra, a surgical 
intern, finds herself 
dreaming of decisions 
she has made during 
her years in the emer- 
gency unit, conjuring 
alternate endings that 
ease suffering and 
allow patients to live. 




SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



33 



A blonde bombshell, 
a death on the dunes, 
and a handsome leading 
man are all part of 
Harvard Medical School's 
celluloid history. 

by Massad Gregory Joseph 






IT WASN'T A DARK AND STORMY NIGHT 

on the Quad; it was simply film noir. Boston's first 
foray into cinema history occurred in the late 1940s 
when Hollywood moviemakers descended on the Hub 



to shoot a murder mystery. Initially 
titled Murder at Harvard but distributed 
as Mystery Street, the film offered cellu- 
loid tourism of Charlestown, Scollay 
Square, Cape Cod, Harvard Yard, and 
that marble marvel Building A, today 
known as Gordon Hall. 

Why Building A? For that answer, 
we need some context. It is night. A 
young woman hurries down the stairs 
of her rooming house and dashes for the 
hall phone. She's in a pale, satiny dress- 



ing gown, and she shows a bit of leg in 
her headlong rush. 

You just know things arerit going to 
go well for her. 

She dials, she demands, she receives 
unheard promises. And she leaves for 
work at a nightclub, the Grass Skirt. 
That's right, the blonde is a B-girl. 

Hours pass, promises go unfulfilled, 
and the now angry woman calls again, 
this time threatening to show up unin- 
vited. A clandestine meeting is set. 



Circumstance offers her transport. A 
drunken young man must move his car. 
She offers to help. In his alcoholic fog, he 
believes he's going to Boston Lying-in 
Hospital, to his wife and the dead infant 
who would have been their firstborn. 
The woman, however, has other plans 
and steers the car toward Cape Cod. 

The man protests, they quarrel, and the 
Grass Skirt gal maroons the wayward 
husband and heads for her assignation 
amid sea grass and sand dunes. She makes 
the rendezvous; recriminations ensue. 
Moments later, she's shot dead and car- 
ried to a sandy grave. The film then 
brightens; the young husband is receiving 
an insurance check to cover the cost of his 
"stolen" car. He'll pay for that he later. 

To this point during my viewing of the 
movie, I was comfortably entertained: 



:*■•■ 



*fc 







A story I had started watching because it 
was partly set at Harvard Medical School 
was turning out to be a solid film noir 
drama. And although it wasn't exactly 
shaping up to be The Maltese Falcon, I 
wanted to know who had done the deed. 

Then the movie offered me something 
to pique my personal interest. I was to 
be guided down this mystery's path by 
one Dr. McAdoo, an HMS expert in 
forensic science, modeled after a real-life 
HMS professor of legal medicine: 
George Burgess Magrath, Class of 1898. 
Ah, I thought, a police procedural and a 
fiction of an actual alumnus. I moved 
closer to the television screen. 

A skeleton is found — a birder discov- 
ers it — and a Cape Cod detective, a Lieu- 
tenant Morales played by a young and 
dashing Ricardo Montalban, teams up 



with McAdoo to assess the remains. The 
skeleton tells McAdoo the victim was 
female; the bones of her feet hint that 
she'd been a dancer. Dogged paperwork 
by Morales yields pictures of far too 
many missing women. To see whether the 
skeleton had belonged to one of the miss- 
ing, the two men huddle in a darkened 
room and watch as each woman's face is 
projected against the body's skull. A 
match is made and, before long, so is the 
link between the young woman and the 
young husband. He is accused and jailed. 
Morales begins to seek evidence for 
a conviction; McAdoo, man of science, 
continues to seek just the facts. Together 
they set a mean pace. Together, too, they 
begin to realize they may have the wrong 
man. Clues, when read by McAdoo, lead 
Morales in a new direction. The real cul- 



*ORE THAN SKIN DEEP: 
the 1 950 movie Mystery 
Street, Ricardo Montalban 
(left) plays a detective who 
works with a Harvard 
Medical School professor, 
played by Bruce Bennett 
(right), to solve a murder 
that occurred on Cape Cod. 




prit is found, chased through a train 
yard, and finally apprehended. The 
detective and the doctor get their man. 

Morales calls the wife of the once- 
accused to tell her the murder charges will 
be dropped. He doodles while he talks, 
and, as he hangs up, the camera peeks 
over his shoulder. There, in block letters, 
is the firm's last word: "HARVARD." 

There it was: Harvard Medical School 
had saved the day. The moviemakers — 
who had come to Boston to shoot a dark 
fiction — had succeeded in hitting a lumi- 
nous fact. ■ 

Massad Gregory Joseph 77 is a dermatologist in 
South Pasadena, California. To view the movie's 
trailer, which includes a statement of gratitude to 
HMS, visit http://alumnibulletin.mcd.harvard. 
cdu/spring2009/mysterystreet.php. 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



35 



Whether penning lines for House, MD or producing independent 
films, these Harvard doctors always have an audience. 




ROLE CREDITS: 
Dr. McDreamy and 
his Grey's Anatomy 
colleagues are just 
a few of the fictional 
physicians with con- 
nections to Harvard 
Medical School. 




by Jessica Cerretani 








i 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 37 



mi 



ILTON '82 



Neurosurgeon Derek Shepherd runs his hand through 
his perfectly coiffed hair as he worriedly reviews an 
MRI scan. His patient, a young pregnant woman, is 
suffering from mini strokes; he must determine whether 
to perform a risky operation to save her life. When she 
dies during surgery, he is devastated. 



The plot is likely familiar to fans of 
ABC's medical drama Greys Anatomy, 
which follows the lives of physicians at a 
fictional Seattle hospital. While Shep- 
herd gets his matinee-idol looks from 
actor Patrick Dempsey, his experiences 
come courtesy of Allan Hamilton '82. 
The real-life neurosurgeon is, he laughs, 
"consulting for Dr. McDreamy." 

For Hamilton, though, television 
was never part of the plan. He was 
already chief of neurosurgery at the 



University of Arizona Health Sciences 
Center and executive director of the 
Arizona Simulation Technology and 
Education Center at that school's Col- 
lege of Medicine when Hollywood 
came calling. "They wanted to use 3-D 
neurosimulation and virtual reality 
techniques in an episode of Grey's," he 
explains. The writers contacted Hamil- 
ton — an expert in these techniques — 
several times with technology-related 
questions before he was eventually 




asked to consult for all neurosurgical 
issues on the show. 

As a consultant, Hamilton reviews 
scripts and helps fit neurological dis- 
eases to suggested storylines while keep- 
ing the details as accurate as possible. He 
knows both patients and physicians 
watch the show closely: patients ask 
whether a treatment shown on an 
episode is suitable for their condition, 
while his peers at a recent talk about 
stem-cell research wanted to know 
"what's happening with Izzie," one of the 
show's more melodramatic characters. 

Hamilton credits his time at HMS 
with his taste for drama. "At Harvard and 
its teaching hospitals, I was surrounded 
by larger-than-life characters, such as 
Gerald Austen ['55] and Judah Folkman 
['57]," he says. "They were so impressive, 
in the heroic mold. Doctors aren't gods, 
but if they come close, it's at Harvard." 

His involvement isn't limited to tech- 
nical aspects. In preparing for the diffi- 
cult storyline in which Shepherd loses a 
patient, Dempsey contacted Hamilton 
to ask how a real doctor might react in 
the situation. Hamilton is no stranger to 
those emotions; the plot is often based 
on his own experiences. The case in 
question is rooted in that of a patient 
who died on his operating table. "Los- 
ing a patient is one of the loneliest feel- 
ings in the world," he says. "I was 
impressed Patrick wanted to convey 
that realistically." 

For all his attempts at accuracy, 
Hamilton still finds parts of the process 
surreal. On a recent visit to the set, for 
example, he chatted with James Pick- 
ens, Jr., who plays the chief of surgery. "I 
found myself saying, 'we're both chiefs, 
I love your work,'" Hamilton says. "I 
had to remind myself that he's an actor." 
Likewise, he marvels at the set itself: the 
hospital's main staircase leads nowhere, 
the cabinets are empty. "When I saw for 
the first time what happens there," he says, 
"I was wide-eyed, just like any other fan." ■ 



%ff, "I was surrounded by 
A\ larger-than-life characters. 
Doctors aren't gods, but if they 
come close, it's at Harvard." 



38 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 




N m 



ER'96 



The script had lain dormant for a quarter century 
before it landed on the desk of Neal Baer '96. Yet the 
story — written by Michael Crichton '69 while at 
HMS — still rang true. "Michael had captured what it's 
like to be a medical student, a resident, an attending," 
says Baer. "It was told from a doctor's perspective, and 



I was really taken with it." That script 
became a television pilot. At the 
request of the producer, a childhood 
friend, Baer flew to Los Angeles to help 
write episodes of the show. With his 
family in Boston, Baer intended to 
return in two months. Instead, he says, 
"I stayed seven years." 

The show, of course, was ER. Baer 
became the first medical student to be a 
staff writer on a television program, 



completing his internship in pediatrics 
at Children's Hospital Los Angeles dur- 
ing production hiatuses. "That gave me 
hundreds of experiences, which became 
things that happened to Noah Wyle's 
character," says Baer. "Being puked on, 
peed on, ordering too many or not 
enough labs — it was all grist for the 
mill." By the end of his stint with ER, 
Baer had finished his medical training 
and become one of the show's executive 



gp^ "When you're writing a 
ylV story with characters, it's 

helpful to have training that 

emphasizes narrative." 



producers. He now holds the same title 
at another NBC drama, Law & Order. 
Special Victims Unit. 

Baer entered show business before 
medical school. He already had several 
degrees, including two master's degrees 
from Harvard, and had spent a year at 
the American Film Institute as a direct- 
ing fellow. He dabbled in the craft for a 
few years, writing an episode of China 
Beach and an after-school special about 
sexually transmitted diseases. 

"I realized I was writing stories that 
were medically oriented," says Baer, 
whose father and brothers are surgeons. "I 
was interested in medical school and 
thought I should try it." 

Baer loved medical school. The fact 
that the HMS curriculum at the time, the 
New Pathway, was embedded in story- 
telling was a happy coincidence. "We 
learned how to elicit patients' stories and 
uncover the nuances of their narratives," 
he explains. That technique became a 
principal feature of the way Baer 
approached screenwriting, too. 

"When you're writing a story with 
characters," he says, "it's helpful to have 
training that emphasizes narrative 
and ethical elements, because TV and 
movies are about conflict." The approach 
has succeeded on ER and on SVTl, where 
Baer has written about such topics as 
transgendered children and skeptics who 
deny the link between HIV and AIDS. 

Baer's passion for storytelling is cen- 
tral to another recent project. He is the 
co-creator of The House Is Small but 
the Welcome Is Big, an initiative that 
explores the impact of HIV/AIDS 
through the eyes of women and children 
in South Africa and Mozambique by 
giving them cameras to document their 
lives in photographs. While his sched- 
ule prevents him from seeing patients, 
Baer continues to give their narratives a 
voice. "I'm very fortunate," he says, "to 
have television and film to help me tell 
those stories." ■ 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



39 




Iffiti? 



ENGA '78 



For most HMS students, the fourth-year play is a time 
to generate a few laughs. For Robert Huizenga 78, 
though, this tradition sparked a lasting interest in show 
business. "As silly as it was," he says, "that experience was 
in many ways much more valuable to me than reading 



another textbook." Huizenga, currently 
most visible as the physician who helps 
contestants shed pounds on NBC's The 
Biggest Loser, helped write and costarred 
in his class's production of Stoma, a 
spoof of Coma, a medical thriller by for- 
mer HMS faculty member Robin Cook. 
Huizenga shot hoops with Cook, who 
advised students interested in the craft 
to write at least an hour a day. 

That advice proved sage for Huizenga, 
who penned the 1995 expose You're Okay, 
It's just a Bruise about his experience as 
team internist for the Los Angeles 
Raiders. Huizenga resigned from that 



position in 1990, disillusioned by drug use 
and the pressure on athletes to play while 
hurt. "Thirty- three former players allowed 
me to share the medical side of their par- 
ticipation in professional sports," he says. 
The book brought national recognition to 
Huizenga, who had previously been a 
medical correspondent for the news pro- 
gram BreakAway; a script consultant for 
such television shows as Trapper John, MD; 
and even an actor playing a neurosurgeon 
on the soap opera Rituals. Huizenga's 
book eventually caught the attention of 
director Oliver Stone, who partly based 
his 1999 film, Any Given Sunday, on it. 



ib« Although Huizenga is a 
■/N. natural on camera, his 
greatest contributions to the 
show have occurred behind 
the scenes. 



A few years later, Huizenga's experi- 
ence with the Raiders opened another 
door. A producer friend contacted him 
with an idea for a television show about 
people undergoing major physical trans- 
formations without plastic surgery. And 
so The Biggest Loser, a show that follows 
obese people as they compete to win 
money by losing weight, was born. 

Although Huizenga is a natural on 
camera, his greatest contributions to the 
show have occurred behind the scenes. 
During his stint with the Raiders, one of 
his jobs had been to help linemen keep 
weight on, a feat that proved challenging 
with the team's intense two-a-day work- 
outs. Huizenga suspected his time with 
the Raiders might offer useful lessons for 
The Biggest Loser: The intense exercise that 
had prevented his players from keeping 
pounds on might help obese contestants 
keep them off. "That observation," he 
says, "led to what has become a salient 
feature of the show." 

Frustrated that the show was being 
viewed as unrealistic, he set out to prove 
that extraordinary weight loss could also 
be achieved at home, without cameras 
and monetary incentives. He formed a 
study group of rejected potential contes- 
tants, put them on a rigorous exercise 
regimen, and tracked their progress. Six 
months later, members of the group had 
lost an average of 65 pounds, results sim- 
ilar to those achieved on the show. 

Huizenga has several new projects in 
the works, including a reality program 
based on grand rounds. Yet showbiz, he 
says, "is just something fun I do on nights 
and weekends." He has a private practice 
in Beverly Hills and is an associate profes- 
sor of clinical medicine at the University 
of California, Los Angeles. Despite his 
schedule, Huizenga still preserves one 
tradition he began at HMS: writing. "My 
goal is never just to be on TV," he says. 
"It's to put emotions in print. And the rest 
comes from that." ■ 



40 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 



IO I 



REWSTER '28 



"I want to make it clear that what I do is not 'Hollywood,' " 
says Joe Brewster 78. "It's at the other end of the spec- 
trum." An independent filmmaker whose work centers 
on the themes of cultural, community, and individual 
struggle, Brewster is far removed from the glitz and 
glamour of Tinseltown — literally. 



Based in Brooklyn, he operates in two 
vastly different worlds: as founder of the 
Rada Film Group, with his wife, Michele 
Stephenson, and as an attending psychia' 
trist at Harlem Hospital and an assistant 
clinical professor at Columbia University. 

Such dichotomy is familiar territory 
for Brewster, who grew up as a self- 
described geek in South Central Los 
Angeles. "To be obsessed with science 
and letters wasn't necessarily appreciat- 
ed in that community then," he explains. 
"So I hid that part of myself." After com- 
pleting a residency at McLean Hospital, 
he decided to pursue another obsession 



and began taking film classes at the New 
School for Social Research in New York 
City. Today, he juggles his work as a 
psychiatrist with running the Rada 
Film Group and raising two boys with 
Stephenson, a human rights attorney. 

The theme of duality is an undercurrent 
in many of their films, including An Ameri- 
can Promise, which recendy received a spot 
in Robert De Niro's Tribeca All Access 
development program. That documentary, 
still being filmed, chronicles a dozen years 
in the lives of two African American boys 
attending an elite Manhattan prep school. 
"We're looking at the ways they accli- 




mate," Brewster says, "and we're exploring 
why, in general, African American boys 
don't do well in such an environment." 

The filmmakers' elder son, one of the 
boys featured in An American Promise, also 
appears in their 2008 documentary, Slay- 
ing Goliath, which follows the parents of 
boys on a Harlem basketball team as they 
travel with their children to Florida for a 
national championship game. The film, 
Brewster says, isn't the typical sports 
movie. "It's really more of a tragedy. We 
look at the families and their expecta- 
tions for what basketball will do for 
them — and watch them self-destruct 
when those goals aren't met." 

Brewster has also produced several 
award- winning dramas, such as The Keep- 
er, a story of a prison guard who helps a 
Haitian immigrant falsely accused of 
rape. The 1996 film, which Brewster also 
wrote and directed, drew on his experi- 
ences counseling inmates at the Brooklyn 
House of Detention. The similarities to 
his own life don't end there: Like Brew- 
ster, the lead character in his 2003 film, 
The Killing Zone, is a psychiatrist, whose 
son is played by Brewster's elder son. 

Brewster's work as a psychiatrist 
informs his filmmaking in other ways. 
"Making a film involves many people 
working together," he explains. "Being a 
psychiatrist helps me with that because 
it makes me a good listener." 

As with his approach to filmmaking, 
when it comes to finding an audience 
for his work, Brewster thinks outside 
the box. "Ticket sales are important," he 
says. "But the Web is a really powerful 
way to get our message to people." He 
and Stephenson draw on their new 
media skills to create documentaries 
and Internet-friendly shorts that non- 
profit clients can use on their own web- 
sites to drum up interest and aid in 
fundraising. It's a way of working that 
reflects their activist roots. "We're 
showing that film is not a luxury," he 
says. "It's something for everyone." ■ 



jffi. "Making a film involves 
/tv many people working 

together. Being a psychiatrist 

helps me with that." 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



41 




mt 



EY'84 



By day, Erroll Bailey '84 helps heal the delicate bones 
and muscles of his patients' feet and ankles. After 
hours, the orthopedic surgeon trades his scalpel for a 
keyboard and a craft no less intricate — or rewarding. 
A partner at Atlanta's Resurgens Orthopaedics, he 
moonlights as a screenwriter and film producer. 



Bailey's foray into film began almost 
by chance. "I'd never thought about 
being a writer," he admits. "But I felt I 
had a good story to tell." That story, the 
tale of a homeless man with supernatur- 
al powers who serves as a guardian 
angel to a troubled African American 



teenager, became a manuscript. On a 
cruise ship in the Caribbean, Bailey 
struck up a conversation with a fellow 
passenger, who turned out to be a book 
editor and who asked to read his manu- 
script. Bailey's novel, Mr: Dream Merchant, 
was published in 1998. 



OO 



To his surprise, Bailey 
A\. has found his work in 
film parallels his time at HMS. 



The book's inspirational message 
soon caught the attention of Hollywood 
producers. Bailey adapted his novel into 
a screenplay, but the special effects nec- 
essary to the plot made funding diffi- 
cult. Still, the seed had been planted. 
"The experience was like Filmmaking 
101 for me," says Bailey. "I decided to 
take what I had learned and keep 
going." He tried his hand at another 
screenplay, this one the tale of six child- 
hood friends who reunite after the death 
of their Little League coach and mentor. 
The resulting film, The Last Adam, which 
was shot in just three weeks, won the 
Southeastern Media Award at the 2005 
Atlanta Film Festival. 

To his surprise, Bailey has found his 
work in film parallels his time at HMS. 
"It was disconcerting to interact with 
people from an entirely different disci- 
pline — film — and to lead in a field I 
wasn't trained in," he admits. "It 
reminded me in many ways of my 
internship, always changing services, 
not having a handle on anything, yet 
having responsibility." As he had on the 
wards, Bailey quieted his nerves and 
saw the process through. "Becoming a 
doctor gave me the confidence to trust 
myself," he says. He now heads his own 
production company, Descending 
Dove Productions. 

Medical school gave Bailey — cur- 
rently at work on the screenplay for a 
romantic comedy tentatively called 
House Calls — another push. As a student 
at HMS, he often played basketball 
with a Hollywood heavyweight: novel- 
ist Robin Cook, then a faculty member 
at the School. "My classmates and I 
used to ask him how he managed to 
practice medicine, teach, and be a best- 
selling author," says Bailey. These days, 
the surgeon-turned-screenwriter is fac- - 
ing those same questions himself, with § 
an answer that's part mantra, part % 
counsel to fellow physicians interested * 
in the business: Just do it. u 



42 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 



WsTER '95 



On the hit television series House, MD, the curmudgeonly 
title character uses a range of diagnostic ploys to iden- 
tify rare medical cases in his patients. Though vastly 
different from the character whose lines he helps pen, 
David Foster '95 shares that same passion for discovery. 
"The ability to delve into a patient's condition and use 
both logic and leaps of faith to make a diagnosis is why 




many of us went into medicine," he says. 
"It's a privilege to listen to patients — 
they tell fascinating stories." 

Such stories inform the fictional cases 
that Gregory House and his team 
explore, from that of a jazz musician who 
can't breathe to that of a patient whose 
pain is triggered by a swallowed tooth- 
pick. "There's a synergy between prac- 
ticing medicine and writing," says Fos- 
ter, who notes that combing the medical 
literature for stories has an added bene- 
fit: keeping up with research. "Writing 
for House serves as a great kind of CME 
program," he laughs. 

As the only physician on the show's 
writing staff, Foster assists with the 
medical aspects of all scripts and has 
written eleven episodes himself. He cred- 
its his interest in writing with an elective 
medical literature course at HMS. The 
class — whose alumni include television 
producer Neal Baer '96 and New Yorker 
scribe Atul Gawande '94 — was, he says, 
"incredibly good fun." 

Yet Foster's path from Harvard to 
House wasn't a direct one. After his resi- 
dency, he practiced at Boston's Dimock 
Community Health Center, running a 
detox program and providing care to 
patients. Occasionally Baer, already 
established in the entertainment indus- 
try, sent a project his way, like consulting 
on the television show Gideon's Crossing. 

Then came the opportunity to work 
on House. The show was not expected to 
be successful. After all, it had a little- 
known British actor playing a cynical 
American doctor with a Vicodin addic- 
tion and a knack for diagnosing rare dis- 
orders unknown to most of the viewing 
public. Yet the program overcame those 
odds to receive critical acclaim — and 
high ratings. Five years later, Foster is a 
full-time staff writer with fond memories 
of his time practicing in Boston. "I used to 
be a doctor who wrote a little," he says. 
"Now I'm a writer who doctors a little." ■ 

Jessica Cerretani is assistant editor of the 
Harvard Medical Alumni Bulletin. 



2£. "It's a privilege to 
/K listen to patients — they 
tell fascinating stories." 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



43 



w«p 



A 



WE 



w 



One believes he's God; another performs exorcisms. 
One commits murder, while another merely hurls cats 
in fits of pique. Meet the fictional graduates of Harvard 
Medical School, by paula byron 





HOLLYWOOD INSIDERS: 
Fictional graduates of 
Harvard Medical School 
on television, from left: 
Frasier Crane from f rosier, 
Lexie Grey from Grey's 
Anatomy, Abbey Bartlet 
from The West Wing, 
and Stephen Franklin 
from Babylon , 



s*\ 



^RVARD MEDICAL ALUMNI BULLETIN 45 



46 




HE LAWYER TAKING THE 



deposition wants to know: Does Jed Hill have a God 
complex? The surgeon — his hair sleek, his suit impec- 
cable, his tie crimson — answers with quiet authority. 

"I have an MD from Harvard. I am board certified 
in cardiothoracic medicine and trauma surgery. I 
have been awarded citations from seven different 
medical boards in New England. And I am never, ever 
sick at sea. 

"So I ask you," he continues with a slow stroke of 
his chin, "when someone goes into that chapel and 
they fall on their knees and they pray to God that 
their wife doesn't miscarry or that their daughter 
doesn't bleed to death... who do you think they're 
praying to?" 

The surgeon leans forward and concludes with a 
taut curve of his lips, part smirk and part sneer: "You 
ask me if I have a God complex. Let me tell you some- 
thing: I am God." 

With that pronouncement, Alec Baldwin's self- 
consecrated surgeon in the 1993 thriller Malice became 
a cinematic icon. But he's not just the archetype 
of imperious doctors or even, as the plot unfolds, 
of rakish swindlers. He also embodies Hollywood's 
take on Harvard Medical School graduates: brilliant, 
arrogant, and deserving of plot twists. 

School of Marred Docs 



Harvard Medical School has long received more than 
its share of attention from Hollywood. When a 
fictional screen doctor's alma mater is identified, in 
fact, it's disproportionately likely to be the School. 

Name recognition undoubtedly plays a role. 
Harvard, the oldest college in the United States and 
often the first in academic rankings, had become a 
brand name even before Ishmael declared, in the 1851 
novel Moby Dick, "A whale-ship was my Yale College 
and my Harvard." And the Medical School has been 
no slouch; in the two decades U.S. News & World Report 
has been ranking research-oriented medical schools, 
Harvard has yet to slip to second place. 




Often HMS seems merely an easy reach for screen- 
writers; the psychiatric resident who clashes with his 
morally flexible mother in the 2002 movie Laurel 
Canyon and the medical resident intent on romancing 
women in the 2006 movie Ways of the Flesh could have 
graduated from any school. 

Occasionally the choice of HMS as an alma mater 
does seem thoughtful: Wilbur Larch, a doctor who 
runs an orphanage in The Cider House Rules, earned his 
degree from the School; the grandfather of the charac- 
ter's creator, John Irving, was a member of the Class of 
1910. And sometimes HMS acts as a marker for intelli- 
gence. Alumna Lexie Grey, a surgical resident on Grey's 
Anatomy, has a photographic memory, a knack that 
earns her the nickname Lexipedia when she remem- 
bers not only a neurovascular disease mentioned in an 
obscure otolaryngology journal, but also the journal 
article's volume, issue, and page numbers. 

For the most part, though, the composite fictional 
portrait of HMS graduates that has emerged over the 
past few decades has been unflattering, with doctors 
falling into a limited range of caricature, from super- 
cilious surgeons to patronizing pathologists to irri- 
table internists. John Becker, an HMS graduate on 
the television sitcom Becker, for example, bristles with 
hostility. "I will kill you," he promises a colleague. 
"And then I'll use my powers as a physician to bring 
you back to life. And then — I will kill you again!" 

The Divine Right of Kings 

HMS resides at the intersection of two institutions 
often considered synonymous with condescension: 
Harvard and U.S. medicine. So it may come as no 
surprise that the characteristic Hollywood most 
commonly bestows upon the School's fictional 
graduates is arrogance. 

Some fictional alumni grow arrogant as a result of 
their power to save lives. Take Stephen Franklin, a 
twenty-third-century graduate of the School. As 
chief medical officer on the science fiction series 
Babylon 5, he compassionately cares for a range of 
alien life forms. When he fails to save the lives of sev- 
eral wounded Minbari — members of a humanoid 
species whose cranial crest resembles the bony frill 
of a dehorned styracosaurus — he autopsies one of 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 



When a fictional screen doctor's 

alma mater is identified, it's disproportionately 
likely to be Harvard Medical School. 




THE CIDER HOUSE RULES 



LABOR IN VAIN: While Wilbur Larch (clockwise 
from bottom left) devotes himself to the care of 
orphans, other fictional graduates, including Jed 
Hill and Charles Winchester III, devote themselves 
to the nurture of their own egos. 



the aliens to understand its anatomy and physiology, 
in the hope of being able to rescue future patients. 

Yet even Franklin echoes Jed Hill's self- aggrandiz- 
ing beliefs. When his space station commander 
demands to know who asked him to play God, 
Franklin retorts, "Every damn patient who comes 
through that door, that's who! People come to doc- 
tors because they want us to be gods. . . .They want to 
be healed and they come to me when their prayers 
aren't enough. Well, if I have to take the responsibil- 
ity then I claim the authority too." 

Other fictional graduates flaunt not their own 
sense of divinity so much as their divine rights as 
Harvard alumni. In one episode of the television 
series Frasier, psychiatrist Frasier Crane complains to 
his station manager about the prankster whose call- 
in radio program follows his. "I did not spend eight 
grueling years at Harvard," he fumes, "to be mocked 
by that juvenile jackass!" 

"Shameless!" she cries. 

"Oh, he's beyond shameless!" 

"I'm talking," she says, "about the way you manage 
to get Harvard into every conversation!" 

The psychiatrist just can't help himself. Minutes 
later, to bolster his argument, he declares, "I am a doc- 
tor! I went to ..." He trails off as he catches the station 
manager's withering look and finishes, with an 
embarrassed bobble of his head, ". . . medical school!" 

Still other fictional graduates vaunt the exquisite 
pedigree that had made Harvard their only possible 
choice for medical school. Charles Emerson 
Winchester III, a Korean War surgeon on M*A*S*H, 
speaks in lofty, nasal tones. "Due to my background 
and breeding," he proclaims, "it was inevitable that 
I attend the finest schools: Choate, Harvard..." to 
which his fellow surgeon Hawkeye Pierce helpfully 
adds, "... the Massachusetts Institute of Snobbery!" 

The Twilight Zone 

While many fictional matriculants cultivate mon- 
strous egos, others are simply monsters. One of the 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



47 



Not all the School's fictional graduates are arrogant, 
and not all play God. But most are extreme, if not m 
character, talent, or immortal status, then in storyline. 



48 




more sympathetic screen characters to 
have attended the School is, in fact, a 
vampire. As a victim of the 1918 flu pan- 
demic, Edward Cullen — the smoldering- 
eyed undead hero of the 2008 movie 
Twilight — had been dying in a Chicago 
hospital when a vampiric physician 
took pity on him, plunged venom into 
his neck to lend him immortality, and 
adopted him. 

Now forever 17, the conscience- 
stricken Cullen wants to compensate 
for his unnatural nature. He battles 
other vampires to save the lives of 
humans, and he practices "vegetarian" 
vampirism, imbibing the blood of ani- 
mals rather than humans. Like his adop- 
tive father, he even once studied medi- 
cine, though he has yet to complete his 
HMS degree. After warning his mortal 
love interest not to requite his affection, 
he tells her, in winsome anguish, "I don't 
want to be a monster!" 

Some fictional graduates don't seem to 
mind being monsters. After graduating 
at the top of his class at HMS, Ted Grey, 
the protagonist of the 2008 movie Pathol- 
ogy, lands a spot at one of the nation's 
most prestigious residency programs in 
pathology. There, in the opening lecture, 
he hears his new adviser declaring, "I like 
to think of the pathologist as offering a 
window to God" — words any fictional 
graduate might long to hear. 

Attracted by his cold confidence and 
superior skills, his fellow residents lure 
Grey into joining their clique. He soon 
uncovers their secret — an after-hours 
morgue game of let's-see-who-can- 
commit-the-perfect-murder. It doesn't 
take long for him to join in their game of 
playing God by murdering those they 



AGAINST TYPE: Edward Cullen, a vampire 
in the movie Twilight, fights against the 
monstrous characteristics of his fellow 
immortals, even to the point of battling 
other vampires. The task takes its toll 
and, one might speculate, may even have 
kept him from completing his medical 
studies at Harvard. 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 




THE LESSER OF TWO EVILS: Although 
the lead character in Becker (bottom 
center in the photo at left) is a School 
graduate who bedevils his colleagues 
on a daily basis, the fictional alumnus 
in The Exorcist, Damien Karras (below), 
must fight a more malevolent form 
of bedevilment. 



term "irredeemable filth" — pedophiles, 
pimps, and murderers. 

Eventually, though, Grey realizes his 
fellow residents arerit simply conducting 
vigilante killings; they're also murdering 
for sport. When Grey fails to save his 
fiancee from being slain, he proceeds to 
autopsy her killer — while the paralyzed 
perpetrator is still agonizingly alive. 

Extreme Measures 



Not all the School's fictional graduates are 
arrogant, and not all play God. But most 
are extreme, if not in character, talent, or 
immortal status, then in storyline. Abbey 
Bartlet, a thoracic surgeon who's married 
to the U.S. president on The West Wing, faces 
an unusual predicament. For years she 
has been administering interferon beta- lb 
to her husband to keep his multiple 
sclerosis a secret from the nation. Only 
when he collapses does she reveal his ill- 
ness to a member of the White House 
staff. Her decision to treat the serious ill- 
ness of a family member clandestinely 
and without establishing a medical 
record — in egregious violation of several 
principles of medical ethics — leads her 
to give up her medical license for the 
duration of her time in the White House. 
But Bartlet's storyline is mundane 
compared with the one Damien Karras 
must follow. Karras had become a Jesuit 
priest before attending HMS. Yet nei- 
ther his spiritual calling nor his psychi- 
atric training could have prepared him 
for his biggest challenge: curing a levi- 
tating, green-bisque-spewing prepu- 
bescent girl of her demonic possession. 



In The Exorcist, Karras initially scoffs at 
the family's request for the ancient ritual. 
No one has believed in demonic posses- 
sion, he assures the girl's mother, "since 
we learned about mental illness, para- 
noia, schizophrenia — all the things they 
taught me in Harvard." Yet Karras soon 
realizes that his Harvard training is pow- 
erless in the face of a malevolence that 
causes rooms to turn frigid, furniture to 
shake violently, and a girl's head to rotate 
completely — and creakily — on her neck. 



In the end, Karras taunts the demon into 
possessing him and then hurls himself 
down a long flight of stone steps, sacri- 
ficing his own life to save his patient. 

Sadly, the HMS graduate lives to die 
another day. In The Exorcist 111: Legion, a 
spawn of the original movie, we find 
Karras possessed by another evil spirit, 
escaped from his grave, and housed in 
a psychiatric hospital. Eventually he 
becomes implicated in his possessor's 
latest killing spree and is shot to death. 




SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 




50 



Be True to Your School 

Other medical schools can claim fic- 
tional alumni, of course. Yale takes 
credit for psychiatrist Niles Crane, 
Frasier's pretentious younger brother. 
Stanford graduated Cristina Yang, an 
ambitious surgeon on Grey's Anatomy; 
B. J. Hunnicutt, an easygoing surgeon 
on M*A*S*H; and Bob Kelso, the callous 
chief of medicine on Scrubs. Tufts educat- 
ed Jordan Cavanaugh, the grim-faced 
medical examiner on Crossing Jordan, 
and Jennifer Melfi, the long-suffering 
psychiatrist to the eponymous mobster 
on The Sopranos. 

But HMS, whose fictional graduates 
have numbered at least two dozen in the 
past few decades, easily edges out even 
Johns Hopkins, its closest rival. Eric Fore- 
man, the pensive neurologist on House, 
MD, graduated from Hopkins, as did Ellie 
Bartlet, the president's middle daughter 
on The West Wing, and Preston Burke and 
Erica Hahn, two hard-driving cardiotho- 
racic surgeons on Grey's Anatomy. 

Hopkins may not have Harvard's 
numbers, but it competes well in the 
realm of extreme character. Although 
not a graduate of the medical school, 
Hannibal Lecter — the infamous cannibal 
from The Silence of the Lambs who comple- 
ments his liver entrees with fava beans 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 




and a nice Chianti — trained at the Johns 
Hopkins Hospital. 

But the Hopkins matriculant who 
should have attended Harvard instead is 
the curmudgeonly protagonist of House. 
Gregory House comes straight from HMS 
casting, with a distended ego and a self- 
anointed divinity. "You will trust my 
diagnosis," he tells an Orthodox Jew, the 
husband of a patient, "because in this 
temple, I am Dr. Yahweh." 

To parse the Harvard-Hopkins screen 
rivalry, we turned to The Simpsons, a fine- 
ly tuned cultural barometer that fea- 
tures a graduate of each school. Julius 
Hibbert, the Simpson family physician, 
earned his medical degree from Hop- 
kins. A genial genius who giggles at dis- 
concertingly inappropriate moments, 
Hibbert tends to offer dubious solu- 
tions to medical dilemmas. When 
Homer Simpson loses a thumb, for 
instance, Hibbert cheerfully suggests 
lopping off the other one for symmetry 
To reduce his malpractice liability, he 
buys a T-shirt with the slogan "Do Not 
Resuscitate," muttering, "This could get 
me out of a lot of sticky situations." 

How could Harvard possibly top such 
an eccentric character? With Eleanor 
Abernathy, better known as the Crazy 
Cat Lady. As a young woman with 
degrees from HMS and Yale Law School, 



COLD CASE: The protagonist of the 
movie Pathology seems to revel in 
being a monster, freely joining a 
game of playing God by murdering 
those he deems to be irredeemable. 



Abernathy had enjoyed two successful 
careers. In one flashback scene, while 
representing a client in court, she asks 
to be excused to deliver a baby. Exhaus- 
tion, however, has led to alcoholism, and 
as the years have passed Abernathy has 
gradually loosened her grip on reality. In 
one episode, a new medication allows 
her to regain lucidity; while rational, she 
can speak intelligently about health care 
reform. The placebo effect wears off, 
though, when she learns the pills are 
really Reese's Pieces. 

Lisa Simpson, ever sympathetic to the 
downtrodden, films a Kidz New£ report 
in front of Abernathy's modest Spring- 
field home. "People say she's crazy just 
because she has a few dozen cats," Lisa 
earnestly says into the microphone. "But 
can anyone who loves animals that much 
really be crazy?" The door slams open 
and Abernathy answers Lisa's question 
in her signature way: With flyaway gray 
hair and a snaggletoothed grimace, she 
lunges forward, shrieking incoherently 
and hurling first a black cat, then a tabby, 
as a mess of yowling, panicked felines 
squirm in her arms and gird themselves 
for flight. 

Natural Selection 



Where on screen, we wondered, could 
we find normal graduates of the School? 
Where were the thoughtful and caring 
physicians who didn't autopsy aliens, 
dissect their colleagues, or catapult 
kitties? For guidance we turned to a 
real-life graduate who works in Holly- 
wood. Neal Baer '96 had left his position 
as a writer and executive producer of ER 



To parse the Harvard-Hopkins screen rivalry 

we turned to The Simpsons, a finely tuned cultural 
barometer that features a graduate of each school. 



years earlier, but as executive producer 
of Law & Order. Special Victims Unit, he still 
had two fictional doctors under his 
creative control. So we asked him: What 
medical schools had they attended? 

"Well," he said, "I never really 
thought about it. Um, I guess Columbia 
and Cornell?" 

We dutifully jotted down his answer, 
but when we reported back to members 
of the Bulletin's Editorial Board, they 
weren't impressed by our journalistic 
objectivity. Go back to him, they urged. 
Claim those doctors for Harvard! 

So at our next opportunity we asked 
Baer: Why not Harvard? "Fine," he 
answered, without a hint of the peevish- 
ness so characteristic of his screen coun- 
terparts. And with that word, the School 
gained two new fictional graduates, doc- 
tors it could be proud to claim: George 
Huang, an insightful and empathetic psy- 
chiatrist, and Melinda Warner, a tough 
and yet not flinty medical examiner. 

The School's list of fictional gradu- 
ates only promises to grow One Harvard 
hopeful can be found in a movie now in 
development; the screenplay has been 
written and optioned, and actor Orlando 
Bloom has been discussed as a possible 
lead. Based on a short story by Edgar 
Allan Poe, Eliza Graves takes place in a 
remote psychiatric hospital. A recent 
HMS graduate accepts a job there, not 
realizing that the patients have staged a 
coup and are now running the hospital. 
Eventually the plot twists to reveal that 
the young man is himself a former 
patient — perhaps even an escaped 
one? — of another psychiatric hospital. 
We can only hope the movie wraps 
before Hopkins recruits him. ■ 

Paula Byron is editor of the Harvard Medical 
Alumni Bulletin. For a list of fictional HMS 
graduates in movies and on television, visit 
http://alumnibulletin.med.harvard.edu/ 
bulletin/spring2009/screenmapping.php. 




SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



51 




GREGORY HOUSE 

House, MD 

Specialties: Infectious disease and 

nephrology 

Bedside manner: Misanthropic, 

juvenile, ardently offensive 

Teachable moment: Convinced 

that the star of his favorite soap 

opera has a medical condition, he 

kidnaps the actor, runs clinical tests, 

and eventually, while watching the 

actor grimace through a fake gin 

and tonic on the set, diagnoses him 

with quinine allergy. 

Lesson drawn: The devil is in 

the details. 

Quote: "Treating illnesses is why we 

became doctors. Treating patients is 

what makes most doctors miserable." 



The 
Narcissist 

MEREDITH GREY 

Grcfs Anatomy 

Specialty: Surgery 
Bedside Manner: Self-absorbed, 
distracted, perennially gloomy 
Teachable moment: She almost 
drowns while treating the victims of 
a ferry crash, and her near-death 
experience spurs her to enter psy- 
chotherapy to confront her "dark 
and twisty" nature. 
Lesson drawn: Physician, heal 
thyself. 

Quote: I've heard that it's possible 
to grow up; I've just never met any- 
one who's actually done it." 



Which Hollywood screen doctors 
should be your role models? 





The Innovator 

FREDERICK FRANKENSTEIN 

YoungFrankcnstcin 

Specialty: Neurosurgery 

Bedside manner: Neurotic, risk taking, animatedly 

pioneering . 

Teachable moment: In a groundbreaking procedure, 
he transfers some of his calm and intellect to his overbed 
monster _ an d unexpectedly reaps a sizable gain in return. 

Lesson drawn: Devotion to science can bring hidden benefits. 

Quote: "Hearts and kidneys are Tinkertoys!" 





The Civilizer 

MICHAELA QUINN 

Dr.Quinn, Medicine Woman 

Specialty: Frontier medicine 

Bedside manner: Nurturing, pacifying, disarmingly plucky 
Teachable moment: When her new employer, who was 
expecting a male doctor, tries to return her to Boston, she refuses 
to leave Colorado Springs and goes on to treat arthritis, diag- 
nose an arrhythmia, deliver a baby, cure an infection and 

Lesson drawn: Hold you^T ""^ te *"*^ in < he ** *■«* 




HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 




The Moralist 

STEPHEN FRANKLIN 

Babylon 5 

Specialty: Galactic medicine 
Bedside manner: Principled, 
open minded, refreshingly 
xenobiophilic 

Teachable moment: Despite 
the threat of arrest, he refuses to 
release autopsy notes that would 
enable EarthForce to develop 
biological weapons against the 
Minbari, a humanoid alien race. 
Lesson drawn: Do the right thing, 
even if it's alien to your nature. 
Quote: "Take responsibility for 
your actions, for crying out loud! 
You go in there and you fight for 
what matters to you. Don't just 
walk away because it's easier!" 



The Elitist 

FRASIER CRANE 

Frasicr 

Specialty: Psychiatry 
Bedside manner: Pompous, 
bombastic, desperately insecure 
Teachable moment: It's Frasier 
Crane Day and he's frantic about 
missing a public rally in his honor 
until a cab driver's quiet recitation 
of real problems distracts him from 
his insatiable ego. 
Lesson drawn: It's not all 
about you. 

Quote: "As we speak, hordes of 
viral Visigoths are hurling them- 
selves over the battlements of my 
immune system, laying waste to 
my — Oh, dear God, you see 
how weak I am? I can't even finish 
a simple Visigoth metaphor." 



The Cy 111 ^^^ PIER ce, m*a*s*h 

Specialty: Surgery 

Bedside manner: Wisecracking, mocking, endearingly puckish 
Teachable moment: He gleefully invents a fictional Army cap- 
tain to authorize the donation of medical supplies to a local orphan- 
age- when he "realizes" the Army hasn't paid the captain in over 
a year, he has that back pay donated to the orphanage as well. 

L-- . Lesson drawn: Survive by your wit-if not your wits. 

Quote: "I'm not here for you to admire. I'm here to pull bodies out of a sausage grinder, 

if possible without going crazy." 




The Competitor 




CRISTINAYANG, Grey's Anatomy 

Specialty: Surgery 

f e e o d , S |! d t. n,anner: A " reSsive ' ambi ' io ^ unerringly tactless 
Teachable moment: She steals another doctor's intriguing 
case-a psychiatric patient whose massively swollen abdomen 
leads him to insist he's pregnant-only to be thwarted by a 
nurse she has treated contemptuously. 
Lesson drawn: Be kind to everyone, especially nurses 
Quote: Colleagues aren't friends! They're competitors." 




The Luddite 

DR. EVIL, AustinPowcrs 




4 



Specialty: Global havoc 

Bedside manner: Outmoded, conniving, cheerfully 

malevolent 

Teachable moment: After being cryogenically preserved 

for three decades, he threatens to hold the world hostage for 

one m/7//on dollars, sparking a round of stifled laughter 

among his criminal cohorts. 

Lesson drawn: Aim high. 

Quote: "It's Dr. Evil. I didn't spend six years in Evil Medical 

School to be called mister!" 




SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



53 



£gx& 



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W"'!' 1 ■"■it,, '■ »ll 

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from sharks to 

bears to 
frogs to bacteria, "w 

"Earth's biodiversity 
holds medical treasures 

waiting to be 

discovered—and crying 
out to be conserved 





DESIGN FOR 





IT'S OFTEN THE UGLY AND THE SMALL THAT SUSTAIN LIFE. 
Consider, for example, the gastric brooding frog. Native to Australia, both the 
northern and southern branches of this frog species are small — about the length 
of a jumbo paperclip — and with large protruding eyes, flattened heads, slimy 
skins, and dull or dun colorations, not quite candidates for poster amphibian. 

And then there's its name, painfully practical: A female gastric brooding frog 
swallows fertilized eggs and hatches them in her stomach. It's a curious process 
but, from a medical standpoint, a fascinating one. After the eggs develop into tad- 
poles — and before the mother frog spews them forth to develop into adults in the 
outside world — the brooding tadpoles apparently secrete a substance or sub- 
stances that inhibit the mother frog's digestive process, thus turning an inhos- 
pitable environment hospitable. Those substances intrigue medical researchers. 

by Eric Chivian 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



55 




■ 



> 



Could they help prevent, perhaps even 
treat, peptic ulcer disease, a condition 
that affects more than 4 million people 
in the United States alone? The ques- 
tion is a tantalizing one. 

And one never to be answered, for the 
gastric brooding frog, abundant in the 
early 1970s, disappeared several years 
later. For more than a decade now, it has 
officially been listed as extinct. 

The reasons for this disappearance 
could be several: climate change, destruc- 
tion of the frogs' forest and stream habi- 
tats, infection by a lethal fungus. But the 
results are clear. A small creature is gone 
because of human activity, the diversity 
of species inhabiting our planet has been 
lessened, and knowledge that could have 
helped doctors alleviate suffering has 
vanished for all time. 

About a decade ago, I became part of a 
scientific effort to investigate the poten- 
tial consequences to human health from 
the loss of species such as the gastric 



brooding frog. Together with colleagues 
from Harvard Medical School's Center for 
Health and the Global Environment, the 
International Union for Conservation 
of Nature (IUCN), and three agencies of 
the United Nations — the Environment 
Programme, the Development Pro- 
gramme, and the Secretariat of the Con- 
vention on Biological Diversity — we 
gathered and sifted data on the well- 
being of humans and our planet. 

We found the two to be inextricably 
entwined. Our findings underscored the 
need to preserve the planet's biodiversi- 
ty — its ecosystems, species, popula- 
tions, and gene pools — if we are to pre- 
serve human health. 

Recycling Center 

Although the gastric brooding frog can 
no longer benefit from improvements we 
make as active stewards of this planet, 
other animals can. The polar bear is one 



such animal. This magnificent mammal is 
one of nine bear species threatened with 
extinction, according to the IUCN. The 
threats come from habitat destruction, 
overhunting, and, for the polar bear in 
particular, exposure to persistent organic 
pollutants and climate change. Increasing 
temperatures are thinning the Arctic ice, 
a condition that compromises the bears' 
ability to hunt seals, their primary food 
source. In fact, during the bears' peak 
hunting season, seals are the first, and 
often only, item on the menu. Dining on 
seal blubber allows a polar bear to build 
a layer of fat several inches thick direct- 
ly beneath its skin. 

Just when this steady diet of seal blub- 
ber leads to a state of obesity, the bears 
begin a several-month period of fasting. 
Given their obesity, we would expect 
polar bears to develop type 2 diabetes 
mellitus, as we and all other mammals 
tend to do. In fact, their cells do show 
some insulin resistance. Yet polar bears 



56 



HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 



do not develop the disease. Instead, their 
metabolism of glucose and fat and 
their production of insulin adjust to 
meet their changed circumstances. Insight 
into how polar bears accomplish these 
metabolic feats could well inform how 
we treat, and maybe even prevent, type 2 
diabetes, a disorder that has reached epi- 
demic proportions in the United States. 

The promise that understanding 
polar bear physiology holds for humans 
with diabetes expands when we exam- 
ine the physiologies of other bear 
groups. Research conducted during the 
past quarter century on hibernating 
black bears, for example, has shown that 
during their three-to-six-month period 
of inactivity they do not lose bone mass, 
nor do they urinate or defecate. By con- 
trast, humans who are bedridden for five 
months lose one-quarter to one-third of 



an inability to excrete 
urinary wastes for 

several days poisons and 
eventually kills a 

person; now is it that 
Dears survive unharmed? 



their bone mass. More dramatically, an 
inability to excrete urinary wastes for 
several days poisons and eventually kills a 
person. How is it that bears survive simi- 
lar circumstances unharmed? 

They recycle. Calcium released by the 
bones cycles back into bone. Urine is 
reabsorbed by the bladder and returned 
to the bloodstream; the reabsorbed urea 



is used as a building block to form new 
amino acids, which assemble into 
new proteins; and free fatty acids are 
returned to fatty tissue, not broken 
down to release ketone bodies as their 
end product. The overall result of this 
remarkable internal chemistry is that, 
during hibernation, bears lose body fat, 
increase lean body mass, and maintain 



ON THIN ICE: Polar bears are 
threatened with extinction as a 
result of climate changes that 
hasten the loss of Arctic sea ice, 
the frozen habitat upon which 
the bears depend. 



m 



% 








SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



57 



our failure to recognize 

the link between 
our health and that 
or the planet's species is 
at the core of the global 
environmental crisis 



bone integrity and healthy renal func- 
tion. To add to that remarkable litany 
females that are pregnant when they 
start their period of fasting and hiberna- 
tion give birth and provide nutritious, 
high-fat milk to growing offspring. 

Even if our study of hibernating bears 
led only to an effective treatment for 
osteoporosis, a disease that currently 
afflicts more than 28 million people in 
the United States alone, protection of 
these animals would be worthwhile. 
But research on bears also has shown us 
that their metabolic accomplishments 
could inform our treatment of such 
medical conditions as obesity, diabetes, 
chronic malnutrition, anorexia nervosa, 
and atherosclerosis. 

Shell Gains 



It's not simply the promise of medical 
advances that may be found in nature. 
Cone snails — marine mollusks that live 
in the soft bottoms of mangroves and in 
coral reefs — have delivered on the 
promise. Each of the world's estimated 
500 to 700 cone snail species is believed 
to produce between 100 and 200 dis- 
tinct peptide toxins. The snails defend 
themselves and paralyze their prey — 
other mollusks, worms, and fish — with 
these toxins, delivering the poisons 
through a hollow, harpoon-like tooth. 

The total number of toxins produced 
by this one genus of snails is remark- 
able— 50,000 to 140,000, compared with 
only about 10,000 alkaloids that have 
been identified in all known plants. Pit 
vipers and other poisonous animals 
taken together produce only a handful of 
different poisons. But cone-snail toxins, 



known as conotoxins, also are excep- 
tional in that each binds with such 
potency and extreme selectivity to one of 
an enormous array of receptor sites. This 
discriminating ability has made conotox- 
ins a must-have for biomedical research 
and a rich resource for the development 
of new medicines. 

Conotoxins have, for example, helped 
scientists characterize certain of the sub- 
types of nicotinic acetylcholine receptors 
found in skeletal muscle, in the brain, and 
in mammalian heart muscles, where they 
have contributed to our understanding 
of the mechanisms that control heart rate 
and contractility. Other conotoxins have 
allowed researchers to identify calcium, 
potassium, and sodium ion channel sub- 
types, advancing our knowledge of the 
toxins' fundamental molecular units. 

These toxins may also prove useful in 
diagnosing early cases of some elusive 
and stubborn cancers, like small-cell 
carcinomas of the lung, as they can help 
identify circulating antibodies formed in 
response to certain cancers, such as 
those that cause the autoimmune neuro- 
logical disease Lambert-Eaton myas- 
thenic syndrome. 

These contributions may seem consid- 
erable, but they likely represent a mere 
fraction of the biomedical treasures cone 
snails may offer. To date, less than 1 per- 
cent of conotoxins have been defined and 
only a small subset of this group has been 
analyzed for biological activity. From 
these few eEorts, however, several poten- 
tial new medicines have been identified. 

One, a painkiller called ziconotide, has 
been shown to be a thousand times more 
potent than morphine. Unlike morphine 
and other opiates, however, ziconotide 



leads neither to tolerance nor addiction. 
In 2004, the U.S. Food and Drug Admin- 
istration approved the use of this com- 
pound for the management of severe 
chronic pain in patients who no longer 
respond to opiates. 

Another toxin that blocks a type of 
neurotransmitter receptor called the 
NMDA receptor has been shown to pro- 
tect neurons from cell death in situa- 
tions in which circulation is inadequate, 
such as during strokes and head injuries. 
Other conotoxins that block NMDA 
receptors could open the way to new 
antiepileptic treatments. 

The potential pharmacopoeia that 
cone snails offer humans understandably 
makes the snails sought-after items for 
biomedical research. But such popularity 
comes at a cost. Harvesting the snails for 
biomedical research, a practice that tends 
to be carefully controlled, may simply be 
contributing a new twist to the over- 
hunting these snails have long suffered at 
the hands of another set of collectors, 
those captivated by the beauty and vari- 
ety of the snails' shell patterns. 

The snails' habitats also face environ- 
mental insults. An estimated 20 percent 
of the world's coral reefs are so damaged 
they are unlikely to recover; another 50 
percent are at risk of collapse. 

Carbon dioxide, released into the 
atmosphere during the burning of fossil 
fuels, threatens reefs in two ways: by 
dissolving in seawater, thereby increas- 
ing its acidity and inhibiting the calcifi- 
cation of the corals that make up the 
reefs, and by causing sea surface warm- 
ing, which affects the viability of algae 
that provide the corals with nutrients. 
Mangroves too are being threatened, 
uprooted for wood, development, and 
aquaculture and devastated by natural 
catastrophes such as tsunamis. 

An awareness of these threats — and a 
willingness to act to stem them — can 
help conserve this population; countries 
like Australia have recently established 
restrictions on the collection and trade of 
cone snails. Yet many countries in South- 
east Asia, where more than half the 
world's cone snail species are found, have 
no such controls. 



58 i HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 
) 
I 



You Can't Bottle Sunshine 

It may seem odd to link the existence of a 
tiny frog that once lived on a single conti- 
nent, a bear that forages in the frigid far 
north, and a snail that inhabits reefs and 
mangroves found only in tropical seas to 
that of humans populating the far reach- 
es of the world. But such links are real. 

With the loss of animal, plant, and 
microbial species, we lose not only new 
medicines and vital models for medical 
research, but also the contributions those 
species make to ecosystems. Such losses 



disrupt the interdependent webs of life 
that pollinate crops, convert wastes and 
dead organisms into nutrients for the 
soils and oceans, hold infectious diseases 
in check, and perform a host of other 
essential services that spark and sustain 
the hves of all organisms on Earth. 

Our failure to recognize the link 
between our health and that of the plan- 
et's species and ecosystems is at the core 
of the global environmental crisis. We 
delude ourselves — dangerously so — if we 
think that taking action to preserve the 
natural world is simply a matter of 



choice. It is not a choice; it is a necessity. 
Our health and our hves depend on it. ■ 

Eric Chivian '68 is founder and director of the 
Center for Health and the Global Environment 
and an assistant clinical professor of psychiatry at 
Harvard Medical School. In 1980, he co-founded 
International Physicians for the Prevention of 
Nuclear War, recipient of the 1985 Nobel Peace 
Prize. In 2008, Time magazine named him one of 
the 100 most influential people in the world. Along 
with Aaron Bernstein, he is the editor of Sustain- 
ing Life: How Human Health Depends on 
Biodiversity (Oxford University Press, 2008). 




SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



59 



Match Game 




IN A RANT ON THE FOLLY OF PHARMACEUTICALS, OLIVER WENDELL 
Holmes, Sr., Class of 1836, once declared, "I firmly believe that if 
the whole materia medica could be sunk to the bottom of the sea, it 
would be all the better for mankind — and all the worse for the fishes." 
Holmes was not the only Harvard doctor to be a quotable notable. 
Can you match the statements on the next pages with their sources? 
(Keep in mind that several of these Harvard Medical School gradu- 
ates and faculty members are quoted more than once.) 



o-o 



Z>-|- 



-, y- U O 

£3 S § 

Z <^S 

2^<c 



111! 






06 £ *J u_ 

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1. 

"If you dorft fall down, you 

arerft trying hard enough, you 

aren't trying to do things that 

are hard enough for you. So, 

falling down is part of learning 

for whatever you do .... " 




SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 61 



Match Game 



..v 



2. The great secret, known to internists and learned 
early by internists' wives, but still hidden from the 
general public, is that most things get better by them- 
selves. Most things, in fact, are better by morning. 

3. An expert is a man who tells you a simple thing in a 
confused way in such a fashion as to make you think 
the confusion is your own fault. 

4. When you have to make a choice and dorit make it, 
that is in itself a choice. 

5. A physician is obligated to consider more than a 
diseased organ, more even than the whole man — he 
must view the man in his world. 

6. A segregated hospital makes the white person feel 
superior and the black person feel inferior. It sets the 
black person apart from all other citizens as being a 
different kind of citizen and a different kind of med- 
ical student and physician, which you know and we 
know is not the case. What the Negro physician 
needs is equal opportunity for training and prac- 
tice — no more, no less. 

7. Drugs are here to stay. History teaches that it is vain 
to hope that drugs will ever disappear and that all 
efforts to eliminate them from society are doomed 
to failure. 



8. Every now and then a maris mind is stretched by a 
new idea or sensation, and never shrinks back to its 
former dimensions. 

9. We all live every day in virtual environments, defined 
by our ideas. 

10. I can play hardball as well as anybody. That's what I 
did, cut people's hearts out. 

1 1 . Sometimes you can tell a large story with a tiny subject. 

1 2. One hears of the mechanical equivalent of heat. What 
we now need to discover in the social realm is the 
moral equivalent of war: something heroic that will 
speak to men as universally as war does, and yet will 
be as compatible with their spiritual selves as war 
has proved itself to be incompatible. 

1 3. Man can't help hoping even if he is a scientist. He can 
only hope more accurately. 

1 4. In the Middle Ages, people took potions for their ail- 
ments. In the nineteenth century they took snake oil. 
Citizens of today's shiny, technological age are too 
modern for that. They take antioxidants and extract 
of cactus instead. 

1 5. Leaders often find themselves temporarily alone. 



ANSWER KEY 

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James 




62 HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009 



Doctors' Notes 



1 6. The state should, I think, be called "Anaesthesia." 
This signifies insensibility. . . . 

1 7. Tobacco is a filthy weed, 

That from the devil doth proceed. 

It drains your purse, it burns your clothes, 

And makes a chimney of your nose. 

1 8. Aloft, floating free beneath the moist, gleaming mem- 
brane of bright blue sky, is the rising earth, the only 
exuberant thing in this part of the cosmos. 

1 9. First, you know, a new theory is attacked as absurd; 
then it is admitted to be true, but obvious and insignif- 
icant; finally it is seen to be so important that its adver- 
saries claim that they themselves discovered it. 

20. Yes, I am the first woman on the Harvard faculty — but 
not the first one who should have been appointed! 

21. A vigorous five-mile walk will do more good for an 
unhappy but otherwise healthy adult than all the 
medicine and psychology in the world. 

22. Ants are so much like human beings as to be an 
embarrassment. They farm fungi, raise aphids as 
livestock, launch armies into war, use chemical 
sprays to alarm and confuse enemies, capture slaves, 
engage in child labor, exchange information cease- 
lessly. They do everything but watch television. 



Fred R. Shapiro is editor o/The Yale Book of Quotations (Yale 
University Press, 2006). 




a. Tenley Albright '61, surgeon and U.S. Olympic gold 
medalist in figure skating, 1956 

b. William B. Castle '21, HMS professor of medicine, 
1924-1968, and a founder of experimental hematology 

c. Michael Crichton '69, writer for film and television; film 
director and producer; author of nonfiction works; and 
novelist whose works, such as The Andromeda Strain 
and Jurassic Park, were often made into movies 

d. Harvey Cushing, Class of 1 895, HMS professor of 
surgery, 1912-1932; father of neurosurgery; and 
medical historian 

e. William Frist '78, cardiologist and U.S. Senate 
Majority Leader, 2003-2007 

f. Ernest Gruening, Class of 1912, journalist; U.S. 
senator, 1 959-1 969; territorial governor of Alaska, 
1939-1953 

g. Alice Hamilton, HMS assistant professor of industrial 
medicine, 1919-1935, and founder of U.S. industrial 
toxicology 

h. Oliver Wendell Holmes, Sr., Class of 1 836, HMS 

professor of anatomy and physiology, 1 847-1 882; 
HMS dean, 1 847-1 853; writer and poet 

i. William James, Class of 1869, psychologist and 
philosopher 

j. Charles Krauthammer '75, Pulitzer Prize-winning 
columnist who writes about policy and politics 

k. Karl A. Menninger, Class of 1917, psychiatrist, 
philanthropist, and author 

I. Eliot Porter '29, celebrated nature photographer 

m. Lewis Thomas '37, dean of New York University School 
of Medicine, 1954-1969; dean of the Yale School of 
Medicine, 1969-1972; president of Memorial 
Sloan-Kettering Institute, 1973-1983; poet and essay- 
ist well known for his many books, including The Lives 
of a Cell: Notes of a Biology Watcher 

n. Benjamin Waterhouse, one of the first faculty 
members appointed to HMS, 1782; first Hersey 
Professor of Theory and Practice of Physic at HMS, 
1 783-1 81 2; scientist; and writer 

o. Andrew Weil '68, author; entrepreneur; and 

practitioner, teacher, and advocate of integrative 
medicine 

p. Paul Dudley White, Class of 1911, pioneering 
cardiologist 

q. Louis Tompkins Wright, Class of 1915, surgeon and 
the first black chair of the Board of Directors of 
NAACP, the National Association for the Advancement 
of Colored People, 1934-1953 



SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN 



63 



Harvard Medical Alumni Association 

25 Shattuck Street 

Boston, Massachusetts 02115 

Change Service Requested 



Non-Profit Organization 

U.S. Postage PAID 
Permit No. 52420 
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BEST IN SHOW: Harvard Medical School 
can boast dozens of fictional graduates 
on screens large and small. Pictured, 
from left, are alumni Abbey Bartlet from 
The West Wing, Stephen Franklin from 
Babylon 5, and Frasier Crane from Frasier.