SUMMER 1997
To everything there is a season, and a time to every purpose under the heaven." This ancient axiom contains the essence of the feature articles in our first issue of Indiana University Medicine, a new magazine we've created to encourage dialogue and understanding among members of our academic community, alumni, students and their advocates.
We move through the commentary of Douglas Triplett, MD, director of the Medical Education Center in Muncie, who witnesses the impact of basic research in hematology on breakthroughs in the treatment of thrombosis (the most common cause of premature death in the western world) to the observations of pediatricians like neuro-oncologist Regina Jakacki, MD, who asserts that parents are our partners in research, willing to take the risks that give their children the greatest opportunity to successfully overcome their disease. Along the way we discover humanity among students who take extra measures to serve our country's less fortunate in homeless shelters, a new partnership between the School of Medicine and Indiana State University that promises hope of better medical care for the underserved rural community and, among alumni, one who is recognized by the School this year for his choices in life that allow him to serve the less fortunate in countries around the world.
Most of all, I want you to see this magazine as a way for all of us to better share our observations and inquiries about the art and science of medicine and its constant revelations about community and humankind. Please feel free to call on me with ideas and comments for us to consider in future issues. I'll be talking with you in all of our quarterly issues. For now, enjoy this premier presentation. James W. Edmondson, MD ('69) Editor-in-Chief
Message from the Dean
WELCOME TO INDIANA UNIVERSITY MEDICINE. It is my sincere wish that this new publication will enhance your communication with the IU School of Medicine. I hope you will find its stories multifaceted, challenging, at times provocative and always interesting. Just as all of medicine is undergoing significant transformation, our school is changing as well. Indiana University Medicine should provide the reader insights and understanding of the changing milieu encompassing the IU School of Medicine and our responses to this altering environment.
Academic medicine is responding to the forces of managed care; and the consolidation of Indiana University Hospital and Riley Hospital for Children with Methodist Hospital of Indiana is a significant reflection of this change. While the School is separate from the hospital consolidation, it will have an impact on our tripartite mission of teaching, service and research. We will, in the coming years, use this medium to illustrate the changes we are undertaking to preserve and enhance the quality of our School.
I believe the Indiana University School of Medicine is the strongest it has ever been. Our school's challenge for the future is acceptance of change, with accompanying behavioral modification, to promote the continued improvement of our profession. Our faculty is proposing an enhanced curriculum that would prepare our graduates to deliver quality care in an ambulatory setting. Our bench research continues to grow. Its combination with technology transfer and translational applications of achievement into the clinical armamentarium will make today's research tomorrow's practice. All of which must be enfolded into our mission of promoting quality care for all Hoosiers.
The Indiana University Medical Center campus is undergoing dramatic change with new construction. Barnhill Drive is permanently closed to traffic due to construction of the IU Cancer Research Institute and the expansion as well as renovation of the Van Nuys Medical Science Building. At Barnhill and Michigan Streets, we opened the Indiana Cancer Pavilion in the fall of 1996, a place where you will find friendly and efficient multidisciplinary ambulatory cancer care. All of these campus additions enhance our ability to fulfill our missionwhile at the same time promoting ever greater excellence.
As you learn about our school and its changes, I wish to extend to you both the opportunity to respond to the articles with opinions and to provide you with a forum to share your personal past and present successes and achievements with other alumni, future alumni, faculty and friends.
In closing, I invite you to become better acquainted with all aspects of our school through your reading of Indiana University Medicine.
Robert W. Holden, MD Dean, Indiana University School of Medicine
Winning the Fight Against Childhood Cancer
Thirty years ago, only about one of every four children diagnosed with cancer survived. In 1997, these survival odds literally have been reversed. Today, about 75 percent of youngsters outlive their cancers and go on to adulthood, thanks to the continuing commitment to basic and clinical cancer research at academic centers such as IU School of Medicine.
During the two-and-a-half years since his birth, Philip Weghorst, son of Carmel, Indiana, residents Jodie and Jim Weghorst, had been the picture of health. But on Easter Sunday 1993 the usually well-coordinated toddler repeatedly lost his balance while gathering the brightly decorated eggs hidden in his backyard. Suspecting an ear infection was the cause of her son's stumbling, Jodie took Philip to the family pediatrician, expecting to be given a prescription for an antibiotic. Instead, the doctor recommended a neurologic evaluation at Riley Hospital. Excellent advice, as it turned out. A CT scan of Philip's head showed a tumor slightly larger than a golf ball growing in the back of his brain, near the brain stem. The diagnosis: medulloblastoma, one of the most malignant types of childhood brain tumors.
Survival Plus Quality of Life
Brain tumors are, after leukemia, the second most common cancer affecting children, with about 2,000 new cases diagnosed each year in children under age 16. Surgery to remove the tumor followed by chemotherapy and radiation therapy is the standard of care for brain and most other pediatric as well as adult cancers. In children, though, radiotherapy, while unsurpassed at halting tumor growth in the brain and spinal cord, also can cause devastating, permanent side effects. These include diminished intellectual capacity - ranging from learning disabilities to profound mental retardation - growth impairment and hormonal abnormalities.
"Three decades ago, survival alone constituted success, but steady advances in treatment of many childhood cancers have raised expectations to the point where we now must also examine the quality of that survival," says Jay Grosfeld, MD, chairman and professor of surgery and director of pediatric surgery. "Decreasing treatment complications while still achieving good outcomes is our new definition of success."
Upping Chemo Doses
An experimental method for reducing the side effects of brain radiotherapy in children without compromising the chances for a cure is cutting back the total radiation dose and balancing this reduction by increasing the dose of chemotherapy. This is the approach Regina I. Jakacki, MD, assistant professor of pediatrics and director of pediatric neuro-oncology, recommended to Philip's parents, who readily agreed.
"Philip first had surgery to remove as much of his tumor as possible, then he received four months of higher-dose and more frequent chemotherapy followed by half the standard dosage of CNS radiation therapy," explains Dr. Jakacki. "The treatment was rigorous, but he made it through with flying colors." In the past four years, six youngsters with medulloblastoma including Philip have been treated with this research protocol at Riley Hospital. Only one child had a cancer recurrence three years after diagnosis, and none has had any significant decline in IQ.
Though the thought of experimenting with a child's life is daunting, most parents are willing to take the gamble, says Dr. Jakacki, if the treatment offers the hope not simply of survival but also good quality of life. TheWe ghorst's concur. "No matter what happens down the line," says Jodie, "we won't regret our decision, because today Philip is living the kind of life a six-year-old is supposed to live."
Useful as they are, all chemotherapy drugs share the same serious drawback. Because they target dividing cells, these drugs also kill off normal tissue and, most importantly, bone marrow - the body's blood cell production factory and mother of the immune system. The higher the dose, the greater the damage. By the same token, high doses also increase the likelihood of a cure.
Protecting the Immune System
To boost bone marrow recovery, IUSM oncologists use a variety of immune system stimulators in conjunction with high-dose chemotherapy. Yet for some childhood cancers, the dosage needed to destroy every lurking cancer cell is so high that even with immune stimulators, treatment would totally wipe out the bone marrow and kill the patient. The only way around this Catch-22 is to replace the bone marrow after chemotherapy.
"For many years, autologous (from the patient) or allogeneic (from a donor) bone marrow transplantation was the only way to rescue patients from certain death following extremely high-dose chemotherapy and total body irradiation," notes Frank Smith, MD, associate professor of pediatrics, clinical director of Riley's stem cell transplant program, and a member of the Wells Center for Pediatric Research. Siblings have a 25 percent chance of matching at least five of the six protein markers known as transplant antigens found on the surface of most body cells; for parents, the odds drop to two percent. Consequently, many stem cell transplants have come from unrelated bone marrow donors identified through the National Bone Marrow Donor Program. Yet, despite over 2.5 million volunteers, fewer than 40 percent of persons who could benefit from this life-saving procedure ever find suitable donors. Fortunately, as a result of the ground-breaking research by Hal Broxmeyer, PhD, scientists in the Walther Oncology Center at IUSM, and collaborators at other institutions in the US and Europe, a seemingly unlimited source of concentrated stem cells has been found: umbilical cord blood.
Not only is the supply of cord blood plentiful, says Dr. Broxmeyer, but stem cells from the placenta also appear to be more adaptable and forgiving than either bone marrow cells or peripheral stem cells, obtained from an arm vein. As a result, the close matching of donor and recipient, so crucial in bone marrow and peripheral blood stem cell transplantation, may be less critical with cord blood. "When cord blood is used for stem cell transplants, instead of matching five or six antigens, we may be able to get away with four and possibly only three matches," Dr. Smith reports. "This means we soon should be able to find donors for most children in need of a transplant - especially good news for children from ethnic and racial minority groups, who currently are underrepresented in the donor registry."
IU is one of only seven transplant centers in the US to receive support from the National Institutes of Health and National Heart, Lung and Blood Institute to study cord blood transplantation. To date, 15 children, all with advanced leukemias or genetic disorders and no suitable related donors, have received cord blood transplants at the Riley Children's Cancer Center. Without a transplant, these youngsters likely would have died. Instead, many are alive and doing well, with three disease-free for over one year.
Battling the Most Difficult Tumors
Peter and Leanda Walls of Indianapolis received the bad news in February 1995. After two years of going from doctor to doctor seeking a cause for their six-year-old daughter LeAnn's periodic vomiting, they came to Riley Hospital, where Dr. Jakacki gave them the grim diagnosis. LeAnn was suffering from a craniopharyngioma, a fairly uncommon tumor located in the center of her brain - an area essential for learning. Chemotherapy, she advised the couple, is not effective in treating this form of cancer, and thoughradiotherapy works, it would leave LeAnn with potentially severe learning and behavioral problems.
"Peter insisted that there must be another option, some experimental treatment that might cure his child," Dr. Jakacki recounts. "I told them there was - a protocol I recently had designed - but I also told them that the treatment had never been tried. LeAnn would be the first test patient in the world." Without a moment's hesitation Peter and Leanda gave Dr. Jakacki the go-ahead.
The idea for Dr. Jakacki's new therapy resulted from a conversation with Biagio Azzarelli, MD, professor of pathology, who told the children's cancer specialist that craniopharyngiomas were derived from the same cells that cause squamous cell skin cancer. "I then called Dr. (C. William) Hanke in dermatology and asked how he was treating this type of skin cancer," Dr. Jakacki states. "He said they were getting pretty good results using the protein alpha-interferon to stimulate the immune system, so I decided it was worth a try in my patients."
Four weeks after undergoing surgery which removed much of her tumor, LeAnn began a one-year course of high-dose alpha-interferon injections, with no chemotherapy or radiotherapy. Side effects were minimal, and she was able to go to school most days. Best of all, the treatment seemed to be working. Monthly MRIs showed steady shrinking of the residual tumor that continues to this day. Because of LeAnn's excellent response, other pediatric oncologists across the country have begun using Dr. Jakacki's protocol for treating craniopharyngiomas. At Riley, four more young patients
Initiatives That Help Women & Minorities Advance End Up Helping Everyone
BY LYNDA MEANS, MD
Despite the growing number of women choosing careers in medicine, women continue to face challenges limiting their ability to achieve their full career potential. Not only are women less likely to succeed in academic medical careers in the US than men, they are underrepresented in leadership roles, have slower rates and lower likelihood of promotion, and are less likely to become professors in their departments.
The Association of American Medical Colleges recently launched a national initiative to increase the number of women leaders. IUSM picked up the baton in February 1996 when Dean Robert Holden convened the Committee on Enhancing Education and Professional Environment (CEEPE). Dean Holden charged the 28 committee members with developing interventions to ensure all IUSM students and faculty a climate that nurtures their career development and pays particular attention to the needs of women and underrepresented minorities.
In response to this charter, several projects have already come to fruition or are underway. Last fall, 52 women faculty volunteered to participate in a mentoring program where they were paired with first- and second-year female medical and graduate students. Assignments were made on the basis of similar professional and/or personal interests. Mentors were asked to meet with their proteg=E9es throughout the academic year and to serve as a resource for issues relevant to women in medicine.
In March, IUSM sponsored Women in Medicine and Science: A Professional Development Seminar. Sixty of our faculty attended the day-long program which offered workshops on topics such as negotiation, time management, research, education and the changing medical environment. Guest speakers Janet Bickel, MA, associate vice president of AAMC, and Carol Aschenbrener, MD, senior scholar in residence at the Association of Academic Health Centers, discussed leadership skills for the new health care environment.
More projects are planned, including measures to examine representation of women and underrepresented minorities in various areas at IUSM and to determine the effect of the interventions planned. Much of our work is inspired by and modeled after that of L. Freid of Johns Hopkins University, published last year in JAMA. That study showed that counter-initiatives can not only change current negative trends, but go even further, to improve the educational and professional environment for all faculty and students.
News & Notes
Dr. Williams ('56) was an assistant professor of medicine from 1965 to 1970. After a 15-year interlude as director of the cardiology division at the University of Texas Medical Branch at Galveston, he rejoined IUSM in 1965 as professor of medicine and senior research associate at the Krannert Institute of Cardiology. He also was chief of cardiology at the Roudebush VA Medical Center. In 1990 he was named associate dean and director of Wishard Memorial Hospital.
Williams has chaired or been a member of numerous IUSM committees. He is a fellow and past president of the American College of Cardiology and has been active in a number of professional societies.
Dr. Smith has served the School as teacher, researcher and clinical pathologist. He joined the faculty in 1970 as professor of pathology and director of microbiology. He was associate chairman for research for the Department of Pathology and Laboratory Medicine from 1986 to 1991 before being named chairman in 1992.
During his tenure, Smith's research has focused on what was once a very rare parasite: pneumocystis carinii. With the advent of transplantation and the emergence of AIDS, his once-small laboratory exploded to become one of the world's largest research centers studying this parasite. P. carinii is the most common cause of pneumonia in patients receiving anti-rejection therapy for transplantation or anti-cancer chemotherapy, and in those with human immunodeficiency virus (HIV).
Smith has served on more than 30 committees for the university. He currently is a member of the Dean's Advisory Council and serves as vice chair of the executive committee for IU Health Care Associates, Inc., IUSM's specialty physician practice group. He also has served on several national committees and professional organizations.
Music, art and dance temporarily replaced textbooks and stethoscopes at the sixth annual Evening of the Arts on April 3 at the University Place Conference Center auditorium. The performing and visual arts showcase, produced by the Medical Student Council, featured the artistic talents of nearly 50 students and a few brave faculty and staff from several IUSM campuses. Twenty-seven acts included vocal, instrumental and dance performances that ranged in style from classical to contemporary, as well as readings of original works. A silent auction featured the works of local artists, including several medical students.
IUSM students have produced Evening of the Arts since 1992 to raise money for the homeless. The benefit arose as an extension of IUSM's Health and Homelessness Project, through which students and doctors volunteer their health care expertise for underserved people in homeless shelters and clinics in the Indianapolis area.
Over the past five years, the event has raised more than $13,000 to purchase health care supplies and equipment for homeless facilities. This year monetary donations were made to Wheeler Mission, the Salvation Army Cli nic and Horizon House in Indianapolis, and to St. Thomas Clinic in Johnson County, just south of the city.
One of the newest additions to Evening of the Arts is the presentation of the Evening Star Award to an individual who has made a significant contribution of time and effort to the care and well-being of the homeless in central Indiana. The first award was presented in 1996 to James Trippi, MD. The 1997 recipient is Matias Vega, MD.
Already an accomplished musician, Anthony Miller took up classical guitar three years ago when he began medical school. He was one of 27 Evening of the Arts performers.
LUTE TROUTT WILL BE REMEMBERED FOR MANY THINGS, but none more fondly than her strawberry shortcake recipe. Miss Troutt is the patron of the Strawberry Shortcake Medical Alumni Luncheon, an IUSM tradition. For half a century, medical alumni have been returning each spring for educational events, class reunions, and a chance to indulge in Miss Troutt's strawberry shortcake - the coup de grace of the annual spring meeting. Miss Troutt, who died in 1987, was a professor emeritus at IUSM and a recipient of the IU Distinguished Alumni Award. The daughter of a country doctor, she was a 1918 graduate of Indiana University, the first intern in the IUSM dietetics program, and the first director for the Department of Dietetics. Years ago, it was tradition that the ever-popular strawberry shortcakes would not be served in the hospitals' dining halls until after the Alumni luncheon, says Bernice Boucher Hopp, who served 41 years as a therapeutic dietician and later director of hospital food service. Back then, the dessert was topped with real "pouring cream" (half and half) instead of whipped topping. According to the 1984 cookbook published by the Department of Nutrition and Dietetics, today's dessert comes in at a whopping 25.8 grams of fat per serving (still less than today's "Whopper" burger)!
Bernardino F. Ghetti, PhD, was awarded the rank of distinguished professor of pathology and laboratory medicine, of psychiatry, of medical and molecular genetics, and of neurology. Dr. Ghetti, long known as an outstanding clinician and teacher in neuropathology, has collaborated on work which is dramatically increasing understanding of Alzheimers, Parkinson's disease and the family of pathologies that includes "mad cow" and prion disease. C. Conrad Johnston Jr, MD, was awarded the rank of distinguished professor of medicine, adjunct professor of nursing. Dr. Johnston's research is praised by colleagues for its creative design, precision and rigor, and has filled many gaps in the understanding of osteoporosis. Robert M. Einterz, MD, clinical associate professor of medicine, received the John W. Ryan Award for Distinguished Contribution to International Programs and Studies. From the day he was offered a faculty position at IUSM, Dr. Einterz has regarded medical education in the developing world as a vital part of the School's educational and clinical missions. Most recently, he developed a collaboration with Moi Univer-sity Medical School in Eldoret, Kenya.
From Bench To Bedside - Basic Research Is Giving Us Tools to Predict and Prevent Thrombosis by Douglas A. Triplett, MD
Athough many people assume cancer is the most common cause of death in Europe and North America, this is not the case. Thrombosis is the most common cause of death in developed countries. By definition, thrombophilia is an acquired or inherited predisposition to thrombosis involving either arteries or veins. A number of risk factors for atherosclerosis have been identified, including obesity, hypercholesterolemia, hypertension and smoking. But until recently many patients with early onset atherosclerosis or deep vein thrombosis were found to have no apparent risk factors.
Sergei Grinkov, a two-time Olympic pairs figure skating gold medalist is an example. A world class athlete, he died suddenly while training at Lake Placid, New York, in 1995. A recently introduced laboratory procedure (polymerase chain reaction) showed him to have an unusual variation of platelet glycoprotein receptor (GPIIIa). There are two variations of this receptor, PLA1 and PL.A2 Grinkov had both receptors.
In the last five years, research laboratories around the world have been able to provide exciting new information directly applicable to the practice of medicine. In 1993, Bjorn Dahlback of Sweden was asked to evaluate a family with a history of venous thrombosis. The pattern of inheritance was autosomal dominant (about one half of males and females in the family were affected).
Based on his clinical observations, he predicted an underlying genetic disorder predisposing to thrombosis. Routine laboratory tests were normal. However, using a simple coagulation test, he was able to demonstrate an abnormality due to a mutation of the gene for coagulation protein: factor V. Factor V is necessary for normal clotting of blood in response to injury. In this case, the abnormal factor V, which had a single amino acid substitution, was not easily "turned off" following activation of the coagulation system. Individuals who inherit one gene for this abnormal factor (named factor V Leiden) have an approximately five- to eight-fold increased risk of venous thrombosis. In persons with two genes for factor V Leiden, the relative risk of venous thrombosis increases still further, to 80 times that of the normal population.
Even more recently, findings have been published which indicate that patients with factor V Leiden and under the age of 45 are nine times more likely to die of ischemic heart disease. Remarkably, the gene for factor V Leiden is found in approximately five percent of the Caucasian population and is essentially absent from other racial groups.
The discovery of factor V Leiden has significantly increased the ability of physicians to identify a predisposition to thrombosis in some patients, and thus apply some very practical considerations to patient care. For instance, if a young woman with one gene for factor V Leiden elects to use oral contraception, her relative risk of thrombosis is increased approximately 30-fold!
A second inherited abnormality can increase a patient's risk even further. Elevated levels of homocysteine have long been known to be associated with arterial disease. Recently, a labile variant of an important gene involved in the homocysteine pathway - methylenetetrahydrofolate reductase (MTHFR) - has been described. This labile MTHFR occurs in approximately 35 percent of the Caucasian population. Approximately eight percent of Caucasians inherit two abnormal genes for labile MTHFR.
Given the frequency of this genetic abnormality, it is not unusual to find patients who have inherited both factor V Leiden and the gene for labile MTHFR. Increasingly, individuals who develop venous or arterial thrombosis are found to have two or more genetic abnormalities. The cumulative effect of multiple genetic or acquired abnormalities tips the balance toward thrombosis.>
The case of a recent patient I was asked to see illustrates this point rather dramatically. The patient was a 32-year-old woman who had sustained a myocardial infarction in her early 20s. In addition, she had a very strong family history of vascular disease. Among the risk factors identified were labile MTHFR, homozygosity (two genes for PLA2) and elevated levels of anticardiolipin antibodies. This case illustrates the importance of a comprehensive evaluation in young patients with thromboembolic events.
Identification of risk factors is critical in discussing patient management involving the use of oral contraception in young women, prophylactic anticoagulation in patients who are exposed to increased risk of thrombosis (elective surgery, prolonged automobile or airplane trips, pregnancy) and evaluation of families with history of thrombosis.
The promise of laboratory research lies in its ultimate usefulness to patient care. In the case of thrombosis, this promise is being realized. Today, in many cases, an astute physician and an informed patient will lead to prevention of thrombotic events. Even world-class athletes like Sergei Grinkov, a two-time Olympic gold medalist, can carry factors leading to sudden, unexpected death due to thrombosis. Inherited risk factors such as factor V Leiden are common, affecting approximately five percent of the Caucasian population.
The scenario is a common one in small, rural towns across Indiana. A child with an ear infection, a man with a sprained ankle, and an elderly woman with diabetes all need medical attention. But the closest doctor is an hour away, so there are time and transportation issues. And getting an appointment can be challenging, since one physician often serves an entire county single-handedly. Such challenges become even more troublesome when emergency care is needed.
The shortage of primary care physicians in rural Indiana continues to be a major problem for rural families as well as the physicians trying to serve them. Thirty Indiana counties are designated as health professional shortage areas, a statistic that flies in the face of some national reports.
"The United States may be producing too many doctors overall, but we certainly aren't in Indiana," says Robert W. Holden, MD, dean of the IU School of Medicine. "In our state, there continues to remain a shortage of primary care physicians. Over the past five years the number of primary care physicians graduating from the School of Medicine has dramatically increased, but not enough of them are choosing to practice in rural areas."
In order to change that trend, IUSM has partnered with Indiana State University (ISU) to create the Rural Health Initiative. The program is the result of more than four years of work between the two institutions. Its aim is to nurture a student's interest in rural medicine by providing hands-on experience alongside physicians practicing in rural areas. Students will have opportunities to learn about rural health issues throughout their four years of undergraduate work at ISU and their four >years of medical school at IUSM.
"I feel very strongly about the importance of this program," says Dean Holden. "It is our responsibility as the state's only medical school to be responsive to the health care environment around us."
John Moore, PhD, president of Indiana State University, agrees. "We're pleased to be a part of this initiative, which we feel will have a profound effect on medical care availability for Indiana's rural residents," he says. "We're committed to attracting top-notch students to ISU and to helping prepare them for the challenges and rewards that rural medicine can offer."
Drs. Holden and Moore agree that the key to making this program work is the universities' collaborative approach. Supporters of the Rural Health Initiative believe that its best hope for success lies in targeting medical students who come from underserved rural communities themselves. Therefore, special efforts will be made to recruit high school students from communities with less than 10,000 residents and from counties with physician shortages.
Each year, as many as ten students will be accepted into the program. ISU will provide tuition waivers or scholarships for students during their undergraduate years. Applicants, who are screened concurrently by ISU and IUSM admissions committees, must submit a personal statement about their desire to practice rural medicine, must have a minimum SAT of 1200 and a high school GPA of 3.5.
Once admitted to the program, students may major in any area for their undergraduate degree; however, they must also complete certain course requirements established by IUSM. In addition, they must maintain a minimum undergraduate GPA of 3.5 and have an MCAT score equal to the average of that year's entering IUSM class. Provided they meet these requirements and successfully complete their undergraduate degree from ISU, they are guaranteed admission to the IU School of Medicine.
In medical school, these students will benefit from a variety of experiences designed to foster interest and skills in rural medicine. "We intend to provide students with as many rural medical experiences as we can," says Roy Geib, PhD, assistant dean and director of the Terre Haute Center for Medical Education and the primary coordinator of the Rural Health Initiative. "Students will take classes in rural health, engage in a rural health seminar series sponsored by both schools, shadow rural physicians, complete summer internships in rural clinics, and participate in summer research programs. Third- and fourth-year medical students will have even more opportunities to serve some of their clerkships in rural areas, away from the medical campus in Indianapolis."
Geib suggested creating the Rural Health Initiative after seeing the success of a similar program at the University of Nebraska. The Nebraska program includes specialized training for all health professions, and has graduated some non-physician students who have already returned to rural areas to work. Medical students enrolled there are now completing their third year.
In Indiana, the Terre Haute Center for Medical Education is one of eight regional IUSM campuses where first- and second-year medical students are educated. Located on the Indiana State campus, the center serves as IUSM's principal organizer of the Rural Health Initiative. The Terre Haute Center will work closely with ISU to recruit students for the program. The Center also will utilize its established relationships with the Midwest Center for Rural Health and Union Hospital, both in Terre Haute. Union offers a family medicine residency focused on rural practice. The Midwest Center for Rural Health will help coordinate summer learning experiences for students at rural clinics such as those located in Clay City and Sullivan, Ind.
Drs. Holden, Geib and Moore agree that the Rural Health Program seems to be an excellent prescription for improving health care in Indiana. Speaking to their shared vision, Dean Holden says, "Students need to see first-hand that practicing medicine in a rural area can be just as rewarding as practicing in an urban area."
1930 Chester S. Laubscher, MD, is enjoying retirement in Santa Cruz, CA, where he is active in his church and bridge club.
1935 Morris E. Stern, MD, is retired and living in Phoenix, AZ, with his wife, Dorothea Jane.
1936 Douglas F. Barkley, MD, practiced medicine in Austin, TX, for 39 years before retiring. He lives in Westminister Manor in Austin.
1944 William Lloyd Bridges, MD, is retired and living in Fort Wayne, IN, with his wife, Margaret.
1945 Fred S. Carter, MD, a retired internist from Stuart, FL, received a special recognition award from the American Society of Internal Medicine at the Society's 40th Anniversary Annual Meeting in October 1996. The award is presented to those who have performed outstanding service to the Society and the patients it serves.
1946 George C. Poolitsan, MD, retired in July 1996 after merging his practice with Internal Medicine Associates, Bloomington IN.
1950 Samuel Slipp, MD, has authored two recent books, Healing the Gender Wars and Freudian Mystique: Freud, Women & Feminism. He is a clinical professor of psychiatry at the New York University Medical School and maintains a private practice in New York City and Englewood, NJ.
1952 John D. MacDougall, MD, is currently the chairman of the governing board for St. Francis Hospital, Indianapolis, IN, and chairman of Physician's Insurance Company, Inc. He retired from his private surgical practice two years ago.
1952 Joseph G. Barkey, MD, retired in September of 1991 from anesthesiology, but continued to practice family medicine and aviation medicine until 1996. Currently, he has a "small office at the Findlay, Ohio airport" where he practices aviation medicine. His wife, Marcia, is a member of the Findlay city council.
1952 Calvin E. Oyer,=20MD, Providence, RI, says, "I am retiring this July. I want more time to spend outdoors and visiting kids and grandkids. I have been working in pediatric pathology at the Brown University School of Medicine."
1952 Everett L. Holt, MD, retired in 1986 and currently resides in Hot Springs Village, AR. Before he retired, he practiced in Corpus Christi, TX for 33 years. During the last 13 years of that time, he was the director of the family practice residency program at Memorial Hospital.
1952 Robert A. McDougal, MD, Indianapolis, IN, retired in 1988 and is currently active in genealogy and research. He spends his February's in Arizona.
1955 Buron O. Lindbloom, MD, recently received the Distinguished Service Award for his outstanding contribution and support to the physician assistants program in the department of community medicine and rural health at the University of North Dakota School of Medicine and Health Sciences.
1961 Edward R. Bush, MD, is practicing family medicine in Anderson, IN. He enjoys running, collecting baseball memorabilia, and spending time with his family. He and his wife, Betty, have four children, Theresa (35), James (32), Laura (23), Angela (22), and three grandchildren. In 1991, he qualified for and ran in the Boston Marathon.
1961 Daniel R. Evans, MD, is retired and enjoying golf, tennis, boating, fishing and reading in Palm City, FL. He and Mary Lou, his wife, have three children, Dan (41), Shayn (38), and Matthew (27).
1962 Leonard E. Lawrence, MD, is the associate dean for student affairs and a professor of psychiatry, pediatrics, and family practice at the University of Texas Health Science Center at San Antonio, TX. He and his wife, Barbara, have three children.
1967 James L. Grainger, MD, South Bend, IN, retired from full-time practice in 1990, but still does some part-time work in diagnostic radiology. He and wife, Linda, enjoy traveling, playing golf, and working with stained glass. They spend most of the winter on Marco Island, FL. They have three sons.
1967 Lloyd L. Rich, MD, practices internal medicine in Carmichael, CA. He and his wife, Sharyn, enjoy going to the theatre and traveling. They have three sons, Adam (33), Todd (29), and Seth (27).
1969 Stephen M. Miller, MD, of Longmont, CO, is practicing interventional radiology in Boulder, CO. He lives on a horse farm, West Winds, where he raises dressage warmbloods and competes in first level dressage events.
1970 Philip N. Eskew Jr., MD, was elected vice president of the American College of Obstetricians and Gyne-cologists (ACOG) at the organization's annual meeting in April 1996. He is the Ob/Gyn residency program director and medical director of the Women's and Children's Service Line at St. Vincent Hospital, Indianapolis, IN. He is also a clinical associate professor of obstetrics and gynecology at the Indiana University School of Medicine.
1972 Victoria T. Smith, MD, was recently appointed chief of physical medicine and rehabilitation at the James E. VanZandt VAMC in Altoona, PA.
1976 Deborah I. Allen, MD, professor and chair of the department of family medicine at the Indiana University School of Medicine was elected to the board of directors of the American Board of Family Practice.
1977 Rodger J. Elble, MD, is the chair of the department of radiology at Southern Illinois University School of Medicine. A native of Wood River, IL, he and his wife, Suzanne, have three children.
1970 Stephen W. Perkins, MD, a board-certified physician in facial and reconstructive surgery, Indianapolis, IN, participates in the National Domestic Violence Project, sponsored by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) in partnership with the National Coalition Against Domestic Violence (NCADV). Participants provide facial reconstructive surgery domestic violence victims with no health insurance or limited financial resources.
1979 Michael S. Cardwell, MD, is the director of maternal-fetal medicine at the Riverside Hospital, Toledo, OH. He has a solo practice and teaches at the Medical College of Ohio and the Ohio University School of Osteopathy.
1980 Kathleen Reagan, MD, is associate professor of radiology at the College of Physicians and Surgeons at Columbia University in New York City, and she practices cardiac radiology at Columbia-Presbyterian Medical Center. She resides in Washington Township, NJ.
1982 Gregory P. Gramelspacher, MD, an ethics expert and an internist, directs the ethics program at IUMC and is an associate professor at IUSM. He left July 1996 for Kenya, Africa, where he is training medical students, treating patients, and examining issues related to death and dying. His wife, Mary Lou, and four children, Maria (11), Joey (10), Gregory Jr. (5) and Gracie (3), also made the year-long trip.
1987 Rebecca Estes, MD, is a board certified anesthesiologist at Central Carolina Hospital in Sanford, NC. She lives on a 26-acre horse farm where she also raises peacocks and pheasants. Her hobbies include carriage driving, fox hunting, dancing, and riding her horses.
1987 Mary Ann Gilligan, MD, joined the faculty of the Medical College of Wisconsin in December 1996 as a health services researcher with a particular interest in cancer prevention. She and her husband, David, have one son, Ross (2).
1987 Philip C. Krause, MD, and Elizabeth Basquin Krause, MD, live in West Lafayette, IN, with their two children, Joseph and Katherine. Phil is a cardiac electrophysiologist at the Arnett Clinic. Elizabeth is currently "Dr. Mom" but anticipates resuming her pediatric practice in three to five years.
1987 John R. Roberts, MD, Crawfordsville, IN, is practicing family medicine in a five-physician group that is part of American Health Network. He and his wife, Kim, have two children, Trip (7) and Lauren (4). His "new love" is snow skiing.
In Memoriam
1934 Theodore D. Arlook, MD 2/22/97 1977 Steven A. Betras, MD 1/29/97 1937 Donald J. Caseley, MD 2/02/97 1940 Paul G. Dintaman, MD 2/22/97 1948 Ada R. Gaskill, MD 2/13/97 1931 Jacob E. Gillespie, MD 1/27/97 1944 Grant C. Johnson, MD 2/15/97 1935 George W. Macy, MD 2/4/97 1935 Walfred A. Nelson, MD 1/29/97 '30/32 Philip B. Reed, MD 3/13/97 1931 Arthur B. Richter, MD 2/25/97 1956 James A. Way, MD 1/4/97
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THE ROAD FROM STUDENT DAYS AT THE INDIANA UNIVERSITY School of Medicine to president of one of the nation's largest philanthropic foundations has been an interesting one for this year's recipient of the 1997 Distinguished Medical Alumni Award and the J.O. Ritchey Medal awarded by the J.O. Ritchey Society.
DAVID A. HAMBURG, MD, president of Carnegie Corporation of New York, received his AB degree from IU in 1944 and his medical degree from IUSM in 1947. At Alumni Weekend this May, he is being honored as the Distinguished Medical Alumnus, the award presented annually to an alumnus who has brought honor to his alma mater by distinguishing himself professionally or by giving extraordinary service to the school.
Dr. Hamburg spent many years in academic medicine, serving from 1961 to 1972 as professor and chairman of the Department of Psychiatry and Behavioral Sciences at Stanford University, where he was also the Reed-Hodgson Professor of Human Biology. There he had the experience that changed his life and career.
Long before Jane Goodall was a household name, Dr. Hamburg had begun nurturing their mutual exploration of primate behavior. Their interchanges between California and Tanzania, where Goodall was doing research, led to the opening of a semi-natural laboratory for primates at Stanford. For several years Dr. Hamburg's department placed students with Goodall, and all went well until rebel forces from neighboring Zaire kidnapped four students. Dr. Hamburg spent three months in Africa negotiating their release. The experience changed his life. "I had my face rubbed in the worst problems of the world - abject poverty, disease, war,"he says. Upon returning to the US, he accepted the position of president of the Institute of Medicine at the National Academy of Science, because it "gave me an opportunity to deal with health policy issues in the broadest sense."
From there he went on to Harvard as director of the Division of Health Policy Research and Education and the John D. MacArthur Professor of Health Policy. He then served as president, then chairman of the board at the American Association for the Advancement of Science. During that time, he also served on the board at Carnegie and, in 1984, was "drafted" as its president.
His contributions as advisor and educator are far-reaching. He served on the United States-Soviet Joint Study Group on Crisis Prevention, through which he met Mikhail Gorbachev, now a personal friend. He is author of Today's Children: Creating a Future for a Generation in Crisis, and was chairman of the Carnegie Council on Adolescent Development which recently completed its decade-long study with the report, "Great Transitions: Preparing Adolescents for a New Century." Numerous honorary degrees include the Presidential Medal of Freedom, presented in 1996, and the American Psychiatric Association's Distinguished Service Award.
Dr. Hamburg married Beatrix A. Hamburg, MD, in 1951. They have two children. Margaret A. Hamburg, MD, is the health commissioner of New York City and Eric Hamburg is an attorney who recently co-produced, with Oliver Stone, the movie "Nixon."
Marie Brunsman
Media Assistant
Public & Media Relations
mbrunsma@iupui.edu