Chironi a n S P R I N G / S U M M E R 2 012 New York Medical College INSIDE: Social Media in Medicine Researchers Stalk Cancer and Cardiovascular Disease Medicine + Music = One Extraordinary Professor
Parting Thoughtsf r o m t h e O u t g o i n g D e a n On June 1, the day after New Touro’s president, was appointed president of New York York Medical College cele Medical College. Following a nationwide academic search, brates its 153rd Commence a candidate was selected to lead New York Medical College ment in Carnegie Hall, I will into the future. We are all very pleased to inform you that on step down as dean of the May 1, Edward C. Halperin, M.D., M.A., became chancellor School of Medicine. As I plan for health affairs and chief executive officer of New York to tell some 362 graduates Medical College. and their families and friends, A graduate of Yale School of Medicine, Dr. Halperin completed the first time I went to medical an internship in internal medicine at Stanford and his residency school it took me only four at Harvard’s Massachusetts General Hospital. He spent 23 years to get through; this time years at Duke University, where he rose to become chairmanit required sixteen. You do slow down as you get older, but in of the Department of Radiation Oncology and vice dean of themy defense, medical education is much more complex today. School of Medicine. He also earned a Master of Arts in LiberalThe 174 newly minted physicians of the Class of 2012 matched Studies there. Before coming to the College, Dr. Halperin wasin twenty medical specialties at strong teaching hospitals dean of the School of Medicine at the Univer ity of Louisville. saround the country. We are very proud of our graduates; they I had the privilege of getting to know Ed when we were bothwill enhance the reputation of New York Medical College serving on the Council of Deans. I can assure you New Yorkwherever they go. The about-to-enter Class of 2016 is shaping Medical College is in very good hands.up as I write this. From more than 11,000 applicants, 1,400 Dr. Halperin will also serve as provost for biomedical affairswere selected to interview for admission to a class of 190. at Touro, and will serve as executive dean of the School ofTheir personal characteristics, diversity and academic creden Medicine after I step down. With his ten years of experience astials predict a very strong class, and we are glad to note that a medical school vice dean and dean, Dr. Halperin is eminentlyour robust applicant pool—among the largest in the nation— qualified to serve in this capacity until we begin a search for aallows us to select the very best candidates. new dean—probably in the coming academic year.The last two years have presented the College with challenges One of the first concrete (literally and figuratively) results of theand opportunities. When Saint Vincent’s Hospital in Manhattan Touro affiliation will be the construction of a new clinical skillsclosed in 2010, we were required to reassign 50 medical students center, which is expected to open in 2013. Watch for moreto clerkships at other teaching hospitals and to place 300 news about this exciting development—and for more in future“orphaned” residents in GME programs. It was a monumental issues of Chironian, both about and by Dr. Halperin, a prolificchallenge that was successfully met thanks to the cooperation writer and speaker who was chosen to deliver this year’sof our teaching affiliates, Westchester Medical Center and Commencement address.Metropolitan Hospital Center. Helping to ease the burden werenew or expanded affiliations with Keller Army Hospital at West In my final weeks as dean, I received numerous calls and visitsPoint, Lenox Hill Hospital in New York City, Phelps Memorial from colleagues and students stopping by to say goodbye andHospital Center in Sleepy Hollow, N.Y., and Saint Joseph’s wish me the best. With great tact, I told them that I planned toHealth Care System in Paterson, N.J. This complicated logisti stay on the faculty, teaching in the Department of Psy hi try c acal exercise would not have been possible without the support and Behavioral Sciences. I have thoroughly enjoyed the honorof our clinical chairs, program directors and the good will of and challenge of serving as dean and, prior to Dr. Halperin’sorganized medicine. I want to express my gratitude to Paul M. arrival, as provost. The best reward is the assurance thatWallach, M.D., vice dean for medical education, Richard G. during my tenure, with the unwavering support of the BoardMcCarrick, M.D., vice dean for graduate medical education of Trustees, department chairs, faculty and administration,and affiliations, and Gladys M. Ayala, M.D., M.P.H., senior approximately 3,000 individuals received M.D. degrees fromassociate dean for student affairs, for playing key roles in the New York Medical College, and are now in residency or praceffort, which provided the opportunity to explore new models tice, shaping the future of medicine.for the curriculum. Sincerely,The transition from sponsorship by the Archdiocese of NewYork to the Touro College and University System was completed this academic year. This historic undertaking was carriedout in the best academic tradition of collegiality, with input from Ralph A. O’Connell, M.D.faculty, administration and students. Alan H. Kadish, M.D., Immediate Past Provost and Dean, School of Medicine
C H I R O N I A N : : New York Medical College : : 03for AnswersZbigniew Darzynkiewicz, M.D., Ph.D., develops the technologyand methods for understanding cell proliferation, opening doorsto more effective cancer treatment.By Alicia M. Prater, Ph.D. ’07T he “War on Cancer” marked its 40th anniversary in Dr. Darzynkiewicz has the distinction of being a pioneer in the December—a long time in anybody’s book, but not field, a man who has been at the forefront of cell cycle, cell long enough to come up with a reliable cure for any of proliferation, and apoptosis research since before he joinedthe thousands of symptoms that use uncontrolled cell growth New York Medical College in 1990. In addition to directingto thrive. President Richard M. Nixon began using the metaphor the Brander Cancer Research Institute (BCRI), he also holdsin speeches to support the National Cancer Act, a historic bill professorships in the departments of pathology, medicine,passed at the close of 1971 to initiate federal government and microbiology and immunology. His research, which hasspending for cancer research. Scientists and physicians could earned him international repute, has been supported by grantsapproach their studies from the laboratory or by clinically treat from the NIH and the National Cancer Institute, including aing patients with medicinal remedies specifically designed prestigious MERIT award for his research on the effects ofaround their genetic make-ups in a process now called trans anticancer drugs on the cell cycle. He was also a recipient of alational, or bench to bedside, treatment. At New York Medical grant from NASA to develop new technologies for cell stainingCollege and affiliated Westchester Medical Center, there are and analysis applicable to the micro-gravity conditions of thenearly 20 investigators with M.D. and Ph.D. degrees who have Space Station. He is the holder of eight U.S. patents, authorspent their entire lives waging the war. One of them, Zbigniew or editor of 15 books, and has published nearly 700 peer-Darzynkiewicz, M.D., Ph.D., has been point man at the cellular reviewed articles.level, achieving world renown for his dogged pursuit of answers COLLEAGUES IN CYTOMETRYto a puzzle: how to turn cancer cells against themselves, Frank Traganos, Ph.D., professor of experimental pathologyinstead of taking more human lives. and of medicine and associate director of BCRI, has workedWhen a cell is damaged, chemical signals are activated that with Dr. Darzynkiewicz for more than three decades anddrive the cell to die without affecting nearby healthy cells. co-authored more than 120 papers with him. “He has madeKnowing how to control this process, known as apoptosis, numerous contributions to our understanding of the processescould allow doctors to control tumor growth with little, if any, and mechanisms underlying cell proliferation, cell death, andtoxicity to healthy cells. Research examining the differences cell damage by investigating processes at the single cell level,”between apoptotic and normal cells uses techniques that dif says Dr. Traganos. In 1992, the two collaborated with otherferentiate between the molecular attributes of individual cells. colleagues on a paper published in Cytometry describing the
04 : : Spring/Summer 2012 molecular attributes that characterize apoptotic cells in flow work is important, because “if replicated, in vivo the findings cytometry. Now considered a landmark paper, it has been would have broad applicability, even though it can take a long cited more than 1,500 times—and Dr. Darzynkiewicz has time to see clinical applications.” written a host of other papers with citations numbering in In the 1970s and 1980s, the understanding behind fighting can the hundreds. cer was to poison the malignant cells, which resulted in devas He coined the term cell necrobiology, or the biology of cell tating side effects that made cancer a word spoken only in death, and is credited with developing techniques for analyz hushed tones of dread. During this period, Dr. Darzynkiewicz’s ing cell kinetics, tumor progression and cell senescence. He lab successfully characterized the mechanism of action of discovered the basis for identifying a cellular resting phase anti-cancer drugs that were effective at lower doses, resulting known as “quiescent” or G 0. Although his name is not quite in less toxicity to the patient than most of the drugs in use at a household word, he is perhaps best known for developing that time. One of those drugs was mitoxantrone, which is cur the TUNEL assay (TUNEL stands for terminal deoxynucleotidyl rently used in the treatment of metastatic breast cancer, acute transferase dUTP nick end labeling), which remains one of the myeloid leukemia and non-Hodgkin’s lymphoma. most widely used techniques for measuring apoptosis. But his GOING WITH THE FLOW work goes beyond simply trying to understand cell suicide. Shortly after being named director of the Flow Cytometry Core After earning his M.D. from the Medical University of Warsaw, Facility at Sloan-Kettering he was recruited to New York Medi Poland, in 1960, Zbigniew Darzynkiewicz earned the equiv cal College. Zalmen Arlin, M.D., tapped Dr. Darzynkiewicz to alent of a Ph.D. on the basis of a thesis on the teratogenic head the College’s new Cancer Research Institute, founded actions of insulin in the chicken embryo. He developed a fasci the summer before to enable research in the etiology, classi nation with cell biology “because the analysis of molecular fication, diagnosis and treatment of tumors. The key to this mechanisms in individual cells reveals the mystery of life.” His research would be flow cytometry, which allows variability early work focused on developing new methods for studying among cancer cells to be evaluated in terms of their sensitiv enzymes in individual cells using radioisotope-labeled enzyme ity to anticancer drugs. “The knowledge of such variability inhibitors. Two years later he accepted a position at the is essential in designng clinical treatments that may be suc i Karolinska Institute in Stockholm, Sweden, which, he says, cessful in eradicating all cancer cells and thereby preventing “was the Mecca for cell biologists because of the capability to cancer relapse,” says Dr. Darzynkiewicz. measure DNA and RNA content in individual cells.” With flow cytometric measurements, apoptosis moved to the ADVANCING METHODOLOGY forefront. When damaged, normal cells become senescent, With the methods and equipment available at that time, but tumor cells do not have the same ability to respond. Lack Dr. Darzynkiewicz was capable of measuring 80 cells per ing any damage control mechanism, they die via apoptosis, a day—a pittance compared to the thousands per second he pattern of events that is so orderly the process is often called measures now. Over the years the technology, and his capa programmed cell death. This difference can be exploited to bility, advanced with radioisotope labeling and autoradiography, increase the response to cancer treatment. and then with flow cytometry and fluorescent probes capable “New strategies are being developed and tested in pre-clinical of identifying a variety of cell attributes. He expanded on each studies to enhance the susceptibility of cancer cells to radia of these approaches to explore mechanisms underlying cell tion and DNA-damaging drugs by increasing their propensity proliferation and the response of cells to anticancer drugs. for cell suicide,” explains Dr. Darzynkiewicz. “Attempts are also In the late 1960s it was time to head for the U.S. There he being made to force cancer cells to undergo ‘cellular senes held positions at SUNY Buffalo and the Boston Biomedical cence,’ which permanently halts their reproductive capability.” Research Institute before moving on to positions in New York His lab is also studying the mechanisms in normal, non-tumor at Memorial Sloan-Kettering Cancer Center and Cornell cells to understand resistance to DNA damage. The goal is University Graduate School of Medical Sciences, where he the same as it has been for the past three decades: to ease met Dr. Traganos. “I was fascinated—not so much by the the injurious side effects of radiotherapy and chemotherapy by technology as with the biological problems this technology reducing toxicity to healthy cells. could help solve,” he says. In their early work together at Sloan-Kettering, Dr. Darzynkiewicz and Dr. Traganos evalu Speaking with Dr. Darzynkiewicz, one gets the sense that new ated potential chemotherapeutic drugs in vitro, and their work avenues in basic research are closely intertwined rather than today is still in vitro. Dr. Traganos explains that the cell-based disconnected areas of study. In the past his work has integrated
C H I R O N I A N : : New York Medical College : : 05The Darzynkiewicz team is well acquainted with the sophisticated technology that aids in his research. From left are Frank Traganos, Ph.D., M.D./Ph.D. studentElise McKenna, Dr. Darzynkiewicz, Dorota Halicka, M.D., Ph.D., Jiangwei Li, Ph.D., and Jan Kunicki. Not pictured is Hong Zhao, Ph.D.chemotherapy with apoptosis, and now it integrates cancer determine the mechanism of anti-cancer drugs. And manybiology with the process of aging. probes used world ide for detecting different stages of cell w differentiation were developed by his lab, including acridineDr. Darzynkiewicz’s work in DNA damage also spans several orange and BrdU incorporation into nucleic acids. “We are onedecades. He was the first to show that the genetic defect in step ahead because we’ve been developing the technology,”DNA repair in xeroderma pigmentosum can be corrected. And he says.in 2010 he published work on double-stranded breaks and thecarcinogenicity of tobacco smoke. His laboratory also detected The probes used in cytometry can include different molecules,constitutive DNA damage signaling as a consequence of oxi such as fluorescence-tagged antibodies or stains. The antidative metabolism. He explains, “This oxidative DNA damage bodies used as probes can be specific for cell surface procauses DNA replication stress which, when combined with teins or indirectly labeled by a secondary antibody. Regardlesscellular growth driven by the mTOR (mammalian target of of the type of probe, they are important in a variety of researchrapamycin) pathway, is considered to be the major cause of areas and have a greater impact over time as more about theaging and predisposes an individual to cancer.” In addition to role of a particular protein in the cell is understood. Dr.rapamycin, the diabetes medication metformin and vitamin D Darzynkiewicz’s lab includes a cell sorter as well as a four-laserare potential agents for suppressing the mTOR pathway. This scanning cytom ter, both with multiple channels for detecting esuppression could create leaner and healthier cells, a context different types of fluorescence.of aging currently being studied in Dr. Darzynkiewicz’s lab. In terms of sheer lab output, Dr. Darzynkiewicz ranks at theSETTING THE STANDARD top of the fields of cell cycle, flow cytometry and apoptosis.Without flow cytometry and similar techniques “the work He explains that his accomplishments in different areas of cellDr. Darzynkiewicz does would be decades behind,” says biology are due to the development of new methods for probDr. Traganos. His colleague agrees. “Without these tools, our ing individual cells at the molecular level. With these methodsresearch would be impossible,” Dr. Darzynkiewicz admits. cell growth, proliferation, carcinogenesis and response to antiHis current work, supported by a grant from the NIH, aims to tumor treatments can be studied.develop probes to study the DNA damage response and And in this, his thirty-third year of continuous funding,aging processes. He is already credited with developing Zbigniew Darzynkiewicz, M.D., Ph.D., continues to probeprobes identifying individual stages of the cell cycle to cells for answers. ■
06 : : Spring/Summer 2012 Pieces of theCardiovascular PuzzleAn Huang, M.D., Ph.D., studies estrogen, blood flow and bloodpressure, and how they fit together.By Cynthia A. ReadA re you among the one percent? need for better understanding becomes professors, so her interest in medicine The question is not about what even more critical. developed early. But her path was tem you may think it is. It refers to porarily derailed by the harsh reforms of An Huang, M.D., Ph.D., associate profesthe percentage of Americans who enjoy the Chinese Cultural Revolution. At the sor in the Department of Physiology, isideal cardiovascular health, according to time she graduated from high school, studying one aspect of this challenge:a position paper released by the American many students were being forced out of the gender-specific regulation of endoHeart Association last March. The figure cities and effectively exiled to work in thelial function in arterioles, the tinyis actually less than one percent. factories or farms, rather than going to blood vessels that branch out from arter college. In 1977, after these policiesHeart disease is still the leading cause of ies throughout the body. Her research, changed, Huang was among the firstdeath—not only in the U.S., but in every supported by a series of grants from the group of students allowed to enter college.major developed country. The myth that National Institutes of Health, is part of She received her M.D. from Shanghaiit is primarily a man’s problem has also a multi-faceted, multi-department pro Second Medical University in 1982 andbeen debunked. In fact, more women’s gram at the College that pairs basic sci was directed by the government to enterlives are claimed by cardiovascular dis ence and clinical research in a quest to the practice of general surgery.ease than by cancer, chronic respiratory improve the outcomes in diseases thatdisease, Alzheimer’s disease, and acci affect the heart and circulatory system. By the time China began to open to thedents combined. When factoring in outside world in 1990, Dr. Huang had FROM CHINA TO NEW YORKdeaths from stroke, diabetes and other earned an M.S. and a Ph.D. in surgery. The youngest of four children, An Huangdiseases that are related to problems Feeling that she’d advanced in her pro grew up in the People’s Republic ofwith blood flow and blood pressure, the fession as far as she could in her home China. Both of her parents were medical country, she was eager to see what she
C H I R O N I A N : : New York Medical College : : 07might learn elsewhere. Although she was After their daughter Angela was born in Hypertension from overly constrictedstill thinking about pursuing her clinical 1996, Dr. Huang brought her to work blood vessels increases the workloadinterests, she landed a position as a in her bassinet when she was only a on the heart, leading to thickening of theresearch fellow in the Depart ent of m month old so the family research proj heart muscle (myocardial hypertrophy),Physiology in 1992. And, in what she ects could continue. often followed by heart failure. Womencalls “one of the luckiest moments in my have a bigger vasodilator response than GENDER DIFFERENCESlife,” she met the late Gabor Kaley, Ph.D., men and, before menopause, a lower Beginning with her first research projectswho served for 37 years as chairman risk of heart disease. It appears that estro with Drs. Kaley and Sun, along with Akosof the Department of Physiology. “He gen is responsible. When the ovaries Koller, M.D., Ph.D., professor of physioltaught me everything about research,” are removed from experimental animals ogy, Dr. Huang has investigated microcirshe says. “It was my great honor to be such as rats, the females have a reduced culation—the term for the small bloodable to work with Dr. Kaley. It would have dilator response, but if the same females vessels embedded in organs that arebeen impossible for me to become an are given estrogen after ovariectomy, the responsible for the distribution of bloodestablished scientist without him.” dilator response returns. within the organ tissues and for maintainThe College brought Dr. Huang an addi ing blood pressure. The arterioles carry In their initial studies, Dr. Huang and hertional gift: Dong Sun, M.D., who was blood to the capillaries and, like all blood collaborators explored the mechanismsalso a product of the first wave after the vessels, are lined with a thin layer of cells of nitric oxide (NO) in dilating arterioles inCultural Revolution, was then a Ph.D. comprising the endothelium. Among the rats and mice. When synthesized in thestudent under Dr. Kaley. The two came many functions of endothelial cells are endothelium of blood vessels, nitric oxidehalfway around the globe to meet on the controlling the dilation and constriction is also called endothelium-derived relaxValhalla campus, and married in 1994. of the arterioles. ing factor, so named for its ability, when
08 : : Spring/Summer 2012“All the expertise I need is here at NYMC.” Assisting Dr. Huang in her study of gender-specific regulation of endothelial function in arterioles are, from left: Dong Sun, M.D., Ph.D., Hongyan Wu, technician, and Caroline Ojaimi, Ph.D.released from the endothelium, to signal exists, which genes are involved, what somewhat protected from cardiovascuthe surrounding smooth muscle to relax. earlier influences come into play, and lar events. She has also provided signifiThis dilates the vessel and increases how changes in vasodilation, and there cant evidence on the relevancy of theblood flow, therefore decreasing blood fore in the regulation of blood pressure, microcirculation in vascular biology andpressure. The team showed that estro are related to aging associated with medicine.”gen increases the expression and activity menopause. LOOKING AHEADof eNOS, the enzyme that synthesizes NO. “All the expertise I need is here at Dr. Huang thinks that better understandGenetically modified mice that lack the NYMC,” she says. She continues to col ing the mechanisms by which estrogengene to produce eNOS, and therefore laborate with her husband and with regulates the dilation of blood vesselslack nitric oxide, are hypertensive—yet co-investigator Caroline Ojaimi, Ph.D., could lead to improved treatment forstill, female mice have better regulation of assistant professor of physiology. She menopausal women, and her researchblood pressure than males do. also receives support from Edward J. could point to a new therapeutic targetSo Dr. Huang’s next step was to study Messina, Ph.D. ’73, professor, and to improve cardiovascular function wherehow estrogen affects the dilation of Thomas Hintze, Ph.D. ’80, professor and NO is deficient.blood vessels independent of the activity chairman of the Depart ent of Physiology, m That is down the road, however. Forof nitric oxide. She discovered additional as well as other members of the depart now, Dr. Huang relies on a motto ofendothelial mediators were dependent ment. Dr. Messina says, “It has been a sorts: “Be solid at every step,” she says,on cytochrome P450 (CYP). She has pleasure and an honor to watch the “keep going, and never give up.” It hasalso learned that different forms of CYP growth of Dr. Huang as an independent served her well, not only in her years ofare responsible for the release of other investigator. I am impressed with her research at New York Medical Collegevasodilators in rats, mice and humans. research success, which has offered but in the life journey that brought herBecause this sequence seems specific important clues to our understanding more than 7,000 miles from Shanghaito females, Dr. Huang has begun to as to why premenopausal women are to Valhalla. ■explore why these gender difference
2012encement! Our omm C H I R O N I A N : : New York Medical College : : 091 C 2 3 4 7 5 8 6 9 PHOTOS 1: Drs. Alan Kadish, Karl Adler, Edward Halperin, 3: rustee Ronald F. Poe, President Alan Kadish, M.D., T 6: r. Halperin with Rabbi Moshe Krupka. D Francis Belloni, Ralph O’Connell and Robert Amler, Honoree Karl P. Adler, M.D., and Board Chairman 7: ace Bearer, Fredrick Z. Bierman, M.D. M and Mr. David Raab. Dr. Mark Hasten. 8: chool of Medicine graduates capture the excitement S 2: Chancellor and CEO Edward C. Halperin, M.D., M.A., 4: raduates from the Graduate School of Basic G in Carnegie Hall. gives the Commencement address. Medical Sciences. 9: raduates from the School of Health Sciences G 5: rs. Kadish, Hasten and Halperin. D and Practice.
10 : : Spring/Summer 2012Music and MedicineMaking a Menu for Life with }Stephen E. Moshman, M.D., } gives equal time to his main passions.
C H I R O N I A N : : New York Medical College : : 11By Marjorie RobertsT he Department of Medicine is a challenging and exceptional place to work. Many members of the fac ulty were recruited to the Valhalla campus by friendsand colleagues from their previous lives. A case in point isStephen E. Moshman, M.D., who radiates energy, caring and has mentored students who are learning to make critical decisions that will impact how they practice medicine the rest of their lives. “My greatest passions are medicine and music, but I am ardent about a lot of things,” he admits, and he is not exaggerating. The mere mention of baseball, history andcollegiality on a daily basis—weekends included. This not only astronomy causes his eyes to light up and his voice to riseenables him to perform an unusual variety of tasks for his job, in intensity.but also allows him to have a second life filled with music. This You can only wonder how he is able to find the spiritualspring, his dual passions for teaching and music became a wherewithal and physical strength to staff, rehearse and conperfect storm that honored Dr. Moshman for both his roles. He duct the Einstein orchestra in four concerts a year. Ask him,was promoted to Professor of Clinical Medicine, a title he will and this Renaissance man replies, “I can do it because I amcherish in recognition of his 43 years of service to medicine—10 a very happy man.”at the College and Westchester Medical Center (WMC)—andgratification for acknowledgement of his 30th anniversary year BEING HAPPYas founder, composer, and conductor of the Albert Einstein How happy is he? Enough to spar with the colleague whoSymphony Orchestra, serving the Bronx community through recruited him from Einstein and its affiliated Montefiore Hospital:the talents of 60 mostly non-professional musicians with a William H. Frishman, M.D., the Barbara and William Rosenthalconcert agenda each year. Professor and Chairman of Medicine. They were both faculty members at Einstein, where Moshman spent 30 years beforeMedicine inspires him to teach, for Moshman a sacred word coming to the College. They take their sworn allegiance tothat covers everything he does for the young heroes who follow differing New York baseball teams as set in stone, yet theirin his path. As director of the third-year medicine clerkship, he
12 : : Spring/Summer 2012}In both the classroom and the orchestra pit,Stephen Moshman dictates what happens from themoment he walks into the room. }love of the game is reason enough to sustain their friendship. the Adult Primary Care Clinic and his teaching duties in the“Baseball is the only sport. I come alive when pitchers and Pre-Internship Program, formerly called the Fifth Pathway. As tocatchers report for spring training,” says Moshman, a former the variety of situations in which he finds himself, Dr. MoshmanBrooklyn Dodger fan. He is ready to take on another frus expresses his satisfaction with volunteering for unscheduledtrating year as a Met supporter, but he wouldn’t want it any teaching assignments by insisting that, “I have always considother way. ered myself a militant non-specialist. I accept these assign ments with enthusiasm. After all, teaching medicine is 75Robert G. Lerner, M.D., vice chairman of the Department of percent of what I do and I absolutely relish it all.” Dr. FrishmanMedicine at the College and chief of hematology at WMC, concurs: “We go back 40 years. Currently, every July, he andshares Moshman’s double appreciation of teaching and music. I share the welcoming lectures for the new clerkship studentsThe Moshmans and Lerners, who have enjoyed many perfor and we teach together on the wards at WMC. He is also verymances of the Einstein Orchestra, also attend Lincoln Center active in recruiting house staff for Valhalla.”events together. “I have been very impressed with everythinghe’s done,” says Dr. Lerner, although it is Moshman’s work When pre-concert time rolls around, you wouldn’t know fromethic that draws Lerner’s greatest interest and admiration. his disposition that he was stressed. Norma Moshman, who“I got to know him better when he and I began teaching sounds as laid back as the husband she is describing, offerssecond-year students along with his brother, Eliot Moshman, this assessment:[M.D., clinical assistant professor of medicine], an internist in “For the most part he is very relaxed. He doesn’t worry. HeWhite Plains who plays French horn in the orchestra.” may have trepidations about a certain passage the orchestraThere is also Norma Moshman, Stephen’s wife, who is coordi is having trouble with, but in 30 years the orchestra has nevernator for the Internal Medicine Residency Program. Together failed him.” Any changes planned for season 31? “He doesn’tthe Moshmans make up a sort of parents-by-proxy situation, wear tails and the musicians just wear black jackets, althoughwhich makes it seem like there are Moshmans everywhere. at the March concert the orchestra wore what is calledStephen claims he never repeats a task two days in a row, but Broadway Black. Stephen wore a silver tie and they all reallycertain responsibilities are his alone. He teaches “Foundations looked good. Now they are considering wearing Broadwayof Clinical Medicine,” a mandatory course for first- and second- Black all the time.”year students. And there is “Harvey,” a favorite mechanism NATURAL BORN TEACHERthat involves an inventive way to teach, sometimes using musi In both the classroom and the orchestra pit, Stephencal sounds for emphasis. Moshman dictates what happens from the moment he walksAN APPRECIATIVE COLLEAGUE into the room. In between he gets as close as he can byThe Harvey Cardiopulmonary Patient Simulator is a digital life becoming an excellent teacher who, like any good performer,size model of a patient with lots of heart problems, which can makes things exciting. A slew of teaching awards attest to hisbe dialed up at will. Cardiac pathology and proper diagnosis tremendous teaching talents and famous sense of humor. Butare the basic skills that Harvey helps teach to third-year stu can he continue to do everything himself? With the orchestra,dents, pre-internship students, interns and residents. this encompasses making the selections to be played (many are his own compositions), choosing the soloists and evenAmong Dr. Moshman’s other purviews are the residency writing the program notes before he rehearses the musiciansprogram in internal medicine where he is deputy director, and conducts the day of the performance. He has been
C H I R O N I A N : : New York Medical College : : 13immersed in this medical/musical arrangement all his life, past season there were six players from New York Medicaland there is one doctor/musician who has been a part of College; about one-third of the group are medical students,most of it. faculty and house staff, and the rest are from the community. Dr. Moshman believes his is one of the longest running comEtta Eskridge, M.D., Ph.D., now an assistant professor of med munity orchestras in the city, and “certainly, the only medicalicine at the College, was 22 when she met Steve Moshman. school-affiliated orchestra.”Both had earned their undergraduate degrees at the Universityof Rochester; she chose Einstein for medical school while he Dr. Moshman has established that even in his spare time, he isselected the University of Buffalo. She found out he was devoted to the students who are his audience—in and out oflooking for musicians for a new orchestra he was assembling hospital settings. Just as he learned to play the violin from hisand she played the viola, a rare commodity in terms of slots to father, his first teacher who made music such an integral partbe filled. The rest, since 1982 and then some, is history. Four of his upbringing, he makes himself available to those whoyears ago Dr. Moshman recruited her to join Westchester need help—even the ones who come around only when heMedical Center, where she is a hospitalist and director of hosts his annual pool party at his Dobbs Ferry, N.Y., homepalliative care. (which, by the way, was designed by a student of Frank Lloyd Wright). The party is Dr. Moshman’s way of plying his guests“He is like a savant,” she says of Moshman. “He is a walking with art and the finer things in life. He has no ulterior motive forencyclopedia of knowledge, and he writes the best program this gesture, and no message is intended or implied—othernotes ever…He has given all of us an unbelievable gift—the than to enjoy life and art, which are all around us. ■opportunity to play music—and we do a pretty good job.” This
14 : : Spring/Summer 2012Is MEDICINE Readyfor Social Media?Its proponents claim the use of new media in medicine isa boon, causing shifting paradigms, seismic changes, andbetter connections online and off.
C H I R O N I A N : : New York Medical College : : 15By Melissa F. PhetersonT witter, tablets, texting: these are using them for health care purposes, Among the speakers was Kent Bottles, means and methods of social and 44 million health apps were down M.D., who serves as the social media media now surging in popularity. loaded in 2011. Even the prestigious liaison for the Association of AmericanThey are also revolutionizing medical Mayo Clinic in Minnesota has started a Medical Colleges. “Most older medicalpractice and education, including Center for Social Media to train physi educators like myself are ‘digital immiat New York Medical College. From cians in social media strategy. grants’ who still speak the new languagethree-dimensional views of anatomy with an accent,” says Dr. Bottles, a “When I first started to meet with groupsto classroom discussions sparked by Senior Fellow at The Thomas Jefferson about social media in medicine, theirtext-messaging, the wealth of material University School of Populaion Health t eyes were rolling,” recalls Dr. Luks. “Theysummoned by a few finger-taps helps in Philadelphia. “It is the medical stu thought it meant posting what you hadeducators share and receive critical dents who are the digital natives that for dinner or checking in at Starbucks.findings, more fully engages students are really leading the way. I think it’s But as in all professions, the immediacywith the curricula, and helps doctors relevant that the topic was introduced and interactivity of social media helpsbuild stronger connections, online and [to NYMC] at a medical student confer us clinicians humanize our presenceoff, with patients. ence and not by faculty.” and foster our relevance in a world“Why am I on social media? Because that’s increasingly going online. TRANSFORMING MEDICINEI’m social,” says Howard Luks, M.D. ’91. Resources for doctors. Smart phones “They’re talking about us, talking aboutThe associate professor of orthopedic and tablets, equipped with task-specific health,” he declares. “Now it’s up to ussurgery at the College and chief of programs (called “apps”), make a wealth to jump into that conversation. If wesports medicine and arthroscopy at of clinical information and references don’t control our own message, othersWestchester Medical Center likes to readily available on a portable screen. will define who we are.”add, “That means sincere, open, collab Among College faculty, popular appsorative, interested, authentic, and like The College has been doing its part to include Epocrates RX, a mobile drugable.” (He’ll admit the acronym is not join in. In April, the annual Student Physi reference database, Medscape, a medioriginal, but it’s been re-tweeted many cian Awareness Day (SPAD), organized cal reference guide, and Diagnosaurus,times behind his Twitter handle, @hjluks.) by first-year medical students, was a database of diseases and symptoms.Dr. Luks writes several blogs on ortho devoted to exploring “iMedicine: The Resources for patients. Social mediapedic surgery and social media, has Role of Social Media in Medicine,” with is changing the doctor-patient dynamic:5,000 Twitter followers, and offers iPads renowned experts convening to discuss how doctors reach out and what kindsin the exam room with videos to edu how social media is altering the nature of information patients bring into thecate his patients. “Why confine my of patient care, medical education and office or hospital. Apps can help docexpertise to the four walls of my prac community outreach. The event was tors engage with their patients by demtice?” he asks. well-attended, and in social media (or onstrating procedures using 3-D views SoMe) parlance, there was a great dealFor doctors and patients alike, social of anatomy, displaying test results, and of chatter and following activity thatmedia is triggering a paradigm shift in sending text message reminders of nudged the College’s profile a bit higherhealth care. Pew Surveys show that appointments and vaccinations. In in the Twittersphere.17 percent of mobile phone users are between office visits, doctors and
16 : : Spring/Summer 2012 patients can communicate directly via text or Twitter messages, or even brief video messages, the form preferred by more than half of the patients Dr. Luks surveyed. “Email,” he says, “is passé.” Telemedicine, the concept of caring for patients remotely, is also gaining ground. Dr. Bottles cites research predicting that by 2016, three million patients will be moni tored via their smartphones, rather than in hospitals, for chronic conditions like heart disease and diabetes. Social media can empower the patient without imperiling the doctor, stresses Dr. Bottles. “Some patients want to record their interactions during office visits, butPhoto by Susan Woog Wagner many physicians are reluctant to embrace social media because of fears of malprac tice suits,” he says. “And yet, studies have shown that patients retain only 50 percent of what the doctor tells them during an office visit, and half of what the patient does remember is remembered incorrectly.” So instead of fearing the patient who comes in with reams of information printed from the Internet, doctors can seize the chance to guide patients as they search for repu table articles, e-mail information after appointments, or maintain a blog or website with concise answers to common questions. Says Dr. Luks: “Some doctors will shy away from a patient coming in with material they’ve Googled, whereas I’m turning on the iPad, hitting Google, saying ‘There are 600 articles on medicine published every day; let’s see if anything was posted today that’s pertinent to your case.’” Resources for both. Increasing numbers of clinicians and researchers have now launched Twitter accounts, whereby they can issue brief messages called tweets to a group of followers, comprising doctors and patients alike. Tweets might include links to new medical findings, spotlight topics posted by other experts, or offer advice on medical issues or healthy living. More than 1,300 physicians have now registered their Twitter feeds on twitterdoctors.net, and communities are emerging online among doctors (Doximity.com, a social networking site for physicians) and patients (PatientsLikeMe.com, a forum for people with similar health conditions to support and advise each other). BEYOND THE CLASSROOM One morning before class, Daniel Peters, M.D., F.A.C.S., assistant professor of cell biology and anatomy, noticed his students deeply absorbed in their phones. “It was clear that almost everyone was texting away furiously, trying to get out that last mes sage before class started,” Peters says. He also noted these same students hadn’t yet responded to emails he’d sent a few days earlier. “I realized that email was obso lete to them: in their world, it served no purpose and it was too slow and inefficient for real-time needs.” But a text or tweet would pop up instantly on their phones, compelling them to respond. As an experiment, Peters began to send messages to the class via Twitter, posing questions and offering points for reflection to spur critical thinking and discussion among his students. “Twitter allowed me to put ideas in their heads outside of class, when they might be together in some social situation, and use the opportunity to have an open and free discussion,” he says. “I was also trying to show that they always had to be think ing—the thought process does not, and should not, stop as soon as class is out.”
C H I R O N I A N : : New York Medical College : : 17 43.7%IN A FACULTY SURVEY, 85 RESPONDENTS WERE ASKED: 40.2% 34.5%Which social media platform do 33.3%you use: Facebook, Twitter,LinkedIn, YouTube or Google+? 10.3%Among students, the study groups posts Twitter and Facebook updates on American Medical Association hasknown as “journal clubs” now benefit behalf of the College several times per released social media guidelines sugfrom instant access to groundbreaking week. “The institution becomes more gesting that doctors use the maximumnews in medicine, with Twitter alerts real to them, more personal, through privacy settings for each mode of onlineoutpacing the snail’s-paced peer-review social media activity. It’s a way to communication, and consider usingmodel that produces journals. spread news to our students and separate profiles for personal and pro employees about what is happening fessional use. Many hospitals and prac “Physicians and researchers in far-flung here, and offers a window for prospec tices now raise the issue with patientslocations can discuss articles and tive students, parents and alumni to as soon as they check in, presenting aexchange knowledge instantly,” says peer through and see what we’re up to.” contract with waivers or disclaimers.first-year medical student Neil Shah,chair of the committee that organized RED FLAGS “Once I learned about social media, ISPAD. “The flow of information is the In the uncharted waters of social media, realized the user has controls,” saysbiggest way social media has helped new ethical and legal dilemmas can Anthony Sozzo, M.A., M.S.Ed., associimprove academic medicine.” pose unexpected hazards. Should doc ate dean for student affairs, who main tors or professors initiate and accept tains a popular page on student financialFor institutions like New York Medical “friend” requests from patients or stu planning, and who has produced podCollege, social networking sites also dents? What if a patient solicits medical casts and YouTube video clips for, andprovide an opportunity to reach out to advice online that ends up flawed? with, the students. “You can still mainprospective students, current students What if a medical student or resident tain a professional presence on socialand alumni. The Office of Public Rela posts descriptive comments of a clinical media.” That synthesis of clinical exceltions, responsible for the College’s offi experience, inadvertently violating HIPAA lence and social media was among thecial social media presence, is now rules governing patient privacy? These major objectives at SPAD, with a liveencouraging other departments and issues are a “major concern,” says Shah, Twitter feed enhancing discussion andgroups to establish their own presence but doctors, professors and institutions debate even further.in social media, using guidelines posted can protect themselves by educatingon the College’s website. Because of SPAD, the College will gain students and patients about the perils a significant amount of attention, kudos“Curating and sharing information with of social media. “Anyone using social and support,” says Dr. Luks. If it meansan audience of followers on social media,” says Kent Bottles, “needs to dissolving the barriers to communicamedia is a way to engage people, and think about the permanent and public tion, then New York Medical Collegeget them talking with us about some nature of anything on Twitter and has added a few more instruments tothing that is of interest to them,” says Facebook.” Howard Luks emphasizes its black bag. ■Donna Moriarty, M.P.H. ’04, associate that he doesn’t treat patients via socialvice president of communications, who media, only shares information. The
18 : : Spring/Summer 2012 BEYOND SKIN DEEP In learning to treat the skin—the mirror of internal diseases— dermatology residents inject dermatologic care into a host of other specialties.
C H I R O N I A N : : New York Medical College : : 19 experiences she and the other residents gain from treating patients, says Jodi Langer, M.D., who serves as co-chief resi dent with William Rietkerk, M.D. MANY CALLED, FEW CHOSEN Considered among the nation’s best, the New York Medical College dermatology residency program is very competitive. From more than 300 applicants, just three are chosen annu ally. To be selected, says Dr. Safai, a resident “must have an intelligent mind and be able to quickly retrieve and grasp a lot of information.” She or he also must be a clear thinker, a good writer and an effective “people person.” Finally, says Dr. Safai, residents must be able to learn independently and be good team players.By Nelly Edmondson Gupta In fact, the competition for dermatology residency slots has become increasingly stiff nationwide. “When I took over, resiI n 1993, Bijan Safai, M.D., professor of dermatology, took dents were mostly selected from the New York area,” says over as chairman of the Department of Dermatology at Dr. Safai. “Now we get the best applicants from all over New York Medical College in Valhalla. Several years later, the country.”he moved the residency program from Westchester to upper In addition to working with a wide variety of interesting patients,Manhattan’s Metropolitan Hospital Center, a public hospital one of the best things about the NYMC program, say the resiand College affiliate that treats many underserved patients. dents, is the solid grounding in both clinical work and pathology.This move turned out to be a boon for both the residency “One of the things that initially attracted me to NYMC was thisprogram and the patient population it serves. clinical-pathologic correlation,” says first-year resident James“I brought the residency to the patients,” says Dr. Safai. By Highsmith, M.D. In other programs, he explains, residents maythat he means that taking care of a more diverse, inner city learn to read pathology slides, but not necessarily the slidespopulation gives the future dermatologists under his tutelage they themselves have prepared from biopsies. “It’s nice to seean opportunity to treat the full spectrum of clinical diseases. the clinical picture—your patients—and then review their biopsyThe residents care for everything from acne to leprosy to toxic slides under the microscope,” says Dr. Highsmith. “It reallyepidermal necrolysis (TEN), a potentially deadly skin disease helps you learn and remember.”that usually results from a drug reaction. TEACHER, TEACH THYSELFThere are other benefits as well. “One of the great things about Yet another draw for the NYMC program is the fact that allworking at Metropolitan Hospital is that we see patients from dermatology residents have plenty of opportunities to teachvaried ethnicities,” says first-year resident Lavanya Krishnan, as well as learn. Each week the residents complete multipleM.D., one of 10 residents currently enrolled in the College- academic duties, including journal reviews of medical and sursponsored program. Many skin diseases, she explains, pre gical dermatology, Kodachrome sessions (clinical slides usedsent very distinctively in different types of skin. For example, for diagnostic practice), pathology training and book reviewrashes that appear on deeply pigmented skin tend to be more lectures. The residents take turns delivering lectures to theirsubtle or textured. If a doctor isn’t well-versed in these skin peers on topics in the main textbook. In order to answer quesdifferences, making an accurate diagnosis can be especially tions and provide background and context, the designatedchallenging. lecturer must go beyond the text, thereby deepening his or her knowledge base.Residents’ learning touches on the entire spectrum of medicaldermatology, including immunologic diseases of the skin, The dermatology residents also teach medical students andcutaneous lymphomas and sarcomas, drug eruptions, genetic give lectures to other departments. “Medical students have asyndromes affecting the skin, and dermatologic emergencies. limited exposure to dermatologic disease during med school,They also learn how to perform laser surgery, Mohs micro but many other specialties, such as internal medicine andgraphic surgery, blepharoplasty and skin cancer removal. In pediatrics, need significant knowledge about the skin,” explainsshort, they learn it all. “We could write a textbook” with the Richard McCarrick, M.D., vice dean for graduate medical
20 : : Spring/Summer 2012 Dermatology director and department chair Bijan Safai, M.D., above, says the highly competitive program at New York Medical College admits only three new residents per year. Residents Lavanya Krishnan, M.D., and William Rietkerk, M.D., prepare to treat a patient at Metropolitan Hospital Center.education and affiliations. “So they rely on the dermatology been migrating away from primary care and general surgery. Asresidents to build their knowledge of skin diseases.” a recent article in The New York Times noted, dermatology—like plastic surgery and otolaryngology—provides relatively controllaAlthough relatively few patients are admitted to hospitals solely ble hours, autonomy, and improved quality of life, and has thebecause of skin conditions, they may have skin problems in tan added benefit of being the kind of doctor patients actually likedem with other disorders. For example, a psychiatric patient may and want to visit.be admitted in crisis, and a subsequent physical exam reveals arash or severe lesions on his lower back. Having dermatology Second-year resident Kathryn Russell, M.D., says that while sheresidents available for consult enables the psychiatric team to was growing up in Sarasota, Fla., her dermatologist “was theprovide comprehensive care. “There is a tremendous benefit only doctor I enjoyed going to.” Every year, her mother tookto having a derm residency in a hospital that goes far beyond fair-skinned, redheaded Kathryn to a dermatologist for a full-treating patients who present with primary skin problems,” says body skin exam; the Russells have a family history of skin canDr. McCarrick. “Throughout the hospital, having derm residents cer and Kathryn is at increased risk. Instead of dreading theseand attendings is clinically and educationally very helpful.” medical visits, she actually looked forward to learning about her skin, hair and nails during her examinations. DermatologyThe residents truly must learn to master the art of diagnosis in “is a very fulfilling field because patients really appreciate you,”order to recognize underlying systemic conditions. In fact, the she says. “You treat them, and they look better—and feel betresidents and their supervising attending physicians provide der ter about themselves.”matologic consultation for all inpatient services and ambulatorycare programs. They have to know the basics of internal medi HAVING SKIN IN THE GAMEcine, pediatrics, neurology, surgery and psychiatry to be able to “There’s a whole list of reasons to go into dermatology,” sayscompetently integrate dermatologic care into all of these fields. second-year resident Robert Lott, M.D. He points out that research in the field of cutaneous immunology and molecularIT’S NATIONAL AND PERSONAL biology of skin is moving at a rapid pace. “As a result, we areIndeed, dermatology has been getting more respect from all developing a better understanding of the immunologic andquarters lately, and is now the most competitive specialty. In molecular pathogenesis of skin disease leading to optimizedrecent years, many American medical school graduates have diagnosis, management and treatment of patients,” he says.
C H I R O N I A N : : New York Medical College : : 21These new developments are helping researchers create used for growing hair and curing some of the blistering dis“designer drugs” for the treatment of skin-related autoimmune eases of childhood, and skin manifestations of graft vs. hostdiseases, like psoriasis. “Many systems collide in the skin,” disease, a serious condition that can develop after bonenotes co-chief resident Langer. “The skin is a mirror of internal marrow transplantation.diseases, with sequelae from immunologic, neurologic, infec “Dermatology is a rapidly evolving field, and cutting-edge intious, endocrine and neoplastic processes.” This “collision” terms of new technology,” adds Dr. McCarrick. “Dermatologistsis evident in many systemic diseases, such as lupus, some are in great demand, and there’s a shortage in many parts ofcancers, hypercholesterolemia and liver disease, which often the country.”show up first on the skin. In other words, adds Dr. Langer,“The research we’re doing on skin may have greater applica Drs. McCarrick and Safai believe this group of residents willtions beyond the skin.” become experts and leaders in the field. Every year, says Dr. Safai, he continues to be pleasantly surprised. “Our derEach year, every NYMC dermatology resident must undertake matology residents are committed and diligent, and they arean intensive research project. This year, they are studying here to learn. They study hard, help each other and work wella broad array of topics, including polymorphisms of non- as a team.” ■melanoma skin cancers, skin stem cells, which can beResidents gather weekly for peer-teaching sessions. Clockwise from the presenter, Pantea Hashemi, M.D., are Jodi Langer, M.D.; David Weinstein, M.D.; JenniferLeininger, M.D.; Lavanya Krishnan, M.D.; Robert Lott, M.D.; William Rietkerk, M.D.; Jennifer Vickers, M.D.; Kathryn Russell, M.D.; and Bijan Safai, M.D., professorand chairman. Not pictured is resident James Highsmith, M.D. • A REAL HONOR In February, Dr. Safai was elected president of the Physician Affiliate Group of New York (PAGNY), made up of more than 2,500 phy icians s and health care professionals who provide services to the half dozen hospitals that comprise the New York City Health and Hospitals Corporation (HHC), the largest public health system in the U.S. “It is quite an honor for me to be trusted by my colleagues and elected as president of such an important organization,” Dr. Safai says.
C H I R O N I A N : : New York Medical College : : 23John Nunez,Izuchukwu Ibeand Andrea Love:Student AthletesCompete to StayMentally and John Nun ezPhysically FitBy Andrea Kott, M.P.H.T he biggest disconnect in pre JOHN NUNEZ, SOCCER “I’m playing at a higher level than I ever paring for a career in the health School of Health Sciences and thought I’d play,” says Nunez, who now sciences may be how unhealthy Practice competes among world class players.the journey can be. Too little sleep, too As John Nunez tells it, two things saved His level of commitment might seemmuch fast food and not enough exercise him during his first semester as a doc incompatible with doctoral studies.are the pillars of life for medical students toral candidate in physical therapy: the Indeed, Nunez says some classmatesand graduate students. That is, unless camaraderie of classmates and playing scratch their heads when he closes histhey are so committed to fitness that semi-pro soccer. “It was the hardest books and leaves for practice. Yet fortheir success depends on it. academic semester of my life,” the this 27-year-old, who is both exuberant second-year PT student says, recalling and calm, there is no choice. In the firstJohn Nunez, Izuchukwu Ibe and Andrea a schedule that included neuro cience, s place, playing soccer keeps him acaLove are such fitness-philes. They don’t physiology and exercise science. Then, demically focused. “It keeps you on topjog or take the occasional Zumba class. two months before school started, he of your school work,” he says. Second,They train for marathons, compete in was invited to try out for the Cosmo being fit is critical for physical therapists,semi-pro soccer tournaments and prac politan League—the Cadillac of amateur who often must lift patients heavier thantice black belt judo. They would no soccer leagues. It was a fantasy come themselves and are uniquely positionedmore miss a workout than they would true for the lifelong soccer player, who to inspire patients toward greater levelscut a class, clinic or lab. had always dreamed of playing college- of health. “As a medical professional, level soccer (he played Division 1 at you should demonstrate fitness and College of the Holy Cross) or going good health to patients,” Nunez says. into medicine.