tufts doctors game day - tufts university school of...

MAGA ZINE OF THE TuF Ts uN IvErsIT y MEd IcAl ANd sAcklEr AluMNI AssOcIAT IONs s p r i n g 2 0 1 1 V O L . 7 0 ns p r i n g 2 0 1 1 V O L . 7 0 n O . 1O . 1

GAME DAY

Tufts doctorsgo to high school

MEDicinE

pLUs:pLUs: a cLinic in india nn eThicaL deba Tes nn OUr bir Thing piOneer

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CavemanCavemanImagine entering a newfound cave. First you stand upright, ducking easily t hrough the rocky, t rickling, moss-walled space. T hen you hunch over, s till advancing, but more warily. Watch your head! Next you drop to your hands and knees. Finally you squeeze though an opening the size of a computer screen, one arm stretched out in front of you, one behind. Welcome to the dim, jagged under-world where Keluo Yao, ’ 13, f inds his peace. “ I’m claustrophilic,” he says happily. “ I like t ight spaces.”

Don’t call this guy a s pelunker—that’s a t ag reserved for half-cocked

weekend adventurers. “ Caver” is the proper term. “ It’s cavers who rescue spelunkers,” Yao explains.

In college, Yao went on a t rip with the Syracuse University Outing Club, a novice wearing street clothes. The organizers c lapped a helmet on his head, gave him a c arbide lamp and coveralls and led him into the murky depths. He took to it. Because the region has plenty of limestone and water, upstate New York is rife with caves. “ I caved a lot in Schoharie County,” s ays Yao, who estimates he has explored as many as 200 caves altogether, including some in Georgia,

where Fern Cave, t he country’s second deepest, offers a 4 00-foot shaft, and Utah, where the caves feature rattle-snakes. Last fall, Yao led a caving trip to New York for a clutch of fellow enthusiasts from the medical school.

Mice, spiders, bats and blind fish aren’t everybody’s cup of tea. But Yao, a romantic, loves what awaits him underground. “ I love it because it’s a different world down there,” he says. “The dazzling sound of water under your feet, the reflection of light from your headlamp bouncing off the ceiling. It’s so serene, it’s like meditation.”

—bruce morgan

photo: steven vote

v i ta l s i g n s

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SS p rp r I N G 2 0 1 1 I N G 2 0 1 1 vv O L U MO L U M e 7 0 N Oe 7 0 N O . 1. 1contentsfeatures

8 LocalHeroInspired by what he saw in France, Philip Sumner, ’55, brought the birthing room to America.

10 HopeforAshokA student helps unravel an epidemic of chronic kidney disease in India. by Lucy Horton, M.D./M.P.H., ’12

14 ToBetterSocietyMeet geneticist Anthony Monaco, the next president of Tufts University. by Taylor McNeil

C O v e r S T O r Y

18 HomeTeamDoctors and students from Tufts have taken athletes at a local high school under their wing, and everyone is coming out on top. by Bruce Morgan

24 TheManWhoDidtheMathJohn Ioannidis uses statistics to refute much of what our medical journals have to say. by Taylor McNeil

departments

2 LeTTerS

3 FroMTHeDeAn

4 puLSea S C a N O F p e O p L e & e v e N T S

28 onCAMpuS M e D I C a L S C H O O L N e W S

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34 BeyonDBounDArieS p r O v I D I N G T H e M e a N S F O r e x C e L L e N C e

36 ALuMnineWS

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Cover photograph by a lonso Nichols

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medicine

l e t t e r s

v o l u m e 7 0 n o . 1 s p r i n g 2 0 1 1v o l u m e 7 0 n o . 1 s p r i n g 2 0 1 1

mmedical eedical editor ditor John K. Erban, ’81

editoreditorBruce Morgan

eeditorial Director ditorial Director Karen Bailey

Design Director Design Director Margot Grisar

DesignerDesignerBetsy Hayes

Contributing Writers Contributing Writers Lucy Horton, M.D./M.P.H., ’12 Taylor McNeil, Jacqueline Mitchell Helene Ragovin, Mark Sullivan

Alumni Association pAlumni Association p resident resident David S. Rosenthal, ’63

vv ice pice p resident resident Laurence S. Bailen, ’93

mmedical sedical s chool Dean chool Dean Harris Berman

eexecutive C ouncil xecutive C ouncil Joseph Abate, ’62, Carole E. Allen, ’71 Mark Aranson, ’78, Fred G. Arrigg, ’47 Paul G. Arrigg, ’82, Kenneth E. Blotner, ’64 Alphonse F. Calvanese, ’78, Stephen J. Camer, ’65, Gena Ruth Carter, ’87, Do Wing Chan, ’01, Bartley C. Cilento, Jr., ’87, Eric R. Cohen, ’86, Paul D. D’Ambrosio, ’88, Ronald W. Dunlap, ’73, John K. Erban, ’81, Jane H. Fay, ’84, William H. Goodman, ’89, Charles Glassman, ’73, Brian M. Golden, ’65, Donna B. Harkness, ’79, Thomas R. Hedges, ’75 Frederic F. Little, ’93, Kathleen M. Marc, ’80 Peter D. Martelly, ’83, Brendan McCarthy, ’97, Tejas S. Mehta, ’ 92, Louis Reines, ’05 Karen Reuter, ’74, Laura K. Snydman, ’04 Paul J. Sorgi, ’81, Elliott W. Strong, ’52 Gerard A. Sweeney, ’67, Jack J. Tsai, ’06

Tufts Medicine is published three times a year by the Tufts University School of Medicine, Tufts Medical Alumni Association and Tufts University Office of Publications. Send correspondence to Bruce Morgan, Editor, Tufts Medicine, 136 Harrison Avenue, Boston, MA 02111 or e-mail [email protected]. The medical school’s website is www.tufts.edu/med.

2 t u f ts m e d i c i n e s p r i n g 2 0 11

Tufts p rints g reen printed on 25% post-consumer waste recycled paper. p lease recycle.

PHOTO: KELviN MA

match Day this spring found Dorian Jones, ’11, delighted with the news

he got. o ut of a class of 177 students, 29 percent got residency placements

in massachusetts, 23 percent will head to n ew York and 12 percent are

bound for California. The magazine will include a complete list of residency

placements with its commencement coverage in our next issue.

TAl k To u sTufts Medicine welcomes

letters, concerns and

suggestions from all its

readers. Address your

correspondence, which

may be edited for space, to

Bruce morgan, editor, Tufts

Medicine, Tufts u niversity

o ffice of publications, 136

Harrison Ave., Boston, mA

02111. You can also fax us

at 617.636.4075 or e-mail

[email protected].

what the — no way!

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f r o m t h e d e a n

The governing idea behind these initiatives is to think in fresh ways about the options that can help us thrive.

No medical school can prosper without the full engagement of its faculty. That’s a given. Accordingly, in mid-January, we held a half-day symposium at which we asked our faculty to participate in brainstorming ideas for additional academic initiatives. Some 100 faculty members joined us in a fruitful give-and-take adroitly moderated by John Brodeur, a member of our board of overseers.

Together, we generated dozens of ideas that were recommended for further explora-tion. Faculty suggested we explore initiatives in areas such as allied health and geriatrics, as well as partnerships with business and industry. They wondered if the well-recog-nized excellence of our computerized cur-riculum management program TUSK might find a market in nations where access to such resources is limited. Distance-learning modalities were another strong area of inter-est, particularly for certificate programs.

Faculty members I spoke with that day, and since, have told me they loved the chance to contribute their ideas and be heard in this way. The symposium was a model of coop-eration that I hope to replicate in the future.

Our current challenges are not going away anytime soon—that much is clear. But I am heartened by the winning spirit of the people around me. Faculty, staff and students understand that whatever the chal-lenge, we at the medical school know how to meet it, and we are doing so.

like many other u.s. medical schools, tufts

has benefited financially from an infusion

of federal research money over the past two

years—a boost in the level of NIH grants that

was provided to us as part of the stimulus pack-

age. The extra funding has been great while

it lasted. Last year, in fact, for the first time

since 2003, the medical school showed a small

surplus on its operating statement. But the

boon was always meant to be temporary, and we knew that. By 2012,

NIH funding will tighten up, and we will once again be forced to deal

with the underlying problems that have not gone away in the interim.

There’s a need for creativity—and we are taking that responsibility seriously. Our strategy for the near future is clear. We will focus on providing more finan-cial aid to students as well as continuing to renovate lab space to enable us to obtain more research funding; making timely, well-considered faculty hires when appropriate; launching new academic programs to generate additional income and laying an ever more secure foundation for initiatives yet to come.

Student debt remains our biggest problem. It may seem unbelievable to many of our graduates, especially those from earlier years, but 85 percent of our students leave Tufts with an average debt of more than $200,000. Such high debt levels are common at medical schools across the country, of course, but Tufts has consistently been near the top in national rankings of student indebtedness over the past decade or more. Therefore, reducing student debt is a top priority. Our short-term goal is to provide quarter-tuition scholarships for one-fourth of the entering class.

Facility renovations are likewise an ongoing concern. Everyone who has visited campus recently has seen the wonderful transformation that has taken place in our teaching facilities following the renovation of the Sackler building into a student center. What is hidden behind the façade of the M&V, Stearns and Arnold buildings, though, is a vast amount of outdated laboratory space that needs to be gutted and rebuilt to bring it up to standards appropriate for top-notch researchers. Our immediate plans are to build out three floors of shell space in Arnold to create a new, state-of-the-art home for microbiology.

By launching a number of new academic programs, we expect to generate additional revenue to help pay for such moves. We are already far along in plan-ning a two-year physician assistant program, for example. We are also consider-ing a slight expansion of our successful M.S. program in biomedical sciences, which helps promising students make successful transitions to medical school.

Creating Our Future

s p r i n g 2 0 11 t u f ts m e d i c i n e 3

harris berman, m.d.

PHOTO: ALONSO NiCHOLS

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illustration: jon cannell4 t u f ts m e d i c i n e s p r i n g 2 0 11

pulsea scan of people & eventsa scan of people & events

Genetics Road TripPediatrician’s travelogue to document locales that put DNA on the map by Jacqueline Mitchell

n a hawaiian delicatessen in the 1970s, two scientists scribblingon a napkin hatched an idea that opened the door to modern biotechnol-ogy. That may sound like an episode of the TV series Lost, but it’s the real story of how the genetics researchers Herbert Boyer and Stanley Cohen

discovered a way to produce specific strands of DNA in large quantities—the basis of genetic engineering.

Diana Bianchi, a professor of pediatrics at Tufts, wanted to find that deli. A geneticist by profession and history buff by avocation, Bianchi has made dozens of pilgrimages to sites where genetics history took place. Now she’s compiling her experiences into a book (the working title is A Travel Guide to the History of

Genetics and Genomics) that will take read-ers from Darwin’s home in England to that Honolulu deli, among other locales.

“I originally conceived the book as a cut-and-dried travel guide,” she says, “but I found along the way it became instead a per-sonal travelogue and a telling of the stories behind the discoveries.”

Bianchi first thought of writing the guide in 1990, when she had the chance to visit the

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gardens where Gregor Mendel discovered the rules of inheritance by cross-breeding pea plants with different physical characteristics and charting those traits through subsequent generations. A scholar and Augustinian monk, Mendel lived in St. Thomas’s Abbey in Brno, about 130 miles outside of Prague in the Czech Republic.

“I just had this epiphany being in this church where Mendel had worked,” says Bianchi of the inspiration for her book, which, she notes, occurred before the Internet took off. “I thought, ‘How many people even know how to get here?’ ”

Visiting the abbey, where you can still lis-ten to the monks chanting, left Bianchi with a much better understanding of Mendel’s life and work. Though St. Thomas is in the middle of a bustling town, Bianchi had imag-ined a bigger building in a rural setting. “The garden was very small, maybe 10 by 12 feet,” she says. “To think about all the discoveries that came out of this fairly small plot.”

No history of genetic breakthroughs would be complete without a trip to Charles Darwin’s home, which is now a national historic site and museum in rural Kent, in southeast England. Bianchi visited Down House last fall. Still evident was the circular dirt path that Darwin walked while working out the theory of evolution.

Bianchi, who is the Natalie V. Zucker Professor of Pediatrics, Obstetrics and Gynecology and vice chair for research in the Department of Pediatrics at the Floating Hospital for Children, does research at the leading edge of genetics. She recently completed the second edition of the award-winning textbook, Fetology: Diagnosis and Management of the Fetal Patient. In 2004, she and her colleagues discovered that fetal cells remain in the mother’s blood and tissue for decades after the child’s birth and could be a source of stem cells to repair tissue injury in the mother.

Still, Bianchi loves artifacts from the past. “I’m interested in the very old and the very new. What ties it together are the stories behind the object.”

Seven years ago, the Floating Hospital for Children was fighting for

its life, losing patients and money— roughly $1 million a month—

and facing possible closure as it struggled for a niche in the

crowded Boston marketplace.

All that has changed. The number of patients checking into the

117-year-old institution has risen 27 percent in the past three years.

Admission grew from 2,976 patients in 2008 to 3,766 last year. In

addition, 35 impressive new doctors have taken staff positions at

the hospital, and cooperative agreements with six community

hospitals to help run neonatal and pediatric units are in the works.

The secret has been the Floating’s ability to charge thousands

less per case than its competitors while maintaining high quality,

hospital officials say. Ellen Zane, chief executive of Tufts Medical

Center, which includes the Floating, has managed to position the

smaller hospital as a first-rate, lower-cost alternative in a time of

intense focus on price, driven by state and federal governments,

insurers, health providers and employers.

The Floating Rises

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p u l s e

6 t u f ts m e d i c i n e s p r i n g 2 0 11 illustration: jon cannell; bottom Photo: melody ko

new cell phone and web-based application isgiving Bostonians a window into the healthiness of their neighborhoods. Using data from the Boston Public Health Commission, the Wellness Trail provides health

statistics for 12 city neighborhoods, comparing morbidity rates for asthma, diabetes, high blood pressure and heart disease.

The Tufts Clinical and Translational Science Institute (CTSI) launched the app in January in conjunction with an exhibit on race at the Museum of Science. “It’s a great starting point for discussion,” says June Wasser, CTSI’s administrative director. “It compares the [neighborhood] rates of those diseases with Boston overall, and it will relate them to your environment.”

The app’s goal is to show that while good health is influenced by race, age, genetics and personal behaviors, it’s also a function of where you live. Areas with high asthma rates, for example, also have very busy surface roads, according to Wasser. In addition to potentially worsening asthma, pollutants from roadways can increase residents’ risk of heart disease.

A spirit of activism underlies the app. In addition to providing background data, the Wellness Trail also encourages users to take action to resolve neighborhood health problems. To see the app in action, go to wellnesstrail.tuftsctsi.org.

in the limelightThe GPS of Sickness and Health

Abraham L. ( Linc) Sonenshein, professor and interim

chair of the Department of Molecular Biology and

Microbiology, has been named a fellow of the American

Association for the Advancement of Science (AAAS) .

Election as a fellow is an honor bestowed upon an

AAAS member by his or her peers.

Sonenshein was recognized for his

contributions to the understand-

ing of gene regulation, sporulation

and pathogenesis in gram-positive

bacteria at the Forum, held dur-

ing the AAAS annual meeting in

Washington, D.C., in February. The scientist’s work

includes studying the conditions that promote germina-

tion of Clostridium difficile spores in the intestinal tract,

an antibiotic-resistant “superbug” that causes severe

diarrhea and sometimes death in patients. He is currently

developing a heat-stable vaccine for use in Third World

countries ( see story, p. 30) .

founding deanhal jenson, professor of pediatrics and dean and chief academic officer of baystate medical center since 2005, has been named the founding dean of a new medical

school at Western michigan university in kalamazoo, mich. the school is still in the formative stages and is scheduled to open in fall 2013 with 40 to 50 students.

“you have to have a bit of entrepreneurial spirit to become a founding dean,” jenson told a michigan reporter. “i’m looking for-ward to the opportunity to leapfrog

other schools because they are stuck in their traditions, and education is really changing.”

originally from utah, where he earned his undergradu-ate and master’s degrees at brigham young university, jenson has been practicing medicine for some 30 years. he earned his medical degree from George Washington university and has conducted extensive research on vi-ruses. jenson also hold an m.b.a. from the university of texas at austin.

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s p r i n g 2 0 11 t u f ts m e d i c i n e 7Photos: toP, istockPhoto; bottom, jim daniels/jackson laboratory

Training Partners

namibia’s only medical school forges working relationship with tufts

The first medical school in the African nation of Namibia, which opened in 2010 with 54 students, has signed an agreement with Tufts Medical School to deepen cooperation between the two institutions. Steven Hong, a clini-cal instructor at Tufts Medical Center, represented Tufts at a ceremony at the University of Namibia School of Medicine in Windhoek, the country’s capital.

Experts from both schools will collaborate on research on diseases of importance for Namibia, located on the southwest coast of Africa, withan eye toward prevention as well as cost-effective treatments. In addition, Tufts faculty will travel to Namibia and Namibian medical students will spend up to six weeks at Tufts to learn about practicing medicine in a developed economy.

“We are optimistic that this will strengthen our capacity to train doc-tors through staff exchange,” says Peter Nyarango, the founding dean of the University of Namibia School of Medicine. “Under this agreement, senior faculty staff from Tufts will come to Namibia to teach students and provide clinical services at the teaching hospi-tals. Our staff will get an opportunity to go to Tufts to train in specialized areas of health care and teaching.”

As part of the collaboration, Logan Jerger, ’12, has been deployed to Africa, where he is helping collect information that could assist Namibia in meeting its challenge of preventing HIV/AIDS, which affects more than 17 percent of adults ages 15 to 49 and is the leading cause of death in the country, according to the Namibian Ministry of Haealth and Social Services. Jerger has joined with Namibian medical students to gather data on the effective use of anti-retrovi-ral therapy to improve outcomes.

a newly struck partnership between the jackson laboratories in bar harbor, maine, and the sackler school of Graduate biomedical sciences will offer its doctoral students a one-of-a-kind learning and training opportunity, divided between urban and coastal settings.

students enrolled in the “mammalian Genetics at jaX” program will be able to take advantage of courses taught by faculty at the sackler school and jackson laboratory and participate in lab rotations at both sites. in july, the first batch of students on the jaX track will begin their summer experience of coursework and research in maine before transferring their efforts to boston in the fall. dissertation research at bar harbor is scheduled in the second year.

“combining our institutional strengths with tufts’ provides unparalleled opportunities to leverage mouse models to investigate human biology and disease,” says mary ann handel, co-director of the cooperative Predoctoral training Program and a senior scientist at jackson. the flexible track will allow students to complete required courses and training “while taking advantage of the best of each institution,” she notes.

With more than 1,200 employees and an annual operating budget of $166 million, the jackson laboratory in bar harbor is an independent, nonprofit organization focused on mammalian genetics research to advance human health. the other co-director of the jaX program is erik selsing, director of the graduate program in genetics at sackler.

when it comes to our own health, weall worry about what ailments might strike us down the line. Will we get cancer and die at age 57? Or will we contract Alzheimer’s and have to deal with the implications of dementia when we’re 72?

Knowing the medica l future could be valuable, and something that a major-ity of people would choose if given the option, accord-ing to a recent online survey conducted at Tufts Medical Center. The survey gave 1,463 people the chance to take a new blood test and find out if they were going to get a variety of diseases—Alzheimer’s, breast cancer, prostate cancer or arthritis. Test accuracy could be imper-fect or perfect. Respondents were told they would have to pay for the test out-of-pocket, and they wouldn’t be able to prevent any of the diseases they were predicted to get. Given that, would they take the test, and how much would they be willing to pay?

Across all scenarios, the majority of people said they would be tested. Responses ranged from 70.4 percent for an imperfect test for Alzheimer’s to 88 percent for a per-

fectly accurate prostate can-cer test. People were generally willing to pay on a scale, from $320 for an imperfect arthri-tis test to $622 for a perfect prostate cancer test.

Respondents who didn’t want even a free test were more likely to be older, female, to have a bachelor’s degree or higher and to engage in risk-reducing behaviors such as shunning cigarettes and using

seat belts regularly.While the scenarios in the survey were

hypothetical, predictive tests for many diseases are not far off, according to Peter Neumann, the study’s lead author, who is a professor of medicine and director of the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center.

The study appeared in Health Economics.

GaminG the future

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philip sumner, ’55, had two traits that would servehim well—he was tough-minded, and he was a sales-man. The toughness came from serving as an 18-year-old machine gunner under Gen. George Patton in World War II. The salesmanship was always there.

Sumner, now 85, occupied the hinge of an American cultural shift, both within his field and on a larger scale.

Q: As an obstetrician/gynecologist, how would you describe your field in the early 1960s?Remember that the Baby Boom came along in the late 1940s and 1950s. In order to handle all those babies effi-ciently, the medical community adopted a policy that was organized like Henry Ford’s assembly line. Women were medicated. The mother was totally unconscious when she delivered, and the father was out in the waiting room or at the local tavern having a couple of beers.

Q: When did you first see another approach?In the middle of the 1960s I had been in practice only about five or six years. Since I had been to a French uni-versity for four months [at the end of World War II] and had a friend there, I decided to go to Paris to see what this Lamaze method was that I had been hearing about. This was 1967.

Well, I went to the Lamaze Clinic, and I was thunder-struck by what I saw. It was a revelation. I saw women in advanced labor, and at no point did they ever lose control of themselves. They were working hard, but they were not fearful. I talked with the women, and they smiled and talked with me.

The essential elements of the program were not only the birthing bed, where the mother could both labor and deliver, but the verbal support she got from the nurse and her husband, and from the doctor. It was a team effort, which was a beautiful thing to watch. I had to debate whether I would try and introduce this to the U.S., because I knew I would encounter significant resistance. Finally, I decided I would give my full weight and devotion to the concept and let the chips fall where they may.

Q: What response did you find back at your home hospital in Connecticut?My colleagues were all opposed to what I was attempting to do. When I got home, I told my partner what I had seen, and he was very skeptical. I informed the hospi-tal administrator that I needed a birthing room and a French labor and delivery bed. There was no such thing in America—they weren’t even thinking about it.

We raised the money to buy the bed, which cost about $5,000, from the French manufacturer. In April 1969 we christened it at Manchester Memorial Hospital as part of the first birthing room in America. The room was suc-cessful from the moment it opened.

Q: Did you try to spread the word nationally?I did. I published on the topic, and I spoke at confer-ences all over. For example, there was an annual ob/gyn conference, and I had a booth there, with pictures docu-menting the appropriateness and validity of the birthing room. The doctors ridiculed me as they went by. They saw me basically as a pain in the neck. To this day, I have not received a single word from the American College of Obstetricians and Gynecologists to recognize the fact that I introduced a change into obstetrics that is now standard throughout the country.

Q: How satisfied are you with the current birthing room movement?One of the major problems that we’re running into is that within the birthing room environment, all these medi-cal procedures continue to interfere with the normal progress of labor. First, the mother is horizontal, when she should be vertical. Then she’s got all these medical devices on her—fetal monitors, epidural catheters on her back, blood pressure cuffs…

Q: Are you saying that even in hospitals that have birthing rooms, there’s still a lot of intrusive medical paraphernalia?Exactly. That’s a big problem today. TM


by b r u c e m o r g a n

p h oto g r a p h by pat r i c k m cn a m a r a

PioneerBirthing Room

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Philip Sumner, ’55

l o c a l h e r o

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dhayavusaidhe vukkaarungu,” i say in tamil, greeting the mother and child standing in the doorway. The mother is dressed

in an orange-and-gold sari; she has numerous bangles jingling on her forearms. Her long hair is pulled into a braid, and she has a red bindi on her forehead. Her son, Ashok, is dressed in his school uniform: navy shorts and a blue-and-white pinstriped dress shirt. He wears thick black socks and shoes and carries a backpack and a plastic basket with his tiffin, a stack of small metal boxes that hold his lunch.

“Vanga!

Above, outside the emergency room at Christian Medical College. Top right, a street scene in Vellore. Bottom right, hand-rolled

cigarettes drying in the sun. Near right, the author with translator Thara Hariharan in the home of a study participant.


forforAshokAshok

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by Lucy Horton, M.D./M.P.H. , ’ 12by Lucy Horton, M.D./M.P.H. , ’ 12

In Vellore, India, we’re In Vellore, India, we’re working to unravel an epidemic working to unravel an epidemic of chronic kidney diseaseof chronic kidney disease

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After recording his ID code and getting con-sent from his mother, I roll up the boy’s sleeves and take his blood pressure. “Asay-a-day,” I say to him, “No moving.” I try to ignore the noises from outside—children’s voices, loud honks from motorbikes and the occasional grunt from a bull or goat—as I carefully listen for the first and last Korotkoff sounds. Later I will calculate the blood pressure percentile based on Ashok’s height, age and gender.

For the past three months, I’ve spent each afternoon at a clinic on the outskirts of Vellore, India, investigating the alarming rate of chronic kidney disease that is affecting very young children. I am working through the Christian Medical College (CMC), where I am spending this year as a Fogarty International Clinical Research Scholar. Tufts has had a long affiliation with CMC, and there have been many research collaborations, in addition to a training and education partnership through the Department of Public Health and Community Medicine at Tufts Medical School.

In addition to CMC’s main 2,000-bed hospi-tal, which sprawls across a city block, there are several low-cost hospitals and clinics through-out the Vellore area that serve the region’s poor communities. I am based at the R.N. Palayam Clinic, roughly five miles from the hospital. A small facility with two main rooms and a basic laboratory, it sits on a dirt road, nestled between a butcher’s shop and a tea stall. The clinic was founded about a decade ago to treat children participating in CMC epidemiological research in enteric infections in infancy and childhood. In addition to providing basic medical care to children in the community, the clinic also serves as a hub for ongoing studies, including the scope of the transmission of the cryptosporidium parasite, which causes severe diarrhea, and the effectiveness of probiotics as a treatment for diarrhea.

Vellore, a small city in southern India, is described in guide books as a “dusty bazaar town.” While Indians consider it small, proportions here are of a different scale than we are used to in the United States: Vellore has a population of 1.3 million, making it about the size of San Diego. The local population is split between Tamil-speaking Hindus and Urdu-speaking Muslims. At least among the women, an individual’s ethnic and religious group can usually be determined by how they dress: Muslim women wear all black and head scarves, while Hindu women wear colorful saris. Men of both religions dress more Western, in trousers and short-sleeve buttoned shirts, but the Muslim men sometimes wear a taquiyah, or knit cap.

Jobs are few. The primary occupation is making beedis, thin, hand-rolled cigarettes made from tobacco flakes and a tengu leaf. Women sit in doorways cradling wicker baskets on their laps, rapidly rolling the beedis with precision while chatting and often

holding a baby across a shoulder or around their waist. The men trim the leaves and then densely pack the finished cigarettes into wooden boxes to dry in the sun. The cigarettes are shipped by train to New Delhi and sold, producing a large portion of local income.

Living WeLL into AduLthoodAlthough the neighborhood around the clinic may not look like much, the children who live here have been the focus of almost a decade of cutting-edge epidemiological research, with stud-ies funded by the National Institutes of Health, Wellcome Trust and the Bill & Melinda Gates Foundation. The group of children I work with on the kidney disease study have been followed by CMC researchers from birth until age three for studies on childhood infections and their health implications later in life. Much as the Framingham Heart Study was able to show what risk factors led to chronic cardiac disease, it is our hope that by following this group of children as they grow into adulthood, we can determine the long-term effects of the diarrheal illnesses that are extremely prevalent in Indian children.

Patience is required. After gathering the initial data when our sub-jects are small, we wait six years before we check in with them again at age nine. Most have little memory of being studied as babies, but evi-dence of their participation remains readily accessible. Their mothers have carefully preserved the paper cards that contain basic information

Although the neighborhood around the clinic may not look like much,

the children who live herehave been the focus of almost

a decade of cutting-edge epidemiological research.

photos page 10 and 11: top left and right, lucy horton; bottom left: m. thiyagarajan; bottom right, Kathleen horton

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about their birth history, clinic visits and immunizations.In India, it is the patient’s responsibility to provide personal health

history, and in my experience, patients are generally good about that. Ashok’s mother carries his card neatly tucked into the folds of her sari. She proudly offers it to me.

Since September I have been screening visitors to the Palayam clinic to record blood pressure and obtain urine samples to look for evidence of kidney damage. By linking broad epidemiological data with detailed microbiology, we hope to uncover some clues about which gastrointestinal infections may be risk factors for long-term chronic kidney problems.

Ours are critical data to collect because India is experiencing an epidemic of chronic kidney disease (CKD). Although the precise prevalence is not known, a few observational studies have made esti-mates of about 0.7 percent of the population, or about 9.4 million people. However, this is probably a gross underestimate: for every patient diagnosed with full-blown CKD, there are dozens of others with preclinical stages of the disease. Patients here tend to present with kidney failure at a young age, and in many cases, the kidneys are so shrunken and damaged that it is impossible to identify the cause of the disease. Several years ago, Madhumathi Rao, a CMC alumnus who is an assistant professor of nephrology at Tufts, and Gagandeep Kang, head of gastrointestinal science at CMC, began exploring why CKD in India differs from that in the West.

They hypothesize that recurring diarrhea and the resulting dehydration during infancy may cause chronic kidney disease and long-term damage to those organs. They further suspect that these

gastrointestinal infections, in addition to other early-life assaults like low birth weight, malnu-trition and immunological disorders, may play a significant role in the early development of renal disease.

I have teamed up with Drs. Rao and Kang to test their hypothesis. We chose to study this particular cohort of children because we already know so much about their health history. In the early days of the study, field workers visited the infants and toddlers at home every other week to gather information on all episodes of disease, and collected stool samples from all episodes of diar-rhea. Researchers also compiled socioeconomic data and family medical histories, which we are using to suss out additional risk factors such as poor sanitation and access to clean water.

Subtropical India is another world from Boston, but beneath the differences there may be lessons that translate from one place to the other. In the process of my work, not only have I seen diseases and conditions that no longer

exist in the U.S., such as polio, measles and tetanus, I have also sifted through multiple social and economic factors that inf luence and often determine a patient’s prognosis and overall health status. The medical system in America undoubtedly will undergo major changes in financing and structure over the next decade—changes that may well include a greater emphasis on prevention in efforts to lower costs. If that happens, CMC’s model of community-based care could be applied to any setting with limited resources.

For now, our research goals in Vellore are straightforward. If we can solve the riddle of what’s causing so much CKD in India, the hope is that we ultimately can stem its proliferation. And that could give Ashok, with his large brown eyes and wide smile, a better future.” tM

Horton is a 2010–11 Fogarty International Clinical Research Scholar, a program that gives health sciences students clinical research training at NIH-funded research centers in developing countries.

From top left, mobile clinic run by Christian Medical College visits a village near Vellore; the author takes blood pressure; Dr. Stefan Collinet-Adler, a fellow in the Infectious Diseases Program at Tufts Medical Center, en route to collect samples for his study of environmental factors in infection.

photos: top left and bottom, lucy horton; top right, louise borst

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he next president of tufts holds a peculiarly British title, pro-vice-chancellor, at that most British of institutions, the University of Oxford. But there is nothing staid or tradition-bound about either the man

or his pioneering work in neuroscience. Anthony Monaco—Tony to friends and colleagues—grew up in Wilmington, Delaware. He attended Princeton University on a generous financial aid package and went on to an M.D. and a Ph.D. from Harvard Medical School, specializing in the genetics of neurological disorders.

Monaco’s fascination with genetics took him to the U.K., then the hub of this burgeoning field. He worked on the human genome project at the Imperial Cancer Research Fund in London and started the human genetics laboratory at the Institute of Molecular Medicine in Oxford. At Oxford, he co-founded the Wellcome Trust Centre for Human Genetics, which identifies the genetic under-pinnings of common human diseases. Monaco’s own research has focused on the genetic basis of disorders such as autism, language impairment and dyslexia. Under his leadership, the Wellcome Trust Centre doubled in size: it is now the largest externally funded university-based research center in the U.K.

As Oxford’s pro-vice-chancellor for planning and resources since 2007, Monaco developed strategies for academic, capital and student-enrollment planning; senior academic appointments and budgeting and resource allocation for Oxford’s academic divisions, libraries, museums, administration and colleges. He has worked to broaden access to Oxford, create and fund interdisciplinary research ventures and boost support for the humanities.

At 51, Monaco has acquired just the skills one would hope to find in the 13th president of Tufts University. Introducing him to the Tufts community in November, James A. Stern, E72, chair of the Board of Trustees, noted Monaco’s “record of exceptional accomplishment as a university leader, biomedical researcher and teacher.” He added, “Tony will bring to the presidency of Tufts deeply held commitments to academic excellence, diversity, a global perspective and the university’s central role in society.”

Tony Monaco—reader of historical novels, father of three active boys, ages nine to 12, who can’t wait to sled down the hill behind the president’s residence on the Medford/Somerville campus, and spouse of Zoia Monaco, a cell biologist who heads a research group at Oxford—will succeed President Lawrence S. Bacow on August 1.

While vacationing at his home in Delaware over the winter break, he spoke about his aspirations, his science and his family.

What’s on your agenda for your first year as president of Tufts University?Anthony Monaco: I’ll be spending a lot of time meeting people and listening. One of my major goals is to understand the strategic issues facing each of the schools, and what the interdisciplinary issues are that knit the schools together into one Tufts. I’ll spend time in each school with the deans and their faculty and students to understand what they do well, what things could be done better, and strategically what they would like to achieve. I will also spend much of my time going out and meeting with alumni and friends of Tufts.

How would you describe your leadership style?I try to approach leadership through transparency and consen-sus building. I want to synthesize and bring together strategic approaches to develop innovative solutions to problems. For me, I need to do that from the ground up. It’s about devising strategies and making choices. The most important ingredient is to work with people and listen to their views. That’s where I spend a lot of time before making big decisions.

How do you see your research background serving you as president of Tufts?At the Wellcome Trust Centre for Human Genetics, there were 30 different research groups, and I had to bring them together into a mission where the sum was greater than the parts. I used that approach when I became pro-vice-chancellor. At Oxford there are four divisions—mathematical, physical and life sciences; medical sciences; social sciences and humanities. Each had its own strategic issues and its own funding problems. My job was to work together with the heads of those divisions, match their objectives with fund-ing and get the four divisions to cooperate to bring the entire insti-tution to a higher level. I think those experiences are essential to leading a major research university.

At Oxford, what has been your involvement with the humanities?As pro-vice-chancellor, I spent a lot of time working with the humanities division. They had their funding cut by government,

That’s how Tufts’ incoming president, Anthony Monaco— in his first interview—defines the role of academia by taylor mcneil


To Better Society

T

photo: rob judges

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Anthony Monaco on the Oxford campus, which he will soon leave behind.

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and were struggling to break even. We are reviewing how we teach the humanities and trying to get a humanities center—which Tufts already has—to create an environment in which faculty can per-form interdisciplinary research and graduate education. I spent a considerable amount of time trying to facilitate their top priorities and assembling the resources, facilities and fundraising programs so that they could have a more solid financial basis. More personally, my own research crosses into the humanities in a certain sense—I work on the genetics of language and communication and reading.

I think the humanities in particular foster an appreciation of the creativity of the human mind. Humanities scholars are always chal-lenging and questioning established ideas and modes of thought. So in some ways, I don’t see the aims of humanities scholars as that different from the aims of colleagues involved in science and math. Both disci-plines try to challenge the current ways of thinking about an impor-tant issue. There are parallels between the sciences and humanities that maybe aren’t appreciated as much as they should be.

What are some of the differences between student experiences in the U.K. and the U.S.? At Oxford, the tutorial system is based on very small classroom teach-ing with leading academics in a college environment. That’s very difficult to replicate elsewhere, because it does have its costs. But the practice of having more personal contact between faculty and under-graduate students in a small classroom setting or as advisers or men-tors is something I value, and Tufts values as well.

I’m also very interested in developing the skills of graduate stu-dents beyond training in a particular discipline. Graduate students need to acquire other skills that are important to their personal and professional development. At Oxford and in the U.K. in general, there has been increasing emphasis over the last few years in building up transferable skills such as communication, presentation and writing, time management and team management, in addition to the supervi-sion of graduate students on their individual projects. Being able to communicate your ideas and the excitement of scholarship and sci-ence—to the media and others—is vital. It’s an area I’ve been involved in at Oxford for many years.

The other big difference is that undergraduate study in Oxford and most U.K. institutions is subject-specific. For example, if you are going to study chemistry at Oxford, you do not normally enroll in humani-ties and social sciences courses to round out your liberal arts educa-tion. So that system does create a different type of graduate at the end.

Is that better?I prefer the American style. I think it is advantageous to give students a bit of time to decide what they want to focus on and enable them to experience a range of subjects in higher education.

Active citizenship is part and parcel of the Tufts identity. Is that idea of service to others important to you, too?Absolutely. You’re not just studying something to understand it better—you’re trying to better society by demonstrating that your research has an impact beyond its essential findings. I think you can bring active citizenship to many different levels, ranging from people

performing research on K–12 educational issues or getting involved in their local communities to the big international issues, such as the international veterinary program at Tufts or the global health issues in which multiple schools at Tufts are involved. These are all important ways of being active citizens.

At Tufts, there’s increasing interdisciplinary collaboration, such as between the engineering school and the medical school. Is that an approach you’d like to see more of?Yes, absolutely. It certainly needs to be a faculty-supported initiative. For example, at Oxford, the biomedical engineers decided to work in the medical school, right in the midst of the medical researchers and some distance away from the rest of engineering. The biomedi-cal engineers now have better access to clinicians and other medical research programs. It’s an example of a great experiment in cross-dis-ciplinary collaboration that is working well. Oxford also has a similar issue to Tufts: our medical sciences division and the hospitals are on two separate campuses, two miles outside the center of Oxford. So you’re always trying to deal with cross-campus practical issues as well as more strategic issues. That said, I think there are ways of integrating across campuses.

The Boston area has many research institutions. How do you see Tufts fitting into that mix?I’d like to see Tufts build on its strengths as both a competitor and a collaborator with other universities and institutes. Tufts should focus on those areas in which it is identified as world-leading and then ensure that we have the facilities, resources and people in place to compete for external funding. Some of this can be accomplished by collaboration. For example, if there’s an area where two institutions, by working together, can win grants from the National Institutes of Health, then the scientists will figure that out, and the central admin-istration should facilitate that collaboration.

The life sciences are a niche area for Tufts, with the veterinary, nutrition, medical and dental schools, as well as the basic science research being performed on the Medford/Somerville campus. There are ways of organizing different programs in the life sciences that would build on the strengths of Tufts and involve other research institutions in the Boston area.

How will you foster diversity in the student body?I obviously want to continue the great tradition that Larry Bacow has built up, trying to make need-blind admission at Tufts a reality. It’s very close, but it’s not quite there yet and will require further fundrais-ing and engagement with alumni and friends of Tufts. It does seem that the admissions policies are quite robust at Tufts, and I want to continue to create opportunities to attract a diverse student body.

A HANDLE ON GENETICSWhat drew you to genetics in the first place?As an undergraduate at Princeton, I was really interested in neuro-science and behavior. When I was in the neuroscience program at Harvard, the geneticist Lou Kunkel gave us a talk on how he was going to take on Duchenne muscular dystrophy using a genetic


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approach. It was just clear to me that this was going to work. I camped out on his doorstep, and when he came in the next morn-ing, I said, “I have to do my Ph.D. with you.” He took me on—I was his first student. He had just started his own lab and had received a grant to try this genetic approach. We worked together for several years. It was great fun, and also challenging.

What have you discovered?For the last 15 years, I’ve focused on learning disabilities and other neurodevelopmental problems in children—where language, the ability to read, and the right social skills don’t develop properly, as is the case with autism, for example. There’s a lot of overlap between these different areas. By studying all of them and taking a general, non-biased genetic approach, we’ve been able to identify genes that are specific to one disorder as well as some genes which are involved in multiple disorders.

Some of these genes can be involved in reading and language; some can be involved in language and autism. Our research, as well as the research of others, has shown that these genes do have effects across these different areas. The outcome can be autism or epilepsy or a language problem, depending on other factors. Once we get a handle on the genetics, we want to understand what those other factors are. If you can influence these other factors and the outcome, you can develop treatments or interventions that might help children compensate for their neurodevelopmental problems.

You kept your research group together at Oxford after you were appointed pro-vice-chancellor. Do you plan to continue with that at Tufts? I’m certainly not going to set up a lab at Tufts, but for a transition period I’m going to try to supervise at a distance the students and postdoctoral fellows I have at Oxford, with senior people there who will be leading the group on a day-to-day basis. I will have to achieve it with Skype and other methods of communication—as I do now as pro-vice-chancellor. I have an obligation to those students and those research programs to stay involved as best I can. I think I’ve already shown that the group can be productive in this situation.

What are you most proud of besides your family?I’m really proud of the members of my lab who, as I have taken a step back over the last three-and-a-half years, have risen to the challenge and have kept the lab at the cutting edge. They devel-oped themselves as the next generation of scientists in this area of research and have been incredibly productive. They identified one of the first genes involved in dyslexia and described its mechanism of action in brain development. In addition, they have just identi-fied one of the first genes involved in human handedness.

What’s the hardest thing you’ve ever done? Identifying the gene for Duchenne muscular dystrophy with Lou Kunkel, and overcoming problems that researchers hadn’t had to face before. It was an intellectual challenge, and also a physical challenge, because of the way we performed molecular biology back then. It wasn’t a thought experiment: you had to get in the

lab and do lots and lots of repetitive things and isolate DNA using big centrifuges. Collecting pieces of DNA from human chromo-somes in those days before the genome project started was quite a physical process.

RETURN TO BOSTONHow have your three sons reacted to the big move?I think that they are quite excited because it’s a new opportunity. There will be new schools, new sports—no more cricket, not much rugby. They love soccer, so they will be trying that. Zoia and I keep them involved, and we try to stay involved in what they are doing. We support them and give them the opportunities, and they do the rest.

And they are moving into a home on a college campus.It will be fun, with all the events going on at Gifford House, the president’s residence. My sons are pretty outgoing, so I don’t think they will shy away from meeting people. They certainly enjoyed the announcement weekend at Tufts.

They also can’t wait for that first big snow so they can sled down the hill behind Gifford House. Larry Bacow sent us some pictures of the blizzard on December 27 so the boys could see what it would be like.

What’s on your reading list?I like reading historical novels such as The Dancer Upstairs, by Nicholas Shakespeare, and An Instance of the Fingerpost, by Iain Pears. For nonfiction, I like history, such as The Greatest Benefit to Mankind, a history of medicine by Roy Porter. I’ve also read America, Empire of Liberty: A New History of the United States, by David Reynolds, and The Ascent of Money, by Niall Ferguson. Also, I just read An Entrepreneurial University: The Transformation of Tufts, 1976–2002, by Sol Gittleman.

Have you and your family v isited the U.S. much?These last five years we’ve come over at Christmas, because we have a house in Delaware, and we usually come over at Easter. During the summer, we go to the beach near our home. The boys like swimming, and they tried surfing last year and took sailing lessons.

This won’t be the first t ime you’ve lived in Boston.I spent seven years at Harvard Medical School, and I did my Ph.D. at Children’s Hospital with Lou Kunkel. I did my clinical rota-tions at different hospitals—Massachusetts General, Roxbury VA Hospital, Brigham and Women’s, and Children’s.

What did you miss most about Boston when you were at Oxford?The soft pretzels they sell outside Fenway Park.

How do Boston and Oxford compare?I would say the biggest difference is that Oxford has one major uni-versity. In Boston there is the excitement of having so many major universities in one city. That’s one thing I missed about Boston when I was in Oxford. When I leave Oxford, I am going to miss the city, its traditions, my colleagues and friends that we’ve built up over 20 years. tM


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