Top: Alumni visited the Smilow Cancer Hospital, still under construction.

Bottom: Alumni toured the High Throughput Cell Biology Center at West Campus.

Alumni gather for 2009 reunion

This year’s festivities feature tours of West Campus and Smilow Cancer Hospital.

A seismic shift in premedical education awaits future applicants to the School of Medicine, Dean Robert J. Alpern, M.D., Ensign Professor of Medicine, told alumni at their annual reunion in June.

“The scientific knowledge needed for a medical education has been growing and changing, but science education has not changed—it is pretty much the same as when you were here,” Alpern said as he described the state of the school in Harkness Auditorium. Alpern, who co-chaired a joint committee of the Association of American Medical Colleges and the Howard Hughes Medical Institute that examined premedical education, recently co-authored an editorial on the topic that appeared in the journal Science in June. The committee found a need for incoming medical students to possess a solid understanding of the biological sciences and their relationship to the physical sciences and math. Alpern also stressed the need to include courses like statistics and biochemistry, which allow a baseline familiarity with key concepts in medical education.

Richard Belitsky, M.D., deputy dean for education and the Harold W. Jockers Associate Professor of Medical Education, is spearheading an effort to examine curriculum design, pedagogy, and assessment of medical students, to maintain the quality of medical education at Yale.

Despite a shortage of doctors in the country, the School of Medicine has chosen not to expand class size, Alpern said. While the school recognizes there is a physician shortage, he added, it sees its mission as training leaders in medicine and the current class size as the best setting for accomplishing that aim.

On the research side, Alpern noted that the school ranked fifth among medical schools receiving funding from the National Institutes of Health, and first for research grants per faculty member. Several interdisciplinary initiatives, including the Program in Cellular Neuroscience, Neurodegeneration and Repair and the Yale Stem Cell Center, are involved in projects linking research and clinical practice. Thomas J. Lynch Jr., M.D., the former chief of hematology/oncology at Massachusetts General Hospital’s Cancer Center, was recruited this year as the director of Yale Cancer Center and physician-in-chief of the Smilow Cancer Hospital, scheduled to open in October.

Financially, the School of Medicine “has been blessed during the past few years by tremendous returns in the endowment: we had the fourth largest endowment of any medical school in the United States,” Alpern said. Although this year’s endowment saw a significant decrease in projected income, most of the medical school’s revenues come from grants and clinical practice, and the school should continue to do well during the economic downturn. The development campaign remains on target as well, having crossed the $100 million mark during the 2008-2009 fiscal year. The medical school was able to continue investing in research and faculty recruitment while maintaining its commitment to financial aid and other key programs.

The Yale system, said Alpern, “is alive and well.” Alpern spoke of the balance between tradition and innovation: “Yale has an incredible tradition of excellence, signified by the historical library. You can’t buy that. But if you think that you can live off that tradition, you are wrong, and the other medical schools will eat you alive. You need a vision for preeminence, to focus on that vision and work toward it.”

Lunch and a tour of West Campus
Alumni also toured the Center for High Throughput Cell Biology, the first center established on the 136-acre West Campus. Lars J. Brandén, Ph.D., director of the center, and his staff demonstrated the capabilities of the lab’s automated liquid and plate-handling platforms to create assays and high-content images of cells. The center’s staff will specialize in genome-wide siRNA screening.

Modeled on the Whitehead Institute at the Massachusetts Institute of Technology, West Campus will be a space where faculty from both the medical school and the college can come together to share ideas, creativity, and innovation.

Advances in cardiovascular medicine

If you are a pig or a mouse, said Michael Simons, M.D. ’84, chief of cardiovascular medicine and Robert W. Berliner Professor of Medicine, physicians can control tissue damage following a heart attack, but it’s not as easy if you’re human. Since biological therapies of the vasculature began in 1992, they have been based on animal models that use growth factors to treat ischemia. The goal, Simons told the audience at the alumni research symposium, is “to induce the growth of new arteries in such a way that we can essentially create a biological bypass.” In both mice and pigs such growth factors as VGEF induce the growth of new blood vessels, preventing the spread of tissue damage after a heart attack. However, in clinical trials, the animal models did not translate to humans. The nature of these animals may have confused the issue, Simons explained, because mice are resistant to vascular disease and pigs used in labs tend to be young and healthy.

Instead, Simons and his lab have “gone back to the bench” to understand “how the biology works” in clinical patients. They noticed that a patient with a 10-year history of diabetes had clogged vessels but was unable to create new arteries, while an older patient with years of angina and clogging but no diabetes was able to create new arteries. Why? Recent studies show that about 25 percent of the general population has pre-existing collateral arteries, while others do not. Simons’ lab found that although there were no differences in any of the growth factor levels between individuals who had collateral circulation and those who didn’t, these two groups had very different genetic profiles when their white blood cells were analyzed. A subset of genes appears to control whether we have collateral arteries or not. In addition, the activation of the arteriogenesis cascade is influenced by diabetes and high cholesterol—the very conditions that often cause and accompany cardiac disease (and which were absent in animal models). The defective activation of this signaling cascade is another reason why simply administering growth factors may not be effective. The field is now exploring the activation of post-receptor signaling as a way to overcome these barriers to induction of growth of new collateral circulation.

Frank J. Giordano, M.D., associate professor of medicine, spoke at the symposium about the use of genetic techniques to address cardiac problems. Unlike Simons, who repeated the quote, “gene therapy is in our future … and always will be,” Giordano sees current methods of using zinc-finger proteins to turn on the VGEF growth factor gene as “a start” to promising new approaches to genetic and epigenetic aspects of cardiovascular disease. His lab, which studies the interaction between gene expression and oxygen levels, has found that an increased need for oxygen in cardiac walls can lead to both atherosclerosis and spontaneous heart attacks. Giordano’s future research will further explore the genetic and epigenetic links between a high-fat diet and impaired vascularization across generations of subjects.

Surgeons honor Robert Weiss

Robert Weiss (left) and John Libertino (right)

As surgeons gathered for grand rounds at the 14th Annual Spring Reunion of the Yale Surgical Society, John A. Libertino, M.D., HS ’70, praised his friend and colleague, Robert M. Weiss, M.D., chief and the Donald Guthrie Professor of Urology, and recalled their joint arrival in New Haven in 1967. The reunion honored Weiss, who served as interim chair of surgery for two years.

“I came as a first-year resident and Bob was a first-year attending,” Libertino said in the Fitkin Amphitheatre. “We were both brought to this institution by Bernard Lytton, who was the new, dynamic chief of urology, and represented the medical school very well. We began working at Yale and came to admire and respect it.” Ten years after Weiss’ arrival in 1967, he became a full professor, and in 1988 he became chief of the Section of Urology.

Robert Udelsman, M.D., M.B.A., chair and William H. Carmalt Professor of Surgery, also praised Weiss, who preceded him as interim chair of surgery from 1999 to 2001. “Everybody in the audience has a personal story of what Bob Weiss did for you,” Udelsman said. “Bob ran the department before I got here and I will always be grateful for his advice, his leadership, and his skills.”

The surgical reunion began with a reception in the newly dedicated Education Suite before the lecture in Fitkin Amphitheatre, where Libertino discussed “Novel Techniques in Partial Nephrectomy.”

After Libertino’s talk, Weiss traced the history of urology at Yale from the early 1900s to the present.

This year’s Samuel Harvey Award went to Karen A. Diefenbach, M.D., who came to Yale as a pediatric surgery fellow and is now an assistant professor of pediatric surgery.

The Lindskog International Travel Awards went to three medical students planning to pursue careers in surgery, and who have already completed surgical rotations abroad: Carolyn Goldberg, who went to Vietnam; Jill Rubinstein, who was in Zambia; and Rajendra Sawh-Martinez, who went to Honduras.

Surgery education suite dedicated

Left to right: Robert Udelsman, Warren Widmann, and Myra Widmann

On June 4 the Department of Surgery dedicated its new Education Suite in honor of Warren D. Widmann, M.D. ’61, HS ’67, and his wife, Myra, in recognition of their generosity in funding the room’s renovations. “It is a pleasure to be able to make this contribution,” said Widmann. “It is possible because of what Yale medical school and Yale surgery did for me.” The Widmanns lived in Morristown, New Jersey for 30 years while he was in private practice in general thoracic surgery, general surgery and surgical critical care for 30 years. They then moved to Manhattan where he spent 10 years on the faculty at Columbia University College of Physicians and Surgeons and he is now program director of surgery at Staten Island University Hospital.

Distinguished Service Award to Robert Lyons

At the alumni meeting, Robert W. Lyons, M.D. ’64, the chief of infectious disease at Saint Francis Hospital in Hartford, Conn., received the Distinguished Alumni Service Award in recognition of his service to his profession, patients, family, and community. Lyons told the audience of fellow alums that “as Dean Alpern said, Yale is not a school, it is a religion, and I was an early convert.”