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Yale’s M.D./Ph.D. Program celebrates a birthday and 188 promising careers When Donald E. Ingber graduated from Yale College in 1977, he had definite ideas about what he wanted to do in life. He was either going to write comedy and raise the standard of the television sitcom or else make his contribution to humanity through science. He admits it wasn’t a conventional career dilemma. Unfortunately perhaps for prime-time viewers, science won out. Ingber enrolled in the M.D./Ph.D. Program at Yale, spent seven more years in New Haven, then went on to discover the angiogenesis inhibitor TNP470, one of the first in a promising class of compounds that physicians hope will provide effective anti-cancer therapies. Ingber did his postdoc with angiogenesis pioneer Judah Folkman, M.D., at Harvard Medical School, where today he is a professor of pathology and an explorer in the largely uncharted field of “mechanobiology,” studying the role of mechanical forces in cell regulation. Ingber says that it was a mindset cultivated at Yale that allowed him to connect the basic science of angiogenesis to the clinical relevance of an agent that might starve quickly multiplying tumor cells of their essential blood supply. With one foot planted firmly in the basic sciences and the other in clinical medicine, he was able to see each realm from a more practical perspective. “By combining them, you really are able to understand what the problems in medicine are and to frame the relevant questions,” he says. “And because you’re trained by the best scientists around, you learn the procedure of attacking the problem and reducing it down to its minimum variables.” Yale’s M.D./Ph.D. Program, also known as the Medical Scientist Training Program (MSTP), turned 30 last year and celebrated the anniversary with a reunion in November. Graduates of the program, Ingber among them, returned to New Haven to attend a symposium and mix with classmates, professors and many of the 80 currently enrolled students. The program’s five-year renewal was approved this past summer with a study section recommendation of $12.4 million in funding over that period. An additional slot each year has also been recommended, which could raise the number of participants in the program to as many as 85 by 2005 when additional funding from the medical school and other sources is taken into account. Nationally, the MSTP traces its roots to 1964 when three schools—NYU, Einstein and Northwestern—received money from the federal government to encourage the training of physician-scientists who would be able to leap nimbly from bench to bedside and back again. Yale joined the ranks in 1969 and is one of 39 MSTPs currently funded by the National Institute of General Medical Sciences (NIGMS), according to Bert Shapiro, Ph.D., the director of the MSTP at NIGMS and chief of the institute’s branch of cell biology. The MSTP got off to a slow start and almost vanished entirely in the early 1970s, when then-President Nixon impounded training funding amid concerns that much of the NIH training program was ineffective. “It funded a lot of residents and they weren’t going into research,” says Shapiro, who says that more than 90 percent of current alumni are in research. In 1974, Congress passed a new act authorizing training grants on a much smaller scale; all the previous programs disappeared and were reformulated. MSTP was one of only a few to survive and grow. The Yale program has 188 graduates, “98 percent of whom are doing funded research,” according to Director James D. Jamieson, M.D., Ph.D., professor of cell biology. “So the program is doing what it set out to accomplish, which was to train physician-scientists to carry out basic research that would be applicable to medicine.” The roster of M.D./Ph.D. alumni includes Yale professors Susan J. Baserga and Michael J. Caplan, who administer the program along with Jamieson and Gerald I. Shulman. Others on the Yale faculty include Michael P. DiGiovanna, Peter M. Glazer, Robert J. Homer, Barry M. Kacinski, William L. Krinsky, Richard R. Pelker, Jordan S. Pober, Marc Potenza and Sandra L. Wolin, as well as a half-dozen recent graduates who are fellows and residents at Yale. These younger graduates are much more likely to pursue careers in research because of the funding provided by MSTP, said Baserga, one of the three associate directors of the Yale program and an associate professor of therapeutic radiology and genetics. Tuition and other academic expenses are covered, and students receive a stipend for six or more years, allowing them to keep their level of debt relatively low and thus resist financial pressures to enter private practice or industry. (According to Shapiro at the NIH, MSTP graduates leave with an average debt of about $10,000, compared to $120,000 for other medical graduates.) “The program was set up to encourage students to go into academic medicine,” says Baserga. “It’s been extremely successful in fulfilling that mandate.” Although the national program has grown dramatically, from $372,000 in annual funding in 1964 to $31.2 million today, some feel it isn’t large enough to counter a documented decline in the percentage of physician-scientists in the United States. “The size of the program should be doubled or tripled,” says Leon E. Rosenberg, M.D., who served as dean of the School of Medicine from 1984 to 1991 and is a highly vocal advocate of bolstering the ranks of the physician-scientist. “The NIH budget has risen hundreds of percents over the last 20 years. The size of the MSTP has gone up much more slowly and I think that’s short-sighted,” says Rosenberg, now adjunct professor of genetics at Yale and a professor at Princeton. “If we are to decipher the information from the human genome, if we’re to find out what that book means, we’re going to have to have medically trained scientists involved at the core. If we don’t have them, there’s going to be great difficulty in translating this fundamental information for the benefit of sick people.” |
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Med school invites neighbors to join in Tercentennial celebration The doors of the School of Medicine have always been open to those seeking medical care. On a Saturday in October the school opened its doors to its neighbors as part of the University’s year-long celebration of its 300th birthday. More than 500 people toured the medical school, which offered a lesson in virtual anatomy and, for children, the chance to dress up in medical gowns and pose for a snapshot with a 6-foot square photograph of an operating room as a backdrop. Throughout the University, more than 35,000 people attended the open house. Celebrations started the day before, Friday, Oct. 20, with a community service award to Mayor John DeStefano Jr. from the School of Public Health. DeStefano was honored for his support of the Community Health Care Van, which provides medical services in underserved areas. The ceremony continued that day with the opening at the Sterling Hall of Medicine of Neighbors: Working Together for a Healthy New Haven, an exhibit of photographs by John Curtis showing students and faculty from the health professions working with local schools and community groups on a variety of projects, ranging from conflict resolution workshops to organizing a library at a shelter for women. (A photographic essay based on the exhibit appears in this issue of Yale Medicine.) Inside the Cushing/Whitney Medical Library, the medical school’s Web designer, Patrick Lynch, opened an exhibit of his art. And the library rotunda was the site of an exhibit chronicling Medicine at Yale 1701-1865. Joining Dean David A. Kessler, M.D., in launching the open house were Michael H. Merson, M.D., dean of public health, and Catherine L. Gilliss, D.N.SC., R.N., dean of the School of Nursing. Public service, Merson noted, is the force that drives public health. Gilliss recalled growing up in New Haven and the links between the University and the city. The medical school, Kessler said, is proud to be in such a vibrant community as New Haven. |
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New research effort will target hypoglycemia “Everything about diabetes cuts two ways,” says William Tamborlane, M.D., professor of pediatrics at the School of Medicine. “There are good parts and there are negative parts.” Take insulin, the heart of treatment regimens for the 1 million people in the United States who have type 1, or juvenile onset, diabetes. Even as it controls the level of sugar in the blood, insulin can increase the frequency and severity of bouts of hypoglycemia. Because it denies the brain a normal supply of its primary fuel, glucose, hypoglycemia can cause seizures, confusion and abnormal behavior. In severe cases it can damage the brain and nervous system and can occur even under a regimen of blood sugar monitoring, careful diet, exercise and insulin injections. Now, with a $5 million, five-year grant from the Juvenile Diabetes Research Foundation International (JDRFI), researchers at Yale have launched a new effort to study hypoglycemia and seek ways to prevent it. At a press conference and luncheon in early November, researchers at Yale and JDRFI officials announced the formation of the Center for the Study of Hypoglycemia at Yale University. Building on 25 years of hypoglycemia research at Yale, the center will draw on the talents of 16 investigators in internal medicine, pediatrics, diagnostic radiology, neurosurgery, psychiatry, neurology and nursing. “You need to bring together people with different perspectives and different knowledge bases to tackle the problem,” says Robert Sherwin, M.D., the C.N.H. Long Professor of Medicine, who will lead the new center and is the president of the American Diabetes Association. A clinical trial led by Tamborlane and Margaret Grey, Ph.D., associate dean for research at the School of Nursing, will gauge whether new technologies in glucose sensing and insulin delivery can reduce the risk of severe hypoglycemia in children receiving insulin for type 1 diabetes. Three research projects will use microdialysis, nuclear magnetic resonance and functional magnetic resonance imaging to monitor the effects of hypoglycemia on the brain. The project leaders are Sherwin, John C. Gore, Ph.D., professor of diagnostic radiology and applied physics, and Douglas L. Rothman, Ph.D., associate professor of diagnostic radiology and director of the Magnetic Resonance Center. |
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New Haven’s young SCHOLARs take to the labs, and dorms In a fourth-floor laboratory in the Farnam Memorial Building, G’Nee Herbert uses a pipette to prepare samples of mouse DNA for analysis. Her task is to ensure that a certain gene, PKC theta, has been eliminated from the mouse’s genome. Working under the supervision of research technician Crystal Bussey, she prepares an array of DNA for testing. “There are so many steps,” Bussey tells Herbert. “From start to finish it will take you a solid week.” Unlike the others in the lab, Herbert is not a graduate student, postdoctoral fellow or medical student. About to enter her senior year at Hill Regional Career High School a few blocks from the medical center, she’s one of 65 students from the high school who spent three weeks this past summer living on the Yale campus while studying biology and chemistry. Herbert, 17, joined the program in its first year, three years ago, and has watched it expand from a two-week program with 15 students. “It prepares you for the next year,” Herbert says of the summer program, which is integrated into the science curriculum at Career. “You already have a step up when you get to chemistry.” A longstanding relationship between the two schools has for several years brought Career students to the medical school and Yale-New Haven Hospital for classes and internships. The summer program, called SCHOLAR, for Science Collaborative Hands-On Learning and Research, allows students to sustain their interest in science and follow Career’s health professions education track. Originally funded by the National Institutes of Health, last year the program received additional support from the Howard Hughes Medical Institute. Career students who have just completed their freshman, sophomore or junior years live in Yale dormitories and study genetics, cellular and developmental biology, chemistry and biotechnology. The students also enjoy activities such as a picnic in East Rock Park in New Haven or a field trip to Branford’s Thimble Islands. In classrooms and laboratories, the students try to solve problems such as this: A young camper has been brought to an emergency room suffering from headaches, a temperature and a rash, followed by a seizure. Students must suggest reasons for his symptoms, questions to ask his fellow campers and possible tests. As more information becomes available, students answer new sets of questions until they go to the laboratory to test samples of water. “After they have gone through the labs, they come up with a final presentation of what it is they think is going on with this problem,” says Liza Cariaga-Lo, Ph.D., until recently the director of multicultural affairs and SCHOLAR’s program director. Career Principal Charles Williams says students return to school in the fall far more comfortable with critical thinking and problem-based learning. “It is very, very necessary for them to be exposed to some of the strategies that are promoted in the summer program,” Williams says. |
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Pediatrics chair Warshaw moves north to become dean When Joseph Warshaw, M.D., returned to Yale in 1987 after a five-year stint at the University of Texas, he was already an internationally renowned expert in newborn care and development. While serving as chair of the Department of Pediatrics, he also emerged as a well-respected leader within the School of Medicine. On Aug. 1, he moved north once again to become the 15th dean of the University of Vermont College of Medicine in Burlington. As chair of the Department of Pediatrics for 13 years, Warshaw built it into one of the nation’s foremost centers for research into childhood disorders. Yale is now the leading recipient of NIH funding among medical school pediatrics departments in the country. The department has added facilities to handle the demands of the growing scientific program, including the Child Health Research Center on Congress Avenue. He also played a key role in the construction of the Yale-New Haven Children’s Hospital. Over the past five years, he guided clinical academic programs for the medical school as deputy dean for clinical affairs. In that role, he oversaw major changes in the organization of the Yale Faculty Practice, worked on the 1999 affiliation agreement with the Yale New Haven Health System and enhanced several clinical programs. Warshaw first came to Yale from Harvard in 1973 and went to the University of Texas Southwestern Medical Center in Dallas in 1982, where he served as professor and chair of pediatrics until his return to Yale. He has published more than 100 scientific papers and six books on developmental medicine and other child-health topics. He said, “I’ve never in my life more enjoyed working with and for a group of people than the people in pediatrics at Yale.” To recognize Warshaw’s contribution, the medical school held a symposium in his honor in early December. |
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Bright Beginnings initiative helps mothers, infants at the start of life It started with a simple statistic. Eight years ago members of the Friends of the Children’s Hospital at Yale-New Haven learned that only 55 percent of the children in New Haven were receiving all their necessary immunizations by age 2. Over the next two years members of the Friends board, pediatric staff and people from the community identified other problems common to young mothers. The solution was Bright Beginnings, a mentoring program that has matched volunteers one-on-one with 164 young mothers since its inception in 1994. Medical Director John Leventhal, M.D., says it was designed to ensure that the mother and her child had timely prenatal visits and well-baby checkups, to reduce the incidence of childhood injuries and to encourage early intellectual and social stimulation. None of the young mothers in the program, who range in age from 15 to 24, are in an extremely high-risk group. They were matched with mentors, 40 percent of whom are health care professionals or students in a health field. Most of the mentors are parents who have raised their own children. “They are people who have extra energy to give support to a young mother,” says program coordinator Lyla Johnson, R.N. After training, the mentors sign on to guide young mothers from the last trimester of their pregnancy through the child’s first birthday. One of the 164 mentors is Courtney Marsh, a 24-year-old nursing student at Yale who plans to become a nurse-midwife. Since January she has made a weekly visit and several weekly phone calls to Tasha Aaron, who gave birth to her daughter Aurora on March 11. Aaron, 23, has a background in health care—she is certified as a nurse’s aide and an EKG technician—and is well aware of the need for checkups. Aaron credits Marsh with “being there for me when I needed someone to talk to. She was with me when I was admitted to the hospital.” “Having someone who is just a friend for her is a big part of it,” Marsh says of their relationship. “A lot of it is about plugging her into resources that can help her.” At their weekly meetings they may go out to lunch, visit a midwife, fill out forms or simply talk. A recent pilot study of the program found that 99 percent of the infants had up-to-date immunizations at 12 months, compared to 80 percent of children in the hospital’s primary care population. Only 4.5 percent of teen mothers were pregnant again within one year, compared to 45 percent of the hospital’s Women’s Center teen population. Successfully matched mothers also missed fewer pediatric appointments and made better use of the health care system. Although Leventhal has embarked on a more detailed study involving 200 young mothers, half of whom will be assigned prenatally to Bright Beginnings and half of whom will receive standard care, he is encouraged by the pilot findings. “Our ultimate goal would be to see if we could expand this program throughout the state of Connecticut,” Leventhal says. |
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For a group of first-year students, an intense week in the lab Exposure to some of the best minds in science has long been a benefit of studying medicine at Yale. For a group of 24 first-year students last spring, that experience was intensified during a week-long immersion in bench research and discussion of the broader themes in science. “The goal was to pick a topic and convey two things—how you come up with strategies to test a hypothesis and how you see the project through its successive steps,” said John N. Forrest Jr., M.D., HS ’67, who along with four other faculty members accompanied the students to the Mount Desert Island Biological Laboratory in Bar Harbor, Maine, in May. “It was a very intensive week in the lab. They worked morning, noon and night. [Dean] David Kessler had proposed that we give students this intense pedagogical experience and it was successful beyond anyone’s expectations.” Working with shark tissue, the students focused their investigation on the structure and function of polarized epithelial cells, examining the topic with techniques from several disciplines, including physiology, biochemistry, cell biology and molecular biology. The faculty included Forrest, director of the Office of Student Research, and colleagues Michael J. Caplan, M.D. ’87, Ph.D. ’87, Bliss Forbush III, Ph.D., and Mark S. Mooseker, Ph.D. “It was a perfect environment for learning to take place,” said Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, associate dean for student affairs, who accompanied the group. Angoff, who wrote her own medical school thesis not on basic science but on an ethics topic, took the Bar Harbor course along with the students in order to bridge some gaps in her knowledge. “I ran my first gel, did PCR, cloned a gene. It was just a great learning experience,” said Angoff. “For the students who haven’t had that introduction to laboratory techniques and how to think scientifically, I think it was especially terrific.” The school plans to repeat the course in May for interested members of the Class of 2004. |
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A closer look at the medical school, from a new angle Nearly every college and university admissions office in the country produces a glossy book introducing the school to prospective students with the aim of attracting ever-higher numbers of highly qualified applicants. Medical school viewbooks adopt much the same format, organizing their presentation around the three primary missions of research, patient care and medical education. This year, Yale is breaking that mold, choosing instead to examine itself in a series of vignettes that make up a typical week at the medical school. 24/7: Medicine at Yale, published in August, takes a photographic look at the life that fills Yale’s laboratories, classrooms and clinical spaces, as well as its involvement with the rest of Yale, the New Haven community and the wider world. Black-and-white photographs and accompanying text explore the world of medicine at Yale over the course of seven days, from a difficult childbirth on a Saturday morning to a discussion among faculty and students the following Friday afternoon. Altogether, more than 40 glimpses of medical school life, accompanied by sidebars of facts and figures, occupy the book’s 52 pages. “We wanted to do something a little different and not just tell the typical story,” says Associate Dean Jane E. Reynolds, who directed the book project and collaborated with Director of Admissions Richard A. Silverman, writer Catherine Iino, photographer François Robert, the Yale Medicine staff and the design firm Pentagram. The book will be mailed to several thousand prospective applicants each year and was sent to alumni and friends of the school in October. |
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Anti-violence partnership chosen as model for national program For nine years the mental health professionals at the Child Study Center have engaged in an unusual collaboration with New Haven’s police department. Psychologists and psychiatrists rode in squad cars to learn how police worked. Police officers came to the medical school for training in child development. Since then, center staff have been on call 24 hours a day, seven days a week, to help children who witness or are victims of violence. “It is a real triumph of collaboration,” says Mayor John DeStefano Jr. Since the program started, it has intervened in the lives of more than 3,000 children and families. The U.S. Department of Justice has supported the collaboration project for the past six years, and this year chose to apply the model around the country. In addition, the department created the National Center for Children Exposed to Violence (NCCEV), based at the Child Study Center. Deputy Attorney General Eric H. Holder Jr. came to Yale in May for the dedication of the national center. Over the next five years, Holder said, the NCCEV will provide $7 million to similar partnerships in nine communities around the country. “The Child Development-Community Policing Program will remain at the heart of the national center,” Holder told local police, government officials, pediatricians and faculty in Harkness Auditorium. The program, Holder said, is one of the first in the nation to recognize that such a partnership is a key element of successful treatment. The Child Development-Community Policing Program and the NCCEV are led by Steven Marans, Ph.D., Harris Associate Clinical Professor of Child Psychoanalysis in the Child Study Center. The national center’s three objectives are to find ways to prevent exposure to violence, to intervene early and effectively in cases of violence and to ensure that perpetrators of violence against children are brought to justice. |
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Congress Avenue Building
Structural steel began arriving at the site for the Congress Avenue Building in early fall and began to transform the landscape immediately. “In the next month and a half, everyone will begin to understand how large this building is,” project leader John Bollier said in early September. The project, one of the largest in Connecticut, remains on schedule with steel work scheduled for completion by March. The construction force of 60 increased to 80 with the arrival of the steel and will rise to between 500 and 600 during the coming year. By January 2002, the building should be completely enclosed. Detailed renderings of the building as well as updates on the project may be accessed at http://info.med.yale.edu/cab. |
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During the first Tercentennial celebration weekend in late October, physicians and artists explored common ground during a symposium sponsored by the Program for Humanities in Medicine in conjunction with the New Haven arts organization artSPACE. Physicians Thomas Duffy and Irwin Braverman, along with students from the schools of medicine and nursing, joined artists represented in the companion exhibit “Foreign Bodies: Art, Medicine, Technology” at the untitled (space) gallery on College Street. The exhibit, curated by Marianne Bernstein, included works by 17 artists who incorporate medical technology or imagery into their work. |
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M.D./Ph.D. Program celebrates a birthday | Neighbors join in Tercentennial celebration | New research targets hypoglycemia | Young SCHOLARs take to the lab | Warshaw moves north to become dean | Bright Beginnings helps mothers, infants | An intense week in the lab | YSM, 24/7 | Anti-violence partnership a model | Congress Avenue Building reaches skyward | Art and medicine
Rounds | Findings | Et cetera
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