Health Sciences Report (1994)

Winter 1994 FROM THE EDITOR Issues facing health care are everybody's business, whether you're in the business or not. Just scan the daily newspaper, a medical journal or a popular magazine. You'll be asked to consider how physician group practices are adapting to health- care reform, if an experimental drug will replace angioplasty in treating clogged arteries or whether male menopause is a myth. Political or clinical, the issues are important, because we all need- and pay for- health care. Yet, just as a migraine headache must be understood in the context of a patient's over-all health, the issues facing health care must be understood in context, that is, in terms of the people who deal with them. As it's been said, awards are given to people, not issues. Individuals formulate the equations that expand into actions that can change our lives. In this issue of Health Sciences Report, we feature the stories of four individuals. They are not necessarily the most familiar faces at the University health sciences center. But each person is tackling an issue that confronts health care with the determination, optimism and passion that are necessary if we are to make progress. Despite suffering the debilitation of hereditary kidney disease, researcher Curtis Atkin continues to investigate the cause of Alport Syndrome. He knows firsthand how the fami-lies he studies feel physically and emotionally, just as we can see through him the critical link between clinical care and basic research. Although surgeon Leigh Neumayer had her father as a role model and her mother as an ardent supporter when she decided to pursue a career in medicine, she realized few women were as fortunate. In addition to promoting math and science among high school girls, Neumayer is an advocate for female students at Utah's medical school, which hope-fully will increase its percentage of women students, now the lowest in the nation. As associate health sciences vice president for clinical affairs, Lucy Osborn is the highest ranking woman at the University health sciences center. But balancing her family responsi-bilities with the demands of medicine, first as a medical student, then as a pediatrician, wasn't easy. She had to forge her own way, a path she helps guide other young women along now. When physician John Williamson began questioning how well doctors were practicing medicine, not everyone wanted to listen. Thirty years later, he is still asking questions, but also providing answers that have become key elements in the nation's health- care reform movement. His research provides a unique perspective on reform, showing the derivation of such concepts as " quality improvement" and " outcome management." Atkin, Neumayer, Osborn, Williamson. Their stories are among those of the many individuals grappling with the issues confronting health care today. They are the faces behind the issues, E Susan Sample 1 9 9 4 HEALTH SCIENCES REPORT UNIVERSITY OF UTAH Vol. 18, No. 1 Published by the Office of Public Affairs, University of Utah Health Sciences Center, 50 North Medical Drive, Salt Lake City, Utah 84132. Telephone ( 801) 581- 7387. Health Sciences Report is mailed to faculty, staff, alumni and friends of the University of Utah School of Medicine; to the staffs of University Hospital and Spencer S. Eccles Health Sciences Library; and to the faculties of the colleges of Pharmacy, Nursing and Health. Articles may be reprinted with permission. Editor: Susan Sample Editorial Consultant: Anne Brillinger Contributing Writers: Doug Boudreaux, Anne Brillinger, Mary Chachas, John Dwan Photographer: Brad Nelson, Medical Illustration Service This issue of Health Sciences Report is printed on recycled paper as part of a major recycling campaign at the University of Utah Health Sciences Center. o HEALTH SCIENCES REPORT Headlines 2 People 6 Faces Behind the Issues 8 Researcher Curtis Atkin 8 He's personally familiar with the degeneration caused by hereditary kidney disease. Surgeon Leigh Neumayer 12 She's an advocate of mentors and models for women in medicine. Pediatrician/ Administrator Lucy Osborn 16 She's balanced a medical career with family life by doing it her way. Physician John Williamson 20 He's a physician's physician, diagnosing and treating the practice of medicine. From the Bookshelf 24 Four faculty members recommend books they'd like their patients to read. Research in Brief 26 Gift of Health 29 Contributions fund a new cancer institute, endowed chairs and student scholarships. Opinion 32What will be the future of specialists under health- care reform? Faculty members from the School of Medicine and College of Nursing offer different perspectives. Christine St. Andre Dale R. Gunnell CHANGES IN LEADERSHIP Christine St. Andre, a longtime administrator at The George Washington University Medical Center, was named executive director of University of Utah Hospital last December, while Dale R. Gunnell was appointed associate health sciences vice president for business operations last November. Gunnell, a 24- year veteran University Hospital executive, had been interim director, overseeing the hospital's day- to- day operations until Feb. 1, when St. Andre's appointment became effective. A native of New Jersey, St. Andre joined the staff of The George Washington ( GW) University Medical Center in Washington, D. C., in 1977, the same year she received a master's degree from GW University. She earned her bachelor's degree in economics and mathematics from Bryn Mawr College in Pennsylvania. From February 1992 until she assumed her position at Utah, St. Andre was director of University Hospital and administrator of the GW University Medical Center. She was responsible for the 488- bed acute care teaching facility that employs a staff of some 2,200, serves as the primary training site for more than 300 house officers and has an operating budget of $ 175 million. She also directed administrative support for a 200- member, multi- specialty medical group practice and oversaw information systems support for the medical center, including the hospital, faculty practice plan, medical school and allied health sciences. Previously, St. Andre served as assistant administrator, associate administra-tor and administrator of the GW University Medical Center. In his new position as associate health sciences vice president for business operations, Gunnell will oversee the business and financial aspects of the health sciences center as it expands its services. Prior to joining University Hospital in 1969 as budget director, Gunnell served six years as director of accounting and finance for the Utah State Department of Health. During his career at the University, he has moved up the managerial ladder to assistant administrator, chief financial officer and interim director. Gunnell holds a bachelor's degree from the U. He serves as chair of the State Medical Care Advisory Committee and is a member of the board of directors of five national and regional health- care associations, m NEUROBIOLOGY HEAD AWARDED $ 2 MILLION TO STUDY DEAFNESS Thomas N. Parks, Ph. D., professor and chair of the Department of Neurobiology and Anatomy, received a seven- year, $ 2 million Claude Pepper Award from the National Institute on Deafness and Other Communicative Disorders last fall. Parks' research focuses on the effects of deafness on brain develop-ment, specifically, how neurotrans-mitter receptors on auditory brain cells are influenced by the loss of hearing. Progress in the treatment of hearing loss and in restoration of hearing em-phasizes the importance of understand-ing what effects early hearing depriva-tion may have on attempts to restore hearing. Previous research has shown that involved portions of the brain do not always remain normal after early hearing loss, according to Parks. There are more than 200,000 Americans whose total deafness began before they were three years old and more than 600,000 with a significant bilateral impairment that began before they were six, said the researcher. He studies structural and functional development in the cochleas and brains of chicks whose hearing, like humans', begins well before birth. Chick embryos and young chicks have a nerve cell in their cochlear nucleus that is almost indistinguishable from a similar cell in the human cochlear nucleus. The first holder of The George and Lorna Winder Presidential Endowed Chair in Neuroscience, Parks was named head of the medical school's new neuroscience program in 1992. Neurobiology research is a major focus of work in the Department of Neurobiology and Anatomy, the new name as of last October for the medical school's anatomy department. Faculty had requested the title change to more accurately reflect the department's work, E Health Sciences Report Winter 1994 MEDICAL STUDENT WINS $ 5 0 , 0 0 0 NATIONAL AWARD Kirk A. Bollinger, a third- year student in the School of Medicine, was honored last October in Washington, D. C., as a recipient of one of the first 10 Pisacano Scholarships. The awards-$ 50,000 to each recipi-ent- are funded by The Nicholas J. Pisacano, M. D., Memorial Foundation, the newly established philanthropic arm of the American Board of Family Practice ( ABFP). Pisacano was the first executive director of ABFP and a leader in establishing family practice as a major specialty. The scholarships are presented to top students who exhibit academic excellence, strong character and interpersonal skills, and are com-mitted to community service and family practice. Bollinger, 23, grew up on a llama farm in Lander, Wyoming. He intends to return to rural Wyoming to practice medicine. A straight student in both high school and college, he graduated from the College of Agriculture at the University of Wyoming with a bache-lor's degree in molecular biology. More than 250 students from 95 different medical schools applied for the Pisacano scholarships. The award provides $ 10,000 for each of the last two years of medical school and the required three- year residency, n DISCOVERY SHOWS SINGLE GENE'S ROLE IN BEHAVIOR PATTERNS New University studies concerning Williams syndrome, published in the Sept. 1,1993, issue of Nature Genetics, provide some of the best evidence to date that a single gene can play a signif-icant role in specific behavior patterns in humans. Mark Keating, M. D., a University of Utah genetic researcher, was co- leader of the team of scientists from the Eccles Institute of Human Genetics and the Howard Hughes Medical Institute at Utah, and geneticists from the Univer-sity of Nevada at both Las Vegas and Reno, who reported last fall that the Medical student Kirk A. Bollinger received the Pisacano Scholar obelisk award from Donna Shalala, U. S. Secretary of Health and Human Services, in Washington, D. C., last October. absence of an elastin gene plays a role in Williams syndrome, a complex condition involving blood vessels, connective tissue and the brain. Rather than inheriting two normal genes, individuals with Williams syndrome inherit only one intact elastin gene; the other is absent or deleted. A deletion is loss of part of a chro-mosome, a condition that occurs during reproduction. Sometimes the genetic material that is duplicated during the development of human eggs and sperm is incomplete. If the missing material is important, as in Williams syndrome, human development is altered. Mental retardation commonly occurs in individuals with Williams syndrome and is accompanied by poor visual-motor integration. As a result, affected individuals have problems visualizing a complete picture, seeing instead only parts. They also may suffer from Atten-tion Deficit Disorder. However, their language development is spared. Some elements of speech- quantity and quality of vocabulary, auditory memory and social use of language- may be enhanced. Many individuals with Williams syndrome also sing or play musical instruments with considerable expertise. Thus, mental retardation is often underestimated in children with Williams syndrome because of their lan-guage skills and engaging personalities. This genetic discovery will improve diagnosis of Williams syndrome and may lead to new treatments. There is no treatment for many of the abnormalities of the syndrome. Further studies on the elastin and neighboring genes will help in understanding the roles genes play in behaviors and development, and the causes of deletion in Williams syndrome. Funding was provided by the National Heart, Lung and Blood Insti-tute; Williams Syndrome Foundation; American Heart Association; March of Dimes; and the Utah Genome Center, E GENETICS PROGRAM AWARDED $ 2 MILLION The Program in Human Molecular Biology and Genetics ( HMBG) in the Eccles Institute of Human Genetics at the University received a $ 2 million grant last August from the Lucille P. Markey Charitable Trust. Stephen M. Prescott, M. D., profes-sor of internal medicine in the medical school's Division of Cardiology and HMBG director, said the grant " rein-forces our efforts to apply research methods from modern biological sciences to problems of human health. The rapid growth in our understanding of the molecular basis of disease has enormous potential for preventing and treating diseases," he noted. " Genetic testing can identify a person's risk for developing a disease long before symptoms occur." The HMBG program is a unique interdepartmental collaboration in which faculty from various depart-ments of the medical school are brought to the Eccles Institute for five years early in their careers to focus on research. The George and Dolores Dore Eccles Foundation provided funding to initiate the program and recruit talented young scientists. Nineteen investigators with appointments in internal medicine, pediatrics, human genetics, radiology, biochemistry, neu-rology, neuroscience, ophthalmology and obstetrics and gynecology are in the program. The Markey Trust was established by the will of the late Lucille P. Markey, owner of Calumet Farms, a well- known thoroughbred breeding and racing stable in Lexington, Kentucky. All funds support and encourage interdis-ciplinary medical research, e Health Sciences Report Winter 1994 Carl R. Kjeldsberg, M. D. PHARMACY FACULTY RESEARCH AWARDS TOP UNIVERSITY LIST Although the College of Pharmacy has the third smallest faculty of 15 colleges and schools at the University, it ranked second in the number of research dollars generated per faculty member for the 1993 fiscal year. The pharmacy college received a total of $ 8.77 million for research from federal, state and private sources, according to David Bardsley, the col-lege's administrative manager. When divided among the 34 faculty members ( professors, associate and assistant professors, and instructors), the awards equal $ 258,065 per individual. Topping the University's research awards list, compiled by the Office of Sponsored Projects, was the College of Engineering, whose 82 faculty members generated a total of $ 24.15 million or $ 294,619 per individual. Following pharmacy was the School of Medicine, whose 402 regular faculty members ( excluding clinical faculty) generated a total of $ 59.8 million or $ 148,790 each. Other health sciences figures were: College of Nursing, a total of $ 1.59 mil-lion or $ 45,495 for each of the 35 faculty members; and College of Health, $ 1.49 million or $ 43,841 for each of the 34 faculty members, n KJELDSBERG HEADS PATHOLOGY DEPARTMENT Carl R. Kjeldsberg, M. D., professor of pathology at the School of Medicine, was appointed chair of the Department of Pathology last November. Kjeldsberg, a member of the medical school faculty since 1971 and senior associate chair of the pathology depart-ment since 1983, was acting chair last year. The U professor is president of Asso-ciated Regional and University Patholo-gists, Inc. ( ARUP), a University clinical reference laboratory that serves more than 2,000 clinical laboratories in 50 states. He was ARUP executive vice president and technical director from 1985 until 1993, when he was named president. Kjeldsberg studied medicine at the University of Edinburgh, Scotland, receiving his degree in 1966. He completed an internship and residency at General Rose Memorial Hospital, Denver, n U FACULTIES LAUNCH NATIONAL PROJECT FOR TEACHING PAs Faculty members from the School of Medicine and College of Pharmacy initiated a three- year project last August to standardize the teaching of clinical therapeutics among the nation's 57 physician assistant ( PA) programs. William M. Wilson, Ph. D., associate professor in the medical school's Department of Family and Preventive Medicine, and co- founder of the Utah PA program, designed and directs the project. Arthur G. Lipman, Pharm. D., professor of pharmacy practice in the pharmacy college, is on the project's committee that will develop the clinical therapeutics ( CT) curriculum. Six other academic medical centers involved in the project are the Univer-sity of Southern California, Stanford University, University of Washington, University of Nebraska, and Duke and Hahnemann universities. The CT Project will ensure that all PA graduates " will receive the same quality and scope of instruction concerning the use of pharmaceutical agents in treating patients," said Wilson. PAs initiated between 35 and 60 million prescriptions in 1991; those estimates are expected to rise dramati-cally as PAs deliver more primary care under proposed health- care reform. The CT Project is funded by the Pew Health Professions Commission and Glaxo, Inc. n COLLEGE OF HEALTH, COALITION SPONSOR COMMUNITY PROJECTS A multi- cultural youth rally, drug-free workplace seminars and a peer court for teens were among more than 100 community projects sponsored last summer and fall by the Salt Lake Val-ley Drug Abuse Prevention Coalition, directed by the Department of Health Education in the College of Health. With a $ 3.5 million grant from the federal Center for Substance Abuse Prevention, the coalition was estab-lished in 1990 by Glenn E. Richardson, Ph. D., professor, and Lynne D. Durrant, Ph. D., visiting assistant pro-fessor, along with Barbara Hardy, director of the Salt Lake County Divi-sion of Substance Abuse. It's directed by Jeff Ross, a U of U doctoral student in health education. The coalition's goal is to prevent or reduce alcohol and other drug use or abuse, and to increase community bonding and pride among children, teens and adults in Salt Lake County. Some 150 teenagers from the county attended a youth rally sponsored by the coalition last October at Camp Williams, where they learned to appre-ciate different cultural values through a variety of activities. In November, a peer court was held at the Salt Lake City- County Building, where teen " judges" handed down sentences, usually community service, to peers 4 Health Sciences Report Winter 1994 who had committed minor infractions, according to Ross. Also in November, a seminar was offered for businesses with fewer than 50 employees to help them establish drug- free workplaces. An on- going campaign initiated by the coalition is geared towards encouraging senior citizens to bring all their prescription medications to a local pharmacy, where they will be evaluated for possible contra- indications. e NURSING FACULTY OPERATE NEW SATELLITE CLINIC Birthcare/ Healthcare and the Uni-versity Birth Center, the first of several satellite clinics planned by the health sciences center, will open this spring in Salt Lake County under the direction of College of Nursing faculty members. The nursing college has operated a clinic in the county that was staffed by certified nurse midwives and pediatric nurse practitioners. The new clinic, located in Holladay near convenient bus routes, will have expanded ser-vices, providing primary care for the entire family, according to Marcia Scoville, M. S., clinical director of Birth-care/ Healthcare and administrator of the University Birth Center. Specialists will include family nurse practitioners and advanced practice psychiatric nurses, in addition to certified nurse midwives and pediatric nurse practi-tioners. Family practice physicians and obstetrics- gynecology residents from the School of Medicine also may rotate through the clinic and birthing center, said Scoville, an instructor in the nurs-ing college's Division of Parent- child and Adult Nursing. Women who meet the requirements for a low- risk birth may deliver at the new birthing center. Adult family members may obtain cancer screenings, sports physicals and employment exams at the clinic, while children may receive regular check- ups, school phys-icals and immunizations. Primary care for sick children and common adult health problems also will be available. Families experiencing a crisis or extra stress will be able to see an advanced practice psychiatric nurse, e COLLEGE OF HEALTH NUTRITION CLINIC HELPS ATHLETES The success of the Sports Nutrition Clinic in the College of Health has prompted other universities nation-wide to establish similar clinics and has boosted subscriptions to the clinic newsletter, according to director Christine Gardner. Twenty- five athletic departments from Division I universities have asked for information on starting clinics like Utah's, which offers nutrition counsel-ing and education to any student-athlete with eligibility to play intercol-legiate sports, said Gardner, clinical instructor in the college's Division of Foods and Nutrition. During the first two months of fall quarter last year, clinic staff had counseled 40 of 250 student- athletes ( the total number excluding 100 football players) from 12 of 13 teams. Gardner expects the clinic to serve about 125, or half of the University's student- athletes, by the end of t