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B E T H I S R A E L D E AC O N E S S M E D I C A L C E N T E R FALL 2016 Fare Gain p. 6 Heart-Earned Results p. 8 BREAKING DOWN WALLS TOM DELBANCO, M.D. Risks and Rewards p. 14 Teach Your Doctors Well p. 17 Despite graduating from both Harvard College and Columbia University College of Physicians and Surgeons, Tom Delbanco, M.D., has only one framed diploma hanging on his office wall at Beth Israel Deaconess Medical Center. The modest certificate marks his chief residency at New York City’s Harlem Hospital Center, which historically has been a safety net to meet the health care needs of a diverse and economically disadvantaged community. At that time, the hospital had just moved under the auspices of Columbia’s medical school, a transition that was at once intense and inspiring for Delbanco— and the experience changed his perspective on medicine for good. “It was the most amazing year,” reflects the renowned internist. “We went from six to 55 house staff in one day. Close to half of my colleagues were black. And on our first day, we had 44 admissions and 11 deaths on the Department of Medicine wards. It was an incredible year— boy, did I learn a lot!— and everything’s been relatively easy since.” Delbanco has certainly made it look easy. Since that decisive year in Harlem, he has moved seamlessly through a celebrated, 40-year-plus career in primary care, or general medicine, with an intellectual assurance that belies his passion. Along the way, he has played a pivotal role in transforming both primary care practice and education; improving the doctor–patient relationship; and championing the underserved. From the beginning, his goal was simple— make health care better for everyone. “I was always a real liberal do-gooder,” he recalls. “I wanted to help the CONTINUED ON P. 2 BREAKING DOWN WALLS TOM DELBANCO, M.D. CONTINUED FROM P. 1 world. I think the debate for me was whether to go back to Harlem Hospital and just work harder, or to try to change the delivery system more broadly. And I thought maybe I should start by bringing a focus on primary care into academic medicine, something that really didn’t exist at the time, at a place with a lot more resources, and then hopefully incorporate some of our successes with the underserved that might work well in a wide variety of settings.” That place ended up being Beth Israel Hospital, one of the founding hospitals of BIDMC. In those days, hospital-based clinics were repositories of care for the poor, the disenfranchised, and the elderly in the community, says Delbanco, existing primarily to teach young health professionals and having far too few resources to deliver firstclass medical treatment. Invited to come to Boston by then—physician in chief, Howard H. Hiatt, M.D., and then—hospital president Mitchell T. Rabkin, M.D., Delbanco began to build on his vision of a one-class system of primary care at Beth Israel, which would serve rich and poor alike with teams of doctors, nurses, and mental health professionals. Reversing the 2 traditional academic sequence of starting with research and education and then focusing on clinical care, he kicked off his unprecedented plan by concentrating initially on bringing teams into the delivery system and then grafting on educational and research components. “And our efforts seem to have helped, because now there’s virtually no general hospital in the country that doesn’t house a primary care program,” he notes. “It disseminated and it metastasized. We first got foundation, then federal, support for our ideas, and now they are part and parcel of the way almost all teaching hospitals work.” From there, Delbanco embarked on a series of firsts in academic primary care, from launching one of the first primary care residency training programs to establishing a Harvardwide research fellowship program in primary care, which has almost 300 alumni to date. He was also one of five founders of the Society of General Internal Medicine, where he served a stint as president. With an uncanny ability to sniff out the day-to-day health care concerns most relevant and meaningful to his patients, Delbanco would light upon potential solutions that invoked his creativity and his desire to reach as many people as possible. He led efforts to help doctors recognize and intervene with patients in trouble with alcohol. He was the major creative force behind the Picker Institute, which developed surveys to solicit patients’ feedback about their experiences in the hospital and the doctor’s office and have become an integral part of medical practice. He explored the complex issue of medical errors, even writing and directing a documentary that explores the issue through the eyes of patients and their families. And he instigated the development of the nation’s first online patient portal, PatientSite, brought to life by information technology gurus Ben Littauer and John Halamka, M.D. (now BIDMC’s chief information officer). “I guess I’m a change agent, and the reason I’ve stayed here is that I’ve been able to reinvent myself many times,” says Delbanco, who was honored with the first Harvard chair in primary care for his efforts in 2000 (see photo on page 3). “But if there’s a unifying theme, it’s that I’ve been trying to break down walls between those who care for people and those who get care. And your best bet for taking optimal care of yourself, in my view, is when you’re as informed as you need to be. It’s Giving Matters | Beth Israel Deaconess Medical Center awfully hard to engage actively and productively in your care if you don’t have all the goods at hand.” Perhaps no project gets to the heart of giving patients the goods like Delbanco’s hallmark OpenNotes initiative (www.opennotes.org), which he launched with long-time colleague and close friend, Jan Walker, R.N., M.B.A., a prominent member of the BIDMC faculty. With the goal of bringing more transparency to the traditionally enigmatic, complex, and often one-sided relationship between patients and those who care for them, Delbanco and Walker embarked on a pilot study funded by the Robert Wood Johnson Foundation to evaluate the impact of offering patients electronic access to the observations and plans their doctors write about them after each clinical encounter. Since the 2012 publication of the findings from their pioneering study in which 100 doctors shared their clinical notes with more than 20,000 of their patients, OpenNotes has spread to offer more than 10 million Americans ready online access to this information. “And we now have a plan to get to 50 million patients in short order, which is basically a mandate to make it the standard of care,” says Delbanco. “I’m very proud of that because it signifies a fundamental change in practice that I’m increasingly convinced will mean better care for patients, in terms of both processes and outcomes. Can’t prove it yet, we need to do a lot more studies, but this is not much ado about nothing.” Certainly, funders have been making much ado about the project’s ongoing promise. Last December, four major philanthropic organizations— the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, the Peterson Center on Healthcare, and the Cambia Health Foundation— gave more than $10 million in combined grant funding to support the national expansion and evaluation of OpenNotes based on its encouraging results thus far. The initiative has mounting evidence that this kind of engagement is an important path toward improving the quality, efficiency, and safety of care. Most patients report that they feel more in control of their care, and more than half report adhering more effectively to their medication regimens. Indeed, whether or not they choose to read what their doctors write, 99 percent want the access to continue, and currently at BIDMC, patients open almost two out of three of their notes. Fears on the part of doctors that they would be flooded with questions outside the visit or that it would take longer to write up their notes have proven unfounded; nationwide, the OpenNotes team knows of only four doctors who have dropped the transparent practice after giving it a try. And perhaps one of the most pleasant surprises for Delbanco personally is that OpenNotes has not turned out to be an intervention serving only the privileged. “We were worried that the young professional with her cell phone and her computer would be the person by far the most likely to read her notes,” he says, “and that people with less than a high school education or the elderly wouldn’t go for it. We were wrong. The elderly, the poorly educated, and more vulnerable populations are at least as interested as the yuppies.” Stressing that OpenNotes is not an app or a computer program but an ideological movement designed to change how we approach medicine, Delbanco has no shortage of ideas on where it might lead next. With support from the Commonwealth Primary Care Chair: Delbanco with Florence Koplow, who with her late husband, Richard, helped to generously endow the Richard and Florence Koplow–James Tullis Professorship of General Medicine and Primary Care at Harvard Medical School, the first chair dedicated to primary care and a post Delbanco still holds. Giving Matters | www.bidmc.org/giving p Topping 10: Since 2012 the landmark OpenNotes initiative, led by Delbanco (right) and Jan Walker, R.N., M.B.A. (left), has grown to offer more than 10 million Americans ready online access to their clinicians' notes and recently garnered more than $10 million in foundation support. Fund, Walker is already exploring a next step called OurNotes, where patients will work with doctors to co-generate notes interactively. BIDMC’s Departments of Psychiatry and Social Work have started OpenNotes projects with mental health professionals, and the OpenNotes team is exploring its applications in adolescent medicine with Boston Children’s Hospital. Delbanco also sees it having important implications for issues like alcohol abuse, pain management, and caring for aging parents. “We hope to introduce totally transparent communication throughout medicine,” he says. “We’ve begun with office practice, but it is also spreading onto hospital wards and intensive care units, and soon it will reach into the long-term care facility, the nursing home, and assisted living. This is just the start.” But with entrenched biases in the practice of medicine and an ever-expanding number of potential offshoots for OpenNotes, Delbanco is fully aware he can’t do it alone. “Doctors are very intelligent, therefore they make the highly unintelligent assumption that they can do everything well,” he muses. “And I’ve always been pretty conscious of what I do well and what I don’t do so well, so I’ve tried to buffer that. I never work alone; I always work with partners.” While he can’t lavish enough praise on Walker, who has been his collaborator and “the brains” of the operation for the past 25 years, he knows that the ongoing success of the OpenNotes movement will lie in the fresh perspectives and creative juices of future generations. He is thrilled that they recently hired a new executive director for OpenNotes, Catherine DesRoches, Dr.P.H., to whom he and Walker plan to pass the torch. And he recently received a generous $3.3 million gift from the Keane family to create a Harvard Medical School/BIDMC professorship whose incumbents will be committed to the ideals underlying the OpenNotes initiative— engagement, transparency, and respect for patients of all kinds— in perpetuity. In addition, there’s a whole new cohort of doctors and patients who, through technological advances and changing social mores, are poised to work together to transform the way medicine is delivered. “If I had to do it all over again,” says Delbanco, “I would become a pediatrician and I would work in pre-kindergarten preparing young people, my grandchildren, to become superb patients, superb members of the health care system. I think we really need a generation shift.” Delbanco’s legacy lies in this next generation of change. He envisions a day when patients don’t fear or over-exalt their doctors. When doctors easily embrace transparency and partnership with patients and their families. When patients have at least as much control over their records as their providers. When the invisible walls that impede the delivery of optimal medical care and shared decision-making among stakeholders crumble away. So as someone who has not just borne witness to the beginnings of this revolution but who has actively made it happen, is Delbanco optimistic? “When I became a doctor, my mother thought I was going to be a god, that I would run the show,” he reflects. “But now that dynamic’s really changing, and it’s good that it’s changing. We have much more to do, I have plenty to keep me busy, and I hope to continue being a part of that change. It’s a lot of fun.” 3 LETTER FROM THE SENIOR VICE PRESIDENT OF DEVELOPMENT Dear Reader, Giving Matters is published by the Office of Development at BIDMC. Kristine Laping Senior VP of Development (617) 667-7334 [email protected] Kate Gorman Senior Executive Director of External Relations (617) 667-7371 [email protected] Alexandra Molloy Senior Director of Development Communications (617) 667-7350 [email protected] Managing Editor: Alexandra Molloy Writing: Allison Knee, Alexandra Molloy Event and Marketing Coverage: Allison Knee, Alexandra Molloy Photography: Charlie Baker, BIDMC Archives, BIDMC Media Services, Michael Blanchard Photography, Lucien Capehart Photography, Danielle Duffey, Joel Haskell, Theresa Johnson Herlihy, Alexa MacIsaac Other photography courtesy of the Epstein Family, the Smith Family, and the National Rongxiang Xu Foundation Design: kor group, Boston Beth Israel Deaconess Medical Center is an institution with rich history in clinical care, medical education, and innovative research. This year marks a unique time for reflection on that history, as our community is experiencing three landmark anniversaries: the 120th anniversary of New England Deaconess Hospital, the 100th anniversary of Beth Israel Hospital, and the 20th anniversary of Beth Israel Deaconess Medical Center. This issue of Giving Matters not only reflects on our storied past—with a look back at Beth Israel Hospital and BIDMC through the words of former President and CEO Mitch Rabkin, M.D. (page 5)—but also envisions our promising future. Thanks to the generous support of our donors, we are improving how we communicate with patients (cover story), establishing new avenues for outcomes research in cardiology (page 8), and solidifying training opportunities in minimally invasive urologic surgery (page 17)—all of which directly benefit our patients and their families. While it is true that we have much to look back on and celebrate with pride, I believe there are many more innovative ideas and exciting discoveries on the horizon. And as we build on our legacy, we recognize that none of this would be possible without your dedication and support. So thank you for all that you have done and continue to do to make this institution great. Sincerely, © 2016 BIDMC Volume 7, Issue 1 Kristine C. Laping il Ma t tha ers t Mat While saying thank you can come in many forms, one of our favorites is receiving letters from our patients and their families. Many have shared uplifting and heart-warming stories of their time at BIDMC and the staff who cared for them. We are pleased to print some of these letters in Giving Matters and encourage you to contribute your own stories. To share your story, e-mail us at [email protected] or write to “Mail that Matters” at the BIDMC Office of Development, 330 Brookline Avenue (OV), Boston, MA 02215. Dear Dr. Tabb, Hello BIDMC, I recently was diagnosed with a GIST tumor in my stomach at BIDMC. From the initial ultrasonic endoscopy procedure to its subsequent surgical removal, I was very pleased with the care I received at your hospital. This type of tumor is often not found until it has become malignant, and the thought of that was very scary. I live on Cape Cod, so BIDMC is not my local hospital. However, after being diagnosed, I felt BIDMC was the best place to have the tumor removed. I want to give credit to the staff who worked on the Labor and Delivery and Postpartum units, January 29–31. From start to finish, the care I received during my delivery and postpartum period with my second daughter was just as excellent as what I fondly remember when I delivered my first in August 2013. From the initial call and visit with Dr. Jennifer Tseng’s office (Surgical Oncology), I was put completely at ease with the professionalism of the staff and Dr. Tseng’s proposed treatment plan. Dr. Tseng is not only an extremely talented surgeon, but she also has a very calming and caring demeanor. From the first office visit through surgery and recovery, I always felt as if I were her most important patient. She thoroughly explained the procedure and every step along the way. After the procedure, Dr. Tseng herself, and not a member of her team, sought out my wife to update her that the procedure had gone well and gave her a warm hug. A few weeks later, I was glad to hear that there was no sign of malignancy. Again, a warm hug concluded my visit. It is nice to know that as a teaching hospital, BIDMC has such a model physician leading a team of students and residents in the way to deal with patients and family. The care I received at BIDMC was top notch. I would highly recommend to friends and family to use your hospital if the need arises. Dr. Tseng and her entire team were outstanding. Sincerely, William Culverhouse 4 I especially want to express my gratitude and make you aware of the exceptional care provided by Bonnie Lake, R.N. She was professional, caring, and always quick to respond. Her presence and demeanor were incredibly calming and helped me relax, even when I felt the most tense. She made me feel like there was always a plan and kept me distracted when I was feeling impatient. Bonnie also intervened with complimentary therapies when I needed extra help. Second only to the support I received from my husband, Bonnie played an integral role in making my birthing experience efficient and positive. As a health care clinician myself, I have high standards for other health care providers. My hopes and expectations were so exceeded by Bonnie! It is one thing to give her my thanks directly, but I want to give her extra recognition by sharing with you what a great gift she is to your staff and patients. Gratefully, Kendra St. Hilaire Giving Matters | Beth Israel Deaconess Medical Center Rabkin (above) in the early 1970s in his role as president and CEO of the former Beth Israel Hospital, and today (left) at BIDMC. This year marks three momentous anniversaries for our institution: New England Deaconess Hospital’s 120th, Beth Israel Hospital’s 100th, and BIDMC’s 20th. In this special Anniversary Leadership Spotlight, we asked Mitchell T. Rabkin, M.D., to reflect on our potent history and how this foundation has put us in a position of strength for the future. For more anniversary reflections from influential leaders at the medical center, please visit: bidmcgiving.org/anniversary. Mitchell T. Rabkin, M.D. A graduate of Harvard Medical School (HMS), Rabkin became president and CEO of the former Beth Israel Hospital in 1966 at the age of 36 and subsequently became the CEO of CareGroup, BIDMC’s nonprofit parent organization, upon its formation in 1996. Today, Rabkin serves as a professor of medicine at HMS and as a distinguished institute scholar at the Carl J. Shapiro Institute for Education and Research at HMS and BIDMC. 2016 marks the 50th anniversary of his association with the medical center. Look back a century ago, and two decades more. Two hospitals — Beth Israel Hospital and New England Deaconess Hospital— established by their communities, each seeking the best care for all patients, generously and warmly given. Physicians joined, and nursing schools were started. Soon, appreciation arose that the best care called for academic connections. This pointed to Harvard and Tufts, ultimately leading to hospital residency and graduate specialty training. The Harvard relationship intensified. Islands of excellence at both hospitals multiplied. We cared for persons, not disembodied diseases. We abandoned open wards, placed inpatients regardless of economic status or race, established hospital-based social services, home care, and linkages with urban community health centers. We issued the first hospital statement on the rights of patients, now posted at every U.S. hospital. The first with primary nursing throughout the hospital, we demonstrated the professionalism of nursing and strengthened the partnership of nurse and physician. We involved patients more fully in their care. Think once again on those early years. Contrast medicine at the 20th century’s start with today’s complexity. Each hospital’s capability grew. Achievements included the first non-invasive study of cardiac physiology, fundamentals in the treatment of diabetes, development of the cardiac pacemaker, early care of cancer patients (whom many hospitals wouldn’t admit), advances in thoracic surgery, liver and kidney transplantation, and psychodynamic psychiatry. Moving the historic Harvard-Thorndike Clinical Research Center from Boston City Hospital enriched clinical studies. Beyond keeping pace with the century’s advances, our two hospitals were among those leading the way. With the burgeoning of knowledge, the challenge of keeping current focused us on the teaching and learning of medicine. Emphasis on critical thinking as a process in diagnosis led to leadership at Harvard Medical School. And then there are some contemporary examples. The characterization of VEGF (vascular endothelial growth factor) opening insight into the nature of cancer. Identification of PI3-K (phosphatidylinositol-3-kinase) and its primary role in cancer, leading to medications for leukemia and lymphoma. Insight into the molecular biology of malignancy, creating a cure for acute promyelocytic leukemia and offering promise of even wider therapy. These are advances of Nobel Prize quality. The nature of pre-eclampsia, devastating in late pregnancy, was defined. Important understandings in migraine and neurology emerged. Information management, sharing medical records with patients, and easing their communication with physicians highlight our advances in the digital world. In 1996, Beth Israel Deaconess Medical Center formed in response to environmental forces but also to an appreciation that what had grown from a few islands of excellence called for even further strengthening. And we moved from “We-They” to “Us.” Our community hospital ties make care more convenient and cost-effective system-wide. The new organization, BIDCO (Beth Israel Deaconess Care Organization) enables our physician groups and hospitals to contract, share risk, and together build better care management systems. Our growth and then merger came about through the insight and generosity of informed governing boards, unwavering support of our communities, affiliation with Harvard Medical School, funding from National Institutes of Health, other agencies, donors, patients, and families, and the steadfast dedication of the physicians, nurses, social workers, and all staff from entry level to top management. As medicine and patient care grow more complex, our commitment, our ever-improving performance, and the continuing—and deeply appreciated—support from our community offer optimism as BIDMC moves into the decades ahead. Mitchell T. Rabkin, M.D. CEO Emeritus, BIDMC Professor of Medicine, Harvard Medical School Giving Matters ||www.bidmc.org/giving www.bidmc.org/giving 5 FARE GAIN Major gifts nourish surgeon’s unique work in the field of nutrition G eorge L. Blackburn, M.D., Ph.D., describes his unusual yet illustrious 45-plus-year career path in nutrition medicine as one “guided by opportunity and driven by need.” Trained initially as a surgeon, Blackburn in the late 1960s discovered that up to 50 percent of hospitalized surgical patients suffered from moderate to severe malnutrition and became intrigued with a new innovation called intravenous (IV) feeding; he went on to revolutionize how IV solutions were formulated. Blackburn was so inspired by this foray into nutrition that he decided to pursue his Ph.D. at the Massachusetts Institute of Technology’s Laboratory of Nutrition and Food Science, a small, now-defunct program that graduated a number of leading Harvard researchers in the field today. “So I had a college degree and an M.D., and then I had a Ph.D. in nutritional biochemistry,” says the 6 director of the Center for the Study of Nutrition Medicine at Beth Israel Deaconess Medical Center. “Not many surgeons have Ph.D.s in nutritional biochemistry but that opened up an entire new industry in medicine.” While Blackburn was drawn into this “new industry” by the problem of undernourishment, what has kept him engaged throughout the years is the emerging medical crisis at the opposite end of the spectrum— obesity. As physicians struggled to address the nascent epidemic in the 1980s, he was one of the first to perform a revolutionary gastric bypass in New England and would later develop the first evidence-based guidelines for weight-loss surgery. Today, his team is partnering with neurologists to understand the biological underpinnings of eating behaviors to create cognition-based treatments, performing research showing that lowering dietary fat intake can improve breast cancer survival rates, and investigating distinctive cohorts of patients like “lean diabetics” who exhibit many of the detrimental symptoms of obesity without the corresponding weight gain. They are even working on designing a new app that will provide users with real-time feedback about their food consumption and its health implications. “We think that food, which is the problem, has one of the best chances of being the solution,” says Blackburn. “We are exposed to food 24/7, so to manage that effectively we need a 24/7 response.” Blackburn’s unique perspective and experience at the intersection of nutrition and surgery has spurred equally unique philanthropy to support his leading-edge work. Feihe International, one of the leading producers and distributors of infant formula, milk powder, soybean, and walnut powder in China, recently made a $4.5 million contribution to create the Feihe Nutrition Laboratory under Blackburn’s direction. This facility conducts pioneering research studies on the connections among diet, nutrition, and cognition across the lifespan and offers young investigators in the field seed funding to explore and advance innovative ideas like the real-time app. The novel efforts of Blackburn’s team also got a major boost from a generous $3.3 million gift from longtime friend and collaborator S. Daniel Abraham to endow the George L. Blackburn, M.D., Professorship of Surgery at BIDMC/ Harvard Medical School (HMS) in his honor. This gift is the second from Abraham, the founder of the multi-billion Slim-Fast Foods who sought Blackburn’s nutritional advice on one of the most successful diet products in history. His first, in 1998, created the S. Daniel Abraham Professorship of Surgery, the HMS chair Blackburn holds currently. Blackburn says that he is so incredibly grateful for this type of flexible, open-minded funding that offers a viable alternative to more rigid government grants for pursuing out-of-the-box thinking. “This money supports innovation,” he says. “If it can be done with other money, we do it with other money, because this type of funding is so special, so precious, so appreciated that we must use it where it’s needed most and where there are no other options. It has allowed me to do a lot more than I ever realized I could.” Giving Matters | Beth Israel Deaconess Medical Center Faces of BIDMC Mary Buss, M.D., M.P.H., is a medical oncologist and palliative medicine specialist at Beth Israel Deaconess Medical Center. Buss, who founded and directs the outpatient palliative care clinic at the medical center, received the 2015 Hastings Center Cunniff-Dixon Physician Award in recognition of her leadership in promoting patient-centered care for those near the end of life. She was also recently the recipient of the inaugural Roger Lange Legacy Award, a grant given to a BIDMC community member for completion of a cancer-focused project, which was established by Robert and Maureen Kelly to memorialize Lange, a longstanding BIDMC oncologist who died in 2012. What is palliative care? Palliative care is a medical subspecialty that is focused on taking care of patients who have serious—although not necessarily terminal—illness, with the primary goal of maximizing their quality of life. The critical component is helping individuals live well. Many people believe palliative care is synonymous with hospice care, but it is so much more. Hospice care—care for people with incurable disease at the final stage of life—is a single component that falls under the umbrella of palliative care. The belief that patients must choose between getting treated for their illness and getting palliative care is simply not true. This is not an either/or approach but a simultaneous care model that considers what’s best for all aspects of an individual’s well-being. And while my area of expertise is oncology, palliative care is equally valuable in any area of acute illness from cardiovascular to infectious disease. What was your goal in founding the outpatient palliative care clinic at the medical center? The vast majority of health care is delivered in the outpatient setting. I quickly realized that if we didn’t start reaching patients in this setting, then we were only going to reach patients when they’re in crisis. Crisis is not an ideal time for productive decision making. There is data that patients who have conversations early in the course of their illness make different decisions about care at the end of their illness, which ends up being more positive for patients and their families and less of a burden on the health care system. Right now our outpatient clinic is open to patients with complex decisionmaking and psychosocial needs for two half-days each week. Expanding this critical resource to five days a week would be incredibly valuable and is where philanthropy could have a huge preemptive impact. What are you working on now at BIDMC? The vast majority of patients in a hospital have palliative care needs, but that doesn’t mean that everybody needs to be seen by a palliative care specialist. It does mean, however, that physicians need to have more competence in palliative care. That’s where education comes in. I have been doing a lot of work educating primary care docs who, because they don’t generally encounter a large portion of patients who are seriously ill or at end of life, don’t have the opportunities to get the skills they need. We also have efforts focused on training cardiologists and oncologists because they deal with the two leading causes of death in this country. Is there anything in particular that you focus on in educating physicians in palliative care? It’s safe to say that palliative care, more than any other specialty, has really embraced communication as a procedural skill that needs to be taught as such. Just like a surgeon is trained how to do a suture, doctors need to be taught how to handle a family meeting with five people who have five different understandings of the patient, the severity of the illness, and what to do moving forward. There’s a skill to that, and the field is trying to be very deliberate and thoughtful on how these skills are Give and Receive A charitable gift annuity is a win-win for you and BIDMC Establishing a deferred annuity was a win-win for Alice Bruce. Not only is she able to support one of her favorite charities, but she is also able to secure an income stream throughout her retirement. MARY BUSS, M.D., M.P.H. Medical Oncologist, Palliative Medicine Specialist taught. Communications field training is expensive because the best way to do it is to make people practice with trained actors and with observation and feedback by experts. As a result, it’s hard and it feels real, and the training is much more effective. But finding the resources to fund this specialized training is challenging. What makes BIDMC special in this area? Historically, BIDMC has been a place that has embraced every patient population regardless of background or illness. That inclusivity and acceptance of individuality is at the heart of palliative care because our goal is to help you live as well as possible, and everyone defines that differently based on who they are. “BIDMC has been a lifesaver for my family for so many years and in so many ways. My annuity was created to thank all the people at the medical center who have worked to keep us all healthy; we know we are in the very best hands.” —Alice Bruce Benefits of a charitable gift annuity include: • Easy to establish • An immediate income tax deduction • Deciding when to receive the income; the longer you wait, the higher the annuity rate • Knowing that your gift supports extraordinary patient care, leading-edge research, and exceptional medical education For more information, please contact Noreen Mitchell at (617) 667-1387 or [email protected], or visit us online at www.bidmc.org/plannedgiving. • Annual, fixed income for life Giving Matters | www.bidmc.org/giving 7 HEART-EARNED RESULTS Family pledges $8.3 million to establish the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology While the phrase “heart attack victim” might conjure up an image of an overweight, middle-aged man clutching his chest, the reality today is far different. Widespread initiatives to reduce smoking and poor eating habits over the last decade have actually lowered heart attack rates in patients middle-aged and younger. Instead, the heart attack victims rushed into emergency departments across the country now tend to be significantly older, more frail—and consequently more difficult to treat. The full picture of this epidemiological change in cardiovascular disease came from evaluating outcomes data from hospital billing information over a 10-year period and is critically important in determining how clinicians best allocate health care resources and accurately evaluate future outcomes. “We are just beginning to understand the value of looking at large amounts of data, not just at the institutional level, but at the national level, to guide the best clinical decisions,” says Peter J. Zimetbaum, M.D., associate chief of cardiology and director of clinical cardiology at Beth Israel Deaconess Medical Center. “The field of cardiology, particularly at BIDMC, has been a leader in this area of looking at outcomes to drive clinical care.” Outcomes research is fundamentally about understanding how we treat disease in real-world practice. It requires both valid, accurate data as well as a robust set of statistical and epidemiological methods to make inferences about that data. As access to data becomes increasingly available and the number of different therapies offered to patients expands, clinicians at BIDMC are actively looking to make sense of all this new information to make improvements in health care. “A home run in discovery that would have a huge impact on survival when it comes to heart disease isn’t coming in the next few years,” says Duane Pinto, M.D., M.P.H., director of the cardiac intensive care unit. “What we need to do is actually apply the technologies and strategies that we already have to more patients in a more effective way.” 8 Longtime BIDMC supporters and grateful patients of Zimetbaum, Richard A. and the late Susan F. Smith recognized the value of this research and pledged $8.3 million to support this work in the Division of Cardiovascular Medicine at BIDMC. A portion of their gift established the Richard A. and the late Susan F. Smith Center for Outcomes Research in Cardiology. The pioneering program, which was the brainchild of Zimetbaum and is the first of its kind in Boston, will capitalize on clinical observations and rigorous data analyses to evaluate health care policy as well as treatments and devices for patients with cardiovascular conditions. Its goal is to ultimately produce safer and more personalized care. Support from the Smith family’s gift has allowed the center to purchase expensive data sets and hire leadership and programmers with the necessary expertise to properly evaluate that data. “They are quite visionary,” Robert Yeh, M.D., M.Sc., says of the Smith family. A national leader in the field of cardiology outcomes research, Yeh was recruited as director of the Smith Center last fall. “They see the importance of developing a better understanding of the safety, cost effectiveness, and ethical implications of the work that we do in trying to prevent and treat cardiovascular disease.” The gift will also establish an endowed Harvard Medical School Professorship in clinical cardiology at BIDMC in honor of Zimetbaum. A national leader in electrophysiology, Zimetbaum is highly regarded for his groundbreaking cardiovascular research studies and personalized, expert patient care. This rare clinical professorship will serve as a testament to the role he has played in advancing the discipline of cardiovascular medicine and will also provide future generations of cardiologists with exciting opportunities to lead their field. But it is the creation of the Smith Center that could define Zimetbaum’s legacy. “It is the highest mark of leadership to initiate a transformational outcomes program at a time when such information is so critically needed and the faculty is so incredibly motivated Giving Matters | Beth Israel Deaconess Medical Center p Richard A. and Susan F. Smith IN MEMORIAM t Peter J. Zimetbaum, M.D. p Robert Yeh, M.D., M.Sc. to make it work,” says Jeffrey Popma, M.D., director of interventional cardiology. “I really have to commend Dr. Zimetbaum for his vision in identifying an area of unmet clinical need for the institution and recruiting the individuals who would be able to navigate the sustained growth of this vital program.” While outcomes research has been conducted in silos within the Harvard hospitals and select locations across the country for years, the Smith Center at BIDMC will be one of only a handful of dedicated programs across the country and the only center created from the ground up with a substantial financial foundation. “We have always wanted to have a place where people interested in these ideas could come together, cross pollinate, interact, and become national and international leaders in developing new ideas for this space,” says Yeh. “None of the other centers have started with the types of resources that we have. We can really create something unique.” The Smith Center also places BIDMC at the nexus of a field that will only become more critical in the years ahead as health care reform places a greater emphasis on providing high-quality, cost-effective care that is centered on the patient. “If there is any place in the country that should be able to bring together people who know how to do this research at a very high level and whose results will stand up and generate effective policy, it is here,” Zimetbaum says. Experts within the Division of Cardiovascular Medicine at BIDMC have an extensive history of managing the full spectrum of heart conditions from coronary artery disease to cardiac arrhythmias. The division has been internationally recognized for its contributions to cardiovascular medicine over the last 60 years, including the invention of the concept of cardiac pacing, defibrillation for cardiac arrhythmias, and multiple “first-in-man” procedures. In addition to their leadership in the clinical arena, cardiologists at the former Beth Israel Hospital started the Cardiovascular Data Analysis Center (CDAC) in the mid-1990s; this center was the pivotal analysis group for many of the new device trials across the Susan F. Smith, 1932–2016 country and around the world, and became widely known for its data integrity and analysis. Now with better access to quality data and the creation of the Smith Center, BIDMC is looking to change the way health data is analyzed once again. “Cardiology is a natural place for outcomes research because there is so much rich data in this area,” Yeh says. “We also have more capability of actually answering the questions that maybe 20 years ago we couldn’t understand.” Yeh and his team have already hit the ground running with a number of projects investigating public policy as well as comparative effectiveness research that could have immediate impact on patient care. Among the specific areas of focus at the Smith Center is work related to evaluating public health policy. “One of the big problems and one of my great frustrations in my career is watching payers and the government make decisions about how we can practice based on poor data,” Zimetbaum says. “Data that is done in a way that doesn’t stand the test of time and then months later, years later, we find out it was wrong and end up changing policies that we suspected were poorly conceived all along.” As part of health care reform and in an effort to build trust with patients, the health care system has experienced a strong push toward increasing transparency. Massachusetts has been on the forefront of this movement and one of the first states to adopt public reporting of outcomes for some cardiovascular procedures. While on the surface, this openness seems like it would be beneficial for patients, there are a number of unintended but potentially harmful consequences of the policy. Angioplasties are surgical procedures to repair or unblock blood vessels, and a paper published by Yeh last year in the Journal of the American College of Cardiology showed that in states with public reporting of angioplasty outcomes, patients who present with heart attacks receive fewer of these procedures and have higher rates of mortality than in states with no public reporting. Since the current methods used to determine the clinicians’ With heartfelt sadness, the BIDMC community mourns the loss of Susan F. Smith, wife of Overseer Emeritus Richard A. Smith, who passed away on July 30 at the age of 83. Mrs. Smith was a dedicated philanthropic supporter and friend to the medical center, along with so many other organizations throughout her cherished hometown of Boston. With gifts through the Richard and Susan Smith Family Foundation, as well as their personal giving, Mrs. Smith and her family established a remarkable legacy of supporting innovative endeavors in a variety of areas at BIDMC, including cancer, endocrinology, and community health. Most recently, the Smiths expressed their commitment to transforming cardiovascular care on a large scale by establishing the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and a professorship in clinical cardiology (see main story). “This gift—as with so many others that bear Susan’s name—was made possible through her tremendous generosity, her imagination, and her firm belief in creating a better world for future generations,” says BIDMC President and CEO Kevin Tabb, M.D. “Susan was a beloved member of our community and will be deeply missed by all those who had the pleasure of knowing her.” In addition to her husband, Richard, Susan is survived by her three children, Amy Smith Berylson and her husband, John; Robert Smith and his wife, Dana; and Debra Smith Knez; eight grandchildren; five great grandchildren; her sister, Carol Flax Frieder and her husband, Sam; seven nieces and nephews; and her sister-in-law, Nancy Lurie Marks. CONTINUED ON P. 10 Giving Matters | www.bidmc.org/giving 9 CONTINUED FROM P. 9 publically reported outcomes do not take into account the patient’s condition at the time of the procedure, it may be that some doctors are actually choosing to avoid performing angioplasties on the increasingly prevalent high-risk patient population for fear of skewing their published numbers. Meanwhile, the same states have reported better outcomes for angioplasty procedures overall because clinicians may be selecting more low-risk patients instead. These results are not only deceiving to the public but also incredibly dangerous for the patients. “No one wants someone who can potentially benefit not to receive life-sustaining therapy because of an admirably intended program like public reporting,” says Pinto, who serves as the governor and president of the Massachusetts American College of Cardiology chapter. As state and federal lawmakers look to potentially publicize all surgeons’ outcome statistics in the future, clinicians at BIDMC are leading the charge to evaluate the implications of this particular health policy and better understand what that means for patients. Pinto has been working closely with the Massachusetts Department of Public Health to refine the way the clinicians’ scorecards are calculated to minimize these adverse consequences. “Transparency is important but the consequences are something that should be on the minds of those making policies,” Yeh says. Clinicians in the Smith Center are also focused on comparative effectiveness research, or evaluating the efficacy, benefits, and potential harms of different treatments for specific patients. One of the biggest advantages of the center compared to stand-alone outcomes research is its access to large amounts of real patient information. One such database is Centers for Medicare & Medicaid Services (CMS) billing information. “We have a cache of 40ish p Duane Pinto, M.D., M.P.H., and Jeffrey Popma, M.D., in the cardiac catheterization laboratory million patients who are registered in an administrative database that captures their individual use of medical services over time,” Popma says. The database contains more than 10,000 procedure codes assigned to patients across all subspecialties and organized by demographics such as age, race, and co-morbidities. “Without actually meeting the patient, we will be able to get a very good impression of the overall health status of the patient by combining complication and co-morbidity codes,” he says. Using this information, Popma plans to explore how 10 “This is an opportunity for people to participate in changing health care in a significant and tangible way.” —Peter J. Zimetbaum, M.D. patients in the United States are treated for structural heart disease, specifically aortic valve disease and mitral valve disease. “We can use the tools that are currently embedded within the database both to identify the risk of the patients and to determine what their outcomes have been,” Popma says. Using specific algorithms to analyze that data, clinicians can then determine which future patients may be the best candidates for a particular treatment. “It is really going to provide phenomenal insight into patient outcomes that will serve to enhance their medical care in the future,” he says. To start, the Smith Center will use the data from CMS and electronic medical records from hospitals around the country along with results from clinical trials to evaluate safety and effectiveness of cardiovascular devices, medical technologies, and therapies. “We will have a whole new understanding of our capability to take advantage of these new sources of data to understand medical safety and efficacy,” Yeh says. As word spreads about the work being conducted in the Smith Center, BIDMC becomes a major draw for those interested in this burgeoning field, both as students and experienced clinicians and researchers. “We want to be a magnet for the best and the brightest to come and learn how to do this research and facilitate their training with the best mentors in the world,” Zimetbaum says. And while initial efforts of the Smith Center are focused in cardiovascular disease, this methodology can be expanded to other specialties throughout the medical center and health care at large. “This is going to allow us to understand how certain disease states are managed in the United States and the bandwidth is limited only by funding,” Popma says. “There is really no limit on what can be done in terms of analyzing disease states.” A new influx of philanthropic funding will provide clinicians with the critical resources to enhance the infrastructure of the Smith Center, such as additional research staff, new databases for research, statisticians, and fellowships for those interested in a career in outcomes research. “This is an opportunity for people to participate in changing health care in a significant and tangible way,” Zimetbaum says. Cardiologists at BIDMC have been innovators in care for decades, and the establishment of the Smith Center is no exception. “It is realistic to think within five to 10 years that policy changes, with regard to things like public reporting and implementation, with regard to how we do our procedures and apply our medications, are going to come out of this center,” says Pinto. And as the Smith Center gains traction in the outcomes research arena, its success is measured not just by papers published and/or policies changed, but by overall improvement in patient care. “The goal is to increase our understanding of how we are treating patients in a way that translates to improving outcomes,” Yeh says. “We want to tackle the pressing challenges in health care today and use scientific methodology to understand those questions and develop better solutions for patients everywhere.” Giving Matters | Beth Israel Deaconess Medical Center Renewed Effort Longstanding kidney cancer research program gets $11.3M in additional funding from the National Cancer Institute W ith kidney cancer afflicting more than 65,000 new patients each year, the National Cancer Institute (NCI) has replenished a major and historically potent arsenal in the fight against this disease by awarding Beth Israel Deaconess Medical Center an $11.3 million, five-year renewal grant for its continued leadership of a multicenter kidney cancer research consortium. The NCI’s highly competitive Specialized Programs of Research Excellence (SPORE) grants promote interdisciplinary partnerships among basic scientists and clinical investigators, and are designed to advance new and diverse approaches to the prevention, early detection, diagnosis, and treatment of diseases in 18 different organ systems. BIDMC has overseen the only Kidney Cancer SPORE program in the country for more than a decade. “Through these SPORE grants, basic scientists work collaboratively with clinical investigators to rapidly move laboratory discoveries into the clinic and to our patients,” says David F. McDermott, M.D., director of the Biologic Therapy and Kidney Cancer Programs in the BIDMC Cancer Center. “The Kidney Cancer SPORE has already been responsible for a significant number of important advances in the understanding, diagnosis, and treatment of kidney cancer, and we hope that the continuation of this funding will help reveal new insights into this disease.” McDermott runs the Kidney Cancer SPORE, which represents a coordinated effort of more than eight major medical institutions, along with William G. Kaelin, Jr., M.D., of Dana-Farber Cancer Institute. p David F. McDermott, M.D. With the contributions of more than 35 researchers, this unique SPORE approaches the therapeutic intervention of kidney cancer from several different angles, including the targeting of critical molecular pathways to prevent and treat the disease, the identification of molecular biomarkers to better monitor and predict patient outcomes, and the improved understanding of the mechanisms by which the disease becomes resistant to standard therapies. The new grant will support four research projects with translational components that address critical problems in kidney cancer, and will also fund three “core” facilities, which are based at BIDMC and provide scientists with the infrastructure needed to conduct their research. In addition, the renewal has a vital careerdevelopment component. “Over its 12-year lifespan, this grant has not only provided direct funding for lab research and clinical investigation, but has also facilitated the growth and development of young investigators in the field of kidney research,” says McDermott. “Many of the field’s leading researchers got their start through our SPORE funding, and the renewal of this funding will ensure that we will be able to continue to support promising new ideas and pursue new directions.” Prominent Physician— Scientist Becomes BIDMC’s New Chief of Cardiology T his spring, Beth Israel Deaconess Medical Center named accomplished cardiologist and researcher Robert E. Gerszten, M.D., as its new chief of cardiology, enhancing the leadership and expertise of a cardiology division historically recognized for its superior clinical care and innovative research. Gerszten’s clinical interests span the spectrum of comprehensive adult cardiology and novel disease prediction, while his extensive research efforts focus on the relationship between cardiac and metabolic diseases. “I couldn’t think of a more ideal place to build collaborative bridges between the clinical and research missions of a cardiology division,” says Gerszten, who served as director of clinical and translational research at the Massachusetts General Giving Matters | www.bidmc.org/giving Hospital Corrigan Minehan Heart Center since 2007. “I am particularly excited that the hospital leadership shares my enthusiasm to make BIDMC a national leader in crossdisciplinary investigation and in the integration of innovative patient care models.” Over the past decade, Gerszten has become a national leader in translational research focused on integrating emerging protein- and metabolismbased approaches to uncover new biomarkers and disease pathways. He and his research team have discovered novel biomarkers that identify patients destined to develop diabetes more than a decade before disease onset. An area of particular interest is the application of these tools to recognize individuals most likely to benefit from clinical interventions in cardiometabolic diseases. p Robert E. Gerszten, M.D. Gerszten’s research is funded by the National Institutes of Health, as well as the American Heart Association, from which he received an Established Investigator Award. “Dr. Gerszten is an outstanding scientist, a superb clinician, and a gifted mentor and teacher,” says Mark Zeidel, M.D., chair of the BIDMC Department of Medicine. “He brings additional depth and a creative spirit to an already strong cardiology division known for extraordinary clinical care and leading-edge research. His leadership will also immeasurably strengthen how the division conducts translational cardiovascular research across disciplines.” 11 Internationally Renowned Oncologist Named Director of Rosenberg Clinical Cancer Center L ast October, Beth Israel Deaconess Medical Center officially named Manuel Hidalgo, M.D., Ph.D., director of the Leon V. & Marilyn L. Rosenberg Clinical Cancer Center and chief of the Division of Hematology-Oncology. Hidalgo is an internationally respected oncologist whose groundbreaking work in experimental cancer therapy and tumor model development has led to key advances in the treatment of pancreatic cancer. He will combine his vast experience in research and patient care to oversee all the clinical cancer operations at the medical center. “We want to lead the revolution in cancer prevention, diagnosis, and treatment,” he says. “We want to contribute by discovering and transitioning those discoveries to patients.” & BITS & PIECES Little updates on big happenings in the BIDMC community. Want to learn more or share one of your own? E-mail [email protected]. A native of Spain, Hidalgo comes to BIDMC from the Centro Nacional de Investigaciones Oncológicas, where he served as director of the Clinical Research Program and vice director of Translational Research. He previously served as co-director of the Gastrointestinal Cancer Program at Johns Hopkins. At BIDMC, in addition to a clinical practice focused on gastrointestinal (primarily pancreatic) cancer, Hidalgo now manages the extensive multi-disciplinary programs currently in place, including 21 specialty patient-care programs ranging from pancreatic and breast cancer to bone-marrow transplantation and biologic therapies. “We want to treat patients with the most efficient care possible,” he says. “But oftentimes in p Manuel Hidalgo, M.D., Ph.D. cancer we know that is not enough. That is where research is very important.” Hidalgo recognizes the value of research to uncover better treatment options to improve care for patients at BIDMC and beyond. His background in translational research is focused on the development of mouse models to develop new strategies to further personalize patient care. This research platform is used for drug screening, biomarker development, and creating tailored Last fall, leaders from the Alliance of Families Fighting Pancreatic Cancer (AFFPC) presented a $165,000 check to A. James Moser, M.D., co-director of the BIDMC Pancreas and Liver Institute, to fund a clinical research fellow and other pancreatic cancer research. A partnership of grass-roots foundations and families across the country, the AFFPC donated another $31,000 to BIDMC in December. Doctors in BIDMC’s Chest Disease Center saved Jennifer Champy’s life at age 39 with a diagnosis of tracheobronchomalacia (TBM), a condition causing her central airways to collapse, and a subsequent arduous but extremely successful surgery. In January, Champy founded a nonprofit foundation called Cure TBM, which in May made its first donation—$30,000—to the center to help fund a clinical trial looking at the efficacy of stents in treating the illness. When Gail Schechter learned that her friend Laurie Gershkowitz had spent some time in BIDMC’s Emergency Department (ED) and was unable to charge her cell phone when it died, she immediately saw an opportunity. Schechter and her fellow book club members (Elyse Balder, Lauren Bogart, Beth Freeman, Denise Goodman, Elyse Marsh, Linda Robert, Susan Shale, Abby Shapiro, and Amy Sucoff) pooled their funds to purchase three much-needed charging stations in the ED to commemorate the bar mitzvah of Laurie’s son, Jake. In May, more than 145 BIDMC staff, friends, and family joined thousands of caring and concerned citizens in the therapies and augments BIDMC’s approach to testing experimental drugs in parallel with human clinical trials. “Dr. Hidalgo is a world leader in developing new ways to treat and one day cure cancer,” says Pier Paolo Pandolfi, M.D., Ph.D., director of the BIDMC Cancer Center and Cancer Research Institute. “His expertise perfectly complements our work and our mission, and we are honored to have him as the newest member of our Cancer Center.” the Louis D. Brown Peace Institute and a more peaceful and violence-free community. For the second straight year, BIDMC President and CEO Kevin Tabb, M.D., served as co-chair. In June, BIDMC’s team participated in the 31st Annual AIDS Walk Boston & 5K Run, raising more than $8,400 to support the work of the AIDS Action Committee, and was named a “gold level” team for commitment to the committee’s mission. With support from the Massachusetts Office of Victim Assistance (MOVA), BIDMC’s Center for Violence Prevention and Recovery (CVPR) within the Department of Social Work offers trauma-informed services to patients and families affected by multiple forms of violence at no charge. Recently, MOVA awarded the center additional Victim of Crime Act funds, which will help expand services and programs for people who have experienced domestic violence, sexual assault, community violence, and homicide, and will provide additional educational opportunities for staff. This summer, 32 high school students ages 14—17 were accepted into the Summer Health Corps program run by the Division of Volunteer Services in Human Resources at BIDMC. During the months of July and August, these student volunteers dedicated 20 hours a week for six weeks exploring various health care—related careers while gaining hands-on experience in a hospital setting. 20th annual Mother’s Day Walk for Peace in support of 12 Giving GivingMatters Matters|| Beth Israel Deaconess Medical Center FILLING THE REGENERATION GAP Foundation Gift Establishes Professorship and Center to Advance the Field of Regenerative Therapeutics I t may seem like the stuff of science fiction, but the field of regenerative medicine is a game-changing area of translational research that could offer extraordinary solutions for patients with currently irreparable conditions caused by disease, damage, or defect. This groundbreaking discipline of exploring innovative ways to replace, engineer, or regenerate human cells, tissues, and organs recently received an enormous boost at Beth Israel Deaconess Medical Center with a gift from the National Rongxiang Xu Foundation, a not-for-profit charitable organization based in the United States. To honor the legacy of its namesake, the foundation’s generous support established the Rongxiang Xu, M.D., Professorship of Surgery in the Field of Regenerative Therapeutics at Harvard Medical School and the Rongxiang Xu, M.D., Center for Regenerative Therapeutics through an endowment fund. A renowned Chinese physician, the late Rongxiang Xu, M.D., graduated from Qingdao Medical College in China. Trained as a surgeon, Xu witnessed the pain and scarring of burn patients treated with conventional therapy and was determined to discover a more effective, less painful approach. He developed a new therapy for burns that helped to restore the physiological structure and function of the skin and other tissues, thereby dramatically reducing pain, illness, and death. Through years of studies, Xu and his research team revealed important fundamental principles for regenerating adult tissue and organs, translating this knowledge into novel topical therapies. His significant contributions saved lives, revolutionized wound therapy, and dramatically improved the quality of life of countless patients around the world. Over the past three decades, Xu’s research in tissue repair and regeneration led to multiple U.S. patents and the growth of his successful multi-national company, MEBO International. The government of China honored Xu, who passed away earlier last year, for his many contributions with a commemorative postage stamp bearing his image. His scientific achievements have also been t q u Giving Matters | www.bidmc.org/giving The late Rongxiang Xu, M.D. Aristedes Veves, M.D., D.Sc. A series of Chinese postage stamps issued in Xu's honor acknowledged by U.S. Presidents Barack Obama, Bill Clinton, and George H. W. Bush. Xu’s interest in translating his work to a broad group of patients was further realized through a longstanding collaboration with Aristidis Veves, M.D., D.Sc., in BIDMC’s Roberta and Stephen R. Weiner Department of Surgery. In recognition of his international leadership in the field of regenerative therapeutics and wound healing, Veves has been nominated to be the first Rongxiang Xu, M.D., Professor of Surgery and will serve as the director of the BIDMC Rongxiang Xu, M.D., Center for Regenerative Therapeutics. “This center will be one of a kind,” says Veves. “Through research, education, and clinical innovations, the center will improve the lives of millions of people around the world suffering from chronic wounds, burns, and other serious conditions.” Dr. Veves focuses much of his research—which also receives funding from the National Institutes of Health and other agencies—on understanding what impairs wound healing in diabetic patients and using that knowledge to develop novel therapeutic products for patients with chronic wounds caused by diabetes, venous ulcers, burns, and more. Veves is concentrating his efforts largely on neuropeptides, protein-like molecules that have multiple functions in the body. He and his collaborators at BIDMC, the Wyss Institute, the Massachusetts Institute of Technology, Tufts University, and other institutions are working on developing new biomaterials, such as topical dressings, that will deliver these neuropeptides and other potentially curative factors to conditions resulting from a failure of tissue repair and regeneration. In addition to providing critical resources to further advance the work of Veves and other groundbreaking scientists in the Boston area, the Rongxiang Xu Center will also conduct joint bench-to-bedside research with investigators worldwide, and educate physicians and scientists internationally about new therapies and the management of the problems they treat. The center will also sponsor an annual lecture by a world-renowned expert. “We are very honored by and excited about this extraordinary gift,” says Veves. “By working collaboratively with the National Rongxiang Xu Foundation and its partners, including the Clinton Global Initiative, we are well-positioned to have a worldwide impact on these pressing health problems.” 13 q Nadine Tung, M.D. RISKS REWARDS BIDMC Researchers Help Launch First National Genetic Testing Study in U.S. Jewish Population Alana Kapust always suspected her chances of getting breast or ovarian cancer one day were high. Her aunt passed away from ovarian cancer at age 34. Her mother was diagnosed with breast cancer around the same time and battled second and third rounds of the disease years later. After her mother and grandfather both tested positive for the BRCA1 gene mutation, they encouraged Kapust to be screened for the cancer-causing abnormality, which can be passed down through generations. When her tests also came back positive, Kapust sought the guidance of Nadine Tung, M.D., director of the Cancer Genetics and Prevention Program at Beth Israel Deaconess Medical Center. “I went from not knowing but having this feeling of inevitability of cancer to having Dr. Tung create a plan with me,” says Kapust, who had ultimately inherited a 90 percent chance of developing breast cancer and a 50 percent chance of developing ovarian cancer. Before age 30, with the support of Tung and her team, Kapust chose preventive surgery— an oophorectomy to remove her ovaries as well as a 14 double mastectomy— effectively eliminating her likelihood of getting ovarian or breast cancer in the future. “Being able to identify who in a family is at risk and who is not at risk is an enormous achievement,” Tung says. “Alana’s mother and aunt were blindsided. But Alana, she knew that she was at risk for these cancers, and that put us in the driver’s seat.” ultimately makes the body’s cells more prone to cancer. The mutated BRCA1 and BRCA2 genes confer an increased risk of developing several particular types of cancer in men and women, including breast, ovarian, melanoma, pancreatic, and aggressive forms of prostate cancer. Upon further study, the impact of these mutations on clinical care expanded from just being able to predict who is at risk for cancer to how to manage that risk and treat the cancers that develop in those individuals more effectively. “For the first time we were able to really finetune risk assessment, tailor strategies for risk reduction, and deliver personalized care for these individuals and their families,” Tung says. genetic testing involves in-person sessions between individual patients and genetic counselors both pre- and post-test. But given that the vast majority of those tested for rare mutations like BRCA will not have a genetic abnormality, what would happen if live counselors were reserved for the patients who need them most, when they need them most? “We want to show that by using our limited counseling services more wisely and augmenting their efforts with technology, we can improve the genetic testing process more broadly,” says Tung. “This could be the way to responsibly and efficiently offer this testing to all individuals who really need it.” When researchers discovered that mutations in BRCA1 and BRCA2 genes caused an inherited risk of breast and ovarian cancer 20 years ago, it was a game changer for clinicians and their patients. BRCA genes, which are present in every individual, produce proteins that suppress tumors, ensure the stability of the cell’s genetic material, and repair DNA that has been damaged. When mutated, the gene does not function properly and But along with the promise this type of genetic testing holds for so many in understanding and managing their health come concurrent challenges in fulfilling that promise. One of the dilemmas facing this relatively new field is how to conduct large-scale testing effectively given the current shortage of genetic counselors and limited resources. Tung and her colleagues believe that the solution may lie in technology. Traditionally, This novel idea has spawned a major collaborative study called BFOR, the BRCA Founder Mutations Outreach and Research project, involving genetic specialists at five institutions— BIDMC, Dana-Farber Cancer Institute, CedarsSinai Medical Center, Memorial Sloan Kettering Cancer Center, and the University of Pennsylvania’s Abramson Cancer Center. Scheduled to launch this fall, it is the first-ever national genetic testing campaign for cancer risk. Giving Matters | Beth Israel Deaconess Medical Center NEWS OF NOTE A month after announcing that two vaccine candidates provided mice with complete protection against the Zika virus, a BIDMC research team led by Dan Barouch, M.D., Ph.D., in collaboration with scientists at Walter Reed Army Institute of Research and the University of São Paulo, reported achieving complete protection against Zika virus in rhesus monkeys. The promising findings, which were published online in the journal Science, support continued optimism for the feasibility of a human Zika vaccine. p Tech Talk: Tung and her team are exploring how technology might make large-scale genetic testing in cancer more efficient and effective. “ This could be the way to responsibly and efficiently offer this testing to all individuals who really need it.” —Nadine Tung, M.D. The initial phase of the project will examine 1,000 Ashkenazi Jewish women and men, ages 25 years and older, in each of the four participating cities: Boston, Los Angeles, New York City, and Philadelphia. A larger second phase of the study could potentially explore the feasibility of a nationwide genetic testing and counseling program for the nearly 3.5 million people in the country of Jewish heritage, and in the process, serve as a model for the implementation of population genetic testing strategies in the future. “For BRCA mutations, it was logical to start with the Jewish community,” notes Tung, who will lead the project at BIDMC. “But we have an opportunity here to understand how to do this work in the best and most conscientious way possible and then apply what we learn to other medical conditions and other populations.” The integral link between BRCA mutations and the Ashkenazi Jewish population offers the researchers an almost ideal platform from which to launch their efforts. Current estimates indicate that one of every 40 Jewish individuals of Eastern European Giving Matters | www.bidmc.org/giving descent, or Ashkenazi Jews, has a mutation in the BRCA1 or BRCA2 gene, compared to one in 800 in the general population. “BRCA1 and BRCA2 mutations are 10 times more common in those of Jewish ancestry, and three recurring mutations explain almost all of the abnormalities,” says Tung. “This makes testing simpler than in other populations.” But currently, genetic testing for these mutations is only recommended for individuals with a personal or family history of breast or ovarian cancer. And unlike Alana, half of Jewish individuals who are diagnosed with cancer and ultimately found to carry the mutation have no family history. Unsuspecting carriers may simply not know that cancer runs in the family, or they may have inherited the mutation from their fathers and thus have few women in the family with cancer— and consequently have no warning of what’s likely to come. Today geneticscreening and insurance-carrier guidelines endorse testing these patients for the mutations only after a cancer diagnosis, denying them the opportunity to determine their risk and take steps to prevent their disease. “Research has shown that, if you are Jewish, the risk for breast or ovarian cancer is virtually the same for everyone with a mutation regardless of whether you meet the established criteria for genetic testing,” says Tung. “To rely on family history in a population in which these mutations are so common is not a good strategy.” Extending genetic testing to more at-risk patients in a resource-efficient way could offer an elegant solution to this conundrum while at the same time provide insights into the complexities of genetically screening large patient populations. The BFOR study will evaluate the feasibility of offering BRCA mutation testing to Ashkenazi Jewish men and women across the United States regardless of their family history using a digital platform. A primary goal of the study is to evaluate the effectiveness of using technology for pre-test counseling and saving in-person counseling services for those who have a mutation— only 2.5 percent of Jewish individuals For the second time, all four hospitals in the BIDMC system were recognized for their commitments to patient safety with “A” grades in The Leapfrog Group’s Fall 2016 Hospital Safety Score, which rates how well hospitals protect patients from preventable medical errors, injuries, and infections. BIDMC in Boston, BID–Milton, BID– Needham, and BID–Plymouth are among only 31 percent of general hospitals in the United States to receive the honor. Recently awarded $42 million in funding from the National Institutes of Health, scientists from BIDMC and Oregon Health & Science University (OHSU) will lead a five-year research initiative to advance efforts to prevent and cure HIV/AIDS through a consortium of investigators across the country. The team will focus on understanding the mechanisms behind the effectiveness of preventive vaccines developed at BIDMC and OHSU in nonhuman primates and building on that knowledge to create effective therapeutics and preventive strategies. BIDMC psychiatry researchers led by Matcheri Keshavan, M.D., have identified three biomarkerbased categories that provide a new, more precise way to classify psychotic diseases based on patients’ underlying brain biology. For the past 100 years, psychoses have been diagnosed solely on clinical observations of symptoms. The identification of these new biomarkers may enable clinicians to more precisely differentiate psychotic conditions and provide patients with more targeted treatments. CONTINUED ON P. 16 15 “ The more we learn and the more people we can reach, the more people we can help.” —Nadine Tung, M.D. CONTINUED FROM P. 15 tested— or those who require more extensive testing— individuals without a BRCA mutation who have a strong family history of cancer. Participants will use an online video to complete a standardized pre-test counseling program and provide consent to genetic testing electronically. They will have the option to receive their test results from their primary care physicians, if those physicians choose to participate, or from members of the study team. If their results are positive, subjects will be offered live consultations to help make the health management decisions best for them. The project will assess patients’ comfort with standardized pre-test counseling, primary physicians’ comfort with disclosing genetic test results, and whether appropriate screening and prevention strategies are followed. But widespread testing does not come without costs. The team is grateful that Quest Labs and Lifelink, a California-based digital health company, have donated their services for blood testing and database management, respectively, for the pilot study, and that the Breast Cancer Research Foundation has been a philanthropic leader in supporting this research. However, each site is responsible for hiring necessary personnel, such as research staff, genetic counselors, and technology consultants, as well as conducting public outreach. Recognizing these gaps in resources, former chair of the BIDMC Board of Directors Steven B. Kay and his wife, Lisbeth Tarlow, hosted an event at their home last spring featuring members of the Boston Symphony Orchestra, which raised both funds for and awareness of this project. “We know the testing is being done for free, but we need personnel who can help navigate all the complexities of this research and promote it to the appropriate populations,” Tung says. “The more we learn and the more people we can reach, the more people we can help.” As a doctor who has treated patients with breast and ovarian cancer for more than 25 years, the end result is all that matters— providing the best care possible to those in need. Her hope is that she can make patient experiences like Alana Kapust’s more commonplace. “Being able to identify these mutations in individuals who would not have received genetic testing otherwise is about saving lives,” she says. “It is not just the individuals who test positive. It is their children, their siblings, their nieces, and nephews. It is about saving families.” IN MEMORIAM The BIDMC community is proud to recognize our loyal and dedicated friends and supporters who passed away from October 30, 2015 to August 31, 2016. These individuals have provided the medical center with unwavering leadership and dedication over the years. We extend our sincerest condolences and heartfelt sympathies to their family members and friends. John Faldetta 1943–2016 friend Bernice B. Godine 1917–2016 friend 16 Marcia M. Yanofsky 1926–2016 friend Norton L. Sherman 1932–2015 overseer emeritus Joan Josephson 1943–2016 friend Janet W. MacLure 1930–2016 overseer emerita Charles H. Hood 1929–2016 overseer emeritus Sarah O. Segall 1930–2015 friend Nancy E. Perry 1928–2016 friend Jerold O. Young 1932–2016 friend Earle G. Woodman 1930–2016 physician, friend Giving GivingMatters Matters|| Beth Israel Deaconess Medical Center t Andrew Wagner, M.D., at the helm of a surgical robot p Top: Esta and Robert Epstein p Bottom: William DeWolf, M.D. TEACH YOUR DOCTORS WELL Epsteins’ lead $1M gift launches fellowship in minimally invasive urologic surgery Beth Israel Deaconess Medical Center has been performing advanced minimally invasive urologic surgery for more than 10 years. During this time, thanks to high-quality surgeons and a strong educational core, the program has skyrocketed to become a leader in the field, pioneering new techniques and treating patients who otherwise might not receive care. Now, with a little help from the patients they serve, the Division of Urology is adding a critical new piece to its repertoire that will help attract leading surgical trainees from around the country and further bolster BIDMC’s already nationally recognized program. In response to outstanding care from Andrew Wagner, M.D., director of minimally invasive urologic surgery, and William DeWolf, M.D., chief of the Division of Urology, Esta and Robert Epstein generously donated the lead gift of $1 million to establish and name the Esta and Robert Epstein Fellowship in Minimally Invasive Urologic Surgery. More than $500,000 in additional philanthropy from grateful patients and donors has helped to launch this endowed fellowship, which will focus on advanced techniques for treating urologic cancer. “Our entire goal around this work is to care for patients,” Wagner says. “When they feel like they get outstanding care, it makes us feel proud about what we are doing and the teams we have built.” The Division of Urology at BIDMC is home to some of the most highly skilled, fellowship-trained surgeons who are experts in minimally invasive surgery, which includes advanced robotic and laparoscopic techniques used on the kidney, prostate, and bladder. Compared to traditional open-incision operations, minimally invasive surgery is conducted through four or five very small incisions allowing patients to recover faster, typically with less blood loss and lower infection rates. Giving Matters | www.bidmc.org/giving But acquiring the skills required to perform these technically precise surgeries is no simple task. BIDMC’s dedication to education is what sets it apart from other institutions in Boston and around the country. For the last five years, Wagner has led the only robotic urologic surgery teaching course in New England—a two-day seminar, which includes lectures, live robotic surgery, and hands-on training using robotic simulation and inanimate tissue models designed at BIDMC. The recent addition of a funded fellowship program will attract the best and brightest minds in the field to the medical center for more specialized training. “We are trying to change the culture of how urology is practiced,” DeWolf says. “We are very active in adding new ideas to the urologic literature.” The Epstein Fellowship supports a one- or two-year experience after urologic residency that not only encompasses focused training in minimally invasive and robotic surgery but also provides the protected time to teach residents and medical students, conduct vital research, and innovate in the field. “You will become an expert at the surgeries that you are doing, you will become more of an expert in understanding and performing research, and you will become more of a teacher,” DeWolf says of the prospective fellow. “It will allow you to become a thought-leader in the field.” The fellowship also now ensures that the medical center can develop the next generation of surgeons, who can continue to offer the same expert, personalized care that BIDMC patients have come to expect. “We are very grateful to the patients who supported this fellowship not only because they are fulfilling one of our driving needs,” DeWolf says, “but also because they are connecting us with what we are trying to do, which is provide great care.” 17 ON THE SCENE 1 2 3 4 ANNUAL MEETING OF THE BOARDS October 15, 2015 More than 270 attendees gathered at the Four Seasons Hotel Boston for last year’s Annual Meeting of the Boards. In addition to remarks by Chair of the Board of Directors Daniel Jick and President and CEO Kevin Tabb, M.D., guests were treated to a video recap of the year and a moving speech from grateful patient, Philip Lipof, co-anchor of WCVB’s NewsCenter 5. Lipof also moderated an informative panel featuring John Halamka, M.D., chief information officer; Jonathan Kruskal, M.D., Ph.D., chair of the Department of Radiology; A. James Moser, M.D., F.A.C.S., co-director of the Pancreas and Liver Institute; and Hope A. Ricciotti, M.D., chair of the Department of Obstetrics and Gynecology. Kidney disease researcher David Friedman, M.D., and diabetes researcher Anders Berg, M.D., were the recipients of the Dvorak Young Investigator Award, an annual honor bestowed on up-and-coming scientists established by Sheldon Simon and Ruth Moorman. 1 2 3 4 5 6 Jonathan Kruskal, M.D., Ph.D., John Halamka, M.D., Hope Ricciotti, M.D., A. James Moser, M.D. Kevin Tabb, M.D., Philip Lipof, Daniel J. Jick Lili Sloane, Todd Sloane, Toby Sloane, Amy Pinel Philip Lipof, Steven Chen, M.D. Manuel Hidalgo, M.D., Ph.D., Pier Paolo Pandolfi, M.D., Ph.D. Front Row, left to right: Anders Berg, M.D., Ph.D., David Friedman, M.D., Vikas Sukhatme, M.D., Ph.D. Back Row, left to right: Harold Dvorak, M.D., Ruth Moorman, Sheldon Simon, Martin Pollak, M.D. 5 6 7 BURBERRY FUNDRAISER FOR OBSTETRICS AND GYNECOLOGY December 15, 2015 In December, Ashley and Paul Bernon hosted a fundraiser at the Burberry store on Newbury Street in Boston to support the BIDMC Department of Obstetrics and Gynecology. The event, which featured afternoon tea with InStyle Executive Style Correspondent Dana Avidan-Cohn, raised proceeds to benefit laborand-delivery facility improvements at the medical center. Co-hosts included grateful patients Jessica Collins, Andrea Finard, Kim Find, Penelope Fireman, Jenny Johnson, Tonya Mezrich, Anne Perkin, Lauren Rosen, Tanja Tatelman, Kathleen VanDernoot, Pramila Yadav, M.D., and Colleen Young. 7 Kristine Laping, Hope Ricciotti, M.D., Todd Shapiro, M.D., Ashley Bernon, Dana Avidan-Cohn, Pramila Yadav, M.D. 18 Giving Matters | Beth Israel Deaconess Medical Center 8 9 PALM BEACH CELEBRATION February 25, 2016 11 10 13 14 16 12 15 In February, guests gathered at the home of Roberta and Stephen R. Weiner for the medical center’s annual Palm Beach event, which showcased the current landscape of cancer care and research. Moderated by former WCVB-TV anchors Natalie Jacobson and Susan Wornick, the program featured distinguished BIDMC cancer specialists—Pier Paolo Pandolfi, M.D., Ph.D., Mark Callery, M.D., Manuel Hidalgo, M.D., Ph.D., Mary Jane Houlihan, M.D., and David McDermott, M.D. 8 9 10 11 12 13 14 15 Stephen R. and Roberta Weiner, Caron and Kevin Tabb, M.D. Theodore S. and Cynthia Berenson Carl J. Shapiro, Linda Shapiro Waintrup Gilda K. Slifka, Lois E. Silverman Yashar Carol R. and Avram J. Goldberg Daniel J. and Elizabeth Jick Helaine B. Allen, Carol Feinberg Cohen Martin and Dena Trust 17 BOSTON MARATHON April 18, 2016 18 19 With 52 runners competing this year, BIDMC’s “Tread Strong” Boston Marathon team raised more than $465,000—topping last year’s total by more than $100,000—to benefit a variety of medical center causes, from community health programs to groundbreaking research. BIDMC labor and delivery nurse Nancy Eaton, R.N., ran in memory of her friend, colleague, and fellow marathon team member Amanda Russell, R.N., who died in a tragic accident while training earlier this year. 16 Theresa Normile, Brianna Normile, Patrick Normile, Tyler Normile 17 Julia Eger, Holly Eger 18 Kira Chamberlain, Scott Chamberlain, Adam Chamberlain 19 Allison Foley 20 CRITICAL VOICES: THE PICTURE OF HEALTH CARE May 11, 2016 21 22 23 In May, BIDMC's Board of Overseers hosted its annual Critical Voices event, which examined the complexities of health care through the lens of politics and medicine. Entitled “The Picture of Health Care,” the evening featured Commonwealth of Massachusetts Governor Charlie Baker and BIDMC President and CEO Kevin Tabb, M.D., who helped to shed light on health care’s implications for eradicating disease, eliminating disparities, and empowering patients. Emceed by Alexandra Drane, the event was co-chaired by Tania and Denis Leary, and Jody Dushay, M.D., and Paul Gompers. Grateful patient Joshua Neudel also shared his inspiring story of receiving a lifesaving liver transplant at BIDMC. 20 Paul Gompers and Jody Dushay, M.D., Kevin Tabb, M.D., Lauren Baker and Governor Charlie Baker, Denis and Tania Cleary 21 Danielle Remis Hackel, Ruthann Remis 22 Jamie Grossman, Virginia MacDowell, Sid Queler, Patricia Berenson 23 Governor Charlie Baker, Kevin Tabb, M.D. Giving Matters | www.bidmc.org/giving 19 Nonprofit Org. U.S. Postage PAID Norwood, MA Permit No. 20 Office of Development 330 Brookline Avenue Boston, MA 02215 www.bidmc.org/giving PICTURE PERFECT From left to right: BIDMC President and CEO Kevin Tabb, M.D., grateful patient Josh Neudel, Vice Chair of the BIDMC Trustee Advisory Board Alexandra Drane, and Commonwealth of Massachusetts Governor Charlie Baker Commonwealth of Massachusetts Governor Charlie Baker is a big fan of “selfies” so when he took part in BIDMC’s Critical Voices “The Picture of Health Care” event in May, it was only fitting that he grabbed a great shot of himself and some of the other featured speakers from the stage. To an audience of almost 300, Baker spoke about the transforming image of health care and his take on knowledge, technology, and demographics in that context. Said Baker, whose three children were delivered at the medical center, “I feel tremendously loyal and just grateful to the folks at BIDMC over the years who have been terrific stewards, collaborators, leaders, researchers, and care deliverers here in the Commonwealth.” BETH ISRAEL DEACONESS MEDICAL CENTER FALL 2016 Your Support Helped Them Go the Distance On April 18, Team BIDMC took part in the 120th running of the Boston Marathon and raised close to $470,000 to benefit a variety of the medical center’s programs ranging from groundbreaking research to innovative community health care. Thank you to our team members and all their supporters for helping us continue to set the pace in medical progress. It’s never too late to make a donation to an individual runner or one of their many worthy BIDMC causes. Go the extra mile and make a gift today at treadstrong.org. Office of Development 330 Brookline Avenue Boston, MA 02215 www.bidmc.org/giving PICTURE PERFECT From left to right: BIDMC President and CEO Kevin Tabb, M.D., grateful patient Josh Neudel, Vice Chair of the BIDMC Trustee Advisory Board Alexandra Drane, and Commonwealth of Massachusetts Governor Charlie Baker Commonwealth of Massachusetts Governor Charlie Baker is a big fan of “selfies” so when he took part in BIDMC’s Critical Voices “The Picture of Health Care” event in May, it was only fitting that he grabbed a great shot of himself and some of the other featured speakers from the stage. To an audience of almost 300, Baker spoke about the transforming image of health care and his take on knowledge, technology, and demographics in that context. Said Baker, whose three children were delivered at the medical center, “I feel tremendously loyal and just grateful to the folks at BIDMC over the years who have been terrific stewards, collaborators, leaders, researchers, and care deliverers here in the Commonwealth.” BETH ISRAEL DEACONESS MEDICAL CENTER FALL 2016 Your Support Helped Them Go the Distance On April 18, Team BIDMC took part in the 120th running of the Boston Marathon and raised close to $470,000 to benefit a variety of the medical center’s programs ranging from groundbreaking research to innovative community health care. Thank you to our team members and all their supporters for helping us continue to set the pace in medical progress. It’s never too late to make a donation to an individual runner or one of their many worthy BIDMC causes. Go the extra mile and make a gift today at treadstrong.org.