Dean's Corner en A Time for Reflection and Healing <p> Today we mark the first anniversary of the Boston Marathon bombings. It is a time for reflection and for expressions of gratitude. It is also an opportunity for us to remember those who died and to honor the strength and courage of the survivors, the first responders and our resilient city.</p> <p> Few among us were not affected, either directly or indirectly, by the events of April 15, 2013, when three people were killed and more than 260 injured at the race's crowded finish line.</p> <p> Many of the wounded were taken to HMS-affiliated teaching hospitals, where hundreds of caregivers responded heroically. Expert triage efforts ensured that Beth Israel Deaconess Medical Center, Brigham and Women's Hospital and Massachusetts General Hospital each received dozens of patients within the first hour. Boston Children's Hospital cared for young patients ranging in age from 2 to 12. Mass Eye and Ear physicians were asked to aid patients suffering from serious blast injuries, and during the following weeks and months, physicians and their colleagues at McLean Hospital and Spaulding Rehabilitation Hospital helped many patients recover and reclaim their lives. Mount Auburn Hospital also provided life-saving care in the days after the marathon.</p> <p> Not one single person transported to our hospitals on the day of the bombings died. Hundreds of hospital personnel, including some third-year HMS students who are graduating this year, responded in droves, doing what the medical profession has always been called upon to do—helping and healing, relieving suffering and saving lives. They followed their impulse to serve, to comfort and to heal.</p> <p> There are a number of ways we can all honor those who were affected by last year's tragic events.</p> <p> I invite you to join me at 2:49 p.m. today in a moment of silence to reflect on the strength, compassion and resilience of those in our city and our community who responded to the violence with bravery, selflessness and an indomitable spirit.</p> <p> For those on the Quad, I invite you to come together as your schedule permits to watch the televised tribute beginning at noon to mark the one-year anniversary. Viewing areas have been set up in the Courtyard Café, in the TMEC atrium and at the NEPRC. You may wish to view the ceremonies with members of our community or you can watch from your computer <a href="" target="_blank">here</a>.</p> <p> Others throughout the HMS community may participate in ceremonies and tributes, panel discussions and healing services organized <a href="/news/hms-community-marathon-anniversary-tributes-4-15-14#">at our affiliated institutions</a>. Through these events, we can publicly acknowledge the innumerable unselfish acts that aided the wounded and their loved ones, inspiring the entire world.</p> <p> Also, to support those still in need of assistance, you may choose to contribute to the <a href="" target="_blank">One Fund</a>, which continues to be an important resource for survivors and their families.</p> <p> Today, I believe we can join together to transform an anniversary of tragedy into a tribute to those whose courage and spirit represents the best of humanity. To all of them, including the many members of our remarkable community who served and who continue to serve, I express my deepest admiration and gratitude.</p> Tue, 15 Apr 2014 14:46:52 +0000 Cat Mooney 7669 at Thoughts on Innovation <p> Roots run deep at Harvard Medical School, both those of the School as a centuries-old institution and those linking alumni and students. The story of HMS is chronicled in its families—the Shattucks, the Richardsons, and the Warrens, to name a few—who have made lasting contributions to the School and to its mission to advance medical education and biomedical research. These contributions continue, if not directly through the founding families, then through the new families and future legacies that are seeded within each incoming class.</p> <p> The latest issue of <a href="">Harvard Medicine magazine</a> looks at family and the facets of legacy, exploring what can be handed down <a href="">from one generation to the next</a>. Researchers who scour the genomes of families in search of clues to inherited conditions talk about their discoveries, as do other scientists who explore the influence that speech, as articulated by parents and others, has on an infant's ability to acquire language.</p> <p> <span style="line-height: 1.5;">Our own family stories also illuminate the rich contributions that are passed down through generations. HMS alumni who are themselves children of HMS alumni tell us what is was like to grow up with a doctor at the breakfast table. An alumnus recalls moments in his early life when the efforts of his physician–parents straddled the terrors of bigotry and conflict to ensure their family's safety and the well-being of history's most notable psychoanalyst. An alumna also describes how classic children's literature presents illness and death to its readers, young and old.</span></p> <p> <span style="line-height: 1.5;">Lifelong bonds</span>—<span style="line-height: 1.5;">with spouses, siblings, children, and friends—are shaped, tended and nourished by advice. Take, for example, the professional counsel delivered by John Collins Warren to his son, J. Mason Warren (Class of 1832), as the younger sailed to Paris to study medicine.</span></p> <p> <span style="line-height: 1.5;">"Observe operations," wrote the elder Warren, "Get as near as possible. Anticipate the steps." And then there was his cautionary advice on social bearing: "Be on your guard against wine. No champagne. Take claret."</span></p> <p> <span style="line-height: 1.5;">As a parent, and a physician, I can only wonder which, if either, J. Mason followed.</span></p> <p>  </p> Wed, 29 Jan 2014 22:21:06 +0000 Max Green 7256 at Celebrating a Successful Collaboration <p> <em><span style="line-height: 1.5;">As Brigham and Women’s Hospital celebrates its 100th anniversary, it is a fitting time to recognize the long, important and fruitful relationship between Harvard Medical School and one of the country’s leading hospitals, one that has flourished through decades of medical evolution as each institution and our faculty helped to shape each other’s trajectory and the face of modern medicine. In recognition of this vital partnership, I was asked to contribute a chapter to "The Teaching Hospital: Brigham and Women's Hospital and the Evolution of Academic Medicine" (McGraw Hill, 2014), which is being published as a tribute to the Brigham’s centennial year. I share with you here some of my reflections on the rich history and success of our productive collaboration with one of the world’s great medical institutions.</span></em></p> <p> <span style="line-height: 1.5;">From its beginnings as Peter Bent Brigham Hospital in 1913, the Brigham Hospital has been an essential partner in the life of Harvard Medical School. Between the founding of the School in 1782 and 1913, medical education underwent dramatic changes in the U.S., such as the introduction of scientific training into the preclinical curriculum and the increasing importance of in-hospital experiences for medical students. Like most medical schools at that time, HMS did not own any hospitals, so education requiring hospital experience involved arrangements between schools and hospitals. Massachusetts General Hospital, Boston City Hospital, Boston Lying-in Hospital, McLean Hospital, and Boston Children’s Hospital were the main providers of clinical training for HMS students at the time of the Brigham’s founding, although no formal affiliation agreement existed until 1949. The HMS move to the Longwood Medical Area in 1906 influenced the site chosen for the Brigham. Beyond the geographic proximity, Brigham leadership sought from the outset to develop the closest possible scientific, clinical and educational relationships with the medical school next door, which began when it allowed HMS to nominate its initial chief of surgery, Harvey Cushing, and chief of medicine, Henry Christian. This set the stage for increasing HMS involvement in faculty appointments at all HMS-affiliated hospitals.</span></p> <p> Before examining the high points of the Brigham–HMS relationship, it would be useful to describe the elements of what we now often call the "Harvard medical community," or Harvard medicine. HMS is one of the 12 degree-granting schools of Harvard University. It is the oldest of Harvard’s graduate schools, and the farthest from the main campus in Cambridge. HMS admits about 165 MD students per year into a four-year medical curriculum, and about 120 PhD students. It has formal affiliation agreements with 16 clinical and research affiliates, including four major teaching affiliates--the Brigham, Mass General, Beth Israel Deaconess Medical Center and Boston Children’s Hospital--where HMS students receive clinical education in their third year and throughout much of their fourth year. Through these agreements, the hospital affiliates, which are independent fiscal entities, have agreed to align themselves and their faculties exclusively with HMS. As a consequence, these entities are universally referred to as "Harvard teaching hospitals," to the benefit of both Harvard and the hospitals.</p> <p> HMS directly hires and houses approximately 200 faculty on its campus--the Quad--in basic and social science departments. An additional 8,000 full-time, and another 4,000 part-time faculty, are employed by the affiliates, all of whom hold HMS faculty appointments granted by the School and Harvard University. This relationship is considered by all parties to be critical to the success of the School, the affiliated institutions and the faculty.</p> <p> The Brigham and HMS are interrelated across a broad array of activities. As noted, all the Brigham faculty members are granted an academic rank ranging from instructor, an annual appointment currently with little review, to professor, which represents the highest level of achievement and recognition. As I write, the Brigham has 956 HMS instructors, 515 assistant professors, 296 associate professors, and 220 professors. Among the professors, a small number hold endowed professorships through HMS, which confer both honor and financial resources to the incumbent. These the Brigham faculty members reside academically in one of 14 clinical departments overseen by HMS (e.g., medicine, surgery and radiology) and a minority--currently about 20 faculty--also hold appointments in a Quad basic-science department. Many Brigham faculty members play important roles in the education of medical students, both during the two preclinical years as masters of the student societies, course directors or tutors; and during the clinical clerkships, now called the principal clinical experience (PCE). About one-third of HMS students participate in the PCE at the Brigham.</p> <p> HMS students are a vital component of the life of the Brigham, its faculty and its programs. Brigham faculty members are also integral to life at HMS, where many participate in and lead preclinical courses. Many HMS students pursue required scholarly projects with the Brigham faculty, in areas from basic science to clinical studies to social science. the Brigham is also a highly sought-after hospital among HMS graduating students seeking residency and fellowship training. As a result, many outstanding students--HMS is the most selective medical school in the country--eventually become faculty there. One-fifth of our students are also in the Health Science and Technology program, a joint venture between HMS and the MIT. A the Brigham faculty member has often served as the HMS leader of this program over the years, beginning with Joseph Bonventre, the Samuel A. Levine Professor of Medicine, through today with David E. Cohen, the Robert H. Ebert Professor of Medicine and Health Sciences and Technology at the Brigham.</p> <p> According to the model by which HMS operates, each affiliate conducts research programs in its own research facilities. However, a significant component of research at the Brigham has been located in space within the New Research Building, which is leased from HMS. One major element of this arrangement is a Brigham genetics program, located strategically near the HMS Department of Genetics, where faculty, including Stephen Elledge, the Gregor Mendel Professor of Genetics and of Medicine, Raju Kucherlapati, the Paul C. Cabot Professor of Genetics, Mitzi Kuroda, professor of genetics, and Christine Seidman, the Thomas W. Smith Professor of Medicine, have joint roles. Another area of strategic alliance is in neurology. Dennis Selkoe, the Vincent and Stella Coates Professor of Neurologic Diseases in the Department of Neurology at the Brigham, played a key role in founding and co-leading the Harvard NeuroDiscovery Center, originally the Harvard Center of Neurodegeneration and Repair. Funded by a significant anonymous gift to HMS, this program leverages neuroscience expertise across all of Harvard, through pilot grants, cores and other community-building efforts, with the dean of HMS serving as chair of its advisory board. HMS manages a major segment of the animal facilities employed by Brigham faculty.</p> <p> Over time, many clinical and research programs at the Brigham have become tightly linked to those at HMS. To highlight just a few of these, HMS and the hospital have deeply interrelated and synergistic programs in the area of global health. This alliance arose out of the passion and accomplishments of Paul Farmer, Kolokotrones University Professor of Global Health and Social Medicine, and Jim Yong Kim, currently president of the World Bank. These two physicians graduated from HMS one year apart, and both received doctoral degrees in medical anthropology from Harvard University. They both participated in medical residencies at the Brigham, where Farmer also completed subspecialty training in infectious diseases. While students, they cofounded the organization Partners In Health (PIH) and became national leaders in the field of global health with faculty appointments in medicine at the Brigham, and in the Department of Social Medicine at HMS. This department has now been renamed Global Health and Social Medicine (GHSM) and is chaired by Farmer. While pursuing their interests at HMS and PIH, in collaboration with residency director and associate professor of medicine Joel Katz, Farmer and Kim also pioneered a highly competitive global-health equity track in the internal medicine residency program at the Brigham, a program that may well become a national model. A Division of Global Health Equity at the Brigham houses the faculty for this program, and many of these faculty members also hold appointments at HMS in GHSM. Together, GHSM, the Division of Global Health Equity, and PIH function as a highly effective and mutually beneficial superorganism. Although at times the borders between these entities can blur, creating administrative ambiguity and financial complexity, these difficulties are more than compensated for by the innovative and transformative work the programs perform.</p> <p> A second example of the collaborative relationship between HMS and the Brigham lies in the realm of clinical research. Beginning in 1961, the Brigham had an outstanding general clinical research center (GCRC) funded by the National Institutes of Health, in which complex human experiments were conducted. Three other HMS affiliates also had similar programs. When NIH announced in 2006 that the GCRC program would be replaced by clinical translational science centers (CTSCs), and that Harvard institutions could have a total of only one center, there was much uncertainty and some consternation at the thought that these fully autonomous programs would likely be ending. In the end, after extensive discussion, it was agreed that HMS would submit the grant, with Lee Nadler, HMS Dean for Clinical and Translational Research and the Virginia and D.K. Ludwig Professor of Medicine, as principal investigator. This decision was made with the full cooperation and involvement of all pre-existing holders of GCRCs, including the Brigham.</p> <p> There was also agreement about institutional support in the form of financial contributions totaling $15 million per year for five years from Harvard University, HMS and each of the affiliated hospitals. A complex multi-institutional governance structure was established, demonstrating both the effect of external pressure and the capacity of HMS leaders to rise to the occasion. The grant was funded on the first attempt, and the federal support of $24 million per year was the largest among CTSCs nationwide. A far more integrated human research laboratory has now taken the place of the previously independent and uncoordinated GCRCs. Brigham faculty play a key role in the leadership of this program, today named Harvard Catalyst The Harvard Clinical and Translational Science Center. Its leadership team includes, among others, Elliott Antman, Associate Dean for Clinical and Translational Research and HMS professor of medicine, who leads the educational effort, and Barbara Bierer, HMS professor of medicine, who leads the regulatory program. Harvard Catalyst, including its Brigham components, is a national model for CTSCs.</p> <p> HMS is also heavily involved in graduate education in biomedical science, with nearly 700 students enrolled in PhD programs in the Division of Medical Sciences, which is part of the Graduate School of Arts and Sciences at Harvard University and home to many of the most highly rated graduate programs in the world. David Golan, the George R. Minot Professor of Medicine at the Brigham, and professor of biological chemistry and molecular pharmacology, is dean for graduate education at HMS. He jointly oversees the MD-PhD program with the dean for medical education, Jules Dienstag, the Carl W. Walter Professor of Medicine, and the program director, Stephen Blacklow, Gustavus Adolphus Pfeiffer Professor of Biological Chemistry and Molecular Pharmacology and a longstanding member of the Brigham’s Department of Pathology. The MD-PhD students often choose Brigham labs for their research, and the Brigham is a preferred site for them to pursue residencies and, often, their subsequent careers. Brigham leadership, including Joseph Loscalzo, Hersey Professor of the Theory and Practice of Physic and head of the Department of Medicine at the Brigham, and Thomas Michel, professor of medicine, has played a critical role in creating a new and exciting track in our graduate program, the Leder Human Biology and Translational Medicine Program at Harvard. This program creates new opportunities for hospital-based faculty to train graduate students in medical science related to faculty research.</p> <p> It should be evident by now that HMS and the Brigham are very closely aligned in a way that immeasurably strengthens both institutions with respect to both function and reputation. It should not be forgotten, however, that there are constant challenges to this close relationship, resulting in part from the fact that each institution maintains independent governance and finances. Furthermore--a rarity among American medical schools--HMS had no history of receiving funds, also known as a dean’s tax, from the clinical affiliates. During prosperous times, when all institutions were experiencing financial success, this situation was tenable. During periods of financial difficulty, with flat or falling NIH budgets, poor endowment returns and problems with the national economy, this model will likely not be sustainable. Two responses to periods of financial challenge have been notable. First, the partner institutions and HMS developed a plan to provide new funds from all organizations to compensate clinical educators. In a second important effort, there was agreement to provide modest financial support to HMS from the affiliates for a three-year period, support that is proportional to the size of the affiliates’ HMS faculty. The extension of this support will be an important indicator of the strength of the bonds that tie us together.</p> <p> Indeed, we must all acknowledge the dramatic changes that will likely shape our institutions, both jointly and individually, over the coming decades. In the realm of clinical medicine, it is clear that the share of economic resources flowing into the U.S. health care sector is unsustainably large.  By one means or another, forces will emerge to profoundly alter this flow of resources over the coming years, and, we can hope, improving, rather than reducing, the quality and safety of the care that we deliver. The Affordable Care Act--whatever an individual’s views may be on its benefits or failures--will not by itself correct this course. Whatever changes take hold through further regulation or market forces, they will almost certainly involve an enhanced need for primary care, care coordination and multidisciplinary teams, as well as more appropriate, and perhaps limited, utilization of some specialty services. How institutions such as the Brigham respond to this challenge will have material impact on the future of the hospital, HMS and our relationship. Although extremely deep in specialty and tertiary care, the Brigham is also a leader in primary care and is dedicated to planning for systems redesign, so I am hopeful about how it may contribute in the future. Many factors will also push HMS to institute important changes to our educational curriculum. Among these will be a need to have greater ambulatory--as opposed to inpatient--experience, new models of team training and greater recognition of the new pedagogical models required by students steeped in the digital age. In all of these areas, HMS will work closely with Brigham faculty, who are key players in the design and conduct of our medical education program. Finally, the future of biomedical research is now evolving in response to fiscal realities and the need to increase the success by which we translate basic research into safe and effective therapies. I am convinced that HMS and the Brigham, as well as other HMS affiliates, will need to work together more effectively if we are to succeed and remain the leaders that we are today.</p> <p> A model through which strategic planning and cooperation leverage our individual strengths and resources will far outpace the model of the past century, in which, with a few important exceptions, our institutions pursued largely separate agendas in independent, albeit successful, pursuit of scientific excellence. The success or failure of this more collaborative approach will occupy the future leadership of HMS and the Brigham for decades to come. I am committed to substantially dedicating the remaining period of my deanship to realizing this vision. </p> <p>  </p> Fri, 22 Nov 2013 19:23:58 +0000 Max Green 6913 at An Inspiring Voice for Education <p> Last week, I participated in an event that I am sure will be among the most inspiring and memorable experiences I will have as dean of HMS. I was invited by the Harvard Foundation to participate in presenting the 2013 Peter J. Gomes Humanitarian of the Year award to Malala Yousafzai in a ceremony at Sanders Theater. This remarkable young Pakistani woman, now 16, burst onto the world stage one year ago, when she was seriously wounded by an assassin’s bullet to the head, while riding to school in a bus in Swat, Pakistan. She was targeted because she refused to bow to threats from local Taliban who sought to keep young women from receiving an education. Malala's father, who is committed to education for both boys and girls, received repeated threats to the entire family, but they bravely chose to persist in spite of the danger.</p> <p> Malala's wounds were life-threatening, but thankfully, she received excellent neurosurgical care from a highly skilled Pakistani army neurosurgeon. After stabilization, and still in a coma, she was transferred to a hospital in England, where she completed a striking recovery and rehabilitation. She and her family have resettled in England, where, in addition to pursuing her studies, she makes many speaking appearances on the need for education for girls around the world, for gender equality and for educational opportunity more generally.</p> <p> Malala spoke to a packed house at Sanders Theater. Her words were remarkable for their clarity and passion, even more so given her age and recent experiences. Before Malala’s acceptance speech, Dr. Paula Johnson of HMS offered wonderful comments on the importance of education for girls around the world.</p> <p> I also had the honor of presenting an award to Dr. Junaid Khan, the neurosurgeon from Peshawar who performed Malala’s life-saving surgery. He had not seen Malala since she left Pakistan for England. Dr. Khan’s award came at the suggestion of Malala and her family, reflecting their incredible values.</p> <p> I was thrilled to be able to sit between Malala and Dr. Khan at dinner later that evening at Winthrop House, joined by many Harvard leaders and students. Our conversation during dinner revealed Malala to be wise beyond her years, even strikingly so. She displays moral passion and brilliance, yet somehow mixed with a calm self-confidence and a great sense of humor. She told me loves science, and all her subjects, but plans to study political science (perhaps at Harvard!). She is co-author of “I Am Malala,” a book that will be published in October. I look forward to reading it.</p> <p> I  have the opportunity to meet so many wonderful people in my role at HMS. Malala Yousafzai is remarkable among them. She is an inspiration to us all, and if she chooses such a path, she may become an important figure in world history. Just a hunch.<br />  </p> Mon, 30 Sep 2013 15:49:07 +0000 Amy Barletta 6605 at Serving those in need, in Boston and Beyond <p> As dean of Harvard Medical School, I have the privilege of working with countless students, faculty and staff  who are dedicated to aiding others—by sharing their knowledge here in Boston and traversing the country and continents to aid disadvantaged populations.</p> <p> At HMS we recently celebrated the recipients of the 2013 Dean’s Community Service Award.  This award honored seven members of the HMS community who embody a remarkable sense of purpose.  I was moved by their generosity of spirit and the impact of their achievements.</p> <p> The awards were first bestowed in 1999 and are administered by Joan Reede, dean for Diversity and Community Partnership, and the Office for Diversity Inclusion and Community Partnership. Over the past 14 years, these awards have recognized the contributions of 92 individuals to 87 organizations from our local, regional, national and international communities.  These organizations receive cash awards from HMS to help them further their important work.</p> <p> The 2013 recipients, selected from 86 outstanding nominations, have made tremendous contributions to diverse populations on an impressively broad scale, from treating vascular birth defects in underserved children in Vietnam, to enhancing the health and educational needs of Tanzania’s impoverished youth.</p> <p> One awardee mentors individuals with disabling conditions who dream of athletic achievement. Another recipient helps to empower the poor of Sri Lanka through micro-enterprise development. Yet another works with young black men in Boston to promote peace, positive self-image, healthy lifestyles and education.</p> <p> These individuals are activists and ambassadors for HMS who have dedicated a meaningful aspect of their life’s work to improving health care in the U.S. and around the world.  I invite you to learn more about these inspiring recipients and the organizations they serve <a href="" target="_blank">here</a>.</p> <p> Among these extraordinary individuals, I want to express my personal admiration for my colleague HMS Dean for Students Nancy Oriol, who was honored with the Lifetime Achievement award for her commitment to <a href="" target="_blank">The Family Van</a>, an innovative mobile health clinic that has been providing curbside care to people living in Boston’s underserved neighborhoods for more than 20 years.  </p> <p> Nancy co-founded The Family Van in 1992, on Martin Luther King Day. The program has since served more than 60,000 people, connecting them with local health and social service agencies. Nancy’s pioneering work has been replicated nationally, and similar mobile clinic programs now serve an estimated two million people across the United States.</p> <p> As always, it was a pleasure to celebrate these truly remarkable members of the HMS community. I am honored to recognize the countless hours they devote to advancing our mission of outreach and service.</p> Thu, 13 Jun 2013 13:44:21 +0000 Cat Mooney 5814 at Medicine in an Age of Change <p> <strong>2013 Class Day remarks by Jeffrey S. Flier, Dean of the Harvard University Faculty of Medicine</strong></p> <p> Members of the class of 2013, families and friends, distinguished Medical and Dental School faculty, Dr. Fineberg, and other honored guests: welcome.</p> <p> At this moment, I am literally all that stands between you and your HMS degree!</p> <p> In a few minutes we’ll officially launch your careers in medicine and in dentistry, in patient care, in biomedical research and in diverse leadership roles, both here in the U.S. and abroad.</p> <p> For this, you have great cause to celebrate and to be optimistic. Your careers will blossom during an era in medicine and science that will be, in equal measure, both challenging and exhilarating.</p> <p> Challenging because the face of health care has been rapidly transforming during your years here, and that pace of change is very likely to further accelerate.</p> <p> Indeed, the way you will practice medicine over the next 10 or 20 years promises to differ greatly from what you have experienced thus far at HMS.  This results both from a fiscal necessity to rein in unsustainable costs of care, and from the need and great opportunity to increase the value and quality of the health care that we provide.</p> <p> If you are like all prior HMS classes (and I’m 100 percent certain that you are), you will be both participating in and leading these changes.</p> <p> Some of you will pioneer the innovative approaches for practicing collaborative, inter-professional, evidence-based medicine that a future new paradigm will likely demand.  Others will develop and deploy new technologies and systems for a future where remote sensing and digital health will be far more prominent than it is today. Others will make paradigm-shifting discoveries that will illuminate the cause of disease, and provide new approaches to treatment. And finally, many of you will do what physicians have done for centuries—work closely with your patients to help them achieve greater health.</p> <p> Now how we will pay for health care’s evolution is a core issue for all of us, and for the nation. This school, and you—our newest alumni—must work to ensure that our country maintains medicine, science and service as core values in our society.</p> <p> In the face of falling research funding, we must continue to be strong advocates for the critical research that we know will lead to improved care for all.</p> <p> Yes, the road ahead will be demanding, but it will also present great opportunities, and you—the Class of 2013—have reason to be hopeful for the world’s future. We are at an amazing pinnacle in the history of biomedical science, in the country that leads the world in this space.</p> <p> We possess remarkable human capital, as well as insights and tools that permit us to better understand physiology and disease.  And we’re rapidly gaining understanding into behavior and the mind in a way that no previous generation of humans had.</p> <p> Genomic exploration is revealing unsuspected therapeutic targets in cancer.  With this approach, we now have—and will soon have many more—custom-tailored treatments for individual patients. This will hopefully lead to rationally designed disease-prevention strategies. We are working hard to transcribe and edit “molecular conversations” with the goal of interrupting the course of disease.  All this means that you will be able to ease human suffering to a degree that is wholly unprecedented.</p> <p> Collaboration and technology will be a cornerstone of your success. Even now, under the rubric “One Harvard,” we’re creating alliances that we expect will lead to new diagnoses, treatments and preventions for the brain, heart and bone injuries of athletes.</p> <p> We also expect to be part of an exciting interdisciplinary brain-mapping initiative designed to allow us to understand the still mysterious functions of the brain.  One day, this will likely lead to new treatments for schizophrenia, Alzheimer’s, autism and epilepsy.</p> <p> Countless other frontiers remain ahead for you to discover, whether your work involves exploring the genome, redesigning care delivery systems or traversing continents to combat cholera and tuberculosis. </p> <p> Of course, today, all health is global.  Pathogens know no borders. To squelch future epidemics, you will collaborate with health care providers in every corner of the world. On this ever-shrinking planet, your reach as caregivers will truly know no boundaries.</p> <p> I hope that you will use the modern tools of medicine to wondrous ends. I also hope you will retain the idealism and passion that has inspired you to want to heal your fellow human beings.  It was that spirit which we saw on Marathon Monday, just six weeks ago in our hospitals and on our campus—the impulse to reach out and provide care in the face of unspeakable tragedy—that truly defines our vocation.</p> <p> As we send you on your journeys, we are certain that you are well equipped for the undertaking ahead. You have labored long and displayed exceptional intellect and spirit.  You will contribute to the future of human health—some as empathetic healers, others as innovators; all with your hearts.  Embrace the privilege of entering the medical profession. You are surely equal to it.</p> <p> Congratulations.</p> Thu, 30 May 2013 21:01:39 +0000 Alyssa Kneller 5671 at Collaborating on Global Health <p> The world of global health is complex and constantly changing.</p> <p> Over the past five decades, with great advances in the field of medicine and with a growing focus on global health delivery, both at Harvard and around the world, we have seen an increasingly complex burden of disease. Julio Frenk, dean of the Harvard School of Public Health, calls this the triple burden: a mix of illnesses typically associated with poverty, including many infectious diseases and high maternal mortality; rising levels of noncommunicable diseases like cancer and heart disease, plus injuries from accidents and violence; as well as what he calls diseases of globalization, like the pandemics of HIV/AIDS and H1N1.</p> <p> To meet these complex evolving challenges, we need to draw on the deep expertise of the biological and social sciences. This requires broad collaborations and strong partnerships.</p> <p> On April 25, 2013, I was honored to participate in a panel discussion at HSPH celebrating the <a href=";llr=aqs5oylab" target="_blank">50<sup>th</sup> anniversary</a> of its Department of Global Health and Population.</p> <p> I was delighted to have the chance to celebrate their achievements, and to highlight the remarkable collaborations between HMS and HSPH that have contributed so much to our shared institutional missions of alleviating human suffering caused by disease.</p> <p> You can read my full remarks from the event <a href="/sites/default/files/assets/News/2013/files/flier_global_health_2013.pdf" target="_blank">here</a>.</p> Wed, 01 May 2013 17:41:32 +0000 Alyssa Kneller 5437 at Undoing Harm <p> There is a certain type of individual who runs toward disaster, whose hands reach out to others during times of unspeakable tragedy. Some use the word hero to describe these individuals, those who led the remarkable response to the April 15 Boston Marathon attack. But for those at HMS, this response is simply a vocation.</p> <p> Medical professionals are often on the front lines of crisis, and such was the case on Marathon Monday when two explosions at the finish line resulted in three deaths and more than 145 injuries of the type more common to the battlefield than the streets of Boston. All of us were profoundly shaken by the day’s horrific events.</p> <p> At Brigham and Women’s Hospital, Massachusetts General Hospital, Beth Israel Deaconess Medical Center and Boston Children’s Hospital, doctors, nurses, medical students and staff heroically performed the difficult work for which we have trained and to which we have devoted our lives. This expert skill and dedication illustrate why Boston hospitals have earned a reputation as best in the world.</p> <p> In the days and months to come, as their work continues, it is my hope that the members of our remarkable community will draw strength from each other, sharing our unique abilities as healers to comfort and restore.</p> <p> I want to offer my deepest sympathy and prayers to the victims and their families. It is clear that the HMS community has united in an extraordinary way during this extremely difficult time, doing the lifesaving work required to care for the injured. To these HMS caregivers and those who support them, I offer my respect, admiration and sincere gratitude.</p> <p> I also want to share with you a few articles that I view as offering especially meaningful thoughts in relation to this tragedy.</p> <p> <a href="" target="_blank">The Meaning of the Boston Marathon</a></p> <p> <a href="" target="_blank">The Boston Marathon Bombing: Keep Calm and Carry On</a></p> <p> <a href=";utm_medium=twitter" target="_blank">Two If By Sorrow: Boston and its Losses</a></p> Tue, 16 Apr 2013 22:16:27 +0000 Alyssa Kneller 5398 at Past as Prologue? <p> Despite the many discoveries that continue to emerge from our basic, translational and clinical research endeavors, this is a difficult time for those involved in biomedical research.  Traditional funding sources are being compromised by the national financial crisis, threatening our core research budgets. At such times, it is valuable for leaders to reflect upon how previous, more optimistic years may provide useful lessons to help us navigate the current challenging environment.</p> <p> In a recent <a href="" target="_blank">Perspective</a> article in <a href="" target="_blank"><em>Science</em></a>, Michael Brown, MD, and Joseph Goldstein, MD, did just that. Their article celebrated a golden era at the National Institutes of Health (NIH) between 1964 and 1972 when they and seven other young physicians trained in basic research labs at the NIH, and then went on to win Nobel Prizes for their important discoveries. Brown and Goldstein used their review of this golden period to frame lessons that might benefit medical education and biomedical research today.</p> <p> I have enormous respect and admiration for these two individuals, both personally and professionally, and I take their perspective seriously⎯Brown and Goldstein are among the most important leaders in modern biomedical science. Indeed, I join them in celebrating the role that NIH has played in shaping the careers of so many scientific leaders, and I agree with many of the points that they make in their <em>Science</em> article. I think they have sparked a much-needed national debate about the scientific foundations of medical education and the future of physician-led research. I do, however, have a different view on several of the issues they raise, and these issues are important to HMS, and more broadly, to medical education and research. I have presented <a href=";keytype=ref&amp;siteid=sci" target="_blank">my reactions</a> to their article in a letter published in<em> <a href="" target="_blank">Science</a></em> on January 11, 2013.</p> <p> There is, of course, much more to be said about these critical issues and I welcome your thoughts.</p> Thu, 10 Jan 2013 23:21:17 +0000 Amy Barletta 4884 at Wounded, Deeply <p> For millennia, a fundamental responsibility of physicians has been caring for the wounds of their patients. Applying salve and ointment, removing dead or diseased tissue, covering and binding with bandages, these are the actions most associated with trauma care. As with so much of medical care, however, the evolution and maturation of techniques, tools, and ideas have brought changes to the diagnosis and treatment of trauma. Time has even brought changes to the scope of what we in the medical profession think of as wounds; psychological and social traumas are ready examples.</p> <p> Such progress and innovation is bedrock to the research and clinical care undertaken by members of the community of Harvard Medical School. The current issue of <em>Harvard Medicine</em> magazine, for example, gives us ample evidence of the School’s innovation in something as fundamental as wound care. As described in the magazine, work by HMS researchers at Brigham and Women’s Hospital and Spaulding Rehabilitation Hospital is improving outcomes for burn patients and paving the way for an artificial skin that will mimic natural tissue. Diagnosis and treatment of brain traumas, injuries that plague members of the military serving in war zones and that concern a growing number of athletes of all ages, are being developed and refined through the efforts of HMS investigators at <a href="">Spaulding</a>, <a href="">Brigham and Women’s</a>, <a href="">Massachusetts General Hospital</a>, and the <a href="" target="_blank">Wyss Institute for Biologically Inspired Engineering</a>.</p> <p> Wounds to spirit and psyche are also addressed by caregivers at HMS, evidenced by the work of child-care experts at the School’s teaching hospitals who guard against the traumas that sickness and hospitalization can bring to their young patients and by the updated use of the ages-old comfort offered the sick by canine companions.</p> <p> The HMS community is one characterized by a diversity of people, backgrounds, and skills. It is also a community anointed with a diversity of ideas. That richness allows us to push the envelope in areas already considered cutting edge, and it allows us to innovate ways to better address the injuries that have historically prompted people to seek out physicians. The pages of our magazine and the pages of this website tell these stories of progress. I invite you to <a href="">explore this issue of <em>Harvard Medicine</em></a>.<br />  </p> Mon, 17 Dec 2012 19:39:32 +0000 Shaun Dow 4741 at Reflections on Three Decades of Discovery <p> Although much is made of the legendary rivalry between Harvard and Yale, much more of our relationship involves cooperation and collaboration.  In that context, I was extremely honored to be invited to deliver the 25th Lee E. Farr Lecture at Yale last May, at the culmination of the annual Student Research Day at the Yale School of Medicine.</p> <p> I was asked to discuss my research career over the course of the last three decades and to offer advice from that perspective to graduating Yale students who are all required to conduct a scholarly project. Research was critical to my own experience as a medical student, and as HMS dean I have made it a priority for our students. I have taken steps to ensure that HMS students have every opportunity to enrich their medical school experience with scientific discovery. As of this year, it is now a requirement for every entering student to complete a scholarly project.</p> <p> In the Farr Lecture, I discussed the trajectory of my own research career, and I hope that some of my experiences will help young scientists who are just now contemplating their future paths.</p> <p> Some people know that my chief areas of investigation are obesity and diabetes and that I have been fortunate that my research has produced several insights into the molecular basis for diabetes and obesity.  What readers may not know, however, is that it was in a basic biochemistry course at Mount Sinai School of Medicine, where I received my MD in 1972, that I first became interested in this area.</p> <p> The chair of the biochemistry department at the time, Dr. P.G. Katsoyannis, led a group that was the first to synthesize the insulin molecule through peptide synthesis and then show it to be biologically active – a major feat at the time.  During my first few months at the school, my interest in insulin and metabolism was sparked. My personal hero at Mount Sinai, Chair of Medicine Dr. Solomon Berson, developed the technique of radioimmunoassay with his scientific partner Dr. Rosalyn Yalow, and my respect for Dr. Berson and excitement about the implications of his discovery powerfully influenced my subsequent scientific development.</p> <p> Although Dr. Berson died prematurely during my senior year, Dr. Yalow went on to win the Nobel Prize in 1977 for their joint discovery.  In short order, I had the opportunity to know and work with the person who first synthesized insulin and the person who first measured its level in blood.  My career in endocrinology took flight, leading to a position at the National Institutes of Health with a student of Dr. Berson where a paper I published in the journal Science on a new form of diabetes established my own lifelong course of research.  That decision, in turn, drew me to what was then referred to as Beth Israel Hospital in Boston and to the faculty of Harvard Medical School.</p> <p> Research also led me to one of the most rewarding and interesting collaborations of my life – with my wife Terry Maratos-Flier, a scientist with whom I have co-authored 29 papers on a variety of topics over the past 34 years. She continues to do critical work studying diabetes, an important disease in which many of the biggest questions remain unanswered. </p> <p> What are the lessons to be learned?  Research and funding sources are threatened today, but scientific discovery remains an incredibly fruitful and fulfilling career choice.  To understand why I believe this, and to find out which research discovery led to one of the great “aha” moments of my career, please take a look at the <a href="/sites/default/files/assets/Multimedia/Blogs/Files/Farr_Lecture.pdf" target="_blank">full text of my Farr Lecture</a>.</p> Mon, 17 Sep 2012 15:27:58 +0000 Shaun Dow 4289 at 2012 Warren Alpert Foundation Prize <p> Dear Members of the HMS Community,</p> <p> I would like to congratulate Kenneth Anderson and Paul Richardson of Dana–Farber Cancer Institute and Harvard Medical School, Alfred Goldberg of Harvard Medical School and Julian Adams of Infinity Pharmaceuticals for their selection as this year’s Warren Alpert Foundation Prize honorees.</p> <p> This group of outstanding scientists and physicians received the prize for their extraordinary accomplishments in taking bortezomib (commercially known as Velcade) from the lab bench, as part of a fundamental inquiry into cellular protein homeostasis, to its current status as a frontline therapy for treating patients with multiple myeloma. Their joint selection celebrates both the fundamental science that provided the foundation and spark for subsequent studies, and the manner in which the discoveries were built upon by clinical science and collaboration within the academy and with industry to benefit human health. Each honoree will discuss his unique contributions to the ultimate development of bortezomib at this year’s symposium, which will take place on Monday, Sept. 24, 2:30-5:30 p.m., at the New Research Building located at 77 Avenue Louis Pasteur. Program details are available at <a href=""></a>.</p> <p> The Warren Alpert Foundation Prize honors individuals whose discoveries have translated into, or show great promise of being translated into, treatments of human disease. First awarded in 1987, and associated with HMS since that time, the prestigious Prize garners nominations from many of the world’s foremost physicians and scientists. Further information on the Warren Alpert Foundation Prize can be found at <a href=""></a>.</p> <p> I hope you are able to join me in attending this symposium. You can RSVP to <a href=""></a> or by contacting Edward Canton (<a href=""></a>) with any questions you might have.</p> Wed, 19 Sep 2012 20:24:27 +0000 Shaun Dow 4308 at Progress & Possibilities <p> As we enter a new academic year, I would like to share with you just a few of the many accomplishments of this remarkable Harvard Medical School community in the areas of education, research, innovation and philanthropy. </p> <p> <strong>Education</strong><br /> 
I am delighted to report that, after a comprehensive two-year process that included self-study and an external review, HMS has been reaccredited by the Liaison Committee on Medical Education. The LCME report lauded our recent clinical educational reforms and praised the Principal Clinical Experience. In addition, our consideration of the review recommendations has accelerated our plans to construct a new clinical skills center, an exciting new environment for our evolving curriculum.</p> <p> To maintain our acknowledged position of educational leadership during a period of rapid change in both pedagogy and biomedicine, we cannot rest on our laurels, but must respond to the many new challenges and opportunities that we face. We are therefore initiating a comprehensive assessment of our preclinical curriculum aiming, in part, to better align our students’ preclinical medical education with the dynamic changes occurring in medical practice and educational technologies.</p> <p> As we conduct this new review, we continue to implement important initiatives from prior curricular revisions that are designed to inspire educational excellence. Our <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">Scholars in Medicine</a> program, in its second year, is providing students and faculty with new opportunities for collaboration and mentorship through 160 faculty-mentored scholarly projects on topics ranging from basic and translational research to global health.</p> <p> Our PhD programs—which include <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">bioinformatics and integrative genomics</a>, <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">biological and biomedical sciences</a>, <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">biophysics</a>, <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">chemical biology</a>, <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">immunology</a>, <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">neuroscience</a>, <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">speech and hearing bioscience and technology</a>, <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">virology</a> and <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">systems biology</a>—continue to rank among the best in the country. This spring, an intensive external review of the MD-PhD program concluded, “The [program] is clearly a national leader in training MD-PhD students, having a long track record of exceptional success. … In many cases, students in the [program] are the engines of change through cutting edge research that is at the interface of science, medicine, global health, and health policy.”</p> <p> To address a major need, we are developing a new therapeutics track for students in the life-science PhD programs at Harvard University. This will provide an integrated curriculum in therapeutics and related fields, including systems approaches. <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">Graduate education</a> at HMS also offers four master of medical science programs, including two in clinical investigation (<a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">SCSP</a> and <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">CITP</a>), one in <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">biomedical informatics</a>, and the newest, in <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">global health delivery</a>, which launched in July. I expect the number of new HMS masters programs to increase in the coming years.</p> <p> The continuing education of physicians is another core responsibility of the School. Our extensive offerings reach tens of thousands of professionals throughout the world, helping them hone their skills in the rapidly changing landscape of medicine. This past year we launched an ambitious and comprehensive review of our CME programs to ensure their future excellence and to consider some entirely new educational efforts. I look forward to sharing with you the recommendations of the HMS-wide task force later this fall.</p> <p> <strong>Research</strong><br /> 
From the search for an effective HIV vaccine to the development of a method for using synthetic DNA as a drug-delivery device, <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">discoveries</a> made by HMS faculty across the Quad and affiliated institutions continue to generate striking advances in science and medicine. To enhance our ability to spur future discoveries, we will foster novel interdisciplinary collaborations, such as the <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">HMS Initiative in Systems Pharmacology</a>, announced last October, which aims to connect basic scientists and clinicians with computer scientists, physicists and mathematicians to transform drug discovery and redefine how we develop safe and effective new therapeutics.</p> <p> Similarly, our clinical translational science center, <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">Harvard Catalyst</a>, increasingly serves as a unifying mechanism for the cross-Harvard clinical and translational research community. In May, Catalyst awarded <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">pilot grants</a> to seven teams for interdisciplinary research on a variety of child-health issues. A summit on childhood obesity this past spring provided an unprecedented opportunity for physicians, researchers, leaders in public policy and lawmakers to unite around this critical issue. The competitive renewal of the Catalyst grant is being prepared for January submission to the NIH.</p> <p> The reach of HMS expertise continues to expand around the world through important collaborative relationships. In its third year, the <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">HMS-Portugal Program in Translational Research and Information</a> provides a global model for enriching clinical and translational research and education in a country working to develop its own programs. The <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">Bertarelli Program in Translational Neuroscience and Neuroengineering</a> is a partnership with Ecole Polytechnique Fédérale de Lausanne to create a robust bi-institutional research and educational collaboration in neuroscience. HMS is currently in discussions with academic leaders in several countries to create additional alliances with the potential to leverage the diverse resources and skills of HMS faculty while advancing joint academic goals.</p> <p> <strong>Leadership and Innovation</strong><br /> 
Each year, without exception, the outstanding members of our faculty receive prestigious <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">awards and honors</a> recognizing their outstanding exemplary leadership, expertise and accomplishments. To retain and recruit the finest educators, physicians and scientists, we will continue to aggressively implement a variety of faculty development and diversity initiatives introduced by our <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">Task Force on Faculty Development and Diversity</a>. Important among these initiatives is the successful streamlining of the senior promotions process. I am delighted to report that <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">more than 100 faculty members</a> were promoted to professor last year—a record number—with average approval time for these promotions reduced from 16 months to just nine.</p> <p> <strong>Philanthropy</strong>
<br /> This year we made progress in addressing one of the nation’s most critical needs, as our newly established <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">Center for Primary Care</a>, supported by a generous $30 million anonymous gift, began efforts to strengthen and transform the discipline of primary care. Led by its inaugural director, Russell S. Phillips, professor of medicine, and co-director Andrew L. Ellner, instructor in medicine, the young Center recently launched the <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">Academic Innovations Collaborative</a>, designed to spur innovation through targeted investments in nine HMS hospital-based primary care teaching practices and eight community-health practices. The <a href=";ms=NDczNDk5NAS2&amp;r=MTgzMzA2MDIwMTYS1&amp;b=0&amp;j=NTIyMTAxNTES1&amp;mt=1&amp;rt=0">Innovation Fellows Program</a>, now in its second year, supports faculty who mentor students while implementing exciting projects in health centers.</p> <p> I salute the achievements of the Harvard Medical School community—students, faculty and staff—for the work that they do every day to shape the future of medical education, biomedical research and patient care.</p> Wed, 05 Sep 2012 17:50:51 +0000 Shaun Dow 4232 at HMS Grads to Shape the Future <p> Members of the class of 2012, families and friends, distinguished Medical and Dental School faculty, honored guests.</p> <p> In a few short minutes we’ll launch your careers-- in medicine and in dentistry, in patient care, in biomedical research, in policy and, ultimately, in a wide variety of leadership roles, both here in the U.S. and around the world.</p> <p> Today you have great cause to celebrate, to be optimistic, to hold your hopes high. Yes, society today is beset with substantial fiscal and social challenges that are as yet unmet. But medicine and biomedical research remain core values in our society, and important national priorities.</p> <p> Your careers are blossoming during a tremendously exciting era for medicine practice, for biomedical science and for public policy related to health.</p> <p> In this country, we are still in the early stages of long overdue and necessary reform of our excessively expensive and underperforming health care system. Many critical details of how this reform will unfold remain unclear, awaiting Supreme Court decisions, and resolution of legislative gridlock, and many aspects are quite contentious. But whatever form this reform ultimately takes, the future practice of medicine will surely differ greatly from that which you have thus far experienced. I take great solace in the belief that some of you will play critical roles in shaping that future.</p> <p> You, the class of 2012, have reason to be hopeful for all the world’s future, not just your own. We are on the cusp of an era when researchers will have the knowledge and technologies to devise rationally designed disease-prevention strategies—including public health interventions, changes in nutrition and exercise, and new medications including vaccines -- which will potentially benefit millions of people worldwide.  Sometimes these preventive strategies will fail, and when they do, we will benefit from many new custom-tailored treatments for individual patients based on genetics and biomarkers that will increase the efficacy of medications and reduce their toxicity.</p> <p> In Boston today, a patient with devastating injuries can be given a new chance at life by our Faculty through facial transplantation. But before too long, we will be able to go much further than that.  Using rapidly evolving technology fueled by basic science, we can already regenerate many cell types and tissues, in many cases derived from a skin cell grown from a patient; given rapidly evolving advances in stem cell science, the impact of regenerative medicine on the future of human health is likely to be profound.</p> <p> We are also working hard to transcribe and edit “molecular conversations” within and between cells with the goal of more completely understanding them, increasingly using the new science of systems biology, and advanced imaging techniques.  Ultimately, our goal is to interrupt the course of cancer, diabetes and many other diseases that are now too often refractory to therapy.</p> <p> In your lifetime, I expect you will have the tools and knowledge to expand the human “healthspan” — that is, the total number of years we enjoy good health, not just life.</p> <p> Class of 2012, yours is a time of exhilarating change that is vast in scope: Today, all health is global. You will, I am certain, have the opportunity to ease human suffering to a degree that is wholly unprecedented.</p> <p> Pathogens know no borders, and the threat of drug-resistant disease continues to loom large. However, as you confront future epidemics, you will be far more able to communicate and collaborate in an instant with experts all around the world. Your generation is intensely interconnected, and you share a keen awareness of the need for quality health care in every corner of the world.</p> <p> On this shrinking planet, your reach as caregivers and health policy shapers will know no boundaries.</p> <p> I hope that you will use the modern tools of medicine to wondrous ends. Remember that despite the many woes of this world, your lives are brimming with opportunity.</p> <p> You will help determine the future of human health. Embrace this privilege. You are equal to it.</p> <p> When you arrived at HMS, some of you had a very detailed plan in mind; and many of you remain precisely on the path you envisioned for yourself four or five years ago. Others of you discovered completely unanticipated paths along the way. Wherever you lie on that spectrum, you will likely encounter unexpected opportunities and forks in the road ahead.</p> <p> But no matter how often you deviate from your initial plans and no matter how often the world shifts around you, I implore you to stay true to your ideals. Above all, I wish that you take the opportunity to touch your fellow human beings—and to experience the profound fulfillment that comes with being a physician.</p> Thu, 24 May 2012 21:43:46 +0000 Shaun Dow 3692 at Surgery yields insights into treatment of diabetes <p> Two recent reports on the success of bariatric surgery in treating diabetes associated with obesity have important implications for the field of metabolic disease, including future approaches to the treatment of obesity and diabetes, and broader implications for biomedical research.</p> <p> First, a bit of history. My research has focused on diabetes and obesity in humans and in animal models. Despite the field’s amazing scientific progress over the past 35 years, which dramatically expanded our understanding of the genetic and biochemical pathways that regulate bodyweight and blood sugar, and despite tremendous investment in basic research and pharmaceutical research and development, obesity and diabetes have become more prevalent, not less. Available treatments remain far less effective than we would like, and the burden of disease continues to increase. Furthermore, the current regulatory environment seems likely to slow development of major new therapies.</p> <p> Now come two well-conducted studies (<a href="" target="_blank">Schauer et al.</a> and <a href="" target="_blank">Mingrone et al.</a>), each of modest size from a single center, comparing the effect of medical therapy vs. bariatric surgery on diabetes in obese patients. The reported results were striking. Surgery, already known to be more effective than medical therapy at inducing durable weight loss, is now shown clearly to be far more effective than medical therapy in improving, and even reversing, diabetes. And the amelioration or reversal of diabetes typically occurs rapidly after surgery, long before substantial weight loss occurs. This strongly suggests that the mechanism by which the procedure(s) improve diabetes must include mechanisms distinct from those associated with weight loss.</p> <p> How does bariatric surgery produce this effect? Altering the levels of various gut hormones or changing the function of the enteric nervous system seem to be the likely mechanisms, but as of now, we lack a clear explanation. Identifying a mechanism apart from weight loss that explains how surgery ameliorates diabetes should be a research priority, as this could point to future medical therapies that would be effective without the need for surgery. Such research indeed exists, including at HMS, but I suspect it will now accelerate. Meanwhile, pressure will build to offer bariatric surgery to more obese patients with diabetes. It will be necessary to weigh the cost and complications of surgery against the projected long-term benefits to the patient of reductions in obesity and diabetes, while factoring in patient preference for a surgical approach to their “medical” disease.</p> <p> Here is the irony of this situation. As a fellow and then junior faculty member in the 1970’s and 80’s, I saw patients with severe obesity and diabetes who experienced rapid and durable reversal of diabetes immediately after bariatric surgery. At the time, it was evident that something interesting was going on. Indeed, reports from a number of centers demonstrated this phenomenon, but typically did so without comparing the results of surgery to those in a medically treated group—i.e., a controlled clinical trial. Because we knew of no other treatment that made the disease reverse so reliably without medication, it was evident even then that surgery induced unique and important pathways that we did not fully understand. But controlled trials have power to influence our thinking, and so, these recent findings will have a major effect on the field.</p> <p> Ten years ago, I was optimistic that effective medical approaches to treating diabetes and obesity would develop out of new molecular research, relegating surgical approaches to the history books.  Today, that belief may be viewed as naïve. But we do now have an opportunity to capitalize on the insights gained from bariatric surgery. We can use this treatment to design experiments that will identify currently unknown pathways for the regulation of body weight and diabetes.  And this approach may lead to effective medical therapies in patients unwilling or unable to undergo surgery. I believe this represents an excellent opportunity to employ a systems biology approach, which I may address in a future Dean’s Corner.</p> Mon, 16 Apr 2012 19:05:10 +0000 Amy Barletta 3472 at Welcome to the new Harvard Medical School website! <img src="/sites/default/files/newwebsite_9.jpg" alt="" /><p> Welcome to the new Harvard Medical School website! And welcome to the Dean’s Corner, where I am looking forward to regularly sharing my thoughts and views on topical issues important to the practice of medicine, to medical education, and to the lively, vital world of biomedical research. This website is a work in progress and will continually be refreshed. I encourage you to visit often.</p> <p> On this site, we invite you to learn about our latest initiatives in biomedical research and education through several new resources including HMS produced videos and podcasts, a news room where you will find current information emanating from the School as well as the 17 pre-eminent Harvard Medical affiliates.  Throughout the site we have introduced new interactive tools with the goal of creating a dialog with you, our visitors. These tools include our Idea Lab blog where you may add your opinion on current issues to those from visitors throughout the world. You may also share your thoughts through our new commenting tool found on all news articles, videos and podcasts.  I’m excited to use this new, interactive website to bring the powerful conversations already happening at HMS to the rest of the world.</p> <p> Above all, I invite and welcome your personal feedback on the work we do at Harvard Medical School, and on its contribution to our mission to alleviate human suffering caused by disease.</p> <p> My vision is that this Corner—and this website—will build new relationships and strengthen existing ones. Please visit us often— I hope you will find that there is always something new to inspire and captivate!</p> Mon, 13 Feb 2012 18:20:12 +0000 Amy Barletta 2752 at