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September 17, 2010
Table of contents
WWAMI Regional News section debuts in this issue
In this issue, I am pleased to introduce the new WWAMI Regional News section of Online News. WWAMI is a five-state regional medical program under the accreditation of the UW School of Medicine. The participating states are Washington, Wyoming, Alaska, Montana and Idaho. Since the program began in 1971 with 10 medical students completing part of their first year in Alaska, there has been an ongoing expansion of WWAMI (Wyoming joined in 1996) throughout the region.
WWAMI has been nurtured through the years by many different individuals at the Seattle campus, including Drs. Ted Phillips, Roy Schwarz, Bob Van Citters, Jack Lein, John Coombs, and others. Many individuals from each state have made this ongoing partnership possible, including physicians, legislators, university leaders and governors. A recent reunion of “WWAMI pioneers” organized by Roy Schwarz (pictured below)showed the strong roots of the program.
I became the vice dean for regional affairs on Dec. 1, 2009 after serving as clinical assistant dean for WWAMI Idaho for five years. I am based in Boise, Idaho, and come to the Seattle campus regularly to interact with colleagues. As the first person to head regional affairs who does not live in Seattle, I have had the opportunity to bring the voice of the region to the WWAMI program. I know firsthand what an important and valuable program WWAMI is for the region and the UW School of Medicine. It is a pleasure and privilege to head the regional program.
The first-year regional WWAMI campuses have been overseen by assistant deans at each of the partner universities since the WWAMI partnership began. The program now has regional offices and regional clinical deans in addition to the first-year leadership. The regional offices, located in Spokane, Cheyenne, Anchorage, Whitefish and Boise, oversee the medical student clinical rotations that occur in each of the states. Both the first-year and clinical regional offices will contribute articles to the new WWAMI Regional News section of Online News.
I look forward to sharing news from the region with the entire UW Medicine community. If you have suggestions for articles about WWAMI, please don’t hesitate to contact me at firstname.lastname@example.org or Kellie Engle at email@example.com.
Researchers at the UW have received a five-year $10 million grant from the National Institutes of Health’s Pharmacogenomics Research Network (PGRN) to create a Northwest-Alaska center to study pharmacogenomics in rural and underserved populations.
Ken Thummel, UW professor and chair of pharmaceutics, and Wylie Burke, UW professor and chair of bioethics and humanities, and their colleagues, are joining a nationwide network of scientists to study how genes affect individual response to medicines.
Thummel and Burke's PGRN program is the first to address the needs of underserved populations in the Pacific Northwest and Alaska. It is a partnership with researchers at University of Alaska - Fairbanks, University of Montana, Southcentral Foundation in Anchorage, Group Health Research Institute, Puget Sound Blood Center and with communities and rural health-care providers in Anchorage and the Yukon-Kuskokwim Delta in Alaska, Northwestern Montana, and parts of rural Washington and Idaho.
"We hope this grant will reduce barriers that limit the inclusion of American Indian and Alaska Native people in pharmacogenomic research," said Thummel. "We'd like these traditionally underserved communities, and their health-care providers, to have increased opportunities to evaluate the merits of this testing and introduce advances into clinical practice when warranted."
The center’s research will focus initially on genetic variables influencing drug therapy with the blood thinner warfarin, the anti-estrogen tamoxifen, and the immunosuppressive drug tacrolims. Researchers will study whether gene variation that has affected drug metabolism responses among other study populations is also prevalent among American Indians and Alaska Natives. Project members will also study the relationship between the population’s genetic makeup and environment interactions, such as diet, which may contribute to changes in blood clotting and an altered need for warfarin among some individuals.
Burke said that she and colleagues have sought to launch this type of research center for years. "We wanted to ensure that pharmacogenomic discoveries contributing to improvements in drug efficacy and safety benefit all people living in our region," she said.
At the UW, the multidisciplinary research group involved in the project includes faculty from the departments of bioethics and humanities, epidemiology, family medicine, genome sciences, law, medicinal chemistry, nephrology and pharmacy.
People want to be informed and asked for consent before deciding whether to let researchers share their genetic information in a federal database, according to a team of Group Health Research Institute and UW investigators. The team’s report, called “Glad You Asked,” appears in the September 2010 Journal of Empirical Research on Human Research Ethics.
To the team’s knowledge, it is the first to ask research participants’ opinions about the need for informed consent for sharing their own information. The team explored participants’ preferences while collaborating on the Electronic Medical Records and Genomics Network. This is a national consortium formed to develop, disseminate, and apply approaches to research that combine DNA biorepositories with electronic medical record systems for large-scale genetic research. The network project involves volunteers enrolled in the joint Group Health-UW Adult Changes in Thought (ACT) study. ACT is a longitudinal cohort study that tracks aging-related changes in thousands of older Group Health patients over time.
When the team asked Group Health patients who participate in ACT whether their "de-identified" (anonymous) genetic and medical record information could be shared in the database, 86 percent said yes. Then the team surveyed 365 ACT study participants who had agreed to let their genetic information be shared, mostly because of a “desire to help others.” In the survey, 90 percent of participants said they thought it was important to have been asked for this reconsent.
Reconsent means getting additional informed consent from research participants before using their information for a purpose beyond what they agreed to originally. Alternatives to reconsent—including opting out, being notified, or neither individual permission nor notification—were unacceptable to 40 percent, 67 percent, and 70 percent of the surveyed participants, respectively.
“Trust is a two-way street, and human research requires lots of trust,” said Evette Ludman, lead author and senior research associate at Group Health Research Institute, said. “People have an understandable feeling of ownership over their bodies and medical records, including their genetic information,” she added. “Researchers show we’re worthy of trust when we ask research participants for permission to use their information in a way that they haven’t already agreed to.” Ludman suggested that research grants include funding and time to pursue reconsent.
Ludman’s UW co-authors included Wylie Burke, professor and chair of the Department of Bioethics & Humanities and affiliate investigator at Group Health Research Institute; Gail Jarvik, professor of medicine and head of the Division of Medical Genetics; Stephanie M. Fullerton, assistant professor of bioethics and humanities, and Susan Brown Trinidad, research scientist in bioethics and humanities.
UW Medicine offers options and comprehensive plans for weight loss
Weight-loss surgery is more widespread than ever. Saurabh Khandelwal, UW assistant professor of surgery, discussed procedures available at UW Medical Center’s Bariatric Surgery Center.
Q: With the LapBand and gastric bypass procedures, do certain patients do better with one or the other?
A: A LapBand doesn’t affect how your body absorbs nutrients. It’s a physical restriction around the top of your stomach that helps you feel full faster. Successful patients tend to actively exercise, they don’t snack, they probably have tried diets. They’re OK with weight loss being more gradual. They also commit to follow up, which is quite extensive – nearly 10 visits the first year.
The bypass is a more invasive operation. The stomach is surgically divided into a small pouch and the GI tract is reconstructed. For patients who are extremely obese and seeking to lose the most weight possible, the bypass is a better operation. It’s also more likely to reduce or resolve conditions like diabetes and hypertension.
If a patient has insulin-dependent diabetes or significant acid reflux, those conditions respond better to bypass.
Q: Can you explain the roles of the nutritionist and the social worker?
A: Before surgery, every patient spends an hour with our social worker, so we can identify potential impediments to success. They also spend an hour with our nutritionist to identify problem eating behaviors to target. This consultation gives a detailed idea of how their eating will change after the operation. When patients come for follow-up, they see the same nutritionist again. We also can immediately engage the social worker again, as needed.
It’s really a longitudinal, comprehensive program, and the goal is that surgery is just one component. Nutrition, diet, exercising and behavioral change are essential parts of weight loss.
For more information, call the Bariatric Surgery Center at 206.598.4804.
UW Medicine faculty and staff are invited to join the UW Medicine Regional Heart Center and the American Heart Association in this year’s premier walking and fund-raising event for the fight against heart disease. The 2010 American Heart Walk takes place at the Seattle Center on Saturday, Oct. 2.
The event takes place in more than 850 cities each year. The funds raised support community health care education, research, best practices and more. Among the areas benefiting are advances in cardiovascular medicine and increased public awareness of heart attack warning signs and lifestyle to optimize cardiovascular health.
Join your colleagues in helping UW Medicine reach its $50,000 goal. UW Medicine teams are already forming. You can join an existing team or be the captain of your own.
To register or to make a donation, visit the Heart Walk website. For more information call Christine Dean at the UW Medicine Regional Heart Center, 206.598.5762. Or you can contact Tara Coffland at 206.834.8607 or Kate Justice at 206.834.8632 at the American Heart Association.
Teresa Massagli, UW professor of rehabilitation medicine, has been elected chair of the American Board of Physical Medicine and Rehabilitation (ABPMR). She assumed the position August 1 and will serve until 2014.
Massagli, who is also program director of the School of Medicine’s Physical Medicine and Rehabilitation Residency, was elected by the ABPMR board of directors.
The ABPMR is one of 24 medical specialty boards that make up the American Board of Medical Specialties (ABMS). The ABMS boards work together to establish common standards for physicians to achieve and maintain board certification. Masssagli has chaired examination committees for the PM&R oral examination, spinal cord injury medicine, and pediatric rehabilitation medicine.
Massagli also serves the vice chair of the Accreditation Council for Graduate Medical Education Review Committee for Physical Medicine and Rehabilitation. The council evaluates and accredits allopathic medical residency programs in the United States. Massagli received the Parker J. Palmer Courage to Teach Award from the council in 2005.
Massagli, a UW faculty member for 22 years, has served as residency program director for 18 years. She provides pediatric rehabilitation care at Seattle Children’s, and consultation to acute care services at Harborview Medical Center and UW Medical Center.
From 2004 to 2005, Massagli was acting assistant dean for Graduate Medical Education (GME) and recently completed seven years on the GME committee.
Geoffrey Gottlieb, UW assistant professor of medicine in the Division of Allergy and Infectious Diseases, has been named the Philip and Helen Fialkow Scholar for 2010. The award recognizes the outstanding achievements of Department of Medicine junior faculty in research, teaching, clinical work and academic citizenship.
A graduate of the University of California, Berkeley, Gottlieb earned his medical degree and a doctoral degree in biological chemistry at the Chicago Medical School. Following his internal medicine residency at Duke, he came to the UW for an infectious diseases fellowship. He joined the faculty in 2001. He is an attending physician in infectious diseases at the UW Medical Center, Harborview Medical Center, and Seattle Cancer Care Alliance, and directs the UW Employee Health Clinic.
Much of Gottliev's research on HIV is carried out in Senegal. He is principal investigator of a study there on the effect of antiretroviral therapy (ART) on HIV-2 disease outcomes and emergence of drug resistance. He also investigates differences between the natural history, clinical, immunologic, and virologic aspects of HIV-1 and HIV-2 infection as well as the effects of dual infection with HIV-1 and HIV-2 on disease outcomes and ART. This work has been an ongoing collaborative effort between the UW and the University of Dakar, Senegal, since the early 1990s.
The Philip and Helen Fialkow award honors the late UW dean of medicine and his wife and carries $10,000 in support for scholarly activities and inclusion on a department recognition plaque. Gottlieb will be recognized at Medicine Grand Rounds during Fall Quarter when he will present a lecture on his work.
UW School of Medicine is the sponsoring institution for WWAMI, the five-state regional medical program for Washington, Wyoming, Alaska, Montana and Idaho. WWAMI is a 38-year partnership that provides high-quality, cost-effective medical education to the citizens of the five states. Partner universities include Washington State University in Pullman and Spokane, University of Wyoming, University of Alaska, Montana State University, and University of Idaho. (Photo left: Bob Van Citters (center) and other WWAMI pioneers celebrated the medical program at a recent reunion.)
The founding goals in 1971 were: 1) to provide access for citizens of the Northwest to publicly supported medical education; 2) to increase the number of primary care physicians and address maldistribution of physicians; 3) to create community-based medical education; 4) to expand graduate medical education and continuing medical education; and 5) to avoid excessive capital costs and duplication of resources by using existing educational infrastructure. The WWAMI Program has made substantial progress in each of these areas, but the founding goals continue to provide a focus for ongoing work.
The WWAMI program began with 20 students at Washington State University in Pullman, 10 students in Alaska, 10 in Montana and 10 in Idaho. Early on, students completed the first half of their first year in their home states and then moved to the Seattle campus. Today, 20 students spend their first year at Washington State University in Pullman; an additional 20 students are in Spokane, 16 students in Wyoming, 20 students in Alaska, 20 students in Montana and 20 students in Idaho. The second year is spent in Seattle.
The community clinical units – community-based medical education -- for third- and fourth-year medical students began in the early 1970s. There are now more than 50 clerkships in eastern Washington, more than 25 clerkships in Wyoming, more than 35 in Alaska, more than 50 in Montana and more than 50 in Idaho.
Residency training also has a strong and growing presence in the WWAMI region. The Family Medicine Residency Network includes 18 family medicine residency programs. In addition, there are two psychiatry residency tracks in Spokane and Boise, and one planned for Alaska. A new three-year internal medicine residency program in Boise is recruiting for its first intern class to start in 2011. There is also an outstanding internal medicine residency program in Spokane. Work is in progress to start a pediatric residency track in Alaska. In addition to these programs and plans, many other community residency rotations are available throughout the WWAMI region in hospital and physician practices.
WWAMI students return to their home states or back to the region to practice at rates that are above the national average of 39 percent for public medical schools. Washington has a 46 percent return rate; Wyoming 66 percent; Alaska 51 percent; Montana 41 percent; and Idaho 49 percent. The return on investment for each state increases these numbers to 68 percent in Wyoming, 71 percent in Alaska, 51 percent in Montana, and 72 percent in Idaho. Most of the WWAMI states are also above the national average for the number of physicians who complete their residency in a WWAMI state and then stay to begin practice.
Discussions are under way regarding expansion of the WWAMI program throughout the continuum of physician training (training from medical school through residency) by increasing the number of students from each of the partner states, increasing capacity for clinical training and expansion of residency training in the region.
WWAMI began as a partnership to help improve the health of the people of the Northwest by providing well-trained physicians for the region. WWAMI has been very successful over the last four decades, and there is strong momentum to build on this record. The WWAMI Program will remain focused on meeting the needs of the citizens of the five-state region.
The following is a listing of some upcoming events that may be of interest to the UW Medicine community. Additional events are listed on the UW Medicine events calendar.
Consortium of Universities for Global Health meeting, Sept. 19-21
"Transforming Global Health: The Interdisciplinary Power of Universities" Monday through Wednesday, Sept. 19-21, UW-Seattle campus. Internationally distinguished speakers, panel discussions, and presentations on universities’ efforts in the areas of global health training, educational technology, climate change, bioengineering, new media, diplomacy and more. For more information and to register, go to www.cugh.org.
Bioethics Grand Rounds, Sept. 21
Neurological Enhancement and Moral Decision Making in Medicine by James Gordon 4 to 5 p.m., Tuesday, Sept. 21, Turner Auditorium, UW Health Sciences Building, D-209. Reception to follow. When healthy people request enhancement of neurological function, clinicians often squirm. What is it about “enhancement” that rankles? How should clinicians respond when faced by such requests? Gordon is UW clinical associate professor of neurology and chair of the Ethics Committee at Northwest Hospital and Medical Center. For more information, contact Bioethics & Humanities at 206.543.5145 or firstname.lastname@example.org or visit the department’s website.
New Investigator Science in Medicine Lecture, October 4
Obesity, Diabetes and the Brain by Gregory Morton, noon, Monday, Oct. 4, Turner Auditorium, UW Health Sciences Building, D-209. Morton is UW research assistant professor of medicine in the Division of Metabolism, Endocrinology & Nutrition and is affiliated with the Diabetes and Obesity Center of Excellence. Morton studies the role of the brain in the regulation of energy balance and glucose metabolism. The lecture is open to all faculty, staff and students. No registration is required. The lecture will be simulcast to other locations. For more information, contact Viola Brown at email@example.com or visit the 2010-2011 Science in Medicine website.
UW Medicine & The Seattle Public Library Medical Lecture Series begins Oct. 6
Lessons in Lessening Your Migraine Pain by Sylvia Lucas, founder and director of the Neurology Headache and Multiple Sclerosis Center at UW Medical Center. Learn what triggers migraine headaches and chronic headaches, how to control them and the medications available for treatment. Lecture takes place at 6:30 p.m., Wednesday, Oct. 6, Microsoft Auditorium, Central Public Library, 1000 Fourth Ave., Seattle. Contact Julie Collier at 206.685.1933 or firstname.lastname@example.org for more information. Or visit the Seattle Public Library website.
Continuing Medical Education Classes, September - October
Comprehensive Oncology Review, Sept. 30-Oct. 2; Otolaryngology Update for Primary Care, Oct. 9; Vascular and Interventional Radiology, Oct. 15-17; Pain Management Frontline Pharmacological and Behavioral Strategies, Oct. 22-23. Visit Continuing Medical Education for more information or to register.