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February 17, 2012
Table of contents
Medical research should remain top national priority
Medical research is in many ways the lifeblood of the nation and world. Research improves and saves lives. Some of the evidence lies in dramatic improvements in mortality rates from common diseases as a result of advances in medical research. I discussed a few of these in a recent op-ed piece in the Seattle Times titled ‘Investment in Medical Research Saves Lives, Boosts Economy.' As cited in that op-ed, the death rate for heart disease is more than 60 percent lower than in the World War II era, and the death rate for stroke is 70 percent lower. Cancer rates have also dropped considerably over the last 15 years due to improved detection and better treatments.
Throughout our 66-year history, UW Medicine faculty and staff have been leaders in medical research. Remarkable discoveries and advances defined the School of Medicine’s early years (the Bruce treadmill, bone marrow transplantation, the Scribner shunt and others) and continue to do so today. At my annual address last week, I had the pleasure of discussing a remarkable number of advances in 2011, including work in infectious diseases that has advanced our knowledge of HIV and its treatment and prevention. I also described dramatic new information about the use of nasal insulin as a potential treatment for dementia. UW Medicine has made truly seminal advances in biomedical research over the years, and our faculty, students and staff continue to conduct world-leading research today.
Given the ongoing evidence for the positive impact of medical research on disease and quality of life, it is extremely disappointing to face a potential freeze on NIH funding. President Obama’s proposed budget for fiscal year 2013 would hold the NIH budget at the current level of $30.86 billion. The budgets for most of NIH’s institutes would remain flat, with some money moved around to address areas defined as high need.
According to an article in Science magazine, the intention would be to obtain more grants from the flat budget, with a target of an eight percent increase in new grants. Continuing grants would be cut one percent below the 2012 level, competing grants would not receive inflationary increases, and the NIH would add a new layer of review for proposals from investigators who already have at least $1.5 million in funding. This would be the 10th year in a row that the NIH’s budget would not keep pace with biomedical research inflation. By one estimate, in inflation-adjusted dollars, this would put NIH research funding at 20 percent below a decade ago. The American Recovery and Reinvestment (ARRA) Act of 2009 provided a temporary stopgap. Those funds have ended, however, and there will be no comparable mitigating factors to soften the impact of a freeze.
What can we do to voice concern about this potential future for medical research? I ask you to work through your specialty and research organizations to craft public messages and develop delegations to describe the value of research and the meaning of loss of those funds. The work of our researchers matters tremendously. While the current era of austerity means that we all must do more with less—and our faculty and staff are doing an outstanding job of finding efficiencies without sacrificing quality—we cannot compromise on our mission of improving the health of the public. Research is a key way to improve health. I thank our many researchers for your outstanding work on behalf of our mission and applaud your focus and dedication during continued difficult economic times.
Paul G. Ramsey, M.D.
The drug, Kalydeco, also known as invacaftor or VX-770, was developed by Vertex Pharmaceuticals with financial support from the Cystic Fibrosis Foundation. The oral medicine targets the defective protein produced by the gene mutation called G551D that causes cystic fibrosis. The mutation accounts for approximately four percent or 1,200 cystic fibrosis cases in the United States.
“This is a breakthrough therapy for the cystic fibrosis community because current therapies only treat the symptoms of this genetic disease,” Janet Woodcock, director of the Center for Drug Evaluation and Research at the FDA, said in a statement.
Ramsey and co-investigators evaluated lung function in patients 12 years or older who carry at least one copy of the G551D mutation. The study included 161 patients at multiple healthcare centers who received at least one dose of VX-770 or placebo. The study was the third and final in a series designed to assess VX-770’s effectiveness and safety before it is approved for public use. The results of the clinical trial were published Nov. 2 in the New England Journal of Medicine.
Researchers found that patients who were treated with VX-770 showed a significant and sustained improvement in lung function. Patients with G551D treated with VX-770 showed improvements in other areas critically important to the health of people with CF. Study participants experienced significant reductions in sweat chloride levels, indicating an improvement in the body’s ability to carry salt in and out of cells – a process which, when defective, leads to CF. They also experienced decreased respiratory distress symptoms and improved weight gain.
Read more about Ramsey’s study in UW Today.
Read more about the FDA approval in The New York Times.
Many doctors do not follow ovarian cancer screening guidelines
(The following is an excerpt of an article published on The Wall Street Journal Health Blog.)
The government estimates that more than 15,000 women died last year from ovarian cancer.
But routine screening of women with no symptoms isn’t recommended by the United States Preventive Services Task Force, American Congress of Obstetricians and Gynecologists or other professional groups, even for women at high risk for the disease. That’s because the benefits of the available tests—a transvaginal ultrasound and a blood test that detects an antigen called CA-125 — have not been shown to outweigh their risks (such as complications from unnecessary surgery), or to reduce the number of deaths.
Despite that evidence, a new study finds that when presented with a scenario of a woman coming to her annual check-up, a significant percentage of physicians surveyed would screen for ovarian cancer.
Some 28.5 percent of the 1,088 primary-care docs—OB/GYNs, family physicians and general internists—surveyed said they “sometimes” or “almost always” offered or ordered ovarian-cancer screening tests for low-risk women. When the vignette involved a woman at medium risk of the disease, that proportion jumped to 65.4 percent of physicians.
About a third of physicians reported believing that ultrasound or CA-125 blood testing is an effective screening test for ovarian cancer, the study found. It’s unclear why that is, and more research is needed to discover why, says Laura-Mae Baldwin, an author of the study and UW professor of family medicine. “We know that in medicine we have an enthusiasm for screening,” she says. “We want to find diseases before they can cause harm.”
The study also found that physicians were more likely to say they’d order screening for patients who requested it—even if the doctor herself didn’t believe screening was effective. In that scenario, physicians may be trying to maintain a relationship with the patient, or they “may lack confidence in explaining why the test is more harmful than beneficial,” says Baldwin. She says there’s an important role for clinical tools that could accurately illustrate the level of risk faced by a particular woman and also illustrate the harms and benefits of the test.
The study is published in the Annals of Internal Medicine.
Read the entire article in the The Wall Street Journal Health Blog.
UW Medicine has joined forces with the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM) to reinforce a commitment to create a new generation of doctors, medical schools and research facilities that focuses on meeting the needs of our military veterans. Recognizing veterans and their families’ sacrifice and commitment, UW Medicine has pledged to mobilize its uniquely integrated mission to improve the health of the public through education, research and clinical care.
“We are honored to participate in the White House Joining Forces initiative,” said Paul Ramsey, CEO of UW Medicine and dean of the UW School of Medicine. “Faculty throughout our system are committed to serve the heroes who have served our country for so long. Our goal is to show these men and women that their country is there for them, no matter what they’re going through.”
Many veterans and their families’ have pressing healthcare concerns, including Post Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI) and acute and chronic pain. “I’m inspired to see our nation’s medical schools step up to address this pressing need for our veterans and military families. By directing some of our brightest minds, our most cutting-edge research and our finest teaching institutions toward our military families, they’re ensuring that those who have served our country receive the first-rate care that they have earned,” said First Lady Michelle Obama.
UW Medicine is committed to ensuring physicians are aware of the unique clinical challenges and know the best practices associated with caring for veterans and their families. Ongoing work also includes developing new research and clinical trials on PTSD and TBI to better understand and treat these conditions; sharing information and best practices with other academic centers through a collaborative web forum created by the AAMC; and growing the body of knowledge that will lead to improvements in healthcare and wellness for U.S. military service members, veterans and their families.
First Lady Michelle Obama and Dr. Jill Biden created Joining Forces to bring Americans together to recognize, honor and take action to support veterans and military families as they serve our country and throughout their lives. The initiative aims to educate, challenge and spark action from all sectors of society to ensure veterans and military families have the support they have earned. The initiative focuses on key priority areas—employment, education and wellness, while raising awareness about the service, sacrifice and needs of America’s veterans and military families. Visit the Joining Forces website for more information.
Read more in UW Today.
(The following is an excerpt of an article written by Menaka Umapathy, a family medicine doctor at the UW Neighborhood Clinic – Factoria.). The article was published by the Journal Media Group Feb. 6, 2012.)
In 2002, the National Heart, Lung, and Blood Institute introduced the Red Dress as a symbol for The Heart Truth, its campaign to give women a “personal and urgent wakeup call about their risk of heart disease.” In support of this effort, the American Heart Association quickly followed suit by adopting this colorful dress as the symbol for Go Red For Women.
The national campaign starts by addressing a significant gender bias. Because heart disease has traditionally been associated with men, research studies, treatment guidelines and educational programs have focused on men. The American Heart Association reports that only 55 percent of women realize that heart disease is their leading cause of death and less than half know what are considered healthy levels for cardiovascular risk factors such as blood pressure and cholesterol.
Women also tend to wait longer than men to call 9-1-1 after experiencing a possible heart attack. One reason may be that only half of women have the classic symptom of chest pain. Others may experience upper body pain or discomfort in one or both arms, the back, neck, jaw or stomach, shortness of breath, weakness, unusual fatigue, cold sweat and dizziness. Because getting to the hospital quickly can save lives and prevent long-term damage from a heart attack, women should seek emergency care immediately if they have any of these symptoms for more than a few minutes.
Although the campaign is targeted to women ages 40 to 60, when a woman's risk of heart disease begins to increase, its fundamental message applies to all ages. It is never too early or too late to begin screening and take preventive action for major risk factors: smoking, diabetes, high blood pressure, high cholesterol, obesity and a sedentary lifestyle.
Read the entire article.
In President Michael Young’s short time at UW, one of the things he has learned, he said, is how well the University organizes itself into groups that address large-scale societal and global problems.
“I frankly can’t think of a larger challenge than trying to address imbalances in respect to the provision of health care around the world,” he said at the Department of Global Health Open House on Jan. 17.
More than 125 guests toured the student space. Luminaries lighted the walkway outside the historic brick Harris Hydraulics building, built in the 1920s to house the best hydraulics research facilities of any university in the United States at the time.
Guests included staff from PATH, the Bill & Melinda Gates Foundation, Public Health-Seattle King County and the Washington State Department of Health, as well as leaders from across campus.
The Department of Global Health, founded just five years ago, has grown explosively with more than 250 faculty, 400 graduate students and many more undergraduates. While part of the department moved into two floors of the Ninth and Jefferson Building near Harborview in 2010, there was no central space on campus for global health students, faculty and staff until this building was renovated.
Now students have their own student lounge, kitchen and computer center with 24-hour access.
Read more in UW Today.
UW students and faculty were well represented at the 40th Western Student Medical Research Forum (WSMRF) meeting in Carmel, Calif. Jan. 27-29.
Laurel Desnick, clinical assistant professor of medicine, is co-executive director of the WSMRF, along with Gary Satou at David Geffen School of Medicine at UCLA. Desnick has been instrumental in the ongoing success of the conference over the past five years.
The annual conference is held in conjunction with the Western Section American Federation for Medical Research (WAFMR), Western Society for Pediatric Research (WSPR), Western Association of Physicians (WAP), Western Society for Clinical Investigation (WSCI) and the California Thoracic Society.
In recent years, student participation has become an increasingly important part of the three-day conference. Twenty-nine medical schools from the U.S. and Canada were represented, with University of Washington having the largest number of student presenters in diverse areas, including basic science, clinical research, global health and community-based projects.
“The conference offers an excellent opportunity for students to interact with senior faculty, establish relationships with students from other medical schools, and gain experience presenting their work. Every year the quality of presentations, breadth of topics, and integration with other societies increases, making this a fantastic experience for the students,” said Desnick.
Numerous UW School of Medicine faculty attended the conference this year. Ellen Cosgrove, vice dean for academic affairs, was in attendance, as were Suzanne Allen, vice dean for regional affairs; Bill Bremner, chair of the Department of Medicine, and a number of faculty from his department: Wes Van Voorhis, Virginia Broudy, Fred Buckner, Robb MacLellan, Kevin O’Brien, David Dale and Alan Chait; Pete Eveland, associate dean for student affairs and several WWAMI deans: Tom Nighswander from Alaska, Jay Erickson and Martin Teintze from Montana, and Mary Barinaga from Idaho. Faculty participated as moderators, discussed posters and attended oral presentations throughout the conference. Several UW residents, fellows and other junior faculty were also in attendance.
“The conference is an opportunity for students to realize the excitement and value of medical research and refine their presentation skills,” Cosgrove said. “Our overall participation is encouraged because of Paul Ramsey’s strong and continuing support. He recognizes the critical role of research in medical education and in the future of healthcare.”
In Cosgrove’s keynote address at the Student Awards banquet, she reminded students that the real goal of a career in medicine is to make life better for the communities we live in, whether local, regional or global. She described successes in basic science, clinical investigation, direct patient care and public health approaches, and commended students for pursuing work to promote improved health status and social equity worldwide.
Matthew Golden, UW professor of medicine in the Division of Allergy and Infectious Diseases, received the Western Society for Clinical Investigation Award and gave a presentation at the opening plenary titled Integrating Research into HIV/STD Public Health Practice. He is also the director of the Public Health - Seattle & King County HIV/STD Control Program.
This year, 270 medical students and 26 residents gave oral and poster presentations. Seventy-two UW students gave a total of 73 presentations at the conference. UW participants were second-, third- and fourth-year medical students, and one junior-year undergraduate.
Following are 2012 Student Award Winners from UWSOM:
WAFMR/WSCI Subspecialty Award Winners
Lindsay Braun: The Effect of Lipid Minimizations on Parenteral Nutrition Associated Cholestasis in Pediatric Surgical Patients
Julia Herbert: Can the Timed Up and Go Define Severity of Fall Risk?
Ryan Murphy: Bumped Kinase Inhibitors Block Malaria Transmission to Mosquitoes
WSPR Subspecialty Award Winner
Beck Longstreet: Nuchal Thickening and Cystic Hygromas: Predicting Postnatal outcomes from Prenatal Outcomes
Klea D. Bertakis, M.D., M.P.H. Award
Stephen Houmes: Dental Cavity Prevention through Fluoride Education in Sandpoint, Idaho.
Since WWAMI started 40years ago, members on the UW School of Medicine Admissions Committee have served from each of the partner states. Beginning in 2007, interviews have been conducted at regional sites as well as in Seattle. Regional interviews started in Anchorage and then followed in Boise, Spokane, Laramie and Bozeman. The regional interviews have been well received by applicants as an opportunity to reduce the costs of interviewing, remain close to their homes and see where they will spend time if accepted as a WWAMI medical student.
This year, 168 interviews will be conducted at regional sites. Seventy six (19 percent) of Washington interviews are completed in Spokane. All Alaska and Wyoming interviews are completed in Anchorage and Laramie. Idaho conducted 57 percent of their interviews in Boise and 49 percent of the Montana interviews were completed in Bozeman.
A committee of 190 faculty, community physicians, alumni and medical students from across the region participates in the admissions process. These members volunteer their time to interview about 700 applicants between October and March each year and to create a class of outstanding students. For fall 2011, 81 percent of applicants accepted into the MD program chose to matriculate.
The ability and intention to spread admissions outside the Seattle region is in line with the mission of the School of Medicine to improve the health of the public, including helping to produce a strong workforce for the WWAMI region.
The WWAMI regional medical education program was first established in 1971 as a partnership between the UW School of Medicine and the University of Alaska Fairbanks (later at Anchorage). Montana and Idaho joined the program in 1972 and Wyoming in 1996. The Alaska program marked its 40th year in September, and other WWAMI sites plan anniversary events in the coming months. These celebrations include: Boise, Feb. 27; Cheyenne, Feb. 28; Spokane, March 22; and Moscow/Pullman, April 16. Billings, Missoula, and Seattle events will be held later in the spring. For more information, please contact Kellie Engle at 206.543.2249 or firstname.lastname@example.org.
The following are events that may be of interest to the UW Medicine community.
Donations after Cardiac Death – Shades of Grey, 4 p.m., Health Sciences Building, T-747. Michael Souter, UW professor of anesthesiology and pain medicine and chief of anesthesiology at Harborview Medical Center, will explore the continuing development of organ donation after cardiac death as a strategy for addressing the problem of patients dying while awaiting vital organ transplant. Souter will discuss ethical questions, including the environment of managing death, the timing of declaration of death, pre-mortem interventions, and issues surrounding consent. Contact 206.543.5145 or email@example.com for more information.
Education in Medicine Lecture, Feb. 24
Medical Education in the Era of Ubiquitous Information by Charles P. Friedman, noon, Friday, Feb. 24, UW Health Sciences Building, Room T-625. Friedman is director of Health and Informatics Program, Schools of Information and Public Health at the University of Michigan. He will examine new challenges and questions for educators and researchers of endowing future physicians to retrieve and integrate information from the “knowledge cloud.” The lecture, sponsored by the UW School of Medicine Office of Academic Affairs, is open to all faculty, staff and students. No registration is required. For more information, contact Mariel Kessel at firstname.lastname@example.org.
UW Medicine Salutes Harborview, Feb. 25
The 20th Annual UW Medicine Salutes Harborview, the premier fundraising event for Harborview Medical Center, will be held at 6 p.m., Saturday, Feb. 25, at the Sheraton Seattle Hotel. The net proceeds benefit Harborview’s Mission of Caring Fund, which helps Harborview serve vulnerable populations and provide world-class care to patients from throughout the region. The event is presented by the Western Washington Toyota Dealers Association. Register to attend the 20th UW Medicine Salutes Harborview. Follow the event on Twitter.
Faculty Development Workshop, March 6
The AMIGO3 model: A learner-oriented teaching methodology, 8:30 a.m. to noon, Tuesday, March 6, UW South Campus Center, Room 316. David Masuda, lecturer in the Department of Medical Education and Biomedical Informatics, will help participants explore the AMIGO3 teaching design methodology, a concept of creating skilled life-long learners, regardless of the discipline being taught. Enrollment in this free workshop is limited. Registration is required. For more information, contact Rachael Hogan at email@example.com or 206.616.9875.
Continuing Medical Education
Visit Continuing Medical Education for more information on upcoming classes.
KING-TV highlights Gabriel Aldea and patient Roy Matsumoto
Gabriel Aldea, UW professor of surgery in the Division of Cardiothoracic Surgery, and his 98-year-old patient Roy Matsumoto were featured in a KING-TV segment Hero's heart goes on due to replaced aortic valve on Feb. 14. The segment was part of a story on the TAVR Partner Trial, a national study determining the safety and effectiveness of transcatheter aortic valve replacement (TAVR) in both high-risk operable and inoperable patients with symptomatic critical aortic stenosis.
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