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o f n o t eDevoted to noteworthy happeningsat the medical schoolMouse Models DepressionMajor depressive disorder (MDD) causes personal suffering, affectsfamilies, and can lead to disability or even death, sometimes in theform of suicide. Pitt researcher and alumnus George Zubenko (MD’81 with a PhD from Carnegie Mellon University) is a professor ofpsychiatry in the School of Medicine. He has led a team that developeda genetically altered mouse that will enable deeper study ofthe affliction.Zubenko’s mouse model is based on the understanding that thefamilial form of MDD is linked to a mutation of a gene called CREB1.Zubenko replicated the mutation in an equivalent mouse gene. Inaddition to furthering the study of the brain mechanisms that lead toMDD, Zubenko says the methodologic approach used in developingthe mouse model may be useful in the creation of models for otherhuman diseases. —Joe MikschFOOTNOTEMarvel-ous! Technology developed by Pitt’sJörg Gerlach, an MD/PhD at the McGowan Institutefor Regenerative Medicine, appeared in Marvel Comics’Avengers Academy in May.McGowan’s Facebook page reports that “after twocharacters are badly injured in a building explosion,Hank Pym, who is one of the top scientific minds of theMarvel Universe, decides to treat their burns with theUniversity of Pittsburgh’s stem cell process”—Gerlach’s skin cell gun.Courtesy Zubenko LabCompared to the healthy mouse (left), Zubenko’s mouse model (right) showslarger cavities, indicated in red—a sign of reduced brain tissue.S tat e o f S c h o o l S t r o n g ,Y e t T h r e a t s L o o mIn May, Arthur S. Levine, senior vice chancellor for the health sciencesand dean of the University of Pittsburgh School of Medicine, deliveredhis annual State of the School Address.The school’s 602 MD students, 308 PhD students, and 2,115full-time faculty members, Levine says, are doing superlative work.The University faculty, driven by the med school, ranked fifth in thenumber of National Institutes of Health (NIH) awards granted between2007 and 2010. Most Pitt MD graduates match with one of their topresidency program choices (nearly 70 percent at top-tier programs).Faculty and student publication of research is at an all-time high. And,as the school develops partnerships abroad—the newest being withChina’s academic jewel, Tsinghua University—and with industry, itsworldwide footprint is getting larger.Levine says the school’s greatest challenges come on the fundingfront, with NIH funding stagnant while state funds are cut. A videopresentation of the address can be found at www.medschool.pitt.edu/about/index.aspx —JMF A L L 2 0 1 1 3

Faculty SnapshotsA&QJoel Greenberger Considers Fukushima DaiichiJoel Greenberger, an MD, professor and chair of Pitt’s Department of Radiation Oncology inthe University of Pittsburgh School of Medicine, is also the director of the Center for MedicalCountermeasures Against Radiation. He has appeared in these pages before. He and his team havedeveloped a drug that, when administered to mice after exposure to radiation, significantly reducedradiation-induced death and adverse effects. In light of the Fukushima Daiichi reactor crisis inJapan, we thought it was time to talk with Greenberger again.Long-term consequences in Japan?Based on what we know … the easiest answer would be to say that long-term impacts are unknown.Unlike the Chernobyl disaster in 1986 and unlike other nuclear accidents, a huge confounding variableis the tsunami and flood damage. So you have two different categories of impact on the populationin both the short term and long term. And so, we have to wait for more data.On the handling of the crisisI have nothing but praise for what the Japanese have done. The way that they handled this everystep of the way was absolutely masterful, and I think it should be a lesson to us as to how a disasterlike this should be handled.On the safety of nuclear powerOur ability to detect radiation is getting much, much better. This makes people reluctant to pushfor more nuclear power plants. My own personal view is that we don’t have enough. We should havetwice as many nuclear power plants in this country. It’s safe, it’s clean, and it makes sense.His questions for usHow concerned are you about levels of radiation exposure for you and your family? What would yourlevel of concern be if you were asked to live near a nuclear power station? On that, I think you’regoing to get the reverse answer. There’s a disconnect here … Some people are terrified of any radiationexposure, even when deemed “safe” by radiation safety officers, but are also willing to acceptwhat their physicians tell them is a safe level. —Interview by Alexis Wnukcami mesaBrad Dicianno (MD ’01, Res ’05) recentlywon the AAP Young Academician Awardfrom the Association of AcademicPhysiatrists. Dicianno is an MD and assistantprofessor in the Department of PhysicalMedicine and Rehabilitation.The AAP praised Dicianno for his teaching,mentoring, his work as medical director of Pitt’sCenter for Assistive Technology anddirector of Pitt’s Adult Spina BifidaClinic, as well as his many publicationsin peer-reviewed journals.Dicianno says he’s grateful for thesupport of his chair, Mike Boninger,and mentor Rory Cooper. The academicDiciannoenvironment they, and others, engender,Dicianno says, “is one of the many reasonsI’ve never left Pitt since undergrad.”The School of Medicine’s recently announcedjoint venture with Tsinghua University isn’tits only foray into China. Pitt’s Department ofPathology, through UPMC, has agreed to provideWeb-based telepathology services for KingMedDiagnostics, China’s largest independent medicaldiagnostic laboratory.Department chair George Michalopoulos,an MD/PhD, says KingMed approached Pittand UPMC about a year ago, seeking remote,second-opinion pathology consultations. Theagreement, which spans three years, started latethis summer. Michalopoulos says he expectsthat Pitt pathologists will consult onabout 2,000 cases per month. Pitt’sdepartment is the largest of its kind,with 175 faculty members.With a grant of $460,000 from AutismSpeaks, Pitt will continue as oneHandenof 17 sites in the Autism TreatmentNetwork (ATN). Benjamin Handen, a PhD associateprofessor of psychiatry and pediatrics at Pitt,is the principal investigator of the local site,which is a collaboration between the Center forAutism and Developmental Disorders at UPMC,Children’s Hospital of Pittsburgh of UPMC,and the University of Pittsburgh Center forExcellence in Autism Research.More than 230 families are enrolled in thelocal program, which supports diagnosis andmedical evaluation for children and adolescentswith autism spectrum disorder. —JM4 P I T T M E D

TreatingUnderservedKidsChildren’s Hospital of Pittsburghof UPMC has received $1.9million from the U.S. HealthResources and ServicesAdministration to expand its residencyprogram for the primarycare of underserved patients inboth rural and urban areas. Thefive-year grant will cover thecosts of training two residentsper year. The program—PediatricAdvocacy, Leadership, andService, or PALS—started in Julywith two residents. “A lot of theprogramming will be focusingon the kind of skills and attitudeyou need to provide effectiveprimary care to the underserved,”says Dena Hofkosh (Res ’82, Fel’84), an MD and director of thePediatric Residency Program.—Megan Kopkecatherine lazureNeurons Don’t Mature FastNew neurons take about three or four weeks to develop in mice. Itwas assumed that the same timeframe applied to humans. But workby Judy Cameron—PhD professor of psychiatry at the University ofPittsburgh School of Medicine—and colleagues show that the processis much slower in primates.Cameron, whose results were recently published in Proceedingsof the National Academy of Sciences, shows that it takes up to sixmonths for monkey granule cells (infant neurons) to reach maturity.These findings, Cameron suggests, call into question the beliefthat it takes antidepressant medications three to five weeks to becomeeffective, because that’s how long it was thought to take for new neuronsto generate in the presence of the drug.Also, she adds, the more leisurely pace of neuronal developmentin primates allows a larger window for environmental factors to impactfetal development.For example: “How does food the mother ingests change the developmentof brain circuits that control metabolism and body weight?There could be a lifelong effect on how you metabolize food and howlikely you are to be chubby or thin,” she says. —JMV e n t e r G e t s D i c k s o n P r i z eJ. Craig Venter is the recipient of the 2011 Dickson Prizein Medicine from the University of Pittsburgh School ofMedicine, which will be awarded on Oct. 6 during theUniversity’s annual celebration of science and research—Science2011. Venter will also deliver the Dickson lectureat the festival’s opening plenary session.Venter, a PhD biologist best known for developinggroundbreaking genomic discovery tools and sequencing thehuman genome, announced in 2010 that he and his team hadconstructed the first synthetic bacterial cell. He is founderand president of the J. Craig Venter Institute and founderand CEO of Synthetic Genomics. His lab focuses on creatingsynthetic biological organisms, developing applicationsrelated to this work, and unearthing the genetic diversity ofthe world’s oceans. Venter received the 2008 National Medalof Science and is a member of the National Academy ofSciences. He is the author of A Life Decoded: My Genome:My Life. —Chuck Staresinic4 P I T T M E D F A L L 2 0 1 1 5

VanCliburn FoundationWorking on CaringHolmes Morton, an MD, was the commencement speaker for the Class of2011. He is cofounder with his wife, Caroline Morton, and executive directorof the Clinic for Special Children in Strasburg, Pa., which specializes inthe diagnosis and treatment of disorders of Amish and Mennonite children.In his address, Morton touched on words spokenat a commencement long ago to illuminate histhoughts on what makes a good doctor:FOOTNOTE“Learn to Care,” in the sense of Dr. FrancisA science fair winner who is out ofPeabody’s famous talk to Harvard medical studentsin 1926, titled, “The Care of the Patient.” [Dr.this world: Andrew Abboud, who willPeabody said,] “One of the essential qualities ofattend Pitt in the fall—with the promiseof admission to the School ofI understand that I am not by nature a friendlythe Clinician is interest in humanity, for the secretof caring for the patient is in caring for the patient.”Medicine upon completion of his bachelor’sdegree—took “first award” inthe life of the person being cared for [in theor caring person. I found that caring for a patientrequires effort, thought. If I make learning aboutthe recent Intel International Scienceclinic] part of my daily work, the work of medicinebecomes a rich human experience. Learning toand Engineering Fair. Abboud, of Ohio, care for the patient [as Peabody suggests] helpswon $3,000 for his research on “Theme value those I care for and adds to my sensethat my work is meaningful.Protective Effects of the ViolaceinMorton is a recipient of many medical honors,including the Albert Schweitzer Prize forPigment against UV-C Irradiation inHumanitarianism. Many of the clinic’s patientsChromobacterium violaceum.” In honor suffering from a genetic condition called mapleof his achievement, Abboud will have a syrup urine disease were cured by liver transplantsperformed in Pittsburgh. —JMminor planet named for him. Really.P r o f R e c o g n i z e da s T o p P i a n i s tLike his father before him, Barry Coutinhotraded in a life in music for a career in medicine.In May, he placed third in the Van CliburnInternational Piano Competition for OutstandingAmateurs. His performance of Maurice Ravel’sGaspard de la Nuit on a brand new SteinwayModel D grand piano was an unanticipatedsuccess for Coutinho: “I played better than Iexpected. It seemed like I could do anythingon that piano.” Choosing a piece known as oneof the most difficult of the early 20th centurywas an easy decision for the physician whoseteacher in London’s Guildhall School of Music &Drama studied under one of Ravel’s own pupils.“I’ve played it so many times now that I knew itinside out,” he says.As a clinical assistant professor of familymedicine in the School of Medicine and formerchief resident of family medicine at UPMCShadyside (Res ’95), Coutinho has not performedoften in the past decade. The Van Cliburncompetition, which attracts the top amateursfrom around the world, was one of his biggestperformances in years: “I was worried about mycompetition experience but was very happy withthe results in the end.” —Marc Melada6 P I T T M E D

c l o s e rw h e n M R S A c a m e t o h e r d o o rMichelle Sunjoo Lee is a gentlewoman and a scholar. And a musician.And an athlete. The energetic 17-year-old, who will be a senior at NorthAllegheny High School this fall, won the Young Epidemiology ScholarsCompetition in Washington, D.C., for research she conducted at Pitt. Sheworked under the guidance of Bruce Lee (no relation), an MD and assistantprofessor of medicine and biomedical informatics in the School of Medicineand of epidemiology in the Graduate School of Public Health, to design acomputer model that examined the cost-effectiveness of testing high schoolathletes for MRSA.Michelle approached Dr. Lee a few years ago after she was shocked tolearn that MRSA, a highly antibiotic-resistant infection typically confined tohospitals, was claiming the lives of high school athletes across the country.There was even a case of MRSA at Michelle’s school, though, fortunately, itwas not fatal. “It was interesting to know that MRSA was actually coming tomy front door, to my own school, so that piqued my interest even more,” shesays. As a tennis player and a rower, Michelle wanted to understand howthe infection could be prevented in young athletes like herself.During the two-year project, Michelle was able to determine the prevalencerate of MRSA at which routine testing of skin infections is cost-effective.Her research earned her first place at the national competition.“I think the best part was getting to meet these other high school studentsfrom all around the country who were really passionate about theirtopics,” she says excitedly. Never mind the all-expense-paid trip or the$50,000 scholarship she scooped up.In addition to her scientific achievements, Michelle is also an accomplishedpianist; she’s given six solo performances at Carnegie Hall in NewYork City, as well as one at the United Nations.Although both of her parents—Joon and Grace Lee (Grace is shown herewith Michelle)—are professors at Pitt med, she’s not sure that med schoolis in her future.“In terms of career, I want to pursue kind of a combination of medicalresearch, medical engineering, and public health,” she says confidently.She’s certainly off to a good start. —Alexis Wnuk—Photograph by Martha Rialm oFn AtL h L 2 0 01 15 75

i n v e s t i g a t i o n sExplorations and revelations taking place in the medical schoolCeledón has been wrestling with this question for his entire career:Why does asthma affect so many Hispanics? In a study of families inPuerto Rico, he recently discovered some surprising possibilities.8 P I T T M E D

Tough on TotsP u e r t o R i c a n C h i l d r e nM o r e L i k e l y t o H a v e A s t h m ai f P a r e n t s a r e S t r e s s e dB y M e l i n d a W e n n e r M o y e rgetty image sWhen Juan Celedón beganhis medical internship atLincoln Hospital in theBronx in 1989, one thing struck him morethan anything else. “I was impressed withhow much asthma there was,” he recalls.In the Bronx, hospitalization rates for therespiratory disease are five times higher thanthe national average, and death rates fromit are three times higher. Asthma predominantlyaffects Hispanics, both in the UnitedStates and abroad—in particular, Costa Ricansand Puerto Ricans, the latter of whom havethe highest lifetime asthma prevalence in theworld. So Celedón, who hails from Colombia,recognized a research opportunity. Now, as theNiels K. Jerne Professor in the Departmentof Pediatrics in the University of PittsburghSchool of Medicine, chief of service in theDivision of Pediatric Pulmonology, Allergy,and Immunology at Children’s Hospitalof Pittsburgh of UPMC, and director ofChildren’s Center for Environmental Health,he is teasing out the potential causes of asthmain Hispanic populations. Among possible riskfactors, he recently discovered that PuertoRican children whose mothers or fathers sufferfrom stress-related conditions like depressionare at a greater risk of developing the disease.Celedón knew that some Puerto Ricansexperience high levels of stress because of povertyand exposure to violence. Given their highasthma burden, he wondered whether the twofactors might be related. In a study he publishedin 2010 with researchers at Harvard University,Virginia Commonwealth University, and theBehavioral Sciences Research Institute in SanJuan, Celedón interviewed the parents of 339pairs of Puerto Rican twins. The researchersinterviewed the parents to see whether theyhad experienced symptoms of post-traumaticstress disorder, depression, or antisocial behavior,and the team also inquired about theirchildren’s respiratory health. Celedón and hiscolleagues found that 1-year-olds had moreasthma symptoms if their dads suffered fromPTSD, depression, or antisocial behavior. Aftercontrolling for a number of potential interveningfactors—such as whether or not theirparents had asthma—he found that kids aged1 and 3 were also more likely to be diagnosedwith and hospitalized for asthma if theirmothers were depressed, and they were morelikely to use oral steroids if their fathers weredepressed.No one yet knows why and how, exactly,parental stress influences asthma severity.“It’s unclear what’s happening,” Celedónsays. It could be that stressed-out parents don’tmonitor or treat their children’s symptoms aswell as healthy parents do, ultimately leadingto complications. But Celedón wonderswhether parental stress could also be affectingcertain genes in the kids, switching them onor off through the addition of methyl groupsin an epigenetic process—a change in geneexpression resulting from environmental influences—knownas DNA methylation. Earlierthis year, Swiss researchers reported that malemice separated from their mothers early inlife—an intervention that causes them stress—give birth to offspring with abnormal DNAmethylation patterns. It’s possible, Celedónsays, that such epigenetic changes could contributeto children’s respiratory problems, andhe plans to conduct more research to find out.Also, obesity has long been known toincrease asthma risk, and Celedón is strivingto understand why. Earlier this year, heand colleagues at Harvard and WashingtonUniversity in St. Louis found that inhaledsteroids do not ease asthma symptoms aseffectively in overweight and obese childrenas they do in normal-weight kids. Obesitycould affect asthma risk for many reasons, butwork Celedón published in 2009 suggests thatgenetics might be a common link: He andcolleagues identified, based on a genome-widelinkage analysis, the very first gene associatedwith both body mass index (BMI) and asthma.The gene, called PRKCA, codes for a proteincalled protein kinase C alpha, which earlierresearch by other investigators suggests affectsairway inflammation, mucous production, andthe smooth-muscle contraction that causeswheezing.Although Celedón is focused primarily onunderstanding asthma’s causes, “there is a lot ofinterest in trying to find predictors of asthmaattacks, or who’s at high risk,” he explains. Ina 2010 study published in CHEST, he andhis colleagues developed a clinical score thatpredicts a child’s risk of suffering an asthmaattack based on answers to 17 yes/no questionsabout symptoms, medication use, and medicalhistory. The team developed the score usingdata from a cohort of Costa Rican childrenand then tested how well it predicted symptomsin a group of American kids. “Muchto our surprise, in spite of major differencesin the type of health care and access to carebetween the two environments, we found thatit performed relatively well,” Celedón says.With this approach, “you don’t need to obtainany lab data to try to assess who’s at risk, so itcould be used for primary care in developingcountries”—and here, as well.nF A L L 2 0 1 1 9

CueTinyBopperPokeT e e n a g e t h r i l l - s e e k i n ga t t h e c e l l u l a r l e v e lB y K r i s t e n C o s b yPausePelletcou rte sy Moghaddam L abStudying adolescence in the lab islike trying to hit a moving target,says David Sturman (PhD ’11), aMedical Scientist Training Program studentat the University of Pittsburgh School ofMedicine. Although adolescence in humanslasts through most of the second decadeof life, it spans from the fourth to the sixthweek in rats. But in spite of these challenges,Sturman and his advisor—Bita Moghaddam,a PhD and University of Pittsburgh professorof neuroscience, psychiatry, and pharmaceuticalscience—have, for the first time, recordedand compared neuronal activity in awakeadolescent and adult rats. Their study, whichwas published in the Journal of Neuroscience inJanuary, provides new insight into the curiousway adolescents weigh risks against rewardsduring this period of development. It alsomay offer insight into their vulnerability todeveloping disorders that could affect themthroughout their lives.The study of adolescent cognition andemotion is both challenging and rich withpossibility. The symptoms of many psychiatricdisorders—such as schizophrenia, anxiety,bipolar disorder, and drug addiction—oftenfirst appear during adolescence. Althoughthese disorders cause great disruption to anindividual’s life and strain relationships withfamily and friends, the physical impact ofthese disorders on the brain is largely invisible.The brain’s shift into a neurobiological disorderis subtle; the processes and interactionsof the neurons change, while the number ofneurons remains the same.Previous studies have observed regionalneuronal activity in adolescents using brainimaging, such as functional magnetic resonanceimaging (fMRI) or electroencephalography(EEG). In contrast, Moghaddam andSturman’s study compares the activity of individualneurons in the orbitofrontal cortex—apart of the brain that calculates payoff andpunishment when an individual is makingdecisions—in both adolescent and adult ratbrains. They did this by surgically wiring electrodesinto the rats, which had been trainedto poke their noses through an illuminatedhole for food, a basic reward-driven task.Logistically, Sturman says, all of the above wastricky, as was timing the surgery and recovery,in order to take advantage of the brief windowof rodent teenhood.Each rodent was placed into a box withthree nose-poke holes. The team found that,overall, the brain activity in the adolescentswas similar to that of the adults; but whenthe adolescents successfully stuck their snoutsthrough the illuminated holes and receivedsugar pellets as a reward, the excitatory levelsof their orbitofrontal-cortex neurons were twoto four times higher than those of adult brains.The young rats’ inhibitory levels, in contrast,were markedly reduced—a critical findingsince neuronal inhibition is key to controllingthe precise timing of neuronal activity.These differences might help answer fundamentalquestions about adolescence: thethrill-seeking, the overreacting to upsetting orpleasurable experiences. Even when behaviormay appear similar between the two groups,says Sturman, “the adolescent prefrontal cortexis in a different state than [that of an] adult.”Give an adolescent rat a treat, and you feed himfor a day. Teach him to find it himself, and youcan learn a lot about the neurobiology of teenagereward-seeking.Inhibitory processes are essential for efficientcommunication between groups of neurons.The variable, frenzied neuronal activity detectedin the young rats does not necessarily indicatethat adolescents are more excited by rewards,says Sturman. Rather, there is something fundamentallydifferent in how the neuronal networkscompute, exchange, and store informationregarding salient events. He and Moghaddamhypothesize that these processes are less efficientin adolescents than in adults, thus requiringmore resources to process rewards—and theirconsequences. A better understanding of thesedifferences in the exchange of informationalcurrency might further illuminate normal teenagedevelopment as well as the various vulnerabilitiesthat come with the territory, fromaddiction to mood disorders.“This is really a magical period in whichwe can step in and prevent these diseases,” saysMoghaddam. Imbalances in the excitatory andinhibitory processes of neurons—which impairthe exchange of information from neuron toneuron—have also been implicated in the onsetof schizophrenia and other psychiatric disorders.Moghaddam says, “If we understand mechanisticallywhat neurons, what receptors, whatneuro-chemicals are involved, or are undergoingmajor changes during [adolescence], then we canunderstand what the trigger point is. And if wecan understand that, then we are much betterequippedto control the disease and prevent thetransition [into psychiatric disorders].” nU n ive rsity of Pittsburg h Arch ive s10 P I T T M E D

c o v e r s t o r y1 2 5 Y e a r s o f R e m o v i n g a n dP r e v e n t i n g T h e i l l s t o w h i c hflesh is heirb y B a r b a r a I . P a u l l , E r i c a L l o y d ,E d w i n K i e s t e r J r . , j o e m i k s c h , e l a i n e v i t o n e ,c h u c k s t a r e s i n i c , A N D s h a r o n t r e g a s k i s“Although the propriety of establishing a medicalschool here has been sharply questioned by some,we will not attempt to argue the question. Resultswill determine whether or not the promoters ofthe enterprise were mistaken in their judgmentand action. The city, we think, offers ample opportunity for allthat is desirable in a first-class medical school, and if you willpermit me to say it, the trustees and faculty propose to makethis a first-class school.”—John Milton Duff, MDProfessor of Obstetrics, September 1886More than three decades after the city’s first public hospital was established, afterexhausting efforts toward a joint charter, Pittsburgh physicians founded an independentmedical college, opening its doors in September 1886. This congested industrialcity—whose public hospital then performed more amputations and saw more fataltyphoid-fever cases per capita than any other in the country—finally would have itsown pipeline of new physicians for its rising tide of diseased and injured brakemen,domestics, laborers, machinists, miners, and steelworkers from around the world, aswell as the families of its merchants, professionals, and industry giants.Today more than ever, Pitt med people are coming up with ways to, as ProfessorDuff put it, prevent and remove “the ills to which flesh is heir.” We’ve saved thosestories for another day. On these pages, we offer some lesser-known moments inthe early history of the city and school along a steady rise to prominence.shown here: Members of the firstfaculty of the medical school, 1886.F A L L 2 0 1 1 11 B

Jose ph Wari n, e ngraved by antoi n e-f rancois tardi e u, 1826.left: Plan of theTown of Pittsburg,by cartographerJoseph Warin,1796. pp. 13 & 14: Alithograph of thebustling new townin 1859.t h e l a n db e t w e e n t h e r i v e r sThis land between the rivers was the frontier, requiringan arduous journey over the mountains or arisky river approach. The terrain was hilly withuntamed streams rushing through steep ravines.Many were attracted by Pittsburgh’s lush, wildlandscape and its bountiful waterways. Settlersbuilt on “The Point,” facing the port on the Monongahela River.Centuries later, this settlement would become a capital of medicine.Some glimpses of its early health history:Aspinwall. The city began getting treated waterin 1908, and the instances of typhoid fever diminishedsignificantly in the next few years.❦ By 1840, Pittsburgh had become an industrialbehemoth of iron and glass making, river travel,coal mining, and natural gas. Airborne coal dust,polluted rivers, and the smell of the slaughterhousebefouled the once-pristine environment.❦ In 1787, locals gave a nod to education with apreparatory school, the Pittsburgh Academy. It wasreincorporated in 1819 as the Western Universityof Pennsylvania, which was later renamed theUniversity of Pittsburgh.❦ At Fort Pitt, the British built two rough sheltersin 1761 for a military hospital. After the war,a few physicians remained to serve the civilianpopulace.❦ The local population was diverse. Blackshelped build Fort Pitt; both freemen and slaveslived within the city. Delaware Indians had a villageon the banks of the Allegheny River, neartoday’s Lawrenceville. Iroquois and Shawneesalso made their homes in the area, thoughthese peoples were decimated by European diseasessuch as smallpox, influenza, and malaria.❦ A public water system, built on the banksof the Allegheny River in 1820, was ineffectual.Refuse and heavy rains transmitted waterbornediseases directly to the public, and thewater itself was unfiltered. Repeated epidemicsof smallpox, Asiatic cholera, and typhoid feverplagued the city.❦ Smallpox, the most feared plague, caused74 deaths in 1828, despite quarantines. Asiaticcholera spread throughout the nation in 1832.To prepare, Pittsburgh built a temporary hospitaland a dispensary, cleaned the streets, andremoved garbage; still 105 died from cholerathat year.❦ As Pittsburgh grew, the quality of the watersupply worsened. Allegheny River pollution wasvisible to the naked eye. In 1907, 5,652 cases oftyphoid fever were reported, 648 of them fatal.As the outcry for clean water grew, constructionbegan in 1905 on a slow sand filtration plant in❦ A disastrous 1845 fire that began in a downtownshed demolished much of the city, includingWestern University of Pennsylvania. The schoolwas rebuilt on Duquesne Way, but fire struck againin 1849.❦ Described in 1820 as “a pleasant and flourishingtown,” Pittsburgh later became known as anindustrial den, dark with the effluvium of its industries.While many believed coal dust was actuallyhealthful, keeping one free from malaria and lungailments, the wealthy boarded trains each eveningto their homes in the suburbs of East Liberty, PointBreeze, and Wilkinsburg. Those who lived nearestthe mills, not surprisingly, were reported tohave the worst health. By 1913, pneumonia wasthe city’s primary cause of death. (Today, after tworenaissances, Pittsburgh has repeatedly been12 P I T T M E D

jam e s t. palmatary, b i rd's eye vi ew of pittsburg h, alleg h e ny, b i rm i ng ham, south pittsburg h, sligo, manch e ste r and l awr e ncevi lle, 1859. ti nted lithograph on fou r sh e ets. duque sne city clu b.voted the nation’s “most livable city.” Its air qualityhas improved markedly, but the region stillfares poorly in terms of particulate matter.)❦ In 1847, Pittsburgh—about 90 years old—stillhad no public hospital. Physicians held a publicmeeting to whip up support for a proposed institution,and the state legislature passed an act ofincorporation in 1848. But the hospital’s realizationwas still years away.❦ Mercy Hospital, now situated on The Bluff nearDuquesne University, was the first hospital foundedby an order of Catholic nuns called the Sistersof Mercy and the first permanent hospital inPittsburgh. In January 1848, the sisters admitted asick boatman to the hospital. He had typhus. Theytreated the man and admitted 18 other typhus victims.When the epidemic ended a few weeks later,15 patients remained alive, but the entire nursingstaff—four Sisters of Mercy—had died.❦ The city’s first public hospital, WesternPennsylvania Hospital, completed in 1850, wasbuilt on a hilly, 24-acre tract overlooking theAllegheny River. It stood empty for two years; nofunds were available to furnish and equip thebuilding. Once it opened, patients were broughtto West Penn up the steep hillside via 28thStreet by a horse- or mule-driven ambulancecrossing the Pennsylvania Railroad tracks atLiberty Avenue.❦ Industrial accidents, especially those sufferedby railroad employees, accounted formany of the admissions to West Penn. Railroadworkers were often injured by the hand-operatedcar brakes or from the link-and-pin systemfor coupling cars.❦ During the Civil War as many as 1,500 woundedPennsylvania soldiers were treated in the mainwards of West Penn or in tents on the lawns. For adecade after the war, West Penn primarily treatedveterans.❦ Before Pittsburgh had a medical school,Western Pennsylvanians seeking a medical educationhad few options. They could travel to theEast Coast for training. Some went to Scotland’sEdinburgh University. Some apprenticed themselvesto local physicians. Medicine was largelyunregulated, so anyone could go into “business,”and there were many forms of quackery.❦ A group of physicians and surgeons, mostlypractitioners at the Western PennsylvaniaHospital, sought harbor with another institutionthat would support a medical college. The groupwas repeatedly rebuffed. Western Universityrefused to give up space for a dissection roomor an anatomy room. When the physicians nextsought a formal alliance with the University, thetrustees said, “No.”❦ The medical men did not give up. They decidedto form a private college themselves. On June4, 1883, Western Pennsylvania Medical Collegewas chartered, and 250 shares of stock wereissued at $100 each. The sale of stock functionedas an endowment.❦ The Western Pennsylvania Medical Collegeenrolled its first class in 1886. The foundersbought land adjacent to West Penn Hospital, at30th and Brereton Streets, in what is now PolishHill. Although West Penn Hospital had refused tosponsor the Medical College, it offered the hospitalwards as a clinical facility for students. nF A L L 2 0 1 1 13F A L L 2 0 1 1 14

E–H, J, l: U n ive rsity of Pittsburg h Arch ive sETh is page: U n ive rsity of Pittsburg h Arch ive sABabove: Surgical operating theater atMercy Hospital, c. 1910.A Anatomy Department staff, 1953.B Students attend a lecture inPennsylvania Hall. Date unknown.C Joyce Barraclough, member of theVirus Research Laboratory staff,opens an inoculation egg to removethe fluid containing influenza virus.Date unknown.D Graduation announcement, 1887.CDt h e E a r l y y e a r s❦ The medical college was housed in a newfive-story building, completed in 1885, on propertyabutting West Penn Hospital. (An undergroundpassageway linked the two buildings.) Mostimpressive was a well-lighted, two-story postmortemexamination room. Other features were alecture room, a dissecting room, several laboratories,and a museum. The museum, a gift from AlbertG. Walter, an orthopaedic surgeon, held severalhundred bones “illustrative of deformities,” plustools and instruments invented by Walter.❦ Applicants to the new college needed only adiploma from a high school or a normal school.❦ Fifty-seven students enrolled in the college’sfirst class. A hundred dollars per year gave studentsaccess to all lectures and clinics. Otherannual fees: matriculation, $5; practical anatomy,$10. The graduation fee was $25.❦ Students attended 14 clinical lectures eachweek and observed hospital surgery. Much of thework was hands-on from the beginning.❦ In the college dispensary, the hospital wards,or the City Alms House, students saw a panoply ofmedical ills: venereal diseases, mental and nervouscomplaints, childhood illnesses, eye and earirregularities, conditions requiring surgery, andnose, throat, and skin disorders.❦ Records are conflicting about whether theschool first offered a one- or two-year degree;but the school soon expanded to a three-yearprogram, with a fourth year recommended.F G H I❦ Most of the professors at the college—notjust after its founding but in later years, too—were unpaid volunteers. They were prominentpracticing physicians.❦ In 1892, the medical college once againwent looking for an affiliation with WesternUniversity of Pennsylvania. This time, Westernwas interested. After all, the 250 shares ofmedical college stock had grown to 1,000shares. The “terms of union” were attractive.The medical college would be self-governingand self-sustaining, at first anyway. WesternUniversity gained partial nonvoting ownershipof the medical college that year, with the optionto take total ownership in the future.❦ In 1908, Western University of Pennsylvaniawas formally renamed the University ofPittsburgh under Chancellor Samuel BlackMcCormick. The University purchased 43 acresof hillside land in Oakland, known as SchenleyCou rte sy Robe rt Cha se15

JCou rte sy Gene StarzenskiKFarms, for its new campus. That same year, theWestern Pennsylvania Medical College becamethe property of the University of Pittsburgh.❦ The School of Medicine moved from PolishHill to Pennsylvania Hall, located on the newUniversity of Pittsburgh campus, in 1911.❦ As third dean of the medical school,Thomas Shaw Arbuthnot (appointed in April1909) was an inspired choice. He was somewhatin the mold of Teddy Roosevelt. Arbuthnot camefrom a wealthy family, was a man of ideas andaction, and was even a big game hunter. Duringhis 10-year tenure, he transformed the medicalschool by modernizing the curriculum, buildinga top-notch faculty, and giving a sense of directionfor the future.❦ At a time when only 15 medical schoolsrequired applicants to have anything beyond ahigh school education, Arbuthnot quickly raisedentrance requirements to a minimum of twoyears of college and transformed the faculty byhiring young, promising medical scientists. (Hisinstincts were excellent: Physiologist/pharmacologistC.C. Guthrie, for example, transformedblood vessel surgery. Oskar Klotz, chair ofpathology, published extensively and recruitedexcellent faculty.)❦ The famed Flexner Report of 1910, whichfound that a large number of med schoolshad created an “enormous overproduction ofundereducated and ill-trained medical practitioners,”suggested that the 155 colleges ofmedicine in the United States should be cut to31 medical departments within large, well-runurban universities. Flexner was astonished byhow well Pitt’s School of Medicine fared underDean Arbuthnot. Since the present managementtook hold last fall, the admission of studentshas been much more carefully supervised, thebuilding has been put in excellent condition,laboratories for chemistry, physiology, bacteriology,and pathology have been remodeled andLequipped with modern apparatus … . The entireatmosphere of the institution has clarified:students may be found actually studying in theroom in which under other conditions last year“four dozen wooden chairs were broken up”in boisterous horseplay.❦ In 1913, the School of Medicine receivedan A+ rating from the American MedicalAssociation’s Council of Medical Education, puttingit in league with medical colleges at JohnsHopkins, Harvard, and Yale.E Original home of the Western PennsylvaniaMedical College on a hillside at 30th andBrereton streets in Polish Hill. In later years,as the school gained traction: F Groundbreakingfor Scaife Hall with Alan MageeScaife and Sarah Mellon Scaife holding theshovel, 1954. G Frank Dixon (middle) andcolleagues, c. 1950s. H Children’s Hospital ofPittsburgh. Date unknown. I Milt Dupertuis(center), inaugural head of Pitt’s plastic surgeryprogram, and residents examine a patient witha cleft lip repair in 1958. Pitt’s program quicklybecame a coveted training ground. J Aerialview of the Oakland campus, c. mid-1940s.K Peter Safar (second row, far left) with thestaff of Freedom House Enterprises AmbulanceService at their Hill District headquarters in1975. L Jack Meyers in action. Date unknown.F AFL AL L L 2 0 21 01 1 1 B 17

During the flu pandemic of1918–1919, Pitt studentswere conscripted into theStudent Army Training Corpsfor the war in Europe, andmany fell sick soon after.W a r t i m e a n d O t h e rC h a l l e n g e s o f a C e n t u r y❦ In 1917, when the United States enteredWorld War I, Dean Thomas Shaw Arbuthnot,by then a major in the army, took a leave ofabsence from the medical school to spend 15months on French soil, along with other membersof the teaching faculty. Base Hospital27, organized and staffed by the Universityof Pittsburgh School of Medicine, was sent toAngers, France, in September of that year. Thegroup was housed in Mongazon seminary. Thehospital was intended to hold 500, but duringone week, 2,300 casualties arrived. The influenzapandemic felled as many as the enemy did.❦ Acting Dean Ogden Edwards Jr. led the schoolthrough the challenges of 1917 to 1919, including aregional onslaught of influenza. More than 23,000Pittsburghers came down with the flu, and thirdandfourth-year medical students were conscriptedto care for those in hospital emergency wards.❦ Edwards, the acting dean, had an active interestin public health. As a former director of theCity’s Department of Public Works, he had pushedfor milk-production standards. He suggested thatthe faculty use its skills to address safety problemsin the mills and coal mines. Edwards, likeDean Arbuthnot before him, thought working withthe community on such problems was importanteven though, according to medical educationhistorian Martin Kaufman, it was “generallyassumed by members of the medical professionthat doctors who devoted their time to the treatmentof industrial workers … were not qualified topass judgment on medical problems.”❦ Wartime students faced stiff academic discipline,and dropouts were automatically drafted.When student Philip Hench (who later won aNobel for his work on cortisone) fell asleep inclass, he was threatened with expulsion but gotoff with a sharp rebuke.18 P I T T M E D

U n ive rsity of Pittsburg h Arch ive s❦ In a 1918 memo, Acting Dean Edwards describedhis vision of a medical center, suggesting that “amedical school building, a laboratory of hygieneand public health, a research laboratory, ... a smallgeneral hospital, an eye and ear hospital, a children’shospital, a general dispensary, a psychopathichospital” should be located together on theH.K. Porter property (a 12-acre site a little furtherdown the hill from the existing Pitt campus). Ifa general hospital were built there, it would bein close proximity to the medical school. DeanEdwards boldly contacted Mr. Porter, asking him toname his price. Mr. Porter was not amenable to theproposal for some time. The University eventuallybought the Porter site for $182,500 in October 1921.❦ On his return from the war, Arbuthnot tenderedhis resignation and could not be convinced tostay on as dean. When Raleigh Russell Hugginsassumed the deanship, the creation of a medicalcenter became his top priority. He wanted “first-ratepractitioners and researchers” a stone’s throw fromthe classrooms. He was encouraged by ChancellorJohn Bowman, who had made important friendshipswith Andrew and Richard B. Mellon; they allwould share the dream for the medical center andUniversity.❦ The medical center proceeded by fits and starts,especially during the Depression. Magee Hospital,in its original location (a former mansion), was thefirst to affiliate with the University. On the Porterproperty, Children’s Hospital opened in 1926, followedby the Eye and Ear Hospital in 1934. FalkClinic, an outpatient facility funded by brothersMaurice and Leon Falk, was dedicated in 1931.❦ Presbyterian Hospital, the much-needed generalfacility, was the toughest case. Presbyterianadministrator Hugh Thompson Kerr, an MD,recalled spending an evening with Dean Huggins,who urged him to make Presbyterian Hospital partof the medical center: “[Huggins] kept saying,‘The idea is right, and it is bound to be realized.’”But because of a lack of money, it took 15 yearsto complete the hospital building, which openedfinally in 1938. The east wing of that structure wasbuilt and occupied by Women’s Hospital and completedin 1939.❦ One other hospital, Western PsychiatricInstitute and Clinic, was made possible by an actof the Pennsylvania General Assembly in 1931.It was located on University property, at Desotoand O’Hara streets. Its primary purpose was totreat those who could improve after about fourmonths in residence.A Having completed their training, soldiersprepare to depart in front of Soldiers andSailors Memorial Hall & Museum. June 11, 1918.B In August 1945, U.S. marines and medicalpersonnel receive Japanese B encephalitisvaccine at a field hospital in Okinawa, whereOliver M. Sell (MD ’26) served as commander.The entire medical school served in either thearmy or navy, as well. C Jonas Salk with labtechnicians, c. 1954. D Children receive polioinoculations, c. 1955.A, c, d: U n ive rsity of Pittsburg h Arch ive s. B: Cou rte sy Stewart Sell❦ In 1943, the military took over floors 2 to 14 ofPitt’s Cathedral of Learning, and air-crew traineesmoved in. A couple of medical students were hiredto work with Henry “Doc” Carlson, Pitt’s physicianfor students (as well as varsity basketballcoach), to treat the trainees. Eventually, the militaryinducted all the med students as privates firstclass. By then, 6,000 University faculty, staff, andstudents were serving at home and abroad.❦ By the time Huggins had assumed hisdeanly responsibilities in 1920, the 13-year-oldPennsylvania Hall was already cramped and inadequate.(Among other issues, the skylight leakedrain on students in the dissecting room.) AfterWilliam S. McEllroy, the school’s fifth dean, wasappointed in 1938, the school expanded to the oldMellon Institute. But it was not until June 29, 1954,that Mrs. Alan Magee Scaife (Sarah Mellon Scaife)turned the first spade of earth for the 10-story, $15million School of Medicine building that four yearslater would bear her husband’s name.❦ Dean McEllroy put his energies into bringingfunded research to the school. (His secretary, EdithGlenn, managed day-to-day activities and knewall the students.) A Pitt medical school graduatehimself, McEllroy (MD ’16) wanted national recognitionfor the school.❦ McEllroy’s determination to hire promisingresearchers bore fruit in the postwar period.His first full-time clinical appointee, ThaddeusDanowski, was an endocrinologist specializing inchildhood diabetes. A $500,000 grant helped himmove his group to Children’s Hospital in 1947.CA❦ Two years later, Dean McEllroy cobbledtogether money from four different departmentsin order to hire Jonas Salk, a young virologistworking on the influenza virus. Salk’s lab was inthe basement of Municipal Hospital (which, atthe time, was not even a part of the Pitt campus).Salk maneuvered directly for what he wanted—more laboratory space, more independence, moremoney for research. He recruited virologist JuliusYoungner and other key team members. SkirtingUniversity protocol, Salk negotiated directly withHarry Weaver, research director of the NationalFoundation for Infantile Paralysis, to get grants.Weaver felt instinctively that Salk had the driveto seek a cure for polio, the disease feared by somany families.❦ Scientists on the polio-vaccine team inoculatedthemselves first, then their own children,before doing field tests. In 1952, children atwhat was then the D.T. Watson Home for CrippledChildren, a rehabilitation center, received thevaccine. On April 2, 1955, scientists at theUniversity of Michigan confirmed that the Pittteam had created a vaccine that was “safe,effective, and potent.”❦ The polio-vaccine team’s accomplishment setthe tone for the school’s future. In the decadesafter, the school would attract, among its facultyand student body, an array of clinical stars andastoundingly good physician-scientists whowould change medical science forever. Beginningon p. 24, we share our Pitt-med-centric view ofdefining moments in medicine.■DBF A L L 2 0 1 1 D19

O p p o r t u n i t yD i d n ’ t A l w a y s K n o c kEarly Pitt medical coeds posefor a group shot in The Owl,1910. Four classes, 1909–12,are represented, yet for threeof those years the schoolbarred additional womenfrom enrolling.❦ The medical college was coeducational until1909, when it barred women from admission.❦ Amelia Dranga, a local physician who headedthe Women’s Medical Society in Pittsburgh,voiced her opinion about the ban on women to theChancellor and others, including the PittsburghPress: The argument advanced for refusing women’sadmittance is that it is embarrassing for thewomen and men to study medicine together. Bosh!If women and men can be embarrassed by studyingmedicine together, then their places certainlyare not in the medical profession.❦ In the face of declining enrollments (becauseof stricter entrance requirements), the Universityboard capitulated, resolving in its June 1912meeting that It will be possible to receive youngwomen students in this school, even though specialfacilities which it is hoped may be made later,are not yet possible. Three women entered thefreshman class in 1913. Today women make upabout half of the student body.❦ In 1901, the School of Medicine graduatedits first African American MD: Allen Gilbert Gantt,who practiced medicine in Pittsburgh for half acentury. He was born in South Carolina and servedas a pastor there for two years before he cameto Pitt. At the time of his death in 1950, he wasmedical advisor at the Davis Home for ColoredChildren, an orphanage in Point Breeze. Gantt andfellow African American alums Harrison M. Brown(MD ’04), Charles Henry Carroll (MD ’06), andJames Charles Gill Fowler (MD ’06) were all foundingmembers of Rho Boulé, the local chapter ofSigma Pi Phi. The fraternity is still going strong tothis day, supporting social action and public-policyefforts in Pittsburgh.❦ The same opportunity didn’t arise for a Blackwoman for several decades, until Harrisburg, Pa.,native Elaine Morris (MD ’75) graduated.❦ By 1915, about a half dozen African Americanshad made the school’s alumni roster. Then, inexplicably,Blacks were barred for some 30 years.This shift reflected the grim national picture inthe Jim Crow era. As late as 1968, only 266 Blackswere enrolled in med schools across the country—all but a few dozen of them at historically Blackuniversities.❦ Enrollment for Jewish students was a slow,uphill climb, as well. According to To Good Healthand Life: L’Chaim (A History of Montefiore Hospitalof Pittsburgh, Pennsylvania, 1898-1990), “Therewas no question. For the Jew aspiring to a medicalcareer,” said Sidney Kaufman (MD ’41), “it wasa hostile environment. Medical schools limitedJewish admissions severely.” He was one of fiveJews to graduate in his class of 55 students.❦ In the wake of civil rights protests, AAmerican undergraduate and graduateschools made unprecedented efforts todiversify enrollment in the early 1970s. Pittmed alums from that time report they’d beenoffered numerous scholarships from otherschools. But to their disappointment, duringm edic al alumni a ssociationtheir interviews, most of those program administratorsconfessed they were accepting only oneor two African American students at a time. Pittoutpaced them all, admitting 15 Black studentsin 1970.❦ Unfortunately, this promising jump in thenumbers wasn’t sustained—the ’70s were rollercoasteryears for enrollment of students fromunderrepresented groups. Black students—who,in addition to the rigors of their studies, werepractically running the school’s diversity recruitmenteffort themselves at that time—called forreinforcements. They finally got them in 1979when a new position was created: assistant deanfor minority affairs.❦ Enrollment among underrepresented groupsshot up from 12 schoolwide in 1978 to 61 studentsby 1984, thanks to William Wallace andCarolyn Carter, the first two to fill the assistantdean role. Wallace discovered that some prospectivestudents who were denied interviews atPitt wound up attending other prestigious medicalschools; this helped himmake a case for changing the Breview process at Pitt.20 P I T T M E D

th e owl, 1910-❦ In the ’70s, Jackson Wright (MD ’76, PhD ’77)became the first African American to earn both anMD and PhD from the School of Medicine. Wrightis now a professor of medicine at Case WesternReserve University. A seasoned clinical researcherfocusing on agents that lower hypertensionand cholesterol, he’s been a key player in nearlyevery major clinical-outcome trial conducted inAfrican American populations in the past twodecades.❦ Sandra Murray, professor of cell biology andphysiology, became the School of Medicine’s firstAfrican American female tenured full professorin 1999. Murray has been a seminal contributorin the field of cell-to-cell communication. (WhenMurray first started haunting science fairs ingrammar school, she was in it for the ticket outof class. Little did she know they’d turn her into alifelong learner and a science lover.)❦ As a Pitt med student, Jeannette South-Paul(MD ’79) led a group that established the BlackBag Award, which honors a faculty membereach year for work with Pitt meders from underrepresentedpopulations. As Pitt’s Andrew W.Mathieson Professor and Chair of the Departmentof Family Medicine, she has herself won a numberof awards for community service, research excellence,teaching, and mentoring, including the2004 McCann Scholar Award from the Joy McCannFoundation. South-Paul was the first womanto serve as a permanent chair of a departmentin Pitt’s School of Medicine.❦ There’s been a bit of a Pittsburghdynasty in SNMA (Student National MedicalAssociation), the nation’s oldest and largeststudent organization focused on theneeds and concerns of medical students ofcolor. Several Pitt meders have served asnational and regional SNMA officers in thepast decade, including Leon McCrea (MD’06), Aderonke Omotade (MD ’03), NikkishaPrentice (MD ’06), and J. Nadine Gracia (MD’02, Res ’05), who’s now chief medical officerfor the U.S. Department of Health and HumanServices’ Office of the Assistant Secretary forHealth.❦ The school now hosts several efforts tospark interest in medicine among young peoplefrom underrepresented groups. Launched in1974, Pitt’s Medical Explorers program—whichteaches teens and tweens about the healthprofessions—is the longest-running amongthe some 10,000 groups around the country. At131 members last year, Pitt’s is probably alsoamong the largest. At least eight explorershave gone on to don white coats in the Schoolof Medicine, and dozens of others have in medschools elsewhere.■th e owl, 1907CDA Jeannette South-Paul (top)with colleagues, May 25, 1979.B Maud Menten (c. 1923) was amongthe first scientists of internationalrenown to join Pitt’s faculty. (See p. 30.)C Charles Henry Carroll (MD ’06) andD James Charles Gill Fowler (MD ’06),two early African American graduatesof the school, shown in their yearbookphotos. E Members of the Classof 1974 on graduation day (from left):William Hicks, Herbert Chissell, BrianBowles, Everett Cantrell, MarionWilliams, Charles Hefflin, JohnHouser, William David Moore, andWilliam Cleveland.Cou rte sy Wi lliam Cleve l an dEU n ive rsity of Pittsburg h Arch ive sF A L L 2 0 1 1 D

E x H o c S e m i n eN o s t r a G l o r i a( F r o m T h i s S e e d O u r G l o r y )What follows are excerpts from the first lecture given to students of the Western PennsylvaniaMedical College in September 1886. Chair of obstetrics, John Milton Duff, an MD, did thehonors. Duff, who raised $15,000 to be put toward a hospital for the South Side, taught humilityand respect for science and nature; he was also a product of his paternalistic times.GENTLEMEN:You enter a profession of which you may well feel proud.Great has been medicine’s work in the past! What maywe expect of it in the future! In your labor the delight ofacquiring knowledge and intellectual power will be compensation.There will be a gratification in searching for theDuffintricate beauties of God’s most holy work, while satisfaction will aboundeverywhere in contemplating the gracious supply of means for removingand preventing the ills to which flesh is heir.Entertaining in its study, often very difficultin its practice, we are sorry to say obstetricsdoes not always receive the consideration itsimportance demands. A large proportion ofthe laity deem the duties and responsibilitiesso slight that they regard any ignorant pretender... as a person thoroughly competentto preside over the lying-in chamber. ... It isobligatory upon the practical obstetrician toacquaint himself intimately with every pathologicalchange of physiological process whichmay or should take place from the momentof conception until the mother, after a returnto a normal condition, walks forth from thelying-in chamber with the child of her wombpressed to her bosom. After delivery, dangerssurround her on every hand. Not only thestate of the solids and fluids demands attention,but the organic changes which must takeplace in every lying-in woman need the closestand most intelligent watchfulness.In the study of obstetrics one of the subjectswhich demands your special attention is thepeculiarities of sex. It is in domestic life thatwoman shows to greatest advantage. … In thishome relation you will have the greatest opportunityto study her peculiarities. The familyhearthstone is her throne, and there she wieldsthe scepter of power. ...What can be more inviting than to watchthe development of the human ovum as itpasses through its many transitions, from thetime it is grasped by the fimbriated extremitiesof the Fallopian tube until—after months ofan interesting developmental existence in theuterus—it at last through the powers of natureis expelled and comes forth to the world aperfectly formed human being breathing thebreath of life.Beautiful as is the uninterrupted display ofnature under these circumstances, … it will benecessary for you who expect to become practitionersto interest yourselves in the abnormalitiesand pathological conditions which oftenoccur. They should be of peculiar interest toyou. There is an importance attached to themwhich calls for the most careful study; animportance which you will not and cannotappreciate until, perhaps far away frominstructor and associates, you will be calledupon to face with fear and trembling.Picture to yourselves a scene: A happyhousehold, joyfully anticipating the adventof a bright and tender baby to add newcharms and new joys. … Suddenly thesunshine of their happiness is darkened.… Listen to the wail that goes up fromthose motherless children—while the ignorantpretender standing by is dumb to allentreaties, forced to inactivity by his incompetence… call upon the rocks and themountains to fall upon him and hide himfrom the presence of his God!Gentlemen, I would that I could let fallupon you words of fire to impress upon youthe sacredness of the obligations you takeupon yourselves when you announce to theworld your readiness to practice medicine.Do not allow yourselves to think a merecursory knowledge of your subject is sufficient… nor that your own ingenuity willsupply all deficiencies and add perfection toevery excellence. Such a course will consignyou most certainly, and soon, to well-meritedoblivion, where you may ponder sadly overthe melancholy memorial of time misspentor of industry exercised unavailingly. You willfind nature a wonderful obstetrician. If letalone, many times she will surmount difficultiesin a manner which would put the blushof shame on your best-directed efforts. nEditor’s Note: While Professor Duff pontificatedon the “peculiarities” of the female sex,women of Pittsburgh were coming together tobuild and support much-needed hospitals forthe city (see opposite page), and then some.22 P I T T M E D

a v i e w f r o mp i t t m e dThe formidableMary Copley Thaw(c. 1910)W o m e n o f S t e e lT h e “ g e n t l e r s e x ” t r a n s f o r m e dh e a lt h c a r e i n P i t t s b u r g hOn Feb. 7, 1898, Annie JacobsDavis called together 17 ofher neighbors in Pittsburgh’slower Hill District. LikeDavis, a 33-year-old motherof six born near Moscow,every woman in the roomwas a Jewish immigrantfrom Eastern Europe. And like Davis, they heldthe principle of charity—tzedakah in Hebrew—in high esteem.At that meeting of like minds, the womenformed the Hebrew Ladies Hospital Aid Society(HLHAS), with annual dues of $5. Their charter,signed the next year, vowed “to assist and providethe deserving sick, injured, and disabled withproper medical and surgical attention and hospitaltreatment,” and when its funds would permit,open a hospital—a move that would also giveJewish physicians, who otherwise faced practicerestrictions, a hospital to staff.The HLHAS campaigned tirelessly and creatively.By 1903, they were providing care for70 patients annually. Through picnics, carnivals,and myriad other events, they raised morethan $25,000 to support the establishment ofMontefiore Hospital, which opened in 1908.Perhaps Davis knew of Louise Wotring Lyle,a 56-year-old MD who, in 1893, had foundedPresbyterian Hospital in a three-story house onwhat’s now Pittsburgh’s North Side. Or perhapsshe took note of the Ladies’ Charitable Associationof the Homeopathic Hospital—now UPMCShadyside—formed in the 1860s.In the latter half of the 19th century, as thecity’s population exploded, the middle- andupper-class women of Pittsburgh instigatedan unprecedented boom in hospital formationand construction. The Irish Catholic Sisters ofMercy had, since 1847, operated the city’s firstcivilian hospital. Two years later, four GermanLutheran deaconesses immigrated to help startand work in the Pittsburgh Infirmary (nowUPMC Passavant). In the 1880s, womenformed the board of directors of Children’sHospital of Pittsburgh, a project conceivedin 1883 by an 11-year-old boy; they raisedenough money for Children’s to provide freecare for all patients for two decades. In 1895,13 women and two male physicians convenedthe founding board of the Eye & Ear Hospital.By the time Davis and her neighbors hadlaunched HLHAS (the Hebrew society), theHomeopathic Hospital’s Ladies’ Association—Pittsburgh’s first permanent volunteer women’shospital auxiliary—had served as a peerlessfund-raising machine and a powerful laborforce for four decades. Twice weekly, two membersinspected the four-story, eight-ward downtownbuilding and its patients. Should the wardsbe found in a filthy condition, or the patientsunkindly treated, or in any way neglected, youmay well imagine that it would not long remain asecret, declared the hospital’s 1870 report.Cou rte sy UPMC SHADYSIDEThe ladies consistently met the needs theydocumented on those inspections. They providedfruits and vegetables from their owngardens, sheets from their own linen closets,and clothing for the infants of unmarriedmothers. They found employment for patientswithout jobs and read the Bible aloud in thewards. And in a time when donors oversaw thedispensation of their beneficence, the Ladies’Association—dominated by members of theTemperance movement—refused to pay for thecare of “those who had brought themselves todistress by their own dissipation.”Mary Copley Thaw—a mother of fiveand wife of Steel City shipping magnateWilliam Thaw—served as chair of the Ladies’Association from 1891 to 1913, ultimatelyoverseeing a campaign that would raise$65,000 for the hospital’s 1910 move toShadyside. In 1918, she sent a memo to theexecutive committee of the HomeopathicHospital. “I cannot think why this has neveroccurred to me before,” she wrote, “but I dobelieve it would be an excellent idea for thehospital to keep chickens.”For three decades, Thaw had seen to thehospital’s needs, both large and small. WhenElizabeth Rigg Pitcairn supplied an ambulancein 1888, Thaw provided the horses to pullit. She also gave $30,000 for an Eye and EarAnnex to the main hospital, homemade jelly,iron heating stoves and ventilators for thekitchen, a dozen brooms, and a pew in herchurch for the nurses. She sponsored weeklybanjo, guitar, and mandolin recitals “to breakthe dull routine of hospital life” and in 1910,interviewed and hired a cook for the nurses’dormitory.Understandably loathe to offend so generousa benefactor, the committee replied thatif Thaw were to provide for their housing, itwould buy hens. Thaw sent the coops and, fora time, patients at the Homeopathic Hospitalenjoyed some of the freshest eggs in town. n—Sharon Tregaskis, with reporting by MaryBrignano, author of Inheritors of a GloriousReality: A History of Shadyside Hospital andA Gracious Legacy: Remembering the Ladies’Association of Shadyside Hospital. Additionalresources include Sister M. Cornelius Meerwald’sMercy Hospital 1847–1959, Lee Gutkind’s OneChildren’s Place: Inside a Children’s Hospital,and To Good Health and Life: L’Chaim (AHistory of Montefiore Hospital of Pittsburgh,Pennsylvania, 1898–1990) by Samuel P.Granowitz, Lu Donnelly, and Carol Stein Bleier.125How has medicine changed since theVictorian era? Let us count the ways.Both in Pittsburgh and beyond, Pittpeople have advanced how we treatdiseases and disorders of the body andbrain—from head to toe, inside out,and all the way down to the molecularlevel. Here are 125 game-changing medical discoveriesand technologies (along with a few sundries) from our125-year history that will blow your bowler back.F A L L 2 0 1 1 23 D24 P I T T M E D

a v i e w f r o mp i t t m e dT H E H U M A N B O D Y :s e e n f r o m h e r eA s h o r t l i s t o f e s p e c i a l ly n o t a b l e b r e a k t h r o u g h s i nm e d i c i n e m a d e b y P i t t p e o p l e ( b o t h a t P i t t a n d e l s e w h e r e )a n d s o m e o t h e r t h i n g s y o u ’ l l w a n t t o k n o w .F r o m h e a d t o t o e :1 Discovery of the first biomarker for glaucoma.(J. Schuman, 2001)2 Promoting stricter surgical criteria for someof the most common operations performed on children,including tonsillectomies, adenoidectomies,and tympanostomy-tube procedures. Perhaps no onehas done more for children by showing that less hadto be done to them than Pitt’s Professor Emeritus ofPediatrics Jack Paradise, whose series of clinical trialshelped make this happen.3 Rewriting the rules on treating head and neckcancer that has spread to the lymph nodes. Byadding chemotherapy to the standard post-opregimen of radiation in the 1980s, doctors in Pitt’sDepartment of Otolaryngology found that theycould prevent local recurrence and increase survivalrates. 4 A decade later, Pitt professor JenniferGrandis (MD ’87, Fel ’92, Res ’93) discovered thatepidermal growth factor receptor is overproduced intumors from patients with head and neck cancer.Enterprises Ambulance Service, which trained firstrespondersfrom the Hill District.9 Advancing a novel candidate vaccine for pneumocystispneumonia, a common illness associated withAIDS and leukemia in children. (J. Kolls, 2005)10 Isolated and cultivated Legionella micdadei, thesecond bacterial species recognized to cause legionella-basedpneumonia. (A.W. Pasculle, 1980)11 Discovering that serine and matrix metalloproteinases—productsof the immune response tocigarette smoke—are at the heart of emphysema andpossibly lung cancer. (S. Shapiro, A.M. Houghton,2008)12 The pneumonia severity index, considered thebest bedside tool to help guide decision-making inpatients with pneumonia. (M. Fine, D. Yealy, 1997)13 Improving paramedic advanced care, especiallymanaging those with circulatory and respiratoryfailure. (1980 through today)nongenetic mechanisms that contribute to a gene’ssilencing—i.e., epigenetics. (N.E. Davidson, 1994)19 Establishing interferon alfa-2b therapy asthe first—and to date the only—effective adjuvantmedical therapy for prevention of relapse and deathfrom surgically treated melanoma with a high riskof recurrence. (J. Kirkwood, 1995)20 The first to use activated natural-killer cells totreat advanced melanoma, as well as kidney cancer.(R. Herberman, 1987)21 The first double-hand transplant in theUnited States was led by Pitt plastic surgeons in2009.22 Making modern vascular surgery possible.Faculty member C.C. Guthrie’s early 20th-centurywork became the basis for future developmentin the field. 23 Many of Guthrie’s experimentswouldn’t go over well today, such as “successfultransplants of heads, kidneys, and other tissues,alive and preserved, on dogs and other animals.”5 The endoscopic endonasal approach for operatingon the skull base using minimally invasive toolsinserted through the nostrils. Pitt otolaryngologistsand neurosurgeons have done more than 2,000 proceduressince 1999 for benign and malignant tumors.6 Demonstrating in 1956 that mouth-to-mouth rescuebreathing was superior to then-current methods. To dothis, Pitt’s Peter Safar (then chief of anesthesiologyat Baltimore City Hospital) paralyzed volunteers withcurare, then monitored blood-oxygen levels as differentmethods of artificial respiration were employed.7 Peter Safar realized that there was little point insaving a heart or lung if the brain was not also protected.He championed the use of mild hypothermiato preserve brain function. The procedure has beenrecommended by the American Heart Association foruse in ventricular fibrillation cardiac arrest patientssince 2003. His colleagues at Pitt’s Safar Centerfor Resuscitation Research are about to start trialsapplying deep hypothermia, now known as emergencypreservation and resuscitation, to buy time while traumaticinjuries are repaired.8 The first modern ambulance service. In 1967, Safarworked with Phil Hallen of the Maurice Falk MedicalFund and community leaders to build Freedom House14 Inventing a technique for correcting deformitiesof the chest wall. (M. Ravitch, 1950)15, 16 Changing the outcomes of countlesswomen with breast cancer by improving their chanceof survival and quality of life. As a result of almost 50years of laboratory and clinical research conductedat Pitt, Bernard Fisher (MD ’43) dramatically changedour understanding and treatment of breast and othercancers. He showed in 1985 that lumpectomy wasjust as effective as radical mastectomy, a disfiguringprocedure that had been widely used for much of thelast century. Fisher was also the first to show thatbreast cancer is a systemic disease and proved, byclinical trials, the value of systemic therapy followingsurgery. Other trials by him demonstrated that somebreast cancers can be prevented and that preoperativechemotherapy enables more women to have alumpectomy instead of mastectomy. He is consideredthe first to promote cancer treatment based on sciencerather than opinion. 17 Fisher is best knownfor these breast cancer treatment advances. Whatmost people don’t know is that the Pitt DistinguishedProfessor of Surgery started out as a renal and liverspecialist.18 Discovering that certain breast cancer cellsmay fail to produce estrogen receptor because of24 Invention of the sutureless heart valve. This1964 innovation, which shortened the dangerouslylong surgery time by an hour, raised valve-replacementsurvival rates from 10 to 98 percent.(G. Magovern Sr.)25 Developing exchange transfusion, a lifesavingprocedure for newborns with Rh disease (1963).Paul Gaffney (MD ’42) performed more than 10,000during his tenure at Children’s.26 Pennsylvania’s first heart transplant, performedby Henry “Hank” Bahnson in 1968 (chairof Pitt’s Department of Surgery from 1963 to 1987).Considered one of the finest surgeons and innovatorsof surgery of his time, Bahnson, while at JohnsHopkins, also was the first to repair aneurysms ofthe aorta where it arched out of the heart. 27 Oneof Bahnson’s trainees happened to grow up playingwith the Bahnson children and recalled some earlymemories—like how the heart surgeon could cavalierlyreach into a horse’s mouth to adjust a bit orcould rig an automobile engine to pull a rope, towingskiers to the top of the hill behind his house.28 The authoritative book on comparative coagulationsystems, by Pitt researcher and leader ofthe Central Blood Bank for decades, Jessica Lewis.Transplant surgeons relied on her knowledge of clottingissues: “I don’t think our program here wouldhave gotten off the ground if it hadn’t been for her,”Thomas Starzl said in her Pittsburgh Post-Gazetteobituary. 29 Lewis was half of a Pitt husbandand-wifeteam that changed medicine in Pittsburghforever. Husband Jack Myers, legendary chair of medicine,was a fabled and exacting diagnostician whoseinfluence on medical education was felt far beyondPittsburgh. The couple drove to Pitt separately, met atday’s end for a cocktail, but had a pact not to discusseach other’s work.30 Confirming in 2000 that diabetic patients whorequire revascularization fare better with surgerythan with angioplasty. This was one of many instancesin which Pitt Graduate School of Public Health’sKatherine Detre “helped establish the gold standardsfor determining whether a medical or surgical therapywas good or not so good in spite of opinions of theexperts,” noted one colleague.31 One of the first research-oriented pathologyprograms. Here, in the 1950s, a young up-and-comernamed Frank Dixon uncovered the mechanisms ofdiseases resulting from immune-response misfires,including serum sickness, lupus, and antiglomerularbasement membrane disease. 32 Dixon, an MD andone of the first immunopathologists, served as Pitt’spathology chair from 1951 to 1961. Apparently, hispassion for the work was infectious—19 members ofthe Class of ’56 alone went into pathology.33 Seminal studies on the pathogenesis of kernicterus,paving the way for future studies on bilirubininducedbrain injury. (R. Day, 1954)34 Understanding the role of hepatocyte growthfactor, its receptor, and the role of extracellularmatrix. (G. Michalopoulos, 1984)35 Revealing that an antiseizure drug may be ableto reverse the clinical effects of a genetic disease—alpha1-antitrypsin deficiency—that is the cardinalgenetic disease for which children undergo livertransplantations. (D. Perlmutter, 2010)36 The world’s first liver transplant. (Pitt’s ThomasStarzl, in Denver, 1963; he did the first successful onein 1967. His arrival in Pittsburgh in 1981 would marka defining era in transplant medicine. His team, withothers at UPMC and Pitt, would make headlines foryears to come. Read on.)37 The world’s first multivisceral transplant. (1983at Children’s Hospital of Pittsburgh of UPMC)38 The world’s first double-transplant operation.(A heart and liver for 6-year-old Stormie Jonesin 1984)39 The world’s first pediatric double-lungtransplant. (1988)40 The world’s first baboon-to-human livertransplant. (1992)41 Proving the clinical viability of the immunosuppressantscyclosporin and tacrolimus. (T. Starzl,1980s) 42 On June 8, 1986, Thomas Starzl andthree other Pitt surgeons looked down from 20,000feet upon the forests of Nova Scotia, where they weregoing to procure a liver. Suddenly, hydraulic fluidspewed across the plane. They lost the nose gear,plus hydraulic brakes and flaps for deceleration.Starzl’s comment: “I always suspected it would endthis way.” It didn’t end that way, of course. Starzl’squestion on deplaning from the smoking hulk beyondthe end of the runway: “How do we get back toPittsburgh?” A new plane streaked to Halifax fromNew York while the team procured the organ. Ninehours after leaving, the team returned to Pittsburghand began the life-saving transplant.43 The classic textbook The Body Fluids:25 P I T T M E DF A L L 2 0 1 1 26

ILlustration by Je sse LenzBasic Physiology and Practical Therapeutics. Pitt’sprolific Thaddeus Danowski, who developed thepediatric diabetes program at Children’s Hospital in1947, penned 600 scholarly works.44 Successfully developing synthetic insulin.Panayotis Katsoyannis’ five years of toiling in hisPitt lab to decipher the 200 delicate steps in the synthesisprocess, LIFE reported in 1964, “was roughlyequivalent to working a dozen jigsaw puzzles simultaneouslywhile blindfolded.”45 Confirming, in 1967, that insulin deficiency distinguishedtype 1 from type 2 diabetes. (A. Drash)Today, Pitt doctors are identifying the genes andproteins involved in the creation of new insulin-producingcells (A. Stewart); they’ve developed an innovativeexperimental vaccine for type 1 diabetes (M.Trucco, N. Giannoukakis); and they’ve shown that thethymus is arguably just as important for type 1 diabetesdevelopment as the pancreas (Y. Fan, M. Trucco).46 Dispelling the myth that pancreatitis is almostalways associated with alcoholism. David Whitcombidentified a number of genetic causes for pancreatitisand proved that all pancreatitis begins with trypsinactivation. 47 In 1995, the Pitt prof made one ofthe most important breakthroughs in pancreatitisresearch in a century ... by throwing a party. At areunion hosted for a family that had a rare, geneticform of pancreatitis, the scientist took more than 100blood samples. The following year he published hisgroundbreaking finding: The affected family memberswere genetically predisposed to pancreatitis throughautodigestion set off by loss of regulation of theprotein-digesting enzyme trypsin.48, 49 Demonstrating that glomerular failurelies at the root of every renal disease. Pitt grad BarryBrenner (MD ’62) also found that antihypertensivedrugs lowered glomerular pressure, allowing thekidney to survive longer. 50 Harvard’s Brenner is“probably the world’s top nephrologist,” noted a colleaguea few years ago. Yet shortly after his arrival asa new student to Pitt med, Brenner spotted a “supergenius” from his high school. Panic washed over him:My God, how am I going to compete if everyone is atthis level? (The genius from home eventually droppedout of the program.)51 Discovery of “Compound E,” now known as cortisone.Philip Hench (MD ’20) and his Mayo Cliniccolleague Edward Kendall had a hunch for yearsbefore they were able to test it—a hunch thatKendall’s newly discovered adrenal hormone,Compound E, might help people with crippling arthritis.But it was a complex compound to create in thelab. The pair waited from 1941 until 1948 before theygot a break. Rumors that Germany had been usingadrenal hormones to give their fighter pilots an edgespurred U.S. military support for synthetic-hormoneresearch. For cortisone work and related studies,Hench and Kendall won the 1950 Nobel Prize inPhysiology or Medicine. 52 The mysteries ofmedicine weren’t enough to satisfy Hench’s fecundmind: A Sherlock Holmes devotee, Hench amasseda collection of first editions and related materialsthat came to be included in the Special Collectionsand Rare Books Department at the University ofMinnesota.53, 54 Pioneering the use of titanium and otherdurable materials in hip and knee replacements.Also: the medial open reduction technique to correctdislocated hips in infants resulting from breechbirth. (A. Ferguson, 1950s)55, 56, 57 Pitt orthopods have managed otherfeats that became the foundation for the future ofcartilage science and repair, including: showing thatinjection of cortisol could harm cartilage (1966);leading the development of cartilage tissue engineering(1970); and the first recorded successfulcartilage cell joint allografts (2000).F A L L 2 011 11 27 B

a v i e w f r o mp i t t m e dT H E B R A I N( A N D N E R V O U S S Y S T E M )S o m e o f t h e m o s t s i g n i f i c a n t a d v a n c e s t o c o m eo u t o f P i t t p e o p l e ’ s u n d e r s t a n d i n g o f o u r s y n a p t i cc o n n e c t i o n s . O u r c o u n t d o w n c o n t i n u e s .58 The Common Sense Book of Baby and ChildCare (1946). Benjamin Spock’s bestselling treatise,rooted in a study of psychoanalysis that encouragedparents to trust their instincts (noting, forexample, that it’s okay to show affection), redefinedparenting. Spock brought to Pitt pediatricsan emphasis on child development rather thanchildhood illness. 59 After World War II, Spock’sbook seemed to be at every cribside, soothinganxious parents. In the turbulent ’60s he built adifferent reputation—as an outspoken opponentof the Vietnam War and the military draft in particular.Arrested for allegedly counseling youngmen to disobey the draft law (charges were laterdropped), he ran for president (1972) and thenvice president (1976). (In 1967, he was slated tobe named Martin Luther King Jr.’s vice-presidentialcandidate at a conference reportedly disrupted by“government agents provocateurs.”)60 One of the first psychiatry departmentsto insist on evidence-based medicine. ThomasDetre arrived in 1973 to take the reins of WesternPsychiatric Institute and Clinic (WPIC) and theDepartment of Psychiatry. From the get-go, Detresaw rigorously researched medicine as the futureof his field—with psychiatrists partnering withbiologists, neurologists, epidemiologists, geneticists,and others. He was one of the people mostresponsible for propelling Pitt to the top tier ofmedical schools and for making UPMC what it istoday.61 Uncovering biologically based root causes ofmood disorders and better detection methods andlong-term treatment strategies. (D. Kupfer, 1990s)62 Revealing the relationship of sleep disordersto cardiovascular health, depression, and menopause.(D. Kupfer, starting in 2000)63 Chairing the task force charged with revisingthe forthcoming fifth iteration of the Diagnosticand Statistical Manual of Mental Disorders (DSM),the bible of psychiatry. That would also be DavidKupfer, a Thomas Detre protégé. By promoting evidence-basedcollaborations between clinical- andbasic-science investigators as chair of the psychiatrydepartment from 1983 to 2009, Kupfer hasmade WPIC one of the preeminent university-basedpsychiatric centers, with an encyclopedic roster ofpsychiatric-disorder studies.64 The recent finding that GABA neurons,which regulate working memory, function improperlyin people with schizophrenia. The abnormalityrepresents a promising molecular target fortreating cognitive impairment in those with thedisorder. The same team has identified a compoundthat boosts GABA-neuron signaling. (D.Lewis, 2004, 2008)65 Tracing signals in the brain using virusesto discover, for example, that learned movement,such as a master pianist’s performance of a concerto,follows a route from cortex to cerebellumto the ivories. Peter Strick’s work has contributedgreatly to our insights on how the brain operatesas a network—most notably, that the cerebellumand the cerebral cortex continuously exchangeinformation in a closed-loop circuit, and that thehuman cerebellum is well connected to higherbraincenters. 66 As befits someone who was ahigh school basketball teammate of baseball legendReggie Jackson, Distinguished Professor ofNeurobiology and codirector of the Center for theNeural Basis of Cognition, Pitt’s Strick, retains apassion for athletics and what it illustrates abouthuman actions, especially automatic movement.28 P I T T M E D

ILlustration by Je sse Lenz67 Building an understanding of neuronal communication,as well as the required cyborg technology,to allow an otherwise immobile person tomove a robotic arm just by thinking about it.(A. Schwartz, starting in 1988)68 Discovering, in the 1960s and 1970s, theneurological mechanism of urination—from theprimitive reflex in infancy to the voluntary controlwe develop as toddlers—as well as how thebladder’s network of nerves rewires itself in thewake of a spinal cord injury. 69 Disorders ofthe sacral nerves, which control the autonomicfunctions of the bladder, bowel, and reproductiveorgans, have always been shrouded in shame.Treatment lagged behind other neurologicalconditions because so little was understoodabout the unique wiring at the base of the spinalcord—that is, until Distinguished Professorof Pharmacology and Chemical Biology William“Chet” de Groat brought these diseases out of thewater closet.70 Pittsburgh Compound B—the first noninvasivemethod of detecting beta-amyloid proteinsthat form the plaques in the brain tissue of peoplewith Alzheimer’s disease. 71 Pitt psychiatristWilliam Klunk and radiochemist Chester Mathishave been fishing buddies for years. Betweenthem, they’ve caught trout, steelhead, salmon,and even each other (with the rare errant cast) ontheir many expeditions along the streams of LakesErie and Ontario. But there’s a reason it’s called“fishing,” not “catching”—it takes patience, somethingthese scientists are no strangers to. Klunkand Mathis tried hundreds of compounds overalmost a decade before successfully developingthe radiopharmaceutical dye known as PittsburghCompound B at Pitt in 2002.72 Outing the dangers of even low-level leadexposure, including lower IQ and shifts in behaviorthat lead to delinquency. Herbert Needleman'sstudies were key in persuading the EnvironmentalProtection Agency to take lead out of gasoline inthe 1970s, making possible a 90 percent reductionin blood lead levels in American children.73 As a self-admittedly cocky young residentin Philadelphia, Needleman (who would later dohis important lead-exposure work as a member ofthe Departments of Pediatrics and Psychiatryat Pitt) brought a little girl with severe leadpoisoning back from a coma, breathed a sigh ofrelief, and told the girl’s mother she’d make it—they’d just have to move out of that lead-paintinfestedhome. Angry, the mother snapped.Where can I go? Any house I can afford willbe no different from the house I live in now.Needleman realized lead itself wasn’t the problem—itwas the society that had allowed her tolive in a toxic environment simply because shecame from a low-income family.74 The discovery, in 1949, of Riley-Daysyndrome, a disorder of the autonomic nervoussystem. 75 When Richard LawrenceDay—Pitt’s chair of pediatrics from 1960 to1965—was 80 years old, he accidentally left aspoon in the freezer, and when he removed it,he dropped it into a cup of hot water he hadheated in the microwave. The water immediatelybegan to boil. Intrigued, Day studied thephenomenon with the help of a Yale engineerand wrote a detailed, erudite explanation thatwas published in a letter to Nature.F A L L 2 0 1 1 29 B

T H E C E L L ( A N D M O L E C U L E S )© Pau l Thompson/National Geograph ic Soci ety/Corbisp i t t m e d e r s s h o w t h a t m i c r o s c o p i c t h i n g s m e a n a l o t .O u r c o u n t d o w n c o n t i n u e s .76, 77, 78, 79 Offering a mathematical means for determiningthe rate of an enzyme reaction. Maud Menten accomplished this inBerlin with Leonor Michaelis. After arriving at Pitt in 1923 as an assistantprofessor of pathology, Menten discovered the azo-dye coupling reactionfor alkaline phosphatase (which is used as a dye in histology), characterizedseveral bacterial toxins, and conducted the first electrophoreticseparation of proteins in 1944. (She also investigated the properties ofhemoglobin, the regulation of blood sugar levels, and kidney function.)That’s some of it. Menten was a clarinetist, an exhibited painter, a polyglot,and a stickler for doing English tea time properly.80 Creating a technique in 1952 that allowed the poliovirus to be producedin adequate quantities for use in the Pitt team’s successful vaccine.81 Julius Youngner, the Pitt virologist alluded to above (who is nowDistinguished Service Professor Emeritus), also figured out how to culturecells derived from animal tissue, forming the foundation of moderncell culturing. (1947) 82 When in the army and stationed at Oak Ridge,Tenn., during the Manhattan Project, a civilian worker asked Youngnerwhat was going on. He had no idea, actually, but couldn’t resist yankingthe man’s chain. Drawing himself up to appear as in-the-know as possible,Youngner looked the gent in the eye and asked, ominously: “Do you wantto get in real trouble?”83 Describing plasma protein metabolism in children with kidneydisease. (D. Gitlin, 1952)84 Unraveling the process of intestinal iron absorption.(D. Gitlin, 1962)85 Identifying alpha fetoprotein as a critical indicator of potentially lifethreateningbirth defects in the developing baby (1967) and ceruloplasmindeficiency as a marker for Wilson’s disease (1952). Certain elements ofDavid Gitlin’s (the late professor of pediatrics) research required humanbreast milk. He assigned student Bertram Lubin (MD ’64) to do the collecting.“I felt like Clarabelle Cow,” Lubin says with a laugh.30 P I T T M E D

a v i e w f r o mp i t t m e d86 Proving that our bodies produce nitric oxideand mapping out its biochemical pathway. A Pittmed grad’s work in immunology helped to unravelthis entirely new principle for signaling in animals.The University of Utah’s John Hibbs Jr. (MD ’63)pursued his studies at the same time as others wholater won the Nobel Prize in Medicine or Physiologyfor similar findings in the cardiovascular system.87 Pitt faculty members are moving nitric oxidebreakthroughs from the bench to the bedside: Inclinical studies, they are using the pathway toprotect the liver from damage. They’re also testingways to remove excess nitric oxide in cases ofshock.88 A Pitt med grad figured out that hormonescontrol certain genes, was the first to isolate a hormone-regulatedgene, and cloned it (showing it waspossible to reproduce genes). 89 The same grad,Bert O’Malley (MD ’63), also uncovered how receptors,and therefore the genes they regulate, turnon and off, and he introduced the endocrine worldto molecules called “co-activators,” which regulategene expression. 90 In the creation story of hisresearch career, which came first for Bert O’Malley,Father of Molecular Endocrinology, the chicken orthe egg? Answer: Neither. Er, both. Well, actually, itwas the oviduct, the passage from the hen’s ovariesto the outside, which undergoes dramatic changesin response to estrogen. O’Malley recognized thatthis system would be ideal for a series of hormonestudies when he was working for the NationalInstitutes of Health in the 1960s.91 Discovery of a new category of lymphocytescalled natural-killer (NK) cells. (R. Herberman, 1975)92 Elucidating the DNA-repair process. Theprocess can be likened to the work of a roadcrew finding a pothole in a highway, assessingthe damage, and filling the hole. In the pastdecade, Pitt has built an impressive braintrustin this area. (The dean himself has an activelab.) One Pitt investigator appended quantumdots to DNA-repair proteins and became thefirst to watch multiple repair proteins in action.(B. Van Houten, 2009) Another realized thatATM kinase, a biochemical catalyst, is vitalfor the survival of cancer cells; it allows themto repair their DNA. By inhibiting ATM activityit’s possible to selectively kill cancer cells thatexperience replication stress as a consequenceof somatic mutation. (C. Bakkenist, 2010)93 Stablizing a cancer stem cell line.Ephemeral by nature, transforming quickly intomature cancer cells, cancer stem cells are difficultto study in their stem cell state. Or at leastthey were until a Pitt prof recently managed tofreeze them in time. (E. Prochownik, 2010)94 Identifying two of the seven known humancancer-causing viruses: KSHV (1993), whichcauses Kaposi’s sarcoma, and MCV (2008), thesuspected culprit in the majority of cases ofMerkel cell carcinoma. (Y. Chang, P. Moore)95 Numerous seminal contributions to ourunderstanding of “unorthodox” DNA structuresand how they can lead to mutation. Fresh out ofPitt med’s PhD program, biochemist Robert Wells(PhD ’64) turned down a faculty gig at Princetonon a hunch that another offer—a fellowship at theUniversity of Wisconsin with H. Gobind Khorana—was the ticket. This turned out to be one honey ofa hunch: Within two years, the group had crackedthe genetic code. (Khorana received a Nobel in1968.) Wells has since led a number of notableorganizations, including the Center for GenomeResearch at Texas A&M.96 Synthesizing adrenocorticotrophichormone, which helps preserve critical brainfunction during physiological stress or trauma.Klaus Hofmann managed to do this in 1961,when chair of the Department of Biochemistry.97 As one of Hofmann’s grad students, RobertWells experienced some stress while running anexperiment that literally blew up in his face. Inthe wake of the accident, Hofmann calmly toldWells, “Bobs, I think you better take the rest ofthe day off.”98 The first evidence that a heart defect isgenetically linked to a dysfunction in cilia.(C. Lo, 2007)99 Showing that there’s order to necrosis,thought to be a chaotic and irreversible process,by finding that it’s actually a response to stressregulated by a protein called a serpin.(C. Luke, G. Silverman, 2007)100 Pinpointing in 2009 an enzyme inhibitorthat allowed for a deeper understanding ofthe role of the fibroblast growth factor pathwayin heart development and wound healing. Withthis knowledge, Pitt’s Michael Tsang even managedto enlarge a developing heart.P E S T I L E N C EA v e r y b r i e f r e c a p o f p r o f o u n d a d v a n c e s i ni n f e c t i o u s d i s e a s e m a d e b y P i t t p e o p l e .101 Halting the spread of polio in America andelsewhere with the development of the killed-viruspolio vaccine. (Pitt polio team, 1955)102 Leading the effort to eradicate smallpoxworldwide. (D.A. Henderson, 1966–1977)103 Creating the Jerne plaque assay, a populartest for visualizing and counting antibody-producingcells that revolutionized immunology researchand was used for many years. (N.K. Jerne, 1963)104 The natural selection theory of immunology(1955), which asserts that all kinds of specific,original antibodies (these came to be knownas products of lymphocytes) already exist in anorganism, pre-formed, ready to fight off intruders.Before this idea took hold, scientists believed thatviruses and other antigens somehow “instructed”the immune system to build original, appropriateantibodies. 105 Pitt prof Niels Jerne’s Darwiniantake on immunology—which began percolatingin Copenhagen while he was doing MD dissertationwork in a lab shared with a young JamesWatson (who was working on another project)—held him up as one of biology’s great theoreticiansand won him a Nobel. But it took years toconvince people. When Jerne secured an audiencewith Linus Pauling to describe his idea,Pauling took it in, understanding it completelywithin minutes. Then he dismissed it entirely.When Jerne met up with Watson years later atone of Pasadena’s all-night eateries, he askedhim what he thought of the theory. Watson wassuccinct: “It stinks!”106 Determining that viral loads, not justT-cell counts, matter in assessing who with HIVis likely to develop AIDS. The same Pitt medteam, led by John Mellors, also contributedto the first long-term effective antiretroviraltherapy and took on the puzzle of HIV resistanceto antiretroviral drugs. These advances weremade possible by the Graduate School of PublicHealth’s Pitt Men’s Study. Founded in 1983 byCharles Rinaldo, the study investigates the naturalhistory of AIDS in more than 3,000 homosexualmen in Pittsburgh. As part of a national effort,the research has allowed scientists to learn howthe virus spread, discover ways of measuringthe disease’s progression, and find interventionsthat help HIV-positive people live longer.107 The Pittsburgh Post-Gazette reportedthat club-owner involvement was a unique partof the Pitt Men’s Study. Tavern Guild memberseven tried to convince bar and bathhouse ownersin other cities to distribute AIDS information andcondoms. A Philadelphia gay bar owner askedone Pittsburgh club owner why he’d want tochase away business by reminding people aboutthe virus. He responded, “When people die, theydon’t buy any drinks at all. They’re not ever comingback.”F A L L 2 0 1 1 31 D

Y o u d i d t h a t ?H e r e ’ s t o t h e c r e a t i v i t y o f P i t tp e o p l e t h a t m a k e s u s h e a lt h i e r .w e e n d o u r c o u n t w i t h A n o t h e rs h o r t l i s t .© Swim I n k/Corbis108 Robert Egan (MD ’50) spent the early part ofhis career using inanimate objects as well as humansubjects to find the perfect positioning of the breastfor X-rays by trying everything from compressingthe breasts to “floating” them in liquid. The “Egantechnique” caught on and became the basis formodern mammography.109 Mark Ravitch, who for 20 years was a Pittprofessor of surgery, helped to introduce mechanicalsuturing techniques in the United States afterseeing surgical staples used on a 1958 trip toRussia.110 Biochemist Herbert Boyer (Arts & SciencesPhD ’63) and geneticist Stanley Cohen first met ata conference in Hawaii in 1972. Afterward, over hotpastrami and corned beef sandwiches, they cookedup a way to genetically engineer cells to producebiological chemicals. Boyer and Cohen’s first successfulattempt at gene splicing, or recombinantDNA, followed a few months later.111 Fellow Pitt undergraduate alum PaulLauterbur (A&S ’62) is further evidence that thebest way to the heart of discovery may well bethrough the stomach. His aha! moment came in1971, mid-bite into a Big Boy burger. Lauterbur wona Nobel Prize in Physiology or Medicine for a conceptthat took shape that day in his scribbling on,yes, a napkin: magnetic resonance imaging (MRI).112 The liver is a big bleeder. When ThomasStarzl was perfecting liver transplantation, docshad to hand pump unit after unit of blood. JohnSassano (Res ’80) found a way around the problemby inventing the rapid infusion pump, which hasbecome standard equipment in ERs and ORs.113 In 1985, a Pittsburgher named Tom Gaidoshreceived an artificial heart, and then, a few dayslater, a heart transplant. His was the world’s secondimplant of the device as a bridge to transplant, andthe first successful one—he lived for 12 more years.Both surgeries were performed at UPMC by BartleyGriffith (Res ’81, Fel ’78).114 L. Dade Lunsford at the Center forImage-Guided Neurosurgery at Pitt used the firstGamma Knife in North America in 1987.115 While at Johns Hopkins University in 1988,Pitt’s Jeremy Berg predicted the structure of “zincfingers,” which slide into the DNA double helix atprecise positions. Research scientists now designcustom zinc finger proteins to recognize geneticsequences they want to exchange in “knock-out”animal models.116 The Peter M. Winter Institute for SimulationEducation and Research (WISER) opened its doorsin 1994. The idea was pretty simple: Give students achance to train in a real-world environment withoutputting a patient at risk. What they built becamethe world’s most widely used patient simulationcenter.117 Former WISER directors created a respiratorysimulator called AirMan, some of whose technologywas later licensed to the company that developedSimMan (a multi-purpose, computer-run simulator)and SimBaby. There are now 4,000 Simfolk helpingto train medical personnel the world over.118 On the top floor of Pitt’s Scaife Hall is theEmergency Medicine Communication Center thatfields calls from commercial airlines, PittsburghMedic Command, and STAT MedEvac, the largestprivate air medicine service in the country (with thesecond busiest heliport after the Pentagon).119 A Pitt prof developed fluorescence lightmicroscopy instruments and reagents, giving scientistsa new perspective on living cells. D. LansingTaylor created his first such image using a newlydeclassified military night-vision camera in 1974.120 Optical coherence tomography, a 3-D opticalbiopsy that can catch signs of many types of eyedisease before vision loss sets in, was patented byPitt’s Joel Schuman in 1994.121 Among Bert O’Malley’s (MD ’63) many patentsis a switch to turn genes off and on in humansand other animals.122 About 11 percent of U.S. hospitals usebasic electronic medical records. UPMC is amongthem—and has been for more than 20 years, thanksto a Pitt prof. In 1989, John Vries developed theMedical Archival System (MARS), one of the firstsuch systems in the country.123 Managing digital radiology images oncerequired huge, centralized systems. That is until aPitt radiologist created the Stentor system, whichleverages less-expensive PCs and the World WideWeb. (P. Chang, 1998)124 The average wheelchair user will pushhis hand rims perhaps 3,000 times a day. So Pittresearchers developed the Natural-Fit, a bestsellingergonomic hand rim that has helped tens ofthousands of wheelchair users see the light at theend of the carpal tunnel.125 Pathologists are able to make evaluationsaccurately from remote sites thanks to workdone by clever folks here. Pitt docs are amongthe first to take thousands of digitized pathologyimages and quilt them together via software. Theycan use these images with integrated clinical datato make pathological diagnoses. n32 P I T T M E D

a v i e w f r o mp i t t m e db y t h e n u m b e r sA n d s i n c e w e ’ r e i n t h e c o u n t i n g m o o d ,w e ’ l l s i g n o f f w i t h t h e s e n o t a b l e n u m e r i c s .✺ In its 125 years, the School of Medicine hasminted 10,671 MDs.✼ Twenty-two men made up the first facultyof the medical college. The School of Medicinenow has more than 2,000 regular faculty members(38 percent of whom are women), plus anadditional 2,098 volunteer faculty.v All six women holding permanent departmentchairs in the medical school, the onlywomen to do so in the school’s history, wereappointed in the past 13 years during Arthur S.Levine’s tenure as dean._ Eleven-year-old Kirk LeMoyne inspired thefounding of a hospital for children in Pittsburgh.In 1883, he formed the “cot club” which sponsored“the baby show,” a beauty pageant forchildren. The first effort raised $3,000 and ledto other fundraisers that planted the seeds forChildren’s Hospital of Pittsburgh.☛ Two hundred and ninety-eight children visitedChildren’s Hospital as outpatients in 1896,and 213 were admitted, mostly “foundlings” lefton its doorstep.★ It’s been said that the clinical trial of thepolio vaccine—involving 1.8 million childrenacross 12 states—could not be done today.(Add this to your list of things that wouldn’t flytoday: Pitt medical students were encouraged toroll up their sleeves for the double-blind trial ofthe vaccine.)☎ Since 1997, the University of Pittsburgh (withits affiliates) has been one of the top 10 NationalInstitutes of Health–funded institutions.✣ The School of Medicine can count four recipientsof the Presidential Early Career Award forScientists and Engineers among its ranks. Theaward, started by President Bill Clinton in 1996,is the government’s highest honor for youngscientists.✂Pitt has the busiest postcardiac-arrestservice in the nation. Since 2007, the servicehas assisted in the care of patients at UPMCPresbyterian and includes the therapeutic useof hypothermia. Thus far, its team has seen 443patients.❂ The Department of Psychiatry has rankednumber one in NIH funding among all suchdepartments since 1987.✯ For 2009, the School of Medicine received5,202 applications. The incoming class consistedof 150 students.✹ Seventeen School of Medicine facultymembers are among the 1,649 members of theInstitute of Medicine. Four have been elected tothe National Academy of Sciences, which votesin just 72 U.S. scientists each year.➤ Pitt med students learn the basics of clinicalpractice from 92 standardized patients, whorange in age from 18 to 77.➶ Pitt’s 10,000-tank zebra fish facility canaccommodate up to half a million fish forresearch models._ The class entering the school in 1908 had145 members, of whom 60 graduated and 40passed the state-licensing exam.❇ The Class of 2008 was the first to completethe scholarly project, which was introduced tothe curriculum in 2004. Their work resulted in 13fellowships, grants, or other national awards;20 School of Medicine awards; co-authorshipof 42 peer-reviewed papers; and more than 46national presentations and abstracts. (HarvardMedical School just announced it will requirea similar scholarly project of all of its medicalstudents.)❋ Bling! After their Super Bowl XLIII victory,the Pittsburgh Steelers had a championshipring fashioned for Robin West (Fel ’03), Pittassociate professor of orthopaedic surgery andthe team’s assistant orthopaedic surgeon. Thering joined her Super Bowl XL pendant.➨ When Rolling Stone magazine ranked“The 100 People Who Are Changing America,”a Pitt scientist checked in at 32. Alan Russell,a PhD professor of surgery and former directorof the McGowan Institute for RegenerativeMedicine, was described as “a medical futuristwho is finding ways for the body to rebuilditself.”❤ At 3 a.m. on Monday, April 27, 2009, theClass of 2009 successfully closed down ForbesAvenue in front of the Original Hotdog Shop tofilm 72 med students performing a Bollywoodstyledance scene for Scutdoc Millionerrs.(You’ve gotta Google this one!)♣ Even if residents aren’t getting a lot ofshut-eye, someone usually is on campus. TheUniversity’s Human Chronobiology ResearchProgram observed 863 overnight studies in just365 days last year. With that, we’ll rest. n1 2 5 t h A N N I V E R S A R Y F E A T U R E C O N T R I B U T O R SMuch of the historic section, “The Ills to WhichFlesh Is Heir,” was written by Barbara I. Paullor is from her book, A Century of MedicalExcellence: The History of the University ofPittsburgh School of Medicine (1986). Ourfeature contributors also include Erica Lloyd,Edwin Kiester Jr., Joe Miksch, Chuck Staresinic,Sharon Tregaskis, and Elaine Vitone, withreporting by Mary Brignano, Marc Melada,and Alexis Wnuk.Sources include Pitt’s Archives Service Center,Robert C. Alberts’ Pitt: The Story of theUniversity of Pittsburgh 1787-1987 (1986),Mary Brignano’s Beyond the Bounds: A Historyof UPMC (2009), Ruth C. Maszkiewicz’sPresbyterian Hospital of Pittsburgh: From itsFounding to Affiliation with the Universityof Pittsburgh (1978), David M. Oshinsky’sPolio: An American Story (2006), Pitt’s Officeof Public Affairs’ Blue Gold & Black (2008and 2010) and Defeat of an Enemy (2005),Peter Safar’s Careers in Anesthesiology; AnAutobiographical Memoir, Volume V: PeterSafar (2000), Thomas Starzl’s The PuzzlePeople: Memoirs of a Transplant Surgeon(1992), many stories from past issues of thismagazine, as well as publications we noteon p. 23.F A L L 2 0 1 1 33 D

A T T E N D I N GRuminations on the medical lifeabove: Officials from the University of Pittsburgh and TsinghuaUniversity met in Beijing in April to ratify an agreement that makestwo years in Pittsburgh part of the biomedical research training ofTsinghua students. right page: Shi and Levine sign the agreement.Beijing in PittsburghC h i n a ’ s C r e a m - o f - t h e - C r o pP h y s i c i a n - S c i e n t i s t s W i l l T r a i n H e r eS t o r y b y M a u r e e n P a s s m o r eQ & A b y E r i c a L l o y d34 P I T T M E D

Afew months ago, Yigong Shifelt that his university wasmissing something. As deanof Beijing’s prestigious Tsinghua University’sSchool of Life Sciences, Shi, a PhD, wassearching for a U.S. school to send Tsinghuamedical students to for biomedical researchexperience. Meanwhile, the University ofPittsburgh’s Arthur S. Levine, an MD, seniorvice chancellor for the health sciences anddean, School of Medicine, had been travelingto China in an effort to build relationshipswith universities there. This was unfoldingwhile Jeremy Berg was about to step down asdirector of the National Institute of GeneralMedical Sciences to accept a senior positionat Pitt. Berg knew both men and, sensing anextraordinary opportunity, introduced them.Levine and Shi met in Beijing, and,though he had a couple of other high-profileU.S. universities interested, Shi chose theUniversity of Pittsburgh for the unique collaboration.Beginning in the summer of 2012,25 to 45 Tsinghua medical and graduate studentseach year will travel to the Universityof Pittsburgh to enter a two-year biomedicaltraining and research program at the medicalschool. The two years the medical studentsspend at Pitt will complement the six years oftraining they’ll receive in China. In addition,the two universities will take turns hosting anannual symposium featuring researchers fromboth institutions.A big deal? Simply put, yes. Here’s why:Tsinghua is highly regarded for its top scienceand engineering programs. It has producedone-fourth of the members of the ChineseAcademy of Sciences and many prominentleaders in China, including Hu Jintao,China’s current president. Shi, himself, is acelebrated structural biologist, renowned fordiscovering a novel path in cancer treatment.He is also what the Chinese call a “sea turtle”—partof a wave of Chinese professionalswho gave up prominent positions abroad toreturn home. In 2008, while he was professorof molecular biology at Princeton Universityand after an 18-year residence in the UnitedStates, Shi surprised the science communitywhen he turned down a $10 million HowardHughes Medical Institute investigatorshipand resigned from Princeton to return toTsinghua, his alma mater. (Shi earned hisundergraduate degrees in biology and mathematicsthere.) After careful consideration,Shi chose to partner with Pitt. Levine considersit a win-win, noting, “Our medicalschool is almost unique among U.S. medicalschools for the extraordinary growth and visibilitywe’ve had in a short period of time.The advantage for Tsinghua students comingto Pitt is that they will become immersed in apeer-reviewed research culture to complementtheir medical studies. And, we’re adding toour lab workforce medical students who arethe best-of-the-best from a country of almost1.4 billion people and who will, undoubtedly,become leaders of medicine and biomedicalresearch in China. They, presumably, will havea good experience in Pittsburgh, and that willcreate a durable and important relationship.”Shi knew Berg (who is now Pitt’s associatesenior vice chancellor for science strategyand planning) from his grad school days. Hereceived his PhD in molecular biophysicsfrom Johns Hopkins University, where Bergwas his thesis advisor; and he was eager forTsinghua students to share the experience andopportunities he had with a U.S. education.Now, in a sense, Tsinghua students will shareShi’s mentor, as well—Berg will oversee theprogram at Pitt.Recently Dean Shi shared with us his perspectiveon the partnership and on medicineand science education in both countries.pitt med: The United States faces a dearthof physician-scientists. Can you talk a bitabout the importance of graduating morephysician-scientists in China?yigong shi: China has seven million physicians,of whom two million have receivedreasonable training and are providing qualityhealth care to the majority of China’s 1.35billion people. However, China has a severeshortage of physician-scientists. Compared tothe U.S., the situation is much direr.Why this partnership? Why Pitt?The medical school at the University ofPittsburgh is exceedingly strong in basic biomedicaland translational research. The affiliatedhospitals are first rate in the U.S. andperhaps in the world. In addition, the size ofthe medical community at Pitt is large enoughto accommodate our students. Last, but notleast, I have been favorably impressed by thevision and leadership of Dr. Levine.You’ve spoken of modernizing Tsinghua’steaching philosophy. What did you mean?The traditional teaching method in Chinaemphasizes passive listening and memorization.Students seldom raise critical questions andcomments. I have been advocating for activelearning in the classroom (engagement betweenteachers and students, small class size, active discussiongroups, student presentations, researchbasedlearning, etc.) ever since I returned toChina.You are a product of both the American andChinese educational systems. What do yousee as the strengths and weaknesses ofeach?The strength of the Chinese educational systemis clear: Students receive comprehensive andsound knowledge in mathematics and naturalsciences. The weakness is also evident: The systemdoes not encourage innovation!In the United States, it is quite the opposite:Innovation is encouraged by the educationalsystem, but students are only exposed to shallowtraining in mathematics and natural sciences.Faculty members here are excited to workwith students from Tsinghua. What mightthey learn from them?They will be impressed by the overall “raw”quality of the students. But these students needto be carefully crafted before they can be truly“useful” to our society.As one of China’s “sea turtles,” how has theexperience been for you and your family?So far, so good. I am physically and mentallyexhausted in China, much more so than in theU.S. But I am happy and enormously enjoy whatI am doing for my home country. nCou rte sy Tsi ng h ua U n ive rsityF a l l 2 0 1 1 35

a l u m n i n e w sMagee, Dennis English helped establish the Dan BergerCord Blood Program.In Jerry Collins’ (Pharmacology PhD ’79) field, theresearch is just beginning to scratch the surface. He studiesthe largely misunderstood neurophysiological mechanismsof itch and its behavioral responses—a strangeresearch interest, it may seem to some. However, “thereality is that itch is a profound clinical problem that a lotof people don’t hear about,” Collins says. “There’s a fairoverlap between the sensation of pain and the sensationof itch. The fibers may, in fact, be the same, and theremay even be cross-talk between some of the systems soone can be interpreted as the other,” he adds. Collins is aprofessor of anesthesiology at Yale University. He is alsoa consultant for the National Institutes of Health Office ofLaboratory Animal Welfare. In that role he educates theresearch community about regulations regarding the ethicaltreatment of lab animals.C l a s s n o t e s’50s In 1966, when newly minted MarkleScholar in Academic Medicine Thomas Piemme (MD’58) attended his first meeting of the Markles, he heardthe term physician assistant (PA) for the first time. Hewas intrigued. “A lot of what a physician does, doesn’trequire a physician,” the former Pitt assistant chief ofmedicine (1966–1970) says with a laugh. “The idea of atrained person who could assist the physician—in takinga history, doing a physical, entering orders, doingprocedures [putting in an IV line, for example]—madegreat sense to me.” In 1972, Piemme launched a PAtraining program at George Washington University,then one of only a handful of its kind. Today there are156 programs and more than 80,000 practicing PAs—who are helping to cover the staffing shortage causedby the 80-hour workweek limit for residents, Piemmenotes. He played a key role in establishing the NationalCommission on Certification of Physician Assistants.He’s now coauthoring a history of the rise of PAs.’70s As a geriatric specialist, JudithBlack (MD ’74, Geriatric Fellow ’87) has seen that, alltoo often, patients’ wishes regarding end-of-life carearen’t made clear to their family members. For decades,Black, clinical associate professor of medicine at Pittand medical director for senior markets at Highmark,has been working with Pitt’s Robert Arnold, the LeoH. Criep Professor of Patient Care and professor ofmedicine, on advance-care-planning. They’ve pursuedvarious projects, including cofounding the Coalitionfor Quality End-of-Life Care. Black also led an effortcalled POLST (Pennsylvania Orders for Life-SustainingTreatment), which produced a form that turns patients’treatment wishes into medical orders. In October 2010,Black saw a dream realized when POLST was adoptedby the Commonwealth of Pennsylvania.Dennis English (MD ’76), vice president of medicalaffairs at Magee-Womens Hospital of UPMC, and hiswife, Denise English, a Pittsburgh physical therapist,have led several teams to remote Haiti. Through theyears, Dennis English, an ob/gyn, has taught midwivesand nurses patient care, and the teams he has traveledwith built homes and schools and established amedical clinic in Lacroix, Haiti. Helping to build selfsustainingmedical resources in these areas has yielded“tremendous Haitian support,” he says. Back at’80s On Ann McGaffey’s (Family MedicineResident ’83) desk is a photo of her after a rugby match,her nose bleeding, her forehead bandaged. She’s brave inher day job, too, where she focuses on childhood healthliteracy, including obesity prevention and (gulp) sexeducation.In 2007, McGaffey collaborated with Kristin Hughes,associate professor in Carnegie Mellon University’sSchool of Design, who created Fitwits (www.fitwits.org), an interactive online tool that uses games andimaginative characters (McGaffey’s favorite is “ElvisPretzley”) to make health ed fun. In East End schoolsand at Bloomfield-Garfield Family Health Center, whereMcGaffey is medical director, she’s using Fitwits to teachkids about nutrition, portion control, and healthy cooking,as well as the birds and the bees. The project hasbeen instrumental in improving the dialogue betweenP E T E R E L L I S : L e s s i s M o r eThere’s an awful lot of duplication in cancer treatments. For metastatic lungcancer alone, there are 38 distinct recommended chemotherapy regimens.How on Earth is a doc to know which to choose for a given patient?“We said, ‘Boy, we could really do ourselves a favor if we narrowed that downto the most effective regimens,’” says Peter Ellis (MD ’85), director of the medicaloncology network for UPMC Cancer Centers and associate professor of medicine atPitt. “‘And if there’s more than one most-effective regimen, let’s pick the one that’sthe least toxic to the patient. And if there are multiple most-effective, least-toxicregimens, let’s pick the one that’s most cost effective—for the patient, for the cancercenter, and for society.’”That, in a nutshell, is the idea behind Via Oncology, a new subsidiary of UPMC.Since 2004, Ellis has led a team at UPMC Cancer Centers in a massive effortto arrive at the ideal “pathway”—the surest, most tolerable, and least costlyoption—for every state and every stage of disease, and did this for 13 separatediseases. Each pathway was determined by a committee of disease-specificexpert physicians, which was co-chaired by a community clinician and physicianscientist.All of UPMC’s 110 oncologists were invited to join in on the effort tocomb through the literature for the strategies that would best fit each uniqueMary Jan e Bent36 P I T T M E D

doctors and patients on this formidable subjectmatter, McGaffey reports.Ellis’ initiative helps doctors care forcancer patients.M egan McGreevytant professor at the University of Maryland School ofMedicine. “It’s not Hannibal Lecter, and it’s not FrasierCrane, and all the media images that people have.”Recently, Daviss and two of his colleagues, psychiatristsDinah Miller and Annette Hanson, coauthoredShrink Rap, which aims to demystify psychiatry for bothlay and professional audiences. The book is based onthe team’s popular blog of the same name, which getsthousands of hits per day, as well as their podcast,which is online at MyThreeShrinks.com.As director of Pitt’s Biomedical Informatics TrainingProgram, Rebecca Crowley (MD ’94) oversees some30 core faculty, 50 affiliated faculty from 25 Universitydepartments and centers, and 40 grad students. Plus,she adds casually, she “teaches and all that stuff, too.”The associate professor of biomedical informatics, intelligentsystems, and pathology has taught post-graduateclasses for 10 years. Recently, she was awarded twoAmerican Recovery and Reinvestment Act supplementsto support new students, faculty, and course offerings.’90s Cervical cancer is far moreprevalent in the developing world than in theUnited States. The hospital in Tegucigalpa,Honduras, for example, treats 60 cases a day.Among these, many are curable, but unfortunately,surgeons who are trained to treatthem are in very short supply. Many followcareer opportunities abroad, not only becausethey can make a better living, but becausethey are frustrated by the lack of technology at theirdisposal, says Frederic Price (Obstetrics and GynecologyResident ’90). “You can try tosolve this problem by sending allthe money and equipment youwant, but if there’s no trainedmanpower, it’s not going towork.” Price, chair of the Societyof Gynecologic OncologistsInternational Network, has organizeda training program for surgicalresidents in Tegucigalpa. Todate, he has made six trips there.Price (right) with colleagueHe plans to launch a similar programin Ethiopia this December.Linus Chang of New Yorkin Honduras.“We’re trying to train indigenousdoctors in the hopes that they will stay and work to solvethe problems in their own country,” he says.Throughout his career, Steven Roy Daviss(Psychiatry Resident ’93) has worked to educate peopleabout psychiatry. “I do often get a sense that people,even other physicians and health professionals, don’treally understand it,” says Daviss, chair of psychiatry atBaltimore Washington Medical Center and a clinical assispatientsubpopulation.Ellis says this program has been shown toslow the rise in the cost of cancer care in theregion. And in a recent internal review, UPMCCancer Centers found that the hospitalizationrates in their breast cancer patients were actuallyreduced, though survival rates stayed thesame. “Because we’re not giving people a toxicregimen they shouldn’t get,” says Ellis.Each center uses a common Intranet systemdesigned especially for UPMC, which has builtinfeatures designed to make oncologists’ jobseasier, like flagging patients for genetic testingto determine whether certain drugs are safe forthem. Several practices across the country havepurchased the system. “We’ve had the complimentof people wanting to copy us,” says Ellis. “Dana-Farber called and said, ‘How’d youdo this?’ and the Mayo Clinic called and said the same thing.” —Elaine VitoneL aissez les Bon temps rouler!As part of Alumni Weekend 2011, the Class of 1961 boarded Pittsburgh’s RiverQuest for a privatecruise and a concert by Dixie Doc and the Pittsburgh Dixieland All Stars. Unfortunately, because ofstrong currents, the boat never left the dock, but the Doc (a.k.a. Richard Paul, MD ’61—that’s himon the cornet) and his crew still made a splash. Catch an encore at the Allegheny Elks Lodge onPittsburgh’s North Side, where they play once a month (schedule at www.dixiedoc.com).Crowley’s research interests include using technologyto develop teaching tools and information systemsfor research. She’s working on several federally fundedprojects, including Cancer/Text Information ExtractionSystems (a highly detailed, anonymous, patient-reportsystem for biomedical researchers) and SlideTutor (anintelligent tutoring system that guides new pathologiststhrough their training).’00s At Pittsburgh’sHilltop Community Healthcare Center,pediatrician Amy Nevin (PediatricResident ’02) is making a difference forchildren in the economically disadvantagedneighborhoods hidden in the hillsabove the city’s South Side, where 90percent of her patients are on Medicaid.She educates groups about the dangerouslyhigh lead levels she sees amongher patients and has even advocated toNevinhave dilapidated buildings demolished.“I’m like a country doctor in the middle of the city,” shesays. “Personal presence and relationships carry a lotof weight.” Barbara Ayars (MD ’86), Nevin’s residencymentor at Wilkinsburg Family Health Center, greatlyinfluenced her. “She taught me to look outside of theoffice to see how poverty and physical and psychiatricillness around a child affect that child’s health.”—Brian Connelly, Megan Kopke, Marc Melada,Elaine Vitone, and Alexis WnukYou never write ...We want to hear your news: careeradvancements, honors you’ve received,volunteer work, publications, and we loveto hear old Pitt memories.To get us your news, drop us a line atmedmag@pitt.edu or see our postaladdress on the inside front cover.F A L L 2 0 1 1 37

S eymou r M. Ante lmanOct. 27, 1938–June 10, 2011Perhaps the most enduringcontribution of Seymour “Sy”Antelman is his study of dopaminesystems in normal and abnormalbehavior. Prior to the PhD’s1975 Science paper, the only knownfunction of the neurotransmitter wasAntelmanmovement. Antelman, a Pitt professoremeritus of psychiatry, died in June.Using an animal model of unexpected stimulus(a pinch on the tail), Antelman found thatthe resulting increased dopamine-system activityheightened the animal’s response to biologicallyimportant aspects of its environment (e.g.,food, threat, offspring). “What changes is youroutlook,” says Henry Szechtman (PhD ’75),professor of psychiatry and behavioral neurosciencesat McMaster University in Hamilton,Ontario, who worked with Antelman as agraduate student. “You need dopamine notjust to move but also for things to be interesting.Without it, you can’t assess and appraise.”This finding helped elucidate the relationshipbetween mental illness and stress.Later in his career, Antelman focused onTime Dependent Sensitization (TDS)—amodel in which the effects of drugs andof stress increase as time progresses—whichstirred controversy. But Antelman enjoyed agood argument, Szechtman says of his old,vertically gifted friend. “Tall trees catch morewind.” —Elaine VitoneB. F rankli n Diamon dJan. 30, 1942–May 17, 201138 P I T T M E DB. Franklin Diamond (MD ’67,Res ’69) established the StrokeCenter at AbingtonMemorial Hospital, the firstJoint Commission-certifiedstroke center in Pennsylvania.He also created the DiamondDiamond Stroke Tool, a protocol to helpEMTs recognize strokes in the fieldand deliver the best pre-hospital care.Diamond himself succumbed to a strokein May at the age of 69.“Frank was way ahead of his timein terms of realizing the importanceof stroke centers and in terms of rapidtreatment, which is so critical to the successof treating a patient with a stroke,” saysDavid Eskin, an MD, former chief of staffat Abington Memorial Hospital, and a closefriend of Diamond.Prior to joining the staff at Abington in1974, Diamond served in the U.S. Air Forcefor two years as chief of neurology at SheppardAir Force Base in Texas. From 1993 to 2007,he was Abington’s chief of neurology.Eskin frequently referred patients and familymembers to Diamond; he saw the neurologistas intelligent, creative, and compassionate.He was the “kind of person that I wanted totake care of a member of my family,” he says.—Alexis WnukI r e n e Jak abJuly 15, 1919–June 18, 2011In 1974, Irene Jakab launched WesternPsychiatric Institute and Clinic’s (WPIC)John Merck Program for children withintellectual disability and co-occurring psychiatricdisorders. Today, Merck is part of a continuumof WPIC services for dual-diagnosispatients throughout the life span—the onlyprogram with this distinction, notes JohnMcGonigle, assistant professor of psychiatry.An early recruit of WPIC director ThomasDetre, a fellow Hungarian, Jakab directedchild psychiatry at Pitt throughout the ’80sand developed a training program on dualdiagnosis that was attended by physicians fromaround the world. As an emeritus professor,in 1989 she returned to Massachusetts—she’dheld an academic position at Harvard since1966 and was still a lecturer there at the timeof her death.Among her devoted old “Mercky” friends,Jakab is sorely missed. She supported patients’interest in art and Special Olympics. She threwgrand holiday parties—think live Christmas’40sEdwin BayleyBuchanan, MD ’47April 23, 2011’50sJohn H. WilkinsonMD ’50Feb. 2, 2011E. David CherupMD ’51Nov. 23, 2010Robert E.Schneider, MD ’54March 26, 2011tree adorned with lighted candlesand Hungarian candy. (McGoniglestood by with the fire extinguisher.)She encouraged professional developmentin every level of her staff.“Susan,” she asked mentee SusanJakabGlor-Scheib in her thick accent, “youwill go get your doctorate someday, won’t you?”Glor-Scheib is now professor of special educationand clinical services at Indiana University ofPennsylvania. —EVK ali patnapu N. RaoMarch 7, 1937–July 4, 2011Even after retiring from Pitt’spathology department in 2004,Kalipatnapu N. Rao, a PhD, maintainedhis interest and work in clinicaland forensic toxicology, chiefly in writinga textbook, Forensic Toxicology: Medico-legal CaseStudies, which he finished just a few weeks beforehis death in July.The longtime pathology professor and nativeof India came to Pitt in 1971 as a research associate.In 1989, he became chief of toxicology in theDivision of Clinical Chemistry, a position he heldfor 15 years. He also served as the director of thelaboratory group for Toxicology and TherapeuticDrug Monitoring for UPMC Presbyterian andChildren’s Hospital of Pittsburgh of UPMC.Beyond his highly respected research in pancreaticcarcinogenesis and the management ofpatients with toxins exposure, Rao will also beremembered as a great listener. He preferredto discuss clinical and scientific topics withcolleagues and students over a cup of tea, saysMohamed Virji, an MD/PhD and pathologyprofessor. Rao recognized the importance “of gettingindividuals away from the busy laboratoryenvironment so that issues could be addressedobjectively,” he says. —AWi n m e m o r i a mHarold W. SloneMD ’55June 10, 2011Michael R. ZernichMD ’57June 1, 2011Donald H. QuintMD ’59May 5, 2011’60sRobert J. DonovanMD ’60June 17, 2010Charles PaulGennaulaMD ’63Nov. 7, 2010Robert GoldwynFel ’63March 23, 2010Samuel C. MinesMD ’63April 8, 2011’70sRobert Jenkins Jr.MD ’70June 13, 2011’80sDavid Servan-SchreiberRes ’87July 24, 2011faculty/staffArthur Phillips Jr.April 24, 2011George F. ThiersJune 9, 2011Rao

B r o c k to n H e f f l i nB r i n g s N a m i n g R i g h t sto t h e M e d i c a l A r e n aBy S h a r o n T r e g a s k i sIn the Biblical account of creation, Adamnamed the animals of the Earth in a singleday. Eighteenth-century Swedish botanistCarl Linnaeus, the father of modern taxonomy,spent more than two decades cataloguing bothplants and animals for his Systema Naturae.Medical epidemiologist Brockton Hefflin (MD’90) has spent the last 14 years creating a taxonomyof another sort—a searchable, onlinecatalog of medical devices.As a Washington, D.C.–based medicalofficer in the U.S. Food and DrugAdministration, Hefflin serves as cochair ofthe expert team overseeing the Global MedicalDevice Nomenclature (GMDN) project, aninternational effort to create a standardizedsystem for naming and categorizing all medicaldevices—from acupuncture needles to prosthetictoe joints.“Medical devices reach the borders of allcountries now,” says Hefflin, noting thatpatient care often involves treatment withitems designed and manufactured overseas.“It’s important to be able to identify devicesin the post-production arena. Approval [in theUnited States, by the FDA] takes place witha clinical trial, but we need to perform postmarketsurveillance after a device is approved.Having a standardized nomenclature helps tofacilitate that.”Launched in the early ’90s by EuropeanGraham Johnstone (MD ’70)PresidentBrian Klatt (MD ’97)President-electMargaret Larkins-Pettigrew (MD ’94)SecretaryPeter Ferson (MD ’73)TreasurerRobert E. Lee (MD ’56)HistorianSusan Dunmire (MD ’85)Executive DirectorM e d i c a l A l u m n iA s s o c i a t i o n O f f i c e r sF ran k haRRISWhat’s in a name?Hefflin buildsa taxonomyfor safety.Union officials hoping a shared vocabularywould ease the reporting and tracking ofsafety data and adverse events among membercountries, the GMDN has grown to contain20,000 preferred terms (e.g., polydioxanonesuture), each with an associated code and definition,as well as more than 1,000 collectiveterms (e.g., suture and bioabsorbable). Already,the database has been translated into morethan 25 languages, including every officialtongue of the European Union.Perhaps the most challenging elementof Hefflin’s work with the GMDN has beendeveloping the intellectual framework toaccommodate thousands of existing medicaldevices—all regularly modified by their manufacturers—aswell as those yet to be invented.“We’re constantly editing the terms,” saysHefflin.He and cochair Alan Fields, a British engineer,review 30 applications for new termsDONALD MRVOS (MD ’55)Carl Robert Fuhrman (MD ’79)GREGORY M. HOYSON (MD ’82)Jan Madison (MD ’85)JOHN F. MAHONEY (MD ’90)VAISHALI DIXIT SCHUCHERT (MD ’94)Adam Gordon (MD ’95)Charissa B. Pacella (MD ’98)Heather Heinrichs Walker (MD ’99)BRETT PERRICELLI (MD ’02)Members at LargeM-200k Scaife HallUniversity of PittsburghPittsburgh, PA 15261tel 412-648-9090; fax 412-648-9500medalum@medschool.pitt.eduevery month, with help from a committeecomprised of an in vitro–diagnostics expertfrom Australia, a radiological-device expertfrom the Netherlands, and a U.S.-based cardiovascular-deviceexpert from Ghana.Hefflin, a 48-year-old Pittsburgh native—whose travels as a volunteer medical missionaryhave included stints in Guatemala, Haiti,and throughout Africa—credits two mentorswith putting him on the path his career hastaken.His father, Charles Hefflin (MD ’74), alifelong learner who worked as a microbiologistand then a dentist before becoming afamily physician in Shadyside, urged his sonto enroll at Pitt for an MD. While the elderHefflin was a clinician “par excellence,” in hisson’s words, the younger Hefflin—intriguedby medical anthropology and internationalhealth care—was ambivalent about clinicalwork; still, he took his father’s advice.After completing his MD, he enrolledin the Centers for Disease Control andPrevention’s Epidemic Intelligence Service(EIS) post-graduate program.His EIS training assignments includedinvestigations of the health effects of the fueladditive methyl-tertiary-butyl-ether in Alaska,seasonal dust storms in Washington State, andexposure to mercury in latex exterior paintused by professional painters in California’sBay Area.Hefflin recalls how Pitt’s former dean ofstudents Fred Rubin, an MD, pointed himtoward the EIS:“He recognized that my interest wentbeyond anatomy and physiology.” nF A L L 2 0 1 1 39

l a s t c a l l➚cou rte sy c apl anr ece nt photos: CI DDE An d Thoma s fam i lyleft: John Donatelli holds his son on graduation day,1985. right: On graduation day this May: the Donatellis.40 P I T T M E DThe McNeil BregarsThe Grecostop: The Class of 1936, includingPaul Caplan (indicated with redarrow). shown here: Paul Caplanwith Josh and David Levenson.The LewisesThe ThomasesT h e o n l y s c h o o l o f n o t eChris Donatelli (MD ’11) was just 5 months old when hisfather, John Donatelli (MD ’85), graduated. Photographerssnapped pictures of the new doc holding his little boy, andhis little boy holding his diploma. The young Donatelliremembers looking through all the books in his dad’shome office, and how, even as a child, he thought aboutbeing a doctor like his dad.A total of six of the Class of 2011’s freshly minted MDsare keeping it in the family. Amy Bregar’s (MD ’11) parents,Melissa McNeil and Frank Bregar, graduated together in1980. Nicholas Greco’s (MD ’11) dad, Frank Greco, graduatedin 1978, and his mom, Maria Costa-Greco, followed twoyears later. Richard Lewis, father of Clayton Lewis (MD ’11),graduated in 1973. Vanessa Thomas (MD ’11) is a third-generationPitt meder, with both her parents and her paternalgrandfather calling Pitt their alma mater.Josh Levenson has more than one familial connection tothe School of Medicine. His father, David Levenson, is onthe clinical faculty at Shadyside Hospital, and Levensongot to work with him during one of his clinical rotations.“It was a great bonding experience,” he says.Levenson’s great uncle, Paul Caplan, is a member ofthe Class of 1936 and, at 97 years of age, our oldest livingalumnus. Caplan, who recently endowed a research grantin perpetuity for the Department of Rheumatology, readthe Hippocratic Oath at his great nephew’s White CoatCeremony four years ago. “You had no choice, you weregoing to go to the University of Pittsburgh,” Caplan toldLevenson. “That’s the only medical school in the country ofnote,” he said laughing. —Alexis Wnuk

C a l e n d a ro f S p e c i a l I n t e r e s t t o A l u m n i a n d F r i e n d sFor information on an event,unless otherwise noted, contactthe Medical Alumni Association:1-877-MED-ALUM, 412-648-9090,or medalum@medschool.pitt.edu.Or go to www.maa.pitt.eduS c i e n c e 2 0 1 1OCTOBER 6–7www.science2011.pitt.eduM U S G R A V EL E C T U R E S H I POCTOBER 14–15Julian J. Pribaz, MD, SpeakerM E D I C A L S T U D E N TP H O N A T H O NNOVEMBER 8–10M E D I C A L A L U M N IW E E K E N D 2 0 1 2MAY 18–21, 2012Reunion Classes:2002 19971992 19871982 19771972 19671962 19572 0 1 2 W I N T E R A C A D E M YFEBRUARY 17, 2012Ritz-CarltonNaples, Fla.For information:Pat Carver412-647-5307cpat@pitt.eduwww.winteracademy.pitt.educpat@pitt.eduU P C O M I N GH E A L T H S C I E N C E SA L U M N I R E C E P T I O N SDATES TBAWest Palm Beach, Fla.Naples, Fla.Cleveland, OhioRaleigh, N.C.Erie, Pa.Los Angeles, Calif.Phoenix, Ariz.For information:Pat Carver412-647-5307cpat@pitt.edut o f i n d o u t w h a t e l s e i s h a p p e n i n g a t t h e M e d i c a l S c h o o l , g o t o w w w . h e a l t h . p i t t . e d u

University of PittsburghSchool of Medicinesuite 401 Scaife HallPittsburgh, Pa 15261change service requestedNONPROFIT ORG.U.S. POSTAGEPAIDPITTSBURGH, PAPERMIT NO. 511125 years latert h e f u t u r e o f m e d i c i n e — m e m b e r s o f t h e C l a s s o f 2 0 1 1