In India, it is quite an achievement to graduate from medical school, given that many students come from modest socio-economic backgrounds.

Its an even higher hurdle for foreign medical graduates to turn that degree into a license to practice medicine in the U.S.

For a [foreign medical graduate] to come to this country, they have to be among the best students in their native country, said Anupam B. Jena, an Indian American who is an associate professor of health care policy at Harvard Medical School. Jena is also a physician at Massachusetts General Hospital in Boston.

The standards for acceptance into a U.S. residency program are high for international applicants. An international medical graduate (IMG) describes a U.S. citizen or green card holder who obtained their degree outside the U.S., while a foreign medical graduate (FMG) describes a foreigner who completes a degree in their country of origin.

Indian FMGs in the U.S. are composed of Indias topmost students, Jena said.

So how does someone with a Bachelor of Medicine, Bachelor of Surgery (MBBS) and a Doctor of Medicine (M.D.) and a post-graduate degree from an Indian institution practice medicine in the U.S.?

It starts with gaining certification from the U.S. Educational Commission for Foreign Medical Graduates, which measures whether FMGs are prepared for a residency program in the U.S.

Graduates must next complete the U.S. Medical Licensing Examination (USMLE). The exams determine an IMGs or FMGs medical knowledge and skills in line with standards and practices in the U.S. The USMLE website describes it as a three-step exam that evaluates an applicants basic medical and scientific knowledge, clinical knowledge and clinical skills. It takes years to achieve medical licensure, but must be accomplished within seven years.

Costs to attain medical licensure through the USMLE vary with each stage of the examination, but it totals about $4,000.

The biggest hurdle is getting admission into a U.S. residency training program, Jena said.

Many Indian medical students participate in internships, unpaid or paid, in the U.S., where they shadow physicians and learn more about U.S. health care and medicine, he said.

Jena urged Indian doctors to apply to at least 30 health care programs in the U.S., to ensure at least five to 10 interviews for employment.

Applicants travel to each hospital for in-person interviews, said Rachana Gavara, an Indian American obstetrician-gynecologist at New York-Presbyterian (NYP) Hospital who studied medicine in India and immigrated to the U.S. in 2000.

There are certain specialties which are much easier for foreign medical grads to get into like internal medicine, psychiatry, pediatrics, family medicine, Gavara said.

Some specialties, like the neurosurgery, dermatology, radiology orthopedics, burns and plastics are very competitive, said Gavara, who was a post-doctoral fellow at Cornell University for three years.

Medical licenses are issued on a state-by-state basis by a medical board, so a doctor would apply in the state in which they intend to work. Licenses must be renewed every two years.

With those milestones achieved, and after completing residency training in a U.S. program, medical practitioners can practice independently in the U.S.

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How Indian Doctors Get a Medical License in the US - Voice of America

The BigPicture

The prosecution continued its case against Jeremy Christian Thursday. Christian is accused of killing two people and injuring a third on a TriMet light rail train in Portland in2017.

Beforehand, witnesses said Christian was shouting racist comments while two young black women were nearby Walia Mohamed and Destinee Magnum. Mohamed is Muslim and was wearing ahijab.

Christian is also accused of harassing and assaulting Demetria Hester, an African American woman, on a TriMet light rail train the dayprior.

He faces a dozen felony and misdemeanor charges, including multiple counts of first-degree murder andintimidation.

Jeremy Christian in court for the third day at the Multnomah County Courthouse in Portland, Ore., Jan. 30,2020.

Mark Graves/TheOregonian/OregonLive/Pool

Prosecutors called five witnesses to the stand Thursday, including the aunt of one of the victims, the MAX train operator, people who were on the train at the time of the stabbings and a Portland Police officer who responded to thescene.

Beatrix Therese VanOlphen spoke on the stand about a phone call she had with her nephew, Taliesin Namkai-Meche, when he was on the MAX thatday.

Namkai-Meche is one of the men whodied.

We were talking about the new house hed just bought and how he was going to get some roommates to help pay the mortgage, VanOlphensaid.

She said there was loud yelling in the background of the call; Namkai-Meche had told her it was a crazy person was ranting racistcomments.

VanOlphen said she told her nephew not to get involved, but to maybe take video of what was going on just in case it was something to give to the police later. That was the last time she talked toNamkai-Meche.

Jeffrey Quintana has been a MAX train operator for the past 12 years. He was the operator on the MAX Green Line the day of thestabbings.

He said he could hear an argument occurring in the train from his seat in the cab and made an announcement over the intercom telling people to settle down. Quintana said he told the rail controller about that announcement. The controller told him to check in on the car at the HollywoodStation.

Quintana also said he was not aware of any audible signalling or visual flashing from any passengers hitting the call button from inside of the traincar.

When the train arrived at the Hollywood Station, Quintana opened the cabs internal door and someone told him there was astabbing.

He said he closed the door back and locked it, waiting for thepolice.

I was kind of fearing for my life because I dont have any defense, any training defense against a knife, Quintana said. So I didnt get out of the cab for mysafety.

There were unfathomable amounts of blood on the floor, Police Police Officer Rehanna Kerridge said. I ended up throwing my boots away because they were saturated withblood.

Kerridge was the first officer to respond to the scene on May 26, 2017. She had been on patrol when she got the call about a disturbance on the MAX. Traffic was really bad, she said. It was the Friday before a three-dayweekend.

She and other officers, as they arrived, offered aid to victims while waiting for medicalstaff.

Charles Button, 24, testifies during the third day in the trial of Jeremy Christian at the Multnomah County Courthouse in Portland, Ore., Jan. 30, 2020. Button attempted to administer aid to one of the victims the day of theattack.

Mark Graves/TheOregonian/OregonLive/Pool

Charles Button was a Portland State University student at the time of the attacks, working to eventually go to medical school. He was on the train thatday.

Button was seated near the back of the train and couldnt see what was going on up front, but he said he heard a man yelling things along the lines of: Immigrants are ruining this country. Trump will fix this, and something along the lines of illegal immigrants dont paytaxes.

He didnt see the stabbing take place, but he heard screams and saw people running from thetrain.

Button said he attempted to administer aid to Ricky Best, one of the victims, using his sweatshirt to apply pressure to Bests neckwound.

Chief deputy district attorney Donald Rees asked Button how he felt after aidingBest.

I was very shaky. I was covered in blood from my toes to my knees and my hands. I was very sad and trying to figure out what to do next after this, Button said. I just felt like Id let the man down on thetrain.

Jurors are expected to tour a MAX train car at a secure TriMet facility Thursday afternoon. The media and the public are not allowed to attend. Christian also wont be there, but defense attorneys, prosecutors and the judge will be inattendance.

Key witnesses that could still testify include Micah Fletcher who was stabbed on the train by Christian and survived. Also, Demetria Hester could testify. Prosecutors say she was assaulted by Christian on a Portland light rail train on May 25, 2017, the day before thestabbings.

After the state rests its case, Christians defense team will call witnesses of their own. So far, theyve argued Christian was acting inself-defense.

The trial itself is expected to last a month, through the end ofFebruary.

OPBs Conrad Wilson contributed reporting.

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'Unfathomable Amounts Of Blood On The Floor' Testimony Continues In TriMet Stabbing Trial - OPB News

Researchers at Harvard Medical School and Boston Children's Hospital have found a potential treatment for hereditary deafness, the same condition thought to have caused Ludwig van Beethoven to lose his hearing.

The scientists are using a new gene-editing approach that they say could someday prevent profound hearing loss.

Beethoven's Symphony No. 5 is a cornerstone of classical music. It is hard to believe the composer was almost completely deaf from a genetic condition when he finished it.

"These children are born fairly normal, but then over 10 or 20 years, they lose their hearing," Harvard neurobiology professor Dr. David Corey.

Aptly named "Beethoven mice" might hold the key to a potential cure. Scientists believe the animals have a defect in the same gene that may have caused Beethoven's deafness.

"Our genome is composed of about 3 billion letters of DNA that together make up 20,000 genes," Corey explained. "For the disease we're studying, one mistake in the DNA in one of the genes causes deafness."

Researchers identified that hearing gene called TMC1. It's a gene that comes in pairs.

Using a newly refined gene-editing system, they disabled the defective copy of the TMC1 gene, leaving the good gene in place.

"By eliminating just the bad copy, that would be sufficient to preserve hearing," Corey said.

The scientists then delivered the edited DNA back into the cells of the mice and tested their hearing.

"We put little scalp electrodes on the back of the head, play sounds into the ear and can measure the brain activity in response," Boston Children's Hospital professor of otolaryngology Dr. Jeffrey Holt said.

Researchers say the mice were able to hear sounds as low as 45 decibels, the level of a quiet conversation.

"This could be life-changing," Holt said.

A famed composer, his namesake mice and a team of scientists are using cutting-edge medicine to help people who would otherwise go deaf.

The scientists say this research paves the way for using the new editing system to treat as many as 3,500 other genetic diseases that are caused by one defective copy of a gene.

It's important to note that Holt holds patents on TMC1 gene therapy.

MEDICAL BREAKTHROUGHSRESEARCH SUMMARYTOPIC: BEETHOVEN MICE PREVENT DEAFNESS: MEDICINE'S NEXT BIG THING?REPORT: MB #4689

BACKGROUND: In the United States, hearing loss affects 48 million people and can occur at birth or develop at any age. One out of three people over the age 65 have some degree of hearing loss, and two out of three people over the age 75 have a hearing loss. Children in the United States are estimated at 3 million in having a hearing loss, and of those, 1.3 million are under the age of three. One of the leading causes of hearing loss is noise, and while preventable, can be permanent. Listening to a noisy subway for just 15 minutes a day over time can cause permanent damage to one's hearing. Listening to music on a smartphone at high volumes over time can cause permanent damage to one's hearing as well. The number of people with hearing loss is more than those living with Parkinson's, epilepsy, Alzheimer's, and diabetes combined. (Source: https://chchearing.org/facts-about-hearing-loss/ and https://hearinghealthfoundation.org/hearing-loss-tinnitus-statistics/)

TREATMENTS: The treatment you receive will depend on the cause and severity of the hearing loss. A reversible cause of hearing loss is earwax blockage where your doctor may remove earwax using suction or a small tool with a loop on the end. Some types of hearing loss can be treated with surgery, including abnormalities of the ear drum or bones of hearing (ossicles). Repeated infections with persistent fluid may result in your doctor inserting small tubes to help your ears drain. If your hearing loss is due to damage to your inner ear, a hearing aid can be helpful. With more severe hearing loss and limited benefit from conventional hearing aids, a cochlear implant may be an option. Unlike a hearing aid that amplifies sound and directs it into your ear canal, a cochlear implant bypasses damaged or nonworking parts of your inner ear and directly stimulates the hearing nerve. (Source: https://www.mayoclinic.org/diseases-conditions/hearing-loss/diagnosis-treatment/drc-20373077)

GENE EDITING WITH CRISPR: Scientists at Harvard Medical School and Boston Children's Hospital have used a newly tailored gene-editing approach in mice thought to have the same genetic defect that caused famed composer Beethoven to go deaf in adulthood. CRISPR-Cas9 gene editing works by using a molecule to identify the mutant DNA sequence. Once the system pinpoints the mutated DNA, the cutting enzyme, or Cas9, "snips" it; however, the gene editors are not always accurate. Sometimes, the guide RNA that leads the enzyme to the target site and the Cas9 enzyme are not precise and could cut the wrong DNA. The Harvard and Boston Children's scientists are using a modified Cas9 enzyme derived from Staphylococcus aureus bacteria that they are finding is significantly more accurate. (Source: https://hms.harvard.edu/news/saving-beethoven)

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'Beethoven mice' prevent deafness: Medicine's next big thing? - WNDU-TV

To commemorate the 10- year anniversary of the Paul L. Foster School of Medicine, State Rep. Csar Blanco presented a resolution to Richard Lange, M.D., M.B.A., Texas Tech University Health Sciences Center El Paso (TTUHSC El Paso) president.

This medical school is not only contributing to the economic activity of our city, but directly serves to improve the physician shortage that West Texas faces, said Representative Blanco during the presentation.

Thanks to the Foster School of Medicine, talented students from the Paso del Norte region with a passion for medicine and serving the community have the option to apply for medical school in their hometown.

Blanco, who represents TTUHSC El Paso in the Texas State House of Representatives, has been a key supporter of the Foster School of Medicine. His resolution comes one month before TTUHSC El Paso holds the medical schools 10th anniversary celebration, A Red Tie Affair for a White Coat Occasion, on February 28.

We are thankful for Representative Blanco and the entire El Paso delegation for their continued support of the students, faculty, and staff at the Foster School of Medicine, Dr. Lange said. This resolution not only recognizes the tremendous work being done at TTUHSC El Paso, but also celebrates the positive impact we are making to the health care and education in our region.

Opening its doors in 2009 with an inaugural class of 40 students, the Foster School of Medicine became the first medical school located on the U.S.-Mexico border.

Since graduating from the school, more than 500 alumni are either currently practicing physicians or in residency programs throughout the United States.

The Foster School of Medicine has 403 students currently enrolled, most of whom have contributed several thousand hours in community service through its student-run clinics and volunteer programs.

The school continues to be a pioneer in health education through a curriculum focused on training students in simulation labs with high-tech mannequins, beginning clinical rounds within the first year of study, and requiring all students to learn medical Spanish.

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State Rep. Blanco presents Resolution to Honor Paul L. Foster School of Medicine's 10-Year Anniversary - El Paso Herald-Post

This transcript has been edited for clarity.

Eric J. Topol, MD: Hello. I am Eric Topol, editor-in-chief of Medscape. It's a real treat for me to bring back Zubin DamaniaZDoggMD, as he's knownwho is one of only two people we've had twice for a Medscape One-on-One interview. Zubin is quite a distinctive fellow. Welcome, Zubin.

Zubin R. Damania, MD: It's a thrill to be back, Eric.

Topol: Since we last convened for Medscape, several years ago, you have gone on to quite an illustrious career as an Internet celebrity, creating viral videos. But you also moved. You had been at Turntable Health in Las Vegas. Can you tell us what happened with that?

Damania: We had a really cool idea for building this concept of health 3.0, which in our mind meant that you have to shape a system to align the incentives with what you want. And what we wanted was to prevent disease before it happens, team-based collaborative care, everybody practicing at the top of their training, in service to the patient, but also in service to each otherbecause if we don't take the caregiver component into it, we're missing half of the equation, right? So with that in mind, we designed a no copay, unlimited access, all-you-can-treat buffet of care, and we had an insurance partner, Nevada Health Co-op. They put our product on the federal exchange so that patients could get access to this high-touch, relationship-driven primary care that, with subsidies, was pretty much for free.

Our job was to navigate the patients through the system, keep them out of trouble, and keep them from unnecessary admissions and out of the hands of cardiologists and other specialists, unless the patient needed it. It worked quite well. We had wonderful outcomes. We had a good number of patients enrolled, and then one day that same insurance company called us up and said, "Yeah, we're going to be out of business in 2 months, so you're going to have to find another medical home for those patients or another partner."

When we approached other insurance partners, they said, "Oh, sure. This looks great. I would send my own family here. But we'll give you one fifth the amount per patient per month as what those guys were giving you. And you have to charge a copay" (which breaks the model). "And maybe you could do Botox or something like that to make up the shortfall." At that point, I decided instead to spin it down.

Our friends at Iora Health are continuing the same model in multiple different states with Medicare Advantage, which is a good, stable partner with incentives aligned for a system like that. I stayed in Vegas for another couple of years, doing my show. But now I'm back in the Bay Area because I think there's a lot more cool healthcare stuff going on here for our show.

Topol: Besides your show and videos, what are you doing? Are you back in practice or are you staying out of that?

Damania: If I had a full-time practice, I would be beholden financially to an organization or something like that, and I wouldn't be able to say the things on my show that I say. One of our real pitches is that we're an unfiltered voice. So instead I'm faculty at UNLV School of Medicine. I go back to Vegas and I round at the county hospital with the house staff for free, as university faculty. If they want to fire me, that's cool; they're not paying me anyway. But they actually appreciate the voice and viewpoint I'm trying to give. That is my clinical work. And then I focus on the show, the videos, trying to shine a light on bright spots, where things are actually working in healthcare, and then shine a light on where they're not working, because I believe both are important for the tribe of medicineto help us come together and have a collective voice, which we've been lacking for so long.

Topol: You're touching on an important topic that I want to drill down with you: Physicians and the medical community need to have a voice. You already hit on that when you said that if you were involved with a medical group in the Bay Area, you might not be able to be unplugged, unbridled. We also know that in general, physicians don't have a history of being activists. But you have been that way since, it seems to me, back in medical school, when you gave one of the graduation ceremony addresses. Was that your breakout moment in '99? Or did you start when you were in the crib? When did that get going?

Damania: Ever since I was young, I was a wise aleck. I never did well in hierarchical organizations, for some reason, and it came off as arrogance. Teachers would say, "You're arrogant; you think you know more than us." But that's not really how I felt. Inside, I felt like an imposter. But I could see enough to realize that this organization makes no sense, this hierarchy makes no sense, and what they're doing makes no sense. In medical school, I expressed the parts that didn't make sense in this graduation speech at UCSF in '99. Now faculty there embrace what I said. I recently was back for a reunion and got an innovator award and all this cool stuff. But at the time, I remember being told that there were faculty who believed that I shouldn't graduate for having said what I said, which was the truth about our experience in a hierarchical system. I talked about the fealty to authority, conditioning, where we learn to just sit down in the face of a system that's broken instead of standing up and saying, "You know what? We have power to actually change this system."

Topol: I suspect that the commencement address was not accompanied by rap music.

Damania: It was before I got involved in the rap game. That took another 11 years before I created ZDoggMD.

Topol: So ZDogg has been going for a decade? How many videos have you made during that decade?

Damania: There's a good 400episodes of our show, multiple music videos, different interviews. It's gotten crazy. And it's spun out in a way that I never would have imagined. It wasn't planned that way, but it became this path that made a lot of sense.

Topol: It is remarkable how much these programs resonate in the medical community. In part, of course, you're a rebel and you'll say things that people are thinking but you'll actually articulate them and do it in an entertaining way. What does it take to get you to say, "I'm going to do a video on this topic"? What stirs you to do something?

Damania: Anytime I round at the hospital, I'm pretty pissed off. I see things in terms of social determinants of health, how we make errors in the hospital, the fallibility of the humans in this very complex and poorly designed nonsystem. And it gets me upset because I think, What if that was my mom or my brother or my kid? And then I end up doing a video or a series of videos about it. We have about 2 million followers across our social media platforms. A lot of healthcare professionals are part of this effort. They call themselves the Z-pack. (I didn't come up with the name.)

They give me input every day in the form of about 2000 Facebook messages, Instagram, Twitter, all that. So they'll say, "Hey, this is happening in my hospital." Or "Have you seen this article?" Or "Can you believe that? Could you talk about this?" I'll find the signal in all of that noise and then act on it. I'll think, That's a story no one is telling. That's how I listen to the front lines. I also listen to administrators and leaders because they have an important voice that needs to be heard. They also are suffering from what we're calling a "moral injury." They have to serve so many masters, and it causes hurt when you have to make these compromises, whether it's based on money, their own personal needs, the needs of the patient, or the needs of their staff. Trying to give a voice across healthcare has been our goal, and not focusing just on doctorsempowering one of the biggest groups, which is nurses. When they get together and get mad, oh, man, they don't lose. So how can we empower that and use that to help transform medicine? It's not just about the doctors.

Topol: These 2 million Z-pack people in the ZDogg camp must include a lot of nurses and doctors and administrators, and probably not only in the United States, right?

Damania: It's international. But it slices right through a cross-section of healthcare professionals in this country. There are 12 million healthcare professionals, and 2 million follow ZDogg. Some of them are activist patients. We call them mugglesnonmedical folk. It can be gratifying. When I'm in an airport, I'm often recognized maybe three or four times and it's always differenta respiratory therapist, a nurse, a healthcare administrator, a doctor's husband. We have to do something good and important with that kind of reach. And that's what I wake up with every morning: Okay, what are we going to do today that's going to make things better?

The things that get me angry are often things that get all of us angry when we think about them, but we're scared to talk about them because we might lose our jobs.

Topol: I don't know any other physician who has that kind of a community. Probably the most followed doctor in America, outside of Dr. Oz, is Sanjay Gupta. But you're right up there. You're saying things and getting the word out on vital issues that help bring people together. You're a voice to take on, whether it's anti-vaxxers or all the conspiracy theories. What are some of the things that have you juiced up and the ones you think have been most successful?

Damania: The things that get me angry are often things that get all of us angry when we think about them, but we're scared to talk about them because we might lose our jobs or affect our incomes. This is something I'm sensitive to. Upton Sinclair said that it's difficult to get a man to understand truths if his salary depends on him not understanding them. When I was in full-time practice, it was hard to say some of these things because if you're attacking a fee-for-service, volume-based mill, well, that's how our system makes money. That's why my salary is subsidized. I'm benefiting from that. There's this deep disconnect. It's almost a kind of moral distress that you feel. So now I try to find those things and talk about them loudly, like price-gouging in the air ambulance space. Marty Makary, at Hopkins, wrote a great book on this, The Price We Pay, and we had him on the show. He got me so mad reading his book that I just took chapter by chapter and started ranting about this idea that hospitals are suing their own patients en masse, patients who cannot afford to pay. These kinds of issues are important.

On the caregiver side, we see so much violence against frontline healthcare professionals now because there's been an erosion of the social norms around what you do in hospitals. The opioid epidemic has made it very dangerous. We haven't put a priority on keeping our people safe because we consider that to be an occupational risk. "Oh, it's part of a nurse's job to get punched." So we did a video called "Say Something." It's based on a very beautiful song by Christina Aguilera. Our video is about healthcare worker violence. I got thousands of stories from people, mostly women. This is never spoken about that it's women who are getting abused in our hospitals, nurses getting punched in the stomach when they're pregnant, getting cut and bit and killed. One interesting dirty secret about this is that nurses are often assaulted and injured, but doctors are murdered more often. There are fewer attacks, but they're more severe. And these are the things we don't talk about. I want to be able to give an unfiltered voice to that.

The other things we want to talk about are issues no one wants to talk about, like abortion, religion, or politics, and why it is that good people disagree on these issues. I want to talk about that because it allows us to understand our patients better, to have more civil discourse and dialogue. Why are we protecting our children from bad ideas when we should be exposing them to these ideas and confronting them, and arguing instead of deplatforming people and shutting them down? These are the kinds of things that get me up in the morning these days, until something better comes along.

Topol: In a way, you're a kind of antiforce to what is considered the traditional doctor, right? You're the true activist, trying to uncover things that are either hidden, suppressed, or unknown.

Why do you think you have these couple million followers? They're captivated by what you're doing, what you're singing about and performing. It's not just the humor or that it's entertaining, but you have a big message and it continues to grow. Why are you such a standout? Why aren't there more doctors who do things like you?

The inclusion of the whole healthcare tribe helps; if I were just aiming it at physiciansphysicians are a tough crowd.

Damania: It shouldn't be rare. Honestly, there's nothing particularly special about me except that I have a degree of oppositional defiance. If someone tells me not to do something, I'll find a way to try to sneak around and do it with a smile on my face. I've been lucky, in a sense, that I hit YouTube at the right time, in 2010. People like Kevin Poe and others have been doing social media really well. There's a guy named Doctor Mike who's been successful on social media. He's a young guy, just out of residency, and mostly aimed at muggles, trying to teach patients. He's very attractiveone of Instagram's sexiest doctors.

I'm the ugly bald short guy who paid his dues going through this academic system and is now going to tell you the truth as far as I see it, and I'm not going to lie to you or try to sell you something. If we do sponsored episodes, it's usually, "Hey, this guy's got a device that thinks it's artificially intelligent and is going to help us with our EHR. Let's figure out whether it's nonsense and have an actual conversation." I think that's what resonates with people. Also, the inclusion of the whole healthcare tribe helps; if I were just aiming it at physiciansphysicians are a tough crowd, Eric. I did a performance at a TCT conference for interventional cardiologists. I ended with "Lose Yourself," an Eminem joint. Twitter blew up"Best thing we've seen; it's amazing"but the live audience didn't know what to make of it.

Topol: That would be the norm.

Damania: Four thousand interventional cardiologists from all around the world. They've never seen anything like that. I gave a similar talk at an American College of Cardiology event that was predominantly nurses, with a few doctors, and got standing ovations, high fives. Very different audiences. Physicians are conditioned to be a bit "in the box"you know, polite. That conditioning is fine, but we need to get them to act because they're smart, creative people. If they stood up and stampeded, we would change the world. That's why I loved your article in The New Yorker where you talked about doctors organizing.

Topol: We should get your help to pull that together. It's coming together. We have remarkable enthusiasm and the leadership is getting established. We have a tentative namethe Osler's Alliance. We're going to enlist your support for sure, because what you do will help. You are organizing doctors and the medical community around an important front.

In social media, people have very emotional responses. Do you get much blowback for your efforts?

Damania: Oh, I get hate almost daily. I get emails that would chill your blood. It's a mix of things. Sometimes it's an anti-vax cult member. We had Paul Offit on our show; he's a luminary in the vaccine world. And the anti-vaxxers found out that he was coming to our studio in Las Vegas, showed up during the live broadcast, and started pounding on the glass holding a picture of a child they said had died of a vaccine injury. It was SIDS, of course. The parents were there, and when you have been led to believe that vaccines murdered your child, of course you're going to act that way. It's very hard to blame them. Who has been doing that conditioning? We've dropped the ball as educators, and these conspiracy theorists have grabbed it and run with it.

So we get that crowd. Sometimes physicians don't like what I say. If I stand up and say, "Hey, you can't have doctors online bullying nurse practitioners. It doesn't become us to do that. We should be practicing at the top of our training and license, and that's all we need to say about that. But going out there and bullying people, saying they have low IQ, things like that, it's beneath us. It's unprofessional." I got a lot of hate for that.

And if I do anything controversial, if I talk about vaping or anything with nuance in it, I'll get a lot of hate, which means I'm probably on the right track. If I don't get hate, I feel like I've done it wrong. I haven't gone hard enough on the nuance, because I do want to upset the fringes on an issue.

Topol: You're a rebel by definition. We first met at the earliest Future of Genomic Medicine (now called Future of Individualized Medicine) conference. Somehow, I think everyone could feel in their bones that you would have an impact like you have. That impact is still developing. It's really quite remarkable.

Where do you go from here? What's the ZDogg plan for the next decade?

Damania: I wish I wasn't stuck with the name ZDogg, but in 2010 I was trying to come up with a handle that no one had taken on Twitter, and ZDoggMD came up. I'm thinking, I like Snoop Dogg, let's go with that. Now it's done. The problem is that it has a tinge of clownery and stupidity. But as we move forward, we really want to be a more serious force. The comedy is important, the music is important, but I want to serve a higher purpose with our show. Now that we're in the Bay Area, we're getting more guests on. I'm hoping to get you on the show because I'm fascinated with all your work on artificial intelligence and everything else you've been doing, especially with organizing physicians. Also, I want to learn a lot more.

The other thing I try to talk about is meditation and those sorts of pursuits. You can talk about moral injury and burnout a lot and say that these are external things that are pushing on us, that we need to fight back on, but then we also need to work on our own personal framing and locus of control. If we decentralize our control and say "this is all out of my control," it becomes very hard to affect change. When we work on things with true mindfulness, meditation, these sorts of practices, which I've been working on myself and trying to teach my audience about, it gives us space to be less reactive, more understanding, more compassionate. I want to go down that route a bit morenot in the "woo-woo," Deepak Chopra, everything-is-beautiful way but in a more realistic, useful way for frontline healthcare workers and others to use.

Topol: When you do your videos, you often have lots of other people in them. Are these extras? Are they on your staff? Where do you get all these people?

Damania: They're all volunteers who want to be in the videos. If I put out a call, 50 people will show up and want to be in the video. It's really fun. We're working with San Mateo Medical Center and we're shooting videos on their campus. It's a fun collaboration because we have a county safety net hospital that we can help by raising awareness for their foundation and things like that. In exchange, we get to shoot in a real hospital, which we've always done in Las Vegas. That and the real medical staff extras help make it authentic. It's not a Hollywood production, although those production values are therewe use 8K cameras and hundreds of thousands of dollars' worth of equipment to make a video that healthcare professionals can feel like, wow, this is a world-class music video about, for example, a doctor who steals pens from nurses.

You would think that's a dumb topic. Who cares? The nurses care. These affluent doctors who could buy their own dang pens are coming up to the nurses and asking, "Hey, can I borrow a pen?" And then they walk off with it. So we did a parody of Rick Springfield's "Jessie's Girl," about Jessie's pen. "I wish that I had Jessie's pen. Oh, never found a ballpoint like that."

Topol: We recently did a Medscape One-on-One with Jen Gunter. You're kind of her male counterpart. She's much more focused on women's health and you are more focused on general issues, but both of you are rebels, taking on the miscommunication in medicine and the misinformation.

What's noteworthy here is the different breed of doctors the two of you represent. Recently, Stanley Goldfarb, a former dean at UPenn, published an editorial in The Wall Street Journal. He wrote that doctors should "stay in their lane," just as the NRA said about doctors and gun safety. He wrote that there shouldn't be anything in the medical school curriculum about things like climate change, social injustice (which he put in quotes), gun controlall the things that get you going. He said that doctors should just take care of their patients, basically ignoring where medicine is headed.

You anticipated that in the past decadethe broader view of what it takes to provide care for patients and have that more panoramic perspective. Where do you see medicine going in general?

Damania: We have to be vocal on all those issues. And here's the thing: We may not agree. When we talk about guns, maybe there are doctors who like to hunt and believe in the right to have a weapon. They don't think gun control in its current form will work. Okay, fine. Let's hear that voice. Let's put it into the mix. And then we'll hear the voice that you often see on Twitter, which is a more leftish voice. That voice says, "No, we need to actually talk about this as a public health issue." Before he became Surgeon General, Vivek Murthy got into trouble just for mentioning it. That's censorship. We should be able to speak freely about whatever we're passionate about, whether it's climate change or something like abortion.

Jen Gunter and I got into an offline argument because we both feel so passionately about this, talking about a woman's right to choose 100%, but acknowledging that many people who we are trying to influence are uncomfortable with the moral ramifications of that. But let's at least have a conversation. Nothing is black-and-white. It's one of the great fallacies that the world is black vs white, good vs evil. It's not. Everyone has their own moral palette and they're trying to do good in the world. So let's get boisterous. We went through a lot of hurt to have knowledge and credibility; why aren't we trying to use it for good in the world? That's part of the healing process. So, yes, we have to have a voice in these issues.

Topol: Do you see a remedy in the future for this disillusionment and physician, nurse, and clinician burnout? Are you hopeful that we're going to get out of these doldrums of medicine?

Damania: I am. You know why? Because I've seen it work. I've seen bright spots. Our staffdoctors, nurses, health coaches, licensed clinical social workers, pharmacists, phlebotomistsgot together every morning. It was a nonhierarchical, everybody-teaches-each-other moment, but they all had their own specialty and training, and they operate at the top of their license. They worked harder than they had ever worked in any organization. But they were happier than they had ever been.

Everyone thinks healthcare workers are just overworked. Well, this is true. We're overworked with stuff that doesn't matter. If we're allowed to work hard at what matters, and we're given the tools, the resources, and the autonomy to do that, we will bust our butts because hey, we got through medical school, residency, and fellowship training. We are good at that. But we need the capacity to do our jobs. And when they have it, people work really hard. They work long hours, but they come away invigorated, feeling a sense of purpose, a sense of connection.

Many of us suffer in silence. So many of us are burning out. Burnout is like dialysis: It's the end stage of multiple insults, one of which is this moral distress or greed; another is poor personal tools to deal with the stress. We think that if we just work hard, we can fix it. That's going to end badly. If we can communalize our pain, with shared suffering comes some relief"Oh, it's not just me. I'm not crazy, the system is crazy."

That's what Samuel Shem's book, The House of God, did, remember? All of us thought, It wasn't just me who felt morally bankrupt during residency. It's a whole thing. This communalization of pain can bring us together. I've seen it work with burnout. I've seen it ameliorated. I've seen the benefits of communalizing our pain, giving us a voice, so I have no doubt that it's going to get better. But it's going to take folks like you to organize physicians. It's going to take folks like me to keep shouting and going, "Hey, we're hurting. You're validated, your suffering is real. And it's not just yours alone." That isolation and disconnection is what's driving people to despair. When people disappear off the grid, that's when you worry about things like suicide.

Topol: I share your optimism. And I'll look forward to talking more about that and the gift of time that we might be able to derive from technology and AI. I think I'm speaking for a plurality of the Medscape community when I say that what you've achieved in the past decade is laudable. We're going to follow you closely. And we're going to revisit all of this in another decade. You're still a young guy, you're a force, you're teaching a lot of people what it's like to be able to get out there and speak your mind. So keep up the great work, Zubin.

Eric J. Topol, MD, the editor-in-chief of Medscape, is one of the top 10 most cited researchers in medicine and frequently writes about technology in healthcare, including in his latest book, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again.

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Work in Healthcare? ZDoggMD Wants Your Voice to Be Heard - Medscape

Writers series: This is the third installment in a series of stories profiling celebrated -- and not so well-known -- nature writers in Minnesota. Today: Charles Eastman.

The life of Charles Eastman is enjoying a Renaissance, 81 years after his death.

The Native American author, physician and lecturer is the subject of a 2018 documentary broadcast on public television and multiple academic appraisals of his philosophy and activism. But a missing piece in the story of Eastman (Ohiyesa in Dakota) is his place in the canon of nature writers with roots in Minnesota. He wrote 11 books, each a mix of folklore, autobiography and adventure, and two more in tandem with his wife.

Nature is the greatest schoolmistress of all, Eastman wrote, as he become one of the first Native voices to be published globally. His childhood experiences in Minnesota, the Dakota Territory and the Canadian prairie, along with his medical training, all informed his work.

One of his main inspirations, said a descendant, Kate Beane of Minneapolis, was that personal health is related to nature, and that is why it is so important.

Eastman, a grandson of U.S. Army officer and painter Seth Eastman, did not publish his first book until he was 44 and living in St. Paul. While I had plenty of leisure, I began to put on paper some of my earliest recollections, with the thought that someday our [six] children might like to read of that wilderness life, he wrote.

Lifes circumstances tossed him around like a leaf on the water. He was born near Redwood Falls in the new state of Minnesota in 1858; his mother died shortly after his birth. Four years later, the U.S.-Dakota War erupted, and his family was caught in its midst. His father, Many Lightnings, was arrested and marched to prison camp in Iowa. Many family members escaped to Canada, including Ohiyesa, who was in the care of grandparents and other relatives.

Hundreds died in the prison, but Many Lightnings survived and was released. He converted to Christianity and took the name Jacob Eastman. Nine years passed and he made his way to Canada, where his relatives were shocked to see him alive. We supposed, and, in fact, we were informed that all were hanged, Charles Eastman wrote. Jacob moved the family to the Dakota Territory and urged education on his children. Charles graduated from Dartmouth College in 1887 and Boston Universitys medical school in 1890.

But fate was not finished with him. He returned to doctor his people in South Dakota. After the Wounded Knee massacre erupted later that year, Eastman led a team to the fields of slaughter. He tended the wounded and comforted the survivors.

The white men [on the team] became very nervous, but I set to examining and uncovering every body to see if any were living. Although they had been lying untended in the snow and cold for two days and nights, a number had survived, he wrote.

Three years later, after marrying teacher Elaine Goodale, he moved to St. Paul to set up a medical practice. But patients were hard to come by for a Dakota doctor, and he took up writing to fill his time. Elaine, who had publishing experience, served as his editor. She encouraged him to write down his stories, said Beane, who is director of Native American initiatives for the Minnesota Historical Society. She edited them in a way to make them sellable, and she was the main contact to the publishing houses.

As his fame spread, Eastman and his family moved to be near Elaines family on the East Coast; he became a popular figure on the lecture circuit and met Mark Twain, British Prime Minister Lloyd George and four American presidents. His organizational accomplishments included helping found the Boy Scouts of America. He established 32 branches of the YMCA in Native communities and owned a summer camp in New Hampshire.

Sharp-eyed witness

His stories combined his experiences with Dakota oral traditions. In his retelling of the 1862 U.S.-Dakota War, he wrote, The dog that howled pitifully over the dead was often the only survivor of the farmers household. He was a sharp-eyed witness of nature, including its weather. The bellowing of the (buffalo) bulls became general, and there was a marked uneasiness on the part of the herd. This was the sign of an approaching storm, he wrote in his book Indian Boyhood. Later, (as) after every storm, it was wonderfully still; so still that one could hear distinctly the pounding feet of the jack-rabbits coming down over the slopes to the willows for food.

Although a city resident for a good deal of his adult life, Eastman preferred the outdoors. In civilization there are many deaf ears and blind eyes, he wrote. In the great laboratory of nature there are endless secrets yet to be discovered.

He sometimes seemed surprised at his success. None of my earlier friends who knew me well would have ever believed that I was destined to appear in the role of a public speaker, he wrote. It may be that I shared the native gift of oratory to some degree, but I also had the Indian reticence with strangers.

Eastman stopped writing after 1921 at the time of his separation from his wife. He died at age 80 in 1939 in Detroit while visiting one of his sons, after a fire in his tepee triggered a heart condition. Much of his soul remained in his boyhood home. (His) story begins at and ultimately at least in spirit returns to the heart of the Dakota homeland in southern Minnesota, wrote University of Arizona Prof. David Martinez in an analysis of Eastmans work.

The Northern Star Council of the Boy Scouts of America at Fort Snelling displays a bronze sculpture of a young Ohiyesa playing lacrosse. Dartmouth College awards a scholarship for Native American graduate students in memory of Eastman the refugee, physician, community organizer, public speaker and nature writer.

Mark Neuzil is chair of the journalism program at the University of St. Thomas and the co-author of Canoes: A Natural History in North America.

Previous stories: Sigurd Olson, Florence Page Jaques

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Outdoors connection threaded through all for Renaissance man - Minneapolis Star Tribune

Laxmi Bhatta,1 Linda Leivseth,2 Xiao-Mei Mai,1 Anne Hildur Henriksen,3,4 David Carslake,5,6 Yue Chen,7 Arnulf Langhammer,8,* Ben Michael Brumpton4,5,9,*

1Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway; 2Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Troms, Norway; 3Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway; 4Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 5Medical Research Council Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; 6Population Health Sciences, University of Bristol, Bristol, UK; 7School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; 8HUNT Research Centre, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Levanger, Norway; 9K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway

*These authors contributed equally to this work

Correspondence: Laxmi BhattaDepartment of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, P.O. Box 8905, MTFS, Trondheim NO-7491, NorwayEmail laxmi.bhatta@ntnu.no

Purpose: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published three classifications of COPD from 2007 to 2017. No studies have investigated the ability of these classifications to predict COPD-related hospitalizations. We aimed to compare the discrimination ability of the GOLD 2007, 2011, and 2017 classifications to predict COPD hospitalization and all-cause mortality.Patients and Methods: We followed 1300 participants with COPD aged 40 years who participated in the HUNT Study (1995 1997) through to December 31, 2015. Survival analysis and time-dependent area under receiver operating characteristics curves (AUC) were used to compare the discrimination abilities of the GOLD classifications.Results: Of the 1300 participants, 522 were hospitalized due to COPD and 896 died over 20.4 years of follow-up. In adjusted models, worsening GOLD 2007, GOLD 2011, or GOLD 2017 categories were associated with higher hazards for COPD hospitalization and all-cause mortality, except for the GOLD 2017 classification and all-cause mortality (ptrend=0.114). In crude models, the AUCs (95% CI) for the GOLD 2007, GOLD 2011, and GOLD 2017 for COPD hospitalization were 63.1 (58.7 66.9), 60.9 (56.1 64.4), and 56.1 (54.0 58.1), respectively, at 20-years follow-up. Corresponding estimates for all-cause mortality were 57.0 (54.8 59.1), 54.1 (52.1 56.0), and 52.6 (51.0 54.3). The differences in AUCs between the GOLD classifications to predict COPD hospitalization and all-cause mortality were constant over the follow-up time.Conclusion: The GOLD 2007 classification was better than the GOLD 2011 and 2017 classifications at predicting COPD hospitalization and all-cause mortality.

Keywords: GOLD grades, ABCD groups, COPD hospitalization, mortality, area under curve, AUC

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in | COPD - Dove Medical Press

Michigan vs. Ohio State

As a University of Michigan alum and the former director of admission at that institutions medical school, Im still reeling from the 56-27 thrashing that marked the Wolverines eighth straight loss to their college football archrival, the Ohio State University Buckeyes.

Yet while I was consumed by the football game, two of the sports mortal enemies were competing in a matchup that literally determines life or death. In its annual blood drive with Ohio State, Michigan actually won although everyone involved was a winner in their own right, from recipients to donors to volunteers to the universities themselves.

In fact, academia is a space where traitors become allies. Take the Big Ten conference. University of Minnesota and University of Wisconsin partner on a $6.3 million grant for advancing evidence-based education practices. Purdue University and Indiana University jointly research the development of life-saving medical devices. Overcoming the tensions of all rivalries, the Big Ten Academic Alliance produces research breakthroughs by leveraging resources from across the consortiums campuses.

This healthy competition brings to mind the numbers that stoke passions in my industry far more than college football scores: business school rankings. In the 2019-2020 Poets & Quants list of the top 100 U.S. MBA programs, my alma maters Ross sits a comfortable 24 spots ahead of Ohio States Fisher.

But even as a higher education technology executive who specializes in business school admissions, I try to look beyond those numbers. Its all about perspective. In a time of declining applications to Americas MBA programs, the college admissions offices that I work with cant afford to get caught up in the rankings. MBA applications are down even at elite programs like Stanford Universitys GSB, Harvard Universitys HBS and University of Pennsylvanias Wharton. Those business schools will need to put aside their rivalries with Massachusetts Institute of Technologys Sloan, Northwesterns Kellogg and University of Chicagos Booth if they want to get serious about the future vitality of their academic discipline as a whole.

Accordingly, Im witnessing business school leaders ramp up their participation in professional networks and associations which provide them with platforms to share best practices. Meanwhile, initiatives like the Big Ten Plus Case Competition bring together MBA programs for competitions that prioritize academic excellence over wins and losses.

The nature of the outcomes at stake also motivates healthy competition. When the football game is over, the players, coaches and fans on both sides will ultimately move on with their lives. But everyone loses if business schools cant fill their seats, as Americas largest companies and the countrys entire economy will be left wondering where the next generation of business leaders will come from.

Even on the football field, the fiercest of rivals end the game with a handshake. They fight hard. They inflict unspeakable pain on one another. And still, they somehow manage to exhale, accepting the outcome and acknowledging their common humanity.

At the same time, if opposing teams cant unite to promote their games to drive fans to stadiums and viewers to televisions, what do schools stand to lose? The very funds that support their research towards discovering solutions for societys greatest problems, like Penn State Universitys pursuit of water sustainability through self-cleaning toilets, Michigan State Universitys use of drone technology to enhance food sustainability and the cutting-edge lung cancer research conducted at University of Nebraska.

Business school leaders can also stand to learn from college football fans. The beloved Iowa Wave, in which University of Iowa Hawkeye fans wave to kids who watch the game from the windows of the adjacent childrens hospital, has also been adopted by Northern Illinois University Huskie fans. MBA programs, too, cant spurn the implementation of their competitors effective strategies purely out of pride.

In an era when so many fault lines threaten to divide us, were much better off not only tolerating each other, but even collaborating with our rivals. From Champaign to College Park, football fans and business school leaders alike should look beyond the numbers this holiday season. Dont be blinded by your schools colors. Whether your passions are ignited by Michigan maize, Indiana crimson, or Rutgers scarlet, its time to work together to generate the prosocial outcomes that transcend scores and rankings.

Robert Ruiz is the managing director of BusinessCAS at Liaison International.

DONT MISS: AN OPEN LETTER TO B-SCHOOL DEANS ON MBA APP DECLINES or WHAT MOST SURPRISED GMACS CHIEF IN 2019

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Beyond The Numbers: Where Business School Meets College Football - Poets&Quants

Gifty Kwakye, 38, an assistant professor of surgery at the University of Michigan, was told by her medical school classmates that she was too nice for surgery. She never questioned her own drive to operate, but she did worry that it would be difficult to balance her work with dreams of being a mother. She hoped to start a family during the research phase of her training, when she had more control over her schedule, but things didnt go as planned. Overcoming medical problems, she became pregnant three months before she was scheduled to return to clinical residency.

Transitioning from maternity leave back to clinical work felt like having cotton wool stuck in your brain, Dr. Kwakye said. She woke up every two hours at night to feed her baby. She was so dazed that she covered her home in sticky-note reminders: Bring the pump to work, the nipple protectors, the ice packs to keep the milk cold.

Worst was the guilt she felt spending 12-hour shifts away from her child. When Dr. Kwakye squeezed in a pickup at day care to relieve her husband, she watched her daughter run to the teacher and call her Mommy. That prompted a day care administrator to ask Dr. Kwakye whether she was on the list of adults approved for pickup, and the doctor had to explain that she was indeed the mother.

The kid didnt want to go to me, and I was like O.K., I deserved that, that was fair, you have no idea who I am, Dr. Kwakye said. But what that does to a mother is painful. I had a moment when I was like, I cant do this anymore; Im failing as a resident and Im failing as a mom.

One morning she sat in her car crying because she didnt want to leave her baby. She wondered if she should have heeded the warnings not to pursue surgery. She told herself, Maybe they saw something you didnt see and youre not tough enough.

As health care providers, surgeons are painfully aware of the ways in which their professional commitments can harm their own health and their familys. Alex Moore, a surgical resident at Brigham and Womens Hospital, said that spending long days away from her 6-month-old baby was especially upsetting because she has studied the medical importance of mother-child bonding. Returning to the operating room after a 10-week leave felt like your soul is getting ripped out, she said.

A surgeons schedule isnt just psychologically taxing, it also takes a physical toll. A resident spends most of the day on her feet. She may go eight to 12 hours without eating, or even drinking water. As one surgical resident put it, health often comes down to Do as I say, not as I do for doctors in training. Dr. Rangel, who had two babies, both born prematurely, wondered whether she was to blame for neglecting her health while pregnant.

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When the Surgeon Is a Mom - The New York Times

In January 2017, the Minnesota State Demographic Center published the report Greater Minnesota: Refined & Revisited. The 68-page document took a hard look at the state outside the population hub of the metro area in order to identify trends driven by Minnesotas changing demographics.

Among the most significant is that Greater Minnesotans are aging faster than their urban counterparts. The findings noted residents of rural and small-town Minnesota are more than twice as likely to be age 80 or older than residents in urban parts of the state. More than 1 in 20 residents in rural and small-town areas in Minnesota were 80 or above, and 44 percent of rural residents were over 50 at the time of the report, compared to 32 percent of urban dwellers.

Unfortunately, as individuals age, they need more health care services, but rural residents are finding fewer care providers available to them. They also report higher rates of perceived fair and poor health and face higher mortality rates than do their urban counterparts. Thats according to the 2017 Minnesota Department of Healths Office of Rural Health publication, Snapshot of Health in Rural Minnesota.

All of those things put together just make [Greater Minnesota] a more complicated environment to provide health care in, says Carrie Henning-Smith, deputy director at the Us Rural Health Research Center, part of the Division of Health Policy and Management in the School of Public Health. Not better or worse, just more complicated.

Bringing doctors into rural Minnesota

The Us Rural Health Research Center studies access to and quality of health care and population health outcomes in rural areas. Its one of seven such health research centers across the country funded by the federal government to improve health outcomes in areas that have unequal access to providers, compared to more urban locations.

Although areas in Greater Minnesota with larger cities such as St. Cloud, Rochester, Duluth, or Mankato have robust health care systems that are easily accessible to nearby residents, more rural areas of the state do not. And as residents in those areas age, they often must travel farther and farther to seek health care.

During a recent trip to Worthington, a town of roughly 12,500 located in far southwestern Minnesota, U of M President Joan Gabel says one of the things she heard from local residents is that they need more help bringing doctors to the area. They asked her if there were ways in which the U could facilitate that?

Henning-Smith says recruiting health care providers to rural clinics is harder now than it was decades ago. Part of the reason is because those providers cant be as flexible in their daily practice as they can in bigger cities.

You cant specialize in any one particular population or health problem, Henning-Smith says about providers in smaller communities. You need to be able to do the full range of practice, and health providers arent always comfortable with that.

That full range of practice is often delivered by primary care doctors, who offer routine, preventative services on a regular basis, and also help patients better navigate the complex health care system. But according to the federal Health Resources & Services Administration, which tracks what are known as Health Professional Shortage Areas, Minnesota has 133 areas with a shortage of medical professionals, including primary care physicians. Only two such areas are in the metro the rest are in Greater Minnesota.

The HRSA lists Lonsdale/Erin/Shieldsville in Rice County, Oshawa in Nicollet County and St. Mary in Waseca County as medically underserved areas. Nearly every Minnesota county aside from the Twin Cities metro and Rochester area is listed as having to have a shortage of mental-health professionals as determined by federal guidelines.

Ironically, at the same time the state notes a shortage of doctors in Greater Minnesota, it also estimates there are between 250 and 400 foreign-trained doctors who cannot practice medicine here without first completing a U.S. residency. And finding a residency in the U.S. can be expensive, time-consuming, and difficult for a physician who may not be a native English speaker or familiar with this countrys medical requirements.

As a first step to helping foreign-trained doctors qualify for a U.S. residency, the U offers a program called BRIIDGE, or Bridge to Residency for Immigrant International Doctor Graduates through clinical Experience. This nine-month program is open to individuals who have a medical doctors degree or the international equivalent; who were born outside the U.S., but who have been permanent, lawful residents of Minnesota for at least two years; and who meet other requirements. BRIIDGE helps those who qualify complete pre-residency requirements so they can proceed to the next step in seeking U.S. licensure.

Michael Westerhaus, M.D., an assistant professor at the U of M Twin Cities campus and director of the program, says that in the first year, four out of four participants in BRIIDGE matched into Minnesota-based residencies. In year two, two of six have so far matched into residencies; the other four are currently applying.

Another related program in which the University participates, the International Medical Graduate Program, offers funding to help international doctors pursue their residencies. IMG was started by the Minnesota Department of Healths Office of Rural Health and Primary Care and currently funds six residency positions, three of which are at the medical school. Students who receive funding agree to work for five years in one of the states underserved areas after they complete their schooling.

Khaled Mohammed, M.D., who attended medical school in his native Egypt, is a current IMG-funded resident who expects to graduate from the medical school next spring. After 10 years of training in his home country, Mohammed came to the U.S. in 2011 for a research scholarship at the University of Pittsburgh. He went to the Mayo Clinic for a research fellowship in 2013, then enrolled in his residency at the U of M in 2017.

While his first two years in residency kept him in rotations in the Twin Cities, for his last year, he is planning an elective rotation in rural Minnesota, although hes not sure where yet. How that rotation goes will factor into where he practices after graduation. (He could also stay in the metro to practice in an underserved area through Childrens Hospitals and Clinics of Minnesota and Hennepin Health care.)

After Im done with my elective, I will have an understanding about practicing in rural settings, Mohammed says.

Another program the U offers to help introduce medical professionals to practice areas in Greater Minnesota is the Rural Physician Associate Program (RPAP). RPAP was established in 1971 as a collaboration between the medical school and the Minnesota Legislature, in response to a shortage of medical providers in rural parts of the state even then.

Kirby Clark is a family physician who has been leading the program for the last two years. He said medical education has long been very metro-centric. The point of RPAP can be summed up in a quote that Clark attributes to the late Jack Verby, another family doctor who helped establish the program: You dont train somebody to work in forestry by training them in a lumberyard.

Clark explains: You want to get [students] serving in a community, learning in a community that looks like where theyre going to practice. RPAP places third-year medical school students on rotations for nine months in clinics across the state. Positions stretch from as far north as Roseau, near the Canadian border, to as far south as Luverne, near the South Dakota and Iowa borders. RPAP is optional, but allows students to meet their third-year requirements. Roughly 35 students, or 20 percent of the U of M-Twin Cities class, participate in the program each year.

Clark adds that about 50 percent of students who participate in RPAP will go on to work in rural clinics after residency.

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In sickness and in health: Access to nearby, quality health care is a growing priority in Greater Minnesota (copy) - Southernminn.com

For the first time, women outnumber men in medical school. According to a new report from the Association of American Medical Colleges, women made up 50% of medical students in 2019, while men made up 49% of students.

Overall, men still make up the majority of doctors with 64% dominating in the profession, as compared to 36% of women. A joint report between the AAMC and the American Medical Association found disparities among men in women in their chosen fields.

Male doctors outnumber female doctors in the orthopedic, neurological and interventional radiology fields. Female doctors dominate in pediatrics, obstetrics and gynecology, allergy and immunology. Fields with an equal amount of men and women include pathology, psychiatry, sleep medicine and preventive medicine.

Theres also an age disparity among doctors with 80% of doctors age 65 or older in 2017 being men and 60% of younger doctors under the age of 35 being women.

The Realist Womans take:

Women surpassed men as students in medical school for the first time ever. Its incredible. I specifically love the fact that 60% of doctors under age 35 are female. Women really are making their mark in the world of medicine and I hope this story inspires young girls who dream of being doctors.

I noticed in the report that female doctors dominate in the fields that serve female patients, which makes sense because female doctors understand women's issues in a way that men cannot. But I'm sure that women in the fields that male doctors dominate are just as excellent as their male counterparts as women can do everything men can.

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Women Outnumber Men in Medical School - The Realist Woman

GLASSCOCK, THOMAS Interviewed 3 Dec 2019 by Joe L. Todd Ponca City, OK

Todd: Today is December 3, 2019. My name is Joe Todd and this is an interview with Thomas Glasscock in Ponca City, Oklahoma. Sir, where were you born?

Glasscock: I was born in Finland, North Dakota.

T: When is your birthday?

G: May 2, 1918.

T: Who was your father?

G: Dr. Timothy Glasscock.

T: And your mother?

G: Sadie G. Glasscock.

T: What was her maiden name?

G: Savre.

T: Did you go through school in Finland?

G: I went to grade school in Finland then we moved to Haywood, Iowa. I went to high school there then back to North Dakota to college.

T: What year did you graduate high school?

G: 1934, I think but it has been so long I have forgotten.

T: Where did you go to college?

G: The University of North Dakota.

T: What did you study?

G: Pre-med. I got my degree then I transferred to the University of Chicago for medical school. I finished my MD in 1942.

T: Do you remember when the Japanese bombed Pearl Harbor?

G: Yes.

T: Where were you?

H: I was in Chicago in school.

T: When you heard about the attack, what did you think?

G: Not much of anything other than we were at war.

T: After you got your MD, what did you do?

G: I took my internship in Chicago and following that, I took a residency in Chicago then I joined the Navy.

T: When did you join the Navy?

G: I joined in 1943 as a medical officer. I was sent to New Orleans to the Higgins Boat Company and assigned to Squadron 30 in New Orleans.

T: What were your duties with the Higgins Boat Company. I was organizing the medical department for the men, getting their records straightened out.

T: How long did it take to get all the medical records for the squadron?

G: It took about three months. I had three hospital corpsmen working with me at the Higgins Boat Company.

T: From New Orleans, where did you go?

H: Got all the records together and organized the men for the squadron. The hospital corpsmen got the records straightened out and organized the medical department for the whole group of boats.

T: How many men were in the medical department?

G: There was a chief, two first classes and myself. That was the medical department for the boats.

T: What was your rank at this time?

G: Lieutenant.

T: From New Orleans, where did you go?

G: We went to New York in the inland water way and put out boats in the group that was going to England. They were put in an attack transport ship. They were lifted and put on the ship.

T: Do you recall the name of the ship you were on?

G: I have no idea.

T: Tell me about the trip to England.

G: It was cold and we did a lot of maneuvering around the North Atlantic to avoid the German submarines. We were lucky, we didnt have any real bad storms. It took a while to get there because of all the maneuvers we had to make, we had to zig zag.

T: Where were your quarters on the ship?

G: Mine were in the sick bay with the doctor. We were in the sickbay and some sailors studied with us.

T: Did many guys get seasick?

G: I dont remember but Im sure they did. I dont remember anyone so sick we had a bad Glasscock - page 3

problem.

T: How did you pass the time on the trip?

G: Doing medical work on the boys that were sick, but none were real sick. We played cards and ate and wondered what we were going to do next.

T: How long did the trip take?

G: I think it was at least eight days.

T: Where did the ship land?

G: We landed on the north coast of England. I think it was Liverpool. Some of the boys were put on boats down to the south part of England and some of us got on a train and went south. All the officer went by train. We went down to Southampton and the British had built a building for the PT boats to come into. They had a real nice area called tent city and they had everything we needed. They had a place where we practiced and eating and sleeping were pretty nice.

T: How did you prepare for D-Day?

G: We werent too involved with that.

T: When did you get to France?

G: We got there on D-Day.

T: Tell me about going to France.

G: We got on the boats and cruised and kept in touch with the other boats. We were going to do what we had been practicing doing.

T: What did you practice to do?

G: Taking aboard the injured and identifying what should be done. It was kind of vague because no one had done that before. We had no specific identification except if someone was injured, we took care of them. We were on the PT Boats doing sea rescue.

T: When you treated the wounded, where were they sent?

G: We sent them to a hospital ship.

T: Tell me about D-Day.

G: It wasnt an organized thing as far as taking care of the wounded. We took care of them and shipped them to the hospital ship.

T: How did you get the wounded on the PT Boat?

G: We fished them out of the water.

T: You were off which beach, Omaha or Utah?

G: We were in the English Channel off all the beaches at Normandy.

T: How long were you off Normandy?

G: We were there until things quieted down. I cant remember the number of days.

T: Did you land in France or got back to England?

G: Our base was in England. We really didnt have a base there, we just anchored the boats in England.

T: What did you do when you went back?

G: We got them back in the water and sent them back to pick up survivors.

T: Were you in a hospital in England?

G: No, we stayed on the boats all the time.

T: Did you land in France?

G: Not early in the invasion. We landed later and took medicine where needed it. We then were based in Cherbourg. The wounded were brought in and we treated them and went sent some to the field hospital in Cherbourg and if they were not badly wounded, they were sent back to their unit.

T: How long were you at Cherbourg?

G: That was our base the whole time. We never got orders to go anyplace else. We never went any place in France except Cherbourg. There was the hospital in Cherbourg that the United States used.

T: Did you get to Germany?

G: No, I spent the rest of the war in Cherbourg. I remember, we had just finished Christmas Ever dinner and we were notified to get to the boats at five oclock in the morning and head out. We were in Cherbourg and a troop ship had sunk but when we got there everyone we pulled out of the water was dead from the cold. Our whole squadron went out and worked all night long. We never pulled anyone out of the water that survived. We put some in the engine room but none of them but they never came to. That was a cold night.

T: That was the SS Leopoldville. It was a Belgian troop ship taking troops to France from England for the Battle of the Bulge. Don Shaub in Bartlesville survived the Leopoldville by getting on a British destroyer that was escorting he Leopoldville.

G: We found no one alive in the water.

T: What did you do on V-E Day?

G: I dont remember. I suspect I celebrated like everybody else, but I dont remember.

T: Did you think you would go to the Pacific?

G: There were a lot pf PT Boats in the Pacific and we wondered if we were going there. But we didnt. The whole group came back to the United States.

T: How long were you in the Navy?

G: Four years.

T: When you left the Navy, where did you go?

G: There was a group in Chicago that were helping veterans find a place to go. There was a clinic in Ponca City and I interviewed with them and came to Ponca City in 1946. I was with the clinic for five years then I moved out to my private practice.

T: Would you join the Navy again?

G: I would join the Navy over the other services.

T: Today when you hear the name Franklin Roosevelt, what is your reaction?

G: We took the advice of what they told us to do. It is hard to evaluate him because things were not too well organized.

T: Harry Truman.

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Glasscock joined the Navy in 1943 - Miami News Record

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Lower hospitalization rates following proton therapy could offset its higher upfront cost compared with standard radiation therapy

A new study suggests proton therapy is as effective as traditional X-ray radiation therapy while causing fewer serious side effects. Pictured is proton therapy equipment at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.

Cancer patients who receive high-tech proton therapy experience similar cure rates and fewer serious side effects compared with those who undergo traditional X-ray radiation therapy, according to a study led by Washington University School of Medicine in St. Louis and the Perelman School of Medicine at the University of Pennsylvania.

The reduction in side effects particularly lower hospitalization rates and fewer emergency room visits could offset the higher initial cost of proton therapy, which often is not covered by private insurance because of its higher upfront expense and limited data on its effectiveness compared to X-ray radiation, according to the researchers.

The study is published Dec. 26 in JAMA Oncology. Some of the findings also were presented in June at the American Society of Clinical Oncologys annual meeting, in Chicago.

We observed significantly fewer unplanned hospitalizations in the proton therapy group, which suggests the treatment may be better for patients and, perhaps, less taxing on the health-care system, said first author Brian C. Baumann, MD, an assistant professor of radiation oncology at Washington University and an adjunct assistant professor of radiation oncology at Penn. If proton therapy can reduce hospitalizations, that has a real impact on improving quality of life for both our patients and their caregivers.

While radiation therapy can be curative for certain cancers, it also causes severe side effects such as difficulty swallowing, nausea and diarrhea that reduce quality of life and can, in some cases, require hospitalization, said Baumann, who treats patients at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.

The study, which included almost 1,500 patients from Penn Medicine, is the first large review of data across several cancer types including lung, brain, head and neck, gastrointestinal and gynecologic cancers to show a reduced side-effect profile for proton therapy compared with X-ray radiation therapy for patients receiving combined chemotherapy and radiation. None of the patients had metastatic cancer, in which a tumor has spread to other parts of the body.

The researchers found no differences between the two groups in survival and cancer control, suggesting that proton therapy is just as effective in treating the cancer even as it caused fewer side effects. Overall survival at one year for the proton therapy group was 83 percent versus 81 percent for the X-ray radiation therapy group. This difference tipped slightly in favor of proton therapy but was not statistically significant.

The difference in side effects was more pronounced. Forty-five of 391 patients receiving proton therapy experienced a severe side effect in the 90-day time frame (11.5 percent). In the X-ray radiation therapy group, 301 of 1,092 patients experienced a severe side effect in the same period (27.6 percent). The patients receiving proton therapy experienced fewer side effects despite the fact that they were, on average, older and had more medical problems than those receiving standard X-ray radiation therapy. After taking steps to control for these differences, the researchers found that patients receiving proton therapy experienced a two-thirds reduction in the relative risk of severe side effects within the first 90 days of treatment, compared with patients receiving X-ray radiation therapy.

Both types of radiation therapy are approved by the Food and Drug Administration for cancer treatment. X-ray beams are made up of photons, which are electromagnetic particles that have almost no mass, allowing them to travel all the way through the body, passing through healthy tissue on the way out. Protons are relatively heavy, positively charged particles that hit their target and stop, essentially eliminating the exit dose of radiation.

Since the study found proton therapy to have fewer adverse events, Baumann said it could prompt radiation oncologists to design clinical trials to investigate whether increasing the dose of proton radiation would help patients do better, while still maintaining acceptable levels of side effects.

Similarly, the reduced side effects of proton therapy could allow older patients with additional medical conditions who are typically excluded from clinical trials because of their frailty to participate in trials investigating more intensive treatments that could be beneficial.

Clinical trials often are limited to patients who have serious cancers but are otherwise quite healthy, and thats not the real-world cancer population, said Baumann. Doctors, rightly, are concerned about toxicity. But with the reduced toxicity that we found with proton therapy, this might open the doors to the possibility of older patients with multiple medical problems getting cancer therapy they can tolerate that is more likely to be curative.

With our aging population, this could have a big impact on a lot of patients, he added. To me, thats an exciting implication of this research.

A new study led by Brian Baumann, MD, of Washington University School of Medicine in St. Louis, found that proton therapy (bottom) is associated with fewer severe side effects than conventional X-ray radiation therapy (top) for many cancer patients. Protons are relatively heavy, positively charged particles that hit their target a lung tumor in this example and stop. X-ray beams consist of photons, much smaller particles that can travel all the way through the body and its healthy tissue including the heart in this example on the way out.

This work was supported by research funds from the University of Pennsylvania.

Baumann BC, Mitra N, Harton JG, Xiao Y, Wojcieszynski AP, Gabriel PE, Zhong H, Geng H, Doucette A, Wei J, ODwyer PJ, Bekelman JE, Metz JM. Comparative effectiveness of proton therapy versus photon therapy as part of concurrent chemo-radiotherapy for locally advanced cancer. JAMA Oncology. Dec. 26, 2019.

Washington University School of Medicines 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Childrens hospitals. The School of Medicine is a leader in medical research, teaching and patient care, ranking among the top 10 medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Childrens hospitals, the School of Medicine is linked to BJC HealthCare.

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Proton therapy as effective as standard radiation with fewer side effects - Washington University School of Medicine in St. Louis

In 1978, the psychiatrist Stephen Bergman published the novel The House of God, written under the pen name Samuel Shem. Based on Bergmans experiences as an intern at Harvards Beth Israel hospital, the book rapidly became a staple of any medical residents required-reading list; to date, it has sold more than two million copies. A 2003 edition included an introduction by John Updike, who wrote that The House of God could probably not be written now, at least so unabashedly; its lavish use of freewheeling, multiethnic caricature would be inhibited by the current terms racist, sexist, and ageist. Its 70s sex is not safe.

For Updike, for those who made this argument before him, and for those who continue to make it today, a measure of freedom has been lost in a culture that requires writers to watch their words for unintended cruelty. An army of chiding librarians seems to have arisen, tsk-tsk-ing the poor writers bawdy, outrageous imagination. Updikes concern is embodied in the real phenomena of Twitter pile-ons and sensitivity readers, but it is also Foucauldian: the chiding librarian is within us, suppressing the writers creativity before it even makes it to the page. In the panopticon where every action can be seen, known, and embedded in a tweet, no actual chains are required. Ultimately, we control ourselves.

The House of God is not a great book, the literary critic Kathryn Montgomery has written, but it is an important book. Bergman claims that it shows how residents are dehumanized in the course of their sleepless, gruelling medical training, and in turn begin behaving cruelly or carelessly toward their patients. As the physician and poet Jack Coulehan has pointed out, however, Bergman undercuts his argument somewhat when his narrator, Roy Basch, refers to patients as a heifer and a hippo on his first day of work. If the narrators callous attitude toward patients is a product of the dehumanizing power of residency training, how did Basch get there so quickly? Coulehan argues that the novel does a disservice to medical-student readers, who internalize the message that clinical training is dehumanizing without sufficiently noticing that the group most dehumanized is patients. Others, such as the emergency physician Jay Baruch, argue that the novels descriptions of the disgust, shame, and horror that patient care sometimes evokes comprise a badly needed articulation of the lived experience of residents. The House of God likely contributed to some of the reforms in medical training that have come about since the nineteen-seventies, particularly in regard to long work hours that lead to sleep deprivation. The book is taught in medical schools and quoted by physicians; whether we realize it or not, we are quoting The House of God when we say, for example, The first procedure in any cardiac arrest is to take your own pulse.

More than forty years after its publication, many of the books episodes, such as the suicide of an intern, still feel contemporary. Other bits are frighteningly dated or always felt slanted, particularly the portrayal of women. The books nurses have none of the clinical insight or skill of actual nurses, but theyre eager to reveal their montes pubis for the interns. There is just one female physician, a frigid, universally loathed character named Jo. The last of the women is Roy Baschs partner, Berry, who is intelligent but inexplicably content to serve as a surrogate mother for Basch, while displaying no expectation that he might broaden her horizons in turn, or even refrain from copulating with nurses.

As sympathetic as I am to Updikes concerns about social control, and as nostalgic as I may be for the time when I wrote like a childblithe, mindless of consequence, the only audience in my mind an audience of people who already loved meI am no longer a child. These days, I write not only for my best friends but for general readers. Growing up involves coming to realize that others are as human as oneself, with inner lives at least as rich as ones own. The realization that others have inner lives is a developmental milestone that we humans are supposed to achieve around age four. But, as it turns out, many of us are still working on it, decades later. Or perhaps we gain the ability to imagine the lives of others around age four, but we may or may not put that ability into practice.

I look to literature to attune my mind to the inner lives of other people, and it is painful when a book falls so short of deeply imagining the other that it portrays some whole wings of the world as flat, airless, not truly worth inhabiting. It is ironic, in a sick way, when the art that ought to bring us closer accidentally insists that some of us are not really worth the effort. I read The House of God in medical school, as many of us do, and was left looking askance at my chosen field. Because the book is lionized so uncritically in my profession, I could only suspect that my future colleagues did not hold women in particularly high regard.

Bergman and his apologists (including many of my women colleagues in medicine) say that The House of God was simply a novel of its time. When asked about the novels sexism in a recent interview, Bergman replied, I was roundly criticized for the way women were seen in the book, then launched into an anecdote about a doctor and nurse having sex in an on-call room in the nineteen-seventies. Things have changed, Bergman added. The anecdote is telling, with its implication that feminist thinkers object to sex itself, rather than to the portrayal of women as sex objects. The accusation that women who display the capacity for critical thought must be frigid is a tired one, and one given full treatment in the character of Jothe only woman in House who occupies a position of authority, the lonely single woman whose supervision of Basch and her other male subordinates equates to lop[ping] a bit off his schlong daily by telling him what hed failed to do.

Other authors have managed to see women in health care as complex humans: Aleksandr Solzhenitsyn, in Cancer Ward; Michael Ondaatje, in The English Patient; Elizabeth Norman, in the beautiful and deeply researched We Band of Angels. As more women have trained as medical professionals, physician writers such as Danielle Ofri, Pauline Chen, the former Surgeon General Joycelyn Elders, and the Navajo surgeon Lori Arviso Alvord have told our stories in memoirs. Part of a books essential work is to bring readers deeply into the worlds of others, and thus it is fair to criticize authors who make no attempt to examine the worlds of whole categories of people. As Eudora Welty said of her stories and novels, What I do in writing of any character is to try to enter into the mind, heart, and skin of a human being who is not myself. Whether this happens to be a man or a woman, old or young, with skin black or white, the primary challenge lies in making the jump itself. It is the act of a writers imagination that I set most high. It is odd to blame the times, then, for a failure of imaginationthat freewheeling, unabashed thing that Updike prized.

The other defense of The House of God that I commonly hear is But its satire! And The House of God is wonderfully effective satire insofar as it points an accusatory finger at systems of power in medicine. But the spectacle of the male Harvard Medical School graduate satirizing women colleagues is painful; good satire deflates systems of power, not the people who toil and suffer in those systems.

Naturally, I turned to Mans 4th Best Hospital, the recent sequel to The House of God, with cautious curiosity. I wondered if a forty-year career as a psychiatrist could have acquainted Bergman with the notion that women have inner lives. The novels first sentenceExcept for her eyes, Berry is fully clotheddimmed my hopes only somewhat. Roy Basch is back, and his life in the years between the two books maps closely with Bergmans. Both men married a psychologist who believes that profound and fixed differences between genders not only exist but also can begin to be bridged by using the word we more frequently; both adopted a daughter from overseas; both became psychiatrists with a special focus on addiction medicine; both wrote a novel called The House of God.

In the first chapter, Basch and Berry are staying at their Costa Rican finca, and Basch requires stitches from a Tica physician. When she bent over to examine me, he describes, I could not help noticing that her purple blouse wasto use a line from The Houseunbuttoned down past Thursday, breasts cradled in the lace palms of a pink bra.... As she left... I noticed she was wearing tight bright pink pants and red high healsmake that heels. For Basch, this is familiar ground: sex and death. Especially in the Medical Intensive Care Unit, in the daily horror of lingering disease and death, the healthy sex with the nurses, orgasms crying out Were still alive and young! At the threat of disease and death, the sensual, the vitaland, yes, the hope.

Now, I happen to be a woman physician. I cant speak for the whole crowd of us, but I think that most of us do not wish for our breasts to be ogled while we stitcheven if it makes our septuagenarian patients feel sensual and vital.

Even if Baschs ogling of the doctor is nauseating, his point about the erotics of medicine has something true in it. All that death does make one wish to prove that one is alive oneself, and that life offers something more exalted than excretion and suffering. Sex is a high line to pleasure, and I have friends both male and female who did fornicate their ways around the cities of their internship. Mostly we were too tired for fornication, though, or we were in love with our spouses and sensible enough to be faithful to the ones who kept us fed and sane. There is an actual orgy in the call room in The House of God which, in retrospect, feels quaint. What intern has time for an orgy these days? You would get paged out of it within ten minutes.

(It occurs to me that I am a pediatrician, and it could just be that childrens hospitals are particularly undersexed. Perhaps, in adult hospitals, the loamy must of sex luffs up around bedpans and ventilators, and interns must splash through puddles of semen to get to their call-room beds. Ive no way to know!)

Although many of the characters, including the physicians, in Mans 4th Best Hospital are women, and, although Bergman has gotten beyond the trope of nurse as dumb mons, his depiction of gender is still old-fashioned. Men are strong and zany and ha-ha funny; women are sensitive and moral and wise, happy either to bed the men or to mother them. (Berry refers to Baschs moral education as her full-time job in the medical field.) In one memorable scene, a nurse named Molly allows Basch to come up to her apartment and fondle her remarkably caressable breasts and strangely long nipples, for old times sake, then does him the service of reminding him of his wifes existence, putting an end to the dalliance before penetration can occur. The virile Baschs formidable sex drive is thwarted, but later he is grateful and falls to his knees on the sidewalkthank goodness Berry never needs to know! Molly goes on to work alongside Berry when she, too, joins the clinic. There is minimal drama and no consequences for Bascha male fantasy fulfilled, even if there was no penetration.

The other aspects of Baschs privilege also go unexamined, and his flaunting of his privilege as a doctor and a wealthy person makes me, as a fellow-physician, cringe. At one point in Mans 4th Best, Basch develops an abnormal heart rhythm and has to go to the hospital. He calls a fellow-doctor en route, and that doctor promises to get a cardiologist to come in and care for Basch. Once at the hospital, Basch continues to lobby for special treatment:

I had learned that if Ior any of my familygo to a doctor, its helpful to say Im a doctor, and when they ask what kind, I tell them and then ask, Have you heard of the novel The House of God? Almost always they perk up and say, Oh, yeah, its my favorite book! Well, I wrote it. And then the word spreads throughout the [emergency ward] and we all get a lot of attention. Docs and nurses crowd the room, want to chat, almost always telling me where they were when theyd read my novel.

For anyone who has struggled to receive proper attention from physicians, this passage could be a little hard to take. It is also difficult to feel sympathy with the Basch family for their financial troubles, which condemn them to owning a vacation finca and also a large Boston-area estate and confine them only to the carriage house of the estate while they rent out the main house. Basch goes into an alcoholic tailspin from the stress of working extra shifts in order to afford their adopted daughters private preschool. (My 24,000 dollar city taxes would have paid for excellent public school, he explains. But wed tried it with Springit didnt work. She was terribly shy.)

I have many shortcomings as a human, and one of them is my failure to sympathize with the struggles of the wealthy to secure private-school spots for their children. I was so shy that my preschool teachers thought that I had a developmental disability, and I still managed to survive public school in rural Texas, where abstinence-only sex education ruled the day and where we dissected a single rat that we shared as a class. Now I am not only a doctor but also some kind of arbiter of taste, called upon by The New Yorker to review this book. All this unexpected glory, despite having shared the rat. Im sure that I was protected by old-fashioned white privilege in public school; I was urged to the front of the class. The parents who really have to worry about the fates of their children in public school rarely have the luxury of choice.

Nor should Updike have worried that the racist label would eliminate free-wheeling multiethnic caricature from Bergmans writing. House employed caricatures of black and Irish-American people, among others. Bergman portrays Navajo people as fully realized characters in Mans 4th Best, but a Latino physician character is still a racist parody whose Spanish is incorrect. Mia madre! he says, and Esta mucho discombobulay, and El segundo causa, and Merck Vioxx kill my madre!and it is unclear if this Spanish is deliberately incorrect or if it has simply been believed to be correct, in a country where literate Spanish speakers are abundant and could correct it.

Basch frequently nods to the struggles of the working class, or, as he refers to them, all the poor and middle-class patients Id seen who were only one illness away, in our nations piss-poor health-care system, from bankruptcy. And the explicit mission of the book is to make medicine humane again. (Boring!) The book advocates, in its way, for universal access to health care as a cure not only for physical suffering and injustices in the system but also for the misery of physicians. Given these explicit missions, Shems tone-deaf approach to the narrative effects of privilege-flaunting is unfortunate.

In recent months, since I finished residency and began working as an attending physician, my way has been smoothed by the grunt work and flattery of trainees. My residents mine the electronic medical record for data and compose my notes; my medical students actually laugh out loud at my jokes. I recognize the precarity of all this, the seductive notion that this deference is not a consequence of a pernicious hierarchy but rather a consequence of my own hard work, wisdom, and virtue. I hope always to deserve the respect of my team. I hope never to be the dupe making sexist jokes that arent funny, to whom nobody in the room is willing to tell the truth. I hope to remember that I am a wealthy person now, and hand-wringing about the cost of private preschool would render me as unsympathetic as a self-appointed advocate for the oppressed.

Perhaps forty years of deference explain why Shem, like Updike, writes as a child would, imagining an audience that will express only adoration. Perhaps it explains why Basch presumes that his book is everybodys favorite, and that the doctors and nurses in the E.R. are gathering round to admire him. Some of them undoubtedly are, but a good portion of them are just staring at a fascinating specimen. We medical folk are simple people, and a famous writer in the E.R., like a case of Sydenhams chorea or an interestingly shaped object lodged in a rectum, excites our general interest.

So what is enough to ask of an elder male writer in this era? I think we women want revenge; we want blood on the ceiling, as Patricia Lockwood gave us in her recent epic takedown of Updike, in the London Review of Books. But also, perhaps, we want the possibility of individual moral progress, particularly among powerful men who have used their power to demean us. We want to recognize that progress when it comes, even as we continue to deserve real justice. Even if I would not wish to be or know the women in Bergmans book, I recognize an effortful appreciation of women here. In medicine, we are only just beginning to reckon with our gender-based wage gap, our failure to promote women leaders, our utter indifference to the needs of working mothers, and the systematic harassment of women trainees. Led by groups like Times Up Healthcare, we are beginning to discuss these things. It is all too slow, and, on my more exhausted days, I wish for torches and pitchforks rather than just these words.

Jo, the only female resident in The House of God, is also the only resident from that book who does not reappear in Mans 4th Best Hospital; she doesnt even rate a mention. Her character was instructive to me when I first read The House of God, because she symbolized so precisely the implicit threats levied against women who seek a career in medicine: that, if we do this unfeminine work, we will become hard and cold. If we assume leadership positions, the men we supervise will see us as schlong-lopping harpies.These threats are powerful tools of social control, instructing women in medicine that we must contort ourselves somehow into sexually available playthings, even as we thread catheters into femoral arteries and stuff tubes down the throats of the dying. For refusing to be pretty or sexy or soft, Jo was hated.

I would have liked to see Jo return, to see the consequences of her treatment in The House of God explored many years later. I would like to know if we women in medicineparticularly those who have been harassed and demeaned and underpaidget to live full lives, after all. I would like to know if we ever get to be both women physicians and people, or if the two conditions are incompatible.

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The House of God, a Book as Sexist as It Was Influential, Gets a Sequel - The New Yorker

PITTSBURGH (KDKA) A new medical school is coming to Pittsburgh.

On Forbes Avenue, opposite the soon-to-open UPMC Cooper Fieldhouse, Duquesne University will construct a five-story building to house a new medical school.

We like to say we educate the mind, body, and spirit of the individual here at the university, Duquesnes Provost Dr. David Dausey told KDKA money editor Jon Delano on Wednesday. It met our mission. It met a regional need. We have a shortage of family care practitioners in this region.

(Photo Credit: KDKA)

Its a College of Osteopathic Medicine, the first at a Catholic university in the state, and the second medical school in Pittsburgh.

Delano: What is osteopathic medicine?

Dause: Its very similar to allopathic. A lot of times, people try to emphasize the difference. The medical doctors go through the same boards. They go through the same training.

The same four years of medical schooling, followed by internships, lead to a D.O., doctor of osteopathy.

But while M.D.s often specialize, these doctors prefer family practice and general internal medicine.

Theres a shortage in this state of people that focus on primary care, said Dausey.

The current Lifes Works building will be replaced by a brand new structure.

Itll be a new front door on Forbes Avenue for Duquesne University, and its something were truly excited about, said Dausey.

Dr. John Kaufmann, who opened up North Carolinas first medical school in 35 years, has just been hired to start up this college.

If all goes according to plan, the new Dean of Osteopathic Medicine will be here on Jan. 1st.

And with a lot of work ahead, this new college will admit its first students for classes in the fall of 2023.

Continued here:

Duquesne Universitys New Medical School To Be Built On Forbes Avenue - CBS Pittsburgh

Russell Ledet, a medical student at Tulane University, tells CNN he got the idea after a conversation with his eight-year-old daughter about a trip they took to Whitney Plantation in Edgard, Louisiana.

"Her insight [to the visit] was, "This is not fair. This is not supposed to happen,"' Ledet said. "So I had this idea that we need to get the black medical students at Tulane and we need come here. We need to do this for ourselves."

He decided to pitch the idea of taking a group tour of the plantation to his classmates, along with taking pictures in their white coats, and it turned out better than imagined.

Ledet said his peers had "no hesitation," and they knew it could have an impact. Fifteen of the 65 black medical school students showed up, and he said the most amazing thing was that all of them had a different takeaway.

"As physicians in training, we stood on the steps of what was once slave quarters for our ancestors. This was such a powerful experience, and it honestly brought me to tears.

For black people pursing a career in medicine, keep going. For our entire community, keep striving. Resilience is in our DNA."

The photo started making the rounds and quickly grabbed the Internet's attention.

"You just get a feeling, and you think this is going to be impactful and this is going to mean something," Labat told CNN. "It's not about going viral or the attention ... it's about being inspirational."

Labat said that if she would have seen these photos as a child it would have motivated her further as she dreamed of becoming a doctor.

"To see people that look like me on this photo would have been so substantial for me as a younger student, and that is the whole purpose."

They hope the photo will inspire generations

The students hope the photo will make a difference for all black students. The plan is to put them in 100,000 schools across the country so that future students can be inspired.

They also hope it shows older generations in their field that the hardship was all worth it.

"We hope that we will make a lifelong impact ... and let [students] know: Yes, you can be smart. Yes, you can be successful ... and you can also do that while being unapologetically black and proud of where you come from and proud of where you are going," Labat said.

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A group of black Tulane University medical students posed at a plantation to show how the past inspired their future - CNN

When you enter the clerkship phase of medical schooltraditionally during the third yearyou are getting exposure to your future in the form of your core clinical rotations.

Lasting between four and eight weeks, at most schools, the core clinical clerkships consist of internal medicine, surgery, obstetrics and gynecology, pediatrics, family medicine, psychiatry, neurology and radiology.

Students have autonomy in their clinical rotations in that they can schedule them as they see fit. Is there a right way to do it? A medical student and resident offered insight on that question.

Kevin Perez is a second-year medical student at A.T. Still University School of Osteopathic Medicine in Arizonaone of 37 member schools of theAMA Accelerating Change in Medical Education Consortium.

When Perez begins his clinical rotations, he plans to start with the ones that are the most broadly applicable.

Im going to pick the most holistic ones first, Perez said. So, Im probably going to pick family medicine. Its slower paced, and it gives you a better understanding of what being a doctor is. So, surgery and EM [emergency medicine] would probably be what Ill do toward the end.

According to Luke Burns, MD, a second-year ob-gyn resident at Michigan Medicine, the rotations that give you the best knowledge base to build upon are going to depend on your preferred medical specialty.

If you want to do ob-gyn, youre going to want to do surgery first, so youre really good at surgery and know how to scrub into a case, Dr. Burns said. Likewise, if you want to do pediatrics, maybe do medicine first, so you have some inpatient experience before you go to the wards.

Perez is planning on going into emergency medicine. Because of that, he plans to do that rotation later in his training.

It's graded kind of subjectively, Perez said. Because of that, your performance and how much you know coming in, are going to define how well you do. If you want to do EM, you want to do well in that rotation for when you apply to EM residencies later. Picking it as your first one wouldnt be a great idea, unless you are truly ready. You only get one shot.

The key metric on which clerkship performance is evaluatedand one which residency programs take into considerationis a medical students scores on shelf exams, which come at the conclusion of a core rotation.

One really important thing I didnt realize would happen is I got better at taking shelf exams, Dr. Burns said. My shelf scores improved as the clinical year went by. If you feel a little shaky taking exams, theres some advantage to making it so your most important exams come at the end.

You may not know what you want to do when youre entering clerkships. But youre likely to know a few specialties you dont want to do. It makes sense to load those at the front of your clerkship schedule.

The common philosophy is to schedule the things you dont want to do first, Dr. Burns said. If you dont want to be a pediatrician, do that rotation first. Because its the one youll cut your teeth on, youll mess up on it, and by the time you get to the next thing, the theory goes, youll know what to do and how to impress attendings and residents.

In Dr. Burns case, he scheduled his ob-gyn rotation as his second-to-last rotation.

That was always the plan, he said, because then it would mean that it wasnt the very last thing, so I had time to change my mind and I had time to get my [subinternships], those important rotations for my fourth year, in order.

When thinking about scheduling core rotations, Dr. Burns acknowledged that it can be a difficult for people who dont know what they want to go into. But, he added, its not the end of the world if medical students wind up doing clerkships early on in specialties they decide to pursue for residency.

For additional tips on a number of relevant medical school topics, including scheduling clinical clerkships, visit the AMA Career Planning Resource.

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The science of scheduling: When to do key medical school rotations - American Medical Association

UMass Medical School and GE Healthcare Life Sciences have announced the companies plan to establish a new large-scale viral vector manufacturing facility that will be housed on the Worcester campus of the medical school.

The facility will be able to provide large quantities of high-quality recombinant adeno-associated virus vectors for preclinical research, according to a news release from the medical school.

The potential of gene therapy to treat human disease has finally become a reality, said Terence R. Flotte, the Celia and Isaac Haidak Professor of Medical Education, executive deputy chancellor, provost and dean of the School of Medicine and professor of pediatrics. However, the ability to move the field forward to treat additional serious diseases remains limited by the efficiency and flexibility of producing gene therapy vectors suitable for testing in new disease models."

A lack of large-scale vector manufacturing facilities has limited preclinical research capabilities, according to the news release.

Researchers often wait 12 to 24 months to secure enough vector for their research. With this facility, researchers will have access to GE Healthcares processing equipment, helping get research to the clinic faster, the medical school said.

Accelerating research that brings novel cell and gene therapies to patients is the mission of our business, said Catarina Flyborg, the general manager of cell and gene therapy at GE Healthcare Life Sciences. By partnering with UMass Medical School to create this large scale AAV manufacturing facility, we will provide researchers with the tools and AAV needed for pre-clinical research that will advance the cell and gene therapy industry and get therapies to patients faster.

The facility will be 3,220 square feet and will be fully operational in 2020. Four to six professional staff members will manage day-to-day operations, with Sylvain Cecchini, an associate professor of microbiology and physiological systems, as the core director, the statement said.

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UMass Medical School and GE Healthcare establishing manufacturing facility in Worcester - MassLive.com

For many years, the parents of children with autism have reported that behavioral symptoms diminished when the child had a fever. The fever phenomenon has been documented in at least two large-scale studies over the past 15 years, but the reasons behind it have continued to mystify scientists.

Now, a new study by researchers at Harvard Medical School and MIT sheds light on the cellular mechanisms that appear to underlie this phenomenon.

In a study of mice, published Dec. 18 inNature, the researchers found that in some cases mimicking bacterial infection, an immune molecule called IL-17a is released and suppresses a small region of the brains cortex linked to social behavioral deficits in animal models.

Our findings finger the signaling cascade that leads to temporary alleviation of autism-like symptoms upon exposure to inflammatory conditions, highlighting the complex interplay between the nervous and immune systems in neurodevelopmental disorders such as autism, said study co-corresponding authorJun Huh, assistant professor of immunology in the Blavatnik Institute at HMS.

People have seen this phenomenon before [in people with autism], but its the kind of story that is hard to believe, which I think stems from the fact that we did not know the mechanism, saidGloria Choi, the Samuel A. Goldblith Career Development Assistant Professor of Applied Biology and an assistant professor of brain and cognitive sciences at MIT. Now the field, including my lab, is trying hard to show how this worksall the way from the immune cells and molecules to receptors in the brainand how those interactions lead to behavioral changes.

Although findings in mice do not always translate into humans, the study may help guide the development of strategies that could help reduce some behavioral symptoms of autism or other neurologic disorders, said Choi, who is also a faculty member of MITs Picower Institute for Learning and Memory.

The lead authors of the research are MIT graduate student Michael Douglas Reed and MIT postdoctoral fellow Yeong Shin Yim.

Immune influence

Choi and Huh previously explored other links between inflammation and autism. In 2016,they showedthat mice born to mothers who experience severe infections during pregnancy are much more likely to show behavioral symptoms such as deficits in sociability, repetitive behaviors and abnormal communication. They found these symptoms stem from exposure to maternal IL-17a, which produces defects in a specific brain region of the developing embryo. The brain region, S1DZ, is part of the somatosensory cortex and believed to be responsible for sensing where the body is in space.

Immune activation in the mother leads to very particular cortical defects, and those defects are responsible for inducing abnormal behaviors in offspring, Choi said.

A link between infection during pregnancy and autism in the offspring has also been documented in humans. A 2010 study that included children born in Denmark between 1980 and 2005 found that severe viral infections during the first trimester of pregnancy led to a threefold increase in risk for autism, and serious bacterial infections during the second trimester were linked with a 1.42-fold increase in risk. These infections included influenza, viral gastroenteritis and severe urinary tract infections.

In the new study, Choi and Huh turned their attention to the often-reported link between fever and reduction of autism symptoms.

We wanted to ask whether we could use mouse models of neurodevelopmental disorders to recapitulate this phenomenon, Choi said. Once you see the phenomenon in animals, you can probe the mechanism.

The researchers began by studying mice that exhibited behavioral symptoms due to exposure to inflammation during gestation. They injected these mice with a bacterial component called LPS, which induces a fever response, and found that the animals social interactions were temporarily restored to normal.

Further experiments revealed that during inflammation these mice produce IL-17a, which binds to receptors in S1DZthe same brain region shown to be affected by maternal inflammation. The experiments showed that IL-17a reduces neural activity in S1DZ, making mice temporarily more interested in interacting with fellow mice.

When researchers inhibited IL-17a or knocked out the receptors for IL-17a, mice did not experience a reversal of symptoms, a finding that pinpointed IL-17a as the responsible trigger. The experiments also showed that simply raising mices body temperature did not have any effect on behavior, offering further evidence that IL-17a is, indeed, the critical player behind reversal of symptoms.

This suggests that the immune system uses molecules like IL-17a to directly talk to the brain, and it actually can work almost like a neuromodulator to bring about these behavioral changes, Choi said. Our study provides another example as to how the brain can be modulated by the immune system.

Whats remarkable about this paper is that it shows that this effect on behavior is not necessarily a result of fever but the result of cytokines being made, said Dan Littman, the Helen L. and Martin S. Kimmel Professor of Molecular Immunology at New York University, who was not involved in the study. Theres a growing body of evidence that the central nervous system, in mammals at least, has evolved to be dependent to some degree on cytokine signaling at various times during development or postnatally.

Behavioral effects

The researchers then performed the same experiments in three additional mouse models of neurologic disorders. These mice lack a gene linked to autism and similar disorderseitherShank3,Cntnap2orFmr1. These mice all show deficits in social behavior similar to those of mice exposed to inflammation in the womb, even though the origin of their symptoms is different.

Injecting those mice with LPS did produce inflammation, but it did not have any effect on their behavior. The reason for that, the researchers found, is that in these mice, inflammation did not stimulate IL-17a production. However, if the researchers injected IL-17a into these mice, their behavioral symptoms did improve.

This suggests that mice who are exposed to inflammation during gestation end up with their immune systems somehow primed to more readily produce IL-17a upon exposure to other inflammatory conditions later in their life. Choi and Huh havepreviously shownthat the presence of certain bacteria in the gut can also prime IL-17a responses. They are now investigating whether the same gut-residing bacteria contribute to the LPS-induced reversal of social behavior symptoms that they found in the newNaturestudy.

Huh and Chois labs are also exploring whether any immune molecules other than IL-17a may affect the brain and behavior.

Whats fascinating about this communication is the immune system directly sends its messengers to the brain, where they work as if theyre brain molecules, to change how the circuits work and how the behaviors are shaped, Choi said.

It was amazing to discover that the same immune molecule, IL-17a, could have dramatically opposite effects depending on context: Promoting autism-like behaviors when it acts on the developing fetal brain and ameliorating autism-like behaviors when it modulates neural activity in the adult mouse brain, Huh said. This is the degree of complexity we are trying to make sense of.

The research was funded by the Jeongho Kim Neurodevelopmental Research Fund, Perry Ha, the Hock E. Tan and K. Lisa Yang Center for Autism Research, the Simons Center for the Social Brain, the Simons Foundation Autism Research Initiative, the Champions of the Brain Weedon Fellowship, and a National Science Foundation Graduate Research Fellowship.

Adapted from an MITnews release

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Cracking the Fever-Autism Mystery - Harvard Medical School

The University of Michigan has received a $20 million gift from the Maxine and Stuart Frankel Foundation of Bloomfield Hills, Michigan, to support the research and development of life-saving therapies at Michigan Medicine in collaboration with other institutions. The gift, which will be used to establish the Maxine and Stuart Frankel Innovation Initiative, will advance U-M faculty-led, collaborative projects that have the potential for rapid clinical application.

We hope this gift will create an environment that will support collaboration among professionals, said Stuart Frankel. We encourage doctors, researchers, people from engineering and other areas, to work together in hopes of achieving monumental, life-saving research. We want the best minds from the University of Michigan and around the world to collaborate on the most innovative research and take scientific discovery to a new level.

Maxine and Stuart Frankelsgift will ensure that the University of Michigan advances its leadership in cutting-edge research that saves lives in our communities, said U-M President Mark Schlissel. The gift will help us translate scientific discoveries into treatments that can reach patients in need. I appreciate the Frankels generosity and their commitment to both innovation and U-Ms very special role as a top public university.

The Initiative will build on best practices of the standout programs developed at U-M and other top institutions, capitalizing on the universitys extensive biomedical research enterprise as the top public university in research spending in the United States.

We are extremely grateful for this gift, which will allow our researchers to move their cutting-edge therapies and other innovative approaches to improving health faster into the life-saving hands of clinicians and scientists everywhere, said Marschall S. Runge, M.D., Ph.D., executive vice president for medical affairs, dean of the University of Michigan Medical School and CEO of Michigan Medicine.

Michigan Medicine is a leader in translational medicine, and our researchers are renowned for their enthusiasm and expertise when it comes to collaboration, both here at the university and globally. This generous support from the Frankels will go a long way toward accelerating this creative engagement and resulting research to market, said Steven L. Kunkel, Ph.D., executive vice dean for research of the Medical School and chief scientific officer of Michigan Medicine.

The Initiative will be administered by Fast Forward Medical Innovation (FFMI), a unit of Michigan Medicine with deep expertise in moving medical technologies from idea to commercialization.

Through FFMI and a host of other established resources at Michigan Medicine, we are committed to bringing together biomedical innovation and entrepreneurship. As such, we are well-positioned to partner with other institutions to transform the Frankels generosity into results moving from the early stages of research into life-saving therapies, said Bradley Martin, Ph.D., managing director of FFMI.

Maxine and Stuart Frankel, both graduates of U-M, have a long history in philanthropy.

Their latest gift is inspired in part by the groundbreaking work of Robert Bartlett, M.D., professor emeritus in the department of surgery, who is known as the father of ECMO (extracorporeal membrane oxygenation), a revolutionary machine used to replace the function of the heart and lungs in critically ill patients.

Bartlett, with continued support from the Frankels through this gift, is currently working with several collaborators throughout U-M to develop other life support technologies, including work that could increase the viability of organs for transplantation.

More recently, the Frankels have supported the translational research program of H. David Humes, M.D., professor of internal medicine, and his group. This program has developed innovative devices to treat a variety of inflammatory conditions, including systemic infections and sepsis, with very high mortality rates. This gift will continue to support Humes program to develop and evaluate miniaturized devices to treat neonates and infants, the tiniest of patients in the intensive care unit.

Humes and Bartletts work are examples of the collaborative spirit behind the new gift. A clinical trial of Humes pediatric sepsis device is underway at seven hospitals around the country, illustrating that the innovative research pursued at one institution can be bolstered by the work of multiple researchers and institutions. Bartlett is leading a worldwide group of scientists who are trying to solve the limitations to prolonged organ perfusion. Typically, organ preservation by perfusion is limited to six hours, but in laboratory tests, the Michigan team has perfused hearts of animal models for three days.

After meeting Bartlett, Humes, and others, the Frankels recognized that similar high-risk, high-reward research occurring throughout the university could benefit from investment by private enterprise. The gift will be used to fund five to seven projects per year, which will be selected by an oversight committee of internationally renowned scientists and venture capitalists external to U-M. The Frankels will also be involved in this process.

We were most interested in funding research at the initial stages so the scientists are able to have the support to get where they need to go, said Maxine Frankel.

Ultimately, the Initiatives goal is to improve health and save lives. Said Maxine Frankel of the researchers who will be supported through the gift, Theres no stopping them once they have the support that they need. The results could be monumental.

About Michigan Medicine:At Michigan Medicine, we advance health to serve Michigan and the world. We pursue excellence every day in our three hospitals, 125 clinics and home care operations that handle more than 2.3 million outpatient visits a year, as well as educate the next generation of physicians, health professionals and scientists in our U-M Medical School.

Michigan Medicine includes the top ranked U-M Medical School and the University of Michigan Health System, which includes the C.S. Mott Childrens Hospital, Von Voigtlander Womens Hospital, University Hospital, the Frankel Cardiovascular Center and the Rogel Cancer Center. Michigan Medicines adult hospitals were ranked no. 11 in the nation by U.S. News and World Report in 2019-20 and C.S. Mott Childrens Hospital was the only childrens hospital in Michigan nationally ranked in all 10 pediatric specialties analyzed by U.S. News and World Report for 2019-20. The U-M Medical School is one of the nation's biomedical research powerhouses, with total research spending of more than $500 million annually.

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$20M gift from Maxine and Stuart Frankel Foundation to fund innovative research - University of Michigan Health System News