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No. 2 Photo: Courtesy Women & Infants  Joanna M. Cain |
She's the One
New chair of ob/gyn appointed.Joanna M. Cain, MD, has been appointed chair of the Department of Obstetrics and Gynecology effective October 1. She will also be chief of Obstetrics and Gynecology at Women & Infants Hospital and the inaugural assistant dean for Women’s Health Programs at Alpert Medical School. She is stepping into the position upon the retirement of Donald R. Coustan, MD.
Cain will relocate from Oregon, where she has been professor and chair of the Obstetrics and Gynecology Department at Oregon Health and Sciences University (OHSU) and the Julie Neupert Stott director of the OHSU Center for Women’s Health, a National Center of Excellence in Women’s Health since 2001.
“Dr. Cain is an internationally recognized leader in women’s health. She is passionate about providing the best health care for women and about caring for women with cancer. She is extremely involved in academic medicine and is interested in resolving ethical issues in medicine,” says Constance A. Howes, president and chief executive officer of Women & Infants’. “We are thrilled she has accepted our offer to come here.”
After completing a residency in obstetrics and gynecology at the University of Washington, Cain went on to become the first woman to complete subspecialty training in gynecologic oncology at the Memorial Sloan-Kettering Cancer Center in New York.
Cain has spent much of her career battling women’s cancers, and was the first woman and first American to chair the International Federation of Obstetrics and Gynecology (FIGO) Committee for Ethics in Women’s Health, the only international committee of its kind. She also chairs FIGO’s Committee for International Cervical Cancer Prevention. She was the first woman president of the Association of Professors of Gynecology and Obstetrics and is past president of the Council of University Chairs of Obstetrics and Gynecology.
“What excites me about Women & Infants Hospital is the opportunity to really expand and develop the model of the very best care that women can possibly have, on a national and international level,” Cain says.
Not So Fast
New research suggests bipolar disorder is over-diagnosed.A study released in early May by a team of Rhode Island Hospital and Brown researchers reports that fewer than half the patients previously diagnosed with bipolar disorder actually had the mental illness. The study, originally published online in the Journal of Clinical Psychiatry, stands in stark contrast to widely reported, recent research that indicates bipolar disorder is seriously under-diagnosed.
Led by principal investigator Mark Zimmerman, MD, associate professor of psychiatry and human behavior and director of outpatient psychiatry at Rhode Island Hospital, the research team interviewed 700 psychiatric outpatients between May 2001 and March 2005 using a comprehensive, standardized tool of psychiatric diagnosis—the Structured Clinical Interview for DSM-IV (SCID). Patients also completed a self-administered questionnaire that asked whether they had been diagnosed previously with bipolar disorder by a health care professional. Of the 700 patients, 145 reported a previous diagnosis of bipolar disorder, but of those, fewer than half, only 43.4 percent, had the diagnosis confirmed by the results of the structured clinical interview. Because bipolar disorder is known to have a genetic component, Zimmerman was able to verify his findings using data regarding family history of bipolar disorder.
“The results of this study suggest that bipolar disorder is being over-diagnosed,” Zimmerman says. Such instances are cause for significant concern given the serious side effects of mood stabilizing drugs—the standard treatment for bipolar disorder—which include possible impact to renal, endocrine, hepatic, immunologic, and metabolic functions. Patients and physicians are both susceptible to the misdiagnosis. Some patients “are looking for a magic pill that will cure all ills,” Zimmerman told the Providence Journal, as a way to skirt the difficult work of psychotherapy. For their part, clinicians are inclined to diagnose disorders they feel more comfortable treating.
“The increased availability of medications approved for the treatment of bipolar disorder,” Zimmerman notes, “might be influencing clinicians unsure whether a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication responsive. This bias,” he continues, “is reinforced by the marketing message of pharmaceutical companies, which has emphasized the literature on the under-recognition of bipolar disorder, and may be sensitizing clinicians to avoid missing the diagnosis of bipolar disorder.”
Zimmerman concludes that clinicians should use a standardized, validated assessment method like the structured clinical interview to diagnose bipolar disorder.
Help for the Homeless
Emergency Medicine docs reach out.On June 25, faculty and residents from the Department of Emergency Medicine performed a Community Service Day at Crossroads Rhode Island. The mission of Crossroads Rhode Island is to assist the homeless and disconnected on their journey toward a better quality of life. The volunteers helped install a garden in the rear area of the building.
The clinical department wants “to raise awareness and create empathy” for homeless individuals and families in Rhode Island, who compose approximately 4 percent of the patients the faculty treat in the Emergency Department. In the U.S. about 7.5 percent of the general population will become homeless at some point in their lifetime.
Many homeless and disadvantaged people use the ED as their main point of access to health and social care. The Department of Emergency Medicine’s residency program teaches its residents to demonstrate an awareness of and responsiveness to the larger context of health care and the system resources available to provide care to the homeless population in Rhode Island.
Brain Trust
International group convenes at Brown.By Kris Cambra
The Society for Research into Hydrocephalus and Spina Bifida held its 52nd annual meeting on the Brown campus in June. Experts from around the world met to present and discuss forty-three papers and twelve posters on hydrocephalus and spina bifida. Interest in the Society’s activities has surged in recent years, spurred by an international quest to find innovative ways to treat cerebrospinal fluid disorders. Professor of Clinical Neurosciences Conrad E. Johanson served as the meeting organizer.
Hosting this high-profile international conference at Brown was partly to introduce a newly developed hydrocephalus center in the Department of Clinical Neurosciences. Activities of the center will include basic research of several animal models of hydrocephalus, as well as clinical investigations of CSF disorders.
We're Banking on It
BioBank experts converge on campus.By Kris Cambra
More than eighty faculty members, scholars, and industry representatives packed the auditorium in the Laboratories for Molecular Medicine on April 30 for the day-long conference “Banking for the Future.” The panel of distinguished experts and key stakeholders from the Brown academic medical center met to discuss best practices in the banking of biologic material for the purpose of genome-wide association studies.
The forum was a key step forward in Brown’s plan to establish the nation’s first population-based biorepository, which would store DNA samples from 20,000 to 25,000 Rhode Islanders.
Speakers at the forum included Paul Downey, director of operations for the UK BioBank. The United Kingdom is recruiting 500,000 people to seed its national biorepository. Representatives from Brown included Stephen L. Buka, an epidemiologist who explained the benefits of biobanking in a state like Rhode Island, and Maureen Phipps, an obstetrician gynecologist from Women & Infants’, who explained how the hospital, which has one of the largest obstetrical services in the country, is uniquely positioned to collect genetic samples for a birth cohort.
Patrice Milos, PhD, chief scientific officer of Helicos, discussed the innovations and technological advances under way that will make high throughput analysis of the samples faster and cheaper. Presenters also addressed the need for electronic medical records in order to tie clinical data to the genetic samples, giving a better picture of the relationship between genes and environment and the predisposition to disease.
Milos, who completed a post-doctoral fellowship at Brown, told the audience, “If there’s one state that can link genomic information with clinical information, this is the state that can do it.”
With Highest Honors
The Class of 2008 recognizes its best teachers.As is Alpert Medical School tradition, the Class of 2008 bestowed a number of awards upon the faculty who most closely guided their medical education. Most of the awards were presented at the class’s graduation dinner on May 24, while the highest honor—the Senior Citation—was given during Commencement exercises at the First Unitarian Church on May 25.
MULTICULTURAL FACULTY AWARD
David Anthony, MD (Family Medicine)
FACULTY AWARDS
Brian Alverson, MD (Pediatrics)Luba Dumenco, MD (Pathology and Laboratory Medicine)
Kelly McGarry, MD (Medicine)
Julie S. Taylor, MD (Family Medicine)
PROFILES IN COMPETENCE AWARDS
Amos Charles, MD (Medicine)Luba Dumenco, MD (Pathology and Laboratory Medicine)
Thomas Bledsoe, MD (Center for Biomedical Ethics)
RESIDENT AWARDS
Michael Connolly, MD (Surgery)Cara Mathews, MD (Obstetrics and Gynecology)
SENIOR CITATION
Clinical Professor of Medicine and Community Health Edward R. Feller was honored with the prestigious Senior Citation for the fifth time. He is co-director of the Community Health clerkship and director of the Division of Gastroenterology at The Miriam Hospital. His primary interests are teaching and medical education, especially fostering student involvement in medical writing for publication and presentation. His clinical focus is on underserved populations.
The text of the citation, presented to him by Rushabh J. Modi MD’08, read:
We pay tribute today to you, Dr. Feller, a person who can only be described as the full embodiment of a true and trusted mentor. For your abiding commitment to our education, betterment, and well being, the Class of 2008 presents you with the Senior Citation Award.
All arduous and sustained journeys require compassionate and committed guides to illuminate the way ahead. Dr. Feller, you are the best of that tradition.
Teaching pathophysiology and community health, you have enhanced our understanding of the science of medicine. You recognize the value of our voices being heard. Thus, you have supported our research and advocated for our presence at conferences. And in our hours of need when we struggled with illness, you were the caring friend who always listened, demonstrating that putting people first is not just good bedside manner but also a wise philosophy on how to live.
Your rare blend of friendship, support, guidance, and respect has enriched our years here in Providence. It is at the heart of that which makes Brown’s Medical School special for all of us. Generous with your time as well as your home phone number, you have managed to do all this with no detriment to your family or love of running marathons.
You once said that helping medical students is your personal way to contribute to the good of the world. We are all better physicians and better people because of that sentiment. In times like this, when the expanse of our indebtedness to you is fully apparent, all we can say is thanks, thanks, and ever thanks. It is our sincerest hope that while we will leave Brown today as physicians, our heartfelt gratitude for all your help and encouragement will not. In that spirit, the MD Class of 2008 is extremely proud to present to you, Dr. Feller, with its highest honor, the Senior Citation.