Buffalo Spree Medicine in WNY 2021 by Buffalo Spree

A periodical supplement to Buffalo Spree November 2021

2021

AESTHETIC ASSOCIATES CENTRE FOR PLASTIC SURGERY AND DENTISTRY Roswell tapped to treat WTC first responders

Studying medicine in WNY

Local institutions take on opioid fight

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MEDICINE IN WNY 2021

2021

16 | Roswell tapped to treat WTC first responders

Cancers are prevalent among 9/11 workers and survivors.

P. 22

BY STEVE BRACHMANN

22 | Diversity, inclusion, equity, and access

Increased racial awareness spurs industry change.

BY JANA EISENBERG

30 | Studying medicine in WNY

More options than you might think BY NICOLE CAPOZZIELLO

38 | Making new treatments easier to find

Cardiologist Dr. Irfan Khan leaves private practice to found Circuit Clinical. BY ASHLEY ZIOMEK

42 | Lineage of a virus

P. 38

UB collaborates on variant research. BY NANCY J. PARISI

46 | Aesthetic Associates Centre

for Plastic Surgery and Dentistry A legacy of innovation, education, and service to the community 48 | Book news: women’s

vascular health Surprise! Women are different from men.

BY CHERIE MESSORE

52 | Local institutions take on opioid fight

Programs seek to decrease dependency. BY STEVE BRACHMANN

P. 52

60 | Exploring the vaccine divide

O N T H E C OV E R :

Brothers Samuel Shatkin Jr., MD and Todd Ellis Shatkin, DDS run the center their father founded. Photo courtesy of Aesthetics Associates Design by Nicholas Vitello

PHOTOS BY STEPHEN GABRIS

By listening to both sides BY NANCY J. PARISI

MEDICINE IN WNY 2021

2021

PUBLISHER

Barbara E. Macks EDITORIAL

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A YEAR PAST OUR 2020 MEDICINE IN WESTERN NEW YORK ISSUE, I hoped COVID wouldn’t still be as salient a topic. But while the bad news is that there are COVID stories in this issue, the good news is that vaccines are here—even if they are causing a divide (page 60)—and that Western New York continues to make critical contributions to virus research (page 42) and testing (Circuit Clinical, page 38). Beyond COVID, I continue to be impressed with the contributions our community makes to national and global efforts in all areas. I’m blown away by Dr. Irfan Khan’s company, Circuit Clinical, which grew out of a need to enable patients’ access to clinical trials that can save or improve their lives. Over at Roswell, doctors are studying racial disparities in breast cancer, an important step toward creating better treatment outcomes for afflicted Black women, and Dr. Emese Zsiros has introduced pain management protocols to reduce opioid dependency that are being modeled nationwide. We are making change in our own backyard. As we move toward a safer COVID normal, I hope that Medicine in WNY 2022 can be all about the hope, humanity, and ongoing innovation of our incredible medical community—and we won’t have need for a single COVID story.

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MEDICINE IN WNY 2021

2021

Ashley Snowden, Roswell Director of Physician and Corporate Relations

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ROSWELL TAPPED TO TREAT WTC FIRST RESPONDERS Cancers are prevalent among 9/11 workers and survivors by Steve Brachmann

AMONG AILMENTS THAT PLAGUE THOUSANDS OF

to and survivors of the 9/11 terrorist attacks, cancers are the third-most common. Statistics collected by the U.S. Centers for Disease Control and Prevention (CDC) indicate that about 14,400 first responders and 9,300 survivors have developed cancer, most commonly nonmelanoma skin cancer and prostate cancer. These affect more than 8,500 first responders who were exposed to chemical fires and other hazards during rescue and cleanup missions.

PHOTO BY STEPHEN GABRIS

FIRST RESPONDERS

18 Roswell continued MEDICINE IN WNY 2021

While the World Trade Center Health Program, which was established by the James Zagroda 9/11 Health and Compensation Act, has coordinated healthcare needs for 9/11 first responders and survivors in the New York City area, many individuals have left the Big Apple region in the two decades since the attacks. As of this past July, 1,600 individuals enrolled in the program and living in the western half of New York

State can get cancer treatment through Roswell Park Comprehensive Cancer Center at no cost and without having to trek downstate. “Cancer is an incredibly complex disease to treat,” says Ashley Snowden, Director of Physician and Corporate Relations at Roswell Park. “Then the travel burden on top of that is insurmountable for some patients.” Snowden recalls one individual who

2021

lives locally but had to travel to New York to receive radiation; the radioactivity of the treatment left this individual unable to stay at a hotel, which meant an immediate long trip back to WNY. “Now that we’re approved to provide cancer care through the World Trade Center Health Program, this person only has to drive twenty minutes from home to receive care,” Snowden says. Attempts to include Roswell Park as a WTC Health Program provider predate Snowden’s efforts to get the cancer center approved, which began in summer 2019. Even as of 2008, a technical document at the CDC that governed the WTC Health Program indicated that no centers outside the NYC area could be designated providers. “Our team was told it would take an act of Congress to get into the program,” Snowden says. While no such act has come forth, Snowden did say that Representative Brian Higgins’ office helped to secure Roswell Park’s recent acceptance. Although Roswell Park can now provide federally funded care for 9/11 first responders and survivors in the WNY, it still cannot work as a screening center for the WTC Health Program. Thus, local individuals suffering health impacts from 9/11 have to travel to NYCarea centers of excellence, which are coordinated by the Mount Sinai Health System, before being approved for treatment at Roswell. However, Snowden notes that Roswell does general cancer screening, so first responders can first be screened here using their insurance before making the long trip downstate to get formally approved. Not only is Roswell Park’s location helpful, as it can serve 1,600 WTC Health Program enrollees living in Onondaga County and westward across the state, but the cancer institution also serves local first responders working in hazarous environments, including several highprofile local fires, like the 2008 chemical fire at a pool supply store on Niagara Street and the 2016 blaze that decimated the remnants of Bethlehem Steel. “The hazardous environment during 9/11 had a very specific chemical composition,” Snowden says, “but chemical fires can happen anywhere.”

MEDICINE IN WNY 2021

DIVERSITY, INCLUSION, EQUITY, AND ACCESS ARE IN THE SPOTLIGHT Increased racial awareness spurs industry change by Jana Eisenberg

Paula Cupertino, PhD, leads University of Rochester’s Wilmot’s Community Outreach & Engagement Office

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WITH INCREASED ACKNOWLEDGEMENT THAT

OUR

C U LT U R E ,

POLICIES,

AND

S Y S T E M S A R E R A C I S T A N D E C O N O M I C A L LY

initiatives around issues of diversity, equity, and inclusion are on the rise, including in the critical areas of healthcare and medicine. Whether under the EDI, DEI, DEIA, (the “A,” trending now, is for access) acronym, universities and medical institutions are taking actions like founding or expanding leadership roles, redoubling efforts to reach underserved communities, and emphasizing communities of color in research and clinical trials.

PHOTO BY MATT WITTMEYER

I N E Q U I TA B L E ,

MEDICINE IN WNY 2021 Laurene Tumiel-Berhalter, director of community translational research at UB’s School of Medicine and community liaison Pamela Harold

Diversity continued

Integrating and serving community

At Roswell Park Comprehensive Cancer Center, Elisa M. Rodriguez, PhD, MS, became the institution’s first chief diversity and equity officer for faculty. In her new role, Rodriguez will lead Roswell Park’s effort to build bridges between researchers and community, highlighting the cultural diversity at the institution and in the surrounding area. She also will serve as a resource and provide support for Roswell Park research and clinical faculty from underrepresented groups. And at the University of Rochester’s Wilmot Cancer Institute, Paula Cupertino, PhD, leads Wilmot’s Community Outreach & Engagement Office. She is also the first in her position of associate director of community outreach, engagement, and disparities; she’s also a professor in the school’s Department of Public Health Sciences. “I have worked to address disparities and equity in rural areas of California with Mexican immigrants, in the Midwest and New Jersey, and now in Rochester,” says Cupertino, who has twenty-five years’ experience with this work. “Traditionally, it’s been through grassroots

movements; communities push and drive agendas. With the current momentum, the disasters in Black and brown communities, organizations and leadership at national and state levels are prioritizing this. It’s just common sense that that we need to alleviate the injustice, disparities, inequities, and lack of diversity. “This is a new office, and Wilmot created it with the understanding that system change takes resources, which they are allocating: $3 million to start,” Cupertino continues. “We will work to ensure that business is conducted through an equity lens, grounded in the needs of community and delivering care while acknowledging things like people’s cultures and languages. We all agree that we need new ways to do things; now, what are we going to do?” In addition to bringing resources closer to the community, there is the renewed commitment to actively recruit and train diverse cancer researchers. Cupertino also helps guide Wilmot’s Cancer Community Action Council, a group of more than fifty community members of diverse backgrounds whose feedback and insights will inform Wilmot’s research.

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WHAT’S GOING ON?

Research for outcomes, not research’s sake

Laurene Tumiel Berhalter, PhD, director of community translational research at UB’s Jacobs School of Medicine & Biomedical Sciences, has spent her career conducting research focused on patients with multiple chronic diseases. In addition to goals of improving care delivery, selfmanagement, and increasing access to preventive services, she has aimed to reduce existing care disparities, centering her research in underserved communities with compounded challenges. She agrees with Cupertino that there has been a shift that has created opportunity for change. “In communities that experience disparities, and where there is extreme historical mistrust, positive relationships have been developing,” observes Tumiel Berhalter. “The historical mistrust has forced us—as researchers and in the larger medical community—to recognize and acknowledge, to be more thoughtful about communicating, for example, the vaccine process. We’re playing catchup in many ways, and I hope that these relationships are maintained.” The notion that more traditional entities—versus grassroots organizing or behind-the-scenes research—are driving action is an important one, Tumiel Berhalter agrees: “Now is the time for large institutions to show that they can be trustworthy. How do we, as larger institutions—for example, Kaleida Health, Catholic Health, or UB researchers— partner and develop longstanding relationships? To do that, we need to understand where the community is coming from; that takes manpower.”

PHOTO BY STEPHEN GABRIS

Rx: value-based models

Raul Vazquez, MD, founded Urban Family Practice in 1996; the practice is now an accredited Patient-Centered Medical Home. Vazquez subsequently formed the Greater Buffalo United Accountable Healthcare Network, now serving around 20,000 members, and the Medicaid-certified Greater Buffalo United Accountable Care Organization (GBUACO), based on a patient-centered care model that, with its value-based payment system, raises patient care quality, reduces costs, and streamlines health care delivery.

INSTITUTIONAL AND GRASSROOTS EFFORTS TO INCREASE D I V E R S I T Y, equity, inclusion, and access take time, as everyone

agrees.

Here are a few initiatives underway:

Outreach At the Wilmot Cancer Institute [urmc.rochester.edu/cancer-institute. aspx], Paula Cupertino is shaking up awareness efforts for diverse populations. “We’re no longer sitting at the center waiting for already sick patients,” she says. “We’re doing preventive care efforts, for example, at the mall! I recently spoke with around 100 members of Black and brown communities at a mall because I was where they are. It might be strange, but we have a lot of work to do to prevent cancer, and to ensure that all communities feel welcome.” Advocacy and education In 2010, Laurene Tumiel Berhalter, as part of UB’s research team, connected with a group of patients with multiple chronic diseases who live in underserved areas of Buffalo, and who wanted to be more active in their care. The group formed the Patient Voices Network [patientvoicesbuffalo.com/about/], a grassroots group. Members advocate for themselves, and also offer patient advocacy and provider education/partnering. For example, they’ve increased uptake in people of color seeking and receiving preventive care like mammograms and colorectal cancer screenings. More inclusive research A research team headed by Roswell Park Comprehensive Cancer Center epidemiologist Zhihong Gong, PhD, has been awarded a five-year, $1.9 million grant from the National Cancer Institute for an investigation into the role that certain genetic molecules play in the disparities seen between Black people and white people with breast cancer. This project is the latest among many multimillion-dollar grants earned by Roswell Park to focus on addressing race-based cancer health disparities. Women of African ancestry are more likely than those of European descent to develop aggressive and hard-to-treat breast cancer tumors. “Our study is novel and addresses an understudied area in breast cancer research among this underserved population with the worst prognosis,” says Dr. Gong. Wilmot and Roswell Park Comprehensive Cancer Center [roswellpark. org/] have announced the first large, national study of diverse patients treated with immune checkpoint inhibitors (ICIs); the study aims to fill a gap in the science around people with African ancestry and this treatment, since the original clinical trials included few people of that population. The study will also look at factors like discrimination by providers and health care systems and how often treatment is stopped, to better understand equity and access to high-quality care. — Jana Eisenberg

26 Diversity continued

PHOTO BY KC KRATT

MEDICINE IN WNY 2021 Raul Vazquez, MD, founded Urban Family Practice in 1996.

Vazquez said that while the pandemic made things like testing and administering vaccines somewhat easier, “the core of health equity has not been truly addressed. Our profit-driven healthcare system often delivers care through hospitals, which silos and isolates doctors and patients; they actually have some of the worst outcomes,” he says. “There’s a lack of empathy for community: Black and brown people are seen as cash cows. Look at things like Black and brown maternity mortality. It’s horrible. People are paying for complications, paying for not getting care coordination.” GBAUCO, his accountable care organization, has had success with patients and providers. “We have to hold entities accountable. When we pay institutions and doctors on outcomes, they have skin in the game,” Vazquez maintains. “There needs to be transparency in healthcare costs, based on a consumer model. Consumer-patients can drive what type of care they need.” Beginning in 2017, Vazquez pushed for value-based agreements with insurers and providers. By integrating care coordination, including different visit options, and working to build trust through churches and community-based organizations, they reduced stresses on and barriers for the highest-cost patients, those managing multiple chronic diseases who historically receive the worst care.

“Managing populations more effectively— especially the small percentage of patients who cost the most—by using things like remote visits, teaching them to eat right, and improving their social determinants of health, made us more efficient,” says Vazquez. “We generated $64 million in incentives that went back to the doctors who could then do game-changing things like add staff and other resources. They learned that the more efficient they were, the better. By 2022, physicians and teams will manage ninetyfive percent of the dollars and make decisions based on patient outcomes.” Such thinking needs to be applied at the national and state levels, Vazquez contends: “The Congressional Budget Office and hospitals must adapt the value-based model. They must partner with [accountable care organizations] to really understand the cost for a particular population— figure it out down to ways to buy beds, buy visits, and hire more hospitalists responsible for holding both the patient and hospital accountable. Then you are really taking care of the patient. This is happening across the country and will continue to happen.”

“The time has passed for allowing things like a non-diverse workforce.” The road ahead

“It’s a slow go; things won’t change overnight,” says UB’s Tumiel Berhalter. “We’ve seen movement. But we need to keep practicing, figuring out how to communicate more effectively. We might need to go door to door, learning from conversations. People like having venues to ask questions. They are bombarded by news and information. It’s important to understand what they are not sure about, and what they need and want to know.” Cupertino, of the Wilmot Cancer Institute, reiterates that, after the experiences of the past year and half, there is determination and intention to advance change. “As a society, we have been pushed into an area of discomfort. There is a new awareness, and I imagine that every organization is trying to do better. The time has passed for allowing things like a non-diverse workforce; they are rethinking approaches, knowing they need to have better impact, and find solutions.”

LIVING THE FRONT SEAT LIFE WITH KELLY MARIE WOFFORD

“ M O S T P E O P L E D O N ’ T R E A L I Z E T H E Y H AV E A M E A S U R E O F M E N TA L H E A LT H , ” Kelly Marie Wofford, mental health

peer advocate, coach, and founder of Front Seat Life LLC and podcast, whose message is that that’s something we need to pay attention to—especially now. “Because right now, there’s no consistency,” she says. “As consistent as we want to be, as all these things are opening back up, we still don’t know what to expect and it affects a lot of folks.” This past May, as part of the development of a peer-led model for mental health coaching, Wofford launched Living the Front Seat Life podcast, produced by Jazzy T Williams, lead producer for JazzCast Pros and creator of Hustle for Health programs. It airs every Monday on her website and features local leaders in discussion about food, sleep, sports, grief, loss, parenting. Along the way, you’ll hear Wofford’s own story: after waking from a suicide attempt in 2013, Wofford found renewed faith that led her to active recovery. “For me, because of the type of illness I have, I will never not have it. Borderline Personality Disorder is something that’s always with a person,” explains Wofford, who shares tools that have helped her and her clients establish better mental health:

Be present and breathe “This falls under the category of mindfulness; that’s not always something people are open to until they realize it’s just being here, right now,” says Wofford. “That and focusing on your breath are key. Knowing you can use what you’re going to do anyway to increase your mental health is the easiest thing since sliced bread.” Establish routine There are small things we can do to give our brain order and structure. If they don’t come naturally, a routine helps us remember to take care of ourselves. Set goals Set achievable goals that make room for life. A goal set has a measure of urgency; it’s not “Oh, I’ll get around to it sometime.” The brain likes to know it accomplished something and it feels the difference. Find more inspiration at frontseatlife.com or Instagram @ thefrontseatlife (#bethelight). — Katie Coleman

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MEDICINE IN WNY 2021

STUDYING MEDICINE IN WNY More options than you might think

Studying close to home can reduce the overall cost of a medical education.

PHOTO BY STEPHEN GABRIS

by Nicole Capozziello

W E S T E R N N E W YO R K I S T H E S TA RT O F

that lead to fulfilling careers in the medical field. From pre-med support for undergraduates to master’s degrees and beyond, options abound for students who want to stick close to home and still get the training they need to make a difference. M A N Y PA T H S

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MEDICINE IN WNY 2021 Innovative design at UB’s Jacobs School of Medicine and Biomedical Sciences

Studying continued

The region’s only medical school is University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences. Founded in 1846 and christened with its current name in 2015, Jacobs boasts a roster of 720 medical students. The school is not only known for its affordability but is also ranked ninety-fourth in Best Primary Care programs in the 2022 U.S. News & World Report ranking of America’s Best Graduate Schools, and eighty-first in medical school research. Students in the four-year program have opportunities to serve the local community, including at the Lighthouse Free Medical Clinic, a nonprofit drop-in clinic for uninsured patients managed entirely by medical students. Beyond the classic MD, the Jacobs School offers various joint programs: MD- PhD, MD/MBA, MD/MPH, and a Medical Oral Maxillofacial Surgery Program. In addition to the Jacobs School, health education at UB comprises the schools of Dental Medicine, Nursing, Pharmacy and Pharmaceutical Sciences, Public Health and Health Professions, Social Work, and Roswell Park Graduate Division. UB also offers support to undergraduates in the form of numerous pre-health tracks, including pre-optometry, preveterinary, and pre-physician assistant.

D’Youville

At D’Youville College’s School of Health Professions, students can earn degrees in nutrition and dietetics, health administration and public health, physical therapy, exercise and sports studies, and occupational therapy, or become a physician assistant, chiropractor, or health professions educator. The small college makes a big impact; in 2020, Buffalo Business First ranked D’Youville as second for Largest Buffalo Healthcare Educators, with nearly 2,500 graduate and undergraduate students enrolled in its School of Health Professions, School of Nursing (which offers undergraduate, graduate, and post-graduate programs), and School of Pharmacy. D’Youville’s newly opened Health Hub brings together students and professionals from eight disciplines to provide specialized services for West Side people in need. These services include primary care at Sisters Health Center–D’Youville, Vital Pharmacy, D’Lish Demonstration Kitchen, Thrive Rehabilitation & Wellness Center, and the Center for Health Equity and Innovation.

Canisius

Nearby Jesuit liberal arts school Canisius College is committed to providing all students with wellrounded education, no matter the intended career path. Students interested in medical careers benefit from a broad knowledge base coupled with connections to the Pre-Med/Health Professions support program. Extended learning opportunities include a medical informatics internship, which exposes student to how information functions in healthcare using modern technology. In line with the school’s dedication to service, pre-med and pre-health students can participate in summer medical mission trips to Nicaragua and Costa Rica, where students stay in communities with which Canisius has spent years developing relationships.

UB LAUNCHES NATIONS’ FIRST PHARMACYBASED CLINICAL AND TRANSLATIONAL THERAPEUTICS MASTER’S

ECC

At SUNY Erie County College (ECC), students can choose from a range of certificates and Associate in Applied Science degrees to prepare them for impactful careers in healthcare. To become an emergency medical technician (EMT), medical assistant, or dental hygienist, ECC’s two campuses offer affordable two-year programs with competitive local job placement. Niagara University

Thought not in Erie County, Niagara is close enough to warrant a mention, particularly for its College of Nursing, which offers a traditional four-year program as well as an accelerated oneyear post-baccalaureate degree. In addition, Niagara offers preprofessional programs in optometry, dentistry, human medicine, and pharmacy.

PHOTOS BY KC KRATT

Daemen

Daemen College offers educational opportunities at both the undergraduate and graduate level. Nursing students can choose from a BS program that allows RNs to earn degrees in as few as twelve months or a unique nursing BS program (1+2+1) in which students complete first and last years at Daemen and an associate’s degree in nursing at an area partner community college in between. Pre-med students complete a two-year, handson research experience during which they work one-on-one with a faculty mentor in their area of interest, from forensic science to brain electrical activity. For students interested in community health or health policy careers, the +PLUS Pathways program enhances a BA or BS by allowing students to concentrate their core and elective classes.

C L I N I C A L A N D T R A N S L AT I O N A L T H E R A P E U T I C S A I D

in bridging scientific discoveries and disease treatment. Combining the clinical sciences with rigorous research and therapeutic application is a critical need nationally; according to the National Institutes of Health (NIH), there has been a worrisome decline of clinical scientists with training in both patient care and research. The innovative MS in Clinical and Translational Therapeutics program was created to meet this need and position UB as a leader in developing future clinical and translational researchers. The degree can be combined with a PharmD or other health professions degree and offers five therapeutic areas of concentration: clinical trials, pharmacotherapy, translational pharmacology, experimental therapeutics, and pharmaceutical outcomes. Whatever the student’s area of concentration, the program provides hands-on research training with a focus on skills that prepare students for success across the healthcare sector, from hospitals to the pharmaceutical industry to regulatory agencies. — Nicole Capozziello

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MEDICINE IN WNY 2021

Studying continued

At the graduate level, Daemen offers degrees in public health, physical therapy, and physician assistant, among others. Working nurses have many options for advancing their careers with flexible master’s degree programs in nursing education, nursing executive leadership, an RN-MS accelerated program, and an adult gerontology primary care nurse practitioner. The school also offers unique post-masters certificate programs to help nurses, including international licensed RNs and clinical nurses who become academic faculty, round out their skills. Buff State

SUNY Buffalo State College offers students interested in careers in dietetics and nutrition a choice of three specialized BS degrees and an allonline MS Multidisciplinary Studies, Nutrition Track. The college also offers an undergraduate major in Health and Wellness, preparing students for careers in community health agencies, corporate wellness, or college health promotion. Bryant and Stratton

At Bryant and Stratton College, students can earn full bachelor’s degrees in health services administration, nursing, and medical services management. At the associate’s level, the school offers specialized programs in medical assisting, medical reimbursement and coding, and occupational therapy assistant, among others. Trocaire

Finally, Trocaire College in South Buffalo offers specialized training options in the form of associate degrees, certificates, and baccalaureate programs, including diagnostic medical sonography, echocardiography, healthcare informatics, and radiologic technology, as well as nursing and healthcare management. In March 2020, the college reported that enrollment in its health care programs was up seven percent, growth thought to be driven by increased appreciation for healthcare jobs as a result of the pandemic. While the past year and a half may have felt uncertain, one thing is clear: healthcare jobs are always in demand, and our region has the educational assets to prepare students to fill them.

MEDICINE IN WNY 2021 Dr. Irfan Khan left private practice when he recognized an industry need to help patients access clinical treatment.

MAKING NEW TREATMENTS EASIER TO FIND

Cardiologist Dr. Irfan Khan leaves private practice to found Circuit Clinical by Ashley Ziomek

GROWING

PHOTO BY STEPHEN GABRIS

AMID

FA M I L Y

Dr. Irfan Khan followed suit and, following the usual rigorous medical training, was enjoying a successful career as a cardiologist in private practice—until a family diagnosis prompted him to leave direct care and help patients in a completely different way. “My father had gotten Parkinsons and an Alzheimer’s diagnosis, in relatively short order,” says Khan, who became frustrated when his research on new treatments led to a world of clinical research, but not much practical information on how to get involved. “We really struggled to find opportunities. Even through our networks, it was really difficult. If somebody who can access health care as easily as I can, and who is as healthcare literate as I am, is struggling, then what about everyone else? It must just be totally impossible.” And so in 2016, Khan left cardiology— something he’d never seen himself doing—and founded Circuit Clinical as a way to help patients find and participate in clinical treatment trials. With the help of local colleagues, Khan began examining whether access to research trials could play a broader role in patient care if primary physicians and non-study sites could make direct connections. Under his guidance, physicians who had never enrolled patients in research trials were successful in helping patients find clinical treatment trials to match their needs. More than 13,000 clinical trials are completed annually in the United States. Eligibility standards—qualities patients must and must not have—are established in Phase I, and then presented to a research team, such as Circuit PHYSICIANS,

Clinical, which works on trials in the Phase II, III, IV stages (see sidebar for more on Phases) and continues follow-ups with patients throughout treatment. Once Circuit receives the protocol, it contacts health system partners to identify patients in its network of more than ninety doctors across 300+ site locations. This is a critical piece of the problem because, according to circuitclinical.com, many patients who could qualify for trials never even find out about them as a care option; for example, nearly forty percent of oncology clinical trials never recruit the targeted number of patients. “Rather than bring the patient to the clinical trial, our job is to bring the clinical trial right to where the patient gets their healthcare,” Khan explains. Circuit’s next duty is to ensure that potential research sites, doctors, and nurses have proper training and equipment, such as freezers, rooms, and even translation capabilities for those who don’t speak English as a first language. Once established, the trial can begin. In pairing patients with studies that match their needs, Khan’s goal is diversification— representation of everyone—which he hopes to attain by working his way into many research hospitals and practices and inviting in communities that have historically been overlooked or too scared to participate. “We could be a part of the solution that not only improves general understanding about clinical trials, but also brings that opportunity to people who have never had that before, and that’s really exciting,” says Khan. It took a couple years before Circuit really started taking off. One thing that helped was trialjourney.com, a website that helps people find clinical studies near them; the challenge, says Khan, was creating a site that looks and feels like the websites people love. The user-friendly site operates much like Yelp! by offering not only available trials, but also reviews from people undergoing the trial, and ratings of doctors and facilities. The website is updated daily and its main goal is to provide comfort, ease, and trust in a process that can be intimidating. “You’re entitled to know what your clinical trial option is. We’ve made the commitment to bring the right people together to solve the problem,” says Khan, who notes that people’s biggest concern is the word “experimental,” and he assures, “Nobody is a guinea pig.”

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New treatments continued

Another boon was winning Buffalo’s 2019 43North competition, where startups are provided with guidance for marketing, public relations, and venture capitalists. After that, Khan and his team have gone on to win other accolades, including Ink magazine’s “Best Places to Work.” These successes led to investments and partnerships with large companies such as Labcorp, and now other entities are looking at the company, identifying it as a trustworthy institution. Originally a team of eight, Circuit Clinical now involves more than sixty people who travel regularly to meet with patients and educate them about the benefits and process of clinical trials, and how to be included. In the past five years, it has participated in more than sixty projects spanning ten therapeutic areas, including cardiovascular disease, diabetes, women’s health, kidney disease, digestive diseases, rheumatoid arthritis, cancer, and COVID-19 as part of developing the rapid saliva test that delivers results in under an hour; the study took just ten days as opposed to a typical six months because of the unusually large pool of qualified participants. Circuit Clinical’s interest in oncology has led the company to team with many research sites, including Roswell Cancer Institute. When Khan realized that he had the potential to grow a nationwide network of patient-trial pairing, he soon learned of out-of-state peers who had the same idea. “What I’d like is for Circuit is to have a national footprint,” says Khan, who says the plan is to open multiple offices across the nation within the next twelve to eighteen months. “It’s a very, very big problem, it’s going to take a lot of smart people working on it, and I’m happy to see other people [having success] as they try to solve the problem as well.” “Circuit is not an easy place to work because we’re trying to do very difficult things; it’s a place for inspired people who want to do great work,” says Khan. “I’m very fortunate. I only work on the hardest problems that I want to help solve and I get to handpick the people I work alongside. We think we can be a very successful company if a person gets a difficult diagnosis, they know they can access clinical research as a care option. We invent a lot of our work as we go along and all of it is based on trying to make the world a better place.”

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THE PHASES OF CLINICAL TRIALS

C L I N I CA L R ES E A R C H T R I A LS A R E A P R O C E S S . To get started, research

teams often conduct preclinical studies on cells and animals before seeking Food and Drug Administration (FDA) approval to begin with Phase I. Each of the standard Phases I-IV must meet certain benchmarks before the next phase can begin. Phase I: Dose-ranging begins with eighty to 100 healthy volunteers—with or without the target condition—to test safety over a period of several months. Seventy percent of treatments tested in Phase I move on to Phase II. Phase II: Several hundred volunteers are treated for up to two years and are monitored for efficacy and side effects. Thirty-three percent of treatments move forward. Phase III: Three hundred to 3,000 volunteers who have the disease or condition are treated for one to four years. The larger group is again monitored for efficacy and adverse side effects. Twenty-five to thirty percent of treatments head to the final phase. Phase IV: Several thousand volunteers with the disease or condition are treated and monitored for safety and efficacy. Success at this phase means FDA approval can be sought. — Ashley Ziomek

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MEDICINE IN WNY 2021 Jennifer Surtees (right) and Don Yergeau, with the Department of Biochemistry, in the Jacobs School of Medicine & Biomedical Sciences

LINEAGE OF A VIRUS UB collaborates on variant research by Nancy J. Parisi

A COMPLEX FAMILY TREE IS GROWING IN NEW YORK

Whereas the typical notations of lineage, progenitors, and generations have names attached, the entries on this graph remain anonymous because they represent SARS-CoV-2 positive specimens. It’s these deidentified samples, culled from five state laboratories designated as critical public health hubs, that are teaching us how the virus–and its challenging variants– are moving through communities. University at Buffalo’s Genome, Environment, and Microbiome (GEM) Community of Excellence is one of them.

PHOTO BY DOUGLAS LEVERE

STATE.

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MEDICINE IN WNY 2021

It’s the job of UB associate professor of biochemistry and GEM co-director Jennifer Surtees and her team to sequence the COVID-19 genome. SARS-CoV-2, like all viruses, creates new variants through mutation of its RNA. The samples being sequenced come from Erie County Department of Health, Kaleida Health, Catholic Health, Erie County Medical Center, and KSL Diagnostics in Williamsville. At a rate of 800 samples a week, sequencing— done with a banal-looking rectangular machine with a small screen displaying progress and results—summarizes the atomic-level structure of the molecules under examination. “We get the samples of inactivated virus, extract the RNA and then we need to convert the RNA to DNA,” explains Surtees. “It’s called reverse transcription PCR. Then we amplify the DNA and make overlapping images—fragments across the genome—and then we attach barcodes to all the different pieces. Then the samples are pooled and put into the sequencer. All of those steps, with our pipeline protocol, take seven days.” This past August, Surtees and her UB GEM staff were selected for the statewide $20 million sequencing partnership with the NYS Department of Health Wadsworth Canter in Albany. The four other labs are located at SUNY Upstate Medical University in Syracuse, Cornell University in Ithaca, New York Medical College in Valhalla, and University of Rochester Medical Center. These five labs report their sequencing

results to NYS Department of Health, and the Global Initiative on Sharing Avian Influenza Data (GISAID) based in Munich, Germany. Surtees explains her work in compact office overlooking the massive atrium at UB’s Jacobs School of Medicine and Biomedical Sciences. On one wall of the office, dozens of champagne bottle empties are lined up neatly on a shelf. Each is a memento, she says, of a student’s completion of grueling coursework; her medical school students so value her guidance that many share a toast with her. And, in maternal fashion, she keeps the mementos. “My work researches genome stability,” says Surtees, a former history/theater kid who discovered a love of biology. “It’s studying the ways in which all of our cells maintain genome integrity. The genome is basically all the DNA, an instruction manual, for how it is supposed to function. It’s a very general area that I’m interested in: mutations–when does that happen and when does that get fixed. “A mutation is basically a change in the DNA. There are lots of different kinds of mutations that change the coding information,” Surtees continues. “The CGAT bases can have simple replacements, and you can have deletions or insertions. There can also be inversion rearrangements when a chunk of the DNA is flipped, or there are translocations when part of the chromosome is fused to a different chromosome. I am primarily interested in replication mutations.”

PHOTO BY DOUGLAS LEVERE

Variant sequencing continued

Surtees gave an hour-long Mini Medical School talk, A Second Dose of COVID (available for viewing on YouTube), presented by UBMD Physicians Group, in early 2021. The all-virtual talk had “probably 100 people in it and the participants had a lot of questions.” Accessibly clarifying this complex information, Surtees outlines the life cycle of SARS-CoV-2 (“the copying process”), virus variants, and the process of sequencing. In the latter, Surtees talks about how the viral RNA genome is decoded in her lab by reverse transcription: RNA is translated into the double helix DNA, what most have seen illustrated. “There’s a certain probability that the virus will make a mistake when it’s being replicated,” Surtees explains. “It’s true for us, too. Whenever DNA gets copied, the daughter cell has all the information it needs but there is a chance that there will be some type of mistake. This is actually how evolution works.” Delta variant, first discovered in India in late 2020, accounted for ninety-one-point-nine percent of all COVID cases in New York State as of August 25, and ninety-nine percent throughout the US, according to the U.S. Centers for Disease Control and Prevention. “Delta is out of hand right now because it’s been divided into twenty-five sub-lineages for epidemiological purposes,” Surtees says. Asked what the teams are learning about variants, Surtees explains that “by creating these phylogenetic trees, we can learn how relative they are to each other: are they identical, or are they diverging? We can make predictions about the path that the virus took to get here and based on sequencing that we generated, we know that the virus in Western New York originated through Europe. “It turns out that Buffalo and Manhattan largely came from Italy, with some evidence of it having also originated through France as well,” she continues. “But what we see in Western New York is distinct from what has been observed in New York City, probably because the path of entry was different, with people traveling to different parts of the world and then bringing the virus back home.” Delta took over because of its “selective advantage,” Surtees says. “It’s doing a couple of different things, increasing the rate that it copies itself. Delta is faster and it has a higher viral load—one thousand percent higher—so it’s spread more efficiently. Delta’s spike proteins are better at getting into cells and infecting people. There has been Gamma, and Lambda, and we are up to Mu now.” Surtees says she’s not sure how science will label future variants once the Greek alphabet is exhausted. “There was a surge in Delta variant during the summer spike,” Surtees says. “There will be more spread as we go indoors in the colder months, but can we get this current wave under better control before? That’s an open question. With every infection, there’s a possibility of a new mutation and a more detrimental virus. Containment is critical to avoid new variants of concern.”

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MEDICINE IN WNY 2021 Brothers Samuel Shatkin Jr., MD and Todd Ellis Shatkin, DDS run the center their father founded.

AESTHETIC ASSOCIATES CENTRE FOR PLASTIC SURGERY AND DENTISTRY FOR MORE THAN THIRTY YEARS, the physicians and dentists of the Aesthetic Associates Centre for Plastic Surgery and Dentistry have been caring for the Western New York Community with a full-service practice group specializing in cosmetic plastic surgery and cosmetic and implant dentistry. The center is staffed with a wide range of knowledgeable health care providers, including a board-certified plastic surgeon, dentists, anesthesiologists, physician assistants, registered nurses, dental hygienists, and medical and dental assistants, along with aestheticians. At the helm, brothers Samuel Shatkin Jr., MD, and Todd Ellis Shatkin, DDS continue, expand, and celebrate the legacy of their late father, Samuel Shatkin, DDS, MD, who founded the Centre.

The senior Dr. Shatkin was both a plastic surgeon and a dentist, whose career spanned more than fifty years. He was well-known as an innovator and educator and generous with his talents, performing volunteer plastic surgery at the VA Hospital for twenty-five years, among other service to the community. In 1989, he established the Aesthetic Associates Centre for Plastic Surgery and Dentistry, with his sons joining him in the practice. The Aesthetic Associates Centre medical campus is not just an ordinary medical/dental facility. The 45,000-square-foot facility boasts a complete plastic surgery, advanced skin care and cosmetic dermatology practice, as well as cosmetic dental procedures, including veneers, dental implants and general dentistry. Its one-of-a-kind ambulatory office-based surgery center is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF).

PHOTO COURTESY OF AESTHETICS ASSOCIATES

A legacy of innovation, education, and service to the community

“When you come to our office, we are sincerely interested in your overall wellbeing. Our team focuses not only on the way you look, but your overall health and wellness.” “When you come to our office, we are sincerely interested in your overall wellbeing. Our team focuses not only on the way you look, but your overall health and wellness,” says Dr. Samuel Shatkin Jr. “We at the Aesthetic Associates Centre strive to make you look better, be healthier, and feel better about yourself.” Dr. Samuel Shatkin is a board-certified plastic surgeon and performs all aspects of aesthetic plastic surgery. He specializes in creating a customized and holistic approach to improve his patients’ appearance from the inside out, which often includes using multiple modalities which Samuel refers to as “combination rejuvenation.” Trained in state-of-the-art technologies, including endoscopic facial surgery, and ultrasonic liposuction, he also performs aesthetic breast surgery and implants, tummy tucks, and nasal surgery, among other procedures. Nonsurgical procedures include tattoo removal, laser resurfacing, Botox injections, microdermabrasion, hair removal treatments, and more. Some of Samuel Shatkin’s most notable awards include Newsweek America’s Best Plastic Surgeons 2021 in the fields of liposuction, facelift, and rhinoplasty, “Top Doctors in America” annually since 2013, the Castle Connelly “Top Doc” Award annually since 2012, and “Top Surgeons in America” since 2009. He is the only plastic surgeon in the world to have received the 5-Star Diamond Award from the American Academy of Hospitality Sciences and to date, the only medical doctor to have received the Buffalo-Niagara Business Ethics Award (in 2017). He is president of the International Society of Aesthetic Medical Professionals and trains health care providers in his Aesthetic Learning Academy. The Shatkin family has always been committed to giving back to the community. Samuel and brother Todd consistently sponsor events throughout Western New York. Under Todd’s direction, Aesthetic Associates Centre offers complete restorative implant, miniimplant, and cosmetic dental care for adults and children, including bonding, veneers, bleaching, crowns and bridges, as well as general dental care.

Innovation has been the key to Todd Shatkin’s success. He has developed a patented mini dental implant system to replace missing teeth in one visit: F.I.R.S.T® (Fabricated Implant Restoration and Surgical Technique), and has extensively lectured internationally on mini dental implants and is respected as a world leader on the topic of mini-implants. “Today, more than ever, the exciting treatment concept of mini dental implants has become an integral part of the general dental practice,” says Todd.

“Today, more than ever, the exciting treatment concept of mini dental implants has become an integral part of the general dental practice.” In response, he launched Shatkin F.I.R.S.T., which provides services and education to dentists worldwide. Along with his 2018 implant technology patent, Todd has a patent pending for “Fix on Six” restoration technique. Dr. Todd has also developed a whitening system (iSmile) and aligner system (Krystal Klear Aligners) that are used by patients world-wide. iSmile Spas, headquartered at 2500 Kensington, allows patients to look their best throughout the year. Like his brother, Todd is known for his humanitarian efforts and philanthropy. When the pandemic hit in March of 2020, he saw the need for N95 filtration masks, purchased machines, and set up a local production facility, hiring forty new employees to produce more than 300,000 masks for first responders, doctors, nurses, and other medical personnel in Western New York during the pandemic. Daemen College’s Todd & Leslie Shatkin Institute for Mobility Innovation & Technology will open this spring, becoming the region’s most advanced rehab facility, featuring the world’s leading robotic devices and assistive technology, and made possible by a generous gift from the Dr. Todd & Leslie Shatkin Philanthropic Fund. Aesthetic Associates Centre for Plastic Surgery and Dentistry

2500 Kensington Avenue, Buffalo 716-839-1700; www.gr8look.com

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UBMD SURGEON FOCUSES ON WOMEN’S VASCULAR HEALTH Surprise! Women are different from men by Cherie Messore

IT TAKES A WOMAN TO UNDERSTAND WOMEN.

When it comes to a woman’s health, a savvy team of physicians applied their expertise to support significant research into a critical and often under-studied area: women’s vascular health. Vascular health refers to our circulatory system, and includes artery or vein disorders, or blood disorders that affect circulation. The most common adverse vascular conditions are heart attack and stroke.

For Dr. Linda M. Harris, nationally renowned vascular surgeon at UBMD Physicians Group, scholarship in the field led not only to multiple publications but also was the impetus behind the first Women’s Vascular Summit, which she organized in 2019 with colleague Dr. Mariel Rivero. “We’ve known for a long time that women don’t respond in the same way [as men] to vascular disease,” says Harris, “but there was never a deeper dive as to why.” The summit was convened to study this issue, and the panelists, according to Harris, did an amazing job in leading collective discussions around how men and women differently present vascular disease and related symptoms, and how initial assessment impacts diagnosis and treatment. The discussions were so robust and substantial that Harris and her peers not only held a second—virtual—summit in April 2020, but also sought to aggregate these discussions in a book.

Dr. Linda Harris wants physicians to know how to treat women’s vascular health issues.

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UBMD surgeon continued

Vascular Disease in Women: An Overview of the Literature and Treatment Recommendations was published by Drs. Harris and Caitlin W. Hicks, MD, associate professor of surgery at Johns Hopkins University School of Medicine. The contributing participants were all summit panelists and are all women. “This is the first book of its kind that examined this topic in depth,” says Harris. So-called classic symptoms of heart attack and stroke have always been based on men. Key to the book’s reported findings is that women display variations from those “typical” warning signs and, consequently, may be not seen as quickly, prescribed different or wrong treatment, or even dismissed. Also, women are often older when symptomatic and may be living alone: symptomatic men are often married and brought to the hospital by a partner when experiencing classic symptoms. “Doctors weren’t taught to look at other symptoms,” says Harris. “The idea now is to help people understand the reason why there is a difference.” While the book is penned with the medical professional in mind, Dr. Harris proffers some solid advice: •

If you’re having symptoms or just feeling poorly, go to your doctor. Discuss your symptoms. Don’t self -diagnose.

•

Know your family history and share it with your doctor.

•

If you have high risk factors— diabetes or you’re a smoker, etc.—take care of yourself. Manage your diabetes, quit smoking, stay well hydrated, exercise. No need for a triathlon, Harris says; even a brisk walk will help.

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BestSelfWNY.org

Roswell, Spectrum programs seek to decrease dependency by Steve Brachmann

Roswell’s Dr. Emese Zsiros developed a pain management program that limits opioid prescriptions.

THE MEDICAL USE OF OPIOID PAINKILLERS has a long history that extends well back through the mid-nineteenth century, perhaps most notably with morphine used to treat soldiers wounded on Civil War battlefields, many of whom came home with drug dependencies. Today, a new opioid epidemic has taken root, buoyed in large part by decades of overaggressive prescriptions and misrepresentations by companies like Purdue Pharma over the addictive qualities of drugs like Oxycontin. The U.S. Department of Health and Human Services recently estimated that 10.1 million Americans over the age of twelve misused opioids in 2019. That same year, 70,630 people died from drug overdoses and nearly 50,000 deaths involved the use of synthetic opioids other than methadone. Reducing patient risk for opioid dependency is crucial at the outpatient phase, especially post-surgery. At Roswell Park Cancer Institute, doctors and surgeons are committed to new pain management guidelines for postoperative patients and, as of this past June, they have led to a forty-five percent reduction in opioid prescriptions while maintaining high levels of patient satisfaction during recovery. The new pain management protocols were first developed in Roswell Park’s gynecological oncology group and led in large part by Dr. Emese Zsiros, who was born in Hungary and completed much of her medical training in the European Union prior to residency and postgraduate fellowship in the US. “In the EU,” says Zsiros, “many countries don’t allow for the prescription of opioids for treating pain during recovery unless there is chronic, intractable pain.” In 2016, with media coverage on the nationwide epidemic on the rise, she was inspired to combat excessive opioid prescription here.

PHOTO BY STEPHEN GABRIS

MEDICINE IN WNY 2021

LOCAL INSTITUTIONS TAKE ON OPIOID FIGHT

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Shanon Schwarberg and Anne Bowback, from Spectrum Health and Human Services

Opioid fight continued

In New York and many other states, doctors can prescribe up to seven days’ worth of an opioid regimen for pain treatment. Often, the opioids are prescribed to be taken once every three or four hours, which means patients can be prescribed anywhere from sixty to seventy pills without raising a red flag for state health officials. Cancer patients are frequently exempt from the sevenday limit, making opioid dependency a critical issue to address at Roswell Park. Led by Zsiros, doctors at Roswell Park committed to not prescribe more than three days’ worth of opioids for surgical patients. Many minimally invasive procedures include no opioids as part of recovery, while some other procedures—like mastectomies—are allotted only a single day’s worth. “If patients still experience pain after three days, we reassure them that they can call in and get another prescription,” Zsiros says. “If they call again after that, we ask them to come in because there’s probably an issue with their recovery.” Patient-facing staff at Roswell Park are also trained to consult with patients on pain management, emphasizing that ibuprofen and other over-the-counter medications can also be effective. According to Zsiros, the new opioid prescription protocols are having a real effect not

only in reducing patient refill requests, but also in decreasing the rate at which patients convert to chronic use. Data collected by Roswell shows that the percentage of patients requesting opioid refills prior to the protocol’s implementation was twenty-one percent; after the protocol was implemented, the number fell to seventeen percent. General research data shows that 6.5 percent of American patients undergoing major or minor surgery convert to chronic opioid use post-recovery. Under Roswell’s new protocols, only 2.6 of patients converted to chronic use, and Zsiros says that more current research data being prepared for medical conferences shows even better outcomes than that. The opioid prescription protocols developed at Roswell Park have generated buzz and interest from the medical community as patient outcome results appeared in medical journals and were presented at conferences. Zsiros notes that the protocol can be implemented in any surgical center and Roswell Park fields several calls a week from other institutions looking to implement the protocol. Although New York and other states limit opioid prescriptions to seven days, other states have no such limits so this protocol could have even greater preventative effect in regions with fewer legal guardrails for patient safety.

Drug Abuse Research & Treatment (DART) 1237 Main St., Buffalo, 14209 DART’s history of treating WNYers goes back to 1971 and the center currently provides both treatment services as well as connections to other human services providers. DART, near Buffalo Niagara Medical Campus, is a program of the Community Action Organization of WNY, headquartered in North Buffalo on 45 Jewett Ave. Hope House Peer Recovery Respite Center 344 Walnut Ave., Lockport, 14094 Peer support services offered through Hope House in Lockport help alleviate mental health issues that keep people locked into cycles of substance abuse. The location offers respite beds for relief from stressful living situations, qualified mental health professionals trained for therapeutic interventions, wellness coaching, group counseling sessions, and a recovery warm line that helps addicts deal with mental health triggers and can provide hospital diversion if necessary. SEVERAL MEDICAL AND HEALTHCARE CENTERS

throughout Erie and Niagara counties offer treatment for opioid dependency and substance abuse. Although these programs serve different neighborhoods, each is contributes to the destigmatizing opioid dependence and addressing related health issues. Many accept Medicaid and Medicare for low-income individuals.

PHOTO BY STEPHEN GABRIS

Colton’s Journey to Liberation (cjtol.com) This is not a center but a comprehensive resource to help opioid users and their families find treatment and support, better their lives, connect services to those in need, and generally raise awareness that changes the conversation around substance abuse. You’ll find a complete list of inpatient, outpatient, methadone, detox, and residential treatment centers here, as well as complementary care options like support groups and holistic health. Alba de Vida Substance Abuse Treatment Program 254 Virginia St., Buffalo, 14201 A program of Hispanos Unidos de Buffalo (Hispanics United of Buffalo), this center offers medication-assisted treatment to reduce opioid dependency as well as comprehensive behavioral health services to help clients find housing, build interpersonal relationships, and take part in social activities.

NorthPointe Council 800 Main St., Suite 2A, Niagara Falls, 14301 For fifty years, NorthPointe Council has served the needs of substance abuse patients in Niagara Falls by offering addiction recovery services or connecting individuals with various drug abuse prevention affiliates. NorthPointe’s First Step Center, located at 2470 Allen Avenue in Niagara Falls, is open 24/7 and offers twenty-four beds, each medically monitored or supervised to ensure detoxification in a sober environment. NorthPointe’s methadone clinic, located in the Trott Access Center at 1001 11th Street, provides medication-assisted treatment for reducing withdrawal symptoms. Personalized Recovery Oriented Services (PROS) at BestSelf Behavioral Health 3176 Abbott Rd., Suite 500, Orchard Park, 14127 2101 Spruce St., North Collins, 14111 254 Franklin St., Buffalo, 14202 The PROS program, implemented at BestSelf locations across the Southtowns and in Buffalo, is dedicated to creating individual recovery plans for those rebuilding their lives after substance abuse. These include goal acquisition, one-onone counseling, medication-assisted treatment, housing assistance, and vocational training. These sites also offer Cognitive Enhancement Therapy (CET) programs designed to help patients develop mental patterns that reduce drug dependencies. — Steve Brachmann

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WNY SUBSTANCE ABUSE TREATMENT CENTERS

Buffalo Adult & Teen Challenge 124 Locust St., Buffalo, 14204 Located near the Fruit Belt neighborhood, Buffalo Adult & Teen Challenge has provided drug and alcohol abuse prevention programming since 1978. The program caters to men ages eighteen-plus and has a Christian focus that includes Bible studies and work projects, although the residential care program accepts applicants without regard to background or religious creed.

MEDICINE IN WNY 2021

2020-2021

Opioid fight continued

Drug abuse is a mental health issue that was exacerbated by the COVID-19 pandemic; isolation from real-life social networks is thought to have contributed to an uptick in local rates of overdose. While rates of opioid-related overdose deaths in Erie County had been declining from a peak in 2016, there was a fifty-seven percent increase in Erie County from 2019 to 2020 leading to 245 deaths locally. For those currently battling addiction, organizations like Spectrum Health & Human Services are making great efforts to both increase the safety net for chronic opioid users and destigmatize their medical condition. According to Ann Bowback, Clinical Director of Spectrum Health’s South Buffalo Counseling Center at 2412 Seneca Street, healthcare professionals at the center perform a comprehensive assessment of each patient walking in the door. For patients suffering from opioid or other substance abuse, the center typically recommends individual and group counseling sessions and will provide medication-assisted treatment designed to help patients control their dependencies. Within the next six months, Spectrum Health’s Seneca Street location will begin offering a comprehensive outpatient program for substance abuse patients. While the pandemic has contributed to rising drug use across the country, improvements to telehealth platforms have made it easier for Spectrum Health to counsel patients with opioid and other substance abuse issues. While remote telehealth services are provided by all Spectrum Health facilities, Bowback noted that in-person visits are beneficial to patients because they provide a face-to-face personal connection. Spectrum Health also provides peer support services from individuals who have lived experiences with addiction, either their own or a loved one’s. Spectrum Health is also looking at expanding this unique resource in the local community.

going to work or engaging in social activities. There’s less opportunity for someone to intervene if a patient is alone.” While Spectrum Health has been making strides to expand access to Narcan training, medication-assisted treatment, and counseling services, Schwarberg says that a lot of her work has focused on damage control in the face of increased substance abuse during the pandemic. There is no correct time to begin seeking treatment for opioid dependency; any efforts to reduce dependency decrease risk of encountering opioids laced with dangerous substances like fentanyl. “People coming here for treatment are generally mandated to do so or they’re at the end of their rope,” says Bowback, who urges treatment for even moderate users because it can help them manage withdrawal cravings, avoid regular and dangerous searches for drugs, and generally help them rebuild parts of their lives that drug dependency has taken from them. “There are patients who try multiple times to get clean, and each time they’re learning different things about how to manage their condition. So even if they’ve tried treatment before and feel like it didn’t work, there’s always hope that they can live healthily and build a life they can enjoy.”

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Narcan, a nasal spray form of the opioid overdose medication naloxone, has been an effective in keeping chronic opioid users alive. A nationwide study published in 2018 by the medical journal Addictive Behaviors linked the enactment of state laws increasing naloxone access to a fourteen percent reduction in overdose deaths in states enacting those laws. Shannon Schwarberg, Senior Manager of Special Projects at Spectrum Health and a certified Narcan trainer, has worked with the Erie County Department of Health in recent months to develop an opioid overdose prevention program designed to train not just medical personnel but also those close to users in how to save their lives. “We make sure that medical staff members are equipped to respond to overdoses,” Schwarberg says, “but we also train clients and their support system, including any significant others or friends who may be around them if and when they’re likely to overdose.” The recent uptick in Erie County overdose deaths reinforces an aspect of substance abuse that has been hard for the US healthcare system to address. “One of the things we’re seeing consistently in fatal overdoses is that people are using alone,” Schwarberg says. “With social distancing orders during the pandemic, many chronic users aren’t

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MEDICINE IN WNY 2021

EXPLORING THE VACCINE DIVIDE By listening to both sides by Nancy J. Parisi

12.7 million people had received the COVID-19 vaccination in New York State (sixty-five percent): sixty-one percent of the total Erie County population age twelve and older are fully vaccinated. And yet the COVID-19 vaccination divide, like other polarizing issues of our time, is causing rifts among friends and family. While finding empathy for opposing choices regarding political or public health issues can be daunting, the following vignettes present different viewpoints that might help. There is fear and anger on both sides of the vaccination divide; let’s listen. AS WE WENT TO PRESS,

I hesitated when the vaccine was offered to me. I am a caretaker of my elderly mother and was with her when she received her first Pfizer shot in March of 2021 and was told that, as it was the end of the day at the clinic, leftover vaccines would be discarded. So I got the shot. My mother and I went together for our second shots: I felt hazy for the next day or so but she felt great. I did worry about the side effects and wanted to wait and see how it affected others. I see a naturopathic physician in Canada and will ask him if I need to do anything—like a cleanse— to prevent any long-term damage to my body, so I guess I’m not a total vaccine believer. However, I’m glad to have had the vaccine. I am concerned about others who are choosing to not get it. The vaccine is not 100 percent effective, but it’s clear that it saves lives. I know that when I did ask friends who were vaccine-adverse about their positions, they were defiant and felt persecuted. I think that says a lot. 1

As a cashier, I’m exposed to people all day long. When I could, I got the vaccine right away. I’m the only person in my family who’s vaccinated and, yes, I do worry about my family members but I can’t change their minds about the vaccine. 2

The unvaccinated have a different perspective and I am not going to lie: I was on the fence. I wanted more data. The first shot I got was in April at my cardiologist’s office and the second one was in August. I wanted to wait as long as possible between shots; Canada was doing that, waiting longer between the vaccine doses. I got vaccinated so that I could travel to visit my older relatives. Some of my relatives are not vaccinated and for them it’s not a political thing, but personal choice. When we get vaccinated, we’re protecting older people in our community. It’s all about time and waiting to see what happens. I feel like we have to move forward and we do need to get vaccinated. When my kids were little, I staggered their vaccination programs; I didn’t want everything done at once. It’s about finding a balance that works for you, with respect for others. 3

I live in the city and have not been vaccinated but am going to go soon. I have an autoimmune disorder and have had terrible reactions to vaccines in the past; even the shot for tetanus made me sick for a whole week. When I do get the shot, I’ll go to my doctor’s office and they said that they will have me sit there and they’ll observe me for a while. I have been keeping an eye on how many reactions others with autoimmune issues that are the same as mine have had. I’ll warn work ahead of time when I am getting the shot, and in case I do get sick from it, I’ll make sure that I have a friend stay with me. 4

People around me started getting sick and I have an app that updates every day, COVID Alert NY, and watched that cases in Erie County were going up and up. I was a little bit scared and afraid of having to quarantine because of the virus. It was hard to accept that one shot would keep me safe from all of this. My parents, who are in their sixties, lost a few friends to COVID. People who I know who are my age and who are conservative don’t want the shot. It doesn’t really make sense, to not respect life by getting vaccinated but wanting to be pro-life. Many were influenced by Trump, who promoted that viewpoint. I was hardcore about the vaccine and got my second shot exactly three weeks after the first one. I am really happy knowing that I am not going to die from COVID. Or from misinformation or fake news. 5

I’m unvaccinated. I had COVID in March of 2020, with all of the flu symptoms, for about a week after I traveled to Costa Rica. I feel pretty healthy and don’t want to be down a couple days after getting vaccinated. I would consider getting vaccinated but I believe my own immunity is better to fight the virus 6

than getting the shot. That’s my opinion. The only way I would get the vaccine is if I need it to travel out of the country. I do have an autoimmune disease, rheumatoid arthritis, and am nervous that the vaccine would make it worse. I know that people who get both shots can still get COVID: I think the bodies of healthy people will adapt to the virus over time. I believe it’s inevitable that people will get it eventually. We are an unvaxxed family: me, my wife, and our kid, who we are homeschooling. I do work with the public at events but feel I am able to socially distance and mask to keep me safe. When I’m not working, we are pretty much home. I feel concerned about the data about the vaccine and feel that it’s a shot, not a vaccine, because you can still get COVID. We live a healthy lifestyle, eat healthy food, and take care of ourselves. I think it’s like catching a cold and we don’t intend to be vaccinated. 7

I believe in choice. There’s a danger when we start overreaching into other people’s gardens and start dictating what they need to look like and how they need to be tended to. My mother taught me the true definition of freedom: to suffer or to accept the natural consequences of the actions that you make. When you’re unvaccinated, you are making a choice based on what you need for your life and you have to accept those consequences. I was vaccinated recently but because I live a fairly isolated life, I didn’t feel it was a pressing need. But [Buffalo businessman and civic leader] Mark Hamister’s death really rocked me to the core. He was a man I really respected and on his deathbed, he said, “I made the wrong call.” My grandchildren can be carriers and I want to spend time with them. So to minimize my risk, I am vaccinated. 8

I am concerned about the side effects of the vaccine, namely the microscopic bloodclots in the lungs [info here: uofmhealth.org/coronavirus/ blood-clots-and-covid-19-vaccines]. The mRNA travels to other parts of your body and they’re not entirely sure what happens then, where it attaches to cell walls [info here: nebraskamed.com/COVID/where-mrnavaccines-and-spike-proteins-go]. I believe there is not enough research yet. I have educated myself as much as I could about COVID and the vaccines. I did take care of my boyfriend when he had COVID but I believe that I didn’t get sick because of my gut health, that I had more protection from the virus. I am vegan and am careful about what I eat: I believe that vegans have better health and are better prepared to fight COVID. My boyfriend is vegan now. My whole family is vaccinated and they do get very upset with me. 9

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MEDICINE IN WNY 2021

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