impact
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Dean’s Report 2018–2019 harvard medical school
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2 1 Message from the Dean 2 Education 10 Discovery 14 Affiliates 16 Academic and Clinical Affairs 18 Reach 21 Campaign Update 22 Honors and Awards 23 HMS Leadership 24 Facts and Figures 25 Financial Report
On the cover: Hetal Verma (left), instructor in radiology at Cambridge Health Alliance, in the interventional radiology lab with second-year MD students Ameen Barghi and Tiffany Minors during their principal clinical experience. Inside cover: HMS students and faculty participate in a White Coats 4 Black Lives demonstration.
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George Q. Daley, HMS Dean
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DEDICATED TO SERVICE
SHAPIN
arvard Medical School was founded in 1782 by innovative thinkers, including John Warren, a Continental Army surgeon during the American Revolution. Today, the School flourishes thanks to educators, students, scientists and practitioners who embody the same passion as its founders. All are fiercely committed to serving humanity by advancing knowledge, improving health care and saving lives. Now, in an era marked by the startling pace of new discoveries and the proliferation of ever-advancing technologies, HMS faculty and students are not only the standard-bearers of a proud legacy but also the cartographers of a bold new future. Our School is at the epicenter of the most dynamic network of research and discovery in the world. In the past year, our scientists on the Quad and at our affiliated institutions have made transformative discoveries—from determining how cancer evades and thwarts the body’s immune system to uncovering new insights into the mysteries of bacterial drug resistance. Our educators are ensuring that our dynamic curriculum, which melds basic, translational and clinical science, is producing tomorrow’s trailblazers. Our students are passionately advocating for patients and for greater health equality while engaging in wide-ranging research— from probing the effects of environmental pollutants on vulnerable populations to developing molecular tools that can be used to engineer cell-based oncology therapies. Our commitment to service involves extending HMS knowledge to an expanding group of learners worldwide through innovative technologies and educational opportunities. We continue to initiate programs around the world that link teaching, research and service to address some of the world’s most threatening diseases, such as malaria and tuberculosis. New initiatives revolve around advancing our capabilities in datadriven science and optimizing our ecosystem for therapeutic discovery, ensuring that promising basic science insights can and will be translated into new treatments. We are expanding and deepening our research infrastructure, investing in cross-disciplinary collaborative research, and enhancing therapeutically oriented and translational research education. And we are doing all this in an environment where people are deeply committed to diversity and inclusion, in a culture where every single individual is empowered to thrive. Harvard Medical School remains devoted to producing the knowledge and ideas that promise a healthier world for all people. Our achievements reflect our shared dedication to education, discovery and service, and I am pleased to highlight in this report some of the past year’s remarkable accomplishments. n
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education
Michael Dougan (left), instructor in medicine at Massachusetts General Hospital, and Stephanie Dougan (right), assistant professor of microbiology and immunobiology at Dana-Farber Cancer Institute, co-teach an immunology course.
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Dean’s Report 2018–2019 3
INTEGRATING RESEARCH AND CLINICAL CARE
Could early exposure to peanuts possibly prevent peanut allergies in high-risk infants? In a new Harvard Medical School immunology course, two groups of third-year students debated the pros and cons of the question this year. “This course took us to the edge of what we know in the field of immunology again and again. Our course directors pushed us to generate our own hypotheses, envision our own theories and question existing paradigms. There is so much still to discover,” said Cannon Society student Andrew Foley. “And how exciting is that?” The immunology course is among eight new advanced integrated science courses (AISCs) introduced for the 2017–18 academic year, designed to help students evaluate new research advances and incorporate them into their clinical decision making as physicians. In the Pathways curriculum, two AISCs are now required for the MD degree. “I think the students really had their eyes opened through these courses,” said Stephanie Dougan, assistant professor of microbiology and immunobiology at Dana-Farber Cancer Institute and one of the two teachers leading the immunology course. “Whenever trial data come out, you have to make a decision about how safe you feel extrapolating that to your patient.” All AISCs are team taught by faculty drawn from HMS basic science departments and HMS-affiliated hospitals. With 19 students enrolled, the immunology course met five times a week for four weeks—three days in the classroom, two days in hospital settings—and was co-taught by Dougan’s husband, Michael Dougan, an instructor in medicine at Massachusetts General Hospital. “The major value for people who are going to become practicing doctors is to see how fundamental concepts in basic science apply to clinical medicine,” said Michael Dougan. “If you don’t understand where these things come from, it’s hard to understand the new medicines you’re working with.” “The AISCs are one of the most exciting things happening at HMS because students are at a new developmental point in their education,” said Dean for Medical Education Edward Hundert, the Daniel D. Federman, M.D. Professor in Residence of Global Health and Social Medicine and Medical Education. “They’ve learned quite a bit of medicine through their time on the wards. Now they are back in the classroom, guided by basic science faculty and clinician-scientists, exploring the boundaries between the known and the unknown in biomedicine.” Developed by basic science and clinical faculty from across the School, the eight AISCs offered during the students’ third and fourth years cover cancer biology, regenerative medicine, neurobiology, translational pharmacology, computationally enabled medicine, human genetics, immunology, and microbiology and infectious diseases. Next year’s courses will include translational biomedical engineering, global health delivery science, and metabolism, nutrition and lifestyle medicine. “Physicians have to incorporate new advances into their clinical care,” said one of the lead faculty AISC developers, John Flanagan, professor of cell biology. “But they also must provide leadership in terms of directing research toward the most pressing clinical problems and unmet needs.” n
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Digital Course Management (since 2015):
430
courses 14 academic programs Users: 2,400 faculty 4,000 students OASIS student information: 8,200 users 250 advanced clinical electives Evaluations: 71,000 Mediasite: 2,200 videos 420,000 views 54,000 hours
PROGRAM IN MEDICAL EDUCATION
Innovation and Impact Over the past four years, Harvard Medical School has been transitioning to an innovative medical education curriculum. In the Pathways curriculum, foundational courses are provided in the first year, clinical clerkships in the second year, and advanced science courses combined with advanced clinical clerkships and a scholarly project in the final two years. Other initiatives led by the Program in Medical Education are now taking shape to support the overall goal—to train wellrounded physicians capable of solving problems and shaping novel therapies that benefit patients. The following are among the new initiatives: Advanced Integrated Science Courses: To heighten the relevance and impact of medical concepts presented to students, the School’s new team-taught courses pair the research challenges of a major area of medicine with clinical care for patients who have related conditions, such as cancer or immunologic disorders (see related story on this page). Entrustable Professional Activities: With HMS clerkships taking place at multiple hospital affiliates and with students rotating through several medical services, the School’s clerkship site directors have adopted a standardized tool that measures how well each student is building core professional skills. The goal is to ensure that all students receive comparable clinical training across all sites and develop suitable competencies of entrustable behaviors, such as correctly entering orders into a patient’s record, prioritizing differential diagnoses, interpreting lab tests and recognizing scenarios that require urgent care. Unconscious Bias Training: All HMS students are required to take a course that educates them about unconscious biases, providing them with tools that can help adjust habitual patterns of thinking. The training is designed to help students improve their own ability to identify and address discriminatory behaviors as they embark on their medical careers.
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STUDENT LIFE
Raquel Sofia Sandoval’s cab was blocked by a mass of sign-carrying protesters taking part in a nationwide women’s march. They were moving toward Boston Common as she headed back to her hotel from her Harvard Medical School admissions interview. Sandoval decided to get out and join them. As an immigrant, a Latinx woman, an artist, a community worker and a first-generation-in-medicine student, Sandoval, Class of 2021, said the two coinciding events reflected her own march to becoming a physician. “I want my medical career as a physician to be another manifestation of my activism,” Sandoval said. As a University of Pittsburgh undergrad, Sandoval worked for a labor union and several social-service nonprofits. Once she arrived at HMS, she was concerned about making a place for herself at the School, “But now here we are, making the most of it and doing the most to uplift our communities.” Sandoval jumped right in, attending a prematriculation community program where first-year HMS students are introduced to under resourced neighborhoods around Boston. There she met about 70 other students also interested in activism and community service. She joined the Racial Justice Coalition, a student group she now co-leads with classmate Titilayo Afolabi. Together they presented at a faculty workshop on microaggressions titled “Negotiating Racism at the Bedside.” She’s also been involved in demonstrations supporting HMS students who are part of the Deferred Action for Childhood Arrivals program, commonly referred to as “Dreamers,” and gun violence victims, and she is part of the White Coats 4 Black Lives movement. “I want to be a physician, and I want to be a physician who empowers—but I also want to be an advocate,” she said. Sandoval is working to ensure that institutional and cultural change takes place at HMS, collaborating with faculty to integrate elements into the Pathways curriculum that will ensure that all classroom voices, particularly women’s, are heard and valued equally. As a result, for the incoming Class of 2022, conversations about classroom dynamics were part of orientation and were woven into the Introduction to the Profession course. Sandoval and her fellow students also developed a practice in which female and underrepresented students regularly encourage each other in class when one of them has been particularly insightful or shared knowledge successfully. This has benefited all students, Sandoval said. “It’s a special way to build community and to be supportive and empowering.” Inspired by social justice mentors at HMS, Sandoval said the School is equipping her for the leadership role in medicine she has always envisioned for herself. “One of the ways that I can leverage these privileges that I’ve been given is to take on leadership positions and institute systemic changes,” she said. “It would be amazing to see me, or someone like me, as the dean of a place like this.” n
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EDUCATION Dean’s Report 2018–2019 5
STUDENT AFFAIRS
Enriching the Student Experience The Office of Student Affairs, headed by Dean for Students Fidencio Saldaña, assistant professor of medicine at Brigham and Women’s Hospital, continues to enhance the career aspirations of HMS students, and this year achieved the following: Student Spaces: Completing two major renovations to the Tosteson Medical Education Center (TMEC), HMS unveiled a new study space adjoining the TMEC atrium. The Student Study and Collaboration Center was designed for all medical, dental and graduate students. Wellness Initiative and Task Force: Fostering and supporting student resilience and well-being, this program is guided by HMS faculty and students in the Wellness Student Interest Group, which organizes on-campus activities. This collaborative effort includes the academic societies and University Health Services. Social Justice: This year, the Racial Justice Coalition student group advocated on a wide range of issues, such as championing the cause of four HMS medical students affected by the nation’s Deferred Action for Childhood Arrivals (DACA) immigration policy and working with course directors to increasingly incorporate health equity and social justice into the curriculum (see related story on facing page).
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Academic and Career Counseling: Conceived by students and faculty from HMS hospital affiliates, a new academic and career advisory group links students to specialty-specific faculty advisers who usher them through selecting and applying for residency programs nationwide.
Facing page: First-year student Raquel Sofia Sandoval working on rally posters for a White Coats 4 Black Lives demonstration.
READ THE STUDENT ESSAYS: hms.harvard.edu/hms-students
HMS Students
Objective Structured Clinical Examinations: Drawing from a pool of 185 faculty applicants, this year HMS selected 65 core faculty to observe and assess medical students’ clinical skills during standardized patient Objective Structured Clinical Examination sessions, which are designed to evaluate students’ ability to complete tasks such as taking a medical history, performing a physical examination, communicating with patients, and making diagnostic and treatment decisions. Faculty Peer Coaching: Encompassing every venue in medical education—classroom instruction, research mentoring, clinical clerkships and other teaching settings—this year HMS introduced a faculty development model that taps into the pedagogical skills of experienced teaching faculty who can coach others on effective ways to present educational materials.
“To my amazement, the surgeon aroused the patient in the midst of the procedure and asked her to speak so that he could observe the movement of the vocal folds.” Elliana Kirsh MD 2019 CANNON SOCIETY
“Students are enabled to address different challenges in medical education throughout the world having gained a unique perspective at HMS.”
“Human suffering from disease often takes the same shape and form, but the tools we have to mitigate that suffering can be hugely different.”
Bao Le
Rumbi Mushavi
MMSC-MEDICAL EDUCATION 2018
MD 2019 CASTLE SOCIETY
“The innovative mindset of a researcher, the disciplined yet flexible spirit we were developing as Air Force officers, were all translatable to improving everyday medicine.”
“We are able to make a significant impact on patients’ lives and on their health in ways that sometimes others cannot.” Damari Croswell MD 2019 PEABODY SOCIETY
Ronit Malka MD 2019 LONDON SOCIETY
“We have the opportunity to act and give a voice to issues where human rights are contested, where justice is absent.”
“Creativity was welcomed, and everyone’s unique perspective moved the team closer to an answer. It was thrilling.”
Dalia Larios Chavez
Ayano Kohlgruber
MD 2019 HOLMES SOCIETY
PHD 2018 IMMUNOLOGY
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GRADUATE STUDENTS SHAPE GLOBAL SOLUTIONS
Elsie Karmbor-Ballah, a Liberian physician, was alarmed. The maternal mortality rate in her country had climbed, from 578 to 1,072 deaths per 100,000 live births between 2000 and 2013. Childbirth was ending tragically for mothers like Queeta, a patient who hemorrhaged postpartum. Carried for two hours in a wheelbarrow to the nearest clinic, another six hours passed before Queeta arrived at a hospital via ambulance. She had already died. “Cases like Queeta’s motivated me to help reduce maternal mortality in Liberia,” Karmbor-Ballah said. In Harvard Medical School’s two-year Master of Medical Sciences in Global Health Delivery program, Karmbor-Ballah studied social medicine, management and research methods in her first year. In her second year, she spent eight months in Liberia executing her mentored research project and then returned to HMS to write and defend her thesis. In 2018, she was one of 48 graduates awarded an MMSc degree by the Program in Graduate Education. Eleven were global health professionals. Challenges abound in Liberia. Following the 2013–16 Ebola outbreak in West Africa, there were only 234 physicians to serve a population of 4.6 million in Liberia. The health care system is still recovering from 14 years of civil war, which ended in 2003. After two years at the C.B. Dunbar Maternity Hospital in Bong County, Karmbor-Ballah was asked in 2013 by the Ministry of Health and Social Welfare to be one of two physicians serving Grand Gedeh County. She headed the county health team while continuing to work at Martha Tubman Memorial Hospital. When the Ebola virus erupted, she led the county’s incidence-management system fighting the disease. Other challenges emerged. “If the road is good, for some people it is a 10hour drive to our 118-bed hospital,” she said. “But if the road is bad, it can take a day or more to get through the dirt and mud. Many have no transportation at all.” During the quantitative arm of her master’s study, Karmbor-Ballah examined 258 maternal death records. Causes included hemorrhage, obstructed labor, sepsis and hypertension—all largely preventable if prenatal and postpartum care were more accessible. Approximately 74 percent of these patients made it to a health care facility but then died there. Recorded data were often inadequate. To better understand why women were dying, Karmbor-Ballah’s study recommended standardizing forms. In the qualitative arm of her study, she traveled to 11 of 15 Liberian counties. She conducted 44 in-depth interviews with peripartum mothers, families of deceased women, and health workers, learning about issues that prevent effective maternal care: transportation delays, staff attrition in rural areas, lack of drugs and medical supplies, and difficulty paying trained traditional midwives. Now back home, with new knowledge and training, Karmbor-Ballah hopes to implement real change. “Improving transportation for health services, hiring and training more doctors and nurses, retraining traditional midwives as community health workers, and improving access to supplies would help save lives,” she said. n
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EDUCATION Dean’s Report 2018–2019 7
GRADUATE EDUCATION
Expanding Programs and Services For the past decade, HMS has been strategically organizing and expanding its graduate education programs. Under the leadership of Dean for Basic Science and Graduate Education David Golan, the George R. Minot Professor of Medicine at Brigham and Women’s and professor of biological chemistry and molecular pharmacology, accomplishments include the following: Growth and Shared Interests: The Division of Medical Sciences trains scientists in six PhD programs: biological and biomedical sciences, neuroscience, immunology, virology, speech and hearing bioscience and technology, and bioinformatics and integrative genomics. In collaboration with Harvard Faculty of Arts and Sciences departments, PhDs are offered in biophysics, chemical biology and systems biology. HMS has helped to shape two other collaborative life science PhD programs: biological sciences in public health at the Harvard T.H. Chan School of Public Health and biological sciences in dental medicine at the Harvard School of Dental Medicine. Program directors for each PhD program meet regularly to discuss resource sharing, curriculum development, student advising and mentoring, and career advisory services. Curriculum Fellows Program: Since its inception more than a decade ago, this training program has enrolled 30 fellows who are active in many areas of graduate and medical education. During their threeyear fellowship, they design and implement creative approaches to improving a specific academic area of education. Many of the fellows go on to leadership positions at medical and graduate schools nationwide. Master’s Programs: The School offers seven master’s degree programs, with a total enrollment of 188 in the past academic year, granting Master of Medical Sciences degrees in the concentrations of clinical investigation, immunology, medical education and global health delivery (see related story on facing page), as well as a Master of Bioethics and a Master of Biomedical Informatics. The Master of Healthcare Quality and Safety program enrolled its first class in September 2018.
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Enrichment Programs: Among many successful programs offered by HMS and its partners, the Leder Human Biology and Translational Medicine Program has attracted 163 doctoral students since its inception. It focuses on translating basic science discoveries into new ways to diagnose and treat disease. The Harvard Therapeutics Graduate Program has had 72 PhD students participate since it launched seven years ago. The program develops interconnected themes leading to new drug discoveries, placing its students in a two- to four-month internship in biopharmaceuticals, clinical investigation or regulatory science (see related story on page 10). Now entering its third year, the Molecular Mechanistic Biology concentration has an enrollment of 27 PhD students. The Harvard Graduate Program in Bacteriology, a new training grant program spanning HMS and the Harvard Chan School, currently supports 63 PhD students. In the past four years, the Landry Cancer Biology Consortium and Research Fellowships have drawn more than 100 faculty and 300 PhD students from across the Harvard Integrated Life Sciences programs, which explore how interdisciplinary fields of study can contribute to a deeper understanding of cancer biology. Recommendations for the Future: HMS spent the past year conducting an extensive review of graduate education. The review engaged more than 100 faculty, students and staff on nine subcommittees, each chaired by a leader of one of the School’s PhD or master’s programs, to broadly examine the nine PhD and seven master’s programs that serve more than 1,000 graduate students. The committee’s draft report, finalized in fall 2018, recommends expanding training and infrastructure to support graduate student mental health, adopting policies to better support diversity and inclusion, and supporting faculty to improve training and mentorship. Broadly, the review recommends that all graduate students should have access to the same services regardless of their home program or degree.
Facing page: In Liberia, Elsie Karmbor-Ballah examines a 22-yearold patient who was 9 months pregnant; this was the patient’s first pregnancy and fourth prenatal care visit. Below: Students present their work at the annual HarvardMIT Program in Health Sciences and Technology Student Research Forum.
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EXECUTIVE EDUCATION
As a premed student in college, Irene Nyavor (MDiv, ’08) had an unexpected realization—medical school might not provide the best path for her to solve the larger problems she wanted to address in health care. “If I had become a doctor, I often would be seeing patients at just one point in their lives, when they’re already in the hospital,” she said. “I wanted to keep people out of the hospital.” Nyavor studied economics instead, focusing on the myriad consequences of income inequality. She grew determined to increase access to education and thereby improve overall health for low-income patients. After earning her master of divinity at Harvard and working for nonprofits, she became a program manager on the Google health search team, the group responsible for helping people find relevant and authoritative health information when they search the web for information on conditions such as “the flu” or “asthma.” Nyavor sees Google as a way for all people to access reliable health information. Now, Harvard Medical School has given Nyavor and her colleagues an invaluable opportunity to ensure that such technological innovations are designed to be as effective as possible for doctors and patients. During a custom five-day program in April 2018 organized by Nyavor and HMS Executive Education, part of the Office for External Education, 40 people from Alphabet Inc., the parent company of Google, participated in classroom discussions and clinical immersions where they worked to gain firsthand knowledge of current challenges and opportunities in real-world health care delivery. “The better we understand health care, the more impact we can have,” said Nyavor. “Even though we often collaborate with doctors in developing products, for those of us who do not have medical backgrounds, coming to HMS means that the challenges doctors and patients face aren’t abstract for us anymore. We’re able to draw on firsthand experience when thinking about the needs of patients and providers when it comes to seeking health information.” The program was the latest in a series that the School’s Executive Education team has been designing and delivering for national and global companies that want to deepen their health care expertise, including GE, athenahealth, Amgen and Takeda Pharmaceuticals. Offering a mix of patient and physician perspectives and the latest research and discussions of best practices for innovation at every level of health care, the programs provide access to the unique strengths, knowledge and diversity within the HMS community. “We provide an up-front view of the art and science of how medicine is practiced day to day—an opportunity to witness those hidden aspects of health care that are hard to understand or even know about unless you’re on the inside,” said Stanley Shaw, associate dean for executive education and assistant professor of medicine at Brigham and Women’s Hospital. n
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EDUCATION Dean’s Report 2018–2019 9
EXTERNAL EDUCATION
Providing Insights and Expertise
Irene Nyavor, MDiv ’08, program manager on the Google health search team, in the Executive Education custom program for Google in April 2018.
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Through the Office for External Education, led by Dean for External Education David Roberts, the Steven P. Simcox, Patrick A. Clifford and James H. Higby Associate Professor of Medicine at Beth Israel Deaconess Medical Center, Harvard Medical School is now providing broad access to its peerless and constantly evolving body of medical knowledge. With School faculty providing firsthand expert clinical insights based on breakthrough research and best practices, this expertise is now available to business and science leaders, pre-health career learners, clinicians, and individuals seeking to increase their working health care knowledge. A global network of millions of learners and annual revenues totaling more than $50 million are demonstrating that diverse audiences are eager to access the vast knowledge and expertise of HMS. Executive Education: HMS exposes business and science leaders working in health care to the real-world practice of medicine and to new trends in science and health care delivery. In the past year, custom Executive Education programs were designed and delivered for organizations ranging from Google (see related story on facing page) and Amgen to other Fortune 100 companies in pharma and health care IT. An HMS open-enrollment program called Functional Genomics and Drug Discovery attracted 35 industry leaders in senior executive and other management roles. HMX Online Learning: Helping students jump-start careers in health care, the HMX Fundamentals portfolio expanded with a new pharmacology course added to existing 10-week courses in physiology, biochemistry, immunology and genetics. This year, HMX ran more than 40 programs for thousands of learners around the world, and an increasing number of U.S. and international universities and medical schools are making the courses available to their students. Designed for professionals, including corporate learners, HMX Pro is a new series of online courses that offer highly relevant, frontline information on medical science. Each focused module requires 10 to 20 hours of learner time and covers topics such as human genetics, cancer genomics and immunotherapies.
Fast Facts HMS faculty who contribute to and teach with External Education:
1,000+
Doctors and allied health professionals who participated in continuing medical education activities in the past year: 42,000+ Unique monthly website visitors to Harvard Health Publishing: 7 million External Education program participants: 100+ countries across 6 continents
Harvard Health Publishing: Demand for reliable consumer health information is reflected in the growth of Harvard Health Publishing (HHP). With 7 million monthly website visitors, well over 2.3 million Twitter followers and more than 500,000 subscribers to its weekly digital newsletter, HHP is expanding offerings with specialtytopic e-reports and interactive online learning courses. Postgraduate Certificate Programs: HMS offers a growing catalog of certificate programs that help physicians, clinicians and clinician-scientists worldwide acquire the latest skills and knowledge in their fields. Programs are delivered in innovative blended formats that meet the needs of busy professionals, with in-person sessions taking place at HMS and at other locations across the globe. Topics include clinical research, patient safety and quality, cancer biology and therapeutics, health care leadership and medical education. Master’s Degrees: A new one-year program leading to a Master in Healthcare Quality and Safety launched in September 2018. It prepares clinicians to lead quality improvement and safety initiatives while striving toward excellence in health care delivery, patient outcomes, and evidencebased best practices. The Master of Medical Science in Clinical Investigation program provides training in the methods and conduct of clinical investigation for future leaders in patient-oriented research. Nearly 50 physicians have enrolled in this two-year program, which prepares participants to launch research careers upon graduation. Continuing Medical Education: In March 2017, this program received a six-year Accreditation with Commendation from the Accreditation Council for Continuing Medical Education. It offers physicians and other health care providers a best-in-class catalog of pedagogically innovative and authoritative learning opportunities. The recently launched CME Online hub features an array of accredited and nonaccredited courses for doctors, researchers and other health care professionals. More than 42,000 doctors, nurses, nurse practitioners and allied health professionals participated in HMS CME activities in the past year. n
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discovery
ACADEMIA MEETS INDUSTRY
David Remillard, a PhD candidate in Harvard’s chemical biology program, was studying a family of proteins that contain gene-regulating regions known as bromodomains (BRDs). Some, if blocked with drugs, appear to turn off otherwise difficult-to-target genes, such as those driving cancer. Remillard’s efforts to design BRD inhibitors led him to the lab of Nathanael Gray, the Nancy Lurie Marks Professor of Biological Chemistry and Molecular Pharmacology in the Field of Medical Oncology at Dana-Farber Cancer Institute. Gray’s work focuses on developing small molecules for important biological targets. “My area of focus has been pioneered in equal parts by academia and industry,” Remillard said. “I wanted the chance to see what life and science are like and how people operate in industry. That, for me, was the selling point for the HMS Therapeutics Graduate Program.” This HMS certificate program offers full-time internships that provide students with real-world experience in drug discovery and development, reflecting the School’s leadership role in modernizing PhD training in the biosciences. Scientists at the Novartis Institutes for BioMedical Research (NIBR) were interested in a protein closely related to the one Remillard was studying. During his NIBR internship, Remillard worked to develop small molecules that specifically inhibit that protein. “It was a short project, but it ended up being very actionable,” he said. “I was able to take my ideas to different teams and draw on areas of expertise that are far from my own.” Collaborating with NIBR scientists, Remillard used basic biology and structural modeling insights to create and test candidate compounds, ultimately succeeding in his goal. “It’s kind of like building a key that fits only this one lock,” Remillard said. “With a small-molecule inhibitor, we can now ask fundamental questions about the activity of this protein, and maybe develop something that could one day be a drug.” His internship over, Remillard returned to Gray’s lab to complete research and write his dissertation. He has accepted a postdoctoral position at the Scripps Research Institute. His time at NIBR gave him an invaluable perspective. “In academia there are conceptions about industry, but one of my most exciting takeaways was seeing the breadth of basic science that was going on,” he said. “It’s often discussed that not a lot people can get academic professorships after their PhDs,” Remillard said. “But there are incredible opportunities to do basic science at the highest levels in industry as well as academia.” n
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Dean’s Report 2018–2019 11
SCHOOL-WIDE INITIATIVES
Therapeutics Initiative: To leverage a growing interest in translational opportunities, Harvard Medical School convened the Strategic Therapeutics Task Force, which defined three broad goals: enable the HMS community to more effectively identify therapeutic targets and strategies; formulate small molecules, proteins, antibodies, genes and cells as therapeutic candidates; and evaluate therapies through translational proof of concept. The Harvard Therapeutics Initiative is being created to pursue these goals. Harvard-MIT Center for Regulatory Science: This inter-institutional program aims to accelerate the development of therapeutics for serious unmet medical needs. Located in the newly expanded Laboratory of Systems Pharmacology (LSP), the Regulatory Science Center has launched interdisciplinary fellowships and research programs combining medicine, engineering, data science and public policy. The effort is overseen by Peter Sorger, the Otto Krayer Professor of Systems Pharmacology, head of the Harvard Program in Therapeutic Science (HiTS) and founding director of the LSP. National Cancer Institute Center for Cancer Systems Pharmacology: Also based in the LSP, this new center pools the expertise of basic and translational biologists, clinical oncologists, pathologists and computational scientists. The team characterizes interactions among immune and cancer cells, with the aim of identifying therapies that combine immuno-oncology and other types of drugs to optimally treat aggressive tumors in individual patients. Dean’s Innovation Grants in the Basic and Social Sciences: This year, HMS has awarded $14 million in grants to support collaborative research at the School, ensuring that HMS remains at the leading edge of basic biomedical and translational research. Substantial additional investments in innovative projects are planned over the next few years. Technology Platforms: The new Harvard Cryo-Electron Microscopy Center for Structural Biology—a collaboration between HMS, Harvard University, Boston Children’s Hospital, Dana-Farber Cancer Institute and Massachusetts General Hospital—features instruments that reveal atomic-level structures of the molecular machinery of cells at cryogenic temperatures to enable in-depth
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understanding of molecular mechanisms in normal and disease states. Plans also are underway to augment other sophisticated imaging technologies across Harvard. Therapeutics Education and Partnerships: To generate novel approaches in industry, HMS created iHub, which partners faculty, students and trainees with industry and finance experts, working in ideation sessions, seminars, symposia and coursework. It complements the Harvard Therapeutics Graduate Program (see related story on facing page). Harvard Longwood Life Lab: The School’s plans include building incubator opportunities, including a shared laboratory space for high-potential life-science projects and biotechnology startups, which will accelerate discovery and connect researchers with business, legal and intellectual property counselors. HARVARD CATALYST | THE HARVARD CLINICAL AND TRANSLATIONAL SCIENCE CENTER
Harvard Catalyst celebrated its 10th anniversary with a newly awarded $89 million grant from the National Institutes of Health. Headed by Dean for Clinical and Translational Research Lee Nadler, the Virginia and D.K. Ludwig Professor of Medicine at Brigham and Women’s Hospital, Harvard Catalyst works to advance initiatives that strengthen the bridge between discovery science and improving human health. Examples include: Education and Training: Creating a roadmap to success for the next generation of clinical and translational (C/T) researchers, Harvard Catalyst helps investigators and trainees navigate career development through course offerings, fellowships, grant-writing workshops and mentored research experiences. Translational Innovator: To identify novel technologies and build collaborative partnerships, Harvard Catalyst is studying the impact of connecting researchers with groundbreaking technologies and resources. The effectiveness of external collaborations for crowdsourcing ideas and perspectives is also being explored. Bioinformatic and Regulatory Tools: Among innovative informatics platforms that accelerate clinical trials, Harvard Catalyst provides leadership in SMART IRB, a national platform facilitating single IRB
Facing page: PhD candidate David Remillard works out a chemical equation in the lab.
(Institutional Review Board) review for multisite studies, and Accrual to Clinical Trials (ACT), which helps researchers design and complete clinical studies across a national network of C/T research centers. OFFICE OF TECHNOLOGY DEVELOPMENT
The Harvard Office of Technology Development (OTD) fosters innovations arising from research with the aim of developing products and services that benefit society. Committed to fulfilling each lab’s vision of translational impact, OTD advances and executes strategic commercialization plans to achieve transformative benefits for patients. Through OTD’s corporate partnerships, the Blavatnik Biomedical Accelerator, technology licensing and the launch of new startups, HMS biomedical innovations enter preclinical and clinical development poised for success. This year, OTD created research alliances with leading biotech and pharmaceutical companies studying infectious diseases and other disease areas. The Blavatnik Biomedical Accelerator sped development of commercially promising technologies through awards to nine HMS labs. OTD also launched 21 startups university-wide, a record number. For example, from the lab of George Church, the Robert Winthrop Professor of Genetics, eGenesis Inc. has licensed innovations in genome engineering that could make pig organs safe for transplantation into human patients. To promote this culture of entrepreneurship, OTD launched Entrepreneur-in-Residence and Bench-toBusiness Boot Camp programs. BIOLOGICAL CHEMISTRY AND MOLECULAR PHARMACOLOGY
Structure of Safety Scissors HMS researchers have deciphered the atomic structure of ADAM10, an enzyme that plays a critical role in normal cell-to-cell communication. When malfunctioning, it is implicated in neurodegenerative diseases such as Alzheimer’s, asthma and certain cancers. ADAM10 is one of 22 ADAMs, short for “a disintegrin and metalloproteinase,” made in the human body. These scissorlike enzymes typically help cells respond to their environment by cutting other proteins on the cell surface. When functioning normally in the brain, ADAM10 helps process amyloid
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I DISCOVERY
precursor protein in such a way that it doesn’t become amyloid beta, the plaque-forming substance believed to drive Alzheimer’s disease. In work published in Cell, Stephen Blacklow, the Gustavus Adolphus Pfeiffer Professor and chair of the Department of Biological Chemistry and Molecular Pharmacology, with Tom Seegar, instructor in the department, and Andrew Kruse, associate professor of biological chemistry and molecular pharmacology, used x-ray crystallography to uncover a fail-safe mechanism that prevents ADAM10 from cutting proteins with abandon. These findings will help researchers understand how ADAM10 works normally and what happens when it goes awry, identifying new strategies for treating diseases fueled by its malfunction. BIOMEDICAL INFORMATICS
Graduate Education Academic Year 2018–19 Total PhD students: 889 Entering PhD students: 145 Total master’s students:
286
Entering master’s students: 150
proteins’ structures has been challenging. In the first of two papers in Nature, a team led by Maofu Liao, assistant professor of cell biology, used cryo-EM to reveal how the membrane protein MsbA transports lipopolysaccharide, which is critical to the antibiotic resistance of Gram-negative bacteria. The second study showed how the membrane protein Hrd1 helps form a channel to move potentially harmful misfolded proteins out of the endoplasmic reticulum into the cell’s cytoplasm for degradation. The molecular details of these protein machines have provided unprecedented insights into their functional mechanisms and will aid targeted drug development. GENETICS
drugs called fluoroquinolones, but results can take up to eight weeks. By contrast, point-of-care molecular tests provide results within hours. A retrospective study of patients in Peru was co-led by Carole Mitnick, associate professor of global health and social medicine, and Maha Farhat, assistant professor of biomedical informatics and a pulmonologist at Mass General. The findings, published in Clinical Infectious Diseases, provide early evidence that molecular tests could soon become a mainstay and a faster alternative to traditional testing for helping clinicians choose the best drug, with specific focus on fluoroquinolones, and predicting the clinical course of a patient’s TB infection.
Variable Sensitivities to Cancer Genes
HEALTH CARE POLICY
Analyzing the records of 1.5 million families, a big data study led by HMS scientists has for the first time quantified the likelihood that a family that has one child with autism would have another child with the same disorder based on the siblings’ gender. Published in JAMA Pediatrics, the results confirmed previous research showing that, overall, boys are at higher risk than girls for having autism and related disorders. But a curious pattern emerged: Siblings born after the birth of a female child with autism had a higher risk than siblings born after a male child with autism. Isaac Kohane, the Marion V. Nelson Professor of Biomedical Informatics and chair of the Department of Biomedical Informatics, and Nathan Palmer, director of the Healthcare Data Science Program at HMS, also determined that autism is somewhat rare, affecting 1.2 percent of the general population. These insights provide context for physicians and genetic counselors to advise families who have a child with autism.
New research has revealed that different tissue types have startlingly variable sensitivities to cancer-causing genes. In a study led by Stephen Elledge, the Gregor Mendel Professor of Genetics and Medicine and professor of medicine at Brigham and Women’s Hospital, researchers built a library of 30,000 bar-coded genes and then used the bar codes to determine which genes drove growth, unmasking hundreds of previously unknown cancer-causing genes. When they tested the bar-coded genes in three types of noncancerous tissues—breast cells, pancreatic cells and fibroblasts—each responded in a distinctive way. Genes that drove proliferation in one tissue often had no effect or even suppressed growth in another. As described in Cell, these discoveries promise to improve scientists’ understanding of normal and malignant cell proliferation. They also help explain why certain cancer drivers appear in some tumors and not others, potentially inspiring more tissue-specific strategies for cancer treatment.
CELL BIOLOGY
GLOBAL HEALTH AND SOCIAL MEDICINE
Visualizing Membrane Proteins
Molecular Tests Drive Tuberculosis Decisions
Using a powerful structural imaging technique called cryo-electron microscopy (cryo-EM), scientists can now see highresolution details of proteins that reside in cellular membranes, where they play important roles in physiology and diseases. Until recently, studying these membrane
An interdepartmental study revealed that new molecular tests for tuberculosis may be as good as or even better than standard lab cultures in predicting response to treatment and risk of dying. Culturebased lab tests are the gold standard for diagnosing TB resistance to a class of
Gender Patterns in Autism
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Understanding Variation in End-of-Life Care A new model for understanding variation in medical care received by cancer patients may improve health care policies and doctor-patient communication. Laura Hatfield, associate professor of health care policy, led a study published in Health Affairs that analyzed more than 14,000 Medicare patients with extensive-stage small-cell lung cancer. Despite short expected survival in this usually terminal condition, the research team found large variation in patient experiences from diagnosis through death. Grouping patients with similar patterns of care, they documented marked differences in care settings, survival times and intensity of care. Accounting for this variation could inform policies to align care with patients’ needs and prognoses. For example, patients with very short predicted survival could benefit from expanded hospital-based palliative care. In addition, using clusters of “typical experiences” can help clinicians communicate to patients what they might experience following a serious diagnosis. MICROBIOLOGY AND IMMUNOBIOLOGY
Flesh-Eating Bacterium Hijacks Neurons When the body is injured, nerve cells normally send two different signals—one to the brain to convey something is wrong and another to the immune system, telling it to stay away—a balancing act to keep overzealous immune cells from damaging
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healthy tissues. Research led by Isaac Chiu, assistant professor of microbiology and immunobiology, with postdoctoral fellow Felipe Pinho-Ribeiro, revealed the tactics used by Streptococcus pyogenes to foil the body’s defenses. This bacterium, which causes strep throat, is also the leading cause of necrotizing fasciitis. As it eats into connective tissue and muscle, the infection is hard to diagnose and treat promptly and can become rapidly fatal. As published in Cell, the bacterium induces neurons to release calcitonin gene-related peptide (CGRP), a neurotransmitter that impedes the body’s ability to summon immune cells called neutrophils to the infection site. CGRP also inhibits neutrophils that do get to the infection from releasing a germ-killing substance. When infected mice were treated with CGRP-receptor-blocking molecules, the infection did not progress, results that hold promise for drug-based treatments. NEUROBIOLOGY
What Babies See and When The primate brain is organized into “maps” for the different senses, but how the brain creates these maps has been a mystery. Research by Margaret Livingstone, the Takeda Professor of Neurobiology, together with Michael Arcaro, instructor in neurobiology, revealed that a primitive blueprint of organization is already present in the primate brain a few days after birth and fills in gradually with age and visual experience. As described in eLife, investigators began by monitoring the brain activity of neonatal macaques, using functional magnetic resonance imaging. Even when asleep, with eyes closed, different parts of the visual cortex were co-active, suggesting that a functional organization connecting these areas is present early in life. Although the neonates exhibited some of the large-scale organization of adults, they were missing prominent adult features. Brain regions for recognizing faces were absent the first several months after birth. With maturity, the early maps gradually refined, acquiring the ability to process faces, but only after visual experience. Ever since the work by 1981 Nobel laureates David Hubel and Torsten Wiesel, founding members of the HMS Neurobiology Department and mentors of Livingstone, neurobiologists have known the earliest visual experiences
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are critical for a child’s perceptual development. These findings underscore the importance of correcting visual deficits, such as congenital cataracts, promptly at birth to prevent blindness and ensure development of higher visual and cognitive functions. STEM CELL AND REGENERATIVE BIOLOGY
Exercise Creates New Heart Muscle Cells Doctors and health organizations all agree that exercise is good for the heart, but the reasons why are not well understood. In a new study performed in mice, researchers from HMS, the Harvard Department of Stem Cell and Regenerative Biology, Mass General and the Harvard Stem Cell Institute (HSCI) discovered that exercise stimulates the heart to make new muscle cells, both under normal conditions and after a heart attack. The researchers first studied two groups of healthy mice: one group had access to a treadmill, on which they voluntarily ran about five kilometers each day. The other group was sedentary. Using a labeled chemical that became incorporated into newly made heart cells, the researchers found that exercising mice made more than four times as many new heart muscle cells as those without treadmill access. They next studied mice that had experienced a heart attack. Compared with sedentary mice, those that exercised showed an increase in the area of the heart where new muscle cells are made. Published in Nature Communications, the study’s two senior authors were Richard T. Lee, professor of stem cell and regenerative biology at Harvard and a principal faculty member of HSCI, and Anthony Rosenzweig, the Evelyn and James Jenks and Paul Dudley White Professor of Medicine in the Field of Cardiology and chief of the cardiology division at Mass General and a principal faculty member of HSCI. SYSTEMS BIOLOGY
From One Cell, Many In three landmark studies published in Science, researchers revealed how a singlecelled embryo becomes a multicellular organism. Principal investigators included Allon Klein, assistant professor of systems biology; Marc Kirschner, the John Franklin Enders University Professor of Systems
Research Funding Academic Year 2017–18 Combined research efforts of Harvard Medical School and Harvard School of Dental Medicine resulted in $259.9M in federal awards and $86.7M in nonfederal awards for sponsored research programs, for a total of
$346.6M. Of those grants, $234.4M was awarded by the National Institutes of Health.
Biology; Sean Megason, associate professor of systems biology; and Alexander Schier, the Leo Erickson Life Sciences Professor of Molecular and Cellular Biology in Harvard’s Department of Molecular and Cellular Biology. Using single-cell sequencing in a single experiment, they recapitulated decades of painstaking research on the decisions cells make in the earliest stages of life. Focusing on zebrafish and the western claw-toed frog, they generated a detailed roadmap of which genes turned on and off, and when. In addition to identifying otherwise difficultto-detect details, such as rare cell types and subtypes, the researchers linked new, highly specific, gene-expression patterns to different cell lineages. In several cases, they found cell types emerging far earlier than previously thought. The unprecedented data produced could be powerfully illuminating to scientists striving to answer questions about cell differentiation and the origins of human disease. HARVARD SCHOOL OF DENTAL MEDICINE
Regulating Metabolism and Bone Density In the brain, the hypothalamus regulates energy and bone metabolism. Alteration of activating protein 1 (AP1) signaling in the hypothalamus has been known to increase energy expenditure, glucose utilization and bone density, yet the specific neurons responsible were unknown. Using neuron-specific, genetically targeted AP1 alterations in adult mice, a team led by Roland Baron, head and professor of oral medicine, infection and immunity at HSDM and professor of medicine at Mass General, found two types of neurons—AgRP and POMC—that stimulate energy expenditure, glucose utilization and bone formation and density. In contrast, AP1 alterations to a third type of neuron, SF1, increased energy but decreased bone density. AP1 signaling also affected the level of galanin, a neuromediator in the hypothalamus that transmits messages between neurons. When the researchers genetically deleted galanin or pharmaceutically blocked galanin receptors, energy and bone metabolism decreased. This study, published in the Journal of Clinical Investigation, is the first to show that galanin acts centrally to regulate bone mass, which is potentially important to developing novel therapies to prevent bone loss that occurs in osteoporosis. n
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affiliates Harvard Medical School offers unparalleled opportunities in medical education at its 15 Boston-area affiliates, all of which excel in research, clinical innovation and professional training. Below are samples of educational programs offered over the past year by these leading institutions. The Carl J. Shapiro Institute for Education and Research at Beth Israel Deaconess Medical Center and HMS, in concert with the Association of American Medical Colleges, sponsored its 10th Millennium Conference, at which teams from HMS and eight other U.S. medical schools convened to work on a critical issue confronting medical education. The conference focused on pedagogical innovations that can more effectively bridge the transition from undergraduate to graduate medical education and on aligning teaching methods that nourish a culture of lifelong learning. The Boston Children’s Hospital Academy for Teaching and Educational Innovation and Scholarship presented a seminar series that promoted professional excellence in clinical teaching, focusing on topics such as effective strategies for supervising students and trainees, recognition of cognitive biases, improvement of small-group teaching, evaluations, teaching high-value care, and promoting teamwork and inclusivity. In 2018, Brigham and Women’s Hospital recruited eight college and first-year medical students from underrepresented populations in medicine from across the U.S. for its annual Summer Training in Academic Research and Scholarship (STARS) program, an intensive eightweek program hosted by Brigham and Women’s Center for Faculty Development and Diversity. Students were paired with a faculty mentor, received hands-on training in research methods, and were introduced to multiple career pathways in the biomedical sciences. A similar nine-week program, the Summer Research Training Program, is offered by Massachusetts General Hospital. Enhancing the Principal Clinical Experience of second-year students, Cambridge Health Alliance developed a longitudinal, case-based curriculum in clinical reasoning called Medical Detective Rounds. It is
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Harvard Medical School affiliates are known for excellence in clinical care, biomedical research and medical education. Pictured here: the pediment of Brigham and Women’s Hospital’s distinctive entrance facing Brigham Circle, a Longwood Medical Area landmark since 1913.
co-led by students and faculty mentors and draws an analogy between clinical reasoning and detective work, engaging learners with evolving clinical cases. It features group discussions on clinical reasoning and clinical skills assessments using Entrustable Professional Activities criteria and evaluations of learners’ preparation. Dana-Farber Cancer Institute, in partnership with the HMS Office of Recruitment and Multicultural Affairs, provided entering students from populations underrepresented in medicine with the opportunity to explore the field of oncology via the Poussaint Pre-matriculation Summer Program at Dana-Farber, founded in 1970 to provide science courses and lab exposure ahead of students’ first semester at the School. Through courses, seminars, clinical shadowing and mentorship, the program promotes understanding of career options in oncology and its subspecialties. Faculty at Harvard Pilgrim Health Care Institute participated in a core leadership team that developed Essentials of the Profession II, a new monthlong required course for third- and fourth-year students that covers health policy, medical ethics, social medicine, clinical epidemiology and population health. The latter topic focuses on the application of tools in clinical epidemiology and population health, case-based collaborative learning, and a broad array of subtopics, including hospital infection control, population health management, opioids, nutrition policy and climate change. Hebrew SeniorLife hosted the Central Geriatrics Sessions, a program that provides first-year students with hands-on geriatrics training as they start to select their specialties and complete their studies. This opportunity to work alongside geriatrics staff allows students to apply their training and knowledge by directly engaging with residents and patients. Joslin Diabetes Center reached more than 6,100 U.S. learners in academic year 2017–18 through its live interactive webcast DiabetesSeriesLive, a network of learning channels that provide online continuing medical education courses on glucose management and the comorbidities of diabetes, including specific complications such as diabetic retinopathy.
A spectrum of specialists present didactic forums followed by questions submitted in real time by online audiences along with case-based discussions to build skills. Judge Baker Children’s Center, dedicated to bridging science and practice to improve access to high-quality behavioral health care for children in community settings, launched a doctoral psychology internship in clinical and school psychology. It is designed to train professional psychologists in health service psychology. Interns spend an intensive year embedded in the center’s direct service programs, where they build advanced skills to help children in clinical outpatient and school settings. Massachusetts Eye and Ear launched an Ophthalmology Hospitalist Program, in which hospitalists teach trainees to view the patient as a whole by focusing on patients’ clinical, social, economic and personal circumstances. The program supports the development of observational, technical, and clinical skills and judgment as well as helping trainees navigate relationships with other faculty, medical students, residents, fellows and hospital staff while working in an intense and complex environment. Massachusetts General Hospital participated in the Partners HealthCare Centers of Expertise for residents and fellows, an enrichment program that supports trainees at Mass General and Brigham and Women’s in four centers: Global and Humanitarian Health, Healthcare Quality and Patient Safety, Medical Education, and Health Policy and Management. Celebrating its 10th anniversary in 2018, the program cultivates relationships in interactive sessions where faculty describe their work and career paths. It also offers mini-courses and symposia, and provides grants to support research projects.
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The Institute for Technology in Psychiatry at McLean Hospital continued to advance innovation at the intersection of mental health and digital technology. A clinical data science lab gives students academic credit and hands-on experience in exploring and analyzing big data in health care. In digital technology workshops, students learn how to create and implement projects using technologies such as smartphones and audiovisual tools. For the third year, Mount Auburn Hospital served as the singular site for the Anchoring Clinical Experience clerkship program for Harvard-MIT Health Sciences and Technology students, which occurs after completion of the preclinical curriculum but before the transition to the lab. Students spend time in inpatient and outpatient services and participate in didactic case conferences that emphasize the role of critical thinking and clinical decision making. Faculty at Spaulding Rehabilitation Network directed a continuing medical education course called Career Advancement and Leadership Skills for Women in Healthcare. This program delivers evidencebased strategies, skills development and education that helps women at various stages of their health care career step into and succeed in leadership positions. It also cultivates female managerial talent in health care settings by developing leadership competencies.
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To advance interprofessional faculty development, leaders at the VA Boston Healthcare System created an online monthly continuing education program. Initially offered at its three major campuses and five community outpatient clinics, it is now streamed live to all 150 VA medical centers across the country. A complementary website allows presentations to be accessed on demand and provides other materials for physicians and trainees, including student and resident applications, information on wellness and burnout, educator awards and guidance for teaching. n
FOR MORE ON AFFILIATES: hms.harvard.edu/hms-affiliates-research
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academic and clinical affairs
PATHWAY TO PROMOTION
Promotion to full professor at Harvard Medical School culminates a lifetime of exceptional work. For William Curry that includes clinical practice, teaching and research. In 2017, Curry, a national leader in the neurosurgical care of patients with tumors of the brain, skull base and spine, was promoted to full professor 20 years after starting as a resident in surgery at Massachusetts General Hospital. “You realize what it means and the impact you are having on the field and on the world of your specialty—just how relatively rare it is, and how it’s a recognition of not just hard work but leadership,” Curry said. A skilled neurosurgeon, Curry has also led and participated in multiple clinical trials and has worked on cancer vaccines for patients with glioblastoma. His research focuses on developing cellular and immune-based therapies for malignant tumors. “The one force of nature that can be variable, that can evolve, that can kind of modulate itself, is the immune system, and it’s doing it constantly,” Curry said. “It’s being borne out that we should be able to harness that ability and to engineer it.” Curry credits many mentors for his success, including a former department chair at Mass General who encouraged neurosurgical trainees to be leaders in academics and research and who motivated him to ask and pursue big questions. “There are people who really, in a hands-on way, taught me things—for example, how to operate or how to manage patients—that I emulate to this day,” he said. Curry’s father, the first black chief resident and then attending surgeon at New York Hospital, was a powerful role model. Now, as a full professor, Curry will also continue to have opportunities to train and inspire future generations. “Some of my proudest moments are when you take a trainee who for years has been attentive, focused, asking questions, and then you see that person as they’re approaching the end of their training really function independently in complex situations,” he said. “It’s very, very exciting.” Going forward, Curry said, his career will focus on bringing groups together at HMS to pursue questions about neuro-oncology and on paving the way for those who will follow in his footsteps. “We’re the leaders of these great institutions now,” he said. “That responsibility is now on people like me.” n
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The Office for Academic and Clinical Affairs creates new avenues to academic excellence, diversity and service and promotes the highest ethical standards for Harvard Medical School Quad and affiliate faculty. Led by Dean for Academic and Clinical Affairs Nancy Tarbell, the C.C. Wang Professor of Radiation Oncology at Massachusetts General Hospital, the office continues to pursue opportunities to develop cross-institutional centers and initiatives, such as the Initiative for RNA Medicine, in which scientists from across the HMS community are harnessing RNA molecules as promising targets for novel therapies. To foster collegiality, the office has instituted new Quad faculty monthly meetings, where junior faculty share experiences and learn about faculty development opportunities. The office also nominates junior faculty for prestigious Foundation Fund awards conferred by 17 highly selective foundations. In academic year 2017–18 HMS nominees secured $720,000, or 11 percent, of the total funding. As highlighted below, achievements cover the combined efforts of the following offices: FACULTY AFFAIRS
This past year, the Office for Faculty Affairs, led by Dean for Faculty Affairs Maureen Connelly, advanced several initiatives: Faculty Promotions: In academic year 2017–18, there were 86 faculty promoted to professor, including 24 women and 3 from populations underrepresented in medicine (see related story on facing page); 161 were promoted to associate professor, and 347 were promoted to assistant professor. With the current guidelines for promotion now in their tenth year, the dean’s Task Force on Promotion Criteria reviewed opportunities to improve the process by which faculty, particularly educators and clinical innovators, are evaluated for promotion. Faculty Searches: The Offices for Academic and Clinical Affairs, Faculty Affairs, and Diversity Inclusion and Community Partnership are developing new online tools that will improve faculty searches and create recruitment guidelines for positions at various levels, all targeted to overcoming unconscious bias, optimizing individual and group interviews, and documenting decisions. Funded by a three-year, $500,000 grant, HMS is
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launching a pilot study with faculty at Boston Children’s Hospital and Mass General to improve recruitment of faculty underrepresented in medicine, achieve better gender representation in medicine and ensure that the best candidates are hired. DIVERSITY INCLUSION AND COMMUNITY PARTNERSHIP
Under the leadership of Dean for Diversity Inclusion and Community Partnership Joan Reede, professor of medicine, several milestones were reached this year: Diversity Statement: Emerging from the Dean’s Task Force on Diversity and Inclusion, a new diversity statement was formalized, empowering all HMS students, trainees, faculty, staff and administrators to be drivers of diversity and inclusion at HMS. Diversity Subcommittees: Six subcommittees are now focusing on diversity in the following areas: residency and fellowships; the Quad and basic sciences; faculty retention and advancement; pipeline and community; culture, climate and communication; and metrics for accountability and tracking. Faculty Fellowships: Launched 15 years ago, HMS continues to select junior faculty for two-year, $100,000 fellowships designed to advance the careers of populations underrepresented in medicine. The Commonwealth Fund Mongan Fellowship in Minority Health Policy, now in its 22nd year, continues to develop minority leaders in medicine. Diversity Dialogues: This year, HMS hosted a series of diversity-focused dialogues designed to create awareness, promote inclusion and provide safe spaces for discussion. The first dialogue focused on public images and art at HMS. Another dialogue explored “being other” in the community. A third examined microaggressions. PROFESSIONALISM AND INTEGRITY
Academic and Research Integrity: In December 2017, new faculty grievance procedures were approved by a faculty committee led by Dean for Faculty and Research Integrity Gretchen Brodnicki, demonstrating the School’s commitment to maintaining a collegial environment free from discrimination and sexual harassment. The School also created a digital resource capable of assessing the integrity
Facing page: William Curry (left), professor of neurosurgery at Massachusetts General Hospital, preps for neurosurgery with Rosalind Lai, clinical fellow in neurosurgery at Brigham and Women’s Hospital, on rotation at Mass General.
of research images and ensuring nonduplication and proper usage. Ombuds Office: This office, which supports an ethical and civil culture that encourages mutual understanding and resolution through respectful dialogue and fair processes, responded to an increase of 13 percent in visitors, from 392 to 443 cases. Work and academic environment issues dominated. As a reflection of its mission, the Ombuds Office provided 53 training sessions to 1,420 members of the Harvard-Longwood community on conflict resolution and negotiation skills, effective mentoring strategies and best practices for authorship disputes, along with 24 general presentations to 1,076 individuals. n
HMS ADMINISTRATIVE MILESTONES
Facilities As programs and priorities change, renovations have been made to optimize learning environments for students, increase accessible routes and enhance research space, for example, by redesigning labs. The School plans to provide additional state-of-the-art technologies for researchers and affiliates, identifying space for more core facilities, such as the new Harvard Cyro-Electron Microscopy Center for Structural Biology. Library The School is examining new ways to use the Francis A. Countway Library of Medicine. A recent survey of its users identified possibil ities that include the creation of a community center where students, trainees and faculty can meet, view an art show or take online classes in managing research data. Information Technology The HMS IT team works to provide innovative, scalable and supported technologies that align to the School’s strategic plans. The IT Project Management Office manages a portfolio of IT initiatives, one of which is to design and build a trusted, secure enterprise data platform for the School. This repository will bring together data generated at HMS to support operational analytics and data visualization for spotting trends and to inform decision making about future directions for the School. n
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reach ARTIFICIAL INTELLIGENCE
As an undergraduate computer science major, Andrew Beam had mapped out his professional life: Make it big in Silicon Valley as a systems engineer for a software giant. But in his junior year, he took an artificial intelligence course and his direction changed. “It was the coolest thing—an awesome mix of philosophy, mathematics and computer science,” Beam said. “We pondered really fundamental questions about humanity and intelligence—everything to make an undergrad go ‘Whoa, dude!’” While pursuing his doctorate in informatics, he met a medical student who would become his wife. Watching her go through training, Beam had profound insights: Evidence is often outdated, and physicians are overworked. It can be difficult at times to reason under uncertainty or calculate probability and analyze statistics with confidence while under pressure. “It was slap-you-in-the-face obvious that AI was going to have a tremendous impact on health care,” he said. Today, Beam is an instructor in biomedical informatics at Harvard Medical School, where he develops data-driven models that will improve decision making in health care. Although his current focus is neonatal and perinatal medicine—his wife, Kristyn Beam is clinical fellow in neonatology at Brigham and Women’s Hospital—the unifying theme of Beam’s work is creating AI systems capable of making sense of the avalanche of data spawned by research in a variety of clinical specialties over the past 20 years. At the top of Beam’s to-do list: develop an artificial neural network capable of performing on a par with a second-year medical student. The long-term goal of this proto-med-student project, funded by the Robert Wood Johnson Foundation, is to evolve the system to the diagnostic level of a fourth-year medical student and make it capable of analyzing clinical scenarios and applying clinical reasoning. “There is great promise and great enthusiasm in the field of medical AI but also a great deal of trepidation about how to harness its promise while avoiding potential pitfalls, of which there are many,” said Isaac Kohane, chair of the Department of Biomedical Informatics and the Marion V. Nelson Professor of Biomedical Informatics. Yet, early indicators are promising. Recent research demonstrated that diagnostic algorithms successfully used a constellation of telltale features in digital images of patients’ retinas to spot diabetic retinopathy, as well as or even better than ophthalmologists could. “What AI is going to allow us to do—if we do it right—is enhance the accuracy and productivity of clinicians by serving as a focused-intelligence assistance or backup,” Kohane said. “But the need for the physician as a holistic thinker who understands both the medicine and the complexity of human life will never go away.” n
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BIOMEDICAL INFORMATICS
Today’s medical professionals are managing vast amounts of information. The Harvard Medical School Department of Biomedical Informatics is developing programs and tools to guide data-driven medicine. Network of Enigmatic Exceptional Responders: Focusing on cancer patients whose therapeutic responses exceed expectations, this program aims to discover why they do so well by pooling data from blood and tissue samples, genetic tests, immune system factors, the gut microbiome and more. Studies of future cohorts will focus on patients with other medical conditions. Harvard Data Science Initiative: In this university-wide initiative, which leverages statistical methodology and computer science to create impactful insights, HMS is designing a deep-learning algorithm that uses pathology images to improve accuracy in detecting and classifying breast, lung and brain cancers. Computationally Enabled Medicine: This advanced integrated science course (AISC) is offered to third- and fourth-year MD students (see related story on page 3). Highlighting the emerging role of bioinformatics tools in clinical practice, the course features practicums at pharmaceutical and insurance companies where data scientists share their expertise with students. Artificial Intelligence: HMS is designing an array of platforms to increase clinical productivity and accuracy (see related story on facing page). Biomedical Informatics Entrepreneurs Salon: Partnering with the Harvard Office of Technology Development, this monthly series offers a forum where entrepreneurs share information about career pathways and innovative approaches to bioinformatics. Healthcare Data Science Program: HMS researchers are conducting discovery research using large databases from health insurers, Medicare and other providers, often in combination. CENTER FOR PRIMARY CARE
The Center for Primary Care, directed by Russell Phillips, the William Applebaum Professor of Medicine at Beth Israel
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Deaconess Medical Center, is developing training and practice models to reduce worldwide shortages of primary care physicians. Student Leadership Committee: Working with the Institute of Health Professions at Massachusetts General Hospital, this group launched an innovative project highlighting the opioid crisis. It also provided new educational experiences for students, including a trip to the Navajo Nation in New Mexico to learn about health care for indigenous peoples in rural areas. Leadership Training: The Charting the Future of Primary Care program, held in Boston and Los Angeles, presented highperforming global primary care systems and Harvard Business School style cases to help more than 100 executives improve care in their own practices. The new Medical Director Leadership Institute was attended by 44 U.S. primary care medical directors. MIT-HMS Healthcare Innovation Bootcamp: This collaboration with MIT attracted 90 innovators and entrepreneurs from around the world to participate in discussions on digital health, diagnostics, care delivery and systems innovation. Advancing Teams in Community Health Program: With grant support from the U.S. Health Resources and Services Administration, the Center is integrating oral and mental health care into 13 Massachusetts community health centers that are managing patients with complex medical and psychosocial needs. Financing Primary Care: In the Primary Care Practice Policy Model program, the Center uses mathematical paradigms to help practices test the financial impact of new payment systems and changes in practice that could assist the transition to value-based care. Family Medicine Careers: To support HMS students pursuing careers in family medicine, a specialty that provides approximately 40 percent of primary care physicians in the U.S., the Center is expanding opportunities and resources, such as the new Harvard Home for Family Medicine, as well as holding events where primary care practitioners share clinical, educational and research activities. Global Impact: Together with the Department of Global Health and Social
Facing page: Andrew Beam (left), instructor in biomedical informatics, and Kristyn Beam, clinical fellow in neonatology at Brigham and Women’s. Below: A passenger on an MBTA bus shows a photo of his foot injury to HMS student Anthony Tucker-Bartley, MD ‘21, during a community site visit, part of the Introduction to the Profession orientation week for first-year students.
Medicine, the Center is leading the HMS Program in Global Primary Care and Social Change. In 2018, at the HMS Center for Global Health Delivery–Dubai, government officials, health care experts, multilateral organizations and private sector partners met to plan and create highfunctioning primary care systems. HEALTH CARE POLICY
This year the Department of Health Care Policy celebrates its 30th anniversary. The four faculty founders included department Chair Barbara McNeil, the Ridley Watts Professor of Heath Care Policy and professor of radiology. The first of its kind in the nation, the department has been emulated widely by medical schools across the U.S. Growth and Leadership: Today the department has 22 full-time core faculty. Applying multidisciplinary expertise, it studies issues relevant to physicians and health care policymakers, often in collaboration with other institutions. Prolific Research: With more than 60 studies published annually, department faculty investigate areas such as health care quality, costs and access, guiding advocacy efforts locally and nationally and informing policymakers in Congress.
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20 Dean’s Report 2018–2019
I REACH
Opposite page: Tami
Center for Healthcare Data Analytics: With the acquisition of 10 years of Medicare and Medicaid data, data analytics capabilities have significantly expanded, generating collaborative work with the HMS Department of Biomedical Informatics. Marshall J. Seidman Fellowships: The department welcomed two new Seidman fellows pursuing mentored research, one studying economic and policy issues related to opioids and pain treatment and the other examining payment delivery reforms and factors that influence the use of telemedicine.
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Above: Stronger integrated health systems in rural Madagascar (pictured) and Rwanda have produced rapid improvements in health care, including declining child and maternal mortality rates.
GLOBAL HEALTH AND SOCIAL MEDICINE
The department trains professionals to design and implement improved health care practices and policies worldwide. Successes in Africa: Working to prevent future Ebola outbreaks, Paul Farmer, the Kolokotrones University Professor of Global Health and Social Medicine and chair of the Department of Global Health and Social Medicine, assessed the response to the 2013–16 Ebola outbreak in West Africa, where HMS and Partners In Health, a humanitarian organization
co-founded by Farmer, helped deliver care and prevent further spread of the disease. In Rwanda and Madagascar, child and maternal deaths declined after health care systems were strengthened through public partnerships, improved data science and access to universal health care. Reframing Global Policy on Noncommunicable Diseases and Injuries: HMS faculty are leading The Lancet NCDI Poverty Commission, which focuses on noncommunicable diseases and injuries among the poorest one billion of the world’s population. The commission is holding meetings in 2018 in Rwanda, Nepal and Mozambique and supporting national NCDI poverty commissions and groups in Afghanistan, Ethiopia, Haiti, India, Kenya, Liberia, Malawi, Mozambique, Nepal, Rwanda and Tanzania. Safe Surgery 2020: HMS faculty are partners in Safe Surgery 2020, a collaboration that aims to improve surgical services in resource-limited settings. In Ethiopia, the HMS Program in Global Surgery and Social Change provides research and policy support to increase national surgical capacity and strengthen data-capture systems. In Tanzania, the program led to the country’s first National Surgical, Obstetric and Anaesthesia Plan in partnership with the Ministry of Health. The HMS team is evaluating a suite of safe-surgery interventions focused on reducing postoperative infections, improving surgical access as measured by volume and referrals, and capturing surgical data in patients’ records. Mental Health: The GlobalMentalHealth@Harvard initiative draws on faculty expertise from across Harvard University departments and HMS-affiliated hospitals. The goal is to catalyze interdisciplinary innovations that can address the global burden of mental health problems, for example, by implementing psychosocial interventions delivered by community health workers. Master of Medical Science: In fall 2018, the two-year MMSc program in Global Health Delivery welcomed 16 health care professionals from 10 countries. Student research focuses on addressing critical problems and producing actionable results in resource-limited settings (see related story on page 6). n
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The Campaign for Harvard Medicine INVESTIGATING SENSORY DISORDERS
David Corey has always been intrigued by how things work. As a child, he tinkered in his father’s home workshop, taking things apart and, sometimes, putting them back together. Later, this fascination drew Corey to physics, partly, he said, because it had the coolest instrumentation. It wasn’t until his last semester at Amherst College that Corey became interested in neurobiology. At Harvard Medical School, he had the good fortune to work as a technician in the lab of Ann Stuart, who was studying the visual system of barnacles. “It was life-changing,” said Corey, recalling how his captivation with sensory neuroscience was born. Today, Corey is still taking things apart to see how they work, but on a scale he never quite imagined. Corey, the Bertarelli Professor of Translational Medical Science, said his lab is focused on mapping the position of every atom of each protein in the molecular complex of inner-ear receptor cells. Those proteins convert motion to electrical signals, and he is determining which parts of the proteins move to generate those signals. Teaming with his wife, Xandra Breakefield, professor of neurology at Massachusetts General Hospital, and colleagues, he has started using gene therapy with viral vectors to correct molecular defects in mice in an effort to prevent hereditary deafness. “Decades of basic, curiosity-driven science are suddenly relevant for human health. It is deeply satisfying to find that our work may help to cure a devastating sensory disorder,” he said. Corey also leads the Bertarelli Program in Translational Neuroscience and Neuroengineering at HMS. Established in 2011 with a gift from the Bertarelli Foundation, the program aspires to help bridge the gap between basic and translational neuroscience and to address important issues that, once solved, will have life-changing outcomes for patients. “I am confident the next five to 10 years will see many new treatments for deafness, blindness and pain, and I think the projects of the Bertarelli Program, which encourage cross-disciplinary solutions, will be among the most exciting and effective,” said Corey. Earlier this year, the Bertarelli Foundation announced it was redoubling its commitment to this area of research with a gift of $6.35 million to HMS to build on the program’s previous successes as part of The World Is Waiting: The Campaign for Harvard Medicine. “The School’s openness to exploring new ideas and collaborating with others for the benefit of patients is very important. This new gift aims to support fresh thinking and enable scientists to take forward new ideas, through effective partnership and innovation,” said Ernesto Bertarelli, an alumnus of Harvard Business School and a member of the HMS Board of Fellows. Nearly 10,000 alumni, faculty, staff, volunteers and friends made gifts to support the HMS campaign from July 1, 2011, through June 30, 2018. Together, they raised more than $789 million to advance the School’s mission. Join us at hms.harvard.edu/giving. Your partnership and passion are critical to our progress. n
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David Corey, the Bertarelli Professor of Translational Medical Science.
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22 Dean’s Report 2018–2019
I HONORS AND AWARDS
Honors and Awards National Academy of Sciences Four faculty were elected members: Daniel A. Haber, the Kurt J. Isselbacher Professor of Oncology at Mass General Dennis Kasper, the William Ellery Channing Professor of Medicine at Brigham and Women’s and professor of microbiology and immunobiology Arlene Sharpe, the George Fabyan Professor of Comparative Pathology and co-chair of the Department of Microbiology and Immunobiology Christopher A. Walsh, the Bullard Professor of Pediatrics and Neurology at Boston Children’s National Academy of Medicine Five faculty were elected members: Scott Armstrong, the David G. Nathan Professor of Pediatrics at Dana-Farber Mark Daly, associate professor of medicine at Mass General Alan D’Andrea, the Alvan T. and Viola D. Fuller American Cancer Society Professor of Radiation Oncology at Dana-Farber Michael Greenberg, the Nathan Marsh Pusey Professor of Neurobiology and chair of the Department of Neurobiology Scott Pomeroy, the Bronson Crothers Professor of Neurology at Boston Children’s 2017 Walsh McDermott Medal, National Academy of Medicine Barbara McNeil, the Ridley Watts Professor of Health Care Policy and chair of the Department of Health Care Policy 2018 Public Welfare Medal, National Academy of Sciences Paul Farmer, Kolokotrones University Professor of Global Health and Social Medicine and chair of the Department of Global Health and Social Medicine American Academy of Arts and Sciences Four faculty were elected members: Patricia D’Amore, the Charles L. Schepens Professor of Ophthalmology at Mass. Eye and Ear Susan Dymecki, professor of genetics Wade Harper, The Bert and Natalie Vallee Professor of Molecular Pathology and chair of the Department of Cell Biology Christopher A. Walsh, the Bullard Professor of Pediatrics and Neurology at Boston Children’s Pioneer Award, National Institutes of Health Jeffrey Macklis, the Max and Anne Wien Professor of Stem Cell and Regenerative Biology David Sinclair, professor of genetics
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American Association for the Advancement of Science Four faculty were elected fellows: Alan Garber, the Mallinckrodt Professor of Health Care Policy and provost of Harvard University David Hooper, professor of medicine at Mass General Pier Pandolfi, the George C. Reisman Professor of Medicine at Beth Israel Deaconess Bernardo Sabatini, the Alice and Rodman W. Moorhead III Professor of Neurobiology Emerging Leaders in Health and Medicine, National Academy of Medicine Marcia Haigis, professor of cell biology Hanni Stoklosa, instructor in emergency medicine at Brigham and Women’s Ramnik Xavier, the Kurt J. Isselbacher Professor of Medicine at Mass General National Academy of Inventors Three faculty were elected fellows: Richard Anderson, professor of dermatology at Mass General Rakesh Jain, the A. Werk Cook Professor of Radiation Oncology (Tumor Biology) at Mass General Bruce Rosen, the Laurence Lamson Robbins Professor of Radiology at Mass General Howard Hughes Medical Institute Four faculty were named investigators: Thomas Bernhardt, professor of microbiology and immunobiology Benjamin Ebert, the George P. Canellos, MD, and Jean S. Canellos Professor of Medicine at Dana-Farber Stephen Liberles, professor of cell biology Beth Stevens, associate professor of neurology at Boston Children’s Early Independence Award, National Institutes of Health Zirui Song, assistant professor of health care policy Outstanding Investigator Award, National Cancer Institute Stephen Blacklow, the Gustavus Adolphus Pfeiffer Professor of Biological Chemistry and Molecular Pharmacology and chair of the Department of Biological Chemistry and Molecular Pharmacology Yang Shi, the C.H. Waddington Professor of Pediatrics and professor of cell biology at Boston Children’s
2018 Victor Fuchs Lifetime Achievement Award, American Society of Health Economists Thomas McGuire, professor of health economics Victor Sidel and Barry Levy Award for Peace, American Public Health Association Fatima Lunze, instructor in pediatrics at Boston Children’s; award shared with Karsten Lunze, Boston University School of Medicine 2018 William Allan Award, American Society of Human Genetics Eric Lander, professor of systems biology and president and founding director of the Broad Institute of MIT and Harvard 2018 Gunther Laukien Prize Gerhard Wagner, the Elkan Blout Professor of Biological Chemistry and Molecular Pharmacology 2017 Abraham Flexner Award for Distinguished Service to Medical Education, Association of American Medical Colleges George Thibault, the Daniel D. Federman, M.D. Professor of Medicine and Medical Education, Emeritus at Brigham and Women’s 2017 Award for Distinguished Research in the Biomedical Sciences, Association of American Medical Colleges Laurie Glimcher, the Richard and Susan Smith Professor of Medicine at Brigham and Women’s/Dana-Farber and professor of microbiology and immunobiology 2018 Distinguished Investigator Award, AcademyHealth Richard Frank, the Margaret T. Morris Professor of Health Care Policy Order of Canada Isaac Schiff, the Joe Vincent Meigs Distinguished Professor of Gynecology at Mass General Officer (AO) in the General Division of the Order of Australia David Sinclair, professor of genetics 2018 Glocker Medal, German Medical Physics Society Thomas Bortfeld, professor of radiation oncology at Mass General 2017 MacLean Center Prize in Clinical Medical Ethics, MacLean Center at the University of Chicago Paul Farmer, the Kolokotrones University Professor of Global Health and Social Medicine and chair of the Department of Global Health and Social Medicine
Medical Library Association One staff member was elected a fellow: Elaine Martin, director and head librarian of the Francis A. Countway Library of Medicine Endowed Professorships The following recently established HMS professorships were celebrated in fiscal year 2018, recognizing the generosity of their respective benefactors and the accomplishments of their inaugural incumbents: Tom Delbanco, the John F. Keane & Family Professor of Medicine Tal Geva, the Farb Family Professor of Pediatrics in the Field of Cardiology John D. Halamka, the International Healthcare Innovation Professor of Emergency Medicine Haiden Huskamp, the 30th Anniversary Professor of Health Care Policy Vikram Patel, the Pershing Square Professor of Global Health Jan Shifren, the Vincent Trustees Professor of Obstetrics, Gynecology and Reproductive Biology 2017–18 Foundation Fund Awards The following HMS researchers received funds from private foundations: 2017 Damon Runyon Clinical Investigator Award Mark Shrime, assistant professor of otolaryngology at Mass. Eye and Ear 2017 Smith Family Foundation Award for Excellence in Biomedical Research Sichen Shao, assistant professor of cell biology 2018 Exceptional Projects Grant, Breast Cancer Alliance Marcia Haigis, professor of cell biology 2018 Edward J. Mallinckrodt Jr. Foundation Grant Ying Lu, assistant professor of systems biology 2018 Karin Grunebaum Cancer Research Foundation Faculty Research Fellowship Justin Kim, assistant professor of biological chemistry and molecular pharmacology
FOR MORE ON HMS AWARDS hms.harvard.edu/awards
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LEADERSHIP Dean’s Report 2018–2019 23
HMS Leadership HARVARD MEDICAL SCHOOL George Q. Daley, MD, PhD Dean of the Faculty of Medicine
HARVARD SCHOOL OF DENTAL MEDICINE R. Bruce Donoff, DMD, MD Dean
Elaine Martin, MSLS, DA Director and Head Librarian Francis A. Countway Library of Medicine Kathleen McDaniel, BS Chief Human Resources Officer Deborah Corwin Scott, MBA Chief Information Officer
ACADEMIC LEADERSHIP
Gina Vild, BA Associate Dean for Communications and External Relations and Chief Communications Officer
Gretchen Brodnicki, JD Dean for Faculty and Research Integrity
Mike White, MS Chief Financial Officer
Maureen Connelly, MD, MPH Dean for Faculty Affairs (March 2010 – Oct. 2018)
PRECLINICAL DEPARTMENT CHAIRS
David Golan, MD, PhD Dean for Basic Science and Graduate Education Edward Hundert, MD, MA Dean for Medical Education Lee Nadler, MD Dean for Clinical and Translational Research Joan Reede, MD, MPH, MS, MBA Dean for Diversity and Community Partnership David Roberts, MD Dean for External Education Fidencio Saldaña, MD Dean for Students Nancy Tarbell, MD Dean for Academic and Clinical Affairs
ADMINISTRATIVE LEADERSHIP Lisa Muto, PhD Executive Dean for Administration Lisa Boudreau, BA Dean for Alumni Affairs and Development Rachel Cahoon, BA Executive Director Research Administration M. William Lensch, PhD Chief of Staff Aili Lewis, MSc, MPP Executive Director Institutional Planning and Policy Stephen Maiorisi, BS, AIA Chief Campus Planning and Facilities Officer
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Paola Arlotta, MS, PhD Golub Family Professor of Stem Cell and Regenerative Biology at Harvard Chair, Stem Cell and Regenerative Biology Stephen Blacklow, MD, PhD Gustavus Adolphus Pfeiffer Professor of Biological Chemistry and Molecular Pharmacology Chair, Biological Chemistry and Molecular Pharmacology Paul Farmer, MD, PhD Kolokotrones University Professor of Global Health and Social Medicine Chair, Global Health and Social Medicine Michael Greenberg, PhD Nathan Marsh Pusey Professor of Neurobiology Chair, Neurobiology Wade Harper, PhD Bert and Natalie Vallee Professor of Molecular Pathology Chair, Cell Biology Ann Hochschild, PhD Maude and Lillian Presley Professor of Microbiology and Immunobiology Co-Chair, Microbiology and Immunobiology Marc Kirschner, PhD John Franklin Enders University Professor of Systems Biology Chair, Systems Biology (Oct. 2003 – April 2018) David Knipe, PhD Higgins Professor of Microbiology and Molecular Genetics Interim Co-Chair, Microbiology and Immunobiology (May 2016 – April 2018)
Isaac Kohane, MD, PhD Marion V. Nelson Professor of Biomedical Informatics Chair, Biomedical Informatics Galit Lahav, PhD Professor of Systems Biology Chair, Systems Biology Barbara McNeil, MD, PhD Ridley Watts Professor of Health Care Policy Chair, Health Care Policy David Scadden, MD Gerald and Darlene Jordan Professor of Medicine Chair, Stem Cell and Regenerative Biology (July 2015 – Aug. 2018) Arlene Sharpe, MD, PhD George Fabyan Professor of Comparative Pathology Co-Chair, Microbiology and Immunobiology Clifford Tabin, PhD George Jacob and Jacqueline Hazel Leder Professor of Genetics Chair, Genetics Amy Wagers, PhD Forst Family Professor of Stem Cell and Regenerative Biology at Harvard Co-Chair, Stem Cell and Regenerative Biology
COUNCIL OF ACADEMIC DEANS Anne Klibanski, MD Laurie Carrol Guthart Professor of Academic Medicine Dean for Partners HealthCare System Orah Platt, MD Professor of Pediatrics Faculty Dean for Academic Programs Boston Children’s Hospital Barrett Rollins, MD, PhD Linde Family Professor of Medicine Faculty Dean for Academic Programs Dana-Farber Cancer Institute David Silbersweig, MD Stanley Cobb Professor of Psychiatry Academic Dean for Partners HealthCare System Jeffrey Saffitz, MD, PhD Interim Faculty Dean, Academic Programs Beth Israel Deaconess Medical Center
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24 Dean’s Report 2018–2019
I FACTS AND FIGURES
FUNDRAISING HIGHLIGHTS
THE WORLD IS WAITING: THE CAMPAIGN FOR HARVARD MEDICINE
Harvard Medical School depends on a generous philanthropic community whose support helps people the world over live longer, healthier lives. The School’s circle of supporters—made up of more than 4,000 alumni, board members, volunteers, faculty, staff, foundations, corporations and friends—gave more than $90 million in fiscal year 2018 to support the School’s four priorities: education, discovery, service and leadership. These generous gifts support The World Is Waiting: The Campaign for Harvard Medicine, our ambitious fundraising initiative that raised more than $789 million over the past seven years, concluding on June 30, 2018. In education, these gifts uphold our twin values of need-blind admissions and need-based aid, ensuring that HMS is accessible to and affordable for all admitted students and providing additional funding to students in the Harvard/MIT MD-PhD Program. In the area of discovery, philanthropy is helping advance curiosity-driven research that holds great promise toward enhancing, sustaining and saving lives—from gleaning new insights into the human brain and neurodegenerative disorders to advancing cutting-edge investigations in fields like cancer research and regulatory science. HMS service initiatives are being amplified through gifts bolstering the School’s commitment to transforming health care systems in the U.S. and abroad. These initiatives include supporting global health education, exploring how to care for the mentally ill in primary care settings and advancing research and policy in health care reform. Finally, in the area of leadership, discretionary gifts provide Dean Daley with the flexibility to invest in innovative ideas that have the greatest potential to improve human health. Learn more about the impact of philanthropy at hms.harvard.edu/giving.
Total raised: $789M FY18 Fundraising total: $90M
FY12–FY17 Fundraising total: $699M
COLLABORATIONS ACROSS HARVARD BY THE NUMBERS As of September 2018 Total faculty 11,502 Tenured and tenure-track faculty on campus in 10 preclinical departments 191 Voting faculty on campus and at affiliates 6,005 Full-time faculty on campus and at affiliates 9,457
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Nobel Prizes (cumulative) Physiology or Medicine, Peace: 9 prizes, 15 recipients | National Academy of Sciences members (current) 81 National Academy of Medicine members (current) 153 Howard Hughes Medical Institute (current): Investigators 36, Faculty Scholars 3
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Total students: MD 712 PhD 889 (885 HMS, 4 HSDM) MD-PhD 179: basic sciences 159, social sciences 20 (total included in MD and PhD counts) DMD 136 DMD-PhD 2 (total included in DMD and PhD counts) MMSc 187 (134 HMS, 53 HSDM) MBE 50 MBI 36 MHQS 13 DMSc 35 Trainees (residents and postdoctoral fellows) 9,184
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MD applicants 6,917 Admitted 232 (3.4%) MD entering 2018 165 (includes 15 MD-PhD) Men 70 (42%) Women 95 (58%) Underrepresented in medicine (African-American, Hispanic, Mexican-American, Native American) 40 (24%) Asian 53 (32%)
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Entering 2018: PhD 145 (144 HMS, 1 HSDM DMD-PhD) DMD 36 MMSc 83 (64 HMS, 19 HSDM) MBE 36 MBI 20 MHQS 11 DMSc 7
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Additional joint degree programs: MD-MBA; MD-MPH; MD-MPP Medical school living alumni: 9,956 (MD and MMSc)
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Broad Institute of MIT and Harvard Harvard Catalyst | The Harvard Clinical and Translational Science Center Harvard Stem Cell Institute Wyss Institute for Biologically Inspired Engineering
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AFFILIATED HMS HOSPITALS AND RESEARCH INSTITUTIONS Beth Israel Deaconess Medical Center Boston Children’s Hospital Brigham and Women’s Hospital Cambridge Health Alliance Dana-Farber Cancer Institute Harvard Pilgrim Health Care Institute Hebrew SeniorLife Joslin Diabetes Center Judge Baker Children’s Center Massachusetts Eye and Ear | Schepens Eye Research Institute Massachusetts General Hospital McLean Hospital Mount Auburn Hospital Spaulding Rehabilitation Network VA Boston Healthcare System
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FINANCIAL REPORT Dean’s Report 2018–2019 25
FY 2018 OPERATING REVENUE n Research grants and contracts n Endowment distribution for operations n Other revenues* n Gifts for current use
4%
6%
n Rental income n Tuition (net)
Total
$297,041,843 $183,334,673 $96,477,114 $54,944,580 $41,911,270 $29,695,523 $703,405,004
42% 26% 14% 8% 6% 4%
8% 42% 14% 26%
* Includes continuing medical education, publications, service income and royalties
FY 2018 OPERATING EXPENSES
7%
n Personnel costs n Supplies and other expenses n Research subcontracts and affiliates n Plant
operations and interest
n Depreciation
Total
$280,435,628 $225,325,994 $103,608,834 $84,052,842 $48,772,587 $742,195,885
38% 30% 14% 11% 7%
11% 38% 14%
30%
FINANCIAL REPORT Last year, I made the financial sustainability of Harvard Medical School one of my highest priorities. As my first full year as dean comes to a close, I’m happy to report positive news concerning the medical school’s finances. While there is still a great deal of work to be done, we made significant progress this year and we remain committed to our financial plan. We are confident the improvements we have made will make the School stronger in the future. These improvements have come from across the organization and could not have been accomplished without our close partnership with University leadership and our community’s commitment to strengthening the financial health of HMS while continuing to advance the School’s mission. We are continuing to invest in our research and education missions through
new pilot funding for our faculty from my recently established Dean’s Innovation Grants in the Basic and Social Sciences. I have been truly inspired by the incredible talents of our faculty at HMS, and these funds will directly support collaborative research in their labs and within our community. Faculty are encouraged to apply for these awards to bring forward exciting new projects they might not otherwise be able to initiate. As these new programs develop, opportunities will be created for faculty to apply for extramural funding or investment funds from other external sources. As we all contend with an austere and resource-constrained funding climate, I feel compelled to provide opportunities for our faculty to take risks and be creative. As we think about our education mission and the upcoming Liaison Committee
Credits: Writing and editing by M.R.F. Buckley and Christine Paul; writing by Bobbie Collins,
Laura DeCoste, Stephanie Dutchen, Kevin Jiang and Ekaterina Pesheva; design and art direction by Paul DiMattia; photography direction by Bobbie Collins; photography assistance by Maya Rucinski-Szwec; copyediting by Bobbie Collins, Susan Karcz and Ann Marie Menting. Photography by Kyle Daniels/Partners In Health, Kathleen Dooher, Gretchen Ertl, Steve Lipofsky, PIVOT,
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on Medical Education (LCME) accreditation site visit in 2019, we have fully committed to an evaluative self-study process over the past year. It has been gratifying to see the dedication and commitment from our faculty, students and staff throughout this process. The medical school as a whole is taking a deep, introspective look at its MD program, as well as its policies and procedures, with an eye toward continuous quality improvement. The students in our MD program will benefit from this process, as will our entire institution. While the School incurred additional costs in support of these efforts in FY18, the MD program is core to the HMS mission and is prioritized as such. I firmly believe we have all the necessary resources in place to keep the School’s MD program at the forefront of medical education. In FY18, as planned, the School
long-term leased one of its major research buildings, the Harvard Institutes of Medicine building. This generated a substantial inflow of capital for the medical school, which will have a major positive financial impact in FY19. HMS ended FY18 with a $39 million operating GAAP deficit, down from $44 million in FY17. In FY18, operating revenues totaled $703 million, an increase of more than $35 million compared with the prior year. The School’s research revenue grew by roughly 6 percent from $282 million to over $297 million. Total operating expenses increased by $30 million to $742 million. As we continue our important work toward financial sustainability, we will also continue implementing our ambitious plans for the future to ensure that HMS remains the leading institution it is today. —Dean George Q. Daley
Michelle Rose/MGH Photography, David Salafia, John Soares, Joshua Touster and Bethany Versoy. Printed by Kirkwood Printing. Produced by the HMS Office of Communications and External Relations: Gina Vild, Associate Dean of Communications and External Relations and Chief Communications Officer, 107 Avenue Louis Pasteur, Suite 111, Boston, MA 02115, (617) 432-0442, communications@hms.harvard.edu.
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25 Shattuck Street Boston, Massachusetts 02115 www.hms.harvard.edu
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