Ignite Magazine | Spring 2018 by NEOMED

A P U B L I CAT I O N O F N O R T H E A S T O H I O M E D I CA L U N I V E R S I T Y â&#x20AC;¢ V O L 19 .1 S P R I N G 2 018

OF MICE AND HUMANS…

n working with mice, researchers at NEOMED learn a lot about the human

VOL 19.1 SPRING 2018

condition. As these individuals advance science, all of society benefits from their discoveries and developments. Sometimes such advancements are

gamechangers that can help detect disease, stop its progression or cure it. Oftentimes, the science helps us to understand things that we can do to enhance our wellness. And most of the time, those opportunities have to do with our lifestyles and the foods we eat. Food: any substance containing nutrients, such as carbohydrates, proteins and fats, that can be ingested by a living organism and metabolized into energy and body tissue. Yes, food is science, but that’s not what I think of when I enjoy a freshly baked

Northeast Ohio Medical University is a communitybased, public medical university with a mission to improve the health, economy and quality of life in Northeast Ohio through the medicine, pharmacy and health science interprofessional education of students and practitioners at all levels. The University embraces diversity, equity and inclusion and fosters a working and learning environment that celebrates differences and prepares students for patient-centered, teamand population-based care.

admit that I battle with my sweet tooth. I somehow manage it with a balance of

Ignite magazine (Spring 2018, Volume 19, No. 1) is published twice a year by the Office of Public Relations and Marketing, 4209 St. Rt. 44, P.O. Box 95, Rootstown, OH 44272-0095

exercise and trying not to overindulge. Too much of a good thing can be harm-

Email: publicrelations@neomed.edu

cookie or a piece of my favorite chocolate. I may be a healthy eater, but I must

ful—or at least bittersweet. On the following pages, we hope you immerse yourselves in this Food Issue as our writers explore the significance of the cultural influence on foods and the resulting melting pots and pans that created Northeast Ohio’s unique food culture. Our writers also explore the origins of obesity. In “Sizing it Up,” we go way back—400 years—to try to understand how our skeletal system relates to our body size. While Chris Vinyard, Ph.D., hopes that Gough Island mice, the world’s largest, will give us insight into evolutionary change and obesity in humans, “Our Animosity to Adiposity” traces the evolution of the dietary choices of Northeast Ohioans and the reasons why many doubt that BMI charts are accurate markers for obesity across cultures. The foods that are so comforting and great tasting can be among the worst contributors to the high rate of chronic diseases faced by Ohioans. Yet even when we know better, sometimes we simply don’t have much choice. Austin Hilt, a second-year College of Medicine student, tells us about the barriers in “Food and Medical Citizenship.” Liya Yin, M.D., Ph.D., and Priya Raman, Ph.D., enlighten us with research that empowers us to maintain healthy diets in “Finding the Heart to Make Healthy Choices.” We are also forewarned: There is no way to precisely identify that point of no return. In “Why Can’t We Quit Fad Diets?” Altaf Darvesh, Ph.D., suggests that we instead adopt a sensible eating plan—not a diet, but a way of life. I’m not sure if this sort of change can be observed in lab mice. This one may be completely up to us humans.

Jay A. Gershen President

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Jay A. Gershen, D.D.S., Ph.D., President NEOMED Board of Trustees: Daisy L. Alford-Smith, Ph.D. Carl A. Allamby, Student Trustee E. Douglas Beach, Ph.D. Paul R. Bishop, J.D., Vice Chair Sharlene Ramos Chesnes James M. Guirguis, Student Trustee Joseph R. Halter Jr. Robert J. Klonk, Chair Chander M. Kohli, M.D. Richard B. McQueen Philip L. Trueblood Editor: Elaine Guregian Contributing Editors: Samantha Hickey; Roderick L. Ingram Sr.; Jared F. Slanina Publication Design: Scott J. Rutan Illustrations: Cover and page 16, Dave Szalay, associate professor of graphic design, University of Akron Myers School of Art; Branden Vondrak, B.F.A., Kent State University School of Visual Communication Design; Christopher Darling, assistant professor of illustration, Kent State University School of Visual Communication Design Photography: Chris Smanto As a health sciences university, we constantly seek ways to improve the health, economy and quality of life in Northeast Ohio. The Accent Opaque paper used for this magazine has earned a Forest Stewardship Council (FSC) and a Sustainable Forestry Initiative (SFI) certification. Strict guidelines have been followed so that forests are renewed, natural resources are preserved and wildlife is protected. Ignite was printed by Printing Concepts in Stow, Ohio, using soy inks. No part of this publication may be reproduced without prior permission of the editors. Copyright 2018 by Northeast Ohio Medical University, Rootstown, Ohio 44272.

DEPARTMENTS 20 HUMANITIES IN MEDICINE

30 CLASS NOTES

24 IN THE REDIZONE

33 WHALE WATCHING

27 FOOD FOR THOUGHT

35 FINAL LOOK

29 HUMANITIES IN MEDICINE

FEATURES

04 FOOD AND MEDICAL CITIZENSHIP How a public health project shaped one medicine student’s perspective.

08 WHY CAN’T WE QUIT FAD DIETS? Pharmacy students learn to compare diets to find the longevity and lifestyle benefits that we really crave.

12 OUR ANIMOSITY TO ADIPOSITY One culture’s fat is another culture’s fit. Why the Body Mass Index metric could use a deep dive into our country’s melting pot. ON THE COVER For our food-themed issue, we contemplate the journey to finding balance in our diets. Cover artist Dave Szalay is an associate professor at the Myers School of Art at the University of Akron, a NEOMED partner.

16 SIZING IT UP Unraveling the genetic history of the world’s biggest mice.

18 FINDING THE HEART TO MAKE HEALTHY CHOICES It all comes back to sugar.

The Association of American Medical Colleges honored Ignite magazine in the Print and Digital Publishing category of its 2018 Group on Institutional Advancement (GIA) Awards for Excellence program.

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FOOD AND MEDICAL CITIZENSHIP: HOW YOUNGSTOWN SHAPED MY ROLE IN MEDICINE BY AUSTIN J. HILT

Austin J. Hilt holds a Bachelor of Science degree and a Master of Public Health degree from Youngstown State University. A second-year student in the College of Medicine, he is also enrolled in the Master of Medical Ethics and Humanities program in the College of Graduate Studies. He expects to graduate from both programs in May 2020.

rowing up, I always felt connected to food. Some of my earliest memories are of gardening with my parents and sisters. In early spring, my father tilled the soil, then we set rows and mounded the soil to bury all kinds of seeds, with much anticipation for what would grow. We had a massive colander that we used to carry and wash our pickings; it always seemed to be piled high with green beans. One of my uncles had trained as a chef; watching him cook and tasting his creations was fascinating to me. I thought that this was something I could do with my life. I wanted to make other people Illustration: Branden Vondrak

feel the way I had in these moments. My mother explained to me that the beauty of cooking was that I could make whatever I want, whenever I want—and it didn’t necessarily need to be a career. When I began transforming my own diet to focus on the deliberate use of food to promote health, I became even more connected to food: its preparation, its politics and its impact on the environment. I was privileged in that I never had to worry about access to food—and healthy food, at that. But throughout the United States and the world, many communities face significant barriers to getting nutritious foods like fresh fruits and vegetables. The term for these places, food deserts, has become well known (unfortunately). There’s another term for areas that are mostly filled with less-healthy outlets like fast food restaurants and convenience stores: food swamps. Youngstown, a former steel-mill town that has seen economic hardship and population decline for decades, is one

such place. In 2016, I was a student at Youngstown State University, pursuing a Master of Public Health degree in a consortium program administered through NEOMED. As a capstone to my coursework, I completed a research project on food access in Youngstown. Here, community engagement was the perfect complement to my studies. Collaborating directly with community organizations and economic development professionals, I explored social and behavioral determinants of health; nutrition environments, community development; and the impacts of urban blight.

HEALING A CITY In Youngstown, there is no shortage of health issues. A Centers for Disease Control and Prevention report called the “500 Cities Project” published in 2017 found that Youngstown’s rates of disease were higher than the national average in category after category: Arthritis, asthma, high blood pressure, high cholesterol, chronic NORTHEAST OHIO MEDIC AL UNIVERSITY

FEATURE

YOUNGSTOWN AND NORTHEAST OHIO HOUSEHOLD FOOD ACCESS SURVEY Sample questions: For these statements, please indicate whether the statement was “often true”, “sometimes true”, or “never true” for you or your household in the last 30 days—that is, in the past month. • “The food that (I/we) bought just didn’t last, and (I/we) didn’t have money to get more.” • In the last 30 days, were you ever hungry but didn’t eat because there wasn’t enough money for food?

Please indicate whether you agree or disagree with the following statements: • It is easy to buy healthy food in my neighborhood

How important are each of the following factors in your decision to shop at the store where you buy most of your food? • Near your home

• There is a large selection of healthy food in my neighborhood

• Near or on your way to other places where you spend time

• It is easy to buy fresh fruits and vegetables in my neighborhood

• Your friends/relatives shop there • Variety of foods

• The fresh produce in my neighborhood is of high quality

• High-quality of foods

• There is a large selection of fresh fruits and vegetables in my neighborhood

• Access to public transportation

• Low prices

• Safety of the neighborhood • Availability of parking

kidney disease, chronic obstructive pulmonary disease, coronary heart disease and diabetes. One of the biggest challenges in modern medicine is chronic disease and the changes in health behaviors that people need to make if they are to keep these diseases at bay. Food can be an effective tool, but it remains severely underutilized: A scant 8.9 percent of Americans and 7.1 percent of Ohioans met their recommended daily servings of vegetables in 2015. The role of diet cannot be neglected in this conversation. But what to do? With the assistance of Kim Trowbridge, M.Ed., of NEOMED as Principal Investigator (lead researcher) on a mini-grant I received to do a household food access survey (see sidebar), I was able to continue a project that forever changed my perspective on my role in medicine and society. The immersive experience of 06 I G N I T I N G

documenting Youngstown’s nutrition environment has shown me how my role as a physician extends far beyond clinical practice.

BECOMING A MEDICAL CITIZEN The art of medicine concerns itself with almost every aspect of a patient’s life, from observable physical features and contents of the mind to shared relationships and community characteristics. A door opened for me when I was introduced to the term “medical citizen,” which highlights the need for health professionals to engage with these social, political and economic contexts of health and well-being. The combination of my experiences in education, research and service have shaped my identity as a medical citizen. I know my efforts can impact not only individual patients and families, but also the broad-

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er community and processes that influence their health. So, there we are. Full circle, right back to where we started. Our health comes back to food, as a medicine, as a social device, as an art—and even more. Its flavors and its reflection of different cultures have a role in defining a community. There is so much joy and power in growing and consuming food, and I’m not talking about just any kind of food here; this is an important distinction. I’m talking colorful, nutrient-dense, living food—the kind that overflowed from that giant colander when I was growing up. For me, the story of how food makes a community and community makes health is just beginning. These experiences have truly made me feel like not just a student physician, but a medical citizen.

MAPPING A

FOOD DESERT BY AUSTIN J. HILT

ince May 2016, five organizations, including Eastgate Regional Council of Governments, Youngstown Neighborhood Development Corporation, Youngstown State University, Mercy Health Foundation and the Youngstown City Health District, have participated in Invest Health—a national initiative by the Robert Wood Johnson Foundation and Reinvestment Fund to help cities like Youngstown address barriers to achieving better health. One focus area for Youngstown was food access. The main goal was to gain a better understanding of where residents get their food and why they choose to shop at certain locations, then to use this knowledge in developing a food access action plan. That’s where I got involved. While planning and writing a proposal for the Paul Ambrose Scholars Program, a national student leadership symposium on public health and preventive medicine, I received an email from Sara Wenger from Eastgate about their interest in performing a city-wide food access survey. This was perfect timing. The plan I was laying out was strikingly similar to what they wanted to accomplish for Invest Health. So, we worked together on finalizing the details and putting the plans into action. We asked community members to complete the survey and return it to drop-off sites throughout the city. An online option was available, too. We also connected with community organizations to attend meetings and events, so we could gather responses in person from Youngstown residents. Gathering a truly representative sample, demographically and geographically, has been a challenging endeavor. I must admit, surveys are not a very popular pastime, but it was important to collect detailed information. We needed to know: What kinds of food are available? What transportation options do Youngstown residents have to reach the food? Are the nutritious choices affordable? What information and advocacy would the citizens of Youngstown like to have?

As of early 2018, we are finishing data collection and working on analyzing the results. We’ll incorporate the findings into our food access action plan. Most important, we are exploring how this information can be made useful to a wide variety of community organizations. For example, can local hospitals use it to help connect their patients with vital food resources if they live in an area that is relatively devoid of healthy options? Are there certain areas of the city that would be better suited for a new grocery store or market? How can we increase access, connect residents to healthy foods and incentivize them to purchase and eat more fruits and vegetables? One example strategy is the Supplemental Nutrition Assistance Program (SNAP) “Double Up” Program, supported by the USDA Food Insecurity Nutrition Incentive program, Youngstown Neighborhood Development Corporation and Mercy Health Foundation Mahoning Valley. Shoppers who use SNAP can double the value of their purchase to get twice as many fruits and vegetables at local food vendors like farmers markets. Mercy Health is also expanding its fruit and vegetable prescription program, which gives patients vouchers for fresh, local produce. Undoubtedly, there are more opportunities to act. Maybe that means stocking convenience stores with healthier options or providing transportation services to larger stores. It could even mean bringing mobile markets to specific neighborhoods. We have only scratched the surface. Youngstown has surely endured a great deal over its history. It deserves a more nuanced characterization than the one it often receives—as a city in decline. It’s also a strong, resilient community with residents and community leaders who truly care for each other and constantly work in pursuit of a better tomorrow. I am incredibly thankful to be part of such an amazing process. Revitalize!

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FEATURE

WHY CAN’T WE QUIT FAD DIETS? BY ELAINE GUREGIAN

want to be skinny as much as the next person, but I draw the line at eating cotton balls. Actually, I draw the line way before that. Not only will you never find me stuffing my mouth with cotton balls instead of food, as a way of tricking my body into thinking that it’s full. You’ll also not catch me eating nothing but grapefruit, matching my blood type to a menu, or bulking up on protein and abandoning my darling carbohydrates. This attitude makes me a misfit, right up there with other boring “everything in moderation’’ lessons I absorbed from my long-lived Midwestern parents. Every year, 45 million Americans go on a diet, according to the Boston Medical Center. (That word isn’t exactly accurate, since whatever a person regularly eats constitutes their diet; what we mean when we say “diet’’ is usually a weight-reduction diet. OK, the English lecture is over.) As Americans, we don’t want to hear that fad diets don’t work. We’re going to Illustration: Christopher Darling

keep trying. Notice that I say “we,’’ because I, too, would like to think that I can control my own destiny through my actions. Here’s a thought: Why don’t we just adopt a sensible eating plan, like the so-called Mediterranean diet that has sustained people living around the Mediterranean Sea for thousands of years? Actually, that’s what a lot of people are doing—they are just calling it by a different name. (Renaming foods to make them trendy is part of our American culture, too—see “ancient grains.”) The currently popular “plant-based diet” is not so far away from the Mediterranean tradition, which constitutes “not a diet but a way of life,’’ says Altaf Darvesh, Ph.D., an associate professor of pharmaceutical sciences and associate professor of psychiatry at NEOMED.

FOOD LEADS THE WAY Olive oil, whole grains, legumes, fruits and vegetables are just the beginning.

“The Mediterranean diet is about the whole social aspect of food, like eating with others. It’s about how food should serve the whole person,’’ says Amy Unruh, a third-year College of Pharmacy student. Unruh was one of the third-year College of Pharmacy students who compared fad diets with medically accepted diets in a class run by Seth Brownlee, Pharm. D., associate professor of pharmacy practice, and Dr. Darvesh. Together, they cover both pharmaceutical and nutritional concerns. The Mediterranean diet evolved naturally, unlike today’s specific weightloss diets. But the healthy lifestyle that goes along with it (including more leisurely mealtimes and walks after meals with family or friends) may result in weight loss, says Unruh. She discovered it for herself as a first-year student in the College of Pharmacy: Even when she didn’t have enough time to cook slow foods like the whole grains that are part of the Mediterranean diet, she lost weight when she made it a habit to exercise a bit more. NORTHEAST OHIO MEDIC AL UNIVERSITY

FEATURE

SCIENCE OR SNAKE OIL? “We are seeing a big trend now in lifestyle diets,” says Dr. Brownlee. “Instead of saying, ‘You’ll lose 10 pounds in two weeks,’ they say, ‘This diet is going to improve your longevity.’” We want students to ask, is this diet a valid way to do that, or a misrepresentation of facts? Is the diet safe or are there any unintended consequences? “What we wanted to do was to have our student peel back the cover of claims like, ‘This diet is the greatest thing ever’ and see if there was any scientific basis for them.” Following principles of biochemistry and nutrition, the students discover which diets are built on solid principles and which, like the Blood Type diet, may begin with a grain of science but go on to draw dubious conclusions, says Dr. Brownlee. If the rest of us were to approach diets like these NEOMED students, we’d review each one’s impact on vitamins, minerals and fluids. We’d determine the macro- and micronutrient composition and look at the biochemical mechanisms involved in the weight loss or other purported therapeutic benefits. A shortcut: Each year, the fad diet class students share their findings

“THE MEDITERRANEAN DIET IS ABOUT THE WHOLE SOCIAL ASPECT OF FOOD, SUCH AS EATING WITH OTHERS. IT’S ABOUT HOW FOOD SHOULD SERVE THE WHOLE PERSON.’’

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Pharmacy student Amy Unruh’s team compared the Mediterranean diet with the Atkins diet. Other groups compared fad diets listed here with the Mediterranean and two others widely endorsed in the medical community: DASH (Dietary Approaches to Stop Hypertension), which the Mayo Clinic deﬁnes as “a lifelong approach to healthy eating that’s designed to help treat or prevent high blood pressure (hypertension)” and the TLC diet, developed by researchers at the National Institutes of Health to help lower cholesterol levels. Unruh and her team determined that following the Atkins diet could help someone to initially lose more weight more quickly than the Mediterranean diet. One downside? A ketogenic diet (high in protein, low in carbohydrates) such as the Atkins diet also relies heavily on the kidneys for waste removal. It could result in kidney damage if adhered to long-term, says Unruh. The Atkins diet can also become quite expensive because it relies on pricey protein, she adds. (Steak or lentils—guess which is cheaper?)

FAD

DIETS

• Paleo

• Vegan

• MIND (a combination

• Atkins

of the Mediterranean and DASH diets)

• 5:2 • Ketogenic • Bulletproof • Soylent

• South Beach • Whole 30 • Gluten-free • 80-10-10 • Sacred Heart

• Fruitarian Anti-inﬂammatory (Arthritis Foundation diet)

• Raw food • Apple cider vinegar • Blood type • Dukan • Alkaline

MEDICALLY

ENDORSED

DIETS

✓ DASH (Dietary Approaches to Stop Hypertension, designed to lower blood pressure) ✓ Mediterranean (olive oil, whole grains, ﬁsh, plant– and lifestyle-based) ✓ TLC (Therapeutic Lifestyle Changes, created by the National Institutes of Health’s National Cholesterol Education Program)

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at an event where the public can view informational posters, pick up educational handouts or ask the students questions.

HONOR THE PATIENT As Dr. Darvesh prepares medicine and pharmacy students to work with patients or customers, he counsels them to find ways to accommodate eating and drinking preferences. “If a patient comes to you and says, ‘Can I do the fruitarian diet?’ then work with them in modifying it. Tell them, ‘Yes, you can do a fruitarian diet, but how about adding protein? Your lunch doesn’t have to be just fruit; it can be a peach and avocado—and chicken salad,’” he says. It doesn’t do any good to advise someone to eat food they can’t afford, or which isn’t readily available, he notes. “Frozen veggies are actually quite nutritious,’’ says Dr. Darvesh, sounding positively counter-revolutionary. The ‘farm to table’ movement of fresh foods makes sense—in fact, it’s nothing new for people living near farms, and it’s fine for urban

dwellers who can afford quality at prices that are often higher than mainstream groceries. For people living in food deserts, the idea of farm to table is a mirage. Dr. Darvesh works hard to be diplomatic, but he has his own tipping point. It came once when he was giving a lecture and noticed what one of his students were eating for breakfast, in what he deems an “Atkins horror story”— about 10 strips of bacon, piled high and washed down with two cans of Diet Coke. Traumatic? Yes. “I was so distressed,’’ he says, “I couldn’t focus on teaching at all.’’ Food is a loaded topic. What we eat reveals who we are, who we wish we could be and where we came from. So, Dr. Brownlee and Dr. Darvesh advise their students to begin with a conversation, to discover the reality for each patient. The rest of us could look in the mirror to do the same. A reality check might help us to focus on the best way to nourish ourselves—body and soul—instead of chasing after the latest weight-loss plan.

FOR PEOPLE LIVING IN FOOD DESERTS, THE IDEA OF FARM TO TABLE IS A MIRAGE.

A REFRESHING

BREAK?

While NEOMED’s fad diet class doesn’t seek to cover every trend, Dr. Brownlee pays close attention to the latest research reports. “There’s quite a growing body of research that would suggest that intermittent fasting actually may be one of the critical components of increasing longevity,’’ says Dr. Brownlee. He cites research showing that eating all your food within an eight-to ten-hour period each day, then fasting for the remaining hours, is good for the cells in your body. The time off appears to give them a chance to recover and rejuvenate from all of the metabolic processes they undergo when you’re eating, the pharmacist explains.That break, says Dr. Brownlee, “may actually be the fountain of youth.’’ But as with any change of diet, Dr. Brownlee has this advice for patients: Talk to your physician or pharmacist ﬁrst.

Illustration: Christopher Darling

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FEATURE

OUR ANIMOSITY TO ADIPOSITY BY RODERICK L. INGRAM SR.

s the light from the candles atop the bar flickers in the mirror, the couple waiting for their table share a small plate of elegantly prepared chicken livers. Sipping an unoaked Chardonnay, Dr. Canter reflects on her day as a family physician at a hospital in a rural, outer-ring suburb, 20 miles from the inner city where her husband, William Fairfax, serves as police captain. Capt. Fairfax was raised nearby, but the trendy neighborhood is nothing like what he remembers. Growing up, it was filled with immigrants from Eastern Europe and African-Americans who migrated from the South. Presented a table, the couple orders: a duck confit (meat submerged and cooked in its own fat), Brussels sprouts and cheddar grits; and a cassoulet, a dish served in a skillet with a variety of meats, including pork sausage and lima beans. As they wait for their food, Dr. Canter begins the conversation: “I had a patient today who hasn’t been feeling well—lethargic, sore joints, you name it. She has had high glucose

results since I’ve known her. Her blood pressure isn’t terrible. But I’m worried about her.” Dr. Canter continues, “Her BMI is 31, so I recommended she change her eating habits—too much starch, fried foods and pork.” “Sounds like what I grew up eating,” says the Captain. “Yeah, but she’s my height, and weighs 25 pounds more than me. She needs to change or she’s going to have problems,’’ says Dr. Canter. “Like?” asks the Captain. “Diabetes or hypertension or heart disease, like about half of my patients,” Dr. Canter answers. As the conversation turns to other topics, Patricia, the head nurse in Dr. Canter’s office, passes by their table. Surprised to see her, Dr. Canter remarks, “Patty, fancy seeing you here! I didn’t know you liked this place.” Patty responds, “It’s expensive but one of the dishes reminds me of my mom’s oxtail stew.”

As comfort food has been elevated to haute cuisine, our love for the trend is evident. According to the 2016 America’s Health Rankings® Annual Report, the rate of obesity has increased nationally, from 27.8 to 29.8 percent of adults. But for Nurse Patty and others, obesity is a complex equation, not just a sum of what she eats. Factors include genetics, prenatal and early life influences, unhealthy diets, insufficient sleep and lack of physical and social activity. Compounding these risk factors, many people dismiss dietary recommendations made by health professionals. Patients across a variety of racial and ethnic groups have raised doubts about the use of body mass index (BMI), as the basis for those recommendations. Their skepticism is not without merit. And at the heart of their pushback lurks more than a hint of concern that the BMI chart is linked with bias against the poor, the rural, the ethnic. Dr. Canter’s patients are black, white, Asian and Hispanic, with lifestyles and eating habits reflecting the traditions of NORTHEAST OHIO MEDIC AL UNIVERSITY

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“MANY BELIEVE THAT BMI IS NOT A FAIR OR ACCURATE MARKER OF WELLNESS OR OBESITY.”

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their ancestors who settled here. Socio-economic concerns and access to healthy choices are still issues in many communities. Yet, as the availability of food education and advancements in preserving and processing have changed, so to have mainstream perceptions of what’s healthy, what’s tasty and what’s shapely. You hear it often: “My doctor says I’m obese though my stomach is flatter than hers.” “Does that affect my insurance?” “My entire family is big-boned, but we’re not obese.” Many believe that BMI is not a fair or accurate marker of wellness or obesity. And some physicians agree with them that being labeled with a “bad’’ BMI might be counterproductive to good health. A journal article in Social and Personality Psychology Compass, “Weighed Down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health,” states that although “some lay individuals and health professionals assume that stigmatizing weight can actually motivate healthier behaviors and promote weight loss,” the stigma is consistently associated with poorer mental and physical health. “Physicians should look at the whole patient and not only look at weight and BMI,” says John Boltri, M.D., professor and chair of the Department of Family and Community Medicine at NEOMED. Dr. Boltri is also the American Academy of Family Physicians Liaison to the National Diabetes Education Program (NDEP) Coordinating Committee Strategic Directions Group. “There are some things that are not in patient’s control, like their genetics. And BMI is a tool for physicians to add to all of the data that they have about a patient. Treatment should be individualized to the patient’s needs, abilities and resources.”

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A MEASUREMENT UNDER FIRE Apparently, blaming and shaming patients doesn’t work. And BMI as a measure? One flaw is that it does not distinguish between muscle and fat. A weightlifter may be labeled as obese, based on their BMI, and so might someone from a particular ethnic group. Surprisingly, the BMI formula, which divides a person’s weight by their height squared, was devised in the 1830s by Lambert Adolphe Jacques Quetelet, a Belgian astronomer, mathematician and sociologist. The formula—not coined “body mass index” until 1972, by Ancel Keys, an American physiologist—was not originally intended to be used to direct a patient’s medical care. Today, the metric is opposed by those who feel that the same benchmark should not be used to compare the body mass of two genetically dissimilar groups, who have completely different body styles, cultures and diets. In an article titled “Why are there race/ ethnic differences in adult body mass index–adiposity relationships? A quantitative critical review,” researchers reviewed race-ethnic differences across non-Hispanic white, non-Hispanic black and Mexican American adults. The researchers considered their anatomic body composition basis and potential biologically linked mechanisms, using both earlier publications and new analyses from the U.S. National Health and Nutrition Examination Survey.

WHAT DID THEY FIND? In reviewing the relationship of BMI to adiposity (obesity), researchers discovered that at the same body mass index and height, body component and regional body mass proportions differ across race/ ethnic groups. They also concluded that more in-depth studies are needed to elaborate on race/ethnic differences in body shape and composition and how these

differences relate to clinical risks of having certain chronic conditions. Here’s another point: BMIs that are in a “healthy range” for one population group may not be for another group. A 2017 Newsweek article, “There’s a Dangerous Racial Bias in the Body Mass Index,” cites a study by Dr. Alka Kanaya, a professor of medicine at the University of California, San Francisco, suggesting that Americans of South Asian descent who have BMIs within the healthy range are two times more likely than whites with similar BMIs to have an increased risk for heart disease, stroke and Type 2 diabetes. The BMI of one is not equal to the BMI of another. In this example, BMI is demonstrated to be a better measurement for health outcomes than it is for obesity. But while a high BMI might not mean that a person is fat, all individuals still need balance, maintaining the social-physical activities, environment and food choices necessary for wellness to go along with the numbers. There are a number of tools, such as weight circumference, to estimate obesity—but obesity is just one factor in estimating a patient’s health or disease states.

WHAT’S THE TAKEAWAY? It’s ok to enjoy favorites from all cultures every now and then, whether in our own kitchens or dressed up for white-tablecloth restaurants. With the right balance in our lives, BMIs charts don’t have to be the bane of our existence. And based upon the 2016 America’s Health Rankings®, which show that obesity decreased in Ohio from 32.6 to 29.8 percent of adults, some of us may already be headed in the right direction. Adds Dr. Boltri, “Just a 5 to 10 percent weight loss can lower your risk for diabetes, lower your blood pressure and improve your sense of well-being.” If we keep going, there should always be enough room for a piece of granny’s pie.

MELTING POTS—AND PANS

ortheast Ohio’s diet exemplifies a melting pot of cultural cuisines. One layer comes from the hunting and gathering traditions, and the staples—corn, beans and squash—of Native Americans. Add in the recipes for baked beans, salt pork and molasses brought by American settlers from the Western Reserve. Then, stir in the German immigrant traditions of sausages, sauerkraut and meat-and-potatoes meals. Next, add flavors from The Great Migration of African-Americans who traveled from the South, where their ancestors were forced to eat the animal parts that slaveowners threw away. Ohioans have a long tradition of eating what situations of the past and their newly settled land afforded them. During the early 19th century through the early 20th century, British and Irish immigrants, and then many Southern and Eastern Europeans and Jews also came to the U.S. As Northeast Ohio’s economic potential grew, so did the emigration from other countries with Italians, AustroHungarians, and Russians—along with our mixture of cultures. People brought their own dishes, spices and ways to prepare them—a melting pot of diets. Ohioans feast on pierogis, pastas and paprikash; stuffed cabbage, kielbasa and pizza; chicken, from the Serbian fried in Barberton, Ohio to southern fried found throughout Northeast Ohio (both using lard); and baked goods, from coconut bars and cannolis to paczkis and sweet potato pie. Immigration acts prohibited large-scale immigration after World War I. According to the Encyclopedia of Cleveland History, new sources of migrants including blacks from the American South met this need. In the 1920s, Cleveland saw the first group of Spanish-speaking immigrants arrive from Mexico. After World War II, people from Appalachia moved north to Ohio, lured by the rubber industry in Akron. Puerto Ricans came to work in the steel mills of Lorain, and then, following the Cuban revolution of 1959, came an influx of Cubans. Northeast Ohioans became exposed to spicy foods and chiles, fried plaintains and yucca, along with seasonings and sauces like annatto, cilantro and sofrito. From these groups came a mixture of Native American foods, and African, Caribbean and Spanish cuisines. From the 70s on, Northeast Ohio drew interest from groups of Asian immigrants—Chinese, Koreans, Indians and Pakistanis—as well as others from Southeast Asia, Central and South America and the Middle East. These cultural influxes enhanced our tastes for legumes, from chickpeas to soy beans; exotic meats, fish and fowl; and fruits, seasonings and drinks. The migration and settlement of a wide variety of racial and ethnic groups define the foods we eat in Northeast Ohio today and our food choices today reflect the diversity in and among them. — Roderick L. Ingram Sr.

NORTHEAST OHIO MEDIC AL UNIVERSITY

FEATURE

SIZING IT UP: UNRAVELING THE GENETIC HISTORY OF THE WORLD’S BIGGEST MICE BY ELAINE GUREGIAN

Christopher Vinyard, Ph.D., professor of anatomy, is funded by the National Institutes of Health as a co-investigator to study Gough (rhymes with cough) Island mice—the world’s largest wild mice.

he mice on Gough Island were said to have been dropped off there by sailors 400 years ago. What’s special about them? There’s this thing that happens on islands, known as the Island Rule: If you’re big and go to an island, you tend to get small and if you’re small and you go to an island, you tend to get big. There are probably plenty of species 16 I G N I T I N G

that go to islands and don’t get big or small but just die out. But the idea is if you go to an island that’s drastically different from what you are used to, something’s going to happen. You may not survive, but something’s going to happen. What drew you to this project? As an evolutionary biologist, one of my main interests is how complex systems—systems that are more than the sum of their parts—evolve. The underlying genetic architecture of the things we see as the working parts of animals has always interested me. The Principal Investigator on this project, Bret Payseur, Ph.D., of the University of Wisconsin-Madison, and

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I have collaborated on a number of projects over the years, starting when we were in graduate school together at Northwestern University. Bret is interested in genome evolution, and islands are great natural experiments. He came to me with the idea. Finding the largest natural mouse in the world provides an interesting case study in how the skeleton and body size evolved so rapidly. What are you hoping to learn? For one, understanding the history of how the Gough mouse genome has changed. You would think oh, one gene changed and now you get a new something—but that tends not to be the case Illustration: David Szalay

with things like size and body weight. in humans. Comparative people like my- proportions are distributed throughout Complex traits, like height or body size, self—people interested in morphology— the genome. For the next five years, on typically have hundreds, if not thousands, are always looking for these natural exper- our renewal grant from the NIH, we will of genes that influence their final form. iments to understand processes that look at one specific region and start to see In fact, we see differences between the happen in evolution. It’s like how our if we can get a little closer to some of the Gough Island and mainland mice all over NEOMED colleague Hans Thewissen specific genes involved. the genome. (J.G.M. “Hans” Thewissen, Ph.D., InChances are, there will be a third projThere are hundreds of genes ect where we see if we can verify with many interactions, each addthat it’s one particular factor. That ing their own little part to create part may start to step beyond the IF YOU LEAVE THESE MICE the continuous distribution of range of quantitative genetics. We these complex traits in a populawould be venturing into molecWITH AS MUCH FOOD AS tion. If selection acts on body size ular biology—that’s the kind of THEY CAN EAT, THEY’LL or skeletal form, there are literalthing that my colleagues Fayez Safadi, Ph.D., and Tariq Haqqi, ly thousands of genes, each with GET REALLY BIG. IT’S some amount of variation, that Ph.D., both professors of anatoA MAMMALIAN THING. may be targets of evolutionary my and neurobiology, can do. change contributing to increasing We’re more likely to collaborate MAMMALS CAN’T SEEM size in Gough mice. as we look to manipulate gene TO RESIST. IF YOU DON’T expression and see its effects on All of this makes it very difficult to pinpoint where changes in size and skeletons. KNOW WHEN YOUR the genome have occurred. How It really does take an army to NEXT MEAL IS COMING, do this project. Graduate students that actually works is one of the biggest remaining questions in here and in Wisconsin have been YOU EAT EVERYTHING evolutionary biology: how do scanning and measuring the mice these complex traits evolve? skeletons. In Wisconsin, they’ve YOU CAN WHEN YOU Another goal we have is to take been creating the next set of mice. SEE IT. THERE’S LOTS OF a crack at one or two of these reRather than just crossing mice gions of the genome where Gough from the mainland with those STUDIES TO SHOW PEOPLE mice differ from mainland mice from the Gough Island and mixDO THE SAME THING. and see if we can identify the gene ing up all of the genomes, they’ve or genes affecting Gough morbeen working to set up a cross phology. One of the objectives of that is just varying on one chroour second grant is to start unraveling the galls-Brown Professor of Anatomy) stud- mosome. That will give us better resolution genetics of one of these regions in the ies his whales: He knows they came from for that one particular chromosome, beGough mouse genome that suggests there terrestrial animals, so he knows they had cause all of the variation in morphology— may be an important size-affecting factor to go through all these transitions to aquat- in theory—should come from variation here. It’s a difficult and expensive process. ic living, and he can then dissect what due to factors on that chromosome. Once What’s the most tangible long-term might have happened in each of the organ that line is created, in a couple of years, systems. So, we’re doing that: studying we’ll start measuring them. application of this research? Understanding how our skeleton and changes in body size and the skeletal sysLike all science, it gets boring after a bodies are put together. Our research could tem in these mice. while because you come in and measure give us an understanding of how rapid size Where are you on the research, six the whole time. change occurs; how the relationships of years in? That’s one of the things I always tell the skeleton are built; how they are relatThe objective for the first five years of students: If you have your “Oh wow’’ moed to size. Maybe this will give us some the project was to see how genetic chang- ment, then you have to demonstrate it insight into rapid size change and obesity es leading to larger size and novel skeletal with statistics.

NORTHEAST OHIO MEDIC AL UNIVERSITY

FEATURE

Liya Yin, M.D., Ph.D.

FINDING THE HEART TO MAKE HEALTHY CHOICES BY JARED F. SLANINA

f the last thing you remember hearing about how to keep your heart healthy had something to do with eating less red meat, I’m with you. What’s the latest thought on how our diets can keep our hearts fit? Liya Yin, M.D., Ph.D., associate professor of integrative medical sciences at NEOMED, can shed some new light, thanks to her research on heart and blood vessel disease, funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. Dr. Yin compares the hearts of healthy animals with those of obese or diabetic animals. What she has discovered certainly provides motivation for paying attention to diet. The animals that consumed a diet

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full of sugar and fat had little to no coronary collateral artery growth—which means that the heart muscle lacked the resilience to repair itself after damage from a cardiac event caused by artery blockage. Here’s what happens after such a cardiac event: Even if an angioplasty is performed to clear the blockage, there may be residual blockage. The body will need to grow collaterals—additional arteries that provide the blood a new pathway to circulate. Without the collateral growth, the cardiac event may result in death, because the heart can’t adequately circulate the blood. Avoiding excessive amounts of sugar and fat may be a key to maintaining a healthy diet and a heart that is more ca-

T H E PA S S I O N O F P H Y S I C I A N S , P H A R M A C I S T S A N D H E A LT H C A R E R E S E A R C H E R S

pable of collateral growth—potentially, making a lifesaving difference after a cardiac event.

GLUCOSE: THE DOUBLEEDGED SWORD One specialty of Priya Raman, Ph.D., associate professor of integrative medical sciences, is atherosclerosis—the blockage of arteries. In her research, funded by the American Heart Association, Dr. Raman specifically seeks to understand why diabetic animals are more prone to these clogs undermining heart health. An intriguing finding by Dr. Raman is that the body reacts to high levels of carbohydrates, not just in the short term, but in an ongoing way. Routinely con-

suming too many high-carb foods over time can actually change the way proteins habitually function in the body. The proteins are “turned on,” creating blockages that can be devastating to the functioning of the arteries. This process happens with both simple carbs (such as candy and sugary drinks) and complex carbs (such as potatoes, which metabolize more slowly). However, says Dr. Raman, the key determinant is the glycemic index of these carbs—which is a better indicator of how rapidly the blood glucose levels will be raised upon consumption of carbs. (For example, potatoes, due to a higher glycemic index than another common carb, kidney beans, would increase blood glucose levels more rapidly than kidney beans.) Why is a rapid buildup of glucose a problem? Let’s say you are diabetic. When glucose builds up in your body, you are unable to efficiently utilize it for energy production. Instead, the buildup may lead to a couple of adverse events. First, excess glucose can lead to activation of harmful proteins. Second, excess glucose could be converted to fats and lipids—and lipids, in turn, can alter proteins into a harmful state. The takeaway? Increased glucose levels can be a double-edged sword.

THE POWER OF HABITS Up to a point, says Dr. Raman, the same proteins that are activated to create blockages due to a poor diet can also be turned off if we lower our intake of sugary foods and complex carbs with a high glycemic index. But here’s the conundrum: There is no way to precisely identify that point of no return. In other words, researchers don’t yet know what levels of carbohydrates the body can handle before the proteins that turn on to create blockage will permanently stay on. Here’s another catch: the body needs

Photos: Chris Smanto

Priya Raman, Ph.D.

carbohydrates for fuel. And fiber is a carb too, but a good one that helps people feel full when they eat fruits, vegetables and whole grains. Now that we know more, what can we actually do? Dr. Raman’s suggestion for a hearthealthy diet is down to earth: Limit our intake of sugar and complex carbs with a

high glycemic index—and do it as early as possible. For children, this means learning from an early age the importance of limiting sweets and finding healthier alternatives. As an adult, making those choices feels a whole lot better when I think of it as caring for myself with food that does my heart good.

NORTHEAST OHIO MEDIC AL UNIVERSITY

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HUMANITIES IN MEDICINE

THE STORY IN THE SKIN BY ELAINE GUREGIAN

irst-year College of Medicine students face a lot of challenges, but here’s a big one. When they first walk into the bright lights and intimidatingly clinical setting of the Gross Anatomy Lab to begin learning the mysteries of how the body functions—or ceases to function—how can they relate to the unmoving frames stretched out before them as real-life people who fell in love, pursued careers, raised families—and were once as young as they are? Hans Thewissen, Ph.D., Ingalls-Brown Professor of Anatomy in the Department of Anatomy and Neurobiology, says that part of a person’s life story is written in their skin, so uncovering it, layer by layer, is like reading a book about them. “Students always are excited about the heart or the brain, but the skin is the place to start,’’ says Dr. Thewissen. Human Structure and Development (HSD) is the biggest class—in terms of hours—for first-year medical students, says Dr. Thewissen, who is the course director and has taught HSD since 1993. He’s passionate about the skills of self-direction that students need to learn from

Photos: Chris Smanto

it. When students read a textbook, they get the impression that every person is the same, says Dr. Thewissen. But in the lab, it’s time for students to learn to think for themselves, says Dr. Thewissen, since every single body they study is different, just as all their future patients will be different from each other. For the most part, students must wait until their third-year clerkships before they begin interacting with patients. The groundwork for teaching respect for the whole patient begins earlier at NEOMED, with sessions such as the one being conducted today, says Dr. Thewissen, adding, “We have done this session for several years now, and I think that it is a great example of how we can integrate humanity into the early medical basic science curriculum. Looking at the skin of a body they dissect really makes students think about the life of that person.’’ No one knows skin like a dermatologist, right? So, for a recent class, clinical faculty member Eliot Mostow, M.D., M.P.H., has been invited to visit the Gross Anatomy Laboratory, better known by its shorthand name, the Gross Lab. Dr. Mostow is a NEOMED professor of internal

medicine with a private dermatology practice in Northeast Ohio. He has come to campus on this day, along with a fleet of other dermatologists and older students from NEOMED teaching hospitals, to assist the Gross Anatomy faculty in teaching 33 teams of first-year students. “Dr. Mostow and Dr. Jenifer Lloyd, who first approached me with the idea to have dermatologists in the Gross Lab, have really enriched our first-year curriculum,” Thewissen says. “They have enabled students to relate the body they see to the life led by the person who inhabited that body.’’

SEARCHING FOR THE STORY Each small group of blue-coated students has gathered in an individual study bay, assigned to a person whose age, sex and cause of death are printed on a card posted on the wall. Starting with those minimal clues, their job is to learn the best kinds of questions to ask themselves to develop a full story about the body lying in front of them. Dr. Thewissen has several goals for the day’s session: for the students to realize how much a physician can learn about the

NORTHEAST OHIO MEDIC AL UNIVERSITY

HUMANITIES IN MEDICINE

health of a person from examining their skin; to learn from Dr. Mostow and the residents how a dermatologist approaches the examination of the skin; and to learn to think of each body they examine as a real person, not just a learning aid. It’s crucial for students to begin developing empathic skills for each patient as early as possible, says Dr. Thewissen. What kind of life did this person lead? Dr. Mostow stands with a group of students at their study bay, guiding them toward further questions. Look for a tan line on the arms and other signs of sun 22 I G N I T I N G

exposure. Was this someone who labored in the hot sun, or who lived a more leisurely life and intentionally got a tan? How about the fingers—was this person a musician? What would the telltale signs be? How would you recognize a violinist? (Hint: Think about the spot on their neck where they press the instrument in place for hours on end.) As he moves from table to table, Dr. Mostow—designated as a master teacher by NEOMED’s Master Teacher Guild—peppers the students with questions that spark longer conversations about inclusion. Have they

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heard of the African-American musician Daryl Davis and his work in race relations? Talking about the markings on the hands of one patient leads to a conversation about the Bangladeshi man who became known to the world as the Tree Man because of a rare, dramatic skin condition that caused bark-like growths. TV or social media—that’s where some of us get our initial medical education, notes Dr. Mostow. Chae Kim, a first-year student at Table 30, says she was glad to hear that at today’s session they would get the perspective of dermatologists on what skin can reveal. She added that it was a revelation to work in the lab with actual bodies, since “pictures are so perfect.’’ First-year student Charlie Nelson was struck by Dr. Mostow’s point that darker pigmentation on a patient’s elbows could tell something about her lifestyle or health. Harib Ezaldein, M.D., a dermatologist and graduate of Yale School of Medicine, shows the students how to use the location of surgical staples in one of the bodies as clues to determine the surgery that had taken place. Before his current dermatology residency at University Hospitals Cleveland Medical Center, Dr. Ezaldein completed a year in surgery, equipping him to help the students relate the two fields of medicine to learn more about the patient. At Table 12, the patient is covered with tattoos that are typical of the Vietnam veterans that Gregory Delost, D.O., sees regularly when he works in the dermatology clinic at the Louis Stokes VA Clinic in Cleveland. Dr. Delost, a second-year resident at University Hospitals, said that the goal is to teach these students to think about each patient’s story, and the impact the particular details of their lives have made on their health. “That’s what we do every day as dermatologists,’’ says Dr. Delost.

ENHANCED FACILITIES This group of students was one of the first to experience recent improvements to the Gross Lab. Cameras and state-ofthe-art computers in each study bay allow the students to display their dissection on a screen so that others may see it. If there’s something noteworthy to show to the entire class, the image can be shared on all 33 monitors. Additionally, professors can record some dissections and post them on the University’s Mediasite portal for students to review later. Each computer has been loaded with the textbooks and videos, lecture videos and other reference materials, and students can surf the web if they want to explore further. In the past, students handled paper copies of books that needed to be replaced each year and were limited in what they provided. Now, they are able to enlist more sources and do not have to buy the expensive books. All of these improvements help the students imagine the life contained in the body before them. First-year student Hirva Joshi calls the day’s experience deeply humanizing: “It helps me realize it’s a real person who had a meaningful life.” Photos: Chris Smanto

NORTHEAST OHIO MEDIC AL UNIVERSITY

nutraceutical

noun | nu·tra·ceu·ti·cal | /ˌnü-trə-ˈsü-ti-kəl / A dietary supplement or a food additive that provides nutrition.

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T H E PA S S I O N O F P H Y S I C I A N S , P H A R M A C I S T S A N D H E A LT H C A R E R E S E A R C H E R S

IN THE REDIZONE

A TASTE FOR BETTER HEARING BY ELAINE GUREGIAN

magine the grinding, drilling and clanging that workers endure on factory floors and construction sites. It’s not hard to believe that the National Institute for Occupational Safety and Health calls noise-induced hearing loss one of the most common work-related illnesses in the U.S. Dangerously loud workplaces put some 22 million workers at risk every year. That’s not to mention hearing loss any of us can suffer from activities like listening to loud music or operating noisy equipment at home. Noise-induced hearing loss is the second most common form of sensorineural hearing deficit, behind only age-related hearing loss. Beyond its obvious drawbacks, recent studies suggest that hearing loss can lead to other brain problems, such as memory loss and depression. Despite the need, currently there are no approved medications for hearing loss. But if a NEOMED researcher has his way, we may be able to combat it by taking an herbal supplement derived from a Chinese plant.

COLLABORATING THROUGH THE REDIZONE For more than 17 years, Jianxin Bao, Ph.D., director of the Translational Research Center at NEOMED, has worked to find practical applications of his research

on hearing disorders such as hearing loss and tinnitus. Working with Gateway Biotechnology, Inc., a company Dr. Bao co-founded with two doctors of otorhinolaryngology, his group was the first to discover a family of antiepileptic drugs able to prevent hearing loss, and obtained Food and Drug Administration (FDA) approval for clinical studies. Subsequently, two Small Business Innovation Research and Small Business Technology Transfer grants from the National Institutes of Health (NIH) were awarded to the company to repurpose FDA-approved drugs for use against hearing loss. After several discussions with Elliot Reed, the program manager of NEOMED’s REDIzone commercialization incubator, Dr. Bao persuaded the company board to move the company from St. Louis to Rootstown in June 2015, mainly due to the excellent support and outstanding core structures at the REDIzone. With the REDIzone’s support, the company has initiated multiple product development projects with top researchers in the field of hearing loss at NEOMED and other institutions, and has obtained additional NIH and private funding.

HOPE FROM A CHINESE HERB People with hearing loss often visit audiologists instead of medical doctors—

but audiologists cannot prescribe medications, which poses a barrier to finding relief. One source of new NIH funding has come to Dr. Bao’s team from the National Center for Complementary and Integrative Health, supporting its efforts to develop a new product that combats the hearing loss caused by common cancer drugs. Based on an herb (to remain nameless, for proprietary reasons), used in Chinese traditional medicine, the product will be categorized as a nutraceutical—a dietary supplement or a food additive that provides nutrition. In this way, Dr. Bao’s product would be able to provide patients access to help without a prescription. By the way, of all the herbs out there, why this particular one? Because it can block calcium channels—and in Dr. Bao’s initial study of FDA-approved drugs, he learned that calcium channel blockers have been found to prevent hearing loss. With extensive preclinical data from the collaborators, Dr. Bao predicts that nutraceutical products for better hearing will be available from the company in 2019. Dr. Bao’s team will then pursue institutional review board (IRB) approval to conduct human studies to further improve the efficacy of these nutraceuticals against hearing loss. If all goes well, millions of people stand to benefit from an old herb put to new use. NORTHEAST OHIO MEDIC AL UNIVERSITY

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FOOD FOR THOUGHT

BEST BLACK BEAN LOAF BY ELAINE GUREGIAN

EOMED’s executive chef, Xavier Smith, likes meatloaf as much as the next person. Which means that while he considers it comfort food, visions float through his head when he thinks of it: all that land needed for the cattle to graze; all those trucks and fuel to transport the meat across the country; all those clogged arteries. So, here it is: another example of his sleight of hand to present us with a sustainable, nutritious—and tasty—version of a favorite dish. Yes, it’s vegan— but that’s secondary to its good taste.

Ingredients:

Directions:

3 tablespoons ground flax seeds

1. Pre-heat oven to 350 degrees and grease a loaf pan.

¼ cup water

2. Combine flax seeds and water in a mixing bowl. Set aside.

1 cup quick oats

3. In a food processor, grind ½ cup oats into a flour-like consistency. Blend 1 ½ cup beans into a paste.

3 cups cooked black beans (2 15-ounce cans, drained) 1 teaspoon extra virgin olive oil 1 onion, diced

4. Sauté onion in oil until translucent (4-6 minutes). Add carrots, red pepper, garlic and jalapeno. Sauté until soft. Add chili powder and oregano; sauté for 2 more minutes.

4 cloves garlic, minced

5. Cook frozen corn in boiling water, then drain. Measure 1 cup corn; add with sautéed vegetables to the flax mixture in the bowl. Add ground oats and remaining ½ cup whole oats, along with the bean paste and remaining 1 ½ cup whole beans.

1 teaspoon dried oregano

6. Season the mixture with salt to taste, oregano and chili powder. Combine well.

2 carrots, shredded 1 red pepper, diced

1 cup frozen corn, cooked Salt to taste (about 1 ½ teaspoons) 2 tablespoons chili powder 1 jalapeno pepper, diced Illustration: Branden Vondrak

7. Spoon mixture into loaf pan and smooth the top. 8. Bake at 350 degrees for 35-45 minutes. Let cool for 10 minutes, then top with a dollop of guacamole and serve with mashed potatoes. It’s comfort food—enjoy! NORTHEAST OHIO MEDIC AL UNIVERSITY

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HUMANITIES IN MEDICINE

eleven/19 In my right white coat pocket there is my stethoscope, a book of poetry In the other, pens leaking ink blue, pink, green and some scribbled observations: During rounds— Fifteen year old boy with a past medical history of obesity, presenting with hypertension.

It’s a decades-long tradition honoring the humanities in medicine: Each year, medicine students from around the country participate in NEOMED’s William Carlos Williams Poetry Competition, named for the acclaimed American physician-poet. Cayce Smith (shown in photo) won third place for this poem at the 2017 competition. Following a year off, she is now a fourth-year medicine student at University of Texas Southwestern in Dallas. Cayce is committed to working with immigrant communities as an activist and future family medicine physician.

The attending doctor says, “The problem is that there is too much of him.” Physical exam signiﬁcant for previous self-harm. How many times will he believe that there is too much of him before there is nothing of him? “How do I get rid of the scars?” he asks. Love, I think— this web of scars maps the beating heart of God.

NORTHEAST OHIO MEDIC AL UNIVERSITY

CLASS NOTES

1983

Serpil Erzurum, M.D., was elected by her peers to the National Academy of Medicine, one of the most prestigious distinctions in the health and medicine fields, for her contributions to the advancement of medical sciences, health care and public health. Dr. Erzurum currently serves as chair of the Lerner Research Institute at the Cleveland Clinic.

Duane J. Taylor, M.D., moderated a seminar at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) annual meeting in Chicago on physician burnout in September 2017. Dr. Taylor was also appointed to chair of the physician wellness task force for the AAO-HNS.

1999

William Hartmann III, M.D., was elected vice president of the medical staff for 2017-18 at the Lindner Center of HOPE, a mental health center, part of UC Health in Mason, Ohio.

2004

Laura Zeigler, M.D., graduated from George Washington University with a Master of Public Health degree.

1994

Edward Pyun, M.D., has served as trauma medical director at OSF Saint Anthony Medical Center in Rockford, Illinois, since 2011. Incorrect information was printed in the fall issue of Ignite. We regret the error.

2006

Jafer Ali, M.D., and his wife Katie, welcomed their first baby, a girl, Zara, on August 20, 2017.

1985

Mark Libertin, M.D., graduated from Carnegie Mellon University with a Master of Medical Management in May 2017. Dr. Libertin is a certified physician executive through the American Association for Physician Leadership and a certified health insurance executive. He currently serves as a senior medical director at Aetna in the medical policy and operations division.

1996

Thomas Vo, M.D., currently serves as the CEO of Nutex Health, a hospital operating company based in Houston.

2009

Nicholas Detore, M.D., was named Lake Health Physician of the Year for 2017. Dr. Detore serves as the medical director for the Center for Comprehensive Rehabilitation, located in Concord Township, Ohio. 30 I G N I T I N G

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2011

Kristin Lehotsky, Pharm.D., was named employee of the month at Summa Health, Barberton Campus, where she works as a pharmacist.

2012

Meredith Barrett, M.D., was honored with the Association of Women Surgeons 2017 Hilary Sanfey Outstanding Resident Award. Dr. Barrett was honored in October 2017 at the American College of Surgeons Clinical Congress in San Diego.

2017

Adam Will, M.D., and Nicole DeLaurentis, Pharm.D. (â&#x20AC;&#x2122;17), announced their engagement on January 6, 2018. Dr. Will and Dr. DeLaurentis will be married on April 28, 2018, in Youngstown, Ohio.

In Portage County, we LIVE UNITED AGAINST POVERTY. In 2017: 7,500 211 Portage calls received. 129 children attended summer camps. 96 youths received mentoring. 340 Head Start children received books. 4,200 meals delivered monthly to seniors. GIVE. ADVOCATE. VOLUNTEER. uwportage.org

United Way of Portage County

One of Many Reasons to Reconnect … Peter Leone, M.D., is a 1982 NEOMED graduate and a professor of medicine in the Division of Infectious Diseases at the University of North Carolina at Chapel Hill School of Medicine. Highly sought after for his expertise in the diagnosis and treatment of sexually transmitted diseases, Dr. Leone has served in several leadership positions including chair for the National Coalition of STD Directors. He currently serves as a member of STD Committee Council of State and Territorial Epidemiologists. In 2017, Dr. Leone was the Watanakunakorn Lecturer and presented “The Great Pox: from Christopher to Columbus.” Dr. Leone’s current work includes an anticipated release of a co-authored longitudinal study on opioid use among HIV-infected patients. ANOTHER NEOMED GRADUATE WHO IS DOING AMAZING THINGS.

NEOMED has 4,131 alumni representing all 50 states plus Canada and the U.S. Virgin Islands. Fellow alumni hail from over 300 undergraduate universities, are employed by nearly 200 health care institutions and pharmacies, and practice in more than 50 ﬁelds of health care.

Reconnect with a Who’s Who of Fellow Health Professionals

Visit neomed.edu/alumni and check out Reconnect! to update your information and receive the following beneﬁts: • Keep in touch with fellow classmates. • Receive access to all registered NEOMED alumni for personal/business networking. • Get invitations to NEOMED events in your area. • Receive the monthly alumni e-newsletter and our daily or weekly University newsletter ( The Pulse).

Check out “Get Involved!” to see the full menu of options.

WHALE WATCHING

STUDENT ORGANIZATIONS BY SAMANTHA HICKEY

Reducing health disparities and advancing social justice are just two of the goals of the many student organizations on the NEOMED campus.

FUTURE MILITARY PHYSICIANS What is it like to serve in the military? The Future Military Physicians group helps students ﬁnd out by fostering relationships between the future physicians and past (and present) service members. Little-known fact: Most members of the Future Military Physicians have biological and chemical warfare training. PEDIATRIC PHARMACY ADVOCACY GROUP If your passion is for helping children, the Pediatric Pharmacy Advocacy Group is the organization for you. With a goal of inspiring and uniting the next generation of pediatric pharmacists, the group hosts several speaker events. It also participates in the Walk for Babies and March of Dimes fundraisers each year.

PUBLIC HEALTH INTEREST GROUP New to campus, the Public Health Interest Group has taken off running, or should we say dancing? Along with co-sponsoring National Advocacy Week 2017: Reversing the Opioid Epidemic, the group hosted a West Coast Swing Dance Boot Camp to promote exercise through basic swing dance steps. PHIG educates students about pursuing public health and more. STUDENT SOCIETY OF HEALTHSYSTEM PHARMACISTS If you have a passion for volunteering, be sure to check out this group, which holds many community service events. It has a record of success in national events such as Script Your Future. Eighteen students from NEOMED’s group participated in the 2017 national American Society of Health-System Pharmacists meeting.

STUDENTS FOR A NATIONAL HEALTH PROGRAM GERIATRICS INTEREST GROUP From sponsoring the annual “Right to Healthcare” This group connects students with older community week to hosting health care debates, this new, members through fun, inter-generational activities like interprofessional organization has a speciﬁc bowling. GIG also pairs members with geriatrician goal: to expand the discussion of a single mentors in the community to learn more about the ADRENALINE CLUB payer health system beyond the walls of specialty through a national fellowship called Trade in your study carrels the NEOMED community, and to work Medical Students Training in Aging Research. for the outdoors. Take a break toward implementing such a system. from studying and get ready for adventure! All are welcome to join the Adrenaline Club for bouldering at local climbing facilities, sports medicine events with the Family Medicine Interest Group, speakers who advocate for medicine through adventure, and more!

For more information on student groups, contact Student Affairs at 330.325.6735 or visit neomed.presence.io. NORTHEAST OHIO MEDIC AL UNIVERSITY

CHAMPIONING A COMMUNITY THAT CARES

A FOCUS ON GIVING TO GERIATRICS AND PALLIATIVE CARE

“We are all given gifts to share, and by sharing them, we grow personally and as a community.”

Eileen Burg (with watercolor of Pete)

Eileen’s passion for philanthropy was sparked in part by the generous spirit of her late husband, former FirstEnergy executive H. Peter Burg.

“He helped others constantly, often quietly and without recognition.”

After Pete’s untimely passing, Eileen established the H. Peter Burg Fund at the Akron Community Foundation to continue his legacy. The Offices of Geriatrics and Palliative Care at NEOMED benefit from this fund. The Office of Palliative Care aims to improve the quality of life and relieve suffering for patients with chronic, severe or life-limiting conditions. The Office of Geriatrics emphasizes health and wellness as well as helping older adults function better while managing complex conditions.

Eileen Burg is committed to NEOMED. She has made generous contributions to the Ofﬁces of Geriatrics and Palliative Care and inspires others to do the same. Eileen Burg and the H. Peter Burg Fund are helping NEOMED Shine On.

38 I G N I T I N G

T H E PA S S I O N O F P H Y S I C I A N S , P H A R M A C I S T S A N D H E A LT H C A R E

To learn how you can help NEOMED Shine On, please call Lindsey Loftus at 330.325.6674 or RESEARCHERS email him at lloftus@neomed.edu.

FINAL LOOK

While e.coli has an ugly effect on the digestive system, the artist David S. Goodsell of the Scripps Research Institute recreated it as a thing of beauty in the art work shown here.

IS IT SAFE TO EAT THE LETTUCE? BY ELAINE GUREGIAN

very now and then, the media explodes with a report of food poisoning that temporarily stops us cold from eating the suspected item. Late in 2017, U.S. and Canadian health officials reported multiple cases of food poisoning from romaine lettuce contaminated with a shiga toxin-producing strain of the bacteria Escherichia coli, better known as E. coli. The outbreak was reported by the media nationally in December, but the end date—and when it was safe to eat romaine again—was not as highly publicized. Gary Niehaus, Ph.D., professor of physiology, is the chief scientist behind Crystal Diagnostics, a multidisciplinary research company in the NEOMED REDIzone, where public-private research

partnerships develop. His team’s liquid crystal-based pathogen detection product permits rapid, accurate detection of contaminated foods before they leave a food production facility. We asked Dr. Niehaus to take us behind the scenes.

WHAT WAS THE SOURCE OF THE PROBLEM? Genomic testing indicated that a single source appeared to be responsible for distribution of the contaminated food, says Dr. Niehaus. Because the contaminated batch of lettuce was available only during its short shelf life, the outbreak ended naturally, as reported in January by the Centers for Disease Control and Prevention (CDC) and the Public Health

Agency of Canada. E. coli is an intestinal bacterial, so fecal contamination from an infected field worker was probably the cause, says Dr. Niehaus. In previous cases, poor sanitary conditions permitted irrigation water to become contaminated before it was sprayed onto the produce. In cases like this, the CDC, United States Department of Agriculture, and the Food and Drug Administration work together to identify the source of contamination and to institute sanitation procedures at that source to prevent future contamination. Dr. Niehaus’s product would identify the pathogens before they could spread and do their dirty work. And we could enjoy our salad with no fear that it might be our last. NORTHEAST OHIO MEDIC AL UNIVERSITY

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ADVANCING INNOVATION & RESEARCH

$5M TO GO BEFORE WE REACH OUR $40M GOAL

NEOMED WILL SHINE ON WITH YOUR SUPPORT

ADVANCING COMMUNITY HEALTH

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