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PULSE R U T G E R S
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J E R S E Y
Combatting
the Opioid Epidemic High-Tech Care for Arrhythmia Beating Back Superbugs
M E D I C A L
S C H O O L
P U L S E F A L L 2 0 1 9 RUTGERS NEW JERSEY MEDICAL SCHOOL
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Dean Robert L. Johnson, MD, FAAP’72 The Sharon and Joseph L. Muscarelle Endowed Dean Rutgers New Jersey Medical School Interim Dean, Robert Wood Johnson Medical School Chief Operating Officer Walter L. Douglas, Jr. Director of Marketing and Communications Tiffany J. Cody Senior Editors, Pulse Mary Ann Littell Tiffany J. Cody Contributing Writers Amanda Castleman Andrew Smith Genene W. Morris Katherine Gustafson Lina Zeldovich Merry Sue Baum Nancy A. Ruhling Ty Baldwin Design www.MarcoCammayo.com Principal Photographer Keith B. Bratcher, Jr.
KEEP IN TOUCH Pulse is published twice a year by Rutgers New Jersey Medical School. We welcome letters to the editor and suggestions for future articles. Send all correspondence to: Marketing and Communications Rutgers New Jersey Medical School ADMC Building 11, Suite 1110 30 Bergen Street Newark, NJ 07107 or via email to njmsmarketing@njms.rutgers.edu ON THE COVER Opiod concept photo by Getty Images.
A MESSAGE FROM THE DEAN With 2,685 overdose deaths in 2017—629 more than the year before—New Jersey is among several other states to show statistically significant increases in drug overdose deaths, according to the Centers for Disease Control and Prevention. Nationally, the CDC reports that almost 400,000 people (more than the population of Mercer County) died from an overdose involving any opioid, including prescription and illicit opioids. So insidious is this public health crisis, it has been credited with reducing the life expectancy in the United States from 78.9 years in 2014 to 78.6 years in 2017.
In response, NJMS has taken an all-handson-deck approach to help reduce the harm caused by the opioid epidemic in New Jersey. Our doctors, representing a variety of specialties and subspecialties—including addiction medicine, anesthesiology, emergency medicine, infectious diseases, internal medicine, medical toxicology, obstetrics/gynecology, pediatrics, psychiatry, and surgery—have banded together in a battle to help put an end to this problem once and for all. In this issue of Pulse, you will read about some of these doctors’ efforts, which include providing lifesaving treatments, exploring alternative measures to treat pain, and developing innovative
training programs geared toward raising awareness and recruiting more doctors to join this noble cause.
So many of the individuals who work at NJMS dedicate a great deal of their time and energy to making a difference in society. Among them is NJMS Executive Vice Dean Maria Soto-Greene, MD, who recently received the Association of American Medical Colleges’ Herbert W. Nickens Award for her tireless commitment to diversity and inclusion in medicine. This recognition is one of the many accolades earned by our faculty members. Their commitment is one of the reasons why NJMS is a respected institution of learning, research, and medical care, and why I am proud to serve as its Dean. In health,
Robert L. Johnson, MD, FAAP’72 The Sharon and Joseph L. Muscarelle Endowed Dean, Rutgers New Jersey Medical School Interim Dean, Robert Wood Johnson Medical School
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On the Frontlines of the Opioid Epidemic A FULL-BORE EFFORT IS UNDERWAY AT NJMS TO ADDRESS THIS PUBLIC HEALTH CRISIS ON ALL FRONTS.
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A CLOSER LOOK
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NJMS PEOPLE
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HIGH-TECH SOLUTIONS FOR CARDIAC ARRHYTHMIA Cutting-edge devices and procedures keep the heart beating in sync.
FYI NOT ABLE
Student Leadership in the AMA From widespread health care reform to technological innovation, our generation of medical students faces an uncertain future. How we practice medicine tomorrow depends on the decisions we make today. Five NJMS students—myself, Rijul Asri (’23); Priya Kantesaria (’21); Alexander Mozeika (’20); Asmi Panigrahi (’20); and Richard Saporito (’22)—have taken these decisions into our own hands through our passionate leadership within the American Medical Association (AMA). Coming from a variety of backgrounds, we found the AMA Medical Student Section (MSS) the perfect avenue to inform the future of health care. “Physicians will need to have a unified voice, on
behalf of ourselves and our patients, as the diversity of stakeholders and interests increases,” Saporito notes. Mozeika adds, “The AMA is the personification of medicine.” We are thrilled to represent our school, with NJMS holding more leadership positions than any other school in the U.S. This year we will tackle such issues as medical student representation, student and physician burnout, entrepreneurship, institutional violence, migrant health, and much more. Together, we are moving medicine in immeasurable ways, and we are excited to shape the future of health care! Rijul Asri
Top, left to right: Richard Saporito (chair, Committee on Health Information and Technology), Rijul Asri (vice speaker, AMA-MSS), Alexander Mozeika (vice chair, Committee on Long-Range Planning) Bottom, left to right: Asmi Panigrahi (chair, Committee on Global and Public Health), Priya Kantesaria (chair, Committee on Long-Range Planning)
RISING STARS A new program is helping future physicians defray their educational debt.
Health for up to 10 years, which totals a $200,000 benefit for each Rising Star.
As a result of an agreement between Rutgers and RWJBarnabas Health, $10 million has been appropriated to retain top students, or “Rising Stars,” from NJMS and Robert Wood Johnson Medical School. The students must commit to join Rutgers Health and/or the RWJBarnabas Health system as an employed clinician after they complete their Rutgers Health-based residency and/or fellowship. Each new physician will receive $20,000 for every year he or she is employed by Rutgers or RWJBarnabas
The inaugural cohort of Rising Stars include the following Class of 2019 graduates from New Jersey Medical School: Monica Azmy, MD Brad Chernock, MD Afif Hossain, MD Louisa Mazza-Hilway, MD Morit Segui, MD Ami Shah, MD Michael Song, MD Loka Thangamathesvaran, MD Fatima Toor, MD Alexander Vlahos, MD
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Follow our journey on Instagram @ama_njms
Transplant Center Marks a Milestone The Center for Advanced Liver Diseases and Transplantation recently successfully performed its 1,500th liver transplant. The center, which opened in 1989, was the first liver transplant center in New Jersey and continues to be one of the busiest in the nation. It provides a comprehensive, multidisciplinary approach for treatment of complex disorders, such as liver masses, bile duct and gall bladder abnormalities, hepatitis C, fatty liver disease, liver cancer and portal hypertension. “Reaching this milestone is a testament to the incredible work done by our dedicated team of physicians,” says Nikolaos Pyrsopoulos, MD, PhD, medical director of the center. “We are extremely proud of the work we have done over the years. We will continue to provide the highest quality care possible, while implementing innovative procedures to help improve outcomes.”
James Guarrera, MD, program director at the center, says he is grateful for all of the organ donors and their families. “We look forward to continuing our engagement with the community, educating them on the benefits of transplantation and the lifesaving importance of organ donation.” The center works in partnership with the New Jersey Sharing Network, a nonprofit organization responsible for the recovery and placement of donated organs and tissue for those in need of transplants. By working closely with hospitals and transplant centers, the number of organs recovered has quadrupled since the organization was founded. Events to celebrate the center’s transplant recipients and highlight the achievements of the center will be held this fall.
SURVIVING SURVIVOR Most medical students will tell you that nothing, absolutely nothing, can prepare you for the first year of medical school. However, Julia Carter ‘22, a secondyear NJMS student, disagrees. But then, she had a pre-med school experience that was invaluable: She was on the television series Survivor. The show places a group of strangers on an isolated island, where they must provide food, fire, and shelter for themselves. They compete in physical challenges for rewards and immunity from elimination. As the game goes on, contestants are voted off the island by their fellow players. The sole survivor wins $1 million. “I wanted to push myself—to find out if I could do it,” she says. “So, one day I just sat down and applied.” The timing couldn’t have been better. Carter had earned a Master of Public Health degree and was working in that field until she entered NJMS in August 2018. “It was a once-in-a-lifetime experience.” The taping was done on the Republic of Fiji, a tiny island in the South Pacific.
Besides trying to win, Carter also looked for ways the experience would translate into her life at home. Beyond the physical and environmental challenges, Carter found the experience to be emotionally and mentally demanding. “I not only learned a lot about myself and my personality, but I also learned how I work with different personality types,” she says. “That is so valuable when working with patients.”
Many of the contestants, she says, saw the experience as simply a game, and tried to win at other people’s expense. “I don’t fault people for that, but I just couldn’t see it that way,” she says. “Everyone is a human being with feelings that should be respected.” While Carter didn’t win the grand prize, she has no regrets. “It was a huge item I crossed off my bucket list,” she says. “How many people get to do that? And being on the show truly opened my mind and my heart. That’s much more valuable than a million dollars.”
NJMS Marks World Lung Day The facts on lung disease are astounding. Here are just a few on the “Big Five” lung diseases.
information on social media about lung diseases impacting patients worldwide.
Chronic obstructive pulmonary disease, or COPD, impacts more than 370,000 New Jerseyans and 384 million people worldwide and kills 3 million people every year.
NJMS has long been a leader in clinical care and research for lung disease. The school’s Global Tuberculosis Institute provides expertise in program development, education, training and research throughout the world. NJMS researchers have contributed fundamental knowledge to the development of every diagnostic test that currently exists for TB. The school is currently creating a university-wide, New Jersey-centric initiative to identify biomedical, environmental and social determinants of lung health and promote healthy lungs for all.
Asthma impacts 334 million people worldwide; 14 percent are children. Tuberculosis (TB) is the leading cause of death from an infectious disease. One-fourth of the world’s population is currently infected, and at least 1.3 million people died from the disease in 2017. Lung cancer, the deadliest form of cancer, kills 1.76 million people globally each year. Nearly 4,500 New Jerseyans have lung cancer. Acute lower respiratory tract infections like pneumonia, kill 4 million people each year. In the last 10 years, nearly 15,000 New Jerseyans died from various kinds of pneumonia and the flu. In addition to the “Big Five,” the dangers of vaping and e-cigarettes are also in the news. “The reports of serious lung disease and deaths linked to e-cigarettes should serve as a call to action that
we need to do more to ensure healthy lungs for all,” says Andrew Berman, MD, professor and chief of the pulmonary division in the Department of Medicine. To raise awareness about these public health crises, on September 25 NJMS marked World Lung Day, an international day of advocacy and action. NJMS experts responded to press inquiries, participated in podcasts, and posted
“Maintaining global lung health and curing lung disease requires excellent health care and innovative biomedical research,” says Maria Gennaro, MD, interim director of NJMS’s Public Health Research Institute. “When we reduce lung disease, we create a healthier population and a stronger economy.”
Check out Dr. Berman’s podcast on vaping’s effects on lung health at issuu.com/rutgersnjms.
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R ES EAR CH
A Field Trip to Future Careers By Lina Zeldovich
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ne day this past summer, a group of students at the School of Graduate Studies (SGS) at the Newark Health Sciences Campus hung up their lab coats, left their benches, and boarded a van to Summit, NJ. The students—undergraduates from colleges around the country who were partaking in SGS’s Summer Research Experience for Undergraduates program—were excited. They were on a field trip to learn about future careers, visiting pharmaceutical company Celgene’s Thomas O. Daniel Research Incubator and Collaboration Center. Organized by Amariliz Rivera-Medina, PhD, assistant professor at the NJMS Center for Immunity and Inflammation, the summer program provides about a dozen handpicked students with an opportunity to do high-caliber research at a top-tier science institution with faculty and lab equipment their colleges often don’t have. The 10-week session includes lectures, lab work, and a research project that culminates with a presentation.
Another important part of the program is helping students identify and pursue personal goals in biology and medicine. Investigators who work in areas ranging from metabolism to aging to infectious diseases discuss career paths with students during their weekly talks. “Our goal is to immerse undergraduates in research and broaden their perspective about what’s possible once you attain a PhD,” Rivera-Medina says. “We want them to know about opportunities in different areas of science—academia, pharmaceutical, incubator.” A modern, 16,000 square-foot lab facility, the incubator aims to foster a creative environment to help innovators accelerate life-changing medical and pharmaceutical discoveries. Already hard at work at the incubator is Renata Pasqualini, PhD, chief of the Division of Cancer Biology in the Department of Radiation Oncology, whose promising company PhageNova Bio focuses on phage therapy, using viruses to battle bacteria as an alternative to antibiotics.
During their visit, the students learned how such innovative partnerships are formed. Incubator director John Anthes spoke about the creative and entrepreneurial aspects of today’s science industry. He explained that modern science develops very dynamically because computers and artificial intelligence algorithms allow researchers to test hypotheses, achieve results, and bring medicines to patients significantly faster than before. He also noted that science entrepreneurship is important not only for health care, but also for economic development.
Juan Manuel Inclan Rico and Samantha Avina—PhD candidates who mentor the undergraduates in the summer program—say the visit helped students understand and ponder their future career choices. “People think that if you have a PhD, you either go into industrial or academic research, but nowadays you can also go into science policy or science entrepreneurship,” says Avina, whose participation in the same program two years ago inspired her to pursue her own postgraduate degree. “I think our students were quite impressed by the job opportunities a PhD brings today.”
Doreen Badheka, PhD, SGS program director for special projects, helped organize the field trip, together with one of the incubator’s advisors, Vincent Smeraglia, Rutgers executive director of research commercialization. Badheka describes the students’ experience as mind-blowing. “They understood how laboratory research translates into medical treatment and how an incubator can help a company achieve that,” she says.
Varoon Phondge, an SGS summer research undergraduate on track to become a physician, says that the trip was an eyeopener. “I found it really interesting how the incubator chooses people with ideas and gives them space to do research and expand their company,” he says. “I am now considering doing a PhD program myself, and maybe even putting my own idea through an incubator. And I don’t think it’s that farfetched.”
Amariliz Rivera-Medina, PhD (center), with PhD candidates Samantha Avina and Juan Manuel Inclan Rico
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CL I N ICAL
PAIN, PAIN, GO AWAY Innovative approaches to pain management go beyond opioids By Nancy A. Ruhling
“There were no further procedures that we could do, so I put him on a low-dose of methadone, five milligrams a day. This allows him to do his daily activities with minimal pain. It was not an ideal solution, but all other options failed.” Another man who needed a hip replacement was placed on opioids until he could lose enough weight and lower his blood sugar sufficiently for surgery. “It took one year for him to make these changes,” Kaufman says. “I’m weaning him off the opioids now that he was able to undergo a successful surgery.” Kaufman said that the majority of the clinic’s patients prefer not to take painkillers. “There’s an awareness among the public of opioid addiction,” he says. “And many of them have personal stories about a friend or a relative who is or was addicted.”
At
New Jersey Medical School’s Comprehensive Pain Management Center, aches are eased, for the most part, without the aid of opioids.
“The majority of our patients are not on opioids and if they are, our goal is to get them off as soon as we can,” says director Andrew Kaufman, MD. “It’s always been our policy to find out what causes the pain, when did it start, what made it better, what made it worse.” Each year the center cares for some 6,000 patients from across northern New Jersey, treating complex, acute and chronic pain ranging from disc herniation and headaches to spinal stenosis and post-laminectomy syndrome. The emphasis is on alternative therapies that get to the root of the pain instead of merely masking it. For instance, if an obese patient complains about knee and back pain, Kaufman and his colleagues will start by creating a weight-reduction plan that will take the pressure of pounds off the aching areas. “In a case like this, it’s about lifestyle change,” he says. “We may prescribe physical therapy and have the patient work with a nutritionist. To manage the pain, we may offer an anti-inflammatory or a muscle relaxer.” For example, a patient in his late seventies was experiencing excruciating bone-on-bone knee pain. Because he wasn’t a good candidate for surgery, the team performed a genicular nerve radio frequency
ablation, which is a thermal ablation of the nerve that blocks the signaling from the knee. The center has other treatment options such as non-opioid medications, transdermal medications, transcutaneous electrical nerve stimulation (T.E.N.S.) units, epidural injections, facet joint injections and nerve blocks. More advanced techniques include the placement of spinal cord stimulator leads into the epidural space to alter pain signaling as well as intrathecal pumps that directly place medication into the region of the spinal cord that may be affected. “With our approach, we teach patients to be more actively involved in their health care,” Kaufman says. There are some patients, however, for whom opioids are the only option. A patient whose pelvis has been crushed in a car crash, Kaufman says, would be a prime candidate for a short-term prescription. For others, painkillers are a chronic answer. “Opioids aren’t evil. When they are used correctly, they are a tool,” Kaufman says, adding that some 10 percent of the center’s patients have ongoing long-term prescriptions for opioids. One such patient is an 85-year-old man with severe spinal stenosis. “It is a debilitating condition,” Kaufman explains.
He notes that the clinic doesn’t treat addiction; that falls under the auspices of the school’s new Division of Addiction Medicine of the Department of Psychiatry. Patients who are prescribed painkillers must sign a consent form detailing the risks and benefits of the medication. They also sign a narcotic agreement that sets out expected behaviors such as prohibiting them from selling or sharing the medication with others and requires them to submit to random urine screenings. Under the state’s strict prescription monitoring program, doctors must check the N.J. State Prescription Monitoring Program before issuing any controlled substance. In addition, the state limits the initial prescription of opioids to five days of medications to anyone who is opioid naïve and the second to 25 days if the caregiver feels that it is justified after speaking with and evaluating the patient. “We monitor the side effects and efficacy of the medication after the first prescription runs out,” Kaufman says. “If we need to continue, the prescription is renewed monthly with an office visit and then when stabilized the visits can become quarterly.” “Our process never changes,” he adds. “We stay close to our patients to ensure the safe and appropriate use of medications.”
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ED UCATI ON
MASTERLY APPROACH Bumper crop of SGS grads TO MEDICAL SCHOOL
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aining admission to medical school is no easy task. Only about 40 percent of applicants matriculate, making the process beyond competitive. While many applicants enter medical school directly from college, others take a different path: obtaining a graduate degree first. The Rutgers School of Graduate Studies (SGS) has long been a source of highly qualified applicants for NJMS. But the class of 2023 is something special: this year a record 17 SGS alums matriculated at NJMS. We asked a few members of the incoming class about their path to SGS, NJMS, and beyond. Priya Gupta, who grew up in Bergen County, says she had heard “overwhelmingly good things” about the SGS master’s program from classmates at The College of New Jersey (TCNJ). “I thought I wanted to go to medical school,” she says, “but I was looking for an opportunity to experience a little bit of what it would be like.” Gupta attended SGS as part of the Medical Scholars Program, which allows students interested in medical careers to explore the field while working toward a graduate degree. She was attracted by the opportunity to take medical school courses with first-year students. “The opportunity to be part of SGS was even more of an advantage than I realized, and I fell in love with NJMS,” she says. The son of Haitian immigrants, Patrick Lundy grew up in Orange. He became interested in medicine in
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enter the NJMS class of 2023
high school, after his father had a heart attack. But in obtaining his undergraduate degree at La Salle University, “my grades and just the way I carried myself in general wasn’t quite up to par with someone who is going to medical school.” Lundy considered applying to medical school in the Caribbean, but after discussing his career plans with Sharon Gonzales, MD, an interventional radiologist at University Hospital, he changed his mind. “She suggested that I look into SGS as a way of preparing for medical school. I thought this over for awhile, and heeded her advice. It turned out to be a great approach.” Abrar Ebady, from Wyckoff, was raised by an Egyptian single mom whom she calls her “biggest cheerleader.” After getting her undergraduate degree at TCNJ, she considered her next steps. “Even though I’ve wanted to be a doctor since kindergarten, there were times when I questioned if medicine was for me,” she says. “It was never a question of whether or not I wanted to do it. The question was always, ‘Can I do this? Am I smart enough?’” She says SGS helped her overcome some of her insecurities. “As a graduate student, I gained confidence,” she notes. “I realized that I can do this. I am smart enough. I came to understand my success would be a matter of putting in the appropriate amount of effort and taking the time to prepare myself for every challenge.” Robert Wayne grew up in the shadow (literally) of Texas Medical Center. “My skyline in Houston was all these
By Ty Baldwin By Ty Baldwin
big hospitals and I wanted to be a part of that,” he says. However, as an undergraduate at a college in Austin, he did poorly. “Even though my grades and test scores weren’t as high as they could be, I wanted to go to medical school,” he says. So he applied to graduate programs as a way of becoming a more competitive candidate, and matriculated at SGS. “I challenged myself by taking more difficult courses,” at SGS, he says. “I took a course titled Molecular Medicine of the Heart, and a difficult neuroscience class,” in addition to the other requirements of the degree. “I’m very appreciative to SGS,” Wayne says. “It opened the doors for me to go to medical school. Only a small percent get to practice medicine. It’s a blessing to be able to do that.”
As a graduate student, I gained confidence. I realized that I can do this. - Abrar Ebady
A C l o s e r look
COM M UN I TY S ERVI C E
Real-Life MEDICINE
NJMS Community Preceptorship Program lets new students try on the white By Katiecoat Gustafson By Katherine Gustafson
One
about the possibility that someone else would dictate care.”
afternoon when Tolu Nurudeen arrived at the office of Guy Francis, MD, her assigned physician for the Community Preceptorship Program during her first year at NJMS, he beckoned her into the room where he was doing a pelvic exam and Pap smear on a patient. With the patient’s agreement, he suggested Nurudeen take over. It was an important and memorable moment for the young student.
Seeing the world of medical practice with fresh eyes is a big part of what makes the program satisfying and educational for the preceptors, who must figure out how to explain the vagaries of reallife practice to those who have so far learned only from books and in simulated patient interactions. “Sometimes I have to think twice how to explain to them, to go into research and detail to help them understand, so I’m also learning myself,” says Elena Altshuler, MD, a pediatrician in Princeton who participates in the program.
“I was able to feel a woman’s ovaries,” she remembers. “The fact that the patient was so open about it really made my day.” Nurudeen, now in her second year in medical school as a participant in the Army’s Health Professions Scholarship Program, appreciates the preceptorship program’s focus on applying classroom teaching to real patient interactions. Students work with local physicians in primary care—often NJMS alumni— to gain exposure to the process of taking patients’ medical histories and doing physical examinations. “The whole idea is you’re practicing to interact with patients as a doctor would, which beautifully supplements the academic materials that you’re learning,” says Carol Apai, a third-year NJMS student who did her preceptorship with Joseph Schwab, MD, a pediatrician and NJMS alum. “It’s a way of getting a view of what it’s like to be a doctor.” First-year students spend one afternoon each week from January through April shadowing and learning from their preceptors, who receive the status of volunteer
The students practicing medical care for the first time are eager and fast learners. They discover quickly that trying the white coat on for size means taking the time to understand the real person who is at the other end of any doctorpatient interaction.
medical faculty at NJMS. The preceptors know what students are learning about each week in class—such as musculoskeletal or cardiovascular or pulmonary systems—and can tailor their mentoring accordingly. “The main purpose of the program is having students integrate what they’ve been learning in the classroom with patient care,” says Lissette Cespedes, MD’11, assistant professor of medicine and a co-director of the program. She is a practicing endocrinologist who precepts students through the program. “It means everything comes full-circle for them.”
Students also learn about the business side of the preceptors’ practices, such as billing and operations. Nataliya Dashevsky, MD, an internist in Princeton who precepts one or two students each semester, says this exposure to the logistical side is as much an education as the medical training. “They are surprised about the insurance limitations we have to deal with in real life,” she says. “If I prescribe a medicine and insurance denies it, we might have to put together an appeal, and we sometimes lose the appeal. The students didn’t even think
“When I practice on my classmates, we’re just trying to complete the assignment,” says Nurudeen. “When you talk to the patients, you see the real person. You get to see how they’re going through what they’re going through.” And coming to see that is one of the most important things a doctor can learn. Pupil with preceptor, left to right: Tolu Nurudeen and preceptor program co-director Lissette Cespedes, MD
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On the Frontlines of
the Opioid Epidemic
A multidisciplinary approach to fighting opioid use disorder, left to right: Lindsay Fox, MD (emergency medicine), Erin Zerbo, MD (psychiatry), Amesika Nyaku, MD (medicine), and Joshua Taffet, LCSW (psychiatry)
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Battalion of NJMS doctors leads mission to treat and train By Genene W. Morris
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hen Petros Levounis, MD, MA, considers the opioid crisis that has bedeviled the U.S. over the last three decades, what goads the psychiatrist and venerated addiction specialist is not just the toll that the epidemic has taken on New Jersey: The careers derailed; the families fragmented; the communities upended. The deaths. It’s the fact that, despite the havoc these drugs have already inflicted, newer, more potent opioids are being developed practically every day, harming vulnerable communities across the country. It’s one of the worries that keeps him up at night.
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Petros Levounis, MD, MA
But Levounis, chair and professor of psychiatry, doesn’t let worry impede his work. He and a battalion of NJMS physicians from multiple specialties have joined forces to battle this crisis, providing state-of-the art treatment; training students and other health care professionals; and developing statewide collaborations to get ahead of this scourge and stymie its effects.
MAT: A Silver Bullet
“This is truly a landmark epidemic,’” says Erin Zerbo, MD, an addiction specialist and NJMS assistant professor of psychiatry. “This crisis is in everybody’s backyard. It’s in all our lanes.” She points out that some physicians are reluctant to treat patients with opioid use disorder. But what they don’t realize is that “these patients are already in their waiting rooms. They’re just not talking to their doctors about it.” Helping physicians understand the neurobiology behind addiction—where the prefrontal cortex, which controls complex cognitive and social behaviors, is weakened, while the primitive part of the brain becomes stronger, causing people to act out compulsively—allows them to see addiction not as a moral weakness but as a chronic illness for which effective treatments exist.
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Among the gold standard of therapies is MedicationAssisted Treatment, or MAT. A powerful weapon against relapse and overdose, MAT combines counseling and behavioral therapies with medications, such as buprenorphine, methadone, or naltrexone to treat patients. “MAT drastically reduces mortality,” says Zerbo, who also runs the Comprehensive Addiction Resources and Education (CARE) Center, a low-barrier clinic that provides MAT without imposing onerous counseling requirements. “In terms of a silver bullet, we have it in MAT.” The most popular MAT is buprenorphine, a Schedule III Controlled Substance. Approved for maintenance treatment of opioid use disorder since 2002, it can be prescribed from an office-based setting. Long-lasting and slow-onset like methadone, buprenorphine allows the brain to heal. And if a patient has a relapse, it dramatically reduces the high, Zerbo says, adding, “They’ll use it and think, ‘I barely felt anything. I just wasted my money.’” Meanwhile, she notes, they’re unlearning the behavior, while maintaining their tolerance; thereby dramatically reducing their chance of an opioid overdose death.
As effective as buprenorphine is, there remains an access issue linked not only to stigma, but also to federal restrictions like the Drug Abuse Treatment Act of 2000 (DATA 2000), which requires doctors to obtain waivers to prescribe buprenorphine. Additionally, the lack of a robust federal framework to combat the epidemic means each state must devise its own plan of attack, says Zerbo. In January, New Jersey Gov. Phil Murphy unveiled several initiatives in response to the spate of drug overdoses in the state. Among them was providing funding for two new centers of excellence for opioid treatment: one at NJMS and the other at Cooper Medical School of Rowan University (CMSRU). Established in April with a $2 million grant from the NJ Division of Medical Assistance and Health Services, the Northern New Jersey Center of Excellence in Medication-Assisted Treatment (NNJ-COE-MATrx) is led by Zerbo along with NJMS assistant professors Amesika Nyaku, MD, MS, (Department of Medicine); Lindsay Fox, MD, (Department of Emergency Medicine); and Emily Gordon, MD, (Department of Medicine); as well as mental health clinician Joshua Taffet, LCSW.
Prevention of addiction…is a much better approach than treating it. - Lewis Nelson, MD
Covering 12 counties, the center’s goal is to increase patients’ access to MAT and support services in northern New Jersey and provide mentorship and consultative support to DATA-2000-waivered physicians and prescribers. The center has hired staff and created a MAT Provider Hotline in collaboration with the other center at CMSRU, supplying real-time advice for providers.
Model Curriculum
NJMS has implemented several educational programs to train students and doctors to battle this crisis. Following the creation of a Pain Management and Analgesic Prescribing Curriculum Workgroup led by Sangeeta Lamba, MD, associate dean for education; Levounis; and Lewis Nelson, MD, professor and chair of emergency medicine, NJMS last year became one of the first medical schools in the country to require all students to receive training necessitated by DATA 2000.
• A one-year Fellowship in Addiction Medicine, which trains fellows to evaluate and treat patients with substance use disorders, behavioral addiction, and co-occurring psychiatric disorders. The fellows rotate on clinical services at University Hospital (UH), the Veterans Affairs New Jersey Health Care System, and Rutgers University Behavioral Health Care. • ECHO (Extension for Community Healthcare Outcomes), a model program that educates primary care providers (PCPs) in the treatment of substance use disorders. Through this program, NJMS doctors consult with New Jersey PCPs via video conference.
One-Stop Shopping
As an internist, Gordon sees firsthand how substance use disorders affect patients’ overall health. “Substance use disorders exacerbate many of the medical conditions we treat,” she notes. For this reason, the Department of Medicine’s Primary Care Clinic provides prescriptions for buprenorphine. Having more PCPs available to handle these cases is vital to overcoming this crisis, Gordon says. “We have to meet the patients where they’re at. When they come to their heart failure appointments, that’s where we need to talk to them about their substance use.”
Third-year students take the school’s eight-hour course and learn about alternative treatments for acute and chronic pain and safe opioid prescribing. Through this course, NJMS, “is becoming a model for other medical schools on how to incorporate buprenorphine courses into their curriculum,” says Levounis. Other educational programs at NJMS include: • A series of buprenorphine-waiver certification sessions—made possible through a $1 million grant from the NJ Division of Mental Health and Addiction Services—where physicians, physician assistants, and advanced practice nurses learn how to prescribe buprenorphine.
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This “one-stop shopping” approach has been implemented in several other NJMS faculty practices, including the Healthy Beginnings Obstetrics/Gynecology Clinic run by Department of Obstetrics, Gynecology and Women’s Health’s Damali Campbell-Oparaji, MD, assistant professor, and Natalie Roche, MD, associate professor. “People have so many responsibilities: working multiple jobs; taking parenting classes; dealing with the judicial system,” says Campbell-Oparaji. “So providing care in one place is very helpful.” Campbell-Oparaji and Roche are involved in the Addiction Consultation Service at UH, which provides consultations for patients— female and male—with substance use disorders. Additionally, Roche helped start an Addiction Workgroup at NJMS, a multispecialty team of physicians from psychiatry, emergency medicine, obstetrics/ gynecology, infectious diseases, internal medicine, medical toxicology, pain management, pediatrics, and surgery. “We’re providing really good coverage with different specialists working together to address substance use disorders,” Roche says. At UH’s emergency department (ED), which sees three to five overdoses a day, a comprehensive approach assists patients with substance use disorders, says Nelson.
“We’re able to initiate people on buprenorphine treatment while they’re in the ED. When they’re stable to leave, we provide them with a buprenorphine prescription and a referral to our CARE center.” To ensure that people make it to their appointments, adds Fox, the ED is hiring peer navigators—individuals with personal experiences with addiction. Made possible through a $1.5 million grant from the federal Substance Abuse and Mental Health Services Administration, the navigators will be trained to walk patients through the process of getting addiction treatment and services. “Bringing individuals with lived experience with addiction onto our team may help decrease the stigma around addiction and addiction treatment,” Fox says. One thing the HIV epidemic has taught Nyaku is that there’s hope. “HIV has gone from being a death sentence to a chronic condition that can be managed. People can be healthy and have near-normal life expectancies,” says Nyaku. She works at NJMS’s Infectious Diseases Clinic, where impressive reductions have been seen in the viral loads of buprenorphine-maintained HIV patients. “Similarly, regarding the opioid crisis, one of the most impressive things is knowing what we can do when we have political will, funding, providers, and community engagement.”
Photos of Drs. Levounis and Zerbo by Leonard Estrada
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Prevention
According to the New Jersey Poison Control Center, which is overseen by the NJMS Department of Emergency Medicine, the opioid epidemic started in 1991 when deaths involving opioids began to rise following a sharp increase in the prescribing of opioid and opioid-combination medications for the treatment of pain. That this crisis is, in part, iatrogenic—i.e., induced inadvertently by medical treatment— makes Nelson uneasy. But it’s not surprising, considering how doctors were once trained, he says. “In medical school, I was told that there’s no dose of opioid that’s too great. You give whatever it takes to relieve the pain. That was 30 years ago.”
Truth is, says the renowned medical toxicologist, “We have pain for a reason. Pain reminds us not to do things that are causing damage.” To help avoid addiction, altogether, Nelson’s department has implemented guidelines that establish a “hierarchical approach” to pain management. For example, says Nelson, “We’ll start with Tylenol and if that doesn’t work, we’ll go to Motrin and if that doesn’t work, we’ll go to a different class of drugs.” Bottom line, Nelson says: “Prevention of addiction … is much better than treating it.”
Get the student perspective on the opioid epidemic with Kishan Shah, fourth-year medical student at issuu.com/rutgersnjms.
Levounis (left) and Zerbo (right) trained health care providers throughout the state on the use of buprenorphine to treat opioid dependence.
MAT Provider Hotline 866-221-2611 Monday - Friday from 8 a.m. to 8 p.m.
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HIGH-TECH SOLUTIONS FOR CARDIAC ARRHYTHMIA
Cutting-edge devices and procedures keep the heart beating in sync By Andrew Smith
T
he human heart cannot function properly for a single second without precisely timed and modulated electric pulses. Any problem affecting the speed or strength of those pulses can throw the heart dangerously out of rhythm, and such arrhythmias are frighteningly common. More than 3 million Americans will be diagnosed with one this year, while millions more go undiagnosed. New medical devices and procedures are improving outcomes for arrhythmia patients. NJMS recently recruited one of the field’s leading researchers and clinicians to build a world-class cardiac electrophysiology department in Newark. Emad Aziz, DO, MBCHB, section chief of cardiac electrophysiology and professor of medicine at NJMS, was still a resident at New York’s St. Luke’s Roosevelt Hospital Center when he began improving cardiac arrhythmia treatment. The efficiency and impact of his work was such that, after residency and a fellowship at St. Luke’s, the hospital made him director of electrophysiology research. Aziz remained at St. Luke’s until a few months ago, when he joined NJMS to launch the Arrhythmia Institute at University Hospital (UH). “We recruited Dr. Aziz to create a state-of-the-art program in electrophysiology, in order to provide
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first-rate cardiac care to our patients in Newark and throughout New Jersey,” says Marc Klapholz, MD, professor and chair, Department of Medicine and chief of medical service at University Hospital. “We are excited about his vision and look forward to all we will accomplish together on behalf of our patients, trainees, students, and the community at large.” With a clear focus on the significantly underserved patient population in northern New Jersey, Aziz has developed a carefully crafted strategic plan to introduce cutting-edge treatments to Newark. “About 5 percent of all people have some sort of arrhythmia, so that comes to about 180,000 of the 3.5 million people in the fivecounty area around UH,” he explains. “About 30 percent of those people, or about 54,000 people in all, will eventually require either a device or an ablation, and the area just hasn’t had the capacity.” The most common heart arrhythmia is a condition called atrial fibrillation or “afib,” which occurs when the heart’s upper chambers (the atria) beat irregularly and fall out of sync with the lower chambers (the ventricles). Atrial fibrillation tends to start off in very sporadic episodes that become more and more common until the heart is rarely or never working well enough to fully empty some parts of the atria, especially a nook called the left atrial appendage.
Stagnant blood in the atria forms clots which eventually get pumped out and cause strokes or other serious problems. After doctors detect a single incidence of atrial fibrillation, they typically check patients once every six months until they catch enough disease progression to justify treatment. Aziz prefers a more aggressive response to the first incidence of atrial fibrillation: tiny implantable cardiac monitors that sit under the skin, check every heartbeat and alert doctors to every irregularity. “Episodes of atrial fibrillation can become very frequent before you can be sure of catching them with semi-annual checkups,” he explains. “Monitors are a safe and affordable way to identify disease progression as soon as it occurs and provide immediate treatment to patients who need it.” Within a few short months, Aziz has already brought several new afib treatments to UH, including the Watchman, an innovative device that seals off the left atrial appendage. The Watchman is a tiny wire-mesh basket that collapses into an even smaller metal cylinder. Doctors insert it by running a tube that contains a collapsed Watchman up the femoral vein, starting from the thigh and ending into the heart. They then position the device inside the left atrial appendage and open it up. After a few weeks, the particles that stick to the mesh
About 5 percent of all people have some sort of arrhythmia, so that comes to about 180,000 of the 3.5 million people in the five-county area around University Hospital.
- Emad Aziz, DO, MBCHB
completely block the appendage so stagnant blood caught inside cannot send occasional clots out into the circulatory system. “It’s not right for every patient,” Aziz says, “but it’s a better option than anticoagulant medications for a significant number of patients.”
greatly over the decades, they are still the most unreliable part of a pacemaker. About one in every 20 patients who receive pacemakers experiences some sort of problem with the device, and leads are responsible for most of them.
He isn’t the first doctor in the state to use the Watchman, but Aziz hopes to be the first doctor here to install a device designed to reverse heart failure. The Impulse system performs “cardiac contractility modulation” by applying relatively high-voltage biphasic electrical signals to failing ventricular muscles. “This is a device for seriously ill patients,” Aziz notes. “I have installed it in people whose hearts were only working at 10 percent of normal levels, and I might soon be able to use it in patients with significantly lower ejection fractions. The stimulation remodels dying heart tissue, essentially making it like younger muscle, and increases function.”
Indeed, leads are responsible for enough problems— such as creating scar tissue, blocking blood flow, failing leads, insulation issues or infections—that lead management has become a major part of advanced cardiac electrophysiology. Traditional transvenous lead extractions were prone to both failure and complication, which is why Aziz is excited about offering laser lead extraction. The laser lead extraction machine, in addition to the vast experience that Aziz will soon bring to Newark, is both surer and safer than older devices.
Another innovation that Aziz champions is a nextgeneration pacemaker that is implanted directly onto the heart rather than being attached via wires that are known as leads. Although these leads have improved
Such a device would be unique in New Jersey, as would a new treatment that Aziz plans to start offering for patients with sleep apnea. Yes, sleep apnea. Most apnea is caused by obstructed airways and is treated either with CPAP machines or weight loss, but
20 to 25 percent of all cases arise when the sleeping brain stops sending the diaphragm a steady stream of signals telling it to control the lungs. These cases of central sleep apnea are diagnosed via sleep studies and treated with a variety of strategies. Aziz plans to make UH one of the first to offer the Remede system (from Respicardia). This implantable treatment device directly stimulates the phrenic nerve that controls the diaphragm. To help add all those new treatments—and launch a new program for cardiac electrophysiology research—Aziz is also adding two new fellows to the department. The department has begun recruiting patients for one new study, and Aziz hopes to begin recruiting patients for at least four more by the end of the year. He says, “The goal is to build this into world-class academic program, one that provides great clinical care, performs vital research and trains the next generation of leading practitioners.” Watch as Dr. Aziz describes several of the devices referenced in the article at issuu.com/rutgersnjms.
Emad Aziz, DO, MBCHB, with the cardiac electrophysiology team at University Hospital
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he says. He hopes to see pharmaceutical companies play a bigger role. “The process of drug development is expensive,” he points out. “Yet a patient typically uses an antibiotic once for a couple of weeks and then it’s done, if all goes well. There’s not enough profit margin for pharmaceutical companies. So we need to incentivize more collaborations between pharma and academia. “I’m on the other side, as a very basic scientist trying to understand how proteins work. But I also recognize that antibiotic-resistance is a fundamental problem that we’re facing. So I’m working to see if we can develop drugs to reverse that.”
By Am an da Ca st le ma n
In
the U.S., at least 2 million people succumb to infections that have mutated to defy all medications—and 23,000 of those cases are fatal each year, according to the Centers for Disease Control and Prevention. It considers antibiotic resistance one of the biggest health challenges of our time. Vasileios Petrou, PhD, assistant professor and Chancellor Scholar, is in the vanguard of the fight at NJMS. The work he is doing may help resolve antibiotic resistance, a threat that some experts warn could wipe out humanity. “The situation is becoming worse, and could reverse many medical advances of the last 70 years,” he says. “This is something that needs to be addressed now with accelerated, incentivized development of new antibiotics, as well as ways to make our current drugs relevant again.”
Petrou, who joined the Department of Microbiology, Biochemistry and Molecular Genetics and the Center for Immunity and Inflammation in July 2019, is exploring how to disrupt antibiotic resistance on a molecular level, by targeting proteins in the cell membranes of attacking bacteria. He’s made significant strides, chronicled in a 2016 report for the journal Science. He and his colleagues solved the atomic structure of the enzyme ArnT that changes the electrostatic charge of the
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bacterial membrane, making bacteria more resistant to polymyxins—“lastresort drugs” often called into play for infections that don’t respond to other antibiotics. The mechanism is simple, he explains: The enzyme ArnT reduces the charge of the outer surface in bacteria like E. coli and Salmonella, preventing them from bonding to the antibiotic, so the drugs cannot do their job. “Think about it like glue,” he explains. “The bacteria are diluting the glue so the antibiotic doesn’t stick as well to them.” This work helped him win a highly competitive National Institutes of Health grant in 2017 and he is carrying the research forward in his new NJMS lab. He is currently working with senior research scientist Apostolia Baki, PhD, and hopes to add two postdocs shortly. “We’ve had some initial success and we now have a much better understanding of how the enzyme works than we had three years ago,” he says. “The same mechanism is at play across different species of bacteria, which gives us more confidence that we’re targeting the right thing.” Originally from Greece, Petrou earned a neuroscience PhD at New York’s Icahn School of Medicine at Mount Sinai before delving into structural biology, specifically studying proteins embedded in cell membranes. “I’ve had a very interesting scientific trajectory,” he notes.
“I’m happy I found my niche; that’s very important for a scientist.” He has been doing some preliminary drug development and has a patent pending with his former postdoctoral advisor at Columbia University Irving Medical Center. He emphasizes that solutions will take time. “Once we find a small molecule drug that can reverse resistance, we forward for FDA approval. In most cases the process would take about 10 years.” Efforts like this need to be paired with the development of new antibiotics,
N J M S P E O PLE
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When Moms or Dads (or Both) Are Students By Ty Baldwin
time to reflect on how much she wanted to be a surgeon. Her daughter’s pediatrician, an NJMS alum, put her in touch with George Heinrich, MD, NJMS associate dean for admissions. He suggested that Yosh take some graduate classes. She did, receiving her master’s in biomedical sciences from Rutgers School of Graduate Studies (formerly GSBS) in 2016, and matriculating at NJMS that same year. Yosh had her younger daughter, Hayley, during her second year at NJMS. “When I got into medical school, I didn’t know what it was going to be like,” she says. “I knew the risk was that if I had a complicated pregnancy I might have to take time off, but I also knew that NJMS would be supportive no matter what happened.”
“We got married before I started medical school,” Povolotskiy says. “We figured that would be the best time for us to actually have some time together before things got a little crazy.” After three years of marriage, the two decided to have a child before Povolotskiy started his residency. “It seemed like a good time logistically,” Povolotskiy adds. “For Jessica, the first year of medical school offers a lot of flexibility, and for me, fourth year should become more or less free in a couple of months, when I finish my acting internships.” Their daughter Vivienne is 11 weeks old. (So perhaps it’s not surprising that Jessica, who’s enrolled in the inaugural class of the NJMS Accelerated Three-Year Primary Care MD Program, gave Roman her “whole-hearted permission to answer questions on her behalf.”) Povolotskiy says,”Sometimes we feel that we’re not getting enough time with our daughter, but it’s not in a regretful kind of way. We knew what this was going to be, so we try to make the most of our time together.” So far, he adds, he’s made it home for bath time every night. “We’ll bathe her together and put her to bed. That’s kind of our bonding moment.”
Yosh’s husband, a former chef, is happy as a stay-athome dad. But even so, she adds, her third and fourth year, “with my clinical duties and studying for board exams,” have been more difficult. “It can be tough being away from them and not being able to give them all the time I want. But I know that it’s the best thing for our whole family, and I think it’s a good example to set for them, seeing me working hard.”
Emily Yosh had no idea how busy she’d be, juggling medical school and caring for two small children.
“There are actually quite a few parents at NJMS,” says Emily Yosh, a fourth-year NJMS student and the mother of two. “I think there are seven moms in my class. And at least two others who had babies during our second year.” For Yosh, 39, the journey to medical school was longer than most. In her twenties, she was living in Queens, NY, and working as a surgical technologist. She’d long had an interest in medicine. Medical missions to Ecuador and the Domican Republic, in 2004 and 2005, spurred her ambition to become a surgeon, but Yosh knew she had a long road ahead of her. “I went back to undergraduate school as a working adult,” she says. “When I finished, I thought about medical school but wasn’t sure it was feasible, because I really wanted to have a family. I figured the two were mutually exclusive.” Yosh chose family first, giving birth to her older daughter, Carrie, five years ago. While on maternity leave she had
Fourth-year student Kristyn Lao spent five years in the corporate world before deciding to attend medical school. “I knew I wanted to start a family and it was on my mind while I was interviewing,” says Lao, 32, whose daughter, Alyssa, is 19 months. “The Office of Admissions was really supportive. That’s actually one of the reasons I chose NJMS.” During the first two years, Lao’s schedule was flexible enough to accommodate her pregnancy. “I had my daughter between second and third year and took some time off, ”she says. “It was like a maternity leave where I could focus on my daughter and study for Step 1. I started my third year just six months off.” Now that she’s begun clinical rounds, Lao sometimes stays with a friend who lives closer to the campus. “It depends on the week,” she says. “If I can, I’ll commute, but many times I do have to stay for the week and go home to my family in Connecticut on the weekend.” She counts herself lucky to have a supportive husband and in-laws who live nearby. Still, “it’s not always easy,” she says, “but many families make sacrifices at the beginning. Ours is just one of those.” Fourth-year student Roman Povolotskiy and his wife Jessica Yakobashvili, a first-year student, both 25, went to the same high school in Staten Island, dating briefly. They rekindled their relationship in college.
Fourth-year student Kristyn Lao counts herself lucky to have a supportive family.
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GRIT Humberto Baquerizo is all about building resilience and giving underrepresented students tools for future success By Ty Baldwin Nataki Douglas, MD, PhD Associate Professor, Researcher ou might say that Humberto Baquerizo, EdD, has a doctorate in
Y
grit. “During my doctoral degree program at Caldwell University, I studied resilience and grit among minority populations in the STEM (science, technology, engineering, and mathematics) fields,” says Baquerizo, program development specialist in the Office for Diversity and Community Engagement at NJMS. “Studies show that this population, particularly millennials, needs strong support systems to help them figure out the journey into college and beyond.” Baquerizo, a resident of Newark, came to the U.S. from Ecuador with his family when he was 14. Growing up in Union City, NJ, he attended Memorial High School in West New York, NJ. Baquerizo understands the social determinants of success. He was raised by a divorced mother and at times the family was dependent on public assistance. To help out, he worked at a local bodega as a carnicero (butcher). He has seen firsthand the challenge faced by immigrants and the benefits of a college education, and personally knows the importance to his scholars of having strong support networks. “The teachers and parents at Memorial were very involved in the educational process,” he recalls, mentioning a science teacher who “made sure you were on top of your game and that you never forgot where you came from. She always said you had to work harder to get where you wanted to go.” Baquerizo (aka Humby, the nickname given to him by his college roommate) graduated from NJIT with a BS in engineering science in 1995, and then embarked on a career with Spanish-language televsion in New York, Boston and Miami. “That gave me a greater understanding of myself and my cultural identity,” he says. “It also gave me the ability to have a voice in the community.” He returned to New Jersey and NJIT, where he served as associate director of the Center for Student Involvement, before joining NJMS in 2016.
A big part of Baquerizo’s job is overseeing the Northeast Regional Alliance (NERA) MedPrep Health Careers Opportunity Program (HCOP). A partnership between NJMS, Icahn School of Medicine at Mount Sinai’s Center for Multicultural and Community Affairs, Columbia University Vagelos College of Physicians and Surgeons, and Manhattan-Staten Island Area Health Education Center, NERA offers a free summer enrichment program for underrepresented and/or socioeconomically disadvantaged college students interested in careers in medicine. “These are young adults who are on the right track,” he says. “They have shown the potential for excellence but may not have had the social capital or displayed the resilience needed to be a competitive applicant for and beyond medical school.”
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NERA takes place over three summers. “In the first summer we focus on academic enrichment. The second summer is MCAT prep, almost like a boot camp,” Baquerizo explains. “During the third summer the students do reseach with NJMS faculty. Our goal is to provide them with the academic skills, motivation, and support system they need to go to the next level.” Students in the NERA program are encouraged to develop a “grit mindset,” Baquerizo says. “It’s finding a mentor, asking for help, or just doing something you’ve never done before. You get out of your comfort zone and become a little less introverted. That makes it more comfortable to seek help along the way.” Baquerizo has also been a part of NJMS Community Engaged Service Learning (CESL) program that allows students to develop service projects that support the needs of local communities. “I believe an institution of higher education always must be part of its community,” Baquerizo says. “Whether it’s CESL programs, or when NJMS takes part in the Puerto Rican Day Festival or the Breast Cancer Walk, it’s a way of saying that we’re here, and we’re thankful for the community’s trust and support.” He adds: “So many of the programs that we offer at NJMS are to help students develop skills to understand who their patients are, to see how the patient looks outside of a hospital room. We want our students to learn the academic skills to be future physicians, but it’s just as important that they learn the humanistic skills to understand their patients’ sociocultural needs.”
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Education, Community, Family Practicing medicine as a spectrum of caring By Katherine Gustafson
Kathyann Duncan, MD’94, was devoted to teaching long before she became a faculty member at NJMS, from which she recently retired after 22 years of full- and then parttime work. She was a teacher in her native Trinidad before pursuing medical education in the U.S., and she continues to precept students in her medical practice, Valley Spring Family Medicine in Maplewood, NJ. “I love teaching,” she says. “I love to see the transitions when they gain the confidence because they’ve taken ownership of the patient’s care.” Duncan joined the NJMS faculty in 1997 after completing her residency in family medicine, and right away she enjoyed helping students improve upon their soft skills. She helped develop a course called Physicians Core that focused on medical ethics, cultural competency, and the doctorpatient relationship. “It was really cool to be developing curriculum from the beginning,” she remembers. “Especially something that was not just facts out of the book, but teaching students the nuances of medicine in terms of how you talk to a patient, how you develop a relationship, how you become aware of their cultural beliefs.”
She had experienced her own abrupt cultural learning curve when she encountered the complex racial dynamics within the United States. Coming from the West Indies, she was surprised to encounter prejudice, social minefields, and inequity and disparities in health care. “It was for me a quick learning experience about what it meant to be a ‘minority’— something that was not part of my vocabulary when I was growing up,” she notes. “I remember rotating in a pediatrician’s office and hearing the staff trying to explain to one of the patients how to get to the office in South Orange without having to go through Newark, because according to them, that was a terrible thing.” As a full-time faculty member Duncan served as director of the SMART (Science, Medicine and Related Topics) Program, which provides science education and SAT preparation for underrepresented children in Newark and the surrounding areas. She also engaged with the community by working at the Student Family Health Care Center (SFHCC), one of the oldest free medical clinics in the country. The SFHCC also provides medical services to Newark’s
Fairmont Health Services Shelter, where Duncan has volunteered once a month for several years. Throughout her career, Duncan has actively pursued and welcomed new opportunities. She was medical director for the Newark Department of Health for three years, where she oversaw the city’s reaction to outbreaks of Ebola, meningitis, and Zika virus. She has done medical missions to Jamaica and Ghana. And she is diversifying her medical practice to include a medical spa and health exams for commercial driver’s license certifications. Duncan has also had to confront new challenges in recent years as the opioid epidemic began affecting her practice. It was necessary to restrict her prescribing methods and do drug testing to ensure compliance.
them out of the ER, and then they present to us in family medicine addicted,” she says. “It crosses all socioeconomic lines and all levels of education. The epidemic is really bad.” For Duncan, medicine is a family affair. Her medical practice is co-located with her husband’s ophthalmology practice, Valley Spring Eye Care Center. Samuel Duncan, MD, is also from Trinidad, though the couple met in Newark. Their son Matthew is now is a third-year medical student. And the importance of family is central to her approach to practicing medicine as well. “Family medicine is not just about a problem, it’s about a person,” she says. “Being able to teach and help generations of people to take care of themselves and take care of their parents and children. It’s a good thing.”
“People are given narcotics in the ER to get
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A Healer is
Healed By Nancy A. Ruhling
Bryan Ciccarelli, a fourth-year student in NJMS’s combined MD/PhD program, has a special bond with his cancer patients. He knows what they are going through, because he has been one of them. Five years ago, over Thanksgiving weekend, Ciccarelli, who is training to be an oncologist, discovered a lump the size of a golf ball on the left side of his neck. His research had focused on leukemia and Waldenström’s macroglobulinemia, a rare bone marrow lymphoma, so he was pretty sure he had Hodgkin’s lymphoma. As it turned out, he was correct. “I guess you could say that given my field of interest, the diagnosis was ironic,” he says. He underwent six rounds of chemotherapy, suffering several side effects and a lot of anxiety, and finally went into complete remission. In June 2019, he was declared cured. But Ciccarelli’s life – and his patient-physician perspective – have never been the same. “I thought I knew what it was like to be a cancer patient because I had worked with them in various capacities for 11 years,” he explains, “but this experience deepened my empathy. It also made me realize that nobody is addressing the long-term ramifications of cancer. In my own case, I still don’t know all the long-term effects of chemotherapy.”
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Ciccarelli, for instance, developed celiac disease after chemotherapy. So, he discovered in the interim, did 12 of his patients. “I’ve started to study the correlation,” he notes.
Because of his compassion and dedication, Ciccarelli was among the 15 percent of his classmates inducted into the NJMS chapter of the Gold Humanism Honor Society in August.
Born in Hackensack, Ciccarelli spent most of his childhood in Tolland, a wooded, rural area of Connecticut. He comes from a family of medical professionals. His father, Carmine Ciccarelli ’79, and his great-uncle, Anthony Passannante ‘66, are NJMS graduates, and his mother Susan graduated from Farleigh Dickinson’s nursing school.
“Honorees are nominated by their classmates and faculty,” says Sarah Karl, PhD, the society’s faculty advisor and assistant dean for academic development and student affairs. “The ones chosen are those who show the most enduring responsibility to model and advocate for compassionate, patient-centered care in their communities and through their careers.”
“I always wanted to be a doctor,” Ciccarelli says. “And I always liked science.”
Ciccarelli says that humanism plays a large role at the medical school because “we treat patients who are the sickest of the sick, and they often have multiple problems.”
Ciccarelli, age 34, started his medical career two decades ago when he got his first hospital job: He was an orderly. As his love of medicine deepened, he continued his hospital work, taking on the roles of file room clerk, operating room orderly, nurse’s aide, perioperative patient care technician, phlebotomist and emergency room technician. After earning a bachelor’s degree at Boston College, he worked at the Dana-Farber Cancer Institute for four years and earned a master’s from Boston University School of Medicine before enrolling in NJMS’s MD/PhD program a decade ago.
At the time of Ciccarelli’s diagnosis, he was newly engaged. In August his wife Ashley delivered their first child, Lucia, at 32 weeks by emergency C-section. The couple spent the first weeks of Lucia’s life visiting her in the neonatal intensive care unit. Ciccarelli, who will graduate in 2020, plans to stay in the northeast for residency, and as a physician/scientist, he will focus on blood cancers. “I don’t know what kind yet,” he says. “But wherever I end up, I want to work survivorship issues into my practice. Unfortunately, they are either not being studied or are understudied at the moment.”
NJMS Class of 2023 – By The Numbers
THERE ARE
51
INCOMING STUDENTS IN THE CLASS OF
2023 49%
51%
35
RUTGERS UNIVERSITY STUDENTS IN THE ENTERING CLASS
3
47 4
hold a bachelor’s degree from Rutgers
are in a combined degree program and will receive their bachelor’s degree following completion of the first year at NJMS
Students in the New Accelerated 3 Year Primary Care Track
Top 10 Schools Represented
17%
of the class are entering with either a master’s degree or doctorate degree
Languages spoken
Countries Represented
17
73%
are first in their family to attend medical school
US States Represented
22%
Underrepresented in Medicine
Watch as Sandra Gold, EdD, co-founder, Arnold P. Gold Foundation, welcomes the Class of 2023 during White Coat Ceremony at issuu.com/rutgersnjms.
Organization U.S. Postage Paid Rutgers University Permit No. 5287 185 South Orange Avenue Newark, New Jersey 07103 njms.rutgers.edu
