Memphis Medical News January 2016

FOCUS TOPICS OBESITY/DIABETES OPHTHALMOLOGY HEALTHCARE CONSTRUCTION

January 2016 December 2009 >> $5

PHYSICIAN SPOTLIGHT PAGE 3

Aaron Waite, MD ON ROUNDS

Launching an Attack against Diabetes BMG will spearhead Memphis’ Effort as Part of National Program Memphis is known as a hub for a number of important enterprises, including transportation systems, barbecue restaurants, the cotton industry, healthcare research and, until recently, grit-and-grind basketball ... 4

Weight-Loss Procedure is Under-Used, Doctor Says Center’s Director Believes More Could Benefit From Bariatric Surgery The Centers for Disease Control and Prevention reported recently that adult obesity rates were stuck at 36 percent from 2011 to 2014, and Virginia (Jenny) Weaver, MD, says that in the Mid-South we live at “the epicenter of obesity in the United States.” ... 5

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TMA Hopes to Cap Medical Liability, Insurance Companies’ Fee Changes

BY BETH SIMKANIN

The Tennessee Medical Association (TMA) plans to tackle a number of legislative issues pertaining to physicians and the future operation of healthcare in the state during this month’s meeting of the 2016 Tennessee General Assembly.

The TMA, the state’s largest professional organization for physicians, has unveiled an agenda that includes: • The limitation of how often an insurance company can change fee schedules and payment policies, • Physician-led, team-based collaboration with practice nurse practitioners and • Tort reform to cap non-economic damages in medical liability

lawsuits.

“These priorities are about making improvement for Tennessee physicians and the patients they serve,” said John Hale, MD, TMA president.

“We feel these legislative priorities benefit both physicians and patients.”

The association supports passage of the Healthcare Provider Stability Act, which would limit how often insurers could make changes to fee schedules and payment policies with providers. Currently, insurance companies can change the terms of agreements with providers in the middle of multi-year contracts.

According to Ron Kirkland, MD, and chair of the TMA legislative committee, the bill was drafted partly in response to Blue (CONTINUED ON PAGE 6)

HealthcareLeader Proton Beam Therapy Pioneer Improves Survival Rates for Children with Cancer

BY JUDY OTTO

Last month, a few weeks before Christmas, St. Jude Children’s Research Hospital presented us with another world-class “first”— the St. Jude Red Frog Events Proton Therapy Center –the first center of its kind dedicated exclusively to pediatric cancer treatment.

But for Thomas Merchant, DO, PhD, and Chair of Radiation Oncology at St. Jude, it

was a personal milestone, as well. Even before choosing a career in medicine, as a senior studying nuclear engineering at the University of Michigan, Merchant wrote a paper on particle therapy research being done at the Swiss Institute for Nuclear Research in Villigen, Switzerland (now known as the Paul Scherrer Institute).

Twenty-five years later, as a St. Jude researcher, he visited the institute and studied firsthand its (CONTINUED ON PAGE 8)

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PhysicianSpotlight

Ophthalmologist Praises Suture-less Procedure

HEI’s Aaron Waite helps lead the way with new corneal technique

BY RON COBB

Long before he transplanted his first cornea, Aaron Waite, MD, was operating on little critters. Well, not exactly operating, but experimenting.

Growing up in Reno, Nevada, the middle child in a family of nine kids, Waite collected pets the way boys of an earlier generation collected baseball cards or marbles. He had snakes, mice, rats, gerbils, lizards, turtles. “Pretty much anything that was a small animal,” he recalls.

“We never really had any dogs or cats,” he said, “so I probably made up for that by having small animals in my room.

I also had fish tanks – freshwater and saltwater. My parents were patient enough so that they let me do all that. They just let me take care of it, which was good experience for me.”

When he was in high school, he wanted to know how one of his rats came to have long hair while the other had no hair.

“I was trying to figure out if it was a dominant or recessive trait – the hairlessness,” he said. “So I bred a hairless rat to a long-haired rat and then bred the offspring to each other and found out that it was an autosomal recessive trait.”

While he acknowledges that breeding rats was not a normal high school activity, it does help explain how Waite came to get an undergraduate degree in zoology at Brigham Young University. How he decided to become an ophthalmologist is another story.

“It wasn’t until I had the idea of trying to get a PhD (in zoology) and started doing research and found it wasn’t as much fun as I thought it was going to be.

I realized that working with people would be a lot more fun.”

Waite now is director of cornea, cataract and refractive surgery at the Hamilton Eye Institute at the University of Tennessee Health Science Center (UTHSC), and is a leading proponent of the relatively new corneal transplant procedure DMEK – Descemet Membrane Endothelial Keratoplasty.

The modern era of corneal transplantation dates roughly to the late ’90s with the introduction of partial corneal transplantation techniques. This led to DALK (Deep Anterior Lamellar Keratoplasty), which replaces the front of the cornea, and DSAEK (Descemet Stripping Automated Endothelial Keratoplasty), which replaces the back of the cornea.

“By 2007, DSAEK became the standard for treating disease of the inside layer of the cornea,” Waite said. “That’s when I started a residency (at UTHSC). DMEK

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has come into vogue more recently because it is the thinnest corneal graft that can be placed inside the eye. It leads to a faster recovery, with better visual results, and lower risk of rejection. Because the incision is so small, no sutures are required.

“It has been phenomenal to have a suture-less corneal transplant technique that can be offered to patients. It really

can make a big difference.”

Waite explained that Fuchs’ dystrophy is one of the most common conditions that ultimately lead to corneal transplant.

“There’s a defect in the inner layer of the cornea so there’s not enough cells to keep the cornea clear,” he said. “So I make a small incision at the edge of the cornea and take out those cells that aren’t working and put new cells in from a deceased donor.”

The DMEK procedure, Waite said, is becoming more common in the United States.

“But it’s not as common as DSAEK because the technique is new and is a little bit tricky to perform,” he said. “As soon as a surgeon learns the technique, it’s something that’s definitely repeatable and doable. So we’re in an early phase of the technique right now, and we’re trying to help other surgeons learn how to do it.

“It’s not something we want to exclusively do here. We want everyone who’s doing corneal surgery to do this because it works so well.”

Waite cited the case of a patient referred from Jackson, Tennessee, whose swelling was so severe she couldn’t see the biggest letters on the eye chart with either eye. After the procedure on one eye, “she

was probably seeing 20/30, so she would be able to pass the driver’s test. Then we did the same thing on her other eye and had a great result on that side as well.

“So it’s kind of a life-changing event for these patients where they’re unable to really function. She was getting around in a wheelchair beforehand and then able to see almost perfectly after the surgery.”

Coming out of med school and residency at the University of Utah, Waite matched at UTHSC. He went back to the West for additional training at the University of Colorado in Denver, followed by private practice at Las Vegas.

He’s clearly a Western guy, but Waite broke the pattern again by returning to Memphis 2½ years ago to work at HEI and UTHSC. “What’s nice here in Memphis is that you can have a big yard, you have seasons and a lot of good people,” he said.

During his spare time, Waite enjoys spending it with his wife, Carolyn, and five children. He also enjoys playing the piano. When he was based in Las Vegas, he played at a country club, providing background music during dinner.

“I can play,” he said. “I think I would be better if I spent more time at it. But I’m too busy with other things.”

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Launching an Attack against Diabetes BMG will spearhead Memphis’ Effort as Part of National Program

BY LAWRENCE BUSER

Memphis is known as a hub for a number of important enterprises, including transportation systems, barbecue restaurants, the cotton industry, healthcare research and, until recently, grit-andgrind basketball.

The city also is a hub –make that the hub – for something far less likely to inspire civic pride: diabetes.

“Four out of the five states with the highest incidence of diabetes touch on Memphis,” says Dr. Jay Cohen, medical director of The Endocrine Clinic, which recently joined Baptist Medical Group (BMG). “There’s Mississippi, Arkansas, Tennessee and Dr. Jay Cohen parts of Alabama and Louisiana. The only outlier is West Virginia. Memphis is the largest city among those states, and we are the epicenter.”

That is one reason BMG will be the leadership arm in the Memphis community for participation in a national program called “Together 2 Goal” that aims

to reduce diabetes through awareness, education and treatment.

Nearly 30 million Americans have diagnosed or undiagnosed diabetes, according to the Centers for Disease Control and Prevention. Despite steady advances in research and treatment, that number has tripled over the past 25 years.

“While diabetes affects 8 percent of the U.S. population, it’s estimated to be 12 to 14 percent in the Memphis area and another 6 to 10 percent have prediabe-

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tes,” Cohen said. “Most of that is because of the rise of obesity in our community.

Decreased exercise and increased calorie consumption have been the major contributors. There are lots of reasons why people are not exercising as much and consuming more calories, but you combine those two and it leads to diabetes.”

Diabetes occurs when a person has high blood sugar, either because insulin production is insufficient or because the body’s cells do not respond properly to insulin or both.

Doctors often call it diabetes mellitus, with diabetes coming from the Greek word siphon and mel being the Latin word for honey and referring to the sweetness from excess glucose in the blood and urine of those with diabetes.

The ancient Chinese noticed that ants actually were attracted to the urine of diabetics, thus the term “sweet urine disease” was coined.

People with diabetes become susceptible to a long list of other health problems affecting the heart, eyes, skin, feet, gums, hearing, blood pressure and even mental health.

Diabetes affects the entire community, Cohen added, including families, employers and, by extension, productivity in the workplace.

There are three types of diabetes: Type 1 or juvenile diabetes in which the body does not produce insulin, Type 2 in which the body does not produce enough insulin for proper function or the cells in the body are resistant to insulin, and Gestational Diabetes in which pregnant women have high levels of glucose in their blood and their bodies are unable to produce enough insulin to transport the glucose to their cells.

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Type 2 diabetes is by far the most prevalent form, making up nearly 95 percent of all cases.

“Diabetes can be prevented, cured and controlled,” said Cohen, who has practiced endocrinology for more than 30 years. “With a family history of diabetes, if one dramatically changes exercise and food behaviors and makes exercise a daily drug, you can prevent development of Type 2 diabetes in many people. We take people off medication every day. Our goal is education, prevention and aggressive management to prevent complications.

“Everybody with diabetes does not need to see an endocrinologist, but everybody with diabetes needs to have a healthy, positive relationship with their primary care provider to help them manage the multiple aspects of diabetes because they have an 85 to 90 percent chance of being overweight, having high blood pressure, having lipid or cholesterol abnormalities.”

The “Together 2 Goal” program, which involves a number of other large, multi-specialty medical groups around the country, including the Mayo Clinic, aims to launch a multi-pronged attack on diabetes.

“This will go way beyond just awareness,” said Cohen, who recently served on the advisory board of the American Board of Clinical Endocrinologists to develop national treatment guidelines. “It will be awareness and active treatment plans that are individualized for each person and family who is part of this program. We’re going after the problem. We’re going to tackle issues from exercise, heart attack reduction, blood pressure improvements, cholesterol lipid management as well as blood sugar.

“There are a number of reasons for this program. The man with diabetes has a 400 percent increase in the chances for a heart attack over a non-diabetic man. For a woman with diabetes it’s a 500 percent increase in cardiac death. That’s quite a number.”

The reason Memphis is the nation’s hub for diabetes has to do with many factors.

“The areas of the country that are more economically disadvantaged have the highest incidence of diabetes, less access to healthy food, less access to education and prevention and less access to exercise opportunities,” Cohen said. “So when you combine that with healthcare disparities and socio-economic disparities, it becomes a pressure cooker for increased incidence of obesity and development of Type 2 diabetes.

“The name of the game is that these risks are unnecessary and treatable, but it takes a coordinated effort educating physicians and other healthcare providers, families, patients, employers, the faith-based communities as well as government and strategic partners. Let’s make Memphis America’s healthiest city.” memphismedicalnews

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Weight-Loss Procedure is Under-Used, Doctor Says

Center’s Director Believes More Could Benefit From Bariatric Surgery

BY PEGGY BURCH

The Centers for Disease Control and Prevention reported recently that adult obesity rates were stuck at 36 percent from 2011 to 2014, and Virginia (Jenny) Weaver, MD, says that in the Mid-South we live at “the epicenter of obesity in the United States.”

Each year, between 700 and 800 patients have procedures at the Dr. Jenny Weaver Center for Surgical Weight Loss at Saint Francis Hospital, according to Weaver, the center’s medical director. Though it’s an impressive increase from the 45 procedures the clinic performed the year it opened in 2003, Weaver considers the number too small.

“In fact, we really only treat a very small percentage of the number of patients out there who qualify for bariatric surgery and should be referred for bariatric surgery,” she said. “Nationally, only 3 percent of people who are obese and

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would qualify for bariatric surgery actually go on to have the surgery.”

A report by London researchers published on the National Institutes of Health Library of Medicine site says of bariatric surgery: “This is the only therapy to have demonstrated the ability to produce a sustained, long-term weight loss and deliver reductions in mortality and morbidity.”

Referring to the most common bariatric surgery procedure, the gastric bypass, the researchers note that it alters “the secretion of various gut hormones associated with appetite and satiety as well as energy expenditure.” A Cleveland Clinic study called bariatric surgery “the most effective method for achieving major, long-term weight loss, with weight loss ranges of 35 percent to 40 percent lasting as long as 15 years.” The authors of that study also link metabolic changes that result from the surgery to changes in the gut hormones.

“When we do the surgery, we are dramatically altering the intestinal hormones; that is what research is showing plays a much greater effect in the success of patients after bariatric surgery,” Weaver said.

“Certainly restricting the amount of food you eat is not the primary way the procedure works. It is one of the factors, but the alteration that we do with the gut hormones, which does pertain to metabolism, has a far greater effect on the weight loss than just simply limiting the amount of food you can eat.”

Weaver speculated that potential patients might avoid bariatric surgery because of fear or uncertainty.

“Basically what we tell patients is it carries the same percentage of risks as taking your gallbladder out or, for women, getting a hysterectomy. People think of it for some reason as a very high-risk procedure, but in reality it’s not.”

At Columbia University’s Center for Metabolic and Weight Loss Surgery, the risks for gastric bypass surgery are described as “the same as the risk for any operation on an obese patient. ... Operative complications such as bleeding or intestinal leakage can occur in less than 2 percent of patients.” The Mayo Clinic cites bleeding, infection, leaks in the gastrointestinal system and blood clots among risks associated with the surgery.

“Long-term, people mistakenly think

that malnutrition also is a risk, but it’s not,” Weaver said, “particularly if you follow guidelines as far as protein and vitamin supplementation.”

Weaver, 45, an All-America swimmer during her undergraduate years at the University of Tennessee, Knoxville, got her medical degree and completed her residency at the University of Tennessee Health Science Center. After a fellowship at the Ohio State University Center for Minimally Invasive Surgery, she returned to Memphis in 2003 to open the Saint Francis clinic.

The Saint Francis clinic has a “robust education process” that includes a mandatory seminar about the surgical process, diet and exercise, Weaver said.

“Patients are required either to watch the online seminar or attend a live seminar before they enter the program. The online seminar is 25 to 30 minutes long; the live seminars take a little longer.” They’re conducted by Weaver or Robert Wegner, MD, who completed a bariatric fellowship at the University of Iowa and joined the clinic in 2010.

The clinic describes surgery candi(CONTINUED ON PAGE 7)

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TMA Hopes to Cap Medical Liability, continued from page 1 Cross Blue Shield of Tennessee’s changing the laboratory reimbursement rate in 2014. Blue Cross Blue Shield of Tennessee, the state’s largest health benefit plan company, notified providers in December 2013 that it would cover only 48 percent of what Medicare pays for laboratory tests instead of matching the Medicare reimbursement rate.

“Doctors had no choice but to accept the changes or be removed from the network,” KirkDr. Ron Kirkland Dr. John Hale land said. “As a result, they could have lost patients if they didn’t comply. Patients were locked into an inbill levels the playing field and offers favorsurance program where certain physicians able options to the insurance companies.” who they thought were covered by the The bill is being held in the state Sennetwork initially, weren’t. There was no ate finance committee and the state House negotiation.” finance subcommittee. The Haslam adThe bill requires health insurance ministration added a $5-million fiscal note companies to honor reimbursement conto the bill at the end of the previous sestracts with physicians for 12 months. If sion. passed, Tennessee would be the first state “The TMA has asked for the current in the nation to limit how often payment administration to make changes on the policies can be changed during a confiscal note to make it more reasonable,” tracted period.

Kirkland said.

“Ideally, physicians want changes to Another key piece of legislation suppayment policies prior to the time of negoported by the TMA is the Tennessee tiation, but we recognize this always isn’t Healthcare Improvement Act. The bill the case,” Kirkland said. “This bill would would put in place a team-based approach allow for insurers to make changes to conwith physicians leading the collaboration tracts with providers at certain times. Also, and coordination of patient care. it would allow patients to receive notifica“A change is coming in the way tions of changes ahead of time. We feel this healthcare is being delivered,” Hale said.

“The government will mandate a primary care physician to coordinate care between hospitals and specialists and this bill is a proactive response to that future mandate.

We want to add structure to a system that is unstructured.”

There is a competing bill being considered called the Nurse Independent Practice/Full Practice Bill, which would give advanced practice registered nurses the ability to treat patients and prescribe medication without a physician to supervise and provide consultation.

The Tennessee Nurses Association, which supports the bill, has a list of talking points on its website which include, “Numerous studies over many years have shown the care given by advanced practice registered nurses is as good as, and in some cases better, than care provided by a physician.”

According to Kirkland, Tennessee Healthcare Improvement Act will allow nurse practitioners to use the full extent of their training, while making sure that a physician is involved in the care of every patient.

“Nurse practitioners are highly valued and take good care of patients,” Kirkland said. “We need them, but there are limitations to their training. If a patient has a complex issue such as an acute heart attack or renal failure, those patients should be treated by a physician.”

The final legislative initiative for the TMA is the passing of a constitutional amendment clarifying the General Assembly can cap non-economic damages in cases including medical liability actions.

The Tennessee General Assembly approved the Tennessee Civil Justice Act of 2011 to cap non-economic damages in tort claims to $750,000, but a Hamilton County Circuit Court judge last March ruled the cap unconstitutional. The cap is being threatened by lawsuits.

A joint resolution must pass two separate General Assemblies before it is put on the state ballot for a vote in 2018. According to Kirkland, if the resolution does not pass this year’s session, the next opportunity to have the issue on the ballot would be 2022.

“This bill has had a positive impact on reducing the amount of frivolous lawsuits in the state,” Kirkland said. “Less money and time spent on filing these lawsuits lowers the cost of healthcare.”

In addition, the TMA hopes to have legislation drafted in 2017 that would increase funding for greater medical education in the state.

“State residency spots haven’t changed since the 80s,” Hale said. “Studies have shown that physicians relocate within 100 miles of their residency. We need physicians trained in Tennessee to stay in Tennessee. There aren’t enough residency spots for the number of medical students in school.”

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Obesity Worsens Lung Function in Young Adults with Asthma Washington University Study Chronicled Asthmatic Patients from Elementary Age to Post College

BY LYNNE JETER

ST. LOUIS, MO. – A new study following nearly 800 asthmatic patients over 15 years shows the progression toward worse lung function in those who become obese as they age.

None of the participants of the Washington University School of Medicine study were obese at the beginning of the research project (ages 5-12), yet 25 percent were obese by the end of the study (early twenties).

Researchers reported that pediatric asthma patients who had become obese by their early twenties had measurably worse lung function than those with asthma who didn’t become obese by the end of the study.

Surprisingly, both groups showed no difference in the severity of their asthma symptoms.

“In extreme situations in adults (morbid obesity), the chest wall is so thick that it interferes with movement and there are decreases in lung function on that basis,” explained Robert C. Strunk, MD, a pediatrics professor at Washington University, who treats patients at St. Louis Children’s Hospital in St. Louis, Mo. “This is a different kind of abnormality (a restriction because of the interference with movement) than we found, which was obstruction due to the airways being more narrow and nothing to do with the chest wall. Others have shown in adults with asthma and obesity (and the same obstruction we found) that there’s likely to be some connection between the airways being narrow and molecules that come from fat tissue and cause inflammation. We didn’t collect data to examine this possibility in our study population, but the obstruction in those who became obese is likely to be related to some type of increased inflammation related to the fat tissue.”

Study findings differ from research in older obese patients with asthma, who have more difficulty controlling their symptoms and as a result, need more medications.

“Our study suggests that younger obese patients can expect worsening lung function as they age,” said Strunk. “We want to emphasize that doctors and patients need to pay attention to weight.”

Strunk noted it’s encouraging that obese young adults in the study don’t report worse asthma symptoms.

“But it’s worrisome that their lung function has clearly gotten worse,” he quickly added.

The CAMP (Childhood Asthma Management Program) research group has published more than 150 articles on

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the study results, with many publications focusing on the genetics of asthma and/or clinical outcomes.

“We’re now working on determining characteristics of the children when they were school age that were associated with the onset of smoking cigarettes,” he said. “In spite of our best efforts and their asthma, yes, some 20 to 25 percent were smokers.”

Strunk noticed no difference in outcomes by gender. “Young men and women gained weight and had decreased lung function,” he said.

When asked about indications whether asthma symptoms had any effect on gaining weight, Strunk said many thought participants with more asthma symptoms might exercise less and therefore gain more weight. “Or that those who gained weight were the sickest and took more steroid medication,” he said.

“Neither symptoms nor steroids were related to the changes in lung function … and thus on gaining weight.”

Trial patients were enrolled in CAMP, a nationwide study originally designed to determine best practices in treating asthmatic pediatric patients. In 2000,

Weight-Loss, continued from page 5

dates as generally 100 pounds or more overweight, with a body mass index of 40 or greater, or those with a BMI of 35 or more and simultaneous conditions such as diabetes.

About 80 percent of bariatric surgery patients are women. “I still don’t quite understand why the percentage is the way it is,” Weaver said. “A lot more men out there could really benefit from the procedure, who for some reason, don’t come see us.”

Weaver says insurance companies often require patients to have a comorbid condition to qualify for bariatric surgery.

Besides diabetes -- “the results as far as putting diabetes into remission after bariatric surgery are honestly just staggering,” she said -- qualifying comorbidities can include hypertension, sleep apnea, elevated lipid levels in the blood, knee or hip pain due to weight, and infertility.

“Some interesting studies show that infertility and obesity are linked, so some of our referrals are women who desire to start families but have been unable to conceive due to obesity,” Weaver said.

“Other than putting diabetes in remission, another one of the exciting things we see is when people who’ve been unable to conceive come back a year or two after their surgery, and they’re pregnant.”

the study produced a landmark paper in The New England Journal of Medicine that altered the standard of care for children with asthma when it demonstrated that a regular medication routine was superior to as-needed asthma treatments.

“That paper launched a whole new approach to childhood asthma management, changing the guidelines for physicians treating those patients,” Strunk pointed out. “We were fortunate to be able to continue following this group of children all the way to their mid-twenties.

Nobody had been able to do that before.

We could answer a lot of questions with data gathered over such a long period of time.”

Because CAMP study patients were only their twenties, they weren’t old enough to have developed COPD. “Good studies show that childhood asthma is a clear risk factor the development of COPD,” he said.

Research from the Washington University study was published in a 2015 edition of The Journal of Allergy and Clinical Immunology.

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Proton Beam Therapy Pioneer Improves Survival Rates, continued from page 1 program in proton spot scanning.

There, in perhaps the premier facility in the world where proton spot scanning, aka pencil-beam scanning, was developed, he experienced what many inventors, scientists, and researchers identify as an “Aha!” moment.

“We have GOT to have this!” Merchant realized.

“St. Jude had proton therapy on its radar and followed it very carefully,” he explained. “But the technology available then (in 2008) wasn’t this leading edge technology. When it became available, that’s when we made the decision to develop our own treatment center.”

Now that St. Jude has treated its first few patients, carefully selected, in meticulously controlled clinical trials, he marvels at the “unbelievable” focus and accuracy in delivering a radiation dose precisely shaped to match its target.

Previously available pencil-beam systems were limited by their comparatively large beams. “Our beam size is the smallest clinical beam in the United States today,” he believes.

Being one of the first systems to employ exclusively pencil-beam technology is

St. Jude last month opened the first proton therapy center in the world dedicated solely to children with cancer.

It includes a three-story high gantry that weighs 100 tons allows scientists to rotate the proton beam 190 degrees around the patient.

not without risks. Whether to include, in part, older “passive scattering” technology with the new was a big decision, said Merchant. “Since we had waited for this new technology to implement proton therapy, however, we chose to make the entire facility pencil-beam. Obviously that was a good decision.”

Medical technology is perpetually threatened by obsolescence, so one of Merchant’s concerns was how long the

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new technology would retain its cutting edge. “This is one of the biggest challenges that the administration put before me in 2011,” he recalls. “They said, ‘You need to open a proton therapy center in the next five years, and it absolutely has to be cutting edge.’ But how do you predict the future?”

Hitachi Ltd.’s ability to make improvements during system development— even up to the last minute—made them an attractive proton therapy vendor partner, said Merchant. “The Center was designed so that we can make modifications over time that will also keep it cutting edge for a long time. What we have today is just the beginning; a year or two from now, it will have more functionality –and allow us to do more and more.”

In the future, will all children be treated with proton therapy?

“I think it’s moving in that direction.

The number of children each year in the United States who need radiation therapy as part of their front-line management is difficult to estimate, but may be from 3,000 to 5,000. If I had my way, we would treat every child with cancer here –but that’s not practical. So St. Jude helps others by performing trials that are designed to treat a specific number of patients, and

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we share those results with other institutions in the U.S. and around the world.”

Merchant is not a stranger to successful research results that have far-reaching benefits. His proudest achievement, in fact, is a change in U.S. and international philosophy regarding the use of radiation therapy on brain tumors in young children under the age of three—which has saved countless lives.

“When I came to St. Jude (from Memorial Sloan-Kettering Cancer Center, New York) in 1996, it was to implement conformal radiation therapy using Xrays. At that time, children under the age of three with brain tumors did not receive radiation therapy as a part of their initial treatment because everyone was concerned about the side effects of radiation.”

Then, for example, children with a tumor known as ependymoma would have surgery and chemotherapy, receiving radiation therapy (potentially) only when the tumor grew back. Merchant characterizes those results as “miserable”, with five-year overall survivals in the 40% range. His efforts galvanized St. Jude’s teams to offer these children radiation immediately after surgery. Five-year overall survival rates have since jumped to 85%.

Merchant then led a five-year national trial (2003-2007) that duplicated St. Jude’s results. “Just by bringing radiation therapy in immediately after surgery for those very young children, we doubled their survival. I’m proud that we pioneered the use of radiation therapy in children under the age of three years with brain tumors.”

He points to St. Jude’s track record of doing pilot studies that lead to national and international studies that bring about change. “We’re going to do the same with proton therapy,” he predicts.

Seeing children in follow up for tumor surveillance once treatment is completed is the most challenging part of his work, he notes. “We’re concerned about each and every patient. We want clean scans, good exams, and we worry a lot about that.”

Does working with children make the job emotionally more difficult?

“Heartbreaking things happen here all the time; but by and large it’s a joyous place to work. Our results are good, and that keeps us going.”

Post-college, Merchant worked for the French Atomic Energy Commission (CEA), evaluating radiation protection and safety and partnering with investigators at the famed Curie Institute. After medical school (Chicago College of Osteopathic Medicine), he was a Fulbright Scholar to the Netherlands at the University of Utrecht, where he received his PhD, cum laude, in experimental pathology.

“The great thing about the field of pediatric oncology and radiation oncology,” he notes, “is the small community. We know each other; we really enjoy helping others – both nationally and internationally.”

For Merchant, this particularly includes one person: his wife, Dr. Jenny Tibbs, who also practices radiation oncology in Memphis. memphismedicalnews

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New Plans May Have Major Effect on Area Healthcare A trio of major announcements made at the close of 2015 could dramatically impact the face of healthcare in the MidSouth. The disclosures included the news that Crittenden County, Arkansas, will have a new hospital, St. Jude Children’s Research Hospital will launch an enormous $1-billion expansion and Methodist Healthcare plans to make a $275-million investment in its campus master plan.

The announcements come on the heels of a report in the November issue of the Memphis Medical News of no less than six other large-scale healthcare projects expected to open this year.

The new hospital in Crittenden will replace one that closed in West Memphis in 2014. According to the plan, Memphis’ Baptist Memorial Health Care will operate the facility. A proposal to reopen Crittenden Regional Hospital was announced by Nashville-based Ameris Acquisitions, LLC, last summer, but never moved forward. Crittenden was the county’s only hospital.

Hopes for a new hospital depends on voters in Crittenden County to approve using proceeds collected from a sales tax previously approved to finance construction of the hospital. Jason Little, chief executive officer at Baptist, indicated it would take about 18 months to build the hospital if voters in March approve the plan.

The massive expansion of St. Jude will come over a six year period, according to Dr. James R. Downing, the hospital’s chief executive officer. It will require more than $1 billion in construction on its campus in Downtown Memphis and add 2,000 employees to its workforce, increasing the total number to 7,400.

The expanded campus will allow St. Jude to increase the number of new pediatric cancer patients treated by almost 20 percent, from about 500 to 600 and double the number of patients enrolled in St. Jude clinical trials testing treatments world-wide.

“By increasing the number of patients that are enrolled in those clinical trials, we can complete them in shorter periods of time, accelerate progress and then design the next trial to accelerate progress,” Downing said.

The Methodist Healthcare Board of Directors last month approved a plan to

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file a certificate of need (CON) for a master campus plan for Methodist University Hospital, the healthcare system’s flagship hospital and the region’s academic medical center. The plan, set for CON filing in February, will modernize the hospital, enhance the patient-and-family centered care experience and relocate services to improve patient flow.

The Expansion includes a

440,000-square-foot addition which will create space to upgrade services within the hospital, as well as provide new medical technology. The upgrade of services includes oncology, transplant and outpatient programs into a new centralized area and will increase efficiency for medical staff, patients and visitors.

The project includes the addition of a 700-space parking garage, which will in-

crease campus parking by more than 100 spaces. Because this structure does not require state approval, it is set to break ground next month.

If the CON is approved by the State Health Services and Development Agency, construction for the entire campus plan could begin in fall 2016 and is expected to take more than three years to complete.

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GrandRounds Yehoshua Levine, MD, Joins Arrhythmia Consultants, P.C. Yehoshua (Shu) Levine, MD has joined Arrhythmia Consultants, P.C. Levine specializes in electrophysiology services and is board certified in Internal Medicine and Cardiovascular Disease. He earned his medical degree from Harvard Medical School and completed his residency Dr. Shu Levine in Internal Medicine at Massachusetts General Hospital. He also completed residencies in Cardiology and Cardiac Electrophysiology at Beth Israel Deaconess Medical Center.

Levine is a member of the American Heart Association and Heart Rhythm Society.

Rhea Seddon, MD, Former Astronaut and UTHSC Grad, Inducted into Hall of Fame

Former astronaut Rhea Seddon, MD, a graduate of the College of Medicine at the University of Tennessee Health Science Center (UTHSC), has been inducted into the Tennessee Women’s Hall of Fame.

Dr. Rhea Founded in 2010, the Seddon Tennessee Women’s Hall

of Fame has honored the achievements of women who have contributed to the cultural, economic and political well-being of Tennessee.

In 1975, Seddon was one of the first women accepted into the general surgery residency at UTHSC. She was one of the first six female astronaut candidates selected by NASA in January 1978. She became an astronaut in August 1979 and went on to spend 19 years with NASA, completing three space shuttle flights (’85, ’91, ’93), and logging a total of 30 days in space.

After her career with NASA, Dr. Seddon spent 11 years serving as the assistant chief medical officer at the Vanderbilt Medical Group in Nashville.

West Cancer Center Opens East Campus Facility West Cancer Center marked the Grand Opening of its East Campus facility with a November ribbon cutting ceremony.

The 123,000-square-foot facility at 7945 Wolf River Blvd. combines many of West’s physicians and researchers all under one roof. For the first time, patients now have access to multispecialty services, including medical, surgical, diagnostic and radiation oncology, in addition to West’s clinical research program, at one location.

Hospital officials said new facility is a tangible result of an innovative partnership between Methodist Healthcare, the University of Tennessee Health Science Center, and West Clinic, which came together in January 2012 to form West Cancer Center.

The accreditation includes a consultative, peer review survey process lasting for two days and includes a review of policies, procedures, guidelines, practices and interviews.

Regional One Rehabilitation Earns CARF Accreditation

Ian Gaillard, MD, has joined Methodist Healthcare. He specializes in gastroenterology with areas of interest that include gastro esophageal reflux disease, liver diseases, interpretation of abnormal liver enzymes, and colon cancer screening.

Gaillard earned his undergraduate degree from Morehouse College and received his medical degree from Howard University College of Medicine. He completed his internship and residency at Penn State University and completed a fellowship in Gastroenterology at the Howard University Hospital.

His practice is at 3725 Champion Hills Drive, Suite 2000.

Regional One Health Rehabilitation Hospital recently completed a successful survey to continue its accreditation status with CARF (Commission on Accreditation of Rehabilitation Facilities).

The Rehabilitation Hospital has been CARF-accredited since opening in 2006 and now has been accredited for three more years for the following programs: Inpatient Rehabilitation Programs – Hospital (Adults) and Inpatient Rehabilitation Programs – Hospital (Children and Adolescents). The Rehabilitation Hospital is a 30-bed inpatient hospital providing comprehensive medical rehabilitation services for adults and adolescents. Common diagnoses and conditions admitted include strokes, amputations, burns, brain injury, spinal cord injury and multiple orthopedic traumas.

CARF is an independent organization that establishes standards and monitors conformance in rehabilitation and other health and human services areas.

Ian Gaillard, MD, Joins Methodist Healthcare

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Research Led by Memphis Physician May Lead to New Obesity Treatments A study led by Joan C. Han, MD, an associate professor in the Department of Pediatrics at the University of Tennessee Health Science Center (UTHSC) and founding director of the UT-Le Bonheur Pediatric Obesity Program, may lead to new approaches Dr. Joan C. Han for the prevention and

treatment of obesity based on individual genetic characteristics.

The study, funded by the Intramural Research Program of the National Institutes of Health (NIH) and published in the online issue of the journal Cell Reports, identified a natural variation in the brain-derived neurotropic factor (BDNF) gene. Previously linked to obesity, BDNF is known to influence the feeling of fullness, thereby regulating appetite.

The genetic variation reduces levels of BDNF, blocking feelings of satiety, and

thus may lead to obesity. The investigators analyzed brain tissue samples from cadavers to identify the variation.

They then studied BDNF in four groups of people enrolled in national clinical research studies. The results confirmed the variation is linked to obesity, and occurs across the population, but tends to occur more frequently in African Americans and Hispanics.

The study authors suggest that boosting BDNF levels may serve as a therapy for those with the genetic variation.

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