UAB School of Medicine Annual Report 2017 by UAB School of Medicine

ANNUAL REPORT

2017

opportunity responsibility impact

The University of Alabama at Birmingham

“

NO GREATER OPPORTUNITY, RESPONSIBILITY, OR OBLIGATION CAN FALL TO THE LOT OF A HUMAN BEING THAN TO BECOME A PHYSICIAN.”

– Tinsley Harrison, M.D.

HIS STATEMENT FROM ONE

of our school’s most illustrious former leaders may refer specifically to the physician’s profession, but the sentiment behind it applies equally across all our mission areas. Our goals are to seize every available opportunity and to not simply meet but exceed our responsibilities, from providing world-class

Tinsley Harrison, M.D., is most widely remembered as the founding editor and editor-in-chief of the

clinical care for one of the country’s most diverse patient

first five editions of

populations, to training the next generation of physician and

Harrison’s Principles of

scientist leaders, to advancing biomedical research to relieve

Internal Medicine. First

suffering and transform human health.

published in 1950—the

Ultimately, everything we do is about creating change for the better, in our patients’ lives, in

same year Harrison

our local community, and in the places our efforts and expertise touch across the globe. We aim for

returned to Alabama to

impact, especially in areas where positive change is not merely wished for but urgently needed.

become the second dean

In the following pages, you’ll encounter a sample of our programs in areas of expanding opportunity, including in precision medicine, cystic fibrosis research, and the microbiome. Our responsibility as the premier medical training institution in a state with unique health challenges is highlighted in stories about changes to our medical education programs; our efforts to enhance diversity among students and faculty and improve health equity for our patients and the health care system at large; and our multipronged approach to understanding and treating obesity, a complex disease that is especially prevalent in the South. We also shine a light on programs in areas where change is urgently needed and we are uniquely positioned and qualified to help, from the growing crisis in access to primary care and rural care to the devastating wave of opioid addiction that is sweeping the nation. There are many more examples of UAB programs that are probing the boundaries of the

of the Medical College of Alabama (now the UAB School of Medicine) and chair of the Department of Medicine—the textbook has been reprinted 16 times and translated into 14 different languages. It remains the most-used

known and the possible, and where our faculty and trainees are building new models of care for

and best-selling internal

the communities we are honored to serve. I am inspired by the commitment to care and innovation

medicine textbook in

I see around me every day at the UAB School of Medicine—I hope you will be, too.

the world.

Sincerely,

Selwyn M. Vickers, M.D., FACS Senior Vice President for Medicine and Dean James C. Lee Endowed Chair

contents OPPORTUNITY

6 10 12

Precision Medicine Revolution

How genomic science is driving research and transforming care

The Road to a Cure

Gut Instincts

UAB scientists are breathing new air into lung disease research Unlocking secrets of the microbiome

RESPONSIBILITY

16 19 24

Adapting for the Future

Changes in medical education and resident training keep UAB at the forefront

Excellence through Equity

Diversity and inclusion are integral to improving health care

Overcoming Obesity

Experts confront a growing problem with innovation, skill, and compassion

IMPACT

30 36

Expanding Access

Confronting a Crisis

Seeking solutions to strengthen primary care and rural health in Alabama How UAB physicians and researchers are stepping forward to combat the opioid epidemic

BY THE NUMBERS

42 46 48 50

Philanthropy Notes

Facts & Figures

Financials & Funding

Leadership & Organization

10 12

oppo opportunity noun | op•por•tu•ni•ty 1: a favorable juncture of circumstances 2: a good chance for advancement or progress Great leaps forward in medicine happen when the right people come together in the right place at a moment in history when necessary advancements in knowledge and technology converge. UAB innovators are seizing opportunities to grow our programs in some of the most important areas of biomedical research today, and in doing so are transforming the treatment landscape for a wide range of diseases and bringing new hope to patients.

UAB SCHOOL OF MEDICINE

ortunity

OPPORTUNITY

Left to right: Matt Might and Bruce Korf are ushering in a new era of precision medicine at UAB.

UAB SCHOOL OF MEDICINE

OPPORTUNITY

Precision Medicine Revolution How genomic science is driving research and transforming care

AST YEAR PROVED TO BE A

turning point in precision medicine at the School of Medicine. In one of the most important developments, Matt Might, Ph.D., was named the inaugural director of UAB’s Hugh Kaul Precision Medicine Institute. Might’s personal quest to help his son Bertrand, who was born with an ultra-rare genetic disorder, started him on the path to becoming a leader in precision medicine. “Bertrand was the first human diagnosed with the missing NGLY1 gene and have it linked to a disease,” Might says. “Our son was literally patient zero. The question then became, what do we do with that information? We now know the exact molecular cause of this disease; can we treat it?” Might’s background in computer science informs his precision medicine perspective, which he defines as the use of data (particularly genomic data) to optimize health care outcomes by giving each patient the right treatment in the right dosage at the right time. His interests encompass novel drug development, especially “de-risking” drug development for rare diseases in order to attract the attention of pharmaceutical companies, and drug repurposing. “We’ve established a blueprint of how we can use precision medicine to go from disease discovery to therapeutic identification within one year,” Might says. “We’ve brought this blueprint to UAB and are scaling it up in a really big way.” Might previously held an appointment with the White House Precision Medicine Initiative, which he joined in 2016 at the invitation of former President Barack Obama. Since coming to UAB, he has been busy building collaborations among experts in a variety of specialties. Although he says his initial focus is in rare diseases and cancer, he has set his sights on exploring the promise of precision medicine in more common and chronic diseases, such as depression and heart disease. For Might, this endeavor began with one special patient. Now, he believes precision medicine will transform the world of medicine and UAB will be at the forefront of this revolution. He looks forward to collaborating with UAB’s Comprehensive Cancer Center, Informatics Institute, Center for Genomic Medicine, and Undiagnosed Diseases Program, among others, as well as partner with organizations like Southern Research and HudsonAlpha Institute for Biotechnology.

“UAB is a place where we can do it all right here,” says Might. “We can take a patient, do deep analysis of their genome, and find the right drug for them. Moreover, UAB leaders are making substantial commitments to make precision medicine a reality for patients in Alabama much sooner than it will be a reality anywhere else in the country.”

GENOME EXPLORER

One of Might’s most frequent collaborators is Bruce Korf, M.D., Ph.D., director of UAB’s Undiagnosed Diseases Program and holder of the Wayne H. and Sara Crews Finley Chair in Medical Genetics in the Department of Genetics. Korf’s key role in expanding access to genome sequencing at UAB was recognized last year with the announcement that he has been named UAB Medicine’s first chief genomics officer. In the past year, Korf has been instrumental in launching two population-based precision medicine research programs at UAB. The Alabama Genomic Health Initiative, which Korf co-directs, is one of the nation’s first statewide efforts to harness the power of genomic analysis to identify those at high risk for genetic disease. A state of Alabama-funded partnership between UAB and HudsonAlpha Institute for Biotechnology, the AGHI is recruiting a diverse group of participants across the state for whom it is providing genomic analysis and interpretation free of charge. The majority of AGHI participants undergo a genotyping array test, which assesses 650,000 genetic markers to look for variants in 59 specific genes that are known to contribute to disease and for which the potential for prevention or treatment exists. Participants who test positive for one of the 59 genes may consent to receive that information through genetic counseling and have it shared with their primary medical providers. A second, smaller group of participants receive whole genome sequencing in an effort to identify an underlying genetic cause for serious medical problems. Participants can also consent to have their genomic information and DNA be stored in a biobank and database for future research use, and information from medical records may be used to study correlations of genetic information with health status. In 2017, UAB also joined a growing network tasked with implementing the National Institutes of Health’s All of Us Research Program, a nationwide effort to advance research into precision medicine. Thanks to a one-year, $4.1 million grant,

ANNUAL REPORT 2017

OPPORTUNITY UAB is now the hub of the Southern All of Us Network, which includes sites in Birmingham, Huntsville, Tuscaloosa, Selma, Montgomery, and Mobile in Alabama, as well as in Jackson, Mississippi, and New Orleans. The All of Us Research Program’s aim is to gather data, including clinical information and “omics” testing (i.e., genomics, proteomics, etc.) from more than 1 million Americans, with the ultimate goal of accelerating research and improving health. Researchers will use the data for studies on a variety of health conditions to learn more about the impact of individual differences in lifestyle, environment, and biological makeup. “Our involvement in All of Us builds on our experience in recruitment and engagement of the population gained from AGHI,” says Korf. “It provides a chance for people in our region to participate in an exciting national initiative that is intended to provide new insights into the prevention, diagnosis, and management of diseases across the nation.”

TARGETING CANCER

Research has shown the best treatment for a cancer can be more dependent on a patient’s genetic makeup than the tumor’s location in the body. As our understanding of the role genes play in cancer development and treatment response grows, so too does the hope for precision medicine breakthroughs in cancer. UAB has joined several major trials that seek to provide cancer patients with the best approved therapies or clinical trial drugs based on the tumors’ genomic profiles. With this participation comes expanded opportunities for cancer patients to receive genomic profiling of their tumors—which is not typically covered by insurance and can cost about $4,000 per test—at no cost. The National Cancer Institute Molecular Analysis for Therapy Choice (NCI-MATCH) trial is among the largest, most scientifically rigorous precision medicine cancer trials to date. The study seeks to demonstrate that matching certain drugs or drug combinations in adults whose tumors have specific gene abnormalities will effectively treat their cancer, regardless of its type. The drugs included in the trial have either been approved by the U.S. Food and Drug Administration (FDA) for another cancer or are still being tested in other clinical trials but have shown some effectiveness against tumors with a particular genetic change. More than 1,100 academic cancer centers and community hospitals are taking part in the study. In June, ECOG-ACRIN Cancer Research Group, which is leading the trial, announced

UAB SCHOOL OF MEDICINE

Eddy Yang is leading UAB’s participation in several important trials to better target cancer through genome sequencing of tumors.

that it had reached its goal of sequencing the tumors of 6,000 patients, nearly two years sooner than anticipated. “This type of clinical trial is very broad in nature, and the information we learn from it can save countless lives,” says Carla Falkson, M.D., professor in the UAB Division of Hematology and Oncology and principal investigator for the trial. Under the leadership of Eddy Yang, M.D., Ph.D., UAB has also joined the Targeted Agent and Profiling Utilization Registry (TAPUR) Study, the first clinical trial conducted by the American Society of Clinical Oncology Inc. Yang is professor and vice chair for translational science in the UAB Department of Radiation Oncology and holder of the ROAR Southeast Cancer Foundation Endowed Chair in Radiation Oncology. He also serves as deputy director of the UAB Hugh Kaul Precision Medicine Institute. As with the NCI-MATCH trial, all drugs used in the TAPUR Study are approved by the FDA for the treatment of specific types of cancer, and the study is researching whether those drugs might effectively treat other types of cancer with similar gene abnormalities as well. Another study UAB joined in 2017, the Strata Trial, seeks to solve a major obstacle in the precision oncology clinical trials paradigm. There are currently hundreds of ongoing studies enrolling genetically defined patient populations. But because most patients do not undergo routine tumor genome sequencing, they don’t know about their eligibility for such

OPPORTUNITY

UAB has joined several major trials that seek to provide cancer patients with the best approved therapies or clinical trial drugs based on the tumors’ genomic profiles. With this participation comes expanded opportunities for cancer patients to receive genomic profiling of their tumors—which is typically not covered by insurance and can cost about $4,000 per test—at no cost.

studies, while researchers and trial sponsors struggle to fully enroll the clinical trials. The goals of the Strata Trial are to dramatically expand patient access to tumor sequencing and precision medicine trials and to accelerate the approval of breakthrough cancer therapies. The study provides tumor sequencing to all eligible cancer patients at no cost and matches patients to Strata’s portfolio of affiliated pharma-sponsored clinical trials. Strata plans to sequence 100,000 patients over the course of the study. Although not all patients who have their profiling done match to a clinical trial, Yang notes obtaining the information is crucial. “Perhaps the most important key in this groundbreaking effort is that the physicians and the patients will be equipped with genomic information about the cancer sooner,” says Yang. “That can go a long way.” Genetic data gathered as part of the Strata Trial will be made available for future research projects, meaning researchers everywhere will benefit from UAB’s unique advantages. “We serve an ethnically diverse population, and research in a lot of other places often doesn’t capture that diversity,” says Yang.

UAB Molecular Tumor

Board established in

2013

When it comes to precision medicine, diversity is critical—by studying genes or cancer progression in only one uniform population, results become skewed and cannot be applied to a broader population.

LEADING THE CHARGE

Along with the growing influence of precision medicine, UAB’s cancer programs entered a new era in 2017 when Michael Birrer, M.D., Ph.D., a leading medical oncologist and trailblazer in the early detection and treatment of gynecologic cancers, became director of the UAB Comprehensive Cancer Center. Birrer previously served as director of Medical Gynecologic Oncology and director of the Gynecologic Cancer Research Program at the Gillette Cancer Center at Massachusetts General Hospital. He also served as the leader of the Dana Farber/Harvard Cancer Center program in gynecologic cancers and a professor of medicine at Harvard Medical School. “Mike Birrer understands drivers for excellence in clinical care and has a vision for growing precision medicine in cancer care, as well as a well-established commitment to fundamental scientific discovery,” says Selwyn Vickers, M.D., FACS, senior vice president for medicine and dean of the School of Medicine. “His strategy in moving cancer research from bench to bedside and back to the bench is also a fundamental element of our Cancer Center’s mission to provide the highest-quality cancer care while advancing our understanding of cancer and translating that knowledge into better prevention, detection, and treatment.” Birrer’s vision for the Comprehensive Cancer Center also incorporates expanding the reach of the center to help patients in underserved areas across the Southeast. “These are areas where the quality and type of outstanding cancer care that UAB is known for would be established, and then populations of people in these areas who may never see a clinical trial would have access to these terrific drugs,” says Birrer. “It would expand the scope of the Cancer Center, but more importantly it would better cover the Deep South where we have a lot of underserved patients.” – Jane Longshore, Kendra Carter, Cary Estes, Emily Henagan, Bob Shepard, Sarah C.P. Williams

230

To date

400+

MTB cases reviewed cancer patients sequenced through October 2017 through the Strata Trial

ANNUAL REPORT 2017

OPPORTUNITY Steven Rowe’s cystic fibrosis research has contributed to significant breakthroughs in dealing with the disease.

In 1989, cystic fibrosis became the first disease linked to a gene. Researchers discovered that all patients with cystic fibrosis had mutations in a gene called CFTR and speculated that a cure—reversing the error in CFTR—would come quickly. But over the years, the story got more complex; much-hyped gene therapy did not come to fruition, and scientists discovered there are nearly 2,000 different mutations that can affect the CFTR protein in different ways. Slowly, studies started to show how CFTR worked: The gene encodes a channel that normally moves molecules from inside airway cells to the surrounding lining, which includes a layer of mucus. When CFTR is mutated, this transport of molecules is defective and mucus is thick and sticky, including in the lungs and gastrointestinal tract. As a result, patients have trouble breathing, persistent lung infections, and digestive problems, and the majority of men suffer from infertility. Despite this initial understanding of disease, more research on how each mutation affects the CFTR channel was still needed. “Up until about five years ago, the treatment was entirely toward the symptoms of the disease instead of treating the underlying defect,” says Rowe. “Patients’ disease was still progressing, and they were still spending lots of time in the hospital with difficult-to-treat exacerbations.”

The Road to a Cure UAB scientists are breathing new air into lung disease research

FEW DECADES AGO, MOST

people with cystic fibrosis only survived into their teens or early 20s. Today, the majority of patients are living into their 30s, 40s, and even longer, and research on the disease is barreling forward faster than ever. This year, UAB researchers conducted both basic research and clinical studies that are helping pave the way for the next generation of cystic fibrosis drugs. “We have the cure in our sights,” says Steven Rowe, M.D., professor in the Division Pulmonary, Allergy and Critical Care Medicine, director of the Gregory Fleming James Cystic Fibrosis Research Center, and holder of the Nancy R. and Eugene C. Gwaltney Family Endowed Chair in Medical Research. “We understand so much more about the disease than we ever have, and we are starting to see very effective therapies—including the ones we’re studying—enter routine care.”

UAB SCHOOL OF MEDICINE

A NEW CLASS OF DRUGS

This May, Vertex Pharmaceuticals announced the results of phase 2 and phase 3 trials of a drug combination—tezacaftor (VX-661) and ivacaftor (VX-770)—based in part on data collected at UAB by Rowe and his colleagues. Ivacaftor, Rowe explains, was previously approved for use in cystic fibrosis as a potentiator, as it helps keep the CFTR channel open for proper transport of molecules in and out of cells. But tezacaftor, a member of a different class of drugs called correctors, helps the cell properly make the channel in the first place. This is important, since CFTR channels that are not processed correctly can be eliminated by the cell so that they are not available for normal cell functioning.

OPPORTUNITY The studies found between a 4- and 7-percent improvement in lung function with the new tezacaftor/ ivacaftor combination, depending on a patient’s particular new cases of CFTR mutation. Moreover, the CF diagnosed each year improvement lasted throughout the treatment. “It was a very successful trial,” says Rowe. “We extended the number of patients who can benefit from ivacaftor alone and in combination with tezacaftor.” Still, he added, the challenge of coaxing cells with certain CFTR mutations to properly make CFTR channels is a difficult one, and tezacaftor with ivacaftor didn’t work in all cases. In July, though, came even more exciting results: Combining new corrector drugs with tezacaftor and ivacaftor led to an even better response and was effective in 90 percent of cystic fibrosis patients, whatever their CFTR mutation. “This was a huge response in a broad array of CF patients,” says Rowe.

30,000 people living with CF in the U.S.

1,000

PRECISION MEDICINE LEADS THE WAY Rowe and his colleagues at the Cystic Fibrosis Research Center are now continuing work to see how to best match a patient’s particular CFTR mutation with the right combination of drugs to treat him or her. While it is easy to study the most common CFTR mutations in large clinical trials, there are hundreds of mutations so rare that trials cannot be launched to study drugs for each one. Instead, Rowe imagines cells being collected from cystic fibrosis patients and studied in the lab. “You can test in a test tube which drug or drug combination works best and even what dose is best,” he says. “This will be ultra-precision medicine.” Rowe and others at UAB are also working toward other kinds of treatments for cystic fibrosis, including drugs to make mucus less sticky and, ultimately, drugs that can completely reverse the genetic mutations in the CFTR gene. In February, Rowe was awarded a $6.5 million Emerging Investigator R35 grant from the National Heart, Lung and Blood Institute (NHLBI) to help with this work. “These medicines are really good, but they’re not a one-time cure,” says Rowe. But he notes that UAB is a great place to be doing research to get closer to a cure. “We have an enormously talented group of investigators doing everything from basic research to screening drugs to working directly with patients,” says Rowe.

CALMING THE IMMUNE SYSTEM

In the basic science realm, J. Edwin Blalock, Ph.D., professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and holder of the Nancy E. Dunlap, M.D., Endowed Chair in Pulmonary Diseases, also received a R35 from the NHLBI this year. He received a $6.14 million Outstanding Investigator grant, which could one day lead to new treatments for cystic fibrosis. Blalock studies how the immune system interacts with the lungs in diseases ranging from chronic obstructive pulmonary disorder (COPD) to cystic fibrosis. Recently, his research has focused on neutrophils, cells that normally respond to bacterial infections. But in chronic inflammatory diseases, neutrophils are often activated even in the absence of an infection. “Neutrophils are a double-edged sword,” says Blalock. “We can’t live without them because they keep us from dying of a bacterial infection. But if they go overboard, it leads to chronic inflammation.” Blalock has discovered that neutrophils—when they’re activated and break down the collagen in the lungs—produce a molecule called PGP. Levels of PGP in patients with COPD or cystic fibrosis can be used as a marker of degree of inflammation. “We think that PGP may help us predict oncoming exacerbations,” says Blalock. “It also might help us track if a therapy is working.” His new grant will also let him focus attention on exosomes—small sacs that are released when neutrophils are activated. Inside the exosomes are molecules that help break down proteins, such J. Edwin Blalock as those that are deconstructed to make PGP. Stopping these exosomes from breaking down lung tissue could help ease the inflammation associated with COPD and cystic fibrosis. “What we’re doing is describing a fundamentally new mechanism of tissue damage involving neutrophilic exosomes,” says Blalock. “Although we’re using COPD as our model for now, we expect that anything we learn about how we can manipulate these exosomes will be beneficial in cystic fibrosis as well.” – Sarah C.P. Williams, Tyler Greer, Jeff Hansen, Viktoria Havasi, Bob Shepard

ANNUAL REPORT 2017

OPPORTUNITY

Gut Instincts

Haydeh Payami is studying how Parkinson’s disease and medications that treat it affect the microbiome.

Unlocking secrets of the microbiome

RILLIONS OF BACTERIA HAVE

made themselves right at home in and on your body. They line your digestive tract, burrow in your skin, and reproduce all along your airways. Some of these microbes are passive passengers along for the ride in your body, but many actually help keep you healthy, warding off disease-causing bacteria. However, others may interact with the immune system in ways that can contribute to a surprising range of conditions, from asthma and allergies to cardiovascular disease and obesity. “It was only recently that we started realizing the monumental importance of the microbiome in human health,” says Haydeh Payami, Ph.D., a professor in the Department of Neurology and the holder of the John T. and Juanelle D. Strain Endowed Chair in Neurology.

UAB SCHOOL OF MEDICINE

At UAB, researchers including Payami are now studying how the microbiome may be involved in disease processes and how clinicians can alter it to treat and prevent these diseases.

A PATHWAY TO PARKINSON’S

Last year, Payami reported that Parkinson’s disease and medications used to treat Parkinson’s have distinct effects on the makeup of the microbiome. “We’ve known for a long time that Parkinson’s symptoms include constipation and inflammation in the gut,” says Payami. “So we wondered if the gut microbiome was involved.” While the link seems far-fetched, scientists already know from studying other diseases that there is an ongoing interplay between the nervous system of the gut and the rest of the body, including the brain. In her new study, published last February in the journal Movement Disorders, Payami and her colleagues studied stool samples from 197 patients with Parkinson’s and 130 healthy

OPPORTUNITY

“ The beauty of the microbiome, from a translational perspective, is that it can be easily altered. Once we identify specific organisms that play a role, we may be able to prevent disease or develop more effective treatments than we have now.” – HAYDEH PAYAMI

controls. Bacterial DNA from each sample was sequenced to tease out which microbes were living in the patients’ guts. The guts of the people with Parkinson’s showed different patterns of microbes, and distinct patterns also appeared based on which drugs patients took for their Parkinson’s. For now, Payami says it is difficult to differentiate which changes might precede the onset of Parkinson’s and which come after a patient has already begun treatment for the disease, but she is planning studies to learn more. “I want to find the bugs that are involved in causing disease and the bugs that are altered as a consequence of disease,” says Payami. “The beauty of the microbiome, from a translational perspective, is that it can be easily altered. Once we identify specific organisms that play a role, we may be able to prevent disease or develop more effective treatments than we have now.” The data also suggested people with Parkinson’s may have more bacteria that break down herbicides and pesticides compared to others. Since exposure to these chemicals has been linked to Parkinson’s before, the new study questions whether this association is mediated by the microbiome.

DONOR MICROBES TO THE RESCUE According to a 2015 study by the Centers for Disease Control and Prevention, Clostridium difficile infection (CDI)—which can cause persistent diarrhea and other digestive problems—has become the most common microbial cause of health care-associated infections in U.S. hospitals, causing almost half a million infections in a single year. It costs up to $4.8 billion each year in excess health care spending for acute care facilities alone, while total annual CDI-attributable cost in the U.S. is an estimated $6.3 billion. Worse still, the study found that one out of every 11 patients aged 65 or older with a health care-associated C. difficile infection died within 30 days of diagnosis.

Left to right: Casey Morrow, Elliot Lefkowitz, Ranjit Kumar, and Martin Rodriguez used a new technology to study the exact composition of patients’ microbiomes after fecal microbe transplants.

Antibiotics have traditionally been prescribed to treat “C. diff,” but the infection returns in about 20 percent of patients. Fortunately, when it comes to altering the microbiome to cure disease, nothing has proven more successful in treating recurrent CDI than fecal microbe transplants (FMTs). The method involves transplanting a tiny sample of a healthy person’s microbiome into the gut of another person with C. diff to help restore a healthy balance of microbes. In recurrent C. diff infections, FMTs are a successful treatment around 90 percent of the time—more often than antibiotics—but research on exactly why the transplants work so well has been sparse. This year, a UAB team including Ranjit Kumar, Ph.D., Elliot Lefkowitz, Ph.D., Martin Rodriguez, M.D., and Casey Morrow, Ph.D., used a new technology to study the exact composition of patients’ microbiomes after FMTs. To detect the fates of donor microbial strains in recipients, the researchers and their UAB colleagues developed a method that uses detection of single nucleotide variations in microbial genomes—in combination with a new bioinformatics algorithm—to identify related microbes. “It essentially is a personalized microbiome ‘fingerprint,’” says Lefkowitz, research scientist in the UAB Center for Clinical and Translational Science Biomedical Informatics Component. They found that strains of bacteria from fecal donors persisted in the guts of the recipients for many months—as long as two years after a transplant in some cases. The finding, as well as the new technology itself, will likely enable more detailed future research into how to alter people’s gut microbiomes for the benefit of health. – Sarah C.P. Williams, Jeff Hansen, Bob Shepard

ANNUAL REPORT 2017

respon responsibility noun |

re•spon•si•bil•i•ty

1: the quality or state of being responsible: such as a: moral, legal, or mental accountability b: reliability, trustworthiness

Upholding our responsibilities as Alabama’s premier medical training site, biomedical research hub, and top-ranked health care provider isn’t a burden—it’s an honor. In addition to fulfilling our inherent duties, UAB is using our unique assets to tackle issues that disproportionately affect the health of our community and our region.

UAB SCHOOL OF MEDICINE

OPPORTUNITY

nsibility

ANNUAL REPORT 2017

OPPORTUNITY

UAB SCHOOL OF MEDICINE

RESPONSIBILITY

Adapting for the Future Changes in medical education and resident training keep UAB at the forefront

F YOU PLACE PHYSICIANS WHO ATTENDED

medical school 20, 10, or even five years ago into a classroom today, chances are they will observe significant differences from the training they received. The Association of American Medical Colleges notes these changes are largely due to shifts in demographics, science, and federal policies that have had a major impact on health care. The phenomenon of medical training constantly evolving, it asserts, will continue. UAB is staying ahead of the curve in medical education with innovative approaches, including in a bedrock part of the curriculum, human anatomy training. The traditional semester of in-depth anatomy training has always given medical students a strong foundation, but it was often hard for them to retain that knowledge throughout medical school. Now, human anatomy is taught in sections that correspond with organ system-based learning modules to improve knowledge retention and content integration. “When students study respiratory health, they dissect the chest cavity. When they study reproductive health, they dissect the pelvic area,” says Craig Hoesley, M.D., senior associate dean for medical education and chair of the Department of Medical Education. “This way they are revisiting anatomy periodically, which gives them a more well-rounded education in it.” UAB’s anatomy training is now taught through lectures, team-based learning activities, and cadaveric dissections. “Many medical schools, including UAB, have integrated anatomy with other disciplines into organ system-based curricula,” says William Brooks, Ph.D., associate professor in the Department of Cell, Developmental and Integrative Biology and director of the Gross Anatomy Lab and Surgical Anatomy Lab. “With these changes, anatomy as a discipline is integrated with physiology, histology, and pathology.”

MORE THAN SKIN DEEP

The collaboration between anatomy and pathology was recently strengthened thanks to a UAB Faculty Development Grant that was awarded to Daniel Atherton, M.D., an assistant professor in the Department of Pathology, and Peter Anderson, DVM, Ph.D., a professor in the Department of Pathology. Atherton says pathology is being incorporated in anatomy training more than ever. “The new chair of the pathology department, Dr. George Netto, has emphasized UAB’s potential to be at the helm on many fronts, including with the use of innovative teaching methods,” he says.

ANNUAL REPORT 2017

RESPONSIBILITY “This project really helps students see how pathology integrates into other subspecialties. We’re helping students appreciate just how integral pathology is in the overall process by which many patients are diagnosed and ultimately treated.” While pathologists provide instruction throughout medical school, Atherton notes that this project is particularly focused on integrating pathology in the actual anatomy lab. First-year medical students perform dissections on different organs in the cadaver lab, and then they look at the anatomy and different tissues in the body with a pathologist present. “Our project focuses on helping the students interpret some of the things they are seeing, especially if they come across abnormal pieces of tissue,” says Atherton. “As a pathologist in the anatomy lab, I point out an abnormality and help the students take a biopsy of it. Then we actually send it through the pathology lab, where the results are turned into slides that students can examine.” With this integration, students receive an early education in general histology—the science of how tissue looks under the microscope—which hopefully increases their understanding of and comfort with the workings of the pathology lab.

A PLACE TO BE HEARD

Another key area in which our students receive an early education is physician wellness. In 2014, the School of Medicine launched 11 Learning Communities—small groups aimed at fostering interpersonal relationships between students from all four classes and their faculty mentors—to help equip medical students to be healthy physician leaders one day. A “Cases and Conversations” series for third- and fourth-year medical students was recently incorporated into the Learning Communities. The series provides a safe space for students to share the experiences and challenges they encounter during their clinical rotations. “We actually started Cases and Conversations in 2015 as an informal, voluntary monthly session for third-year and fourth-year medical students to share their experiences,” says Caroline Harada, M.D., assistant dean of community engaged scholarship and associate professor in the UAB Division of Gerontology, Geriatrics, and Palliative Care. “We felt that it was such an important model that this past year we added it to our Learning Communities curriculum to help students build critical reflection skills.” The topics discussed involve everything from dealing with stress to handling their first patient death to learning how to elicit constructive feedback from attending physicians. “Students are given a theme and asked to first write a reflection about that theme and then share their stories with their peers during the Learning Community meeting,” says Harada. “It is a meaningful opportunity for them to reflect on their experiences and realize they aren’t alone. We think it will make them better physicians.”

UAB SCHOOL OF MEDICINE

STEERING THE SHIP

Not only is the School of Medicine training more mentally and emotionally well-equipped physicians, but it also has appointed two new leaders to steer the school’s admissions and graduate medical education (GME) programs. Christina Grabowski, Ph.D., who joined UAB as the new associate dean of admissions and enrollment management from the Oakland University William Beaumont School of Medicine in Rochester, Michigan, is an expert in holistic medical school admissions—a method in which admissions committees consider an applicant’s resiliency, listening skills, personal life experiences, and a host of other attributes in addition to more traditional measures like MCAT scores and grade point averages. “Sometimes people think there is only one set of admissions criteria and everyone has to meet a cookie-cutter profile,” says Grabowski. “That’s not what holistic review is. It’s the individual consideration of an applicant and how that person can contribute to the learning environment as well as the workforce. We want a diverse student body and workforce, because one type of doctor doesn’t meet all health care needs.” And it does not end at the student level. Residents and fellows must also represent a diverse range of backgrounds to better meet patients’ needs. As the new associate dean for graduate medical education, Alice Goepfert, M.D., helps ensure UAB’s residents and fellows are best equipped for their soon-to-be roles as full-time physicians. “We’re looking at how we can help them balance their professional and personal lives by developing physician wellness initiatives,” says Goepfert. “We’re also working on implementing more infrastructure for research in quality improvement, as well as learning how we can offer training in health care policy, advocacy, and the business aspects of medicine. Everything is done with the goal to continue to provide our future generation of physician leaders with the highest-quality and most supportive clinical training possible.” – Emily Henagan, Kendra Carter, Nancy Mann Jackson, Gail Allyn Short

“Holistic review is the individual consideration of an applicant and how that person can contribute to the learning environment as well as the workforce. We want a diverse student body, because having one type of doctor doesn’t meet all health care needs.”

—CHRISTINA GRABOWSKI

OPPORTUNITY

Excellence Through Equity Diversity and inclusion are integral to improving health care

First-year medical student Farrah-Amoy Fullerton was born in Jamaica. She is the first in her family to attend medical school and hopes to become an OB/GYN.

ANNUAL REPORT 2017

RESPONSIBILITY

HE PURSUIT OF EXCELLENCE

is an ideal people have been chasing since the beginning of time. It is the benchmark by which all organizations, businesses, and schools are measured. For the UAB School of Medicine, promoting diversity and inclusion is paramount to achieving and maintaining overall excellence. “Diversity is vital to excellence,” asserts Selwyn Vickers, M.D., FACS, senior vice president for medicine and dean of the School of Medicine. “In order to attract the best people to an organization and have the best ideas within an organization rise to the top, an environment must exist that is inclusive and diverse. The goal is not a number, but a culture of acceptance. We owe it to our students, our faculty, our staff, and our patients to create, sustain, and nurture the most diverse, inclusive School of Medicine possible.” Through the Office for Diversity and Inclusion—which includes independent efforts focused on faculty, staff, trainees, and students, as well as collaborations with UAB Hospital and the UAB Health System—the school is working to interweave diversity and inclusion into its fabric. “One of the ways to grow in diversity and inclusion is to continually promote and discuss them to the point where they become part of the culture,” says Carlton Young, M.D., assistant dean for medical student diversity and inclusion, professor in the Department of Surgery, and director for Pancreas Transplantation at UAB Hospital. “I would love to one day not talk about it, but we’re not at that point yet. We’re constantly working to get the number of underrepresented minorities and women that we need to better serve the general population.”

AN INCLUSIVE ENVIRONMENT

Better serving our patients starts by training a more diverse generation of clinicians and biomedical researchers. Last fall, the School of Medicine welcomed 29 students from populations that are underrepresented in medicine (URiM) to its Class of 2021, the highest number of URiM students of any class in school history. It is also a 71-percent increase in URiM students over the previous year’s incoming class, which had 17 URiM students. This milestone is thanks in part to a partnership between the Office for Admissions and Enrollment Management and the Office for Diversity and Inclusion, Student Affairs to integrate efforts and have a more well-rounded approach that incorporates making regular recruiting visits to areas in Alabama that may have been previously overlooked. Another way the school is becoming more attractive to students who are underrepresented in medicine is through the creation of more minority scholarships, thanks in large part to the generous support of donors. Three new minority scholarships were established in 2017 alone: the Love Family Scholarship in Medicine, the V. Michael Bivins, M.D., Endowed Medical Scholarship, and the Capital City Medical Society Endowed Medical Scholarship.

UAB SCHOOL OF MEDICINE

When Ted Love, M.D., the president and CEO of Global Blood Therapeutics, became co-chair of the School of Medicine’s Board of Visitors, he witnessed firsthand the impact the school has on the community and why it is critical to offer opportunities to medical students who can use their unique experiences to better serve patients. “I think talent and potential are equally distributed across all races and gender, and the problem of underrepresentation is really about access,” says Love, who notes his own career would not have been possible without scholarship support. “Scholarships are critical in trying to balance the access equation.” V. Michael Bivins, M.D., a 1996 School of Medicine alumnus specializing in urology, established a scholarship to support

RESPONSIBILITY

Clockwise from left: The incoming class of medical students, pictured here at the 2017 White Coat Ceremony, includes the greatest number of students from populations that are underrepresented in medicine in the school’s history; the Health Equity Scholars program was created to help students understand and learn to address the complexities around health disparities; several new scholarships that support minority students were established in 2017, a critical part of our efforts to promote diversity and inclusion in our student body.

African-American students who need financial assistance. “Having been a student and knowing the challenges in resources that many students face, I wanted to do my part to give back,” says Bivins. “Most of the doctors in Alabama come from this medical school, and it would be great to recruit and keep a diverse group of medical professionals here.” Members of the Capital City Medical Society, a professional organization for African-American physicians in the Montgomery, Alabama, area, have been devoted to helping URiM students, and they began raising funds to create a School of Medicine scholarship three years ago. The scholarship will benefit third-year and fourth-year African-American medical students at the UAB Montgomery Regional Medical Campus.

“Just like the School of Medicine, the Capital City Medical Society believes in producing a physician workforce that reflects the communities in which those physicians are needed,”says Vickers. “We’re thankful for their dedicated service.” Vickers also notes that having a more diverse physician workforce can help reduce health care disparities.“We believe providing culturally competent health care is also key to reducing—and ultimately eliminating—a range of health care disparities among African-Americans, Hispanics, and other medically underserved populations,” he says. “To make a true and lasting impact on such disparities, we need those populations and communities represented in our classrooms, laboratories, clinics, and leadership ranks, and this year our school has taken a significant step forward in that regard.” One way the school is addressing health care disparities is through the creation of the Health Equity Scholars program (HES), which is designed to support and train students interested in careers working with vulnerable populations. The Robert Wood Johnson Foundation defines health equity as, “The absence of disadvantage to individuals and communities in health outcomes, access to health care, and quality of health care regardless of one’s race, gender, nationality, age, ethnicity, religion, and socioeconomic status.” The new four-year longitudinal program welcomed its first class of seven scholars from the Class of 2020 last year and will select an additional class of scholars from the Class of 2021 this winter. “What is unique about our program is that we are open to students interested in a wide variety of medical specialties,” says Caroline Harada, M.D., assistant dean of community engaged scholarship and associate professor in the UAB Division of Gerontology, Geriatrics, and Palliative Care. “We found that students who weren’t sure what specialty they wanted to enter still wanted to make a difference in their communities. This program has really helped our students deepen and extend their knowledge of the social determinants of health while also better serving the community. These students will be prepared for careers serving vulnerable populations, regardless of the specialties they choose.” Each HES student develops his or her own scholarly project that confronts a health inequity. The project can be traditional research, an education project, or even the creation of original materials for community outreach. Mobile native Hannah Hashimi’s project, Cooking Healthily on a Penny (CHOP), is one example. She recently coordinated a series of student-led cooking demonstrations at the East Lake Market that provided the farmer’s market patrons with low-cost, healthy recipes that were also flavorful and easy to prepare. “This project is teaching me how to listen to the community so that we can work together to influence choices and make those choices stick,” says Hashimi, who previously worked with people struggling with food insecurity and witnessed the negative effects on their health. “HES has highlighted how environment plays into a person’s health. Sometimes unpredictable barriers make it hard for a patient to accommodate a physician’s instructions, but this program has taught me how to realistically navigate those tough transitions early on to help spare extra cost.”

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TRANSLATING SCIENCE INTO BETTER HEALTH Last year, the UAB Minority Health and Health Disparities Research Center (MHRC) celebrated 15 years of groundbreaking work to understand, address, and reduce health disparities among ethnic and racial minorities. In 2002, when Mona Fouad, M.D., MPH, senior associate dean for diversity and inclusion and director of both the Division of Preventive Medicine and the MHRC, received NIH funding to investigate the differences in health and health outcomes among groups of people in the U.S., the term “health disparities” was largely unused. Fouad—together with MHRC co-directors Edward Partridge, M.D., and Vickers—has since worked tirelessly to establish the validity of health disparities as a scientific research priority. Last fall, Fouad’s key role in bringing health disparities to the forefront in medicine was recoginized when she was elected to the National Academy of Medicine, one of the highest honors given to a physician or scientist in the U.S. “In the MHRC’s early years, much of my time was spent convincing the scientific community that health disparities research was far more than community outreach; it was science,” explains Fouad. “We looked at the whole research continuum, from discovery to delivery.” The MHRC’s unique three-pillar approach—which combines research, training, and community engagement—has expanded health disparities research to an unprecedented extent, increased the number of researchers investigating minority health and health disparities, and helped build healthier communities. Their model, which relies on interdisciplinary collaboration, has been duplicated across the globe: It has been used to establish similar centers in the U.S., as well as in the United Kingdom. The MHRC is home to three of the NIH’s national Transdisciplinary Collaborative Centers. These centers, led by Fouad, Vickers, and former U.S. Surgeon General and School of Medicine alumna Regina Benjamin, M.D., all explore distinct and critical aspects of health disparities, race, and the social determinants of health. Among many other key findings, the MHRC’s research has discovered crucial linkages among race, gender, and cancer rates; uncovered connections between social determinants of health and poor health outcomes; examined the importance of geographic location; and studied the linkage between maternal health and the health of children. Since 2005, the MHRC has secured over $100 million in competitive federal awards, granted $6.18 million in pilot funding to 130 investigators, and leveraged their funds to generate $163 million in additional extramural funding. “The MHRC laid the foundation for the scientific exploration of health disparities in the United States,” says Vickers. “Their work will have implications for health disparities research for decades to come, not only in the United States but also around the globe.”

UAB SCHOOL OF MEDICINE

“The MHRC laid the foundation for the scientific exploration of health disparities in the United States. Their work will have implications for health disparities research for decades to come, not only in the United States but also around the globe.” —SELWYN VICKERS

INTENTIONAL EFFORT

Fouad also leads the Office for Diversity and Inclusion (ODI) and is focused on improving diversity and inclusion efforts within the school, which will ultimately help reduce or eliminate health disparities. Implicit bias—which the Kirwan Institute of The Ohio State University defines as the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner—is inherent to everyone. However, Fouad’s team is working to teach school leaders, faculty, and staff how they can acknowledge and understand their implicit biases. The ODI offers implicit bias training for faculty search committees and recently hosted a workshop about implicit bias for school leadership. Lenora Billings-Harris, a world-renowned expert on dealing with bias in the workplace, led the workshop. “Diversity is simply who is on the team,” says Billings-Harris. “Inclusion is who gets to play.” She also points out that the term “diversity” carries with it uncomfortable baggage because people often think of diversity as affirmative action or meeting quotas when it is neither of those things. She notes that increasing diversity increases the types of perspectives around the table, which gives way to fruitful ideas and concepts being shared for the betterment of the entire workplace. Another key area of support the ODI offers is through empowering minority and women’s groups within the school. For example, the team helped the American Medical Women’s Association relaunch its UAB chapter in 2015 and still supports the organization today with practical and organizational help. It also hosts an annual event that recognizes women faculty who have been promoted to the position of professor. “This event helps us celebrate exceptional women who are working to make significant advances in research, teaching, mentoring, and clinical work,” says Fouad. “Years ago, these women made a deliberate choice to seek out excellence regardless of inequities or personal and professional obstacles.”– Emily Henagan, Kendra Carter, Laura Coulter, Susan Driggers

CELEBRATING DIVERSITY

HE UAB SCHOOL OF MEDICINE’S

Office for Diversity and Inclusion held an inaugural Diversity Fair on February 3, 2017. The wildly successful event celebrated UAB Medicine’s wealth of diversity. The fair featured booths sponsored by departments within the School of Medicine, which highlighted the unique culinary talents of participating faculty and staff members’ cultures. The Birmingham Girls’ Choir entertained the crowd, while local visual and performance artists were also showcased.

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UAB SCHOOL OF MEDICINE

RESPONSIBILITY

Overcoming Obesity Experts confront a growing problem with innovation, skill, and compassion

URGEONS IN UAB’S METABOLIC BARIATRIC

Surgery Program change the lives of over 100 people each year by performing weight loss surgery on patients grasping at an often last-ditch effort to lose weight, and that number is growing. Richard Stahl, M.D., associate professor of surgery and director of the Metabolic Bariatric Surgery Program, is too humble to acknowledge surgery is often a lifesaver for these patients. “We feel we’re helping them,” he says. “I don’t like to say I saved them; the patients saved themselves.” Stahl notes there is a negative stigma often associated with weight loss surgery because some in society view it as the easy way out. “Obesity is a chronic disease, and patients die from it just like others die from cancer,” he says. “We don’t look at the surgical treatment of cancer as ‘the easy way out.’ We shouldn’t look at the surgical treatment of the metabolic disease called obesity any differently.” Stahl is among a key group of School of Medicine physicians, surgeons, dieticians, and researchers who battle obesity and its related diseases with a multipronged approach that targets a patient’s genetics, eating habits, activity Richard Stahl level, mental state, and family and social context. Armed with millions in grant money, UAB is taking the fight to a condition the Centers for Disease Control and Prevention estimate affects more than one-third of American adults and costs the U.S. health care system $200 billion annually. In Alabama, the statistics are equally alarming. The state has the third-highest adult obesity rate in the nation, according to The State of Obesity: Better Policies for a Healthier America, released in August 2017 by Trust for America’s Health. The adult obesity rate is currently 35.7 percent, up from 22.6 percent in 2000. Comorbid conditions of obesity are also among the highest in the country: Alabama ranked second in diabetes in 2016 and third in hypertension in 2015. “The public understands diabetes and hypertension are chronic diseases. In that same vein, obesity is a chronic disease,” Stahl explains. “It is a disease of abnormal metabolism where people tend to gain weight. Most people reach a weight and tend to stay at that weight; obese people keep gaining weight.”

ANNUAL REPORT 2017

RESPONSIBILITY

SUPPORT SYSTEM Amy Warriner, M.D., associate professor in the Division of Endocrinology, Diabetes and Metabolism and director of the Weight Loss Medicine Clinic at UAB Highlands Hospital, explains losing weight is not as simple as dieting and exercising. “There are multiple variations to how a patient becomes overweight and what needs to be done for the patient to lose weight,” she says. “As such, we need to approach each patient individually when developing a treatment plan for weight management.” At the UAB Weight Loss Medicine Clinic, Warriner and colleagues from various health professions use a comprehensive approach to fighting obesity. Their tools include looking at any underlying medical issues that might contribute to a patient’s weight gain, addressing behavioral causes such as binge eating and late-night eating, developing an exercise plan with personal trainers, and providing nutrition counseling. Warriner and her team also use point-of-care hemoglobin A1C testing, which tests for diabetes and pre-diabetes. Since beginning the testing, clinic staff have identified a significant percentage of those tested who were unaware they had diabetes and pre-diabetes. Three months of lifestyle changes is frequently enough to reverse the march toward full-blown diabetes for most patients with pre-diabetes. “It’s something tangible we can monitor objectively,” she says. And their success is evident in the over 3,000 total pounds lost by clinic patients in 2016. Warriner notes that one of the most promising tools to help some patients lose weight is the availability of safe weight loss medications, five of which have been approved by the FDA. However, she says insurance companies have been slow to integrate these medications into coverage plans. “The patients who have access to weight loss medications are much more successful at losing weight and keeping it off,” she says. “It’s not always as simple as calories in versus calories out.” Treating childhood obesity can be more complex than treating adult obesity, but the need for programs that address the issue is growing. The CDC reports about 17 percent of children and adolescents are now obese. Warriner is working with Stephenie Wallace, M.D., MSPH, associate professor in the Department of Pediatrics and medical director for the Center for Weight Management at Children’s of Alabama, to open a family clinic where doctors can work with parents and children to fight multiple generations of obesity. “Part of the problem we see is many parents and young adults don’t know how to cook or really learn what a proper diet is,” Warriner says. “That leads to further generations not knowing how to cook and not understanding proper nutrition, which evolves into an over-reliance on processed foods.”

FAMILY TIES Generational obesity is also the focus of the new UAB Strategically Focused Obesity Research Center (SFORC), which was made possible by a $3.7 million grant from the American Heart Association (AHA). UAB is one of four universities—along with Johns Hopkins University, New York University, and

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Vanderbilt University—to receive funding as part of the AHA’s Obesity Research Network. “Obesity perpetuates itself from one generation to the next,” says Timothy Garvey, M.D., principal investigator of the SFORC, director of the UAB Diabetes Research Center, and chair of the Department of Nutrition Sciences in the UAB School of Health Professions. “Mothers with obesity tend to give birth to children with obesity, which continues into adulthood and causes the cycle to start over. While the causes of obesity are complex, events that occur in the womb are particularly powerful and program long-term regulation of body weight, as well as greater risks for diabetes and heart disease.” Researchers will examine how the womb environments of lean mothers and overweight mothers can program hormones’ ability to regulate appetite. This is accomplished by acting on the centers in the brain that recognize satisfaction, the amount of energy expended by the body at rest, the speed at which the body uses fat for fuel, and the insulin’s ability to control glucose. Investigators will also look at modifications in DNA produced by the womb environment that can continue after birth and alter gene expression. UAB researchers are equally invested in working with partners to illuminate the social context of this complex problem. Led by UAB’s Minority Health and Health Disparities Research Center (MHRC), the Mid-South Transdisciplinary Collaborative Center for Health Disparities Research (Mid-South TCC) is a consortium of academic institutions and community partners working together to reduce the burden of chronic disease experienced by minorities across six southern states. A group of Mid-South TCC researchers published a study last year in a special supplement of the American Journal of Preventive Medicine that examined the relationship between street connectivity—a measure of walkability for the local

RESPONSIBILITY

Left: The Strategically Focused Obesity Research Center includes faculty from the UAB Schools of Medicine, Health Professions, and Public Health. Above: David and Jennifer Pollock are studying renal control of sodium and salt balance, a particular concern for the typical Southern diet.

environment—and obesity risk. The study clarified how race, income, education, and perceived discrimination contributed to systemic inflammation. Their findings suggest interventions reducing inflammation should focus on African-Americans and people who are socioeconomically disadvantaged, including those with low education levels. The MHRC’s leading role in researching the intersection of health disparities and obesity was cemented in the fall when the center was awarded a $7 million grant from the National Institute on Minority Health and Health Disparities (NIMHD) to establish the UAB Obesity Health Disparities Research Center. UAB is one of 12 academic institutions in the U.S. to receive funding through the NIMHD’s Centers of Excellence program, which fosters collaborative multidisciplinary research in minority health and health disparities. Using Alabama as a model, UAB investigators will study the complex contributors and interactions among biological, behavioral, and social factors related to obesity; determine how they vary at critical periods during life; and develop interventions to address these contributors.

DIET DANGERS Diet can present risks beyond contributing to obesity, especially in the South. Previous UAB research has linked the traditional Southern diet—high in salt and fat—to increased risk of hypertension, stroke, and chronic kidney disease. Last spring the National Heart, Lung, and Blood Institute awarded a five-year, $11.2 million Program Project (P01) Grant to UAB Division of Nephrology researchers David Pollock, Ph.D., Jennifer Pollock, Ph.D., and Ed Inscho, Ph.D., and their collaborators at the University of Utah to study renal control of sodium and salt balance.

David Pollock says today’s diets have more salt than humans have ever regularly consumed throughout history, and he notes the human body is not built to handle such high salt intake on a regular basis. The FDA recommends no more 2,300 milligrams of sodium a day, but Americans are now taking in about 3,400 milligrams daily and sometimes more. Previous studies by the Pollocks into renal control of salt have shown there is a small peptide made by the lining of the blood vessels and kidney tubules that helps the body get rid of salt. When there is damage in that system, it can contribute to hypertension, plaque build-up in the arteries, and many other cardiovascular complications. The latest grant will look at other aspects of salt intake on the body, including a focus on how blood pressure is controlled throughout the day. For example, the research will look at the time of day salt is consumed to see how it affects nighttime blood pressure. “Now that it’s understood a high-salt diet may contribute to the rise of many diverse health problems—including autoimmune disease—trying to understand how the body regulates salt is extremely important,” says David Pollock. “That’s the work we hope to continue to do with this grant.” Fast food is often a culprit in weight gain, but UAB researchers are studying other ways fast food can threaten health. Perfluoroalkyl substances (PFAS) are known to be harmful to humans and have been found in fast food wrappers at many popular chain restaurants. Diseases including kidney and testicular cancers, thyroid disease, low birth weight and immunotoxicity in children, and other health issues have been linked to PFASs in previous studies. Scientists from the UAB School of Medicine and the University of Notre Dame have developed a new method that enables researchers to radiolabel three forms of PFAS and track them in the body. In the method, one of the fluorine atoms on the PFAS molecule was replaced with a radioactive form of fluorine, the same radioisotope fluorine-18 used for medical positron emission tomography (PET) scans in hospitals. “For the first time, we have a PFAS tracer or chemical we have tagged to see where it goes in mice,” says Suzanne Lapi, Ph.D., senior author of the study published in the Journal of Environment Science and Technology, an associate professor in the UAB Department of Radiology, and the director of UAB’s Cyclotron Facility. “Each of the tracers exhibited some degree of uptake in all of the organs and tissues of interest that were tested, including the brain. The highest uptake was observed in the liver and stomach, and similar amounts were observed in the femur and lungs.” “We are very excited about this technique, which borrows from our current work developing nuclear medicine imaging agents,” said Jennifer Burkemper, Ph.D., a scientist in UAB’s Cyclotron Facility and the first author on the study. “This work can enable rapid screening of PFAS compounds to gain key insights into their biological fate.” – Ryan Broussard, Jim Bakken, Susan Driggers, Tyler Greer, Alicia Rohan

ANNUAL REPORT 2017

impac impact noun | im•pact 1: the force exerted by a new idea, concept, technology, or ideology At UAB, we strive for positive impact in everything we do, but change in medicine can be slow to come and some problems can’t wait. That’s why we are bringing the full force of our expertise and experience to bear on overcoming some of the greatest threats facing the health of our state and our country, and helping turn the tide.

UAB SCHOOL OF MEDICINE

OPPORTUNITY

ANNUAL REPORT 2017

OPPORTUNITY

Medical student Sherwin Chiu examines a patient under the supervision of family medicine physician Shivani Malhotra at the UAB Huntsville Regional Medical Campus.

UAB SCHOOL OF MEDICINE

IMPACT

Expanding Access Seeking solutions to strengthen primary care and rural health in Alabama

N ITS 2017 REPORT “COMPLEXITIES

of Physician Supply and Demand,” the Association of American Medical Colleges (AAMC) made dire predictions about a shortage of physicians in the U.S. One of the most alarming deficits is in primary care. In Alabama, the situation is nearing crisis levels. The AAMC’s 2015 State Physician Workforce Data Book ranked Alabama 45th in the nation for the number of active primary care physicians per 100,000 in population. In addition to the problems in primary care, another threat to Alabama’s health is a growing list of hospital closures in rural areas and lack of access to health care in those areas. After it was announced last August that J. Paul Jones Hospital in Camden—the only hospital in Wilcox County, one of Alabama’s poorest rural areas—would close, UAB entered into a nonbinding Memorandum of Understanding with the hospital’s Board of Trustees to discuss a management agreement to keep the hospital open. Were it to close, J. Paul Jones Hospital would become the seventh rural hospital that has closed over the past eight years, placing Alabama near the top in rural hospital closures nationwide. With strong leadership and innovative strategies, the UAB School of Medicine—in Birmingham and through its regional medical campuses—is working to address the primary care shortage and growing rural health care crisis head-on through initiatives that include targeted recruitment and training programs and bold, new telemedicine plans.

PROMOTING PRIMARY CARE

The shortage of primary care physicians has prompted the School of Medicine and its regional medical campuses in Huntsville, Tuscaloosa, and Montgomery to develop a variety of initiatives aimed at promoting primary care as a career. One such program is a new Primary Care Track that started taking applications in fall 2017. It is being offered by the UAB School of Medicine in collaboration with The University of Alabama’s College of Community Health Sciences (CCHS), which has had a mission to produce family physicians for the

state since its formation in 1972. CCHS also serves as the School of Medicine’s Tuscaloosa Regional Campus. Those accepted into the Primary Care Track spend their first two years completing the prerequisite basic science curriculum in Birmingham and their third year in a model of clinical education called a longitudinal integrated clerkship (LIC), based in Tuscaloosa or other communities around the state. Working one-on-one alongside faculty and community practitioners, students follow and care for patients longitudinally across the core medical disciplines in a variety of settings—from hospitals to outpatient clinics, on home visits, and even in nursing homes. “Students in the LIC become part of the community and have the unique opportunity to understand heath care, disease and wellness, and cultural influences on health over time and in the context of family, community, and society,” says Richard Streiffer, M.D., regional dean of the Tuscaloosa Regional Medical Campus and dean of the CCHS. In Huntsville, efforts are being made to foster students’ interest in primary care—with a focus on those likely to practice in rural areas—before they enter medical school. David Bramm, M.D., assistant professor in the Huntsville Family Medicine Program, says the first step in Huntsville’s multifaceted approach is its Rural Premedical Internship. For several weeks each summer, undergraduate students from rural Alabama come to the Huntsville Regional Medical Campus and rotate with rural family physicians to learn about primary care and boost their applications should they decide to apply to medical school. The second step is the Rural Medicine Program, which accepts students who intend to practice family medicine in a rural area and agree to participate in a program designed to further those interests. (The Tuscaloosa Regional Campus offers a similar program, the Rural Medical Scholars Program.) These admissions are limited to Alabamians who have lived in rural Alabama for at least eight years. “If accepted, they spend a prematriculation year at Auburn,” explains Bramm. “Then, if they maintain a certain GPA, they go straight to medical school at UAB with the regular population of students.” The newest element of Huntsville’s three-point initiative is the Integrated Family Medicine Residency Program, which adds an enriched curriculum to the fourth year of medical school to make students more competitive in their residencies. Students participate in all resident didactic teaching sessions as well as

ANNUAL REPORT 2017

IMPACT in the continuity clinics. Fourth-years also complete rotations in critical care, nephrology, pulmonary medicine, anesthesia, and cardiology. Roger Smalligan, M.D., regional dean of the Huntsville Regional Medical Campus, says the Integrated Family Medicine Residency Program, introduced by Bramm in 2017, helps kick-start a student’s residency. “Our students are interested in having extra training in primary care,” says Smalligan. “The option they have to move into a high-quality family medicine residency program here in Huntsville—where they know the specialists, the hospital, and the city—becomes a big part of why they want to stay.”

A WEALTH OF INSIGHTS

Wick Many Jr., M.D., FACP, who retired from UAB in 2017 after over 30 years of service—most recently as the inaugural regional dean of the UAB Montgomery Regional Medical Campus—sees cause for hope and concern in relieving the primary care shortage in Alabama. One problem, he says, is it is easy for medical students to become seduced by what he calls the “weird and wonderful” cases more commonly seen in Birmingham. However, the more serious concerns are the continuing problems of compensation and high patient volume. Many sees the regional campuses as UAB’s antidote, because they give students more exposure to the most rewarding aspects of practicing primary care. “Regional campuses provide our students opportunities to participate in true primary care,” he says. “We are basically the first line of defense. We’ve been fortunate in having some superb preceptors here in Montgomery as well as in Selma and Marion who are not only excellent physicians but also excellent role models. They show the students one can have a rewarding professional and personal life in primary care. We do everything we can to foster and support them in their interest in primary care.” Gustavo Heudebert, M.D., who was named interim regional dean for the Montgomery campus in October, agrees regional campuses offer unique strengths in training new generations of motivated, skilled primary care physicians. “I think all the regional campuses were created with the purpose of promoting primary care,” he says. “Hopefully the exposure to the community environment will help entice graduates to go that route.” Although he notes the issues surrounding reimbursement between primary care physicians and subspecialists, he wants students on his campus to see the other side of the coin. “People do it because they love the physician-patient relationships,” Heudebert says. “I don’t think there’s another area of medicine where you’re going to get as close to your patients or develop these long-term relationships.” Heudebert has other ambitions for the Montgomery campus, including working more closely with the UAB Family Medicine Residency Program in Selma where Montgomery medical students do a family medicine rotation. “We can also potentially create rotations in which family medicine residents from Selma come to Montgomery and vice versa,” he says. “Then we can demonstrate the importance of delivering care in what is one of the most impoverished areas in the nation.”

UAB SCHOOL OF MEDICINE

TELEMEDICINE CONNECTIONS

Telemedicine is emerging as a powerful tool to counteract the shortage of specialty care medicine in rural areas, a problem that disproportionately affects Alabama. Eric Wallace, M.D., has been named the first medical director for telehealth at UAB. He sees endless possibilities for connecting specialists and subspecialists with the patients who need them, in ways that eliminate onerous travel and maintain the quality and efficiency of the health care delivered. Wallace says the health care field has been moving closer toward accepting telemedicine, but there are several factors that have come together now to make it a truly viable alternative to in-person visits. “I think we’ve reached a point where health care technology has decreased in cost, patient/ provider/insurer acceptance has increased, and the applications of telehealth are expanding quickly,” he says. “It is the confluence of all these factors, which I think has led to a tipping point to have a telehealth boom.” To enable virtual connections between specialists—such as Wallace, who is a nephrologist specializing in rare kidney disease and home dialysis—and patients, Wallace is working

IMPACT routine part of medical school training for students. “Investing in telemedicine training programs is going to be key to expanding choices for patients,” he says. “At institutions like UAB, we fortunately have the ability to train upcoming graduates on telemedicine. When they graduate, they will have telemedicine as yet another tool with which they can deliver care, as opposed to learning how to implement and deliver care through it after graduation.”

THE POWER OF GIVING

with a first-rate IT team and UAB Medicine Executive Director of Telehealth Bart Kelly to develop a telecommunications infrastructure that connects UAB doctors with patients at facilities across the state, even locations that are not part of the UAB system. He also advocates for policies to support insurance reimbursement for telemedicine that is comparable to in-person visits. Wallace believes telemedicine will improve specialized care delivery for patients in rural areas often used to traveling several hours for routine follow-ups that could be done by video. He emphasizes that making sure the care is equal to in-person visits was vital to his involvement. “It took me three years to get to the point where I was ready for my first telemedicine visit,” he says. “I had to make sure that I could do everything remotely that I did in person. I wasn’t going to settle for less.” “The specialties that are best suited for telemedicine right now are largely image-based and lab-based, where the physical exam is important but targeted and there are already telemedicine solutions in place,” Wallace notes. “We have room to innovate in specialties that require very detailed and in-depth physical exams. I think there will be solutions for even these specialties, some of which we will design right here at UAB. Ultimately, I think we will have solutions for every subspecialty.” Wallace anticipates telemedicine will one day become a Clockwise from top left: Wick Many helps an incoming medical student into her white coat at the annual White Coat Ceremony; Medical Director for Telehealth Eric Wallace consults with a patient via telecommunications technology; the Tuscaloosa Regional Campus is home to a new Primary Care Track.

An anonymous gift is making a special telemedicine program possible at the UAB Center for Palliative and Supportive Care (CPSC). The Community-Based Virtual Access to Palliative and Supportive Care Experts (CAPE) program is designed to bring the center’s expertise in providing care and support for seriously ill patients and their caregivers to communities across Alabama. It uses telehealth interventions to reach people where they live, providing “virtual” visits for advance care planning and reducing the number of trips to the doctor to improve patients’ comfort and well-being. Specifically, the gift supports personnel to develop the center’s community-based practice and build the center’s telehealth infrastructure, which includes a demonstration and training suite as well as the technology to enable virtual visits. “Palliative care sits at the intersection where patients may receive care in a variety of locations, whether in the hospital, clinic, skilled nursing facility, or at home,” says Rodney Tucker, M.D., the CPSC director and the Christine S. Ritchie, M.D., Endowed Chair in Palliative Care Leadership. “Our goal in palliative care and in medicine in general is to deliver care in the most appropriate location. By developing more robust telemedicine approaches, we can hopefully extend our expertise to patients and families close to their homes in a manner that meets their goals and preferences.” The center also plans to partner with general internists, oncologists, and regional hospice organizations to help them deliver highly specialized complex care to patients who live in more remote areas and typically rely heavily on emergency rooms for acute care. Giving the primary health care providers of those patients access to palliative and supportive care experts could spare these patients from frequent, urgent trips to the hospital. It will also help health care professionals keep patients more stable and comfortable at home. Another goal for the center is to expand access to resources like Project ENABLE (Educate, Nurture, Advise Before Life Ends). This supportive training approach combines an in-person palliative care team assessment with phone-based patient and caregiver coaching sessions, providing an extra layer of support for those facing serious illness. “The people who support palliative medicine through philanthropic giving truly believe in this model of holistic care for patients and families and are committed to excellence, innovation, and spreading palliative care throughout our community, state, and region,” says Tucker. “They are partners in changing our health care system for the better.”– Rosalind Fournier, Tyler Greer, Jane Longshore, Bob Shepard

ANNUAL REPORT 2017

UAB SCHOOL OF MEDICINE

Primary Care and Rural Health Programs BIRMINGHAM UAB Department of Family and Community Medicine Chair: Michael Faircloth, M.D. (interim) UAB Division of General Internal Medicine Director: Carlos Estrada, M.D., M.S.

UAB School of Medicine Medical Director for Telehealth – Eric Wallace, M.D. UAB Medicine Executive Director of Telehealth – Bart Kelly New leadership positions tasked with increasing access to specialty care in rural areas through the creation of a statewide telehealth network. UAB Medicine Neighborhood Clinics • UAB Hospital-Highlands • Gardendale • Inverness • Hoover • Leeds • UAB Urgent Care (downtown Birmingham)

HUNTSVILLE

Tinsley Harrison Internal Medicine Residency Director: Lisa Willett, M.D. • Primary Care Residency Track Director: Erin Snyder, M.D.

UAB School of Medicine Huntsville Regional Medical Campus Regional Dean: Roger Smalligan, M.D., MPH Provides clinical training for third- and fourth-year UAB medical students.

UAB Department of Pediatrics Chair: Mitchell B. Cohen, M.D.

UAB Huntsville Family Medicine Clinic UAB Health Center Huntsville

Pediatrics Residency Director: Michele H. Nichols, M.D.

UAB Huntsville Family Medicine Residency Program Director: Nancy Blevins, M.D.

Med-Peds Residency Director: J.R. Hartig, M.D.

UAB Huntsville Integrated Family Medicine Residency Program Fourth-year medical students interested in family medicine participate in resident didactic teaching sessions and continuity clinics and complete rotations in critical care, nephrology, pulmonary medicine, anesthesia, and cardiology. Successful students may receive scholarships and are strongly considered for the Huntsville family medicine residency.

Family Medicine Clerkship Four-week required clerkship for all third-year medical students. Pathway Program Four-week elective in rural ambulatory medicine for pre-clinical students offered by the UAB Department of Family and Community Medicine with a grant from the Alabama Family Practice Rural Health Board. Rural Family Medicine Selectives and Electives Clinical experiences in a rural family medicine practice for thirdand fourth-year students facilitated by community volunteer faculty. Equal Access Birmingham Medical student-run free clinic where students provide primary care services to underserved populations under the supervision of faculty mentors. Primary Care Week A week of student-driven events each fall focusing on the growing need for primary care physicians.

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UAB Huntsville Internal Medicine Clinic UAB Health Center Huntsville UAB Huntsville Internal Medicine Residency Program Director: Farrah Ibrahim, M.D., FACP UAB Huntsville Pediatric Clinic UAB Health Center Huntsville Huntsville Rural Pre-Medical Internship Eight-week pre-medical program open to 16 rural Alabama college sophomores and juniors. The program gives students experience in primary care in suburban and rural areas, provides didactic experiences, and requires a group research presentation. Rural Medicine Program Jointly sponsored by Auburn University and the UAB School of Medicine, the program selects 12 rural students interested in family medicine who spend a prematriculation year at Auburn before entering medical school in Birmingham, then completing their third and fourth years in Huntsville. Graduates are expected to go into primary care in rural Alabama. Community Free Clinic of Huntsville Family medicine and internal medicine faculty, residents, and medical students provide care for indigent patients. Lincoln Village/Huntsville Hospital Mobile Medical Unit Internal medicine faculty, residents, and medical students staff a mobile clinic in a low-income area of Huntsville.

MONTGOMERY UAB School of Medicine Montgomery Regional Medical Campus Regional Dean: Gustavo Heudebert, M.D. (interim) Provides clinical training for third- and fourth-year UAB medical students. UAB Montgomery Internal Medicine Residency Director: Jewell H. Halanych, M.D., M.Sc. UAB Health Center Montgomery Baptist Medical Center South Offers primary care for adults and infectious disease specialists.

SELMA

UAB Selma Family Medicine Center Vaughan Regional Medical Center Offers family medicine care for patients of all ages and is the primary training site for the UAB Selma Family Medicine Residency Program.

TUSCALOOSA UAB School of Medicine Tuscaloosa Regional Campus Primary Care Track Regional Dean: Richard Streiffer, M.D. Part of the University of Alabama College of Community Health Sciences (CCHS), the Tuscaloosa Regional Campus provides clinical training for third- and fourth-year medical students. The campus is home to the new Primary Care Track, which started taking applications in fall 2017. Rural Medical Scholars Program A five-year pre-medical and medical education program of the CCHS and the UAB School of Medicine, whose mission is to produce physician leaders for rural Alabama. Part of a pipeline at the CCHS that includes the Rural Health Scholars Program, a summer program for rising high school seniors, and the Rural Minority Health Scholars Program, for current high school seniors. Research Support The UAB Center for Clinical and Translational Science (CCTS) has trained CCHS clinical trials staff to work with rural populations. The CCTS has also trained a new rural health research-oriented faculty member, Mercedes Morales-Aleman, Ph.D., assistant professor in the CCHS Department of Community and Rural Medicine and Institute for Rural Health Research. The CCTS has also collaborated with the CCHS in recruitment of rural populations for the NIH-sponsored All of Us precision medicine initiative.

OTHER Area Health Education Centers (AHEC) Network Director: Cynthia Selleck, DNP Works to reduce health disparities by improving the quantity, diversity, distribution, and quality of Alabamaâ&#x20AC;&#x2122;s health care workforce. Five regional offices around the state work to increase the number of students who enter health care programs, train in rural and underserved areas, and obtain health care jobs. Deanâ&#x20AC;&#x2122;s Primary Care Scholars Program Merit-based scholarship program designed to promote and sustain interest in primary care with the goal of developing future primary care physician leaders.

UAB Selma Family Medicine Residency Program Director: Tiffani Maycock, D.O. (Interim)

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OPPORTUNITY

Left to right: Cayce Paddock and Stefan Kertesz are two of UABâ&#x20AC;&#x2122;s leading experts who are combating the opioid epidemic by educating the state and federal government about the problem and helping patients overcome addiction.

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IMPACT

Confronting a Crisis How UAB experts are stepping forward to combat the opioid epidemic

INCE 2010, A WAVE OF OPIOID ADDICTION has swept the country, leaving a trail of broken people, families, and communities in its wake. More than 2 million Americans have been diagnosed with opioid use disorder, a figure that has doubled over the past decade. There were approximately 64,000 drug overdose deaths in the U.S. in 2016, more than half involving opioids. As the White House Commission on Combating Drug Addiction and the Opioid Crisis put it, “America is enduring a death toll equal to September 11 every three weeks.” Alabama is not immune from the pain. According to the Centers for Disease Control and Prevention, Alabama ranks highest in the nation in opioid prescriptions per capita, with 5.8 million opioid prescriptions in 2015 for a population of approximately 4.8 million. A recent study by the Blue Cross Blue Shield Association found that 16.4 of every 1,000 BCBSA-insured members in the state have been diagnosed with opioid use disorder, twice the national rate of 8.3 per 1,000. State regulators have adopted new rules to curb high rates of prescriptions: The Alabama Board of Medical Examiners now requires doctors to check the statewide Prescription Drug Monitoring Program for certain patients to make sure they aren’t getting prescriptions from multiple physicians. “It is a huge problem,” says Stefan Kertesz, M.D., M.Sc., associate professor in the Division of Preventive Medicine. “This crisis has hit particularly hard in rural communities and declining industrial communities with low economic resources and low social opportunities. And we have both of those in Alabama.” Kertesz has become one of the nation’s top authorities on opioid addiction and how U.S. policies affect patients with pain. He briefed the U.S. Surgeon General on these issues in January 2017, and presented to the 2017 Summit of the Alabama Healthcare Improvement Task Force. In October, he received an award for Most Downloaded Manuscript over the previous two years by the journal Substance Abuse for his article “Turning the tide or riptide? The changing opioid epidemic.” Kertesz says the current situation began with an increase in opioid prescriptions from 2001 through 2011, then grew worse in recent years as the number of prescriptions declined and legal opioids were replaced by a black market of more dangerous illegal drugs. “The cause-and-effect discussion pins a significant part of the blame on excess prescribing of opioids for pain, and then those pain patients turn into addiction patients. But that is too limited of an explanation,” Kertesz says. “Excess prescriptions created a big pool of redistributable drugs to people who were already in distress. They were already living in communities with low economic opportunity, rising levels of loneliness, and high rates of drug and alcohol abuse. All those patterns were in place, and they were accelerated when we basically dumped massive amounts of opioids on those areas. “Then, when physicians pulled back on prescribing, some of those people began saying, ‘OK, what is available now?’ And what was available was even more lethal, such as heroin and

ANNUAL REPORT 2017

IMPACT opioids related to fentanyl. The common form of fentanyl that is causing so many deaths today is illegally manufactured, because it’s easy to make. In a strange way, we caused trouble by contributing to the market for redistributed pills, and we may well have made the problem even worse by quickly diminishing the supply of those drugs.” A host of UAB experts are using their knowledge to confront the problem from multiple angles, from inpatient and outpatient addiction treatment services to training health professionals to better work with patients with addiction, to helping our community stem the tide of overdoses.

TREATING THE PERSON AND THE ADDICTION Housed in the UAB Center for Psychiatric Medicine, the UAB Medicine Addiction Recovery Program (ARP) offers inpatient and outpatient treatment options for alcohol and substance abuse, though the patients tend to be “heavy on the opioid side,” according to Cayce Paddock, M.D., assistant professor in the Department of Psychiatry. “In Jefferson County, more people die from drug overdose than from suicide,” says Paddock, who oversees the program along with ARP Director Peter Lane, D.O. “Unfortunately, drug addiction is an illness with a lot of stigma behind it, and I don’t know if it’s treated like the disease that it is. It is a chronic relapsing brain disease. But the good news is it’s treatable.” ARP uses licensed and certified counselors and social workers to work individually and in groups with patients to provide treatment for their addiction. The 90-day program starts in-house, with patients staying at UAB Hospital for the first month and then transitioning to an outpatient program for the second and third months. In 2017, ARP increased the number of available inpatient beds from 11 to 16, and it offers outpatient

Opioid Crisis in Alabama

No. 1 in the U.S. in opioid prescriptions per capita

≈ 30,000 Alabamians are estimated to be dependent on opioids

282 OPIOID OVERDOSE deaths in 2015 Sources: Centers for Disease Control and Prevention 2015; Kaiser Family Foundation

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treatment for up to 50 patients at any given time. Patients are at the center five days a week for seven hours each day during the second month, and three-and-a-half hours per day during the third month. They take part in group and individual therapy, including family sessions and psychological and psychiatric evaluations as needed. There also is a follow-up care plan to assist patients after the initial treatment. “The idea is to bring the patient in, detox them and wash the substance away, and then tackle what’s left,” Paddock says. “Most of the time, people abuse substances for a reason. Whether it’s grief or trauma or family conflict, we work on all of those things while they’re in treatment.”

SAVING LIVES, ONE DOSE AT A TIME Narcan is the trade name for the generic drug naloxone, which prevents opioid overdose. The drug knocks the opioids off the receptors in the brain and binds to those receptors to prevent the overdose, sending the patient into immediate withdrawal. Naloxone has been available for more than 30 years, but until recently it was used primarily in emergency room or EMT settings. That began to change at UAB in 2015, when the School of Medicine raised $11,500 through its crowdfunding platform to purchase 200 naloxone kits (a number that has since increased to 300) for free distribution, mainly to family members and friends of opioid users. Each kit contains 2 milligrams of naloxone in a pre-drawn syringe. “We can train people who are not medical professionals on how to administer naloxone, then they can call for emergency help or get to the ER,” says Karen Cropsey, Psy.D., professor in the Department of Psychiatry and Behavioral Neurobiology. “It’s a way to extend somebody’s life until they can get the professional help they need.” Cropsey says her team has distributed approximately 280 of the 300 total kits, and there have been 28 overdose reversals. The biggest issue, she says, has been getting the kits in the hands of the people who might need them. “We thought we could just put up a bunch of flyers and people would come to us, but that wasn’t the case at all,” Cropsey says. “We learned you have to catch them where they are in order to give out this medication, even though it can save their lives. So we’ve been targeting treatment centers, the ER, inpatient units, and the Drug Court system.” Cropsey says the Narcan study has also helped dispel the concern that opioid users would use the kit as an excuse to become riskier in their drug use and push the limits, knowing that someone could give them naloxone if they overdosed. “We’ve found that is really not the case,” Cropsey says. “Most of the kits have been used on a third-party person, meaning someone who was not even involved in our study. The kits are used mainly by people who are around [a drug user]. The whole idea is if we can give out kits and train people how to recognize the signs of opioid overdose and administer naloxone, then we can save people’s lives and hopefully get them into treatment.”

IMPACT

UNIQUE TRAINING

Karen Cropsey has led efforts to distribute Narcan kits, which are used to reverse opioid overdoses, to friends and family members of people suffering from opioid addiction. One of those efforts involved raising the funds for the kits through UAB’s online crowdfunding program.

“We can train people who are not medical professionals on how to administer naloxone, then they can call for emergency help or get to the ER. It’s a way to extend somebody’s life until they can get the professional help they need.” – KAREN CROPSEY

People with addiction have unique care needs that may or may not be directly related to addiction treatment. To address those needs, UAB Hospital launched the Addiction Scholars Program in 2017 to provide training and insight on opioid addiction to a wide range of health care providers, including physicians, nurses, therapists, and social workers. The 15-month curriculum is being taught by UAB experts in addiction medicine, including Paddock. “The goals are to better prepare staff for the challenges facing patients with opioid addiction and to find better ways to provide the appropriate care to this patient population,” says Jordan DeMoss, senior associate vice president of UAB Hospital. “To our knowledge, this is the first such effort in the nation to address the issue in this way.” The initial class of scholars consists of 25 members of the UAB Hospital staff. The program began with an intense two-day workshop on addiction—including sessions with both opioid patients and their family members—followed by monthly meetings to examine other topics. “This is one of my favorite projects that we’re doing,” Paddock says. “We just dunked the scholars into it to get them to understand exactly what addiction is, then we started doing monthly lunch-and-learns. We broke the scholars up into small groups, and they’re each doing a quality improvement project in the hospital. It’s a way for us to get some of the things we’d like to see happen in addiction up and running. It’s like planting the seeds. The hope is that the scholars will go back to wherever they work in the hospital and teach their colleagues about addiction.”

THE SMALLEST PATIENTS One of the most alarming aspects of the opioid epidemic is the rise in the number of women who are addicted during pregnancy. “Women with substance use disorders during pregnancy face substantial barriers to care,” says Lorie Harper, M.D., associate professor in the UAB Division of Maternal-Fetal Medicine. These barriers include social stigma, legal consequences, transportation issues, poor communication between providers, and limited facilities for addiction treatment

ANNUAL REPORT 2017

IMPACT programs. In response, UAB’s Women and Infants Services established the UAB Comprehensive Program for Addiction in Pregnancy, which provides coordinated, multidisciplinary care to women suffering substance use disorders during pregnancy and postpartum. As part of the Addiction Scholars Program, prenatal services are integrated with the Addiction Recovery Program. This gives patients access to pre- and postnatal care alongside addiction treatment programs, including opioid replacement therapy. Patients get help navigating government programs that can enhance their care, such as Medicaid and family court. Prenatal care groups meet weekly to discuss what to expect during labor and delivery, infant care, and breastfeeding, and to provide information unique to women with substance use disorders, such as neonatal abstinence syndrome (a set of conditions caused when a baby withdraws from drugs he is exposed to in the womb) and pain management after delivery. Postnatal care is aimed at decreasing unintended pregnancies and increasing adequate newborn care. Subspecialty pediatric care will help mothers manage routine pediatric visits and provide neurodevelopmental follow-up for the infants. “This is a groundbreaking step in the battle against opiate addiction and will help us have better information on the growth and development of these infants,” says Brian Sims, M.D., Ph.D., associate professor in the UAB Division of Neonatology. After delivery, the women transition into a parenting care group that focuses on routine postpartum care, breastfeeding, and contraception, as well as psychosocial support for the stresses of parenting to help prevent relapse during this challenging time.

HELPING VETERANS Between 2012 and 2017, the number of veterans nationwide receiving opioid prescriptions fell by nearly a third. That’s mostly thanks to a new push by Veterans Affairs (VA) health care providers to prevent and treat opioid addiction among veterans. This includes the Birmingham VA Medical Center (BVAMC), a key care and education partner for the School of Medicine, where many of our faculty members treat patients and our students and residents are trained. “A lot of these veterans don’t know what they’re getting into when they’re started on an opioid prescription,” says Marca Alexander, M.D., who leads the BVAMC’s Opioid Safety Initiative. “Then years later they’re dependent on opioid prescriptions, and they don’t understand how it happened.” The VA’s Opioid Safety Initiative was first launched in 2013 and led to changes in how patients on opioids are monitored. Patients must get regular drug screens if they are on opioids long-term and have to sign an agreement that they won’t steal or deal opioids and won’t miss appointments. In addition, around 2015 VA data was first placed into the state’s Prescription Drug Monitoring database and all doctors check their patients against the statewide Prescription Drug Monitoring Program to make sure they are not getting additional opioid prescriptions from outside the VA system.

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Alexander has also led a push to be more understanding of patients who rely on opioids and provide them with the help they need to wean off the drugs. “I’m a proponent of a kinder, gentler approach,” she says. “I don’t want patients going through extreme withdrawals; when you cut them off all at once, they end up back on drugs.” With that in mind, Alexander is running an opioid weaning clinic that sees patients both in person and, using telemedicine, at satellite VA locations around Alabama. She is currently helping about 100 patients, but she says she hopes to expand the program in the near future. Each patient is slowly weaned down on opioids to safer levels or completely off them if possible. If necessary, the patients receive Suboxone, a drug that combats withdrawal symptoms and cravings. But Alexander weans the patients over the course of many months, decreasing their opioid prescriptions by just 10 percent a month. It is an approach that is time consuming, she admits, but effective in the long-term. At the same time, the VA is adding other services—including Tai Chi, yoga, acupuncture, and outpatient pain programs—to its repertoire to make sure veterans are getting the help and pain relief they need. And the VA is actively distributing naloxone to patients who are at risk of overdose. “When patients’ stress levels go up, that’s when they want the opioids they previously had,” Alexander says. “Our challenge is to help them develop the tools to stay off.”

GUIDING PAIN CARE One aspect that is often overlooked in the discussion about the opioid epidemic is the significant number of people who are dealing with true pain issues and need relief through medication. In order to help provide physicians with direction, the Federation of State Medical Boards updated its opioid use guidelines for state medical associations this past July. Mark Bailey, D.O., Ph.D., a clinical professor in the Department of Neurology, was one of 15 experts in pain management and addiction who sat on the panel, which also included government officials. He says the new guidelines include conducting a risk assessment on every patient, regular drug testing, increased observation for aberrant behavior (such as running out of a prescription too early), and an emphasis on low-dose, short-acting medications. The guidelines also call for medical professionals to have patients sign written consent for opioid therapy, and craft a treatment agreement that outlines the joint responsibilities of the clinician and patient. However, the increased scrutiny of pain management, coupled with a mandate from the FDA requiring pharmaceutical companies to reduce production of opioid medications by 25 percent or more in 2017, has made it more difficult for patients who truly need strong pain control. “Pain management is hard now and will get harder,” Bailey says. “Some pharmacies don’t stock the more potent opioids, and some insurers are denying claims for medications above an established threshold. Non-opioid treatment is going to have to assume a much more prominent role in chronic pain management, and patients are going to have to buy into this.”

IMPACT

ADDICTION UNDER THE MICROSCOPE If you put a recovering opioid addict who is feeling particularly stressed out in a room where he used to take drugs, his craving for opioids will skyrocket. Neurons associated with reward seeking and desire will be activated in his brain, encouraging him to relapse. “It’s known that the context in which you take a drug can be a powerful trigger to elicit a craving,” says Jeremy Day, Ph.D., assistant professor in the Department of Neurobiology. In fact, mice in Day’s lab who have received a drug in one side of a two-room cage will spend more time in that room. If you turn off some of the genes that shape the brain’s reward pathway, they’ll no longer link the room with the drug. It’s a phenomenon that Day hopes can one day be applied to human addiction, through compounds that may curb addicts’ cravings. Day and his colleagues are working to understand what causes addiction at both the cellular and molecular levels. Although most of their studies use cocaine to probe addiction, the findings can be applied to other illicit drugs, including opioids. Day notes that researchers answering basic questions about how addiction changes the brain and who is prone to addiction have the potential to unlock new treatments. “Not everyone who takes a drug becomes addicted,” he acknowledges. “But when you look at who does become addicted, it cuts across a wide swath of socioeconomic levels, education, genders, and ages. It’s really nonselective in terms of who is affected.”

It is well-established that drugs elevate the levels of dopamine—a molecule used to signal reward and drive motivated behaviors—in the brains of human and animal addicts. Blocking the surge of dopamine that usually accompanies a dose of drugs prevents animals from seeking the drugs out again, researchers have found. What Day wants to know is how that surge of dopamine influences each part of the brain, how it changes levels of genes that are turned on in the brain, and how it leads to long-term rewiring of neurons. Jeremy Day (center) and his Day’s work is still research team are working to ongoing, but he says understand the neurobiological he is hopeful the results underpinnings of addiction. he obtains will not only suggest drug targets to combat addiction but will also help destigmatize addiction. “The more we know about the basic neuroscience of addiction, the more people will understand that there’s a biological underpinning to this,” Day says. “When we can show the biology that’s controlling how a drug influences someone’s behavior, it makes us more compassionate.” – Cary Estes, Adam Pope, Alicia Rohan, Bob Shepard, Sarah C.P. Williams

“The more we know about the basic neuroscience of addiction, the more people will understand that there’s a biological underpinning to it. When we can show the biology that’s controlling how a drug influences someone’s behavior, it makes us more compassionate.” – JEREMY DAY

ANNUAL REPORT 2017

PHILANTHROPY

Investing in the Future Philanthropy drives innovation and excellence CARING FOR CAREGIVERS Changes in modern health care have created new challenges to wellness, not only for patients but also for the physicians who care for them. ProAssurance Corp., a property and casualty company headquartered in Birmingham, made a $1.5 million gift to establish the ProAssurance Endowed Chair for Physician Wellness. The initial gift to the School of Medicine will endow the academic chair and support a research team dedicated to addressing health issues that are unique to physicians as they deal with the stress and pressures associated with providing patient care in today’s rapidly evolving health care environment. The chair is the first of its kind in the U.S. “We are fortunate to have some of the best physicians in America right here at the School of Medicine,” says Selwyn Vickers, M.D., senior vice president of medicine and dean of the UAB School of Medicine. “It is important we consistently work to provide them with an environment that promotes wellness opportunities to help them flourish in their fields. Physicians who take care of themselves are better role models for their patients and for their children, have higher patient satisfaction and safety scores, experience less stress and burnout, and live longer. We are grateful to ProAssurance for their gift, which will greatly enhance our training programs and enable them to create a sustainable culture of wellness.” ProAssurance Chairman and CEO Stan Starnes underscores the importance of the research that will emerge from the company’s gift. “Physicians have always been subject to high stress levels from a variety of factors, such as society’s expectations for successful outcomes, the threat of litigation, and the effects of their professional obligations on the quality of their lives and their family’s lives,” Starnes says. “As medicine evolves to address the changing dynamic of health care in America, we must find ways to address these pressures.”

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Clockwise from above: A gift from ProAssurance Corp. has created a new endowed chair to promote physician wellness; Medical Properties Trust has invested in UAB’s diabetes research; a multigenerational love of medicine inspired a scholarship gift from the Weinrib family.

ALLIED AGAINST DIABETES A group of prominent Birmingham businessmen have come together to advance a common interest in helping eradicate diabetes—a disease that affects almost 30 million Americans, including members of their own families and companies. “We are in the health care business, and diabetes is one of the most prevalent diseases in this country,” says Edward Aldag Jr., CEO and president of Medical Properties Trust (MPT), a self-advised real estate investment firm that made a $2.5 million gift to the UAB Comprehensive Diabetes Center (UCDC). “We heard what [UCDC Director] Dr. [Anath] Shalev’s team was doing, and it was an easy decision to make to give this gift.” The School of Medicine has agreed to match MPT’s gift, and David Silverstein and Benny LaRussa Jr., whose philanthropic efforts were instrumental in establishing the UCDC in 2008, are leading an effort to raise an additional $2.5 million in gifts from the Birmingham community for a total investment of $7.5 million. The MPT gift was officially honored at a gala event in October that also served as a kickoff for the community fundraising effort. More than $82,000 was raised at the event.

indicator of diabetes stage and progression, and also of therapeutic success. “We are in the buckle of the diabetes belt, and we are typically either the No. 1 or No. 2 state in the nation in terms of our diabetes prevalence,” Shalev says. “We are grateful to Medical Properties Trust for this gift because it addresses an urgent need.”

CARE ACROSS GENERATIONS

Helping people with diabetes live healthier lives is a cause Silverstein and LaRussa have championed since their daughters, Sarah Silverstein and Chelsey LaRussa Heslop, were each diagnosed with Type 1 diabetes as children almost 20 years ago. “At the time Sarah was diagnosed, I knew very little about the disease,” admits Silverstein. “But having a child with a life-threatening disease puts everything into perspective, and I made a commitment to Sarah that I would better understand the disease and do what I could to raise money to find a cure.” Shalev notes the gift will support two key efforts: recruiting new faculty to enhance the center’s robust interdisciplinary research and finding new, noninvasive tools and methods to measure a patient’s functional beta cell mass—an important

Michael Weinrib, M.D., then a young aspiring doctor, saw his first dead body in 1944 at age 8. “I wanted to become a doctor like my dad who took me to see an autopsy at the Montgomery VA Hospital,” says Dr. Weinrib. “Dad told me to expect a lot of blood and bad smells, but it piqued my curiosity and interest.” Since that memorable event more than 70 years ago, Dr. Weinrib has retained an abiding sense of curiosity and passion for medicine throughout his career. In 1965, he joined his father, Joseph Weinrib, M.D., an internist and cardiologist, and his brother, Peter Weinrib, O.D., an optometrist, in private practice in an office designed by his father, who was formerly a civil engineer. Dr. Weinrib officially retired in 2002 from internal medicine and gastroenterology practice in Montgomery. He now volunteers at the Medical Outreach Ministries Family Health Center, where retired specialists and subspecialists provide care for uninsured and indigent patients. After his sophomore year at Tulane Medical School, Dr. Weinrib met his wife-to-be, Louisa Herzfeld, from Cincinnati when she visited her father’s family in Montgomery. They married following his graduation. After his post-graduate training in New York City, New Orleans, and Cincinnati, they settled down into medical practice and rearing three sons, two of whom graduated from UAB School of Medicine. UAB brought medical education to Montgomery in 1974 with the launch of the Montgomery Internal Medicine Residency Program, which was started under the auspices of Tinsley Harrison, M.D., and Jack Kirschenfeld, M.D. Dr. Weinrib was among the first recruited as an attending physician and lecturer in gastroenterology. The program started with two medical residents. Since then, it has blossomed into a medical campus with an internal medicine residency program with 27 doctors and a family practice residency with 24 doctors. With this well-established legacy in place, Montgomery became the School of Medicine’s fourth Regional Medical Campus for thirdand fourth-year medical students in 2014. Both Michael and Louisa Weinrib have had an abiding interest in medicine and in medical education in Alabama’s River Region, and have established the Weinrib-Herzfeld Family Endowed Medical Scholarship to support medical students on the Montgomery Regional Medical Campus. The scholarship also honors three generations of Weinrib physicians who trained or practiced medicine in Alabama. Michael and Louisa’s sons Dr.

ANNUAL REPORT 2017

PHILANTHROPY David Weinrib and Dr. Stephen Weinrib are currently practicing infectious disease medicine and endocrinology, respectively, in North Carolina where Stephen has a college-aged daughter who hopes to enter medical school. “We want to help facilitate the education of our next generation of physicians,” says Louisa, who honored her parents by co-naming the scholarship after them. “We have such good quality medicine in Montgomery, and it’s a matter of pride to want to keep it alive. This scholarship aims to help relieve the overwhelming cost of medical education and bring more physicians to this friendly city, where we hope they will remain.”

COMMITTED TO DISCOVERY

Alabama natives Deborah and Clarence Pouncey are advocates for having breast cancer research conducted in their own backyard because they realize how critical research is to finding better treatments. Deborah was once a breast cancer patient at UAB, and she and her husband credit UAB physicians with saving her life. “From the first time we met her treatment team, which was led by Dr. [Lisle] Nabell, it was obvious that we were in the right place for Debby’s treatment,” says Clarence Pouncey, executive vice president and COO of ServisFirst Bank. “Dr. Nabell was forward-thinking, bright, and articulate. She genuinely cared about her patients and was honest about what Debby’s treatments would entail and their likelihood of success. The medical team around Dr. Nabell provided the same high level of care. Throughout her appointments, we met people from all over the country and the world who came to UAB to receive treatment. We felt very fortunate to live in Birmingham and have access to this extraordinary care that was and continues to be provided by UAB Medicine.” Deborah has been in remission for more than a decade, and she and her family wanted to celebrate in a meaningful way by establishing the Deborah Cason Pouncey Endowed Chair in Breast Cancer Research. Clarence committed a planned gift to the chair, while Deborah’s mother, Frances E. Lecroy, followed suit and also committed a planned gift. Their combined $1.5 million gift will help UAB recruit and/or retain an expert faculty member and research scientist who will be focused on accelerating discovery and translating knowledge into new and better therapies for breast cancer treatment. “We weren’t aware of how pervasive breast cancer was, as we met many young ladies in their 30s and 40s with breast cancer throughout this process,” says Clarence. “Our family wanted to give back to the breast cancer research initiatives underway at UAB so that we can get closer to ultimately finding a cure for breast cancer. We also want to see women maintain their quality of life while going through treatment and then surviving breast cancer, as we know research will continue to provide an improved healing environment. We wanted to

UAB SCHOOL OF MEDICINE

Above, left to right: UAB Comprehensive Cancer Center Director Michael Birrer with Frances LeCroy, UAB oncologist Lisle Nabell, and Deborah and Clarence Pouncey. At right, left to right: UAB Multiple Sclerosis Center Co-Directors Khurram Bashir and Etty “Tika” Benveniste with Program Manager Michelle Belue.

provide a small contribution to assist with accelerating this world-class breast cancer research.” The UAB Comprehensive Cancer Center, one of 41 Comprehensive Cancer Centers in the U.S., is at the forefront of improving cancer prevention, diagnosis, and treatment. Its researchers have pioneered advances in chemotherapy, surgery, immunotherapy, and nutrition. For example, last year, researchers found that a plant-based diet converted lethal breast cancer to a treatable form in animal models. Moreover, UAB experts are utilizing new tools and methods like gene sequencing to help physicians determine the most appropriate treatment for each patient. “This generous gift helps advance scientific discovery for the betterment of our breast cancer patients,” says Michael Birrer, M.D., Ph.D., the director of the Comprehensive Cancer Center. “It allows us to transition cancer research from the bench to the bedside. With this gift, we can provide the highest-quality care while advancing our understanding of cancer and translating that knowledge into better prevention, detection, and treatment. We’re thankful to the Pounceys and Mrs. Lecroy for supporting and enhancing our breast cancer research efforts.”

RIPPLE EFFECTS In the years since an anonymous donor made a $1.3 million gift to the UAB Multiple Sclerosis Center (MSC) in 2015, the gift has advanced the center’s work in meaningful ways. The center serves as a hub for all MS-related research activities and is a comprehensive resource for patients, UAB physicians and scientists, and community physicians. “We are truly grateful for this incredible gift that has transformed our MS research efforts,” says Etty “Tika” Benveniste, Ph.D., MSC co-director, holder of the Charlene A. Jones Endowed Chair in Neuroimmunology, and senior associate dean of research administration in the School of Medicine. “The obvious goal is curing MS. In order to reach this, we need to understand what causes MS so we can effectively treat and modify disease development. This gift makes identifying new therapies for MS care and treatment here at UAB possible.” Since receiving the gift, the center has hired a program manager to coordinate and streamline the center’s activities, and has funded four research projects so far through a newly established research acceleration fund to support novel MS research and to accelerate the most promising MS-related drug discovery projects. The gift has also enabled the center to to begin development of a new MS Biorepository and Database Initiative that will further propel future MS research. “With this gift, we can move some of our research into the clinics so patients will have the opportunity to participate in cutting-edge research, which no other center would be doing,” says Khurram Bashir, M.D., MPH, the MSC’s co-director. Another advancement the gift made possible in 2017 is

growing the MS Fellowship Program, with two fellows joining the center in July and two fellows expected to join in 2018. New quarterly patient support programs are now being offered, and the center is facilitating a series of meetings among MS clinicians, basic science researchers, and students to increase cross-disciplinary communication and advance research. “It is exciting to know we have a research acceleration fund that promotes new science and moves us faster toward a cure for MS,” says MS Center board member Rob Burton, president and CEO of Hoar Holdings LLC. “The new MS Center, with an excellent manager and committed leaders, will improve collaboration across many disciplines to improve patient care and advance research projects. I hope others will join in supporting this cause.” The MSC’s clinical excellence was recognized this past April when it was designated a Center for Comprehensive MS Care by the National Multiple Sclerosis Society, the highest designation in the three-tiered system developed by the society. To achieve this status, an organization must offer a multidisciplinary model of care to address the often complex needs of persons with MS and offer access to a full array of coordinated medical, psychosocial, and rehabilitation services in which providers share common goals for patient outcomes. – Emily Henagan, Tyler Greer

Campaign for UAB Update

$1 BILLION GOAL $838,791,626 RAISED TO DATE

$540,239,547 RAISED FOR THE SCHOOL OF MEDICINE

27,635 DONORS

MADE CAMPAIGN GIFTS TO THE SCHOOL OF MEDICINE * Totals as of October 31, 2017

ANNUAL REPORT 2017

FACTS & FIGURES School of Medicine Entering Class 2017

3,800+ applications

3.77 average

undergraduate GPA

456 applicants interviewed 186 students matriculated 52 undergraduate institutions

22-32 age range 94 men, 91 women, 1 not reported

9 M.D./Ph.D. students 5 M.D./MBA students 3 M.D./MPH students 164 Alabama residents

507.9 average MCAT score 29 underrepresented

22 out-of-state residents

Match Day 2017

GME Profile 2017

98% match rate

30 ACGME residencies

in medicine

Students matched into

75 institutions in 29 states

Top 5 specialties

• internal medicine (28) • pediatrics (24) • general surgery (18) • emergency medicine (17) • family medicine (17)

220 new residents, representing 63 U.S. and 27 international universities, matched into UAB residencies

UAB SCHOOL OF MEDICINE

55 ACGME fellowships 988 trainees 80 underrepresented minorities

UAB Research & Innovation 60 startups 1991-2017 45 patents issued in FY2017 with at least one SOM-affiliated inventor

555 U.S. patents issued 1991-2017

1,960 U.S. patent

applications filed 1991-2017

30 license

$88,919,767

cumulative revenue 1991-2017

78 intellectual

agreements per year*

property disclosures per year*

324 license

agreements executed 1991-2017

2,535 intellectual property disclosures 1991-2017

29 new patent

* Five-year average

applications filed per year*

UAB Economic Impact

UAB Medicine

$7.15 billion a year in Alabama

2,262 beds

64,292 jobs supported throughout the state

49,149 discharges

$268.6 million in state and local government revenue

1.2 million+ outpatient

(UAB Hospital)

attributable to presence of UAB

clinic visits

For every $1 in state funding received, UAB generates $25 in economic impact returned to the state UAB Health System supports more than $144 in charity care to underserved populations

million

4,087 babies delivered 16,361 employees 1,147 physicians

For fiscal year 2016

ANNUAL REPORT 2017

FINANCIALS & FUNDING Operating Revenues & Expenses FY2017 Total Revenues $725.9 Million

$113.3M 16%

Federal Grants Direct

$190.7M

Other Grants Direct

26%

Clinical Enterprise (UH, HSF, HS)

$43.3M 6%

Indirect Expense Recovery

$85M

$56.8M

12%

State Appropriations Including Earmarks Philanthropy

$176.3M

$22.5M

24%

Tuition

Other

$37.8M 5%

Total Expenses $653.5 Million

Campuses, Departments, Centers

$247.5M

Grants

38%

Space SOM Infrastructure

$364.6M 56%

$30.6M 5%

$10.6M 2%

UAB SCHOOL OF MEDICINE

Endowment Assets $176.2M

FY15

Corpus Fund Balance Interest Earned

$12.6M $191.4M

FY16

$14.8M $207.9M

FY17

$15.3M

Funding Ranking & Trends NIH Grant Funding $195M Active Grants & Contracts $339.5M NIH Ranking 25

NIH Ranking 22 NIH-Funded Principal Investigators 303

NIH Funding

Award Types

$195M

262 Research Projects (R)

$186M

48 Research Career Programs (K) 47 Cooperative Agreements (U)

$166M

29 Fellowship Programs (F) 28 Training Programs (T) 20 R esearch Program Projects and Centers (P) 1 NIH Director’s Pioneer Award (D) 1 N IH Director’s Other Transaction

2015 2016 2017

Award

2015 2016 2017

ANNUAL REPORT 2017

SCHOOL OF MEDICINE LEADERSHIP

Selwyn M. Vickers, M.D., FACS

Anupam Agarwal, M.D.

Etty “Tika” Benveniste, Ph.D.

S. Dawn Bulgarella, MSHA, CPA

Mona N. Fouad, M.D., MPH

Craig J. Hoesley, M.D.

Keith (Tony) Jones, M.D.

Robert P. Kimberly, M.D.

David A. Rogers, M.D., MHPE

Senior Vice President of Medicine and Dean James C. Lee Endowed Chair

Senior Associate Dean for Administration and Finance, UAB School of Medicine Chief Financial Officer, UAB Health System

Senior Associate Dean for Clinical Affairs

Executive Vice Dean Marie S. Ingalls Endowed Chair in Nephrology Leadership

Senior Associate Dean for Diversity and Inclusion

Senior Associate Dean for Clinical and Translational Research Howard L. Holley Research Chair in Rheumatology

UAB SCHOOL OF MEDICINE

Senior Associate Dean for Research Administration and Development Charlene A. Jones Endowed Chair in Neuroimmunology

Senior Associate Dean for Medical Education Chair, Department of Medical Education

Senior Associate Dean for Faculty Affairs and Professional Development Chief Wellness Officer, UAB Medicine

UAB MEDICINE UAB Health System UAB Hospital - Licensed for 1,157 beds and dedicated to top-quality patient care. Facilities include: UAB Hospital-Highlands - A general acute care facility providing emergency care, orthopedics, pain management, occupational medicine, and the region’s first coordinated care unit for geriatric patients. The Kirklin Clinic of UAB Hospital - Nearly 600,000 outpatient visits annually with more than 33 specialties under one roof.

Selwyn M. Vickers, M.D., FACS Chair, UAHSF Board

Spain Rehabilitation Center - One of the Southeast’s foremost providers of comprehensive rehabilitation care with nationally recognized programs designed to address all aspects of patients’ rehabilitation, including physical, social, and psychological health.

William Ferniany, Ph.D. Chief Executive Officer, UAB Health System

Women and Infants Center - Designed with patient comfort and familycentered care in mind and providing advanced medical technology dedicated to healthy and high-risk pregnant women and newborns, as well as women receiving care for various gynecological problems, including cancer. Center for Psychiatric Medicine - Provides inpatient clinical services including addiction recovery, child and adolescent treatment, and geriatric psychiatry in a dedicated facility

Keith (Tony) Jones, M.D. UAHSF President Chief Physician Executive, UAB Medicine

The Kirklin Clinic at Acton Road - Offers a multidisciplinary approach to cancer, heart/vascular care, and an array of other services south of the city. UAB Prime Care Clinics - Includes metro area neighborhood clinics in Hoover, Inverness, and Gardendale. For convenience, UAB physicians also are available at primary care locations in Leeds, Huntsville, Montgomery, Selma, and Tuscaloosa.

ORGANIZING FOR SUCCESS

UAB Callahan Eye Hospital - The only specialty hospital in Alabama focusing on eye care and the nation’s first Level 1 Ocular Trauma Center.

and the University of Alabama

In 2017, the entities that comprise UAB Medicine—the UAB School of Medicine, the UAB Health System, Health Services Foundation—began a reorganization aimed at improving

UAB Urgent Care - A convenient office in Midtown Birmingham offering medical care seven days a week without an appointment.

alignment and integration in order to achieve our AMC21 strategic goal

University of Alabama Health Services Foundation A nonprofit, 1,100-member physician practice that includes The Kirklin Clinic and The Kirklin Clinic at Acton Road, and serves UAB Medicine through more than 30 centers of excellence.

of becoming the “Preferred Academic Medical Center of the 21st Century.” With this realignment comes sharper focus on a single, distinct mission for the entire organization; governance that reflects the full scope of our

Joint Operating Leadership Committee

efforts across research, education,

This committee, established as part of Organizing for Success, includes Selwyn Vickers, M.D., FACS, senior vice president for medicine and dean of the School of Medicine; Will Ferniany, Ph.D., CEO of UAB Medicine; Tony Jones, M.D., chief physician executive of UAB Medicine and president of the Health Services Foundation; Ray Watts, M.D., UAB president; Cheri Canon, M.D., chair of the Department of Radiology; Herb Chen, M.D., chair of the Department of Surgery; and Seth Landefeld, M.D., chair of the Department of Medicine. The purpose of the group is to actively address issues within the Health System and support its financial and operational success, as well as the success of the academic enterprise.

and clinical care; strengthening of trust through transparency and accountability; increasing physician leadership throughout every aspect of UAB Medicine; commitment to discovery science from all areas of the institution; and greater opportunities to improve our financial stability and accountability for growth.

ANNUAL REPORT 2017

UAB School of Medicine Annual Report 2017 Produced by the UAB School of Medicine Development Communications Office Executive Director of Communications Paige Dorman

Executive Director of Development Jackie Wood

Managing Editor Jane Longshore

Associate Editor Emily Henagan

Art Director Kristin Farmer

Contributing Writers Jim Bakken Amy Bickers Ryan Broussard Kendra Carter Laura Coulter Susan Driggers Cary Estes Rosalind Fournier Tyler Greer Jeff Hansen Viktoria Havasi Adam Pope Alicia Rohan Bob Shepard Sarah C.P. Williams

Contributing Photographers Nik Layman Andrea Mabry Dustin Massey Steve Wood UA Photography

All rights reserved. No part of this publication may be reproduced or transmitted in any way without written permission. ÂŠ 2018 by the Board of Trustees of the University of Alabama System for the University of Alabama at Birmingham. UAB is an EEO/AA/Disability/Veteran Employer www.uab.edu/medicine

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