UB Medicine 175th Celebration Magazine by UBAA

Me age from the Dean We celebrate the 175th

a iversary of the Jacobs School of Medicine

and Biomedical Sciences at a time when many situations urgently demand our attention and energy. We are in the throes of the worst pandemic in over a century, which in turn is highlighting health care disparities in our country that are grounded in deeply rooted social injustices. These realities are necessitating conversations about the need to more effectively address issues of racial diversity and inclusion in medical education and academic medicine. Similar conversations are taking place around gender disparities. As difficult as these issues are, however, they also make this an opportune time to shine a spotlight on the Jacobs School as both an agent of positive change in our community and as a vast resource that has yet to realize its full potential. On the following pages, you will read about both aspects of the Jacobs School—its positive impact on our community since its founding in 1846, and its aspiration to have an even more positive impact in the future. This aspiration—which I know our faculty, staff, students and medical residents share—will require much listening and learning as a foundation for action, and is something that cannot be done in a silo. We must work in full partnership with our community, locally and globally, to serve it in ways that impact health care in a positive, sustained way. This is how we will best honor the legacy of the those who came before us, and best educate and train those who will be tasked with improving upon it.

Michael E. Cain, MD Vice President for Health Sciences Dean, Jacobs School of Medicine and Biomedical Sciences

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TA B L E O F C O N T E N T S

UBMEDICINE

UB MEDICINE MAGAZINE, Spring 2021, Vol. 9, No. 1

MICHAEL E. CAIN, MD Vice President for Health Sciences and Dean, Jacobs School of Medicine and Biomedical Sciences

175

a iversary

th In this special issue of UB Medicine, we commemorate the of the Jacobs School of Medicine and Biomedical Sciences, the founding academic unit of the University at Buﬀalo, The State University of New York.

To put the school’s long and illustrious history into context, we will start at the beginning, and then invite you to travel through time with us as we highlight the present and envision our future . . .

Eric C. Alcott Associate Vice President for Advancement, Health Sciences, Senior Associate Dean of Medical Advancement Editorial Director Christine Fontaneda Executive Director of Medical Advancement Editor Stephanie A. Unger Contributing Writers Bill Bruton Jr., Alexandra Edelblute, Ellen Goldbaum, Dirk Hoffman, Kathy Swenson, Ann Whitcher Gentzke Copyeditor Tom Putnam Photography Joe Casio Sandra Kicman Meredith Forrest Kulwicki Douglas Levere Art Direction & Design Karen Lichner Editorial Adviser John J. Bodkin II, MD ’76

Buffalo, 1863. Courtesy of the Buffalo History Museum.

Affiliated Teaching Hospitals Erie County Medical Center Roswell Park Comprehensive Cancer Center Veterans Affairs Western New York Healthcare System Kaleida Health Buffalo General Medical Center DeGraff Memorial Hospital Gates Vascular Institute John R. Oishei Children’s Hospital Millard Fillmore Suburban Hospital Catholic Health Mercy Hospital of Buffalo Sisters of Charity Hospital

Learn about the people, places and events that have shaped our history from 1846-2021—and some of the notable research accomplishments that have resulted.

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The COVID-19 pandemic has swept across our world, reshaping all facets of society, including medical education at the Jacobs School, ushering in or accelerating changes that may be here to stay.

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Correspondence, including requests to be added to or removed from the mailing list, should be sent to: Editor, UB Medicine, 916 Kimball Tower, Buffalo, NY 14214; or email ubmedicine-news@buffalo.edu

24 Underrepresented medical students at UB

have a vision for the future and are generating initiatives that promise to inform positive change.

In a conversation with Dean Michael E. Cain, UB Medicine asks him about what it is like to lead the Jacobs School at such a tumultuous time in history and what he envisions for the future.

48 Meet patients and families who are partnering

In a series of essays titled “Forward Thinking,” faculty leaders describe a field or topic in medicine and predict how it will evolve in 25 years, when the Jacobs School celebrates its 200th anniversary.

54 In a photo collage, we pay tribute to Jacobs School

faculty and medical residents serving on the frontlines of the COVID-19 pandemic, assuring that patients in our community receive the best care possible.

with Jacobs School faculty to advance patient care and clinical translational research for undertreated or underresourced diseases.

Adeline “Addie” Fagan, MD ’19, died of COVID-19 complications while serving her OB/Gyn residency in Texas. Her family, friends and the Jacobs School community honor her life and service. SPRING 2021

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Celebrating 175 Jacobs School of Medicine and Biomedical Sciences

Join us as we travel 175

years

into the past to tell the story of

University at Buﬀalo’s medical school, how it was established in a thriving new metropolis on the shores of Lake Erie and grew in tandem with its populace to serve the City of Buﬀalo and Western New York. Many of the school’s graduates—then as now—stayed and made their home here, providing the community with a steady supply of highly trained physicians, researchers, medical educators, public-health leaders and bold innovators. Others moved

Founding Faculty The UB medical school’s founding faculty were “as notable a faculty . . . as one could hope to find anywhere,” according to Harvey Cushing, renowned neurosurgeon at the time. James Platt White, MD, the individual most responsible for the founding of the medical school, was a pioneer in American obstetrics and gynecology. He introduced the clinical teaching of obstetrics in the United States, advocated for the use of anesthesia in childbirth and was responsible for the development of many new surgical techniques and instruments, including forceps. In 1850, he showed a live

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Erie County separates from Niagara County, and the Medical Society of Erie County is founded.

....

1825

British burn Buﬀalo, despite the negotiations of Dr. Chapin, a colonel during the War of 1812. Buﬀalonians rebuild their village, beginning with the aptly named Phoenix Tavern.

1821

Dr. Cyrenius Chapin, Buﬀalo’s first physician settles in the region.

1813

1801

to new locales, but none has forgotten where they got their start

The western terminus of the Erie Canal opens in Buﬀalo.

birth to his medical students, the first time that demonstrative midwifery was used in the United States. Austin Flint, MD, was a superb clinician whose many clinical contributions included the description of the cardiac murmur that bears his name. His treatise, titled Principles and Practice of Medicine, first published in 1866, was the book most likely to be found in the oﬃce of a physician at that time. Frank Hastings Hamilton, MD, in 1847, was the first physician in Buﬀalo to use ether (for a patient with a dislocated shoulder). He wrote a famous book on fractures that went through eight editions and was translated into French and German.

First issue of the Buffalo Medical Journal is published. The Buﬀalo Medical Association is formed to provide a free interchange of medical opinions.

In 1854, he performed the first successful skin graft, to treat an ulcer on a patient’s leg. Alden S. Sprague, MD, performed the first major operation under anesthesia (amputation at the thigh) in Buﬀalo, also in 1847. Thomas E. Rochester, MD, who joined the UB medical school faculty in 1853, made significant contributions to the understanding of appendicitis. Julius F. Miner, MD, joined the faculty in 1855 and quickly established himself as a bold and original surgeon. He was the first to successfully perform a thyroidectomy and also demonstrated the principle of enucleation in the removal of ovarian tumors, a method that was adopted universally.

1894

1846

Buﬀalo is incorporated as a city. Dr. Ebenezer Johnson is the first mayor.

1845

1832

Class of

The University at Buﬀalo is founded with the establishment of the Medical Department, which remained the only department for 40 years. The first class graduates in 1847.

Devillo W. Harrington, MD, Class of 1871. Toward the end of the Civil War, sick and injured soldiers from New England regiments were transported to Buffalo General Hospital. One such soldier, Devillo W. Harrington, lay wounded on the battlefield for three days before being evacuated. When he arrived in Buffalo, his case was considered hopeless. The interns tried a new dressing of permanganate of potash, one of the first antiseptic surgical dressings used, and he recovered. Harrington graduated from the UB medical school in 1871 and later became the first professor of genitourinary and venereal diseases at UB. To commemorate the 25th anniversary of his graduation, he established an endowment. For 175 years, the Harrington Lectureship has brought outstanding physicians and scientists to Buffalo. SPRING 2021

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1848

Sisters of Charity Hospital—the first regional hospital and first teaching hospital in Buﬀalo— opens under the leadership of Sister Ursula Mattingly. Housed in a former school building at the corner of Pearl and Virginia streets, the new hospital is sorely tested by a devastating cholera outbreak in 1849. Sister Ursula’s willingness to take a chance on new therapies led to the recovery of 80 of the 134 cholera patients admitted. By 1872, the hospital has outgrown its facilities and a new site is purchased on Main and Delavan.

Lucian Howe, MD, a seminal figure in early American ophthalmology, was the school’s first professor of ophthalmology. He came to Buffalo just prior to the Civil War and introduced the practice of modern ophthalmology to the region. In 1876, Howe established the Buffalo Eye and Ear Infirmary. Throughout his career he held leadership roles in the American Ophthalmological Society, the American Medical Association Section on Ophthalmology and the Medical Society of the State of New York. He is renowned for having established medals rewarding original research and distinguished service at these three organizations. In 1928 a fourth Howe Medal was created posthumously by UB and the Buffalo Ophthalmic Society.

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Buﬀalo General Hospital is dedicated.

1863

Buﬀalo is the thirteenth largest city in the United States, substantially larger than Detroit, Cleveland or Chicago.

1858

The university constructs a medical school building at Main and Virginia streets.

1850

1849

Photo courtesy of Buffalo History Museum

Buﬀalo General Hospital is designated a United States Army General Hospital. It receives nearly 100 hundred soldiers from New England regiments involved in the Civil War, many of whom are totally exhausted and more than half of whom die.

Roswell Park, MD, a surgeon of consummate skill and an eminent teacher, was recruited from Chicago to Buﬀalo in 1883. In 1898, the New York State Pathological Laboratory was established and housed in the UB medical school on High Street. Funded by a state appropriation, it was the first laboratory in the world to be devoted solely to the study of cancer, and Park became its first director. In 1901, a separate building was constructed and the institute was renamed for Mrs. William Gratwick, who provided much of the funding for the building. In 1911, the laboratory became a state institute and its name changed to the New York State Institute for the Study of Malignant Disease. In 1946, it was

An Alumni Association of the medical school is formed. The Alumni Club, which boasted about 800 members before the stock market crashed, acquired a clubhouse in 1921. The yellow brick mansion at 147 North Street was previously owned by General Edmund Hayes, for whom Hayes Hall is named. Dues were $40 a year.

The medical school has nine teachers. Incoming students are advised that “Good board, with room, fuel and lights, can be found for $4.50 to $6 per week.”

again renamed, in honor of its founder and first director— hence, today’s Roswell Park Comprehensive Cancer Center. Francis E. Fronczak, MD, Class of 1897, was one of the foremost authorities on public health. In addition to his medical degree, he received a law degree from UB in 1900. He gained an international reputation aiding the people of Poland during World Wars I and II. From 1910 to 1946 he was associate professor of hygiene and preventive medicine. Fronczak Hall, on the North Campus, is named after him. Grover William Wende, MD, Class of 1889, a much-loved Buﬀalo physician, was one of the leading dermatologists in the

1872

High Street is paved and sewers are installed eight years after the founding of Buﬀalo General Hospital.

1867

1866

1875

Medical school faulty 1861

Millard Fillmore Hospital is founded as the Buﬀalo Homeopathic Hospital.

country. He noted many rare diseases, including a description of nodular tuberculosis of the skin. He was one of the most skillful dermatologic photographers in the country. Wende Hall, on the South Campus, is named after him. Ernest Wende, MD, Class of 1878, Grover Wende’s older brother, was one of the most outstanding health oﬃcers in the country. He invented the modern nipple for baby bottles. Easier to clean than the nipple-and-tube contraption of earlier years, it helped prevent milk-borne infections in infants. (See more details on page 16.)

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1893

One of the oldest pediatric hospitals in the country, Children’s Hospital of Buﬀalo (now the John R. Oishei Children’s Hospital) is founded. The hospital greatly facilitated the development of the Department of Pediatrics in the UB medical school.

The medical school moves into its new building on High Street. Grover Cleveland begins his second (nonconsecutive) term as president of the United States.

1893

Former Buﬀalo Mayor Grover Cleveland is elected president of the United States.

1892

1884

Photo courtesy of Buffalo History Museum

Charles Cary, MD, Class of 1875, worked untiringly to raise funds for a new medical school. It was largely through his eﬀorts that a new school building opened in 1893 at 24 High Street.

1901–McKinley Assassination

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President William McKinley, in Buffalo for the Pan American Exposition, is shot on September 6, 1901 by a self-declared anarchist, Leon F. Czolgosz. Dr. Roswell Park—the surgeon of first choice—was in Niagara Falls performing an operation on a patient with a malignant lymphoma of the neck. Halfway through the operation a messenger burst into the operating room and said, “Dr. Park, you are wanted at once in Buffalo.” When Dr. Park answered that he could not leave the case even if it were for the president of the United States, the messenger answered: “Doctor, it is for the president of the United States.” In his place, Dr. Matthew D. Mann was chosen to perform the operation. The bullet had perforated both front and back walls of the stomach, taking off a tip of the pancreas, and lodging out of reach somewhere in the paraspinal musculature. The operation lasted 91 minutes and the patient was subsequently transferred to a private home, where he died September 14. Although the official announcement about the president’s death showed unanimity among his physicians, criticism of the handling of the president’s care continues to this day. UB MEDICINE

Diversity and Inclusion At a time when many universities were operated by churches and limited their admissions accordingly, UB exhibited a surprising openness in its admission policy. Women and blacks were admitted at relatively early dates. The university’s welcoming attitude was formalized in its 1920 fundraising slogan “For all Buﬀalo Boys and Girls—regardless of race, creed or class.”

Erie County Hospital is established in a building formerly occupied by the county hospital for the insane and an almshouse. Located on the site of the present-day South Campus at Main and Bailey, the facility was vacated due to a law that placed the care of the insane under state control.

1898

1894

1849—The Buffalo Medical Journal, under the editorship of UB medical school professor Austin Flint, MD, is the first medical journal in the United States to publish an article written by a woman physician. The author is Elizabeth Blackwell, MD, who, that year, was the first woman to graduate from medical school in the country.

Niagara University medical school merges with the University of Buﬀalo medical school.

1876—Mary Blair Moody, age 40, and the mother of six, is the first woman to graduate from the UB medical school. Though some professors welcomed her, others hoped she would be the last. A few rough fellows greeted Moody with catcalls or smoked excessively near her at recess, but most were willing to treat her fairly. Moody was an active physician and scientist, particularly concerned with preventive medicine. She was the first woman member of the Medical Society of Erie County, a fellow of the American Association for the Advancement of Science, and a contributor to the Buffalo Medical Journal. She was a founder of the Women’s Educational and Industrial Union in Buffalo in 1885, and the first supervisor of its program in Hygiene and Physical Education. 1880—Joseph Robert Love is the first black graduate of the UB medical school. He played an important role in stimulating the political activity of the black population of Jamaica and in inspiring the racial consciousness of Marcus Garvey, the charismatic leader who organized the first important U.S. black nationalist movement. Born and raised in Nassau, Bahamas, he came to the United States as an adult, working with the Episcopal Church. He was ordained in Buffalo and began his medical training at UB in preparation for missionary work in Haiti. At the alumni banquet held the year that he graduated, the last regular toast was to “Our Colored Fellow-Citizens.” Love, in his eloquent response, predicted that soon blacks would enjoy equality. 1902—M. Louise Hurrell, Class of 1902, spent 1918-19 as director of the American Women’s Hospital, Unit One, in Luzancy, France. There she and her all-female staff administered care to 20,000 patients at the cost of less than one dollar per patient. She practiced most of her life in Rochester, NY. SPRING 2021

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Photo of Mary Blair Moody courtesy of Buffalo History Museum

1918

In response to the critical need for a larger hospital to treat tuberculosis patients, Buﬀalo City Hospital is opened on Grider Street. In 1939, it was named the Edward J. Meyer Memorial Hospital in honor of the physician who led the hospital from its founding until his death in 1935. Meyer, Class of 1891, was responsible for the hospital’s close aﬃliation with the UB medical school. In 1946, the hospital passed from city to county control and was renamed Erie County Medical Center.

duates

The Great Influenza Pandemic of 1918

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Photo courtesy of Buffalo History Museum

In 1918, the great influenza pandemic struck, killing 20 million worldwide, including 550,000 Americans. Buﬀalo weathered the pandemic better than most cities because of the leadership provided by UB medical school’s faculty and alumni, who advocated for strict public-health measures in the city. Within a month of the outbreak, it appeared that the measures had worked, as the city suﬀered only a 6 percent morbidity rate, compare to 10 percent nationwide. The city’s acting health commissioner, Franklin C. Gram, MD, Class of 1891, formed a special advisory committee to deal with the pandemic. were asked to dedicate UB M E D I C I N Hospitals E

UB’s Endowment Fund Campaign raises $5 million in ten days from 24,000 subscribers.

1918

The site of what is now the UB South Campus was purchased.

1920

Of the 689 physicians practicing in Buﬀalo at this time, 400 graduated from the UB medical school.

1909

Mercy Hospital, founded by the Sisters of Mercy, opens in a house on Tiﬀt Street in South Buﬀalo. It had 30 beds and cared mainly for the large Irish Catholic population of the city.

1905

1904

1904 gra

half their beds to influenza cases, and Buﬀalo’s Central High School (today Hutchinson Central Technical High School) was converted into a temporary hospital. The greatest need, however, was for health-care workers. On October 16, 1918, the senior class of the medical school was pressed into service, and the next day the order was extended to include members of the junior and sophomore classes. Though citizens complained, Gram imposed draconian measures that virtually shut down the city for weeks. Public assembly of more than ten people was prohibited. This included streetcars, theaters, movies, schools, saloons, and church services, even funerals.

1939

The School of Nursing begins as a division of the medical school.

1940

First Spring Clinical Day, sponsored by the Medical Alumni Association, is held.

1936

1934

Photo courtesy of Buffalo History Museum

1929

A second $5 million Endowment Fund Campaign is successful, with the theme: “Buﬀalo’s boys and girls are her richest treasure and her highest obligation!” At the close of the campaign—on the same day the stock market crashed—the goal had been exceeded. Some of the pledges from 33,000 individuals were never received due to financial hardship.

David K. Miller, MD, professor of medicine, becomes the first full-time professor in a clinical department.

The bequest of DeWitt H. Sherman, MD, for a medical research building further strengthened the research eﬀorts at the medical school. Dr. Sherman, professor of pediatrics, died in 1940 and the funds became available upon the death of his wife in 1957. The Sherman Hall addition to Capen Hall on the South Campus was dedicated in 1958.

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World War II Shortly after the United States declared war in 1941, medical students were inducted into the armed services. By the following summer, the curriculum had been reorganized into a three-year program with classes continuing year-round. Specialized training units were formed within the school. Every morning the students lined up in uniform in front of the High Street building and marched

to a nearby field for drill exercises. Many volunteer and full-time faculty also served in the armed forces. Those who stayed behind placed their energies on patient care and teaching while research suﬀered. In 1945, the American Medical Association’s accreditation team recommended that the medical school be placed on probation, prompting dramatic changes.

The medical school moves from High Street to the UB South Campus at Main and Bailey.

1956

The Veterans Administration Hospital is dedicated. It is built on Main and Bailey streets in anticipation of the UB medical school relocating to the South Campus.

1953

Seven out of every 18 physicians in Buﬀalo are UB medical school graduates. The UB Centennial Fund campaign publicizes this statistic to boost its fundraising.

1950

1946

In 1946, the Elizabeth Blackwell Society, named for the first woman medical graduate in the United States, was formed at UB by the 23 women medical students at the university.

The medical school receives the largest bequest in its history up to that time. Ralph Hochstetter, president of Cliﬀ Petroleum Company, gave $8 million to support fellowships in medical research. Named in honor of Henry C. Buswell, professor of medicine at Niagara University, the endowment significantly strengthened basic research at the school.

Photo courtesy of Hauptman-Woodward Research Institute

Carl F. Cori, MD, adjunct assistant professor of physiology at UB from 19301931, and his wife, Gerty Cori, MD, receive the Nobel Prize in Physiology and Medicine. The couple came to Buﬀalo from Germany in 1922 to work on carbohydrate metabolism at the New York State Institute for the Study of Malignant Diseases, today Roswell Park Comprehensive Cancer Center. SPRING 2021

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1985

1947

Nobel Prizes Herbert Hauptman, PhD, research professor of biophysics at UB, wins the Nobel Prize in Chemistry. A renowned mathematician, he later becomes president of HauptmanWoodward Medical Research Institute, formerly the Medical Foundation of Buﬀalo. Hauptman and his collaborator, Dr. Jerome Karle, devised what came to be the standard method to determine the three-dimensional structures of complex molecules, which enabled researchers to identify and manipulate molecules and to develop new drugs.

1967 1966

1962

The private University of Buﬀalo joins the State University of New York System. Pictured is an aerial view of the South Campus, circa 1962.

School of Health Related Professions is established.

Buffalo Physician magazine, originally named The Buffalo Medical Review, is launched. The magazine’s name changed again in 2013, when it became UB Medicine.

The school changes its name to the UB School of Medicine and Biomedical Sciences.

1983

1978

Buﬀalo General Hospital and Deaconess Hospital of Buﬀalo merge.

1990

A 16-story medical tower is added to Buﬀalo General Hospital complex on High Street.

After 10 years of planning and seven years of construction, Erie County Medical Center opens its new 12-story “airconditioned” building, replacing the E.J. Meyer Memorial Hospital.

1979

The original German Deaconess Hospital was founded in 1896. When New York State mandated that a university family practice residency be instituted, the program developed at the hospital became the UB Department of Family Medicine in 1969.

1987

1985

1969

Samuel Sanes, MD ’30, shown here teaching in his lab, was a much-loved professor of pathology and legal medicine for more than 30 years. In the 1950s, he was coordinator of Modern Medicine, one of the first medical shows on television. He was dedicated to educating the public, and when he contracted cancer in 1973, he wrote a series of articles for the Buffalo Physician on what he learned being a patient.

The medical school works with its affiliated hospitals to form the Graduate Medical Dental Education Consortium to govern residency and fellowship training programs in Buffalo. It offers postgraduate medical trainees a wide range of clinical experiences and training opportunities and serves as a national model for graduate medical education.

A 39,000-squarefoot research building is dedicated at the Buﬀalo Veterans Administration Hospital on Bailey Avenue. In 1995, the Biomedical Research Building

onUthe S P R I N G 2 0 opened 21 B South M E D Campus. ICINE

1999

For the first time, students take Step 1 of the United States Medical Licensing Examination electronically.

A new entity called the Buﬀalo Niagara Medical Campus—formerly referred to as the “High Street medical corridor”—is formed by the major players in medical care, research, education and biotechnology in Buﬀalo.

Aﬃliation agreements that fundamentally change the working relationship between the medical school and Kaleida Health and Erie County Medical Center are announced.

The UB Clinical and Translational Research Center opens on the Buﬀalo Niagara Medical Campus.

2008

Hauptman-Woodward Medical Research Institute and its Structural Biology Research Center open on the Buﬀalo Niagara Medical Campus. Located on Ellicott and Virginia streets, the building is also the new home to UB’s Department of Structural Biology.

2015

2005

Approximately 12 miles of fiber-optic cable is installed by UB, enhancing high-speed data links between its three campuses and its aﬃliated research institutes, an essential step in the creation of a life-sciences campus for Western New York.

2012

UB’s New York State Center of Excellence in Bioinformatics and Life Sciences opens. It is temporarily located at 901 Washington Street while construction begins on a building to house it. The new building opens in 2006.

Photo by Douglas Levere

2004

UBMD Physicians’ Group is formed.

Buffalo General Hospital, Women and Children’s Hospital of Buffalo, Millard Fillmore Gates, Millard Fillmore Suburban and DeGraff Memorial merge to form the CGF Health System, renamed Kaleida Health on January 20, 1999.

2001

1998

2000 1997 2002

The medical school opens a medical computing lab.

New York State Supreme Court announces an agreement between Erie County Medical Center (ECMC) and Kaleida Health, resolving a yearlong impasse on how to begin consolidation of ECMC and Kaleida services, paving the way for the creation of centers of medical excellence.

UB receives a $15 million Clinical and Translational Science Award from the National Institutes of Health. With the grant, UB joins an elite tier of research institutes.

2011

A Historic Gift—George M. Ellis Jr., MD ’45

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The largest gift to the medical school at the time is made by George M. Ellis Jr., MD ’45, who, upon his death, left the school close to $50 million. Ellis was a family physician who practiced out of his home in the rural Midwest for over 50 years, assisted by his wife, Gladys “Kelly” Ellis, RN, the nurse for the practice. Ellis wanted the gift to remain anonymous until both he and Kelly passed, which happened in 2018, at which time their names were made public. “Not enough can be said about both the generosity and the timing of this remarkable gift,” said Michael E. Cain, MD, vice president for health sciences at UB and dean of the medical school. “This was something that George Ellis planned for close to 70 years, and it came in 2011, just after UB—with the support of Governor Andrew Cuomo—had made the decision to build a new home downtown for the medical school. Just knowing we had this gift invested made all the diﬀerence in our having the confidence to plan and move forward.” UB MEDICINE

2015

School Renamed Jacobs School of Medicine and Biomedical Sciences

First classes are held in the new medical school building on January 8.

UB’s Clinical and Translational Science Award is renewed by the National Institutes of Health for $21.7 million.

Photo by Sandra Kicman

2020

The Medical Education and Educational Research Institute is established in the medical school.

In June 2018, the school completes its $200 million Build the Vision Campaign in support of the new school.

Photo by Doug

las Levere

2019

Class size is increased to 180, up from 144, in an eﬀort to help address physician shortages in Western New York and nationwide.

Conventus building opens on the Buﬀalo Niagara Medical Campus.

Photo by Douglas Levere

2017

The new medical school building, located at 955 Main Street in downtown Buﬀalo, opens December 12. The $375 million, 628,000-square-footbuilding is located just steps from where the medical school was located from 1893 to 1953.

2018

2015

Jeremy M. Jacobs, his wife, Margaret, and their family give $30 million to the UB medical school. Jacobs is chairman of Delaware North, a global hospitality and food service company, and a longtime chair of the UB Council. The Jacobs family’s giving to the university totaled more than $50 million, making it one of UB’s most generous benefactors. In recognition of Jeremy Jacobs’ service and generosity to the university, the school is renamed the Jacobs School of Medicine and Biomedical Sciences. “This is a great and historic milestone for UB, as the first school-naming in our university’s long and distinguished history,” said UB President Satish K. Tripathi. “It is truly fitting that the medical school—UB’s founding school— would have this great distinction.”

In response to the COVID-19 pandemic, the medical school transitions to distance-learning in March. Fourth-year students participate in a virtual Match Day and commencement ceremony. Third- and fourth-year clinical rotations are altered to accommodate a two-and-a-half month pause in students’ access to clinical sites. (See related article on page 18.)

Sources for this timeline include Another Era, A Pictorial History of the School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 1846-1996; and Buffalo Physician and UB Medicine magazines. All photos courtesy of UB Archives, University at Buffalo, The State University of New York, SPRING 2021 UB MEDICINE unless otherwise indicated. 15

Landmark 175 Achievements years Since the school’s founding in 1846, its faculty have made significant contributions to the advancement of the basic sciences and clinical care. Below are a few highlights.

Public Health and Infectious Disease Pioneer After graduating from UB medical school in 1878, Ernest Wende, MD, studied in Berlin and Vienna, where he was introduced to a new theory that implicated germs in disease. In 1887 he returned to Buﬀalo, opened his own practice and worked to promote healthy hygiene practices, which led to his being ridiculed as a “bug doctor.” When he became health commissioner of Buﬀalo in 1897, Wende greatly reduced mortality rates associated with a typhoid outbreak in the city by having the water supply tested and ordering its source changed when the typhus bacteria was detected—actions initially derided by the mayor and water board. Wende also determined that the nipple-and-tube bottles used to feed children were contaminated by bacteria, and he posited that the deaths of many children could be attributed to the resulting milk-borne infections. His proposed ban on the long-tubed bottles was met with a campaign of resistance from the bottle manufacturers, pharmacies that sold them and politicians. Despite this, Wende oversaw passage of a law banning the bottles, after which the number of pediatric deaths in the city dropped by 50 percent. He invented the easier-to-clean shortnipple bottle that is still in use today.

Safer Blood Transfusions Ernest Witebsky, MD, the founding chair of the Department of Microbiology and Immunology, along with Niels Klendshoj, MD, isolated the B-antigen found in human blood, a discovery that made blood transfusions safer. Witebsky and his associates also conducted pioneering studies in autoimmune disease and its relation to thyroiditis, Addison’s disease and myasthenia gravis. In 1959, he received the Karl Landsteiner Award for his work with blood antibodies.

Father of Autoimmunology Up until the 1950s, scientific dogma held that the body could not produce antibodies against itself. Noel Rose, PhD, MD ’64, who came to UB in 1951, overturned that theory. Working under Ernest Witebsky, MD, Rose conducted experiments showing that the immune cells of rabbits could destroy their own thyroid glands. This discovery led to an entirely new field of science, autoimmunity, and the discovery of what causes Hashimoto’s disease in humans. While at UB, Rose attended medical school, graduating in 1964. In 2016, he became an emeritus professor at Johns Hopkins University. An article titled “The Father of Autoimmunity: A Profile of Noel Rose” was published in the June 2020 issue of The Scientist. Written by Diana Kwon, it describes in detail Rose’s work with Witebsky at UB. Rose died of a stroke on July 30, 2020, at age 92.

Lippes Loop Intrauterine Device As an obstetrician-gynecologist in the 1950s, Jack Lippes, MD ’47, fielded many complaints from patients dissatisfied with their limited options for birth control. This prompted the UB professor to research a new design for the intrauterine device, despite much controversy. The result was the plastic double “S” loop—a trapezoidal-shaped IUD that closely fit the contours of the uterine cavity, thereby reducing the incidence of expulsion. First distributed in 1962, the Lippes Loop quickly became the most widely prescribed IUD in the United States.

PKU Test: Preventing Mental Retardation In 1960 Robert Guthrie, MD, PhD, professor of microbiology and pediatrics, assisted by Ada Susi, a nurse who was his principal lab technician, invented a simpler “heel-prick” method for screening infants for phenylketonuria (PKU), a genetic disorder characterized by an inability of the body to break down the amino acid phenylalanine. Damage caused by PKU often resulted in severe cognitive impairments. Guthrie, who had a son who was mentally retarded, declined to patent his test or accept royalties from its sales, which allowed hospitals to quickly and inexpensively implement PKU screening on a large scale. The “Guthrie test,” as it came to be known, launched a worldwide movement to screen infants for disease soon after birth.

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Implantable Cardiac Pacemaker Wilson Greatbatch, a UB assistant professor of engineering, developed the first practical implantable pacemaker. To bring his idea to fruition, he carried out two years of experimental work with William Chardack, MD, then chief of surgery at the Buﬀalo Veterans Aﬀairs Hospital, and Andrew Gage, MD, UB professor of surgery. Since 1960, the Greatbatch pacemaker has improved and saved the lives of millions of people worldwide.

Sickle Cell Anemia Screening Test Michael D. Garrick, PhD, professor of biochemistry, was recruited to UB in 1970 by Robert Guthrie, MD, PhD, a pioneer of newborn screening who invented a simple test for phenylketonuria (PKU). Guthrie’s lab was searching for other disorders that could be detected through neonatal screening. After joining the lab, Garrick succeeded in devising a test for sickle cell anemia. Key to his success was his collaboration with Lydia T. Wright, MD, the first African-American pediatrician in Buﬀalo and a tireless community activist. In 1975, New York became the first state in the nation to mandate testing for sickle cell anemia. Today, over a quarter of a million New York babies are tested annually for hemoglobin SS (abnormal type of hemoglobin), resulting in about 100 to 150 sickle-cell diagnoses a year.

Avonex: Treatment for Multiple Sclerosis Lawrence Jacobs, MD, professor of neurology, was determined to improve the lives of his patients. His resolve led to groundbreaking research on multiple sclerosis (MS)—most notably the development of Avonex (interferon beta-1a), the drug most prescribed for people suﬀering from relapsing MS. In 2000, the Harvard Health Letter named Jacobs’ research one of the top 10 health advances of the year. As chair of the Department of Neurology, Jacobs hosted and trained scientists from around the world in his MS Clinic.

Infasurf: Lifesaving Treatment for Premature Babies Since 1999, hundreds of thousands of premature infants have been rescued with Infasurf, an exogenous surfactant that decreases the incidence of respiratory distress syndrome and associated mortality. The drug was developed in the late 1980s and early 1990s by UB researchers Edmund A. Egan, MD, professor of pediatrics, physiology and biophysics (pictured right); Goran Enhorning, MD, PhD, professor of obstetrics and gynecology; and Bruce A. Holm, PhD, professor of pediatrics, gynecology-obstetrics and pharmacology. Egan subsequently founded ONY Biotech, a neonatology pharmaceutical company, which manufactures Infasurf and is a leader in creating other products for the treatment of premature infants.

Pioneer in Minimally Invasive Neurosurgery L. Nelson (“Nick”) Hopkins III, MD, SUNY Distinguished Professor of neurosurgery and radiology, and chair of the Department of Neurosurgery from 1989 to 2013, was among the first neurosurgeons to apply minimally invasive endovascular techniques to the treatment of cerebrovascular disorders. In the mid-1970s, he pioneered the adaption of existing endovascular technologies, originally designed for cardiology, to suit the more delicate vessels of the brain. An advocate of cross-specialty collaboration, Hopkins fostered the creation of UB’s Toshiba (now Canon) Stroke & Vascular Research Center. He also was a lead visionary for and founder of Kaleida Health’s Gates Vascular Institute (GVI) and the Jacobs Institute (JI), co-located on the Buﬀalo Niagara Medical Campus along with UB’s Clinical and Translational Research Center.

Partial Liquid Ventilation for Critically Ill Newborns In the mid-1990s, Bradley Fuhrman, MD, a UB professor of pediatrics and anesthesia, developed a revolutionary technique called partial liquid ventilation (PLV) to treat respiratory distress syndrome, a common, often fatal complication in premature infants. Prior to the development of PLV, treatment involved increasing the pressure and oxygen concentration inside a baby’s lungs in an eﬀort to force more oxygen into the blood stream, sometimes resulting in permanent lung damage. PLV introduces an oxygen-rich liquid called perflubron into the baby’s lungs. The liquid allows the lungs to inflate with less pressure than air, and permits oxygen and carbon dioxide to pass through the air sacs and into the blood stream more easily and eﬃciently. Reaching this milestone took approximately 30 years. One of the major barriers to clinical application around the world was the fact that liquid breathing required a highly specialized ventilator. Fuhrman simplified the entire process by discovering a way to apply liquid breathing using a standard hospital ventilator.

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Medical Educatiо IN THE MIDST OF A The 2020 White Coat Ceremony included face coverings and social distancing, as 182 new students entered the Jacobs School of Medicine and Biomedical Sciences during the COVID-19 pandemic.

Pandemic STORY BY DIRK HOFFMAN

PHOTOS BY SANDRA KICMAN

he COVID-19 pandemic has had a far-reaching impact on the Jacobs School of Medicine and Biomedical Sciences, with reverberations cascading through its medical education, training, and research programs.

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“Our students, perhaps especially the first-year students, are profoundly aware of the significance of undertaking their medical education during the worst global pandemic in a century,” says Michael E. Cain, MD, vice president for health sciences at the University at Buﬀalo and dean of the Jacobs School. During this extraordinary time in the school’s history, much eﬀort has been dedicated to keeping the lines of communication open between administrators, faculty and students. At the onset of the pandemic, the Jacobs School put in place a

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number of mechanisms for gaining feedback from medical students. “We have monthly discussions with the deans for our first- and second-year students,” says Jennifer A. Meka, PhD, associate dean for medical education and director of the Medical Education and Educational Research Institute. “These are open sessions where students can meet with us and bring to us any questions, concerns or suggestions. “Every class has curriculum representatives, as well as student organization representatives,” she adds. “It is the responsibility

of the curriculum representatives to collect feedback from their classmates and bring it to us—and they often do that at our curriculum meetings. We also have town hall meetings for our third- and fourth-year students, along with mandatory class meetings for all fourth years to check in and provide important informational updates.” In addition, students fill out evaluations related to learning experiences they participated in each week, and, at the end of each course, they complete a course evaluation. “Part of what we are hearing is that students are thankful to have the opportunity to come together and participate in learning experiences they have with one another,” Meka says. “Learning is a very social activity and relationship-based, and what we know from all of the literature is that relationships—especially the relationship between the educator and the student—can make a huge diﬀerence not only in students’ overall learning, but also in their motivation, their engagement and their success.”

STUDENTS FEELING STRESSED Lisa Jane Jacobsen, MD, associate dean of medical curriculum, says the school’s leadership is aware that many of the medical students are feeling more stress than usual. “A lot of students are expressing feelings of isolation, which is hard,” she says. “Medical school, in general, is a diﬃcult time. The students spend a lot of time studying and they don’t have a lot of free

Nadia Vazquez, Class of 2024

time. If they don’t have much opportunity to interact with others, it becomes even more diﬃcult. Their mood is not as ideal as it could be.” Jacobsen says that last spring, when it became clear the school would need to move to hybrid or remote learning, there were certain elements of the curriculum that the school’s leadership wanted to preserve. “We knew we had to be quick to come up with ideas, but we did not want to sacrifice the quality of the education,” she says. “We had to keep our students engaged, and we needed to try and find ways to keep them interacting with us in the classroom, even though we were going to be online.”

This photo, taken several months before the pandemic, pictures the Office of Medical Education team that led efforts to move the curriculum to a hybrid model in response to COVID-19. From left: David Milling MD; Alan Lesse MD; Lisa Jane Jacobsen MD; Daniel Sheehan, MD, PhD. SPRING 2021

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Photo by Douglas Levere

Jennifer A. Meka, PhD, associate dean for medical education and director of the Medical Education and Educational Research Institute.

Along with lectures, crucial teaching elements such as small group learning and team-based learning continued to be emphasized. Jacobsen, a clinical associate professor of obstetrics and gynecology, says she tried to let the second-year students in the course she was teaching know she was aware that some of them may be struggling. “I incorporated some COVID-19 updates during the course so they knew we were not ignoring the world around them,” she says. “I tried to acknowledge the stress they were going through.” The idea of starting medical school during a global health pandemic was simultaneously distressing and exhilarating, according to Nadia Vazquez, Class of 2024.

{ } “Our students, perhaps especially the first-year students, are profoundly aware of the significance of undertaking their medical education during the worst global pandemic in a century. ” —MICHAEL E. CAIN, MD, VICE PRESIDENT FOR HEALTH SCIENCES AND DEAN

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“The unknown is daunting, but the opportunity to forge ahead and create a better, healthier world is exciting,” she says. “I am proud to be a part of a team of aspiring physicians that can appreciate the frailty and the fortitude of life and medicine.” First-year medical student Danya Ziazadeh says she is passionate about working at the intersection of public health and medicine in order to address the system-level factors that influence the health of populations. “The COVID-19 pandemic has uncovered significant structural inequities in our society, amplifying the importance and urgency of improving access to high-quality aﬀordable health care,” she notes. “I am so grateful for the opportunity to attend medical school at this time—at an institution that recognizes the impact of structural, social, environmental and biological factors on health outcomes.” The sense of isolation the pandemic has caused is an ongoing concern for many as well. “I do better when I am with people and in the hospitals,” says Micha Gooden, Class of 2021. “I live alone in a studio apartment, so being cooped up in my apartment is rough. It’s so much better being with people and patients.”

CLERKSHIPS PAUSED Medical clerkships are clinical rotations that enable third- and fourth-year medical students to experience various specialties and provide patient care. At the outset of the pandemic in the U.S., clerkships were put on hold across the nation in accordance with guidelines from the Association of American Medical Colleges. As a result, on March 16, 2020, students at the Jacobs School were removed from direct patient care and received clerkship core content

remotely. On June 15, 2020, they resumed direct patient care and completed their clerkships with clinical immersions. “We were sent home in the second semester of my third year,” says Gooden. “I was going to do an emergency medicine elective, but it was revamped. At that time, I was considering emergency medicine. It was low on my list, but not being able to get a true feel for the specialty, it was hard to make a decision.” Ultimately, Gooden decided against pursuing emergency medicine. “I think the pandemic aﬀected decisions about specialties for a lot of students,” she notes. For clerkships that would have spanned six weeks—like pediatrics and psychiatry—students undertook four weeks of core content with two weeks of clinical immersion. For longer clerkships—like surgery—they undertook four weeks of core content with four weeks of clinical immersion. “Each clerkship director analyzed his or her course-level objectives and

did not show any diﬀerences from scores obtained over the last five years, suggesting that there was eﬀective delivery of knowledge utilizing this format,” Lesse reports.

RESIDENCY INTERVIEWS GO ONLINE Typically, fourth-year medical students travel to residency programs to interview for them in person. But during the pandemic, most residencies have interviewed applicants via online video software. Interviews are an important opportunity for candidates to assess whether programs are compatible with their goals and lifestyles. “You need to be able to experience a program’s vibe,” says Gooden, who applied to internal medicine residencies. “You want to see how people are treated in the hospital and how residents get along. But you also want to see the community and culture where you’ll be living.” Saarang Singh, Class of 2021, agrees. “Figuring out where you fit is difficult when applying to programs in cities you have never even visited,” says Singh, who applied to residencies in physical medicine and rehabilitation. Since he could not learn about programs in person, he participated in virtual openhouse sessions and contacted programs’ residents and coordinators. “That helped me get an idea of the attitude within certain residencies, especially in how they view wellness and lifestyle,” he says. Meka says the Office of Medical Education helped students with interview preparations in different ways, including surveying them about their needs, creating a Zoom best-practices guide and conducting mock interviews. “In mock interviews, we practiced with faculty members on Zoom,” notes

{ } “I am so grateful for the opportunity to attend medical school at this time—at an institution that recognizes the impact of structural, social, environmental and biological factors on health outcomes.” —DANYA ZIAZADEH, CLASS OF 2024

determined which objectives could be delivered eﬀectively via remote instruction and which required clinical time to complete,” explains Alan J. Lesse, MD, senior associate dean for medical curriculum. Lesse, associate professor and vice chair for education in the Department of Medicine, says the eﬀectiveness of the curriculum was assessed, in part, through national “shelf ” exams. “Comparisons of the scores from the COVID-19-impacted clerkships

Danya Ziazadeh, Class of 2024

Micha Gooden, Class of 2021

Saarang Singh, Class of 2021

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Shirley Xu, PhD, candidate in pharmacology and toxicology

Gooden. “We got advice and feedback about how we were answering their questions. There was also a webinar on how to troubleshoot situations like Wi-Fi going down during the interview.” Along with the drawbacks of virtual interviews, there were some benefits. “Students could apply to more programs without worrying about airfare and hotels for interviews,” says Singh. “The interviewee might have an advantage on interview day as well, where you can tailor your environment to make it as comfortable as possible.” Over the summer of 2020, residency program directors and staﬀ at the Jacobs School, in turn, began planning how to eﬀectively alter residency interviews for a virtual format. “Meeting current residents and faculty of the program and witnessing how we interact gives candidates an idea of the flavor and collegiality of the program,” says Jeremy P. Doak, MD, program director of the orthopaedics residency and clinical associate professor of orthopaedics. Doak and program administrator Tammy Smith developed methods such as a video question-and-answer session and an online socializing opportunity to help applicants experience this collegiality in a virtual format. Additionally, Smith and Thomas R. Duquin, MD, clinical associate professor of orthopaedics, found a way to acquaint prospective applicants with the residency via the web. Over the summer, they created an online lecture series featuring faculty members, which included sessions where attendees could interact with current residents. The department also posted grand rounds online, allowing prospective residents to glimpse the training at UB.

pediatrics and senior associate dean for research integration. “It’s not only before entry into a study, but also during a study. “Potential participants are hesitant to enter studies,” adds Quattrin, “especially if they require an in-person visit to the campus. Things like a focus group in person—which we recently ran successfully—become very cumbersome. You have to screen and social distance everybody and make sure that you provide masks in case someone doesn’t have one.” All this is done despite the fact that participants are entering an environment in which every precaution has been taken to make it safe. Shirley Xu, a trainee in the doctoral program in pharmacology and toxicology, is energized to continue her own research in the lab. “Once labs started reopening, it was reassuring to return to a more normal routine. Also, as more research about SARS-CoV-2 is published, I find a lot of similar molecular interactions between the immune reaction to the virus and some of my own research in the lab,” Xu says. “It encourages me to continue my work, even if it is only indirectly related to the pandemic we face.” Xu also notes that the pandemic shutdown made her realize even more strongly the importance of collaborative research, including the training of new students and coordinating schedules for complex experiments. Gary J. Iacobucci, PhD, a postdoc in the Department of Biochemistry, agrees that despite the disruptions it has caused, the pandemic has created more cohesive research lab environments.

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RESEARCH PROTOCOLS REVAMPED COVID-19 has also impacted research projects and clinical trials. In accordance with a directive from the UB Oﬃce of the Vice President for Research and Economic Development, all nonessential university labs were closed March 15, 2020, and reopened June 5, 2020, in strict conformity with safety guidelines provided by the oﬃce. All individuals participating in clinical trials must be screened and vetted, and a strict COVID-19 related protocol must be followed for every visit. “There are additional tasks and precautions that all teams have to take,” says Teresa Quattrin, MD, UB Distinguished Professor of

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“We had to keep our students engaged, and we needed to try and find ways to keep the students interacting with us in the classroom, even though we were going to be online.” —LISA JANE JACOBSEN, MD, ASSOCIATE DEAN OF MEDICAL CURRICULUM

“It was a steep learning curve on the new regulations,” he says, “but scientists always enjoy a problem to solve. We became even more fastidious with our cleanliness and with polite, respectful enforcement. “And most importantly, when people were going through challenging times, everyone was always there for support. So, in some ways, the shared struggle to overcome these new barriers helped foster more camaraderie and an even more cohesive lab environment.”

LESSONS IN RESILIENCE Despite the disruptions, David Dietz, PhD, professor and chair of pharmacology and toxicology, has been impressed with how the Jacobs School has handled the challenges the pandemic has brought.

Virtual

MILESTONES

Historic “firsts” for school during time of pandemic

David Dietz, PhD, professor and chair of pharmacology and toxicology

“Strong senior leadership—particularly above my level—has been fantastic, so we haven’t just been running around doing things in a vacuum. That has been enormously helpful,” he says. “I also have new respect for the faculty and their commitment to the students, and I have new respect for the young trainees, the scientists, who have been continuing on with their research in the face of really difficult working environments,” Dietz adds. “And the unsung heroes have been the staff. I can’t emphasize that enough. They were busier at the start of this pandemic than they normally are, setting up Zoom meetings, and so on. They really made it work. “We’ve all come together in a way that I haven’t seen before, to get the educational mission completed and to facilitate safe research.” The Jacobs School also established services and activities to support student wellness. “We have a student-led wellness group with a faculty adviser who provides activities for students, and there are a variety of programs offered by UB Counseling Services, including yoga classes and mindfulness-based stress-reduction sessions,” Meka notes. “In addition, counseling and psychiatric services are available, and we make sure that students know these resources are available to them. The counselors and psychiatrists have been proactive in terms of being aware of the different challenges of medical school and the stresses of being in a demanding educational program during this time of uncertainty. “Many of our students throughout this pandemic have certainly had to deal with their own challenges—both educational and personal—and they are trying to navigate those complex situations. At the Jacobs School, we’ve tried to do our best to provide them with the support and resources they need to succeed and have the best possible educational experiences,” she adds. Jacobsen notes that while studying medicine during a global health pandemic is taxing, it has presented valuable lessons to be learned. “One of the skills you need as a physician is resilience—the ability to maneuver when things get tough and unexpected circumstances come your way, and yet you need to keep going,” she says. “Every difficulty that students go through ultimately helps to prepare them for some of the things that will come their way when they are caring for their patients.” Bill Bruton Jr. and Alexandra Edelblute contributed to this story.

The 174th commencement of the Jacobs School of Medicine and Biomedical Sciences was held virtually on May 1, 2020—the first such commencement in the school’s history. All students wore identical UB-blue sweatshirts and “hooded” themselves live, on Zoom. Pictured here is Gabrielle DeAbreu, MD ’20, newly hooded. She is currently a pediatric resident at Hofstra Northwell Health/Long Island Jewish Medical Center.

The first virtual Match Day in the school’s history was held on March 20, 2020. On August 7, 2020, a new class of 182 students celebrated its entry into the Jacobs School during the school’s first hybrid White Coat Ceremony (see photo on page 18). The ceremony was conducted in person for students in the M&T Auditorium on the downtown campus. Students who were unable to attend—as well as family and friends—were invited to view the ceremony via a Zoom video live-streamed on YouTube. Both Match Day 2021—held on March 19—and the 175th commencement for the Jacobs School—held on April 30, 2021—were celebrated as socially distanced outdoor events.

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Photo by Sandra Kicman

“TIME TO MOVE THE PENDULUM” UNDERREPRESENTED MEDICAL STUDENTS HAVE A VISION FOR THE FUTURE STORY BY ELLEN GOLDBAUM PORTRAITS BY DOUGLAS LEVERE

ny physician will tell you that medical school was one of the most—if not the most—stressful times of their life, even if they attended when societal and cultural dynamics were relatively stable. Given this reality, one can’t help but wonder how today’s students will remember their medical school years, as one norm-shattering event after another has unfolded, competing for their time, energy and attention. In just this last year alone, students have seen their teachers and mentors battling a devastating pandemic; experienced the

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sudden closure of their classrooms and labs, which severed them from interactions that help ease the challenges of medical school; witnessed the nation rocked by a powerful protest movement catalyzed by the killing of George Floyd; and lived through a volatile presidential election that culminated in an attack on the U.S. Capitol. While all medical students have been aﬀected by these events, medical students of color have been aﬀected in a more immediate way, and the manner in which these aspiring physicians are responding is generating initiatives—and insights—that promise to inform positive changes in the Jacobs School of Medicine and Biomedical Sciences for years to come.

The White Coats 4 Black Lives march was organized by Ashley Jeanlus, MD, obstetrics and gynecology resident, right, pictured with Latrice Johnson, MD, also an obstetrics and gynecology resident.

CUMULATIVE TRAUMA Underrepresented students have been dealing with the very real effects of social upheaval in their communities, observes Dori Marshall, MD ’97, associate dean, director of medical admissions and associate professor of psychiatry in the Jacobs School. “There has been a cumulative trauma for our students,” notes Marshall. “Just in the time I’ve known them, I’ve watched them feeling disenfranchised by top leadership in the country, uncared for by all layers of government. They look around, especially those who are new to the city, and they say, ‘Where is my place in this school, in this city?’” For many students of color in the Jacobs School, reaching out to their own communities—paving the way for the next generation—provides one answer. As a result, they often take on additional commitments, mentoring Buffalo’s middle and high school students and working with undergraduates in groups such as the Minority Association for Premed Students at UB. In 2017, Karole Collier, MD ’21, was instrumental in establishing Second Look Weekend, an initiative that gives underrepresented students a chance to take a closer look at the Jacobs School. Students who participated in the event say it cinched their decision to enroll in the school because of the strong sense of community it creates. Since its inception, Second Look Weekend has helped the Jacobs School to nearly double the number of underrepresented students it enrolls compared to the previous years, and those numbers continue to increase. Student-led initiatives such as this have developed in tandem with school-wide efforts to partner with community groups in order to begin addressing the social determinants of health in Buffalo. In 2018, the Health in the Neighborhood course debuted as an elective, combining research into health disparities with real-world experience, pairing medical students with families of the Hopewell Baptist Church on the city’s East Side. The goal is to give students an understanding of how structural racism and widespread implicit and explicit bias persist, and how health care delivery in these communities can be improved. Over time, families and medical students have developed a rapport, working to overcome the mistrust many community members have had in the health care system. Health in the Neighborhood is currently being expanded by placing students with clinical preceptors in underserved communities. This further introduces them to the community and allows them to incorporate clinical skills and patientcentered care principles in this setting. In 2018, UB partnered with the community to hold the inaugural Igniting Hope conference focused on eliminating health disparities. Now an annual event, the conference has spawned a broad array of initiatives, from working to eliminate neighborhood food deserts to addressing the disproportionate levying of fines and fees on blacks in poor neighborhoods for minor violations. In December 2019, following years of in-depth discussions between faculty, Buffalo clergy and community leaders, UB established the Community Health Equity Research Institute aimed at addressing the causes of health disparities and developing innovative solutions to eliminate them. One month later, in January 2020, word of a lethal virus impacting Wuhan, China, began to circulate. Soon, COVID-19 was exploding into minority communities in the U.S., dramatically magnifying health disparities. Classrooms were locked, instruction went virtual. For medical students of color, it hit close to home.

Ashley Jeanlus, MD, obstetrics and gynecology resident, top, organized the White Coats 4 Black Lives march; faculty, staff, students and area health care workers, center and bottom, marched from the Jacobs School to Niagara Square. Photos above by Sandra Kicman.

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A DIFFERENT LIVED EXPERIENCE “Our peers were talking about Netflix, and we were doing virtual funerals,” says Collier. “It was such a diﬀerent lived experience, so stark. You couldn’t shake it oﬀ. It was real; it wasn’t a history lesson. The people you love were the ones at risk.” Just as the nation was beginning to experience the shock of living in a lockdown, Breonna Taylor, a 26-year-old black health care worker, was killed in her sleep by policemen who mistakenly entered her apartment looking for a suspect. While social protests had swept the nation after the killing of George Floyd in May, it was Taylor’s killing in March that shook Jacobs School students, as she was a victim with whom they identified. “That really hurt,” recalls Adetayo Oladele-Ajose, Class of 2023. “She was a health care worker. She was a very bright person, working her way up. It felt especially personal.” Echoing Oladele-Ajose, other medical students of color explain that the killing of Taylor—someone in their chosen field—was especially painful because their decision to become physicians often stemmed from a strong desire to combat the health and social justice disparities that they and their families have personally experienced. One such student is Aswad Jackson, Class of 2022, a native of Mississippi, and a graduate of Tougaloo College, a historically black college and university (HBCU) with which the Jacobs School has a partnership. Following graduation, Jackson plans to eventually return to his home state to practice medicine. “As far as health disparities, Mississippi is among the top of the list,” says Jackson, who has an interest in primary care so that he can provide comprehensive and continuous care to his patients. He is well aware of the mistrust that people of color feel toward the health care system. “I want to be an advocate for my patients,” he says. “I want to be part of the solution to gain back that trust.” In the summer of 2020, Jackson was studying for his USMLE Step One exam. “There was a lot happening,” he recalls. “Studying for this huge exam, COVID, the presidential election, and then there were the social injustices across the country. It was tough.”

CLASSMATES MARCH SIDE BY SIDE The killing of George Floyd by Minneapolis police on a busy street in the middle of the day on May 25 was a turning point. Within hours, the video of his death revealed a level of police brutality many Americans had no idea existed, or could not bear to face in a sustained way. “A lot of people felt hopeless,” explains Neneyo Mate-Kole, Class of 2022. “It’s like you could have the greatest education and go to medical school, but if a person feels a certain way about me, I could have been George Floyd, with someone’s knee on my neck.” The surge of activism from Americans of all backgrounds who took to the streets to protest police killings and support Black Lives Matter was pivotal. “I think that was a moment when people were finally getting it, no matter how bittersweet,” says Collier. “It was telling to black people in general just how low we had to get for others to acknowledge the basic humanity we have been calling for. But you had to celebrate, regardless, because people were listening. If there ever was a time to move the pendulum, it was then.” In towns and cities, including Buﬀalo and its suburbs, citizens gathered to express solidarity with victims of police brutality.

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Ten days after Floyd’s killing, several hundred Jacobs School faculty, staff, students and medical residents participated in a White Coats 4 Black Lives march, walking from the Jacobs School to Niagara Square, where they knelt in silence for the amount of time Floyd was pinned to the ground until his death. “The march was a great thing,” says Mate-Kole. “You don’t know who really cares, but when you see a lot of your classmates by your side who you don’t talk to about these things, it does something. You have some faith.” Ashley Jeanlus, MD, an obstetrics and gynecology resident, organized the march. Working with Keturah Lowe, DDS, a pediatric dentistry resident, she also cofounded the Black Leadership Committee, an independent organization that works to enhance the education and social experience of black and other underrepresented physicians in Buffalo. Committee activities focus on community building, outreach in surrounding neighborhoods, cultural diversity, education, mentorship, professional networking, and recruitment and retention of black and other underrepresented residents, fellows and faculty throughout UB and neighboring health systems. Jeanlus says that the events of the summer of 2020 have had a noticeable impact on her colleagues. “There are a lot of allies who maybe weren’t so aware of the challenges facing people of color,” she observes. “I think now many more individuals want to participate and engage and make a difference. I’ve never before had so many colleagues use the terms ‘white privilege’ and ‘white supremacy.’ It’s the silver lining.” Jacobs School students subsequently created a video, filmed in black-and-white, titled “Racism Is a Public Health Issue,” which went viral. Each frame shows a student or faculty member stating that police violence is a leading cause of death for young black men, that black infants are more than twice as likely to die as white infants, and that some white medical students and residents falsely believe that black people feel less pain than whites and that black skin is thicker than white skin. As underrepresented students came together during this time to plan how they would respond to the ongoing turmoil, they were also aware of the need to support one another. The executive board of the UB chapter of the Student National Medical Association (SNMA)—the nation’s oldest and largest organization focused on medical students of color—scheduled virtual town halls where people could come together to process what had happened and to vent. In addition, virtual yoga nights, meditation sessions and even a virtual paint night were held.

“The march was a great thing. You don’t know who really cares, but when you see a lot of your classmates by your side who you don’t talk to about these things, it does something. You have some faith.” —NENEYO MATE-KOLE, CLASS OF 2022

FORMAL RESOLUTION PRESENTED The students most substantive, impactful, yet challenging work began immediately after the Floyd killing. After dozens of meetings and intensive writing sessions, the students, led by Oladele-Ajose and Melissa Sloley, Class of 2023, president of the UB chapter of SNMA, drafted a resolution to “acknowledge and respond to the recent acts of race-based violence against black people nationally” and an eight-page addendum with recommendations. On June, 2, members of Polity, the medical student government, and the SNMA presented both documents to Dean Michael E. Cain, MD, and Jacobs School administrators. Although efforts to address racial inequities not just in the curriculum but in the overall educational experience had been taking place for several years, it was clear that a dramatic shift had occurred. On June 4, Jacobs School faculty, staff and students gathered for a well-attended virtual town hall called Supporting Our Community: Advocating for Change and Inclusion, featuring diversity consultant and clinical psychologist Donald E. Grant, PhD. In the months that followed the town hall, Cain chaired a special task force that met weekly to formalize the school’s responses to the student-led resolution/ recommendations and to incorporate the ensuing new action items into its strategic plan for diversity and inclusion. Throughout the process, student representatives from Polity and SNMA were invited to several of the weekly meetings and asked to provide feedback on progress made and input on next steps. “As educators of the next generation of physicians, medical schools have a critical role to play in addressing the racial inequities in health care and beyond that have burdened underrepresented communities for so long,” Cain says. “We are Adetayo Oladele-Ajose, Class of 2023 committed to reversing systemic racism and to making that principle a core value of every physician we train at the Jacobs School.” In February, a second town hall meeting was held to present and discuss proposed actions. The town hall—called Response to the Student National Medical Association/Polity Resolution—was attended by students, staff and faculty, as well as representatives of Niagara Frontier Transportation Authority and the police departments of Kaleida Health and Roswell Park Comprehensive Cancer Center. The recommendations cover many aspects of the medical student experience. They include incorporating antiracist training for professors and lecturers; protecting students and applicants who speak out against social injustice; and training or hiring personnel to establish a crisis response/bias advisory response team. While the resolution notes that student-driven ideas for diversity and inclusion efforts must continue, the students’ goal is for faculty and staff to execute action items “to reduce the burden felt by past and current students.” They recommend that scholarships be created for students who take on the administrative work required to respond to race or identity-related crises.

Karole Collier, MD ’21

Aswad Jackson, Class of 2022

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Without this type of support, the students contend, long-term change cannot be implemented because the burden to redress wrongs will fall upon medical students, at the expense of their education. This important work, says Collier, “falls disproportionately on minority students, who are already encountering multiple obstacles.” The students who prepared and endorsed the resolution note that while many Jacobs School faculty and administrators are very generous and kind on an individual level, the students’ requests for fundamental, transformational change often hit roadblocks when they hear, “My hands are tied.” “It’s important for institutions to establish guidelines that foresee challenges that people may face and to try to make provisions to address them beforehand,” says Daniel Popoola of the Class of 2023. For example, the students say such change is needed regarding police and security on campus. The June 2 Polity resolution references a Jacobs School town hall meeting on community policing last year at which a police officer stated that he was unaware of the history of tension between black Americans and police. Students also pointed out that bias persists with some individuals charged with handling security at UB, the Jacobs School and affiliated hospitals. For example, students of color can be asked to show their ID cards to the same security officer day after day when entering buildings on the Buffalo Niagara Medical Campus, while other individuals are routinely let through without being asked for ID. While incidents such as having to show an ID card may seem inconsequential, they compound to create an unwelcoming environment, which works against some of the school’s most pressing goals, such as recruitment and retention of diverse students and faculty.

Daniel Popoola, Class of 2023

Melissa Sloley, Class of 2023

COMMITTED TO CHANGE AT THE TOP Hiring more underrepresented faculty and staﬀ is a goal to which the university as a whole has committed through the establishment of President Satish K. Tripathi’s Advisory Council on Race. Administrators acknowledge that such diversity is sorely lacking at the medical school, but that change is coming with new diversity requirements for search committees and an emphasis on holistic interviewing. Margarita Dubocovich, PhD, senior associate dean for diversity and inclusion, sees a sea-change coming. “This is the moment—we have a real commitment to make this happen,” she says. It is well documented that having more diversity among instructors benefits all students and faculty and that mentoring is key, a premise taken for granted throughout the medical profession. “One of the big challenges for our underrepresented students, not just here, but everywhere, is that when they look around, they can’t find mentors who look like them,” says Marshall. “This is one way that alumni can help,” she adds. “Just to have somebody who can share stories and experiences from a place of understanding would be so helpful for our students.”

Neneyo Mate-Kole, Class of 2022

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Underrepresented students at the Jacobs School have also stepped up to mentor their own. This year, they established an M1-M2 buddy system so that underrepresented first-year students are paired with a second-year buddy who comes from a similar background. Jacobs School faculty and administrators, many of whom were already engaged in fighting health care disparities, have also intensified their commitment. “The events of the summer really brought it to the top rung of the ladder,” says Alan J. Lesse, MD, senior associate dean for medical curriculum. “We need to use these tragedies and heightened public awareness as ways to introduce physicians-in-training to the role they will play in society.” Curricular changes include addressing why marginalized populations are susceptible to certain diseases; directly acknowledging the eﬀects of systemic racism and the threat of police violence on the physical health of those aﬀected; and diversifying the standardized patient population involved in clinical competency training. Sloley and her colleagues successfully advocated for a new subcommittee on developing an antiracism curriculum, which was established in October 2020 and is led by Lesse and Jennifer Meka, PhD, associate dean for medical education. Several SNMA students serve on the subcommittee. President Tripathi invited Sloley to serve on the university-wide Advisory Council on Race.

TIME TO FOCUS ON HEALING While these are just a few of the many proposed changes underway at the Jacobs School, the students and residents driving them have expressed that it is time to focus on healing as well, but not at the expense of denying the oftentimes hidden legacy of systemic racism. “We are members of the communities that are affected and traumatized, yet we have to display our trauma for the sake of progress,” says Oladele-Ajose. “I want people to know that even if you see black faculty, staff and students who are smiling and showing up and engaging, they are hurting and they are going through it.” Jeanlus agrees. “This year has been very challenging. Everyone needs to have grace for one another. People of color are under a lot of stress, and continue to perform. Take time to acknowledge that, and have grace for people, see people as fully human.” While driving in Buffalo on Martin Luther King Jr. Day, Jeanlus says she passed two billboards. The first was a picture of Reverend King with a tagline: “The dream is still alive.” The second displayed a message from the FBI asking for tips about the attack on the Capitol. “The juxtaposition of the two can be seen everywhere. I am a woman, a person of color and a physician,” Jeanlus says. “The work is far from over before we achieve the dream.” White Coats 4 Black Lives marchers knelt in silence at Niagara Square for the amount of time George Floyd was pinned to the ground until his death. Photos above by Sandra Kicman.

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A Conversation

WITH DEAN CAIN

LEADERSHIP DURING A TIME OF HISTORIC CHANGE AND CHALLENGES

M ichael E. Cain, MD, is the

PHOTOS BY SANDRA KICMAN

third-longest-serving dean in the history of the Jacobs School of Medicine and Biomedical Sciences.

Since being recruited to the University at Buffalo 15 years ago, he has focused his energy and expertise on preparing the Jacobs School to excel in the 21st century and beyond. Indeed, many of the initiatives he has guided to fruition will represent a lasting legacy. In 2011, Cain was named vice president for health sciences at UB. In this role, he leads the university’s five health sciences schools, which, in addition to medicine and biomedical sciences, include dental medicine, nursing, pharmacy and pharmaceutical sciences, and public health and health professions. A major milestone of Cain’s tenure as dean took Michael E. Cain, MD, vice president for health sciences and dean, Jacobs School place in 2017, when, after a decade of planning, the of Medicine and Biomedical Sciences, presiding at Match Day 2021. medical school relocated to a new, state-of-the-art building in downtown Buffalo, in close proximity to its health care and research partners. advancing medical education; and proactively worked to Prior to that, Cain helped put in place a process that support the establishment of the UB Community Health resulted in the university’s winning a prestigious Clinical Equity Research Institute, launched in January 2020. Translational Science Award in 2015, which was renewed In retrospect, no one could have predicted that the in 2020. Much of the groundwork for this accomplishment complexity of these many undertakings would pale in was laid years earlier, when Cain led efforts to build the comparison with what lay ahead, as the COVID-19 pandemic 170,000-square-foot Clinical and Translational Research arrived, bringing with it a host of challenges, the depth and Center (CTRC), which opened in 2012 on the Buffalo Niagara magnitude of which few other deans in the school’s 175-year Medical Campus (BNMC). Designed to promote scientific history faced. curiosity and collaborative synergies, the CTRC serves as a In December 2020, Cain was asked by Governor Andrew state-of-the-art hub for clinician-scientists to more rapidly M. Cuomo to co-lead the Western New York (WNY) translate laboratory findings into improved treatments. Vaccination Hub along with Mark Sullivan, president and Co-located in the building are Kaleida Health’s Gates CEO of Catholic Health System, and Thomas Quatroche, Vascular Institute and the Jacobs Institute. president and CEO of Erie County Medical Center. The Cain also envisioned the construction of a multiundertaking—which Cain refers to as “almost a full-time disciplinary ambulatory care center to be utilized for job in itself ”—encompasses planning, executing and student and resident education—a vision that was realized monitoring a comprehensive vaccination roll-out plan in 2017 with the opening of Conventus, a 350,000-squarefor five WNY counties. (The role of this task force and its foot building on the BNMC that houses two floors devoted continuing evolution, will be featured in an upcoming issue to such care. of UB Medicine.) In addition, Cain has recruited more than 30 chairs and Recently, UB Medicine talked with Cain about his long physician-scientist leaders; guided the school through tenure as dean, the unprecedented changes COVID-19 has successful accreditation reviews and curriculum revisions; brought to medical education, and what he sees ahead for formed the Medical Education and Educational Research the Jacobs School. Institute—a comprehensive and innovative institute for —S. A. UNGER, EDITOR

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The average tenure for a medical school dean in the country today is less than four years. You have been dean of the Jacobs School of Medicine and Biomedical Sciences for 15 years. What has sustained your commitment to this complex and demanding role?

Prior to coming to UB, I had two successive leadership positions at Washington University, each of which I held for about 13 years. Based on those experiences, I came to understand that if your intention at the outset is to make a difference, then you have to be willing to devote a sustained amount of time to building infrastructure and programs. Then, of course, you have to do a job that satisfies the people who are employing you, and you have to feel that you have and are building a team that has a comTalking with Lt. Governor Kathy Hochul during a visit she made to the school in June 2020 to mon vision, which is probably the most meet with faculty and discuss the public health impact of COVID-19 in Western New York. important element. What I have seen at UB is a very serious commitment on the part of our faculty and leaders in the school and university to constantly work to achieve excellence. Our shared purpose is to graduate the next generation of the best physicians and scientists and to work collaborWhat are some of the foremost issues medical atively to improve the public health of Western New York school deans will confront in the next few decades? and beyond. I firmly believe that we are doing that. My efforts and the efforts of the faculty excite me and make this worthwhile. One of the biggest challenges is going to be the Another factor is that we have been able to bring really business model of academic health centers. This business outstanding leadership to the school. model is going to be closely coupled to whether or not there When you put all these things together, it has been fun is a national health policy and program. to come to work. The largest source of income for the school is revenue that comes in through our clinical departments as our medical faculty provide care for patients. We need a national health policy that simplifies reimbursement of What has changed most about your role since physicians and hospitals for clinical care and recognizes 2006, when you began as dean? efforts to promote wellness. The fact that such a policy does not exist is the biggest threat to the current economic model I’m clearly managing a much larger, more proactive for academic health centers. institution than existed in 2006. And it’s not just at the Research is becoming more expensive, and it’s never level of the school. We have stronger partnerships with been completely covered by NIH grants. Today, competitive UB’s other health sciences schools and with our affiliated research programs require such things as complex inforhospital systems. Working together we have made progress matics systems, a biorepository and a clinical research in creating the Buffalo version of an academic health center. office. There are also rising costs associated with medical As a result, I am spending more time in a good way with our education, which has become a specialty now. It’s based hospital programs, which are true partners in delivering on science and not just personal opinion. One needs to better care. hire people who are trained in how to share and deliver The other area that is different today is that we have information and how to analyze and assess whether or not many more community partners: we benefit from them, you are delivering a better product. and they benefit from us. These increased costs associated with building and So, the Jacobs School has grown into a much more maintaining the infrastructure needed to support medical mature, much more comprehensive institution than it education and biomedical research weren’t apparent or as was 15 years ago. critical 15 years ago.

Q: A:

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What role do you see philanthropy playing in the school in the decades ahead, and why?

Philanthropy is and will continue to be a critical component in providing resources necessary for an academic health center. We are all aware of the cost to go to medical school. Accordingly, we need more scholarships. We’ve been able to bring renowned people here to build and sustain excellent programs because of the prestige that goes with an endowed professorship or an endowed chair. We need more.

Support for research is also critical. More and more there are essential things you need—equipment and facilities, such as an electron microscope, or a biorepository—that are not funded by grants, so the institution has to be able to support most of that infrastructure. We have four very aggressive, forward-looking strategic plans, all of which require an infrastructure and funds to help support, so philanthropy is clearly one of the keystones in providing the resources needed to realize these plans.

You have led the school’s response to the COVID-19 pandemic, in addition to your many other responsibilities. How has this been for you? What have you learned?

At the 2016 beam signing ceremony for the new medical school building, Dean Cain pictured with students, from left: Joelle Hartke, MD ’19, Connor Arquette, MD ’19, and Rahul Kapoor, MD ’18.

First, there is the emotional component, which I think everyone can relate to. This is a virus that kills people and causes severe illness. The pandemic is not something occurring in another country that we read about in the newspaper. We are directly experiencing it. We each have fears and concerns. Then there is the toll that it has taken on day-to-day operations for the school—every decision is impacted. I haven’t had a textbook that I could check out of the library that says ‘this is what you do when you have a pandemic’. COVID-19 has been, and continues to be, a situation that requires a team response. We have needed to build a team that works together and that is nimble and resourceful— even inventive at times—so I have learned how to do that. I have also learned that a world crisis such as this puts tremendous stress on individuals, as well as on systems, and it has made me appreciate how dependent we all are on each other.

As dean, you have been a forceful advocate for increasing diversity in our faculty and student body, as well as for efforts to actively address health care disparities in our community. How does the social justice movement in medicine dovetail with your goals in this area?

In 2018, President Satish K. Tripathi presented Dean Cain with the UB President’s Medal in recognition of his extraordinary service to the university.

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The school’s strategic plan for inclusion and cultural enhancement that we completed in 2018 required six months of regular meetings to develop. We put tremendous eﬀort into the plan because we understood there are health care disparities, racial injustices and inherent biases that we needed to address. Our energy was driven by the desire and need to develop a plan. We had confidence that implementation of the plan over time would have a favorable impact. There was urgency, but not an emergency to fully implement the plan.

“I have also learned that a world crisis such as this puts tremendous stress on individuals, as well as on systems, and it has made me appreciate how dependent we all are on each other.” Then we saw two catastrophes unfold in 2020. With the pandemic we saw firsthand health care disparities. We realized that the infection rates, the severity of the infection, and the death rates differed among populations in Western New York. We observed firsthand that the response to treatment differed among different populations of people, whether you looked at it by age, by gender, or by race. Then we witnessed multiple episodes of racial injustice and the murder of people. These events acted as an incredibly powerful catalyst. We may have previously thought, ‘Boy, we have a great plan,’ but we realized such a plan is useless unless we accelerated its implementation. We realized we had to take action immediately and we had to identify people whose responsibility it is to get this done now.

Q: How would you like the current students,

residents and faculty of the Jacobs School to be remembered in the decades ahead for how they learned and trained and taught amidst a pandemic and tumultuous times in society?

A: What has impressed me the most about our medical

school community is how rapidly and without contention people from diverse backgrounds and different levels of training realized that this is something different. The impact of the pandemic is bigger than moving the medical school. They understood that this was life-changing disruption and instead of running from it, everybody— our students, our staff and our faculty—everybody rose to the occasion and said, ‘If we stick together as a team and we keep in mind our four strategic plans and why we exist, we will come up with alternate ways to do what we do and get it done.’ And that’s what happened. We modified every one of our educational programs, every lecture, every lab experience and every patient encounter. So, when you look back and ask how did that group of people in 2020 and 2021 do, you will see that all of them rose to the occasion and every one of them, when it was time to step up and to shine—guess what? They stood up and they shined and they met the challenge.

DEAN MICHAEL E. CAIN, MD, STEPS DOWN As this issue of UB Medicine was going to press, Michael E. Cain, MD, announced that he is stepping down as vice president for health sciences at UB and dean of the Jacobs School of Medicine and Biomedical Sciences, effective August 31, 2021. Cain will assume a faculty position in the Division of Cardiovascular Medicine in the Department of Medicine and focus his effort on continuously enhancing the school’s educational, research and clinical care learning environments. In an announcement to the UB community on April 27, President Satish K. Tripathi stated: “An exemplary leader and a true visionary, Dean Cain has left an indelible mark on our university community, and our broader region, by elevating every facet of medical education and training, biomedical research and clinical care. His enduring commitment to UB’s mission of excellence has profoundly enhanced the impact and stature of the Jacobs School and all of UB’s health science schools— and this, in turn, has contributed immeasurably to the health and vitality of Western New York. “Quite simply put, Cain is peerless,” Tripathi said. “As we celebrate our university’s 175th anniversary this year—a university, I note, that was founded as a medical school—we can also celebrate the extraordinary legacy that Cain leaves as dean and vice president. I am deeply grateful that he will continue to contribute his wealth of knowledge and expertise to our Jacobs School students, our university and our broader community as a faculty member.”

To read the entire interview with Dean Cain, go to medicine.buﬀalo.edu/alumni/cain

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Forward

inking

o one can say for sure which issues will be front and center in health care in 25 years, when the Jacobs School of Medicine and Biomedical Sciences marks its 200th anniversary.

Experts in medicine and the biomedical sciences, however, are trained to think ahead and anticipate the shifting landscape of knowledge, both practical and theoretical, in order to help prepare society for challenges and opportunities that lie ahead. On the following pages of UB Medicine, you will read a series of essays written by some of our school’s top faculty experts who have been asked to address a variety of topics germane to society today and to ponder how these issues will evolve over the next 25 years. Many topics and experts are not included here, but we hope these essays will help set a tone of open and shared inquiry as we look to a future in which academic medicine will play an increasingly important role in efforts to improve the health and well-being of populations worldwide. We begin with an overview essay by Nancy Nielsen, MD ’76, PhD, senior associate dean for health policy and clinical professor of medicine in the Jacobs School of Medicine and Biomedical Sciences. She is a former president of the American Medical Association. –S. A. UNGER, EDITOR

Health Policy

ealth policy decisions underpin the structure and function of any health care system. They determine how and where care is delivered, what is encouraged or discouraged, how care is paid for, and who benefits in the high-tech, innovative and entrepreneurial environment that makes up our current health care enterprise. For more than a decade, health policy has taken center stage in the national debate, beginning with enactment of the Affordable Care Act (ACA) in 2010. At that time, nearly 20 percent of Americans had no health insurance and medical costs were the number one cause of personal bankruptcy. The number of uninsured has since been cut in half. Quality has improved somewhat, but medical care in the U.S. costs more, by far, than anywhere in the world. Tremendous medical advances are available, but equitable treatment for all has been elusive—we can’t decide if health care is a right or a privilege. This is not a new problem; policy-makers have grappled with it dating back to the time of Theodore Roosevelt.

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BY NANCY NIELSEN, MD ’76, PHD

Twenty-five years from now, any number of issues will require health-policy decisions to maximize benefit and reduce negative consequences. For example, artificial intelligence holds great promise for predictive modeling, risk assessment, improving diagnoses and therapeutic approaches. It can be used for remote monitoring and to facilitate communication between patients and clinicians. But the promise of these tools demands a careful analysis of ethical, legal, privacy, and equity-related issues. Privacy concerns will loom large in 2046, when monitoring of big data is routine. Legal matters ranging from confidentiality to intellectual property rights will require attention, as will data security and the proper balance between commercialization and government investment in research.

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Physicians will derive much of their income from “pay for value” or “population-based pay”; fee-for-service payments will decline dramatically. More physicians will seek employment arrangements, rather than enter private practice. Consolidation of medical groups will accelerate, and more will align with, but not be employed by, hospital systems or insurers. Telemedicine will be routine, involving all specialties; it will cross state lines and will be paid on par with face-to-face encounters. With technology, in-person encounters will be fewer but more meaningful.

Photo by Sandra Kicman

American angst surrounding whether health care is a right or a privilege will remain, with movement toward “a right,” but vigorous partisan debates about financing will continue. Employerbased health insurance will remain, but will decline in prominence, giving way to a new public option for those who don’t have insurance through work and don’t qualify for Medicaid or Medicare. Medicare for All will not be enacted. The administration of government plans will be increasingly outsourced to commercial insurers, with growth in Medicare Advantage and privatization of Medicaid.

Nancy Nielsen, MD ’76, PhD, senior associate dean for health policy and a former president of the American Medical Association.

Chronic illnesses will be managed with wearable devices and remote monitoring tools. Some conditions that now call for hospitalization will be managed at home using advanced technology, real-time feedback and precise, individualized therapeutics. New categories of health care workers will emerge, including monitoring technicians, population health specialists and sophisticated data analysts who can translate artificial intelligence into actionable items. Biomedical engineers will be integral to research and clinical care. There will be increasing emphasis on understanding and influencing human behavior, so patients can live healthier lives, better understand their chronic conditions and take

effective action. Motivational interviewing will become an integral tool for physicians in all specialties. Behavioral health will ascend in prominence in medical schools and residency programs. For them to be prepared to shape future health policy, our medical students should be exposed to leadership training and become well-versed in team science and data analysis. If we are to make health care equitable, there will need to be diverse voices in the ranks and in leadership and tough conversations at the policy table. There will always be tension between what may be ideal and what is doable. The powerful voices of physicians can influence decisionmakers to craft benevolent, effective policies that will improve the health of all of us. That’s health policy in action.

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Health Disparities

ood health is not shared equally among the residents of the United States, New York State, and metropolitan Buffalo. African American, Latinx and indigenous populations, in addition to economically disadvantaged individuals of all races and ethnicities, experience striking health disparities. The approximately 100,000 black Buffalonians have poorer health, on average, than Erie County whites. Black Buffalonians are more likely to have serious, chronic, and often preventable diseases with a rate of premature mortality that is about 300 percent higher than whites who live in the Buffalo metro area. In 2020, according to the Robert Wood Johnson Foundation, Erie County’s health outcomes ranked 57 out of 62 New York counties, as measured by the length and quality of life. Racebased health inequities are the reason for the poor ranking.

absence of grocery stores and vital services, poor access to health care, and unkept streets, sidewalks and vacant lots. Physicians often advise people who suffer from common chronic ailments such as hypertension, diabetes and obesity to get more exercise by taking walks, eating a healthy diet with fresh fruits and vegetables and complying with antihypertensive medications. These lifestyle and pharmacological interventions are challenging when unkept sidewalks make walking dangerous, supermarkets do not exist and low-incomes force choosing between medicine and other vital needs. Blacks are also sometimes reluctant to seek medical attention because of racist encounters with the health care system. The Jacobs School of Medicine and Biomedical Sciences and the University at Buffalo (UB) are taking a social justice perspective, which views health as a human right. Abolishing the health inequities facing African Americans will require turning their neighborhoods into good places to live, improving access to quality health care and deepening our knowledge and understanding of the health challenges they face. UB launched the Community Health Equity Research Institute to meet this challenge. The institute’s goal is to perform research to advance understanding of the root causes of race-based health inequities and to develop and test innovative solutions to eliminate them.

Photo by Sandra Kicman

Photo by Douglas Levere

These health inequities result largely from the reality that blacks and whites in metropolitan Buffalo live in separate and unequal neighborhoods. The educational, labor and housing markets interact to produce these marginalized and underdeveloped neighborhoods in which many African Americans reside. Systemic structural racism causes the undesirable social determinants of health found in these communities, which include low wealth, distressed and lead-contaminated housing, limited internet access, under-resourced schools, dependence on public transportation,

BY TIMOTHY F. MURPHY, MD, AND HENRY LOUIS TAYLOR JR., PHD

Timothy F. Murphy, MD, a SUNY Distinguished Professor of medicine and microbiology and immunology, is senior associate dean for clinical and translational research, director of the Clinical and Translational Science Institute, and director of the UB Community Health Equity Research Institute.

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Henry Louis Taylor Jr., PhD, is professor of urban and regional planning in the School of Architecture and Planning, where he directs the Center for Urban Studies. He is an associate director of the UB Community Health Equity Research Institute.

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The institute arose from a five-year partnership between the African American Health Equity Task Force, a community-based group led by influential pastors and community leaders, and UB. The most significant health impact will come from research and interventions that attack the social determinants of undesirable health outcomes. This community-based strategy requires an interprofessional community of faculty, students and community stakeholders to apply a community-based participatory research model. In this approach, the community guides the research agenda, contributes to the research design, serves on the research team and benefits from the research. The great universities of the 21st century will be judged by their ability to help solve our most urgent social problems. Health inequities are one of the most urgent problems facing our nation. Our community partners and the Jacobs School are determined to meet this challenge head-on.

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Medical Education

edical education is both art and science and requires the intentional application of evidence to deliver an excellent program. The goal of medical education extends beyond supporting students in mastering essential knowledge and skills; it seeks to develop future physicians who serve our communities, advocate for patients, are leaders in research and health care, and provide outstanding patient-centered care. In 2018 we relocated to our new building, which provided us with space to infuse more active learning, including a beautiful stateof-the-art clinical competency center and simulation center. These centers provide a safe environment where students can develop their patient-interviewing and procedural skills. The COVID-19 pandemic introduced myriad challenges for our existing curriculum (see article on page 18). In the first two years of the curriculum, our faculty and students were able to transition to remote formats. Faculty quickly learned new tools to engage learners while students modified their approaches to be successful learning in a primarily online environment. Despite the lessons learned with this transition, the importance of hands-on educational experiences remains paramount. With this in mind, our faculty and staff instituted safety protocols that allowed for the anatomy course and lab experiences, along with clinical-skills instruction and related practice sessions, to continue in person.

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BY DAVID MILLING, MD, AND JENNIFER MEKA, PHD

alone or the teaching of the art of medicine. They will come from learning with and from each other—with our local community, health care systems, and across the university. They will come from embracing challenges and intentionally pursuing unique opportunities for collaboration. As we look to the next 25 years, we recognize that the practice of medicine will be more dependent on teams of professionals caring for complex patients and patients with multiple chronic conditions. In addition to preparing our students to deliver high-quality patient-centered care, we must focus on developing our local communities’ trust in the health care system. This means helping our students develop the skills necessary to promote and advance social justice and equity. Medical education in the future will require more emphasis within the classroom and clinical environment on the application of artificial intelligence, bioinformatics, population and community health, genetics, and lab sciences. The future presents vast challenges and tremendous opportunities. Through deliberate planning and collaboration across the university and within our local community, we look forward to educating the next generation of physicians and physician scientists who will be leaders in our evolving health care systems.

The most essential innovations in medical education and the most needed changes in the practice of medicine won’t come from the exploration of science

Photo by Sandra Kicman

While the pandemic has introduced unanticipated challenges, it has also presented us with unexpected opportunities to collaboratively reimagine the future of medical education at the Jacobs School. We’ve found unique ways to incorporate technologies to enhance student learning and to connect (virtually) in new and different ways with experts within the UB community and around the world. Further, we are beginning to identify what content is essential and needs to be learned early in training versus what is best learned within clinical settings.

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In the clerkships, the need to transition to a remote experience for core content gave us the opportunity to re-examine what is most important for each specialty. Once students were able to safely reenter the clinical environment, they participated in immersions that focused on the clinical aspects of the clerkship. Faculty and residents reported that they found students to be more engaged and autonomous during the immersions.

David Milling, MD, is senior associate dean for student and academic affairs in the Offices of Medical Education, and associate professor of internal medicine.

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Jennifer Meka, PhD, is director of the Medical Education and Educational Research Institute, associate dean for medical education, and assistant professor in the Department of Medicine, Division of Behavioral Medicine.

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Team-Based Health Care

magining health care 25 years from now is nothing short of exciting, as biomedical advances that are in their infancy will become mainstream: a single blood test to predict future potential for chronic disease, genomic-driven personalized medicine, wearable biomedical devices that provide sophisticated monitoring and reporting through mobile applications, and 3D printing of organs and prosthetics. While these advances in biomedical technology will continue beyond our imagination, the delivery of care by talented health care professionals who are highly skilled in team-based care is the essential ingredient for the translation of these advances into positive health outcomes for people with illness, injury and chronic diseases. Medical advances have changed diseases that were life-ending into manageable, albeit chronic, health conditions. This increase in the number of people with chronic physical and mental health conditions results in an increasing demand for health care services and providers. Using a team-based approach to care for this increasing population of people with chronic conditions will utilize the rich knowledge and skills of health care providers from many professions to optimize patient outcomes and ensure that people are healthier throughout their entire lives. We know that team-based health care is associated with improved patient health outcomes and satisfaction, strengthened health systems and reduced costs of patient care. Team-based care will be the culture of all health care systems. Collaboration with other

BY PATRICIA J. OHTAKE, PT, PHD

health care providers, the patients and their caregivers, either in person or virtually, will be commonplace. The increased demand on health care providers that currently is associated with high rates of provider burnout and job dissatisfaction will be a thing of the past because of our collaborative health care culture, a culture well known to be protective against burnout. It is essential to this vision of collaborative health care delivery that primary care will be highly valued, easily accessible and available and will be delivered at community clinics using a team-based culture. In addition to caring for people when they are unwell, these health care teams will work together to ensure optimal community health through the provision of annual wellness visits to screen for health risks and current problems associated with the social determinants of health, physical health and mental health. The outcomes of these screenings will be visits with the appropriate health care team members and the implementation of coordinated strategies to mitigate the risks, rectify problems and provide wellness counseling. So how do we make this vision of a culture of collaborative health care practice a reality? Four years ago, UB embarked on the mission to prepare highly competent health care professionals who improve health outcomes by excelling in interprofessional communication, teamwork and the provision of safe, ethical patient- and population-centered care. We are on an exciting trajectory to advance health care delivery through team-based care by providing interprofessional education for our students. Through participation in the Office of Interprofessional Education’s learning experiences, health-professions students come together to learn from and with each other. Each year, UB graduates more than 1,000 health-professions students who have learned the essential skills of collaborative practice—the roles and responsibilities of other health care providers, interprofessional communication and teamwork.

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Twenty-five years from now, there will be approximately 30,000 UB health-professions graduates who have been educated to practice in the culture of collaborative health care—and many of these graduates will be providing care in our local communities. In 25 years, not only will our community be physically and mentally healthier due to their positive interactions with their collaborative health care team, but health care providers themselves will also be healthier, with negligible burnout due to their practice culture of collaboration. Patricia J. Ohtake, PT, PhD, is assistant vice president for interprofessional education at the University at Buffalo, and an associate professor in the Department of Rehabilitation Science in the School of Public Health and Health Professions.

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Behavioral Medicine

Obesity, smoking, alcohol use, low activity levels, unhealthy diets and inadequate sleep contribute to the majority of disease burden. The most direct approach to these problems is to help people change their habits so that a healthy lifestyle becomes the default, rather than the exception. In fact, behavioral treatments are the evidence-based treatment for some disorders. For example, behaviorally based weight loss has been shown to be better at preventing people with prediabetes from transitioning to type 2 diabetes than the most commonly prescribed medication, Metformin. Similarly, cognitive behavioral treatment for insomnia is superior to pharmacological treatments for insomnia, both in terms of quality of sleep and duration of treatment effects. I anticipate, therefore, that evidence-based behavioral treatments will become more available as part of standard medical care. A corollary of this shift in emphasis should be enhanced assessment tools that focus on health behavior. At present, the medical system does a good job of surveilling common diseases (e.g., assessment for early signs of hypertension, cardiovascular disease, diabetes, cancer), but rarely are a person’s diet, exercise, sleep or stress levels assessed. If we are to place disease prevention on equal footing with disease treatment, these factors need to be measured regularly and interventions need to be easily accessible within the medical home model. Prevention means we should be implementing behaviors for an individual’s future benefit, not for how they make them feel in the present. Yet no assessment is currently made of someone’s temporal orientation or whether they can make positive decisions to influence their future health. In the future, measures of important health behaviors and behavioral phenotypes (consistent behavior patterns) will be considered biomarkers of disease in the same way high blood pressure is today.

BY LEONARD H. EPSTEIN, PHD

self-regulation so that people can learn what causes changes in their symptoms and how to reduce them. These devices also provide detailed information that will help doctors make more nuanced treatment plans tailored to individual characteristics. Efforts to tailor treatments to individuals in order to provide optimal care has been a hallmark of applied behavior analysis for decades. Now these efforts are being recognized as important to medicine as precision medicine. In the years ahead, precision medicine should begin to include behavioral phenotypes, which influence not only the course of a disease but also how well people can adhere to individualized treatment regimens. Noncompliance with treatment regimens is a major barrier to improving health care. Across medicine, innovative experimental designs are being developed to establish the effectiveness of treatments tailored to individuals’ genetics, microbiome, health behaviors, or patterns of treatment compliance. The future is bright, but much work needs to be done to integrate a focus on health behaviors into routine medical care. UB is well poised to play a leading role in this transformation by incorporating ideas from behavioral health experts university-wide to create a community of scholars in health behavior.

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he primary model in our current health care system is to take care of people after they become sick and need medical care. Given that many chronic diseases can be prevented with changes in behavior, the next stage in medical care is to have a greater emphasis on healthy behaviors.

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Another important direction for medical care is to incorporate the use of new personal technologies as a means to encourage and enhance healthy behaviors. These technologies—such as heart rate, glucose and blood pressure monitors—make it possible to improve Leonard H. Epstein, PhD, is a SUNY Distinguished Professor in the Department of Pediatrics and chief of the Division of Behavioral Medicine.

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Biomedical Informatics

iomedical informatics is the field of medicine that deals with the representation, use, analysis and prediction of health information. Subfields include bioinformatics and health informatics, which includes public health informatics, clinical informatics (a new board-certified medical subspecialty), biomedical ontology, imaging informatics and human-factors engineering for health. To understand where biomedical informatics is moving health care, one needs to look first at the wonderful progress that we have brought to health care to date. Informatics created MedLine and Pubmed, which expose the biomedical literature to clinicians and biomedical researchers all over the planet and are the basis for systematic reviews and meta-analyses that drive clinical guidelines and evidence-based medicine. Informaticians helped map the human genome, and it is estimated that this may have saved five to ten years of laboratory work. This has now led to precision medicine, which is changing the practice of medicine through the use of genomic and proteomic data to direct therapy (see related essay on page 42). Informaticians developed standardized electronic prescribing methods, which increased the safety of prescriptions nationally. They developed the technologies that drive electronic health record systems (EHRs). Along with EHRs, informaticians developed order sets and clinical-decision support that help clinicians to practice accurate and evidence-based medicine. These are now bolstered

BY PETER ELKIN, MD

by cellphone applications that bring medical knowledge to the palm of your hand. Unanswered questions in the practice of health care will less often delay or lead to non-evidencebased practice. We have begun to change health care from a cottage industry where clinicians practice as they were trained, to a systematized practice of medicine. The Affordable Care Act was made possible in part due to the development of systems that use interoperable semantic data that monitors the quality of care a patient receives. Natural-language processing and standardized observational databases have strengthened our ability to algorithmically understand patients’ longitudinal clinical history of care and their clinical outcomes. Today, there are systems to determine the risk of individuals based on their health conditions. In the future, we will monitor all providers’ risk-adjusted quality performance measures. This will allow us to incentivize clinicians to provide high-quality care to patient populations that have high-risk conditions. Looking to the future, the goal is to produce a learninghealth system where we learn from our practice of medicine every day in order to provide better care and to keep our populations healthier in the long term. In order to accomplish this goal, we need to work together. We need to use our data to derive value. This can be accomplished in part by using artificial intelligence and machine learning to create predictive analytics to determine who is at risk for bad outcomes, and to give those individuals access to intensive preventive therapy. An example might be to provide more frequent screening to individuals at high risk for cancer, thus leading to fewer cancers. Other examples are new models of collaborations between specialties to ensure that we communicate and share best practices. This could include electronic tumor-board applications, which have the capability of bringing expertise to bear on a patient’s case across distance and time.

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Biomedical informatics with its new specialty of clinical informatics is leading health care toward a set of human-computer partnerships that will keep our populations healthy, and will expediently and accurately treat the sick. Informaticians at UB and around the world will need to partner with all specialties to advance and improve health and health care through faster and more systematized clinical practice, medical education and biomedical research.

Peter Elkin, MD, is professor and chair of the Department of Biomedical Informatics and professor of internal medicine.

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The Impact of Stem Cells

he isolation of mouse embryonic stem cells (mESCs) by Martin Evans in 1981 ushered in a new era of biomedical research. It enabled investigators to study the function of any gene in a mouse. Almost 40 years of mouse research has cured many mouse diseases that are used to model the human versions, from cancer to Alzheimer’s disease. Numerous failed clinical trials demonstrate that humans are very different from mice. The derivation of human embryonic stem cells (hESCs) in 1998 by James Thomson ignited the hope in doing for humans what was done for mice. Ethical concerns on the use of human embryos stimulated the search for alternatives, which culminated in the revolutionary discovery of induced pluripotent stem cells (iPSCs) by Shinya Yamanaka, for mouse in 2006 and for human in 2007. This disruptive technology enables investigators to study any inborn condition of an individual by converting easily accessible cells (e.g., those flushed out in urine) to iPSCs, which are virtually the same as hESCs and can thus be differentiated into any types of cells. Explosive growth in this area is rapidly changing biomedical research, drug discovery, and therapeutic development. It is now possible to generate virtually any types of human cells, not only in a flat layer, but in 3-D organoids that bear structural and functional resemblance to various human organs. We have converted human iPSCs to the naïve state, which is very similar to the state of mESCs. When naïve human iPSCs are injected into mouse blastocysts, human cells develop with the mouse embryos and generate chimeric embryos with up to 4 percent of mature human cells of various types, e.g., enucleated red blood cells, lens fiber cells, and liver cells. Several disruptive technologies on the horizon will fundamentally change our understanding of human biology and medicine in the next 25 years.

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chimeras will have the same appearance as mice, but with human components that would enable more accurate disease-modeling and therapeutic development. Because the development of human cells is dramatically accelerated to match the developmental pace of the mouse, it is also possible to study how human cells define age epigenetically. These studies may lead to such dramatic applications as attenuation or even reversal of aging. From a fertilized egg to an adult, any organism is a DNAbased information processing system that deploys a prescribed sequence of epigenetic changes in cell states. The next 25 years will witness the revelation of this operating system for humans. UB is well-positioned to ride the wave to the forefront of making disruptive medical breakthroughs. The most important task is to acquire talents who can shape the trajectory of the wave. There will be plenty of resources ready to support such exciting explorations. The time to act is now.

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By injecting naïve human iPSCs into mouse blastocysts lacking a critical gene (e.g., Pdx1) for making a certain organ, it may be possible to make human organs, such as a pancreas, in a mouse. This technology, called blastocyst complementation, has been used to make a rat pancreas in a mouse and vice versa, by Hiromitsu Nakauchi. The goal is to make human organs in large animals with physiology similar to human (e.g., pigs). On a parallel track, pigs have been made compatible for human organs by CRISPRmediated deletion of all porcine proviruses that are innocuous to pigs but harmful to humans. On the other hand, it is now possible to study the development of human cells, tissues and organs in mice through blastocyst complementation. These mouse-human Jian Feng, PhD, is a professor in the Department of Physiology and Biophysics. His research is aimed at finding the cause of Parkinson’s disease, and a cure for it.

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Precision Medicine and Precision Diagnostics

Precision diagnostics, in turn, is the toolbox which pathologists and laboratory medicine physicians use to assemble precision diagnostic statements. How does precision diagnostics work? An example in breast cancer care may help. If a woman has a small breast cancer that is completely excised, she has an overall good prognosis, but she still has some risk for tumor spread in the years to come. We know that this risk can be dramatically reduced by adjuvant chemotherapy. There are however many risks with chemotherapy, and the majority of these women really do not need it. So how could we make a precise decision on which women will progress, offer them treatment and avoid the adjuvant therapy risks for the rest? Tests of multiple genes associated with breast cancer progression can be performed on the tumor tissue and/or we can use computer algorithms to precisely exam the pixels in microscopic pictures from the breast cancer. Amazingly, each method can precisely diagnose which woman needs the adjuvant chemotherapy and which woman does not. The best precision diagnostic tests predict a patient’s response to a chosen therapy such that almost 100 percent of the treated patients have a good response. Precision diagnostics makes precision medicine possible.

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hat if every medical decision always resulted in the best outcome for every patient? This, of course, is a cherished dream of all patients and medical practitioners. Until recently this dream has seemed to be an utter impossibility. But now, maybe not? The first part of the 21st century has seen an explosion in medicine’s access to “big data” in the digital forms of human molecular biology, radiology and cell and tissue imaging. All of these approaches have expanded our understanding of the complexities of human biological systems, and these approaches have been made even more powerful and accessible by the advent of modern computing. This means that fast computers running advanced algorithms may be able to help physicians make important decisions by looking for patterns in the digital data. These digital data come from gene and protein analyses, high-resolution microscopy, and radiological examinations of human tissues and organs. The decisions made from massive digital data may be better because they take into account lots of very detailed quantitative data sources, which makes for the possibility of more precise choices. This sequence is known as the big-data-to-big-knowledge paradigm, and it is the process that can fuel choosing the best diagnosis and the best treatment for an individual patient every time. We call this process precision medicine.

John Tomaszewski, MD, is a SUNY Distinguished Professor and Peter A. Nickerson, PhD Chair of Pathology and Anatomical Sciences.

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BY JOHN E. TOMASZEWSKI, MD

So, what will the practice of precision medicine and precision diagnostics look like in 25 years? Physicians will continue to start by taking a patient history. The patient’s signs and symptoms along with their full medical history will be entered into a precision diagnostics artificial intelligence (AI) system, and the physician along with the AI assistant will choose the best precision diagnostic tests. Noninvasive highresolution cell and tissue imaging will be used in targeted scans to find disease hot spots. The data from the imaging, along with molecular microsampling of these hotspots, will be used by the physician and AI assistant to create precision medicine treatment plans that are 99 percent effective. For the last 10 years at UB, the departments of Pathology and Anatomical Sciences, Biomedical Engineering, Biomedical Informatics, Computer Science, and Materials Design and Innovation, and such centers as the UB New York State Center of Excellence in Bioinformatics and Life Sciences, have been building the basic science programs on which precision medicine and precision diagnostics will be established. Because of this, our university is well positioned to make the jump to this new paradigm of medical practice.

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Surgical Training

hirty years ago, it seemed so simple to teach the art of surgery. There were a few basic tools: knife, clamps, forceps, retractor and the Bovie cautery. We would see one, then do one, then teach one. If you transported surgeons from that time to today via a time machine, they would hardly recognize their environment. Yes, we still use the basic tools occasionally, but the revolution of minimally invasive surgery has created an explosion of instruments, techniques, energy sources and novel approaches that would be inconceivable not that long ago. This raises the issue of how to train the next generation of surgeons. Even a procedure as seemingly straightforward as an inguinal hernia has been transformed. Instead of making a four-inch incision on everybody, we can use laparoscopic approaches through the abdomen, minimally invasive approaches in the abdominal wall, and robotic approaches, using sutures, staples, tacks or even sticky mesh. How will we train residents to perform inguinal hernias four different ways? We used to treat simple colon tumors by organ removal and inpatient admission. Now, in some situations, these tumors can be removed with an endoscope and the patient discharged the same day.

Many of these basic skills, therefore, will be learned in simulation centers, where the building block training can be performed in a safe environment. The surgical community is developing toolsets for skills mastery such as SAGES’ (www.sages.org) Fundamentals of Laparoscopic Surgery, Fundamentals of Endoscopic Surgery, and the Fundamental Use of Surgical Energy. The latter program highlights the complex changes that surgical energy has gone through in the last three

BY STEVEN D. SCHWAITZBERG, MD

decades. It was relatively straightforward when electrosurgery could be used to make incisions or treat small bleeders, but now there are multiple modalities, ranging from advanced bipolar energy to ultrasonic coagulation to argon beam plasma coagulation and the like. These high-energy devices need to be mastered outside of the clinical milieu in order to be used safely in the operating room. In the next 25 years we will see a proliferation of simulation techniques, applications of artificial intelligence, surgical robotics and virtual reality that will be central to training all future physicians as well as surgeons. We already see the value in the dual-console robotic systems, where teacher and trainee have the identical view and instrumentation during live patient cases, which in some ways is even more advanced than what is available in a pilot’s cockpit, where student and instructor instead work their hands in mirrored fashion. At the Jacobs School of Medicine and Biomedical Sciences, the opportunities afforded by the Behling Simulation Center, UB RIS2E2 and Tjota Advanced Procedure Suite will be critical to teaching these techniques. Advanced training with a wide variety of models, techniques and technologies has already begun there and will continue in the years to come.

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There is not enough time or potentially even enough patients to garner that level of expertise for everyone upon graduation. Classic apprenticeship models of surgical training are no longer practical for a variety of reasons, including the value of operating room time, liability and reduced training/work hours. Furthermore, surgical curriculum in the 21st century has expanded to include an increasing number of topics outside of the operating room that must be covered. These include use of the electronic health records, HIPAA, cultural competency, the ethics of consent and the culture of safety, to name a few. As a result, it is no longer viable to comprehensively train surgeons in the operating room. Instead, we need to bring trainees into this highly complex environment after having already mastered the basic skills, which can then be refined.

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Steven D. Schwaitzberg, MD, is professor and chair of the Department of Surgery.

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Pediatric Medicine

ur country’s 75 million school-aged children are an abundant treasure. While only 24 percent of the population, they are 100 percent of our future. Their future will be our legacy.

Research is fundamental to infant and child health. In recent decades, it has resulted in substantial progress in reducing deaths and improving the health-related quality of life worldwide, but many problems remain. Continued and increased investment in research will be especially effective if it focuses on preventable conditions and emphasizes local health issues when findings are implemented. Infants and children tend to be healthy, so much of their care is preventive. This population, however, is uniquely vulnerable to the effects of prolonged, elevated stress that can have a toxic effect on development and life course trajectory. Today’s pediatricians therefore not only manage the physical and psychological wellness of infants and children, but additionally their socioemotional development and well-being. The powerful impact of the social context on children’s health cannot be overstated. Social determinants of health—including quality schools, transportation, housing, health care, food and jobs—affect outcomes in life, since child health is a strong predictor of adult health. These complex, integrated and overlapping issues, which in many communities are widening, are responsible for most health inequities.

BY STEVEN LIPSHULTZ, MD

UB faculty are involved with identifying systems that perpetuate inequality and with examining risk factors that contribute to health disparities and inequities. All children should have an equal opportunity to be healthy, to learn, and to achieve their maximal potential. The zip code where a child grows up should not determine his or her future. Over the next 25 years, UB pediatricians will increasingly focus on the role of children’s social and physical environments in lifelong health, social competence, and the quality, accessibility, outcome efficacy and cost-effectiveness of clinical care. To do this, they will more often incorporate developmental and behavioral pediatrics, mental health and treatment of emotional disorders of children, especially for members of vulnerable special needs populations. All of this will involve reframing how children and their families receive care and services by increasing effective advocacy and by engaging myriad child-focused community stakeholders; e.g., pediatricians, health agencies, neighborhood organizations, human services organizations and policymakers. Research initiatives will increasingly focus on improving the public and economic health of underserved populations and on identifying conditions that predispose children and adolescents to adult diseases. A paradigm shift from cost containment to avoiding unnecessary suffering and premature death will be key.

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The UB Department of Pediatrics is well prepared to accomplish its research goals by focusing on precision genetic medicine and personal health history to: (1) create therapies for individual patients, (2) enhance preventive medicine to transform health care systems from illness to prevention and wellness, and (3) manage chronic illnesses. Determinants of health, well-being and disease exist in our community, and that is where they should be addressed. Health is our outcome. There is a tremendous, relatively untapped set of opportunities to create synergy between UB, the Jacobs School of Medicine and Biomedical Sciences and our many world-class partners on the Buffalo Niagara Medical Campus and in Western New York. A dynamic interaction between these research entities with policymakers, advocacy groups and funding institutions is essential if we are to ensure that infant and child health research remains a top priority in concert with the teaching and training of future child health care professionals. Steven Lipshultz, MD, is the A. Conger Goodyear Professor and Chair of the Department of Pediatrics.

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If successful, our combined efforts will accelerate pediatric research advances over the next 25 years, helping to ensure that future generations of children have a healthier life than those who have gone before.

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Maternal Mortality

he United States has one of the best and most expensive health care systems in the world, yet the maternal mortality rate (MMR) is rising and significantly higher than that of other developed countries. Pregnancyrelated death is defined as the death of a woman while pregnant or within a year from termination of pregnancy, occurring as a result of a pregnancy-related illness or as a result of an underlying illness exacerbated by pregnancy. Between 1987 and 2016, the MMR increased from 7.2 deaths to 16.9 deaths per 100,000 live births. Approximately half of the more than 700 maternal deaths in the U.S. each year are deemed preventable. What is more striking, although maybe not unexpected, is the racial disparity in maternal mortality, as well as severe maternal morbidity, with greater than three times the rate of death in nonHispanic black and indigenous women compared to white women, regardless of income or education level. There is an association with government insurance, as well as poverty level. This points to differential access to quality prenatal care and high-performing hospitals; Hispanic and black women are more likely to deliver their babies in low-performing hospitals.

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BY VANESSA BARNABEI, MD, PHD

to identify female deaths that were pregnancy-related, to conduct a comprehensive, detailed review of factors leading to these deaths, and to develop strategies and interventions to decrease the risk of future deaths. The MMRB, which includes experts from throughout the state, began meeting early in 2020, and has been reviewing all cases of maternal mortality that are possibly related to pregnancy. Future strategies might include improved education about certain medical conditions, and the development of hospital policies to limit disparities in care. Working through the UB Community Health Equity Research Institute, for example, UB and Jacobs School faculty can investigate the specific causes of maternal morbidity and mortality, in order to develop solutions that address the impact of social determinants of health on MMR in our own community. We can also recognize our own biases and the impact these may have on the care of our most vulnerable neighbors.

The leading causes of pregnancy-related maternal death in New York state are embolism (blood clots), hemorrhage, infection and cardiomyopathy. Cardiovascular disorders, including hypertension, are increasing in women of childbearing age and are adversely impacting prenatal outcomes. In 2019, the New York State legislature approved funding for the establishment of a statewide maternal mortality review board (MMRB) in order

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There is a concerted effort nationwide to address both the high rate of MMR, as well as the racial disparities. Even prior to pregnancy, it may be possible to impact a woman’s risk of serious morbidity and mortality associated with pregnancy. Improved access to family planning services (including abortion) and affordable contraception would decrease the likelihood of unplanned pregnancy, which in and of itself is a risk factor for maternal morbidity and mortality. The Affordable Care Act, passed in 2010, eliminated substantial insurance co-pays for contraception, decreasing the disparity in access to these options—although many groups have argued successfully against this provision. The Biden administration has plans to reverse some of these rollbacks, as well as end the Hyde Amendment, which prevents public funding for abortion services. President Biden has already reversed a ban on federal funds going to international aid groups that perform or inform about abortions. Women’s reproductive rights continue to be assaulted at the state and local levels as well, even though the majority of individuals in this country support access to affordable contraception and abortion.

Vanessa Barnabei, MD, PhD, is professor of obstetrics and gynecology and associate dean for faculty affairs in the Jacobs School of Medicine and Biomedical Sciences. She is one of three co-chairs of the New York State Maternal Mortality Review Board.

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Biomedical Ethics

iomedical ethics is a young, evolving field. The discipline as we now recognize it took shape in the mid-20th century as advances in the scientific foundation of medicine resulted in new dilemmas that were not strictly biomedical. Rather, these quandaries required a shared perspective that drew upon the humanities and social sciences. The earliest dilemmas included equitable dialysis allocation, but this interdisciplinary approach was soon applied to countless decisions in both public policy and patient care. Contemporary biomedical ethics subsumes a number of different clinical activities and academic disciplines. Hospital ethics’ committees participate in dispute mediation among patients, families and staff. University academic programs study empirical and conceptual matters relative to clinical, legal and societal implications of ethical analysis. Looking forward to the next 25 years and beyond requires that we anticipate parallel changes in biomedical science and clinical care.

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I expect that many aspects of contemporary clinical bioethics will continue to migrate into clinical medicine. Topics like informed consent, decision-making capacity and end-of-life decisions will properly take their place in the comprehensive care of patients rather than remain a separate discipline of medical ethics. Ethics committee meetings will be replaced by interdisciplinary team meetings. Similarly, research ethics will continue to evolve into an

BY JACK FREER, MD

integrated compliance and institutional review board (IRB) function within the research framework. What I expect to remain relatively unchanged is the scholarly function of the academic institution. Advances in medical science will necessarily create new problems and dilemmas in the realm of biomedical ethics. A thorough, deliberative process that is guided by clear thinkers and informed by human history will produce the best answers to these seemingly unique challenges. Indeed, many of these new situations will echo prior circumstances. The analytic approach to these dilemmas will help determine which historical references are relevant and which are not. This historical perspective can be found in the growth of the gene-editing technology CRISPR-Cas9. CRISPR is a powerful tool for editing genetic material by replacing nucleotide sequences. It appears to be a promising technology for correcting genetic mutations, such as the one that causes cystic fibrosis. Presumably, this modality is capable of other edits, raising the possibility of preventing other diseases or even enhancing functional capabilities or physical appearance (if and when these traits can be localized on the genome). When one places CRISPR in the context of history, however, we see that it cannot be separated from the matter of eugenics. Eugenics is the advocacy for improvement in the quality of the human genetic makeup by means of selective breeding. In the early 20th century, there was an active eugenics movement in the U.S. that had strong ties to academia. This movement and educational programs associated with it likely resulted in state laws permitting involuntary sterilizations and antimiscegenation laws criminalizing interracial marriage. Now that we are able to modify genetic material directly (rather than with selective breeding), society must revisit the thorny issue raised by earlier generations of scientists and governments. Time will tell whether it was the goals of eugenics or their practical implementation that were more odious. The answer to this and many related questions will be the focus of bioethical inquiry into this new modality.

Jack Freer, MD, is an emeritus clinical professor of medicine and co-director of the UB Romanell Center for Clinical Ethics and the Philosophy of Medicine. For 30 years, he directed the clinical ethics course that UB medical students are required to take.

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UB is well positioned to address these and similar issues that arise in the next quarter century. The breadth of academic programs across the university could provide the foundation for a robust ELSI (Ethical, Legal, and Social Implications) research group for emerging technologies. Similar to ELSI programs in genomic or nanotechnology projects, a permanent unit would be able to address these issues for novel endeavors early in their development.

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Gender Disparities in Academic Medicine

e in academic medicine have known for some time that inherited social inequities prevent us from keeping our fundamental pledge to do no harm. We have, even if unwittingly, harmed people and stymied our own aspiration for excellence by ignoring the systematic disenfranchisement of certain populations. Discrimination on the basis of race and sex, along with other protected characteristics, has been illegal in the United States for more than half a century. Yet, as a nation, we are far from achieving equity in the workplace. In academic medicine, we have not been the leaders, humanists or healers we aspire to be. Just last year the National Academies of Sciences documented substantial sexual harassment and gender discrimination in academic sciences and medicine, and acknowledged their corrosive effect on our humanistic mission. This report, along with the concurrent MeToo movement, has brought home the reality experienced by large numbers of our students, trainees and colleagues. How can the situation be so dire after years of intentional efforts to combat discriminatory practices? To even aspire to do better going forward, it is important to acknowledge the harsh truth that academic medicine has been historically unfriendly to women and that progress over the past 25 years has been marginal.

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BY GABRIELA K. POPESCU, PHD

the need to move beyond compliance and reporting and to take the steps necessary to transform the culture of academic medicine. The AAMC has issued a similar call to action for all its member institutions and societies. Both recommend a focus on defusing power differentials by increasing the number of women who serve in senior and leadership positions, making women’s achievements more visible, and increasing transparency and accountability throughout the system. With specific recommendations such as these, along with a growing body of research and an agreed-upon strategic plan in place at the Jacobs School of Medicine and Biomedical Sciences, we are ready to begin articulating metrics and specific goals to increase gender equity. If over the next 25 years we firmly commit to optimizing the potential of all members of our community, regardless of gender, then we will mark the 200th anniversary of the Jacobs School by celebrating a level of excellence that more accurately reflects our humanistic mission—and perhaps even elevates it.

For almost two decades, women have been applying to, matriculating in, and graduating from medical schools in equal numbers with men. Yet the latest statistics from the AAMC (2018-19) show that only 41 percent of full-time faculty are women, and of these, most remain in low-rung positions. Currently, women represent only 25 percent of full professors, 18 percent of chairs, 29 percent of chiefs and 18 percent of deans. These low percentages have been stable over the last two decades and result in power differentials that obstruct progress in achieving gender equity.

Photo by Sandra Kicman

Therefore, to reach our common goals of excellence, we must take immediate and concrete action to transform our environment into one that is inclusive, respectful and equitable for all learners and workers. Fortunately, leading scholars have joined to recommend interventions and to provide resources for institutions and individuals committed to action. The National Academies of Sciences’ report stressed Gabriela K. Popescu, PhD ’99, is a professor in the Department of Biochemistry and a leading neuroscientist who directs NIH-funded research on the biophysical mechanisms of learning and memory. She serves on the Association of American Medical Colleges’ (AAMC’s) board of directors and is chair of the AAMC’s Council of Faculty and Academic Societies, which is charged with identifying and voicing critical issues facing medical school faculty and academic societies. She also serves as chair of the Committee for Professional Opportunities for Women within the Biophysical Society, the international scientific society of biophysicists.

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Patients and Families Helping to

Advance Care T

hroughout its 175-year history, the Jacobs School of Medicine and Biomedical Sciences has taken great pride in faculty discoveries that have transformed the lives of patients and their families.

As varied as these research breakthroughs have been, however, something they all have in common is that they didn’t happen overnight, but were the product of many years of incremental discoveries made by researchers, often from around the world. The recent development of the lifesaving COVID-19 vaccines illustrates this reality, despite perceptions to the contrary. The vaccines appear to have been created in a matter of months, when in fact they are the culmination of years of research on previous coronaviruses—SARS in 2003 and MERS in 2012— conducted by teams of international scientists. Another thing that all major medical advances have in common is their immediate, positive impact on patients and their families.

This is why physician-scientists in the Jacobs School partner everyday with patients and families who are motivated to advance standards of care for a particular disease or condition. These individuals help to support and inform research that is crucial in moving studies forward, especially when there are gaps in external funding or insuﬃcient awareness about the need to improve treatments or find a cure. On the following pages, you will meet patients and families who are partnering with Jacobs School faculty and who feel tremendous gratitude for the care they are currently receiving. This form of collaboration is a crucial component of academic medicine and a foundation for many of its most notable achievements. —S. A. UNGER, EDITOR

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Hope

“He Is Our Main Source of

Hope”

BY KATHY SWENSON

ike most young married couples, Callum and Nikki McKeefery describe the months and days leading up to the birth of their son, Hudson, as exciting, hopeful and filled with anticipation. “I had a really easy pregnancy and delivery,” recalls Nikki. Hudson, born in 2016, was the perfect baby in their eyes, and they had no reason to be concerned. As he grew during his first year, however, they began to realize that he was struggling to achieve typical milestones of infant development. “By six months he hadn’t gained head control, and he wasn’t reaching or rolling over as expected,” says Nikki. The couple started searching for a doctor who could help Hudson. They took him to see a multitude of pediatricians, therapists and specialists in Orange County, California, where Nikki grew up and where Hudson was born, and in Leicester, England, where Callum hailed from. The couple had their home and business in Leicester. In his first years of life, Hudson endured magnetic resonance imaging (MRI) scans, electroencephalogram (EEG) tests, and numerous blood draws, in the hopes of finding a cause for his delayed development. “Hudson handled everything so well,” Nikki recalls, fighting back tears. “But no one had any information for us. It was deflating, and we felt really lost.” Then, results from the 100,000 Genomes Project, coordinated by Genomics England, diagnosed Hudson with a rare genetic mitochondrial disorder—flavoprotein ferredoxin reductase (FDXR) mutation. The McKeefery’s physician in the U.K. gave them a research paper by Taosheng Huang, MD, PhD, chief of the Division of Genetics in the Department of Pediatrics at the Jacobs School of Medicine and Biomedical Sciences. In the paper, Dr. Huang described his work in this specialized area of genetics, and they immediately reached out to the renowned scientist. “It’s his life’s work—he’s knowledgeable, compassionate and understanding,” Nikki says. “He’s the only person working in this specific field.” A few weeks before the COVID-19 pandemic shut down travel from Europe, the family flew to the U.S. to connect with Dr. Huang. “Time is critical,” Nikki says. “The sooner we can get Hudson help, the better.” Feeling heartened and hopeful by their interactions with Dr. Huang, the McKeeferys made the decision to donate $1 million to the Jacobs School to develop a national and international patient registry for FDXR genetic mutation research, as well as to establish and equip Dr. Huang’s laboratory to further research the FDXR genetic mutation. “Mitochondrial dysfunction lies behind many neurodegenerative disorders,” Dr. Huang explains.

“This significant investment will accelerate research, with the ultimate goal of bringing medications and therapeutics from the lab to the bedside for FDXR patients.” Steven E. Lipshultz, MD, A. Conger Goodyear Professor and Chair of the Department of Pediatrics in the Jacobs School, adds: “The McKeefery family’s philanthropic leadership demonstrates a sincere dedication to innovative medical discoveries. Thanks to their support, Dr. Huang and the Division of Genetics will vastly expand its leading-edge scientific and clinical expertise in genomic medicine.” For the McKeeferys, the commitment is as practical as it is heartfelt. “The best way for us to help our son, and other families like ours, is to support Dr. Huang and the science,” says Nikki. “He is our main source of hope.” To support the Department of Pediatrics, contact Kathy M. Swenson, senior director of advancement for the Jacobs School of Medicine and Biomedical Sciences, at kswenson@buﬀalo.edu or call 716-829-5052.

Nikki, Callum and Hudson McKeefery

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Generosity Expertise and

Generosity BY ANN WHITCHER GENTZKE

Photo by Sandra Kicman

enny Pennington can often be found sitting at her computer in the evenings, poring over scientific papers and reading emails from multiple sclerosis (MS) researchers while her two Vizsla dogs, Bogart and Mitchell, vie for her attention. Pennington has been studying MS since 1977, when she experienced sensory symptoms in her legs along with optic neuritis resulting in temporary loss of vision in one eye. She was poised to graduate from the University of Maryland with a BS in biochemistry and animal science and had early admission to the University of Pennsylvania School of Veterinary Medicine. Although the symptoms went into remission, she had a relapse the following year and was formally diagnosed with MS, which led her to reevaluate her career goals. Instead of entering vet school, Pennington earned a master’s in administrative science from Johns Hopkins and was recruited by Merck to work in health economics. Her career there included management of clinical trial liaisons and 15 years as director of federal health care aﬀairs in Washington, D.C. During that time, her MS kept a “fairly benign course” as she commuted from Washington to Buﬀalo, where she had met David Bartlett, whom she married in 1989. In 2017, Bartlett died. Pennington says she was fortunate to be able to retire early, particularly since her MS sensory symptoms were becoming more frequent. Although her symptoms have not progressed to

Penny Pennington

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other areas, she says that “there are periods when I am dealing with chronic pain.” In retirement, Pennington has put her public-policy and research expertise to work by helping to evaluate legislation for the National MS Society and by participating in their Research Program Advisory Committee meetings. She also gives her time and expertise to the Buffalo Neuroimaging Analysis Center (BNAC) in UB’s Department of Neurology, where she is a past chair and a current member of the center’s advisory council. At the BNAC, which is an internationally recognized leader in MS research, the scientists have been open to and interested in exploring areas of research that council members have proposed, Pennington says. Pennington also works closely with faculty in the Department of Neurology’s clinical arm, the Jacobs MS Center, where she is a patient of Bianca Weinstock-Guttman, MD, professor of neurology in the Jacobs School of Medicine and Biomedical Sciences and a world-renowned researcher. In 2013, Pennington’s volunteer efforts took on new momentum when she met Pamela Jacobs, wife of the late pioneering MS researcher, Lawrence Jacobs, MD, professor and chair of neurology at UB. The two women helped form ARMS— Advancing Research in MS—which supports research that advances understanding of the illness. In addition to her service and advocacy, Pennington has named UB as a beneficiary of her retirement account in support of MS research in the Department of Neurology and has made numerous outright contributions to MS research at UB. Pennington’s dedication and generosity are all the more notable—and appreciated—given that her professional background enables her to discern the “exceptional” quality of treatment she receives and the “high level of innovative research” she helps to guide in UB’s Department of Neurology. “Buffalo Neuroimaging Analysis Center is thankful for the many contributions that Penny has made over the years,” says Robert Zivadinov, MD, PhD, professor of neurology and director of the center. “Her efforts as a volunteer and her support as a donor have—and will continue to have—a direct impact on what we have accomplished. In particular, her effort to assure that patients’ voices are heard has led to new, productive avenues of research.”

L k

L k to “Dr. Jack”

BY KATHY SWENSON

ryce Stone’s struggles with sight began when he was just a preschooler. Familiar with the signs of vision loss because of a blind family member, Susan and Daniel Stone wanted to get the best diagnosis, treatment and support possible for their young son. They found John M. (Jack) Sullivan, MD, PhD, professor of ophthalmology in the Jacobs School of Medicine and Biomedical Sciences, and staff physician at the VA Western New York Healthcare System. Sullivan focuses his lab research on development of gene-based therapeutics for retinal and macular degeneration. Through genetic testing, he diagnosed Bryce with retinitis pigmentosa (RP), a group of rare genetic disorders that involve a loss of cells in the retina, the light-sensitive tissue that lines the back of the eye. Symptoms include difficulty seeing at night and a loss of peripheral vision. Eventually, most individuals with RP will lose their sight. Bryce Stone with John M. (Jack) Sullivan, MD, PhD, left, and his parents, Susan and Daniel Stone At age 11, Bryce is legally blind and preparing to live without vision. “I have a cane now, and I’m learning how to read braille,” he platform that has the potential to significantly accelerate geneexplains. “I use a sighted guide, too, where I hold onto someone’s based therapeutics by more rapidly and accurately identifying elbow to find my way.” and testing viable drug targets. Bryce and his family are receiving support from several Because the promise of Sullivan’s research is so compelling, community resources, including the Olmsted Center for Sight patients and families affected by these diseases are offering and the Chautauqua Blind Association. support. UB alumnus Roberta Stevens and her husband, George, “Those doors all opened up because of Dr. Jack,” Dan Stone says. have committed $1 million in a bequest gift to support the Despite his vision loss, Bryce is very active. “I like to fish, and Department of Ophthalmology and research into age-related my dad and I play catch by using glow sticks so I can see the ball. macular degeneration (AMD). Aleksandra Thon, whose late I have braille playing cards and a magnifier, too.” father suffered from AMD, has pledged $76,000 to establish Bryce and his parents are hopeful that future medical the LMA Thon Endowment with the Foundation of Jewish discoveries and advances in technology may someday lead to a Philanthropies to support research at UB, including Sullivan’s. therapy or cure that restores his sight. That’s Sullivan’s vision, too. Recently, Thon met Bryce and decided to provide additional He is using the latest advances in gene-based therapeutics philanthropic support to fund sight-assisting equipment for to develop promising new approaches to treating retinal and him: OrCam Myeyes2 and iPhone supported by Alek. macular degeneration. To accomplish this, he and his team “My father lost his sight due to age-related macular are developing therapies that target and suppress (shut down) degeneration,” Thon says. “As his primary caregiver, I watched genes that stress retinal cells and cause them to degenerate. The this condition deprive him of his vision and independence. molecular agents Sullivan is developing (ribozymes or RNAi), That’s why I support macular degeneration research at UB, and may also be used to alter the expression (functioning) of normal why, in my father’s memory and honor, I wanted to help Bryce genes in order to slow down the progression of age-related and his family.” retinal and macular degeneration. The research described above is supported, in part, by a VA In a further development, Sullivan and his team have created Merit Review award from the U.S. Department of Veterans Affairs, and are currently testing an RNA drug-discovery technology and a National Eye Institute award.

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Photo by Kathy Swenson

Bryce and His Family

Survive Expertise That Helps You

Survive

Photo by Chang W. Lee/The New York Times

hen Val Bias learned that the Jacobs School of Medicine and Biomedical Sciences had partnered with Western New York BloodCare to establish the Rosemary “Penny” Holmberg Hemostasis and Thrombosis Clinical Fellowship in memory of his former nurse, his response was, “She deserves it.” Bias, a Buﬀalo native and immediate past CEO of the National Hemophilia Foundation, was diagnosed with hemophilia B at birth. He attended School 84, dedicated to children with physical disabilities. By the time he was in fourth grade, he had such severe bleeding episodes, he was on crutches and in a wheelchair intermittently. “Many of the children were more disabled than I, so there was a kinship between us, and I remember those days fondly,” recalls Bias, now 62. “It was a safe place. There were no social barriers because we all had disabilities.” Val Bias Another thing that made the school a safe place was that it was located across the street from Western New York BloodCare, then known as the Hemophilia Center of Western New York. Penny Holmberg was the nurse at the center for 38 years, leader of its comprehensive care team, and the primary contact for children and parents. “She was like my mother,” says Bias. “She taught me how to manage my disease, she visited me in the hospital, she was with me every step of the way. When I was 12, she taught me how to self-infuse by practicing on her arm so I could hit the vein.” Bias says that Holmberg followed his career with great pride as he rose through the volunteer ranks to become a national leader in the hemophilia community. “I called her regularly over the years,” he says. “We stayed in very close touch and she was like a grandmother to my son.” Bias knows better than most how important it is for partnerships to develop such as the one between the Jacobs School and WNY BloodCare. It is at this intersection of patient care and academic research and training where excellence can be sustained. In Western New York, as in many parts of the country, there is an acute need for hematologists who are trained and

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skilled in the management of complex bleeding and thrombotic disorders, as well as in state-of-the-art clinical and translational investigation. Since 2018, WNY BloodCare has awarded the Jacobs School two grants aimed at addressing these needs. The first grant, for $890,000, established the Robert Long Career Development Award. It invests in a junior physicianscientist who is dedicated to conducting advanced research, facilitating training for medical professionals, and providing expert care to local patients and families with these disorders. The second grant, for $675,000, established the Rosemary “Penny” Holmberg Hemostasis and Thrombosis Clinical Fellowship in nonmalignant hematology at UB. It provides one to two years of training in advanced medical management of patients with complex bleeding and thrombotic disorders. Bias, who recently returned to Western New York to retire, says partnerships such as the one between WNY BloodCare and the Jacobs School are “key to a treatment center working well because they help form relationships with physician-scientists who have expertise in and access to resources that help you survive.”

Mental Heal Mental Heal A Team Approach to

To address this issue, the Lee Foundation has partnered with UB to provide scholarships to medical students specializing in psychiatry. Now in its fifth year, the program has supported ten medical students who are committed to remaining in Western New York. The addition of just one psychiatrist means quality care for hundreds of patients and their families. In 2019, building on the success of the scholarship program, the Foundation provided seed funding for the creation of a doctoral psychology internship program focused on serious mental illness. Each year two interns, selected through a competitive, national process, receive in-depth training while working full-time in a variety of clinical settings. “Our work is possible because of our strong community partnerships,” notes Lee. “From the beginning, UB demonstrated a shared commitment to our goals of building a meaningful mental health workforce and ensuring that people with mental illness have access to high-quality treatment and services. UB encourages a team-centered approach to care, and, just as important, an opportunity to make a lasting impact in our community. The Patrick P. Lee Foundation, based in Williamsville, New York, focuses its investments in mental health and education. Patrick P. Lee, who built International Motion Control, a worldwide manufacturer of industrial and aerospace products, formed the Foundation in 2005.

Photo by Tom Wolf

ne of the many take-away lessons of the last year and a half is the pressing need for our country to have a comprehensive, well-coordinated mental health infrastructure in place to help individuals and families in crises. A particular area of concern is the shortage of trained mental health providers, both locally and nationally. In its efforts to address this problem, the University at Buffalo has been greatly aided by its partnership with the Patrick P. Lee Foundation. For the last decade, the Foundation has had the foresight and determination to support training programs at UB that increase the number of highly skilled mental health workers in Western New York. “My family, like so many families across the United States, has been directly impacted by mental illness,” says Patrick Lee. “At times, we struggled to navigate the system and access the appropriate services. There were also times when we benefited from dedicated professionals providing quality treatment and thoughtful care. It has been these experiences—both challenging and promising—that gave rise to the Foundation’s focus in mental health.” In further describing his motive for giving, Lee explains that he was taught the importance of helping others at a very young age. “During World War II, I lived in Paris with my grandparents. Every day my grandmother and I attended mass, and on our walk home we saw people in need. Although we did not have much ourselves, my grandmother always gave a few coins to those we passed. Her simple acts of kindness remind me that even during difficult times we can find ways to help others. “Years later, I was able to attend college through the War Orphans Education Program, which provided tuition assistance to the children of military men and women who died in combat,” Lee continues. “The support was an incredible relief to my mother and me. I am not sure how I would have managed the cost of college without it. My education provided me the tools to secure my first job, which set me on the path to future success. The support I received motivates me to provide similar opportunities.” With effective treatment and support, individuals with mental illness experience fewer symptoms and have an enhanced quality of life. Unfortunately, many barriers to treatment exist, including access to care. Over 100 million Americans, including those residing in Western New York, live in a mental health professional shortage area.

BY S. A. UNGER

Patrick P. Lee

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UB faculty physicians and medical residents on the frontlines of COVID-19 The physicians portrayed on the following pages would be the first to say that they serve as part of a team and could not do the work they do without the assistance of other health care providers who practice alongside them. One such provider is Jaclyn Funk, a vascular technologist with UBMD Surgery, pictured here on the surgical intensive care unit at Buffalo General Medical Center caring for a COVID-19 patient. Photo courtesy of Kaleida Health/Joe Cascio.

“THIS IS WHAT WE DO” Only history will tell where COVID-19 ultimately ranks in comparison with other pandemics, but for UB faculty physicians and medical residents working on the frontlines of the crisis, the pandemic is an epic challenge, both in its acute and chronic phases. More than 500 faculty physicians and 700 medical residents from the Jacobs School of Medicine and Biomedical Sciences provide care to patients in UB’s affiliated teaching hospitals throughout Western New York. Many of these physicians are treating COVID-19 patients in work conditions unlike any they have experienced before. They are doing this while providing instruction and oversight as professors or while conducting research. Their expertise and around-the-clock patient care in such large numbers is one of the benefits of having a medical school in a community, says Michael Cain, MD, vice president for health sciences and dean of the Jacobs School. “I know I speak for our entire community in expressing deep gratitude to our dedicated health care workers and our UB

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faculty physicians and medical residents who are providing care to our community’s most vulnerable members during this pandemic,” Cain says. Despite the many complex and enduring challenges for health care workers on the front lines, UB’s faculty physicians and medical residents have pressed on. Time and time again during the COVID-19 crisis, they tell us: “This is what we do.” On the following pages we feature photographs of some of these UB faculty physicians and medical residents, taken during the height of the pandemic. It is our hope that these portraits will serve as part of a historical record that will acknowledge and honor their service to the community.

—S. A. UNGER, EDITOR

PORTRAITS BY DOUGLAS LEVERE

Samuel D. Cloud, DO, assistant clinical professor, Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences; UBMD Emergency Medicine, at Erie County Medical Center, a UB teaching affiliate. Photo by Joe Cascio/ECMC.

SANJAY SETHI, MD, Professor and Chief, Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; Assistant Vice President for Health Sciences; Division Chief of Pulmonology, Critical Care & Sleep Medicine, UBMD Internal Medicine

THOMAS A. RUSSO, MD, Professor and Chief, Infectious Disease, Department of Medicine; Division Chief of Infectious Disease, UBMD Internal Medicine

ALYSSA S. SHON, MD, Clinical Assistant Professor, Department of Medicine; Infectious Disease Specialist, UBMD Internal Medicine HEMA D. DODD, MD, Assistant Professor, Department of Medicine; Infectious Disease Specialist, UBMD Internal Medicine

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JAMES LUKAN, MD, left, Clinical Associate Professor, General Surgery Residency Program Director, Department of Surgery; UBMD Surgery, pictured at Erie County Medical Center, a UB teaching affiliate. Photo by Joe Cascio/ECMC.

KARIN PROVOST, DO, PHD, Associate Professor, Department of Medicine; Pulmonologist and Intensivist, Division of Pulmonology, Critical Care and Sleep Medicine, UBMD Internal Medicine

LAUREN DUBE, DO, left, and STEPHANIE COHEN, DO, Chief Residents, Department of Emergency Medicine

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JOSEPH L. IZZO, MD Professor and Chief, Clinical Pharmacology, Department of Medicine; Physician with UBMD Internal Medicine

PRAVEEN K. CHANDRASEKHARAN, MD, MS, Assistant Professor of Pediatrics, Department of Pediatrics; Neonatologist, UBMD Pediatrics

ALBERTO F. MONEGRO, MD, Assistant Professor, Department of Medicine, a Pulmonology, Critical Care and Sleep Medicine physician with both UBMD Internal Medicine and UBMD Pediatrics, pictured at Buffalo General Medical Center, Kaleida Health, a UB teaching affiliate. Photo by Joe Cascio/Kaleida.

JOHN A. SELLICK JR., DO, MS, Professor, Department of Medicine; Infectious Disease Specialist, UBMD Internal Medicine SHEHZAD S. MERCHANT, MD, Clinical Assistant Professor, Department of Medicine; Infectious Disease Specialist

JAMIE N. NADLER, MD, Clinical Assistant Professor, Department of Medicine; Pulmonologist and Intensivist, Division of Pulmonology, Critical Care & Sleep Medicine, UBMD Internal Medicine

VANDANA PAI, MD, Co-Chief Pulmonary Critical Fellow, Department of Medicine

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KIRVIA UBRI, DO, vascular neurology fellow, right, speaking to MAURICE (MO) HOURIHANE, MD, clinical assistant professor, neurology, Left, AARON TAYLOR, MD, neurology resident. Taken at Buffalo General Medical Center, Kaleida Health, a UB teaching affiliate. Photo by Joe Cascio/Kaleida.

DAVID JANICKE, MD, PHD, Clinical Associate Professor, Department of Emergency Medicine RAJESH KUNADHARAJU, MD, Pulmonary and Critical Care Fellow, Department of Medicine

ARCHANA MISHRA, MD, MS, Clinical Associate Professor, Department of Medicine, Division of Pulmonology, Critical Care and Sleep Medicine

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MANOJ J. MAMMEN, MD, Associate Professor, Department of Medicine; Pulmonologist and Intensivist, Division of Pulmonology, Critical Care and Sleep Medicine, UBMD Internal Medicine

TUNG-LIN JESSE YUAN, DO, Emergency Medicine Co-Chief Resident, PGY-3 FRANCES “FRANKIE” UWECHUE, MD, General Surgery Resident, PG1

SARAH ACKAH, MD, MPH, 2020-2021 Chief Resident; Internal Medicine-Pediatrics Department

GALE R. BURSTEIN, MD ’90, MPH, Clinical Professor, Department of Pediatrics; Commissioner, Erie County Department of Health “WE CAN DO IT”

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IN MEMORIAM

ADELINE ‘ADDIE’ FAGAN, MD ’19 Adeline “Addie” Fagan, MD ’19, died on Sept. 19, 2020 due to COVID-19 complications. She was 28. Adeline was just beginning her second year of residency in obstetrics and gynecology in Houston. In July, she started a rotation in an emergency department at a hospital and became ill with COVID-19. She was hospitalized and placed on a ventilator and on extracorporeal membrane oxygenation (ECMO), a specialized form of life support. On Sept. 18, after being removed from ECMO and appearing to family and friends to be on the road to recovery, she suffered a massive brain bleed and passed away in the early morning hours of Sept. 19. Her father, Brant Fagan, wrote an online journal to keep family and friends updated on Adeline’s condition throughout her illness. Many members of the Jacobs School community reacted to the devastating news by remembering the Syracuse-area native as a caring and compassionate physician. “Addie decided on a career in obstetrics and gynecology fairly late in medical school, but once she made up her mind, she was willing to do whatever it took to pursue her goal,” says Vanessa M. Barnabei, MD, PhD, professor of obstetrics and gynecology and associate dean for faculty affairs. “She had an amazingly positive attitude and infectious smile and her passing will deprive thousands of women of her empathy and commitment to their health.” “Addie was a bright spot in an often-dark world, exuberantly joyful, humble, troubled by the woes of others, and determined to leave this world a better place through her outreach on many fronts,” says Dori R. Marshall, MD, associate dean, director of medical admissions and assistant professor of psychiatry. While a student at the Jacobs School, Adeline participated in four global medicine outreach trips to Haiti. David M. Holmes, MD, clinical associate professor of family medicine and director of global health education, remembers her as “a wonderful person who really cared about people and the world.” A medical school classmate of Adeline’s says: “What I will remember most about Addie is her perseverance and her joy.” The classmate noted Adeline also loved music and was the leader of the medical student acapella group.

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“I also remember her dedication to her family. Medical school is so busy, and she lived two-plus hours from home, but she still managed to see her family weekly and talk to them daily.” Adeline is survived by her parents and three sisters. In Adeline’s memory, alumni, classmates, faculty, and the community joined her family to create the Adeline M. Fagan, MD ’19 Memorial Fund. Gifts to the fund can be made online at buffalo.edu/giving/addie Or call toll free 1-855-GIVE-2-UB. Direct mailed donations to: University at Buffalo Foundation Inc., c/o Adeline M. Fagan, MD ’19 Memorial Fund, PO Box 730, Buffalo, NY 14226-0730

BOLD MEANS DREAMING BIG.

Daniel and Gail Alexander, campaign co-chairs

“All that is not given is lost” is a proverb* that Daniel Alexander, MD ’99, BA ’95, and Gail J. Alexander, BS ’87, live by. That is why they decided to give $1 million to the Jacobs School of Medicine and Biomedical Sciences. Now, they’re helping underserved and underprivileged students achieve their dreams of becoming doctors. Your generosity has emboldened our dreams and honed our vision: the Boldly Buffalo campaign is on an unprecedented course to raise $1 billion. And with your continued bold support, we’ll make history together.

buffalo.edu/campaign/medicine *from the poet R. Tagore

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