Johns Hopkins Gazette: November 28, 1994


Medical School dean emeritus recognized for lifelong efforts

     Throughout his 40-year career at the Johns Hopkins School of
Medicine, Dean Emeritus Richard Ross has worked to preserve and
protect academic medicine's inextricably linked missions of
education, research and patient care. His lifelong effort was
recognized last month by the Association of American Medical
Colleges, which presented Dr. Ross with their 1994 Abraham
Flexner Award for Distinguished Service to Medical Education.
     "This award represents for me a recognition by my peers of
the accomplishments we all have achieved at Hopkins in the years
I was dean," Dr. Ross said. "I personally am most proud of the
fact that I was able to recruit such an outstanding faculty. This
is important to me, because I believe the current faculty is
directly descended from the hospital's original 1893 faculty.
They recruited some of the best doctors in various fields who, in
turn, recruited a subsequent group, who recruited the next group.
So, I'm very pleased to have been able to continue that lineage
of excellence.
     "And the quantitative measure of that success is the
research funding we have been able to attract to Hopkins. When I
became dean, Hopkins was something like seventh in National
Institutes of Health grants to medical schools. When I retired,
we were either first or very close to it," he said. "And this
allowed us to continue to recruit top doctors and produce top
     Dr. Ross, who trained at Hopkins as an intern and resident,
and was dean from 1975 through 1990, is considered an expert in
coronary cineangiography, myocardial blood flow and myocardial
performance as affected by coronary artery disease. He is the
author and co-author of more than 150 articles and textbooks on
various aspects of cardiovascular physiology and disease.
     "Our work is not by any means done, however, because the
challenges continue in the changing health care environment," he
said. "A premium is being placed on efficient and rapid care,
shifting treatment more and more to outpatient clinics. This cuts
into the teaching aspect of our mission. But my successor
[Michael E. Johns] is working very hard to move education
opportunities to these outpatient settings.
     "Hopkins is well positioned to take on the challenges we
will face in the years ahead," he said.

Public Health's Research Day showcases faculty projects    

     Sharon Krag is well aware that the School of Public Health's
mission is too often expressed in many, and often conflicting,
languages. To try to bridge the gap between research and
understanding, Dr. Krag, associate dean of research
administration, organized the second annual School-wide Research
Day on Nov. 10, a daylong event when young and seasoned faculty
members showcase their most recent projects for colleagues and
students. It is among the most important events on the school's
academic calendar.
     "Interdisciplinary understanding often is limited by our
vocabulary," Dr. Krag said. "But we have to stop to learn from
each other, how to talk to each other.  That challenge is a
powerful thing that binds us all together. One of the school's
greatest strengths is its interdisciplinary approach to tackling
public health challenges."
     Several hundred students and faculty members packed into the
East Wing Auditorium throughout the day to discuss work and
discover common threads.
     The day was divided into three sessions: women's health was
chaired by Carol Weisman, professor of health policy and
management. The second session on molecular epidemiology was
chaired by Gloria Petersen, associate professor of epidemiology.
During the session, Lawrence Grossman, professor of biochemistry,
presided over the liveliest question-and-answer period of the
day. His topic concerned DNA repair as a biomarker in
epidemiologic studies, and he served as referee between the
epidemiologists and the biochemists. It was clear, he said, there
was a communication problem.
     "You can see why we need these research days. We have to
start sharing language and ideas," Dr. Grossman said.
     The third session on health care delivery, specifically
patient outcomes research, was chaired by Judith Kasper,
associate professor of health policy and management. One
presenter, Donald Steinwachs, professor and chair of Health
Policy and Management, discussed how outcomes research affects
health policy.
     "We've entered a new generation of accountability," Dr.
Steinwachs said. "Outcomes and quality information must be
increasingly relevant to judge the performance of health care
     "All new measures must consider diversity in health states,"
added Anne Riley, an assistant professor of health policy and
management. "The goal is more than to just keep people alive. The
best health status measures should be simple, universal, easily
interpreted and applicable to a wide range of people." 
     Dr. Krag was pleased both by the turnout for the event and
by the quality and diversity of the presentations.
     "This event allowed us to recognize and reinforce our common
threads of participation and cooperation," Dr. Krag said. "That's
the powerful purpose for this day."

Hutchins determined to create world-class international services 

     John J. Hutchins got his new position as Hopkins' first
director of international services by making his prospective
employers an offer they couldn't refuse.
     In his eight years as director of the International Center
at the Cleveland Clinic Foundation, Hutchins built the annual
volume of international business from $7 million to $70 million,
said James Block, the hospital's president and chief executive
officer. Hutchins, 53, invited himself to interview for a similar
position at Hopkins, even though no such position existed there.
But his offer to build Hopkins' international patient services
into one of the finest in the world met receptive ears.
     Within the past year, Hopkins treated about 630 patients 
from 77 countries. The Cleveland Clinic Foundation treated that
many international patients in a month. Part of the reason for
the clinic's numbers is that they had aggressively courted
international contacts and let it be known that the hospital was
very accommodating to patients and their companions, Hutchins
said. Hopkins, too, had been interested in attracting the
business, but that had not been a priority.
     But it could have been, said Hutchins' boss in Cleveland,
William Kaiser, who was a consultant to many U.S. hospitals,
including Hopkins. Hutchins said that Dr. Kaiser told Hopkins
administrators that they were losing a lot of revenue because
their programs for attracting international patient services were
underdeveloped and that the director of the program at Cleveland
Clinic was about the only one who could straighten it out. That
was John Hutchins. Although the seed was planted, the timing, for
Hopkins, was not right.
     A year later, however, Hutchins was seriously entertaining
offers from other hospitals, because Dr. Kaiser had retired and
the new administration was not receptive to expanding its market
share. As he mulled over offers from several other institutions,
he asked himself a question.
     "If I were going to go to work somewhere else, should I go
to where the offers are or should I go to the best hospital in
America and offer my services," Hutchins recalled. "The best case
scenario, I thought, was to go where the best doctors are,
because ultimately that's the service the hospital is selling."
     So John Hutchins called Johns Hopkins and invited himself
for an interview. He got the job.
     In his new position, Hutchins will be responsible for
familiar duties such as foreign patient services, marketing
programs and education. He will also assist patients and their
representatives and will coordinate all aspects of admissions, in
36 languages, with the help of interpreters. 
     Hutchins said he will draw on his 25 years of experience as
a hospital administrator, including a five-year stint as a senior
administrator at a 375-bed hospital in Taif, Saudi Arabia, to
help him smoothly handle the diverse international patient
     "There is a lot of competition out there for these
patients," Hutchins said. "Hopkins is the best hospital in the
world, with the top doctors. We can and should get a larger
percentage of them. That's my challenge."

 Researchers identify genetic alteration in prostate cancer

     Researchers at the Johns Hopkins Oncology Center and
Department of Urology have identified a genetic alteration linked
to prostate cancer that they believe is the most frequently
occurring genetic error associated with the disease. Their
findings were reported in the Nov. 21 issue of the Proceedings of
the National Academy of Sciences.
     The investigators, led by William G. Nelson, assistant
professor of oncology and urology, found the alteration--
hypermethylation of the glutathione S-transferase gene (GSTP1)--
in all of the human prostate cancer samples they studied.
     Methylation is a cellular punctuation mark control-ling the
function of DNA in a cell. Too much methylation or abnormal
patterns of it can markedly alter cell function. The researchers
believe over-methylation of the GSTP1 inactivates it, which shuts
down the cell's ability to manufacture an enzyme that detoxifies
environmental carcinogens and protects against cancer.
     "Without the enzyme, prostate cells may be more vulnerable
to carcinogens," Dr. Nelson said.
     Preliminary studies at Hopkins and elsewhere, involving men
with noncancerous prostate tumors, have shown that some produce
the enzyme while others do not. Researchers believe alteration of
the gene at this stage, leading to its inactivation, may cause
these benign prostate tumors to turn malignant.
     "If continued research confirms this hypothesis," Dr. Nelson
said, "tests for the enzyme could serve as an early diagnostic
marker for prostate cancer."

Diagnosis may sideline athletes unnecessarily

     Some athletes who lose consciousness during or after
physical exertion sometimes stop exercising, because they wrongly
fear they may suffer sudden cardiac death. But according to a
study done at Hopkins and the University of Michigan, many of
these athletes have no underlying heart problems and can be
successfully treated to prevent fainting.
     The researchers, led by Hugh Calkins, director of
electrophysiology and associate professor of medicine at Hopkins,
studied 17 boys, men and women who were involved in either
competitive or non-competitive athletics. The participants,
ranging in age from 11 to 45, all had a history of fainting
during or just after exercise.
     "Our findings are important, because they demonstrate that
athletes may lose consciousness due to vasodepressor syncope,
which is a benign and often treatable condition," Dr. Calkins
said. Following treatment with medication and an increase in salt
intake, he said, they can resume their activities.
     But researchers point out that the vasodepressor syncope
that occurs only during exercise may also reflect an underlying
heart abnormality. It is important, therefore, to diagnose
carefully those athletes who faint during exercise, because they
may only have exercise-related vasodepressor syncope and not a
potentially fatal heart abnormality.

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