Holly Korschun

Personalized Medicine Day in Georgia

Governor Nathan Deal was joined by Ambassador Andrew Young, Georgia State Representative Calvin Smyre and Leroy Hood, founder of the Institute of Systems Biology, in formally proclaiming September 1, 2011 Personalized Medicine Awareness Day in the State of Georgia.

Georgia Governor Nathan Deal presents Morehouse School of Medicine’s Dean and Executive Vice President, Valerie Montgomery Rice, MD, with a state proclamation declaring Sept. 1, 2011 Personalized Medicine Awareness Day in Georgia.

The event at Morehouse School of Medicine (MSM) was sponsored by Georgia Bio; the Atlanta Clinical & Translational Science Institute (ACTSI, which is funded by the NIH and led by Emory University with partners MSM and Georgia Tech); and Iverson Genetics, Inc.

“The collaboration within the ACTSI between these three research universities is an important undertaking and an example of how it should be done,” remarked Governor Deal as he kicked off the day’s program.

A visionary in the personalized medicine field, Dr. Hood developed the DNA gene sequencer and synthesizer and the protein synthesizer and sequencer – four instruments that paved the way for the successful mapping of the human genome.

During his keynote address he proposed a revolution in medicine.  P4 Medicine – Predictive, Preventive, Personalized and Participatory – is a proactive (instead of a reactive) approach to medicine. The paradigm change will drive radical changes in science.

For P4 medicine to succeed, a cross-disciplinary culture with team science and new approaches to educating scientists, as is done through the ACTSI, has to take place. Dr. Hood predicts the human genome will be part of individual medical records in 10 years.

Leroy Hood, MD, PhD

“The vision of P4 medicine is that each patient will be surrounded by a virtual cloud of billions of data points. Advances in science and technology will reduce this enormous data dimensionality to simple hypotheses about human health and disease,” says Hood.

“The ultimate outcome is to create individualized patient disease models that are predictive and actionable. The shift to P4 Medicine will also require societal changes.”

Personalized Medicine Awareness Day celebrated the first-of-its-kind personalized medicine study, approved by the Centers for Medicare and Medicaid Services. The study will determine the utility of genetic testing in calculating doses and reducing the incidence of adverse events associated with the initiation of Warfarin therapy. Warfarin is the world’s leading anti-blood clotting drug.

Researchers hope the study will provide data to demonstrate that individualizing treatment can improve patient safety and reduce healthcare costs, says Dean Sproles, CEO of Iverson Genetics, Inc., which is collaborating in the study with MSM and the ACTSI.

Governor Deal congratulated the ACTSI for leading the landmark Warfarin study with Iverson and is “proud that Georgia will be leading the effort.”

The Warfarin Study is led by ACTSI Senior Co-Principal Investigator Elizabeth Ofili, MD, MPH, director of the Clinical Research Center, chief of cardiology and associate dean for clinical research at MSM, and will engage 50 sites across the country and 7,000 participants. The first participant was recently enrolled at Grady Memorial Hospital.

“This study should help us understand how to use each patient’s genetic information to deliver a safer and more effective dose,” says Ofili.

Sproles noted, “The study is evidence of the growing role of genetics in helping doctors to develop optimal individual treatments for their patients.”

A panel including Emory medical leaders David Stephens, Fred Sanfilippo and Kenneth Brigham discussed and addressed questions like how to communicate ‘big science’ to the individual, how to move genetic testing to medical outcomes and who owns genome data.

“Personalized Medicine is the future,” stated Governor Deal. The presence of Governor Deal, Ambassador Young and Representative Smyre is a sign that policymakers are beginning to recognize that personalized medicine is not just a vision for better healthcare; it has the power to improve health and reduce healthcare costs.

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Fat distribution in black and white women may help predict heart disease

A woman’s body shape – often described as pear, apple or hourglass – is usually determined by the amount of fat in various regions of the body including the bust, waist, arms and hips. New research from Emory University School of Medicine suggests that these patterns of fat distribution may help predict arterial stiffness – a precursor to cardiovascular disease.

Stiff arteries make the heart work harder to pump blood and are associated with atherosclerosis, or the buildup of plaques in vessels that can block blood flow and cause a heart attack.

Noting that fat distribution generally differs between black and white women’s bodies, researchers enlisted 68 black women and 125 white women, all middle-aged, to see whether these patterns could help assess cardiovascular risk.

The study, conducted by Danny Eapen, MD, a cardiology fellow at Emory, used data from Emory’s Center for Health Discovery and Well Being. He presented his findings recently at the American Heart Association’s Arteriosclerosis, Thrombosis, and Vascular Biology 2011 meeting.

Using skin calipers, the researchers measured subcutaneous fat in seven sites: the upper chest; midaxillary, or the side of the torso just under the armpit; triceps, or the back of the arm; subscapular, or on the back just below the shoulder blade; abdominal; suprailiac, or just above the front of the hip bone; and the thigh.

“Black women have higher rates of cardiovascular disease than white women and are more likely to die from it,” says Eapen. “Black and white women also have different patterns of fat distribution, so we were interested in measuring these pockets of fat at various regions of the body to evaluate whether it might be helpful in predicting cardiovascular risk between the two groups.  Our hope was to evaluate whether a quick, easy-to-use clinical tool could aid in further risk stratifying our female patients.”

The study also assessed the arterial stiffness of the women, adjusting for heart rate.

As a group, the black women had greater arterial stiffness than the white women. They also had more subcutaneous fat in the armpit, triceps, shoulder blade and hip bone areas.

In addition, they also found specific race dependent pockets of fat that could be related to arterial stiffness – fat measurements in the triceps area could predict increased arterial stiffness in black women, while fat in the suprailiac areas was a predictor in white women.

Content contributed in part by Sarah Goodwin, Emory’s Center for Health Discovery and Well Being.

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EPA Administrator Jackson leads town hall on children’s health

People don’t think of the Environmental Protection Agency as a public health agency, says EPA Administrator Lisa P. Jackson, but the EPA’s job is to protect the health of adults and children by safeguarding air and water and promoting clean communities. Jackson was the keynote speaker last week at a Children’s Health Town Hall at Emory’s Rollins School of Public Health.

Children eat more, drink more, and breathe more in proportion to their body weight than adults, and without the EPA our jobs as parents would be much more difficult, said Jackson. And although a renewed focus on reducing air pollution has significantly improved air quality, still millions of young people have asthma and are particularly susceptible to pollution, and there have been no limits on some pollutants, such as mercury emissions from coal-fired power plants.

Last month the EPA presented the first national mercury and air toxicity standards for power plants, Jackson noted. This effort to cut emssions of mercury, arsenic, and other neurotoxins is a common sense goal that would save lives and prevent 17,000 premature deaths annually, she said.

Laura Seydel, Paige Tolbert , Stephanie Owens, EPA

The EPA recently named Emory and Georgia Tech as one of four new EPA Clean Air Research Centers and awarded $8 million to the new Southeastern Center for Air Pollution and Epidemiology (SCAPE) center. Center directors Paige Tolbert from Emory and Armistead (Ted) Russell from Georgia Tech will lead programs aimed at quantifying health effects from air mixtures containing toxic pollutants and studying the specific effects of toxic air on commuters, pregnant women, newborns, and adults with cardiac illnesses.

Russell noted the tremendous cost of air pollution, including millions of lost school days for asthmatic children, and the important of using study results as the basis for changes in policy.

A “Call to Action” panel of experts and advocates at the town hall suggested steps everyone can take to improve environmental health.

Environmental health champion Laura Seydel called for “zero waste zones” in homes, churches, and offices, and the outlawing of toxic chemicals to help create “zero toxic waste zones” in the bodies of adults and children.

Laura Seydel, Robert Geller

Dr. Robert Geller, director of the Southeast Pediatric Environmental Health Speciality Unit at Emory, and Director of the Georgia Poison Center, emphasized the importance of lowering exposure to toxic chemicals for children in the first two years of life, including contaminated soil. Civic leaders should expect the EPA to use the best science to advance its programs of reducing pollution.

Irene Barton of the Georgia PTA recommended using local school wellness councils to advocate for children.

Attorney Brian Gist of the Southern Environmental Law Center warned about mercury toxicity in Georgia fish and in sushi, and applauded efforts to regulate emission of mercury from coal-fired power plants.

Maeve Howett, an Emory pediatric nurse practitioner and a faculty member in Emory’s School of Nursing, encouraged everyone to make a personal commitment to choosing transportation that is less harmful to the environment, for the sake of children with asthma.

A videocast of the town hall is available.

 

 

 

 

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China-U.S. health care forum highlights similarities, challenges, solutions

The recent Westlake Forum III at Emory brought more than 250 leaders from Chinese and U.S. academic and government institutions together to examine and compare health care reform in the two countries, focusing on cost, quality, and access to care.

“This was an incredible human partnership, bringing together two countries with very different governments and cultures, recognizing our common problems and desires for improved health of all our citizens, working together on difficult issues and exploring workable solutions,” said Jeff Koplan, director of the Emory Global Health Institute.

The third Westlake Forum was the first to be held in the United States. It was co-hosted by the Emory Global Health Institute, Zhejiang University School of Medicine, and the China Medical Board.

Shanlian Hu, William Roper, William Hsaio, Jeffrey Koplan, Kenneth Thorpe

“Now China and the US are facing the same challenge: to push healthcare reform forward. Our two countries need to share knowledge and experiences with each other, and to learn from each other,” says Yu Hai, MD, PhD, director of China Medical Board Programs, Zhejiang University School of Medicine.

Howard Koh, assistant secretary for health, U.S. Department of Health and Human Services, presented an overview of U.S. health care reform.

Shanlian Hu, a professor at Fudan University, described China’s health care reform priorities: expanded coverage, equal access, improved benefits, improved care delivery systems and containment of soaring medical costs. These are remarkably similar to priorities of the recent U.S. Affordable Care Act.

In China, the government is committed to health care as a public good, with the goal of complete coverage by 2020. Although 90 percent of citizens are currently covered, cost and accessibility varies considerably. Hospital stays are longer than in the United States, medical training is less rigorous, and access to high-quality care is limited. As in the U.S., China’s public hospitals and providers struggle with the economic and quality issues generated by a “fee-for-service” reimbursement mechanism.

Participants worked on developing concrete collaborations such as joint research, educational exchanges or partnerships.

Yet health care costs in China are only 5.13 percent of the country’s GDP, compared to 17 percent in the U.S.

William Roper, dean of the University of North Carolina School of Medicine and CEO of the UNC Health System, said health care in the United States is a “paradox of excess and deprivation,” and Americans need to rethink their long-held assumptions.

Americans believe they have the best health care system in the world, yet we spend more on medical care than any other country, we are the only rich democracy in which a substantial portion of citizens lack care, nurses are in short supply, quality and safety are not as high as they should be, and incentives for physicians are skewed toward specialization and expensive technical procedures, Roper said.

Harvard Professor William Hsiao noted that China has made significant progress in health care reform over the past seven years. In 2003, 75 percent of Chinese citizens were uninsured, whereas today China offers coverage on some level to 90 percent, with out-of-pocket payments continuing to decline. Problems persist in lack of well-trained physicians and equipment, distorted prices, and profit motives of public hospitals and officials.

Ken Thorpe, from Emory’s Rollins School of Public Health, outlined the newly passed U.S. health reform law, which aims to expand and improve coverage and access to quality care and control rising costs. Many of these improvements would likely be paid through Medicare reductions and increased taxes on higher income households, he said.


 

 

 

 

 

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March madness: National global health case competition features 13 universities

March Madness of a different flavor overtook Emory University March 18-19 as more than 200 students, judges, observers and staff convened for the first national Emory Global Health Case Competition.

The competition involved 20 teams of five students each, representing at least three academic disciplines per team. Emory fielded eight teams, and 12 teams came from leading universities across the country: Dartmouth, Princeton, Penn, Cornell, Yeshiva, Duke, Vanderbilt, UAB, USC, UCSF, Rice, and Texas A&M. All these universities are members of the Consortium of Universities for Global Health.

The first-place team, from Emory (l-r): Jason Myers, Candler School of Theology; Abdul Wahab Shaikh, Goizueta Business School; Stephanie Stawicki, Laney Graduate School; Andrew K. Stein, Goizueta Business School; Jenna Blumenthal, Laney Graduate School; Krista Bauer (judge), GE director of global programs; Meridith Mikulich, School of Nursing (not pictured)

As in two past local and regional case competitions, this year’s event was student initiated, developed, planned, staffed and conducted.

This year’s signature sponsor was GE, with additional sponsorship from Douglas and Barbara Engmann, and internal Emory funding.

“Global health continues to grow as a primary interest of students at universities across the United States, and the Emory Global Health Case Competition has gained a reputation as the leading national team event to showcase the creativity, passion, and intellect of our future leaders in global health,” says Jeffrey Koplan, MD, MPH, director of the Emory Global Health Institute.

The Feb. 17, 2011 issue of The Lancet included an article by Koplan and Mohammed K. Ali, assistant professor of global health at Rollins School of Public Health on the benefits of problem-based competitions to promote global health in universities.

Teams worked through the night on Friday for their Saturday morning presentations. The case involved a proposal for improving conditions in several East African refugee camps in the face of a severe budget cut. Judges were blinded to the academic affiliations of the teams, but Emory won the top two prizes (first prize was $5,000). UCSF and Dartmouth received honorable mentions, and Rice was given an innovation award.

 

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University-industry partnerships: a matter for cautious aggressiveness

Emory President James Wagner was keynote speaker last week at the 2011 Academic & Industry Intersection Conference sponsored by Georgia Bio and the Atlanta Clinical & Translational Science Institute (ACTSI). The conference focused on ethical issues in translating academic research into commercial drugs and medical devices.

Wagner pointed out the great power these relationships hold for the service of humanity, provided they are properly structured and managed. He recommended “cautious aggressiveness” by both universities and industry.

We should incorporate ethical considerations into our partnerships so that the practice of ethics is not “restrictive and paralyzing, but instead becomes part of the design criteria motivating our success, not restricting it.

Wagner is co-chair of President Obama’s Commission for the Study of Bioethical Issues. The commission lists five principles with broad application for biomedical translational research: public beneficence; responsible stewardship; intellectual freedom and responsibility; democratic deliberation; and justice and fairness.

He emphasized that researchers should guard against personal conflicts of interest and ensure against any compromise of research objectivity. But he cautioned against the temptation to value the process of ethics more highly than the ethical principles themselves, and the temptation to substitute compliance for true ethical practice.

Is it possible that we and our partners have come to place too much faith in documented protocols, and that excessive regulatory burden may give investigators a false sense of absolution of their own responsibility to exercise judgment and ethical practice? he asks.

“How does that square with the moral imperative to bring new knowledge that can benefit individuals and society to practice as soon as possible? Wouldn’t it be unethical to withhold the application of such knowledge if it is known to be able to do good?”

Ethical practice should not be an afterthought, Wagner emphasized, but instead a deeply understood and critical part of design and protocol and procedure — where the exercise of expert judgment goes beyond regulatory compliance.

“A challenge to all of our universities is to advance an ethics education that will bring heightened abilities to our investigators and their partners with the goal…of establishing even more trusting partnerships that can bring technology more safely and swiftly…from the minds of creative investigators, to the laboratory bench, to the manufacturing assembly line, to the vendor’s shelves, and to the bedside.”

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HIV in metro Atlanta concentrated in four-county geographic cluster

The HIV epidemic in metropolitan Atlanta is concentrated mainly in one cluster of four metro area counties – Fulton, DeKalb, Clayton, and Gwinnett that includes 60 percent of Georgia’s HIV cases, according to a study by researchers in the Emory Center for AIDS Research (CFAR).

In a paper published in the Journal of Urban Health, the researchers found that the rate of HIV in the cluster is 1.34 percent. This fits the World Health Organization’s description of a “generalized epidemic” (>1 percent). Outside the cluster, the HIV prevalence in Georgia is 0.32 percent.

The researchers matched HIV prevalence data from the Georgia Division of Public Health, as of October 2007, to census tracts. They also used data from the 2000 census to examine population characteristics such as poverty, race/ethnicity, and drug use.

The large Atlanta HIV cluster is characterized by a high prevalence of poverty along with behaviors that increase the risk of HIV exposure such as injection drug use and men having sex with men.

The investigators also found that 42 percent of HIV service providers in Atlanta are located in the concentrated cluster, which should facilitate prevention and treatment.

Paula Frew, MPH, PhD

“A major aim of our study was to improve public health practice by informing local planning efforts for HIV services,” says corresponding author Paula Frew, MPH, PhD, assistant professor of medicine at Emory University School of Medicine and an investigator in the Emory CFAR.

With more than 50,000 new HIV infections reported yearly in the United States, according to the Centers for Disease Control and Prevention, the HIV/AIDS epidemic continues to be a major public health problem. The number of HIV/AIDS cases is increasing faster in the South compared to other areas of the country. According to Kaiser State Health Facts, Georgia ranks 9th in the nation in the number of HIV/AIDS cases with more than 3,000 new HIV infections diagnosed in 2007.

The study showed differences between Atlanta and other large cities in the distribution of HIV cases. While cases in several other large cities were concentrated in specific neighborhoods, HIV cases in metro Atlanta are more generalized within the four-county metro area. All the cities, however, were similar in the link between HIV, poverty and men having sex with men.

“Prevention efforts targeted to the populations living in this identified area, including efforts to address their specific needs, may be most beneficial in curtailing the epidemic within this cluster,” Frew says.

Other authors of the paper include Emory CFAR members Brooke Hixson, MPH; Saad B. Omer, MBBS, MPH, PhD; and Carlos del Rio, MD.

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National Academy of Sciences recognizes Yerkes Primate Center neuroscientist

Elizabeth A. Buffalo, PhD

The National Academy of Sciences (NAS) has recognized 13 individuals with awards acknowledging extraordinary scientific achievements in the areas of biology, chemistry, physics, economics and psychology.

Elizabeth A. Buffalo, PhD, a researcher at the Yerkes National Primate Research Center, is one of two recipients of the Troland Research Awards. Buffalo is being honored for innovative, multidisciplinary study of the hippocampus and the neural basis of memory. Troland Research Awards of $50,000 are given annually to recognize unusual achievement by young investigators and to further empirical research in experimental psychology.

The recipients will be honored in a ceremony on Sunday, May 1, during the NAS 148th annual meeting.

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National AIDS Strategy: Comments on a coordinated effort

In this month’s issue of the journal Future Microbiology, Emory infectious disease physician/scientists Rana Chakraborty and Wendy Armstrong from Emory School of Medicine summarize and comment on the goals and challenges of the National HIV/AIDS Strategy released July 10, 2010.

The National AIDS Strategy was the result of a directive by the Obama Administration to the Office of National AIDS Policy. The strategy’s overall goals were to reduce the number of people who become infected with HIV, to increase access to care and improve health outcomes for people living with HIV, and to reduce HIV-related health disparities.

“The National HIV/AIDS Strategy calls for a long overdue national coordinated effort to curb the rise in new HIV infections and enhance therapy in those already infected,” write the authors.

While the goals are worthy, the strategy will present many challenges, and the authors address each goal individually, and highlight challenges:

  • The initiatives are expensive, and already resources in the United States are not adequate to treat all patients currently diagnosed with HIV infection.
  • Convincing the general population that HIV is still a major problem and an incurable and often-fatal disease will remain a challenge.
  • Nontraditional testing sites outside clinics or hospitals, such as churches, while central to enhancing testing, may present problems of confidentiality.
  • Increasing the number and diversity of available providers of care is difficult given the current financial realities of the American healthcare system where medical practices with a high percentage of HIV patients often can’t break even financially.

The creation of a strategy is a positive step, say the authors, but it needs a clear financial commitment. The strategy’s strengths include a focus on specific high-risk populations, the concept of re-introducing conventional prevention methods including condom distribution and needle-exchange programs, and creating better outreach between leading HIV/AIDS centers in cities and HIV providers in rural settings.

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Tobacco free cities project aims to curb smoking in China

Jeffrey Koplan, MD, MPH

Jeffrey Koplan, MD, MPH, director of the Emory Global Health Institute and vice president for Global Health at Emory University, is leading the second phase of the Tobacco Free Cities project in China, funded by the Bill and Melinda Gates Foundation. The project, which launched in 10 Chinese cities this week, is a partnership with the ThinkTank Research Center for Health Development in Beijing.

Vice mayors of each of the 10 cities signed an official pledge to strive to create tobacco-free cities for residents. China has more than 300 million smokers, the most of any country, and more than 500 million people in China are exposed to secondhand smoke.

“The two-year project aims to enhance the overall capacity in smoking-tobacco control of the cities and help ease the burden caused by tobacco to public health, the environment and the economy,” Koplan says in an article in China Daily.

The project launch was covered by other major Chinese news outlets, including Xinhua News Agency.

The first phase of the Tobacco Free Cities project launched in June 2009 in seven Chinese cities. The project is part of the Emory Global Health Institute-China Tobacco Partnership. In January 2009 Emory University received a $14 million, five-year grant from the Gates Foundation to establish the partnership.

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