Of Staggering Scale
What it's like to oversee one of the largest hospital construction projects in the country.
Amid the clang of jackhammers and grinding whir of power saws, the heart of the Johns Hopkins Hospital campus is not-so-quietly being transformed. With work about one-third complete on the new cardiovascular and critical care tower and a children’s tower—on a five-acre plot at Orleans and Wolfe streets—we hit the construction site with Michael Iati, director of architecture, and Sally MacConnell, vice president of facilities, to find out what’s involved in completing the mammoth project.
Just how big is this building?
Iati: The scale is staggering. The building is two 12-story towers and encompasses 1.6 million square feet. That’s four Weinbergs! You could fit the entire Billings Building in the front entry circle and it wouldn’t touch anything.
What’s it likebeing at the helm of this thing? People renovate kitchens and go crazy.
Iati: It’s like building a 60-million-ton watch. All these pieces have to fit together. Between architects, engineers, contractors, the construction manager, and the suppliers, all these things need to be coordinated. There are thousands of discussions that go on every day.
MacConnell: All my maintenance guys need to understand all of the things they’re going to need to do to maintain the building. Because on day one all of its systems—its HVAC systems, its plumbing systems, its medical gas systems—need to be installed properly and function as they were designed. That’s where it departs from being like your kitchen. Quite frankly, if the stove doesn’t work on day one, you call the guy back; if the medical gas outlets don’t work, that’s a crisis.
How do you ensure that the building actually works as it should?
Iati: Everything in many respects is custom. We built a life-sized portion of the building’s glass wall at a testing facility in Florida and subjected it to hurricane winds and earthquake forces to make it leak. Then we rebuild it, test it again, and when it’s weather-tight, then, OK, that’s what we’re building. Then there are the small details, like how do you clean the windows? We have to make sure that the guy who needs to dangle over the side of the building has everything he needs to safely attach to the building.
When will you reach the peak of the project?
MacConnell: We expect the height of construction to be in late 2009. We’ll have close to 1,000 workers on the job site by that time. There are 5,000-some-odd drawings for the building. It takes an army.
What are you proudest of?
Iati: For the first time, it will feel like we have a fitting entrance for the Hopkins Hospital. There are four entrances under the canopy—the critical care tower, the adult emergency department, the children’s ED, and the children’s hospital. Everybody comes to the front door.
MacConnell: This is an enormously important building. It’s the entry to Johns Hopkins Hospital for the next 100 years.
Reported by Mary Ellen Miller
The Great Grant Chase
Flat funding is hampering medical progress, Miller tells Washington legislators.
Ed Miller is putting it all on the line: Cutting support for research is casting a pall across the land for scientists everywhere, he told a Senate committee in March. The flattened funding is coming at a pivotal moment in medical discovery, he says, and it’s having “a particularly insidious effect on our young scientists.”
The Dean/CEO of Medicine’s appeal to Washington is simple: Please find a way to restore healthy science funding so the best and brightest can get back to their labs. To drive the point home, Miller described how one ambitious cancer researcher here has spent “90 percent of his time chasing grants” instead of pursuing his promising new approach to reversing breast cancer.
Miller and other senior heads of major research institutions made the late-winter pilgrimage to raise the visibility of a report detailing the grander problem. The report—“A Broken Pipeline? Flat Funding of the NIH Puts a Generation of Science at Risk”—profiles a sampling of variously hindered young scientists. The institution heads all worry that the greatest young researchers will soon exit the career field altogether, squandering big ideas and the medical advances they would have made for patients everywhere.
In the text that supported his panel discussion before the Senate Committee on Health, Education, Labor and Pensions, Miller underscored one of the key concerns voiced by veteran scientists around our campus. To wit: In their efforts to secure funding, “all of our scientists, both young and more senior, are becoming risk-averse.”
So why aim for the wild frontiers at a time when cautious science funders are looking for the safest bets?
Because, answers Miller, many of the sharpest minds are drawn to those frontiers, where the greatest discoveries are so often found. Miller cited a number of Hopkins-linked breakthroughs, including that of genetics professor Carol Greider, who more than two decades ago played a key role in mapping the telomerase enzyme that helps maintain the ends of chromosomes. That discovery opened up untold new areas of medicine: Today, scientists know that telomerase is elevated in 85 percent of all human cancers.
Greider was in her early 20s at the time of the original discoveries. Her two senior partners were in their 30s. If Greider’s trailblazing group sought funding for similar work today, asked Miller, would the NIH provide them funding?
Miller rounded out his list of powerful examples with cancer researcher Ben Ho Park, whose lab is using powerful molecular genetic techniques to pursue genes involved in clinical drug resistance. The lab is also exploring the mechanisms of growth/hormone receptor signaling that appears to support cancer growth. But, Park told Miller, “I can’t think about science anymore, I have to focus on getting grants.”
Total funding for the NIH has been plateaued near $29 billion for five years, lagging well behind inflation. The net effect is driving promising young scientists to look for work overseas. What discoveries might be leaving with them? “It would be a shame to never know,” says Miller.
Brody to Retire as University President
Higher education’s eloquent advocate will be missed.
As he has with every entity of The Johns Hopkins University, William Brody created an enduring legacy within Hopkins Medicine throughout his dozen years as president of this large, diverse institution.
Brody, 64, announced in March that he will retire on Dec. 31, the official conclusion of the current $3.2 billion “Knowledge for the World” fundraising campaign—the second successful, billion-dollar-plus campaign he has overseen.
“I simply love this job,” Brody said in a message to students, faculty, staff, and alumni. “But leaving is inevitable. Twelve years is a great run, and stepping down at the completion of my second campaign will allow the trustees to recruit a highly talented and able leader who will take Johns Hopkins to the next level.”
A former professor and director of the radiology department at Hopkins and professor of biomedical engineering and electrical and computer engineering, Brody expanded and modernized the research and education facilities for the health professions schools on the East Baltimore campus as part of a master plan that includes the current construction of two new clinical towers and a new education building at the Hospital.
Among the interdisciplinary institutes, centers, and offices established during Brody’s presidency are the Institute for NanoBioTechnology, the Center for Global Health, the Office of Critical Event Preparedness and Response, the Brain Science Institute, the Institute for Cell Engineering, and the Malaria Research Institute.
With the creation of Johns Hopkins International in 1998, Hopkins Medicine expanded its mission of teaching, research, and patient care to the Middle East, Africa, Asia, Europe, and Latin America through partnerships with governments, universities, and health service providers.
Under Brody’s direction, the Hospital and Health System, along with the university, also have worked closely to provide financial support, time, and talent to help solve problems much closer to home, in the neighborhood surrounding the medical institutions’ campus.
“There is no one who speaks more eloquently for the mission of higher education than Bill Brody,” said Edward Miller, Dean/CEO of Johns Hopkins Medicine. “Bill put those words into action and our university is well-positioned to meet the challenges of the 21st century. He has been a strong advocate for Johns Hopkins Medicine and I will miss his leadership.”
Neil A. Grauer
|> Brown led the charge to ban latex.
Born Here, Now Banished
Latex surgical gloves began at Hopkins, but their time has come.
Robert Brown was braced for more noise. After all, it’s not every day that a man engineers the end of a 114-year tradition that was pioneered by the very institution he calls home. Latex surgical gloves, first instituted here by William Halsted in 1894, have been completely banished from the far-flung empire that is Johns Hopkins Medicine. All gloves must now be made of synthetic rubber.
Hopkins is one of the first medical institutions to enact such a “latex-safe” policy, and Brown—an anesthesiologist who occupies a research office on the seventh floor of the Bloomberg School of Public Health—is chiefly responsible for the revolution. He took part in early studies regarding the prevalence of latex allergies, and quickly found himself drafted onto the hospital’s risk management team. He now holds the auspicious title of Chair of the Johns Hopkins Hospital’s Latex Task Force.
As the official change became effective last summer, Brown started to get a bit spooked by the silence. So he “called around” to well-placed colleagues in key departments. Everything’s fine, they all said. Now, Brown jokes about how much free time he suddenly has to do his other work.
The chemical properties of natural latex rubber affected some people much the way bee venom did, Brown explains. The allergic reactions showed up in about 6 percent of patients exposed to the natural rubber during medical procedures—it’s also commonly used in other medical products such as surgical tubing and blood pressure cuffs—and by the mid-1990s hospitals everywhere started offering non-latex alternatives.
But with 12 or more sterile glove types offered in the inventory here up until recently, many latex devotees declined to give up without a fight. A few surgeons were especially noisy in the early going, says Brown. Some of them openly pleaded: “Can I just keep latex gloves for myself? In my locker, maybe?”
Though glove manufacturers have come up with compelling non-latex alternatives—made of synthetics such as neoprene and polyisoprene—Brown says the manufacturers have learned that it takes about 22 days of active use before a surgeon gets accustomed to the new hand wear. The synthetic gloves have a slightly less tactile feel than latex, but wearers seem to adjust.
The Rangos Building Rises
The first of five life sciences buildings planned for the “Biotech Park” has opened.
Residents from East Baltimore gathered with Hopkins leaders and a score of other dignitaries on April 11 to celebrate the opening of The John G. Rangos Sr. Building at the corner of Ashland Ave. and N. Wolfe St.—a gleaming emblem of the revitalization of this once destitute neighborhood.
The $54 million research facility is the first of five life sciences buildings within the planned Science and Technology Park at Johns Hopkins.
While Edward Miller, Dean/CEO of Johns Hopkins Medicine, praised the new building’s potential for fostering scientific and medical advances, he also emphasized another goal of its construction. “This was not just about a building,” he pointed out. “This was about building a community.”
It was a theme echoed by the other 17 speakers, including Pittsburgh philanthropist John Rangos (who donated $10 million and for whom the building is named), Governor Martin O’Malley, Senator Barbara Mikulski, Congressmen Elijah Cummings and John Sarbanes, and Mayor Sheila Dixon.
They saluted the hard work and dedication required by an 88-acre act of urban renewal. And they envisioned a new East Side that will attract newcomers with as many as 6,000 jobs and stand as testament to the ongoing collaboration between the Johns Hopkins Institutions, East Baltimore neighborhoods, city and state governments, property developers, businesses and non-profits.
The Rangos Building’s largest tenant, Hopkins’ Institute for Basic Biomedical Sciences, has already started moving in. IBBS will fill a space roughly equivalent to the Light Street Pavilion at Harborplace.
Other tenants are Cangen Biotechnologies and Biomarker Strategies, both Hopkins-born ventures. Cangen is developing noninvasive tests for early detection of cancer while Biomarker Strategies is creating a solid tumor cell testing system to improve the diagnosis and treatment of cancer. Howard Hughes Medical Institute, a national non-profit medical research organization, is the fourth tenant.
Raising the Bar for Surgical Trainees
A new skills checklist makes evaluation less subjective.
Many professions require a lengthy, exacting apprenticeship, but few can match the rigors of medicine. Residents in Johns Hopkins’ Department of Otolaryngology-Head and Neck Surgery spend nine months training in general surgery, then three months in otolaryngology, one or two years in the lab, and four more in Otolaryngology. All is capped by certifying boards, both written and oral.
And yet, even that is not enough, says Nasir Bhatti, the department’s associate director of residency training. The boards, he points out, test knowledge and judgment. What’s missing: an objective assessment of surgical skills.
“All too often, these skills are assessed subjectively by faculty,” Bhatti says. “In contrast, consider the airline industry. Airline pilots have broken down the art and science of flying into smaller tasks that can be individually tested on flight simulators before they can fly an actual plane. My goal over the next few years is to do exactly the same for our trainees.”
Already, Bhatti has developed a “surgery skills checklist,” an instrument designed to evaluate a resident’s ability to perform various surgical procedures. Working on cadaver tissue, residents first learn surgical techniques in the lab. Then they’re tested on specific aspects of certain procedures. On the mastoidectomy checklist, for example, there are 20 separate tasks involving, say, placement of initial bone cuts or identification of critical anatomic structures.
Hopkins ear surgeons as well as impartial outside examiners rate the residents on each task. Residents receive unbiased feedback. The residents, as well as their physician teachers, understand exactly which areas will require additional attention.
“With the cadaver course simulations and these objective instruments,” says Bhatti, “we can bring the residents to a very safe level before they can operate on real patients.”
Anne Bennett Swingle
In Perpetual Motion
Phebe Ko ’10 has her sights on the Olympics.
As spring emerges from winter, Phebe Ko ’10 bounds across the muddy grass in a Baltimore park, her iPod ear- buds in place. Today’s training companion is “Coma, Persistent Vegetative State & Brain Death,” a medical school lecture she estimates should last roughly seven of her 15-mile training run.
| > At press time, Ko (featured in posters throughout Boston) reported a personal best of 2:45:20.
In six weeks, Ko will stand at the starting line of the 2008 Olympic marathon trials in Boston, competing against America’s fastest women. But first, she faces exams, the next step toward a possible future of orthopedic surgery.
You might say the 25-year-old is in a perpetual state of preparation.
Ko proved her mettle last year at the Boston Marathon, the race that qualified her for the Olympic Trials. It was also the race that almost wasn’t when a fierce Nor’easter threatened to shut down the course with wind gusts up to 40 miles per hour.
At the time, the Hopkins med student was pretty new to the marathon distance as well as the study of medicine. She had spent four years on the cross-country team at Duke University before taking a post-college year to apply to medical school. It also provided time to try her legs at the marathon’s daunting 26.2 miles. It was a distance she was made for.
“I have really good endurance,” Ko says. “I can hold a pace forever without getting tired.” At 5'1" tall, 103 pounds, she runs with the combination of fluidity and strength that marks elite runners—as well as a keen self-awareness that allows her to pace herself without a watch.
When she started at Hopkins, Ko established a running home base in Robert E. Lee Park, just north of the city, where she could adapt to her 90-mile-a-week training schedule. Her second year at med school has gone something like this: Eat, Attend Classes, Eat, Run, Lift Weights, Eat, Labs, Study, Eat, Study… Sleep???
Despite her training, it’s unlikely Ko will make the three-woman Olympic team, at least this year. Those chosen for Beijing are expected to run at least 20 minutes faster than Ko’s best time to date. In her mind, the race is another chance to improve, and, perhaps, to prepare for London, 2012.
Last year, Ko needed to pare more than two minutes off her best marathon time to meet the Olympic Trials standard of 2:47:00. The Boston Marathon course with its legendary hills was menacing even without sheets of rain blowing straight into the runners’ faces.
When she crossed the finish line, she wasn’t sure she’d made her goal until an aide brought the news. The 21st woman overall, Ko had maintained a pace of 6:21 per mile for the entire second half of the marathon. Her final time was 2:46:30.
“I just started screaming,” she recalls. “I was so incredibly happy.”
And the Survey Says…
Hopkins Hospital achieved scores at or above the national average in the 10 categories that appear online as part of a new patient satisfaction survey. Called the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, the survey has gotten the attention of hospital leaders across the country because it will eventually be tied to reimbursement by Medicare and U.S. News & World Report rankings.
The new report cards show that Johns Hopkins Bayview and Howard County General Hospital scores hovered around average or slightly lower. In efforts to address the data (gained from a 27-question survey mailed to half of all adult inpatients), HCGH has added hourly rounds by nurses to deal with issues like pain management and toileting. At Hopkins Bayview, employees get monthly feedback about service behaviors. Hopkins Hospital will work to address its weakest link, the food service, by piloting programs to mimic restaurant-style ordering and presentation.
Hopkins Hospital has found that implementing patient- and family-centered care models on units such as surgery and obstetrics consistently improves satisfaction scores. Still, says JHH Chief Operating Officer Judy Reitz, “we need to be highly focused on exceeding patients’ expectations to keep our reputation strong … [and] to truly achieve ‘service equal to our science.’”
HCAHPS and other survey results can be found at hospitalcompare.hhs.gov
Barbara Fivush will use science to improve opportunities for female faculty.
Making Medicine a better place for all.
Since she arrived as an intern at Hopkins in 1978, Barbara Fivush, professor of pediatrics and chief of pediatric nephrology, has seen significant improvements in the opportunities women have for advancement in the School of Medicine.
Full equity, however, remains frustratingly elusive. Appointed this winter as the first director of the school’s new Office of Women in Science and Medicine, Fivush will lead the school’s effort for achieving the goals of the university’s Vision 2020 report, with the mandate of increasing women in leadership throughout the university. She believes that scientific methods—at which Hopkins excels—can help determine why gender inequity problems have proved subtly persistent, despite an institution-wide commitment to eliminate them.
“We live in a scientific community,” says Fivush, “and without studies and objective data, sometimes of root causes that we don’t even understand, women may not have the opportunities for leadership roles that men have.
“The challenge really is identifying the problems. I don’t believe that people purposefully are doing these things, but I do believe that an enhanced knowledge that these problems exist will make things much better.”
Fivush long has been in the forefront of efforts to address faculty diversity and gender issues. She has been co-chair of the Women’s Leadership Council for five years and was responsible for such studies as a 2004 survey that found female faculty members’ salaries were 6.3 percent lower than those of male faculty.
Such a disparity is not intentional, she says, “but that doesn’t make it OK.”
Fivush notes that the School of Medicine’s Committee of Faculty Development and Gender used a data-driven approach to identify potential barriers to the career progression of female faculty. It issued a 2005 report citing not only the salary disparity but other issues, such as the longer length of time it takes for women to be promoted.
The report included nine recommendations for alleviating these and other inequities. Most have been or are in the process of being implemented, Fivush says, and the creation of her new office “is critical for these to be achieved.”
“It’s really an opportunity for all faculty,” she says, “because as we work toward improving gender inequities and diversity inequities, we’re going to make this School of Medicine a better place to work for everybody.”
Sheila West aims to end this preventable eye disease—which blinds 4 million people annually—by 2020.
The bacterial eye disease trachoma “has been around since the pyramids were built, but shouldn’t exist at all today,” says Sheila West. Yet an estimated 84 million people worldwide contract it each year—and some 4 million of its victims go blind annually. Most are in African or Middle Eastern countries without the resources or ability to distribute antibiotics on a mass scale, or the knowledge of how to do so most effectively.
With a $10 million grant from the Bill & Melinda Gates Foundation, a consortium of researchers that West has assembled hopes to ensure trachoma’s elimination by the World Health Organization’s target year of 2020—a particularly apt deadline, she notes, given the date’s numerical allusion to perfect eyesight. The consortium includes researchers from Hopkins’ Wilmer Eye Institute, where she is a professor of ophthalmology; London’s School of Hygiene and Tropical Medicine; the University of San Francisco; and WHO.
West earned a PhD in epidemiology from Hopkins’ Bloomberg School of Public Health in 1981. She joined Wilmer in 1984, drawn by “an opportunity to get in on the ground floor of a brand new discipline: public health/ophthalmology.”
Trachoma, caused by the chlamydia bacterium, is spread by simple contact in unsanitary conditions. Repeated infections scar the eyelid and cause eyelashes to turn inward, damaging the cornea and eventually causing blindness. Eliminated in much of the world by the early 20th century, it remains a scourge in 48 nations, most of them poor.
Success in reducing it in some African nations is not duplicated in others, but West says she sees “a lot of countries that are on the cusp, heading toward elimination. We are missing the answers to some final key questions,” she says, “particularly with the use of antibiotics, such as how long we treat patients with them and how to use them more efficiently.”
West took more than two years to assemble the consortium and prepare the proposal. “When we’re slogging it out in villages, I sometimes think, ‘Why am I doing this?’” The answer, she says, “is in every country where I see the trachoma rates are going down.”
More Alpha Docs
Benjamin Carson, professor and director of pediatric neurosurgery, has been presented a 2008 Ford’s Theatre Medal by President George Bush. The medal honors Carson’s accomplishments and personal attributes, which reflect the strong character and lasting legacy of Abraham Lincoln, who died after being shot at Ford’s Theatre on April 14, 1865.
J.P. Dunn, associate professor of ophthalmology, director of the division of ocular immunology, and director of The Wilmer Eye Institute’s residency program, has received the 2007 Straatsma Award for Excellence in Resident Education from the American Academy of Ophthalmology and the Association of University Professors of Ophthalmology.
Jeffrey Janofsky, associate professor of psychiatry and director of the psychiatry and law program, has been installed as president of the American Academy of Psychiatry and the Law.
Maureen Lefton-Greif, associate professor of pediatrics, has been elected a fellow of the American Speech-Language-Hearing Association. The lifetime fellowship is one of the highest honors the association can bestow.
Victor McKusick, University Professor of Medical Genetics, widely acknowledged as the “father of genetic medicine,” has been awarded the 2008 Japan Prize in Medical Genetics and Genomics, bestowed by the Science and Technology Foundation of Japan for his “original and outstanding achievements.” McKusick, this year’s sole recipient of the 24-year-old prize, received a medal and 50 million yen ($470,000) at a formal ceremony in Tokyo attended by Japan’s Emperor and Empress, as well as other national dignitaries.
Michelle Mielke, assistant professor of psychiatry, has been named one of 10 recipients of the International Junior Investigator Award given by the International College of Geriatric Psychoneuropharmacology (ICGP). The citation recognizes her research to identify potential serum biomarkers for early diagnosis of Alzheimer’s disease.
Victor Velculescu, associate professor of oncology, has received the Judson Daland Prize from the American Philosophical Society for his outstanding work in patient-oriented research. The prize is accompanied by a $20,000 award.
Myron “Mike”Weisfeldt, William Osler Professor of Medicine and director of the Department of Medicine, has received the 2008 Association of Professors of Medicine Diversity Award in recognition of his effective efforts to improve diversity within the department and the entire School of Medicine.
Zeng-Jin Yang, a research fellow in the Department of Anesthesiology and Critical Care Medicine, has received the first annual American Heart Association-Philips Resuscitation Fellowship Award. The award, which provides a $100,000 grant over a two-year period, will enable him to pursue research to improve the understanding of the potential mechanisms of brain-cell damage in newborns that often occurs because of oxygen deficiency.
Four School of Medicine faculty have been elected fellows of the American Association for the Advancement of Science. They are: Jef Boeke, professor of molecular biology and genetics and founding director of the High Throughput Biology Center; Thomas Quinn, professor of medicine and pathology and director of the Johns Hopkins P3 HIV/AIDS Research Facility and the International STD/HIV Research Laboratory; Theresa A.B. Shapiro, Wellcome Professor and director of clinical pharmacology; and David Valle, professor of pediatrics, molecular biology and genetics and Henry J. Knott Professor and director of the McKusick-Nathans Institute of Genetic Medicine.
The Association of American Physicians has elected as members Gregg
Semenza, professor of pediatrics, director of the vascular cell engineering program in the Institute for Cell Engineering (ICE),
and a member of the McKusick-Nathans Institute of Genetic Medicine; and Ted Dawson, professor of neurology and neuroscience and co-director of the neuroregeneration program in ICE.
Esquire magazine’s 2007 “Best and Brightest” list included Jacques Grosset, Sanjay Jain, Gyanu Lamichhane, and Eric Nuermberger, of the Hopkins Center for TB Research. Cited for their work on finding new cures for tuberculosis, they were among 36 scientists, physicians, artists, engineers, and a free-speech advocate cited as “reasons for hope” in the world.