New travel restrictions bar Cuba rotations

A program that allowed Yale residents to observe the island nation’s health care system ends.

For each of the past four years, up to four residents at Yale-New Haven Hospital have spent six weeks studying health care in Cuba. Those rotations are unlike other foreign rotations that take residents to more than a dozen countries, said Michele Barry, M.D., HS ’77, co-director of the Yale/Johnson & Johnson Physician Scholars in International Health program, which sends 40 Yale residents abroad each year.

“It’s a little bit different than our other rotations in underserved areas, where they desperately need doctors,” Barry said. Cuba has no shortage of physicians and Barry sends residents to Cuba, she said, to observe the Cuban approach to primary care. “They have a physician assigned to an entire neighborhood. The physician takes ownership of the neighborhood’s health and does outreach in a way that we have never been very effective at,” Barry said.

That exposure to Cuban health care practices is no longer possible because of new restrictions on travel to Cuba that the U.S. Department of the Treasury put into effect on June 30. Among other limits on travel by American citizens, students must stay in Cuba for at least 10 weeks, too long for hospital residents, Barry said.

The rotations in Cuba were organized through Medical Education Cooperation with Cuba (MEDICC), a nonprofit organization that has sent almost 900 students from more than 100 medical, nursing and public health schools to Cuba since 1997. “These regulations will make it very difficult for health sciences students to study in Cuba, since most academic institutions do not have the resources to organize a course of 10 weeks,” said MEDICC’s director, Diane Appelbaum, R.N., M.S.

The new guidelines, she said, restrict MEDICC in several ways. For one, it’s not an academic institution, the only entity now allowed to send faculty, staff or students to Cuba. The new guidelines also require that students wishing to study in Cuba must do so as part of accredited courses in the institution in which they are enrolled, rather than under the auspices of other organizations or programs. And the courses MEDICC offers in Cuba only last between two and six weeks.

For most of Fidel Castro’s reign, which began in 1959, the United States has restricted travel by U.S. citizens to Cuba. Typically only scholars, journalists and Cuban-Americans with relatives on the island have been allowed to travel there. The latest restrictions are based on recommendations by the Commission for Assistance to a Free Cuba, which President Bush created last fall to find ways to move Cuba toward democracy. The new rules do not affect graduate students pursuing independent research.

Barry sees a political motive for the new rules—a desire to garner support from conservative Cuban exiles in Florida in the presidential election. And she believes the restrictions are counterproductive. “I only see good things coming out of the exchange,” Barry said. I do not think a country like the United States should foster censorship and thus prevent an exchange of ideas and cultures which could effectively promulgate democracy in Cuba.”

—John Curtis

Neurobiologist Hockfield leaves provost post for presidency of MIT

When she embarked on her career as a neurobiologist in the early 1980s, Yale Provost Susan Hockfield, Ph.D., never imagined that her academic path would take her from running a laboratory to running a university. She devoted herself to research, devising novel uses of monoclonal antibody technology and discovering a gene that may play a role in brain cancer. “Being a scientist is a wonderful, wonderful career,” she said in September in her office on Hillhouse Avenue. “I had no aspirations to move into positions of academic leadership.”

But early on her administrative skills emerged. After she came to Yale in 1985, she ran a summer program in neurobiology at the Cold Spring Harbor Laboratory on Long Island, where she had previously worked. At Yale, Hockfield, the William Edward Gilbert Professor of Neurobiology, served as director of graduate studies in the medical school’s Section of Neurobiology and on the graduate school’s executive committee. In 1998 she was named dean of the Graduate School of Arts and Sciences (the first member of the medical school faculty appointed to that post), and in January 2003, she became provost when her predecessor, Alison Richard, Ph.D., was chosen to lead Cambridge University.

As provost she has worked to advance science, medicine and engineering at Yale—initiatives that include a $500 million investment in facilities. She has also fomented interdisciplinary collaborations throughout the university.

In August the Massachusetts Institute of Technology (MIT) announced that Hockfield would become its 16th president, the first woman and the first life scientist so named. She will move to Cambridge, Mass., with her husband, Thomas N. Byrne Jr., M.D., HS ’81, clinical professor of neurology, neurosurgery and medicine at the medical school, and their daughter, Elizabeth, 13, in December.

At MIT she replaces Charles M. Vest, Ph.D., who announced his retirement last year after 14 years leading the school. (In October, President Richard C. Levin appointed Deputy Provost Andrew D. Hamilton, Ph.D., to succeed Hockfield.)

“MIT is an inspiring place, populated by inspiring people,” Hockfield said. “From my first conversations in the search process, the Institute’s central themes—the pursuit of truth, integrity and the great meritocracy—have resonated with my own core values.”

Although MIT, with its strong reputation in engineering, has never before named a biological scientist as its leader, Hockfield said that the school’s grants and contracts supporting research in the life sciences, largely from the National Institutes of Health, have grown at a remarkable rate over the last decade. And the school is constructing a three-building complex devoted to neuroscience. With its strengths in engineering, the physical sciences and the biological sciences, she believes MIT is well-positioned for collaborative, interdisciplinary science. “I am hoping to do what I can to encourage bridge-building among these disciplines,” she said.

She also plans to continue the practice of past MIT presidents who have served as advocates for sound national policies on science, technology and higher education. (The school maintains an office in Washington, which she will visit once a month.) One of her main concerns is that American students are falling behind their peers around the world in math and science. She’d like to see improvement in math and science education from kindergarten through high school, to engage and inspire students. “Almost every child gets a thrill from building and inventing things that work,” she said. “Math and science in our schools can do a better job in tapping and encouraging that creative energy.”

For now, though, her attention is on MIT. “My overarching goal is to help MIT to be an even greater MIT,” she said. “I hope that MIT is increasingly seen as among the very best places in the world for people—faculty, staff and students—who are enormously inspired by innovation in both teaching and research.”

—J.C.

Yale CME gets a new lease on lifelong learning as it adapts to the Internet age

Nearly 25 years ago, when Continuing Medical Education (CME) at Yale was created to develop programs that present the most current information and research to a broad range of medical professionals, the practice of medicine was very different. Advances in medicine did not occur at such a rapid pace, managed care had not permeated the medical landscape and 15-minute office visits were not yet the norm.

Today, as physicians try to keep up with their profession in a changed medical environment, Yale CME is overhauling its continuing education activities, which include courses and conferences, regularly scheduled grand rounds and two newsletters (The Medical Letter and Diabetes Newsletter) that include tests on their content for CME credit. Its goal is to build CME at Yale into an educational clearinghouse that acts not only as a resource, but as the facilitator of new information.

“One of the challenges in the environment is that physicians, because of managed care, find it increasingly difficult to leave the practice and go to a meeting,” said Lawrence S. Cohen, M.D., HS ’65, the Ebenezer K. Hunt Professor of Medicine, special advisor to the dean and chair of the CME Faculty Advisory Committee. In response, Yale CME is taking advantage of the Internet to streamline many of its activities. A revamped website allows participants to register for conferences online and access The Medical Letter and its corresponding exams at their convenience. (The Diabetes Newsletter will be available online sometime next year). In addition, physicians will be able to take online courses and examinations for CME credit within the next few months.

“On a practical basis, we are formalizing activities that have been ongoing at the School of Medicine, such as grand rounds and tumor boards (which meet to discuss cancer cases), and making them easily accessible to CME for credit,” said Cohen. “Most importantly, we are uncovering, not surprisingly, a wealth of investigators/educators who are in the process of putting together programs appropriate for CME at Yale.”

A major issue is compliance with guidelines set by the Accreditation Council for Continuing Medical Education (ACCME), including standards for commercial support that outline the steps that must be taken when accepting financial support from sources such as drug companies and device manufacturers. Two years ago the program’s accreditation was at risk over shortcomings in its record keeping and compliance with ACCME rules. Then Mary D. Marcarelli became director of CME, which is now up-to-date on ACCME standards and has trained almost 50 departmental coordinators to ensure compliance. In July the Yale CME program learned it received full accreditation from the ACCME through June 2008.

Plans under consideration for the future include video coverage of grand rounds on the Web; a lecture series focusing on research that can be directly translated to patient care; and the production of a CME program through the cable channel Discovery Health to offer CME credit to those unable to travel to conferences. The next few years may also usher in the use of handheld personal digital assistants to deliver CME course materials and the revival of the Mini-Med School Program, begun in 1995, which presented a series of lectures to the general public.

CME at Yale has become a high-profile project, and will continue to evolve as new technologies, research and treatments become available. “Medicine moves forward,” said Marcarelli. “We’re moving with it.”

—Jill Max

Yale CME can be found online at cme.yale.edu/.

A conservative “hit list” targets aids researchers, including some at Yale

In the fall of 2003 Margaret R. Weeks, Ph.D., got a call from her project officer at the National Institute on Drug Abuse (NIDA). Weeks, an anthropologist and the associate director of the Institute for Community Research in Hartford could hear the stress in her project officer’s voice. The National Institutes of Health (NIH) needed an immediate report on her study that recruits drug users to spread a message about how to prevent HIV/AIDS.

“We were two and a half years into a four-year study. We didn’t have findings,” Weeks told the audience at aids Science Day in April, describing her response. She said, ‘Give me anything you can.’ ”

Weeks and her project, which is affiliated with the Center for Interdisciplinary Research on aids based at the School of Public Health, were on what came to be known as the “hit list” of about 200 federally funded studies deemed by the conservative Traditional Values Coalition to be “prurient,” “smarmy” and having “little or no bearing on public health.” The list found its way to Congress, which demanded explanations. Elias A. Zerhouni, M.D., director of the NIH, looked into the studies and went back to Congress with a vigorous defense.

The project Weeks is leading recruits active drug users and trains them to become peer health advocates who can introduce harm reduction measures into drug use sites. Weeks was one of four panelists at aids Science Day to discuss the implications of this list.

Michael H. Merson, M.D., dean of public health and moderator of the panel, said the list made him think back to the 1950s and another politician with a list. “As someone who has his name on this list, I immediately recalled the words of Senator Joseph McCarthy,” he said. Merson appeared on the list as principal investigator of studies on drug use in high-risk settings and aids in China.

Panelist Judith Auerbach, vice president for public policy at the American Foundation for aids Research (amfAR), placed the “hit list” in the context of other assaults on science. She noted that the Union of Concerned Scientists issued a report in February that cited examples of what it called the administration’s distortion of science, and scores of scientists, including 20 Nobel laureates, issued a statement accusing the administration of misrepresenting scientific findings.

Studies on air pollution, mercury emissions, lead in water and global warming—which affect key industrial constituents of the Bush administration—have been questioned, Auerbach said. Religious views have dominated discussion of condom use, sex and the sale of contraceptives over the counter. “All of this misuse or misinterpretation of science is happening in a very political context,” Auerbach said. “The goal of the attacks is to disallow certain kinds of research.”

“Some of what is going on is not entirely new,” said Kevin Cranston, M.Div., acting director of the HIV/AIDS bureau at the Massachusetts Department of Public Health, “even if in a matter of degree it is entirely unprecedented.”

Ana Oliveira, executive director of Gay Men’s Health Crisis in New York, said organizations in Washington and San Francisco have undergone audits of their grant funding. “The kind of threat and intimidation an audit represents is unbelievable. It diverts precious time and resources.”

Indeed, Weeks said her entire office mobilized to gather information for the NIH. “Everyone stopped what they were doing and helped,” she said. Apart from the waste of time and energy, Weeks said, targeting individual projects and scientists has the effect of chilling studies of controversial topics. “We absolutely cannot use this as a reason to shy away from this research,” she said.

—John Curtis

Et Cetera

Yale joins diabetes trial

The School of Medicine has joined 11 other medical centers in a national study that will compare three treatments for type 2 diabetes in children and teenagers. The study is the first clinical trial to look at the impact of intensive lifestyle change designed to lower weight by cutting calories and increasing exercise. It is also the first trial sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to focus on type 2 diabetes in youth.

The five-year trial will look at how each treatment option, including drugs currently used in adults, controls blood glucose levels in younger patients. It will also evaluate safety and the effects of treatments on insulin production, insulin resistance, body composition, nutrition, physical fitness and risk factors for disease.

The principal investigator at Yale is Sonia Caprio, M.D., associate professor of pediatrics (endocrinology).

—J.C.

Eyewitness accounts flawed

Soldiers engaged in survival training had trouble identifying people they encountered during threatening and stressful events, according to a Yale study published this Spring in the International Journal of Law and Psychiatry.

“Contrary to the popular concept that most people would never forget the face of a clearly seen individual who had physically confronted them and threatened them for more than 30 minutes, a large number of subjects in this study were unable to correctly identify their perpetrator,” said Charles A. Morgan III, M.D., associate clinical professor of psychiatry.

Morgan studied more than 500 soldiers who were subjected to stress modeled after the experiences of prisoners of war. For 48 hours prior to questioning, they were deprived of food and sleep. Asked to identify their guard and interrogator a day later, those who experienced less stressful interrogations had better recognition.

“The present data have a number of implications for law enforcement personnel, mental health professionals, physicians, attorneys and judges,” Morgan said.

—J.C.


			Originally published in Yale Medicine, Fall/Winter 2004. Copyright © 2004 Yale University School of Medicine. All rights reserved.