Guy Jirawuthiworavong, a third-year ophthalmology resident, examined the eyes of Michael Stallings at the Hill Health Center on a Wednesday in April. A grant from the Community Foundation for Greater New Haven has allowed the center and the medical school to bring eye care to the neighborhood.

A new site for sore eyes

After 10 years, doctors and patients welcome the return of an eye clinic to the Hill Health Center.

When Candace Ford went for her exam at the new eye clinic in the Hill Health Center, doctors said they couldn’t test her while she was wearing her contact lenses; they wanted to see her glasses. So Ford ran home to get what she needed and was back in the examining chair within minutes.

This kind of convenience for Hill neighborhood residents, many of whom don’t own cars, is one of the many reasons health center administrators and doctors in the Department of Ophthalmology and Visual Science wanted to open an eye center in the neighborhood.

The health center used to offer ophthalmology services, but about 10 years ago the program died, forcing many Hill residents to travel to the medical school for their eye care. “We had a tremendous number of no-shows from the Hill, so we realized the distance patients had to travel was a barrier to access,” said Susan H. Forster, M.D., HS ’81, an assistant professor in the department. She and others decided the solution was to locate an eye clinic in the same place where patients go for the rest of their medical care.

Organizers applied for and received a $50,000 grant from the Community Foundation for Greater New Haven, which enabled them to set up the clinic and outfit it with state-of-the-art equipment. Hill Health Center Chief Operating Officer Gary Spinner says the eye clinic is a much-needed addition to the center. “We serve a large population with diabetes who need ongoing eye care to detect and treat the complications that can affect their eyes,” he said.

Four chief residents take turns staffing the clinic, which is open one day a week. Patients are billed for their treatment, but there is a sliding-fee scale for those who don’t have medical insurance. “We all felt it would benefit a medically underserved population as well as the medical residents who rotate through here,” Spinner said. “They learn a lot about providing health care beyond the technical end of it.”

Although the clinic has been open only since January, Forster said it already served about 20 patients a day and was booked through June. The clinic provides vision tests and screening for such conditions as glaucoma, amblyopia (lazy eye) and retinopathy, which is linked to diabetes. Patients who need surgery or a diagnostic procedure are referred to Yale. Forster said the clinic’s close ties with the ophthalmology department allow patients to benefit from the expertise of Yale specialists, who have ongoing consultations about patient care with the on-site residents.

While convenience was a major selling point for Ford when she decided to go to the eye center, she also appreciated the quiet, relaxed atmosphere. “They had the radio playing R&B, it was clean and there was only one person ahead of me,” she said, “so I was in and out real quick.”

Guy Jirawuthiworavong, M.D., a third-year ophthalmology resident who works in the clinic, also enjoys the intimate atmosphere. “It’s been a really great experience,” he said. “Community clinics by nature are smaller and homier. I like the family setting.”

He said the majority of his patients have a family history of glaucoma and want to get their eyes checked, or they need an annual screening for diabetes. This is just the news Forster wanted to hear. She said many people overlook preventive eye care until it’s too late. “Our goal with this center is to catch things early.”

—Jennifer Kaylin

Contract still unresolved, union strikers spend five days out in the cold

During a week of subfreezing temperatures, a heavy rain and a blizzard, thousands of Yale employees, including hundreds at the medical school, took to the streets in March to strike over contract negotiations that had stalled over wages, job security and pension benefits. The strike had clerical and technical workers from Local 34 and service and maintenance employees from Local 35 sharing picket lines with hundreds of graduate students from GESO, the Graduate Employees & Students Organization, which is seeking union recognition from the university. The unions also support the right of hospital workers to unionize.

Over the course of the weeklong strike, the unions held rallies at Woolsey Hall, Phelps Gate and the medical school, led by supporters including the Rev. Jesse Jackson, New Haven Mayor John DeStefano Jr., U.S. Rep. Rosa DeLauro, local clergy and local and national union leaders. Disruptions at the medical school appeared to be minimal—58 percent of Local 34 workers remained on the job.

Each side blamed the other for the impasse. Union leaders said the university had refused to budge on its offers. The university accused the unions of linking contract negotiations with GESO’s organizing efforts and with a drive by the Service Employees International Union to organize service and other nonprofessional employees at Yale-New Haven Hospital. The university opposes unionization of graduate students and says the hospital is a separate entity from the university and that workers there must decide whether to unionize.

In April Local 34 rejected the university’s 10-year contract proposal, and in early May graduate students rejected GESO as their bargaining agent.

—John Curtis

Does industry funding equal conflict of interest? Often it does, Yale authors claim

As biomedical researchers increase their dependence on industry support for research, Yale investigators say this relationship has led to “pervasive and problematic” conflicts of interest. Between 1980 and 2000, while the federal government’s share of funding fell, industry support rose from 32 percent to 62 percent.

The Yale team found that business-sponsored studies are far likelier to yield results favorable to the industry than those funded by sources without a vested interest, such as the federal government. They also found that industry studies are designed to favor such results, that negative outcomes meet with delays in publication or aren’t published and that many researchers and institutions have financial ties to their sponsors.

“Industry sponsorship has the potential to distort the scientific process in a very disturbing way,” said Cary P. Gross, M.D., an assistant professor of medicine and the study’s lead author. “I am in no way against industry sponsorship,” he said, noting that he has taken part in such studies. “But our results show that we need very close oversight.”

The team’s review of 37 studies on the extent and impact of conflicts of interest appeared in January in JAMA: The Journal of the American Medical Association. They found that studies sponsored by industry were 3.6 times more likely to have conclusions favorable to industry than studies without that support.

Industry studies also tended to compare an industry’s drug to a placebo instead of a drug already on the market, said Justin E. Bekelman, a fourth-year medical student and a study co-author. “Placebo-controlled trials are likelier to end with positive results,” he explained. Another study found that when the industry’s drug was compared to a medicine already on the market, patients were given inappropriate doses of each drug in a way that supported the newcomer.

When results didn’t favor the industry-sponsored therapy, publication was delayed or reports were not published at all. Sometimes studies were stonewalled while the industry sought patents; at other times, some researchers were denied access to the data.

“It’s very important that all trial results, whether positive or negative, be published,” said Bekelman.

The study also found that a quarter of investigators have industry affiliations, and that two-thirds of academic institutions (including Yale) hold equity in startup firms founded upon research at those institutions. Gross said that universities must erect a “very firm fire wall” to avoid conflicts of interest.

Bekelman said a “balance of power” is needed. Academia and medical journals have begun to insist on more financial disclosure and access to data. But more needs to be done, Bekelman said, because without complete and unambiguous disclosure, the research “will not serve the needs of patients or our health system well over the long term.”

—John Dillon

NIH awards Yale $18 million to develop new technologies for proteomics research

The university has received an $18.2 million award from the National Institutes of Health to establish one of 10 national centers to develop proteomic technologies for the diagnosis, understanding and improved treatment of heart, lung and blood disorders.

The National Heart, Lung and Blood Institute (NHLBI) Proteomics Center will bring together 21 Yale faculty from 12 departments and will build on the expertise of the Howard Hughes Medical Institute (HHMI) Biopolymer/Keck Laboratory at Yale University, one of the largest biotechnology laboratories of its kind in academia. The Proteomics Center is headed by Kenneth R. Williams, Ph.D., director of the HHMI/Keck Laboratory and professor (adjunct) of research in molecular biophysics and biochemistry. The center will focus on two technologies: proteome profiling and synthetic peptide-based reagents to block specific protein-protein interactions. The latter effort will be directed by the co-investigator on the NHLBI contract that established the center, William C. Sessa, Ph.D., director of the Yale Vascular Cell Signaling and Therapeutics Program and professor of pharmacology.

“By developing two complementary technologies in parallel, we hope to use protein profiling to identify key proteins involved in diseases of the heart, lung and blood and then develop novel reagents capable of specifically blocking the activities of those proteins,” Williams said. “The overall goal is to increase our understanding of the disease process, which should lead to more effective treatment.” Additional information and continuing updates on progress of research carried out in the Yale/NHLBI Proteomics Center may be found at http://info.med.yale.edu/ nhlbi-proteomics/.

—John Curtis

A winning spirit

When 12-year-old Millie Suggs rode her wheelchair in a Family Fun race at Disney World in January, two second-year medical students offered moral and medical support. Deborah Kaplan, who met Millie six years ago through her sister, a teacher, ran in a marathon while Michele Flagge accompanied Suggs during the 5-kilometer race. Suggs, who suffered a spinal cord injury in a car accident when she was 2, won a prize as the only wheelchair racer. Thanks to her friendship with Suggs, Kaplan wants to be a pediatric physiatrist when she graduates. “Millie has taught me so much about the human spirit,” she said.

—Jennifer Kaylin

Et Cetera

The thesis goes digital

With a vision of electrons prevailing over paper, Charles J. Greenberg, M.L.S., M.Ed., head of reference services at the Cushing/ Whitney Medical Library, has launched the Yale Medicine Thesis Digital Library (YMTDL), an online collection of the theses required of all Yale medical students.

The YMTDL debuted in February at http://ymtdl.med.yale.edu. The Internet, Greenberg said, has become the “number-one way” of accessing medical research, as foot traffic falls at the library.

Greenberg’s biggest challenge has been to convince students that publishing online won’t harm their chances of publication later in a scholarly journal. Students may delay online publication for up to three years, but abstracts are automatically included on the website.

Last year 12 students agreed to provide their theses; this year Greenberg hopes to get 40. Eventually, he expects that all theses will be available online.

—John Dillon

Two yale experts on bioethics panel

As medical and ethical concerns move from the laboratory to the front page, the Bush Administration has named 11 people, including two experts with ties to Yale, to serve on a new advisory committee on federal protections for human research subjects. The panel is charged with reviewing regulations aimed at safeguarding volunteers in medical and behavioral studies.

“There’s more of a consumer interest and input into bioethics than in the past,” said Celia B. Fisher, Ph.D., director of the Center for Ethics Education at Fordham University and a visiting bioethicist in residence at Yale. Fisher is especially interested in examining protections for special populations, such as pregnant women, prisoners and children. How federal guidelines should be applied to embryos is expected to be one of the more controversial issues the panel considers.

Mary Lake Polan, Ph.D. ’70, M.D. ’75, HS ’77, chair of the Department of Gynecology and Obstetrics at Stanford University School of Medicine, was also named to serve on the panel.

—Jennifer Kaylin


			Originally published in Yale Medicine, Summer 2003. Copyright © 2003 Yale University School of Medicine. All rights reserved.