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First-year
class brings more than smarts to school
Gaining entry
to the School of Medicine remains among the academic world’s
most competitive selection processes. With more than 3,000 applicants
for the approximately 100 slots in each first-year class at Yale,
being smart and well-prepared are givens. It takes more than
that to get in. “We’re looking for people who have
shown that they are truly concerned about other people and have
done something in their lives that really illustrates that spirit,”
says Deputy Dean for Education Robert H. Gifford, M.D., HS ’67.
The 102 members of the Class of 2002 arrived in New Haven at
summer’s end with just that experience.
The 57 men and
45 women represent a broad cross section of backgrounds and interests.
They include 21 Yale graduates, 15 Harvard graduates, at least
one lawyer, a mother of three, and two children of faculty members.
The mean age of the class is 24. About half the class is Hispanic,
African-American or Asian-American. As for the assessment of
those more humane qualities, Dean Gifford says, “they needn’t
have anything to do with medicine. We look for people who have
given of themselves to others, such as working with kids, or
as camp counselors, or with the disadvantaged in the community.”
Among the entering students,
Vivek Murthy organized a program while in college that sent American college
students to India to conduct HIV prevention workshops for teenagers. Alison
Norris developed school libraries in Zanzibar and helped restore overgrazed
land in Kenya before working on public health issues at Harvard and the
Rockefeller Institute. Patricia Diaz traded an apartment on Central Park
South and a successful career as a lawyer in New York City for a dormitory
room in Harkness and a full schedule as a medical student. She finds that
she’s not alone in having an unexpected background for a medical
student. “Everyone here,” she says, “has an exceptional
and fascinating story of their own.”
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A clean
room for gene therapy and stem cell transplantation
In 1989 leukemia
patient Richard D. Frisbee III became the first child in Connecticut
to receive a bone marrow transplant. He died later that year,
but were he alive today he might be a candidate for a stem cell
transplant, which has emerged as a promising way to halt leukemia
and other cancers. To help pursue new treatments and honor this
young patient, the Richard D. Frisbee III Laboratory of Stem
Cell Transplantation and Hematopoietic Graft Engineering opened
in October at Yale-New Haven Hospital’s Blood Bank in the
Department of Laboratory Medicine.
A “clean
room” laboratory for gene therapy and stem cell manipulations,
the Frisbee Laboratory will be used for both clinical applications
and basic science research by a number of medical school departments
and the Yale Cancer Center. “It is literally a biological
manufacturing facility,” says Edward L. Snyder, M.D., the
blood bank’s director and a professor of laboratory medicine.
“This unique laboratory provides an opportunity to link
together the Yale Cancer Center, Yale-New Haven Hospital and
the School of Medicine in a three-pronged attack against cancer.”
In the new Class
10,000 laboratory—so named because it has fewer than 10,000
dust particles per cubic foot of air—Yale physicians and
scientists will have a cleaner environment in which to process
stem cells from the blood or bone marrow of both patients and
donors. After chemotherapy, a patient’s previously collected
stem cells are reinfused and migrate to the bone marrow, where
they reproduce and differentiate, creating blood cells that commit
to specific functions in the body. For stem cell transplants
for patients who do not have a “matched” donor, T cells
can be removed from donor blood or bone marrow to prevent graft-versus-host
disease in recipients. “We need to be in a special environment
with purified air so that we do no harm to the cells when we
are doing our manipulation,” says Diane Krause, M.D., Ph.D.,
assistant professor of laboratory medicine and director of stem
cell processing at the Blood Bank at Yale-New Haven Hospital.
Stem cell therapy
is especially promising because “rather than trying to beat
the disease to death with chemotherapy, it allows us to step
back and apply a more gentle treatment,” says Dennis Cooper,
M.D., HS ’82, clinical director of stem cell transplantation
at the Yale Cancer Center. He says that work by investigators
including Joseph P. McGuirk, D.O., and Stuart E. Seropian, M.D.,
is pushing the limits of existing therapies. By manipulating
stem cells to attack tumor cells through an immunologic response,
these new therapies give patients a much better chance of surviving
after being diagnosed with cancer. “The most exciting area
in the next 10 years,” Dr. Cooper says, “is going to
be in identifying the different cell types that can attack the
tumor without harming the patient. The Frisbee lab is where many
of these cell manipulation studies will be done.”
As the field
of gene therapy matures over the next five to 10 years, the laboratory
will provide a facility for testing newly designed vectors, the
altered viruses that are used to deliver therapeutic genes in
the treatment of cancers and other diseases. (Yale has another
Class 10,000 clean room in the Sterling Hall of Medicine that
is also used for basic research in gene therapy, under the directorship
of Albert Deisseroth, M.D., Ph.D.)
Creation of
the Frisbee Laboratory was made possible through the fund-raising
efforts of Christine Frisbee, Richard’s mother and former
administrator of the stem cell transplant unit at Yale. In 1990,
she launched a foundation named for her son, which, since then,
has raised and distributed more than $1 million. The new laboratory
is the foundation’s largest undertaking to date. “We
want to fund things that other people won’t fund, that we
think are innovative and that bring the field of transplantation
forward,” she says.
The foundation
also provided support for the First Annual Frisbee Foundation
Stem Cell Symposium, held in October to coincide with the opening
of the Frisbee Laboratory. Speakers discussed cord blood processing
and its effect on stem cell transplantations, advances in breast
cancer research and graft-versus-host disease. “Our aim,”
says Ms. Frisbee, “is to get people who are doing the most
advanced research to educate other health care professionals
with the hope that more people will use this knowledge to help
find cures.”
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From
cough medicine to deadly addiction, a century of heroin and drug-abuse
policy
A century ago,
scientists at a German pharmaceutical firm investigated a chemical
modification to morphine that made it more palatable as a cough
suppressant. The Bayer Co., predecessor to today’s pharmaceutical
giant, marketed its popular new remedy as “Heroin.”
Although it worked against coughs caused by serious and then-common
diseases such as tuberculosis and pneumonia, physicians and pharmacists
soon noticed an unhappy side effect—patients required ever
larger doses and were becoming increasingly dependent on the
elixir. By 1912 it had emerged as a recreational drug among young
men in New York City. Two years later, addicts were knocking
at the doors of New York and Philadelphia hospitals in search
of treatment.
The history
of the drug’s use and abuse was the topic of One Hundred
Years of Heroin, a conference held at Yale in late September.
It brought together some of the nation’s leading thinkers
on the drug problem, such as U.S. Sen. Daniel Patrick Moynihan
of New York; Egil Krogh Jr., who directed drug policies during
the Nixon administration; and Jerome H. Jaffe, M.D., who, under
President Nixon, became the nation’s first so-called drug
czar.
Organized by
David F. Musto, M.D., professor in the Child Study Center and
the Section of the History of Medicine and a leading historian
of drug abuse and drug-abuse policy, the conference focused largely
on the Nixon years because, according to Dr. Musto, it was then
that the modern federal drug program was created. Social and
political issues drove many developments in drug policy. Spurred
in part by a desire to show a drop in crime before the 1972 elections,
the Nixon administration began a pilot program in the District
of Columbia, where half the inmates in local jails tested positive
for opiates. Mr. Krogh, now a lawyer in private practice in Seattle,
told the conference audience, “If we could get results in
the District, we could use them across the country.” As
treatment, including methadone, became available in the capital,
crime did indeed drop, he says.
Another impetus
for solutions to drug use started half a world away, in Vietnam,
where studies found that up to a fifth of the American soldiers
were addicted to heroin. On a trip to Vietnam Mr. Krogh told
soldiers, “I’m here from the White House to find out
about the drug problem.” Then, Mr. Krogh recalls, a soldier
took a drag of marijuana and replied, “I’m from Mars,
man.”
Dr. Jaffe, who
was director of the Special Action Office for Drug Abuse Prevention
at the time, introduced programs that reduced the addiction rate
among returning Vietnam veterans. He also tried to expand treatment
programs, create a research base and develop a national strategy
for drugs. Money became available in greater amounts than ever
before, for both treatment of addiction and training in substance-abuse
treatment. “We developed more federal support in treatment
capacity in the first two years than had been developed in the
preceding 50,” says Dr. Jaffe.
A century after
its introduction, heroin continues to pose complex medical, legal,
social and public health questions and to resist efforts at control.
“We seem to have a peak in heroin use every 20 to 25 years,”
says Dr. Musto. “Some have explained this as ‘generational
forgetting.’ Whatever the explanation, heroin will remain
a problem indefinitely for those who become addicted. However,
it is, in part because of methadone, more treatable than uncontrolled
cocaine.”
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