THESE TIMES CALL ON US FOR MORE - OUR COMMUNITY HAS RESPONDED - Dartmouth-Hitchcock | Geisel School of ...
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Giving in Action DARTMOUTH-HITCHCOCK | GEISEL SCHOOL OF MEDICINE REPORT ON PHILANTHROPY | FALL 2020 THESE TIMES CALL ON US FOR MORE. OUR COMMUNIT Y HAS RESPONDED. Researchers Pivot Alumni Back Norris Cotton Cancer to Concentrate on Geisel Campaign Center Focuses on COVID-19........................... p. 3 Priorities.......................... p. 12 Innovation.............p. 20
FEATURES 3 SAVING LIVES, IN FOCUS 08 T he Economics of Vaccine Development SERVING SCIENCE 09 Snapshot of Federal Grants Cutting-edge COVID-19 research gave our patients options 10 R esearch Briefs not available in most rural communities. 14 S eeding Change within Medicine 16 M ilestone Gift Funds Geisel Student Scholarships 18 I ncreasing Our Capacity to Care 24 A lumni Gifts Launch Entrepreneurial Accelerator 26 D onors, Fiscal Year 2020 28 G iving Highlights 12 31 Pinnacle Society SUPPORTING OUR STUDENTS Giving in Action Alumni and donors get behind Fall 2020 Geisel’s campaign goals with groundbreaking gifts Executive Director to scholarships and student Kate Villars wellness programming. Managing Editor Lauren Seidman Editorial Assistant Patti Green Design Production Farah R. Doyle Contributors Audra Burns, Timothy Dean, Jennifer Durgin, Susan Green, Kendall Hoyt, PhD, Sue Knapp, Lara Stahler Cover Photograph Yujia Shentu ’23 volunteers at Dartmouth-Hitchcock 20 Medical Center’s Farmacy Garden, which helps provide food to those in need in our community. Photo by Mark Washburn. Photography Mark Washburn (except where noted) Produced by Office of Development and Alumni Relations MOTHER. MENTOR. Dartmouth-Hitchcock | Geisel School of Medicine SCIENTIST. at Dartmouth ENTREPRENEUR. One Medical Center Drive, HB 7070 Lebanon, NH 03756 Norris Cotton Cancer Center scientists like Arti Gaur, PhD, Websites excel at bringing discoveries to dartmouth-hitchcock.org/donate the marketplace. dhgeiselgiving.org geiselmed.dartmouth.edu/campaign
LEADERSHIP LETTER THESE TIMES. These times are most often described George Floyd, Geisel students began that’s carried us through this year. As as difficult, extraordinary, challenging, steering efforts to address the racism health care professionals, scientists, and unprecedented. But let’s be that exists in our own community, and educators, we are called to the honest. The nine months since a novel and continue that work today. When vital work of creating healthier, more coronavirus upended life as we knew it these times called for selflessness, resilient, and more equitable commu- have been heartbreaking, lonely, scary, our medical students led by example. nities. We must confront the persistent and frustrating. Doctors, nurses, and staff across the racism and inequities that lead to un- Yet they’ve also been inspiring. From Dartmouth-Hitchcock Health sys- acceptable disparities in nearly every the moment the first case of COVID-19 tem have shown commitment and aspect of modern life—including health in our region was diagnosed at Dart- resourcefulness in caring for patients care. That’s why Geisel and D-H have mouth-Hitchcock Medical Center and during the pandemic. Our Connected launched multiple initiatives to address the Geisel School of Medicine moved Care team dramatically expanded use the policies, practices, and cultural its curricula online, to the ongoing of telemedicine appointments in order norms that perpetuate bias, racism, and protests against endemic racism in to ensure continuity of care for people inequity within our institutions and to America, our faculty, students, care- at home. Then, as conditions allowed, better support our employees, students, givers, and neighbors have stepped up. our care teams worked together to and patients from underrepresented These times call on us for more, and adapt our operations to safely and and disadvantaged groups. This work our community has responded. successfully re-open for in-person will not be easy nor quick. It will require appointments and procedures. When sustained engagement and investments. Last spring, Geisel and Dartmouth- These times call on us for listening Hitchcock (D-H) researchers, in these times called for creativity, our providers envisioned different ways and self-examination, and we are collaboration with Dartmouth College committed to this undertaking. colleagues, quickly pivoted to focus on to deliver their care. COVID-19 diagnostics and treatments. Throughout the crisis, you—our donors, Flexibility, selflessness, creativity, That work enabled D-H to provide friends, and volunteers—have stood generosity, listening and self-examina- accurate and rapid coronavirus testing with us. You used your connections tion—in these ways and so many more, early in the pandemic, and to offer to ensure that our frontline staff were our community has responded to the patients with COVID-19 the most equipped with personal protective challenges of these times, and we are promising treatments through clinical equipment (PPE). You aided those deeply grateful. trials—options not routinely available in need with gifts to our COVID-19 in rural communities. When these Community Relief Fund, D-H’s HOPE times called for flexibility, our Fund for employees, and Geisel’s student scientists and clinicians took action. emergency fund. You participated in a In-person classes and clinical rotations virtual Prouty and virtual CHaD Hero ended abruptly for Geisel students, to raise money for Dartmouth’s and an enormous disruption in their Dartmouth-Hitchcock’s Norris Cotton DUANE A. COMPTON, PHD medical education. But they have Cancer Center and the Children’s Dean, Geisel School of Medicine demonstrated the resilience, empathy, Hospital at Dartmouth-Hitchcock. and determination we need from our And in the midst of great economic future physicians. While adapting to uncertainty, you stayed the course with online learning, students like Yujia your crucial support for research, mental Shentu ’23 also volunteered their time health, medical student scholarships, to distribute fresh produce to food and so much more. When these times called for generosity, you moved us JOANNE M. CONROY, MD pantries, help frontline workers with with your kindness. CEO and President, childcare, and serve in nonclinical Dartmouth-Hitchcock and roles in hospitals. After the murders of Looking ahead, we will act with the Dartmouth-Hitchcock Health Ahmaud Arbery, Breonna Taylor, and same commitment and resourcefulness GIVING IN ACTION | FALL 2020 • 1
DHART (Dartmouth-Hitchcock Advanced Response Team) nurse Adam Bean transports a patient from another hospital to the COVID-19 Unit at DHMC. CALL ON US TIMES THESE TO CARE
S A V I NG L IV E S , S E R VI NG SCIENCE Clinical Research in Robert Trembley, MD, was the first patient enrolled in Our Rural Community DHMC’s remdesivir trials. BY LAUREN SEIDMAN R obert Trembley, MD, is no stranger before known asymptomatic spread and I. MARCH 2020 to illness. As a primary care physician mask recommendations. in Vermont’s Northeast Kingdom for Soon after arriving home in Vermont, over 30 years, he treated countless patients both Trembleys started to develop symptoms. in a rural health center, at North Country While his wife felt better after a couple of Hospital, and in local nursing homes. And days, Trembley couldn’t shake a low-grade as a person with cancer, he’s undergone temperature and an overwhelming sense treatment for both Hodgkin’s disease and of weakness. He wasn’t experiencing any acute myeloid leukemia (AML). respiratory symptoms, but he was suspicious. “I survived potent chemotherapy, With coordination from John Hill Jr., a bone marrow transplant, and ongoing MD, one of Trembley’s hematologists at challenges of graft versus host disease,” says Dartmouth-Hitchcock Medical Center Trembley. “All of which put me at high-risk (DHMC), Trembley was admitted to North for COVID-19.” Country Hospital. He needed IV fluids and When SARS-CoV-2, the virus that causes oxygen. A chest X-ray showed inflammation COVID-19, began spreading in the United in his lungs. The next day, his COVID-19 States in early March, Trembley and his swab came back positive. wife, Carol, were in Florida. They headed “Dr. Hill arranged for me to be transferred back north by car, staying twice along the to DHMC right away,” Trembley says, way with friends and, once, at a hotel. They “because that very day was the start of the used hand sanitizer, cleaned surfaces, and remdesivir trial.” avoided crowds, but this was in the days GIVING IN ACTION | FALL 2020 • 3
R emdesivir, an antiviral medication, is II. REMDESIVIR now known to be one of the few drugs that may shorten recovery time for a patient with COVID-19. But in March 2020, open-label (non-placebo-controlled) clinical trials of remdesivir as a COVID-19 treatment were just beginning. DHMC was one of the first 20 U.S. sites to participate in the worldwide trial and the only site participating in New Hampshire or Vermont. “COVID-related research displays our agility and ability to activate studies,” says Leigh Burgess, vice president of Dartmouth- Hitchcock’s (D-H) Office of Research Operations. “It also demonstrates the Dartmouth-Hitchcock mission of advancing understand both what they’re agreeing to health by providing each person the best and that they are free to bow out at any time. care, in the right place, at the right time, Patients and their research nurse establish a every time.” deep, trusting relationship, with a lot of one- In what can typically take two to three on-one interaction throughout the course of months, a team of experts in research a trial. But for COVID-19 clinical trials the operations, including Jami Wilson, director research nurses had to do most of their work of the Clinical Research Unit and director from outside patients’ rooms because of the of research nursing at DHMC, and principal contagiousness of the disease and the need investigator Richard Zuckerman, MD, to minimize the number of people coming MPH, opened two therapeutic studies of into contact with these patients. remdesivir in a remarkable eight days. These Robert Trembley was the first patient Phase III trials were designed to gather enrolled in DHMC’s remdesivir trials. He information about safety and efficacy by had come to DHMC specifically to take part studying different populations and different in the research and was ready to consent treatment durations, as well as using the drug upon arrival. He recalls being in his bed in in combination with other supportive care. the COVID Unit with signed consent form “With any novel virus there is no in hand, and his research nurse, by phone, standard of care,” says Wilson. “This was asking him to bring the form to the window an international pandemic and everyone so she could take a photo of it. But he was worked together to get the trials up and too weak to get out of bed. running because we didn’t have two months He doesn’t remember doing this, but it Above: Jami Wilson, to figure it out.” director of the was around that time that he’d texted his Clinical Research Wilson explains that in any clinical trial, a wife, “On six liters of oxygen. Not good.” Unit and director of research nursing at research nurse is the patient’s primary point Shortly after that, Trembley was put on a DHMC. of contact. They make sure trial participants ventilator. By the * NUMBERS 477 177 109 1,333 *data accurate as active therapeutic opened trial of August 2020 studies trials studies, enrollments, 2020 to-date 2020 to-date Clinical Research at Dartmouth-Hitchcock
“This outbreak has reminded us why it’s so important for our academic medical center to be involved in clinical trials and groundbreaking research.” “ This outbreak has reminded us why it’s for its ability to prevent “cytokine storm” in III. LENZILUMAB so important for our academic medical organ transplant patients and in patients with center to be involved in clinical trials refractory leukemia and lymphoma. The hope and groundbreaking research,” says Richard is that it can do the same to protect coronavirus Zuckerman, director of D-H’s Transplant and patients from the cytokine storm that often Immunocompromised Host Program, program leads to the need for mechanical ventilation. director for the Infectious Disease Fellowship, “Dartmouth connectivity was key to and associate professor of medicine at the bringing the lenz trial here,” says Lewis. Of Geisel School of Medicine. “As a clinician, to the 17 sites participating in the randomized, quickly get an agent that may have efficacy is placebo-controlled Phase III study, DHMC so important. Even if we don’t have a huge was one of the first four medical centers to volume of patients with COVID-19, it shows initiate the trial—once again in just eight the community that we are poised to offer days. An alumnus of Dartmouth’s medical cutting-edge medicine and we care to bring it school, Dale Chappell MED’99, MBA, is chief to the medical center in a safe way.” scientific officer for the drug’s developer, In May, Zuckerman began serving as co- Humanigen, and Michael Zubkoff, PhD, an principal investigator on another drug trial associate dean at Geisel, faculty director of with Lionel Lewis, MD, medical director the Center for Health Care at the Tuck School of the Dartmouth Clinical Trials Office, of Business, and director of the MD-MBA co-director of Dartmouth’s and Dartmouth- Program at Dartmouth, put Chappell in Hitchcock’s Norris Cotton Cancer Center touch with Lewis. (NCCC) Early Phase Clinical Trials Oncology This study will comprise 300 adult patients Group, and professor of medicine at Geisel. at sites including DHMC, the Mayo Clinic, The drug, lenzilumab (or “lenz”), is different and hospitals at the University of Southern from remdesivir in that it’s not an antiviral California and in Brazil. Participating patients medication but a monoclonal antibody. sick enough to need oxygen will get either lenz Monoclonal antibodies are laboratory-made or a placebo. If the drug works, Humanigen versions of proteins naturally produced by the will ask the Food and Drug Administration immune system in response to invading viruses (FDA) to authorize its emergency use. Results or other pathogens. In some patients with are expected in November 2020. Above: Richard COVID-19, signaling proteins called cytokines Zuckerman, MD, “It was so important to our hospitalized that activate immunity go into overdrive, and MPH, principal patients at DHMC to have us involved in investigator on the immune system goes haywire. The massive the remdesivir and inflammation that results damages lungs and this research,” Zuckerman says. “Now we lenzilumab trials at had options.” DHMC. other organs. Lenz has already been studied GIVING IN ACTION | FALL 2020 • 5
A fter five days on a ventilator, Robert useful treatment option to as many people as IV. ANTIBODIES AND CORONAVIRUS IMMUNITY Trembley was extubated. possible.” “I think the very early intervention To date, plasma collected at DHMC has was instrumental in turning things around gone to patients at the medical center and for me,” Trembley says. “If I hadn’t been close to patients at hospitals in Southern New enough to an academic medical center with Hampshire, which experienced a greater the option of the clinical trial, I would likely early surge of people sickened with the novel have remained at my community hospital and coronavirus. Likewise, people who’ve recovered been treated with hydroxychloroquine, put on a from COVID-19 have traveled to DHMC from ventilator, and that’s it. The timeline of getting across the region in order to donate their blood. to DHMC and getting on remdesivir created “The response from our community has been a window of opportunity for me that made a amazing,” says Jenna Khan, MD, assistant difference in my survival.” director of the Transfusion Medicine Service While Trembley was recovering, Zbigniew at DHMC and assistant professor of pathology “Ziggy” Szczepiorkowski, MD, PhD, D-H’s and laboratory medicine at Geisel. “People have section chief of Laboratory Medicine, director been eager and willing to do anything they can of Transfusion Medicine Service and of the to help others suffering from the disease.” Blood Donor Program, and professor of A single blood draw can provide plasma pathology and laboratory medicine at Geisel, for up to two patients—as well as samples had started evaluating the use of blood plasma for research. Investigators throughout D-H, rich in antibodies as a COVID-19 treatment. Geisel, NCCC, and Dartmouth College are Supported by federal government agencies using these and other donated samples by including the FDA, and with the Mayo Clinic enlisting volunteers to further understand serving as the Institutional Review Board, the COVID-19 disease and the body’s response DHMC program was making plasma collection, to it. In one such collaboration, Peter Wright processing, and access to treatment easier for D’64, MED’65, professor of pediatrics at patients throughout Northern New England. Geisel, Margaret Ackerman, PhD, professor of “Treatments with convalescent plasma, or microbiology and immunology at Geisel and a plasma from patients who have recovered from professor at the Thayer School of Engineering, a disease, date back to the Spanish Flu of 1918,” Jiwon Lee, PhD, of Thayer, and colleagues says Szczepiorkowski. “The belief is that plasma from the biotech firm Adimab and from the makes a difference, but we’re still waiting for University of Texas-Austin, are studying the results of randomized, controlled trials.” breadth of immune responses in the blood and in the respiratory secretions of patients who Because plasma is known to be safe and have recovered from COVID-19. The groups are anecdotal evidence suggests it can help patients, profiling and isolating the effective antibodies in the spring the FDA authorized its emergency for use as therapeutics and to inform potential use as an Investigational New Drug, or IND. vaccine efforts. (The FDA further expanded the emergency use of convalescent plasma in August 2020.) “We have a strong consortium at Dartmouth The designation allowed DHMC to provide pulling together expertise in immune plasma to anyone who met the criteria for responses,” says Wright, an infectious disease it—hospitalized in an Intensive Care Unit and specialist, “and the Clinical Research Unit about to be intubated—and the outcomes will at D-H has been extraordinarily helpful in contribute to the understanding of its efficacy. coordinating and accommodating our work.” “We felt that if we believe this might work Lionel Lewis also notes the benefits of as a COVID-19 treatment, we have to offer working in a small, tight-knit community. it,” Szczepiorkowski says. “There are other “Geisel and College scientists walk the same halls sites conducting randomized controlled trials as D-H clinicians. We don’t feel like two separate of convalescent plasma and we need those, institutions. And the more collaborations we but for us the right choice was to join the have, the more successes we’ll have.” Successes Mayo Clinic’s protocol and get this potentially for patients like Robert Trembley. DARTMOUTH-HITCHCOCK | GEISEL SCHOOL OF MEDICINE • 6
Plasma collected at DHMC has gone to patients at the medical center and to patients at hospitals in Southern New Hampshire, which experienced a Zbigniew “Ziggy” Szczepiorkowski, greater early surge of MD, PhD, principal investigator on people sickened with the the convalescent plasma program. novel coronavirus. F ive months after contracting are underserved by academic medical V. AUGUST 2020 COVID-19, Trembley says he’s back centers. We get to bring things to our rural to baseline. Or, according to his wife, population that generally wouldn’t be “even better than” his previous baseline. available.” He doesn’t feel like he’s had significant “During a health crisis, a really scary time, residual effects from the disease, perhaps, we’re able to offer patients treatments that in part, because of the health challenges let them stay close to home,” says Wilson, the he’s already faced. director of research nursing. And she notes “This experience has made me even that these options are available to patients more determined to be consistent about facing any number of health crises—not exercising and doing the things that help just COVID-19. There are currently more keep me healthy,” he says. “I received than 450 research studies actively enrolling exceptional care and I’m so fortunate. Now at DHMC, and Dartmouth-Hitchcock I’m just enjoying each day as it comes.” With Manchester is ramping up its abilities to the permission of his care team, Trembley’s enroll study participants in the southern been able to spend most of the summer in region of New Hampshire. Massachusetts, swimming, boating, and “I’m extremely grateful that I had the relaxing on the beach. opportunity to be part of a clinical trial,” For everyone involved in Trembley’s says Trembley. “Everyone at DHMC did treatment or other research at D-H, it’s a superb job and I want to extend my stories like his that drive them. Lewis says, profound and sincere thanks.” “Rural populations in developed countries PHASE III Large participation (1,000 to 3,000) to allow PHASE II researchers to collect data on safety and PHASE I Studies a new drug, device, or efficacy of a drug or treatment and to com- pare the new treatment to the standard Determines the safety of a treatment with 100 to 300 partici- treatment or to placebo. This phase may be treatment, device, or drug pants with condition or disease for randomized and blinded by assigning par- in a small group of people. the target of the treatment. It’s ticipants randomly to the groups with the Also called nonblinded designed to determine if the drug new treatment, standard treatment, or pla- as both researchers and or device is an effective treatment cebo, when relevant. A blinded study means volunteers know what for a specific disease, has any side patients and/or doctors do not know which medication is being used. effects, or has any risks. treatment they are receiving. The Phases of a Clinical Trial
W hen I led Medicine Grand Rounds at Dartmouth-Hitchcock Medical Center on January 10, 2020, we discussed the The scientific, economic, and logistical factors that make epidemic vaccine development especially challenging. I shared a chart that illustrated the growing frequency and intensity of new Economics of outbreaks around the world and noted that it was already out of date given the reports of unidentified viral pneumonia circulating in China. The discussion was lively, but did we know how deeply invested we would all become in finding solutions to these problems in the coming months? VACCINE With forecasts indicating that COVID-19 could claim 40 million lives and reduce global economic output by $12 trillion by the end of 2021, there is not a moment to lose. DEVELOPMENT Well over 300 vaccine candidates are now in development, with scientists, corporations, and nations racing for the finish line. Before the pandemic, I’d been collaborating with Christopher Snyder, PhD, the Joel Z. and Susan Hyatt Professor in Economics at Dartmouth College, on a paper outlining mechanisms to address market failures for epidemic vaccines. Companies are often reluctant to respond to smaller outbreaks such as Ebola or Zika in part because they have to redirect personnel and facilities away from other more profitable projects to focus on an outbreak with an uncertain future. In some ways, high demand and global competition suddenly seemed like a great problem to have. However, uncoordinated free market competition may actually hinder efforts to develop a COVID-19 vaccine. In a free market, vaccines will go to the highest bidder, which will drive up the price—by a factor of 13 according to our research—and reduce access. Furthermore, protectionist measures on the part of any one nation could hamper the pace of progress since vaccine development expertise, manufacturing capacity, and supply chains are highly distributed around the world. Dr. Snyder and I, along with our colleague Dimitrios Gouglas from the Coalition for Epidemic Preparedness Innovations (CEPI), make the case for a global coordination mechanism much like the one that Gavi, the Vaccine Alliance, launched earlier this year to procure large amounts of vaccine from multiple developers. An advance purchase commitment from such an entity would reduce the cost and risk of development and allow vaccine to be allocated on the basis of need, prioritizing individuals most likely to transmit the virus or suffer severe consequences from it. Equitable allocation is not just the right thing to do; it also provides the highest probability of ending the pandemic in the shortest period of time. Pandemics are transnational issues that no one country can solve alone. The challenge in the years ahead is to develop institutions and tools that will allow nations to address these problems collectively. An advance purchase mechanism takes one important step in that direction, allowing nations to pool and coordinate resources to produce pandemic vaccines as a global public good. Kendall Hoyt, PhD, is an assistant professor of medicine at the Geisel School of Medicine and a lecturer at the Thayer School of Engineering at Dartmouth. She is the author of Long Shot: Vaccines for National Defense.
Snapshot of Federal Grants Federal grants support the work of researchers throughout Dartmouth-Hitchcock and the Geisel School of Medicine. Below is a sample of recent grant awards and the studies they support. $19.9M $3M A collaboration between Geisel and the The Center for Technology and Behavioral University of New Hampshire to enhance Health (CTBH) at Geisel received a 5-year, biomedical research capabilities in the state $3 million grant from the National Institutes as part of the New Hampshire IDeA Network of Health to test the effectiveness of digital of Biomedical Research Excellence (NH-INBRE) behavioral intervention tools in high-risk continues with a five-year, $19.9 million grant patients who suffer from Type 1 diabetes—a from the National Institutes of Health. condition that is difficult and expensive to manage. The study is led by Catherine Stanger, PhD, a deputy director for CTBH and an $15.5M associate professor at Geisel. $1.5M The National Cancer Institute (NCI) has renewed its Cancer Center Support Grant to Dartmouth’s and Dartmouth-Hitchcock’s Norris Cotton Cancer Center (NCCC), continuing core A four-year, $1.5 million grant from the funding for the only Comprehensive Cancer National Cancer Institute was awarded to Center north of Boston. The five-year, $15.5 investigators at Dartmouth’s and Dartmouth- million grant will provide continued core Hitchcock’s Norris Cotton Cancer Center support for NCCC’s clinical care and research (NCCC) to build and validate machine learning missions. The prestigious designation as a approaches to non-small cell lung cancer Comprehensive Cancer Center indicates that (NSCLC) that can reveal relationships between NCCC is one of only 51 centers in the United clinical and pathologic findings, patient genetic States recognized by the NCI for its leadership profiles, and drug resistance—and lead to and resources. better, personalized treatment strategies for NSCLC patients. Saeed Hassanpour, PhD, a computer scientist at NCCC and an associate $6.4M professor of biomedical data science and epidemiology at Geisel, leads the study. $12.5M Two federal grants are helping Dartmouth- Hitchcock (D-H) expand support for children and families impacted by trauma and parental substance misuse. Project Launch, funded by the Substance Abuse and Mental Health Michael Whitfield, PhD, chair of the Services Administration, as well as Partners to Department of Biomedical Data Science at Promote Safety, Permanency and Well-Being Geisel, is principal investigator on a five-year, for Families Affected by Substance Abuse $12.5 million grant from the National Institutes (P2P), funded by the Children’s Bureau of of Health to establish a Center for Quantitative the Administration for Children and Families, Biology at Geisel that brings together and involve cross collaboration across different enhances initiatives in computational biology, departments of D-H, including psychiatry, bioinformatics, and experimental genomics population health, pediatrics, and obstetrics across Dartmouth. and gynecology. GIVING IN ACTION | FALL 2020 • 9
RESEARCH BRIEFS Kurt Wehde Monitoring Wastewater for COVID-19 Promising New Test to Measure Brain Function A collaboration between the Geisel School of Medicine and Northwestern University is shedding light on the effects of the Human Immunodeficiency Virus (HIV) on the central nervous system (CNS). Jay Buckey, Jr., MD, who led the study, says, “We thought The presence of SARS-CoV-2—the virus that causes COVID-19— we’d find that HIV affects the ear, but what seems to in municipal wastewater can give an early warning that the virus is be affected is the brain’s ability to process sound.” re-emerging in that area. A team of Dartmouth-Hitchcock (D-H) Using tests that measure not whether a person can researchers led by Isabella Martin, MD, and Jacqueline Hubbard, hear a sound but how the sound is processed by the PhD, is now measuring the level of the virus in wastewater in brain, investigators found that the auditory-neuro- specific communities or individual institutions such as nursing physiological responses to certain speech cues were homes, prisons, and colleges throughout New Hampshire and disrupted in HIV-positive adults, even though they Vermont. With these warnings, community leaders and public performed normally on hearing tests—confirming health officials could more promptly manage outbreaks. that these hearing difficulties are grounded in the Wastewater surveillance will not replace human diagnostics, but CNS. Researchers are using auditory processing as a is expected to complement it. Especially in institutional settings, “window” into brain function, which may lead to a it could provide an efficient, cost-effective, and less invasive signal better understanding of many disorders that strike of a significant spread of SARS-CoV-2. the brain—not just HIV. A generous gift from Vickie and Ken French enabled D-H to Buckey says, “We think these tests hold a lot launch this important work. of promise as a way to assess the brain easily and objectively.” Co-leading the wastewater surveillance project team for D-H are (l-to-r) medical microbiologist Isabella Martin, MD, and clinical chemist Jay Buckey, Jr., MD, is a professor of medicine at Geisel, Jacqueline Hubbard, PhD. Both are assistant professors of pathology director of the Space Medicine Innovations Laboratory and laboratory medicine at Geisel. The project coordinator is Gregory at Dartmouth, and an adjunct professor at the Thayer Tsongalis, PhD, vice chair for research and director of the Laboratory School of Engineering. for Clinical Genomics and Advanced Technology in the Department of Pathology and Laboratory Medicine at D-H. DARTMOUTH-HITCHCOCK | GEISEL SCHOOL OF MEDICINE • 10
Preserving Jon Gilbert Fox Independent Primary Care Practices Rob Strong VISTA Keeps the Immune System Quiet Against Cancer The COVID-19 pandemic has led to severe finan- A team of researchers at Dartmouth’s and Dartmouth-Hitchcock’s cial stress for both hospitals and physician practices, Norris Cotton Cancer Center (NCCC), led by Randolph Noelle, PhD, raising serious concerns that many may either close have identified some of the molecules that the immune system uses to or be purchased by larger organizations. Carrie Colla temper immunity. While these molecules are usually good, they also limit D’01, PhD, a health economist and member of a the magnitude of the immune response to cancer. The team has learned team of researchers at The Dartmouth Institute that turning off these “brakes” on immunity allows a stronger therapeutic for Health Policy and Clinical Practice, is using her response to cancer. VISTA is one of these molecules. expertise to fight for policy change that would help “We have learned that keeping your immune system quiet is a challen- to preserve independent primary care practices. ging and very active process,” says Noelle. “VISTA may be a valuable target As co-author on a recent study that showed in regulating the immune response in cancer and autoimmunity.” independent primary care practices provide equal An antibody specific to VISTA identified by the Noelle Lab is currently quality care to integrated health systems, Colla notes in Phase I clinical trials at Dartmouth-Hitchcock. that these practices need and deserve support during this time of disruption. “The policy implications of this research are clear,” says Colla. “With COVID-19 Randolph Noelle, PhD, is the Thomas S. Kosasa, MD, Professor at Geisel and wreaking financial havoc on smaller health care member of the Immunology and Cancer Immunotherapy Research Program organizations, policy makers—both at the federal at NCCC. Noelle is the co-founder of ImmuNext, a company that develops immunoregulatory drugs. and state levels—should ensure that purchases of practices and hospitals adhere to current antitrust law. They should also consider financial support for those most threatened by the pandemic.” Carrie Colla, PhD, is a professor of The Dartmouth Institute. In 2020 Colla was named an Emerging Leader in Health and Medicine Scholar by the National Academy of Medicine. RESEARCH BRIEFS GIVING IN ACTION | FALL 2020 • 11
SUPPORTING UR STUDENTS Alumni-Donors Answer the Call For medical students, the challenges and opportunities of their chosen career path are greater than ever. Yet Geisel School of Medicine students—and the faculty, staff, alumni, and donors who support them—are as committed and passionate as ever. When the pandemic disrupted nearly every aspect of life, including in-person medical education and training, Geisel students didn’t hesitate to ask themselves “how can I help?” The examples are many. They set up networks to help health care workers in multiple regions find childcare. They secured and distributed personal protective equipment. They worked with rural health clinics to provide access to food for people in need. And they helped conduct a regional population health survey to guide COVID-19 responses. Then, when police killings of unarmed Black people spurred protests nationwide, Geisel students advocated for renewed commitments and actions within their own medical school. Because of the tireless work of these students and the support of faculty, staff, and senior administrators, Geisel is now launching several new initiatives to eliminate all forms of racism, to better support underrepresented minority students, and to create a truly equitable and inclusive academic community. The philanthropic support of alumni and donors will be critical to propelling these efforts—and to achieving Geisel’s larger vision to Educate Complete Physicians. Gifts of all sizes can advance diversity, equity, and inclusion. (See contact information in adjacent column.) Photos by Jeffrey Andree, Paul Reitano, Kata Sasvari, Rob Strong, Mark Washburn, Kurt Wehde
Educating the BY JENNIFER DURGIN & LAUREN SEIDMAN COMPLETE PHYSICIANS Our World Needs Geisel seeks to increase scholarship Educate Complete Physicians is one of four unifying themes support for its within Geisel’s $200-million fundraising campaign, which is part of students, to set the Dartmouth College’s The Call to Lead campaign. With the support of generous donors, Geisel will prepare the “complete physicians” standard nationally for that our world needs—physicians who provide medically excellent, highly compassionate, and culturally sensitive care, and who educating complete work to improve health systems. Through its curriculum, thought leadership, and student programming and supportive services, physicians, and to Geisel will set the standard nationally for medical education and for creating a healthy, equitable learning environment. create a healthy, Thanks to the generosity of Geisel and Dartmouth College alumni, fundraising goals for the Educate Complete Physicians equitable learning priority are within reach. environment. Gifts from visionary donors Learn more about Geisel’s other campaign goals: are helping achieve Strengthen Healthcare Systems, Innovate to Overcome Cancer, and Build the Foundation for Children’s Health. those goals. Visit: GeiselCampaign.Dartmouth.edu TO DISCUSS MAKING A GIFT, CONTACT ROBERT HOLLEY, Senior Associate Director of Development for Geisel School of Medicine: Robert.D.Holley@Dartmouth.edu or 603-369-1129
Seeding UR STUDENTS CHANGE WITHIN MEDICINE Geisel’s Revolutionary Approach to Student Mental Health SUPPORTING I t’s no secret that medical school is extremely demanding, says Duane Compton, PhD, dean of the Geisel School of creating high levels of stress among students. Nationally Medicine. Launched in late 2019, the program is a top priority nearly one-third of medical students report symptoms of for Geisel, has a fundraising goal of $5 million, and is part of depression and related illness, and one in ten have considered The Call to Lead campaign. suicide. These higher-than-average rates persist throughout Healthy Students, Healthy Physicians provides and continues residency and physicians’ careers—and have a direct impact to plan a variety of training and supports, including mental on quality of life, productivity, and patient care, according health screening, increased access to individual and group to several studies. At the Geisel School of Medicine, surveys counseling, and wellness and resiliency programming—all at no of MD students have found that they are not immune from cost to students. Geisel MD, MD-PhD, and MD-MBA students these issues. can utilize the program, and it will be available to students from Thanks to a $2M gift from a Dartmouth College alumnus The Dartmouth Institute for Health Policy and Clinical Practice and his spouse, Geisel has launched Healthy Students, Healthy by 2021. Fundraising to further expand these offerings is Physicians, a new comprehensive mental health and wellness ongoing. Duncan notes that while general awareness of mental program that prepares Geisel graduates to meet the stresses health issues has improved, they remain highly stigmatized in and challenges of their profession without sacrificing their the field of medicine. A program like Healthy Students, Healthy own health. Physicians is a vital step in ending that stigma. “This gift is allowing Geisel to launch a truly revolutionary “We want to create a community in which developing program that sets our medical school apart as a model for other resilience is part of physician training and seeking mental health institutions,” says Matthew Duncan, MD, MED’01, an assistant care is seen as a sign of strength and not a personal weakness professor of psychiatry at Geisel and leader of the program. or professional liability,” says Duncan. “This gift will help plant “We hope the generosity, vision, and leadership of these the seeds of cultural change within the practice of medicine.” donors will inspire others to support this pioneering program,” FAST, FREE SUPPORT T ailored to medical students’ unique schedules, the communities and health care systems,” says Duncan. “Our program offers flexible hours for individual and group new counselor has joined a task force of faculty, staff, and counseling in two locations near the Geisel campus, students focusing specifically on the mental health needs of as well as video and phone appointments. Students who our underrepresented minority students and, later this fall, call the dedicated Geisel Counseling phone line to schedule they will set forth a proposal for expanded workforce and a non-emergency appointment are guaranteed a response programming to meet these needs.” within 48 hours, and offered a first appointment within seven Another resource that will soon be available to students days. Counseling is available throughout students’ entire through Healthy Students, Healthy Physicians is the Interactive time at Geisel with no limits to number of appointments Screening Program (ISP), a 27-item questionnaire that screens and no billing hassles. for stress, depression, alcohol and drug abuse, and eating In August 2020, a licensed mental health counselor disorder symptoms. Used by more than 25 medical schools with experience in race-based trauma and the mental and more than 120 higher education institutions, the ISP health impacts of structural racism joined the Healthy helps students understand if what they’re feeling is normal Students, Healthy Physicians counseling team. “Students stress or something more serious. Counselors receive the from underrepresented minority groups often face additional encrypted results and can engage with the student—who stressors, especially in predominantly white academic remains anonymous—to give an assessment, open a dialogue, and point the student to additional resources as needed. DARTMOUTH-HITCHCOCK | GEISEL SCHOOL OF MEDICINE • 14
“Many of our students are experiencing common life or school-related stressors that are resolved through a HEALTHY supportive approach or coaching,” explains Duncan. “For those who meet the diagnostic criteria for a formal mental STUDENTS, HEALTHY health disorder, counseling is most useful and appropriate. The ISP is one more tool we can use to identify the students who could benefit from any of these types of help.” PHYSICIANS RESILIENT Making an Impact on the FUTURE Lives of Medical Students PHYSICIANS O ther Healthy Students, Healthy Physicians offerings include Mental Health First Aid Training that Total students served teaches students, faculty, and staff how to identify, understand, and respond to signs of mental illnesses; wellness and resiliency workshops, seminars, and electives on topics such as mindfulness, meditation, and cognitive 100 Percentage of behavioral therapy; and a stigma reduction workgroup to student body 25% increase discussions about mental illness among physicians that has utilized counseling and the importance of seeking help. services With philanthropic support from additional donors, AS OF OCT. 1, 2020 Geisel hopes to broaden services to the program. A dedicated psychiatrist could provide assessments, medication DATA Cost to students SHOWS management, and continuity of care to Geisel students. A neuropsychologist could provide neuropsychological evaluations—tests that are essential to students in need of reasonable accommodations in order to have equal access to $0 the academic environment. 9.54 In the meantime, program data and survey results gathered since the program launched demonstrate a high Student likelihood of level of satisfaction among students. One hundred medical recommending Geisel Counseling AVERAGE to a classmate on a 0-10 scale students have received confidential counseling through (0 Not at all likely, 10 Extremely likely) the program so far, and a vast majority indicated that they are very likely to recommend Geisel Counseling to a classmate. Healthy Students, Healthy Physicians leaders will continue to measure the program’s success through the use of anonymous surveys and confidential reporting. Duncan sometimes uses an athletics analogy to explain the importance of mental health supports for medical students. “If you recruit a top athlete, you provide them with athletic trainers and supports to help them keep their bodies in peak physical condition. Likewise, we want to provide medical students with mental health supports and resiliency training to help them navigate the stresses of medical school “Taking part in this and perform at their very best throughout their careers— which benefits everyone, especially their patients.” program is probably the single most helpful thing I’ve ever done for myself.” —anonymous student GIVING IN ACTION | FALL 2020 • 15
MILESTONE GIFT Funds Geisel Student Scholarships The scholarship support that Tlalli Moya-Smith ’20 received while at Geisel is helping her pursue her goal of working with underserved communities. A new $10 million gift commitment from a Dartmouth general practice and internal medicine for nearly 40 years medical school alumnus is the third largest gift in before retiring in 1997. Like many of his classmates, he the school’s history and the largest commitment has been a long-time supporter of the medical school. “I received to date by the Geisel School of Medicine as part hope my gift will encourage the development of the next of The Call to Lead, Dartmouth’s comprehensive fundraising generation of primary care physicians,” Gasteyer says. campaign. Combined with a bequest commitment of When received, these gifts will establish endowments approximately $1 million from a second alumnus, the gifts that together are expected to provide more than $500,000 will add $11 million to the school’s scholarship endowment, a year in additional scholarship aid to Geisel students—a significantly increasing financial aid for medical students. nearly 15 percent increase in the total amount available The groundbreaking $10 million gift, to be fulfilled today. As the endowments grow over time, so, too, will their through a bequest, will provide scholarship support for annual distributions. medical students at Geisel based on their demonstrated “These incredible commitments will make a Dartmouth financial aid need. “As I look back over a fulfilling and medical education possible for more students with financial rewarding life, I consider my admission to the medical UR STUDENTS need and reduce the debt burden that so many of our school at Dartmouth, and the supportive and humanistic students graduate with,” says Duane Compton, dean of teaching I received there, as perhaps the finest gift I have Geisel. “Reducing this debt is a top priority because it helps ever received,” says the first donor, who prefers to remain ensure that students’ choice of medical specialty is driven anonymous. He noted his particular interest in supporting by their passions and desire to serve, and not by earning students who hope to provide primary care, such as family potential.” medicine, geriatrics, pediatrics, and internal medicine— specialties that encourage and enable physicians to care These philanthropic commitments come at a time for people in their communities. “It is my hope that future when Dartmouth is doubling down on its long-standing graduates will one day no longer be burdened by student dedication to ensuring affordability for all students through financial aid. In response to the current economic crisis and SUPPORTING debt as they begin their professional careers,” he says. increasing student need, the College recently reaffirmed its Together with the bequest commitment from alumnus campaign goal to secure $500 million in endowed funds to Ted Gasteyer D’54, MED’55, the two gifts advance progress support graduate and undergraduate students. toward Geisel’s campaign goal of raising $20 million in new scholarship support for medical students. Gasteyer was in DARTMOUTH-HITCHCOCK | GEISEL SCHOOL OF MEDICINE • 16
On June 5, 2020, Geisel students and Dartmouth-Hitchcock THESE TIMES ON US CALL employees took part in the national White Coats for Black Lives movement, standing in solidarity with those speaking out against the death of George Floyd. TO ACT
Increasing Our Capacity to Care DARTMOUTH-HITCHCOCK MEDICAL CENTER’S NEW PATIENT PAVILION * 200 + 396 By the Patients are denied access to DHMC each Total current inpatient beds at DHMC, of NUMBERS month because of a lack of capacity which 316 are in single- occupancy rooms
N ewborns in distress. Teenagers with appendicitis. Men and women with sudden-onset seizures, life-threatening injuries, brain bleeds. Again and again, Dartmouth-Hitchcock Medical Center (DHMC) is forced to send patients elsewhere for care, simply because there aren’t enough beds. More than 200 critically ill and badly injured children and adults are turned away every month. Instead of receiving superb, sophisticated care close to home, near families and loved ones, these patients are sent to medical centers hours away, at great cost and inconvenience—and at added risk from the delay in receiving care. Dartmouth-Hitchcock (D-H) recently took a major step in addressing this problem. On July 22, 2020, a small group gathered to break ground for a new Patient Pavilion. This facility, scheduled to open Renderings courtesy of HDR. by 2023, not only will provide 64 additional single-occupancy rooms to meet current needs but also include unfinished space to allow for future expansion. Dartmouth-Hitchcock Health (D-HH) and D-H Board Chair Ed Stansfield remarked at the ceremony, “When our community needs us, we must be ready to take action, and this new Pavilion is the evidence of that.” Also at the groundbreaking, Charlie Plimpton, the Chair of the Board’s Finance Committee, outlined the project’s financial viability, and he highlighted the role that donors will play. “In order for D-H to sustain its uniquely essential mission as an academic health system, an increase in philanthropic support becomes essential.” Plimpton and his wife, Barbara Nyholm, made the inaugural commitment to support the construction. D-H and D-HH CEO and President Joanne M. Conroy, MD, reiterated that the team at D-H is committed to providing world-class health care in our region. “We know that the demand continues to grow in the communities we serve, and thus the demonstrated need for the Pavilion. It really is a testament to our community that, in the midst of all the uncertainty facing the country, we are still going ahead with this project.” 64 + $150M 2022-23 New single-occupancy Projected cost of Expected completion inpatient rooms, with five-floor (~200,000 date when the building the flexibility to add sq. ft.) facility will be ready for patients another 64 in the future
MO T HE R. MENT O R. SCI E NT I ST . ENT R E P RE NEU R. Arti Gaur and Her Fearless Pursuit Arti Gaur, PhD. BY JENNIFER DURGIN F or scientists like Arti Gaur, PhD, entrepreneurship “Make sure the consequences of your discoveries is essential to achieving their ultimate goal: reach humanity,” she says “and you can’t just go from lab dramatically improving patients’ lives. to humanity. You need things like intellectual property, “If you truly are passionate about making a difference, you need venture capitalists, you need to talk to them, please follow through,” Gaur tells the students she present to them, and convince them that your project mentors in her lab at Dartmouth’s and Dartmouth- is an endeavor that they should fund.” Hitchcock’s Norris Cotton Cancer Center. An assistant Gaur has done all of those things, herself, multiple professor of neurology at the Geisel School of Medicine, times. She admits it’s been a steep learning curve. In her Gaur applies her training as an immunologist to study many years of scientific training, she never learned how the development and treatment of brain tumors. She to bring a discovery to the marketplace. Those lessons insists that her students conduct their scientific and came later, when pure frustration and grief set her on a academic work with “absolute rigor and excellence.” But path toward entrepreneurship. she also pushes them further. DARTMOUTH-HITCHCOCK | GEISEL SCHOOL OF MEDICINE • 20
“You can’t just go from lab to humanity. You need things like intellectual property and venture capitalists,” says Gaur. In early 2020, Gaur and Dartmouth chemist Glenn Micalizio, PhD, (far right) met with Barry Schweitzer, PhD, D’82 (far left) of the Technology Transfer Office and Jamie Coughlin (second from right) of the Magnuson Center for Entrepreneurship to discuss a promising new therapy for brain cancers. NO TIME TO WASTE G aur was in the second year of her doctoral “My child taught me how to be fearless and training at the University of Cologne focus on what really matters,” says Gaur. She draws when her mother was diagnosed with on this fearlessness, this determination in the face B-cell lymphoma—the very cancer she had of a devastating illness, to power her science, her studied as a graduate student at the University of entrepreneurship, and her mentorship of students. Rochester. Her mother died six months after her Gaur wants to find ways to monitor cancer diagnosis, not from the cancer but from the side treatments in real time to prevent “horrific, effects of the cancer treatment. systemic side effects,” to detect brain diseases “I used to think the saddest day of my life was early, to deliver treatments directly to tumors, when my mother passed away,” recalls Gaur. Then, to recognize unhealthy changes in the immune shortly after she became an assistant professor system—and she wants to achieve all this as at Geisel and received the National Brain Tumor quickly as possible. She knows that when a loved Society’s prestigious Daniel Paul Bogart Chair of is suffering, there is no time to waste. Research, her second child was diagnosed with Gaur already holds seven patents that range from Rett Syndrome, a severe neurological condition diagnostic biomarkers and potential treatments that would require a lifetime of round-the-clock for brain tumors to tiny wireless devices to detect care. “My husband and I were devastated, burned cancer and deliver targeted therapies. She also down to ashes.” They had to build a new normal leads a multi-institutional, prospective clinical trial, for themselves, their family, and their research which aims to establish ways to diagnose, predict programs. (Gaur’s husband, Makul Sharma, PhD, outcomes, and monitor treatments for brain tumor is a professor of earth sciences at Dartmouth who patients using only a few milliliters of blood. studies geological processes.) The Cancer Center ranks sixth nationally for entrepreneurship among National Cancer Institute-designated Comprehensive Cancer Centers. GIVING IN ACTION | FALL 2020 • 21
LEARNING THE SCIENCE AND THE INDUSTRY “ Dr. Gaur embodies exactly what I was looking New York City-based Mount Sinai Health System. After for,” says Jordan Isaacs, a third-year graduate the fellowship, Ravi will continue her doctoral research student in Geisel’s Program in Experimental and in Gaur’s lab, investigating potential vulnerabilities in Molecular Medicine. Gaur is helping Isaacs pursue brain tumors that could become therapeutic targets. both her PhD in Cancer Biology, Pharmacology, For Isaacs, the focus of her laboratory work so far and Molecular Therapeutics and her ambitions to has been a new “drug-like” steroid that appears highly work in venture capital. Isaacs wants to be the one effective in treating brain cancers and was created by assessing which technologies, new therapies, and Dartmouth chemist Glenn Micalizio, PhD. Isaacs is other innovations to support. In her first year at also working closely with Dartmouth’s Technology Dartmouth, Isaacs became a Healthcare Fellow at Transfer Office, which will help Micalizio and Gaur Ulysses, a local biotech venture fund. “I was able to move the therapy from academia to industry—a see the full picture of how to bring a drug from the critical step on the way to clinical trials in patients. bench where I’m working to really being looked at as Dartmouth’s Magnuson Center for Entrepreneurship a potential investment,” says Isaacs. and the Technology Transfer Office use their Divya Ravi, another PhD student in the Gaur lab, is knowledge of intellectual property, private industry, learning about biomedical entrepreneurship as a Mount and venture capital to assist researchers at Dartmouth. Sinai Innovations Partner—a competitive program at the (See adjacent article about the Accelerator.) RIGHT PARTNERS, RIGHT STRATEGY T he collaboration with Micalizio is one of several evade the immune system. Lodestone is now pitching for Gaur. She is also co-founder of a new its technology as a way to monitor new therapies in company with Axel Scherer, PhD, a professor real time, thereby reducing the risks of clinical trials at Caltech. Gaur and Scherer are developing wireless for both patients and companies. Using this approach, nanoscale sensors that can be implanted in the body Lodestone recently secured a major federal grant (details to monitor signs of health and disease—and ultimately below) that will fund the development of the technology, detect cancers early. That’s especially important for making it more appealing for investors and moving it brain cancers, which are almost always detected too closer to clinical trials. late for life-saving treatment. The technology is still Philanthropy has also been critical to Lodestone’s years away from testing in humans, but if Gaur and progress. In 2018, Diamond received the J. Brian and Scherer can attract enough financial support through Allie J. Quinn Scholars award, which helped him find federal grants, investors, and philanthropists, they can the right strategy for Lodestone and develop himself accelerate that timeline. as a faculty entrepreneur. Another collaborator of Gaur’s is Solomon “The collaborations and idea sharing that came Diamond, PhD, at Dartmouth’s Thayer School and out of the Quinn Scholars is just so much more co-founder of Lodestone Biomedical. Lodestone than the dollars,” says Diamond. As a requirement struggled for years to attract funding and investors, of the Quinn award, Diamond presented to several despite having a remarkable imaging technology experienced biotech entrepreneurs and investors. based on magnetic nanoparticles. Their guidance, along with Gaur’s, led to a $400,000 “We needed a collaborator with deep subject matter Small Business Innovation Research (SBIR) grant from expertise and a track record of experience in translational the National Cancer Institute (NCI). Dartmouth- work,” says Diamond. “That search led us to Arti.” affiliated companies have secured more than 20 With Gaur as a scientific advisor, Lodestone refined such NCI-SBIR grants in the last decade—making it its market strategy. Tumors are not isolated islands, sixth in entrepreneurship among all NCI-designated Diamond learned. They are living communities of cells comprehensive cancer centers. that are constantly interacting with and attempting to DARTMOUTH-HITCHCOCK | GEISEL SCHOOL OF MEDICINE • 22
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