Partners HealthCare Announces New CEO
BWH President Gary Gottlieb Accepts Top Post, Effective January 1, 2010

The Partners HealthCare Board of Directors voted unanimously on Feb. 24 to offer the position of president and CEO to Gary Gottlieb, MD, MBA, who is currently serving as president of Brigham and Women’s Hospital (BWH). Dr. Gottlieb will succeed Partners President and CEO James J. Mongan, MD, who is retiring at the end of the year.

“Since he joined Partners in 1998 as our first chairman of Partners Psychiatry and Mental Health and professor of Psychiatry at Harvard Medical School, Dr. Gottlieb has brought his immense talent and thoughtful leadership to every facet of the Partners organization—and to the international community,” said Jack Connors, Jr., chairman of the Partners Board of Directors.

A nationally recognized psychiatrist and health care administrator, Dr. Gottleib has distinguished himself as president of BWH since 2002. During his tenure, the hospital has received dozens of prestigious awards for quality, safety and efficiency, establishing it as a national and international leader in academic medicine. These awards include a consistent spot on U.S. News & World Report’s annual honor roll of America’s Best Hospitals, the quality award from the National Quality Forum and five-star and top-performer ratings from the University HealthSystem Consortium, a national association of academic medical centers that focuses on quality and performance improvement.

Prior to taking the helm at BWH, Dr. Gottlieb served as President of Partners’ North Shore Medical Center (2000-2002). In 2006, he was the interim President and Psychiatrist-in-Chief at McLean Hospital, while continuing his role as President of BWH. Between 1986 and 1998, Dr. Gottlieb served in positions of increasing leadership in health care in Philadelphia, at the University of Pennsylvania Health System where he ultimately became interim Chair of Psychiatry and Associate Dean for Managed Care and also at Friends Hospital where he was Director and CEO.

Dr. Gottlieb received his B.S. Cum Laude from Rensselaer Polytechnic Institute and his M.D. degree from Albany Medical College of Union University in 1979, through a six-year accelerated biomedical program. After serving as a resident and chief resident at NYU/Bellevue, he became a Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania. There, he earned an M.B.A with Distinction in Health Care Administration from Penn’s Wharton Graduate School of Business Administration.

Upon accepting his new role, Dr. Gottlieb thanked Dr. Mongan for his generosity, wisdom and dedication to the Partners HealthCare system and its 50,000 employees during the last seven years. “As I think of the challenges that lie ahead, I stand in awe of all Dr. Mongan has achieved during his years as Partners CEO,” Gottlieb said. “We owe him our deepest gratitude for his passionate leadership and for the path of progress he carved with a steady hand and unshakeable devotion; it is a path we will continue to follow by the same compass and commitment to our mission.”

Under Dr. Mongan’s leadership, Partners has become an international model of an integrated, academic health care delivery system, committed to quality, access, and cost management. His signature initiative at Partners — High Performance Medicine — has succeeded in bringing 100% of Partners primary care physicians on to an electronic medical record system, reducing medication errors through computerized physician order entry, improving care for patients with chronic disease, and developing opportunities to better manage health care costs. In 2008, he was named the most powerful physician executive in America by Modern Physician and received the CEO IT Achievement Award from Modern Health Care. His body of work has helped to transform Partners HealthCare into America’s leading integrated academic health care system, and has improved the lives of countless patients, caregivers, and families across the globe.

Editorial: International Implications of the Jupiter Study

By Gilbert H. Mudge, Jr., MD
Senior Cardiologist, BWH
Associate Professor, Harvard Medical School
Senior Medical Advisor, Partners International Medical Services

Statin therapy has been shown to prevent myocardial infarction in patients who either have established vascular disease or are considered at high risk because of underlying risk factors. Over the past several years, indications for statin therapy have been expanded to include patients at lower and lower risks. The JUPITER Study addresses the impact of statin medication in apparently healthy patients, and serves as a landmark study for the primary prevention of cardiovascular disease.

Of the 89,890 patients from 26 countries who were initially screened, 17,802 were ultimately studied. These individuals were selected because they met the following three criteria: 1) an absence of known cardiovascular disease; 2) an acceptable cholesterol level; and 3) the presence of an elevated marker in their blood called C-reactive protein.

Prior studies by the same investigators suggest that this protein becomes a marker for patients at higher risk for heart attacks or strokes. When the JUPITER patients were randomized to therapy with a statin drug or a placebo, the group taking the statin experienced an approximate 50% reduction in catastrophic events of myocardial infarction, stroke or death.

Prior to The JUPITER Study, primary prevention of vascular disease had been limited to sensible diet, regular exercise, smoking cessation, blood pressure control, and maintaining an ideal body weight. JUPITER now suggests that primary prevention of cardiovascular disease with statin therapy should be extended to a much larger population whose major risk factor is an elevation in CRP.

It has been suggested that if the results of the JUPITER Study were applied to the Unites States population, at least 250,000 heart attacks, strokes, revascularization procedures, or deaths could be prevented each year. While many nuances of this study still need to be explored, JUPITER is a call to action for anyone who is concerned about the emerging epidemic of cardiovascular diseases within our global population. The next twenty years present a paradox that we cannot ignore: while cardiovascular disease will continue to decline in the developed world, it will expand exponentially in the developing countries of Africa, the South Asian subcontinent, and the Far East. For those populations, primary prevention will ultimately constitute a greater service to humanity than all the current secondary care strategies that are currently being implemented in the West. At this critical juncture in global health policy planning for cardiovascular disease, The JUPITER Study challenges us to rethink some long held assumptions about when – and for whom – statin therapy makes sense.

Senior Cardiologist, BWH
Associate Professor, Harvard Medical School
Senior Medical Advisor, Partners International Medical Services

1. Which observations made the strongest impression on you?
   
   The role of computers and the sophisticated information systems in the Partners Hospitals impressed me very much. In Turkey, I use my computer for approximately 50% of my activities that are related to patient care. The other half I do by handwriting. Prescriptions and chemo schedules, for example, are always written by hand. At home I use the telephone to reach my nurse to make appointments for chemotherapy; in Boston, it’s all computerized. I was also really impressed that the hospitals send electronic prescriptions directly to the pharmacy. In Turkey, patients must carry paper prescriptions to their local pharmacies.
   
   I was also impressed by the holistic approach to care that I observed in Boston, and all of the support services that are available to cancer patients. Although I work with a psychologist, I do not have a social worker on my team at home.
   
   
2. How do practices at the Partners Hospitals differ from those at Metropolitan Hospital in Istanbul?
   
   Aside from the integration of computer technology into the practice of medicine, and the fact that there is a PC in every exam room, the most outstanding difference was the American patients’ full awareness of their disease. In Boston, patients conduct extensive research about their conditions before they arrive at the physician’s office. They frequently ask to participate in clinical trials, or inquire directly about the survival rate for their particular disease.
   
   In Turkey, sometimes the family doesn’t want the patient to know the full truth about the disease. Health care proxies don’t exist — often there are several relatives who are actively involved in accepting and following the treatment plan.
   
   Therefore my first question to patients usually is, “What do you know about your diagnosis?” Before they meet with me, only 30 percent of my patients actually understand that they have cancer. Usually they have been informed by a surgeon, or another practitioner.
   
   For the vast majority of my patients, the other 70 percent, I don’t say the word “cancer.” Instead, I use terms like tumor, neoplasm, or abnormal tissue. It takes much more time to talk around a diagnosis rather than addressing it directly. It’s emotionally draining, too.
   
   
3. How did you first learn about the Visiting Physician Programs at Partners? Why did you wish to participate?
   
   I learned about this opportunity through the Turkish Medical Oncology Society. I actually applied two or three times before being selected this year. It’s very competitive!
   
   
4. How do best practices in Boston differ from those in Turkey?
   
   It’s difficult to even make the comparison because the health care systems are so different. First of all, most people in Boston have primary care physicians, and there is such a concentration of cancer specialists as well. In Turkey, not every patient has a primary care physician, nor do we have medical oncologists in every city. Many Turkish patients have to travel for medical oncology and radiation therapy. And some insurance policies don’t cover the full course of treatment for particular cancers.
   
   In Boston, there are literally hundreds of Phase I and Phase II clinical trials taking place every day. We do conduct trials in Turkey as well, but they are very limited in number and in scale.
   
   
5. Have you learned any specific techniques or approaches here that you plan to incorporate into your practice when you return to Turkey?
   
   In the area of health policy, I will certainly advocate for the establishment of palliative care centers and hospice services in Turkey. I will also recommend to my hospital that we should establish our own in-house health care proxy form. And on a day-to-day level, I’m going to start using my computer for prescriptions and consultations. Hopefully the Radiology Department will soon be able to send scans directly to my PC as well.
   
   
6. What advice would you give to other international oncologists who are considering participating in this program?
   
   I would definitely recommend this program to my colleagues, whether they are early in the careers or mid-career like me. I wish that every medical oncologist in Turkey could have a chance to visit the Partners Hospitals!

Pediatric Traumatic Brain Injury
Innovative Research Aims to Improve Outcomes for TBI Patients

CONTRIBUTORS:
Michael J. Whalen, MD
Pediatric Critical Care, MassGeneral Hospital for Children; Associate Professor of Pediatric Critical Care Medicine, Harvard Medical School

Michael R. Hamblin, PhD
Wellman Center for Photomedicine, Massachusetts General Hospital; Associate Professor of Dermatology, Harvard Medical School

Traumatic brain injury (TBI) is a leading cause of mortality and morbidity among children. Each year in the United States, an estimated 2,700 children between ages 0 to 14 years die from TBI, 37,000 are hospitalized, and 435,000 are treated in emergency departments, according to the Centers for Disease Control and Prevention. The two age groups at highest risk for TBI are 0- to 4- year-olds and 15- to 19-year olds, with males about twice as likely as females to sustain a TBI.

The causes of TBI in the pediatric population vary by age. During infancy, the most common causes are shaken-infant syndrome and falls. Falls and struck by/against events, which include colliding with a moving or stationary object, are common causes of TBI among preschool and primary school-aged children. During adolescence, TBI is often caused by motor-vehicle crashes and sports injuries.

In 2000 alone, the direct and indirect costs associated with TBI for all age groups in the United States were an estimated $60 billion. Yet most TBI is preventable through relatively simple, low-cost measures: window guards and safety gates on stairs; the proper use of child-safety or booster seats and seatbelts; helmet use for engaging in all types of sports and recreational activities and while operating two-wheeled vehicles and snowmobiles; and staying off allterrain vehicles, which are unstable.

Advances in critical care medicine over the past few decades have reduced the mortality rate for severe TBI pediatric patients. Yet considerable work remains to be done for survivors, who frequently face a long, painful, and costly rehabilitation followed by an entire lifetime of often-disabling cognitive and motor deficits, neuropsychiatric disorders, and an increased risk of early Alzheimer’s disease, epilepsy, and other neurologic disorders.

Secondary injury a focus of research Much of the damage caused by TBI is not the direct result of initial trauma to the brain, as was once believed. Rather, most of the sequelae of TBI are due to secondary brain injuries that result from a cascade of complex cellular and biochemical events that are triggered by the initial event, occur over days to months, and affect regions of the brain well beyond the initial site of injury. For example, diffuse axonal injury — once thought to be solely the result of shearing caused by inertial forces during the primary injury — is now believed to be largely the result of subsequent biochemical events.

While the outcomes of patients with severe TBI are virtually impossible to predict and are influenced by many factors (notably the administration of critical neuroprotective measures, such as prevention of hypotension and hypoxemia, in the immediate post-trauma period), it is becoming increasingly clear that patients’ genes also play a significant role in how they will fare over time.

With the goal of improving the outcomes of pediatric patients with TBI, MassGeneral Hospital for Children (MGHfC) physician-scientists in Mass General’s Neuroscience Center are engaged in research aimed at identifying the genes that affect TBI outcomes; elucidating the mechanisms of secondary brain injury; and, based on those discoveries, finding new therapeutic targets and evaluating innovative therapies using immature animal models of TBI.

Targeted pharmacologic agents
In previous studies,MGHfC researchers found that the dual inhibition of tumor necrosis factor-alpha (TNF-α) and Fas, which are induced at TBI, reduce brain tissue damage, motor dysfunction, and spatial learning deficits in mice (see Selected References). They are now searching the TNF-α/Fas pathway for downstream mechanisms, which might have greater specificity and a longer therapeutic window, as potential therapeutic targets.

Building on this work and with NIH funding, MGHfC researchers are currently evaluating a novel agent in a novel class of agents — necrostatin-1 — in various mouse models of TBI. Necrostatin-1 targets a new, regulated cell-death pathway— coined “necroptosis” by Harvard Medical School neuroscientist Junying Yuan, PhD — that recent studies have shown occurs in TBI as well as some other neurodegenerative conditions.

Thus far, the drug has shown striking effects in TBI mouse models, including reducing tissue damage and improving motor and cognitivefunction. The drug has a short therapeutic window, so may have the greatest potential for use in combat situations. Yet the identification of a new cell-death pathway involved in TBI presents many other opportunities for investigation and potential pharmacologic interventions.

Another gene in the researchers’ crosshairs is ApoE4, which, because it affects beta amyloid production, is the subject of much Alzheimer’s disease research. Mice with the ApoE4 mutation have a higher incidence of poor outcomes after TBI.MGHfC researchers are now investigating whether mice with this gene variant produce more beta amyloid and, if so, will evaluate whether BACE inhibitors might improve motor and cognitive sequelae in mouse models of TBI.

A potential noninvasive option: laser therapy
In a collaboration with scientists at Mass General’s Wellman Center for Photomedicine, MGHfC researchers are pursuing an innovative approach to neuroprotection following TBI using low-level laser therapy (LLLT). A non-invasive therapy applied transcranially, LLLT has been used to significantly improve recovery in human stroke patients, following only one treatment at ~18 hours after stroke. It has also been used successfully by researchers elsewhere in a mouse model of TBI.

LLLT (810-nm) works, in part, by increasing respiration in the mitochondria — an effect that continues long after the light is removed — causing activation of transcription factors leading to cellular effects such as increased brain antioxidant capacity, reduction of key inflammatory mediators, and inhibition of apoptosis.

With funding from CIMIT (Center for Integration of Medicine and Innovative Technology), Mass General researchers will study LLLT mechanisms on a photobiological and cellular level in vitro, and evaluate its effectiveness in animal models of acute and chronic TBI.

If, as the collaborators hypothesize, LLLT is effective for TBI treatment, it would become the first therapy to improve cognitive, neuropsychiatric, and motor function in TBI patients. In addition to being a noninvasive, safe, ambulatory and potentially even home-based therapy, LLLT may offer another important advantage: it could also be used in the chronic management of TBI, offering new hope to patients well after their initial injury.

SELECTED REFERENCES
You Z, Savitz SI, Yang J, Degterev A, Yuan J, Cuny GD, Moskowitz MA, Whalen MJ. Necrostatin-1 reduces histopathology and improves functional outcome after controlled cortical impact in mice. J Cereb Blood Flow Metab 2008; in press.

Bermpohl D, You Z, Lo EH, Kim H, Whalen MJ. TNF alpha and Fas mediate tissue damage and functional outcome after traumatic brain injury in mice. J Cereb Blood Flow Metab 2007; 27:1806-18.

Mechanisms for Low-Light Therapy I; Edited by Hamblin MR, Waynant RW, Anders JJ. Proceedings of SPIE; Vol. 6140 (SPIE, Bellingham, WA 2006). ISBN-13 978-0-8194- 6183-4.

Langlois J, Rutland-Brown W, Wald M. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006; 21(5):375-8.

Partners Team Consults, Lectures in India

With the epidemic of heart disease in India, the Partners cardiology team is working with SRM leadership to develop a phased plan for introducing cardiac clinical facilities and services that will enable SRM to address the chronic and acute needs of its patient population.

Recently, a team of Partners experts traveled to Chennai to evaluate SRM’s cardiology and medical simulation capacities, and to lecture before an audience of 500 physicians and staff at a cardiology conference held in celebration of World Heart Day.

MGH, Harvard and MIT Establish Ragon Institute

In partnership with Harvard and MIT, MGH has announced the formation of the Phillip T. and Susan M. Ragon Institute, which will unite scientists, clinicians and engineers in a multidisciplinary effort to improve our understanding of how the body fights infections and ultimately to apply new knowledge to a wide range of cancers and infectious diseases, including HIV/AIDS. The Ragon Institute will be administratively based at MGH and will be directed by Bruce Walker, MD, who has led the Partners AIDS Research Center (PARC) since 1995. PARC will be incorporated into The Ragon Institute and will continue to work closely with clinicians and researchers at an MGH-affiliated center in KwaZulu-Natal, South Africa.

Blumenthal To Lead Health IT For The US

David Blumenthal, MD, MPP, who currently directs the Institute for Health Policy at the Massachusetts General Hospital (MGH), will take a 2-year leave of absence to join the Obama Administration as national coordinator for health information technology. In his new position, Dr. Blumenthal will play a key role in determining how to spend the $19 billion devoted to medical technology in America’s economic stimulus package.

As a widely-respected physician, a dedicated policy researcher, and a leading scholar on health information technology, Dr. Blumenthal is uniquely qualified to develop a national electronic medical record system that will protect patient privacy, while also improving both the quality and efficiency of the US healthcare infrastructure.

Qatari Delegation Visits Partners

A delegation from Hamad Medical Corporation (HMC) visited Boston in October and met with a broad range of clinical and administrative leaders at Partners to discuss healthcare system development and integration. HMC is Qatar’s principal healthcare delivery system, providing primary, acute and tertiary care through a system of five general and specialty hospitals along with 21 primary care sites.

Discovery of ALS6 Gene Mutation

Co-led by Thomas Kwiatkowski, MD, PhD of MGH, an international team of researchers has announced the discovery of a new gene mutation, ALS6, which may lead to treatment for amyotrophic lateral sclerosis, or ALS. Also known as Lou Gehrig’s Disease, ALS is a progressive, neurodegenerative disease that affects nerve cells in the brain and spinal chord.

MGH Dermatologist Opens Free Children’s Clinic in Vietnam

Martin Mihm, MD, a dermatologist at MGH, has established a free clinic in Ho Chi Minh City, Vietnam, to help children with vascular anomalies, including hemangiomas, port wine stains, venous malformations, arteriovenous malformations and lymphatic malformations. These disfiguring skin growths often interfere with a child’s abilities to see, smell, eat or breathe. Treatment usually involves surgery to remove the lesions as well as laser procedures. Mihm, an expert in vascular anomalies, has previously established similar clinics in Spain, Italy and Greece.

Harvard Announces New Undergraduate Major In Stem Cell Science

Harvard University has approved a new undergraduate major focused on stem cell science and related areas of biology, including human disease, human genetics and aging. The new course of study, entitled Human Developmental and Regnerative Biology, is believed to be among the first majors of its kind at a US university.

Kucherlapati Elected to IOM

Raju S. Kucherlapati, PhD, scientific director of the Harvard Medical School—Partners HealthCare Center for Genetics and Genomics, has been elected to the Institute of Medicine—one of the highest honors awarded to Americans in the fields of health and medicine. Throughout his career, Kucherlapati has advocated for advancing the cause of personalized medicine. As scientific director of the Harvard Medical School-Partners HealthCare Center for Genetics and Genomics, he launched initiatives that resulted in a large number of novel molecular diagnostics. He also built new information technology programs that captured the results of clinical and basic genetic research in structured formats that could be applied meaningfully in clinical decision-making to benefit diagnosis, prognosis and treatment of patients.

This publication provides medical news. It is not intended to provide medical advice, which should always be obtained directly from a physician. To subscribe, request additional copies or make comments, please contact us via email at partersinternational@partners.org or by phone at +1 (617) 535-6550.

©2009. Partners HealthCare System, Inc.