An apple a day...and a glass of merlot
Good business decisions, hard human ones
ER follow-up...stat!
Mice stem cells, human hearts
Practicing what we preach
Rankings: One magazine's opinions
Mood and magnets
All for one and one for all
Brothers attack HIV/AIDS
Gasp! A 'monster' of a gift
Taking a quack at children's cancer
Here come the laws

Moving Forward


Evidence is growing that an apple a day, along with a nice glass of merlot, might keep the doctor away. A new study by Emory and Yale researchers has shown for the first time that moderate use of alcohol is associated with a lower risk of heart failure among older people.

While this conclusion is not an excuse to drink excessively, the researchers say, studies of 2,235 people from 1982 through 1996 found that participants who consumed 21 to 70 ounces of alcohol per month had the lowest rates of heart failure. Those consuming no alcohol had the highest incidence of the disorder. The study by cardiology fellow Jerome Abramson and his colleagues also suggests that the important factor for lowering the risk of heart failure is alcohol and not the kind of beverage (beer, wine, or liquor) consumed.

An apple a day . . .  and a glass of merlot

The Emory Clinic is closing several outlying centers, including Emory Clinic North, a multispecialty and primary care facility; Lawrenceville, a two-physician practice; Snellville, a six-physician practice; and the two-physician obstetrical practice at Perimeter, which will remain open for all other services.

"Closing health centers may be good business decisions, but they are hard human ones," says Penny Castellano, chief medical officer for primary care at the clinic and director of the Emory Clinic North.

Emory wants to make the transition as easy as possible for everyone. Some physicians at these facilities will move elsewhere within Emory Healthcare, while others will remain in the community in private practice. Nurses and other staff will be offered positions at Emory. Patients will receive letters explaining how to continue their care.

The closings are part of Emory's continuing strategy to effectively allocate its physicians and other resources in response to evolving metropolitan demographics and the changing health care environment, says Rein Saral, clinic director. Demand is high for Emory physicians and health care services at its hospitals, Emory Clinic Perimeter and other busy Emory Healthcare facilities. But the younger, healthier population in the north area did not require as many outpatient specialty services as anticipated. Since the center opened four years ago, some specialists have left or transferred closer to other Emory facilities because of low demand for their particular services at Emory Clinic North and high demand for these services elsewhere in the Emory system. Many patients in the community did seek out specialty services at Emory Clinic North, says Saral, but these patients often are better served by the full spectrum of extremely sophisticated facilities and technology available in one of the Emory hospitals, none of which are nearby. Lawrenceville and Snellville, almost exclusively primary care centers, also were hampered by not being near Emory hospitals and specialty care.

The lack of demand for key services, combined with ongoing reductions in reimbursement, made the continued operation of Emory Clinic North untenable. The large, modern facility was simply too expensive to maintain.

Emory hopes to refocus its efforts by providing inpatient specialty services at Emory Johns Creek Medical Center in Duluth. The state recently approved a certificate of need to build the $93 million hospital, which will serve densely populated Fulton, Forsyth, DeKalb, and Gwinnett counties. Johns Creek will offer the same services now available at The Emory Clinic North plus sophisticated technology, maternity services, an emergency room, an intensive care unit, and, of course, hospital beds.

Good business decisions, hard human ones

When a patient is discharged from the emergency department (ED), it's important that he or she follows up with a physician. But in the past, making the transition from ED to the physician's office was chaotic at best. Handwritten discharge forms and a patient's memory of what happened were the primary ways in which information was communicated between physicians, leaving a lot of room for human error and misunderstanding. In more serious situations, emergency doctors had to track down the follow-up physician in person, a time-consuming and distracting task in the urgent world of emergency medicine.

Now Emory is using advanced technology to make sure this transition is not only a smooth one, but also the most effective for the patient's recovery.

A new state-of-the-art patient-tracking system called Logifax made its debut last spring in the ED at Emory University Hospital. The database composes a detailed letter for all ED patients and faxes this letter (at the time of patient discharge) to designated follow-up physicians or specialists. The Logifax letter includes such details as the patient's demographics, the attending and resident physician(s), the patient's diagnoses and treatment, and any medications prescribed and tests performed. By the time the patient arrives at the physician's office for the follow-up visit, the office has received the fax, the patient's file has been pulled, and the doctor and staff are fully aware of what happened to their patient in the ED.

Physicians who would like their name or fax number added to the Logifax system should contact Marcia Soden, emergency medicine, at 404-712-0448.

ER follow-up . . . stat!

A high school track star suddenly collapses during practice -- his heartbeat inexplicably thrown into quivering, life-robbing chaos. But how and why did his heart suddenly produce the electrical storm of deadly irregular beats known as ventricular fibrillation, leading to sudden death?

The intracellular secrets of heart function may be unraveling in the Cellular Therapy Center at the Atlanta Veteran's Affairs Medical Center (VAMC). There Emory researcher Samuel Dudley, chief of the division of cardiology, and his research team are using gene targeting to manipulate mice stem cells into perfect replicas of human cell mutations linked to arrhythmias. In the long term, this technology has great potential to alter not only cardiology therapies - especially genetic disorders - but the basic landscape of medicine, Dudley believes.

Just growing heart cells in a lab is remarkable. Cardiac electrophysiology researchers, who study and map the electrical landscape of the heart, have been long hampered by how quickly isolated heart cells die in a culture dish. But Dudley and his colleagues Alice Huang and Mark Leimbach have developed techniques to overcome this problem.

Their work may be applicable to future cardiac therapies as well, including growing replacement tissue for damaged hearts and helping prevent or alter restenosis, the reclogging of vessels after they've been opened by angioplasty.

Technology involving stem cells is even more promising than genetic therapy, Dudley believes. "We can alter the genome of these cells before putting them into people -- and we can do it in the culture dish where we know exactly what we've done. Unlike genetic therapies so far, this is a long-lasting change. "We can even design cells sensitive to a certain medication so we can make sure the altered cells die on command if something goes wrong."

Another advantage is the high likelihood that these cells, which do not express the immunologic markers associated with rejection, can be transplanted successfully from animals to humans.

Stem cell research might even hold the key to why humans age -- and how the process might be altered, Dudley believes. "In theory, aging is a stem cell function disorder. It is becoming clear that the number of stem cells you have decreases by about 10% every decade of life. By the time you get to fairly old adulthood, you don't have too many any more. So maybe the reason we all break down as we get older is that we don't have enough stem cells floating around to fix us up again. There's the possibility we could take stem cells out of your body, propagate them in the lab and expand them, then freeze them until you need them. Theoretically, we could take out a few and give you back millions if you get sick or have age-related problems."

Mice stem cells, human hearts

 'There's the possibility we could take stem cells out of your body, propagate them in the lab and expand them, then freeze them until you need them.' --Samuel Dudley, chief of the division of cardiology, Atlanta VA Medical Center

The word is out: don't light up. No smoking anywhere on any Emory hospital or clinic property.

In July, the Emory Healthcare Board of Directors banned smoking on the campuses of Emory University Hospital, Crawford Long Hospital, and The Emory Clinic. This is the healthy next step for a process that has been going on for the past few years, each step reducing the places where staff, patients, and visitors could smoke.

Several years ago, smoking was banned inside the hospitals. Facilities management teams now have removed the sand-filled cigarette disposal urns that were placed outside buildings for families and staff who wanted to smoke. Many other health sciences center facilities, such as the Woodruff Health Sciences Center Administration Building, already were completely smoke free.

In Emory Hospitals, the word was out for weeks that this move was in the offing, and since July 1, there has been a noticeable reduction in staff and visitor smoking. Now, in addition to no-smoking signs, patients receive notices on their meal trays, and staff hand visitors who are smoking a small card explaining that Emory is a smoke-free campus. Physicians may order nicotine patches for inpatients through the hospitals' pharmacies, which will bill the patient.

Employees who wanted to quit smoking could take free classes at the hospitals this summer. In addition, employees may sign up for "Freedom from Smoking" classes by calling 404-727-WELL.

"Emory Healthcare is a place for healing, a place that represents good health, and a place where researchers look for ways to beat cancer, to treat lung diseases, and to help people live longer," says Michael Johns, executive vice president for health affairs and CEO of Emory Healthcare.

"While we recognize the inconvenience and discomfort of this move for our patients, visitors, and employees who still smoke, we owe our patients and employees a smoke-free environment," he says. "We have a responsibility to send the message loud and clear that we are concerned about the health impacts of tobacco use."

Practicing what we preach

Emory University Hospital is one of America's Best Hospitals in five areas, according to US News & World Report.
  • Cardiology, 9th
  • Ophthalmology, 9th
  • Kidney disease, 18th
  • Gynecology, 40th
  • Urology, 41st

Cardiology has been recognized as one of the top 10 programs for 11 years since the magazine began ranking hospitals in 1990.

Emory's eye program has been among the top 10 for the past three years. Emory was the only hospital in Georgia this year to be ranked in the top 10 in cardiology or ophthalmology.

Rankings: One magazine's opinion

Parkinson's patients who suffer from chronic depression and don't respond to antidepressants may have an alternative to drug therapy -- one that lies outside the conventional. Neurologist Charles Epstein and colleagues at Emory are exploring whether magnets powered by an electric current can improve mood.

Their research is one of the beneficiaries of an initiative by the National Institutes of Health to subject alternative therapies such as electromagnetic stimulation to the rigors of the scientific method. NIH recently awarded Emory five-year grants totaling $5.7 million, establishing a Center for Complementary and Alternative Medicine (CAM) in Neurodegenerative Diseases. The center is one of 12 across the nation.

In the mood study, electrically powered magnets are placed over the left frontal region of the patient's brain for 10 to 20 minutes per day. The magnetic pulses generated pass through the skull, transmitting a targeted current into the brain.

"The current option for depressed Parkinson's patients who aren't responding to drug therapy is electroconvulsive shock therapy, which is an invasive procedure that can have side effects, including memory loss," Epstein says. "Should the magnetic treatment prove effective, it could abate depression with fewer side effects."

Other studies of alternative therapies under way at the center include the use of the herb valerian to treat sleep disorders in older adults and the practice of Tai Chi to improve balance in adults suffering from movement disorders.

According to the NIH, the percentage of Americans using alternative therapies rose from 33% in 1990 to 42% in 1997 and continues to rise. If dollars spent - $27 billion in 1997 - measured scientific effectiveness, there would be proof enough that these treatments work. "Unfortunately, little has been done to determine whether this is the case," says Mahlon DeLong, neurology chair and co-principal investigator of the electromagnetic stimulation study.

Funds are available for pilot studies and postdoctoral fellowships. Those interested should contact Rebecca Portman at 404-727-3251 for more information.

Mood and magnets

After negotiating with an all-for-one and one-for-all attitude, Emory Healthcare has hashed out new contracts with HMOs that will benefit patients, doctors, and staff across the entire Emory system.

"The single biggest benefit to patients," says Patrick Hammond, director of managed care contracts for Emory Healthcare, "is that most of our physicians are included in the contracts so that we can provide patients with the full continuum of services."

Under previous contracts, for example, hematologists were in one managed care network while surgical oncologists were in another. A patient who came to Emory for chemotherapy might find himself outside of the Emory system when it was time to get the tumor surgically removed. The end result was fragmented patient care across Emory Healthcare.

In addition, specialists will no longer have to worry what networks they belong to. "Now in most cases, if they're on board with The Emory Clinic, they're on board," says Hammond. In the past, specialists within the same department found that they were competing with each other because they belonged to competing networks.

All told, Emory Healthcare eliminated more than 40 contracts. And at the end of the day, fewer contracts mean fewer administrative headaches and less room for billing errors.

While not perfect yet, the new contracts better address the increasing costs of medical care -- drugs, technology, and dealing with a sicker, aging population, Hammond says. Emory Healthcare was also able to get some rate and reimbursement increases under the new contracts. And there are now agreed-upon fee schedules for services provided, which means the clinic will be able to keep its books in order with fewer hassles.

All for one and one for all

As a result of the Brothers Health Issues Conference on HIV/AIDS, aimed at African-American men and their families, Emory Healthcare has set its sights on prevention and treatment education, including a video that demonstrates the physical manifestations of the disease.

Because African-Americans have the highest rate of HIV infection of any racial or ethnic group -- one out of every 50 men and one out of every 160 women, it was crucial for Emory Healthcare to focus its fifth annual Brothers Health Issues Conference on HIV/AIDS prevention and treatment education.

The spring conference was filled with workshops focusing on the prevention of HIV/AIDS in men, women, youth, and infants. Community participants discussed what the public can do to help with HIV prevention and education. Out of that discussion came specific recommendations, some of which will be initiated by Emory Healthcare in the coming months.

Of prime importance is disseminating information on how HIV/AIDS can be contracted and what it can do to the body.

"Not only is it a devastating crisis for the African-American community right now, but one that the media and the community itself are trying to ignore," says Don Speaks, associate director of Emory Healthcare's office of community affairs and market development.

"We are tremendously excited about the ripples the conference has had throughout the community," says Speaks. "First, it forced this issue into the public arena so people realize how bad the situation really is. Second, the conference was co-sponsored by numerous local HIV/AIDS care providers and resources that collaborated to make the conference happen. This kind of collaboration is a first for the Atlanta community. And now, many of the organizations are continuing to find ways to work together to help fight the epidemic. Plus, so many people at the conference didn't realize just how many resources there are. I think we really made it clear that there are a variety of places to get information and help if you need it." During the conference, speaker Howard Tutman, Grand International Polemarch of Kappa Alpha Psi Fraternity, one of the largest African-American organizations in the world, said the fraternity will work with Emory Healthcare to help improve outreach in the African-American community.

Next year, the Brothers Health Issues Conference will focus on cancer and will be co-sponsored by the Georgia Cancer Coalition.

Brothers attack HIV/AIDS

Actually seeing the ravages of HIV/AIDS and hearing directly from people with the virus would send a powerful message that young people will listen to, youths told the fifth annual Brothers Health Issues Conference on HIV/AIDS

Georgia's only lung transplant program has received a gigantic breath of fresh air. A $20 million gift from Andrew McKelvey, founder and CEO of TMP Worldwide, who is perhaps best known for his high-profile Internet career portal, promises to make Emory a gargantuan in transplantation and pulmonary medicine.

McKelvey's gift - his largest to any single institution - will fast-track research at Emory, home to the state's first lung transplant in 1993. Funds will be used to establish the Augustus J. McKelvey Chair in Lung Transplantation Medicine, in honor of McKelvey's late father, a general medical practitioner. Pulmonologist Clinton Lawrence, medical director of lung transplantation at Emory, has been nominated to fill the McKelvey Chair.

At least five new faculty in basic and clinical sciences related to lung disease will be recruited as McKelvey Young Investigators. And an additional research fund will enable Emory to bring to campus each year a distinguished leader in the field as the McKelvey Visiting Professor.

Gasp! A 'monster' of a gift

Did you know...

Since the state's first lung
transplant at Emory University
Hospital in 1993, 71 procedures
have been performed here.
Transplant recipients have
done well. Survival rates here
are comparable to the national
one- and three-year survival rate
of 72% and 61%, respectively.

The collaboration of two formerly independent programs - pediatric oncology and hematology - to form the AFLAC Cancer Center and Blood Disorders Services promises to improve the care and treatment of childhood cancers. The alliance between Children's Healthcare of Atlanta (CHOA) and Emory School of Medicine catapults the center to the fourth largest in the nation focusing on childhood cancer.

The center's corporate sponsor, AFLAC, a Fortune 500 company that insures more than 40 million people worldwide, has given more than $7 million toward building the comprehensive children's oncology and hematology program. Additionally, AFLAC is donating the proceeds from Internet sales of a stuffed duck that quacks "AFLAC" - part of the company's highly successful national advertising campaign - to the AFLAC Cancer Center.

Drawing on the research strengths of the Winship Cancer Institute and the medical school, and the clinical care of CHOA, the new center's research priorities include childhood leukemia and blood cancers, stem cell transplantation, experimental therapy, childhood cancer etiology, neurooncology, and sickle cell disease. By combining resources, the partnership will also qualify for larger federal and state monies, participate in nationwide clinical trials, and perform advanced laboratory and epidemiological research using shared facilities.

"The AFLAC Cancer Center has a patient volume comparable to the nation's top children's cancer centers. Now coupled with Emory's research, pediatric cancer therapy can move quickly from the laboratory to the patient's bedside," says William Woods, chief medical officer of the new center and director of pediatric hematology, oncology, and stem cell transplantation at Emory. A world-recognized leader in pediatric hematology and oncology, Woods wants to build the research program at the center by recruiting clinician/scientists who are developing experimental therapies.

Taking a quack at children's cancer

A number of new laws went on the books this year that will affect patients, health care providers, and insurance companies, says Linda Womack, director for state affairs in the Emory office of governmental and community affairs.

By next July, Georgians will have access to more information about their physicians, including their education, certifications, and any previous disciplinary action. The Composite State Board of Medical Examiners will profile each of the state's 25,000 physicians, based on information from the physicians, the board, medical malpractice insurers, hospitals, medical and specialty societies, and other sources. The board is also responsible for providing that information to the public, including on the Internet.

The Georgia Partnership for Health and Accountability was formed last year to improve patient safety while reducing medical errors. To advance the collaborative work of the partnership, the current statute was amended to strengthen confidentiality of peer reviews.

The search for a cure for cancer received an important boost this year with a public-private initiative funded by tobacco settlement funds, The first phase of those funds will set up a core staff for the Georgia Cancer Coalition, establish funding incentives to support distinguished cancer clinicians, create a Tier 3 cancer center at Grady Hospital, improve statewide screening, detection and treatment of cancer, and provide caregiver training.

The 2001 General Assembly also decided that patients cannot be charged fees above and beyond those contracted for between their physicians and their health benefit plans, and physicians must attempt to contact the patient in a "timely manner" regarding laboratory test results. Insurers now must cover annual screenings for women at risk for ovarian cancer, and cannot deny benefits to individuals who are diagnosed with autism when their policies already cover neurological disorders.

Legislators directed the Department of Community Health to appoint a health care work force policy advisory committee to oversee and coordinate work force planning activities in Georgia. Under the statute, the department may also establish pilot projects to provide health care coverage and access to the uninsured and underinsured, including pharmacy assistance programs.

Here come the laws

Other new laws set fees for medical records copying, require smoke detectors in each resident sleeping room in nursing homes, and allow for the suspension of anyone's license who has defaulted on a loan or service obligation.

One act that was vetoed by the governor would have removed the penalty of applying points to a motorcyclist's record for failure to wear protective headgear and eye protection.

During the interim between the 2001 General Assembly and next year's session, legislators will be studying such measures as prevention and emergency care of injuries in Georgia, hospital access and managed care contracts, and federally funded prescription drug benefits for low-income elderly citizens.

Womack says her office will follow a number of bills that were introduced in the 2001 General Assembly and will carry over to the 2002 session. These address issues such as the nurse workforce shortage, prompt and timely payment to hospitals by health care insurers, patient safety, and credentialing of physicians.

For more information, see or contact Linda Womack at 404-727-5306 or

In this Issue

From the Director  /  Letters


How to remake a hospital


Moving Forward  /  Noteworthy

On point: Healer or line worker?

Nation at a crossroad


Copyright © Emory University, 2001. All Rights Reserved.
Send comments to the Editors.
Web version by Jaime Henriquez.