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 n 1975, a squat, two-bedroom house at 1518 Clifton Road served as offices for a small master's degree program in community health within the Emory School of Medicine. Today, at that same address towers the 10-story, 137,000-square-foot Grace Crum Rollins Public Health Building, home of the Rollins School of Public Health (RSPH). This year the school celebrated not only milestones of brick and mortar but accomplishments with impact far beyond Clifton Road.
In just 25 years as a public health program and 10 years as a school, RSPH is competitive with the best public health schools in the country. RSPH offers several master's and doctoral programs and boasts of more than 2,000 alumni. In the past fiscal year alone, the school attracted applicants from 43 countries, internationally known faculty brought in more than $25 million in sponsored research (second only to the School of Medicine), and faculty members authored 434 articles in refereed journals, 102 book chapters, and 16 books. RSPH Dean James Curran came to lead the school in 1996 after more than 20 years as an epidemiologist at the Centers for Disease Control and Prevention, where he was a point man for efforts to control the AIDS epidemic. A former assistant US surgeon general, Curran is one of many accomplished RSPH faculty. When the Bill and Melinda Gates Foundation needed a senior adviser for its global health program, for example, the school recruited William Foege -- the man famous for creating the strategy that eliminated smallpox. When the national press corps needs an expert to comment on the health care proposals of presidential candidates, they call RSPH health policy guru Kenneth Thorpe. And when PBS broadcast a special nationwide report on a syphilis epidemic in Rockdale County, they interviewed RSPH behavioral sciences researcher Claire Sterk. From its infancy in the 1970s, the idea of a public health program at Emory had great potential. Situated in the "public health capital of the world," with the CDC, CARE, the American Cancer Society, and other public health groups nearby, Emory was perfect for such an undertaking. |
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Now celebrating its 10th year as a school, the Rollins School of Public Health has more than 100 faculty, 860 students, 2,000 alumni, and more than $25 million in sponsored research. It is ranked 11th in the United States among schools of public health. Photo by Ann Borden. |
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In the beginning, the program had 16 students and a tiny core of faculty, most from other Emory departments and CDC. But by the early 1980s, enrollment boomed, and a larger, more diverse group of students began applying. In 1990, the public health program within the medical school became a respected school itself, attracting students straight from four-year colleges, midcareer professionals, fellows from around the globe, and doctoral candidates in epidemiology, biostatistics, and nutrition. But this staggering growth had a down side. The school was bursting at the seams. Self-made businessman O. Wayne Rollins heard about the fledgling school's dire need for space. The school's mission to help underserved communities appealed to him. After his unexpected death in 1991, his widow, Grace, and sons, Randall and Gary, honored his memory with a $10 million lead gift to the school. By the end of 1995, the School of Public Health had a new home at 1518 Clifton Road. The Rollins family continues to be the school's biggest booster, recently contributing $5 million to the O. Wayne and Grace Crum Rollins Endowment Fund. One priority for this funding is to establish a Rollins chair of epidemiology, the field that investigates the spread and underlying causes of disease. But this story is far from over. Curran continually reminds faculty and students to look ahead. "We have grown a tree of public health knowledge, and our branches are reaching out to create a healthy shade for our world," he says. "But we must continually reinvent ourselves to meet the complex public health challenges of the 21st century." |
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 lthough scientists have known for more than 30 years that Down's syndrome results from having three copies of chromosome 21 instead of the normal two, they still know surprisingly little about why and when the chromosome error occurs. Moreover, they still don't understand why the increase in the number of chromosome 21 genes leads to the particular birth defects and health problems that vary among individuals with Down's syndrome.
A $6 million grant from the National Institutes of Health will help a group of scientists and research institutions, led by Emory geneticist Stephanie Sherman, look for answers to these questions. Although scientists are certain that maternal age is by far the biggest risk factor for Down's syndrome, Sherman and her colleagues are using molecular and epidemiologic studies to help understand the origin of the maternal age effect and whether smoking or using oral contraceptives contributes to the effect. Sherman views Down's syndrome as subgroups of conditions rather than a single entity, and her research efforts will also begin now to investigate why some children with Down's syndrome have birth defects such as congenital heart defects or an increased risk for leukemia, while others do not. More than 1,350 families throughout the country will be subjects of the chromosome research. In addition to obtaining DNA samples from the families, interviews of parents and controls will be conducted. This research group is part of a National Birth Defects Prevention Study sponsored by the CDC and includes the Metropolitan Atlanta Congenital Birth Defects Program, the University of Arkansas for Medical Sciences, the California Department of Health Services, the University of Iowa, and the New Jersey and New York departments of health. |
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 atients across Emory Healthcare are getting the opportunity to tell us how we're doing. In Emory's most extensive patient satisfaction survey ever, we've found out that our patients are pleased with the high-quality care they receive. On the other hand, patients say we need to improve how we communicate and shorten waiting times.
More than 15,000 patients were chosen randomly from all patients seen last summer at The Emory Clinic, Emory Children's Center, Emory University Hospital, Crawford Long Hospital, and Wesley Woods Geriatric Hospital. Surveys were mailed within 10 days of the patient's visit or discharge. Questions varied, depending on the facility visited and the services patients received. Questions for hospital visits covered such things as admission, rooms, meals, nursing, care, and the discharge process. How easy was it? How pleasant? Were people nice to you? Clinic patients were asked how long it took before being shown to an exam room, time in the room, friendliness, and helpfulness of the staff, and the patient's perception of the clinicians' competence and interest. This patient satisfaction survey marks the first systemwide approach at Emory to improve service and will continue on a weekly basis. Summaries compiled by the survey vendor will be given every six months to administrators in different sections and departments as well as Emory Healthcare leadership. Administrators and employees will receive training on how to read and interpret the results and offer concrete suggestions for areas in which we need to improve. After reviewing preliminary results in September, the Emory Healthcare Board of Directors resolved to make service a priority for the system. There are two aspects of patient satisfaction, says Peg Bloomquist, associate administrator of Emory Hospitals, who heads the group of survey representatives throughout the system. "The first is our clinical performance, and we are reputable there," she says. "The second is our patients' and families' perception of how we deliver our service. Customers have high expectations, and this is an area where we have great opportunity for improvement." She adds that patient satisfaction is of utmost importance in the health care industry. "Satisfied patients are more likely to choose Emory for repeat visits. And satisfied or not, they share their experiences with friends and families. So it's vital that we treat our patients well in every sense of the word." |
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 ife as a nematode usually isn't very remarkable -- or very long. But Emory scientists and their research collaborators recently found a way to extend that invertebrate's life by about 50%. And if worms can live a long time with a little help, why not humans?
The researchers used drugs that eliminate oxygen radicals -- the toxic by-products of metabolism -- from the mitochondria of the nematode worm C. elegans. These drugs also restored a normal life span to mutant worms with a mitochondrial defect causing rapid aging. These discoveries reported in Science support the hypothesis that oxygen radicals generated during metabolism contribute to degenerative diseases and aging. The research opens the door for more investigation into drugs that act on mitochondrial metabolism and oxygen radicals for age-related diseases like Parkinson's, Alzheimer's, cardiovascular disease, and diabetes. Douglas Wallace, director of the Center for Molecular Medicine, conducted the experiments with collaborators from the University of Manchester, the Buck Center for Research in Aging, and Eukarion, a biopharmaceutical company. Since the early 1970s, Wallace and colleagues in Emory's Center for Molecular Medicine have studied mitochondria, the tiny power plants in cell cytoplasms where metabolism occurs. Oxygen radicals are by-products of energy generation that gradually destroy the mitochondrial DNA. "If you have a power plant that burns coal, you will get energy but also toxic smoke," says Wallace. "You can decrease the toxicity of the smoke by putting a scrubber into the smokestack. In this case, the catalytic drug acts like a scrubber to eliminate the oxygen radicals. We believe this protects the mitochondria and the cell from being damaged and allows them to function efficiently for much longer." |
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Illustration by Don Morris
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The drugs used in the nematode experiments are synthetic forms of superoxide dismutase and catalase -- enzymes that naturally help control oxidative stress. Simple antioxidants like vitamin E eliminate individual oxygen radicals one-on-one and lose their effectiveness quickly. But the synthetic drugs are catalytic, converting oxygen radicals into water and then reconstituting themselves. They continue to destroy oxygen radicals as long they remain in the body. |
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 he best medicine for heart disease is to stop it before it starts. That kind of prevention is the key to INTERxVENT Atlanta, a year-long lifestyle management program individually tailored for people at risk for cardiovascular disease.
Cardiovascular disease can be prevented by managing diet, exercise, and stress, and by smoking cessation. With frequent monitoring and support, participants can change habits that put them at risk for heart disease and stroke. "Through INTERxVENT, participants not only learn about heart-healthy habits, but they also practice the skills they need to maintain those habits," says Douglas Morris, director of the Emory Heart Center. Participants are first evaluated for risk factors of cardiovascular disease and then given a computer-generated personal action plan with individualized goals. Participants regularly visit a health professional who serves as a personal coach, helping them track their progress and stay on course. The program also offers information kits and audio CDs to reinforce health concepts, including how to read nutrition labeling and manage stress. Well established in Savannah, INTERxVENT has proven both cost- and time-efficient. About $400 per person covers the initial evaluation and 22 follow-up visits throughout the year. Designed to work in concert with participants' regular medical care, personal physicians are kept well informed of their patients' status and progress. The new Atlanta company offers both fee-for-service and capitated payment programs. "This important new product for effectively managing an at-risk population will help us become leaders in the area of preventive health and develop new and better ways to deliver health services," says John Fox, president of Emory Healthcare. Emory Healthcare partnered with Savannah-based INTERxVENTUSA to form the new program for Georgians outside of Savannah. Laurence Sperling, head of cardiac rehabilitation at The Emory Clinic, is medical director. The program has operated successfully in Savannah, where 13 major employers have purchased INTERxVENTUSA services for their employees since 1997. The company offers services at a large shopping mall, two hospitals, several physician practices, and local YMCAs in Savannah. INTERxVENT has begun enrolling patients at The Emory Clinic in Atlanta and plans to open sites in other Emory Clinic locations as well. For more information, visit the web site www.interventusa.com, or call 404-247-8331. |
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ccording to a survey conducted by the National Mental Health Association, 49% of people over 65 think depression is a personal weakness. And 58% believe depression is a normal part of aging. Individuals who suffer from clinical depression bear a double burden of public misunderstanding and social rejection. Unfortunately, the problem can be compounded by being misunderstood or even completely overlooked by health care professionals.
At Emory's Fuqua Center for Late-Life Depression at Wesley Woods, clinicians are working to change these perceptions. The center was established in early 1999 through a $1 million grant from businessman and philanthropist J. B. Fuqua, who has now given a second $1 million. The most recent gift will expand the center's educational initiatives to address the stigma of depression and to train more health care and other professionals to recognize and treat the illness. The center is developing a model comprehensive treatment center to improve the access of older adults to treatment. This will be accomplished by placing nurse practitioners in Atlanta-area assisted-living facilities as well as developing local networks of people throughout Georgia who are trained to recognize depression in older people and know where to refer them for treatment. These networks will include primary care physicians, the staff of local community agencies who serve older adults, clergy, and persons working in assisted-living and retirement communities. |
  Strength training and in some cases, testos- terone supplements, have given new vitality to grandpas (from front) Bob Gary, Joe Grno, and Ed Luck. |
 hen 68-year-old Bob Gary started doing leg presses about a year ago, he could lift only 80 pounds. Today he can leg press 820 pounds -- more than 10 times the original amount. An 82-year-old gymmate of Gary's could barely move 45 pounds of weight on a leg squat machine. He now does eight repetitions of 325 pounds each.
These guys aren't training for the senior Olympics. Their goal is to prolong their vitality by increasing their lean body mass. They are just two of 32 participants in a study conducted by Emory researcher Michael O'Grady, who's finding that age-related loss of muscle mass and strength, a condition known as sarcopenia, can be reversed in elderly men through a combination of strength training and testosterone supplementation. The study, funded by ALZA Corporation, a pharmaceutical company that manufactures testosterone patches, is the first to look at the effectiveness of the combination of resistance exercise and hormone replacement in rebuilding muscle mass and increasing strength. Sarcopenia decreases mobility and makes movements like getting up out of a chair, climbing stairs, or arresting a fall difficult for older people. The condition increases the chance of serious injury from falls and contributes to the likelihood that a person will require long-term care and help with activities of daily living such as bathing. Study participants have shown increases in both elongated type 1 muscle fibers used for endurance and type 2 fibers (bulky muscles) used for motions that demand a lot of strength at once. They've had a significant increase in type 2 muscle fibers -- the "fast twitch" fibers that rapidly generate power. Not only has the regimen yielded great physical results, but the psychological outlook of the participants has improved too. "It's given me a real sense of accomplishment," says Gary, former director of pastoral services for Emory Hospitals and now professor emeritus in the Candler School of Theology. His four children and seven grandchildren are "enjoying the experience of granddaddy being a weight lifter." |
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university research moves into the commercial arena where discovery cangrow and maximize its impact on health, the centerpiece of Emory's and Georgia's biotech boom is a start-up company known as AtheroGenics.
The dramatic success story of the company, founded by cardiologists Russell Medford and Wayne Alexander, chair of the department of medicine, continued to unfold last summer when AtheroGenics went public. In its initial public offering, the start-up company raised $43 million for research and development. The biggest winners, though, will be millions of people who stand to benefit from AtheroGenics' new treatment of chronic diseases such as atherosclerosis, asthma, and arthritis. In 1993, Medford and Alexander identified a protein that could inhibit inflammatory responses that damage endothelial cells, the cells that line the inside of the blood vessels. The Georgia Research Alliance helped the cardiologists found AtheroGenics in Northcross in 1994 with $1 million backing from Alliance Technology Ventures. AtheroGenics has now developed a proprietary drug-discovery platform called vascular protectants or v-protectants, which protect damaged blood vessels from developing deadly atheriosclerotic plaque. The possibilities offered by the new therapy are enormous when you consider the toll taken by inflammatory diseases: coronary artery disease is the leading cause of death in this country, affecting more than 11 million people; asthma affects more than 17 million people, and rheumatoid arthritis another 2.1 million. Emory has granted AtheroGenics an exclusive license under certain patents for diagnostic and therapeutic products useful for atherosclerosis. In a phase II clinical trial, AtheroGenics is currently testing the safety and effectiveness of its lead product, AGI-1067, for the treatment of postangioplasty restenosis. AtheroGenics plans to develop other v-protectants rapidly and may seek regulatory fast-track status to expedite development and commercialization. Preclinical programs targeting rheumatoid arthritis, cystic fibrosis, asthma, and solid organ transplants are also moving forward, as is research to find additional anti-inflammatory genes. Today, Medford heads the company, which has 58 employees and is based in Alpharetta. Schering-Plough is paying all the costs of the new development program and subsequent development fees and royalties. If all goes well, AGI-1067 will hit the market in a few years. |
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 ust as we have good cholesterol and bad cholesterol, there's "good" bacteria as well -- bacteria heroes, in fact.
Certain bacteria can cause disease when present inside the human gastrointestinal tract, but far more common are those bacteria that normally thrive inside us, helping break down vitamins and other substances and keeping the bad bacteria at bay. How those beneficial bacteria co-exist under the watchful eye of the immune system is unknown. Emory pathologists Andrew Neish, James Madara, Andrew Gewirtz, and their colleagues have discovered that those millions of beneficial bacteria normally present in the intestine may even be more active than originally thought. It seems they deliver a signal that blocks immune pathways that otherwise could cause an unhealthy inflammatory response against the good bacteria. "This mechanism for tolerance," says Neish, "could be fundamental to the pathogenesis of inflammatory bowel disease (Crohn's disease and ulcerative colitis) and to infectious intestinal diseases. It's interesting that the organisms we are studying are nonpathogenic and have no ability to elicit inflammation themselves, yet they are able to block inflammatory pathways and create tolerance for themselves and perhaps other organisms." |
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Illustration by Don Morris |
Now that's intestinal fortitude. |
  Louis Favorite/Atlanta Journal/Constitution |
 eorgia is poised to launch the largest, most aggressive fight against cancer in the nation with the help of a statewide initiative, Emory's Winship Cancer Institute (WCI), and corporate generosity such as that demonstrated in recent months by Avon Products.
Announced by Governor Roy Barnes in November, the Georgia Cancer Coalition will tap Georgia's leading hospitals and universities, biotech firms, civic groups, and nonprofit and government agencies to prevent and treat cancer. The first priority is to enhance treatment and screening, starting with the areas of highest incidence. An extensive treatment network anchored by three yet unnamed cancer centers of excellence will be expanded through treatment centers in hospitals and in coordination with private physicians throughout the state so that every Georgian will have access to cutting-edge care. Another priority is to recruit 150 eminent clinicians and scientists to the state's medical centers, to coordinate research and develop new treatment. As part of the $800 million initiative, Governor Barnes will ask the legislature to contribute up to $400 million during the next five to seven years, primarily from tobacco settlement money. By partnering with foundations, pharmaceutical and bio-technology firms, and corporations to raise funds, the state hopes to leverage its efforts to receive more federal funds designated for cancer treatment and research. Individual and corporate efforts will make a difference too. More than 2,600 people (including 30 from Emory) trekked from Lake Lanier to Atlanta in the Avon 3-Day Walk last fall to raise funds for the Avon Breast Cancer Crusade for research and clinical care. And in October, Avon gave the WCI $5.3 million -- Avon's second gift to the institute within the past year, following a $2.2 million gift in the spring. Of this most recent gift to Emory, $3.3 million will fund a new Avon translational research laboratory and breast imaging research center, jointly situated at the WCI and at Grady Memorial Hospital, and a new comprehensive clinical center at Grady. The remaining $2 million will fund breast cancer genomics research by seven Avon scholars. These junior cancer scientists and physicians on the medical school faculty will study the causes of breast cancer, potential new targets for prevention, and improved treatment options, including new genetic medicines. Several research studies will explore why breast cancer is unusually aggressive in many African-American women. "Genomics -- the science of understanding the genes that cause breast cancer to develop and spread and that result in more aggressive cancers -- is revolutionizing how we can diagnose, treat, even prevent breast cancers," says Jonathan Simons, WCI director. "We want to make certain that the patients seen at Grady have access to the latest science, to the new molecular tools of genomics." The breast center at Grady will include mammography, diagnostic and treatment services, genetic counseling, and psychosocial support services. Bilingual staff will provide written, video, and electronic information about breast cancer and other women's health concerns. Community health advisers will work with local community and faith-based organizations to educate the public about breast cancer and the services available at Grady. |
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Visit the institute's web pages at www.emory.edu/WHSC/WCI for more information and a link to the Avon Breast Cancer Crusade. |
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he largest postdoctoral training grant in Emory's history has been awarded by the National Institutes of Health (NIH) to Emory and the five institutions that make up the Atlanta University Center (AUC): Clark Atlanta University, Morehouse School of Medicine, Morehouse College, Morris Brown College, and Spelman College.
Named PREP (Postdoctoral Research and Education Program), the Emory-AUC grant is one of four such grants in the United States, all of which include top national research universities linked to the country's leading minority-serving institutions. The nearly $7 million award will be spread over five years and support postdoctoral fellows in their research for three years, with concurrent mentorships in teaching methodology and practice, including development and production of web-based courses. Fellows will work with a laboratory mentor at Emory or one of the AUC schools as well as with a teaching mentor at one of the undergraduate AUC schools. The program will support 10 fellows in the first year and will add 10 each year for the next two years. "PREP should enable Emory and the AUC to attract and train excellent minority students who will be amenable to becoming faculty in Atlanta's undergraduate minority-serving institutions," says Robert Gunn, physiology chair in Emory's School of Medicine and principal investigator for the grant. Read more about this new program at www.emory.edu/WHSC/MED/PHYSIOLOGY/ PREP/. |
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n the first effort in the state to consolidate two aging hospitals into a smaller one, EHCA has proposed to replace the facilities of Emory Dunwoody and West Paces medical centers with a single, state-of-the-art medical center in north Fulton County.
EHCA, a joint venture of Emory Healthcare and HCA, asked for state permission last month to build Emory Johns Creek Hospital -- a four-story, 62-bed hospital that would have 400 fewer beds than the existing hospitals. The now-closed West Paces Ferry was at I-75 in Buckhead, and Emory Dunwoody is just north of I-285 on North Shallowford Road. To be located on 30 acres near McGinnis Ferry Road and Medlock Bridge in Duluth, the proposed facility would be in the heart of a densely populated area that covers parts of Fulton, Forsyth, DeKalb, and Gwinnett counties. Tom Gilbert, EHCA president and chief executive officer, cites increasing traffic congestion in north Fulton county in support of the plan. Residents of the affluent, high-growth area must now drive several miles to a hospital for maternity services, Gilbert says. Besides offering maternity services, an emergency room, and an intensive care unit, the new $93 million hospital would provide a venue for medical education for family practice and gyn/ob residents from Emory. The new hospital could open by Fall 2003 if the requested certificate of need is approved by the state. |
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fter careful evaluation of its 13 health centers, The Emory Clinic (TEC) has discontinued operations at its Fayetteville site, with plans to close the one at Social Circle as well.
"These were difficult decisions, but we believe that they were the right decisions," says Penny Castellano, chief medical officer for TEC primary care. "While patient care at the Fayetteville and Social Circle centers were of the highest quality, recent evaluation of growth determined that they had not met overall practice goals set by the clinic six years ago. The clinic's top priority is to guarantee that patients are the primary focus of our efforts, and concentrating our resources at the remaining facilities will ensure this commitment." All physicians and staff employed at the centers are guaranteed placement within the Emory system. In addition, TEC will maintain a nonmedical presence in Fayetteville with the expansion of a telephone call center and billing system that now has six employees. The plan is to expand this operation to more than 20 employees in 2001. |
  Photo by Steve Ellwood  The new Nursing School Building at the corner of Clifton and Houston Mill roads was completed in October 2000, under budget and ahead of schedule. Nursing faculty and students will begin the spring semester in their new home. |
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June 2000
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Copyright © Emory University, 2000. All Rights Reserved.
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Web version by Jaime Henriquez.