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WINTER 2017
MCW
magazine
P 16
Clinical
Trials
Translating
Research to
Benefit Patients
P 14 P 24
Warrior Partnership Helps Transitioning From
Students Learn From Veterans Pediatric to Adult Care
W
SUI NMTME E
R R2 2
0017
16
LEADERSHIP MESSAGE
MEDICAL COLLEGE OF WISCONSIN BOARD OF TRUSTEES
Welcoming New Leadership
Stephen Roell – Chair
Mary Ellen Stanek, CFA – Immediate Past Chair
Cory L. Nettles – Vice Chair
A
Jay B. Williams – Secretary
Jon D. Hammes – Treasurer s MCW continues to grow and expand across our
Steven C. Bergin, MD ’74, GME ’78 missions of education, research, clinical care and
Elizabeth (Betsy) Brenner
Ricardo Diaz community engagement, our leaders remain com-
Susan Feith
Philip B. Flynn
mitted to maintaining the inherent values of our insti-
tution in the face of ongoing changes in the healthcare
“I am confident that
Joseph E. Geenen, MD ’60, GME ’65, FEL ’67
Paul W. Griepentrog environment. To aid us in this critical pursuit, in the these new leaders,
Jacqueline D. Herd-Barber
Ted D. Kellner, CFA
past few months we welcomed three new leaders who
bring significant passion and expertise to our team.
along with the many
Joseph E. Kerschner, MD ’90, FEL ’98
Wayne Oldenburg Gregory M. Wesley joined us in late 2016 as senior talented individuals
Janis M. Orlowski, MD ’82
John R. Raymond, Sr., MD
vice president, strategic alliances and business develop-
ment. A former member of the MCW board of trustees,
already on the MCW
Kristina M. Ropella, PhD
Roy Silverstein, MD Mr. Wesley acts as a key strategic leader, ambassador team, will continue to
Thomas L. Spero
Owen J. Sullivan
and advisor for MCW, and is responsible for ensuring
the execution of MCW’s strategic initiatives through
foster a strong
ALUMNI ASSOCIATION EXECUTIVE COMMITTEE established and emerging partnerships. Mr. Wesley will institutional
Marie L. Nakata, MD ’89, GME ’93 – President
Brian J. Bear, MD ’84, GME ’89 – Past-President
deepen, nurture and create relationships with stra-
tegic partners, burgeoning enterprises and alliances,
culture…”
Neil R. Guenther, MD ’83, GME ’88 – President-Elect
Ronald J. Gerrits, PhD ’99 – Secretary/Treasurer and others that support and create opportunities for
Barbara B. Calkins, MD ’96 MCW’s long-term growth in Milwaukee, Madison and
Timothy A. Crummy, MD ’97 communities partnered with our regional campuses. His
Matthew Goldblatt, MD ’97, GME ’04
significant involvement with local and regional busi-
Executive Director of Alumni Relations: Seth M. Flynn nesses, governments, civic organizations and philan-
alumni@mcw.edu / (414) 955-4781 thropic groups positions him well as a leader to grow
and sustain MCW’s critical partnerships and strategic
MCW MAGAZINE STAFF
Sara L. Wilkins, MA, MPA – Executive Editor initiatives.
Teresa Manion – Production Manager In early January, we welcomed our inaugural chief diver-
Angela K. Nelson – Content Strategist
sity and inclusion officer, C. Greer Jordan, MBA, PhD, who
Kristin Pelisek – Art Director
Lyniece Rzepka – Web Production Editor provides strategic leadership including vision, manage-
Cheri Saathoff – Graphics and Production Specialist ment and strategic planning for institution-wide diversity
Contributing Writers: and inclusion initiatives, and is responsible for developing
Holly Botsford, Anthony Braza, John Burlingham,
a broad-reaching approach to enhancing the excellence of
Greg Calhoun, Samantha Cavallo, Nicole Etter, Alex Krouse,
Maureen Remmel, Karri Stock, Sara L. Wilkins senior leadership and the entire workforce relating to
Chief Development Officer/Vice President of Development:
diversity and inclusion. See more information on
Alice G. Archabal Dr. Jordan on page 7.
Vice President of Communications, Experience and Also in January, Barclay Ferguson assumed the role of
Brand Strategy: Mara Lord, MBA
Chief Historian: Richard Katschke, MA
chief financial officer. Mr. Ferguson most recently served
as chief financial officer at Integrated Health Network,
CONTACT US
Phone (414) 955-4725 and has more than 20 years of experience growing enter-
Fax (414) 955-6699 prise value for large public and private healthcare and
E-mail: MCWmagazine@mcw.edu
health insurance organizations.
Medical College of Wisconsin
I am confident that these new leaders, along with the
8701 Watertown Plank Rd.
Milwaukee, WI 53226 many talented individuals already on the MCW team,
CONNECT WITH US
will continue to foster a strong institutional culture
while also helping us to build for a successful and
transformational future – in which we hope you will
TO DONATE A GIFT OR PLEDGE play a part!
Phone (414) 955-4700
I encourage you to share your input online or by con-
www.mcw.edu/giving
tacting our editor at MCWmagazine@mcw.edu.
John R. Raymond, Sr., MD
President and Chief Executive Officer
CONTENTS
COVER STORY
16 / C
LINICAL TRIALS:
TRANSLATING RESEARCH
TO BENEFIT PATIENTS
04 / FROM
GRAD STUDENTS TO
FACULTY MEMBERS
05 / ALUMNI ASSOCIATION PRESIDENT’S MESSAGE
8 08 / R
AISING AWARENESS
OF AN UNDERDIAGNOSED
DISEASE
10 / BRIDGING
ONCOLOGY AND REPRODUCTIVE
MEDICINE TO HELP PRESERVE FERTILITY
BEFORE AND AFTER CANCER TREATMENT
12 / D
ALUMS SUPPORT RESEARCH, STUDENT
EXPERIENCES
14 / WARRIOR
PARTNERSHIP BENEFITS
VETERANS, MEDICAL STUDENTS ALIKE
14 22 / H
EALTHCARE DINNER HONORS
SARAH AND JEFF JOERRES
24 / T RANSITIONING FROM
PEDIATRIC TO ADULT CARE
INSIDE EVERY ISSUE
6 / STAT REPORT 32 / IN MEMORIAM
28 / HAPPENINGS 34 / C HANGE AGENT
30 / A LUMNI NOTES 35 / A MOMENT IN HISTORY
16 ALUMNI
PHILANTHROPY
CLINICAL COMMUNITY ENGAGEMENT
SCHOLARSHIP
DISCOVERY
ON THE COVER: Lucas Lindner, paralyzed in an automobile accident in May 2016, has regained some fine motor actions of his arms, hands and fingers
following a clinical trial involving surgery to inject engineered stem cells into his spinal cord, performed by Shekar N. Kurpad, MD, FEL ’01, PhD.
The trial is based on more than 15 years of Dr. Kurpad’s research into cellular transplantation for spinal cord injur y. PHOTO CREDIT: Mark Battrell.
W W W.MCW.EDU 3
ALUMNI | SCHOLARSHIP
From Grad Students to Faculty Members
Photo courtesy of Jay Westhauser
(l-r) Alison Kriegel, PhD ’08, and Caitlin O’Meara, PhD ’11, earned doctoral degrees from MCW’s Graduate School and later joined the faculty in MCW’s department of physiology.
M Three Former Graduate
edical College of Wisconsin assis- worked as a technician in MCW’s depart-
tant professor of physiology Caitlin ment of pediatrics (infectious disease).
O’Meara, PhD ’11, first roamed the
institution’s halls as an undergraduate
Students Find a Home Drs. O’Meara, Kriegel and Patitucci all
later chose to attend MCW’s Graduate
student interested in zoology, botany and Within MCW’s Faculty School and earned their respective doc-
cell biology. “A family friend had been in toral degrees. “I really liked the culture at
MCW’s Summer Program for Undergraduate Research (SPUR) and MCW, and the interdisciplinary program was a great fit for me as
had a wonderful experience,” Dr. O’Meara says. “With my family I was still deciding what to specialize in,” Dr. Patitucci notes.
in nearby Wauwatosa, it was a natural opportunity for me to Drs. O’Meara and Kriegel each studied physiology, but with dis-
explore biomedical research.” tinct research interests. Dr. O’Meara’s advisor was personalized
Alison Kriegel, PhD ‘08, MCW assistant professor of physiology, medicine pioneer Howard Jacob, PhD (who served on MCW’s faculty
found her connection at a similar point in her academic career – from 1996-2016). “I focused on the genetic mapping of kidney disease
when an undergraduate immunology professor told her about a and really enjoyed learning with the other graduate students,
major genetics grant for which MCW was recruiting staff to imple- especially our tightly-knit cohort in physiology,” Dr. O’Meara says.
ment. “At the interview, I was absolutely fascinated by the oppor- “We worked together well and challenged each other constantly.”
tunity to apply genomic analysis to physiological phenotypes, and After working as a staff member with Andrew Greene, PhD, the
I was hired in a support staff role,” Dr. Kriegel shares. Dr. Robert D. and Dr. Patricia E. Kern Professor in Biotechnology
Teresa Patitucci, PhD ‘16, MCW assistant professor of anatomy, and Bioengineering, and professor of physiology at MCW, Dr.
4 MEDICAL COLLEGE OF WISCONSIN MAGAZINE
ALUMNI ASSOCIATION
PRESIDENT'S MESSAGE
I
MARIE L. NAKATA, MD ’89, GME ’93
n 1996, the MCW/Marquette Alumni
Association was at a crossroads. Its
board of directors spent a great deal
of time thinking about and discuss-
ing the organization’s future. And, in
the end, two pivotal decisions were made
that allowed the Alumni Association to
transition into an organization of greater
inclusivity.
Those decisions – eliminate dues and
welcome alumni of ALL programs into
the Association – redefined
the scope and breadth of
our charge as an organiza-
tion. At the time, the board
hoped to encourage more
people to participate in and
take advantage of alumni
programs. Now, nearly two decades later,
Photo courtesy of Emily Voss
MCW Graduate School alumna Teresa Patitucci, PhD ‘16, applied her anatomy skills and love of teaching to setting our Alumni Association finds itself at a
up and managing a new anatomy lab at MCW-Central Wisconsin. similar turning point.
With the tremendous growth occur-
Kriegel knew that she wanted him as her ring at MCW, the Alumni Association has
Motivation for Graduate School advisor. “One thing I a similar – and great – opportunity to
admire about Dr. Greene is his openness advance in its mission. While we are in
Discovery to new ideas and approaches, including the initial stages of constructing a multi-
those that I wanted to explore in cardio- year strategic plan, we have committed
Dr. Teresa Patitucci expected an emotional
experience when she attended her first Spinal vascular physiology,” Dr. Kriegel com- to initiate one major undertaking in early
Muscular Atrophy Conference during graduate ments. “I also enjoyed the high-level spring 2017.
school. Organized by ”Cure Spinal Muscular research environment in which I was In order to increase alumni engage-
Atrophy,” a non-profit foundation focused on ment, we must design programming that
supported but also expected to be on the
funding research and supporting patients and
front edge of the field.” is more aligned with our diverse popula-
families, this annual conference is the largest
such event in the world for the disease, bring- Dr. Patitucci’s primary focus was her tion. One size does not fit all!
ing together physicians and other healthcare research into the role that structural Thus, the Alumni Association has
providers, researchers and families. brain cells play in spinal muscular atro- asked Ron Gerrits, PhD '99, to serve as
“One part of the conference is for research- chair of the Graduate School Alumni
phy, which she undertook with advisor
ers and physicians to discuss and share the
Allison Ebert, PhD, assistant professor of Engagement Taskforce. He, alongside
latest scientific findings. A second part is for
families to network with each other and learn cell biology, neurobiology and anatomy. board members Beth B. Krippendorf,
about new developments, such as new health- Dr. Patitucci also worked with Todd PhD '93, and Jessica M. Olson, PhD '15,
care products and clinical trials,” Dr. Patitucci Hoagland, PhD, professor of cell biology, will assemble a workgroup to devise a
says. While these pieces operate in parallel, plan to increase the Alumni Association’s
neurobiology and anatomy, to train in
the communities intersect in the evenings and
anatomy. offerings to Graduate School alumni.
during other activities.
“I was able to meet families and hear their “After I had proven my organization We must continue to serve all alumni
stories. In just a few days, the research I was and time management skills, Dr. Ebert – but also to better serve all alumni. ■
doing seemed so much more valuable, as I trusted me to meet my research obliga-
was able to get to know the people that my
tions while learning anatomy and later
work was intended to help,” she recalls.
“Whenever I ran into a particularly challenging serving as a teaching assistant for Dr. GRADUATE SCHOOL ALUMNI
obstacle in my science, I would think of the Hoagland,” Dr. Patitucci recalls. “Many of WHAT DO YOU WANT FROM YOUR
people I met and find the motivation to con- my classmates joined MCW’s department ALUMNI ASSOCIATION?
tinue to push myself and find a solution.” » please see pages 26-27 for more EMAIL US AT ALUMNI@MCW.EDU
W W W.MCW.EDU 5
NEWS AND ANNOUNCEMENTS
STAT REPORT
Photo courtesy of Gary Porter
Preparing Students for Medical/Grad School
I
n December 2016, MCW hosted more pants. In addition to a science enrich-
than 150 Milwaukee-area middle/high ment curriculum, the Program will
school students who learned about address practical skills, such as
StEP-UP (Student Enrichment Program test-taking strategies and how to pursue
for Underrepresented Professions in a path to medical or graduate school. A
Medicine) – a new pipeline program in goal of StEP-UP is to give students the
which they will be able to participate. academic preparation, mentorship and
StEP-UP, supported by funding from other tools they need to be strong can-
the Advancing a Healthier Wisconsin didates for medical or graduate school.
Endowment, helps address the gap During the December visit, students
between the diversity of the medical got a taste of what StEP-UP will offer.
workforce that MCW educates and the Five 20-minute sessions led by MCW
diversity of the populations cared for by medical and graduate students covered
this workforce. such topics as brain anatomy, auscul-
Starting in fall 2017, MCW will host tation, vitals, bedside manner and
Photo courtesy of Gary Porter
quarterly weekend programs for 50-65 ultrasound – followed by a panel
StEP-UP middle and high school partici- discussion. ■
6 MEDICAL COLLEGE OF WISCONSIN MAGAZINE
Chief Diversity
and Inclusion
Officer Joins MCW
C.
Greer Jordan,
MBA, PhD,
joined MCW
as chief diversity and
inclusion officer on
January 3, 2017. Most
recently, Dr. Jordan
served as associate
vice chancellor, diver-
sity and inclusion, for
the University of
New Family Medicine
Massachusetts
Medical School and
UMass Memorial
Residency Accredited Health Care, and was
assistant professor of
T
he Medical College of While the shortage of family nursing in the Graduate School of Nursing.
Wisconsin and Froedtert medicine doctors is greatest in In her new role at MCW, Dr. Jordan will provide
Health are scheduled to launch Wisconsin’s rural areas, it also is a strategic leadership including vision, management and
a new family medicine residency problem in Milwaukee and other strategic planning for institution-wide diversity
program this summer at Froedtert cities throughout the state. Increas- and inclusion initiatives, and will be responsible
and the Medical College of ing residency positions is a proven for developing a broad-reaching approach to
Wisconsin Community Memorial strategy for recruiting doctors to enhancing the excellence of senior leadership and
Hospital in the Milwaukee area. The stay long-term, according to Ken the entire workforce relating to diversity and
goal is to train more resident phy- Simons, MD, senior associate dean inclusion.
sicians who will elect to stay in for graduate medical education More specifically, Dr. Jordan will provide stra-
Wisconsin to practice and meet and accreditation at MCW and tegic direction in recruiting, attracting and retain-
the rising demand for family executive director of Medical ing diverse faculty, physicians, students and staff,
medicine expertise. College of Wisconsin Affiliated identify areas of opportunity, collaborate with
The new program will train six Hospitals. “Physicians who com- departments, programs and constituencies, and
family medicine residents per year plete residency in Wisconsin have serve as a liaison between MCW and individuals
over a three-year period – for a total a better than 70 percent chance of with similar roles – both locally and nationally –
of 18 new residents in place once the remaining in the region to practice to share best practices and innovations related to
program is up to full speed. MCW medicine," Dr. Simons shares. diversity and inclusion.
already has begun recruiting, with a “If even one of the residents from Prior to her career in academia, Dr. Jordan
planned start date for the residency this program decides to stay and worked in the automotive industry for nearly 20
program of July 1, 2017. As back- practice in Wisconsin, MCW will have years – in engineering and management positions at
ground, there is a current deficit of greatly improved access to family Ford Motor Company and General Motors. The breadth
nearly 200 family medicine/primary medicine/primary care within a of her experiences gives Dr. Jordan a deep understand-
care physicians in Wisconsin and a decade,” adds Joseph E. Kerschner, ing of organizational culture, academia and the
projected deficit by 2035 of about MD ‘90, FEL ’98, executive vice presi- mission of an academic medical center. ■
900 to 3,800 – mostly in primary dent and dean, School of Medicine. ■
care and psychiatry.
W W W.MCW.EDU 7
Drs. Ann Rosenthal and Lawrence Ryan authored a review article in the June
2016 issue of the New England Journal of Medicine which reflects more than
40 years of research on Calcium Pyrophosphate Deposition disease.
Photo courtesy of Gary Porter
F
or a disease that was discovered more than 50
years ago, Calcium Pyrophosphate Deposition
THE LAWRENCE M. RYAN, (CPPD) disease, a form of arthritis caused by
MD, ENDOWED EDUCATION calcium pyrophosphate crystals, remains
FUND IN RHEUMATOLOGY relatively misunderstood and underdiagnosed.
has been established to permanently
honor Dr. Ryan’s contributions. Through As major contributors to our under- on CPPD disease conducted at the
this endowed fund, donors will help standing of this disease, Ann Rosenthal, Medical College of Wisconsin.
residents, fellows and medical students MD, FEL ’89, Will & Cava Ross Professor “Why do we study CPPD disease and
travel to rheumatology conferences,
of Medicine, chief of rheumatology and arthritis in general? As people live lon-
sponsor external expert speakers to
discuss clinical and research topics, and director of the Medical College of ger, healthier lives, rates of CPPD disease
support other educational opportunities Wisconsin Arthritis Institute, and and arthritis will rise and become even
that enhance the vitality of MCW’s Lawrence Ryan, MD, GME ’75, FEL ’77, greater threats to independence,” Dr.
division of rheumatology. For more professor emeritus of medicine (rheuma- Ryan says. “Plus, these maladies hurt!”
information, please contact Angela
tology), were invited to author a review One contributing factor to CPPD
Nelson, senior director of development
and alumni giving, at (414) 955-4708 or article in the June 2016 issue of the New disease’s lack of exposure is the thorny
annelson@mcw.edu. England Journal of Medicine which issue of its name. Since it was first
reflects more than 40 years of research described in 1962, the disease has had
ALUMNI | CLINICAL | DISCOVERY | PHILANTHROPY
Raising Awareness
of an Underdiagnosed Disease
a number of nomenclature changes, “Our best estimate is that between four than when I started, and it has been in-
including the popular name of “pseudo- and seven percent of adults in the US credible to watch how these fields have
gout,” which was coined due to clinical and Europe have CPPD disease, so it transformed over time,” Dr. Ryan states.
similarity of one form of CPPD disease appears to be a relatively common When he had the opportunity to speak
to gout. It subsequently was noted by disease that we are not consistently at the Commencement Ceremony for
Daniel McCarty, MD, former chair of diagnosing,” Dr. Ryan adds. the MCW Medical School Class of 1999,
medicine at MCW, that the crystals Once diagnosed, treatment of the he asked the graduates to recall all of
were composed of calcium pyrophos- acute form of CPPD disease focuses on the family members, friends and other
phate rather than uric acid. In 2011, reducing inflammation until symp- mentors who had helped them along
experts from the European League toms stop – which can be a matter the way. Dr. Ryan recommended that the
Against Rheumatism recommended that of weeks or months. Symptoms are graduates return these many favors by
specialists use the term “CPPD disease” particularly persistent in the chronic assisting other promising physicians
and categorized clinical involvement as form, and strategies to reduce inflam- and scientists. “While we both feel
either acute or chronic arthritis. mation and pain can improve quality passionately about CPPD disease, I am
“Looking back, the naming issue makes of life, but they also must be balanced most grateful for Dr. Ryan’s dedication
sense from a historical progression, but against side effects. In contrast to as a mentor, colleague and friend,”
it also has been a major problem in the gout, which has long-term therapies to Dr. Rosenthal says. “He has had a huge
field,” Dr. Rosenthal shares. “We have to reduce urate crystal formation, no drug influence on my career.”
agree on uniform naming criteria so that has yet been proven to remove calcium Another pivotal experience came
we are all talking about pyrophosphate crystals when Dr. Rosenthal was selected in
the same thing.” “It feels like a completely or reduce their forma- 2013 to participate in the Hedwig van
In the early stages of tion in CPPD disease. Ameringen Executive Leadership in
this disease, calcium
different world in medicine “We’re looking for Academic Medicine® (ELAM) program,
pyrophosphate crystals and rheumatology than better treatments,” Dr. run by Drexel University College of
develop inside cartilage. when I started, and it has Rosenthal comments. Medicine, which focuses on helping
Once present, these “Rather than targeting senior women faculty members at
crystals begin to dam-
been incredible to watch systemic inflammation, academic medical centers enhance their
age cartilage tissue by how these fields have we’d like to focus on leadership skills. “It was a great oppor-
inducing inflammation, transformed over time.” preventing or dissolving tunity to gain further education into the
along with other harm- the crystals.” nuts and bolts of how academic medical
– Dr. Lawrence M. Ryan
ful changes. Untreated In addition to commit- centers operate,” Dr. Rosenthal shares.
CPPD disease may lead to severe, painful ting themselves to uncovering new po- “The best part was developing a new
attacks or chronic pain and inflamma- tential treatments for CPPD disease and network of aspirational women leaders
tion. Over time, joints may degenerate other forms of arthritis, Drs. Ryan and across the nation.”
or break down, resulting in long-term Rosenthal have dedicated their careers to Dr. Rosenthal is poised to continue
disability. treating patients and mentoring promi- what Dr. Ryan and his contemporaries
The crystals themselves are the key to sing rheumatologists. After blazing a trail began more than 40 years ago by treat-
diagnosis, and researchers have shown as MCW’s first rheumatology fellow and ing arthritis in all its forms – while also
that their presence can be most accu- Wisconsin’s first rheumatology trainee, leading research into better therapies
rately assessed in the fluid inside the Dr. Ryan served as chief of rheumatology for CPPD disease. “With age being the
arthritic joint, known as synovial fluid. at MCW for more than 20 years – recei- biggest risk factor for CPPD disease,
“Identifying these crystals with ving the institution’s highest honor in and an aging population on the horizon,
a microscope requires patience and 1999: the Distinguished Service Award. this research is more important than
experience, and our field needs to get “It feels like a completely different ever,” Dr. Rosenthal notes. ■
better at it,” Dr. Rosenthal remarks. world in medicine and rheumatology – GREG CALHOUN
W W W.MCW.EDU 9
Preserving Fertility 10 MEDICAL COLLEGE OF WISCONSIN MAGAZINE
CLINICAL | DISCOVERY
Bridging Oncology and Reproductive Medicine to Help
Preserve Fertility Before and After Cancer Treatment
T
he pathway to “My goal when talking and modate schedules to get the job,” says Kashian. “A diagno-
parenthood meeting with patients recent- treatments done during the sis of breast cancer, however,
often contains ly diagnosed with cancer is patient’s window of opportu- was not in our plan.”
more bumps or to inform and educate them,” nity,” notes Dr. Schoyer. “The After meeting with the staff
routes than says Katherine (Kate) Schoyer, team truly understands that at the Reproductive Medicine
anticipated. The MD, assistant professor of time is of the essence, and Center, Kashian felt hopeful
Froedtert & the obstetrics and gynecology at mobilizes to do whatever is for the first time after her
Medical College of Wisconsin MCW. “There is a benefit to needed.” diagnosis. “What stuck with
Reproductive Medicine knowing one’s options and Today, those with cancer me after our meeting was Dr.
Center, however, as one of the hearing that these treatments and other diseases have many Schoyer reassuring us that
few fertility programs in the don’t have to end hopes of options to preserve fertility – ‘whatever choice you make
region offering complete having a family.” before and after treatment. is right for you.’ It took the
onsite fertility evaluation and The process begins quickly New techniques are providing pressure off, and reminded
treatment services for men with collaboration at the hope for preserving or re- me that love and hope will be
and women, can make that Center. Once a patient is storing fertility, and the team at the center of this decision.”
journey a bit smoother. Its diagnosed, the doctors works together to determine Kashian opted for egg
physicians are reproductive immediately work with onco- the best way to treat each retrieval, and, as a result,
endocrinology and infertility logists at Froedtert Hospital patient’s unique situation. now has 16 cryopreserved
specialists and urologists and Children’s Hospital of “Our Center emphasizes the embryos stored at the Center.
specifically trained in female- Wisconsin to determine if the use of egg, sperm and embryo “Seeing the positive results
and male-factor fertility patient is well enough and freezing as the most reliable and having the team cheer
concerns. cleared physically to undergo means of preserving fertility. each time a viable egg lit up
The team consists of three fertility treatment, as well as We also recognize and review on the screen was a happy
infertility experts, a urologist, the patient’s timeframe. with our patients a multitude thing to look forward to,”
a genetics counselor, two “The Center is staffed of other options for having a Kashian shares. “It took my
embryologists, two andro- seven days a week, and we family,” Dr. Schoyer shares. mind off going through the
logists (who treat the male make every effort to accom- “Our strongest asset is cancer treatment plan. I am
reproductive system), special- collaboration. Patients get pleased with my decision and
ized nurses and support staff. the opinion of not one, but experience and look to the
A burgeoning area of multiple experts who will future with hope, thanks to
research and interest is
“We were planning to recommend the safest, most all the staff at the Center.”
oncofertility, a subfield that start trying to become effective and cost-efficient “Together, the whole
bridges oncology and repro- pregnant again in May. means of having a family,” team is pulling for success
ductive medicine to explore adds Dr. Schoyer. “Our Center for every patient,” says Dr.
and expand options for the
The timing was perfect is an example of open dia- Schoyer. “We all truly care,
reproductive future of cancer for a sibling to our logue and partnership across and worry about each patient.
survivors. While chemo- four-year-old son and campuses.” We are there every step of the
therapy, radiation and One patient, Virginia Kashian, way and celebrate success-
surgery can effectively treat
for my job. A diagnosis was diagnosed with breast es together. The pathway to
cancer, these treatments also of breast cancer, cancer in early spring 2016. parenthood is not the same
may affect a woman’s and however, was not “We were planning to start for every person. It’s up to us
man’s fertility. The F&MCW trying to become pregnant to give patients options and
Reproductive Medicine
in our plan.” again in May. The timing was help them choose their route.
Center is at the forefront of – Virginia Kashian, patient perfect for a sibling to our We give them hope.” ■
this new area. four-year-old son and for my – HOLLY BOTSFORD
W W W.MCW.EDU 11PHILANTHROPY | SCHOLARSHIP
Dalums Support Research,
Student Experiences
P “Our philosophy,
hilanthropy, prayer and pleasant happen- Tom had their lake property. There, they’ve
stance are deeply rooted in the sunken held events to benefit juvenile diabetes
rose garden at the lake home of Tom and which we’ve research and between 15 and 20 charitable
Maripat Dalum in Hartland, Wis. It is there
the Dalums, longtime supporters of the
discussed with our organizations.
The Dalums’ community philanthropy
Medical College of Wisconsin (MCW), have children, is ‘learn, runs side-by-side with their support of
continued to nurture their mutual philosophy
of giving back by offering the use of their
earn and return,’ student financial aid, cancer research and
endowed research funds for Parkinson’s
garden for charitable events. and they’ve started disease and arthritis at MCW.
“I think it was part of our Christian
upbringing, that you should be thankful for
giving, too.” Tom and Maripat also provide annual
funding for an MCW medical student to
– Maripat Dalum
what you have and use your talents and give attend a week at the Summer Institute for
back in ways that you can,” says Maripat. Medical Students program at the Betty Ford
“Our philosophy, which we’ve discussed with our children, Center. The summer of 2016’s participant, Chelsea Kiehl
is ‘learn, earn and return,’ and they’ve started giving, too.” (Class of 2019), was immersed in the daily life of patients in
The Dalums’ ability to match financial capacity with treatment at the Center in Rancho Mirage, California.
their philanthropic philosophy took many years. Maripat The “patient buddy” assigned to Chelsea was a 21-year-
chose to forgo her career as an occupational therapist to old college graduate. “I’d never have thought that my buddy
raise their children – Joe, Marikris, Amy and Judie – on a had a heroin addiction, upon first impression,” she shares.
tight budget. At the same time, she did a lot of volunteering “This young adult was so bright and talented. The experi-
for various organizations. ence opened my eyes to the types of people who can be
In 1964, Tom began working for Dalum’s Utility fighting with addiction. I can never thank the Dalums
Equipment Company, the business his father, CE “Pete” enough for the opportunity to participate in such a
Dalum, started in 1955 with just four employees in a bed- life-changing experience.”
room office at the family home. After his father died in 1979, As part of the program, Chelsea met with the Dalums to
Tom became president and CEO, and the company expanded. report on her experience and “absolutely loved meeting
By the time it was sold, Tom had started another business them.”
of his own and bought additional companies. Tom notes, “I think the students come back with an
The use of a rose garden in their philanthropic endeav- understanding that there are people who really can’t control
ors came in a roundabout way and with plenty of praying addiction, that it’s a disease, that they don’t know how to
from Maripat. An arthritic knee convinced her that they cope, that people were genetically born different.”
needed to move from their two-story to a house with bed- That perspective on addiction led to Tom and Maripat’s
rooms on the main level, and she suggested they try to live creation in 2015 of the Dalum Scholar in Addiction
on a lake. Their search for a lake home ultimately stretched Research, a program that empowers a bright MCW student
to two years. “I started saying a prayer: Lord, help us to in the neurosciences to explore innovative approaches to
find the place that’s right for us,” says Maripat, “and when addiction treatment.
it’s right, I know I shouldn’t ask for a sign, but could there The Dalums believe that their investment in MCW,
be a rose somewhere on the property?” especially endowments, provide a long-lasting benefit of
No rose emerged until Maripat revisited a lake property research and education unique to the institution. “We’ve
she thought they’d lost to another bidder. There, to her sur- been so blessed,” says Maripat, “and whatever talents and
prise, was a rose garden previously hidden by snow. When gifts God gives you should be shared.” ■ – JOHN BURLINGHAM
the deal with the other bidders fell through, Maripat and Photo courtesy of Jay Westhauser
12 MEDICAL COLLEGE OF WISCONSIN MAGAZINETom and Maripat Dalum provided funding
for medical student Chelsea Kiehl to attend
a week at the 2016 Summer Institute
for Medical Students program at the
Betty Ford Center.
CHELSEA KIEHL, MCW CLASS OF 2019 SUMMER INSTITUTE FOR MEDICAL
STUDENTS (SIMS)
Summer Institute for Medical Students participant
at the Betty Ford Center Chelsea Kiehl shares SIMS highlights:
Chelsea Kiehl, an Army Health Professions Scholarship Program recipient, is an Army reservist. • lectures by recovered addicts previously involved in the program
Commissioned as a 2nd Lieutenant in autumn 2015, Chelsea will switch to active duty once her
residency begins. Her interest in military psychiatry was her motivation for applying to this • group therapy with in-patient women (ages 22-75) with addictions
program. spanning many different substances
Residency preference: Walter Reed National Military Medical Center in Bethesda, MD. • observations of businessmen in treatment discussing their addiction
and recovery with medical professionals
Potential specialties: pediatric, adolescent or adult psychiatry and perhaps family medicine.
• children and family program “which hit close to home for me as
For more, visit mcw.edu/thedalums someone who is exploring her role as a pediatrician in addiction
medicine”
• interacting with other medical students who share a passion for
addiction medicine and learning from their experiences
W W W.MCW.EDU 13COMMUNITY ENGAGEMENT | SCHOLARSHIP
Warrior Partnership
Benefits Veterans, Medical Students Alike
O
ne afternoon in 2011, three MCW Milwaukee campus once a semester gram, the effects of combat are ampli-
second-year medical students, to meet with students during four fied in the civilian life rather than
two veterans and a faculty mem- sessions. At each session, the vets treated and supported sufficiently.”
ber met and hashed out a plan to discuss their experience during An unanticipated bonus from the
launch the Warrior Partnership, a pre-deployment (life before joining program is the strong bond formed
program they hoped would benefit the service), their deployment and between the veterans and the
students and veterans alike. Little did post-deployment (what it is like to students who participate.
they know how much each group would return home to a new world). “Not only has this experience pro-
eventually gain from this effort. Students share their medical school vided me with invaluable information
The Warrior Partnership, led by and training experiences. Through as a future physician, but the group also
Michael McBride, MD ’92, FEL ’97, this dialogue, students become com- provided me with a second family,” adds
assistant professor of psychiatry fortable communicating and interact- Kiehl, who is attending MCW on a mili-
and behavioral medicine at MCW, ing with veterans and learning about tary scholarship. “The first veteran I was
brings veterans and medical stu- their unique healthcare needs. The paired with in my group was my first
dents together for mutual benefit: veterans learn how to be more open salute at my commissioning ceremony,
the veterans open up about their and comfortable talking to health- and has become a role model and men-
experiences and leverage them to care providers, and help the students tor. My medical school experience would
teach the students how to care for expand their knowledge. be drastically different without the men
other veterans, and the students “Through this group, my eyes and women who give their time to the
learn how to integrate the unique were opened to the fact that the war Warrior Partnership.”
needs of this population into their is not the biggest challenge in life Dr. McBride, a psychiatrist at the
care. Now in its fifth year, the faced by vets,” says second-year stu- Clement J. Zablocki VA Medical Center
par tnership has grow n from sev- dent Chelsea Kiehl – and one of the and commander in the United States
eral Vietnam veteran volunteers to Warrior Partnership’s current student Navy, was part of the original group that
about 25 volunteers who ser ved in leaders. “Most of their difficulties and met to plan the Warrior Partnership.
World War I I, Korea, Vietnam, hardships started when they returned Another member of that group was
Operation Deser t Stor m, Operation home. Whether it be addiction, depres- Vietnam veteran Michael Orban, who
Iraqi Freedom and A fghanistan. sion or post-traumatic stress disorder, says he had specific reasons for wanting
The volunteer veterans visit MCW’s for most of our veterans in the pro- to start a group like this in Milwaukee.Photos courtesy of Jeff Zmania
MCW-Milwaukee medical students meet each semester with veterans who share their experiences, which helps the students better understand
the unique healthcare needs of veterans.
“I had worked with veterans for about three original MCW students who medical assessment.”
15 years before, and many told me they helped launch the Warrior Partnership; Nicholas Jelacic, a second-year
weren’t able to communicate or connect she says the Partnership helped her to MCW medical student and one of the
with their physicians,” Orban shares. better understand how to incorporate three current student leaders, shares
“We wanted to come up with a way to help the unique experiences of the veterans that the experience has been very
veterans play a role in their healthcare into their care. educational for him as well.
and help them feel more comfortable “Every patient comes to us with a “One of the things people rarely learn
talking with physicians.” story and narrative, and we need to let in high school and college courses are
Robert Lyons served with the US them tell it,” Dr. Stout notes. “This is the problems veterans face when they
Army infantry in Afghanistan and cur- especially true with veterans who suf- return home and try to assimilate back
rently works at Dryhootch, a coffee shop fer from PTSD and don’t like to admit into society,” says Jelacic, who attends
that offers veterans free access to peer anything is wrong. We need to let them MCW on a military scholarship. “The
mentor support and information about open up and share through their nar- Warrior Partnership allows medical
available healthcare and support. He rative instead of through the regular students to ask questions they may be
learned about the Partnership from too scared to ask of veterans they don't
other veterans who come to Dryhootch, know. This allows us to identify aspects
and says that after having participated
in the program for two semesters, he
Commitment of medical care that we can improve on
to make the veteran medical experience
plans to continue returning to MCW. Starts at the Top more enjoyable and worthwhile.”
“Veterans can be interesting and MCW’s commitment to veterans starts at the Other Warrior Partnership leaders
unique, and our culture and experiences top. Despite his rigorous and hectic schedule, include Gregory Burek, MD, a third-
can be difficult to relate to, and it is John R. Raymond, Sr., MD, MCW president and year psychiatry resident and Marine
important for upcoming physicians to CEO and a practicing nephrologist, spends up to Corps infantry veteran, and Gretchen
one month each summer at the Zablocki VA
understand this,” Lyons says. “The Floan, a second-year medical student.
Medical Center seeing patients with chronic
Warrior Partnership is a great opportu- renal failure, providing consultations, assisting Active and retired military comprise
nity for me to share my experiences and with dialysis and tending to acutely ill patients. about 10 percent of the nation’s adult
hopefully make another veteran’s health- In addition to supporting the Warrior population, and more than 65 percent
care easier down the road.” Partnership and Dryhootch, the Medical College of American physicians receive at least
of Wisconsin has a robust commitment to help-
Monica Stout, MD ’15, a family some of their professional training in
ing veterans through patient care and research.
practice resident in the Fox Valley MCW has 112 faculty, 59 staff and three post- Veterans Administration (VA) hospi-
Residency program, was one of the doctoral fellows from 13 departments and the tals. Most physicians will provide care
Office of Research working at the Zablocki VA. for veterans and their families at some
(l-r) The Warrior Partnership is led by Dr. Michael Approximately $9 million in research is point during their professional
McBride, assistant professor of psychiatry and conducted by MCW faculty at the VA, and
careers. ■ – TONY BRAZA
behavioral medicine. Medical students listen to a all of the physicians there are MCW faculty.
veteran discuss his experiences and healthcare needs.
For more, visit mcw.edu/warriorpartnership
W W W.MCW.EDU 15“
If your clinical work goes well, it
makes you feel good on your drive
home from the hospital. But when
your research goes well, it makes
you feel good from one Christmas
”
to the next.
– Dr. Shekar N. KurpadCLINICAL | DISCOVERY
“We’re in the
Hope Business”
Clinical Trials: Translating Research to Benefit Patients
By Maureen Remmel • Sara L. Wilkins
T
wenty-two-year-old Lucas Lindner develop into many different types of cells advancement. Curiosity pushes them to
of Eden, Wis., was on a routine in the body) into the spinal cord – needed investigate and seek answers for those
trip to the grocery store one to be conducted within 30 days of the important, yet elusive, scientific and
Sunday morning in May 2016 injury (once the inflammation had less- medical questions.
when a deer unexpectedly jumped into ened). Lindner was to be the first patient “As we come across newer diseases or
the path of his car, causing a serious in this exciting clinical trial undertaken gain new understanding of how disease
accident. In mere minutes, Lindner went by Dr. Kurpad and his team of Froed- processes work, we want to test if our
from having an active life as a technical tert & the Medical College of Wisconsin understanding is correct and determine
college student and manager for Mc- healthcare providers, and built on a solid what would work in treating or curing
Donald’s to total paralysis below the site foundation of MCW’s bench research. But that condition. A clinical trial is a great
of his C5-C6 cervical spinal cord injury. would it restore Lindner’s ability to live a way to answer those important questions,”
Flight for Life airlifted Lindner to more independent life? says Amit Gode, MD, MPH, administrative
Froedtert Hospital, where, upon awaking director of the MCW Clinical Trials Office,
several days later, he was able only to The Power of Clinical Research which provides centralized clinical re-
shrug his shoulders, use his biceps in The National Institutes of Health (NIH) search resources for the conducting of
a crude fashion, wriggle his wrists and defines a clinical trial as a “research clinical trials in a safe, efficient, cost-
bring his hands to his mouth, according study in which one or more human sub- effective and compliant manner.
to his surgeon, Shekar N. Kurpad, MD, jects are prospectively assigned to one or
FEL ’01, PhD, interim chair and professor more interventions (which may include Types of Clinical Trials
of neurosurgery at the Medical College placebo or other control) to evaluate There are two primary types of clinical
of Wisconsin (MCW), and director of the effects of those interventions on trials: interventional and observational.
the Froedtert & the Medical College of health-related biomedical or behavioral Interventional clinical trials test the safe-
Wisconsin’s Spinal Cord Injury Center. outcomes.” ty and effectiveness of a drug, therapy or
Lindner could not master fine motor Academic medical centers such as investigational treatment. Observational
skills such as writing, holding small MCW conduct large-scale, country- clinical trials consist of the observation
items, buttoning clothes, eating or using a wide, multi-institutional studies as well and monitoring of participants and their
computer keyboard. He was despondent, as smaller specialized, earlier phase health over a period of time. This type
noting that “everything I was working on and complex trials. Every year, MCW of trial can provide important data to
in my life was lost.” researchers and physician scientists advance the understanding of a disease
Dr. Kurpad, however, had reason to conduct more than 1,000 cancer and and potential ways to treat it. In addi-
offer hope. Lindner was a candidate for a non-cancer clinical trials at partner tion, healthy participants are needed for
new clinical trial based on 15 years of Dr. hospital and clinical locations across clinical trials so researchers can compare
Kurpad’s research into cellular transplan- southeast Wisconsin. MCW’s halls are their study results to the results of people
tation for spinal cord injury. The timing filled with faculty and staff committed with the disease or illness being studied.
was ideal, as the surgery – injection of to serving as an indispensable source Before a clinical trial can begin, the
stem cells (cells with the potential to for life-changing knowledge and medical principal investigator (PI) must set clear
Photo courtesy of Gary Porter
W W W.MCW.EDU 17guidelines for the clinical trial protocol. provide transparency and education to
She/he must identify the question or aim participants. Clinical trial participants
of the research, why it is important or rele- can withdraw their participation at any
vant, and what research is already avail- time throughout the trial.
able to help answer the question or aim. In
addition, timeframes should be established, Clinical Trial Funding
along with indicators for success. A rigor- Clinical trials are funded by many
ous and clearly defined patient safety plan sources including grants from the federal
also is included in the protocol. government (such as the NIH, Department
Other key components of the protocol of Defense and Department of Veterans
include background on the condition and Affairs), private organizations and indi-
the PI’s hypothesis; an exact proposal of vidual philanthropy, or sponsored by in-
the trial; quantifiable data and detailed dustry – such as pharmaceutical or medi-
explanations of the risks associated with cal device companies. At MCW, additional
participation; details on how data will be clinical trial funding may be provided
collected and stored; and overall safety by the institution itself, the Advancing a
information regarding the treatment or Healthier Wisconsin Endowment, donors
procedure. or the Clinical & Translational Science
Institute of Southeast Wisconsin (CTSI).
Clinical Trial Participation
Three-year-old Joel Chmielewski (pictured here with Clinical trials vary in size and scope, The Role of the IRB
his mother, Kay) has been participating in a clinical trial involving a few patients to a few thousand. Institutional Review Boards (IRBs) are
that adds two additional medications to his conventional Clinical trials can be conducted locally, institutions that work with investigators
leukemia therapy. Diagnosed at 16 months, Joel is in regionally and even globally, and last to protect the rights, welfare and privacy
remission and completing treatment to prevent the
several months to several years. Each trial of individuals who participate in clinical
cancer’s recurrence. Photo courtesy of Jay Westhauser
has eligibility criteria as well as exclusion trials; IRBs also ensure researchers are
criteria for participation. This rigorous set behaving ethically and with good scienti-
of criteria is not designed to create barriers fic principles. The IRB must thoroughly
Philanthropy Drives to participation, but rather to ensure that review and approve each clinical trial
Search For New the scientific questions posed are accurate-
ly answered. Typically, the more serious
and its protocol, considering necessity,
ethics and patient privacy before the trial
Treatments or well-known the disease, the greater the can begin. All IRBs must follow federal
The Triumph Fund, established by the family participation rate. In addition, individuals guidelines and respective state laws in
of the late John Hovel, raises funds to support who may have exhausted their standard their review of clinical trials. Members of
training, education and research projects for clinical options may turn to clinical trials IRBs can include researchers, physicians,
the MCW Clinical Trials Office. Since 2013, the
as a possibility for treatment. clergy, ethicists, individuals from the
family has raised approximately $165,000.
Recently, their fundraising efforts supported a Prior to participation, patients or community and others.
clinical trial by Meena Bedi, MD, GME ’13, to volunteers are informed of their rights
study sarcoma, a type of cancer that grows in and risks, as well as assured that their Cancer Clinical Trials at MCW
connective tissues. privacy is protected. Known as “Informed Achieving National Cancer Institute
Consent,” this is an exhaustive process to (NCI) designation is a priority for the
From Bench to Bedside
PRE-CLINICAL TESTING PHASE 1
4+YEARS
8+
YEARS 20-80
LABORATORY APPROVED ANIMAL TESTING PATIENTS O
STUDIES PROTOCOL Collect information to determine Obtain prelim
safety, side effects and how the drug is in people w
metabolized/excreted. Safety cont
short-term
18 MEDICAL COLLEGE OF WISCONSIN MAGAZINEMCW Cancer Center, and expanding us to become more competitive with thousands of clinical trials nationwide.
the clinical trials enterprise has been pharmaceutical companies, which in turn F&MCW’s Cancer Network will be one of
a critical component in that quest. NCI gives us access to patients and clinical only two academic institutions in the US
designation recognizes excellence in trials. We are now conducting clinical pioneering the use of Watson for clinical
cancer research, opens doors to expanded trials where our faculty approach trial matching – which is slated to occur
research funding and related economic pharma companies, but also where we in mid-to-late 2017.
benefits and jobs, and brings the most develop the compound and bring it “I want fewer people to have their lives
advanced cancer care to patients. directly to patients,” Dr. Thomas adds. shortened by cancer, and the only way we
To strengthen its program, in 2010 the Dr. Thomas acknowledges the sig- can improve this is through clinical
MCW Cancer Center recruited two criti- nificant impact of the Nicholas Family research. I firmly believe we are in the
cal leaders: Ming You, MD, PhD, as direc- Foundation Cancer Translational Re- hope business,” Dr. Thomas adds.
tor, and James Thomas, MD ’91, GME ’95, search Unit (TRU) of the CTSI on clinical
PhD ’89, as director of the Adult Cancer trials, which provides an optimal clinical Pediatric Cancer Clinical Trials
Clinical Trials Office (ACCTO). Both indi- research environment for both research The Pediatric Cancer Clinical Trials
viduals recognized that a more compre- participants and translational investiga- Office (PCCTO) was created in 2009
hensive clinical trials effort was needed tors through access to space, resources through a five-year, $5 million infrastruc-
at Froedtert & the Medical College of and the expertise of research support ture investment from the MACC (Midwest
Wisconsin. “We weren’t broad or deep personnel. “The TRU has helped us Athletes Against Childhood Cancer) Fund,
enough, both for NCI designa- double the number of cancer which supported staff, a translational
tion and for our commu- clinical trials in the past component (the tissue bank at Children’s
nity,” notes Dr. Thomas,
“I want fewer people four years, triple the num- Hospital of Wisconsin) and the develop-
who also is a professor to have their lives ber of patients and dra- ment of a database. The PCCTO now com-
of medicine (hematol- shortened by cancer, and matically improve the prises 14 individuals with the expertise
ogy/oncology). “Every number of early phase needed to run all phases of clinical trials.
department had its own
the only way we can and investigator-ini- “We took advantage of this tremendous
little shop for clinical improve this is through tiated clinical trials,” opportunity afforded by the MACC Fund
trials, and we needed to clinical research.” he says. Currently, the to expand clinical research, as we had
make a centralized office to ACCTO is running nearly excellent clinical care providers and won-
– Dr. James Thomas
bring together the people and 220 cancer clinical trials. derful patients – but no infrastructure,”
technology necessary to build a “In conjunction with the CTSI, says Michael Kelly, MD, PhD, associate
robust and all-encompassing program.” we need to continue to grow both our professor of pediatrics (hematology/on-
Following a year of planning, in Janu- faculty and our patients in order to cology) at MCW, director of the PCCTO
ary 2012 the Clinical Trials Office began support more cancer clinical trials,” Dr. and director of the Cancer Program at
using OnCore clinical trial management Thomas shares. “Trials are getting more Children’s Hospital of Wisconsin. The
software and created an educator posi- complicated, and some are not just dis- PCCTO is administered through the hos-
tion to develop standard operating pro- ease-based any more. Watson will help pital and staffed with pediatric cancer
cedures and training manuals. Today, the coordinate accessibility so we can get our specialists from the MCW Cancer Center.
MCW Cancer Center boasts more than 70 patients into clinical trials here and else- The PCCTO undertakes three different
staff members and 100 physicians who where around the country,” he says, refer- types of clinical trials: treatment trials
are actively engaged in cancer research. ring to IBM’s cognitive computer technol- (exploring whether a treatment or device
“Building the infrastructure has allowed ogy that will match cancer patients with is safe and effective for humans), registry
CLINICAL RESEARCH
PHASE 2 PHASE 3 PHASE 4
FDA APPROVAL TOTAL
Gather additional
3+ 15+
information about risks,
benefits and ideal use.
100s 1000s PHASE 5
Additional trials may be YEARS APPROVED YEARS
OF PATIENTS OF PATIENTS conducted to determine
minary data on drug efficacy Gather more information about better dosing guidelines,
who have a certain disease. safety and effectiveness, different new formulations, effects on
tinues to be evaluated and populations and dosages different populations or new
m side effects are studied. and drug interactions. indications.
Sources: US Food & Drug Administration; smrc.org
W W W.MCW.EDU 19You can also read
