Issuu

Fall/Winter 2020

Gut Health

Exploring the hidden domain of our largest immune organ, the gastrointestinal tract

GUTSY Visionary health leader Maria S. Gomez (NHSâ€™77) reflects on innovations in care p 38

FALL/WINTER 2020

Gut Health

Musings

Alumni in the Field

The Mouth and the Microbes

Why Gut? Why Now?

Harmony in the Gut-Brain Relationship

Virtual Classroom

Probiotics and the Gut

Ruesch Center Targets Gastrointestinal Cancers

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Letter from Edward B. Healton Check Up

News & Research

Covering COVID-19 On Campus Alumni Connections Reflections on Cura Personalis Maria S. Gomez (NHSâ€™77)

From the Archives: Tummy Ache Trichobezoars, or hairballs, come in all shapes and sizes. This legendary stomach-shaped one from the collection at the National Museum of Health and Medicine in Silver Spring, Maryland, was removed from a 12-year-old girl. She survived the surgery and continues to inspire others to stop chewing their hair. Photo courtesy NMHM. [AFIP 1126060],â€? (Photo ID: 100720-D-TY520-0003). Anatomical Division, National Museum of Health and Medicine.

FALL/WINTER 2020

Health and Inclusion Welcome to the inaugural issue of Georgetown Health magazine, exploring ideas from Georgetown University Medical Center’s laboratories, patient care settings, and campus virtual classrooms. Today we define “campus” in a broad new way. The global COVID-19 pandemic has invited us to blur the boundaries of the classroom, as students learn remotely, sometimes asynchronously, but still in community. Alumni know that the delivery of patient care, too, has changed dramatically, with telehealth practiced in ways we’d never imagined just a year ago. Now more than ever we are learning and practicing across divisions and specialties, across oceans and time zones, as patient care teams. In a similar spirit, we launch this twice-annual magazine. Over the years Georgetown created separate publications for nursing, dental, biomedical graduate, and medical alumni. With a unified approach, the stories that follow represent our inclusive mission, naming health as our priority. This year the Georgetown community suffers as the nation reels with the killings of Breonna Taylor and George Floyd and countless more at the hands of police. COVID-19’s disparate impact on our communities of color also serves as a reminder of the seemingly intractable challenges of health inequities. For some of us, 2020’s awakening to the brutal injustice of racist structures and behaviors is harsh and new. For many of us, the experience is personally known and at times insurmountable. The sickness of racism hurts us all. It is a health issue, at its core. All of us in the Georgetown family are called to respond, to not only shine a light on racism, but to help root it out, particularly in our space as a Medical Center. Racism impacts the experience of health for many Americans. We stand in solidarity as health professionals with the vulnerable and the oppressed, and we commit to change. Read on the following pages about the student-driven response at Georgetown University Medical Center and the establishment of the Racial Justice Committee for Change. We will continue to update our community on this work. In this edition of Georgetown Health, we look at new understandings around the gut. Find stories on research, education, service, patient care, and alumni in the field. With a more inclusive name and audience, we continue as a Catholic and Jesuit institution not only to read the signs of the times, but also to lead them. We lean into our call to practice racial justice in every aspect of our world, with a particular focus on health—for individuals and for the community. With tremendous work ahead, I can’t imagine a better place and time to begin than here and now with each of you. My gut tells me we are on a good path. Edward B. Healton, MD, MPH Executive Vice President for Health Services Executive Dean, School of Medicine

A publication for alumni and friends of the schools and programs of Georgetown University Medical Center Editor Jane Varner Malhotra

Co-Editor Chelsea Burwell (G’16)

Contributors Rhea Bhatt (G’22) Bill Cessato (C’98, G’16) Kate Colwell Martha Dee Gay Tyisha Henderson Patti North Beth N. Peshkin Irene Sanchez Brualla Camille Scarborough Karen Teber Kat Zambon

Design Director Elisa Morsch (G’20)

University Photographer Phil Humnicky

Executive Vice President for Health Sciences and Executive Dean, School of Medicine Edward B. Healton, MD, MPH

Georgetown Health is published by the Georgetown University Office of Advancement Communications. Visit online at alumni.georgetown.edu/health-magazine. The magazine welcomes inquiries, opinions, and comments from its readers. Address correspondence to healthmagazine@georgetown.edu or: Editors Georgetown Health Office of Advancement P.O. Box 571253 Washington, DC 20057-1253 For address changes contact alumni records addup@ georgetown.edu or 202-687-1994. For information on Georgetown events and alumni news on campus and around the world, visit alumni. georgetown.edu. © 2020 Georgetown University On the cover: Maria S. Gomez (NHS’77), President and CEO of Mary’s Center Community Health Organization serving the greater Washington, D.C. area.

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C HECK UP

NEWS & RESEARCH

Building Racial Justice at the Medical Center As activists across the country protested against racism and police brutality, a group of Georgetown medical students exchanged text messages about how the university should respond. One of them suggested writing an open letter to university leaders. Seventy-two hours later, more than 500 students had signed the letter, which inspired the launch of the Georgetown University Medical Center Racial Justice Committee for Change (RJCC). “The RJCC is responsible for developing specific recommendations to achieve racial equity in admissions, education and the diversity of faculty, students, and staff across schools and programs at the Georgetown University Medical Center campus, to better achieve Georgetown University’s commitment to diversity and inclusion, and to address systemic racism,” said Edward B. Healton, MD, MPH, executive vice president for health sciences and executive dean at Georgetown University School of Medicine, when charging the committee at its first meeting July 17. The RJCC Steering Committee is headed by faculty co-chairs Michelle Roett, MD (M’03), and Tamika Auguste, MD (M’00), and student co-chairs Jerome Murray (M’22) and Stephen Kane (M’21). “I think this is a tremendous opportunity for us as an institution, and feel extremely blessed that we have a leadership team that was willing to listen to our students and really pay attention to the open letter,” said Roett, professor and chair of the department of family medicine. “I think for us as faculty, to watch this level of engagement and advocacy amongst our students is really inspiring and exciting.” n n

Photo: Ranit Mishori (M’02)

Driven by Students, Supported by Staff United by their dedication to fighting institutional racism and anti-Black white supremacy, the students wrote their letter because they wanted the university to do more to address racial equity. “I think there’s been a number of people at Georgetown over the decades who have brought up issues of racial justice and equity within our institution,” said Brendan Crow (M’21), member of the RJCC subcommittee on safety and campus police relations who the students asked to speak on their behalf. “People talk about it, mostly people of color talk about it, and the response is frequently a verbal response and pledge to do better.” Using a Google doc to organize their thoughts, the group grew to include 27 students, who met nightly on Zoom to

Georgetown medical student Jennifer Gyamfi Holiday (M’22) speaks to health care providers about anti-Black racism and implicit bias in medicine before a White Coats for Black Lives protest at the White House in June.

refine their ideas and add examples of actions taken at other universities. “In meeting with our group, one thing we tried to do at the beginning of every meeting was reﬂect on the moment and the purpose and the importance of that work,” Crow said. “That mattered a lot in our work.” Crow stressed that the letter was largely based on the work of Black physicians, alumni, and students at Georgetown and beyond. “A lot of the work that we did built on the examples set by others, and it could not have been done without all of that,” he said. “In fact, we’re simply restating things that have been stated for decades.” At the first RJCC meeting, Stephen Kane (M’21), one of two student co-chairs of the RJCC steering committee, also recognized the contributions of the faculty and staff who have been working to promote racial justice at Georgetown for years. “Building upon that is going to be an honor for the FALL/WINTER 2020

CHECK UP

RJCC,” he said. “I want to be involved as an ally to create anti-racist policies and an anti-racist community here at Georgetown.”

Representing the Entire Medical Center The RJCC subcommittees will address specific areas: underrepresented minority well-being, experience, and responsiveness; safety and campus police relations; recruitment, retention, and success of underrepresented minority students and faculty; and racial justice curriculum reform. In addition to the School of Medicine, the subcommittees will address challenges that students, faculty, and staff have been working on at the School of Nursing & Health Studies, within Biomedical Graduate Education, and at Georgetown Lombardi Comprehensive Cancer Center, Healton said. “So I’m also including in the charge that you open up the lens of the work and the structure of this committee to be inclusive of a broader representation and participation in the work and the committee’s processes,” he said. “It will not dilute the work. It will enrich it.” Members of the committee were nominated by the students in consultation with leadership and were appointed by the executive vice president. They are expected to meet twice a month with their subcommittees and once a month with the entire committee. Their recommendations will be presented to the medical center leadership by December 15, while encouraging earlier input.

Working for Necessary Change The open letter has already led to changes at the Medical Center. In his letter announcing the RJCC on July 18, Healton outlined actions immediately implemented in the five weeks after the open letter was shared, including a planned workshop to review the medical school curriculum and the immediate diversifying of content for the dermatology section, the renaming of a learning society to represent more inclusivity, the diversification of portraiture across GUMC, and the addition of anti-racism prematriculation materials. Working with her classmates to write the letter was a positive experience for Mariama Jallow (M’22), student co-chair of the RJCC subcommittee on underrepresented minority well-being, experience, and responsiveness.

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“As a Black student, this process of standing in solidarity with my colleagues from various identities and backgrounds to write the open letter and the subsequent outpouring of support from faculty and staff that led to the formation of the RJCC, has been both comforting and empowering,” Jallow said. “It has felt like history in the making and I have faith that this is just the beginning of sustainable institutional change.” The desire for changes that will make Georgetown a better place for future students, faculty, and staff motivates members of the RJCC steering committee. “I’ll just say I’m here because I’m extremely invested in Georgetown University, with 21 years as a student, resident, fellow, faculty, and now a department chair,” Roett said. “Diversity, equity, inclusion, health equity, and community engagement are also important to me. And so this is one of the reasons that I wanted to be a part of this.” “Georgetown has a very dear place in my heart,” said Tamika Auguste (M’00), MD, professor of obstetrics and gynecology at Georgetown and faculty co-chair of the RJCC steering committee. “I truly feel a duty and responsibility to work together to make the situation better. Twenty-five years ago, when I was a GEMS student, we were talking about these same issues. So we have work to do. We will get the work done.” “I was also a GEMS student,” said Jerome Murray (M’22), student co-chair of the RJCC steering committee. “The reason I’m invested and involved in this is, as a current student, current Black student, having been mentored by Black students and Black faculty that have gone through Georgetown and mentoring other Black students hopeful to come to Georgetown, I think there’s just been a need that’s been identified. And I’m hopeful that I can bring something to the table to bring some of that necessary change.” n

For more information about the launch of the RJCC, check out the premiere episode of our new podcast, The Reservoir, and visit gumc.georgetown.edu/racial-justice-committeefor-change.

Georgetown Students and Fauci Explore Pandemic Policy In July, Georgetown students engaged in a live virtual conversation with Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health and a member of the White House Coronavirus Task Force. The renowned researcher offered an update on the COVID-19 pandemic and its implications for public policy. More than 135,000 people tuned in to the event, co-sponsored by Georgetown’s Global Health Initiative, the Kalmanovitz Initiative on Labor and the Working Poor, the Institute of Politics and Public Service at the McCourt School of Public Policy (GU Politics), and the O’Neill Institute for National and Global Health Law. “This is a pandemic of historic proportions,” said Fauci. “When history looks back The Jesuit-educated physician and immunologist engaged with students and faculty in a virtual seminar this summer, noting that thoughtful and informed decision-making will be key in combating the spread of on it, it will be comparable to what we saw the coronavirus in the months ahead. in 1918.” Health Law LLM student Alanoud AlsuIn response to a question from Claire Cushman (C’22) laiman (L’21) opened the session, which featured moderators about the pandemic’s disproportionate impact on poor comJohn Monahan (C’83, L’87) of Georgetown’s Global Health munities and communities of color, Fauci said that one thing Initiative and GU Politics’ Mo Elleithee (SFS’94). In her the federal government can do now is concentrate resources to introductory remarks, Alsulaiman pointed to the unique risks increase access to testing and health care in the communities and responsibilities students and youth bear in mitigating the most affected. spread of COVID-19. The ensuing discussion covered the curIn the long term, Fauci said it requires a decade-long comrent state of the pandemic, vaccine development, protecting mitment to address and eliminate health disparities. vulnerable populations, and more. Fauci explained that if a person is infected and recovers, it When asked how citizens could find reliable information is likely that the immune system eliminates the virus, but no about the virus, Fauci urged viewers to turn to trusted scientists. one knows how long that immunity will last. Studies are under“For the most part, you can trust respected medical authoriway to examine whether getting the infection a second time ties. I believe I am one of them,” said Fauci, a graduate of Jesucould lead to enhanced or worse symptoms, he added. it schools. “I would stick with respected medical authorities “No vaccine is going to be 100 percent protective,” said Fauci who have a track record of telling the truth, who have a track in response to a question about the specific timeline for vaccine record of giving information and policy and recommendations development and wide distribution. The hope, he explained, based on scientific evidence and good data.” is that with a combination of people already exposed and a Fauci said that while young people may be tempted to vaccine that is anywhere from 70– 75 percent effective, there ignore guidelines because they may have lower chances of getwill be enough herd immunity to reduce people’s worry ting infected than vulnerable populations, that line of thinking about becoming infected. n is what spreads the pandemic and “is part of the problem and not the solution.” “Think about your societal responsibility,” Fauci said. “We Watch the full discussion here. are all in this together. Everybody has a place and role in getting this outbreak under control.” n n

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CHECK UP

Children Use Both Brain Hemispheres for Language Young children have a superpower, of sorts, say Georgetown University Medical Center neuroscientists. Whereas adults process most discrete neural tasks in specific areas in one or the other of their brain’s two hemispheres, kids use both the right and left hemispheres to do the same task. The finding suggests a possible reason why children appear to recover from neural injury more easily than adults. Published in PNAS in September, the study looks at language using functional magnetic resonance imaging (fMRI). To process spoken sentences, young children use both hemispheres. This finding fits with previous and ongoing research led by n n

Georgetown neurology professor Elissa L. Newport, PhD, former postdoctoral fellow Olumide Olulade, MD, PhD, and neurology assistant professor Anna Greenwald, PhD. “This is very good news for young children who experience a neural injury,” says Newport, director of the Center for Brain Plasticity and Recovery, a joint enterprise of Georgetown University and MedStar National Rehabilitation Network. “Use of both hemispheres provides a mechanism to compensate after a neural injury. For example, if the left hemisphere is damaged from a perinatal stroke—one that occurs right after birth—a child will learn language

using the right hemisphere. A child born with cerebral palsy that damages only one hemisphere can develop needed cognitive abilities in the other hemisphere. Our study demonstrates how that is possible.” It solves a mystery that has puzzled clinicians and neuroscientists for a long time, says Newport. In almost all adults, sentence processing is possible only in the left hemisphere, according to both brain scanning research and clinical findings of language loss in patients who suffered a left hemisphere stroke. But in very young children, damage to either hemisphere is unlikely to result in language deficits; language can

be recovered in many patients even if the left hemisphere is severely damaged. These facts suggest that language is distributed to both hemispheres early in life, Newport says. Now, analyzed in a more complex way, the researchers have shown that the adult lateralization pattern is not established in young children, and that both hemispheres participate in language during early development. Brain networks that localize specific tasks to one or the other hemisphere start during childhood but are not complete until a child is about 10 or 11, she says. “We now have a better platform upon which to understand brain injury and recovery.” n

“The United States needs a formal inquiry into our public health catastrophe.” — Ranit Mishori (M’02), The BMJ, August 5

Image: Elisa Morsch

An investigation by an independent body of experts, with public hearings, would produce a blueprint for preventing a similar outcome in the future, shed light on the political determinants of health, and offer tribute to the vulnerable whose lives were lost to COVID-19, said the professor of family medicine and Georgetown’s new Interim Chief Public Health Ofﬁcer.

Under Study: Addiction n n Georgetown is launching a new Master of Science in Addiction Policy and Practice. Students in the program will develop an understanding of addiction science, treatment, health care financing, data analysis and statistics, and addiction policy. “This program seeks to build the next generation of leaders in addiction policy to develop a science and evidence-based approach to addiction, one of the most untreated chronic health conditions in the United States,” explains Regina LaBelle, JD, director of the program. LaBelle is currently with The O’Neill Institute at Georgetown University Law Center and served as chief of staff and senior policy advisor in the White House Office of National Drug Control Policy during the Obama Administration. “For too long, addiction policy in this country has been based on stigma, or preconceived notions about what causes addiction,” says LaBelle. “This course of study is intended to change that and build a future where we recognize that addiction is a chronic, preventable, and treatable condition.”

The full-time, one-year interdisciplinary program offers a comprehensive view of substance use disorders and addiction, including public health and criminal justice policy, basic science, and evidence-based medicine. The first cohort of students will begin in July 2021. n

Visit addictionpolicy.georgetown.edu.

Save the Parasites? Pinworms, head lice, and leeches, oh my! Have the little critters gotten a bum rap? For generations, Western society has sought to reduce the debilitating impact of parasites in human and animal health. Should we embrace them as part of our rich biodiverse family? How much do we even understand their role? Colin Carlson, PhD, assistant research professor with the Center for Global Health Science & Security at Georgetown, joined a team of scientists

Bottom photo: iStock

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from multiple countries and institutions to call for conservation of the largely unclassified varieties of parasite species. The working group suggests that parasites are the hidden heroes of ecosystem stability, wildlife population control, and nutrient cycling. Parasites are threatened not only by the changing climate or habitat loss, but also by extinctions of their hosts, making them highly vulnerable to extinction. A recent study estimated that one in every three parasite species

might be at risk of extinction in the next 50 years. Yet it is estimated that less than 10 percent of parasites have been adequately described or even named by the science community, a number that the group proposes to bring up to 50 percent in their global parasite conservation effort. The plan appeared August 1, 2020, in a Biological Conservation special issue: “Parasite Conservation in a Changing World.” The plan outlines 12 goals focused on data collection and

synthesis, risk assessment and prioritization, conservation practice, outreach, and education. Developing an inventory of the world’s diverse community of parasites is an important first step. n

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COVERING COVID-19

Medical Practices Face Challenges and Change

A Sudden Halt “Up until a few months ago, we’d been flying,” he says of the thriving practice. “Then the virus came, and the brakes hit. All the fears, anxieties—people didn’t want to go anywhere near a medical facility.” Across the country, private practices like his are feeling the economic impact of the COVID-19 pandemic.

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Pediatrician Frank Giancola sees some patients using teleheath, with assistance from his grandson Jonathan.

“In 30 years as a pediatrician, I can honestly say I have never seen anything else alter the course of medical care in such an encompassing manner, and with such remarkable speed,” says Giancola. “Many of our patient’s parents are essential workers without childcare flexibility or work-from-home options. They work behind-the-scenes in restaurants, as home and office cleaners, as health

aides—they can’t miss a beat. They have to provide for the family. There’s no luxury of working from home or homeschooling their kids,” he notes. “Fortunately, they’re bringing the kids in for all their health checks.” With schools and daycare centers closed, childcare became a challenge even for his own nursing staff, he adds. “Many are in their 20s and 30s, and they have to

Photo: Michelle Giancola

hen the COVID-19 pandemic brought his private pediatrics practice to a sudden halt in March, Frank Giancola (C’82, M’86, R’89) had to innovate or sink. “I’m not a big fan of change,” he admits. “I have to be a little bit forced. But I surprised myself with how fast business-wise we adapted.” In less than two weeks, they restructured the practice to use telehealth for many concerns, and scheduled all in-person well visits for the mornings. “After all the well checkups and the non-ill appointments are completed, we close and clean, and then in the late afternoons only see patients who are potentially infectious, and those are now very few in number,” said Giancola in July. He co-founded the PediatriCare practice in Manassas, Virginia, in 1996, when the area was a sleepy semi-rural outpost of the Washington metro area. Today the practice has two locations and employs 50 people, including 18 nurses, seven pediatricians, three nurse practitioners, and about 20 in reception, administration, and billing. Many team members are bilingual. The group serves an economically diverse population in booming, semi-urban western Fairfax and northern Prince William counties, including many Latinx families.

adapt for childcare. Many are enlisting the help of grandparents or great grandparents so they can continue to come to work.” Medical practices operate like small businesses, and the customer base is shrinking as in most every other sector. For safety, people are avoiding in-person contact, and even more so in spaces that serve the sick. COVID-19 is putting private practices in financial risk. Giancola’s team is making it work, but it hasn’t been easy.

Liquidity and Innovation How can small and mid-sized medical practices weather the storm? Georgetown McDonough School of Business finance professor Rohan Williamson, MBA, PhD, says cash holdings are key. “Whether we’re talking about large corporations or small businesses, good financial ﬂexibility helps us adapt,” he says. It’s not unusual for medium and small medical practices to struggle with this, he adds, because staff is typically focusing on the core business of patient care, not on expanding the organization’s liquidity. “Even post-COVID, lost revenue could be a persistent issue. Continue to invest in technology that supports telemedicine, for example, so that the practice can evolve,” he suggests. “As in all industries, look forward to lead the change.” One sector in the health field is doing well, for now. “Across the board, insurance companies are very profitable in this situation,” Williamson notes. Regular office visit claims have dropped, as have elective procedures, and even the cost of COVID-19 care is low compared to the number of cases, since most do not require hospitalization. Insurers are well positioned financially to manage through the epidemic, at least for now, according to a July report from Georgetown’s Center on Health Insurance Reforms, based on interviews with executives at 25 health insurance plans

in May and June. The industry went into the crisis on solid financial ground, and has continued to fiscally strengthen during the pandemic. Costs related to the testing and treatment for the coronavirus have not been as high as expected. In addition, insurers saw dramatically decreased utilization since March, while individuals and employers continued to pay premiums at pre-pandemic rates, leaving insurers in strong financial shape. “For business reasons, insurers are doing what they can to help providers and consumers,” says Kevin Lucia, JD, MHP, research professor with Georgetown’s McCourt School of Public Policy and lead author of the report. “They are concerned that many providers are vulnerable to the financial impact of COVID-19.” The report indicates that small and mid-sized practices like Giancola’s may further consolidate as a result. To support the providers, many insurance companies are offering bridge funding and loans to complement federal support for medical practices, says Lucia. Back in Northern Virginia, Giancola’s team continues to innovate so that patients and staff are safe and cared for. “The virus has upended how we are delivering medicine,” he says. Reception staff call parents to make sure well care is maintained and to schedule as many appointments in advance as possible, he says. And nurses are increasing the volume of triage to ensure hesitant parents are seeking care when it is necessary, he adds. “We use telehealth for rashes, things like that, and medication follow-up for conditions like ADD. But we won’t do well care through telehealth. In a pediatric practice, we have to do vaccinations, and measure growth, which require hands-on care. And for things like ear infections, or strep, they must come in.”

Finding the Music

mentor for developing his love of science. Ellen Henderson, who passed away in February 2020, focused on studying slime mold when he was her student. “She laid a lot of groundwork for research in cell cultures,” Giancola recalls. “We were freezing and thawing things to see how cells lived through it—it was all very new, and of course we didn’t have a fraction of the techniques we have now. But she took me under her wing, and we published a paper together. It was exciting to be part of something developing.” Giancola grew up in Jersey City, New Jersey, the grandson of immigrants. His parents prioritized their children’s education. He went to the Jesuit, tuition-free Regis High School in Manhattan and came to Georgetown in 1978. “I love the Jesuit mindset, the educational experience, the service-oriented activism, and the God-centered teaching,” he says. Being at Georgetown through the 1980s during the AIDS epidemic prepared him uniquely for today’s uncertainty. “We faced that same search for what’s true. We were shown how to approach patients who have questions about the disease process, how to best make people comfortable with information, and help people feel comfortable simply coming into the office.” Though the times were challenging, Giancola’s medical school years marked an important chapter in his life. “The four years of medical school were probably the best years of my life. I had reached what I wanted to do. And I finally got to a place where you didn’t have to take calculus or physics or philosophy!” he laughs. Working with kids was a natural for this new grandfather. “I went through the different rotations. Psychiatry was not for me—you come home every night wondering what’s wrong with you! But when I walked onto the pediatric ward, I swear I heard music. I knew this is what I was meant to do.” n

A triple Hoya, Giancola credits his Georgetown biology professor and

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G e o r g e t o w n H e al th

Gut Health ILLUSTRATION BY ELISA MORSCH (G’20)

Gut, be my guide I don’t think I ever recall not being nervous as a child. Incredibly shy and mild-mannered, I wouldn’t even eat in public or play with relatives my age, and this unusual behavior definitely worried my mom. Chalk it up to my introverted nature or lackluster charisma, but when attention would turn to me, the visceral signs would kick into overdrive: warmth behind my ears, prickly heat sensations on my back and underarms, and a rumbling in my gut. In those anxiety-inducing moments, my gut ping-ponged between two states: butterflies and knots, especially when I was the center of attention, whether for good or bad reasons. Butterflies were like giddy vibrations that came after acing a pop quiz or receiving praise from a supportive teacher, but knots nearly turned me to stone and were immediately followed by hot palms and the sting of tears to come. I was the epitome of a hot mess. Fast-forward to my 20s when I garnered advice from the important women in my life, who advised me to trust my intuition, my inner voice, my gut. But honestly, I didn’t even know what that meant. Where and what was this gut I was supposed to turn to when faced with a big decision? Writing this now, the answer is clear. After yet another month of living in a pandemic world, another year of raising a little Black boy in America, and another life season of making difficult decisions for my own growth, I see I’ve been letting my gut lead the way. Through self-reflection and research, I’ve learned the gut is just as spiritual and ethereal as it is scientific and actual. I’d even assert the gut should be trusted with just as much certainty as your head and heart. From pesky acne and lethargy to chronic disease, manifested symptoms can signal us to the condition of our gut and offer us answers to our deepest health questions. In this issue of Georgetown Health magazine, readers will meet experts in this field who delve into the wonders of gastro health and share why the gut is key to wellness, particularly for underserved populations, cancer survivors, and all who are looking for ways to boost immunity in the time of COVID-19. Plus, our featured faculty and alumni examine the gut’s close relationship with the brain, oral health, and why it’s best to turn back to basics for gut-healthy diets and lifestyles. As obscure and figurative as the gut seems to be in reference, that’s what makes it so amazing. It embraces diverse microbiomes and flourishes accordingly when given some probiotic TLC. It is transcendent and clairvoyant, reading the body’s state of well-being, even before physical symptoms manifest. The gut truly knows what it’s doing. So, whether butterflies or knots, consider giving your gut more credit and taking heed of this sixth-sensory organ. Take care and be well. Chelsea Burwell (G’16) Co-editor

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GUT HEALTH

Image: The University of Liverpool

start here

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The Mouth and the Microbes By Jane Varner Malhotra

Not many people go through life without lifestyle changes, here else to begin a discussion of the gut than the gateway? Besides the place where food gets chewed, especially in today’s world. What can our microbiome reveal about our past and what lies ahead? and words get spewed, the oral cavity hosts its own “A lot of researchers are starting to believe that changes unique, complex microbiome that scientists are just beginning to gut microbiome associated with lifestyle—such as diet and to understand. A dark, moist environment, it is a moving landexercise—might be involved in development of low grade scape of varying soft and hard surfaces like the fleshy insides inflammation and metabolic diseases like diabetes and high of the cheek, the teeth, tongue, and gums. The mouth offers a blood pressure in the future,” says Dash. But before we get too large, visible membrane that acts like a window pane into a far down the esophagus, let’s back up a bit. person’s overall health. A healthy mouth flora is complex. Most humans have several hundred species of bacteria inside the mouth, in addition Reaching Out to Local Communities to other microorganisms including viruses and fungi. A diverse In 2016, Dash and his colleagues launched a study focusing collection of bacteria in the mouth seems to correlate with good on oral health among medically underserved populations in overall health. When our health declines, so does this diversity. Washington, D.C. The project, supported by a grant from “In conditions like type 2 diabetes, obesity, and metabolic the George E. Richmond Foundation, is led by Lucile Adamssyndrome, we have evidence that there are changes in microbiCampbell, senior associate dean for community outreach ome composition and diversity,” says Chiranjeev Dash, associand engagement, and professor of oncology at Georgetown ate professor of oncology and assistant director at Georgetown’s Lombardi Comprehensive Cancer Center. Office of Minority Health and Health Disparities Research. Located in the ever-evolving Navy Yard community in What’s the connection? Is it that when we’re sick, our tiny Southeast Washington, the Office of Minority Health’s organisms die off? Or do we get sick because for some reason faculty and staff have focused on reducing health dispariour microorganisms are depleted or less diverse? ties and improving health outcomes for residents within the “We don’t know what’s causal here,” Dash notes. “We do metro area, including the 4.1 million residents of the District, know that the gut, oral, and lung microbiomes develop at a Prince George’s, Montgomery, Arlington, and Fairfax counvery early age, and that during our lives a person’s microbiome ties, and the city of Alexandria. To accomplish these goals, doesn’t change much—unless there’s a radical change in enviAdams-Campbell and her colleagues have diligently engaged ronment or diet, which can happen with migration, for example, community members, offered educational outreach opportunior when a person develops cancer or chronic disease, or makes ties, and conducted research to determine effective health a major change in lifestyle. While there’s a large variability in interventions. microbiome diversity from one person to the next, if the envi“A lot of research was already being done on the gut microbironment and lifestyle remain unchanged, an individual’s micro- ome, so we focused on the oral microbiome,” says Dash. biome remains remarkably constant.”

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GUT HEALTH

The nation’s capital has some troubling oral health disparities, particularly among African American males living in lowincome communities, who experience higher rates of periodontal (gum) disease and missing teeth. African American men are also more likely to present with later stages of oral cancer, and have worse outcomes compared to other races. Using salivary samples collected from more than 250 volunteers, the team at Georgetown’s Office of Minority Health is aiming to characterize an oral microbiome profile for the community. By looking at the composition and diversity of organisms and comparing it to data from around the country, the scientists hope to better understand potential links to cancer, diabetes, cardiovascular disease, and poor nutrition. “Your diet has a large influence on your microbiome, but what you get from your diet also depends on the microbes in your gut,” Dash says. Good nutrition is not as simple as eating healthy foods. The existing microbial environment in the body impacts what nutrients we can harness from whatever we eat. In addition to poor nutrition, smoking and excessive alcohol play a negative role in oral health, as does a lack of exercise. Physical activity has benefits beyond weight loss, Dash asserts, as seen from research the team conducted among African American women at high risk for breast cancer. Although they didn’t always see a change in weight, women in the aerobic exercise group significantly reduced their metabolic risk facRetired D.C. dentist Salvatore Selvaggio, DDS (D’79), helps educate the tors for cancer within six months, compared to the group that community about oral health care, immunity, and aging. did not exercise. oral bacteria overgrow, causing bleeding gums that pull away “We have enough evidence to show that physical activity has numerous benefits on health, but its effects on the oral microbi- from teeth, breaking the normal seal and exposing a pathway to the bloodstream—essentially creating an open wound. ome are not well known,” says Dash. In the future, he hopes to “Then cytokines—chemical messengers—get unleashed and study how exercise might affect the oral microbiome. can cause inflammation throughout the body,” he says. “Mouth bacteria don’t normally make it to the gut, because even though Dentistry and Oral Health you swallow them, they get destroyed by the stomach acids. But Early training as a research immunologist led Georgetown densome can survive past the stomach and get into the intestines, tal alum Salvatore Selvaggio (D’79) on a continuous path to where they don’t belong. This can cause changes to the barrier understand connections between oral and whole-person health. cells lining them, causing ‘leaky gut.’ Alterations in barrier For 34 years he operated a thriving practice in D.C., and after permeability can contribute to bowel inflammation and other retiring in 2014, continues to support oral health in the commuproblematic outcomes.” nity as a member of the District of Columbia Dental Society He notes that taking antacids can contribute to this problem, Foundation, offering lectures for Certified Nursing Assistant especially when people overuse them, because it weakens the students and in-home health care workers on the importance of stomach’s power to kill off bacteria, letting more sneak by and oral care for the older population. disturb the intestinal lining. “When a person develops periodontal disease—gum disease At his dental practice, Selvaggio noticed a shocking decline —the normal mouth bacteria get off balance,” Selvaggio says. in oral health among aging patients who moved into long-term Imbalance in the microbiome is known as dysbiosis. Abnormal care facilities.

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Martha’s Minute Kids of all ages learn about health with Martha Gay, PhD

“When people get into their older years, poor oral health can have serious consequences on their general health,” he says. As Selvaggio explains, dry mouth from taking multiple medications, or a decreased swallowing reﬂex, can cause bits of food covered with disease-promoting microbes to enter the lungs, resulting in aspiration pneumonia. “Since our immune systems are less active as we age, the resulting hospitalizations and death are a major problem for residents of long-term care facilities.” Numerous studies have shown that by simply teeth brushing better, these dangerous outcomes can be reduced. A host of other medical conditions have been linked to poor oral hygiene, such as diabetes and coronary artery disease. “When people get pneumonia or viral infections, a lot of the mortality and morbidity comes from bacterial superinfections,” says Dash. “These are superimposed on top of a viral infection. We see a known association between periodontal disease and these bacterial superinfections.” Periodontal disease can easily move from the mouth to the lungs because the pharynx and the larynx share a lot of the same territory and microbiome. Current research indicates that unhealthy respiratory systems may increase susceptibility to COVID-19, and the oral ﬂora play a part in this dance.

Many children and adolescents are all too familiar with messaging from parents, pediatricians, and media alike that urges them to integrate raw, fresh foods into their diet. But their understanding as to why vibrant produce and dark leafy roughage are the body’s best friends for reparative function and immunity may not be crystal clear. Enter Martha Gay, PhD, science communications fellow for Georgetown Health magazine and Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS) Postdoctoral Research Fellow. An expert in the fields of gastroenterology and hepatology, Gay invites kids to the laboratory to understand the function of the liver and its importance in overall health. This three-part series features one-minute videos to highlight the liver in all of its key player glory, and provides young viewers with a fun explanation of one of the body’s most underrated yet essential organs. Check out the first Martha’s Minute video about the liver here.

The Value of Spit A healthy, watery mouth is protective against infection, in addition to helping with taste, digestion, and swallowing. Both Dash and Selvaggio expressed concern for cancer patients who undergo treatments that cause loss of saliva, resulting in a steep decline in oral health. “We need our spit,” says the dentist. “I remember one patient who had radiation for neck cancer, but it killed off all his salivary glands. It was terrible.” The team at the Office of Minority Health continues to search for answers on how the oral microbiome develops, especially around lifestyle, social determinants of health, and chronic disease. With the COVID-19 pandemic’s emergence and the devastation in communities of color, we know more than ever how critical immunology and virology are to community health. n

Photo: Paul Jones

Chelsea Burwell contributed to this story.

FALL/WINTER 2020

Images: iStock

GUT HEALTH

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Harmony in the Gut-Brain Relationship By Irene Sanchez-Brualla and Jane Varner Malhotra ILLUSTRATION BY ELISA MORSCH (G’20)

hen we walk into a concert, or a roomful of laughing friends, or onto a bus packed with solemn strangers, or stroll alone in the forest— we experience internal, bodily sensations that are difficult to describe with words. We feel good energy, a sense of despair, a calming quiet, an unsettled awareness. When we are paying attention we can “read the room.” We have a gut feeling about the situation—but what does that really mean? Does the gut actively feel things? What’s the role of the brain in processing and responding to that data? For basic digestion, the gut depends on the brain to transmit signals that move a bite of sandwich down the pipe—gastric motility—and take out the needed nutrients. But now scientists are beginning to understand the reciprocal role—how the gastrointestinal tract communicates back to the brain. “I used to think of the gut as an organ of nutrition,” says Michael Zasloff, MD, PhD, professor of surgery and pediatrics at Georgetown University School of Medicine. “But I have begun to think of it in a very different, important way: the gut is a massive sensory organ.” Zasloff, who is also the codirector of the Center for Translational Transplant Medicine at Georgetown University Medical Center and scientific director of the MedStar Georgetown Transplant Institute, studies the gut-brain axis. In fact, the inside lining of the intestinal tube forms a protective barrier not unlike our skin. When we swallow something, the intestinal tract filters some microbes out, and takes others in, through a membrane that repeatedly “touches” what we consume. What is inside our intestines is technically outside the body, drawing comparisons to the human form as donut, with one long hole through the middle.

So how is the gut mechanically interacting with this sensory data? Research teams at Georgetown are seeking answers, unraveling the mysteries of the exquisitely intimate relationship between the brain and the gut.

The Gut in Motion After completing her formal training as a scientist, Lorenza Bellusci, PhD, became interested in the nervous system and in particular its connection to the gut. As is often the case, the curiosity stemmed from a personal experience. She had been diagnosed with a rare immunological disease, cyclic neutropenia, and the most prominent symptoms it produces are digestive issues. Intrigued by the groundbreaking research of Georgetown neuroscientists Stefano Vicini, PhD, and Niaz Sahibzada, PhD, in the department of pharmacology and physiology, she contacted them and joined the team. Her focus is on studying exactly how the nervous system controls the movement of food through the body. “Basically, everything is controlled by the nervous system,” Bellusci says, “starting from the moment when you eat, to the moment you start digesting, to how the food moves in your esophagus, in your stomach. What I work on is the contraction of the muscles—how the nervous system can control different muscles and different movements at the same time.” Out of a massive and complex brain-gut axis, Bellusci studies a very specific, small area of the hindbrain, the Nucleus of Tractus Solitarius (NTS) and the dorsal motor nucleus of the vagus nerve. The nerve fiber bundles control gastric motility including functions like the gag reflex. She conducts her research using optogenetics, activating the neurons in live mice using light. The approach allows her to

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GUT HEALTH

target the specific area and observe the organs in operation. “By exciting specifically one group of nerves in that area, I am able to control the changes in the contraction of the gastric muscles,” she explains.

What Happens in Vagus… Bellusci and her team are trying to unravel the circuitry of these areas that control gastric motility. The vagus nerve plays a key role, connecting the gut, heart, lungs and other organs to the brainstem. Sometimes referred to as a neural superhighway, the long nerve arises from the brainstem, reaches the gut, and provides it with input to control its movements, but it also detects the sensations of the gut and transmits them to the brain. In other words, the vagus nerve is not a one-way street. Not much is known about the interneurons that are connected at the end of the vagus nerve. This is where Bellusci hopes to uncover some answers, by looking at the role of neurotransmitter gamma-amino butyric acid (GABA). “What we are interested in is particularly the effect of the GABA signaling. And that’s why I am working on two different particular interneurons, the somatostatin and the neuropeptide Y neurons.” Her research on gastric motility will have multiple applications for a host of common gut ailments, including diabetes, and others not typically considered GI disease, such as Parkinson’s. “What we’re learning is important from different points of view. If you know how does it work, not only the ending part of the vagus nerve, but even the interneurons that are involved in the circuitry, it helps understand several diseases. There are many pathologies correlated to the gastrointestinal tract, such as reﬂux, and they have so many different symptoms. It can really affect people’s lives,” says Bellusci. For health providers, diagnosing diseases affecting the gut is complicated. But, as Bellusci points out, research connecting the brain and gut disease is relatively new. “Everything published in this field is from the last 20 years,” she notes. Understanding the correlation between the gut and brain, and the specific functions of the connecting neurons, poses an immense challenge, but one worth pursuing.

Gut and Parkinson’s Disease Another Georgetown scientist investigating the brain-gut connection is Michael Zasloff, MD, PhD, professor of surgery and pediatrics at Georgetown University School of Medicine, co-director of the Center for Translational Transplant Medicine at GUMC, and scientific director of the MedStar Georgetown Transplant Institute.

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“There are many pathologies correlated to the gastrointestinal tract, such as reﬂux, and they have so many different symptoms. It can really affect people’s lives.” -Lorenza Bellusci, PhD Like Bellusci, Zasloff did not start his research career working on the brain. He studied innate immunity for many years and described for the first time antimicrobial peptides in vertebrates. He became interested in the role of enteric nerve cells— those of the gut. He wondered how they defend the organism from infection, and what is the effect of their malfunction on the brain. “Why aren’t they inﬂamed all the time? How is it that these enteric nerves are able to live in harmony with bacteria?” he says. Zasloff ’s interest in the gut-brain axis started about 10 years ago, when a relative of his was diagnosed with Parkinson’s disease. The symptoms of this disease appear to result from the death of dopamine-producing neurons from the brain’s substantia nigra. This may be linked to the toxic accumulation of aggregates of a protein called alpha-synuclein (αS). The reason why these neurons die is not yet understood. However, in the last decade, pathologists all over the world found some clues along the enteric nervous system (ENS)— the neural network of the gastrointestinal tract. In patients with advanced Parkinson’s disease, tangled deposits of αS accumulate in the enteric nerve cells of the gut and travel up the vagus nerve to where it meets the brainstem. But in later, more advanced stages of the disease, scientists found the αS aggregates further along, into the more cranial portions of the brain. This led scientists to wonder: Could the neurodegenerative disease of Parkinson’s begins in the gut? Zasloff wanted to find out if αS production increases with gut infection. With a structure similar to antimicrobial peptides which emerge to fight infection, αS might accumulate in the gut as a consequence of abnormal interactions with viruses or even bacteria. From the gut, it would then be trafficked up the vagus nerves to the brain. So Zasloff and his team started a simple study, in collaboration with the Transplant Institute at Georgetown and the NIH, to determine what the role of αS was in a healthy framework of non-Parkinsonian patients: kids. The colleagues studied biobank samples from children who had received intestinal transplants and who had documented

Harmony in the Gut

“I used to see the gut as an organ of nutrition. Now to me the gut is a massive sensory organ.” -Michael Zasloff, MD, PhD cases of Norovirus infection—a common occurrence among immunosuppressed transplant recipients. Would αS be found in the gastrointestinal tract when the children developed an acute Norovirus infection? Studying serial biopsies taken over time as part of the regular follow-up of these patients, the scientists found that the kids did not have αS before the norovirus expression. During the Norovirus expression, however, they recorded the emergence of αS, which frequently persisted for months afterwards, inferring prolonged protection on the nerve. “With my colleagues at NIH, we were able to go on and show that αS was a potent chemokine—a full-blown component of the immune system.” The findings suggest that αS, as part of the immune system, may be part of how the human body manages infection. It’s also possible that people with Parkinson’s develop the disease as a consequence of viral infections of the GI tract during childhood or early adulthood.

The discovery has changed profoundly the way that Zasloff thinks about the gut. “I used to see the gut as an organ of nutrition,” says Zasloff. “Now to me the gut is a massive sensory organ. Massive. And it obviously must provide the brain with an enormous amount of information—about ﬂuid, temperature, nutrients, numbers of immune cells, and so on. The brain hears this “music” on a regular basis. It hears the music during the morning, when it expects food. It goes into a nocturnal state at night, as the central organs cool. If the gut is not working properly, it may cause conditions when the music that the brain listens to isn’t right.” Interpreting what enters, reading the molecules like notes in a song, perhaps the gut is like an orchestra of multiple, finely tuned instruments playing in harmony. With the inside lining of the gastrointestinal tract an extension of our skin, we compose the music by touching what we eat, all along the pathway from start to finish. “Now the brain and the gut relationship is no different in my mind than the brain and the eye, the brain and the ears, the brain and the nose.” The gut as one incredible sensory organ? With increasing scientific evidence that backs up his gut feeling, Zasloff says yes. n Zasloff is the Founder and Chief Scientific Ofﬁcer of Enterin, Inc.

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Probiotics and the Gut By Jane Varner Malhotra

A Hot Commodity “We teamed up with Penn State because they’re a land-grant university, so they have cows and their own dairy,” says Dan Merenstein, MD, family medicine professor at Georgetown and lead investigator in the study. “They make us probiotic yogurt. And we give them poop.” Not just another pile of fecal matter coming out of the nation’s capital. This set of samples came from children who were administered antibiotics. Because antibiotics strip the body of both bad and good bacteria, probiotics like those naturally occurring in yogurt and fermented foods may restore the healthy balance of ﬂora in the body. Up to 30 percent of people develop mild to severe diarrhea while taking antibiotics. While previous studies have found that probiotics can help prevent it, questions remain about which strains are most effective, how they work, and if a certain strain is more effective when taking a particular antibiotic. Not all beneficial bacteria can survive the stomach’s acidity, but BB-12 is known to have that capability, explains Merenstein. The strain has also been found to help with chronic constipation by improving transit time, reducing bloating, and boosting immune function. Today the collaboration includes University of Maryland, another site where scientists analyze Georgetown-provided fecal matter. They look at the genetic makeup of bacteria found in children’s stools during and after treatment to see which types are present and how they change over time.

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Merenstein, who is also a professor of human science in the School of Nursing & Health Studies, tapped students for an important role in the clinical research, helping recruit families for the study,” notes Merenstein. “Georgetown undergraduate students are working in doctors offices, and talking to parents and physicians about our study.”

TURNPIKE

Antibiotics and Immunity Overuse of antibiotics in the U.S. continues to be a problem, said Merenstein, whose lab has been studying probiotics and the gut microbiome since 2005. Keeping a balanced bacterial community in the body can impact not just gut health but overall disease prevention, because the gastrointestinal tract is home to most of the human immune function. “The main problem of overuse of antibiotics is that it makes you susceptible to so many other things,” he says. Last year, Merenstein and his colleagues set out to better understand how probiotics work. The researchers tracked changes in the gut microbiome of 60 adults on antibiotics over a course of 30 days. One-third were given regular yogurt to take with their meds, and two-thirds were given a probioticinfused yogurt to take. Use of antibiotics appears to disrupt the production of short-chain fatty acids (SCFAs), which are the preferred food of gut bacteria. SCFAs are found in high-fiber foods and fermented foods, and play a big role in metabolism. A deficiency in SCFAs correlates to dysbiosis, an imbalance of gut ﬂora that may be linked to colon cancer and obesity. Fecal samples hold the key, because they offer a snapshot of how the microbiome is doing.

Illustration: Carolyn Zimmerman (G’18)

The swap took place every month in Breezewood, a truckstop town halfway between Washington, D.C., and Pittsburgh, Pennsylvania. Georgetown scientists would drive two hours with the goods, carefully stored in red picnic coolers. They’d pull into the parking lot and up to the waiting vehicle from Penn State, which held precious cargo: a fresh batch of strawberry yogurt infused with an added active bacteria known as Bifidobacterium lactis strain BB-12. What Georgetown offered in return might surprise you.

PENNA

Babies and Gut Health Renowned Probiotics and Sepsis Researcher Joins Georgetown

Last year pediatrician Pinaki Panigrahi, MD, PhD, came on-board to lead international microbiome research at Georgetown University Medical Center. His work focuses on gut microbiota in newborns, and the use of probiotics against deadly sepsis and necrotizing enterocolitis (NEC) in preterm infants. Early results from the study showed that participants who were on a regular course of antibiotics took a hit to the microbiome that lasted 30 days. Those taking the probiotic along with the antibiotics maintained their normal level of short-chain fatty acids throughout the month of observation. “The probiotic we’re giving seems to protect the GI tract,” says Merenstein.

Photo courtesy of Asian Institute of Public Health

Watch This Space Merenstein plans more studies to look at specifics—when is the best time to take the probiotics, should they be taken simultaneously with the antibiotics or spaced out. As is often the case, one question leads to a thousand more. What does it mean to ingest live cultures? What can fermentation teach us about human health? A glance at the global human diet indicates some historic preference for consuming foods like yogurt, kimchi, and sourdough breads. Every country and culture has its favorite pickle, and some reports suggest a craving can even develop in vitro! Pinaki Panigrahi, MD, pediatrician and director of international microbiome research at Georgetown, is studying the link between sepsis prevention and yogurt consumption in rural India. Look for more on his work in the near future as gut microbiome exploration and insights continue to multiply. “Gut health is such a big part of our overall health,” says Merenstein. “It’s not just about having diarrhea or constipation, but it’s connected to our respiratory health, how we feel mentally, and most importantly, our immune system.” Georgetown researchers hope to shed light on the mysteries of gut health, by continuing to examine what exits the intestines. Thanks to fecal samples, the gastrointestinal tract offers no shortage of rich material to explore. n Merenstein serves in an unpaid executive position at the International Scientiﬁc Association for Probiotics and Prebiotics and occasionally as paid scientiﬁc consultant for Bayer and DuPont.

“More than 20 years ago, our lab showed for the first time that it is not a pathogen or toxin from bacteria that causes NEC, but rather the lack of good bacteria that could have prevented disease,” says Panigrahi, whose decade-long NIH study led to an industry-altering clinical trial of probiotics against sepsis published in Nature. “This concept of good bacteria—or probiotics—was considered snake oil in those early days because of lack of scientific evidence. Over the years, this field has grown exponentially and microbiome is talked about not just in the gut, but as a potent immunomodulator, playing a protective role in many diseases.” Today his team studies global variations in immunity, and disproportionate prevalence of cancer, diabetes, and neurodegenerative disorders in countries, such as colon cancer in the United States. Drawn to Georgetown’s collaborative approach, Panigrahi partners with Merenstein’s team to look at underlying mechanisms of probiotic use. To sort through complex factors like diet, genetics, and environmental exposures in gut health, Panigrahi works with data scientists led by Subha Madhavan, PhD at the Innovation Center for Biomedical Informatics. Panigrahi’s 2017 study with 4500 infants in India involved a synbiotic treatment to prevent sepsis that reduced mortality by 40 percent. The trial was terminated early by the Data Safety Monitoring Board (DSMB) due to its overwhelming success. This growing work at Georgetown was launched with a $1.1 million grant from entrepreneur and philanthropist Dan Mishra. Panigrahi owns a trademark and has an issued patent and a pending patent in the probiotic and microbiota domain.

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ALUMNI IN THE FIELD

Daina Trout (NHS’03) “I’m passionate about nutrition and food, and how it can heal people. But I’m also passionate about feeling good and finding ways to make the world feel better.” “We started with very little money and experience,” Trout shares. “But we had a lot of passion and a sincere instinct that we wanted to build something that was our own and do it on our own terms.” Proponents of kombucha say that the bubbly beverage is filled with probiotics and antibiotics, and may have a positive effect on the gut if the end product is not too sugary. The process of fermenting tea with specific strains of bacteria, yeast, and sugar produces acetic acid and other compounds that may facilitate probiotic function. “I’m passionate about nutrition and food, and how it can heal people. But I’m also passionate about feeling good and finding ways to make the world feel better,” she says. Trout adds that while Health-Ade has blossomed into a 200+ team with a retail presence in 36,000 stores worldwide, their mission is deeply rooted in wellness. The company aims to provide a realistic and sustainable beverage option for consumers to enjoy as they dedicate more attention to their health. When Trout is not tending to her growing brand and life as CEO of Health-Ade, she’s putting her energy into being the mom of two boys. “I definitely have a full plate, but it’s important to me to have balance and set boundaries so I don’t compromise the values that keep me happy,” she says. “For me, it’s simple: what you feed grows and what you don’t dies. So it’s more than just the business that’s important to me.” n

Photo: Hope Rollins

When Daina Trout arrived at Georgetown in 1999, she jumped into the new health sciences track offered at the nursing school. While she had planned to transition directly into medical school after graduating, she crossed paths with someone who would change her perspective on not only medicine, but also nutrition. She was placed in a 16-week senior internship with Artemis Simopoulos, MD, a physician and nutritionist not affiliated with Georgetown. Simopoulos authored The Omega Diet, which spotlighted the health benefits of Mediterranean cuisine—full of fish, vegetables, legumes, and low in saturated fats. “Working as her research assistant, I saw that she was really ahead of her time,” Trout says, describing Simopoulos’ unconventional take on eating “good fats.” Trout’s work alongside the popular author and nutrition guru opened her eyes to a different approach to health and medicine: “I was just really intrigued by how food can heal, and I wondered how I could continue down the path that Dr. Simopoulos led me to.” In addition, Trout’s own campus experiences as a medical technician for the Georgetown Emergency Response Medical Systems (GERMS) team allowed her a sneak peek into what can be an exhausting routine for physicians. “I had this idealistic vision about doctors being able to problem-solve really complicated health issues and think outside of the box as a trailblazer, but in my GERMS experience, I learned that there were a lot of protocols and rules and paperwork to adhere to,” Trout says. “I’m not good with rules.” After completing her degree at Georgetown, she started a dual graduate program at Tufts University, where she received master’s degrees in nutrition and public health in 2007. The launch of her business, Health-Ade Kombucha, would take another five years, and it all began with setting up shop at a farmers’ market.

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Will Bulsiewicz (M’06) “I believe the path to optimal gut health is a predominantly plant-based diet. And that’s a radical change for the average person in the United States, whose diet typically consists of only 10 percent plants and about 60 percent processed foods.”

When Will Bulsiewicz, MD, isn’t in his white coat meeting with patients in his Charleston, South Carolina medical office, one may catch him donning a more informal wardrobe—specifically a shirt that reads, “Eat plants. Take epic dumps.” Even in his funny shirt, the gastroenterologist is serious about teaching the importance of tending to gut health. In this time of pandemic, he encourages patients to fortify overall well-being using plant-based nutrition. Affectionately known by his Twitter followers as “TheGutHealthMD” and by his patients as “Dr. B,” Bulsiewicz grew up in a Jesuit-educated family. When choosing a medical school, he was drawn to Georgetown’s emphasis on caring for the whole person—cura personalis. “This was more than just nuts and bolts, more than science and physiology. This was about recognizing human nature and the importance of the connection between humans in the process of healing,” Bulsiewicz shares. Originally interested in pediatrics, he turned to gastroenterology when he began working with Caren Palese, MD, a GI fellow at the time who is now associate professor of medicine and gastroenterology at the School of Medicine. “I was just this third-year medical student—completely new to the scene—and she treated me with great respect, like a colleague and a member of her team,” he says of his mentor. Today his approach to health care is emblematic of the teachings that drew him since his first moments on campus. “In allopathic medicine, due to job demands and the fragmentation of our medical system, the body is dissected into systems and organs, and there are barriers and boundaries. But the body has no barriers,” Bulsiewicz explains. “The body is whole, and therefore that is the best way to view and ultimately treat the body.” He believes that around 80 percent of health outcomes are led by diet and lifestyle choices. “If our solutions don’t include addressing the root of the problem, then how can we ever improve?” he asks.

Advocating for a lifestyle medicine approach, Bulsiewicz says this moment of pandemic precarity is an optimal chance for people to think positively and re-evaluate even the most mundane and overlooked parts of their routines, including cooking at home and spending time with loved ones, both of which he says does wonders for overall health. Bulsiewicz’ own transformation inspired him to write Fiber Fueled: The Plant-Based Gut Health Program. Stepping away from his junk food-laden diet and subsequently shedding more than 40 lbs, the husband and father of two credits his improved health to his gastroenterology research, as well as tapping into the power of plant-based eating. “I believe the path to optimal gut health is a predominantly plant-based diet,” he says. “And that’s a radical change for the average person in the United States, whose diet typically consists of only 10 percent plants and about 60 percent processed foods.” Bulsiewicz acknowledges that access to healthy foods poses a barrier for many Americans. But when possible, people should be surrounded by as much life as they can, she says, including houseplants and pets, and be spending time in nature. n

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Why Gut? Why Now? By Will Bulsiewicz, MD (M’06)

Image: iStock

Gastroenterologist and Georgetown University Medical Center alumnus Will Bulsiewicz is passionate about all things gut health. On top of helping patients map out better options for improving their gastrointestinal health, Bulsiewicz has also written a best-selling book on the subject. We recently asked him to share his thoughts on the importance of the gut’s most central component—the microbiome—and its starring role in wellness.

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ow more than ever, I wish I had a megaphone and could stand on a table to shout to the world about the importance of gut health. As a gastroenterologist, Georgetown Med 2006 alumnus, and author of Fiber Fueled: The Plant-Based Gut Health Program, I’m happy to see this forgotten organ ﬁnally get some of the attention it deserves. But clearly there is a lot of room for improvement, when most Americans think of bone broth and probiotics as the backbone of a healthy gut. (They’re not!) Let’s start with the basics. Inside each of us is around 39 trillion microbes. Mostly bacteria but also fungi, sometimes parasites, and my personal favorite—the archaea. These microbes actually outnumber our human cells—yes, you are less than 50 percent human—and they account for 99.5 percent of our genetic code. Although these microbes are invisible, they are as alive as you and I and they’ve been a part of human history from the very beginning. Through three million years of coevolution, we’ve grown to trust these microbes with essential functions in our health. They are critical to digestion and allow us access to the nutrients in our food. They strongly influence inflammation and immunity. Did you know that 70 percent of our immune system resides in our gut? Through bioactive molecules, these microbes affect our metabolism, including our weight balance, insulin sensitivity, and satiety. They regulate estrogen and androgen balance. They affect our mood and cognition. There’s even evidence to suggest that they control our cravings. In short, they are powerful! Consider the role of these microbes in the era of COVID-19. Our immune system is our shield against this virus. We need it optimized to defend us, and there are numerous studies showing a direct connection between our gut microbes and immune system. When they are strong, our immune cells are strong. When they are disturbed, which we call dysbiosis, then our immune cells are disturbed as well. You’ll ﬁnd dysbiosis present in all cases of autoimmune disease. The same is true with our mood. In times of stress, the brain releases corticotropin-releasing hormone (CRH), which is known to have an adverse effect on our gut microbes. Ninety percent of the serotonin and fifty percent of the dopamine in our body are produced in the gut. When the gut microbes are negatively affected, they alter the balance of serotonin, dopamine and other neurotransmitters, and their precursors. The result can be anxiety and fear, which leads to increased CRH

release. It’s a vicious cycle, but it can be broken with attention to the gut microbes. Sadly, we have done more than just neglect our little friends. The changes in our diet and lifestyle over the last century have been an all-out assault on their health, and we are exacerbating these issues by doubling down on our unhealthy habits under the stress of COVID-19. We’ve traded real food that’s derived from the dirt for a diet of mostly processed, fried, or hormoneand antibiotic-laden foods. We strip out the ﬁber, the preferred food of our microbes, and replace it with preservatives, emulsifiers, colorants, and other chemical additives. We’ve stopped moving and instead spend our days at a desk and our nights on a couch inside a hyper-sterile human-built edifice. We’ve shunned “early to bed, early to rise” and instead spend all night on Twitter, with the blue light from our tablet disrupting our circadian rhythm. My friends, we have transitioned into an overfed, undernourished, and hyper-medicated life that is unfriendly to our gut microbes. So what’s the solution? It’s rather simple. We need to get back to the basics by restructuring our diet and lifestyle. There are no shortcuts, no supplements that take us from a C- gut to an A+. Instead, we should form healthy habits. When we do this, small changes start adding up to massive results. Exercise, a good night’s rest, human connection, and time spent outdoors are all important to the health and balance of our gut microbes. But the most important thing is the food we eat. Researchers running the American Gut Project, the largest study to connect diet and lifestyle to the health of our microbiome, found that the single most powerful predictor of a healthy gut is the diversity of plants in our diet. Why’s that? All plants contain fiber. In fact, they contain unique types of fiber. Not all fiber is created equal! There’s tremendous biochemical variety in this highly complex category. Our gut microbes love fiber, but they are picky eaters. Not all microbes eat the same fiber: some microbes prefer black beans while others feast on kale. So for us to feed all of our gut microbes, we must eat a diet with as many varieties of fruits, vegetables, whole grains, seeds, nuts, and legumes as possible. It’s fascinating to consider that the key to human health comes from something that isn’t even human. We really do need these microbes for optimal digestion, immune and metabolic health, and hormonal and mood balance. Now more than ever, we should be making choices to nurture and support these microbes so that if and when we need them, they’ll be there for us. n

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GUT HEALTH

Take a seat in the

Virtual Classroom Alumni and Friends Come to “Campus” to Learn About Foraging, COVID, and Gut Health By Kate Colwell and Rhea Bhatt (G’20)

n the pandemic summer of 2020, the landscape shifted for everyone, including higher education. But at Georgetown, one group of faculty and students at the Medical Center hardly noticed the change in their coursework. That’s because for nearly 10 years, those in the School of Nursing & Health Studies graduate programs have been learning remotely yet together in virtual classrooms around the country. Over the years, many beneﬁts from this novel approach have emerged. Students are able to stay in their home communities and bring their varied, daily, immersed work experiences to the classroom. For students located in remote areas, where health workers are often in short supply, distance learning offers an ideal solution. For students who have commitments at home that prevent them from attending inperson courses in Washington, D.C., the flexibility of online learning can make all the difference. For faculty, the richness of the living experiences among the students creates rich material for discussion and opportunity for applied learning and feedback in real time. When Georgetown’s physical campus classrooms shuttered this spring, all students and faculty quickly shifted to online classes. By late summer, Georgetown Health magazine readers were able to get a sneak peek into two of these evolving learning communities.

Urban Foraging In August the Georgetown University Alumni Association, in partnership with Georgetown Health magazine, offered alumni a virtual class on Urban Foraging on the Hilltop led by two beloved faculty members. Biology professor Martha Weiss, PhD, and pharmacology professor Adriane Fugh-Berman,

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MD (M’88), led a one-hour class on gathering wild edibles on and around the Georgetown campus. The two professors have been friends for many years and typically lead a seasonal foraging feast on campus, preparing a meal with students and faculty together in a dormitory kitchen. Highlights of this year’s virtual edition included information on preparing gingko tree nuts, and using delicious mixed greens like sorrel to create a Georgetown Campus Salad. Participants asked about eating acorns, and where to find wineberries on campus. Weiss noted that she looks forward to next year’s super foraging feast: cicadas! Both professors stressed the importance of studying biology, ecology, and botany before strolling along the roadside to harvest a free meal. Many plants are part edible and part toxic, Weiss noted, such as potatoes, asparagus, and rhubarb. “What’s good for a bird might not be good for you,” she added. For the most part, foraging is legal except on private property and in national parks, the professors said. Weiss shared that she makes persimmon bread for a neighbor who offers the fruits from her tree each year. She also makes acorn cookies, though the process of removing the tannins from the oak tree nuts is long and arduous. An underappreciated native tree, pawpaws can be found all along the C&O Canal, Weiss noted, bearing their tropical fruit in late August and September. Similar in consistency to a banana or mango, with a smooth custard texture, the tasty pawpaws look like green potatoes. Humans are not the only fans, Weiss warned. “It becomes a race between you and the squirrels.” n View the class here.

The Gut Microbiome and COVID-19 In September 2020, more than 170 Georgetown alumni, students, and friends tuned into a live virtual class to examine the dynamic relationship between the microbiota and disease expression, particularly in relation to gut health and the novel coronavirus. The webinar, co-sponsored by Georgetown Health magazine and the Georgetown University Alumni Association, convened microbiome experts from Georgetown University Medical Center for an hour packed Tune in to watch a one-hour recorded class with Georgetown faculty as they explore a systems medicine approach with insight. to understanding the gut microcbiome and COVID-19. The panel was inspired by a popular course on clinical applications of the Genetics, environmental factors, and medication contribute microbiota, offered through the Master’s in System Medicine to the composition of the microbiome and disease expression, program. The program’s creator and director, Sona Vasudevan, Chutkan said. She noted that research linking antibiotic use in PhD, is a professor of biochemistry and molecular and celluchildhood and the subsequent development of inflammatory lar biology, and co-directs the course that explores the abunbowel disease (IBD) is particularly helpful in understanding an dance and diversity of gut, vaginal, and skin microbiomes. epidemic of autoimmune diseases. For the webinar, she was joined by Georgetown MedStar gas“It’s really a message of optimism,” she noted. “Because it’s troenterologist Robynne Chutkan, MD, and faculty member not this idea that your genes are your destiny. There are many Kate Michel, PhD, MPH. Douglas Varner, MS, MLS, assisother factors that can control and contribute to whether a distant dean for information management at Dahlgren Memoriease is expressed. And the good news is that many of them, like al Library, moderated the panel. Michel and Varner co-direct diet, are within our control.” the Clinical Applications of the Microbiota course along with With regards to the gastrointestinal symptoms of coronaviVasudevan. rus, Chutkan cited emerging international research about the Vasudevan pointed to the role of big data and systems medfrequency of gut issues in combination with respiratory sympicine in recent findings showing a correlation between changes in the lung microbiota and outcomes of COVID-19 patients. toms. Co-occuring conditions such as dysbiosis could be a significant risk factor for viral infection due to the interplay The novel approach utilizes computer models to analyze vast between diet, medications, and host immune system, such as amounts of clinical data. The multidisciplinary field uses the immunosuppressive properties of steroids. “-omics” technologies—like genomics, metabolomics, and proAn audience member asked about food insecurity in minorteomics—to treat patients with precision, and its scope and ity populations and ways to strengthen health outcomes, applicability has increased since the sequencing of the human particularly in the current climate addressing a pandemic and microbiome. recognizing racial and social injustice. Michel discussed the role of the microbiome in health and “We know that there’s an increased prevalence of disease disease, noting that as a raw count, there are more bacterial cells in the body than there are human cells, and their genetic poten- like hypertension, diabetes, and obesity in our minority populations,” Chutkan said, emphasizing the importance of access tial is far greater than the human pan-genome. She also disto nutrition and other ways to emphasize prevention as a pubcussed the increased risk in people with compromised immune lic health priority. n systems and the interplay between the microbiome and the immune system. She elegantly described the gut-brain and the Watch the webinar in full on YouTube. gut-lung axis.

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Ruesch Center Targets Gastrointestinal Cancers By Beth N. Peshkin ILLUSTRATION BY ELISA MORSCH (G’20)

hen Otto Ruesch was diagnosed with pancreatic cancer in 2003, he received compassionate care from the oncology team at Georgetown Lombardi Comprehensive Cancer Center. The survival rate was just 4 percent, and he succumbed to the deadly disease a year later. He left not only an aching absence for his family, but also an inspiration to improve outcomes for future cancer patients and their loved ones. While her husband received treatment, Jeanne Ruesch saw firsthand the dishearteningly protracted pace of gastrointestinal cancer research. She was inspired by the care that she and her husband received from oncologist John Marshall, MD, but at the same time recognized a gaping need for a better understanding of GI cancers and how to treat them. Through a gift made in memory of her husband, she founded the Ruesch Center for the Cure of Gastrointestinal Cancers in 2009. Today the Center is globally renowned in the growing ﬁeld of GI research and care. Led by Marshall, who also serves as chief of the division of hematology/oncology at MedStar Georgetown University Hospital, it is an international center of excellence within Washington, D.C.’s only National Cancer Institute (NCI)-designated Comprehensive Cancer Center at Georgetown Lombardi. Every year, more than 650 patients seek consultation from the Center’s expert team of clinicians. In the last four years, the Ruesch Center has supported more than 50 clinical trials, and about one ﬁfth of their patients are eligible for and offered participation in such trials.

The Evolution of the Ruesch Center According to the American Cancer Society, the collective cancers of the GI tract have the highest incidence and are the second leading cause of cancer deaths in the United States. These include cancers of the colon, rectum, esophagus,

stomach, liver, pancreas, and bile ducts/gallbladder. Although GI cancers usually affect individuals later in life, since 1995, there has been a 22 percent increase in the incidence of GI cancers diagnosed before age 50. Despite this trend, funding for GI cancer research has traditionally been scarce. Just a decade ago, breast cancer research garnered ten times more money than all other cancers combined. The picture has improved, but the funding gap still exists and may be attributable in part to the general public’s lack of awareness of GI cancers. The Ruesch Center aims to change that. Together with Marshall and the Center’s care team, Jeanne Ruesch has steadfastly infused her vision of hands-on advocacy and research to jumpstart studies on better treatments and care, to improve the quality of life for patients with GI cancers.

Leveraging Cancer Biology Marshall notes that out of the gate, he and Jeanne Ruesch aimed high. They purposefully chose to use the word “Cure” in the name of the Center. They stay laser-focused on ﬁnding better treatments for the patients who fill the clinics, the majority of whom have metastatic cancers. “We knew we needed to reach for the stars,” says Ruesch. “We both believe that curing these patients will be possible someday.” When reﬂecting on the last decade since the Center’s inception, Marshall underscores the growing impact of precision and personalized medicine in treatment decision making. The first step in doing that was to divide GI cancers into different subgroups, to identify which patients should get which therapies. “It seems so obvious now,” he says. “But it took a while to recognize that we’re dealing with hundreds of diseases, and they all can’t be treated the same way.”

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Indeed, each person’s cancer has a unique “signature” that can be revealed through a test called tumor or molecular profiling. By sequencing a cancer’s genes, mutations may be identified that can act as targets for various therapies, often administered to the patient as part of a clinical trial. Immunotherapy is another promising strategy for fighting these aggressive cancers. Elegant in its simplicity, this approach relies on rallying cells in the body to recognize and attack the cancer. “There was a time when we thought that stimulating the immune system would never work,” Marshall says. “We now know that cutting the brakes off of the immune system so that it can destroy cancer cells has dramatically influenced cancer care.” Marshall believes that unlocking the secrets of GI cancers, and ultimately curing them, may lie in the crosstalk between the immune system and the microbiome—the trillions of bacteria, fungi, and viruses that live within and on our bodies. Several intriguing ﬁndings support this theory. For example, bacterial DNA has been identiﬁed in colorectal liver metastases, leading to questions about the causative role that bacteria may play and how they may help cancer cells evade detection by the immune system. Another recent observation in small studies is that stool transplants may improve response to immunotherapy. By using stool to transfer the microbiome from a healthy individual into the colon of a cancer patient, cancer cells become vulnerable to reinvigorated immune cells. Finally, research is ongoing to figure out why left- versus right-sided cancers often present and behave differently. The bacterial habitat of the colon could explain why location matters when it comes to treatment and prognosis.

Mud Pies and Green Tea What can these revelations about treatment tell us about the cause of GI cancers, and why more young people are getting diagnosed? Marshall points out that changes in our lifestyle habits over the years may affect the microbiome. In response, we need to train our microbiomes better. As Marshall is fond of saying, “eat more dirt!” (Or make mud pies, like he did when he was a kid.) “Exposure to microbes in our everyday environment might teach our immune systems to fend off disease,” says Marshall. However, in the current COVID-19 climate, he acknowledges that giving up disinfecting wipes and handwashing rituals is not likely to happen. He speculates that these protective behaviors today may not bode well for gut health in the long term. Fortunately, research is illuminating other ways that we can reduce the risk of GI cancers.

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“This kind of seed funding is the honey that drew the bees.” -John Marshall, MD For example, Georgetown researchers are studying a compound that occurs naturally in green tea and may bolster liver health. Patients with cirrhosis are good candidates for prevention, given that they have a very high risk of developing liver cancer. A pilot consortium study is evaluating what the effects are of the green tea extract in such patients. And a large multisite NIH study is assessing whether a specific biomarker in the liver can be used to predict the risk of liver cancer development or recurrence. Aiwu Ruth He, MD, PhD, associate professor at Georgetown Lombardi Comprehensive Cancer Center and the scientific lead for liver and biliary cancers within the Ruesch Center, is a principal investigator on these studies. Collaborators include Fung-Lung Chung, PhD, professor of oncology at Georgetown, who studies how DNA damages generated from activities in a person’s own body result in cancer development. Chung provides scientific support for the NIH study. In addition, Coleman Smith, MD, a liver specialist at MedStar Georgetown University Hospital, helps to identify patients for the research. “The goal of these studies is to identify people with an increased risk of developing liver cancer, then treat them with green tea to lower their risk,” says He. “We would much rather prevent the cancer than treat it,” she adds.

An Alliance of Advocates Marshall’s vision, which he projects on and beyond the Georgetown hilltop, embraces a culture of advocacy to move the field forward. In 2015, the Ruesch Center founded the GI Cancers Alliance. The coalition, whose mission is to bring awareness and education to the public, unites forty advocacy groups with academic centers and industry leaders to accomplish this goal. “I don’t think it’s an overstatement to say that the Ruesch Center catalyzed this movement,” Marshall says, noting that this tour de force has contributed to the Center’s continuous investment in scientiﬁc study. In fact, all Ruesch Center philanthropy is earmarked for research. This commitment has unified leading researchers and clinicians in multidisciplinary, transformative collaborations around the globe.

Photo on right courtesy of Jeanne Ruesch

The shared vision of Marshall (left) and Ruesch (right) has brought much needed focus to GI cancer research and care.

Otto’s experience with pancreatic cancer care at Georgetown inspired Jeanne’s transformative gift in his honor.

Investing in Bold Ideas and Planting the Seeds

“The best philanthropy makes room for scientists to make mistakes and then learn from them,” says Jeanne Ruesch. From there, she adds, “We expect and respect the ability of our funded researchers to leverage their preliminary data to obtain the big, often federally funded grants.”

Private philanthropy cannot replace government funding in terms of dollar amounts and the scope of supported research. But one thing that Ruesch, Marshall, and He all recognize is that the Ruesch Center’s commitment to funding early-stage basic science research goes one step further. It empowers scientists to test their out-of-the-box hypotheses that might be deemed too “risky” by extramural agencies. “This kind of seed funding is the honey that drew the bees,” says Marshall. And those bees turned out to be a team of innovative clinician-scientists such as He and Chung. The human trial examining green tea extract for liver cancer prevention came about after the Ruesch Center funded a pilot, which sought to determine if intriguing animal model data generated in Chung’s lab could be replicated in human tissues in the laboratory. These kinds of preliminary data have driven He and her colleagues to shoot for the moon. Indeed, she is the site principal investigator for an NCI Moonshot project assessing the role of biomarkers in predicting the response of liver cancer patients to immunotherapy. “We were selected as one of the sites based on a pilot study funded by the Ruesch Center,” He says. “Other considerations were our active contribution to many clinical trials that are evaluating immune therapies in liver cancer, and the comprehensive care of these patients by our robust multidisciplinary team.” She adds that unlike extramural reviews, the internal review process within the Ruesch Center is dynamic, interactive, and undertaken with a collaborative spirit. For He, the review process itself led to acquiring new collaborators. “I didn’t just get funding,” she says. “I gained a community.” Bringing this community of innovative scientists together is precisely the mission of the Ruesch Center.

Cancer Gets Personal There is no doubt that the evolving science ignites passion in Marshall. But the cures ultimately take place at the bedside, not the laboratory bench. Tending to patients is something he always prioritized—now more than ever. To be sure, each of Marshall’s patients has left an indelible impression on him. But when his wife Liza was diagnosed with an aggressive triple-negative breast cancer in 2006, his perspective changed completely. Through her surgery, chemo, and radiation, he tamped down his doctor impulses to focus on being present as a caregiver and husband first and foremost. Both John and Liza Marshall were humbled by the level of care and attention that Liza and their family received. Liza is now cancer-free, and the doctor pays this gift forward through his leadership and patient care at the Ruesch Center. “We’re delivering turnkey services to patients and their families, in a setting that combines cutting edge-treatment merged with care and compassion,” Marshall says. These are the qualities Ruesch saw in him as her husband’s physician, and form the legacy of the Center for future patients and their families. n Beth N Peshkin, MS, CGC, is a professor of oncology and director of genetic counseling at Georgetown Lombardi Comprehensive Cancer Center. This year she celebrates 25 years at Georgetown.

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ON CAMPUS

Introducing: The Reservoir A New Podcast for Alumni Voices This fall Georgetown Health magazine is launching a podcast, The Reservoir, a collection of conversations with alumni and friends of the schools and programs of Georgetown University Medical Center (GUMC). Created particularly with alumni in mind, the podcast seeks to bring relevant topics on health and medicine to the earbuds of readers (and future listeners) each month. The Reservoir features valued voices from the Georgetown health and medical community across various disciplines, schools, regions, and generations. The premiere episode, releasing in November, spotlights the newly developed Racial Justice Committee for Change (see story, page 3) within GUMC, and features a conversation with two of the group’s appointed leaders: fourth-year medical student Stephen Kane (M’21), and Department Chair of Family Medicine at GUMC and MedStar Georgetown University Hospital Michelle Roett, MD, MPH (M’03). n

Listen in and share your feedback at healthmagazine@georgetown.edu.

LISTEN HERE

White Coat Ceremony Firsts In its first all-virtual White Coat Ceremony, the School of Medicine warmly welcomed the Class of 2024 on Friday, August 22 as the students donned their white coats and recited the Hippocratic Oath together for the first time. The traditional short white coats, generously donated by the School of Medicine Alumni Association, were mailed to students in the weeks leading up to the ceremony. The care packages included learning society and Georgetown gear, along with personal notes of encouragement from alumni. In his remarks, Georgetown University President John J. DeGioia acknowledged that the students were beginning their journey to becoming physicians at a “time of consequence for our world.” Members of the Class of 2024 were the first to join the new Harley Learning Society, the first to be named in honor of an African American physician, Earl H. Harley, MD. The Georgetown professor of otolaryngology and pediatrics led the new medical students in reciting the Hippocratic Oath. Thousands tuned in for the event, which was broadcast live online. n Aaron Ford proudly coated his son, Avery, during the School of Medicine’s virtual white coat ceremony for the incoming class of 2024. “[I’m] so proud of this young man, a soon-to-be @GUMedicine doctor and world leader,” Ford tweeted.

Top image courtesy of Aaron D. Ford

A Quiet Campus Goes Smoke-Free Georgetown University became a smoke-free campus as of August 15, 2020, per a plan announced in April 2019. Under the policy, smoking and other tobacco use, including carrying any burning cigarette, cigar or pipe, or any form of e-cigarette, is prohibited within university-owned or leased buildings, grounds, and vehicles. The policy applies to all students, faculty, staff, visitors, and contractors. The university joins thousands of other smoke- and tobacco-free campuses around the country, as well as MedStar, the Medical Center, and the Law Center who instituted bans over the past 10 years. “Making this important change is about caring for our community—smokers, tobaccousers, and non-users alike—and aligning ourselves with our value of care for the whole person,” says Charles DeSantis, interim vice president and chief human resources officer. The university remains committed to providing tobacco and smoking cessation resources and supporting those who need them. With very few people currently living and working on campus due to the COVID-19 pandemic, this long-planned transition turned out to be well-timed and seamless. n

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All the Little Graces Hospital chaplains and the ministry of presence during the pandemic In August we caught up with Rev. Tarra L. Taylor, MDiv, interim director in the university’s Department of Mission & Pastoral Care at MedStar Georgetown University Hospital, to learn about chaplaincy and COVID-19—what has changed, and what remains constant. How is the work of hospital chaplaincy today? Chaplains are essential, and our staff demonstrates daily that pastoral care is alive and viable. We bring the ministry of presence, comfort, and advocacy to the patients. They have questions about their medical conditions, or concerns about life and death. The primary conversation is: Why is this happening to me? Where is God in this process? Where do I find solace? How do I cope with my illness? I was tested for COVID-19, and I don’t know if I have it or what’s my risk for being COVID-positive. We bring emotional, spiritual, or religious support to them. For some patients and family members, their faith anchors them. Some may not identify with a specific faith tradition. We have chaplains of different faith traditions who provide ministry in the spirit of cura personalis—care of the whole person.

How has your relationship to patients changed? As a result of COVID-19, our visitor policy restricts family member visits. Being an inpatient can be an isolating experience. The inability to have visitors makes it more so. In their absence, we find ourselves, along with hospital staff, being that family member for patients. Bonds are formed with patients and family members as we provide pastoral ministry to them.

Rev. Taylor, left, meets with the nursing team.

families and seeing how important presence was, to know somebody cared for you. I retired and went into seminary following a call to ministry, chaplaincy in particular, to journey with people and help them see that there is a divine that cares for you.

How do you use technology to support your work?

What drew you to health care chaplaincy? My initial call to this work was the desire to be present for those who are suffering. I grew up in a home where my mother was ill all the time. Knowing she was cared for and loved by myself and other relatives showed me how important it is to have someone there during the time of suffering. I spent more than 20 years in the Army Medical Service Corps. I was in and out of hospitals, providing support for servicemembers and their

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How do you pray? When I start my call, I always pray to be the hands and feet of the divine in the hospital, whether it’s for patients, staff, or family members. In times when we can’t physically touch one another, to be the presence, and extend my hand, whether it’s through the words I’m using, my eyes, or through the prayers or meditation that I’m lifting up to the patient that allows us to connect.

What gives you hope working in a hospital? In the midst of all the tragedy, we see a lot of patients being discharged that are going on to improve. We see good outcomes of surgeries, bone marrow transplants, and chemotherapy. In our NICUs, in our labor and deliveries, we see babies going home and families rejoicing with the new life. Every staffmember pictured can offer a vignette of hope that motivates us to continue this work. There are a lot of little graces in which we see glimpses of God’s hand. n

Photo: Sarah Burt

We assist in helping them have Zoom chats with family members. A COVID-19 patient’s daughter wanted me to have prayer with her mother before she passed away. The unit used their tablet to connect with the daughter at home, and I used our tablet to connect with the daughter and patient in the room. We were able to make a seamless visit, like we were all there together. The families appreciate being able to have someone there for their loved ones, to know someone’s praying for them or visiting with them. To know they’re not alone.

ALUMNI CONNECTIONS

A Leap of Courage

Photo: Sujith Abraham

Biomedical Graduate Education’s newest alumni reflect on first-generation experiences

To become a first-generation college graduate requires “making hard decisions, navigating unique paths, and working hard to accomplish your dreams,” says Carla Ochoa, project manager in Biomedical Graduate Education’s Office of Career Strategy & Professional Development. Ochoa herself is a first-generation college graduate. Making the leap to transform your future— and often the future of your family—requires hard work, an enterprising attitude, and courage, she says. Four firstgeneration students from the Class of 2020 demonstrate these qualities. The parents of Nopell Wong, MS (G’20), were 24 years old when they left everything behind in China to immigrate to the U.S. with few connections, little money, and broken English. “Nevertheless, here I stand at 24, with a world of opportunities ahead of me, due to the sacrifices made by my parents,” says Wong. “Getting a master’s degree was only the beginning of those opportunities.” In her integrative neuroscience program, Wong was able to observe and study post-mortem human brains. “I pursued this degree because the field of neuroscience is fascinating and challenging,” she says. “It challenges me to be a better thinker and person.” After her grandfather passed away of leukemia, Lacye Yata, MS (G’20), dedicated her career to cancer research. “From that day, I made a commitment to myself to find out what really happened to him, and I have dedicated my studies ever since to become an oncologist in the future.” When she did not immediately gain acceptance into medical school after college, Yata decided to build upon her work at the University of Hawaii Cancer Center with a Georgetown graduate biomedical degree in tumor biology. “I knew this would be a oncein-a-lifetime opportunity, and I could not pass it up,” says Yata, who hopes to return to Georgetown for medical school. Brandi Towar, MS (G’20) had a wellestablished marketing career, but after 20 years, she felt dissatisfied. She decided to pursue a more fulfilling calling. “After much consideration and feeling directed by God, I chose Georgetown,” she says. A memorable experience as a Georgetown integrative neuroscience student was visiting the Library of Congress. “A small group of our policy class

had the opportunity to access a wealth of information not readily seen by the public,” she recounts. “The experience was exciting and amazing!” The parents of Tsion Habtamu, MS (G’20), immigrated to the United States to give their daughter a chance to achieve her dreams. “I am now one step closer to making those dreams come true,” she says. In her Georgetown physiology and biophysics program, she collaborated with people from many different cultural and faith backgrounds, motivating her to become a compassionate and respectful physician to diverse patient audiences. When first-generation students encounter more obstacles than their peers, Habtamu advises students to think of themselves as trailblazers. “Embrace and use those challenges as a learning opportunity in order to blaze the path for those following in your footsteps,” she says. “When things get hard, reflect on how far you have come.” n

Tsion Habtamu is one of a handful of first-generation graduates from the Biomedical Graduate Education class of 2020. Specializing in the areas of physiology and pharmacology, Habtamu now works as a clinical laboratory assistant in the D.C. metro area.

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Gift Supports Geriatric Nursing Education In the midst of the COVID-19 crisis, Luci Baines Johnson (NHS’69, H’18)—daughter of President Lyndon B. Johnson and Lady Bird Johnson—and her husband, Ian Turpin, made a $1M gift to the Georgetown University School of Nursing & Health Studies (NHS). The Johnson/Turpin Fellows Endowed Fund supports scholarships for graduate students who have a demonstrated interest in serving adult and geriatric populations, along with other underserved communities, many of which have been disproportionately hurt by coronavirus. The gift will empower NHS students to meet the challenges of caring for a rapidly aging population. By 2050, the number of Americans aged 65 and older is projected to reach 88.5 million, more than one fifth of the population, according to the U.S. Census Bureau. To meet the health care needs of seniors, the United States requires an estimated 3.5 million health care providers with expertise in gerontology, the study of aging, by 2030, reports the Institute of Medicine. “The geriatric nursing workforce is going to be really important, given the demographic changes in the U.S.” says Carole Roan Gresenz, interim dean of NHS and a professor in the Department of Health Systems Administration. In addition to the challenges of a rapidly aging population, the COVID-19 pandemic has further exacerbated strains on the U.S. health care system. “Nurses have really been the frontline of our nation’s response to COVID-19,” says Gresenz. The gift will support NHS graduate students who have difficulty securing financial aid. These include distance-based learners in the online Adult Gerontology Acute Care Nurse Practitioner program, who provide primary care services to 36

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Philanthropist and businesswoman Luci Baines Johnson, pictured here during the School of Nursing & Health Studies’ 2018 Commencement ceremony, implores students to lead purpose-driven lives and be of service to others.

patients in rural and underserved areas. The gift will also bolster students in the Clinical Nurse Leader Master of Science Program, who train to assess health care systems, such as nursing homes and hospitals, for quality and safety issues. Luci Baines Johnson began her undergraduate studies in nursing at Georgetown in 1965, and has been an advocate for nurses throughout her life. “I am so proud of the nursing profession, and so thankful to have had a 55-year association with them,” says Johnson. “Cura personalis has truly been embraced by NHS students, and I will be forever grateful to have been among them.” n

ALUMNI CONNECTIONS

What’s in my White Coat?

Interview by Patti North

Top photo: Michael Menchca

Michael Menchaca (G’15) graduated from the School of Nursing & Health Studies Family Nurse Practitioner Program five years ago. After a relatively short stint at a traditional fee-for-service clinic, he founded the Menchaca Family Clinic in Harlingen, Texas, using a direct primary care model. Its success has allowed him to open a second location. I began to experience the onset of clinician burnout and thought there has to be a better way. For me, fee-for-service became the proverbial hamster wheel—all about numbers and processing insurance forms. How many patients can you see a day? Are you maximizing your per patient billing? It becomes more about what you can do to the patient than what you can do for them. I thought there has to be a better way—something akin to a gym membership that a patient can use whenever it is needed, convenient and at a reasonable monthly rate. I went home that night and googled “gym style membership family practice,” and discovered the direct primary care model, that works much like a gym membership. Now I see fewer patients, but can give them better care, when they need it, and at a cost they can afford. There is less revenue generated, but the tradeoff is a much better quality of life for my family and me. And there are other benefits. When the coronavirus hit, we were already doing telemedicine,

so it was a seamless transition for us. And my great grandfather, grandfather, and father were all entrepreneurs, so that desire was always there. I always thought I would jump in when I was 40, instead of 27, but it no longer made sense to wait.

1. My iPad is indispensable for keeping patient records, with

apps like Epocrates to check dosages and drug interactions and Spruce for HIPAA-compliant telemedicine. 2. Stylus to jot fast notes down. Sometimes I will draw a simple graph for a patient to better understand the effect of the changes I am recommending. 3. Bluetooth ear buds for virtual appointments and other meetings. 4. Stethoscope for all the usual reasons. 5. A pen because I still have occasion to write on paper— prescriptions or maybe a post-it note with a recommended vitamin. n

FALL/WINTER 2020

Reﬂections on Health

Maria S. Gomez, RN, MPH (NHS’77)

I grew up in Colombia, South America, which has a very harsh civil rights history, because of poverty. My father was killed and my mom and I had to get out. We came to D.C. when I was 13. It was 1968, the heat of the civil rights movement and Vietnam War. My mom raised me conservatively, so it was a little overwhelming. I went to Western High School—now Duke Ellington, down the street from the university. My mom worked hard 12– 16 hour days. I chose Georgetown to be near her. Some of my best friends were the Jesuits. Their theology kept me grounded. Be driven by your passion. Faith carries you forward, not the bricks-and-mortar church.

There’s good in every single human being—bring it out, and it multiplies. Integrity will carry you and pardon you, if you do everything with intention to do good. Be introspective. Listen to people and be in touch with the environment you’re in. I was a daredevil as a kid and had a lot of broken bones. I had wonderful nurses. I wanted to be one of those good people in the health field. When I expressed my interest in nursing and medicine in school, advisors said people like me rarely make it in the sciences. But Colombians are hardheaded and very determined. So I was like, I’m gonna do it. In essence they did me a favor. My mom was older. I needed a job to support us. There were pages and pages of nursing jobs in the paper—true my whole career. Once I started practicing nursing, I realized the value is beyond the bedside and administrative stuff. You help people by transforming lives. Resilience can go dormant when you’re full of sorrow, about to lose your home, worn down by racism, violence, hunger. Everybody if given the chance wants to do good, to have an 38

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impact. It’s up to us to open that up in others and put it on a silver platter. To awaken the power of the human spirit. Early in my career I worked at a D.C. Health Department clinic in Southeast. I saw how scarcity divides us. Regardless of who we are— brown, Black, white—if we’re poor we have so much in common. To have an impact, I returned to the community I knew best—the Latino one. A small group of health professionals and I opened Mary’s Center in 1988 to support women who crossed the border and were pregnant. What was helpful coming into this country was systems: education, health, social support. We offer these together at Mary’s Center, using the social change model. We offer workforce development and education for parents. We remind parents that it’s not selfish to learn and feel good about yourself. It helps you do better for your children. Nurses pick up the phone and work with social workers to demand that somebody get better housing. It’s our job to share the stories we get from our patients. It’s powerful data. During the pandemic we’ve been gathering data about who is getting the virus—people living in crowded conditions. Housing is so super expensive in this area. In the future we will get paid by how well the patient gets.

It’s going to make health care a lot better. We need a model of care that brings together health workers. We have to go beyond the four walls to have an impact. Patients are only as successful as the community where they come from. n

Photos: Christopher Ambridge / Bill McLeod / iStock

Founder, President, and CEO of Mary’s Center, a community health center serving over 60,000 people in the Washington, D.C. area through an integrated model of health care, social services, and education.

An Eye on Service

A grade school science project that involved carrying a cow eyeball to school in a cooler sparked a lifelong interest in ophthalmology for Alice “Wendy” True Gasch (M’92).

In her late 30s, she entered Georgetown School of Medicine as a second career. Today her expertise includes uveitis, photography, and the National Cathedral gargoyles. The Washington, D.C., eye doctor draws inspiration from her parents’ commitment to the value of education and the importance of giving back. In addition to supporting more than 25 medical students at Georgetown through the True Scholarships, she runs the eye clinic at So Others Might Eat (SOME), and volunteers with Washington Tennis and Education Foundation, Aid Association for the Blind, and Prevention of Blindness Society of Washington. Thank you, Dr. Gasch, for your commitment to Georgetown and to the community!

To learn more about supporting critical initiatives at Georgetown University Medical Center including student scholarship, contact giving@georgetown.edu or 202-687-1690.

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