Episode 08: Why is the study of the immune system so important and what is the impact of that research?

Narrator:

Hi and welcome to Viewpoint with Dean Mary Klotman from the Duke University School of Medicine. Today we spoke with Dean Klotman and asked her why is the study of the immune system so important and what is the impact of that research?

Dean Klotman:

So this Translating Duke Health Initiative is quite broad. I mean we now know that an immune response really is part of almost all disease, particularly important in areas like infectious diseases, but also in autoimmune diseases. I think one of the most important breakthroughs in the last couple of years was really what came along in the field of cancer immunology, which was the development of checkpoint inhibitors, where we found that you could actually engage the immune system as a therapeutic approach to cancer.

So that opens up all sorts of possibilities. So this initiative really asks very broadly, how can we use what we know about controlling the immune system to apply it to understanding transplantation, and what will lead to more robust organ preservation? How can we use it to really, more efficiently and effectively, develop vaccines? How can we use it to, certainly more efficiently, develop therapeutics for cancer? So it's an exciting time for Immunology and it's largely because we really are developing tools to harness the immune system, both in terms of facilitating an immune response, but also regulating and controlling immune response.

Narrator:

Viewpoint is a production of the Duke University School of Medicine. Tune in each month for Dean Mary Klotman's thoughts and ideas about important and timely topics and issues related to medical education, science and discovery, and patient care.

For more information please visit medschool.duke.edu/viewpoint

Episode 7: What are Duke researchers doing to better understand Alzheimer’s and other brain diseases, and what is being developed to prevent and treat these conditions?

Narrator:

Hi and welcome to Viewpoint with Dean Mary Klotman from the Duke University School of Medicine. Alzheimer’s affects nearly 6 million people. It's a devastating disease and little progress has been made in efforts to understand and treat it. We asked Dean Klotman, what are Duke researchers doing to better understand Alzheimer’s and other brain diseases, and what is being developed to prevent and treat these conditions?

Dean Klotman:

So, the Translating Duke Health Neuroscience Initiative is really focused on this concept of resilience and repair. The idea is that if you look at a chronic disease at the end of the disease, you're seeing the effects of years of damage even before there were symptoms. But if you start just looking at the basic biology of a damaged cell, no matter what the cause, you might really start to uncover the events that start early.

So conceptually, this approach is stepping back and really saying what is the basic science of repair when a cell is damaged? And resilience—which means when a cell is stressed— how well does it respond? That's really basic biology. It's basic neurobiology, but if there are signals derived from that basic biology, then those could become clues to really doing more translational research. Or you might discover a biomarker that could be used to detect a disease like dementia even before it develops symptoms. Now the underpinning of all the Translating Duke Health Initiatives is the concept that these are going to be multidisciplinary approaches. So it's not just going to be neurobiology, but the neurobiology will inform clinical research.

For instance, we know that there are a number of genetic mutations that have been identified in clinical research. Those mutations might inform the neurobiologist. The neurobiologist might find a clue that the clinical investigators can go and use in their research. So we really go from the continuum of basic science, translational science, clinical investigation and that's really the team approach to one of these major challenges.

Narrator:

Viewpoint is a production of the Duke University School of Medicine. Tune in each month for Dean Mary Klotman’s thoughts and ideas about important and timely topics and issues related to medical education, science and discovery, and patient care.

For more information please visit https://medschool.duke.edu/viewpoint

Episode 6: Why is it Important to Explore the Early-life Origins of Health and Disease?

Narrator:

Hi and welcome to Viewpoint with Dean Mary Klotman from the Duke University School of Medicine.

One of the aims of the Translating Duke Health Initiative is to explore the early-life origins of health and disease. Today we spoke with Dean Klotman about the impact this work will have on future children and adults.

Dean Klotman:

So this Translating Duke Health initiative really captures the principles of what we are trying to achieve with these big initiatives. So it's a multidisciplinary approach to exploring the very, very beginning of disease, which in many cases begins at birth or around birth. Those might include genes and biology, the physical environment, health behaviors, or even social and economic factors. And the idea is you start designing ways to look at the biology early on and you develop biomarkers and ways to predict disease later in life. Now hopefully that data will start to inform interventions and preventative approaches to improve health in both the child as well as in adult populations. So what's really exciting and unique about this initiative is that it really leverages across Duke, in terms of bringing together not only the biomedical and clinical scientists, but also the social scientists, the scholars in education, the scholars in policy, to really address this unique challenge. In fact the tagline for this initiative is “Ending Disease Where it Begins” which I really think summarizes what we're trying to do.

Narrator:

Viewpoint is a production of the Duke University School of Medicine. Tune in each month for Dean Mary Klotman’s thoughts and ideas about important and timely topics and issues related to medical education, science and discovery, and patient care.

For more information please visit medschool.duke.edu/viewpoint

Episode 1: Why is Diversity Important in Academic Medicine?

Narrator:

Hi and welcome to Viewpoint with Dean Mary Klotman from the Duke University School of Medicine. Today we spoke with Dean Klotman and asked her, “Why is diversity important in academic medicine?”

Dean Klotman:

Diversity is really one of our core values of an academic medical center. Traditionally, we think that having a community that is diverse will enhance the way that we look at problems - the way that we approach care delivery, particularly in medicine where diversity enriches our ability to understand those that we take care of.

I have been struck by a really compelling argument put forward by Scott Paige who is at University of Michigan, who has a book coming out called Diversity Bonus. He provides a framework of, not only is it the right thing because we're a diverse society, but really makes a compelling case that whether it's a business argument, or it's a complex problem that you're trying to solve, that if you have a diverse group of thinkers approaching that problem from a different view, that you'll get a better answer. And he had so many examples where that was the case. So there is an economic argument as well.

We're very fortunate in medicine, because we really deal with society and everybody that's within that society, so having providers and educators that reflect that diversity, I think enriches our ability to understand how to provide care.

We might not always understand how those in front of us are thinking, or how they're feeling, but having faculty that might have come from a similar background, or a similar culture, from our patient standpoint, that helps us to really think about what are the barriers to care, how we can improve care delivery. So I think particularly in medicine, we need to reflect those that we care for.

So many of our learners really model their careers by the people in front of them, and having faculty that they identify with, culturally or from similar backgrounds, it really engages our trainees. And it's important that we have faculty that they can identify with. So it enriches our education environment as well.

Narrator:

Viewpoint is a production of the Duke University School of Medicine. Tune in each month for Dean Mary Klotman's thoughts and ideas about important and timely topics and issues related to medical education, science and discovery, and patient care.

For more information, please visit https://medschool.duke.edu/viewpoint

Episode 3: What did it take to change HIV from a fatal diagnosis to an often-manageable chronic disease?

Narrator:

Hi and welcome to a Viewpoint with Dean Mary Klotman, from the Duke University School of Medicine. Today we spoke with Dean Klotman and asked her “What did it take to change HIV from a fatal diagnosis to an often-manageable chronic disease, and how can we learn from that success and apply it to other diseases?”

Dean Klotman:

My field of both research and clinical care started, really, when the HIV epidemic started in this country, and I was really able to see what happens when you bring together the power of an academic medical system in partnership with NIH and the federal government in partnership with industry. We had training of doctors. We had investigators change their research focus to HIV. We had funding from the government to support that research, and we had an industry that was really motivated to develop the therapeutics. And, when all that comes together it was a tremendous success story. Within a period of 25 years, HIV went from 100 percent fatal disease to a completely manageable disease. To me that is the justification to have academic health systems, because there is no other model that could bring together the clinical care, the training of the next generation of physicians, and scientists, and the research that was needed.

Certainly with HIV there was a sense of urgency. It rapidly became an international epidemic. The other areas of research have a sense of urgency as well, and in fact the war on cancer was declared in the 1970s. But some issues are more challenging than others. It just turned out with HIV, that at least in terms of the therapy and coming up with drugs, that was pretty straight forward because molecular biology had really come to maturity. And so you could understand the whole virus and start really developing drugs targeting the different critical proteins of the virus.

Cancer has been a lot more elusive. And so I don't think it's a lack of urgency, but I think we are almost at that tipping point for cancer now, where the technology, the understanding of basic cancer biology is at a point where I see an era where you could have again a great partnership between industry, NIH funding, and academic medical centers to really capitalize on what we think are really opportunities in cancer.

The moonshot initiative really does try to create incentives for institutions to come together to share data, and I think that that is potentially a major catalyst. But in the end of the day it's funding and the moonshot brings funding to be very focused on cancer. So yes, that kind of visibility helps quite a bit.

Narrator

Viewpoint is a production of the Duke University School of Medicine. Tune in each month for Dean Mary Klotman’s thoughts and ideas about important and timely topics issues related to medical education science and discovery and patient care. For more information, please visit medschool.duke.edu/viewpoint.

Episode 2: What is Data Science and Why is it Important?

Narrator:

Hi and welcome to Viewpoint with Dean Mary Klotman from the Duke University School of Medicine. Today we spoke with Dean Klotman and asked her about data science. “What is it and why is it important?”

Dean Klotman:

Data Science is really this growing field of quantitative scientists, scientific method and processes that you need to analyze very, very, large data sets that might come out from a lab; could even come from a single cell; they might come from a health system; or might come from the National Medicare Database. That data has a lot of information in it that we need, either to better care for patients, or to really develop a scientific hypothesis. The problem is that we're not organized, currently, to really be able to utilize that data.

So, realizing the power of big data, my first initiative was to create a Health Data Science Center, and engage Rob Califf, the former FDA Director to lead that. The cross-campus initiative, will really bring teams of scientists, both quantitative scientists that have the methods to analyze the data with the clinical and lab-based scientists that bring the questions to the table.

The center will address a broad range of questions, some might come from our clinical mission and ask "can we predict which patients might do poorly in an ICU setting?" And the idea is, with quantitative scientists and experts in machine learning, we will be able to have better algorithms to predict who might not do well, and then to put in processes that might prevent an adverse event.

On the laboratory side, we might bring together a team of basic scientists and quantitative scientists to ask "if we perturb a cell, and look at a data set before and after, can that tell us what change in that cell we might be able to prevent? Let's say, in a cancer cell. So, a whole range of questions we'll be addressing.

I think that the power of data science, right now, is just enormous. I will be very disappointed if we really can't take advantage of it.

Narrator:

Viewpoint is a production of the Duke University School of Medicine. Tune in each month for Dean Mary Klotman's thoughts and ideas about important and timely topics and issues related to medical education, science and discovery, and patient care.

For more information, please visit https://medschool.duke.edu/viewpoint

Episode 5: Translating Duke Health Initiative: In the coming year and beyond, how will Duke address society’s most significant scientific and healthcare challenges?

Narrator:

Hi and welcome to viewpoint with Dean Mary Klotman from the Duke University School of Medicine. Today we spoke with Dean Klotman and asked her "How will Duke address society's most significant scientific and healthcare challenges in the coming year and beyond?"

Dean Klotman:

I think the big opportunity today is that we can put together teams of scientists to address some of our biggest challenges. And one of those approaches that we're using is called the Translating Duke Health Initiative. We've identified five areas where we think we can put multidisciplinary teams together, and we can really make some progress. The five areas are kind of the obvious ones - cardiovascular disease. Why? Because it continues to be the major cause of death. Neuroscience, because we know dementia is becoming an increasing problem in our aging population. Certainly, children's health, with the idea that if we can identify risk factors early in life we can prevent later-in-life disease. Cancer, and we've chosen specifically to focus on metastatic disease as a major cause of morbidity and mortality. And then, immunology, because we know the immune system and harnessing the immune system is the underpinning of most diseases and therapeutic approaches today. So with that idea we are putting together teams approaching these major areas.

So brain disease to me is one of the most intriguing. We are entering into a new discovery for chronic brain diseases, particularly dementia. But the challenge is that those diseases are recognized way too late in the process. So the idea under the neuroscience initiative is to really move the science early in terms of being able to recognize diseases before they become symptomatic and that would hopefully give us some clues for early intervention that would allow repair, whereas currently we think we're identifying disease when we can no longer figure out any repair pathways.

So this is going to be one of our approaches multidisciplinary, bringing together technology, and really taking on some of our most pressing challenges.

Narrator:

Viewpoint is a production of the Duke University School of Medicine. Tune in each month for Dean Mary Klotman’sthoughts and ideas about important and timely topics and issues related to medical education, science and discovery, and patient care.

For more information please visit med school dot Duke dot edu backslash viewpoint.

Episode 4: “One Duke” . . . What does that really mean?

Narrator:

Hi and welcome to Viewpoint with Dean Mary Klotman from the Duke University School of Medicine. Today we spoke with Dean Klotman about the guiding principle of One Duke and why it's important to her.

Dean Klotman:

So, I think Duke has an incredible advantage over many other institutions that I feel has not been completely leveraged. That is the fact that we are a world-class health system attached to a world-class university. Physically, we are in close proximity. So, what that means to me in terms of “One Duke” is that that's an opportunity to leverage all the different connections that can enhance our missions in the School of Medicine. For instance, a world-class School of Engineering, a world-class School of Medicine, the obvious opportunities there are to really start working in teams to solve problems. Or we look at data science, we are looking at a full university that has all those quantitative departments of scientists that can contribute to the science at the School of Medicine. The other way I look at “One Duke” is in our Health System. We have the opportunity to really integrate our practices with our hospitals in a way that we haven't done as much of or haven’t needed to do as much of in the past. We've had a very successful practice that has grown. We've grown our hospitals. But when we look forward to how we deliver care, we really have to integrate across the delivery of care. That means that whether a patient is being seen in a practice or being taken care of in the hospital, that we make that a seamless transition, and in order to do that all the pieces have to work very well together. So, whenever I look at any opportunity at Duke, whether it's the research opportunity, it's the education opportunity or the clinical mission, I think if we work as a single institution we will be a lot more successful.

Narrator:

Viewpoint is a production of the Duke University School of Medicine. Tune in each month for Dean Mary Klotman's thoughts and ideas about important and timely topics and issues related to medical education, science and discovery, and patient care.

For more information, please visit https://medschool.duke.edu/viewpoint