In 2018, while chair of the AAMC Board of Directors, Wayne State University President M. Roy Wilson delivered an address titled "The Most Important Lesson I Learned in Medical School." This article is an edited version of that address.

Herman Gray, M.D., M.B.A., chair of Wayne Pediatrics, discusses why the need for a new clinical pediatrics home came about and its vision for the future, serving the children of Detroit.

Regardless of her reputation as a performer, Aretha Franklin ‘s cancer doctors say she was no diva as a patient. As the anniversary of her death approaches, two of her doctors relate that the Queen of Soul handled the diagnosis and treatment with grace — and the grit to keep performing for years with a rare type of cancer. Franklin, who died in Detroit on Aug. 16, 2018, at 76, had pancreatic neuroendocrine cancer, which starts in the pancreas but is far different and much slower developing than the more common, aggressive type of pancreatic cancer known as adenocarcinoma. Franklin’s kind is exceedingly rare: Neuroendocrine cancers comprise about 7 percent of cancers originating in the pancreas, according to the Neuroendocrine Tumor Research Foundation. Dr. Philip Agop Philip, a professor at Karmanos and Wayne State University, recalled how she wanted to continue her life as normally — and positively — as possible. “She was full speed — she wasn’t even complaining,” said Philip, who first saw Franklin in early 2011 and was her doctor of record at the time of her death. “That was different than what I expected. ... She never showed signs that she was close to thinking that she may give up ... until the end, close to the end.” Philip saw a patient who didn’t demand star treatment, saying she never made him or his staff “feel that we need to treat her as a celebrity.”

Wayne State University has created a new practice plan called Wayne Pediatrics, according to Dr. Herman Gray, chair of the new Wayne Pediatrics department. Gray says the department is taking advantage of this opportunity to reimagine how care is delivered to children and their families in an urban setting. As part of that effort, Wayne Pediatrics has created the Urban Children’s Health Collaborative, an initiative to connect urban kids with better health care. Gray also talked about the wider health care disparities that exist, both in Detroit and around the country. “Certainly, poverty and racism are pretty much universally acknowledged as the foundational components of societal disparities,” says Gray. “We believe that being minimized, being disrespected, being uncertain of your place in society induces toxic stress.”

Legislators and public-health officials are celebrating a recent rise in Ohio’s smoking age as a triumph in the battle against teenage smoking. Anti-smoking advocates, on the other hand, worry that the new age limit will discourage cities and towns from adopting the strict regulatory approach that they argue is more effective in the fight against teen tobacco use. Advocates worry that police, with bigger problems to handle than smoking among youths, will leave age limits on tobacco purchases unenforced. Jeff Stephens, government relations director in Ohio for the American Cancer Society’s Cancer Action Network, approved of the state raising its tobacco age, but he said the risk of a retailer losing its license is the best way to keep stores from selling to young people. There is research to support both approaches. Yale University health policy professor Abigail Friedman conducted research that found underage smokers often acquire tobacco and vaping products from adult friends. Other studies came to similar conclusions, said Wayne State University School of Medicine professor Daniel Ouellette, who has reviewed research on teen smoking. That suggests that raising the age limit is a good way to deter smoking by minors, he said.

The future of newly formed Wayne Pediatrics and restructured University Physician Group, two affiliates of the Wayne State University School of Medicine, is becoming clearer with a planned occupancy in October of the former Hospice of Michigan building at 400 Mack Ave. in Detroit. In late June, UPG signed a two-year lease with an option to purchase the 55,000-square-foot, five-story building, across the street from the Detroit Medical Center campus. Wayne Pediatrics also has committed to sublease an unspecified amount of space for its new administrative and clinical offices. On Oct. 1, 75-80 UPG administrative staff will move into the practice's new headquarters and clinic, said UPG CEO Charles Shanley, M.D.

Wayne State University Assistant Professor of Psychiatry Arash Javanbakht answered some questions about mental illness, mass murder and whether it’s possible to prevent horrific shootings. Is a person who commits mass murder mentally ill? What is the difference between extremism and mental illness? And, are there ‘red flag’ behaviors that can indicate risk? According to Javanbakht, the good news is that, to prevent a violent person from access to firearms, we do not need an established diagnosis of a mental illness. The history of unreasonable violence itself is enough. These measures may not prevent some of the mass shootings, but they can help with a lot of murders and deaths by suicide.”

Arash Javanbakht, assistant professor of psychiatry, wrote a piece for The Conversation talking about the complexities of mental illness and guns. “President Donald Trump called for reform of mental health laws on the heels of two deadly shootings that claimed the lives of at least 31 people and left a grief-stricken country in disbelief. The president, saying that “hatred and mental illness pulls the trigger, not the gun,” also called for better identification of people with mental illness and, in some cases, “involuntary confinement” of them. These sentiments are similar to comments that Trump and a number of other politicians have made previously…In this debate, many questions arise that those discussing mental illness and gun violence may not even think about: What do we mean by mental illness? Which mental illness? What would be the policies to keep guns away from the potentially dangerous mentally ill? Most of these questions remain unanswered during these discussions.”

Roughly 1 in 6 LBGTQ people nationwide report being discriminated against when visiting a doctor or health clinic, while 1 in 5 say they’ve avoided health care because of discrimination fears, according to a 2017 survey of  lesbian, gay, bisexual, transgender, and queer adults. That, in turn, deepens health disparities over a lifetime as patients skip screenings and get less help for chronic conditions and poor health habits, according to an overview of health research by the U.S. Office of Disease Prevention and Health Promotion. From public health clinics to large hospital systems, Michigan’s health care industry is reaching out to close such disparities, from updating forms to accommodate genders beyond “male and female” to adding LGBTQ-specific services. Among the most tangible efforts is the Corktown Health Center in Detroit, which opened in 2017 as Michigan’s first nonprofit health center with a focus on LGBTQ patients. It’s also one of only a few dozen such centers nationwide. As vice chair of education at Wayne State University’s Department of Internal Medicine, which helped establish Corktown Health Center,  Dr. Diane Levine is helping Wayne State’s medical school incorporate coursework, clinical teaching, and even residency slots at Corktown so that medical students today are more aware of the needs of LGBTQ patients tomorrow. The curriculum will mean that new medical students will go from “about two hours” of focus on LGBTQ health in the classroom, to about two dozen hours, she said. Among her presentations, she said, is the genderbread person, to prompt discussion on the interplay of the mind, heart, and reproductive organs. Understanding these basics, she said, is a first step in understanding a patient, she said. “And that,” she said, “is really Doctoring 101.”

A new research division at Wayne State University will focus on ways to improve health by reducing the use of nicotine and tobacco. The unit at the School of Medicine's Department of Psychiatry and Behavioral Sciences launched this month and it's called the Nicotine and Tobacco Research Division. It offers Wayne State researchers a hub to enhance research communication, collaboration and educational opportunities. Dr. David Ledgerwood, an associate professor of Psychiatry and Behavioral Sciences, is director of the division. The division will encourage multidisciplinary collaboration among scientists who are studying nicotine and tobacco use as well as in the broader academic community. It also will seek to heighten the profile of nicotine and tobacco research by showcasing studies and scientific programs.

Dr. Ghassan Saed, associate professor of obstetrics and gynecology at Wayne State University, wanted to see the link between talcum powder and ovarian cancer for himself. His lab focuses on studying how ovarian cancer cells evolve and become cancerous, and why they eventually become resistant to chemotherapy. “I heard the talcum powder ads about increased risk of ovarian cancer and thought, ‘is there a link?’” Saed said. In February 2019, Saed and his team conducted and published a study to Reproductive Sciences confirming the link between the powder and ovarian cancer. WSU’s findings are the first to confirm the cellular effect of talc and provide a molecular mechanism to previous reports linking genital use to increased ovarian cancer risk. Women who have used talcum powder are at a higher risk of developing ovarian cancer and should receive special medical attention, said Saed.

Presidential candidate Rep. Seth Moulton, D-Mass., and Sen. Tina Smith, D-Minn., recently delivered confessions that are rare for members of Congress: They once struggled with and were treated for mental health conditions, he for post-traumatic stress disorder and she for depression. Discussing such problems out loud is a gamble in politics, and over the years few others in Congress have been forthcoming, but the chances are high that a number of politicians have faced mental health problems. An estimated 47 million people in the U.S. in any given year struggle with conditions such as anxiety or depression. Of those, 11 million have more serious conditions such as bipolar disorder or schizophrenia, according to the National Alliance on Mental Illness. Among the members of Congress who have shared their diagnoses are Rep. Ruben Gallego, D-Ariz., who started speaking openly about his PTSD after he was elected in 2014, and former Rep. Lynn Rivers, D-Mich., who shared in 1994 that she was successfully being medicated for bipolar disorder. "People use anything they can find against their opponent," said Arash Javanbakht, assistant professor of psychiatry at Wayne State University School of Medicine. Most insults, he said, are "rooted in ignorance or misinformation." He added, however, that he believes substance abuse or having a personality disorder would be most worrisome for a leader because they impair judgment.

A recent study shows that the number of people living with MS is on the rise. A recent MS Prevalence Study funded by the National Multiple Sclerosis Society shows that in 2010 the estimated 10-year prevalence of adults in the U.S. was 727,344 cases, not the 400,000 that had previously been thought. In addition, the study shows the prevalence of MS cases from 2000 to 2017 is now estimated at 913,925 cases, though that number may be as high 1,000,000. Dr. Robert P. Lisak, who specializes in neuroimmunologic diseases at Wayne State University School of Medicine, said that an initial increase in the numbers of people with MS was thought to be because of better diagnostic tools and more awareness of the disease. "But over the last 10 to 20 years we think there are more cases," Lisak said, though nobody knows why. The problem is if you don't know the cause of the disease you can speculate all you want, but you don't really know," he said. "But there is probably no one single cause or one single risk factor," Lisak said. Lisak said there are new medications out that delay or even prevent progression of the disease. But researchers still need to find out what ultimately causes MS — the mechanisms of what causes attacks, what causes attacks to shut off and what causes progression. Until that is known it is hard to develop therapies, he said. "We need to get more basic knowledge in order to make further progress."

If you live in southeast Michigan, your ZIP code may determine how long you live. Live in the 48236 ZIP of Grosse Pointe and at birth you can expect to live to an average of 82 years. Just a few short miles away, however, if you’re born and live in the Detroit ZIP of 48201, you can shave 13 years off that respectable mark. The 13-year loss can be attributed to numerous factors, including a lack of access to healthy food, health care and safe places to exercise. Resource limitations and socioeconomic disparities in the 48201 ZIP code also contribute to soaring levels of toxic stress and poor health. That stress often manifests in the form of disproportionate levels of high blood pressure, which, if uncontrolled, brings on a host of illness guaranteed to shorten lifespan. That’s the bad news.
The good news, as attendees of the Detroit Regional Chamber’s annual Mackinac Policy Conference heard Thursday morning, is that a radically new form of mapping health data by census tract may give policymakers, researchers and health care providers the information they need to design targeted efforts to improve health in areas with a long history of worse outcomes. The goal, said Phillip Levy, assistant vice president of Translational Science and Clinical Research Innovation for Wayne State University, is to develop a precision approach to population health, guided by data provided by drilling down as far as possible, perhaps even to individual neighborhoods.

Arash Javanbakht, assistant professor of psychiatry, wrote a piece for The Conversation about the growing interest in trauma and childhood trauma. “A child’s brain is a sponge for learning about how the world works and who they themselves are. We humans have an evolutionary advantage in having the ability to trust the older and learn from them about the world. That leads to cumulative knowledge and protection against adversity, about which only the experienced know. A child absorbs the patterns of perceiving the world, relating to others and to the self by learning from adults. But when the initial environment is unusually tough and unfriendly, then a child’s perception of the world may form around violence, fear, lack of safety and sadness. Brains of adults who experience childhood adversity, or even poverty, are more prone to detecting danger, at the cost of ignoring the positive or neutral experiences.” Javanbakht continued: “Childhood trauma is more common than one would think: Up to two-thirds of children experience at least one traumatic event. These include serious medical illness or injury, firsthand experience of violence or sexual abuse or witnessing them, neglect, bullying and the newest addition to the list: mass shootings.

A client suffers from one of the oldest and most common fears: arachnophobia. The mere thought of a spider causes her anxiety, and she often has a friend check a room for spiders before she enters. She wants to get help, but she lives in a remote area without access to a clinical expert. Could the use of augmented reality help the client overcome this phobia and actually touch a tarantula? Arash Javanbakht, an assistant professor of psychiatry and director of the Stress, Trauma & Anxiety Research Clinic (STARC) at Wayne State University, has found that it can. At STARC, Javanbakht uses augmented reality along with telepsychiatry as a method of exposure therapy for clients with phobias.

“You can throw all the medicines you want at the [hypertension] problem, but if you can’t fix the upstream social determinants, you’ll never solve it,” said Dr. Phillip Levy, an emergency room physician at Detroit Receiving Hospital and cardiovascular researcher who developed the tool. Levy’s work will be presented Thursday at the Detroit Regional Chamber Mackinac Policy Conference. If all goes well, the map could one day address health disparities at the street level throughout Michigan, combining neighborhood health data with demographic information such as age, race, demographics, income, insurance coverage, pollutants, access to transportation, fresh food and more. “This is about using information to address adverse health outcomes of the state. We know that heart disease disproportionately affects Detroit, so it makes sense to start there,” he said. Levy’s work is part of an emerging focus in health care on “precision public health, as more practitioners, public health advocates, and even community leaders and businesses better understand that certain demographics and neighborhoods carry more “disease burden” than others.

Cystic fibrosis (CF) is a complex, life-threatening disease that affects many organs in the body, including the lungs, kidneys, and gastrointestinal tract. It’s caused by a genetic mutation that causes a certain protein to stop working. “The predominant way CF affects the body is in the gastrointestinal and respiratory system, but it causes a wide variety of complications that affects every system in the body,” Zubin Mukadam, M.D., assistant professor of pulmonary and critical care at Wayne State University, tells Health. “We do a lot of newborn screening,” says Mukadam. “However, a lot of kids get missed because there are over 1,700 genetic mutations that could prompt CF, and most genetic tests only screen for the most common mutations.” 

Steven Ondersma discovered that "only a very small proportion, maybe 10 percent" of the people who need professional care realize that need and have the means to address it. "I've just become really interested in having whole-population effects, rather than helping a few people who might be ready to make use of the treatment and have access to that treatment," says Ondersma, deputy director of the Merrill Palmer Skillman Institute at Wayne State University. Ondersma and others in Michigan who are interested in addressing the social determinants of health have increasingly turned to technology as an answer to that question. Weisong Shi, professor of computer science at Wayne State envisions the potential for technology to bring a doctor's office to those more remote patients. He proposes a vehicle, "just like an ice cream truck," that would allow people to get basic physical tests in their communities, with the results being transmitted back to a provider's office. "You can go to this rural area and ... run these checks without asking these people to drive about 50 miles away to go to a hospital to do this kind of test," Shi says. Asthma disproportionately affects African-Americans nationwide, but in Detroit the problem is particularly pronounced – and often an emergency situation. Karen MacDonell, associate professor in Wayne State’s School of Medicine, has been using technology to improve those outcomes with the Detroit Young Adult Asthma Project. Funded by a series of National Institutes of Health grants, MacDonell began the project over 10 years ago by interviewing young African-American Detroiters about their asthma. She asked participants what strategies would help them adhere to their medication before an emergency arose. "Long story short, they wanted something using technology – something they could have with them, something easy to manage, something brief," she says. MacDonell developed a text messaging program that collects information about a patient's asthma and then sends the patient conversational messages encouraging medication use.

Researchers in Wayne State University’s department of ophthalmology, visual, and anatomical sciences have discovered in experimental models that the Zika virus can cause glaucoma. The study was published in mSphere, a peer-reviewed journal of the American Society of Microbiology. Zika virus, or ZIKV poses challenges in reproductive health and has been shown to cause neurological disorders, primarily microcephaly, or the abnormal shrinking of the head circumference. Several clinical studies have also linked ZIKV to ocular deformities. “The eye is protected from systemic infection due the presence of a protective barrier called the blood retinal barrier,” says Ashok Kumar, associate professor and lead author of the study. “Previous studies from our laboratory have shown that ZIKV has the ability to infect and replicate in cells making the blood retinal barrier, hence potentially allowing the entry of ZIKV into the eye."