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21
2014

Peds ID Fellow Jeff Donowitz one of 7 chosen for the Pediatric Scientist Development Program

Dr. Donowitz

Jeff Donowitz, M.D., seen here during a recent visit to Bangladesh, will examine the role small bowel bacterial overgrowth plays in vaccine failure and malnutrition in impoverished communities.

“The world’s malnutrition cannot be explained by food insecurity alone,” says Jeff Donowitz, M.D., an infectious diseases fellow in the Department of Pediatrics.

For children in the developing world, it’s more complicated than whether they get enough to eat. Malnutrition can also be impacted by unsanitary conditions and poor overall health that interferes with their ability to absorb nutrients.

Their future is further compromised by diseases like polio and rotavirus. Oral vaccines that are effective in the U.S. and Europe have a high failure rate in developing countries like Bangladesh. Not yet understood, this failure carries deadly consequences.

Donowitz has hit upon a theory that’s won him the support of a two-year fellowship. Donowitz is one of just seven pediatricians in the U.S. selected this year by the Association of Medical School Pediatric Department Chairs for the Pediatric Scientist Development Program.

He hypothesizes that that a condition known as small bowel bacterial overgrowth could hold answers to both the malnutrition and the unexplained vaccine failure seen in infants born into the developing world’s impoverished communities.

The small intestine normally contains bacteria. But those with small bowel bacterial overgrowth (SBBO) have abnormally high numbers of our body’s normal bacteria. Living in unsanitary conditions predisposes children to develop SBBO. Those with the syndrome suffer from poor nutrient absorption, and their immune system may also be compromised, since the gastrointestinal tract houses essential components for healthy immune function.

“Your gut’s immune system is the first place to react to an oral vaccine,” explains Donowitz. “Could an unhealthy gut be interfering with the vaccines’ effectiveness?”

During his two-year fellowship, Donowitz will work under the mentorship of William Petri, M.D., Ph.D., the highly respected chief of Infectious Diseases and International Health at the University of Virginia. He’s got a track record of mentoring young scientists along with funding from the NIH and the Bill and Melinda Gates Foundation. He’s also connected to the International Centre for Diarrhoeal Disease Research, Bangladesh that will provide Donowitz a ready-made research network with a more than 50-year history of clinical studies and life-saving treatment.

Jeff Donowitz, M.D.

Jeff Donowitz, M.D.

Nested within Petri’s on-going study, Donowitz’s project will enroll children who’ve received oral vaccines against polio and rotavirus. . He’ll use a breath test never before tried in Bangladesh to diagnose SBBO and then determine whether the children with SBBO fail the vaccine at a higher rate than children who do not have abnormally high levels of bacteria. Donowitz will also track specific biomarkers over time to gain a better understanding of the possible biomechanics at work.

Because SBBO is treatable with antibiotics, Donowitz’s hypothesis has the potential to improve many aspects of the children’s lives.

Donowitz was 17 when he took his first trip to the developing world to work in a clinic in northern Haiti. Struck by what he describes as the unfairness of the poverty he saw, Donowitz determined then that he would become a physician and work to benefit those born to the world’s poorest countries.

While an undergraduate, Donowitz majored in anthropology despite being advised toward the basic sciences. He felt “this discipline could teach me about the customs, beliefs and cultures of those people I meant to serve.” That led to a semester living with a family of rural farmers in the Himalayas of
Nepal.

“We ate mostly rice with few fruits or vegetables and got our water from a local river,” Donowitz remembers. “I contracted giardia, then scurvy. I began to better understand my target population.”

Donowitz traveled to Bangladesh for the first time this winter and will go again in the summer. For two years, he will focus entirely on his research project and will be relieved of all clinical responsibility in the Department of Pediatrics. The support of his fellowship makes that possible.

The Pediatric Scientist Development Program was established in the 1980s in response to a decline in the number of young research-trained pediatricians. The program supplies postdoctoral research training at a critical period in the career development of academic scientists by providing intensive training in research relevant to specialty areas of pediatrics.

The fellowship program is funded by the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, the American Academy of Pediatrics, American Pediatric Society, Sick Kids Foundation in Toronto, the March of Dimes and Paediatric Chairs of Canada. It is coordinated by the Cincinnati Children’s Hospital.

12
2014

M1 Jackie Britz among the winners at ACP national meeting

Edith Mitchell

The Class of 2017’s Jackie Britz in front of Big Ben. She studied at the London School of Hygiene and Tropical Medicine, earning a master’s degree in public health last year.

First-year medical student Jackie Britz is one of five winners in the research category of the American College of Physician’s Abstract Competition, held April 12 in Orlando, Fla., during the ACP’s Internal Medicine 2014 conference.

The competition, while a bit stressful at times for the West Hartford, Conn., has reinforced her passion to bring medical care to underserved populations.

“I was a little nervous, but the judge was very interested in my research and asked a lot of questions,” Jackie said. “It was a wonderful experience.”

Jackie was one of just 40 students from across the country chosen to present her research, which focused on the effects of charging immigrants in England to access primary healthcare services. Currently, primary care is free for immigrants, but the country is considering changing that, as some argue it would discourage those who immigrate solely to access free healthcare.

“This would affect more than one million people,” Jackie said. “The consequences would be huge.”

Jackie spent about a year researching the proposal’s impact as part of her thesis project at the London School of Hygiene and Tropical Medicine. She graduated last year with a master’s degree in public health.

After interviewing members of Parliament, the Department of Health, clinicians and others, the implications of charging immigrants became clear to Jackie. Most would delay seeking medical attention, which would lead to higher costs down the line. This would not only impact the patient, but the healthcare system and society as a whole.

“Jackie’s selection to the conference says a lot about her and will undoubtedly feed her enthusiasm,” said Lisa Ellis, M.D., associate professor of internal medicine and OB/GYN at VCU and the Governor of the state ACP chapter, which supported Jackie’s trip to the conference. “It is very impressive.”

Judges called Jackie’s research “timely.” It goes beyond pointing out healthcare’s problems by also offering solutions. Jackie cites international models, such as the London Pathway, which integrates mental, social and physical healthcare together for a more coordinated effort that saves money in the long run.

“Too often, when a person comes to the emergency room, just enough is done to get them out the door,” she said. “Then, they are back a few weeks later. How much better to get the whole picture right away.”

Jackie’s research has implications worldwide, including the United States, given the ongoing debate surrounding the Affordable Care Act and Medicaid expansion.

“A subset of the population will be denied healthcare if Medicaid is not expanded,” Jackie said. “There’s a gap – people who are not poor enough to qualify for Medicaid but they don’t qualify for subsidies under the Affordable Care Act. They are caught in the middle.”

Edith Mitchell

M1 Jackie Britz is one of five winners in the research category of the American College of Physician’s Abstract Competition.

Jackie, who hopes to get her research published, has come face to face with the underserved by volunteering in London, Paris, Guatemala, South Africa, Nicaragua and the United States.

“I’ve seen levels of poverty I never imagined,” she said. “I believe everyone has a fundamental right to healthcare.”

Jackie, 25, grew up with an interest in medicine. The youngest of four, she remembers concocting homemade remedies for her three brothers whenever they were sick. Mint leaves and mustard seeds on Cheerios were some of her more tasty solutions.

“Anytime they went to the doctor, I’d be right there asking questions,” she recalled. “I’ve just always felt drawn to medicine.”

She holds a bachelor’s degree in anthropology from James Madison University and, after earning her master’s, headed to the MCV Campus, primarily because of two big draws: the International/Inner City/Rural Preceptorship program, which prepares student doctors to provide quality, compassionate care to medically underserved populations, and the school’s Honduras Outreach Medical Brigada Relief Effort (HOMBRE).

“Studying medicine is a huge commitment, but I feel pushed to do this,” said Jackie, who heads to Peru this summer as part of HOMBRE. “I’m combining a lot of my passions together, and I feel so fortunate to be able to pursue them.”

- By Janet Showalter

11
2014

The Class of 1974’s Edith Mitchell returns to campus, speaks about cancer disparities

Edith Mitchell

The Class of 1974′s Edith Mitchell returned to campus and spoke with a full house about minimizing cancer care disparities. She also had the chance to meet student reps from our Student National Medical Association chapter.

For the Class of 1974’s Edith Mitchell, M.D., FACP, Reunion Weekend was more than a chance to reconnect with classmates and re-visit campus. It was also the chance to encourage a new generation of student doctors to consider racial disparities in cancer diagnosis, treatment and outcomes.

On Friday April 11, Mitchell spoke to an audience of faculty, residents and medical students in the Goodwin Research Laboratory. She discussed the myriad factors that are at work in cancers that disproportionately affect African-Americans and shared the cancer disparities trends she’s seen over a nearly 40-year career.

Mitchell asked the medical students and trainees in the room to include cancer research and treatment among their career options. To get them started, she shared information about a funding opportunity available to young investigators through the American Society of Clinical Oncology. The Jane C. Wright, MD, Young Investigator Award memorializes a physician who performed patient trials in chemotherapy as early as the 1940s. By 1967, when African-American women physicians numbered only a few hundred in the entire U.S., Wright was the highest-ranking African-American woman at a nationally recognized medical institution.

Following Mitchell’s talk, she met student representatives from the medical school’s Student National Medical Association chapter. The SNMA is the oldest and largest student-run organization focused on the needs and concerns of medical students of color.

The SNMA chapter’s president, Stequita Hankton, was on hand. “One thing I found surprising yet refreshing was Dr. Mitchell’s ability to present her extensive science-based research while simultaneously advocating for underserved communities,” said the member of the Class of 2017.

“Dr. Mitchell’s story of being one of only two African-American students was inspiring and was an affirmation as to how far the VCU School of Medicine has come in seeking diversity,” Stequita said. “I believe it is immensely helpful for students to hear from alumni who’ve gone before them. Having the opportunity to network with alumni provides students the opportunity to establish mentors as well as interact with their future colleagues.”

In 2012, Mitchell established the Center to Eliminate Cancer Disparities at Thomas Jefferson University’s Kimmel Cancer Center. She is a clinical professor of medicine and medical oncology in the Department of Medical Oncology at Jefferson Medical College of Thomas Jefferson University. Mitchell has also served as the program leader in gastrointestinal oncology for more than 15 years and has a focused research effort in aggressive breast cancers.