Health Care in the Spotlight at Aspen Ideas Festival

Novel ways to prevent and treat Alzheimer’s disease, deploy immunotherapies to fight cancer, and train pediatricians to teach brain-building skills to new parents were among the topics discussed by experts from the Mount Sinai Health System at the 2019 Aspen Ideas Festival in June. For seven consecutive years, Mount Sinai’s leading doctors have participated in the Festival, which is a unique forum for the exchange of ideas held each summer in Aspen, Colorado.

“The Aspen Ideas Festival is a special place where innovation is showcased,” says Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System. “Mount Sinai is an academic medical system on the leading edge of discovery. We have a lot to share.” As a panelist and moderator, Dr. Davis participated in discussions on several topics, including ways to stem increasing drug prices that cost Americans an estimated $460 billion a year. “We want to ensure that patent laws favor innovative drugs and not just brand-name drugs with patents that extend their market exclusivity, even when there’s no additional benefit to patients,” Dr. Davis told an audience.

Kenneth L. Davis, MD, second from right, led a roundtable discussion in Aspen about the future of health care.

Dr. Davis also moderated a panel discussion titled “What Will it Take to Prevent Dementia?” which offered attendees a positive glimpse of future developments. The panel of experts said that within the next five years they expect to see new blood tests to predict Alzheimer’s disease and new drugs to slow its development in the brain, which can take 20 to 30 years.   

Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System, discussed his role in co-inventing a patented method for treating patients with treatment-resistant depression, SPRAVATO™ (esketamine) nasal spray, which was approved by the U.S. Food and Drug Administration in early 2019. SPRAVATO uses the first new mechanism of action in decades to treat major depressive disorder (MDD). It is estimated that approximately one-third of U.S. adults with MDD have treatment-resistant depression. The discovery, Dr. Charney said, came from “a small group of researchers who met every week to share ideas. We also created a collaborative relationship with a pharmaceutical company to bring forth a treatment for a devastating disorder that has a profound impact on people’s lives.”

Three Mount Sinai cancer specialists participated in a panel discussion about the latest methods to harness the immune system to fight cancer: Steven Burakoff, MD, Dean for Cancer Innovation and Chief of Pediatric Oncology; Fred Hirsch, MD, PhD, Executive Director of the Center for Thoracic Oncology in The Tisch Cancer Institute; and Miriam Merad, MD, PhD, Director of the Precision Immunotherapy Institute, and Director of Mount Sinai’s Human Immune Monitoring Center. They said some of these immunotherapies are being used successfully in conjunction with traditional chemotherapy.

Free Skin Cancer Screening in Aspen Leads to Wake-Up Call

Click above to watch Maley Thompson tell her story.

Growing up in Aspen, Colorado, Maley Thompson enjoyed an active lifestyle, spending time outdoors in the summer and skiing in the winter. For years, Ms. Thompson routinely applied sunblock to her fair skin and believed it was providing her with adequate protection from the sun.

But her notion of safety changed abruptly at the 2018 Aspen Ideas Festival, when a complimentary skin cancer screening by doctors from the Mount Sinai Health System identified a small, but oddly shaped mole on Ms. Thompson’s neck. Each year, physicians and nurses from Mount Sinai’s Kimberly and Eric J. Waldman Department of Dermatology and Mount Sinai Heart perform hundreds of free screenings for skin, and blood pressure and cholesterol, onsite at the Aspen Ideas Festival.

“I was pretty cocky going into the Mount Sinai tent,” Ms. Thompson said during an interview at this year’s Aspen Ideas Festival. “But last year I was five months pregnant, and when they found something on my neck, I said, ‘is this something I need to treat immediately?’ And the doctor said, ‘yes.’”

Two days after returning home to Seattle last year, Ms. Thompson visited a dermatologist who biopsied the mole and found that it was precancerous. “I now know that I am at high risk because I grew up at high altitude, and I am so fair,” she said. “I have to get checked every six months rather than every year.” Ms. Thompson said she was grateful to Mount Sinai’s doctors for performing such a thorough screening and immediately zeroing in on the suspicious mole. “Without this service I would not have known that I had a precancerous mole in the middle of my neck,” she said. “I wouldn’t have had it taken care of. The problem would have exacerbated, and I would be dealing with it now as opposed to when it was easy to remove.

Lung cancer expert Dr. Hirsch told the audience that over the past decade there has been “tremendous progress in the treatment of patients with lung cancer, particularly those with metastatic disease.” This, he added, was due to the development of “molecular targeted therapies and most lately, immunotherapy,” which have extended survival rates to five years from seven to nine months, for certain patients. The targeted therapies require physicians to sequence the tumor mutations to find out which drug will work best for that tumor.

Dr. Burakoff urged cancer patients to get a full genomic panel review of their cancer. “Twenty-five years ago you would go to an oncologist who treats many cancers, but now everything is very specific,” Dr. Burakoff said. “It is important to go to a tertiary care center where the subspecialty expert will look at the tumor and the type of mutations you have to help identify or define the treatments.”

Dr. Merad, Mount Sinai Professor in Cancer Immunology, said that the development of immunotherapies to treat cancer represented a revolution in care and that these therapies would improve over time as researchers gained more knowledge. Her laboratory is currently investigating novel biological pathways and new clinical trials.

“We have never been as excited as we are now,” Dr. Merad said. “There has been success, but not 100 percent success, and my group focuses on those cases that resist this treatment.” 

In a panel discussion on reinventing the pediatric visit, Carrie Quinn, MD, Executive Director of the Mount Sinai Parenting Center, discussed the Mount Sinai Health System’s collaboration with the nonprofit Bezos Family Foundation to enhance learning opportunities for children in their first years of life, when their brains are primed to learn. In addition to leading an eff ort to create upbeat messages that encourage enhanced communication between parents and their babies that will be placed throughout Mount Sinai’s labor and delivery and pediatric hospital units, Dr. Quinn has helped build and pilot a free and self-directed online curriculum to train pediatric residents about the science of early childhood development.

“How the parent responds to a child’s cues and emotions really builds those brain connections,” said Dr. Quinn. “It might be a baby turning their head away or crying, or arching their back. That’s a signal, that’s a sign of communication for an infant. So we want to help parents recognize those cues, the language of babies, and respond back and forth with them.”

Awards Ceremony Honors Exceptional Mount Sinai Faculty

Back row: Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System, right, and Joanne Stone, MD, MS, Faculty Council President and Professor of Obstetrics, Gynecology and Reproductive Science, left, presided over the Faculty Awards ceremony. Honorees included, front row, from left: Lauren Peccoralo, MD, MPH; Jeffrey Laitman, PhD; Christina Weltz, MD; Nathan Kase, MD; and Chitra Upadhyay, PhD; back row, starting second from left: Juan Wisnivesky, MD, DrPH; Madhav Menon, MD; Gaelle Doucet, PhD; Florian Krammer, PhD; and Ari Greenspan, MD.

The annual Faculty Awards ceremony recently recognized 14 outstanding physicians, researchers, and educators of the Icahn School of Medicine at Mount Sinai. Honorees included senior faculty who have made significant contributions to Mount Sinai and to their fields, as well as junior faculty who have demonstrated exceptional potential in the early stages of their careers in medicine and science.

The Honorees:

Faculty Council Lifetime Achievement Awards: Nathan Kase, MD, Dean Emeritus and Professor of Obstetrics, Gynecology and Reproductive Science; and Jeffrey Laitman, PhD, Distinguished Professor of Medical Education

Faculty Council Senior Faculty Awards: Andrew Hecht, MD (Orthopedics); Florian Krammer, PhD (Microbiology); Christina Weltz, MD (Surgery); and Juan Wisnivesky, MD, DrPH (Medicine)

Faculty Council Junior Faculty Awards: Lauren Peccoralo, MD, MPH (Medicine); and Junqian Xu,PhD (Diagnostic, Molecular and Interventional Radiology)

Dr. Harold and Golden Lamport Research Awards (Basic Research): Ian Maze, PhD (Neuroscience); and Chitra Upadhyay, PhD (Medicine); (Clinical Research): Gaelle Doucet, PhD (Psychiatry); and Madhav Menon, MD (Medicine)

Solomon Silver Award in Clinical Medicine: Ari Greenspan, MD (Medicine)

Special Faculty Council Award of Appreciation: Tanvir Choudhri, MD (Neurosurgery)

 

 

Innovators in Psychiatry

From left: Murad Khan, MD; Annie Hart, MD; Psychiatry Innovation Lab judge Debbie Profit, PhD; Isobel Rosenthal, MD, MBA; and Jordyn Feingold, MAPP, MD/MSCR candidate. Credit: David Hathcox

A group of medical students and residents from the Icahn School of Medicine at Mount Sinai recently won the $10,000 grand prize at the Psychiatry Innovation Lab competition, which was held at the American Psychiatric Association’s annual meeting in San Francisco. At the competition, contestants pitch their ideas to create products or services that promise to transform mental health care.

Annie Hart, MD; Isobel Rosenthal, MD, MBA; Jordyn Feingold, MAPP, MD/MSCR candidate; and Murad Khan, MD, received the grand prize for developing Medimmunity, an online platform that helps medical students and residents survive the stress of medical training.

The project is based on Mount Sinai’s PEERS program, which uses small group sessions to provide medical school students and residents with skills for managing personal and academic challenges. The sessions are held twice a year and are led by a psychiatry resident and a senior medical student who are paired with students during their four years of medical school.

Drs. Hart and Rosenthal and Ms. Feingold are currently at Mount Sinai. Dr. Khan is now a psychiatry resident at the Yale School of Medicine.

Road to Resilience Episode 14: Measuring the Mental Toll of Child Separation

From left: Priscilla Agyeman, MPH, and Craig Katz, MD

Mount Sinai researchers have published the first large, empirical study examining the mental health of children held at a U.S. immigration detention center in Social Science & Medicine. In episode 14 of Road to Resilience, co-authors Craig Katz, MD, director for advocacy of the Mount Sinai Human Rights Program, and Priscilla Agyeman, MPH, a clinical research coordinator at the Icahn School of Medicine at Mount Sinai, talk about what they found and what it means for all of us.

Ms. Agyeman and two colleagues spent two months speaking with more than 400 mothers about the mental health of their children who were being detained with them. The researchers found higher rates of emotional and behavioral difficulties, as well as PTSD, among the children compared to their peers in the general U.S. population. Children who had been separated from their mothers demonstrated a significantly greater number of emotional symptoms and total difficulties compared to children who had not been separated, suggesting that separation is associated with increased psychological distress.

“The efforts in this study exemplify how psychiatry can be more proactive, community-oriented, and public health oriented,” said Dr. Katz. “We as psychiatrists need to get out there in the world and not wait for the world to come to us. Our findings told us in science what you know in your heart.”

Road to Resilience brings you stories and insights to help you thrive in a challenging world. From fighting burnout and trauma to building resilient families and communities, the podcast explores what’s possible when science meets the human spirit. To listen, visit Apple Podcasts, Spotify, Stitcher, Google Play, or the Road to Resilience website.

Elizabeth Howell, MD, MPP, at TEDMED 2018: How to Improve Care for Pregnant Women

Every year, between 700 and 900 women suffer a pregnancy-related death in the United States. Even more concerning is that a significant portion of these deaths are preventable.

In addition, for every death, more than a hundred women experience a severe pregnancy complication, such as a blood clot, blood transfusion, a hemorrhage, or a seizure during their delivery hospitalization. And significant racial disparities exist in both rates of maternal deaths and severe complications related to pregnancy.

In November 2018, Elizabeth Howell, MD, MPP, the founding Director of The Blavatnik Family Women’s Health Research Institute  at the Icahn School of Medicine at Mount Sinai, gave a TEDMED talk that explored maternal mortality, severe complications of pregnancy, and race in the United States.

“The shocking thing is that our maternal mortality rate in the United States is actually higher than all other high-income countries, and the numbers are far worse for women of color. Our rate of maternal deaths has actually increased over the last decade while other countries have reduced their rates. And here’s the biggest paradox of all: we spend more on health care than any other country in the world.”

In her talk, Dr. Howell, who is also Vice Chair of Research and Professor of Obstetrics, Gynecology and Reproductive Science, and Professor of Population Health Science and Policy, describes current statistics, the magnitude of the racial disparities that exist, and national efforts currently in place aimed at reducing maternal death, severe complications and disparities.

The Mount Sinai Hospital and David H. Adams, MD, Receive Top State Rating for Cardiac Valve Surgery

Members of the Mount Sinai Health System’s Mitral Valve Repair team, from left, Julie Swain, MD; Javier G. Castillo, MD; Ahmed El-Eshmawi, MD; Amit A. Pawale, MD; David H. Adams, MD; Percy Boateng, MD; Anelechi Anyanwu, MD; and Ricardo A. Lazala, MD.

The highest quality rating for adult cardiac valve surgery has been awarded to The Mount Sinai Hospital and to David H. Adams, MD, Cardiac Surgeon-in-Chief, Mount Sinai Health System, and Marie-Josée and Henry R. Kravis Professor and Chairman, Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai.

In the 2019 annual report by the New York State Department of Health (NYSDOH), Dr. Adams was recognized as the highest-volume valve surgeon in the state, performing 1,055 valve operations from December 1, 2013, to November 30, 2016. The report also noted that The Mount Sinai Hospital’s program overall performed 2,271 valve operations in that period, more than any other hospital in the state.

“I am very proud to lead a multidisciplinary team of professionals who are so committed to quality,” says Dr. Adams, who was one of only six surgeons in the state to achieve the top rating. “Our volume and outcomes are a testament to our team’s outstanding dedication to each and every patient with valvular heart disease whom we are honored to take care of at Mount Sinai.”

The state report, “Adult Cardiac Surgery in New York State 2014-2016,” tracked data for patients discharged from 38 New York State hospitals where cardiac surgery is performed. Using a risk-adjusted mortality rate (RAMR), the state evaluated the quality of care that hospitals and surgeons provided. The NYSDOH has been publishing quality ratings for more than 20 years in reports designed to help patients make better decisions about their care based upon a statistical review of each hospital’s data.

The adult cardiac valve ratings measure the quality of “index” open-heart procedures. These are coronary artery bypass graft. (CABG) surgery, in which a vein or artery from another part of the body is used to bypass a blocked artery in the heart; cardiac valve surgery, in which a malfunctioning heart valve is repaired or replaced; and operations that combine CABG and valve surgery. For index procedures, the report showed The Mount Sinai Hospital to be the best in New York City, and one of the top three in the state.

During the study period, the Department of Health’s report found that The Mount Sinai Hospital achieved a risk-adjusted mortality rate of 2.32 for isolated valve and combined valve and CABG surgery, significantly lower than the state average of 3.12. In the ratings for individual surgeons, Dr. Adams achieved an RAMR of 0.33, significantly lower than the statewide average of 2.24, while performing more of these procedures than any other surgeon.

“Many studies have looked at the correlation between volume of procedures and quality of outcomes, and there is a good correlation,” says Julie Swain, MD, Vice Chair, Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai. “Generally the higher the volume, the better the results.” Dr. Swain says the hospital’s superior rating in adult cardiac surgery reflected well on the entire heart team, because nurses, administrative staff, housekeeping, and all members of the team are critically important in successful outcomes.

Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, says, “Patient safety is the ultimate goal in cardiac surgery, so this rating makes all of us very proud.”