The critical developmental windows for the observed discrepancies varied for each element, suggesting that systemic dysregulation of environmental pollutants and dietary elements may serve an important role in ASD. In addition to identifying specific environmental factors that influence risk, the study also pinpointed developmental time periods when elemental dysregulation poses the biggest risk for autism later in life.
Kenneth L. Davis, MD, President and CEO of the Mount Sinai Health System, delivered this speech at the MD, PhD and Dual Degree Commencement of the Icahn School of Medicine at Mount Sinai on Friday, May 12.
Graduates, four years ago, at our first gathering, you each received your white coat—a symbol of compassion. As you’ve worn it, I trust you’ve come to understand that the practice of medicine requires more than study, more than knowledge, more than skill. It also requires compassion and empathy. As graduates of our school, I want you to hold firm to that core value, because the compassion you feel will never allow you to abandon the most vulnerable, or being my brother’s keeper.
I raise this because our ability to treat each and every patient in need of care, to prevent disease, and to optimize care is under threat today. Last week, the House of Representatives passed a bill that sharply conflicts with our core values. I speak, of course, of the American Health Care Act, which, if allowed to become law, would dramatically alter the health care of America.
Since 1965, when President Lyndon Johnson signed the law that created Medicare, the United States has increased access to health care under both Democrats and Republicans. President Ronald Reagan expanded Medicaid to cover more low-income children and their mothers. President George H.W. Bush created the Children’s Health Insurance Program to provide health care coverage for low-income children previously not covered by Medicaid. President George W. Bush further expanded the number of Americans who could receive coverage under Medicaid and added a prescription drug benefit to Medicare. And of course the Affordable Care Act, signed by President Obama, continued the tradition of Americans caring for Americans, drastically reducing the number of uninsured.
Turning back the clock
What the House of Representatives has done turns back the clock. For the first time in over 50 years, we would be diminishing access to health care for tens of millions of our citizens. For the first time in over 50 years, we would become a less compassionate society.
Those who promoted the bill make some extraordinary claims. Among those are: Our most vulnerable citizens would have improved health care; no one would lose their insurance; people with pre-existing conditions would be protected.
Here’s the reality: The bill would slash nearly a trillion dollars from Medicaid—nearly a trillion dollars— causing millions to lose health care coverage. New York State alone stands to lose $7 billion a year. Federal Medicaid funding for Planned Parenthood, which some of you may know was started by Mount Sinai OBGYNs, would be ended, and tax credits could not be used to buy insurance that includes abortion coverage. States would allow insurance companies to charge patients with pre-existing conditions higher rates—thousands, even tens of thousands, more dollars than they’re being charged now. And, of course, we’ve heard that high-risk pools will be established, allegedly to offset some of the rate increases. I need to say a word about those high-risk pools. High-risk pools are not a panacea. They’ve been underfunded in the past. They have been tried before, and by most estimates the number in this bill is inadequate. In fact, 35 states have tried high-risk pools, and in 31 of them they have failed. Most of the pools lost huge amounts of money. The consequence was that patients could not afford to buy into those high-risk pools.
Stripped-down health policies
The House bill also allows states the option to waive the requirement that insurance plans have the essential benefits. Essential benefits under the Affordable Care Act included ambulatory care, emergency care, hospitalization, maternity care, prescription drugs, lab services, pediatric services, mental health and substance abuse, and prevention and wellness services. So what’s left? What kind of stripped-down policies would insurance companies be allowed to sell under the rubric that we’ll have more affordable, less expensive policies? Under the heading of choice, Americans can be sold virtually worthless policies, policies that carry high deductibles and co-pays, policies that will produce awful surprises when the buyer becomes ill and discovers what services are not covered.
One of the essential services that need not be covered is mental health and substance abuse care, this despite the fact that 60 percent of the leading disabilities in the world are brain diseases. When we make mental health coverage optional, what we say is, “You don’t really need that.” But this could not be further from the truth, particularly as many people with mental health problems deny their illness until it is too late, a circumstance that is aided and abetted by this choice.
The Affordable Care Act has delivered health insurance to 16 million Americans. The Act has brought the uninsured rate down to the lowest level in American history. As a result, Americans are healthier and living longer; there is lots of data to support that. The bill passed by the House would roll back those victories. Indeed, the Congressional Budget Office estimates that 24 million Americans would lose health care coverage, and, of course, people without health care insurance often go without health care.
A study published prior to the Affordable Care Act found that nearly 45,000 deaths per year in the United States were a consequence of a lack of health care coverage. The truth is the American Health Care Act, as passed by the House of Representatives, would have devastating consequences for millions of Americans. And the most vulnerable—the poor and the sick—would suffer the most severe consequences.
Unusual request in unusual times
Our society at its best accepts the notion that we take care of each other. In fact this is the idea underlying the economics of health care insurance: We all pay in so that those who do get sick have affordable insurance. Insurance that makes possible the quality of health care we need and does so at an affordable price. For an insurance pool to work, the well and the wealthy must help the sick and the unfortunate. Health insurance, after all, is a subtle social contract, a contract built on the long-held religious ethic of caring for one’s neighbor, especially those who are less fortunate than we might be.
You graduates chose to become doctors today to live up to those principles, simply put, to help others, and this is the ethic that underlies the Mount Sinai Health System. We are committed to caring for everyone. We have always been committed to that core value—serving the most vulnerable as well as the most fortunate; we don’t differentiate. So now I implore you to retain and live the values you’ve been taught here. Practice compassionate care. Help the most vulnerable.
And in that spirit I have a request, a request I have never made at a commencement, but these are unusual times. Our core values are at stake. Lives are at stake. I ask each and every one of you— graduates, parents, family, faculty, and staff—to call or write your senators, demand that they stand by our values, your values. Demand they refuse to rip up the nation’s social contract. Demand that they not turn back the clock on the extension of health care to all Americans.
Please do not allow the rhetoric of choice, free markets, and personal responsibility to eclipse the fact that, as doctors, we are our brother’s keeper.
From left: Dennis S. Charney, MD; Mark Kostegan, Chief Development Officer; Peter W. May, Chairman, Boards of Trustees; and Kenneth L. Davis, MD.
The Mount Sinai Health System has launched a new capital campaign that is expected to raise $1.5 billion over the next seven years and serve as the organization’s roadmap for the future in medical research, patient care, and education.
As fundraising begins in earnest in 2018, Mount Sinai will steer a course that calls for significant investments in precision medicine, next generation health care, and emerging areas in cancer, immunology, neuroscience, heart disease, pediatrics, and other specialties.
This is the first capital campaign since the formation of the Mount Sinai Health System in 2013, when The Mount Sinai Hospital, Mount Sinai Queens, and the Icahn School of Medicine at Mount Sinai combined with the former Continuum Health Partners and its five hospitals to become one of the largest health systems in the New York region.
“We anticipate that our new capital campaign will be transformational, a game changer that is as successful as the campaign we undertook 10 years ago for The Mount Sinai Hospital and the Icahn School of Medicine,” says Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System. The earlier campaign raised $1.6 billion and led to the creation of 19 research institutes, the recruitment of 150 academic faculty, and the establishment of the 500,000 square-foot Leon and Norma Hess Center for Science and Medicine.
Backed by robust investment, Mount Sinai advanced its research portfolio and experienced significant growth in funding for genetics, microbiology, pharmacology, and neurosciences from the National Institutes of Health. In addition, The Tisch Cancer Institute expanded its programs and received the elite classification as a National Cancer Institute-designated cancer center, one of 69 such centers in the country.
Mount Sinai also broadened its culture of innovation and entrepreneurship by entering into educational and industry partnerships and investing in high-performance computing, genomics, and multiscale biology.
The new strategic plan was the result of a yearlong study led by 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; and Eric J. Nestler, MD, PhD, Dean for Academic and Scientific Affairs, Director of The Friedman Brain Institute, and Nash Family Professor of Neuroscience.
“We enlisted 200 faculty members and more than 150 external experts—some of the best minds in science and medicine—to participate in a dynamic exchange of knowledge and ideas that would help us chart our future in education, biomedical science, and clinical research with the ultimate goal to improve human health,” says Dr. Charney. “Our campaign is based on their bold recommendations.”
To fully capture the clinical and capital needs of Mount Sinai’s seven hospitals, each hospital president worked closely with Margaret Pastuszko, MBA, Chief Strategy and Integration Officer, and her team to establish priorities and develop a strategic plan to support the unique strengths of each hospital.
The new capital campaign will help fund strategic investment in infrastructure, equipment, training, and other services. Mount Sinai’s patients will receive advanced clinical care in every hospital throughout the Health System. This coordinated approach, in combination with world-renowned research, will enable Mount Sinai to achieve its objective—improving human health.
Plans call for Mount Sinai to expand the scope of its advanced research and clinical care in diabetes and obesity, and kidney, lung, and gastrointestinal disease. In addition, Mount Sinai will leverage its large and diverse patient population to excel in areas that include drug addiction, and environmental, adolescent, and women’s health. It will establish five institutes devoted to this research and to creating transformative clinical trials.
“The connectivity between our education, research, and clinical care reflects a collaborative and unified Health System,” says Mark Kostegan, Chief Development Officer and Senior Vice President for Development, Mount Sinai Health System, who is leading the current campaign and led the earlier one. “Our new effort will strengthen Mount Sinai in its entirety, advancing all of our hospitals and our school.”
Mount Sinai leaders saluted volunteers at The Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai during a breakfast held Wednesday, April 26, during National Volunteer Recognition Week. More than 160 volunteers attended the celebration. Also making an appearance was a special breed of Mount Sinai volunteers—the gentle dogs, big and small, who bring comfort and smiles to patients and staff through the Pet-Assisted Therapy program.
“The Mount Sinai Hospital was founded by a group of volunteers, and today more than 1,200 volunteers continue this rich legacy of service,” Peter W. May, Chairman, Boards of Trustees, Mount Sinai Health System, told the guests. “Our patients are so grateful, and it’s always a pleasure to honor all that you do.”
Linda Frank and Tazzy have volunteered in the Pet-Assisted Therapy program for eight years.
Kenneth L. Davis, MD, President and Chief Executive Officer, Mount Sinai Health System, thanked all volunteers, but also singled out their efforts with PACT, the Preventable Admissions Care Team, which was created to reduce 30-day hospital readmissions and Emergency Department visits—a program now considered a national model. “Volunteers became the backbone of this program to keep people well and out of the hospital, and their contributions make a difference between Mount Sinai being a good Health System, and a great Health System,” said Dr. Davis.
One table of guests—including first-year medical students—were among the volunteers applauded by 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. “At the beginning of 2017, more than 200 volunteers, including high school, college, and post-baccalaureate students interested in health care careers were assisting in basic science laboratories, and 150 volunteers were helping with clinical research projects,” he said. “The volunteers become part of our family.” Dr. Charney also noted that Mount Sinai students have a supportive role in Chemo Companions, a program that pairs them with patients undergoing chemotherapy at The Tisch Cancer Institute.
“Our unique programs provide insight into a wide range of areas and lead many of our volunteers into social work, nursing, and other patient-centered health careers,” said Claudia Colgan, Vice President, Hospital Operations, The Mount Sinai Hospital. David L. Reich, MD, President and Chief Operating Officer, The Mount Sinai Hospital, talked about the innovative ideas that volunteers introduce to Mount Sinai and also noted the compassion that they bring. “The human kindness that our volunteers show to patients is invaluable,” said Dr. Reich, “and every day, this contributes to patient healing.”
‘‘The drug works. It gives you your life back,” says Austin Jacobson. Watch the video
The U.S. Food and Drug Administration has approved a new biologic drug that is based on seminal research by Emma Guttman-Yassky, MD, Professor of Dermatology, and Medicine (Clinical Immunology), at the Icahn School of Medicine at Mount Sinai. The drug, dupilumab, was approved in March—fast-tracked because it is a “breakthrough therapy” for adult patients with uncontrolled eczema. “It brings hope to patients who have tried everything.” Dr. Guttman-Yassky says.
One of them is her patient Austin Jacobson, a personal injury defense lawyer in Manhattan. “Living with eczema is like having poison ivy from head to toe,” he says. “You can’t sleep because you’re itching so badly. It affects every single aspect of your life.” Mr. Jacobson took part in clinical trials of the drug, which is injected every two weeks, and still uses it now. He says he felt relief from itching “two hours after taking the first injection.”
Emma Guttman-Yassky, MD, Professor of Dermatology, and Medicine (Clinical Immunology), at the Icahn School of Medicine at Mount Sinai
At least 31 million Americans are affected by some form of eczema. The most common type is atopic dermatitis, caused by a combination of genetic, immune and environmental factors. Dupilumab, sold by Regeneron Pharmaceuticals as Dupixent, is an antibody that binds to a protein, IL-4 receptor alfa, inhibiting the inflammatory response that leads to eczema’s rashes and itching. Dr. Guttman-Yassky’s laboratory was the first to map immune pathways underlying eczema, including those now targeted by dupilumab and other drugs in clinical trials.
Her team is among those testing more new therapies, including a drug made by Pfizer Inc. that targets a different immune molecule, interleukin 22 or IL-22. Dr. Guttman’s research was the first to identify the lymphocytes that produce IL-22, and show their link to eczema. With funding from the National Institutes of Health, she designed a study that tested IL-22 antibody targeting in the clinic and in the lab—a treatment that is showing promising preliminary results.
“These are exciting times for patients with eczema, and for me specifically, as I am able to contribute to the scientific development for this disease and help millions of patients worldwide,” Dr. Guttman-Yassky says. “This is a dream come through for a physician-scientist.”
As for Mr. Jacobson, he says that his skin, which had been “100 percent” covered with a scaly, flaking rash, is now largely clear. “The drug works,” he says of dupilumab. “It gives you your life back.”
Dr. Guttman-Yassky has received research funding from Regeneron, and drug and research support from Pfizer, and is working with most companies developing treatments for atopic dermatitis/eczema.
Barbara Barnett, MD, Chief Medical Officer, Mount Sinai Beth Israel, center left, and David L. Reich, MD, center right, flanked by two strong allies of the transgender community, New York City Councilwoman Rosie Mendez and New York State Assemblyman Richard N. Gottfried.
Patients, caregivers, family, friends, and elected officials recently gathered to celebrate the one-year anniversary of the Center for Transgender Medicine and Surgery. “What is CTMS? CTMS is a reflection of the vision of the Mount Sinai Health System,” David L. Reich, MD, President and Chief Operating Officer, The Mount Sinai Hospital, said at the event, on Monday, April 10, at Mount Sinai Beth Israel. “We see ourselves as champions of social justice, and one aspect of social justice is providing the highest quality, seamless, coordinated, and culturally sensitive care to the transgender community.”
The outpatient location offers care that incorporates primary, transition, and behavioral-health services. The Center completed its first surgical procedure at Mount Sinai Beth Israel in March 2016, and has since performed more than 200 procedures, including vaginoplasty, phalloplasty, metoidioplasty, facial feminization, chest-wall reconstructions, hysterectomy, and orchiectomy. CTMS is the first such center in New York, and among the pioneers in the nation. Health care services are delivered in a welcoming and affirmative environment devoted to the wellbeing of transgender patients.
Mahogany Phillips with Leonie Taylor, RN, a Senior Nurse Manager at Mount Sinai Beth Israel.
“We’re all proud of what we have accomplished, and are enthusiastic about what the future holds for us,” Dr. Reich said. This summer, the Center will welcome its first fellows—one in transgender surgery and another in psychiatry—and an experienced reconstructive urologist, in further pursuit of Mount Sinai’s core missions of clinical care, education, and research.
Mahogany Phillips, who reunited with friends and caregivers at the event, says that while growing up, she felt like “just a regular girl” and had surgery at Mount Sinai in September 2016 and March 2017. “For me it was important to make me comfortable in my own body and to see myself, whole, in the mirror,” she says.
