From astronauts to elders, Brian Clark studies how we stay strong

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Brian Clark, Ph.D., came to our medical school in 2006 as an assistant professor of physiology and neuroscience, fresh out of graduate school at Syracuse University. He admits now that he arrived expecting to quickly migrate somewhere else.

“I always joke that when I came to Athens, I did not anticipate staying very long,” says Clark. Rather than moving on, however, he has risen to be a full professor, executive director of the Ohio Musculoskeletal & Neurological Institute, holder of the Osteopathic Heritage Foundation Harold E. Clybourne, D.O., Endowed Research Chair and an internationally recognized authority on healthy aging.

It wasn’t that Ohio University and Athens didn’t suit Clark’s younger self; he just feared that he couldn’t find enough volunteers in a small rural community for the kinds of clinical research studies he wanted to do. Instead, he recalls, “I was just flabbergasted by what strong support members of the local community give to research projects.”

Over the years, he has become friends with many of the people who have volunteered for his aging-related research studies. One reason is probably the deep commitment to the safety and comfort of study subjects that’s instilled in OMNI staff at all levels.

“My philosophy has always been, when somebody is volunteering for a study, the key word is ‘volunteering,’” Clark says. “So we do everything in our power to make it a positive experience.”

When Clark started at the Heritage College, his research focused on the effects and causes of muscle fatigue and the effect of prolonged disuse on muscles. Because astronauts on prolonged space flights can suffer such effects, NASA was an important funding source for his early work.

While Clark had long had an interest in aging as a health issue, his research wasn’t focused in this area until NASA moved away from supporting investigator-initiated muscle-disuse studies shortly after his arrival at the medical school. This prompted Clark to look for a field of research in which his expertise could come into play and which could attract support from the National Institutes of Health. Healthy aging fit the bill.

As the percentage of seniors in the U.S. population has grown, NIH has sought ways to help keep the elderly mobile, self-sufficient and out of nursing homes. And the phenomenon of muscle pain and wasting through disuse, which Clark had already been studying, in some ways parallels what happens to our muscles as we age. “It’s actually a model of aging to some extent,” he explains. He took to the new research agenda enthusiastically – and quickly caused something of a shake-up in the field.

At that time, most scientists who studied aging believed they should look primarily at the muscles themselves to understand loss of muscle strength and function in the elderly. Though research dating from the 1970s and ’80s had shown that the nervous system “is a very heavy contributor to muscle function,” Clark says, the aging research community still “basically saw the muscles as the prime culprit in muscle function losses.”

Clark – who maintained that the neuromusculoskeletal system was a better, more holistic subject for research – took a deliberate step toward refuting the consensus view when he and colleague Todd Manini from the University of Florida College of Medicine, Gainesville, published a paper in the Journal of Gerontology, which they intended as something of a shot across orthodoxy’s bow. “We tried to write it in a pretty provocative way,” Clark admits.

Titled “Sarcopenia ≠ Dynapenia,” the article argued that sarcopenia (age-related loss of muscle mass) and dynapenia (loss of muscle strength with aging) are two very different things, and that the first is less a cause of the second than many scientists then believed. Instead of assuming that age-related loss of muscle mass equates to loss of strength, the authors suggested, researchers should be looking at other mechanisms that might underlie dynapenia, including changes in neurological function. In other words, the brain and nervous system may be major players in the process.

The 2008 paper, and a follow-up article in 2011, have had their intended impact in shifting scientific perspective, Clark says, and since their publication have been cited more than 1,000 times. They also mapped out a research territory that Clark and OMNI have made their own, and that has helped make Clark one of the college’s top translational scientists.

The entity now known as OMNI was created in 1979, and was originally known as the Somatic Dysfunction Research Institute; from 1979 to 2008 it was under the direction of John Howell, Ph.D., associate professor in the Department of Biomedical Sciences. Clark credits Howell’s vision for the institute’s growth with laying the groundwork for its future advancement; he also pays tribute to the foundational work of Bob Hikida, Ph.D.,distinguished professor emeritus of microanatomy; and exercise physiology and anatomy professors Fritz Hagerman, Ph.D., and Gary Dudley, Ph.D., both now deceased.

Since Clark took over as head of OMNI upon Howell’s retirement in 2008, the institute has grown into a powerhouse of research, whose two main areas of focus are pain disorders and healthy aging.

From 2014-2018, OMNI attracted close to $11.5 million in external funding – 93 percent of its total funding for the period. It’s consistently one of the best externally funded institutes at Ohio University. This support has come most heavily from NIH, but also from the state of Ohio, private industry and the Osteopathic Heritage Foundations. OMNI’s principal investigators and junior scholars published 204 peer-reviewed PubMed articles with an OHIO affiliation during this time – up 39 percent from the previous five years.

With over 110 published journal articles or book chapters to his credit, Clark’s research has illuminated the role of neurology in muscle function and assessed the effectiveness of drug and exercise interventions in helping seniors retain muscle strength and mobility. In addition to scholarly outlets, his work has caught the attention of the popular press, earning write-ups in major media outlets including the New York Times, Scientific American and The Atlantic.

When he shifted his focus into healthy aging studies, Clark says, it headed him down a path of discovery that he still finds deeply rewarding every day.

“I can easily say that the aging work is what keeps me excited, and engaged, and happy to come to work,” he says.

 

Learning from Cuba

Barone and Skinner in Viñales
Adam Barone, OMS-I , (left) and Daniel Skinner, assistant professor of health policy

Daniel Skinner and Adam Barone

For a week in March 2019, we were privileged to visit Cuba to learn about the nation’s health care system. Our contingent ran the health professions gambit, including people in nursing and medicine, health care administration, global health, health communication and health policy. But our mission was unified: to learn about health care in Cuba and use the experience to reflect on our situation in the United States.

While in Cuba we met with physicians (both urban and rural), diabetes and vaccine researchers, farmers, educators, medical students, HIV-AIDS patients and more. We visited medical schools, clinics, physicians’ offices, rural villages and more. We walked the streets of bustling Havana and rural Viñales. At night, we processed what we had seen and explored our thoughts – often with the sound of salsa music in the background.

Though Cubans acknowledge that their system is not perfect (and what system is?), they are proud of what they have accomplished in health care. Despite widespread poverty – compounded by a lack of resources that has been intensified by the American-led embargo – Cuba’s infant and maternal mortality and life expectancy rates are comparable to those in the United States, and lack the racial and class-based disparities that plague American health outcomes.

Cuba is deeply invested in medical education, for aspiring physicians both in Cuba and around the world. A drive through the western parts of Havana reveals a vibrant, sprawling complex of buildings immersed in vaccine and other biotechnological research. In a nation that cannot afford the high costs associated with widespread acute and chronic illness, Cuba’s focus is on prevention, from frank talk about STI prevention, to mandatory vaccines that are not part of our regular vaccine schedule in the United States – such as vaccines against tuberculosis, leptospirosis and typhoid fever – to the much-discussed treatment they are exploring for lung cancer, to genomic research that aims to prevent diseases before they arise.

Cubans emphasize the hyper-rational organization of the system’s three-level approach to health care delivery, with family physicians located in communities serving as the first point of contact (including house calls), “policlínicos” serving as a community-based second tier and hospitals serving as a last resort for cases of acute need. While Cubans are allowed to access any of these tiers at any time, most opt to utilize the system as it was intended. Few Cubans go to the hospital when they do not need to. The system incentivizes this through unfettered access and by building trust in the overall design.

A particular highlight of the trip was when we American students were afforded an hour to converse with Cuban medical students at the Victoria de Girón Institute of Basic and Preclinical Sciences.The students compared notes on their experiences. Despite significant resource differences in education systems, the students found they utilized common textbooks and study strategies. Perhaps the most important takeaway was the revelation that their lives – their aspirations, as well as challenges – were not so different. Two days later, as further evidence that friendships were in the making, the students met again, this time in an unplanned run-in at a fashionable Havana art and music center, where yet more conversation and connection took place.

Cuba has a lot to offer osteopathic medicine in particular. After all, osteopathic approaches to health care emphasize the importance of the physical exam and prevention, turning to pharmaceuticals and technologies only when necessary. In Cuba, where many drugs and expensive equipment are hard to come by, there is an opportunity to reflect on core principles and see what osteopathic principles can accomplish in a resource-poor environment. It is well known that Americans overuse medical technology and testing; in Cuba, the problem is the inverse, where the American embargo is making it hard for Cubans to get some of the medical equipment they need.

In the weeks and months to come, we plan to explore ways to strengthen connections with Ohio University and Cuba. The clinicians and researchers with whom we met emphasized their hope that we could see past diplomatic tensions and focus on mutual goals of addressing pressing health needs, such as collaborative diabetes and cancer research. Sometimes, working on common projects can serve as a kind of diplomacy in its own right. Other osteopathic colleges have found value in such connections as well. Clearly, as our experience reminded us, the future of medicine – from the training of clinicians to research – is in global connectivity.

Daniel Skinner, Ph.D., is assistant professor of health policy. He is director of Ohio University’s Comparative Health Systems – Cuba program, administered through the Global Health Initiative.  

Adam Barone, M.S., is a first-year medical student.

 

3 questions all health care providers should be asking veterans

 

The 20 million veterans living in the U.S. today have specific health care needs unique to their military experiences, but research has shown that many civilian physicians feel uncomfortable or inexperienced dealing with health-related exposures and risks these veterans might encounter.

To help close this gap, Todd Fredricks, D.O. (’93), an associate professor of family medicine at our medical school, and Brian Plow, an associate professor in the School of Media Arts & Studies in OHIO’s Scripps College of Communication, created a feature-length documentary, “The Veterans’ Project,” with the goal of helping health care providers better treat veterans. The film uses real stories from veterans and health care professionals to highlight the challenges many combat and service-wounded veterans face when seeking care from military, VA and civilian health care systems.

To help physicians better understand and build trust with their veteran patients, Dr. Fredricks, a U.S. Army Colonel and medical officer with the West Virginia National Guard, has identified three simple questions that health care providers should ask all patients.

Question 1

Have you ever served in the armed forces?

Question 2

Did you ever experience any wounds, illnesses or injury as a result of your service?

Question 3

Have you registered with the VA?

These closed-ended questions help health care providers understand who the veterans are within their patient population, while giving veterans who are not comfortable with in-depth conversations about their experiences an out. To hear Dr. Fredricks explain more about the importance of asking these three questions, watch this video.

 

“The Veterans’ Project” is a production of Media in Medicine, a collaborative project led by Fredricks and Plow that brings together visual media, the arts and medicine to create and teach through storytelling. The award-winning film was shown Nov. 10 during the inaugural Columbus Veterans Film and Arts Festival, and has also been presented at the Columbus International Film & Animation Festival, the Broadcast Education Association Festival of Media Arts and the National Communication Association Annual Conference.

 

The importance of breastfeeding then and now: A response to U.S. threats against Ecuador over their resolution supporting breastfeeding

Wolf_JackieJacqueline H. Wolf

For every 100 infants born in the United States in 1900, 13 died before their first birthday. More than half of the babies who died, died of diarrhea. Physicians and public health officials recognized, and widely publicized, the cause. In the late 19th– and early-20thcenturies, feeding babies cows’ milk-based infant food, what we now call “formula,” was a deadly practice. Public health posters, circulated nationwide by municipal health departments, advertised that fact. “Mother’s Milk for Mother’s Babe Cow’s Milk for Calves” implored one particularly popular poster. “To Lessen Baby Deaths Let Us Have More Mother-Fed Babies.”

The American dairy industry was largely unregulated before 1930. Milk, shipped in large, open vats, took up to 72 hours to travel in unrefrigerated railroad cars from rural dairy farmer to urban consumer. By the time the milk reached its destination, it was spoiled and greying. To whiten the milk, shippers and merchants often threw handfuls of powdered chalk, and worse, into the vats.

Beginning in the 1890s, urban newspapers heralded what they dubbed “the milk wars,” to urge states to pass legislation regulating the shipping and sale of milk. Headlines about the progress of these “wars” dominated newspapers for the next 30 years. The Chicago Tribune wrote of cows’ milk: “It is worse than fraud…[and] play[s] no small part in this colossal crime of infanticide.”

I recalled this history when news broke that the United States had threatened Ecuador with trade sanctions and the withdrawal of military aid after Ecuador sponsored what they thought was an uncontroversial resolution at the World Health Assembly to “protect, promote, and support breastfeeding.” Breastfeeding is especially important in developing countries where populations still contend with unclean water that can be life-threatening to formula-fed infants. But human milk is more than just a sanitary food – it is a living substance that contains antibodies, beneficial bacteria, oligosaccharides and countless other bioactive factors not found in formula. In all countries, breastfeeding prevents respiratory and gastro-intestinal infections among infants and lowers the incidence among older children of obesity, type 1 and type 2 diabetes, allergic diseases and cancer. In 2016, scientists writing for the Lancet estimated that universal breastfeeding would prevent 800,000 children’s deaths and yield $300 billion in health care savings annually.

We should all be grateful that cows’ milk, and therefore cows’-milk-based formula, is safer than it was a century ago. But because human milk is essential to short- and long-term human health, infant formula should be used only when mothers are unable to breastfeed, for whatever reason. In other words, the formula industry should not be a growth industry. Rather than protect formula companies at the expense of the health and life of the world’s children, the U.S. government should join the rest of the world in a full-throated endorsement of societal supports for breastfeeding, the most effective way to ensure that every child lives a healthy, long life.

Jacqueline H. Wolf is a professor of the history of medicine in the Department of Social Medicine at the Ohio University Heritage College of Osteopathic Medicine and the author of Don’t Kill Your Baby: Public Health and the Decline of Breastfeeding in the 19thand 20thCenturies and, most recently, Cesarean Section: An American History of Risk, Technology and ConsequenceThe opinions expressed in this piece are her own.

40 Things to Know: Our college was led by the first female African American dean of a medical school

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Embracing diversity and serving the underserved are bedrock values for both our college and the osteopathic profession. So it shouldn’t be too surprising that we made history in August 1993, when our university and college chose an African American woman to be our dean.

When we announced that our new physician leader was Barbara Ross Lee, D.O., sister of Motown superstar Diana Ross, it marked a step forward for diversity in medical education. And Dr. Ross-Lee clearly understood that bringing more minorities into health care can mean better care for underserved populations. She also stressed the important role that osteopathic medicine can play in making that happen.

Speaking to Black Issues in Higher Education about her new job, Dr. Ross-Lee said osteopathic medicine offers great opportunities for minority physicians to improve care delivery to populations “we are most concerned about.” And as she has throughout her career, she spoke frankly about racial disparities in health care, calling them “a scandal of such long standing that it has lost the power to shock.”

Predictably, the national press had some fun with the fact that the new dean was sibling to a pop music icon. “Diana Ross’s big sister hit No. 1 on the charts this month,” deadpanned Knight Ridder/Tribune News Service. “Not the record charts. The medical charts.”

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Dr. Ross-Lee speaks at the 2014 Ohio Osteopathic Symposium.

African American media, though, cheered the appointment as a landmark. Dr. Ross-Lee herself hinted it was about time, telling Jet magazine that initially, she hadn’t realized her appointment was a historic first. “I probably, like the rest of the country, was a little surprised,” she admitted, adding that she hoped “this breaking of a barrier will just turn into a tide and we’ll see a lot more black females achieving in medical academics.”

Dr. Ross-Lee’s seven years at the helm were important for more than barrier-busting. Dean emeritus Jack Brose, D.O., who served from 2001-2012 and is now vice provost for health affairs, praises Ross-Lee for her bold innovation and “terrific leadership skills. I know I certainly learned a lot from her.”

Creative leadership was indeed, as Dr. Brose suggests, a hallmark of her tenure. Under her direction the college developed the nation’s first osteopathic post-doctoral training institute; its Centers for Osteopathic Research and Education; its two curricular options; an independent Department of Biomedical Sciences; and a Center of Excellence for Multicultural Medicine.

In 2001 Dr. Ross-Lee left our college to go to the New York Institute of Technology, where she currently serves as vice president for health sciences and medical affairs, and site dean for the Jonesboro, Ark., campus of NYIT’s College of Osteopathic Medicine.

Since moving on, she has continued to carry the standard for osteopathic medicine, health care diversity, and serving the underserved. In doing so, she has carried on a tradition as old as osteopathic medicine founder A.T. Still, who battled throughout his 19th century career against slavery and racism, and in favor of women’s rights.

Perhaps the symbolic breakthrough she achieved should have come earlier. We’re proud that it happened here.

Our People: Mark Loudin, Technology Expert and Friend

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“I have never enjoyed anything more than becoming friends with our many students”

There are those who sit in the front of the class and those who prefer the back of the class. And then there are those who’d rather sit with Mark Loudin.

How many of our alumni, faculty and staff did a spell in the Irvine 194 lecture hall control booth with Mark? Mark joined the Heritage College in 1999 as multimedia producer and director, with a responsibility and an incomparable talent for ensuring that the classroom technology works effortlessly for faculty and students. A familiar face – and voice – to nearly half of our graduates, many of us have have appreciated his warm welcome and a moment of respite in that dark room, participating in the classroom intensity from behind the glass wall, and enjoying Mark’s company, counsel and hundreds of refrigerator magnets and collection of college memorabilia.

Favorite part of his job: “Seeing a first-year student attending orientation, timid and afraid, without confidence and a bit more than overwhelmed. In four short years, that same individual blossoms into a confident, competent leader and then graduates – and enters a practice as a trusted and life-altering physician.”

Thoughts on technology: “Computer-age students have demanded that we change the way we approach education. We record and post thousands of classes and events and make them available in minutes online. We have integrated several types of technology into a cohesive unit of learning, which is unique of any medical school on the planet. Our students are amazing, and giving them the proper tools to learn and truly integrate the medical knowledge they must possess helps them in the real world.”

Inspiration: “I have had a very fortunate career. I have interviewed two sitting presidents, worked NFL sidelines for thousands of games, won a bunch of TV awards. All of that pales in my mind to the pride and accomplishment I feel on a Heritage College graduation day. I have never enjoyed anything more than becoming friends with our many students, and I certainly enjoy keeping in touch with as many as I can.”

Parting thought: “Let’s go! On to the next ideas, advancements and accomplishments!”

Our People: Sherman Brooks, ‘Resident Dean of Humanity’

yearbook024Reminisce with any member of our first class and sooner or later you’re likely to hear about Sherman Brooks, who served as mentor, confidante, adviser and tutor to students from 1976, when the college opened, till his retirement in 1985. And he did it all while keeping the hallways clean.

“There was a janitor – he was the nicest guy,” remembers 1980 alum Stephanie Knapp, D.O., now a pediatrician and allergist in Pennsylvania. “He was from southern Ohio. He was very encouraging when we were studying at night. He was such a great guy, and I really remember him and how kind he was and how welcoming.”

Knapp is just one of the many alums who still remember Brooks, who died in 1987. A 1978 student yearbook featured an in-depth feature on him, reporting that the custodian “has gained a legacy of respect from the osteopathic students by not only being a physical plant employee, but also a ‘resident dean of humanity’ … What can you say about a janitor who can tell you how cadavers are preserved, explain the functions of the heart, know the birthdates of 59 students and root and cheer for them through every arduous step of their scholastic career?”

Brooks reportedly had a lifelong interest in medicine, and had asked Ohio University to transfer him to work in Grosvenor Hall when the new medical school opened. “He would quiz the kids, and they loved him,” recalls Chip Rogers, who first worked for the college as assistant and driver to first Dean Gerald Faverman, and later went on to become director of alumni relations and director of advocacy.

In 1990, a number of people who had been with the college from its earliest days got together to honor the man who had always remembered students’ birthdays and had a kindly word to offer when they needed one. Some 25 year later, the Sherman Brooks Memorial Scholarship is still helping first-year students from small southeastern Ohio towns who have expressed an interest in rural family practice.

Do you have a Sherman story? If so, please share below.

Our People: Anthony Chila, D.O.

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“The hands-on part is central to the whole idea”

Chila has had contact with every Heritage College graduating class, and his passion for teaching osteopathic manipulative medicine (OMM) has left many Heritage College alumni with a favorite Chila story. He joined the Heritage College faculty in 1978, and today is a professor emeritus of family medicine and faculty practitioner at University Medical Associates. A leading authority on OMM, he has served a variety of leadership roles in the American Academy of Osteopathy and in 2013 received the American Osteopathic Foundation’s Educator of the Year award.

Favorite class?: “I always had a great deal of favoritism for the Class of 1982. I enjoyed that group of people tremendously. I think they had as much fun with me, poking fun at me, as I had with them, harassing them. It was just a kind of a chemistry with that particular group. And that, by the way, was part of my learning process.”

Osteopathic medicine’s “secret sauce”: “The hands-on part is central to the whole idea of what an osteopathic physician is or is to be. Unfortunately, there is so much material thrown at students that it just boggles my mind that they can struggle with the hard-core academic material and still have some interest and some hope that they want to get something from the hands-on.”

His inspiration: “That ‘aha’ moment when you are working with your hands and you are trying to explain to a student or intern or a resident what it is you are looking for, how it is that you are preparing to make a diagnosis and what it is that you’re doing when you are implementing a treatment. There is something about that close work one-on-one with the student or resident over a patient and there seems to come a time when a huge light bulb goes on and a student literally says ‘aha, I understand what you’re talking about.’”

Parting thought: “Happy 40th anniversary, Heritage College of Osteopathic Medicine. It’s been a pleasure and a privilege to be with you.”

 


Founding Voices
Perspectives from those whose personal story is woven into the college’s beginning.