LAURENCE F. MCMAHON JR, MD, MPH
Division Chief/Professor

Emeritus Faculty
Jeoffrey K. Stross, MD

Professor
Steven J. Bernstein, MD, MPH
John E. Billi, MD
A. Mark Fendrick, MD
Rodney A. Hayward, MD
Joel D. Howell, MD, PhD
Howard Hu, MD, MPH, ScD (secondary)
Steven J. Katz, MD, MPH
John D. Piette, PhD, MSc
David S. Rosen, MD (secondary)
Sanjay K. Saint, MD, MPH
Peter A. Ubel, MD
James O. Woolliscroft, MD

Associate Professor
Michael E. Chernew, PhD (secondary)
Matthew M. Davis, MD (secondary)
Paul L. Fine, MD
Scott A. Flanders, MD
John G. Frohna, MD, MPH
Susan D. Goold, MD
Timothy P. Hofer, MD, MSc
Eve A. Kerr, MD, MPH
Kenneth M. Langa, MD, PhD
Rajesh S. Mangrulkar, MD
Mark A. McQuillan, MD
Thomas P. O’Connor, MD
David A. Spahlinger, MD
Connie J. Standiford, MD
David T. Stern, MD
Sandeep Vijan, MD
Brent C. Williams, MD, MPH

Assistant Professor
Linda M. Balogh, MD
William E. Barrie, MD
Daniel W. Berland, MD
Susan G. Blitz, MD
F. John Brinley III, MD
Stephanie L. Brown, PhD
Martha L. Buckley, MD
Xian Chen, MD
Davoren Chick, MD, FACP
Michael Clay II, MD
Kristin M. Collier, MD
David A. Cooke, MD
John R. C. Crump, MD
David Deguzman, MD
Rodney L. Dewyer, MD
Monica DiMagno, MD
Mark Ealovega, MD
Arvin S. Gill, MD
Steven E. Gradwohl, MD
Clinton Lindo Greenstone, MD
Michele Heisler, MD, MPA
Jenny N. Hsu, MD
Mary M. Johnson, MD
Sean K. Kesterson, MD
Catherine Kim, MD, MPH
Christopher S. Kim, MD
Anita H. Kirsch, MD
Mary D. Kleaveland, MD, MPH
Kristen A. Krieger, MD
Yeong S. Kwok, MD
Thuy B. LeDesai, MD
Jennifer Lukela, MD
Michael P. Lukela, MD
Monica L. Lypson, MD
Jane T. McCort, MD
Cara McDonagh, MD
Lawrence J. McMaster, DO
Julie A. Morelock, MD
Jennifer G. Nastelin, MD
Elisa A. Ostafin, MD
Vikas I. Parekh, MD
Rajesh N. Patel, MD
Edward Post, MD
Pamela J. Reeves, MD
Allison Rosen, MD, MPH, ScD
Andrew L. Rosenberg, MD (secondary)
Namita Sachdev, MD
Amy F. Saunders, MD
Maria J. Silveira, MD, MPH
Mark J. Skalski, MD
Jeffery D. Smith, MD
Barbara C.S. Soyster, MD
David R. Stutz, MD
Eleanor Y. Sun, MD
Jeffrey L. Sweet, MD
Caroline L. Taylor, MD
Linda B. Terrell, MD
Paul K. Tichenor, MD
Adam S. Tremblay, MD
Denege A. Ward, MD
David H. Wesorick, MD

Research Assistant Professor
Angela Fagerlin, PhD
Sarah T. Hawley, MPH, PhD
Sarah L. Krein, PhD
Mary A. Rogers, MS, PhD
Dylan M. Smith, PhD
Brian J. Zikmund-Fisher, PhD

Instructor
Greta L. Branford, MD
Jennifer E. Castillo, MD
Robert Chang, MD
Sarah Cookinham, MD
Amanda M. Cox, MD
Kathryn E. Dietz, MD
Elizabeth A. Drake, MD
Audrey Fan, MD
Deborrah Frable, MD, PhD
A. Anca Froman, MD
Charisse F. Gencyuz, MD
Paul Grant, MD
Bansari Gujar, MBBS
Annissa Hammoud, MD
Sarah C. Handeyside, MD
Jyotsna Kapoor, MD, MBBS
Kathleen Longo, MD, MPH
Liana Marquis, MD
Francis McBee Orzulak, MD
Kimberly O’Donnell, MD
Brian Parkin, MD
Christine A. Persson, MD
Meredith Peters, MD
Nicole Pilz, MD
Avinash Prabhakar, MD
William T. Repaskey, MD
Jeffrey Rohde, MD
Seema Saini, MD
John P. Schmidt, MD (secondary)
Kosha Thakore, MD
Bing Xue, MD
Denise H. Zao, MD

Lecturer
Aaron Berg, MD
Christi Cavaliere, MD
Eric Cober, MD
Todd Dardas, MD
Rowena Delos Santos, MD
Najwa El-Nachef, MD
James Farry, MD
Brian Garvin, MD
Prasanth Gogineni, MD
Pavan Gupta, MD
Anita Hart, MD
Gopa Iyer, MD
Robert Kennedy, MD
Carla C. Keirns, MD, PhD
Hae-Won Kim, MD
Sarah Kohnstamm, MD
Jennifer Meddings, MD
Manya F. Newton MD, MPH
Satyen Nichani, MBBS
Joseph Norman, MD
Ann-Marie Rosland, MD
Susannah Watson, MD
Bryan Zweig, MD
 
Grappling with the thorniest ethical issues in medicine and science: the U-M Bioethics Program

Can dementia patients consent to take part in potentially risky studies? How can we divide up our scarce healthcare dollars fairly? Should assisted suicide be legal? Should terminally ill patients have a right to take experimental drugs that haven’t been proven to work? Is it right to use embryonic stem cells for research that may never lead to a new treatment?

These ethical issues, and many others, might make the average person’s head spin. But for members of the U-M Bioethics Program, they’re all in a day’s work.

Formed in 2000, and headed by Susan Dorr Goold, MD, MHSA, MA (below), the program includes several members of the Division on its core faculty, including Angela Fagerlin, PhD; Joel D. Howell, MD, PhD (below); Maria Silveira, MD, MA, MPH; and David Stern, MD, PhD. It also draws faculty from other Medical School departments and other U-M schools.

Together, these faculty, their collaborators, and their students bring research methods and analytical skills to bear on some of the most current ethical issues facing physicians and life scientists.

They also help others learn to apply ethics to their own work, whether in a clinical trial, laboratory, hospital, or clinic. One example is the NIH-funded Valid Consent Training Program, which helps clinical researchers and their staff learn how to obtain a valid, truly “informed” consent from a research volunteer. A similar curriculum teaches students and residents how to obtain consent for clinical interventions. The program also sponsors weekly Bioethics Values & Society Seminars and offers a Speakers Bureau.

CHAT (Choosing Healthplans All Together), an allocation exercise Goold developed, is now being used by several state Insurance Commissions in the design of basic benefits packages.

This year, Dr. Goold was recognized on a national level for her leadership in bioethics, when she was named to a seven-year term on the American Medical Association’s Council on Ethical and Judicial Affairs.

Because her research focuses on the allocation of scarce healthcare resources, and especially on the perspectives of patients and citizens, this is a particularly interesting time to be elected to the council, says Goold, the only trained bioethicist on the panel. A paper published in The Journal of the American Medical Association on medical school ties with industry feeds directly into an opinion the Council is working on, for instance.

Silveira, another member of the Division in the Bioethics Program, received an American Academy of Hospice and Palliative Medicine Award for Young Investigators. She conducts research that aims to improve end-of-life care. General Medicine faculty in the Bioethics Program work closely with faculty from other departments with similar interests. Scott Kim, MD, PhD, who studies the ethics of research participation for those with impaired decision-making ability, successfully competed for a prestigious Greenwall Faculty Scholars Award. Ray De Vries, PhD, in the department of Medical Education, studies the sociology of bioethics and the regulation of science.


One person, many diseases—A study and a new program focus on people with multiple chronic conditions

It’s hard enough having one chronic disease. But many people, especially older people, have more than one simultaneously. The special challenges and risks that these patients face are the focus of a study published in 2007 and a program launched in 2006 by researchers in the Division of General Medicine and the VA Ann Arbor Healthcare System.

The study, published in the Journal of General Internal Medicine by a team led by Eve Kerr, MD, MPH, and John Piette, PhD (below), shows that 92 percent of older people with diabetes also have at least one other major chronic medical condition. Nearly half have three or more major diseases besides diabetes.

The sheer number and severity of these other conditions appears to decrease patients’ ability to manage their diabetes, the team found. The type of co-existing condition also matters: diabetes self-care lags most among patients with conditions that they think aren’t related to their diabetes.

For instance, if a person with diabetes also has arthritis pain, or shortness of breath from heart failure, and these aren’t fully addressed, the person may refrain from physical activity. And that in turn means they’ll struggle to control their blood sugar or blood pressure, both important risk factors for cardiovascular disease among people with diabetes.

Piette directs, and Kerr co-directs, the Program for Quality Improvement for Complex Chronic Conditions, or QUICCC—a joint U-M/VA research program that focuses on the issues that face patients who have multiple conditions, and their caregivers. QUICCC fosters the development and testing of new services to help assess and improve care for such patients, with an emphasis on identifying services that support effective primary care and patient self-management.

In just its first two years, QUICCC has leveraged funding from the National Institutes of Health and the department of Veterans Affairs to design and launch multiple studies focused on patients with complex chronic conditions. All are aimed at improving the way these patients receive their healthcare, or helping patients with the self management tasks that are important for their long-term health.

In fact, the recent paper on the multiple health conditions faced by people with diabetes was based on a new conceptual framework that the QUICCC team published in 2006. This framework allows them to study how such co-existing conditions affect patients, and to look for factors that influence patients’ health, both positively and negatively.

Among the QUICCC collaborators are several members of the Division’s faculty, including Steven Bernstein, MD, MPH; Rodney A. Hayward, MD; Michele Heisler, MD, MPA; Timothy P. Hofer, MD, MS; Sarah L. Krein, PhD, RN; Kenneth M. Langa, MD, PhD; and Sandeep Vijan, MD, MS. Other faculty from the department, and from other areas of the Medical School, the School of Public Health, and the School of Information also participate.

Older Blacks and Latinos still lag whites in controlling blood sugar
Despite decades of advances in diabetes care, African Americans and Latinos are still far less likely than whites to have their blood sugar under control, even with the help of medication, according to a nationally representative study led by Michele Heisler, MD, MPA (right), and published this year in the Archives of Internal Medicine.

This lack of glucose control puts such patients at a much higher risk of blindness, kidney failure, foot amputation, and other long-term diabetes complications.

The comprehensive new national study of middle-aged and older adults documents the persistence of strong racial and ethnic disparities in diabetes control, which have been observed for decades and contribute to the much greater impact of diabetes on those two ethnic groups. The results, based on data from the Health and Retirement Study, suggest that diabetes will continue to kill and disable Black and Latino adults disproportionately for decades to come.

But the study delves deeper into the reasons behind this difference in blood sugar levels, using complex statistical analyses to find factors that do—and don’t—play a role. Two factors were found to account for much of the difference in glucose control: how well patients persist in taking their diabetes medicines regularly; and how they respond emotionally to having diabetes. Fortunately, these factors are likely to change in response to specific outreach efforts—including two randomized, controlled trials now being spearheaded by Heisler in collaboration with other U-M and VA researchers.

One project involves nurse-led group sessions where patients can break their diabetes self-care goals into short-term specific steps, and link up with a diabetes peer buddy for mutual coaching and support. The other project trains VA pharmacists to reach out to diabetes patients with poor risk-factor control and difficulties refilling medications, and to provide motivational, interviewing-based counseling. This proactive outreach will specifically target blood pressure, which, like glucose, is a crucial factor in the development and progression of diabetes complications.

 
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