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For more details, visit kuendowment.org/bequestsOr contact Nell Lucas at 888-588-5249, or nlucas@kuendowment.org

A bequest to KU Endowment is a powerful expression of your faith in the future of the university. Bequests can benefit any academic or program area, while you

retain the flexibility to update your plans as circumstances change.

Please remember KU Endowment in your will or trust.To include KU Endowment in your estate plans, the recommended legal language is:

“For the benefit of The Kansas University Endowment Association.”

Be the difference for KU

+ On the Cover:

Illustration by Keith Negley

Executive Editor

Marcia Nielsen, PhD, MPH

Editor

Donna Peck

Art Direction and Design

Design Ranch

Copy Editors

C.J. JanovyMarcia Nielsen, PhD, MPH

Contributing Writers

Chris DeffenbaughCari MerrillDonna PeckMcKay Stangler

Contributing Photographers

Michael ForesterKenny JohnsonMike Shepherd

Contributing Illustrators

Keith NegleyNazario GrazianoDesign Ranch

The University of Kansas Administration

Bernadette Gray-Little, PhD, Chancellor

Barbara Atkinson, MD, Executive Vice Chancellor, KU Medical Center,Executive Dean, KU School of Medicine

Karen Miller, RN, PhD, FAAN, Senior Vice Chancellor, Academic and Student Affairs, KU Medical Center, Dean and Professor, University of Kansas School of Nursing, Dean, University of Kansas School of Allied Health

Kansas Medicine + Science is published by the Office of Public Affairs at the University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, Kansas 66160, (913) 588-5258, www.kumc.edu/. This publication is available in alternate formats upon request by calling (913) 588-7963 (TDD). To view Kansas Medicine + Science online, go to www.kumc.edu.

All changes of address, undeliverable copies and other correspondence should be sent to this address. The views presented in this publication do not necessarily reflect the opinions of the administration of the University or the Kansas Medicine + Science staff. The entire issue is copyrighted and no part may be reproduced without prior permission. Patient photos are used with permission.

For the past three years, many of you have been loyal readers of the University of Kansas Medical Center’s magazine 39th + Rainbow. That publication has brought us scores of fascinating stories on the amazing education, research, clinical care and community service endeavors going on at the KU Schools of Medicine, Nursing and Allied Health.

But as the scope and reputation of KU Medical Center has grown over the past several years, it was imperative that our flagship publication grow along with it. The revamped magazine you now hold in your hands (or are reading online) has a new title, Kansas Medicine + Science, a bright new look and an expanded editorial focus.

With Kansas Medicine + Science, we plan to explore more deeply the innovative people and ideas that are making KU Medical Center one of the fastest rising academic medical centers in the country.

The success of this magazine is very dependent on your feedback. We want to know what you think, so please drop us an email at kmands@kumc.edu. We look forward to hearing from you soon!

SAY HELLO TO THE NEWEST

ADVANCEMENT OF 39TH + RAINBOW.

Marcia Nielsen, PhD, MPHVice Chancellor of Public Affairs

kMANDS@kUMC.EDULET US kNOW WHAT YOU THINk ABOUT THE RENOVATIONS.

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THE INTERSECTION OF OPPORTUNITY AND INGENUITY

09

THE SILVER ISSUE

INSIGHTS FROM THE UNIVERSITY OF KANSAS MEDICAL CENTER

FALL

We are proud to present the University of Kansas Medical Center’s new magazine, Kansas Medicine + Science. You may have immediately noticed the new name and look, but the changes go much deeper than that.

Over the past 10 years, KU Medical Center’s reputation as an academic medical center has grown tremendously. The School of Medicine continues to move up the ranks of medical schools rated by the National Institutes of Health and is now in the top 35 public medical schools in the country. The NIH also ranks all but one of our basic science departments in the top 25 for public medical schools. And this summer, our School of Medicine was named one of the top five “social mission” medical schools in the country because of our success in training primary care physicians and doctors who practice in rural and underserved communities.

We want our magazine to reflect the growth and excellence that has come to exemplify the work we do at the Medical Center. I think the breadth of the articles in this first issue of Kansas Medicine + Science demonstrates the quality and vitality of the education, research, clinical and community programs that are part of today’s KU Medical Center.

Our cover story, “Tough Medicine,” describes how families with seriously ill children face challenges in getting effective – and palatable – doses of drugs for their kids. KU Medical Center researchers are part of a unique collaboration that is reformulating drugs for children that have been proven to work for adults. The fruits of this collaboration will improve the chances of recovery for thousands of critically ill children across the country.

“Closing the Gap” takes a look at the devastating health problems facing this nation’s American Indian population and what KU Medical Center’s Department of Preventive Medicine and Public Health is doing to reduce those health disparities.

This issue also spotlights research that could lead to determining the brain’s role in obesity and other addictive behaviors, and to reducing or even preventing cerebral palsy.

Whether you are a student, an alumnus, a policymaker, a business leader or are part of our team here at the Medical Center, I hope you find our new magazine insightful and enjoyable. We look forward to bringing you more stories from KU Medical Center in the months and years to come.

MESSAGE FROM the ExECUTIVE VICE CHANCELLORBARBARA ATkINSON, MD Executive Vice Chancellor, KU Medical Center Executive Dean, KU School of Medicine

KANSAS MEDICINE + SCIENCE 02

FEATURESClosing the Gap

KUMC researchers are working to reduce American Indian health disparities.

Tough Medicine

Families of seriously ill children struggle with giving kids their medicine. Scientists at KU Medical Center are trying to help.

A Helping Hand

Many patients at the JayDoc Free Clinic are recovering faster, thanks to KU physical therapy students.

The Digital Future is Here

The era of electronic medical records has arrived.

ARTICLES

Obesity and the Brain

10 Questions with Parvesh kumar

The Fight Against Cerebral Palsy

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TABLE OF CONTENTS +

In a new report published by the Association of American Medical Colleges (AAMC), the University of Kansas School of Medicine ranked in the 100th percentile for medical schools producing primary care doctors. The School also ranked in the 100th percentile for developing physicians for rural areas and for training Native American students. It ranked in the 75th percentile for the number of Hispanic students. In the AAMC survey, students also ranked the KU School of Medicine in the 75th percentile when it comes to providing instruction in women’s health and training in culturally appropriate medical care for diverse populations. The School of Medicine’s instruction on the role of community health and social service agencies play in medical care was ranked in the 100th percentile among medical schools. The AAMC’s Medical School Missions Management Tool was developed to provide medical schools with benchmarking data related to its mission and goals.

The University of Kansas School of Medicine is ranked 5th among 141 U.S. medical and osteopathic schools in a first-ever study on how well medical schools meet their social mission to train doctors to care for the nation. The School of Medicine has long been ranked among the top schools in the country for producing primary care physicians and physicians who practice in rural and underserved areas, and this latest study illustrates the commitment the University of Kansas has to training primary care and rural physicians. The George Washington University researchers who conducted the study defined social mission in three ways: the percentage of graduates practicing primary care; the number of graduates from underrepresented minorities; and how many work in health-professional-shortage areas.

KU School of Medicine in top five on “Social MiSSion”

aaMc ranKingS place School of Medicine aMong the beSt for training priMary care phySicianS

This spring, The University of Kansas Cancer Center leadership met with the External Advisory Board (EAB) to review the progress KU has made toward submission of its application for NCI designation. The EAB review is a significant milestone for institutions applying for NCI designation. In a report submitted after that meeting, the EAB concluded that the Cancer Center has made solid progress over the last year, and that recent successes on recruitment are positive, although a number of critical recruitments remain. The EAB’s advice was to stay the course, although the Board mentioned that the NCI is expected to change its designation guidelines once they have appointed a new NCI director. Roy Jensen, MD, director of the KU Cancer Center, said he was pleased that the EAB believes the Cancer Center is on the right track and has made considerable progress in its quest to achieve this critical designation.

nci deSignation on the right tracK

Three Kansas City civic leaders have been elected as officers of the Advancement Board. Cheryl Jernigan was elected for a second term as board chair. David Wysong was elected chair-elect, and Mary Hunkeler was elected as secretary. The Advancement Board is an 80-member advisory group that represents the objectives of the University of Kansas Medical Center, The University of Kansas Hospital and University of Kansas Physicians Inc., collectively known as the academic medical center. The board works to develop community and political support for the academic medical center and to bolster philanthropic efforts for education, research and patient care. The Advancement Board meets twice each year, with committee meetings and community affairs events held throughout the year. The board’s immediate project includes helping the academic medical center in its quest for National Cancer Institute designation.

new advanceMent board officerS naMed

PULSE +

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ILLUSTRATION by Nazario Graziano, colagene.com

PUBLIC HEALTH PROGRAMS AIM TO IMPROVE AMERICAN INDIAN HEALTH

“It is so distressing to see how many of us are suffering from serious medical conditions,” Cully says. “There has been so little emphasis on prevention and leading a healthy lifestyle in the Native community, and that’s apparent when you see the health issues many of us are facing.”

How severe are the health disparities between American Indians and the rest of the population? American Indians have the highest rates of smoking, obesity, and diabetes of all ethnic groups – and the lowest five-year survival rates for all major cancers and the lowest screening rates for breast cancer and colorectal cancer. Incidence of and mortality from diabetes, heart disease, and various cancers are rising at alarming rates. In addition, American Indians are 770 percent more likely to die from

alcoholism, 650 percent more likely to die from tuberculosis, 280 percent more likely to die from accidents, and 52 percent more likely to die from pneumonia or influenza than other ethnic populations.

Those shocking statistics come as no surprise to KU Medical Center researchers, who are looking for ways to lessen the cultural, social, economic and structural barriers that continue to limit American Indian access to health care.

Researchers in the KU School of Medicine’s Department of Preventive Medicine and Public Health have developed a number of programs designed to address some of the health disparities that are affecting the

Rex Cully has seen firsthand how chronic and debilitating medical conditions are affecting American Indians. Cully, a member of the Cree, Seminole and Apache tribes, is a recreation coordinator at Haskell Indian Nations University in Lawrence, Kan. He says the health problems facing this country’s Native population have reached almost epidemic proportions.

CL SINGGAPTHE

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American Indian communities of Kansas and the United States.

Won Choi, PhD, MPH, an associate professor of preventive medicine and public health with the KU School of Medicine and executive director of the Masters of Public Health (MPH) program, says these efforts are critical, even though American Indians make up just 1.8 percent of the Kansas population and 1.5 percent of the U.S. population.

“You just have to look at the data to see that American Indians have the largest health disparities of any population group in the country,” Dr. Choi says. “And when you combine that with the fact that we have the least amount of information about American Indians than almost any other demographic group, it is a very grave situation.”

From the earliest days of colonization, the diseases brought from the Old World proved far more lethal to American Indians than any weapon in the European arsenal. Infectious diseases, including measles, smallpox, and typhus, among others, annihilated entire communities even before they had seen a single European.

The toll taken by disease, when combined with the effects of war, the expulsion of virtually all of the more than 500 American Indian nations from their ancestral lands, and the destruction of their traditional ways of life, decimated the self-governing structures of American Indian communities. The majority of the Native population became dependent on the federal government to provide basic needs, including health care. The Indian Health Service provides basic health care to Native people who

are enrolled members of federally recognized tribes, but due to under-funding, trust issues, and a variety of other problems, the Indian Health Service has not had much success in meeting the needs of the Native population.

In large part because of this failure, American Indians are dying of diabetes, alcoholism, tuberculosis, suicide, unintentional injuries, and other health conditions at shocking rates. Beyond mortality rates, American Indians also suffer significantly lower health status and disproportionate rates of disease compared with all other Americans.

Over the past several years, KUMC researchers and faculty have received 11 grants, totaling about $17.5 million, from national, local, and internal sources, to address health disparities among American Indians.

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Angel Talawyma and Won Choi, PhD, MPH

Over the past 10 years, KU School of Medicine has developed a national reputation for its programs to reduce health disparities for minority and rural populations. Edward Ellerbeck, MD, MPH, Chair of the Department of Preventive Medicine and Public Health, says the department’s research, service and education programs aimed at underserved populations are desperately needed.

“Most public health programs have traditionally been targeted towards white populations,” Dr. Ellerbeck says. “At KU Medical Center, we are conducting research and developing programs that take into account the distinctive cultural and economic factors that play a key role in other underserved population groups.”

The majority of the health disparities programs developed by KU Medical Center over the last decade are in the areas of cancer control, tobacco use and obesity. Future plans include launching programs that help minorities and rural residents prevent and cope with diabetes.

Dr. Ellerbeck says the common issue shared by underserved minority and rural populations is the lack of access to health care. This means that African Americans, Latinos, American Indians and rural residents are less likely to undergo basic preventive health care screenings and take advantage of smoking cessation and obesity prevention programs.

One way that KU Medical Center is trying to improve minority and rural access to health care is by building relationships with community groups that have close ties with their populations. Paula Cupertino, PhD, an assistant professor of preventive medicine and public health, says she and her colleagues have spent the last five years forging partnerships with organizations such as El Centro and the Coalition of Hispanic Women Against Cancer in an effort to reduce health disparities in Wyandotte County’s Latino community.

“No one group or institution can close or reduce a community’s health disparity gap on their own,” says Dr. Cupertino. “But we are optimistic we can make some systemic changes when we all pool our strengths and work together.”

BOLD ACTION ON HEALTH DISPARITIES

Most recently, in May of 2010, the National Institutes of Health (NIH) awarded KU Medical Center and the American Indian Health Research and Education Alliance (AIHREA) a $7.5 million National Center on Minority and Health Disparities (NCMHD) Center of Excellence grant to create a Center for American Indian Community Health. Among other things, the grant will help set up a pipeline to attract American Indian high school and college students to the KU School of Medicine’s Masters of Public Health degree program, other graduate programs at KU Medical Center, and to careers in public health. KU School of Medicine faculty are working with Haskell Indian Nations University to identify potential students for the MPH program. Five years ago, there were no American Indian students in the KU-MPH program. Three Native students have already earned degrees, and five more are currently enrolled, with several additional applicants for fall semester.

Christine M. Daley, PhD, an associate professor of preventive medicine and public health at the School of Medicine and the director of AIHREA, is one of the principal investigators for the NCMHD grant. Dr. Daley says training American Indian public health professionals will be a key tool in reducing health disparities among the Native population in Kansas.

“Because of our country’s long history of breaking promises to the American Indian community, many Native people are still very mistrustful of outsiders,” Dr. Daley says. “Our goal is to train and educate the next generation of Native health researchers and health care professionals, hoping that they will return to their communities and help to address these health disparities.”

In an effort to improve breast cancer screening rates, the NCMHD grant also provides funding for a study, lead by Kim Engelman, PhD, an associate professor of preventive medicine and public health, on why many American Indian women fail to get repeat mammograms.

Because smoking and death rates from tobacco-related diseases among Native people are double those of other ethnic groups, reducing tobacco use by American Indians has become a major priority for researchers at the KU School of Medicine. A second study funded by the NCMHD grant focuses on tobacco

use, diet, and exercise patterns among tribal college students.

This study continues efforts that started in 2003 with the creation of the All Nations Breath of Life smoking-cessation program, which is culturally tailored for a multi-tribal American Indian population. The program, created in collaboration with the Native community, recognizes and respects that tobacco is a sacred plant to many American Indians and that ceremonial use is entirely different from recreational use.

“Tobacco is used in a variety of ceremonies throughout Indian Country,” says Angel Talawyma, who has been actively involved in the All Nations Breath of Life program, and serves as a community outreach coordinator for the new Center for American Indian Community Health at KUMC. “Our smoking-cessation program recognizes and honors that.”

For the All Nations program, researchers and community members worked together to develop a 12-week curriculum. While it is designed to respect the sacred nature of tobacco to many Native people, the program also recognizes that not all Native people use tobacco for spiritual or cultural reasons. Early indications are that All Nations Breath of Life has had some success in helping American Indians quit or reduce smoking. Preliminary data shows that 65 percent of those enrolled were smoke-free after completing the program, and 25 percent were smoke-free six months after completing the program. This rate of success is similar to those for top programs designed for other ethnic groups.

While the disparities in American Indian communities seem overwhelming, there is some optimism that the research and outreach programs spearheaded by KU Medical Center and its partners are making a difference. Rex Cully says he is sure that the next generation of American Indians will not suffer the severe health disparities experienced by previous ones.

“I suffer from high blood pressure and my wife has diabetes,” Cully says. “Because we now know so much more about how these health problems can impact our lives, we are determined that our son and daughter will take better care of themselves and will live longer and healthier lives.”

Obesity is close to overtaking smoking as the primary preventable cause of death in the United States. It’s a public health threat with consequences that physicians and policymakers are only beginning to understand.

According to the Centers for Disease Control (CDC), two-thirds of U.S. adults are officially overweight, and about half of those have graduated to full-blown obesity. The rates for African Americans and Latinos are even higher. Among kids between 6 and 19 years old, 15 percent, or 1 in 6, are obese, and another 15 percent are headed in that direction.

The societal costs are overwhelming. Obesity severely increases likelihood of coronary disease, diabetes, stroke, hypertension and osteoarthritis, among other ailments. It also carries staggering economic costs. The CDC estimates the total medical tab in the United States for illnesses related to obesity is $117 billion a year – and climbing. In Kansas alone, health care expenditures for overweight and obese residents account for 5.5 percent of total health spending and cost more than $650 million annually, which includes $138 million in state Medicare costs.

Scientists have spent decades searching for clues about why some people compulsively overeat and others don’t. Obesity appears to be both a complex genetic disease and a product of lifestyle choice. This apparent paradox has led to the development of two distinct fields of obesity research, one biological and one psychological.

Researchers at KU Medical Center are hard at work trying to understand the basic biochemistry of hunger. Scientists are studying brain networks, which are supposed to tell the body when and how much to eat, and the signals that originate in the stomach and then flow into the brain, triggered by the amount of food a person eats.

Cary Savage, PhD, director of the Center for Health Behavior Neuroscience at KU Medical Center, in partnership with other researchers at the University of Kansas, has been awarded a number of grants from the National Institutes of Health to decipher the intricate brain patterns associated with overeating. The hope is that greater understanding of how the brain processes such stimuli can lead to better health care outcomes.

“We make hundreds of health decisions every day,” Dr. Savage says. “From waking up at a certain time, to what we eat for breakfast, to walking versus driving to work, to where we park, to what we eat for lunch, if we smoke and how much we smoke, if we drink and how much we drink.

These decisions have a basis in the brain, and we’re trying to discover how eating decisions correlate to that.”

In Dr. Savage’s current research study, obese, healthy-weight and test subjects are shown pictures of appealing food while a magnetic resonance imaging (MRI) machine scans their brains. The subjects then view pictures of animals not traditionally considered appetizing. The scan is performed twice, once when the subjects haven’t eaten for four hours and once after a small, 500-calorie meal. Remarkably, the brain scans show that obese test subjects are hyper-responsive to food pictures, both when they are hungry and right after they have eaten.

Joseph Donnelly, EdD, director of the Center for Physical Activity and Weight Management at the University of Kansas, and collaborator with Dr. Savage, believes the results of this research could lead to more effective weight-loss programs – once scientists better understand the relationship between brain activity and food.

“When specific aspects of brain function are identified, it will then be possible to have targeted interventions that best suit the individual,” Dr. Donnelly says. “Most people can lose weight but very few can maintain weight loss. If we know how brain function affects weight maintenance, we can provide targeted behavioral strategies or drugs that will increase the likelihood of sustaining weight loss over extended periods of time.”

This kind of research being conducted at KU Medical Center is possible in large part to recent advances in neuroscience and the widespread use of functional magnetic resonance imaging. Functional MRI is a relatively new procedure that uses magnetic resonance imaging to measure the tiny metabolic changes that take place in an active part of the brain.

Dr. Savage has also been awarded NIH grants to launch a brain imaging study to determine why some people can adhere to an exercise program while others cannot.

He says what is really exciting is that the implications for this research could reach far beyond the area of obesity.

“Brain imaging could be used to study why people compulsively gamble, drink, or eat too much,” Dr. Savage says. “We may be able to one day use brain imaging to predict addictive behaviors in people and find behavioral or drug therapies to stop destructive habits before they begin.”

Do our brains cause us to overeat?

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Parvesh kumar, MD

Why did you decide to come back to KU?

There were three very influential women who played a big role in my decision. One was (KU Medical Center Executive Vice Chancellor) Barbara Atkinson. She had been persistent in trying to recruit me for several years, and she finally persuaded me. The second was Annette Bloch, whose dedication to quality cancer care and her generosity was a sign to me that KU was committed to building a world-class radiation oncology department. And the third was my wife, who even though she was from Los Angeles, encouraged me to pursue this opportunity in Kansas.

What drew you to radiation oncology as a career?

Was being a KU School of Medicine alum a big part of that decision?

When I was going to medical school here, the chair of radiation oncology was Carl Mansfield. When Dr. Mansfield talked to us about radiation oncology, he was so passionate about how you can take photons, protons and neutrons and use them to cure cancer. Since I had a strong physics and engineering background, this was so fascinating, and I knew right then that this was the career for me.

Oh, definitely so. It had always been in the back of my mind that I would want to return to KU one day if the university got to a place where it could make a commitment to a top quality radiation oncology department.

In early 2010, KU Medical Center recruited Parvesh Kumar, MD, from the University of Southern California’s Keck School of Medicine to become the Joe and Jean Brandmeyer Chair and Professor of Radiation Oncology, and to serve as interim deputy director of The University of Kansas Cancer Center. We asked Dr. Kumar, a KU School of Medicine alumnus, 10 questions about his return to Kansas, the future of radiation oncology and the region’s drive for NCI designation.

NCI designation is a seal of approval signifying that you are one of the best research institutions in the country. And cancer patients in Kansas will benefit because they will have better access to the latest therapies and the opportunity to take part in early trials of promising treatments.

You’ve spent your entire career in academic medicine settings. Why does that appeal to you?

I think it is a privilege to be in academic medicine. I followed this path because I am driven to find ways to improve cure rates for cancer patients. Our society is counting on us to find better methods of treating cancer and to find a cure someday.

What are some of your goals for KU’s radiation oncology department?

Why is achieving NCI designation so critical for KU and for this region?

Treating cancer with radiation has been around for nearly 100 years. How has radiation oncology changed over that period of time?

What are some the challengesof running clinical trials?

What do you enjoy doing away from the office – in your spare time?

What new radiation technology is on the horizon?

To put it simply, I want our department to be a leader in national research, and I want our clinical program to be among the country’s best. We need to sponsor more clinical trials. One of my goals for my first year here was to recruit several high-caliber faculty members for our department. I’m happy to say we’ve already met that goal.

Radiation oncology has changed as much as air travel has changed since the Wright Brothers’ flight at Kitty Hawk. Early 2-D radiation has been replaced by 3-D conformal radiation, which is used to treat tumors that in the past might have been considered too close to vital organs for radiation therapy. And now we’re using IMRT (intensity-modulated radiation therapy), which is a high-precision radiation that is considered the next generation of 3-D conformal radiation.

First is making sure you comply with all the regulatory issues surrounding clinical trials in this country. You also need to make sure you write the best trial for your patient population. And being the principle investigator of a clinical trial is very time-consuming. But despite all that, we are committed to running more radiation oncology clinical trials here.

I have two boys who are ages 12 and 6, and I love hanging out with them. I’m also a lifelong Kansas City Chiefs fan, so I’m looking forward to going to some games this season. And, of course, it goes without saying that I’m a rabid KU basketball fan!

I’m very excited about new drugs like radiosensitizers that make tumor cells more sensitive to radiation, and mitigators, which minimize toxicity after radiation has been delivered.

BACk WHERE HE BELONGS

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ILLUSTRATION by keith Negley

KUMC researChers are MaKing better drUgs for Children

aMy Jollie thoUght getting her Child to taKe his MediCine woUld be the easy part.

Hearing the devastating news that her three-year-old son, Trevor, has leukemia? Now that was tough. Making frequent trips to the hospital from her family’s home in Independence for Trevor’s treatments? Haggling with the insurance company over what is covered? Trying with her husband to divide attention between Trevor and their two other young children, plus a fourth on the way? Those are the kinds of challenges that nearly every family with a seriously ill child knows they may face.

But Amy had no idea that preparing and giving her son the medicine he needs to fight his leukemia would be such a nightmare. Like many other parents, she is often forced to crush adult pills and place them in a liquid such as apple juice in an effort to make them more palatable to Trevor.

“When we first started, it was torture,” Jollie says. “Trevor’s still a toddler and isn’t always cooperative. He doesn’t like the way most of the medicine tastes, and when I try to give him some of the steroids he needs, he gags and sputters, so I’m never sure he’s getting enough. I just can’t believe it should be this difficult to give my child his medicine.”

Most parents are blissfully unaware of the complications involved in developing effective medicines for children. After all, drugstore aisles are stocked with a large variety of fairly easy-to-administer cherry and bubble-gum-flavored liquids and chewable tablets to sooth all manner of childhood ailments. The real challenges arise when physicians treat children affected by more serious afflictions – conditions like cancer and cardiovascular problems. The pharmaceutical industry has invested decades and billions of dollars to develop successful drugs and therapies for adult patients, who are the more visible victims of serious illnesses. But when those same conditions strike pediatric patients, the number of options for effective and safe treatments plummets.

Kathleen Neville, MD, a clinical pharmacologist and practicing hematologist/oncologist at Children’s Mercy Hospital and Clinics in Kansas City, Mo., is Trevor Jollie’s physician. Dr. Neville says the emotional and physical toll on families of critically ill children is nearly unfathomable. That burden is intensified when there’s the added pressure of trying to make sure those children are getting the right doses of medicine.

“If you’re relatively lucky, you can go to a place like Children’s Mercy Hospital, where the pharmacy will compound some of the medications,” Dr. Neville says. “But if you’re not so fortunate and have to go to a hospital or pharmacy that doesn’t do compounds, you’re out of luck. And even

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compounding is not the same as a proper formulation – it’s like a home recipe, except that a pharmacist is doing it.”

The United States may lead the world in pharmaceutical advancements and treatments, but it turns out that the industry, for the most part, has overlooked one key patient population: children.

“What has occurred is that there are drug products on the market today that could be extremely beneficial to children, but they’re not available in pediatric form,” says Scott Weir, PharmD, PhD, a professor of pharmacology, toxicology, and therapeutics at KU Medical Center and the Frank B. Tyler Cancer Research Professor in Therapeutic Discovery at the KU School of Medicine. Dr. Weir is also director of KU’s Institute for Advancing Medical Innovation (IAMI), which is at the forefront of efforts to increase the number of drugs specifically formulated for children.

Recognition of pediatric patients’ unique therapeutic needs has led to a creative partnership between four institutions, including IAMI, which bring their unique expertise, capabilities and resources to address these needs. The partnership is devoting substantial resources toward creating drug formulations engineered and packaged specifically for children. Reformulating already-tested adult medications so they are effective for children is faster and less expensive than trying to develop new therapies for children.

“We are usually talking about a very small population of patients,” says Ross Trimby, chief operating officer at the Boston-based Institute for Pediatric Innovation. “For example, one of the cardiac drugs we’re working on would affect a population of less than 30,000 young patients in the United States. For a drug company to go through the Food and Drug Administration (FDA) regulatory process, plus the manufacturing and distribution process for a drug which is only going to be delivered to fewer than 30,000 patients…it is going to be very difficult to justify that economically.”

Studies in the journals Pharmacoeconomics and the Journal of Health Economics estimate the average cost of new drugs – from inception to regulation and distribution – at a minimum of $500 million and as high as $2 billion. Because of the tremendous investment required to develop new drugs, pharmaceutical companies are reluctant to devote that amount of money for a medicine or treatment that would impact a relatively small patient population. The expense means that, theoretically, a pharmaceutical company could spend, in some cases, as much as $67,000 per potential patient to develop a treatment – the economic equivalent of developing a new luxury car to sell to just a handful of consumers every year.

“We know this is a huge issue, particularly when it comes to pediatric drugs,” says Dr. Weir. “The FDA and many other organizations, including the American Academy of Pediatrics and the National Institute of Child Health and Human Development, have lists of the most important drugs that should be available in pediatric form. But we need to act on these recommendations. That’s why we are taking the bull by the horns.”

The pediatric drug reformulation effort at KU represents not only a significant step forward for medicine, but is a prime example of public-private partnerships and collaborations required in an age of lowered investment and diminished public funding.

KU, through IAMI, is working with the Institute for Pediatric Innovation in Boston, Children’s Mercy Hospital, and Beckloff Associates, an Overland Park, Kan.-based pharmaceutical development and regulatory consulting firm, to reformulate drugs for pediatric patients. IAMI currently supports the partnership by developing two pediatric drug products per year for the next five years. The work is being funded by an $8.1 million from the Kauffman Foundation and a challenge match of $8 million from University of Kansas Endowment.

The Institute for Pediatric Innovation’s role is to identify the drugs that need to be reformulated into a pediatric liquid form. The drugs for reformulation are selected after careful review and input from a consortium of pediatric heath centers, including Children’s Mercy Hospital.

After a drug is chosen for reformulation, IAMI works with the partners to define the path from development to market, beginning with outlining the pediatric drug product properties. Input from its partners at this stage is crucial.

Dr. Weir says the extent of clinical testing required for FDA approval will vary for each product developed. In some cases, clinical testing requirements will be focused on demonstrating that the absorption of the active ingredient from a pediatric drug product is similar to that from the currently marketed adult form of the drug. This testing can most likely be conducted in adult subjects.

SUMMER 2010 17

reCognition of pediatriC patients’ UniqUe needs has led to a Creative partnership

In other cases, the safety and efficacy trials must be conducted in children to determine the optimally effective and safe dose. The development time and cost is significantly greater when clinical trials with children are required. Studies in children will be conducted at Children’s Mercy, as well as other partnering pediatric health centers through a network established by the Institute for Pediatric Innovation.

Defining requirements to bring the pediatric drug products to market is the role played by Beckloff Associates. The company assists KU in the transfer of pediatric drug product manufacturing from its laboratories to commercial facilities, a step required to prepare supplies for clinical trials and commercial launch of products. Beckloff also prepares materials for FDA review, and manages the review and approval process.

This still relatively new collaboration is already bearing fruit. The development of two pediatric cardiovascular drug products is well under way, and a critical meeting with the FDA to define the specific development requirements for one of these products is scheduled for later this year. Dr. Weir says that KU will work with the FDA to define specific studies required to bring the cardiovascular product to market.

“We anticipate we’ll be able to do so within three years, at a cost of less than $3 million,” Weir says. “That is in sharp contrast to 10 to 17 years and in excess of a billion dollars normally required to bring a new drug to market.”

Once the reformulated drug has been approved, a drug company can manufacture and distribute it.

“Essentially we’ve done the development and FDA approval work for these pediatric drug products, so that a drug company can just license the new formula and sell it to individual hospitals, physicians and pharmacies,” says Ross Trimby.

Another valuable tool in this process is the University of Kansas School of Pharmacy. The School has a long-standing, world-wide reputation in drug delivery expertise, and last year was ranked second in the nation when it comes to attracting National Institutes of Health funding.

Under the leadership of Michael Baltezor, PhD, director of the Biotechnology Innovation and Optimization Center on the Lawrence campus, the pharmacy team conducts research leading to the development of pediatric drug products which can practically and safely be prepared and dispensed by pharmacies. The products must possess the right potency, stability and taste.

“Especially taste,” Dr. Weir says with a smile. “That can’t be downplayed in formulating drugs for children. It seems pretty obvious, but if kids don’t like the taste, they’re not going to take it.”

Parents Amy and Doug Jollie with sons Tanner, Tyler and Trevor

This arrangement, in which a nonprofit consortium helps orchestrate a partnership between public universities and private businesses for the eventual benefit of pediatric patients, is a relatively new business model. The economics of health care frequently require massive investment from either a government agency or a private corporation, but this effort attempts to bridge the funding gap between the two and create a cooperative with mutually beneficial results.

“What makes this model significant, I think, is that academic institutions, a non-profit patient advocacy organization, and industry have partnered to form an entity that will develop and commercialize drug products for children,” says Weir. “Because of this and other initiatives, KU is fast developing a national reputation as a leader in defining the new role of academia in drug discovery and development.”

Children’s Mercy Hospital also plays a crucial role in this partnership. Children’s Mercy is recognized internationally as a leader in pediatric clinical pharmacology. Research conducted at Children’s Mercy has directly led to revisions of over 35 drug product labels by pharmaceutical companies to include specific pediatric clinical pharmacology information. Steven Leeder, PhD, PharmD, directs Children’s Mercy’s Division of Clinical Pharmacology and Medical Toxicology, which has a long track record of providing this kind of scientific leadership. Stephen Spielberg, MD, PhD, one of the nation’s best-known specialists in pediatric pharmacology, leads the pediatric personalized medicine research program at Children’s Mercy. Dr. Spielberg also serves as chief scientific officer for the Institute for Pediatric Innovation. Children’s Mercy’s leadership and expertise is critical to not only defining the requirements of pediatric drug products developed by the partnership but also in providing the clinical expertise to evaluate these products in children.

IAMI and The University of Kansas Cancer Center have also forged a direct partnership with Children’s Mercy Hospital on another project to reformulate anti-cancer agents for children. One such product, a drug currently prescribed for children with leukemia, will advance to clinical trials at Children’s Mercy prior to the University’s planned application next year for National Cancer Institute designation as a Comprehensive Cancer Center.

Everyone involved in these ventures is optimistic that their efforts to formulate, test and market the safest and most effective drugs possible for children will make those drugs available to the families of seriously ill children – and sooner rather than later.

“These collaborations focus on practical needs and feasible solutions for children,” says Ross Trimby. “I think we’re going see a number of these solutions turned into real products that will improve the way we care for children.”

That can’t come quickly enough for the Jollie family in their quest to heal Trevor.

“Whatever we need to do, we’ll do it,” Amy Jollie says. “But having medicine made just for a three-year-old with leukemia would definitely make our lives much easier.”

SUMMER 2010 19

CEREBRALPALSY

against

2

RESEARCHERS AT kU SAY INFLAMMATION IS THE REAL CULPRIT

More than half a million Americans have cerebral palsy, and an additional 4,500 infants and children are diagnosed every year. It’s a potentially

devastating disorder that affects muscle tone, movement, and motor skills and can lead to other health issues, including vision, hearing,

and speech problems, and learning disabilities.

Because of recent advances in health care, the number of children born with cerebral palsy is actually on the rise. Improvements in prenatal, pediatric and intensive care over the past 30 years have enabled more critically premature and frail babies to survive infancy. Many of these children suffer developmental and neurological disorders – including cerebral palsy.

But researchers and physicians at KU Medical Center and the University of Kansas now believe they have gained a promising foothold against the disorder. Until recently, cerebral palsy was believed to have been a result of labor abnormalities that interrupted oxygen flow from the mother to the baby. That long-held theory has largely been proven untrue, according to Carl Weiner, MD, the K.E. Krantz Professor and Chair of the Department of Obstetrics and Gynecology.

“No more than one in seven cases of cerebral palsy is related to problems during delivery,” says Dr. Weiner. “It has now been established that the common factor among cerebral palsy cases is low oxygen levels during pregnancy.”

These chronically low levels of oxygen in the womb cause inflammation, particularly in the brain of the fetus.

Armed with the knowledge that premature babies and babies who experience inflammation and the resulting

infection carry higher risk of cerebral palsy, KU Medical researchers believe they can stop the effects, if not the actual

cause of low oxygen.

”By using ultrasound, we can identify which babies are not getting enough oxygen in the womb,” Dr. Weiner says. “We know that through

different interventions, we may be able to block brain inflammation and damage caused by low oxygen. Then we think we can limit the damage from

possible inflammation.”

When a fetus’ brain is damaged during pregnancy, the real culprits are oxygen-free radicals – atoms with unpaired electrons that can be highly reactive and potentially dangerous. When oxygen-free radicals develop in vitro, they can affect neurological development and cause problems in the areas of the brain linked with cerebral palsy. A few drugs can help absorb or neutralize these free radicals, but they haven’t been totally successful.

Dr. Weiner and his team at KU Medical Center have been working for several years with Peter Swaan, PhD, an associate professor of pharmaceutical sciences at the University of Maryland, to develop more effective drugs to defuse oxygen-free radicals during pregnancy.

“We really believe there could be a pharmaceutical solution to preventing the brain damage that leads to afflictions such as cerebral palsy,” says Dr. Swaan. “We are currently in the process of screening compounds that could neutralize the toxic effects of oxygen-free radicals.”

Dr. Swaan believes they are less than five years away from identifying compounds that can safely and effectively interfere with oxygen-free radicals’ damaging attacks on the brains of fetuses. He says the compounds will then be tested on cells, mammals and eventually human subjects. If the clinical trials are successful, it could mean the elimination of cerebral palsy – or, at the very least, the eradication of its more severe types.

Dr. Weiner and his colleagues’ research is significant in a larger sense because it goes to the fundamental origins of adult diseases. Scientists believe more than 80 percent of adult diseases can be traced to in vitro problems. The association between low birth weight, which reflects intrauterine nutritional status, and the development of adult diseases has been confirmed in many studies for type 2 diabetes, hypertension and coronary heart diseases.

Dr. Weiner believes that by shifting the focus from late-life treatment to early-life prevention, scientists might be able to head off diseases before they start – and save society from massive financial outlays down the line.

“If you’re treating chronic hypertension at age 40, you’re about 41 years too late,” Dr. Weiner says. “The goal is to intervene with the environment before the child is born, so we can stop health problems – whether it’s cerebral palsy or other conditions – before they can surface later in life. We really believe that this new approach to research and medicine has the potential to improve the health and well-being of every person on the planet.”

SUMMER 2010 23

OPPOSITE: Carl Weiner, MD

Cerebral palsy doesn’t discriminate. It affects one to three babies per 1,000 births worldwide. It doesn’t appear to be more prevalent in one country, race or class than any other.

KANSAS MEDICINE + SCIENCE 24

Physical therapy students are getting patients on the road to recovery

Gary Chowning

a helping hand

ILLUSTRATION by Jordan Gray

SUMMER 2010 25

He would trip over his own feet every once in awhile or have occasional trouble grasping his fork. Before long however, these minor annoyances became much more pronounced. After a conversation with his employer, Chowning realized that his physical issues had become serious.

“My boss was concerned and thought that I might have had a minor stroke,” Chowning says. “He noticed I was dragging my left foot and getting sluggish and tired early in the afternoon. Not long after that, my back pain spiked, and I started to have trouble standing and walking. When I started losing my ability to function, I knew my only option was to go get checked out.”

After an MRI scan revealed that he needed a cervical spine fusion, Chowning found himself scheduled for surgery at The University of Kansas Hospital to repair the discs in his neck that were causing progressive nerve damage. In the space of one week, Chowning endured two separate surgeries performed through the front and back of his neck. Shortly thereafter, he was able to stand and, after months of physical therapy, he regained some of his range of motion.

Much of his medical care was free. Thanks to the services provided by the JayDoc Free Clinic, as well as the care and support of the orthopedic surgery team at The University of Kansas Hospital and KU Family Care Clinic, Chowning received surgical and post-surgical care even though he didn’t have any medical insurance.

The JayDoc Free Clinic is a safety net clinic in Wyandotte County that provides free health care services to underinsured and uninsured populations. Medical students from the University of Kansas have been treating patients like Chowning since the clinic opened in 2003. In addition to providing urgent and preventive care, the clinic also offers diabetes, women’s health, ophthalmology and physical therapy services. For patients who need additional care, JayDoc has a social services division

which includes KU law students to help them locate clinics and other services to better assist their needs.

None of the patients are asked for compensation after they’ve been treated. If a patient insists on paying, it’s considered a donation and used to purchase supplies and equipment. The urgent and preventive care division of the clinic is organized entirely by students from the KU School of Medicine, who are supervised by physicians from the School of Medicine. JayDoc executive directors, such as second-year medical student Jennifer McRae, work to keep volunteers and resources ready to assist patients.

“The JayDoc Free Clinic fills such an important niche in our community,” McRae says. “There’s no other acute care evening clinic in Wyandotte County, and there are very few free clinics in Kansas City. Even if patients have to wait for awhile to be seen, our feedback is always very positive.”

Thanks to support from partnerships and private donations, JayDoc is able to treat patients at a facility that can meet a wide range of health care needs. Whether it’s diagnostic tests or custom-fitted orthotic devices, the student doctors make every effort to provide top-quality care. For patients like Gary Chowning, who need ongoing assistance to recover from surgery or deal with musculoskeletal issues, the physical therapy service at JayDoc can be a tremendous help. With a physician’s referral, patients can receive on-site treatment from physical therapy students from the KU School of Allied Health and have detailed therapy plans configured to meet their needs. The students are supervised by Linda Denney, PT, a clinical professor with the Department of Physical Therapy and Rehabilitation Science.

“One of the first things we teach our first-year students is the importance of pro bono work in the community,” says Denney. “As our students go out and serve the community, they learn the sorts of interpersonal and problem-solving skills they’ll need to be successful in their practice.”

Since Denney has been supervising the physical therapy services at JayDoc, she’s seen a growth in student interest. During their orientation, first-year students in the KU Doctor of Physical Therapy (DPT) hear from second- and third-year students about the opportunities available

at the free clinic. The enthusiastic veterans have no problem extolling the many benefits they’ve received from donating their time.

“It’s an easy sell,” says Denney. “After our new students hear about JayDoc, there’s always a rush for open positions at the clinic. Most of them arrive at our doors ready to take their first steps into the profession, and the clinic gives them that opportunity. Thanks to their motivation, and our generous donors, we’ve doubled in size – both in terms of patients and volunteers.”

For Chowning, the opportunity to receive ongoing physical therapy has made a world of difference. Thanks in part to his own perseverance, he’s seen amazing results. Since September of 2009, Chowning has attended the JayDoc Free Clinic at least once a month – sometimes more often. In that short period of time, he’s become the physical therapy service’s most loyal client.

The student volunteers are enjoying the experience as well. For Jenna Hamilton, a third-year physical therapy student and one of the first volunteers to treat Chowning, the opportunity to interact with patients in a clinical setting has been a terrific learning tool.

“It’s been great to see Gary progress,” says Hamilton. “We’ve had a lot of time to work with him, and it’s been really beneficial to watch his recovery. Each time we see him, we’re able to build on our previous session and monitor the changes in his range of motion and endurance.”

Hamilton is quick to add that, with patients like Chowning, it hardly feels like work.

“The last time I saw Gary, he told me he was really happy because he could now walk from one end of Walmart to the other without becoming exhausted,” Hamilton says. “I like that kind of positive attitude in my patients.”

In turn, Chowning feeds off the energy he sees at the JayDoc Free Clinic.

“When I went back to the KU Family Care Clinic, they asked me how I was doing emotionally and if I needed to speak with someone,” he says. “I told them, ‘You know, I really don’t.’ I’ve been so fortunate, and I’m around so many upbeat people at JayDoc that it’s hard to get depressed about anything.”

At first, Gary Chowning’s health problems were manageable.

In the 1950s, decades before the creators of Microsoft, Google or Facebook had programmed their first software applications, the dawn of the computer age was inspiring novel theories on the way information technology could improve the understanding, diagnosis and treatment of disease. As basement-dwelling mainframe computers began to churn through massive amounts of data, many in the medical profession (and a few science fiction writers) began to speculate if the day would come when medical care would be fully automated.

While it’s widely agreed that computers will never achieve the level of independent thought or decision-making required for patient care, the role of technology in the consolidation, transfer and understanding of medical data has increased at a rapid rate. Today, nearly every recordable function of health care, from diagnostics to administration, can be integrated into a networked computer system designed to maximize the efficiency and delivery of treatment. It’s no longer a question of whether all health records will go digital...it’s just a matter of when.

CAN ELECTRONIC MEDICAL RECORDS FULFILL THE PROMISE?

KANSAS MEDICINE + SCIENCE 26

Even at the earliest point in the merging of computer technology and health care, it was obvious that the barriers, as well as the benefits, to utilizing digitally-stored medical records would be enormous. Researchers in the fields of health care, computer science and computer engineering formed a scientific discipline most often referred to today as medical or health care informatics.

“Informatics, and the integration of sustainable delivery networks within health care provider systems, was a field born largely out of necessity,” said Russ Waitman, PhD, director of medical informatics at the University of Kansas Medical Center. “When you consider the wealth of information that has always surrounded patient care and the extremely important function it provides, it seems intuitive that we would build a centralized data network to automate those processes.”

The University of Kansas Medical Center has been working for years to ensure that sure health care practitioners in Kansas and the country remain well informed about the advancements in health care informatics. Through grants and research initiatives, KU researchers and students are collecting data and working with vendors to improve health care IT systems that are being utilized all around the world. One such project is the KU Center for Health Informatics – an interdisciplinary initiative designed to advance the research and education of biomedical science and information technology.

Under the leadership of Helen Connors, RN, PhD, FAAN, associate dean of integrated technologies in the KU School of Nursing and executive director of the KU Center for Health Informatics, the Center has been highly involved in improving the informatics process. Since 2001, the KU School of Nursing has had an academic business partnership with Cerner to help design and field test health IT systems within academic programs. In addition, the school established the Health Information Technologies Scholars (HITS) program in 2007 to train additional faculty across the country who are then able to help integrate new technologies into academic and clinical practices.

“Nursing has always been at the forefront of informatics,” said Dr. Connors. “Nurses and nurse practitioners have a great deal of interpersonal interaction with patients and they’re responsible for recording a great deal of medical information. As such, it’s extremely important they be able to not only understand the data, but then convert that data to wisdom and teach others.”

With a strong emphasis on research and education, KU Medical Center has long been recognized as a leader in informatics research. Soon, the first students will earn degrees from an interdisciplinary master’s program in health informatics established through KUMC’s Graduate Studies Program and coordinated by the Center for Health Informatics.

Despite the many health informatics successes taking place at KU Medical Center and at other institutions across the country, the United States isn’t considered a global leader in the push for IT systems integration. According to a recent study of office-based physicians released by the Centers for Disease Control and Prevention, just 44 percent of office-based doctors had adopted a partial, basic, or fully functional electronic health records system.

Still, initiatives are in place to move the United States to the front of the informatics pack. President Barack Obama authorized $27 billion in stimulus funding over several years to speed doctors’ and hospitals’ move toward electronic records. Through the use of state-based health information exchanges, the federal government is hoping health care professionals will share higher quality data and re-establish the country as a global leader in health care technology.

However, resistance remains. For a physician or clinic that has yet to incorporate an advanced computer system into their daily operations, the process needed to transition to a fully computer-based system can be intimidating. A 2008 study by the U.S. Congressional Budget Office examined the costs associated with implementing health IT systems and found that initial expenditures could range from $25,000 to $45,000 per physician. According to Doug Girod, MD, FACS, senior associate dean for clinical affairs at KU Medical Center and professor and chair of the Department of Otolaryngology, the time, energy and cost of integrating IT systems into smaller clinical and private practices can be overwhelming for everyone involved.

“When your office makes the shift to IT systems, it’s a completely different work flow,” Girod says. “How a patient enters your system, how that initial data is collected… it requires a lot more manpower time up front. Upon integration, you can see a 50 percent reduction in productivity. However, that’s usually the sign of a poorly integrated system.”

Then there are the privacy concerns. Many physicians, especially those in private or small practices, have resisted the idea of allowing third parties access to their data. According to Girod, privacy concerns, both by doctors and patients, are understandable. But he says the reality is, electronic medical records are here to stay.

“We’re headed into an age of evidence-based medicine,” Girod said. “Medicare and third-party payers want to see outcomes before they provide reimbursement and that can’t be done without sharing information.”

Despite the headaches the new technology and mandates may cause for late adopters, IT systems could be of tremendous help to rural health care providers.

“There are huge advantages when we start talking about rural Kansas,” Girod says. “If we can build out our system and offer it to physicians in sparsely populated areas of the state, those smaller practices and clinics won’t have to build their own systems and repeat that long and costly process.”

Despite the fact that digital health records systems have been a part of the medical landscape for nearly twenty years, the industry is still in its infancy. In the coming years, software programs will become more efficient and switching to electronic health records will be much easier...and necessary.

“Information technology systems can be an indispensable tool,” Dr. Girod said. “It’s not what’s going to change medicine…it’s what’s going to allow us to change medicine.”

SUMMER 2010 27

This summer, Elizabeth Ablah, PhD, MPH, an assistant professor of preventive medicine and public health at the School of Medicine–Wichita, helped 25 children and youth place “No Dumping” medallions on stormwater drains in Planeview, a low-income Wichita neighborhood. The drains had been identified as heavy contributors of trash, chemicals, and harmful bacteria, such as E. coli, that pollute the Arkansas River.

“Our intention is to raise awareness that littering in stormwater drains affects our health, economy, and our environment,” Ablah says.

For more than a year, the KU School of Medicine–Wichita Department of Preventive Medicine and Public Health has led a grassroots effort to investigate public perceptions and concerns on environmental health issues. The stormwater drain medallion project, in partnership with the City of Wichita and Kansas State University, was so successful that Dr. Ablah and the group have scheduled return trips to the Planeview and Hilltop neighborhoods.

KANSAS MEDICINE + SCIENCE 28

Elizabeth Ablah, MD, with 14-year-old Vanida Janjumpa

Alumni Reunion Weekend

October 8-9, 2010Mark Your Calendar!

KUMC Alumni Association invites you to come home and rediscover the spirit of

your campus with great activities planned for the weekend.

Full schedule of events and registration at www.kumc.edu/alumni

Follow us on Facebook at www.facebook.com/KUMCAA.

For more information call (913) 588-1255 or (888) 679-5951.

‘50 . ‘55 . ‘60 . ‘65 . ‘70 . ‘75 . ‘80 . ‘85 . ‘90 . ‘95 . ‘00 . ‘05

NON-PROFIT ORG.US POSTAGE PAIDPERMIT NUMBER 3

EUdORa, KS

3901 Rainbow Blvd.Kansas City, KS 66160

COME ON INSIDE.We examine the gap in Indian American health disparities, analyze the coming wave of digital health records, weigh in on the brain’s influence on obesity, and a whole lot more.

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