Linda Van Marter: Big Leaps for Little Lungs

Helping little breathers
Spring 2016

One might assume that Linda Van Marter (MD ’80) was destined for a life in medicine. Born in Magee-Womens Hospital while her father, Neal (MD ’54), was in his first year of medical school at Pitt, she grew up in Erie, Pa., in the top two stories of a three-story house: The first floor was where her father, by then a family practitioner, had his office. She remembers observing him with patients there and even rounding with him at the hospital. But it didn’t occur to her that she might follow in his footsteps.

“I didn’t realize then that girls could be doctors,” says Van Marter. “Boys became lawyers and doctors, and girls—if they didn’t become homemakers—became teachers and nurses.”

Because her father had referred patients to Massachusetts General Hospital (MGH), she was aware of the nursing school there, so she headed to Boston. “It was at MGH that I encountered women physicians—including a former nurse—who inspired me to go to medical school,” she recalls. She then enrolled at Pitt as an undergrad and stayed on through medical school, supporting herself by working as a cardiovascular weekend charge nurse at UPMC Shadyside Hospital. Then it was back to Bean Town for her internship and residency at Boston Children’s Hospital, followed by a neonatal-perinatal medicine fellowship at Harvard (where she picked up an MPH along the way). In 1986, she joined the faculty of Harvard’s Division of Newborn Medicine in the Department of Pediatrics, where she was the first to pursue a research career in neonatal epidemiology. Since 1988, she has practiced exclusively at Brigham and Women’s Hospital, which contains Harvard’s largest perinatal-neonatal service, accommodating some 9,000 births per year, many of which are designated high-risk.

Neonatology was a relatively new field then, Van Marter says, “but I was fascinated by the medicine, the clinical challenges, the research opportunities, the intensity.” That fascination has not ebbed in 30 years, and she continues to serve as associate professor of pediatrics at Harvard and vice chair of pediatric newborn medicine. Her research has focused on the epidemiology of neonatal cardiopulmonary disorders, including persistent pulmonary hypertension of the newborn (PPHN), which generally affects otherwise normal full-term infants, and chronic lung disease of prematurity (also called bronchopulmonary dysplasia). Van Marter was among those who identified the association between PPHN and factors such as maternal intake of nonsteroidal anti-inflammatories and antidepressant and antianxiety drug exposure during pregnancy (specifically, SSRIs). She was also in a group that evaluated treatment of PPHN babies with inhaled nitric oxide versus heart-lung bypass—two therapies that have dramatically reduced mortality.

“It was very, very hard early on,” she says. “When I was training, 30 to 50 percent of full-term babies with PPHN died. To be able to save them now is wonderful.”

But, she says, “We still have a lot of work to do in the chronic lung disease of prematurity. We now know that extremely preterm babies suffer from structural as well as biochemical lung immaturity and are at increased risk of long-term lung problems. My research focuses on the intersection of the biological immaturity of these babies and the impact of specific care practices on the likelihood of an infant developing chronic lung disease. I strive to discover new treatments that will enhance survival and lifelong health of ill or immature infants.”

Van Marter considers herself “an intensivist at heart,” relishing the challenges of complex medicine, the procedural aspects, the hands-on work. But she also loves the “softer side”—counseling families, supporting them as they’re reunited with a baby who is hospitalized. She often develops a relationship with the family and has continued to follow some of her patients for decades.

Even more than loving the research and practice and teaching and learning, she says, “I love seeing healthy babies go home to their families and grow, thrive, and become happy children and productive adults.”

 

Pranav Shetty: Ebola and Optimism

BY KEITH GILLOGLY

Shetty in Liberia.

Perhaps Pranav Shetty’s (MD ’07) most formative experience at Pitt med was his disaster-relief work overseas. He’s now global emergency health coordinator for International Medical Corps, a nonprofit organization that provides health and emergency services. During the Ebola outbreak of 2014, he traveled to West Africa to train responders and establish two treatment units in Liberia.

His work earned him an invitation from President Barack Obama to attend the 2015 State of the Union address, where Shetty represented military and civilian health care workers deployed to West Africa to combat Ebola. In regard to the outbreak, Shetty has maintained guarded optimism. “We’re miles ahead of where we used to be, but it’s still not over,” he says, noting that new Ebola cases have appeared even after countries have received the all clear. “A threat anywhere is a threat everywhere.”

Shetty was born in India, but when he was 1, his family moved to Trinidad and eventually to Pittsburgh. His relief efforts have also brought him to Haiti, Libya, South Sudan, Jordan, Iraq, the Philippines, Europe, and Yemen.

He completed a residency in emergency medicine at Harbor-UCLA Medical Center and a fellowship in global health and international emergency medicine at the University of Maryland, where he also received his Master of Public Health degree.

During his emergency medicine instruction at Pitt, Shetty says he learned an important truism that he’s applied to his Ebola response efforts and elsewhere: Don’t try to learn everything about the patient before trying to help. “You don’t have to have everything figured out before you could save somebody’s life,” he says. “Don’t let lack of knowledge become lack of action.”

Photo courtesy International Medical Corps/Stuart J. Sia.

 

MAA Says, "Meet the Hench Award Winner"

BY ELAINE VITONE

When Eric Klein (MD ’81) was a urology resident at Cleveland Clinic, radical surgery was the main option for many patients with prostate cancer, which was then a much deadlier disease. Because half of newly diagnosed cases were metastatic, there were no good medical alternatives to castration.

Some 30 years later, Klein, chair of the Glickman Urological & Kidney Institute and a staff member in the Taussig Cancer Institute at Cleveland Clinic, has seen a sea change in the field. Patients come to him with elevated levels of PSA, an early marker for prostate cancer (as well as a number of benign conditions). Those who require treatment for prostate cancer are far fewer—and their cancers are usually curable. Many more turn out to have low-grade, nonlethal cancers, so the majority of the time, “the main goal is to prevent people from being over-treated. ... It’s really been an interesting evolution.”

In the intervening years, the field has learned that not every PSA-detected cancer needs surgery, radiation, or other treatment, all of which come with side effects that can mean quality of life takes a hit. The trick, of course, is deciphering what separates those who need treatment from those who are better off with watchful waiting. Klein—who was honored with Pitt’s Philip S. Hench Distinguished Alumnus Award in August 2015—has been at the forefront of this effort throughout his career as a physician-scientist.

More than 20 years ago, he started a database that linked prostate-tumor biopsies with patients’ outcomes, a powerful tool that’s made Cleveland Clinic an important ally in broadening our understanding of the biology of prostate cancer. His group has been involved in developing or validating three of the four genomic tests for prostate cancer that have entered the market in recent years. Now, they’re investigating how genomics can inform precision medicine across all stages of prostate cancer: how best to use imaging studies, when treatment is necessary, which treatments are best for which patients. It’s a far cry from his training days, he says. “That’s been very satisfying.”

To nominate candidates for the Hench award, contact Jen Gabler at jag188@pitt.edu.