Deborah Gentile Helps Kids Living Downwind

Spring 2021

Asthma is a “disease of disparities,” says Deborah Gentile. (No relation to Natalie Gentile) “But [Deborah] has volunteered for us doing vaccines!” says Natalie. (Photo: Courtesy Gentile)

Deborah Gentile (MD ’94) was an associate professor of pediatrics at Drexel University in 2010 when she signed on as a clinician at a series of “asthma camps” for families living in medically underserved Pittsburgh neighborhoods. The events combined screening and patient education with hands-on sports drills led by professional and college athletes.

Gentile was skeptical when school nurses at the camps told her that, in their schools, nearly half of the students—five times the national average—used rescue inhalers. Then the pediatric allergist and her colleagues started crunching numbers. Some 20% to 30% of camp participants had an asthma diagnosis or met the screening criteria. Yet fewer than 50% of the children who needed care had the prescriptions or the know-how to prevent asthma attacks. 
 
A chronic inflammatory condition, asthma makes the lungs hypersensitive, triggering severe airway inflammation, coughing, even suffocation in response to irritants like respiratory infection or secondhand smoke. Over the long haul, uncontrolled asthma impedes sleep, school attendance and extracurricular participation.
 
With the right meds, however, families can keep symptoms in check. “There are so many things we can do to help children with asthma live healthy, productive lives,” says Gentile, who has spent the past decade analyzing asthma rates among Pittsburgh-area kids living downwind from power, steel and coke-production plants.
 
Asthma is a “disease of disparities,” says Gentile. Neither the risks of developing asthma nor access to the screening and treatment that control it accrue proportionally. Air quality is worse in poorer neighborhoods, and poverty exacerbates exposure’s effect: The hours-long commute via public transit to an affordable provider can put treatment beyond reach, and because of Pennsylvania’s low reimbursement rates, few private allergists accept public insurance.
 
Gentile was funded by the Heinz Endowments in 2012 to run elementary school–based asthma clinics. Fifteen schools hosted the free screening events; the vast majority were near major Mon Valley polluters. In November 2020, the Journal of Asthma published Gentile’s latest analysis of data from those screening clinics, on the role of outdoor air pollution on asthma prevalence and control. Of the 1,202 children Gentile and her colleagues screened, 22.5% had asthma. Black children fared worst: 26.8% had asthma.
 
While the investigators statistically accounted for factors like race, socioeconomic status and exposure to secondhand tobacco smoke, they were unable to achieve the gold standard of experimental study design—inclusion of a control group. They simply couldn’t find an elementary school distant from the smokestacks at which students matched the participants’ racial and socioeconomic demographics. “It’s an environmental justice issue,” says Gentile. “The kids who live nearest to these sites are poor and African American. Their families lack the means to move away.”
 
Clairton’s residents live in the shadow of North America’s largest coke facility. After a plant fire there in December 2018, Gentile documented a rise in asthma diagnoses and exacerbation of symptoms among adults. She subsequently testified before the Pennsylvania Senate to advocate for stricter emissions controls. In 2019, she received the Michelle Madoff Award of Environmental Excellence from Pittsburgh’s Group Against Smog and Pollution. That same year, she established the nonprofit Community Partners in Asthma Care to formalize her ongoing efforts.
 
The nonprofit’s first venture—a dedicated asthma clinic, headed by Gentile—features a partnership with a federally qualified health center (FQHC) in Clairton. “We did the math,” says Gentile, who hopes to prove that when delivered through an FQHC, high-quality asthma care can be accessible for patients and affordable for providers. “This model could generate revenue for the community health center so we could train an asthma navigator, bring in health educators.” At the clinic ribbon cutting in November 2020, Gentile wielded the outsized ceremonial scissors.

Kaplan helps teens who’ve been exploited. (Photo: Courtesy Kaplan MD, Inc.)

Stuart Kaplan: Relief and Renewal

BY SAMANTHA PAIGE ROSEN

Getting a tattoo is typically a choice. Perhaps it’s a memory of someone’s best day or a reminder of strength after their worst. For victims of sex trafficking, tattoos—a form of branding by their pimps—are scars of abuse.

Stuart Kaplan (Res ’84) strives to give victims a physically clean slate by removing their brandings. For three decades, Kaplan, a clinical assistant professor of medicine and dermatology at the UCLA Geffen School of Medicine, has volunteered with Children of the Night, a nonprofit that helps sexually exploited children. According to the National Center for Missing and Exploited Children, the average age of child sex-trafficking victims is 15. “These girls have the emotional scars,” Kaplan says, “and then they have physical manifestations of these scars.”
 
Kaplan sees up to four Children of the Night patients per week. Each tattoo can take up to 10 treatments to remove, depending on the color, amount of ink and whether the tattoo was done professionally. The protocol is to use a laser to gradually break the ink particles into smaller pieces until they can be absorbed by the body’s white blood cells. 
 
Even receiving the initial numbing injection can be traumatic for victims who were branded. “It’s almost reliving the experience they had before,” Kaplan explains. He has removed pimps’ names from places as intimate as patients’ genitalia and the insides of their lips. Sometimes patients cry, not always from physical pain, but out of emotional relief.

Kaplan, who has a private practice in Beverly Hills and is founder and CEO of KAPLAN MD Skincare, was drawn to dermatology to help people feel better about themselves. “The skin is the window to the rest of the body,” he says. Kaplan has diagnosed brain tumors, thyroid conditions and metabolic problems, all by observing patients’ skin. Of his work with Children of the Night, he says: “I will remove the tattoo no matter how difficult it is. I want to show these girls that there are good people out there, because they have not seen the best side of humanity.”   —Samantha Paige Rosen


Obituaries

Michael Davidson

April 8, 1943–Nov. 8, 2020
 
When Michael Davidson (MD ‘69) was a Pitt Med student, he and Thomas Welty (MD ‘69) drove across the country in a 37-horsepower VW bus to the Public Health Service Indian Hospital in Fort Defiance, Arizona. They sputtered through mountain passes to find their way to the community medicine elective under the direction of Pitt’s Kenneth Rogers.
 
Fort Defiance is where Davidson discovered his passion for working with Native populations. 
 
He “was motivated throughout his career to serve underserved people,” says Welty.
 
Davidson also was motivated by the outdoors: running marathons, skiing between remote Alaskan villages, hiking in the desert, rafting frigid rivers.
 
Davidson was an internist at Alaska Native Medical Center, a medical epidemiologist at the CDC’s Arctic Investigations Laboratory and a cancer researcher in Hawaii. He received his PhD in clinical epidemiology from Johns Hopkins University just four years before a 2003 bicycling accident left him with quadriplegia, cutting his activities short.
 
Much of Davidson’s research focused on infectious diseases, including the connection between these diseases and cardiovascular health. He also helped to establish the link between HPV and cervical cancer. He found COVID-19 fascinating.
 
“Once COVID started, he said, ‘Boy, I wish I were younger. This would be really interesting,’” says fellow physician John Finley.
 
Trish O’Gorman, another longtime friend and former nursing director at Anchorage Neighborhood Health Center, recalls that Davidson would come into the health center on Saturdays to work part-time.
 
“I found him very easy to work with because he was very good to patients,” O’Gorman says. “Very patient, very nonjudgmental.”
 
Davidson, whose grandparents died during the 1918 flu pandemic, sparking his interest in infectious diseases, died of COVID-19 in November 2020.  –Sarah Stager

Robert E. Lee

OCT. 11, 1930—OCT. 29, 2020

Robert E. Lee (MD ’56) was a born-and-raised Pittsburgher who attended Pitt both as an undergraduate and medical student. His 40-year career as a Pitt Med pathologist, begun in 1962, centered on the 

study of Gaucher’s disease. Lee published more than 60 articles on the subject—including after he retired in 2001. 
 
There’s a new plaque in the main corridor of UPMC Presbyterian Department of Pathology honoring Lee, who graced its hallways long after his retirement to chat with his former mentees and colleagues. “He’d come to my office about once every couple of months,” recalls George Michalopoulos, chair of Pitt’s Department of Pathology. “It was always such a pleasure to see him.” 
 
Lee—who served as historian for Pitt’s Medical Alumni Association—died in October at age 90. He’s remembered by his colleagues for his warmth and avuncular humor. “He was always smiling,” Michalopoulos says. “At the end of each sentence, he was always smiling.”
 
Lee served as UPMC Presbyterian’s chief of pathology as well as its vice chair for clinical affairs and director of laboratories. Many of his mentees, says Michalopoulos, “have evolved to become major faculty directors” themselves. For his outstanding service to the University, Lee was recognized with the Philip S. Hench Award as Distinguished Alumnus of the University of Pittsburgh School of Medicine. 
 
Lee died on his 54th wedding anniversary with his wife, Kathleen, at his bedside. —Rachel Mennies 
 

Abraham Twerski

Oct. 6, 1930–Jan. 31, 2021 
 
People often stopped Abraham Twerski on the streets of Pittsburgh to express their gratitude. A rabbi and world-renowned psychiatrist, Twerski founded Gateway Rehabilitation Center in 1972, at a time when treatment centers weren’t widely available and people with alcoholism were often sent to jail.  
 
Beyond reducing the stigma of treatment, Twerski’s success “advanced the idea that people can actually recover,” says Pitt psychiatry professor David Brent. 
 
Twerski, a descendant of grand rabbis,  witnessed the counseling his father offered to his congregation in Milwaukee. The younger Twerski noticed that people were starting to reach out to to medical professionals for counseling as well, so he became a doctor. 
 
Twerski completed his residency at what is now UPMC Western Psychiatric Hospital and served as clinical director of psychiatry at St. Francis Hospital for 20 years. His experience supporting one patient’s recovery inspired him to create much-needed drug and alcohol addiction treatment options. Gateway now treats more than 1,000 people each day at 17 locations.
 
Twerski lectured globally, and he wrote more than 90 books on topics like self-esteem, addiction, spirituality and stress. He collaborated with “Peanuts” creator Charles Schulz on a guide to Alcoholics Anonymous’ 12 steps, “Waking up Just in Time.” Twerski was one of the first Orthodox leaders to write about domestic violence in that community.
 
He also wrote an advice column in the Pittsburgh Post-Gazette and co-created a program for boys from Orthodox Jewish homes struggling with addiction-related problems.
 
“He was a medical giant in terms of his contributions locally and nationally,” says Loren Roth, Pitt professor emeritus of psychiatry. “Deeply wise, kind and universally caring.” —Samantha Paige Rosen

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