Jackson Wright Jr. Takes African American Medicine to Heart

Summer 2016

Why do racial disparities in health outcomes exist? Wright’s research has unveiled some surprising answers.

 

Author and orator Booker T. Washington was just 59 years old when he was hospitalized for exhaustion and difficulty breathing. “Racial characteristics are, I think, in part responsible,” his physician told the New York Tribune in November 1915, just days before Washington’s death. Readers of the time understood the statement as a veiled reference to syphilis, fueling speculation that the emancipated slave, a champion of morality and virtue to advance racial progress, had died a hypocrite.

A century later, Jackson T. Wright Jr. (MD ’76, PhD ’77), an emeritus professor of medicine at Case Western Reserve University, put the issue to rest with a review of Washington’s original medical records—including the blood test that had confirmed for Washington’s own physicians that he never had syphilis. Actual cause of death? Malignant hypertension. (Wright presented his findings at a historical clinical pathology conference at the University of Maryland in 2006.)

In Washington’s day, doctors knew little of the fatal cascade of organ damage precipitated by hypertension. Today, we know a lot more about this disorder, and physicians have a wealth of weapons in their arsenal for prevention and management of the disease. We also know that high blood pressure is an epidemic among African Americans. What role do characteristics related to ethnic heritage play?

As program director of the William T. Dahms MD Clinical Research Unit and the Clinical Hypertension Research Program at Case Western, Wright untangles the biological, cultural, and medical roots of racial disparities in kidney disease and hypertension. Last year, the American Heart Association recognized his labors with its 2015 Clinical Research Prize.

“One of the objectives of mine has always been to obtain credible data in African American patients so we’d better understand why racial differences in health outcomes exist,” says Wright, who was two years into his PhD studies in pharmacology when he decided to earn a medical degree, in part to advance the clinical applications of his research. “At the time I started training, most of the data in black patients was either anecdotal reports, very small studies, or opinion. There were almost no well-controlled scientific studies.”

Four decades later, Wright has authored more than 200 peer-reviewed papers detailing the prevalence of hypertension among African Americans, revealing contributing factors, and—because his work has shown that African Americans respond differently to some drugs—offering treatment guidelines.

He has also served as a principal investigator for multiple long-term, National Institutes of Health–funded clinical trials, including the 1,100-participant, 21-center African American Study of Kidney Disease and Hypertension Trial (AASK); the 42,400-participant Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT); and the Systolic Blood Pressure Intervention Trial (SPRINT), the latter of which was published in the New England Journal of Medicine in November 2015 and prompted changes in hypertension guidelines.

In 2013, NEJM published a report coauthored by Wright revealing a variant of the APOL1 gene that speeds the progression of kidney disease and is more common among black people. And yet, he says, relatively few racial disparities in kidney disease and hypertension owe to genetic explanations. Rather, patterns of diet, exercise, stress, income level, toxin exposure, access to health care, and other aspects of life in America that correlate with race likely have an outsized effect.

The study of racial differences in disease presentations, especially in populations at highest risk, provides critical information that benefits all populations with the disease, says Wright. He notes that simply asking patients whether they consider themselves black remains a potent predictor of risk for hypertension and its consequences.

“Even though the answer may not necessarily define the genetic makeup of the person, it clearly in many instances defines their risk of developing and suffering from a disease.” Why that is remains an important unanswered question.

 

Photo credit: University Hospitals Case Medical Center


Natalie Shaw: Let Sleeping Kids Lie

BY JASON BITTEL

Shaw

A butterfly undergoes metamorphosis inside a chrysalis. A tadpole transforms while swimming around a pond. For humans, the big change happens beneath a comforter.

“The brain is what controls puberty, and when it turns on, it releases hormones that then tell the ovaries or the testicles to make estrogen or testosterone, respectively,” says Natalie Shaw (MD ’04), a researcher at the National Institute of Environmental Health Sciences in North Carolina.

“And the neat thing is that we think the brain first turns on those signals while kids are asleep,” she says. The intricacies of how this works remain murky, but Shaw’s work suggests that slow-wave sleep, the deepest sleep, is important. As a pediatric endocrinologist, Shaw seeks to discover what triggers puberty and how sleep communicates with the reproductive centers of the brain. Unraveling these mysteries may have important implications for kids who don’t get enough sleep (like sleep apnea sufferers) or kids for whom puberty is delayed.

Shaw is also part of a group at Massachusetts General Hospital conducting research on Kallmann syndrome, a genetic disorder characterized by delayed or absent puberty, infertility, and an inability to smell (or, rarely, the absence of the entire nose). Defects in the two very different systems—reproductive and olfactory—occur together because the brain cells responsible for starting puberty begin life in the nose and must migrate along the olfactory system “highway” to reach the brain.

Shaw credits the endocrine program at Children’s Hospital of Pittsburgh of UPMC for encouraging her early interest in the field and says the city is still near and dear to her. “I miss it and try to visit often,” says Shaw.

 

Photo courtesy NIEHS/Steve McCaw


MAA Says, "A Black-Code Affair"

BY ROBYN K. COGGINS

Cisneros, Thomas, and the Fridmans.

"We were a very close class—everybody hung out together,” said Pitt assistant professor of medicine Holly Thomas (MD ’09) as she hovered over the Class of 2009’s yearbook. She and her husband, pediatrician Gabriel Cisneros (MD ’08), gathered with nearly 70 others, who hailed from classes ranging from 1958 to 2019, on a drizzly night this May to reminisce, nosh, and mosey around the Andy Warhol Museum.

The shindig, sponsored by the Medical Alumni Association, welcomed classmate extraordinaire Ryan McGarry (MD ’09) back to the ’Burgh. McGarry was in town to speak at the School of Medicine’s commencement. He also gave talks at Pitt related to his role as executive producer of the new CBS series Code Black, which is based on his award-winning documentary of the same name.

Also around the yearbook: Hilary Fridman (MD ’09), an academic hospitalist at the VA Pittsburgh Healthcare System and clinical instructor of medicine, and her med school sweetheart, cardiology imaging fellow Yaron Fridman (MD ’09). The Fridmans shared stories of McGarry’s party-planning prowess: As class president, he organized an epic semiformal in a surprise location that wasn’t revealed until the guests arrived. They emerged from school buses with blacked-out windows to find themselves at Heinz Field.

This spring’s quasi-reunion was organized by MAA to hold folks over for a spell. The annual Medical Alumni Weekend has moved to the fall—mark your calendars for September 23–25. (For information contact Ashley Knoch at akk57@pitt.edu.)

While you’re at those fall festivities, stop and say hi to Kelsey Thayer, the MAA’s first-ever assistant director. And in the meantime, stay in touch with your alumni association through Instagram (@PittMedAlum) and Twitter (@PittMedAlum).

Professors Georgia Duker and Joan Harvey with McGarry.