The covers that got away
Fall 2019
 This was almost a cover for this issue. (See legend.) How do we make these decisions? Keep reading.

Rarely are the images and words that land on our front cover the very first things we imagined. On the occasion of the magazine’s 20th anniversary, we’re sharing some of the thinking behind that process. Here, we offer a glimpse of would-be Pitt Med covers. Ones we didn’t choose.

Sometimes, people ask us, “How do you do your graphics?” That’s the realm of the discerning Elena Cerri, our art director. She fields and hones editorial suggestions and works directly with talented contributing artists to make these covers, and the rest of our graphics, happen.

October 1999 
Our first cover story was “Killer Mice!” 
The Frank Walsh photo of Paula Monaghan-Nichols (in lab coat), who studied aggressive behavior, was too “film noir” for Art Levine, our publisher, who is also senior vice chancellor for the health sciences and dean of the med school. Pitt creative director, Gary Kohr-Cravener, found the cheesy mouse shot for a more straightforwardly playful approach. 
January 2000
We wanted to do something unconventional with Bert O’Malley (MD ’63), leading hormone researcher and known prankster. The dean encouraged us to tilt the distinguished physician-scientist. (Photo by Pam Francis.) Later that year, the dean made another suggestion: Stop using portraits on the cover. That lit a spark.
May 2005
Illustrator Michael Lotenero proposed this crowd of shadowy figures for our first package feature, a 10-pager on neurodegeneration called “Stolen Lives.” It worked well on the inside of the magazine, but felt vague for the cover. We landed on another Lotenero illustration for a companion story—Cindy Gill’s essay on witnessing her father’s decline into Alzheimer’s. (Among other things, we substituted the cigarettes pictured with unpaid bills.) The coffee cup setting and line from the story signaled that an intimate narrative awaited the reader.
Fall 2008
This feature was about shifting our thinking, and vocabulary, for cancer. Scientists no longer saw cancer cells as invaders; they were more like ne’er-do-wells among us, looking for opportunities to propagate. 
Spring 2010 
Sometimes it’s a toss-up. Illustrator Juliette Borda gave us two takes for a cover story on Pitt scientists helping populations likely to be exposed to a dangerous fungal toxin that grows on corn and peanuts in the tropics. The researchers were testing a broccoli-sprout tea antidote. We used the broccoli teapot inside the magazine. Not to be blithe, but who can resist scary corn?
Fall 2013 
When scientists start rethinking organ rejection, there are lots of reasons to give a damn. (We were fond of senior editor Elaine Vitone’s multiple-choice proposal, but did not, er, choose it.)
Summer 2015 
Remember the 2015 Super Bowl halftime show where Katy Perry led a phalanx of improbably dressed dancers, including two in 7-foot-tall shark costumes? Remember how one of the sharks was out of step? No??? Well, we also missed the “Left Shark” incident, but learned of the resulting meme by covering that year’s Scope and Scalpel production, which had its own version of the Left Shark. Em DeMarco, then a graphic journalist, created a comic for our cover story. While we loved her initial shark sketch, the reference was too obscure for a cover. We chose another DeMarco illustration showing the class coming together for the big production.
Fall 2015 
Sometimes landing on the perfect cover is about iteration. Photographer Cami Mesa must have given us a dozen outtakes of ironing boards for our feature on obsessive compulsive disorder. Another Mesa shot we passed up: one of a young woman heading out in a silly unmatching superhero costume. That shot depicted a real exposure therapy, which our story’s main character completed to overcome her difficulties leaving home because of OCD. 
Winter 2016 
Illustrator Stacy Innerst created the Lichtenstein-esque cover concept (kissing couple) for the “correlation is not causation” idea. Though a fun spin on the search for “meaningful relationships in data,” it was a no-go. Innerst’s other offering: a Rube Goldberg machine interrupted by a cat. What could go wrong? (The cat was modeled after associate vice chancellor Maggie McDonald’s late feline companion, Abbey. McDonald has been a key advisor to the magazine staff for 20 years.)
Summer 2017 
This astonishing story is about an experimental nutritive therapy Pitt docs administer via spinal fluid. It relieves certain forms of otherwise intractable depression. We asked Jesse Lenz to add nerves to his initial carrot spine concept, then asked him to take them away. In between was some editorial hand-wringing; yet less is more. (See carrot cover, above)
Spring 2019 
“West Wing,” on the addition to Scaife Hall, was a potential cover. That’s an important topic for the Pitt Med community, yet more profound was the Tree of Life shooting. How would we depict the medical response to the massacre? Bullet holes in glass seemed predictable. The cell phone alert would have felt appropriate if our timing had been more immediate; this issue came out six months after the horrific event. We went with a compelling line from Gavin Jenkins’s story, set simply on army green.
Other rejects, many of which we would have been happy to have on the cover:
Cover contributors shown on these pages: 
   Juliette Borda
   Charlee Brodsky
   Esther Bubley
   Elena Cerri
   Em DeMarco 
   Greg Dunn 
   Pam Francis
   Getty Images
   Frank Harris
   Michael Hirshon
   Jim Judkis 
   Catherine Lazure 
   Jesse Lenz
   Michelle Leveille 
   Michael Lotenero
   Merck and Co. 
   Cami Mesa
   Pictogram Studio 
   Pittsburgh Post-Gazette
   Pitt Med students 
   David Pohl
   Sebastião Salgado  
   Frank Walsh 
   Wikimedia Commons