When people are asked what poses a risk to their lungs, they typically bring up smoking. Then they may mention vehicle and industrial emissions as well as smoke from wildfires. Few consider the quality of the indoor air in their homes and offices, says Johns Hopkins pulmonologist and critical care specialist Nadia Hansel. And even fewer think of the food they’re eating.
Thanks to funding as the Lavinia Currier CIM Scholar, stretching back several years, Hansel is researching whether healthy diets that include a higher intake of such omega-3-rich foods as salmon and walnuts help participants with chronic obstructive pulmonary disease (COPD) to breathe more easily. She is also examining risk from chronic exposure to low levels of indoor air pollution.
According to the Centers for Disease Control and Prevention, more than 14 million Americans live with COPD, a lung disease that makes breathing difficult and may lead to other conditions. Its prevalence is nearly doubled among individuals with a household income below the poverty level.
So Hansel has zeroed in on the social causes of health-related risk factors for COPD, including poverty, obesity, diet and indoor air pollution. Her work has produced groundbreaking research showing indoor air cleaners may improve symptoms and reduce the risk of COPD flare-ups.
Hansel’s research also suggests that access to healthy food and the ability to afford it can become critical factors. One study of “food-insecure” participants living in the Baltimore area reported more respiratory symptoms. And she has shown that people with COPD who reported eating more omega-3-rich foods or had higher levels in their blood had fewer respiratory flare-ups, better quality of life and better lung function. She is currently studying whether those who receive three months of free deliveries of healthy food to their homes may have fewer respiratory flare-ups.
Taken together, such findings offer up the tantalizing possibility that a healthy diet and nutritional supplements could be key to improving the lives for millions in underserved communities who are struggling with respiratory disease.
“The work at CIM is helping to change the face of medicine, and that’s really exciting. It’s also encouraging both our medical trainees and our rising stars in medicine to really think about how we can give back to our patients: both one on one, and in terms of the clinical trials we develop, our community partnerships and our policies.” – Nadia Hansel
As the newly named director of the Department of Medicine, Hansel praises CIM’s support for allowing early-career faculty “the flexibility to ask and answer important questions that can pave the way to government-funded research.” In her own case, support that she received from CIM was instrumental in helping her receive NIH grants to lead her current two clinical trials.
“The work at CIM is helping to change the face of medicine, and that’s really exciting,” Hansel says. “It’s also encouraging both our medical trainees and our rising stars in medicine to really think about how we can give back to our patients: both one on one, and in terms of the clinical trials we develop, our community partnerships and our policies.”
Don Willett October 30th, 2024
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The CIM faculty scholars program is a powerful way to help jumpstart the promising work of clinicians and researchers early in their careers. CIM Director David Hellmann has compared it to the McArthur “genius” award — “an investment in a person’s originality, insight and potential.”
Few have done more to realize that investment than CIM scholar Antoine Azar, whose mission when he joined the Hopkins faculty in 2015 as clinical director of the Division of Allergy and Clinical Immunology was to create a center of excellence dedicated to the understanding and treatment of an extremely difficult to diagnose complex of disorders known as adult PID (primary immunodeficiency disorders).
It’s a condition thought to impact one in 1,200 people, though Azar believes it is more common than people think, and that’s because it requires a lot of time and detective work — and specialized testing — to pinpoint the precise failure in the immune system a particular case represents. As many as 90% of PID cases have likely gone undiagnosed.
“I wanted to extend the knowledge of immunology in adults, and I wanted to create a home for patients living with adult PID,” he says.
Azar’s appointment in the spring of 2018 as the Tara & Richard Parker CIM Scholar afforded him the support he needed to make that dream a reality. Generous and ongoing support from Cindy and Bart McLean allowed Azar to enhance his clinical work and research, and help devise and explore additional therapies for many patients with atypical disorders affecting their immune systems.
Immediately after his appointment as a CIM scholar, Azar launched the Adult Primary Immunodeficiency Center of Excellence — one of the only centers of its kind — at the Johns Hopkins Bayview Medical Center. He secured space for a lab, and hired and trained a full-time nurse and nurse practitioner to work with patients who come from all over the world, often after years of struggling with infections and other symptoms that have defied diagnosis.
“We have learned so much about the immune system over the past 20 years, how it works, how it is affected by genetics and other factors.” – Antoine Azar
Today he works tirelessly to promote collaboration with other departments at Johns Hopkins Medicine — including rheumatology, pulmonology, neurology, otolaryngology and nephrology — whose specialists are often key in the diagnosis and treatment of adult PID. And he has traveled extensively to educate his fellow physicians within and outside of the allergy/immunology specialty.
“We have learned so much about the immune system over the past 20 years, how it works, how it is affected by genetics and other factors,” he says. It is easier now to tease out how and why a patient’s immune system is failing and to identify targeted therapies to treat them.
Azar was a primary investigator, for instance, on a study published in Blood in July 2024 describing a new targeted therapy, a pill recently approved by the FDA to treat a rare but extremely debilitating immunodeficiency disorder called WHIM syndrome.
“I am so proud and honored to be a CIM scholar,” Azar says.
Don Willett October 30th, 2024
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Survey any of the dozens of Hopkins faculty members who have received CIM funding early in their careers, and you’ll hear a common theme: Receiving CIM recognition and support has been nothing short of life-changing — and in many cases has ultimately helped catapult them to top leadership positions.
Consider the experience of Hopkins radiologist Pamela Johnson, a very early leader in advocating for “high-value” medical care — moving away from unnecessary, high-cost medical testing and procedures that can harm patients and lead to financial ruin.
“David Hellmann believed in the importance of my work so much that he secured generous funding to make me the (CIM) Stanley Levenson Scholar. It was the honor of my life, and it effectively launched my career,” Johnson says. The funding proved crucial to her co-leading the launch of the High Value Practice Academic Alliance, a national organization of academic partner institutions collaborating on high-value quality improvement.
“The funding I received as a CIM Scholar was like a stamp of approval; it set off a cascading effect that led to this major appointment.” – Pamela Johnson
She says it also shone the light on the value of her work among Johns Hopkins leaders. In 2020, she was appointed vice president of care transformation for the entire Johns Hopkins Health System. “The funding I received as a CIM Scholar was like a stamp of approval; it set off a cascading effect that led to this major appointment,” she says. In her role as vice president, Johnson — who also continues as a national leader in high-value care — leads frontline clinical teams across Johns Hopkins Medicine in improving patient care.
From his vantage point as vice dean for research at Johns Hopkins, rheumatologist Antony Rosen has witnessed, over and over, the “highly catalytic” impact that CIM support has had. “Through David Hellman’s leadership, CIM has really been able to ignite the careers of so many promising individuals, myself included,” says Rosen, Cosner CIM Scholar in Translational Research.
“So many of today’s leaders at Johns Hopkins — and others who have gone on to lead at academic medical centers around the world — have been in the orbit of CIM.” – Antony Rosen
“So many of today’s leaders at Johns Hopkins — and others who have gone on to lead at academic medical centers around the world — have been in the orbit of CIM,” says Rosen.
Indeed, Rosen is among a very long list of CIM Scholars, now numbering more than 60, who have risen to key leadership positions across Johns Hopkins Medicine — and at prominent academic medical institutions across the country. Individuals on this list include:
• Steven Kravet, a Miller Coulson CIM Scholar, president of Johns Hopkins Community Physicians, the largest primary care group in Maryland
• Landon King, an early CIM Scholar, who is executive vice dean for the Johns Hopkins University School of Medicine
• Cynthis Rand, Mary Gallo CIM Scholar and co-leader of the Aliki Initiative, who is senior associate dean for faculty at the Johns Hopkins University School of Medicine
• S. Chris Durso, Miller Coulson CIM Scholar, who became director of the Division of Geriatric Medicine and Gerontology and is now director of the Department of Medicine at Johns Hopkins Bayview Medical Center
• Colleen Christmas, an early Miller Coulson CIM Scholar, who directs the Primary Care Care Leadership Track at the Johns Hopkins University School of Medicine as well as the Medical Student Training in Aging Research program
• Cynthia Boyd, an early Lavinia Currier CIM Scholar, who is director of the Division of Geriatric Medicine and Gerontology
• Constantine G. Lyketsos, Alafouzos CIM Scholar, who is director of the Department of Psychiatry and Behavioral Sciences at Johns Hopkins Bayview
• Jeremy Greene, Jacobs & Rosenthal Family CIM Scholar, who is director of the Department of the History of Medicine and the Center for Medical Humanities and Social Medicine
• Erica Johnson, a Mary Gallo CIM Scholar, who was recently named senior vice president for academic and medical affairs at the American Board of Internal Medicine (see p. 45 for more about her work)
• John Stone, a Cosner CIM Scholar in Translational Research, who is professor of medicine at Harvard’s Massachusetts General Hospital, where he is also director of clinical rheumatology
• Linda Fried, a Cosner CIM Scholar in Translational Research, who has served as dean of Columbia University’s Mailman School of Public Health since 2018
In August, Nadia Hansel, a Lavinia Currier CIM Scholar, became perhaps the latest CIM affiliate to be tapped for top leadership at Johns Hopkins when she was named director of the Department of Medicine, a position she had filled as interim since 2022.
“Young superstars, incredibly talented individuals who make a huge difference at Johns Hopkins and in medicine around the world, are hungry for inspiration and support.” – Roy Ziegelstein
“Dr. Hansel will be the first woman to lead the storied Department of Medicine in its 131-year history,” noted Dean/CEO Theodore DeWeese and Kevin Sowers, president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine, in the announcement of the appointment, which praised Hansel’s work as “a world-renowned investigator and accomplished physician leader.”
(Read more about Hansel and her translational research aimed at improving the lives of people living with chronic obstructive pulmonary disease in Tackling COPD, One Breath at a Time.)
Cardiologist Roy Ziegelstein has spent his entire career at Johns Hopkins. The very first CIM Scholar (made possible by support from the Miller family), he rose to become vice dean for education at the Johns Hopkins University School of Medicine, as well as vice chair of humanism in the Department of Medicine.
He adds his voice to the chorus of CIM believers. “Young superstars, incredibly talented individuals who make a huge difference at Johns Hopkins and in medicine around the world, are hungry for inspiration and support,” says Ziegelstein, a Miller Coulson master clinician and the Sarah Miller Coulson and Frank L. Coulson, Jr. Professor of Medicine.
“The Center for Innovative Medicine has offered both — by providing a community of established clinicians who serve as trusted mentors and by providing financial support, which is in such short supply for early-career physician-scientists,” says Ziegelstein.
“CIM has provided a model for other groups at Johns Hopkins and also beyond Hopkins — a model that we really need now more than ever. And that is how to engage each other in a world that is increasingly divided by Zoom meetings, that is divided by people who are busy and protective of their time, and geographically separated. CIM has created a model for how to use philanthropy to bring people together to make the world a better place — to make medicine a public trust.” – Roy Ziegelstein, Vice Dean for Education
“It’s exciting to think about where CIM will go in the future. We now have a new chair of the Department of Medicine, Nadia Hansel, who herself is an example of the fruit CIM has borne. She embraces the values and goals of CIM. I see tremendous opportunity in using the structure and philosophy of CIM to create a really novel partnership going forward, with CIM being deeply integrated within the mission of the Department of Medicine and beyond, at Johns Hopkins. There are so many great opportunities for where CIM will go next. That’s a story for the 25th anniversary issue. Stay tuned!” – Cynthia Rand, Senior Associate Dean for Faculty
Don Willett October 30th, 2024
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The idea that medicine is a public trust is foundational at CIM, and it fully informs the work of Aliki Perroti CIM Scholar Panagis Galiatsatos — not only as a deeply empathic physician, but as the award-winning co-founder and co-director of Medicine for the Greater Good (MGG).
“CIM was our first funder, our first advocate,” says Galiatsatos of the program he helped formally establish at Johns Hopkins Bayview in 2013 that promotes community engagement — among Bayview medical residents and other providers, as well as among hundreds of volunteers across Hopkins — as a powerful way to address inequities in health care. “It was clear from the beginning that Dr. Hellmann saw this as a way medicine could have a real impact on people beyond the hospital walls.”
Working with Baltimore City churches, schools and community groups, MGG teams have trained an army of lay health educators, created “caregiver cafes,” staffed health fairs, and organized lice eradication and smoking cessation workshops. Galiatsatos is a lung and critical care specialist who runs the Hopkins Tobacco Treatment Clinic, so MGG launched the Lung Health Ambassador Program to teach middle and high school students about respiratory health, and even how to successfully advocate for public policy changes — like the bill passed by the Maryland state legislature in 2019 to raise the smoking age in the state to 21.
“Our biggest allocation of resources at the moment is collaborating with the many people who are trying to create a sustainable model for the deployment of community health workers (CHWs),” Galiatsatos says. CHWs are professional lay health educators who serve as health care liaisons within their own communities, certified by the state and typically paid.
“The volunteer model is great, but we want people to be able to devote their time to helping their neighbors without worrying about their own income security,” he says.
MGG has made a difference in the lives of thousands of Baltimore residents, not least because of the trust Dr. G., as he is fondly known, and his colleagues have built in the community.
“He was building those bridges by coming, and that meant a lot to us,” the Rev. Ernest King, an early MGG partner and youth advocate at the Poe Homes housing project, once told an interviewer. Trust, King said, is a big issue “in our community because we get a lot by people wanting to bring programs in and… they might stay a month and after they get what they need they leave.” Dr. G stuck to his promises, showed up when he said he would, and just keeps coming. “So we knew he was concerned about our community.”
But MGG has also made a difference in the lives of the Bayview physicians and other health care providers who have participated, Galiatsatos says.
“One of the most rewarding things I hear from my residents, pre-meds and med students who go out and do MGG is, ‘I feel like I’ve made a bigger difference in more lives in a few hours than I ever could as a clinician,’” he says. “Of course, it’s incredibly rewarding to be a clinician, but when you participate in these community engagement efforts, you realize the impact you can have, just spending a few hours working on a project the community has asked us to dive into.”
The mission of Medicine for the Greater Good also resonates with public figures from across the region and around the country. Each year, MGG takes center stage at Johns Hopkins Bayview when the Department of Medicine dedicates an entire session of Medical Grand Rounds to highlight the program’s impact. In 2016, the now late Congressman Elijah Cummings addressed a packed Grossi Auditorium, where he lauded the work of MGG and other Bayview programs in fortifying the communities he represented. In November, the Grammy-winning opera singer Renee Fleming will take the podium to share her support for the program.
Galiatsatos’ long-term vision for MGG is no less than a revolution in the practice of medicine.
“My hope is that the MGG concept becomes commonplace, a new paradigm, and that every health care institution training the next generation of physicians and nurses recognizes that while they need to know the science and medicine, they also need to know the communities where patients are coming from, because that contextual level of interaction will dictate better outcomes.”
Don Willett October 30th, 2024
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Question: What do the following have in common?
The rolling fields of Folly Farm, the beautiful Baltimore County home of Stephanie Cooper Greenberg, chair of CIM’s International Advisory Board. The conference room table in the office of CIM Director David Hellmann. A Zoom screen. The faculty dining room at Bayview Medical Center.
Answer: All are venues where CIM faculty and friends have gathered over the years, in groups large and small, to hatch exciting ideas, forge powerful new collaborations, explore what it means to be human and, more often than not, to dream big — all fueled by a shared vision to advance medicine as a public trust.
These gatherings are key to what makes CIM unique within the wider Johns Hopkins universe, and so valuable, say longtime Hopkins leaders.
“Hopkins is a collection of like-minded individuals; however, we are not organized ideally to facilitate group interactions,” observes Vice Dean for Education Roy Ziegelstein, the Sarah Miller Coulson and Frank L. Coulson, Jr. Professor of Medicine. “Many of us may only rarely have the occasion to speak to each other. It limits the ability for Hopkins to be even more impactful.
“I think the real benefit, the ‘secret sauce,’ to me of CIM, is its ability to bridge unconnected networks and groups and individuals for the betterment of what we do at Hopkins — and beyond,” adds Ziegelstein. “Through CIM, I’ve met colleagues I never would have otherwise interacted with. I’ve learned about their work and found collaborations.”
Among CIM’s notable regular convening events:
Book Club Discussion
At the twice annual directors’ meetings at Bayview, held over dinner during Hellmann’s long tenure as director of the Department of Medicine, the second portion of the evening was devoted to discussion of a literary work — including classics in poetry, history and fiction.
David Wu, director of palliative care at Bayview, who was invited to lead a book discussion on Leo Tolstoy’s The Death of Ivan Ilyich in early 2020, recalled it as “a powerful example of how a work of literature can cut through a lot of the facades of regular life and get right down to the heart of big questions: of life and death, of loss and suffering, of love and God, and of what’s truly important.”
CIM Seminars
When Hellmann first launched the CIM Seminars series, the meetings were held in his office at Johns Hopkins Bayview. This limited participation to just 25 or 30 people — primarily fellow doctors with expertise and interest in the seminar topic. Once the COVID-19 pandemic hit, Hellmann moved the seminar series online, which opened the door to vastly expand the list of invitees and speakers.
“We’ve gone from a few dozen people in my office to sometimes more than 200 or 250 people participating online,” says Hellmann. “And we’ve been able to invite a much broader array of participants, including patients, donors and former faculty members who want to stay connected to Johns Hopkins and informed about the latest research and findings in clinical care.”
Most of the speakers are CIM Scholars who provide fascinating updates on their work. In addition, other faculty member whose work epitomizes the CIM philosophy that “medicine is a public trust” have participated, including Henry Brem, the Harvey Cushing Professor and director of neurosurgery; Patrick Walsh, former longtime director of the Brady Urological Institute: Justin McArthur, the John W. Griffin Professor and director of the Department of Neurology; Jimmy Potash, the Henry Phipps Professor and director of the Department of Psychiatry and Behavioral Sciences; Peter Agre, Bloomberg Distinguished Professor and winner of the 2003 Nobel Prize in Chemistry; Sarah Szanton, the Patricia Davidson Professor and dean of the School of Nursing; and Alfred Sommer, winner of the prestigious Lasker Award (known as “America’s Nobel”) and former longtime dean of the Johns Hopkins Bloomberg School of Public Health.
CIM Annual Retreat
Since 2014, CIM has sponsored a late summer retreat at Folly Farm, a 100-acre rural villa in northern Baltimore County that is the home of Stephanie Cooper Greenberg, chair of CIM’s International Advisory Board, and husband Erwin L. Greenberg. It is here that CIM faculty and leaders from across Johns Hopkins Medicine come together to talk and dream about what’s next for CIM.
The 2021 and 2022 annual retreats proved fertile ground, for example, in planting the seeds for CIM’s far-reaching Initiative for Humanizing Medicine. “We’re able to offer a rural setting that’s beautiful and calming, where you can breathe the country air. That’s when the ideas can start to flow!” says Stephanie Greenberg.
Don Willett October 30th, 2024
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