Beyond book smarts: What this international medical school gives future doctors


For most pursuing a career in medicine, the long-haul investment in studying, training and preparing to become a physician is the fulfillment of a lifelong dream. Others have personal goals too, whether it’s to explore their Jewish backgrounds or spend time in a new location. Some choose to make the challenge a little more exciting by engaging in a new environment, being immersed in a different culture and picking up a new language. 

The benefits of studying medicine in Israel are numerous, especially at the world-renowned Technion-Israel Institute of Technology. Situated upon the Rambam Health Care Campus on the Haifa shores, Technion American Medical School (TeAMS) provides a top-notch medical education and extensive training at several of Israel’s best hospitals. At this prestigious medical school program, students get one-on-one time with leading faculty members, including two Nobel Prize winners and numerous researchers who have contributed to several medical breakthroughs and innovations. All students complete a thesis. Graduates can continue to residency programs in the U.S. 

The acclaimed academic and research repertoire attracts top students, but the students who actually enroll in TeAMS bring an extra uniqueness to the program. They are attracted to the school for unique reasons, hoping to get a more well-rounded education that will make them more compassionate and focused doctors.   Let’s meet some of the students beginning their medical careers at TeAMS this October.

Balancing Judaism and Medicine

For many observant Jews, there is a dilemma of maintaining a certain lifestyle while seeking a high level of professional training.  While Technion is not a religious institution, its location in Israel makes key issues like Shabbat, the Jewish holidays and kashrut much easier to address.

Josh Simons, an incoming student from Monsey, NY, said one of the things he liked most about TeAMS is the schedule. “It fits around the High Holidays and works perfectly for an observant student,” said Simons, who is starting medical school only one month after his release from a 14-month volunteer service in the Israel Defense Forces in the Netzach Yehuda battalion in the Kfir Brigade. Simons, who earned his bachelor’s degree in biology from Touro College in Jan. 2013, served as a machine gunner in a religious unit.

“This is unparalleled for medical schools in general and even in Israel,” described Chris Thomas, an incoming student from Syracuse, NY.  “Studying at TeAMS is both a good place to keep up my religious observance and learning, and a solution for staying in Israel long term.” 

Thomas chose medicine after shadowing and admiring his father, an emergency room physician in New York. “Medicine seemed like the most selfless profession in the world,” Thomas said, thoughtfully reflecting upon how he used to visit patients on Shabbat at Columbia Presbyterian Hospital. “This was a really profound experience – seeing the way people grappled with the experience of sickness and what a challenge that is… They meet the challenge and show incredible inner strength, bringing out faith and hope. But also at the hospital, I saw people devastated and crushed by illness. Overall, I was amazed at how much of a difference I could make by just visiting.”

 “Medicine is a sacred profession; as a healer, I can fill the charge of implementing G-d’s will in profound and meaningful ways,” Thomas said. “I am very happy to begin studying at Technion because I’ve only heard positive things, that everyone is so friendly and it sounds like a very positive environment,” he added.

Simons noted a similar thought, “It was by far the nicest program because people were so friendly and the staff is really impressive.” He recalled a “simple, pleasant and inviting” interview experience. “Plus the campus is beautiful and right by the beach,” he said with a smile.

The Diversity of Israel

Both Simons and Thomas plan to stay in Israel following graduation, like their classmate Ilana Barta, who made aliyah to Israel this past August from Teaneck, NJ. “It was good to know that I didn’t have to choose between my want to be in Israel and to be a doctor,” she said. “I was brought up in a home that emphasizes Israel as the homeland, and at the age of 8, I decided wanted to be a doctor.”

“I liked that TeAMS was a smaller program, with fewer students per class,” she explained. “My initial thought after speaking to students is that there is a more attention for each student, individual guidance and more interaction in the classroom. As a whole, the university is a really amazing, innovative place to be.”

Moreover, what attracted Barta was being at one of the most diverse campuses in Israel. Having studied foreign languages at Queens College, Barta knows Arabic, in addition to Hebrew. Barta and fellow TeAMS students participate in rotations at many of Northern Israel’s hospitals, which service Jews, Arabs, Christians, Druze, African refugees and others. 

TeAMS also caught the eye of incoming student Lydia Daniels, from the suburbs of Pittsburg, PA, because of its diversity. Daniels, who graduated with a bachelor’s in pre-med from Bob Jones University in South Carolina, was fascinated after studying about the Middle East region. 

“After my bachelor’s degree, I wanted to travel and study abroad. Because of the classes I took, I thought maybe to study in Israel,” she said. “I looked at all the different medical schools in Israel and was attracted to the family atmosphere here. I feel that we are all in this together and it not a competition.”

Daniels arrived in Israel six weeks before classes started to move into the dorms, take a Hebrew course and explore. “So far, it’s been a very good atmosphere,” she said. 

After medical school, Daniels hopes to work in the developing world, to serve a community and be immersed in the health and the culture to people around the world. “The human body is just amazing and the more I learn about it, the more it amazes me, and I want to bring my knowledge to the different areas of the world that need a whole lot of help.”

Such experiences make doctors more balanced and equipped to treat patients; they excel in the academics, have a grasp of research and technology, develop into more open-minded and compassionate people and gain hands-on experience.

Fake medicine


Counterfeit Drugs Kill People and Fund Terrorism in the Middle East

Caveat emptor means “buyer beware.” Fake medicines are now a multibillion-dollar industry affecting people in virtually every country in the world, and the problem is getting worse. It has been estimated that up to 15 percent of drugs sold worldwide are counterfeit, and in parts of Africa and Asia it can surpass 50 percent. We are also vulnerable in the United States even though we have a better-regulated pharmaceutical system. 

This problem became epidemic in the late 1990s with the globalization of pharmaceutical manufacturing, the commercialization of the Internet and the relatively new drug Viagra. By 2002, hundreds of thousands of fake Viagra pills flooded the market, and today birth control pills, hormone replacements, diabetes treatments, weight-loss aids, cancer and transplant drugs, schizophrenia medicines and HIV therapies have all been counterfeited. The list goes on. The selling occurs mostly through online pharmacies worldwide, but the manufacturing appears to focus mainly in loosely regulated countries like China and India. Unfortunately, medications that come in injectable forms, like insulin, are even easier to counterfeit than tablets. One can just use sterile water or even tap water. 

To create an online pharmacy is rather simple. Get the active pharmaceutical ingredients from China, put together a Web page, and you are ready to go. It literally could take 45 minutes to create your own. 

Accountability for these “pharmacies” is virtually nonexistent. Of 10,000 Internet drug outlets surveyed by the National Association of Boards of Pharmacy, 97 percent were out of compliance with legal or patient safety standards.

Historically, drug smugglers are often penalized by way of imprisonment if the drugs in question are heroin or cocaine. But those who produce or smuggle counterfeit medicines, by contrast, often face lax enforcement and light punishment. Some governments look at drug counterfeiting as a trivial offense. After all, everybody likes cheap “Viagra.” Recently, the pharmaceutical industry has persuaded several governments to stiffen regulations against fake drugs because counterfeit drugs can kill. Most are poorly made, containing the wrong dose of the active ingredient or a totally different ingredient, such as antifreeze or arsenic. Drug resistance against bacteria can occur because of ineffective antibacterial medications, particularly in Africa and Southeast Asia; it is estimated that up to 30 percent are fakes. The United Nations estimates that roughly half of the antimalarial drugs sold in Africa are counterfeits. The World Health Organization estimates that at least 100,000 people per year, mostly in poor countries, are killed as a result of fake medicines. It is estimated that the global market for fake medicines could be worth over $200 billion per year.

Although the United States has the Food and Drug Administration (FDA) to watch over us, according to the commissioner at this organization, 80 percent of the ingredient manufacturing sites for FDA-approved drugs sit outside our country — located in one of the 300,000 facilities in 150 different countries. These small companies export FDA-regulated products into the United States. Clearly, there are many weak points along this odyssey from which to steal or introduce adulterated and counterfeit products. You may recall that in 2007, 149 people died as a result of contaminated Heparin.

There have been some recent reports suggesting that terrorist organizations in the Middle East are using fake medicine to fund their heinous activities against Israel.

The Rise of Counterfeit Cancer Medication

The counterfeiters have recently moved from fake Viagra to making counterfeit cancer drugs, probably because of the larger profits. These illegal manufacturers have become more aggressive, as a vial of the cancer drug Avastin sells for $2,400 compared to $10 to $20 a tablet for Viagra. Although speculative, I also believe these very immoral thieves feel that the patients with cancer will probably die anyway, so no one can prove the fake drugs were causative.

The United States traced some of these drugs that originated from China, which then passed to Turkey through England, and then were transported to our country. These fakes contained starch, salt, cleaning solvents and other chemicals, but not the active ingredient, according to Roche, Avastin’s manufacturer. Bogus copies of the breast-cancer drug Tamoxifen also have entered our shores in recent months.

In China, the manufacturers are licensed as chemical companies, therefore they are not subject to regulation or inspection, as in our country. It is rare that anyone is arrested or convicted for these heinous crimes against humanity. 

Where Do We Go From Here?

Over the past 10 years, there have been some collaborations between national and international public health agencies, such as the FDA and the World Health Organization. Many counterfeit and illicit drugs have been confiscated, resulting in the arrest of more than 80 people, as well as the elimination of more than 18,000 illegal online pharmacies. The pharmaceutical manufacturers and the FDA are developing new anti-counterfeiting techniques, such as handheld counterfeit detection devices designed to analyze chemicals and potential tampering of these medicines. Also, some pharmaceutical companies have put identifying markers on drug packaging, which can be scanned, somewhat like radio-frequency identification. Some are more covert, using UV fibers woven into the packaging, inks and images. More recently, nanotechnological markers in DNA are being incorporated into the makeup of the drugs themselves to help prevent drug counterfeiting processes. 

Unfortunately, these new technologies, to detect counterfeiting, do not eliminate the problem, but only minimize it. The FDA has recently discovered that counterfeiters target some consumers through social media platforms like Facebook and Twitter. 

On an optimistic note, the government of Nigeria, where fake drugs are prevalent, has declared its intention to adopt a “war” against the counterfeiters. The Pharmaceutical Security Institute gives warning that this war will be hard to win. Hopefully, more obstacles developed by each country will raise the cost and complexity of manufacturing counterfeit drugs, thus the profit margin will diminish. Hopefully the “bad guys” may now choose to fake other objects instead of medication that cannot harm or kill anyone. 

Dr. Norman Lavin is a clinical professor of endocrinology and director of endocrinology education at UCLA Medical School.  He writes the Jewish Diseases blog at

Israeli medical residents say they’ll ignore back-to-work order


Hundreds of Israeli medical residents who resigned said they will not obey an order by the National Labor Court sending them back to work.

The court issued its decision Wednesday morning, declaring that the resignations were a collective action and therefore invalid. The resignations came in the form of personal letters.

Two days earlier, the state prosecutor had asked the court to issue an injunction against the resignations and order the residents back to work as they continue to negotiate for a solution to a labor dispute. Hundreds of residents had resigned and did not show up for work this week, leaving hospitals understaffed.

Non-urgent surgeries were canceled in hospitals throughout the country and outpatient clinics were closed. Patients reportedly also were turned away from some hospital emergency rooms.

According to Ynet, the residents are considering a petition to the Israeli Supreme Court. Some had said before the ruling that they would not honor any injunctions.

The resignations originally were scheduled to take effect in September, but were delayed by the court. The residents then agreed to stay on until Sunday in order to get past the Yom Kippur holiday.

Approximately 500 residents did not show up for work Tuesday, according to reports. More than 300 had not shown up the previous day.

The residents are dissatisfied with a nine-year agreement signed recently between the government and the Israel Medical Association. They also rejected an offer by Prime Minister Benjamin Netanyahu, who is the acting head of the health ministry, that would have provided an increase in the salaries of young doctors who worked only in the public health system.

Many of the residents already have secured positions in other countries, Ynet reported.

Netanyahu on Monday asked the residents to delay their resignations by another two weeks to allow him to help find a solution.

Czech Republic: Doctors’ Group Apologizes to Jews


From nytimes.com:

A Czech doctors’ organization apologized to Jewish doctors Thursday for the persecution they endured in pre-World War II Czechoslovakia, an official of the organization said. In October 1938, before the Nazis invaded, organizations of Czechoslovak doctors, lawyers and others issued a memorandum urging the government “to take energetic measures” to prevent Jews from practicing. “We apologize for what our predecessors did to you,” stated a document by the Czech Medical Chamber in Prague. Many Jewish doctors lost their jobs when the government banned them from working in state institutions. The Czech bar association issued a similar apology a year ago.

Read the full story at http://www.nytimes.com/2010/03/19/world/europe/19briefs-Czech.html

Get the doctor’s attention — for a fee


Rising costs, crowded waiting rooms and decreasing access to doctors are among the reasons medical patients in Southern California and across the nation use words like “headache” and “frustration” to describe America’s health care system. And with declining insurance reimbursements, rising malpractice premiums, claims frustrations and growing paperwork, individual practitioners are often forced to increase the volume of patients they see as they decrease time spent in the examination room.

It’s an exasperating experience for all concerned, and a small but growing number of doctors and patients are choosing to bypass or minimize the role of insurance in health care through an approach to medicine that is known by a variety of names — platinum practices, retainer medicine or concierge medicine.

Consumers can pay a fixed annual retainer directly to a medical practice in return for a package of medical services that can include same-day or next-day appointments at an office with a spa-like atmosphere, house calls, 24/7 access to a physician via phone or e-mail, preventative care and programs, free checkups and a comprehensive physical once a year. For a fixed price, a growing number of physicians are adding or exclusively providing these and other personal touches.

Annual fees for a concierge practice vary from less than $100 to $20,000, with most practices charging an average of about $1,500. The fixed fee covers all related expenses and allows the physicians to limit the number of patients they see, which supporters say allows them to devote more time to each patient. But detractors of the practice, which includes the American Medical Association (AMA), say its proliferation could eventually limit access to care for those unwilling or unable to pay a retainer fee.

Beverly Hills-based Dr. Albert Fuchs, 39, opened a traditional internal medicine practice in 2000 but switched to a concierge practice more than two years ago. He says without the constant pressures associated with a traditional practice he’s able to spend more time with his patients and follow through with treatments he deems necessary, rather than having to check with an insurance company first.

“I get to actually practice medicine that I was trained in,” he said. “I can be much more comprehensive and it kicks the insurance company out of the examining room because I no longer have to worry about what’s covered, what’s not covered.”

On a typical day Fuchs sees six to eight patients without any real time limits, compared with a doctor in a traditional office who sees mostly double that amount, spending as little as 15 to 20 minutes with each.

Fuchs charges patients an annual fee of $2,400 for his services, a price he believes is within reach for many people.

“It requires a realization that your health is valuable, that it deserves extra spending,” Fuchs said.

By eliminating the third party of insurance companies, concierge doctors say they save money by not having to hire a staff to handle the insurance billing, co-payments and extensive paperwork. For most of these practices the retainer covers the costs for services, so there is no need for billing.

While concierge doctors save money by not relying on insurance for payments, patients don’t necessarily reap similar rewards, since most concierge patients still have and are encouraged to retain some level of medical insurance to cover hospitalization, drug prescriptions and outside lab work. Fuchs’ patients use health insurance for lab tests from Cedars-Sinai, where the doctor has hospital privileges.

And while such practices typically don’t feature specialists, concierge internists and general practitioners will frequently accompany patients on visits to specialists to consult and make recommendations.

Glen Melnick, the Blue Cross Professor of Health Care Finance at USC and a health economist at the Rand Corporation, views concierge medicine as a successful small niche market. It’s something he likes to see.

“In the sense that people are willing to pay for something and the market is providing,” he said.

However, Melnick believes that concierge medicine is far from being a part of the mainstream health care, let alone a cure for the problems plaguing the current health care system. A reason for that is the cost, which he says makes sense only for those whose time is so valuable that paying upfront for quick access isn’t an issue.

“It doesn’t make sense for the average person to pay a couple of thousand bucks extra a year just to get a guaranteed quick appointment,” Melnick said.

Doctors who convert their existing practices to include a concierge service often create a two-tier system whereby patients who pay more get direct access to a doctor while all other existing patients are passed on to a nurse practitioner who will likely be less convenient and possibly less skilled.

And while critics acknowledge that a shift to concierge-level care isn’t possible for most doctors in the highly dysfunctional U.S. health system, they say the trend is still inherently discriminatory and that the public at large will suffer as a dwindling number of general practitioners and internists opt to make themselves available to a small, privileged group of patients.

Gordon Schiff, founder of Physicians for a National Health Program, finds little encouraging about concierge medicine from a patient’s point of view.

“Many of the things that doctors are saying they’ll do under concierge medicine should already be expected by patients. It shouldn’t be a privilege that you have to pay extra for,” he said in an interview with The San Francisco Chronicle.

“If medicine is a public service and we’re here to take care of everyone, you don’t limit yourself to people who have money. Most people expect to be treated based on need, not on how much money they have,” Schiff said.

In 2003, the AMA stated that doctors who engage in a two-tier system “in which some patients have contracted for special services and amenities and others have not, must be particularly diligent to offer the same standard of diagnostic and therapeutic services to both categories of patients.”

And in 2004, California Rep. Pete Stark (D-Fremont) described concierge care as a new country club for the rich. During a joint economic committee hearing in Congress, he said, “The danger is that if a large number of doctors choose to open up these types of practices, the health care system will become even more inequitable than it is today.”

Ashkenazi women and ovarian cancer


Dr. Beth Y. Karlan is the director of the Cedars-Sinai Women’s Cancer Research Institute at the Samuel Oschin Comprehensive Cancer Institute. Her specialty is ovarian cancer, the deadliest of gynecologic cancers and one that is diagnosed in more than 22,000 women annually. As newly appointed editor-in-chief of Gynecologic Oncology, the medical journal of the Society for Gynecologic Oncology, Karlan will be in a unique position to help shape the direction of this field.
The Jewish Journal spoke with Karlan about the nature of ovarian cancer and its particular implications for Ashkenazi Jewish women.

Jewish Journal: What is most important to know about ovarian cancer?
Dr. Beth Y. Karlan: First, it isn’t rare. Ovarian cancer affects one in 60 women in the U.S.
Second, it doesn’t have to be deadly. When it is diagnosed early, the five-year survival rate for ovarian cancer is over 90 percent. We can even preserve fertility for many of these women. The problem is that there aren’t effective means of early detection in asymptomatic women. Thus, most women are diagnosed with late-stage disease.
Third, we need to debunk the myth that ovarian cancer is a ‘silent disease.’ Women and even some doctors still believe that there are no symptoms, but that’s wrong. In over 95 percent of cases, there are vague, nonspecific symptoms, which are overlooked by both women and their doctors.

JJ: What are these symptoms?
BK: They include abdominal bloating, pelvic and/or low back pain, early satiety or a feeling that you are getting full too quickly, and a change in the frequency or urgency of urination. Now these are very common complaints, and most often are due to many other causes. But when they occur together, are persistent and progress, day after day, then it’s time to call your doctor. Ovarian cancer isn’t silent. It whispers, and we need to learn to listen.

JJ: What should you do if you are experiencing these symptoms?
BK: If they persist, you should talk with your doctor and ask about having a transvaginal ultrasound and a CA 125 blood test. These are not screening tests for asymptomatic women, but are helpful diagnostic tests in the face of symptoms.

JJ: What puts a woman at high risk of developing ovarian cancer?
BK: The most common risk is age. The median age of diagnosis in the U.S. is 59. But the most significant risk factor is a family history of cancer. If you have a close relative with breast and/or ovarian cancer, you may be at a high risk of the disease.
Although ovarian cancer is a ‘female cancer,’ a woman is just as likely to inherit a risk of it from her father as she is from her mother. So it’s important to know about cancers in your paternal lineage as well as on your mother’s side. Another risk factor may be a personal history of cancer. If a woman has a previous history of breast cancer, she is also at higher risk of ovarian cancer. Lightning can strike twice.

JJ: Can you speak to the special concerns of Ashkenazi women?
BK: As we understand genetics and family history, we know that mutations of the BRCA1 and BRCA2 genes are associated with ovarian cancer — although these cases make up only 10 percent of all ovarian cancers. The frequency for carrying these mutated genes in the general population is one in 800. The frequency in the Ashkenazi population is around one in 40. That means 2.5 percent of the Jewish population carries this mutation.
For carriers, the chance of being diagnosed with cancer by age 70 approaches 85 percent for breast cancer, and is 40 percent to 60 percent for ovarian cancer. So for women with a family history, it’s appropriate to discuss testing with a genetic counselor and/or your physician.

JJ: What if you are found to have one of these genetic mutations?
BK: Knowing that you have the gene empowers you with knowledge so as not to be victimized — there are courses of action you can take. You can be more vigilant with screening. Or you can reduce your risk surgically. In terms of screening, at this time, I recommend transvaginal ultrasound and a CA 125 test, as well as a rectal-vaginal pelvic exam, to be performed at least annually.
You can also participate in studies, like the ones we are doing at The Gilda Radner Hereditary Detection Program at Cedars. And you may want to discuss this with family members, as they may also be at increased risk.

JJ: How is ovarian cancer treated?
BK: Treatment involves surgery and post-operative chemotherapy. Surgery is the cornerstone of treatment and should be performed by a specialist, a gynecologic oncologist. Chemotherapy has evolved over the last decade, and shows improvements in survival and quality of life, even with advanced-stage disease. The median survival time is more than five years, and I’m optimistic that it will be longer in the near future. Interestingly, women with a BRCA mutation who get ovarian cancer are more responsive to treatment and have even better survival rates. There are clinical trials of targeted therapies, and women can discuss eligibility and the pros and cons of participating in these trials with their doctors.

JJ: What are the promising directions in research?
BK: Better screening and more targeted treatments. Researchers are working on blood tests, which can identify tumor markers and indicate early-stage ovarian cancer. And when we find it early, we can cure it. Also, there are molecularly targeted therapies that are showing a lot of promise. These new molecules specifically target the tumor cells and are less toxic and have fewer side effects.

Doctor with ‘healing hands’ helps kids from Iran to L.A.


When Ralph Salimpour was six years old in Esfahan, Iran, he had malaria — a blood disease spread by infected mosquitoes that kills millions of people in the developing world every year.

After his parents took him to “The English Hospital” for a prescription of anti-malarial drugs, a guard at the hospital gate looked at the boy and told his mother, “He has healing hands.”

The man’s words in 1937 might as well have been prophesy. Seven decades later and across two continents, Salimpour is now a top pediatrician in Los Angeles. and will be honored by the UCLA Health Services Alumni Association in May.

In his self-published memoir, “Silent River, Empty Night” (Outskirts Press, $15.95), the 76-year-old Salimpoor recounts his journey in medicine and with patients in Iran, England and America.

Salimpour decided to become a doctor at an early age, after hearing stories about how two doctors saved his father’s life as a teenager from cholera and malaria.

“I owe my life to these two righteous people.” Salimpour’s father said.

“I think this night had an eternal impact on me. I worried at times if I could get accepted to medical school or if I could stand seeing blood or a child in pain. But then I remembered my father — who had lost his father at 2 and managed to raise a family — and reassured myself.”

If Salimpour worried about getting into one of two medical schools in Iran, it doesn’t much show. While no one would say his life was “charmed” — he was an Iranian Jew who fled the country at 48 to start life from scratch in America — the man makes it sound easy.

“I think my life is success story — it doesn’t matter what you go through as long as you see that you succeed,” he said in an interview.

And succeed he did. Salimpour graduated medical school at 23 years old, later becoming an expert in malaria and continuing his studies in England.

His sweet and meandering stories about pre-revolution Iran often have lessons. For example, when he was a medical student, a 16-year-old girl who cleaned his house and shopped for him suddenly became sick with joint pain and a fever. It turned out she had been drinking some of his milk, but didn’t know to boil it beforehand to kill the germs.

Salimpour treated her, and writes: “A lot of young children who should be at school learning, work to make a living in the developing countries. We now go to a supermarket, pick up our milk of choice, in size, fat content and even with our without lactose for taste and need, without remembering or appreciating that in just one generation before us, and in many parts of the world even today, milk, if available, is contaminated.”

Involved as he was in medicine — he became the director of the Research Institute of Child Health — Salimpour didn’t realize how bad things were getting in Iran.

“When you live in a revolution, it’s hard to comprehend what’s going on day by day and you don’t feel it, but when you look back you are surprised,” he said. “When you’re a doctor you’re surrounded by people who praise you and compliment you, and you tell yourself, ‘Everyone loves me, how can any harm come to me?'”

But his wife knew better. In 1979, when they went to visit their oldest son, Pejman, at medical school in the United States, though they had return tickets, they took a few possessions with them.

“I knew that there was no way to go back, that there was no future for the children there, that there was no choice,” his wife Farah said.

She convinced him to start over in America.

“I knew that he was a hard worker and he could do whatever he wants,” she said.

But it was strange to leave everything behind, Salimpour writes: “I often wish I had had another look at our home before we got into the car, and had viewed Tehran better from above when we flew away, to better remember what I missed for the rest of my life.”

After a year in Cleveland, Salimpour convinced the head of UCLA medicine to give him an internship there, and he eventually opened up the Salimpour Pediatric Medical Group in Los Angeles, joined by his two sons, Pedram and Pejman.

Today, with three centers (Sherman Oaks, Van Nuys and Panorama City), they treat some 200 patients per day. But the patients are different from the ones he treated from infectious diseases in Iran.

“I haven’t seen a malnourished child since I was in Iran,” he said, smiling. Today, the problem is the opposite — obesity.

But he hopes his stories will help people put things in perspective.

“I tell the teenagers I see every day, I remind them they shouldn’t take it for granted they can have running water; they should not take it for granted they can eat whenever they want to. They can dress the way they want to, wear their hair the way they want to, and no one can tell them why,” he said. “We take it for granted here. I love every breath I take in, and I can do anything I like. I love it and I appreciate it much more.”

Dr. Ralph Salimpour and grandchildren
Dr. Ralph Salimpour with his grandchildren

Veggie lovers could fare better in cancer fight


If you’re a middle-aged man (or already past it) here’s what should be on your menu today: tomato sauce, watermelon, stir-fried tofu and veggies, selenium and vitamin E. Wash it all down with a swig of green tea or pomegranate juice and you may be able to ward off prostate cancer.

New and better information is coming to light every day about ways to prevent this common disease. Since doctors are getting better at catching it early, fewer men are dying of prostate cancer. But one in six men will still develop the disease in their lifetime.

Eat your Veggies, Drink Tea

Luckily, if you are at risk, there are things you can do. Prevention may be as simple as eating better, exercising more and taking a few key supplements. Many of these remedies, which cut inflammation, may also help men struggling with a benign enlarged prostate.

For example, eating a lot of red meat, processed foods, alcohol, sugar and high-fat dairy products can lead to inflammation in the prostate gland (and other parts of the body).

“It’s best to have an overall healthy lifestyle,” said dietician Dee Sandquist, a spokesperson for the American Dietetic Association (ADA). “You need to eat a balance of foods in moderate amounts.”

Processed meats and high-fat dairy have more chemical residues, which also may be related to cancer risk. Instead, Sandquist suggests, eat lower on the food chain. Add more grains and legumes. Go vegetarian a couple of times per week.

One of the most promising natural compounds for prostate cancer prevention is lycopene, Sandquist suggested. You can find it in cooked tomatoes, watermelon and pink grapefruit. Sandquist recommends shooting for two to four servings of lycopene-rich foods per week. Since the body needs a little fat to absorb lycopene, have some olive oil with your pizza or spaghetti sauce.

Green tea can help, too. It’s full of antioxidants that appear to fight cancer. In particular, studies show, it has a lot of promise for preventing prostate cancer cells from growing into a threat.

“Green tea leads damaged cells or cancer cells to commit suicide,” said University of Wisconsin Cancer Center researcher Dr. Hasan Mukhtar.

He points to several epidemiological studies that show people who drink two to four cups of green tea per day have a lower incidence of prostate cancer (men in Asian countries, for example).

A 2005 study by Mukhtar showed pomegranate juice (the equivalent of two fruits per day) has anti-inflammatory effects that may also help with benign swelling of the prostate and cancer prevention.

Cruciferous vegetables — such as broccoli, cauliflower, radish, turnip, cabbage and brussels sprouts — also have cancer-busting qualities, studies show. Soy may help, but since it contains natural plant estrogens — and prostate cancer is tied to hormones — more study needs to be done. All of these foods should be part of a varied diet, Sandquist said. “We get the most health benefits from the overall variety,” she said. “There’s a synergy when these foods work together in the body. No one food has all the nutrients we need.”

Does Selenium + Vitamin E = Prevention?

Meanwhile, a Phase III clinical trial of 35,000 men sponsored by the National Cancer Institute (NCI) is underway. Scientists want to know if a mix of selenium and vitamin E prevents prostate cancer. Doses used in the study include 400 milligrams per day of vitamin E and 200 micrograms per day of selenium (selenomethionine, not the yeast kind). Some of the subjects will take a placebo. Results for this longterm study, known as SELECT, will be released in 2012.

Researchers started the SELECT trial after previous smaller studies revealed benefits — almost by accident. One study (which was actually looking at lung cancer) found men who took vitamin E had 30 percent lower incidence of prostate cancer. Another study (originally aimed at skin cancer) showed a 50 percent decrease in prostate cancer in men who took selenium.

“These are interesting agents that deserve study,” said Dr. Howard L. Parnes, chief of the cancer prevention division of NCI’s Prostate and Urologic Cancer Research Group. “They’re both antioxidants, but that may not be how they work. They might interrupt the process in other ways.”

Zyflamend Shows Promise

Another promising supplement is Zyflamend, a cluster of anti-inflammatory herbs such as tumeric and ginger, for sale by New Chapter (www.new-chapter.com) in most health food stores. Dr. Aaron Katz, director of Columbia University’s Center for Holistic Urology, discovered Zyflamend when many of his patients said they were trying it for prostate problems. His initial research showed the mix of herbs in Zyflamend could stop cancer cells from growing.

“To date, 91 percent of the patients have not converted to cancer,” Katz said.

He estimates 40 percent would have developed prostate cancer if they did not take Zyflamend. The men in the study took the compound three times a day, Katz said.

Mixed Results for Proscar

The only scientifically proven way to reduce the odds of prostate cancer is the conventional drug finasteride (Proscar). It’s currently approved by the FDA to treat benign prostatic hyperplasia (BPH), or enlarged prostate and male-pattern baldness.

A recent NCI clinical trial showed finasteride reduced the relative risk of prostate cancer by 25 percent. But research also showed the men who took finasteride had a 1.3 percent higher risk of having high-grade prostate cancer — the kind that is more deadly. More studies are underway that may explain the high-grade cancer risk, Parnes said. Studies of a similar drug, dutasteride, may offer additional hope.

Back to Basics

For now, making lifestyle changes and maintaining a healthy diet may be the most effective ways to prevent prostate cancer, experts say. “Obesity is actually an inflammatory state, so being physically active is incredibly important,” Parnes said. “It’s all about the balance between how much we eat and how much exercise we get.”

In other words, get off the couch. And eat your vegetables. Especially the broccoli and tomatoes.

Melissa Knopper is a freelance writer specializing in health and science issues.

Botox Treatments Aid Stroke Survivors


Until recently, significant recovery from the physical and mental losses inflicted by a stroke was thought to be limited to a matter of months following injury to the brain, using conventional physical and occupational therapy. Now patients supplementing this with novel treatments, including an innovative use of Botox and a variation on old-fashioned plaster casts, are demonstrating that aggressive long-term therapy can increase the likelihood of complete recovery after a stroke.

One such patient is art curator Meg Perlman, who not too long ago spontaneously applauded at a jazz concert, clapping her hands together for the first time in 19 months. This was another small triumph in her major recovery from a stroke that had initially paralyzed her left side.

Caused by a clot or a ruptured blood vessel in the brain, stroke is the leading cause of severe disability today. In the United States alone there are now some 5.4 million stroke survivors, with nearly one in three suffering from permanent disabilities.

“When I went to medical school, the prevailing view was that you lose nerve cells and that’s it, you’re not going to get better. We know now that’s not true. The brain is plastic. It can remodel itself,” said Dr. Steven Flanagan, associate professor of rehabilitation medicine at New York’s Mount Sinai School of Medicine, and the neurophysiatrist treating Perlman.

One recent study showed that therapy could benefit patients who had suffered a stroke more than a decade earlier.

“It’s not something magical that happens in the brain and everyone will recover,” he warns, “but the brain has a greater capacity to recoup from injury than we thought in the past.”

Dr. Steven R. Levine, professor of neurology at Mount Sinai School of Medicine, admits that medicine “still doesn’t know the underlying mechanisms in different phases of stroke recovery.”

Such understanding would make it possible to individualize treatments for most effective results. On the horizon, experiments in mice and some early human trials show promise for enhancing stroke rehab with stem cells, growth hormone, amphetamines, even Viagra.

“Not everyone will improve,” Levine said, “but you never say never and you never take away hope from people.”

Anatomy of a Recovery

Stricken at the young age of 53, physically fit and intellectually active, Perlman has been a prime candidate for total recovery. She’s come a long way since her stroke in August 2003 while vacationing in the south of France. When she awoke on what should have been another day in paradise, she was semiparalyzed and confused. Her husband, author Doug Garr, immediately understood what had happened.

“Her left side was immobile. The left side of her face was frozen,” he recalled. “I recognized it as a stroke because I had seen my father have a stroke two weeks before he died.”

Perlman spent two weeks in intensive care at one of France’s leading teaching hospitals, then was transferred to Mount Sinai’s brain injury rehabilitation unit for another six weeks. There, days filled with physical and occupational therapy helped her reprogram her nervous system to regain control over posture and movement on her left side, and to relearn vital everyday tasks.

Better known for cosmetic enhancement, Botox injections immobilize key muscles in stricken arms or legs, allowing physical therapy and exercise to extend range of motion and flexibility. Effects wear off, so the Botox is reinjected every three months for a year or more. In Perlman’s case, it was the second dose that allowed her left hand to flex out enough to applaud at a concert, after successful attempts during therapy sessions at home.

With research in rehabilitative medicine generally underfunded, doctors don’t have data from large clinical trials to properly assess new treatments. Often patients proceed by trial-and-error, sampling therapies from the exotic to the high-tech; Perlman has had mixed results with acupuncture and with an electrical muscle stimulation device called a NeuroMove.

Then again, low-tech plaster of Paris has proven extremely effective. Called “serial casting,” a monthslong treatment involves stretching affected muscles with a series of plaster casts on an arm or leg for weeks at a time, followed by physical therapy to secure gains in flexibility. Perlman’s latest leg cast had just come off when she was able to stretch the toes on her left foot out and wear a shoe.

By all her therapists’ accounts, Perlman has shown exceptional resolve in fighting the fatigue, discomfort and frustration that are part of stroke recovery.

She has also had to battle the severe depression that a stroke leaves in its wake.

Flanagan observes that depression should be treated early and aggressively in stroke patients.

“We know that happy patients do better in rehab than sad patients,” he says. “We have to help them get the most out of their time in therapy.”

Fuller recovery from stroke takes a loyal, experienced team of therapists. With them, Perlman still keeps up a rigorous schedule of five physical therapy and two occupational therapy sessions a week at home.

“I expect to be 100 percent back,” she said. “I won’t stop until I am.”

She’s thankful for her “wonderful personal team,” including the friends and clients who rallied to her side after she was stricken.

Also appreciated: an occasional boost from strangers.

“I was walking to a restaurant with my cane. A short, Russian-looking man came up to me and said: ‘Did you have a stroke?’ I said ‘yes.’ He jumped up in the air and said: ‘So did I and look at me!'”

Steve Ditlea writes for the New York Daily News.

Parent Wins School Pesticide Battle


A new law that bans that use of experimental pesticides in schools is the latest achievement of Robina Suwol, a Jewish anti-pesticide activist.

The law, which took effect last month, grew out of a presentation two years ago before an L.A. Unified School District (LAUSD) advisory committee of which Suwol was a part.

As Suwol recalled it, a researcher asked to use LAUSD school sites to test an experimental pesticide.

“The woman said, ‘We use less [pesticides] and they’re stronger [so] therefore they’re safer,'” Suwol said. “We all kind of laughed and politely declined.”

But in the back and forth, the researcher mentioned that a school site had already been secured in Ventura County for the experimental product.

“That haunted me, and I began to research it,” she said.

What Suwol said she found was an arena of murky practices and documentation. It wasn’t clear that experimental pesticides were being used at any schools, she said, but it also wasn’t clear that they weren’t or that they never had been — or that they wouldn’t be tried at school sites in the future. So she decided to do something about it.

Suwol soon met with various environmental and public health organizations to marshal opposition to experimental pesticides in schools: “Everyone was on board that this was a curious loophole.”

Assembly member Cindy Montanez (D-San Fernando) agreed to author the legislation, which became Assembly Bill 405. Assemblymember Lloyd Levine (D-Van Nuys) backed it, as did organizations including the California Medical Association, the state PTA, the Asthma and Allergy Foundation of America, and many others.

An early critic of the effort was the state’s own Department of Pesticide Regulation (DPR), which has responsibility over these matters. At the time, officials there characterized the proposed restrictions as potentially redundant, confusing and over-reaching.

While permission to test can, in fact, be granted to experimental pesticides whose safety has not been determined, these permits “are time-limited, relatively few, and are closely controlled under very specific and restrictive conditions,” said Glenn Brank, director of communications for the Department of Pesticide Regulation.

He added that the department “has never allowed an experimental pesticide project at an active school facility, and we never would.”

Suwol said she had trouble obtaining data from the department about experimental test sites. Brank insisted, however, that such data is publicly available on request.

As it happens, even the researcher whose comment prompted Suwol’s quest contends there was a misunderstanding. This different version of events was reported by a pesticide industry news e-journal on Pesticide.net called Insider, which identified the researcher in question as UC Berkeley entomologist Gail Getty.

Getty told Insider that she did indeed give L.A. Unified a presentation on an anti-termite poison that she was researching called Noviflumuron. But as for the Ventura County school test site, Getty told Insider that it was an abandoned school building fenced off from the public due to extreme termite damage — though she acknowledged that she did not mention this fact during her Los Angeles presentation. She added that her aim was simply to make LAUSD aware that a potentially helpful product was in the works. In the end, Getty told Insider, her test in Ventura never happened anyway. Noviflumuron received EPA approval in 2004.

Whatever the case, as far as Suwol and the legislation’s backers are concerned, it’s better to be safe than sorry.

Lawmakers passed AB405 in 2005 and Gov. Arnold Schwarzenegger signed the bill into law. The Department of Pesticide Regulation says it fully supports the new regulations in their present form. The bill was eventually amended to avoid the problem of creating potential legal hurdles if a school used a widely accepted product, such as bleach, in ways not specifically mentioned in regulations.

Suwol’s interest in the subject of pesticides dates to 1998, when a worker accidentally sprayed her 6-year-old son, Nicholas, with a weed killer as he walked up the steps of Sherman Oaks Elementary.

“I saw someone in white near the steps,” said Suwol, then “Nicholas yelled back at me, ‘Mommy, it tastes terrible!'”

Nicholas suffered a severe asthma attack afterward. Suwol started meeting with doctors and scientists, and she began raising concerns with L.A. Unified officials. At first she was treated like one more crazy mom, but she persisted, eventually getting the attention of the school board, where she got backing from board members Julie Korenstein and David Tokofsky.

In some cases, she made officials consider the obvious: Why should pesticides be sprayed when children are present?

Today, Suwol heads California Safe Schools, an L.A.-based nonprofit that advocates lower-risk pest control in schools, including barriers and natural predators, and keeping parents and school staff informed when poisons must be used. Its advisory board includes directors of various environmental organizations, including Dr. Joseph K. Lyou of the California Environmental Rights Alliance and William E. Currie of the International Pest Management Institute.

At L.A. Unified, her efforts bore fruit in the 1999 creation of the Integrated Pest Management (IPM) system, which recommends a more holistic approach to eliminating pests and weeds than simply dousing them with poisons. It was before the district’s IPM oversight committee, on which Suwol sits, that she first heard from the pesticide researcher and became convinced there was a problem that needed to be addressed.

The governor’s office and others, Suwol said, “recognized that this was a situation that, even if it happened in just a few instances, should be stopped.”

 

Transplant Recipient Will Parade Success


Like many native Angelenos, Ilene Feder has never been to the annual Rose Parade in Pasadena. However, the Studio City resident not only will be attending the New Year’s day festivities on Monday, Jan. 2, for the 118th Rose Parade, but will have a vantage point few get to experience: She’ll be riding on a float.

Feder is one of 23 individuals from throughout the country who will ride on the Donate Life Rose Parade Float, representing organ and tissue recipients, living organ donors and donor family members. The float’s theme is “Life Transformed.”

In 1995, Feder, then a 40-year-old international flight attendant, led a healthy, active lifestyle that included skiing, running and scuba diving. Following a routine checkup that showed elevated liver enzyme levels, she was diagnosed with a rare blood disease.

The condition caused a clot in the artery that supplied blood to her liver. Feder underwent surgery to bypass the blockage, but within nine months, it was clear that her liver was shutting down.

When her doctor told her that she would need a liver transplant, “I flipped out,” Feder said. “But the support that I had from the transplant community and from my family saved me. I got heaps and heaps of information that I didn’t get from my doctors.”

Now Feder, who received a donated liver in August 1996, reaches out to others who are awaiting or have received a transplant. She helped start local chapters of the Transplant Recipient International Organization (TRIO) in Westlake Village and Sherman Oaks and became an ambassador for OneLegacy, the transplant network serving the greater Los Angeles area. She has also spoken at various synagogues and organizations to promote organ donor awareness.

Although Orthodox, Conservative and Reform Judaism sanction — and in fact advocate — organ donation, Feder believes that some may retain misconceptions about Judaism’s view.

“People think you need to be buried whole, but it’s a mitzvah to donate an organ,” Feder said. “It makes me feel good that my religion backs my convictions.”

Feder’s transplant has enabled her to resume an active lifestyle. Although she has less stamina than she had before getting sick, she has since traveled to such locales as Israel and China. She’s also attended the Transplant Winter Olympics. And, of course, she’s getting ready for her role on Jan. 2.

“I’m practicing my Princess Di wave,” she said. “I’ve got it down.”

The Rose Parade, with the theme, “It’s Magical,” will take place on Monday, Jan. 2, at 8 a.m. and will air on several local TV stations.

On Tuesday, Jan. 10, the Santa Ana/Tustin group of Hadassah of Long Beach/Orange County will host “Pikuah Nefesh — to Save a Life,” a program discussing the Jewish view of organ and tissue donation. The event will feature Rabbi Ken Millhander of Temple Beth Tikvah in Fullerton; Sharon Zepel, mother of a teenage donor; and organ recipient Lynda Trachtman. For event location and more information, call (714) 545-7162.

Is There a ‘Docta’ in the House?


"There’s a big controversy on the Jewish view of when life begins. In Jewish tradition, the fetus is not considered viable until after it graduates from medical school." — Old Jewish joke.

The link between Jews and the medical profession might not serve as a punch line to a joke in the near future, because the Jewish doctor — especially the kind featured in "my son the doctor" gags — is becoming something of an endangered species.

Jewish medical school candidates, who reportedly made up 60 percent of the applicant pool in 1934, dropped to 9 percent in 1988, the last year figures were available. By contrast, 26 percent of all applicants in 1995-1996 were Asian American, a group that represents 4.4 percent of the U.S. population.

Michael Nevins, a New Jersey cardiologist who also studies the history of Jews in medicine, estimates that at the tail end of the 20th century there were between 80,000 and 100,000 Jewish physicians in the United States, comprising between 12 percent and 15 percent of the nation’s 684,414 medical doctors. Jews make up 2 percent of the total U.S. population. If Jewish doctors seemed more ubiquitous than these statistics imply, it is because they are clustered in major urban environments, especially in California and the Northeast.

If it’s true that there are fewer Jews entering the medical field, is it a commentary on the field of medicine — or does it indicate something about the state of the next generation of Jews?

Some believe that declining number of Jewish doctors can be viewed as a step forward: a sign that young Jews are moving beyond stereotype and becoming thoroughly absorbed into the fabric of American life.

But Elliot Dorff, rector and distinguished professor of philosophy at the University of Judaism, sees the downside. For Dorff, whose specialty is medical ethics, fewer Jewish doctors will inevitably mean "fewer people who share Jewish values about medical care."

This might have grave consequences in thorny areas like abortion, infertility treatment, stem cell research and end-of-life issues, on which Jewish doctors instinctively tend to reflect the teachings of Jewish tradition. Dorff believes that for most Jews, whatever their level of Jewish education, the sanctity of life and the sacred calling of medicine are articles of faith. It’s disheartening to think of a future in which Jews no longer hold the health of a nation in their hands.

But medicine as a field of choice has recently declined as a career goal among undergraduates of all backgrounds, said Linda Sax, a UCLA professor of education, who directs the Cooperative Institutional Research Program, which has polled incoming students at four-year colleges nationwide since 1966.

The desire to become a doctor peaked among Jews in 1993, according to Sax, and among all students in 1995. In 1999, 9.5 percent of Jewish freshmen and 7 percent of non-Jews planned to be physicians. In 2002, 7.1 percent of Jewish frosh, as opposed to 6.7 percent of all students in the study, aspired toward a medical career.

Moreover, the future Jewish doctors might not be anyone’s sons. In the last few years, among both Jews and non-Jews, more women than men have set their sights on medicine. A 50/50 gender split is common in medical classes today, and females can outnumber males by as much as 20 percent.

Although Sax’s surveys indicate Jewish freshman are more committed to the field of medicine than the general freshman population, the makeup of today’s medical school classes reveals fewer Jews. This is particularly true in Southern California, where ethnic diversity is prized. USC medical student Ari Isaacson estimates that while 40 percent of the doctors teaching his preliminary medical courses were Jewish, 5 percent of the 160 students in his fourth-year class are Jews.

At UCLA’s highly regarded David Geffen School of Medicine, 5,100 applicants vie for 121 slots. Though UCLA is not allowed to choose students on the basis of race, the school’s dean Dr. Gerald Levey explained that "our demography has changed as California has changed."

"It’s a fair impression that the traditional Cohens and Levys and Goldbergs are going into other things," he said.

The current fourth-year class contains perhaps eight Jews, and about half are of Persian descent. It’s common at UCLA for two-thirds of the class to be non-white, with Latinos and African Americans amply represented. At this year’s graduation ceremony, the new doctors were hailed in 20 languages, reflecting their wide range of native tongues.

In top medical schools as widely scattered as Tufts (Boston), Duke (Durham, N.C.) and Baylor (Houston), the situation is similar. Even in New York City, known for its well-entrenched Jewish population, the number of Jewish medical students has gone down. In Dr. Marian Rosenthal’s 1967 New York University (NYU) graduating class, all but about 30 of the 120 new doctors were Jewish. Today, 23 percent of Joseph Glaser’s NYU classmates are Jews: the rest represent a broad spectrum of whites (29 percent), Asians (24 percent), Indians and Pakistanis (9 percent), blacks from America, Africa and the Caribbean (9 percent) and so forth.

Jews have excelled in the medical field as far back as the Middle Ages, Nevins said. In mid-20th century America, the medical profession offered an unbeatable combination of intellectual challenge, community service and financial reward for bright young Jews.

Social yearnings underpin many medical degrees, said Dr. Gary Schiller, associate professor of medicine at UCLA: "Historically, medicine has been attractive to the sons and daughters of immigrants. It’s a way to rapidly establish yourself in a professional class by virtue of intellect and hard work."

Schiller, from a family of Holocaust survivors, grew up with a sense that medicine is the safest career path, because its skills can be transported anywhere in the world. His grandfather had been a prominent Prague attorney. When the Nazis came, he failed to get out in time, because "he couldn’t transfer a legal career across a border."

Rosenthal said of her contemporaries: "We fulfilled our parents’ aspirations."

Her own parents’ dreams were thwarted by the Depression and widespread quotas used to turn Jews away from medical schools. So great was her mother’s desire for a doctor in the family that she vowed to scrub floors, if necessary, to finance her child’s medical training.

Dr. Jerrold Steiner, who co-directs the Saul and Joyce Brandman Breast Center of Cedars-Sinai Medical Center, is part of a classic multigenerational family of doctors. His immigrant grandfather, a walnut farmer-turned-carpenter, put his daughters to work to help pay for his son’s medical education. Eventually that son had two sons of his own, who were both steered toward medicine.

"Essentially I went into the family business," Steiner said.

He stayed out of his own children’s career choices, and was stunned when his eldest elected to follow in his footsteps. Now his wall bears a photo of father and son performing surgery together; it is inscribed, "To a great surgeon, role model and mentor, and most importantly, a great father. Love, Josh."

But Jewish father/son doctor teams are becoming increasingly rare. Steiner admits that within his own social circle, "I’m the only one whose kid has become a doc."

In fact, in recent years, some veteran Jewish doctors have explicitly dissuaded their children from entering the field.

Their attitude stems from recent changes that have made doctors, in the words of one specialist, "slaves to a bunch of administrators." With malpractice litigation a constant threat, today’s medical professionals feel caught between the lawyers and the insurance companies. And cutbacks in reimbursements mean they no longer command the astronomical incomes that helped make up for expensive schooling and long hours.

Steiner says that today’s young doctors won’t find it easy to afford the perks he enjoys, which includes a home in Benedict Canyon and membership in Hillcrest Country Club.

It’s also true that many young Jews are not interested in medicine as a discipline. Unlike past generations, they face few social barriers in their career choice. For some, the real excitement lies in entrepreneurial fields like business and biotechnology. Others, cushioned by their parents’ earning power, feel free to explore filmmaking and the arts.

Internist Mark Hyman posits several reasons why medicine has become less attractive to young American Jews. Due to changes in family structure, pressure from relatives has far less effect than it once did. Also, as Jews have assimilated into American life, they "no longer feel they are part of an underdog minority that has to prove itself." And the years of arduous training that a medical career demands have little appeal for affluent youngsters raised on instant gratification.

A Los Angeles pediatrician speaks for many in insisting, "This generation’s Jews are Asians." Medical schools today are filled with ambitious, hard-working Asian Americans, not far removed from their immigrant roots. Alan Bienstock’s closest friends among the reconstructive surgery residents at Baylor College of Medicine are second-generation Korean and Indian Americans. Given medicine’s appeal to recent arrivals, it’s no surprise that those Jews who gravitate to medical school are mostly from Russian or Iranian families. Among Middle Easterners, a deeply rooted respect for the profession is part of the allure.

Evelyn Salem is an Iraqi Jew who spent years in Iran before immigrating to the United States. She and her two sisters have six children among them; three have become doctors. Among her relatives, it’s customary for a child to receive a toy doctor kit as a first gift. But, Salem admitted, "The less traditional the families are becoming, the less the kids want to be physicians."

Still, there remain young Jews who view the study of medicine as a privilege. Med student Ari Isaacson is undaunted by the warnings of veteran doctors that the field is not what it was. His reasoning: "I didn’t think I’d miss that control and that money as much as they do. They forgot why they started doing it in the first place."

Dr. Richard Finn, a young oncologist who graduated from USC Medical School in 1997, has hardly forgotten. At 18, he watched his mother undergo treatments for the cancer that ultimately claimed her life. Now he feels honored to be a Jewish American physician, caring for patients of all colors and creeds.

Finn notes that throughout history, "Jews have been isolated, not always by choice." Through the practice of medicine, Jews have a way "to be involved with society, and to give back," he said.

For Finn, medicine remains a profoundly Jewish endeavor, in keeping with the famous Talmud passage: "If you save one life, you save the entire world."

Cedars-Sinai Ministers to Spiritual Needs


"A woman came into my office yesterday needing to make a decision about the amputation of her husband’s leg," said Rabbi Levi Meier, the chaplain at Cedars-Sinai Medical Center. "It was a very difficult case, because her husband cannot give proper, informed consent, because his mind is not functioning anymore.

"Then I had another woman who wanted to know about code vs. no code," the Orthodox rabbi continued. "’Code’ means to try to resuscitate. Her husband is on life-support system, and the doctors were pressuring her to make a decision about whether they should code him or not. I helped her understand the Jewish medical ethics involved, and to make a decision."

It’s all in a day’s work for Meier, who has served as the Jewish chaplain at Cedars-Sinai since 1978. (There is also a Catholic chaplain who serves Christian needs.)

With over 50 percent of the beds in the 905-bed hospital occupied by Jewish patients at any given time, Meier finds himself administering pastoral care to patients who are terminally ill, have presurgery anxiety or depression or need to deal with family dynamics that have changed with the encroachment of debilitating illness. He also helps doctors cope with a job that finds them getting up close and personal with death on a regular basis.

"The main aspect of my counseling is from a spiritual perspective. I use [the same techniques] psychologists and psychiatrists use, but I look at the spirit, where people can feel their relationship with God personally, not in a cognitive sense, but in a personal sense," said Meier, the father of four, who holds a doctorate in gerontology and is a licensed psychologist. "Because when you feel God in a personal way, you become a different person."

In his role as chaplain, Meier has found many ways to bring God to Cedars-Sinai. The rabbi has organized Jewish medical ethics conferences and synagogue services for Shabbat and the Jewish holidays. He has produced closed-circuit religious television programs for the patients. Meier also teaches a Torah class at the hospital every Thursday, which is open to patients, doctors, staff and members of the board of directors and board of governors.

During his tenure, the rabbi has overseen the establishment of a kosher kitchen that can service kosher patients with special dietary requirements, (such as low-sodium needs). And working with Sharon and Herb Glazer, he has seen that mezuzot were placed on every door of the hospital, including patients’ rooms.

Meier also confers with the medical center’s board of directors and board of governors about how they can best live up to the facility’s motto: "And be a blessing," a verse taken from Genesis.

"’And be a blessing’ means taking care of poor people, no matter what culture, ethnicity or religious faith they have," Meier said. "Taking care of indigent patients of all religions is central to Judaism, and that is why the ambulatory care center (a walk-in clinic that has a sliding fee scale for low-income patients) is a central part of the hospital."

Under the same program, Cedars-Sinai also operates traveling coaches that take doctors and other health-care workers into low-income communities that are underserved medically, making it convenient and affordable for families to receive quality medical attention.

Meier recently parlayed his experiences at Cedars-Sinai into a book titled, "Seven Heavens: Inspirational Stories to Elevate Your Soul." The book is about a fictional patient named Jonathan, a scientist who worked on the human genome project. Jonathan finds himself facing mortality, and feels the need to bare his soul to Meier.

This story line is secondary to the messages that Meier wants to bring out in the book, that life is a series of moments, and each is moment is perpetually sacred. The book talks frankly and openly about death, and helps readers come to terms with the inevitable.

"I say vidui [the Hebrew confession for those facing imminent mortality] with people a few times a week," Meier said. "And what that has done to me is it has helped me prioritize what is important in life. Sometimes people will have an argument about the color of furniture, should it be blue or purple, or things like that. And while it is nice to have good colors, there is a larger picture."

Meier said every story that he tells in the book is true, although identifying details were changed. "My main character, Jonathan, is an M.D. Ph.D. A lot of the people around here are M.D. Ph.Ds, and they have a sense of certainty about themselves and about life, until something happens to them, and then they begin to look at their soul.

"That is what this book is about, what I call, ‘The Soul Project.’ What I am trying to do is to combine the human genome project that they are doing with the human soul project that I am doing. I want to make people aware of how their soul is affecting their health."

"Seven Heavens: Inspirational Stories to Elevate Your Soul" (Devora Publishing, $24.95) is available in bookstores. To reach Rabbi Levi Meier at Cedars-Sinai, call (310) 423-5238

Joined by a Kidney


On the anniversary of Sept. 11, we offer a pancultural exchange with a happy ending.

Back in November, UP FRONT reported about Patricia Abdullah, a Caucasian woman of Muslim faith who, after leading an unsuccessful search for a type O-positive kidney donor for acquaintance Mike Jones, an African American Christian, ultimately donated her own kidney. The Sept. 25 procedure was performed by Jewish and German surgeons at Cedars-Sinai Medical Center, a hospital founded by Jews.

Nearly a year after their surgeries, Abdullah and Jones are leading happy, healthy lives and stay very connected.

"She’s truly a blessing," Jones, 42, said. "She’s one of God’s angels. She gave me the ultimate gift that a person can receive."

"It’s been amazing," Abdullah, 54, said. "Mike and I seem to share an uncanny knowing of how one another is doing. The doctors told me, the only way we could’ve been a closer match [is] if we had been born together from a single cell."

Following their surgeries, Jones and Abdullah participated in a triathlon to raise awareness and money for the Dina LaVigna Breath of Life Fund. They are now training together for the L.A. Marathon.

Jones is currently working on a book, "One Miracle," and spreading awareness about kidney disease on cable TV ("The Wright Place") and online (wrightplacetv.com).

He shares what he has learned.

"If you believe in your God, everything is possible," Jones said.

So why bring all this up again now? Due to conflicting schedules of the two transplant teams, the surgery was rescheduled to Sept. 25. The original date of surgery? Sept. 11, 2001.

JNF Honors Eight


In a tribute to eight of its members, among them Holocaust survivors, a rabbi and two doctors, the Jewish National Fund will hold a 100th anniversary dinner Sept. 19 at the Hyatt Regency in Long Beach. The honorees include:

Miles and Esther Sterling of Aliso Viejo. She is a Holocaust survivor, charter member of Garden Grove’s Jewish senior center and regional chair of JNF’s Sapphire Society. He a member of JNF’s board since 2000.

Joseph and Marjorie Hess have both served in JNF leadership positions. Raised by an English family, Joseph came to England via the Kindertransport, which spirited Jewish children out of Germany prior to World War II. He retired from the U.S. space program.

Longtime members Rabbi Sydney and Eleanor Guthman. He is chaplain of the Long Beach Veterans Administration Medical Center and rabbi emeritus of Long Beach’s Temple Beth Zion Sinai.

Drs. Michael B. and Wendy Groner Strauss. He is a retired Naval Reserve captain, expert in undersea medicine and is a Long Beach orthopedic surgeon. She is a hospital pharmacist, consultant to a community clinic and activist in several national Jewish groups.

A Miracle Worker


Maria Teresa and Maria de Jesus Quiej Alvarez are twins who were born conjoined at the cranium. Headline-makers since arriving at the Pediatric Intensive Care Unit at UCLA’s Mattel Children’s Hospital in Westwood, the twins were separated in a nearly 23-hour surgery on Aug. 6.

“This single case has captured the global community in a unique way,” Israeli-born neurosurgeon Dr. Itzhak Fried said.

Fried is co-director of the Seizure Disorder Center at UCLA Medical Center and heads the Neurobiology of Human Memory Program in the Department of Psychiatry and Biobehavioral Science. The Tel Aviv native came to America in 1972 to pursue his medical education. His Polish father trained as a Reform rabbi in 1930s Breslau — an outspoken Jew who stirred the pot in Nazi Germany.

“He was arrested by the Gestapo for Zionist activities,” Field said. “He got out of Germany just before 1939.”

Field, his wife and three children divide their time between living on the Westside and in Tel Aviv, where Field created an epilepsy program.

“My work is to set up things there that will improve medical technology in Israel,” said Field, whose passion is researching the central nervous system.

As of Aug. 26, both Marias remain in serious condition with stable vital signs. “There’s a very good likelihood” that they will lead normal, healthy lives, Field said.

“We’re dealing with very young patients. The brain has flexibility at this age,” he told The Journal. “They both tolerated the procedure reasonably well. The team has been cautiously optimistic from the start.”

Field is quick to credit his team of neurosurgeon and plastic surgeons, anesthesiologists and nurses. “The work is really a teamwork,” Field said. “It’s the experience of many people pulling together.”



To donate to the twins’ funds, contact Robyn Puntch at (310) 794-5143 or rpuntch@support.ucla.edu .

Hearts in the Right Place


Call it a mission with a mission.”It was the most amazing trip,” Dr. Charles Pollick told The Journal. “I’ve been to Israel many times, but they really rolled out the red carpet for us.”

Unlike previous visits, this sojourn was more business than pleasure. Pollick, a cardiologist at Good Samaritan Hospital, was among three local medical professionals — 21 overall from America and Canada — who volunteered for a weeklong emergency medical care program, Aug. 4-11, organized by the Jewish Agency and the Israel Defense Forces (IDF).

The Beverlywood family man did not hesitate to sign up for the program.

“If Israel is sick, we need to help,” Pollick, 52, says. The doctors participated in an intensive medical orientation, which included a tour of Israeli hospitals, the IDF Medical Corps School of Military Medicine and the medical branches of the Central and Homefront commands. The doctors also met with Health Minister Nissim Dahan and Col. Hezi Levi, deputy surgeon general of the IDF.

The IDF’s goal, Pollick notes, is to train the doctors so that “should there be a war, we will go back to work in civilian hospitals because their doctors will have to work [on the frontline].”

Pollick is not exaggerating when he says that Israeli doctors work on the frontlines. Of the 13 soldiers ambushed in Jenin earlier this year, eight were medics, he says.

He adds that Israel is looking for more volunteers, especially surgeons and anesthesiologists.

“The most poignant part of the trip,” Pollick says, “was when we met with an 18-year-old victim of terror [of the May 28 Itamar study hall ambush]. He survived, but he’s now a paraplegic.”

Ultimately, volunteers such as Pollick and Pasadena pediatrician Henie Fialkoff came away impressed.

“Their readiness for biological and chemical warfare is incredible,” he says. “They’re very prepared in Israel. Far more advanced than in America.”

“It impressed on me that Americans are very naive,” Fialkoff adds. “The entire world has really changed. We’re in the 1930s, on the brink of major catastrophe. Israel is prepared for it. America is not.”

Area doctors who would like to volunteer their skills for emergency situations in Israel should contact Dr. Eric Karsenty in Israel at eric.karsenty@moh.health.gov.il .

Israel Security Experts Advise L.A.


The topic was terrorism. “How underprepared are we in the U.S.?”

“Very.”

That exchange, between an emergency care physician at Cedars-Sinai Medical Center and Dr. Jonathan Halevy, director of Shaare Zedek Medical Center in Jerusalem, was part of an ongoing effort in Los Angeles to change the answer.

Almost immediately after Sept. 11, El Al’s legendary security became a model for improving procedures at American airports. Now the scope has broadened, and Los Angeles hopes to learn from Israel’s hard-won knowledge of terrorism, prevention and response. Local officials for law enforcement, private security and medical care are reaching out to their Israeli counterparts for answers: What do we do if, or when, it happens here?

“[Suicide bombing] is likely to start happening here,” says Los Angeles County Deputy Sheriff Mark Seibel. For 10 days in late April, Seibel traveled throughout Israel with deputies and LAPD bomb-squad members, visiting sites of previous attacks and going through the paces of prevention and response with Israeli national police.

“There’s things they do there that we can do here,” Seibel says. Though he could not share details of law enforcement tactics or plans, Seibel did offer one area where local agencies are taking cues from Israel. “Patrolmen get briefings from the bomb squad twice a year on the procedures of the bad guy,” in order to know what to look out for, and civilian versions of those briefings are presented to high school students. Seibel believes the average Israeli high school student has a level of awareness of danger signs equal to any patrol officer in America. “They share information fantastically, distribute every piece of information immediately,” said Seibel.

Since returning from Israel, the deputy sheriff has worked with the L.A. County Terrorism Early Warning Group, a six-year-old task force, presenting what he learned in Israel to police and fire departments and representatives of all agencies responsible for safety throughout the county. “The bad guys are a network team,” he says, “In order to respond well, we need to respond in kind.”

That sentiment is echoed by Amotz Brandes of Chameleon Consulting, Israeli American security experts based in Canoga Park who co-sponsored a security forum in March, with the Israel Economic Mission, called, “Collaboration of Knowledge in the Age of the Terrorist Threat.” That conference attracted 170 attendees from law enforcement, public institutions and corporate security groups. Brandes calls the techniques and technology of security “the most important product Israel has to offer.”

In addition to more effectively sharing information with other agencies, Brandes recommended that local security officials overhaul the way they look at security. “The basic thing police and the public sector have to learn is to look at security in a more targeted fashion,” he said. “American law enforcement has a lot of procedures, but no goal. In Israel, there is a goal, but few procedures.”

Even the Israelis, of course, cannot prevent every attack. Los Angeles has much to learn from Israel’s similarly hard-won expertise in responding once the deed is done. That is where Halevy hopes to be of service. He took to the road in June, visiting hospitals across the United States with a lecture on “The Impact of Urban Terror on Hospitals: The Jerusalem Experience.” In his presentation, the doctor walked his L.A. colleagues through every step, from the first call to the post-cleanup arrival of the politicians, that his hospital has developed and repeatedly put into action after a “mass casualty event (MCE).” An MCE may be natural, unintentional or intentional; intentional may be conventional or unconventional. Hospitals must prepare for every scenario, and Halevy added this chilling addendum: “We have an official alert that hospitals are targets.”

At Cedars-Sinai, 100 doctors listened carefully and took notes. Halevy described a cabinet in his emergency room, holding an extensive, color-coded list of toxicological agents with protocols for treatment in the event of a mass exposure. In the audience, above the sound of quick, careful note-taking, a doctor’s voice could be heard, whispering to a colleague: “That’s a good idea.”

Physician, Heal The Soul


Physicians played a significant role in the Holocaust, and today’s doctors can learn from the ethical failures of that period, according to an article recently published by Dr. Joel Geiderman, co-chair of the emergency department (ED) of Cedars-Sinai Medical Center.

"I’ve always taken an interest in the Holocaust and its lasting effects, because my mother was a survivor," Geiderman said. With 23 years of emergency medicine at Cedars-Sinai under his belt, he has always taken an interest in the philosophies of bioethics but became "passionately" involved five or six years ago. Now, he serves on the ethics committees of Cedars-Sinai and the Academy of Emergency Medicine. "Most of us know about the medical experiments, the doctors in the camps," he said, "but as I started reading about this, about the history, I was blown away."

In "Physician Complicity in the Holocaust: Historical Review and Reflections on Emergency Medicine in the 21st Century," Geiderman sets out a series of moral failures he attributes to German physicians before, during and after WWII. Published in the March issue of Academic Emergency Medicine journal, the two-part article enumerates ethical challenges requiring greater vigilance from today’s physicians.

"So much of the Holocaust is unexplainable. But when you start to break it down, step by step, it starts to make sense in a perverse way," Geiderman said. "So much of what doctors contributed to the horror came out of economic opportunism, greed and convenience."

The first part of the article traces the German medical establishment’s slippery slope, from being healers toward full participants in genocide. Starting long before Hitler came to power, Geiderman shows how German doctors embraced the false science of eugenics, or "racial hygiene." This made it easier to accept, with the rise of National Socialism, the exclusion of Jewish physicians from the practice of medicine (which also advanced many non-Jewish doctors’ careers).

When the Nazis passed the Sterilization Act, doctors not only participated in designing the program to forcibly sterilize the "genetically diseased," they exceeded the government’s goals for implementation. Throughout the regime, ordinary physicians acted as instruments of racist Nazi policies; doctors became murderers, and later made efforts to hide the truth about their activities.

In Part Two of his "Physician Complicity" article, Geiderman examines the ethical challenges faced by his colleagues in emergency medicine today. He worries about doctors being asked to serve as agents of the state, as with mandatory reporting laws for patients whose injuries might be caused by foul play or infectious disease. He considers the denial of modesty to patients when "reality television" films in an emergency room. He considers the various ways in which patients are dehumanized by their doctors, who may refer to them by room number, by their ailment or even by nasty nicknames. Economic pressures affecting the practice of medicine and technology that allows for genetic screening, testing and even genetic engineering also pass through Geiderman’s bioethical radar.

"These are not Holocaust analogies," he says of Part Two, adding that in the article, "I took a neutral stance on physician-assisted suicide. Personally, I’m against it. But I don’t think it’s useful to play the so-called Holocaust card in these debates."

The doctor compares his research and writings to reflection on the Holocaust in other fields. "In ‘Au Revoir les Enfants,’ the French director Louis Malle described the Holocaust through his childhood eyes in a French monastery … while others responded by building new lives or even a new nation. For me, as an emergency physician who has spent 25 years in an ED, dedicated my most recent years to the study of bioethics, and who is the son of a survivor, Part Two is the natural expression of my feelings or philosophy."

It is a decidedly practical sort of philosophy for a doctor of emergency medicine to study. "What’s become really clear to a lot of us who advocate bioethics is that you have to have considered these issues in advance," Geiderman says. "In emergency medicine, there’s not always a lot of time to call in an ethical consult." He views the product of his historical and ethical research as timeless. "Unlike hard science, where the science will change, this will never change."

Though his research relies on previously published materials, and his description of physician complicity in the Holocaust is carefully documented, Geiderman says some peer reviews of his work came back with incredulous comments — doctors who could not believe such events could have happened. He writes: "The keys to preventing such a recurrence lie in understanding and teaching the lessons of the past; in speaking, teaching and writing about ethics; in incorporating ethical principles and professionalism into our medical practices, and in being willing to stand up and make personal sacrifices for the ethical principles in which we believe."

And, as he says, "Certain things need to be learned over and over again."

Celebrating A Miracle


If you need proof that miracles still happen in this world, look no further than Benjamin Kadish.

When Kadish, who was shot twice during the Aug. 10 attack on the North Valley Jewish Community Center, was first brought into the emergency room he had no pulse, according to Dr. Charles Deng, head emergency physician for Providence Holy Cross Medical Center.

“We had only seconds to get an IV in and get his pressure back up,” Deng said. “We also knew that in order for [his pressure] to drop that much, there had to be internal damage. Fortunately, everything worked out that day. The paramedics did exactly what they should have done, which is get him over here as quickly as possible, what we call ‘scoop and run.’ There’s not a doubt in my mind that if they had tried to fly him to Children’s [Hospital] or another hospital, Ben would not have made it.”

Because of the extensive media coverage, many people knew that Benjamin’s abdomen and left leg were pierced by bullets. What most people do not know is that, because of the severed artery and vein on his right side, Ben could easily have lost the use of his right leg. Deng credits Vascular Surgeon Dr. Mehdi Fakhrai, along with Dr. Clarence Sutton, Dr. Robert Roth and anesthesiologist Dr. Rene Barga, for making it possible for the boy to walk again.

“I, too, want to mention Dr. Barga,” Fakhrai said. “He was there all the time, for the entire six hours the boy was in surgery, and because of him we were able to get everything done we needed to do.”