September 22, 2006

Greer, Lane first Stahlman Scholars in Biomedical Ethics

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John Greer, M.D.

Greer, Lane first Stahlman Scholars in Biomedical Ethics

Kirk Lane, Ph.D.

Kirk Lane, Ph.D.

John Greer, M.D., and Kirk Lane, Ph.D., have been selected to be the first Stahlman Scholars in Biomedical Ethics and Society at Vanderbilt University Medical Center.

The scholarship program was established this spring by the Vanderbilt Center for Biomedical Ethics and Society to enable faculty members in the schools of Medicine and Nursing to pursue in-depth explorations of ethical issues in health care delivery.

“We are thrilled about starting this new program to strengthen research and understanding of ethical issues in the Medical Center,” said Ellen Wright Clayton, M.D., J.D., co-director of the center with Larry Churchill, Ph.D. “We look forward to working with these scholars as well as many more in the future.”

Greer is professor of Medicine and Pediatrics, and clinical director of the Stem Cell Transplantation Program in the Division of Hematology/ Oncology. Lane is research assistant professor of Medicine in the Division of Allergy, Pulmonary & Critical Care Medicine.

Each will receive $15,000 in salary support and $2,500 in research funds during the six-month scholarship period, which begins Jan. 1. The program is supported in part by the Ann Geddes Stahlman Chair in Medical Ethics.

Greer said he intends to explore bioethical issues involved in the treatment of cancers such as leukemia and Hodgkin lymphoma, with the view of possibly developing a course on the subject for medical students.

As an example, a lifetime course of Revlimid, a new medication for myeloma, can cost more than a peripheral blood stem cell autograft.

“So now we have pills that are more expensive than transplants,” Greer said. This creates an economic, as well as ethical dilemma for doctors and their patients: “Do you give them a more expensive pill, or a more dangerous transplant?”

The nation's fragmented health care system also makes it difficult to recruit adults into clinical trials of new cancer treatments. “Very few adults, probably less than 2 percent, are in clinical trials,” he said. “It's very hard to make progress in oncology if you do not have large numbers of patients participating.”

Greer said he hoped that an ethics course for medical students would help raise their awareness about these troubling issues.

Lane, who helped discover the gene for primary pulmonary hypertension (now known as pulmonary artery hypertension or PAH), said he would explore what it would take to “bring basic research information into individualized medicine.”

Basic research studies of inherited lung diseases such as PAH and idiopathic pulmonary fibrosis (IPF) can determine which members of a family carry genetic mutations associated with the disease.

But because basic laboratories validate their findings in a different way from clinical laboratories, their findings are not considered to be “sufficiently controlled” to be reported to research subjects or to their doctors, Lane said.

Approved PAH testing is now offered at Vanderbilt by the clinical genetics laboratory, Lane said. But tests for the mutation associated with IPF have not yet reached the clinical setting. As a result, family members in studies of IPF who have the mutation but who are not yet sick are not counseled to avoid occupational exposure to chemicals that could increase their risk, he said.

Lane said he wants to find out whether basic research labs could make the changes necessary for their findings to become “reportable.”

With the help of Paul Harris, Ph.D., and his colleagues in the General Clinical Research Center's Informatics Core, Lane will design an online questionnaire to survey scientists, Institutional Review Boards, which approve clinical research protocols, and bioethicists.