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Upcoming Events
June 19 June 19 WEBCAST - Lunch Colloquium - Jeffrey Watkins
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This issue of our newsletter is sent to members and friends of the Emory University Emeritus College (EUEC). I hope the newsletter will help keep you informed about our activities and help you feel connected with our members throughout the U.S. On the left are links to our website and links to contact either me or the EUEC office.
With best wishes,
Gray
Gray F. Crouse Director, EUEC
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 Message from the Director
In spite of the summer season, we are maintaining a busy schedule, with a Lunch Colloquium last week on heart attacks and strokes, an afternoon seminar tomorrow on the history of medical lapses in judgment dating back to the time of George Washington, and a Lunch Colloquium next Monday on appreciating Shakespeare. A varied, rich, and fulfilling diet! Related to that Lunch Colloquium, I hope you will be able to join us on June 25 at the Shakespeare Tavern to see Richard III. Details are below.
Special thanks to two members, Jim Van Buren and Linda Pine, who wrote articles on Virgil Brown's talk. Virgil made clear there is nothing simple about blood lipids, but their role in heart attacks and strokes, and new treatment options that are currently available, are both interesting and important stories. If you didn't get a chance to hear Virgil, in addition to reading the articles in this newsletter, you can watch the recording of his talk by going to the videos section of our website.
In this issue, we finish our series of articles on the EUEC members who received awards at our ceremony this year, and present a summary of the work to be supported by the second Heilbrun Fellowship award. It is amazing to read about the activities of our members. Please let us know what you are doing. In the Faculty Activities section of this newsletter you can see that EUEC Member Don Stein is a featured artist at the Art of Medicine Gala this fall in Orlando, which will raise money to support TBI (traumatic brain injury) research, which is particularly appropriate as much of Don's research is in that field.
I am very grateful to John Bugge, Herb Benario, and Gretchen Schulz for help with proofing and editing.
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Lunch Colloquium June 19
 The Keys to the Kingdom: An Everyman's Guide to Loving Shakespeare
The Luce Center
Room 130
11:30-1:00
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Lunch Colloquium June 5
Heart Attack and Stroke: The Role of Genes and Drugs
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Afternoon Seminar June 13
 All the Kings' Doctors: How the Medical Treatment of Leaders Changed History
The Luce Center
Tuesday, June 13
Room 130
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Excursion to the Shakespeare Tavern--June 25
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Heilbrun Distinguished Emeritus Fellowships
Fellowships to emeritus faculty in the Arts and Sciences are funded by a generous contribution from the family of Emeritus Professor of Psychology Alfred B. Heilbrun Jr. This year there are two recipients: EUEC Members Ron Gould, Goodrich C. White Professor Emeritus of Mathematics, and Larry Taulbee, Associate Professor Emeritus of Political Science. Larry describes his project for this issue; Ron's description was in the previous issue. Click here to read below about Larry Taulbee's Heilbrun project
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Faculty Activities
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Walking the Campus with Dianne
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Lunch Colloquium June 19
The Keys to the Kingdom: An Everyman's Guide to Loving Shakespeare
Jeffrey Watkins, CEO and Artistic Director, Atlanta Shakespeare CompanyJeff Watkins, the man (and some of us might say the genius) most responsible for the fact that Shakespeare is alive and well and available for our viewing pleasure year-round in Atlanta, will begin his presentation-cum-demonstration with a brief contextualization of Shakespeare's work and its relation to how we define ourselves as Human Beings through myth and story. He will then present Five Keys to understanding Shakespeare in performance: (1) Shakespeare's Playhouse, (2) The Role of the Audience, (3) The Elizabethan World View, (4) Shakespeare's Verse Structure, and (5) Shakespeare's Dirty Jokes. He will be using illustrations from performance to emphasize his points--not least references to the handling of scenes from the production of Richard III, scheduled through June at the Shakespeare Tavern, a production members of the Emeritus College will be able to attend, en masse, or in a good-sized group, anyway, on June 25. (See the article about this excursion elsewhere in this newsletter.)
About Jeff Watkins (from the ASC website) Jeff Watkins was born and raised in Dallas, Texas. He studied theater with Paul Baker at Trinity University where he received his degree in 1978. After training and working throughout the United States and Europe, Jeff brought his Elizabethan expertise to Georgia. Since 1984, he has been Artistic Director of the Atlanta Shakespeare Company (ASC). ASC is a theater company dedicated to performing Original Practice productions of Shakespeare plays and other classics complete with live, Renaissance music, live organic sound effects and hand-made, period costumes. In 1990, Jeff designed and built America's Only Shakespeare Tavern®. The Shakespeare Tavern is the southeast's only Elizabethan playhouse. Simply put, it is a place to eat, drink, and nourish the soul. In 1995, under Jeff's direction, ASC became the first American Company to perform on the stage of Shakespeare's Globe Theatre in London, England. In 1999, Jeff oversaw ASC's $2.1 million-dollar capital campaign to purchase, renovate and expand ASC's performance facility. In October of 1999, Jeff and ASC opened the doors on the Shakespeare Tavern Playhouse, an even better Original Practice playhouse® that includes a Globe-inspired balcony. In September 2001, Jeff was recognized as a Lexus Leader of the Arts. In 2003, he staged a Southeast first, directing four Shakespeare history plays in chronological order with the same company of actors playing their characters throughout all four plays. ASC's "Shakespeare History Extravaganza" consisting of Richard II, Henry IV: Part 1, Henry IV, Part 2, and Henry V played to sold-out houses over a stunning five-week period. ASC and this project received national attention with articles in the Washington Post and the Los Angeles Times in addition to being named Critic's Choice for "Best Theatrical Mini-Series" by the Creative Loafing. This past fall, the Company undertook a similar feat, offering a week of performances of each of the three parts of Henry VI, in succession, and then the three plays in three nights in succession. The production of Richard III, due to open at the Tavern on June 17, is the fourth play in this tetralogy of history plays that Shakespeare wrote early in his career. If you're able to join the group of emeriti (and friends and family) who'll be attending the production on June 25, you'll seewonderful evidence of why Jeff is considered a leader in the field of Original Practice performance in America. Click here to return to top
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Afternoon Seminar June 13
All the Kings' Doctors: How the Medical Treatment of Leaders Changed History
Maan Jokhadar, MD, FACC, Associate Professor, Internal Medicine, Division of CardiologyThis talk will include several historical examples of doctors who had lapses in judgment of medical treatment involving George Washington, Franklin D. Roosevelt, and Lyndon B. Johnson among others. About Maan Jokhadar Maan Jokhader is an Associate Professor, Internal Medicine, Division of Cardiology, at Emory University. He specializes in adult congenital heart disease and in heart failure. Maan went to medical school in Damascus, Syria, and subsequently completed his internal medicine training at the Mayo Clinic in Rochester, MN. He then came to Emory for a cardiology fellowship and joined the Emory cardiology faculty in 2009. Maan has won numerous teaching awards, and so we should be in for a real treat:
2016 Golden Apple Teaching Award
2015 Excellence in Teaching Award
2014 Hurst Teaching Award
2010 Excellence in Teaching Award
2007 Fellow Teaching Award
2006 Senior Medical Resident Teaching Award
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Lunch Colloquium June 5
Heart Attack and Stroke: The Role of Genes and Drugs
W. Virgil Brown, Charles Howard Candler Professor Emeritus of Medicine
At the Lunch Colloquium of June 5, Dr. Virgil Brown, an emeritus professor of medicine at Emory, an Emory alumnus, and an Emeritus College member as well as a nationally and internationally recognized expert on lipids, led us on a trip regarding heart attacks and strokes, their basic causes, and what has been done, is now being done, and, in a peek into the future, what will likely be done to control these serious problems. He pointed out that it really wasn't until the 1950s and '60s that we began to realize that the underlying cause of atherosclerosis, which of course is the major cause of heart attacks and strokes, is a problem of abnormal lipids (fats in the blood). He took us on a biochemical journey to explain all of this. (It reminded me of my freshman biochemistry course in medical school!)
He pointed out that while cholesterol is an important and necessary component in our blood, it's the very complex relationship between cholesterol and the liver, the major organ in metabolizing cholesterol to its breakdown components of Apo B lipoprotein (LDL and VLDL cholesterol) at the cellular level, that determines the atherosclerotic health risk. The routine measurements of LDL and VLDL, as well as HDL and triglycerides, are those that help us establish the risk for the development of atherosclerotic diseases. The development of drugs, such as the statins, ezetimibe, and mipomersen that help to modify those risks, has proven to be very beneficial.
More recently it's been determined that there are multiple genetic factors that play a significant role in how we metabolize these chemicals. There is ongoing work in the understanding and science of how these genetic factors work. This has led to the development of some drugs to modify these factors that are so important to cholesterol metabolism. For instance, an inhibitory drug for the PCSK9 protein that works to limit the beneficial LDL receptor cells helps to enhance the survival of the LDL receptors that are so important to keeping the LDL low. He did note that the economics related to these new developments and drugs is becoming a significant societal problem.
We all know those risk factors for atherosclerosis that we can modify: a reasonable low fat diet, no smoking, moderate exercise, and control of blood pressure, weight, and diabetes. We need to be able to discuss these factors with our medical providers. We are fortunate to have the Emory Healthcare team to support us!
--Jim Van Buren (James K. Van Buren MD)
Many risk factors contribute to the overall incidence of cardiovascular disease: poor diet (high in saturated fats/trans fats), hypertension, smoking, diabetes, lack of exercise and obesity are all contributing risk factors. Individual genetics have also been shown to be an important factor in the risk (or diminished risk) of cardiovascular disease. There is, however, some "good news"! The incidence of cardiovascular disease and mortality has decreased over the past several decades, due in large part to lifestyle modifications and the use of pharmacologic agents to decrease cholesterol levels and more aggressively treat hypertension. Cholesterol metabolism with many associated proteins and enzyme pathways is a very complicated process. Below is a summary of key points in Dr. Virgil Brown's presentation; it highlights some of the scientific advances that have contributed to this recent decrease in CV disease and the pathways that may be utilized in the future for even further improvement. - Increased cholesterol, LDL-C, triglycerides, Apo(a), ApoCIII, ApoB (100) are all markers for increased risk of cardiovascular disease (myocardial infarction and stroke).
- Cholesterol is produced and metabolized in the liver to VLDL particles (necessary for transporting energy to all tissues and organs of the body - except the brain) and LDL remnants. These LDL remnants then circulate and bind to LDL receptors in various organs and tissues within the body. If circulating LDL levels are "too high," then LDL is available to enter artery vessel walls, forming atherosclerotic plaques, and the risk for CV disease increases. When the natural balance is in the correct proportion, excess circulating LDL is "taken up" by the liver (binding to LDL receptors in the liver) and taken out of circulation. The LDL is no longer "free" to enter the cell wall of blood vessels and does not cause plaque formation/rupture, thus reducing the risk for cardiovascular disease.
- HMG-CoA reductase is the naturally occurring enzyme that leads to cholesterol production in the liver. HMG-CoA reductase inhibitors (i.e. statins) interrupt this cholesterol production process, by allowing an increase in LDL receptors in the liver, which in turn increases the catabolism of plasma LDL, lowers the plasma concentration of LDL-C, and markedly decreases the incidence of cardiovascular disease. There is a marked linear relationship between decreased plasma levels of LDL-C and decreased cardiovascular disease (MI and stroke). There seems to be "no limit" to "how low" one can drive the LDL-C plasma levels. Very low (<30mg/dl) levels result in very low incidence of CV events over time, seemingly without side effects. Dr. Brown showed a compilation of studies that demonstrated actual "resolution" of plaque in vessel walls when LDL-C levels were driven low. So, maximizing statin use/doses to decrease LDL-C levels to "goal range" (based on incidence of CV risk factors) has become the standard of care.
- Ezetimibe (Zetia) is a drug that lowers plasma cholesterol levels by decreasing cholesterol absorption in the small intestine. It is an alternative therapy to therapy that lowers LDL-C and may be used alone or in combination with statins.
- ApoB is a primary lipoprotein found on the cell surface of LDL cholesterol. It is the primary organizing protein on LDL molecules and is the actual binding site for LDL receptors in many tissues of the body. High levels of ApoB, especially associated with higher LDL concentrations, are the primary driver of plaques that cause cardiovascular disease. ApoB may actually be a better marker for CV disease risk than is LDL-C.
- ApoCIII is a naturally occurring enzyme that inhibits lipoprotein lipase and is thought to inhibit hepatic uptake of triglyceride-rich particles. An increase in ApoCIII levels results in the development of hypertriglyceridemia. There are genetic variants that lead individuals to have elevated levels of ApoCIII. (Note: Dr. Brown was the first physician/researcher to characterize and isolate the structure for ApoCIII lipoprotein in 1965 when he was at the NIH.) There is now an ApoCIII inhibitor currently in clinical trials. It is hoped that decreasing ApoCIII levels will decrease serum triglyceride levels and thereby decrease cardiovascular disease as well.
- PCSK9 is a naturally occurring enzyme that binds to the LDL receptor, thereby reducing the LDL receptor's ability to bind LDL and remove it from plasma circulation. If PCSK9 is blocked (with new PCSK9 inhibitors), more LDL receptors are available on the surface of cells (i.e. the liver) to bind and remove LDL from circulation, and LDL levels in the plasma are reduced. Two new PCSK9 inhibitors are approved for clinical use in the US in patients who have not achieved LDL goals with other therapies (i.e. statins, ezetimibe- Zetia). Alirocumab (Praluent -Regeneron) and evolocumab (Repatha-Amgen) are the two PCSK9 inhibitors approved in the US. They are given by SC injection once or twice per month at a cost of ~$14,000/yr. However, the negotiated price with insurance companies may be significantly less than this amount, and the decrease in CV disease and mortality may warrant the use of these drug therapies in spite of the cost. Dr. Brown reported a case study in which 3 patients had NO PCSK9 enzyme (genetic variant). Their subsequent LDL levels were "extremely low" (i.e. 15-17mg/dl). They had no evidence of cardiovascular disease and no "bad effects" from having these extremely low LDL-C levels for their entire lives. This is further evidence that driving LDL-C levels to very low levels may prove to be beneficial in reducing cardiovascular disease.
In summary, many advances have been made in the understanding of lipid metabolism and its relationship to cardiovascular disease. With the addition of increased knowledge of genetics and more "personalized" medicine, we can expect even further advances in the future for the treatment of CV disease as new therapies are developed that target specific pathways within this complicated lipid cascade. --Linda Pine
A recording of this Lunch Colloquium can be seen on our video page by clicking on this link.
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EUEC Distinguished Service Award--Marianne Scharbo-DeHaan
It is with great enthusiasm that I nominate Dr. Marianne Scharbo-DeHaan for the Distinguished Service Award. I have had the privilege of knowing Marianne since 1985 when she joined the faculty of the Nell Hodgson Woodruff School of Nursing where she taught masters level core courses as well as midwifery specialty courses. She was an outstanding teacher and professional colleague and had been honored with several teaching awards before her retirement from Emory in 2000. She accepted an appointment at the CDC and held several leadership positions before retiring again in 2005. She received Performance Awards for every year of her time at the CDC. She continued to do public health research and to coordinate the establishment of preventative health and health educational programs both here and in South Africa and Ethiopia. Women's health and disease prevention continue to be her areas of professional interest. She continues to serve as consultant to the CDC and to the American Medical Women's Association on the subject of sexually transmitted diseases. Her post-retirement activities have been broad, and she has served in a variety of service activities in the University and in the greater Atlanta community. She continues to serve as Chair of the Public Information Section, Division of Women's Health Leadership and Policy for the American College of Nurse Midwives. In addition, she still serves on the Advisory Board for the Emory University Center for Women. In 2007 she received the "Stand Up For Choice Award" from the Feminist Women's Health Center. Marianne has been one of the most active and involved members of the Emeritus College. She served on the EUEC Executive Committee from 2009-2014. She served as chair of the EUEC Service Committee from 2009 to 2015, during which time our longstanding relationship with MedShare was instituted, and she continues to coordinate that monthly activity and to serve as the liaison between the EUEC and MedShare. She is a docent for Trees Atlanta on the Beltline and conducts tours of the Arboretum on the Eastside Trail of the Beltline. She completed a three-month course at Trees Atlanta in order to qualify as a docent. She is an active Master Gardener for Central Fulton County and served five years on the Executive Committee and chaired the recruitment activities during that same period. She coordinates activities between the Master Gardeners and Habitat for Humanity, which results in landscaping and planting the property around new Habitat for Humanity homes. She also serves at farmers' markets by answering questions about gardening and food. In addition, she works at the Gold Medal Garden at Centennial Olympic Park. Marianne is currently working with the Atlantic Regional Commission Council on Aging and has done a large number of educational workshops on the topic of Healthy Sexuality in Aging and Managing Medications and Money Wisely. Finally, Marianne serves as street captain for the Morningside Lenox Park Neighborhood Watch Program. In that role, she serves as liaison between police, security patrol, and the neighborhood when there is crime in the neighborhood area. Clearly Dr. Marianne Scharbo-DeHaan has been and continues to be active in service to the University and to the community as a whole. I believe she meets the criteria for the Distinguished Service Award.
--Helen O'Shea
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Heilbrun Distinguished Emeritus Fellowships--Larry Taulbee
Larry writes: I would like to thank the members of the Emeritus College, the Emory College faculty, and the Heilbrun family for my award of the 2017 Heilbrun Distinguished Emeritus Fellowship. When I first came to Emory in 1968, Professor Heilbrun was a very vibrant presence and role model for young faculty. I am truly honored to receive an award bearing his name.
My project has the descriptive name of Kein Geld, Kein Schweizer: No Money, No Swiss-- Reflections on the Mercenary Option. Thirty-five years ago, a small item in the UN Chronicle caught my eye. The United Nations had appointed a Special Rapporteur and Committee to look into the use of mercenary troops. This took me somewhat by surprise because I thought the problem had passed with the end of the Nigerian Civil War. One influential author had observed that: "The mercenary world is permanently awash with activity." In an article, "Raiders of the Leased Art (1987)," I asserted that while I would not disagree with that statement, it missed the point. The critical questions did not center on the level of activity within the mercenary world, but the nature and extent of the intersection of the mercenary world with the world of political action at any particular point in time. I became very interested in the question of "Why do societies resort to mercenaries?" At base, whether an entity employs their own subjects or elects to use mercenaries is an economic transaction subject to supply and demand. Still, many other factors (or intervening variables) condition the nature and extent of the intersection between the two worlds. The long-term project has focused on questions relating to WHY various collective organizations (city states, states, empires, etc.) have elected to pay others for their defense rather than use subjects/citizens or, in the case of companies or private individuals, construct their own private armies. It encompasses a very broad historical range beginning with the use of mercenaries from, in H. C. Parkes' words, "time immemorial." The project does not attempt a systematic historical account, but rather presents a series of structured analytical "snapshots" of eras where mercenaries were major players. The focus is on recurring patterns in terms of opportunity, cost, skills, performance, and problems.
Let me provide all with an interesting comparison to illustrate some problems. Intuitively we all just know that mercenaries are independent "soldiers for hire" who often work for governments other than their own. Yet let us consider the following. The U. S. army went all-volunteer in 1979. To attract recruits, the government significantly increased pay and benefits. A lot of green card holders (permanent resident aliens) joined in anticipation of receiving citizenship. Now, everyone also knows that the French Foreign Legion (FFL) is a mercenary force by definition because it employs soldiers from other countries. Yet, the FFL has officers from the French regular army, soldiers receive the same pay as equivalent grades in the regular French Army, and the Legion fights only for French goals. After five years of honorable service, one can apply for French citizenship. The American army and the FFL fought side by side in Desert Storm (1991). Given the enhanced pay to attract recruits for the American Army and the number of resident aliens who enlist, what really distinguishes the current volunteer American Army from the French Foreign Legion? Click here to return to top
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Donald G. Stein
Asa G. Candler Professor and Distinguished Professor
Department of Emergency Medicine
EUEC Member Don Stein was one of the exhibitors in our Arts Exhibition this spring at the Schwartz Center. He will be having his latest works shown this Fall at the Orlando Museum of Art. The Gala is a charity event whose proceeds will go to support TBI research and patient care at the University of Florida.
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New Members
New members are the lifeblood of any organization. Please make a special effort to welcome them to EUEC!
In transition:
David G. Kleinbaum, PhD, Professor, Department of Epidemiology, Rollins School of Public Health
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Excursion to the Shakespeare Tavern--June 25
A short summary of the information below: if you want to attend the June 25 performance, you need to call the Tavern box office and speak to Becky, as Gretchen outlines below. The tickets that Gretchen has reserved are on the main floor, and there are a limited number available in that space at our special price. Note that other tickets in other seating areas at full price may be available after our set of tickets is gone..
EUEC Theater Excursion: Richard III at the ASC Sunday, June 25, 6:30 p.m. to 9:30 p.m. Gretchen Schulz, Emeritus College member and Resident Scholar of the Atlanta Shakespeare Company (ASC), invites Emeritus College members, along with their family and friends, to join her for a production of Richard III at the New American Shakespeare Tavern, 499 Peachtree Street. The ASC has reserved seating on the main floor for Emeritus College guests. Show time is from 6:30 to 9:30 p.m. on Sunday evening, June 25. Arriving no later than 6:00 is recommended--or earlier if you plan to have dinner. Food and drink are available and may be enjoyed during the play. The menu is online. Gretchen has secured discounts that will keep the cost to $28.94 per person (tax included). Those who wish to attend as part of the Emory group should call the Tavern (at 404-874-5299) between 10:00 and 5:00 Monday through Friday, press 0 for the Box Office, and ask to speak with Becky (the chief Box Office person and the only one who can handle these special requests). Just say you're calling to claim one (or more) of the Emory/Schulz tickets, and they'll set aside your ticket(s) and allow you to pay for it (or them) at the discounted rate. These reservations must be made by the end of the day on Monday, June 19. After that day, you may still make arrangements to attend on the 25th, but you'll be paying a bit more (able to claim only the educator/senior discount). And you may not find seats available on the main floor. (Of course, all seats at the Tavern do provide a good view . . .) On the evening of the play, you may pick up your ticket(s) at the ticket desk. Mention that you are with the Emory/Schulz group when you pick up your ticket(s) and again, prior to being seated. Those handling the seating will direct you to the main-floor tables they have reserved for members of our group. (Or look for familiar EUEC figures waving you towards the tables we've been assigned.) The Tavern is located right across from Emory Midtown Hospital. Parking is readily available in the Hospital parking deck (the entrance to which is opposite the Tavern front door in the middle of the block) and in an open lot, also belonging to the Hospital, at the corner of Renaissance and Peachtree, half a block north of the Tavern. Maps and directions can be found on the Shakespeare Tavern website. Parking in the deck is payable upon exit. Parking in the open lot is payable upon arrival in a machine up front. The front entrance to the Tavern involves one flight of stairs, down to the main level. There is a good chair lift attached to the stair railing. Handicapped parking and an entrance without stairs are available at the rear of the Tavern (see details online). We hope you can join us at the Lunch Colloquium on the 19th and at the production of Richard III on Sunday, June 25. If you cannot attend the play on the 25th, we'd encourage you to make arrangements to go another time. It will be playing Thursdays through Sundays from June 17 to July 2. Click here to return to top
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Walking the campus with Dianne
It appears a few emeriti are visitors to the Michael C Carlos museum--because I received a number of correct guesses for our last photo. It is indeed the back entrance, which can be found on Kilgo Circle from the bridge off Fishburne Drive. The front entrance to the museum is, of course, within the quad on campus. I've supplied photos of both entrances below.
Our next walk takes us to a brand-new place on campus. During the next couple of months, it will be filled with participants from the various summer camps at Emory, but come Fall Semester, the Emory students will take over the building.
Where will you find this on the Emory campus?
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Emory University Emeritus College The Luce Center
825 Houston Mill Road NE #206 Atlanta, GA 30329 |
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