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Interview with the Dean
I have the pleasure of being here today with two of our distinguished faculty: Dr. Costantino Iadecola, the Anne Parrish Titzell Professor of Neurology and the director of the new Feil Family Brain and Mind Research Institute. Also with me is Dr. Matthew Fink, the new chair of the Department of Neurology and a professor of neurology. We're coming together today to talk about this new institute and the future of neurology and neuroscience at Weill Cornell.
LAURIE H. GLIMCHER: So let's start out by having you tell me about the Feil Family Brain and Mind Research Institute. What is it about, how is it going to work and what are the goals?
COSTANTINO IADECOLA: Weill Cornell has a very strong tradition of excellence in neuroscience, both from the clinical end and from the basic science end. But over the years, it has developed into a somewhat fragmented environment, requiring a resetting of the structures. And the way we envision this process is to go all the way from the molecules to the patient bedside. To do that will require a wide variety of expertise and the contributions from a wide variety of physicians and basic scientists and clinician scientists to, kind of, fill this gap that has been now created between what goes on in the laboratory and what happens at the clinic. And we hope that, through this interaction, we will be able to succeed in that.
GLIMCHER: And how do you see this Matt, from the point of view as the new chair of Neurology?
MATTHEW FINK: I see this as a great, great step forward for us at Weill Cornell and also for patients and families who are dealing with neurological disorders. Until relatively recently, most of them had no treatments. And I think both of us made commitments to push the envelope and really work towards developing new therapies for these patients. My approach has been through clinical care. Cos has been working towards that in the laboratory, and I think having the two of us together as partners to bring these areas together is what will really make the difference.
GLIMCHER: I think the concept of establishing interdisciplinary centers is quite innovative. How do you think this is going to impact the way we carry out biomedical research in the future?
IADECOLA: So, I think this creates a new model, I believe, that we will be pioneering in which we are going to have neuroscience without walls. We will be able to learn from our patients in a way that was never possible before, thereby being able to help our patients in a way that we were never able to before.
FINK: And from the clinical approach, we recognize that we have to bring in every specialty to bear to treat patients who have neurological problems. A person who has a heart problem, that's going to affect the brain. A person who has a kidney problem or a liver problem, it's going to affect the brain. We actually are already bringing in multidisciplinary teams to take care of these patients.
GLIMCHER: What do you perceive as some of the most critical issues facing us in neuroscience now?
IADECOLA: There are two major issues. One has to do with head trauma. We have a lot of people overseas, 12 years of wars. The new kind of injury we are seeing are close head injuries, blast injuries, that will have a tremendous effect on the brain years and years later on. The other one is the diseases associated with aging. Many neurological diseases are age dependent. So the incidence of stroke, Alzheimer's disease and dementia goes all the way, increases tremendously with aging, and we are going to be faced with an epidemic. Now is the time to act on it and to prepare for that.
FINK: Everyone is living longer and unfortunately, now we're subjected to the neurodegenerative diseases as a result of that. So those are the areas we have to work on strengthening. And those are also the areas that lend themselves the most to a translational approach, of taking something which is developed in the laboratory and moving it into the clinic, and we are going to have to be much better at doing that. It takes at least 10 years to take something that's been discovered in the laboratory as a potential treatment and move that to clinical trials, and we need to, I think, try to cut that in half. With Alzheimer's disease, the pathology develops probably 20 years before the first memory loss develops. Well, if we can identify who those people are with biomarkers and have a treatment that can delay the onset of the disease by five years, we will reduce the prevalence of Alzheimer's disease by about 50 percent. That is an achievable goal, I believe.
GLIMCHER: Well, 50 percent would be marvelous when we think about the statistics that one out of every two individuals over the age of 85 is going to have Alzheimer's disease. It's pretty scary. The three of us sitting here, at least one of us is going to have Alzheimer's disease, probably.
FINK: Yes, yes.
GLIMCHER: And we'd all like to figure out how to prevent that.
GLIMCHER: Cos, what's your own specific interest? What's your focus, your expertise?
IADECOLA: So, I started as a, almost like a vascular biologist, but then I had the fortune to interact with my basic science mentor, which was Donald Reece, a professor here at [Weill] Cornell. And Don was one of the earliest investigators who understood that the solution to the problem of the brain was multidisciplinary research. My career has been kind of trying to implement that and apply that to the different neurological diseases. So, we started with stroke, but now we are working on Alzheimer's disease, where vascular risk factors play a determinant role. So each risk factor, like diabetes, high blood pressure or hyperglycemia, they add double the risk of Alzheimer's. So if you have three of them, you have six times the risk of getting Alzheimer's disease.
GLIMCHER: So, you've been interested in and are one of the founders of neurocritical care. How did you get into that?
FINK: I got interested in this as a resident in neurology. What I observed as a resident was that the most critically ill patients who are admitted with neurological disease were simply dismissed as beyond help. It occurred to me that I did not think that should happen, that I felt that we could be treating these patients and that there were some new things that we probably could do. And one of the lessons I learned very early on in my training is that when you have neurological injury or illness, you get sick very fast but you recover very, very slowly. And you need to have patience to allow someone to recover and you can't give up so fast. So, as I was finishing my training, I really decided I wanted to pursue this area and be the one who was going to be trying to take care of the most critically ill patients. And fortunately, I had a chairman at the time who thought that was a great idea and supported me to do that. And so we developed one of the first specialized neurocritical care units in the United States. This was at NewYork-Presbyterian Hospital although it was at the other campus at the time when we got started. It's become a really very, very successful specialty, really just growing out of the desire to come up with new treatments for patients that were simply left to die. I think that all of us as neurologists face that type of thing all the time. We are dealing with really terrible, tragic diseases that are hard for people to face and grapple with sometimes. And we're of the state of mind where we don't give up.
GLIMCHER: Did you predict when you were a boy growing up that this is where you would end up?
FINK: One thing we didn't say is, Cos and I both play the guitar. [Glimcher and Iadecola laugh]
IADECOLA: We shouldn't demonstrate now.
FINK: Not now, not now. [Iadecola laughs] But when I was growing up, all I wanted to do was play the guitar. And I was in a band and my band used to go on tour. I had no particular career aspirations in college. And then I took a course, it was more of a neurobiology course, and I went immediately from the band and the guitar to being interested in the brain. And I spent a year doing animal research. As the undergraduate student, I was the one who was asked to stay up all night [Glimcher and Iadecola laugh] to take care of all the sick animals. After a year of that, I suddenly said, 'Well, if I'm willing to stay up all night taking care of all these sick animals, why not take care of sick people?' [Glimcher laughs]
GLIMCHER: We're lucky that you changed your mind. And Cos, of course, you didn't grow up in this country.
IADECOLA: No. I was in born in a town, a rural town about 70 kilometers south of Rome called Aquino. And my father was a physician and I was sent to a classical school because that's what you do if you are a doctor's son. I got a lot of Dante and this and that, which I did not like particularly. [Fink laughs] We had a course, a physics course, which was the same course that was given to United States students. That really turned me to science. Then I went to medical school in the '70s when in Rome, there was a riot every other day. It was like a privilege to go to class. I went into neurology because there was a professor who just came who sent people abroad, you know, to the States, and that's how I got to New York, to Cornell, in 1980. And the rest, you know, is history.
GLIMCHER: Is history? [Iadecola laughs] Well, this has been terrific. I think you two of you are a dynamic duo and so critical that you work so well together. So, thank you for spending all this time with me and telling me about your thoughts and plans for the future of neuroscience and neurology at Weill Cornell.
FINK: We appreciate the opportunity ...
FINK: To have this extraordinary experience.
Posted April 8, 2013 3:20 PM | Permalink to this post
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