Summer 2007 Vol. V, No. 4
of Medicine and Medical Center: Deep Roots, Endless Skies
A Healthier Health Care System
By Emily Dorman
The rate of intermarriage within families, or consanguinity,
is as high as 60 percent in certain communities in the Middle East, resulting
in some of the worlds highest incidences of progressive neurogenetic
disease. Public concern of the risk factors and impact of these diseases
on families and society is growing in the region, and AUBs Abu-Haidar
Neuroscience Institute is providing an unprecedented level of care for
common, but potentially devastating neurogenetic diseases.
The Abu-Haidar Neuroscience Institute, which was established
in 2006, is bringing together state-of-the-art treatment, research, and
development in a uniquely patient-centered approach to neurological disease.
Efforts to involve patients and parents as partners in research and treatment
are also under way, and include the institutes participation in
establishing the Lebanese Muscular Dystrophy Association.
At the helm of this forward-looking institute is a woman whose ties to
AUB stretch far back into the past. Third-generation AUBite, Dr. Rose-Mary
Boustany has returned to Beirut after 26 years in America to chair the
institute, the first of its kind in the Middle East. As old AUB families,
both the Boustanys and the Abu-Haiders are dedicated to the same vision
of AUB and Lebanon at the forefront of medical care, education, and research.
Boustanys commitment to AUB and to medicine is an old one. The eight
years she spent at the University completing her Bachelor of Science in
biology and chemistry, her medical degree, and pediatric residency (1972-73
and 1979-80) were some of the most violent of Beiruts civil war.
We studied by candlelight for months on end, with bombs dropping
in the background, Boustany remembers. When the medical school contemplated
shutting down for safety considerations, she and many of her classmates
gave up their homes rather than their studies and moved into the basement
of the present medical school basic science building, sleeping on floor
mattresses to avoid the treacherous walk home.
In an institute where psychiatrists and neurogeneticists
work side by side, there is a much higher likelihood of arriving at the
correct diagnosis early in the course ofthe illness.
Boustany points to the recent improvements at the AUB Medical
Center as a testament to the Universitys endurance and progress.
Though there is some resistance to change, Boustanys objectives
and plans are firmly set and progress is underway. With a strong team
of outstanding specialists, she hopes there will be more programs at the
institute geared towards specific disorders. An active scientist herself,
she also hopes to expand the basic neurosciences, together with her colleagues,
building on the excellent programs already established by Drs. Afifi,
Bergman, Jabbour, and Saade. There is money in the Abu-Haider endowment
to fund the training of fellows at the institute. This past year the endowment
supported three adult neurology fellows; next year support is pledged
for a pediatric neurology fellow, a post-doctoral researcher, and a neurosurgery
The institute also seeks collaboration with complementary organizations
in the community. On May 3, 2007, AUB signed a memorandum of understanding
with the Nour Al Shorouk Center, one of a number of addiction centers
founded by Saudi philanthropist Tarek Ahmad Juffali. AUBs psychiatry
team will provide acute detox care and therapy, with psychologists and
social workers at Nour Al Shorouk supplying the vital long-term follow-up
and care that recovering addicts require. Boustany knows what shes
looking for: The road ahead is arduous and long, but I will acknowledge
progress when the number of patients receiving care increases, the numbers
of young faculty are rising, and more residents and students are attracted
to the neurosciences and psychiatry.
In addition to addressing complex common disorders, such
as Alzheimers, multiple sclerosis, epilepsy, brain tumors, back
pain and herniated discs, the Abu-Haider Neuroscience Institute is also
focusing on regional problems, such as fatal neurogenetic diseases that
result from consanguineous marriages. When two first cousins have children,
recessive genes that otherwise lie dormant have a much greater chance
of pairing with the same recessive genes in the spouses DNA. A closely
shared gene pool results in an increased incidence in brain and other
inherited disorders. Breaking the tradition of intermarriage will go a
long way towards lessening the burden of all inherited diseases on families
Because the diseases of consanguinity are genetic, they are often difficult
if not impossible to cure. Prevention is the key, says Boustany.
Even if the tradition of intermarriage proves strong, there are many alternatives
to having affected children with a spouse to whom you are related, or
indeed with any partner with whom there are genetic risks. Adoption, artificial
insemination, and the use of egg donors are popular options. With many
neurogenetic diseases, a diagnosis can be made in the very early stages
of pregnancy, even before the artificial implantation of an embryo. This
means that obstetricians need to react before it is too late, says
Boustany. It should be commonplace for your obstetrician to ask,
Are you related to your husband?
Luckily, increasing consanguinity awareness has proven to be highly effective
in treating other diseases. European Ashkenazi Jews, for example, are
at particular risk for developing Tay Sachs disease, an often fatal brain
disorder, due to their tradition of intermarriage. However, once this
risk was acknowledged, the incidence of Tay Sachs disease in the Ashkenazi
population decreased by 90 percent in just one decade. Involving
lay people is a huge priority for us, says Boustany. This is the
type of collaboration that Boustany is promoting at the institute with
parents, patients, doctors, media, and government working towards a healthier
population and an enhancedand healthierhealth care system.
Obstetricians need to react before it is too late.
It should be commonplace for your obstetrician to ask, Are you related
to your husband?
New in Neuroscience: the Raymond D. Adams and Maria Salam
Adams Neuroscience Library
Dr. Raymond Adams, who is known as the father of neurology,
and whose department has produced more than 200 professors, chairmen,
and chiefs of departments worldwide, is donating his valuable 4,000-volume
medical library to AUB on the occasion of the appointment of his former
student, Dr. Rose-Mary Boustany, as chair of the Abu-Haidar Neuroscience
Dr. Adams collection includes books on a wide range of topics from
psychology and psychiatry to neurology and neuropathology, and will be
a unique resource for medical students in all specialties. Adams has been
building the collection, which is currently at his home in Brookline,
Massachusetts, since his student days at the University of Oregon and
Duke University in the 1930s. I have tried to keep them (the books)
arranged according to subject matter, but they have never been catalogued.
AUB will have that arduous task!
Although Adams has been a teacher and mentor for AUB neurologists since
the 1960s, his connection to AUB actually began in the 1940s when AUB
graduate Dr. Fouad Sabra worked in Adams neuropathology lab at Boston
City Hospital. Sabra subsequently invited Adams to give the second annual
Wilder Penfield Lecture at MEMA in 1962. After that visit,
Adams recalls, I thought it would be very much worthwhile to help
in the training of medical students who wished to pursue an academic career
in neurology. Adams arranged to have a few of the brightest AUB
medical students train in his department at Massachusetts General Hospital
(MGH) where he became chief of neurology in 1951. I am gratified
that my liaison with AUB and the Neurology Department at MGH has produced
many talented neuroscientists and clinicians. In particular, I recall
Fouad Sabra, and later on his son Amin Sabra, Jean Rebeiz, Samir Atweh,
Mohammad Mikati, and of course Rose-Mary Boustany. I hope that there will
be many more in the future
Dr. Boustany spent five years with me
in Boston first as a resident in training at MGH, then as a research associate
at the Shriver Center. She was and is a gifted neuroscientist and it gives
me great pleasure to see her continue her research at AUB and achieve
such success in her medical career.
Throughout the 1960s and 1970s, Adams returned to AUB as a visiting lecturer
and participated in medical rounds at AUH. He also met his future wife
at AUBpediatric neurologist Maria (Zabnieska) Salam (MD 50),
originally from Poland, who settled in Lebanon and completed her undergraduate
and medical studies at AUB. She was a pediatrician at AUH specializing
in childrens neurology, and eventually completed some of her post-graduate
training in Boston before moving there permanently in the late 1960s.
In addition to serving as chief of the Neurology Service at MGH for many
years (1951-78), Adams also created the Department of Pediatric Neurology
at MGH, was the Bullard Professor of Neuropathology at Harvard
Some of my lasting impressions of AUB were its prominence and excellence
as an educational center for the entire Middle East, and the talent and
knowledge of individual medical staff and students. But I was most especially
impressed that AUB remained untouched and a safe haven during
the many years of strife affecting Lebanon, and continued to function
as an important asset to the Lebanese people and an American presence
in the Middle East.
Medical School, and founded the Eunice Kennedy Shriver Center
for Research in Mental Retardation. Eight universities worldwide have
awarded him honorary degrees, including the University of Louvain (Brussels),
the Karolinska Institute (Sweden), the University of Lausanne (Switzerland),
Newcastle University (Great Britain), the University of Brazil (Rio de
Janeiro), and Harvard University in Cambridge, Massachusetts. In 1977
he was given the rank of Knight of the Order of the Cedars of Lebanon
in recognition of the help he had given to many Lebanese AUB graduates
in furthering and facilitating their neurology training, both in Lebanon
and in the United States.
The Raymond D. Adams and Maria Salam Adams Book Collection
This fund will support restoration, archiving, conservation,
teaching, research, and dissemination of information related to this valuable
collection. For more information, please contact AUB Director of Development,
Dr. Deborah Chay, via e-mail (firstname.lastname@example.org),
or by calling her at 212.583.7675.