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Summer 2007 Vol. V, No. 4

Faculty 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 world’s 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 AUB’s 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 institute’s 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.

Boustany’s 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 Beirut’s 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 University’s endurance and progress. Though there is some resistance to change, Boustany’s 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 resident.

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. AUB’s 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 she’s 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 Alzheimer’s, 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 spouse’s 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 and society.

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 enhanced—and healthier—health 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 Institute (AHNI).

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 AUB–pediatric 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 children’s 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 Fund:

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 (chay@aub.edu.lb), or by calling her at 212.583.7675.