September 26, 2018

Jerry L. Nadler, MD

Eastern Virginia Medical School
Vice Dean of Research, Harry H. Mansbach Endowed Chair in Internal Medicine

Jerry L. Nadler, MDAlthough there were no physicians in his family, Dr. Jerry Nadler remembers always being interested in science and medicine. “Actually, my Uncle Sam influenced me,” he says. “He had what we today call Adult Onset Type 1 Diabetes. Growing up, I saw all the problems he had: heart attack, circulation problems in his leg, all of it. His mind was always sharp, but his body gradually had all of the complications of diabetes.” It made an impression.

In college, he got excited about a research project in endocrinology, an interest that became solidified when he went to medical school. His family had moved to Florida, so he chose the Miller School of Medicine at the University of Miami. Between his first and second years, he had the opportunity to work with Dr. Daniel Mintz, the founding Scientific Director and Chief Academic Officer of the Diabetes Research Institute. “He was a visionary,” Dr. Nadler remembers. “I was doing islet cell transplants in animal models to reverse diabetes. It was the first time that had been done. That’s when I decided I wanted to go into internal medicine, with a focus on diabetes.” He was hooked on research, he says, a theme that has informed his entire career.

He did his internship and residency in internal medicine at Loma Linda University Medical Center, and specialized endocrinology training in research at the University of Southern California. He did extra work at USC, funded by the National Institutes of Health and the American Heart Association. “That’s where I got my dual interest in heart disease and diabetes, and how to reverse diabetes,” he says.

Dr. Nadler stayed on at USC as tenured faculty, but when word came that the City of Hope Medical Center in nearby Duarte was looking for a director to build up its diabetes program, he enthusiastically took the position. “When I got there, there was one nurse, one full-time and one part-time doctor,” he recalls. “It was a real opportunity to focus on research.” Over the next nine years, and with the support of a local philanthropist, the program grew into a major diabetes center, and is today considered one of the most influential diabetes research programs in the world.

The next call came from the University of Virginia, asking him to head up the diabetes and endocrine division. The Nadlers were enjoying California, and said no to the offer three times. “But the offer got better and better, so we came to Charlottesville,” Dr. Nadler says. “We were there nine years, and during that time, the endocrine division was listed in the Top Ten in the country almost every year. We were No. 5 one year, ahead of Harvard and other programs.”

But the Nadlers were used to a big city, and missed the water. So when Dean Gerald Pepe called saying he needed a Chairman of Medicine and someone to head EVMS’s diabetes center, Dr. Nadler was very excited. “I’m going on my sixth year,” he says, “and I’m still excited about the work we’re doing at EVMS.”

During that time, a number of world-class physicians and endocrinologists have been recruited, including both Dr. Joseph Aloi and Dr. David Lieb. While there is a national shortage of endocrinologists, EVMS has doubled the size of its endocrine fellowship. Because there are so few endocrinologists, Dr. Nadler points out, most diabetes patients are cared for by family doctors and primary care physicians. “Here at EVMS, we see the most difficult patients, some of whom go on insulin pumps,” he says. “We’re very happy to partner with general practitioners in caring for them, because of the severity of their disease.”

Research remains his passion. The Diabetes Institute is involved in several studies he finds very exciting, particularly those dealing with reversing diabetes. “We’re working on research now to reverse Type 1,” he says. “We can do it in mice, but we can’t yet do it in people.” It would require stopping the body from destroying its insulin cells, because even if these cells could be regenerated, the body would simply try to destroy them all over again. “I am very fortunate to be collaborating with a wonderful physician scientist, Dr. Yumi Imai, who just got a grant from the state to use a combination approach, using one compound to regenerate cells and another drug to stop the immune system from destroying them,” Dr. Nadler explains. “The goal is to start doing that in the animal model, and if it works well, we can move it up to the clinic. It’s exhilarating.”

He’s working on another grant studying the causes of the tremendous increase in heart disease and heart diseases related death among diabetics. Another grant seeks to identify a virus that might be one of the triggers of Type 1 diabetes, which might ultimately lead to the development of a vaccine.

Despite the grim statistics (“we’ve already exceeded the number of diabetics estimated for the year 2025,” he notes), Dr. Nadler is hopeful that as the country moves into a new health care era, focusing on prevention and lifestyle change and being rewarded for that – and with continued vigorous research – “We might be able to stem the tide.” In the meantime, he and his colleagues offer a great opportunity for the people of Hampton Roads: “We do outreach, we do prevention, we try to reverse disease,” he says, “and we provide exceptional treatment for the diabetic patient.”

David C. Lieb, MD

Eastern Virginia Medical School
Associate Program Director, Endocrinology and Metabolism Fellowship

David C. Lieb, MDWhen Dr. David Lieb meets diabetic patients at their initial visit, one of the first things he tells them is that he understands what they’re going through. Those aren’t just empty words: Dr. Lieb was diagnosed with Type 1 diabetes when he was 12 years old, and has been dealing with the disease ever since. “I was always a husky kid,” he says, “and I started losing a lot of weight. I was drinking a lot of water, and urinating with increasing frequency.” While he and his mother were delighted with his weight loss, his father – a practicing dentist who had taught anatomy at MCV – suspected something wasn’t quite right. “My dad had done research on diabetes,” he says, “so he made sure I was tested.” There was no significant family history of the disease, just one great uncle with Type 2 diabetes.

But the tests confirmed his father’s fear: David had Type 1 diabetes, the less common, auto-immune form of the disease in which the body recognizes its own insulin-producing beta cells as foreign, and attacks them. The year was 1989.

It wasn’t necessarily the diagnosis that led Dr. Lieb to a career as an endocrinologist. He’d always been interested in science because of his father’s influence. He majored in cell biology at the University of Maryland, where he was exposed to research as a summer student at the National Institutes of Health. He earned his medical degree at the University of Virginia in 2003, where he first met Dr. Jerry Nadler. “I wasn’t just his student there,” he explains, “because of my diabetes, I was also a patient.”  He did both his internship and residency at Oregon Health and Science University before returning to UVA for a fellowship in endocrinology.  “Because endocrinology deals with hormones, which affect every part of the body, I knew I’d get to work with many different health care providers,” he says. “That appealed to me.”

As a graduating fellow, Dr. Lieb recalls the email he received from Dr. Nadler, who had come to EVMS and had an opening in the clinical educator program. Eager to work with his medical school mentor – and to work in an atmosphere that would welcome a clinician who also wanted to teach – Dr. Lieb joined the EVMS staff in 2009, reuniting with his mentor as well as with Dr. Aloi, another recruit from UVA.

Today, Dr. Lieb splits his time between caring for patients in all stages of diabetes, teaching, and researching the effects of bariatric surgery on Type 2 diabetes. “We have good therapies for diabetes,” he says, “but nothing works as well as weight loss and dietary changes. Research shows that bariatric surgery is one of the most effective treatments for Type 2 diabetes. The data are striking, and now, both the American Diabetes Association and the American Association for Clinical Endocrinologists mention bariatric surgery in their guidelines for the management of diabetes.”

Dr. Lieb is optimistic about the vast research being done at EVMS, but responds cautiously when patients ask about the possibility of cure. “I remember when I was diagnosed, somebody came into my hospital room and said, ‘don’t worry, there’ll be a cure in ten years.’ Twenty-five years later,” he says, “the technology for managing the disease is worlds different, with wearable sensors that measure blood sugar and pumps that can distribute insulin” – but he emphasizes that diabetes remains a chronic disease that patients have to learn how to live with.

He has reason to be concerned about a cure: as the father of three sons, Dr. Lieb knows that their risk of developing Type 1 diabetes is five percent greater than if his wife had the disease. “There’s something about the Y chromosome,” he says. “We don’t yet know why.”

But a healthy lifestyle can influence the outcome of every diabetic, he tells his patients. Dr. Lieb introduces them to the concept of mindfulness about their diet, their exercise habits and how they deal with stress. “There’s data that these things can really help with blood sugars,” he tells them.

That’s a message he shares with the students he teaches, in addition to their regular medical curriculum. He gives them another piece of advice, as well: choose your study partners wisely. In medical school, he says, he was paired with a fellow student named Emily White. “Emily and I studied together, and worked on projects together, and I fell in love,” he says. Today, Dr. Emily Lieb is a family practitioner working in the Bon Secours system. She sees patients and is the medical director of the Hampton Roads Care-A-Van Mobile Free Clinic.

 

Joseph A. Aloi, MD

Eastern Virginia Medical School
Associate Professor and Director, Strelitz Diabetes Center

Joseph A. Aloi, MD“I didn’t grow up thinking I’d be a physician. It was the furthest thing from my mind,” Dr. Joseph Aloi says, explaining, “I hated doctors when I was growing up.” He had good reason: as a dutiful grandson and nephew, he routinely drove his grandmother and aunt to various medical appointments as they each dealt with debilitating diseases. “I saw the way they were treated by their physicians,” he remembers, “and it gave me a real dislike for the profession.”

A self-described ‘nerdy science guy’, he was the first member of his family to go to college. During his freshman year at the University of Maryland at College Park, he got a job working in a lab at the National Institutes of Health, which piqued his interest and convinced him to pursue a PhD in pharmacology. At one point, he was running the chemistry lab, and loving the work, when one of his mentors, Dr. Thomas Insel, suggested he apply to medical school. “He knew I wanted to do clinical research,” Dr. Aloi says. “His reasoning was that as a PhD, I’d always need to partner with an MD, but if I became an MD, I could lead the research myself.” That might have been the end of it had Dr. Insel not cornered Dr. Aloi’s mother at a Christmas party and told her she needed to ‘make him go to medical school.”

He took the MCATs, and was invited to interview at George Washington University. “I was a full-time chemist with NIH at the time, and they offered to help me with loan applications,” he says, “and my family was extremely supportive.”

At George Washington, he continued to work at NIH, and ultimately found his niche in endocrine and diabetes. “There’s the challenging scientific part, learning how insulin functions in people and how to manage it,” he says, “but because it’s a chronic medical problem, I get to see patients regularly throughout their lives. I become a member of their family.”

Because he treats these patients in all stages of their disease, he says he’s not above using those personal relationships to blackmail them into doing the right things. He recently did a seminar at a diabetes conference on motivation. “My piece was obesity management,” he notes. “I reminded the students, ‘you have to know that what’s right for one patient isn’t right for another. You have to know how to interact with patients.’”

He’s had ample opportunities to interact with patients from all across the Commonwealth during the screenings the Strelitz Center regularly conducts, particularly for those in under- or unserved communities. For many years, Dr. Aloi and his colleagues have worked in the Western Tidewater Health District, dealing with people in every stage of diabetes. They’ve conducted community-based screenings, funded by the Obici Healthcare Foundation, where they’ve found 20 to 50 percent of the people are either diabetic or pre-diabetic.

The reception has been surprisingly good, especially in Suffolk, where more and more people are coming to understand the dangers of diabetes. “They have people in their families on dialysis at age 40 and 50, and they don’t want that for themselves,” Dr. Aloi says. “When we tell people how they’re at risk, they’re motivated to make some of these small changes, even if it’s just reducing the amount of sugary drinks they have each day. And we’re having extraordinary results with a telephone intervention tool that Phyllis Woodson, our Certified Diabetes Educator, developed. Knowing someone’s going to hold them accountable works – and we’re able to collect information that aids research.”

All tolled, he estimates, as many as 3,500 people in Virginia have been screened thus far. Often, they’re surprised to learn that they’ve been diabetic for many years. That might change if the hemoglobin A1c test were a standard part of a general physical exam, Dr. Aloi believes. “I’d fashion something similar to the cholesterol test,” he says. “Everyone knows their HDL and LDL numbers today. If we routinely gave them their A1c numbers too, they’d know what they needed to act on.” Dr. Aloi currently serves on committees of several national organizations that favor including the A1c in a general exam. “I think the time is right,” he emphasizes. “The cost is only a few dollars. We now have point-of-care testing, which gives a result in 90 seconds. Family or personal history also predict risk: someone who is African American, overweight and has a family member with diabetes is at very high risk for pre-diabetes or diabetes.”

To update physicians and medical students on the work being done in diabetes, Dr. Aloi and his team at Strelitz have developed a web-based Continuing Medical Education learning tool for EVMS, entitled Practical Management of Diabetes: A four part module. The series of four CDs offers modules on the evolution of diabetes (two sections), treatment of diabetes with oral agents and treatment with injectables. “It’s free online content at the EVMS website,” Dr. Aloi says, “and it’s good for two more years.”

When he isn’t waging a hands-on, research-based war against diabetes, Dr. Aloi faces another uphill climb – literally. A couple of times a year, he grabs his ice axe and crampons and approaches the world’s highest mountains. Lobuche, Kilimanjaro, Rainier, Machu Pichu – he accepts their challenge with equal fervor.

Thomas Manser, MD

Manser1Thomas Manser wasn’t anticipating a career in medicine when he enrolled at the University of Michigan at Ann Arbor to study chemical engineering. He’d never envisioned himself as a physician, although he was always interested in becoming a scientist. But while he was an undergraduate, he had the opportunity to do some volunteer work at the walk-in clinic in nearby St. Joseph’s Hospital and recalls, “I found that I really enjoyed it.  I liked the work itself, and of course, I enjoyed the scientific aspects of medicine.”  He started going to the clinic one evening a week, doing basic tasks like checking patients in and taking their blood pressure.

He found he admired the physicians who were working at St. Joseph’s, and soon began looking at them as role models.  “These were guys I wanted to be like,” Dr. Manser remembers, “some of whom have gone on to be real leaders in the area of internal medicine.”  And ever practical, he found himself drawn to the flexibility of medicine in terms of finding a good job in an appealing location.  “Medicine seemed more portable than chemical engineering,” he says.  “As a physician, I knew I could potentially go anywhere – I couldn’t think of any place in the country that didn’t need doctors.”

And in the long run, internal medicine may not differ that much from chemical engineering, at least philosophically.  Chemical engineers must apply a knowledge of chemistry in addition to other engineering disciplines – and are sometimes referred to as ‘universal engineers’ because their scientific and technical mastery is so broad.  Similarly, the internist is trained to deal with any problem an adult patient brings, and, according to the American College of Physicians, specifically trained to solve puzzling diagnostic problems and handle severe chronic illnesses and situations where several different illnesses may strike at the same time.

Dr. Manser earned his medical degree from Michigan State University, followed by an internship in internal medicine at Henry Ford Hospital in Detroit, and a residency at EVMS. He liked the variety of opportunities within medicine.  “When you start out as a doctor, you can take care of all kinds of people,” he explains, and “there are other roles as well, administrative roles, roles as teachers – all of which is a significant part of what I do today.”

Indeed, today Dr. Manser not only maintains a robust practice as a member of the Internal Medicine-Primary Care group at EVMS, he’s also the Oscar Edwards Distinguished Professor of Internal Medicine at the Medical School. He also serves as an administrator as well – Chief of the General Medicine Division, a position he describes as “helping recruit new faculty, making sure the schedule works out and coordinating things in the office practice.”

Part of that coordination involves working with sixteen very busy physicians, six of whom are hospitalists – internal medicine physicians who practice only inpatient medicine.  That number will soon grow to nine, in order to accommodate the increasing need.  As Chief of General Internal Medicine, Dr. Manser also has indirect responsibility for a number of important EVMS programs staffed by his faculty members, including the sickle cell clinic, two residency programs and the outpatient clinics that care for indigent care patients.  “It’s part of our mission to care for these individuals,” he says. “So we are routinely seeing patients from the very well off to those with no virtually no resources whatever.”  He’s quick to add, “I like that.  I like having a spectrum of patients.  We like being able to care for people of all socioeconomic levels, all genders, all races, etc.” It’s not as burdensome as it might seem, he says, because, “In our group, we all work together – we’ve got a very democratic group.”

It makes for a full and diverse schedule, which includes hospital rounds as well.  “Those of us who are not hospitalists still rotate periodically seeing inpatients,” he explains, “so in one month, I may have a weekend in the hospital, and the next month, I’ll be there every morning, but still maintain outpatient responsibilities as well.”

It’s an exhausting schedule, but you wouldn’t know it from the way Dr. Manser chooses to spend his rare leisure time.  He’s been an avid road cyclist for more than a decade, and this spring, he’s participating in the 65-mile Tour de Cure, a fundraiser for the American Diabetes Associates – part of the Strelitz Diabetes Center Team.  He’ll be riding with his partner, Dr. Mark Flemmer, under the banner of team captain Dr. Joseph Aloi.

Dr. Manser has received several honors throughout his career: he has been named a Top Doc by Hampton Roads Magazine and also US News and World Report.  He was named Outstanding Faculty Member by the EVMS Combined Family Medicine/Internal Medicine Residency Program in 2003.  He was chosen to serve as the American College of Physicians Virginia Chapter representative for the 1999 Leadership Day on Capitol Hill.  He received the Golden Flea Award and the Sir William Osler Award, both presented by EVMS internal medicine residents and students to outstanding attending physicians.

But if you ask him which honors he has cherished the most, he will very likely begin the list with the Manser Fund for Excellence in Internal Medicine, a fund established by grateful patients at EVMS whose lives and families he’s touched.