A wise man once said, Do not tell people your problems.
Half of them do not care and the other half are actually glad
you got them. Health care in Boston continues to pose challenges
similar to those probably experienced by each of you.
I will not dwell on the problems, because I think they are far
overshadowed by our progress. The academic medical centers
have unique challenges due to decreased funding for research
and education. It is still unclear path as to the impact of the
Massachusetts Health Care reform bill. All of the academic
medical centers have adapted a strategy of forming satellite
facilities and we are no exception. While these are convenient
for patients and can add efficiencies hard to reproduce in the
academic Medical Center, they also cause both internal and
external challenges. We are now on five different campuses and
soon will increase to a sixth. Our Faulkner Hospital Unit continues
to grow and, in fact, represents the greatest growth in
our program. Dr. Michael Wilson continues to be chief of that
program. We have opened four new operating rooms outfitted
with state-of-the-art orthopedic arthroscopic cameras and video
systems. We have also just moved into new operating room
facilities at the main campus. For those of you who remember
rooms 11 and 14 where a hip revision, major trauma or spine
set up would take every square inch of the room, these new
rooms are very spacious. As the Brigham has opened the Carl J.
and Ruth Shapiro Cardiovascular Center with several new operating
rooms, we have taken over the old cardiovascular suite.
These rooms have been refitted for orthopedics and will give us
an operating suite that is light years ahead of our old facilities.
One of the challenges of satellite facilities is not only moving
surgeons and support staff around the Greater Boston area,
but also interacting in a positive way with other colleagues at
the local hospitals. It is clear that we will do best to integrate
with and complement these hospitals and surgeons rather than
try to compete. I am sure that these are similar problems faced
throughout the country.
As our Hand Service has grown
there has been a need for an additional
surgeon. Following a national search
we are pleased that Dr. George Dyer,
a recent graduate of both the Harvard
residency and the combined Harvard
hand fellowship will be joining our
staff. I have had the pleasure of knowing
George since medical school and
he has lived up to the high expectations that many of us had
formed. George will also be working at the West Roxbury VA
Hospital. This unit is led by our colleague, Dr. Tamara Martin,
and Georges addition, both in hand, upper extremity and
trauma will be invaluable.
Georges hiring is something that Barry Simmons and
the rest of the hand group have been working on to mollify
the increased demand. Unfortunately, this became even more
acute with the illness of our colleague, Dr. Mark Koris. Many
of you know about Marks illness. I am pleased to report that
he is making good and steady progress. I spoke recently to his
wife Francine and with their permission, I reporting that Mark
is on medical leave due to problems stemming from longstanding
hypertension. He has had an extensive rehabilitation and
is now walking with a walker. His speech is much improved
and his speech therapy is almost completed. Mark and family
will spend the summer in Ipswich at their summer house as
it is on a single floor. He will be there probably through the
summer and early fall and then we will return to Brookline for
continued therapy. I know that he would love to hear from his
old friends, but we are not sure where he will be over the next
several months. You can send your well wishes to the office. We
all wish Mark a speedy recovery.
Our second recruit is Dr. Kimberly Thurmond. Dr.
Thurmond will be working with Dr. James Ioli to help with the
increased podiatric need in the department. She is also a great
addition to the staff.
BWH ORTHOPAEDIC DEPARTMENT
As I review the various aspects of our clinical research and
education programs, I will try to be brief and give you an overview.
Our strategic plan over the next three years is to achieve
a better balance of the three legs of the academic stool, namely,
clinical activities, research activities and educational activities.
I will discuss each as well as to define a restructuring of our
administrative organization to help with this balance.
Administrative organization: Mr. Tom Gakis continues to
be our administrative director, Jenny DIsola as my executive
assistant is the integrator and quarterback for the department.
As I have assumed the additional role as Chairman of the
Executive Committee for the Harvard Combined Orthopedic
Residency Program, it also has added an additional burden
to Jenny. As we have grown and restructured our divisions,
there is growing responsibility at the Division Chief level. This
includes resource allocation, fellowship and student training,
resident education and budgetary issues.
Adult Arthroplast y Service:
After serving as head of the Adult Arthroplasty Service for
many years, Dr. Richard Scott electively stepped down from this
position though he maintains a very active clinical and teaching
practice. He still runs a weekly conference for the residents
and fellows and it continues to be one of the most popular of
conferences. We also still have the Roberts Conference on
Thursday mornings, which is an interactive clinical case discussion.
I usually run this conference and we would welcome any
interesting cases submitted in PowerPoint presentation. We
have often taken one specific case to add as a separate article
to this journal.
The new Chief of the Arthroplasty Service is Dr. Daniel
Estok. Dan continues to be a leader in revision surgery. During
their exit interviews, the fellows find that their experience with
Dan Estok assuages some of their fears in approaching difficult
hip revision cases. Our current fellows will be going to great
practice opportunities, Brandon Feeney will be returning to
the Salt Lake area, Dr. Mike Laker will be going back to Detroit
and Kathleen Hogan will be practicing nearby in Concord, New
Hampshire. We continue to have an active international fellowship
program, which is a complement to our educational
I am pleased that the Arthroplasty Service continues to be
a mainstay of our program reflecting our history at the Robert
With the addition of Dr. Christopher Bono as Chief of
Spine our program with Chris, Mitch Harris and Greg Brick
is extremely active. Moreover, they have been very active in
clinical research and in integrating with our basic science
departmental researchers. I have recently reviewed the nearly
20 papers written from that unit and our clinical program continues
to grow. There is a Brigham based unit for complimentary
medicine under the direction of Dr. David Eisenberg at our
850 Boylston campus. This is a well-funded, evidenced based
program that includes complimentary therapies for the nonoperative
management of patients with back pain. Moreover,
we continue to have a nonoperative spine unit predominantly
based in rheumatology and are working with our neurosurgery
colleagues as they expand their program.
Dr. Bono reports The Orthopaedic Spine Service at BWH
has continued to have multi-faceted growth over the past
year. In addition to its clinical productivity, which continues
to increase at a steady pace, the Spine Research Division has
witnessed remarkable achievements. Under the excellent coordination
of Natalie Warholic, the Spine Division has six IRB
protocols that are currently approved, in progress, or recently
submitted. These research projects vary from multi-center
prospective evaluations of spinal cord compression from metastatic
disease, degenerative spine conditions, and spinal trauma
to retrospective evaluations of C2 fractures in the elderly and a
comparison of anterior cervical discectomy and fusion with a
titanium cage versus allograft.
The past year has seem a number of projects completed,
presented, and on the path to publication. Spearheaded by
Dr. Michael Glotzbecker and guided by Dr. Bono, the Research
Division has produced a series of extremely worthwhile studies
regarding DVT prophylaxis after spinal surgery. In one study, a
nationwide survey of spine surgeons DVT prophylaxis practices
for high-risk tumor or trauma patients was performed, which
has been presented both nationally and internationally and
has been accepted by Spine. In another study, a systematic
review of the worlds literature on this topic was performed.
Also presented nationally and internationally, this paper has
been selected to appear in a special issue of Spine focusing on
highlights from the recent annual meeting of the International
Society for the Study of the Lumbar Spine in Geneva,
Switzerland. In the past year, Dr. Harris and the Spine Research
Division completed an exquisitely important paper regarding
mortality rates in elderly patients after cervical spine fractures.
In its final stages of manuscript preparation, this work was
awarded Best Resident Research Study at the last Cervical
Spine Research Society annual meeting in San Francisco. Also
under Dr. Harris guidance, Dr. Joe Simon has completed an
important study assessing the differences in radiologists and
spine surgeons clearance of the cervical spine using CT.
This paper has already been submitted for publication. Now in
the final stages of data analysis, Natalie Warholic and the Spine
Research team have completed a multi-disciplinary PRIDE
project, with critical participation from Drs. Jeff Katz and Elena
Losina, nicknamed PIPAC, which assessed pains influence on
patients acceptance of complications following lumbar spinal
surgery for low back pain.
In addition to the BWH collaborative projects described
above, the Spine Research Division has seen a great many individual
project achievements as well. In the 2008 calendar year
thus far, Dr. Bono has published eight peer-reviewed articles
in prestigious journals such as Spine, Journal of Bone and
Joint Surgery American, and Journal of American Academy of
Orthopaedic Surgeons on a variety of topics. Notwithstanding
his publications about orthopaedic trauma, Dr. Harris thus far
published four excellent peer-reviewed articles in 2008 on spinal
topics in such journals as New England Journal of Medicine,
Spine, JAMA, and Clinical Orthopaedics and Related Research.
Beyond peer-reviewed projects, Dr. Bono has just launched production
of a new textbook of spinal surgery entitled Prove It,
which is a practical guide to evidence-based decision-making
for common spinal conditions.
The combined BWH-MGH Spine Surgery Fellowship has
just begun its second year, under the direction of Kirkham
Wood, MD and Christopher Bono, MD. The fellowship celebrated
the graduation of three outstanding fellows this past June.
The new fellows have begun training as of August 1, 2008 and
show equal, if not more, promise both clinically and academically.
Above the excellent local reputation that the fellowship
has gained since its inception, it is becoming increasingly recognized
on a national basis as well.
Musculos keletal Oncology
With the addition of John Abraham, the Sarcoma Program
has experienced rapid growth. Division Chief Dr. John Ready
continues to be active both in his oncology role and arthroplasty
roles. The Dana-Farber recently prepared their semiannual
report to the Brigham Chiefs and the musculoskeletal
sarcoma program was one of its highlights. The strong relationship
between the Brigham and Womens Hospital and the
Dana-Farber has been a great plus for both institutions.
Foot and Ankle Service
When Dr. Mike Wilson became Chairman of Orthopedics
at our Faulkner Department, Dr. Chris Chiodo assumed the
role as Division Chief of Foot and Ankle. Chris has also been
president of the Massachusetts Orthopedic Association and is
increasingly active in regional and national issues concerning
foot and ankle.
The Foot and Ankle Division remains extremely productive.
Patients are now seen at the main campus and all three
satellites. With continued clinical growth, we are proud to
announce the addition of two new members to the team. Dr.
Eric Bluman, MD PhD, will be on board within the year. Eric
comes from Tacoma Washington, where he is Chief of the Foot
and Ankle Division at the Madigan Army Medical Center. Eric is
very active in the American Orthopedic Foot and Ankle Society
(AOFAS) and has a strong commitment to academic research.
Also joining Dr. Jim Ioli in Podiatry is Dr. Kimberly Thurmond,
DPM. Dr. Thurmond was previously with Healthdrive Medical
in Newton and will be seeing patients at the main campus.
The Foot and Ankle Division also remains committed to
our academic mission. Drs. Chiodo and Wilson have presented
their exciting basic science research on the quality of autologous
bone graft at both the AAOS and AOFAS annual meetings.
Additionally, they have presented clinical research on peroneal
groove deepening and have served as moderators for several
scientific sessions and symposia. This fall, Dr. Chiodo will also
serve as Chair of the AOFAS Complete Foot Care Course.
Dr. Barry Simmons as Chief of the Hand Service will be
honored this year by the Massachusetts Arthritis Foundation
with a Marion Ropes Award recognizing his many years of
patient care and education in the field of arthritis. As I mentioned
last year there was a successful 25th reunion of the Hand
fellowship which has trained many outstanding graduates who
have assumed leadership roles throughout the country. We
are hoping that many of these individuals will be returning to
honor Dr. Simmons this fall. Dr. Phil Blazar continues to run
our Ethics and Quality Control programs. Dr. Brandon Earp
is the orthopedic liaison to our Physician Assistant Program.
We now have 12 physicians assistants who are essential to our
patient care activities.
The Sports Service is headed by Dr. Larry Higgins. He
also heads the Brigham component of the Partners Shoulder
Service. The Shoulder Service per se will be covered in a separate
Partners section, as it is co-run by Dr. Higgins and Dr. J.P.
Warner at the Massachusetts General Hospital.
One of the difficulties that we have had and continue to
have is that some of our surgeons crossover amongst the divisions.
Dr. Tom Minas has successfully maintained the sphere
of influence in the prearthroplasty adult reconstructive arena.
He still performs over a 100 osteotomies a year and has been
doing unicompartmental, bicompartmental, tricompartmental
and patellofemoral arthroplasty in younger patients with isolated
osteoarthritis. As director of the Cartilage Repair Center
he is one of the leaders in autologous chondrocyte implantation,
OATS procedures and other forms of mosaicplasty. Their
data registry is a source of numerous clinical papers and will
enable us prospectively to ascertain the long-term efficacy of
these procedures. Dr. Andreas Gomoll, who is a graduate of
this laboratory, the Harvard Orthopedic Program, and a fellowship
at Rush in Chicago has been a great addition to the Sports
Program and the Cartilage Repair Center. He is busy clinically
particularly in the knee and the shoulder and has taken an
active role in cartilage repair. Dr. Gomoll has been very productive
academically and is clearly one of the stars of the future.
With the integration of the Cartilage Repair and Partners
Shoulder Service in the Sports Medicine Division, this has
become one of our largest groups. Dr. Scott Martin runs a very
active program in sports medicine. As he is dually trained in
sports medicine and arthroplasty, he has a unique perspective
in dealing with the transition in the ageing athlete.
The Sports Program has become actively involved in the
area of High School Athletic programs and we are increasing
this program to care for an ever increasing demographic.
The prototypic success model of the Partners integration
has been the Partners Trauma Service under the direction of
Mark Vrahas as the Partners chief, Dr. Mitch Harris as the BWH
Trauma Chief and Dr. Malcolm Smith as the MGH Trauma
Chief. As this is a truly integrated unit, it will be presented in a
separate section of this report.
The BWH Orthopedic Department continues to be active
in both fellowship and resident education. As you will see from
Dr. Herndons report there are many changes going on in the
Residency Program including a change in residency director.
The executive committee has a shortlist of candidates who each
has significant experience at the level of the RRC, as a program
director and/or a director of a residency training program. We
feel that any of these candidates will be capable of carrying on
the positive changes made under the tenure of Jim Herndon.
Dr. Herndon will have reviewed, in his section, the results of
resident survey and a retreat that has led to significant changes
in the program. The major change is that we have lengthened
rotations so that there will be more continuity between resident
and attending. This has been facilitated by the growth at
the institutions that allows parity in training. While there is
a downside of the fact that not every resident is able to work
with every attending, it is the residents council and the executive
committees feeling that the educational experiences will
be similar. The other challenge at all of our institutions is the
fact that we are all going to satellite units. This poses logistical
problems in resident education. Finally, it is essential that we
comply with the resident work hour restriction and be certain
that it does not diminish from the educational opportunities
for each resident.
A manifestation of the success at the Brigham and
Womens Hospital has been that five of the last six Golden
Apple awards have been given to individuals affiliated with the
Brigham. The Golden Apple is an award given each year by the
residents to an attending, who they feel has been outstanding
in their education. Our other challenge is to maintain a balance
between resident and fellowship education. We think that it can
be synergistic but must be careful that the requisites of each of
these training programs are met. Finally, we still have an active
program in medical student training both from our Harvard
students and visiting students. While, as at most institutions,
this is most intense prior to the deadline for residency application,
we are actively pursuing students at earlier levels to ignite
an interest in orthopedics. The leadership of the early medical
student education has been assumed by Dr. Charles Day at
the BIDMC with active participation from all members of the
Combined Program Orthopedic Departments.
Many of the old graduates remember fondly the six month
chief residency and felt that its demise would be a long term
determent to the program. I was one of those skeptics but it has
evolved to be even better. The PGY-5 trauma service is akin to
the old chiefship. Each institution has an administrative chief
resident whose role is integral in the training program.
The orthopedic research continues to be stratified into specific
areas. We are integrated as the musculoskeletal line in the
Brigham Research Institute and there are many opportunities
for interdepartmental and translational studies.
Skeletal Biology Research Laboratory
The Skeletal Biology Research Laboratory studies basic,
clinical, and translational aspects of skeletal pathophysiology,
skeletal cell differentiation, effects of age and vitamin D status
on bone physiology, mechanisms of chondro/osteoinduction,
and tissue engineering approaches for skeletal regeneration.
The groups original basic research publications in the past year
include reports on a new model in which nicotine is used to
impair distraction osteogenesis in rats, intrinsic effects of age on
human marrow cells and their differentiation to osteoblasts, and
uses of porous collagen scaffolds for tissue engineering. Clinical
research publications concern the importance of vitamin D in
fracture care pathways and the finding that hip fracture patients
with greatest deficiency of vitamin D showed significantly more
falls and poorer muscle function in the year following the fracture
than did patients with better vitamin D status.
Drs. Chris Bono, Chris Chiodo, Mitch Harris, Larry Higgins,
Tom Thornhill, Mike Wilson, and John Wright are active surgeon
members of the Skeletal Biology Research Laboratory.
Current research is funded by NIH grants, BWH Biospecimens
Pilot Awards, and the OREF. Ongoing basic science work concerns
the mechanisms of skeletal aging, effects of age on cell
signaling, bone cell differentiation with post-mortem biospecimens,
effects of vitamin D status on marrow cell differentiation,
and vitamin D metabolism by human marrow cells. Tissue
engineering research involves the regulation of chondrocyte
and osteoblast differentiation, optimization of the Mizuno tissue
bioreactor, and mechanisms of actions with differentiation
agents to enhance histogenesis. Translational and clinical
research continues our multidisciplinary program to improve
follow-up management of osteoporosis in fragility fracture
patients, expand fracture pathways with other in-hospital
caregivers, the effect of fracture on circulating pre-osteoblasts,
regional differences in quality of bone grafts, the natural history
of osteoporosis in patients with osteoarthritis, the pathophysiology
of rotator cuff arthropathy, and impact of medications in
vivo on marrow biology in vitro.
Joe (Shuanhu) Zhou, Ph.D. received two competitive,
prestigious honors this year. He was selected as one of the
very few young scholars invited to participate in the weeklong
Buck Institute Summer Training Course in Experimental
Aging Research in Seattle. He was also selected to participate
in the highly-competitive National Institute on Aging Summer
Institute on Aging Research, held for one week at the Aspen Wye
River Conference Center in Queenstown, MD. Each of these
intensive programs identifies outstanding young investigators
with interest in modern biogerontology and exposes them to
the breadth and depth of knowledge needed for developing successful
careers in clinical, basic, and translational research in
aging. Joe was able to network and share his recent discoveries
about human skeletal aging during those programs.
Dr. Glowacki continues to serve the department as representative
to the BWH Biomedical Research Institutes Research
Oversight Committee, Co-Chair of the BWH Musculoskeletal
Research Center of Excellence, and as Professional Standards
Officer for BWH Research Staff. She is a member of the NIH
review panel for Musculoskeletal Tissue Engineering, advises
NASA and the FDA, and is on the Ethics Advisory Committee
of the American Society for Bone and Mineral Research, after
serving as its co-founder and chair for 4 years.
Center for Molecular Orthopedics
Dr. Keith Crawford reports Since the establishment of the
Center for Molecular Orthopedics (CMO) in 2000, the Chairman
has continued fostering cutting-edge research, which improves
our understanding of Orthopedic diseases. The CMO focuses on
gaining a better understanding of the molecular mechanisms
associated with Osteoarthritis and the development of gene
and cell-based therapeutics for the repair and regeneration of
damaged tissues. Our research, focusing on the joint milieu,
has uncovered a small population of mononuclear cells in
Osteoarthritic patients. Within these cells exist subsets possessing
regenerative properties. Molecular analysis of these subsets
has enabled us to identify dominant molecular pathways,
modulating during disease progression. These finding have
allowed us to identify an inflammatory cytokine profile unique
to Osteoarthritis. In addition, these studies have uncovered a
number of proteins, which may be of interest for therapeutic
modulation of Osteoarthritis.
Biomechanics, Biomaterials and Nanotechnology
Dr. Anuj Bellare reports In this academic year, our laboratory
has developed several new processes to fabricate joint
replacement prostheses from ultra-high molecular weight
polyethylene, with high resistance to wear and oxidation, while
retaining high mechanical properties. These processes utilize
several novel approaches to optimize the performance of joint
replacement prostheses such as: (1) high pressure annealing of
irradiated polyethylene to induce wear & oxidation resistance
(2) utilizing shape memory characteristics of polyethylene to
increase its ductility, (3) confining crosslinks in polyethylene
components to articular regions to preserve bulk mechanical
properties and (4) developing rubber-like polyethylene by
blending with elastomeric polyethylene copolymers to prevent
catastrophic failure. Each of these technologies is being tested
in the laboratory to measure wear resistance, oxidation resistance
and clinically relevant mechanical properties.
Anuj is productive on many areas. There are several patented
processes registered through CSRL at Partners, which
may prove to enhance the mechanical and biological properties
of implant materials.
Optical Coherent Tomography
Dr. Mark Brezinski as chief of this research unit is well
funded in this very difficult period of time of obtaining research
grants. His collaborative work with Dr. Scott Martin promises
to give us greater insight in both the degeneration and regeneration
of cartilage. In an attempt to keep this report within its
limits, I will not reiterate the many publications from this unit
over the past year.
Cartilage Repair Center
I have discussed the integration of the Cartilage Repair
Center in the section on the Sports Medicine Program. With
the addition of Dr. Gomoll to the unit and the additional year
of data, we are and will continue to see prospective evidence
based reports on the efficacies of these technologies. As an
extension of this center Tom Minas, Wolfgang Fitz, Phil Lang
of radiology and I have been working with a small company to
develop custom implants capable of resurfacing single and dual
compartments in arthritic knees.
Orthopedic and Arthritis Center for Outcom es Research (OrACORe)
The establishment of this center under the direction of Dr.
Jeffrey Katz and Dr. Elena Losina has been a major advance in
the Orthopedic Department and integration with Rheumatology.
The program had worked to consolidate various joint registries
within the group to permit more retrospective and prospective
studies. Moreover, they will work through the critical process of
obtaining IRB approval and in complying with conflict of interest
regulations both at Partners and the medical school. This
group works actively with our clinicians in study design, power
analysis, data analysis, and manuscript preparation.
Rather then give you an exhausted list of their achievements
of the past year let me give a significant yet representative
example. The METEOR project is now operational. It is a
multicenter study headed by Jeff Katz at the Brigham, which
includes the Brigham and Womens Hospital, the Hospital for
Special Surgery, Cleveland Clinic, Mayo Clinic, and Vanderbilt
University. There are lead investigators in each group and the
goal is to ascertain the role of arthroscopy in early osteoarthritis.
This has been a very controversial subject and as a scientific
advisory to this group, I have learned more about study design
and the control of confounding variables as I watch this study
The enthusiasm and expertise of OrACORe group is incredible,
and it has provided great opportunities for residents, fellows,
attendings, and medical students to participate in important
In 1995 Dr. Lawrence Dorr established the program of
Operation Walk to realize his vision of bringing state of the
art total joint arthroplasty to patients in international locations
who would otherwise be unserved or underserved. After
the early success of his Operation Walk group in Los Angeles,
he recruited Orthopaedic Surgeons from other parts of the
Country to establish chapters and organize trips to serve people
in other parts of the world. Over the next 12 years, Operation
Walk grew to 8 chapters and missions have been performed
across the globe including Cuba, China, Nepal, the Philippines,
Nicaragua, Guatemala, Peru, El Salvador, Mexico, Kenya and
Two years ago, I had the pleasure of traveling with my
friend, Dr. Doug Dennis of Denver on an Operation Walk Denver
program to Panama. Participating in this trip solidified for me
my commitment to the mission of Operation Walk. This year,
I made my second trip - this time to the Dominican Republic
as a combined Operation Walk Boston/Operation Walk Denver
group. The trip was a great success. There were approximately
30 volunteers from the Brigham that went on this mission and
were joined by a group from Denver. Together, this dedicated
group of volunteers performed 47 total joint replacements on
37 patients who would otherwise have never had these surger-
ies that they greatly needed. I will quote from an article that
appeared recently in a Brigham and Womens publication that
reported on this trip: The day after a total knee replacement,
50-year-old Isabela didnt just get out of bed and walk. She did
steps for the Merengue by her bed and continued to progress so
much that she was dancing through the halls of the Plaza de la
Salud Hospital in the Dominican Republic within a week.
With the help of the Operation Walk Denver and the
Operation Walk Los Angeles. groups, we are now officially
established as Operation Walk Boston and plan to return to
the Dominican Republic in 2009. We have worked closely with
surgeons, physicians and administrators in the Dominican
Republic and are excited about this association and being part
of Operation Walk.
This has been a brief synopsis of the years activity. I
apologize for many omissions. There is not much news from
our past mentors. I have spoken with Dr. Clement Sledge, who
spends much of his time in Maine. Dr. Fred Ewald and Sarah
divide their time between Colorado and the Boston area. Dick
Scott said that he saw him recently and that Fred is extremely
fit and both are very active. I had the pleasure of seeing Dr.
Bill Thomas at the resident graduation. The William Thomas
award, which we established several years ago, has become
a mainstay of the graduation program. It is to signify the
excellence in teaching, patient care, and collegiality that were
the hallmarks of Bills practice for many years. Finally, I did
speak recently to Dr. Bob Poss, and he and Anita are still in
Marblehead. He seems fine and has done an outstanding job
working with Dr. Jim Heckman at JBJS. I wish you all the best
and look forward to seeing you at the Academy, especially at the
Harvard Combined Residency Program alumni reception.