As a college student, Hannah Giunta, OMS II, resolved to pursue an unconventional path as a physician: She’d combine the practice of medicine with writing about the ethical issues she encountered in her clinic. Each activity would inform and enrich the other, like the scholar inspired by the interplay between the classroom and the archives.
Giunta searched the curricula of medical schools nationwide for programs offering combined degrees in medicine and bioethics. She soon discovered that most dual-degree programs limited their PhD options to one of the basic sciences. Then she learned of Michigan State University College of Osteopathic Medicine (MSUCOM) in East Lansing, which offers a DO degree with a PhD in bioethics. “I was very excited to see that, yes, what I wanted indeed was a viable option,” Giunta says.
In 2009, Giunta was one of seven, from a pool of about 60 applicants, to secure a spot in MSUCOM’s increasingly popular 7 1/2-year DO-PhD program. “Just about five years ago, we would typically have 20 or 30 applicants, but the number has since doubled,” says Bethany Heinlen, an administrative assistant for MSUCOM’s DO-PhD program, which is among eight in the nation, according to the American Association of Colleges of Osteopathic Medicine.
Students’ increasing interest in pursuing a DO-PhD reflects the osteopathic medical profession’s growth, says Andrea Amalfitano, DO, PhD, a 1990 graduate of MSUCOM’s program who today serves on its faculty as professor of pediatrics, microbiology and molecular genetics.
“As osteopathic medicine expands and attracts greater numbers of people, there’s going to be a growing percentage of students leaning toward research as part of their medical careers,” Dr. Amalfitano says. “These people might not see patients every day, but they know that their research can impact thousands or hundreds of thousands of people.”
Bridging the gap
Founded in 1986, MSUCOM’s DO-PhD curriculum prepares students for careers as physician-scientists who can bridge the chasm between the clinic and the biomedical research lab. PhD coursework includes concentrations in biochemistry and molecular biology, cell and molecular biology, genetics, microbiology and molecular genetics, neuroscience, pharmacology and toxicology, epidemiology, and integrative toxicology. The college added studies in bioethics in 2007 and medical anthropology in 2009. Twenty-three students currently study in the program.
“A physician-scientists’ unique blend of basic science and clinical experience provides them with a perspective much more sophisticated than an average physician’s,” says Justin McCormick, PhD, MSUCOM’s associate dean of research.
Dr. McCormick adds that physician-scientists’ clinical experience enables them to better formulate focused questions to guide research. In turn, their research expertise guides them in translating lab findings to bedside.
The school structured its curriculum to mirror students’ dual concentrations. “Our philosophy is that you are a physician-scientist in training from the day you enter the medical college and graduate program,” says Dr. McCormick says. “So we mix the course work to continuously remind students of that fact. For example, a student in the PhD track will also be doing ambulatory care clerkships once a week.”
From clinic to lab
To illustrate the versatility of physician-scientists, Dr. McCormick cites the career of Dr. Amalfitano. As a researcher at Duke University in Durham, N.C., 10 years ago, Dr. Amalfitano was a primary investigator in the trial that pioneered the use of the enzyme-replacement therapy algucosidase alfa to successfully treat patients with Pompe disease, a form of muscular dystrophy.
Today, aside from teaching at MSUCOM, Dr. Amalfitano cares for children with developmental disabilities and researches gene therapy. “My lab research involves applying advanced molecular techniques to a variety of diseases, both genetic and nongenetic. One technique I’ve developed involves inducing the body’s immune system to reject colon cancer. And that is now in a phase 1 human clinical trial.”
Dr. Amalfitano attributes his successes to his DO-PhD training.
“As I identify clinical problems, I simultaneously have a fairly good grasp of what it would take in the lab to solve them,” he says. “Conceivably, someone with a medical degree or a PhD could do the same thing, but I do believe it would be more difficult.”
Parsing difficult issues
Similar to Dr. Amalfitano’s unique perspective on clinical problems, Giunta says the combination of medical and bioethical studies will equip her to help patients and their families articulate and parse difficult ethical issues. She plans to specialize in neonatal, perinatal medicine and pediatric critical care in an academic medical center. “My goal is to split my time between the clinic and reading and writing about issues such as resuscitation ethics at the border of viability,” she says. “I do think that bioethics is a wonderful extension of osteopathic principles and practices because if we want to be good osteopathic physicians, we have to be concerned about the ethics of our choices. When we’re faced with very difficult decisions with patients, that’s the time we really need to care for the whole person.”