From throat ache to heartache

Faculty Lecture will focus on intersection of medicine and culture

There are places in the world where a sore throat can be a death sentence.

Rheumatic fever – which can result from untreated strep throat – was once prevalent in the U.S. Over the past 50 years, it has all but disappeared, thanks to penicillin. But it’s still endemic in developing nations and crowded conditions.

“It’s a public health disaster that gets no attention,” said Joshua Wynne, vice president for health affairs and dean of the School of Medicine & Health Sciences. “The money spent studying it is miniscule, and penicillin costs just a few cents per dose.”

Wynne, who is also a practicing cardiologist, will present “From Throat Ache to Heartache – a Tale of Rheumatic Fever Through Time and Across Continents” as he kicks off the first Faculty Lecture of the academic year. It’s set for Wednesday, Sept. 26, 4:30 p.m. in the Memorial Union Lecture Bowl. A reception will precede the lecture at 4 p.m.

Wynne will discuss rheumatic fever, research he and colleagues conducted in India which led to established clinical management guidelines, and the cultural and social aspects of performing surgery and research abroad.

“This is not a medical talk,” Wynne said. “This is for a broad audience.”

The Faculty Lecture

Faculty Lecturers are selected by a committee of Chester Fritz Distinguished Professors.

“Dr. Wynne is a great speaker with an engaging topic that will be of interest across campus,” said Holly Brown-Borg, Chester Fritz Distinguished Professor of Biomedical Sciences and a member of the committee. “He’s excited about what he does, and even though he’s a dean and vice president, he’s a practicing physician who writes, does research and teaches.”

Brown-Borg said the Lecture Series has been moved to the Memorial Union Lecture Bowl to make it easier for faculty and members of the campus community to attend.

“We want to show people what’s going on across campus and let them see what others are doing,” Brown-Borg said.

Cross-cultural research

In 2015, the latest year for which information is available, there were 33.4 million people suffering from rheumatic heart disease, resulting in at least 319,400 deaths.

Rheumatic fever is preventable if strep throat is treated. If not, it can cause an infection of the body and heart, leading to rheumatic heart disease – a potential death sentence that narrows the heart valves and gradually wears out the heart. Surgery to open the valve can be life-saving.

Wynne and his colleagues traveled to India throughout 1987 and 1988 and thereafter to study the effectiveness of two different types of surgery compared with a balloon technique to correct damaged heart valves in patients with rheumatic fever. They provided surgery to patients who could not afford it and practiced side-by-side with Indian doctors, following the patients for 10 years.

“We helped 100 patients get care,” Wynne said. “That experience was immensely satisfying.”

Their work was published in 1994 as the lead article in the New England Journal of Medicine and became the seminal study that established management recommendations by the American College of Cardiology. The follow-up was completed in 2000.

Living another culture

“The work made me a better doctor,” Wynne said.

“People in India don’t like to tell bad news to those who they feel outrank them,” he said. “I didn’t always hear if patients had problems, so I examined all my patients post-op and did the follow-up myself. We had very good results and few problems.”

“It was amazing to see the largest democracy in the world function,” Wynne said. He recalled that at a dinner to thank the American team, the minister of health lauded them and congratulated his colleagues for preventing rheumatic fever by dispensing penicillin.

“Then he announced that they had run out of funds to buy penicillin for that quarter,” he said.

Wynne added that the American medical team disposed of surgical gloves after each procedure, thinking nothing of it.

“We walked around a different corner of the hospital and discovered a stretcher with washed gloves hanging down the sides,” he said. “After we left, they collected and washed the gloves, then sterilized and re-used them.”

The Faculty Lecture

Wynne has been dean of the SMHS since 2010. He earned bachelor’s and medical degrees from Boston University, training at what is now Brigham and Women’s Hospital. He joined the faculty of Harvard Medical School where he directed Brigham’s Noninvasive Cardiology Laboratory, then moved to Wayne State University as one of the youngest chiefs of cardiology in the nation. He came to UND in 2004.

He holds an MBA from the University of Chicago and an MPH from the University of Michigan, has authored or co-authored more than 80 manuscripts, 70 abstracts, and multiple articles, chapters and book reviews, as well as one book. He and his colleagues have garnered more than $5 million in research funding.

“I enjoy being in the audience at the Faculty Lecture Series,” he said. “I learn about colleagues across campus and what they’re doing. A really successful lecture is one where a non-musician or a non-engineer can be engaged. I hope this is of interest to the UND and local communities.”