The Bioscience Boon

In the operating rooms of television medical dramas, it looks pretty easy. Just slip a tube down the patient’s throat to keep her breathing and save her life. But in reality, intubation is often a lot harder than that, requiring a combination of both precision and chance.

For starters, medical technology only gives an anesthesiologist a partial view of the trachea, so getting it right is a bit of a guess. And it gets even tougher if there’s an obstruction such as a tumor in the way. Go too far past the vocal cords and you can puncture a lung. Take too long and a patient can suffer dire consequences.

“We only have three minutes to reestablish oxygen delivery to the lungs,” explains Sean Runnels, a cardiothoracic anesthesiologist and assistant professor at the University of Utah. “If we don’t get it right, they are brain dead or have cardiac arrest.” With that in mind, Runnels set out to find a better way. His idea: Marry two existing pieces of technology into a single, slim color-coded device that makes the process easier for doctors and safer for patients.

Sean Runnels, a cardiothoracic anesthesiologist and assistant professor at the U

In October, the intubation innovation will launch through Runnels’ new medical device company, Through the Cords. Built with a team assembled through the U’s Lassonde Entrepreneur Institute, the device is the first significant innovation in intubation technology in 40 years, Runnels says.

It’s also an example of the kind of U-based medical innovation that has been changing lives for the better since the 1950s—think plastic catheter, Jarvik heart, the first artificial arm—and is now driving Utah’s economy in a dramatic way. Last year alone, companies in what’s broadly known as the life sciences industry (also referred to as bioscience) reported $10 billion in sales, pumped nearly $500 million in tax dollars into state government, and added jobs at a faster rate than any other segment of Utah’s economy.

These companies are using next-generation technology to make medical devices and equipment, produce drugs and pharmaceuticals, or do medical research, diagnostics, biomedical distribution, and more. “There’s such a strong need for the technologies being developed,” says Clark Cahoon of the Governor’s Office of Economic Development (GOED), whose job exists to support the needs of the life sciences industry. “There’s so much going on, and it’s growing faster than anybody expected.”

So how fast is fast? When measured by job growth data from the industry trade association BioUtah, it’s pretty fast. Between 2012 and 2017, the number of life sciences jobs across the state grew by 25.4 percent, far faster than the national industry average of 5.9 percent, a recent California report shows.

One could chalk up the explosion in the sector to market forces or technology advancements that have helped flatten the path to discovery—and those things would be true. But it’s also something more: A sort of convergence of aptitude, opportunity, ingenuity, and institutional support that when combined with a Utah-born spirit of collaboration has people in education, government, and industry working toward common goals.

“The state is completely supportive and wants to work to decrease the number of barriers for the university, and the education system is evolving to provide the right environment for young people with ideas,” explains Keith Marmer, who runs the U’s Center for Technology & Venture Commercialization (TVC), which helps bring campus-driven invention to the marketplace. “It’s like a perfect storm.”

It’s no secret that Utah is a business-friendly place. Over the past decade, the state has been consistently named one of the best for business by Forbes magazine, and this year, it was ranked second best for startups by the financial website WalletHub. This climate has allowed Beehive State industries to flourish, and the life sciences sector is no exception. Over the past decade, its successes have grown into a bona-fide boon for Utah’s bottom line, pumping billions in taxes, private investment, grant funding, and higher-than-average wages into the economy.

It’s also drawing the attention of companies considering a relocation and adding additional value to Utah communities by fostering growth among indirect goods or services companies, including retailers and small manufacturing and construction firms. “We see a return on investment when we see these [life sciences] companies taking root here,” Cahoon adds. “There are no losers. When you draw this kind of industry and it’s successful economically, it makes for better jobs. It drives education programs. It helps the whole community.”


Research, testing, and medical laboratories:

37.6% = 16,120 jobs

Medical devices and equipment:

32.1% = 13,760 jobs

Drugs and pharmaceuticals:

16.6% = 7,127 jobs

Biosciences-related distribution:

13.6% = 5,824 jobs

Data provided by BioUtah, the Utah Department of Workforce Services, and the Biotechnology Innovation Organization, a national biotech trade association.

New data from a first-ever study of the industry by the U’s Kem C. Gardner Policy Institute shows the breadth of the life sciences boom. According to the data, in 2017, Utah’s 1,038 life sciences companies:

  • made up about 7 percent of all state employment, 6 percent of all personal income, and 8 percent of Utah’s gross domestic product
  • paid $3.1 billion in employee wages and benefits, with an average compensation of $86,396—salaries 46 percent higher than the statewide average
  • directly or indirectly employed 130,439 Utahns, putting $7.6 billion in personal income into the pockets of workers
  • drew $188 million in research grant funding from the National Institutes of Health, of which 91 percent was distributed to universities, including the U

The report also shows that the industry’s job growth rate has been consistently high over the past 15 years. From 2002 to 2007, it grew by 14 percent. The rate held steady during the recession that began in 2008 and then skyrocketed to 26 percent over the last five years.

“Utah already has the fastest pace of job growth in the nation, and then life sciences is growing at a rate even faster than that,” says Juliette Tennert, the institute’s director of economic and public policy analysis. “But I don’t think you can have this result without the University of Utah being here.”

University-based research and innovation is a key player in the growth seen in life sciences companies, Tennert says. “And now I think the labor force is so critical that we need to continue to invest in opportunities for students to become skilled, so that they can stay here and work, not go somewhere else,” she adds.

Building a highly skilled workforce that is nimble and rooted in the kind of next-generation thinking that drives translational research is precisely what the university aims to do, explains Troy D’Ambrosio BA’82, executive director of the Lassonde Institute. The approach isn’t really new. Innovative research and invention, along with entrepreneurial thinking, have long been valued on campus, where many life science industry leaders got their start. Myriad Genetics, Sorenson Genomics, and Merit Medical, for example, all spun out to the marketplace from ideas incubated here, which helped plant the early seeds of cooperation between industry and education that U administrators have sought to grow over the past decade.

That’s happening through interdisciplinary initiatives like the Center for Medical Innovation and the Lassonde Studios that provide opportunities for students to launch startup business ventures, with seed money from the U, or join forces with faculty to work to find solutions to real world industry problems that improve health care and reduce costs.

And it works. Over the past seven years, the competitive Bench to Bedside program has awarded grant funds to teams that have developed more than 180 new technologies, filed 111 patents, started over 50 sustainable companies, and trained more than 1,000 students to be the next generation of entrepreneurial leaders. “Traditionally, much of our education system has been focused on how things have been done, or what is being done, not on the new and the next,” says D’Ambrosio, who works closely with GOED and the Economic Development Corporation of Utah. “Now we’re building those kind of thinkers so that we can say to industry, we have people trained to do what you want to do.”


Troy D’Ambrosio confers with students at the Lassonde Institute.

The approach is attracting students and faculty who might not previously have considered the U. It’s also drawing interest from corporations looking to partner with campus-based inventors and bringing in additional research dollars. “We’ve been a part of very large grants from the National Science Foundation, the

National Institutes of Health, and the Department of Energy, because as we’ve gotten better at translating faculty technology ventures out into the world, we are able to say, ‘We can do that commercialization piece,’” D’Ambrosio adds.

The cross-disciplinary idea sharing also appears to be increasing the number of innovative technology ideas percolating on campus, particularly since the Lassonde Studios launched, D’Ambrosio says. In its first year, the $45 million studios launched some 300 companies—many of them producing new medical devices.

Some Lassonde-based teams have been able to capitalize on collaboration in ways that have shortened the runway from prototype to product. At least one brought its invention—an inexpensive tool for cervical cancer screenings—to market in about 18 months. That’s far faster than the industry standard of seven years, says John Langell MBA’13, an associate professor of surgery at the U and executive director of its Center for Medical Innovation.

For his part, Runnels says his Through the Cords endeavor would not likely have been possible were he living and working in any other place. At each step in the process—from the department chair who granted him a teaching sabbatical, to Lassonde, TVC, and the relationships the U has with state economic and business leaders—Runnels says he found support and enthusiasm for his vision. “Most places, it’s all window dressing, but here it’s actually happening,” he says. “This is such a privilege to be at an institution where I can do this. I just feel lucky.”

Of course, not every U invention will make it to market like Through the Cords’ tool. In reality, only a fraction—less than 10 percent—says Marmer. Still, the U manages to launch between 10 and 20 companies annually. “As a university and a single entity, that’s probably more than anyplace else in Utah,” Marmer adds. Not all are life science-related endeavors, but the medical school historically outpaces other U schools and colleges in the number of annual invention disclosures—977 since 2013—and those make up about two-thirds of TVC’s total work.

U successes in the life sciences industry are also driving something that Marmer says might be just as important as funding: buzz. “Increasingly, there’s a reputational value,” he says. “There is a lot of importance to that, even if it’s just that potential industry partners will want to work with us more because they see us doing the work.”

That buzz is drawing visits from educational institutions worldwide who are looking to replicate U programs on their own campuses, as well as from venture capitalists like Victor Gatto of Tennessee, who routinely tracks innovation at universities, looking for his next investment.

Gatto says he was reluctant to visit Utah about two years ago after he was invited by an investor who was also a U grad. The school, he says, just wasn’t on his radar screen. “I was really blown away,” says Gatto. “Every other university I know is much more siloed. What’s really unique about Utah is its partnerships and the willingness to work together, share creativity, and solve problems.”

Such stories make D’Ambrosio nod his head. “We hear that from people time and time again who visit our programs,” he says. “And usually they say, ‘We’d never be able to do that at our campus, because we’d never get people to play along.’ ”


The U’s Technology & Venture Commercialization office has been helping push campus-based innovation into the marketplace since 1965. Here’s a look at a few life sciences companies and their products and technologies that have the power to improve health care and change lives:

PEEL Therapeutics: A drug research company developing cancer treatments by harnessing the cancer-resistant proteins found in elephant blood.

Larada Sciences: Makers of the AirAllé device, which delivers a 30-minute single treatment that kills head lice and 99 percent of lice eggs.

XEnd Medical Systems: Creators of the patented XEnd Needle that is designed to reduce infections from hypodermic needle injections and speed up the identification of sepsis-causing bacteria.

Veritract: Developers of a feeding tube with integrated optics and a steering function that allows for the more precise placement of feeding tubes in patients to prevent complications that can lead to death.

Jennifer Dobner is a Salt Lake City-based freelance writer and former Salt Lake Tribune reporter.

Clearing the Air

Every day, Ron Fessenden clicks open the in-box for his email account and looks for the daily air quality indicator messages distributed by the Utah Division of Air Quality. Depending on the reading—red, yellow, or green—the retired local television sales executive and onetime University of Utah sports information director decides how he’ll spend his day. “When the air quality starts to get bad, I just don’t go outside,” the Midvale, Utah, resident says.

Fessenden suffers from idiopathic pulmonary fibrosis (IPF), a little-known, progressive disease that is slowly scarring and hardening his lungs. His disease has progressed more rapidly over the last year, and eventually, IPF will kill him, just as it does roughly 40,000 people annually in the United States. Diagnosed seven years ago after seeking a doctor’s care for a persistent dry cough, Fessenden uses supplemental oxygen round the clock and has had to give up many of the things he loves. That includes his beloved golf game, just when he “was finally getting good,” he jokes. “I can’t take a deep breath,” he says, and he also must pause at the halfway mark when coming up the stairs from his basement. “It really limits the things you would like to be able to do and hampers your quality of life.”

Fessenden has been a willing participant in five different University of Utah-based drug trials that sought to cure his disease. None provided any relief, but Fessenden says he’s encouraged by news that U researchers across a wide range of fields—from biology and bioinformatics to engineering, epidemiology, medicine, meteorology, and more—are now working together on projects aimed at understanding the connections between pollution and health. The research is part of the University’s Program for Air Quality, Health, and Society, a two-year-old initiative designed to foster cross-disciplinary, collaborative study of all facets of air quality in hopes of identifying pathways for reducing pollution and improving quality of life for those in Utah and beyond. University leaders hope the program will establish the U as the national leader in research and information on air pollution and health, as well as innovative ways to help solve the problems.

Dr. Robert Paine, professor and chief of pulmonary medicine in the U School of Medicine, co-founded the U’s Program for Air Quality, Health, and Society and serves as its director. The program brings together researchers from diverse disciplines to study the various impacts of air pollution. (Photo by August Miller)

“As a major research institution, we at the University of Utah are uniquely positioned to bring together the expertise from health and epidemiology to engineering, atmospheric science, urban planning, and more to tackle the challenge of improving our air quality,” says Vivian S. Lee, senior vice president of University of Utah Health Sciences, dean of the U Medical School, and chief executive officer of U Health Care. “We view this as both an opportunity and an obligation.”

Winter weather inversions are common along Utah’s Wasatch Front and occur when a layer of warm air traps cold air, and pollution, in the valleys. (Photo by Erik Crosman)

Ruth Watkins, senior vice president of academic affairs, shares Lee’s view on the importance of interdisciplinary collaboration in the endeavor. “Air quality is a significant issue for the people of this region, the state of Utah, and beyond,” Watkins says. “As a public research university, it is imperative that we lead in efforts to address societal challenges. The quality of our air and environment is closely linked to quality of life, and this is core business for the University of Utah.”

Utah has attracted national attention in recent years for its air quality problems. Winter inversions trap pollutants in the Cache and Salt Lake valleys, and ozone levels leave a haze over much of the Wasatch Front, primarily in the summer but also across the Uintah Basin in winter months. At times, pollution levels have been so high during a single 24-hour period that the U.S. Environmental Protection Agency has placed some Utah communities at the top of its list for cities with the nation’s worst air. In 2013, daily EPA monitoring in 10 Utah counties found air pollution levels exceeded national healthy air standards a combined 99 times.

The problem has raised the ire of Utahns worried about the impact of breathing bad air, which has been linked to a range of health problems, including increased incidence of asthma, cardiovascular disease, and dementia, as well as adverse outcomes for babies in utero, including low birth weight and high infant mortality. In January 2014, more than 4,000 concerned Utah residents, many wearing gas or surgical masks, rallied at the Utah Capitol, demanding more aggressive state action on the issue. State lawmakers responded by proposing a record number of legislative solutions, although only a handful passed and none include regulatory standards that are tougher than those already imposed by the EPA.

Beyond its impact on health, the pollution has economic costs, including lost work days due to illness and increased health care costs. The air pollution also has an impact on employee recruiting for Utah businesses. And it can present costly regulatory challenges for industries large and small.

It’s a problem Lee knows about firsthand. When she was hired at the University of Utah in 2011, she had planned to bring three New York University faculty members with her as members of her research team. To her dismay, however, one declined, citing significant concerns about air quality. “I know I’m not alone: Many other Utah business leaders frequently report about the challenges they face in convincing companies to relocate to our wonderful state,” Lee says. “And as a health care institution, we are particularly concerned about the impact of air pollution on the health of our patients and on the broader community, including our employees.”


Kerry Kelly, a University of Utah chemical engineering researcher who helped co-found the University’s Program for Air Quality, Health, and Society, works with U student Timothy Carter on some sensor equipment in a campus laboratory. (Photo by August Miller)

The U’s Program for Air Quality, Health, and Society is the brainchild of Dr. Robert Paine, chief of pulmonary medicine at University Hospital, and Kerry Kelly, a College of Engineering researcher. The pair met by chance in 2009, when both were appointed to the state’s Air Quality Board and were assigned to sit next to each other at a meeting. The appointments launched a friendship and a conversation about the need for University collaboration between academic disciplines, many of which were already, albeit separately, engaged in cutting-edge air quality science. “We needed an umbrella, and we needed a catalyst to greatly enhance what we do,” says Paine. “One of the key things about air pollution is that it’s easy to do pieces of research. It’s much harder to come up with opportunities where we bring all these pieces together and say, ‘How do we go from what’s emitted to what the health consequences are?’ ”

The pair believed that the U’s academic experts and researchers were well suited to the challenge. So after six years of conversation, Paine and Kelly in 2011 crafted a proposal for the Program for Air Quality, Health, and Society and began a conversation with University leaders.

“The idea was that we’re much stronger together,” says Kelly. “It’s not just a health problem and also an engineering problem, it’s an atmospheric science problem, and we’re going to come up with better solutions if we all get together and take advantage of everyone’s expertise.”

Robert Adler, dean of the University of Utah’s College of Law, says scientific advances from the U air quality research may help lead to better environmental law and policy. (Photo by August Miller)

University leaders agreed. By 2012, Paine and Kelly had secured enthusiastic support, as well as some funding, from Lee, Watkins, the office of the vice president for research, and the College of Engineering. Paine now serves as the program director, and Kelly is the associate director. The program’s steering committee also includes representatives from atmospheric sciences, biology, chemical engineering, internal medicine, law, and pediatrics.

The program’s first event, a spring 2013 retreat designed to stir up interest in cross-disciplinary projects, drew nearly 100 curious U investigators and spurred a number of grant requests. Research began in earnest in January 2014, when the program distributed $165,000 in grants from the University’s Funding Incentive Seed Grant Program, which is administered by the office of the vice president for research. Kelly says the six projects were selected based on their potential to advance science and draw additional large grants from organizations such as the National Institutes of Health or the EPA.

The seed grants have supported both first-time research and ongoing work. One grant, to obstetrician and gynecologist Jeanette Carpenter-Chin, is allowing her to study a suspected link between in utero exposure to air pollution and children’s health. The study focuses on children whose pregnant mothers were exposed to air pollution from Utah County’s Geneva Steel Mill in the 1980s.

Another study, led by Russ Richardson PhD’92, a U professor with joint appointments in internal medicine and exercise and sport science, examines the effects of particulate air pollution on vascular function in chronic pulmonary disease. And Hanseup Kim, a USTAR professor of electrical and computer engineering, is using his grant to develop a wireless system for detecting volatile organic compounds that are part of air pollution.

Dr. Cheryl Pirozzi, a University of Utah pulmonologist, is leading a cross-disciplinary study of the effects of air pollution on patients with idiopathic pulmonary fibrosis. (Photo by August Miller)

The U program’s grant funding has also furthered study of correlations between air quality data and the number of patients suffering from diseases with known connections to pollution exposure, such as some cancers and respiratory illnesses. Led by U bioinformatics professor Ramkiran Gouripeddi, a team that includes experts in meteorology, atmospheric science, chemical engineering, medicine, and informatics is working with combined data sets to analyze any possible links between disease occurrence and air pollution concentrations.

Amanda Bakian, a U research assistant professor of psychiatry, has used her grant to study links between air pollution and suicide. The project, believed to be the first study of its kind nationwide, combines the expertise of a diverse group of psychiatrists, suicidologists, environmental and genetic epidemiologists, psychologists, and biostatisticians. “Assembling a team composed of individuals with diverse expertise helps guarantee that the problem or question is approached from the best angles possible and ensures that the study design is maximized appropriately,” says Bakian. “This is how science is moving forward in this day and age and how gains in scientific understanding are being made.”

Dr. Cheryl Pirozzi, a U pulmonologist, is another grantee, and she shares Bakian’s enthusiasm for cross-disciplinary work. Pirozzi is studying the effects of air pollution on individuals with idiopathic pulmonary fibrosis, the disease from which Fessenden suffers. This winter, the pilot study will place 20 air quality sensors in patient homes across the Salt Lake Valley to gather data about indoor air pollution exposure, daily respiratory symptoms, and lung function during an eight-week period. To meet Pirozzi’s data-gathering needs, Kelly is working with Tony Butterfield BS’96 PhD’07, an assistant professor of chemical engineering with an expertise in prototyping and data analysis. He and a team of students are retooling a commercially available sensor for Pirozzi’s study. “There are people in all aspects of the University who are interested in air pollution and have expertise in areas I know nothing about, so I think getting people together to work on projects like this is a huge opportunity,” Pirozzi says.

Butterfield also is working on a separate community outreach effort that would place the sensors in K-12 schools across the Salt Lake Valley, increasing the number of locations where air quality measurements are gathered for the state’s monitoring. About 30 teachers have already expressed interest in using the sensors as curriculum tools in a wide range of subjects, from mathematics to biology. “People are really interested in doing citizen scientist work,” says Butterfield. “They like being a part of the process that helps us in discovering how we can make the world a better a place.”

Watkins says the University has also begun a hiring initiative to recruit faculty members—four over the next two academic years—for the colleges of Social and Behavioral Science, Mines and Earth Science, and Engineering to enhance the work of the U’s air quality program while also advancing scholarship and understanding of broader environmental issues. “That will accelerate our potential to address challenging problems, including water and air quality, and relationships with climate and weather,” she says.

The increased environmental focus the faculty members will bring, along with the work of the air quality program, will enhance the academic experiences and opportunities for students who work with those professors, says Robert Adler, dean of the U’s S.J. Quinney College of Law and a member of the Program for Air Quality, Health, and Society’s steering committee. “The program reflects the best of what universities can be,” he says. “Rather than working in isolated disciplinary silos, the effort reflects shared commitment to advancing knowledge and helping the community through collaboration within the U and beyond.” The law college’s Wallace Stegner Center for Land, Resources, and the Environment recently has hosted events examining regulatory changes regarding air pollution, and the annual Stegner Symposium this coming March will examine air quality as it relates to health, energy, and economics.


Winter air pollution cloaks the U’s Rice-Eccles Stadium and the rest of the Salt Lake Valley, while the mountains above the inversion remain clear and sunny. The U currently has six cross-disciplinary research projects that include installing more sensors across the valley to help the state’s air monitoring. (Photo by Erik Crosman)

Adler and Watkins also say the scientific advances expected from the U air quality research may ultimately help lead to innovations in industry practices and environmental regulation and law, as well as better public policy. “Good decisions about complex issues are always informed by better science and related policy analysis,” Adler says.

For now, Paine and Kelly hope the program’s initial research projects will result in promising findings to draw in large grant awards from national institutions and organizations. The Program for Air Quality, Health, and Society currently has no ongoing funding and needs those grants and private funding to further its goals. Years down the road, Paine says, “success would be a robust research enterprise here so that people around the nation and around the world think about Utah as the place that produces high-quality air pollution research.”

Fessenden says he’ll be happy if researchers are finally able to answer the question that so many Utahns find themselves asking each time they wake up to another day of gray, mucky winter air or summer haze: What is breathing this stuff doing to my body? “I have thought about moving, but my life is here, my family and my doctors,” says Fessenden. “When the pollution is bad, my breathing is just more labored, and if I do go outside, I find myself constantly coughing.” In life, you “play the cards you are dealt,” he says, but he welcomes any advances in science and medicine that will help cure or even ease the struggles of patients like him. “Anything that would buy some time would obviously be great.”

—Jennifer Dobner is a Salt Lake City-based writer and a frequent contributor to Continuum.

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Educating Tomorrow’s Dentists

When Devin Daniels was thinking about choosing a career, he conducted a quick assessment of his personal qualities. Small hands? Check. Ability to understand people with their mouths full? Check. His decision? Dentistry. “I knew I wanted a career in the health industry and wanted to own my own business,” says Daniels, who grew up in St. George, Utah, and graduated from Dixie State University with a degree in biology in 2013.

Amber Lunsford’s interest in the profession was more idealistic. “I’ve always wanted to help people improve their confidence,” says Lunsford, who received her bachelor’s degree in biology from the University of Utah in 2013. “I see myself being able to do that in dentistry through individuals’ smiles. When you can restore someone’s smile and make such a drastic change in their lives, it has an amazing impact. That’s very real.”

Daniels and Lunsford are among the 20 students who enrolled in the historic first class of the University’s new School of Dentistry in fall 2013. It’s the nation’s first new dental school at a major research university since the 1960s and the first new school on the U campus in more than 50 years. With the addition of the dental school, the University of Utah now offers students opportunities in every aspect of health sciences education. In August 2013, the U also broke ground on the $36.4 million Ray and Tye Noorda Oral Health Education Building, which will house the U’s new dental school. The nearly 80,000-square-foot building in Research Park, slated for completion this December, is being constructed with a $30 million gift from the Noorda family and will provide state-of-the-art lab and classroom facilities, administrative and faculty offices, and a dental clinic that will treat patients.

Rena D’Souza, dean of the U School of Dentistry, stands in front of the construction site of the Ray and Tye Noorda Oral Health Education Building, slated for completion in December.

Rena D’Souza, dean of the U School of Dentistry, stands in front of the construction site of the Ray and Tye Noorda Oral Health Education Building, slated for completion in December.

“The College of Dentistry is a remarkable asset to the University of Utah,” says Vivian S. Lee, the U’s senior vice president for health sciences, dean of the School of Medicine, and chief executive officer of University of Utah Health Care. “Dental health is increasingly being recognized as a key driver of overall health, and our opportunity to enhance the health of the state and region through our research; clinical services, particularly for the underserved; training of future dentists; and community service complements the outstanding work across the Health Sciences campus.”

Rena D’Souza, who was named the school’s first permanent dean in August 2013, notes that it’s a large task, but the U is well positioned to build a program aimed at providing an innovative, 21st-century environment for dental education and research. “The School of Dentistry will shape the future of dentistry worldwide by developing exemplary oral health professionals who are clinicians, educators, researchers, and community leaders,” she says.

Building any new academic program from the ground up is ambitious, but the University of Utah seems uniquely suited for the challenge, says Charles Bertolami, dean of the New York University College of Dentistry. The U’s long tradition of first-rate scientific research and medical education provide the right academic and cultural foundation for building a top-notch dental school by attracting the right students and faculty, says Bertolami, who like D’Souza is a former president of the American Association for Dental Research. With dentistry an increasingly popular profession, many new dental schools have opened nationwide. But until now, none have been housed at a major university interested in cultivating a strong research mission. “The Utah dental school is very special,” Bertolami says. “It’s an opportunity to retain excellent students within the state who will then practice in the state.”

Dental student Devin Daniels is interested in both general dentistry and orthodontics.

Dental student Devin Daniels is interested in both general dentistry and orthodontics.

Bertolami says D’Souza has a combination of skills that make her exactly the right person to build the new program. D’Souza, who grew up in Mumbai, India, and received dental degrees in both India and the United States, is known for being an exceptional scientist and clinician; a pragmatic, outcome-oriented thinker; as well as a mentor and consummate networker who consults widely with colleagues and has sharp administrative skills. “She brings people together,” Bertolami says. “She knows their talents. She recognizes their interests and then mobilizes people and resources and ideas, marshaling them together into very creative kinds of outcomes. She can attract the kind of faculty that you need on both the clinical and the research side.”

D’Souza came to Utah by way of Texas A&M Health Science Center’s Baylor College of Dentistry and the University of Texas in Houston, where she spent 30 years teaching, developing evidence-based curriculum, and conducting research in craniofacial development and regenerative dental medicine. Her research in the use of small molecule replacement therapy for tooth agenesis and dental stem cells is in the process of being translated into therapies for congenitally missing teeth and those that succumb to decay.

Her career and scientific achievement have also garnered her millions in federal grant funds, appointments to leadership roles with prestigious national dental professional associations, and numerous accolades and awards, including the 2010 Presidential Award for Health Research and Excellence from the Texas A&M Science Center. This September, she is scheduled to be inducted into the German National Academy of Sciences Leopoldina, an honor earned by nomination from other academy members.

“First and foremost, I’m a dentist,” says D’Souza, who admits she initially chose dentistry because the path to graduation was shorter than medical school. “My roles as a researcher and educator have centered around solutions to problems I encountered as a clinician while chairside. I am inspired by the need to integrate new research into dental practice.”

G. Lynn Powell, the U School of Dentistry’s founding dean, a dozen years ago helped begin the process to create the school.

G. Lynn Powell, the U School of Dentistry’s founding dean, a dozen years ago helped begin the process to create the school.

Once decided on a career path, D’Souza says, she pushed herself to excel. She came to the United States with her father in 1977 at age 23, after graduating with a bachelor’s of dental surgery degree from the former University of Bombay. Although the U.S. trip was intended only as a short visit, D’Souza was offered a chance to work with a renowned functional anatomist, so she stayed on. A year later, she gave up graduate study in orthodontics at Columbia University to marry a young engineer bent on a career in deep water technology and moved to Houston. By 1987, D’Souza had obtained DDS, master’s, and doctoral degrees, all from the University of Texas Health Science Center. During those years, she also became a mother of two children. She maintained a busy dental practice and went on to join the faculty at UT Houston’s School of Dentistry.

D’Souza found herself drawn to funding opportunities available for dentist-scientists like herself while she continued her practice of dentistry. Although she says she loved working with patients, she wanted more. “I like to get to the bottom of things. I like to analyze things and ask, ‘Why and how do things happen this way?’ ”

She wants to encourage that same the kind of curiosity and drive in students at the U’s new School of Dentistry. Toward that end, she is working to oversee development of a curriculum that marries traditional foundational education and clinical professional best practices with new technology and cutting-edge research. She wants to train professionals who are not just proficient inside the dentist’s office but who are also critical thinkers and problem solvers, with deep emotional intelligence and compassion. D’Souza believes that sort of education will position the U as a “leadership” school and empower its graduates to transform the dental profession. “While most dental schools do a good job graduating technically skilled dentists, it takes a lot more to be a good oral health care provider,” she says.

Cultivating a vibrant environment for dental research is a key part of that vision, so among the goals for the school is the establishment of an interdisciplinary center in craniofacial medicine. The center would draw top researchers and faculty to Utah and provide opportunities for collaboration with medical researchers in human genetics, stem cell biology, substance abuse, tissue engineering, and other areas of study for which the U’s health sciences center is renowned. Another goal: Bring diversity to the dental school’s student and faculty ranks, and by extension, into Utah’s broader dental community. About 98 percent of the state’s 1,700 professional dentists are male. The U’s first class of 20 dental students includes just four women. It’s a small start, the dean says, but a start just the same.

Glen R. Hanson, the School of Dentistry’s associate dean of research, says the curriculum encourages dental research and will help broaden opportunities for U students and benefit the community.

Glen R. Hanson, the School of Dentistry’s associate dean of research, says the curriculum encourages dental research and will help broaden opportunities for U students and benefit the community.

Getting the school from dream to reality wasn’t easy and required the backing of the U’s top administrative and academic leaders as well as the state’s Board of Regents. Additional approval and support was needed from the Utah Legislature and the Utah Dental Association, says Glen R. Hanson PhD’78, the U School of Dentistry’s associate dean of research. “You have to work through a lot of systems, and the path isn’t obvious.”

Since 1980, the University of Utah had offered the Regional Dental Education Program, which provided students with a one-year dental education program at the U and then shipped them off to Creighton University in Nebraska for the remaining three years of training and a diploma. The concept worked but was limited, says G. Lynn Powell, the U dental school’s founding dean, who teamed with Hanson to begin the steps toward founding Utah’s dental school about a dozen years ago. The old regional program’s design also meant that annually a few hundred students and millions of tuition dollars were leaving the state. With the cost of education rising, some academic and dental professionals in Utah wanted to try to give students a local, affordable option, Powell says.

Detractors argued that Utah already had a healthy per-capita supply of dentists and the existing program was sufficient. But Hanson and Powell worked to design a proposal for a new school that made academic and economic sense, and they spent two years traveling the state to meet with dentists and lawmakers to promote their vision and listen to concerns. “The opposition was that we were going to overpopulate the practitioners,” Powell says. To address those concerns, the University agreed to cap the new school’s class size at 20 students, the same number historically enrolled in the regional program. To ease lawmakers’ worries over requests for large amounts of public funds, plans for the new school also included a commitment to not seek funds from the Legislature beyond the annual $500,000 appropriation that had historically been provided for the regional program.

Amber Lunsford, a U dental student, appreciates the School of Dentistry’s small class sizes.

Amber Lunsford, a U dental student, appreciates the School of Dentistry’s small class sizes.

A critical moment in the project’s development came in 2007, in the form of an unexpected gift. Tye Noorda, whose late husband Ray Noorda had founded the software giant Novell in the 1980s, and her four surviving children came forward with $30 million and the hope of starting a dental school. Her gift was accompanied by a request that the school’s mission include an emphasis on serving those who can’t otherwise access dental care. “The story Mrs. Noorda told was that when she was first married, she broke her teeth in a fall outside her church,” says Powell. “They were students with no resources to fix it and help her smile again,” and she had to wait until later to have her teeth repaired. Her memory of that experience prompted her request with her gift at the U. “Part of her motivation was to provide care for those who can’t afford it.”

The school was finally approved by the Legislature in 2012. Hanson hopes the school will serve to better integrate dentistry into the broader health sciences so that tomorrow’s practitioners will work more closely with physicians and other health care providers. Encouraging dental research will also help broaden opportunities for U students and change the future of dental health for the community. “We believe students can come here and get outstanding clinical training and have a very productive and fulfilling life as practicing dentists; however, we think there are benefits to having this other emphasis in research,” he says. “The two are not mutually exclusive. It’s a different sort of vision for what a dental school can be.”

The combination of an innovative curriculum and a state-of-the-art facility helped the U draw outstanding students to its inaugural class. More than 850 students applied for the 20 class slots. Those selected had an average grade point average of 3.81, which was the highest of any class admitted to all the nation’s dental schools in 2013, D’Souza says.

Dental students Daniels and Lunsford both applied to multiple schools across the country, but they had the U’s School of Dentistry at the top of their list, even though they knew the program was unproven. The affordable $33,837 annual in-state tuition was a factor for both students (by comparison, Creighton’s 2013-14 annual tuition was $52,886), but the idea of being a part of building an innovative program was also a draw. “It was exciting to know that I’d be a part of the inaugural class and that we’d all play a big role in setting the stage for how this school grows and evolves,” says Daniels.

U dental school dean Rena D’Souza’s goals include establishing an interdisciplinary center in craniofacial medicine.

U dental school dean Rena D’Souza’s goals include establishing an interdisciplinary center in craniofacial medicine.

Classes are small, and the faculty-to-student ratio is high—sometimes four or five clinicians for every 10 students. Lunsford says that makes the learning environment more individualized and supportive. “Most schools have more than 80 students,” says Lunsford. “The fact that we have more interaction with the professors and faculty means we can build relationships.”

At the one-year mark, D’Souza couldn’t be happier with the progress that has been made. Key faculty members have been hired. Curricula are well into development, and the school has secured preliminary accreditation and been awarded its first two research grants: one focused on drug addiction and another examining brain function and pain. Other grants awarded to new faculty recruits, including D’Souza, support research in genetics, tissue engineering, and salivary gland biology. And construction of the new building is on time and on budget. With those pieces together, D’Souza says she knows what kind of place she wants the school to be a decade from now: “A place whose students have gone out and transformed the profession. A place where faculty and students are not just good consumers and producers of knowledge, but whose leadership in the community exemplifies the spirit of giving back.”

—Jennifer Dobner is a freelance writer based in Salt Lake City and a frequent
contributor to

Listening to the Natural West

Here’s an animal-noise pop quiz: What sound does a frog make? What about a wolf? A slithering snake? Or a hawk? Too easy? Try something harder: A North American river otter, perhaps? An American pika? What about a Utah prairie dog?

Listen to sounds from the archive

Listen to sounds from the archive

If the specific croaks, howls, hisses—or rattles!—and squeals of these animals aren’t already part of your sound repertoire, then the University of Utah’s J. Willard Marriott Library can help. The library is home to the Western Soundscape Archive, a collection of animal sounds and ambient noise gathered across 11 contiguous Western states. Established through a federal grant in 2007 by then-U librarians Jeff Rice and Kenning Arlitsch, the archive is a treasure trove of all that chatters, growls, hoots, squeaks, and warbles.

“But it’s more than just a collection of recorded sounds tucked away in a library,” says Rice, who is now the managing editor at the University of Washington’s Puget Sound Institute. “It’s about paying attention to the world out there. The more you start looking into it and the more time you spend outdoors, you realize how important sound is to the environment.” A river, for example, sounds different under the snows of February than it does beneath the sunny skies of July. Birds sing in dialects, so the sweet chirp of a robin won’t be the same in Iowa as it is in Idaho. Even the tiniest ants make vibrational sounds that the human ear can’t detect without amplification.

The U archive is intended to foster both preservation and education, says Arlitsch. Wild places and their animal inhabitants disappear by the day due to factors such as commercial development and climate change. Kurt Fristrup, a scientist who works for the U.S. National Park Service’s Natural Sounds Program, says preservation efforts aimed at saving those landscapes or animals aren’t uncommon, but often they are driven by the visual stimuli. “We don’t think about the need to preserve the auditory landscape,” he says, and so we may not notice if sounds disappear.

Arlitsch notes that the sounds of howling wolves, which draw thousands to Yellowstone National Park each year, were once gone from the park because the animal had been eradicated there by humans in the early 20th century. “It was a part of the ecosystem that was missing,” Arlitsch says.

A hawk takes flight in the Goshute Mountains of Nevada. Hawk sounds are included in the U library’s collection. (Photo by Kenning Arlitsch)

A hawk takes flight in the Goshute Mountains of Nevada. Hawk sounds are included in the University of Utah library’s collection. (Photo by Kenning Arlitsch)

Once a species is gone, it’s not likely to come back. As a means of sharing that conservation message, sound has proved to be a powerful tool, Arlitsch and Rice say. “A recording can appeal to so many different people,” says Rice. “It can appeal to a 5-year-old or my 9-year-old son, and they think it’s fascinating. That same recording can appeal to a professional biologist who wants to understand the bioacoustics of that creature. It really crosses over.”

Recordings from the Western Soundscape Archive are featured throughout the U’s new Natural History Museum of Utah. Rice worked closely with the museum and recorded and designed sounds for six major dioramas and several other listening areas within the building. Many recordings were also supplied by archive consultant Kevin Colver MD’83, a former Utah physician now living in Florida who has recorded the songs of many birds in the West.

Scientifically defined, sound is the auditory sensation created by pressure variations that move through mediums such as air or water. A soundscape is the symphony of sounds that populate a place—a combined chorus of wind, water, wildlife, vegetation, and even man-made noises that make up the background music of life. The gift of hearing those sounds is not just for communication or auditory enjoyment, but a critical part of survival for every species on the planet, says Fristrup, who is based in Fort Collins, Colorado. It is sound that alerts all creatures to things unseen and helps them locate prey or predators and even mate. Sound is so important that researchers have found some cave-dwelling animals that have evolved to survive without sight, but no vertebrate species is known to have lost hearing, he says.

“It doesn’t matter what you are doing, including when you are sleeping: Your ears are always tuned into the world,” Fristrup says. “The value of something like the Western Soundscape Archive is to provide people with educational material so that the next time they go out into nature, they listen more intently.”

Sound can also leave a strong auditory footprint in our minds. Because of the way the brain processes the senses, sounds, like smells, are wired for connections on a very elemental level. It’s why music can make a person cry, or a wave of homesickness can be triggered by crickets singing on a hot summer night. “Hearing connects us intimately with nature and with our environments, but also connects us quite intimately with memory,” Fristrup says.

That sort of emotional tug led Rice to pursue a life with a microphone in hand. As a kid growing up in western Washington, Rice was captivated by the croaking frogs in the woods near his home. “With frogs especially, very often, you don’t see them, you just hear them. It’s mysterious and interesting,” says Rice. “I never got over that.”

Kenning Arlitsch, shown here at the U’s Rio Mesa Center, was a co-founder of the Soundscape Archive.

Kenning Arlitsch, shown here at the U’s Rio Mesa Center, was a co-founder of the Soundscape Archive. (Photo by Kenning Arlitsch)

Rice went on to obtain degrees in electronic music and recording media. A career as a radio producer allowed him to pursue stories that fed his interest in science and the natural world, and along the way, he began to develop a robust collection of animal and ambient wilderness noise recordings. But he also noticed a gap. Some of the sounds he sought for use in storytelling—a northern grasshopper mouse call, for example—weren’t readily available. Others were disappearing as development and human activity encroached on open spaces, and he thought they ought to be preserved. “I realized that this stuff wasn’t really available anywhere and thought this might be something libraries would be interested in collecting, so I approached Kenning with the idea,” Rice says.

Arlitsch, then the associate dean for Information Technology Services at the University of Utah, loved the idea. Raised in crowded and noisy New York, Arlitsch had become an avid hiker and recreationalist with a deep love for the West’s wide open spaces and dramatic landscapes. At first, though, those feelings were largely tied to his visual experience, he says. “Jeff really turned me on to the auditory concept that places don’t just change with the human impact, but they also change in terms of sounds that are there or not there,” says Arlitsch, who in 2012 became dean of Montana State University’s library in Bozeman.

At the University of Utah, the soundscape project was a natural evolutionary progression of work already being done to digitize the Marriott Library’s collections, including books, photographs, maps, and newspapers, Arlitsch says. In 2007, he and Rice won a three-year, $350,000 National Leadership Grant from the federal Institute of Museum and Library Services, and the Western Soundscape Archive was born.

Today, the archive features about 2,640 recordings, including animal sounds and ambient noise from areas across 11 Western states: Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. The collection also contains 60 hours of recordings from Alaska’s Arctic National Wildlife Refuge gathered during a 2006 expedition that was partially funded by the University of Utah. Through the entire collection, curious listeners can enjoy more than 680 hours of sounds that include screaming hawks, hooting owls, and growling bears, says Anna Neatrour, a Marriott librarian who was a project manager for the archive. Listeners seeking a more peaceful or relaxing experience might prefer to tune into the pre-dawn rain shower and birdsong from the Ironwood Forest National Monument in Arizona, or the babbling alpine stream that crisscrosses Alta, in Utah’s Albion Basin. Some of archive’s recordings last only a few seconds, like the high-pitched squeak of an arboreal salamander’s exhale. Others go on for several minutes, and many of the ambient sound recordings, including the one from the Ironwood Forest, can last nearly a half hour.

Deciding just what should be recorded and how to gather it was a challenge. From the Pacific coast to the valleys, deserts, and peaks, the West has countless soundscapes to document. The landscape includes more than 1,100 different vertebrate species, including various types of frogs and toads, salamanders and newts, birds, turtles, lizards, snakes, and mammals. Rice attacked the sizeable problem by dividing the West up by region and species and making strategic decisions about what was needed to create a collection that provided a strong representation of Western animal species.

Rice recorded much of the archival material himself, but also relied heavily on contributions from volunteers. In all, 80 individual recordists or organizations contributed to the project, including the National Park Service, which donated thousands of hours of recordings for which there was no publicly accessible archive.

Archive co-founder Jeff Rice records sounds in Utah’s Range Creek area during a 2009 trip. (Photo by Kenning Arlitsch)

Archive co-founder Jeff Rice records sounds in Utah’s Range Creek area during a 2009 trip. (Photo by Kenning Arlitsch)

The craft of making a recording depends in part on what story one is hoping to tell, so the approach to each recording and the equipment needed to get it will vary, Arlitsch and Rice say. If the focus is on an individual species, then the approach is more targeted. An animal’s habitats and habits must be identified. Permission or permits might be needed from state or federal agencies to gain access to an area. Then the recordist heads into the field, armed with a microphone, a recording device, headphones, and a parabolic dish—a sphere that collects sound from a large area and focuses it on the microphone. If ambient sounds from a location are the goal, a microphone can be set up in a specific spot and left to record on its own for hours at a time.

Either way, the recordist needs a good plan, a healthy dose of patience, and a reliable alarm clock. Rice often gets up well before dawn to trek to a recording location, because the early morning hours are the best for finding wildlife and limiting man-made disruptions. “There’s a window from about 4 a.m. to maybe 6 a.m. where it does feel like you’re alone in the world,” says Rice, who counts Yellowstone National Park among his favorite places to record. “You keep your ears open for the bears, and you’re alert, and then the animals start to tune up and chorus us. It’s a pretty special experience.”

Once sound clips were gathered, Arlitsch and his team, including Neatrour, stepped in to build the archive’s website and the infrastructure needed to support it. That meant shepherding high-resolution recordings through the digitization process, which readies the audio files for streaming over the Internet. Metadata for each recording also had to be written. The goal was to provide as much information about the animal and its specific recording as possible, right down to the time of day, weather conditions, and global positioning system coordinates. As designed, the site,, lets curious listeners browse the archive using an animal’s common name—like greater sage-grouse—or by its Latin name, so in this case, Centrocercus urophasianus. A link to maps also lets site visitors see just where various species make their homes across the West.

Arlitsch says he and Rice would like to see the U’s Western Soundscape Archive become a research and teaching tool, and not just for those interested in bioacoustics. “We think there are medical or therapeutic or psychological practices that can come out of this, as well as environmental research, of course,” Arlitsch says.

The call of a moose is part of the collection in the Western Soundscape Archive. (Photo courtesy J. Willard Marriott Library, University of Utah)

The call of a moose is part of the collection in the Western Soundscape Archive. (Photo courtesy J. Willard Marriott Library, University of Utah)

Without additional grant funding, no new recordings are currently being added to the archive, but Neatrour says the Marriott Library has acquired a state-of-the-art digital preservation system and plans to transfer the archive’s contents, to better preserve the files for the long term. The soundscape’s availability is also expanding. Its contents recently were added to two larger collections: the Mountain West Digital Library, a digital hub for libraries, museums, and historical societies in six Western states; and the Digital Public Library of America, which aggregates photographs, manuscripts, sound, and film from sources across the United States.

It’s not clear whether the Western Soundscape Archive contains sounds that have never before been recorded—that’s a difficult thing to know—but both Rice and Arlitsch say the project brought more than a few surprises and deeper awareness of just how rare and special it is to record the animals that roam the West. “There is so much more variety and so much potential to discover, that the work is never going to end. There’s always going to be more to do,” says Rice. “It’s important for all of us to just pay attention to the natural world. If a recording in an archive will help you with that, which I think it does, that’s valuable.”

—Jennifer Dobner, a former longtime Associated Press reporter and editor, is now a Salt Lake City-based freelance writer and a frequent contributor to Continuum.

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Genetics and U

Gregg Johnson is trying to outlive his family history. To do that, the 57-year-old textiles artist has had a colonoscopy every year since the mid-1980s. Each time, doctors remove upward of 150 tiny polyps in hopes of preventing colon cancer. Johnson lost his mother, Sandra “Sammy” Moon Johnson, to metastasized colon cancer in 1983 when she was just 47 years old. Her mother also died from the disease, at age 42, just like dozens of others on the branches of Johnson’s family tree. “We’re cancer magnets,” Johnson says.

Johnson, who lives in Salt Lake City, keeps his health closely in check thanks in part to University of Utah scientists and researchers who tapped his family for genetic testing and cancer studies more than 20 years ago. Tests confirmed what the family essentially already knew: Their biological lineage includes a genetic mutation that predisposes them to colon cancer and can be traced back to a single English couple who emigrated to America in the early 1600s. The U’s research study, which stretched over a dozen years and included data on hundreds of Utahns, helped investigators unlock critical genetic coding linked to APC— adenomatous polyposis coli—a syndrome characterized by the early onset of colon cancer, says Deborah Neklason PhD’99, research assistant professor of oncological sciences at the University of Utah Medical School and director of the Utah Genome Project. The data and health protocols, when paired with a clinical intervention, including genetic counseling, testing, and regular colonoscopies, have helped reduce familial cancer rates for Johnson and others. “We have prevented almost all the [potential] cancers in that family,” says Neklason. “This is about a change in behavior and awareness. This is an incredible story of the impact of genetic testing.”

For decades, U researchers and investigators have played a critical role in identifying pieces of the genetic puzzle that continue to change the face of medicine, from understanding how some diseases work to improving patient diagnoses, medical outcomes, and daily health management. At the same time, researchers and patients have been watching court cases, involving Myriad Genetics and the U Research Foundation, proceed over patenting of some of that research and related questions about future studies, as well as public access to genetic testing and personalized medicine. The outcome of those cases is factoring into the future course of the research.

Genetics is the study of how specific traits and characteristics are biologically transmitted to us by our parents. Formed by deoxyribonucleic acid, or DNA, genes are the physical units of heredity that are carried on our chromosomes. Scientists believe each person’s body has about 20,500 separate genes, the totality of which is known as the genome. Isolating those genes has helped scientists identify anomalies that either cause or increase our risk for some diseases. Over the past four decades, advancements in genetic research have provided enormous insight into the workings of the human body and the causes of disease, says Lynn Jorde, chair of the U Medical School’s Department of Human Genetics. Genetic tests can indicate if a person is a carrier for a disease or if an unborn child will have genetic conditions. “It gives us the potential to treat disease more efficiently and, in some cases, even to prevent disease altogether,” says Jorde, whose own research includes the genetic basis of both hypertension and human limb malformation.

Deborah Neklason, a U research assistant professor of oncology and director of the Utah Genome Project, notes that genetic testing, paired with clinical intervention, has helped save patients’ lives. (Photo by Tom Smart)

Deborah Neklason, a U research assistant professor of oncology and director of the Utah Genome Project, notes that genetic testing, paired with clinical intervention, has helped save patients’ lives. (Photo by Tom Smart)

University of Utah researchers can claim dozens of key discoveries in genetic and molecular medicine, including genes responsible for more than 30 diseases, such as melanoma, atrial fibrillation, hypertension, macular degeneration, and neurofibromatosis. U scientists also are credited with developing key tools in bioinformatics to help further understanding of how genetic material works. “The University of Utah is great at this, and they have been for a long time,” says Lawrence Brody, chief scientific officer at the Maryland-based Center for Inherited Disease Research at the National Human Genome Research Institute. “The faculty there has made fundamental contributions to human genetics.”

Brody attributes Utah’s critical mass of talent to two factors: significant philanthropic funding to support genetics research, and a population of large families with a Mormon church-supported predilection for genealogy work, which has provided a trove of family history to aid in genetic study. The University houses the Utah Population Database, with some 20 million records that layer family genealogies with state demographic records, including data on births, deaths, cancer rates, and other medical diagnostic and treatment records. It is the only resource of its kind in the United States and the largest such database in the world. The church/state partnership provides records on about 7.3 million individuals, some of whom can be linked to 11 generations of relatives. The databasesupported through the generous financial assistance of the Jon M. Huntsman family, the Huntsman Cancer Foundation, and the Huntsman Cancer Institutehas enabled about 100 research studies, allowing investigators to analyze patterns of genetic inheritance and identify specific genetic mutations.

Genetic data are instrumental in the development of personalized medicine. Knowing what’s in a person’s genome allows physicians and patients to make more informed health care choices, Jorde says. To date, scientists have been able to link about 4,000 diseases to mutated genes, according to the American Medical Association. Yet genetic testing still has many limitations, Jorde says. The testing, which is done through sampling of tissue, blood, or other body material, can only provide a predictive risk assessment, and then only for some diseases. Test results can be missed or misinterpreted. In some cases, research and technology may not yet exist to explain some genetic mutations, even though those mutations can be identified. “People think, well, I can just get genetic tests and find out everything about me, all of my predispositions to everything,” Jorde says. “In reality, genetic testing, while it can be very useful in certain contexts, only reveals predisposing factors. Sometimes they can be very powerful predictors; sometimes they can be only approximate predictors.”

The biomedical community can sometimes contribute to public confusion about the power of genetic testing, in part because researchers “want to say this is important and useful,” Jorde says. That’s where some in the research community become uncomfortable with companies that offer direct-to-consumer genetic tests that in many cases are for diseases for which the genes haven’t actually yet been identified, such as the gene for bipolar disorder.

A computer charts a genetic analysis of a patient at the University of Utah. Genetic data are instrumental in the development of personalized medicine. (Photo by Tom Smart)

A computer charts a genetic analysis of a patient at the University of Utah. Genetic data are instrumental in the development of personalized medicine. (Photo by Tom Smart)

Questions about commercial genetic testing were at the center of the 2009 lawsuit against the Salt Lake City-based biotech company Myriad Genetics, the University of Utah Research Foundation, and their partners. Filed by the American Civil Liberties Union on behalf of more than 20 plaintiffs, including medical associations, researchers, health advocates, and patients, the case asked one central question: Can a human gene be patented? More specifically, ACLU attorneys challenged whether the U.S. Patent and Trademark Office should have issued a patent on the tumor suppressor genes BRCA1 and BRCA2 to Myriad Genetics, which was founded in 1991 by a team of scientists, including then-U genetics researcher and medical professor Mark Skolnick.

One of the first companies to examine the relationship between genes and human disease, Myriad was created to develop genetic tests based on research from the U, including Skolnick’s work to isolate the BRCA1 and BRCA2 genes. The U Research Foundation, which facilitates commercialization of faculty inventions from many academic disciplines, later licensed Skolnick’s discoveries to Myriad. Over two decades, Myriad has paid its BRCA patent partners—the U, the Hospital for Sick Children, Endorecherche Inc., and the Trustees of the University of Pennsylvania—8 percent of its annual profit in the form of royalties, or more than $57 million, Myriad spokesman Ron Rogers says. The U’s share of the royalties has amounted to more than $40 million over the years as of last fall and is used to support further research and education programs at the University, according to Tom Parks, the U’s vice president for research.

Certain variations in the BRCA1 and BRCA2 genes signal a person’s risk for some hereditary forms of cancer. Women with a BRCA mutation face a 36 to 85 percent lifetime risk of breast or ovarian cancer. In men, BRCA gene mutations are linked to breast and prostate cancers. The BRCA genes earned wide public attention in May 2013 after film actress Angelina Jolie announced she had undergone a bilateral prophylactic mastectomy following genetic testing. Jolie lost her mother to both breast and ovarian cancers.

In the lawsuit, ACLU attorneys claimed the patents on the BRCA genes gave Myriad, which didn’t license the patents to other researchers, an unfair monopoly on the genes and their associated genetic information, as well as the predictive tests for the mutations, which at roughly $3,000 could be too expensive for some patients. ACLU attorneys argued the exclusivity was a civil liberties issue because it “limits the public’s right to benefit from scientific breakthroughs that advance medical research,” court documents state. “This monopoly has a chilling impact on other researchers’ ability to conduct medical research, undermining advances toward better treatment, cures, and more accessible, affordable genetic testing. … Such a monopoly serves to profit one company at the expense of the public good.”


Elaine Lyon, director of molecular genetics and genomics at ARUP, says many in the molecular sciences industry have long been opposed to patents and see them as a disincentive to innovation and a barrier to helping patients. The royalty fees have also driven up research costs and made patient tests expensive. (Photo by Tom Smart)

Myriad attorneys argued that patents have been used for more than 100 years, across all kinds of commercial economies and industry, to provide a critical incentive for investment in innovation and discovery. “Research is a very expensive proposition,” Myriad attorney Ben Jackson says. “Companies have to spend millions of dollars to make these discoveries. But more importantly, to bring these discoveries to the average person, companies need incentives.”

The U.S. Trademark and Patent Office has issued thousands of gene patents since the early 1980s as the pace of genetic research and discovery exploded. By 2005, nearly 24,000 genes had been identified, and more than 4,300—20 percent of the whole human genome—had been claimed as intellectual property. In the early days of genetic discovery, academic researchers, private labs, and biotech companies all sought out patents as a means of preserving future commercial opportunity, even if they weren’t quite sure about the value of their work. “Twenty or so years ago, [patents] really helped push people a little bit forward,” says Brody, of the Center for Inherited Disease Research. “There was a rush to find the genes that were responsible for the major diseases, and because they were patentable, they were patented. They were staking out turf.”

But patents proved troublesome and less profitable for most in biomedicine, says Brody. In most cases, patent holders found “there was little money to be made” from the claims they had staked on specific, single genes, he says. Researchers also found that the patents were barriers to advancing their scientific discovery.

As a young researcher, molecular geneticist Elaine Lyon says she found herself stymied many times in the lab because she kept bumping into patents in her work on a test to identify a protein that metabolizes drugs in the body. In some cases, Lyon wasn’t even studying the specific patented gene but was still blocked because the area of her interest was part of a genetic sequence that fell under a patent’s umbrella. “At this point, I was getting more and more frustrated,” says Lyon, who is now the director of molecular genetics and genomics at ARUP, an anatomic pathology reference laboratory on the University of Utah campus.

Lynn Jorde, chair of the U Medical School’s Department of Human Genetics, notes that genetic research helps give doctors the potential to treat disease more efficiently and, in some cases, prevent it altogether. (Photo by Tom Smart)

Lynn Jorde, chair of the U Medical School’s Department of Human Genetics, notes that genetic research helps give doctors the potential to treat disease more efficiently and, in some cases, prevent it altogether. (Photo by Tom Smart)

Lyon says many in the molecular science industry have been long opposed to patents and see them as a disincentive to innovation and a barrier to helping patients. The royalty fees associated with using patented genes have also contributed to stalling research by driving up costs or making the tests that resulted from research too expensive for patients, says Lyon, who is also president of the Association for Molecular Pathology. The association’s members had mixed opinions about the Myriad case, but Lyon says she shared the views of one colleague who said no matter the outcome, “it would be best for the field if we just had this decided once and for all.”

The unanimous decision from the U.S. Supreme Court came on June 13, 2013. The court ruled that genes cannot be patented, because they are a product of nature. “Myriad did not create anything,” Justice Clarence Thomas wrote in the court’s opinion. “To be sure, it found an important and useful gene, but separating that gene from its surrounding genetic material is not an act of invention.”

The decision invalidated Myriad’s five patents associated with BRCA genes and has similar implications for other gene patents that have been issued over the years. But the court did not leave researchers or biotech companies entirely without opportunity or incentives for competition. The ruling says patents can apply to cDNA, or artificially constructed DNA that contains some section of isolated, natural genomic DNA. Innovations in medical research technology and development in disease testing processes would also likely be patentable.

Whether the court’s decision will squelch investment and commercial development isn’t clear, although it may cut into the profits of biotech companies by increasing competition. On the same day the ruling was announced, two companies said they would immediately begin offering their own BRCA tests to the public. At least five related lawsuits remain pending.

Myriad Genetics, with headquarters located in the U’s Research Park, was founded in 1991 by scientists including then-U professor Mark Skolnick. (Photo by Tom Smart)

Myriad Genetics, with headquarters located in the U’s Research Park, was founded in 1991 by scientists including then-U professor Mark Skolnick. (Photo by Tom Smart)

Another potential impact: Research universities that have partnered with private companies to take their discoveries into the commercial marketplace may suffer some financial losses. Revenues from royalties, which are paid in exchange for licensing rights, could drop, Myriad’s Jackson says. “Any university should be concerned about an alternate, broad reading of the court decision.”

Jackson believes the court’s opinion is “appropriately narrow,” but also not entirely timely. “Gene patenting is in its twilight,” he says, because most of the important gene discoveries were made prior to 2001, when the Human Genome Project, which has mapped the entire human genome, first began publishing its findings.

Brody agrees that Supreme Court case was somewhat oddly timed, considering the fizzling competition for gene discovery, but he still believes it will have a significant impact. “I think it’s an important decision, because it allows individuals and companies to go forward and use the genetic information to innovate and invent new things without worrying about whether you’re on somebody ’s turf,” he says.

Neklason, at the U Medical School, says that if the ruling had come 10 to 15 years earlier, it might have made the research climate “more collaborative and less competitive,” but neither she nor Jorde believe it will have much effect on the day-to-day mission of U genetics investigators. “No matter what, you are going to see some competition; scientists are competitive people,” Jorde says.

Currently, U scientists are involved with at least nine ongoing research studies in medical genetics, such as projects to identify high-risk genes for childhood cancer, and assessing cancer risks for diseases with known cancer genes, including psoriasis and arthritis, chronic obstructive pulmonary disease, and familial atrial fibrillation. In addition, more than a dozen new projects are beginning this year, including studies on the genetics of Lou Gehrig’s disease, genetic susceptibility to spontaneous pre-term birth, and locating a “thinness” gene to prevent obesity.

Gregg Johnson credits genetic testing with helping prevent cancer in his family. (Photo by Charlie Ehlert)

Gregg Johnson credits genetic testing with helping prevent cancer in his family. (Photo by Charlie Ehlert)

Meanwhile, the effects of the Supreme Court ruling should help drive down the costs of gathering genetic information, ultimately benefiting patients in terms of both access and overall health and well-being, U researchers predict. Currently, it costs about $8,000 to have a private lab produce a person’s entire genetic sequence—far less than in the past, and about the same price Myriad charges now to run just the two BRCA gene tests. In the future, sequencing could cost even less.

For his part, Johnson believes knowing more about his genetic health is saving his life. Not a fan of doctor visits or pill popping, the father of two boys says his increased awareness about genetic factors has also led him to gently nudge many of his friends to seek testing. “I’ve outlived my mom by a number of years, so from my perspective, this is saving my life,” he says. He’s also grateful to know that in some small way, his family ’s history and participation in research work will likely help many others. “My mom was very gracious and giving, and she was always thinking about others,” says Johnson. “I’m sure she’d approve.”

—Jennifer Dobner, a former longtime Associated Press reporter and editor, is now a Salt Lake City-based freelance writer and a frequent contributor to Continuum.

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Paths to Completion

Sarah Hammer’s friends like to say she “runs the U.” Hammer giggles with some embarrassment at the description but can’t deny the facts: Over her four years at the University of Utah, the 22-year-old senior has developed an impressive résumé of campus involvement that includes serving as both a Freshman Council and Student Alumni Board member, an Associated Students of the University of Utah representative, and a dormitory resident adviser. She’s also worked as a social justice advocate and was the 2012 Homecoming Queen. All the while, she’s taken close to a full load of classes each semester as an exercise and sport science major and has maintained a 3.7 GPA.

But juggling school and extracurricular activities has had a downside: It has slowed Hammer’s path to graduation. This fall, the Brigham City, Utah, native is starting her fifth year of college, and she says she’s feeling “pressure to graduate next spring.”

Hammer is far from alone. Most college students now take more than four years to get from freshman year to cap and gown. Like Hammer, some delay by choice, opting out of full-time classwork to balance their busy lives, while others may be derailed by financial or family challenges.

Hammer says she’s glad to have taken more time, because her experiences and opportunities have led to scholarships and helped her decide on what she wants in a career. But with the United States now ranked 14th among the 36 countries that track graduation rates, higher-education institutions are increasingly looking for ways to help students finish in four years and still have a rich collegiate experience. “It’s a complex problem facing a majority of educators,” University of Utah President David W. Pershing says.

In 2011, the most recent year for which comprehensive figures are available, the average graduation rate for students receiving a bachelor’s degree within six years of entering college was 59 percent nationwide, according to data gathered from both public and private colleges by the U.S. Department of Education’s National Center for Education Statistics. The University of Utah’s graduation rate was slightly below that national average, at 55 percent.

According to The Chronicle of Higher Education’s 2011 College Completion report, the U in 2010 had the highest graduation rate of any publicly funded Utah college, at 56.4 percent. Utah State University was second at 54.6 percent, and Weber State University was third, at 40.6 percent. That’s something to celebrate, says Pershing, but the U still has “significant room for improvement” and myriad reasons why it is important to do so.


University of Utah President David W. Pershing, left, has said one of his main goals is improving student success, including graduation rates. (Photo by August Miller)

University of Utah President David W. Pershing, left, has said one of his main goals is improving student success, including graduation rates. (Photo by August Miller)

“The first is the long-term impact of graduation on individual lives,” the president says. “Every student who enters the U makes an investment in their education. In turn, the University and the state also make an investment in them. If they leave before graduation, there is far less return on either investment. The student will likely feel the impact of not completing their education throughout their lives, in both psychological and financial terms.”

grad-rates-500pxResearch in many disciplines over the years has found that college graduates typically have better health and live nearly seven years longer, on average, than those who only finish high school. College graduates generally have better work lives, are less likely to use government assistance, have better family relationships, and volunteer more often. Their children also tend to have more educational success.

College graduates fare better economically, as well. A 2012 report by the State Higher Education Executive Officers Association, titled The Economic Benefit of Postsecondary Degrees, shows that those who receive associate degrees earn at least $9,000 more annually than individuals who have only a high school diploma. A bachelor’s degree can raise annual income another $11,753. At the University of Utah, where 75 percent of the students come from within the state and many stay after graduation, that translates into a stronger tax base that benefits the state as a whole. “We are building stronger communities with stronger graduation rates,” the president says.

When Pershing began his presidency in 2012, he announced that one of his main goals would be improving the undergraduate experience and student success, including graduation rates. The U also has backed Utah Governor Gary Herbert’s initiative to raise college graduation rates statewide.

U.S. Census data show that just 40 percent of Utahns hold an associate or bachelor’s degree. That’s better than the national average, but the data also reveal that more Utahns—28 percent compared to 22 percent nationwide—have taken some college coursework without completing a degree.

Herbert wants to increase the proportion of Utahns obtaining post-secondary degrees or certificates to 66 percent by 2020. The goal is based on the findings of a 2010 study by Georgetown University’s Center on Education and the Workforce that projects that two-thirds of Utah jobs will require a postsecondary certificate or degree by 2020. Pershing admits the 66 percent goal is “ambitious” but says that even after just a few years of effort, the numbers are trending in Utah’s favor. To keep college educators and administrators on track, the Utah System of Higher Education has also set a smaller goal of increasing the number of degrees awarded in the state by 4 percent each year.

“That might not seem like a lot,” Pershing says. “But the number of degrees awarded in the state increased by 3.76 percent in 2010, 5.69 percent in 2011, and 4.1 percent in 2012.”


Sarah Hammer, right, and Machi Johnson walk outside the U's residence halls. (Photo by Brian Nicholson)

Sarah Hammer, right, and Machi Johnson walk outside the U’s residence halls. (Photo by Brian Nicholson)

Utah is far from the only state wrestling with the complicated issue of improving educational performance and increasing graduation rates. And while there’s a crushing amount of data on the issue, with studies and analyses from multiple foundations, think tanks, and research centers in addition to the annual federal reports, it’s hard to find reliable numbers that provide a clear and accurate picture, says Terry Hartle, senior vice president for government affairs at the American Council on Education: “In every case, you need to look below the numbers to understand what’s taking place.”

The federal government calculates graduation rates based only on full-time, first-time students who enroll in the fall. If you transfer to another school, or take time off to work or, to use an example particularly relevant in Utah, serve a mission for The Church of Jesus Christ of Latter-day Saints, then statistically, you’re considered a dropout by the U.S. Education Department, he notes.

In the University of Utah’s case, the federal numbers show the rates of U students completing degrees after six years at close to or slightly behind the national average for comparable schools. Look a little farther out, and the picture gets brighter, with 71 percent of U students receiving their degrees within eight years, compared with the national average of 60 percent.

Three-fourths of the state’s college students work while attending school, and they tend to graduate with less debt than their peers nationwide. Many Utah college students also get married and have children earlier than their counterparts nationwide. And students often are unprepared for the academic rigors of college. About 50 percent of freshmen entering Utah’s two-year colleges enroll in some remedial courses. Remedial course work is also required for about 20 percent of those entering the state’s four-year colleges.

Another common denominator that presents a barrier to college completion is lack of financial resources. “Funding for education has continued to shrink across the nation, and tuition rates have increased to compensate,” the president says. “It is critical that we find ways to support our students financially as they endeavor to attain an education.”

Barbara Snyder, the U’s vice president for student affairs, says decades of research show several common denominators point to student persistence and success. Students who live and work on campus, for example, tend to stay on track educationally, and keeping work hours to a part-time schedule also helps. Other factors that contribute to success include family support, financial support, and learning communities that help strengthen students’ commitment to reaching their educational goals.

Barbara Snyder, vice president for student affairs, is overseeing the strategies for increasing graduation. (Photo by Brian Nicholson)

Barbara Snyder, vice president for student affairs, is overseeing the strategies for increasing graduation. (Photo by Brian Nicholson)

Addressing the U’s graduation rate challenge isn’t simple, and the University has launched a series of programs and strategies to tackle the issue on multiple fronts. Chief among them is an enrollment initiative that more carefully considers which students come through the door. The approach takes a comprehensive look at students, from grade point averages and test scores to extracurricular activities and the specific courses in which high school students were enrolled.

“We want to make sure we are admitting the right students,” says Mary Parker, the U’s senior associate vice president for enrollment management. “We also want to ensure that we look holistically at the student, not just at their GPA.”

The new approach also means understanding that the challenges are different for full-time and part-time students, males and females, those married and unmarried, working students, those who are parents, and those who live on and off campus. Identifying and understanding those hurdles allows the U to develop strategies for providing better student support, including academic and career counseling, access to financial resources, and a range of other needs, she says. “The other piece of that is making sure we are communicating with students so that they know about us and the services on campus,” Parker says, “so when they do hit that speed bump, they know where to go.”

Pershing notes that the U also is expanding its opportunities for collaborative learning within and beyond the classroom. Those include the BlockU Program, which gives students a set schedule, organized around a specific theme; the Integrated Minor Program, a thematic course through General Education that extends over four years; and Learning Portfolios, a program that allows students to use digital portfolios for increased assessment benefits and to reflect on and synthesize their learning experiences, the president says.

The U Honors College has taken that theme of engaged learning a step further, by integrating academic and residential life. Some 300 students now live together in the Donna Garff Marriott Honors Residential Scholars Community on campus. Also in the works is the Pierre Lassonde Institute, a campus-based residential community for entrepreneurial-minded students.

The U is also working to support the state’s overall initiative to graduate more students with backgrounds in science, technology, engineering, and math, by increasing the size of entering classes in those disciplines, and hopes to get state help in funding the Crocker Science Center, which will improve laboratory experiences for students. And for students who may not otherwise have found a campus home, the U now offers the Beacon Scholars Program, which aims to connect students with peer groups, Pershing says. The University is also working to create a more efficient course structure and expand online and integrated course offerings to allow students greater flexibility as they try to balance education with work and life.

Snyder notes that the U has found more good results through strategic student support. In the summer of 2012, the U Futures Scholarship Fund was created by the Board of Trustees to help U seniors pay for their education when facing financial challenges due to unexpected life events such as an illness, accident, or family crisis. Thirty students were awarded aid in amounts totaling nearly $60,000, with the stipulation that they graduate within two semesters, and all of them did so by the end of this past summer, Snyder says. “We’re expanding that program, because we know that there are many students who get close to the finish line who just need a little push.”


Senior Associate Vice President Mary Parker is heading up the U's new enrollment initiative. (Photo by Brian Nicholson)

Senior Associate Vice President Mary Parker is heading up the U’s new enrollment initiative. (Photo by Brian Nicholson)

One statistical factor in the state remains a challenge for the University, however: Utah women start college at the same rate as men and at rates above the national average, but they are less likely to complete their bachelor’s degrees, Snyder says. About 31 percent of all Utah men hold bachelor’s degrees, but only 25 percent of the state’s women do. That gap is the highest in the nation.

“We’re quite concerned about that,” Snyder says. “We know many of our female students are going to end up as primary breadwinners for their families, and they are not completing their degrees.” According to the Utah Department of Workforce Services, more than 59 percent of married Utah women work, as do 74 percent of mothers with school-age children.

Utah System of Higher Education data also show that Utah women earn only 47 percent of all bachelor’s degrees, the lowest percentage in the nation. It’s a trend the state can’t afford to see continue, says Mary Ann Holladay, director of the Utah Women and Education Initiative, a spinoff from a governor’s task force on women in education. She and University leaders want to help foster a “culture of college” that helps expose young girls and their families to career and educational opportunities that motivate them to complete college degrees.

“As women, we compartmentalize our lives,” Holladay says. “We think education is an either/or proposition, but it’s not. We need to speak to young women early about the importance of having dreams fulfilled through education.”

The recent change in the minimum age for Mormons to serve missions for their church also presents a challenge for the U. Last year, the church announced the age requirement would change from 19 to 18 for men, and 21 to 19 for women. Many of those young men and women will forgo college after high school graduation to serve as LDS missionaries.

The Utah System of Higher Education anticipates some temporary challenges for the state’s seven public colleges, including drops in enrollment and revenue from the loss of tuition. U officials have told the State Board of Regents they anticipate as many as 860 fewer students for the 2013-14 academic year.

Sarah Hammer, right, talks with Emily Glende at the Heritage Center. (Photo by Brian Nicholson)

Sarah Hammer, right, talks with Emily Glende at the Heritage Center. (Photo by Brian Nicholson)

In response, the U has adopted a deferment policy that allows students to delay starting school for up to seven semesters after acceptance. That should accommodate the time students are serving missions: two years for men, and 18 months for women.

“We’re certainly paying a lot of attention to the missionary piece and what that means,” says Snyder. “One strategy will be making sure [students] make a commitment to higher education before they go, and making sure we have programs in place so that there is a seamless opportunity for them to return to the University.”

The American Council on Education’s Hartle believes it’s possible that the change may ultimately have a positive effect on Utah graduation rates, because students will enter college having learned a few life lessons and gained some maturity. Hartle compares the experience to what’s commonly called the “gap year” around the world, the time some students take between high school and college to “get a better sense of who they are, what their interests are, and what their skills are.”

Despite the challenges and uncertainties, Pershing says the U has ample support statewide from business and political leaders for its goals. And each of the programs being implemented at the University is designed to improve the quality of education overall, not just move the needle on graduation rates. “Our goal is to fully prepare them for success in this changing, competitive global economy and in life,” Pershing says.

Hammer says she supports those goals but doesn’t want administrators to think that every student who takes a slower path to graduation is a problem that needs to be solved. She’s been so inspired and enriched by her experiences at the U that she’s already got an eye on graduate school and a doctorate.

“I’d rather have had those experiences and taken a little bit more time to get my degree,” she says. “Just because we are taking a bit longer doesn’t mean we aren’t driven.”

Jennifer Dobner is a reporter with The Salt Lake Tribune and has been a
frequent contributor to Continuum.

Armed with Knowledge

On the day his high school classmates in Pensacola, Florida, donned caps and gowns to pick up their diplomas back in 2000, Gerald Sanders was already a week into Air Force basic training—learning the rules of the military justice code and marching to drills barked out by a tough sergeant. He went on to serve in the Iraq war and ran electronic warfare jamming systems to protect pilots, but he was forced to end his military career in 2006 when he developed iritis, a painful inflammation of the iris that can cause blindness. After he was discharged from Hill Air Force Base, he worked for a few years before enrolling at the University of Utah. Now 30, he is a business management major on track to graduate this summer. But his first years on campus were a blur of heavy course loads and limited interaction with other students, he says. Like many veterans, he learned quickly that talking about one’s military service can have a downside, even in conservative and patriotic Utah.

“People automatically think you’re a pillager, or a baby killer, or that every single war veteran has post-traumatic stress disorder,” he says, shaking his head. “We have veterans who don’t want to claim themselves as veterans because they don’t want to get asked the stigmatic question: How many people did you kill?”

Roger Perkins directs the Veterans Support Center, which opened in 2011

Roger Perkins directs the Veterans Support Center, which opened in 2011.

Experiences like his are becoming more common on college campuses nationwide. With wars in Iraq and Afghanistan coming to an end, many of the United States’ 2 million service men and women are enrolling in college. Over the past three years, more than 870,000 student veterans have tapped their Post 9/11 GI Bill benefits for school, according to the federal Veterans Administration. It’s said to be the largest influx of student veterans into higher education since World War II.

As of fall 2012, the University of Utah had identified 889 student veterans on campus, including 213 women. The group makes up about 3 percent of the University’s overall population and has been steadily growing. The U’s student veteran population has nearly doubled since 2007, when 459 vets were enrolled.

The University also has more student veterans than any other school statewide. Salt Lake Community College is a close second with 850, followed by Brigham Young University with 700, Weber State University with 650, Utah Valley University with 520, and Utah State University with 430.

Campus life has gotten a little easier for student veterans at the University of Utah since May 2011, when the U opened its Veterans Support Center. The center offers vets and active duty service men and women a place to connect with each other and a resource for navigating through the college experience.

Tucked away in a corner on the first floor of the Olpin Student Union Building, the center buzzes with students going in and out throughout the day to use computers, pick up information about coming events, or just grab a free cup of coffee and talk with staff or other vets. “The goal is to help veterans transition from a military environment to an academic environment—get in, graduate, get out, and go on to successful lives,” center director Roger Perkins says. “That means tutoring, accessing the GI Bill, counseling. One woman needed a babysitter. It means doing whatever it takes, because each veteran has a different set of circumstances.”

“We’ve got a guy, 62, who served in Vietnam, a 49-year-old with a 20-year Marine career, a 17-year-old, and everything in between,” says Perkins, a Vietnam-era vet who served 21 years in the Army and retired following Desert Storm. “They’ve got some college, no college, some were in school 20 years ago, some three or four years ago, and it’s difficult to get back into the swing of things sometimes. We give them a place to come and talk about that.”

Hitting the books after the battlefield presents a number of challenges, Perkins says. Veterans tend to be older than traditional students. Their life experience is more varied. They may have added responsibilities such as families to support, or ongoing military duties if they are now serving in the reserves. Many student veterans are also facing an education gap. Some may have gone from high school straight into the military, and it may have been five or more years since they sat in a classroom. And for those who have been to battle, there may also be some residual emotional issues to manage, including PTSD.

At the same time, veterans returning to school have already trained for and worked in skilled jobs, Perkins says. Most have developed strong work ethics. They know how to establish priorities, make decisions, and complete tasks. Those qualities can be assets, but sometimes also bring frustrations in the college setting, he says.

“I don’t know of any other job [like those in the military] where a guy 26, 27, 28 years old with a high school diploma and maybe a little college is going to be responsible for $4.6 million in capital equipment and seven people,” says Perkins. “Then you get out of the military and you come to college, and they treat you like a freshman. That’s a source of frustration.”

David Rudd, a former dean of the U’s College of Social and Behavioral Science and a psychologist whose research includes veterans issues, says societal systems, whether on a college campus or in professional employment communities, don’t give veterans credit for their work experience and training. A combat medic in Afghanistan or Iraq comes home from war having treated the wounded in a combat zone, for example, but can’t automatically qualify as an emergency medical technician in civilian life.

“You start back at the end of the line in terms of working your way back up,” says Rudd, who founded the National Center for Veterans Studies at the U and now is provost at the University of Memphis. “They have to repeat all of that education experience and then get supervisory experience. Those are the kinds of things that not a lot of people think about.”

Another problem is that the most common public narratives focus on veterans who are in crisis. It’s a story line that’s only true for a quarter or less of the veteran population, Rudd says. The majority, 75 to 80 percent, return from war with no mental health problems. And while combat veterans statistically will show a higher rate of PTSD than other military vets, studies have shown that among student veterans the percentages are not disproportionate to the rate of emotional struggles in the wider student population. On average, Rudd says, 20 to 25 percent of vets struggle with emotional issues secondary to combat. The same percentages of students have issues that are developmentally based on the transitioning to independence and being adults. “It’s just a different kind of struggle,” and not one that is widely known, he says.

Rudd believes that because the United States has an all-volunteer military, some veterans may suffer under the preconceived notions the public may have about what type of person even joins the military. Young college students who have not been in the military may have some stereotypical ideas about what it means to be a veteran and about what it means to be in combat, what it means to be deployed and to be in wartime and to have military experience. “So there’s really a chasm between how most people think about military service and what military service is really like,” he says.

Veteran Mary Huggins, 26, knows firsthand about those stigmas and says some of the issues differ for women. Huggins says when people find out she has been in the Air Force, they assume she has PTSD. She doesn’t. “I think that there’s a perception that everyone in the military is damaged goods,” says Huggins, who was a radio communications specialist and is working on a degree in communications. “We’re not. One thing I’ve heard in the classroom is that everybody expects that one day some vet is going to go postal and shoot everybody up.”

Both she and Sanders say most civilian students also think everyone who serves is in the Army and that the folks with the boots on the ground are also responsible for U.S. policies that involved the country in war. “They don’t realize that soldiers and sailors and airmen don’t make those policies,” says Huggins, who works at the Veterans Support Center.

Gerald Sanders, an Iraq war veteran and U student, is a business management major.

Gerald Sanders, an Iraq war veteran and U student, is a business management major.

Sometimes, it’s hard to hold your tongue, says Michael Cumming. The 31-year-old served 10 years on active duty, including three as a Marine and seven in the Army, achieving the rank of staff sergeant in an infantry unit on the front lines in Iraq. Now in the Army Reserves, the Seattle native is working on a degree in adventure and outdoor programs and frequently uses center services, including counseling for PTSD.

In one classroom, when the discussion turned to an incident involving Marines accused of urinating on the dead bodies of their enemies, Cumming says he blew his stack.

“I just had to stand up, and went off about what you have to do in war in order to be able to do the job. You have to dehumanize the enemy,” says Cumming, who served three tours and lost 17 of his friends. “I think people were pretty mortified, but I said what I had to say.”

Despite (and perhaps because of) moments like that one, Rudd says student veterans are an educational asset in the classroom. Vets bring a different set of experiences and perspective that can deepen the experience for both students and faculty. That includes providing a different way of thinking about the Middle East, America’s role in the world, and what an American presence in a foreign country means.

Part of Perkins’ mission is also to help faculty understand and appreciate the challenges veterans face. He wants professors to see the military as a culture with a set of standards, habits, and values that has shaped its young men and women, just as other forms of culture do.

Vice President of Student Affairs Barbara Snyder says the U, which funds the support center with about $120,000 annually, is committed to helping student veterans succeed and meet their unique challenges with grace, and not judgment. “We feel a tremendous sense of responsibility toward our veteran population,” Snyder says. “We provide an awful lot of support for traditional students, and parents, and all kinds of subsets in our student population. How could we not do this?”


“Writing on War” Offers Many Lessons

One of the first things you notice about Jeff Key, besides his towering 6-foot-4-inch frame, is his tattoos. “Warrior” stretches along the inside of his left forearm, all in lowercase script. “Poet” scrawls along the right. Both are apt descriptions.

Maximilian Werner

Maximilian Werner

Key is a 47-year-old U.S. Marine veteran who served in Iraq and is completing a bachelor’s degree in English at the University of Utah. The Alabama native, who enlisted in 2000, is also an accomplished playwright whose one-man show, The Eyes of Babylon, toured eight U.S. cities and Ireland. The play is based on journals and videos that document Key’s months in Iraq. Through storytelling, Key says, “we have a chance to redefine the veteran.”

Key was a natural fit for the U’s “Writing on War” course taught by Maximilian Werner, an instructor and lecturer with the College of Humanities. An author with three published books, Werner BA’93 (along with an MFA from Arizona State University) introduced the class in the spring of 2012 and taught it again in 2013. The course, which is open to both civilian and veteran students, draws on some of the best writing and films on war and pushes students to think beyond the stereotypical ways in which military service people are mostly portrayed: warrior as hero or monster.

“When you look at the narratives that we use to explain or to make sense of these different experiences, we’re just not given a lot of options,” Werner says. “There are broad ranges of experiences when we talk about the experience or phenomenon of war. It’s a complex story that has a lot of facets.”

Werner’s students contribute their own work, both fiction and nonfiction, to the conversation and are asked to look critically at the rhetorical devices used in crafting narratives. The class also has provided lessons in changing perspectives. Civilians, including Werner, who has no military background, have been given a window into the sharp edges of war. They have learned about the practical matters of unit organization and what military acronyms mean, as well as the political nuances that drive the way conflicts play out on foreign soil. And they have gained deeper perspectives about why someone like Key, who joined the Marines at age 34, one year before the attacks on 9/11, volunteers to serve.

Veterans have also been able to hear from civilian students about their views on 12 years of war as seen from U.S. soil, and gained deeper insight from telling their own sometimes difficult stories. “We learned from our collective experience,” says Key.

The goal of the class has never been to offer a therapeutic release, but Werner says students have told him that they were changed by the undertaking. A newcomer to writing, veteran Michael Cumming says the class took him on a journey he didn’t expect.

Cumming, 31, served three tours in Iraq. He was prodded to take the class by another teacher who saw promise in his prose. “It seemed like a good way to write about some of the experiences I’d had and to get some of that off my chest,” says Cumming.

Writing about war seemed easier to him than talking about it, and he says he was surprised by what ended up on paper. “I thought I would write about the battles. I ended up writing about taking a well-aimed shot on a kid that was digging a hole for an IED and about some of the guys I knew and the relationships I made,” says Cumming. “It was the first time I had real emotions about it.”

Werner considers the class perhaps the most important thing he’s done in his 20 years of teaching and hopes the class will continue to be offered during the next academic year. “It’s our responsibility as citizens to hear the stories of war, so that we understand what’s at stake,” he says.

Web Extras

Read samples of students’ writing from the class:

Well-Aimed Shot, by Michael Cumming
A Jazz Requiem for the Male of the Species, by Jeff Key
The Last Confession of Lance Corporal Judas Iscariot, by Jeff Key

One particular area of study critical to successful transitions for veterans is college outcomes and graduation rates, Mitcham notes. Over the past year, some media reports have suggested that as many as 88 percent of student vets drop out of college before graduating. The figure comes from a study by the Colorado Workforce Development Council and the Colorado State Office of the Department of Labor’s Veterans’ Employment and Training Service. But that study’s findings have been questioned by the national Student Veterans of America, which contends insufficient research has been done on student-veteran outcomes.

The conversation about developing a student support center came “at the right time and with the right people around the table,” she says. University officials were already talking about ways to address the issue when the campus Student Veterans of America group, which was an informal club, sought official status from the Associated Students of the University of the Utah (ASUU). “What I hope we are learning is that after someone has paid the debt to us and to our country, we have an opportunity to pay our debt to them,” Snyder says.

Mary Huggins and Michael Cumming chat with one another at the Veterans Support Center.

Mary Huggins and Michael Cumming chat with one another at the Veterans Support Center.

Other campuses across the nation are taking similar steps to accommodate veterans, according to the American Council on Education. Data collected from ACE surveys in 2009 and in 2012 show the number of dedicated veterans support offices on campuses nationwide grew 18 percent between those years. The findings of the 2012 report, based on responses from 690 institutions, show that 62 percent of colleges now provide military-specific programs and services. Nearly 90 percent of those had increased their campus services since 2009. The survey also found that the services, programs, and policies dedicated to meeting student-veteran needs are as varied as the veterans themselves, says Meg Mitcham, ACE’s director of veterans programs.

That’s about to change. In January, U.S. Secretary of the Department of Veterans Affairs Eric K. Sinseki announced the agency would partner with Student Veterans of America and the National Student Clearinghouse to gather graduation data to create an education database. Separately, in fall 2012, the U’s veterans studies center launched its own nationwide study of the factors contributing to the academic success of veterans. Those can include school-related factors, family military history, support from family and friends, life experiences, health, and stress, says Craig Bryan, an associate director of the U’s National Center for Veterans Studies and a former Air Force psychologist. As of this spring, more than 200 student veterans from across the country had taken the short online survey. Bryan is hoping for a total of 750 responses before closing the study.

A portion of the study focuses on suicide risk, which past studies suggest may be significantly higher in student veterans when compared to traditional students. “What we seem to be seeing so far is that the majority of student veterans who report ever having suicidal thoughts or making a suicide attempt did so before they joined the military,” he says. “Interestingly, we have found similar patterns in other military samples—which has caused us to reconsider how suicide risk emerges over time in military personnel and veterans, whether or not they are enrolled in college classes.” Rudd, who has testified before Congress about the needs of veterans, says he hopes such data will help the U and other institutions make thoughtful decisions about programming.

Perkins has high aspirations for the future of the Veterans Support Center, which now hosts monthly events, including a free pizza lunch and employment seminars. He wants to expand outreach to efforts and programs such as peer-to-peer counseling. He’d also like more space, and a bigger coffee pot. In time, he wants the center to grow into a gathering place for veterans, much like the day rooms that military units have in their barracks. “So that if [the world] out there doesn’t feel like a fit, you can come in here. It’s a touchstone to something that’s familiar. The culture exists in here,” he says.

Perkins has deep respect for the current generation of vets and says the battle against terrorism in which the United States is engaged is a conflict far different than those fought by past generations of soldiers, sailors, and airmen. “These kids for 10 years have known that this was a dirty war, and not one that anybody had trained for,” he says. “There’s not a homeland to take, there’s not ground to take. It’s more like a gang fight, but they still go in. I’m absolutely in awe of this generation.”

—Jennifer Dobner, a former longtime Associated Press reporter and editor, is a Salt Lake City-based freelance writer and a frequent contributor to Continuum.

Ed. note: In the print version, Barbara Snyder’s title was misstated, and Craig Bryan was noted as affiliated with an incorrect program. We apologize for both errors.

Web Extra

View a related video on “The Psyche of a Soldier” featuring former University of Utah Dean David Rudd here.

Web Exclusive Photo Gallery

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Game On

As kids growing up in Boston, Andrew Witts and his older brother Jason spent hours before a video screen, locked in fierce battle with armies of skeletons and zombies that were wreaking havoc over a virtual Conan the Barbarian-type world. The video game, Golden Axe, paired the brothers as heroes—one in the form of a gnome and the other a muscle-ripped barbarian. They fought against the kingdom’s archenemy, who had captured the royal family and stolen a magic axe. In the end, of course, the brothers always prevailed from their perch on the family couch, their nemesis was vanquished, and peace was restored to the kingdom.

“It was pretty much Lord of the Rings, only with an axe,” says Witts, a self-described “hard-core gamer.” “I really felt like my brother and I were the rulers of this land and we were protecting it from the evil enemy. We played endlessly.”

Curse of Shadows was released through Xbox in 2012. (Photo courtesy U Entertainment Arts & Engineering Program)

//Curse of Shadows// was released through Xbox in 2012. (Photo courtesy U Entertainment Arts & Engineering Program)

Now, as a first-year graduate student in the University of Utah’s Entertainment Arts & Engineering program, Witts is learning to channel his unbridled enthusiasm for game playing into a career. A collaborative, interdisciplinary effort between the School of Computing and the Department of Film and Media Arts, the program teaches graduate and undergraduate students to develop, design, and publish video games. It trains artists and engineers in the creative, analytical, and technical skills required to navigate a wide spectrum of digital mediums and to be leaders in next-generation technologies. Graduates are becoming game designers, filmmakers, special effects experts, animators, and more.

Andrew Witts, who grew up in Boston, is a first-year graduate student in the University's Entertainment Arts & Engineering program. (Photo by August Miller)

Andrew Witts, who grew up in Boston, is a first-year graduate student in the University of Utah’s Entertainment Arts & Engineering program. (Photo by August Miller)

“It’s an extremely broad set of skills and understandings that you have to have in order to make good games,” says Robert Kessler BS’74 MS’77 PhD’81, the program’s co-founder and the associate director of the School of Computing. “It’s very complex, and the technology and graphics being used are really pushing the frontier.”

Launched in 2007, the Entertainment Arts & Engineering program is already making its mark. The program has already been ranked among the top three video game design programs in the nation by The Princeton Review, which began issuing rankings just three years ago. [*In March 2013, the program became ranked number one for its undergraduate degree program and number two for its graduate program. See the Editor’s Note below the short author bio at bottom for more.] 


Corrinne Lewis, left, program manager of the U's Master Games Studio, talks with Rachel Leiker, a program assistant and graphic designer. (Photo by August Miller)

Corrinne Lewis, left, program manager of the University of Utah’s Master Games Studio, talks with Rachel Leiker, a program assistant and graphic designer. (Photo by August Miller)

Getting Women in the Game

Corrinne Lewis is a gamer. She got hooked as a kid playing alongside her father. By the time she was a young teen, she was hanging out in a Salt Lake City-area bar where she played console games. She also loved Dungeons & Dragons.

“I think I have always been a puzzle solver,” says Lewis BA’03, who is program manager for the University of Utah’s Master Games Studio, the graduate component of the U’s Entertainment Arts & Engineering program. Many of the video games she played while she was growing up focused on finding keys to riddles in order to win the game. More often than not, she was playing games with and against boys. Later, when she began working in sales and marketing jobs in the tech industry, she was also often one of only a handful of women. “But the reason I always liked tech is that it never mattered what I looked like; it was what was in my brain,” she says.

Even so, Lewis says she thinks about gender balance a lot when it comes to her students. At the undergraduate level, only about 10 percent of the approximately 200 students in the U Entertainment Arts & Engineering classes are women.

Women also have made up only about 10 percent of each of the program’s three graduate cohorts, Lewis says. The inaugural class in 2010 had 19 students, including three women, all of whom were artists. Class numbers jumped to 30 in 2011, but again that included only three women artists. The 2012 class also has 30 students and three women, although they come from diverse fields: one artist, one producer, and one engineer.

To help promote and support women in the digital entertainment industry, Lewis launched a U-based chapter of Women in Games International (WIGI) in April 2012, along with Laura Warner BFA’10 MFA’12, who was then a graduate student in the U program. Founded in 2005, the national nonprofit group, made up of both female and male professionals, works to promote diversity in all aspects of the video game industry, including game development, publishing, media, education, and workplace environment. Nationally, the number of female video-game designers is small. WIGI wants to change that, and believes that increased equality and camaraderie among genders will improve the industry overall and the quality of games produced. The WIGI chapters hold monthly social activities that double as networking and mentoring opportunities. The group also has an online mentoring service for members.

Graduate student Michelle MacArt BA’11 appreciates the effort. An artist whose true love is sound design, MacArt was one of the first women to enroll in Entertainment Arts & Engineering program classes as an undergraduate and expects to complete her master’s degree this spring. While developing games as class projects, MacArt says, she often advocates for the inclusion of female characters. She also pushes for those characters to look like “real” women, not ultra-skinny girls with unrealistic physical proportions.

“I was the only girl for the longest time,” says MacArt, who was on the student team that developed the Rapunzel’s Fight Knight game. “It’s a growing industry, and we need more women and ideas from women in game companies to balance them out. I’d like to see more in the arts and as programmers so that things are more diverse.”


Robert Kessler, left, co-founder of the U Entertainment Arts & Engineering program, sits with student Ashley McMillan. (Photo by August Miller)

Robert Kessler, left, co-founder of the University of Utah’s Entertainment Arts & Engineering program, sits with student Ashley McMillan. (Photo by August Miller)

In 2012, the U’s undergraduate program was ranked third in the nation, just behind the University of Southern California and the Massachusetts Institute of Technology. At the graduate level, the U’s program, known as the Master Games Studio, wasn’t among the 10 ranked programs, but was included with the nine other schools that received honorable mentions.

“Those rankings are amazingly useful,” says Kessler. “Now we’ve got kids calling us from all over—kids who never thought about Utah before. This year, we had 12 or 13 international students apply. The first year, we had none.”

The machinima movie Sekhmet was created by U students. (Photo courtesy U Entertainment Arts & Engineering Program)

The machinima movie //Sekhmet// was created by U students. (Photo courtesy U Entertainment Arts & Engineering Program)

Another source of bragging rights is that Entertainment Arts & Engineering students get jobs. Good jobs. Six-figure jobs, sometimes even before they finish the program. In 2012, each of the 16 graduating students in the first Master Games Studio graduate-program class had jobs in hand, Kessler says.

One thing that sets the program’s graduates apart is that they enter the workforce having already published a video game.

That puts them way ahead of the competition, Kessler says. “Industry says it’s like our students have had their first year of working out of the way, so that they can come in and really be productive. We really have tried to make this like a studio simulation.”

The U faculty members are also making technology advancements and developing new areas of academic research and design, particularly in the so-called “serious games” arena. That opens doors to commercial opportunities for the University and provides students with additional hands-on projects for learning.


Minions! was created and released by U students in 2011. (Photo courtesy U Entertainment Arts & Engineering Program)

The video game //Minions!// was created and released by University of Utah students in 2011. (Photo courtesy U Entertainment Arts & Engineering Program)

A Panoply of Games

Got game? The students of the University of Utah’s Entertainment Arts & Engineering program do. A driving purpose of the program at both the undergraduate and graduate levels is making sure students have the opportunity to produce and publish video games—valuable experience that gives them an advantage as they head to jobs in the entertainment arts industry. So far, most of the student-produced games are getting to market through small student-run companies—an experience that introduces them to careers as entrepreneurs. A handful of projects are being published through Utah Game Forge, a University-run company formed last year.

Here’s a year-by-year look at games students have created:


  • Rapunzel’s Fight Knight became the first published game by the student-created company Axull. About 500 copies have been sold through Xbox.
  • Urban Space Squirrels was published by DTA Entertainment, a student company. About 2,000 copies have been sold through Xbox Indie Games.


  • Mr. Gravity was published by the student-run team Angry Newton and distributed by Xbox. About 750 copies have been sold.
  • The Last Pod Fighter was published by the student company Fighter9 Studios and is distributed by Xbox.
  • Minions! was released by Turtle Toss Studios, a company composed of 10 students. With nearly 25,000 sold, this is the most financially successful Entertainment Arts & Engineering program game and was ranked by players as one of the 16 best Xbox Live Indie Games.


  • Curse of Shadows was published by the student company 1 Block East. Released through Xbox, some 400 copies have been sold.
  • Heroes of Hat became the first student-generated game published through Utah Game Forge, a U company created to market student work, and was the first game from students to use multi-player cooperative mode technology, which allows players to work as a team to accomplish the game’s goals. About 400 copies have been sold.
  • Tactical Measure was designed by students to work with a U professor’s prototype game controller that allows deaf people to play music-based games. Published by Utah Game Forge and released on Xbox Live Indie Games, it received an honorable mention at Microsoft’s 2012 Imagine Cup competition.
  • Robot Pinball Escape was developed by a team of graduate students, published through Utah Game Forge, and distributed by Desura. Downloaded about 13,000 times, PC Gamer mentioned it as a top free download. The game was also published on a disk that was inserted in Computer Bild, a European technology magazine, and distributed to 500,000 subscribers.
  • Erie was also released as a free download by Desura, after being published by Utah Game Forge. The virtual horror game has been downloaded by more than 35,500 people. It can also be played though YouTube and has developed a following among players who have posted videos of themselves playing the game. More than 2 million people have seen those videos.

Those kind of credentials are exactly what Witts, a graduate of the University of Massachusetts at Amherst with a degree in English and creative writing, was looking for in a graduate school. After considerable research of the 50 or so programs nationwide, Witts says the U’s program was the “intelligent choice,” so he quit his marketing job and moved 2,500 miles west to Utah. “I wanted to make games and release games, and I wanted to be given a forum where I could express myself,” says Witts, a self-taught Web programmer who also worked for an education software company. “What I saw in this program was a program that promised opportunity above all. I knew it would prepare me to get out and get a job doing what I love every day.”

Video games and other forms of digital entertainment media are big business. Economic forecasters project the global market for games—both hardware and software—will grow from about $67 billion in 2012 to more than $82 billion by 2017. In 2011 alone, the industry generated revenues of nearly $25 billion, according to data from the Entertainment Software Association. Consumer demographic data also show that the driving force behind the industry isn’t the stereotypical 17-year-old boy, playing games in his parents’ basement. In fact, more than 47 percent of all game players are women over age 18. Men ages 18 and younger make up only 17 percent of the games market. And the games themselves are also more diverse than stereotypes suggest. More than 40 percent of games played are digital versions of popular board games, puzzles, TV game shows, or trivia games.

In terms of dollars, Utah isn’t yet among the top 20 places where video games are made, but it’s getting close, says Roger Altizer MS’06, co-founder of the U’s Entertainment Arts & Engineering program and its director of game design and production. The state is perched on the industry’s cutting edge, and the presence of the U’s program provides an invaluable opportunity for both industry and students, he says.

Information technology is among seven industries that receive the focused attention of the Utah Governor’s Office of Economic Development. The state has set aside $5 million to support new information-technology companies and recruit top researchers through the Utah Science Technology and Research initiative, or USTAR. Craig Caldwell, whose experience includes work as a 3-D specialist for Walt Disney Animation Studios and serving as head of the largest film school in Australia, was hired by the U in 2009 as a USTAR professor of digital media.

Video gaming is by far the largest sector of the state’s information-technology effort, says Jeff Edwards, chief executive officer of the Economic Development Corporation of Utah, a private, nonprofit group that works closely with state officials. A 2011 report by that group said Utah had the fourth-highest per capita concentration of multimedia artists and animators in the nation. The industry employs about 2,100 people and added more than $93 million to Utah’s economy in 2009. The state has approximately 5,200 technology companies, of which more than 100 are digital media shops or film studios. Among the notable names are Disney Interactive Studios; Electronic Arts, Inc.; Imagine Learning; Chair Entertainment/Epic Games; Smart Bomb Interactive; and TruGolf, Inc.

Roger Altizer, co-founder of the U Entertainment Arts & Engineering program, stands with an original Pong console (signed by Nolan Bushnell) that was donated to the program. (Photo courtesy Roger Altizer)

Roger Altizer, co-founder of the U Entertainment Arts & Engineering program, stands with an original //Pong// console (signed by Nolan Bushnell) that was donated to the program. (Photo courtesy Roger Altizer)

To grow, the industry will need a steady stream of skilled workers and creative, innovative thinkers. The U Entertainment Arts & Engineering program’s focus and deep connections to industry set it apart from programs at other Utah schools, says Steve Roy, associate vice president for economic development at Utah Valley University and USTAR’s director of outreach and innovation activities in central Utah. “One of the key elements of economic development is workforce development and talent development,” says Roy. “The University of Utah has been able to access the industry and align themselves with industry needs. I think that’s why that program is such a good, solid program. They’ve spent the time to develop the curriculum.”

It should be no surprise that industry would find Utah’s flagship university offers a breadth of talent and a cutting-edge program, Edwards says. The Entertainment Arts & Engineering program’s roots reach back nearly five decades, to the mid-1960s, when a fledgling Computer Science Department with a deep bench of visionaries began to revolutionize computer technology and graphics. Computer scientist David Evans BA’49 PhD’53 was hired by the U in 1965 to start up the Computer Science Department within the College of Engineering. Evans knew competing with early computer science powerhouses such as Stanford University and the Massachusetts Institute of Technology would be difficult, so he looked for a wide-open field in which a new program could establish itself. That field, he decided, was computer graphics.

Funded by grants from the U.S. Defense Department’s Advanced Research Projects Agency (ARPA), for open-ended research, Evans and his colleague Ivan Sutherland recruited bright graduate students and challenged them to make new discoveries and advances in computer graphics. Those students went on to essentially found the computer graphics industry, developing such concepts as graphical user interface, object-oriented programming, simulation techniques, and computer animation. And after graduating, those students established companies such as Adobe Systems, WordPerfect, Netscape, and Pixar Animation Studios.


U Company Helps Get Student Games to Players

Photo courtesy U Entertainment Arts & Engineering Program

//Heroes of Hat// was the first game published through Utah Game Forge, in May 2012. (Photo courtesy U Entertainment Arts & Engineering Program)

It’s one thing to build video games. It’s another to get them to market and into the hands of gamers, and the University of Utah has taken the unusual step of creating a company, Utah Game Forge, to do just that.

The University’s Entertainment Arts & Engineering program and the U’s Technology Commercialization Office started Utah Game Forge in 2012. The company is owned and financed by the U and works to place student games with commercial distributors. Utah Game Forge has also secured about a half-dozen commercial game-development contracts with outside companies and employs students to do the work.

“Few schools publish games, and we have yet to run into another that has a company dedicated to publishing student games and landing contracts for students to work on,” says Roger Altizer MS’06, co-founder of the U’s Entertainment Arts & Engineering program and its director of game design and development. “The University of Utah is one of the most entrepreneurial schools in the nation, and Utah Game Forge is both a product of that culture and a service for its business-minded students.”

Utah Game Forge cultivates relationships with game-platform holders such as Microsoft and Apple and offers them student-produced games for distribution consideration. Utah Game Forge then handles the finances and legal obligations of any contracts. Royalties from any game sales are shared equally by the students, Utah Game Forge, and the University. Students surrender some commercial rights to their games when they publish through Utah Game Forge. However, students retain their intellectual property rights to the games they develop and can use elements of them for future projects.

Some students form their own companies and publish their games on their own, but for those students who opt to use Utah Game Forge, the company makes the publishing process a bit easier, says Robert Kessler BS’74 MS’77 PhD’81, Entertainment Arts & Engineering’s co-founder and executive director. Having a published game to their credit gives program graduates a jump start in the highly competitive video games job market, he says.

So far, the company’s games have received more critical acclaim than financial reward. The first published game, Heroes of Hat, debuted in May 2012. About 400 copies have been sold, at a cost of $1 each. Heroes was followed in the fall by two games produced by graduate students: Tactical Measure and Erie.

Among the department’s alumni of note are Nolan Bushnell BS’69, the co-founder of Atari; Ed Catmull BS’69 PhD’74, who launched Lucasfilm’s computer division, later co-founded Pixar, and now heads both Pixar and Walt Disney Animation Studios; Alan Kay MS’68 PhD’69, who helped pioneer the laptop computer; and John Warnock BS’61 MS’64 PhD’69, who was the first to develop desktop publishing systems and co-founded Adobe. “It’s a great story about how Utah took a very early and very prominent place in the development of the computer industry,” says Edwards.

Games studies programs have existed in academe for about a decade. For many people, though, it may still seem counterintuitive to teach video games in a university setting. But technologies and digital media permeate both the modern economy and the cultural conversation, making games “too big to ignore,” says Altizer.

Even with the U’s history of innovation in computer science, the Entertainment Arts & Engineering program’s existence is something of a serendipitous accident. In the mid-2000s, Kessler was pondering a couple of problems. Enrollment in computer science courses was dropping, and the program needed a jump start. Kessler also wanted a better way to teach engineering students how to develop software programs that would last more than a nanosecond.

A video game provided a solution. At a Microsoft conference, Kessler acquired the source code for the game Half-Life 2. Back in Utah, he set students to work rewriting nearly a half-million lines of code, altering the game from its dark and violent, first-person shooting foray into a team-oriented video version of capture the flag. “The students loved it,” he says. “They already loved games, and then this is a game that they got to modify and work on.”

With the seed of an idea now growing, Kessler sought out his industry contacts to get a clearer picture of their needs. When graduates enter the workforce, he asked, what skills are students still missing? The answer: Most have good computer science skills or really good art skills, but they don’t have any idea how to work together. “I talked to a lot of companies—Pixar and Disney and Electronic Arts and Microsoft—and they all said, in essence, the same thing: You have to be really good, and you’ve got to be able to work with the other side,” Kessler says.


Games for Health

Vance B. Strong is the hero of the University of Utah video game Sandy Shores. (Photo courtesy U Entertainment Arts & Engineering Program)

Vance B. Strong is the hero of the University of Utah video game //Sandy Shores//. (Photo courtesy U Entertainment Arts & Engineering Program)

Can a virtual superhero have therapeutic powers? He might if his name is Vance B. Strong, star of Sandy Shores, a video game designed to help young cancer patients battle their disease.

The game was designed in 2011 by Roger Altizer MS’06, a professor and co-founder of the University of Utah’s Entertainment Arts & Engineering program, and a team of five graduate students, in collaboration with Carol Bruggers, a pediatric oncologist at Primary Children’s Medical Center, and Grzegorz Bulaj, a U associate professor of medicinal chemistry. Robert Kessler BS’74 MS’77 PhD’81, a co-founder and executive director of the program, handled the technical issues of working with new technology, and Craig Caldwell, the program’s director of digital technology, worked on the artistic aspects of the game.

Sandy Shores became the first health game created at the U, and more are in the works. For Sandy Shores, Bruggers and Bulaj obtained seed money from the U Department of Pediatrics and approached Entertainment Arts & Engineering for help after talking about ways to incentivize treatment for children in a way that was not just fun, but also contributed to physical and emotional well-being. Young cancer patients often spend weeks quarantined in small hospital rooms and undergo intense treatments that leave them feeling sicker than their disease had. The result can be a loss of physical conditioning and emotional health, which can undermine the children’s ability to recover.

Altizer and the other U researchers set about creating a video game to help incentivize physical exercise for the patients. Then-students Kurt Coppersmith BFA’10 MFA’12, Laura Warner BFA’10 MFA’12, Brandon Davies BS’12, Wade Paterson MS’12, and Jordan Wilcken MS’12 also worked on the game. Each element of the game, from its theme and colors to the type of tasks accomplished and the physical movements the players use, was vetted and tested with patients, physical therapists, and social workers. Altizer was also able to tap his industry contacts to find a motion-control device being developed by Sony with an electronic frequency that does not interfere with sensitive medical equipment.

The resulting game features the cape-clad Vance, who battles a series of obstacles that threaten his relaxing beach vacation. In one scenario, Vance scrambles to clean up after an army of bright red robotic crabs littering the beach, and in another, he uses mortar and bricks to build a wall to stop a tidal wave from flooding a city. With each victory, Vance’s image on the screen gets stronger and healthier, just like the kids who are battling cancer. The children primarily use upper body and arm movements to play the game, which helps raise their heart rate. Best of all, the game isn’t boring. There are no pills, no IV bags, and no negative side effects. And, importantly, no one dies. “The psychological message of that is huge,” Bruggers says.

Kids who have played the prototype love it, and other medical centers are clamoring for a chance to use it. “Our biggest compliment is that one kid played to exhaustion,” says Altizer, though that did lead to an adjustment in the game’s design. Since exhaustion isn’t a desired outcome for kids whose bodies are already stressed, designers added a “cool down” feature, which helps avoid repetitive motion and forces kids to switch to a different part of the game, with different physical activity, or take a two-minute break.

Bruggers and Bulaj plan to conduct a series of clinical trials and hope the FDA will eventually approve the game for therapeutic use. A nonprofit company in development through the University’s Pierre Lassonde Entrepreneur Center and the Technology Commercialization Office will eventually make the game commercially available, Bulaj says.

The U has already begun developing more health games. John Hollerbach, a U research professor who directs the robotics track in the School of Computing, is working on a National Science Foundation-funded project to enhance physical therapy for patients with spinal cord injuries. His team’s “treadport” is a giant treadmill inside a cave with three large video screens that transport patients to virtual worlds.

Entertainment Arts & Engineering students are assisting Hollerbach in developing other games and virtual environments to engross and motivate patients to work harder and spend more time on physical therapy. Neuroworx, a Utah physical therapy provider, is a project partner.


The U student game The Last Pod Fighter was released in 2011. (Photo courtesy U Entertainment Arts & Engineering Program)

The U student game //The Last Pod Fighter// was released in 2011. (Photo courtesy U Entertainment Arts & Engineering Program)

Back in the classroom, Kessler was working on a second video-driven experiment: a course in machinima, or 3-D movies that use video-game programming to generate computer animation. Again, the students responded with enthusiasm. “And this is when the serendipity happens,” Kessler says. One of the graduate students in the class at the time was Altizer, who was studying communications and had been working as a video-games journalist. Altizer was also teaching video-game design courses in the film department. They decided to try to create a way for art, film, and engineering students to take classes together.

Selling the idea across the campus to both Film Department and administrative leaders wasn’t hard. “I haven’t had anybody up here at the University who thinks this is a bad idea,” Kessler says. To make the new program a reality, a committee of faculty from both the Film and Computer Science departments met to examine existing electives and knit together the academic requirements of the program. “We didn’t ask for any money, and we didn’t create any new classes; we just kind of moved things around,” Kessler says.

When the program was unveiled in the fall of 2007, students in both disciplines clamored to join it, and the demand has remained strong ever since. The program now has three tracks: design and production, led by Altizer; art, directed by Caldwell; and engineering, directed by Mark van Langeveld PhD’09. For the current academic year, Kessler estimates that of the 800 students collectively enrolled in the Film and Computer Science departments, about 200 are in the Entertainment Arts & Engineering program. The program has remained only an academic course of study, but that may change during the 2013-14 academic year if a proposal to elevate it to a full-fledged degree program is approved this spring by the state Board of Regents.

Success at the undergraduate level helped lay the groundwork for a master’s degree program launched in 2010, under the Master Games Studio name, with just 19 students. The studio provides a study program for artists, engineers, and producers—the key team leaders who in both the classroom and industry manage projects from start to finish. The students from the various disciplines work together throughout most of their two years of academic study.

In the first year of study, students work on prototype games for real-world clients. In 2012, those included a marketing-focused game to drive up sales of the Utah-made Beehive cheese and a game to teach the Shoshone language to Native American teens. Second-year students focus on developing an original video game for publishing. The University in 2012 launched Utah Game Forge, a company that helps students market their games without having to form their own companies. Currently, 60 students are enrolled in the graduate program—a number Kessler hopes to double.

Erie was published by Utah Game Forge and released by Desura in 2012. (Photo courtesy U Entertainment Arts & Engineering Program)

//Erie// was published by Utah Game Forge and released by Desura in 2012. (Photo courtesy U Entertainment Arts & Engineering Program)

The results of both the graduate and undergraduates tracks have been extraordinary. Students are winning awards for their video games and films. They’re also pushing the boundaries of technology and grasping an academic approach to video games with ease. And the interdisciplinary work helps the students evolve and learn. “In the beginning, I think there’s not a lot of respect between them,” Kessler says. “You have the artists saying, ‘It’s because of me the games are beautiful, and you don’t have any art skills,’ and the engineers are saying, ‘It’s because of me that the game even works.’ ”

Kevin Hanson MFA’84, chair of the Film Department, says the artists and engineers often discover skills they didn’t know they had: “There are some engineers who turn out to be painterly, and some filmmakers who can actually do calculus.” Corrinne Lewis BA’03, who directs the Master Games Studio, says the students grew up playing video games, and the program helps transform their knowledge. “We give all of this practical skill stuff with an academic flavor so that they think more broadly,” she says.

Even after a single semester, Witts says the program has stretched his creativity, and his ideas about games. “Video games go way beyond just sitting there for hours getting to new levels and shooting people,” he says. He now finds himself playing games with a notepad at his side and pausing to write down what he finds interesting about how a game is designed. “It doesn’t ruin the fun of playing,” he says. “I’m still having fantastic fun.”

—Jennifer Dobner is a former longtime Associated Press reporter and editor who now is a freelance writer based in Salt Lake City.

*Editor’s Note: On March 12, shortly after this article was published, the Princeton Review released its 2013 rankings, and the U’s Entertainment Arts & Engineering was ranked number one for its undergraduate program and number two for its graduate program. Read more here:

Web Exclusives

This video trailer showcases Robot Pinball Escape, a game developed by a team of University of Utah graduate students and published in 2012 through Utah Game Forge:


This video trailer gives a preview of Heroes of Hat, which in May 2012 became the first University of Utah student game published through Utah Game Forge:


This video trailer shows scenes from Erie, a virtual horror game by University of Utah students that was published by Utah Game Forge in 2012:


Photo gallery:

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The Shifting Tide

Expecting a new baby girl in early December, Katina Anthony and her husband, Chris, were both excited and worried. Already the parents of a 2-year-old boy, the couple has no health insurance, and they don’t know just how they’ll pay the hospital bill. “A delivery is like nine or 10 thousand dollars,” says Katina, who works part time as a night janitor for the University of Utah, a job that doesn’t qualify her for insurance benefits.

Her husband had been working for a small company that supports the construction industry, in a job that also lacked insurance coverage. Like many people, the couple found themselves living in an unfortunate financial gap: They couldn’t quite afford to buy private insurance, but still made too much to qualify for Medicaid. Katina says state workers advised her earlier this year that the only way the family could qualify for assistance was for her husband to quit his job. “Before that, they told me I could divorce my husband and live alone, and then I would qualify,” she says. “I was shocked. There’s got to be a better way.”

Katina Anthony and her husband, Chris, walk with their son Daniel in Salt Lake City. The new law would help the Anthonys, who lack health insurance.

By 2014, the young couple likely won’t have to worry so much. That’s when the major reforms in the federal Patient Protection and Affordable Care Act are slated to take effect, expanding access to health care to about 32 million Americans and potentially transforming nearly every aspect of the way health care is paid for and provided. “Overall, I’m happy about the Affordable Care Act,” says Katina, whose family would have access to coverage under the law.

Focusing on Core Values

Passed in early 2010, the Affordable Care Act is considered the most sweeping reform of the health care system since the implementation in 1965 of Medicare, a publicly funded insurance program for seniors over age 65, and Medicaid, the assistance program for low-income Americans. The new federal law’s provisions are intended to expand access to insurance, increase protections for consumers, improve health care quality, streamline care delivery, curb costs, and shift the focus in health care to prevention and wellness.

For providers like University of Utah Health Care and the U’s School of Medicine, understanding and preparing for the law’s reforms isn’t easy. The complex law has many ramifications and will likely have unintended consequences for consumers, providers, insurance plans, and governments. As a paradigm shift, the law is “huge,” says Vivian Lee, the U’s senior vice president for health sciences, dean of the School of Medicine, and the chief executive officer of University of Utah Health Care.

“What we are trying to do is focus on some of the core values and core principles of how we need to deliver care,” Lee says. “We’re working on the things that prepare us for the new world but also enable us to survive in the old world.”

And how exactly does an institution change? “That’s the million dollar question,” says Lee. “It’s a migration.”

A number of factors are driving the way the U’s health care system—and other providers nationwide —will address the law’s countless changes. Those include volatile national and state-level political and philosophical debates and the more practical realities of funding and personnel. Proponents say the law will provide critical relief to the more than 50 million uninsured Americans by providing access to health care at affordable prices. The supporters say tax credits and subsidies will help both businesses and individuals manage costs and that health care will be less expensive for all.

Opponents of the $900 billion law, however, see it as a government takeover of health care that infringes on states’ rights. They contend the law hurts businesses and unfairly meddles in the private financial decisions of citizens. Opponents also argue the law will cost more than projected, raising the federal deficit even while curtailing as much as $500 million in Medicaid spending and imposing new taxes.

Although passed by Congress, no Republicans voted for the law, and since 2010, more than 30 unsuccessful attempts have been made to repeal it. Twenty-six states, including Utah, and the National Federation of Independent Business also sued the government to stop the Affordable Care Act’s implementation, arguing that many of its mandates are too expensive for already strained state budgets. That particular legal battle was lost this past June, when the U.S. Supreme Court upheld the law’s implementation, on a 5-4 vote.

That the debate over the Affordable Care Act is mired in politics is no surprise to Robert Huefner BS’58, a U professor emeritus of political science and former director of the U’s Governor Scott M. Matheson Center for Health Care Studies. Politics and government are in part about making choices between values, Huefner says.

Quinn McKenna, chief operating officer of University Health Care, says that “a redesign of the system makes sense.”

“Government programs tend to be those where you’re having to balance things that you can’t just balance with a cost equation. You get those kinds of concerns in health all the time,” says Huefner, who helped two Utah governors through major changes to public health programs during the 1960s. “A second reason is cost. Health care is now the second biggest cost of state government in the country, behind education, so that means it’s political just in terms of the tradeoff between financing a public service and maintaining acceptable taxes.”

Huefner predicts that even if the Affordable Care Act is ultimately repealed, the U.S. health care system won’t go back to where it was two years ago because the system—from individual doctors to government programs and institutions such as University of Utah Health Care— has already started to change. “Too much has happened, and they are already moving on it,” he says.

Medicaid Expansion

As the law now stands, some of the key—and controversial—provisions include Medicaid expansion to cover individuals with incomes below 133 percent of federal poverty guidelines, and a requirement that individuals, with some exceptions, have health insurance through public or private providers, or face a penalty. Businesses will be required to offer insurance or face a penalty. States must create health-insurance exchanges to allow consumers to easily shop for and compare health-insurance plans and costs. And insurance companies will no longer be able to exclude individuals from coverage because of preexisting conditions, or charge variable premium rates.

How the Affordable Care Act will play out in Utah depends in part on decisions made by Governor Gary Herbert and the Republican-dominated Legislature that controls the state budget. Census figures from 2010 show 411,926 Utah residents without health care. State health-department data project about 111,400 of those people would qualify for Medicaid under the Affordable Care Act. Of those, about 53,000 would be newly eligible. The remainder are people who already qualify but have never enrolled in Medicaid, says Tom Hudachko BA’98, spokesman for the Utah Department of Health. That group of people is also likely to come onto the Medicaid rolls under the new law’s expanded provisions.

Helping the Uninsured

But Medicaid spending, which represents more than 21 percent of Utah’s budget, is already vexing lawmakers. State analysts project expanding the rolls could cost the state as much as $1.7 billion dollars between 2014 and 2022, despite continued federal reimbursements. The Affordable Care Act allows states to opt out of the Medicaid expansion plan, and it’s not yet clear what Utah will do.

At the University, Lee says the state ends up paying for uninsured people’s health care costs anyway, regardless of whether the federal law prevails. Some costs are “baked in” to insurance premiums paid by others, and the rest is covered through so-called charity care, meaning that the University’s health care system picks up the tab, she says. Last year alone, University of Utah Health Care spent more than $80 million of its $1.2 billion budget providing care to uninsured or underinsured patients, says Quinn McKenna, chief operating officer of University Health Care.

Lee notes that it’s far more costly for institutions, and individuals, if patients defer care until they reach a crisis point. “You’d rather have them on Medicaid, managed and seen in clinics, so they don’t come to the ER three weeks later,” she says.

If the new federal law continues on track, just how many of the uninsured would come into the U system as patients in 2014 with either private insurance or as part of expanded Medicaid isn’t clear. Both expanded Medicaid and private insurance rolls have the potential to bring some dollars back to the University, and that could cut the volume of charity care so that those funds could be redirected for medical education, direct care, and other uses.

Another uncertainty is what the rest of Utah’s health care market will do under the new federal law, Lee says. “If the rest of the market is receptive to these patients, then the distribution will be the same. If there are barriers put up for some of these patients, then more of them will come to us, because we take everybody.”

Vivian Lee, the University of Utah’s senior vice president of health sciences and dean of the Medical School, says the school’s class size must grow, to address the state’s physician shortage.

Either way, it seems certain that the demand for health care will grow. That has Lee, as dean of the School of Medicine, focused on making sure that Utah is training enough new doctors to meet the need. The U has the only medical school in the northern Intermountain region and is typically the main supplier of physicians for Utah, Idaho, Montana, Wyoming, and northern Nevada. Nationwide, a shortage is predicted of at least 91,500 physicians by the year 2020. Utah’s own physician shortage is even more severe, Lee says. A 2008 Association of American Medical Colleges study found Utah currently has fewer than one primary-care physician per every 1,000 people. Only three other states have fewer physicians per capita, and it’s hard to close the gap quickly, because it takes nearly a decade to train a physician. “With the Affordable Care Act and the fact we are the fastest-growing state in terms of population, that means that it’s just going to get worse,” she says.

Training More Doctors

To address the shortage, U administrators want to use a two-step process to restore the number of students accepted into the medical school annually from 82 to 102, and then expand the enrollment to 122. In 2008, the school had to reduce its class size from 102 students to 82 due to cuts in federal funding that were not replaced by the Legislature. Increasing the annual class size, however, will require money, and that funding is a top priority for the U with the Legislature in 2013, says Jason Perry, the U’s vice president for government relations.

Lee says that the U Medical School gets about $26.5 million annually in funding from the state. Increasing the number of medical students to 122 will require a projected $12.2 million in annual funding. The U is asking state lawmakers to cover $10 million of those costs. A similar appropriation request was made, but not funded, in 2012.

Raising tuition to help cover expanded enrollment costs just isn’t an option, Lee says. “Our students come out with an average of $158,000 in debt,” she says. “You don’t want to increase tuition more, because then they will have more debt, which forces them away from primary care [careers] and pushes them toward the higher-paying specialties.” Primary care doctors are expected to be in high demand after 2014, because the Affordable Care Act seeks to place more emphasis on wellness care and prevention.

The federal law will also begin to change the way doctors and hospitals get paid, and that has administrators like McKenna concerned about the bottom-line costs of doing business. In addition, the law’s reforms require that more of the health care dollar be spent directly on patient care, and the government will give more scrutiny to care delivery to make sure benchmarks are met.

Chris and Katina Anthony shop for baby items, with their son Daniel.

University Health Care facilities and staff annually handle an average of 1 million outpatient visits and 27,000 inpatient admissions and surgeries, McKenna says. That care gets paid for fairly evenly through private insurance and publicly funded programs. Data from the past three budget years show that on average, Medicare payments make up about 32 percent of the budget, and Medicaid payments total about 13 percent. Commercial insurance and managed care programs represent another 46 percent of the budget, with 5 percent coming from other government programs and 4 percent from patients who self-pay.

Those percentages are bound to change after the new law’s implementation, but no one can yet project what the numbers will look like. “From a philosophical standpoint, no matter what health care reform looks like, we know we are going to get paid less for what we do,” McKenna says. “Our strategy is to ask ourselves, ‘How do we live on less?’ It’s not a bad strategy, and that’s why a redesign of the system makes sense.”

Redesign is what McKenna’s job is all about. For nearly five years, he has promoted initiatives to keep the U ahead of the health care reform curve through staff-driven redesigns of care delivery and the processes needed to support the health care mission. Both on paper and in practice, the initiative seems a match with many of the criteria outlined in the federal law’s reforms. It’s also helping the U health care system meet its own goals of bettering the patient experience, improving care quality and outcomes, and bolstering overall financial strength.

The work is already netting tangible results. One review of patient outcomes for individuals needing ventilator support found that U patients stayed on the breathing machines longer than those in many other hospitals. A performance excellence team—a group of system-management engineers working in concert with doctors and nurses—reviewed the treatment protocols, looking for ways to improve. Under the changes they proposed, the number of patients staying on ventilators longer than 48 hours has dropped by 27 percent. The amount of time patients remain hospitalized has also been cut by 2.7 days, and the number of ventilator-associated pneumonia cases has been reduced by 67 percent.

Overall, that has saved the U health care system $3 million, McKenna says. “That’s what we’re trying to do across the board. We’re looking across the system and asking, ‘Where do we have those kinds of opportunities to redesign the way we do things?’ ”

Poised for Reforms

So far, care redesign has been approached on a project by project basis, McKenna says. The next step will be to up the tempo of change and spread the initiative across the wider health care system—a move that will help the U better prepare for the federal law’s broad reforms.

No matter what changes the law brings, the main goal of the University’s health care system is to provide the highest quality of care, McKenna says. “Our goal, my personal goal, is, whatever we are doing, we’re going to make it better.”

Lee and McKenna believe the institution is poised to weather the reforms well. The proactive work already begun has helped to reduce or flatten costs in recent years. Utah’s smaller and generally healthier populations also play in its favor. “I’d say we’re in a pretty good starting position,” Lee says. “And I hope were a good model for the country.”

To help that happen, Lee has established a health care reform committee to study the law’s reforms and analyze what protocols are already in place to ensure the U system makes the best possible choices for the future on the uncertain road ahead.

“I can picture seven scenarios where we’re doing the right things, and we’re going to be just fine,” McKenna says. “I can also picture two or three scenarios where all bets are off, and we’re going to have to be wildly creative and [think] out of the box, more so than what we are doing now. I think that’s where the nervousness comes. Is it going to be the seven or the three?”

Regardless of which scenario unfolds, uninsured patients like Katina Anthony are hoping the law prevails and provides them with much-needed help. Her husband lost his job this past fall, and the couple hoped they’d qualify for Medicaid in time for the baby’s birth, so the bills can get paid and so Katina and the newborn would have a few months of care. “It’s ridiculous,” Katina says. “We don’t want to the be the ones who are living off the government, and Chris is out looking for a job right now, but this will help.”

—Jennifer Dobner is a former longtime Associated Press reporter and editor who now is a freelance writer based in Salt Lake City.

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Partners in Change

About 15 miles from Ghana’s second-largest city of Kumasi, where the pavement turns to hard-packed dirt and the African rainforest grows up thick and tangled, a story of transformation is unfolding. In Barekuma, generations of villagers have carved out a meager existence by farming the equatorial soil. They’ve lived on dirt floors and without electricity and toilets. Access to health care and education has been limited, and the water the community has always relied on for everything from laundry to cooking and bathing has been so contaminated that most of Barekuma’s 2,500 villagers became chronically ill.

Over the last eight years, though, a partnership with the University of Utah’s Global Health Initiative has led Barekuma to remake itself by engaging educators, medical practitioners, university students, and the community in a cross-disciplinary approach to problem solving that helps residents increase their own capacity to improve their lives and create sustainable change. Villagers now have—and use—clean water sources and restrooms. The incidence of disease has been reduced, and greater economic stability is being fostered.

Paired with education-centered programs for medical students and other health-care providers at the Komfo Anokye Teaching Hospital in Kumasi, the efforts in Ghana are a cornerstone example of how the U’s Global Health Initiative is charting new pathways for addressing the challenges of health, education, and economic development, not just in West Africa but in other developing nations and here at home. The initiative is now working in 20 Ghanaian villages and changing the lives of more than 30,000 people. Recently created programs in India, China, and Peru are in their infancy, but already have enhanced opportunities for learning for more than 100 students and faculty members.

Some may wonder why the University of Utah should focus resources and talent on solving problems in places half a world away, when there are community health challenges here in the United States. But in a shrinking world, where global travel is common and refugee programs relocate tens of thousands of people from the developing world, medical providers in Utah need the skills to recognize and treat a wider variety of diseases, say the U Global Health Initiative’s co-directors, Dr. Stephen C. Alder and Dr. DeVon C. Hale. Alder is chief of the U Medical School’s Division of Public Health, and Hale is a U professor of internal medicine and pathology, whose specialty is exotic diseases and travel medicine. They note that many ailments in the developing world can be prevented and treated, so enhancing health education both in medical schools and communities abroad can markedly improve many people’s quality of life.

“The reason we’re in Ghana or China or Peru or India is that we can learn so much in being a part of that community,” Alder says. Hale agrees and says, “I think it’s important that we sitting here in Salt Lake City, Utah, realize that we’re part of the world.”

The U Global Health Initiative’s approach differs from other international programs, Alder says. “We’ve come in, and we’ve looked at the comprehensive health system,” he says. “The community is our patient. And we think that for a healthy community, you certainly need great clinical care and great care delivery systems, but you also need clean water. You need sanitation systems. You need immunization. You need good, clean food; people that are educated; economic viability; and you need good government.”

University of Utah professor Stephen C. Alder, right, shakes hands with Nana Joseph Tabiri, the Ashante Tribe’s chief of Barekuma, joined by Ghanaian pediatrician Daniel Ansong, left. (Photo courtesy Stephen C. Alder)

Started by Hale in 1998 and spurred by medical students’ desire to help in the world’s developing countries, the largely volunteer program is something of a happy accident that has grown in unexpected ways. What Hale first envisioned was nothing more than an exchange program that would send medical students and residents abroad for clinical care experience in the developing world. His own interest in exotic, infectious diseases was fueled by a travel study he conducted of health risks and medical resources in 25 countries where missionaries for The Church of Jesus Christ of Latter-day Saints were at work.

With Hale’s help, many U medical students went abroad, and most returned with wide smiles and tales of invaluable learning. Others had spent frustrating weeks in locales severely strapped for resources or were used as the vacation relief for overworked local staff. In Swaziland, for example, a female resident arrived to find herself left alone to care for a ward of 40 patients suffering from HIV. “That isn’t a position we want our students in,” Hale says.

Hoping to do better, in 2001, the U Medical School partnered with Indiana University, which had a well-established exchange in place at a Kenyan hospital. The plan was to study Indiana’s program before deciding whether Utah should attempt one of its own, Hale says. But a persistent group of students kept up the pressure for a program through the U, and that same year, the University launched its own fledging program at the Komfo Anokye hospital in Ghana. Ten students and Hale made the first trip, spending a month working on immunization efforts and breast-feeding education, as well as weighing babies and treating dehydration in children.

From the start, the U wanted to build a collaborative, long-term relationship to enhance medical education and training rather than provide one-time donations of money or medical supplies. Hale ended that first visit with a promise to doctors and administrators at the Komfo Anokye hospital that he would return the next year with a new crop of students. “They were suspicious of us,” Hale says of his Ghanaian counterparts. “By the third year, I think they realized maybe we were serious and would keep coming back.”

It was a critical turning point. In 2004, Hale recruited Alder to join the program. Alder had been seeking a way to add an international component to public health education at the U, and he helped the Komfo Anokye hospital develop community-health-oriented outreach and programming. The two Utah doctors were then invited by Ghanaian physician Daniel Ansong to Barekuma. Ansong and two other doctors had adopted the village as their own and were working to try to improve the community’s health conditions. “We went in pretty naively, and our partners went in pretty naively, but we very quickly realized that there were some incredible opportunities for us to make a big difference,” says Alder.

U medical professor DeVon C. Hale, center, listens to residents in Barekuma, Ghana. He says listening has been key to the Global Health Initiative’s success. (Photo courtesy U Global Health Initiative)

In Barekuma—and shortly thereafter in the smaller villages of Kumi and Anikroma—Alder and Hale met with the village chief and other leaders, trusting their assessments of those projects and problems that most needed University help. “Our philosophy has been that we don’t go take charge of a system or a program, but we go as support, as partner,” Alder says. “There are times when we can be a mentor or a technical adviser, but we also go there to learn.”

A prime example of how that process has worked is a Global Health Initiative research project mapping the prevalence of a parasitic flatworm disease known as schistosomiasis. The chronic disease, which is transmitted through human urine and contracted through exposure to contaminated water, was a known health problem that the community wanted to address. The U doctors got community participation in their research project by starting at the top. “We had everybody pee in a cup. The chief started it out to demonstrate that this was a good thing to do,” Alder says. “We did it appropriate to Ghanaian culture, and we got great participation.”

Testing found 41 percent of villagers suffered from the disease. The U team compiled the results into a report and suggested mechanisms for changing local practices and reducing disease. The findings were presented at a community meeting. “There were just these fantastic debates about what this all means, and we never got to the solutions because the community did it before we could. They fixed it,” Alder says of their resolve to find ways to avoid using or getting in the contaminated water.

Other projects have included a health census of villagers and Global Positioning System mapping to better track the spread of disease, early identification and treatment of malaria, efforts to stem the transmission of rotavirus, continued schistosomiasis studies, and the development of sanitation and water treatment systems. A community-based medical clinic that will provide primary medical care and prevention programs for 5,000 residents in five villages also has been completed and is set to open this year. The U doctors this year also launched the Healthy Families Initiative, a program based on the Ghanaian government’s plan for health care that places community health nurses in local clinics.

Working in concert with the Ghanaian government, the U Global Health Initiative helped secure funding and building materials for two schools in the village of Anikroma, with labor supplied by local villagers. In Barekuma, U teams have helped build a community bathroom facility near a school and install a sewer system, so villagers no longer have to use an open pit covered with boards for a toilet. And U students helped write a grant that secured loan funding so villagers could transform a five-acre plot of unused land into an orange grove. Proceeds from the sales of the fruit and its juice will provide an ongoing revenue stream to increase the village’s economic viability and help break the cycle of poverty.

Even more exciting for Hale is what’s happening back in the Kumasi hospital where the U program has its roots. Each year, more students and faculty from both countries have become involved, expanding opportunities for research and learning. The annual summer medical exchange that brings Hale and U students to Africa now also allows for Ghanaian students and faculty to come and study at the University of Utah. About 40 U faculty members are involved and have developed new residency, teaching, and training programs for budding doctors, nurses, dentists, laboratory technicians, and community health workers, as well as physicians’ assistants, who play a critical role in health-care delivery across Ghana and are often the first, or only point of contact a rural village may have with medical care.

The difference the U program has been making is dramatic. An ophthalmology program has expanded access to cataract surgery for patients of all ages, and the Global Health Initiative has helped build an eye surgery center in Kumasi that is nearing completion. Infant mortality is decreasing through the efforts of a neonatal resuscitation course, as well as a new method for treating severe dehydration in babies. A growing dental program for Ghanaian students will graduate its first class this September, improving access to dentistry in a place where the dentist to patient ratio is one per 80,000 people.

A Ghanaian medical worker takes a blood sample. (Photo courtesy U Global Health Initiative)

The University’s success in Ghana has drawn plenty of attention to the community, and requests have come in recent years to expand the Global Health Initiative. Programs and medical exchanges are now in place or in development in China, India, and Peru, opening new opportunities for U students and faculty and those in host countries, Hale says.

Hale and Alder now have a very specific dream: a Global Health Institute at the U that would support both the work already under way and serve as a launching pad for new endeavors. The institute would help them foster new collaboration with universities worldwide and sponsor conferences and research. Hale says a formal institute would also lend the kind of credibility needed to win grants to support the work.

To date, participants in the Global Health Initiative have self-funded most of their work and travel. The U’s medical school provided Hale with a small budget of $60,000 for the first time this year. A fully funded institute would create the needed stability to hone the focus on programming, rather than finding the money to fund the work, Alder says.

For students, working in Africa is as much a lesson in trans forming their own perspectives as it is in medicine, public health, or any other discipline, says Chris Brown, the current chief resident at University Hospital. Brown has traveled to both Kenya, where the University remains involved with the Indiana program, and Ghana. “Their resources are much more limited, so simple lab tests and things that we order here without even thinking about it are very costly, or sometimes you can’t get them,” he says.

He believes he has become a better doctor because of the time he has spent in Africa. He has encountered diseases, sometimes at very advanced stages, that he might never have seen at home. He thinks more about the implications of expensive diagnostic tests and tries to rely more heavily on doing what he says his Ghanaian counterparts do so well: listening closely to patients and conducting more thorough health histories to map a path to diagnosis. He also has a deeper commitment to a medical career entwined with public health work.

University of Utah ophthalmologist Alan Crandall, right, performs eye surgery on a child in Ghana, with Ghanaian ophthalmologist Peter Osei-Bonsu, left, and U nurse Brittnee Zacherson. (Photo courtesy U Global Health Initiative)

Stephen Oluaku Manortey, a Ghanaian who is now studying in Utah in the U’s doctoral program in public health, says conducting community-based participatory research with the Global Health Initiative has allowed him to develop a deeper understanding of the health challenges his country faces. “It has helped me learn more about my own backyard,” says Manortey, who plans to work in Ghana after finishing his degree.

The Global Health Initiative has developed health centers there that bring primary health services to rural communities and has created a database of demographic and health data that aid disease surveillance work. Efforts like those are changing Ghana’s health systems, all without creating a dependence on foreign partners, he says. “This has helped my people to see themselves as stakeholders and owners of the projects much more than the foreign counterparts who have come to work with them,” Manortey says. “I think the GHI is having an impact in Ghana and is there to help make Ghana and the world a better place.”

— Jennifer Dobner is a former longtime Associated Press reporter and editor who now is a freelance writer based in Salt Lake City.

If you would like to participate in a service trip or visit any of the Global Health Initiative sites, or make a donation, contact Taylor Scalley at (801) 585-6874 or

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