Dermatologist David Leffell has declared war on skin cancer



Three decades ago, some physicians began noticing unusual-looking skin lesions on a substantial number of male patients. David Leffell was one of those doctors.

 “In the early 1980s I was in New York, at [Memorial] Sloane-Kettering [Cancer Center],” Leffell recalls. “I was seeing men coming in with purple spots” — cancerous tumors that soon would become known beyond the medical community by their technical identification: Kaposi’s sarcoma.

 “They were people with HIV,” explains Leffell, who conducted research on what would become a major medical focus. “It was clear to me that was an exciting new area.”

 That experience is what sparked Leffell’s interest in dermatology. Currently one of the most renowned physicians in his field, his work revolves around prevention, treatment and diagnosis of skin cancer.

 Today Leffell is deputy dean for clinical affairs at the Yale School of Medicine, and for the past 15 years he’s headed the Yale Medical Group — one of the largest faculty practices in the country. The organization offers care in more than 100 specialties.

 “The purpose is to oversee strategies for the state. That’s been my big role for 15 years,” says Leffell, whose tenure concluded last year.

 When he first took the position he sought to make the group better.

 “At that time Yale was primarily a research medical school. I wanted to make it more patient [oriented].” Among initiatives instituted under Leffell’s watch were patient-satisfaction ratings. “We had a great deal of success,” he notes.

 For example, patients noted less than total satisfaction with something so fundamental it could easily be overlooked by quality-assurance personnel: the telephone system.

 “There’s always been a problem with people getting through by phone. [So] we implemented a monitoring system,” says Leffell.

 For inpatients, a common source of dissatisfaction is food, and for office-based practices, “The No. 1 complaint is parking,” Leffell notes. Such information might not be known — and improvements made — without the patient-satisfaction ratings.

 “So we’ve made great strides,” Leffell says.

 “Transition is essential to stay alive,” he adds, and the time has come for “new blood” to head the group. He still has ideas about the course of the group’s future, however.

 As a new CEO of the Yale Medical Group begins to assess needs and devise ways of addressing those needs, Leffell says he’d like to “see a new strategy laid out. I’d like to see physicians and other providers, such as nurse practitioners, take more of a leadership role in health care.”

 Leffell also has helped to advance the field of dermatology through research and invention. He was instrumental in the discovery of the skin cancer gene PTCH and the protein it is involved in coding, and holds joint patents for that discovery. He also holds a patent for a medical instrument that measures aging of the skin. In addition, Leffell has developed a streamlined method for treating vitiligo surgically.

 Leffell is also a prolific author, having written or co-written more than 120 published works. Among them is Manual of Skin Surgery, and Fitzpatrick’s Dermatology in General Medicine, a leading dermatology textbook which Leffell edited. Leffell’s book Total Skin: The Definitive Guide to Whole Skin Care for Life was published in 2000. Refreshingly absent of medical jargon, it was written as a handy education tool about skin health for the general public. It has been widely used by laypersons as a reader-friendly reference book.

 Born and raised in Montreal, Leffell came to the United States for undergraduate study at Yale. He returned to Canada to earn his medical degree at McGill University in Montreal. He came back to Yale in 1988 to join the School of Medicine faculty as an assistant professor.

 Leffell and his family (he is a married father of two) have residences in New Haven and the Litchfield County town of Norfolk. Active in the local community, he extends himself beyond the medical field. He is, for example, a board member of New Haven’s Artspace and of Connecticut Public Television, and is also a Hopkins School trustee.

 Leffell has even ventured into photography. A 2011 coffee table book, Connecticut Pastoral, designed by Leffell’s niece, Rebecca Leffell, features his striking scenic photographs of locations across the state.

 “One of my pastimes is photography,” says Leffell. He gives the book to people who make charitable donations to special causes.

 Among causes about which Leffell is most adamant is the dermatological harm that can be caused by tanning salons.

 “Far and away the most important cause of skin cancer is ultraviolet radiation,” he notes.

 Leffell has fought vigorously for legislation that would require parental consent for minors to utilize tanning facilities. However, his advocacy has been met with resistance from some politicians and others set squarely against such legislation.

 “So that was my introduction to politics,” say Leffell, who maintains such legislation is needed.

 “We are ignoring, damaging and hurting our children” without it, he says, “and I’m the one who sees the end result. I’m the one who has to operate on them.”


 State’s health ‘exchange’ struggles to enroll uninsured



WALLINGFORD — HealthyCT, the nonprofit, federally funded co-op established to sell health insurance for Connecticut individuals, families and employers, has received hefty monetary backing. Yet, those eligible are taking their time to sign up.


That doesn’t seem to faze CEO Ken Lalime, who says work has only just begun to make residents more aware of the plan and its benefits.

“As you can imagine, with a startup, we have got a lot to do,” says Lalime. “We’ve got a team working hard” to increase awareness and smooth out the enrollment process, he says.


Part of the work involves quelling rumors and anxiety about the unknown, which have dogged the Affordable Care Act since its inception. Among them is the notion that signup for HealthyCT is only in the low double digits. That is not the case, says Lalime. While the number is not as high as administrators would prefer, they hover around three to four percent of the market share, he says.


“It changes every day,” he allows, acknowledging, “We had projected a bit higher.”


The more people hear and learn about HealthyCT, the more they will be inclined to sign up for it, Lalime insists. “Helping with that goal are the hundreds of brokers HealthyCT has enlisted.


“They understand the difference of what we bring to the marketplace” and can clearly explain it to consumers, Lalime says. “I think that the consumer gets a little bit different flavor, if you will, once they get that personal contact.” The intent, he says, is to “increase awareness and take away some of the stigma.”

According to Access Health CT, the state’s official health insurance marketplace established in response to the Affordable Care Act, about 340,000 Connecticut residents are uninsured. Between October 1 and mid-November the Access Health CT website had 301,280 unique visitors and its call center fielded 39,964 callers. There were a total of 13,128 enrollees by November 14. Those signups were the result of 7,445 completed applications.


States throughout the country have received federal start-up support to establish healthcare insurance co-ops as one option available through ObamaCare. For HealthyCT, headquartered in Wallingford, the sum was $76 million in loans. HealthyCT is one of the options available via Access Health CT.


While the intent is an affordable alternative to for-profit insurance choices, among concerns about HealthyCT is its cost to consumers. Rates are among the highest, critics complain.


“Yes, that is a little bit of aconcern. We have heard that,” admits Lalime. “We are much more competitive in the gold and bronze metallic level than we are in the silver,” he adds, referring to the state’s insurance tier choices. He also addresses HealthCT’s nonprofit nature.


“Profits go back into the local marketplace to reduce premiums and increase quality programs,” he notes.


Lalime reiterates that a major emphasis for HealtyCT is communication about its “patient centered” structure.


“We’ll continue to get the word out through outreach,” he says.

 FAIRFIELD, HARTFORD The Fairfield County Medical Association (FCMA) and the Hartford County Medical Association (HCMA) have jointly filed a federal court lawsuit challenging UnitedHealthcare’s (UHC) termination of many of their physician members as participating providers in United’s Medicare Advantage (MA) Networks.  These terminations are due to take effect in February 2014. 

According to the lawsuit, UHC’s actions violate Medicare regulations, and are in breach of UHC’s agreements with its physician members.  The suit alleges that UHC’s actions have “a significant adverse impact not only on the terminated physicians, but on their longstanding elderly and disabled patients, who must now either find new physicians, switch plans to continue treatment with the terminated physician, or incur significant additional out-of-pocket costs to continue treatment with an ‘out-of-network’ provider.”

The lawsuit further notes that “patients may be forced to change and to reluctantly go elsewhere for medical care, which is particularly difficult for the elderly and/or disabled. There will likely also be patients so discouraged by United’s changes that they may even be unwilling to seek covered preventative care. This will shift the geriatric population to a crisis-oriented culture which further impacts the health and safety of Medicare beneficiaries and increases the cost of their healthcare, a situation that the Affordable Care Act was meant to address.”

“UnitedHealthcare’s plan will mean the termination of more than 2,200 physicians statewide — that’s almost 20 percent of its entire network and that it turn would have an adverse impact on the delivery of medical care to patients,” says Robin Oshman, MD, president of the Fairfield County Medical Association.

For its part, UHC spokeswoman Maria Gordon Shydlo said in a prepared statement, "We are focusing our Medicare Advantage network around the needs of our members to encourage higher quality health care coverage and help keep that coverage affordable. We will respond to the society's filing at the appropriate time."

 HAMDEN, DERBY — The Frank H. Netter MD School of Medicine at Quinnipiac University and Griffin Hospital have reached a five-year clinical affiliation agreement. Under the agreement, Quinnipiac med students will complete clinical rotations with required supervision at Griffin Hospital beginning in the summer of 2015, and physicians working with the students will be appointed clinical professors at Connecticut’s newest school of medicine.

“We are excited about and look forward to working with Griffin Hospital as we build the clinical components of our curriculum,” said med school Founding Dean Bruce Koeppen, MD. “Its Planetree model of health-care delivery, which organizes care around the needs of patients, will provide a valuable and unique experience for our students.”

Griffin Hospital joins the medical school’s other clinical affiliates, St. Vincent’s Medical Center of Bridgeport, which is the medical school’s principal clinical partner, MidState Medical Center of Meriden, Middlesex Hospital of Middletown, Waterbury Hospital and Jewish Senior Services, the Jewish Home of Fairfield. Hartford Hospital is a research partner of the medical school.

 NEW HAVEN — The Cornell Scott–Hill Health Center and Chapel Haven have announced the expansion of their joint “Weigh to Live” program, a wellness initiative designed to help adults with developmental and social disabilities achieve and maintain a healthy lifestyle. 

The collaborative program was rolled out earlier this year to encouraging results, according to the two groups, albeit for a small sample. Of the 15 students who attended the spring class, 12 students lost a combined 62 pounds. Eleven students achieved lower blood-pressure readings. Six students reduced their cholesterol. And six students lost inches in their waist or hips.

"Weight management and fitness are vital components of leading a happy and healthy adult life," said Michael Storz, president of Chapel Haven. "The staff of the Cornell Scott-Hill Health Center are remarkably skilled at making fitness fun and manageable for our students and that is the key to any sustainable health program."

Due to the program’s success it is being offered again this fall. This semester there are 14 students enrolled. The program is also expanding to include students from Chapel Haven’s Asperger’s Syndrome Program.

 NEW HAVEN — Being left-handed has been linked to many mental disorders, but Yale researcher Jadon Webb and his colleagues have found that among those with mental illnesses, people with psychotic disorders such schizophrenia are much more likely to be left-handed than those with mood disorders like depression or bipolar syndrome.

The new study is published in the October-December 2013 issue of the journal SAGE Open.

About ten of the U.S. population is left-handed. When comparing all patients with mental disorders, the research team found that 11 percent of those diagnosed with mood disorders such as depression and bipolar disorder were left-handed, which is similar to the rate in the general population. But according to Webb, a child and adolescent psychiatry fellow at the Yale Child Study Center with a particular interest in biomarkers of psychosis, “a striking 40 percent of those with schizophrenia or schizoaffective disorder are left-handed.”

Webb and his colleagues studied 107 individuals from a public outpatient psychiatric clinic seeking treatment in an urban, low-income community. The research team determined the frequency of left-handedness within the group of patients identified with different types of mental disorders.

The study showed that white patients with psychotic illness were more likely to be left-handed than black patients. “Even after controlling for this, however, a large difference between psychotic and mood disorder patients remained,” said Webb.

 BRIDGEPORT — St. Vincent’s Medical Center this month becomes the first and only hospital in Connecticut to become a member of MD Anderson Cancer Network, a program of the University of Texas MD Anderson Cancer Center. This affiliation will provide certified physicians at St. Vincent’s, through the Medical Center and its Elizabeth Pfriem SWIM Center for Cancer Care, access to evidence-based guidelines, treatment plans and best practices developed by MD Anderson experts. These are disease-specific guidelines for cancer treatment, cancer prevention, early detection and follow-up care.

“This affiliation represents a tremendous development in our cancer program,” said St. Vincent’s President Stuart G. Marcus, MD, FACS.  “The affiliation will enable us to successfully expand the scope of our services and  raise the standard for cancer diagnosis and treatment in collaboration with the nation’s leading cancer center.”

NEW HAVEN — Bee stings are no fun, and for people who are allergic to the bee’s venom, they can be deadly. But a new study from the Yale School of Medicine finds that the key toxic component in bee venom — the major allergen — can actually induce immunity and protect against future allergic reactions to the toxin.

The Yale research team examined the effect in mice of an allergic component called Phospholipase A2 (PLA2). They found that, once detected by the innate immune system of the mice, the PLA2 triggered a cascade of immune responses designed to fight the intruding toxin.

“These findings support the argument that allergic responses evolved to protect us from noxious environmental substances,” said senior author Ruslan Medzhitov, professor of immunobiology at Yale School of Medicine and a Howard Hughes Medical Institute investigator.

Medzhitov cautions, however, that when the allergic response over-reacts, it can lead to a dangerous condition known as anaphylactic shock. “We found that there is a very thin line between protective and potentially life-threatening allergic reactions to bee venom.”