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| | | May 5, 2006 >
Washington people
Discovering drugs that work  John W. Newcomer, M.D., studies metabolic effects of antipsychotic drugs in people with schizophrenia By Jim Dryden When he first came to St. Louis, John W. Newcomer, M.D., hadn't yet picked a career path. His family moved several times when Newcomer was a child. In fact, because his father was in the Navy, he was born in the Philippines at the Subic Bay Naval Base. Later his dad, John L. Newcomer, was in the FBI, and when John W. was in kindergarten, the family lived in St. Louis for about 18 months. "I remember seeing the Arch halfway constructed," he recalls. "I have a vivid image of that in my brain."
He left Detroit for Rhode Island to attend Brown University, and it was during college that he decided what he wanted to do with his life. He was intrigued by the tremendous amount of uncharted territory in neuroscience. "I had taken a summer job at a psychiatric facility, and I saw a person who came in acutely psychotic," he remembers. "After about two or three days of antipsychotic therapy, however, she was much better. She wasn't completely healed by any means, but she was able to engage in rational and meaningful conversations with her family again. I was struck by the dramatic changes that must have been occurring in her brain." After completing his undergraduate work at Brown, Newcomer returned to Detroit for medical school at Wayne State University. The psychiatry department's Lafayette Clinic, which at the time housed a collection of National Institutes of Health-funded researchers, was where Newcomer developed a research interest in neuroendocrinology in his spare time. During his fourth year of medical school, he took electives at the University of California, San Francisco and at Yale University. Then it was on to Stanford University for residency and a research fellowship. "I lived in the city and commuted down the peninsula," he recalls. "It was really nice. Plus, Stanford was a center for neuroscience research and one of the most biological and research-based psychiatric training programs of the time. Being there was highly stimulating and a lot of fun." He finally arrived in St. Louis in 1990 and started a research unit at the old Malcolm Bliss Hospital. Continuing studies of glucocorticoid effects on memory that he began at Stanford, he also became interested in the effects of insulin and glucose on memory, an area of research that has continued to inform his work. He was looking at the influences of glucose and insulin on memory function in schizophrenia when he encountered disease- and treatment-related disturbances in glucose metabolism.
Patients with certain psychiatric diseases are more apt to be obese, to have high cholesterol, hypertension or to smoke. Those factors increase their risk, but it turns out that some psychiatric drugs also are associated with weight gain and insulin resistance. Some of those same drugs are also linked to an increased risk of a problem with blood lipid levels called dyslipidemia, and diabetes. So Newcomer and his colleagues have spent part of the last several years studying the metabolic effects of antipsychotic drugs in people with schizophrenia, funded by the National Institute of Mental Health (NIMH). They're also preparing to launch a similar NIMH-funded study in children treated with antipsychotic medicines. That research informs Newcomer in another of his professional functions. Since 1997, he's been chairman of the Drug Utilization Review Board for Missouri Medicaid. That board is charged with the tricky task of trying to make the best prescription drugs available to Missouri's Medicaid patients at the best prices the state can negotiate. A substantial portion of Medicaid patients has psychiatric disabilities, and it turns out that psychiatric patients receive many of the drugs that Medicaid covers. Newcomer points out that the top three drugs, in terms of Medicaid dollars spent per month, are antipsychotic medications. "It's interesting because we know that some of these drugs are linked to risk for high cholesterol and diabetes," he says. "Those problems are expensive to treat, too. Our board is very interested in strategies to reduce medical risk and cost in people with psychiatric symptoms, while also preserving access to all the psychiatric medications needed for treatment of the severe mental disorders found in our Medicaid population. "These complex problems lead to a lot of concerns and some complex dynamics involving the legislature, the pharmaceutical companies, the governor's office, physicians and patient advocacy groups." These days, Newcomer also finds himself on administrative committees for professional scientific societies, working on policies to try to ensure better care for patients. For example, he's chairing an American Psychiatric Association work group on antipsychotic drugs and their metabolic risks. That group will complete a "white paper" on the issue later this year. He also was part of an American Diabetes Association consensus conference on that issue.
Working with investigators to find drugs that treat symptoms with fewer side effects also is part of his role in Newcomer's newest University position: Medical Director of the Center for Clinical Studies. The center supports two types of clinical research: industry-initiated and investigator-initiated studies. Newcomer hopes that in the future, the center will expand its focus on investigator-initiated research. "That's where an investigator has an idea and, working with the Center for Clinical Studies, can find an interested and willing industry supporter," Newcomer says. "We think investigator-initiated research offers the greatest opportunity for growth in the coming years, especially if the NIH budget continues to be tight. There's just an enormous amount of intellectual wealth at Washington University, and industry wants to come and take advantage of those resources." One person helping investigators navigate some of the barriers that exist between industry and academic medicine is James A. Moran, J.D., assistant dean for clinical trials and executive director of the Center for Clinical Studies. Where Newcomer focuses on the clinical side, Moran concentrates on administration. "John's just a great guy to work with," Moran says. "We've gotten to work very closely together, and we have some exciting plans in the works. I think clinical research here is really going to be changing in the next few years as we find new ways to match investigators with funding." With all that he has going on professionally, Newcomer doesn't have a lot of time left, so he spends all his spare time with family. Newcomer's wife, Barbara Freedman, is a psychotherapist in private practice in Clayton, and his daughter, Leah, and son, Adam, attend John Burroughs and Whitfield School, respectively. The entire family enjoys cooking and eating great food together, traveling rigorously and discussing political and social issues, Newcomer says. The family also has two yellow Labrador retrievers, Max and Ruby, so when the weather is nice they like to hike with the dogs in Queeny Park. Newcomer's father ran marathons, but the son now has a life-long pass from such grueling competition. He earned it about three years ago when he was playing in a parents vs. kids soccer game. "I ruptured my Achilles tendon," he recalls. "That's an experience you never forget. I had a great surgical repair, but let's just say my enthusiasm for playing against the children in soccer has diminished." | | ||||||||||||||||||||||
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