The doctor is in, clinically speaking

The doctor is in, clinically speaking

Holy Name's Barkama helps make medical magic happen

Dr. Ravit Barkama oversees research at Holy Name Medical Center. Photo by Jeff Rhode/Holy Name Medical Center

To many of us non-physicians, medicine seems like magic; somehow doctors – the superhuman figures we think of as “they” – somehow they figure out exactly how the toe bone is connected to the foot bone, the foot bone connected to the ankle bone.

They analyze how miracle drugs work, and create new ones; they figure out how the body’s electrical and hormonal and muscular and molecular systems intertwine with each other. They wave their hi-tech wands, and we are cured.

Dr. Ravit Barkama of Tenafly is not only one of them, she is one of them on steroids (metaphorically speaking, but of course). As executive director of the Institute for Clinical Research at Holy Name Medical Center in Teaneck, she manages, directs, and oversees the research operations at the hospital – in other words, she is a physician who manages, directs, and oversees the development of little bits of magic.

New drugs and medical devices constantly are developed to treat a range of disorders, but whether those drugs and devices actually work – and whether they are safe – is something that only rigidly controlled clinical trials can determine. Without such trials, none of these drugs and devices can win approval by the United States Food and Drug Administration. Each has to be tested, in a series of ever-larger and more complex settings, before that approval is given. Dr. Barkama said

Holy Name often is part of that clinical trial process. “That means we get early experience, so we can offer it early to our patients, and potentially enhance patient care by offering them tomorrow’s drugs,” Dr. Barkama said. Because overwhelmingly most of the drugs and devices tested at Holy Name eventually make it to market, the risk to the patients is low, and the possible payoff generally is fairly high.

The Institute for Clinical Research conducts trials in a variety of clinical fields, Dr. Barkama said – in cardiology, infectious diseases, interventional radiology, multiple sclerosis, oncology, and gastroenterology, among others. Generally, drug manufacturers fund those studies, but some are paid for by government agencies, chief among them the National Institutes of Heath.

The hospital, too, supports the studies. “Clinical research enhances patient care by providing new cutting-edge devices and drugs that otherwise we couldn’t provide to patients.” The hospital often teams up with universities in this work.

“The system here is very supportive of the clinical research program.”

Although many hospitals allow research programs, in its Institute for Clinical Research, Holy Name has “an organized, centralized research institute that oversees the research,” Dr. Barkama said. “That is why we have a lot of companies contact us. We have to assess what kind of studies we want; we assess for safety and for the study design, and we look to see if we have the patient population that matches the criteria.”

For example, Dr. Barkama said, there is a kind of diarrhea called c diff – a nasty condition, caused by the clostridium bacteria, that develops when antibiotics change the flora of the intestines. The condition is not unusual, often develops in hospitalized patients, and can be dangerous, even fatal. The standard treatment is more antibiotics, but while that can stop an outbreak, it rarely cures the underlying problem, and the diarrhea often recurs. Merck has begun to manufacture an antibody that helps fight both the episode and its recurrence.

“The New England Journal of Medicine published a study that showed a decrease in recurrence from 25 to 7 percent,” Dr. Barkama said. “That is amazingly significant.” She is overseeing a Phase 3 test of that drug; the hospital already has treated 50 patients with the antibody.

The institute also is studying a vaccine against c diff that is given to patients at high risk for the problem.

Another new study Dr. Barkama finds exciting involved the use of a drug-coated balloon in patients who have vascular occlusions. The condition can cause great pain and keep wounds from healing; it often is treated with a balloon, but the drugs coating the device are a clever new idea, she said.

New medical procedures also must undergo testing. One such procedure, Dr. Barkama said, is designed to treat patients who suffer from a condition known as critical limb ischemia – reduced blood flow to the leg. There are ways to treat that condition, but they don’t always work. In the procedure now under study at Holy Name, doctors take marrow from a patient’s pelvic bone, filter out the stem cells, and then inject those cells back into the patient’s blood vessels.

“Sometimes we have exhausted all the regular options, but we don’t want to give up on patients,” Dr. Barkama said. “By doing clinical research, we give ourselves more options.”

Dr. Barkama arrived at her position at Holy Name through a clear-eyed, open-hearted willingness to choose among the many options available to her.

She was born on a kibbutz in Tiberius in the late 1960s; during the first four years of her life she was brought up as a classic kibbutz child, in a mode that was becoming less common even then and is nearly nonexistent now. She lived in a children’s house there; she and her parents would visit each other often, but they did not live together and they were not her primary caregivers.

Dr. Barkama comes from an unusual family.

Her father, Dr. Gideon Bar-Kama, grew up on that kibbutz. He was the son of a rich, well-educated Russian Jewish family; his father, Misha Bar-Kama, born in 1913, had grown up not in a shtetel but in St. Petersburg.

In fact, family lore says, Dr. Barkama’s grandfather’s own grandmother, Sophie Pomeranz, had been a journalist in Vienna; her newspaper sent her to Basel, Switzerland, in 1898 to cover Theodor Herzl and the third Zionist Congress.

Jews were ejected from St. Petersburg after World War I, however, so her grandfather made his way to what was then the Free City of Danzig. He was a pure Zionist, ideological through and through; clearly brilliant, and marked as a leader early on. He was sent to Sweden to learn agriculture, so that he could work the land in the most modern way when he got to Palestine.

He met his wife, Nomi, a teacher, in Danzig, and the two made aliyah together in 1932. They went straight to the kibbutz, where they could live the socialism they already loved. He found that he did not like working the land as much as teaching others how to do it; he developed a specialty in teaching about the Land of Israel; his work ranged from the politically abstract to the entirely practical.

When they got to Palestine, the young couple Hebraicized their last name from Kamber to Bar-Kama; their granddaughter morphed it into one word when she arrived in the United States.

Her other grandparents, Yakov and Tova Salzman, also arrived in Israel in the early 1930s; they came from a less wealthy, less ideological background. She was a housewife, and he was a manager for Solel Bonei, then as now Israel’s largest construction company. Their daughter, Dahlia, grew up in Haifa.

When Ravit Bar-Kama was 4, the family moved to Los Angeles so her father could earn a Ph.D. from UCLA in behavioral science. They returned to Israel when she was 11. That explains Dr. Barkama’s entirely fluid, completely unaccented English – she insists that her vocabulary is not quite as flawless as her accent would lead a listener to expect, but it is difficult for that listener to notice any such lapses.

When they returned home, though, it was to Raanana, not Tiberius. “My mother told my father that he had to chose between the kibbutz and her,” she said. Ideology can push a person only so far.

After high school, Dr. Bar-Kama went to the army; she was in intelligence, where she served as liaison to the air force. Next, she went to medical school at Hadassah Hospital in Jerusalem. She began a residency in radiology, “but after a year, in 1999, I decided to transfer to the Israeli medical industry,” she said. That move is not entirely unconventional now, but it was then. “I was inspired by the opportunities,” she said. “It was really exciting to be at the forefront of the technological revolution.”

For 10 years, Dr. Bar-Kama worked with medical device companies in Israel, “trying to identify clinical needs, doing clinical trials, assisted in marketing, attending international conferences.” She did not work directly patients because “I decided that I wanted to make a difference in people’s lives in health care on a more strategic level,” she said. She defines herself as a health care director, a job classification that is both large and growing rapidly.

In 2006, Dr. Barkama “joined a company that focused on software solutions for cardiac cath labs,” she said. “Cardiologists at Columbia – probably the number 1 group in the world – were consultants for our company. After working for them for about two years, they pulled me out of Israel to New York.

“It was a hard and a fabulous experience.”

Dr. Barkama’s husband, Zafi Dayan, is a systems engineer; they have three children, Gal, 16; Roy, 15, and Itay, 7.Their transition to the United States was not particularly easy, but the family now is ensconced in the large Israeli community in Tenafly.

After she began to work at Columbia, Dr. Barkama earned a master’s in public health there. About two years ago, she moved to Holy Name. “I love it,” she said.

She plans on moving back to Israel one day, but she is very glad that her trajectory has taken her through New York, Teaneck, and Tenafly. “It has been so inspiring and so interesting,” she said. “If I had to chose my career path again, I would do it all over again.”

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