For the past few weeks, I’ve been traveling around my adopted home of Cleveland playing the Prelude to Bach’s First Cello Suite. Music may not be able to solve the world’s problems, but I believe it can, as Lincoln said, “bind up the nation’s wounds.”
“With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation’s wounds…to do all which may achieve and cherish a just and a lasting peace among ourselves, and with all nations.”
Abraham Lincoln, Second Inaugural Address
Special thanks to Katarina Davies for her help with this project. Also, thanks to Grace Gill and Jennifer Woloschyn Harrell.
A medical device based on technology developed by three faculty members from Case Western Reserve University and University Hospitals Cleveland Medical Center (UH) has won a prestigious 2020 Edison Best New Product Award.
EsoCheck, a device designed to help detect precancerous changes in the esophagus, was named a “Silver” winner of the 2020 Edison Best New Product Awards in the “Medical/Dental – Testing Solutions” subcategory.
Esophageal adenocarcinomas have increased more than five-fold in recent years and are a highly lethal cancer, with less than 20% 5-year survival. These cancers arise from a precursor lesion of Barrett’s esophagus (BE), which is an abnormal cell type that arises in the lower esophagus.
EsoCheck is a swallowable balloon-based device that, in a simple five-minute outpatient exam, can collect cells from the lower region of the esophagus to help determine if Barrett’s disease is present. Unlike endoscopy, the current method for examining the esophagus, EsoCheck does not require a patient to undergo sedation, lose a day of work or need a companion for transportation.
The EsoCheck device works together with EsoGuard, a companion molecular assay that tests the DNA from the cells retrieved by EsoCheck for the presence of genetic changes indicative of the presence or absence of Barrett’s disease.
Lucid Diagnostics, a subsidiary of New York-based PAVmed Inc., licensed the EsoCheck and EsoGuard technology through the Case Western Reserve University Technology Transfer Office in 2018.
The EsoCheck device and EsoGuard DNA test were co-invented by Amitabh Chak, MD, (Professor of Medicine at the Case Western Reserve School of Medicine and gastroenterologist at the University Hospitals Digestive Health Institute); Sanford Markowitz, MD, PhD, (Ingalls Professor of Cancer Genetics and Medicine at the School of Medicine and an oncologist at University Hospitals Seidman Cancer Center); and Joseph Willis, MD,(Professor of Pathology at the School of Medicine and Pathology Vice-Chair for translational research at UH).
The technology was developed as part of the Case Comprehensive Cancer Center’s GI SPORE (Gastrointestinal Specialized Program of Research Excellence) and BETRNet (Barrett’s Esophagus Translational Research Network) programs led by Markowitz and Chak, and was first tested in humans in a clinical trial led by Chak at University Hospitals.
Further support for the clinical assay development was derived from a National Cancer Institute award led by Willis. The development was also supported by the Case-Coulter partnership and the State of Ohio Third Frontier Technology Validation Start-up Fund.
Last fall, the new EsoCheck method for examining the esophagus received clearance from the U.S. Food and Drug Administration for clinical use, and, this February, the companion EsoGuard DNA test for Barrett’s detection received breakthrough designation from the FDA.
Since 1987, the Edison Awards, named after Thomas Alva Edison, have recognized some of the most innovative products and business leaders in the world. They’re among the most prestigious accolades, honoring excellence in new product and service development, marketing, design and innovation.
About University Hospitals / Cleveland, Ohio
Founded in 1866, University Hospitals serves the needs of patients through an integrated network of 18 hospitals, more than 50 health centers and outpatient facilities, and 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship academic medical center, University Hospitals Cleveland Medical Center, located in Cleveland’s University Circle, is affiliated with Case Western Reserve University School of Medicine. The main campus also includes University Hospitals Rainbow Babies & Children’s Hospital, ranked among the top children’s hospitals in the nation; University Hospitals MacDonald Women’s Hospital, Ohio’s only hospital for women; University Hospitals Harrington Heart & Vascular Institute, a high-volume national referral center for complex cardiovascular procedures; and University Hospitals Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, including cancer, pediatrics, women’s health, orthopedics, radiology, neuroscience, cardiology and cardiovascular surgery, digestive health, transplantation and urology. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to Harrington Discovery Institute at University Hospitals – part of The Harrington Project for Discovery & Development. UH is one of the largest employers in Northeast Ohio with 28,000 physicians and employees. Advancing the Science of Health and the Art of Compassion is UH’s vision for benefitting its patients into the future, and the organization’s unwavering mission is To Heal. To Teach. To Discover. Follow UH on LinkedIn, Facebook @UniversityHospitals and Twitter @UHhospitals. For more information, visit UHhospitals.org.
Second Breath will help save lives during coronavirus pandemic
It’s called “Second Breath,” and this piece of equipment will save lives.
“Without this ventilator there are a lot of folks who might not have a chance at a breath,” said Dr. Mada Helou, from University Hospitals.
Three Cleveland organizations put their innovative skills, knowledge and can-do attitude together to create and manufacturer a breathing pump that will alleviate some of the demand for ventilators, all across the country.
“We like to respond to things, and more importantly the team likes to respond. There were eight engineers that developed this and these guys wanted to do something and they came to me,” said Dan T. Moore, president and CEO, Dan T. Moore Co.
It collaborated with several other organizations and in three weeks, designed “Second Breath.”
“Coronavirus’ main target is the lungs. It effects many organs, but it has a profound effect on our ability to hold oxygen within our blood,” said Dr. Helou.
Experts said an average ventilator costs anywhere from $20,000 and up to $100,000. Second Breath costs about $6,000.
Dan T. Moore Co. has made about 36 ventilators and they’re ready to ship out around the world. Engineers told 19 News they can design about a hundred ventilators a day.
The team tells 19 News they are proud.
“I think great innovation comes under pressure and when the COVID-19 surge showed up folks thought you know what, we need to respond to this quickly,” said Dr. Helou. “Everything about this says Cleveland. It speaks helping people and it speaks collaboration,” she said. “Cleveland, you’ve done this!”
When the COVID-19 outbreak started to become increasingly prevalent in Northeast Ohio, Mitchell Thom, a first-year medical student at Case Western Reserve University, and his friends were looking for ways to help. The group started discussing how much physicians and health care employees on the front lines are juggling, so they came up with simple ways to take care of providers’ regular, everyday needs.
As Thom started reaching out to more teachers and students about the idea, someone mentioned Lyba Zia, a third-year student, was doing something similar. And, with that, Cleveland Students Supporting Health Workers was born.
These two students—who have never met in person—joined forces, creating a process to match student volunteers with physicians, nurses and other health care staff needing help with errands and chores outside of work. In less than a week, they signed up more than 100 volunteers to shop for groceries; prepare meals; tutor children online; feed, walk and take care of pets; and run much-needed errands for Cleveland health care workers.
Volunteers are provided with safety guidelines developed by doctors at MetroHealth and are encouraged to drop off deliveries without direct contact, if possible, Thom said.
“We want CWRU students from all schools who want to help. The more, the better,” said Thom, noting that the majority of its volunteers now are from the medical, nursing and dental schools. Thom also noted that his group can help students away from Northeast Ohio who want to help in their own communities.
What does this group need most? “We need health workers to take advantage of these volunteers,” said Zia. “Right now, we have only 24 physicians and staff signed up, and we’re ready to take on so many more. We have an army of students waiting to take a load off those who are working overtime to treat patients and save lives.”
Health workers and volunteer students can sign up by emailing their contact information to covidvolunteer.cwru@gmail.com. When emailing, please note how you would like to help or if you need assistance.
A woman falsely claimed she had coronavirus at a security checkpoint at Cleveland Hopkins International Airport, shutting down the checkpoint for 20 minutes, officials said.
By Adam Ferrise
A Los Angeles woman caused the temporary closure of a security checkpoint at Cleveland Hopkins Airport Sunday after she told a TSA agent that she contracted the coronavirus.
The woman licked her fingers as she handed her driver’s license to the agent, Cleveland police and the TSA said.
The 63-year-old woman was not arrested and criminal charges were not filed as of Monday afternoon. Police reports say the woman could face a charge of inducing panic.
The incident caused the checkpoint to close for 20 minutes for the area to be cleaned, according to police and a TSA spokeswoman. The TSA spokeswoman said the agency plans to pursue a civil citation against the woman, which could result in a fine.
The incident happened as coronavirus continues to spread in Ohio and Cuyahoga County. Of the 50 confirmed coronavirus cases in Ohio so far, 24 are in Cuyahoga County.
Airport spokeswoman Michele Dynia referred questions about airport operations to Cleveland’s Joint Information Center. A woman answering the phone there said she could not immediately answer any questions about the woman’s encounter with the agent.
The incident happened about 5:20 p.m. Sunday. The woman walked up to the TSA checkpoint, licked her fingers just before handing her driver’s license to a TSA agent, and said: “Good thing you are wearing gloves because I just licked my fingers and I have coronavirus,” according to police reports.
TSA agents called for the Cleveland fire and medics posted at the airport to respond. The woman denied telling the TSA agent she had coronavirus, but said she did lick her fingers and told the agent she was glad he was wearing gloves, police reports say. She told officers she had no health issues and did not have coronavirus.
An airline banned her from flying on Sunday, according to the TSA. TSA agents prohibited the woman from entering the airport for 24 hours, according to the police report.
Researchers from Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center (UH), Cleveland Clinic and Lifebanc (a Northeast Ohio organ-procurement organization) have developed a new way to preserve donated kidneys–a method that could extend the number and quality of kidneys available for transplant, saving more people with end-stage renal disease, more commonly known as “kidney failure.”
The team identified a drug–ethyl nitrite–that could be added to the preservation fluid to generate tiny molecules called S-nitrosothiols (SNOs), which regulate tissue-oxygen delivery. This, in turn, restored flow-through and reduced resistance within the kidney. Higher flow-rates and lower resistance are associated with better kidney function after transplantation.
Their research was funded by a grant from the Roche Organ Transplant Research Foundation and recently published in Annals of Surgery.
The United States has one of the world’s highest incidences of end-stage renal disease, and the number of afflicted individuals continues to increase. The prevalence of end-stage renal disease has more than doubled between 1990 and 2016, according to the Centers for Disease Control.
The optimal treatment is a kidney transplant, but demand far exceeds supply. Additionally, donation rates for deceased donors have been static for several years, despite various public-education campaigns, resulting in fewer kidneys available for transplant. And while the proportion and number of living donors has increased, this latter group still only makes up a small percentage of recovered kidneys for transplant.
Increasing the number of kidneys available for transplant benefits patients by extending lifespans and/or enhancing quality of life as well as the potential for reducing medical costs (a transplant is cheaper than ongoing dialysis). To help improve outcomes for kidney transplant patients, the team explored ways to extend the viability of donated kidneys.
Improvements in surgical techniques and immunosuppression therapies have made kidney transplants a relatively common procedure. However, less attention has been paid to maintaining/improving kidney function during the kidney-transport phase.
“We addressed this latter point through developing enhanced preservation methods,” said senior author James Reynolds, professor of Anesthesiology and Perioperative Medicine at Case Western Reserve School of Medicine and a member of the Harrington Discovery Institute at UH.
For decades, procured kidneys were simply flushed with preservation solution and then transported in ice-filled coolers to the recipient’s hospital. But advances in pumping technology slowly changed the field toward active storage, the preferred method for conveying the organ from donor to recipient.
“However, while 85% of kidneys are now pumped, up to 20% of kidneys are determined to be unsuitable for transplant during the storage phase,” said Kenneth Chavin, professor of surgery at the School of Medicine, chief of hepatobiliary and transplant surgery and director of the UH Transplant Institute.
“For several years, our team has directed research efforts toward understanding and improving the body’s response to medical manipulation,” Reynolds said. “Organ-donor physiology and ‘transport status’ fit well within this metric. We identified a therapy that might improve kidney perfusion, a significant factor in predicting how the organ will perform post-transplant.”
Previous work by Reynolds and long-time collaborator Jonathan Stamler, the Robert S. and Sylvia K. Reitman Family Foundation Distinguished Chair in Cardiovascular Innovation and president of the Harrington Discovery Institute, determined that brain death significantly reduces SNOs, which impairs blood-flow and tissue-oxygenation to the kidneys and other commonly transplanted organs. The loss of SNOs is not corrected by current preservation fluids, so impaired flow through the kidneys continues during storage and transport.
Dr. Peter Pronovost: “So much of this work that I’m doing now is relational. It’s about building trusting relationships, because change progresses at the speed of trust, and trust grows when we do things with rather than to people.” (Gus Chan, The Plain Dealer)The Plain Dealer
By Brian Albrecht, The Plain Dealer
CLEVELAND, Ohio — The ghosts of medical errors haunt Dr. Peter Pronovost.
Two deaths, both caused by mistakes. First, his father’s, who died as the result of a cancer misdiagnosis. Then a little girl, a burn victim who succumbed to infection and diagnostic missteps at the hospital where Pronovost worked early in his career.
Those deaths led Pronovost to pursue a medical career dedicated to patient safety, and to create the medical checklist he has become known for worldwide.
Now, he’s implementing his second act, at University Hospitals, as its chief transformation officer, a job he has held since late 2018. His goal: To transform a $4 billion health care system by reducing shortcomings in medical care and increasing the quality of treatment.
The challenge fits Pronovost, says one of his former Johns Hopkins University professors, Dr. Albert Wu. “He’s one of the few people for whom the title might be appropriate, because his work has led to significant changes and innovations in how we deliver health care in the United States.
“He’s a once-in-a-generation guy.”
“One of the lasting impacts of the work we did in infections [with the checklist] was to change the belief that harm was inevitable,” says Dr. Peter Pronovost, chief transformation officer for University Hospitals. (Gus Chan, The Plain Dealer )The Plain Dealer
Taking the harm out of health care
Pronovost appears younger than his 54 years; he’s a self-described wellness fanatic, who loves running, biking, hiking and lifting weights. He’s comfortable at the office in everything from a pink, French cuff, button-down to an open-collar, checkered shirt.
In conversation, he can link medicine with a seemingly disparate array of subjects: United Kingdom economics, the shared learning of birds, the autobiographical nature of a Picasso painting. And yet, somehow, it all makes sense.
People who know him use words like charismatic, passionate, gifted, caring and high-energy to describe a physician whose prescription for health care reform combines research, bottom-line statistics and an unabashedly fervent dose of love.
Pronovost earned the nickname Dr. Checklist for his pioneering work 19 years ago developing a simple set of mandatory steps to eliminate infections from catheter lines, which once killed from 30,000 to 60,000 patients in the U.S. every year.
He wasn’t the first to use a checklist in medicine. But he’s been recognized as being among the first to maximize its use to save lives.
The success of the checklist concept spread to other medical procedures and has since become an accepted standard of health care and patient safety.
“We’ve shown with the checklist that we can take one problem and reduce it by 90 percent across the country,” Pronovost says. “What I want to do is broaden that and say, ‘Could I now take one health care system and eliminate defects in value . . . so we make health care much less harmful, much more affordable and more patient-centered?’
“But just like we did in my prior role, I want to create a model at UH and share it with the world.”
And checklists are very much involved in his vision.
Genesis of the checklist
Preparation for Pronovost’s life’s mission began when he was growing up in Waterbury, Conn. He credits his parents, an elementary school teacher and a mathematics professor, with providing needed support and validation of his views.
Pronovost says his high school study of philosophers like Plato and Socrates inspired an interest in understanding systems.
“One of the things I enjoy is stepping back and saying, ‘OK, here’s all the levers, here’s how the system works. How do we begin to pull those levers to move the needle in a big way?’ ” he says.
Thinking bigger led to the creation of his first checklist, one that tackles infections resulting from central line catheterization.
The process worked, spectacularly, and hospitals in other states and abroad started using the checklist model, which was gradually applied to other hospital procedures.
One application of the checklist concept was developed for blood clot prevention by Dr. Elliott R. Haut, vice chair of quality, safety and service at Johns Hopkins’ department of surgery.
Haut describes Pronovost as “super energetic. He’s a big thinker . . . a broad, how-to-change-the-world kind of guy.”
Pronovost will quickly point out that checklists alone “aren’t Harry Potter’s wand.”
They have to be part of a broader program that includes setting goals, building an enabling infrastructure, engaging with frontline clinicians and creating accountability systems.
When the checklist team started in 2001, at Johns Hopkins in Baltimore, an emphasis on patient safety in medical training and treatment was just in its infancy, You couldn’t even mention “human error” in a medical setting, says Bryan Sexton, now an associate professor of psychiatry and behavioral science at Duke University, who worked with Pronovost.
“Then, here comes this guy who looks like a Ken doll, out of nowhere. He brought science to the table and made it easy to do the right thing,” Sexton says.
“Peter Pronovost provided almost like a list of to-dos to get where [patient safety] needed to go. He was the right person at right time for something that was sorely needed.”
Accolades and accountability
In the years after the checklist debut, Pronovost gathered an array of accolades as he continued working in patient safety.
Time Magazine named Pronovost one of the 100 Most Influential People in the World in 2008, and that same year he won a MacArthur Foundation “genius” grant.
In 2003 he established the Quality and Safety Research Group at Johns Hopkins, and later became head of its Armstrong Institute for Patient Safety and Quality.
“Peter was very effective in positioning his center [the Armstrong Institute] as being about innovation and research, but sufficiently connected to the [health care] delivery system to make the changes that are necessary. His center really got it right,” says Dr. Bob Wachter, a patient safety expert and professor and chairman of the Department of Medicine at the University of California, San Francisco.
“I consider him to be one of the most important forces of my generation in health care,” says Dr. Thomas Lee, chief medical officer for Press Ganey, a national health-care consulting service. “Getting people to use the checklist took a special mix of confidence and passion and resilience. He earned the reputation he has for being a real leader.”
Pronovost helped The Leapfrog Group, a national organization that monitors hospital performance and encourages patient safety, develop its Hospital Safety Grade and annual Leapfrog Hospital Survey programs, says Leah Binder, president and CEO.
“We track reductions in deaths, errors and accidents, and I can say that through Leapfrog, he has saved thousands of lives,” Binder says. “He holds health care accountable for its performance.”
Beyond the checklists
There’s another side to Pronovost, says his daughter Emma.
“A lot of people only see the professional side of him. I get to see the fun side. He teaches me lot about not taking life too seriously,” says Emma, 19, a sophomore at Tulane University.
Like during one of the family’s ski trips when her father, knowing her fondness for dance, started singing waltzes, skiing to the beat, as they sped downhill together, to make her laugh.
And no, he doesn’t make checklists at home. Emma says that falls to her mother, Dr. Marlene R. Miller, pediatrician-in-chief for University Hospitals and chair of the Department of Pediatrics at Rainbow Babies & Children’s Hospital.
Driven and dedicated are words Ethan Pronovost, 22, a software engineer in San Francisco, uses to describe his father.
The dedication extends beyond working hours. Ethan says his father is constantly “looking for opportunities to expand his horizons.”
At work, “he really enjoys the propagation effect. It’s not just him, directly doing it himself, but inspiring others, building this cohort of influence.”
Pronovost’s wife of nearly 24 years is also a quality and safety researcher and says her husband’s qualities as a researcher include being “methodical, persistent. He brings good ideas to the table and then helps, through good analytical approaches, to make sure we can actually know if that intervention makes a difference.”
When asked how he’ll meet his newest challenge at University Hospitals, she laughs and says, “He’s been pretty successful so far. I don’t see that changing.”
Transforming a system
Pronovost cited a quote by poet Emily Dickinson, “Hope inspires the good to reveal itself,” to open a recent meeting of the team of health care specialists who are helping him transform University Hospitals.
He used the quote to illustrate a story about a homeless woman who repeatedly came to a UH hospital emergency room to ask for food. Instead of turning her away, the hospital arranged to have social services bring food to her home and helped resolve her other problems.
“In so much of health care we live these extremes of humanity where we can see what could be despair and self-destruction, or you can see hope and beauty and love,” Pronovost said. “All of us have that choice every day . . . whether we go to the dark and see the despair, or whether we have the hope and see the dignity.”
That said, the meeting got down to the business of the job he was hired for.
Pronovost and UH CEO Thomas Zenty co-developed several goals for the hospital system after Zenty hired the doctor in late 2018.
Their objectives capitalized on trends and challenges in health care, including:
Treat more people on an outpatient basis.
Utilize new technology that enables an increasing number of patients to be cared for at home.
Enhance the value of treatment and services to be more cost-effective and quality conscious.
Pronovost brought several attributes to the job, Zenty says. “Peter is not just a theoretician, but he is also very practical in terms of finding better ways to care for the patients we treat.”
He also was impressed by Pronovost’s work as a practicing physician, which enhances his credibility among fellow doctors, Zenty says.
Pronovost says the first challenge to providing the highest-value health care was identifying defects and working with others to eliminate them.
“We want to develop a new attitude that defects aren’t inevitable, but preventable, and value is all our responsibility,” he says.
Instead of the past “whack-a-mole” approach of trying to resolve individual health care problems as they surface, Pronovost says they organized their goals into three general areas:
Addressing patients’ needs for regular doctor visits, getting needed immunizations and screenings, and developing healthy habits.
Helping people with chronic diseases get well by reducing the risk of misdiagnosis and needless hospitalization.
Improving acute-care management, such as coordinating hospital care with a patient’s primary physician, and reducing unnecessary procedures (as many as 30 percent aren’t needed, Pronovost says).
Weekly interdisciplinary team meetings were established to plan policies, programs and, yes, checklists.
“[Attendees] all have very specific goals on their checklists. [Such as] how are we implementing protocols to reduce the length of [patient] stay and complications? How do we put the right rules in place so people go home rather than to a [skilled nursing facility], and that they get personal care-physician follow-up?” he says.
Pronovost notes that as a result of new efforts “we had about 1,000 to 1,200 fewer people readmitted” to the University Hospitals system last year.
Pronovost also says: There was a 12% increase in patients returning home, vs. a skilled nursing facility, after hospitalization. Acute care costs decreased by 25%. And, personal care physician follow-ups for post-hospital treatment went from 2% to 69%.
In just over a year since he was hired, Pronovost says, “We’re maybe 15 to 20% deployed in building this web of eliminating all these defects.”
Moving ahead
Pronovost is currently involved in an industry/government one-year Quality Summit to determine how to streamline programs administered by the U.S. Department of Health and Human Services to deliver a value-based care model. These programs include health care offered through Medicare, Medicaid and Veteran’s Affairs.
Part of that effort includes looking at the more than 2,000 measures the federal government uses to track health care quality. Pronovost says there needs to be a balance between unnecessary measures and those lacking in certain areas.
Additionally, Pronovost says, improving value in patient care and reducing preventable harm, the third leading cause of death, can trim health care costs, which run an estimated $3.5 trillion annually.
Pronovost’s program of value improvement and defect reduction at UH will probably take another four years to fully deploy, “and no doubt it will continue to get better and improve over time,” he says.
Police captured a pig after a man called 911 to report the animal following him. (North Ridgeville Police Department)
Police officers in Ohio were convinced a man who called 911 about a pig following him was drunk and hallucinating — but turns out the caller was telling the truth, and “very sober.”
North Ridgeville police officers received a call just before 5:30 a.m. Saturday from a man who said a pig was following him while he was walking home from the Amtrak train station in Elyria, located about 30 miles west of Cleveland. The caller added that he “didn’t know what to do,” the department wrote in a Facebook post.
Police officers were skeptical to believe the man and thought he was intoxicated and walking home from the bar.
“Night shift responded to the obviously drunk guy walking home from the bar at 5:26 in the morning. He was at least drunk enough to call the police on himself while hallucinating,” the police department said.
But the officers’ theory was actually wrong. Not only was the man very sober and walking home from the train station (like he said), a pig was actually following him.
“Yes, a pig,” the department added.
One of the officers managed to get the pig into the police cruiser and take him to the city’s dog kennel — that doubled as a pig pen for a few hours.
By 8:23 a.m. Saturday, the pig was returned to its owner, whose identity was not revealed, police said.
“You’d have thought we would have learned our lesson after the kangaroo incident,” the police department said, referencing to a 2015 incident when a “runaway kangaroo” was located in the town.
The police department posted a photo of the pig in the police cruiser on Facebook, which received more than 21,000 reactions, 11,500 shares and more than 2,000 comments as of Sunday morning.
If you unwittingly pass through this Midwestern town on the first weekend in August, you might think you’ve stumbled into a mirrored funhouse.
Everywhere you look there are identical twins, all of them wearing matching outfits. Here, two stout gray-haired men dressed as pilgrims. Over there, a pair of bearded dudes in lederhosen, hoisting trays stacked with mugs of beer. Even the baby girls in the two-seat stroller, sporting Steelers onesies, are spitting images.
This double-vision spectacle is Twins Days, an annual festival that brings thousands of twins from around the globe to northeastern Ohio to celebrate their twin-ness. The festival bills itself as the largest annual gathering of twins in the world.
It’s also one big petri dish for scientists, who flock to the festival every summer to study twins’ genetics and behavioral differences.
“It’s a club you can’t buy your way into,” says Katie Barry, 32, of New York City, who has been coming to Twins Days with her twin sister Kristy every year since they were 7. She gazes around at the carnival of costumed couples with a smile, searching for the right words.
“It’s this oasis of twin love.”
‘Where’s your twin?’
It’s almost too perfect that Twins Days is held in Twinsburg. The Cleveland suburb is named for identical twin brothers who helped settle the town and died of the same ailment in 1827, within hours of each other.
The festival got off to a quiet start in 1976, when 36 sets of twins showed up. It grew fast. This year, the event attracted more than 1,900 sets of twins, along with a smattering of triplets and at least one set of quadruplets. They come from almost every US state and from as far away as Australia.
The event has a county fair feel and includes a parade, look-alike contests, a talent show and an enormous group photo — a human blanket of twins — taken in a field from atop a crane.
Twin humor is abundant. Siblings stroll the grounds in T-shirts that say, “Thing 1” and “Thing 2,” “The Good Twin” and “The Evil Twin,” or “I’m not Steven” and “I’m not David.”
More than a few have rhyming names, like Bernice and Vernice, Carolyn and Sharolyn and Jeynaeha and Jeyvaeha.
It may be the only place in America where you can stroll into a hotel and be asked by a staffer, “Where’s your twin?”
For many identical twins, who spend the rest of the year drawing stares and enduring stupid questions — actual example: “Do you have the same birthday?” — it’s a rare chance not to stand out.
Twins say they enjoy profound bonds that few “singletons” — as non-twins are called here — fully understand.
“Some people bring spouses or boyfriends, and it’s a terrible mistake,” says Barry, “because they feel isolated.”
Katie and Kristy Barry, 32, of New York City, in homemade costumes inspired by “Wonder Woman.”
An exclusive club
About 33 in every 1,000 human births in the US are twins, a rate that has climbed in recent decades as more women marry later and take fertility drugs or employ in vitro fertilization. Identical twins are an even more exclusive club — roughly 4 in every 1,000 births.
They are formed when a single fertilized egg splits in two after conception, creating two embryos with the same genetic makeup and DNA.
Scientists love to study them because they help answer the age-old question about nature vs. nurture. Because identical twins share the same genes, any differences between them — say, more wrinkled versus less wrinkled skin — must be the result of their environment.
Take Laura and Linda Seber, 41, from Sheffield, Ohio.
The pair tied for 8th in their high school class of 404 students, attended the same grad school — “It was great to buy one set of books,” Linda says — and now share a home while working as physical therapists.
“If we’re genetically identical, I should be able to do everything that she does,” says Linda. “But sometimes it’s difficult being compared to each other. Because if I can’t achieve what she achieves, it’s like … why? Why can’t I do that?”
Indeed, it is hard to underestimate the mysterious psychic forces that bind one twin to another.
Don and Dave Wolf, 59, have identical graying beards that hang halfway down their chests. The identical twins live in Fenton, Michigan, and do long-haul trucking, sharing turns at the wheel during marathon cross-country drives.
The pair recall waking up one morning as boys, age 11 or 12, to discover they had just had the same dream. A few years later, Dave suddenly became overwhelmed with concern for his brother only to learn from their dad that Dave had just broken his collarbone in a motorbike crash.
“I can’t explain it. I didn’t feel any pain,” Dave says. “But I just knew something had happened.”
Don and Dave Wolf, 59, share a home in Michigan and drive a tractor-trailer together.
In the name of science
In a long white tent on the festival grounds, a long row of twins sit at tables before trays of color-coded food flavors: milk, potato chips, artificial sweeteners. Wearing nose clips to mask aromas, they uncap each sample, take a taste and then spit into a plastic cup before taking a swig of water and tasting the next. They record their opinions on an iPad.
These twins are serving as volunteer subjects for the Monell Chemical Senses Center, a nonprofit research institute in Philadelphia whose sponsors include such food giants as Coca-Cola and General Mills.
“Our question is whether some people are taste-blind and if so, to what? Our interest is whether this is a genetically determined trait,” says Danielle Reed, a Monell behavioral geneticist. “We like to compare genetically identical twins to twins that are no more similar than ordinary siblings.”
This can help food scientists understand which traits — say, an affinity for bitter flavors — are most strongly determined by genetics.
Tara Louis tastes different types of milk as part of genetic research into food preferences.
“You can imagine if we look subjectively at their DNA we could predict what will taste better or worse to people,” Reed says. “So you can tailor dietary advice to people’s actual ability to taste and smell.”
Monell is just one of a handful of research groups that attend Twins Days. A few feet away at Procter & Gamble’s Olay tent, scientists are studying twins to better understand the aging process and its effect on skin. Nearby, a forensics expert from the Los Angeles Police Department is collecting latent fingerprints from identical twins — yes, twins’ prints are slightly different — to improve fingerprint-identification tools.
And at West Virginia University’s tent, biometric researchers take hi-res photos of twins and record them speaking to help computer scientists create better facial and voice recognition systems. The FBI has funded similar research here as well.
“If you can build a system that can differentiate between identical twins,” says Jeremy Dawson, a WVU associate professor of computer science, “then it’s a lot easier to tell the difference between (regular) people.”
Gregarious identical twins Doug and Phil Malm grew up in Idaho. Identical twins Jill and Jenna Lassen, both introverts, grew up in Michigan. Their father would address them as “sisters” because he was too proud to admit he couldn’t tell the girls apart.
All four were visiting the Twinsburg festival in 1991 when they met and sparks flew. Luckily, there was never a question over who would be with who.
“It was instant,” says Phil, who chose Jenna. “We knew right away which one we were with.”
Patrick M. Ketter and Paul R. Ketter Jr. sport patriotic outfits. One twin is liberal, the other more conservative.
Doug and Jill and Phil and Jenna
Twins Days is also about the science of attraction.
New kings and queens are crowned here each summer. But the closest thing to perennial festival royalty are the Malms.
Phil, Jenna, Jill and Doug Malm. The foursome met at Twins Days in 1991 and were married here two years later.
The foursome now live in Moscow, Idaho, as members of a tiny subset — identical twins married to identical twins. Doug and Phil, 60, are retired carpenters, while Jill and Jenna, 50, work in day care.
All four share one home. Separate houses, even side by side, wasn’t an option.
“It never would have worked,” Doug says.
But the couples have had to learn to solve domestic disputes as a foursome.
“When we fight, we can’t work it out as just two of us. We have to work it out as four,” Phil says.
And yes, sometimes household confusion reigns.
“When I look at my wife and her sister, there are days when I cannot tell them apart,” Doug says.
He has been known to come up behind Jill and give her a playful bite on the neck, only to realize he’s nuzzling Jenna. “And then,” he says, “we get teased for a while.”
Lauren and Allison Knight wear matching tops celebrating their Canadian heritage.
A year’s worth of data
Back at the research tents, the twins line up, sometimes for an hour or more, to participate. It’s a mutually beneficial arrangement.
The twins enjoy it because they get money or free samples. Many say they feel good knowing they are contributing to science.
The scientists like it because it’s an efficient way to gather data from a hard-to-find group of people.
The Monell Chemical Senses Center expects to collect research on some 450 twins over the course of the weekend.
“We collect a year’s worth of data in four hours,” Reed says.
Braeden and Aaron Chulskiy, 2 1/2, are pulled in a wagon by their dad.
The saddest man at Twins Days
Amid the procession of coupled siblings, one man wanders alone.
Shawn Riggins, 45, wears a T-shirt with images of his twin brother Shane’s face and a festival badge bearing both their names. And he wears his heart on his sleeve.
Shane is not here. He died last September of colorectal cancer.
“There’s a sense of emptiness that no words can describe,” Shawn says. “There is a pain that’s so deep you can’t cry it out. You can’t scream it out. You just need to walk through.
“He’s not here in the physical, but I see him every day when I walk past a mirror.”
The two brothers had been coming to Twins Days together for 20 years. They thought they were fraternal twins until 2002, when they took DNA tests at the festival and learned they were identical.
Shawn Riggins, center, talks with friends at his first Twins Days without his twin brother Shane, who died last year.
“We looked exactly alike,” says Shawn, who is a kindergarten teacher in Columbus, Ohio, and remains cancer free. “We did everything together. We had the same eyeglasses. We had the same facial hair. If we went to an event, we always had to walk in at the same time.”
Shawn agonized for months about whether to come to Twins Days this year. But in the end, he decided the support of his fellow twins, many of whom knew Shane, made it worth the trip.
“I came back here because no one else but a twin can understand the enormity of what I’m feeling,” he says.
The scientists, focused on sets of twins, no longer want to study Shawn. They can measure twins’ DNA, but they can’t fathom the depths of their grief.
But twins here, many of whom remember his brother, take him in their arms for tearful embraces.
Just then, as if on cue, a woman approaches Shawn and gives him a long hug. He thanks her.
For now, he says, “the energy in this place has given me the strength to stay.”
Riggins takes a deep breath, pulls himself together and shuffles toward a passing throng of festivalgoers. He’s ready for more hugs, two at a time.
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