By: Mohamed Dungersi & Mahdieh Danesh Yazdi, Associate Student Editors
Each month, the editors at the Rho Chi Post have the opportunity to interview one or more of our faculty members. This month, we had the tremendous opportunity to interview the dean of St. John’s University College of Pharmacy and Allied Health Professions, Dean Mangione. In this in-depth interview, we spoke to him on a number of pertinent issues ranging from his recent research grant, the past, the future, and so much more in between…
Mohamed: We recently learned about the grant you received for celiac disease research. What will your research entail?
Dean Mangione: The grant is actually from the National Foundation for Celiac Awareness (NFCA), who I have been working with for a number of years (currently, Dean Mangione is serving on the Medical Advisory Board for the NFCA). As you know, celiac disease is an intolerance to wheat, barley, and rye. It had always troubled me as a pharmacist that medications were an overlooked hidden source of gluten and the regulatory issues associated with that are not particularly strong. I am concerned if there are any celiac patients or other gluten intolerant patients who are taking medications and may not realize the fact that there is gluten in the medication and that it is in turn causing symptoms or predisposing the patient to harm. Our thought was to possibly compile some anecdotal reports, for example, asking patients if they had any problems with medications through surveys and then analyzing whether in fact the medications contain gluten. I am working with Loretta Jay (co-primary investigator and NFCA consultant) at the NFCA and equal recognition should also go to Dr. Zito and Dr. Pal who will be assisting me with the research. Dr. Pal is going to be looking at the data since he is a biostatistician along with his other qualifications. We will identify certain drugs that might be worth looking at and Dr. Zito will analyze the drugs to see if in fact the medications have gluten in them. It is interesting from the perspective of identifying drug products that may be problematic; but, I am even more interested in just seeing whether or not individuals with celiac disease are even thinking about drugs as a source of gluten. I am not sure what the study will conclude, but I am sure we will contribute to the literature. I am also happy to note that the FDA has an interest in the study.
Mohamed: We wish you the best of luck with the study and hope that you are able to increase awareness on this important issue.
Dean Mangione: One of my personal objectives is also to raise the awareness of pharmacists. I think pharmacists can do a lot more for patients with celiac disease; however, the first step is to make sure they understand the disease, without which they will be unable to help people. That’s possibly another benefit we hope to achieve.
Mahdieh: You have been at our school as a student, a teacher, as well as an administrator. What was/is your favorite class to teach or learn about?
Dean Mangione: As a student, I cannot really say if I disliked any of my courses. Obviously, I liked some more than others. When I think of my days as an Undergraduate, I tend to think more about the faculty members than the class. I was blessed to learn from some truly outstanding professors and I do not wish to offend anyone. However, I feel that Dr. Jarowski was the professor who had the most profound impact upon me, inspiring me to try to be as good a teacher he was. As it turned out, I really struggled in his physical chemistry/pharmacy class, but he was just a wonderful teacher and my hope was that someday I could be close to where he was.
In terms of teaching, I always enjoyed every course I taught and I have taught many courses, but I would say it is the pediatric pharmacy class that I certainly enjoyed a lot. It was a course I created and nurtured, and one that I certainly miss teaching.
Mohamed: Was that the focus of your residency training?
Dean Mangione: During my residency, I focused somewhat on pediatrics. It was also my first faculty appointment here in drug information and pediatrics. There was a curricular need and opportunity, and Sr. Jane Durgin gave me the opportunity to focus on pediatrics. It was a great place to be.
Mohamed: Sometimes, fate does have an important role to play. The timing of the job opening and your specialty training in pediatrics worked out well.
Dean Mangione: Yes, it was great. I do not know if when I started that I was a specialist. You have to work at that and I learned a lot every day. By the same token, it was difficult as I was always deeply troubled when I saw sick children. You had to try to find that balance, where you could not be incapacitated by the sadness you felt when you saw an ill child; and to this day, I feel that way. You hope you can reach inside and say, “maybe I can do something to relieve that suffering”. That is what drives you. It is easy to succumb to the sadness and to not be able to move forward. It was Sr. Jane Durgin who kept me grounded and who helped me find the courage to go back every day. A lot of people helped me along the way.
Mohamed: Moving on to the next topic. As the dean, you constantly have to make tough decisions. Throughout the last couple of years, what has been your most difficult decision to make?
Dean Mangione: Well, you do not want to make mistakes. I think that when I am confronted with an academic discipline issue that impacts upon a student, those decisions are the most difficult. The more severe the violation of the honor code, the more difficult it is because the consequences are more severe. If you get to the point where you have to recommend expelling a student, those are very difficult moments and you never forget them. Then again, those are the decisions you have to make to support the students who are doing the right thing. We are all human and we do make mistakes, but unfortunately there are consequences. Do not get me wrong; there are other decisions that are difficult, for example important policy issues such as funding, but whenever you impact a person’s individual life, it can get very difficult indeed.
Mahdieh: On the flipside, what do you feel is one of the best decisions you have made as dean?
Dean Mangione: I tend to move on to the next project. I would say, and I’m not going to mention any names, my best decisions have been the faculty that I have been able to hire or who I have been involved in hiring. It is a real gift to see them blossom and do great things and I will often reflect on that. I am very proud of who we have hired and the great things that they are doing with our students. So, that is what I feel most proud of in terms of the decisions I have had to make.
Mahdieh: Pharmacy is progressing as a profession and now we have collaborative drug therapy management (CDTM). What are your thoughts on CDTM? Where do you see the pharmacy profession in 10 years’ time?
Dean Mangione: Well, we fought very hard for CDTM and I think when the process was ultimately approved, there were some pharmacists who focused on what was not approved instead of what was; I think that was a mistake. We should be grateful for what we have. It is a great start. We all know it is not the final product that we want, but unless you run the first lap, you cannot run the remaining 5, 6, 7, or 8 laps. I am encouraged by it.
I think for the future, pharmacists will be held accountable for drug therapy outcomes to a greater degree than we currently are. I think that it is very important that our profession never loses the responsibility for and the greatest knowledge of the product. I think we have to understand better than anyone else, for instance, what makes a tablet a tablet, or a sustained release capsule a sustained release capsule. I think that pharmacists will be looked upon to contribute more to achieving a desirable therapeutic outcome or to recognize an undesirable outcome. Pharmacogenomics is going to have a significant impact; where a pharmacist will be able to determine beforehand whether a drug will be good to treat not only a disease, but a specific patient. This will be a very dynamic change.
I think it will be a mistake if we relinquish our responsibility or association with the product. That’s just my opinion. But it goes beyond that to therapy outcomes.
Mohamed: Building on that, do you think pharmacists will have prescriptive authority in the future?
Dean Mangione: I think there will be. However, another piece of that which is often overlooked is the education of the patient. I am the first generation of my family to go to college; and I mean no disrespect when I say this, but if I think back say two generations, my guess is that that generation’s understanding of healthcare was far less than this generation’s understanding. As consumers of healthcare, future generations will have a greater capacity to comprehend the challenges associated with drug therapy. I think that is going to be a part of it too in terms of who is receiving the information. Of course there are inequities throughout the world that we have to think of as well. I think we have an obligation and a responsibility to those who are less fortunate.
I think there is going to be an increase in prescriptive authority but that it will be very carefully framed. Physicians, nurse practitioners, and physician assistants have a pretty good handle on that right now so I do not see it dramatically changing.
Mohamed: Currently, there is a trend in pharmacy schools offering combined degree programs (i.e. PharmD/MBA, PharmD/PhD). What are your thoughts on combined pharmacy programs? Will we be seeing the St. John’s University College of Pharmacy and Allied Health Professions offering similar programs?
I have a great interest in combined programs. I tried unsuccessfully in the past to establish them. I do not think we would ever have a significant number of students pursuing them, but that does not mean that should discourage us from offering them. I would love to see a PharmD/MBA, even a PharmD/JD. I have even spoken to the deans of the law and business schools about it. The biggest challenge is that you are looking at a PharmD being worth 201 credits and an MBA worth another 50 or 60 credits; how many credits do you crossover? I think both degrees would make a case for not giving up some of their credits and that makes it a challenge.
In the past few years, we have been so consumed with other projects that this always got pushed to the future. My thoughts? Yeah, I think combined degree programs are great! Do we have the capacity to do it? I think we do. But right now, it just has not made it to the top of the priority list because there have been other things sitting there.
Mohamed: Do you feel that having a combined degree program, for example the PharmD/MBA, would devalue one of the degrees?
Dean Mangione: No, I do not. I think it would add an interesting perspective. The PharmD student enrolled in the MBA program would bring an interesting perspective to the business school and the MBA student enrolled in the PharmD program would bring an interesting perspective to the pharmacy school, in the way they look at the world. When you look at healthcare and the business oriented decisions that have to be made, it is a natural for a PharmD/MBA to assume positions of greater authority in healthcare delivery (from a systems approach). So, I think it is the right way to go. You also have to make sure it is the right MBA also. For instance: is it finance? is it management? and what are the implications. Or maybe, a new MBA in healthcare management. That would be something we would have to work on with the business school, which is not a concern; they are great to work with. It is just that right now there are so many other things that we are deploying our resources towards accomplishing.
Mahdieh: After you wanted to come back to teach, you decided to get your doctorate in Education. Is that something that you would like to see: a PharmD/EDD?
Dean Mangione: Well, I am an outlier. That whole story, when I was named Assistant Dean for Student Affairs in 1990, I realized I did not know a whole lot about administration, particularly fiscal management. So I approached the dean of that time, Dr. Belmonte, to ask, “What do you think?” And he said, “ If you want to go back to school, why not?” Then, I went to see Dr. Bartilucci, who has always been a mentor to me, and he said, “Well, you’re gonna be here anyway.” So I started down the journey. It was very difficult at the beginning, because it was such a difference, such a change, but I had great faculty and people who were very patient with me. I became more and more interested in it and at the end of the day I found myself drawn to many areas, but particularly the economics of higher education: how can you get quality in a manner that is not going to compromise your ability to pay for that quality? And so, that kind of became an interest. It was unanticipated, to be honest with you. When I first started the EDD, I was not quite sure where I was going to end up. I just knew that if I was going to be an effective administrator, as assistant dean, and I never expected to be dean, but if I was going to be the best assistant dean I could be, I felt that going for that degree would help me. And I had great faculty in the School of Education. No regrets…it took me a long time, but I have no regrets. So PharmD/EDD, I do not know.
Mahdieh: Do you have any mentors? You spoke about Dr. Bartilucci and other professors, what advice did they give you?
Dean Mangione: I had and still do have mentors. There have been so many. I mentioned Dr. Jarowski, Dr. Bartilucci, and Sr. Jane Durgin; there is also Dr. Olsen, who was my dissertation advisor and is still a great source of advice to me. They mentored me through both words and actions. Seeing how they would respond to various issues that were raised, various challenges. When I seek their advice, and I certainly do, though I do not see Sr. Jane as much as I would like to, I think it always comes back down to: “Do what you think is right to do.” My hope is that I would always make them proud and I think that is a motivation in and of itself. If they are going to know what I did, then I want to make sure that they are proud that I did it. But also, there is a strong foundation in scholarship. It is not all just, “Well, let’s see what happens.” You have to understand the situation, study it without excessively delaying the decision, and then make the best decision you can. I think I go to different mentors for different things. And I think an overlooked mentor is my wife. I talk a lot about these great theorists in higher education and pharmacy education, but at the end of the day, I am blessed to be able to talk things out with her and get her perspective, which is always fresh, always insightful, and always helpful.
Mohamed: You are a mentor for all pharmacy students; do you have any words of wisdom for pharmacy students? I know you already went through some of them, but anything specific?
Dean Mangione: Well, we have really great students, I am really proud of them. I often say that our students make me look better than I am. I just think that you should treat your patients as if they were members of your family and never forget that even when it is difficult, that patient is a mother or a father or a son or a daughter and people really care about them. Look in your patient’s eyes; they are not a prescription, they are a person, and that can be very difficult sometimes. You may not want to do it; you are busy; it is a fairly routine prescription… but sometimes when you dig a little deeper, you find that what appears routine really is not. That would be my advice; do not lose that personal touch, no matter how busy it is. I mean, I have worked in many situations where we were getting overwhelmed. I always tried hard, even if it was brief, to know who I was dealing with, not just a prescription number. I think when it becomes depersonalized, it loses its humanity. We are not technicians. I’m not saying there is anything wrong with technicians, but we are pharmacists. I think we have to understand the different roles we play.
Mohamed: Absolutely. My next question was going to be about your advice to current pharmacists, but I think you covered that. Do you have anything specific to add for current pharmacists?
Dean Mangione: Focus in on the things you really like. If you find yourself in an area of the profession that you do not enjoy, move to another one. We talk loudest with our feet. So, if you are in a community pharmacy and you say: “I do not like this,” well then try hospital. And if you are in a hospital setting, well then try another hospital. Find that peace. I think we are deceiving ourselves if we feel: “I don’t need peace at work, I’ll be OK.” I do not know if we are really being honest with ourselves. You have to continue to seek that. I am fortunate, in anything I have ever done: as a community pharmacist, hospital pharmacist, faculty member, assistant dean, associate dean, and dean, I have always enjoyed it. I have always considered myself privileged to be doing what I am doing, never really regretted it. I did not wake up in the morning and say, “Oh, I do not want to face that”. There were some things that obviously worried me, some daunting challenges, I hoped I was up for the challenge, but that does not mean I did not enjoy it or that I was not grateful for the opportunity to be involved in that. I think that is the advice: find that peace. And sometimes, we spend our lives looking for that peace.
Mohamed: A famous person once said, “Find something you love, and you’ll never work a day in your life”, which I think is what you were heading for.
Mahdieh: So pharmacy schools are undergoing a lot of changes. I think we are one of only nine schools that have a 0—6 program. There are more schools adopting a bachelor’s requirement before professional pharmacy school training. In the next few years, what changes do you think our pharmacy program here will undergo? How about pharmacy schools nationwide?
Dean Mangione: Clearly there is that trend. You see more and more schools become 3—4, or 4—4 schools. Here, I have charged the faculty to look at the curriculum from a zero base and build one. And maybe that is going to look like the one you are in right now, I do not know. But, I think there will be some changes. Will we ever become a 2—4? Well, I think we might. Is that going to happen this year? No. Within the next five years? I do not know. I think when you look at the ability to effectively manage enrollment but also to help our students progress through, sometimes having that second review period, might be helpful to the students, between that sophomore year and the first professional year. But I also think we have to be consistent with the roots and foundations of this university, providing accessibility to gifted students to complete the program. So with that in mind, are we going to make a change tomorrow? No. Do I think we are going to see significant curriculum reform within the next five years? Definitely. Will that be a 2—4? I do not know. But I do think it is important to at least look at the curriculum. And if the faculty come back and say: “We are where we need to be” and that decision can be supported with appropriate data, well then so be it. But there is value in that as well. But if you just assume it is ok, that is when you get caught. And we do not want to assume anything. We are going to see changes. Part of those changes will be imposed on us through external accrediting changes. But I think that if you return after ten years to visit as alma mater after you graduate, if we do our jobs correctly, you will still see evidence of the core values that you respect and that you embrace. Because if we lose those core values, that would be a tragedy. As much as there are going to be changes, the courses might look different, the sequence might be different, but we’re still going to be St. John’s University and I mean that in a good way.
Mohamed: I think this is very important. I am from Kenya; Mahdieh is from Iran. This is a pretty diverse table. But regardless of the differences in cultures, nationalities, and religious beliefs, we all relate to these values. Core human values remain core human values.
Dean Mangione: Well I also think that you strengthen the core values of the institution. The perspectives that you bring, the enthusiasm, the triumphs, the struggles; those are things that make us stronger. I think sometimes when we look at diversity in education we tend to focus on those who contribute to the diversity. But there is extraordinary value to the group that occupies the majority, because they in turn are better educated because of the individuals who bring new culture into that group. It is a win-win. I am glad we take our diversity for granted. When I visit schools that are not diverse I am uncomfortable, I think what is going on here? But, I grew up in Queens and it is just part of my life and I have been blessed with great diversity in all components of my family, so it is a real plus… a real strength. But I will tell you, I tend to notice schools that are not diverse, rather than schools that are. I would not want to be anywhere else.
Mohamed: In the past, we know that you have played/coached basketball. Do you still play or coach?
Dean Mangione: Well, people might question whether I played or not. I sat on the bench of my high school basketball team. No, I do not play anymore, but I do miss it. Basketball has had a profound impact on me. In many ways it is a metaphor for life. Maybe my failures in basketball have been more rewarding than my successes: to pick yourself up and try again. I have made some great friendships through the sport and coached some really great young men and young women who taught me a lot. But I coached for about 20 years in my parish, and the police athletic league, but then it became difficult as my positions changed at St. John’s University. But what I always felt as a coach was that you should prepare your team. It really was not important to win; it was to be prepared for the game. And to try to understand how the other team was going to try to do what you wanted to do.
Mohamed: Kind of like life….
Dean Mangione: It really was. I always felt and always will feel that when it is played right, the game of basketball is an absolutely beautiful game. While there is great joy in the game, there is also great reward in preparing, competing, and doing the best you can. Although I was good enough to make the team, I was far from a starter. But I worked very hard in practice because by doing that I could make the starters better. I played against some very good basketball players, whether it be in the Catholic High School Athletic Association or summer basketball leagues. It is a good thing to look back on. When there was only one college that had a minor interest in me to play, I knew it was time to…
Mohamed: Find something else?
Dean Mangione: Yes. But it is always in your heart.
Mahdieh: Knicks fan?
Dean Mangione: Well, you know, when Jeremy Lin is playing yes, [laughs] No, I’m more of a college basketball fan than a pro-basketball fan I guess. But I am a New Yorker so I root for the Knicks.
Mahdieh: Which college basketball teams besides St. John’s University’s do you like?
Dean Mangione: Oh, I am going to get into trouble here. Besides ours, I very much enjoy watching Princeton and Georgetown play. And Georgetown basically runs a modified Princeton offense. Northwestern, they run that same offense. I really enjoy the screens, the back door plays… I really enjoy watching women’s basketball because it is fundamentally sound. And that is the part of the game that I think you find the real beauty in. The person who sets up the screen, who provides the opportunity for the person who hits the jump shot… the person who hits the jump shot is going to get the recognition but without that screen, or without the pass you know… and that to me, when you see the court and you see that happening… and sometimes you get lucky and you see it happening before it does. You know it is going to happen and you can see it. It is kind of fun but those are the teams I enjoy watching. That style of basketball I find very interesting.
Mahdieh: What advice would you have for students who want to do more outside of school, the curriculum, and school organizations to promote the profession?
Dean Mangione: I think you have to assume that each encounter you have, talking about pharmacy, or practicing pharmacy, that counts and that has consequences. So you always want to speak honestly and if possible, not negatively. Because if you are discouraged and you devalue what pharmacists do, then really you are devaluing yourself. There are some things that we do not do well, we need to do better, but the emphasis should be on what we are going to work on getting better at, not what we are really terrible at. So I think that is really the way you should go forward. And also recognize the contribution that you are making. There are things that pharmacists do and should do better than anyone else, and there are things that we should not do. We are not surgeons. And we do not want to be surgeons. Chances are they do not want to be pharmacists. Try to understand what other people do and respect that. Make sure that people respect you and I think the rest falls into place. It is an institutional core value: Respect. Sometimes it is more difficult than others.
Mohamed: If you could spend time with anybody dead or alive who would it be?
Dean Mangione: No doubt, Dr. Martin Luther King Jr. Not even close. Always a hero for me. When you think about Dr. King… his courage, obviously a brilliant man; our world is a better place because of him. I often reflect on how terrifying it must have been to do what he did. A man of faith, a man of courage, a man of vision. That would be really special, to be able to talk to him.
There is someone I have great respect for, again thinking of Dr. King, Major General Joseph McNeil who I would like for you guys to meet. General McNeil was one of the four students at North Carolina A&T who on February 1, 1960, were instrumental in starting the sit-in movement which was so critical to the success of the civil rights movement. And he is a friend and certainly one of my heroes.
That struggle, to think of what Dr. King overcame through peaceful means, is extraordinary. So, he would be the one. I mean there are many others of course but if I could only pick one, he would be the one.
Mahdieh: So we have published seven issues to date of the Rho Chi Post. Which one is your favorite? Was there an article that stood out, or a specific section that you enjoy reading?
Dean Mangione: Oh, I like them all. First of all, it is extraordinarily impressive, I mean in the depth and extent of coverage. I do not know how you guys find the time to do it. But, you are really amazing. So I cannot say there is one issue I prefer over the others. But I enjoy reading about the faculty; I really do. It is kind of fun, and I know it is fun for them too. It was very nice of you to come here and talk to me today. I think that is the aspect that I particularly enjoyed. I think that we tend to be a quiet faculty, and that is ok, we get pleasure from the work, which we should; but, it is nice to see them highlighted, put in the spotlight. They deserve to be there; they really do. So I won’t say I have a particular favorite but I will say that it is fun to read about that.
Mohamed: Do you think there is anything we need to improve on, something we should bring to the Rho Chi Post?
Dean Mangione: You guys have certainly set a new standard. I do not think anyone will ever equal. There were previous Rho Chi chapters that nobody thought would be equaled. And then you guys come along and no one is going to equal you. You guys are doing a great job and you have a wonderful advisor in Dr. Zito. I would say it is all good.
On behalf of the entire Rho Chi Post Editorial Team, we would like to thank Dean Mangione for taking time away from his busy schedule to sit down with us. As always, he was very gracious with his time and very patient with our questions. We wish him the best of luck in all his future endeavors.