BIDMC Medical Grand Rounds: Major Advances in Gastroenterology & Hepatology: A Half-Century Retrospective

J. Thomas Lamont MD giving presentation

I recorded audio of the following presentation by my father at Beth Israel Deaconess Medical Center in Boston in January 2020 and later worked with him to incorporate the slides and post it as a video. The video not only gives a history of major developments in gastroenterology from 1965-2020, but also gives insights into how crucial discoveries and paradigm shifts (including those in other fields) can upend the established order. A transcript is included below.

Medical Grand Rounds: Major Advances in GI & Hepatology: A Half-Century Retrospective.

Presented by J. Thomas Lamont, MD (Rabb Professor of Medicine at Harvard Medical School). Sherman Auditorium, Beth Israel Deaconess Medical Center, Boston, January 9, 2020.

Watch the video here

Introduction by Nezam H. Afdhal, MD:

The Zetzel Visiting professor lecturer this year is Professor Thomas Lamont, who is, as you all know, the Emeritus Chief of Gastroenterology at BIDMC. Tom started his career at UCLA, where he did his residency, and then has the dubious distinction of having worked at every teaching hospital in the Boston area, except Tufts.

After his fellowship at MGH was on the Faculty at Harvard Medical School until 1980, when he became the chief of GI at Boston Medical Center. He then came to BIDMC to be the Chief of Gastroenterology in 1996. His career has spanned major achievements in all areas of gastroenterology. Many of you don’t know this, but he was one of the first people who worked out how gall stones developed in the gallbladder.

He published a paper that was the cover of Nature that illustrated why the stomach does not digest itself due to the interactions of mucins and the effect of acid on the mucin structure within the stomach. At BIDMC he and his research team worked on the mechanism of action of the toxins for C. difficile. These are just some of his scientific advances. He is a clinician, still sees patients today, and is a well sought after teacher, and has educated innumerable fellows and faculty. He’s been a mentor to many. He’s been a great friend to the GI division here at BIDMC. His lecture this morning is going to be a look back at what has happened in the 50 years of Tom’s career in gastroenterology. ,

Dr J. Thomas Lamont, MD:

This is the UCLA Medical Center where I was an intern in 1965. During my training there I thought that the wisdom and knowledge that I was taught was really top level. Looking back now, I realize that all of it has been wiped away, or superseded by new knowledge .What I was taught then was thought to be state of art, but eventually the bulk of it was discarded and replaced by more accurate and improved medical science

I used to think, and a lot of people believe that discoveries are incremental, that knowledge is added like bricks to a wall which you gradually build. But in fact scientific discoveries are primarily revolutionary not incremental. There’s a paradigm shift which is a radical change in the way we do things. It’s often disruptive, a word borrowed from technology, where the new discovery or invention blows up whatever was there before. Later in the talk I’ll show you some examples of disruptive discoveries and inventions in the field of Gastroenterology.

A major feature in the field of scientific discovery is resistance from the establishment. I can tell you that Boston has a very powerful medical establishment, and the resistance to some of what I’m going to show you was quite robust. So, if you’re interested in this topic, there’s a very important small book, about 100 pages long, by Thomas Kuhn called “The Structure of Scientific Revolutions”. Kuhn championed the concept of paradigm shift, in which scientists have to move away from something that has been accepted for a long, long time. And the new paradigm replaces the original paradigm, which eventually fades away.

For example, an original paradigm in GI was, “excessive gastric acid secretion causes duodenal ulcers”. This paradigm is what we thought up until about the late ’80s. But then we gradually learned that in fact Helicobacter pylori infection is the cause of the majority of duodenal ulcers.

Here is an overview about some of the major discoveries I’m going to talk about. There’s dozens of things that could be discussed at a talk like this, and I’m not even sure I’ll be able to get through the ones I put in the timeline here. I’m going to start with fiberoptic endoscopy, because I think that had the biggest influence on our specialty, and defined what it is today. The discovery of H2 acid blockers was a major advance, followed around the same time by the discovery of the role of Helicobacter, and the invention of proton pump inhibitors. The major discoveries in Hepatitis C virus infection have taken us to the point where this disease is now curable .

If you were a patient in 1820 in Italy, your doctor might approach you with one of these instruments, and it would certainly put the fear of God in you. You can imagine that this urethroscope might be quite uncomfortable. especially as the procedure was performed without pre-medication or sterility.

The GI tract is curvy. That’s the problem with these early endoscopes: they’re not flexible but rigid. Illustrated hers is the type of gastroscope that was still in use in Los Angeles when I was an intern. You can see the gastroscope there over Dr Schindler’s right arm. On his right is Mrs. Schindler who attended every endoscopy and who assisted in moving the patient’s head. During the procedure the patient’s neck would be hyper-extended to allow introduction of the metal endoscope. As you know the esophagus is straight; that’s the only reason why this technique worked at all. The scope couldn’t go around any curves and it was really quite a difficult and even brutal test.

These metal sigmoidoscopes were in daily use up until about 1985 or even 1990 at Boston teaching hospitals. We used plastic scoped that were disposable and every GI fellow and internal medicine residents learned how to do proctoscopy for colon cancer screening.

In 1842 a critical experiment establishes that light could be bent. As shown here a bead of light is transmitted through a tank of water, and you can see that the light follows the curvature of the water as it exits the container. The light actually bounces or is refracted off the side of the column of water. The next big discovery was the development by Narinder Singh Kapany of fiber optic cable, which eventually replaced metal cables and had a huge impact on the field of telecommunications.

Kapany and colleagues then had the idea that extremely thin flexible glass fibers could transmit endoscopic images. This was picked up by Basil Hirschowitz, a native of south Africa, who in 1953 was a GI fellow at the University of Michigan. He was already trained in endoscopy in England before he went to Michigan. Hirschowitz was trained in the Schindler type of endoscopy that I showed you earlier, but he realized that this older technology was difficult and dangerous because of the rigidity of the Schindler scope.

Hopkins and Kapany published a paper in Nature entitled “A Flexible Fiberscope Using Static Scanning.” What they reported was a flexible endoscope that transmitted light through 10,000fiberglass rods that were slightly bigger than a hair. The exciting new and innovative aspect of this paper was the fact that the endoscope was flexible, and that when the scope was bent the image was not distorted.

Hirschowitz heard about this paper from a cardiology resident who had heard about it at journal club in London. Hirschowitz flew to London, met Kapany and Hopkins in a pub, and discussed their invention. They were very encouraging to Hirschowitz and gave him a few glass fibers to take back to Ann Arbor. Hirschowitz returned to his fellowship at Michigan and built the first fiberoptic gastroscope with help from Larry Curtis and Wilbur Peters who were physicists. After a few years of trial and error, they produced the first gastroscope

GI doctors in the audience will notice there’s no wheels on this first scope, so it’s not steerable. It’s a side-viewing scope which makes it really difficult to insert. compared to what we have today, it is not very practical or useful. But this invention marked the beginning of fiberoptic endoscopy.

Hirschowitz, like a lot of fellows and young researchers in science, first tested the device on himself in February 1957. He managed to control his own gag reflex, passed through his esophagus and looked around in his own stomach. He then scoped a patient indicated on the slide as patient #2. A most remarkable aspect of this discovery was that it was not supported by grants and was carried out by a GI fellow, and two physicists who worked very hard to create this incredible advance.

Dr Hirschowitz then linked up with American Cystoscope Manufacturing Inc. an American device company that made rigid Urologic scopes who produced this first commercial fiberoptic gastroscope. Again, it had no wheels to allow steering, but it had an air channel and the optics were good enough to allow examination of most of the stomach. Hirschowitz himself published this seminal paper in Lancet in May of ’61 that described his experiences in a series of patients he examined with the new scope. In the next to last sentence he challenged the existing paradigm. “The conventional gastroscope ( Schindler gastroscope) has become obsolete on all counts.”

The invention of endoscopy was not a hard sell. Some of the other things I’m going to talk about later were met with strong opposition, but fiberoptic flexible endoscopy was widely and quickly accepted. By the time I was a GI fellow in 1971 and into the early ‘1980s gastroscopes had was being taught at all the Boston teaching hospitals. The opposition was not to the scope itself, but rather to the idea of fellows leaving the laboratory and learning what sounded like a surgical technique.

Certain research-oriented professors at Harvard were somewhat opposed to this. One of my mentors said to me,, “Once they taste blood, they’re gone forever.” He meant that once GI fellows had used the scope to diagnose a GI bleeder they would lose their interest in basic research.”

The impact of fiberoptic endoscopy on practice was massive. Currently about 100-million endoscopies performed a year in the United States, about two thirds of them by GI doctors. Flexible fiberoptic endoscopy has had important impact worldwide in many medical and surgical fields.

This slide compares how we treated common GI diseases at UCLA in 1965, and how we handles these conditions currently. For example patients with GI bleeding that did not respond to antacid therapy typically went to surgery. Nowadays we manage this situation with proton pump inhibitors, and if bleeding continues or is torrential then we manage the situation endoscopically. Variceal hemorrhage was a fearsome occurrence in the mid 1960s and if persistent life-threatening was referred for a portocaval shunt. Currently this operation is seldom performed here, and we rely almost entirely on endoscopic control of variceal bleeding and radiologic placement of portocaval shunts or TIPS.

Management of obstructive jaundice was very difficult because we did not have any imaging studies to examine the bile ducts. Sometimes we resorted to so- called steroid whitewash especially if you were afraid of doing an laparotomy. This involved administration of corticosteroids for a week. If the jaundice improved then it was likely not mechanical obstruction but hepatitis or some other form of cholestatic jaundice for which surgical exploration was not required. Treatment of achalasia typically required either a forceful dilatation of the lower esophagus which was quite dangerous or a surgical myotomy. Currently we can perform a myotomy through the endoscope to treat achalasia at our hospital .

Now I’d like to tell you about a few advances in endoscopy that have been made here in our division. new approach is called molecular endoscopy where the scope can analyze tissue from tumors using laser light scattering.

This approach was developed here by clinical investigators in our GI unit working with Professor Lev Perelman a physicist in the GI division who specializes in photonics. Dr Perlman and colleagues hand-built this equipment which includes a scanner that goes through the biopsy channel of the endoscope. This allows a laser beam to be aimed at the epithelial lining of the esophagus and then measures reflected light from the wall of the esophagus. As the scope is withdrawn the instrument turns so it’s like an internal CT scan of the esophagus, except it’s spectroscopy. The reflected light ia analyzed to detect dysplasia more accurately than the optical techniques and biopsy.

Here is some information on the first prospective randomized clinical study on artificial intelligence to improve colon screening for cancer. This work is being carried out here by Tyler Berzin and Jeremy Glissen-Brown, one of our fellows, and was just published in Gut. They report the ability of artificial intelligence developed through game technology, to assist a physician doing a screening colonoscopy. The main quality outcome of a screening colonoscopy is adenoma detection rate or ADR.The goal is o find all the adenomas and take them out and prevent future development of colon cancer. The arrows indicate the polyp detection rate, or PDR, using routine optical colonoscopy at 29% vs 45 %with the assistance of artificial intelligence. This innovative technology will have huge impact on the ability of endoscopy to find and remove colonic polyps, and will improve our ability to prevent colon cancer.

S Mel Wilcox, the division director at the University of Alabama, where Dr. Hirschowitz spent his career, stated that it Basil Hirschowitz created the field of modern gastroenterology. When I started my training, GI was a reflective, diagnostic, minimally invasive specialty similar to endocrinology. Now the field is closer to urology or ENT than it is to some medical specialties.

I’d like to turn now to story of discovery that started in Australia. Pictured here: a medical resident, the tired-looking fellow on the left. He was working in the Royal Perth Hospital and asked his boss, the head of the GI unit, if he could help him find a suitable research project. — He was becoming interested in gastroenterology, had a curious mind, and was keen to explore although up to then he had never done any research. His boss referred him to Robin Warren, shown here on the right, an assistant professor of pathology at the hospital.

Barry went over one afternoon and sat down with Dr Warren to examine pathology slides that Warren had been collecting from GI patients with gastritis and ulcers. Warren was especially interested in this silver stain of a spiral bacteria that was present in the stomach. Warren recognized that this organism had been described for at least 100 years. But so far it had not been identified or named, and its role in diseases like gastritis and ulcers was unknown to medical science.

Barry Marshall realized that some of the patients that Robin Warren was telling him about were his own patients. He had learned fiberoptic endoscopy, and he was performing biopsies on these same patients and knew their medical histories. So this clinical connection lit a spark, and the two of them teamed up and made a remarkable discovery. What they did was to simply correlate this finding with the presence of active chronic gastritis. They published their first paper, a brief letter to the editor in Lancet in 1983t, which described a series of their patients with active gastritis and the present of this curved bacillus in their stomachs.

They went on then to make further correlations between the curved bacilli and peptic ulcers and eventually gastric cancer. This discovery was innovative and totally new. and was met with huge resistance by the medical establishment. The notion that peptic ulcer was an infectious disease met with near universal rejection. I actually remember the journal club in a Boston teaching hospital near here where this was first presented. The discovery was universally rejected by most of us in attendance. The problem was that in certain parts of the world, 80% of the population were infected. How could something that common be a cause of a disease like peptic ulcer that only occurs in, say, 1% of the population?

Barry Marshall wrote in his note cards and some of his later publication “Everyone was against me, but I knew I was right.” So who was against him? The acid mafia, a powerful group of senior investigators who championed the idea that hydrochloric acid was the key to formation of stomach ulcers. When we were residents and fellows we had to know a lot about gastric hydrochloric acid secretion. So those who believed in the primacy of stomach acid were definitely strongly opposed to these Australian upstarts, Marshall and Warren.

Listed here are Koch’s postulates; the last two are particularly important in establishing the infectious etiology of a given disease. The pure culture, when inoculated into the experimental animals, must reproduce the disease.” “Microorganisms must be recovered from the diseased animal.”

In this instance the experimental subject was Barry Marshal himself He swallowed a pure culture of Helicobacter pylori that he had isolated from one of his patients that he had previously biopsied and cured. So he knew that the strain was treatable and curable. He drank the culture of H pylori and over the next several weeks developed severe acute Helicobacter infection with nausea, vomiting, and severe dyspepsia. He stated that his halitosis was so bad, that his wife told him that he had to sleep on the couch. After the infection was established he treated himself with the anti-Helicobacter therapy and completely recovered. His experiment was soon published in the Medical Journal of Australia in 1985.

Eventually the etiologic role of H pylori in stomach diseases was established without a shadow of doubt. That doesn’t mean that acid doesn’t play an important role in ulcer formation, An old dictum was, “No acid, no ulcer.” That’s pretty much true.

You can easily cure ulcers with proton pump inhibitors. But if you want to cure an ulcer permanently then you have to eradicate Helicobacter. In this study in the New England Journal patients with active duodenal ulcers and Helicobacter infection were first “cured” with, in this case with Tagamet for two weeks, and then they were randomized after the Tagamet was finished to either antibiotics for two weeks to get rid of the Helicobacter or placebo.

You can see here a huge separation of these curves. Without eradication of the H Pylori infection by antibiotics, most patients had recurrence of their ulcers by the end of the study. Many other studies like this finally established the important causative role of this pathogen.

Helicobacter pylori is probably one of the most common infections world wide; in some countries the prevalence overall is about 60- 80%. For example, in Bangladesh about 80% of children are infected by age 5, particularly in areas with poor access to clean food and water. The peptic ulcer rate is about 10% and it turns out to be the cause of a number of important diseases of the stomach and duodenum that are shown on this graphic.

About 100% of patients with Helicobacter get some form of gastritis. It’s not the only cause of gastritis but it’s a major one. Eventually, with chronic, lifelong infection, gastric atrophy may occur. This leads to achlorhydria and in some patients to pernicious anemia with vitamin B-12 deficiency. It’s thought that the majority of stomach cancers result from chronic infection with H pylori. This states that about 1% of infected patients will get gastric cancer. That’s an over-estimate; it’s more like 1 in 1,000, or perhaps even less than that. Infection is also the cause of MALT lymphoma which can be cured by treatment of Helicobacter without chemotherapy, and without removal of the stomach. As already discussedH pylori accounts for the majority of gastric and duodenal ulcers.

Marshall and Warren were finally justified in 2005 when they won the Nobel Prize for Medicine. A couple of blokes from Australia who had not done a lot of research at all, with very little support. they used equipment and tools that were right at hand. This seems to be a study that could have been performed by almost anyone. But they were the first, and their persistence in the face of heavy opposition payed off.

The medical treatments we had for peptic ulcer in the mid 1960s and right up to about mid-’70s was actually very limited and not very effective. The mainstay of medical therapy was antacids. House officers and trainees were expected to know the properties of antacids very well, including doses, and their side effects. We sometimes used a special treatment called the Sippy diet” which consisted of two ounces of cream every half hour alternating with an 30 to 60 ml of an antacid. But a large number of the patients developed severe and semi-acute atherosclerosis from the fat so it was finally abandoned.

At this hospital William Silen and colleagues developed a very unique approach to acute stress ulcers of the stomach with GI hemorrhage in patients in intensive care units. He and his colleagues published a report in a major medical journal that described a technique to reduce the acidity of the stomach. An NG tube was placed in the stomach and the pH was measured. Antacids were instilled through the NG tube to bring the pH above four. This technique was a common treatment for bleeding stress ulcers in that era just prior to the development of effective drugs to block gastric acid secretion.

When antacid therapy failed to heal ulcers and stop bleeding we then turned to surgery. The first thing was to cut the vagus nerve, a vagotamy, and then remove the distal half of the stomach to remove the ulcer and reduce some of the acid-producing cells in the antrum, and then hook up the small intestine. As you can see it’s not very physiologic. There were many side effects. And every GI fellow and house officer had to know the side effects of ulcer operations that were so frequent after these types of operations.

The introduction of acid-blocking drugs truly changed everything. Again there was some push-back from the establishment. Editorials appeared in the New England Journal from internists and surgeons decrying the overuse of acid blocking drugs across America. A quick survey of the in-patient service at Yale New Haven Hospital revealed that 56% of the patients were on an acid blocker. Some of us commented, “Why so low?” Perhaps these meds were over-used but their effectiveness and clinical impact justified widespread use.

Show here is a simplified diagram pf receptor-mediated control of hydrochloric acid secretion. It was known for many years that histamine could strongly stimulate gastric acid secretion. But it was thought that there must be a special receptor for histamine which eventually was called the “histamine 2 receptor.” The gastrin receptor was thought to be a major regulator, and then finally the vagus nerve through acetylcholine, all of them having separate receptors with somewhat different transduction mechanisms. The ultimate step in the acid secretion pathway was the proton pump which secretes a hydrogen ion into the lumen of the gastric gland in exchange for a potassium ion.

Smith, Kline & French started an acid blocker discovery program in 1964 under the leadership of James Black who had already invented and developed propranolol. He was a lead investigator in receptor-mediated physiology and was also an experiences medicinal chemist.

His research team at Smith, Kline & French in the UK finally developed cimetidine, the first billion dollar drug, which hit the market in ’76. It was a blockbuster drug. I was just starting my career as a faculty member and I remember the AGA Digestive Disease Week at that time was all about Tagamet. They were everywhere with it. People were just a-buzz about this new drug. So it was a pretty easy sell except for the over-use that I mentioned.

James Black and colleagues at Smith, Kline & French studied the histamine molecule and then made critical modifications. Substitution of the methyl group on the imidazole ring created an agonist. So that was actually the first discovery. Once you have an agonist — and it did not stimulate H1 receptors — so they knew that they were onto something. It took them about six years to develop this molecule, an H2 blocker which is Tagamet. They had a couple of earlier ones which were very effective but when they tested on patients caused agranulocytosis and pancytopenia. So there were a few missteps but in general it was a very successful campaign.

James Black was awarded the Nobel Prize in 1988 for his discovery of two major drugs: propranolol and H2 acid blockers. He shared the prize with Gertrude Elion and George Hitchings. for their drug development of purine analogs that were used successfully to treat a number of important diseases including autoimmunity, transplant rejection ,infections and gout.,

I would like to say a few more words about Dr. Gertrude Elion. She was born in Brooklyn, went to Hunter College where she started at age 15 and graduated summa cum laude. She then decided to go to graduate school for a PhD. but could not get into a chemistry doctoral program. She was told at one interview by the head of the laboratory, “You might be qualified but you would be a distraction in a lab full of men.”

She then worked for the A&P supermarket company testing the acidity of pickles. Dr Elion finally joined Burroughs Wellcome in 1944 at age 26 as an assistant to George Hitchings with whom she shared the Nobel Prize. She never received a Ph.D, but was awarded many honorary Ph.D.s including one from Harvard

Elion and Hitching developed these drugs two of which, mercaptopurine and azathioprine were used in gastroenterology. They developed the antibiotic trimethoprim, acyclovir, and the others listed there. These are all actually still in use in some form or another. All of these novel drugs were based on modifications of the purine molecule.

When I read about Gertrude Elion I became curious about how many women won the Nobel Prize. Of the 943 Nobel laureates awarded since 1901, only 53 were women. And the graphic shows by 20-year segments that the number of women awardees is slowly rising. In the last 20 years from 2001 to o 2018, the number has increased from previous 20 year segments. The trend is in the right direction and I suspect it will improve over the next 50 years.

Hepatology in the mid 1960s was not very well developed. I can basically summarize what we had then as nothing. We could measure AST and ALT, bilrubin, and Alkaline Phosphatase, and prothrombin time and albumin. We had no imaging, of any kind. As I mentioned before we frequently resorted to exploratory laparotomy as a major diagnostic test.

There were few effective treatments for cirrhosis. I remember one of my teachers I think in residency or perhaps for the fellowship saying that the prognosis of a patient with cirrhosis when you have a complication such as bleeding, ascites or infection was about the same as a person with stage 4 metastatic lung cancer which at that time was not very treatable. Our knowledge of viral hepatitis was quite limited. We used descriptive terms for such as infectious hepatitis, short incubation hepatitis, post-transfusion hepatitis, and several other designations which weren’t very useful.

Shown here is a timeline of post-transfusion hepatitis, a major clinical problem in the post war era as blood transfusions was widely accepted and became well-organized. The first big improvement in the rate of post-transfusion hepatitis was the discovery of the Australian antigen by Baruch Blumberg about 1970, a discovery which allowed screening of donor blood. The rate of post-transfusion hepatitis in the United States in 1965 was about 22%. So the blood supply was not very clean. A big issue then was heavy reliance on professional blood donors, about 40 % of whom were infected with a hepatitis B or C. .

Screening of donated blood for virus infections picked up with anti-HIV testing because some of those donors were affected by hepatitis viruses as well. the next step in screening ALT and AST to screen donated blood. The final step in making the blood supply safe was the introduction of screening for HCV in the 1990s.

The HCV story started with the discovery at the NIH of the so-called non-A, non-B hepatitis which subsequently was re-named hepatitis C. The virus was identified in 1989, and this led to the development of a screening test for test blood donors. Interferon therapy started in the early ’90s and then the big revolution in the last 20 years occurred around 2014 with approval of direct acting anti-viral drugs. It is predicted that HCV will eventually disappear about 2030.

These four researchers found a single clone of DNA in a sample of blood from a patient with nonA nonB post-transfusion hepatitis. This seminal discovery eventually led to isolation of the HCV, followed by complete genetic sequencing.

The global burden of HCV is huge disease, with about 2% of the world’s population being infected. This map shows the geographic distribution:: the redder the color the more prevalent the infection.

Initial infection with HCV can produce a number of different outcomes. The unusual thing about hepatitis C is the very high rate of chronic hepatitis. We learned that about 20% of acutely infected patients recovered but about 80% developed chronic infection with serious complications. including cirrhosis and hepatocellular carcinoma developing decades after infection, usually in individuals who were asymptomatic.

This slide shows a timeline of the treatment starting on the left in the early 90s with interferon, first for six months, then for 12 months. And then the addition of ribavirin which increased clearance from the blood of HCV. And eventually introduction of pegylated interferon, and finally the current agents of choice, the direct acting anti-viral drugs. Currently about 100% of people with infection can be cured by these powerful medications.

A lot of the clinical research on HCV eradication has taken place here at BIDMC, much of it under the leadership of Nid Afdhal and his colleagues who published this paper in the New England Journal in 2014. This landmark study was the first randomized trial demonstrating cure of HCV infection with all oral direct acting antiviral therapy with these two DAAs, together known as Harvoni. Currently, we’re at the point where this condition can be cured. These new drugs have revolutionized our approach to this silent killer.

Howard Gruber was a psychologist who studied the processes and backgrounds of discovery and invention. He wrote: “The power of the beauty of science,” I think you can substitute “medicine” there, “do not rest upon infallibility, which it has not, but on corrigibility, without which it is nothing.” Corrigibility, or correctability derived from the Latin word corrigere, “to correct.” I have shown examples of how previous medical paradigms have been corrected and replaced. As I mentioned at the beginning of my lecture most of what I learned about Gastroenterology in my early training at UCLA has been corrected. And the same will happen to you. So what you’re learning now is as correct as we can make it, but eventually it will be replaced. So stay tuned.

For more information, see the video of the slides (includes audio). J. Thomas Lamont MD’s bio.

How I responded to The Harvard Crimson’s request for comment on its Extension School degree article

The Harvard Crimson just published an article about the Harvard Extension School degree designations. I’ve been writing about Harvard Extension School ALM and ALB degree designations for more than 10 years on Ipso Facto and the Harvard Extended blog, and know quite a bit about this topic. The Crimson isn’t breaking any new ground with its article, although for many current Harvard College undergraduates it’s probably the first time they’ve ever heard about the issue.

The Crimson reporter also asked me for a phone interview. Here is my response:

Thanks for reaching out. I don’t do voice interviews about the Extension School — it’s a charged topic, and frankly the treatment of the Extension School by the Crimson and other institutions at Harvard has skewed negative over the years, typically focusing on scandal or how we don’t deserve equal treatment, and often leaving out important context.

The serious students, the success stories, the accomplishments, the areas where the school is doing some very innovative things … those are rarely covered by The Crimson. The Harvard Gazette sometimes does, but it also avoids any discussion of the name issue/unequal treatment. This is part of the reason why I have been active on my @harvardextended twitter account and blogging (Ipso Facto and Harvard Extended) where I try to explore both the good and bad aspects of HES.

Regarding your specific question:

Despite years of lobbying by the former Extension School dean, various petitions and letter-writing campaigns, and online activism, the Faculty Council and Mass Hall have consistently blocked or ignored any attempt to change the name of the Extension School or the ridiculous “In Extension Studies” degree designation. The University has further taken steps to exclude Extension School students from housing and open cross-registration with other schools at Harvard. As a graduate student at MIT, it was even possible for me to cross-register for classes at Harvard Business School, the Graduate School of Education, and the Harvard Kennedy School. An MIT classmate even studied at the Divinity School! Yet as a matriculated graduate student at the Extension School, I was forbidden from attending classes for credit at any of these schools.

Taken together, this state of affairs perpetuates the elitist notion that the Extension School isn’t really part of the Harvard community, and students do not deserve the same treatment or respect accorded others at the University.

In the short term, the only hope for change on the naming front would involve sustained demonstrations outside of Faculty Council meetings and Mass Hall. Failing that, there won’t be change until a new generation of faculty, trustee, and University leadership takes office and realizes that the Extension School, far from being an “extension” of Harvard, is in fact a crucible for innovation, accomplishment, and community involvement that the rest of the University should look up to.

You are welcome to use any part of this email in your article.

The reporter did not use any of this material in her story, so I am publishing it here.

Lastly, I give credit to outgoing Dean Huntington Lambert for commenting at length about why “in Extension Studies” is academically incorrect for graduates who concentrated in computer science, history, or biology. That said, there is a lot more that could have been written about the difficulties that students and alumni experience when presenting a resume with a strange “official” designation. People have been negatively impacted, as one ALM software engineering concentrator found out when he attempted to find a job.

Harvard Extension School now requires 12 courses for grad degrees, pushing the cost >$30,000

(UPDATED) This week I noticed that many liberal arts-focused graduate degree programs at Harvard Extension School now require 12 courses in order to meet the graduation requirements, compared to 10 previously. I don’t know when this happened, but it was probably in the last year or two (Update: the switch happened in 2018; see details at the bottom of this post).

For instance, the ALM Biology degree now lists the following requirements:

  • Proseminar
  • 5 biology courses
  • 1 biology seminar
  • 1 statistics course
  • 1 elective
    • EXPO 42c is an elective option
  • Crafting the Thesis Proposal
  • Master’s Thesis part one
  • Master’s Thesis part two

My own degree (ALM History) now has the following requirements:

  • Proseminar
  • 5 history courses
  • 1 history seminar
  • 2 general electives
    • EXPO 42b is an elective option

Additional Thesis Track Courses

  • Crafting the Thesis Proposal
  • Master’s Thesis part one
  • Master’s Thesis part two

Additional Capstone Track Courses

  • 1 additional general elective
  • Social Reform Movements in America Precapstone
  • Social Reform Movements in America Capstone

When I went through the ALM program, the thesis counted as a single class, even though no coursework was involved. What seems to have happened is the thesis (or new capstone) for these ALM programs has been turned into a three-“course” process that divides the thesis proposal, research, and review work into separate stages. But the stages themselves look pretty much the same as what was expected under the old single-“course” thesis requirement.

I use “courses” in quotes because they aren’t courses or seminars or lectures in the normal sense. The process is more like a series of one-on-one meetings with research advisors (at the Extension School) and thesis directors (Harvard faculty members) and sending drafts and comments back and forth via email. The thesis takes years to complete, as I documented on my old Harvard Extension blog. Many people get stuck in “A.B.T.” status (“All But Thesis”) and never finish.

Why bump up the number of required ALM courses from 10 to 12? I can only speculate (Update: See insights below from a current ALM student):

  1. Boosting revenue is an obvious incentive (see below).
  2. Setting  parity with the ALM in Management degree is another — the ALMM has been 12 courses since inception, as I recall, but without a thesis requirement.
  3. A third is the introduction of the “capstone” option to the ALM liberal arts degree for people unable or unwilling to do the thesis (see “ABT,” above). Because the capstone requires taking extra courses, maybe the Harvard Extension School thought it necessary to stretch the thesis coursework to 3 classes to make them “equal” from a cost point of view.

The impact on costs is scary. This paragraph on the thesis description page for the ALM History degree actually made me laugh when I first read it:

To ensure affordability, tuition rates for thesis work are the same as our regular 4-credit, graduate-level courses. Master’s Thesis Part One: $2,750 and Master’s Thesis Part Two: $2,750 or Master’s Thesis One and Two: 8 credits/$5,500.

Affordability? There are now three thesis “courses,” so the cost is $2750 x 3, or $8,250 – three times as what the thesis would cost prior to 2018. It also pushes the total cost for ALM degrees that require a thesis up 20%, from $27,500  to $33,000, based on current rates.

That doesn’t count as affordable in my book (despite the claims of “Affordable Tuition” plastered all over the Extension School website, as shown below), but with hundreds of students engaged in thesis work at any given time, it increases Extension School revenues by hundreds of thousands or even millions of dollars every year.

Harvard Extension affordable tuition

UPDATE: A current Harvard Extension School grad student explained the switchover on Twitter:

“I find the thesis component being split into three separate courses a bit silly. I began taking the three courses for admission before the change (2017) and became a student after the changes (2018).

They gave students the choice at the time when I was taking classes in 2017 to stick with the old format or change to the new one which lowered admission course criteria by one class. So you only need two for consideration into the program.

As a result, we have to deal with the split thesis course (3 instead of 1) which is more of a pain than beneficial for some degree programs where the the administration isn’t as helpful in guiding students to resources to complete the thesis. Also, students foot the bill.”

Regarding the reasons why the ALM thesis now requires three expensive courses to complete, Simon says:

I think it was mostly to, in theory, give more guidance to students who need help getting through the thesis. Not everyone has written a paper or knows how to. It takes time to vet a proposal and do revisions. So I would imagine they want the research advisors to be compensated.

It’s true the thesis is extremely tough. When I was a student, only 52% of matriculated students were able to complete the ALM program, and a lot of that had to do with the thesis. It works well if you can write and can push yourself to complete the research requirements, but some people definitely need more help, even after the Proseminar, which is supposed to prepare people for advanced research projects.

What employers think about Harvard Extension School degrees

For more than 10 years, I have received questions from prospective Harvard Extension School students (and some current students) about whether or not Harvard Extension School degrees will help them get a job, and what employers think about them. Here’s a typical query:

I am considering the Harvard Extension School for Management. I really want your opinion if this will be worth doing in terms of getting a job. I am an international student and have one year of business experience. Do you get an internship in summer? Does the Harvard brand help?

The short answer is “maybe.” Aside from the Harvard or Harvard Extension School brand, there are a few factors employers typically consider:

  1. It depends on the person and what else he or she brings to the table in terms of job experience, specific technical/work skills, and whether or not he or she will be a good fit for the team.
  2. It depends on the field/location/position. It will matter less in a highly competitive field in a big city compared to a less competitive market in a rural area or overseas.
  3. It depends on the person’s network.

As for the brand: By itself, the Harvard Extension School degree is not an automatic signal to “hire this person because he/she has ‘Harvard’ in his educational background.” But it may help you get noticed. My ALM thesis director (a tenured professor in the Faculty of Arts and Sciences) said the Harvard association and reputation — even for Extension School students — carries a lot of weight, and will help open doors that might otherwise be closed. He actually offered to help me find work related to my research (Chinese foreign policy analysis using computer-based research) if I was interested. I wasn’t — at the time I had a pretty good job in tech media and a young family, and becoming an analyst required moving to Washington, D.C.

Another thing that may help graduates get noticed are automated resume processing programs that search for specific keywords or phrases, which may include the name of famous universities … such as Harvard.

But when the resume gets passed to an HR screener or hiring manager, things start to get tricky for many HES grads. A lot of people do not make it clear that they attended the Extension School, and instead list “Harvard University” on their resumes, either in a misguided justification to hide the Extension School affiliation, or an outright misleading attempt to make it seem as if they graduated from Harvard College, the Harvard Graduate School of Arts and Sciences (GSAS), or the Harvard Business School. Here are just a few examples from LinkedIn:

Harvard BiologyHarvard ALB economicsHarvard ALM digital media

Not everyone does this, of course. It’s also possible to find people who proudly list their Extension School degrees on LinkedIn:

Harvard Extension ALM nonprofits

I’ve covered the issue of how to represent your Extension School diploma in the past, and it has been debated by hundreds of people on this blog and elsewhere. You can read more at Harvard Extension School résumé guidelines are bogus.

In short, while a Harvard Extension Degree is issued by Harvard University, it is not the same degree that is issued to graduates of other schools at Harvard such as a Harvard College AB degree, a Harvard Business School MBA degree, or a Harvard GSAS AM degree. The former has a rigorous process that makes students prove they can do the work before they are admitted, but the others are among the most highly selective undergraduate and graduate programs in the United States. Students are in classrooms with other high-achievers, which raises the level of discourse and focus. Yes, HES gets some high achievers as well (including graduates of Ivies and other competitive programs) but the classrooms are also filled with casual class-takers.

The curricula and graduation requirements are also completely different. The most obvious is the Extension School’s use of distance education for course credit and for many of the professional programs,  the fact that there is no requirement to take classes taught by faculty with actual teaching appointments at Harvard.

What this means is McKinsey or Bain won’t regard an HES ALB or ALM in Management grad the same way they will treat a recent Harvard College AB or HBS MBA recipient.

What HR and hiring managers think about Extension School grads

Several people involved in hiring decisions have commented how they regard HES grads compared to their counterparts from other schools. I’ll start with the positive evaluations, followed by some of the negative takes:

Josh:

I’m a hiring manager and I would hire an HES graduate any day of the week.

Paul:

As the president and founder of our company with final say in hiring/firing, the choice is clear. Being only book smart is not nearly enough to cut it as there are already too many book smart people out there to choose from. Candidate B’s qualities along with street smarts are harder to find and what the real world is looking for.

justanotheropinion:

If I had to hire one of two applicants for my accounting firm and one said hire me because I got good grades in high school and was active in the community (real Harvard applicant), and the other said I have years of experience in accounting and will work for three months to prove myself to you and if you don’t like what you see I will leave (HES applicant) I would hire the latter.

Why? Simple, the latter has shown they can complete a course of study, are working to better themselves and have decided to take on a great amount of additional responsibility.

But there are more than a few managers out there who have been burned by HES grads misrepresenting their degrees:

As somebody who has personally on-boarded somebody claiming an HES degree as a HGSAS degree, I can tell you that this is pure bullwack. What a complete waste of time and energy her fraud was. I wasted a ton of time looking into the issue. Harvard’s own standards have always made it clear to grads that their HES degree is not a Harvard College degree. Period… It’s willful ignorance on the part of HES grads that it will be overlooked. Anyone who doesn’t know how to represent an HES degree on a resume is a liar.

Another example:

It happens every few years where my firm gets an HES grad misrepresenting their degree. The latest “MA Anthropology – Harvard,” which after a little checking (we have learned to ALWAYS be suspicious), ends up being an MLA with a concentration from HES. When confronted they always plead ignorance and make the same BS argument about how they took classes on campus at Harvard taught by faculty and blah, blah, blah. Some are otherwise good candidates, but they are still committing resume fraud. I would take an honest UMass or UConn grad over HES any day. Had they listed their true HES credential on the resume and sold it in the interview, they would be fine.

As I have said many times in the past, HES grads should be proud of what they have accomplished and be proud to list “Harvard Extension School” on their resumes. If enough people do so and do as well in their careers as they did while at HES, the reputation of the Harvard Extension School will grow … making it easier for all Extension School grads to leverage ALB and ALM degrees to advance their careers.

Do music playlists hold the same emotional and temporal connections as songs and albums?

A friend of mine asked an interesting series of questions on Facebook about music, noting that certain albums had the ability to bring people back to a certain time and place. I think this is common experience that traverses cultures and age groups — e.g., the first time you heard Miles Davis or the Beatles’ Sgt. Peppers album. He then asked, what about playlists, such as those that might be found on Spotify or Apple Music or some other service?

I started making playlists on iTunes in late 2004, so I could have music to listen to on my iPod as I walked to the bus stop to go to Harvard, where I worked. Looking through the songs definitely brings back memories of that winter walk, especially on cold winter mornings when the temperature was below 20 degrees and the wind was whipping up the street into my face. Later on I set up playlists to keep me going late into the night as I worked on my graduate thesis for the Harvard Extension School.

The mixtapes I made or were given to me from about the early 80s to the mid 1990s also take me back to specific times and places, including other countries where I lived. The ones shared with me also remind me of people who gave them, and where they were in their lives.

I remember one called “Sherman’s Heroes.” A guy named Neil Sherman who I met in a hostel in Taipei gave it to me in early 1993. It consisted of American and British bands that would now be called Shoegaze, such as Love Battery and Ride. Listening to those songs now takes me back to the hot, humid summer, when I was just getting established in Taiwan.

Around the same time, another friend sent me a tape of rap and another one of rock which also takes me back, and reminds me of him.

But maybe all of these examples are special because I or a friend curated the playlists, and knew my tastes and therefore had a better chance of making that emotional connection.

I haven’t had much of an experience with curated playlists. The ones on Amazon Music are generally quite poor — one that springs to mine is the “Classical Guitar Chillout” which contains a small assortment of songs and performances by the greats of the genre (Segovia, Diaz, etc.) but whose marketing copy was clearly made by someone who knows next to nothing of classical guitar (see screenshot, below). The Apple Playlists are really interesting, but because I never got a subscription I have to manually recreate them on Amazon which is a pain (readers, please let me know if there is a way to easily do this by using the comment form below!)

Amazon playlist emotional connections

Petition to change Harvard Extension School diplomas faces an uphill battle

A group of current Harvard Extension School students has created a petition to remove the “In Extension Studies” designation from Harvard Extension School diplomas, and replace it with the actual concentration of the student receiving the degree. It’s a great idea, and has received lots of support (the petition currently has hundreds of digital signatures, including my own). Unfortunately, I don’t think it will result in change, based on some historical context that I will share below.

First, some background. A matriculated HES student needs to meet the requirements for his or her respective program in order to receive an ALB degree (undergraduate) or ALM degree (graduate). The Extension School has concentrations (equivalent to “majors”), ranging from computer science to visual arts. My concentration was history. But, instead of receiving a diploma that identified my degree (ALM) and concentration (history) it instead lists “ALM in Extension Studies.”

This ridiculous and confusing designation has bedeviled Harvard Extension School graduates for decades. It does not correspond to any real concentration or course of study. As I recall, there may have been a class or two in the past 100 years that related to extension schools or continuing education, but there were never enough credits available to form a distinct concentration. Aside from the wording of the diploma, the Harvard Extension School does not use the term “Extension Studies” in its marketing, course descriptions, or communications with students and alumni. It’s basically a historical anachronism, or an attempt by the Harvard Faculty of Arts and Sciences to differentiate (or denigrate) the accomplishments of Harvard Extension School students.

The petition, hosted on Google Docs, sums up the issue as follows:

HES Degree Title Change Initiative

Hello Extension students!This committee has been created to research, reach out and to take action to have the “in Extension Studies” part of our diploma replaced by our actual concentration. We need your support whether you are only taking classes or a degree seeker. If you have no intentions of investing your time and money to end up with a degree in “Extension Studies” which does not reflect your Harvard experience, please sign the following petition and share it with your friends.Check out www.facebook.com/hesdegreechange for updates.

harvard extension school petition to change in extension studies

The petition asks for names and graduation year, and then asks:

  • When you signed up for classes at HES, did you know you were getting a degree in “Extension Studies”?
  • Are you a distance student?
  • Extension School Program?
  • Your personal feedback

Until I read the petition and the associated Facebook page, I regarded the “In Extension Studies” designation as an irritant. After all, the Harvard Extension School allows students to list their concentration on their resume. But then I began to read some of the stories about Extension School alumni who had serious problems, such as this student who told his story on an online Extension School forum:

Want to add my 5 cents to the problem. I graduate with ALB in 2014; currently enrolled in ALM, Software Engineering.

For the last 6 months I’ve been looking for jobs in the US (I’m a remote foreign student). HES doesn’t provide student visas for foreign students, so it was already a challenge to find companies that would even consider interviewing someone with a US degree, but without a temporary permit to work after graduation (so called OPT). I was aware of that from the very beginning, but didn’t expect to that so few companies actually work with foreigners without experience. In case you’re interested, I didn’t get a single offer in Boston even though I tried really hard to move there. Luckily NYC and San Francisco were much more visa-friendly cities.

After I found a couple of companies who were ready to interview despite the required visa sponsorship and almost lack of experience, I had to explain “liberal” part of the degree name (nobody actually paid attention to “Extension School” words). It wasn’t too bad since most HRs and engineers I talked to were more interested in my actual knowledge and whether I can confirm that I know the things I listed in my resume. Liberal/extension “flaw” wasn’t much of a concern for them (including big companies, e.x. Google, Microsoft). And I personally felt fine about that since my program of study really wasn’t that rigorous compared to the college one (I skipped a couple of math classes that I wasn’t interested in).

However, after I got a job offer and started to work with the lawyers the real troubles came into play. The degree officially says “in extension studies” rather than “in Computer Science” whereas the transcripts specify concentration (sciences), field of study (computer science) and a minor (thesis/research). The lawyers immediately saw an inconsistency between transcripts and the diploma. For a couple of days I was explaining to them how HES works, provided links to the web site and even contacts of HES admission office for further inquiries. In the end, my attorney said that they’ll have to send my degree for special evaluation to confirm Computer Science concentration because the transcripts specify one thing and the diploma a different one.

I’m sure it will all work out and I’ll get an additional paper from some evaluation service that will confirm that my degree is a real computer science degree, but Harvard should feel embarrasses that lawyers have to send a degree from Harvard with transcripts to verify the field of study mentioned in the transcripts.

In short, I don’t complain about “liberal” arts or requirement to specify Extension School in my resume and about frankly explaining to employers what school I attended and why. I slightly object the lack of F1 support because that wasn’t the case before 2009. However, I strongly feel that the degree conferred in Harvard Yard in Tercentenary Theatre with all other Harvard diplomats should not be a subject for any additional verification or legal doubts.

This young man is absolutely right. There should not be any doubt or questioning about the degree he received, yet he was subjected to something that graduates from other Harvard schools would never experience. Three stupid words — “In Extension Studies” — threatened his ability to work at a job that he was otherwise qualified to do.

The three students leading the charge to replace “In Extension Studies” with the name of the concentration are doing all of the right things. Besides the petition, they have met with the Harvard Extension Students Association (HESA) and the Extension School administration. They organize events. They have a solid social media presence.

Unfortunately, they are fighting a stacked deck. They are not the first to protest “In Extension Studies.” As I recall, the HESA administration in the mid-2000s also lobbied the administration. The head of the Harvard Extension School – Dean Shinagel – even told hundreds of new graduates at the 2008 dinner for new graduates that he wanted to get rid of “In Extension Studies.” I was there, and when Shinagel made this announcement, everyone cheered. A proposal was eventually put in front of the FAS faculty committee, and … nothing happened.

So I have to ask: If a very powerful and esteemed dean (Shinagel had led the school since the 70s, and served as a house master for Harvard College, and FAS faculty member) was unable to get anything done 6 or 7 years ago, what has changed in the interim that would encourage the powers that be (the University administration and FAS faculty) to change the diplomas now?

Keep in mind that Harvard Extension School students have been treated as second-class citizens at Harvard for more than 100 years. We put in years of effort to complete our degree requirements, conduct serious research under Harvard faculty, and earn our degrees. Yet Extension School students can’t cross-register. Students can’t live in University housing. Students can’t get proper visas. FAS and the rest of the University have no interest in changing the status quo, and I am afraid that the petition will suffer the same fate as similar efforts have experienced in years past — it will be ignored or rejected.

What are your thoughts about the latest petition? Are things different now? What hope do we have as students and alumni to get a diploma that reflects our accomplishments and concentrations?

Harvard Extension faculty and the Harvard Instructor requirement

So you’re thinking about attending the Harvard Extension School, or you want to know more about the degree programs. A common question that prospective candidates have is whether students are taught by real Harvard faculty. Others are interested in whether Harvard Extension faculty are tenured professors at the University.

The short answer: It depends on the concentration and the classes being taken.

Instructors with appointments at Harvard Widener Library
Harvard Widener Library

Looking at the Harvard Extension Faculty Directory, the first page of results contains numerous associate and assistant professors, lecturers, and preceptors from FAS, the Harvard Medical School, the Harvard School of Public Health, Widener Library, and other units. The page also lists faculty from other area universities (Boston College, Suffolk, Northeastern, UMass, etc). There are many non-academic-affiliated instructors, too, who teach in the Extension School’s professional programs.

Generally speaking, the liberal arts and science classes are more likely to have Harvard faculty, including tenured professors. The Extension School has a “Harvard Instructor” requirement for the liberal arts masters degrees, requiring 7 out of 9 courses to be “a faculty member with a teaching appointment” at Harvard.

Harvard Extension faculty and Harvard Summer School classes

However, the school bends the rules for Summer School classes. All Harvard Summer School instructors are regarded as Harvard Instructors, even if they don’t have a teaching appointment. That’s not just for Extension School students taking Summer School classes; the rules are bent for Harvard College students attending the same classes — most on-campus Summer School coursework counts for credit for attending Harvard College students, with some conditions. Online classes offered by the Summer School cannot be taken for credit by Harvard College students, though.

I was a history concentrator in the Extension School’s Master of Liberal Arts program from 2003-2008, taking all of my classes on campus. Here’s the Harvard/non-Harvard faculty breakdown:

  • 2 classes taught by tenured Harvard faculty members
  • Thesis project directed by a tenured Harvard faculty member
  • 1 class taught by a non-tenured Harvard lecturer
  • 2 classes taught by Harvard post-docs/research affiliates
  • 1 class taught by a visiting professor from Boston College
  • 1 class taught by a visiting professor from Northwestern
  • 1 class taught by a visiting professor from Western Michigan University
  • 1 class taught by Museum of Fine Arts research affiliate

The 3 or 4 courses I took during the summer generally had non-Harvard instructors, but counted toward the Harvard Instructor requirement based on the Summer School exception described above. The Northwestern and Western Michigan lecturers had received AB/JD and PhD degrees from Harvard and had visiting scholar affiliations at Harvard, while the late Professor Thomas H. O’Connor of Boston College was considered the leading scholar in his field.

For other liberal arts concentrations, it’s possible to choose classes so most or even all instructors are tenured Harvard faculty or tenure-track professors. I know students who have done this, or even applied for (and received) Special Student status to take GSAS/College classes taught by Harvard faculty.

As for the professional programs (Finance, Digital media arts, etc.) there are no longer any Harvard Instructor requirements. This is not surprising, considering many of the topics being taught have no equivalent in Harvard College or any of the professional schools. Practically speaking, this means it’s possible to receive a degree from Harvard without ever taking a class with Harvard faculty. It’s ridiculous, and reflects very poorly on the Extension School, as I noted in another post several years ago:

… The professional degree programs have failed to fit the model established by the Extension School to offer a Harvard academic experience led by Harvard faculty members to students. It further sets a precedent for launching new professional degree programs that have no connection to the University’s existing areas of study, and opens the door to criticism that Harvard Extension School degrees aren’t “real” degrees because they no longer represent study under Harvard’s top-notch faculty.

I advise students considering these programs to make every effort to take actual classes with real Harvard faculty. For some fields, it’s impossible because there are no Harvard instructors available or willing to teach in these areas. But for others, there may be course offerings from time to time.

For online courses, there is an additional dimension to Harvard Extension faculty participation: Whether the classes are “live” with a participating professor, or whether they are prerecorded lectures with no opportunity to interact with faculty. In such classes, online discussion and assignments are handled by non-faculty TAs. Many students don’t know this before they sign up, and are disappointed by the experience, as one student discovered:

… Most of my distance classes were recorded lectures of College classes from the current semester. I had problems in both of my prerecorded classes that were related to the fact they were prerecorded and the professors were not involved. In one class, I had an outstanding TF and she made a huge difference; in the other things went badly and students complained. The professor was not accessible and this was not explained prior to the start of the class. …

In summary: If you are looking for a real Harvard experience, take as many classes on campus with real Harvard instructors as you can.

Harvard headlines: Clickbait and the Extension School

Last week there was a flurry of Harvard headlines, after a male student attacked a senior citizen at Logan airport. I won’t get into the details of the story itself, but wanted to talk about the sensationalist coverage and the collateral damage to the Harvard Extension School.

When the story first hit the Internet, it was all about the Harvard connection:
Harvard headlines extension school
Many of the initial headlines, including those from Boston .com, the Huffington Post, and other national and international outlets, omitted the fact that the student, Cameron Shenk, was an Extension School student. In the absence of such context or knowledge of the Extension School, many people skimming the news would assume it was a Harvard College student, even though Mr. Shenk and his lawyer did nothing to insinuate otherwise. It’s a common assumption, as I’ve cited repeatedly on this blog (see my earlier article about Harvard Extension School resume guidelines).

Predictably, when the Internet commenters and follow-on coverage appeared, the angle turned from tragic crime to criticism of the Extension School and its students. Boston .com’s Eric Levenson claims that Extension School students “just need an interest to learn and some money to spend,” neglecting to mention the wide gap between casual class takers and degree candidates who have to prove they can do coursework at a high level before being admitted.

As I said in the comments section of the Boston .com article, there are a couple of issues at play when it comes to mainstream media stories about the Extension School:

  1. Clickbait headline writers who want to play up any story involving weird/unstable/criminal behavior and “Harvard”
  2. A continuing education division that is not well understood (for example, there are casual class takers as well as degree candidates) and often gets defined by strange headlines or fakers.
  3. A student and alumni population which includes a fair number of people who are apt to play down their Extension School affiliation or deliberately mislead others into thinking they attended Harvard College or one of the highly competitive professional programs, such as the Business School.

I think journalists such as Eric Levenson deserve much of the blame Unfortunately, previous stories about Extension/College imposters, combined with a large number of alumni who claim “Harvard” while hiding “Extension” are adding another negative context to this story.

It’s unfortunate, because the Extension School has some great classes and degree programs, and have helped hundreds of thousands of people further their educational goals. Most of them are good people and are honest about the Extension School affiliation, yet the fakers and bizarre headlines are increasingly defining what it means to be an Extension School student.

I welcome your comments below.

Harvard Black Mass debacle and the damage to the Extension School

Harvard Black Mass flyer
Harvard Black Mass announcement (click to see full size)

Once again, a Harvard Extension School club has caused great offense on campus. In 2011, it was a student group inviting a panel of anti-gay Christian conservatives to campus. Yesterday, it was the Harvard Extension School Cultural Studies Club inviting a New York Satanic society to campus to hold a “Black Mass”, a deeply offensive ritual meant to mock core Catholic beliefs. The Harvard Black Mass event, originally scheduled to be held in the basement of Memorial Hall, was moved to the Hong Kong restaurant after outrage exploded across campus and the national media.

There should be little surprise that the event drew such outrage. Boston is still a heavily Catholic town, and the event’s Harvard association magnified the interest and controversy. But I was saddened to see the frustration directed at Extension School students who had nothing to do with the event. I was also disappointed in the poor response by the Extension School and the non-response by Extension School student leaders, namely the officers of the Harvard Extension Student Association (HESA).

Reaction to news of Harvard’s Black Mass

The comments on The Crimson website in reaction to the Harvard Black Mass news illustrate how the reputation of the Harvard Extension School and its students became collateral damage, with some people going so far as to call into question the necessity of the Extension School:

Harvard ’14 Lowell House:

I hate this school. Especially demoralizing that this is coming from the extension school.

Increase Mather:

Most annoying about this is the fact that people reading/hearing about this stupidity in the media will not focus on that word “extension,” which basically means this is an organization of random people who paid Harvard a couple hundred dollars to take a dumbed-down evening course. They are not “Harvard students,” and in most instances they are not even taught by “Harvard faculty.” They are outside posers who use Harvard’s classrooms in the evening — period. Then they go around either lying by omission — “When I was at Harvard” — or outright — “I graduated from Harvard,” ultimately damaging the brand for all the rest of us simply by being who they are and claiming to be who we are.

We have enough problems with controversy generated by legitimate Harvard students and faculty. Why is it that this sort of thing always seems to come from extension school students or visiting “executive education” pole dancers in the business school or some other abomination abusing Harvard’s good name?

Quoiquilsoit:

Why are the Extension School and its students included in “Harvard?” When last I looked, the Extension School provided a way for a limited number of local people to pay and physically attend courses by Harvard faculty and earn, conceivably some day, in the case of a very few of them, a peculiar degree–not a BA. This must have been an exercise in 19th century-style Community Relations. Care has always been taken to keep these locals rigorously segregated from “real Harvard students.”

It seems to me that EdX renders this instrumentality, with all the questions it raises as to selectivity of admissions and the rights and discipline of Extension students, finally obsolete. Our faculty doesn’t need the very modest supplemental income.

Assuming academic integrity, quality and degree content could be assured, which they could right now, I feel great assurance that even so, and despite accelerating advances in medical science, no one capable of reading this will live long enough to see the day when degrees are awarded to EdX students (who, in contradistinction to Extension, are NOT “Harvard students”). The reasons for this are entirely financial.

But, OK. Why go on offering some weird degree? Lop off the decorative old branch and let EdX grow, even though it won’t be green.

This is not the first time that the Harvard Extension School’s reputation has been tarnished by the actions of individual students. Negativity has been brought to the fore when fake Harvard College students with Extension School backgrounds are outed or Extension Student alumni publish C.V.s that avoid mentioning their Extension School affiliation.

Official Response To The Black Mass Event From The Harvard Extension School

The Extension School’s response to the Black Mass was to portray this as a student free speech issue, and attempt to equate the Black Mass with other club events, such as a Shinto tea ceremony. Meanwhile, the elected leaders of HESA — including the director of club affairs — were nowhere to be seen. This would have been an opportunity to reject the Black Mass as totally offensive and unwelcome, and point out that the actions of a few naive and misguided students do not reflect the attitudes of the rest of the student body.

For the Black Mass event, the cultural club went through the trouble of creating an online flier (since removed from weebly) but I couldn’t find any record of the names of the club officers. The organizers of the Black Mass were defended by Harvard on the grounds of free speech rights, but nowhere did they actually have to clearly identify themselves or stand behind their pronouncements.

My advice to Harvard, the Harvard Extension School and HESA: If clubs from any part of Harvard can use “free speech” as a reason to organize any event on campus, then the club organizers have to publicly take responsibility for the event and any fallout or damage that transpires. If club leaders insist on anonymity, then they shouldn’t be granted official club status — and the events should take place off campus.

Harvard Extension School ALM in Management vs. full-time MBA

I received an email from a prospective student asking about the Harvard Extension School’s ALM in Management program. He wanted me to compare the ALM in Management vs. a full-time MBA.

In my reply, I noted that I have never taken any ALM in Management classes. My ALM concentration was history. But I have followed the Management program since it was introduced and have a full-time MBA under my belt, and feel qualified to make some comparisons.

Harvard Extension School ALM in Management vs. MBA: Where the programs differ

From my point of view, while the ALM in Management has a price that’s hard to beat, it does not compare with a full-time MBA. Here’s where I think the ALM in Management program comes up short:

  1. There is no cohort experience, vital for building a network that can serve you long after after the program concludes.
  2. Even though many of the classes are similar to those you would find in a business school, the ALM in Management degree is technically not an MBA. It’s a liberal arts degree in management (!). This fact may cause skepticism among some potential employers.
  3. Many instructors are not Harvard faculty, and there is no affiliation with the world-famous Harvard Business School.
  4. While online classes are a lot of work for students, they are not a substitute for in-person learning experiences. Extension School students have complained about some of the deficiencies in the past.
  5. Some recruiters view any part-time business degree with skepticism.
  6. Among recruiters, the reputation of the school has been damaged by HES graduates who have omitted their Extension School background on their resumes. In some cases graduates have innocently followed the Harvard Extension School resume guidelines, but in many cases there have been deliberate attempts to portray themselves as graduates with a Harvard MBA or Harvard College degree.

In other words, it’s a mistake to assume the ALMM is like a Harvard MBA lite. That said, I think there is real value in some of the on-campus classes that expose students to important business concepts. There are takeaways that can be brought back to the workplace, or help students shift their careers in a new direction. For students who cannot enroll in a full-time MBA program, ALM in Management classes are an attractive alternative.