clinical immunologist at the Johns Hopkins Medical Institutions. Despite receiving informed consent prior to the start of the trial, Roche was not made aware of the potential fatal implications of the research study, only being told of the potential side effects of wheezing, chest tightness, and transient dyspnea. In the second phase of the experiment, hexamethonium, a drug blocking lung relaxation caused by deep breathing, was administered to Roche and all test participants. Despite the drug's known adverse effects in the 1950s, the research study used the drug, which is not approved by the Federal Food and Drug Administration (FDA), and ultimately resulted in Roche contracting flu-like symptoms and a 35% reduction in her lung function within 36 hours and her death. Roche's death raised questions about the ethical treatment of test subjects, and her death was reported to the University's Institutional Review Board and to the Office of Human Research. Clinical reform In 2005, the Johns Hopkins Center for Innovative Medicine devised the idea of the Miller-Coulson Academy in an effort to adhere to the pillars of research, education, patient and clinical care, and health systems management associated with academic health centers. The Academy's inaugural class became focused on the Department of Medicine, and invited eight physicians to join, with the stipulation that 20 hours of service annual was required to maintain membership. The clinical portfolios of these physicians were reviewed by a body of medical officials comprised across different medical institutions. References Bayview, Baltimore Teaching hospitals in Maryland Hospitals in Baltimore Affiliates of Johns Hopkins Hospital Johns Hopkins University Municipal hospitals 1773 establishments in Maryland Hospitals established in the 1770s