April 1997
NATIONAL
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Breaking News
Standard-Speaker
Tampa Tribune |
Gaining Control Over Binge Eating
"Self-reverence, self-knowledge, self-control--these three
alone lead life to sovereign power."
-- Alfred, LordTennyson
D-fenfluramine, the first weight-loss drug approved by the Food
and DrugAdministration in 23 years, may also be useful in reducing
or eliminating binge eating behavior. In a study led by Albert
J. Stunkard, MD, DM, professor emeritus of psychiatry,
d-fenfluramine significantly reduced the frequency of binge eating
episodes in severely obese women with binge eating disorder.
Stunkard and his colleagues found that women who took the drug,
marketed as Redux, in an eight-week double-blind study reduced
their rate of binge eating three times more rapidly than the women
who took a placebo. "This study strongly suggests that the
benefits go beyond weight reduction and maintenance of weight
loss," said Stunkard.
According to Stunkard, up to 30 percent of patients entering
weight-reduction programs are also binge eaters. To meet this
clinical diagnosis, patients must eat large amounts of food in a
short period of time at least two days a week over a six-month
period.
Reports began December 26. |
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The New York Times
Seattle Times
St. Louis Dispatch
Orange County Register
Daily News
Patriot-News
Times News
The Press
The Herald
Ridgeway Record
KYW-TV3
WCAU-TV10 |
Sleep and Mood
Your body has its own schedule as to when you should be in a
good mood and when you should be grumpy. That is the finding of
two recent studies on sleep. Both studies--one conducted in
Boston, and one in Manchester, England--suggest that even people
who have had sufficient rest will be irritable or depressed during
times when their body's biological clock tells them they should be
sleeping. And people who have suffered sleep deprivation--for
example, 36 hours without sleep--still report good moods at the
times when their biological clock is telling them to be awake and
alert.
The studies show that at "some hours of the day, we're
happier than others, and it's occurring inside us, not just in
reaction to the world around us," said David F.
Dinges, MD, PhD, associate professor of psychology in
psychiatry. "We don't really understand whether (sleep)
disturbances...are leading to some of the mood disturbances
associated with night shift work or chronic exposure to time zone
changes."
Dinges added that depression, anxiety, and other disorders are
so widespread that "being able to identify the fundamental
processes in every human that may go awry in producing them is
hugely important."
Reports began February 12. |
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The New York Times
Philadelphia Tribune
KABC-TV7 (Los Angeles) |
Mammograms for Forty-Somethings
At what age should routine mammography begin? Recommendations
vary. Some groups, including the American Cancer Society and the
American Medical Association, have recommended the test every year
or every other year for women between the ages of 40 and 49, and
yearly after 50.
The National Cancer Institute recommends that routine
mammography start at age 50. But to investigate whether the
starting age should be reduced, the NCI, along with several other
government committees, recently assembled a panel to examine how
useful mammography is to women in their 40s. In a statement, the
panel said that its purpose was to weigh the lifesaving benefits
of mammography against the disadvantages, including discomfort and
inconvenience, as well as mammographic radiation.
After much deliberation, the panel concluded that women under 50
should decide for themselves when to start mammograms. The panel
emphasized that they were not concluding that there was no benefit
to mammograms for women age 40 to 49, but that the benefit is
small.
According to The New York Times, studies have shown
that between zero and 10 percent of women in their 40s have their
lives prolonged by mammography screening, but not necessarily
saved. There is a 30 percent drop in the death rate from breast
cancer that is detected by mammography in women in their 50s.
According to panel member Daniel C. Sullivan, MD,
associate professor and chief of Penn's mammography section, "If
women ask me my personal opinion or recommendation for them based
on what I know about the pros and cons, my recommendation for most
women in their 40s is that annual mammography is likely to be
beneficial to them."
Reports began January 23. |
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Hospitals and Health Networks |
CEO/CIO Connection in Health Systems
A substantial cover story in Hospitals and Health Networks
magazine examined the intimate--and sometimes
tumultuous--relationship between health system CEOs and CIOs. In
the spotlight--William N. Kelley, MD, CEO of the
University of Pennsylvania Health System and Dean of the School of
Medicine, and Ward Keever, CIO of UPHS.
"To be really successful, there needs to be a covenantal
relationship between the CEO and CIO, as opposed to a contract
counting failures and successes," Keever told Hospitals
and Health Networks reporter Chuck Appleby. "In a
contractual relationship, you spend too much time avoiding risks."
In Keever's case, he reports to Senior Vice President William T.
Foley, not directly to the CEO. Still, Keever says, there is good
chemistry between him and Kelley, which is not "something you
can find easily."
"As hospitals, clinics, doctors and health plans merge and
purge, information technology has replaced bricks and mortar as
the symbol of capital investment. A sound information management
strategy has become the electrical charge that brings the new
creation to life. It's no wonder that the CEO/CIO relationship has
taken on a meaning never before possible," Appleby wrote.
The article appeared in the February 5 issue. |
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The Washington Post
The New York Times |
Gulf War Syndrome Committee Extension
In early January, President Clinton announced his decision to
extend the life of the Presidential Advisory Committee on Gulf War
Veterans' Illnesses. However, in the future, the commission may
exist in a different form, with additional members. The news came
after the commission released its final report, calling for
outside oversight.
"There are some questions about how aggressive earlier
efforts have been. There's some mistrust, so external
accountability is going to be crucial," said Arthur
L. Caplan, PhD, director of the Center for Bioethics, and
a member of the commission. In addition, Caplan said, "It
makes some sense to maintain continuity between what we've been
doing and future oversight. There's no sense in starting from
scratch."
The commission's report concluded that stress and other factors
have not been adequately studied by the Pentagon. The other
factors include low-level chemical exposure, the interactive
effects of pesticides, and oil fires.
To date, about 80,000 of the 700,000 American troops who served
in the Gulf have sought medical treatment for various post-war
symptoms, including digestive problems, chronic fatigue, and
memory loss. In May 1995, President Clinton formed the committee
to study reports of chronic illness and the government's response
to them. Last winter, the committee reported that it has found
little evidence of a "Gulf War Syndrome." But, at the
same time, the panel criticized the Pentagon's investigation into
the possibility that some U.S. troops were exposed to low doses of
nerve gas.
Reports began January 5. |
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The New York Times |
Genetic Discrimination
Women who have tested positive for the mutated genes that could
cause breast cancer have more to contend with than the bad news
that they have a 90 percent chance of developing the disease. They
also have to worry about whether information about the mutation
will be disclosed to insurance companies and employers, who may
then discriminate against them.
An article in The New York Times examined the various
ways that women have been discriminated against since the genetic
testing became available, and how they might deal with it.
Barbara Weber, MD, associate professor of
medicine in hematology-oncology, revealed the story of a patient
whose test indicated that she had the mutated gene. The woman
wanted to have both of her breasts removed prophylactically. Weber
submitted a claim to the insurance company for pre-approval, and
was turned down because the company considered the surgery a
preventive measure, which therefore wasn't covered. At the
patient's request, Weber resubmitted the claim with the genetic
test results attached. The insurance company then responded that
the surgery wouldn't be covered because the patient had a
pre-existing condition.
A Georgetown University School of Medicine study of 332 people
who had a variety of genetic disorders showed that 25 percent
believed they were denied life insurance, 22 percent believed they
were denied health insurance, and 13 percent believed that they
were not hired for a job or lost a job because of their disorder.
Some researchers advise women who are tested not to tell even
their own doctors unless their physicians agree not to write the
results down in their medical records.
The article appeared February 4. |
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The Wilmington News Journal
The Reporter (Lansdale, PA)
The News (Danville, PA)
The News (McKeesport, PA)
Republican
Times and Observer
Pocono Record |
Proving du Pont Insane
According to the defense in the trial of John E. du Pont for the
murder of wrestler David Schultz in January 1996, du Pont did not
believe that killing Schultz was wrong. His mental illness, they
say, made him believe that Schultz was part of an international
conspiracy that threatened his life.
During the trial, several psychiatrists who had examined du Pont
testified to his insanity. The third expert in the defense lineup,
just before the defense rested its case, was Robert
Sadoff, MD, clinical associate professor of psychiatry.
Sadoff was hired by defense lawyers two days after the shooting.
He interviewed du Pont 10 times over the months that followed the
murder.
Sadoff told jurors that du Pont refused to discuss the day of
the killing with him. However, there was a "mountain of
evidence" about du Pont's delusions and fears that convinced
Sadoff that du Pont did not know it was wrong to kill Schultz.
During the trial, it was revealed that du Pont's personal
lawyer, Taras Wochok, had sought to involuntarily commit du Pont
to a mental hospital in the early 1990s, but strict Pennsylvania
laws governing involuntary commitment made it impossible.
"Mr. du Pont has never seen himself as mentally ill and
would never cooperate to voluntarily go to the hospital,"
Sadoff told jurors.
Ultimately, the jury found du Pont "guilty, but insane."
Reports of the final testimony appeared in early February. |
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Hospital and Healthcare News |
HealthChoices: A Good Choice
HealthChoices, the Commonwealth of Pennsylvania's mandatory
managed care program for Southeastern Pennsylvania, began official
operation in February. Under the plan, Medicaid recipients are
required to choose an HMO by July 1, or be assigned to one. The
HMOs participating in HealthChoices include Healthcare Management
Associates, HealthPartners, Keystone/Mercy, and Oxford/Oaktree.
Many hospital officials are anxiously waiting to see how the
unfolding plan will change the way hospitals do business, and how
it will affect their pocketbooks. For example, emergency
department visits will be governed more strictly by the HMOs than
they were in the past by Medicaid.
Martha Marsh, senior vice president for
professional services and managed care for the University of
Pennsylvania Health System, told Hospital and Healthcare News
that she expects the changes to be positive. "I really
believe in managed care. Patients who used to have trouble finding
a doctor who would accept Medicaid now have a whole program set up
for them. It could mean that they won't have to use the emergency
room as their doctor's office. "Marsh added that UPHS has
good relationships with the four contracted HMOs.
The article appeared in the February issue. |
LOCAL
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Philadelphia Business Journal |
The Holy Redeemer Affiliation
In February, the University of Pennsylvania Health System
announced its affiliation with the Holy Redeemer Health System,
headquartered in Huntingdon Valley, Pa. Through the arrangement,
UPHS will strengthen its presence in Northeast Philadelphia and
its surrounding communities. The agreement is not a merger and
does not include a transfer of any assets, but the two partners
may form joint ventures in specific areas in the future.
In addition to its 250-bed acute care hospital, the Holy
Redeemer Health System is known for its home care and elder care,
including Holy Redeemer Visiting Nurse Agency and Redeemer Long
Term Care and Elder Service. According to Holy Redeemer Health
System President and CE Michael B. Laign, Holy Redeemer is one of
the most experienced local providers in managing risk contracts.
William N. Kelley, MD, CEO of the University
of Pennsylvania Health System and Dean of the School of Medicine,
commented on the affiliation in the Philadelphia Business
Journal. "Together, our institutions will be able to
provide a broader range of health care and preventive health
services in a coordinated manner for the benefit of the
communities served."
Kelley added that each partner will benefit from the expertise
of the other. UPHS will gain access to patients and the
communities that Holy Redeemer serves--an area of about 250,000
residents. Holy Redeemer will gain access to Penn's clinical
expertise, educational strength, and managed care contracts.
The article appeared February 14. |
PERSPECTIVES
When reporters need opinions on current issues,
they frequently consult University of Pennsylvania Health System
experts. Below are samples of comments made to the media on various
timely topics:
"The old and the sick are accorded little enough value in this
society as it is. Then you throw in doctors answering to their HMOs
every time they want to run another test or prescribe another
medication. And now you want to legalize suicide?"
--Arthur L. Caplan, PhD, director of the Center
for Bioethics
"The Doctor Will Kill You Now"
Contemporary Long-Term Care, February
"Long term, it's inevitable that the majority of health care
will be covered by capitation. Over the short term, I don't have a
clue. It's a zoo out there."
--William L. Kissick, MD, DrPH, George S. Pepper
Professor of Public Health and Preventive Medicine
"What's Holding Back Capitation?"
Medical Economics,1/27/97
"It's an amazing treatment of health care as a commodity, like
grain, milk, or meat. I've never heard anything like this before. But
I really can't find any fault with it. Maybe this is one of the first
rational collaborations between hospitals and the government."
--Alan Hillman, MD, MBA, associate dean of the
School of Medicine, associate professor of medicine, director of the
Leonard Davis Institute's Center for Health Policy
Subject: U.S. to Pay New York Hospitals Not to Train Doctors, Easing
Glut
In Touch Networks,2/18/97
"We're all reading the same tea leaves. Most physicians around
here realize that the days of the small, independent practice are
numbered."
--Paul R. Rogers, MD, senior medical director of
Clinical Care Associates
"How Fast Can Things Change? Just Look at Philadelphia"
Medical Economics,1/27/97
"It really does open the door to a kind of genetic engineering
of humanity that we've only been able to fantasize about or has been
the stuff of science fiction."
--Arthur L. Caplan, PhD, director of the Center
for Bioethics
Subject: History's First Clone of a Sheep
NBC Nightly News, 2/23/97
SNIPS & SNIPS
WOMEN AND HEART ATTACKS. . .For American women,
the risk of dying from a heart attack is greater than that of breast
cancer. But according to Prevention Magazine, only one-third
of women realize that. Irving M. Herling, MD,
associate professor of medicine, commented on the findings to
KYW-TV3's Larry Kane. "Lots of studies generated about heart
disease include only men. And I think part of it occurred because
women defer their heart disease until later on in their lives--10
years usually--than men because their female hormones protect them."
Herling recommended that women prone to heart disease exercise and
watch their cholesterol. Aired February 3.
WHY MOISTURIZE?. . .Applying moisturizer is an
easy, inexpensive way to look younger. But why does it work the way it
does? Albert M. Kligman, MD, PhD, professor emeritus
of dermatology, explained the reasons for Your Health
magazine. "The dry, rough look that older skin gets whenever the
humidity is low has to do with the way cells close to the surface are
shed. A moisturizer will smooth things, fill in the cracks, reduce
friction and cover the skin so that it looks and feels better."
Appeared in the February 4 issue.
HELP FOR STAGE FRIGHT. . .Those suffering from
stage fright--a form of social phobia--don't have to pass up
invitations for public speaking. Medication can help with the common
symptoms of nervousness, blushing, dry mouth, tremors, and increased
heart rate. Michael Cirigliano, MD, assistant
professor of medicine, discussed the option in the Tampa Tribune.
"Beta-blockers have a calming influence. They're like
tranquilizers--except that your cognitive abilities remain more
intact." He warns that the medications must be prescribed and
supervised by a physician. And they may cause side effects in patients
with asthma, diabetes, or emphysema. Printed in the January 2 issue.
HELP FOR STAGE FRIGHT. . .Despite the high cost,
improved in vitrofertilization success rates have made the
procedure more attractive to couples who are having difficulty getting
pregnant. On average, it costs $5,000 to $15,000 to conceive with
in vitro, which may actually be a better "bargain"
than methods that are cheaper per cycle, but may take many more cycles
to work, if they work at all. "Maybe time, in a sense, is money,"
said Christos Coutifaris, MD, PhD, associate
professor of obstetrics and gynecology, on KYW-TV3's 11 p.m. news.
Aired February 10.
DRESSED FOR SUCCESS. . .In many hospitals,
patients are confused by the endless stream of employees who enter
their rooms during their hospital stays. Relaxed dress codes have
broken down the dress barriers between physicians, nurses, orderlies,
and other employees. The Philadelphia Inquirer reported on
the effort of the Hospital of the University of Pennsylvania --and
other area hospitals -- to maintain consistency in dress and diminish
confusion. According to nurse historian Julie Fairman, PhD,
RN, assistant professor of nursing, it makes good business
sense to let patients know who the doctors are, who the nurses are,
and soon. "The client's paying. Why shouldn't they know who it
is?" Printed in the February 3 issue.
YOUNG ATHLETES. . .The American Medical
Association is encouraging the development of clinical guidelines for
physicians who care for child athletes. American Medical News
reported that Charles Cutler, MD, clinical associate
professor of medicine, introduced the resolution. Cutler explained
that training for more than 20 hours a week can put children at risk
for stress fractures and spinal damage. Female athletes are
particularly at risk. For them, excessive training can lead to delayed
puberty, impaired fertility, and psychological problems. Printed in
the January 6 issue.
CONVINCING STUFF. . .If you want to be heard,
learn how to be a good listener. That's the advice that David
Burns, MD, clinical associate professor of psychiatry,
offered to the readers of R. O. Monthly. "The biggest
mistake you can make in trying to talk convincingly is to put your
highest priority on expressing your ideas and feelings. What most
people really want is to be listened to, respected, and understood.
The moment people see that they are being understood, they become more
motivated to understand your point of view." Printed in the
January issue.
LOZENGE ETHICS. . .It was recently revealed that
the physician who published the article in the Annals of Internal
Medicine praising the Cold-Eeze zinc lozenge was a major stock
owner in the company that makes the product. The lozenges, reported to
shorten the duration of the common cold, are selling very quickly at
stores across the country. Arthur L. Caplan, PhD,
director of the Center for Bioethics, told The Philadelphia
Inquirer that he believes similar situations will become more
common as the federal government gets less involved in funding
clinical research, and private institutions--with their own ethics
policies--dominate the market. "I believe it's time for a
national commission to be formed to take a look at this whole area,"
Caplan said. Appeared in the January 31 issue.
RESIDENTS IN SURGERY. . .Many people wish they
could have plastic surgery to improve their looks, but they think that
the price would be prohibitive. There are ways to get plastic surgery
done at a lower cost, and one of them is to have a resident perform
the operation with an experienced surgeon by his or her side. Good
Morning America followed one patient who had a face-lift and lip
augmentation done at HUP through the Edwin and Fannie Gray Hall Center
for Human Appearance. The patient saved almost $5,000. "The
downside is... our residents take a little bit longer, and there's a
little bit more instruction time," said Louis Bucky, MD,
assistant professor of surgery, who attended the operation. Aired
February 20.
WATCH WHERE YOU SNEEZE. . .When you sneeze into
your hand and fail to wash afterward, everything you touch can become
contaminated with infection-causing bacteria. WCAU-TV10's Cherie Bank
hired a biochemist to follow several "sneezers" to determine
what germs they were leaving behind on keyboards, telephones, and
doorknobs. Bacteria, including streptococcus and staphylococcus,
turned up in every sample. P. J. Brennan, MD, assistant professor of
infectious diseases, hospital epidemiologist, and director of
infection control, commented on the findings. "The germs can live
on the surface for anywhere from minutes to a few hours," Brennan
said, "and if the conditions are right, possibly even days."
Aired February 23.
EXPLOSIVE SITUATIONS. . .Would you know what to do
if you were confronted with a agitated and possibly intoxicated person
on the job? Iradj Maany, MD, clinical associate
professor of psychiatry, and J. Michael Rivard, MD,
clinical associate and staff psychiatrist at the Philadelphia Veterans
Affairs Medical Center, co-authored an article for Materials
Management in Health Care, offering tips. Showing respect for the
potentially violent person and a willingness to listen is one such
tactic, as is using positive body language and active listening
techniques. Printed in the February issue.
POLICING SPECIAL SERVICES. . .In December,
Pennsylvania lifted its limitations on the number of
highly-specialized services that can be offered at institutions in the
state. Hospitals have reacted by expanding their special services at a
record pace, adding cardiac care, organ transplant, and other
services. But recently, Senate Democratic Leader Robert Mellow
introduced a bill to bring back the regulations. He is one of many
experts who fear that multiple programs will result in excessive
services, the cost of which will be passed on to the consumer.
John W. Hirshfeld Jr., MD, professor of medicine,
told The Philadelphia Inquirer that an overabundance of
programs will diminish quality of care. "The health-care industry
can't police itself, and needs to be regulated externally,"
Hirshfeld said. Printed February 12.
CADAVER SHORTAGE. . .Medical schools have always
relied on donors to provide them with cadavers for introductory
anatomy classes, for advanced courses that prepare surgeons, and for
research. But in recent years, the number of incoming cadavers had
dropped. To keep up with the education and research needs of its 10
medical schools, the commonwealth of Pennsylvania requires about 800
bodies, and is only receiving about 600. "In the last few years,
there has been somewhat of a shortage," said John
Weisel, PhD, professor of cell and developmental biology for
the University of Pennsylvania School of Medicine, in an article that
appeared in the Pittsburgh Post-Gazette. "It's hard to
tell what the reasons are. There was a drop in the early '80s and
there seems to be a slight decline at the moment. So there has been
some problem, especially getting enough for research purposes."
Printed February 10.
PARITY FOR MENTAL ILLNESS. . .Insurers often draw
a line between what they consider severe mental illnesses and less
serious ones, opting to cover the former and not the latter. But many
"minor" psychiatric disorders, left untreated, can seriously
disable a patient and may lead to more severe illness. In a
Clinical Psychiatry News forum, psychiatrists expressed their
opinions about whether insurers should be allowed to restrict their
coverage this way. "An ounce of prevention is worth a pound of
cure," and most fiscally conscious managed care companies realize
this, commented Lance Wright, MD, clinical associate
in psychiatry. Printed in the January issue.
NEW ROLES FOR SCHOOL NURSES. . .Gone are the days
when school nurses simply handled the little ouches and illnesses in
otherwise healthy children's lives. These days, many school nurses are
being called upon to take care of children with an array of
complicated disabilities. In the past, many of these children were
placed in special schools. But because of laws such as the Individuals
with Disabilities Education Act of 1975 and the Americans with
Disabilities Act of 1990, schools are being forced to accommodate
seriously ill children. "It's put tremendous burdens on the
schools," said Arthur L. Caplan, PhD, director
of the Center for Bioethics, in the Tribune. "You see a
child in school and wonder, what are we doing here? I've seen almost
comatose children going to school." Printed February 10.
MEDICAL MYTHS. . .Does eating chocolate and other
fatty food cause people to break out in pimples? It's simply a much
handed-down myth, said Albert Kligman, MD, on
WCAU-TV10's nightly news. "The sebaceous gland, which is pumping
out the oil, doesn't know whether you're an Eskimo eating blubber or
if you're eating kosher food in Brooklyn. It has no idea, and it
doesn't give a damn." Kligman added that pimples are usually
genetic, and that there are many effective treatments to control them.
Aired February 11.
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MEDIA Review
|
April, 1997
Linda Bird Randolph, Editor
Kathryn
Hankins,
Lori Lantz, Staff
Colleen Hughes-Behler, Designer
Administration:
William N. Kelley, MD, CEO, University of Pennsylvania
Medical Center and Health System, and Dean, School of Medicine
Lori Doyle, Chief Public Affairs Officer
Rebecca Harmon, Director of Media Relations
Media Review is published monthly by the University of
Pennsylvania Medical Center's Office of Public Affairs to keep the
faculty and administration aware of recent Penn-specific media
highlights. To make comments, write to Editor, Media Review, 220
Blockley Hall, 3400Spruce Street, Philadelphia, PA 19104 |
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