April 1998 National Anorexia May have a Genetic Link Gene Therapy Enables Transplantation Without Immunosuppressive Drugs New Heart Attack Indicator Helps Docs Diagnose Gun Talk: A Physician's Responsibility Blast From The Past: The House Call Attitudes About Adultery Combining Chemo Drugs to Treat Advanced Bladder Cancer "Old" Newborns Local Penn Is Third in NIH Rankings Perspectives Snips & Clips
	NATIONAL
The Washington Post New York Post Milwaukee Journal Sentinel The Philadelphia Inquirer WCAU-TV10 WTXF-TV29 WFLD-TV32 (Chicago) KTVI-TV2 (St. Louis) WWMT-TV3 (Grand Rapids) WAGA-TV5 (Atlanta) WNYW-TV5 (New York) WSVN-TV7 (Miami) WHDH-TV7 (Boston) WPEC-TV12 (West Palm Beach) WPMT-TV43 (Harrisburg)	Anorexia Nervosa May Have Genetic Link "Everyone knows about dieting, the enthusiasm at the start, the dreariness of continuing the self-denial, and the relief of giving it up. Anorexics are different--they go on and on." --Hilde Bruch, M.D. (physician and renowned anorexia researcher) Traditionally, experts have blamed societal pressures for the high incidence of anorexia nervosa, a sometimes deadly eating disorder characterized by a relentless pursuit of excessive thinness. But a new study shows that anorexia may be due, in part, to genetics. Research conducted by Wade Berrettini, M.D., Ph.D., director of Penn's Center for Neurobiology and Behavior, has found that both members of a pair of identical twin sisters (who share 100 percent of their genes) were substantially more likely to suffer from anorexia than were both members of a pair of fraternal twin sisters (who share 50 percent of their genes, as do siblings born to the same parents). Additionally, immediate family members of anorexic women were 10 times more likely to develop the disorder than were members of the general population. "There's an enormous emphasis on thinness in society's image of female beauty, and most people think a woman's risk of developing anorexia nervosa derives solely from that fact," Berrettini said. "But studies of twins and families suggest that about half the risk of developing this eating disorder is inherited." It is hoped that the discovery will lead to improved therapies for anorexia. "There is not a single government-approved medicine to treat anorexia," Berrettini said. "It's our hope that if we can find susceptibility genes, we will then be able to develop better treatments for the disorder." Berrettini and researchers at the University of Pittsburgh, under the direction of Walter Kaye, M.D., will continue their research by analyzing the DNA extracted from samples collected from 200 families in which at least two siblings have anorexia or bulimia. The most likely finding, Berrettini said, is that several different susceptibility genes contribute to an individual's risk of anorexia. Reports began January 21. Return to index
Hospital & Healthcare News ScienceNOW Reuters WPVI-TV6 KCOP-TV13 (Los Angeles) WHYY-FM (NPR)	Gene Therapy Enables Transplantation Without Immunosuppressive Drugs Researchers at the University of Pennsylvania Medical Center, working in a rat model, have succeeded in transplanting livers without the need for immunosuppressive drugs. In a scientific first, a gene therapy strategy was used to alter the donor liver prior to surgery so that the immune system of the recipient became permanently tolerant of the new organ. Although additional animal studies will be required before human clinical trials of the approach can be considered, the advantages of such a localized system for countering the immune-system rejection of newly engrafted organs are potentially significant. The powerful immunosuppressive drugs now required to allow a life-saving transplanted organ to survive in a recipient's body without rejection do their work only at a substantial cost to the overall well-being of the recipient. "Currently, all immunosuppression is systemic and lifelong," said Kim M. Olthoff, M.D., an assistant professor of surgery and lead author of the study published in Nature Medicine. "So, to protect the new organ from rejection, long-term drugs that suppress the entire immune system must be given, making the person susceptible to infections, cancer, and a number of other complications, including nerve and kidney damage. In our study, a one-time gene therapy treatment of only the donor liver made the recipient's immune system tolerant of the new organ without the need for any further immunosuppression." "What we have developed is a feasible model for a gene therapy approach to local immunosuppression in liver transplantation," explained Abraham Shaked, M.D., Ph.D., an associate professor of surgery and senior author of the report. "We were able to deliver the gene for a protein that blocks the immune system from attacking an engrafted organ, and we were able to do so with a single treatment that obviated the need for follow-up drug therapy. Taken together, these are exciting initial results that we're now working to extend." Reports began January 29. Return to index
Reuters Health Online The Chronicle of Higher Education Clinica Biomed Technology Medical Industry Today Philadelphia Tribune	New Heart Attack Indicator Helps Docs Diagnose Each year, millions of people rush to emergency rooms complaining of chest pain and are subsequently hospitalized for suspected coronary problems. But according to studies, up to three-quarters of patients with chest pains are inaccurately diagnosed with a heart attack or unstable angina. On the other hand, as many as one-third of all heart attacks go unrecognized. Researchers at the University of Pennsylvania Medical Center have shown that diagnostic accuracy of chest pain can be dramatically increased -- up to 90 percent, in some instances--by using a clinical approach that combines the results of an echocardiogram with a simple blood test that measures a patient's troponin T (TnT) levels. TnT is a protein released by the body during cardiac cell injury or death. In a prospective study of 100 patients who presented with chest discomfort and were subsequently admitted to a hospital in Indiana, the TnT/echocardiogram combination correctly predicted that 90 percent of those who were not suffering from ischemic heart disease did not need to be admitted and would not return to the hospital with similar ailments. In addition, 90 percent of the patients who sustained acute heart attacks had an increased level of TnT within four hours of entering the ER. The study's lead author, Emile R. Mohler, M.D., said that he hopes the results will lead to methods that emergency departments can use to better triage patients and determine which patients should and should not be admitted to the hospital. "It will also help us make initial diagnoses to determine appropriate medication," added Mohler. "Most importantly, this research lays the groundwork for a study that will determine the safety of this data." Reports began February 3. Return to index
The Washington Post Houston Chronicle Rocky Mountain News (Denver) Dallas Morning News San Diego Union-Tribune Sun-Sentinel (Fort Lauderdale) Columbus Dispatch Atlanta Constitution San Jose Mercury News Fort Worth Star-Telegram Pittsburgh Post-Gazette Asbury Park Press Beaver County Times Times (Reading, Pa.) WWMT-TV3 (Grand Rapids) KRI-TV26 (Houston)	Gun Talk: A Physician's Responsibility Everyone knows that guns can cause needless deaths. But many people -- even physicians -- might be surprised at how many deaths can be attributed to gunshot wounds. According to a survey published in the Annals of Internal Medicine, there were 39,720 gun-related deaths in 1994. Among them were 13,593 intentional killings of another person, and 20,540 suicides. Firearm deaths increased by more than 60 percent between 1968 and 1994. At this rate, by the year 2003, more people will die of gunshot wounds than in automobile accidents. More teenagers currently die from gunshot wounds than all other natural causes combined. So are doctors discussing this epidemic with their patients? The survey of 915 physicians showed that less than 20 percent of the surgeons and internists bring up the subject with their patients. "Do you have a gun in the house? Is it loaded? And did you know suicide can go up five-fold when you have one around that is loaded? Those are the kinds of questions that doctors should start asking and telling their patients," said Frank Davidoff, internist and editor of the Annals of Internal Medicine, in an article that appeared in The Washington Post. C. William Schwab, M.D., chief of trauma and critical-care surgery, and co-author of the article that reported on the survey, told the Post, "If this was any other disease, if this was a virus, the public would be demanding a cure. . . . They'd want something done about it. The problem is nobody is willing to come out and say, 'This is a public health emergency,'" as former surgeon general C. Everett Koop did with AIDS. Reports began February 2. Return to index
The Philadelphia Inquirer Sunday Denver Post Press Enterprise Times-Picayune (New Orleans)	Blast From The Past: The House Call Prior to World War II, Americans were quite accustomed to having their physician come to their home when a member of the family was ill. But now such visits are very rare. But as the population of elderly, home-bound patients increases, home visits are becoming necessary. Many doctors are learning how to respond. "The need is there and is growing," Risa Lavizzo-Mourey, M.D., M.B.A., director of Penn's Institute on Aging, told The Philadelphia Inquirer. In addition to providing a convenience to home-bound patients, Lavizzo-Mourey said that visiting homes is important to treatment. "If you never see how patients are functioning in their homes, you are in many ways treating them in the dark." According to the Inquirer, Penn's program recently received $70,000 through the John A. Hartford Foundation to improve the teaching of home care to medical students. "In an acute situation like a hospital or a clinic, a doctor is accustomed to having certain backups on the spot," she said. "If the doctor goes into the home, and they don't have the ability to order a chest X-ray or get the lab exam at that moment, that can be very disconcerting to them." Starting in January, Medicare reimbursement for home visits went up, the Inquirer reported. The maximum a physician can be paid is now $168, compared to $101 last year. In her care of patients in their homes, Lavizzo-Mourey works side-by-side with a team of health care professionals, which includes doctors, nurse practitioners, and a social worker, in an effort to provide the circle of care provided in a hospital setting. The team treats about 220 patients at home. Reports began January 25. Return to index
CNN	Attitudes About Adultery Did he, or didn't he? And does it matter? These were the topics being mulled over around water coolers across the country amidst recent allegations that President Clinton had an affair with a White House intern. Has the public become more accepting of such behavior, or perhaps even less accepting than in the past? According to experts, Americans periodically alternate between periods of liberalism and periods of conservatism. And, they say, in 1998, the country is feeling rather conservative. On CNN-TV, Paul Root Wolpe, Ph.D., senior faculty associate for Penn's Center for Bioethics, explained: "After a liberal period, there's usually a conservative period. We've elected conservative congressmen. We have had the AIDS epidemic, which brought into question the kind of sexual freedom that we had in the 60s and 70s. And so, there's been this move back." Wolpe added, "I think our attitude toward adultery has become much more complex. In terms of politics, it depends entirely, in my view, on how the politician has presented himself." If Ronald Reagan or Dan Quayle -- both ardent defenders of conservative family values -- had been caught committing adultery, Wolpe said, the public would have been more outraged. "People did not elect Clinton because of some deep sense of inner morality that they felt he had. Clinton was smart not to deny that he had tried marijuana, to admit that his marriage has had problems," Wolpe asserted. "I don't think [the American people] judge his adultery as harshly--if, in fact, he did commit adultery." The broadcast aired January 19. Return to index
Hospital & Healthcare News	Combining Chemo Drugs to Treat Advanced Bladder Cancer Patients suffering from advanced bladder cancer, many of whom are elderly, may be treated with a better tolerated chemotherapy treatment regimen. According to a study published in the January issue of the Journal of Clinical Oncology, clinicians at the University of Pennsylvania Cancer Center have demonstrated that the combination of paclitaxel and carboplatin is tolerable and has significant anti-tumor effects. Researchers treated 33 patients, averaging an age of 70, who suffer from advanced bladder cancer with paclitaxel intravenously over three hours followed by carboplatin for 30 minutes. Patients who participated in the trial were treated at the Hospital of the University of Pennsylvania and other local Philadelphia hospitals, and toxicity levels were monitored frequently. David Vaughn, M.D., assistant professor of medicine and principal investigator on the study, said that, "The standard regimen for advanced bladder cancer is often too harsh for elderly patients and may cause significant side effects." Commonly, treating advanced bladder cancer involves administering a total of four chemotherapy drugs typically referred to as MVAC. While MVAC is considered the gold-standard for treating this disease, the regimen can result in severe side effects and the treatment is not well-tolerated for elderly patients, especially those in frail health. Additionally, MVAC is difficult to administer to patients with renal impairment, which may be seen in this population. According to the American Cancer Society, approximately 50,000 people in the United States suffer from bladder cancer and the disease kills nearly 12,000 Americans each year. Bladder cancer strikes three times as many men as women. "We observed that many of the patients' tumors actually shrunk," said Vaughn. "And we believe that their quality of life greatly improved. The regimen was tolerable in most patients who normally might not be physically able to undergo the standard treatment and the patients fared well with the two-drug combination therapy," he concluded. Reports began January 30. Return to index
The Philadelphia Inquirer	"Old" Newborns In mid-February, it was announced that a reproductive "first" had occurred when a California mother gave birth to an infant who began as a seven and one-half year-old cryopreserved embryo. And even though the news services picked up on the story with great interest, heralding the story of "the oldest newborn," an inaccuracy was quickly pointed out: an even "older" newborn had been born at Pennsylvania Hospital late last year. At Pennsylvania Hospital, the healthy baby resulted from an embryo that had been frozen for over eight years. Later reports revealed that an even "older" newborn was born late last year in New York, after an embryo that had been frozen for eight and one-quarter years was thawed and transferred to the mother's womb. Experts predict that an increasing number of children will be born many years after they are conceived and frozen as embryos. In most cases, unused embryos are frozen as "leftovers" after an infertile couple undergoes in vitro fertilization. If the attempt at IVF is unsuccessful, the frozen embryos may be used in the near future for additional attempts. And if the couple is successful in conceiving through IVF, the embryos often remain frozen in case the couple decides to initiate a second pregnancy with them in the future. Usually, this is within one to three years. Unused and unwanted embryos are often destroyed down the line, or in some cases, forgotten about and "orphaned." Now that experts know that it is possible to thaw and use an embryo almost a full decade after it is frozen, many are pondering the ethics of this method of reproduction. In a Philadelphia Inquirer article, Arthur L. Caplan, Ph.D., director of Penn's Center for Bioethics, estimated that there are about 50,000 frozen embryos in clinics and hospitals throughout the nation. Yet there are no laws governing how these embryos should be used and disposed of. "We are way overdue in this country for some policy that allows destruction of these embryos after five years without consent." England, Caplan said, sets a limit on the amount of time embryos can be preserved. "We are ducking a moral problem by allowing this large window of time," he said, referring to the latest generation of "old" newborns. Stephen L. Corson, M.D., director of reproductive medicine at Pennsylvania Hospital, defended a couple's right to preserve embryos, even for a long period of time. "The freezing of the embryo means that they [the couple] don't have to go through the emotional roller coaster of the initial donation," Corson said. "People who get pregnant easily have the luxury or ability to decide when they have a 7 or 10-year-old that they want to increase their family," he continued. "People who require assisted technology should have as much as possible the same option." Reports began February 17. Return to index
	LOCAL
WTXF-TV29	Penn Is Third in NIH Rankings According to figures released from the National Institutes of Health (NIH), the University of Pennsylvania School of Medicine now ranks third among academic medical centers in the United States. The new ranking, based on total research and training awards of $175 million in fiscal year 1997, represents a leap ahead from the institution's place as fifth in fiscal year 1996 with $149 million in grants. Penn also posted the largest growth in funding for research and training among the top ten medical schools in the country for the same period -- 17.6 percent. "Our faculty and staff, already among the best in the world, can take great pride in this new accomplishment," said William N. Kelley, M.D., dean of the School of Medicine and CEO of the University of Pennsylvania Health System. "To be ranked third in the nation for NIH funding means we can continue to provide our patients with the benefits of advanced medical training coupled with cutting-edge research." In a WTXF-TV29 segment highlighting the American Association for the Advancement of Science convention, held in Philadelphia in February, the importance of NIH funding was touched upon. Reporter Bruce Gordon described how important funding is to the research led by James Wilson, M.D., Ph.D., director of Penn's Institute for Human Gene Therapy. "Our goal is to correct [a disease such as Alzheimer's] at its root by replacing that defective gene with a new gene," Wilson said. "It's an investment in humanity." Reports began February 12. Return to index
	Perspectives "In twenty years, medicine is going to be completely unrecognizable." --C. William Hanson III, M.D., associate professor of anesthesia "Medical Miracles in Your Family's (Near) Future" Woman's World, 3/3 "It's not that we can't identify the ethical issues. It's that scientific advances move much more quickly than the political process and public education is able to carry them." --Arthur L. Caplan, Ph.D., director of Penn's Center for Bioethics "Call to Halt Using Animal Tissue in Man: Top Scientist Says Society Must Consider the Risks" USA Today, 1/22 "You've invested all this effort and you're not quite sure what's going to be waiting for you. So much is changing." --Cara Pellegrini, first-year medical student "Medical Schools Post 8.4 Percent Decline in Applications" The Wall Street Journal, 1/26 "It may sound kind of weird to say: the people we would turn away are the people who want it most." --Glenn McGee, Ph.D., assistant professor of bioethics for Penn's School of Medicine "Scientists Caution On Human Cloning" The Philadelphia Inquirer, 2/15 "Seed announcing that he wants to clone humans is like me announcing that I want to take a space launch to Mars." --Arthur L. Caplan, Ph.D., director of Penn's Center for Bioethics "Clone Scientist A Sea Of Calm Amid A Storm" Atlanta Journal-Constitution, 1/11 Return to index
	Snips & Clips MEDICATING KIDS. . . More and more parents are seeking help from their doctors--in the form of a pill--to treat undesirable behavior or depression in their kids. And docs are responding. According to The Philadelphia Inquirer, doctors prescribed antidepressants to 207,000 children between 6 and 12 years of age last year, a 43 percent increase over 1996. Doctors also prescribed antidepressants to 702,000 13 to 18-year-olds. According to Sara Kinsman, M.D., adolescent-medicine professor at the Children's Hospital of Philadelphia and a faculty associate at Penn's Center for Bioethics, the high cost of these drugs prohibits poorer families from using them, a situation Kinsman deems unfair. Kinsman also expressed concern for the long-term effects of antidepressant use in children. "We don't tell parents enough [about what] we don't know," said Kinsman. "We think these drugs are fine, but we don't know yet." Printed January 18. TESTING THE GLUE. . . A scientific advisory panel recommended that the Food and Drug Administration approve a new medical glue for closing wounds. The new glue, painless to use, would also reduce scarring, which stitches and staples tend to leave. "The addition of tissue adhesives should prove a rapid, painless alternative to sutures for one-third of patients" treated in emergency rooms, said Judd Hollander, M.D., quoted in The New York Times. Hollander, associate professor of emergency medicine at Penn, tested the glue, known as DermaBond. The glue, which is only for skin-deep cuts, is a chemical similar to that used to make Super Glue. Appeared January 31. INHERITING HAIR LOSS. . . Angela Christiano, M.D., of Columbia-Presbyterian Medical Center in New York, recently identified the first human gene ever linked to hair loss. The genetic defect causes a rare disorder, not common baldness. Still, the newly identified gene appears to play a critical role in the formation of hair, and understanding its function may help scientists devise better ways to prevent and treat various forms of baldness. George Cotsarelis, M.D., director of the hair and scalp clinic and assistant professor of dermatology, called the study "a beautiful piece of work." It could provide important information about factors that control the growth of hair and hair loss, he told The New York Times. Printed January 30. ‘TIS THE SEASON. . . What should you do if you indulged in a few too many treats during the holidays and put on some pounds? That was the question posed to David Sarwer, M.D., of the Center for Human Appearance, on WCAU-TV's News 10 Today. Recognize that special occasions can disrupt your diet, and set a reasonable weight-loss goal, said Sarwer. "Think about trying to lose one to two pounds a week... as opposed to thinking you need to have it all off by Friday." And try to plan ahead for those special events. "If you have a birthday coming up in the next couple of days or in the next week, you're going to your favorite restaurant, you're going to want to enjoy that meal and maybe order your favorite dessert. A good strategy, then is to reduce the amount of calories that you eat for lunch that day to save room for dessert." Aired January 6. WHAT TO EAT. . . Should diet be used to help treat incurable cancers? No, said Kevin Fox, M.D., assistant director of clinical affairs for the University of Pennsylvania Cancer Center, in The Washington Post. "Fatty foods are often the best tasting, and with twice the energy content of carbohydrates, they are the easiest way to obtain calories," he said. "For that reason, I consider it inhumane to impose dietary restrictions that are inherently less palatable and detract from the overall quality of life during the final months. Such diets, low in fat and thus in calories, probably hasten the onset and advance of disability," he added. Printed February 24. SKIN TIPS. . . Woman's Day asked "top women doctors" to share their advice for keeping healthy. Cynthia Guzzo, M.D., associate professor of dermatology, told the magazine that the biggest misconception her patients have is that it's safe to tan. "Tanning is a reaction to sun exposure, which damages the skin." Check your skin monthly for new moles or changes in existing moles, she added, which could be early signs of skin cancer. If you find moles that are larger than a pencil's eraser, with asymmetrical, irregular borders or bleeding, crusting, or changes in color, go to your dermatologist, she advised. Printed February 1. LIFE AFTER CANCER. . . A study of women treated for ovarian cancer at Memorial Sloan-Kettering Cancer Center in New York found that patients who show no sign of cancer after initial surgery, chemotherapy, and a follow-up exploratory procedure have an overall survival rate of 51 percent after 10 years. The odds improve dramatically for women whose cancer was caught early. "What's new about this is the long-term follow-up," Stephen C. Rubin, M.D., professor of obstetrics and gynecology, told USA Today. "Now we know there's little recurrence of ovarian cancer between five and 10 years" after the follow-up surgery, a standard second-look procedure done after the completion of chemotherapy. Printed February 9. ANTIBIOTIC OVERUSE. . . Rocephin, an injectable antibiotic that has been on the market for 13 years, can now officially be used for treating ear infections—or acute otitis media— in children. But Rocephin also works well against serious infections, including meningitis, so many doctors worry that using the drug frequently for ear infections could lead to the development of resistant bacteria and ultimately render it and kindred drugs useless. Paul Offit, M.D., associate professor of pediatrics, estimates that only three of every 10 children diagnosed with ear infections actually have them. "Otitis media is one of several reasons why children get antibiotics they don't need," he told The Philadelphia Inquirer. Printed February 2. BRAVE NEW WORLD?. . . "Lots of people are frightened by the idea that with widespread genetic testing, we may be able to see our own futures," said Arthur Caplan, Ph.D., director of the Center for Bioethics, in the Utne Reader. What's more, "the idea that genetic information would be made widely available lends fire to Big Brother conspiracy theories." According to Caplan, the best way to address such fears is to weigh them against the lessons of history—for example, the Tuskegee Experiment, in which the U.S. Public Health Service allowed a group of African American men to harbor untreated syphilis for 40 years. "If we remember this, we will agitate now for laws that protect genetic privacy in the future. With forethought, we can make technology work for instead of against us." Printed in the January-February issue. BIG GIFT. . . In December, Leonard and Madlyn Abramson pledged $100 million to the University of Pennsylvania Cancer Center to establish the Leonard and Madlyn Abramson Family Cancer Research Institute. According to John H. Glick, M.D., director of the Cancer Center, the money will be used to attract top people in the field of research and to expand clinical staff and programs. "Cancer is many times curable," he told the Philadelphia Business Journal. "We want to get as many people as possible every chance for a cure. When that is not possible, we want to increase their survival and quality of life." He characterized the Abramson gift as "an unprecedented act of philanthropy that will offer an increase in the number of cures." Printed in the January 30-February 5 issue. WHY SUFFER?. . . Experts have identified over 150 symptoms of premenstrual syndrome. Anxiety, fatigue, cramps, headacheS, backaches, food cravings, and crying spells are familiar monthly complaints for a large number of women of childbearing age, many of whom do not realize that help is readily available. Over-the-counter medications such as acetaminophen and ibuprofen are helpful to many women, as are mild diuretics and antihistamines. And many women are now finding relief by taking anxiety medications or selective serotonin reuptake inhibitors. "For years, women were told that PMS was in their heads," Ellen W. Freeman, Ph.D., director of research at Penn's Premenstrual Syndrome Program, told American Woman. "We now know it's a real medical condition that can be treated." Printed in the March issue. Return to index
	MEDIA Review April, 1998 Linda Bird Randolph, Editor Roshonda Jones, Marion Wyce, 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