December 1996

INTERNATIONAL

Breaking News Vancouver Province Reuters Pittsburgh Post-Gazette WPHL-TV17 NPR WHYY-FM   Muscular Dystrophy: Penn Advances Gene Therapy "The first rule of intelligent tinkering is to save all the parts." -Paul R. Ehrlich   News of an important step forward in the fight against muscular dystrophy by researchers at Penn's Institute for Human Gene Therapy was released on the eve of the annual Jerry Lewis Muscular Dystrophy Association Labor Day Telethon. Hansell H. Stedman, MD, assistant professor of surgery, elaborated on NPR's Talk of the Nation: "It's interesting to note that 10 years ago, almost to the day, there was a report in Nature describing the cloning of the gene that causes the predominant form of muscular dystrophy, known as the so-called Duchenne's muscular dystrophy form," he said. "And 10 years later I'm delighted to say that we have a paper coming out in [the October 1 issue of] the Journal of Human Gene Therapy describing, for the first time, the ability to put essentially the full length of that gene into a common cold virus that can now infect muscle and transfer the gene so that this protein, dystrophin, is made in the muscle that lacks dystrophin." Lead author Sarah Ehlen Haecker, PhD, postdoctoral researcher, and her colleagues, injected a dramatically stripped-down version of an adenovirus to ferry working constructs of the unusually large gene into the muscle cells of dystrophin-deficient mice. Within two weeks of the injection, between 30 and 40 percent of the muscle fibers in one experimental group produced the essential protein. Television, radio and print reports began August 29 in response to pitches made by the Media Relations staff.   NATIONAL Breaking News: UPI American Medical News WHDH-TV7 Boston WUSA-TV9 Washington KTLA-TV5 Los Angeles WPXI-TV11 Pittsburgh KUSA-TV9 Denver WKRC-TV12 Cincinnati KGTV-TV10 San Diego KYVK-TV3 Phoenix KING-TV5 Seattle WTVJ-TV6 Miami KCRA-TV3 Sacramento WFSB-TV3 Hartford CNN   Penn Investigation: Cleaning Agent For Dialyzers Questioned   Most kidney dialysis centers sterilize and reuse a filtering device called the dialyzer, a key component of the blood purifying treatment for patients with failed kidneys. But a report published by Penn researchers in the August 28 issue of the Journal of the American Medical Association indicates that patients at facilities using a combination of peracetic and acetic acid to clean the filter had a slightly shorter life span than those undergoing hemodialysis at clinics that didn't reuse dialyzers or used another chemical instead. "There is a small elevation in the rate of death among facilities using this mixture," author Harold I. Feldman, MD, assistant professor of medicine, told CNN viewers. Investigators studied nearly 28,000 patients with end-stage renal disease who began hemodialysis in 1986 and 1987, to evaluate the impact of dialyzer reuse on their survival. The authors found that in free-standing facilities using peracetic/acetic acid to clean dialysis equipment, death rates were eight percent higher than when formaldehyde was used. "My hope is that the impact [the study] will have initially is to encourage centers to re-examine their practices and help them to ensure that they adhere to the best-known standards currently available for implementing dialytic reprocessing," he said on Washington's Eyewitness News. Nationwide coverage began August 27 with facilitation by the Media Relations staff.   Breaking News: Associated Press Reuters Scripps Howard USA Today New York Times Wall Street Journal Boston Globe Atlanta Journal Chicago Tribune Minneapolis Star Tribune Philadelphia Inquirer Ft. Lauderdale Sun-Sentinel Allentown Morning Call WHDH-TV7 Boston   Doubts Raised: Safety Of Obesity Drug & Editorial, Too   An international group of researchers - writing in the August 29 issue of The New England Journal of Medicine - say that people taking appetite suppressants, such as the new prescription Redux, are at an increased risk of developing a rare, but often fatal, lung disorder. The research team found those taking fenfluramine or dexfenfluramine for more than three months are 23 times more likely to develop primary pulmonary hypertension, a condition that can cause heart failure. In an accompanying editorial, JoAnn Mason of Harvard Medical School and Gerald A. Faich, MPH, adjunct professor of medicine, argue that despite the risk, the weight-loss drugs will prevent about 20 obesity-related deaths per year for every person who dies from the side effect of the medication. The journal, however, now says it should not have published the editorial because it discovered the authors had been paid consultants for the companies that market Redux. But was it a serious conflict of interest? "My views are mine,"Dr. Faich told the Associated Press. "I'm not going to change my medical and scientific views for 14 billable hours." According to The New York Times, the editor of the NEJM said that there had been a "genuine misunderstanding," acknowledging that the wording of the journal's standard request for disclosure could have been misleading. Print and broadcast accounts began August 28.   Wall Street Journal Pocono Record Harrisburg Patriot In Touch Radio Networks   Pain Treatment: Insurers Quibble Over Cost   Health-maintenance organizations and other insurers can be a real pain when it comes to their reluctance to cover the cost of pain treatment. And there's little relief in sight for doctors and patients who try to fight the system. F. Michael Ferrante, MD, associate professor of anesthesia and director of the Cancer Pain and Symptom Management Program, told The Wall Street Journal, "Managed care views pain as a big black hole in which they keep dumping money." When a 59-year-old woman came to HUP with fractured ribs, severe pain, and breathing difficulties, her physicians wanted to keep her hospitalized on an intravenous patient-controlled analgesic. According to C. William Schwab, MD, professor of surgery and chief of the division of traumatology and surgical critical care, the insurance representative told doctors to "send her home and give her opiates by mouth." The hospital decided to keep the woman for four more days, absorb the cost, and appeal the insurer's decision. "Good pain management is not only more humane, but also cost-effective, allowing patients to heal more quickly after accidents and surgery," said Ray H. d'Amours, MD, assistant professor of anesthesia and director of acute pain service. The syndicated article was first published August 20 with facilitation by the Media Relations staff.   New York Times Dallas Morning News Baltimore Sun Houston Chronicle Cleveland Plain Dealer Minneapolis Star Tribune CBS This Morning KTVT-TV11 Dallas KFMB-TV8 San Diego KCTV-TV5 Kansas City In Touch Radio Networks   PMS: Better Diagnosis & Treatment Of Age-Old Ill   The cause of premenstrual syndrome (PMS) continues to elude researchers, but better ways to diagnose and treat the disorder have emerged in the last 10 to 15 years, according to a New York Times report. "Now that there are proven ways to help women, physicians are paying more attention to patients with disruptive premenstrual symptoms," said Steven J. Sondheimer, MD, professor of obstetrics and gynecology and medical director of the PMS Program. Since there is no laboratory test to diagnose PMS, women are asked to chart their emotional and physical symptoms over a period of months. "The daily symptoms reports can document whether the symptoms are even related to the menstrual cycle in the way PMS symptoms are expected to be," Ellen W. Freeman, PhD, professor of obstetrics and gynecology and co-director of the program, told CBS This Morning viewers. Every woman with premenstrual symptoms can benefit from exercise, stress reduction and diet modifications. If these lifestyle changes do not provide enough relief, medications tailored to address specific problems such as breast pain, insomnia or depression may work. Dr. Sondheimer stressed that patients may need to try a few different drugs before they find one that is effective. The syndicated article first appeared August 28; the segment aired September 11 with facilitation by the Media Relations staff.   Associated Press New York Times Orange County Register Tampa Tribune Imperial Valley Press Baltimore Sun Philadelphia Daily News Jersey Journal Allentown Morning Call Reading Times York Daily Record WCAU-TV10 In Touch Radio Networks   Gene Therapy: New Drug Is A Turn-on   What if a gene, once it is added to cells, runs amok? How can it be dosage-controlled? This fundamental problem of gene therapy has been tackled by molecular biologists who have devised a "chemical dimmer switch" that successfully regulated the activity of a human gene implanted in mice. The strategy might one day mean pills instead of injections for people who take regular doses of proteins for such conditions as dwarfism, multiple sclerosis and diabetes. (Such proteins can't be taken as pills because they are destroyed by the digestive tract. The new strategy would allow the person's body to make the protein, using an implanted gene that turns on and off in response to a drug taken by mouth.) In an editorial in the September issue of Nature Medicine, where the study was reported, James M. Wilson, MD, PhD, director of Penn's Institute for Human Gene Therapy, called it "a pharmacologic rheostat for gene therapy." Dr. Wilson wrote that the work was "a shining example of the use of the fundamental concepts of biology to attack what may appear to be insurmountable problems." He told the Associated Press that the study marked the first time scientists have been able to implant a gene in a whole animal, rather than an egg, and then control how active it was. Numerous reports were published beginning August 29 with facilitation by the Media Relations staff.   Associated Press Dallas Morning News Houston Chronicle San Diego Union Tribune Rocky Mountain News Allentown Morning Call Observer-Reporter Beaver County Times   Fat Chance: Obesity Gene Linked To Emotions   There may be too many 'mays' when it comes to the latest research on the obesity gene (OB) shown to make mice fat: According to a preliminary study published by California researchers in the journal Molecular Psychiatry, the gene may put pounds on young women and may foster anxiety and depression, as well. The gene's effect on emotions may come from the chemical it uses to dampen appetite. Although the new study is the fourth published since May to suggest some kind of link, researchers have yet to prove that the human OB gene has the same effect, R. Arlen Price, PhD, associate professor of psychiatry and genetics, told the Associated Press. Dr. Price, who reported evidence that the OB gene might promote cases of extreme obesity in people, sid the new paper Awas intriguing, but its evidence weak," he said. "I think it's impossible to tell at this stage whether or not these findings will prove to be valid." In mice, the OB gene prompts fat cells to produce a hormone called leptin, which tells the brain how much fat the body has stored. Mice with defective OB genes become obese, but lose the excess weight if they're given leptin injections. The discovery made headlines because it offered the possibility of an effective treatment for obesity in people. Dr. Price's comments appeared in a syndicated article published September 15.     LOCAL Philadelphia Business Journal West Chester News   Healthy Relationships: UPHS & Suburban Hospitals   Chester County Hospital and Holy Redeemer Hospital are among the most efficient and profitable acute-care hospitals in suburban Philadelphia. Now, they can also be counted among the institutions associated with the University of Pennsylvania Health System. Chester County - already affiliated with Penn's Cancer Center - signed a cooperative agreement with the Health System in July; Holy Redeemer Health System signed a letter of intent to affiliate in September. Officials from each hospital stress that the agreements will not lead to a sale, acquisition or merger, but to strengthen each other's ability to compete. "We seek to affiliate with like-minded organizations who have a proven track record," said William N. Kelley, MD, CEO of the University of Pennsylvania Medical Center and Health System and Dean of the School of Medicine. The agreements - which expand Penn's ability to enter into negotiations with insurance and managed-care companies - will provide an opportunity to increase research and teaching programs and bring new services to the community. The articles were published September 13 and 24 with facilitation by the Media Relations staff.   Philadelphia Inquirer Jewish Exponent   The Holocaust: When Ethics Turned Evil   Medicine is still grappling with the standards of consent that are the legacy of 100,000 victims of Nazi medical atrocities. In an effort to shed light on that horrific history, as well as the issues surrounding new medical technologies - especially in the field of genetics - Penn's Center for Bioethics recently presented a symposium called "The Nazi Medical Trials: A Legacy of Horrors." The conference marked the 50th anniversary of the so-called "doctors' trial" at Nuremberg, in which 15 Nazi physicians were convicted of performing medical experiments on concentration-camp inmates. Much of the struggle to guard against cruel or unscientific medical experiments had its origins in the Nuremberg Code, which was drawn up to serve as an ethics guidepost for medical researchers. But "the issues raised in the doctors' trial continue to confront the world," Arthur L. Caplan, PhD, the center's director, told the Jewish Exponent. Informed consent is central to the doctrine of human experimentation, he said, but immoral experiments abound in American history. Features were printed September 30 and October 10 in response to pitches made by the Media Relations staff.   WTXF-TV29's Good Day Philadelphia   SAD: Lighten Up With A Light Box   Down in the dumps at summer's end? It may have more to do with the amount of daylight you're getting than with saying good-bye to the beach. As the days get shorter and there's less and less sunlight, your mood may be darkened by Seasonal Affective Disorder. "[SAD] is characterized usually by depressions that come on virtually every winter," explained Martin P. Szuba, MD, assistant professor of psychiatry. "If you notice that ... your energy starts to drop, your mood starts to drop, you're oversleeping, maybe overeating, you may start to question if you have this." There are a variety of medications that may be helpful - including anti-depressants and melatonin - but often, light therapy relieves the symptoms. "It's relatively simple," Dr. Szuba told viewers. "It involves sitting in front of a light box - that you can purchase or rent - for a half-hour or an hour every morning ... Within a couple of weeks, it usually starts to make people feel a lot better." Dr. Szuba's live interview aired September 20 with facilitation by the Media Relations staff.   WPVI-TV6 ECMO: A Life-Saving 'First' At HUP   The technology's not new. "What is new," medical reporter Anita Brikman told Action News viewers, "is the way it's being used at the University of Pennsylvania Medical Center." The treatment is called extracorporeal membrane oxygenation, or ECMO, a heart-lung bypass machine that has been a success story in treating newborns whose lungs aren't fully developed at birth. "The experience with adults was not nearly as encouraging, and use of ECMO for adult patients largely stopped in the United States in the late 1970s," said Trauma's Michael Shapiro, MD, assistant professor of surgery. Using a modified machine and an intense team approach, Dr. Shapiro and Harry L. Anderson, III, MD, assistant professor of surgery, tried the procedure on a risky adult patient who was in respiratory failure: A car radiator explosion had sent searing steam and antifreeze into 26-year-old Eric Andres' lungs. Four days on ECMO gave his lungs a chance to rest, and the healing process began. More than a month after the life-threatening accident, HUP's first ECMO patient went home in a limousine, provided by his grateful friends. The Health Check segment aired September 4 with facilitation by the Media Relations staff.     KYW-TV3 Itchin', Sniffin' & Sneezin': Fall Allergies Arrive   Nearly 375,000 people in Philadelphia suffer from seasonal allergies. To find out about the differences between summer and fall allergies, allergies and colds, and the latest medications, the Media Relations staff put Channel 3's Carol Erickson in touch with Burton Zweiman, MD, chief of allergy and immunology. People can be sensitive to a combination of allergens outdoors, and still others as they spend more time indoors, he said. Try to avoid being outside in the morning - or when it's windy - when pollen counts are at their highest. And to reduce indoor allergens, "keep it simple, synthetic, and hot temperature washable," Dr. Zweiman advised. You'll know it's not a cold if your symptoms include that itchy feeling: "People with allergies practically always have itching of the nose, the mouth, the eyes," he said. A number of new non-sedating antihistamines are available by prescription, but if you want to stick with over-the-counter medications, Dr. Zweiman suggested lowering the dosage or using them only when you're home, "so they won't interfere with driving or work." The segment aired September 29.   WTXF-TV29's Good Day Philadelphia     Prostate Cancer Week: News You Can Use   It's the No.1 cause of cancer in men - the second leading cause of cancer death - and efforts were under way during Prostate Cancer Week to increase awareness of the disease. "The numbers are staggering," S. Bruce Malkowicz, MD, co-director of urologic oncology, told Good Day Philadelphia viewers. "Over 300,000 cases are predicted for this year." Typically, there are very few symptoms until it's too late. "We don't have any cure for advanced disease right now," said Dr. Malkowicz. "There are ways we can palliate it; ways we can slow things down, but it's not easy to remove it once things have advanced." The key is early detection: "And awareness and getting regular physical examinations and the emergence of the PSA tests - which is prostate specific antigen," he said. "This simple blood test ... has become the most valid tumor marker in all of cancer biology." Dr. Malkowicz appeared on the program September 23 with facilitation by the Media Relations staff.   ISSUES & ANSWERS Reporters ask Arthur L. Caplan, PhD, director of the Center for Bioethics, for his opinion on an array of ethical issues. Here's a sampling of his recent responses:   "We're going to eat animals, we're going to hunt animals. This use is probably the most morally defensible reason, that I can think of, for which we sometimes must take the animal's life." Transplantation of Animal Organs Boston's WBZ-AM Radio, 9/20   "For doctors, the questions that such financial conflicts of interest generate are, do patients get adequate full disclosure of options or are you skewing how you present the facts because you have a financial stake in the treatment and you personally profit from it every time it's used?" ECT Experts' Ties To Shock Machine Industry The Washington Post, 9/24   "... If brain death is the same as death, then why are brain-dead people on life support and why would a brain-dead baby be able to 'live' another month? The answers have nothing to do with death and everything to do with human feelings." In America, Is It Possible To Die Twice? The Philadelphia Inquirer, 9/6   "Dr. Plows [chairman of the AMA's Council on Ethical and Judicial Affairs] is, if not standing in front of a steamroller, he's at least got a rapidly moving train headed straight at him." Medical Community Discusses Guidelines For Assisted Suicide Delaware State News, 9/26   "This is a good start. It breaks a tradition of five decades - that someone must consent. But, in cases when there is no time to get a surrogate, the only way you're going to improve the current treatments ... is to do this research." U.S. Drops Barrier To Treatment Of Comatose Los Angeles Times, 9/27   "The problem with many of these guarantee programs is that they're not promising that you'll take home a baby. They're promising a refund if you don't get pregnant. That's the small print." It's A Baby, Or It's Your Money Back The New York Times, 8/25   "You want to know the number [of live births], not the fact that somebody's offering a sale price or a prize in the Cracker Jack box." Fertility Clinics Offer Consumer Rebates MSNBC-TV, 8/27   This, from the Center for bioethics' Glenn McGee, PhD:   "Some ... vulnerable people may get lured into suicide when there are other answers. The fact that the Constitution provides for free speech does not mean it should be practiced without restraint." Finding Death On-Line: DeathNet Nature Medicine, September issue   SNIPS & SNIPS FAMILY MATTERS. . . Marjorie A. Bowman, MD, MPA, has been appointed the first chair of Penn's recently established department of family practice and community medicine. As noted in the Philadelphia Tribune and Physician's News Digest, she is president-elect of the North Carolina Academy of Family Physicians and president of the Society of Teachers of Family Medicine Foundation. Prior to her appointment, Dr. Bowman was chair of family and community medicine at Bowman Gray School of Medicine of Wake Forest University. Printed 9/20 and in the October issue.   UNFIT TO BE TRIED. . . Noting that there was "universal agreement" among those who had examined him that John E. du Pont was "actively psychotic," the judge ordered the multimillionaire murder suspect to Norristown State Hospital for treatment. "There's a 10 to 20 percent chance that [patients] will not respond to treatment," said Richard G. Petty, MD, clinical director of the schizophrenia unit, referring to people who suffer from paranoid schizophrenia and delusional disorders. "Usually, response to treatment in either of these disorders is six to eight weeks, and full response can take up to six months," he told The Philadelphia Inquirer. Printed 9/25.   BABY STEPS. . . Trying your darndest to start a family, but there's still no baby on the way? Before you ask for fertility drugs, find out if you've got a problem. Which tests to expect when you're not expecting depend on your medical history, the crucial first step in a thorough infertility evaluation. "You have to tailor the workup for each couple," Luigi Mastroianni, Jr., MD, director of the division of human reproduction, told Glamour. "The doctor shouldn't take a cookbook approach." Printed in the September issue.   SURF'S UP. . . According to the Los Angeles Times, the Internet's "premier cancer site" is OncoLink, maintained by the University of Pennsylvania Cancer Center. With more than 1 million hits monthly, http://oncolink.upenn.edu has provided valuable information to users in at least 75 countries. "The empowerment of patients is where OncoLink's getting its most utility," said co-editor in chief Ivor Benjamin, MD, assistant professor of obstetrics and gynecology. "Patients grappling with a new cancer diagnosis or a change in management have a thirst for knowledge. These patients are turning to the Internet in record numbers." Printed 9/30.   LUAUS vs. SUSHI. . . According to a report published in the Journal of the American Medical Association, Alzheimer's disease among men of Japanese ancestry is twice as common in Hawaii as it is in Japan, boosting the theory that environmental factors play a role in the development of the mind-robbing illness. "The most likely explanation - and I'm sure, one of the things they'll look at more closely - would do with diet," Christopher M. Clark, MD, director of the Memory Disorders Clinic, commented in a WTXF-TV29 interview. "I think it's a very important study, the beginning of a very important tool in trying to sort out the many causes of Alzheimer's disease." Aired 9/24.   SURVIVAL GUIDE. . . In a teenager's world, life is tough for boys who are shy or sensitive: Jocks get the glory and the girls. The best solution? "Hook up with other kids who like the things you do," Laura Sanchez, MD, assistant professor of psychiatry, told the teen column in the Philadelphia Daily News. It might seem "geeky" to wear your sensitivity on your sleeve, but Dr. Sanchez says it isn't healthy to hide the real you. If high school seems grim, try to keep your eyes on the shy-guy prize: the future. "Because you scored a touchdown in high school, that doesn't mean much when you're 25," she said. By that time, "you're valued for what type of person you are." Printed 9/17.   HARD DAY'S NIGHT. . . Despite opposition by the health insurance industry, President Clinton has signed legislation designed to end so-called "drive-through deliveries." The new law requires health plans to pay for hospital stays of at least 48 hours for normal deliveries and double that for cesarean deliveries. Michael T. Mennuti, MD, professor and chair of obstetrics and gynecology, told the Associated Press that he supports the measure "because it puts the decision back in the hands of the physician and mother." Syndicated 9/26.   JUST DO IT. . . A daily dose of exercise is good not only for the body, but also for the mind and spirit. American Fitness and Vibrant Life offered some great reasons to begin and maintain an exercise program, including one from Edward S. Cooper, MD, emeritus professor of medicine, that may not have occurred to you: Adults should exercise not only to benefit themselves, but to act as role models for their children. While it's never too late to start, Dr. Cooper stresses that it's important for people to begin exercising at an early age because America's young people are growing more heavy and less fit. Printed in the September/October issues.   KNOWING THE ODDS. . . As "one of the top tier researchers who are defining the genetic predisposition to breast cancer" and part of "a very small group both active in their research and active in the clinical environment", Barbara L. Weber, MD, director of the Cancer Risk Evaluation Program, is in a position to bring the most up-to-date scientific knowledge into the examining room. The geneticist, the subject of a lengthy profile in Inside Magazine, acknowledges that "it's difficult to tell people they carry this gene and have a high risk of developing cancer." But as a mom, she said, the hardest part is listening to the anguish of a mother who learns her children have inherited the defect. Printed in the Fall issue.   NEWS RADIO. . . About three out of four mothers-to-be have their contractions and baby's heart rate electronically monitored, but according to Parents Magazine, many women don't like being confined to bed the entire time they are in labor. Thanks to a technology called telemetry - which uses radio waves to transmit the monitor's readings to a video screen at the nurses station - fetal monitoring is now less confining at some hospitals. "Wires are attached to a small unit you can walk around with," explained Mark A. Morgan, MD, director of maternal-fetal medicine. Printed in the September issue.   GETTING THE MESSAGE. . . Neurotransmitters are at the core of the brain's communication network. Staggeringly complex, there may be more than 100 types and multiple systems of these messenger substances at work. As recently as 15 years ago, researchers thought one system - which includes dopamine, serotonin and other transmitters - worked with just one or two receptors. But molecular biology techniques keep turning up new dopamine receptors. "The number changes every week," Marc A. Dichter, MD, director of Penn's Epilepsy Center, told The Philadelphia Inquirer. And at last count, there were more than half a dozen serotonin receptors. "To make things more complicated, the same neurotransmitter can act in different ways, depending on what receptor it sees," Dr. Dichter added. Printed 9/9.   HOW 'BOUT A QUICKIE?. . . A new, unproven treatment for heroin withdrawal using naltrexone and anesthesia - touted as "painless one-day detox" - drew fire from Charles P. O'Brien, MD, professor and vice-chair of psychiatry. "It clearly costs more, it's clearly more risky, and there's no evidence in the literature that this is any more effective than other treatments out there," he told the Miami Herald. "Everybody's always looking for a quick fix, an easy way out. Addiction is a chronic disease ... It has to be continually managed and treated as such." Printed 9/19.