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Obesity: Another Thing to Blame on Your
Mother
"There is no love sincerer than the love of food."
- George Bernard Shaw
Researchers may have more evidence that points to the theory
that obesity may be the result of bum genes, and not simply
overeating. A study of 79 babies conducted by Robert I.
Berkowitz, MD, assistant professor of psychiatry at
Philadelphia Child Guidance Center, and his colleagues, showed
that babies with overweight mothers fed much more "vigorously"
from computer-wired bottles than those with normal weight mothers.
On average, the babies of the overweight mothers consumed 20
percent more formula, and by age one, the same infants had put on
more weight.
It has long been known that heavier people tend to have heavier
children, but the old-school theory was that this was because
children picked up unhealthy eating and exercise habits from their
parents. But Berkowitz's study on babies as young as three months
challenges that theory because the babies were too young to have
been influenced by their parents' habits. The ultimate goal of the
study, Berkowitz said, was to find an early warning signal of
obesity.
The articles were published starting on October 14 with
facilitation from the Media Relations staff.
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NATIONAL
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Los Angeles Times
Philadelphia Inquirer
Sun-Sentinel
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Thalidomide May Make a Comeback
Thalidomide, the drug that was widely prescribed in the 1950s
and later found to cause serious birth defects--most notably,
gross deformities of the limbs--may be useful to AIDS and cancer
patients. Researchers have found that the drug may alleviate
AIDS-related conditions, such as mouth ulcers and severe weight
loss. It may also be useful in the treatment of glaucoma, lupus,
leprosy, Crohn's disease, and other ailments. The drug has been
used abroad for years in treating leprosy in Mexico, the
Philippines, South America, and Asia.
Originally prescribed as a sedative and anti-nausea drug,
thalidomide appears to work by suppressing the body's production
of "tumor necrosis factor," a hormone that controls the
immune system and helps fight infection.
A Food and Drug Administration panel met in early November to
discuss the pros and cons of licensing thalidomide. Two small
companies--Andrulis Pharmaceuticals and Cellgene-- are competing
to manufacture the medicine for sale in the United States.
"It is excruciatingly ironic that thalidomide--a drug that
triggered a host of protections that govern drug research and
regulation--should return," said Arthur L. Caplan, PhD,
director of Penn's Center for Bioethics. "Nonetheless, if
there is a benefit associated with a drug, you shouldn't hold its
history against it."
Caplan's comments appeared in a syndicated article published
November 7.
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No Pain, More Gain: A Case for Pre-Op
Painkillers
Penn researchers have found that pain medicine given before
surgery may reduce post-surgery pain. Typically, anesthesiologists
give pain medicine when surgery is nearly or just completed.
At a convention of the American Society of Anesthesiologists,
Allan Gottschalk, MD, assistant professor of anesthesia,
spoke on the theory that pain "winds up" nerves, making
them more sensitive. "If you stub your toe, portions of the
foot might hurt for days because the blow sensitizes that part of
the nervous system," Gottschalk said. "The same thing
happens after surgery."
Gottschalk studied 90 men who were having their prostate glands
removed because of cancer. They were divided into three groups:
two experimental groups received different painkillers both before
and after surgery, and a third control group received painkillers
only after surgery. Those in the control group reported
significantly more pain than those in the two experimental groups.
Gottschalk also studied the long-term effects of the combination
of pre-surgery and post-surgery painkillers versus only
post-surgery painkillers. At intervals of 3 2, 5 2, and 9 2 weeks
after discharge, the men were telephoned and asked about their
pain. During the first two phone calls, the men reported little
difference in pain, but at 9 2 weeks, 81 percent of the
experimental group was feeling no pain and had returned to work
and other activities. Only 44 percent of the control group was
pain-free.
"If the results from the study [replicate] in future
studies, it may cause us to think very hard about what our
standard level of care is," Gottschalk told NBC's Today
show.
Print and broadcast accounts began October 21.
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New York Times
Philadelphia Daily News
CBS Up To The Minute
Los Angeles Times
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Experimenting on Patients Who Cannot
Consent
Is it ethical for physicians to perform medical experiments on
patients who are unable to give their consent? The debate has been
waged for decades, and until recently, such experimentation was
illegal. But on September 26, the Food and Drug Administration and
the National Institutes of Health jointly ruled that some medical
research can be conducted under strict guidelines on uninformed
patients.
The current medical standards requiring that physicians give
full disclosure of potential risks and obtain consent date back to
the post-World War II Nuremberg trials of Nazi doctors, when it
was clearly established that no human should ever be forced to
take part in an experiment.
Arthur L. Caplan, PhD, director of Penn's Center for
Bioethics, was asked by several news outlets to explain the pros
and cons of the new ruling, which would allow institutional review
boards to give approval for experimental treatment in
circumstances where patients are not able to provide informed
consent. On CBS's Up To The Minute, Caplan illustrated a
positive way the ruling could work.
"Let's say you were out in the woods and you ate a bad
mushroom and you were rushed to the hospital," he said. "The
doctors might say, 'We don't have a cure for that... but we've got
a guy who's been trying out a drug on rats given the same kind of
poisonous substance. Maybe it'll work on this person.'" Under
the new rules, Caplan said, the experimental antidote could be
given without permission, possibly saving a life.
The program aired November 7.
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Science
Business Week
Harrisburg Evening News
Los Angeles Daily News
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How Chicks May Hold the Key
Human hearing loss is often the result of damage to the cochlear
hair cells that are responsible for converting sound waves into
electronic signals for transmission to the brain. Until recently,
it was believed that this damage--a factor that accounts for about
60 percent of the hearing loss suffered by 28 million
Americans--was not treatable. But researchers at Penn have
identified a cellular mechanism that permits regeneration of hair
cells in the cochleas of chicks, which may have implications for
treating this form of hearing impairment.
In the October issue of the Journal of Nature Medicine,
J. Carl Oberholtzer, MD, assistant professor of pathology
and laboratory medicine, and his associates, reported that, in the
cochleas of chicks, new hair cells grow around damaged ones. Their
study indicated the involvement of cyclic AMP--an intercellular
chemical that transmits and amplifies other signals that seem to
induce the proliferation of hair cells. Oberholtzer warned that it
is too early to predict a strategy for development of therapies
for humans. It will first be necessary to determine whether the
same pathway is involved in mammals, but, he added, "it will
change the direction of research."
Print and broadcast accounts began October 1.
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America Online |
HUP Emergency Department--Online!
Recently, netsurfers were able to take a close look inside the
Emergency Department at the Hospital of the University of
Pennsylvania by simply clicking their mouses. The America Online
segment, entitled "ER Watch," featured HUP's Mike
Fiedler, RN, Jean Marie Perrone, MD, and Francis DeRoos, MD,
in action. The players were shown on a busy night in the ED in
which they treated patients for ailments such as acetaminophen
poisoning, twisted ankles, and abdominal pain. The physicians and
nurse talked about what it is like to work in a busy emergency
department and also gave some tips on how to know when a trip to
an ER is appropriate.
"Some people hate their jobs, but I go to work happy each
day," Fiedler told Health Ink Communications, who developed "ER
Watch." Fiedler talked of the satisfaction he gets out of
helping patients from all walks of life: "Cut us all open,
we're the same. Nobody knows better than us that everybody bleeds
red. You treat patients as human and don't get judgmental. We have
to work to remember that what may seem minor to us can be very
major to a patient."
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Longer Life for Genetic Ovarian Cancer
Patients
Researchers have found that patients who carry the BRCA1 gene
and develop ovarian cancer live longer by an average of about four
years than those who do not carry the gene.
"It raises a lot of interesting questions as to whether we
should treat these cancer patients differently," said Stephen
C. Rubin, MD, professor of obstetrics and gynecology and
director of gynecologic oncology at Penn.
Rubin and his colleagues tracked 53 women with ovarian cancer
and the defective gene. Those with the bad gene lived an average
of six years after diagnosis, compared with about two years for
others. A study comparing the two groups was published in The
New England Journal of Medicine in early November.
"It's hard to find much encouraging when talking about
this, but women who get these cancers can be a little bit
encouraged that their outlook is better than that for the typical
ovarian cancer patient," said Rubin.
Numerous reports were published beginning November 6 with
facilitation by the Media Relations staff.
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Gulf War Syndrome Theories
The debate continues about what is causing illnesses in large
numbers of American troops who served in the Persian Gulf War. 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.
The presidential panel formed in 1995 to study reports of
chronic illness and the government's response to them recently
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.
Arthur L. Caplan, PhD, director of Penn's Center for
Bioethics, and a member of the Presidential Advisory Committee on
Gulf War Veterans' Illnesses, told The New York Times that
the Pentagon's efforts to "collect, present, and disseminate
crucial information has been, at best, wanting." He added, "there's
been an explosion of doubt and second-guessing and distrust"
of the Pentagon.
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Philadelphia Inquirer
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Overweight Now in the Majority
For the first time in history, the number of overweight
Americans outnumbers those of normal weight, according to
statistics released by the National Center for Health Statistics
(HCHS). Defining overweight as having a body mass index (BMI) over
25, the center revealed that 59 percent of men and 49 percent of
women have BMIs over that level. The statistics were based on
surveys of 30,000 people between 1991 and 1994. Ten years earlier,
51 percent of men and 41 percent of women had high BMIs.
Katherine Flegal, of the NCHS, theorized that the gain has to do
with a combination of too much television and a fear of crime,
which keeps people inside and on their couches.
Albert J. Stunkard, MD, professor emeritus of
psychiatry, had a simpler explanation. "It's just eating too
much. Physical activity hasn't increased enough to make up for it."
The data, which was presented at a meeting of the North American
Association for the Study of Obesity, also showed that people in
their 50s are most likely to have high BMIs: 73 percent of men and
64 percent of women in that group have BMIs over 25.
Print and broadcast reports began October 16 with facilitation
by the Media Relations staff.
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Dallas Morning News
New York Times
Times News
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Stroke Patients Fare Better With
Neurologist Care
According to a study published in the November issue of Stroke,
elderly patients are more likely to survive a stroke if treated by
neurologists instead of their family physicians. Death rates
during the first 90 days after a stroke were 36 percent lower for
patients treated by neurologists; however, costs were higher.
Ninety days of care for stroke victims treated by a neurologist
averaged $15,919, versus $11,838 for those treated by their family
physicians. The study was based on hospital records for 38,612
Medicare patients over 65 treated at U.S. hospitals for strokes
caused by blood clots.
Alan L. Hillman, MD, associate professor of medicine and
director of Penn's Leonard Davis Institute's Center for Health
Policy, said that, despite the finding that neurologists' patients
have better survival rates, "people should not use this paper
as a rationale for 'the more we spend, the better we do.'" He
added that the study failed to report the patients' conditions
after the three-month study period. If the more costly
neurological care is simply buying more time for seriously ill
patients, "I don't think that's a good use of money,"
Hillman said.
The syndicated article first appeared November 5 with
facilitation by the Media Relations staff.
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LOCAL
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Philadelphia Business Journal
Philadelphia Inquirer
Republican
The Phoenix
Times-Herald
Daily/Sunday Local News
The Intelligencer
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The Phoenixville Merger
In late October, Phoenixville Hospital signed a letter of intent
to merge with the University of Pennsylvania Health System by the
spring of 1997. Since 1994, the hospital has had a contractual
affiliation with the System, and has collaborated on certain
clinical and educational endeavors. The new agreement will involve
a transfer of ownership of the hospital to the System, under which
the hospital will have a board of trustees consisting of four
voting members from the Health System and seven advisory members
from the Phoenixville area.
"A formal merger is a logical next step in what has already
been a mutually beneficial relationship between Phoenixville and
Penn," said William N. Kelley, MD, chief executive
officer of the University of Pennsylvania Medical Center and
Health System and dean of the School of Medicine.
Phoenixville Hospital is a 140-bed institution that annually
treats about 6,000 inpatients and 105,000 outpatients, receives
16,000 emergency room visits, and delivers more than 1,400 babies.
Phoenixville has been a member of the University of Pennsylvania
Cancer Network since 1991, and 40 of Phoenixville Hospital's 64
primary-care physicians belong to Clinical Care Associates, the
System's network of primary-care physicians.
News accounts began October 31.
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Philadelphia Inquirer |
The Tribulations of Drug Trials
Scientists are familiar with the many hoops they must jump
through to get an experimental drug approved for human trials. A
recent article that appeared in The Philadelphia Inquirer
followed researchers at the Institute for Human Gene Therapy as
they sought approval from the Food and Drug Administration to
start human trials on a revolutionary gene therapy drug that
offered much promise to infants born with a very deadly inherited
liver disease.
When James M. Wilson, MD, PhD, chair of molecular and
cellular engineering, and director of the Institute for Human Gene
Therapy, became aware of the drug's potential, he guessed it would
take six months before clinical trials could begin. As it turned
out, it took 18 months before Wilson and his associate, Mark
L. Batshaw, MD, physician-in-chief at the Children's Seashore
House, were allowed to start.
The drug they worked to push through the regulatory maze is
designed to fight ornithine transcarbamylase (OTC) deficiency, a
disorder of the urea cycles that strikes about 100 infants a year,
and kills about half of them within a week of birth.
The article appeared October 25.
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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:
"It is particularly devastating to find medicine and science
playing such central roles in the events leading up to the Holocaust
as enthusiastic participants."
Symposium Explores Role of Doctors in the Holocaust
Jewish Exponent, 10/10
"We need a sort of Cadillac out there with a large V-8 engine.
What we've created now after a whole lot of wrangling is kind of a
Yugo. And I'm happy to see someone take a ride in that little vehicle,
but I hope it isn't the last word in terms of what the president or
Congress thinks we need with respect to these tough bioethics
questions."
The National Bioethics Advisory Commission
National Public Radio, 10/4
"It makes no sense to take someone who is unconscious and say,
`No one can do any research to try to save him.'"
U. S. Drops Barrier to Treatment of Comatose
Los Angeles Times, 9/27
"I am all for President Clinton's effort to wage war on tobacco
in order to protect children. But, evaluating prospective parents on
the basis of smoking takes the war into places where it should not be
fought."
Are Smokers So Odious They Shouldn't Adopt?
The Philadelphia Inquirer, 10/31
"Public understanding of genetic information is in its infancy.
I'd be surprised if five percent of the population knows the
difference between a gene and a chromosome."
Genetic Research Raising New Questions
Courier-Post, 10/21
"Now that the court has gotten involved, all these issues are
going to move to center stage. We're going to have a yearlong national
seminar on dying and assisted suicide."
Supreme Court to Decide Issue of Right to Die
Los Angeles Times, 10/2
"My own opposition has been, and remains, the slippery-slope
fear... Let nobody think that this is an argument about putting to
death people with cancer. That will last about five minutes. Then it
will move to, `I don't want to live with Alzheimer's disease. I'm not
terminally ill, but by the time I am, I will not be able to ask for
help in dying.'"
Concerns Grow That Doctor-Assisted Suicide Would
Leave the Powerless Vulnerable
The New York Times, 10/20
SNIPS & CLIPS
HEALING THE ANGRY
HEART. . . Irving Herling, MD, associate professor of
medicine and director of consultative cardiology, appeared on
KYW-TV's News 3 This Morning to comment on a recent Harvard study
that revealed that men prone to angry outbursts were two to three times
more likely to have heart attacks than more relaxed men. "The
people who had more attacks of anger tended to be heavier, tended to
smoke, tended to drink more, so in general, their entire personality was
a high stress, type A personality." Is the solution to hold all of
that anger in? Not exactly, said Herling, who prescribed a healthier
lifestyle: "Lose weight, exercise... people who exercise tend to be
less strung out emotionally." Aired 10/31.
DEPRESSION IN THE TWILIGHT YEARS. . . While some people may
consider depression in the elderly a normal part of aging, nothing
could be further from the truth. Depression, characterized by
sleeplessness, inability to concentrate, social withdrawal, crying,
and lack of energy, can be treated; and quality of life can be
dramatically improved in those who exhibit the symptoms. Ira Katz,
MD, professor of psychiatry at the Veterans Medical Center and
medical director of geriatric psychiatry at Penn, told The
Washington Post, "I think the reasonable place to start
is with the primary care doctor, who would look for side effects of
medication that might be the cause of the depression." Katz
stressed that "depression is absolutely not the same thing as
senility." Many seniors may seem reluctant to seek care because
of the stigma once attached to seeking mental health care. Printed
10/22.
THE BREAST CANCER WAR. . . Physicians may soon have a new
and better way to detect breast tumors. According to the Washington
Post, University of Pennsylvania researchers have been awarded
over $1.9 million from the Department of Health and Human Services to
research how military technology used to detect missiles in the sky
can be used to scan breasts for tumors. Mammography, which has been
credited with detecting millions of cases of early breast cancer over
the 40 years it has been used, still misses some tumors and cannot
distinguish between cancerous and benign growths. Printed 10/2.
ONCOLINK'S SUCCESS. . . OncoLink, the University of
Pennsylvania's Cancer Center's information site, is hugely popular
among Internet users, with the site being tapped about 1.2 million
times a month by people in 75 countries. And now the site has been
recognized for its achievement by being named one of 60 finalists in
the 1996 National Information Infrastructure Awards Program.
According to Your Health, the site appeals to cancer
patients and their families, who typically have a thirst for knowledge
about their diagnosis and managing their disease. This year, the site
has provided up-to-the minute coverage of the American Society of
Clinical Oncology's annual meeting. Visitors can also see the "Confronting
Cancer Through Art" exhibit in a virtual gallery. Printed 11/26.
PENN ADDS SECOND HELICOPTER. . . The University of
Pennsylvania Medical Center added a second helicopter to its PENNSTAR
flight program in October, making it the first medical center in the
Philadelphia region to operate two aircrafts. The new chopper will be
based in Montgomery County, and will support the original helicopter
based at the medical center. C. William Schwab, MD, chief of
traumatology and surgical critical care, told the Philadelphia
Business Journal, "Having the second aircraft will enable us
to dramatically decrease the response time to patients who require the
specialized care of a trauma center." Unlike ground-based
ambulances, PENNSTAR carries units of blood, and its nurses and
paramedics can administer more advanced drug therapies. The PENNSTAR
program has flown more than 4,500 patients since its inception in
1988. Printed 10/18.
SLAVES TO THEIR SCALES. . . Many women weigh themselves
every day, and some become so obsessed that a gain as little as
one-half a pound can put a damper on the mood for the day. But is a
scale a valuable tool in weight management? "The scale is a rough
gauge of body composition, and we know that if you're more than 30
percent overweight you have a higher risk of things like early heart
attack or stroke," Thomas Wadden, PhD, professor of
psychology in psychiatry and director of the Weight and Eating
Disorders Program, told Elle magazine. He added that some
women rationalize that extra weight that shows up on the scale is the
result of weight training. However, he said, "muscle mass might
increase weight by a pound or two, but not five or six... There's a
lot of room for rationalization." Printed in the October issue.
NEW OPTIONS FOR MOMS-TO-BE. . . For years, expectant moms
who wanted to check for inherited abnormalities in their babies had to
chose either amniocentesis or chorionic villus sampling, procedures
that involve extracting material from the uterus. Now, a new,
non-invasive test of the mother's blood developed at the Howard Hughes
Medical Institute appears to detect sickle-cell anemia and beta
thalassanemia, and offers promise of detecting single-gene disorders
such as cystic fibrosis. "This is an exciting and intriguing
observation," Mark A. Morgan, MD, associate professor of
obstetrics and gynecology and director of obstetrics and
maternal-fetal medicine, told the Sacramento Bee. He added
that because the test is so sophisticated, it will be awhile before
physicians will be able to use it. Printed 11/1.
LIMBER UP WITH EXERCISE. . . Many older people with chronic
orthopaedic problems avoid exercise because they fear it will make
their conditions worse. But experts know that moderate exercise and
stretching can reduce pain, improve mobility, and improve arthritic
joints. Nicholas A. DiNubile, MD, assistant professor of
orthopaedic surgery, told The New York Times that he suggests
swimming or walking in a pool as ideal exercise for arthritis
sufferers. Water exercise is a "non-impact and non-weight bearing
activity that does not place a lot of pressure on arthritic joints,"
DiNubile said. The surgeon also recommends that patients graduate to
walking, cycling, and stretching exercises. Printed 10/16.
THE ANCIENT ART OF ACUPUNCTURE. . . Acupuncture, which is
growing in popularity in the United States, appears to cause
pain-relieving changes in the brain that can be documented
scientifically, reported The Washington Post in its coverage
of the conference of the American Academy of Medical Acupuncture and
the National Institute on Drug Abuse. Abass Alavi, MD,
director of nuclear medicine and professor of radiology, presented
nuclear images of the brains of acupuncture patients. "We
measured cerebral blood flow before acupuncture treatment and
immediately after it," said P. David Mozley, MD,
assistant professor of radiology. "We found that they had
significant increased blood flow to the thalamus after treatment."
The scientists speculate that the insertion of needles and the
transmission of electrical currents causes the brain to release
endorphins. Printed 10/8.
NO NEED TO SUFFER. . . Those who suffer from chronic
pain--pain that lasts six months or longer--due to conditions such as
arthritis, back problems, and cancer, have an arsenal of treatments
available to them. On NBC's Today show, Michael Ferrante,
MD, associate professor, director of anesthesia for the Pain
Management Center, and director of the cancer pain and symptom
management program, explained some of the options. For example, for
cancer pain, there are three lines of treatment available:
nonsteroidal anti-inflammatory drugs, opioids, and finally, opioids
that have long term effects, such as methadone. The bottom line? "There
a number of noninvasive therapies that can be tried," Ferrante
said. "Stoicism really has no place, and I would really advocate
to people that, in 1996, they really should seek out help (for chronic
pain) because there really is no need to suffer." Aired 11/4.
RARE GIANT MOLES. . . Many people are born with small moles
that cause little immediate concern, but about one in a half million
are born with moles over eight inches in diameter. The large moles,
otherwise known as congenital nervi, are deemed rare birth defects and
have the potential to turn cancerous. "Birthmarks themselves are
not that uncommon, but birthmarks that are large are very rare,"
Allan Halpern, MD, assistant professor of dermatology and
codirector of the Pigmented Lesion Group, told the Sunday Review. "It's
very, very disconcerting to parents, both because of the cosmetic
implications and the potential risk." Printed 11/10.
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