Media Review

   January 1998


INTERNATIONAL


Breaking News

The Lancet

Pittsburgh Post-Gazette

Fetal Echocardiography Web Site Helps With Detection of Congenital Heart Disease

"Knowledge is of two kinds: we know a subject ourselves, or we know where we can find information upon it."

-- Samuel Johnson

Fetal sonograms are used by many obstetricians to detect most forms of congenital heart disease. But a sonogram's effectiveness is only as good as the technician performing the exam. Many heart abnormalities go undetected due to the technician's lack of experience. In an effort to better teach physicians how to read and analyze echocardiographic data, researchers at the University of Pennsylvania Medical Center and The Children's Hospital of Philadelphia (CHOP) have developed the Fetal Echocardiography Homepage and the Fetal Echo Expert System.  

"Unless [defects] are obvious, many congenital heart abnormalities remain undetected," said Krzysztof P. Wroblewski, Ph.D., assistant professor of biochemistry and biophysics, in an interview with The Lancet.  

"The Homepage and Expert System are part of a multi-disciplinary project drawing on the combined expertise of biophysicists, cardiologists, and medical informatics specialists," Wroblewski said. It contains a library of typical views of normal and abnormal fetal hearts, as well as links to other fetal and neonatal cardiological and ultrasound-imaging sites. The Expert System is a computer program designed to help physicians, medical students, and technicians improve their skills at reading and analyzing fetal sonograms.  

In November, the website was highlighted at the 1997 Website World Conference -- a joint meeting between the Web Society and the Association for the Advancement of Computing Education -- in Toronto, Canada.  

Reports began November 5.


NATIONAL


Nation Public Radio

United Press International

ScienceNow

HIV Blocker Suggests New Therapies

Last year, scientists discovered several new receptors on the surface of immune-system cells that are required--along with the long-known CD4 receptor -- for HIV to enter and infect cells. And now, researchers at the University of Pennsylvania Medical Center and the University of Texas Branch of Galveston have identified a small molecule that blocks one of these so-called coreceptors, preventing infection by a number of the HIV strains that target T cells. These strains of the virus are associated with progression from relatively asymptomatic HIV infection to the disease AIDS.  

The discovery suggests that novel combination therapies that inhibit the full set of coreceptors could prove effective in preventing or treating HIV infection and AIDS. The findings were reported in the Journal of Experimental Medicine.  

Penn's group and two other research groups have found that a peptide compound called ALX40-4C blocks the CXCR4 receptor route of entry. When added to cultured cells, the molecule blocked infection.  

"The importance of these studies is that they provide proof of principle," said coauthor Robert W. Doms, M.D., Ph.D., assistant professor of pathology and laboratory medicine, in whose laboratory many of the experiments were conducted. "They show that we can develop small molecules to inhibit these newly identified coreceptors that HIV absolutely needs to get into cells, thus preventing infection."  

Reports began October 20.


Reuter's Health On-Line

ScienceNow

The Scientist

The Two Sides of Tobacco

Scientists have known for many years that nicotine is responsible for addiction to tobacco and that it interacts with acetylcholine receptors. They are now starting to realize that the many types of these receptors rule out a simple explanation for how nicotine behaves in the brain. By understanding the complicated interplay between nicotine and acetylcholine receptors, researchers may be able to develop nicotine-like drugs to treat such neurological disorders as Alzheimer's disease, Parkinson's disease, and chronic pain.  

Recent studies of acetylcholine receptors by investigators at the University of Pennsylvania Medical Center are shedding light on the molecular biology of dependence on, tolerance to, and withdrawal from nicotine. The researchers, led by Jon Lindstrom, Ph.D., professor of neuroscience, found that chronic exposure to concentrations of nicotine typical of that found in a smoker's blood first stimulates and then permanently inactivates the two most prominent subtypes of human acetylcholine receptors, alpha-4 and alpha-7, but affects a third type, alpha 3, much less.  

"This finding provides an appealing explanation for why chronic tobacco users become tolerant of levels of tobacco that would sicken the naive user," Lindstrom said. He added that habitual users become dependent on nicotine through the same neural reward pathways observed with cocaine and other addictive drugs.  

Reports began November 14.


Physician's News Digest

Philadelphia Tribune

Milwaukee Journal Sentinel

Morning Call (Allentown, PA)

Penn (Indiana University)

The Press (St. Mary's, PA)

The Eagle (Butler, PA)

Curriculum 2000: Still Attracting Attention

Curriculum 2000, the School of Medicine's revamping of medical education as we know it, has received much national media attention in recent months. The new curriculum shifts the focus away from curative medicine to preventive medicine and provides students with a thorough, well-rounded medical education. Students spend only about two hours a day in lecture-style classes, and the rest of their hours in "hands-on" or research formats.  

Students are "no longer curing, but caring," said Gail Morrison, M.D., vice dean of education and chief architect of the new curriculum.  

Morrison explained how, under the new curriculum, students will no longer study one component of health care in a vacuum. "For the cardiovascular system, as an example, you will start learning about the anatomy of the heart and then move into histology, then normal physiology, pathophysiology, specific drugs that affect pathophysiology, the infectious disease processes that can occur, the immunology in cancer. These are now horizontal themes that run through every single organ system. Following that, in the afternoon, you will see patients with specific diseases that you just heard about. You will see chest X-rays, you will see angiograms, you will have patients and families come in to talk about what it is like to be sick with heart disease."  

Reports appeared frequently throughout the summer and fall.


Morning Call (Allentown, PA)

Alzheimer's: A Disease That Can Devastate Spouses

Alzheimer's Disease is not suffered by patients alone. As the disease progresses, their caregivers, often spouses, find that caring for their loved one becomes a 24-hour, grueling job. Many caregivers report not getting enough sleep, not having time for their own activities, and feeling like they are on a non-stop treadmill.  

A discussion of these stresses was recently spurred by a murder/suicide of an elderly Bethlehem, Pa., couple. From all accounts, the husband, 79, and the wife, 76, were deeply committed to each other. But when the wife developed severe Alzheimer's and could no longer talk or recognize familiar faces or care for herself, her caregiver husband found himself overwhelmed. Yet he refused to put his wife in a nursing home. In October, he turned a gun on his wife and then on himself.  

"Alzheimer's may cause suffering in a broader sense, suffering the loss of self," said Arthur L. Caplan, Ph.D., director of the Center for Bioethics, in an interview with the Morning Call. "It doesn't hurt. It's arguably a state in which you are pleasantly demented. But it extracts a toll on others."  

And the effects are not just emotional. "There is also a terrible financial burden on people, just facing the prospect of going broke and being overwhelmed," Caplan said. "And we don't have a good system in this country so that everyone with dementia gets good, decent care."  

Caregivers of Alzheimer's patients need to know when to ask for help. Many community resources, such as adult day cares, support groups, and respite services, are available to them.  

The article appeared October 28.


San Jose Mercury News

Fox News Channel

WPVI-TV6

How Far Away is a Real Gattaca?

Will it soon be possible for parents to genetically-engineer their children? The recent release of the movie Gattaca had a lot of people wondering. In the science fiction thriller, parents are able to choose which traits they want their children to have, and which they do not. The genetically "perfect" children grow up to be part of an elite society, and naturally-conceived children are viewed as "invalids."  

Several University of Pennsylvania Medical Center experts spoke to various media about the concerns and dialogues the movie sparked. When asked how far away a Gattaca world is, Glenn McGee, Ph.D., assistant professor of bioethics for Penn's School of Medicine and senior fellow in health economics at Penn's Leonard Davis Institute, told WPVI-TV6 that "the tests that are in [Gattaca] are all tests that are right around the corner." McGee added that while we may want to eliminate disease through genetic testing and therapy, we don't know what we will do if we develop the ability to eliminate other human traits.  

Arthur L. Caplan, Ph.D., director of the Center for Bioethics, told the San Jose Mercury News that the timing of the movie was carefully planned. "When the culture says, 'We're afraid of genetics, we're afraid of what it might do,' that's real. Hollywood knows that and tries to play off of that. ... Just yammering about what Hollywood does is pointless. ... Use Gattaca as a tool to open up discussion."  

"I think we are definitely going too fast with genetic testing," said David Magnus, Ph.D., graduate studies director for the Center for Bioethics and associate professor of cellular and molecular engineering and philosophy, in a discussion that aired on the Fox News Channel. "There are a few laws that prohibit the use of embryonic research. ... There's a tendency for the public to sort of say, 'Yuck,' and they don't like it. And there's a tendency for politicians to respond to that very visceral response. However, we know that over time, people get used to technology, and those responses go away."  

Reports began October 22.


People

Bioethicist Art Caplan Featured in People

"When doctors need an ethics check, the bioethicist is in," read the subhead to a lengthy People magazine profile of Penn's own Arthur L. Caplan, Ph.D., director of the Center for Bioethics. The four-page article, complete with six photographs of Caplan at work and at home, discussed the ethical quandaries that Caplan deals with on a daily basis.  

The article highlighted some of Caplan's recent press-worthy cases, such as the case of a 27-year-old widow who wanted doctors to procure sperm for future insemination from her husband, who had died only hours before. The issue at hand was whether it was ethical to make a father in this manner of someone who obviously had no say in the decision. The couple had been trying for some time to have a baby, and Caplan concluded that this meant the man had given his consent to fatherhood before his death. After discussions with the widow, the hospital's attorney, and eight doctors, the widow's wish was granted.  

Also highlighted were Caplan's involvement in the Gulf War veterans' panel, his prior experience on the President's health-care panel, a mention of the 21 books he has edited, including a new one that came out in December, and his opinions on many popular bioethical issues.  

Caplan touched on the subject of experimental drugs and the morality of doctor-assisted suicide. These modern issues do not have cut and dry answers and solutions. "Most doctors want to do good," Caplan told People. "But they're human, and humans tend to be flawed."  

People magazine also surveyed many of Caplan's nearest and dearest, from his wife Jane to his fellow bioethicists, and asked about their experience with Caplan. "Art's the best in the world," said William N. Kelley, M.D., CEO of Penn's Health System and dean of the School of Medicine.  

The article appeared in the November 11 issue.


LOCAL


The Philadelphia Inquirer

Directing His Energy

As a child, he was tormented by symptoms of Attention-Deficit/Hyperactivity Disorder, or ADHD. But no one knew that at the time. Mark Batshaw, M.D., professor of pediatrics for Penn's School of Medicine and chief of child development and rehabilitation at The Children's Hospital of Philadelphia, had tons of energy -- so much that he had much difficulty sitting still in class and failed in reading and handwriting.  

Batshaw's story was the focus of the "Local Angle" column that appears weekly in Inquirer Magazine. According to Batshaw, the person who taught him that he had "what it takes" to be a doctor was his mother, who gave up her career to spend time making sure he understood his schoolwork. Under his mother's tutelage, Batshaw's grades began to improve, to the point where he was consistently earning straight A's throughout high school, college, and medical school.  

The article highlighted Batshaw's care with children with ADHD, which he said is a frustrating disorder because it's hard to nail down. "If you have pneumonia, you can take an X-ray and it shows you have it. ADHD is a diagnosis of a symptom. It's a combination of clinical findings."  

The magazine referred to Batshaw as "the Dr. Spock for parents of children with special needs." One of his books, Children With Disabilities, is considered required reading in the field.  

The article appeared in the October 12 issue.


Philadelphia Business Journal

Philadelphia Daily News

The Allegheny Aftermath

In October, Allegheny Health Education and Research Foundation announced the layoffs of 1,200 of its 20,000 area employees. And while the region adjusted to the news, local economists and experts were called upon to share their opinions about why the layoffs happened, what could have prevented them, and whether similar cutbacks are predicted for neighboring institutions. Many speculated that Allegheny's problems stemmed from its 1997 acquisition of the five local hospitals of the debt-plagued Graduate Health System.  

"In my opinion, Allegheny grew too big too fast," said Alan Hillman, M.D., M.B.A., director of the Center for Health Policy of the Leonard Davis Institute of Health Economics, in an interview with Philadelphia Business Journal. "As with any business, and we have to consider health care a business, when you grow too big too fast, you jeopardize your ability to properly manage the way things happen where the rubber hits the road. I think what happened here is a miscalculation by the strategic planning people and marketing people and the boss himself. They spent too much of their capital too quickly and did not accurately calculate the revenues from all of their acquisitions."  

When asked if he thought the layoffs were caused by the Graduate deal, Hillman said he could not be sure. "Without being on the inside, it's hard to know. But that was their last big acquisition."  

Some experts commented on how the cutbacks will impact patient care at the affected hospitals.  

"This is hazardous to the quality of care patients will receive," said Linda Aiken, R.N., Ph.D., S.A.A.N., professor of nursing and sociology and director of Penn's Center for Health Services and Policy Research, in an article in the Philadelphia Daily News. "This is a dangerous set of circumstances when you consider that lives are at stake."  

The reports appeared in mid-October.


The Philadelphia Inquirer

The Morning Call

The Express-Times

Joining Forces With St. Luke's

In mid-November, the University of Pennsylvania Health System and St. Luke's Hospital and Health Network of Bethlehem announced their agreement to cooperate in the areas of cancer and trauma care, as well as medical education. The 829-bed St. Luke's system will become a member of Penn's Cancer Network. C. William Schwab, M.D., chief of traumatology and surgical critical care, will help St. Luke's develop a new trauma center.  

Through the agreement, St. Luke's patients will have access to the expertise of Penn doctors and researchers, and less duplication of tests and paperwork involved in referrals. The University of Pennsylvania Health System will gain specialist referrals, and medical students and residents will gain valuable experience caring for patients in St. Luke's territory.  

"It brings our region access to unparalleled world-class research and renowned national specialists," said Richard Anderson, president and CEO of St. Luke's Hospital and Health Network.  

St. Luke's Hospital and Health Network includes 1,200 physicians, more than 3,500 employees, and operates hospitals in Bethlehem, Allentown, Quakertown, Palmerton, and Coaldale.  

Reports began November 12.


PERSPECTIVES


"This ad scared the 'bejeezus' out of people. They wondered if they could really call a 1-800 number and get Gattaca on the phone and order up a perfect baby."
--Glenn McGee, Ph.D., assistant professor of bioethics for Penn's School of Medicine and senior fellow in health economics at Penn's Leonard Davis Institute
Subject: The Movie Gattaca, in Which "Perfect" Babies Are Engineered
WPVI-TV6, 10/24
"I think Americans who try this untested combination of medications could lose a whole lot more than just a few pounds."
  --Thomas A. Wadden, Ph.D., professor of psychology in psychiatry and director of Penn's Weight and Eating Disorders Program
"Diet Drug Mania Lives On Despite Recall"
Investors' Business Daily, 11/3
"It's almost as if the pendulum has swung out and then back again."
  --Mark Woodland, M.D., acting chair of obstetrics and gynecology at Pennsylvania Hospital
"Caesarean Births Drop Under Managed Care"
The Philadelphia Inquirer, 10/25
"Do we really want tomatoes enhanced with chemically copied pig genes (and can Jews and Muslims eat them)?"
-- Paul Root Wolpe, Ph.D., assistant director of the Center for Bioethics "Bioresearch: Reflections in a Golden Age"
The Philadelphia Inquirer, 10/21
"It's a great relief to have a major teaching hospital back in the fold."
--William N. Kelley, M.D., CEO of Penn's Health System and dean of the School of Medicine
"Pennsylvania Hospital Officially Joins the Penn Health System"
Philadelphia Business Journal, 11/7-13
"Sure, it's natural. But then so is deadly nightshade. So is arsenic."
--Richard Petty, M.D., assistant professor of psychiatry
Subject: Taking St. John's Wort to Treat Depression
WCAU-TV10's News 10, 11/6


SNIPS & CLIPS


SLEEP AND AGE. . . Insomnia tends to worsen as we age. But why? "We don't really understand the reason, but something goes wrong with the sleep drive," said David Dinges, Ph.D., associate professor of psychology in psychiatry, in an interview with The Philadelphia Inquirer. "As we age, we produce less melatonin, which is believed by some to be the sleep hormone." Dinges added that environmental changes disturb sleep. And everyone should have a pre-sleep ritual to help them switch gears into the resting mode. Appeared in the November 14 issue.  

TRACKING DRUG REACTIONS. . . The Food and Drug Administration learns about adverse reactions to approved drugs mostly through reports from doctors. When patients experience adverse drug reactions, doctors are supposed to complete a form and send it to the FDA. But "most doctors don't know the system exists," Brian L. Strom, M.D., M.P.H., chair of biostatistics and epidemiology, told The New York Times. He and other physicians say a system that depends on health care workers, patients, and hospitals to notice and report adverse drug reactions is inadequate and out of date. Strom and others are calling for the establishment of an independent drug monitoring agency, paid for by the pharmaceutical industry, to systematically assess the safety of drugs once they reach the market. Printed October 7.  

NIGHTTIME EATING. . . Many obese people are light eaters during the day--skipping breakfast and consuming a light lunch. But at nighttime, their appetite switches into high gear. These are symptoms of Night Eating Syndrome, a condition that affects about 10 to 50 percent of obese people. "These people eat more than 50 percent of their food after supper," said Albert J. Stunkard, M.D., D.M., professor emeritus of psychiatry, in Woman's World magazine. "They also experience agitation and insomnia at night." Medications, including antidepressants, appear to help some people. So does planning social activities or exercise sessions in the evening and having relaxing rituals before bedtime. Appeared October 14.  

STICK IT TO ME. . . A panel of scientists at the National Institutes of Health agreed that acupuncture clearly works to treat a number of conditions, including nausea and vomiting after chemotherapy and surgery, the nausea of pregnancy, and post-operative dental pain. The panel's "consensus statement" recommends integrating acupuncture into standard medical practice, calls for further study into how acupuncture works, and urges Medicare, Medicaid, and private insurance companies to begin paying for acupuncture treatments. Marjorie Bowman, M.D., chair of the department of family practice and community medicine, served as an NIH panel member. "We did not find acupuncture a panacea," Bowman told The Philadelphia Inquirer. "But for chronic problems which have no good alternatives for treatment, acupuncture seems worth a try. There's very little downside, and there may be a gain." Printed November 6.  

KEEPING MEN HEALTHY. . . According to The Philadelphia Tribune, the Men's Health at Overbrook program was created to give men an opportunity to go to a medical facility and feel comfortable discussing their health. "In general, men particularly African-American men don't tend to access the health care system as much as they should," Harold Mignott, M.D., assistant professor of medicine and physician at Men's Health at Overbrook, told the Tribune. "We have a group of physicians who understand the issues of male patients, and can also make referrals to social workers who can assist with financial difficulties." Printed October 31.  

DID YOU KNOW?. . . "Sexual activity is a form of physical exercise," Michael Cirigliano, M.D., assistant professor of medicine, told Men's Health magazine. Each individual sex act isn't much exercise. But if you have sex three times a week, you'll burn about 7,500 calories a year the equivalent of jogging 75 miles. In addition to its aerobic benefits, sex offers a small amount of the benefits of resistance training. "During arousal and orgasm there is myotonia, or contraction, of the muscles," said Cirigliano. Printed in the November issue.  

SWITCHING GEARS. . . Preschoolers have a difficult time making the transition from one activity to the next. This is completely normal, according to Jerilynn Radcliffe, Ph.D., assistant professor of pediatrics and director of preschool assessment services at Children's Seashore House. Radcliffe told Parents magazine, "Three- and 4-year-olds are developing a greater sense of autonomy and becoming more committed to following their own interests. They're harder to distract at transition time than they used to be at age 2. ...They're passionate about what they do; they don't even want to stop to go to the bathroom." Radcliffe recommends giving children fair warning before asking them to switch activities, such as getting dressed or leaving a play group. Appeared in the November issue.    

TRANSPLANT ETHICS. . . Strict rules govern the sequence and circumstances under which organs from cadavers are distributed to patients requiring transplants. For organs from live donors, however, the process is less uniform. It is a federal felony to accept compensation for an organ, and transplant programs have designed procedures to determine whether the gift of a kidney or part of a pancreas, liver, or lung is truly voluntary. But hospital screening committees "aren't the cops," said Arthur Caplan, Ph.D., director of the Center for Bioethics. "You aren't ever going to get a system that (guarantees) people aren't being bullied, pressured or bought," he told the San Jose Mercury News. Printed October 21.  

BELIEVE IT, OR NOT?. . . When Craig Rabinowitz pleaded guilty to murder, he claimed that a dream had motivated him to do so. Could that be possible? many wondered. According to Joseph DiGiacomo, M.D., clinical professor of psychiatry, one has to be suspicious when dealing with someone accused of murder. "They often fabricate incredible stories and they can lie very well because freedom is at stake," he told WCAU-TV's News 10. Still, he noted, lies can reveal the truth. "I see that the dream of these dead people his father, his father-in-law, and his wife represented the role models and the people who were his conscience, so-called super-ego. And that's the thing that eventually tells us to do the right thing," he said. Aired October 31.  

PUTTING PAIN INTO WORDS. . . Describing pain accurately to your doctor can help you get a quicker cure. But sometimes it's hard to put into words what we're feeling. American Health magazine, with the help of F. Michael Ferrante, M.D., associate professor of anesthesia and medicine and director of the Pain Management Center, offered readers methods for evaluating their pain. Before an appointment, ask yourself these questions: Where does it hurt? Does the pain radiate or move? What makes the pain better? What makes it worse? How often does it hurt? Also helpful is rating your pain on a scale from zero to ten, with zero standing for no pain at all and ten being the worst pain you could possibly imagine. Printed in the November issue.  

UNPALATABLE CHANGES. . . Elderly people often lose so much of their ability to taste and smell that they are in danger of malnutrition, immune problems, and food poisoning. But the problem is often overlooked by doctors and other caretakers of the elderly. Why? "People often don't even complain of it," the Smell and Taste Center's Natasha Mirza, M.D., assistant professor of otorhinolaryngology, told the Indiana Gazette. Loss of taste can be caused by medicines, surgical procedures, and diseases such as Parkinson's and Alzheimer's. Printed October 21.


MEDIA Review
January, 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


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