INTERNATIONAL

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The Incredible Shrinking Brain: Round 2 "First you forget names, then you forget faces, then you forget to pull your zipper up, then you forget to pull your zipper down." Ñ Leo Rosenberg In February, Ruben C. Gur, PhD, director of the brain behavior laboratory, told a gathering at the American Association for the Advancement of Science that according to his latest research, men's brains lose neural tissue at almost three times the rate of women as both age. Dr. Gur was inundated with requests for commentary, and scores of media outlets reported the findings. Philadelphia Daily News reporter Scott Flander had other assignments at the time, so it was almost two months later when he contacted the Media Relations staff for an interview. His report added a new angle to the earlier accounts - tissue loss in the left frontal region of the brain may explain why so many old men are grumpy, Dr. Gur had told him, and why so many have difficulty concentrating or remembering things as well as they did when they were young - and it gave birth to another media blitz. In addition to wire service reports, magazine articles, and television and radio newscasts, the Penn research made Jay Leno's monologue, David Letterman's Top Ten list, Dave Barry's syndicated column, Andy Rooney's biting commentary, and The Osgood File. "There are some men who grow old gracefully, aren't grumpy and have excellent memories," veteran CBS correspondent Charles Osgood said. "But I can't remember who they are." International coverage appeared - for the second time - throughout April, May and June with facilitation by the Media Relations staff.

NATIONAL

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Penn Lab Links BRCA2 To Ovarian Cancer According to Jeffrey A. Boyd, PhD, director of the gynecologic oncology research laboratory, patients with inherited BRCA2-related ovarian malignancies do not always present what scientists have come to view as the classic indications of a hereditary cancer. Frequently, neither are they early onset victims of the cancer nor do they have a large number of relatives with the disease. "Until now, we thought five percent to 10 percent of all ovarian cancers were the result of a hereditary predisposition," he told USA Today. "But our data suggest it may be significantly higher, perhaps as high as 20 percent." An analysis in Dr. Boyd's laboratory of 130 consecutive ovarian cancer patients - published in the June 15 issue of Cancer Research - revealed BRCA2 mutations in about five percent of the women. "What we found is that women with no family histories of note - who would not have been included in our usual estimates of hereditary frequency - do in fact, have germline mutations of BRCA2 associated with their ovarian cancer and, thus, would be hereditary ovarian cancer cases." Print and broadcast coverage followed presentation of the findings at the annual meeting of the American Association for Cancer Research on April 23.

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Fusin: Paving The Way For HIV Infection In order to do its lethal damage, HIV needs some way to fuse or latch onto - and then permeate - its target cell. It has long been known that one such entry point is a receptor molecule called CD4, which lies embedded in the surface of some immune system cells. But it was also known that CD4 by itself is not sufficient for infection to take place, and that a co-factor was needed to effect HIV's entry. Now, researchers say a newly discovered cell surface protein, dubbed "fusin," explains in part how the AIDS virus can enter a human cell - the first step in its takeover of the cell's genetic machinery. Investigators at the National Institute of Allergy and Infectious Diseases reported in the journal Science that fusin is a long-sought "co-factor" that lets HIV penetrate immune system cells. Associate professor of medicine James A. Hoxie, MD, who also studies how HIV infects cells, called the work "very exciting stuff that opens doors to several lines of research." While the discovery of fusin does not answer all questions about the process HIV uses to enter and compromise many types of cells, he said, it knocks down a barrier that has stymied some research for years. The article was syndicated in newspapers across the country on May 10.

PBS

Decisions: Ethics Vs. Healthcare Dollars Who plays God when a brain damaged, premature baby is dependent upon life-support? When an AIDS patient asks for help committing suicide? When a person living in poverty is refused a life-saving organ transplant? Who Plays God? Medicine, Money and Ethics in American Health Care presents frightening and often controversial answers to these questions and others. The two-hour special, which aired on PBS stations across the country, contains five short documentaries focusing on individuals facing life and death situations. Following each documentary is a brief roundtable discussion moderated by ABC's medical correspondent George Strait, in which health care experts - including Glenn McGee, PhD, faculty associate in Penn's Center for Bioethics - debate the implications of the story. Who Plays God? takes a critical look at both ethical and economic decision-making in the American health-care system, exploring real-life cases in which average Americans are forced to decide how long to fight and how much a loved one's last days are truly worth. The program aired in Philadelphia on May 5.

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Kodak Moments: Soothing, Reminiscent Videos Some of the emotional distress of Alzheimer's patients can be reduced by showing them videos of scenes from their past, according to preliminary results of a pilot study by researchers in Penn's Memory Disorders Clinic. Chris Clark, MD, director of the clinic, told The Philadelphia Inquirer that "reminiscent" videos - a photographic family history selected by the patient and his family, combined with some favorite music - were not meant to restore the fading memory of patients with Alzheimer's, but rather to provide a pleasurable experience that could decrease the agitation, anger and frustration that patients with the progressive neurodegenerative illness typically feel. That, in turn, could make things easier for their care givers. Robert Moore, one of six study participants, was diagnosed with Alzheimer's three years ago. His wife knows the day will come - as his disease inevitably worsens and his memory deteriorates - when the reminiscent video will become a regular part of their routine. "You don't just want to let the future happen; you prepare for it," she told Channel 29 viewers. Moore, the father of six children, and his wife viewed over 1,000 family slides to select the 40 pictures that make up his video. "Memories, memories, memories," he commented. The segment aired May 10; the article was first published May 27 in response to pitches made by the Media Relations staff.

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Waking Up To Napping These days, it may be far more acceptable to lie down on the job if you're the boss, or perhaps, a sleep researcher ("Uh, just doing a little research!") than, say, a bank teller. "A lot of upper-management types will tell you regular naps are part of their 'power thinking,'" David F. Dinges, PhD, director of the unit for experimental psychiatry, told the Associated Press. "Just let someone under them try it and see what happens." But sleep scientists predict that in the not-too-distant future, forward-thinking employers will encourage naps and even provide office accommodations. Trend forecasters say napping is the next rung up on the ladder of the nation's health craze; an about-face from our long-held notion that short-sleepers are more motivated than those who make time for rest. Social change and technology have turned us into a nation of walking zombies - and made us prone to costly errors and deadly accidents. Dr. Dinges and his colleagues have been promoting the nap as an efficient way to replenish our sleep deficits ever since they documented its positive impact on chronically sleep-deprived adults. What has worked so well for astronauts, pilots and others who nap to stay alert, is slowly being touted for the rest of us. Syndicated articles were published across the country in April and May.

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News To Help You Lose: Fen-Phen, Fads & Redux At any given time, about one in three women is dieting. Most take the smart route, but the lure of the quick-fix remains strong - especially for teens. Some combine over-the-counter diet pills with cold medications or laxatives in a desperate attempt to lose weight. "Unfortunately, it's a trend among adolescent females," Gary D. Foster, PhD, clinical director of Penn's Weight and Eating Disorders Program, told Good Day Philadelphia viewers. "No matter what the cost, they want to be thin." Drugs for the severely overweight can, however, be safe and effective. "The most popular medications are fenfluramine combined with phentermine," program director Thomas A. Wadden, PhD, said in a Channel 10 interview. The so-called Fen-Phen diet is "effective for helping people lose about 10 to 15 percent of their initial body weight." And dexfenfluramine - marketed as Redux - has been approved by the Food and Drug Administration "for both weight loss and maintenance of weight loss. "I think that's where it's going to have it's real strength," he told Good Morning America co-host Joan Lunden. Interviews appeared throughout April and May with facilitation by the Media Relations staff.

LOCAL

Philadelphia Inquirer

Byberry Shutdown: Penn Study Finds Strong Safety Net In 1990, Pennsylvania closed the Philadelphia State Hospital (PSH) - the infamous hospital known as Byberry - and replaced it with a wide array of community services for its mentally ill patients. The experience provided a unique opportunity to study the effects of closing a facility in a major urban area where community-based services were substantially increased and no provisions were made to divert future patients to other institutional facilities. Researchers at Penn's Leonard Davis Institute evaluated the impact of the PSH closure on the public mental health system, and found that the city can care for its mentally ill population outside the walls of an institution. The study suggests that the system is a more costly alternative because the mentally ill who might have used the state hospital during psychiatric episodes are being admitted to expensive general hospitals for long stays. "What the study is showing is where the system is backing up," said psychiatry's Aileen B. Rothbard, DSc, an assistant research professor and an author of the study. Community-based care may be more expensive, but "The quality, quantity and intensity in the treatment they're getting is significantly better," said Trevor R. Hadley, PhD, director of Penn's Center for Mental Health Policy and Services Research, and one of the study's investigators. The article was published May 13.

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Pap Tests: Preventing Cervical Cancer Developed half a century ago, the Papanicolaou smear - the Pap test - was a breakthrough that could have put a virtual end to cervical cancer. The safe, inexpensive test detects not only cancerous cervical cells, but abnormal cells, that, if left untreated, often become cancerous. "Before the Pap smear, we would have to apply an iodine solution to the cervix, it would be picked up by abnormal tissue, then we'd do a biopsy," recalled John J. Mikuta, MD, professor of obstetrics and gynecology. "It was painful, costly, and not foolproof." "The Pap test was one of the great discoveries of this era," he told the Inquirer. Indeed, national records show that incidence and mortality rates have fallen by 40 percent in the last two decades. Still, this year, about 15,000 women will be diagnosed with cervical cancer, and about 5,000 will die of the disease. An estimated 40 percent of American women - mostly low-income, the uninsured, and the elderly - are not getting tested regularly. Authorities say the numbers should be far better, since cure rates approach 100 percent if the disease is detected before it becomes invasive. The feature, which included two photos of Dr. Mikuta, was published April 1 and May 17.

Philadelphia Magazine

Philadelphia: A Great Place To Get Sick More than 170 physicians throughout the University of Pennsylvania Health System are named in Philadelphia magazine's annual "Top Docs" survey, including those from HUP, Presbyterian, CHOP, hospitals associated with UPHS, and Clinical Care Associates, the Health System's network of primary-care physicians. "We asked doctors to tell us whom they'd send a family member to for everything from arthritis to a urinary-tract infection," wrote senior writer Carol Saline. The list of outstanding specialists in the Philadelphia region was honed from nearly 1,000 responses. Luigi Mastroianni, Jr., MD, graced the cover of the issue, published in May.

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Keeping Score: Athletes & HIV No doubt you've heard about Magic Johnson and Tommy Morrison. But AIDS experts say the basketball star and the boxer aren't the only pro-athletes infected with HIV. Some may not be aware they have contracted the disease; others - fearing the attention it will arouse - choose to remain anonymous. "I'm sure of it," Stephen J. Gluckman, MD, associate professor of medicine in infectious disease, told the Philadelphia Daily News. Using age-group averages for the disease, AIDS researchers estimate there are at least 30 HIV-infected professional players among the nearly 3,000 who play baseball, basketball, football and hockey. Factor in the additional risk incurred through unprotected sex with above-average number of sexual partners and steroid or drug use, and that number might be higher. "Unless you can give me a sensible reason why this group would be protected from the usual risks of HIV, they ought to at least have the risks the rest of us do," said Dr. Gluckman. "And we know that the general risk in the population of men that age means that guys like Johnson and Morrison are just the tip of the iceberg." The syndicated article was first published April 18 with facilitation by the Media Relations staff.

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Chemotherapy: Growth Hormone Spurs Platelet Growth Drugs that are powerful enough to kill cancer are often destructive to bone marrow - temporarily inhibiting its ability to manufacture new blood cells. As a result, patients may suffer from life-threatening shortages of disease-fighting white cells, oxygen-carrying red cells and platelets, the tiny disc-shaped cells essential for clotting. To counteract the devastating effects of chemotherapy, natural hormones that prompt the body to make red cells and white cells are routinely given to boost the body's production of these cells. However, until now, there has been no good treatment to overcome low levels of platelets, which can cause dangerous internal bleeding. Scientists recently isolated a protein that stimulates platelet growth and began producing it through genetic engineering. At the annual meeting of the American Society for Clinical Oncology, doctors described preliminary testing of two versions of this growth hormone. Both appear to work. "This is an approach that looks very promising," Lynn M. Schuchter, MD, assistant professor of medicine in hematology-oncology, told the Associated Press. "This is not a lot of hoopla about nothing." The report was syndicated May 21.

WTXF-TV29

Labor Intensive: Letting Nature Takes Its Course For years, many doctors have assumed that waiting for labor to start naturally after a woman's water breaks - which occurs when the fetal membranes rupture - could be hazardous to the baby. The fear is that germs may get into the uterus and infect the child. Some experts believe, however, that when doctors use drugs like Petocin to speed up the labor, they are more likely to have to deliver the baby by Caesarean section. "What we've been classically taught was that if you allow women to go into labor on their own, it might decrease the chance of Cesarean section," Todra L. Anderson, MD, assistant professor of obstetrics and gynecology, told Channel 29 viewers. But "what we have found is that most patients with their first baby don't necessarily want to wait." A new Canadian study concludes that women should choose the option they prefer, since there is very little difference in terms of outcome. More than 5,000 women were randomly assigned either to have induced labor or to wait for labor to start on its own. In both groups, about three percent of the babies had infections, and about 10 percent were delivered by C-section. The segment aired April 17 with facilitation by the Media Relations staff.

Issues & Answers

In the words of Arthur L. Caplan, PhD, director of the Center for Bioethics:

"I think he's turned up the heat on this debate, and in some ways, will be remembered as the central figure who made America grapple with the question of assisted suicide."

Snips & Clips

LOVE THE ONE YOU'RE WITH. . . Men considering an extramarital affair should also consider that it may be harmful to their health. According to one study, 80 percent of men who suffered heart attacks during lovemaking were making love to someone else's wife. On his syndicated radio call-in show, Dr. Gabe Mirkin read a poem by David Kritchevsky, MS, PhD, professor of biochemistry in veterinary medicine, on the phenomenon: "Heart beats stay at a normal rate / When one beds down with a legal mate / But roosting in another's nest / Flirts with cardiac arrest." Aired 5/8.

LOOKING STRONG. . . The Philadelphia Business Journal announced that the University of Pennsylvania Health System has recruited Michele Volpe to be Chief Operating Officer of Presbyterian Medical Center. Volpe, who left her post as president of Mount Sinai Hospital to join Presbyterian, says she will focus first on expanding the hospital's presence in West Philadelphia and maintaining its focus on acute care. "The Presbyterian 'look' will be one of a very strong community hospital with a broad array of services focused on community needs," she said. Printed 5/10.

A BUMPY RIDE. . . At least 15 of New York City's 78 hospitals will be forced to shut down by the year 2000 as a result of the managed care revolution, The New York Times reported. Alan L. Hillman, MD, director of the Center for Health Policy at Penn's Leonard Davis Institute, commented that the forecast is consistent with what has already happened in Philadelphia and across the nation. "All across the country, health care is being turned over to the market," he said. "In the long term the market should provide the right number of beds for the right number of patients, but until we reach that equilibrium it may be a very bumpy ride." Printed 4/7.

RATS! . . . There is new hope for insulin-dependent diabetics, thanks to Ali Naji, MD, PhD, professor of surgery. The Omaha World-Herald reported that Dr. Naji has successfully transplanted healthy, insulin-producing cells into diabetic laboratory rats, which are then able to fight off the renegade white blood cells that cause diabetes. "The islets are sustained indefinitely, and the rats are then indistinguishable from normal rodents," he explained. Printed 4/17.

BLOOD MONEY. . . The National Institutes of Health has awarded $10 million to five complementary research projects headed by Leslie E. Silberstein, MD, associate professor of pathology and laboratory medicine. The projects, to be funded over five years, will attempt to answer critical questions related to blood transfusions. "We'll be looking for ways to intentionally manipulate immunity in blood cells to treat diseases of the blood with transfusion therapies," Dr. Silberstein told Hospital and Health Care News. Printed in the April edition.

HEART SMART. . . Think all doctors start out as health nuts? Think again. "I went to college before I found out most people don't put butter on bologna sandwiches," cardiovascular's Susan E. Weigers, MD, assistant professor of medicine, confessed in Your Health. But now that she has a family of her own, all that has changed. "My kids think the yolk of an egg is poison," she says. The article, which surveyed female doctors to learn how they stay healthy, also noted that Judith Lea Swain, MD, chief of the cardiovascular division, takes a baby aspirin and a vitamin E tablet everyday to help prevent heart disease. Printed 4/2.

Rx FOR SUCCESS. . . "There are studies I've read where 17 percent of patients leaving physicians' offices decide at that time they're not going to take their medications," Jeffrey Bourret, director of pharmacy, told Modern Healthcare. That's one of the reasons the University of Pennsylvania Health System aims to give its primary-care doctors and some hospital departments on-line access to the medical profiles of employees in its health plan. "Think about this scenario: Every physician uses a personal computer to put in prescription information, the printer spits out the hard copy for the patient to take to the pharmacy, and we check a database to see if the prescription was filled," he said. Printed 4/15.

CUTTING RED TAPE. . . The recent move by the FDA to streamline the process by which cancer drugs are approved and made available to patients is being lauded by cancer-patient advocates, oncologists, and industry officials alike. John H. Glick, MD, director of the University of Pennsylvania Cancer Center, told The Scientist that by reducing approval times and expanding access, the new policy takes "great steps." But, he said, the FDA must go even further. "We have to simplify and expedite the process of approval for new off-label uses of approved drugs," said Dr. Glick, who is also the president of the American Society of Clinical Oncology. Printed 4/29.

SHE DELIVERS. . . Assistant professor of obstetrics and gynecology Michelle M. Battistini, MD, thinks too many women undergo Caesarian sections, and she shared her views during an appearance on the Donahue show. Between 22 and 25 of every 100 babies born are delivered by C-section - a rate that has quadrupled since 1960. These numbers are alarming, Dr. Battistini said, "because the morbidity and the mortality rates for women are higher with Caesarian sections as compared to vaginal delivery." The danger, she explained, as with any major surgery, lies in the potential loss of blood and in the risk of infection. Aired 4/23.

AN EYE ON SAFETY. . . Each year, 500,000 people suffer from sports-related eye injuries, says Nicholas J.Volpe, MD, professor of neurology, but most of these injuries are preventable. "You should never play any sport with a high-moving ball unless your eyes are protected with certified safety glasses," he warned. Children should be fitted with protective lenses as well, he added, noting that school-age children account for about one-third of sports-related eye injuries. Printed in neighborhood papers across the Delaware Valley in April and May.

A STICKY SITUATION. . . Researchers at Johns Hopkins University have detected an altered version of a platelet surface protein that seems to make them even stickier than usual. About 20 percent of the population carries the genetic quirk, increasing their heart-attack risk at least as much as smoking or high cholesterol would. Garret A. FitzGerald, MD, professor of medicine, told Science the study's results offer "the first inkling of an association of a modification in a platelet target protein with card iovascular risk." Printed 4/26.

GEMS & JUNK . . . You can find a treasure trove of health information on the Internet, but a syndicated New York Times article warns that the quality of medical sites is highly variable. Newsweek noted that OncoLink - the University of Pennsylvania Cancer Center's award winning web site that provides medical information to cancer patients, health care professionals and others Ñ is one of the best places online. "Knowledge is power, and we're trying to empower patients by giving them knowledge at their fingertips," said OncoLink co-editor Ivor Benjamin, MD, assistant professor of obstetrics and gynecology. Printed 4/10 and 5/27, respectively.