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The Intelligencer |
Making
New Fathers of Dead Men
"People will not look forward to posterity who never
look backward to their ancestors."
--Edmund Burke
For over a decade, a procedure has been available to retrieve
viable sperm from men after their deaths. Until recently, its use
was generally restricted to men who had given consent before
dying. But a new study shows that sperm retrieval is now being
requested rather frequently. The question arises: is it ethical
and legal for sperm to be procured from a deceased individual who
has not given his consent?
This topic needs to be looked into more closely, said Arthur
L. Caplan, PhD, director of the Center for Bioethics. Caplan
was the senior author of the study, published in the June issue of
The Journal of Urology, that found the growth in
post-mortem sperm procurement.
Researchers conducted telephone surveys of 273 assisted
reproductive facilities in the United States. The facilities
reported a total of 82 requests for post-mortem sperm procurement
between 1989 and 1995 at 40 facilities in 22 states. More than
half of the total requests (43) were made in 1994 and 1995, and 25
of those requests were honored.
Most deaths (86.4 percent) were the result of sudden trauma.
Many of the requests were made by the wife of the deceased, but
the survey showed that requests were also made by girlfriends,
social workers, and parents.
"Right now, there are no rules about who can give
permission, about who should be asked whether they want to do
this, and there's no rules governing who the sperm could be given
to," Caplan said in an interview for The Schneider Report
(Fox News Channel).
The authors of the study concluded that ethical questions raised
by the extraction of sperm from unconsenting corpses must be
addressed. "I think the ethical issues really boil down to:
should we be making babies without consent? If so, for whom?"
Caplan said in USA Today. Other ethical considerations
include whether it's right to create a child who will grow up
without a father, and exactly who should have access to the sperm.
Reports began May 27.
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Edmonton Journal (Canada)
Winnipeg Free Press (Canada)
USA Today
The Washington Post
The Boston Globe
The Philadelphia Inquirer
The Philadelphia Daily News
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Tampa Tribune
WPVI-TV6
North Hills News Record
Reading Eagle
Morning Call
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Reassessing Breast
Cancer Risk
A series of studies published recently in The New England
Journal of Medicine show that the two "breast cancer
genes"--BRCA1 and BRCA2--may have less medical value than
originally thought. One of the studies, led by Barbara Weber,
MD, associate professor of medicine and genetics, showed that
BRCA1 mutations were found in only 16 percent of women with a
family history of breast cancer. As the study notes, the
percentage is "less than the 45 percent predicted by
genetic-linkage analysis." The figure drops to 7 percent in
the case of women from families with a history of breast cancer
but not ovarian cancer. Among women with family histories
of both breast and ovarian cancer, the risk of having BRCA1
mutations was higher. "BRCA1 mutations were identified in . .
. 18 of 45 families (40 percent) with a single member with both
breast and ovarian cancer." Weber's study concluded: "Even
in a referral clinic specializing in screening women from
high-risk families, the majority of tests for BRCA1 mutations will
be negative and therefore uninformative."
"Clearly there are other genes involved,"
Weber commented in USA Today. "We, and others, are
looking for them."
Many women have opted to have their breasts and ovaries removed
prophylactically after testing positive for the defective genes.
But, "surgery doesn't eliminate 100 percent of the risk of
cancer," said Jill Stopfer, a genetic counselor, in
USA Today. "The big question is how much risk is left."
Reports began May 15.
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NATIONAL
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The Philadelphia Inquirer
Orange County Register
Reading Eagle
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Seeing Past Macular Degeneration
Macular degeneration, the most common cause of vision loss in
the Western world, is an unfortunate aspect of aging for some
people. It is a condition in which the center of the retina--the
macula--deteriorates. Little can be done to treat it, and
eventually patients lose their central vision but keep their
peripheral vision. Researchers continue to search for effective
treatments.
At the University of Pennsylvania's Scheie Eye Institute,
doctors are studying the use of thalidomide in treating macular
degeneration. Thalidomide is the drug that was widely prescribed
in the 1950s and later found to cause serious birth defects--most
notably, gross deformities of the limbs. But more recently, the
drug has been found useful to AIDS and cancer patients.
Allen Ho, MD, assistant professor of ophthalmology, and
his colleague Stuart Fine, MD, professor of ophthalmology,
are studying the drug's effects on 30 patients. Thalidomide is one
of a class of drugs that stop the growth of blood vessels, and it
may help people with one type of the disease. Although he's
hopeful, Ho said it's still too early to tell whether the drug is
working.
Ho reported to The Philadelphia Inquirer that working
with these patients can be frustrating because many become
depressed by the news that their condition is irreversible.
In some cases, Ho said, he has used a laser operation to attempt
to cauterize blood vessels, but only a small amount of patients
are eligible for this treatment.
Reports began May 26.
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Chicago Tribune
Modern Medicine
Soap/Cosmetics Specialities
Mass Market Retailers
News (McKeesport, Pa.)
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A New Wrinkle in Skin Lotions
Move over, alpha hydroxy acid. New skin treatments containing
beta hydroxy acid are showing up on drugstore shelves and at
cosmetic counters.
Beta hydroxy compounds have been used for decades by
dermatologists to treat acne, dandruff, and psoriasis. But they
have now been proven useful in reducing fine wrinkles with less
irritation. In a study of 190 patients comparing the two hydroxys,
Albert Kligman, MD, PhD, professor emeritus of dermatology,
found that beta hydroxy acid was better in improving skin
appearance. In fact, the study showed that alpha hydroxy acid did
not test much better than a placebo.
After two weeks of use, 50 percent of the alpha hydroxy acid
users in the study complained of stinging and burning, compared to
only 5 percent of the beta hydroxy group.
"[Beta hydroxy acid] is lipid-soluble, so it can get down
to the follicle," Kligman told Modern Medicine. "Alpha
hydroxy acids are water-soluble, and they are therefore unable to
get into the greasy follicles."
Kligman advises patients to look at the product's pH when
choosing a brand. A pH of 4 or 5 is too high, making the product
ineffective, and a low pH makes the product irritating. A pH of
about 3 is ideal.
Reports began May 13.
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Bucks County Courier Times
Standard Speaker
The Record
Times News
Metropolitan News-Enterprise
WPVI-TV6
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When the Golden Years Are Tarnished
Minor depression is common in the elderly, affecting about one
in five people age 65 and older. Many health care providers have
just assumed that depression in the elderly is due to having to
cope with physical ailments and the loss of loved ones. But
according to Anand Kumar, MD, associate professor of
psychiatry and director of Penn's Mood and Memory Disorders
Program, there may be a biological reason that seniors get
depressed.
Kumar studied 18 patients who had experienced depression for the
first time later in life. He compared them to 31 non-depressed
patients. Using magnetic resonance imaging, Kumar found that the
prefrontal lobe--the region of the brain associated with emotional
states and behavior--was much smaller in the depressed elderly
patients than in the non-depressed patients.
Kumar, whose study was published in the May 15 issue of the Archives
of Neurology, said that he hopes that this finding will help
doctors recognize the signs of minor depression and that they will
encourage seniors to get the help that they need.
"The term 'minor' sort of suggests that it's trivial,"
Kumar said in an interview for WPVI-TV6's Action News. But
if minor depression is ignored, he said, it can develop into major
depression. "If minor angina, if you will, is neglected, you
could end up having a heart attack."
Kumar added that, even though the study concentrated on seniors,
he suspects that the findings apply to everyone, regardless of
age.
Antidepressant medications, combined with psychological and
social intervention, may relieve
late-life minor depression. "My colleagues and I hope that
family members, caretakers, and
primary care doctors will recognize the signs of minor
depression and encourage seniors to get the help they need,"
said Kumar. "If fatigue, the 'blues' or crying spells persist
for more than a few weeks, appropriate diagnosis and treatment may
ease the symptoms and significantly improve the patient's quality
of life."
Reports began May 14.
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NBC News
WTXF-TV29
KYW-1060AM |
Count Your Moles
For years, we've been warned about the dangers of sun exposure,
and we've been advised to look for changes in moles. A normal mole
is round, small, and uniform in color, we've been told, and
anything that deviates from that description should be reported.
But a recent study published in the Journal of the American
Medical Association has shown that people with more than 25
small moles are at twice the risk for malignant melanoma as those
with fewer. People with both small and large moles are at four
times the risk. Allan Halpern, MD, assistant professor of
dermatology, co-authored the study of 716 patients.
"The average person has in adulthood approximately
20 to 25 small moles," Halpern explained to WTXF-TV29's Jill
Chernekoff. "By small, we mean somewhere between two and five
millimeters. That's less than the size of a pencil eraser. And
anyone with more than that is at increased risk."
"If missed in its early stages," Halpern
added, "a small melanoma on the skin is capable of spreading
and killing. However, if caught early, it can be cured by a simple
office procedure."
Reports began May 13.
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The Philadelphia Inquirer
Seattle Times
San Diego Union-Tribune
Arizona Republic
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Apology For an Atrocity
In May, President Clinton offered a ceremonious apology to the
survivors of the Tuskegee Study of Untreated Syphilis in the Negro
Male. The study, which lasted from 1932 to 1972, involved 600
black men, 399 of whom had syphilis. The infected individuals were
never told that they had the disease, and were not treated,
despite the fact that penicillin became available in 1947.
Instead, they were told that they had "bad blood," and
were given placebos.
Only eight men from the study are still living. Four, ranging in
age from 91 to 100 years, traveled to the White House for the
formal apology, as well as 23 wives of victims, 15 children, and
two grandchildren.
Medical professionals report that awareness of the study has
made many African-Americans skeptical of medical treatment and
studies.
The study "has cast a long shadow" over mainstream
medicine for minority communities, said Arthur L. Caplan, PhD,
director of the Center for Bioethics, in The Philadelphia
Inquirer.
"You see it when you go to big, inner-city teaching
hospitals where a lot of research is going on," Caplan said. "You
see those suspicious attitudes about research, new drugs, new
devices. It's a real problem."
Reports began May 16.
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Business Week
Science News
National Public Radio, Kentucky
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More Than One Way to Kill Bacteria
The antibiotic vancomycin is known as the drug of last resort
when treating stubborn and deadly infections. But
vancomycin-resistant strains of some bacteria, including a common
systemic pathogen called enterococcus, have emerged in recent
years. For years, scientists have feared that dangerous
Staphylococcus aureus would become vancomycin-resistant.
Indeed, in May, doctors in Japan reported a strain of Staphylococcus
aureus that is now resistant to the drug.
Recently, researchers at the University of Pennsylvania Medical
Center provided an important tool in the effort to create new
drugs that will prove effective against vancomycin-resistant
bacteria. The finding was reported in the February 19 issue of the
Journal of the American Chemical Society by co-authors
Paul H. Axelsen, MD, and Patrick J. Loll, PhD,
assistant professors of pharmacology.
In an interview with Business Week, Loll explained that
vancomycin, because of its structure, is difficult to synthesize
chemically. "Since you can't synthesize the parent compound,
it's hard to spin off derivatives." But the researchers were
able to identify the 3-dimensional atomic structure of vancomycin.
Now they are able to use a computer to predict which possible
variants would be most effective against resistant Staph.
"Once you have something that has a reasonable chance of
working, it's worth killing yourself to try to synthesize it,"
Loll said.
Reports began June 16.
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Philadelphia Business Journal
Modern Healthcare
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Making It Official
On June 2, the board of managers of Pennsylvania Hospital voted
unanimously to merge with UPHS, a giant step in the negotiations
that have gone on between the two institutions for several months.
Although the original affiliation plans called for a gradual
integration over the next two to five years, under the new
agreement the Health System would assume full control of
Pennsylvania Hospital later this year. The board of UPHS and the
university trustees voted on the proposed merger agreement in late
June.
John Ball, MD, Pennsylvania Hospital's president and
chief executive officer, said that market conditions led to the
board's decision to forego a planned two- to five-year timetable
for the integration. "The more the board talked about it, the
more we said, in fact, Penn and we are the same," Ball was
quoted in Philadelphia Business Journal. "If we
postpone the governance turnover, there are certain things we
can't do that would make us more efficient."
Ball said that the transfer would allow the Health System to
re-establish certain clinical services within Pennsylvania
Hospital. And Pennsylvania Hospital will serve as the prime
location for certain UPHS services, such as the Penn
Musculoskeletal Institute.
Pennsylvania Hospital will retain its historic name. "One
of the interesting things is watching how the health systems have
applied their names to hospitals they acquire," Ball
commented. "You see a huge sign for Allegheny and an
itty-bitty 'Hahnemann.' You see a huge sign for Jefferson above an
itty-bitty 'Methodist division.' Here, you will see a huge sign
that says 'Pennsylvania Hospital,' and under that you will see the
University of Pennsylvania Health System."
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LOCAL
Hospital & Healthcare
News
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Infertility Grant
The University of Pennsylvania Medical Center was recently
awarded a $5.6 million grant from the National Institute for Child
Health and Human Development for research on the causes of
infertility and the development of new treatments. The five-year
grant will fund the creation of the National Center for Research
on Female Infertility.
The National Center for Research on Female Infertility will
focus on studying the genetic basis of a condition known as
polycystic ovary syndrome (PCOS), a disorder in which multiple
cysts develop on the ovaries and ovulation rarely occurs. The
disease is one of the leading causes of infertility in women,
affecting 10 percent of women of reproductive age. "Our
multi-faceted research program will use. . . molecular genetics,
molecular and cell biology and rigorous clinical investigation to
better understand and treat PCOS," said Jerome F.
Strauss, MD, PhD, professor and associate chairman of the
Department of Obstetrics and Gynecology, and the principal
investigator of the new grant, in Hospital & Healthcare
News.
The center will serve as a national resource for the career
development of young scientists who are interested in pursuing
infertility research. Strauss will collaborate with
co-investigators Deborah Driscoll, MD, and Richard
Spielman, PhD, as well as researchers from the Pennsylvania
State University Medical Center and the University of
California-San Francisco.
The article appeared in the May 1997 issue.
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Philadelphia Business
Journal
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Building on a Top-Notch Management Team
A recent issue of Philadelphia Business Journal focused
on recent additions to the Health System's management team. It
announced that J. Michael Agar joined the system as vice
president of managed care, and Allen L. Johnson joined as
executive director for network development, Delaware division.
Agar came to the system from the Crozer-Keystone Health System,
where he was vice president of managed care and president of
Health Plans of Pennsylvania. Johnson formerly was president and
CEO of the Medical Center of Delaware.
Johnson said that he sees the system development in Philadelphia
and elsewhere as an effort of hospitals to get control of
health-care delivery back from insurance companies. "Unfortunately,
hospitals sat on their hands not wanting to step out and lead
change," Johnson said. "As a result, we abdicated our
responsibility for controlling the health system. There was a
vacuum and the insurers stepped in."
Agar announced that his top priority is "to try to solve
the equation of how you support world-class teaching, research and
clinical services in a managed-care environment."
The article appeared in the June 20-26 issue.
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PERSPECTIVES
When reporters need opinions on current issues, they frequently
consult University of Pennsylvania Health System experts. Below are
samples of comments made to the media on various timely topics:
"We're not better off without the understanding of how
to clone, but we'd be much better off if the scientists who brought us
cloning had an understanding of society."
--Glenn McGee, PhD, assistant professor of bioethics for
Penn's School of Medicine and senior fellow in health economics at
Penn's Leonard Davis Institute
"Reproductive Research Far Outpaces Public Policy"
The Los Angeles Times, 4/29
"I think it's very very sad that this is now the third
case we're seeing, that we have not educated children enough--that
they feel that this is their only way out. . . We need to take a long
hard look at ourselves."
--Todra Anderson, MD, assistant professor of obstetrics and
gynecology
"Post-Birth Activity Amazes Docs" (N.J. Teen Gives Birth
at Prom)
Philadelphia Daily News, 6/11
"There are very few people who are completely mentally
healthy or completely mentally ill. I think we are going to realize
through this kind of policy that our work force is much closer to
Woody Allen than to Marcus Welby."
--Arthur L. Caplan, PhD, director of the Center for
Bioethics
"EEOC Bureaucrats' Take on Disabilities Act Needs a Reality
Check" Star Tribune, 5/21
"In the old days, scientists were competitive, but
they shared information. There was openness. Materials and information
had to be available to your peers. It was an ethic and a value of
research. That's how science worked--until genetics."
--Glenn McGee, PhD, assistant professor of bioethics for
Penn's School of Medicine and senior fellow in health economics at
Penn's Leonard Davis Institute
"Genetic Bias Strike Work Force"
Courier-Post, 5/22
"American culture denies the acceptance of death. Even
doctors don't like to talk about dying. Until that culture changes, we
will ignore the fact that people are dying and will use technology to
keep them alive."
--Arthur L. Caplan, PhD, director of the Center for
Bioethics
"US Eases Off on Insistence to Cure the Dying"
Sacramento Bee, 4/13
SNIPS & CLIPS
AWARD-WINNING MAN. . . William N. Kelley, MD, CEO of the
University of Pennsylvania Health System and Dean of the School of
Medicine, was recently named 1997 Man of the Year by the Delaware
Valley Chapter of the Crohn's & Colitis Foundation of America. He
was honored at a ball at Philadelphia's historic Crystal Tea Room in
May. An item about the award was featured in the May issue of Hospital
& Healthcare News.
DE-GERMING YOUR KIDS. . . Do parents need to go out of their
way and buy special antibacterial products--such as special soaps and
even bacteria-resistant plastics and fibers--to keep kids protected
from germs? Brad Dyer, MD, a Clinical Care Associates
pediatrician, told WCAU-TV10's Arthur Fennell that "those
products are steps in the right direction toward antibacterial
control." But, Dyer added, "Good hygiene techniques--you
know, soap and water, wiping things down, drying them off and so
forth--is really, I'd say, 90 percent to 95 percent of the battle."
Aired May 6.
HOLIER THAN THOU. . . One can't miss the constant news
reports about the dangers of sunbathing. But with some people, it's in
one ear and out the other. The reason is that some people think that
they are somehow immune to the effects of the sun--that skin cancer is
a risk for others, but not for them. "Tanners have this magical
belief that they are special and the sun won't hurt them," Caroline
S. Koblenzer, MBBS, MD, clinical professor of dermatology, told
Elle magazine. "They want to live for the day and damn
the consequences." Printed in the May issue.
SHARING WITH YOUR PARENTS. . . Are Mom and Dad to thank for
your weight problem? Possibly. But just because you have an overweight
parent doesn't mean you are doomed to a life of heftiness. "While
you share your parents' genes, you may be more active than they are
and eat less fat and fewer calories," said Gary Foster, PhD,
clinical director of Penn's Weight and Eating Disorders Program, in an
article in Glamour magazine. "Or your particular mix of
genes may be less fat-prone than those of your parents." Appeared
in the May issue.
SPECIAL GATEKEEPERS. . . Some managed care plans are
re-evaluating whether primary- care physicians should be the only "gatekeepers"
for their members. Many believe that nurse practitioners can offer
many of the services that primary-care physicians do. Other plans are
considering that some patients with chronic problems such as asthma or
heart disease might fare better when specialists provide the bulk of
their care. The issue was recently addressed in Physician's
News Digest. According to David Shulkin, MD, chief medical
officer for HUP and chief quality officer for the Health System, "It's
just not going to work to let everyone come to their own conclusion
about best practice." Shulkin said that "end-stage renal
disease is an example. When you get certain patients to a nephrologist
earlier, you can better prevent end-stage renal failure. Also with
AIDS patients. You're probably better getting those patients to a
specialist to manage their care." Printed in the May issue.
MUST-HAVE ADS. . . The Philadelphia area is swamped with
advertising from hospitals. And in the future, we will probably be
seeing even more ads. A media monitoring service based in Tucson,
Ariz., reported that Philadelphia hospitals spent 65 percent more on
advertising in 1996 than they did in 1995. "If you don't do it,
you won't survive," said Will Ferniany, associate vice
president for marketing and strategic support for the Health System,
in the Philadelphia Business Journal. "It's one of those
situations where if nobody did it, you would be OK. But if one does
it, you have no choice but to participate. Or you will lose. Patients
will not come." Printed in the May 16-22 issue.
HERBAL PHEN/FEN. . . In the quest for thinness, Americans
are always looking for the next quick fix. And the latest fix,
according to The Philadelphia Inquirer, may be an herbal
preparation manufacturers hope will rival the diet-drug combination
phentermine/fenfluramine, or "phen/fen." ("Phen/fen"
has been linked to a variety of health problems, including--most
recently--an unusual type of heart valve disease.) The new preparation
contains two herbs--ephedra, which has been used in Chinese herbal
medicine for 5,000 years for asthma symptoms, and Saint-John's-wort,
considered by some a "substitute" for pharmaceutical
antidepressants. The weight-loss chain Nutri/System is already selling
the compound in its 500 diet centers. Even if the herbal preparation
really suppresses appetite, weight-loss experts say that it probably
won't help to keep the weight off. "When people go off
weight-loss drugs, the weight goes right back up. That's absolutely
predictable," said Albert J. Stunkard, MD, DM, professor
emeritus of psychiatry. Printed May 12.
MANAGING MENOPAUSE. . . Many women expect menopause to be a
turbulent, depressing passage. But it doesn't have to be that way.
Michelle Battistini, MD, assistant professor of obstetrics and
gynecology, dispelled some common myths about menopause for Philly
Health and Fitness. For one thing, menopause doesn't mean that
women will gain weight. And it does not equal depression, although
some women will find that the hormonal changes will bring on or worsen
chronic symptoms. Medication can restore well-being. "Be
positive, exercise, eat a balanced diet, maintain an adequate calcium
intake, and have regular health-care screenings," Battistini
said. Appeared in the May issue.
MARITAL WEIGHT. . . Sometimes, well-meaning husbands and
wives use insults as way to encourage their spouses to lose those
extra pounds. This method rarely works, and sometimes backfires.
Overweight spouses need nurturing and support to get back into shape,
and the best approach is for a couple to pursue diet and exercise
goals together. Thomas Wadden, MS, PhD, professor of
psychology in psychiatry and director of Penn's Weight and Eating
Disorders Program, gave some tips to the Tampa Tribune on how
to initiate a conversation about weight with a loved one. "Be
candid and honest," said Wadden, "and first, elicit your
spouse's concerns about their own weight. Say something like, 'Tell me
your thoughts on your weight. ... How do you
feel?" Hopefully, the spouse will open up and admit there is a
problem. Only then can a solution be formulated together. Printed
April 24.
SKIN AND WELL-BEING. . . People experiencing times of
emotional upset are likely to develop skin problems. And the link
between mind and skin develops before birth. "The skin and the
central nervous system develop out of the same embryonic tissue,"
said Caroline Koblenzer, MBBS, MD, clinical professor of
dermatology. Koblenzer told Shape magazine that babies with
chronic eczema usually have had problems bonding with their mothers,
and their inflamed skin is a way of crying for affection. "Through
touch, we receive our first messages about how others feel about
us--and how we feel about ourselves." Printed in the June issue.
WHERE'D I PUT MY KEYS?. . . It's common knowledge that
almost everyone experiences some memory loss as they grow older. But
the reasons, according to Murray Grossman, MD, associate
professor of neurology, "aren't explicitly clear. It could be
shrinkage of the cells, or neurons, or there may be some dropout
[cells shrink until they are so small they "die"], just the
way our body has other cells that get less effective as we get older."
Grossman told USA Weekend that some other theories include an
age-induced decline in neurotransmitters, or a degeneration of brain
tissue caused by stress-released chemicals like cortisol. Appeared in
the May 16-18 edition.
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