Trauma: Life & Death in HUP's ER

"The people in this world put on a tremendous show, and doctors have a front row seat."

Carl Augustus Hamann

The Philadelphia Inquirer's Jonathan Storm called Trauma: Life and Death in the ER "the best show on television" the night it premiered on The Learning Channel. "From Ben Casey to ER, television has given us glimpses into hospital life. Through Trauma: Life and Death in the ER , we get to live that life. It's scary, sobering and exhilarating. A night in the life of the HUP trauma center, filmed with in-your-face, small format cameras by Video News International, Trauma has more excitement than Cops ... more drama than almost any made-up show." New York Times television critic Walter Goodman called the program "a blast": "The professional cool is as impressive as the array of miracle tools at the team's beck."

To obtain the graphic footage for the hour-long special, producer Glenda Hersh had five cameramen shadow the staff in emergency medicine and trauma inside the Hospital of the University of Pennsylvania over a five-week period. The way the teams function at HUP is "no different than Vietnam, no different than Korea," says C. William Schwab, MD , chief of the division of traumatology and surgical critical care. "It's just the streets of Philadelphia."

But the show isn't all gunshot wounds and accidents: The documentary also enables the viewer to glimpse the interpersonal drama of the resilient men and women who still get a "high" from the fast pace and constant action, even as they battle exhaustion and workplace tension to care for the sick and injured.

Drs. Steven C. Larson and Sarah A. Stahmer , assistant professors of emergency medicine, and trauma fellow Michael Grossman, MD, are also featured prominently in the program, which first aired March 13 with facilitation by the Media Relations staff.

Editor's Note: The critics were right: Trauma is in the running for a national Emmy Award in the "News and Documentary" category. Stay tuned!

Cautious Optimism: Growth Hormone for Heart Failure

Exceptionally short children may not be the only beneficiaries of human growth hormone. When Italian researchers gave the drug to a patient who also happened to have idiopathic dilated cardiomyopathy a common cause of heart failure in which the walls of the heart are too thin to support its main pumping chamber they noticed that it worked impressively on the heart condition.

In a preliminary study published March 28 in the New England Journal of Medicine, seven patients who received the genetically engineered hormone showed "significant improvement in most indexes of cardiac size, shape and func tion, and in maximum exercise tolerance." That improvement waned three months after the drug treatments were discontinued.

In an accompanying editorial, Evan Loh, MD , assistant professor of medicine, and Judith Lea Swain, MD , chief of the cardiovascular division, said that while the results "are exciting and dramatic, our optimism must continue to be cautious." They noted the small study did not include an untreated comparison group, and pointed out that the researchers do not understand how the hormone works nor its long-term effects on patients.

Published reports appeared March 28 through April 7.

CIA Technology: Spying On Breast Cancer

High-tech spy systems that enable the nation's defense and intelligence commu nities to conduct its covert operations are being tested at the Medical Center for a humanitarian purpose early and accurate detection of breast cancer. The U.S. Pub lic Health Service's Office on Women's Health has initiated a unique partnership with the Central Intelligence Agency to shift the imaging technologies used for mis sile guidance and target recognition from the battlefield to the war on breast cancer. The project is enabling scientists to use the same ultra-smart imaging techniques that scan the surface of Mars and pinpoint tanks behind heavy camouflage to search out small tumors in dense breast tissue.

U.S. Senator Arlen Specter introduced the breakthrough techniques March 4 at a standing-room only press briefing organized by the Media Relations staff. The pro gram From Missiles to Mammograms also featured assistant surgeon general Dr. Susan Blumenfeld, federal intelligence and information specialists, and radiology's Mitchell D. Schnall, MD, PhD, chief of the Magnetic Imaging Section, who detailed pilot studies being conducted at Penn. "What this technology allows us to do is find the cancers sooner; find them when they're smaller; find them when they're more treatable," he told Channel 10's Janet Zappala.

Print and broadcast reports began March 4.

Penn Researchers Resolve Elusive 3-D Structure

For more than 30 years, scientists have tried to learn the molecular structure of a protein identified as the lac repressor. Knowing what the protein looks like in three dimensions has long been considered an important step for future discoveries, be cause the lac repressor has been an extremely useful model of gene regulation.

Now, Penn researchers have resolved the structure. In the March 1 issue of Science, Mitchell Lewis, D.Phil., associate professor of biochemistry and biophys ics, and his colleagues, including Ponzy Lu, PhD , professor of chemistry, reported how they crystallized the lac repressor in three conformations and then, using defraction analysis, deduced its structure. A full-color, computer-generated image of the lac repressor molecule bound to DNA in the act of blocking gene transcrip tion appears on the journal's cover.

The object of this long search is the protein responsible for regulating a cluster of genes that control the metabolism of lactose in E. coli bacteria. Now that they have a clear picture of the protein's three-dimensional structure in hand, scientists can understand precisely how the lac repressor functions at the molecular level. One possible result is that researchers may be able to customize similar molecular switches to turn selected genes on or off on demand. Such technology would have significant implications for gene therapy and other molecular medicine.

Coverage began March 4 in response to pitches made by the Media Relations staff.

Advil & Tylenol: Ads Give Consumers A Headache

The makers of Advil and Tylenol are battling in print and television advertise ments about which is the safest bet for pain relief. Advil ads point out that Tylenol (acetaminophen) comes with a warning relevant to alcohol use; Tylenol ads attack Advil (ibuprofen) by suggesting it causes stomach problems. The risks being debated are very small, but with a potential market of about $3 billion in sales of over-the -counter pain relievers, how consumers perceive those risks is vital.

An authority cited by both sides, Brian L. Strom, MD, MPH , director of the Center for Clinical Epidemiology and Biostatistics the author of an editorial on the relative risk of the two drugs published in the Journal of the American Medical Association told The New York Times that it was difficult to calculate the comparative risks, but that a rough estimate would suggest that, setting aside the seri ousness of the side effects, the number of cases of gastrointestinal bleeding from ibuprofen was probably 50 to 100 times as great as the number of cases of liver disease caused by acetaminophen.

"I am very concerned that people, especially alcoholics, not begin a big switch from acetaminophen to ibuprofen," said Dr. Strom. If they do, he said, it could mean a sudden epidemic of gastric bleeding, adding, "no one wants to see that."

The article was published March 27.

Formularies: Increasing Health Care Costs?

Patients in health maintenance organizations whose access to prescription drugs was most restricted incurred the highest overall health-care costs, according to a controversial study of cost-containment practices involving 13,000 patients in six HMOs. The report, being published in a new journal called the American Journal of Managed Care, said patients in the HMO that didn't use a formulary an ap proved list of medications had the lowest costs.

The study found that in the HMO with the strictest formulary, patients got more prescriptions, had more visits to the doctor, more emergency room care and higher hospital use than patients in the HMO that didn't limit the use of brand -name or high-cost drugs.

J. Sanford Schwartz, MD, director of Penn's Leonard Davis Institute, said the findings point to the need for better integration of cost strategies with the delivery of care. "My gut feeling is that well-constructed formularies can be cost-effective. But most systems out there are still just managing costs, not managing care. It isn't as simple as creating a formulary and thinking all the problems are going away."

The article was published March 20.

Penn Med: 'Top 10' School Has 'Best Docs'

In "the most accurate, and exhaustive nationwide appraisal of great doctors ever undertaken by a magazine," American Health named "The Best Doctors in America" after surveying more than 3,200 specialists at 350 academic medical cen ters across the U.S. The specialty listings included the following Penn physicians at HUP and CHOP:

Our acclaimed faculty may be part of the reason that the University of Pennsylvania School of Medicine placed sixth up a notch from last year among 125 research-oriented medical schools ranked by U.S. News & World Report in its annual "America's Best Graduate Schools" issue. A reputational survey of medical school deans and senior faculty placed Penn's pediatrics program among the top five in the country.

Published in the March issue and the March 18 issue, respectively.

Penn Study: Neighborhoods In Distress

In a groundbreaking study based on over 50,000 prior addresses, Penn researchers have found that two-thirds of all the families who became homeless in New York City and Philadelphia during a five-year period came from three densely clustered areas within the poorest neighborhoods in both cities. The areas identified with high rates of homelessness are distinguished by overcrowded housing, aban donment, and high vacancy rates, yet the housing remains unaffordable to the mostly African-American families and female heads-of-households who populate them.

"Many of the neighborhoods are in a state of decay, and sometimes entire blocks of homes are vacant and abandoned, suggesting that problems like disinvest ment and concentrated poverty are chipping away at neighborhoods and driving men, women and children into homelessness," said principal investigator Dennis P. Culhane, PhD, associate professor in psychiatry's Center for Mental Health Policy and Services Research.

In a Channel 6 interview, North Philadelphia resident Adrene Taylor testified to Dr. Culhane's findings: She and her two children were the last tenants in their apartment building. "We had no heat. Then my landlord turned the water off and never came back," she said. "We had to leave."

Print and broadcast coverage began March 28 in response to pitches made by the Media Relations staff..

Hurry Up & Get Well: Managing Mental Health

In an in-depth cover story for The Philadelphia Inquirer Magazine, Gloria Hochman examined managed mental health care "the incendiary hybrid of medi cine and business that is up-ending the practice of psychiatry and psychology and revolutionizing the delivery of treatment to medicine's most vulnerable patients." According to Ms. Hochman, under most insurance plans, it's no longer the patient or the therapist who makes the big decisions: Increasing numbers of patients with mental illness are stunned to learn that, if they expect their insurance to pay for treatment, they must leave the therapist who has been helping them get well, that they must bargain for the number of visits they need to recover, and that confiden tiality is passé.

"The psychiatrists of the future will have to be more multifaceted willing to evaluate, supervise, work in a team with other mental health specialists, teach, and measure treatment outcomes," said John A. Sargent, III, MD , associate professor of psychiatry.

Some compare managed care's bottom line approach to mental illness with people who support the "pull-yourself-together-and-snap-out-of-it" mindset. "It's nonsense," said Jay D. Amsterdam, MD, professor of psychiatry. "Getting some one to talk himself out of mental illness is like getting someone to talk himself out of diabetes."

The seven-page feature was published March 3 with facilitation by the Media Relations staff.

Sound Bite: Joint Replacement for TMJ

Conservative therapies such as stress management, physical therapy and mouth guards are effective for most of the patients who suffer from temporomandibular joint (TMJ) problems which include facial pain, clicking of the jaw and grinding of the teeth. Surgery is the treatment of choice when the joint is damaged, and now the most severe cases may benefit from joint replacement.

Peter D. Quinn, DMD, MD, chair and professor of oral and maxillofacial sur gery, has developed a procedure in which a deteriorating ball and socket mechanism is replaced with an artificial joint. "We work in a tunnel, and make a small incision in front of the ear and one down in the neck," he explained to Channel 29 viewers. "We put the socket part through the upper incision, and the ball part through the lower incision. It actually screws to the jawbone.

"There are patients who have been almost crippled by this jaw disease," he said. "It clearly has been the best advance for that type of patient."

The interview aired March 26 in response to pitches made by the Media Rela tions staff.

A Capsule A Day Keeps The Doctor Away

According to a British study, an inexpensive food supplement may be a power ful weapon in the fight against heart disease. Researchers found that a dime's worth of vitamin E reduced heart attacks by 75 percent when taken daily by people with heart disease.

Cardiology's Irving M. Herling, MD, associate professor of medicine, told Channel 3's Carol Erickson that he wasn't surprised by the findings. Doctors have noticed in recent years that people who consume lots of vitamin E supplements seem to lower their risk of heart attacks. Vitamin E one of a group of nutrients known as antioxidants is thought to thwart the process that leads to the build-up of fatty deposits in the arteries. "Here we have something that has no down side and a poten tial significant upside," he said.

Investigators have seen no unwanted side-effects from the vitamin. Dr. Herling told viewers, "It's a safe thing to take if you are prone to coronary heart disease, or a history of coronary disease," adding, "It's probably a reasonable thing to con sider." Indeed, he prescribes a daily capsule of the risk-free vitamin to his patients to help keep their hearts healthy.

The report aired March 25 with facilitation by the Media Relations staff.

PET Scans: Showing Damage Before Symptoms

Using sensitive brain scans, researchers in Arizona were able to detect the dam aging effects of Alzheimer's disease on the nerve cells of 11 healthy patients years before doctors could expect to see outward symptoms. All of the study volunteers each carried a variant of a gene called APOe, associated with high risk of develop ing Alzheimer's had brain scans showing significantly reduced cell activity.

With the help of psychiatry's Anand Kumar, MD , director of the Mood and Memory Disorders Clinic, Channel 29's Dr. Brian McDonough was able to show viewers the powerful images produced by positron-emission topography (PET). PET scans identify brain activity by measuring how well cells turn blood glucose into en ergy. "Red and orange show areas of high glucose absorption, and blue and green, low absorption," explained Dr. Kumar. "These 'normal' people had abnormal PET scans; their brains were utilizing glucose as though they had Alzheimer's disease."

The technique may someday provide a powerful tool for identifying people likely to develop the degenerative brain disorder. Such a predictive tool, scientists believe, will help test whether experimental drugs can slow or halt the progression of the disease.

The segment aired March 20 with facilitation by the Media Relations staff.