March 1999

National

• Penn Study Debunks ‘No Pain, No Gain’ Philosophy
• Fighting Sex Viruses With . . . Crest Toothpaste?
• The Fall Guy
• Don’t Get Stressed, Get Petty
• Clean-Air Measure May Be Hazardous

Local

• Nursing a Shortage

Perspectives

Snips & Clips

Penn Study Debunks ‘No Pain, No Gain’ Philosophy
 

For decades, experts advocated a workout that pushed the heart to 60 percent to 90 percent of its maximum rate for 20 to 60 minutes, at least three times a week. Now, a Penn study demonstrates that moderate exercise, such as walking or climbing stairs, is at least as effective in terms of increasing weight loss and overall well-being. The study was published in the January 27 Journal of the American Medical Association. 

“It turns out you don’t have to get your heart rate up as high as the exercise mafia used to believe,” Thomas A. Wadden, PhD, senior author and director of Penn’s Weight and Eating Disorders Program, told The Philadelphia Inquirer. “It’s the shift from being totally sedentary to being moderately active that is the real key.”

In the study, 40 obese women age 21 to 60 with an average weight of 196 pounds were put on a low-fat, 1,000-calorie diet, combined with either three aerobic-exercise sessions a week or 30 minutes a day of moderate physical activity such as walking briskly or climbing stairs. 

All of the women were treated for 16 weeks, then followed for a year. During treatment, both groups lost about 18 pounds, mostly because of the restricted diet. Even without exercise, they probably would have lost 15 pounds, Wadden told the Inquirer. 

During the follow-up period, when they were counseled just to eat sensibly, the aerobic-exercise group regained an average of 3.5 pounds, while the lifestyle group’s weight remained stable. More women in the lifestyle group kept up their exercise level than those in the aerobic group. By the end of the year, both groups had significant, similar improvements in cholesterol and triglyceride levels and blood pressure. 

(In the same issue of JAMA, a separate study conducted at the Cooper Institute for Aerobics Research in Dallas showed that lifestyle activity was generally as effective as more intensive aerobic exercise in improving cardiovascular health and fitness in 235 men and women.)

Said Wadden: “This study shows the benefits of accumulating small amounts of physical activity throughout the day and provides a welcome alternative to traditional moan-and-groan exercise.” 
Reports began January 27. 

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A substance found in common household items might help stop the spread of sexually transmitted viruses that cause AIDS, genital herpes, and genital warts. And researchers say FDA approval could be swift, considering that millions of people put the substance in their mouths and on their hair every day.

The substance is sodium dodecyl sulfate, a member of a family of chemicals called alkyl sulfates that are found in high concentrations in most toothpastes, shampoos, and skin products. The discovery that it can kill such viruses could have massive worldwide public health implications, say researchers, including Penn professor of biochemistry Daniel Malamud, PhD. “This is potentially very exciting,” he told The Omaha World-Herald. Human trials could begin within a year, and within five years could lead to the development of inexpensive, over-the-counter products that women could apply intravaginally before intercourse to protect themselves or their sexual partners from infection. In addition to helping to curb the spread of AIDS, use of the substance could block the human papilloma viruses, HPV, which cause genital warts. HPVs afflict one out of four women. In addition to being a potential source of cancer, they can cause physical lesions and emotional stress.

Many microbicides are effective against HIV, Malamud noted, but finding a weapon against HPV has frustrated scientists for some time. “This is the first one that shows what appears to be very potent activity against the papilloma viruses,” he said. Other research has shown that a person with HPV is more likely to contract HIV.

Reports began February 13.

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Last fall, American Health for Women sent Pamela Jacobs, a Philadelphia investment banker, to two leading stress-management experts, in exchange for sharing the experience with the magazine’s readers. The resulting article provided a rare, behind-the-scenes look at a patient consultation. Expert number one was Richard G. Petty, MD, assistant professor of psychiatry. 

“I had written out a list of what I wanted to talk about,” wrote Jacobs, “things that were worrying me. But Dr. Petty wasn’t the least bit interested in my list.” Instead, Petty took another route: He “started posing questions that really made me think about my relationship with stress. . . . He made me see that quite a lot of stressful events have happened in my life.” 
In the last eight years, she moved from Hong Kong to Philadelphia, switched jobs, had a baby, suffered four miscarriages, and developed allergies, back and neck problems, and chronic sinus infections. Petty listened with “rapt interest.” He asked her to describe her work and what she thought made her successful in it. 

“Business comes naturally to me,” she said. “I tend to think strategically, easily hypothesizing potential stumbling blocks in all situations, which is a real asset in the business world. At home, however, that kind of thinking only feeds my impulse to worry.” 

Petty’s diagnosis: “an obsessive-compulsive personality style.” That diagnosis worried Jacobs. “Wow, I thought I was doing pretty well,” she told him. “You are,” said Petty. “I didn’t mean that you have obsessive-compulsive disorder, just that you’re really trying to do the best for everybody and worrying a lot about it. If you let go of some of that, you could do even better.” 

Among his stress-reducing recommendations (including stretching and deep breaths) was to “recall epiphanies”: Think back on times when you successfully balanced work and family and “sit with your memories for a while. Try to recall as much detail as you can. Then file five or six of those icons at the forefront of your memory so you can call on the feelings to help you through stressful times in the future.” 

Printed in the January issue. 

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Is there a link between the use of a gasoline additive meant to clean the air and “an explosion of asthma” in the years since it was introduced? Peter M. Joseph, PhD, professor of radiology, thinks so. Examining statistical and anecdotal evidence from clinics, hospitals, and schools in the Philadelphia area, Joseph concludes that methyl tertiary butyl ether, or MTBE, is having the opposite effect than the one intended (by adding it to gasoline under a clean-air program in the city in 1993). He presented his findings before a general assembly of Connecticut lawmakers. 

“MTBE is not improving public health, but is actually harming it,” Joseph told The Hartford Courant. “I cannot prove it; I admit that upfront,” he said of the apparent link between asthma and MTBE use. “But I think the evidence shows it.” 

MTBE is a man-made chemical that most oil companies add to gasoline to comply with clean-air rules governing much of the East Coast and California. Proponents say that the additive poses no more health risks than gasoline without it. They say it helps reduce the amount of air pollution from cars, and that the federal Environmental Protection Agency agrees. But Joseph presented a chart of Connecticut Department of Environmental Protection data that showed that MTBE has not improved smog levels since the clean-fuels program began. He said a survey of kindergarten students by Stamford’s health department in 1996, after several years of MTBE use, found that 24 percent of the children has asthma, up from 7 percent in a smaller survey in 1992-93. 

Printed February 5.

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The American Association of Colleges of Nursing reports that enrollment in nursing bachelor-degree programs is down 5.5 percent. Various parts of the country have reported nursing shortages, and in others, nursing jobs have been cut. But in many cities — Philadelphia, for one — the demand for nurses remains steady. 

“We have plenty of teaching hospitals where you find a lot of patients who are very sick and require intensive care, and that creates a constant need for critical-care nurses,” Maureen McCausland, DNSc, RN, chief nursing officer for the Health System and associate dean for nursing practice at Penn’s School of Nursing, told the Philadelphia Daily News. 

Opinions on current nursing trends range from those who think the changes reflect a normal, cyclical ebb and flow, to those who see a deepening crisis. The baby boomer population is aging and people are going to live longer with chronic diseases, spelling out a greater need for nurses in the future. The average age of all registered nurses nationally was 44 in 1996; more than 62 percent of registered nurses are 40 or older. 

“It looks like we may be gearing up for one of the biggest shortages ever by the year 2010 or so,” McCausland said. “The baby boomer population of RNs will begin to retire, but the number of nurses behind them will be smaller.”

Printed January 17. 

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“There is absolutely nothing that prolongs life longer than estrogen for postmenopausal women — not seat belts, not stopping smoking, not regular mammographies.”
 — Barbara L. Weber, MD, associate professor of medicine [Subject: Hormone-replacement therapy and breast cancer]Mirabella, January/February issue 

“There’s still a lot of smartening up that can go on in the ICU.”
— C. William Hanson III, MD, associate professor of anesthesia  “Raising the IQ of Critical Care Units”
Technology Review, January issue

“Consent is irrelevant. When you’re dealing with desperate illness, people will consent to anything.” 
— Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics [Subject: Sham surgery — the latest medical controversy] Time, 2/22

“Back home it’s below zero during this time of year, so this for me is fantastic. If this is what Philadelphia is like, I’m staying.” 
— John Kotis, MD, plastic surgery resident and native of Chicago “Mother Nature Brings Summer Break to Keystone State” Associated Press, 2/12

“When it comes to losing weight there is no free lunch. And if there is a free lunch, then you probably don’t want to eat it.” — Thomas A. Wadden, PhD, professor of psychiatry 
and director of Penn’s Weight and Eating Disorders Program “Rules to Be Issued to Curb any Harm in Diet Programs” The Wall Street Journal, 2/10 

“Using the Internet, patients will continue to become more informed consumers. At the same time, medical students and trainees, as well as other interested parties worldwide, will use the Internet increasingly, changing the way they learn.”
— William N. Kelley, MD, CEO of the Health System and 
dean of the School of Medicine “CEO Predictions” 
Philadelphia Business Journal, January 1-7
 

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HIGH-PROFILE DISEASE. . . When asked to identify the greatest threat to their health, most women name breast cancer, ignoring more common killers, such as heart disease and lung cancer. Some doctors worry that excessive fear of breast cancer might lead women to be cavalier about smoking or lack of exercise, or to refuse estrogen- replacement therapy after menopause because of the slightly increased risk of breast cancer linked to the hormone. Advanced heart failure “sounds like something you can live with, even though it’s a fatal disease,” said Barbara L. Weber, MD, professor of medicine, in the Omaha World-Herald. “It sounds less painful than breast cancer.” Printed January 31.

The MONITOR WILL SEE YOU NOW. . . Soon consumers may flock to malls for more than just shopping, fast food, and movies. At the MacDade Mall in Pennsylvania, shoppers can get a quick doctor’s visit for $15. But there’s a twist: Patients to the new MacDade Medical Center are treated through telemedicine, using a videophone and a high-speed modem to link the patient to a doctor who may be miles away. The doctor uses typical physicians’ tools, including laryngoscopes and otoscopes, but they’re attached to cameras, so the doctor gets an up-close view on his or her own TV screen. If the doctor cannot make a diagnosis via television, the patient can return for an in-person visit at no additional cost. Some experts, including Center for Bioethics Director Arthur L. Caplan, PhD, wonder about the quality of these consultations. “There is no agreed-upon schema for doing consults from the mall on the television,” he told The Philadelphia Inquirer. “We need standards and consensus on what questions need to be asked and how to diagnose.” Printed January 3. 

HOW LOW CAN YOU GO?. . . While the risks of high blood pressure may be well known, most people are unaware that low blood pressure may be a risk factor for glaucoma, the most common cause of preventable blindness. Recent research at Penn revealed that people with low blood pressure often have poor blood flow or circulation in the optic nerve, the part of the eye damaged by glaucoma. People at risk for glaucoma — including those with a family history of the disease and African-Americans — should strive to keep their blood pressure as close to “normal” (120 over 80) as possible. “When I start hearing people say, ‘Oh, my doctor says my blood pressure’s great. It’s 110 over 60,’ I get really nervous,” Jody Piltz-Seymour, MD, assistant professor of ophthalmology, told WCAU-TV’s News 10 First at 4 p.m. Aired January 28.

GOD BLESS YOU!. . . Can attending church increase your chances of catching a cold? Sounds sacrilegious, until you consider some aspects of attending mass: drinking wine from a common chalice; receiving the communion wafer in your hand or mouth; shaking hands during the “sign of peace”; hugging. Germs have plenty of opportunities between “let us pray” and “amen.” “The added risk of picking up [a cold or flu] is small, but real,” Rob Roy MacGregor, MD, professor of medicine, told the Philadelphia Daily News. “But because the most common way of passing on germs is from hand-to-hand contact, I’d probably not shake hands with somebody who was coughing and sniffling.” MacGregor said common sense and common courtesy are often enough to reduce the risk of transmitting germs. “I think people are sophisticated enough to know not to extend their hand if they have a cold, and to not be offended if someone doesn’t extend theirs,” he said. Printed February 3.

THE YEARLONG PREGNANCY. . . Though gestation usually takes nine months, many obstetricians say women should start thinking of pregnancy as a 12-month event. The additional three months should be for preparing physically and psychologically for pregnancy. Luigi Mastroianni, MD, professor of obstetrics and gynecology, told the Tampa Tribune that the period should include a visit to the doctor for a complete medical history, along with a physical exam and a Pap smear. In addition, women should have a blood test to check for immunity to certain viruses and be screened for sexually transmitted diseases. Genetic screening may also be suggested, said Mastroianni, depending on family history or racial or ethnic background. Printed February 3.

OUT OF SIGHT. . . Age-related macular degeneration strikes one in 20 Americans 65 and older. In its most severe form, it can cause legal blindness within three years. Researchers are testing a number of strategies for halting its progression; one approach uses radiation therapy. While studies have suggested that it may hold promise in the fight against AMD, the technique has not yet been tested in clinical trials. “There are conflicting reports [about radiation therapy],” Jeffrey Berger, MD, PhD, assistant professor of ophthalmology, told USA Today. “Some show encouraging results, and some show no help at all.” Printed February 9.

DID SOMEBODY SAY McDONALD’S?. . . Experts say there’s a difference between real hunger and cravings, and the weight-conscious can benefit from learning to distinguish them. Hunger is a biological need to eat something because your stomach is empty, Thomas A. Wadden, PhD, professor of psychiatry and director of the Weight and Eating Disorders Program, told USA Today. If you are really hungry, almost any food will satisfy you, although most people tend to want protein rather than high-sugar, high-fat foods when it’s time for a meal. A craving is an intense desire for a specific food—for example, says Wadden, you watch a movie and think, “I’ve got to have popcorn.” It’s hard to bear cravings, and people who never give into them tend to feel deprived. But by resisting some of your cravings—which experts say last about 10 minutes—and learning to eat only when hungry, you can better manage your weight. Printed January 4.

FAMILY PLANNING. . . Is it ethically acceptable for parents of a child with leukemia to have another child in the hopes of creating a suitable bone-marrow donor? Yes, says Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics. Caplan told the Cleveland Plain Dealer that he sees no problem “as long as [the parents’] motives are mixed: They want the child and they want to save their other kid.” After studying 40 cases in which couples conceived children hoping to create a compatible donor, Caplan said, “I’ve never come across the family who conceived a child just as a bag of parts.” Printed January 24.

THE THREE PHASES OF EVE. . . What lies ahead for girls on the verge of adolescence and their parents? Liana R. Clark, MD, adjunct assistant clinical professor of pediatrics, told Essence magazine that teens go through three phases of emotional development. During early adolescence, teen girls may feel awkward about changes in their bodies. In middle adolescence, they try to fit in with their friends, rebel against their parents, and seek out a way to develop their own identities. By late adolescence, teen girls, with a new sense of self, are able to think more philosophically and make plans for the future. Parents should make a concerted effort to stay involved in every phase, says Clark. “Most troublesome situations arise when there is a breakdown in communication between the parent and the teen.” Printed in the February issue.

CHECKING THE MALE. . . The New Observer turned to Harold Mignott, MD, assistant professor of medicine, for the lowdown on the Men’s Health at Overbrook program. Created by the Health System’s Office of Community Affairs and the Father’s Day Rally Committee, the program aims to highlight men’s health issues and provide diagnosis and treatment services. “One of the biggest problems we have in the community is lack of information on health issues,” says Mignott. “When you have information, you can use it to whatever degree you choose. I don’t have any problems with somebody being informed and deciding not to go the route we say. What I have problems with is making decisions out of ignorance.” Printed January 27.

MADE TO ORDER. . . Advances in genetic and fertility services mean that some day soon parents-to-be may be able to pick their baby’s sex, eye or hair color, or other characteristics. While many experts believe genetic screening should be limited to testing for inherited diseases, prospective parents may be tempted to try to create the “perfect” child. The Center for Bioethics’ Glenn McGee, PhD, has been surveying couples going through infertility treatment about their attitudes toward designer-baby issues. “Couples are astonishingly willing to change their future offspring, right up to the moment when you give them any sort of real risk to a potential human being,” he told The Detroit News. Printed January 31.

HOLD IT. . . Women with stress incontinence may experience involuntary urine leakage during physical activities such as running, lifting, and laughing. The problem? Usually weak pelvic floor muscles, which support the bladder and help control the flow of urine, Alan J. Wein, MD, chair of urology, told Fitness magazine. Physical activity puts pressure on the pelvic muscles and bladder, and if the bladder is full, urine can be forced into the urethra. Urinating before working out can prevent accidents, and Kegel exercises can strengthen the pelvic floor muscles. Printed in the February issue.  

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