Breaking News

USA Today

The New York Times

CNN Morning News

The Philadelphia Inquirer

New York Post

Science

Essence Magazine

Jet

Internal Medical World Report

Sacramento Bee

Oakland Tribune

Rodale Press' Heart & Soul

WPVI-TV6

Philadelphia Tribune

WRC-TV4 (Washington)

Black Women Burn Calories More Slowly

At rest, overweight black women burn fewer calories than overweight white women, according to a study led by Gary Foster, PhD, clinical director of Penn's Weight and Eating Disorders Program. The findings--published in the January issue of Obesity Research--may explain why black women seem to have a harder time losing weight than white women.

Foster and his colleagues studied the resting metabolic rates of 122 obese white women and 44 obese black women who weighed an average of 224 pounds. They found that the black women burned an average of 1,638 calories a day, versus the 1,731 calories that the white women burned daily. The difference remained even after the calculations were adjusted for body weight and muscle mass.

Statistics show that about 52 percent of black women are overweight, compared to 33 percent of white women. Previous studies have focused on the socioeconomic and cultural factors that may explain the weight differences.

"The take-home message... is that environmental factors clearly are important, and these data don't diminish that," Foster was quoted in The Philadelphia Inquirer. "However, these are among the first to suggest that biological factors, over which people have no control, have an effect on weight."

Foster told USA Today that the exact reason for the difference is not known. However, the results don't mean that black women are "doomed to be fat. They may just have to work harder. We hope these findings can help obese black women and their doctors appreciate the many factors that affect weight loss."

Reports began March 10.

.

Newsweek

USA Today

The New York Times

The Wall Street Journal

The Philadelphia Inquirer

New York Daily News

Time

Business Week

Los Angeles Times

Baltimore Sun

Atlanta Constitution

Seattle Times

CBS Evening News

NBC's Today

ABC World News Tonight

The Ethical Implications of Cloning

When researchers in Scotland announced the first successful cloning of an adult sheep in February, the news stunned the world. And the ensuing question that begged to be answered was: can humans be cloned? If so, is it ethical, and should it be legal? Around the water cooler, people pondered the ways human clones could be used--to create offspring for childless couples, to ÒreplaceÓ a loved one who has died, or to create "spare parts" bodies for organ transplants.

Numerous news outlets sought the insight of University of Pennsylvania Health System experts on the topic, including Arthur L. Caplan, PhD, director of the Center for Bioethics, 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, and Luigi Mastroianni, MD, professor of obstetrics and gynecology.

"This is as close to a Xerox machine as we are going to get in reproductive technology," McGee told The Philadelphia Inquirer.

"Maybe having a copy made of Fluffy or Fido if you know (the pet) is going to expire, would be appealing to people," Caplan said in USA Today. However, he told the Atlanta Constitution, "There's absolutely no excuse for doing this anytime soon in a human being. It would be morally despicable."

Within days of the announcement, President Clinton stepped in to ban the use of federal funds for human cloning research. He also asked private-sector researchers to voluntarily refrain from such research. Meanwhile, the president's bioethics panel, on which Caplan sits, will study the issue.

"[The National Bioethics Advisory Commission] was a quiet committee that would take a reasonably paced look at two emerging areas and let the media and Congress understand what's going on," Caplan told The New York Times. "All of a sudden, cloning explodes, and the president looks desperately for whom he can turn to for help and advice. The only group he can go to is the [commission]."

Reports began February 24.

Infection-Fighting Peptide Discovered

Researchers at Penn have identified a single molecule--a naturally occurring antibiotic peptide--that may play a role in the human lung's natural immunity to infection. The presence of the peptide, called human beta-defensin 1, may explain why, even through the air we breathe is laced with bacteria, healthy people do not become infected by it. In cystic fibrosis patients, however, the peptide is inactivated by the high salt levels present in the lungs, which result from the genetic defect.

An article in The Washington Post reported on the finding, which was published in the February 21 issue of the journal Cell. The news offers an explanation of how the genetic defect implicated in cystic fibrosis leads to lung infections in patients. Lung damage caused by repeated infections is the cause of death in 95 percent of cystic fibrosis victims.

"To me, the fascinating issue was, what is the relationship between the defect in this gene and the disease?" said James M. Wilson, MD, PhD, director of Penn's Institute for Human Gene Therapy, and senior author of the report. "This, I think, is the first model that makes logical sense and is based on experimental data."

Wilson noted that, even though the cystic fibrosis gene was discovered in 1989, researchers still do not fully understand why the defective gene causes the disease. But in recent years, evidence has grown that the defective gene is linked to the patient's vulnerability to infections.

The article appeared February 25.

USA Today

The New York Times

Modern Healthcare

North Hills News Record

Metropolitan News-Enterprise

Bucks County Courier-Times

The Best Approach for Clogged Arteries

Angioplasty and heart bypass surgery both result in about the same improved quality of life and relief from symptoms for patients suffering from clogged arteries. But according to a study published in the Journal of the American Medical Association, many angioplasty patients require additional procedures over the next five years because their arteries clog up again.

Some doctors criticize the report, claiming that it does not take into account state-of-the-art improvements in treating clogged arteries and does not fully consider the need for repeat angioplasties.

"Nobody is getting harmed by having angioplasty first," said Timothy Gardner, MD, chief of cardiothoracic surgery and the William Maul Measey Professor of Surgery, in an article that appeared in USA Today. "But the people who have angioplasty are going to have many more procedures, and at least a third are going to end up having surgery anyway." Gardner noted that about 5 percent of bypass patients need another procedure within five years.

According to the study, 550,000 Americans have either angioplasty or bypass surgery each year. The five-year survival rates for the two procedures are about the same, except with diabetic patients, who have better survival rates with bypass surgery.

Reports began March 5.

Desperately Seeking Marcus Welby

Perhaps the best thing that physicians can do to avoid malpractice suits is to develop a concerned, compassionate attitude toward patients. According to a study that appeared in a recent issue of The Journal of the American Medical Association, doctors who tell patients what to expect during a visit, use humor, and solicit their patients' opinions have fewer malpractice suits filed against them. Patients faced with a bad outcome are more likely to sue a physician if they feel he or she is not caring and compassionate.

The authors of the study said that, although previous studies have recognized the link, theirs is the first to identify what specific communication behaviors physicians need to adopt to decrease their malpractice risk.

David Shulkin, MD, chief medical officer for HUP and assistant professor of general internal medicine, commented on the study in Hospital and Healthcare News. "The study shows that patients still want Marcus Welby in their doctor," Shulkin said. "They want a good relationship and a physician who explains things to them; a doctor who is warm and who will take the time to interact."

Shulkin noted that the study showed that patients did not expect the same attitudes from their surgeons. "In surgeons, patients want good technicians," Shulkin said. "They have a specific issue that needs correcting and they want that done in the best technical way possible. They don't care as much about the warmth of the relationship with the surgeon."

The article appeared in the March issue.

Penn Among the Highest Ranked Medical Schools

The University of Pennsylvania School of Medicine ranked seventh in a U.S. News & World Report survey of the nation's research-oriented medical schools.

According to the survey, the nation's ten best medical schools are (in descending order): Harvard University, Johns Hopkins University, Duke University, University of California-San Francisco, Washington University, Yale University, University of Pennsylvania, Columbia University's College of Physicians and Surgeons, University of Michigan at Ann Arbor, and Stanford University.

In two specialities--pediatrics and women's health--Penn ranked among the top five programs nationwide. The programs topping the list in various specialties were the University of California--San Francisco for AIDS research; Harvard University for drug and alcohol abuse treatment, internal medicine, pediatrics, and women's health; the University of Washington for family medicine and rural medicine; and Johns Hopkins University for geriatrics.

The criteria used in the survey of 125 medical schools included student selectivity, faculty resources, research activity, and the average percentage of graduating doctors going into primary care. Overall reputation was assessed based on the results of two questionnaires--one distributed to medical-school deans and senior faculty, and the other to directors of intern-residency programs.

Disease Management Extraordinaire

The University of Pennsylvania Health System's disease management program was called a leader in the field in a recent issue of Strategies for Healthcare Excellence. For his extensive write-up, managing editor David O. Weber interviewed David Bernard, MD, senior medical director for disease management, David Shulkin, MD, chief medical officer for HUP and assistant professor of general internal medicine, and Stanley Schwartz, MD, associate professor of medicine. "Bill Kelley... is so committed to disease management," Shulkin said, "he's now telling people he believes it's not only the wave of the future, but, in fact, the real promise of integrated delivery systems."

"[Disease management] has really been in the making for years," Bernard added. "At its core is what we've done to manage costs and clinical quality in the hospital setting. But now that integrated delivery systems are forming and reimbursement mechanisms are changing, there's a fantastic opportunity to take what we've been working on inside the hospital and have much more impact by spreading it across the whole continuum of the healthcare system."

Schwartz provided some details of the disease management program he is working to design for diabetic patients in the University of Pennsylvania Health System. It includes taking a teamwork approach to outpatient care and supervision of people with diabetes, insisting that patients monitor their own blood glucose levels at home, and ensuring that the patient and the team remain in constant contact.

About program guidelines, Schwartz cautioned, "We can give [physicians] guidelines, but guidelines are not judgment." He added, "Everybody gives guidelines... But unless you do more, they just sit there."

The article appeared in the March issue.

Ready for Change

Medical school applicants have always wondered what the trick is to getting accepted to the best medical schools. In a Newsweek supplement, Gaye W. Sheffler, Penn's director of admissions and financial aid for the School of Medicine, gave readers some inside information. "Obviously, we look at academic excellence, which means the applicant's academic record [GPA], the quality of [his or her] school, and the medical college admissions test," Sheffler began. Additionally, nonacademic experience, leadership roles, and letters of recommendation are pluses.

When asked what she looks for in an applicant today that she wasn't looking for five years ago, Sheffler replied, "They have to be able to adapt to change. Medicine is an evolving discipline and career. Doctors in the future will have to work as members of a team and part of a managed-care environment. And because there has also been an explosion of science in the last 30 years, individuals have to be very resourceful and be able to be lifelong learners."

Sheffler said that today's candidates are more computer-literate than their predecessors. She has also noticed that students have become more socially responsible and more community-service oriented. She added that the average applicant these days applies to 12 medical schools.

And what was the single most important tip she could give an applicant? "Know thyself," Sheffler said. "I think they have to love what they're doing and really love the helping services and helping sciences and be prepared for change. We know we want to continue to provide quality care. But we don't know exactly what kind of establishment we'll have."

The article appeared in the "1998 Edition Special Supplement."

A Rare Heart-Liver Transplant

In February, doctors at the Hospital of the University of Pennsylvania performed the region's first combined heart and liver transplant. Nationally, only about a dozen patients have received the surgery.

A front page article in The Philadelphia Inquirer tracked the progress of the patient--Terry Rivers--before and after her surgery. Rivers is a 39-year-old Philadelphia mother who was close to death from heart and liver failure. Prior to the transplant, physicians debated the merits of using two organs on the same patient, especially because there are hundreds of patients in the region waiting for hearts and livers. "If we did it and we failed, it would be a total waste," said Michael Acker, MD, assistant professor of surgery and director of HUP's heart-transplant program.

"You think to yourself whether it's worth the investment," said Abraham Shaked, MD, PhD, associate professor of surgery and head of HUP's liver-transplant program. But the conclusion was in Rivers' favor because of her age, and because her heart and liver were the only diseased organs in her body. They also considered that she had an eight-year-old daughter to raise

Shaked and Acker performed the surgery together--first the heart and then the liver. Both organs were donated by the family of a 24-year-old man killed in an auto accident. The heart portion of the surgery took about three hours, and the liver portion took about four. Both organs started working immediately. "We were all very happy," Shaked said.

Rivers' physicians estimate that she has a 70 to 80 percent chance of surviving the first year after the surgery, and it is likely she will live much longer than that.

The article appeared March 1.

Emergency Care for Stroke Patients

In the past, there was little physicians could do for patients who suffer strokes other than evaluate the damage. But now, with the availability of drugs such as tissue plasminogen activator, or TPA, some patients have a chance at reducing the amount of disability that commonly results from stroke. The catch is that TPA must be given within three hours of a stroke.

Researchers are looking into the effectiveness of additional drugs to treat stroke, such as neuroprotective agents, which make the brain more tolerant of low blood flow and protect if from the chemical reactions that occur in the injured tissue.

"We are at a watershed in the development of neuroprotective compounds," said Eric C. Raps, MD, associate professor of neurology, in an interview that appeared in The Philadelphia Inquirer. "Many will complete studies this year, and the FDA approval may come in the next 12 to 24 months.... What the future holds is combination treatment, with neuroprotectives combined with thrombolytics."

The article appeared March 10.

Disabled for a Day

Medical school lecturers can talk about bedside manner and compassion for patients, but it's usually difficult for young students to understand how a patient is feeling because most have never "been there." Seeking insight, 14 University of Pennsylvania School of Medicine students took part in a 28-hour workshop in January designed to teach them firsthand what it is like to be chronically disabled. The workshop was conducted by Alicia Conill, MD, an assistant professor of medicine and a multiple sclerosis patient.

Students were divided into two groups. The members of one group were assigned specific disabilities, including multiple sclerosis, effects of a stroke, and blindness caused by diabetes. The other half played the role of caregivers to the patients. Props were used to help simulate the disabilities. One student wore a plastic bottle cap in her mouth to simulate a speech impediment; another wore dark glasses with Vaseline smeared on the lenses to simulate blindness. "Disabled" students were required to sleep "in role," wearing whatever braces and supports were associated with their disabilities.

"You can't teach the issues of living with a disability in a lecture format, because students won't get it," Conill told The Philadelphia Inquirer. But students in the workshop learned a lesson. The "patients" found it frustrating to have to rely on someone else to help them meet their basic needs. And as patients, modesty and control were no longer theirs. "Caregivers" reported exhaustion from the effort that was required to push, soothe, and dress their charges, as well as to assist in toileting. Conill admitted that the 28-hour class gave students only a small taste of what it is like to be ill. "There isn't a way to fully reproduce a chronic disability," she said.

The article appeared February 17.