NOVEMBER 1996

INTERNATIONAL

Breaking News New Scientist (London) Associated Press USA Today Wall Street Journal New York Daily News Los Angeles Times San Francisco Chronicle Denver Post Baltimore Sun Atlanta Constitution Dallas Morning News Philadelphia Inquirer CNN WABC-TV7 New York WLS-TV7 Chicago Science News   Penn Discovery: HIV Locked Out By Mutated Gene "When meditating over a disease, I never think of finding a remedy for it, but, instead, a means of preventing it." -C Louis Pasteur   Penn scientists have found that as many as one in 100 whites of European descent have a genetic defect that may protect them from AIDS sexually. The finding may explain at least in part why a fraction of people defy the odds and escape HIV infection despite repeated unprotected exposure to the virus. It also opens new possibilities for treating and preventing the disease. In June the same research team and others identified a so-called co-factor, a chemical receptor called CKR5 or CCR5, that must be present for certain strains of HIV-1 to enter and infect cells. The latest work shows that cells from people with two mutated copies of CCR5 - one from each parent - appear to be completely resistant to the most common sexually transmitted varieties of HIV. People with one defective copy can get infected, but they will remain disease-free much longer than people with no defective copies of the gene. So far, the mutation has never been found in African or Asian populations. "People are walking around who don't have this CCR5 molecule, who can't get infected, and who are healthy," Robert W. Doms, MD, PhD, assistant professor of pathology and laboratory medicine, told the Atlanta Constitution. "So you could knock this protein out, protect against HIV, and it won't cause side effects." The study, the result of a collaboration with Belgian and French researchers, appeared in the August 22 issue of Nature. Media accounts began August 9 in response to pitches made by the Media Relations staff.   NATIONAL Breaking News: Knight-Ridder Seattle Times Orange County Register Atlanta Constitution Reading Eagle Philadelphia Inquirer Asbury Park Press Hospital & Healthcare News Philadelphia Medicine     Brain Cancer: Gene Therapy Trial Begins   A lengthy addition to Donald C. Drake's series, "The Quest: Seeking an Ultimate Cure," focused on an experimental gene therapy effort at the Medical Center to eradicate malignant brain tumors that have proven unresponsive to conventional treatments. The goal of the Phase I clinical trial - a joint effort of Penn's Institute for Human Gene Therapy, the University of Pennsylvania Cancer Center, and the Wistar Institute - is to establish the safety and feasibility of the protocol, which uses a genetically engineered virus to deliver a "suicide gene" to the tumor cells. The gene codes for production of an enzyme called thymidine kinase, which makes the cells selectively susceptible to a powerful follow-up drug therapy. On July 15, Kevin D. Judy, MD, assistant professor of neurosurgery, injected the vector into several sites within the relapsed cancerous brain tumor of volunteer Joseph C. Hilly, a HUP electrician. Two days later, Jane B. Alavi, MD, associate professor of medicine in the division of hematology-oncology and one of the study's two principal investigators (the other is Stephen L. Eck, MD, PhD, director of cancer gene therapy), started injecting Hilly with ganciclovir, a drug converted by thymidine kinase to a poison that disables the genetic apparatus of cancerous cells. A week later, the patient underwent surgery to remove the tumor and a second dose of the altered virus was given to reach remaining inoperable cancer cells. The syndicated feature was published August 2 in the Inquirer with facilitation by the Media Relations staff.   Wilmington News Journal West Chester News WJBK-TV2 Detroit KDFW-TV4 Dallas WTXF-TV29   Bloodletting: Penn Opens 1st Clinic For Hemochromatosis   Genetic specialists at the Medical Center have established the world's first clinic dedicated to diagnosing and treating hemochromatosis, or iron overload disease. The most common genetic disorder - one that's easily and inexpensively treated by periodic phlebotomy (a therapeutic drawing of blood) - hemochromatosis remains a costly, destructive and often fatal health problem for lack of understanding. "It's not the first thing most doctors think of," said Christopher Friedrich, MD, PhD, assistant professor of medicine in the division of medical genetics and director of the new clinic. That's because iron overload is the underlying cause of a host of chronic diseases that doctors treat at face value, not as a manifestation of a genetic disorder, he told the West Chester Local News. "It causes several common problems, particularly congestive heart failure and common diabetes ... It can cause arthritis and liver cancer." Treatment is easy, if a bit old-fashioned. "Blood is taken out of the body and then your body makes another unit of blood to replace it, and it does that with the iron that it's pulling out of the heart or the pancreas or the liver - wherever it's stored," he told Channel 29 viewers. Coverage began August 5 in response to pitches made by the Media Relations staff.   New York Times Cleveland Plain Dealer Pittsburgh Post-Gazette   Brain Images: Addiction In Action For the first time, neuroscientists have captured images of the brains of addicts in the throes of craving for a drug, revealing the neural circuity that is the basis for all addiction. Reports from three different labs using positron emission tomography (PET) scans of the brains of patients being treated for cocaine addiction show that when addicts feel a craving for a drug, there is a high level of activation in a single circuit for pleasure deep in the most ancient part of the brain. This primitive pathway, called the mesolimbic dopamine system, shows heightened metabolic activity "when people are in a profound state of craving for cocaine [or any other addictive substance], primed to seek it out and take it," said Anna Rose Childress, PhD, clinical associate professor of psychiatry, who did one of the PET studies. The same system seems to be ordinarily in play to provide a sense of pleasure in whatever people find rewarding, "like sex or chocolate or a job well done." In Dr. Childress' study, PET scans were done while the patients were being exposed to cues that had made them crave cocaine in the past - like seeing a videotape of people taking cocaine or handling crack pipes or other drug paraphernalia. The work has been reported at scientific meetings but has not yet been published. The syndicated article was published in the Science Times on August 13.     ABC's Nightline Medical Ads: Prescription For Problems?   Wedged between sitcoms and sporting events are an increasing number of commercials for doctors, hospitals and health plans. According to Alan L. Hillman, MD, director of the Leonard Davis Institute's Center for Health Policy, that can be a prescription for a problem. Dr. Hillman's main concern is that radio and TV commercials and newspaper advertisements do not contain enough information to enable patients to make good health care decisions. "Awareness and advertising are two separate things," he told Nightline's Chris Wallace. "By the very nature of the television commercial or the quarter-page ad, you cannot convey the kind of information that would be helpful to a patient making a complicated decision about the kind of health care that patient needs." Partial information can be misleading and even harmful. For example, Dr. Hillman said, a person with heart-attack symptoms might travel to a distant hospital advertised as the best heart facility, even though heart-attack victims benefit most from quick treatment. "We do need to get better ways of educating ... but on the television or in the magazine is not the place," he said. Instead of relying on advertising, patients should build a good relationship with a primary care physician, Dr. Hillman suggested. The program aired August 1.   WHDH-TV7 Boston KDKA-TV2 Pittsburgh WXYZ-TV7 Detroit WPEC-TV12 West Palm Beach WCIA-TV3 Springfield   Exogen: Sonic Accelerated Fracture Healing   Every year, nearly six million people fracture a bone. Now a simple, painless device can speed up the healing process. Exogen, a sonic accelerated fracture healing system, sends low-intensity sound waves into the bone, putting bone cells under mechanical stress. "Bone is an interesting organ, in that it responds to stress by laying down more bone," R. Bruce Heppenstall, MD, professor of orthopaedic surgery, told viewers. "It responds to rest by giving up bone." A hole is left in the cast so that the small, portable device can lock in. Patients use the non-invasive system for a short period every day until X-rays show the break has healed. Patient Darlene Cooke, who fractured her shin bone in a skiing accident, said she felt "absolutely nothing, not even a vibration" while she was using the device. Studies show this treatment heals bone fractures about 40 percent faster, and even shortens the time it takes for smokers' bones to heal (which tend to take longer). "I've been very impressed with the device," said Dr. Heppenstall. "Twenty minutes a day seems to do it." The syndicated segment was seen across the country beginning August 9 with facilitation by the Media Relations staff.   U.S. News & World Report HUP: One Of America's Best   The Hospital of the University of Pennsylvania is one of the best hospitals in the nation, according to U.S. News & World Report. The magazine's seventh annual survey evaluated 1,961 hospitals in the country; the rankings included the 126 hospitals that earned the highest scores in 16 specialties. HUP ranked higher than any other hospital in the Delaware Valley in the areas of: AIDS; cardiology; endocrinology; gastroenterology; geriatrics; gynecology; neurology; orthopaedics; otorhinolaryngology; rheumatology; urology; and psychiatry. In addition, Penn's Cancer Center was ranked 18th in the country among the nations's leading cancer centers. The survey - conducted in conjunction with the National Opinion Research Center - was based on a mathematical model that weighed three factors equally: reputation among physicians, patient mortality rates, and a collection of medical measures specific to each specialty. Ophthalmology, pediatrics, psychiatry and rehabilitation, however, were ranked solely on reputation, because mortality in these specialties is low. The magazine's 1996 guide to "America's Best Hospitals" was published August 12.   LOCAL Breaking News: Philadelphia Inquirer Philadelphia Business Journal Morning Call Harrisburg Patriot Norristown Times-Herald Scranton Tribune Indiana Gazette West Chester News Trenton Times   Health Systems: Allegheny Absorbs Graduate   The Pittsburgh-based Allegheny Health, Education and Research Foundation made big news in August when it became the largest health system in the Philadelphia region by adding the Graduate Health System's five hospitals to its existing five. With the move, the foundation controls 4,000 hospital beds, 25,768 employees, and 450 primary-care physicians. The combined systems posted total revenues of $2.3 billion in fiscal 1996. "This is a very big and important deal," William N. Kelley, MD, CEO of the University of Pennsylvania Medical Center and Health System and Dean of the School of Medicine, told The Philadelphia Inquirer. "Now we're down to three major health systems," he said, referring to Penn, Allegheny, and Jefferson. "Eventually all of the hospitals in the region will have a relationship with one of those three systems." Still, size is not the only important component of a health system, Dr. Kelley remarked in a follow-up article in the Inquirer. He noted that it remained to be seen how successful the move would be. "There's nothing about a bigger system that necessarily is going to make it better or more competitive," he said. Dr. Kelley's comments were published August 7 through August 11 with facilitation by the Media Relations staff.   Breaking News: Associated Press Gannett News Service North Hills News Record WPVI-TV6   "Skeleton-Key" Protein Implicated In FOP   Researchers at Penn have discovered that the unwanted production of a single protein may be responsible for a terrible genetic disease that relentlessly converts the body's soft tissues to bone. The disease - fibrodysplasia ossificans progressiva, or FOP - strikes in childhood and often relegates its victims to near-total immobility by early adulthood. The protein, called bone morphogenetic protein 4 (BMP4), plays a crucial role in the formation of the skeleton during development, but is inappropriately expressed in FOP patients. The findings, published in the August 22 issue of The New England Journal of Medicine, represent the first firm foothold toward understanding the molecular mechanisms of the devastating disease. "Nearly identical proteins have been found in mice, chickens, worms, flies, as well as in human beings," said Frederick S. Kaplan, MD, senior author of the study and chief of the division of metabolic bone diseases and molecular orthopaedics. "When was the last time flies and humans shared a common ancestor? It would likely be more than 600 million years ago. That's dramatic evidence of the extraordinary role these molecules play in the development of the body plan." Reports began August 22 in response to pitches made by the Media Relations staff.   Philadelphia Inquirer Stroke: Raising Awareness Lowers Risk   Stroke is the leading cause of disability in America, yet a recent poll found that most people are unfamiliar with its five primary warning signs: sudden weakness, numbness or paralysis of a limb or the face; speech problems; sudden blurred vision; unexplained loss of balance; or sudden, severe headache. Nor do they realize that with new medications, getting fast treatment might mean less long-term damage. According to the American Heart Association, high blood pressure - hypertension - is the major controllable risk factor in stroke. Other risk factors include smoking, obesity, excessive alcohol consumption, long-term use of oral contraceptives, cocaine use, intravenous drug use, diabetes and heart disease. While the effects of stroke can be devastating, there is room for optimism: "More than half of all strokes are preventable," said Edward S. Cooper, MD, emeritus professor of medicine, in a Philadelphia Inquirer feature. "By controlling high blood pressure and other risk factors and by recognizing the warning signs of stroke, many episodes could be avoided." The article was published August 19.   WTXF-TV29 Addiction: Kids & Nicotine   It is estimated that 90 percent of adults who are addicted to smoking began the habit while they were kids. And each day, as many as 3,000 youngsters light a cigarette for the first time. "There's no question in my mind that nicotine is an addictive drug," said Robert M. Weinrieb, MD, assistant professor of psychiatry. He told Channel 29 medical reporter Dr. Brian McDonough that there are several keys to recognizing a substance as an addictive one: First, a person feels a loss of control over the drug. "Another problem is that there's some psychological or physical things that happen when you become addicted to a drug," he explained. "You get 'tolerance', meaning that it takes more drug to get the same effect, so you begin to smoke more to keep it the same level and prevent yourself from having withdrawal." The medical community has strongly supported tobacco regulations for decades, and recently, the nation's health leaders began to address smoking as a pediatric disease. "We really do need to let people know how serious this is, and that it occurs at an age when children and teenagers are unable to understand the long-term effects of this drug," Dr. Weinrieb said. The story aired August 23 with facilitation by the Media Relations staff.   Good Day Philadelphia   "The Zone": Too Good To Be True?   Dr. Barry Sears, author of a best-selling book called "The Zone," advocates a diet of high protein to lose weight, prevent disease, enhance mental productivity and achieve maximum performance in daily activities as well as in sports. The diet is based on finding your personal nutrition zone by figuring out how many protein grams you should consume - based on your lean body mass - and then eating protein to carbohydrates in a three-to-four ratio. According to the author, when you hit your zone, you will tap into "a whole new body." In an interview on Good Day Philadelphia, sports medicine's Joseph Bernstein, MD, assistant professor of orthopaedic surgery, told viewers that the diet is "pretty sensible," but that weight loss occurs because Dr. Sears "is really restricting your calories." Dr. Bernstein discounted claims that the diet can help overcome genetic diseases or increase mental or physical performance, but the self-professed "simple bone setter" did agree that food is, in some ways, like medicine: "If you eat a lot of carbohydrates, you get an insulin surge to store the sugar in your body and then you're going to bottom out," he said. "On the other hand, it's very hard to convince this Jewish doctor that bagels and other carbohydrates are a bad thing." The segment aired August 16.   WPVI-TV6's AM Philadelphia   Redux: The Answer To Obesity?   Hollywood and Madison Avenue hammer us with images of slender, well-toned bodies. Fashion magazines are full of diets. But 58 million Americans - one out of every three adults - are obese. "Could the answer be a magic pill?" asked AM Philadelphia's Karen Rogers, referring to Redux, the first weight-loss drug approved by the FDA in 23 years. "Clearly, this is not a miracle drug," said Gary D. Foster, PhD, clinical director of the Weight and Eating Disorders Program. "It's not so much that it improves weight loss, [rather], for the first time, there's a medication available that will help people maintain their weight." Dr. Foster cautioned viewers about assuming that all overweight people overeat. "They overeat for the number of calories they require to maintain their body weight, but there are overweight people who eat less than some average-weight people." And he had a sharp response to a caller's comment: "Words like lazy, undisciplined, and gluttonous are inaccurate, and I don't think they serve overweight people very well," Dr. Foster said. "I think that we have to be respectful of the fact that weight can describe you, but it certainly doesn't define you." The show aired August 8 with facilitation by the Media Relations staff.     ISSUES & ANSWERS The following remarks were made by Arthur L. Caplan, PhD, director of the Center for Bioethics, in nationally syndicated newspaper articles and on radio and television:   "There are no specific ordinances in this country at all - period - that apply to these technologies. They cry out for regulation and oversight." Fertility Clinics: What Price Pregnancy? Boston Globe, 8/5   "There is this long tradition in American society of redeeming a death by recovering the body. It's not surprising the government yields to the emotional needs of the family members." Flight 800 Priority: Recovering Victim's Bodies Philadelphia Daily News, 8/1   "When someone says they don't want to try to live longer because they don't want to bankrupt their family, that's rationing." When Savings Run Out, Some Shun Lifesaving New York Times, 8/14   "The real issue is, if you have embryos more than five years there has been some scientific data that seems to show that these embryos are less likely to become babies ... The other issue that comes up is the oddity of saying, 'Well, how long do we keep these embryos? Can we turn them into babies, even if another couple wants them, if the people who they come from can't be contacted to give their permission?" Human Embryos Destroyed In Great Britain National Public Radio, 8/3   "In a sense, they haven't really done the ethics work, which is to persuade the mainstream that they're right. And by holding the Republican Party prisoner of their vision, they've done the incredible. They've made one of the least popular presidents electable - Clinton." Christian Leader Becoming GOP's Strong Right Arm San Diego Union-Tribune, 8/4   "Too often we tend to forget in this society that individual rights have limits. When it comes to tuberculosis, the limit on your right to go without treatment and die is when your decision puts the rest of the community at risk." Quarantines: A Serious Answer To Grave TB Threat The Philadelphia Inquirer, 8/2   "He owes it to the people he helps to die to know everything relevant about them. And in this case, he doesn't appear to have taken that obligation seriously." Dr. Kevorkian Aids Suicide Of Depressed 42-Year-Old NBC Nightly News, 8/17   "If you want to support what he did, then you would have to say that anybody who is despondent, despairing or desperate should have the right to assisted suicide at the hands of a doctor. I don't think Americans are anywhere close to being ready to accept such a policy." A New Question Amid Suicide Debate: What If The Patient Isn't Fatally Ill? USA Today, 8/23 SNIPS & SNIPS WELCOME ABOARD. . . Articles in the Philadelphia Business Journal and The Philadelphia Tribune focused on Wesley K. McGavock's appointment as executive director for network programs, Philadelphia division, for the Health System. He formerly served as senior vice president of Mercy Health Corporation and CEO of Misericordia Hospital. In his new position, McGavock will be responsible for coordinating primary-care physician activities as well as the development and implementation of plans designed to increase access to the Health System. "I like to be where change is taking place," he told the Tribune. Printed 7/26 and 8/2, respectively.   OPENING DOORS. . . The increase in cancer survival rates has created a new set of challenges and problems for patients who have overcome the disease. To help meet those challenges - which include a host of physical and psychosocial issues - the National Cancer Institute has created the Office of Cancer Survivorship (OCS). Anna T. Meadows, MD, professor of pediatrics (oncology), has been appointed the office's first director. "The idea behind the new office is to support and coordinate any research that might be helpful to individuals who are cancer survivors," Dr. Meadows told Nature Medicine. Printed in the August issue.   AMA vs. NRA. . . In a national random survey of over 1,000 doctors, about two-thirds agreed that physicians should support legislation restricting the possession or sale of handguns. What's behind their strong views on guns? C. William Schwab, MD, chief of the division of traumatology and surgical critical care, said it's due in part to the fact that gun violence has reached epidemic proportions. "We see over 500 gunshot wounds a year at this hospital," he told American Medical News. Gunshot wounds are "the most frequent single mechanism of injury that we see ... and I'm sure it's true of most urban trauma centers." Printed 8/5.   JAVA JUNKIES. . . Today's coffeeshops market themselves as hip gathering places. And they are whipping up ever sweeter concoctions in an effort to attract coffee novices. It's no wonder that many appeal to even the youngest tastebuds, and more kids are becoming coffeehouse regulars. But coffee consumption by youngsters raises some concerns among parents and doctors who warn that caffeine is a stimulant drug. "Caffeine can affect sleep and the nervous system," Charles P. O'Brien, MD, PhD, professor of psychiatry, said in a syndicated Wall Street Journal article. "Therefore I strongly discourage consumption by young people." Printed 8/21.   DIRECTORIAL DEBUT. . . Physician's News Digest and Hospital & Healthcare News announced the appointment of Julius J. Deren, MD, as the new director of gastroenterology at Presbyterian Medical Center of the University of Pennsylvania Health System. Dr. Deren was formerly the chief of gastroenterology and nutrition for Graduate Hospital. Printed in the August issues.   KNOWLEDGE IS POWER. . . Ian Frank, MD, assistant professor of medicine, presented an update on treatments for AIDS and its associated opportunistic infections at a recent Philadelphia FIGHT forum, Philadelphia Gay News reported. "My intention is not to scare anybody," he said. "Many of these [infections] you will not get. But knowledge is power, and knowing how to deal with these things will cause you to seek preventions and treatments." Printed 8/23.   ALTERED STATES. . . Over the last three years, Philadelphia medical schools have not only graduated more students headed into residencies in primary-care settings, but they've adjusted their curriculums to meet the demand for such doctors caused by the rise in managed care. Barbara R. Wagner, director of student and housestaff affairs, told the Philadelphia Business Journal that medical students realize if they want a job, they need to learn what managed-care companies want. "Our students are smart, and they are seeing the writing on the wall," she said. Printed 8/30.   BLOCKBUSTER VIDEO. . . Curtis W. Slipman, MD, director of the Penn Spine Center and chief of the Clinical Musculoskeletal Program, is a featured physician in the recently released Time Life Medical Videos called "At Time Of Diagnosis," hosted by Dr. C. Everett Koop. The video kits are designed to help patients and their families understand a diagnosis of a serious disease or medical condition. According to Hospital & Healthcare News, Dr. Slipman is featured in the "Back Pain" video kit. Printed in the August issue.   CAUTIOUS OPTIMISM. . . Researchers have reported the first evidence that gene therapy for cardiovascular disease can work. An elderly woman with leg arteries so clogged that she was developing gangrene in her foot was given gene therapy and grew new blood vessels that increased the blood flow in her leg by 82 percent. "This is an interesting anecdotal experience, and I think it is suggestive that this technology might really work," Judith Lea Swain, MD, chief of the cardiovascular division, told The New York Times. "But you have to be cautious about a study with one patient." Printed 8/27.   FOREVER - NOT!. . . In a teenage world where kids change hairstyles like they change their minds, the permanency of a tattoo is often disregarded. But technology has come to the rescue of those who look back with regret: "It used to be, the only way to remove one was by cutting it off or dermabrasion, which is like sanding it off," Debra J. Grossman, MD, MPH, assistant professor of dermatology and director of the Skin Laser Center, told the Bucks County Courier Times. Now, "The laser explodes the pockets of ink that form the tattoo. Then the ink is carried away by ... blood immune cells that act like garbage scavengers." Cool! Printed 8/5.   KEEP ON TICKIN'. . . After middle-age, men's testosterone levels begin to drop - much more slowly than estrogen in women, but possibly with similar consequences. An ongoing study at the Medical Center has men over the age of 65 wearing patches with replacement doses of the hormone to see if it can help them stay healthy longer. "We're attempting to find out if testosterone improves their sense of well-being and their energy; if it improves their bone calcium, their muscle mass, and muscle strength," Peter J. Snyder, MD, professor of medicine, said in an interview on ABC-TV's World News. Aired 8/7.   MAINSTREAM DETOX. . . When most people think about a detoxification program, chances are they picture junkies going through withdrawal or Hollywood stars entering the Betty Ford Clinic. But a Center City program - based on a method developed by the Church of Scientology - promises optimum health by eliminating toxins that have accumulated in the body. The 21-day regimen entails heavy doses of vitamins, exercise and long hours in a hot sauna. "Your body does an excellent job of getting rid of toxins on its own," Joseph R. Volpicelli, MD, PhD, assistant professor of psychiatry, told the Philadelphia Business Journal. Sauna therapy "is probably relaxing and maybe it helps people feel better, but I would not make any claims about [the health benefits of] removing toxins." Printed 8/9.   CIRCLE OF LIFE. . . Because the full recovery rate from anorexia and bulimia is just under 50 percent, most women with eating disorders carried the illness over from adolescence, when it typically develops. Often, the self-destructive behavior becomes a family legacy. "There's a much higher incidence of eating disorders in women whose mothers had eating disorders, and they do pass it on to their own daughters," Barbara J. Wingate, MD, medical director of the Weight and Eating Disorders Program, told The Philadelphia Tribune. Printed 8/27.   THE ART OF THE DEAL. . . The American Cancer Society has sold its name to two corporate giants, offering exclusive endorsements to SmithKline Beecham's NicoDerm patches and the Florida Citrus Marketers Association's orange juice for at least $4 million in sales royalties. A widely syndicated Associated Press article said the deals will provide the society with needed cash to boost its programs at a time when donations are stagnant. But if the trend accelerates, "We're going to end up with the health equivalent of the Olympics," predicted Paul Root Wolpe, PhD, senior faculty in the Center for Bioethics. "If they want to endorse products, they should do it in the spirit of an educational agency, not as a paid shill." Printed 8/17.