November 1998

International

• Researchers Link Vitamin E To Healthy Hearts 

National

• A New Option for Women In Pain
• Face Facts

Local

• Still Making Whoopie
• Colon Cancer: The Lion Is a Lamb If Caught Early
• Alternative Medicine Poised to Go Mainstream?
• The Brain Teasers

Perspectives

Snips & Clips

In mice genetically manipulated to develop atherosclerosis, Penn scientists have for the first time conclusively demonstrated that vitamin E confers potent protection from the artery-clogging disease. The team found that mice given vitamin E for 16 weeks had 40 percent fewer lesions in their cardiovascular systems than untreated lab animals. 

The lesions studied were similar to those found in people suffering from atherosclerosis, the most common form of arteriosclerosis, characterized by fatty deposits in the arterial linings of the cardiovascular system.

The researchers were also able to show that the benefit was due to the antioxidant action of vitamin E, not to other possible effects such as a reduction in blood cholesterol levels. This fact strongly suggests that cell-damaging free radicals do, in fact, play a central role in heart disease, a theory long proposed but never proven. A novel method recently developed by the same group for directly measuring oxidant stress in the body provided the data in support of the observations. 

A report on the new findings appears in the October issue of Nature Medicine.

“This study offers powerful evidence for the efficacy of vitamin E as an antioxidant in atherosclerosis,” Garret A. FitzGerald, MD, chairman of the department of pharmacology and senior author on the report, told The Toronto Star. “Significantly, it also shows that free-radical injury is functionally important in the development of cardiovascular disease.” FitzGerald cautions against taking large doses of vitamin E until human trials are conducted. 

Reports began September 28. 

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Of the approximately 600,000 hysterectomies performed in the United States each year, about 30 percent are done to relieve symptoms from fibroid tumors, which grow on the muscle wall of the uterus. Up to 80 percent of women over 35 have them. Most of them don’t experience extreme symptoms. For thousands of others, fibroids cause abnormal bleeding, pain, discomfort, and recurring miscarriages.

In addition to a hysterectomy, treatment options include a myomectomy, or surgical removal of the fibroids. But the tumors can, and do, grow back. 

Now, Penn doctors are using a technique that kills tumors while leaving the uterus intact. It’s called uterine artery embolization, a technique long used to treat other types of tumors, as well as such conditions as gastrointestinal bleeding.  A catheter is inserted into a uterine artery, through which plastic particles are sent, shutting off the blood supply to the tumors. 

It is performed under local anesthesia, takes about an hour, and usually 
requires no more than an overnight hospital stay. “It treats all of the uterus, and that’s important, because most patients have more than one fibroid,” Richard D. Schlansky-Goldberg, MD, assistant professor of radiology, told the Orlando Sentinel. 

It also avoids the trauma of hysterectomy. “A hysterectomy takes about six weeks of recovery and involves a woman losing an entire organ, and there’s a lot of emotion behind that,” said Schlansky-Goldberg. 

So far, results have been impressive: a 92 percent success rate in achieving relief from symptoms and a 90 percent success rate in controlling excessive bleeding, according to a recent UCLA study involving a small number of patients.  But long-term results are needed before its efficacy is accurately gauged. “We don’t know the long-term effect this procedure has on infertility,” Richard Tureck, MD, professor of medicine told the paper. He recommends myomectomy as the primary option for relieving symptoms and retaining fertility. 

Printed September 15. 

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Oily and acne-prone skin erupts in the summer but problems hibernate during the cool winter months. If you believe that, it’s time for an about face. “Oil is more apparent in the summer because it mixes with sweat and becomes shiny, but you aren’t oilier,” James J. Leyden, MD, professor of dermatology, told Self magazine.

In fact, many people experience more problems with their skin in the winter. Leyden suggested one reason why: In research on scalps, he found that skin cells were shed more rapidly in the winter, independent of environmental factors and scalp condition. It’s this build-up of dead cells that contributes to congested pores, and spottier skin. 

Leyden warns patients against making the situation worse. “When you break out, you tend to scour your skin clean, aggravating the cycle,” he said.  Instead, patients should wash gently with nonirritating soap-free cleansers. Apply moisturizer only where your skin feels dry. If you’re using a prescription acne treatment, consider switching formulations, he said. (For example, if you use Retin-A, ask for a gel instead of a cream, which is less drying.) 

For sudden winter breakouts, Leyden recommends a regimen of a lotion in the morning to clean out cells accumulating in pores and a benzoyl peroxide cream at night to kill bacteria. “The winter protocol for this routine is to follow it every other day if the combination of products is too drying.” 

Printed in the September issue. 

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The overwhelming demand for Viagra hinted at it, and a new survey spells it out: Seniors are sexually active, and many of those who aren’t would like to be. 

The National Council on Aging study found that nearly half of the 1,300 men and women questioned said they engaged in sexual activity at least once a month. And 40 percent said they’d like to have sex more often. “The perception of older people as uninterested in sex is wrong. It’s part of vital aging,” Neal E. Cutler, MD, professor of medicine and director of survey research for the council, told The Star-Ledger. 

In the survey, 61 percent of sexually active seniors said their sex lives were as satisfying or more so than when they were in their 40s. “That was a surprise,” said Cutler. “But the explanation is that pregnancy is out of the picture, the house is empty and people who are retired can do it when they feel like it. And some of it is practice — if you’ve been married for 30 or 40 years to the same person, you’re relaxed with each other.” 

Cutler said there’s no way to gauge whether more older people are more sexually active now than in the past because there’s never been a similar survey. The most comprehensive survey to date, the 1994 “Sex in America,” by the University of Chicago, stopped at age 59, he said. 

Printed October 18. 

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It’s one of the most common cancers in the United States. The survival rate is 92 percent for those whose cancer is found and treated in an early stage, before the disease has spread. Yet only 37 percent of colorectal cancer is detected at that early stage, according to the American Cancer Society. 

Once the disease has spread, the survival rate plummets to 64 percent. For those whose cancer has spread to the liver or lungs, the survival rate is only 7 percent. One big problem with the disease is that by the time symptoms show up (bleeding from the rectum, change in bowel habits, weight loss, stomach cramps), the disease is often in an advanced stage. But early detection is possible because the disease develops as polyps, which take a long time to become cancerous. “If you look at patients who’ve had polyps removed, and compare them to historical groups who haven’t had polyps removed, you find a 70 to 90 percent reduction in cancer,” Timothy C. Hoops, MD, assistant professor of medicine, told the Philadelphia Daily News. “That’s the rationale for early screening.”

More than 90 percent of colorectal cancer cases strike people 50 and older and are not linked to inherited DNA, Hoops noted. “It’s really an equal opportunity disease, not much difference among the races, and about the same number of men get it as do women,” he added. 

Printed October 6.

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Once held at arm’s length by the American medical establishment, alternative therapies such as herbal remedies, massage therapy, and spiritual healing are finally finding a place within mainstream research and patient care.

“There is virtually not a major medical center which is not struggling with how to accommodate alternative medicine,” Paul Root Wolpe, PhD, of Penn’s Center for Bioethics, told The Philadelphia Inquirer. Penn is one of three Philadelphia-area academic medical centers that opened clinics blending conventional Western medicine with alternative care. Penn Medicine at Radnor offers acupuncture, yoga, and meditation. 

(The Inquirer noted that patients are exploring options, equipped with information tools such as the Internet, and spending big bucks on unconventional therapies, to the tune of $14 billion annually. Financially strapped medical centers could use a cut of the pie.) 

But before they delve into uncharted waters, academic medical centers have some talk and study to do. This summer, William N. Kelley, MD, CEO of the Health System and dean of the School of Medicine, appointed a task force to define the role alternative, or complementary, medicine should play at Penn. 

Then there’s a lot of research to catch up on. Scientific proof for alterative therapies is scanty. “Rather than close our minds as scientists, it is important to look at it as scientists,” Thomas E. Beeman, senior vice president of hospital operations, told the paper. “If there is medical efficacy, we will write about it.” 

Printed October 9. 

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Imagine if there was a pill that could help you remember where you put your car keys or a serum that could jog your memory to conjure the name of a high school classmate. 

Such a drug is the stuff of science fiction. There’s no quick fix for memory, partly because scientists know little about how it works. “Memory is not just one thing,” Daniel Kimberg, PhD, a post-doctoral researcher, told The Philadelphia Inquirer. “Memory is multiple abilities. It is not just the ability to remember but the ability to keep things in mind for a long time.” 

A study by Kimberg and Mark D’Esposito, MD, assistant professor of neurology, published last year in the journal Cognitive Neuroscience, yielded an insight into memory. The pair was studying a group of healthy Penn students. They first gave them standard memory tests then repeated the tests after the students took a dose of a medicine that treats Parkinson’s disease. 

The drug improved the memory of the students who had poor short-term memory to begin with. Then the researchers looked at the students who had a good short-term memory. The pills made their memories weaker.  “We were definitely intrigued,” said Kimberg. “Nobody has ever published anything like this before.”

The drugs given to the students boosted the level of a dopamine-like substance in their brains. “At a neurochemical level, it shows there is an optimal level of dopamine in the brain,” said Kimberg. “People who fall below that level can improve with additional activity at those receptors. If they are above the optimal level and you give them more dopamine, then they’ll get worse.”

No one is suggesting using potentially memory enhancing drugs on healthy people (the drugs’ toxicity would outweigh any memory benefit). Still, researchers admit the idea is seductive in the Information Age. 

But the notion of using existing drugs to treat dementing diseases like Alzheimer’s disease isn’t the answer. “There’s no reason to assume that things that work in disease with a major memory component will help to improve memory problems in normal people,” Christopher M. Clark, MD, assistant professor of neurology and associate director of Penn’s Alzheimer’s Disease Center, told the paper. “That’s a leap of faith.”

“In normal aging, the loss of words [or] loss of names of cities is not disease,” he said. “Any parent will tell you how bad memory can get among kids who are asked to take the garbage out. It is attention-dependent. If you are not paying attention, you are not going to reinforce what you should remember.” 

Printed September 14. 

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“We’re known in the field as very tough competitors. If somebody beats us today, we’ll beat them tomorrow.” 
— John Q. Trojanowski, MD, PhD, professor of pathology
 and laboratory medicine 
“Devoted to Each Other and Alzheimer’s Work”
The Philadelphia Inquirer, 10/19 

“Americans are surprisingly more comfortable altering things and enhancing things than almost any other people in the developed world . . . Europeans and Scandinavians tend to be much more convinced about the wisdom of nature, whereas Americans tend to think nature is something they can manipulate.” 
— Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics
“Entranced By Enhancement”
The Boston Globe, 9/13 

“I think this is just one more chapter in a very long book and I don’t think we are anywhere close to the end of that book.” 
— William N. Kelley, MD, CEO of the Health System 
and dean of the School of Medicine
“Tenet Healthcare Says It Is Aware of Its Challenge”
The Philadelphia Inquirer, 10/4

“I think it could contribute to the ‘pizzafication’ of medicine.” 
— Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics
[Subject: Advertising claim of free emergency visit 
if not assisted within 30 minutes]
Healthcare Marketing Report, September 1998

“I have friends who retire and go down to Florida. They play a little golf. They end up drinking more liquor. Then they get bored and die. Well, I want to live.” 
— F. William Sunderman, MD, age 100, School of Medicine Class of ‘23
“For Doctor, a Catalog of Honors is Growing”
The Philadelphia Inquirer, 9/24

“If you want to have good skin, lead a shady life.”
— Albert Kligman, MD, PhD, professor emeritus 
of the department of dermatology
[Subject: Treating aging skin] 
Soap/Cosmetics/Chemical Specialties, August 1998

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LETHAL COMBO. . . A letter sent to the New England Journal of Medicine co-authored by David McCarthy, MD, associate professor of medicine, noted that Viagra could be dangerous for men with heart disease. The letter, mentioned in USA Today, cites a study showing that 31 percent of men with heart disease do not get enough oxygen to their heart muscle during sex and 24 percent experience chest pain. The authors fear that some men with chest pain may be given nitroglycerin, which can cause deadly drops in blood pressure when given in combination with Viagra. Printed September 3. 

RAY BANS. . . Even short exposures to the sun over the course of a lifetime can increase the risk of developing cataracts, a new study shows. An increase of 1 percent in lifetime sun exposure translates into a 10 percent increase in cataract risk. “Cataracts are the number one cause of blindness around the world,” Jeffrey W. Berger, MD, PhD, assistant professor of ophthalmology, told the Medical Tribune for the Family Physician. “Researchers everywhere are investigating causes and treatments. And this [study shows that sun exposure] is one very preventable risk factor.” Printed September 17. 

CREAM AND SUGAR TOO?. . . Some cosmetics companies are promoting skin care products that contain tea, claiming that the beverage may offer protection against skin cancer. But do the products work? Possibly, says Albert Kligman, MD, PhD, professor emeritus of dermatology, though evidence is scanty. “There are good experiments showing that green tea extracts applied topically can inhibit ultraviolet B damage in mice, but we don’t have empirical data proving that applications in cosmetics will have any effect,” he told Your Health. “In theory, green tea is beneficial. It works as an antioxidant” to enhance cell function and protect the skin, he said. Printed October 1.

ASTHMA DRUG REEVALUATED. . . Doctors often prescribe Serevent, a long-acting bronchodilator, for sufferers of exercise-induced asthma. A recent study of patients revealed that Serevent does offer protection against attacks but loses its effectiveness significantly after daily use for several weeks. “Nobody anticipated that,” John Hansen-Flaschen, MD, chief of the pulmonary and critical care medicine division, told New Jersey’s The Record. Hansen-Flaschen co-authored an editorial that appeared with the study’s results in the New England Journal of Medicine. The findings may change the way doctors prescribe Serevent. Printed August 17.

DON’T DELAY. . . Should women wait until after their childbearing years to find out the cause of their kidney stones? wondered one reader of the Philadelphia Daily News. Keith N. Van Arsdalen, MD, professor of urology, told the paper that there is no reason to delay treatment unless a woman is currently pregnant: Tests pose no threat to a woman’s reproductive system. Anyone who has a number of stones should go through a metabolic workup to determine whether they should avoid certain contributing foods or beverages, he said. Printed September 23.

BABY STEPS. . . People who can’t stick to their diets may simply be setting unrealistic goals, says Gary Foster, PhD, clinical director of the Weight and Eating Disorders Program and assistant professor of psychiatry. If your diets always fail, try asking yourself these questions: Did your previous diets leave you feeling deprived? Was it a daily struggle to fit workouts and meal planning into your schedule? Did you find it impossible to maintain new eating habits? “Answering yes to any of those questions means you made too many drastic changes that you couldn’t stick with,” Foster told Good Housekeeping magazine. If your lifestyle is too hectic to make major changes, make small ones instead, he suggested. Printed in the October issue.

BAD BLOOD. . . Some 300,000 Americans were infected with Hepatitis C from blood transfusions before 1992, when a reliable test became available. Many of these people are unaware of their illness because it may take years for an infected person to experience symptoms. The FDA has pledged to work with hospitals and blood banks to identify the people who may have received tainted blood. But critics say the FDA isn’t working fast enough to alert the blood recipients. “The blood industry has been on notice that we expect a look-back in this area and yet delay seems to be the order of the day,” Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics, told CNN Today. Aired October 7.

UNNATURAL SELECTION. . . Researchers have discovered a way to separate sperm so parents can choose whether their child will be a boy or a girl. The announcement has led to calls for regulation from people worried about the technology’s impact on the sex ratio and gender relations. Glenn McGee, PhD, assistant professor of bioethics, thinks that restrictions on the procedure are likely. “It’s the same kind of thing that accompanies cloning. The yuck factor on gender selection is very high,” he told Cleveland’s Plain Dealer. Printed September 11.

ACTIVE DUTY . . . Exercise can help stave off bone and joint problems common in older adults, according to the American Academy of Orthopaedic Surgeons. “Most individuals are aware of the cardiovascular benefits of exercise, but we are just beginning to appreciate the importance of exercise for the musculoskeletal system,” said Nicholas A. DiNubile, MD, clinical professor of orthopaedic surgery, at a meeting of the academy, as reported in the Times (Sayre, Pa.). Loss of muscle mass and strength in people 55 and older is mainly due to inactivity. Just 30 minutes of physical activity daily can help older people stay healthy. Those with joint problems should avoid running and aerobics and stick to low-impact activities like swimming, says DiNubile. Printed September 25. 

ON THE ATTACK. . .The American Lung Association of Southeastern Pennsylvania and a coalition of hospitals, health agencies, businesses, and community leaders have launched a new initiative called Attack Asthma. The program aims to improve awareness and education and reduce the suffering and costs associated with the disease. “This joint effort goes beyond improving the care in physicians’ offices and hospitals to managing asthma in homes and schools,” Allan Pack, MD, PhD, professor of medicine and director of the Penn Center for Sleep Disorders, told the Philadelphia Business Journal. The project, which Pack is chairing, will focus initially on the population in West Philadelphia. Printed in the October 9-15 issue.

HOUSTON, WE HAVE A PROBLEM. . . What common health problem do astronauts in space share with the earth-bound? Sleep deprivation. David Dinges, PhD, professor of psychiatry and director of the unit for experimental psychiatry, told U.S. News and World Report that astronauts average only six hours of sleep per night. Dinges is part of a National Space Biomedical Research Institute team studying sleep and the body’s circadian rhythms, which are regulated by the rising 

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