October 1996   

INTERNATIONAL

Breaking News Glasgow Herald Philadelphia Inquirer CNN WRIX-TV11 New York KTLA-TV5 Los Angeles WLVI-TV56 Boston WUSA-TV9 Washington WAGA-TV5 Atlanta KPRC-TV2 Houston WSVN-TV7 Miami KPHO-TV5 Phoenix KWGN-TV2 Denver KYW-TV3 WCAU-TV10 WTXF-TV29     Penn Research: Genetic AIDS Vaccine Proves Safe Every great advance in science has issued from a new audacity of imagination. -John Dewey A novel vaccine developed at Penn has sparked a substantial immune-system response in HIV-infected patients in a Phase I clinical trial. The same technology protected uninfected chimpanzees against high doses of HIV in another Penn study, and lowered the amount of virus present in HIV-infected chimpanzees to undetectable levels in still another. The human clinical trial results were presented by Rob Roy MacGregor III, MD, director of the AIDS Clinical Trials Unit, at the XI International Conference on AIDS in Vancouver, Canada, in July. Pathology and laboratory medicine research associate Jean D. Boyer, PhD, discussed the chimpanzee data at the same gathering. The findings involving human patients are significant because they confirm the feasibility of a new and deceptively simple direct-DNA inoculation strategy. The tactic involves laboratory constructs of genetic material called plasmids that are injected into the muscle. There is no expectation that the genes in the vaccine will be integrated into the recipient=s DNA or retained in the body over time, only that they will provoke an infection-fighting response - seen in this case as elevated levels of antibodies to HIV proteins. "These results suggest that this technology can work in humans", says assistant professor of pathology and laboratory medicine David B. Weiner, PhD, developer of the direct-DNA vaccine approach. "Researchers and scientists now truly have a new tool ... [that] can be examined and tested for a wide range of human applications in both infectious diseases and the cancer arena," he told CNN viewers. "We think it's an important step forward." Coverage began July 2 in response to pitches made by the Media Relations staff.   NATIONAL Breaking News: Associated Press New York Times Washington Post Boston Globe Chicago Sun-Times Denver Post Orange County Register Tampa Tribune Somerset American CNN In Touch Radio Networks AHA News   Late Enrollment: Hospice Care Underused   Hospice care provides a supportive environment for terminally ill patients in the final months of life: nursing assistance, physical and psychological therapy, and social services usually take place either at home or in a homelike setting. Although it sets the stage for a more comfortable and less expensive death than hospital-based care, research suggests most hospice patients enroll too late to take full advantage of the benefits. In reviewing Medicare claims data of more than 6,000 hospice patients, investigators from Penn and the University of Chicago found the average survival rate for patients entering a hospice program was 36 days, barely one-third of the optimal 90-day period. The findings were published in the July 18 issue of The New England Journal of Medicine. The authors cite several causes for hospice underutilization, including an unwillingness on the part of physicians, patients, and families to shift the primary goal of care from cure to comfort. "This is primarily an issue of dying with comfort and dignity, but it also involves the injudicious use of health care dollars," co-author JosJ J. Escarce, MD, assistant professor of medicine, told the Associated Press. Television, radio and print reports began July 18 in response to pitches made by the Media Relations staff.     Boston Herald Milwaukee Journal Tampa Tribune Easton Express-Times Philadelphia Inquirer NPR Science News   Penn Innovation: Radical Measures   How do you know if the antioxidant compounds found in the fruits and vegetables you eat are enough to block the damaging effects of free radicals in your body? What dosage of antioxidant vitamin supplements might help? Free radicals - volatile oxygen molecules implicated in the development of cardiovascular disease and cancer - are produced by exposure to cigarette smoke, alcohol, pollution and other substances. Garret A. FitzGerald, MD, chairman of pharmacology, told reporters at an American Heart Association Forum that Penn researchers have developed a non-invasive test that measures levels of an "oxidant stress" byproduct. He and his colleagues used the biochemical yardstick in a study published in the July 1 issue of Circulation that showed treatment with vitamins C and E reduced free radical levels in smokers. "The attraction of this test," said Dr. FitzGerald, "is that it's a specific, chemically stable marker of antioxidant activity that can be measured with great accuracy." Coverage began July 1 in response to pitches made by the Media Relations staff.       New York Times In Touch Radio Networks   Alzheimer's: Plaques Or Tangles?   Until scientists determine the basic cause of brain-cell destruction, advances in the treatment of Alzheimer's disease can be marginal, at best. Researchers have discovered two fundamental molecular aberrations in the brains of Alzheimer's victims, but the evidence does not clearly establish which of these, if either, lies at the heart of this devastating disease. Some researchers believe that brain cells are damaged from the outside by an external protein that accumulates into plaques. According to The New York Times, pathology and laboratory medicine professors John Q. Trojanowski, MD, PhD, and Virginia M.-Y. Lee, PhD, favor the second theory, that cell injury and death occurs from tangles that build up inside cells when a crucial internal protein, called tau, goes awry. The conundrum poses a problem for anxious drug manufacturers. "This is such a terrible disease that pharmaceutical companies feel they have to move forward in the face of imperfect knowledge," said Dr. Trojanowski. The feature was published July 30.   NPR The Scientist   Lose The Sugar, Gain The Fat   A promising new family of drugs designed to help diabetics make better use of insulin also has a potential down side: a Penn study published in the June 11 issue of the Proceedings of the National Academy of Sciences has found that the drugs - called thiazolidinediones - may encourage obesity by interfering with the production of leptin, which helps curb hunger and speeds up the body's metabolism. Because obesity is a risk factor for diabetes, the drugs may pose a treatment dilemma. When Mitchell A. Lazar, MD, PhD, chief of the division of endocrinology, diabetes and metabolism, and his colleagues tested the drugs in the laboratory, leptin production virtually shut down. He concludes the antidiabetic drugs could interfere with weight control, but points out that the biochemical mechanisms behind the potentially beneficial and harmful effects of the drugs may not be linked. Therefore, "There's the possibility of [creating] a second generation of these drugs that still lowers blood sugar but doesn't have the unwanted effect on fat," he told The Scientist. The reports appeared June 10 and July 8 in response to pitches made by the Media Relations staff.   Knight-Ridder Chicago Tribune Albany Times-Union San Diego Union-Tribune Houston Chronicle Philadelphia Inquirer   Depression: Infection Connections   It's a provocative, yet unproven, idea - that infections or abnormalities in the immune system could lead to mental illnesses generally believed to stem from life experiences or faulty genes. "It may have less to do with whether you love your mother," Jay D. Amsterdam, MD, director of the Depression Unit, told The Philadelphia Inquirer. Dr. Amsterdam and Mady Hornig-Rohan, MD, assistant professor of psychiatry, began investigating the link between viral infections in depressed patients more than ten years ago with a study involving the "sad horse" disease virus called Borna. "The virus has a predilection for the hypothalamus - the part of the brain that, in humans, mediates our moods," Dr. Amsterdam says. Additional evidence of the link may come from Lithium, which often provides relief for patients with manic-depression. In a radical experiment, small doses of the drug given to mentally healthy women with severe genital herpes suppressed the virus. The article was seen in newspapers across the country beginning July 8.   Breaking News: Associated Press San Diego Union-Tribune Intelligencer Journal Orange County Register CNN KCRA-TV3 Sacramento WDIV-TV4 Detroit KNWS-TV51 Houston KNXV-TV15 Phoenix   An Easier Match: Cord Blood Therapy   The New England Journal of Medicine has published two studies that suggest blood cells from a newborn's umbilical cord may offer new hope for children and adults with leukemia and various other blood-related disorders. Rich in immunity-producing stem cells, even genetically mismatched umbilical cord blood worked well in young patients. Cord-blood transplants may offer a good alternative to many people who cannot find a matching bone-marrow donor. "It would provide us with the ability to transplant many more of the patients with cancer and other deficiencies disorders," Leslie E. Silberstein, MD, director of blood bank and transfusion medicine, told CNN viewers. The results of the two new studies are "very hopeful," said assistant director Leigh C. Jefferies, MD, who co-authored an accompanying editorial. "Right now, the most important thing is to prove that cord blood is safe and effective." Print and television coverage began July 17 with facilitation by the Media Relations staff.   WNBC-TV4 New York KXAS-TV5 Dallas WMAQ-TV5 Chicago KPRC-TV2 Houston KRON-TV4 San Francisco KXAS-TV5 Dallas WTVJ-TV6 Miami KUSA-TV9 Denver WCAU-TV10 CNBC   Happy Hour: PMS Cocktails   It was cocktails for two when Channel 10 health reporter Cherie Bank and patient Dana Wright sipped PMS Escape, a dietary supplement of complex carbohydrates that seems to raise serotonin levels in the brain. Designed to reduce symptoms in women who suffer from premenstrual syndrome, the so-called PMS cocktail may give a whole new meaning to happy hour. Preliminary research on the product is promising. "It appears to reduce the symptoms of PMS: the irritability, the anger, and of course, the food cravings," said Ellen W. Freeman, PhD, co-director of Penn's PMS Program. She is conducting a study of the efficacy of the 188-calorie cocktail - which is available in lemon flavor and raspberry-lime - when taken premenstrually twice a day for five days. Dr. Freeman's office received over 600 calls from hopeful participants in response to the syndicated segment, which first aired July 28 in response to pitches made by the Media Relations staff.   LOCAL Breaking News: Philadelphia Inquirer Philadelphia Daily News Philadelphia Business Journal West Chester Daily News   HC4: Hospitals' Financial Health   For its annual Hospital Financial Report, the Pennsylvania Health Care Cost Containment Council (HC4) studied 26 urban and 25 suburban hospitals in the Philadelphia area. Although eight hospitals in the city lost money, most reported modest increases in operating income and a decrease in operating costs. The Hospital of the University of Pennsylvania had a surplus of revenues over expenses of $122.7 million in Fiscal Year 1994 and of $110.7 million for FY '95. In both years, HUP's surplus was the highest in the state. "We are very proud of our success," 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 Business Journal. "We worked very hard with sound financial management to aggressively reduce expenses before the most severe cuts came in our revenues." Dr. Kelley attributed HUP's surpluses to re-engineering programs initiated years ago in anticipation of decreases in utilization and lengths of stay. The reports were published July 19 with facilitation by the Media Relations staff.   Philadelphia Business Journal Survey: High Marks For Managed Care   With so much negative publicity about managed care, you would think the public has soured on hospitals. You would be wrong. The surprising results of a survey by Deloitte & Touche LLP show that patient satisfaction is as high or higher at Pennsylvania hospitals than it was two years ago. "You are dealing with a field that, in general, is just discovering the patient as a customer," said David J. Shulkin, MD, chief medical officer. "In an environment like Philadelphia, where choice [of providers] is now so evident, patient satisfaction becomes a key driver to the success of a health system." The Philadelphia Business Journal reported that the "University of Pennsylvania Health System will soon announce an incentive program for its employees that uses patient satisfaction rates to determine bonuses and raises for everyone in the system." The article appeared in the July 5-11 issue with facilitation by the Media Relations staff.   Philadelphia Inquirer Letters: Speaking Out On Animal Research   In a passionate letter-to-the editor, Adrian R. Morrison, DVM, professor of behavioral neuroscience, said The Philadelphia Inquirer "abrogated its responsibility to readers" by neglecting to pair an opinion piece that deplored the use of animals in medicine "with one by, for example, a physician who knows both science and the misery of patients who depend upon the research." Continuing, he made his case: "Ask stroke victims who are not permanently impaired because of new methods developed with animals to block the cascade of events leading to permanent brain damage. Ask those who have benefitted from open-heart surgery requiring the use of machines developed with the aid of animals. Ask the grandparent whose grandchildren were spared the risk of polio thanks to all the monkeys used to develop the vaccine. Perhaps best of all, ask the 99 percent of the country's physicians who recognize the value of animal research ... what they think of [the] piece." Dr. Morrison's letter was published June 27   Newark Star-Ledger Pittsburgh Post-Gazette Allentown Morning Call Scranton Sunday Times York Sunday News West Chester Daily News Delaware County Daily Times Philadelphia Inquirer   Legionnaires' Disease: Then And Now   It's been 20 years since a mysterious illness sickened 221 war veterans and killed 34 of their fellow American Legion members after attending a convention at the Bellevue Stratford Hotel. Medical investigators traced the disease - named for the Legionnaires it killed - to a tiny bacterium that thrives in lukewarm water found in domestic water systems. Experts believe the "untraditional pneumonia" was contracted when the guests inhaled infected water vapor from the hotel's huge air-conditioning system. Today, Legionella pneumophila is a treatable, though still deadly, infectious agent. But the 1976 outbreak caught the nation's health experts off-guard: According to Paul H. Edelstein, MD, director of clinical microbiology, people had become somewhat complacent in the fight against infectious illness. "Now it's fairly commonly accepted there will always be new disease," he told the Associated Press. The widely syndicated story was published July 21.     WPVI-TV6   Words Of Wisdom: Have It Pulled!   Impacted wisdom teeth may stay buried in the jaw for years with no discomfort, but that's no guarantee they aren't causing serious problems. Infections and damage to the adjacent teeth are common, and occasionally a destructive cyst will grow. "As it eats away at the bone, it weakens the bone and makes it more likely that it can fracture," said Lawrence Levin, DMD, MD, chief of oral/maxillofacial surgery. "[A patient] can actually be eating an apple one day and the jawbone will break." Forty-eight year old Bob Walton, who had such a cyst, allowed Channel 6 cameras to film the highly specialized surgery it required. As one surgical team delved into the patient's mouth - working carefully to remove the cyst without breaking the weakened jawbone - another cut into his hip, harvesting bone marrow to fill the hole it leaves behind. It's no wonder oral surgeons recommend removal of impacted wisdom teeth or, at the very least, careful monitoring. The segment aired July 3 in response to pitches made by the Media Relations staff.   WCAU-TV10 WTXF-TV29     Going For The Gold: Athletes Are Pumped   As the competition at the Olympic Games got underway, sports medicine's Joseph Bernstein, MD, assistant professor of orthopaedic surgery, visited the Channel 10 studios to discuss the pressure that athletes put upon themselves. While setting their sights on a world record may help them get "pumped" for peak performance, "I think we're pretty close to the limit of what the human body can do," he said. "I think personal best is a really good standard." But what if "personal best" doesn't seem good enough? Weight lifters and body builders often turn to the black market to "pump up" with steroids. Indeed, a recent study confirmed that testosterone, taken at ten times the normal amount found in the body, increases muscle mass. But there are dangerous side effects: "People should not take large doses of testosterone for athletic enhancement because over long periods of time it can lead to liver damage and liver cancer," Michael D. Cirigliano, MD, assistant professor of medicine, told Channel 29 viewers. Ironically, steroid abuse can decrease fertility and lead to stunted growth in teens. The interviews aired July 21 and July 3 with facilitation by the Media Relations staff.   ISSUES & ANSWERS The following is a sampling of recent comments made by Arthur L. Caplan, PhD, director of the Center for Bioethics...   "I think if you put companies into this area, and you start having them market, the danger is that they are going to prey upon fears of people." Umbilical Cord Blood Therapy CNN, 7/17   "The AMA Code has grown feisty, ornery and even courageous." The Code Of Medical Ethics American Medical News, 7/1   "It's going to be hard to keep a two-tier system going. Someone is going to say, 'Hey, I'm 65 and one month. I want an organ from the good list." A Faulty Heart, A New Chance The New York Times, 7/17   "What is Bob Dole smoking? Certainly something that is addling his mind. There is no other way to explain his bizarre statements about tobacco." Problems Of Tobacco Are Too Big To Ignore The Philadelphia Inquirer, 7/10   "A moral community owes its frail and weak members a fair shot at fulfilling their potential. But, when the price of educating a single child becomes so great that it threatens a community's ability to educate the rest of its children, it is time to think about the limits of community duty." Educating The Disabled: Is The Price Fair? The Philadelphia Inquirer, 6/30   "Anybody who thinks that it's not gonna seem a little weird to somebody to be told that they're going to live for the next five, 10, 15, 20 years with a pig heart beating inside their chest, isn't paying attention to the ... symbolic value and meaning that we associate in this society to organs like that. There's no doubt in my mind that people are going to need psycho-social counseling and some conversation about this." Transplanting Animal Organs Into Humans NPR's All Things Considered, 7/17   "I think the fix for nine out of ten of these situations is not to say, well here's a pill or here's an injection. It's to say we've got to make it possible for you to have a decent, humane life, even though you're sick, even though you're old, even though you're dying." Assisted Suicide WTXF-TV29's New Jersey Journal, 7/19   SNIPS & SNIPS A SENSE OF PURPOSE. . . Meggin Hollister, PhD, neuropsychiatry research fellow, was 12 years old when her sister Annick was diagnosed with schizophrenia. Inspired, Dr. Hollister has devoted herself to finding the cause of her sister's devastating psychiatric disorder. Last January she published the findings of a two-year study that could lead to a clearer understanding of how schizophrenia develops in the brain of a fetus. "It's too late to rewire Annick's brain," she told People magazine. "But it's not too late to prevent it from happening to someone 20 years from now." Printed 7/15.   ANOTHER FRONT. . . A compound originally developed by U. S. Army researchers to protect soldiers from the effects of nuclear weapons has been approved in Canada to make chemotherapy safer for patients fighting cancer of the lung, ovary and possibly the breast. When used 30 minutes before chemotherapy, Ethyol helps protect against a drop in the production of white blood cells while leaving tumor cells open to attack. "It diminishes the risk of infection and there are improvements in overall kidney function," assistant professor of medicine Lynn M. Schuchter, MD, told the Toronto Star. Printed 7/18.   CAVEAT EMPTOR. . . To people looking for more natural solutions to their health concerns, holistic medicine is an attractive field. But without controlled studies, how do you know if you're being offered a legitimate alternative to conventional treatment? "The danger is that there are toaster ovens that have been tested more than some alternative medicines," Glenn McGee, PhD, faculty associate in the Center for Bioethics, told Good Day Philadelphia viewers. "And while there's a lot that's healthy here, we want to think carefully about what we bring into the fold. For every good alternative medicine healer, there's another one who's selling crystals." Aired 7/26.   REACHING OUT, REACHING UP. . . The High School Educational Pipeline Program, sponsored by Penn's School of Medicine, is designed to interest and motivate inner city youth to pursue careers in medicine by providing mentors and a variety of medical school experiences. A photo on the front page of The Tribune captured Horace M. DeLisser, MD, assistant professor of medicine, as he described X-rays of diseased lungs to two Edison Fareira High School students during a class about the hazards of smoking. Printed 7/11.   HELPFUL HINTS. . . An alarming number of children have become violently ill from eating fast-food hamburgers. What can we do to protect ourselves from E. coli and salmonella bacteria? In an interview on Good Day Philadelphia, Lisa Hark, PhD, RD, director of the Nutrition Education and Prevention Program, said it's important to make sure that meat and poultry is well-cooked. But that's not all: "Don't eat anything that contains raw eggs ... keep hot food hot and cold foods cold ... [and] once you put your meat or chicken or turkey on the barbeque, throw away the marinade," she advised. Aired 7/10.   LIKE MOTHER, LIKE DAUGHTER. . . An article in the Jewish Exponent about the chances of a daughter patterning her mother's menstrual cycle, her pregnancies, menopause, bone density and other physical traits included the expert commentary of Samantha M. Pfeifer, MD, assistant professor of obstetrics and gynecology. Since one-half of a daughter's genetic material comes from her father, her menstrual cycle might be patterned from female ancestors of both parents, she explained. Heredity can determine the age of onset, length of the cycle and the level of pain. Printed 7/25.   WARM MEMORIES. . . The Sunday Inquirer Magazine highlighted some Philadelphians' remembrances of great summers past, including those of Helen C. Davies, MD, professor of microbiology. "Every summer for 20 years, I took a student from one of the Philadelphia high schools into my laboratory," she recalled. "We encouraged them to apply to college, helped them with their applications and found that they became wonderful additions to the laboratory C as well as friends." Printed 7/7.   PLAQUE ATTACK. . . The Food and Drug Administration has approved a new drug to treat people with high cholesterol. Pravachol works by slowing the development of plaque which, in turn, reduces the risk of heart disease. In a syndicated sound bite on KIRO-TV7 in Seattle, WLWT-TV5 in Cincinnati, and News 8 Cable in Washington, Daniel J. Rader, MD, director of the Lipids Clinic, was enthusiastic about the decision: "For the first time we have a medication that we can use to treat high risk people -- to actually prevent the risk of their first heart attack and to prevent them from dying of their first heart attack." Aired 7/9.   LOMBARD LAMBADA. . . Concerned residents continue their tango with a developer who unveiled plans to convert vacant properties on the 900 block of Lombard Street into independent housing for persons with chronic mental health problems. Should neighbors be concerned about property values? "There have been studies on whether the housing has a negative market impact, and it has no impact," says psychiatry's Dennis P. Culhane, PhD, research assistant professor in the Center for Mental Health Policy and Services Research. "That particular type of housing ... has been very successful in breaking the cycle of homelessness," he told the City Paper. Printed 7/26.   DOUBLE TROUBLE. . . In New York's young and rapidly expanding managed care industry, many patients find themselves fighting with their health plans while they are battling serious illness. "Eighty-five percent of medical care is routine, and the plans take care of that readily," Alan Hillman, MD, director of the Leonard Davis Institute's Center for Health Policy, told The New York Times. "The gaps in HMOs exist in the less routine situations. And of course the good organizations seek to plug them, but that can take years." Printed 7/15.   DAMPENED SPIRITS. . . Despite the association of incontinence with old age, a surprising number of younger women encounter the problem. There's a strong association with being overweight, although it is unclear whether this is because of diet, excess abdominal fat or increased pressure on the pelvic muscles and bladder. "Thinner people generally have less stress incontinence," Alan J. Wein, MD, chair of urology, told Living Fit. "However," he added, "even if you're thin and otherwise fit, you can still experience leakage if your pelvic floor muscles don't have good tone." Printed in the July/August issue.   STAYING POWER. . . Endurance. Perseverance. People with stamina never seem to run out of steam. What gives them such staying power? In an interview published in the Arizona Republic, Edward Schweizer, MD, associate professor of psychiatry, said it depends on some degree to your body's neurochemical makeup. However, one of the ways you can boost your stamina is to make yourself useful. "Giving of oneself really is its own reward," he said. "It can recharge your psychological and emotional batteries." Printed 7/14.   SWEET SUCCESS. . . Despite the fact that they had to forego most candy and constantly slow themselves down, the kids in the Children's Hospital-YMCA diabetic day camp program had a great time. "They're learning that it is their responsibility to check their glucose levels," Eva Desrosiers, third-year Penn medical student, told The Philadelphia Inquirer. First-year student S. Kareem Anderson said he and the other camp counselors "make sure [the children] eat what they are supposed to and that they understand the importance of monitoring their sugar." Printed 7/18.   DYING FOR ORGANS. . . While reluctance to donate organs certainly is not unique to Jews, the belief - totally unfounded - that Judaism prohibits organ donation because it mutilates the body still persists throughout the Jewish community. According to the Talmud, however, the act of saving a life takes precedence. Despite rabbinical interpretations, emotional obstacles remain. "All people, not just Jews, have a hard time accepting the traumatic death of a loved one," Rabbi Deborah Pipe-Mazo, pastoral care chaplain, told Inside magazine. "Those left behind don't want to inflict more suffering on someone whose death they have not yet accepted." Printed in the Summer issue.