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International
INTERNATIONAL
The London Times
The Ottawa Citizen
The Associated Press
Men’s Health magazine
Seattle Times
Orlando Sentinel
Philadelphia Daily News
WXPN-FM
WHYY-FM
KYW-TV3
WPVI-TV6
WHTM-TV27 (Harrisburg)
“The scientist is wiser not to withhold a single
finding or a single conjecture from publicity.”--Johann
Wolfgang von Goethe (1749-1832)
Scientists Discover
Mutation in Prostate Cancer Gene
Researchers have identified a gene mutation that they say plays a significant role in the development of prostate cancer. Men who carry the mutation in the gene CYP3A4 had more advanced prostate tumors than men without the mutation, Penn scientists said in the August 19 issue of the Journal of the National Cancer Institute.
The mutation allows more testosterone, the hormone that fuels prostate cancer, to be available to the prostate gland, according to principal author Timothy Rebbeck, MD, assistant professor of epidemiology.
Rebbeck said that the discovery could identify men who have a higher risk of prostate cancer, the second leading cancer killer in men. (This year, the American Cancer Society estimates that 184,500 new cases of prostate cancer will be diagnosed and approximately 39,000 men will die of the disease in the United States.)
The researchers studied 230 white men with prostate cancer. Those with the mutation who were diagnosed after age 63 and who had no family history of the disease were nearly 10 times as likely to have a higher-stage tumor than men without the mutation, the study found. (The mutation was believed to have no hereditary link.)
“This discovery has opened up a number of possibilities for further studies,” said S. Bruce Malkowicz, MD, associate professor of urology and co-collaborator on the study. “We’re getting closer to answering the question of why one person developed the disease instead of another.”
Rebbeck said the information will lead to more studies
that could help researchers devise better prostate cancer
prevention strategies.
Reports began on August 18.
BBC News
Edmonton Sun
Reuters
Rocky Mountain News
Seattle Times
CNN
Orange County Register
Injured Brains Smart For Weeks, Not Days
Brain injury due to motor vehicle accidents, falls, and sports accidents, among other reasons, affects nearly 2 million people every year, with related deaths claiming more than 56,000, according to the Brain Injury Association. Still, how the brain responds to injury is poorly understood.
Looking at a particular pattern of apoptosis—programmed cell death that amounts to cellular suicide—in animal models, Penn researchers have discovered that this cellular destruction continues for weeks after the initial trauma.
“A brain-injured patient may look stable, but cells are still dying,” Tracy K. McIntosh, MD, professor of neurosurgery, bioengineering, and pharmacology, told BBC News. McIntosh and colleagues report their findings in the August 1 issue of the Journal of Neuroscience.
The researchers induced brain damage in rats and then examined their brain tissue at points ranging from 12 hours to two months after injury. Initially, cells died most rapidly near the surface of the brain where the injury occurred, but cells deeper in the brain started dying later.
Classically, research in this field has focused almost exclusively on the first few days after an injury. Scientists hypothesized that this was when the maelstrom of neurochemical changes occurred, and after that, the brain’s response calmed down.
“But this study points to the fact that things are
not so quiet,” said McIntosh, who is also director of
Penn’s Head Injury Center. “Realizing this will be
important for coming up with ways to recover, regenerate,
and stem the loss of brain tissue.” McIntosh believes
“these findings could eventually affect protocols in
rehabilitation and lead to ways to pharmacologically block
cell death.”
Reports began on August 1.
NATIONAL
Philadelphia Daily
News
WPVI-TV6 (Prime Time)
WXYZ-TV (Detroit)
KPRC-TV (Houston)
WHDH-TV7 (Boston)
WPEC-TV12 (West Palm Beach)
WCBS-TV2 (New York)
WGAL-TV8 (Harrisburg)
WEWS-TV5 (Cleveland)
WFOR-TV4 (Miami)
WHTM-TV27 (Harrisburg)
WPEN-AM
It’s not acupuncture, but it involves the insertion of pins under the skin. It’s not massage, but it is a form of muscle stimulation. Whatever it is exactly, chronic pain sufferers may not care—they just want it. Now.
The procedure, available only at Penn and known as Automated Twitch Obtaining Intra-Muscular Stimulation, or ATOIMS, goes right to the source of the problem—tapping on sick nerves to produce a twitch that breaks painful muscle spasms.
How Jennifer Chu, MD, associate professor of rehabilitation medicine and director of the electrodiagnosis laboratory, invented the procedure involves a bit of serendipity. Eight years ago, while conducting an electromiographic nerve study, Chu discovered that patients found relief from pins used in the exam. “So, I said, since I got the results with the EMG pins, why don’t I use the EMG pin to treat people,” she told WPVI-TV6’s Prime Time.
Chu automated the procedure this year with the addition of a sewing-machine-like device that inserts and removes the pins. “The needle trajectory is very smooth so it will go in fast and will come out fast,” she explained. “And, because the track is very smooth, it will hurt less.”
In essence, the twitch produced by the pins relaxes tight muscles in spasm, allowing blood to flow more freely and calm irritated nerves. “[In spasm], nerves and blood vessels inside the muscle are choked by the tightness of the muscle,” she explained. “When this happens, the nerves cannot heal.” The contracting of the muscle allows the healing to begin. Close to 70 percent of patients treated with ATOIMS report pain relief, she said.
Like acupuncture, the method doesn’t work for all
pain. “This is for nerve-related pain . . . neck pain,
back pain, hip pain, leg pain, or arm pain,” she said.
“This treatment is not for people who have pain because
of a surgical incision or a gunshot wound, or an abscess or
rheumatoid arthritis, for example.” The number of
sessions needed depends on the nature of the pain. Age is a
factor too: “The older you are, the stiffer the muscles
become.”
Reports began April 8.
[Editor’s note: Since issuing the press release on Dr. Chu’s procedure in February, Media Relations staff have fielded more than 100 calls from prospective patients across the country.]
Oncology magazine
Oncology Times
News Journal (Wilmington)
WPVI-TV6
WHTM-TV27 (Harrisburg)
WSVN-TV7 (Miami)
Paul Harvey Syndicated Radio Show
Packing Heat to Fight Liver Cancer
Though rare—about 1 percent of all cancers in the U.S.—liver cancer is particularly deadly: untreated patients usually die in three or four months; treated patients may live six to 18 months if they respond to therapy. One reason: Many patients have tumors that cannot be safely removed while still preserving the remaining organ, or they may have multiple tumors that make surgical extraction almost impossible.
Now, Penn scientists are testing a method, called radio frequency ablation, by which surgeons seek out the tumors and literally cook them to death. First, surgeons insert a needle-sized probe into the abdomen. Guided by ultrasound, the probe is positioned inside a tumor. There, the tip of the probe sprouts into an umbrella of wires that sends high-frequency radio waves (transformed into 100 watts of heat) through the tumor for 10 to 15 minutes.
Once the larger malignancies have been microwaved, surgeons put in a intra-arterial chemotherapy pump that will kill other cancer cells. “The hope is that by treating the largest tumors immediately, the smaller ones, as well as any residual microscopic disease, will have a better response to chemotherapy,” principal investigator Douglas L. Fraker, MD, associate professor of surgery and chief of the division of surgical oncology, explained in Oncology Times.
The procedure is the flip side of cryosurgery, which uses extreme cold to destroy tumors. “The heater probe appears to have an advantage over cryosurgery because a much smaller probe is used and vascular complications are ultimately decreased,” Fraker told Oncology magazine. (The equipment used is also 25 percent less expensive than the cryoprobe machine.) “We hope that the study results will indicate that radio frequency ablation completely destroys tumors so that patients who are currently inoperable will have the option of [it] in the near future,” said Fraker.
The next phase of the trial will deliver heat therapy to
selected tumors in four patients with colon or rectal cancer
and liver metastases.
Reports began in April.
The New York Times
An NIH study shows that young men are more forthright about their sexual behavior and risk of HIV infection when completing computer surveys instead of traditional handwritten questionnaires. “We know people have a tendency to report more socially desirable or normative behaviors [in written surveys],” David S. Metzger, PhD, research assistant professor of psychiatry, told The New York Times.
But computers add a new dimension. Experts said the results are consistent with studies showing a decrease in inhibition when a computer mediates human communication. In the national survey, those who listened to questions on earphones and viewed them on a computer screen were almost four times more likely than the paper-and-pencil group to report some type of male-male sex (5.5 percent vs. 1.5 percent); 14 times more likely to report sex with an I.V. drug user (2.8 percent vs. 0.2 percent); and 5.5 times more likely to report that they were “always” or “often” drunk or high when they had heterosexual sex (10.8 percent vs. 2.2 percent).
“We know that for kids in their adolescence, their
drug use is at such an early stage that their primary
concern is keeping it hidden,” said Metzger. “I
think this moves us a lot closer to the truth.”
The report appeared on May 8.
The Associated
Press
Los Angeles Times
The Baltimore Sun
San Francisco Examiner-Chronicle
Orange County Register
Philadelphia Tribune
Bucks County Courier Times
Times-News (Erie, Pa.)
Intelligencer-Record (Central Bucks)
Herald-Standard (Uniontown, Pa.)
Standard-Speaker (Hazleton, Pa.)
Sun-Sentinel (Fort Lauderdale, FL)
Newsday (Long Island, NY)
Tribune-Review (Greensburg, Pa.)
Plain Dealer (Cleveland, OH)
One doctor says it’s “absolutely schizophrenic.” It’s crazy, he’ll tell you, that the same people who tell you not to smoke, counsel you on addiction, or remove cancerous tumors, own and profit from tons of tobacco. That’s the word from the Associated Press. Their computer analysis, cross-checking a federal farm database with medical rosters from tobacco states, revealed at least 760 American doctors and other health care workers who own valuable federal tobacco-growing rights, known as allotments or quotas, to the tune of $13 million.
All told, they control production of more than 7 million pounds of tobacco—enough to make 193 million packs of cigarettes a year. They also grow nearly 290,000 pounds of the varieties of leaf used in chewing tobacco and cigar wrappers.
For professionals who have taken an oath to do no harm, those numbers are “shocking and disappointing,” said Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics. “I think you just cannot argue that you’re going to make money on the back of this obvious health menace. To own and farm and produce tobacco as a doctor, especially in small communities, sends a resoundingly wrong message.”
But argue (or, at least, rationalize) is what many
physicians did when the AP contacted them by phone. Some
sample responses: “I’m too greedy.”
“Tobacco is a proud heritage for North Carolina ... I
want to maintain that part of my heritage.”
“Owning a tobacco farm has nothing to do with
smoking.” “You could argue that the farmers in
South and North Dakota that raise barley (for beer
companies) are also contributing to a product that ... hurts
the lifestyle of many families.” “The Hippocratic
Oath is specific for your practice. I don’t give these
products out in my practice.”
Reports began on June 27.
Cincinnati
Enquirer
Philadelphia Business Journal
The Philadelphia Inquire
New drugs to treat AIDS don’t work for everyone and have limited use in developing countries, where 90 percent of the estimated 30 million people with HIV live. For that reason, explains Neal Nathanson, MD, professor emeritus of microbiology, “an AIDS vaccine is now one of the most urgent needs in all of biomedical research.”
Nathanson is in a position to direct the strategy to create one. In July, the world-class virologist became director of the federal government’s Office of AIDS Research. “It’s an opportunity to do something that is both challenging and greatly needed,” Nathanson told The Philadelphia Inquirer.
Vaccine research accounts for less than 15 percent of the government’s $1.7 billion annual AIDS research budget. But money isn’t the only thing needed to close the gap between the dreaming and the doing, said Nathanson. A more coordinated approach is required, he said—one that tests only the most promising vaccine candidates. (It is already clear, he noted, that proposed vaccines that use a live but weakened form of HIV are not safe.)
While “at least a dozen” preliminary studies show that some protection against HIV is possible with other types of vaccines—including those made with DNA of the virus—Nathanson doesn’t expect the “ultimate” AIDS vaccine anytime soon. Realistically, the first wave of vaccines will be only partially protective, he said, but still useful in stopping at least some of the devastation from an epidemic that has claimed 10 million lives worldwide.
Nathanson’s fine-tuned approach will include
strategies for every demographic affected by the epidemic.
For example, for women who are infected by having
unprotected sex with infected men, the use of microbicides,
chemicals that could be put in the vagina before sex to kill
HIV, remains more a promising notion than a reality.
“Everyone pays lip service to the idea that we need
good microbicides, but I’m taken aback by how little
progress has been made.”
Reports began on June 25.
LOCAL
Citizens’ Voice
(Wilkes-Barre)
The Record (Hackensack, NJ)
What we know: Antioxidants, such as vitamins C, E, and beta-carotene, rid the body of free radicals. It’s a good thing, too: Free radicals wreak havoc with cells, suppress the body’s immune system, and play a role in cancer, heart disease, and various degenerative diseases.
What we don’t know, for sure: Are vitamins doing the job?
“We presently have no rational basis for choosing a particular dose of a vitamin or choosing a disease in which to evaluate the effect of a vitamin,” Garrett FitzGerald, MD, told the Citizens’ Voice. “And indeed, we have reason to suspect there might be quite a degree of inter-individual difference in susceptibility to the benefit of vitamins.”
FitzGerald and his collaborators are working on a more precise measure of success. They have discovered two markers that can show how susceptible someone is to free radical damage and tell whether antioxidant vitamins are having any effect. The markers are two byproducts of oxidation to a fat molecule found in cell membranes throughout the body. The Penn researchers found that the first marker, called 8-epi-PGF2alpha, is elevated in cigarette smokers and in people undergoing bypass surgery or other treatment shortly after a heart attack. (The study with smokers also found vitamins C and E were effective in lowering the chemical signals of free radical damage.) The second marker, IPF2alpha-1, is somewhat easier to find and detect, the researchers said.
In a recent study, FitzGerald found high levels of both
chemical markers in plaque tissue removed during surgery on
blocked carotid arteries. FitzGerald says that using the two
markers together helped the refine and validate the new
marker, setting the stage for more widespread human studies,
including a large-scale clinical trial on antioxidant
vitamins.
Reports began April 6.
Perspectives
“The shadow of the Holocaust is dense and incredibly powerful still. It leaves Europe terrified about the abuse of genetics. To them the potential to abuse genetics is no theory. It is a historical fact.” --Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics “Europe, Bucking Trend in U.S., Blocks Genetically Altered Food” The New York Times, 7/20
“We know that it’s happened in the past. The idea that this is a foolproof system when administered by overworked and underpaid individuals in hospitals is just wrong.”--Glenn McGee, PhD, assistant professor of bioethics for Penn’s School of Medicine [Subject: Virginia toddler switched at birth.] National Public Radio, Morning Edition, 8/5
“No one knows a woman’s breast as well as the patient, the woman herself. Women must take charge of their own destiny.” --John H. Glick, MD, professor of medicine and director of the University of Pennsylvania Cancer Center [Subject: Self-exams for breast cancer.] Eyewitness News 3, 8/3
“Body-building isn’t something that happens by accident. It’s a purposeful sport. You don’t just stumble along being in shape.” --Michael Rodricks, MD, third-year anesthesia resident and champion body-builder “Dr. Fitness” Philadelphia Daily News, 7/1
“They look at just about every corner of your facility. It’s a little scary.”--Thomas Beeman, senior vice president for hospital operations “Inspecting Hospitals: Is System Sick?” The Philadelphia Inquirer, 7/19
“A dedicated, smart 14-year-old hacker with access to the Internet, I believe, can find out medical information from medical databases on anyone in the United States today.” --Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics [Subject: A national health records database.] CBS Evening News, 7/20
Snips & Clips
THINK BIG. . . In recent years, the focus of gene therapy research has shifted from rare inherited illnesses to more common diseases—areas with more potential for profits—such as cancer, AIDS, and heart disease. Pharmaceutical companies have little financial incentive to focus their efforts on genetic disorders, many of which affect only a handful to a few thousand people worldwide. “The whole concept of gene therapy for genetic diseases doesn’t fit the business model,” James M. Wilson, MD, PhD, professor of medicine and director of Penn’s Institute for Human Gene Therapy, told The New York Times. Printed August 4.
A TOUGH NEIGHBORHOOD. . . Allegheny Health, Education and Research Foundation filed for Chapter 11 bankruptcy protection in July, paving the way for a sale of its Delaware Valley hospitals to for-profit health systems Vanguard or Tenet. “It’s an unfortunate turn of events for Philadelphia and the region,” said William N. Kelley, MD, CEO of the Health System and dean of the School of Medicine, in Modern Healthcare. While executives at the two for-profit health systems are confident they can restore the Allegheny hospitals to profitability, rising costs and declining reimbursements remain serious obstacles to financial recovery. “There’s a long way to go,” Kelley said, “and this is a very tough marketplace.” Printed July 27.
CURE OR CRUTCH?. . . Does methadone, a prescription drug given to heroin addicts, help users quit—or does it compound their drug problems? Proponents claim that the drug allows addicts to live a normal life, but critics argue that unless addicts change their lifestyle, methadone simply becomes another drug they abuse. And methadone’s street value leads some addicts to become dealers of the medication. “[Addicts will] take a swig of methadone and not swallow it, and then spit it out as soon as they step outside the clinic and sell it,” Robert F. Forman, PhD, director of Presbyterian Medical Center’s Addiction Treatment Services, told the Philadelphia Daily News. Printed August 12.
LEAVE MY DNA OUT OF IT. . . Ideally, genetic testing could help people make more informed choices about their health care based on their genetic predisposition to certain illnesses. But people may refuse to take these tests because no laws exist to regulate how the results would be used. “If people are fearful that they’re going to lose their jobs, worried that they can’t protect their privacy, concerned that if they get genetic testing they may find themselves unmarriageable, they are not going to rush forward and say, ‘Bring me the fruits of the genomic revolution,’” said Arthur L. Caplan, PhD, director of the Center for Bioethics, in the Dallas Morning News. “The genomic revolution will not come until we fix that.” Printed July 19.
TAKE YOUR PICK. . . There are dozens of over-the-counter painkillers. Which one should you chose? Jennifer Chu, MD, associate professor of rehabilitation medicine, offered Woman’s World readers some tips. “Anti-inflammatories like acetaminophen [Tylenol] and ibuprofen [Advil] work about the same,” she told the magazine. “The only difference is how often you have to take them and how irritating they may be to your stomach.” Studies show buffered anti-inflammatories are the easiest on the stomach. Printed July 14.
YOU’RE NOT ALONE. . . As of 1997, 92 percent of the nation’s physicians had some type of managed care contract, according to the American Medical Association. With the rise of managed care, one mode of medicine has become largely extinct. “Compare the Marcus Welby type of doctor that existed up until 10 years ago, where a doctor owns his or her own practice, sets his or her own rates, practices his or her own style of medicine”said Alan Hillman, MD, MBA, director of the Center for Health Policy and associate professor of medicine, in The New York Times. “Now you have doctors subject to outside management, most doctors being employees of an organization or highly managed. The loss of autonomy and control is astounding. The doctors are battered.” Printed August 3.
UP TO PAR. . . All international medical graduates seeking residences in the United States must pass the Clinical Skills Assessment test. The test costs $1,200 and is administered only in Philadelphia, making it both expensive and inconvenient. But it’s also necessary, say supporters. It’s a way to ensure that foreign medical school graduates have been taught basic skills before progressing to the next level of training. “We know the medical school system in the United States and know that most who graduate can perform basic rudimentary clinical skills,” Lisa Bellini, MD, associate chair for education in the department of medicine, told the Philadelphia Daily News. “We don’t know as much about other countries.” Printed June 29.
CHECK PLEASE. . . Hemochromatosis is the most common hereditary disease in the world, affecting some 24 million people. Marked by excessive iron absorption, it can be fatal if left untreated. Fortunately, it’s easily diagnosed with a simple blood test. Yet the disease is often missed in afflicted patients until it has progressed to an advanced stage. “Doctors will order a dozen tests for liver failure, but they usually don’t think of hemochromatosis until dead last,” Christopher Friedrich, MD, PhD, assistant professor of medicine, told The Philadelphia Inquirer. “And yet it’s the easiest to treat.” Printed August 14.
NO KNOW. . . Although 13 million Americans suffer from incontinence, a recent survey shows that 83 percent of adults know little or nothing about the condition. Urology Chair Alan Wein, MD, released the survey findings at the American Urological Association’s annual meeting in San Diego. Wein said the results call attention to the need for doctors to educate patients about incontinence. Printed in the August issue of Senior News Long Island.
WHO NEEDS IT?. . . At least a dozen U.S. for-profit companies are urging expectant parents to spend as much as $1,000 to collect and store their newborn’s umbilical cord blood, just in case a sibling might someday need a transplant. But the chances that a family will ever need the blood are one in 10,000, unless the family already has a child with a disease such as leukemia, Paul Root Wolpe, PhD, assistant director of the Center for Bioethics, told the Orange County Register. Children who do need transplants have only a one in four chance of matching their sibling’s cord blood. Nonetheless, companies are successfully marketing their cord blood services to concerned parents. “There is a lot of money to be made in autologous blood storage and quite a lot of overselling is occurring,” said Wolpe. Printed July 19.
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September, 1998 Marion Wyce, Assistante Editor Lori Doyle, Chief Public Affairs Officer Rebecca Harmon, Director of Media Relations Jacquelin Sufak, Director of Internal
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