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International
INTERNATIONAL
USA Today-Europe
Study Finds Sexism Rampant in Medicine
“Almost everyone ‘gets it’ in terms of sexual harassment, but the other issue, gender-based harassment, I think is truly a problem.” --Andrew Thomas, MD, resident trustee on the board of the American Medical Association
The examples of blatant sexism — pinching, lewd remarks, sneers — have become rare in the medical realm, but a far more insidious form of sexism remains widespread, affecting almost half of today’s female doctors, according to a study published in The Annals of Internal Medicine in February. About 48 percent of the 4,501 female doctors who answered the survey said they have experienced harassment based on their gender, from being called “honey” in front of patients to being told medicine is not a fit career for women.
Frances Conley, a brain surgeon who resigned her tenured position at Stanford School of Medicine in protest of sexism, finds greatest concern in the number of young women reporting harassment from their young male colleagues. “We tend to perpetuate the badness of our profession,” she said. “Young men see the personal characteristics of their elders and copy them.”
Women in specialties dominated by men are more likely to
report harassment. Melissa Schiffman, MD, a Penn resident
and co-author of the Archives article, said women consider
attitudes in making career decisions. “A lot of women
in my class were interested in surgery but didn’t go
into it because they were so badly treated in that
rotation,” she said. “Once you pass through the
training, you’re fine because you’re higher in the
hierarchy. But, unfortunately, women might be steered away
thinking they’d be subject to that through their
career.”
The report appeared February 24.
Reuters
ABC Radio
Science News
New Scientist
San Francisco Science
Science
Cardiology Today
Researcher Finds Bone in Heart Valves
About 71,000 people each year have heart valves replaced because they become so calcified that they can no longer control blood flow. Doctors always thought the calcium was deposited on the valves in much the same way that lime builds up in a pipe carrying hard water. But Emile Mohler III, MD, assistant professor of medicine, made a startling discovery. “It’s not just calcium,” he said. “It’s organized bone. It looks just like bone you would see in an arm or a leg.”
Mohler looked at 228 heart valves removed from 206 patients over three years and found bone tissue in 30. “The most important question is: What’s the trigger?” he said. “One theory is that, under the right conditions, either valve cells or inflammatory cells at the area of heart damage undergo a genetic change and start making bone-cell proteins.”
Mohler’s ultimate goal is to devise a treatment to
prevent the hardening. The research also could help
scientists better understand how calcium deposits form in
the arteries of patients with atherosclerosis and other
vascular diseases.
Reports began April 1.
NATIONAL
The Boston Globe
The Washington Post
The Philadelphia Inquirer
Philadelphia Daily News
Reuters Health
ScienceNOW
KYW-TV3
WPVI-TV6
Morning Call (Allentown, Pa.)
Blocking Pain in Surgery Shows Benefits Weeks Later
Even if you don’t feel pain while you’re under anesthesia, your body does, and apparently the memory of it causes the pain to linger for weeks. David Smith, MD, PhD, associate professor of anesthesia, and Allan Gottschalk, MD, PhD, assistant professor of anesthesia, believe they have found a solution — giving patients painkillers before doctors make their first cut. “This is the first study to look at issues of pain beyond the first three to five days after surgery. We wanted to see what happens when a patient goes home: Is there something we can do to improve their functionality and quality of life,” Smith said.
The study, which was published in the Journal of the American Medical Association, involved 90 men who underwent prostate surgery. One group received painkillers before the operation and both groups received them afterward. The men in the first group reported 33 percent less pain during their hospital stay. Nine weeks later, 86 percent said they had no pain, compared with only 40 percent of the other group.
“By putting local anesthesia in before the pain
begins, we’re blocking that painful input from reaching
the spinal cord,” Smith told The Boston Globe.
“General anesthesia alone does not do this; it does not
protect against this sensitization of the nervous
system.”
Reports began April 8.
USA Today
Responding to Treatments for Advanced Breast Cancer
When Cathy Hainer, a reporter for USA Today, was diagnosed with Stage IV (metastatic) breast cancer, she decided to chronicle her battle for the national daily. Hainer, age 36, has been given a life expectancy of 10 to 12 months. As part of a clinical trial, she has endured three rounds of Taxol and is moving on to Adriamycin. Hainer is also using alterative treatments, nutritional therapy, and faith to try to prolong her life.
Hainer’s goal is to become a “complete responder”—a patient whose cancer can no longer be detected. A recent USA Today feature noted that clinical trials for breast cancer treatment include combinations of new and standard chemotherapy drugs and bone-marrow transplants.
“There is a suggestion that survival is improved by
some of the experimental treatments. The survival benefit at
this point is measured in months,” Lynn Schuchter, MD,
associate professor of medicine in hematology-oncology,
said. “But the quality of life, I’m sure, is
improved. Not only do people feel better, but they also have
a better ability to tolerate chemotherapy (with new agents
that minimize nausea and damage to the blood) than they had
in the past.”
The report appeared March 26.
The New York Times
Patients Wary of
Tests for Cancer Genes
When labs began offering tests for breast and colon cancer genes a year ago, some experts expected a flood of patients wanting to see into the future. The crush never developed. Instead of performing thousands, the labs have performed just hundreds of the tests. The reasons vary: Some patients fear discrimination in insurance or the job market, others are unsure how knowing will help them, and others just don’t want to know. “Everyone misunderstood this field,” said Timothy Triche, head of Oncormed, a company that offers tests for the colon and breast cancer genes.
The wariness is welcomed in some quarters. “Many of us have been worried that plunging into this too quickly before we really know what the information means might, in retrospect, be seen as unfortunate,” said Francis Collins, director of the Human Genome Project at the National Institutes of Health. “A little caution seems appropriate.”
Others worry that patients whose lives might be saved are
not being tested. “A lot of people are frightened and
misinformed about testing,” said Barbara Weber, MD,
associate professor of hematology/oncology and director of
Penn’s breast cancer program. “A lot of people
have been discouraged from even getting
information.”
The article appeared March 27.
USA Today
Philadelphia Daily News
WCAU-TV10
The drug tamoxifen offers good odds for women predisposed to breast cancer, but the therapy is still a gamble. In a recently completed National Cancer Institute clinical trial, half of the 13,338 high-risk women who took tamoxifen instead of placebo had 45 percent fewer cases of breast cancer. “If we can, out of a hundred women, prevent breast cancer in 45 of them, I think that’s tremendously significant,” Michael H. Torosian, MD, associate professor of surgery and principal investigator of the study at Penn’s Cancer Center, said in a Philadelphia Daily News interview.
On the other hand, tamoxifen has been linked to uterine cancer and lower-limb blood clots that reach the lungs. Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics, called prevention drug trials “ethically sticky.” “These studies get close to risking harm for no gain,” he said.
According to Torosian, the tamoxifen therapy is not for
everybody. “It depends on the analysis of the family
history — when they had their first child, when they
started their first menses, or whether they’ve had
pre-cancerous biopsies.”
Reports began April 7.
NBC Dateline
Orthodontists Keep Recycling Data from Patients
For two decades, orthodontists have been taking braces out of one child’s mouth, sterilizing the little brackets, and then cementing them to another child’s teeth. Do parents know their children get recycled braces? Not in most cases, according to a Dateline report on NBC-TV. The practice raises questions.
Do recycled braces work as well as new brackets? The manufacturers put warnings against recycling on the packages and an industry group has sent letters to orthodontists saying reusing brackets can dramatically impair the performance. Some lab studies indicate some recycled brackets might come unglued or corrode more easily. Others show recycling would probably not affect treatment. Orthodontists who use recycling say they see no difference.
What are the chances of getting an illness from the recycled braces? The Centers for Disease Control has never studied the issue, but says no confirmed case exists of anyone getting a disease from any dental equipment. The Food and Drug Administration has never studied the recycling procedures, mainly because the agency has never received a complaint.
The lack of regulation concerns Maryanne McGuckin, PhD,
senior research investigator in internal medicine, who
wonders if someone might have become ill from recycled
braces and not known it. “We need to monitor the
procedures that they are doing. We all need to know what
their data looks like in terms of quality control,” she
said.
The report aired March 9.
The New York Times
Modern Healthcare
Atlanta Constitution
Politics Enter Transplant Decisions
Politics have entered the world of transplants on a large scale, raising concerns by small centers fearful of not surviving and doctors fearful of misguided intentions. The federal government has ordered the United Network for Organ Sharing to devise a system by late summer to get donated organs to the sickest patients, regardless of where they live. The current system allows organ centers to favor regional patients, meaning an acutely ill person on the West Coast might die while someone less ill receives a new liver on the East Coast. In issuing the order, the government noted that more than half the livers used locally went to patients well enough to be at home, while 400 patients who died were awaiting transplants in hospitals.
The changes came after intense lobbying by John Fung, chief of liver transplant surgery at the University of Pittsburgh Medical Center, where the liver procedure was pioneered. The center has seen its number of liver transplants plummet by about 60 percent as more and more doctors trained in Pittsburgh introduced the operation in different parts of the country.
Small transplant centers have argued that a national list would concentrate organs in big cities, hurting poor patients who do not have the means to travel. They also believe they will experience much more difficulty in persuading locals to donate if the organs go to patients outside of the area.
“I wish we were having an open-ended debate about what’s fair,” said Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics. “Unfortunately, what I suspect we are seeing is a political squabble among transplant centers about what’s in their interest.”
While the national policy might seem to make the most sense to laymen, Caplan said it might not be the best use of organs. Sicker people are more likely to die after their transplants, or to need a second and even third. “It’s as if we were in a lifeboat and instead of trying to figure out how many of us might survive a shortage of food and water, we said, ‘Let’s pick the people who are the closest to dead and save them,’” Caplan said. A UNOS study indicated the new system would result in 761 additional repeat transplants each year, and the survival rate would drop from 75 percent to 68 percent.
After caring for thousands of transplant patients,
Abraham Shaked, MD, chief of Penn’s liver transplant
program, said he also questions whether organs should go to
the sickest patients. “Society — not HHS (the U.S.
Department of Health and Human Services), not just UNOS, and
not just transplant people — must reach some kind of
agreement about where they want to put their money,” he
said. “What’s the best bet: Should (livers) go to
the sickest or to the less sick?”
Reports began March 25.
LOCAL
Philadelphia Business Journal
It’s a medical advancement right out of StarTrek: a Philadelphia-based medical device company called Cytometrics Inc. is developing an instrument that obtains common blood-test results without drawing blood. The device, dubbed the Hemoscan, captures and analyzes a video image of blood flowing through the capillaries.
The device consists of a hand-held probe placed under the patient’s tongue, a computerized image-processing unit, and an optional monitor that displays the image captured by the probe.
Anesthesia Chair David Longnecker, MD, is a member of the Cytometrics advisory board. “I see [the Hemoscan] being especially helpful with pediatric patients,” Longnecker said.
He said another application for the Hemoscan is in the early diagnosis of shock and heart failure, conditions that result when oxygen traveling in hemoglobin isn’t being carried effectively to the various organs in the body. “Being able to look at a patient’s micro-circulation system, [the Hemoscan] could serve as an early-warning system” for patients at risk for stroke or cardiovascular disease, he said.
Cytometrics hopes to get the Hemoscan, which will require
approval from the U.S. Food and Drug Administration, on the
market by next year.
The report appeared March 27.
Philadelphia Daily
News
The National Institute of Diabetes, Digestive, and Kidney Diseases recently reported that “yo-yo dieting”— repeatedly losing and regaining weight — is not as harmful as previously thought. According to the report, excerpted in the Philadelphia Daily News: “There is no convincing evidence that it is better to stay overweight than to go through weight cycling [losses and gains ranging from five to about 50 pounds per weight-loss period].” The report says aging — not yo-yo dieting — causes dieters to experience greater difficulty losing weight each time they regain it.
“A national task force on obesity treatment reviewed
past studies — our own lab did some of that work —
and found them greatly exaggerated,” said Thomas A.
Wadden, PhD, professor of psychology in psychiatry and
director of Penn’s weight and eating disorders program.
The psychological effects of yo-yo dieting have also been
overstated, Wadden added. “While regaining weight is
disappointing, frustrating, and annoying, it doesn’t
destroy self-confidence or lead to clinical
depression.”
The report appeared April 10.
Philadelphia Daily
News
Allergy sufferers can expect to suffer long and hard this season, according to S. Michael Phillips, MD, professor of medicine. “Due to the unusual effects of El Nino, with the warm and moist winter, plants have survived well, resulting in more pollen and an earlier and longer allergy season,” Phillips told the Philadelphia Daily News. In the Philadelphia area, the allergy season begins with the pollination of juniper trees in April, followed by elm trees in May, grasses in June, weeds and molds in late summer, and ragweed in the fall.
According to Phillips, women and middle-aged people tend to suffer most from seasonal allergic rhinitis, but non-sedating prescription antihistamines — such as Claritin, Allegra, and Zyrtec — provide good relief. “Over-the-counter medications can also be effective, but most have significant side effects, the most common of which is drowsiness,” Phillips said.
Also available is immunotherapy, which exposes patients to materials they are allergic to; after time, the body’s immune system begins to turn off the allergic reaction. While immunotherapy is effective in 85 percent of cases, it is expensive and lengthy and should be a last resort, Phillips said.
The bottom line: “Allergies probably won’t kill
you, but they can definitely affect your quality of
life.”
Reports appeared April 6..
Perspectives
"“Striving for scientific accuracy is a commendable goal, but asking someone to have a hole drilled in their head for no purpose is putting science ahead of the subject’s interest.” -- Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics “Parkinson’s Surgical Experiment Sparks Ethical Questions” The Associated Press, 3/27
“There is something unseemly in peeking under the skirts of the dead, even if it might do some good to the living.” -- Paul Root Wolpe, PhD, adjunct assistant professor of sociology and associate at Penn’s Center for Bioethics “All About Yves [R.I.P.]”[Subject: Exhuming bodies for DNA testing] The Philadelphia Inquirer, 4/2
“Disease management is the final, common variable that integrates it all. It’s so intuitive; there’s no other way to solve these [organizational] problems.” -- William N. Kelley, MD, dean of the school of medicine and CEO of Penn’s Health System “Recognizing Quality” [Subject: Award-winning approach to quality] Modern Healthcare, 2/2
“Most of the concern comes from more senior physicians saying that today’s whippersnappers don’t know how to do it the old-fashioned way.”-- David A. Asch, MD, assistant professor of medicine “Physical Diagnosis 101” Los Angeles Times, 4/13
“When we begin testing on humans, who goes first? A person with a month or a week to live may not be the best person for the trials.” -- Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics “Wall Street Rocked, Cancer Institute Asks Quick Testing” [Subject: Reaction to reports about cancer-killing drugs] Philadelphia Daily News, 5/5
“By definition, all drugs are poisons. They are given to interfere with normal bodily functions. I cannot tell you how many times, when I start [prescribe] a drug, the patient asks, ‘Does this have side effects?’ And the answer is, ‘Of course it does. All drugs have side effects.’ The real question is, what are its side effects?” -- Brian Strom, MD, professor of medicine “Falling for the Love Drug” The Washington Post, 5/3
Snips & Clips
DOCTOR IN CHARGE . . . As hospitals put increasing emphasis on developing strong relationships with community doctors, a few have opted for putting a doctor in the executive suite. William N. Kelley, MD, dean of the School of Medicine and CEO of Penn’s Health System, said the advantages are obvious. “When the doctors try to spin a little take about something, it’s harder to get by me,” he told the Physicians Financial News. Kelley had no formal business training, learning what he needed to know on the job. “I helped build each of the research divisions I worked for into one of the top operations of its kind in the country. I really enjoyed that and felt I was ready for the next level, even though that meant giving up my own work in research.” Kelley dons a white coat for a month each year. “It’s enjoyable to get back to seeing patients, and it gives me a chance to see how the hospital is working, not through four or five layers of administrators, but right on the front lines.” Printed February 15.
CYBERSPACE PLEA . . . In desperation, Irena Matijevic sat before her family’s computer in Rijeka, Croatia. Her daughter’s lungs were slowly filling with fluid from a rare disease that doctors in her homeland had no expertise to treat. Could the doctors at Penn help, she asked in an e-mail? To her shock, Paul Lanken, MD, associate professor of medicine, said yes. Six months later, 19-year-old Vesna Matijevic underwent surgery at Penn that gave her a 30 percent chance of ridding her lungs of fluid. The story illustrates how the Internet is making medical information much more accessible to laymen. “The world is at the doorstep,” Ivor Benjamin, MD, assistant professor of obstetrics/gynecology and coeditor of OncoLink, told The Philadelphia Inquirer. Printed March 26.
NEW LIFE . . . With a survival rate of about 66 percent now, heart attacks no longer mean a death sentence. For more and more Americans, they offer an opportunity to change the way patients live and to find new activities and interests. “The majority of people who have attacks recover and have no further symptoms,” said Daniel Rader, MD, assistant professor of medicine. Low-fat eating and stress management are important. Rader also emphasizes exercise. “It is important to get heart attack patients out of the hospital quickly and gradually exercising,” he told Parade Magazine. Printed March 15.
DIFFICULT CHOICES . . . As America ages, a growing number of people are opting to use dialysis to extend their lives, raising a complicated question: Should patients ineligible for kidney transplants receive the expensive treatment or should it be used, as originally envisioned, as a stopgap to transplant? The number of people on dialysis has more than doubled in the last decade, costing Medicare $9.74 billion in 1995. The ballooning expense was one factor that killed a national health-care plan, some analysts said. “Dialysis is one of the few treatments in America where money does not make a difference because it is covered for most Americans,” Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics, told the Chicago Tribune. “Yet dialysis shows that no matter what system we live in, choices must still be made about when to use and when to discontinue treatment. It shows that factors beyond money drive our views about what’s worthwhile, the quality of life, and the burdensomeness of the intervention.” Appeared March 1.
PROMISES, PROMISES . . . A word of caution from Edward Bondi, MD, professor of dermatology, about anti-wrinkle treatments: “Any treatment that allows you to go right back to work is unlikely to have lasting benefits. You have to create some damage to the skin to go deep enough to get to the line.” Bondi was commenting in the Philadelphia Daily News on “wrinkle-plumping” patches, glycolic acid peels, and diamond peels, a process that involves bombarding the skin with aluminum oxide crystals. Appeared April 8.
INEXACT SCIENCE . . . Experts in the hospice industry said Medicare policies designed 16 years ago undermine care today. Medicare patients must have a life expectancy of no more than six months to qualify for hospice care, even though many of today’s patients suffer from AIDS and congestive heart failure, two conditions with unpredictable courses. In addition, Medicare reimburses at a flat rate, even though the expenses of setting up care and the care in a patient’s final days are far higher than day-to-day care. When patients die soon after admission to a program, hospice programs have no opportunity to recoup. “Medicine is not an exact science, and getting a six-month prognosis is, at best, an educated guess,” said Priscilla Kissick, RN, MSN, executive director of Wissahickon Hospice, part of Penn’s Health System. Beverly R. Ginsburg, MBA, administrator of Penn’s Cancer Center, suggests government policies also have cut hospice care off from the other parts of the health-care system. Instead, she told The Philadelphia Inquirer, hospice care “should be a part of the continuum and integrated with the rest of the health-care network.” Appeared April 21.
SNIPS AND TUCKS . . . Brazil leads the world in number of plastic surgeries performed annually, beating the United States by a nose. The Philadelphia Inquirer reported that nearly 200,000 Brazilians had cosmetic procedures in 1997, and a quarter-million are expected to go under the knife this year. American doctors perform about 600,000 procedures a year; however, most patients get two or three procedures during a single surgery, according to the American Society of Plastic and Reconstructive Surgeons. Cultural differences partly explain the trend. “Brazilians have an openness in their culture about cosmetic surgery and their appearance. . . . They don’t have that puritanical background that we have, of covering everything up,” said Linton A. Whitaker, MD, professor of surgery and chief of Penn’s plastic surgery division. Brazilian women, unlike their American counterparts, strive for small breasts and large derrieres.
HYPERTENSION . . . One out of four Americans suffers from high blood pressure. “No one knows the cause of 95 percent of the people who have high blood pressure,” said Raymond R. Townsend, MD, associate professor of medicine. “It is a silent killer because most people have vague complaints or symptoms or none at all.” Townsend has several recommendations for everyone: Know whether you are overweight; know the approximate sodium content of what you eat; keep in mind that more than two alcoholic drinks a day can increase your blood pressure; and know that regular exercise can combat hypertension. Appeared in Main Line Today in March.
PLANNING AHEAD . . . Luigi Mastroianni, MD, a professor of obstetrics/gynecology, has a few tips for women planning to have children a few years down the road. He suggests they see a gynecologist for a medical evaluation. One test should involve a cervical culture for sexually transmitted diseases, which can cause an infection in the fallopian tubes. The doctor also should look for signs of endometriosis, a condition that can lead to scarring, blockages, and, ultimately, infertility. Both can be treated with drugs, and, in some cases, with surgery. Appeared in the June-July issue of Bride’s Magazine.
AGE ATTITUDE . . . As the Baby Boom generation ages, society’s definition of “old” changes. Because of medical advances and more knowledge about aging, 50 is only halfway for some folks. “It sounds sort of trite, but the second 50 often is the best 50,” said Risa Lavizzo-Mourey, MD, MBA, professor of medicine and director of the Institute on Aging. “You don’t have as many problems in our second half of life as you do in the first half of life.” On one hand, she said, you have more health concerns, but, on the other, you have better judgment and more financial security. Lavizzo-Mourey recommends exercise and a healthy diet to make the second half better than the first. Aired March 1 on WCAU-TV10.
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June, 1998 Rebecca Harmon, Director of Media Relations
Media Review is published monthly by the University of Pennsylvania Medical Center's Office of Public Affairs to keep the faculty and administration aware of recent Penn-specific media highlights. To make comments, write to Editor, Media Review, 220 Blockley Hall, 3400Spruce Street, Philadelphia, PA 19104 |
