FISHERS’ $50 MILLION GIFT SUPPORTS NEW TRANSLATIONAL RESEARCH CENTER

SUMMER 2008

GENE THERAPY RESTORES PARTIAL SIGHT Help for Unhealthy Environments Behind the Jannetta Procedure Comparing Drugs: When Cost and Science Collide Going Public In his piece, Offit argues that a few do.” Ad hominem attacks, he says, are years ago, “vaccine court judges turned utilized “when you don’t have data.” Faculty members and alumni of their back on science by dropping pre- Offit makes no secret of his work Penn’s School of Medicine are no strang- ponderance of evidence as a standard.” on vaccines, and the Times op-ed piece ers to print, whether publishing study He disputes the claim of an expert who included a note that he is a co-inventor results or writing textbooks. But not testified on behalf of the Polings that and co-patent holder of a rotavirus vac- everyone has the inclination to weigh in the five vaccines had stressed Hannah’s cine. By an odd form of reasoning, some on controversial topics. For one thing, already weakened cells: “The Institute people on the other side of the issue the authors may have to express them- of Medicine has found that multiple believe that being an expert in the field selves a little more forcefully and less vaccines do not overwhelm or weaken automatically disqualifies a person as a subtly to be heard. For another, the re- the immune system.” trustworthy source. But Offit has seen sponses to these ventures are often less Within the day, readers had sent enough to convince him of the benefits genteel than might appear in the letters in 114 comments, arriving from all of vaccination, and he’s concerned that section of a professional journal. Not over the United States and several parents are being misled – and children everyone, in other words, has the heart foreign countries. Many comments will suffer as a result. for lively public discourse. supported Offit’s position, and because His most recent book is Vaccinated: Paul A. Offit, M.D., apparently does. of the Times’s policy, even those who One Man’s Quest to Defeat the World’s A well-known advocate of vaccines, disagreed had to express themselves Deadliest Diseases (Smithsonian Books, he is the Maurice Hilleman Professor civilly. Not so on the Internet, where 2007). An account of the life of Mau- of Vaccinology in Penn’s Department one blog describes Offit as a “vaccine rice Hilleman, who created almost of Pediatrics and chief of infectious terrorist” and another wonders “what three dozen vaccines, the book was diseases for The Children’s Hospital of sort of deal with the devil” Offit has favorably reviewed in both The New Philadelphia. This spring, he wrote an made. After the piece appeared, Offit England Journal of Medicine and The opinion piece for The New York Times, received about 50 e-mails a day for Journal of the American Medical Associa- about as public a forum as one can several weeks – the largest response to tion. Offit’s next book, scheduled to imagine. His piece was a response to anything he’s written – “and 90 percent be published in the fall by Columbia the news that the federal government was incredibly favorable.” University Press, promises to be more had agreed to compensate the family But on the day in June that we controversial: “Autism’s False Prophets: of Hannah Poling. At 19 months, she spoke, Robert F. Kennedy Jr., a lawyer Bad Science, Risky Medicine, and the received five vaccines; afterwards, she who has argued for a connection be- Search for a Cure.” In the prologue, was diagnosed with encephalopathy. At tween mercury in vaccines and autism, Offit cites many of the threats he’s re- an April press conference following the was at a rally in Washington, D.C., ceived and describes how he came to decision, her parents announced that where he called Offit a “biostitute.” specialize in infectious diseases. “Some the government had admitted that vac- (Apparently a combination of biology people who believe vaccines cause cines had contributed to her autism. As and prostitute.) Then there is the hate autism hate me because they think I’m Offit puts it in his op-ed, “Health offi- mail and the occasional death threats in the pocket of the pharmaceutical cials at the Centers for Disease Control Offit receives. In the face of such at- industry, that I say vaccines are safe and Prevention and at the American tacks, why continue to speak up for because I am paid to do it. To them, it Academy of Pediatrics have steadfastly vaccines? “Because it’s the right thing to is logical that I would spend 25 years assured the public that vaccines do not do.” A moment later, Offit adds, “But working on a rotavirus vaccine – a cause autism. Now, in a special vaccine it’s sometimes not the easy thing to vaccine that has the chance of saving claims court, the federal government hundreds of thousands of lives every appeared to have said exactly the op- year – so that I could lie about vaccine posite. What happened?” (March 31, safety and hurt children. But the rea- 2008). Readers are not kept in sus- son I say vaccines don’t cause autism is pense about Offit’s view: the op-ed’s they don’t.” title is “Inoculated Against Facts.” Paul Offit is not backing down.

Cover:  2 ■ Penn Medicine SUMMER 2008 / VOLUME XX NUMBER 2

6 10 BEGINNING TO SEE THE LIGHT WHEN GENES MEET ENVIRONMENT Some 20 years after the idea first came to them, Jean Bennett, M.D., Ph.D., and Albert M. By Thomas W. Durso Maguire, M.D., have used gene therapy to restore partial sight to patients with Leber’s con- Penn’s Center of Excellence in Environmental Toxicology seeks genital amaurosis (LCA). Until now, there has been no treatment for this retinal disease. to understand the link between environmental exposures and diseases caused by the environment. The members of the center share their discoveries in professional journals – and at community meetings.

Departments PETER JANNETTA SHOWS THEM HOW IT’S DONE By Nan Myers Inside The neurosurgeon who developed a radically new procedure to treat the Front EDITOR’S NOTE 14 Cover often excruciating pain caused by compression of the trigeminal nerve Going Public was honored last fall for his achievements. Despite early resistance to his procedure, he went on to train many leaders in the field. 2 VITAL SIGNS $50 Million Gift Supports New Translational Research Center A Glowing Showing A DIFFICULT PATH TO CLARITY By Lisa J. Bain Penn investigators were eager to launch an ophthalmology trial that Eight Glasses of Water? Not So Fast compared the effectiveness of two drugs for treating age-related 16 Transitions & Appointments macular degeneration. But before they could get it up and running, they first had to overcome many unexpected barriers. Honors & Awards Letters 24 DEVELOPMENT MATTERS The School of Medicine Goes to “The Sims” CHANGING THE PARADIGM – 28 ALUMNI NEWS PREPARING FOR THE CRISIS By Nan Myers Progress Notes and Obits Mark A. Kelley, M.D., G.M.E. ’79, executive vice president for the 22 Henry Ford Health System, returned to Penn to suggest ways aca- Inside Back THE LAST WORD demic health systems can prepare for the impending national crisis Cover Conflict of Interest in health care.

Staff JOHN R. SHEA, Ph.D. Editor LEWIS & NOBEL DESIGN Design / Art Direction ADMINISTRATION SUSAN E. PHILLIPS Senior Vice President for Public Affairs MARC S. KAPLAN Director of Communications

Penn Medicine is published for the alumni and friends of PENN Medicine by the Office of Public Affairs. © 2008 by the Trustees of the Uni- versity of Pennsylvania. All rights reserved. Address all correspondence to John Shea, Penn Medicine, 3535 Market Street, Suite 60 Mezzanine, University of Pennsylvania Health System, Philadelphia, PA 19104-3309, or call (215) 662-4802, or e-mail [email protected].

Visit Penn Medicine’s web site: http://www.uphs.upenn.edu/news/publications/PENNMedicine/ Anne Fisher served on the Board of Overseers for the Graduate School of Fine Arts, now known as the School of Design, from 1992 to 2002, and in 1999 was awarded the Dean’s Medal in Land- scape and Architecture. Jerome Fisher, a 1953 graduate of the Wharton School, is founder and emeritus chairman of the Nine West Group Inc. He has served on the Whar- ton School’s Undergraduate Executive Board and was a University trustee from 1996 to 2000. He has been a member of PENN Medicine’s Board of Trustees since 2006 and is an honorary emeritus

Penn’s translational research will have a new home in 2010. (Architectural rendering) trustee of the University. The Anne and Jerome Fisher Transla- tional Research Center will be adjacent $50 Million Gift Supports New “This new research center makes possible to PENN Medicine’s two new state-of- Translational Research Center an unprecedented level of focused scientific the-art outpatient facilities, the Ruth and exchange among researchers, clinicians, and Raymond Perelman Center for Advanced Anne and Jerome Fisher have made a educators from which will emerge important Medicine (opening this year) and the $50 million gift to support the construc- new medical knowledge and treatments,” Roberts Proton Therapy Center (opening tion of a new biomedical-research center said Arthur H. Rubenstein, M.B., B.Ch., in 2009). dedicated to the growing field of trans- executive vice president of the University The international firm of Rafael Viñoly lational medicine. Scheduled to open of Pennsylvania for the Health System and Architects PC is designing the center to in 2010, the 400,000-square-foot Anne dean of the School of Medicine. incorporate innovative features that will and Jerome Fisher Translational Research “Anne and I love Penn,” said Jerome support the collaboration of researchers Center will dramatically increase Penn’s Fisher, “and we have long felt that in- across disciplines. research space. It will also enhance PENN vesting in this world-class university is The Fishers’ gift is part of “Making Medicine’s ability to recruit top scientists investing in the future of humankind it- History: The Campaign for Penn,” which in strategic areas, such as cancer, cardio- self. We are especially pleased to be able has a goal of $3.5 billion to be raised by vascular disease, and diabetes. The center to make a contribution that will impact June 30, 2012. So far, more than half of will accommodate the research and office- advances in health care.” that amount has been raised.

based activities of 100 principal investiga- WatsonStuart tors and 900 additional staff. “All of us at the University of Pennsyl- vania are enormously grateful to Anne and Jerome for this incredibly generous and transformational gift, which will further position Penn at the forefront of bench-to- bedside medicine,” said Amy Gutmann, Ph.D., president of the University. She noted the Fishers’ “long and steadfast commitment to Penn,” which includes funding renovations to the fine arts library and helping establish the Fisher Program Celebrating the Fishers’ gift are, from the left, Ralph Muller, Amy Gutmann, Jerome Fisher, Anne Fisher, in Management and Technology. and Arthur Rubenstein.

2 ■ Penn Medicine HUP was ranked were: Cancer; Geriatric Health System, was listed among the top Glowing Showings Care; Gynecology; Heart & Heart Surgery; hospitals in Orthopaedics and Urology. For the 11th consecutive year, the Neurology & Neurosurgery; Orthopaedics; Johns Hopkins Hospital was ranked first University of Pennsylvania School of Psychiatry; Rehabilitation; Rheumatology; this year, closely followed by the Mayo Medicine was ranked among the top five and Urology. Clinic in Rochester, Minn. medical schools in the United States in “We are especially pleased to note Since 1990, U.S. News & World Report has the annual survey by U.S. News & World that 14 specialties at HUP improved in provided a ranking of hospitals’ quality of Report. The school was ranked #4 among their rankings over last year,” said Ralph care on a nationwide basis, evaluating hospi- the research-oriented medical schools. W. Muller, chief executive officer of the tals based on factors such as mortality rate, Penn was also listed in the top ten in Health System. “This achievement high- technology, staffing of nurses, factors related four clinical specialty programs high- lights the success of our commitment to to the individual specialties, and reputation lighted by the magazine: pediatrics (#2), quality of care. Together with our focus among a group of randomly selected, board- women’s health (#3), internal medicine on biomedical research and medical edu- certified physicians. This year, only 170 hos- (#4), and drug/alcohol abuse (#6). Penn’s cation, this ongoing commitment enables pitals scored high enough to rank in even a Ph.D. programs in biological sciences our hospital to continue to grow and ex- single specialty. To be on the “Honor Roll,” ranked 21st overall; immunology/infectious cel as one of the nation’s best.” hospitals must be ranked very highly in at disease was ranked #7 and microbiology Pennsylvania Hospital, part of Penn’s least six of the 16 specialties. ranked #8. Among medical schools with a primary-care orientation, Penn was Fermano Olivia ranked 31st. According to the U.S. News survey, the top five medical schools are: Harvard University, Johns Hopkins University, Washington University in St. Louis, Penn, and the University of California at San Francisco. This year, U.S. News surveyed 126 medical schools, weighing peer assessments, assessments by residency program direc- tors, research activity, student selectivity, and other factors. The Hospital of the University of Penn- sylvania (HUP) also fared very well in a U.S. News survey, landing on its “Honor Roll” of best hospitals in America. As featured in its July 23rd issue, HUP was ranked tenth among the approximately 5,400 facilities surveyed. Only 19 hospitals Double Treat were honored with the “Honor Roll” desig- Joshua Udoetek had more than one called to the stage, Udoetek won the nation, awarded for excellence in multiple reason to be happy on Match Day 2008. bag containing a dollar from each of his specialties. For a start, both he and his wife, Sade, 139 fellow students. Cheering him on, HUP also ranked in the top 20 in 11 of matched to Baylor College of Medicine from left, are Barbara Wagner, director the 16 specialty categories that U.S. News for their residencies. In addition, the of student affairs; Jon B. Morris, M.D., surveys. Five HUP specialties were rated Penn tradition is that students’ names associate dean for student affairs; Gail among the top 10 nationally: Digestive are randomly picked from a hat, and Morrison, M.D., vice dean for educa- Disorders; Ear, Nose, and Throat; Endo- when called, the students go to the tion; Arthur H. Rubenstein, M.B.,B.Ch., crinology; Kidney Disease; and Respira- stage to receive the envelopes informing dean of the School of Medicine; and tory Disorders. Other specialties in which them of their match. As the last student Helene Weinberg, registrar.

2008/SUMMER ■ 3 troduction to Health Care Systems classes the International Rhinologic Society and Eight Glasses of Water? praise his ability to “make clear extremely as editor-in-chief of the American Journal Not So Fast complex material” and his “mastery of of Rhinology. Many of us “know” that we should evidence-based clinical studies.” be drinking eight glasses of water a day. Effective July 1, Peter D. Quinn, M.D., All that water, we have been told, would D.M.D., chair of the Department of Oral bring benefits, such as helping flush toxins Transitions & Appointments and Maxillofacial Surgery, will become from the body; suppressing appetite; Larry Kaiser, M.D., the John Rhea vice dean for professional services and se- improving our skin; and reducing head- Barton Professor and Chairman of the nior vice president. He is also the Schoen- aches. In popular lore, water seemed Department of Surgery, has been named only slightly less effective than an apple a the president of the University of Texas day in keeping the doctor away. Health Science Center in Houston. Kai- But Stanley Goldfarb, M.D., a profes- ser, who joined Penn in 1991 as associate sor of medicine in the renal, electrolyte, professor and chief of general thoracic and hypertension division, and Dan surgery, founded and directed Penn’s Negoianu, M.D., a research fellow in the Lung Transplantation Program. He was division, have done research that basi- appointed chair of the department in cally throws water on these beliefs. In a 2001 and was named surgeon-in-chief widely publicized editorial in The Journal of the Health System in 2006. A pioneer of the American Society of Nephrology, in the technique of video thoracoscopy, they noted “multiple web sites warning he is a fellow of the American College of health-conscious readers they must drink Surgeons and a member of the Institute eight glasses of 8 oz/d to remove danger- of Medicine of the National Academies. ous ‘poisons’.” While acknowledging that The UT Health Science Center in “individuals in hot, dry climates” have an Houston has an operating budget of increased need for water, they ask wheth- $725 million. It employs more than er “average, healthy individuals living in 1,300 faculty and enrolls some 3,775 a temperate climate” need the extra wa- students. leber Professor and Chair of Oral and ter. They conclude: there is no scientific A search committee has been formed Maxillofacial Surgery and Pharmacology evidence that they do. In most cases, the to identify outstanding candidates for in the School of Dental Medicine. He has benefits are told in “wives’ tales” or “ur- PENN Medicine’s next chair of the De- been chair of HUP’s Medical Board, chair ban myths.” partment of Surgery. Richard P. Shannon, of the Faculty Senate in the School of In fact, as Goldfarb told NPR in April, M.D., chair of the Department of Medi- Dental Medicine, and chair of CPUP’s fi- “drinking large amounts of water surpris- cine, is heading the committee. nance subcommittee and billing oversight ingly tends to reduce the kidney’s ability committee. He will take office as president to function as a filter. It’s a subtle decline, David W. Kennedy, M.D., vice dean of the American Society of Temporoman- but definite.” for professional services for the School of dibular Joint Surgeons next year. In most cases, Goldfarb and Negoianu Medicine and senior vice president of the argue, there is no evidence of a lack of Health System, stepped down from those benefit, either. positions on June 30. He was elected Honors & Awards As an educator and associate dean for president of the Academy of American Abass Alavi, M.D., professor of radi- curriculum for the School of Medicine, Otolaryngology: Head and Neck Surgery ology and neurology, received an honor- Goldfarb may have a special interest in and will assume office in the fall. A for- ary degree from University of the Sci- debunking unsubstantiated health beliefs. mer chair of Penn’s Department of Oto- ences in Philadelphia. He was recognized He recently received the Lindback Award rhinolaryngology – Head and Neck Sur- as a pioneer in the field of molecular for Outstanding Teaching from the Uni- gery, Kennedy led the Clinical Practices of imaging. Alavi and his team introduced versity. According to the supporting mate- the University of Pennsylvania for seven Fluorodeoxyglucose (FDG) Positron rial, students in his Nephrology and In- years. He will continue as president of Emission Tomography.

4 ■ Penn Medicine cipient, Hennessy presented a lecture en- Terrence R. Malloy, M.D.’63, G.M.E titled “Unraveling Drug Effects Through ’67, chief of urology at Pennsylvania Hos- Epidemiology.” He is a former president pital, was honored in May at the national of the International Society for Pharma- meeting of the American Urological As- coepidemiology and currently serves as sociation. Malloy received the Gold Cane a member of the U.S. Food and Drug Award, presented to a senior urologist Administration’s Drug Safety and Risk who has made outstanding contributions Management Advisory Committee. to the profession and to the association.

Zhe Lu, M.D., Ph.D., professor of Barbara K. Schmidt, M.D., has won physiology, was selected to be a Howard the first annual “Trial of the Year Award” Hughes Medical Institute (H.H.M.I.) in- from the Society for Clinical Trials for vestigator. The institute honors and sup- her study on the caffeine treatment for ports some of the nation’s most creative premature infants. It was published in biomedical scientists by giving them the The New England Journal of Medicine opportunity to tackle their most ambi- last year. The award was announced on Alavi, left, receives his degree. tious and risky research projects. Lu is International Clinical Trials Day, May one of the 56 biomedical scientists cho- 20, during the Society’s annual meet- Lance B. Becker, M.D., professor of sen this year, and H.H.M.I. has commit- ing. Last year, Schmidt was appointed emergency medicine and founder/director ted more than $600 million to support the Kristine Sandberg Knisely Professor of the Center for Resuscitation Science, these newly selected investigators. in Neonatology for a term of ten years. was named a recipient of the American Kaczmarek/AP,Joseph HHMI © She is a professor of pediatrics at the Heart Association’s Award of Meritorious Children’s Hospital of Philadelphia and Achievement for helping to found the a clinician-educator in the School of Resuscitation Science Symposium. He was Medicine. recognized during an awards luncheon in April during You’re the Cure on Capitol Brian L. Strom, M.D., M.P.H., chair Hill in Washington, D.C. of the Department of Biostatistics and Epidemiology and director of the Center Arthur L. Caplan, Ph.D., the Emanuel for Clinical Epidemiology and Biostatis- & Robert Hart Professor of Bioethics and tics, received the 2008 John Phillips Me- Chair of the Department of Medical Eth- morial Award for Outstanding Work in ics, was made an honorary fellow of the Clinical Medicine. The award, given by American College of Legal Medicine at the the American College of Physicians, was college’s annual meeting in March. Caplan presented in May at the College’s annual is director of Penn’s Center for Bioethics. Lu works on ion channels, tunnels in a meeting. Previous recipients of the award At the annual meeting, he also delivered cell’s membrane that allow ions – such as include Arthur Rubenstein, M.B.,B.Ch., the 2008 Sandy Sanbar Lecture. potassium or chloride – to enter or exit. executive vice president of the University He has been exploring the inner workings of Pennsylvania for the Health System Sean Hennessy, Pharm.D., G.M.E. of ion channels and how this knowledge and dean of the School of Medicine, and ’96, Ph.D. ’02, assistant professor of sheds new light on the pathology of such William N. Kelley, M.D., former CEO epidemiology and pharmacology, re- diseases as cystic fibrosis and MRSA. of the Health System and dean of the ceived the 2008 Leon I. Goldberg Young This is the first time that H.H.M.I. School of Medicine (now professor of Investigator Award from the American opened up a general competition to the medicine and of biochemistry and bio- Society for Clinical Pharmacology and direct application process. It chose the physics). Strom serves as vice dean for Therapeutics. The award recognizes finalists from among 1,070 applications institutional affairs in the School of Medi- and encourages young scientists who are submitted in a nationwide competition, cine and senior advisor to the provost for active in clinical pharmacology. As re- which was announced in 2007. global health.

2008/SUMMER ■ 5 Beginning to See the Light Some 20 years after the idea first came to them, two Penn physicians have been able to restore partial sight to patients.

Photographs by Daniel Burke Albert Maguire and Jean Bennett 6 ■ Penn Medicine Back in 2001, Jean Bennett, exciting and impressive step: In a clini- The patients were tested over a period M.D., Ph.D., was eager to speak cal trial conducted at The Children’s of six months after Maguire administered about her team’s exciting suc- Hospital of Philadelphia, researchers the gene therapy. After treatment, one cess in restoring eyesight to dogs. from Penn have used gene therapy to patient was able to navigate an obstacle Through gene therapy, research- safely restore vision in three young course better than before the injection – a ers from Penn, Cornell University’s adults who have Leber’s congenital sign of the improved visual acuity that all College of Veterinary Medicine, amaurosis. Although the patients have three had to varying degrees. The patients and the University of Florida were not achieved normal eyesight, the pre- also had less nystagmus, an involuntary able to reverse blindness in dogs liminary results set the stage for further movement of the eyes that is common in afflicted with a variation of Leb- studies of an innovative treatment for LCA. One patient experienced better vi- er’s congenital amaurosis (LCA). LCA and possibly other retinal diseases. sion in the uninjected eye as well, leading A severe form of retinal degeneration, in The international team – led by Penn, the researchers to suggest that the reduced humans LCA usually begins to steal sight Children’s Hospital, the University of Naples nystagmus benefited both eyes. in early childhood and causes total blind- Federico II, the Telethon Institute of Genet- The Penn/Children’s Hospital study ap- ness during a patient’s twenties or thirties. ics and Medicine (both in Italy), and several peared in The New England Journal with a The disease damages light receptors in the other American institutions – reported their retina. Being a scientist, however, Bennett findings in April in an online article in The expressed caution about the pace of future New England Journal of Medicine. developments. As Bennett, then associate “This is the first gene therapy trial for professor of ophthalmology at Penn, put it a nonlethal pediatric condition,” said in 2001, “We are nowhere near the intro- Maguire, who injected the gene into the duction of the missing protein in humans retina of one eye of each of the three to restore sight.” patients. As the title of the study makes Her caution was understandable. clear, the focus at this stage was “Safety With her husband, Albert M. Maguire, and Efficacy of Gene Transfer” for LCA. M.D., associate professor of ophthalmol- But the investigators found more than ogy at Penn, Bennett had been research- they may have been expecting. ing inherited retinal degenerations such As Maguire pointed out, “Patients’ vi- as LCA since the late 1980s. There was sion improved from detecting hand move- no treatment then available for LCA and ments to reading lines on an eye chart” none on the horizon. When Bennett – an improvement that encouraged both and Maguire arrived at Penn in 1992, the research team and the three patients. they had already thought long about The improvements were noticed start- similar study conducted at University Col- the possibility of injecting a corrective ing two weeks after the injections. All lege London, where the results were also gene into a patient’s eye that would re- three patients reported improved vision promising but somewhat more modest. place the faulty gene. But the molecular in the eye that had received the injection. Both studies made an immediate impact. geneticist (she) and the surgeon (he) “Standard vision tests showed significant- Morton F. Goldberg, M.D., an ophthalmol- did not find the going easy. In fact, as ly improved vision in the patients,” said ogist at the Wilmer Eye Institute of Johns Maguire recently told The Philadelphia Alberto Auricchio, M.D., a study leader Hopkins University, told the Los Angeles Inquirer, very early in his career, he from the Telethon Institute of Genet- Times: “In the field of retinal dystrophies, shared the idea he and Bennett had for ics and Medicine and the University of this is, I believe, the most important ther- treating LCA with a pioneer in retinal Naples Federico II. The researchers also apeutic discovery” in four decades. “It’s surgery. Bluntly, the expert told Maguire reported that each injected eye became a landmark.” Savio L. C. Woo, Ph.D., a it would never work. approximately three times more sensi- gene-therapy specialist at the Mount Sinai Seven years after their study about tive to light, which is essential for vision. School of Medicine and former president the dogs was published in Nature Genet- Each injected eye improved compared to of the American Society of Gene Therapy, ics, Bennett, Maguire, and their multi- the uninjected eye, which had previously called the Philadelphia trial “exceptionally institutional team have taken another functioned better. exciting. . . . It’s absolutely remarkable.”

2008/SUMMER ■ 7 Joan W. Miller, M.D., of the Massachusetts Eye and Ear Infirmary, was more cautious in her editorial in NEJM. She noted that the increased visual acuity reported by the Jean Bennett Image Courtesy: Dr. patients in the Philadelphia study is “sub- jective,” but also pointed out that the pu- pillary light reflex that Maguire tested was “an objective measure of retinal function,” Left panel: Right eye of an LCA patient prior to injection. Note pigment epithelial atrophy in the macula, retinal suggesting improvement in the treated thinning, mild pallor of the optic disc, and vascular attenuation. Right panel: A normal eye, by comparison. eyes. In all, she wrote, the preliminary results suggest that the procedure is safe in governing how the correct protein things – an obstacle course. It would and efficacious. was made. Bennicelli arranged – and re- test the patients’ mobility. As Bennett An excellent start, and Bennett, Magu- arranged – the gene’s building blocks and explained, the obstacle course had to ire, and their collaborators are moving tested each version two to three times, have a flexible design so her team could straight ahead. “The current clinical trial hoping that each one would be the “per- make quick changes to it. “Patients with will continue with more patients,” said fect” gene. “I worked on one version for LCA have incredible memory,” she noted. Bennett. “We expect improvements to be 18 months that I thought would work,” “That’s how they live – memorize how more pronounced if treatment occurs in she recalled, “but, in the end, I wasn’t many steps from the front door to the childhood, before the disease progresses.” getting as much expression of the gene as street, how many steps to climb to the I wanted.” So she started over. first-floor classroom.” Who are the other principals in this Finding the best combination is essen- Medical and undergraduate students very promising study? The original direc- tial before going to the Food and Drug in Bennett’s lab set to work creating a tion came from Bennett, who is also se- Administration, Bennett said. “Once you course that would imitate obstacles in nior investigator at the F. M. Kirby Center present your data to the FDA, you’re everyday life. Purchases were made at for Molecular Ophthalmology at Penn’s locked into that reagent. We were look- Home Depot, toy stores, a carpet ware- Scheie Eye Institute, and Maguire. Ben- ing for something that would last a life- house, and furniture stores. To allow for nett and members of her laboratory had time, something that could treat many easy re-arranging, the students put Velcro already cloned the human counterpart to people with just one administration.” on the backs of the tiles that covered the gene that was used in the initial dog As part of her research, Bennicelli in- the floor. They painted arrows on them studies – the gene that makes the protein vestigated the gene’s ability to infect the to guide the patient through the course. needed by the retina to sense light and cell, the amount of protein it made, and Built-in obstacles included a raised tile send images to the brain. The challenge how well it was expressed. She was also that mimicked a tree root and a black tile facing them was to refine the human gene involved in making sure the delivered gene that represented a hole in the ground. and optimize it for use in humans. was as small as possible, to avoid an im- Patients would also have to maneuver A major contributor to the effort was mune response. By the end of 2006, she around a floor lamp and step over a toy. Jeannette Bennicelli, Ph.D., a senior re- had filled three notebooks with results. search investigator who has worked with All testing was done on cultured retinal Another crucial part of the LCA study, of Bennett for six years. Bennett said the as- cells. Dan Chung, D.O., who is in train- course, was getting the right vehicle to de- sistant professor of pathology and labora- ing to be a pediatric retinal specialist, liver the normal version of RPE65 to the af- tory medicine “was a key force in helping harvested tissue cells from the back of the fected patients. What they used was a “vec- with the cloning and testing.” retina in animal models and grew them in tor” manufactured in the Center for Cel- Part of Bennicelli’s responsibility was culture for testing. He also worked closely lular and Molecular Therapeutics of nearby to take the human gene used in the dog with Maguire on the surgical aspects of Children’s Hospital. The center is directed and modify a few of what she called its the study, helping to inject copies of the by Katherine A. High, M.D., the William “10,000 building blocks” to make the working gene into animal models and to H. Bennett Professor of Pediatrics in Penn’s gene as efficient as it could be. She nar- measure the restoration of visual behavior. School of Medicine and an investigator of rowed the search to specific areas of Part of determining how well the gene the Howard Hughes Medical Institute. A the gene that she knew were involved therapy worked depended on – of all pioneer in translational and clinical studies

8 ■ Penn Medicine Image Courtesy: Dr.Courtesy: Image Bennett Jean

provide them with sufficient resources to make the “bench to bedside” translation of gene therapy more easily. In 2007, the scientists at the center’s Clinical Vector Core were awarded a National Institutes of Health contract to produce clinical-grade vectors for trials Images extracted from a video taken during the subretinal injection. throughout the United States, which at- Panel A: pre-injection. The cannula is approaching the retina. Its shadow is seen near the optic disc. Panel B: the injection has just begun. The cannula tip is in the subretinal space and the retina is rising. tests to the high quality of their manu- Panel C: the injection has been completed and the cannula tip has been removed from the retina. The "bleb" covers the entire macula and is bordered on the left side by the optic disc. The raised fovea is visible. facture. The center’s staff for regulatory affairs has expertise in clinical gene therapy and coordinates trial approvals have been related to the surgery rather from multiple scientific and ethics review than to any biological effects of the thera- committees; manages the study activities peutic gene or the vector used to carry it. at all clinical sites; and ensures compli- The patients enrolled in the study to ance with international quality standards date were identified at the Department for conducting, monitoring, and report- of Ophthalmology at the University of ing clinical trials. Naples Federico II, an institution with extensive experience in collecting and Bennett and her team have already studying patients with inherited retinal moved to the second phase of the pub- diseases. Supervising their enrollment lished trial. She explained that they are was Francesca Simonelli, M.D. increasing the dose and testing the re- According to High, “This result is im- agent in younger individuals. Another portant for the entire field of gene thera- member of Bennett’s lab, Defne Amado, Katherine A. High, M.D. py.” She noted that gene transfer has been who is pursuing her M.D./Ph.D. degrees, in clinical trials for more than 15 years, is working on a different strategy that of gene therapy for genetic disease, she is a “and although it has an excellent safety could be used to treat any form of retinal former president of the American Society of record, examples of therapeutic effect are degeneration. If successful, it would be, Gene Therapy who led studies that cured still relatively few. The results in this study in Bennett’s words, “a magic bullet!” hemophilia in dogs. In 2005, High began provide objective evidence of improve- They are also planning a second a collaboration with Bennett and her group ment in the ability to perceive light, and trial on other diseases that manifest in to translate their exciting animal findings thus lay the groundwork for future studies children, such as Stargardt Disease. An into a clinical study. in this and other retinal disorders.” inherited form of macular degeneration, The vector High and her team produced The pace of moving from pre-clinical said Bennett, “it causes loss of central vi- was a genetically engineered adeno-asso- discoveries into clinical trials has typi- sion and often becomes symptomatic in ciated virus, intended to carry a normal cally been slow in the field of gene ther- the pre-teenage years.” version of the gene efficiently and without apy. The main reason is the breadth of As noted, experts in the field have harmful effects. Three patients from Italy, expertise required, ranging from in-depth recognized the enormous promise shown ages 19, 26, and 26, received the gene knowledge of the disorder to detailed in the Philadelphia and London studies. therapy via surgical procedures performed understanding of vector design, manu- Among them was Paul Sieving, director by Maguire between October 2007 and facture, and pre-clinical evaluation. In of the National Eye Institute, who told January 2008 at The Children’s Hospital. addition, the complexities of regulatory Science: “It is a marvelous thing for the The vector showed no signs of causing oversight at both the federal and local field and for the future.” inflammation in the retina or other toxic levels present challenges. Through its side effects. One of the three patients did Center for Cellular and Molecular Thera- Contributing writers: Karen Kreeger, Joey have an adverse event, a hole in the ret- peutics, The Children’s Hospital has been Marie McCool (Children’s Hospital), and ina that did not affect eyesight and may able to gather the necessary experts and Sally Sapega.

2008/SUMMER ■ 9 When Genes Meet Environment Penn’s Center of Excellence in Environmental By Thomas W. Durso Toxicology Tackles Some Stubborn Health Problems Photographs by Tommy Leonardi

Lung cancer is the leading cause of cancer in smokers and nonsmokers alike. meeting of the American Chemical all cancer deaths among both men and Unraveling the interactions between Society in Boston involving one class of women in the United States. Yet while 85 genes and environment in diseases of chemical carcinogens (polycyclic aro- percent of lung cancer is found in people complex genetic traits is one of the areas matic hydrocarbons, or PAHs) that are who smoke, only 10 percent of smokers of research emphasized in Penn’s recently found both in tobacco smoke and in air get lung cancer. In addition, the inci- established Center of Excellence in Envi- pollution. “PAHs are present in soot that dence of lung cancer can vary based on ronmental Toxicology (CEET). is found at relatively high concentrations geographical location. For example, the Last August, CEET investiga- in the air we breathe in urban environ- incidence of the disease is 50% higher tors presented studies at the national ments,” says Trevor M. Penning, Ph.D., in urban areas such as Philadel- director of CEET and a professor of phar- phia than in rural areas such Penning macology, biochemistry and biophysics, as Dauphin County in central and obstetrics and gynecology. The CEET Pennsylvania. team discovered that these carcinogens Statistical and epidemiologi- cause DNA damage not by binding to DNA cal data of this sort tell Penn themselves but by causing mutations to scientists that there are sig- DNA by generating reactive forms of oxy- nificant interactions between gen. These studies were recently published genes and environment that in the Proceedings of the National Academy determine a person’s suscepti- of Sciences (May 2008). In parallel stud- bility to lung cancer. In trying ies published the same month in Chemical to figure out why, they have Research in Toxicology, CEET researchers developed several theories. show that one of the major genes mutated One compelling theory is that in lung cancer (the tumor suppressor gene carcinogens are likely to be p53) is mutated by the reactive forms of higher in urban areas than in oxygen. Reactive oxygen turns off the sup- rural areas – and that may pressor function of p53, which allows tu- increase the incidence of lung mors to grow.

10 ■ Penn Medicine “The link between reactive oxygen and ning asks. “Those stresses can be socio- carcinogen exposure points to preventive economic, but that’s part of the built en- measures that could involve using antioxi- vironment, the man-made environment, dants,” says Penning. “These studies speak and that is also an aspect of environmen- to the power of environmental health sci- tal health.” ence and its translation into medicine.” Those two areas of focus have led to numerous projects. For example, as de- In late 2002, Edward A. Emmett, scribed earlier, researchers are investigat- M.D., M.S., director of occupational and ing genetic susceptibility to lung cancer environmental medicine in the Depart- and the development of biomarkers of ment of Emergency Medicine, led a Emmett exposure and response to tobacco smoke. School of Medicine retreat focused on Others are studying the genetics of fo- environmental health. At the same time, The center’s leaders identified four late and homocysteine metabolism as it Penning was leading a retreat in molecu- research cores in which its scientists relates to spina bifida; identifying expo- lar toxicology. The retreats had a similar would work: oxidative stress and oxida- sures that alter genetic imprinting in em- goal – to create a center for environmen- tive stress injury; endocrine/reproductive bryos before they have been implanted; tal health sciences at Penn with a focus disruption; lung and airway disease; and identifying biomarkers of pre-term birth; on environmental toxicology. genes and the environment. These are seeking genetic alterations that play a Emmett and Penning teamed up and, areas that affect Southeastern Pennsylva- role in the development of melanoma; after hashing out their ideas a couple of nia’s environmental and public health in and conducting large, population-based years, wrote a grant proposal to the Na- substantial ways. epidemiologic studies of the etiology of tional Institute of Environmental Health “When we put the center together, one autism spectrum disorders. Sciences. They were competitive but of the things we realized is that it was Ian Blair, Ph.D., professor and vice unsuccessful in their first try. The next going to be an urban center and that we chair of the Department of Pharmacology, year, 2006, they landed a four-year grant were going to be dealing with environ- codirects CEET’s research core in oxida- of $4.1 million from the institute to fund mental health issues that affect the urban tive stress and oxidative stress injury and the new Center of Excellence in Environ- environment,” Penning says. “Moreover, is the principal investigator on an N.I.H.- mental Toxicology. those issues that we face and their solu- funded project to study biological indica- Researchers affiliated with the center tions might be translatable to urban envi- tors of exposure to cigarette smoke. He seek to understand the mechanistic link ronments not just across the country but hopes that his and his colleagues’ work between environmental exposures and globally as well.” will provide tangible evidence compelling diseases of environmental etiology, with Penning and others dug through dis- enough to convince people to change the an eye toward early diagnosis, intervention, ease registries for the Philadelphia area behaviors that harm them and persuade and prevention strategies. It is not housed and found two especially relevant prob- communities to mitigate the environmental in a single facility but instead draws on the lems. One was a high incidence of lung factors that lead to poor public health. expertise of 50 Penn faculty members from and airway disease, including ozone- “If you look at the literature, prob- 16 departments and five schools, includ- exacerbated asthma, chronic obstructive ably about 50 percent of deaths through ing the School of Law and the Wharton pulmonary disease, and lung cancer. As known causes arise from some kind of School. CEET is one of only 22 Environ- Penning puts it, “It was very obvious environmental factor – cigarette smoking, mental Health Science Centers in the coun- to us that one of our research themes poor diet, poor exercise – that you can try and the first in Pennsylvania. should be lung and airway disease.” actually do something about,” says Blair. “The N.I.E.H.S. grant provides us the The second major regional health is- “One of the most exciting things that means to be the coordinating unit for all sue was a high incidence of adverse we have done is to show that we have a environmental health science initiatives pregnancy outcomes – pregnancies that specific marker of how smoking damages across the University, not just within the fail to go to term, resulting in low birth DNA, and we very much hope that by School of Medicine,” says Penning. “Envi- weight and developmental defects. “What conducting population screens, we will ronmental health is actually much broader are these stresses that cause those adverse have a test that will tell people that they than just the School of Medicine.” pregnancy outcomes to begin with?” Pen- may belong to the subset of patients who

2008/SUMMER ■ 11 may have smoking-related illness. If you they can go into the show people they have high cholesterol, field and measure ex- they’ll often modify their diet. If we could posure levels in people. show smokers how they damage their In effect, he says, they DNA, in that particular individual it might can do “real-time moni- catch their attention more than reading a toring that provides box that says, ‘Smoking will kill you.’ ” us with much greater Identifying and validating biomark- insight into what the ers of cigarette smoke exposure and re- true exposures are and sponse require sophisticated approaches. therefore what the conse- Changes induced by toxicants can occur quences are likely to be.” at the genome, proteome, or small- molecule level. Blair’s group has focused As Kensler suggests, on biomarkers that could be detected by moving from the lab to non-invasive techniques in the plasma the community is essen- and urine. They reasoned that smoking- tial, and that is a primary induced DNA damage would be repaired focus of CEET, although in to yield small-molecule adducts (changed atypical ways. N.I.E.H.S. DNA) in the urine. recommends community The next challenge was to develop outreach for its grant re-

analytical methods that were sufficiently Blair cipients, and most of them specific and sensitive. To this end they develop K-12 educational developed liquid chromatography-mass programming. CEET has spectrometric methods to purify the “We have a lot still to learn,” says Mar- taken a different approach. changed DNA and detect its mass. By garet R. Spitz, M.D., professor and chair Edward Emmett, who serves as CEET’s spiking the sample with a synthetic of the Department of Epidemiology at deputy director, runs a residency pro- source of the adduct labeled with a heavy the University of Texas M.D. Anderson gram that places PENN Medicine resi- isotope, they are able to quantify the ad- Cancer Center. She delivered a keynote dents in communities where there is a duct relative to this internal standard. address to the 2007 symposium. “We perceived environmental or occupational This method is being used to distinguish know that smoking causes lung cancer, health hazard. The residents then work smokers from nonsmokers in a test and but that’s not enough. Why do some with local leaders to identify areas where validation set of patients. smokers get cancer and others don’t? CEET may wish to conduct community- What was the relevant environment or based participatory research. In addition to bringing scholars to- exposure? What is the role of second- One highly successful example of this gether on research projects, CEET pres- hand smoke exposure and the role of approach was the discovery by the resi- ents an annual symposium on topics other exposures such as dust and radon?” dents of Little Hocking, Ohio, that they related to the center’s initiatives. In 2006, According to Spitz, CEET’s efforts could had highly elevated levels of C8 (perfluo- for the first symposium, the theme was eventually lead to the development of indi- rooctanoic acid), a chemical used in the environmental health and disease. Last vidually tailored treatments to induce the production of nonstick surfaces for cook- year’s theme was genes and environmen- patients at the highest risk to change un- ware. The levels were 60 to 80 times higher tal health, chosen to highlight the Penn- healthy habits and seek early intervention. in people living near a Teflon manufac- sylvania Department of Health’s recent Another keynote speaker, Thomas turing facility along the Ohio River than four-year, $4.2 million award to CEET to Kensler, Ph.D., a professor of environ- those found in the general population. establish a Center for the Study of Gene- mental health sciences at the Johns Hop- Emmett and his collaborators concluded Environment Interaction in Lung Cancer. kins School of Public Health, notes that that water was the major source of con- These symposia allow scientists to reflect scientific progress has given researchers tamination. C8 is nondegradable and has on where the field has been and where “phenomenal” tools to gain insight into a half-life of four to five years in humans; they should direct their efforts. pathways and processes of disease. Now its accumulation has been associated with

12 ■ Penn Medicine birth defects and development defects as local leaders with risk assessment and “When you do environmental issues well as cancer in rodents. communication. In this capacity, the and you are trying to get the support of The usual procedure would have been center currently is working most closely local government and industry, it’s im- for the research team to write and publish with the city of Chester, Pa. portant that they understand that there a paper about its findings, then allow the “That area is very environmentally are outside interests that are monitoring media to disseminate the story to the com- challenged,” says Penning. “It is the and are concerned about the same things munities where the testing was conducted. home of all the waste incineration for in your community,” says Rev. Horace “They said, ‘We don’t want that,’” says Delaware County.” He also notes the Strand, pastor of Faith Temple Church Emmett, recalling the responses of com- presence of the I-95 interstate highway and president of the Chester Environ- munity leaders. “As soon as we were sure and the oil refineries on the Delaware mental Partnership. Penn’s presence, he of the results – and we needed to be sure River. “It’s a city of lower socioeconomic continues, grabs the attention of govern- of the results – we decided the individual status, so there are real issues of environ- ment and industry representatives. “Penn participants should get them first. The mental justice there.” has credibility. With Penn at the table, we communication should maximize con- also have someone with some expertise structive responses and minimize point- who understands the scientific data and less concern.” who can advise us on things that we as The Penn scientists presented their laymen are not experts in.” findings at a well-attended community meeting in Little Hocking, making rec- In Emmett’s view, the prevalence of ommendations on how residents should such public-health dangers as obesity cope and answering their questions and smoking even in the face of over- about the study. Only afterward did they whelming evidence of their short- and publish their results in a pair of papers long-term dangers points to the difficulty that appeared in the Journal of Environ- of convincing people to change their mental and Occupational Medicine. habits. Yet CEET, with its focus not on The community-based research was CEET is working with community macro-level communication but on mi- publicized in Environmental Health Per- groups in Chester to inform them of the cro-level community partnerships, may spectives (an N.I.E.H.S. publication) and environmental health impact of another be on to something. elsewhere. More recently, the project trash incinerator in the city, and it is de- In the wake of the announcement of was named 2008 recipient of the Com- veloping a pair of on-line tools for city Emmett’s C8 findings, the company man- munity-Campus Partnerships for Health residents. One, TOXOLINK, will allow ufacturing the chemical almost immedi- Award, presented in May. them to ask questions about chemical ately offered free bottled water to residents CEET also works with Penn’s School of exposure and health risks. The other will in the affected areas until it could install Arts and Sciences, conducting academi- give them access to GIS (geographic in- filters at its plant to prevent further release cally based community seminar courses formation system) tools so they can enter into the local water supply. in which researchers teach undergradu- their street addresses and view informa- An astounding 78 percent of people ates studying environmental health sci- tion about their air quality, water quality, took the company up on its offer. ences about such issues as exposure to and more. “There was a feeling in the communities lead and tobacco smoke, as well as ex- “Once we have these two things put that they had become empowered,” says posure to and abatement of allergens. As together,” says Penning, “we will actu- Emmett. “We have gone back and have Penning explains, “Once they’ve learned ally be in a very powerful situation to do looked at the levels of C8, and they have that material, they then go into, say, a both environmental epidemiology, from fallen in people. The levels have gone middle school to translate that informa- a research perspective, but also identify down significantly. The message got through tion to the children and their families. It’s communities in real need.” very effectively.” a train-a-trainer model.” Community leaders have been recep- The final part of CEET’s three-pronged tive to such efforts. They have found that For more on the Center of Excellence for outreach approach is forming partner- working with an organization like CEET Environmental Toxicology, see www.med. ships with certain communities to assist lends validity to their calls for help. upenn.edu/ceet.

2008/SUMMER ■ 13 right,” says William C. Welch, M.D., eter Jannetta chief of neurosurgery at Pennsylvania P Hospital. “He had some significant resistance,” shows them how it’s done agrees Frederick Simeone, M.D., a former By Nan Myers professor of neurosurgery at the Univer- sity of Pennsylvania School of Medicine

Jasmine Gehris / Tribune-Review Gehris Jasmine who recently retired. “But when enough surgeons began to do the procedure and saw that it worked, the procedure was slowly accepted.” And many of the neurosurgeons performing the procedure were in fact trained by Jannetta. “I was able to develop people so they could become the chairs of neurosurgery,” he says. At last count, there are 17 neurosurgery chairpersons in the United States who were trained by Jannetta. “He hired me at the University of Pittsburgh Medical Center in 1993,” says Welch. “I went to Pittsburgh because of Peter Jannetta. In 1993, it was the best Honored by a big bash last fall, the Department of Neurosurgery.” celebrated neurosurgeon continues his By Nan Myers An internationally recognized expert research and explores new applications in the treatment of cranial nerve disease, of microvascular decompression. Jannetta credits much of his success to the training he received and the relation- ships he developed at Penn. Besides his skills as a neurosurgeon, locates a vein or artery pressing against For example: He learned to use the Peter J. Jannetta, M.D. ’57, G.M.E. ’64, the trigeminal nerve. This is a large nerve microscope in surgery when he was a had something else that he would need that carries sensation from the face to the general surgery resident working with in his profession: persistence in the face brain, so the patient’s pain can be excru- Dr. Solomon D. Erulkar in the pharma- of skepticism. ciating. The surgeon then cuts the vein, cology department. He credits the influ- In 1965, while serving a neurosurgery or, if an artery is involved, moves it aside ence of Dr. Jonathan Evans Rhoads, then residency at the University of California and inserts a tiny pad between the artery chair of the Department of Surgery, with at Los Angeles, Jannetta was asked to put and the nerve to relieve the pressure. convincing the Louisiana State University together a dissection of the cranial nerves The process, known as microvascular School of Medicine in New Orleans to to present to a class of dental students. decompression, does not damage or destroy hire him as associate professor and chief “I was working on the trigeminal nerve, the nerve. Jannetta successfully performed of the neurosurgery division after he left which is the largest of the cranial nerves, his first procedure in 1966 and eliminated U.C.L.A. – but before he finished his and I noticed that something was differ- the facial pain of a 41-year-old man. neurosurgery residency. “I began there on ent,” he explains. This discovery was the Jannetta is proud of this accomplish- December 1 and completed my residency genesis of what would become the radi- ment, but it took a long time before the on December 30,” Jannetta recalls. And cally new Jannetta Procedure. After drill- traditional medical community accepted he remembers the words of Dean John ing through the skull and viewing the it. “It was considered controversial for McK. Mitchell, who told the incoming area microscopically, the neurosurgeon many years but finally he was proven Class of 1957 how lucky they were to

14 ■ Penn Medicine G`fe\\i`e^jli^\ip ;i%G\k\iAXee\kkX#m`Z\Z_X`idXef]k_\[\gXikd\ekf]e\lifjli^\ipXk8cc\^_\ep>\e\iXc ?fjg`kXc#n`ccY\Z\c\YiXk\[XkXjpdgfj`ldfeJXkli[Xpkfi\Zf^e`q\_`j]fli[\ZX[\jf] g`fe\\i`e^Zfeki`Ylk`fejkfYiX`ejli^\ip%?\`jY\jkbefne]fi`em\ek`e^Xd`Zifjli^`ZXc gifZ\[li\kfXcc\m`Xk\j\m\i\gX`e`e]XZ`Xce\im\j%

Ca rol GifYc\d ine H i 8e\jk`dXk\[fe\`e(,#'''g\fgc\jl]]\i]ifdX rt / T r [`jfi[\if]k_\ki`^\d`eXce\im\n_\i\XYcff[m\jj\c ib u n i\jkjkffZcfj\kfk_\e\im\#glcjXk`e^X^X`ejk`k% e be at Penn Medicine. “I believed him,” - that his microvascular decompression R K_`jX^^iXmXk\jk_\e\im\#ZXlj`e^\oZilZ`Xk`e^gX`e% e v i Jannetta says. “Penn was the intellectual e procedure is a convincing example of w Ki`^\d`eXccenter of the world.” 8ik\ip how a novel theoretical concept can lead e\im\ Jannetta Fgk_Xcd`Zwas fully trained first?

2008/SUMMER ■ 15 A Difficult Path to Clarity by Lisa J. Bain

When Penn investigators tried to get an ophthal- mology trial with important economic implications up and running, they first had to overcome many unexpected barriers.

Photographs by Addison Geary

16 ■ Penn Medicine On a wintry day in February, a 75-year-old woman in Knoxville, Tennessee, be- came the first subject to begin a clinical trial that will test two drugs designed to treat age-related macular degeneration (AMD). Drops were put into her eye to dilate her pupil, and an anesthetic was given to numb her eye. Then, using a tiny needle, her ophthalmologist injected the drug directly into the jelly-like vitreous of the eye. If all goes as hoped, the drug will stop the leakage of blood vessels in the back of the eye, leakage that has blurred and distorted her vision. Like the other 1,199 subjects in this trial, Patient Number One has no idea which of the two drugs she has received. What she does know is that one of the drugs, Lucentis, has been approved by the Food and Drug Administration (FDA) to treat age-related macular degeneration and costs about $2,000 per dose. The other drug, Avastin, costs only about $50 per dose but has not been ap- proved by the FDA for the treatment of that particular disease; it was devel- oped as a cancer treatment but is used “off label” to treat other conditions. And she also presumably knows that the drugs have the same mechanism of action and, somewhat surprisingly, were developed and are marketed in the United States by the same com- pany, Genentech, the biotechnology Most people with AMD have blurred central vision that may progress to a blurred spot in the center of company based in San Francisco. the visual field. Although – or perhaps because – the results of this trial have important impli- cations not only for people with AMD but also for Genentech, health insurers, and Medicare (which covers most people with AMD), getting the trial off the ground has been anything but easy. According to Maureen G. Maguire, Ph.D., the Penn biostatistician who is directing the coordinating center of the trial, she and the study chair of the trial, Daniel Martin, M.D., of Emory University School of Medicine, originally applied to the National Eye Institute in January of 2006 to test the two drugs head to head. “If we had been able to start the trial that summer as we had hoped, we would be done with the one-year results by now,” said Maguire as the trial was about to begin in 2008. “But things got complicated.”

2008/SUMMER ■ 17 Optical Coherence Tomography provides views of the layers of the retina affected by choroidal neovascularization.

(PDT), added an intravenously injected Lucentis trial knew that something was compound that undergoes a chemical happening because some of their patients reaction when exposed to light from a were having dramatic, almost immediate laser. The activated compound clots the improvements in vision.” leaking blood vessels in the macula, ar- In May 2005, Genentech released ini-

The fluorescein angiogram shows the abnormal resting the fluid build-up and preventing tial results from its Lucentis trial. Then in growth of blood vessels that characterizes wet macular degeneration. the growth of new vessels. While PDT July the company presented the results causes less damage to surrounding tis- from the first pivotal study at a meeting The most common cause of blindness sue than the standard laser treatment for of the American Society of Retinal Spe- Age-related macular degeneration is AMD, both approaches are of limited cialists in Montreal. The study exceeded the most common cause of legal blind- use because they can be used only in the expectations even of Genentech sci- ness in older people, affecting nearly two the small number of people whose leaky entists: after one year of treatment, the million Americans. According to some vessels are limited to one or only a few drug not only prevented further deterio- estimates, that number could climb to as small spots. Most people with wet AMD ration of vision, but most patients actu- high as three million by the year 2020 have diffuse neovascularization. More- ally could see better. as the population rapidly ages. Most over, while both treatments slow the pro- “It just knocked everyone’s socks off,” people with AMD have the early “dry” gression of the disease, neither improves said Maguire, the Carolyn F. Jones form that causes slightly blurred central vision. It was clear that the ever-growing Professorship of Ophthalmology and vision and may progress to a blurred spot number of people who were losing their director of Penn’s Center for Preventive in the center of the visual field or even vision to AMD needed better treatments. Ophthalmology and Biostatistics. “In the to loss of central vision. Early AMD can Late in 2004, words was spreading in past, when we would speak to patients also progress to the more severe “wet” the ophthalmology community about we would say, ‘This will not make you form, which is associated with a rapid Genentech’s Lucentis trial. Lucentis (ra- better – it will slow down how fast you loss of central vision. In both forms of nibizumab) is derived from a monoclonal get worse.’ Lucentis was a complete change. AMD, the problem results from damage antibody that binds and inhibits Vascular Most patients pick up a little bit of visual to the macula, a small (1.5 mm) spot in Endothelial Growth Factor (VEGF), a pro- acuity, so rather than facing a steady de- the center of the retina that contains the tein involved in angiogenesis, the growth photoreceptors responsible for central of new vessels. Injected directly into the vision and, in particular, for seeing fine eye, the drug was designed to inhibit neo- detail. In dry AMD, these photorecep- vascularization in the entire macula, rather tors slowly break down. Wet AMD, in than at a single spot. Theoretically, this contrast, occurs when blood vessels be- meant that anyone with the neovascular hind the macula grow abnormally and form of AMD could benefit. begin to leak, lifting the macula from the Although results from the trial had back of the eye. This type of AMD is also not yet been announced, many ophthal- called “neovascular” AMD, referring to mologists had begun to draw their own the growth of new vessels. Both Lucentis conclusions, said Stuart L. Fine, M.D., and Avastin are effective only against the the William F. Norris and George E. De- wet, neovascular form of AMD. Schweinitz Professor and Chair of Oph- Until recently, the best treatment for thalmology at Penn. “It’s unusual to do a neovascular AMD used lasers to seal the clinical trial where people can figure out leaking blood vessels and to prevent their what is working just by looking at the 10 further growth. An improvement to this or 20 patients at their own center. But approach, called photodynamic therapy many of the people participating in the

18 ■ Penn Medicine cline for the next couple of years, they AMD was one of Maguire’s passions. By were facing a little bit of improvement early 2005, she and her colleagues had over the next few months and then pla- designed two or three full trials of poten- teauing at that good level. So that was tial AMD treatments, only to reject them fantastic, and the whole ophthalmology when preliminary data showed that the world was taken aback and thrilled.” drugs were not as effective as originally Right after Genentech presented its re- thought. When the first results of the Lu- sults, Philip J. Rosenfeld, M.D., Ph.D., an centis trials were announced, her group ophthalmologist from the Bascom Palmer stopped everything else. “We said, nobody Eye Institute in Miami, got up to speak. is going to want to look at anything else He had come up with a possible alterna- but this drug.” Avastin changed all that, tive to Lucentis, another VEGF inhibitor but Maguire’s advanced preparation left called Avastin (bevacizumab), which was her group ready to launch a Lucentis/ already on the market and far less expen- Avastin trial, since much of the infrastruc- sive than Lucentis. Avastin had been de- ture was in place and decisions about out- veloped by Genentech for the treatment come measures had already been made. of colon cancer; in fact, it was derived So in January 2006, even before Lucentis from the same monoclonal antibody that had been granted FDA approval, Maguire’s was later used to design Lucentis. Rosen- per year. A head-to-head comparison of group applied to the National Eye Insti- feld wondered if Avastin’s anti-angiogenic the two drugs was the obvious solution. tute for permission to conduct a study to properties might also reach the eyes of It is not surprising, then, that Genentech compare the two drugs. people with AMD. After showing benefits balked at conducting such a trial. Lucen- The primary hurdle was financing the using intravenous injections of Avastin, tis, the company’s representatives argued, study. At $2,000 a dose, given every 28 Rosenfeld injected a small amount of was designed specifically for intraocu- days for two years, the cost of Lucentis Avastin into the eyes of two AMD pa- lar use and was thought, therefore, to alone would be $52,000 per subject – tients. The results were dramatic, similar have a better safety and efficacy profile. and that did not include injection fees, to those seen with Lucentis. Moreover, Lucentis was predicted to be a diagnostic imaging costs, and the myriad “What happened after that was truly blockbuster drug for the company. of other costs to run a clinical trial. Be- amazing,” said Maguire. Within six cause most people in the study would be months, perhaps as many as 10,000 pa- A long road to approval covered by Medicare, Maguire reasoned tients around the world were treated with Maureen Maguire conducted her first that as soon as Lucentis was approved, intraocular injections of Avastin, despite the clinical trial related to AMD some 30 the Center for Medicare and Medicaid fact that it had not been developed or test- years ago when she began to work with Services (CMS) would be eager to cover ed for intraocular use nor were safety data Stuart Fine at Johns Hopkins. Since then, the cost of the trial because of the huge available. But ophthalmologists, described she has become a specialist in ophthal- claims they would be facing. After ob- by Fine as normally a very medically con- mology, running countless clinical trials taining approval from the trial from the servative group, knew Avastin’s similarity and coordinating multi-center trials for National Eye Institute, Maguire’s team to Lucentis and knew that Lucentis was AMD and other eye disorders (such as started meeting with CMS. By this time, unlikely to be available for at least one year. glaucoma) as well as a multi-center trial the summer of 2006, Lucentis had been But there were questions: Would Avas- of corneal transplantation. In 1994, she approved. That was when they found out tin be as effective as Lucentis? Would followed Fine to Penn, working with him there was a problem: CMS said Medicare it result in adverse side effects not seen on AMD prevention trials and on a trial would not pay for the drug. According with Lucentis? Should the dosing regi- of thalidomide for treating AMD. Fine to the CMS interpretation of existing men be similar? And, of course, there speaks glowingly of Maguire’s acumen policy, an investigational drug could not was the cost factor. According to Fine, and skill in conducting trials: “I can’t say be covered by Medicare. That eliminated if Avastin is as effective as Lucentis, the she’s the best, but in the whole world, payment for Avastin, which was not annual savings to Medicare would be there’s no one better.” FDA-approved for AMD as well as for somewhere between $3 and $6 billion Searching for a better treatment for Lucentis, which was.

2008/SUMMER ■ 19 “We were flabbergasted,” said Maguire. not to come back until she had a plan “Probably the first five times they said approved, in writing, by CMS. that to us, we didn’t believe them.” The In the meantime, Maguire, Fine, and intent of that policy, formulated under other members of the team were lobby- President Clinton’s directive to Medicare, ing Congress and the White House. They was to expand access for patients under met with Elias Zerhouni, M.D., director Medicare so that they would not be pe- of the National Institutes of Health, and nalized for participating in clinical trials. had conversations with Leslie Norwalk, But the CMS lawyers did not see it that acting administrator for Medicare. Ev- way, and it would be more than a year eryone agreed that the trial should go before a new policy was expected to be forward, but finding a way to make it in place. “We said that would be far too happen was proving difficult. When CMS long to wait,” said Maguire. finally approved a demonstration project, While continuing to search for a reso- the Department of Health and Human lution to the financing issue, Maguire’s Services lawyers refused to approve it. team continued to work with CMS on At one point, Genentech indicated that it designing an acceptable trial. Another would provide the study drug but later problem emerged regarding the masking reversed its decision. Eventually, after of participants in the trial so that none months and months of aborted plans, The team settled on what could be of the parties involved – the subjects, the long negotiations, and repeated disap- called “partial masking.” While the clinicians treating them, the people eval- pointments, Maguire and colleagues ophthalmologists and the people who uating the results – would know which devised a plan that did not depend on evaluate data from visual acuity and im- treatment an individual patient had re- any special treatment from CMS beyond aging tests are masked, and the patient ceived. Typically this is called “blinding,” approval of the study. By that time, the is masked at least at the outset, the clinic but for obvious reasons, Maguire pointed new clinical trials policy was in place; it coordinator is not masked. He or she is out, the ophthalmology community pre- allowed Medicare to pay 80% of the cost told to which treatment “arm” the patient fers the term “masking.” The problem is of Lucentis, and supplementary insur- has been randomized, obtains the correct that Medicare typically sends a notice to ance would pick up most of the rest. The vials, fills syringes with the appropriate clients saying that it has paid 80% of the cost of Avastin is covered by NEI. drug, and gives them to the ophthal- cost of a specific drug, making it difficult One last hurdle remained. Avastin is mologist for the injections. Because both to shield subjects from knowing if they packaged by Genentech in large vials for drugs are clear and colorless, have the were receiving Lucentis or Avastin. use in treating colon cancer. To be used same viscosity, and take up the same vol- From August 2006 through September for AMD, the drug must be repackaged ume, only the clinic coordinator knows 2007, Maguire’s team worked with peo- into much smaller vials. Physicians who which drug has been provided. ple at CMS to devise a plan that would are using Avastin off label for their AMD solve the financial and masking issues. patients rely on compounding pharmacies Only time will tell As many as six to eight plans were devel- to do this repackaging. At Penn and other Now the trial begins. While many clini- oped, and each one had to be carefully larger hospitals, the hospital pharmacist cal trials have difficulty enrolling sufficient considered from different perspectives by repackages the drug. The FDA objected to numbers of subjects, so far this appears a number of people and offices at Penn: the use of compounding pharmacies for not to be the case for the CATT (Compari- Glen Gaulton, Ph.D. executive vice dean distribution, so Kenneth A. Rockwell Jr., son of AMD Treatments Trials) study. Pa- and chief scientific officer; the offices of Pharm.D., HUP’s director of the Investiga- tients understand that the drugs given in Human Research, Research Services, Bill- tional Drug Service, came up with a plan both treatment arms are highly effective, ing, Compliance, and Legal Affairs; and that was eventually approved. Avastin is said Fine. Moreover, they understand that the Investigational Drug Service. Penn sent to a company that uses good manu- only a head-to-head comparison of the put quite a lot of time, effort, and sup- facturing practices to fill the vials, which drugs will answer the question of whether port into getting this trial off the ground, are then sent to Rockwell’s service for dis- one is more effective than the other. And said Maguire, but eventually she was told tribution to study sites. there are other important questions to be

20 ■ Penn Medicine followed for a total of two years. Fine and labeling for Avastin as a treatment said that in addition to clarifying the ef- for AMD. At this point, that step seems fectiveness of the two drugs and the best highly unlikely because it could only dosing regimen, he hoped that data from hurt sales of Lucentis. And Genentech the trial would allow the researchers to will still be able to control the packaging construct a risk profile to identify which and marketing of the drug. patients are likely to need monthly injec- “It’s hard not to get incensed by this,” tions and which could benefit from less said David Asch, M.D., M.B.A., the Robert frequent treatments. D. Eilers Professor of Health Care Man- agement and Economics at the Wharton A question of science – or policy? School and the School of Medicine. As Completion of the trial is not expected Asch, who directs Penn’s Leonard Davis until early 2011, and regardless of the Institute of Health Economics, put it, “It’s results, there will still be questions to be a marketing strategy that far more sup- answered. When two drugs are equally ports the bottom line of the company than effective for an illness that affects millions it supports the interests of society.” of people and one of them is significantly Which may leave ophthalmologists, at cheaper than the other, what is the re- the end of this trial, with the same choice answered as well – for example, whether sponsibility of the drug companies, the they face now: prescribing an approved the dosing regimen for the two drugs is FDA, health insurers, and the federal gov- drug or an off-label drug, albeit one that similar. Lucentis is given every 28 days, ernment to determine which one should has been fully tested for effectiveness and regardless of whether the disease is con- be used? After Genentech took steps to safety. For Stuart Fine, whether a drug tinuing to progress, but it may be that limit the availability of Avastin to com- has been approved for that indication or Avastin would require less frequent dosing pounding pharmacies in October of 2007, not has little bearing on what he tells his because it is a bigger molecule and pos- Senator Herbert Kohl of Wisconsin, who patients. “Treating patients is a partner- sibly more likely to persist in the eye. Ge- chairs the U.S. Senate Special Committee ship,” he said. Fully tested or not, all nentech developed Lucentis based on the on Aging, entered the fray. In November, drugs have beneficial effects as well as supposition that Avastin, being a larger he made public copies of letters he sent to side effects. By taking the time to explain molecule, would not be able to penetrate CMS, the FDA, and Genentech expressing the benefits and risks of each treatment the retina to reach the macula, but that “great concern” about Genentech’s inten- and making sure that his patients are ful- supposition was subsequently disproved. tion to limit access to Avastin. ly informed, he and his patients can de- As a result of these questions, CATT “I take very seriously the Committee’s cide together which treatment to choose. has been designed with four treatment responsibility to protect and advocate The choice can be highly individual, he arms. One group will get injections of on behalf of our nation’s seniors,” he added. For example, one patient might Lucentis every 28 days; one group will wrote to Genentech. “Part of this re- place a high value on the convenience receive Avastin every 28 days; and two sponsibility is ensuring that seniors are of less frequent dosing even if it resulted other groups will receive one of the two receiving appropriate and cost-effective in slightly poorer results, while another drugs on an as-needed basis. In these prescription drugs.” patient might think the inconvenience a “variable dose” groups, after the first Genentech subsequently reversed small price to pay for even slightly im- treatment, the treating ophthalmologist its decision, stating that the company proved vision. will evaluate test results each month to “believes physicians should be able to Fine does not expect a better drug to determine whether there is active new prescribe the treatment they believe is come along. On the other hand, he does vessel growth. If not, the subject will most appropriate for their patients.” Yet foresee better delivery systems in the fu- skip that dose of the drug. A reduced this may be only a temporary solution. ture, such as an implantable pellet or dosing schedule might not only save Even if the Lucentis/Avastin trial were to even topical administration. “In terms of money, but might also substantially re- show that Avastin was equivalent to or effectiveness, it’s going to be hard to beat duce the burden and risks to patients. better than Lucentis, it would still be up this drug. This is a silver bullet that Each subject enrolled in the trial will be to Genentech to apply for FDA approval we’ve been waiting for for 25 years.”

2008/SUMMER ■ 21 Changing theParadigm Paradigm – Preparing for the Crisis By Nan Myers were not prepared for foreign competi- tion. At the same time, not only were health-care costs rising for employees, Despite the challenging and often frus- but job reductions often resulted in early trating nature of the health-care market- retirement. That meant a burgeoning of place these days, Mark A. Kelley, M.D., the retiree population, whose health-care G.M.E. ’79, believes there are ways for a costs were covered by the car companies. health system to manage what he called (And many people no longer had health the coming health-care crisis or at least insurance because they lost their jobs.) to withstand its worst effects. As a result, the car companies made the According to Kelley, who serves as decision to shift monies from union pay executive vice president for the Detroit- to health-care payments for current and based Henry Ford Health System (HFHS) retired union workers. and chief executive officer of the Henry The challenges faced by the Big Three Ford Medical Group, the Henry Ford ex- reflect those of Medicare and the nation. perience can serve as an example. “One problem is that our life expectancy Kelley, a longtime member of Penn’s is improved; people were supposed to medical faculty, was the featured speaker vice dean for clinical affairs, and chief of die by age 67,” Kelley pointed out. An- at this year’s Samuel P. Martin III, M.D., medicine at the V.A.” other problem was the rising costs of Memorial Lecture. The annual event is In 2000, when Kelley arrived in new technology and drugs. “We are the one of the highlights of the Health Policy Detroit after 27 years at Penn, the car only developed country where the big Seminars sponsored by Penn’s Leonard companies that are virtually synonymous pharmaceuticals are so strong. It is a sad Davis Institute of Health Economics. The with Detroit were beginning to suffer state when people can’t afford their medi- title of Kelley’s talk was “Health Care in greatly because of declining sales and in- cations. Medicare beneficiaries spend Detroit: A Preview of the Impending Na- creasing health-care costs for retirees. so much more on their meds than the tional Crisis.” As Kelley put it, “I was under the younger generation.” His blunt warning: “We need to make delusion that the leaders of the car Today, as it is in Philadelphia, health a paradigm shift.” companies – some of whom were even care is the largest industry in Detroit. Introducing Kelley was a former col- Wharton M.B.A.s – knew something Unlike what is happening in Philadel- league, Sankey V. Williams, M.D., the about the management of health care. phia, however, young, healthy workers Sol Katz Professor of General Internal After all, they were managing the cover- are leaving the Detroit area. And in both Medicine and Health-care Systems. Kelley, age for thousands of employees. Instead,” metropolitan areas, the cost of health said Williams, brought to Henry Ford he continued, “I learned what they did care is rising faster than wages. the management skills that Dr. Martin, know – it was about costs.” Kelley believes that Penn’s health sys- the namesake of the memorial lecture In his lecture, Kelly used the experi- tem, like HFHS, will have to change the and a former director of the Leonard Da- ences of the auto manufacturers to il- way it operates because of factors out of vis Institute, thought were so necessary lustrate the issues and difficulties that its control. On the other hand, he said, for instilling some order and economic caused major problems for HFHS. In his Penn has an advantage over Henry Ford know-how in medicine. In addition, said view, they are the same issues that are because of its history and its excellent Williams, Kelley has been able to pre- contributing to our current national crisis reputation. serve the all-important academic values. in health care. It is an “unhealthy environment that “Mark had an interesting career at The auto industry was the largest we live in,” he continued. Both public Penn because it involved all the pieces of employer in Michigan. From 2000 to and employer funding are shrinking. an academic health center,” added Wil- 2007, because of many factors, the state Most Detroit city hospitals – both pri- liams. “Among his positions were pro- lost 402,000 jobs, mostly in the auto vate and not-for-profit – have closed, gram director of the residency program, industry. The Big Three (as General Mo- and 50 percent of the population is un- vice chair of the Department of Medicine, tors, Ford, and Chrysler were known) derinsured or uninsured. Medicare and

22 ■ Penn Medicine Changing the Paradigm – Preparing for the Crisis

Medicaid are assuming the role of payers. For its part, HFHS adopted electronic computer. It eliminates the need for Malpractice is very costly, although tort prescribing, developed a program for the pharmacist to call the doctor for an reform has helped. managing chronic disease, standardized explanation of what is written on the With seven hospitals, the non-profit MRI treatment, and reduced overall ICU prescription. “We did a pilot study and HFHS is the largest system in the region. and surgical infections. found that although it does not provide It offers its own health plan. The Henry Even with the successful changes, time-saving for physicians, e-prescribing Ford Medical Group, its employed physi- which he explained are widespread across does provide an overall cost savings to cian practice that is similar to Penn’s the U.S., primary care as a practice re- the system. It also eliminates errors.” primary-care network but much larger, mains in danger. Higher co-pays result Kelley quoted the saying from an has 1,100 physicians. Henry Ford Hospi- earlier era: As goes Detroit, so goes the tal is affiliated with Wayne State Univer- “To remain profitable, hos- nation. In the near term, systems of care sity School of Medicine. Like Penn’s health as well as doctors and hospitals must system, HFHS is dominant in its region pitals will have to convince become aligned with information systems and operates in an urban setting. On an patients of their quality and and financial incentives. To remain prof- annual basis, Henry Ford admits two mil- itable, hospitals will have to convince pa- lion patients, compared to Penn’s nearly superiority and be able to tients of their quality and superiority and 1.4 million. control their costs.” be able to control their costs. In addition, To succeed in this difficult environ- as Kelley asked rhetorically, “Who will ment, the Henry Ford Health System in fewer office visits. Then there are too rescue the Federal Government from its took a number of steps. Kelley suggested many “non-revenue” patient demands, legacy costs? Care for Baby Boomers will that, in the near future, UPHS will also such as fielding telephone calls, providing flood Medicare, and, like the Big Three, have to reinvent parts of itself to retain social services, filling in forms, and report- the Federal Government has an unsus- its dominance. HFHS began by empha- ing lab results. And these responsibilities tainable entitlement.” sizing quality as a differentiator and has come in the face of reimbursements that One of Kelley’s main points came in re-engineered some of its processes, are flat – or worse. “Small primary-care response to a question: “We have to take including a redesign of its primary-care practices will probably disappear,” Kelley politics out of the picture,” he said. “I services to feature easier access for ap- predicted, “because there are none of the think that we will have to raise taxes pointments. “We learned the importance necessary economies of scale.” to take care of the older population. of patient satisfaction,” said Kelley. “We In discussing the success of HFHS, Medicare won’t exist in its current form. like to say that we can’t treat a patient Kelley highlighted e-prescribing. In Nothing I have seen in the proposed po- who doesn’t choose to see us.” this process, a physician sends the pre- litical agenda is reality. The presidential Especially if patients are forced to ac- scription directly to the pharmacy by candidates are flip-flopping around the cept the burden of paying for more of real health-care issues. their health-care costs, Penn, too, will “The problem is who will pay. The have to figure ways to become more ef- insurers won’t get on board unless they ficient, Kelley explained. feel they will get a quick payback. If Medicare takes the lead, the insurance companies will follow. Congress will have to pass some mandates – for example, about diabetes care. “We need a catalyst to affect this shift.” Kelley concluded his talk with an ad- monition to his audience. “As health-care providers,” he said, “we should do more to affect health-care costs. We know where there are problems. We have to be vocal in the efforts to change them.”

2008/SUMMER ■ 23 Development Matters Development Matters PENN Medicine Turns to Simulators for Improved Training Penn’s New Clinical Simulation Center Is Where Medical Procedures Become Practice

For more than 200 years, PENN Medicine has expanded the frontiers of medicine and medical education. That tradition continues with the multi-million dollar PENN Medicine Clini- cal Simulation Center, opening this summer. Located at PENN Medicine at Rittenhouse, the center will feature 21,000 square feet of space for simulation training and continuing medical edu- cation programs. Here practitioners and residents from across the health-care field will turn to Penn to master the most ad- vanced techniques in medicine. The Center is a shared endeavor – by the University of Penn- sylvania Health System, the Clinical Practices of the University of Pennsylvania, and the School of Medicine – that will further improve patient safety and enhance medical education. Such innovations are made possible thanks to the support of “Making History: The Campaign for Penn” and its focus on providing fund- ing for educational advancements as well as PENN Medicine’s outstanding faculty and clinicians. PENN Medicine at Rittenhouse will be the site for the multi-million dollar PENN Medicine Clinical Simulation Center: 21,000 square feet of space for simulation training and con- tinuing medical education programs, opening this summer. The Center will be a shared endeavor by the University of Pennsyl- vania Health System, the Clinical Practices of the University of Pennsylvania, and the School of Medicine that will further improve patient safety and enhance medical education. A simulated operating room, emergency department, intensive-care unit, and labor and delivery room are planned for the center, which will integrate different approaches – from responsive mannequins to high-tech simulators – across its re- search and education programs. Physicians, nurses, residents,

and other professionals will be able to rehearse: COLOR CHART • general surgery NOVEMBER 21, 2007 • interventional radiology • ear-nose-throat and oral and maxillofacial surgery • obstetrics and gynecology • ophthalmology • emergency medicine • and other invasive medical procedures such as endoscopy, bronchoscopy, and cardiac catheterization. These hours of training in the simulator will translate into great- er safety and better outcomes for PENN Medicine’s patients.

24 ■ Penn Medicine Training for the Constant Evolution of Medicine Put simply, “simulation technology is the future,” says PENN Medicine Turns to Simulators for Improved Training James L. Mullen, M.D., professor and vice chair of surgery and chair of the Simulation Center Steering Committee at the The PENN Medicine Clinical Simulation Center, located at PENN Medicine at University of Pennsylvania Health System. At the new PENN Rittenhouse, will feature 21,000 square feet of space for simulation training and continuing medical education programs. Medicine Clinical Simulation Center, human patient simulators will mimic operating conditions, even responding to anesthe- sia and drugs according to dosage. Training sessions can be viewed, recorded, and replayed through the technologically advanced control center located in the core of the facility. For example, the rise of robotic surgery is just one sign that medicine and surgery are constantly advancing, with in- novative technologies, devices, and procedures that offer new hope to patients with life-altering illnesses. “PENN Medicine has a true, multi-specialty robotic surgery program,” says Mul- len. “Our surgeons are performing more and a broader range of procedures than most of our peer institutions.” Indeed, PENN Medicine utilizes robotic surgery in a num- ber of disciplines – cardiology, gynecology, and otorhinolaryn- gology, to name only a few – and is one of a small number of training centers for robotic surgery serving the East Coast. So training in these new techniques now has to be built in to all levels of medical education. Another example can be found in Penn’s Department of Obstetrics and Gynecology. The simulation center will provide an opportunity for the residents and students to practice basic skills and procedures (such as normal deliveries, laparoscopy, and suturing techniques) and to introduce new clinical skills. The simulation center may also be used to offer refresher courses for obstetricians who are returning to the work force after taking leave to spend time with their families.

Practice Makes Perfect for Health-Care Teams Perhaps the most significant opportunity afforded by the new center is the ability to train physicians, nurses, and techni-

Photo courtesy of Laerdal Medical Corporation. All rights reserved. rights Corporation.All Medical Laerdal of courtesy Photo cians in operating as a well-rehearsed team. “During the past two years, we have focused on providing patient-centered care using a team approach on labor and delivery,” says Debo-

COLOR CHART rah A. Driscoll, M.D., chair of the department. NOVEMBER 21, 2007 The department plans to use the simulation center to create scenarios with a focus on developing clinical and com- munication skills. After these drills, teams of physicians and nurses should be prepared for, and perform more effectively in, crisis situations in the real-life setting. Technology, however, is only one part of creating excellence in patient care and education. “What will truly make the PENN Medicine Clinical Simulation Center a model for training and education is the PENN Medicine faculty,” notes Mullen. “We are very fortunate to have leaders in practically every medical

2008/SUMMER ■ 25 Development Matters According to one of the pioneers

in the field of simulation training,

“There’s a transformation going on

globally that challenges the way

we practice health care. . . . We

[can’t] rely on live operations as

the only training tool or the only

place to introduce new techniques.”

discipline as part of the simulation training process, and their Introducing simulation into obstetrical training at Penn knowledge and experience will be key to the center’s success.” “will help us achieve our goals of providing high-quality care Just as important as providing the opportunity to learn and and improving patient safety,” says Driscoll. “We will be using practice individual surgical techniques, the Center will enable what’s learned through simulation training to help prevent or whole medical and surgical teams to rehearse difficult pro- reduce adverse events through prompt recognition and better cedures and stressful scenarios, planning for any number of management of any medical situation.” possible complications. Mullen also sees the current live, inter- According to one of the pioneers in the field of simulation active surgery telecasts, funded by The Benjamin & Mary Sid- training, “There’s a transformation going on globally that chal- dons Measey Foundation, as “a major leap – a revolutionary lenges the way we practice health care. . . . We [can’t] rely approach to medical education.” The Foundation also supports on live operations as the only training tool or the only place to the Measey Surgical Skills Suite, which will be part of the new introduce new techniques.” simulation center, and the Measey Medical Simulation Center Jon B. Morris, M.D., professor of surgery and program at the School of Medicine, which opened in October 2006. director for general surgery in the division of gastrointesti- In order to build a successful program, PENN Medicine nal surgery, agrees that the new simulation center presents turned to a pioneer in the field, Richard Reznick, M.D., from tremendous potential. “While we’re seeing this growing the University of Toronto. There, he leads a team of up to 80 body of evidence that surgical simulation will enhance not faculty members who use their simulation laboratories as the only the quality, efficiency, and effectiveness of the clinical hub for training and continuing medical education. He pre- care for our patients, we’re also seeing enormous opportu- sented many of his surgical training ideas, insights, and experi- nities to promote greater patient safety and improved surgi- ences at Penn’s 2007 Agnew Surgical Society Lecture. cal outcomes.” “There’s a transformation going on globally that challenges Incorporating simulation into the PENN Medicine cur- the way we practice health care,” he explains. “I trained in a riculum, Morris continues, “marks the dawning of a new era in bygone era. . . . We [can’t] rely on live operations as the only surgical education.” training tool or the only place to introduce new techniques.” Reznick also notes “Penn is ahead of the game, since it is al- For more information about supporting the new PENN ready dedicating part of the curriculum to simulation. That’s rare.” Medicine Clinical Simulation Center, PENN Medicine’s surgi- Penn Surgery’s residency program is among a select few nation- cal or medical education programs, or its faculty, please wide with a dedicated simulation rotation – a month-long, full-time contact the PENN Medicine Office of Development and component of general surgery training. Simulation will also be a Alumni Relations at (215) 898-5164 or 3535 Market vital part of Penn’s OB/GYN residency training program. Street, Suite 750, Philadelphia, PA 19104-3309.

26 ■ Penn Medicine Recent Gifts

The Robert Wood Johnson Foundation awarded the African American Collaborative Obesity Research Network (AACORN) a five- year, $3.5 million research grant to generate and conduct community- partnered research to reduce obesity in African American children and adolescents. The network was founded by and is under the direction of Shiriki Kumanyika, Ph.D., M.P.H., professor of epidemiology at Penn. The Benjamin & Mary Siddons Measey Foundation – A Comprehensive Approach The estate of Evelyn S. Butterworth continues to support Penn’s Department of Genetics with gifts this year totaling $4.9 million. The in Supporting Medical Education estate has given the department more than $12 million over the past three years. In October 2006, PENN Medicine dedicated the Measey Medical Simulation Center. There, technology allows Penn’s Patricia Dunn-Jahnke has made a $1.8 million pledge to raise or medical students to practice a variety of procedures – until the personally support the Ovarian Cancer Vaccine Initiative at Penn’s Abramson Cancer Center, under the direction of George Coukos, movements and processes become second nature – before M.D., Ph.D. This initiative supports the testing of an autologous vac- ever touching a live patient. Remarkably, this is just one example cine that uses the patient’s own tumor tissue to direct the patient’s of The Benjamin & Mary Siddons Measey Foundation’s com- own immune cells to deploy more of the patient’s own tumor-specific mitment to advance medical education in the Delaware Valley. killer T-cells to attack the cancer. At PENN Medicine alone, the Foundation supports 11 en- Theodore Aronson and his wife, Barbara, have contributed $1.1 dowed chairs, including: million to support acute stroke care and the research of Scott E. Kasner, M.D. • The William Maul Measey Professorship in Surgery, The Harold B. Robbins estate recently contributed $1 million to its held by Michael A. Acker, M.D., chief of the division of Car- Neurology Research Fund, which supports research into the care and diothoracic Surgery; prevention of cerebral atherosclerotic disease with associated brain • The Brooke Roberts/William Maul Measey Profes- degeneration. sorship in Surgery, held by Joseph E. Bavaria, M.D., di- rector of PENN Medicine’s Thoracic Aortic Surgery program; To make a gift to PENN Medicine, or for more information, please contact the Office of Development and Alumni Relations, • The William Maul Measey Professorship in Surgical 3535 Market Street, Suite 750, Philadelphia, PA 19104-3309, Research, held by Jeffrey A. Drebin, M.D., Ph.D., F.A.C.S, or call 215-898-8094. chief of the division of Gastrointestinal Surgery; and • The Clyde F. Barker-William Maul Measey Professor- Alumni Events ship in Surgery, held by Ronald M. Fairman, M.D., chief of You can find out more about these and other upcoming events at the division of Vascular Surgery and Endovascular Therapy. http://www.med.upenn.edu/alumni/events/calendar.html.

In addition, there are hundreds of medical students, resi- August dents, and fellows who have received generous scholarship Friday, August 15 – Parents and Partners Program, Philadelphia support from the Measey Foundation and who have made an Friday, August 15 — White Coat Ceremony, Philadelphia impact in the Delaware Valley community – and beyond. Many September of these talented physicians and researchers wouldn’t have Tuesday, September 23 — Otorhinolaryngology Reception, 7:00-9:00 been able to receive a Penn education without that vital support. p.m., Chicago “I am honored to work with people who are utterly com- October mitted to the future of medicine and medical education,” says Friday, October 3 — Fall Medical Alumni Advisory Council Meeting, Dean Arthur H. Rubenstein. “The Measey Foundation has invest- 8:00 a.m. — noon, Philadelphia ed in people and in the medical knowledge they can acquire and Friday, October 3 — Gamble Scholars & Medical Alumni create. And through the Measey Medical Simulation Center, it is Advisory Council Luncheon, 12:00-2:30 p.m., Philadelphia Tuesday, October 14 — American College of Surgeons also supporting state-of-the-art educational technology.” Reception, 6:00-8:00 p.m., San Francisco “As the world changes, the medicine we practice within it must change as well,” Rubenstein continues. “The need for November simulation technology arises from such change, and we deeply Sunday, November 2 — American Association of Medical appreciate the Measey Foundation’s willingness to embrace it Colleges, Alumni Reception, 6:00-8:00 p.m., San Antonio Saturday, November 8 – Ophthalmology Reception, with us.” 7:00-10:00 p.m., Atlanta

2008/SUMMER ■ 27 Progress Notes Medicine. She also served on the ’60s ’80s staff of both Children’s Hospital Send your progress notes to: and Presbyterian Hospital. In Andrea Pesce Spencer Foreman, M.D. ’61, re- Carol Beer Benson, M.D. ’80, 1950 she was appointed by May- Assistant Development Officer tired in January 2008 as president and her husband, Peter M. Dou- or Joseph Clark to head the Divi- PENN Medicine Development of Montefiore Medical Center (the bilet, M.D., Ph.D., both professors sion of Maternal and Child Health and Alumni Relations university hospital for the Albert of radiology at Harvard Medical at the Philadelphia Department of 3535 Market Street, Suite 750 Einstein College of Medicine) School and the Brigham and Public Health. In 1956 she joined Philadelphia, PA 19104-3309 after nearly 22 years of “health- Women’s Hospital, are the authors Penn’s Department of Public care statesmanship and service of Your Developing Baby: Concep- Health and Preventive Medicine. to the hospital and community.” tion to Birth (McGraw-Hill, 2008). She later moved to the Depart- Montefiore is the largest health- The book, written with Roanne ment of Community Health and ’50s care provider and employer in Weisman, uses two- and three- helped lay the groundwork for the area, serving more than 1.5 dimensional ultrasound images to John R. Senior, M.D. ’54, G.M.E. involving medical students and million residents of the Bronx show the development of a baby ’59, residence, received the Out- residents in community-based and parts of Westchester County, over the course of nine months. standing Service Award from the learning and outreach. In 1974, N.Y. Under Foreman’s leadership, Beer is director of ultrasound and Food and Drug Administration’s both Dr. Roses retired from their the hospital added an adolescent co-director of high-risk obstetri- for superior performance and practices and faculty positions at AIDS program, a Child Advocacy cal ultrasound at Brigham and outstanding national leadership Penn. A strong advocate for wom- Center to protect at risk children Women’s Hospital. in studying the effects of phar- en in medicine, Rose held picnics from abuse, the largest School maceuticals on the liver and for for female medical students and Health Program in the U.S. and Frank G. Haluska, M.D. ’89, contributing to public health alumnae of the medical school a program that gave respite and Ph.D. ’89, was appointed se- safety. Senior is associate director in 1962. This event evolved into housing to families and their nior medical director of ARIAD for science in the FDA’s Office of the annual Elizabeth Kirk Rose children who were at risk for lead Pharmaceuticals, Inc. Haluska Surveillance and Epidemiology. Women in Medicine Dinner, poisoning. will be responsible for leading to celebrate Rose and to bring multiple clinical trials of oral Tsung O. Cheng, M.D., G.M. medical school alumnae back to deforolimus as part of the joint ’56, professor of medicine (cardi- campus to advise and serve as global development plan with ology) at The George Washington mentors for female medical stu- ARIAD’s partner, Merck & Co., University, was honored with its ’70s dents. In addition to serving as a Inc. He is a recognized authority mentor, Rose was the long-time first Lifetime Achievement Dis- Vanessa Northington Gamble, on the targeted therapy of kinase secretary of the Class of 1926. In tinguished Research Award. He M.D. ’78, Ph.D. ’87, has been abnormalities in solid tumors. 1983, both Elizabeth Rose and received the award at the 12th appointed the University Profes- Most recently, Haluska served as Edward Rose received the medical Annual George Washington Uni- sor of Medical Humanities at the a senior faculty member in the school’s highest honor, the Distin- versity Medical Center Research George Washington University. A departments of medicine and guished Graduate Award. She was Day in recognition of his out- historian, she specializes in the genetics at Tufts University School active in many professional and standing research achievements role of race and racism in Ameri- of Medicine, where he was clini- civic organizations, among them in cardiology over a long period can medicine and public health. cal director and deputy director the Philadelphia United Cerebral of time. He has more than 1,400 Previously she had been director of the Tufts-New England Medical Palsy Association, the Society for peer-reviewed publications. of the National Center for Bioeth- Center Cancer Center. He is also Prevention of Cruelty to Children, ics in Research and Health Care at a major in the Medical Corps of the Philadelphia Pediatric Society, Jules B. Puschett, M.D. ’59, was Tuskegee University in Alabama. the United States Air Force and the Penn Alumnae Association, promoted to vice dean for pro- A health commentator for NPR, the Massachusetts Air National the Philadelphia-Camden Social gram development at the Texas she served as an associate profes- Guard. Service Exchange, the Mulberry A&M Health Science Center Col- sor of health policy and manage- Tree Nursery School, the Shut- lege of Medicine. Puschett trained ment at the Johns Hopkins Uni- In Society, and the Philadelphia in internal medicine at the Uni- versity since 2002. versity Hospital in Baltimore and OBITUARIES Youth Hostel Association. She was in renal-electrolyte medicine at president of the Penn Women’s Richard C. Wender, M.D. ’79, Elizabeth Kirk Rose, M.D. ’26, HUP, sponsored by the National Faculty Club from 1968 to 1970). professor and chair of the Depart- G.M.E. ’30, Kennett Square, Pa., Institutes of Health. He was chief A member of many medical so- ment of Family and Community emeritus associate professor of of the renal-electrolyte division cieties as well, Rose received the Medicine at Thomas Jefferson community health and pediatrics at the University of Pittsburgh Distinguished Daughter of Penn- University, served as co-chair of at the University of Pennsylvania School of Medicine from 1980 sylvania Award in 1993, honoring the Dialogue for Action Confer- School of Medicine; February 23, to 1990. From 1990 to 2005, he her leadership and contributions ence, sponsored by the Prevent 2008. At the age of 106, she was was chairman of the Department to the state. Cancer Foundation in April. The Penn’s oldest alumnus/alumna. of Internal Medicine at the Tulane event in Baltimore focused on When she completed her intern- University School of Medicine. Allen Wilson Cowley, M.D. screening for colorectal cancer – ship at HUP, she was the only Now a professor of medicine at ’29, G.M.E. ’33, Naples, Fla., “Despite a Broken Health-Care woman of 28 on the staff. She Texas A&M Health Science Cen- former chief of the Department of System.” He is a member of the married a colleague, Dr. Edward ter, he also maintains a research Medicine at Harrisburg Polyclinic foundation’s medical advisory Rose, and then completed a year laboratory that focuses on the Hospital; October 10, 2007. He board. of residency at The Children’s pathophysiologic mechanisms maintained an active practice in Hospital of Philadelphia. For two and novel treatments of volume Harrisburg for 42 years. He estab- decades, Rose was a practicing expansion-mediated hypertension. lished the first free clinic in car- pediatrician at HUP and a mem- diology in the 1940s at Polyclinic ber of the faculty of the School of Hospital. A former president of the Dauphin County Medical

28 ■ Penn Medicine Society, the Pennsylvania Heart Charles E. Myers, M.D. ’39, residency in ophthalmology at the Smith Kline in 1958 as a senior Association, and the Pennsylva- Larksville, Pa.; December 9, U.S. Naval Hospital in Philadel- research biochemist, after having nia Medical Society, he had also 2006. In April 1942, he entered phia and was then assigned to the served as chief of biochemical been chairman of the board of the U.S. Medical Corps as a para- U.S. Naval Hospital in Charles- research at the Wills Eye Hospital Pennsylvania Blue Cross and Blue trooper with the rank of first lieu- ton, S.C. as chief of the eye, ear, in Philadelphia. He co-wrote 60 Shield. In his retirement years, he tenant. In 1945, he was awarded nose, and throat department. He publications, including four with devoted his efforts to the applica- the Legion of Merit Award for his joined the Guthrie Clinic in 1954 former Penn professor and Nobel tion of biomedical engineering care of psychiatric causalities in and was on the staff for 28 years. Prize-winner Otto Meyerhof. to medicine and was one of the the Mediterranean Theater. He founding board members of the was discharged from the military Edward F. McGrath, M.D. ’40, Horace C. Reider, M.D. ’42, Whitaker Foundation, on which in 1946 with the rank of lieuten- Milton, Mass., a retired pediatri- Bryn Mawr, Pa., a retired physi- he served for 50 years. ant colonel. In 1950, he entered cian; November 12, 2003. He cian; May 9, 2007. into private practice, specializing was appointed to the Carney Sidney D. Apt, M.D. ’32, Phila- in internal medicine and chest Hospital staff in 1950 and was L. John Bingham, M.D. ’43, Salt delphia, an art director who later disease. In 1962, he founded and a physician in chief of the pe- Lake City; July 7, 2007. He took owned an advertising firm in the organized the Associate Internists diatrics department from 1955 over a family practice in Idaho city; May 30, 2007. of Wyoming Valley. He served as to 1958. A former chairman of Falls in 1955 and practiced there vice president of the Health and the hospital’s laboratory com- until 1983, when he semi-retired Felda Hightower, M.D. ’33, Hospital Planning Council of mittee, he was on the intern and to St. George, Utah, with a group Winston-Salem, N.C., emeritus Northeastern Pennsylvania; was resident committee and the phar- of emergency room physicians. professor of surgical sciences at chairman of the Long-Range Plan- macy committee. He was also on He accepted a Latter Day Saints Wake Forest University; May 30, ning Committee at Wilkes-Barre staff of St. Margret’s Hospital in mission to the Manila Mission in 2007. He was governor of the General Hospital; and served as Dorchester, Children’s Hospital in the Philippines, where he served American College of Surgeons chief of staff and as the chief of Boston, and Milton Hospital. as the area medical coordinator from 1963 to 1975. A lectureship the Department of Medicine at from 1989 to 1991. at Wake Forest was named in his Wilkes-Barre General Hospital, Salvatore Cucinotta, M.D., GM honor in 1989. where he was also the founder ’41, Cherry Hill, N.J., a decorated John Gray Hunter, M.D. ’43, and chief of the Anthracosilicosis World War II battlefield physician G.M.E. ’50, Albemarle, N.C., a Francis F. Hart, M.D. ’36, G.M. Clinic. A former president of the who delivered babies in South former surgeon; September 26, ’46, Ambler, Pa.; October 13, Pennsylvania Thoracic Society, Philadelphia for more than 50 2007. 2005. He was former chief of ra- he also served as president of years; December 30, 2007. He diology at Montgomery Hospital the Wyoming Valley TB Society. learned to use hypnosis to elimi- Frederick M. Owens Jr., M.D., in Norristown, Pa. In 1975, he received the Envi- nate patients’ pain and helped G.M.E. ’43, St. Paul, Minn., a ronmental Leadership Award of establish the Philadelphia Hyp- former surgeon.; June 4, 2004. J. George Teplick, M.D. ’36, the NEPA Environmental Coun- nosis Society in 1972. He taught He had been a clinical professor G.M. ’42, Philadelphia, a retired cil; and in 1983, he won the obstetrics to medical students at of surgery at the University of professor of radiology at Hahne- Distinguished Internist Award Hahnemann University Hospital Minnesota. mann University Hospital; May of the Pennsylvania Society of and directed a research project on 17, 2007. Author of Lumbar Internal Medicine. cervical cancer at HUP. Floyd M. Hess, M.D. ’44, San Spine: CT and MRI, he was coau- Antonio; June 17, 2004. thor of several other books in the Harry A. Pfingst, M.D., G.M. Roy J. Grubbs Jr., M.D. ’41, Sy- field of radiology. ’39, Chittenden, Vt., a retired lacauga, Ala.; March 21, 2001. Warren L. Candela, M.D. ’46, ophthalmologist; April 19, 2004. Stockton, Calif.; January 22, John E. Dotterer, M.D. ’38, San- The first director of the Louisville Jay W. Fidler Jr., M.D. ’42, Pom- 2007. ford, N.C., March 23, 2007. He Lions Eye Clinic, which was pano Beach, Fla., February 18, had been associated with Center established to diagnose eye dis- 2007. A retired psychiatrist, he Walter C. Klingensmith, M.D. County Hospital. A life member ease for needy patients, he had a had taught in the School of Occu- ’46, G.M.E. ’50, Gladwyne, Pa., of the North Carolina Literary private practice in Louisville. He pational Therapy at Misericordia January 1, 2007. An internist, he and Historical Association, he had also taught ophthalmology at the University in Dallas, Pa. He was a had been a clinical associate pro- served as a county commissioner University of Louisville. co-editor of Group Psychotherapy fessor of medicine at Penn. of Lee County. and Political Reality: A Two-Way Edward A. Bershof, M.D., G.M. Mirror and Group Processes and Anna Kane Laird, M.D. ’46, John J. B. Light, M.D. ’38, G.M. ’40, Denver; May 30, 2001. Political Dynamics. He had been Ph.D., Madison, Wis., a retired ’46, Lebanon, Pa.; September a fellow of the American Group psychiatrist; June 10, 2007. She 23, 2001. Known as a physician Edward Kulczycki, M.D. ’40, Psychotherapy Association. had been with the Division of Bi- with a passion for caring for his Athens, Pa., retired head of oph- ological and Medical Research of patients, he often based his fees thalmology at the Guthrie Clinic Harry Green, Ph.D. ’42, Boyn- Argonne National Laboratory and on their ability to pay. He was in Sayre; February 5, 2007. Dur- ton Beach, Fla., vice president of published in Nature and Science. board certified in radiology and ing World War II, he was a flight scientific liaison and technology ophthalmology, and he was on surgeon at the U.S. Naval air at the old Smith Kline Corp. Edward B. Price Jr., M.D. ’46, the staff of Wills Eye Hospital in station in Pensacola, Fla., before (now GlaxoSmithKline), until Omaha, Neb., a former patholo- Philadelphia at the time of his becoming a medical officer of his retirement in 1983; Febru- gist; October 11, 2007. He had death. Patrol Bombing, Squadron 11 ary 19, 2006. At Penn he was worked at the National Cancer (the Black Cat Squadron) of the awarded the Harrison Fellowship Institute. Maurice L. Zox, M.D., G.M.E. Seventh Fleet. After serving in the in Chemistry in 1940 and served ’38, Columbus, Ohio, July 16, South Pacific he became senior as an assistant professor in the John “Jack” W. Alden Jr., M.D., 2006. A surgeon, he had retired medical officer on the aircraft Graduate School of Medicine. G.M. ’47, Wilmington, Del, a from the Ohio State University carrier U.S.S. Saipan. He took his He began his 25-year career at College of Medicine.

2008/SUMMER ■ 29 retired radiologist; October 20, hearing department and helped retired professor of dermatology Albert S. Terzian, M.D., G.M. 2007. He joined the staff of the establish the hospital’s first school at Temple University; September ’50, Wilmington, N.C., a retired Delaware Hospital in 1947 and for autistic children. He was an 28, 2007. psychoanalyst who practiced later became the head of its De- attending physician at Washington for more than 35 years; April 8, partment of Radiology. In 1969, Hospital Center and was a clini- Charles A. Doehlert, M.D. ’49, 2007. He received his undergrad- he went into private practice with cal assistant professor at George Sarasota, Fla.; April 13, 2007. A uate degree from the University Papastavros Associates. In 1976, Washington University Hospital. former adjunct professor of clini- of Pennsylvania and his medical he retired to Ft. Lauderdale, Fla. cal medicine at the University of degree from Hahnemann Medical Albert P. Giannini, M.D., G.M. Wisconsin Medical School, he College. He went overseas as a Edward K. Atkinson, M.D. ’48, Fort Collins, Colo., a former took his internship at Evanston, member of the Medical Corps of ’47, founder and former direc- thoracic surgeon; February 29, Ill., Hospital. During the Korean the Army in World War II. tor of the Greenville Hospital 2004. War, he was a Navy physician on Department of Anesthesiology, the aircraft carrier Franklin Delano Robert M. Akey, M.D., G.M. ’51, Berea, Ky.; December 5, 2005. George W. Moore, M.D. ’48, Roosevelt. After an honorable dis- Topeka, Kan.; February 14, 2007. He entered active duty with Venice, Fla., a retired urologist; charge, he served a fellowship in He completed a fellowship at the the U.S. Marine Corps in 1950 August 1, 2007. He completed cardiology at the Mayo Founda- Mayo Clinic in internal medicine. and eventually became chief of tours in the Navy and Marines, tion and earned his M.S. degree He then went on to practice as anesthesiology at the U.S. Naval attaining the rank of lieutenant, from the University of Minnesota. an internist/diagnostician with a Hospital at Camp Pendleton in and was honorably discharged He went on to practice internal cardiology specialty at the Watson Oceanside, Ca. After returning to from the Navy in 1951. He medicine with Associated Physi- Clinic for 40 years until retiring civilian life, he moved to Green- completed his internship and cians in Madison, Wis., for 36 at age 70. ville, Pa., where he practiced until residency at Geisinger Hospital in years. He retired from active prac- 1973. He subsequently continued Danville, Pa., and joined a uro- tice in 1991. Robert Balin, M.D., G.M.E. ’51, to practice in the Drexel Hill and logical practice in 1955. A former Las Vegas, a psychiatrist; July 1, Hazelton, Pa., areas. He retired chief of staff at both the Jameson Coleman W. Kovach, M.D., 2003. from anesthesiology in 1993 Hospital in New Castle, Pa., and G.M. ’49, Jamison, Pa.; February and established a private medi- St. Francis Hospital, he had also 10, 2007. A retired physician, he Lewis P. Frank, M.D., G.M. ’51, cal practice in Berea, treating a been president of the Lawrence practiced in Philadelphia and was Lebanon, Pa., a retired surgeon; variety of ailments with chelation County Medical Society. associated with Thomas Jefferson February 1, 2003. He retired as a therapy and nutritional supple- University Hospital throughout staff physician at the Coatesville ments. William A. Robie, M.D., G.M.E. his entire career. Veterans Administration Medical ’48, Cary, N.C., a former pediatri- Center in 1982. He was a deco- Milton A. Kamsler Jr., M.D. ’47, cian; December 28, 2006. He had Jordan Thompson, M.D. ’49, rated World War II Army captain, G.M. ’51, St. Augustine, Fla., a been a medical director at Wake New Orleans, a specialist in inter- serving in the Pacific theater as physician who had maintained a Med health system and a consul- nal medicine; April 2, 2001. a combat military surgeon from practice in Burlingame, Calif., for tant for North Carolina’s Disability 1942 to 1946. He opened a prac- more than 30 years; March 23, Determination Service. David L. Hearin, M.D., G.M.E. tice in Lebanon, Pa., in 1948. 2007. He served in the U.S. Army ’50, Alpharetta, Ga.; July 19, in Germany during the post- Robert H. Shedd, M.D. ’48, Pun- 2006. After completing his William H. Hulet, M.D. ’51, World War II era. ta Gorda, Fla.; October 23, 2007. residency in dermatology he Ph.D., Key West, Fla.; April 15, He served as a surgeon with the maintained a private dermatology 2000. He completed his intern- Andrew W. Lawrence, M.D. ’47, United States Marine Surgical practice in Atlanta until 1985. He ship and residency in internal Centerport, N.Y., a retired ortho- Unit during the Korean War. In served as head of the Department medicine at G. F. Geisinger paedic surgeon; November 11, 1953, he moved to Punta Gorda, of Dermatology at the VA hospital Memorial Hospital in Danville, 2007. He was a former member becoming only the third doctor in in Decatur and served as a derma- Pa. For a time, a member of the of the Scoliosis Research Fellow- the area. During that period, he tology consultant to the hospital, Department of Medicine at New ship, dedicated to the education, made house calls to families and conducting weekly dermatology York University, he was interested research, and treatment of spinal delivered more than 1,000 ba- clinics until fully retiring with 37 in research and physiology. In deformity. bies. He served on the Charlotte years of service in 1988. In re- 1969, he took a permanent leave County Commission from 1972 cent years, he delivered Meals on of absence from human medicine Russell P. Sinaiko, M.D., G.M. to 1982, was mayor of Punta Wheels to home-bound residents and pursued a Ph.D. degree in ’47, a retired surgeon, Los Ange- Gorda for two terms, and was an of the Alpharetta area. marine science at the University les; September 21, 2002. active member of its city council. of Miami. For four years, he was chief of William F. Monroe, M.D. ’50, Max J. Fischer, M.D., G.M. ’48, staff at the Charlotte Regional Cincinnati; April 23, 2006. David G. Rimer, M.D. ’51, Santa former chief of the ear, nose, and Medical Center, and he founded Monica, Calif., a retired gastro- throat division at Children’s Hos- the Charlotte County Medical H. Luten Teate Jr., M.D., G.M.E. enterologist; February 17, 2007. pital, Washington D.C.; December Society. He was the medical direc- ’50, Decatur, Ga., a former pe- He was the first G.I. fellow and 15, 2007. He was chief resident tor for the Life Care Center of diatrician; September 3, 2006. chief resident at UCLA. He main- at Georgetown University Medi- Punta Gorda, the Port Charlotte For seven summers he headed to tained a private practice in Santa cal Center before taking over the Care Center, and St. Joseph Nurs- Central America to treat children Monica for most of his 44-year ear, nose, and throat practice of ing Care Center, and also served through Care-Medico and Amigos professional life. A clinical profes- his uncle, Dr. Aubrey Fischer. He as staff physician for South Port de las Americas. He is believed sor of medicine at UCLA, he was worked there for the next 55 years Nursing Center. to be the first doctor in Georgia chief of G.I. service at Harbor/ and retired in spring 2007. In ad- to perform a blood exchange UCLA Medical Center in 1963 dition to running the otolaryngol- Carroll F. Burgoon, M.D., transfusion on a newborn baby and served as director of the ogy division at Children’s, he also G.M.E. ’49, Chester Springs, Pa., to save the lives of babies born to Medical Ambulatory Care Center was director of the speech and Rh-negative mothers. and associate director of the Gen- eral Internal Medicine Residency

30 ■ Penn Medicine Training Program at UCLA. He Samuel H. Horton, M.D., at the University of Colorado ship and residency at the Univer- was the first full-time gastroenter- U.S.N.M.C. (ret.), G.M.E. ’52, Healthy Sciences Center; Sep- sity of Michigan Hospital in Ann ologist at St. John’s Hospital. He Beaufort, S.C.; March 16, 2007. tember 15, 2004. He had been Arbor, then spent two years in founded and was director of the on the faculty of the University Morocco as a United States Air G.I. lab at St. John’s and was chief Lewis G. Richards Jr., M.D., of Colorado since 1972 and was Force Captain and head of the of G.I. He also served as chief of G.M. ’52, Hardy, Va.; October 10, an emeritus professor at the time medical services at the 3922nd G.I., director of G.I. training, and 2004. He served four years as a of his death. For many years he Air Force Hospital. He returned chief of medicine at Santa Monica medical doctor in the Navy dur- was a senior member of the Car- home to practice medicine in Hospital. ing World War II. He practiced diovascular Pulmonary Research Burlington, N.C., where he served surgery in Lynchburg, then Roa- Laboratory in the Department of as chief of staff at Memorial Hos- Luis F. Sala, M.D., G.M. ’51, noke, retiring to Franklin County Medicine. He had been an inte- pital. Ponce, P.R., former head of Puerto in 1983. gral part of the Developmental Rico Board of Medical Examiners; Lung Biology Laboratory in the Samuel H. Black, M.D. ’56, June 23, 2005. Gustave T. Anderson, M.D., Department of Pediatrics, and Ph.D., College Station, Texas; G.M.E. ’53, Calminesa, Calif., a most recently he played a signifi- March 30, 2007. A faculty mem- Bernard Shapiro, M.D. ’51, former dermatologist; November cant role in establishing the Colo- ber of Texas A&M Health Science G.M.E. ’55, Lower Merion, Pa.; 13, 1999. He was a physician for rado Center for Altitude Medicine Center College of Medicine since November 27, 2007. A pioneer 45 years, 12 of those for Kaiser and Physiology in the Department 1975, he was an emeritus profes- in nuclear medicine, he retired Permanente Fontana Medical of Surgery. sor of medical microbiology and in 1998 after 40 years at Albert Group in Fontana. Anderson immunology and of humanities in Einstein Medical Center, where served in the U.S. Navy Medi- Isadore Brodsky, M.D. ’55, Nar- medicine. After serving two years he had been chief of the Divi- cal Corps for 25 years, spanning berth, Pa.; October 6, 2007. He in the U.S. Army Medical Corps, sion of Nuclear Medicine. His World War II, the Korean War, served for two years in the U.S. he received his Ph.D. degree in research on radiation protective and the Vietnam War. Public Health Service in Bethesda, microbiology from the University agents received support from the Md., and was a National Cancer of Michigan. He taught at several N.I.H., the American Cancer So- F. Wilson Daily, M.D., G.M. Institute fellow in hematology be- other schools before coming to ciety, the Army, and the Air Force. ’53, Savannah, Ga., February 22, fore joining Hahnemann Medical Texas A&M, where he served as After retiring as division chief, he 2007. He had set up the obstetric College in 1962. He performed professor and head of medical remained on Einstein’s board of anesthesia department at Candler the first stem-cell transplant in microbiology and immunology trustees. He was a former presi- General Hospital and had been the Philadelphia area more than from 1975 to 1990. Among the dent of the Pennsylvania College associated with Obstetric Anes- 30 years ago. Before retiring last positions he held there were as- of Nuclear Medicine. thesia of Savannah. January, Brodsky had been chair sistant dean for curriculum and of hematology and oncology at undergraduate medical education; Edward C. Sutton, M.D. ’51, Julio A. Ayulo, M.D., G.M. ’54, Drexel University’s College of interim dean of the College of Burlington, N.C., a retired obste- Harbor City, Calif., a former gas- Medicine, medical director of Medicine; associate dean of the trician-gynecologist; February 16, troenterologist; May 10, 2004. its Isadore Brodsky Institute for College of Medicine; and associ- 2007. Blood Diseases and Cancer, and ate dean for academic affairs. He Jerome I. Brody, M.D., G.M.E. managing partner in an oncol- was speaker of the Faculty Senate William Beautyman, M.D., ’54, Bala Cynwyd, Pa.; September ogy and hematology practice at from 1986 to 1987. His many G.M.E. ’52, Blue Bell, Pa.; Sep- 20, 2007. He studied violin at the Hahnemann University Hospital. honors include the Faculty Dis- tember 5, 2000. He had been Manhattan School of Music before Since 1976, he and his medical tinguished Achievement Award chief pathologist, director of earning his degree from Jefferson team had performed more than in Teaching from Texas A&M laboratories, and chair of the pa- Medical College. In addition to 1,000 bone-marrow transplants University in 1982 and 1989. A thology department at the former his medical training at Penn, he on patients with leukemia and lecture hall was dedicated in his Pittsfield General Hospital, which completed a hematology fellow- other types of cancer. His research name in May 2003. later became Berkshire Medical ship at Yale University. For almost projects included the study of Center. He was highly regarded 30 years, before retiring at 75, retroviruses to control cancer and Louis E. Goldberg, M.D., G.M. for having introduced computers Brody was a professor of medi- the use of interferons to treat can- ’57, Hatfield, Pa., a former oph- into the pathology laboratory in cine at the Medical College of cer, leukemia, and AIDS. In 2003, thalmologist; July 11, 2001. the 1960s, in a way that became Pennsylvania. Earlier, he had been he and his son Robert, a hema- a model for others. He served an associate professor in Penn’s tologist and oncologist at Johns Paul M. Mitchell, D.D.S., G.M. on the board of governors of the School of Medicine, where he was Hopkins University, developed a ’57, Yardley, Pa., October 17, College of American Pathologists a National Institutes of Health chemotherapy drug treatment for 2007. from 1974 to 1980. After retiring fellow. For the last several years, multiple sclerosis. in 1993, he lectured on apopto- Brody, author of more than 100 Lloyd David Hall, M.D. ’59, Co- sis, a type of cell death. medical articles, had been writ- David G. Ostrolenk, M.D. ’55, lumbus, Ohio, a retired obstetri- ing a book profiling physicians Monmouth Beach, N.J.; Septem- cian-gynecologist, June 3, 2006. Gumersindo Blanco, M.D., G.M. who were also writers, artists, and ber 27, 2007. After taking his ’52, San Antonio, Tex.; Septem- musicians. radiology residency at New York Robert J. Kirschner, M.D., G.M. ber 22, 2007. He specialized in Hospital, he worked at various ’59, Bryn Mawr, Pa., an ophthal- thoracic surgery in Philadelphia Frederick R. Haase, M.D., G.M. hospitals, including Mount Sinai mologist who had served on the and New Jersey. He was co-author ’54, Toms River, N.J., a former Hospital and Jersey City Medical faculties of Graduate Hospital and of more than 40 articles in his otolaryngologist; October 7, Center. He finished his career at the Wills Eye Hospital; September field. His last appointment was as 2007. the Veterans Administration Hos- 4, 2007. chief of surgery at the University pital in Columbia, S.C. of Puerto Rico, from which he John “Jack” T. Reeves, M.D. Kirk P. Kalemkeris, M.D., G.M. retired in 1986. ’54, Denver, a former professor of Paul Forrester Williams, M.D. ’62, Ho Ho Kus, N.J., a general medicine, pediatrics, and surgery ’55, Burlington, N.C.; January 11, surgeon and oncologist who spe- 2007. He completed his intern- cialized in cancer surgery for four

2008/SUMMER ■ 31 LEGACY GIVING

decades; July 19, 2002. He served of Radiology and The Journal of on the staff of The Valley Hospital the American Medical Association, in Ridgewood and Pascack Valley and he was an invited as a guest Hospital in Westwood. speaker at national seminars. With Gratitude Koolpe had academic appoint- Sherwood V. Cohen, M.D., G.M. ments at Temple University, Al- ’63, Elkins Park, Pa., a retired bert Einstein Medical Center, and ophthalmologist; May 9, 2007. the University of Medicine and He earned his medical degree Dentistry of New Jersey. from the State University of New rs. David and Kathy Guarnieri have always York at Syracuse. He had been on Saroja D. Adusumilli, M.D., placed great value on education. They support the staffs of several hospitals in G.M.E. ’02, Westlake, Mich., their private high school in Scranton, Pa., and they also the Philadelphia area, including a clinical assistant professor of D Graduate, Holy Redeemer, and radiology at the University of donate to their undergraduate alma mater. Despite earn- Rolling Hill. During the Vietnam Michigan Medical School; March ing medical degrees from different schools, they agree War, he served in U.S. Army 3, 2007. An authority on mag- that the University of Pennsylvania School of Medicine hospitals, stateside. Cohen wrote netic resonance imaging, she was prepared David extremely well for his profession. medical columns for The Jewish a member of her department’s “I would not be where I am without my degree from Exponent and The Northeast Jewish abdominal imaging group. the School of Medicine,” says David, a member of the Times. Class of 1984. “It was a basis, a wonderful beginning for my profession. And even though she did not attend, Kathy Lorenzo G. Runk III, M.D. ’63, FACULTY DEATHS has a great appreciation for the School as well.” G.M.E. ’67, Lansdowne, Pa., a The Guarnieris decided to transform their heartfelt ap- retired neurologist; August 29, Jerome I. Brody, M.D. See Class 2007. After serving in the Air of 1954. preciation into a scholarship that is included in their will. Force for two years in Alabama, The David M. and Kathleen M. Guarnieri Scholarship will he returned to the Philadelphia Alfred Gellhorn, M.D., New provide a world-class School of Medicine education to area to do clinical research at York City, former dean of the many students who otherwise could not afford it. Graduate Hospital. He joined a School of Medicine; March 24, “We decided to make a planned gift, which we feel is a neurological practice in South 2008. He came to Penn as the wonderful way to perpetuate our name and to extend our Philadelphia in 1972 and was first director of its Medical Center gratitude to the School of Medicine,” says Kathy. associated with St. Agnes Medi- and served as dean of the medi- In 1994, the Guarnieris, who are both anesthesiologists, cal Center and Methodist, Mercy cal school from 1968 to 1973. moved to Scottsdale, Arizona. Even though the move was Fitzgerald, and Misericordia He was credited with introducing more than 2,000 miles away, the Penn name resonated hospitals. He taught neurology new dimensions of social thinking at Penn in the 1970s and later into many aspects of curriculum among David’s peers. “The University of Pennsylvania was a clinical assistant professor and health-care delivery, includ- School of Medicine is an incredible name to put behind of neurology at Thomas Jefferson ing reviving the Department of you,” he says. “To this day, it continues to open a lot of doors.” University. According to his wife, Community Medicine. His focus The Guarnieris want future generations of medical stu- Nancy Gordon Runk, his great on collaboration with the local dents to experience “the best of the best” with the same love was music, and he played community led to the creation high-caliber education, admiration from their peers, and the French horn with the Lower of such programs as the West pride a University of Pennsylvania School of Medicine Merion Concert Band for 26 Philadelphia Community Mental education can bestow. years. Health Consortium, the Health “We have taken stock of our lives, and we are happy Education Program, and Gate- with where we are. It now feels like the right time to give Peter R. Kaplan, M.D. ’64, Gross way to Higher Education, which Pointe, Mich., a former cardi- encouraged minorities to pursue back. The only way we got to be where we are is through ologist; March 2, 2006. He had medical degrees. While serving Penn. Through the wonderful vehicle of planned giving,” been a teacher and physician at as dean, he held an appointment says David, “we will be able to give others the same op- St. Thomas Hospital in Nashville as professor of medicine and portunities we had.” since 1972. pharmacology. Gellhorn served The Guarnieris have chosen one of a multitude of a 25-year tenure at Columbia creative gift opportunities that benefit both the School John R. Scott, M.D. ’64, Delmar, University; was founding direc- of Medicine and its donors. As you plan your financial N.Y., a radiologist; February 12, tor of the Sophie Davis School of future, the Office of Planned Giving is ready to assist in 2007. At one time he had been Biomedical Education of the City developing an appropriate strategy to incorporate your clinical associate professor of College of New York; and was charitable objectives. Contact Christine S. Ewan, J.D., As- radiology and clinical associate director of medical affairs at the professor of radiology in pediat- NY State Department of Health. sociate Director of Planned Giving at 215-898-9486 or at rics at Penn. He received his medical degree in PENN Medicine, 3535 Market Street, Suite 750, Philadel- 1937 from Washington Univer- phia, PA 19104-3309. You can e-mail Christine at cewan@ Harvey A. Koolpe, M.D. ’73, sity in St. Louis. In 1993, Penn upenn.edu. Also, you can visit the Office of Planned Giv- Elkins Park, Pa., an interventional awarded him an honorary degree ing’s web site at www.med.upenn.planyourlegacy.org. radiologist at Albert Einstein for his contributions to medicine Medical Center; October 18, and to physician education in the 2007. He was the inventor of service of humanity. several catheters now widely used in the field. His articles appeared Elizabeth Kirk Rose, M.D. See in many professional journals, Class of 1926. including The American Journal

32 ■ Penn Medicine Conflict of Interest tions with physicians closer in line with evidence-based content rather than market- In this issue, you can read that our ing” (September 2006). There is certainly a School of Medicine was ranked among the need for medicine and industry to interact, top five research-oriented medical schools and when it is done properly, our patients by U.S. News & World Report and the benefit. We would not have established the Hospital of the University of Pennsylvania Office of Corporate Alliances in 2003 if we earned a spot on the U.S. News Honor thought otherwise. In fact, the meeting in Roll of best hospitals (p. 3). Those are tre- 2004 and a second forum in April 2006 mendous achievements. But Penn recently principles of medical professionalism.” The were ably assisted by that office. received another high grade from a less AMSA survey, in contrast, was limited to Speaking of evidence-based policy, one widely known organization, and its impli- the pharmaceutical industry. of the reasons for a stricter approach to cations are worth considering. As the Times headline intimated, the re- gifts is based on recent research in social The organization is the American Medi- sults of the PharmFree Scorecard are some- science and psychology. As the JAMA ar- cal Student Association (AMSA). In late what grim. Our School of Medicine was ticle put it, “the impulse to reciprocate for May, AMSA published its PharmFree Score- one of only seven in the country to receive even small gifts is a powerful influence on card 2008, which evaluated conflict-of-in- an “A” for its conflict-of-interest policies. people’s behaviors.” Free pens and meals, terest policies in 150 medical colleges and Only one other medical school in the state, that is, can have more impact on the recipi- colleges of osteopathic medicine. Given the the University of Pittsburgh, received an ents than they are aware. public’s interest in the integrity of our insti- “A.” Surprisingly, 60 schools across the na- Soon after AMSA’s survey appeared, the tutions of higher learning, it was not sur- tion received a failing grade; some schools Association of American Medical Colleges prising that The New York Times reported received an “F” because they had weak issued a fuller report that covered similar on the survey. Its headline was sober: “Sur- policies or no policies, and some did not ground, “Industry Funding of Medical Ed- vey of Medical Schools Is Critical of Perks” respond despite repeated requests. PENN ucation.” Here, too, the call is to maintain (3 June 2008). The scorecard assessed Medicine has worked hard to eliminate professionalism and to have full transpar- policies on accepting gifts and meals from potential conflicts of interest of this kind, ency and disclosure by personnel of aca- industry; consulting relationships; speaking and AMSA’s initiative was something we demic medical centers. I should note that relationships; disclosing financial conflicts; applauded. For those reasons, it is gratify- Dr. Brennan was a member of the AAMC’s pharmaceutical samples; financial support ing to see our efforts recognized. task force that issued the report. for educational events (both on campus Those efforts go back a few years, when Receiving an “A” is very nice, but we and off); industry support for scholarships the seriousness of the matter was becoming must remain vigilant and work to achieve and trainee funds; and access of industry clearer. Our medical students had an im- the best relationship with industry. To that sales personnel to the medical school or portant influence on our new policies, and end, Glen Gaulton, Ph.D., our executive hospital. Schools were also asked whether P. J. Brennan, M.D., professor of medicine vice dean and chief scientific officer, and I the academic curriculum includes materials and senior vice president and chief medical recently issued a memorandum to our fac- on conflict of interest and whether individ- officer for the Health System, took the lead ulty on extramural consulting activities. As uals with financial conflicts participate in among our faculty members. In October we note, we have seen a significant increase an institution’s purchasing decisions. These 2004, our institution held what we believe in the number and complexity of consult- are problematic areas, although sometimes was the first symposium in the nation that ing arrangements. Our institution has re- the issue is one of degree and transparency. brought together representatives from aca- sources, such as the Office of Corporate Al- AMSA specifically referred to a widely demic medicine and the pharmaceutical liances, the Office of Faculty Affairs, and publicized article that appeared in The industry, specifically to consider how to the Office of General Counsel, to advise Journal of the American Medical Association handle our interactions. As such an event our faculty in this sometimes ambiguous two years ago, “Health Industry Practices suggests, PENN Medicine did not take an area. Our goal is a simple one: to avoid That Create Conflicts of Interest: A Policy accusatory approach. Two years ago, Dr. even the appearance of a conflict of interest Proposal for Academic Medical Centers” Brennan told Physician’s News Digest that al- and maintain the public’s trust. (25 January 2006). That article focused on though we had some policies in place, they the efforts of manufacturers of pharmaceu- were not being enforced well enough. As Arthur H. Rubenstein, M.B., B.Ch. ticals and of medical devices to sell their he put it, Penn needed to review and revise Executive Vice President of the University of products to institutions like ours, which its policies, “not to demonize pharmaceuti- Pennsylvania for the Health System the authors believe “pose challenges to the cal companies, but to bring their interac- Dean, School of Medicine FISHERS’ $50 MILLION GIFT SUPPOR NEW TRANSLA

TIONAL RESEARCH CENTER

SUMMER 2008 TS

ome 20 years after the idea first came to

Sthem, Jean Bennett, M.D., Ph.D., and Albert

M. Maguire, M.D., have used gene therapy

to restore partial sight to patients with

Leber’s congenital amaurosis (LCA). A severe

form of retinal degeneration, the condition

leads to total blindess. The preliminary re-

sults set the stage for further studies of an

innovative treatment for LCA and possibly

other retinal diseases. GENE THERAPY

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