A New Office Sharpens the Focus on World Health

FEBRUARY 2006

Global Engagement: A New Office Sharpens the Focus on World Health GOAL: A GOOD NIGHT’S SLEEP TESTIFYING ON STEM CELL RESEARCH GAMMA KNIFE BRINGS A NEW EDGE Daniel Burke islet transplantation, which can help the body maintain the proper level of insulin. One major challenge is to keep the patient’s immune system from re- jecting the islet cells. Diabetes experts are also studying ways to make the processing of islet cells more efficient and to regenerate islet cells in the body. Schutta mentioned some new devices and therapies that the Rode- baugh Center is testing, such as the Continuous Glucose Monitoring Sys- tem and the Insulin Pump Program Miss America’s 30,000 Sticks 24 percent of Americans were obese; (for patients who would normally take today, it is closer to 30 percent. And, multiple insulin injections a day). t a campus event that cele- as Iqbal emphasized, obesity leads to In her keynote speech, Nicole Johnson brated PENN Medicine’s dia- increased blood glucose, which leads to Baker began by describing the “grim” betes program, Mitchell A. diabetes. In the question-and-answer picture. By her estimate, some 21 mil- Lazar, M.D., Ph.D., director segment that followed the program, lion Americans have diabetes. Yet on A of the recently created Insti- Mark H. Schutta, M.D., medical director the whole she offered a more positive tute for Diabetes, Obesity, and Metab- of the Rodebaugh Center, said bluntly view. After all, she noted, it has been olism, took the opportunity to articu- that “diabetes will shave off six to seven only 85 years since the “miracle drug” late the institute’s “big plans”: to pre- years of your life.” insulin was introduced, and diabetics vent diabetes, to cure diabetes, to im- But Schutta also made clear that have had glucose meters for only about prove diabetes treatment, to prevent there is hope. Type 2 diabetes, he as- 30 years. (Johnson Baker remarked complications from the disease, and to serted, “is a completely preventable that it has been “so crucial and critical train the next generation of profes- disease.” And a patient can have ex- to know my numbers.”) In addition, sionals to take on these ambitious pert help. While acknowledging that experts began studying “women-spe- roles. A tall order, but Lazar and the “the patients have to do most of the cific” aspects of diabetes only 10 to 15 multidisciplinary team at the institute work,” he also said that “diabetes care is years ago. Pregnant herself, Johnson and the Penn Rodebaugh Diabetes a team sport.” As he spoke, he showed Baker said that she has been a partici- Center exuded confidence. So did a a slide of the personnel at the Rode- pant in research on how diabetes affects special guest, Nicole Johnson Baker, baugh Center, all of whom looked ex- pregnant women. And something that who won the Miss America title in 1999. tremely fit! Lowering one’s blood sug- she said happens to about 20 percent She competed in the pageant while ar through diet and exercise, Schutta of pregnant women has happened to wearing an insulin pump. said, is extremely important. Yet he her: her body is now making about 30 The event, scheduled during Amer- also said that people on diets should percent of the insulin she needs. “The ican Diabetes Month, was called “Trans- be able to have “an occasional mimosa” bad news,” she added with some irony, lating Discoveries into Care.” Several or slice of cake. is that “it will go away in about eight of the speakers made note of the Michael R. Rickels, M.D, assistant weeks” – after she delivers. But this alarming statistics related to diabetes director of the Type 1 Diabetes Unit, change is a rich area for further study. and obesity. Lazar pointed out that an spoke about the promise of pancreatic Living with diabetes (the name of estimated one in three Americans born her 2001 book) “has been a pain,” said in 2000 would get diabetes. Nayyar the former Miss America, estimating Iqbal, M.D., assistant director of the that she has had 30,000 insulin sticks institute’s Type 2 Diabetes Unit, noted in the last 12 years. “But I’m going to that as recently as 2001, 20 percent to choose to live in a world of great hope.”

Cover montage Lewis & Nobel/NCS Globe: Comstock FEBRUARY 2006 / VOLUME XVIII NUMBER 2

THE IMMERSION METHOD The School of Medicine’s revitalized programs in global health provide intense experiences for the students By Linda Bird Randolph who take part. The credo: The only way to understand 8 another country “is to go there and immerse yourself.” GIVING TESTIMONY This fall, Pennsylvania’s House Democratic Policy Committee came to campus to hold a public hearing By John Shea on stem cell research. Among the experts who testi- 15 fied were two prominent members of Penn’s faculty. UNQUIET SLUMBERS The multidisciplinary Center for Sleep and Respiratory Neurobiology brings together clinicians, researchers, By Martha Ledger and clinical investigators seeking to unravel the mys- 18 teries of sleep – and problems associated with sleep. HOW DO OTTERS Following his sabbatical at a national park, John W. Weisel, Ph.D., a professor of cell and developmental REMAIN SLEEK biology, used the tools of his profession to study otter AND WARM? hair. He found some unusual traits. By Karen Kreeger

26 ® THE KNIFE THAT Neurosurgeons at the Penn Gamma Knife Center have a new, 20-ton tool to accomplish the most delicate ISN’T A KNIFE procedures. It uses 201 finely tuned beams of radia- By Nicole Gaddis 28 tion to treat brain lesions and tumors. TREATING THE Penn researchers are studying a promising new way to extend the lives of people with Glioblastoma DEADLIEST BRAIN Multiforme. The drugs they administer attack only TUMORS the cancerous cells in the brain. By Kate Olderman, with Nicole Gaddis 31 AN EYE FOR NATURE Morris Swartz, M.D., a pulmonologist, uses vacation time to photograph eye-catching landscapes across the country. Several of his prints were displayed at 32 Penn’s Faculty Club this past fall. STAFF DEPARTMENTS JOHN R. SHEA, PH.D. Editor Inside Front EDITOR’S NOTE NICOLE GADDIS Miss America’s 30,000 Sticks Assistant Editor 2 VITAL SIGNS LEWIS & NOBEL DESIGN CAM: A Groundbreaking and a Gift Design / Art Direction Penn to Lead Search for New Mood-Disorder Drugs ADMINISTRATORS A New “Breast Cancer Center of Excellence” REBECCA HARMON How Effective Is That Treatment? Chief Communications Officer Penn Named Part of a Site for National Children’s Study SUSAN E. PHILLIPS Honors & Awards Senior Vice President for Public Affairs ? LETTERS Penn Medicine is published for the alumni and friends of 34 DEVELOPMENT MATTERS PENN Medicine by the Department of Communications. © 2006 by the Trustees of the University of Pennsylvania. All rights Focus on Foundations reserved. Address all correspondence to John Shea, Penn Recent Gifts Medicine, 3600 Market Street, Suite 240, University of Pennsylvania Health System, Philadelphia, PA 19104-2646, 38 ALUMNI NEWS or call (215) 662-4802, or e-mail [email protected]. Progress Notes

Visit Penn Medicine’s web site: Inside Back THE LAST WORD http://www.uphs.upenn.edu/prnews/publications/ Professionalism and Humanism Stuart WatsonStuart In her remarks at the groundbreaking, Amy Gutmann, Ph.D., president of the University of Pennsylvania, noted the political support for CAM. “This project has also enjoyed the enthusiastic backing of our city and Commonwealth officials.” She went on to assert that the Center “will advance our boldest aspirations to redefine Penn as the eminent urban university. It will transform the delivery of cancer and cardiovascular care and out- Benefactors: Raymond and Ruth Perelman, left, share a moment with Dr. Denise Rubenstein and Dr. Arthur Rubenstein. patient surgery in Philadelphia and along the Northeast corridor; it will bring hun- CAM: A Groundbreaking Among the several speakers at the dreds of new jobs to West Philadelphia, and a Gift groundbreaking was John H. Glick, M.D., and we have also established local eco- Only a month after the University of director of the Abramson Cancer Center. nomic inclusion goals; and the Center Pennsylvania Health System broke sym- “As a physician who has spent 35 years will bring new luster and energy along bolic ground on the Center for Advanced caring for cancer patients, it will be my the Schuylkill River, which is now in the Medicine, it announced a gift of $25 mil- privilege, and that of my colleagues, to early stages of a dramatic transformation.” lion from Raymond and Ruth Perelman deliver the most outstanding and human- The $25 million gift to help finance the to name the new state-of-the-art facility. istic care possible to our patients in this construction and completion of the new Scheduled to open in 2008, the $232 wonderful new facility,” he said. “Our many facility continues a tradition of generosity million center, now to be called The Ray- physician leaders have worked with tal- to PENN Medicine by the Perelman family. mond and Ruth Perelman Center for Ad- ented administrators to act as advocates Since 1992, Raymond Perelman has been vanced Medicine, will house Penn’s for our patients and provide them with a president and chairman of the board of Abramson Cancer Center, radiation on- world-class building that meets their RGP Holdings, Inc., a privately held hold- cology, cardiovascular medicine, and an needs today and well into the future.” ing company that includes manufacturing, outpatient surgical pavilion in its 300,000 While patients and their families have mining, and financial interests. A 1940 square feet of clinical space. It will be lo- provided the motivation for the Center, graduate of the Wharton School, he serves cated on the corner of 34th Street and many of them have made major contri- as a PENN Medicine Trustee. Mr. and Mrs. Civic Center Boulevard, on the former site butions to its construction as well. Donors Perelman are trustees of the Raymond of the Convention Center. The Perelman to the Center also include many of the and Ruth Perelman Education Foundation, Center for Advanced Medicine represents School of Medicine’s own faculty as well Inc., which supports Jewish cultural and the largest capital project undertaken in as trustees, patients, and alumni. welfare organizations, as well as arts and the history of PENN Medicine. With shovels in hand: (middle to right) President Amy Gutmann, Madlyn Abramson, Ralph W. Muller, Dr. John H. As Arthur H. Rubenstein, M.B., B.Ch., Glick, and Dr. Larry Kaiser. executive vice president of the University of Pennsylvania for the Health System and dean of the School of Medicine, said at the groundbreaking on October 20, “We already have abundant talent and recognized national leadership at the Abramson Cancer Center. We already have exceptional programs in surgery and cardiovascular medicine. But what we haven’t had until now is a building worthy of this level of excellence.”

2 ■ PENN MEDICINE history museums and other cultural insti- tecting the effects of antidepressants on tutions. In addition, the Perelmans are chronic stress using neurogenesis. With parents to Jeffrey E. Perelman and Ronald such a model, researchers could begin to O. Perelman, both graduates of the Uni- better understand the delay in the efficacy versity of Pennsylvania who have had of antidepressant drugs and how it may distinguished careers in business and relate to changes in neurogenesis. philanthropy while maintaining close ties to the city and the University. A New “Breast Cancer Center In announcing the Perelmans’ “magnif- of Excellence” icent gift,” Rubenstein said it would “trans- The Department of Defense has named form the way medicine is practiced at Penn Penn’s School of Medicine a Breast Cancer and world-wide.” Center of Excellence. This designation, “The Raymond and Ruth Perelman which comes with a five-year grant of

Center for Advanced Medicine will be a Irwin Lucki, Ph.D. $10 million to Lewis A. Chodosh, M.D., spectacular statement of where PENN Ph.D., principal investigator and director Medicine is going in the 21st century,” “Increasingly, we are learning that certain of the center, establishes Penn as one of said Ralph W. Muller, chief executive officer areas of the brain are responsible for gen- only 14 such sites in the United States. of UPHS. “It will provide a place where erating new cells, and this renewal process The center is part of a multidisciplinary our superb health-care professionals will is causing us to reexamine the way that approach to understanding the progression practice the most advanced medicine stress affects the brain,” said Irwin Lucki, of breast cancer by using genetically en- available in a setting that is as patient- Ph.D., professor of psychiatry and princi- gineered mouse models and state-of-the- focused as it can possibly be.” pal investigator of Penn’s part of the co- art non-invasive imaging techniques. operative. As Lucki explained, stress re- “While tumor progression is a problem Penn to Lead Search for New duces the amount of neurogenesis, or cell of unrivaled clinical importance, the mech- Mood-Disorder Drugs growth, in these areas of renewal. At the anisms underlying it are poorly under- In September, the National Institute of same time, chronic administration of anti- stood,” said Chodosh, who leads the Mental Health (NIMH) awarded the School depressant drugs increases neurogenesis. Breast Cancer Program at the Abramson of Medicine $1.8 million to establish a The cooperative is seeking to identify com- Cancer Center and serves as director of National Cooperative Drug Discovery pounds that facilitate neurogenesis in cancer genetics at the Abramson Family Group for the Treatment of Mood Disor- crucial areas of the brain as a basis for Cancer Research Institute. ders. The group comprises researchers developing innovative therapies for de- Researchers at Penn’s center will employ from the Center for Neurobiology and pression. an array of sophisticated technologies – Behavior at Penn and the Neuroscience Recently, researchers at Penn and Wyeth including positron emission tomography Discovery Department at Wyeth Research examined a hormone called insulin-like (PET), magnetic resonance imaging (MRI), Laboratories, Princeton, N.J. growth factor (IGF-1) that has been shown computed tomography (CT), magnetic The aim of this collaboration between to promote neurogenesis. Brian Hoshaw, resonance spectroscopy (MRS), single- academe and industry is to develop new Ph.D., a research associate in Penn’s De- photon emission computed tomography antidepressant drug treatments based on partment of Psychiatry, and Jessica Mal- (SPECT), and ultrasound – to visualize the role of neurogenesis in regulating berg, Ph.D., a senior research scientist at and track tumor cells from their origins stress and depression. Advanced brain- Wyeth, discovered that IGF-1 produces in living animals to their eventual progres- imaging techniques show distinct shrink- behavioral effects similar to antidepressant sion to metastasis and recurrence. These age in the hippocampus and cortex, re- treatments in animal models. By examin- animal models mimic crucial features that gions known to play a role in mediating ing the way that IGF-1 and other neu- occur in humans with breast cancer. By mood and cognitive reasoning. Animal rotrophins increase neurogenesis, the re- identifying the critical molecular targets studies reveal that chronic stress leads to search team may be able to develop better and pathways by which breast cancers similar volume and cell loss in these brain antidepressant drugs. progress, the researchers hope to develop regions, suggesting a link between depres- The Drug Discovery Group is also de- more effective therapies against highly sion and stress. veloping an animal model capable of de- aggressive forms of this cancer.

2006/FEBRUARY ■ 3 Mitchell D. Schnall, M.D., Ph.D., asso- tional Children’s Study (NCS). The study tors; behavioral influences and outcomes; ciate professor of radiology at Penn, and will examine the effects of environmental genetics; cultural and family influences Ruth J. Muschel, M.D., Ph.D., professor influences on the health and develop- and differences; and geographic locations. of pathology and laboratory medicine, ment of more than 100,000 children Researchers will analyze how these elements are co-principal investigators of the grant. across the United States, following them interact with each other and what helpful The Center of Excellence, which is based from before birth until age 21. Teams and/or harmful effects they might have at Penn, includes two dozen investigators from the Vanguard Centers will be the on children’s health. By studying children at Penn, the University of California at first to recruit participants and collect data through their different phases of growth Davis, Albert Einstein College of Medicine, as part of the decades-long research effort, and development, researchers expect to McGill University, and The Children’s and investigators anticipate that close to understand the role of these factors on Hospital of Philadelphia. 1,200 families from Montgomery County health and disease better. will participate in the study. Penn was The study will also allow scientists to Penn Named Part of a Site for also awarded the contract to serve as the find the differences between groups of National Children’s Study analysis center for the NCS as part of a people, in terms of their health, access Together with The Children’s Hospital joint proposal with Westat in Rockville, Md. to health care, and other issues. of Philadelphia and Drexel University The National Children’s Study uses a “Gathering this information not only School of Public Health, the University of broad definition of “environment” that advances the state of pediatric medicine Pennsylvania has been named one of the includes: natural and man-made environ- but it will also provide possible cures six “Vanguard Centers,” or study centers, mental factors; biological and chemical and solutions to particularly troublesome that will implement the $2.7-billion Na- factors; physical surroundings; social fac- childhood illnesses,” said Donald F. Schwarz, M.D., M.P.H., M.B.A., associate professor of pediatrics at Penn and chief of adolescent medicine at Children’s Hospital. How Effective Is That Treatment? The Vanguard Centers will work with- The Center for Clinical Epidemiology amine the association between antidepres- in their communities to recruit participants and Biostatistics (CCEB) is now part of sant drugs and aspiration pneumonia in (including women who are pregnant or the Effective Health Care Program, a new the aged. Brian L. Strom, M.D., M.P.H., likely to have a child in the near future initiative within the federal Agency for the George S. Pepper Professor of Public and their families), collect and process Healthcare Research and Quality. The Health and Preventive Medicine and di- data, and pilot new research methods for program is intended to help clinicians rector of the CCEB, is the principal investi- incorporation into the full study. and patients determine which drugs and gator for the grant. According to Jonas H. Ellenberg, Ph.D., other medical treatments work best for According to Sean Hennessy, Pharm.D., professor of biostatistics at Penn and certain health conditions. Ph.D., co-principal investigator of the principal investigator for the analysis CCEB becomes part of a new network Penn DEcIDE program, “Nearly all drugs center, the NCS is unprecedented in its of 13 Developing Evidence to Inform De- are approved based on studies comparing scope and complexity. The study has been cisions about Effectiveness (DEcIDE) re- the new drug to a placebo.” Yet as Hen- in active planning for more than five search centers that will conduct studies nessy, assistant professor of epidemiology years, and several national agencies and aimed at filling knowledge gaps about and of pharmacology, explains, “What institutes have solicited extraordinary in- treatment effectiveness. It has been awarded patients and clinicians really need to know put from the scientific and lay communi- $250,000 for its first study within the is not how well the new drug works ties on issues of design, community in- DEcIDE program. Operating under strict compared with a placebo, but compared put, and ethical considerations. procedures to guarantee privacy and se- with what is already available. This lack of Experts believe that the National Chil- curity, DEcIDE centers will use “de-iden- information on comparative effectiveness dren’s Study will be one of the richest re- tified” data available through insurers, makes it very difficult to make evidence- sources of information available for answer- health plans, and other organizations to based decisions. In the years to come, the ing questions related to children’s health answer questions about the use, benefits, DEcIDE Network will play a key role in and development and will form the basis and risks of medications and other thera- addressing the need for information on of child health guidance, interventions, pies. To start, CCEB researchers will ex- comparative effectiveness.” and policy for generations to come.

4 ■ PENN MEDICINE Honors & Awards PENN Cardiovascular Institute. The award Garret A. FitzGerald, M.D., the Elmer is given at the annual meeting of the Heart Bobst Professor of Pharmacology who Failure Society of America to recognize serves as chair of the Department of research excellence in young investiga- Pharmacology and director of the Institute tors. Cash prizes were awarded based on for Translational Medicine and Therapeutics, the investigators’ abstract presentations. has won the Boyle Medal. The medal is Cappola’s was on a novel approach to an- awarded every other year by the Royal alyze cardiac gene transcription in human Dublin Society and The Irish Times to a subjects with advanced heart failure. distinguished Irish-born scientist working abroad; on alternate years, it is presented Julius Deren, M.D., professor of med- to a scientist working in Ireland. Accord- icine in the gastroenterology division, was ing to The Irish Times, research done by honored in September at the National FitzGerald “has profoundly influenced Board of Trustees Dinner of the Crohn’s the prescribing of low-dose aspirin used This year’s Jay N. Cohn New Investigator and Colitis Foundation of America. Based by millions of people around the world” Award in Clinical/Integrative Physiology at Penn Presbyterian Medical Center, he to help against heart attacks. It also noted has gone to Thomas Cappola, M.D., as- serves as medical director for the Inflam- his early warnings on COX-2 inhibitors, sistant professor of medicine and a cardi- matory Bowel Disease Network for Penn’s such as Vioxx and Celebrex, which are ologist and heart-failure specialist at the Health System. used to alleviate arthritis pain.

Penn Faculty Members Garner National Honors Four faculty members of the University * Virginia A. Stallings, M.D., professor of Pennsylvania School of Medicine were of pediatrics, School of Medicine elected to the Institute of Medicine of the * Marjorie K. Jeffcoat, D.M.D., dean of National Academies. Two other professors the School of Dental Medicine at the University of Pennsylvania were * Mary D. Naylor, Ph.D., professor of also elected, bringing Penn’s total to six gerontology, School of Nursing in this year’s list of 64 new members and In addition, three faculty members of five foreign associates. the School of Medicine were named Fel- The Institute of Medicine was established lows of the American Association for the in 1970 by the National Academy of Sci- Advancement of Science. The new Fel- ences to honor professional achievement lows will be officially inducted February Norman B. Hecht, Ph.D., the William in the health sciences and to serve as a 18, 2006, during the Association’s 2006 Shippen Jr. Professor of Human Reproduc- national resource for independent analysis annual meeting in St. Louis. tion in the Department of Obstetrics and and recommendations on issues related to The new Penn AAAS Fellows are: Gynecology, was named the recipient of medicine, biomedical sciences, and health. * Ian A. Blair, professor of pharmacology, the 2006 Distinguished Andrologist Award. The new Penn IOM members are: School of Medicine, and director of He will receive the award next spring at * Larry R. Kaiser, M.D., professor and the Center for Cancer Pharmacology. the annual meeting of the American Society chair, Department of Surgery, School * Richard L. Doty, professor of otorhino- of Andrology. of Medicine laryngology, School of Medicine, and Hecht has been one of the pioneers in * Virginia M.-Y. Lee, Ph.D., M.B.A., pro- director of Penn’s Smell and Taste Center the use of molecular biology to understand fessor of pathology and laboratory * Irwin B. Levitan, professor and chair the pathways that control spermatogenesis. medicine, Center for Neurodegenerative of the Department of Neuroscience in In addition to his prolific and ground- Disease Research, School of Medicine Penn’s School of Medicine and director breaking research accomplishments, he * Stanley A. Plotkin, M.D., emeritus pro- of the Mahoney Institute of Neurological has served the Society and the broader sci- fessor of pediatrics, School of Medicine Sciences. entific community in a variety of capacities

2006/FEBRUARY ■ 5 and has trained many students who have tional Academy of Clinical Biochemistry. Program in Public Health Studies, serves gone on to successful independent careers. Recipients of the award have made note- on the executive board of the American Hecht is serving as interim director of worthy contributions to the under- Public Health Association. Penn’s Center for Research on Reproduc- standing of the biochemistry of disease, tion and Women’s Health. the application of the principles of clini- Sandra Norman, Ph.D., F.A.C.E., re- cal biochemistry, or the important use of search associate professor of epidemiology The National Arthritis Foundation has laboratory techniques. According to the in the Department of Biostatistics and presented the Sir John Charnley Award Academy, Jarett’s major research accom- Epidemiology, received two awards in to Craig Israelite M.D., an orthopaedic plishments included his observations that October: the St. George Award of the Na- surgeon at Penn Presbyterian Medical insulin caused occupied insulin receptors tional American Cancer Society and the Center. The award, given for excellence on adipocytes to behave differently from Sword of Hope of the Pennsylvania and achievement in the field of orthopaedics, any other cells. He has had numerous Chapter of the American Cancer Society. is named for the English orthopaedic publications on insulin’s control of signal Both are considered the highest service surgeon who invented the modern total transduction. awards bestowed upon a member for dis- hip replacement in 1962. Israelite has tinguished, exemplary, and inspirational been an active volunteer with the National leadership. She is the first individual to Arthritis Foundation. According to the have received these awards together at Foundation, Israelite “graciously provides the annual ceremony. Norman is also a input on many of our programs and ac- senior scholar in the Center for Clinical tivities and has served on several com- Epidemiology and Biostatistics. mittees. Dr. Israelite has been the driving force behind the Chapter’s successful Anil K. Rustgi, M.D., chief of the di- Medical Gala.” vision of gastroenterology in the Depart- ment of Medicine, was recently appointed Leonard Jarett, M.D., Distinguished editor-in-chief of Gastroenterology. Published Professor of Pathology and Laboratory monthly by the American Gastroenterology Medicine and former chair of the depart- Association, it is considered the specialty’s ment, received a Distinguished Alumni leading peer-reviewed journal and is ded- Award from Washington University in St. Shiriki Kumanyika, Ph.D., M.P.H., icated to publishing clinical and basic Louis at its annual Founders Day celebra- professor of biostatistics and epidemiology, studies of all aspects of the digestive system. tions. Jarett, who earned his medical de- has won the first Population Research Rustgi, the T. Grier Miller Professor of gree at Washington University, was rec- Prize of the American Heart Association. Medicine and Genetics, also serves as di- ognized as a leader in diabetes research She was honored for her outstanding rector of Penn’s Center for Molecular whose work has led to advances in un- contributions to the advancement of car- Studies in Digestive and Liver Diseases. derstanding how insulin is internalized diovascular science while serving as head Several other members of Penn’s medical in the cell nucleus. Before coming to Penn of an outstanding laboratory studying faculty have been named to Gastroenterol- in 1980 as chair of the Department of cardiovascular population research. She ogy’s editorial board as well. Pathology and Laboratory Medicine, Jarett has also received the 2005 Dr. Herbert served as the first head of the Academic W. Nickens Epidemiology Award from Division of Laboratory Medicine in the Association of Black Cardiologists, Washington University’s departments of Inc. (The award is named after the late Pathology and Medicine and as the first Herbert Nickens, M.D. ’73, G.M.E. ’84, full-time director of Barnes Hospital Di- former director of the Office of Minority agnostic Laboratories. At Penn, he has Health in the Department of Health and been chairman of the clinical practices Human Services.) Kumanyika, who is and assistant dean of faculty affairs. also associate dean for health promotion This fall, Jarett also received the Dis- and disease prevention in the School of tinguished Scientist Award from the Na- Medicine and director of the Graduate

6 ■ PENN MEDICINE Steven A. Thomas, M.D., Ph.D., as- Penn Student Wins Basic Genetics Research Award sociate professor of pharmacology at the Nuo Yang, a Ph.D. student in the lab- City, where she delivered a talk entitled University of Pennsylvania, received an oratory of Haig H. Kazazian Jr., M.D., “Antisense transcript suppresses human honorable mention from NARSAD, a na- chair of the Department of Genetics, has LINE-1 retrotransposition via an RNAi tional organization that funds scientific received the Predoctoral Basic Research mechanism.” Yang was recognized for her research on brain and psychiatric disor- Award from the American Society of Hu- research on transposable elements (trans- ders. He was praised for his research on man Genetics. She received the award at posons). Commonly known as jumping the role of the neurotransmitter norepi- the society’s annual meeting in Salt Lake genes, transposons can move from one nephrine in the development of depression chromosome to another or within the and in the action of antidepressant med- same chromosome. One category of ications. Thomas received NARSAD Young transposons is called LINE-1s (L1s), Investigator grants in 1999 and 2001. which make up 17 percent of the human genome. “My Ph.D. study is focused on Two members of Penn’s medical fac- the regulation of the jump, what makes ulty were elected Fellows in the Ameri- L1s jump or not jump, and the effect on can Academy of Microbiology: Craig B. the genome,” explains Yang. Transposons Thompson, M.D., professor and chair of can trigger evolutionary changes in the the Department of Cancer Biology, and human genome and are associated with Jeffrey N. Weiser, M.D., professor of mi- several types of human diseases, includ- crobiology and of pediatrics. They were ing hemophilia A, beta thalassemia, and elected in recognition of their scientific retinitis pigmentosa. achievements and original contributions Yang and Kazazian that have advanced the field of microbiology.

LETTERS

WOMEN IN ACADEMIC told the Mead Johnson rep that we needed helped other children. Keep up the good MEDICINE head circumference charts for children work. My copy of Penn Medicine just arrived beyond the age of 3 years, the cut-off at and I read your article on women in medi- that time. Eighteen months later I received Ruth Abrams Dillard, M.D. ’51 cine [“A Matter of Potential,” by Linda Bird a letter from the company thanking me Boone, N.C. Randolph, Summer 2005] with great infor the input and several copies of the terest. I am a graduate of the Class of 1951. “new” head charts from 3 to 18 years of REACHING POTENTIAL? Unexpectedly, I wound up in academic age. I also wrote a letter about two siblings I was an NIH “Special Fellow” in Mol- medicine when my husband of the same who had had an unusual reaction to the ecular Medicine, 1966-68, in [Penn’s] class decided to go into OB-GYN at U.N.C. pertussis portion of DPT immunizations, Department of Medicine with Dr. George By that time I already had two children one of shock and weight loss, etc. It was Ludwig. and had to support the family. Gradually nowhere in the literature. Now it is listed Penn Medicine is “very well done” and I worked up to an associate professor at as a regular warning of such vaccine. I it is a pleasure to read – very informative – the University of Texas Medical Branch in should have researched and published regarding programs, research, and col- Galveston. I never made full professor both of those ideas but no one mentored leagues. Kudos. because the demands of work and of home me or suggested such a thing or helped The article “A Matter of Potential” was left me no extra time to do the research in any way. It was only in retrospect that superb – I was one of the 9% of women even to write up the material which I I realized my errors. who became a full professor, which is could have used to publish articles. I am delighted to know that you have now about 12%. I do not regret my decision to give time such a program [FOCUS on Health & to my family. I do know that others have Leadership for Women] to help women Doris Bartuska, M.D., G.M.E. ’68 reaped the benefit of my knowledge and academicians to get ahead. At least I know Allegheny University of the Health Sciences observations. I am a pediatrician. I once that my thoughts and observations have

2006/FEBRUARY ■ 7 8 ■ PENN MEDICINE THE SCHOOL OF MEDICINE’S GLOBAL HEALTH PROGRAMS PROVIDES INTENSE, HANDS-ON, INTERNATIONAL EXPERIENCES THAT PARTICI- PANTS WILL NEVER FORGET.

TBy Linda Bird Randolph

omething is fundamentally wrong with the traditional way American medical S students are taught about international health, claims Neal Nathanson, M.D. Attending lectures and viewing slide-show presentations that depict health-care challenges in other countries does have some educational benefit, says Nathanson. But he asserts that the best way to introduce students and trainees to a global health experience is to immerse them in a health-care environment far away from the ivy- covered walls of University City, Philadelphia. “When you’re in a classroom in Philadelphia, you don’t know what is going on in Botswana, no matter how descriptive the lecture,” says Nathanson, who serves as associate dean for Global Health Programs at the School of Medicine. “The only way to understand Botswana is to go there and immerse yourself in that situation.” That is exactly what GHP was able to help Adriana Izquierdo do in the spring of 2004. Izquierdo, who graduated this year, spent six years completing her medical degree while also earning a master’s degree in epidemiology and biostatistics. What she witnessed in Botswana, she says, was “a sense of hope and optimism, in spite of really tough conditions. For example, the AIDS/HIV rate there is 40 percent, and very young adults are dying daily of disease and inadequate resources.” Nothing quite prepared Izquierdo for the culture shock she experienced in Botswana. “I grew up speaking Spanish, learned English in school, as well as French and

Photographs of individuals by Addison Geary

2006/FEBRUARY ■ 9 German, so it was the first time I was in a place where I couldn’t communicate with the people in a fluent fashion. I think it was also tough working in a hospital that didn’t count on the same technical, medical, and clinical resources as we are accustomed to having here at Penn, or anywhere in the United States for that matter. Talk about health disparities! So it was hard.” Under Nathanson’s direction, Global Health Programs, started in July 2004, coordinates the school’s global activities and supports the international aspects of Penn’s research, educational, and service programs. Through the international rotations GHP arranges, medical and postdoctoral students can gain the direct exposure to international medicine they are seeking. At the same time, the program also hosts international medical students at Penn and recruits postdoctoral fellows who come from international institutions. Like Izquierdo, many of the Penn students experience the reality of health disparities when they take their rotations in poorer nations, but many of them are also inspired to try to do something about the matter. “Today’s students are into different types of things and quite a number of global health things,” says Gail Morrison, M.D. ’71, G.M.E. ’77, vice dean for education for the School of Medicine. “We are all starting to truly realize that the world is much smaller than we anticipated. About five years ago, it became apparent that interest in global health issues was increasing. In fact, many students are now displaying an interest in international health issues as undergraduates.”

A New Office but a Long Tradition For Nathanson, associate dean of Global Health Programs is a new role for a long- time University citizen. From 1978 to 1994, he served as chair of the Department of Microbiology at Penn, then became vice dean for research and research train-

10 ■ PENN MEDICINE Top: Neal Nathanson, M.D., a long-time ing for the School of Medicine. He left And until the 1940s, the school operated a Penn faculty member, now serves as associate dean for Global Health Programs. Penn to head the Office of AIDS Research medical school in Shanghai, known as the Bottom: Steven C. Larson, M.D., assis- at the National Institutes of Health. In Pennsylvania Medical School at St. John’s tant dean, has long been a champion of global medicine. 2000, he was drawn back to Penn as the University, founded by Josiah McCracken, University’s vice provost for research. He M.D. 1901. assumed his current position last year. Global Health Programs, in fact, was In addition to Nathanson, the staff for not the first international health pro- the evolving operations of Global Health gram at the School of Medicine. The Programs includes Steven C. Larson, M.D. Office of International Programs was ’88, assistant dean; Nancy Biller, M.A., formally closed in July 2003. After a M.P.H., administrative director; and ad- “transition year,” during which Nathanson ministrative coordinator Valerie Sica. Larson was recruited from his position as vice comes to the post with a substantial amount provost of research at the University and of experience in global medicine. He helped a new staff was put together, GHP was establish Frontline Medicine, a program ready to open. at the School of Medicine created to pro- “We’ve never made any real attempt to vide medical students, residents, and fac- figure out what wasn’t working. We simply ulty members with the opportunities and started from scratch,” says Nathanson. “But resources to examine and study critical what we are doing seems to be working.” issues in the area of global health. He has The earlier office, set up about 15 years also been a faculty advisor for students in ago, had a number of highlights, opening the Global Health Interest Group. channels with foreign medical schools “There is a national upturn in interest in Latin America, the former Soviet on the part of medical students on global Union, and the People’s Republic of China. health, whatever that means to them,” says Dr. Storey, who had directed the Office of Nathanson, who added that the definition International Programs and who speaks can vary from school to school and person Russian, was particularly accomplished at to person. bringing physicians and medical students More students request an elective in from Russia to Penn for training they which they are sent to another country, would not get in their own country. and few schools across the country have In Larson’s mind, the major difference formal set-ups to assist them in doing between the two similarly oriented pro- this. Things are likely to change. grams is “philosophical.” The Office of In April, Nathanson gave a presentation International Programs, he feels, put less at “Penn Preview” week, an event for emphasis on a “hands-on, in the field” medical-students-to-be who have been experience. Global Health Programs, he accepted at Penn but may not have made continues, has sought “to provide all stu- their minds up yet. In a one-hour pres- dents the opportunity to explore global entation on global health, nearly all re- health through an ‘in country’ experience sponded when he asked them to show that highlights the realities of work within their interest by a show of hands. the confines of limited monies and re- Throughout its history, Penn’s School sources.” of Medicine has had an international bent. From its earliest days, graduates of the The Timing of Non-Traditional school often traveled to Edinburgh and Electives elsewhere in Europe for the equivalent of “Medical students have limited oppor- graduate studies, according to Patrick B. tunities to enhance their exposure to in- Storey, M.D., emeritus professor of medicine. ternational health issues,” says Nathanson.

2006/FEBRUARY ■ 11 “Penn’s current curriculum is designed so that there are two windows of opportunity to take on independent electives that are not part of their required curriculum.” These opportunities take place over the summer between the first and second year, and then again during the last 18 months of the medical school curriculum, when a student may be able to carve out three months or more to add on an elective that is not required for graduation. Considering the current situation, says Nathanson, “students don’t have enough time to get deeply into something of interest. Medical students are overwhelmed by intensive curriculum.” To address this problem, Nathanson and his staff have carefully constructed a Global Health Programs elective that is non-traditional in every sense. “Participation in Global Health Programs is not for credit, there are no exams, there is no required reading,” says Nathanson. “There are no papers, no lectures to sit through, and so forth. Our goal is to immerse students in an international setting.” At the same time, there is no formal Through Global Health Programs, Neil Gupta has worked in clinical, laborato- credit for those GHP rotations. ry, and community settings in Brazil, South Africa, and Senegal. Another challenge for international initiatives is the limited funding. Students who take part in a Global Health Programs has become such an important issue with terest in rotations is up.” In 2004, GHP elective receive assistance with their out- respect to medical education means that sent 50 students abroad; last summer it of-pocket expenses. The money to subsi- we need to heighten institutional aware- was 75. dize their efforts is raised through private ness and prioritize fund-raising efforts to Opportunities for the program’s partic- foundations, not through the School of support the mission.” ipants abound, including those in about Medicine. A primary provider of support 30 different countries, including Botswana, is the Measey Foundation. A Rotation, Not a Vacation Ghana, South Africa, India, Central As Larson puts it, “The greatest challenge At first glance, taking a summer off to America, Guatemala, and Peru, and in that I see facing GHP at Penn is funding. travel to an international setting to learn industrialized countries such as Austria, Interest in global health is a nationwide about foreign health-care sounds almost Belgium, England, France, Ireland, phenomenon that many of my colleagues like a vacation. But students who have Japan, Netherlands, and Scotland. at other institutions such as Harvard, finished Global Health rotations report Through Global Health Programs, Neil Hopkins, Yale, etc., have observed. Un- that the work they did while traveling in Gupta, now a second-year medical student, fortunately, we all struggle for the same the program was the toughest they have worked in clinical, laboratory, and com- ‘piece of the pie’ with respect to grants ever done. munity settings in Brazil, South Africa, and available dollars from programs like “No one site can take more than two and Senegal. “The most significant chal- the Fogarty, the Gates Foundation, and or three students at any given summer,” lenges that I faced,” he says, “were in cre- others. The simple fact that Global Health says Nathanson. “But demand and in- ating and defining my role in each of the

12 ■ PENN MEDICINE Haitian immigrants – often lack the structural safety nets that are available to most poor people in this country.” In the Botswana hospital where she spent her rotation, reports Adriana Izquierdo, “There were beds on the floor and scant supplies.” She found it emo- tionally challenging to deal with so much advanced disease and death. “Morning report always started with the death count,” she says. “Two to 10 people had usually died the evening before. It was sobering.” One of the main things Izquierdo learned was to “draw bound- aries” and protect her own self and health, “or else you could easily go crazy.” “But somehow people managed,” says Izquierdo, “and the nurses were an inspi- ration and a source of strength and en- couragement.” Gupta, Harris, and Izquierdo are among many students who, through GHP, have a strong taste of what health care in other countries can involve. And that’s exactly what Nathanson would like to see. “The vision behind Global Health Programs – or at least my vision – is that we become Julian Harris conducted research in the Dominican Republic on how HIV patients were adhering to anti-retroviral medicines. successful at giving the student some interest in seeing life in other countries, particularly developing countries, with communities I have worked in, profes- ond-year student, was taken aback by the the idea that this might be something sionally as well as socially, and then social and economic conditions he en- they would want to do on a career basis.” maintaining the energy and enthusiasm countered while conducting research in According to Larson, interest in global to execute that role effectively.” the Dominican Republic. He was there to health both at Penn and in institutions “I have learned to keep a proper per- study how HIV patients were adhering to across the nation “has risen off the spective on challenges that I might face anti-retroviral medicines. charts” in the last three or four years. in the future,” he adds. “The people I “I learned that in countries where HIV “Students are arriving in their first year have worked with are chronically under- is still highly stigmatized, providing peo- with a very sophisticated understanding served and under-resourced in health ple with access to medications is one of of global health and, at the very least, a care, education, housing, and economic the best ways to decrease the stigma and working knowledge of the vocabulary – opportunities. I have learned not only to to promote HIV testing and prevention,” sustainability, non-governmental organi- make the very most of what is available, says Harris. zation, etc.” As a board member of the but to always continue to struggle for In addition, the disparity in income in Global Health Education Consortium, basic human and civil rights. The people the Dominican Republic “is much more a national group, Larson feels safe in I met had a profound appreciation for stark than in the U.S,” Harris notes. “The saying that Global Health Programs at what is already around them, what they wealthiest Dominicans live as well as the Penn “is one of the most organized love and enjoy.” wealthiest Americans, but poor people in and sophisticated in existence at a U.S. Like Gupta, Julian Harris, another sec- the Dominican Republic – many of them medical school.”

2006/FEBRUARY ■ 13 sible to combine experiences abroad with experiences locally. As a result, students can gain greater insight into the reality that poverty, lack of access, and health disparities do impact the health of those in our local communities and throughout the rest of the world.” The goal, she adds, is “to give students tools to be future leaders committed to improving the health of populations here or abroad.” This kind of initiative seems very much in tune with two of the three components of the Penn Compact, articulated by Amy Gutmann, Ph.D., the University’s president, at her inauguration in October 2004. One principle is the better integration of knowledge. As she put it, “The most challenging problems cannot be addressed by one discipline or profession. We cannot understand the AIDS epidemic, for exam- Nancy Biller, M.A., M.P.H., is GPH's administrative director. ple, without joining the perspectives of medicine, nursing, and finance with Other Global Health Features the transition from being a graduate stu- those of biochemistry, psychology, sociol- In collaboration with the School of dent to being an independent researcher, ogy, politics, history, and literature.” Nursing, the School of Social Work, and which is what is supposed to happen.” Another principle of the Penn Com- the Wharton School, the School of Medi- He cites a real shortage of commensu- pact is “to engage locally and globally. . . . cine has introduced a number of other rate opportunities for people who earn Through our collaborative engagement elective courses in order to create a Glob- their Ph.D. degrees in European counties. with communities all over the world, Penn al Health educational track for those with “Many do not have anywhere near enough is poised to advance the central values of specific career interests in this area. opportunities once they get their Ph.D., democracy: life, liberty, opportunity, and Not only does Global Health Programs and they are ending up as taxi-drivers. mutual respect.” “outsource” medical talents to other coun- That’s going to be a disaster for European According to Nathanson, “We are not tries for rotations, it also works to attract science.” Penn, he asserts, can help in trying to train anyone in public or global postdoctoral students from other coun- that area, “because we have an abundance health.” Instead, he says, “We are trying to tries and bring them to Penn. of opportunities.” give them a flavor of what is out there with As Nathanson puts it, Global Health Global Health Programs has also teamed the idea that if they are interested, they Programs is trying to send the message with Penn’s Bridging the Gaps program would go get additional training later on.” that, although other medical institutions to create a Global Health Scholar Track. “I felt strongly – and I think the stu- offer mentoring, there are very few that Bridging the Gaps provides interdiscipli- dents also agreed – that simply giving have Penn’s comprehensive training pro- nary health-related service in underserved students formal lectures about global gram for postdocs in global health. “I feel communities while training health and health is not enough,” Nathanson says. that Penn has maybe the best postdoc social-service professionals who are re- “Through our programs, we’re trying to program in the country,” he says. It is not sponsive to community needs. For med- give them an experience that will show just the individual experience in the lab- ical students, explains Lucy Wolf Tuton, them what it’s about. A small portion of oratory, he explains, “which would be Ph.D., executive director of Bridging the them might make international health a similar to those in other institutions, but Gaps, the collaboration “will offer students career goal, but the experience is valuable this is a program that helps people make a menu of opportunities that make it pos- to every medical student.”

14 ■ PENN MEDICINE Two faculty members urged GIVING Pennsylvania lawmakers to TESTIMONY support stem cell research. By John Shea

n September, about a dozen members of the Commonwealth’s House Democratic Policy Committee came to the School of Medicine to hold a public hearing on one of the most controversial matters Iin biomedicine: stem cell research. They were there to hear from experts and advocates from a variety of institutions and organizations. Given the range of those who testified – from a senior fellow at

the conservative Family Research Coun- Nicole Gaddis cil to the chairperson of domestic affairs for Hadassah to a Penn oncologist Nations, Caplan was eager to provide a Caplan also sought to address another who has worked with stem cells – it global context. There are, he said, “a lot crucial question: What is an embryo? “Some was not surprising that they heard of countries that have committed to do people sincerely believe that an embryo is different views. this work” – among them Singapore, India, a person,” he said. On the other hand, he The meeting was held in the auditorium the U.K., and Australia. Such nations have likened it to an acorn, with the potential of Biomedical Research Building II/III, itself what Caplan called “a permissive or flexible to become an oak. Many embryos are a monument to Penn’s commitment to policy” on embryonic stem cell research, yet “miswired or misprogrammed” and thus innovative research like the topic of the all have continued to ban human cloning. do not fully develop. Using a more elabo- day. Television cameras from the Pennsyl- According to a slide Caplan showed, the rate metaphor, Caplan suggested that if vania Cable Network (PCN) were posi- world as a whole believes in the value and there were a fire at a Home Depot, “we tioned near the stage to film the proceed- importance of embryonic stem cell research have lost the ingredients” for houses, not ings, and large screens were available to “and rejects adult stem cell research” as the houses themselves. What Pennsylva- show slides. First to speak was Arthur H. an alternative or finds it inadequate. nians have to do, he said, is balance the Rubenstein, M.B., B.Ch., executive vice The policy of the Bush administration loss of potential with “real needs” of “real president of the University of Pennsylvania is that federal funds would be available persons,” such as those in wheelchairs, for the Health System and dean of the only for 60 existing stem cell lines. Caplan those with damaged hearts, those with School of Medicine. After welcoming the argued that there are at most 20 viable Parkinson’s disease. committee, he asserted that stem cell re- cell lines out of those 60, an insufficient During the question-and-answer period search is “an extraordinarily important amount for scientific research. California, that followed Caplan’s remarks, Rep. Richard area” that intersects medical practice and he said, has indicated that it will fund Grucela (Northampton), said, “with all science. He cited the “vast constituency” at stem cell research ($3 billion over ten due respect,” that he hoped Caplan would PENN Medicine that has a stake in the issue. years). Caplan asked, is the Common- find a better metaphor for human life The first expert to testify was Arthur L. wealth ready to tell its scientists that than Home Depot. Rep. Dan B. Frankel Caplan, Ph.D., chair of the Department of they will not be able to do the necessary (Allegheny) appeared more sympathetic Medical Ethics and director of the Center clinical trials in Pennsylvania? Or that to Caplan’s argument. While noting that for Bioethics. Having chaired a panel on its citizens will have to go overseas for “I would assign some value to an embryo,” cloning and stem cell research for the United such trials? he emphasized that he would choose

2006/FEBRUARY ■ 15 saving the life of “a productive human being” over a “potential” life. The issue of adult stem cell research was pursued by several of the state representatives, who appeared sensitive to the EMERSONIAN notion that no embryos would have to be VIEWS

“So the question that faces us in the Commonwealth is not whether embryonic stem cell research is going to be done, it is where it’s going to be done. . . . Are we prepared to fall behind? . . . Are we prepared to say that if people make breakthroughs in other countries for diabetes or Parkinsonism or cancer, that they Following are excerpts from the state- As a young medical student 30 years can’t bring them here? . . . Are we ment prepared by Stephen G. Emerson, ago, I was fascinated by the miracle of prepared to tell Pennsylvanians to M.D., Ph.D., for the House Democratic human development, in which a fertilized go overseas or to California if they Policy Committee during its hearing egg divides thousands of times, each time want to get into clinical trials?” on stem cell research. Emerson is a sending signals to the daughter cells to form professor of medicine, chief of the di- perfectly functioning tissues and organs – Arthur L. Caplan, Ph.D. vision of hematology-oncology, and as- in just the right pattern. We now know sociate director of clinical research for that this process is based on the creation, destroyed to produce adult stem cells. In Penn’s Abramson Cancer Center. expansion, and tightly controlled growth fact, Rep. Thomas A. Tangretti (Westmore- and education of master cells called stem land) claimed that the stem cell research tem cell biology – that is, the cells. Moreover, the medical research com- program at the University of Pittsburgh, study of how stems cells are pro- munity is now coming to realize that this where the committee had visited in August, duced, grow, and work in both process of stem cell recruitment and de- was focused entirely on adult stem cells. animals and humans – is now velopment continues throughout life and “From an ethical standpoint,” asked Tan- Smoving to become the central is responsible for every aspect of human gretti, shouldn’t Pennsylvania explore the paradigm in American biomedicine, influ- health and disease. When brain tissues are promise in adult stem cells? In response, encing the way we think about injury and crippled by suddenly blocked cerebral Caplan noted adult stem cell research healing, disease and healing, prevention, arteries, they call out to the bone marrow may not work, and it would be better “to diagnosis, and healing. The impact of stem to create and mobilize neural stem cells, see the chips put on all the numbers.” cell biology is being felt in every area of in an attempt to repair the damaged brain Penn’s second expert, Stephen Emerson, medicine, research, and biotechnology, from tissue by actually recreating its intricate M.D., Ph.D., had a more forceful response. spinal cord injury and repair to diabetes, pattern of neural networks. And when He has found that adult stem cells lack from heart disease to breast cancer. On oncologists diagnose breast cancer or the regenerative power of embryonic behalf of our patients and our citizens, we leukemia, they are detecting the tip of the stem cells. “There is a one in a million here in Pennsylvania have the opportuni- lethal iceberg, the core of which is a tiny chance that [adult stem cells] can con- ty to contribute to, lead, and take advan- population of cancerous stem cells. To cure tribute at all,” he said, adding: “It is true tage of the next generation of discoveries the patient, we now know that we must in a dish, you can see some cells grow,” and advances in stem cell research. It is find, hunt down, and selectively remove but outside a dish, adult stem cells have therefore essential that we make every effort or kill this nest of malignant stem cells. not worked. to create the legal, political, and economic Discovering the language of stem cells, Emerson, who is a professor of medicine, climate that will foster stem cell research and the secrets of its translation, will make chief of hematology-oncology at HUP, and in our Commonwealth. clear much that has previously been un-

16 ■ PENN MEDICINE associate director of clinical research for Penn’s Abramson Cancer Center, described himself as a stem cell biologist who has worked with adult stem cells and embryonic stem cells “all my life.” He also noted his knowledge of what has been published and reviewed in the field, explaining that he has a sense of “what is done and what can be done.” Emerson emphasized that medicine is in the midst of a paradigm shift – “everything will be recast in the stem cell mode.” For example, without understanding stem cell biology, “we won’t cure cancer.” In the future, doctors may be able to give a stroke victim a drug that will regenerate his brain cells. Furthermore, said decipherable. How do you repair heart ogy companies targeted to develop new Emerson, scientists need to work with em- muscle damaged by heart attacks? Deliver stem cell based diagnoses and treatments bryonic stem cells to understand adult the right stem cell population to the dam- will follow. I had the opportunity to develop stem cells. Emerson’s figures on the stem aged tissue, at the right time, with the right one of the first stem cell biotechnology cell lines that are currently available for hormones to instruct the cells to form heart companies, Aastrom Biosciences, and research were even lower – and bleaker – muscle. How do we prevent the crippling I think the lessons are useful. Aastrom than Caplan’s: “17 non-infected lines that blindness of diabetes? Prevent blood vessel was based on science discovered at the are aging.” stem cells from rushing headlong into the University of Michigan, out of a collabo- Like Caplan, Emerson also spoke to the diabetic eye, forming new, chaotic blood ration between the schools of Engineer- matter of economics. “In Philadelphia, vessels that bleed and clog. . . . ing and Medicine. . . . Several years later, biomedicine is our main engine for the We must support embryonic stem cell Aastrom now is fully independent, em- economy,” he said, adding, “it would be research as well as studies of adult stem ploys 70+ scientists and other employees, an enormous, enormous mistake” not to cells, because it is embryonic stem cells and conducts clinical trials in bone repair support embryonic stem cell research. If that we know have the ability to create all and cancer therapy around the world. the state did not, there would be a negative tissues. Having studied adult stem cells The State of Michigan has already reaped impact on the next generations of local for over 20 years, it is clear that adult stem substantial rewards from their support of scientists as well. He referred to Penn’s cells do not normally regenerate tissues this venture, and the company is still achievements in research, but argued that as do embryonic stem cells, and diseases very young. it would be difficult to recruit young sci- like cancer have distinctive embryonic Needless to say, not supporting stem entists who could go to institutions in stem cell features that we need to solve. cell research puts our biomedical enterprise states or nations that supported stem cell Unless we can unlock and harness the at great risk. We will not sustain, let alone research. And when Rep. Babette Josephs secrets of embryonic stem cells, trying to expand, the biomedical economy so vital (Philadelphia) raised concerns about the achieve our health goals with adult stem to our Commonwealth’s interests. We role of corporations that might be interested cells only will be severely hampered. will not retain, let alone attract, the best only in “the profit line,” Emerson replied These diseases are powerful villains, and researchers and physicians who want to that the nation needs “open research” on we cannot fight them without the coordi- study stem cells, develop and utilize new stem cells – in universities. nated use of our best weapons. . . . stem cell technologies and treatments, Rep. Josephs has introduced a bill in I do want to underscore the impact of and the obvious economic benefits that the Pennsylvania House that would au- stem cell research on the economy of our will follow. And most of all, we will not thorize research in the state on “human Commonwealth. Not only will current be providing the citizens of Pennsylvania embryonic stem cells, human embryonic hospitals, schools, and industries be sup- with access to the best medical research germ cells, and human adult stem cells ported, but, in addition, new biotechnol- and the best care which they deserve. from any source.”

2006/FEBRUARY ■ 17 18 ■ PENN MEDICINE ( UnquietSLUM ( ERS BBy Martha Ledger

As they treat thousands of troubled sleepers a year, clinicians and scientists at Penn are learning more about the mysteries of sleep.

ometimes you just get lucky. In 1995, reporter George Beschen was assigned to write a story for HUPdate that saved his life. The piece was about the Penn Sleep Center and focused on obstructive sleep apnea, because the disorder accounted for 70 percent of patient visits. Beschen witnessed an overnight sleep Sstudy and also interviewed, among others, Richard J. Schwab, M.D. ’83, G.M.E. ’88, now associate professor of medicine, who ticked off a list of risk factors for sleep apnea that included a neck size of 17 inches or greater. Beschen, who is as fascinated by numbers as by words, was struck that the figure was so specific. Five years later, when he was 30, Beschen started to feel really tired. “I’d been tired before,” he said, “but this was something entirely different. I couldn’t keep my eyes open at meetings, and I started thinking this is what it must feel like to be old.” He fell asleep once sitting at his desk at work; another time, when he was driving his sister home from the Jersey shore, his eyes started to close and his car momentarily swerved off the road. Beschen had put on 30 pounds since 1995 and now weighed 230 pounds. He snored

heavily, and his neck size grew to 17 1/2, then 18. The numbers triggered recollections of Dr. Allan I. Pack, director of the Center his sleep apnea article, and, thinking he might have the disorder, he tape-recorded his sleep. for Sleep and Respiratory Neurobiology “It was like learning I was a werewolf at night,” Beschen says. “I was making sounds I didn’t know I was capable of. I was very clearly gasping and wheezing. Hearing myself choke was bad enough, but then not hearing anything at all was even scarier.” He arranged for a sleep study and, on a Tuesday night in March 2000, checked into the Penn Sleep Center. * * * Sleep apnea remains the most prevalent disorder treated at PENN Medicine’s sleep clinics, still accounting for 70 percent of all patient visits. According to Charles R. Cantor, M.D., clinical assistant professor of neurology and medical director of the center, the clinics’ total number of patients has risen 30 to 40 percent annually since 2001, and this year they will see close to 3,500 people with sleep apnea. Given the current obesity epidemic and given that obesity is a risk factor for sleep apnea, this figure should continue to climb. Almost everyone currently diagnosed with this disorder, as well as those in the foreseeable future, will receive a mechanical treatment invented 25 years ago. It successfully controls the disorder but does not seem particularly on the cutting edge when compared to the new surgical techniques and breakthrough drugs used to treat disorders in other specialties.

Photographs by Maureen Helwig, except where noted.

2006/FEBRUARY ■ 19 Yet what has advanced in sleep medicine – and dramatically so – is an understanding not only of sleep apnea, but also of the related mechanisms of normal sleep and wakefulness. Pioneers in a specialty that was recognized only a decade ago by the American Medical Association and only two years ago by the Accreditation Council for Graduate Medical Education, Penn researchers have illuminated both the specific problem of sleep apnea and the fundamental questions about the nature and function of sleep. In just the past few years, their discoveries have opened up new areas for investigation that will likely lead to new and improved treatments. The motor for this collaborative machine is a research entity called the Center for Sleep and Respiratory Neurobiology (CSRN). The first of its kind in the country, it was founded in 1991 when William N. Kelley, M.D., then the dean of the School of Medicine and CEO of the Health System, was actively promoting multidisciplinary centers. Its 45 or so current members include physicians who work at the Penn Sleep Center, clinical and basic science researchers in the Divi- sion of Sleep Medicine, and clinical in-

vestigators from associated medical spe- Dr. Richard J. Schwab can predict sleep apnea as quick as a wink. cialties like cardiology, genetics, and neuroscience. In addition, the CSRN serves as an umbrella for basic science researchers SCREENINGS from various University schools and departments who are studying sleep behav- Richard J. Schwab, M.D. ’83, G.M.E. ’88, structures that form the upper airway. iors or sleep chemistry. The research unit associate professor of medicine, can look Schwab can also make an accurate also provides lecture series, seminars, re- in my mouth and pretty well predict prediction without the peek inside — treats, compilations of abstracts for inter- whether I’ve got sleep apnea. He’s not so and in 30 seconds or less. “You use four national dissemination, mentoring for sure other doctors can because, except features: two physical findings and two students, trainees, and young faculty perhaps for a single lecture, medical questions,” he says. “The physical find- members, and opportunities for joint sci- schools do not teach students how to ings you can determine in an instant: Is entific projects. It is one of only three screen for the disorder. He was never the patient overweight? Does the patient Specialized Centers of Research in Neu- taught how, yet he believes it takes just a have a receding chin -- retrognathia? As robiology of Sleep and Sleep Apnea fund- little practice. Of course, he has done soon as they’re inside the door, you have ed by the National Institutes of Health.. such screenings for his whole clinical this information. In varying combinations, CSRN mem- career and has carried out research that “And then you ask them two ques- bers have published the findings of hun- involved volumetric measures of the tions. Do they snore? And are they sleepy

20 ■ PENN MEDICINE dreds of successful studies and, in the area of sleep apnea, have developed in- struments currently in use worldwide. These include the Functional Outcomes of Sleepiness Questionnaire, the Multi- Variable Apnea Prediction Index, and screening strategies that have been used on commercial drivers. Joan Hendricks, V.M.D., Ph.D., the Henry and Corinne R. Bower Professor of Small Animal Medicine and section chief of critical care in Penn’s School of Veterinary Medicine, described the only natural animal model of obstructive sleep apnea — the English bull- dog. She also showed that the rest state of the fruit fly (Drosophila melanogaster) is analogous to mammalian sleep, providing the entire field of sleep research with a model organism for molecular and genetic studies. The director of this synergistic enterprise is Allan I. Pack, M.B., Ch.B., Ph.D., professor of medicine, chief of the Divi- sion of Sleep Medicine, and director of the Center for Sleep and Respiratory

during the day? If you have positives body size, age, and gender, and it now in on a minimum of two of the four, you use worldwide. should ask more questions related to Whatever the tool of choice, Schwab em- sleep apnea and potentially think about a phasizes that screening is important, be- sleep study.” cause sleep apnea is widely underdiag- A more comprehensive survey for nosed, especially in patients with diabetes, determining who is likely to have sleep hypertension, coronary disease, and stroke. apnea was developed by Greg Maislin, “Often patients feel like they’ve had a M.S., M.A., adjunct assistant professor of brain transplant after they’re treated for statistics in the Division of Sleep Medicine. apnea,” Schwab says. “It’s one of the few Called the Multi-Variable Apnea Predic- diseases you can actually treat, one where tion Index, it makes its calculations you can actually make a big difference.” based on a combination of symptoms, — Martha Ledger Dr. Charles R. Cantor

2006/FEBRUARY ■ 21 Neurobiology, whose own work reflects the diversity of the center: “I do basic research. I do molecular mechanism of sleepiness. I do patient-oriented research, and I see patients.” The focus of his career, however, has been sleep apnea. The disorder has been on the medical radar screen for a relatively short time. In fact, writers, not doctors or scientists, first took note of it. World literature has many examples of overweight characters who snore their heads off at night and are dead-tired during the day. Pack is fond of Skrymir, a giant from a 13th-century Ice- A CPAP (continuous positive air pressure) device at work. landic saga, whose nighttime snoring wakes the whole forest and whose daytime sleep few seconds or more than a minute. The tional Sleep Foundation, roughly 5 percent is so profound that he scarcely feels mal- sleeper awakens, breathes, and falls asleep of adults and 2 to 3 percent of children let blows to the head. again, and the cycle repeats itself, poten- have it. It is often linked to obesity, but A better-known example is Joe, the red- tially for hours. Sleep specialists estimate anatomical features such as a large tongue, faced fat boy who falls asleep chewing a that people with sleep apnea can lose as oversized tonsils, or a recessed chin can mouthful of pie in Dickens’s 1837 novel much as a third of their nighttime sleep. be risk factors, too. It even afflicts people The Pickwick Papers. In fact, Pickwickian Even if they spend a proper number of who seem in good condition, like athletes. syndrome — described as the combina- hours in bed at night, they’re exhausted In a study of 300 NFL players published tion of obesity and daytime sleepiness — the next day. in the New England Journal of Medicine in was the name originally given to sleep No wonder, then, that sleep apnea can 2003, 14 percent were found to have sleep apnea. Dickens, however, did not portray make daily life a struggle. “The sleepiness apnea; within that group, 34 percent of its most medically significant attribute: is so intense,” Pack says, “it makes people the linemen, who are generally the bulkiest the breathless silences that occur between do crazy things just to stay awake.” One players on the field, had the disorder. (Sleep the snores. C. S. Burnett, the researcher of his patients reported applying ice to apnea is thought to have played a role in who named the syndrome in 1956, missed himself while driving. Sleep apnea also the premature death of Reggie White, former the mark even more. He studied patients increases a person’s risk for hypertension, defensive end for the Philadelphia Eagles.) only in the daytime and was unaware of myocardial infarction, and stroke. If un- In addition, sleep apnea is a progressive both their snoring and breath stoppage. treated, severe sleep apnea can be life- disorder, so neither physician nor patient Burwell wrongly attributed their daytime threatening. knows exactly when non-harmful symptoms, drowsiness to high blood levels of carbon It also represents a huge public health like snoring, become clinically significant. dioxide. Sleep apnea was clinically de- problem, because sleepy people are more An estimated 95 percent of sleep apnea scribed, snoring and all, for the first time prone to auto and occupational accidents. cases are undiagnosed and untreated. in 1965 in Europe. Even then, the medical Canada, Sweden, Great Britain, Australia, Yet it is treatable. In 1981, Colin Sulli- community paid little attention to it be- and France attribute 10 to 30 percent of van, M.D., an Australian pulmonologist, cause there wasn’t much interest in sleep. auto accidents in their countries to drowsi- invented a device that uses a stream of Snoring, which by itself is not a mark- ness resulting from sleep loss or sleep air to keep the soft tissue structures open. er for sleep apnea, occurs when the pas- disorders. Sleepiness has also been impli- It is called CPAP (pronounced SEE-pap), sage of air causes the soft tissues surround- cated in notorious disasters, like the Exxon which stands for continuous positive air ing the upper airway to vibrate. The si- Valdez grounding and the Staten Island pressure. The device consists of a mask lences in between snores signal that these ferry crash. that covers the nose and is connected, structures have collapsed and that a pas- Sleep apnea is a prevalent disorder as via five feet of hose, to a machine that sageway for air has temporarily closed. well, about as common in the total pop- generates air pressure. “It sounds crude,” These stoppages of breath can last for a ulation as asthma. According to the Na- Pack acknowledges, “but it is very effec-

22 ■ PENN MEDICINE tive, and it meant we had a treatment.” in smart cards or connect the machine’s down-up, enzyme levels change. The Oral devices and surgeries are also some- computer chip to a port for downloads “up” part of the cycle produces a burst of times prescribed if CPAP treatment fails, by phone modem, or they upload infor- harmful free radicals, those nasty things or if patients don’t want to be chronically mation to a Web site that the physician our high-antioxidant diets are supposed under treatment. (Virtually all CPAP users, checks. CPAP fittings also continue to to neutralize. Veasey’s mice, which were with the exception of those who lose improve. The Penn Sleep Center offers normal, showed a significant increase in considerable weight, are lifelong users.) 20 different models, which represent just total sleep time in the weeks following But according to Richard Schwab, the first a fraction of what’s on the market. the experiment, as well as an increase in line of treatment is definitely CPAP. “We * * * REM sleep. She finds this abnormal behave all these new CPAP masks that are It took about 25 minutes for a technician havior consistent with damage to the much more comfortable than they’ve ever to attach electrodes to Beschen’s temples, chin, brain’s arousal systems that produce been,” he says. “Most patients — all mo- shins, and behind his ears. He placed two neurotransmitters and to other forebrain tivated ones — will be able to tolerate CPAP. straps around Beschen’s torso, taped a moni- neurons important in wakefulness. In In the past, I don’t think that was true.” tor to his pointer finger and placed a tube other experiments with normal mice, It certainly wasn’t. Lots of patients did- just under his nostrils. While being hooked up, n’t take to CPAP at all, and for good rea- Beschen watched the election returns from sons. The machine generates a continuous Super Tuesday. flow of air, so patients must get used to At 11:30 p.m., he turned out the lights, exhaling against its pressure. (Many cur- and despite all the attached wires and what rent CPAPs have bi-level control, which he recalls was an uncomfortable bed, he lessens the air flow during exhalation.) quickly fell asleep. The next thing he remem- The hose connection restricts movement bers is the technician saying, “You’re not do- in bed. For example, patients could not ing too well.” keep turning rotisserie-style into more Beschen recalls thinking, he means this is comfortable positions. In some patients, a waste of time, you don’t have sleep apnea, it causes claustrophobia. get up and go. “Do you mean I don’t have Physicians suspected the masks were it?” Beschen asked. being used far less than patients reported. “No,” the technician said, “you have it Dr. Sigrid C. Veasey One of the earliest important studies to very bad.” He helped Beschen put on a come out of the Center for Sleep and CPAP mask. Veasey has shown that intermittent re- Respiratory Neurobiology confirmed * * * duction of oxygen also causes damage to their doubts. In 1993, the Pack team According to Pack, the biggest obsta- upper airway motor neurons. The upper proved that CPAP was being used much cle to CPAP use is attitudinal. “Patients airway is already compromised in sleep less than patients claimed. Researchers just don’t think this is a major condition.” apnea — the tissues already collapsing — had microprocessors built into about And here’s where the research at the Center and oxidative damage here would suggest three dozen CPAP units so that machine really kicks in. Study after study — from that, without treatment, the disorder is use could be monitored covertly. It turned basic science to clinical — is showing just going to get progressively worse. out that fewer than half the patients how potentially serious sleep apnea is. Sleep apnea might also be contribute studied met the criteria for regular use. For example, sleep apnea might irre- to Type-2 diabetes and coronary disease. That finding prompted an awareness versibly damage the brain. In experiments Gary Foster, Ph.D., associate professor of campaign to publicize the importance of on mice, Sigrid C. Veasey, M.D., G.M.E. psychiatry, is looking at the role of sleep “adherence,” or faithful use. Says Pack, ’91, assistant professor of medicine, has apnea in “metabolic syndrome” — the “We developed the adherence monitor, looked at what happens when a normal combination of Type-2 diabetes, hyper- showed what the determinants for adher- organism is intermittently deprived of tension, and obesity. In a national, multi- ence were, and made adherence an im- oxygen, as happens to people with sleep year study of 4,500 people who have this portant part of medical management.” As apnea during nighttime breathing stop- syndrome, researchers are trying to de- a result, today’s CPAP machines have pages. It is already known that when a termine if weight loss improves their car- built-in monitoring devices. Patients mail person’s oxygen level goes down-up- diovascular outcomes. In a supplemental

2006/FEBRUARY ■ 23 jects back for testing while varying the Tommy Leonardi Tommy amount of sleep they gave them the week before the test. What they discovered is that an individual’s response to sleep deprivation is extremely consistent. If you had almost no response to the deprivation the first time, you would have the same lack of response the next time, regardless of how much sleep you lost the week be- Dr. David F. Dinges fore. And if your response was an order of magnitude worse, you had that response study, Foster had the group tested for Clinicians who treat sleep apnea have every time. “In other words,” Dinges sleep apnea. The prevalence was stagger- long noticed that some patients on CPAP says, “it was trait-like – which makes it ing: 92 percent. It was actually hard to have no daytime sleepiness while others look like it’s genetic.” find anyone who didn’t have it. And 40 continue to suffer from it. They noticed, As he puts it, “This is one of the most percent had sleep apnea that was consid- too, that even when patients had equally exciting, also provocative, things we’ve ered severe. The questions to answer severe cases — which they determined ever uncovered.” now: How much of the cardiovascular by measuring the number of breathing They also found that lack of sleep ex- risk from obesity is related to sleep ap- stoppages during sleep — some were aggerated inherent differences. “The more nea? And does sleep apnea contribute in sleepy during the day, and some were you keep people awake,” Dinges says, some way to diabetes or to glucose con- not. About two years ago, Penn researchers trol in patients with Type-2 diabetes? were able to explain these differences. Basic science research, much of it now More important, their work opened up a focused on molecular mechanisms, has whole new line of investigation. It was as shown some of the chemical effects if a form inside the block of wood the caused by the absence of sleep. Essential scientists had been carving suddenly be- substances are not produced; others came visible. build up and are not neutralized or de- The experiments were done by Hans P. graded. The person with sleep apnea is A. Van Dongen, Ph.D., research associate absorbing all these bodily insults. professor of sleep and chronobiology, and * * * David F. Dinges, Ph.D., professor of psy- When Beschen woke up in the morning, chology in psychiatry, chief of the Division Elena Nikonova, M.D., a postdoctoral fellow the technician showed him a printout of his of Sleep and Chronobiology, and director sleep. Before CPAP, it was filled with jagged of the Unit for Experimental Psychiatry “the more different they become from peaks. “It looked like a seismographic read- (all within the Department of Psychiatry). each other in their functioning. When ing of an earthquake,” Beschen recalls. From They showed that healthy people differed they’re alert, they’re different, but the dif- the point where he put on the mask, it read greatly in the magnitude of their response ference is only units. If you keep them almost as a straight line. to a night without sleep, and that they awake, the differences keep getting big- “I took to it immediately,” Beschen says. “I differed in exactly the same way on each ger and bigger.” adapted to it so well that eventually I could occasion that they were deprived of sleep Dinges explains: If they were to keep even sleep on my stomach and wear very little and retested. people awake for more than 40 consecu- of the actual harness. I didn’t wear the head- In carefully controlled experiments, tive hours — a day, a night, and a day — piece, just the strap that went around the Van Dongen and Dinges kept subjects everybody would become impaired. But back of my neck. I grew to accept the sound awake and tested the degree of their im- within the range of “normal” sleep depri- of the machine and the restriction as part of pairment, using, among other indicators, vation — a student pulling an all-nighter, going to sleep. It actually helped me separate the highly sensitive psychomotor vigi- a truck driver adding miles to make his from wakefulness.” lance test that Dinges developed in 1985. trip more profitable, a pilot on a long- * * * The researchers kept bringing the sub- distance flight, a soldier during combat

24 ■ PENN MEDICINE operations — individual differences be- on the psychomotor vigilance test, as phy of upper airway structures, is also come clear. well as their brain-wave patterns during taking part in the genetic study in Iceland. Their experiments also showed that recovery sleep. After testing 40 twin sets, Previously he showed that people with vulnerability to impairment differs de- Kuna reports that the preliminary results sleep apnea have smaller upper airways pending on what skill is being tested. “seem to indicate that performance on because their upper airway structures — People were not crashing across the board, the reaction time test is more similar in tongue, uvula, lateral muscles — are gen- but doing so selectively. “It may mean identical twins than in fraternal twins, erally larger. This finding suggests that different parts of the brain in differ- suggesting that this may indeed be a anatomic risk factors for sleep apnea. ent people are differentially vulnerable,” heritable trait.” He plans to do 600 MRIs of Icelandic says Dinges. “So some people are very Pack has designed another study that patients with sleep apnea. Then, combin- vulnerable in their memory when they seeks to identify the genes related to ing the information from these studies don’t get sleep. Others have trouble sus- sleep apnea. This work is being done in with the genealogical data base and DNA taining attention and vigilance, and others Iceland, where the population has ex- profiles, he hopes to uncover genes for feel exhausted. And all combinations are traordinarily favorable characteristics for intermediate traits, such as a large possible, too. genetic studies. First of all, the people tongue. He expects multiple genes to be Van Dongen and Dinges’s findings on are largely homogeneous: almost every- involved. The findings, he says, will “so- “inter-individuality” quickly prompted one living there now has been bred from lidify the case for anatomic risk factors other researchers to confirm whether the an original mix of Viking men and Gaelic and lead to new screening strategies for response to sleep deprivation is in fact women. Little immigration has occurred patients with sleep-disordered breathing.” genetic. The customary route is to test a since the island was settled between the As Pack sees it, such screening would trait in both identical and fraternal twins. 9th and 12th centuries. Second, the Ice- be valuable for high-risk groups in general, If sleep-deprivation vulnerability is genetic, landers created and have maintained de- such as commercial drivers or individuals the identical twins, who have the same tailed genealogical records. A company with new-onset coronary artery disease. set of genes, should test more like each called DeCode Genetics has set up a vast “Through this investigation, we also hope data base through which Pack can identify to identify new targets for therapeutic in- who is related to whom. A colleague of tervention,” says Pack. “Whether this will Pack in Iceland has compiled a list of be achieved easily or not will depend on 1,650 people there using CPAPs. Pack the nature of the genes.” can enter the name of a person with * * * sleep apnea (kept confidential through Beschen used his CPAP device faithfully protective identifiers) and have the pro- from March 2000 to August 2004. There gram put together a list of all relatives were only one or two nights that he didn’t (second cousins or closer, for example) use it. who also have the disorder. The other He continued to gain weight, though, even- critical aspect of the design is that 60 tually reaching 245.“I ignored my food aller- percent of the Icelandic population has gies,” he says. “The CPAP allowed me to in- given DNA to be genotyped. As Pack ex- dulge. It was like a crutch. It will give me plains: “You have the sequences across sound sleep, I thought, no matter what I do.” Dr. Samuel T. Kuna the genome. You have basic information In November 2003, Beschen started a diet other than do the fraternal twins. Pack on the DNA. The idea is that if you and I he designed for himself, mostly based on what and Samuel T. Kuna, M.D., G.M.E. ’79, are related and if we have the same med- he had read about white flour and sugar, but chief of pulmonary, allergy and critical ical condition, there’s going to be some also with some input from his sister, who is a care at the Philadelphia Veterans Affairs part of that genome that you and I are nutritionist and herbalist. By September 2004, Medical Center and director of its Re- going to share much more in common he had lost 65 pounds. He was able to go off gional Sleep Center, have launched just than we do with the rest of the population.” medications he was taking for high blood such a study of 80 twin sets. They are Richard Schwab, who for many years pressure and for an allergy. depriving sets of identical and fraternal has done magnetic resonance imaging His nighttime breathing had become normal – twins of sleep and comparing their scores and electronic beam computed tomogra- and he put his CPAP unit away.

2006/FEBRUARY ■ 25 tters spend a considerable amount of time cavorting in water. But ow Do Otters unlike polar bears, seals, dol- phins, and whales, river otters Odo not have a thick layer of body Remain Sleek fat to keep them warm. They are, in fact, remarkably sleek. How do the otters and Warm? Or, manage this apparent contradiction? Some recent research by a Penn scientist What One Cell and his team has demonstrated that otters rely on a few unique adaptations — namely, their fur and the densely packed Biologist Does Away layer of specially adapted underhairs. Using scanning electron microscopy From the Bench and polarizing light microscopy, John W. Weisel, Ph.D., professor of cell and developmental biology at the School of By Karen Kreeger Medicine, examined the structure of these hairs for clues to their exceptional insulation qualities. What he and his colleagues found is that the cuticle surface structure of the underhairs and the base of the less-abundant guard hairs are distinctive- ly shaped to interlock: the wedge-shaped fins or petals fit into the wedge-shaped grooves between fins of adjacent hairs. Weisel’s team reported its findings in the May 1, 2005 issue of the Canadian Journal of Zoology. Weisel and Chandrasekaran Nagaswami, M.D., a research specialist in Penn’s De- partment of Cell and Developmental Bi- ology, usually work on defining the physical properties of blood clots. They apply this knowledge to find better treatments for heart disease. But two years ago, Weisel, who has long been an avid hiker, climber, and white-water kayaker, took a month of his sabbatical year to study wolves – a life-long interest of his – on Isle Royale National Park in Lake Superior, Michigan. While he was there, he also collected hair samples from the island’s mammals, including wolves, moose, and otters. Isle Royale has been a training ground for many ecologists, and lessons learned there were useful for re-introducing wolves

Micrograph of river otter underhairs.

John W. Weisel, Chandrasekaran Nagaswami, Rolf O. Peterson; NRC Research Press 26 ■ PENN MEDICINE to Yellowstone National Park. But Weisel’s hair loosely insert into the grooves between underhairs are also aligned away from scientific background was different. “While fins of an adjacent hair, thus permitting the body, which is consistent with the di- we have engaged molecular biologists in the hairs to form a web-like pattern that rection in which otters run their paws studies of animal genetics and isotope keeps water from the otter’s skin and de- through their hair during this process of dynamics, John is the first structural mo- creases heat loss. The researchers also self-grooming. That way, their claws do lecular biologist that we have worked with,” found that the grooves between fins trap not get caught on the fin-like projections. says Rolf Peterson, a wildlife biologist air bubbles, which help increase the ther- Weisel is continuing these studies of from Michigan Technological University, mal insulation of the otter’s coat. Indeed, mammal hair in his spare time. Already, who has spent the last three decades do- biologists have observed otters actively he has returned to Isle Royale once since ing field research on Isle Royale. blowing air bubbles into their fur while his sabbatical, doing radio telemetry of Once back in his lab at Penn, Weisel grooming, and their energetic rolling radio-collared wolves and collecting samples made use of his extremely powerful tools catches air in their fur. As Weisel puts it, of their scat for DNA analysis. to examine the hair of wolf prey. His plan “The air insulates like a down jacket.” “I discovered that it can be very enjoy- was to identify the diet of wolves by Besides their playfulness, otters are able and stimulating to expand your sci- studying wolf scat. When he began, he also known for their constant grooming. entific horizons beyond the familiar, and had no inkling that he would find any- This behavior is another important aspect even get to take a ‘busman’s holiday’ in a thing unusual about otter hair. of an otter’s heat-conserving abilities. In beautiful place with wonderful people,” “Most hair from animals has a distinc- addition to the interlocking structure of says Weisel of his experiences away from tive pattern, which is how we can distin- the underhairs, these hairs are coated the bench. “There are still a great many guish one species from another,” says with a thin layer of body oil from the ot- new things to learn, but some approach- Weisel. “But otter hair is so different that ter’s sebaceous glands. That layer provides es and ideas from one field can be useful it caught my attention.” The fins of one another barrier to water. The fins of the in another.” Meanwhile, Back at the Lab . . . n June, a team of Penn scientists led As reported in the online edition of According to Weisel, by understanding by John W. Weisel, Ph.D., published a the Proceedings of the National Academy of the microscopic mechanical properties of paper describing the microscopic me- Sciences (28 May 2005), the investigators a clot, researchers may be able to make chanical properties of blood clots. They found that the fibers, which are long and predictions about clot physiology. For ex- Iused “laser tweezers” to measure the very thin, bend much more easily than ample, when clots are not stiff enough, elasticity of individual fibrin fibers in they stretch. That finding suggests that problems with bleeding arise, and when clots. The “tweezers” is essentially a laser clots deform in flowing blood or under clots are too stiff, there may be problems beam, which they focused on a microscopic other stresses primarily by the bending of with thrombosis, which results when bead “handle” that is attached to the fibers. their fibers. clots block the flow of blood. Then they were able to pull on the fiber Weisel likens the structure of a clot “If we can change a certain parameter, in different directions. composed of fibrin fibers to a microscop- perhaps we can make a clot that’s more Clotting is the body’s first defense against ic version of a bridge and its many struts. or less stiff,” says Weisel. For example, damage to the blood vessels. Clots are a “Knowing the mechanical properties of various peptides or proteins (such as an- three-dimensional network of fibrin fibers, each strut, an engineer can extrapolate tibodies) bind specifically to fibrin, af- stabilized by another protein called factor the properties of the entire bridge,” he fecting clot structure. The idea would be XIIIa. A blood clot needs to have the explains. “To measure the stiffness of a to use such compounds in people to alter right degree of stiffness and plasticity to fiber, we used light to apply a tiny force to the properties of the clot, so it can be less stem the flow of blood when tissue is it and observed it bend in a light micro- obstructive and more easily dissolved. damaged. Yet it must also be digestible scope, just as an engineer would measure — K. K. enough by enzymes in the blood so that the stiffness of a beam on a macroscopic it does not block blood flow and cause scale.” heart attacks and strokes.

2006/FEBRUARY ■ 27 The Knife That Isn’t a Knife By Nicole Gaddis Addison Geary 2005

Delivery in Progress: The Gamma Knife arrives at Pennsylvania Hospital.

t first glance, it looks deceptively that uses multiple radioactive cobalt hour or so after treatment is completed. like your garden-variety CT sources to destroy discrete anatomical re- It’s outpatient brain surgery, with no pain scanner. It’s only the collection gions in the brain while minimizing the and no incision. And because there are of 350-pound “helmets” lined effect in surrounding tissues. The device no incisions, there is no risk of infection, A up against the wall and the black that was installed at Penn’s Center is one bleeding, or other possible complications “safety line” running across the floor that of only ten of the latest-generation models that come with cutting into the skull and tells you that this is quite a different beast. in the country. It uses a robotic attach- exposing the brain. Welcome to the Penn Gamma Knife Center ment to accurately position the patient “The Gamma Knife is a powerful and at Pennsylvania Hospital, where an expert, within the device based on coordinates versatile complement to our existing neu- multidisciplinary team uses 201 finely developed by the treatment team. In addi- rosurgery services,” explains Peter LeRoux, tuned beams of radiation to treat brain tion, the model Penn is using is faster, al- M.D., vice chair of neurosurgery for Penn’s lesions, tumors, and venous malformations. lowing surgeons to cut treatment times Health System. “This will give patients a Developed by Lars Leksell, a Swedish in half. Patients generally require only much wider range of treatment options physician and neurosurgeon, in 1968, local anesthetic and mild sedation for a and will make many inoperable tumors the Gamma Knife is a stereotactic device procedure, and many can go home an and lesions quite treatable.”

28 ■ PENN MEDICINE Weighing in at 20 tons, a powerful and versatile tool will help neurosurgeons accomplish the most delicate procedures.

Part of the Team: (from left) Drs. Peter LeRoux, John Lee, and Jeffrey Rosenstock.

The Gamma Knife, made by Elekta In- nous malformations, fistulas, and cavernous struments, S.A., was brought to Pennsyl- malformations. It has also been used to vania Hospital in rather spectacular fashion treat facial pain (such as trigeminal neu- in the early morning hours in September ralgia), epilepsy, and severe, disabling 2005. Spruce Street was closed as spe- that is located not in a basement but in tremor caused by essential tremor or cialists brought the 20-ton unit through an attractive, patient-friendly center on Parkinson’s disease. Symptoms often re- an 8 feet by 10 feet section of the exterior the ground floor. The location is not only solve in a few weeks after treatment. wall of the hospital’s Spruce Building and convenient for patients and physicians, “Precision is paramount,” notes John carefully nestled it into a concrete-encased but also makes it much easier to replace Lee, M.D., medical director for the Gamma vault, 19 feet by 24 feet, that took three the cobalt source once it has reached its Knife Center. Lee came to Penn after be- months to build. Because of the Gamma half-life. ing part of the Gamma Knife team at the Knife’s tremendous weight, the vault is Besides being able to treat a range of University of Pittsburgh Medical Center, supported by 14 pilings that plunge 80 malignant and benign brain and skull where the device made its U.S. debut. “If feet down into solid bedrock. Penn’s is base tumors, the Gamma Knife can also we damage brain tissue, it stays damaged,” the only Gamma Knife center in the U.S. treat vascular disorders such as arteriove- he says. “Aiming customized doses of ra-

2006/FEBRUARY ■ 29 he is moved into the dome section of the Gamma Knife. The physicians administer the radiation from the control room, and this is where the complexity of the Gam- ma Knife system also becomes elegant: beneath two screens, which allow the physicians to monitor the patient in the treatment room, lies a single gray control panel that has a microphone and three simple buttons. Only one button needs to be pushed to begin treatment, and only one button is required to stop treatment. The system’s software takes care of the rest. One of the advanced features of the Gamma Knife used in Penn’s health system is the built-in audio and video system, which allows physicians to see and talk to patients throughout the procedure. Just as important from the patients’ perspective, the system allows them to speak to the physicians. “The radiation does not actually remove diseased tissue,” Lee explains. “It dam- diation is safer – and more effective – than the physicians to pinpoint the area to be ages individual abnormal cells: brain tumor using open-brain surgery or whole-brain targeted by radiation while keeping the cells lose their ability to multiply, blood radiation. There’s also a much lower risk patient stationary. Detailed images of the vessel malformations close off. The cells target site in the brain are created using eventually stop growing and then begin “Precision is paramount,” says magnetic resonance imaging (MRI), com- to shrink. And these effects continue John Lee, M.D., medical director puted tomography (CT), or angiography. over time.” for the Gamma Knife Center. “Since we’re sending individual beams The treatment itself usually lasts an of radiation to the target site, we essentially hour, and patients typically can go home “Aiming customized doses of superimpose a series of overlapping ‘soap the same day. “The most amazing thing radiation is safer – and more bubbles’ approximately the size of the about the surgery is its minimally invasive effective – than using open-brain site,” says LeRoux. “We have a choice of nature,” says LeRoux. “Patients can have four helmets that can surround a patient’s complex brain surgery during the day surgery or whole-brain radiation.” head and are attached to the stereotactic and then enjoy dinner that same night.” frame.” According to LeRoux, the helmets The center’s team monitors progress over of side effects such as paralysis and cog- allow individual beams of radiation either the next year through regular imaging nitive problems.” 4mm, 8mm, 14mm, or 18mm in diameter procedures (MRI, CT, angiography). This precision comes not only from to pass through. “We may use more than “Gamma Knife stereotactic radiosurgery the technology of the Gamma Knife itself, one helmet during a treatment period in is a successful, powerful technology with but also the expertise of the neurosur- order to best target the tumor or lesion a proven 30-year track record,” says Lee. geons, otorhinolarygnologists, radiation while preserving healthy tissue.” “It offers new hope to patients with neu- oncologists, specialized nurses, and physi- Unlike other neurosurgical procedures, rological conditions, ranging from tumors cists who work together to develop the Gamma Knife radiosurgery does not require to epilepsy and movement disorders, that patient’s treatment plan. A patient who cutting or shaving the patient’s hair. Once were once considered hopeless.” comes to the Center is fitted with a light- the patient is reclined comfortably on the Startling that a behemoth can be such weight stereotactic head frame that allows device’s couch and the helmet is in place, an elegant solution as well.

30 ■ PENN MEDICINE Treating THE DEADLIEST Brain Tumors

esearchers at the Hospital of the of damaging the adjacent normal brain pushes the drug solution through the University of Pennsylvania are tissue limits its overall efficacy. GBMs are catheters. Once in the brain, the drug at- studying the effectiveness of a intrinsically resistant to most chemother- taches to the remaining tumor cells, but novel way to deliver drugs to ex- apy, and very few drugs cross the natural not to normal brain cells. “The way the Rtend the lives of people with barrier present in the blood vessels of the drug is distributed is a very important Glioblastoma Multiforme (GBM), the most brain (the blood-brain barrier). Even drugs component of this study,” says Judy. “The common and aggressive form of primary that work in the laboratory and in animals placement of the catheters is the key to brain tumors. In this approach, the drugs cannot reach the tumor cells within the get the drug distributed in the right areas attack only cancerous cells in the brain. brain. These factors mean that only one to kill those stray cells.” “It is one of the largest and most compre- form of chemotherapy for this type of tu- Patients in the study are randomly as- hensive clinical trials ever conducted to mor has been approved by the Food and signed to one of two groups: two-thirds identify new and more effective treatments Drug Administration. There are two forms receive the study drug and one-third re- for recurrent GBM,” says Kevin D. Judy, of delivery, by vein or by local biodegrad- ceives FDA-approved chemotherapeutic M.D., associate professor of neurosurgery able wafers. The impact of these approved “wafers” after the tumor is removed. The at Penn and the study’s principal investigator therapies, although statistically signifi- GLIADEL Wafer contains BCNU (car- of the Penn component of the trial. There cant, increases survival in patients with mustine), an approved chemotherapy are approximately 50 hospitals across the this deadly tumor by only a few weeks. drug used to treat brain tumors. During nation participating in what is called the On the other hand, preliminary results treatment, the surgeon places up to eight PRECISE trial. Penn’s Health System is from the PRECISE trial show great prom- of the dime-sized wafers soaked in BCNU the only study center in the region. ise. The study drug, IL13-PE38QQR (or in the cavity created after removal of the Treatment options to prevent the rapid cintredekin besudotox), is a combination tumor. The wafers slowly dissolve (over recurrence or progression of the Glioblas- protein that consists of two parts: a tumor- two to three weeks), releasing BCNU to toma Multiforme tumor are very limited. targeting molecule made from a human the brain surrounding the cavity. GLIADEL GBMs have a tendency to intermingle with protein (Interleukin 13, or IL13) and a typically extends the patients’ median the normal brain tissue that surrounds cytokine (a kind of “chemical messenger” survival by eight weeks. the main tumor, and some cancer cells can protein), which allows the drug to bind to The median survival rate for 97 patients remain undetected and scattered through- tumor cells that contain the IL13 recep- on the study drug almost doubled from out the brain tissue that surrounds the tor. Like a key to a lock, the cytokine binds 26 weeks to 44 weeks. Several patients tumor site. In addition, most tumors to the receptor and allows the study drug have survived for more than three years, grow back close to the cavity that is left to enter and potentially kill the tumor and the FDA has granted the drug the after the removal of the main tumor; the cells. Normal brain cells do not have an rare fast-track designation to accelerate cancerous cells may also invade mem- IL13 receptor, so the study drug does not its approval. NeoPharm, Inc., based in branes that cover the brain or may spread bind to them. Lake Forest, Ill., is funding the PRECISE to the spinal fluid surrounding the brain. The drug is administered using con- trial and supplies the cintredekin besudotox, Radiation has been the most effective vection-enhanced delivery. A surgeon which was developed in the FDA’s Labo- therapy for these tumors, but the inherent places from two to four small catheters in ratory of Molecular Tumor Biology. resistance to radiation therapy and the risk the patient’s brain. Then a pump slowly — Kate Olderman, with Nicole Gaddis

2006/FEBRUARY ■ 31 AN EYE

Crimson Aspen North Lake

Mist Meadow

32 ■ PENN MEDICINE FOR NATURE

“In the field I’m in, there’s a s a specialist in pulmonary problems who is often called in for difficult cases, Morris Swartz, M.D., spends a good part of his lot of radiology, which is day on alert. A clinical associate professor of medicine at the School of Medicine, he is director of pulmonary diagnostic serv- really a form of photography, Aices and respiratory services at Penn Presbyterian Medical Cen- ter. He frequently provides evaluations for shortness of breath, asthma, chronic obstructive pulmonary disease, lung nodules, sacroidosis, and in which we’re analyzing other interstitial lung diseases. So when does he find time to pursue his love of photography? images and looking for “It’s very hard,” he says. “The only time I can really do this is when I disappear, when I go away. My job takes so many hours, and weekends forms and shapes.” are spent with family.” In this case, disappearing for Swartz means using vacation time for a photography trip into what he calls “beautiful, unspoiled nature.” His usual equipment for the trip has been a Canon EOS 35 mm camera, Fuji Velvia slide film, and a Gitzo tripod. The sites he has visited include the Cascade Great Smokey Mountains National Park in Tennessee, Yosemite National Park, northern Arizona and southern Utah, as well as New Hampshire. And despite the relaxing surroundings, he remains on alert – for a landscape that inspires him. The fruits of Swartz’s trips into the natural world were shown in “Earth Tones – Landscape Photography,” an exhibition this fall at the Burrison Gallery of the University’s Faculty Club. Although the surroundings are very different, Swartz can find some similarities between photographing nature and working as a pulmonologist. “In the field I’m in, there’s a lot of radiology, which is really a form of photography, in which we’re analyzing images and looking for forms and shapes. But the real creative part of photography — the part where I use the right side of my brain – I don’t get to use a lot while at work.” Still, he points out, there are many “technical aspects in photography similar to the detail work that I do as a doctor.” But the technical aspects, for Swartz, are not the primary ones: “My photography is a real form of relaxation.” And, he reports, his patients enjoy the photos that he displays in his practice.

2006/FEBRUARY ■ 33 Development Matters FOCUS ON FOUNDATIONS

The current group of RWJ Clinical Scholars at Penn gathered in November to present their findings on "young men in wheelchairs." Front row, from left to right: Joanna Starrels; Aliya Esmail; Peter Ehrenkranz; and Kristen Feemster. Back row: J. Sanford Schwartz, co-director of the program; Lucy Wolf Tuton, one of the program's faculty members; Melissa Times; Patrick Conway; Reena Duseja; Tara Lagu; and Eunice Franklin-Becker, managing director of Penn's program.

RWJ Clinical Scholars Learn to Translate Research into Results oundations play an important role in advancing medical knowledge, by es- The School of Medicine is one of only tablishing endowed professorships, underwriting research, and creating new four sites in the country chosen to host education programs. They range from national organizations with missions the Clinical Scholars Program of the as broad as “improving health care” to small family foundations focused on Robert Wood Johnson Foundation (RWJF), F a single disease or purpose. At PENN Medicine, foundations contributed which helps young physicians learn to $27.6 million in gifts and grants in Fiscal Year ’05. Here we share with you the im- conduct health-services research. The pact that three foundations – one national and two local – have had recently on highly prestigious two-year program, en- the School of Medicine. tering its fourth decade, has been hosted at different groups of universities over the years, including Penn from 1974 through sults,” explains Harold I. Feldman, M.D., 1995. Its current president and CEO, Risa 1996. Now, as the program has become M.S.C.E. ’86, G.M.E. ’91, professor of Lavizzo-Mourey, M.D., M.B.A. ’86, was a more focused, the number of host uni- medicine and of epidemiology and director Clinical Scholar at Penn in the mid 1980s. versities has been limited to four – and of the Division of Epidemiology, who serves Penn is again among them. as co-director of the program. Real World Results, Right Away “In 2002, RWJF reformed the program, The Foundation, whose mission is to As one of their first assignments, the establishing the goal of producing indi- improve the health care of all Americans, class of eight Clinical Scholars devoted viduals who could conduct meaningful, was started by Robert Wood Johnson, much of last summer to a group project multidisciplinary research in collabora- founder of Johnson & Johnson. RWJF that was defined as broadly as possible: tion with community organizations, and has awarded close to $4 billion to health Look at young men in Philadelphia who translate that research into real world re- care-related projects and programs since are confined to wheelchairs and come up

34 ■ PENN MEDICINE with a recommendation to improve their under the name “Wheelworks.” The pro- Thieringer is also interested in exploring quality of life. gram would employ and train young the feasibility of launching Wheelworks “There were many lessons in this exer- people in wheelchairs to design and per- or a similar program at Magee. cise,” notes Feldman. “There’s a lot of form home modifications, drawing on In addition to providing training for paradigm shifting going on as the Schol- the skills of wheelchair-bound trades- the Clinical Scholars, the group project ars transition from their residency – they people who would train and serve as was also intended to help them bond as were guided immediately away from the mentors. a cohort. Peter Ehrenkranz, M.D., M.P.H., medical arena to a community context, One of the organizations the Scholars G.M.E. ’05, one of the Scholars, says, “I setting the stage for them to look at consulted was Magee Rehabilitation, was impressed by how quickly everyone health care through lenses outside of which serves people in Philadelphia dis- jumped in and contributed their particu- medicine.” abled by spinal cord injury, brain injury, lar expertise – we come from different After meeting with both representatives stroke, orthopaedic injury, or amputation. specialties, have worked with different of community organizations and individ- Pat Thieringer, director of Magee’s com- populations, and have varied ways of uals in wheelchairs, the Scholars identified munity programs, says that Magee is al- looking at problems.” crucial issues and developed a concept to ready acting on one of the Scholars’ rec- address several of them: affordable, ac- ommendations. They called attention to The Scholars, Present and Past cessible housing; meaningful employment; the lack of a single centralized source of This year’s class of Clinical Scholars, mentoring; and a sense of community. information on resources for the wheel- trained in the nation’s top medical programs, They presented the strategy to the Mayor’s chair-bound, and Magee is now redesign- comprises Ehrenkranz, Patrick Conway, Commission on People with Disabilities ing its website to address that need. Reena Duseja, Aliya Esmail, Kristen A. Feemster, Tara Lagu, Joanna Starrels, and Melissa Times. Like Ehrenkranz, Feemster and Lagu hold master’s degrees in public Penn and the Clinical Scholars Program: “A Real Congruence” health in addition to their M.D. degrees. What made Penn such a strong com- tive; you can’t fake that. I think the visi- The Scholars’ specialties include internal petitor this time? J. Sanford Schwartz, tors sensed an extraordinary commit- medicine, pediatrics, surgery, and emer- M.D. ’74, G.M.E. ’78, co-director of the ment to the program and everything it gency medicine, and their diverse re- program, cites several factors. (A profes- stands for throughout the university. search interests include: sor of medicine and of health manage- There’s a real congruence between what •Policy-driven research around emergency ment and economics, he participated in the Clinical Scholars program is about departments the program in the late 1970s.) “By any and what Penn is about.” •The impact of media on nutritional measure, we are one of the top institu- The program’s associate directors illus- choices and the prevalence of obesity tions in health-services research and clin- trate its collaborative nature. Joshua P. in children ical epidemiology – and that is a direct Metlay, M.D., Ph.D., a research associate •Barriers to HIV education and treatment outgrowth of having the CS program here in health-services research and staff physi- services experienced by immigrants for 20 years – and we were able to put cian at the Philadelphia Veterans Affairs •The effects of homelessness and neigh- together a remarkable set of committed Medical Center, serves as the program’s borhood environments on children’s community partners.” Penn is also partic- associate director for veterans’ affairs. health and access to health services ularly strong in multidisciplinary educa- Donald F. Schwarz, M.D., M.P.H., M.B.A. •The impact of existing pharmacy policy tion and collaboration. That strength, ’87, also a former Clinical Scholar, will on disadvantaged communities. notes Schwartz, was vividly illustrated lead the program’s community partnership The Scholars are joining an impressive during the Foundation’s site visit. advocacy activities. Schwarz is vice chair club. For more than 30 years, some 900 “All of our schools are represented in of Penn’s Department of Pediatrics, as physicians have participated in the Clinical the Clinical Scholars faculty,” says well as chief of the Craig-Dalsimer Divi- Scholars program. Many of the 93 alumni Schwartz. “At the site visit presentation, sion of Adolescent Medicine and deputy of Penn’s program have risen to leadership it was obvious that we all knew each physician-in-chief at The Children’s Hos- positions in academic medicine, government, other well, that we truly are collabora- pital of Philadelphia. health-care systems, foundations, and the

2006/FEBRUARY ■ 35 Development Matters FOCUS ON FOUNDATIONS

private sector. Among them are: •David J. Brailer, M.D., G.M.E. ’91, Ph.D. ’92, National Coordinator for Health Information Technology, U.S. Department of Health and Human Services •Raynard S. Kington, M.D., G.M.E. ’88, Ph.D. ’91, deputy director, National Institutes of Health (NIH)

•James L. Mills, M.D., M.S.C.E. ’79, Jonathan A. Epstein, M.D. chief, Pediatric Epidemiology Section, NIH The W.W. Smith Charitable Trust •Risa Lavizzo-Mourey, M.D., M.B.A. ’86, Supports Medical Research president and CEO, The Robert Wood For nearly 30 years, until his death in Johnson Foundation; former Director 1976, William Wikoff Smith led the Ke- of Penn’s Institute on Aging and former wanee Oil Company, which was founded Sylvan Eisman Professor of Medicine by his great grandfather, Joseph D. Potts, •Gary Gottlieb, M.D., M.B.A. ’85, presi- in 1871. Potts was one of the most dent, Brigham and Women’s Hospital prominent figures in Philadelphia in the •Elliot J. Sussman, M.D., G.M.E. ’80, 1880s and was asked to join Penn’s board M.B.A. ’81, president and CEO, Lehigh of trustees in 1886; both of his sons at- Valley Hospital and Health Network tended the College. Smith’s will created •Neil R. Powe, M.D., M.P.H., M.B.A. ’86, The W. W. Smith Charitable Trust, which director, Welch Center for Prevention, focuses its contributions, primarily locally, Andrew Kofke, M.D., M.B.A., left, tries out a simulation Kofke, director of neuroanesthesia, also directs the Epidemiology, and Clinical Research, on meeting essential human needs, pro- Johns Hopkins Medical Institutions viding scholarships, and supporting Benjamin and Mary Siddons •Sankey V. Williams, M.D., G.M.E. ’77, medical research. Measey Foundation Funds chief, Division of General Internal Over the past 25 years, the Trust has Simulation Center Medicine, University of Pennsylvania; supported many Penn undergraduates In 1958, as a memorial to his parents, Sol Katz Professor of General Internal and helped PENN Medicine scientists William Maul Measey established the Medicine; former director of Penn’s conduct research in cancer, AIDS, and Benjamin and Mary Siddons Measey RWJ Clinical Scholars Program heart disease. One of its grants was Foundation, whose purpose is to fund •Mitchell J. Blutt, M.D. ’82, M.B.A. ’87, awarded to Jonathan A. Epstein, M.D., medical education initiatives in the president, Beta Advisors (an invest- for his early research into the causes of Philadelphia area. Over the past few years ment firm focused on health care); for- congenital heart disease. Now one of the alone, the Measey Foundation has funded mer executive partner, J. P. Morgan world’s premier investigators in the field several million dollars’ worth of scholar- Partners LLC; PENN Medicine trustee. of molecular cardiology, Epstein is profes- ships, fellowships, and professorships in “When you look at the graduates of sor of cardiovascular medicine and direc- the School of Medicine and supported its this program at Penn, what’s surprising is tor of the Penn Molecular Cardiology Re- M.D./Ph.D. program, the FOCUS program that the preponderance of them have search Center. When the Trust generously for women in medicine, and programs in made — are making — substantive con- decided to establish the William Wikoff global and community medicine. tributions to improving the health of the Smith Chair in Cardiovascular Research at Two recent contributions are particu- public in some way,” says Schwartz. “It Penn, the University provost recognized larly noteworthy. With a $1 million gift, would be hard to find another program Epstein’s outstanding research by appoint- the Foundation established the Measey that has had that kind of impact.” ing him the first holder of the professorship. Medical Simulation Center, whose high-

36 ■ PENN MEDICINE RECENT GIFTS

PENN Medicine trustee Raymond Perel- M.D., Ph.D., and Howard Hurtig, M.D., man, WEv ’40, and his wife, Ruth Caplan to discover new drug therapies and Perelman, have contributed $25 million to identify biomarkers for earlier diagnosis name “The Raymond and Ruth Perelman of Parkinson’s Disease. Center for Advanced Medicine.” (See Vital Signs, page 2) Dr. Sankey and Senator Connie Williams have contributed $2 million to The Abramson Family Foundation create the Leon Hess Professorship in In- continues to support research into the ternal Medicine in honor of Senator causes of and cures for cancer, contribut- Williams’s father. Dr. Williams is chief of ing $10 million as part of its $100 million Penn’s Division of General Internal Medicine pledge for the Abramson Family Cancer and the Sol Katz Professor of General Research Institute. Madlyn Abramson is Internal Medicine. a trustee of PENN Medicine. The Bingham Trust has made a $1 million With their leadership gift to the Perelman grant to the Institute on Aging, which will Center for Advanced Medicine, Dr. Henry fund pilot research initiatives in the field of A. (M.D. ’62) and Barbara McNeil Jor- aging and support new faculty entering dan have created the Jordan Center for the field. Gynecology in the Abramson Cancer Center. Dr. Jordan is a PENN Medicine trustee. With a $1 million gift to the Perelman Center for Advanced Medicine, Stanley Jack and Rebecca Benaroya have com- and Janet Zolot have dedicated the Yetta mitted $2.5 million for The Benaroya Dietch Novotny Mammography Center Parkinson’s Program Fund, which will within the Abramson Cancer Center. model with Brian Ash, a fourth-year medical student. support research by John Q. Trojanowski, Measey Medical Simulation Center. To make a gift to PENN Medicine, or for more information, please contact the Office of Development fidelity simulation models (nicknamed and Alumni Relations, 3535 Market Street, Suite 750, Philadelphia, PA 19104-3309, 215-898-8094. “Ben”) and task simulators will allow medical students to practice many common ALUMNI EVENTS medical procedures before they treat actual patients. The Measey Center also makes it You can find out more about these and April possible to simulate and rehearse multi- other upcoming events at ■ Tuesday, April 4, 2006, Elizabeth Kirk Rose faceted scenarios, including emergencies, http://www.med.upenn.edu/alumni Women in Medicine Dinner, Philadelphia that involve teams of health professionals. ■ TBA, Helen O. Dickens Dinner, Philadelphia A second million-dollar gift provided March ■ Tuesday, April 25, 2006, PENN Medicine funding for the Clyde F. Barker – William ■ Sunday, March 5, 2006, Academy of on the Road, Dallas Maul Measey Professorship in Surgery, Dermatology Reception, San Francisco ■ Wednesday, April 26, 2006, PENN Medicine which honors the Foundation’s founder ■ Tuesday, March 7, 2006, PENN Medicine on the Road, Houston and Clyde Barker, M.D., chair of Penn’s on the Road, Palm Beach, Fla. Department of Surgery from 1983 to 2001. ■ Friday, March 10, 2006, Orthopaedic May Barker did pioneering work at Penn in Surgery Annual Alumni Cocktail Recep- ■ Save the Date! May 12-14, 2006 is transplantation, surgical oncology, la- tion, Chicago (at American Academy of Medical Alumni Weekend. paroscopic surgery, surgical immunology, Orthopaedic Surgery Meeting) – RSVP ■ TBA, Academy of Obstetrics and Gyne- and gene therapy. He also directed the to [email protected] cology Reception, Washington, D.C. Harrison Department of Surgical Research ■ Saturday, March 11, 2006, The Orthopaedic ■ TBA, American Urological Association for many years. Rehabilitation Association Specialty Reception, Atlanta Day, Chicago – Register at www.aaos.org

2006/FEBRUARY ■ 37 Progress Notes 2005. He has been chairman of Ph.D., director of the Vollum In- ’60s the Department of Diagnostic stitute at Oregon Health & Sci- Send your progress notes to: Radiology in the OHSU School ence University, has been elected Jason B. Bozzone of Medicine since 1992. to the Institute of Medicine of the Associate Director of Alumni Out- Doris G. Bartuska, M.D., G.M.E. National Academies. Goodman reach and Reunions ’68, emeritus professor of medi- Andrew C. Von Eschenbach, is also professor of cell and de- PENN Medicine cine at Allegheny University of M.D., G.M.E., ’68, director of velopmental biology and of bio- Development and Alumni Relations the Health Sciences, was one of the National Cancer Institute, chemistry and molecular biology 3533 Market Street, Suite 750 five honorees at the First Health Philadelphia, PA 19104-3309 was appointed interim director at the Oregon Health & Science Sciences “Distinguished Service of the Food and Drug Adminis- University School of Medicine. Awards” presented this fall by tration by President Bush. He is His laboratory focuses on deter- Wilkes University, where she a former chair of urology at the mining how extracellular and in- earned her undergraduate degree. University of Texas M. D. Ander- tracellular signals are integrated ’50s She served as a Special Fellow in son Cancer Center. to control the onset and level of Rody P. Cox, M.D. ’52, G.M.E. Molecular Medicine for the Na- gene expression. Last December, ’56, Dallas, Texas, was recently tional Institutes of Health and is a Goodman’s lab published a tech- nominated as a laureate of the former president of the American nique, developed in collaboration Texas Academy of Internal Medi- Medical Women’s Association ’70s with scientists at Brookhaven Na- cine, the Texas Chapter of the and of the Philadelphia County tional Laboratory in Upton, N.Y., American College of Physicians. Medical Society. In 1988, she Jeffrey C. Oram-Smith, M.D. and State University of New York, He is now a teaching attending was one of seven women honored ’71, G.M.E. ’78, Colorado Springs, Stony Brook, for characterizing a physician and an active member by the Commonwealth of Penn- Colo., was named chief medical family of genes regulated by the of the faculty of internal medi- sylvania for outstanding contri- officer for Penrose-St. Francis “cAMP response element binding” cine at University of Texas butions to the state and the nation. Health Services. A general, vas- protein, or CREB. The molecule Southwestern (UTSW) and re- Bartuska is also featured in a trav- cular and trauma surgeon, he is among a group of proteins cently received the Aesculapius eling exhibition titled “Changing has been active in the Penrose called transcription factors that Award from the UTSW-St. Paul the Face of Medicine,” which ex- system since 1980 and has been a interact with regulatory elements house staff for his teaching. He amines the achievements of women partner with the Colorado Springs in DNA that are responsible for is recognized as a leading expert in medicine. The exhibition can Surgical Associates since 1981. increasing or decreasing the lev- in maple syrup urine disease. be accessed at the web site of the el of gene expression in cells. In National Library of Medicine. Frederick P. Rivara, M.D. ’74, 2002, Goodman was elected to Ronald B. Berggren, M.D. ’57, M.P.H., the George Adkins Pro- the National Academy of Science. G.M.E. ’61, Galena, Ohio, emer- Frederick S. Keller, M.D. ’68, fessor of Pediatrics at the Uni- itus professor of surgery at Ohio the Cook Professor of Interven- versity of Washington, has been State University, received the John tional Radiology and director of elected to Institute of Medicine C. Gienapp Award from the Ac- the Dotter Institute at Oregon of the National Academies. He is creditation Council for Graduate Health & Science University, be- the only new member from the ’80s Medical Education (ACGME) for came the only practicing physi- State of Washington. Rivara has Stephen L. Comite, M.D. ’82, is lifetime contributions to the Coun- cian at OHSU to have an endowed studied methods to control in- the co-author of three papers cil and to graduate medical educa- chair established in his name. In juries, specifically in such areas published earlier this year in a tion. He has served on Council August, the Cook Group Inc., as bicycle and pedestrian injuries, peer-reviewed dermatology jour- for more than 20 years and has manufacturers of medical devices, motor vehicle injuries, and alco- nal, Dermatology Online Journal. been chair of its Institutional Re- donated $2.5 million to create hol-related trauma injuries. His The initial paper discussed a new view Committee, its Residency the Frederick S. Keller Chair of current interests include examin- non-invasive technique that uses Review Committee for Plastic Interventional Radiology Endow- ing the cost-effectiveness of trau- massagers to produce vibration as Surgery, and its Monitoring Com- ment Fund. Keller received an- ma care, the impact of domestic a way to lessen the pain associated mittee. He has also been chair of other recent honor when he was violence on women and chil- with certain dermatology proce- the Council’s board of directors. only the second American to be dren, and the effectiveness of in- dures such as Botox injections for named a distinguished fellow at terventions in childhood and which local anesthesia may not be Billy W. Long, M.D., G.M.E. ’57, the Cardiovascular and Interven- adolescence on later health out- sufficient. The paper is the first a member of Gastrointestinal As- tional Radiological Society of comes. His goal is to focus pub- in peer-reviewed dermatology sociates in Jackson, Miss., since Europe. The honor, which he re- lic policy attention on imple- literature, and one of the first 1981, was cited in the most received at the organization’s an- menting programs that can have papers in all of the medical liter- cent “Best Doctors in America” nual meeting in September in a long-term impact on the health ature, that contains movies show- survey. When Long is not per- Nice, France, is given each year of children and adults. Rivara is ing the techniques involved. The forming more than 2,000 proce- to individuals who have shown head of the Division of General second paper was an editorial dures annually, he makes medical leadership in the field of inter- Pediatrics at the University of discussing this innovative mission trips to Guatemala, Be- ventional radiology. “Many med- Washington, a faculty member method of presenting medical lize, and Honduras. He was part ical devices used in intervention- of its Child Health Institute, an information in a refereed Inter- of a team that built a hospital in al radiology are developed in the attending physician at Children’s net journal. The third paper dis- Guatemala about six years ago. U.S.,” says Keller, “but clinical Hospital and Regional Medical cussed the use of a new filler, A former assistant professor of trials on these devices are often Center and Harborview Medical Radiance (recently renamed medicine at Penn, Long has also first conducted in Europe, so the Center, and a faculty member at Radiesse), to cosmetically restore worked at the National Institutes sharing of information is para- the Harborview Injury Preven- the faces of certain patients with of Health. mount.” Keller also received the tion and Research Center. HIV who suffer from a condition Gold Medal of the Society of In- known as facial wasting or lipoa- terventional Radiology in April Richard H. Goodman, M.D.’76, trophy. Comite is affiliated with

38 ■ PENN MEDICINE the Department of Dermatology radiology residency at the Alton He is survived by Cynthia Douglas MacArthur’s Surgeon at Mount Sinai Medical Center Ochsner Medical Foundation Swartley Zimmer, M.D. ’45, General’s Staff in Tokyo. After and has a private dermatology (named after a cousin) in New G.M.E. ’49. the war, Zinsser was the Chief of practice in midtown Manhattan. Orleans. He taught at the Tulane Medicine at the Army’s 361st University School of Medicine Charles Long II, M.D. ’48, a General Hospital. In 1947, he David D. Lo, M.D. ’86, Ph.D., is for 32 years. A former president physician who practiced at moved to Philadelphia to take a a member of the Department of of the American College of Radi- Cleveland’s Highland View Hos- research fellowship in the U.S. Developmental Immunology at ology, he received the College’s pital for 26 years; August 8, 2005. Public Health Service of the Uni- the La Jolla Institute for Allergy Gold Medal in 1981. Ochsner He was former chief of physical versity of Pennsylvania. He was a and Immunology. His research also served as president of the medicine and rehabilitation at member of the Penn medical fac- focuses on the development of American Roentgen Ray Society. Highland View and held a simi- ulty from 1947 to 1982. He also the mucosal immune system and The Seymour F. Ochsner Radiol- lar position at the Veterans Hos- served as chief of cardiology at on the regulation of CD4 T cell ogy Lectureship was established pital in Tampa, Fla., where he the University of Pennsylvania’s responses. Director of Neurome’s in his honor at Ochsner in 1999. retired in 1991. An expert in the Presbyterian Hospital and chief Vaccine Technology Division, he treatment of hand injuries, he of cardiology and chairman of has served on numerous NIH re- Sidney O. Krasnoff, M.D. ’42, was an early developer of ways medicine at its Graduate Hospi- view committees. He is editor- Philadelphia, a cardiologist and to employ mechanical and elec- tal. He is credited with perform- in-chief of Current Immunology pioneer in the use of computers tronic devices to allow patients ing the first heart catheterization Reviews. Author of more than in medicine; August 15, 2005. to regain use of their limbs. He and first angiocardiography at 120 scientific articles, he was a In 1943, then an intern, he was was credited with inventing a the University of Pennsylvania, featured speaker in November called to active duty. He served fiber-optic hypodermic micro- and he designed and donated the University of California at in Europe, where he set up a scope. After serving as an Army the first catheterization laborato- Riverside’s Health Sciences Ini- mobile army surgical hospital on medical officer, he moved to ries at both the Graduate Hospital tiative, where his topic was D-Day and went on to become a Cleveland Heights in 1956 and and the Presbyterian Hospital. A “Dual-use Weapons: Genes Reg- captain. He began his medical joined Highland View. In 1962, former president of the Pennsyl- ulating Both Tissue Development practice at Einstein Medical he traveled to Europe, Africa vania Heart Association, he had and Immunity.” Center, where he later served as and India to do research and at- also served as vice president of chairman of the medical staff. He tend medical forums and work the American Heart Association taught at the Graduate School of at the Christian Leprosy Mission and as vice president of the Col- Obituaries Medicine of the University of in Vellore, South India. He also lege of Cardiology. He was an Pennsylvania and at Temple Uni- helped develop a clinical engi- elected member of the American Ralph W. Stevens, M.D. ’33, versity School of Medicine. He neering laboratory at Highland Society for Clinical Investigation. Walla Walla, Wash., a retired did volunteer medical work in View, where equipment was built ophthalmologist; May 27, 2004. Afghanistan in 1968. A member to measure the electrical potential Fausto M. Prezioso, M.D., G.M. of dozens of professional organi- of muscles and custom devices ’53, Towson, Md.; November 9, Gerald C. O’Neil, M.D., G.M.E. zations, he served as president were created to help patients use 2004. ’39, Littleton, Colo.; April 17, of the Pennsylvania Society of those muscles. He had been a 2005. O’Neil obtained both his Internal Medicine in 1960 and clinical professor at Case West- Jerry W. Draheim, M.D. ’53, B.S. and M.D. degrees from of the Philadelphia County Med- ern Reserve University and at Sylvania, Ohio; November 3, 2004. Creighton University, then re- ical Society in 1980. In 1967, he the University of South Florida. He was the former head of oph- ceived his Master of Medical Sci- published a pioneering textbook, thalmology at Toledo Hospital. ence degree from the University Computers in Medicine: A Primer William K. Runyeon, M.D. ’48, of Pennsylvania in 1938. He served for the Practicing Physician, which Wyomissing, Pa., surgeon; June 8, Irwin J. Polk, M.D. ’53, Mill his residency at Penn and per- was translated into several lan- 2005. Valley, Calif.; December 5, 2003. formed medical research toward guages. Krasnoff retired in 1985 During World War II, he served the measles vaccine. His pediatric and pursued his love of writing. Robert L. Tornello, M.D., G.M. in the U.S. Army. After complet- practice spanned from 1940 to In 1998, he published Truman ’49, Youngstown, Ohio; April 5, ing his medical degree, he prac- 1983. He served two terms as and Noyes: Story of a President’s 2003. ticed pediatrics, then allergy, in president of the staff of Children’s Alter Ego, a collection of letters New Jersey. He also earned a Memorial Hospital in Omaha, between Harry S. Truman and Harry F. Zinsser Jr., M.D., G.M.E. master’s degree in public health Nebraska, and was on the teach- advertising executive David Noyes. ’49, Bryn Mawr, Pa., emeritus from Columbia University. He ing staff at Creighton School of professor of medicine and for- ended his career in clinical med- Medicine and the University of D. Franklin Milam, M.D. ’44, mer chief of staff at Graduate icine with the pharmaceutical Nebraska Medical Center. G.M.E. ’48, Morgantown, West Hospital; August 30, 2005. He company Hoffmann-La Roche Va.; May 10, 2002. He was for- earned his medical degree from Inc. The author of two books – Seymour F. Ochsner, M.D. ’40, mer chair of urology at West Vir- the University of Pittsburgh in one on asthma and the other on Metairie, La., former chairman ginia Medical Center. 1939, where he was president of figure skating – he was once a of radiology and radiation oncol- the Alpha Omega Alpha Honorary nationally syndicated medical ogy at the Ochsner Clinic in New Frederick E. Zimmer, M.D. ’45, Medical Society. He enlisted in columnist. Orleans; May 28, 2005. During G.M.E. ’49, Fort Myers, Fla., a the U.S. Army Reserves in Janu- his senior year at Penn, he con- retired physician; April 27, 2004. ary 1941. As part of the Surgeon William K. Buchanan, M.D. ’54, tracted pulmonary tuberculosis. After interning at HUP, he was a General’s Office, he inspected Hudson, Ohio, anesthesiologist; With limited treatment options at fellow at the Mayo Clinic from medical bases during the final May 29, 2005. the time, he “endured 39 months 1949 until 1952. From 1952 months of the war in prepara- of strict bed rest, read a few until 1985, he was on the staff tion for the invasion of Japan. William E. Riemer, M.D. ’54, hundred books,” as he once put of the Geisinger Medical Center, Upon the Japanese surrender, Ma- Miami, Fla., pathologist; it, and earned his medical degree where he eventually founded the jor Zinsser was assigned to Gen. October 23, 2003. several years later. He took his Department of Endocrinology.

2006/FEBRUARY ■ 39 A Shining Example

Lindley Murray Winston, M.D. 2003. He had been deputy di- hen Arthur Peck, M.D. ’52, applied to med- ’54, Malvern, Pa; August 14, 2005. rector of medicine at Kingsbrook ical schools in 1948, he received 39 rejec- An advocate of community men- Jewish Medical Center. tions and one acceptance. Initially, Peck tal health, he served as a psychi- Wwas puzzled – his academic record was “unimpeachable,” atrist for numerous hospitals and Manuel H. Espinosa, G.M. ’69, smaller clinics and organizations. Easton, Pa.; October 17, 2004. and he was active in many extracurricular activities. These included the Institute of Peck suspected that the rejections were based not on Pennsylvania Hospital, Commu- FACULTY DEATHS his career as a student but on the fact that he was a nity Services for Human Growth Jew. In that era, he explains, most American medical in Paoli, and Family Service of Thomas W. Langfitt, M.D., former schools limited their student bodies to 10 percent racial Chester County in West Chester. vice president of health affairs at or religious minorities. Penn was the rare exception. He also had a private practice in the University of Pennsylvania “I was considered a minority and I was not judged Philadelphia, West Chester, and and former president of The Pew in the same way as other students,” says Peck. “Penn Malvern. He was a founding Charitable Trusts; August 7, 2005. gave me an opportunity that changed my life. They member of the American Associ- After earning his medical degree ation of Community Psychiatrists from Johns Hopkins School of judged me on merit, not my religion.” and received awards from the Medicine in 1953, he served a The School of Medicine’s dean, Isaac Starr, M.D. American Medical Association, the second stint in the Armed Forces ’20, eliminated the quota system at Penn, which had American Psychiatric Association, before completing his residency required applicants to provide photo identification and and the Eastern Pennsylvania Al- in neurosurgery at Johns Hopkins. answer an extensive questionnaire about their family liance for the Mentally Ill. In 1961, he became head of history. The purpose was to weed out prospective stu- neurosurgery at Pennsylvania dents who might fib about their heritage. William L. Hamilton, M.D. ’54, Hospital. He moved to the Uni- “Penn was a shining example of ethics and morals,” G.M.E. ’58, a Philadelphia der- versity of Pennsylvania in 1968 says Peck. “The School had a moral compass, and I matologist; October 28, 1999. and served as chair of its neuro- will always be grateful for that.” surgery program until 1987. Herman D. Colomb, M.D. ’59, Recognized for his research on A retired psychiatrist who now resides in Tenafly, N.J., a psychiatrist and medical direc- the central nervous system, he Peck has transformed his gratitude into philanthropy. tor of the post-traumatic stress was credited with advancing the He has established four charitable gift annuities and syndrome team at Veterans Af- treatment of traumatic brain in- has allotted a percentage of his IRA to the School of fairs Medical Center in New Or- jury. In 1974, Langfitt became Medicine. leans; October 28, 2004. He took Penn’s vice president of health His philanthropic tendencies are a family trait. Peck his internship at Lankenau Hos- affairs, overseeing the hospital as grew up during the Great Depression with parents who pital in Philadelphia and his res- well as all the health-related always made it a point to give to their favorite charities, idency at Pennsylvania Hospital. schools. He first became involved including the Red Cross and the March of Dimes. He served as a lieutenant com- with the Pew Charitable Trusts “My parents showed me that philanthropy was im- mander in the U.S. Navy and as an adviser on their health-re- was director of the Navy psychi- lated grants. In 1980, he was portant by what they said and what they did. They atric clinic of Treasure Island, elected to the board of the Glen- could only give small amounts, but to me, the lesson San Francisco. Colomb had been mede Trust Company, which was clear: philanthropy enriches your life.” president of the medical staff of handles the assets of the Pew Today, Peck’s life is enriched by his various civic ac- Coliseum Medical Center; for- trusts, and advanced to president tivities. He serves on Tenafly’s library board, and in his mer vice president of the med- of both in 1987.Under his lead- spare time, he loves “horsing around” with his five ical staff of DePaul Hospital; ership, Pew grew into one of the grandchildren. president of the New Orleans largest charitable foundations in Dr. Peck’s charitable gift annuities helped him find a Area Psychiatric Association; the nation while becoming less way to make a significant gift, while obtaining a current vice chairman of the Host Com- secretive and more engaged with income tax deduction and the security of guaranteed, mittee of the American Psychi- its community. Langfitt stepped atric Association; and former down as president of Pew in 1994, partially tax-free, lifetime payments. His IRA gift will president of the Louisiana Psy- then served for two years as presi- help him avoid its potential 80% reduction by taxes. chiatric Association. A Maitre of dent of the College of Physicians These are just two of a multitude of creative gift oppor- the New Orleans Chapter of the of Philadelphia. While there, he tunities that benefit both the School of Medicine and its Commanderie de Bordeaux, led the development of an Inter- donors. As you chart your financial future, the Planned Colomb was elected Mr. Gourmet net-based medical information Giving Office is ready to assist in developing an appro- in 1991 by the Society of Bacchus system that was designed to im- priate strategy. Contact Marcie Merz, J.D., Director of America. prove access to medical data Planned Giving, PENN Medicine, 3535 Market Street, among the poorer communities. Suite 750, Philadelphia, PA 19104-3309, or e-mail: Joseph Nelson Vizzard, M.D., Author of more than 200 profes- [email protected]. G.M. ’59, Scotts Valley, Calif.; sional publications, he sat on May 19, 2005. After serving as several medical advisory and ed- an officer in the U.S. Navy, he itorial boards. He had also been a practiced medicine in Lafayette trustee of New York Life Insurance and San José for 40 years. Co. and what is now GlaxoSmith- Kline, the pharmaceutical firm. Arthur E. Reinhard, G.M.E. ’62, Brooklyn, New York; July 6, Harry F. Zinsser Jr., M.D. See the Class of 1949.

40 ■ PENN MEDICINE Professionalism and Humanism Robert Clink course emphasizes the importance of establishing trust. s I have told each entering class In recent years, Penn has made in- since becoming dean of this creasing use of standardized patients. wonderful institution, I firmly Taking the role of patient, actors help our believe there is no nobler and students learn the craft – and art – of Amore satisfying profession than dealing with the human beings who come being a physician. All of us who become to them in need. Because the actors are physicians have the opportunity to help not actually ill, the students feel less pres- others, often during their times of great- sure during the interactions. The students est need. For all the hard work and the deal with fictitious, yet credible, circum- years of education and training involved, stances before they face them in real life. being a doctor is among the highest of all We also believe that the commentary they callings. Whether we are in a clinic help- receive from the standardized patients ing an elderly patient during a regular some of our graduates continue to over- can be extremely valuable. checkup or are on the Gulf Coast help- look one of the most important aspects Another important step our school ing survivors of a disaster, our efforts are of being a physician. Indeed, some may has taken in recent years is establishing never in vain. call it the single most important aspect: the Office of the Vice Dean for Human- So we must ask ourselves why the establishing a genuine relationship with ism and Professionalism. We are one of popular press and even some of our pro- the patient. the very few schools schools to have fessional journals seem ready to highlight At Penn, we are not coasting on our such a position. Our choice for the first those instances when doctors perform reputation and tradition. During the White dean was Paul Lanken, M.D., G.M.E. ’77, badly or treat a patient coldly and unpro- Coat Ceremony, which is held for our in- who has long been a champion of those fessionally. Part of the answer, I believe, coming students at the very beginning of very values. In fact, he was a finalist for lies in that last word: unprofessionally. the academic year, our speakers emphasize the 2001 Humanism in Medicine Award Being a physician is a profession. Like all humanism and professionalism. In addition, of the Association of American Medical professions, it has a long history and a one of the very first courses our new stu- Colleges. set of standards that practitioners should dents attend is “The Doctor-Patient Rela- Dr. Lanken has also been our chief embrace. We do not serve our patients or tionship: Culture and Communication.” As liaison with STEP, Strategies for Teaching ourselves well when we depart from those the course description puts it, “Regardless and Evaluating Professionalism. STEP is a standards. of your mastery of pathophysiology, you partnership between the American Medical Last summer, a series of articles that will not be able to take a good history Association and 10 leading medical schools appeared in The New York Times offered a from your patients if they do not feel that is working to design innovative sobering look at the practice of medicine they have established a therapeutic rela- methods for educating the next genera- from the patient’s point of view. The titles tionship with you.” This matter is so im- tion of physicians in the competencies of the articles gave the gist of the series: portant that I have made a commitment that constitute professionalism. The part- for example, “In the Hospital, a Degrading to address our new students during this nership has been an opportunity to share Shift from Person to Patient” (August 16, course, and our curriculum emphasizes what our School has developed as well as 2005) and “Sick and Scared, and Waiting, the doctor-patient relationship throughout to learn about successful initiatives by Waiting, Waiting” (August 20, 2005). In all four years. Students must pass “The our peers. the many examples and testimonies in the Doctor-Patient Relationship” in order to We sometimes hear that we cannot teach articles, the focus was not on the quality continue into the next module of the values. Professionalism and humanism of the treatment but on the manner of the curriculum. are certainly values, but they are also part treatment, the interaction between patient In this course, one of the things stu- of our professional code. At Penn, we are and physician. Patient after patient spoke dents learn is how to interview patients – committed to providing a well-rounded of being treated like an inanimate object or which also means how to listen. They medical education. a helpless child, whose legitimate ques- also learn that patients don’t necessarily tions and pleas for more information mention their most important concerns Arthur H. Rubenstein, M.B., B.Ch. were treated cavalierly. at first; the practitioner must be able to Executive Vice President of the University of What these news reports tell us is that, probe delicately to get a sounder sense Pennsylvania for the Health System despite the efforts of our medical schools, of the patient’s problems. All in all, the Dean, School of Medicine “ e are all starting to truly realize that the

world is much smaller

than we anticipated,” Wsays Gail Morrison, M.D., vice dean for education. Student

interest in international health has been

rising steadily. In 2004, the School of

Medicine opened its Global Health

Programs office. Part of its mission is to

go far beyond classroom lectures by

offering students the opportunity to

immerse themselves in another nation

and culture.

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