APRIL 2005

Dealing with America the Super-Sized: Penn’s Weight and Eating Disorders Program ‘AN EXTRA SET OF EYES’ IN THE ICUs A TRIO OF NEW INSTITUTES ANTIQUES ON DISPLAY Editor’sNote

A No-Nonsense Approach to The format they developed had already The recipes sprinkled throughout range Eating Well been tested in various dietetic, medical, from spicy whole-grain pilaf to “nutrient- and nursing programs. By the mid dense” chicken noodle soup. iet is one of those dangerous 1990s, more than 50 medical schools One section, Hark points out, “puts topics about which people and teaching institutions were using 45 of the most popular diets under the feel strongly – often very the material, which was sold in a three- microscope,” organizing them by type strongly. Followers of carbo- ring binder before its publication in and by underlying theory and provid- Dhydrate-controlled diets may book form. The third edition of Medical ing representative menus for each. Hark sneer at the adherents of the high-car- Nutrition and Disease appeared in 2003, is particularly proud of the “Food as bohydrate, low-fat schools of Ornish filled with chapters written by many Medicine” section, which is aimed at or Pritikin. Vegetarians may mock the Penn experts. According to the editors, preventing as well as treating nutritional Atkinites with the vehemence of true “Its integrated, case-based approach of- problems. The recommendations, she believers. As Gary D. Foster, Ph.D., fers a complete perspective on the med- notes, are evidence-based. In the section clinical director of Penn’s Weight and ical and nutritional implications of various on digestive disorders, for example, Eating Disorders Program, told The clinical scenarios, with emphasis on man- she worked with experts in Penn’s G.I. New York Times last year, when it comes agement of disease and prevention.” division as well as specialists in kidney to diet books, “evangelism creeps in” Today, Hark continues as director of disease and other fields. The entry on (22 February 2004). So I was a tiny the School of Medicine’s Nutrition Ed- “Treating Constipation” gives an overview bit concerned when Lisa Hark, Ph.D., ucation and Prevention Program, which of the problem; recommends increas- R.D., a medical dietician for Penn’s no doubt informs her new book. Yet ing one’s intake of fiber and of fluids; School of Medicine, came by to talk it’s also true that, as she puts it, “I’m a and explains how magnesium-rich about her new book, Nutrition for Life: working mom, struggling with the same foods (spinach, almonds, raisins, etc.) The No-Fad, No-Nonsense Approach to issues” that face her readers. She tries and exercise can help. Eating Well and Reaching Your Healthy to make sure that her two children get “Where people are getting their nutri- Weight (published by DK). If Hark healthy snacks, but she also knows that tion information is the problem,” she turned out to be a zealot, I was making with all the temptations out there, it’s a says. Consumers need “a credible re- plans to bolt from my office. balancing act. source.” And according to Hark, many I am happy to report that Hark was Elegantly designed, with plenty of doctors lack authoritative information far from a zealot. She was enthusiastic colorful photographs, sidebars, charts, when it comes to talking to their pa- and obviously eager to promote Nutrition and the occasional “jargon buster,” tients about diet. Nutrition for Life, she for Life, written with Darwin Deen, M.D., Nutrition for Life attempts to deliver as believes, can help fill that gap. of Albert Einstein College of Medicine – much as a reader can absorb. It begins It’s clear that Hark and Deen view but she was refreshingly down to earth with a section called “Assess your health their book as something helpful for and very well-informed about the topic. and lifestyle,” then follows with sec- the long run, not as a guide for losing Her history at Penn certainly lends her tions that provide basic information on a few pounds quickly. On the matter credibility. food (fats, carbohydrates, fiber, vitamins, of overweight, Hark appears not to In the early 1990s, supported by etc.); the elements of a healthy diet; blame carbohydrates or (by themselves) grants from the Howard Heinz Endow- eating appropriately for your age; genes. “There’s no question that people ment and the National Cancer Institute, weight control; “Food as Medicine”; are eating too many calories.” Hark and Gail Morrison, M.D. ’71, G.M.E. buying, storing, and preparing food; That’s largely the view of the profes- ’77, now vice dean for education, de- and food analysis. Along the way, we sionals in Penn’s Weight and Eating veloped a program for teaching nutrition can learn about the benefits and risk Disorders Program, too. You’ll find a to Penn medical students. Unlike some of drinking alcohol and read about fuller account of that program’s goals other programs at the time, this one ways to deal with lactose intolerance. and achievements starting on p. 8. was detailed and extended over parts In the meantime, I’m going to take of three years. In 1996, Medical Nutrition Hark’s advice and put my peanut butter and Disease, edited by Hark and Morrison, aside while I try almond butter in my was published by Blackwell Science. sandwiches. “It’s healthier,” she says.

Cover Illustration: Wally Neibart, after Grant Wood. MARCH 2005 / VOLUME XVII NUMBER 2

AMERICA THE SUPER-SIZED Over the last four decades, Americans have become dramatically heavier, creating talk of “an epidemic of By Marie Gehret obesity.” And it’s not a matter of aesthetics – it’s a matter of health. The professionals in Penn’s Weight and Eating Disorders Program are studying the causes of this trend, evaluating the available treatments, and helping 8 their patients lose weight in healthy fashion. PENN LAUNCHES ON-LINE From four blocks away, specially trained physicians and nurses can monitor how patients are doing via a sophisti- CRITICAL CARE cated and comprehensive telemedicine system. The goal is By Ed Federico and Sally Sapega greater patient safety. As C. William Hanson, M.D., puts it, “It can’t replace bedside care, but, as an extra set of eyes, it 16 can help eliminate preventable medical mistakes.” INSTITUTIONAL Already a very friendly place for multidisciplinary centers and institutes, PENN Medicine has recently added three ADVANCEMENTS more institutes. They are expected to enhance the study By John Shea and treatment of some major illnesses and disorders – and, in general, to enhance translational medicine at Penn. All three are meant to strengthen the interrela- 18 tionships of research, patient care, and education. A GOOD KIND OF For more than 40 years, the Philadelphia Antiques Show has been a major fund-raising event for the Hospital of AMBITION the University of Pennsylvania and the University of Pennsylvania Health System. This year’s loan exhibition is called “Vaulting Ambition: Gothic Revival in Philadel- phia, 1830-1860.” Beginning with a preview gala on 21 Friday, April 8, the show runs though Tuesday, April 12.

STAFF DEPARTMENTS

JOHN R. SHEA, PH.D. Inside Front EDITOR’S NOTE Editor A No-Nonsense Approach to Eating Well LEWIS & NOBEL DESIGN 2 VITAL SIGNS Design / Art Direction A Mark of Financial Health ADMINISTRATORS Before Construction Comes Demolition The Costs of Medical Education REBECCA HARMON Orphans’ Court Approves Sale Chief Public Affairs Officer U.S. Settles Gene Therapy Case SUSAN E. PHILLIPS Honors & Awards Senior Vice President for Public Affairs

22 DEVELOPMENT MATTERS Penn Medicine is published for the alumni Scholarship Support and friends of PENN Medicine by the Office Calendar of events of Public Affairs. © 2005 by the Trustees of the University of Pennsylvania. All rights 26 ALUMNI NEWS reserved. Address all correspondence to Progress Notes John Shea, Penn Medicine, 2018 Penn Tower, University of Pennsylvania Health Inside Back THE LAST WORD System, Philadelphia, PA 19104-4385, or Planning a New Center call (215) 662-4802, or e-mail the Editor at [email protected].

Visit Penn Medicine’s web site: www.uphs.upenn.edu/prnews/publications/ VitalSigns

A Mark of Financial Health Sally Sapega n a university campus, receiving an “A” is great, but an “A” from Standard & Poor’s Rating Serv- ices may be even better than Omost. Earlier this year, Standard & Poor’s as- signed its “A” standard long-term rating to Pennsylvania Higher Education Facilities Authority bonds that were issued for the University of Pennsylvania Health System. In the course of restructuring its debt, much of it incurred during its rapid ex- pansion in the mid-to-late 1990s, UPHS was able to sell about $361 million in the insured bonds. According to the headline on the front page of The Philadelphia Inquirer,

it was “Penn Health back in the pink” The demolition process for the Commerce Museum (shown partway completed) and Convention Hall has been (February 2). The newspaper also noted slow and deliberate. that the bond issue was the first for UPHS since 1998. decade, and this whole strategy is de- Much of the architectural grandeur of Representatives from Standard & Poor’s signed to make us one of the top five Convention Hall, both internal and ex- explained that the improved ratings re- clinical centers as well.” ternal, has been saved. One of the more flected the Health System’s “impressive remarkable pieces removed from the operational track record” over the last Before Construction Comes building is the 8,000-pipe organ that four years and its “continued excellent Demolition dates back to the early 1930s. In addi- reputation and position as one of the As the Health System moves forward tion, the CAM team worked with federal, leading health-care systems in the in its plans for the Riverview Project, one state, and local historical agencies to Greater Philadelphia market affiliated of the major tasks has been to clear space photograph, identify, and preserve repre- with one of the most prestigious medical for the first phase, the Center for Ad- sentative architectural elements, many of schools in the country.” Liz Sweeney, a vanced Medicine. The future site of CAM which will be incorporated into the new health-care analyst at Standard & Poor’s, is where the Commerce Museum and Center. also noted that the Health System’s sale Convention Hall have stood. The Com- Construction on the Center for Advanced of Phoenixville Hospital last summer to merce Museum came down in February, Medicine is scheduled to begin in the fall. Community Health Systems had helped and demolition is continuing on Conven- Penn strengthen its financial position. tion Hall. The process has been slow and The Costs of Medical Education Standard & Poor’s wasn’t the only deliberate, and Douglas Aitken, project From her vantage as vice dean for edu- bond-rating agency to notice the improved executive for CAM, said that the workers cation at the School of Medicine, Gail financial position of UPHS. Moody’s In- are hoping to recycle 60 to 75 percent of Morrison, M.D. vestors Service upgraded the Health Sys- the building materials. ’71, G.M.E. ’77, tem’s outlook from “stable” to “positive.” Keating Building Corporation was can see at first According to Ralph W. Muller, CEO of hired to oversee the abatement and dem- hand that “a vi- Penn’s Health System, “What you see olition process. Before the demolition, all cious circle of in- here is a financial strategy that supports a hazardous materials were carefully re- creasing tuition very aggressive strategy to build clinical moved, following strict regulations. The and student debt” programs on a whole range of fronts. We demolition company, Mazzochi Wreck- is threatening the future of medical educa- have been one of the top five research ing, was responsible for taking down the tion. That’s how she put it in a brief “Per- centers in the nation over the last remains of the World Trade Center. spective” in the 13 January 2005 issue of

2 ■ PENN MEDICINE The New England Journal of Medicine. She after graduation and to reduce the impact Health has agreed to pay $25 million for asserts that the cost of obtaining a med- of debt as new M.D.s make their deci- the 183-bed Chestnut Hill Hospital and ical education “has been spiraling up- sions.) its network, which includes a rehabilitation ward for the past 20 years” and “nothing Given the financial difficulties facing hospital and an assisted-living facility. has happened to change the alarming government, where can one look for so- Community Health has also agreed to in- pattern.” lutions? Morrison suggests that “our best vest an estimated $43 million for capital Her figures are indeed alarming: the hope” lies with the individual medical improvements to the Chestnut Hill network. average tuition and fees during the 2003- schools, which may find “creative ways Penn will have specialists located at the 2004 academic year were $16,153 for to reduce the need for loans and to adjust Chestnut Hill HealthCare sites, as it con- public medical schools and $32,588 for financial policies so as to reduce tuition. tinues to have at Phoenixville Hospital. private schools. “Adding $20,000 to Schools that can increase grants and $25,000 for living expenses, books, and scholarships and develop subsidized loan U.S. Settles Gene Therapy Case equipment brings the estimated cost of programs will be able to ameliorate their In February, more than five years after four years of attendance to about $140,000 students’ debt.” Yet, as Morrison acknowl- the death of Jesse Gelsinger in a gene for public schools and $225,000 for pri- edges, solutions of that sort depend on therapy trial at the University of Pennsyl- vate schools.” each school’s ability to raise funds and vania, the United States Government Morrison notes that the tuitions have increase endowments. She also points reached civil settlements with three indi- increased more rapidly than inflation – out that medical schools “must take an- vidual investigators and two of the insti- for example, 17.7 percent for public other look at the costs of education and tutions involved. The settlements cover medical schools and 5.7 percent for pri- determine how to halt the rising cost of alleged false statements and claims made vate medical schools in 2004. Although tuition.” between July 1998 and September 1999. there are still two applicants for each Penn’s School of Medicine is already Gelsinger, 18 years old, was enrolled medical-student position in the United taking that look, as the Admissions Office in a Phase I clinical trial seeking to develop States, applications have indeed decreased. and the Development Office attempt to an effective treatment for ornithine trans- What concerns Morrison more, however, come up with imaginative solutions. See carbamylase (OTC) deficiency. OTC defi- is that, “for the past two decades, approxi- pp. 22-25 of this issue for a glimpse of ciency is an inherited disorder that, in its mately 60 percent of medical students some initiatives for raising scholarship most common form, causes death in af- have come from families in the top quin- support. fected newborn males because they are tile of income, with the bottom three unable to properly process nitrogen in quintiles together accounting for about 20 Orphans’ Court Approves Sale food proteins, which results in too much percent, arousing concern that medical Last fall, the sale of Chestnut Hill ammonia in the blood. Gelsinger died on education may be beyond the reach of HealthCare to a joint venture formed by September 17, 1999, four days after being students from middle-class and working- the University of Pennsylvania Health injected with a genetically engineered class families.” System and Vanguard Health Systems, Inc., adenovirus carrying the OTC gene. Citing studies by the Institute of Medicine a for-profit system based in Nashville, As part of the settlement, the University and the Association of American Medical Tenn., was approved by Chestnut Hill’s of Pennsylvania agreed to pay $517,496 to Colleges, Morrison points out that the board of trustees. That deal collapsed the Federal Government to resolve its alle- cost of attending medical school was the when Vanguard subsequently withdrew. gations, and the Children’s National Med- reason most often cited for not applying In February, however, the Philadelphia ical Center, of Washington, D.C., agreed by underrepresented students; and 32 Orphans’ Court approved the sale to to pay the government $514,622. In ad- percent of students who graduated in UPHS and a new partner, Community dition, the three named investigators – 2002 indicated that their level of debt in- Health Systems, Inc. James M. Wilson, M.D., Ph.D., former fluenced their choice of specialty. (At A for-profit health system based in director of Penn’s Institute for Human Penn, Anne and Walter J. Gamble, M.D. Brentwood, Tenn., Community Health is Gene Therapy; Mark L. Batshaw, M.D., ’57, established the Twenty-first Century the same organization that bought former professor of pediatrics, now at the Endowed Scholars Program in the 1990s Phoenixville Hospital from UPHS last Children’s National Medical Center; and to make it easier for Penn medical students year. Penn will be the minority partner, Steven E. Raper, M.D., associate profes- to consider the less lucrative specialties with a 15 percent stake. Community sor of surgery, who headed the OTC

2005/MARCH ■ 3 VitalSigns

study – will have restrictive controls on ty statement issued on February 9: “To- would be appropriate for scientific ad- their clinical research activities. (Almanac, day’s announcement marks the conclusion vancement.” the publication of record of the University of the federal investigation into events of Pennsylvania, has published the full surrounding the unexpected death of Honors & Awards restrictions: http://www.upenn.edu/ Jesse Gelsinger, a participant in a gene almanac/ volumes/v51/n21/gts.html.) Ac- therapy clinical trial at Penn. As this set- A “Hospital of Choice” cording to the government, the restric- tlement recognizes, over the last five years The Hospital of the University of tions on Wilson are more severe given Penn has established what is now a na- Pennsylvania was one of about three his “pivotal role” as sponsor in the clini- tional model for the conduct of research, dozen in the nation to earn a “Hospital of cal trial in which Gelsinger participated. including the mandatory training of in- Choice” Award. The awards, presented “Perhaps most significant is the impact vestigators and staff coupled with a com- by the American Alliance of Healthcare that these settlements will have on the prehensive internal monitoring program Providers, are designed to recognize hos- way clinical research on human partici- for research involving volunteers. As part pitals “that go beyond their walls in pur- pants is conducted throughout the coun- of the resolution of this matter, Penn fac- suit of excellence and high-quality care” try,” said Patrick L. Meehan, the United ulty members Dr. James M. Wilson and and have developed a collaborative rela- States Attorney who announced the set- Dr. Steven Raper may continue to make tionship with physicians and health-care tlement. “This action covers two major ongoing contributions to medical re- organizations in their communities. research centers which have instituted search. Out of this tragedy has come a The Alliance is a private stock corpora- important changes in the conduct and renewed national effort to protect the tion headquartered in Alexandria, Va. monitoring of clinical research on human safety of those who help to advance new Founded in 1992, it seeks practical, ef- participants. We hope that these settle- treatments and cures through clinical re- fective, and efficient ways to improve pa- ments will now serve as a model for sim- search. As this investigation closes, we tient care in the American health-care ilar research nationwide.” reaffirm our commitment to the safe con- system. Among other allegations, the govern- duct of research, strengthening our resolve The honored hospitals were rated on ment alleged that the study had produced to continue to set the highest standards the Alliance’s criteria in professional toxicities in humans that should have led possible in this important area.” (One of ethics, standards of conduct, patients’ the investigators to terminate the study, the most visible actions taken by the rights, performance management, staff yet the study continued. It also alleged University and PENN Medicine was cre- development, and communication sys- that reports submitted to the Food and ating the Office of Human Research.) tems. Several of the hospitals receiving Drug Administration, the National Insti- Wilson is prohibited from leading clin- “Hospital of Choice” awards have also tutes of Health, and to the institutional ical research that involves human subjects appeared in the “Honor Roll” published review boards charged with oversight of until 2010. He may resume participation annually in U.S. News & World Report. the OTC study misrepresented the actual in studies involving human subjects be- clinical findings associated with the study. fore then if he undergoes additional Judith A. Coche, Ph.D., clinical asso- In addition, the government claimed that training in such research and his work is ciate professor of psychology in psychia- the consent form and process did not independently monitored. According to try, was named a 2004 Woman of Distinc- disclose all anticipated toxicities. the agreements, Wilson will lecture and tion by the Philadelphia Business Journal On the other hand, as set forth in the write an article on the lessons learned and the National Association of Women recent agreements, the University, the from the OTC study. In a separate state- Business Owners. Coche, one of 25 Children’s National Medical Center, Wil- ment issued on February 9, he said: “In women honored, is founder of the Coche son, Batshaw, and Raper do not admit to the last few years, I have focused my re- Center, one of the first non-medical men- the government’s allegations and contend search on the discovery and design of tal-health practices on the East Coast that their conduct was at all times lawful new gene transfer vectors for gene therapy owned by a woman. Co-author of Powerful and appropriate. and genetic vaccines. Reaching this Wisdom, a clinical research study of 192 In Penn’s case, it has already taken sig- agreement means that I may continue to distinguished female mental-health pro- nificant steps to make its clinical trials devote myself fully and without restric- fessionals, Coche has served as president safer and to fulfill the agreements with tion to my laboratory research and that I of the Philadelphia Society of Clinical the government. According to a Universi- may conduct clinical research when it Psychologists.

4 ■ PENN MEDICINE Dwight L. Evans, M.D., the Ruth Foa is director of Penn’s Center for the director of transla- Meltzer Professor and Chair of the De- Treatment and Study of Anxiety. tional research at partment of Psychiatry, received the 2004 the Abramson Can- Award for Research in Mood Disorders, Steven L. Galetta, M.D., the Van Meter cer Center of the presented by the Professor of Neurology and Ophthalmology, University of Penn- American College received the Robert J. Glaser AOA Distin- sylvania, is one of of Psychiatrists. guished Teacher Award at the annual two recipients of The award is given meeting of the Association of American the first grant to a scholar or in- Medical Colleges. The award, established awarded by the Alliance for Cancer Gene vestigator who has by the Alpha Omega Alpha medical honor Therapy, Inc., for research in treating lym- made “exceptional society, is presented in collaboration with phoma and leukemia. contributions to the treatment of mood the AAMC. There were four recipients in According to June, “We have recently disorders” and displayed excellence in re- all for 2004. According to the AAMC, developed a new strategy to create T cells search. According to Evans, “Depression “Over the past 16 years, Dr. Galetta has that express a hybrid gene that endows has become the number one cause of dis- won virtually every University of Penn- the engineered T cells with the ability to ability within Western Europe and North sylvania teaching award for which he has specifically kill leukemia cells.” With the America.” In the United States alone, he been eligible. He is recognized by both grant, he plans to carry out a Phase I said, about 20 million people suffer from medical students and residents as an out- clinical trial in patients with advanced or serious depression. standing teacher in the classroom and at recurrent leukemia who have not re- Evans received a second honor recently the patient’s bedside. Colleagues note his sponded to prior chemotherapy. when he was elected president of the unselfish encouragement of students and June and his collaborator, David Porter, American Foundation for Suicide Preven- residents to get involved in clinical re- M.D., associate professor of medicine, tion. According to the foundation, in the search; students and trainees under his will receive about $1 million over the United States, a person dies from suicide direction served as the primary-authors next three to four years to use genetically every 18 minutes; and suicide is the on more than half of his published re- engineered T cells to target leukemia and third-leading cause of death among 15- search papers.” Galetta heads the neuro- lymphomas. If properly activated, T cells to 24-year-olds and the second major ophthalmology division and serves as di- have demonstrated a strong capacity to cause of death among college students. rector of neurological training. kill tumor cells. Evans calls the foundation “uniquely po- sitioned to help marshal the national Eli J. Glatstein, M.D., professor and Irwin B. Levitan, Ph.D., the David J. forces necessary to address death from vice chair of radiation oncology, was Mahoney Professor of Neurological Sciences suicide as a major public health problem.” named one of three recipients of a 2004 who serves as chair of the Department of Gold Medal from the American Society Neuroscience, was elected secretary of Edna B. Foa, Ph.D., professor of clinical for Therapeutic Radiology and Oncology. the Society for Neuroscience. The society is psychology in the Department of Psychi- The award honors his more than 35 the world’s largest organization of scien- atry, received an honorary degree from years of service in the field of radiation tists devoted to the study of the brain. the University of oncology, including his pioneering work Levitan also serves as director of Penn’s Basel in Switzer- in the 1970s, at the National Cancer Mahoney Institute of Neurological Sciences. land in November. Center, when he successfully integrated She was honored different modalities of cancer treatment Stephen A. Liebhaber, M.D., professor for her contribu- by combining radiation oncology with of genetics and of medicine, has received tions to the under- medical oncology. Glatstein, also a member a Method to Extend Research in Time standing of the psy- of the University’s Abramson Cancer (M.E.R.I.T.) award from the National chopathology and Center, came to Penn in 1996. Heart, Lung, and Blood Institute. As the to the treatment of anxiety disorders, institute notes, the M.E.R.I.T. award “is with an emphasis on obsessive-compul- Carl June, M.D., the professor of designed to provide long-term, stable sive disorder and post-traumatic stress pathology and laboratory medicine in support to investigators whose research disorder. Penn’s School of Medicine who serves as competence and productivity are distinctly

2005/MARCH ■ 5 VitalSigns

superior, and who are likely to continue ing and root planing or to tooth polishing. one of seven to perform in an outstanding manner.” A cohort of 700 women without periodontal women named Liebhaber’s work deals with genetic path- disease will also be followed for compari- Distinguished ways that control the expression of the son. The subjects will be followed to Daughters of human globin genes, which encode the track spontaneous pre-term births. Re- Pennsylvania last hemoglobin molecule that fills red blood searchers will also evaluate some of the fall. The awards cells and transports oxygen from the lungs mechanisms through which periodontal were presented by to the tissues of the body. According to disease may exert its effect. Governor Edward Liebhaber, “The hope is that by under- In addition to Macones, the other prin- G. Rendell and Judge Marjorie O. Ren- standing how the information flow is cipal investigators are Marjorie Jeffcoat, dell, First Lady of the Commonwealth. regulated in human cells, it will be possi- D.M.D., dean of Penn’s School of Dental “These seven women are committed to ble to understand the basis for a wide range Medicine, and Jerome F. Strauss III, M.D., issues of importance in Pennsylvania, of disease processes and to formulate ap- Ph.D., director of the Center of Research and their accomplishments and aware- proaches to therapy.” for Reproduction ness will shape the future of our state,” said Judge Rendell. Pujols-McKee was George A. Macones, M.D., associate Charles P. O’Brien, M.D., Ph.D., vice honored for promoting access to health- professor of obstetrics and gynecology chair of the Department of Psychiatry care resources for all members of the and of epidemiology in the School of and director of the Center for Studies of community, particularly those in the Medicine and director Addiction at the School of Medicine and West Philadelphia area. She has also of maternal fetal medi- the Philadelphia Veterans Affairs Medical served on the advisory committee of the cine at HUP, has re- Center, was invited by the Academisch Federal Drug Administration. ceived a $4.8 million Medisch Centrum (Academic Medical grant from the Com- Center) and the University of Amsterdam C. William Schwab, M.D., professor monwealth of Pennsyl- in Holland to present “The Anatomy Les- of surgery and chief of the division of vania to support a Cen- son.” A tradition that dates back to the trauma and surgical critical care at ter of Excellence for Research in Preg- 16th century, the modern version of the UPHS, has been elected president of the nancy Outcomes. The grant was awarded Anatomy Lesson is a week-long event American Association for the Surgery of by the Department of Health using funds consisting of a presentation by an inter- Trauma. Under from the Tobacco Settlement. According nationally prominent scientist on a sub- Schwab’s leadership, to the grant proposal, the University of ject on the cutting edge of science. O’Brien Penn has become a Pennsylvania will collaborate with Penn- spoke about brain mechanisms of addic- Level I Regional Re- sylvania Hospital, The Children’s Hospi- tion and the development of new treat- source Trauma Cen- tal of Philadelphia, and Albert Einstein ments for these disorders, based on work ter, recently recog- Medical Center to establish a multidisci- of his teams at the Department of Psychi- nized as a “model plinary, randomized, controlled clinical atry and at the Philadelphia Veterans Af- program” for the nation. Founded in trial to determine if screening and treat- fairs Medical Center, where he serves as 1938, the association provides leadership ing periodontal disease during pregnancy director of psychiatric research. Thanking and fosters advances in the surgery of is warranted to reduce pre-term births. the people of Amsterdam for the honor, trauma, serving as an intellectual forum Periodontal disease has been linked to O’Brien noted that “Addiction is a mod- for the exchange of knowledge pertaining pre-term birth in numerous epidemiolog- ern problem facing the whole world. We to research, practice, and training in the ical studies. The prevalence of periodon- all have the capacity to become addicted, surgery of trauma. Schwab is also direc- tal disease is highest in under-served and we are all affected by it in one way tor of the Firearm & Injury Center at populations, with some estimates as high or another.” O’Brien holds the Kenneth E. Penn (FICAP). as 40-50 percent. As part of a four-year Appel Professorship of Psychiatry. study, researchers will recruit 1,600 preg- Albert J. Stunkard, M.D., emeritus nant women from under-served areas in Ana Pujols-McKee, M.D., chief med- professor of psychiatry, was awarded the Philadelphia. Women with periodontal ical officer and associate executive direc- 2004 Rhoda and Bernard Sarnat Interna- disease will be randomized either to scal- tor of Presbyterian Medical Center, was tional Prize in Mental Health by the In-

6 ■ PENN MEDICINE New to the Chairs dren’s Hospital of Philadelphia, was ap- Pennsylvania. The students have worked pointed the first holder of the Mary alongside members of the East Parkside Downs Endowed Chair in Craniofacial community to develop an understanding Joseph E. Bavaria, M.D., G.M.E. ’90, Treatment and Research at Children’s of the community’s needs and have provided vice chief of the division of cardiothoracic Hospital. The chair has a term of ten free medical care, social services, and health surgery at HUP, has been named the first years. education. Today, UCC serves over 600 Brooke Roberts-William Maul Measey Jonathan A. Epstein, M.D., a profes- patients per year. In the past year, the stu- Professor of Surgery. Larry Kaiser, M.D., sor in the cardiovascular division of the dents have expanded services to include chair of the department, noted that Department of Medicine and director of hypertension management, HIV/AIDS Bavaria “was integral to the initiation of the Penn Molecular Cardiology Research testing, eye care, and basic dental care. the lung transplant program in 1991 and Center, has been named the first recipi- Gupta herself was also honored last has achieved a national and international ent of the William Wikoff Smith Chair in year as a 2004 Solvay Pharmaceuticals reputation for both himself and Penn Cardiovascular Research. It is supported Student Research Fellow, administered by with his unprecedented work in thoracic by a gift from the W. W. Smith Charitable the Crohn’s & Colitis Foundation of aortic surgery. Dr. Roberts, M.D. ’43, Trust. According to Michael S. Parmacek, America. The fellowships are awarded to G.M.E. ’50, emeritus professor of surgery, M.D., chief of the division of cardiovas- students who will perform full-time men- died in 2003. According to Kaiser, Roberts cular medicine in the Department of tored research on inflammatory bowel “one of the pioneering vascular surgeons Medicine, “Dr. Epstein is considered one disease. Under the supervision of James D. in this region.” of the top 10 investigators in molecular Lewis, M.D., M.S.C.E., assistant professor Scott P. Bartlett, M.D., associate pro- cardiology research in the world. This of medicine and of epidemiology, she is fessor of surgery at Penn and a member honor befits his talents and drive to find studying the association between IBD and of the Department of Pediatric Plastic the causes of common forms of congenital multiple sclerosis. and Reconstructive Surgery at The Chil- heart disease.” A Chairman Departs Effective March 31, 2005, Gillies stitute of Medicine. The Sarnat Prize is in dents from the University of Pennsylva- McKenna, M.D., Ph.D., the Henry K. recognition of the international scope and nia in the West Philadelphia neighbor- Pancoast Professor and Chair of the De- significance of Stunkard’s contributions hood of East Parkside, has received a partment of Radiation Oncology, will step to psychiatry and mental health, particu- $10,000 grant from the Dorothy V. Cas- down as department chair. He has accepted larly for his research on eating disorders. A sard Fund and the Children and Families a position as professor of radiation oncol- pioneer in the field of psychosomatic Fund of The Philadelphia Foundation to ogy and biology at Oxford University in medicine, Stunkard was the first to de- support its expanding services and pro- England. He will also become director of scribe binge eating disorder and night grams. According to Gauree Gupta, a the Gray Cancer Institute and director of eating syndrome and has spent more Penn medical student and one of the the Radiation and Genome Stability Unit than 50 years conducting clinical research medical coordinators of UCC, the funds of the Medical Research Council. on these disorders. In the 1970s, he was would be used for health and social-serv- McKenna joined Penn’s faculty in 1987 instrumental in the development of be- ice programs, medical supplies, commu- and was appointed chair of the depart- havioral therapy for obesity and anorexia nity events, and other general program ment in 1991. In that time, the number nervosa; and in the 1980s he developed support. “With this grant, UCC will be of full-time faculty has grown from eight the most widely used questionnaire to able strengthen the quality and quantity of to more than thirty; the number of pa- assess the psychological aspects of eating services needed by the East Parkside com- tients treated per day has grown from behavior. A former chair of Penn’s Depart- munity. Students will receive the unique about 100 to 300; and research funding ment of Psychiatry, he was the founding opportunity to learn more about respon- to the department has grown from $1.7 director of the Weight and Eating Disorders sive, responsible service for under-served million in 1992 to $9.6 in 2004. Among Program. communities.” the clinical programs that have devel- UCC was started as a collaborative ef- oped and thrived under McKenna’s lead- The United Community Clinics, a fort in 1996 by medical, nursing, and so- ership is the Photodynamic Therapy community health clinic operated by stu- cial work students from the University of Program.

2005/MARCH ■ 7 America Tsai and Wadden, who is di- theSuper-Sized rector of the Weight and Eating By Marie Gehret Disorders Program, found very few studies of the weight-reduc- tion programs that fit their strict scientific criteria. As they put it in the article, “Weight As Americans become more obese, Watchers is the only weight-loss program whose ef- the professionals in Penn’s Weight ficacy has been demonstrated in a large, multi-site, and Eating Disorders Program are randomized trial.” Jenny Craig and L.A. Weight Loss, the other two largest non-medical commercial pro- studying the causes of this trend, evaluating available treatments, and helping their patients lose weight in healthy fashion.

t a session on the Penn campus last spring to discuss “The American Obsession with Weight Management,” Robert I. Berkowitz, M.D., put it plainly: “We’re really in a A worldwide epidemic of obesity.” That may be bad enough, but, Berkowitz added, the obesity comes with “all these myriad diseases,” which can include diabetes, arthritis, sleep apnea, and respi- Berkowitz sees “a worldwide epidemic of obesity.” ratory and heart problems. Furthermore, there are no easy solutions or shortcuts to losing the extra grams in the United States, did not have comparable weight, despite a multitude of competing books, studies. In the case of Weight Watchers, Tsai and programs, and experts, often with large advertising Wadden found that its program “produces a loss of budgets. As Berkowitz put it, when it comes to approximately 5% of initial weight, which may be dieting and losing weight, “most of what you see on sufficient to prevent or ameliorate weight-related TV is bogus.” health complications.” On the other hand, the cost of If that’s the case, what’s a would-be dieter to do? Weight Watchers puts it out of reach of some people. Fortunately, two of Berkowitz’s colleagues in Penn’s According to Tsai and Wadden, “Studies of OPTI- Weight and Eating Disorders Program, Thomas A. FAST and Health Management Resources, of which Wadden, Ph.D., professor of psychiatry in psychology, only 1 was a randomized trial, indicate that these and Adam Gilden Tsai, M.D., instructor of medi- programs included losses of approximately 15% to cine, recently published a study in the Annals of In- 25% of initial weights in persons who complete 3 to 6 ternal Medicine (4 January 2005) that evaluates months of treatment.” They also noted that medically Weight Watchers and several other major com- supervised programs like Health Management Re- mercial diets and self-help weight-loss programs. sources are expensive, more than Weight Watchers – The goal of the study was to provide physicians and that participants are likely to have a weight loss and their overweight patients with the first com- of between 8% to 9% after one year and 5% after prehensive review of these resources – without the four years. In addition, they wrote, those results hype. That such an approach was welcome was “clearly represent a best-case scenario. They do not clear when The New York Times reported on it on include the substantial percentage of persons who the front page of its Tuesday “Science News” did not complete treatment or declined to partici- (4 January 2005). pate in follow-up assessments.”

Photography by Tommy Leonardi Although scientific evidence was scarce 2003. One low-carb alternative to Atkins, when evaluating Internet-based weight- The South Beach Diet book, has sold more loss plans and self-help programs, Tsai than 5 million copies alone. and Wadden believe they may have po- To help sort out the claims and contro- tential and they anticipate additional versy, three of the leading researchers studies. And those kinds of programs are in Penn’s Weight and Eating Disorders much less expensive. As Wadden told Program presented “America’s Obsession USA Today, “People need some social With Weight Management” during last support to bolster them against our fat- spring’s Medical Alumni Weekend. In tening environment. That’s why sometimes An advertisment from the 1920s. addition to Berkowitz, who is medical it helps to join a program, because you rates are projected to double over the director of the program, the pan- have a counselor patting you on the back next 30 years. The increases in overweight elists were Albert J. Stunkard, M.D., or other people encouraging you” (3 January and obesity cut across all age, racial, and emeritus director and founder of the 2005). ethnic groups, as well as both genders. program, and Gary D. Foster, Tsai and Wadden ended their article in From 1962 to 2000, the percentage of U.S. Ph.D., clinical director of the Annals by acknowledging that some health- adults who are overweight or obese rose program and professor of psy- care providers might steer clear of ever sharply from 45 percent to 64.5 percent. chiatry. recommending commercial or self-help Each year, Americans spend $33 billion These three panelists are only a programs because of the “clearly modest” on weight-loss products, and the annual few of the PENN Medicine physicians evidence. As they put it, “such an assess- economic cost of obesity in this country and scientists working on the prob- ment would not relieve providers of the is estimated to be $75 billion to $90 billion. lem of obesity, in several de- need to assist patients with weight control. Nearly 300,000 deaths are associated partments and divisions. Neither practitioners nor their patients can with obesity each year, and it is coming A primary afford to overlook the epidemic of obesity, closer to overtaking smoking as the lead- mission of with its profound health and economic ing contributor to mortality. the new In- consequences.” What has caused this epidemic? There stitute for There’s that phrase again: epidemic of are many theories but few definitive an- Diabetes, obesity. Another Penn expert, Mitchell A. swers: a growing genetic predisposition, Obesity, Lazar, M.D., director of the new Institute carbohydrate-laden diets, super-sized for Diabetes, Obesity, and Metabolism, portions of fast food and cola, sedentary echoed the phrase at the formal announce- lifestyles, or even the decade-long increase ment of the institute in January when he in high-fructose corn syrup, as proposed said, “There is nothing funny about the in a 2003 book? Does the primary re- obesity epidemic and the diabetes epi- sponsibility for preventing obesity rest demic in the country and, in fact, in all with the individuals – or with physicians, industrialized societies” (see pp. 18-20). public health agents, nutritional and fit- So what support is there for using this ness experts, community leaders, schools, grim description? workplaces, urban planners, or food Obesity has become so prevalent in manufacturers and marketers? the United States that many experts are While the debate rages on, many mil- calling it a major threat to public health. lions of Americans have taken matters in At the same time, the news media are their own hands by joining the so-called saturated with idealistic standards of Atkins Revolution and following low-car- thinness and conflicting strategies for los- bohydrate diet plans. Meanwhile, accord- ing weight. ing to Consumer Reports magazine, more The prevalence of overweight and obesity than 1,000 low-carb versions of food has nearly tripled for adolescents over products ranging from ice cream to beer the past four decades, and overall obesity have been introduced since December and Metabolism is to bring these people their natural parents. erhaps as complex as the genetic- together more productively. The Weight and The other longitudinal study, on which environment connection is the Eating Disorders Program, however, has he collaborated with Berkowitz, tracked design and evaluation of treatment been around for 45 years and is under the 33 children of obese mothers and 37 programs for obese patients. umbrella of the Department of Psychiatry. children of thin mothers from birth to P Berkowitz, who last year was Stunkard began the session by posing age 6. Strikingly, at age 6, 30 percent of appointed the Frederick H. Allen Chair of the question: How does psychiatry become the high-risk children had become over- Child and Adolescent Psychiatry at The involved in weight management? weight, with the most significant weight Children’s Hospital of Philadelphia as Explaining that the root cause of obesity increase occurring between the ages of 4 well as executive director of its Behavioral is generally considered to be 70 percent and 6. In contrast, only one of the low- Health Center, has conducted extensive genetic and 30 percent environmental, risk children was classified as overweight research on the efficacy and safety of Stunkard said that the condition comes by age 6. Stunkard said this points to a different modes of treatment for obesity. down to two behaviors: overeating and “strong genetic connection.” The study, He explained that the type of obesity exercising too little. The program, which published in the January 2005 issue of treatment selected often corresponds to uses a behavioral approach to understand- American Journal of Clinical Nutrition, also patients’ body mass index (BMI). BMI is ing and treating obesity, has a dual clinical shows evidence for the activation of body a measure of a person’s weight relative to and research focus and is led by a multi- weight genes at different age intervals. his height and waist circumference. disciplinary team of more than two dozen faculty and staff members who collectively have published more than 25 major pa- pers on weight-related issues just since An Overview on Overweight With Thomas A. the early 1990s. Currently, there are at least eight different research studies under way, spanning the gamut of weight and Is it possible to pinpoint the exact cause(s) of eating topics: behavior modification and an individual person’s overweight (i.e., genetic pharmacotherapy, low-carb diets, adolescent vs. environmental, physiological vs. emotional)? obesity, exercise, diabetes, and sleep apnea. In the vast majority of cases, multiple The program offers a variety of clinical factors interact to cause overweight. Per- services: individualized assessments in sons with a genetic predisposition toward behavior and nutrition, group and indi- obesity will achieve the highest weight in vidual therapy through the PENNSTART countries such as the U.S. Our culture program, bariatric surgery, compulsive explicitly encourages consumption of super- overeating treatment, long-term weight sized portions of high-fat and high-sugar control, and other eating disorder treat- foods. Similarly, our environment implic- ment and referrals. The program strives itly discourages physical activity. The same to assess the causes of a patient’s weight person who is overweight in America problem, determine its medical and psy- might be average weight in a developing chological consequences, and then develop country, simply because the lifestyle is Tom Wadden: a moment of truth? an appropriate plan. not present to support obesity. The dramatic a society which implicitly encourages As Stunkard noted, one way to get at increase in obesity over the past 25 years people to eat in response to negative the root cause of overweight and obesity can only be explained by changes in our emotions. In America, we are encouraged to is to understand the interaction between environment (eating and activity habits). eat in response to all emotions – whether genes and environment. He referred to The gene pool certainly hasn’t changed happy or sad. two authoritative studies on the topic: during that time. the first, which he led in the mid-1980s, Persons with a history of depression How powerful is psychology in the prevention followed 540 Danish twins who were are predisposed to gain weight. Those and treatment of weight management? Can adopted as infants and who, as adults, who gain the most, however, probably an obese person ever be “cured” of obesity? turned out to be very similar in size to have a predisposition to obesity or live in I think the environment is far more

10 ■ PENN MEDICINE Normal BMI is considered from 18.5 to weight loss that is necessary to improve ment, he said that associated health 24.9. For patients ranging from 25 to 29.9, blood pressure, blood glucose levels, and problems – such as lipids, blood pres- the treatment followed by the Weight cholesterol levels. sure, and sleep apnea – improved. and Eating Disorders Program is diet, exer- With behavior modification, which About 40 percent of patients who take cise, and behavior. For those with a BMI usually focuses on changing eating habits weight-loss medications can achieve and greater than 30 (or in the 27-29 range and increasing exercise regimens, pa- maintain a fairly good weight loss, partic- with other risk factors), the treatment is tients do “pretty well,” Berkowitz said. ularly when they follow behavior modifi- pharmacotherapy. And for those with a Behavioral treatment generally results in cation that is designed to improve their BMI greater than 40 (or greater than 35 if a mean weight loss of 9 to 14 percent at eating habits and emphasize exercise. they have an obesity-related disease), the the end of one year. Berkowitz indicated that the gastroin- treatment is surgery. (See Penn Medicine, In comparison, Berkowitz said that pa- testinal drug Xenical (Orlistat), which Spring 2004, for an article on Penn’s tients undergoing pharmacologic therapy blocks the body’s absorption of fat, pre- bariatric surgery program.) average a 7 to 10 percent mean loss after vents about 30 percent of consumed fats Penn’s Weight and Eating Disorders one year. “It’s not much different than the from being digested and results in an av- Program considers it a success when a usual treatment, but it may be different erage weight loss of 8 percent. Side ef- person loses 5 to 10 percent of his body people responding to different treatments,” fects are generally restricted to gastroin- weight. In theory, that is the amount of he pointed out. With both types of treat- testinal discomfort and complications,

Wadden, Ph.D., Director of Penn’s Weight and Eating Disorders Program

important than psychology for preventing means never having to worry about their health risks of excess weight. So, for peo- and treating obesity. We need to create weight management. That’s true even ple who have lost and regained weight environments that make it easier for people with persons who have had bariatric sur- repeatedly, I suggest that they focus on to make healthy eating and activity choices. gery. They must continue to focus on increasing their activity, eating a healthy This includes putting physical activity their diet and physical activity. Maintaining diet, and obtaining regular medical care. back into our schools and work places a significant weight loss is virtually a They may end up being healthier than and providing healthier food choices. part-time job for most people, given the lean individuals with a sedentary Currently, people have to swim against need to exercise about an hour a day and lifestyle. the tide to make healthy eating and activity to eat a low-calorie diet. choices. For many people, that requires Given some of the recent low-carb research an enormous amount of effort. Are people too concerned with their actual conducted by Gary Foster and other re- Psychology places the emphasis on the weight number? Should we be concentrating searchers, do you think the Food Guide individual’s need to make appropriate more on other metrics? Pyramid needs revamping? What evidence (healthy) choices, when surrounded by As a nation, Americans have not been would be needed to make a compelling case so many poor choices. A public health concerned enough about the numbers on for changing the guide? approach to obesity prevention would in- the bathroom scale. Sixty-five percent of I think components of the Food Guide troduce new policies that would create a us are overweight or obese. So, most Pyramid need to be reconsidered. Not all healthier environment, thus making it people need to pay more attention to the fats are bad. People clearly should avoid easier to adopt a healthy lifestyle. Dr. Phil’s scale to prevent the development of over- saturated fats in favor of mono- or poly- approach to weight management, while weight and obesity. unsaturated fats. In addition, not all carbs engaging, is not going to stop the obesity Some individuals have difficulty losing are created equal. Fruits and vegetables epidemic. It focuses too much on individual weight, despite their best efforts. They should be freely consumed, as should responsibility and not enough on public should focus on increasing their physical high-fiber foods. But we could certainly policy. activity. Several studies suggest that phys- cut down on our servings of white bread Few people are cured of obesity, if that ical fitness protects people against the and Philly pretzels. — Marie Gehret which can be reasonably managed with a efficacy data are available. Yet he also of overconsuming carbohydrates, Atkins low-fat diet. suggests that “medication is likely of Nutritionals says, the body’s insulin re- Researchers studying obesity, Berkowitz greatest benefit for long-term mainte- sponse can be impaired, causing hypo- said, are learning more about the parts of nance” and to improve lipid levels and glycemia in the short term and diabetes the brain involved in appetite, including other health outcomes. He also mentioned in the long term. Atkins supporters also the thalamus, hypothalamus, and pituitary that several new weight-loss medications contend that low-carb diets enhance ketosis, gland. From a pharmacologic perspec- are expected to hit the market soon, and which is essentially the body’s “fat metab- tive, medications that block neurotrans- numerous clinical trials are under way. olism.” The premise is that the ketosis mitters in the brain and the re-uptake of process prevents fat from being stored in the chemical serotonin – such as the iven the widespread popularity the body and, instead, is burned for fuel. drug sibutramine (Meridia) – have been of the Atkins Diet and other In fact, it was claims about ketosis that successful in treating classic psychological low-carbohydrate diets, it is not got Foster interested in the topic – the disorders like depression and anxiety surprising that researchers in idea that it enables people “to eat all you and, more recently, in helping weight loss. G Penn’s Weight and Eating Disor- want and not count calories,” which di- Berkowitz and Wadden are co-authors ders have investigated them. According to rectly contradicted what he had spent of the study “Behavior Therapy and Sibu- The American Heritage Stedman’s Medical “most of my adult life counseling people.” tramine for the Treatment of Adolescent Dictionary, “carbohydrate” defines “Any Resolved to set the record straight, Foster Obesity,” which was published in The of a group of organic compounds that in- and his research team conducted the first Journal of the American Medical Association cludes sugars, starches, celluloses, and randomized, controlled study of the (JAMA) in 2003. The randomized, double- gums and serves as a major energy source Atkins Diet. blind, placebo-controlled trial included in the diet of animals.” Of course, this According to Foster, only two studies 82 adolescents ranging in age from 13 to definition cannot explain the fanaticism other than his own had been published 17, with a BMI of 32 to 44. For the first with which some people have sought to comparing the effectiveness of low-carbo- six months of the trial, participants re- reduce carbohydrates in their diet. hydrate and calorie-restricted low-fat diets. ceived either behavior therapy and sibu- At the weight-management symposium, One, published in The Journal of Clinical tramine or behavior therapy and placebo. Gary Foster was quick to dispute three Endocrinology and Metabolism in 2003, in- For the next five months, all participants claims that the Atkins group and other dicated that the low-carb group experi- received sibutramine in an open-label anti-carb camps often make about carbo- enced greater weight loss, lower triglyc- treatment. At six months, the behavior hydrates: erides, and lower LDL (bad) cholesterol therapy and sibutramine group experi- 1. Carbs increase hunger – This has not but, interestingly, there was no relation- enced greater mean weight loss (17.2 been scientifically proven, Foster noted; ship between weight loss and ketones. pounds vs. 7 pounds in the control group) 2. Carbs increase insulin – They should, The other study, led by Frederick and an 8.5 percent reduction in BMI he said, temporarily; Samaha, M.D., assistant professor of (compared to 4 percent in the other 3. Carbs are addictive – “I have seen no medicine at Penn, was published in The group) and reported greater reductions in scientific evidence to suggest that car- New England Journal of Medicine in May hunger. From months seven through 12, bohydrates are addictive,” said Foster. 2003 (ironically, in the same issue as adolescents who continued to use the “They are certainly not addictive in the Foster’s groundbreaking study). Samaha’s medication gained an average of 1.8 classical sense. There is no physiologi- group reported similar findings. For six pounds, whereas those who switched cal evidence such as tolerance or with- months, Samaha and his colleagues at from placebo to sibutramine lost an addi- drawal.” the Philadelphia Veterans Affairs Medical tional 2.9 pounds. In all, about 40 percent To be fair, Atkins Nutritionals, Inc., Center (where he is chief of the cardio- of the adolescents lost 10 percent or discriminates among carbohydrates. vascular division) studied 132 patients more of their starting weight. Atkins claims that highly refined carbohy- who were an average age of 53 years and While reporting the success of sibu- drates – white breads, cookies, chips, weighed an average of 288 pounds. Their tramine, Berkowitz cautioned that weight- soft drinks, and sweets – are responsible patient groups consisted of a high male loss medications should be used in ado- for the “sugar roller coaster” that occurs population with several co-morbidities. lescents and children only on an experi- upon consuming these rapidly digested, Among the low-carb dieters, weight loss mental basis until additional safety and blood-sugar-spiking products. After years was greater (18.5 pounds vs. nine pounds),

12 ■ PENN MEDICINE is to conduct a metabolic ward study. “This cannot be done on an outpatient basis,” he emphasized, because people cannot accurately remember what they eat and generally don’t follow instruc- tions well. “It should get our attention as clini- cians that when we ask [patients] to count carbohydrates, they actually consume fewer calories than when we tell them to count calories.” Gary Foster, flanked by two associates from the Weight and Eating Disorders Program: Angie Makris, P.h.D., R.D. (left), and Brooke Bailer, M.S. For diabetics in particular, nutritional planning requires strict attention to food triglycerides were significantly lower, and greater increases in HDL cholesterol (18 choices, carbohydrate servings, and por- they experienced improvements in insulin percent vs. 3 percent) and greater reduc- tion sizes. Attuned to this matter and the sensitivity compared to the low-calorie tions in triglycerides (-28 percent vs. 1 direct link between obesity and diabetes dieters. percent). However, neither group showed (the Centers for Disease Control and Pre- Foster’s one-year, three-center study significant changes in LDL cholesterol or vention project that one in three Ameri- examined 63 participants (predominantly in insulin sensitivity. cans born in the year 2000 will eventually women) who were an average age of 44 Overall, the study revealed that low- develop adult-onset diabetes primarily years, weighed an average of 216 pounds, carbohydrate diets may be more effective due to obesity), Thomas Wadden is par- and had an average BMI of 33. Penn was and less harmful than most experts antic- ticipating in a 16-site “lifestyle interven- the lead center in the study, which also ipated. The Atkins results are “encourag- tion” for overweight men and women included researchers at the University of ing but preliminary,” said Foster, whose with type 2 diabetes, funded by the Colorado and Washington University. article in NEJM garnered significant at- N.I.H. Researchers already know that As Foster explained, the study was de- tention in both medical and media circles. when diabetics lose weight, they tend to signed to have a “self-help” approach. Yet he also noted that there are limitations become healthier and require less medica- The Atkins dieters were given a copy of of the literature, an absence of long-term tion. Dr. Atkins’ New Diet Revolution and asked results, limited clinical assessments, and In the May 2004 issue of Annals of to follow the diet, which includes a carb a lack of behavioral treatment because Internal Medicine, doctors Linda Stern restriction of 20 grams in the first two his study used a self-help approach. and Frederick Samaha at the Philadelphia weeks with incremental increases in sub- Unable to explain the increase in HDL V.A. published a one-year follow-up of sequent weeks, as outlined in the book. under the Atkins plan, Foster is absolutely the earlier study. The second study found The conventional diet group was pre- certain why the diet resulted in greater no statistical difference in the overall scribed to follow diets of 1,200-1,500 short-term weight loss. “It was calories.” weight loss in the two groups (low-carb calories a day for women and 1,500-1,800 Contrary to popular belief, Atkins di- dieters and low-calorie dieters) after one calories daily for men, which consisted of eters are not permitted to eat all of the year. They lost an average of 10 to 16 60 percent carbs, 25 percent fat, and 15 fat they want in a day. Research has re- pounds from their original weight – and percent protein, as based on the U.S. De- peatedly shown that low-carb dieters lose more than a third of patients in both partment of Agriculture’s Food Guide their weight the old-fashioned way: by groups dropped out. In all of the recent Pyramid. ingesting fewer total calories. studies, cholesterol levels improved in At three months, Atkins participants “It’s energy in, energy out,” Foster ex- both low-carb and low-calorie diets, but lost an average of 14.7 pounds compared plained. “At the end of the day, it comes triglyceride levels were considerably with 5.8 pounds in the conventional down to the number of calories you eat – lower in Atkins, suggesting that risk of group. At six months, Atkins patients that’s in terms of pure weight loss, not heart disease could actually be reduced had lost 15.2 pounds versus 6.9 pounds health outcomes.” He also mentioned when fat is included in the diet and and, at 12 months, 9.5 pounds versus that the only way to credibly evaluate the starches and fine carbs are eliminated. 5.4. Overall, Atkins participants had effects of carbohydrate and caloric intake Longer-term weight maintenance under

2005/MARCH ■ 13 Atkins, however, is on par with conven- and children are overweight or obese. products, and that parents must do their tional diets. Researchers like Foster don’t believe all part to promote “healthy living.” For now, more compelling, long-term of them gained weight because of carbo- According to the National Institute of evidence is necessary to convince most hydrate “addiction.” For Berkowitz, how- Diabetes and Digestive and Kidney Dis- nutritionists, researchers, and physicians. ever, the startling rates of childhood obe- eases, nearly 40 percent of young people Foster is one of the skeptics. At this point, sity can be explained rather simply. “Kids (ages 12-21) report getting no or very lit- he said, “I’m not convinced that Atkins is and inactivity and high amounts of junk tle recent physical activity, and less than the diet that all obese Americans should food are a formula for disaster,” he said. one-third of adults get regular leisure-time be on. I would need at least two years’ He believes that food manufacturers need physical activity (defined as light or worth of credible data and measures of to take more responsibility in marketing moderate physical activity five times or bone, kidney, and lipids.” He also added their high-fat, high-sodium, high-calorie more per week for 30 minutes). Moreover, that the potential long-term effects of low-carb diets on dieters’ cancer risk are not known and are a “real concern.” For Foster, the main issue is whether Night these diet approaches help patients main- tain their weight loss better than conven- tional approaches and whether patients Albert J. Stunkard, sustain better lipid levels and other health M.D., founding director outcomes during weight loss and weight of Penn’s Weight and Eat- maintenance. ing Disorders Program Foster is currently leading another and a former chair of the three-center study with his colleagues at Department of Psychiatry, the University of Colorado and Washing- has many achievements to ton University to further examine low- his credit. Now an emeri- carbohydrate and low-calorie diets. Funded tus professor, he contin- Albert Stunkard considers a full-bodied figure of long ago. by the N.I.H., this comprehensive study ues to do research and spans five years and includes 360 patients. publish his findings. His most Not only does Foster hope to collect more recent book is Overcoming Night definitive data, he would like to explore Eating Syndrome: A Step-by- studied more than 140 NES and control more individual responses to the diets. Step Guide to Breaking the Cycle (New Har- patients combined. With the jury still out on the long- binger Publications, Inc. 2004), written First described by Stunkard in 1955, term safety and effectiveness of low-carb with Kelly C. Allison, Ph.D., a clinical NES is a stress-related eating disorder and low-glycemic plans, Penn’s Weight psychologist who directs Penn’s Night that is associated with disrupted sleep, and Eating Disorders Program is not pre- Eating Study, and Sara L. Thier. At last inconsistent moods, and disordered neu- pared to abandon conventional clinical May’s symposium on “America’s Obses- roendocrine function. It affects an esti- practices or the Food Guide Pyramid just sion with Weight Management,” Stunkard mated 1.5 percent of the general popula- yet. Indeed, Wadden adds reason and presented the gist of the new book. It tion, 9 to 15 percent of obese patients practicality to the debate: He believes draws from leading research on the dis- seen in clinics, and 28 percent or more that the most useful approach for dieters order, including the 2004 Penn study of severely obese patients, many of whom is to “consume a diet of foods that [they] “Clinical Characteristics of the Night Eat- have been evaluated for surgical treatment. like, but to reduce sizes.” ing Syndrome: Findings From a Con- NES can afflict both men and women, trolled Study,” which Allison and and men represent more than 40 percent s physicians continue to investi- Stunkard conducted with John P. O’Rear- of all night eaters – an interesting gender gate – and disagree – and con- don, M.D., assistant professor of psychia- trend that differs from many other eating sumers continue to count carbs, try, and David F. Dinges, Ph.D., professor disorders, such as anorexia and bulimia, the fact remains that more than of psychiatry and chief of the section on which overwhelmingly affect women. A 200 million American adults sleep and chronobiology. In all, they have Night eaters often skip breakfast and

14 ■ PENN MEDICINE researchers at the Harvard School of Public Wadden is examining the benefits of a proach,” Berkowitz argued. “As people Health have found, based on the Nurses’ structured exercise program for the treat- get heavier and heavier, their risk for pre- Health Study, that about 30 percent of ment of overweight; Gary Foster is look- mature death goes up, and I think this is new cases of obesity and 43 percent of ing at the effects of a two-year school- the reason why we should all be concerned new cases of diabetes could be prevented based obesity prevention (nutrition and about obesity.” if people adopted a relatively active exercise) program on the prevalence of For its part, Health and Human Services lifestyle, including walking briskly for at obesity among middle-school children in announced in July 2004, on the heels of least 30 minutes a day and watching tele- Philadelphia; and Robert Berkowitz is unveiling its calorie-counting strategy, a vision for less than 10 hours a week. continuing to study adolescent obesity as change in Medicare and Medicaid policy Setting themselves against these un- part of an N.I.H. grant. manuals that would allow for the reim- healthy patterns of inactivity, Thomas “We must take a public health ap- bursement of some obesity-related med- ical expenses. HHS ruled that certain obesity-related conditions should be cov- ered by medical insurance, although the Eating Syndrome department was not ready to classify obe- sity as a “disease.” According to Wadden, one of the diffi- wait until the afternoon to eat for the only 5 percent of first-degree family culties in maintaining weight loss comes first time. Typically, their interest in food members of the controls were affected. down to dieters’ expectations. During the returns at dinnertime, when they tend to Still, Stunkard contends that the interac- dieting phase, dieters are encouraged and consume large meals and continue eating tion between genes and environment that reinforced by seeing the physical change into the night. Then, having trouble occurs with obesity and any behavioral in their bodies and by receiving compli- falling asleep, they wake up shortly after disorder is also true for NES. For example, ments from family and friends. During falling asleep and a few times thereafter. he noted that social class, which has a the maintenance period, however, these “These awakenings are quite fascinating,” strong environmental influence on obesity, reinforcements cease, so they must find said Stunkard. “People awake, eat, and can have a notable impact on NES as well. rewards in other ways. In addition, fat go back to sleep within 20 minutes.” The stressful environments often associ- cells never completely disappear, only Stunkard maintains that night eating ated with low social class can provide the shrink, after weight loss, which could leads to obesity in patients – not the re- stimulus for night eating in those who mean that dieters are never totally able to verse. In the Penn study, approximately are genetically vulnerable. achieve the body of their dreams. half of all overweight night eaters were of According to Stunkard, individualized It is important “to underscore how normal weight before they started night cognitive therapy can help patients take desperate overweight people are to lose eating. He also points out that depression control of their dysfunctional thoughts. weight,” Foster said, “and it’s not because is common among night eaters, and 45 Another promising treatment involves of their failure or because of some moral percent of NES patients in the Penn sertraline (Zoloft). In a 12-week open-label flaw. It’s because our treatments are large- study had a major bout of depression trial of sertraline vs. placebo, which ly ineffective in the long term, short of sometime in their lives. In night eaters, O’Reardon published with Stunkard and surgery. I think we have to acknowledge depression appears to worsen as the Allison in the January 2004 issue of the that . . . and we need to start thinking night progresses; as Stunkard put it, this International Journal of Eating Disorders, about multiple treatments.” finding is “very striking because most the total nighttime awakenings of NES And while some experts like Wadden forms of depression show improvement patients decreased by more than 50 per- consider it better to have lost and regained in the evening.” cent. In addition, their snacking after than not to have lost at all, the fact re- Based on their research, Penn re- awakening was reduced by two-thirds mains that obese Americans need the searchers have discovered that NES is a and the total number of calories consumed proper help and guidance – and validation. familial disorder. They found that 17 after dinner dropped by 50 percent. “I think there’s really a bias against obe- percent of all first-degree relatives (par- Stunkard indicated that a current double- sity as a disease,” Berkowitz insisted during ents, siblings, children) of NES patients blind trial of sertraline with 28 patients is an interview on National Public Radio. “Obe- were also affected with the disorder, while showing “very strong results.” — M. G. sity is as real a disease as any other.”

2005/MARCH ■ 15 Nicole Gaddis

Penn Launches O

Screens galore: Heather Smith, R.N., at the workstation.

ach year, almost five million pa- the forefront of cutting-edge technologyONfor the technology at HUP and Pennsyl- tients are admitted to intensive focused on quality and patient care,” says vania Hospital, and Presbyterian Medical care units in the United States, C. William Hanson III, M.D., the professor Center will be brought on line in the next and more than 500,000 of these of anesthesia who serves as medical di- several months using additional funding. E patients die. Studies reveal that at rector of the Penn E-lert program. “We’ll least one in ten patients who die in ICUs set the mark on how to bring ICU care A New Level of Care every day would survive if intensivists – into the future, while at the same time enn E-lert features real-time data, physicians who are board-certified in enhancing patient care.” audio, and video monitoring of critical-care medicine – were present in Penn E-lert has gone “live” in ICUs at ICU patients from one central the ICU and managing their care. the Hospital of the University of Pennsyl- command center – seven days a Providing this level of expertise and vania and, for a brief testing period, at P week, 365 days per year. Located knowledge around the clock electronically Pennsylvania Hospital. The system is ex- in a suite at 3440 Market Street, the is the next step in the University of pected to cover all adult ICU beds in the command center is at least four blocks Pennsylvania Health System’s commit- Health System, including those at Presby- away from the patient beds it is monitor- ment to improve patient care. In Novem- terian Medical Center, within 24 months. ing. The aim of the center is to supplement ber, it launched Penn E-lert, which per- UPHS is the first health system in the the on-site care provided in the ICUs by mits coverage of ICUs that is, paradoxi- Pennsylvania, New Jersey, and Delaware critical-care doctors and nurses, especially cally, both remote and “live.” The eICU area to go live with this new technology. during off hours, such as nights and technology, a patented product of Balti- “UPHS has already made a significant weekends. more’s VISICU, Inc., enables critical-care commitment to implement evidence- Currently, the command center houses intensivists to cover their patients based medicine to assure the highest- two workstations that Hanson says are through a comprehensive telemedicine quality and safest care,” says Patrick J. capable of covering the approximately 120 system that includes early-warning soft- Brennan, M.D., professor of medicine ICU beds at the three hospitals. According ware, order entry, clinical decision sup- and chief of Health-care Quality and Pa- to Hanson, “One intensivist and two critical- port, electronic documentation, and re- tient Safety for UPHS. “This new technol- care nurses will cover between 50 and 75 mote physiologic monitoring. Like an air- ogy provides us with an opportunity to beds remotely.” traffic control center, the system provides take patient safety and quality to the next Each work station comprises five screens. assistance and guidance to the attending level.” One displays the patient’s medical record, doctors, residents, and nurses in the hos- Part of that commitment, of course, is another has bedside monitor information, pital ICUs. financial. According to Hanson, Penn’s and a third offers access to hospital infor- “This new initiative brings UPHS to Health System has spent close to $3 million mation, such as Sunrise or Navicare. An-

16 ■ PENN MEDICINE Sally Sapega

On-line Critical Care

The Penn E-lert screen shows a patient’s room.

LINEother is a “smart” alert system that tracks a former ICU nurse on Rhoads 5 who addition, there’s no capability for making a patient’s condition based on vital signs, now works at Penn E-lert’s command video or audio recordings. test and lab results, and imaging informa- center, “After the training, many of the Over time, the system is expected to tion. “The limitation with physiologic nurses were excited. I think it will be lower health-care costs through reduced monitoring is that it gives a five-second comforting to know that there’s another mortality and length of stay in the ICU. window of data, not a trend,” Hanson ex- experienced nurse looking after the pa- According to an independent study of plains. “This system combines all the tients, an extra layer of care.” Sentara Norfolk General Hospital in Vir- data and provides evidence-based recom- ginia, using the eICU system from mendations.” Security On Many Levels VISICU reduced intensive-care mortality While Penn E-lert provides constant linically, Penn E-lert will fill two rates by 25 percent and shortened the vigilance via these information screens, essential roles. First, it will help average length of stay for these patients the system also has an audio/video screen prevent adverse events by pro- by 17 percent. Arnold Milstein, M.D., a that provides visual access to the patient’s viding real-time information for founder and quality expert for the Leapfrog room. According to Heather Smith, R.N., Cthe health-care staff to use in Group, a Washington-based consortium the operations manager of Penn E-lert, their patients’ care. As Hanson puts it, of large companies that are seeking to “we can ‘camera-in’ with the speaker off “The cycle time between information and improve medical quality, also speaks to do an assessment without disturbing correction will be much shorter, and this highly of the online system. As quoted in the patient.” is what intensivist care needs.” a VISICU release, he said that using in- The patient automatically knows when Second, the system will also help in formation technology strategically “can the camera is “on” because it turns to face the non-emergency decisions that are help hurdle health-care labor shortages the patient’s bed. An audio signal – sound- part of day-to-day patient care. “A patient and deliver breakthroughs in patient safety ing like a door bell – also alerts both the might be ready to be taken off a ventila- and health-care affordability.” patient and the health-care provider that tor but a staff person might be hesitant, At HUP, Hanson emphasizes that the camera is on. especially if it’s during the evening or Penn E-lert “can’t replace bedside care, The staff in the ICUs can just as easily night shift,” explains Smith. “An extra set but, as an extra set of eyes, it can help communicate with the command center. of trained eyes could help. We make de- eliminate preventable medical mistakes A dedicated phone line and an e-ICU terminations as a team.” and will serve as an added comfort to button in each patient’s room provide im- Penn E-lert also meets all H.I.P.A.A. patients’ families. They’ll know that mediate access to the Market Street site. recommendations. A high level of elec- someone is always watching over their All ICU nurses have received Penn E-lert tronic data security ensures that all patient loved ones.” training. According to Kami Schaal, B.S.N., information is secure and confidential. In — Ed Federico and Sally Sapega

2005/MARCH ■ 17 INSTI- tutional

Parmacek FitzGerald Ad- va

3 Rubenstein Lazar

he lobby of the Clinical Research Building was packed with department other centers and institutes on campus, chairs, directors of centers and institutes, faculty members, administrators, the three new institutes will emphasize even some members of the board of PENN Medicine. A few white coats were cooperation, partnership, and combina- sprinkled among the elegant suits. It was late afternoon, a fitting time for tion of efforts. Not only do these new ini- T light refreshments. The event was special, but since CRB is a site where the tiatives spring directly from PENN Medi- pace of work rarely flags, those who gathered for the scheduled announcement occasion- cine’s strategic plan, the collaborative spir- ally heard the squeak of the front door as people came and went. Undaunted, Arthur it is also much in keeping with the re- H. Rubenstein, M.B., B.Ch., executive vice president of the University of Pennsylvania cently developed “Roadmap” from the for the Health System and dean of the School of Medicine, welcomed the audience. National Institutes of Health. “This afternoon,” he said, “we have an institutional event in more senses than one: In setting the context for the new in- stitutes, Rubenstein referred to the work the occasion is the announcement of three new institutes, which I suspect is unprece- of committees that laid the groundwork. dented even at Penn.” The three he announced were the Penn Cardiovascular Institute; For example, a report on the need for a the Institute for Diabetes, Obesity, and Metabolism; and the Institute for Translational cardiovascular institute noted that, de- Medicine and Therapeutics. Rubenstein and Ralph W. Muller, the CEO of the Health System, spite a multitude of excellent clinicians explained the rationale for the three institutes. Then the new directors briefly shared and researchers, “the work of these dis- their views. tinguished individuals does not collec- The setting for the January announcement was appropriate, because all three of the tively show our institution to the greatest institutes will be housed in the Clinical Research Building. As Rubenstein put it, “al- advantage.” That observation, Rubenstein though only one of the three new institutes has the word translational in its name, all said, could apply to other medical fields three share a general impulse to bring the fruits of research to the patient as swiftly as well. Concluding his remarks, Ruben- and safely as possible. All three will be doing what centers and institutes can do more stein quoted from the vision articulated effectively than loose confederations of investigators – that is, encourage the interac- at the beginning of the “Plan for PENN tions among researchers, physicians, trainees, and students more systematically.” Medicine”: Noting Penn’s tradition of fostering research that cuts across departmental, disci- “To benefit from the opportunities that plinary, and even school lines, Rubenstein continued, “We have so many centers and lie ahead, greater collaboration among re- institutes on campus because we have found them to be an effective structure in ad- searchers, clinicians, and educators is re- vancing our research, clinical, and educational missions.” He noted that, as with the quired; and in particular, the collaboration

18 ■ PENN MEDICINE that springs from a mutual appreciation Muller praised the three new directors: of respective and complementary skills.” Michael S. Parmacek, M.D., director of the Strengthening the interrelationships at Penn Cardiovascular Institute; Mitchell the intersections of research, patient care, A. Lazar, M.D., Ph.D., director of the In- and education, he continued, “presents stitute for Diabetes, Obesity, and Metabo- Muller tremendous potential for the prevention lism; and Garret A. FitzGerald, M.D., di- Photos by StuartWatson Photos by and cure of disease and improvement in rector of the Institute for Translational the human condition.” Medicine and Therapeutics. “You are Clearly, the three new institutes are in- wonderful – and forceful – colleagues,” tended to foster and benefit from that kind said Muller. “In your own distinguished of collaboration. But why these three? The work in your respective fields and in your ancements leaders of PENN Medicine acknowledge proven leadership at Penn, you have Already the home of several that resources have to be used judicious- demonstrated a devotion to the best ly – as Muller put it a few minutes after qualities of academic medicine. . . . These widely respected institutes Rubenstein had finished, “We often have institutes represent not just physical and centers, PENN Medicine to make difficult decisions.” But Muller space, but a big idea whose time has expects three new interdisci- went on to say that the areas targeted by come – and you are the best people to the three new institutions “represent high put it into action.” plinary institutes to help it priorities for PENN Medicine. . . . These Parmacek, the Herbert Rorer Professor realize more of its tremendous institutes allow us to focus our strengths of Medicine and chief of the division of in these important areas of medicine and cardiovascular medicine, was the first di- potential for preventing and do so in a way that supports our faculty rector to speak. Citing the breadth and curing disease. and benefits our patients.” quality of faculty involved in cardiovas- cular research and medicine on the campus, Parmacek asserted that Penn “is uniquely positioned to address the ongoing epi- Penn Cardiovascular demic of cardiovascular disease around Institute: First Steps the world.” And the need for the best in research and care is evident, as shown by the grim statistics Parmacek recited: 16.7 Michael S. Parmacek, M.D., director of iv. Channel Biology/Cardiac Electrophys- million people around the world die each the Penn Cardiovascular Institute, out- iology; and year from cardiovascular diseases; by the lined some crucial early steps that the in- v. Cardiovascular Imaging/Bioengineering/ year 2020, heart disease and stroke will stitute will be taking. Nanotechnology. pass communicable diseases as the lead- The first step is to establish the Penn Third, to promote communication ing cause of both death and disability Cardiovascular Disease Institute Advisory among disciplines by establishing a com- around the world; cardiovascular disease Council, which will be composed of munications office and a Cardiovascular is the greatest single cause of mortality leaders in cardiovascular science, medi- Institute web site. (The model Parmacek among women. cine, and engineering from across the cited was OncoLink, which serves the As if echoing Rubenstein’s opening University. Abramson Cancer Center so well.) comment about the importance of trans- Second, to establish multidisciplinary Fourth, to establish an Office of Regu- lational medicine, Parmacek summed up working groups in strategically targeted latory Affairs and Industrial Relationships to the mission of the Penn Cardiovascular areas, including: assist investigators taking part in patient- Institute thus: “to translate knowledge in i. Atherosclerosis/Preventive Cardiology oriented research. cardiovascular biology and medicine across ii. Cardiovascular Development/Con- Fifth, to provide the necessary infrastruc- the University and Health System, and to genital Heart Disease ture and core laboratories required to create a culture where cardiovascular re- iii. Myocyte Biology and Heart Failure promote translational research. search and patient care are indeed truly and Transplantation one integrated mission.”

2005/MARCH ■ 19 Lazar, the Sylvan H. Eisman Professor notions without the investment made of Medicine and Genetics and chief of possible by his imaginative development the division of endocrinology, diabetes, of the Health System.” and metabolism, also cited some sober- Surprisingly, although his institute is ing statistics to explain the need for the called the Institute for Translational Med- new institute he directs. As he put it, “there icine and Therapeutics, FitzGerald was in is nothing funny about the obesity epi- some ways the most cautious on the topic. demic in the country and, in fact, in all The national importance of translational industrialized societies.” Overweight chil- great promise in working with the Uni- research, he acknowledged, is great. “Yet, dren are now in the majority in Philadel- versity’s other schools, noting that Stella L. for all the talk, we are not very good at it.” phia; and one out of three children born Volpe, Ph.D., R.D., of the School of Taking one of his own areas of expertise in the United States in the year 2000 will Nursing will be helping to “catalyze col- as example, he said, “Academic medicine develop diabetes in his or her lifetime. laboration across the schools.” Lazar, too, had lost, in large part, the skills of drug The mission of the new institute “is to touched on the translational theme: The discovery and development.” The old in- play a leading role in understanding the goal of all three institutes “is to reduce dustrial model “is now in crisis.” causes of diabetes and obesity – from the barriers we face in translating our sci- “Despite unprecedented investment in genes to behavior to the environment – entific discoveries into therapies.” novel approaches to target identification and to use this knowledge to develop The last director to speak was Garret for drug development, the number of new ways to prevent, treat, and even FitzGerald, chair of the Department of new drugs approved has been in decline cure these diseases and their complica- Pharmacology and the Robinette Foun- and public confidence in the industry tions.” Like Parmacek, Lazar described dation Professor in Cardiovascular Medi- and the F.D.A. has plummeted. Perhaps Penn as “a perfect place to take this on cine. After praising Rubenstein’s vision there lies, within this crisis, an opportu- with a comprehensive and collaborative for Penn, he also thanked Muller: “These nity for academic medical centers to reas- approach.” Lazar also underscored the institutes would remain philosophical sume a role, in partnership with or, in some cases, in competition with the for- Institute for Diabetes, Obesity, and profit sector in drug discovery and devel- Metabolism: Four Units opment – translational therapeutics, if you will. But first we have to relearn how In describing the structure of the new Birnbaum, M.D., Ph.D., the Rhoda and to do it. . . . The challenges are organiza- Institute for Diabetes, Obesity, and Me- Willard Ware Professor of Diabetes and tional, fiscal, and cultural.” tabolism, Mitchell A. Lazar, M.D., Ph.D., Metabolic Disease and a Howard Hughes But Penn, of course, loves a challenge, the director, identified its four interacting Medical Investigator. Both of the diabetes and the three new institutes and his in units. Each unit is devoted to a major units are expected to benefit from the particular will attempt to do what FitzGerald disease, and each is directed, in Lazar’s Rodebaugh Diabetes Center, under the envisions: “try to increase the feasibility words, by “an internationally recognized direction of Mark Schutta, M.D. of pursuing translational research” and leader.” The obesity unit is led by Thomas A. “increase the size of the community of The unit dedicated to Type I diabetes Wadden, Ph.D., professor of psychology investigators with the skills to pursue (also known as Juvenile Diabetes) is di- in psychiatry and director of the Weight translational research at Penn.” FitzGerald rected by Ali Naji, M.D., Ph.D., the J. and Eating Disorders Program, whom likened the challenge to that of dreaming William White Professor of Surgical Re- Lazar described as one of the world’s up and then constructing some of the search. According to Lazar, Naji’s pio- leading experts on obesity. glorious buildings of ancient Rome and neering transplants of whole pancreas Daniel J. Rader, M.D., associate profes- Renaissance Italy – a “hugely ambitious” and insulin-producing cells have the sor of medicine, whom Lazar called “one undertaking. promise to cure Type I disease. of the great translational cardiovascular “The stakes are high,” he said, “but suc- The unit dedicated to Type II diabetes – researchers in this country,” heads the fourth cess would leave an impact on American by far the most common kind of diabetes unit, focused on cardiovascular metabolism health care which was both lasting and in the world – is directed by Morris J. and complications. fundamental.” — John Shea

20 ■ PENN MEDICINE or four decades and more, the Although “Gothic” frequently refers to a FPhiladelphia Antiques Show has style of architecture or literature, the loan nursed a grand ambition: to serve as a exhibition will showcase examples of fur- major fund-raising event for the Hospital A niture and decorative arts from that period, of the University of Pennsylvania and the GOOD KIND both from this region and elsewhere. It is University of Pennsylvania Health Sys- a style in which arches, columns, and tem. Each year, the organizers select a re- OF AMBITION crests are in abundance, and a mere ink cipient for the proceeds of the show, which bottle can bear medieval-looking images are used to advance patient care. Last of the apostles. year, for example, the Philadelphia An- ray of disorders of the digestive and res- Ably organized by a committee of more tiques Show was able to raise more than piratory tracts. The Center’s goal is to than 250 volunteers, this year’s show will $735,000 for the Ultrasound Section of purchase state-of-the-art endoscopy feature the wares of 56 of the nation’s HUP’s Department of Radiology. The for- equipment, including a digital x-ray system, leading antiques dealers. The Haverford tunate recipient of this year’s show will which will allow for real-time patient Trust Company is the presenting sponsor. be the Division of Gastroenterology – evaluation and treatment. And if the Center’s Beginning with a preview gala on Friday, specifically, its Endoscopy and Imaging ambition is to be among the very best in April 8, the show runs though Tuesday, April 12. Center, which performs more than the world, who would fault it? As usual, it will take place in the Armory 10,000 procedures a year for a wide ar- The loan exhibition for the 44th annual at 33rd and Market streets in Philadelphia. show is called “Vaulting Ambition: Goth- For tickets, brochures, group rates, and ic Revival in Philadelphia, 1830-1860.” information on guided tours and special events, call (215) 387-3500 or visit the show’s web site at www.PhilaAntiques.com.

Clockwise from upper left: Stoneware Water Pitcher. Staffordshire, 1842- 1870. Glazed stoneware. Private collection. Joined Side Chair. Probably Philadelphia, 1845- 1860. Mahogany and mahogany veneer, with tulip poplar. Private collection. Glass Water Pitcher. France, 1830-1850. Private collection. Cane Side Chair. Philadelphia, 1845-1860. Walnut and walnut veneer, with maple. Private collection.

Center: Ink Bottle. United States, 1860-1890. Cobalt glass. Private collection

2005/MARCH ■ 21 Development Matters

Scholarship Support Increases that it doesn’t hinder students from off student loans for most of their Access, Ensures Competitiveness working in public health, primary working years. care, global medicine, and pediatrics? • In recent years, physician incomes t her October inauguration as “Many more students apply for aid,” have increased only slowly – and Penn’s president, Amy Gutmann, says Gaye Sheffler, director of admissions have trended slightly downward in Ph.D., invited her audience to and financial aid at the School of Medicine, constant dollars. join with her in a new “Penn “but we don’t have the resources to give • Since 1987, more than 60 percent of A Compact.” Its first priority: in- them all scholarships. Most of our aid medical students have come from creased access to education. comes in the form of loans. And students families in the top quintile of family “The excellent education we offer must are telling us that they’re making school income – and less than 3 percent be more accessible,” said Gutmann. “We selections based on their projected amount from the lowest quintile. must make a Penn education available to of debt, as well as on the school’s educa- • In a recent national survey for the all outstanding students of talent and tional programs.” AAMC, cost was cited most often (by high potential. In a democracy and at Penn is not alone in facing these issues. 33 percent) as the factor that deterred great universities, diversity and excellence Medical school tuition – here and across academically qualified minority stu- go together. Keeping them together requires the nation – is rising faster than inflation. dents from applying to medical access based on talent, not income or race.” The sheer volume of information doctors- school. Cost was fourth on the list of There’s no question that Penn’s School to-be must master has expanded expo- deterrents for majority students. of Medicine, ranked 4th in the nation in nentially in the last 20 years. New technolo- Among students who graduated in 2002, the most recent survey by U.S. News & gies have greatly improved both medical 32 percent indicated that their level of World Report, offers an excellent education. care and the management of information, debt influenced their choice of specialty. Some 5,000 students competed for slots but at the same time have increased the The latest match conducted by the Na- in this year’s class; 242 were accepted, cost of medical education. Student debt tional Resident Matching Program shows a and three-fifths of those matriculated burden continues to spiral upward, career continuing decrease in the number of med- here. Top faculty, Penn’s combined degree choices are trending toward higher-paying ical students pursuing careers in primary programs and integrated campus, a unique specialties – and many students, especially care and an increase in the numbers curriculum, a diverse and collaborative minorities, wonder whether financial gravitating toward radiology, orthopaedics, educational community, and excellent considerations make medicine an impossible ophthalmology, and dermatology, all of mentoring are just a few of the reasons career choice. which offer higher discretionary incomes. they give for turning down other superior In addition, as the number of medical- Sheffler puts it bluntly: “To attract a schools. school applicants declines – from 47,000 highly qualified, diverse group of students This year, the School of Medicine in 1996 to 34,500 in 2004 – competition to Penn, who will take advantage of our awarded $4.9 million in scholarships to for the most gifted students becomes even educational opportunities and lead tomor- approximately 250 students, ranging fiercer. row’s health-care work force, we need to from $5,000 to full tuition ($35,690). In March 2004, the Association of have strong financial aid packages, em- These figures place us in the middle of American Medical Colleges documented phasizing scholarships and minimizing the pack, in terms of scholarship compar- disturbing national trends in a study debts.” At Penn, she adds, “We’ve been isons among our peer medical schools. called Medical School Tuition and Young fortunate to have many generous contrib- But is it enough – Physician Indebtedness: utors to the financial aid program. But • to compete successfully for top students, • Since 1984, median tuition and fees we need others to follow their great example, when some schools have twice as at private medical schools have increased as long as the cost of medical education much scholarship funding? by 251 percent (50 percent in constant is rising, students’ debt burden increases, • to maintain and increase diversity, dollars). and many students aspiring to become enriching our educational environ- • The median debt for a private medical- physicians choose other careers because ment and helping to produce a school graduate in 2003 was $135,000. of the cost.” physician work force more representa- If tuition increases continue, this figure tive of the population? is projected to grow to $158,000 for • to keep debt burden low enough 2007 graduates. Many will be paying

22 ■ PENN MEDICINE Marjorie Ernest Supports a Scholar – and Finds a Friend

mind is a terrible thing to “ waste” is a sentiment that res- onates deeply for Marjorie Ernest, a 1956 graduate of A Penn’s College of Women. “I knew it would give me tremendous pleasure to help someone with a good mind get a good education,” she says of her decision to fund a four-year, full-tuition, need-based scholarship to the School of The First Recipient: Becca Newlin Hutchinson (right) has a friend and supporter in Marjorie Ernest. Medicine. Becca Newlin Hutchinson, now in her third year of medical school, were military scholarships available, but practice, and he never took vacations be- is the first recipient of the Richard B. and Hutchinson, who was raised as a Quaker cause he was unwilling to entrust his pa- Marjorie G. Ernest Scholarship. Yet Mar- and attended Swarthmore College, was tients to other doctors. Her mother, trained jorie Ernest discovered that not only had unwilling to become part of the armed as a massage physiotherapist, worked she enabled a deserving student to get a forces. Other scholarships she could have with him. world-class medical education, in a manner applied for would have required her to “My father would carve the Thanksgiving that honors her father’s medical career practice in specific fields. turkey, and in the middle of all these won- and alma mater, she had also made a While she is deeply grateful for the finan- derful smells, he would say, ‘this is the close friend. cial support, Hutchinson says that the aspect such and such nerve,” Ernest remembers “I met Becca on October 11, 2002. We of this scholarship that touches her most with a laugh. Dr. Ernest died in 1983; met at the Faculty Club at the Inn at Penn on a day-to-day basis is her relationship Mrs. Ernest, in 1988. for lunch, and we instantly bonded,” Ernest with Ernest. The wedding sampler that When it came to the mechanics of creat- says. “She’s very down to earth, very sweet, Ernest cross-stitched for the young couple ing the full-tuition scholarship fund, Ernest and has a great sense of humor. She’s really hangs prominently in their apartment. was pleased with the way PENN Medicine’s become part of my life.” “It is great to have someone who is development officers made it possible for With the demands of Hutchinson’s championing my cause, who offers un- her to spread her sizable contribution medical studies, she and Ernest keep in conditional support and understands out over several years. “They worked touch primarily through a constant ex- how hard medical school is,” Hutchinson with me to set up a payment schedule change of cards and letters. Ernest was says. that wasn’t so difficult,” she notes. Ernest an honored guest at her 2003 wedding to Ernest was inspired, in part, by the is also gratified when she hears recipients classmate Pete Hutchinson, and last year scholarships that Anne and Walter Gamble, of her family’s scholarships talk of one day Ernest took the couple as guests to the M.D. ’57, have created. She also saw this supporting School of Medicine scholar- Medical Alumni Society’s brunch and to as a way to express her love and respect ships themselves. the Franklin Institute’s exhibition on the for her father, Richard B. Ernest, C’13, As Ernest puts it, “To know that a Titanic. She also sends occasional care M.D. ’15. Her mother, Lydia Ernest, cre- scholarship you have provided can make packages of deluxe steaks, fruits, and ated the Richard B. Ernest, M.D, Class of a seemingly unattainable dream become such – welcome treats for students on a 1915 Scholarship Fund in 1987 to help reality, or to know that endowed money tight budget. support fourth-year medical students to be given as a gift or prize will ease the For her part, Hutchinson says, “This planning to specialize in orthopaedics. financial burden of a graduating student, scholarship meant a lot in terms of enabling But Marjorie Ernest wanted to honor her is the most rewarding, satisfying feeling me to choose Penn, and it makes a big father in her own way. in the world.” And, she adds, everyone difference in my career choices. I grew “We were really a medical family,” says benefits. “You think about what you up in Philadelphia and feel a commitment Ernest. Family life revolved around her could do, and then do it,” she says, to serving inner-city communities.” There father’s dedication to his private orthopaedics adding firmly, “You will never regret it.”

2005/MARCH ■ 23 Development Matters

Scholarship Support: Intrigued by an experience so close to her own interests, she delved further and Jordan Scholar Scarlet Soriano liked what she saw of Penn’s minority Reaches Out to Teens community, innovative curriculum, and opportunities for community service. Soriano Reaching out to those who are needy, notes that Stanford University offered marginalized, and underserved comes as Rowinsky and her more in scholarship naturally as breathing to Scarlet Soriano. aid; but Penn came close enough that the She grew up in poverty, first in the Domini- couple felt it was worth a small financial can Republic, where she lived until age 14, tradeoff to go with their first-choice and then in Brooklyn, where her mother, school. “The Jordan Scholarship made all aunts, and uncles worked in factories. It the difference,” she says. Henry A. Jordan, was an undergraduate year she spent in M.D. ’62, G.M.E. ’67, a trustee of PENN South Africa, where she studied the impact Medicine, and his wife, Barbara, have es- of apartheid on health-care infrastructure tablished scholarship funds that provide and worked as an HIV/AIDS health educator, support for several medical students. that set her on the path to medical school. They also contribute to the Medical Class “I feel an absolute commitment to im- of 1962 Scholarship Fund and to many proving the fate of my community,” says other initiatives of the Health System and Soriano. “The pride that my family feels, the School of Medicine. that I am their emissary, walking the halls Scarlet and cousins. At Penn, Soriano has become involved of Penn – it gives me goosebumps.” with Covenant House Pennsylvania, one A second-year student in the School of get past the obstacles to better health, of a nationwide network of centers serving Medicine, Soriano is also the recipient of such as homelessness, domestic violence, homeless youth. She also volunteers with a full-tuition Jordan Scholarship. Thanks and addiction. Penn’s chapter of Boricua Latino Health to that support, Soriano knows she will When they first applied to medical schools, Organization, working to improve re- be able to serve inner-city communities, Soriano and Rowinsky cast a wide net, cruiting among Latino students. armed with a world-class medical degree and both were very impressed when they “All these experiences have really – but without a crushing debt burden to visited the School of Medicine. “My student helped me lay out my plans for the fu- derail those dreams. Her husband and interview was fantastic,” she says. “I met ture,” says Soriano. She intends to spe- classmate, Peter Rowinsky, who plans to with a fourth-year Latina student who cialize in adolescent medicine and practice medicine with migrant workers, was doing an HIV/AIDS research project would like to be part of – or create, if is partially supported by a Medical Class in the Latino community.” she has to – a community organization of 1944 Scholarship. that would deal with the comprehensive On her journey to PENN Medicine, needs of teens at risk: employment Soriano earned an undergraduate degree training, education, family therapy, and in anthropology from Princeton University, health care. with a concentration in medical anthro- Soriano speaks frankly about the role pology; lived a year in her native Domini- tuition, scholarship aid, and debt play in can Republic, doing HIV/AIDS work and the decisions minority students must sharing authorship of a United Nations make about medical school: “I think a lot paper on the status of women; and served of minority students are much closer to three years as a bilingual guidance counselor poverty – no more than a generation in an inner-city high school in Boston. away – than many whites. We often have Then she worked for a year doing com- responsibilities beyond tuition and basic munity outreach and advocacy with Pre- living expenses.” In her own case, she vention and Access to Care and Treatment notes, “I have been involved with the (PACT), which helps HIV-positive people Scarlet and Peter. support of my family since I was 18 and

24 ■ PENN MEDICINE am responsible for a major portion of my UPCOMING EVENTS Medical Alumni Weekend mom’s support since she became disabled May 13-15, 2005 due to lupus and a stroke.” Visit our website at www.med.upenn.edu/ For medical alumni celebrating their re- A recent report by the Institute of alumni for more details, times, and locations, union (classes ending in 0 and 5) and all Medicine found that although Latinos or call 215-898-5164 and ask to speak with other medical alumni. This family-friendly constituted 12 percent of the population, one of our staff members in Medical Alumni weekend provides alumni with the oppor- they accounted for only 3.5 percent of all Development and Alumni Relations. tunity to reconnect with the School and physicians; similarly, 1 in 8 Americans is with classmates, faculty, and mentors. Guest black, but fewer than 1 in 20 physicians American College of Obstetricians and rooms for this event have been reserved is black. At the School of Medicine, 9 Gynecologists (ACOG) at the following hotels: percent of last fall’s new students are Monday, May 9, 2005, 6:00-8:00 p.m. Hotel Sofitel 1-877-411-7634 black and 7 percent are Latino. San Francisco The Loews 215-627-1200 “When I went home for Thanksgiving, Park Hyatt at the Bellevue 1-800-233-1234 30 people in my family got together,” So- The Helen O. Dickens, M.D., Memorial Sheraton Society Hill 1-800-325-3535 riano says. “I know that I am standing on Dinner their shoulders and, thanks to them, will April 30, 2005 American Academy of Urology be able to do something important. Now An annual gathering of under-represented Tuesday, May 24, 2005, 6:00-8:00 p.m. I can see that I’m a role model for my little minority students, alumni, faculty, and San Antonio, Texas cousins and nephews and nieces – they house staff will be held at the College of were playing with my stethoscope!” Physicians of Philadelphia.

RECENT GIFTS

he Estates of Richer Goodwin, N.C.I., the N.I.H., and other granting through the Paula A. Seidman Breast M.E. ’30, G.M.E. ’41, and his agencies grew 89 percent from FY 2000 Cancer Research and Education Fund. widow, Elizabeth M. Goodwin, to FY 2004. have recently distributed more With their $1 million gift, Richard B. T than $5 million to the University, Continuing their support for cancer re- Worley, a trustee of PENN Medicine The sum will be used to create the Richer search and care at the University of Trustee, and Leslie Anne Miller, Esq., and Elizabeth M. Goodwin Professorship Pennsylvania Health System, Rena have provided substantial support for in the School of Engineering and Applied Rowan Damone and Vic Damone have both the construction of the Center for Science and the Dr. John Bernhard made a $2 million gift, enabling plans to Advanced Medicine, which will house Mencke and Ada Collins Mencke Schol- expand and relocate the Rena Rowan the Abramson Cancer Center, and for the arship Fund in the School of Medicine. Breast Center into the new Center for Alan J. Wein Professorship in Urology. Advanced Medicine upon its completion, The Abramson Family Foundation has now scheduled for 2008. In October An anonymous gift of $400,000 from contributed $10 million as part of its 2005, the Rena Rowan Breast Center will School of Medicine parents will expand $100 million pledge for the Abramson celebrate its 5th anniversary. the Doctoring Longitudinal Patient-Cen- Family Cancer Research Institute. Private tered Experience (DLPCE), created with donations are critical for “seeding” med- In honor of her daughter, Mrs. Frances their earlier gift. Part of the School’s Pro- ical research, to bring studies to the Berger Seidman made a $1 million gift fessionalism and Humanism coursework, threshold where they are considered for to support construction of the Center for the DLPCE partners pairs of first-year national grants. In large part thanks to Advanced Medicine. Mrs. Seidman has students with a patient with a chronic the early support of the Abramson Fami- also supported important patient service health condition for three years, to help ly Foundation, funding to the Abramson programs at the Abramson Cancer Cen- doctors-to-be understand disease from Family Cancer Research Institute by the ter, such as psychosocial counseling, the patient’s point of view.

2005/MARCH ■ 25 AlumniNews

Progress Notes division at the University of Pennsyl- Tampa since 1991. He is president Laura Ehrlich Morrow, M.D. vania, Rubin is a recognized expert of Central Florida Eye Associates. ’37, West Orange, N.J., a retired Send your progress notes to: in the clinical management and psychiatrist; January 13, 2004. Penn Medicine experimental therapy of ovarian She was former director of psy- Development and Alumni Relations cancer. He has published more OBITUARIES chiatry and a senior attending 3535 Market Street, Suite 750 than 250 papers and five text- physician at Passaic Beth Israel Philadelphia, PA 19104-3309 books in the field. Rubin joined William Menin, M.D. ’31, Chel- Medical Center and served on the the Penn faculty in1993, after tenham, Pa.; December 19, 2003. staffs of Beth Israel and St. Mary’s spending the early part of his ca- Menin joined the staff of the gas- Hospital in Passaic. She did her reer at Memorial Sloan-Kettering troenterology department at Albert internship at Lancaster General ’60s Cancer Center. Einstein Medical Center in 1933 Hospital in Pennsylvania, then Stanley N. Cohen, M.D. ’60, pro- and practiced there until he was completed a psychiatry residency at fessor of genetics and of medicine James M. Seltzer, M.D. ’77, was 90; he was former chairman of the former St. Elizabeth’s Hospital, at Stanford University, and Herbert appointed clinical professor of the department. In 1987, Menin the federal psychiatric hospital in W. Boyer, co-founder of the biotech- medicine in the Center for Occu- and his wife, Margaret Greis Menin, Washington, D.C., and Greystone nology firm Genentech Inc., were pational & Environmental Health established an annual award to be Park Psychiatric Hospital in Parsip- the recipients of the Albany Med- at the University of California at given to an Einstein resident pany. An advocate for women in ical Center Prize in Medicine and Irvine. He also serves as assistant physician who “demonstrates car- medicine, Morrow was the first Biomedical Research for 2004. They clinical professor in the Division ing, warmth, and sensitivity to the woman president of the Society of were recognized for their pioneer- of Pediatric Immunology and Al- physical and emotional needs of Clinical Psychiatrists of Northern ing work in genetic engineering. lergy at the University of California. his patients.” New Jersey. She played important The $500,000 annual award is He has spoken widely on the roles in the Medical Women’s Inter- said to be the largest prize in med- health effects of mold and on al- Arthur H. Bernstein, M.D. ’35, national Association and was icine in the United States and second lergies and asthma. Maplewood, N.J., former associate president of the American Medical worldwide only to the $1.4-million professor of cardiology at Penn; Women’s Association. In 1968, Nobel Prize. The early partnership February 22, 2004. He earned his she was named Woman of the of Cohen and Boyer eventually led B.A. and M.S. degrees from the Year by the New Jersey Medical to their development of recom- ’80s University as well. Appointed as- Women’s Association. In 1976, sistant instructor of bacteriology she was inducted into the Douglass binant DNA technology, commonly C. Gene Cayten, M.D., G.M.E. known as gene cloning. That re- at the School of Medicine in Society of Douglass College, where ’82, M.P.H., professor of surgery 1935, he became an instructor in she earned her undergraduate degree search in turn has served as a foun- and of community and preventive dation for genetic engineering and cardiology in 1956 and associate when it was still called the New medicine at New York Medical professor in cardiology in 1959. Jersey College for Women. A former the creation of the biotechnology College, has been appointed senior industry. He left Penn in 1978 to become president of the New Jersey Psy- associate dean at Our Lady of medical director of Crossroads chiatric Association, she received Mercy Medical Center in the Bronx. Frederick Keller, M.D. ’68, profes- Health Plan and Essex County its Golden Merit Award for outstand- He had been serving as director Health Organization in New Jersey. ing contributions in the field of sor of surgery and diagnostic radi- of surgery there. He was recently ology at Oregon Health & Science A member of many professional psychiatry in the state. awarded a certificate of appreciation societies, he was also a diplomate University School of Medicine, re- by the State of New York Depart- ceived the Gold Medal from the of the American Board of Internal Paul W. Eyler, M.D. ’38, G.M. ment of Health for his 15 years of Medicine. Dr. Bernstein remained ’47, Lancaster, Pa.; June 8, 2003. Society of Interventional Radiology. service as a member of the New The medal recognizes those who active at Penn throughout his career York State Trauma Advisory as president of the University of Nino De Prophetis, M.D. ’40, have demonstrated extraordinary Committee. service to the society or to the dis- Pennsylvania’s North Jersey Alumni Media, Pa.; June 3, 2003. He cipline of vascular and interven- Club and received the Alumni earned a Bronze Star for rescuing Frederick (Rick) L. Jones III, Award of Merit in 1974. He also a fellow medical corpsman during tional radiology. The Cook Profes- M.D. ’83, M.B.A., has left the global sor of Interventional Therapy, established the Arthur Bernstein World War II. A thoracic and vas- business development section of Cardiology Library Fund in 1977, cular surgeon, he was a staff surgeon Keller is also chairman of diagnostic Wyeth Pharmaceuticals to become radiology at OHSU and serves as dedicated to the continuing pur- at Chester Hospital, Philadelphia head of business development at chase of library materials in the General, Temple University, and director of the Dotter Interventional BioRexis Pharmaceutical Corpora- Institute there. field of cardiology. the Hospital of the University of tion, based in King of Prussia, Pa. Pennsylvania (where he also taught Harry Pariser, M.D. ’35, D.Sc., a surgery). He served as chief of Jay Mulaney (Moolchandani), retired dermatologist; August 8, surgery at Sacred Heart Hospital M.D., G.M.E. ’89, Lakeland, Fla., 2003. After serving in Norfolk, and at Riddle Memorial Hospital. ’70s an ophthalmologist, was elected Va., during the Second World War Stephen C. Rubin, M.D., ’76, has president of the Polk County as the venereal disease control of- Smith F. Hogsett, M.D., G.M. ’40, been named chair of the Depart- Medical Association at its annual ficer with the United States Public Spokane, Wash.; June 2, 2003. ment of Defense’s Ovarian Cancer meeting. Currently, he is president Health Service, he practiced as the He served as a Navy captain in Research Program review panel. of the medical staff at Lakeland city’s first board-certified derma- the Marine Corps from 1941 to This program, which awards nearly Regional Medical Center, where tologist. When the Eastern Virginia 1946. He practiced ophthalmology $10 million annually in scientific he also serves on the board of di- Medical School opened, he became for 40 years in Spokane and was grants, supports some of the rectors. Recently appointed to the a professor of microbiology there a member of the Spokane Medical country’s most innovative research board of the Central Florida and was instrumental in the de- Society. in the field of ovarian cancer. The Physicians Alliance, he has been velopment of its division of der- Franklin Payne Professor of Gyneco- clinical assistant professor in the matology. His two sons joined Josiah McCracken Jr., M.D. ’40, logic Oncology and chief of the Department of Ophthalmology at him in practice until he retired at Framingham, Mass.; September 28, the University of South Florida in age 84 in 1995. 2003.

26 ■ PENN MEDICINE Benjamin Rhea Mooney, M.D. ’40, and the New England Baptist Award from the Pennsylvania Sec- oxygen toxicity, and mitochondrial York, Pa.; October 29, 2003. Hospital in Boston and had been tion of the American College of metabolism, all of which had im- on the faculty of Harvard Univer- Obstetrics and Gynecology. plications for the treatment of Lewis T. Corum, M.D., G.M. ’41, sity. In 1979, Copeland moved to heart disease, diabetes, and other a retired pediatrician; September 10, Cincinnati and joined the Veterans Thomas Scarlett, M.D., G.M. diseases. In 1952 he won a Guggen- 2003. He served in the Medical Administration Hospital as chief ’47, Hendersonville, N.C.; June heim Fellowship. Dr. Haugaard Corps of the U.S. Army from 1932 of pathology. He was an emeritus 13, 2003. He was a radiologist at retired in 1987, but continued to to 1946. In private practice in the professor at the University of the Akron General Medical Center work as a research scientist in the Tampa, Fla., area from 1946 to Cincinnati Medical School. for 25 years. He was a member of lab of Dr. Robert Levin. In 2001, 1970, he served a term as president the American College of Radiology, he won a University Research of the Florida Pediatric Society. Robert H. Kough, M.D. ’45, G.M.E. the Ohio State Medical Association, Foundation Award for his work From 1970 to 1984, he was a ’59, Danville, Pa.; June 26, 2003. and the Summit County Medical on lipoic acid. civilian pediatrician at MacDill Air A Navy veteran, he was director Society. During World War II, he Force Base. of the Department of Hematology/ served as a captain in the Medical John C. Mutch, M.D. ’50, Oncology at Geisinger Medical Corps. Moorestown, N.J.; October 1, Rahn L. Hottenstein, M.D. ’42, Center from 1974 to 1986 and 2003. Halifax, Pa.; July 20, 2003. After served as a senior consultant there Joseph R. Wilder, M.D., G.M.E. serving in the U.S. Army Medical until his retirement in 1991. He ’48, New York, N.Y.; July 1, 2003. Gladys Rosenstein, M.D., G.M.E. Corps in World War II (including was a clinical professor of medicine He was professor of surgery at ’50, Arlington, Va.; November 1, the Battle of the Bulge), Hottenstein at Pennsylvania State University Mount Sinai School of Medicine 2003. returned to Millersburg to practice and served on the board of Penn- and director of outpatient and until his retirement in 1979. sylvania Blue Cross/Blue Shield. emergency surgery at the Hospital Edgar Archer Dillard Jr., M.D. for Joint Diseases and professor of ’51, Galveston, Texas; May 29, Russell E. Morgan Sr., M.D., William A. Phillips, M.D. ’45, surgery at Mount Sinai Hospital 2003. He served as a naval aviator G.M.E. ’42, Bethlehem, Pa.; G.M.E. ’49, Holland, Pa.; June 30, for more than 20 years. He had in World War II before beginning December 5, 2003. 2003. He was a member of Penn’s also served as chief of surgery in his medical training. He then Department of Psychiatry until the United States Air force. A worked abroad with Medico and John H. Bailey II, M.D. ’43, the mid-1970s. A former medical well-known artist, he had several USAID as head of a surgical team. Meadville, Pa.; February 22, director at the Eastern Pennsylvania paintings appear on the cover of Upon his return to Texas, Dillard 2003. Following graduation, he Psychiatric Institute, he had been The Journal of the American Medical served as director of gynecological completed an internship at Robert president of the Philadelphia Psy- Association, and he exhibited his oncology in the Department of Packer Hospital in Sayre, Pa., and chiatric Society and the Pennsyl- paintings at the Museum of Modern Obstetrics and Gynecology at the then served as a flight surgeon in vania Psychiatric Society. Phillips Art in New York and the National University of Texas Medical the U.S. Army Air Corps through was a life fellow of the American Portrait Gallery in Washington, D.C. Branch for 20 years. the end of World War II. After the Psychiatric Association. His book, Athletes: The Paintings of war, he completed a residency in Joe Wilder, M.D., featuring repro- Ji Toong Ling, M.D., G.M.E. ’52, internal medicine at the Mayo J. Colin Campbell, M.D. ’47, ductions of more than 100 of his Louisville, Ky.; September 30, 2003. Clinic and returned to his home- G.M.E. ’51, Basking Ridge, N.J.; paintings, appeared in 1985. Wilder town of Meadville, where he December 18, 2003. was one of nine Americans featured Peter Safar, M.D., G.M.E. ’52, practiced for 50 years. in a PBS documentary, “Ageless Pittsburgh; August 3, 2003. An C. Sanford Carlson Sr., M.D., Heroes,” for their productive lives anesthesiologist by training, Safar Frank Cline, M.D. ’43A, Santa G.M. ’47, Knoxville, Tenn.; July after the age of 65. Wilder was founded and led several institutions, Barbara, Calif.; June 30, 2003. He 19, 2003. Carlson practiced or- also a member of the Lacrosse including the International Resus- was a communicable disease officer thopaedics in Knoxville for almost Hall of Fame. citation Research Center at the for the Santa Barbara Health Depart- 40 years and served as chief of University of Pittsburgh; but he is ment. During World War II, he staff at Baptist Hospital. He founded Niels Haugaard, Ph.D. ’49, emer- best known for developing life-sav- served as a naval medical officer the East Tennessee Orthopedic itus professor of pharmacology; ing cardiopulmonary resuscitation in the South Pacific. Clinic. He was a member of the January 15, 2004. A native of techniques, commonly known as American Academy of Orthopedic Copenhagen, Denmark, he left CPR. He was a member of Physi- Samuel Herbert Wyatt, M.D., Surgeons, the American College the country after it was invaded cians for Social Responsibility and G.M.E. ’43, Deptford, N.J.; of Surgeons, and the Knox County by Germany. He received his un- of International Physicians for November 5, 2003. Academy of Medicine. dergraduate degree from Swarth- Prevention of Nuclear War. more College in 1942 and his Edwin M. Cohn, M.D., G.M.E.’45, Henry H. Fetterman, M.D. ’47, Ph.D. degree in biochemistry Martin Goldberg, M.D., G.M.E. Bethesda, Md.; November 22, G.M.E. ’53, Allentown, Pa.; May from Penn in 1949. He was married ’54, Lafayette Hill, Pa.; January 27, 2003. Cohn retired in the late 26, 2003. A Navy Medical Corps to Dr. Ella Schwartzman, also a 2004. A psychiatrist who dedicated 1980s as chief of gastroenterology veteran, he served during World professor of pharmacology at the his career to marriage and family at Albert Einstein Medical Center. War II and the Korean War and School of Medicine, with whom counseling, he was appointed He had been on the staff of the retired from the Naval Reserve as he wrote several of his early pub- emeritus chairman of the Council hospital and also maintained a a commander in 1971. Since lications. She died in 1980. Dr. for Relationships in 1997, after practice in Jenkintown, Pa., for 1955, Fetterman had practiced Haugaard published the classic serving as director of the center more than 40 years. obstetrics and gynecology. He also series of studies on oxygen toxicity for nearly 15 years. (It was founded served as assistant chief and as with Dr. William Stadie in the as the Marriage Council of Bradley E. Copeland, M.D. ’45, chairman of the Obstetrics and Journal of Biological Chemistry. His Philadelphia.) For more than 40 G.M.E. ’49, Cincinnati; May 23, Gynecology Department at Lehigh research on cellular energetics and years, he was a clinical professor 2003. He served as chief of pathol- Valley Hospital. In 1987, he re- metabolism led to many publications of psychiatry at the University of ogy at New England Deaconess ceived a Distinguished Recognition in the fields of hormone actions, Pennsylvania School of Medicine

2005/MARCH ■ 27 AlumniNews

and a psychiatrist at the former Donald M. Blatchley, M.D., staff at Akron City Hospital and FACULTY DEATHS Institute of Pennsylvania Hospital. G.M.E. ’58, Greensburg, Pa.; was a member of the American He was a former president of the October 15, 2003. College of Physicians. Arthur H. Bernstein, M.D. See Philadelphia Psychiatric Society. Class of 1935. Banyong Thavaramara, M.D., Vincent Patrick Blue, M.D., G.M.E. Marvin Goldman, M.D. ’54, G.M. G.M. ’58, Chatuchak, Thailand; ’62; Newtown, Pa.; May 27, Donald L. Clark, M.D., ’56, Bala Cynwyd, Pa.; June 19, June 6, 2003. 2003. Moorestown, N.J., emeritus asso- 2003. ciate professor of anesthesia; March Arthur A. Helgerson, M.D., Ronald S. Gottlieb, M.D. ’65, 20, 2004. After serving in the Elizabeth Jackson Esoda, M.D., G.M.E. ’59, Lexington Park, G.M.E. ’71, Ambler, Pa., a cardi- U.S. Air Force, he entered Jefferson G.M.E. ’56, Williamsburg, Va.; Md.; January 21, 2004. While in ologist at the Graduate Hospital; Medical College, where he taught July 7, 2003. She practiced der- medical school, Helgerson was July 18, 2004. Dr. Peter Duca, his before joining Penn. He later matology for 34 years in Haddon commissioned in the United partner in a cardiology practice, served as vice president of med- Heights, N.J., and taught at the States Navy and served 32 years estimated that Gottlieb had per- ical affairs and chief of the anes- University of Pennsylvania. She on active duty all over the world. formed more than 10,000 cardiac thesiology department at Deborah was a member of the Society of He retired as a captain in the intervention procedures in his ca- Heart and Lung Center. He made Investigative Dermatology, the Medical Corps in 1978. reer. Named a “Top Doc” in inva- several trips overseas as part of a Philadelphia Dermatological Society, sive cardiology by Philadelphia hospital team that performed sur- the New Jersey Medical Society, William N. Watson, M.D., G.M. Magazine in 1994, 1999, and gery on young heart patients. and the New York Academy of ’60, Milton, Fla.; June 30, 2003. 2002, Gottlieb became head of in- Sciences. He began his private medical and terventional cardiology at Graduate Nino De Prophetis, M.D. See general surgery practice in 1962 in 1989. Earlier, he had worked Class of 1940. Roger E. Cupps, M.D., ’57, after serving as a lieutenant and at Thomas Jefferson University Rochester, Minn.; July 9, 2003. medical officer in the U.S. Navy. Hospital. In 1968, he joined the Elizabeth Jackson Esoda, M.D. An associate professor of radiology Air Force and was transferred to See Class of 1956. at the Mayo Medical School, he William W. Reynolds, M.D., the Army. He worked as a doctor specialized in therapeutic radiology. G.M. ’61, Akron, Ohio; July 23, in the Central Highlands in South Martin Goldberg, M.D. See Class He was a member of the board of 2003. After serving in both the Vietnam, then finished his hitch of 1954. the Olmstead County Division of U.S. Army and the U.S. Navy, he at the former Valley Forge Military the American Cancer Society and maintained a private practice in Hospital. Niels Haugaard, Ph.D. See Class a member of the Radiologic Society internal medicine in Akron for 35 of 1949. of North America. years. He also served as chief of William A. Phillips, M.D. See Class of 1945 MAKE THE CONNECTION MEDICAL ALUMNI WEEKEND MAY 13-15, 2005 REUNION 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Learn, Explore, Reminisce, Discover

Reunion is a time to return to campus, rekindle old friendships and rediscover PENN Medicine. All classes are welcome for Medical Alumni Weekend, May 13-15, 2005, especially those cele- brating their 5th, 10th, 15th, 20th, 25th, 30th, 35th, 40th, 45th, 50th, 55th, and 60th reunions. Experience the excitement and energy of PENN Medicine today! Register now! Visit www.med.upenn.edu/alumni or call PENN Medicine Alumni Development & Alumni Relations at 215-898-5164 for the schedule of activities and hotel accommodations.

28 ■ PENN MEDICINE TheLastWord

Planning a New Center Robert Clink operating rooms. It will also have under- ground parking (an additional 156,000 o ensure its continued excellence, square feet) and other patient amenities. an academic health system must As part of our overall plan for the invest in both its people and its Riverview Project, we also hope to develop a infrastructure. While the faculty proton-beam facility with Children’s Hospital. T and students are the most visible The nearest facility offering proton therapy intellectual resources of our institution, we is at Massachusetts General, so we believe also have to invest in the traditional there will be a demand for this cutting-edge “bricks and mortar” that house our faculty, treatment in our region. Unlike traditional students, staff, and patients. Our last major radiation therapy, proton therapy acts only research construction was the Biomedical on the tumor and does not cause collateral Research Buildings II/III, opened in 1999; damage. Yet proton therapy requires a large for patient care, it was the Jonathan The Center for Advanced Medicine will facility: patient rooms will be 30 feet high Rhoads Pavilion, opened in 1994. With be built on the site of the old Convention to accommodate the necessary equipment. our Plan for PENN Medicine to guide us, Hall and the Commerce Museum. Like the Building such a facility would be nearly however, we have begun to move ahead rest of the buildings to be demolished, impossible without a partner. Although we with an ambitious project that we expect Convention Hall has long stood vacant. Even are continuing to work out the details of will transform ambulatory and cancer care if our programs could fit in the hall, experts such a partnership with Children’s Hospital, at our institution. Just as maintaining faculty have determined that it would have been we are hopeful that both parties will ap- excellence is one of the primary goals of prohibitively expensive to convert its interior prove the plans soon. our strategic plan, so is keeping our medical for clinical care. In fact, much of the Demolition has proceeded slowly and campus attractive and functional – to the interior – its stands, for example – was deliberately. The Commerce Museum was people who work here and to the patients not usable at all. When completed, CAM first to come down. Demolition began we are seeking to serve. will be a spectacular, state-of-the-art fa- inside Convention Hall with the removal As I mentioned at the annual meeting of cility, with about 360,000 square feet and of hazardous materials, and crews are now the Medical Alumni Society, the Riverview from five to seven stories. We have charac- tearing down the exterior as well. Our goal Project will eventually allow us to create a terized CAM as a “hospital without beds.” is to have the CAM site prepared by October cutting-edge clinical and clinical research Its main concourse will be broad, airy, and 2005 and open the center in 2008. complex that will put us in excellent shape welcoming. Even a touch like having Last June, the University Trustees voted to face tomorrow’s challenges. The Riverview plenty of windows will serve to make the to approve the necessary expenditures to Project will be built on the former site of patients feel less intimidated. We have begin the work on CAM. I have no doubt the Philadelphia Civic Center complex. We been greatly encouraged by the support of that our plan to finance it without borrow- are calling the first phase the Center for Penn’s President, Dr. Amy Gutmann, who ing was a major point in our favor. Already, Advanced Medicine (CAM). While offering has also made it clear that she believes helped by our Development staff, we have the most sophisticated diagnostics and buildings devoted to health care need not received some leadership pledges that have treatments for outpatients, CAM will also forsake fine design. buoyed everyone’s spirits. Through the end serve as a practice site for many of our CAM will also house the patient services of December, pledges for Riverview totaled physicians as well as a training site for of the Abramson Cancer Center of the nearly $18 million. We are very encouraged medical students and residents. At the same University of Pennsylvania, parts of which that our alumni and friends share our vision time, we expect the project to be a vital are currently located throughout our campus. of what CAM can be. economic engine for Philadelphia and the Radiation oncology, in conjunction with surrounding region – not just during its The Children’s Hospital of Philadelphia, Arthur H. Rubenstein, M.B., B.Ch. construction but also because of the per- will be one of the premier services provided Executive Vice President of the University of manent health-care positions that will be at CAM. In addition, CAM will accommodate Pennsylvania for the Health System created. our cardiovascular center and outpatient Dean, School of Medicine he lean couple in American

Gothic have had a strong

iconic presence in our

culture since Grant Wood T painted them in 1930. Yet today, fewer and fewer Americans

resemble them. Forty-five percent of

Americans were considered overweight

or obese in 1962; in 2000, it had risen

to 64.5 percent. The professionals of

Penn’s Weight and Eating Disorders

Program are busy evaluating treatments

and diets and helping their patients lose

weight in a healthy fashion.

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