SUMMER 2007

Multi team Leadership Teamwork approach Communication Skills Cooperation Unity Challenge Group dynamics Goals HOW TO BUILD A TEAM A Neuro-Orthopaedist in Action Crossing Boundaries with Mitchell Blutt The Standard in Biomedical Studies Revisiting the New Curriculum Teamwork Fedyna, Karen Revere, Nikhil Singh, or “transformational” models that em- Justin Ziemba, David Alonso, and Sophie phasize the leader’s “inspirational” role It’s not always easy getting a group Woolston formed two rows as catchers in motivating followers and that assume of medical students together. After all, in a Stemmler classroom. Maria was a long-term relationship between leader with their busy schedules, there are volunteered to be the catchee. And and followers. That form of leadership probably many other things they could catch her they did, several times, like does not apply fully on the trauma unit. be doing than gathering for a photo a smooth-working team, while Dan There is a team of specialists (includ- shoot. So I was happy when Maria took shot after shot with his Nikon ing nurses and anesthesiologists) that Ciocca, a first-year student, was able to D2X. Then it was time for class. I am changes frequently as individual mem- round up the other six people in her happy to report that I returned Dan’s bers cycle on and off the floor. The three team for an early-morning shoot in April. lighting equipment without damage. most senior members, in order, are the This year, getting seven students to- attending surgeon, the surgical fellow, gether may not have been as difficult as in As our cover story explains, the School and the admitting resident, but the ac- the past. The difference is that the stu- of Medicine worked out the concept of tive leadership role shifts frequently dents who entered the School of Med- grouping its students into teams with and fluidly. The researchers found the icine last August are the first to be the help of The Wharton School. It is system “paradoxical” – a dynamic and grouped – officially – into teams of six or not the first time scholars from Wharton flexible system within the rigid hier- seven. So there was already a bond have shared their expertise with the archy ingrained in the field of surgery. among the students in Maria’s group. medical school. One long-term collab- Ultimately, as they put it in their Because of the tight schedule and the oration is Penn’s Leonard Davis Insti- study, leadership “is not a product of a need for an assistant to help with light- tute of Health Economics, where many leader’s individual differences, but of ing, I came along with photographer senior fellows are drawn from Wharton any organization or unit’s norms, rou- Daniel Burke to the first floor of Stemm- and the School of Medicine. Another col- tines, and role definitions.” ler Hall. Stemmler has some handy laboration, involving Wharton, Leonard Interestingly, while the School of classrooms where we could recreate Davis, and the Department of Surgery, Medicine is adopting the team concept some “group learning.” It also has a was the PENN Medicine Patient Safety from Wharton, a recent news item sug- spacious hallway with flags from earlier Leadership Academy (2003-2004), a gests that ideas about teamwork remain medical classes and portraits of promi- pilot program designed to improve somewhat fluid. This year’s incoming nent faculty members of the past – a patient safety by improving the leader- students at Penn’s School of Medicine possible backdrop to suggest contrasts ship skills of surgical teams. were encouraged to take at least some between then and now. But for me, the More recently, Katherine J. Klein, Ph.D., tests as a team, but that was certainly pressure was on. I had to hold Dan’s a professor of management at Wharton, not the case at Duke University’s busi- Nikon SB-800 flash for back-lighting – was one of the authors of “A Leader- ness school. Twenty-four students were keeping it pointed in the right direction ship System for Emergency Action found guilty of cheating (“inappropriate and steady. If the students were con- Teams: Rigid Hierarchy and Dynamic collaboration”) on a take-home exam cerned about the obvious inexperience Flexibility.” Funded by the U.S. Army this spring. When the incident was of the photo assistant, they were gra- Research Institute, the project involved first reported, a professor of leadership cious enough not to comment. And observing the Shock Trauma Center in at the George Washington University they played along with our suggestions. Baltimore as a way to analyze team School of Business, James R. Bailey, Yes, it’s unlikely that all seven teammates leadership in diverse settings. As de- commented to The Chronicle of Higher would gather around a computer moni- scribed in Wharton Alumni Magazine Education. “They were enterprising, tor to view a slide, but the resulting (Winter 2005), the traditional view of they took initiative, and they worked photograph is a stylized version of reality. leadership is usually based on “dominant” together,” he said, perhaps with tongue I believe it was Maria who recalled partly in cheek. “Aren’t those all the the “falling” exercise meant to build qualities we’re trying to encourage of trust among team members. It was one business-school students?” of the options presented during last year’s Apparently, even with teams, there are orientation program. So, gamely, Sean some lines that cannot be crossed.

Cover: Standing l-r: teammates Sophie Woolston, Karen Revere, Maria 2 I PENN MEDICINECiocca, Sean Fedyna, and Justin Ziemba. Kneeling: David Alonso and Mikhil Singh. Photo: Daniel Burke SUMMER 2007 / VOLUME XIX NUMBER 2

6 24 HOW TO BUILD A TEAM By Dawn Fallik A MODEL PROGRAM: BIOMEDICAL The Wharton School groups its M.B.A. students into teams and teaches them communication STUDIES AT PENN By Nicole Gaddis and leadership skills. Why shouldn’t Penn’s medical students, who are likely to work in hospi- Overseeing seven highly interdisciplinary – and interschool – graduate tals, large practices, and other systems, learn the same valuable interpersonal skills? Now, with groups, the Biomedical Graduate Studies program continues to set the some help from Wharton, they will. standard for teaching basic science. It’s a model that has been followed by other centers and institutes at Penn, as well as by other universities.

Departments A PROMISING ANNIVERSARY By Thomas W. Durso Last fall, experts gathered in Germany to celebrate the 100th anniver- Inside sary of the discovery of Alzheimer’s disease. Two Penn researchers, 12 Front EDITOR’S NOTE Cover John Trojanowski and Virginia Lee, were among the invited speakers. Teamwork Trojanowski reports a sense of optimism about future developments. C 2 VITAL SIGNS School of Medicine: A Ten-Year Streak New Center Focuses on Ovarian Cancer MARY ANN KEENAN CAN MAKE A MUSCLE DO ANYTHING By Sally Sapega A Guided Missile That Targets Brain Tumors The only full-time neuro-orthopaedist in the nation can often help pa- 14 Honors & Awards tients who have had strokes regain their physical capabilities when HUP Earns Magnet Status other approaches have failed. According to Keenan, the patients she sees “are one of the most underserved populations in this country.” Letters 34 DEVELOPMENT MATTERS CROSSING BOUNDARIES WITH MITCHELL BLUTT The Penn Cardiovascular Institute By Mark Gaige An internist, venture capitalist, entrepreneur, philanthropist, and 18 38 ALUMNI NEWS Penn trustee, Mitchell Blutt, M.D., M.B.A., has excelled in a variety Progress Notes of roles. In his “spare time,” he has a few hobbies, too. Inside Back THE LAST WORD Cover Recruit, Retain, Endow TEN YEARS OLD AND GOING STRONG By John Shea Launched in 1997, Curriculum 2000 promised to equip medical students more effectively for the health-care world they’d be working 30 in. The Vice Dean for Education gives an update on what’s worked and how the original version has been improved to meet developing student interests. Staff JOHN R. SHEA, Ph.D. Editor NICOLE A. GADDIS Assistant Editor LEWIS & NOBEL DESIGN Design / Art Direction ADMINISTRATION SUSAN E. PHILLIPS Senior Vice President for Public Affairs MARC S. KAPLAN Director of Communications

Penn Medicine is published for the alumni and friends of PENN Medicine by the Department of Communications. © 2007 by the Trustees of the University of Pennsylvania. All rights reserved. Address all correspondence to John Shea, Penn Medicine, 3600 Market Street, Suite 240, University of Pennsylvania Health System, Philadelphia, PA 19104-2646, or call (215) 662-4802, or e-mail [email protected].

Visit Penn Medicine’s web site: http://www.uphs.upenn.edu/prnews/publications/ * Early Detection and Prevention School of Medicine: A Ten-Year Streak * Advanced Therapeutics * Biology and Pathogenesis For the 10th year in a row, the School Following Penn in the annual rankings Coukos, who did an internship, resi- of Medicine was ranked in the top five were Washington University in St. Louis dency, and fellowship at Penn, now holds among research-oriented medical schools and the University of California at San the Celso Ramon Garcia Associate Profes- in the annual U.S. News & World Report Francisco. sorship of Obstetrics and Gynecology survey of graduate and professional schools. In a memo announcing the survey results and serves as director of gynecologic on- And for the second year in a row, Penn’s to faculty and staff, Arthur H. Rubenstein, cology research. One of his areas of re- school was ranked third, behind only M.B., B.Ch., executive vice president of the search is tumor vasculature, and his lab- Harvard and Johns Hopkins. Penn was University of Pennsylvania for the Health oratory recently discovered the unique also ranked 16th among medical schools System and dean of the School of Medicine, molecular make-up of vascular cells in for students going into primary care. wrote: “Our ranking as one of the top three ovarian cancer. Because these molecules U.S. News weighs peer assessments, medical schools in the United States is a are bound to the surface of tumor blood assessments by residency directors, re- reflection of the commitment and dedica- vessels, they can be used to visualize tu- search activity, student selectivity, and tion to excellence exemplified by our fac- mors in the body using molecular imag- other factors. ulty, students, and staff. While it is impor- ing or even to attack tumors with spe- Penn was also ranked in the top 10 in tant to bear in mind that such reputational cially designed “killer bullets” – a form of four specialty programs: Internal Medicine surveys must be kept in their proper per- targeted therapy. And because some of (#4), Drug/Alcohol Abuse (#6), Women’s spective, it is always nice to be recognized these molecules may be shed into the Health (#3); and Pediatrics (#1). so publicly for our successful efforts.” blood stream and detected using a blood test, the lab’s discovery may lead to de- veloping early detection tools. Christina S. Chu, M.D. ’95, G.M.E. ’99, assistant professor of obstetrics and gy- necology, is leading an effort to develop New Center Focuses on Ovarian Cancer vaccines for preventing ovarian cancer. George Coukos, M.D., Ph.D., has no The first trial uses dendritic cells loaded hesitation in describing the reason for a with Her-2 and hTERT. Another promis- new center on the Penn campus. “There ing approach is being taken by Coukos was a tremendous need for this center and Carl June, M.D., professor of pathol- and to advance the fight against ovarian ogy and laboratory medicine and director cancer,” said Coukos, director of the re- of translational research for the Abramson cently established Center for Research on Family Cancer Research Institute. June’s Early Detection & Cure of Ovarian Can- lab is engineering lymphocytes to redi- cer. “The need for early detection is cru- rect them against tumor cell targets. The cial to win this fight. If caught in Stage I, hope is that the lymphocytes can be made the five-year survival rate of ovarian can- to recognize tumor vascular targets, so cer is over 90 percent. If caught in Stage they can destroy the tumor vasculature III, the survival rate drops to less than 30 that is crucial for the survival and growth percent.” Under Coukos, the center will of a tumor beyond 2-3 millimeters. focus on developing better detection According to Deborah A. Driscoll, M.D., methods and new treatment therapies, chair of the Department of Obstetrics while improving the quality of life for and Gynecology, the new center will also women with ovarian cancer. serve as “a catalyst to unite existing talent The Center for Research on Early at Penn, recruit new investigators, and Detection & Cure of Ovarian Cancer promote interdisciplinary collaboration George Coukos, M.D., Ph.D. features three research programs: in the field of ovarian cancer.”

2 I PENN MEDICINE The center was launched by the Depart- According to Myrna R. Rosenfeld, M.D., ment of Obstetrics and Gynecology, the Ph.D., chief of Penn’s Division of Neuro- Center for Research on Reproduction and Oncology, another challenge in treating Women’s Health, the Abramson Cancer brain tumors is the difficulty of deliver- Center, and the University of Pennsylvania ing therapeutic agents to the brain through Health System. the blood-brain barrier (BBB). Cotara is delivered through a method called con- A Guided Missile That Targets vection enhanced delivery, which uses a Brain Tumors catheter to bypass the BBB and target the specific tumor site in the brain. “This method enables us to treat GBMs with local therapy that does not have side ef- fects elsewhere in the body,” says Robert Lustig, M.D., clinical associate professor of radiation oncology at Penn. In November, 2006, Marfuta was the first patient in the U.S. to be treated in this clinical trial of Cotara. The first step was a stereotactic MRI to place the catheters accurately. As Kevin Judy, M.D., professor of neurosurgery, ex- plains, “This is a fine-cut MRI that has undergone a three-dimensional recon-

Phil Marfuta and his fiancée, Judy Law. struction that is then registered directly on the patient’s head. In this way, the Physicians initially diagnosed Phil brain tumor can be accurately localized Marfuta, 28 years old, with tension from outside the skull.” headaches, which seemed reasonable to Judy made two burr holes into Marfuta’s him because he was a busy graduate student Kevin Judy, M.D. skull and placed the catheters into posi- studying physics at Princeton University. As tion inside the tumor. the days went on, however, his headaches “It involved just catheters, so compared did not subside. When a CT scan and an HUP is one of four sites participating to a craniotomy, that sounded quite nice,” MRI revealed two tumors, Marfuta un- in the clinical trail of Cotara, a biological recalls Marfuta. “When I came to, I had derwent emergency surgery at HUP. “guided missile” for the treatment of almost no pain. I was shocked at how Marfuta’s biopsy revealed that one of GBM, which is newly diagnosed in more easily the surgery went.” To date, his his tumors was a grade IV glioblastoma than 10,000 Americans each year. GBM has been stabilized. multiforme (GBM), the most aggressive Cotara is a monoclonal antibody that The Phase 2 clinical trial is designed to form of primary brain tumor. Typically, targets the DNA of cancer cells and car- evaluate a single Cotara infusion in pa- once a patient is diagnosed with GBM, ries a radioactive isotope to them, literally tients with a first or second recurrence of the median survival time is 12 months. destroying the cancer cells from the inside GBM. The primary endpoints of the trial “That kind of news is the kind you out. GBMs are complicated to treat be- are to confirm safety and determine me- don’t want to have to call your family cause filaments of malignant cells spread dian survival time and median time to and tell them about,” says Marfuta. out like fingers from the tumor and take progression in patients treated with Cotara. Marfuta’s tumors had stopped re- root deep in the surrounding tissue, mak- Cotara has been granted orphan drug sponding to traditional chemoradiation ing it difficult to remove them without status and fast track designation by the treatment and to a clinical trial that added damaging healthy brain cells. The new U.S. Food and Drug Administration for an immune modulator to his therapy. That’s approach targets the cancer cells, while the treatment of GBM. when he learned of the Cotara® trial. sparing healthy tissue in the brain. — Kate Olderman

2007/SUMMER I 3 Academy of Ophthalmology for his Honors & Awards contributions to the academy and to the profession. Abass Alavi, M.D., professor of radiology, received an honorary degree from the Clara Franzini-Armstrong, Ph.D., pro- University of Bologna in Italy for his out- fessor of cell and developmental biology, standing achievements in “Medicine and has been named the recipient of the Surgery.” The university is considered the 2007 Founders Award, presented by the world’s oldest institution of higher learn- Biophysical Society for outstanding ing. Alavi and his team introduced Fluo- achievement in biophysics. She was cited rodeoxyglucose (FDG) Positron Emission for her significant contributions to the Tomography, and he performed the first understanding of the excitation-coupling human studies with this methodology in mechanism of striated muscles through August 1976. her ultrastructural analyses of muscle. Shiriki Kumanyika, Ph.D., M.P.H., a professor of epidemiology who serves as Giulio J. D’Angio, M.D., emeritus pro- associate dean for health promotion and fessor of radiation oncology, and Eli J. disease prevention, received a Red Dress Glatstein, M.D., vice chairman and pro- Award from Woman’s Day magazine. She fessor of radiation oncology, have been was one of three women to be recognized named fellows of the American Society nationally for making an exceptional for Therapeutic Radiology and Oncology contribution to fighting heart disease in (ASTRO). Fellows must have been part of women, the nation’s leading killer. A long- the society for at least 20 years, have time supporter of the American Heart As- served in a leadership role for the organi- sociation, Kumanyika has been especially zation, and have made a significant con- concerned about the impact of heart dis- tribution to the field of radiation oncology. ease on African-American women. She most recently studied programs to prevent Dwight L. Evans, M.D., chair of the or treat obesity among African-American Department of Psychiatry and the Ruth children and adults. Meltzer Professor of Psychiatry, was named Psychiatrist-in-Chief of the Uni- versity of Pennsylvania Health System. The appointment recognizes his significant contributions in building and maintain- Mark Greene, M.D., Ph.D., the John ing world-class clinical, research, and ed- Eckman Professor of Medical Science in ucational programs in psychiatry since the Department of Pathology and Labora- his appointment as chairman. Under his tory Medicine, was awarded the 22nd an- leadership, the department established nual J. Allyn Taylor International Prize in Penn Behavioral Health to provide struc- Medicine by Robarts Research Institute. ture and marketing focus to its wide ar- He was honored for his pioneering work ray of psychiatric and behavioral-health that led to the development of Herceptin, clinical services and to expand its offerings. the breast cancer drug that defines a new The Leukemia & Lymphoma Society class of targeted cancer therapies. Greene honored Peter Nowell, M.D. ’52, G.M.E. Stuart Fine, M.D., professor and chair and his colleagues have discovered how ’56, emeritus professor of pathology, in of the Department of Ophthalmology to disable breast cancer tumors without Washington, D.C., in March. He is one of and director of the Scheie Eye Institute, harming adjacent non-cancerous cells, the two discoverers of the “Philadelphia was one of six recipients of the Lifetime which can happen in chemotherapy or chromosome” in chronic myelogenous Achievement Award from the American radiation. leukemia. According to the society, that

4 I PENN MEDICINE discovery changed the way scientists a cure, and to improve the quality of life demiology and Biostatistics, has won the looked at cancer: “This discovery meant of patients.” Roger R. Williams Award for Genetic that for the first time ever, scientists had In the fall, Nowell was honored by the Epidemiology and the Prevention of Ath- discovered a genetic abnormality linked School of Medicine, which held a recep- erosclerosis. She presented her winning to a specific kind of cancer, setting off tion for him as well as a symposium, “The abstract at the annual Conference on other research into the genetic causes of Legacy of the Philadelphia Chromosome: Cardiovascular Disease Epidemiology cancer.” Nowell was presented with the From Discovery to Therapy.” and Prevention in March. Society’s Return of the Child Award, which recognizes researchers “who take Hedi Schelleman, Ph.D., a postdoctoral Correction: inordinate risks and work tirelessly to find researcher in the Center for Clinical Epi- In the previous issue, an honor bestowed on Brian L. Strom, M.D., M.P.H., the Seeking Nominations George S. Pepper Professor of Public Health and Preventive Medicine and The Distinguished Graduate Award is the highest honor that the School of Medicine chair of the Department of Biostatistics bestows upon an alumnus. The Awards recognize alumni for their outstanding service to and Epidemiology, was garbled. He received society and to the profession of medicine, as well as for notable accomplishments in the Sustained Scientific Excellence Award, biomedical research, clinical practice, or medical education. The accomplishments must presented by the International Society for have resulted in national or international recognition. Each year, the Award is present- Pharmacoepidemiology. The award was ed during the Medical Alumni Weekend festivities to two alumni. presented in Lisbon, Portugal. Strom also You are invited to submit nominations for recipients of the 2008 Distinguished serves as director of the Center for Clini- Graduate Awards. All graduates of the School of Medicine and its residency training cal Epidemiology and Biostatistics, as programs are eligible to receive this honor. Please forward names and supporting docu- well as associate vice dean of the School mentation to Melissa Fikioris in the Office of Alumni Development and Alumni Relations, of Medicine and associate vice president 3535 Market Street, Suite 750, Philadelphia, PA 19104-3309, or fax to 215-573-2992. for strategic integration for the Health Nominations must be received no later than September 1, 2007. System. We apologize for the error.

HUP Earns Magnet Status Letters

On June 22, some 150 HUP employees Flawed Excellence? The editor replies: Stanley Finger, Ph.D., gathered to hear the long-anticipated de- from whose book Doctor Franklin’s Medicine cision coming by telephone through an The excellent article on Benjamin we took our excerpt, is not responsible overhead speaker: “Congratulations! Your Franklin’s medicine [Winter 2007] has for any of the images we used to accompany hospital has been designated a Magnet one important flaw. his text. We took the illustration cited by organization.” The illustration on page 17 is not an Dr. Kent from “Smallpox: A Great and The announcement meant that HUP had example of how people were inoculated Terrible Scourge,” an on-line feature from joined a select group of U.S. hospitals – against smallpox. This is a picture of the the National Library of Medicine. The sec- only 4 percent – to receive nursing’s highest lesion of cowpox, as was found on the tion called “Variolation” shows the illustra- honor from the American Nurses Creden- hand of the milkmaid Sarah Nelmes and tion with this caption: “In contrast to Asians tialing Center, a subsidiary of the American from which Jenner obtained the material and Africans who inoculated by blowing Nurses Association. It becomes the first to inoculate young Phipps, thus immu- dried smallpox scabs up the nose, Euro- academic medical center in Pennsylvania nizing him against smallpox. peans and their American cousins tended to to receive Magnet status. The procedure was called vaccination, inoculate through a puncture in the skin.” The Magnet process is rigorous. HUP’s after vacca, which is the Latin for cow. My reading of the caption was that the illus- 2,000-page application filled 10 volumes. tration showed the inoculation. The exhibit Once the documentation satisfied the Cen- Donald F. Kent, M.D. ’40, Ph.D. (College ’35) can be found at http://www.nlm.nih.gov/ ter’s requirements, surveyors came in April Maplewood, N.J. exhibition/smallpox/sp_variolation.html. to visit every patient care unit in the hospital.

2007/SUMMER I 5 How to Build a

by Dawn Fallik

With a vital assist from The Wharton School, the School of Medicine has taken the bold step of organizing its students into teams. The patients they will go on to care for are likely to benefit. Photographs by Daniel Burke

6 I PENN MEDICINE When David Chacko started medical school at the University of Pennsylvania, he didn’t ex- pect that hula hoops would be part of the cur- riculum. But there he was, not even a week into his first year, standing with a group of eleven other ual pursuit until one actually arrives at the level students and trying to figure out how to move of the senior resident or attending,” he said. the hoop from their shoulders to the ground At that point, he noted, on a hospital floor as without dropping it, using only their fingers. head of a health-care team, a person needs to Chacko, a former business major and invest- know how to motivate the rest of the team. ment banker, first thought it seemed silly, but For the most part, a medical-school curricu- he came to see that it taught a serious lesson lum was based on individual achievement. Stu- about working together. dents took tests and completed projects mainly “It sounds like an easy task at first,” he said. on their own, were graded individually, and “But when people start, and one person starts moved ahead in their own worlds. too slow, or someone else is raising their hand And that’s the way it’s always been, said Rus- too much, it makes it impossible.” sell Kaufman, M.D., director of The Wistar In- The hula hoop challenge is all part of a new stitute, the University of Pennsylvania’s long- three-year “team building” program, taught in time basic science neighbor. Kaufman was one conjunction with The Wharton School and in- of the faculty members involved in developing spired by a former student. The aim is to give the Penn program. “When I went through would-be physicians better tools for communicat- medical school and through my training, medi- ing, brainstorming, and solving problems in teams – first at school and eventually in the hospital. Today, according to Gail Morrison, M.D. ’71, G.M.E. ’77, vice dean for education in Penn’s School of Medicine, “physicians are working in large groups, or in heath-care systems, and they’re less out there on their own. But in med- ical school, have you been taught to work in a system? You got a certain grade on a test, and it was every man or woman for him or herself.” The idea for building teams started less than cine was different in a lot of ways,” he said. two years ago and was implemented for the “One way was that the individual physician current academic year – fast action for a uni- took responsibility for the whole team and for versity. Maybe it was because the step seemed the patient.” like such a common-sense one for the medical While that individual approach might school to take. have served the students well when it came to But it took a student to get things moving. grades, it did not necessarily benefit patients in Arvind Saini was enrolled in Penn’s joint M.D.- the hospital. Patients often had more than one M.B.A. program in 2006 when he found that medical issue that required multiple doctors many of the business skills he was learning at and a multi-team approach. A Safe Landing: Maria Ciocca's Wharton also came in handy in medical According to Morrison, mistakes could often team demonstrates a trust-build- ing exercise as she falls into the school, particularly when it came to working be traced back to poor communication, from arms of the other six students. with others. operating on the wrong limb to giving the “I generally feel that doctors are risk averse wrong blood type. As the medical professionals by nature and that medicine is a very individ- wondered what they could do better to im-

2007/SUMMER I 7 As Jeffrey S. Berns, M.D., puts it: “The plane doesn’t get off the ground and it doesn’t land unless everyone is doing their job and understands what each other’s roles are. You could be the best pilot in the world, but if the maintenance guy is not doing his job, there’s a problem.”

prove communication and performance, a growing body of research about team- work in corporate America found that teams that worked well together had better results than those who did not. So when professors and administrators at the two Penn schools got together to develop the program, they had specific goals in mind. They also understood that they would be dealing with a different class of students than found in an M.B.A. program: on average, younger and with less experience in the workplace. “Medical students are sharp and bril- liant, but they don’t always play well with each other,” said Evan Wittenberg, former director of Wharton’s Graduate Leadership Program, who now does simi- Combining Brain Power: From left to right, Maria Ciocca, Sophie Woolston, and Sean Fedyna examine a model of the human brain. lar work at Google. “It’s not enough just to be technically good, because no matter and Morrison about applying business As a result, on the third day of med- how smart they are, medicine is too com- skills to medicine. Both of them were ical-school orientation last fall, all 150 plex and one person can’t do everything.” enthusiastic and immediately realized first-year students were conveyed off Residents often watched and learned a the potential in cooperating. campus to Lafayette Hill, outside very autocratic style of leadership, Wit- “If there was a school that could de- Philadelphia, and divided into groups of tenberg noted: I tell you what to do to, velop a program to tackle true medical six or seven. Accompanying them were you do it, and you don’t ask questions. leadership, . . . it was Penn,” Saini wrote 12 faculty members who would serve as But that kind of training on the hospital in an e-mail interview. That leadership, mentors – all of them trained by Whar- floor led to problems in today’s increas- he went on, would go beyond medical ton personnel. The students will remain ingly complicated health care, where research to include “all of the challenges in these groups for the next three years several teams of five to 10 people each that will face the 21st-century medical of school. As part of the program, stu- could be involved in caring for a patient. practitioner.” Penn has the opportunity dents not only work together during And in Wittenberg’s view, that reality to produce “a physician that was not the orientation, they go on to take tests means that it’s more important than ever simply trained in fear of failure, but one together and create projects and per- that communication skills are taught – who created new health-care initiatives form tasks together. and just as important that people on the and outreach programs.” The plan is for the groups to move team feel able to ask questions and con- For his part, Wittenberg said he was next fall into the “real-world” environ- firm decisions. As Wittenberg put it, impressed by how quickly the medical ment, where they will observe different “The patient gets better care if the phar- school took on the new idea. “No med- teams working together in the Health macist feels like part of a team and if the ical school had ever done anything like System’s hospitals. nurses feel like part of the team.” this before,” he said. “Academic institu- “When they start being exposed to That was the context, then, when tions don’t usually change very quickly, patients, all of a sudden the challenges Arvind Saini approached Wittenberg but that wasn’t the case here.” will be great,” said Wistar’s Kaufman.

8 I PENN MEDICINE “It’s a different type of communication, the theory, but, as Ciocca recalled, “We conflict be mistaken for interpersonal and it’s a major transition to go from sort of ended up in a pile on the grass!” conflict or disintegrate into interpersonal the classroom, where they haven’t had Still, despite the occasional goofiness, conflict.” any kind of patient experience.” Ciocca believes most of the students With this framework in mind, the The new team-building program be- were very focused. It helped that the students had to come up with a set of gins at the very start of orientation. For orientation was offered at the beginning rules to help their teams function. The two full days last fall, the students of the term, she explained, before the rules ranged from requirements that learned about each other and went students knew each other and no one everyone show up on time to bound- through a variety of exercises, each wanted to offend anyone or take con- aries for handling disagreements. Often aimed at developing different skills, trol. Because the exercises were not the rules were created to deal with par- from listening to decision-making. graded and were outside the classroom, ticular personalities on the team. For At a conference center in Lafayette Hill, said Ciocca, it was a low-stress way to example, if one member tended to talk the teams were brought to a grassy get to know each other. too much, the team might impose a stretch about 20 feet long, provided Many of the team-building challenges time limit – for everyone – on speaking. with two six-foot wooden planks and were based on the work of Bruce Tuck- “There have been some funny ones, pieces of string, and shown the starting man, an educational psychologist, like having to do a push-up for every and stopping points. “We had to cross whose influential model of team devel- minute that you’re late – or everyone the area of grass,” without touching the opment included four separate stages: else has to do push-ups while the late grass directly, said Maria Ciocca, 24, forming, storming, norming, and per- person watches,” said Wittenberg said. from Buffalo, “and if anyone fell off, forming. (He later added a fifth: ad- “One team had people put a dollar into you had to start again. journing.) One of the most important a kitty if they were late, and at the end “The groups had a lot of fun, but it areas, Penn’s professors and administra- of the year, all the money went for a was interesting to see how people ap- tors agreed, was learning how to dis- team party.” proached it very differently,” she said. agree and move forward without “mak- At Wharton, students are placed into Ciocca’s team decided to have all mem- ing it personal.” teams during the first year and allowed bers stand with one foot on each plank, “Task conflict should be recognized to choose their own teams the second. using the string to tie their shoes to the as something positive that can lead to Often, said Krage, students ask if they plank. “Then one person called, ‘1-2-3, innovation for new ideas,” said Lynn can return to the random set-up. It will left,1-2-3, right,’” she explained, and Krage, associate director of Wharton’s be different for the School of Medicine. the teammates moved ahead in a syn- Graduate Leadership Program. “What After the orientation, said Morrison, chronized manner. That, at least, was we don’t want to happen is that task the medical students have continued to work together throughout the year. They took tests together, have had lab together, and have made presentations together. For Ciocca, who is in a group of sev- en, one of the most interesting chal- lenges involved a group exam in which the team had to identify body structures and answer questions – with a time lim- it. For a start, the group had to decide how to take the test. They could have everyone look at every body part as a group of seven; or they could split up based on individual expertise and trust each other for the answers. Ciocca’s team came into campus one Saturday morning to do a practice run of Sharing Expertise: From left to right are Sean Fedyna, Karen Revere, Nikhil Singh, Maria Ciocca, their idea: in the interest of time, they Justin Ziemba, David Alonso, and Sophie Woolston.

2007/SUMMER I 9 would break the larger group into three For Jeffrey S. Berns, M.D., associate one alert medical students to the ‘real minigroups. At least two of the mini- professor of medicine and director of world’ context of the practice of medi- groups would answer every question. clinical nephrology, learning how to cine.” As currently planned, next se- And when test time came, the whole handle disagreements and move ahead mester the student teams will be able to team felt they needed to show their unity. as a team is one of the most crucial les- observe real-life teams in action, from “We decided to wear every bizarre arti- sons of all. One of the faculty mentors the emergency room to the dialysis cle of clothing, from knee-high socks to for the new program, Berns emphasized units. The expectation is that students Mardi Gras beads and sweatbands on our that it is necessary to understand what will be able to evaluate how the profes- arms,” Ciocca said. “Another group took happened when things have gone wrong. sional units work and learn the skills of scrubs and made Braveheart costumes.” Taking the metaphor of the doctor as evaluation in general so they can apply But even beyond the finery, the pilot, Berns explained: “The plane does- them to their own situations. group’s grades were “superb,” said n’t get off the ground and it doesn’t land Morrison made it quite clear that the Ciocca, and they learned more than unless everyone is doing their job and students will likely see a wide range of anatomy. “It helped us realize that, real- understands what each other’s roles are. activity. In her own experience, trans- ly, seven heads are far better than one,” You could be the best pilot in the plant teams worked very well together. she said. “And the only way to get there world, but if the maintenance guy is But, as she added, when the student is to do this kind of productive activity.” not doing his job, there’s a problem.” groups evaluate the health-care teams, According to Krage, one of the The team-building program, in its “they are going to be surprised that groups did not get along because of first year, is a work in progress. But the some of them do not work as well as we personality issues. At a certain point, basic approach has been validated at think teams should work. There tends the students came to the School of The Wharton School for a long time. to be more of a hierarchy in the hospital Medicine faculty and asked to be dis- Other medical schools have used system” – with a single person as leader. banded and moved into other groups. groups and taught team dynamics. “We’re trying to make the next gener- The answer was no. What Penn’s School of Medicine has ation of physicians, and most of us be- “At Wharton, that happens and we that none of the other medical schools lieve that health care is all going to be say, ‘Sorry, that’s the whole point. You have is the association with Wharton very much system driven,” said Morri- have to learn how to resolve these situ- and its business principles. As Carol As- son. “It’s important to understand the ations, and that’s why we’re putting you chenbrener, M.D., executive vice presi- difference between being a good team on teams,” said Krage. “You have this dent of the Association of American leader as opposed to being part of a opportunity in school to make mistakes Medical Colleges, put it, “Inter-school group, and we’re starting with this gen- – it’s an environment where it’s safe.” partnerships and programs such as this eration and saying, ‘this is what will make you different out there.’” Chacko, the former investment banker who is now a medical student, said he thinks the three-year exercise will prove very important in the long- run. Learning how to take different roles in a group, developing listening skills, making use of basic communication tips – all these and more will have an impact on the medical students’ careers. “It’s just important to keep an open mind,” said Chacko, confidently predict- ing that “everyone will see, soon enough, that it’s a very valuable experience.”

New Meets Old: The team poses in front of class flags and faculty portraits.

10 I PENN MEDICINE October 20, 2007 7 0 0 2

, Homecoming 2007 All alumni are invited to come and celebrate 0 PENN Medicine’s tradition of innovation and excellence, 2 October 20th!!!! as several world-renowned faculty will discuss key medical

r challenges and breakthroughs and their effect on the e health-care world of today. b From 8:00 a.m. to noon: o

t I new approaches to cancer treatment c I successful brain aging

O I global and community health programs 8:00 a.m. to noon Faculty seminars ... and more! An official invitation will be mailed in the fall, but please Noon to 2:00 p.m. mark the date on your calendar as this is an event you do Penn vs. Yale Football Game not want to miss! Questions? Please contact PENN Medicine’s Office of Alumni Development and Alumni Relations at either 215-898-5164 or [email protected]. PENN Medicine A PROMISING anniversary By Thomas W. Durso

It is the most common type of de- died earlier that year in her mid-50s, and therapies,” Trojanowski notes. “Now there mentia, affecting 4.5 million Americans. what Alzheimer discovered when he ex- are 60 clinical trials of drugs that are di- It is a truly devastating disease, one amined her brain were the plaques and rected at various targets in the disease that mercilessly robs its victims of their tangles emblematic of the disease that pathways. Maybe it’ll be our bad luck memories and cognitive capacity while now bears his name. that none of them will work, but I can’t forcing their loved ones to watch helpless- “Alzheimer: 100 Years and Beyond” believe that will be the case.” ly as they gradually lose the ability to celebrated the achievements of the last Trojanowski was by no means the only function on a daily basis. century and featured presentations on scientist at the centenary conference to It costs the county more than $100 the latest developments in virtually every exude such optimism. billion per year. If current models hold, aspect of the disease. Among the scien- “All of us went there mindful of the the number of sufferers and the cost to tists who presented were Trojanowski treat them could quadruple in the next and Virginia M.-Y. Lee, Ph.D., M.B.A. 40 to 50 years. ’84, professor of pathology and laborato- Yet when the world’s foremost Alzheimer’s ry medicine, the John H. Ware 3rd Pro- TAKING THE INITIATIVE AGAINST ALZHEIMER’S DISEASE disease researchers and leaders in the field fessor in Alzheimer’s Research, and direc- met in Tübingen, Germany, in November tor of Penn’s Center for Neurodegenera- Established in 2004 through a gift of to commemorate the centennial of the tive Disease Research. Trojanowski and $6 million from Marian S. Ware, a long- disease’s discovery, the prevailing mood Lee, who are married, together have writ- time supporter of the University, the Marian was one of optimism. That was the view of ten numerous well-regarded papers on S. Ware Alzheimer Program is a set of John Q. Trojanowski, M.D., Ph.D., G.M.E. neurodegenerative diseases. collaborative initiatives between PENN ’80, director of Penn’s Institute on Aging From Alzheimer’s discovery in 1906 Medicine and the School of Nursing to and of the Alzheimer’s Disease Center. until the early 1980s, “things were being advance drug discovery, clinical research, “We have now been at work for 100 done, . . . but not very much,” says Tro- and patient care related to Alzheimer’s years trying to solve Alzheimer’s disease,” janowski. “The beginning of the molecular disease. The drug discovery initiative says Trojanowski, the William Maul era was probably 1984, with the Glenner seeks to identify novel compounds that Measey-Truman G. Schnabel Jr., M.D., and Wong discovery of the amyloid may prevent or ameliorate the onset or Professor of Geriatric Medicine and beta peptide that forms the plaques in progression of Alzheimer’s disease. Gerontology, who was an invited par- Alzheimer’s disease. That put a molecular Heading drug discovery for the program ticipant at the gathering. “You could write face on a pathology. It was like finding are John Q. Trojanowski, M.D., Ph.D., off the first 50 or 70 years of that as hav- the virus that causes AIDS or the prions G.M.E. ’80, and Virginia M.-Y. Lee, Ph.D., ing been modestly effective in advancing that cause mad cow disease.” M.B.A. ’84, both of whom were invited understanding. The last 20 years have Beginning with that discovery, re- guests at November’s centennial observance been a phenomenal success. . . . There searchers have spent the last couple of of the discovery of Alzheimer’s disease in really has been a revolution.” decades honing findings on Alzheimer’s Germany. According to Trojanowski, In 1906, Alois Alzheimer, a German to the extent that what has been learned “Many of us feel there’s enough informa- psychiatrist, presented his findings on a through basic science is now being trans- tion now, which is very different from 20 patient, Auguste D., whom he described lated to drug discovery. years ago, to be very deliberate in push- as having suffered from an unusual brain “In 1984, when this discovery was ing drug discovery.” At this point, he disorder of the elderly. The woman had made, there were no disease-modification

12 I PENN MEDICINE At the conference commemorating the centennial of the discovery of Alzheimer’s disease, one Penn representative finds that optimism prevails.

Last fall, Virginia Lee and John Trojanowski visited the home of Alois Alzheimer as part of the centennial celebration. A plaque honoring Alzheimer is visible behind them.

opportunities and of the progress that beginning, and the sense of pessimism can identify someone age 40 or age 50 has created these opportunities,” he says. that it would be a long time before thera- and say, ‘You’ve got a 90-percent risk of “We were full of enthusiasm that in our pies were developed. Now people are liv- Alzheimer’s, and do this and this and this lifetime serious drugs with the possibility ing longer and longer” with the virus. and take this drug.’ There’s a lot of inter- of modifying the disease’s onset and pro- Actually, people are living longer and est in that.” gression will emerge. For scientists that is longer, period, which helps to explain While those who attended the confer- exhilarating.” He concedes that treatment why treating Alzheimer’s disease is so im- ence spent a good deal of time looking for Alzheimer’s disease has not reached portant. In the century since the disease forward, there was also considerable ret- the stage of AIDS treatment yet, “but I was discovered, life expectancy has risen rospection regarding Alzheimer himself. remember the AIDS epidemic at the very from about 50 to the mid-to-late 70s. “This guy was just a regular doctor,” says Alzheimer’s once was a rare occurrence Trojanowski, marveling. “He had the insight simply because people did not live long and the good fortune to be in the right place enough to develop it. No more. at the right time to make this discovery AINST ALZHEIMER’S DISEASE As Trojanowski observes, “This is what that was obviously of seminal importance. has gotten many people’s attention – not Maybe five years later someone else would continues, “while basic science still just the scientists in the room, but also have made the observation, but you have should be supported to advance under- politicians, demographers, sociologists, to give credit where credit was due.” standing, we all feel there should be a and so forth. If you think about 20 mil- Alzheimer “could have been off play- road map, increased efforts to try to trans- lion people who for 10 or 20 years will ing golf all the time,” but instead chose late insights into Alzheimer’s disease need caretakers to take care of them, that to conduct research, using his wife’s for- into therapies. That will happen at will be an enormous cost.” tune to fund it. Those who study Alzheimer’s pharmaceutical companies, but now And so, according to Trojanowski, today continue that legacy with “this universities are much more engaged in therapies that delayed onset of Alzheimer’s sense of mission that this is such an im- drug discovery.” by as little as half a decade could have portant disease to do something about In the Ware program, “We’re trying to enormous benefits, in terms of both “the that we have devoted our lives to it.” come up with targets that are ‘druggable’ human price” and the enormous costs of “What I hope is that 100 years from and then trying to identify drugs that treating those with the disease. “There now, we’re celebrating the fact that hardly will hit those targets.” are models that show you would reduce anybody remembers Alzheimer’s disease,” One promising approach makes use of incidence and prevalence by 50 percent.” he says. As Trojanowski imagines it, this a robotic system to screen tens of thousands The key to delaying the onset of scenario could indeed happen if society of compounds for their ability to inhibit Alzheimer’s, Trojanowski notes, is to de- decides to apply “all available resources” the formation of Tau fibrils, which Lee and termine the likelihood that it would de- to curing the disease. Trojanowski believe play a crucial role in velop in a person as early as possible. Once “There is reason for optimism, but we the development of Alzheimer’s disease. the disease takes hold, it is irreversible. have to get our act together. We have to The high-capacity screen produces many “We need to identify people before the wake up and do something now, because “hits,” which are being evaluated and then nerve cells are gone. What was clearly the natural disaster that Alzheimer’s dis- chemically modified to produce potential something we all agreed at this meeting ease will bring to our nation far exceeds candidates for clinical testing. was important to do was to look for pre- Katrina or any other natural disaster you antecedent markers of the disease so we and I know.”

2007/SUMMER I 13 Mary Ann Keenan Can Make a Muscle Do Anything

Mary Ann Keenan performs a total knee replacement on a patient who had suffered traumatic brain injury and was paralyzed on one side of the body.

14 I PENN MEDICINE n Can Make a MuscleMUSCLEDo Anything By Sally Sapega

THE ONLY FULL-TIME Each year, 700,000 people suffer a Lewis with right-sided paralysis, she had stroke in the United States. Thanks to developed a club foot, and her right arm NEURO-ORTHOPAEDIST medical advances over the past several frequently dislocated from the weight of years, their survival rates have significantly her shoulder. IN THE COUNTRY CAN improved. What has not kept pace, how- “I had to wear a boot on my right foot OFTEN HELP PATIENTS ever, are the resources to help these pa- all the time to keep it straight, and I walked tients regain the physical capabilities they with a cane,” says Lewis. “And I was very WHEN OTHER APPROACHES need to live a fuller, more satisfying life. depressed.” Mary Ann Keenan, M.D., chief of neuro- Keenan’s first step with Lewis, as with HAVE FAILED. orthopaedics and professor of orthopaedic all her patients, was to determine how surgery at Penn, is working to change much control her brain retained over the that situation, one patient at a time. Op- affected muscles. Keenan used dynamic erating on muscles and tendons, she has EMGs to record Lewis’s multiple muscle helped straighten hands, feet, and limbs activities simultaneously. “If some control that had been curled or twisted by neu- remains, I can manipulate the muscle so rologic conditions. it’s more useful,” she explains. But even It’s a simple mechanical approach, if the brain no longer sends signals to she explains. “You ask yourself, ‘Is this a muscles, “I can relieve contractual defor- muscle whose force I can redirect to gain mities, which can improve the patient’s useful function? Or should I eliminate its ability to function.” action because it’s causing a deformity?’ Keenan notes that a clubfoot deformity You can’t fix a brain or spinal cord, but generally results from a muscle imbalance. you can sometimes relax or redirect a Correcting the deformity involves mak- muscle to give the patient a better quality ing the overactive muscle relax and do- of life.” As she puts it, “You can make a ing tendon transfers to redirect the force muscle do anything.” of the muscles. To relax the muscle, she Keenan approaches each case with a cuts it where the tendon and muscle general perspective. “You have to under- overlap and stretches the muscle a small stand how a weakness or deformity in amount. “Lengthening muscles help one area affects the whole system,” she them relax, but you still want to main- says. “I had one patient whose arm kept tain strength. I use a specific technique pulling up. After assessment, I discovered which allows the muscles to self-adjust.” that his arm pulled up because his foot Fixing Lewis’s club foot allowed Keenan was crooked and he struggled to walk. to see that the patient’s “stiff knee gait” had As soon as I fixed his foot, the stimulus nothing to do with the knee joint itself. to make his arm pull up went away.” As a It resulted from the quadriceps muscles, result, she adds, “I never had to operate as Keenan puts it, “turning on at the on his shoulder.” wrong time.” Keenan used the same approach with This discovery exemplifies the impor- Elizabeth Lewis, a 45-year-old special ed- tance of diagnosing the neurologic impact ucation teacher and mother of three who accurately. “If you do a total joint in a suffered a stroke in September 2003 and patient with a stroke but don’t understand became her patient a year and a half later. that it’s a neurological problem, it could According to Keenan, the stroke left actually make it worse for the patient,” Photographs by Addison Geary

2007/SUMMER I 15 Keenan does not see the neuro-or- That was certainly Elizabeth Lewis’s re- thopaedic procedures she performs as a sponse. “I want to tell everyone about the substitute for other options. “It’s not a amazing things that Dr. Keenan can do,” question of ‘Do we do surgery or some- she says. “There are so many people stuck thing nonsurgical?’ You’re looking at a in wheelchairs who might be helped. I can’t combination of treatments – injections, begin to explain what she’s done for me.” rehab, surgery, brace – that works best Last August, Keenan gained some na- for the patient and his problems.” tional attention when she was named Keenan is the only fulltime neuro-or- one of the recipients of the first annual thopaedist in the country. “There aren’t Ladies’ Home Journal Health Breakthrough many people in this field. In fact,” she Awards. The new award recognizes leading adds, “these patients are one of the most medical professionals who are making life- Keenan soaps up before operating. underserved populations in this country.” saving and life-enhancing discoveries in The question most patients ask after see- research, treatment, and diagnostics that says Keenan. “But if you know in advance, ing her is “Why didn’t someone send me have significantly helped women and fam- you can treat the spasticity with length- to you years ago?” ilies. Keenan was selected from a candidate

enings or other procedures and have the C o u r

joint replacement afterwards, if it’s needed.” t e s y

The next step in improving Lewis’s o f

L a

ability to walk was to perform a tendon d i e s ’ transfer at her knee. That procedure H o m e

would allow the knee to bend while J o u r

walking and would lengthen two other n a “overactive” muscles in that area, allow- l ing them to relax. Keenan’s summary: “In less than a year, she went from barely Keenan displays her Health Breakthrough Award from able to walk to having a functional gait Ladies’ Home Journal. She accepted her award from without the need for a brace.” Diane Salvatore, center, the Journal’s editor in chief, Keenan also performed a procedure to and actress Sally Fields. help Lewis keep her right shoulder in its socket – and to alleviate the pain she felt A CALL FOR A PROFESSORSHIP every time it slipped out. Lewis is now undergoing rehabilitation to help her re- At the reception in September to salute endowed the Isaac and Rose Nassau gain some motion in her fingers. Mary Ann Keenan, M.D., as one of the Professorship, named after her parents. recipients of the Ladies’ Home Journal That professorship was very valuable in An Underserved Population Health Breakthrough Award, Arthur H. allowing Kaplan to devote himself to Although surgery can bring positive Rubenstein, M.B., B.Ch., was lavish with his research. results for patients any time after a neu- his praise. He also had a brief tale to tell “This kind of relationship,” said Ruben- rologic injury, Keenan says that “the about a relationship that illustrates how stein, “enables medical professionals to sooner it’s done, the less weakness, con- valuable private philanthropy can be. take the thoughtful risks that sometimes tracture, and fixed deformity.” Last year, Frederick Kaplan, M.D., yield great discoveries. I hope that Mary In Keenan’s experience, a patient has one of Keenan’s colleagues in the De- Ann’s recent well-deserved exposure will to wait a sufficient period after a stroke partment of Orthopaedic Surgery, an- inspire another partnership.” or brain injury to gauge the extent of any nounced the discovery of the gene that For more information about creating spontaneous recovery. “That’s when tem- causes fibrodysplasia ossificans progres- an endowed professorship, please contact porary treatments, such as Botox injections, siva (F.O.P.), a catastrophic bone disorder. Heather Wiley Starankovic, Senior Major work well,” she says. “But after six months, Ten years earlier, Diane Weiss, a trustee Gifts Officer for PENN Medicine Develop- the recovery slows or ends.” of the University of Pennsylvania, had ment, at (215) 898-0578.

16 I PENN MEDICINE list of more than 100 accomplished medical professionals and joined six other doctors and researchers at the award luncheon in New York City. All recipients were pro- filed in the magazine’s September issue. In September, Keenan was guest of honor at a Penn reception that recog- nized her award. Speaking of her achieve- ments, Arthur H. Rubenstein, M.B., B.Ch., dean of the School of Medicine and exec- utive vice president of the University of Pennsylvania for the Health System, said, “Mary Ann has broken new ground by developing surgical techniques that re- animate limbs deformed or paralyzed by brain injury. Hands that were clenched or feet that were turned inward are, through her surgical technique, relaxed and made open to new possibilities.” For her part, Keenan took the oppor- tunity to thank both her colleagues and her patients, many who came to the re- In surgery, Keenan is assisted by Gregory Deirmengian, M.D. ’04, a resident in orthopaedic surgery. ception. “You have taught me much about living life with a strong and positive out- solutions to some rather unique and per- she hoped to develop Penn’s program in look,” she said to the patients. “You have plexing problems.” Keenan again noted neuro-orthopaedics. (In an average year, challenged me on many occasions and in that the population whose problems she Keenan operates on 230 patients and per- many ways to be innovative in seeking confronts is “greatly underserved,” and forms up to 700 procedures.) At the reception, Dean Rubenstein also noted Keenan’s role as a trailblazer within the medical profession. She is the Keenan and Karen Boselli, M.D., an orthopaedic surgery resident, first woman to achieve the rank of pro- examine the leg of William O’Neil. fessor in orthopaedic surgery at the School of Medicine. Before coming to Penn, she was the first woman to chair an academic department of orthopaedic surgery at Albert Einstein Medical Center. Helping patients recover a lost quality of life is a constant goal for Keenan, but a related ambition is “to get this field es- tablished here at Penn so we can train more people. I want it to become as common as a joint replacement.” As for Lewis, she’s planning to under- go speech therapy and ultimately return to teaching special education. And she’s moving ahead physically. “I’ve even gone rock climbing!” she says, adding that she plans to take up running again.

2007/SUMMER I 17 C

Lights and action: New York City offers Mitchell Blutt the variety he has sought in his professional life. Here he takes a break in Times Square.

18 I PENN MEDICINE ES ARI G ND SIN OU S TH TT O I U IGE R W L GA B RK L MA B HEL BY ITC Mitchell Blutt, M.D., C M.B.A., has never met a boundary M line he liked. He designed his own undergradu- ate major at Penn by combining psychology, biology, an- thropology, and statistics. He established a hybrid career path in business and medicine. He has funded a visiting professorship in entrepreneurism and medicine in Penn’s School of Medicine. He is exploring his own artistic muse in the genre-crossing in- terface between rock, folk, R&B, and rap. Blutt seems to have lived out the lyrics to “Don’t Fence Me In” on a more or less literal level. A board-certified internist, venture capitalist, entrepreneur, denizen of corporate and non-profit boards (including several years with the Michael J. Fox Foundation for Parkinson’s Research), philanthropist, and budding singer-song- S writer and poet, Blutt is also a Penn man ES SIN D BU LLE ND CE L, A S EX ICA HA ING ED UTT OR E, M L BL XPL UAT HEL W E AD ITC O GR , M IS N ER NN ND S. ND PE – A EST H U M DS ER WIT FRO IEL INT ES L F EW RE ERA N DEG EV S RDI IN NA LEO MY TOM BY HS RAP TOG PHO

2007/SUMMER I 19 © T o

through and through. He earned his un- d d

D a

dergraduate degree in 1978, his M.D. v i d s o n

degree in 1982, and his M.B.A. in 1987, / I m a g

as a Robert Wood Johnson Clinical Scholar. e s . c o He’s gone on to become a trustee of the m University, an overseer of the School of Arts and Sciences, and a member of the PENN Medicine board. For someone who has just turned 50, he has packed more into his years than any number of combined, highly accomplished lifetimes. In the 1980s, Blutt quickly became an attention-getter in the business world as one of the first physicians to play a prominent role on Wall Street. He vaulted into the second-ranking executive slot at Chase Capital Partners (the venture capital arm of Chase Manhattan) and helped build it into a multi-billion-dollar business. In that role, he spearheaded the Chase invest- ments in hundreds of health-care companies worldwide. These included pharmaceuti- cals, medical publishing, orthopaedic devices, the first portable defibrillator (now in restaurants and workplaces around the globe), clinical services such as radiology and imaging for long-term care facilities, health services for colleges and universities, the largest clinical lab company in Brazil, and ophthalmic surgery centers in China. Relying on his medical training to help identify potential successes, Blutt worked exclusively on health-care businesses for the first five years of his Wall Street career. But the urge to cross boundaries proved indomitable. True to form, he began to explore everything from high-technology talked to the company’s intended market the thousands of possibilities he investi- Israeli firms to show-business enterprises. to see how they would view the product or gated. Blutt clearly was doing something Blutt’s role in helping to bring promis- service. I would then make recommenda- right, because his reputation for targeting ing businesses to fruition was, as might tions on which of these that we should winning ventures spread quickly, generat- be expected, multi-pronged. He explains: consider investing in or even purchasing. ing profiles in the national and interna- “The investment bankers would introduce The process took months for each com- tional business press, speaking engage- businesses for us to consider investing in. pany, and I racked up a lot of frequent flier ments, and guest lectures. I spoke with the company’s managers, miles – but it’s the only way to proceed if So what was the key to his success? employees, and investors, really dug deep you want to increase your chances of Blutt modestly gives the lion’s share of into the product or service they were of- picking a real winner.” The process was the credit to his training. “I was quite fering, scrutinized the company’s financials, indeed arduous: he recommended that fortunate in being prepared so well by researched possible competitors, and Chase invest in less than one percent of my education. First, being a physician

20 I PENN MEDICINE gave me a solid framework to evaluate members of my extended family, much as a copy in my office to this day. It remains the health-care products and services Uncle Sydney used to do for us.” the best paper any of my students have that were being presented. Second was Robert Blake, a high-school biology ever written.” Blutt admits being moved the marketing benefit of being a physi- teacher in Windsor, Connecticut – with a by Blake’s response. cian. Many companies chose to work very good memory– was a second inspira- Then there was that bottle of wine. with us because they felt comfortable tion. While a student of Blake’s, Blutt spent After medical school, Blutt began his that a physician was involved in the a year writing a 162-page paper on Tay- residency at Cornell’s New York Hospital. process of generating resources for their Sachs disease. During the course of that One of his teachers, a professor of infec- company. Third was the professional net- project, the teacher encouraged his student tious diseases, was conducting clinical work that I developed in medical school to consider a career in medicine. “That trials for a new antibiotic. The professor, and afterward. When I was evaluating a encouragement really meant a lot to me. It clearly an expert in motivating young product or service in an area outside of helped me to forge ahead into the med- adults, promised that residents identify- my medical specialty, I had friends and ical world. I know first hand the impor- ing patients who fit the enrollment criteria colleagues from medical school and be- tance mentors can play in young lives.” would receive a bottle of wine. As Blutt yond whose judgment I trusted that I notes, “That was an exciting prospect at could turn to for their assessment.” What One of the first physicians that point in my career. Seriously, I had type of person was he drawn to? “To me already been thinking about research as to play a prominent role on the technical knowledge, while of course a career path” – the influence of Uncle important, was secondary. If someone Wall Street, Mitchell Blutt Sydney. “At the time I believed medical was honest, experienced, and clearly a science was advanced by the physician- spearheaded the Chase hard worker with a demonstrated track scientist experimenting in a lab. But the record, I would choose to work with him Capital Partners venture into more I read and talked to people, the over someone who had a cure for cancer health care. To determine clearer it became that in most cases, new but was a poor manager or egotistical.” drugs come from the pharmaceutical in- As Blutt tells it, there were three dis- which businesses to invest in, dustry, not physicians in medical institu- tinct elements that served as professional Blutt “really dug deep” into tions.” As he put it in an interview in Penn inspirations: his beloved Uncle Sydney, Arts & Sciences, “These giant businesses the product or service. In the an encouraging high school teacher, and spend billions of dollars trying to find a bottle of wine (in that order). end, he recommended that the next compound that will have clinical Sydney Cohen, M.D., was a psychiatrist efficacy and be a successful product. I Chase invest in less than one at U.C.L.A. who, among other professional decided that if I were to have an impact on activities, was one of a number of scien- percent of the thousands of this profession and this industry, I would tists who studied the use of innovative possibilities he investigated. have to understand the business side of therapies in combating problems such as health care.” schizophrenia and autism. “People aren’t That realization led Blutt to pursue a aware of it today,” says Blutt, “but by 1965, Where does Blake’s memory come in? Wharton M.B.A. degree, which in turn researchers had published more than In 1999 Blutt and some colleagues were led to an 18-year career on Wall Street 2,000 papers describing the treatment of relaxing after completing a challenging that began at Chase and culminated when 30,000 to 40,000 patients with non-tra- deal. After a while, as sometimes happens, he became executive partner at J. P. Morgan ditional compounds.” Cohen, Blutt’s great- there was a certain amount of boasting. Partners, one of the world’s largest private- uncle, was a cardinal role model; so much According to Blutt, “My contribution was to equity firms. Blutt was part of the general so that Blutt traces his undergraduate (self- humbly suggest that after some 25 years, leadership of the latter firm and had par- created) major at Penn – the precursor to my high-school biology teacher would ticular responsibility for overseeing its Life today’s Biological Basis of Behavior inter- still remember my paper on Tay-Sachs. Sciences and Health Care Infrastructure disciplinary major – and his early interest So we dialed information, tracked down Group. “I thoroughly enjoyed my years in a potential medical career as a psychi- Mr. Blake in his office, and I asked him if as a private-equity investor. I was able to atrist directly to him. “Up until a few years he remembered my paper.” Unprompted, identify and help provide financial re- ago, I even provided medical care for the teacher said, “Remember it? I still keep sources to many companies that had ter-

2007/SUMMER I 21 rific ideas for improving people’s health. with his business. “These were all talented orthopedics (now DJO Incorporated) and That, of course, meshed perfectly with people, and it was difficult to choose the other businesses that he helps direct. why I entered medical school in the first among them,” said Cross. “But what sold Through his service on the PENN Medi- place.” Not that he stopped practicing me on J. P. Morgan was Mitchell Blutt. cine board, he has witnessed what strong medicine. For years he worked on the Not only was he obviously very astute, leadership can accomplish. In his view, investor side of the ledger four days a he was also a physician, someone who PENN Medicine’s financial turnaround of week, leaving one full day to see patients knew that our business was about helping the last few years “is the most impressive and teach medical students. Even then people. He has a genuine talent for really business management of any health-services he often returned to his business office listening to people, addressing their con- entity that I have ever seen, including the after his day duties as a physician ended cerns, and then bringing in remarkable private sector. Dr. Arthur Rubenstein and to make sure no promising investment insights of his own.” Ralph Muller have been superb.” Indeed, opportunities slipped through. Eventually dj Orthopedics became a publicly traded he jokingly asked the UPHS leaders, “When the demands on his time forced him to company in 2001 at an opening value of can we take it public?” And Blutt practices give up his medical practice. $17 per share. A year later, partially in what he preaches: when his 85-year-old Tom Cooper, M. D., a partner in Aper- light of the stock market contraction, its father, Herbert, recently became ill, Blutt ture Venture Partners, a health-care ven- share price was down to $3. “It’s easy to made sure they came down from Con- ture capital firm and a lecturer at the be a good business partner when times are necticut to be treated at what he calls the Columbia School of Business, has known easy,” says Cross. “It’s when things get “Mecca of Medicine,” Penn. “I’m very Blutt for more than 20 years. He has run tough that you see the true mettle of a attached to the entire Penn enterprise,” several health-care companies that Blutt’s person. And when things got tough for says Blutt. As he sees it, “Penn and I are investment firms have backed. “Mitchell us, we saw that Mitchell was a man of partners.” and I bonded so well because we had his word. He lived up to his commitment Blutt has shown his gratitude to Penn taken rather unique career paths: physi- to help us manage through the good times beyond serving on boards. Among his cians who moved full force into the busi- and the bad. In fact, he was my number multi-million dollar contributions to the ness world. He is by far the most gifted one personal cheerleader through the tough University is establishing the Mitchell businessman I have ever met.” times.” One of Blutt’s major contributions Blutt, M.D., Visiting Professorship in En- According to Cooper, who has served during those tough times was his ability trepreneurism and Medicine in the School on the boards of four health-care compa- to identify high-quality managerial and of Medicine. “As an investor specializing nies with Blutt, he was not the only one leadership talent. “We were able to bring in the health-care industry, I’ve spent my to feel that way: “When Mitchell began in an excellent team to support the com- career in the dual worlds of medicine and to say something at board meetings, the pany and help it weather the storm,” Blutt business,” he says. “There is no other music just stopped. His business sense recalls. “Their products were absolutely place that combines these fields nearly as was so sharp that people wanted to hear first rate, so we really believed in them. well as Penn.” When Blutt’s recent gift every word he said.” For example, Cooper They just needed additional experience in was announced, Amy Gutmann, Ph.D., cites Blutt’s careful reading of the business some areas, and we were fortunate enough to the University’s president, said, “Like Penn, plan for a portable EKG machine. The identify the right people to fill those slots.” Mitchell Blutt is truly interdisciplinary, in device was being touted as something Today, dj orthopedics is the largest public perspective as well as accomplishment.” physicians would love because it was company in the nation that specializes in The visiting professorship will begin in easy to transport. But Blutt pointed out non-surgical orthopaedic supplies. Its cur- this spring – and Blutt will deliver the that physicians wouldn’t respond to that rent stock price? $40 per share! “After inaugural lecturer. It will feature full-day marketing message because they weren’t Mitchell retired from J. P. Morgan, that seminars, workshops, and lunch discus- the ones who actually conducted individual could have been an opportunity for us to sions for Penn medical students with ex- EKGs – special technicians did. part ways,” says Cross. Instead, the com- perts in health-care industries. The goal is Les Cross, president and CEO of dj pany invited Mitchell to be on its board, to teach the students leadership and team- Orthopedics, initially met Blutt when J. P. “where he sits today and where I hope he work skills as well as practical aspects of Morgan Partners invested in his company. will continue to sit long into the future, help- the business side of medicine. Four sessions Cross notes that J. P. Morgan was one of ing steer this company to greater heights.” per year are planned. 13 investment firms interested in working Blutt’s board stints don’t end with dj In May, for support of this kind, Blutt

22 I PENN MEDICINE was happy to help him. I guide him in the honing of his songwriting, and he shepherds me in aspects of investment and business in which he excels. But more important, we’ve become good friends.” As much as he enjoys it, however, Blutt knows that music is and will always re- main a creative outlet. He considers the world of investing to be his primary fo- cus. For instance, he recently founded Consonance Capital, an investment firm focused chiefly on the health-care indus- try. Located in New York City, the firm Room with a (Very Nice) View: From his office, Mitchell Blutt has a good perspective on New York. invests principally in the public equity markets. “When I retired from J. P. Mor- received the School of Medicine’s Alumni poetry, I’m very impressed with the poetic gan Partners, it was because I needed to Service Award. and rhyming achievements of so much of try new things. Eighteen years is a long Blutt’s previous philanthropy at Penn rap. It’s an art form that provides a ready time, and I was seeking a fresh challenge. includes gifts to create the Mitchell J. and match for my style of composition.” At first I was investing out of my home; Margo Krody Blutt Endowed Scholarship, Blutt attributes his wide-ranging inter- now I’ve ramped things up a bit by hir- and the Mitchell J. and Margo Krody Blutt ests to what he calls “a militant curiosity.” ing employees and getting an office. I’m Challenge for undergraduate financial aid. That curiosity has now led him all the way excited about what the future holds for (Margo Krody Blutt, a former ballerina in to taking voice and piano lessons. “I enjoy this firm. We bring a private equity ap- the New York City Ballet, and Blutt were singing and rapping, though my skills are proach to public as well as private health- married in 1993. They have three children: still very rough,” he says. “I hope to complete care companies. By that I mean that, unlike Gillian, 11; Eliza, 9; and Emerson, 5.) a full album’s worth of material in the near a lot of investors, we spend a great deal of Part of his most recent gift will fund three future. And at some point, I’m hopeful of time researching a public company before we music-related programs. And those point performing live. With the guidance of my invest in it – indeed, about as much as we to another of Blutt’s developing interests. music partner, Nona Hendryx, my aim is spend before we decide to invest in a pri- Blutt has long had a keen interest in to introduce my music to an audience vately held firm. While that obviously takes the arts. Building on a life-long fondness slightly larger than my current one, which more time, we find that the superior re- for writing poetry, he recently has moved is essentially my three kids.” sults justify the extra effort. I think this into the realm of writing song lyrics and The connection with Nona Hendryx gives us a fantastic competitive advantage.” recording songs under the registered came about through a social encounter. Another reason Blutt decided to pro- moniker of BLUTT. His songs appeared “We were at a party together,” Blutt re- fessionalize Consonance Capital was to in two films last year: Kettle of Fish, a calls, “and she had sat down to play the help his children understand what their romantic comedy, and Secrets of the Code, piano and sing, and I was so impressed father does for a living. “They knew I a documentary about the Da Vinci Code with her that I introduced myself and we was a doctor, but they saw me at home phenomenon. The music Blutt creates is, chatted for a while. Later, when I wanted working from the family computer, so not surprisingly, as eclectic as his profes- to make a recording of some of my poet- they were understandably confused sional life, a fusion of rock, folk, R&B, ry for my wife, I contacted her for help.” about what it is that Dad actually does.” and rap (the latter, Blutt emphasizes, free According to Hendryx, who was a mem- Despite his many interests, Blutt doesn’t of violence, obscenity, or misogyny). The ber of the group Labelle and who has hesitate in naming his most important name of his music publishing firm suggests collaborated with such artists as Prince, priority. “It’s definitely my family. I have a sense of humor on his part: Hobby Gone Talking Heads, and Peter Gabriel, “Mitchell a terrific wife and three great kids. They Haywire. Rap may seem an unlikely di- obviously has a passion for writing and is represent the easiest reasons in the world rection for Blutt, but he explains: “As clearly very good at it. I was also impressed for me to frame my ambitions in the someone who enjoys writing metrical with his desire to learn a new craft. So I right context.”

2007/SUMMER I 23 Susan Ross, Ph.D., director of Biomedical Graduate Studies, observes the lab work of student Dionne Robinson.

A Model Program: BIOmedicalSTUDIES By Nicole Gaddis

Twenty years ago, when Penn established the Biomedical Graduate Studies (BGS) program, few people were familiar with the concept of broad-based training that transcended academic departments and schools. Today, however, many institutions are discovering that research and education can be more effective when spread across multiple disciplines and departments.

Photographs by Candace diCarlo

24 I PENN MEDICINE Speaking at the BGS tions. Other alumni find positions in the Sonic hedgehog signaling pathway in the anniversarycelebration biomedical industry, in government development of the cerebellum and in in November, Arthur H. Rubenstein, agencies, or in professions such as patent the genesis of a brain tumor called M.B., B.Ch., dean of the School of Med- law and science journalism. Graduates medulloblastoma. In 2007, he received icine and executive vice president of the are not necessarily in research science, Duke’s W. K. Joklik Award for Excellence University of Pennsylvania for the Ross noted, but they definitely are using in Cancer Research and was named one Health System, called the program “one their science education. of the first six Duke Med Scholars, an of the jewels of our institution.” The first of the five graduates to pres- award that recognizes rising stars in sci- Led by Susan R. Ross, Ph.D., professor ent at the anniversary event was Blossom ence and provides additional financial of microbiology, the BGS program today Damania, Ph.D. ’98. She is now associate support for their research. includes seven highly interdisciplinary professor of microbiology and immunol- The third anniversary presenter was graduate groups that are no longer based ogy at the Lineberger Cancer Center of Laurence Eisenlohr, V.M.D. ’83, Ph.D. in academic departments. Since its the University of North Carolina at ’88, professor of microbiology and im- founding, the program has more than Chapel Hill. Her laboratory is investigat- munology at Thomas Jefferson Universi- doubled in size and applications have ing Kaposi’s sarcoma-associated her- ty. His research interests lie in how T more than tripled. The faculty members pesvirus (KSHV/HHV-8), which is associ- cells recognize antigens. Antibodies can – around 600 – come from more than 30 ated with three types of human cancers. prevent interaction with cellular recep- departments across seven of the Universi- As Damania told the newsletter of The V tors (the first step of infection) by bind- ty’s schools: Medicine, Veterinary Medi- Foundation for Cancer Research, “KSHV ing to the surface of the pathogen, which cine, Dental Medicine, Arts and Sciences, encodes more than 80 genes, so we’re makes the pathogen a target for phago- Engineering and Applied Science, Whar- trying to figure out which of these genes cytes to engulf and destroy the S ton, and Nursing. The program also has is responsible for KSHV’s ability to in- pathogen/antibody complexes. In 2004, affiliations with other institutions, in- duce cancer in its host.” The 2003 recipi- the Leukemia & Lymphoma Society hon- cluding the Children’s Hospital of ent of the American Herpes Foundation ored Eisenlohr as one of five scientists to Philadelphia and the Wistar Institute. Research Award, Damania also was receive its Stohlman Scholar Award for “Frankly, it’s right that we are very awarded an Investigator in Pathogenesis outstanding contributions to the ad- proud of the Biomedical Graduate Stud- of Infectious Disease award from Bur- vancement of blood cancer research. As ies program and its students,” said Glen roughs Wellcome Fund last year. the society put it, his work investigates N. Gaulton, Ph.D., executive vice dean Robert Wechsler-Reya, Ph.D. ’95, is “the rules of engagement between mi- and chief scientific officer at the School now an associate professor of pharmacol- crobes and the immune system, subse- of Medicine. Gaulton, a professor of ogy and cancer biology at Duke Universi- quently using them as a reference when pathology and laboratory medicine, ty. He investigates the molecular mecha- targeting cancers.” served as director of the program from nisms that regulate cell growth and the Karyn T. O’Neil, Ph.D. ’98, earned her 1995 to 1998. “We have the unique op- genesis of tumors in the nervous system. doctorate in biochemistry and molecular portunity to think very broadly about In particular, he studies the role of the biophysics. She is now director of pro- science, to think differently, and make a tein optimization at Centocor, Inc., a bio- real change in research.” medicine company that seeks innovative To help celebrate 20 years of Biomed- ways to treat cancer and immune-medi- ical Graduate Studies, Ross and her staff ated inflammatory disorders such as invited five distinguished graduates of rheumatoid arthritis and psoriasis. She is the program to present their current investigating protein engineering of anti- work at the anniversary event in Novem- body-based therapeutics. ber. The event also included a poster ses- The last presenter was Mark Shlom- sion featuring the work of current stu- chik, M.D.-Ph.D. ’89, professor of labora- dents. As the program administrators tory medicine and immunology at Yale point out, many of its graduates accept University. His long-term interest has prestigious academic postdoctoral fellow- been the development and regulation of ships and often go on to faculty posi- B lymphocytes, and his lab focuses on

2007/SUMMER I 25 autoimmunity, B cell memory, and trans- researchers – new, bright minds in the field. plant-related immunopathology. Shlom- That same kind of development is oc- chik was named Scientist of the Year for curring in genetics. “At the time when I 2006 by the S.L.E. Lupus Foundation. received my graduate degree, in the 1980s, there were only two or three hu- Making Medical Education History man genes that were known and had To the modern eye, having an interdis- been identified,” said Gaulton. “So, for ciplinary science program in a medical the most part, if you wanted to under- school seems almost like common sense; stand about gene regulation, you studied treatments are now turning towards tar- bacteria – not to understand bacterial geted therapies and personalized medicine pathogenesis, but to study the genes that Susan Ross meets with Judy Jackson, center, administrative director of BGS, and student Chenere Ramsey. based on an individual’s genetic makeup. you inserted into the bacteria, because But exactly why is it common sense? they were easy to work with.” veloped in one field could be more easily Gaulton’s encapsulated history of bio- Now researchers can directly study in- applied to answer questions in another. medical research in the twentieth century dividual genes, viruses, and bacteria in These changes in science began to ac- suggests the answer. humans. As spheres of knowledge in celerate in the 1970s and especially in “When modern molecular science be- these fields continued to grow, they be- the 1980s. And it was in the fall of 1984 gan – generally from the 1930s to the gan to overlap – and people could start that Penn appointed a director of Bio- 1950s, and then onwards – people were truly working together. Techniques de- medical Graduate Studies, Saul Wine- studying whole organisms,” he said. “People weren’t studying the molecular THE RISE OF A MICROBIOLOGIST mechanisms behind the development of fruit fly eyes, for example; they were lit- Susan R. Ross, Ph.D., had a wealth of gram for (largely minority) undergradu- erally looking at fruit fly eyes. graduate program experience behind her ate students from other, smaller schools. “In other words, they were working when she was appointed director of the “I also wanted to generate enthusiasm with the technology and knowledge they Biomedical Graduate Studies program in among other faculty members to go out- had available at the time. So the scientific 2003. Ross had played an active role in side the campus and do recruiting,” said disciplines, and therefore academic de- graduate education and directly super- Ross. She is proud to report that minori- partments, were very ‘siloed.’ Because vised more than 25 graduate students ty enrollment in BGS has increased dra- knowledge was so limited, everyone was and fellows during her years at the Uni- matically, with rates increasing every year building very little domains.” versity of Illinois Collage of Medicine for the past five years. It was the discovery of DNA and the at Chicago and at Penn. Ross sits on the steering committee for growing interest in molecules that helped “I’ve always been very interested in the Association of American Medical Col- drive collaboration across fields. As re- training, in education,” said Ross. “In lege’s GREAT Group (Group on Graduate searchers moved away from discrete or- some ways, that’s the most important Research, Education, and Training). She ganisms – bacteria infected by a certain thing that a scientist can do: train the fu- has also served on the review panel for a virus – and could focus on individual ture generations of scientists. The long- program, at the Howard Hughes Medical mechanisms – studying the virus itself – lasting legacy of a scientist’s work is who Institute, that provides research training they found that they had more common she trains.” fellowships for medical students. knowledge to share. In accepting the position of director, Her own research interests and activi- Funding was also a strong influence: she explained, “I was interested in train- ties also cross departmental lines, and she the National Institutes of Health was ing from a higher level – going beyond is a member of many graduate groups originally founded to train medical re- one-on-one teaching.” and centers. “Before coming to Penn, I searchers for its own organization, not to Ross’s particular goal as director was to was struggling to get an interdepartmen- provide biomedical research funding. But improve admission rates of under-repre- tal graduate training program going. At as funding started to match the molecular sented minorities. She spent much of her Penn, there is a philosophy that research direction that science was taking, there time developing a recruitment strategy; is not bound to any one department. BGS was finally a boom in funded biomedical she launched a summer internship pro- offers that philosophy in action.”

26 I PENN MEDICINE two years, BGS was a “virtual” program – “A very good example of how and why the first students arrived in 1986. the structure of BGS changes, through In addition to providing a common our graduate groups, is in genomics,” experience in the fundamentals shared said Ross. “That’s a field that is truly by practically all contemporary biomed- cross-disciplinary: it involves computer ical research, the BGS program provides scientists, it involves biologists, it in- a wide range of areas for research in volves people in the medical field, it in- greater depth: Biochemistry and Molecu- volves geneticists. Here we already had lar Biophysics; Cell and Molecular Biolo- these people working together in other gy; Epidemiology and Biostatistics; Ge- graduate programs and they saw the nomics and Computational Biology; Im- need to train students in this specific e director of BGS, and student Chenere Ramsey. munology; Neuroscience; and Pharma- field. And the structure to do it was al- grad, M.D. ’56. His primary role was to ceutical Sciences. There are also affiliated ready there.” provide leadership and to coordinate the graduate groups in Biology (Arts and Sci- But, continued Ross, “The program is- activities of 13 graduate groups that had, ences) and Bioengineering (Engineering n’t just about receiving training in a par- until then, operated autonomously. The and Applied Science). The program’s his- ticular specialty. You’re being trained in School of Medicine provided administra- tory, structure, and nature have given it an approach to science that is cross-disci- tive oversight, financial support, and of- the ability to respond as new fields and plinary. There are many medical ques- fice space for program staff. For the first subfields arise in biomedical science. tions where it really doesn’t matter which

An example of how the interdisciplinary between hosts and viruses, the immune to mouse APOBEC3 has been shown to approach of BGS can work to help solve a response to retroviruses, and mouse defend some cell types against HIV-1 medical mystery involves HIV, an area of models of breast cancer. infection. research that Ross knows quite well. More recently, Ross and her research Currently, Ross holds four research At BGS, some faculty members and team were also first to show that a mouse grants sponsored by the N.I.H. and has students focus on how the virus enters a protein, APOBEC3, whose human equiv- published 75 articles and reviews. She cell – which may lead to a way to devel- alent is related to defense against HIV-1, has served on the N.I.H. Experimental op inhibitors. Others are focusing on inhibits the infection and spread of a Virology Study Section; was a board gene therapy and developing better vec- mouse tumor virus. The study, which ap- member of the Leukemia Research Foun- tors for delivering the therapy. Without peared online January 28, 2007, in ad- dation; and served as chair of the Molec- knowing how the viruses used for gene- vance of its print publication in Nature, ular Biology & Genetics Panel of the De- therapy vectors actually work, Ross provides a new model for the discovery partment of Defense Breast Cancer Re- pointed out, “we would never be able to and evaluation of anti-HIV drugs. HIV-1, search Grants Program. get to the point where we would be able like the mouse tumor virus, is a retro- A B. Kenneth West University Scholar to use them in the clinic.” virus that infects immune system cells. at the University of Illinois, 1992-94, Ross Ross was one of the first investigators Unlike HIV-1, however, the mouse virus held the American Society for Microbiolo- to use transgenic mice to study virus causes breast cancer in mice. gy Wellcome Visiting Professorship at gene transcription, infection, and patho- “Although this study was performed Lehigh University for 1998-99 as well as genesis; in the 1990s, she and her col- with mice and used a mouse tumor virus the Society’s International Professorship at leagues demonstrated that mice retain for which there is no human counterpart, the Academia Nacional de Medicina in endogenous super antigens (formerly the mouse model of infection we have de- Buenos Aires in 2001. The following year, known as minor lymphocyte-stimulating veloped may be useful as a test system she was elected a Fellow of the American loci) in their genome as an antiviral de- for evaluating drugs that augment the Academy of Microbiology. fense mechanism. It was this discovery role of human APOBEC3 in defending “Basically, once you’re in the lab,” Ross that initiated her current research of us- against HIV,” said Ross. Since its dis- said with a smile, “you know that’s where ing genetics to investigate interactions covery in 2002, the human equivalent you belong.”

2007/SUMMER I 27 discipline you’re doing that research in – early as 1986. This option allowed stu- you can apply that method, that ap- dents to enter graduate training in bio- proach, to any discipline. medical science without having to desig- “And it’s really an apprenticeship: you’re nate a defined area of specialization for under the direction of faculty and the sen- their first year. ior staff in the lab. They’re all helping you The program established fully funded learn how to think, intellectually, about the fellowships for all students (except those question you’re trying to answer.” with professional degrees, such as M.D.s Gaulton, too, believes that the person- and Ph.D.s) in 1993. A second office was al development that accompanies aca- created to help administer funding and demic growth is vital. “One of my great centralize payments for student stipends, joys from working with graduate stu- tuition, and fees. There is central support dents at Penn is to see them develop over for the development of training grant the years,” he said. “These are clearly proposals and the financial administra- bright, talented students who must tackle tion of training grants. The School of scientific and medical questions that Medicine’s information services is cur- have never been answered – they have to rently helping to develop databases of do something completely new and not student records and faculty teaching simply walk someone else’s path. throughout BGS. “Every student is going to face a time This “back-office,” everyday support Andrew Lippa, a BGS student, is doing his thesis when nothing in the lab works. To develop has been crucial. “One of the most im- work in Susan Ross’s lab. the perseverance and patience to finish the portant keys to the success of our pro- work – it’s how medicine moves forward, gram is having a unified administrative demonstrating its commitment to bio- and how students become scientists.” structure,” said Ross. “It makes it actually medical research in bricks and mortar. In quite simple to create new graduate 1991, for example, the University A Strong Backbone groups and programs; we have formal trustees approved the Master Site and Fa- In the early days at BGS, a number of processes in place.” cilities Concept Plan. The plan originally initiatives were undertaken and com- The BGS structure also makes it easier included seven phases – three of which mittees formed. An advisory committee, for people to connect. Faculty are often led to the construction of biomedical re- consisting of the chairs of each of the members of multiple graduate groups, so search facilities. In fact, when Biomedical graduate groups, was charged with dis- dialogue flows between them. Students Research Building II/III opened in May cussing general policy. A single admis- share lab space with those studying dif- 1999, many observers saw it as a state- sions committee formulated the principle ferent disciplines. And all have a way of of-the-art research site. that only students sufficiently distin- bringing new ideas to the program’s vari- guished to merit full support would be ous administrative committees. National Leadership and Recognition accepted to the program. A curriculum Administrators saw this potential from At the celebration of BGS’s 20th an- committee worked to identify new aca- the beginning. Back in 1985, even before niversary, Dean Rubenstein said, “BGS demic programmatic needs. the students arrived, Saul Winegrad ex- has a highly qualified body of students The sweeping re-organization was plained in Almanac, the faculty newslet- who learn from and are guided by an matched by developments in BGS’s pro- ter, that the structure of BGS would al- equally impressive range of faculty mem- gram of study. In 2000, for example, the low it to adjust to changes in biomedical bers. Indeed, it is a model for universities Curriculum Reform Task Force devel- sciences without having to reorganize across the country. ” oped a “core curriculum.” These were ba- every three to five years. Already, Wine- “The Biomedical Graduate Studies pro- sic courses that faculty and students felt grad noted, other schools were visiting to gram is about having departments ‘with- provided some of the “broad-based” look at this “Penn model.” out walls,’” said Neal Nathanson, M.D., training that would make collaboration The Penn model has to be considered associate dean for Global Health Pro- across specialized areas more fruitful. An in a larger context as well. While BGS grams and emeritus professor of microbi- “undeclared program” was introduced as was being developed, Penn was also ology. “It’s something that we may take

28 I PENN MEDICINE for granted at Penn, thanks to strong sup- for many avenues of investigation,” while I was working with BGS, was to port from the School of Medicine’s ad- Eisenlohr continued, “and what made enroll students who would come out the ministration, but it’s something that other Penn’s program particularly strong were other side – to share our faculty’s expert- schools are still struggling to emulate.” the huge pools of talent that were ise and provide an exceptional education Harvard, for example, launched a brought into one place. I personally to those who would be committed to fin- comparable program, Harvard Integrated loved working with the faculty. ishing the program.” Life Sciences, only three years ago. “For many years, it seemed that re- Gaulton and his team had found that “Penn is totally unique because all of searchers in immunology were ‘insulated’ applicants with higher GPAs and GRE its schools are located on the same cam- and faced many intellectual problems scores were actually more likely to com- pus,” explained Ross. “Obviously most of that may have remained unsolved. But plete the program; so the admission our faculty and students come from the one did have to reach deeply into other process was made even more competitive. School of Medicine, but about 25 percent medical and scientific fields to find these It initially resulted in lower admission come from all of the other schools at answers, and at Penn, you felt that you numbers, but, again, those numbers have Penn. It’s not just about crossing academ- were among the top echelon of experts in risen – as has the quality of students. ic department lines – the learning that the field, and I believe they really laid the Recently, BGS received a prestigious happens at BGS takes in other profession- groundwork for modern immunology.” award from the Howard Hughes Medical al disciplines and approaches. It’s that Institute to fund a post-baccalaureate structure that puts us at the head of the Continuing Quest for Excellence program: the “med into grad initiative.” pack in biomedical graduate education.” Of course, the program continues to This program teaches would-be basic sci- Laurence Eisenlohr, one of the BGS evolve and the success of BGS is clearly entists more about human biology and graduates who presented at the anniver- seen in the growing excellence of its stu- medical issues and research while pro- sary event, has a keen appreciation of that dent body. Not only has the number of viding them with the additional laborato- fact. He teaches in the graduate program applications increased, but GPA and GRE ry experience they would need to be ac- at Thomas Jefferson University. According scores have risen steadily as well. Ruben- cepted into a prestigious graduate re- to Eisenlohr, Robert Korngold, Ph.D. ’79, stein, at the anniversary symposium, stat- search program. It also helps them with who earned his doctorate in immunology ed that he believes such quality in the the application process. through BGS, “essentially created the im- student body spurs innovation in all the Another new master’s program trains munology program” at Jefferson. “So School’s faculty. students interested in infectious disease we’re using our experiences from being at His comments echo what Winegrad or cancer biology in public health. Both Penn’s program.” (Korngold is now chief said more than 20 years earlier: “Bright programs train students for future re- of research at The Cancer Center at Hack- and satisfied students drive the whole search that bridges basic and clinical dis- ensack University Medical Center.) system.” ciplines – taking what is learned at the “Universities are learning that multi- Gaulton noted that scores are only part bench and bringing it to the public disciplinary approaches are now essential of the story. “An important point for me, health arena. As Ross pointed out, without basic sci- ence discoveries, “there’s nothing to Christopher Vecsey, in the BGS neuroscience program, presents his poster at the 20th anniversary event. translate to the bedside. “You can’t just train people on how to take your work at the bench and bring it to the patient. You need to train basic scientists to make those fun- damental discoveries. If you don’t have people doing that basic research, who knows what you may be missing down the line. “I believe all scientists appreciate the importance of what they do at the bench – and what that means for human health.”

2007/SUMMER I 29 Ten Years Old and Going Strong

Last October, Ezekiel J. Emanuel, M.D., Ph.D., chairman of the Department of Clinical Bioethics at the National Institutes of Health, published an essay in The Chronicle of Higher Education called “How to Redefine a Medical Education.” In his piece, Emanuel began by citing the Flexner Commission’s landmark report of 1910. He argued that medical education “must go beyond the biomedical sciences and be reformed once again, at both the graduate and undergraduate levels.” After running through several areas that he feels must be added to the curriculum, Emanuel ended his piece this way: “The changes I’ve recommended would better prepare students for medical school and for their profes- sional careers in medicine.” R i c k

C u s h

Q: Dr. Emanuel argues that “Med- m a ical students and physicians must be n familiar with statistical concepts like sample sizes, odds ratios, specificity, and positive predictive values.” A: Right in the beginning in 1997, we put in biostatistics and epidemiology. We figured you’ve got to be able to understand when you read any kind of paper. Our students needed to read the literature – yes. They needed to do diagnostic tests – yes. Analyze data from research trials – yes. Interpret, evaluate – yes. [According to Emanuel, the Liaison Committee on Medical Education does not require sta- At this year’s Match, Neha Amin, Gauree Gupta, and Reshama Saralkar (left to right) found good news tistics], but we’ve always felt we had to. It in their envelopes. is more than just plain biostatistics. Our into play – to basically show students and then clinical decision-making. That students started with biostats and epi- that doctors don’t just sort of flip a coin course runs basically for the entire first demiology, and they do it around journal when they don’t have all the information. year of medical school. Then, when they clubs and reading articles, so it’s applica- There really is a rationale to how you go on to the clinics, they end up having tion – you’re learning about statistics, but make a decision. small group discussions where they use it isn’t just learning statistics. “Let’s look at Then they move on to rational ap- these skills again. That’s three years in the this article and let’s understand the meth- proaches to algorithms and how you make curriculum – it doesn’t stop at the end of ods that are used, and did they do it right, those decisions – don’t box yourself in, the first year and a half. We’ve had that etc.?” Then the students move on to clin- always be able to come around to getting since 1997. ical decision-making, which is how do more information, etc. Then we have one The same thing with health-care eco- people, with all this information, then more course that involves being able to nomics. The students have that in the make decisions? It’s risk/benefit ratios assess information and analyze information second half of the first year, learning about and all these kinds of things that come clinically, all using biostats, epidemiology, what is a health-care system and what is

30 I PENN MEDICINE GAIL MORRISON, M.D., VICE DEAN FOR EDUCATION, GIVES AN OVERVIEW OF CURRICULUM 2000, WHICH g Strong BEGAN IN 1997 AND REMAINS AT THE FOREFRONT OF MEDICAL EDUCATION PROGRAMS.

It may be time for other medical schools in America to start catching up with Penn. Ten years ago, the entering students became the first to begin their education in the School of Medicine’s innovative new course of study, Cur- riculum 2000, which includes just about everything Emanuel called essential for helping to make “undergraduate and medical-school students better citizens and contributors to our country’s health-care system and to our society as a whole.” This May, the seventh class finished its four-year course of studies in the revised curriculum. For a fuller perspective on the status of Curriculum 2000 a decade after it was instituted, John Shea of Penn Medicine interviewed Gail Morrison, M.D. ’71, G.M.E. ’77, vice dean for education. Morrison was able to show how Penn has already incorporated the areas cited by Emanuel: management; statistics; health economics; law; information technology; and ethics and communication.

Medicare and what is Medicaid and what’s how they differ across different states – tion technology, so students learn how to the British system, the Canadian system, never mind different countries! – and what use it, access information, etc. [A recent the American system. What’s insurance? expectations are. We talk about abortion, visit to the Virtual Curriculum site What’s reimbursement? What about payment abortion laws, conflict of interest, patient showed several on-line videotaped lec- for the uninsured? What are the incentives rights, and HIPAA [The Health Insurance tures that were accessible, including for reimbursement? What are the different Portability and Accountability Act]. That’s “Psychiatry Optional Review I”; “Health- payer systems? also been in since 1997. Care Systems Payers Part II”; and “Pain The next thing Emanuel cites is infor- Symposium V: The Pain of Childbirth Q: These are all matters that the mation technology. We put in a virtual cur- and Its Managements,” taught by faculty individual practitioner of a few years riculum at the same time we put in our of the School of Medicine and the Whar- ago didn’t have to bother with. new curriculum: audio, video, everything. ton School; as well as several slide shows, A: We don’t teach students how to set We keep doing much more with informa- including “Dynamic Human Anatomy.”] T

up their own practice. They’re medical stu- o m m

dents, and our belief is that by the time y

L e o

they’re ready, if they do go into a group n a r d

practice or try to set up their own practice i (I doubt most of them will set up their own practice), I don’t know what’s going to be there 5-7 years out. So we give them a major course on health-care economics, and we bring in people from the outside to talk to them. That’s also been from 1997. Then there’s the “law of the land.” In Module 6 we have Paul Lanken [M.D., G.M.E. ’77, professor of medicine] heading our whole bioethics curriculum. That runs for four years and deals with questions like termi- nating therapy; different religions and William Hiesinger prepares to sign the Alpha Omega Alpha book during the medical honor society’s cultures and their beliefs; health laws and induction ceremony. Jon B. Morris, M.D., associate dean of student affairs, offers congratulations.

2007/SUMMER I 31 R i c k

C

Q: The computerization of medical u s h m

records is in the news again. a n A: It’s all relevant. Our kids are trained on Epic [integrated hospital software] and trained in HIPAA and trained on anything the house staff do or the faculty do. If it’s a computerized record out on the outpa- tient floor where they use Epic, our stu- dents have to be trained on Epic so they can enter their notes as well. Ethics and communication studies: we have a four-year course in professionalism and humanism and bioethics, and that’s with Paul Lanken and Art Caplan [Ph.D., Melissa Briggs couldn’t wait to share where she will take her residency. chair of the Department of Medical Ethics]. The students take the Hippocratic Oath And now we realize that there really is a tremendous learning experience when at the time of the White Coat Ceremony. whole curriculum about how to talk to students say, “Oh, they’re wrong! I know They learn about caring for the vulnera- difficult patients, and angry patients, and I did that,” or “I know I asked that ques- ble populations, confidentiality, informed patients with poor educational back- tion,” or “I know I didn’t roll my eyes,” consent, end of life, resource allocation. grounds, patients with different language or “I know I didn’t yawn in his face,” etc. They learn about health-care systems, as skills, and how to use the interpreter. Then you can say, “Okay, now let’s pull well as when they’re on the wards. And The only way you could be sure that the videotape.” So videotaping is really then we have a whole communication every single student gets those types of important. And it allows you to do fewer skills program, which is basically learn- patients before they leave medical school sessions because it’s great for feedback. ing how to talk to people. was to have standardized patients and a The reason you have them do all of these curriculum in which we could observe different things in medical school is in Q: Do you use standardized pa- the students. So we can say all 150 stu- the hope they learn something for the tients for that? dents, before they leave medical school, next time they do it – and to do it differ- A: We use standardized patients at the had this kind of preparation. What Emanuel ently or better or, if it’s good, the same. start of the first year of medical school. And called for is what we’re doing – and were With so many students, you can’t have it keeps going right through to the end. doing in 1997. enough faculty observing every single stu- dent when they do every single thing. So Q: I saw a demonstration of a pa- Q: The Wharton School for many you pick the things a student really must tient simulator recently. Even that years has videotaped its M.B.A. know how to do, and you train them will give you a little bit of feedback, students giving presentations. Do how to do it formidably. like, “Ouch! Not so hard!” we use videotape or anything of A: Or you do something bad, and it that sort when the students deal Q: Dr. Emanuel suggests that the dies or it bleeds! In the past, the belief with standardized patients? biggest challenge in carrying out his was that if you just observe somebody, A: When we use the standardized pa- recommendations would be to stimu- you’re going to understand exactly what tients, the rooms all have microphones late collaboration across professional they’re doing and how they interacted and cameras. We have VCRs or DVDs, schools. with the patient – that’s probably the and we have a main computer room A: We’re lucky because we’re located model that most of us came through. You where we can observe all twelve stations on a university campus. We stress that we watch some of the great practitioners that going at the same time. We have some- are one university, with multiple graduate existed here, the Sylvan Eismans [M.D. body review the videotapes of the stu- and professional schools all geographically ’41, G.M.E. ’50] of the world, talking dents. If standardized patients said that together. That allows you to do a lot of with people. You tell yourself, “Gee, didn’t someone didn’t do a good job, we can go things in an interdisciplinary way. It’s he do that great? I’ve got to try that too.” over the videotape with the student. It’s a something which is encouraged by our

32 I PENN MEDICINE president, encouraged by the dean/exec- ment, or are you working for the Gov- have all stayed the same. But we’ve added utive vice president. We have one health ernment, or are you working for a phar- a whole series of things, because we have system, where the school and the health maceutical company? Thinking back on such a flexible curriculum and dual degree system are all together. Therefore, the fac- your education, how well did we train programs. More students are getting mas- ulty all work for the same master. Every- you in basic sciences, in some of the ter’s degrees in an M.B.A. program with a body’s part of the system, and that really clinical areas, in procedures, in commu- dual M.D./M.B.A. We now have a master’s has tremendous advantages. nication and all the other things that we’re in bioethics. We now have a master’s in doing now that we didn’t do in 1980. public health and in clinical epidemiology. Q: The students still do clinical ro- We want to know what they thought There’s probably going to be a master’s in tations in some of the affiliated hos- about their education now that they’ve health policy. And we’re probably going pitals and in the small practices of been out five years, 10 years, or whatev- to have a five-year M.D. program that will Clinical Care Associates? er, and looking back, what do they wish allow you to get an M.D. plus a master’s A: And also in Kids First [the network they had learned something about that in translational medicine. of practices associated with the Children’s they didn’t, for whatever reason. It may be We wanted a flexible curriculum be- Hospital of Philadelphia]. because we didn’t know it had to be cause we know people like to do time-out

T experiences and do research for a year o m

m funded by the Doris Duke Charitable y

L e

o Foundation or the American Heart Asso- n a r d

i ciation or N.I.H. or the Howard Hughes Medical Institute. We had very few master’s degree programs in 1997, primarily the M.B.A. program. We had some students that were interested in doing that back then, but this has now flourished. The other program that has flourished has been global health – in Third World countries, among underserved populations. That program has been built up tremen- dously. We’re trying to push global health with public health, global health with translational medicine, global health with Natasha Wehrli, left, and Andrea Goldberg are two of this year’s AOA inductees. clin-epi for outcomes – because if you Q: Have you had feedback from taught. They might say, “We should have put it all together, you could go run an the students who have gone through had more genetics because genomics is NGO or work for the Bill and Melinda the four years? Have they told you, important in diagnosing, prescribing, and Gates Foundation. If these people are really “Wow, I’m glad you taught me this” treating today.” But we could then say, interested, they could work for the or “We didn’t learn anything about “But nobody knew about the genome World Health Organization or the CDC. this important subject.” back in 1980.” These are things that can all help you A: We are going to be sending a survey We’re particularly interested in the down the line putting your career to- out to everybody who graduated from more recent graduates. Basically, how gether. We call it the M.D.+ Degree. our medical school from 1980 on. In that well were you prepared to go out and We’ve gotten much more aggressive in survey, we are going to be asking: what are do what you do? promoting the M.D.+ Degree because we you doing right now? We’re particularly happen to think the way we built the interested in what kinds of leadership Q: What is different in curriculum allows them to do lots of roles you have played in medicine in any today’s curriculum? things within five years that would nor- way: are you head of your safety board in The actual structure of the curriculum mally take people a lot longer. The stu- your group practice, or are you a division as far as what students do and these dents have been pretty happy, with good chief, or are you a chairman of a depart- blocks or modules of curriculum – those positions after graduating.

2007/SUMMER I 33 Development Matters Penn Cardiovascular Institute: Catalyzing Discovery and Improving Patient Care

In 1918, America’s leading cause of death was Spanish influenza. For every other year since 1900, it has been cardiovascular disease, by a wide margin. According to the American Heart Associ- ation, nearly 80 million Americans – one in three adults – have some form of heart disease, and in 2004 it was the cause of death for nearly 900,000 people – more than cancer, chronic lower respiratory diseases, accidents, and diabetes mellitus combined. In 2004, nearly seven million inpatient cardiovascular procedures and operations were performed in the U.S.; the estimated cost of cardiovascular disease to our economy for 2007 is more than $430 billion. “By 2020, as the world population ages, heart disease and stroke will overcome communicable diseases to become the leading cause of death, worldwide, for the first time in the history of hu- manity.” That was how Michael S. Parmacek, M.D., director of the Penn Cardiovascular Institute, put it at the reception introducing the Institute, in January 2005. Parmacek speaks passionately about the problem – and equally passionately about Penn’s strengths in battling it. “I believe that giv- en the breadth and quality of the faculty involved in cardiovascular research and medicine, Penn is uniquely positioned to fight the on- going epidemic of cardiovascular disease around the world.” Why an Institute? Parmacek cites an impressive list of areas where Penn is at PENN Medicine is already a powerhouse in cardiovascular re- PEthe forefront of Nthe practice ofN cardiovascularM medicine, suchedi as: search and clinicalcine care. Every year since 2002, it has received $50 million or more in funding from the National Heart, Lung, and •Researching ways to raise the level of “good” HDL cholesterol, Blood Institute – including $59 million in 2006. It has nationally which may prevent coronary artery disease. recognized programs in cardiac surgery, cardiac electrophysiology, heart failure and transplantation, and invasive and non-invasive •Pioneering the use of mechanical assist devices in patients with cardiac imaging. So how does the Cardiovascular Institute strengthen end-stage heart failure who are not eligible for transplant. Penn Penn’s fight against heart disease? is one of the only centers in the U.S. approved to use such devices “The Institute catalyzes research discovery and translation in as “destination therapy.” three ways,” Parmacek explains. “We provide state-of-the-art lab- oratory facilities, concentrated in one campus location. We pro- •Developing new strategies to diagnose and treat atrial and ventricu- vide our scientists with the administrative support they need to lar rhythm disturbances, including potentially curative therapies for complete complicated grant and patent application processes. atrial fibrillation. Most importantly, we are paving new avenues of communication: cross-pollination of ideas among scientists working on basic, trans- •Mapping the basic mechanisms of cardiovascular cell develop- lational, and clinical research that leads to innovative thinking and ment and the molecular and genetic basis of congenital heart collaboration. The Institute is structured into six disease-focused disease. Such studies offer promise for children with congenital programmatic units that bring together basic scientists and clinical heart defects as well as for adults who develop heart disease. investigators.

34 I PENN MEDICINE d Improving Patient Care

Michael S. Parmacek, M.D., foreground, is CVI faculty members have made discoveries that have affected director of the Penn Cardovascular Institute. cardiovascular health and disease on a national level, publishing Below, the artery shown here is 70 percent obstructed by cholesterol. Daniel Rader, several hundred journal articles in 2006. Following are just a few M.D., is a national leader in researching examples: how to raise HDL “good” cholesterol and lower LDL “bad” cholesterol. •The first human trial of mitral valve replacement without open heart surgery, reported in Journal of the American College of Cardiology. •Identification of resistin as an inflammatory marker for athero- sclerosis, reported in Circulation. •Identification of a new gene associated with risk for heart at- tack, reported in Nature Genetics. •Discovery of a way to remove cholesterol from cells and arter- ies, reported in Journal of Clinical Investigation.

“The University of Pennsylvania has a long tradition of foster- ing research that cuts across departmental, disciplinary, and even school lines,” says Arthur H. Rubenstein, M.B.,B.Ch., executive vice president of the University for the Health System and dean of the School of Medicine. “The Cardiovascular Institute does what centers and institutes can do more effectively than loose confederations of investigators – that is, encourage the interactions among re- searchers, physicians, trainees, and students more systematically.” While much of the Cardiovascular Institute’s research is sup- ported by NHLBI funding, the Institute itself has funded two impor- tant pilot projects: “Let me give you an example,” he continues. “Recently, the Commonwealth of Pennsylvania asked for research proposals ex- •The Penn Heart Failure Study, launched in FY05, currently in- amining gene-environment interactions. Through our website cludes approximately 1,000 heart-failure patients who have [www.med.upenn.edu/cvi/index.shtml] we announced a meeting to been rigorously phenotyped and genotyped – already one of the discuss how we would respond to this opportunity. By the end of largest genetic cohorts of heart-failure patients in the nation. At the the day, we had a proposal with three exciting new projects, exam- same time, Thomas P. Cappola, M.D., who helped launch the ining how genetic background and environmental factors such as study, collaborated with members of the Penn Genomics Institute alcohol use lead to coronary artery disease, diabetic vascular dis- and the Center for Clinical Epidemiology and Biostatistics to de- ease, and atrial fibrillation.” velop a new biostatistical methodology, called “transcriptional genomics,” to identify a novel family of transcription factors that Research Discoveries of National Importance affect the progression of heart failure. His study was published In the two years since its founding, the Institute has estab- in Circulation, and Cappola received an award as the Young In- lished basic, translational, and clinical research core laboratories vestigator of the Year from The Heart Failure Society of America. with specialized expertise that is available to all of its faculty mem- bers. These include a CVI-CCEB Biostatistics Core, CVI-Radiology •PennCath Study – In the late 1990s, Daniel Rader, M.D., estab- Clinical and Translational Imaging Core Laboratories, Genetics Core lished a protocol through the cardiac catheterization labs at both Laboratory, Histology and Gene Expression Core Facility, Mouse HUP and Penn Presbyterian Medical Center in which patients were Physiology and Microsurgery Core Laboratory, and Transgenic and recruited to donate blood to be saved for genetic and biomarker Knockout Core Facility. studies. The stored DNA for several thousand patients, which had

2007/SUMMER I 35 Development Matters

cluded a 15.2 percent increase in cardiology admissions and a 15 percent increase in interventional and noninvasive cardiology pro- cedures. For FY06, comparable growth in the Cardiothoracic Surgi- cal Program firmly positioned Penn’s as the leading program of its kind in the mid-Atlantic region. Also in FY06, Institute funds were used to support a Cardiology Quality nurse at HUP, who tracks the outcomes of all patients under- going interventional and electrophysiology procedures. The goal is to emulate the Division of Cardiothoracic Surgery’s excellent docu- mentation of its outstanding clinical outcomes. Outcomes data is being collected in a new Cardiovascular Information The plasticized arteries and veins illustrate the work of Jonathan Epstein, M.D., System, for the benefit of who researches the molecular and genetic basis for normal and abnormal heart and vascular development. These studies have implications for both children with both clinical and research congenital heart defects and adults who develop heart disease. programs.

been phenotyped for several cardiovascular risk factors including the presence of type II diabetes, helped lead to two important dis- Inspired by Science coveries by deCODE Genetics, a biopharmaceutical company based in Iceland. The first confirmed the link between a certain gene (LTA4 hydrolase) and myocardial infarction, and revealed that its associa- tion with MI is considerably stronger in African Americans than in Herbert and Doris Gunther have benefited from decades of Americans of European descent. The second discovery reinforced American economic growth – and from PENN Medicine’s cardiac deCODE Genetics’ previous finding that the gene TCF7L2 is a major care. Now, they are helping to expand our knowledge of cardiovas- and important gene for the development of Type II diabetes. Both cular health and disease, by supporting young researchers in the discoveries were published in Nature Genetics. Penn Cardiovascular Institute. “Economically, our generation is the luckiest in the history of In addition to federal funding and that provided by the Institute mankind,” Herb Gunther says, noting that the more-than-doubling itself, it has worked closely with the School of Medicine’s Office of U.S. population since World War II fueled much wealth, including ofPE Corporate Alliances toN establish partnershipsN withM pharmaceutical edithe Gunthers’ successcine in residential construction and rental prop- and biotech companies. The partnerships have led to several col- erty ownership and management. “We were in the right place at laborative CVI research projects with GlaxoSmithKline and Abbott the right time.” Laboratories. As the Gunthers were looking for ways to give back to society, PENN Medicine was a natural choice: they have been under the Increasing Patient Access and Quality of Care care of Penn physicians for years. The couple is particularly im- Parmacek notes that the Institute is also enhancing Penn’s pressed with the dedication of their cardiologist, Gary Vigilante, ability to recruit the very best scientists because they know that M.D., and in 2001 they sought to learn more about Penn’s work in they will have opportunities to collaborate within a very broad car- cardiology and how they could support it. diovascular community. In FY06, new faculty members were hired Michael Parmacek, M.D., director of the Penn Cardiovascular with expertise in many priority areas. Institute, showed them through several labs, arranged for a research “The majority of CVI-sponsored new faculty recruits possess presentation by Jonathan A. Epstein, M.D., and suggested that outstanding skills in clinical cardiovascular medicine as well as in they support the work of young scientists. “Dr. Parmacek inspired translational and/or clinical research,” says Parmacek. us – and we felt research was the way to go. It’s the future of medi- Accordingly, growth in clinical activity and patient access are cine,” says Doris Gunther. also measures of success for the Institute. With new faculty, clinical With the substantial proceeds from the sale of real estate, the activity of HUP Cardiology in the first seven months of FY07 has in-

36 I PENN MEDICINE “I’m very excited about all the discoveries we’ve made – and about the difference these novel therapies will make in the lives of today’s cardiovascular patients and those to come,” says Parmacek. Recent Gifts “The Institute’s $59 million in research funding from the National Heart, Lung, and Blood Institute is a wonderful measure of the Steven B. Atlass’s $1 million gift supports the John H. Glick, M.D., quality and quantity of scientific knowledge we produce here, but it Abramson Cancer Center Director’s Professorship and the Abramson only provides support for our ongoing research projects. We remain Family Cancer Research Institute Endowment. critically dependent upon philanthropic support for the money to ‘seed’ new research, to build new facilities, and to endow profes- Jack Albert Benaroya has made a $2.5 million gift establishing sorships and fellowships that will bring the nation’s brightest sci- the Benaroya Family Parkinson’s Program, a multidisciplinary entists to Penn and enable them to do their best work.” approach to accelerating drug discovery and clinical trails of novel therapies for Parkinson’s disease. For information on charitable giving opportunities, please contact William Green, Director of Development for the Penn Cardiovascular Plans for The Clyde F. Barker Transplant House, named for the Institute, at 215-898-0578. Penn transplant surgery pioneer and former chair of the Department of Surgery, have been advanced with a $500,000 challenge gift from The Board of Women Visitors. The gift is the largest in the e Board’s 122-year history.

Recently nominated to the Medical Alumni Society Executive Council, Philip D'Arrigo, M.D. ’60, G.M.E. ’64, has contributed Gunthers had set up a Charitable Remainder Annuity Trust, whose $125,000 to the Philip D’Arrigo, M.D., Scholarship Fund, which beneficiary they then designated as PENN Medicine. They receive he established in 1997. annual payments from the trust, and its assets will belong to Penn upon their deaths. They did not have to pay capital gains tax on To commemorate his 50th reunion next year, Richard Janeway, their profit from the property and received a sizable charitable de- M.D. ’58, G.M.E. ’62, has made a $250,000 planned gift in duction as well. “Financially, it did more for us than it did for Penn,” support of his class’s scholarship fund. Herbert Gunther explains. Each year, they also make a cash contribution to the Cardio- With their $1 million gift, James Maguire and his wife, Frances, vascular Institute. In 2006, the Gunthers took advantage of the have established the Stephen J. Schuster, M.D., Lymphoma Pension Protection Act to make an IRA Charitable Rollover. Those Research Program at the Abramson Cancer Center. over 70 and a half can take advantage of the act in 2007 as well and transfer up to $100,000 from their IRAs directly to charity Jeffrey Rapp, M.D. ’88, and Neil Silverman, M.D. ’84, have given without having to recognize it as income. (Donors do not receive an $25,000 to the Penn-Botswana Program, for sending School of Medi- income tax charitable deduction on the rollover.) The Pension Pro- cine residents to Botswana to enrich their training and expand tection Act was signed in August 2006 – and was particularly timely their understanding of global health issues. for the couple, as Doris Gunther had been treated for arrhythmia in April by Francis Marchlinski, M.D., a Penn cardiac electrophysiologist. Mr. Timothy Wilmott and his wife, Dr. Nancy Barna, have made a “We believe in and are inspired by science – the things we’ve $2 million gift establishing The Wilmott Family Professorship in the seen in our lifetime are just astounding,” Herbert Gunther says. Division of Gastroenterology.

For more information on Charitable Remainder Annuity Trusts and To make a gift to PENN Medicine, or for more information, please the IRA Charitable Rollover, visit www.med.upenn.planyourlegacy.org contact the Office of Development and Alumni Relations, 3535 Market or contact Marcie L. H. Merz, J.D., Senior Director of Planned Street, Suite 750, Philadelphia, PA 19104-3309, 215-898-8094. Giving, at [email protected] or 215-898-9486.

2007/SUMMER I 37 Progress Notes Andrew C. von Eschenbach, was chair of the Diagnostic Radi- nal area Chamber of Commerce M.D., G.M.E. ’68, who was sworn ology Study Section at N.I.H. In and was a board member and offi- Send your progress notes to: in as the 20th commissioner of 2004, he became the first recipi- cer of numerous other organiza- Jason B. Bozzone the U.S. Food and Drug Adminis- ent of the Outstanding Contribu- tions. He was honorary president Associate Director of Alumni tration in December, received tions in Research Award from the of the Utah State Medical Associa- Outreach and Reunions the Distinguished Service Award American Society of Neuroradiolo- tion in 1976. In 2003 he and his PENN Medicine Development from the American Association for gy Education and Research Foun- wife, Dorothy, donated the major and Alumni Relations Cancer Research at its annual dation in recognition of lifelong cost for a replica of an allosaurus, 3535 Market Street, Suite 750 Philadelphia, PA 19104-3309 meeting in April. He was recog- accomplishment and consistent placed outside the Utah Field nized for exemplary leadership as excellence in clinical neuroscience. House of Natural History in Vernal. director of the National Cancer He is currently president of the Institute during a time of flourish- American Society of Neuroradiolo- John A. Grove, M.D., G.M. ’41, ’60s ing scientific and technological gy, a fellow of the American Col- McPherson, Kansas; August 25, advances with gradually dimin- lege of Radiology, and a fellow of 2006. Paul G. Killenberg, M.D. ’63, ishing resources. The association the International Society for Mag- emeritus professor of medicine in noted that, during his five-year netic Resonance in Medicine. Herbert P. Harkins, M.D., G.M. the Division of Gastroenterology at tenure, von Eschenbach fostered Author of Neuroradiology: The ’42, Gladwyne, Pa.; July 4, 2006. Duke University Medical Center, new and productive inter-agency Requisites, he is editor-in-chief of A retired head of otolaryngology received a distinguished faculty agreements among the F.D.A. and the American Journal of Neurora- and broncho-esophagology at award from the Duke Medical the Centers for Medicare and diology. Hahnemann University, he had Alumni Association in October. Medicaid Services that stream- also served on the faculty of Penn’s According to the association, in his lined the development and deliv- School of Medicine. He had been more than 30 years on the Duke ery of new medicines to seriously on the staff at Bryn Mawr, Lanke- medical faculty, Killenberg estab- ill patients with cancer. nau, Presbyterian, and Coatesville lished himself as a national leader ’90s Veterans hospitals. He was a for- in the diagnosis and treatment of Edward M. Copeland, M.D., mer president of the American So- benign and malignant liver disease. G.M.E. ’69, the Edward R. Wood- Michele A. (Burkardt) Kettles, ciety of Ophthalmology and Oto- He led the creation of Duke’s liver ward Distinguished Professor of M.D. ’90, Dallas, Texas, a physi- laryngology as well as a trustee of transplant program, which was the Surgery at the University of Flori- cian at the Cooper Clinic, is a Lafayette College, where he earned first in North Carolina, and served da College of Medicine and a sur- board-certified specialist in pre- his undergraduate degree. During as chief of liver service and direc- gical oncologist, was installed as ventive medicine who focuses on World War II he had served as a tor of the G.I. Clinical Laboratory. the 87th president of the Ameri- exercise for better health and commander in the U.S. Navy, sta- Killenberg is senior editor of Med- can College of Surgeons in Octo- fitness. She is a co-author of tioned in New Guinea. ical Care of the Liver Transplant ber. A fellow of the College since Women's Health and Fitness Guide, Patient, now in its third edition. In 1974, he has also served as chair available through Human Kenneth M. Carroll, M.D.’44, recognition of his dedication to of its board of governors and its Kinetics publishers and online at Dunedin, Fla., a retired internist medical teaching, Duke’s Division board of regents. He has also been www.cooperaerobics.com. and medical administrator; July of Gastroenterology created the chairman of the American Board 22, 2006. For more than 20 years Paul G. Killenberg Medical Teach- of Surgery and president of the Michael D. Cabana, M.D. ’93, he was in a group practice in Lan- ing Award in 2002, and he was the Association for Academic Surgery. M.P.H., Mill Valley, Calif., associ- caster, Pa.; from 1971 to 1980, he first recipient. During his training at Penn, he ate professor of pediatrics, epi- was medical director of St. was a research fellow in the Harri- demiology, and biostatistics, has Joseph’s Hospital. For the next 10 R. Barrett Noone, M.D. ’65, son Department of Surgical Re- been appointed director of the Di- years he held executive positions, G.M.E. ’71, G.M.E. ’73, Bryn search and a clinical fellow for the vision of General Pediatrics at the including medical director and Mawr, Pa., a plastic surgeon whose American Cancer Society. University of California at San president, with Health Care Plan primary affiliation is with the Bryn Francisco. He has also joined the of New Jersey in Cherry Hill, Mawr Hospital, received the 2006 core faculty at the Institute for which later merged with Health Distinguished Fellow Award from Health Policy Studies. Cabana’s Insurance Plan (HIP) of New the American Association of Plastic research focuses on improving the York. After retiring in 1990, he Surgeons. One of 21 living Distin- ’70s quality of care of pediatric asth- served as a consultant for HIP in guished Fellows, Noone was rec- ma, as well as the primary pre- Fort Lauderdale for five years. A ognized for his oversight of board Robert I. Grossman, M.D. ’73, vention of asthma. jazz enthusiast, he helped found certification and maintenance of the Louis Marx Professor of Radi- the Pennsylvania Jazz Festival in certification programs in plastic ology and chairman of the Depart- Lancaster, which benefited St. surgery and for his leadership as ment of Radiology at New York OBITUARIES Joseph’s Hospital. the first executive director of the University School of Medicine, American Board of Plastic Surgery. was named dean of the school Tyrrell R. Seager, M.D. ’34, W. Russell W. Pfeil, M.D. ’46, He pioneered the development of and CEO of the N.Y.U. Hospitals Jordan, Utah, a retired physician; G.M.E. ’50, Montoursville, Pa.; breast reconstruction at the time of Center. He will assume both posi- September 8, 2006. He did his August 5, 2006. A general practi- mastectomy, stemming from the tions in July. A long-time faculty medical training at Salt Lake Gen- tioner who had maintained a program he and his colleagues be- member at Penn, former associate eral Hospital, becoming the first practice from 1949 until his re- gan at Bryn Mawr Hospital in chair of its Department of Radiol- doctor to receive a medical resi- tirement in 1989, he had served 1978. A clinical professor of sur- ogy, and chief of neuroradiology, dency from a hospital in the state on the staff of Divine Providence gery at PENN Medicine, he is the he joined N.Y.U. in 2001. Gross- of Utah. After 10 years associated and Williamsport hospitals. He site director of the Penn Plastic man was awarded the Javits Neu- with mining businesses, he moved was on the Williamsport board Surgery Residency affiliation at roscience Investigator Award by to Vernal, Utah, where he practiced for two terms. During World War Bryn Mawr Hospital, where he the National Institutes of Health in for the next 30 years in general, II, he served in the U.S. Army as served as chair of the Department 1999 for his work on multiple industrial, and surgical services. a captain on hospital ships in the of Surgery 1991-2001. sclerosis. From 1997 to 2000, he He served as president of the Ver- Pacific.

38 I PENN MEDICINE Charles W. Thacker, M.D. ’47, degree from Hahnemann Medical the Society of Gastrointestinal Ra- 1962. He joined Penn five years Coolville, Ohio, a retired patholo- College, he completed a five-year diologists, considered the highest later as an assistant professor of gist; January 9, 2007. residency in surgery at HUP. He honor in the field. In December, radiology. He was promoted to as- also taught there and became he published A Dream Surpassing sociate professor and then full Cletus W. Schwegman, M.D., head of its solid tumor program Every Impasse: Becoming a Doctor professor. In 1976, he was ap- G.M.E. ’48, Ph.C., Gladwyne, Pa., and codirector of the neoplastic Against All Odds: As an Austrian pointed clinical professor while emeritus professor of surgery at chemotherapy clinic. He taught at Jew, On the Eve of World War II, A he practiced at Graduate Hospital the University of Pennsylvania; Hahnemann Medical College and, Memoir (Xlibris), written with and served as chairman of its ra- December 8, 2006. He worked as for a few years, at Eastern Virginia Laurel Marshfield. diology department. He left Penn a pharmacist while earning a Medical School. In 1978, he was in 1997 and retired from Gradu- medical degree from the Universi- named professor of surgery at Jef- Truman G. Daughtridge, M.D., ate Hospital in 1999. In 1972, ty of Cincinnati, then served in ferson and chief of surgery at G.M.E. ’73, Rocky Mount, N.C.; Chait was one of the 50 founding the Navy Medical Corps during Thomas Jefferson University Hos- August 6, 2003. members of the Society of Cardio- World War II. Chief surgical resi- pital. He performed the Philadel- vascular and Interventional Radi- dent at HUP, he joined the hospi- phia region’s first liver transplant Victor Patin, M.D. ’86, Hamden, ologists, an organization formed tal’s staff and the medical school’s there in 1984. “His surgical tech- Conn.; July 12, 2006 by the first doctors to perform an- faculty in 1946. He continued to niques doubled the life spans of gioplasty. perform surgeries until he was 70. patients with pancreatic cancer,” John W. Jung, M.D. ’06, WG ’06, For almost 25 years, Schwegman said James W. Fox IV, M.D., chief Philadelphia; August 27, 2006. Anna-Marie Chirico, M.D., was secretary of the American of reconstructive surgery at Jeffer- Philadelphia, emeritus professor Board of Surgery and traveled son. Rosato wrote several books of medicine, February 4, 2007. around the country giving oral and more than 250 scientific pa- FACULTY DEATHS After earning her medical degree boards to surgical candidates. pers on cancer. He was the recipi- from the University of Chicago ent of numerous professional Fredric D. Burg, M.D., School of Medicine in 1950, she Arthur L. Warner, M.D. ’48, awards. Among his many relatives Huntsville, Ala., emeritus profes- was an intern at Philadelphia Denver, Colo., a specialist in pub- with degrees from Penn is a sor of pediatrics; September 1, General Hospital, a hematology lic health and pediatrics; August brother, Ernest F. Rosato, M.D. 2006. After earning his M.D. de- resident at Presbyterian Hospital, 8, 2006. He worked many years ’62, G.M.E. ’66, a professor of gree from Northwestern Universi- and an internal medicine resident to promote community health lo- surgery at Penn. ty, he took his residency at Chil- at Temple University. She spent cally and globally. He was a con- dren’s Memorial Hospital in several years in private practice scientious objector to war. Harold S. Orchow, M.D., G.M.E. Chicago. He also served two years and in 1959 joined the HUP fac- ’70, Las Vegas, former medical di- in Public Health Services in ulty. She retired in 1987. In addi- Joseph J. Toland III, M.D., rector at Montevista Hospital; Cincinnati and was on the faculty tion to providing care to the most G.M.E. ’49, Philadelphia, a retired February 25, 2006. of the University of Cincinnati needy Philadelphians, she also orthopaedic surgeon; June 18, and Northwestern. He served as cared for many University faculty 2006. Hans Herlinger, M.D., G.M.E. associate director of the National members and their families, who ’72, Haverford, Pa., a renowned Board of Medical Examiners. In considered her the “doctor’s doc- Walter Patterson, M.D., G.M.E. gastrointestinal radiologist for 25 1974, he joined Penn’s School of tor.” Among the positions she ’50, Warwick, R.I.; June 26, 2006. years at HUP; August 4, 2006. Medicine as assistant clinical pro- held at Penn was chair of the Born in Graz, Austria, Herlinger fessor of pediatrics. In 1982, he Medical Board. A recipient of the John J. Helwig Jr., M.D. ’54, was sent into exile in Italy after was promoted to professor of pe- University of Pennsylvania’s Lind- G.M.E. ’60, Worcester, Pa., a re- the Nazis invaded Austria in diatrics at The Children’s Hospital back Award for Distinguished tired cardiologist; October 1, 1938. While dispossessed, he of Philadelphia. From 1980 to Teaching, she also received the 2006. He was chief of cardiology practiced medicine without a de- 1989, he served as the school’s as- Medical Student Government at the former Germantown Hospi- gree from 1938 to 1942 in East sociate dean for academic pro- Award and was named by the stu- tal for almost 30 years until the Africa. After World War II, he grams, then became vice dean for dents to the Teaching Honor Roll. early 1990s and remained on the studied to be a pediatrician. Her- education. He was a senior fellow She also received the Distin- staff until his retirement in 1998. linger also studied tropical medi- at Penn’s Institute for Research on guished Alumna Leadership He served on the board of the cine and practiced in Guyana, Higher Education and a faculty Award from her alma mater, Se- Pennsylvania Medical Society and South America, for several years associate at the Center for ton Hill College. For many years, was president of the Philadelphia in the 1950s. In 1960, he became Bioethics. Burg left Penn in 1995 Chirico volunteered at the Morris County Medical Society from head of radiology at St. James’s to serve as associate dean at the Arboretum, working in the micro- 1978 to 1979. While society pres- University Hospital in Leeds, Eng- University of Alabama. He held propagation lab, where she pro- ident he appeared on a weekly land. He developed a technique that position until 2004. He was duced plants for medical research program on WCAU-TV to discuss called enteroclysis – a radiograph- appointed by Governor Bob Riley from leaves, twigs, or roots using medical subjects. He headed the ic technique to detect abnormali- to chair the Emergency Response a form of cloning. The Chirico catheterization lab at Penn and ties of the small intestine. Her- Commission to Address the Horticultural Research Endow- then was associate director of the linger wrote a widely used text- Health Care Crisis in Alabama. ment helps fund the continuation Cardiovascular Research Center book, Clinical Radiology of the of her work at the Arboretum. before joining Germantown Hos- Small Intestine, and lectured Arnold Chait, M.D., former clini- pital in 1965. around the world. When he was cal professor of radiology; Sep- Gertrude Henle, M.D., Newtown 63, nearing mandatory retirement tember 12, 2006. After earning Square, Pa., an emeritus professor Francis E. Rosato, M.D., G.M.E. age, he was invited to HUP to his medical degree from the Uni- of virology in pediatrics in the ’65, Gladwyne, Pa., a retired pro- conduct research and teach. He versity of Utrecht in the Nether- School of Medicine; September 1, fessor of surgery at Jefferson Med- worked at HUP until retiring in lands, he completed his residen- 2006. A pioneering virus re- ical College and retired chief of 2003. In 1990, the University of cies in pathology and radiology in searcher who worked at The Chil- surgery at Thomas Jefferson Uni- Graz presented him with an hon- hospitals in New York and began dren’s Hospital of Philadelphia, she versity Hospital; October 18, orary medical degree. In 1996, he teaching radiology at SUNY collaborated with her husband, Dr. 2006. After earning his medical received the Cannon Medal from Downstate Medical Center in Werner Henle, in groundbreaking

2007/SUMMER I 39 LEGACY GIVING

research from 1941 until shortly came chair of the pediatrics de- before her husband’s death in partment at Hahnemann Universi- 1987. The National Library of ty Hospital. He later assumed the Medicine, part of the National In- same position at the Medical Col- A Particular Joy stitutes of Health, called the Hen- lege of Pennsylvania. An early re- les “a prodigious force in virology, cipient of the University of Penn- immunology, and viral oncology sylvania’s Lindback Award for Dis- during the second half of the tinguished Teaching, he was a twentieth century.” She earned her member of the Alpha Omega Al- medical degree from the University pha Honor Medical Society. Kaye of Heidelberg in 1936. She met was one of the authors of The Core Werner Henle in Heidelberg and Textbook of Pediatrics, a classroom married him after emigrating to standard for more than 20 years. the U.S. in 1937. Both joined He served on the board of the Penn’s Department of Microbiolo- Philadelphia Chapter of the Amer- gy. In 1943, the Henles demon- ican Diabetes Association. strated the effectiveness of an in- Charlotte Snyder and Douglas Fraker, M.D. fluenza vaccine. They also devel- Donald B. Martin, M.D., Bryn oped a diagnostic test for mumps Mawr, Pa., emeritus professor of hirty years ago, Penn legend Jonathan E. Rhoads, and collaborated with Dr. Joseph medicine; November 1, 2006. Af- M.D., G.M.E. ’40, gave Charlotte Snyder a gift Stokes Jr. in using gamma globulin ter earning his medical degree at unlike any other — six more years with her hus- to combat infectious hepatitis. Harvard University and complet- band, Arnold. Inspired by the eminent surgeon’s expertise Their work on viral infections laid ing a residency in endocrinology T the groundwork for scientists to at Massachusetts General Hospi- and friendship, Mrs. Snyder created two charitable discover interferon. The Henles tal, he became chief of the dia- annuities and established a bequest supporting the were particularly notable for betes unit at Mass General. He Jonathan E. Rhoads Endowed Professorship in Surgery. studying Epstein-Barr virus, first studied in Paris on a Fulbright “Arnold and I talked it over and we knew that giving demonstrating that the virus was scholarship in 1962 and in Gene- to this professorship was the ideal way to show our linked to mononucleosis and later va on a Guggenheim fellowship gratitude,” she recalls. “I know my gift is not only a showing that the virus contributed in 1974. Recruited to Penn in way to honor Dr. Rhoads, it is a way to honor Arnold.” to two types of cancer. Gertrude 1979 as the founding director of Dr. Rhoads, a former Penn provost and chair of the Henle became an assistant profes- the Rodebaugh Center for Dia- Department of Surgery, died in 2002 at the age of 94. sor of virology in 1951, a full pro- betes Research and Education, he Today, the Rhoads professorship is held by Douglas fessor in 1965. She was elected to became associate chair of the De- the National Academy of Sciences partment of Medicine in 1985. Fraker, M.D., chief of the Division of Endocrine and in 1979, one of its few female He led the internal medicine resi- Oncologic Surgery. Last October, Mrs. Snyder spoke with members at that time. With her dency program from 1985 to Dr. Fraker at an event celebrating endowed professor- husband, she received many hon- 1996, when he earned emeritus ships. “He was wonderful,” she says. “I can see that he ors, including the Bristol-Myers status. Known for his dedication has the same qualities that Dr. Rhoads had — a strong Award for Distinguished Achieve- to clinical education, he was dedication to his work and his patients.” ment in Cancer Research, the equally devoted to his residents That evening Mrs. Snyder met other donors who sup- Mead Johnson Award for Research and stood at the forefront of a port the more than 120 endowed professorships at the in Pediatrics, the Virus Cancer Pro- movement in medical education School of Medicine. “All of us are providing support gram Award of the National Can- to make residency more humane for future research and medical education. It just brings cer Institute, and the Gold Medal for doctors during their training. of The Children’s Hospital of Among his honors were the Don- me a particular joy that I can do this.” Philadelphia, awarded in 1983. na K. McCurdy Department of Another activity that brings Mrs. Snyder joy is learn- Medicine Housestaff Teaching ing more about planned giving. She regularly attends Hans Herlinger, M.D. See Class Award, the Penn Pearls Teaching Charles Custis Harrison Society events. The Society is of 1972. Award for excellence in student the parent organization of the Medical Legacy Circle, teaching, and the Medical Student which honors individuals who name PENN Medicine Robert Kaye, M.D., Philadelphia, Government Teaching Award for as a beneficiary of a will, living trust, or other planned emeritus professor of pediatrics; Clinical Medicine. In 1996, the gift vehicle. “I love meeting other people who have the July 14, 2006. After receiving his School of Medicine established same philanthropic vision that I do.” medical degree from Johns Hop- the Donald B. Martin Teaching Mrs. Snyder’s bequest and charitable gift annuities kins University, he did his pedi- Service Award in his honor. He atric residency there, then became continued to teach until 2006. In are just two of many creative gift opportunities that a fellow at the Harvard School of 1997 the American College of benefit both the School of Medicine and its donors. Public Health. He began his career Physicians board of regents As you chart your financial future, the Planned Giving at Penn in 1948 as an instructor awarded him a Mastership. Office is ready to assist in developing an appropriate in pediatrics, advancing to profes- strategy. Contact Marcie Merz, J.D., Director of sor in 1956. He also held hospital Francis E. Rosato, M.D. See Planned Giving, PENN Medicine, 3535 Market Street, and administrative appointments Class of 1965. Suite 750, Philadelphia, PA 19104-3309 or email: at The Children’s Hospital of [email protected]. Also, check the Planned Philadelphia, where he served as Cletus W. Schwegman, M.D. See Giving Office’s new web site: www.med.upenn. deputy physician-in-chief. After Class of 1948. planyourlegacy.org. leaving Penn in 1973, Kaye be-

40 I PENN MEDICINE Recruit, Retain, Endow Craig and Elaine Dobbin/Nancy Blumenthal Professorship of Advanced Lung Disease. When we presented the Plan for PENN Until his death last October, Craig Dob- Medicine, our strategic roadmap, five years bin was a Canadian industrialist and a ago, we organized a wide array of aims member of the board of PENN Medicine. and priorities under six major goals. One One of the interesting aspects of this pro- goal was “Develop World-Leading Programs fessorship is that it was partially named in Selected Areas of Research.” While prais- for Nancy P. Blumenthal, C.R.N.P., senior ing the quality and breadth of research nurse practitioner for HUP’s lung trans- that PENN Medicine had achieved in the plant program – and one of the essential previous decade, the plan articulated the people who make that program one of need to advance to an even higher level the nation’s best. We believe this is the as an internationally recognized leader in first endowed professorship to honor the biomedical research. Quite plainly, the plan crucial collaborative relationship between spelled out the very first step to achieving physicians and nurses. As for Dr. Kotloff, the next level: “The first and overarching the professorship is an opportunity to ex- goal of PENN Medicine is to implement plore new medical and surgical treatment the highest standards of excellence for the options. The professorship, he says, “was recruitment, promotion, and retention of established to promote research, education, faculty.” It made – and continues to make – Cardiovascular Research in 2004. The and scholarship in this burgeoning field perfect sense: for all its resources, no insti- endowed professorship, says Epstein, who of advanced lung disease.” tution can be great without great people. subsequently became our chair of Cell Kevin R. Fox, M.D., G.M.E. ’85, professor They are the ones who attract other faculty and Developmental Biology, “has allowed me of medicine and medical director of the members as well as the most highly quali- to take scientific risks, providing the free- Rena Rowan Breast Center at the Abram- fied students. They are also the ones who dom to explore new ideas and dreams.” son Cancer Center, was recently named tend to be most successful in garnering The donors who endow the professor- the first recipient of the Mariann T. and support from the government and the pri- ships may do so because a family member Robert J. MacDonald Professorship in vate sector. But how do we compete with or friend has suffered from a particular Breast Cancer Care Excellence. As its name other academic health systems that are just disease. Sometimes, it’s because they see a suggests, this endowed professorship is as eager to recruit or retain these leading need and have the philanthropic resources focused on clinical care. But as Dr. Fox figures? Not only that: we must compete to try to meet it. Whatever the donors’ notes, the MacDonalds’ support also “will with industry for the same faculty members. specific motivations, endowed professor- enable the Abramson Cancer Center to Over the years, we’ve found that one of ships have a respected place in our School take another significant step toward pro- the most effective ways is to offer endowed of Medicine. The very first dates back to viding new insights into the cause and professorships. These professorships, funded 1877, when Sarah Rittenhouse Barton en- treatment of breast cancer.” by individuals, families, and foundations, dowed the John Rhea Barton Surgical Pro- For 130 years, endowed professorships not only indicate the high esteem in which fessorship. Its first holder was D. Hayes have helped sustain the excellence of our faculty members are held but also provide Agnew, considered the leading surgeon of institution in research, education, and a valuable sense of stability for the hold- his day. Our current chair of the Depart- clinical care. They honor esteemed faculty ers and allow them to devote more time ment of Surgery, Larry Kaiser, M.D., holds members, memorialize family members, to their chosen area of scholarship. For that prestigious chair today. At present, and recognize the achievements of admired example, Virginia M.-Y. Lee, Ph.D., there are nearly 110 endowed professor- colleagues – all the while providing in- M.B.A., who holds the John H. Ware 3rd ships in our school and another 10 or so valuable support for the three-part mission Endowed Professorship in Alzheimer’s shared with other schools in the University. of PENN Medicine. An endowed profes- Research, notes that the professorship “has To suggest the variety of these endowed sorship is a legacy whose impact continues enabled me to explore more cutting-edge chairs, let me cite a couple of the more to be felt for many years. areas of research, taking scientific risks recent ones. with the potential of a high yield of re- Robert M. Kotloff, M.D., G.M.E. ’91, Arthur H. Rubenstein, M.B., B.Ch. sults.” Her words echo those of Jonathan professor of medicine and chief of the Executive Vice President of the University of A. Epstein, M.D., who was named to the section of advanced lung disease and lung Pennsylvania for the Health System William Wickoff Smith Professorship of transplantation, is the first recipient of the Dean, School of Medicine 007 R 2 ME SUM For the first time last fall, the School of Medicine divided its incominga classm into teams of six and seven. tThee idea is that, lti to be effectiveu as doctors, students willls M Skil rkhave to learn how to work well in teams wo tion ge am andc alearn how to lead them.e Mostn Te uni all p m health care Ctodayh is not provided by rshi om de h C soloit practitioners;y and in hospitals, Lea ac n Un s ro patients arel often cared for by multiple app atio oa r s Gdoctors and teams of professionals. pe amic Coo dyn EAM roup A T G BUILD O tion t T in Ac l Blut OW edist itchel H thopa ith M dies ro-Or ries w al Stu Non Profit Neu undUNIVERSITYa edi cOF PENNSYLVANIA HEALTH SYSTEM Organization A Bo iom m U.S. Postage ssing in B riculu Cro ndard3600 Market Cur Street, Suite 240 Sta Philadelphia, New PA 19104-2646 PAID The g the isitin Phila., PA Rev Permit No. 4097

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