Summer I 2006

SUMMER I 2006

WANTED: A HUMANIST PROFESSIONAL

Fixing Jaws, Fixing Eyes Arnold Ludwig’s Way with Words A Matter of FACTT What’s Happened Since . . . n that same issue, Helene D. Gayle, and Reaching Your Healthy Weight. Hark, M.D. ’71, G.M.E. ’77, M.P.H., was director of the medical school’s Nutri- hat a surprise! It turns out featured in a short piece about the tion Education and Prevention Program, that events often happen School of Medicine’s 2005 Com- is now host of a new series on The quickly, developments Imencement. Gayle, who was then Learning Channel (TLC) called Honey, occur, people move from director of the HIV, TB, and Reproduc- We’re Killing the Kids. Hark visits fami- Wone position to another. tive Health Program of the Bill & Melinda lies across the country and shows Sometimes, after we’ve dotted the last Gates Foundation, delivered the grad- them how the children’s unhealthy life “i” in Penn Medicine, had it printed, uation address. Exhorting the Class of styles are harming them. One of the fea- and sent it out across North America, 2005 to action, she asserted that a med- tures is a computerized sequence that the people we’ve featured make a ical degree is “one of the most powerful suggests how the children will look as change. Here is an update on some tools I know to enable you to make a they age. Still, the show is not all grim, recent stories we’ve run. difference.” She was also the subject of a and the families attempt valiantly to The cover story of our Fall 2005 issue full-length article I wrote for our Win- switch from their diet of junk food. was “Rx: Better Information Technology ter 2003 issue, “Helene Gayle: Agent of Hark has also written another book for Better Health,” by Martha Ledger. Prevention,” which described her work with Deen, The Whole Grain Diet Miracle Much of the focus was on Penn’s at- at both the Gates Foundation and, be- (DK Publishing, 2006). tempts, through better information fore that, the Centers for Disease Control technology, to reduce costs, reduce and Prevention. Her focus was HIV/AIDS, he last item concerns Robert medical errors, and improve the quality of which she called “the defining public W. Miller, M.D. ’46, who died care. Providing the national perspective health issue of our time.” on February 23. Miller, emer- on the opportunities – and challenges – In February, Gayle became president itus scientist at the National involved in such an endeavor was David and CEO of CARE, the international T Cancer Institute, had sent an J. Brailer, M.D., G.M.E. ’91, Ph.D. He poverty-fighting organization, which in occasional note to Penn Medicine, such had done his medical training at Penn its 2005 fiscal year spent $514 million as a critique of our annual coverage of as a Robert Wood Johnson Clinical to support its programs. Announcing the 50 Year Class. He wanted us to tell Scholar and also earned his Ph.D. de- Gayle’s departure from the Gates more about “the high points in the gree from The Wharton School. Brailer Foundation, Patty Stonesifer, its presi- lives/careers” of the alumni rather than is an advocate of electronic health dent, thanked Gayle for her “extraor- the number of their grandchildren or records and “interoperability” among dinary leadership.” According to their hobbies. That sounded good to me. information technologies, which he CARE, its mission is “to tackle the un- Miller joined the ranks of our au- believes are seriously fragmented. Ap- derlying causes of poverty so that thors when we published “A Wartime pointed National Coordinator for Health people can become self-sufficient. Student Remembers” (Fall 2002). He Information Technology in the U.S. Recognizing that women and children was very willing to make edits and to Department of Health and Human suffer disproportionately from poverty, flesh out some of the events and char- Services in April 2004, he resigned CARE places special emphasis on acters in his early drafts. In his memoir, earlier this spring. working with women to create per- Miller gave a vivid sense of life at the According to a statement issued by manent social change.” School of Medicine during World War Michael Leavitt, Secretary of Health and Lisa Hark, Ph.D., R.D., was featured II, when the students were also civil- Human Services, “David has made sig- in my editor’s note for the April 2005 ians in the Army or Navy medical re- nificant progress in advancing the pres- issue. At that time, she had just pub- serve. Miller described the faculty ident’s health IT agenda and laying the lished (with Darwin Deen, M.D.) a members who taught the students building blocks for future progress.” book called Nutrition for Life: The No-Fad, and the officers who trained them; Brailer is expected to continue to No-Nonsense Approach to Eating Well breakfast en masse in the Palestra; serve as vice chairman of the Ameri- posters that warned about V.D.; and can Health Information Community, the challenges of saluting properly. an advisory organization, and as a We will include a more traditional consultant to HHS. obituary of Dr. Miller in our next issue.

Cover Art: Lewis & Nobel Design and Graham P. Perry/NCS Studios Psychi atrist a sWriter,Wri teras Ps ychiatrist

SUMMER I 2006 / VOLUME XVIII NUMBER 3

PSYCHIATRIST AS WRITER, WRITER AS PSYCHIATRIST BY MARIE GEHRET AND JOHN SHEA The impulse to rule, the connection between creativity and 22 madness, the ways individuals shape their identities – these are among the fascinating and occasionally controversial topics of Arnold M. Ludwig’s books. Then came a novel.

PONDERING PROFESSIONALISM BY JOHN SHEA In the spring, the School of Medicine held a symposium featuring both Penn physicians and outside 14 experts who have been prominent in the effort to foster professionalism. Said one of the panelists: “Altruism is non-negotiable.” PROFESSING HUMANISM BY NICOLE GADDIS Inspired in part by earlier Penn physicians, Paul Lanken, M.D., has taken the lead in bringing humanism to the School of TAKING ON TMD BY JENNIFER BALDINO BONETT Medicine’s curriculum. One new program pairs students with For patients with the excruciating facial pain of temporo- chronically ill patients over their first three years of study. mandibular joint disorder, a prosthesis recently approved 16Auth o r and by the F.D.A. is a life-saver. It was developed by Penn’s flanke subjec d here ts: Arn two o by Na old Lud 8 f the gr Peterpoleo nD. Quinn,wig is M.D., D.M.D. ea a 22 t leade nd Juli I PEN rs he h us Cae N MED as stud sar, ICINE ied. Departments SEEING STRAIGHT BY JON CAROULIS Although misaligned eyes are often thought of as a condition that affects children, Nicholas Volpe, M.D., IFC EDITOR’S NOTE 19 operates exclusively on adults with strabismus. The cor- What’s Happened Since . . . rective surgery has psycho-social benefits as well. 2 VITAL SIGNS JONATHAN EPSTEIN ASSUMES DEPARTMENTAL Still Going Strong: The Patient – and the Program CHAIR BY JOHN SHEA School of Medicine Rises to Third in Survey 30 Only weeks after receiving the Outstanding Investigator Award from a national organization, Jonathan A. Epstein, M.D., Environment and Disease: What’s the Connection? was named to lead the Department of Cell and Develop- Sad News from Botswana mental Biology. A Center for Muscular Dystrophy Research Honors & Awards PENN NEUROSURGERY GOES THREE-DIMENSIONAL BY KATE OLDERMAN 7 LETTERS Using a Dextroscope® to get a detailed visualization 31 of the brain, Penn neurosurgeons can perform deli- 34 DEVELOPMENT MATTERS cate surgery in a less invasive way. The Board of Women Visitors Recent Gifts THE FINEST HOSPITAL CARE – WITH A DIFFERENCE BY NICOLE GADDIS 38 ALUMNI NEWS 32 The Pavilion at HUP offers extra amenities for the patient Progress Notes while complementing the hospital’s nationally recognized care.

IBC THE LAST WORD A MATTER OF FACTT BY KAREN KREEGER Translational Medicine: Some First Steps A research team at Penn has developed a new, super-sensitive blood test to detect abnormalities at 33 a much earlier stage, when there are more treat- STAFF ment options. JOHN R. SHEA, Ph.D. Editor

NICOLE A. GADDIS Assistant Editor

LEWIS & NOBEL DESIGN Design / Art Direction Penn Medicine is published for the alumni and friends of PENN Medicine by the Office of Communications. © 2006 by the Trustees of the University ADMINISTRATORS of Pennsylvania. All rights reserved. Address all correspondence to John REBECCA HARMON Shea, Penn Medicine, 3600 Market Street, Suite 240, University of Pennsyl- Chief Communications Officer vania Health System, Philadelphia, PA 19104-2646, or call (215) 662-4802, or e-mail [email protected]. SUSAN E. PHILLIPS Senior Vice President for Public Affairs Visit Penn Medicine’s web site: http://www.uphs.upenn.edu/prnews/publications/ School of Medicine Rises to Third in U.S. News Survey

In its annual survey of graduate and because as recently as two years ago, Still Going Strong: professional schools, U.S. News & World Penn was ranked 46th in that category. The Patient – and the Program Report ranks the University of Pennsylva- In a memo announcing the survey nia School of Medicine third among all results to faculty and staff, Arthur H. The Hospital of the University of research-oriented medical schools in the Rubenstein, M.B., B.Ch., executive vice Pennsylvania recently celebrated the 40th nation. Last year, the school was ranked president of the University of Pennsylvania anniversary of its first kidney transplant fourth. This is the ninth year in a row for the Health System and dean of the by inviting back the two brothers – re- that Penn’s medical school has been listed School of Medicine, wrote: “While it is cipient and donor – who went through among the top five schools in the coun- important to remind ourselves that such the historic operation. During the cele- try. The magazine weighs peer assess- reputational surveys must be kept in bration, Larry Kaiser, M.D., chair of the ments, assessments by residency direc- their proper perspective, it is always nice Department of Surgery and Surgeon- tors, research activity, student selectivity, to be recognized so publicly for our suc- in-Chief for Penn’s Health System, an- and other factors. cessful efforts, and I congratulate you all nounced the launch of the Transplant Penn ranked in the top 10 in four of for your contributions to this recognition. House initiative. According to Kaiser, it is the specialty programs that U.S. News According to the survey results, the “a courageous effort by our transplant surveys: Internal Medicine (#5), Drug/Al- top three medical schools are at Harvard program to provide an affordable haven cohol Abuse (#6), Women’s Health (#4), University, Johns Hopkins University, for patients, and their families and friends, and Pediatrics (#2). The School of Medi- University of Pennsylvania, followed by to find privacy and rest.” It would be the cine was also ranked 16th among medical the University of California at San Fran- first such facility in the City of Philadelphia. schools for students going into primary cisco and Washington University in St. It was in 1966 that Clyde Barker, M.D., care. This represents a significant advance, Louis in a tie for fourth. former chair of surgery, bravely attempted to transplant a kidney from a living donor, Joe Mehl, into his 20-year-old off medications for those transplant recipi- want to conquer the diseases that can brother, Howard. Four decades later, the ents who recover well. cause organ failure, such as Hepatitis C, so brothers are still doing well, and Howard is “One of the things we’re looking at as that transplants would not be necessary.” now the longest-surviving kidney-trans- the future of transplant medicine is being Besides celebrating the remarkable plant recipient with a working graft in able to identify patients who would toler- success of Howard Mehl’s transplant, the Pennsylvania. ate transplanted organs without any im- evening commemorated Penn’s transplant It’s a track record that still impresses munosuppressive therapy,” said Abraham program. According to Arthur H. Ruben- many in the medical field. Although the Shaked, M.D., Ph.D., chief of Transplant stein, M.B., B.Ch., executive vice presi- science is widely taken for granted today, Surgery. “We also need to develop less- dent of the University of Pennsylvania for transplantation was extremely risky in invasive diagnostic tests for determining the Health System and dean of the the 1960s. Live, or heart-beating, donors the likelihood of organ rejection so that School of Medicine, the “incredible dedi- were rare; and the standards for “brain our patients will no longer need to have cation and skill” of the surgeons and death” were not defined until 1981, which biopsies performed. And, of course, we health-care professionals make Penn’s meant that many organ donations came

from cadavers. In addition, there was no Joe and Howard Mehl, donor and recipient N i c o l e

commonly available tissue-typing test. A . G a

“What was used at HUP could have been d d i called ‘home-made’,” Barker said. He also s noted that only two immunosuppressive drugs were available, and only one of them – steroids – is still used. Things have moved forward consider- ably since then. Modern immunosuppressive drugs have improved short-term results, and research is now focusing on making more potent and targeted agents as well as determining how best to taper

2 I PENN MEDICINE “the most comprehensive transplant cen- Edward A. Emmett, M.D., professor ter in the region.” of occupational medicine, is the center’s As Ali Naji, M.D., Ph.D., surgical di- deputy director. rector of the Kidney Transplant Program, In its efforts to study the interplay be- Penning explained, “Our transplant program is tween environmental pollutants and genes, unique because of its relationship with local communities selected to be part of Penn researchers will look at questions basic scientists.” the effort are the Eastwick neighborhood such as what makes one person suscep- “Donating an organ – it’s the most in southwest Philadelphia; the neighbor- tible to disease and another not. “If two intimate of human exchanges,” Howard hood of West Philadelphia; Chester, in people breathe the same polluted air,” Mehl concluded. “You become part of a Delaware County; Pottstown, in Mont- asks Penning, “why does one get asthma much larger family.” gomery County; and Palmerton, in Carbon and one does not?” — Nicole Gaddis County, about 70 miles north of — Karen Kreeger Philadelphia. Environment and Disease: According to Trevor M. Penning, Ph.D., A Change of Name What’s the Connection? director of the new center, “The idea is to The Department of Family Practice and Over the next four years, the School of have two-way dialogues, to disseminate Community Medicine is now known as Medicine will receive $4.1 million from findings of the center to community the Department of Family Medicine and the National Institutes of Environmental leaders by way of workshops and other Community Health. The department was Health Sciences to study the effects of en- educational programs We’re also looking instituted in 1994 and continues under vironmental pollutants on human health. for community leaders to tell us their en- the leadership of Marjorie A. Bowman, The new Center of Excellence in Envi- vironmental concerns. By working with M.D., M.P.A., its founding chair. The ronmental Toxicology (CEET) represents communities, we can empower them department has grown to more than 40 a partnership between research scientists with the knowledge to make changes in physicians; each year, its specialists handle and communities in southeastern Penn- environment and public health policy.” more than 35,000 outpatient visits, 400 sylvania. Its mission is to understand the Penning, who is a professor of phar- inpatient stays, 180 deliveries, and home mechanism by which environmental ex- macology, biochemistry and biophysics, visits when necessary. posures lead to disease. Understanding and obstetrics and gynecology at the these processes can lead to early diagnosis, School of Medicine, notes that Penn is an Sad News from Botswana intervention, and prevention strategies. ideal place for an environmental health On March 19, Richard K. Root, M.D., The goal will be to improve environmental sciences center because Pennsylvania is a former associate professor of medicine at health and medicine in the region. highly polluted state: “Pennsylvania is Penn, was killed while on a two-month The Penn CEET is one of 22 designated considered to be the fourth-most polluted assignment as part of the Penn Program Environmental Health Science Centers in state in the country, by a series of different in Botswana. Root, 68, was on a guided the United States and the first in Penn- indices.” At the same time, Pennsylvania canoe ride in the Tuli Nature Reserve sylvania. has the second-highest incidence of cases when he was pulled from his canoe by a An area of interest will be to study the of cancer per 100,000 people. crocodile. His wife, Rita O’Boyle, was in role of environmental exposure in lung Penn’s Center of Excellence in Envi- another canoe and was unharmed. Root disease, including cancer, mesothelioma, ronmental Toxicology will not be housed had come to Botswana to teach and pro- asthma, and emphysema. Researchers in a single building. Instead, it will draw vide medical care for HIV patients at will also focus on how certain environ- on the expertise of 50 faculty members Princess Marina Hospital. Most recently, mental triggers can disrupt the body's from 16 departments and five schools at Root was an emeritus professor and vice endocrine and reproductive systems, the university, including the law and chairman of the Department of Medicine causing problems such as pre-term birth business schools. Penning points out that at the University of Washington. He had and birth defects. the scientific aspects of environmental also been chairman of medicine at the In addition to its research agenda, the exposure cannot be looked at in isolation. University of California at San Francisco center will have a major community out- There are political, social, and health-care and chief of infectious diseases at Yale reach and education component. The five issues to deal with as well. University School of Medicine. Earlier in

2006/SUMMER I I 3 T h e

his career, Root came to Penn to form the pion of muscular dystrophy research. In M u s c

infectious disease division of the Department u addition to the Muscular Dystrophy As- l a r

of Medicine with Rob Roy MacGregor, M.D. y sociation, they are funded by the National s t r o p

Although the Penn Program in Botswana h Institute of Arthritis and Musculoskeletal y

A s s

has been a success since its founding in o and Skin Diseases, the National Institute c i a t i o

2001 and more than 40 Penn residents n of Neurological Disorders and Stroke, and and medical students worked in its clini- the National Institute of Child Health and cal programs during the recent academic Human Development. year, the countryside is very different Under Sweeney’s leadership, the Penn- from what many visitors are used to. Ac- based Center will focus on ways to in- Sweeney cording to the U.S. Embassy in Botswana: crease muscle growth and examine com- “Wild animals pose a danger to tourists. of Penn’s Department of Physiology. Kathryn pounds to inhibit enzymes involved in Tourists should bear in mind that, even R. Wagner, M.D., Ph.D., of The Johns the degradation of muscle tissue. The in the most serene settings, the animals are Hopkins School of Medicine, is co-director. core facility, located at Penn, will analyze wild and can pose a threat to life and safety.” “This award will accelerate the pace muscular dystrophy animal models. Donations can be made to the Richard K. of our translational work and provide a Planned clinical trials, to be based at the Root Memorial Fund, c/o Harvey Friedman, pathway to patient trials,” said Sweeney, N.I.H. in Bethesda, Md., will determine M.D., Chief, Infectious Diseases, Direc- the William Maul Measey Professor of the safety and feasibility of a potential tor, Penn-Botswana Program, University Physiology. “It will also be the nucleus of drug treatment for muscular dystrophy, of Pennsylvania, 502 Johnson Pavilion, a larger translational-research initiative which was first developed in Sweeney’s Philadelphia, PA 19104-6073. for muscular dystrophies that I hope to research lab. Other research sites con- Fortunately, the Botswana program re- catalyze at Penn.” tributing to the investigations directed by cently received positive news: the Presi- All six Wellstone Centers honor the the Penn Center include Johns Hopkins dent’s Emergency Plan for AIDS Relief has memory of the late U.S. senator, a cham- and the University of Florida/Gainesville. made the School of Medicine a one-year grant of $933,551 to support clinical and educational activities in Botswana. The Match Day Mania one, as their names were called, the stu- money will be used to support Penn fac- The N.C.A.A. tournament was not the dents received their sealed envelopes from ulty, residents, and students as they treat, only madness in March. On Match Day, administrators, returned to their seats, . . . study, and research the AIDS epidemic in a the 159 students who would be graduat- and tore open their envelopes to read the nation where about 38 percent of adults ing from the School of Medicine learned names of their residency programs. between the ages of 15 and 49 are infected. where they would be taking their resi- Here, from left to right, Neil Wimmer, “Botswana is considered the test dencies. They gathered in Dunlop Audi- Jesse Goldstein, Rebecca Nerenberg, and tube case in Africa regarding AIDS,” said torium of Stemmler Hall. Then, one by Esti Schabelman celebrate their good news. Dr. Friedman. “This is one of the frontiers K a t

in HIV care, and I am proud that Penn is e

O l d

leading the way.” e r m a n A Center for Muscular Dystrophy Research Funded by a $1 million grant from the National Institutes of Health and the Muscular Dystrophy Association, the School of Medicine has established one of only six Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research Centers in the United States. The center at Penn is directed by H. Lee Sweeney, Ph.D., chair

4 I PENN MEDICINE A Generous Bequest fessor emeritus at West Chester University. ter’s director and the Parker Family The Parkinson’s Disease and Movement Keetz suffered from Parkinson’s Disease Professor of Neurology at the University of Disorders Center, part of the Penn Neu- until her death in July 2004 at age 73. Pennsylvania. The gift, he said, would be rological Institute at Pennsylvania Hospi- “We are extremely grateful to Dr. Keetz used to fund basic research to help us tal, has received a $3.2 million gift from for her vision, hope and generosity,” better understand the mechanisms of the estate of Mary A. Keetz, Ph.D. a pro- said Matthew B. Stern, M.D., the Cen- Parkinson’s Disease.

Honors & Awards current principal investigator of a grant preeminent contributions to their disci- from the National Institute of Aging. His plines and to society at large.” Jo Buyske, M.D., chief of surgery at research interests focus on Alzheimer’s Englander is also a member of National Penn Presbyterian Medical Center, has disease and the development of diagnos- Academy of Sciences as well as an Hon- been appointed a director of the American orary Fellow of The Biophysical Society Board of Surgery. Her primary responsi- and of the American Association for the bility is to help set standards for obtain- Advancement of Science. His laboratory ing and maintaining certification in sur- studies protein structure, function, fold- gery and to administer the board’s certifi- ing, misfolding, and amyloid. The study cation examinations. of protein folding, in particular, is expected to shed light on the errors in the David J. Casarett, M.D., assistant pro- process that can lead to such disorders as fessor of medicine, fellow of the Institute Alzheimer’s disease, Huntington’s-related on Aging, and physician at the Philadel- diseases, and prion-related en- phia VA Medical Center, is the first recip- cephalopathies. ient of the William A. Nelson Award for Excellence in Health Care Ethics, pre- Susan S. Ellenberg, Ph.D., professor of sented by the National Center for Ethics biostatistics and associate dean for clinical in Health Care. Throughout his career, Clark research, is one of 17 scientists around the Casarett has promoted ethical health-care nation who have been selected as members practices through his focus on understand- tically specific markers, the identification of the first class of “Fellows of the Society ing and improving the way patients make and evaluation of new treatments, the de- for Clinical Trials.” This recently established health-care decisions at the end of life. velopment of new instruments to meas- fellowship recognizes past and current ure rates of change, and studies of the Society members who have made signifi- Christopher M. Clark, M.D., associate relationship between Parkinson’s disease cant contributions to the advancement of professor of neurology, has been named and Alzheimer’s disease. clinical trials. Ellenberg was honored in to the Alzheimer’s Association Early-Stage May at the Society’s annual meeting. Professional Task Force. The national S. Walter Englander, Ph.D., the Jacob task force will focus on the unique chal- Gershon-Cohen Professor of Medical Sci- Larry Kricka, Ph.D., professor of pathology lenges facing people with early-stage ence and professor of Biochemistry and and laboratory medicine and director of Alzheimer’s disease and will help develop Biophysics, has been elected to the general chemistry at HUP, was named the recommendations to increase their par- American Academy of Arts & Sciences. winner of the 2006 Edwin F. Ullman ticipation in the leadership and services Founded in 1780, the Academy has a Award for contributions that advance the offered by the Association. Clark serves broad-based membership of scholars and technology of clinical laboratory sciences as associate director of Penn’s Alzheimer’s practitioners, which fosters interdiscipli- through the creation of new technologies Disease Center as well as director of the nary studies and public policy research. and analytical methods. The award is Memory Disorders Clinic. He is also di- According to Patricia Meyer Spacks, pres- presented by the American Association rector of the recently initiated Center of ident of the Academy, “Fellows are selected for Clinical Chemistry and sponsored by Excellence for Research on Neurodegen- through a highly competitive process that Dade Behring Inc. Two of Kricka’s efforts erative Diseases at Penn, and he is the recognizes individuals who have made have had a profound effect on the field of

2006/SUMMER I I 5 laboratory medicine. He was instrumental appeared on The Charlie Rose Show on PBS autoimmune blistering disorder. The goal in developing two of the three major in March as part of a panel of experts of her current project is to genetically chemiluminiscent technologies currently who discussed “The Diabetes Epidemic.” characterize the immune response in used in routine testing, and he played an pemphigus in order to identify novel and The Association of Bone & Joint Surgeons potentially safer antibody-targeted thera- selected Jess H. Lonner, M.D., director pies for this life-threatening disorder. of knee-replacement surgery at Pennsyl- vania Hospital’s Department of Orthopaedic Daniel J. Rader, M.D., the Cooper/McLure Surgery, as the 2006 Knee Society Young Associate Professor of Medicine, has re- Scholar. He received a scholarship to at- ceived a Freedom to Discover Unrestricted tend the Association’s meeting in Buenos Biomedical Research Grant from Bristol- Aires, Argentina, in April, where he pre- Myers Squibb. He is one of only two sci- sented a scientific paper. entists in the field of cardiovascular medicine to receive the honor in 2006. The Andrew D. A. Maidment, Ph.D., chief of the physics section of the Department of Radiology, was elected a Fellow of the American Association of Physicists in Kricka Medicine. According to the Association, important role in adapting chemilumines- his fellowship is in recognition of “distin- cent and bioluminescent assays to point-of- guished contributions” to the field. care testing. Kricka’s other main contri- bution to the field has been with minia- Gail Morrison, M.D. ’71, G.M.E. ’77, vice turization. In collaboration with Peter dean for medical education, received the Wilding, Ph.D., Kricka played a critical Daniel C. Tosteson Award for Leadership role in developing micro-fabricated clinical in Medical Education, presented by the analysis devices and devices that isolate Carl J. Shapiro Institute for Education cells, analyze DNA, test for fertility, assist and Research at Harvard Medical School in vitro fertilization, and integrate tests and Beth Israel Deaconess Medical Center. for malignancy. The award is presented annually to an individual whose leadership has brought Rader Mitchell A. Lazar, M.D., Ph.D., the Sylvan about significant innovation or improve- H. Eisman Professor of Medicine and Ge- ment in undergraduate and/or graduate award includes $100,000 per year for netics who serves as chief of the Division medical education. The recipient receives five years to support Rader’s research. of Endocrinology, Diabetes, and Metabo- an honorarium of $5,000 and delivers a Rader is recognized for his translational lism, was named to the advisory council lecture for the Shapiro Institute. research that applies basic research in of the National Institute of Diabetes and pathways of cholesterol metabolism and Digestive and Kidney Diseases. The advi- Aimee S. Payne, M.D., Ph.D., a clinical atherosclerosis to the development of sory council meets three times annually instructor and postdoctoral fellow in the new therapeutic approaches to reduce to advise the Institute about its research Department of Dermatology, received the risk of heart disease. He is especially portfolio and typically undertakes broad one of the four 2006 Research Scholar well known for his work on boosting issues of science policy. An important Awards from the American Skin Association. HDL levels and function. role of the advisory council is to provide The $50,000 awards are made to “prom- Rader serves as director of the Preventive second-level peer review of grant applica- ising investigators conducting research in Cardiovascular Medicine and Lipid Clinic, tions that have been scored by scientific the causes, prevention, and treatment of associate director of the Institute for review groups. skin diseases and cancers.” Payne is study- Translational Medicine and Therapeutics, Lazar, who is also director of the Institute ing genetic and molecular mechanisms of and program director of the General for Diabetes, Obesity, and Metabolism, pemphigus in order to identify a cutaneous Clinical Research Center.

6 I PENN MEDICINE Kathryn Schmitz, Ph.D., M.P.H., assistant Angeles of Taiwanese parents, graduated is interested in using the tools of engi- professor of epidemiology at the Center summa cum laude and Phi Beta Kappa neering and physical science to help solve for Clinical Epidemiology and Biostatis- from Harvard University in 2004, with a medical problems. tics, is a recipient of the Trudy Bush Fel- B.A. degree in engineering. At Penn, she is lowship for Cardiovascular Research in conducting research on angiogenesis. She Paul Root Wolpe, Ph.D., senior fellow Women’s Health, sponsored by the Amer- at the Center for Bioethics and a professor ican Heart Association. The award was in the Department of Psychiatry, has been presented in March during the 46th Annual elected president-elect of the American Conference on Cardiovascular Disease Society for Bioethics and Humanities. He Epidemiology and Prevention. will assume the role of president in October 2006. The national professional organiza- Colette Shen, an M.D./Ph.D. student, is tion for scholars in bioethics and the among 30 Paul and Daisy Soros New medical humanities has more than 1,600 American Fellows for 2006. The Soros members, including physicians, nurses, Fellowships provide up to a $20,000 social scientists, legal scholars, historians, stipend, plus half-tuition for as many as and philosophers. Wolpe, who serves as two years of graduate study, for the natu- director of the Program in Psychiatry and ralized American citizens, resident aliens, Ethics at Penn’s School of Medicine, is the or children of naturalized citizens who first chief of bioethics for the National are selected. Shen, who was born in Los Shen Aeronautics and Space Administration.

LETTERS Open to Improvement I read with interest your latest article is perceived as yet another technological the notes, because it is not intuitively on Health Information Technology [“Pre- barrier by patients who are desperate for clear where to look and how to sort the scription: Better Information Technology quality “face time” with their doctors. wheat from the chaff. I believe that graphic for Better Health,” Fall 2005]. I have a Second, in my role of an independent experts are needed to clean up this ava- clinical practice in Orthopedics and also medical examiner, I am always struck by lanche of data so that it can be digested perform many independent medical ex- the difficulty reading the voluminous easily by a non-engineer viewer. So often ams and thus have to read massive num- output from systems that use electronic computer technology is designed for very bers of chart notes. I was struck by two charting. The main difficulty from my technical reasons and the average end aspects of your article. standpoint is that very little effort seems user or the patient’s experience of this First, in my clinical practice I hear con- to have been expended on good graphic technology is forgotten. stant complaints from patients who come display concerns, especially on printed I just thought I would point out two from practices that use computer charting. copies of the notes. Fonts are all the same aspects of Health Information Technology The complaint is always the same: “My size. Extraneous bureaucratic or system that is frustrating and hopefully can be doctor spends all her time looking at her data is given the same visual weight or improved so that it is embraced by all. computer screen and doesn’t seem to be placement as critical patient data. There talking with me.” The perceived lack of is not enough visual spacing. Critical sec- Scott Jones, M.D. ’82 direct contact, as doctors spend more time tions of data are not well differentiated. Portland, Oregon inputting into the computer, is perfectly Dates of visits are often very hard to find illustrated by your picture on page 10 and it seems that everything else is date- The editor replies: Dr. Jones’s observations showing the doctor and the patient both and time-stamped. Sorting all of this out are well taken. In the case of Dr. Carmen intently watching the screen of the com- visually is exhausting. Physicians in a Guerra, however, we selected the photo- puter rather than talking with each other. particular system eventually get used to graph to emphasize the computer screen I am in favor of all the benefits of elec- their own system, but physicians outside that showed the electronic health record, tronic charting, but this technology often of a particular system are often baffled by which was the focus of the article.

2006/SUMMER I I 7 Wherever the art of medicine is loved, there is also love of humanity. — Hippocrates

By Nicole Gaddis

Dr. Paul Lanken believes in the usefulness of small groups for teaching doctoring and humanism. Here he leads a session with a standardized patient, meant to help students learn to break bad news. Dr. Natasha Mirza, far right, is a preceptor for the course.

everal times during my interview Penn, and I feel that it is good for people medicine – indeed, may see cynicism as with Paul Lanken, M.D., G.M.E. to have those examples to look up to. intrinsic to medicine – because they see ’77, he turns to face the portrait You don’t forget the people who uphold us ‘say one thing and do another.’” He also that hangs at the end of the eighth- such high standards.” raises concerns about medicine’s preoccupa- Sfloor conference room; this often Yet, while it’s clear that Lanken has tion with finances and economics. In re- happens when I ask him about the human drawn inspiration from Mayock and other cent decades, he writes, “Core functions side of medicine. Lanken turns his chair, Penn luminaries, his success as the driv- of the academic medical center became takes a moment to examine the face on ing force of humanism in the School of ‘enterprises’ . . . Teaching of medical stu- the wall, and then returns to face me, Medicine’s curriculum also comes from dents, because this activity was not re- formulating his answer. Many respected within. And Lanken’s efforts have been munerative, was referred to as ‘an un- doctors have stood on the shoulders of recognized. Two years ago, he was named funded mandate.’” That, of course, is an giants, so it’s very appropriate that Lanken Penn’s first associate dean for profession- extreme position, but Lanken and like- turns again to someone who was a men- alism and humanism. minded faculty members are determined to tor during his fellowship at Penn, the late help medical professionals reclaim their Robert L. Mayock, M.D. ’42, G.M.E. ’46, n recent years, academic medical centers role as healers and to transmit the values when he considers his own role in shap- have been increasingly concerned about that students need to fulfill that role. ing future Penn physicians. the twin themes of professionalism In Lanken’s own case, the roots of his “Dr. Mayock was the consummate pul- and humanism. In 2003, for example, interest in the art of medicine go back monary practitioner: he was very capable, Ithe Association of American Medical well before he had even considered a but also a very fine person. I think he Colleges published a report by Thomas S. medical career. Originally a chemistry represents the tradition of the physician Inui, Sc.M., M.D., called “A Flag in the and physics major in college, he wrestled with the wonderful bedside manner and Wind: Educating for Professionalism in with the question of how best to put his the art of medicine,” says Lanken. “There Medicine.” Inui argues that “students talents to use. “I liked the idea of making are many of those kinds of physicians at become cynical about the profession of contact with others by practicing medicine,

8 I PENN MEDICINE Photographs by Tommy Leonardi

and I realized that medicine offered, let’s After serving in Vietnam – he was the lecture halls and labs for seven, eight say, a variety of careers. I was interested among the last group of physicians to be hours a day – that is not why they are in in research; I was interested in public drafted – Lanken came to Penn in 1975 medical school. I think helping build re- health; I was interested in teaching; and as a fellow in the pulmonary medicine lationships with patients and families can one could also work in administration.” program. He originally considered going help students through that first year and During his fourth year at Harvard into practice in the Pacific Northwest or reconnect them with their love of medicine. Medical School, Lanken performed med- Maine, but he felt drawn to his colleagues “You form strong relationships when ical missionary work in Haiti, which fed at HUP and the research activities going you’re under stress and, frankly, yes, his interest in public health and gave him on around the Intensive Care Unit. And medical school is stressful!” Lanken con- experience in identifying the needs of a he felt particular satisfaction in being tinues. “So, we have an opportunity to community. “Suddenly you realized that able to teach the interns and residents, have those kinds of bonds form.” Such what they needed wasn’t simply a good something that could not be so easily done bonds, he hopes, “have added dimensions diet, proper nutrition,” he recalls. There in a private practice. He decided to stay to the students’ education, as well as re- was no clean water or sanitation. They at Penn. Today, he is professor of medicine inforced their own abilities and added to needed education and basic skills train- and medical ethics and senior fellow at the their sense of humanism.” ing; they needed a public health system. Center for Bioethics. His comments suggest the important “I had thought, for a time, that it influence of mentors. For Lanken, there might have been my calling to be out ou know, most people don’t think was Mayock, the first chief of the Pul- in the field,” he continues. But he no- “ of how difficult the first year of monary Disease Section at the University ticed that everybody at the mission medical school can be,” says of Pennsylvania, who served in that posi- hospital was sending their children Lanken. “The students are asking tion for nearly two decades. He trained back to the states for their education. Y themselves: ‘Am I sure I want to more than 180 pulmonary physicians Being in the field, he decided, “simply be in this med school business? I’m not during his career and established one of wasn’t practical.” seeing patients at all.’ They’re sitting in the first two-year fellowship training

2006/SUMMER I I 9 programs in pulmonary medicine, which upon their prior education and experience” became a model for other academic (September 13, 2005). medical centers. “I asked the course director, ‘Shouldn’t Lanken also admires Alfred Fishman, our students know something about when M.D., now senior associate dean for pro- not to resuscitate, too?’ He agreed and gram development at the medical school, gave me one morning for teaching ACLS for his impressive research, critical think- ethics. My goal was for students to con- ing, and rigorous application of high sider learning medical ethics as relevant standards. “I’m particularly interested in and interesting as the ACLS algorithms acute respiratory distress syndrome, which and simulations. To fuel discussions and had just been discovered around 1967 ethical analyses, the small groups of stu- and was related to the Vietnam War,” dents and faculty facilitators used au- Lanken explains. “Drs. Fishman and [G. G.] thentic (but disguised) cases from my Pietra were doing very basic, very exciting personal experience. We also encouraged research on this condition when I came students to bring cases from their own to Penn, and Dr. Fishman has continued clinical experiences to their groups. The to influence the standards in my research initial morning session has evolved into a and my writing.” required one-week course, Bioethics and Lanken hopes to see similar relationships Professionalism, that seniors rate as one develop for Penn’s medical students. of the best courses in their four years of “Humanism in medicine has quite a bit medical school.” to do with the patient, but it’s also about The session was particularly relevant the strength of the relationships that the because of a precedent setting court case physician has with his colleagues, his in New Jersey. In April 1975, Karen Ann students, his friends and family,” he says. Quinlan suffered irreversible brain dam- “I want our students to learn that it’s about age after experiencing an extended peri- being human: trying to balance your work od of respiratory failure and subsequent- life; having feelings; going through cycles ly was placed on a respirator in hospital. of your life with other people. Being able to Her parents wanted to have her taken off create a support network, and being able to the respirator but hospital officials re- draw strength and understanding from those fused. In 1976, the Quinlans took their relationships, is vitally important to how case to the New Jersey Supreme Court, the student can then relate to the patient.” which decided in favor of her parents – and Quinlan became the first major fig- anken teaches courses in medical ure in the right-to-die debate. According to Lanken, the essence of humanism is putting the patient's welfare first. "If you keep that in mind, everything ethics and in “doctoring” and was The hospice and palliative care move- else simply falls into place: decorum, respect, professionalism." instrumental in creating the Lon- ment was also gaining ground after the gitudinal Experience to Appreciate Quinlan verdict, and the physicians at can ethics be taught? There were many L Patient Perspectives (LEAPP) pro- HUP were facing more challenging ethical who argued, “No,” and many who re- gram two years ago. The course in medical decisions. “Making these kinds of deci- sponded, “We’re already ethical here.” ethics has its roots in some “borrowed” sions wasn’t a purely intellectual process,” But, Lanken realized, HUP was an aca- time out of the Advanced Cardiac Life notes Lanken, “and the Hospital decided demic institution – a place centered on Support (ACLS) course that was required that the physicians needed some guid- learning. It educated house staff and stu- for third-year students. As he noted in ance in making those decisions, especial- dents. And it was this approach that finally “Teaching ‘What Can’t Be Taught,’” an ly after the Quinlan verdict, and I was won the senior staff over. article in Almanac, the publication for one of the founding members of the Hos- Both the ACLS sessions and HUP’s the University’s faculty, that course “was pital’s ethics committee.” Naturally, the ethics committee helped lay the ground- practical, interactive, timely, and built committee first had to face the question: work for a full-fledged, one-week inten-

10 I PENN MEDICINE San Francisco; he realized that such a “The student’s team that was working on course, taught to a vastly more experienced the patient may not even discuss it – so audience, would be much more useful. “I it becomes vitally important to provide asked for two weeks from the curriculum an arena, albeit a smaller and more per- committee. They voted to give me one,” sonal one, to share this kind of experience he says with a chuckle. “But the course and also gain perspective from those who has been offered for the past ten years have faced this issue before. We’re able to and is required of all of the students for improve the quality of the experience for graduation – it’s not marginalized or pe- our students by providing these groups ripheral or elective, and there’s no competi- where they can receive this kind of support tion from other courses.” Fourth-year from their peers and faculty preceptors.” students are taught in small groups and Yet, like Lanken’s first stab at a bioethics bring in their own cases to this 9-to-5 course, the doctoring program was pre- immersion in bioethics. sented to first-year students with no clin- Perhaps more challenging than convinc- ical experience. “It was becoming clear to ing students and physicians about the me that talking about the doctor-patient need to teach ethics, however, is defining relationship to students who have never “humanism” – especially when one is seen a patient lacked a certain punch,” charged with developing the “Profession- he recalls. Yet, by the time the students alism and Humanism” model of Curricu- reach their clerkships later in the curriculum, lum 2000, the medical school’s ambitious they are simply too busy to look back. overhaul of its curriculum. William N. Kelly, What was missing, as Gail Morrison, M.D., then the dean, wanted “humanism” M.D. ’71, G.M.E. ’77, vice dean for edu- emphasized. As Lanken recalls it, “After I cation, astutely pointed out, was the pa- started as director for this module, I in- tient-centered experience. Supported by vited a group of esteemed colleagues from an extremely generous anonymous dona- the School of Medicine and the University, tion, the school introduced the Doctoring including sociology professors and the Longitudinal Patient-Centered Experience chaplain – people that I knew were inter- (as LEAPP was originally called) into its ested in the humanistic aspects of medi- curriculum. “You may do a three-week cine – and we convened a meeting. I said, outpatient rotation in pediatrics and see a ‘One of our tasks is to try to define this patient twice,” Lanken notes. “You don’t thing,’ and we spent about three months see that patient over six months or a year having many, many discussions about it, or two years.” but we could never pin it down.” “Today, ninety-five percent of patients e patient's welfare first. "If you keep that in mind, everything Lanken came to believe that it wasn’t are seen outside of an acute-care setting,” necessary to define humanism in concrete explains Morrison, “yet most medical sive ethics course, which was piloted in terms; the essence of humanism is putting schools, up until ten to twelve years ago, the early 1990s. The course was originally the patient’s welfare first. “If you keep that trained students in only the hospital set- an elective for first-year students, and al- in mind, everything else simply falls into ting.” The shift came when insurance though the real-life cases were interest- place: decorum, respect, professionalism.” companies began to benchmark for a pa- ing, the first-year students didn’t have the The small-group approach was applied tient’s length of stay and paid claims ac- clinical experience, insights, or knowl- to the new doctoring course, which is cording to clusters of conditions (diag- edge to make the experience more than the keystone of the Professionalism and nostic related groups, or DRGs); pre- just an intellectual exercise. Humanism Module. “These groups are dictably, the length of hospital stays Lanken then learned of a successful two- particularly useful in discussing the stu- shortened, and most patients who were week intensive course that was being dents’ personal, very sensitive experiences, admitted to the hospital were very ill and taught at the University of California at such as patients who die,” says Lanken. often had multiple complications. Says

2006/SUMMER I I 11 that it was largely a problem of perception: her patient would feel fine even if his glucose was far too high, but he can easily feel the effects of low blood sugar. (Downes was extremely concerned about an inci- dent a couple of years ago when he fell off a high ladder because of a drop in his glucose level.) Finally, Downes observes, “Well, English isn’t his native language, and he dropped out of school when he was quite young. There’s probably a health literacy issue here.” The discussion with her fellow students is having

As part of the LEAPP program, students Scott Caesar (left), Lauren Marlowe, and Stephan Kadauke the desired effect: she is taking a second meet with Ida Morris of West Philadelphia. look at her observations and receiving support in her effort to help her patient Morrison, “There was just an incredible dents have noted that they had to keep modify his eating habits. number of conditions that our students from falling into the trap of thinking of “It’s been difficult to ask my patient were no longer being exposed to.” their LEAPP patients – with whom they some of these very personal questions,” LEAPP sounds quite simple, but it is had developed relationships as individuals – says Downes. Still, she plans to go into amazingly complex in its execution: stu- only in terms of their disease or condition. primary care medicine – and believes dents are paired with chronically ill pa- that this kind of encounter is a challenge tients over the first three years of their nd the relationship that we build that will serve her well. medical school careers. They visit that “ with our patient is also unique,” Andrew Wilmot, one of the first Penn patient in her home, when she visits her says one of the students, Alison medical students to take part in the pro- doctor, and when she is admitted to the Downes. She has just concluded gram, was paired with Ms. Dollie Williams hospital; and the students share their Aa brief presentation on her pa- of West Philadelphia. “I don’t think a experiences with the groups in the tient – who has diabetes and is struggling doctor can fully appreciate the importance doctoring course. with glucose control – and wonders, “Is of what he does without getting the op- “This program is truly unique from he a really good LEAPP patient?” portunity to follow up on his patients anything else that has come before, or “He’s a wonderfully warm and friendly and see the impact of his care,” he says. since, because it is required of all medical person,” she explains, “and I feel more “It has been a really profound experience school students from day one,” says Mor- like a friend than a medical student who forming this bond with Ms. Williams, and rison. “The patients who are part of the is supposed to learn from him. He has I hope I get to know my future patients program must have a chronic illness, and some challenges, such as his relation- the same way I’ve gotten to know her.” the entire experience is fully integrated ship with his children, but he doesn’t Williams, who undergoes dialysis at Penn into the medical school curriculum. There face many of the hardships that some Presbyterian Medical Center, notes that simply isn’t anything else like it.” people living in West Philadelphia could Wilmot and Autumn Michelle Martin, “Now,” says Lanken, “first-year students normally encounter. He doesn’t live like the second student, “were wonderfully can get right into the trenches, hit the he’s handicapped.” down to earth, respectful, and let me ground running, and see professionalism But the discussion goes on to reveal ‘take charge.’ . . . These students are eager and humanism in action.” an underlying problem with the patient’s to learn from my life, to get involved. They’ll Second-year students now integrate diet – and his tendency to splurge on the make better doctors, hands down.” their experiences in the LEAPP program occasional large plateful of spaghetti. “He Another student in the LEAPP program with their clerkships and encounter a tests regularly and keeps a meticulous di- is Christopher Guerry, who has been paired new set of challenges that will shape ary,” Downes says, “but we’re still working with a patient from Shiloh, N.J., Deb their future as doctors. A clerkship is by on showing him how important diet is in Becker. “Medical students can learn from its nature disease-centered, and the stu- maintaining glucose control.” She noticed me,” says Becker, who has long battled

12 I PENN MEDICINE cystic fibrosis and must remain on oxy- help of the grant, Penn tested a pilot pro- Distinguished Teaching. (He’s also received gen around the clock. “When it comes to gram to improve students’ communica- the Special Dean’s Award for Teaching.) medical treatment, . . . I want to know tions skills in breaking bad news. In this The Lindback Award was the context for why someone’s doing something. I want case, “standardized patients” – profes- his article in Almanac, which reported the young doctors to learn to respect the sionals who are trained to act as actual that Lanken’s bioethics course is one of patient as a thinking person and make patients would – were employed. Audiey the highest-rated in the medical school time for them.” Kao, M.D. ’90, G.M.E. ’93, vice president curriculum and that he consistently re- Guerry spent two hours with Becker of the AMA’s ethics group, visited Penn ceives among the highest teaching scores on the first visit. “Mrs. Becker is wonder- for an update on the STEP project. “The both as a lecturer and in group sessions. fully open, and there is so much we can humanism and professionalism course- He is described as “an engaged physician” learn from her personality and strength,” work is a clear reflection of the School of and “a dedicated mentor.” One student he says. Medicine’s commitment to improvement,” wrote: “His thought-provoking approach LEAPP remains ready to incorporate to medical ethics, implementation of pro- new ideas. Inspired by a program started gressive humanistic training, and his un- by Premera Blue Cross of Washington The LEAPP program “is truly paralleled dedication to students make State, LEAPP now has a “Brown Bag” ex- him a true role model.” Another added: ercise. Patients are asked to put all their unique from anything else that “Years from now I will smile when I tell prescribed medications in a brown bag people that I trained under Dr. Lanken at LEAPP provides, along with over-the- has come before, or since, Penn, one of the giants of his day.” counter medications, vitamins, dietary So Lanken appears to have come full supplements, and a list of injectable med- because it is required of all circle. ications they take. When they meet with “Paul Lanken is an individual who truly their students, they compare what’s in medical school students from understands the importance of the doctor- the bag with the patients’ list of current patient relationship and appreciates the recommended medications and supple- day one,” says Gail Morrison, moral standards and ethical dilemmas ments. In addition, the students try to that doctors will face in the twenty-first make sure the patients are taking the M.D., vice dean for education. century,” says Gail Morrison. “He’s taken prescribed medications properly. “Anec- “The entire experience is fully a stand and developed the content, skills, dotally, I’ve heard of the students finding attitude, and required competency for out things about patient’s medication use integrated into the medical these relatively new issues of profession- that was important for the patient’s physi- alism and humanism for the curriculum.” cian to know,” notes Lanken. school curriculum.” As she sums up: “He is a role model and leader for our students.” hile it will be many years be- Lanken’s final words of our meeting fore the benefits of LEAPP still echo the influence of Mayock and and Curriculum 2000 are says Kao, noting that Penn “is still on the Fishman and the support of many col- effectively measured, Lanken’s cutting edge of how to train new genera- leagues through the years: “You want to Wefforts are beginning to be tions of doctors.” get it across to the students that it’s im- recognized more widely. In September Being appointed associate dean, says portant to have someone who cares about 2004, he was appointed associate dean Lanken, is “really a sort of dream come the patient, to have the patient know that for professionalism and humanism at the true. I don’t know of any medical schools you care, as a human being,” he explains. School of Medicine, which continues his that have such a position – it would be “But you can’t separate the competence, oversight of all of the courses and classes great to be setting a precedent!” Most of the expertise from being a professional. related to the Professionalism and Hu- all, Lanken is grateful that this commit- “I look at it as an investment that’s not manism Module. He has also received a ment by Penn means that his work will only paying off now, for me and for these STEP (Strategies for Teaching and Evalu- continue long after he’s gone. students, but that will be paying divi- ating Professionalism) grant from the Lanken is also a recent recipient (2005) dends for a long, long time at PENN American Medical Association. With the of the University’s Lindback Award for Medicine.”

2006/SUMMER I I 13 PONDERING PROFESSIONALISM . d e v r e s e R

s Medical Alumni Hall began to s t h g i R

fill, it became clear that the event l l A . m

on this March afternoon was o c . k n

drawing a good share of depart- a b n o o t ment chairs and senior faculty r a c

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members, in addition to house staff and r f

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medical students. The title of the sympo- v e t S

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sium seemed both abstract and practical – i M

4 9

“Professionalism: What Is It? Can It Be 9 1

n o i Taught? What Can It Do for Us?” t c e l l o C

Alan G. Wasserstein, M.D., associate r e k r o

professor of medicine and vice dean for Y

w e N faculty affairs, set the context for the e h T

symposium. He acknowledged the work © of Gail Morrison, M.D., ’71, G.M.E ’77, and Paul Lanken, M.D., G.M.E. ’77, in developing a curriculum in professional- “Hi! My name is Kevin, and I’ll be your doctor today” ism and humanism that extends throughout the four years of medical school. “Professionalism is the current byword of humanism is the cause of this malaise, ical” and tend to see themselves as “tech- of a movement, now some decades old, then professionalism may well be the right nicians.” 2. Some successfully navigate the to instill humanism in medicine,” said treatment. But you wonder where and dangers, often by finding the right role Wasserstein. “Not only is professionalism how, in the current environment, it can models. 3. The middle group of students supposed to restore humanism to medical really flourish.” – the likely majority – exhibit “non-re- practice that has become exclusively The guest speakers have all written and flective professionalism.” That means technical, it is also supposed to restore to spoken widely on the day’s topic. First to they hold certain views that are mutually physicians some of the authority that has speak was Jack Coulehan, M.D., M.P.H., contradictory, and their behavior may passed to government and corporations. a professor of preventive medicine at the sometimes be inconsistent with their be- And all this in an environment that is State University of New York at Stony liefs. As Coulehan put it, they may tell somewhat adverse to professionalism, Brook, where he also serves as director of themselves “the patient comes first,” but where (as the recent literature tells us) the Institute for Medicine in Contemporary they remain detached from the patient, house staff and faculty have impossibly Society. In the Stony Brook medical school, acting out of self-interest and a sense of busy schedules and are increasingly sus- he directs its required four-year curriculum entitlement. ceptible to burnout and depression, and in ethics and social issues in medicine. Despite this daunting picture, Coulehan where medicine increasingly resembles a Coulehan began by noting that incom- had some concrete proposals for fostering business. Our medical students hear high- ing medical students at Stony Brook enter professionalism: sounding phrases about the primacy of the school determined to be activists and Medical schools need to change their patient welfare, altruism, and integrity, “complete physicians.” Four years later, clinical departments so that they include and then enter a hurly-burly of clinical however, there is “a very complex kind more role models “who demonstrate the activity that sometimes includes unpro- of change,” brought about primarily be- qualities we want to inculcate.” Second, fessional behaviors from so-called role cause of the disparity students often wit- although medical students are often “afraid” models. It is not surprising that some ness between a medical school’s explicit to experience an emotion, they must be become cynical.” curriculum and “the informal curricu- taught that it is normal. Third, students He expressed what could be called lum.” Coulehan cited three possible out- can be taught to make use of “narrative,” cautious optimism: “Of course, if absence comes: 1. “Frankly, they become very cyn- not in the patients’ charts but “in our

14 I PENN MEDICINE By John Shea minds, in our relationships.” Finally, During their presentation, Richard who teach in the “Physician Apprentice- Coulehan recommended that the schools Cruess and Sylvia Cruess, M.D., professor ship” course. They are selected from a list introduce socially relevant service-oriented of medicine at McGill University and generated by the students themselves. learning. member of its Centre for Medical Educa- A person in the audience asked whether When Wasserstein asked how to per- tion, spoke of the dual roles of the physi- the current generation of physicians is re- suade faculty members to become role cian: healer and professional. While con- ally different, as the Association of Amer- models, Coulehan responded: “That’s ceding that role models can be effective, ican Medical Colleges has suggested – more where the deans come in!” Medical schools they believe the educational system re- concerned with “income and lifestyle.” need to “send a message” from the top. quires more. As one of their slides put it, In reply, Richard Cruess said that At Stony Brook, said Coulehan, those “What in the past has been IMPLICIT must members of the younger generation “don’t who serve as mentors and role models now be made EXPLICIT.” The method like the word altruism,” which they per- receive letters, “special awards,” even they recommend is “situated learning,” ceive as too broad, involving 24-hour “certain supplements to their salaries.” from theory to experience. This involves a service that is neither healthy for the A member of the audience suggested cognitive base; self-reflection; role model- practitioners nor compatible with their that the most important thing was to create ing; and a suitable environment that does lifestyles. “We say that altruism is non- “more emotionally intelligent” physicians. not subvert professional values. negotiable,” Cruess asserted. If altruism “I agree with you,” said Coulehan, “but At McGill, said Sylvia Cruess, the first is not a given, patients “can’t trust you.” the term professionalism sells these days.” lecture the medical students hear promotes As Sylvia Cruess pointed out, that’s why At this point, another panelist, Richard opportunities for self-reflection. The all would-be medical professionals need Cruess, M.D., said that he “objected Cruesses also emphasized that when a an explicit description of their part of the strongly” to the idea that professionalism society grants physicians “the privilege of contract. is only about emotions. Cruess, a professor self-regulation,” it demands certain things Another questioner cited an ethnographic of orthopaedic surgery at McGill Univer- in return. In fact, McGill offers a fourth- study of residency programs that found sity and member of its Centre for Medical year seminar called “The Social Contract that residents can heal, but they don’t Education, stated that professionalism in- and You.” Another recent addition at McGill know the social contract. Because they cludes many other elements, such as com- is the Osler Fellows, faculty members were never taught it, Richard Cruess petence, accountability, self-regulation, replied forcefully. “We’ve got monstrous altruism, and so on. failures in meeting our societal obligations,” he said. The newcomers don’t understand . d e v

r that “they are their brothers’ keepers” when e s e R they join a profession. s t h g i R

Sylvia and Richard Cruess obviously l l A .

m believe that professionalism can be taught. o c . k n

a Coulehan concurs. As he put it, “We are b n o o t

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o despite what he jokingly called their r f

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8 9 9

1 medical school.

n o i t

c The third panelist was Richard Cooper, e l l o C

r M.D., who returned to the School of e k r o Y Medicine last year from the Medical w e N

e College of Wisconsin. His talk was called h T © “Medical Education in Flexner’s Second Century.”

“Ah, Mr. Bremley. Nice to put a face on a disease.” 2006/SUMMER I I 15 Peter Quinn goes face to face with the joint replacement prosthesis he helped develop. 16 I PENN MEDICINE t commonly starts with a telltale “We had a waiting room full of people clicking of the jaw, nails-on-chalk- who needed the last option,” recalls Quinn, TAKING board teeth grinding, and unmistak- whose program drew some 2,100 patients able facial pain. For patients with a in 2005. “And we didn’t have it.” Until ONItemporomandibular joint disorder now, that is. (TMD), it’s excruciating. Earlier this year, the Food and Drug Ending the pain is the passion of Peter Administration approved the W. Lorenz D. Quinn, M.D., D.M.D., chair of Oral Total TMJ Replacement System, a pros- and Maxillofacial Surgery at the Hospital thesis developed by Quinn and tested of the University of Pennsylvania. Every over a ten-year period. The clinical trials day, patients from around the world seek began in 1995 at Penn, where 75 percent out the expertise of Quinn and his col- of the surgeries were performed, and at leagues in the renowned program for TMJ Southwestern University in Texas. It is and facial pain. An international authori- the first stock prosthesis of its kind to ty on TMD, Quinn is the author of Color earn the F.D.A.’s approval. Atlas of Temporomandibular Joint Surgery The prosthesis is precisely what patients By Jennifer Baldino Bonett (Mosby, 1998). With other “physicians of like Emily Angus (not her real name) the mouth,” he treats one of the largest were waiting for. She had undergone five populations of patients with TMD in the surgical attempts over four years to correct country, seeing them at HUP and at Penn’s her TMD, including two three-month School of Dental Medicine. periods when her jaws were wired shut. And the patients keep coming. TMD Finally, her oral surgeon referred her to With appointments in affects nearly one-fifth of the U.S. popu- Quinn. She became one of the people he lation. The good news for many of them fitted with the Lorenz prosthesis. Penn’s School of Medi- is that conservative approaches such as physical therapy and mouth guards are Conceiving, Creating, and Testing cine and School of Dental highly successful. For six percent of pa- Quinn is both a D.M.D. and an M.D. tients with TMD, however, the only re- and in fact also serves as chair of Oral Medicine, Peter Quinn course is surgery. Surgery and Pharmacology at the School Penn’s TMJ and facial pain program – of Dental Medicine. That interdiscipli- has been in an excellent which includes interdisciplinary specialists in nary background allows him to draw oral medicine, oral and maxillofacial sur- from the best techniques in both dental position to solve one of gery, neurology, neurosurgery, rheumatology, medicine and surgery, particularly or- otorhinolaryngology, rehabilitative medi- thopaedic expertise in joint replacement. the most painful max- cine, and anesthesiology – offers the full In his quest to develop a prosthesis for range of surgical services for TMD. These patients like Angus, he also needed imag- illofacial disorders. include arthroscopy, which uses a fiber- ination – and persistence. In 1989, he optic probe to remove scar tissue and began approaching orthopaedic compa- flush the joint; arthroplasty, a kind of nies, hoping to persuade one to help cre- open joint surgery, usually to reposition a ate and test the prosthesis he imagined. locked jaw or remove a perforated disc; But the initial response was not encourag- and total joint replacement. But for some ing. Because there were likely to be only patients with the disorder, even traditional 1,000 TMJ replacements in the U.S. each oral surgery techniques are not enough. year, the companies did not see much Photographs by Tommy Leonardi

2006/SUMMER I I 17 Building a Program commercial potential in the Quinn came directly to Penn for his project. In contrast, there are D.M.D. degree after college in 1970. In a half million hip and knee 1982, he completed his M.D. training at replacements every year. the Medical College of Pennsylvania. He Then, in the early 1990s, joined Penn’s medical faculty as its only Quinn received a positive re- full-time oral and maxillofacial surgeon in sponse from Biomet, an in- 1984 and so has had a hand in developing ternational orthopaedic the department into what it is today: seven equipment company head- full-time oral and maxillofacial surgeons and quartered in Indiana. The 18 oral and maxillofacial surgery residents, company, which had ac- as well as four oral medicine residents. quired Walter Lorenz Surgi- Now that the W. Lorenz total TMJ re- cal, Inc., a developer of cran- placement system had been approved, iomaxillofacial products, invit- Quinn is likely to remain busy, as an in- ed Quinn to begin working structor and trainer. He is one of only on a clinical trial. two oral and maxillofacial surgeons in In August 1995, Quinn the United States with expertise in im- placed the first Lorenz stock planting the Lorenz replacement. Quinn prosthesis in a patient. The has run training sessions abroad and began device features a polyethyl- training American oral and maxillofacial Peter Quinn played a major role in expanding Oral and Maxillofacial ene socket, a metal condyle Surgery at Penn. surgeons in March 2005. He notes that made from cobalt-chromium- the F.D.A. mandated that only surgeons molybdenum alloy, and tita- who have been trained are permitted to nium alloy screws. First of all, the pros- Today, Quinn’s clinical focus is almost perform the procedure “since it is so tech- thesis underwent vigorous biomaterial exclusively TMD. The surgery is delicate. nique-sensitive.” laboratory testing to make sure its mate- As Quinn puts it, the socket where the In his more than 20 years at Penn, rials did not fail, which had been a prob- device has to fit “is only a millimeter or Quinn has had an impact that goes well lem with earlier models. Indeed, many of two from your brain, is very thin in the beyond the Lorenz TMJ prosthesis. Quinn’s current TMJ surgeries involve re- middle, and has this bump that differs Greenberg describes him as “the major moving old prostheses that had failed from person to person. So we flattened force in expanding the role of Oral and and replacing them with the Lorenz the design to eliminate the bump, created Maxillofacial Surgery” both at the medical prosthesis. In contrast, the oldest Lorenz three different sizes, and enabled the device school and at Penn Dental. “When he ar- prosthesis, placed nearly 10 years ago, is to be screwed into the cheek bone.” rived, Oral Surgery mainly consisted of still functioning well. One of the people who knows Quinn’s intra-oral surgical procedures. The faculty “Because of materials testing, we think work best is Martin S. Greenberg, D.D.S., of the Department of Oral and Maxillo- this has a much longer lifespan,” says professor and chair of the Department of facial Surgery, who have been trained by Quinn. Oral Medicine at Penn’s School of Dental Dr. Quinn, now make major contribu- The clinical trial also tested for mechan- Medicine. Greenberg serves as co-chair tions to the fields of facial trauma, surgery ical flaws – and again the new prosthesis with Quinn of the TMJ and facial pain of complex maxillofacial pathology, and passed convincingly. Just as important, program. According to Greenberg, the temporomandibular joint surgery.” Ac- patients were very satisfied. joint prosthesis Quinn developed “was a cording to Greenberg, Quinn also was re- Quinn is the clinician-consultant on major advance for patient care in this the sponsible for greatly expanding both the the project, and Lorenz-Biomet holds the field. Previous TM joint prostheses had size and scope of the Oral and Maxillofa- patent. He concedes that his initial hopes many setbacks and resulted in serious cial training program both for dental stu- for the prosthesis were modest. “I just complications. Dr. Quinn's joint prosthe- dents and postdoctoral trainees in the Oral wanted something in my hands that I sis has allowed patients with advanced, Surgery residency program. “This program,” could use here at Penn since we had no previously untreatable diseases to have says Greenberg, “is now one of the most other safe and efficacious alternative.” good function with greatly reduced pain.” highly regarded programs in the country.”

18 I PENN MEDICINE ALTHOUGH MISALIGNED EYES ARE OFTEN THOUGHT OF AS A CONDITION THAT AFFECTS CHILDREN, DR. NICHOLAS VOLPE OPERATES EXCLUSIVELY ON ADULTS WITH STRABISMUS

By Jon Caroulis Photographs by Daniel Burke

ecause of her eye condition, Anna Maria DiStefano

wore dark sunglasses all the time. Her co-work-

ers at the bank knew about it and said nothing,

but every now and then a customer would see Bher with the sunglasses on and ask, “Are you SEEINtrying to be a movie star orG something?” STRAIGHT “Take a look at this!” she would reply, removing the glasses:

her eyeballs were rigid, even bulging out of their sockets.

“See what’s wrong with my eyes? Movie star? Get out of

here! I can’t take the bright lights,” she’d tell the customer,

who was typically shocked.

Three years ago, DiStefano developed thyroid trouble that

swelled and stiffened her eye muscles. Doctors thought it

might be cancer, and they removed her thyroid. After the

surgery, she was still having trouble moving her eyes. To see

to her left or right, she’d have to tilt her head, which would

make her dizzy. To watch TV in bed, she’d have to lie on her

After successful surgery for strabismus, Anna Maria DiStefano no longer hides behind dark sunglasses. 2006/SUMMER I I 19 side and cover one of her eyes – she had double vision, and the images were not side-by-side but one on top of the other. She also had to tilt her head while driv- ing or cooking. Her endocrinologist suggested she see two specialists at Penn’s Scheie Eye Insti- CORRECTIVE SURGERY FOR STRABISMUS HAS BOTH FUNCTIONAL tute: Roberta E. Gausas, M.D., associate AND COSMETIC BENEFITS, BUT AS DR.NICHOLAS VOLPE POINTS professor of clinical ophthalmology, who performs orbital decompression, and OUT, THERE ARE PSYCHO-SOCIAL CONCERNS AS WELL.“WITH Nicholas J. Volpe, M.D., professor of PEOPLE, EYE CONTACT IS SO VITAL,” HE SAYS, ADDING THAT SEV- ophthalmology, who performs surgery to ERAL STUDIES HAVE REPORTED THAT PEOPLE WITH STRABISMUS correct the crossed eyes and double vi- “DON’T DO AS WELL LOOKING FOR JOBS.” sion that are among the primary symptoms of strabismus. First Gausas and then Volpe operated on DiStefano in the spring of 2004, and within days her vision improved. “I feel so much better now,” said DiS- tefano. “It’s changed my life.”

bout five percent of all children are born with strabismus, in which the eyes are misaligned. According to Volpe, the cause is A not known, but surgery can correct the problem. In adults, strabismus can be caused by problems that persist from childhood, brain injury, orbital disease, or trauma; in the case of thyroid disease, the eye muscles can become stiff and enlarged. Volpe also notes that a child born with strabismus who had corrective surgery might develop a recurrence of the condition. About 50 percent of his patients have this type of problem. Volpe operates exclusively on adults (from age 16 to people in their 80s) and performs about 15 surgeries of this type per month. The corrective surgery to realign the eyes has functional benefits that can eliminate double vision and restore normal binocular and three-dimensional vision. For some patients, it is a constant strain to use the eyes and maintain good alignment, and surgery can be very helpful in relieving these symptoms. For others,

Dr. Nicholas Volpe makes use of the tools of his profession.

20 I PENN MEDICINE forms of eye misalignment and double vision, in addition to other neurological movement disorders. Volpe has used it when a patient has suffered a brain injury and developed a nerve palsy, which prevents her from moving the eye in an there are “cosmetic” benefits, but as Volpe ple, eye contact is so vital,” he says, outward position. As a result, the eye points out, there are psycho-social con- adding that several studies have report- crosses in. Botulinum toxin is also used cerns that go far beyond simple cosmetic ed that people with obvious strabismus, for patients who have excessive twitching issues. Cosmetic surgery changes a nor- for example, “don’t do as well looking of eye or facial muscles. mal, sometimes aged structure; functional for jobs. It’s very disturbing and makes surgery alters a disease state. “With peo- eye contact and conversation difficult for olpe came to Penn after earning some people.” In his view, correcting his M.D. degree from SUNY such a problem with strabismus sur- Health Science Center at Brooklyn gery, in addition to the visual benefits, and completing his training at can be vital to an individual’s self-con- VMassachusetts Eye & Ear Infirmary, fidence and successful interactions Harvard Medical School. He has been with others – and that goes far beyond recognized as a “Top Doc” by Philadelphia “cosmetic” surgery. Magazine and has also been listed in Best Strabismus can also occur in patients Doctors in America. With two other Penn with thyroid disease, an auto-immune faculty members, Grant T. Liu, M.D., and disease in which anti-bodies react with Steven Galetta, M.D., he is an author of the thyroid and affect it, causing it to be Neuro-Ophthalmology: Diagnosis and Man- inflamed and/or leak. The result is a hyper- agement (2001), which was described by a thyroid state as well as an inflammation reviewer in The New England Journal of of the tissues of eye sockets and eye Medicine as “uniformly high in quality, muscles. What happens is that the eye- authoritative, cohesive, down to earth, ball can be pulled in a different direction; and easy to read.” or, as in DiStefano’s case, the stiffened Volpe remembers always wanting to be a eye muscles severely restrict the eye’s doctor. He chose ophthalmology, he says, normal movements. “because I wasn’t good at dealing with Volpe’s surgery “loosens” the muscles death and dying, and I liked the fact that and puts them into a position in which you’re providing a fair amount of medical the patient can regain movement. Using care and also have the option to incorporate adjustable sutures, Volpe creates a “tem- surgical care into practice.” His practice porary pulley” system and repositions the goes beyond dealing with strabismus. eye. On the following day, he examines Yet, as he goes on to explain, “Those where the eye has been relocated. If it’s patients who have neuro-ophthalmic vi- in the right position, he’ll tie the sutures sion problems are among the most diffi- (which are subsequently resorbed) or, if cult to take care of, and that’s how I came necessary, will reposition the sutures based into the field – I wanted that challenge.” on how the eye is positioned and how One of those patients with a challeng- the patient describes her vision. ing condition, Ann Maria DiStefano, still There are non-surgical therapies for visits Volpe for routine follow-ups, and treating strabismus, and one is using bot- Volpe has told her she’s doing fine. Now, ulinum toxin. Although botulinum toxin is she says, she can enjoy doing all the also used for cosmetic reasons, its muscle- things she couldn’t do with her strabismus, weakening qualities can alleviate some “like redecorating the house!”

2006/SUMMER I I 21 Psychiatrist asWriter, Writer as Psychiatrist

Author and subjects: Arnold Ludwig is flanked here by Napoleon and Julius Caesar, two of the great leaders he has studied. 22 I PENN MEDICINE er, Writer as Psychiatrist By Marie Gehret and John Shea Photographs of Dr. Ludwig by Karen Philippi

Arnold M. Ludwig, M.D., a Penn alumnus, has studied some of the most interesting questions in psychiatry and beyond while sharing his insights with a wide audience.

t may be the lot of many an academic tone-deaf psychologist. . . . The prose A Biological Impulse to Rule? psychiatrist to publish little that is has personality.” Ludwig’s most recent nonfiction publi- noticed outside his or her narrow When Ludwig’s Understanding the Alco- cation is King of the Mountain: The Nature field, to be read only by a handful of holic’s Mind: The Nature of Craving and How of Political Leadership (University Press of Ireaders. That certainly has not been to Control It appeared in 1989, it drew fa- Kentucky, 2002). As Ludwig told Brian the case with Arnold M. Ludwig, M.D. ’58, vorable notice from specialists and from Lamb, the project took him in a direction emeritus professor and former chair of self-avowed alcoholics. The publisher, he could not have anticipated: into the psychiatry at the University of Kentucky. Oxford University Press, cited a quotation world of monkeys, apes, and chimpanzees. Now a resident of Rhode Island and from G. Alan Marlatt, Ph.D., a professor of In his book Ludwig attempts to answer newly appointed as adjunct professor of psychology at the University of Washington this fundamental question: Is there an in- psychiatry and human behavior at Brown and director of its Addictive Behaviors nate biological impulse that governs the University, Ludwig can point to a plump Research Center: “This book will . . . save hunger for power in world leaders, much curriculum vitae. It includes 10 nonfiction lives.” Diane J., reviewing the book on as it does for other primates? books and a host of articles, as well as LifeRing (www.unhooked.com) called it In books such as Presidential Power (1960) the occasional mention in newspapers like “a fascinating and elegant little book on and Presidential Character (1972), political The New York Times and The Philadelphia craving and relapse, the cognitive distor- scientists Richard E. Neustadt and James Inquirer and an appearance on C-SPAN’s tions that accompany both, and methods David Barber argued that personality – Booknotes with Brian Lamb. In part, this used by successfully sober alcoholics to particularly charisma and a talent for attention comes because of the subject ‘avoid or resist temptation.’ ’’ persuasion – was a definitive factor in matter of Arnold’s writings: the nature of determining the success of American addiction and craving; the possible con- presidents. Similar studies gained mo- nection between creativity and madness; mentum in the early 1970s, when the U.S. the ways individuals shape their identities; government established the Center for and the traits of political leadership. the Analysis of Personality and Political Arnold also seems to have a way with Behavior at the C.I.A. The center’s staff words that allows him to reach a broader advised presidents and officials of the audience than many of his fellow special- State Department on the psychological ists, while doing justice to complex ideas. idiosyncrasies of foreign leaders. Although Reviewing Arnold’s How Do We Know Who the center is no longer in operation, today We Are? A Biography of the Self (Oxford there are an estimated 900 programs in University Press, 1997) in Biography leadership studies at American universities. Magazine, William Todd Schultz wrote: Ludwig, however, has taken the psy- “Ludwig’s prose is delightfully informal chological scrutiny of leaders a step far- given the density of the subject at hand. ther. He began to develop the concept He writes far better than the typically for King of the Mountain while conducting

2006/SUMMER I I 23 research for The Price of Greatness: Resolv- and Stalin (29), as well as a lone American he classified the rulers into six categories ing the Creativity and Madness Controversy president, Franklin D. Roosevelt (30). to “show how certain kinds of people are (Guilford Press, 1995). The earlier work Ludwig also selected a subgroup of drawn to certain kinds of rule and how examined a sample of more than 1,000 377 leaders, including former Ugandan these certain kinds of rule reciprocally extraordinarily creative men and women President Idi Amin, British prime ministers shape their characters.” The categories are: from 18 different professions. Winston Churchill and Tony Blair, and supreme monarchs; tyrants and despots; “In almost all other professions, there’s former President Ronald Reagan, about authoritarians; visionaries; transitional something tangible you can go on,” Lud- whom substantial biographical information democrats or rulers of emerging democ- wig said on C-SPAN. “A scientist does re- was available. He examined their early racies; and, finally, democrats or leaders search. He publishes his work. An artist backgrounds, religious upbringing, edu- of established democracies. performs. A business man makes money.” cation levels, marital histories, professions But what is a politician’s product and how before they entered politics, methods is his or her greatness measured? they used to rise to power, how their rule Ludwig’s exploration took 18 years, ended, and causes of death. Ultimately, during which he studied the lives of more than 1,900 world leaders who represented 199 independent countries between Jan- uary 1, 1900, and December 31, 2000. Ludwig pored over biographies, treatises, and political accounts of these rulers. Ludwig identified 11 common features of successful leaders, which include: loss or gain of territory, how long a leader stayed in power, whether he won or lost wars, whether he engaged in social engineering, whether he improved or worsened the economy of the country, whether he created original ideology, and whether he WHY RULERS RULE served as a moral exemplar to his subjects. These features formed the basis of Lud- y comparing the behaviors of in- As it happens, of all the fields of human wig’s “Political Greatness Scale,” which he dividuals with those of their simi- endeavor, politics seems to be the one used to score leaders’ relative “greatness” an ancestors, I am not trying to most rooted in primitive primate behav- on a scale of 1 to 37. According to Lud- disparage the political activity of ior. . . . In contrast to the arts and sciences, wig, the scale filled a void where no Bhumans – nor, for that matter, of which require the use of mankind’s high- cross-cultural measure of political suc- other primates. I am only saying that est mental faculties, located largely in the cess previously existed for measuring a there is a dimension of ruling that has neocortex, the most evolutionarily ad- leader’s impact on the world, not just his not yet been adequately explored. People vanced part of the brain, the striving for personal virtue. On this scale, warmon- may choose to ignore their animal heritage political power seems fueled more by se- gering turns out to be critical to one’s by interpreting their behavior as divinely cretions from man’s nether parts – his go- long-term historical standing. inspired, socially purposeful, or even self- nads and adrenal glands – as well as ac- That criteria can make for some unex- serving, all of which they attribute to be- tivity from within the limbic system and pected juxtapositions. For example, Yassir ing human; but they masticate, defecate, hypothalamus, the most ancient parts of Arafat, the Palestinian leader who died masturbate, fornicate, and procreate much the brain, all of which deal with such in- recently, scored 17 points, placing him as chimps and other apes do, so they stinctive responses as fight-or-flight, ter- on a par with Dwight D. Eisenhower. The should have little cause to get upset if ritoriality, aggression, sex, and survival. scale’s highest performers, moreover, are a they learn that they act like other primates — from King of the Mountain: The Nature mixed bag of dictators and political tyrants, when they politically agitate, debate, ab- of Political Leadership (University Press of including Hitler (25), Mussolini (26), dicate, placate, and administrate, too. Kentucky, 2002)

24 I PENN MEDICINE Using his scale, Ludwig went on to hierarchal society of power and dominance. Although intellectual or academic cre- score his 377 chosen leaders. His find- Because such societies require a single dentials seem irrelevant for ruling, one of ings revealed seven clusters of traits that dominant leader, a drive for social the time-honored ways individuals estab- separate the great from the non-great dominance had to evolve to ensure the lish their qualifications for leadership is by rulers, which he termed the “Seven Pil- survival of the community. Ludwig showing physical prowess and courage in lars of Political Greatness”: writes, “The drive to be the alpha male battle. •overwhelming desire for social dominance provides the basic impetus for the dom- Throughout history, rulers who attain and leadership inance hierarchy, which . . . seems to legendary status often tend to be those •contrariness, rebellion against existing govern most social interactions who have conquered other nations, won authority among higher primates.” major wars, expanded their country’s •personal charisma As Ludwig drew similarities between boundaries, founded new nations, forcibly •change agency, initiation of large-scale human and non-human primate rulership transformed their societies, and imposed social change in King of the Mountain, he arrived at these their own beliefs on their subjects. •vanity, self-confidence conclusions: Ludwig also argues that ruling is the •courage, risk-taking All nations have rulers. Despite anarchy, most dangerous professional activity be- •a wary unease, a chronic psychological juntas, and troikas, one person almost al- cause of assassination, execution, impris- unease ways emerges to take charge. onment and exile, coups, public riots, As Ludwig analyzed his data, he came Essentially all the rulers of all the mental breakdowns, and suicides. He to hypothesize that the key to under- countries in the world during the past notes that rulers are disproportionately standing political leadership is found in century have been men. In addition to likely to die of unnatural causes because evolutionary theory. The connection citing the sociological factors that con- they tend to approach risks in a rather ir- evolved during the course of his work, as tribute to male dominance, Ludwig con- rational manner. As Ludwig explains from he was able to establish a number of sim- tends that man’s striving for political power a psychobiological perspective, “The reason ilarities between what he calls “the pri- is also fueled biologically by secretions is once the hypothalamus of male primate model of ruling” and characteristics from his gonads and adrenal glands as mates becomes activated and stimulates of human political leaders. well as activity from the limbic system and their testicles to manufacture testosterone According to Ludwig, both humans hypothalamus, the most primitive parts and other androgens, which increase and non-human primates are motivated of the brain. their sexual libido, aggressiveness, and by the evolutionary desire to establish a Of the nearly 2,000 leaders of the 20th competitiveness, they are inducted into century, only 1.4 percent were women. the struggle for dominance and lose all Half of the women Ludwig studied became sense of perspective and rationality.” rulers by succeeding their martyred or In addition, he found that the rate of revered husbands or fathers. drug abuse, alcoholism, and mental illness In many societies throughout the world, is often higher among the rulers than in male rulers have a decided breeding the general population. The lifetime rate advantage over other men, not only in of mania is especially high among tyrants access to women, but also in the size of and visionaries, who are also likely to their harems and the number of suffer from paranoid conditions. mistresses they keep. From the cover of King of the Mountain, No identifiable form of which depicts an ape wearing a crown, to intelligence, talent, ge- the book’s final chapter, Ludwig uses col- nius, or even experience orful anecdotes and humor to illustrate seems necessary to rule a his points. “When I initially tried several nation. times to write the book with a more seri- Leaders need not be ous tone, I found myself becoming de- sane, rational, or even pressed and troubled by the terrible mentally competent to crimes and awful decisions of so many rule a country. rulers,” said Ludwig.

Is there a Mussolini for every culture? 2006/SUMMER I I 25 Ludwig’s commentary about the sexual as occasional confidant for his mother sire or power recognized by every prima- promiscuity of leaders has some humorous and as a surrogate parent to his younger tologist as a universal alpha male charac- touches while imparting relevant statistics: siblings while his father worked away teristic.” But Ludwig has also been chal- “From the many photographs of the male from home. lenged for what critics see as a lack of rulers I have examined, only a small mi- “A poor to average student [at the Na- credible data and theoretical contribu- nority qualify as handsome and hardly tional Military Academy], he compensated tion. For example, Robert Rotberg, re- any seems sexy, although I probably do for his academic deficiencies by his devo- viewing King in Compass, the publication not have the proper hormones or inclina- tion to duty, his love of discipline, his of the Center for Public Leadership at tions to judge objectively. So, for the vast loyalty to his superiors, and his enthusi- Harvard’s John F. Kennedy School of majority of rulers, their seductive or co- astic embracing of the spit-and-polish Government, calls the book “intriguing” ercive appeal for women has to rest mostly drills. . . . Perhaps his greatest asset was and praises Ludwig’s effective writing on their prominence and power.” If his his remarkable ability to let everyone feel style. He describes the book as “a mass of theory holds, he goes on to note, “rulers superior to him, so no one begrudged anecdotes strung together in innovative with the least curbs on their powers – him his successes. Consistent with his and mostly relevant ways,” but argues that namely, monarchs and tyrants – should military personality, he also held little re- it “does not rise to a level capable of provid- engage in more philandering over the spect for democracy. Debate was ineffi- ing solid hypotheses or conclusions about course of their married lives than those cient, compromise was surrender, and central questions of leadership or rulership.” with the most curbs on their power – dissent was anarchy.” Even if the response to King of the namely, leaders of established democra- One of the admirers of King of the Mountain has been mixed, Ludwig has cies. . . . Within my entire sample of Mountain is primatologist Frans de Waal, provoked some fresh looks at political married rulers, at least 57 percent were author of Chimpanzee Politics: Power and power, the place of war and aggression in sexually promiscuous, a rate substantially Sex Among Apes (2000). De Waal notes our society, and the glaring absence of above that noted by the Kinsey Institute that world leaders, “who love to present women in power. [37% for married American Men].” Ac- themselves as having their peoples’ inter- “My hope is that some of what was cording to Ludwig, monarchs had a sexu- ests at heart, are driven by the same de- learned from my studies will be taught in al profligacy rate of 87 percent; tyrants, 95 schools so that people can make more percent; and democrats, 40 percent. enlightened choices about their leaders His consideration of authoritarian rulers and revise their criteria for what constitutes is representative of Ludwig’s approach. political greatness.” First, he defines the category: “Unlike to- talitarian governments with visionary “Tell Me About Your Earlier Life . . .” leaders, authoritarian governments do Born and raised in Philadelphia, Ludwig not operate under an all-pervasive ideology spent his undergraduate years at Swarth- and often suffer some pluralism in society. more College. After graduating from the The primary purpose of authoritarians is School of Medicine in 1958, Ludwig to preserve law and order, maintain social completed his psychiatric residency at stability, and keep the machinery of gov- the University of Colorado and then spent ernment working.” two years in the public health service. Next, Ludwig provides examples from His next stop was Mendota State Hospital 20th-century history, including Augusto in Madison, Wisconsin, where he served Pinochet, who, as Ludwig tells it, “led as director of education and research. Then the bloody military coup that toppled the he joined the faculty at the University of Marxist government of President Salvador Kentucky College of Medicine. Ludwig Allende of Chile in 1973. . . .” Some of served as chairman of its Department of the psychiatrist’s observations become Psychiatry from 1970 to 1979 and, in clearer here, as when Ludwig notes that 1980, was named the Evalyn. A. Edwards Pinochet, born into a lower-middle-class Professor of Psychiatry. Catholic family of modest means, served Throughout his career, Ludwig has re- Pinochet the Authoritarian.

26 I PENN MEDICINE raphical freedom,” arguing that we are free to emphasize, interpret, and fashion the facts of our lives into a meaningful narrative of our own choosing. As he writes, “The terrain of the self is vast, parts known, parts impenetrable, and parts unexplored.” Ludwig interviewed 21 modern-day biographers to learn how they went about constructing a person from all of their research data, which often contained con- flicting points of view. Among the biographers included are Gloria Steinem on Marilyn Monroe, Peter Gay on Sigmund In his Newport, R.I., home, Ludwig shares space with his artistic alter ego, done in the style of Van Gogh. Freud, and David McCullough on Harry Truman. ceived several of the most distinguished earlier books have earned extensive criti- Using the biographers input and his awards in psychiatry for research and cal acclaim. own observations, Ludwig takes the reader teaching, including the Lester N. Hofheimer In How Do We Know Who We Are? Lud- through the process of how such forces Prize for Research given by the American wig attempts to form a coherent picture of as personal experiences, culture, and Psychiatric Association. He has also been the self, with all its many properties, family all work to make us who we are. designated as a Distinguished Lecturer by paradoxes, and contradictions, just as a As he notes in his opening pages, he wrote the association.In addition to King of the biographer reconstructs his subjects from the book because “I had no choice”: Mountain, Ludwig has published more letters, diaries, memoirs, and interviews. “In my clinical work, I found myself than 100 articles and book chapters. His Ludwig introduces the concept of “biog- intrigued by my patients who were struggling to give voice to their ‘true’ selves. As a scientist, I was drawn toward inves- tigating the contortions of the self when LUDWIG'S FORAY INTO FICTION: people became psychotic or developed THE CHAIR OF SURGERY VISITS THE PATHOLOGY LABS multiple personality or displayed over- powering cravings for drugs or were ex- en long rows of laboratory and the busy babble from other types of posed to such powerful mind-altering benches spanned about two-thirds expensive machines that had completely techniques as hypnosis, sensory depriva- of the room. The tops were covered revolutionized the clinical lab. Medicine tion, or hallucinogens. And in my own with racks of test tubes, contain- had come a long way from the time when personal life, I’ve always collected anec- T ing assorted blood samples, flasks doctors tasted the urine of patients for dotes about people from biographies, of urine, cartons of stool specimens and sugar to make a diagnosis of diabetes. newspapers, magazines, films, and per- miscellaneous bodily fluids, all awaiting With a natural love for instrumentation, sonal encounters, any tidbits that could analysis. A cacophony of sounds greeted Nick always marveled at this electronic shed light on who they were and what him – the whirring of centrifuges, the empire. A mechanization that permitted made them tick.” whooshing of the flame photometers, the the laboratories to become the philosopher’s Published two years earlier, The Price of pumping noise of the large refrigerators, stone for the hospital, transmuting those Greatness explores the lives and achieve- the humming of the SMAC/SDM system, base bodily excrements, cultures, and as- ments of the world’s most creative and the murmuring of the gas chro- sorted specimens into gold – perhaps the eminent people of our times from the matographs, autoanalyzers, autoclaves, largest cash cow for the hospital. arts, sciences, politics, business, sports, and mass spectrophotometers, the jarring — from Mount Aesculapius (iUniverse, and the military. For this book, Ludwig rings of automatic timers, the machine-gun 2005) read more than l,000 biographies and clacking bursts of automated printing other publications about his subjects,

2006/SUMMER I I 27 who included such luminaries as German philosopher Friedrich Nietzsche and American playwright Eugene O’Neill, in an attempt to answer a persistent question: Is there a link between creativity and madness? As in King of the Mountain, Ludwig presents his findings in the form of col- Philosopher Friedrich orful anecdotes supported by theory and Nietzsche is among the creative people data. About one-third of the eminent po- studied by Ludwig ets, musical performers, and fiction writ- who were troubled by psychological ers in Ludwig’s study suffered from seri- problems. ous psychological symptoms of some kind as teenagers, a rate that increased to about three-quarters when they reached adulthood. From 46 to 77 percent of poets, fiction and nonfiction writers, painters, and composers went through periods of serious depression, at least twice the rate observed in persons in other fields. Ma- nia appeared most often in actors, poets, architects, and nonfiction writers, with lifetime rates ranging from 11 to 17 percent. Ludwig contends that some professions induce emotional turmoil, while others According to Ludwig, eminent people From a Mountain to a Mount quell it. Fields that allow for ambiguity who manage to avoid emotional turmoil In the fall of 2005, Ludwig published and flexibility in creative expression, such evidently arouse a sense of psychological his 11th book. A departure in some ways, as painting, poetry, and fiction writing, unease when they feel the need for cre- Mount Aesculapius is fiction – but it builds more readily accept practitioners with ative tension. This tactic, notes Ludwig, on everything he has learned over the mental disorders and allow them to wrestle may pleasantly stimulate mood and be- years in the profession of medicine. The with their inner demons in their art. Fields havior, much like mild mania. book, he explains, was brewing for a that emphasize accumulated knowledge Ludwig acknowledges that the subject long time. As chair of a department and and structured means of exploration, such of creative greatness continues to raise as a member of many high-level commit- as science, attract and promote people important questions, including the extent tees both at the University of Kentucky with calmer temperaments. to which innate talent shapes great achieve- and around the country, he “had the op- In Ludwig’s model, truly great creative ments and the role early physical illness portunity to learn first hand about the achievers generally harbor an ingrained and disability play in the lives of eminent many intrigues, power plays for space, contrariness and opposition to established people. money, and influence, and various con- beliefs, which frequently antagonizes One of the reviewers who found The tentious issues taking place within a other people; possess a capacity for soli- Price of Greatness impressive was Mark A. medical center.” An academic medical tude and self-reliance; face physical trials Runco, Ph.D., professor of child and center, he continues, “represented a unique, early in life, often a life-threatening illness adolescent studies at California State small society within a larger one, with its or physical disability; emblazon their University at Fullerton and editor of the own language, goals, values, social hier- works and achievements with a personal Creativity Research Journal. He wrote: “I archy, and mission. . . . Only a novel could and distinctive style; and experience a am not exaggerating when I say that this do justice to this world.” restless, driven state of psychological un- book is required reading for anyone in- And, to judge by its heft (676 pages), ease that finds relief through solving terested in the nature of creativity and only a long novel. In fact, Ludwig says problems creatively. greatness.” his agent told him that, as a first-time

28 I PENN MEDICINE novelist, he would have to cut the draft pation, he launched into a discourse times unscrupulous chair of psychiatry, substantially to appeal to a major pub- about the different physical signs and is, like Ludwig, an expert in the relation- lisher. After some failed attempts – “my symptoms of other cardiac and circula- ship between genius and mental illness, characters rebelled” – he decided to tory abnormalities. When several stu- Ware embodies some of the characteris- publish the book on his own through dents began taking notes, he ordered tics Ludwig identifies in King of the iUniverse, which has backing from them to stop. Mountain: “When he presided over these Barnes & Noble. (Copies are available “I want you to listen and comprehend,” meetings, Nick Ware always had to be through www.iuniverse.com.) he sternly lectured. “You always can wary about threats to his personal au- The novel’s setting is Philadelphia’s read up on the basic pathophysiology thority by these aspiring alpha males, prestigious Benjamin Franklin School of in my textbook. For now, just focus on each seeking to extend the borders of his Medicine, widely known to its admirers understanding the principles underly- own fiefdom and, if opportunity permit- as Mount Aesculapius. According to Lud- ing these clinical abnormalities. If you ted, to annex the resources, space, and wig’s prologue, Benjamin Franklin School truly understood what was wrong, you operating times of his fellow chiefs as of Medicine traces its origins to the Uni- will not need to rely on memorization.” well. . . . Almost all of the Division Chiefs versity of Pennsylvania and to the bitter Then, as he often was wont to do, he were trying to liberate themselves from rivalry between John Morgan, the slung his arm around the shoulders of the monolithic control of Surgery and es- founder, and William Shippen, the one of the awe-struck students, as if tablish separate departments of their own, would-be founder, of Penn’s School of they were bosom colleagues, and began each with its own Chair.” Medicine. According to Ludwig, Morgan asking him about himself as they marched Before the novel ends, readers will rec- in particular showed some of the traits of out of the room. His entourage followed, ognize many aspects of the life of a mod- leadership described in King of the Moun- murmuring among themselves and ern academic medical center – in fictional tain. Morgan, says Ludwig, ‘was ruthless shaking their heads in wonder. form. These include power struggles, dif- in his pursuit of power and fame.’ The ficult searches to fill empty departmental Franklin School, goes the premise, was es- As Ludwig presents the volatile situation chairs, faked research, financial hanky tablished early in the 19th century. at Ben Franklin, the modern incarnations panky, sexual intrigue, addiction, protests His years of being a department chair of John Morgan and William Shippen are for animal rights, the place of primary seem to have provided Ludwig with an Phillip Machaon Coffin, dean of the care and the place of specialization, a endless supply of raw material for fiction. school, and Nicholas Ware, the masterful satirical show put on by the students He is able to suggest the motivations, chair of surgery. The conflict between (which cuts quite close and upsets some self-deceptions, and actions of the pow- Coffin and Ware is less personal than of the professors) – and the perennial erful and near-powerful with a sure satir- professional. Ware and his surgeons lack of sufficient parking space around ical touch. Here, for example, is Ludwig’s strongly resent “running a welfare program the medical center’s campus! Mount Aes- description of Woodrow A. Barrett III, for the poorer departments. . . . Under the culapius is not a roman à clef, Ludwig in- chairman of the Department of Internal current financial arrangements, he had sists, but he feels it presents “a more real- Medicine. In this scene Barrett has con- no say where the money his Department istic portrayal of an academic medical cluded his rounds by putting on “one of donated to the Dean’s Tax went.” The center and the professionals who inhabit his heralded clinical performances.” dean, of course, feels the current system – it than any nonfiction account ever which has to support, among other things, could.” Then, after this dramatic demonstra- the basic science departments – is work- It’s a bold claim, but Arnold Ludwig has tion of the value of inspection and pal- ing well enough. But Ware decides the never been the shy and retiring type. dean has to go. At one point, Ware assembles his nine division chiefs, “a gathering of angry warlords, . . . all spoiling for battle.” Much as Maggie Scottsdale, the some-

William Shippen, left, and John Morgan were bitter rivals. 2006/SUMMER I I 29 JonathanXÑáàx|Ç Assumes Departmental Chair or the last couple of years, Jonathan creative scientist who has utilized a variety Heart, Lung, and Blood Institute, as well A. Epstein, M.D., seems to have of experimental approaches, including as the McCabe Fellow Award for research been on a mission to redefine the human, mouse, and zebrafish models to that bridges clinical and basic sciences. meaning of “fast track.” In 2004, elucidate the molecular and genetic mech- Epstein came to Penn in 1996 as an as- F he was promoted to professor in anisms underlying heart and cardiac out- sistant professor and was promoted to as- Penn’s Department of Medicine, with a flow tract development and congenital sociate professor in 2001. That same secondary appointment as professor in heart disease.” Another calls him “a su- year, he was elected to the American So- the Department of Cell and Developmen- perbly trained physician-scientist” who ciety of Clinical Investigation and be- tal Biology. He also became the first hold- has expanded his earlier interests to include came a councilor of the society in 2004. er of the William Wickoff Smith Chair in the study of tissue regeneration, angio- Epstein is an Established Investigator of Cardiovascular Research, established genesis, and cardiac hypertrophy, “with the American Heart Association. through a $2 million gift from the W. W. implications for mechanisms and poten- “The basic science departments are the Smith Charitable Trust. In 2005, Epstein tial new treatments of heart failure.” foundation upon which all great medical was appointed the scientific director of Epstein is also widely known for his schools stand,” says Epstein. “The dean the new Penn Cardiovascular Institute. commitment to teaching, both on the and the University have taken a bold and Earlier this year, he was elected to the wards in the Cardiac Intensive Care Unit laudable step to enhance our ability to Association of American Physicians, one and in medical school classes. He has bring new therapies to the clinic by in- of the nation’s most prestigious societies also been a director and lecturer in grad- vesting in the basic sciences at the same for academic physicians, which numbers uate seminars in Genetics and Develop- time as they build new clinical buildings Dr. William Osler among its founders. mental Biology and has directed the Pro- and enhance clinical resources. Although Then in March, Epstein received the gram in Molecular Cardiology since 2001. everyone is eager to translate new find- Outstanding Investigator Award, the After receiving his B.A. and M.D. de- ings into clinical practice, we cannot let highest honor of the American Federa- grees from Harvard, Epstein completed the fountain of new ideas run dry.” tion for Medical Research. his residency and cardiology fellowship In the 1990s, the current department Which brings us to April, when he was training at Brigham and Women’s Hospi- evolved from the Department of Anato- named chair-designate of the Department tal. He then received funding from the my into a more modern research enter- of Cell and Developmental Biology. Howard Hughes Medical Institute to per- prise. Now, says Epstein, the department As Arthur H. Rubenstein, M.B., B.Ch., form postdoctoral research in genetics. “stands ready to transform yet again. We executive vice president of the University He received the Clinician Investigator will serve as the catalyst to bring cut- of Pennsylvania for the Health System Development Award from the National ting-edge stem cell and regeneration and dean of the School of research to Penn, and we will e

Medicine, put it, “Dr. Epstein k collaborate with the recently r u B

l e

is considered one of the i formed Cardiovascular Insti- n a world’s leading investigators D tute and the Institute for Dia- of the molecular mecha- betes, Obesity, and Metabo- nisms of cardiovascular lism, among others, to pro- development and their vide a basic science home for implications for under- institute scientists. . . . We will standing human disease.” be expanding into new areas A member of Penn’s with the same rigorous cri- medical faculty described teria and expectations.” Epstein as “a tremendously — John Shea

30 I PENN MEDICINE PENN NEUROSURGERY By Kate Olderman Another Penn neurosurgeon who has GOES THREE- been impressed by the Dextroscope technology is Gordon H. Baltuch, M.D., Ph.D., associate professor of neurosurgery and eurosurgeons and neu- director of the Center for Functional and DIMENSIONAL roradiologists at the Restorative Neurosurgery at the Pennsyl- Hospital of the University of Pennsyl- vania Neurological Institute. Baltuch spoke about Dextroscope at the Volume Inter- vania are the first in Philadelphia actions exhibit at last year’s annual meet- to use virtual reality, three- ing of the Congress of Neurological Sur- dimensional imaging for geons, where he presented a case study on an intraventricular tumor. (accessible surgical planning, eval- on the Dextroscope web site, www.dextro- uation, and education. scope.com). “Using the Dextroscope has already had a profound impact on the way we’re technically doing surgery,” he says. “We’re actually able to offer much more limited corridors to our lesions: smaller incisions, minimally invasive neurosurgery.” The Dextroscope works by fusing multi- modality images – such as CT and MRI – into three-dimensional volumetric objects that, when viewed through special stereo- scopic goggles, are transformed into virtual reality, 3-D images. The suspended brain images give surgeons a detailed ad- Before walking into the operating room, vance visualization of the complex anatom- Penn neurosurgeons can now use a Dex- ical relationships and pathology of the troscope® to create interactive 3-D images patient’s brain. In addition, surgeons can of their patient’s brain and plan the best easily manipulate the images, in real time, surgical approach in dealing most effectively by using a control mechanism and stylus with a diagnosed condition. Dextroscope that work in conjunction with the Dextro- is a product of Volume Interactions, now scope. Such hands-on interaction – which part of Bracco Diagnostics. includes “virtual drilling” for planning a “This superior technology provides re- surgical path and tools for measuring lin- markable advances in imaging and surgi- ear distances and curved surfaces in 3-D cal planning for brain and skull-base tu- space – permits the surgical team to plan mors and epilepsy,” says M. Sean Grady, and “test” their exact clinical approach. M.D., the Charles Harrison Frazier Profes- The Dextroscope, in Baltuch’s words, sor and Chair of Neurosurgery. “It allows “is a tremendous teaching tool.” us to look at the brain in ways similar to According to Grady, the technology how we would during surgery, and then can help neurosurgeons at any level of plan the best technique for each patient expertise, teaching both basic anatomy before we even begin. This is of great and advanced surgical techniques. With Images courtesy of Volume Interactions benefit to the patient, because it results this technology, the user can practice a in a less-invasive surgical process.” procedure over and over.

31 I PENN MEDICINE 2006/SUMMER I I 31 THE FINEST HOSPITAL CARE – WITH A DIFFERENCE

THE ENHANCED LEVEL OF SERVICE IN THE PAVILION WILL COMPLEMENT HUP’S NATIONALLY RECOGNIZED PATIENT CARE

By Nicole Gaddis

The Family Business Center (above) and patient room in The Pavilion's current home at Rhoads 3.

lthough it would never be mistaken Ralph W. Muller, CEO of the Health A for a hotel room, one of the new System. “Now we have the pleasure of private rooms at The Pavilion at the Hos- marking a milestone for inpatient care pital of the University of Pennsylvania at Penn.” certainly has a few creature comforts. A Rooms at The Pavilion, which are cur- small refrigerator is stocked with bottled rently located on Rhoads 3, are available and sparkling water, fruit, cheese, and to any patient admitted to HUP who does chocolate truffles; soft sheets are topped It was PENN Medicine’s own donor not need to be placed in intensive care off with pillowcases featuring the Penn community that expressed interest in and whose vital signs are stable. crest; a terry-cloth robe hangs in the closet. having such services and amenities made An individual room is only about $160 And while these amenities are similar to available for those willing to pay the extra more per night than the hospital’s standard those found at deluxe hotels, Garry cost. “Although The Pavilion at HUP is single room; suites are also available, and Scheib, executive director of HUP, em- the first to offer these kinds of amenities guest suites are available for patients’ phasizes that the medical care provided in the Philadelphia area, many hospitals families. Meals are prepared by a pair of in the unit “will be exactly the same as across the country – including Johns dedicated executive chefs, one of whom every other patient unit in HUP.” Hopkins, Mount Sinai, and Brigham & was formerly from Lacroix at the Ritten- The Pavilion is a natural outgrowth of Women’s – have already been providing house. Each room has a flat-screen plas- the Patient Facilitated Services program these services,” explains Kelly Brennen ma television with DIRECTV®. Patients that was started in 2003. The goal for the Abramson, R.N., M.S.N., administrative can, for a fee, take advantage of The program was to provide an enhanced level director of Patient Facilitated Services Pavilion’s concierge services: in-room sa- of service that complements HUP’s na- and International Programs. “It was an lon services, meals for guests and family tionally recognized patient care. “Indeed, opportunity for HUP to remain competitive, members, or parking, just to name a few. the success of this program demanded and the revenue generated from these ex- A permanent pavilion is scheduled to that we create a dedicated patient unit in tra services will help fund other medical open in 2009. order to take this program to the next programs, initiatives, and facilities.” “What we will be providing at The level,” explains Arthur H. Rubenstein, “In October 2005, we celebrated the Pavilion is just a small part of the kind of M.B., B.Ch., executive vice president of beginning of a wonderful new era in service excellence that we hope to bring the University of Pennsylvania for the outpatient care at PENN Medicine with to the entire Health System,” says Abramson. Health System and dean of the School of the groundbreaking for the Perelman “From the moment you enter, we will be Medicine. Center for Advanced Medicine,” notes at your service.”

32 I PENN MEDICINE A matter of FACTT The research team: (from left) Hongtao Zhang; Mark I. Greene; and Xin Cheng. P h o t o

b y

D a n i e l

B u r k e

By Karen Kreeger

super-sensitive blood test developed protein molecules. The new technology most widely used clinical Her2/neu tests — A at the School of Medicine may help represents the further evolution of an earlier IHC (immunohistochemistry) and FISH avoid late-stage diagnosis of cancer and approach that was developed in collabora- (fluorescence in situ hybridization). When other diseases. The Fluorescent Amplifi- tion with James Eberwine, Ph.D., professor screened with the new FACTT method, cation Catalyzed by T7-polymerase Tech- of pharmacology at Penn, which employed Her2/neu-positive cancer patients showed nique, or FACTT test, is five orders of radioisotopes. This research was funded in dramatically elevated Her2/neu levels (aver- magnitude (100,000 times) more sensi- part by The Abramson Family Cancer Re- age: 384 ng/ml), while the levels in Her2/neu- tive than ELISA, a common immune- search Institute. negative breast cancer patients (19.5 ng/ml) system-based assay. Mark I. Greene M.D., The researchers compared how ELISA were close to the levels of the healthy control Ph.D., the John Eckman Professor of and FACTT detected Her2/neu in the participants (16.6 ng/ml). Medical Science, Hongtao Zhang, Ph.D., blood. Her2/neu proteins were in fact first Using FACTT, the researchers found that research specialist, Xin Cheng, Ph.D., re- identified by the Greene laboratory in the nine out of 10 of the Her2/neu-positive search investigator, and Mark Richter, a early 1980s, and the Her2/neu gene was patients had elevated Her2/neu levels and research technician in Greene’s lab, re- found by other scientists to be overexpressed one out of four in the Her2/neu-negative ported their findings in an online publi- in breast cancer. Part of the Her2/neu mole- group had elevated Her2/neu levels. Using cation of Nature Medicine. In an interview cule is shed from the surface of tumor cells. ELISA, they found only two out of 10 in with ABC News, Greene, the senior au- Higher blood concentrations of Her2/neu the Her2/neu-positive group showed ele- thor, said, “I think this technology will correlate with a lower response rate to vated Her2/neu levels. ultimately help change the way we prac- chemotherapy and shorter survival time after The researchers have also tried the tice medicine, in terms of dealing with relapse. FACTT method on other rare, but med- the prevention of major problems.” The Greene lab developed mouse models ically important molecules, and they “The current ELISA tests can only detect that carry cancer cells overexpressing will be developing tests for other cancer proteins when they are in high abundance,” Her2/neu. When these cells are implanted markers, including lung cancer and says Zhang. “But the problem is that many into animals, they form tumors exactly like colon cancer. of the functional proteins – those that have breast tumors in humans. Using ELISA, “The technology is remarkably adaptable a role in determining your health – exist in the researchers could not detect Her2/neu to any protein and can be performed in an very low amounts until diseases are apparent from mouse blood until the tumors reached automated format,” says Greene. He notes and cannot be detected or measured at an inoperable size; with FACTT technology, that the technology will soon be robotized early stages of medical pathology.” Ac- however, they could detect Her2/Neu in so that it will be able to screen for many cording to Zhang, it was important to de- some mice when tumors were barely visible rare disease-causing proteins using tiny velop a technique that can discern these and within two days of implantation. amounts of blood. “It is even possible that rare molecules “to detect abnormalities at The researchers then compared detection one could screen for multiple diseases at an early stage.” of Her2/neu in humans: they collected the same time and produce a precise ac- The FACTT technology uses a different blood samples from healthy women and counting of whether disease-causing mole- enzyme amplification system so quantitative breast cancer patients who did or did not cules are present at an early time when signals can be obtained from even a few overexpress Her2/neu, as detected by the disease can be readily treated.”

2006/SUMMER I I 33 Development Matters The Board of Women Visitors: HUP’s First Volunteers

Only a year after the Hospital of the University of Pennsyl- Today, the Board of Women Visitors’ 21 active members vania admitted its first patients, its Board of Managers estab- continue to work to improve patient care and comfort, through lished a Board of Lady Visitors “to assist the managers in the activities of its committees: the discharge of household duties and to administer such comfort to the patients as their thoughtful care might suggest.” Inspection Committee. Board members act as representa- It was 1875, Penn did not yet admit women, and this tives for HUP departments, visiting assigned areas on a reg- was the first time in the University’s history that women ful- ular basis, discussing needs and problems with nurse man- filled the responsibilities of a board of overseers. Although agers, and submitting formal reports. members started out primarily as caregivers, the Board took patient advocacy very seriously from the beginning; it peti- Abrahamsohn Committee. Founded in 1895 in memory of tioned HUP’s Managers to create a training school for pro- Oscar Abrahamsohn, an immigrant volunteer, this commit- fessional nurses, which was established in 1885. HUP’s tee sponsors a Christmas tree-decorating competition at School of Nursing, distinct from Penn’s School of Nursing, HUP, arranges for “Santa” and carolers to deliver poinset- trained more than 5,000 nurses in its 92 years of operation. tias to each patient on Christmas morning, and, on Easter Nancy Williams is the BWV’s new chairperson – and her Saturday, delivers azalea plants to patients. The Abraham- Penn roots run as deep as the Board’s. Her husband, Quincy, sohn Committee also sponsors Holly Days, a program pro- is a direct descendent of Benjamin Franklin and received his viding needy families with clothing, gifts, and food during the M.B.A. degree from Wharton. Her father, W. D. Gillen, chaired holiday season. the University’s Board of Trustees during the 1960s and helped establish the Scheie Eye Institute. Her daughter, Ali- The Nearly New Shop Committee. The hospital’s volunteer-run son, received a Ph.D. degree in Pharmacology from Penn. consignment shop, located in Ardmore, sells clothing, toys, And she’s been an active member of BWV since 1984. “My jewelry, furniture, and bric-a-brac, and holds jewelry, sweater, father had a great love for Penn,” Williams says. “I wanted and Christmas ornament sales at HUP. to become more involved as well – and do more.”

PESally Sapega NNMedicine Sally Sapega

projects. With more than 250 volunteers, the Show Commit- tee now operates largely independently of the Board of Women Visitors. (See accompanying article.)

Funding Improvements to Patient Comfort As Board members regularly evaluate patient comfort throughout HUP, they often provide the solution to the problems brought to their attention. Above and beyond the funds raised and disbursed by The Philadelphia Antiques Show Committee, the BWV has funded more than 100 projects, totaling more than a million dollars, just since 2000. The Board reviews proposals three times a year, for anywhere from a few hundred dollars for patient literature to $350,000 to completely revamp a surgical waiting room. Among the many projects funded by the BWV in the past

Every year, the Board's Abrahamsohn Committee sponsors a tree-decorating few years: competition at HUP. One of the winners in December was the staff of Rhoads 3, •layettes for newborns which took the motif of Dr. Seuss's Cat in the Hat. •sleep chairs for oncology The Women’s Committee of the University of Pennsylvania •exercise equipment for cardiac and bone-marrow patients Medical Faculty. Made up of doctors’ wives, this committee •creation of the Nursing Network Center organizes social and fundraising events and reaches out to •one-day Alzheimer’s caregiver seminar the wives of new faculty. •motivational seminar for chronic hemodialysis patients •Save A Child fire detector program The Philadelphia Antiques Show Committee. Last but not •sound system for dermatology surgery unit least, “The Philadelphia Antiques Show: A Benefit for the •portable blood pressure devices Hospital of the University of Pennsylvania” was born when, in 1959, HUP’s Board of Managers asked Ali Brown, then The Board recently approved Williams’s own recommen- Chair of the Board of Women Visitors, to develop a major dation to provide $102,000 in financial support for three fundraising project that would also offer something of sub- HUP employees while they attend nursing school, as part of stance to the community. In one sense, an antiques show the Nursing Department’s Seedling Program. “The Seedling seemed a natural choice: “Philadelphia, of course, as every- Program not only helps support our nursing needs, but also body knows, has the finest antiques and furniture in the benefits these employees, their families, and their commu- world. . . . The best cabinetmakers were here,” Ali Brown is nities,” she says. quoted in a booklet about the Show’s early years. Noticeably more active in funding proposals since 1999, But recruiting the top dealers that Brown considered es- when Felicia Lemonick became chairman, the Board of sential to the Show’s success was a challenge. A prominent Women Visitors has received both the Edward S. Cooper Hu- Wilmington dealer told Mrs. Thomas Gates, the Show’s hon- manitarian Award and a community service award from orary chair, that members of old Philadelphia families “were HUP’s Medical Board. Williams credits her predecessor with very unlikely to want to procure [their antiques] in other increasing the Board’s professionalism as well as its visibility ways rather than inheritance.” Brown prevailed, and in April within the Health System, and she hopes to build on Lemon- 1962, the first annual University Hospital Antiques Show ick’s hard work and success. took place. Renamed The Philadelphia Antiques Show in As Williams puts it, “I want to maintain the momentum 1989, the event has long since vindicated its founder’s con- we’ve built and attract a new generation of women with the fidence, raising more than $14,000,000 for Health System imagination and energy to lead the Board into the 21st century.”

Nancy Williams, chair of the Board of Women Visitors, stands in HUP’s Surgical Family Lounge, one of the many areas to receive funding from the Board.

2006/SUMMER I I 35 Development Matters Antiques and Art for New Hearts The Philadelphia Antiques Show raises money this year for Penn’s Total Artificial Heart Program.

In 1962, The Philadelphia Antiques Show’s first year, it raised $40,000 – and that was three times what Ali Brown, its legendary founder, had hoped for. Since then, the Show has continued to outdo expectations: It has raised more than $14 million for Health System projects. Last April’s 44th Show brought in a net profit of $866,000, funding in full 2005’s beneficiary proposal from the Division of Gastroenterology. Collectors come from all over the country, pay hundreds of dollars for a ticket, and line up hours in advance at 33rd and Market to be first through the doors of the Armory for the Preview. The Show is annually lauded in the pages of The Magazine Antiques, Antiques & Fine Arts, Maine Antiques Digest, and other publications – and The New York Times called it “the premier Americana fair” last year. The Show began with 50 dealers and now holds steady Recently restored, Mount Pleasant is one of the Fairmount Park mansions on the An- tiques Show’s trolley tour. Library shown here. Photo: courtesy of the Philadelphia Muse- at 56; perhaps three or four of the coveted spots turn over um of Art. each year, according to the Show manager, Josh Wainwright of Keeling Wainwright Associates, and there are many dealers five years in advance, inviting, for example, an expert who is clamoring to be included. writing a book on a particular topic to curate the Show’s Where the Show has grown is in its professionalism and similarly themed exhibit to coincide with the book’s release. the funds it brings in. It now takes a committee of more This year’s theme, “The Schuylkill Villas,” arose from PEthan 250 volunteersN to organizeN the Show; Monly public rela-ediJohnson’s knowledgecine that the Philadelphia Museum’s Park tions and show management are paid for. For Chris Smith, House Guides were interested in promoting Fairmount the 2006 chairman, it’s more than a full-time job – but one Park’s 18th century houses – and that the restoration of for which she’s well-prepared: She had previously organized Mount Pleasant, the Park’s Grande Dame, would be com- a smaller antiques show, and like all Show chairs, she’s ro- pleted early this year. Besides the exhibition, curated by tated through several executive board committees in her 10 Park House Guide Fytie Drayton, and related lectures, visi- years with the Show. “We’re a pretty well-oiled machine,” tors to the Show can take trolley tours of the mansions. Smith says. “It’s the perfect audience, and great publicity for the Park,” Each year’s Show has a theme, with a museum-quality says Johnson. loan exhibition and lectures structured around it. Joan Johnson Dealers’ rental fees, ticket sales, catalogue advertising, is in charge of the theme – she’s collected American antiques and proceeds from the Show’s Eagle Café cover the Show’s for 50 years, serves on the executive committees of the actual costs, while preview ticket sales and corporate and boards of trustees for both the Philadelphia Museum of Art private underwriting fees become the “profits” that benefit and the American Folk Art Museum in New York, and has far- the Health System. Each year, the Show’s executive commit- reaching contacts in the arts and antiques worlds. She plans tee evaluates several proposals, and chooses one beneficiary.

36 I PENN MEDICINE Alumni Events This year’s recipient is the Division of Cardiothoracic Surgery’s Total Artificial Heart Program, which will be the You can find out more about these and other upcoming first such program on the East Coast. The total artificial events at http://www.med.upenn.edu/alumni/events/ heart, which program director Rohinton Morris, M.D., calls calendar.html “the Holy Grail of heart surgery,” was approved by the Food September and Drug Administration in 2003 as a bridge to heart trans- Sunday, September 17-Wednesday, September 20: American plant. Its use makes it possible to keep patients with dilat- Academy of Otolaryngology – Head and Neck Surgery Reception, ed cardiomyopathy – “very common in our patients,” Morris Toronto, Canada says – alive and healthy until a human heart becomes avail- October able. Proceeds from the Show will fund three artificial hearts Sunday, October 8-Tuesday, October 12: American College as well as the necessary capital equipment to support the of Surgeons, Chicago surgical procedure; patient insurance will reimburse the cost of each heart as it is used. Saturday, October 28: Homecoming 2006. Join fellow alumni “We hope to implant our first total artificial heart by the for a brunch with the Penn Glee Club before cheering on the end of the summer,” Morris says. “New technology is always Quakers as they take on the Brown Bears. a little scary – I give the Philadelphia Antiques Show committee Monday, October 30: Association of American Medical Col- a lot of credit for being visionary.” leges Reception. Alumni who live in the Seattle, Wash., area What looked like a pretty good idea at the time has turned or are attending the annual meeting of the A.A.M.C. are in- into a fundraising powerhouse, and a showpiece, not just vited to this reception hosted by Dean Arthur H. Rubenstein. for Penn’s Health System, but for Philadelphia as well. Mrs. Brown, no doubt, would be proud. November Monday, November 13: American Academy of Ophthalmology, Las Vegas Clockwise, from top: Triple Chest, c. 1735-1745 Philadelphia Museum of Art Recent Gifts – Spring 2006 Daybed Philadelphia, c. 1745-1755 With a $2.5 million gift to The Raymond and Ruth Perelman The Dietrich American Foundation Center for Advanced Medicine, Stanley and Janet Zolot English Delft Charger, c. 1750 Naomi Wood Trust, Woodford have dedicated the Yetta Dietch Novotny Mammography Photo: Charles Gardner Center within the Abramson Cancer Center. With their $1 million gift, Daniel and Suzanne Cohen will establish the Abigail R. Cohen Intensive Care Nursery at Penn- sylvania Hospital. Marilyn and Robert Birnhak’s $1 million dollar gift to the Perelman Center for Advanced Medicine will create the Tracey Birnhak Nutritional Counseling Program, named in memory of the Birnhaks’ daughter. The F. M. Kirby Foundation has pledged $2 million to create The F. M. Kirby Professorship in Ophthalmology at the Scheie Eye Institute, supporting research into gene therapies for retinitis pigmentosa, macular degeneration, and other hereditary causes of vision loss. A $1 million gift from George and Lynn Ross will dedicate and support the Abramson Cancer Center’s Patient and Family Services Program in the Perelman Center for Advanced Medicine. Mr. and Mrs. Leonard Siegel have created a $1 million charitable gift annuity to honor two Penn cardiologists, Dr. Susan E. Wiegers and Dr. Frank E. Silvestry, and establish an endow- ment for research and education in noninvasive cardiac imaging.

2006/SUMMER I I 37 Progress Notes the 2005 Circle of Life Award, thesia Information Systems, he is Richard C. Wender, M.D. ’79, which is presented by the Ameri- responsible for the implementation Alumni Professor and chair of the Send your progress notes to: can Hospital Association to three of the intra-operative anesthesia Department of Family and Com- Jason B. Bozzone hospitals each year for innovations information system and the devel- munity Medicine at Thomas Jef- Associate Director of Alumni in palliative and end-of-life care. opment of an integrated electronic ferson University, is president-elect Outreach and Reunions In 2003, Selecky was the first re- medical record system for the pre- of the American Cancer Society. PENN Medicine Development cipient of the Outstanding Clini- operative Patient Testing Center at He will become president in the and Alumni Relations cian Award given by the American Thomas Jefferson University Hos- fall. Wender is chair of the Society’s 3533 Market Street, Suite 750 Philadelphia, PA 19104-3309 Thoracic Society. A clinical profes- pital. He is a member of the elec- Incidence and Mortality Commit- sor of medicine at U.C.L.A., he is tronic health-record steering com- tee and is a member of the edito- also medical director of the Pul- mittee of the Healthcare Informa- rial advisory board for CA: A Cancer monary Department and the Sleep tion Management Systems Society. Journal for Clinicians, one of the ’40s Disorders Center at Hoag Hospital. Society’s journals. Judith A. Fisher, M.D. ’78, who Stanford B. Rossiter, M.D. ’40, formerly worked in Penn’s Depart- emeritus professor at the Stanford ment of Family Practice and Com- University School of Medicine, was ’70s munity Medicine, has joined ’80s profiled in The San José Mercury Martha’s Vineyard Hospital. She News (February 5, 2006), which Bernard Fisher, M.D., G.M.E. had been a summer visitor to Howard Frumkin, M.D. ’82, described him as the oldest physi- ’74, the Distinguished Service Martha’s Vineyard for the past 22 Dr.P.H., G.M.E. ’84, was recently cian on regular duty – 36 hours a Professor of Surgery at the Uni- years. At Penn, she developed a named director of the National week – at Stanford Medical Center versity of Pittsburgh, received the model for community health and Center for Environmental Health and the veterans hospital in Palo Award for Lifetime Achievement in taught a varied approach to health and the Agency for Toxic Substances Alto. Rossiter, 91 years old, is a Cancer Research from the Ameri- care. and Disease Registry, both part of radiologist. can Association for Cancer Re- the Centers for Disease Control search. According to the associa- Vanessa N. Gamble, M.D. ’78, and Prevention. He reports that tion, his early work on tumor Ph.D., director of Tuskegee Uni- these agencies address a range of metastasis paved the way for later versity’s National Center for environmental health concerns, ’60s hypotheses about the spread of Bioethics in Research and Health from hazardous waste sites to air this disease. Fisher used clinical Care, was elected to the Institute pollution to lead poisoning. Be- Myron Genel, M.D. ’61, G.M.E. trials to confirm that patterns of of Medicine of the National Acad- fore joining the CDC, Frumkin ’65, emeritus professor of pedi- tumor spread are not dictated emies. Before joining the Tuskegee was professor and chair of envi- atrics at Yale University, was re- solely by anatomical considerations University faculty in 2004, Gam- ronmental and occupational cently elected vice president of but are also influenced by intrinsic ble held several different positions health and professor of medicine the Connecticut Academy of Sci- factors in the tumor cells and the with the Johns Hopkins School of at Emory University. His recent ence and Engineering, a state- organs they invade. His research Medicine and the Johns Hopkins books include Urban Sprawl and chartered society limited by law to is credited with changing the way Bloomberg School of Public Health. Public Health (Island Press), Envi- 200 members and modeled after physicians manage patients with She is also the founder and for- ronmental Health: From Global to the National Academy of Sciences. breast cancer. mer director of the Center for the Local (Jossey-Bass), and Safe and His two-year term as Academy Study of Race and Ethnicity in Healthy School Environments (Ox- president will begin in July 2008. Marie A. Bernard, M.D. ’76, has Medicine at the University of ford University Press). Last fall, he was named to Con- been elected to the board of di- Wisconsin-Madison. A frequent necticut’s Stem Cell Research Ad- rectors of The International member of national committees, Mark A. Smith, M.D., G.M.E. ’82, visory Committee, which will di- Longevity Center-USA, a research she served as chairwoman of the has been appointed executive vice rect the distribution of $100 mil- policy organization in New York planning committee for the 2005 president of physician services for lion allocated by the state’s General City with a staff that includes “Creating a Black Agenda in Altus HealthCare Incorporated. Assembly. economists, medical and health Bioethics” conference at Tuskegee. He is responsible for building its researchers, and demographers physician syndicates in key regional Lawrence B. Erlich, M.D. ’63, who study the impact of population Harold M. Szerlip, M.D. ’79, areas. Altus’s physician syndicates G.M.E. ’69, is medical director of aging on society. Bernard holds G.M.E. ’85, a professor of medi- form the backbone of the Altus the NeuroScience Institute of the Donald W. Reynolds Chair in cine at the Medical College of Physician Network, a nationwide Florida, in Celebration, Fla. A Geriatric Medicine and is profes- Georgia whose research focuses equity-owned association of “best Distinguished Life Fellow of the sor and chairperson of the Don- on preventing and treating acute of breed” surgeons. Smith will American Psychiatric Association, ald W. Reynolds Department of renal failure and evaluating and continue to operate his private he is the author of A Textbook of Geriatric Medicine at the Univer- treating hypertension, has been practice in Palm Springs, Calif. Forensic Addiction Medicine and sity of Oklahoma College of Med- named to the editorial boards of Psychiatry (2001). icine. She also serves as the asso- two professional journals: CHEST, Kenneth R. Beer, M.D. ’89, is the ciate chief of staff for geriatrics and published by the American Col- founder and owner of Idealskin.com, Paul A. Selecky, M.D. ’64, New- extended care at the Oklahoma lege of Chest Physicians, and the a web site that features skin-care port Beach, Calif., received the City Veterans Affairs Medical Clinical Journal of the American So- products that he has formulated. 2005 Robert Angarola Award from Center and is director of the Ok- ciety of Nephrology. A former asso- Board certified in dermatology the Southern California Cancer lahoma Geriatric Education Center. ciate chair of medicine at Tulane and dermatopathology, Beer has a Pain Initiative in recognition of University School of Medicine, private practice in West Palm his achievements in palliative and Richard H. Epstein, M.D. ’78, Szerlip came to MCG in 2001. He Beach, Fla., where he focuses on end-of-life care. He is medical di- Jenkintown, Pa., has been pro- is a fellow of the American College cosmetic dermatology and skin rector of the Palliative Medicine moted to professor of anesthesiol- of Chest Physicians and of the cancer surgery. He is a clinical in- Program at Hoag Hospital (New- ogy at Jefferson Medical College. American College of Physicians. structor of dermatology at the port Beach). The hospital received Recently named director of Anes- University of Miami and he holds a

38 I PENN MEDICINE faculty appointment in dermatology York and is in practice at Cayuga and became immune to it, then George S. Watson, M.D., G.M. ’49, at Duke University. He is founder Ear, Nose, Throat – Head and Neck went on to treat others who were Plympton, Mass.; June 24, 2003. and director of “The Cosmetic Boot Surgery. He recently wrote a “Health afflicted with the disease. After He served in the Navy during Camp,” which he describes as the Watch” column on tinnitus for serving in the army from 1952- World War II as head of tropical leading training seminar for cos- The Ithaca Journal. 1954 and caring for soldiers who medicine at Bethesda Naval Hos- metic dermatologists. returned from the Korean War pital. Later, he was also superin- with tuberculosis, Mayock brought tendent of Lakeville Hospital in OBITUARIES his unique experience with TB to Massachusetts and Grasslands the Penn campus. Along with Hospital in New York. A member ’90s O. Norris Smith, M.D. ’33, renowned physician and scientist of Physicians for Social Responsi- G.M.E. ’37, Greensboro, N.C.; Julius Comroe Jr., M.D., Mayock bility, he served on the Plympton Robert H. Glassman, M.D., G.M.E. October 25, 2004. also established one of the first Board of Health. ’90, Short Hills, N.J., was recently two-year fellowship training pro- promoted to managing director of Marcus D. McDivitt, M.D. ’38, grams in pulmonary medicine at Paul F. Zito, M.D., G.M. ’50, Key Healthcare Investment Banking in Tucson, Ariz.; April 19, 2005. HUP, which became the model in West, Fla.; February 18, 2005. He Merrill Lynch’s Mergers and Ac- other academic medical centers. served as a medical officer in the quisitions Group. He remains on Franklin B. Husik, M.D. ’40, Later, he shifted his attention to Navy during World War II. Fol- the faculty of Weill Medical College Glassboro, N.J., a retired physician; sarcoidosis, a disease similar to lowing his training at Penn, he of Cornell University, in its Divi- September 21, 2005. He took his TB that has no known infecting became assistant chief of surgery sion of Hematology and Medical internship at Philadelphia General organism. He built a clinic at HUP at the U.S. Marine Hospital in Oncology, and continues to see Hospital and completed his resi- to treat those who had it; and he Staten Island, N.Y. He served as patients. dency in Florida. In addition to is known in the medical commu- councilman for the City of Perth treating patients at his home, he nity for writing several important Amboy, N.J., from 1982 to 1990. James M. Musser, M.D., Ph.D., also served on the staff of Ancora papers on the topic. He served as G.M.E. ’91, has been named the Psychiatric Hospital and was a chief of the pulmonary disease Nathan L. Comer, M.D., G.M.E Fondren Foundation Distinguished consulting physician at Glassboro section at Penn for nearly two ’51, Narberth, Pa.; November 21, Endowed Chair, executive vice State College (now Rowan Uni- decades, stepping down in 1972. 2005. A psychiatrist, he maintained president, and co-director of The versity). He was among the staff He also served as chief at the a private practice until his recent Methodist Hospital Research In- members at Elmer Hospital when Philadelphia General Hospital illness, with offices in his home stitute in Houston, Texas. Musser it opened in 1950. where, in 1955, he founded the and at the Institute of Pennsylva- also serves as director of the Center School of Respiratory Therapy – nia Hospital, where he had served for Molecular and Translational Carlos M. Gutierrez, M.D. ’41, the first of its kind in the United as president of the medical staff. Human Infectious Diseases Re- San José, Costa Rica, retired chief States. He was active in many He was on staff and taught at many search at the Institute and as vice surgeon of oncology at Hospital professional organizations and Philadelphia area hospitals and chair of the Department of Pathology San Juan de Dios; June 14, 2005. served as chairman of the Ameri- had been a clinical assistant pro- at The Methodist Hospital. Following his retirement, he was can Thoracic Society. Mayock also fessor of psychiatry at Penn. ambassador to the United King- led the effort to remove all cigarette Paul Fragner, M.D., G.M.E. ’92, dom; he also represented Costa vending machines inside HUP George Gittelson, M.D. ’51, Palm an orthopaedic surgeon at White Rica in the Scandinavian countries. and helped the American Lung Beach, Fla.; March 8, 2005. Plains Hospital Center, has been He was Caballero de Gracia Association in its push for a “smoke appointed as a medical consultant Magistral in the Order of Malta. free” society. Lewis Sumner Thorp, M.D. ’52, to the New York Rangers ice hockey Rocky Mount, N.C.; August 17, team. He is a partner with Bone & James E. McMillan, M.D. ’41, Henry Brown, M.D. ’44, G.M. ’48, 2005. His practice at Boice-Willis Joint Associates in North White Scottsdale, Ariz.; January 8, 2002. Waban, Pa.; October 15, 2005. A Clinic in Rocky Mount spanned Plains. His subspecialty includes hand surgeon, he did clinical 41 years until he retired in 1994. hand and wrist problems. In ad- Robert L. Mayock, M.D. ’42, work in Liberia and conducted Over the last decade, he served as a dition to sports injuries, Fragner G.M.E. ’46, Wynnewood, Pa., a research in Buenos Aires, Argenti- consulting physician on Social Se- treats carpal tunnel syndrome, pioneer in pulmonary medicine at na; the Sorbonne in Paris; and curity disability. He was the direc- tendonitis, arthritis, and children’s Penn; January 30, 2006. He founded Cambridge University, England. tor of medical special initiatives problems of the hand, wrist, and the modern pulmonary division, He ran in the Boston Marathon and clinical director of the Area L elbow. one of the first in the U.S., at the for twenty-five years. AHEC (North Carolina Area Health Hospital of the University of Penn- Education Center). He also served Brian S. Cain, M.D. ’93, Piedmont, sylvania. His colleagues and stu- Roland A. Mariani, M.D. ’44, New as medical director of Guardian Calif., and his wife, Janice Cain, dents knew him as a trailblazer in London, Conn.; September 23, Care Nursing Home. C.R.N.A., have welcomed their the care of pulmonary medicine 2004. second child, Bailey Cain. Brian is and as a role model. Mayock J. Peter Muhlenberg, M.D. ’54, an adult cardiac surgeon and Janice trained more than 180 pulmonary Jay H. Portner, M.D. ’44, G.M.E. G.M.E. ’58, Wyomissing, Pa.; is a nurse anesthetist, both at physicians during his career, ’45, G.M. ’49; Wyncote, Pa.; October 28, 2005. Kaiser Permanente in Oakland. many of whom are today’s leaders October 18, 2005. in the field of academic and clinical He was former chair of surgery at Lindley M. Winston Jr., M.D. ’54, pulmonary medicine. He taught Elkins Park Hospital. Malvern, Pa.; August 14, 2005. ’00s his students always to be mindful of the three “A’s” of a successful Victor Newcomer, M.D., G.M.E. Charles C. Wolferth Jr., M.D. Jonathan E. Cryer, M.D. ’00, is medical practice – Availability, Af- ’49, Santa Monica, Calif.; March 15, ’54, G.M.E. ’59, Gladwyne, Pa., an otorhinolaryngologist who fability, Ability. His medical career 2002. the retired head of the Department serves on the medical staff of started off remarkably. In 1942, as of Surgery at Graduate Hospital; Cayuga Medical Center in New a medical student, he contracted Wayne F. Spenader, M.D. ’49, November 15, 2005. A nationally tuberculosis (TB); he survived Mendota, Ill.; January 28, 2001.

2006/SUMMER I I 39 known expert in medical trauma, a private practice in Lancaster. He LEGACY GIVING he spearheaded a state law in 1985 served on the staff of both Lan- that created the Pennsylvania caster General Hospital and St. Trauma Systems Foundation. His Joseph Hospital. goal was to help prevent victims from dying needlessly during the Joseph N. Vizzard, M.D., G.M.E. Like Father, Like Son so-called golden hour, the first 60 ’59, Scotts Valley, Calif.; May 19, minutes of care that can make the 2005. difference between life and death. hen it came time to choose a career, the During his 44-year career, he was Conrad H. Nebeker, M.D. ’62, young W. Benson Harer Jr., M.D. ’56, was a department head, surgeon, and Ogden, Utah; November 26, sure of one thing: he did not want to go teacher at HUP, Hahnemann Uni- 2005. into medicine. He figured his father, W. Benson Harer Sr., versity, and Presbyterian Hospital, College ’17, M.D. ’21, a renowned Penn obstetrician among other hospitals. He received Alan I. Mandell, M.D. ’69, G.M.E. and former president of the Pennsylvania Medical many awards, including the Na- ’73, Memphis, Tenn.; March 14, Society, would be a hard act to follow. tional Safety Council Surgeons 2005. Award for Service to Safety. His Despite his misgivings, Harer entered his father’s alma father, Charles C. Wolferth, was a Henry B. Polin, M.D. ’75, Seattle; mater in the fall of 1952. “My first year of medical HUP cardiologist. November 13, 2005. In a recent school was a dreadful bore,” he says. “But I stuck it issue of Puget Sound Consumers’ out. Then, it all got better because I met Pamela.” His Ralph Cash, M.D. ’56, Southfield, Checkbook, he was listed as one of wife of 53 years graduated from the Penn’s College for Mich., a retired pediatrician; Oc- the top-rated primary-care physi- Women in 1956. tober 25, 2005. After taking his cians in the area. After residencies Coincidentally, Harer was studying labor and delivery internship at Sinai Hospital of De- at the State University of New York when the first of their four children was born. “My troit, he was a pediatric resident and Buffalo General Hospital, he view of Ob/Gyn transformed completely and I finally at The Children’s Hospital of came to Seattle for an advanced understood my father’s passion. The field was about Philadelphia. He began his long course in pulmonary medicine at association with Wayne State the University of Washington and watching a new life emerge. I decided that I did indeed University School of Medicine as remained in Seattle for his med- want to follow in his footsteps.” a clinical instructor in 1960 and ical practice. He spent the past Following his residency at HUP in 1960, Harer had a became emeritus professor there decade in practice at The Polyclinic successful private practice in San Bernardino, Calif., in 2003. He served as chairman on Seattle’s First Hill. The recipient for more than 30 years. Career highlights include serv- of pediatrics at Sinai Hospital of of a master’s degree in German ing as president of the San Bernardino County Medical Detroit from 1972 to 1985 and from Yale University, he served as Society and of the American College of Obstetricians was an attending physician at physician to the German consulate and Gynecologists. Children’s Hospital of Michigan in Seattle for several years. A car To celebrate his 50th reunion this year, Harer created from 1959 until his death. Cash enthusiast, he had recently writ- a charitable gift annuity benefiting the Department of was vice chief of staff at Sinai ten two articles, one about Ger- Hospital for two years. In 1972, man cars, that were published in Obstetrics and Gynecology. “I owe much of my success to he received the Teacher of the Road & Track magazine. Penn, and I feel very fortunate to be a graduate,” he says. Year Award at Children’s Hospital In addition to returning to his “beloved campus” to of Michigan. In 1981, he was Richard I. Perzley, M.D., G.M.E. reminisce with old friends, Harer will also be a guest named “Physician of the Year” by ’77, Kingston, N.Y.; May 10, 2005. speaker, leading a presentation on his other great pas- the National Dysautonomia Foun- In 2002, he joined the Mid-Hudson sion — the history and culture of ancient Egypt. He is dation, on whose medical advisory Family Health Institute in Kingston an adjunct professor of Egyptology in the humanities board he served for 27 years. He as medical director of the pedi- department at California State University at San Bernardino. was honored as “Humanitarian of atric care center. A graduate of He has written numerous articles on Egyptology, in- the Year” by the March of Dimes Jefferson Medical College, he cluding several that combine his knowledge of medicine Foundation of Michigan in 1989. had been in pediatric practices He wrote newspaper columns for in Chapel Hill, N.C., Wilming- with his passion for ancient history and archeology. the Detroit Free Press on pediatric ton, Del., and Philadelphia, Reflecting on his alma mater, his career in obstetrics, issues (syndicated by Knight Rid- among other locations. He was a and his philanthropy to the School of Medicine, Harer der) and appeared frequently on Fellow of the American Acade- gratefully acknowledges the model his father provided: radio call-in shows and a Detroit my of Pediatrics, the North Car- “I am proud to follow in his path.” TV morning show. olina Medical Society, and the Harer’s charitable gift annuity helped him find a way to North Carolina Pediatric Society. make a significant gift, while obtaining a current income Warren J. Robbins, M.D. ’57, tax deduction and the security of guaranteed, partially Lancaster, Pa., a retired orthopaedic tax-free, lifetime payments. This is just one of a multi- surgeon; November 11, 2005. Af- FACULTY DEATHS tude of creative gift opportunities that benefit both the ter medical school, he enlisted in the Army and took his internship Nathan L. Comer, M.D., G.M.E. School of Medicine and its donors. As you chart your and residency in orthopaedic sur- See Class of 1951 financial future, the Planned Giving Office is ready to gery at Walter Reed Army Med- assist in developing an appropriate strategy. Contact ical Center. Among his posts was Robert L. Mayock, M.D. See Marcie Merz, J.D., Director of Planned Giving, PENN the Army hospital in Valley Forge, Class of 1942. Medicine, 3535 Market Street, Suite 750, Philadelphia, where he was chief of surgery. Re- PA 19104-3309 or e-mail: [email protected]. tiring from the Army as a lieu- Charles C. Wolferth Jr., M.D. tenant colonel in 1967, he opened See Class of 1954.

40 I PENN MEDICINE k n i l C

t r e b o Translational Medicine: R One of the important steps we took in Some First Steps this direction was formally establishing three new institutes in January 2005. t academic medical centers, we are Only the Institute for Translational hearing the term translational Medicine and Therapeutics (ITMAT) has medicine more and more these days. translational in its name, but both the From every indication, it will be Penn Cardiovascular Institute and the Aone of the most important themes Institute for Diabetes, Obesity, and Me- for PENN Medicine and our peer institu- tabolism share with it a general impulse tions for many years to come. But what to bring the fruits of research to the pa- do we mean by it? tient as swiftly and safely as possible. All Translational medicine appears to have three also seek to alleviate major, com- followed closely on the heels of transla- plex problems. In the case of ITMAT, the tional research, but the terms seem largely focus is drug discovery and development. synonymous. What is implicit in transla- This collaboration is facilitated by estab- This spring, at the first symposium ITMAT tional medicine – the broader term – is lishing an intellectual environment in which has sponsored, Garret FitzGerald, M.D., that the research usually precedes and in- highly talented individuals are working its director, asserted that what we have at forms the practical application of the together in teams to integrate a full con- present is “a broken model of drug devel- medicine, whether it be a new drug or a tinuum – from basic science to clinical opment . . . a highly inefficient and cost- new therapy. We often describe transla- practice to population health observations ly process.” In recent years, new drug ap- tional medicine as the process of moving and back to basic, translational, and clinical provals have been stagnant at best. Bring- discoveries from the laboratory to the pa- research – to achieve remarkable results ing together basic researchers and clini- tient for clinical use – from the bench to in research, patient care, and education. cians from Penn and beyond, as well as the bedside. At the same time, the process Strengthening the interrelationship at the representatives from the pharmaceutical can move the other way, so that clinical intersections of these dimensions presents industry, regulatory agencies, and gov- care can direct and inform the research. tremendous potential for the prevention ernment, the symposium can serve as an Translational research, however, has a and cure of disease and improvement in example of a translational approach in sense of greater urgency about it than re- the human condition. . . .” microcosm. search in general. As the authors of “Trans- As described in the research section of As our Plan for PENN Medicine makes lation in the Health Professions: Convert- the Plan for PENN Medicine, strengthening clear, support for translational medicine ing Science Into Action” put it: “At present, translational and patient-oriented research does not mean a withdrawal from basic it may take as long as one or two decades is a specific goal. The Plan also urges us to research. We will continue to support for original research to be translated into make creative use of our world-class Univer- our basic scientists, whose work is the routine medical practice. . . . Without ef- sity and to “build new linkages both within foundation of subsequent developments. fective translation, the fundamental aspects the University and to the private sector.” Yet, as the recent ITMAT symposium un- of quality health care – effective, efficient, The explosion of knowledge over the derscored, the present state of drug de- current, and timely care that could save past few decades has made it virtually im- velopment is not working well, and ef- many lives – cannot be achieved” (Evalu- possible that today’s individual biomedical fective translational research can make a ation & The Health Professions, March 2006). investigators can be Renaissance men or tremendous difference there and in At PENN Medicine, the centrality of women, knowledgeable about all aspects many other areas of medicine. translational medicine was made explicit of their fields and related fields. Therefore, With the explicit encouragement of more than three years ago in our strategic we must look to teams, linkages, interrelation- the National Institutes of Health, transla- plan. In the first section, where we pres- ships. One of the most effective ways to tional medicine will play an important ent our vision, this passage emphasizes enhance the team approach is through role in our academic medical centers. the need to connect and translate: centers and institutes that bring together a We will keep you up to date on what “To benefit from the opportunities that diverse group of talented people. Penn has happens at Penn. lie ahead, greater collaboration among re- long been noted for its many centers; now searchers, clinicians, and educators is re- our mandate is to use them more effec- Arthur H. Rubenstein, M.B., B.Ch. quired; and, in particular, the collaboration tively – or create new ones that will focus Executive Vice President of the University of that springs from a mutual appreciation on selected areas and provide necessary Pennsylvania for the Health System of respective and complementary skills. infrastructure, space, and leadership. Dean, School of Medicine rofessionals adhere to estab-

lished standards, keep up

with advances in medicine,

and accept their obligation P to give back to society. Humanists put their patients first, making

empathy as important as technical skill.

With a new position of associate dean

of professionalism and humanism and

an innovative program that pairs medical

students with patients from the very

start of their education, Penn’s School of

Medicine has been a leader in fostering

these concepts in its curriculum.

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