SUMMER 2015
A Penn Center Helps Traumatized Children
To Spread the Light of Knowledge:
Commemorative Book Celebrates the Perelman They Founders, But School of Were Medicine’s Milestone Birthday
Their Friendship Foundered
Class Notes from America’s First Medical Students
Celebrating the 250th From Burma to Penn: A Family Saga Anniversary, Penn-Style
THE PREP
A Time for
High Spirits
Pack 159 graduating Penn Med students and their very interested families into an auditorium used primarily for more sedate academic matters, and there’s bound to be anxiety, anticipation, excitement, and – finally – exhilaration. It’s Match Day, 2015. Where will they be doing their residency training? Envelope by envelope, all of them will learn if they get their top choices. As the auditorium fills, the support among the students is palpable. This year, there are 24 states where students will begin their residencies. Penn, Children’s Hospital of Philadelphia, and the Scheie Eye Institute account for 41 students. The top three specialties in the Class of 2015 are internal medicine, general surgery, and pediatrics, and 46 percent of these industrious graduates head off having completed certificates or advanced degrees in addition to their M.D. degrees.
Photos by Daniel Burke
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DEPARTMENTS
Left THE PREP A Time for High Spirits 2 VITAL SIGNS Taking Aim at HIV 32 DEVELOPMENT MATTERS 250 Years Young, and Looking to the Future 36 ALUMNI NEWS Progress Notes and Obituaries 40 EDITOR’S NOTE The Enduring Presence of Dr. Morgan 41 ONE LAST THOUGHT Discovering the Art in Science
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27 SUMMER 2015 / VOLUME XXVI NUMBER 2
After Trauma, Helping Children and Adolescents Heal 8 By Susan Worley
The unfortunate fact is that the Penn Center for Youth and Family Trauma Response and Recovery meets a need in today’s world. Steven J. Berkowitz, M.D., and his team are dedicated to helping children move beyond a horrifying event.
16 Founders . . . and Feuders |
18
The Power of Green? |
By Mark Gaige
A recent Penn study that used heart rate as a physiologic marker of acute stress suggests that the greening of vacant lots may be associated with reductions in stress.
20 A Festive Weekend 250 Years in the Making |
John R. Shea, Ph.D. Editor Graham P. Perry/NCS Studios Design / Art Direction ADMINISTRATION Susan E. Phillips Senior Vice President for Public Affairs Holly Auer, M.B.E. Director of Communications
By John Shea
Medical Alumni Weekend happens every year – but this time around, the birthday of the Perelman School of Medicine made things more special.
24 Doing Well By Doing Harm | STAFF
By John Shea
The medical school’s first two professors, John Morgan and William Shippen Jr., had talked about starting a medical school. But when Morgan took the first step by himself, their friendship suffered.
By John Shea
Kelly Parsons, M.D. ’97, a surgeon in San Diego, had long had the urge to write fiction. Last year, he published a medical thriller, and the first-time author earned an enthusiastic blurb from Stephen King.
27 Technology for a Healthier World |
By Katie Delach
Penn Medicine’s faculty and staff are creating and adapting information technology to serve clinicians, researchers, and patients more effectively.
30 I. S. Ravdin: Larger – and Smaller – Than Life |
By John Shea
To many who knew him at HUP, I. S. Ravdin seemed larger than life. But even they probably did not expect him to show up in the popular Steve Canyon comic strip.
Penn Medicine is published for the alumni and friends of Penn Medicine by the Office of Public Affairs. © 2015 by the Trustees of the University of Pennsylvania. All rights reserved. Address all correspondence to John Shea, Penn Medicine, 3535 Market Street, Suite 60 Mezzanine, Philadelphia, PA 19104-3309, or call (215) 662-4802, or e-mail john.shea@uphs.upenn.edu.
Visit Penn Medicine’s web site: http://www.uphs.upenn.edu/news/publications/PENNMedicine/
VITAL SIGNS Taking Aim at HIV
Researchers from the Perelman School and and the Penn Center for AIDS Research (CFAR) have been awarded $7.5 million over five years by the National Institutes of Health to initiate a multiproject HIV study. Its goal: to investigate a new gene therapy approach to render immune cells of HIV-positive patients resistant to the virus. The project includes principal investigator James L. Riley, Ph.D., associate professor of microbiology; Pablo Tebas, M.D., director of the AIDS Clinical Trials Unit at Penn’s CFAR; James A. Hoxie, M.D. ’76, professor of medicine and director of CFAR; E. John Wherry, Ph.D., professor of microbiology and director of the Institute for Immunology; Frederick D. Bushman, Ph.D., professor of microbiology; and, from Sangamo Biosciences, Inc., Michael C. Holmes, Ph.D., vice president for research. The Penn-led team, in collaboration with Sangamo, will investigate the ability of a synthetic molecule consisting of a viral entry inhibitor called C34 fused to CXCR4, an HIV co-receptor used by the virus to enter and infect T cells. Building upon the success of past studies such as the one recognized by the Clinical Research Forum, the new Penn project – in both preclinical and clinical studies – aims to safely build an army of modified T cells in HIV-infected patients that are resistant to HIV. They will use a lentiviral technology to express the C34-CXCR4 molecule. This approach, researchers believe, will make more CD4 T cells resistant to the virus and thus may re-invigorate the immune response to control HIV-1 replication in the absence of antiretroviral drug therapy (ADT). The grant is funded under NIH’s U19 Research Program, which funds collaborative projects involving multiple institutions, including an industry collaborator. Gene Therapy Efforts Honored In April, researchers from the Perelman School and CFAR were named among the 2015 recipients of the prestigious Clinical Research Achievement Award. They were honored for their personalized gene therapy work in HIV. The team included Carl H. June, M.D., the Richard W. Vague Professor in Immunotherapy in the Department of Pathology and Laboratory Medicine; Bruce L. Levine, Ph.D., the Barbara and Edward Netter Professor in Cancer Gene Therapy in the Department of
From left: Pablo Tebas, Carl June, and Bruce Levine.
Pathology and Laboratory Medicine and the director of the Clinical Cell and Vaccine Production Facility; and Pablo Tebas, M.D., of CFAR. At its annual awards ceremony, the Clinical Research Forum recognized the 10 most outstanding research papers written by teams from across the nation. The winning papers were chosen based on their degree of innovation from a pool of more than 50 nominations from 30 research and academic health centers nationwide. The Forum and its supporters believe these papers represent the best work in the field and will lead to advancements in medicine that will change lives and patient outcomes worldwide. The Penn team’s work, published in the New England Journal of Medicine in March 2014, was the first successful clinical test of any gene-editing approach in humans. In the phase I study, they engineered the immune cells of 12 HIV-positive patients to resist the HIV infection, by mimicking a naturally occurring mutation that occurs in a very small number of people and renders their cells resistant to HIV infection. The researchers used a zinc finger nuclease technology to induce the genetic CCR5 mutation in patients’ T cells to lock out HIV. The modified T cells persisted in all patients, they found, and reduced viral loads in some who were taken off treatment entirely. – Steve Graff
Join the 5K for the IOA
Support aging-related research and care at Penn’s Institute on Aging by joining the 5K run or the 1.5mile Memory Walk on Sunday, September 20. The run begins at 8:00 a.m. and the walk at 8:10 a.m. at the Shoemaker Green entrance on 33rd Street between Walnut and South streets. To register and for more details, go to pennmedicine.org/5kioa.
UPHS Welcomes Lancaster General
The University of Pennsylvania Health System has reached a final agreement for Lancaster General Health (LG Health) to join UPHS. A three-hospital health system located in South Central Pennsylvania, LG Health has been recognized regionally and nationally for its patient-centered services, clinical excellence, patient safety. It has also been designated a Magnet hospital for nursing excellence three times. As Ralph Muller, CEO of Penn’s Health System, put it, “Increasingly, medicine is a team sport,” adding that “we share a passion for excellence, aimed at improving health and providing more value at less cost.” Joining two of the state’s top health systems will build on the strengths of each, allowing them to provide better healthcare services to more people. In addition, Penn is exploring opportunities to increase the number of medical students and residents who spend time at Lancaster General Hospital. The detailed agreement is subject to various state and federal reviews before moving ahead. 2
PENN MEDICINE
New to the Academy
Two researchers from the Perelman School of Medicine have been elected to the American Academy of Arts and Sciences, one of the nation’s most prestigious honorary societies and a leading center for independent policy research. The new honorees, who join 23 other Penn Medicine experts previously elected, are Jean Bennett, M.D., Ph.D., the F. M. Kirby Professor of Molecular Ophthalmology, and Paul A. Offit, M.D., the Maurice R. Hilleman
Professor of Vaccinology and Professor of Pediatrics at the Perelman School as well as Professor in the Division of Infectious Diseases at The Children’s Hospital of Philadelphia. Bennett studies the molecular genetics of inherited retinal degenerations, seeking to develop rational approaches to treat these diseases. Her laboratory reported the first gene therapy success in slowing the disease process in an animal model of inherited retinal degeneration. Her team’s successful preclinical studies on an inherited blinding disease, Leber congenital amaurosis, led to human clinical trials for this disease that have been successful in improving sight. An elected member of the Institute of Medicine of the National Academy of Sciences, she has received the William Osler Award for Patient Oriented Research from the Perelman School Offit is co-inventor of a rotavirus vaccine that has been credited with saving hundreds of lives every day. He has been a member of the Advisory Committee on Immunization Practices of the Centers for Disease Control and directs CHOP’s
Vaccine Education Center. He is the author of several books in the popular press, including one disputing the claim that vaccines are associated with autism. An elected member of the Institute of Medicine, Offit also received the Lindback Award for Distinguished Teaching from the University of Pennsylvania this year. Among the Academy’s Fellows are more than 250 Nobel laureates and 60 Pulitzer Prize winners. The new class will be inducted at a ceremony on October 10, 2015.
Chain of Life
An unprecedented kidney exchange involving 25 transplant centers and 70 patients began in late January with an altruistic donor at the University of Minnesota. It ended in late March when a kidney from Matt Crane was flown from the Hospital of the University of Pennsylvania to the final recipient waiting in Madison, Wis. In the meantime, Michele Crane, Matt’s wife, received a kidney from another perfectly matched stranger in New York. Like Matt, the last donor was not a match for his or her loved one. Paired exchanges are giving new hope to patients who are in need of a lifeline but do not have a match among their family or friends. The National Kidney Registry organized the national exchange.
Madison
New York City Philadelphia
Sixty-eight patients, 25 transplant centers, three months of surgeries, one massive kidney transplant chain. The lifesaving chain ended in March with two Penn patients after a New York donor’s kidney w as delivered to a recipient at Penn, whose husband donated a healthy kidney to a recipient in Wisconsin.
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VITAL SIGNS Appointments
Donita Brady, Ph.D., was named the seventh Presidential Professor at the University of Pennsylvania, effective July 1. She will be Presidential Assistant Professor of Cancer Biology in the Perelman School of Medicine. Brady’s groundbreaking research studies the links between cancer and copper, with potential for the development of future cancer treatments. She and a team of Duke University researchers discovered that reducing the body’s supply of copper also blocks the growth of certain kinds of cancers – specifically, cancers with a mutation in the BRAF gene that require copper for the growth of cells and tumors. This class of cancers includes melanoma, one of the most common and deadly forms of skin cancer, as well as colon, lung, and thyroid cancers. Brady’s research, which has been featured in first-author studies in such leading journals as Nature and Molecular and Cellular Biology, has significant implications for the production of new treatments, including the use of existing drugs for Wilson’s disease, a rare genetic disorder in which the body accumulates too much copper. Brady had been a senior research associate in the Department of Pharmacology and Cancer Biology at the Duke University School of Medicine. She earned a doctorate in pharmacology in 2008 from the University of North Carolina at Chapel Hill. Thomas P. Cappola, M.D., Sc.M., a physician-scientist with expertise in heart failure, was named chief of the Division of Cardiovascular Medicine and the Herbert C. Rorer Associate Professor of Medical Sciences. The division includes interventional cardiology, electrophysiology, heart failure and transplantation, adult congenital heart disease, consultative cardiology, noninvasive imaging, preventive cardiology and vascular medicine. It cares for more than 68,000 patients each year. Since coming to Penn in 2003, Cappola has served as an attending cardiologist on Penn’s nationally recognized advanced heart failure and transplantation service. A former director of
Turning the Pages of History
HUP’s Clinical and Translational Research Center, he was recognized in 2008 with a Presidential Early Career Award for Scientists and Engineers for applying genomic methodologies to identify the molecular and genetic basis of heart failure. He is co-principal investigator of the Mid-Atlantic Heart Failure Network, sponsored by the National Heart Lung and Blood Institute. A member of the American Society of Clinical Investigation, he is a fellow of the American Heart Association. Emma Meagher, M.D., associate professor of medicine, was appointed senior associate dean and chief clinical research officer. This new leadership position was created to elevate Penn Medicine’s standing at the forefront of clinical and translational research and to enhance the conduct of clinical trials. The mission of the Office of Clinical Research is to standardize the approach to clinical research across the various research centers and departments in the Perelman School and to support investigative teams through regulatory and operational assistance as well as enhancements in study management and oversight. Meagher has served as executive chair of Penn Medicine’s Institutional Review Board, associate vice provost for human research, and associate dean for clinical research. Meagher recently received the 2014 Alpha Omega Alpha Robert J. Glaser Distinguished Teacher Award. Among her cited achievements: redesigning the Perelman School’s formerly fragmented pharmacology curriculum and creating “Case Studies in Translational Research,” a course for M.D./Ph.D. students that explores the challenges and opportunities surrounding personalized (precision) medicine, diagnostics, and devices. Her teaching has also been recognized by the University of Pennsylvania, which honored her with the Lindback Award for Distinguished Teaching.
In the fall of 1765, two forward-looking physicians, John Morgan and William Shippen Jr., began lecturing at the first medical school in North America – part of what was then called the College of Philadelphia, forerunner of the University of Pennsylvania. Before that time, American physicians received their medical education as apprentices to practicing physicians and from scarce textbooks published in Europe. Those with means, including Morgan and Shippen, may have studied abroad. The University of Pennsylvania changed those paradigms and transformed medical education in this part of the world. A limited-edition book, To Spread the Light of Knowledge, was published to mark 250 years of what is now known as the Perelman School of Medicine. Filled with never-before-compiled archival images, the book chronicles the fascinating history of the school, from its beginning as a few lectures given in borrowed space to the extensive curriculum, research, and multidisciplinary clinical practice within Penn Medicine today. To learn more about the 192-page, full-color book that celebrates this momentous milestone and to explore the book’s companion website and an interactive timeline, go to www.med.upenn.edu/psom250. 4
PENN MEDICINE
What’s New in Botswana?
and clinics across rural areas of Botswana. The pilot project, The Botswana-UPenn Partnership (BUP), established in called “Project Kgolagano,” will provide clinical consultations 2001, has continued to make significant progress in improving and diagnoses to a patient population that would otherwise the health of the population of the African nation. One of have to travel far distances to the capital city of Gaborone the Partnership’s recent initiatives is the unforeseen refor specialized care. sult of interventions two decades ago: the introducPenn Medicine telemedicine experts and physiBOTSWANA tion of antiretroviral drugs that considerably incians, including Ramogola-Masire and Ryan Littcreased the life expectancies of people living man-Quinn, director of Mobile Health Inforwith HIV. Many of them are women (now matics at BUP, will provide the support and from 39 years to the low 60s) who were medical expertise for the referred paalso infected with the human papiltients. Harvey M. Friedman, M.D., loma virus (HPV). As a result, this professor of medicine in the Divigroup of women is at a much higher sion of Infectious Diseases at Penn risk of developing HPV-associated cerviand director of the Partnership, is the cal cancer. principal investigator of Project Kgolagano, To better understand these co-infections which means to be connected or networked. and develop optimal prevention and therapeutic Through its 4Afrika initiative, Microsoft has approaches, the Perelman School and the Botswalaunched similar pilots across Africa. Project Kgolagna-UPenn Partnership will use a five-year, $3.5 million ano will have a specific focus on providing access to U54 grant from the National Cancer Institute (NCI). The specialized maternal medicine, which will improve the liveNCI’s U54 program is an initiative developed to strengthen lihoods of women located in small towns and rural areas. the capabilities of sub-Saharan African institutions by collaboThis latest project builds upon the Partnership’s continuing rating with partnering institutions or cancer centers. Collabotelemedicine efforts with cell phone technology in the country. rating investigators come from Penn’s departments of Microbi“People won’t have to travel hundreds of miles to the see speology, Radiation Oncology, Obstetrics & Gynecology, the divicialists, which are lacking in many of the rural hospitals in the sion of Infectious Diseases, and the Annenberg School of Comcountry,” said Friedman. “They will be able to engage with Penn munication, as well as the University of Botswana. Medicine doctors and residents who work over there from The grant supports the continued efforts of Doreen Ramogotheir local hospitals and clinics in a live telemedicine connecla-Masire, M.D., country director of the Botswana-UPenn Parttion that will deliver care in a faster, more convenient, and nership, in cervical cancer screening in Botswana, as well as the cost-effective manner.” telemedicine efforts with mobile phones. In Philadelphia, the Other collaborators on the project include Global Broadband virology laboratory led by Erle S. Robertson, Ph.D., professor of Solutions, Vista Life Sciences, BoFiNet, Adaptrum, and USmicrobiology, will sequence and analyze patient samples to study AID-NetHope. the viruses more closely. It will also identify other viral, bacte– Steve Graff rial, and parasitic agents that are involved in tumor formation.
HPV
Extending Reach Through Telemedicine The Partnership is also collaborating with Microsoft, the Botswana Innovation Hub, and other global partners to launch the first telemedicine service in Africa. It will use TV “white spaces” technology to bring Internet connectivity to hospitals
Quite an Impact Each year, Penn Medicine contributes . . .
NEARLY 39,000 JOBS
jobs to the region
$6.5 BILLION
in total economic impact on Pennsylvania
On Uncertainty
I am a medical geneticist, and I have been struck by the irony that, as we are able to scrutinize our individual genetic codes in ever more precise ways, down to one nucleotide change out of 6.4 billion possibilities, we have more and more difficulty interpreting any given variation. This irony gives me and my genetic counselors considerable heartburn, but is typical of the health sciences today. . . . We faculty were expected to teach the truth and rid you of uncertainties. However, we are notorious for telling our first-year medical students that one-half of what we will teach will be viewed as incorrect in ten years; unfortunately, we just do not know which half. eed Pyeritz, M.D., Ph.D., the William Smilow R Professor of Medicine and Incoming Chair of the University’s Faculty Senate; delivered at the University Commencement, May 16, 2015.
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VITAL SIGNS Honors and Awards Xianxin Hua, M.D., Ph.D., a professor of cancer biology, was named one of 11 recipients of a Harrington Scholar-Innovator Award. Presented by the Harrington Discovery Institute at University Hospitals in Cleveland, the awards support drug discovery efforts of great promise. Hua’s award is for $100,000 over two years. According to Hua, the award will serve as a catalyst to accelerate transition from his laboratory’s basic biomedical research “to develop a novel modality to treat diabetes, by tapping diabetes patients’ own ability to regenerate beta cells.” Hua’s lab looks at a protein called menin and how it regulates the expression of genes and growth of certain types of cancer cells and endocrine cells such as insulin-secreting beta cells. Menin works by physically interacting with other partner proteins, and these protein complexes then bind to the promoter of various specific genes, ultimately modulating a beta cell’s capability to regenerate. The Scholar-Innovators also are given access to Harrington’s Innovation Support Center, which includes a renowned group of industry experts charged with helping guide drug development. Successful initiatives have access to several rounds of capital support to commercialize their basic discoveries. Carl June, M.D., an expert in cancer and HIV, has continued to accrue honors this year. He is the Richard W. Vague Professor in Immunotherapy in the Department of Pathology and Laboratory Medicine and director of Translational Research in Penn’s Abramson Cancer Center. June is widely recognized as leader of the team responsible for the first successful and sustained demonstration of the use of CAR T cell therapy, an investigational approach in which a patient’s cells are removed through an apheresis process similar to dialysis and modified in Penn’s cell and vaccine production facility. Scientists there reprogram the patients’ T cells through a gene modification technique using a viral vector that trains them to recognize specific types of cancer cells. The modified cells – known as chimeric antigen receptor (CAR) T cells – are then infused back into the patient’s body, where they multiply, hunt and attack tumor cells. June was named one of two recipients of the 2015 Paul Ehrlich and Ludwig Darmstaedter Prize for his outstanding work in cancer immunotherapy. Since 1952, the prize has been awarded to scientists who have made great advancements in the fields in which Paul Ehrlich worked, in particular immunology, cancer research, microbiology, and chemotherapy. June also received the Lloyd J. Old Award in Cancer Immunology, presented by the American Association for Cancer Research at this year’s annual meeting. He is a senior editor of the Association’s journal, Cancer Immunology Research. In addition, Pennsylvania Bio, the statewide bioscience trade organization, hon6
PENN MEDICINE
ored June with its 2015 Hubert J. P. Schoemaker Leadership Award. It is presented to a Pennsylvania scientist who has shown a “spirit of innovation” throughout his or her career. Last year, June was elected to the American Academy of Arts and Sciences. Robert L. Mauck, Ph.D., an associate professor of orthopaedic surgery, is one of four scientists given awards by the Kappa Delta Sorority and the Orthopaedic Research and Education Foundation at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons. Awardees are chosen for their outstanding basic science and clinical research related to musculoskeletal disease or injury, with the ultimate goal of advancing patient treatment and care. Each award carries a $20,000 stipend. Mauck received the 2015 Kappa Delta Young Investigator Award for his research on developing and optimizing nanofibrous scaffolds – extremely small, bioengineered materials – to repair or replace complex connective tissues, such as those that make up the meniscus of the knee joint or the intervertebral disc of the spinal column. Complex connective tissues do not heal well, primarily because of their dense makeup with few cells and blood vessels. The challenge, says Mauck, a researcher at the McKay Orthopaedic Research Laboratory, is to find or create a regenerative treatment to restore the fiber arrangement of the tissue and the mechanical integrity of the structure. He and his team used a process called electrospinning to produce the nanofibrous, mesh scaffolding. This process uses a variety of synthetic and natural polymers to provide an organized healing framework for cell recruitment and tissue formation in damaged areas. The laboratory of David Weiner, Ph.D., a professor of pathology and laboratory medicine, received the 2015 Vaccine Industry Excellence Award for Best Academic Research Team at the World Vaccine Congress in Washington, D.C. The Congress is an annual meeting of vaccine professionals from industry, academia, and non-profit organizations. The Weiner lab’s DNA vaccines program was chosen over other finalists from Duke University, Harvard Medical School, and the Memorial Sloan-Kettering Cancer Center by hundreds of vaccine stakeholders who voted for those most deserving of recognition for their work across 14 vaccine-related categories.
The award is given annually to the research group that has produced products with a novel mode of action, seen them progress into human trials, and can demonstrate significant supportive research grants. Weiner is also chair of the Gene Therapy and Vaccine Program and co-leader of Tumor Virology Program in the Abramson Cancer Center. James M. Wilson, M.D., Ph.D., professor of pathology and laboratory medicine, received the 2015 Scientific Achievement Award, presented by Pennsylvania Bio, the statewide bioscience trade organization. It honors a Pennsylvania scientist who has advanced scientific knowledge, innovation, and/or patient care. From the earliest days of work with gene therapy in the 1980s, Wilson’s research focus has been rare inherited diseases, ranging
from cystic fibrosis to dyslipidemias to a variety of metabolic disorders. Most recently, Wilson’s laboratory discovered a family of viruses from primates that could be engineered to be very effective vehicles for transferring genes. These “vectors” have become the technology platform of choice and have helped set the stage for the recent resurgence of the field of gene therapy. Since joining Penn Medicine in 1993, Wilson has received more than 90 patents. He directs Penn’s Orphan Disease Center and the Gene Therapy Program.
Letters More on the Penn-Burma Connection
The feature “From Burma to Penn: A Family Saga” in the recent Spring issue of Penn Medicine was very interesting. There were, in fact, several doctors and a nurse who came from Burma to Penn prior to 1970 thanks to Professor Ravdin. Ruby Thaw, a Burmese nurse who had also been with Dr. Gordon Seagrave, the Burma surgeon, was in the OR with Dr. Ravdin at the 20th General Hospital and was the first to come to HUP. Although the hospital was in Assam [India], Drs. Julian Johnson, Cletus Schwegman, and Ravdin traveled into northern Burma as far as Myitkyina. Sometime near the end of the war in 1945, Dr. Ravdin was in Rangoon and met Dr. Ba Than, Professor of Surgery and Dean of Rangoon University Faculty of Medicine. Dr. Ba Than had refused to leave the country during the Japanese occupation even when the university was closed and Rangoon was being bombed regularly, especially on Sunday mornings. It may have been forgotten, but after the war tentative plans were in progress between Penn and the Rangoon University Faculty of Medicine for an exchange program intended to upgrade Rangoon U, which had been stripped by the Japanese. All of the equipment, books, and supplies were sent back to Japan, including the bronze statue of Sir Spencer Harcourt Butler, a former British Governor of Burma. The negotiations were suddenly and abruptly called off by the Burmese government for reasons which were probably covertly political. However, from 1954 to 1959 the first group of Rangoon University Medical graduates came to HUP for residency training programs: Dr. San Baw (Orthopaedics), Dr. Aung Than (Dentistry and Plastic Surgery), Dr. Myint Myint Khin (Medicine), Dr. Saw Nyun (Neurosurgery), Dr. Albert Ai Lun, a protégé of Dr. Seagrave (Surgery), and me, Simon Kyaw Myint
(Surgery). Although born and brought up in Burma, I am a graduate of Northwestern University School of Medicine. Dr. Kyee Paw (Surgery) and Dr. Ronald Lwin (Cardiology) came to HUP for short-term visits. Sent by the U.S. State Department, both were on the faculty of Rangoon University. There was a hiatus after this group, and then a few more came along. I might add that I am the only one left of the first group and at 87 am still able to do volunteer work as a surgeon at a remote hospital in Nepal. Simon Kyaw Myint, M.D., G.M.E. ’66 Diplomate American Board of Surgery American Board of Thoracic Surgery
Another Look at Gurin and Gellhorn
A splendid issue of Penn Medicine Spring 2015 and a discerning article on deans (“A Pair of Visionary Deans”). I knew both Sam and Alfred. Sam Gurin tried to teach me biochemistry and was one of the basic science trio, with Dale Coman and Lew Flexner, who wrenched control from the HUP clinicians. I did not know he was almost a professional pianist, like Hilary Koprowski, but a lovely man. Alfred Gellhorn was ahead of his time, for Penn certainly, supplied us with pregnant sheep and hated to be recognized as Hemingway’s brother-inlaw. He was anathema to some HUP clinicians and much of what he did was taken down after he left. But two steps forward and one back. Robert Forster, M.D. ’43 D Editor’s Note: Dr. Forster, the Isaac Ott Emeritus Professor of Physiology and former chair of the Department of Physiology, received the School of Medicine’s Distinguished Graduate Award in 1995. SUMMER 2015
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After Trauma, Helping Children and Adolescents
. L A E H By Susan Worley
Photos by Tommy Leonardi
COVER STORY
The Penn Center for Youth and Family Trauma Response and Recovery can help kids move beyond a horrifying event and avoid toxic stress.
L
ast April, what USA Today characterized as a “stabbing rampage” took place at Franklin Regional High School in Murrysville, Pa. A 16-year-old teen who had been teased was the attacker. To help make sense of the violence and learn what to do in its aftermath, the newspaper sought out Steven J. Berkowitz, M.D., for perspective: “In these kinds of situations, the psychological casualties usually outnumber the physical casualties,” he said. “It’s not just the kids who were stabbed, but all the kids at the school.” He noted the symptoms of psychological distress that the children might experience, including trouble sleeping, intrusive thoughts about the incident, mood swings – and, in some cases, post-traumatic stress disorder (PTSD) or depression. Despite the fears of both children and their parents, however, Berkowitz advised parents to send them back to school and return to their normal routine. “One of the most important things,” said Berkowitz, “is to get back on the horse.” Last October, in Marysville, Wash., a 15-year-old student shot five other students in the cafeteria, killing four of them, and then took his own life. As has happened elsewhere, the school debated what to do with the specific site of the killings. Should it be closed? Remodeled? Berkowitz, contacted by The Seattle Times, noted the impact that reminders of trauma – or cues – can have. Remodeling and changing the appearance of a building where an emotionally devastating incident took place can be beneficial, he said, but only if done in tandem with treatment. The change “has to be integrated into their lives.” The national standard in response to school shootings, he explained,
is for students to attend a type of group therapy in a classroom, perhaps their homeroom, and therapy with their families. Who is Steven Berkowitz, one of the experts most sought after by the media after this kind of horrific event? An associate professor of clinical psychiatry at the Perelman School of Medicine, he is the founding director of the Penn Center for Youth and Family Trauma Response and Recovery. And the sad truth is that his expertise and well-researched advice remain in demand two and a half years after one of the worst massacres of schoolchildren in U.S. history. On December 14, 2012, 20 first-graders and six adults were gunned down by a deranged and heavily armed 20-year-old assailant. A shower of gunfire that lasted less than 25 minutes, the shooting at Sandy Hook Elementary School left not only Newtown, Conn., but the entire country and many parts of the world stunned. Berkowitz was among the recognized experts who fielded countless interview requests in the aftermath of the massacre. Displaying practiced calm, he provided reporters and anxious adults with exactly what they seemed to need most: basic advice regarding what to expect after such an incident and simple guidelines for how to begin to move beyond the horrifying event. In this particular case, however, Berkowitz was actually at the site. A long-time faculty member at the Yale University Child Study Center before coming to Penn, Berkowitz joined former colleagues in Connecticut shortly after the shooting to prepare intervention materials for local pediatricians and providers of behavioral health care. Soon afterward, he returned home. As he explains, “I have a firm belief that experts should not be flown in to do the one-on-one work. It’s essential that local people are trained to provide interventions, because they need to sustain these efforts over time.” He describes the initial intervention employed in Newtown – psychological first aid (PFA) – as “a stabilization model”; its objectives include identifying and attending to the immediate needs of disaster survivors while instilling both calm and a sense of hope.
For Steven J. Berkowitz, M.D. (left), the focus is on healing.
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A Crucial Role for Parents
Although he specializes in treating children and adolescents, Berkowitz has a highly regarded track record of assisting the community at large in the wake of violent tragedies. His work reflects his belief that trauma does not occur in a vacuum. In December 2012, he was featured on WHYY’s Radio Times, along with Joel A. Fein, M.D., M.P.H., G.M.E. ’91, professor of pediatrics and emergency medicine at the Children’s Hospital of Pennsylvania and the Perelman School. Berkowitz emphasized that while children were at the center of the Connecticut tragedy, the event was profoundly traumatizing for parents and the surrounding community as well. For many of the children who were at the center of the tragedy in Connecticut, the road ahead has been a long one. But many have likely benefited from the admirable early efforts of local professionals. “There will be a range of responses,” says Berkowitz. “Some kids will recover independently and some will need considerable professional help. It’s important after a truly devastating event like this to make sure that the whole community is recovering. Children, particularly the youngest ones, really rely on their parents to mediate this type of experience – and, as you can imagine, many of the parents have been symptomatic and completely overwhelmed.” A significant 10
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challenge for mental health care providers in such situations is treating symptoms of post-traumatic stress disorder (PTSD) in order to allow normal mourning to happen. It’s a process Berkowitz says can be fraught with complications. As for predicting how different individuals will fare, many variables play a role in outcomes. Children who were direct witnesses of violence or were close to those who died are, not surprisingly, at greater risk of post-traumatic difficulties. So are those who had experienced earlier traumatic events. One thing is certain for survivors in Connecticut, Pennsylvania, Washington, and far too many other sites of violence: “This is not something any of these children are ever going to forget.” The children who will do best, he explains, are those able to integrate the experience – that is, who allow it to be an experience that is part of their life, but doesn’t define it – as they grow and change and return to their developmental tasks. Although Berkowitz is someone the media seeks out after children are victims of violence, his professional interests extend to less sensational, more ordinary, situations as well. For example, last fall he was called on by WTOP, the highest-rated radio news station in Washington, D.C. The topic: the best way for parents to guide their children through grief after a death.
COVER STORY According to Berkowitz, the best thing parents can do is to acknowledge, not ignore, their own emotions and the emotions of their child. He said it was all right for parents to cry in front of their children, but it is important for parents to let them know that they will get through their grief together, as a family. He cautioned against telling children that their loved one is “in a better place,” such as Heaven. “Children will think that’s a real place they should go to,” he said. His advice is to explain matters gently but realistically – even if that means telling children they will not see their loved one again.
Closer to home
A community’s ability to deal with the needs of children and adolescents who are at risk for traumatic symptoms has become increasingly important – and not simply because of the recent increase in events with numerous casualties. Many children in the United States experience potentially traumatic events (PTEs) in their daily lives – often in neighborhoods riddled with varying degrees of crime and violence. The impact of such events, says Berkowitz, “is just as personally catastrophic as a larger-scale event.” It is not uncommon for children, especially in inner cities, to hear gunshots, witness criminal behavior and even killings, or find themselves victims of random acts of violence such as drive-by shootings. Other sources of trauma, which are wide-ranging and unpredictable, include motor vehicle accidents, serious illness, bereavement, intentional or unintentional injuries, maltreatment, and rare occurrences such as terrorist attacks and natural disasters. “Trauma is Greek for injury or wound,” Berkowitz notes, “and psychological trauma can be defined as an experience or group of experiences that cause injury to the brain. Psychological trauma causes neurophysiologic dysregulation that can lead to difficulties in cognitive, emotional, and social functioning.” Although we have a tendency to think of traumatic events as isolated, an accumulation of adverse experiences also can cause injury in the form of toxic stress. Such stress is a subject of growing concern for Berkowitz and others in his field. “Early-childhood exposure to traumatic events is a public health problem of epidemic proportion,” says a long-time colleague of Berkowitz, Arthur Evans Jr., Ph.D. Evans is commissioner of the Department of Behavioral Health and Intellectual Disability Services (DBHIDS) in Philadelphia and a clinical professor at the Perelman School of Medicine. Epidemiologic studies have provided unsettling statistics to support Evans’s contention: each year, about 60 percent of all children are exposed to a PTE, either as a victim or a witness, and one in four children will witness a PTE before the age of four. Evans notes that the latter statistic translates to approximately 25,000 affected children in Philadelphia alone. Statistics on crime and violence explain only part of the problem; many sources of trauma remain relatively hidden. One example in Philadelphia is the widespread and evidently underreported violence in its school district, the topic of a Pulitzer Prize-winning report in 2012 by The Philadelphia Inquirer. Violence within the family and sexual abuse are also significantly underreported. The Penn Center for Youth and Family Trauma Re-
sponse and Recovery was founded in 2009 to help identify and confront these circumstances.
An early focus on trauma
For Berkowitz, a lifelong devotion to working with children began early. As he explains, it developed “partly from an intellectual interest in the nature-versus-nurture debates, back when research was beginning to prove that this was a false dichotomy.” During the early 1980s, his interest led to the famous Orthogenic School in Chicago, where, still in his early twenties, he was profoundly affected by the experience of working with children in long-term residential treatment. “What was most gratifying to me then,” says Berkowitz, “was the realization that, with the right treatment, even children who were severely damaged by trauma could get better.” During his residency in adult psychiatry at Yale, Berkowitz worked not with children but with Vietnam veterans, during rotations at the West Haven VA. As he listened to the veterans’ personal stories, however, he learned firsthand why early childhood trauma is the greatest risk factor for developing
With Steven Berkowitz is Lauren Cliggitt, L.C.S.W., program coordinator of the Center.
PTSD after combat. The veterans who had been abused as children were essentially more susceptible to the horrors of combat. Their stories, says Berkowitz, “led to my belief that we have a much better chance of effecting change if we can engage in preventive intervention at an early age.” While on faculty at the Yale Child Study Center, Berkowitz responded to crisis calls and worked at crime scenes. The experience deepened his involvement with children as well as his interest in community and public-sector work. Then, on September 11, 2001, he and his colleagues were put to the SUMMER 2015
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test when Evans, then deputy commissioner of Connecticut’s Department of Mental Health and Addiction Services, relayed an urgent request from the U.S. government to develop guidelines for responding to emergencies. The Yale team collaborated with the state and the University of Connecticut to quickly develop a plan for assisting more than 1,000 fami-
lies affected by the disaster. Days later, Berkowitz shifted his focus to children and was featured on Nickelodeon News, in a televised dialogue with youths who had witnessed the destruction of the World Trade Center from across the street. In the weeks and months that followed, he and his colleagues continued to attend to the needs of similarly affected children.
Increasing emotional support
A Composite Case: How Improving Communication Helps Prevent PTSD
After his younger cousin was shot during a drug-related dispute, Sam, 13 years old, began to experience intrusive thoughts, sleep disturbances, and generalized anxiety. Immediately after the shooting, Sam had run outside to his cousin, lying on the ground and bleeding from a wound to his hip. At the time, Sam – who lived with his mother, stepfather, and two half-siblings – was also struggling with depressive feelings. His father was dying from a chronic disease in a distant city. It was not a surprise that Sam’s depression and withdrawal grew worse in the aftermath of the shooting. While his mother was aware that Sam was upset, she did not know how preoccupied he was with his father’s condition. Sam had avoided discussing his feelings with her because he knew that his parents did not get along. A social worker who had talked with Sam at the hospital when he accompanied his cousin for treatment referred Sam to the Penn Center for Youth and Family Trauma Response and Recovery. Sam’s mother arrived alone at the center for the first Child and Family Traumatic Stress Intervention (CFTSI) session, which is designed to allow caregivers to meet privately with the clinician. She listened as the clinician described each step of the CFTSI process, reviewed typical responses to potentially traumatic events, and explained the critical protective role of the caregiver. Next, the clinician administered a questionnaire to assess possible post-traumatic symptoms in the mother’s own response to the shooting. It showed that, despite minor anxiety symptoms, her psychological status was good, and she was eligible to take part in the program. The clinician then questioned her about significant events in Sam’s past, including previous traumatic experiences, and had her assess his mood and potential symptoms of post-traumatic stress disorder. 12
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A few days later, Sam arrived with his mother for the second session. The clinician began the session by meeting with Sam alone, to explain the CFTSI process and to have him answer questionnaires to learn how he evaluated his own mood and symptoms. During a conversation with the clinician, as Sam revealed his preoccupation with his father’s condition, he began to cry. Shortly afterward, Sam’s mother joined her son for a joint session in which the clinician compared their responses to the questionnaires. What they found was a minor discordance between their responses – Sam’s mother had not been aware that he was having nightmares. The session helped increase communication between them, a major goal of the program and a critical step toward the primary aim: to increase the mother’s emotional support of her son. Earlier during the second session, when Sam’s mother asked why he had been crying, the clinician guarded the child’s confidentiality and offered only a vague explanation. As a result, Sam began to feel he could trust the clinician. At the same time, Sam had a deepening sense of support from his mother, who showed that she was willing to listen while he described his nightmares and other symptoms. Before the end of the session, Sam decided on his own to tell his mother about his concerns for his father. The clinician ended the meeting by giving them handouts on sleep hygiene and coping with depressed feelings, meant to help Sam manage the symptoms that were most distressing. In addition, the clinician reviewed the coping skills outlined in the handouts and taught Sam how to practice them on his own. When Sam and his mother returned for the third session, Sam reported that talking about his feelings with the clinician had made it easier to share them with his mother. He also expressed relief that his mother was now aware of his feelings about his father’s condition. In turn, his mother said that being aware of Sam’s preoccupation with his father made her more understanding of Sam’s moods and more inclined to give him the attention he needed. The session concluded with a review of Sam’s symptoms, which were improving, and Sam had an opportunity to practice his coping skills with his mother and the clinician present. As Sam continued to practice his coping skills, he found he could effectively manage his post-traumatic symptoms. In fact, by the fourth CFTSI session, they had resolved completely. At that point, Sam’s mother arranged to have him visit his father for a long weekend. When his father died three weeks after the visit, Sam’s mother accompanied him to the funeral.
At CHOP, Joel Fein, M.D., professor of pediatrics and emergency medicine, refers traumatized children to Dr. Berkowitz’s center. But fortunately, as shown here, he sees many healthy children as well.
Lowering the risk for PTSD in children
Well before 9/11, Berkowitz was convinced of the need for an effective and efficient intervention for children at risk for PTSD. Based on research and his own experience, he knew that while many children exposed to a PTE could be expected to recover on their own, as many as two in ten who did not receive treatment were at risk for lasting emotional damage. Randomized controlled studies of successful early interventions did not exist. In addition, research had begun to show that a popular model – critical incident stress debriefing (CISD) – was deeply flawed. Initially developed for adult first responders, CISD encourages the survivors of catastrophic events to express their emotions in a cathartic manner. Although the approach has benefitted some first responders, when used in groups it typically fails, partly because of differences in the severity of symptoms among individuals. It turns out as well that the subjective experience of trauma can be somewhat contagious: people not severely impaired by a PTE can be negatively affected by those who are. Many experts, aware of such drawbacks of CISD and excited by relatively new findings regarding resilience – which is the ability to cope and manage despite exposure to extremely stressful events – concluded years ago that indiscriminately interrogating adults who have experienced a PTE might interfere with their own successful coping efforts. But Berkowitz and a Yale colleague, Steven Marans, Ph.D., went several steps further. They saw the need for a preventive intervention for children, driven not by reaching a catharsis but by promoting
factors that lead to resilience. Research repeatedly showed that youths who had a caring and supportive adult in their lives were more capable of coping with upsetting and stressful events; in addition, individuals who felt supported after a PTE were less likely to develop psychological issues. Based on this data, Berkowitz and Marans developed an intervention that features the indispensable participation of a caregiver, most often a member of the child’s family. By 2008, after years of fine-tuning, they had developed a pilot study of the Child and Family Traumatic Stress Intervention (CFTSI). “The beauty of CFTSI is that it’s practical, it’s brief, and it works,” says Fein, who is also co-director of the Violence Prevention Initiative at the Children’s Hospital of Philadelphia. CHOP’s emergency department refers traumatized children to Berkowitz and his center. The unique four-session intervention, provided within 45 days of a child’s exposure to a PTE, seeks to enhance two crucial factors that help to prevent trauma: social or familial support and coping skills. The goal is to improve communication between an affected child and his or her caregivers, which ultimately increases the caregiver’s support of the child. At the same time, it provides the child with the skills needed to effectively manage symptoms. In 2011, when the favorable results of the pilot study (those receiving the intervention were 65 percent less likely to develop PTSD) were published, Berkowitz was already at Penn, putting CFTSI and other interventions into action. These included an innovative home-based psychiatric treatment for children and adolescents that he also co-developed at Yale. He was also SUMMER 2015
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Some images created by traumatized children, juxtaposed with one of the places that should be most safe: a playground.
busy training professionals to use CFTSI, as well as teaching and lecturing throughout the city and around the country. To further these efforts, the Penn Center partnered with Philadelphia’s DBHIDS and successfully applied for a grant to be part of the Substance Abuse and Mental Health Administration’s National Traumatic Stress Network. The grant, the Philadelphia Alliance for Child Trauma Services (PACTS), has allowed Berkowitz and colleagues at the Philadelphia department to disseminate both CFTSI and Trauma-Focused Cognitive Behavior Therapy to multiple public-sector agencies throughout the city. (TF-CBT is the most well-researched, effective treatment for children from 3 to 18 years old with post-traumatic stress disorder.) Before this grant, the approximately 30,000 youth in Philadelphia with PTSD had only three options for treatment, all located in the Center City area. Now there are well-trained providers geographically dispersed throughout Philadelphia. In addition, PACTS has facilitated trainings for several other systems in the city, such as juvenile justice and child welfare, to help them become more informed about trauma.
Treating children and adolescents at Penn
During the 33 years that have passed since PTSD first entered the Diagnostic and Statistical Manual of Mental Disorders as an official diagnostic category, Penn’s departments of 14
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psychiatry and psychology have been at the forefront of many developments related to trauma, resilience, and the treatment of psychological disorders in children and adolescents. Pioneering work by Edna Foa, Ph.D., an international expert on PTSD in adults and adolescents, and by Martin Seligman, Ph.D., the founder of the positive psychology movement who designed groundbreaking studies on resilience in children, are among the many notable contributions that preceded and provided fertile ground for the center Berkowitz founded in 2009. In addition, Foa, Seligman, Dwight Evans, M.D. (the chair of psychiatry), and other prominent figures at Penn were instrumental in launching the Adolescent Mental Health Initiative, which analyzes, conducts, and disseminates scientific research on preventing and treating mental disorders in adolescents. What didn’t exist before 2009 was an academic center focused on the impact of trauma on children. “Steve’s center brings at least two important new contributions to the study of trauma at Penn,” says Foa, “a focus on children and a new spirit of collaboration, which brings together and draws on the expertise of organizations throughout the city.” She adds that she and Berkowitz regularly exchange ideas and have begun to work together on the topic of prolonged exposure therapy for treating traumatic stress. In turn, Berkowitz points out that Foa’s early conviction that
COVER STORY PTSD is a “failure of recovery” helped to provide a framework for much of his own research. In addition to forging new ties, Berkowitz has helped to reinforce collaborations already established by the university. As Dwight Evans puts it, “The Department of Psychiatry has a longstanding and deep commitment to the study and treatment of child and adolescent mental health disorders.” That includes a partnership with Arthur Evans and Philadelphia’s Department of Behavioral Health and Intellectual Disability Services. He also notes that Berkowitz was jointly recruited by Penn’s Department of Psychiatry and the City of Philadelphia.
Preparation and prevention
While Philadelphia continues to improve trauma-focused resources throughout the city, preparing for a potential largescale crisis, professionals like Berkowitz think daily about wanting to see an end to rampant violence. “One of the things we need to talk about is the cycle of violence,” he says. Berkowitz alludes to abundant research indicating that children raised in violent environments are at risk for a broad spectrum of antisocial behaviors, including becoming a criminal. One way to break the cycle, he believes, is to make the most of current pediatric and trauma-focused services. “Each visit from a child or adolescent seeking care is an opportunity to examine the broader context of that individual’s life, to engage in screening, and to identify the need for referrals to appropriate social services.” Intervening in this manner, Berkowitz adds, “can interrupt pathways to poor mental and physical health, homelessness, unemployment, and violence.” As part of the Philadelphia Adverse Childhood Experiences Study task force and the National Child Traumatic Stress Network, he meets with other health-care providers, academics, and community-based groups to identify and evaluate new opportunities for assessment and intervention. “Another issue we need to examine is access to treatment,” says Berkowitz. “We have to ask ourselves why it is so difficult for children and adolescents to gain access to necessary mental health care.” Although Berkowitz and colleagues around the country recognize numerous barriers to access, they generally agree that two such barriers require immediate attention. First, continued and expanded training of professionals is needed to ensure that more people are able to recognize and take necessary steps to deal with serious mental health problems exhibited by relatives, friends, and coworkers. Second, preventive mental health care services must become eligible for reimbursement by insurance providers; at present, mental health professionals must go to great lengths to prove the “medical necessity” of preventive services to qualify for reimbursement. Then there is the issue of guns. Few experts in the field of health care want to find themselves steeped in a political battle over the subject of guns; however, Berkowitz and Fein agree with an increasing number of physicians in this country on a few basics. Both believe the ban on assault weapons should be reinstituted and that the magazine and ammunition capacity and tissue-destruction capability of weapons must be
limited. In addition, they believe that safety regulations such as background checks are sorely needed and that gun owners should be licensed. And they join other physicians in wanting to preserve a doctor’s prerogative to provide safety counseling by inquiring about guns in the home. The American Academy of Pediatrics supports such a prerogative; the State of Florida, on the other hand, has made it illegal. In a “Perspective” published in The New England Journal of Medicine about two weeks after the killings at Sandy Hook, Garen J. Wintemute, M.D., M.P.H., a professor of emergency medicine and director of the Violence Prevention Research Program at the University of California at Davis, offered some evidence that effective changes can be made: “We know that comprehensive background checks and expanded denial criteria
Joel Fein confers with Camilia Kamoun, left, a Penn Med student, and Katie Gensemer, a CHOP nursing resident.
are feasible and effective, because they are in place in many states and have been evaluated.” Even with such a program, some 600,000 firearms were sold in California in 2011. At the same time, Wintemute continued, “The denial policy reduced the risk of violent and firearm-related crime by 23% among those whose purchases were denied.” Some of the parents of children who died in the Newtown massacre and elsewhere are finding meaning in their loss by taking part in national dialogues of this sort. In so doing, they are, perhaps unknowingly, serving as much-needed models for the surviving children and for others across the nation who must find productive ways to integrate their own tragic experiences as they make their way to healing. SUMMER 2015
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FOUNDERS . . . AND By John Shea
The relationship between the two Philadelphia physicians who shared plans about founding a medical school became more than a little strained.
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he names are often linked: John Morgan and William Shippen Jr. They were the first two professors of medicine in the College of Philadelphia in 1765, the beginnings of what would become the University of Pennsylvania’s medical school. Today’s Hospital of the University of Pennsylvania includes the Founders’ Pavilion – note the plural possessive. Both Morgan and Shippen earned their medical degrees from the University of Edinburgh, one of the leading institutions of its day, and both sought to learn as much as they could from European schools 16
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and medical practitioners before returning to the American colonies. Both were praised by one of Philadelphia’s most important citizens, Benjamin Franklin. In a letter of recommendation, Franklin described Shippen as “an ingenious worthy young Man.” Morgan he described as “a young gentleman of Philadelphia whom I have long known and greatly esteem.” Both physicians, delivering the early lectures in their respective areas of expertise, were essential for the success of the new medical school. Yet by the time the school was established, Morgan and Shippen were barely on speaking terms. And over time things would get worse. According to Stanley Finger, Ph.D., author of Doctor Franklin’s Medicine (2006), when Shippen headed to Edinburgh, “he was knowledgeable about surgery, pathology, and midwifery. He also had letters of recommendation from Franklin and the idea of an American medical school firmly planted in his head.” In 1760, Finger continues, when Franklin, Shippen, and Morgan were in London, they exchanged ideas about the future of American medical education with John Fothergill, a prominent English physician. For his part, Morgan was developing plans for the first American medical school before he returned to Philadelphia. Unlike Shippen, however, he envisioned a school associated
FEUDERS with an institution of higher learning, as was the case in Edinburgh. Shippen’s idea was closer to the London model of a hospital-based school. When Shippen returned to Philadelphia in 1762, he inaugurated a series of lectures on anatomy, surgery, and the practice of midwifery. His lectures on anatomy were the first ever delivered in America and incorporated anatomical drawings and casts made by Jan Van Rymsdyk, a Dutch painter and engraver highly sought as a medical illustrator.
An Ambitious Plan
Morgan, more of a visionary than Shippen, presented his proposal for a medical school to the trustees of the College of Philadelphia when he returned to the city in 1765. The trustees were persuaded. That May, Morgan delivered his plan at the College’s commencement. It was subsequently published as the justly famous Discourse upon the Institution of Medical Schools in America. His discourse was unabashedly ambitious. For part of his presentation, however, Morgan sought to distinguish the physician from the more lowly apothecary or surgeon: their practices, he argued, were outside the true frame of the more gentlemanly “theory and practice of physick.” According to George W. Corner, in Two Centuries of Medicine: A History of the School of Medicine, University of Pennsylvania (1965): “Morgan had disparaged surgery as an unintellectual mechanical art, repugnant to sensitive men. He was apparently willing to leave it to be taught by apprenticeship alone, for he proposed no chair of surgery in the school.” As Morgan obviously knew, surgery was Shippen’s specialty, and Shippen did not appreciate Morgan’s characterization. In a letter to the trustees, Shippen wrote: “I should long since have sought the patronage of the Trustees of the College, but waited to be joined by Dr. Morgan, to whom I first communicated my plan in England, and who promised to unite with me in every scheme we might think necessary for the execution of so important a point.” Nevertheless, he accepted an appointment as the College’s professor of anatomy and surgery. It was, in fact, Shippen who lectured first, on November 14, 1765, four days before Morgan. As it turned out, Shippen gave his lectures in his private anatomical rooms near the College; Morgan delivered his on material medica – the body of collected knowledge about the therapeutic properties of substances used for healing – in the College’s lecture hall. The arrangement seemed to work, and America’s first medical school was on its way.
Continental Appointments
The animosity between Morgan and Shippen, however, did not lessen. In fact, it grew worse years later, when both became involved with the new Continental Army in the struggle for independence. Morgan was appointed the Director General and Chief Physician of the army. Corner notes that “Morgan’s temperament included neither tact nor patience,” so perhaps he was not the ideal person for the position. Two years later, after various intrigues, Morgan was dismissed from his post.
FEATURE In his place, Congress appointed . . . William Shippen. Morgan was convinced that Shippen was behind his troubles, and he had some justification. But that was not the end of it. Like Morgan, Shippen was eventually dismissed, in part because of the efforts of Morgan and another pioneer of Penn’s medical school, Benjamin Rush. It became even more complicated. According to the Office of Medical History of the U.S. Army Medical Department, the charges against Shippen included ignorance and neglect of his duties, misapplication of hospital supplies and funds, and providing false morbidity and mortality reports. Shippen appeared before a court martial at Morristown, N. J., on March 15, 1780. “The case was not finally settled until August 18, 1780, when Congress passed a motion to the effect, ‘That the court-martial having acquitted the said Doctor W. Shippen that he be discharged from arrest.’” Only a few months later, however, the medical department underwent another reorganization by act of Congress, and Shippen was again elected medical director of the army. He served a few months before resigning.
Cameos in a Novel
It sounds rather like the stuff of fiction – and an alumnus of Penn’s School of Medicine had the idea of using the stormy relationship of Morgan and Shippen as a kind of framework for a novel. Arnold M. Ludwig, M.D. ’58, an emeritus professor of psychiatry at the University of Kentucky and author of several books of nonfiction and fiction, published Mount Aesculapius in 2005. It is a novel about the fictional Benjamin Franklin School of Medicine, which traces its origins to the University of Pennsylvania and to the bitter rivalry between Morgan and Shippen. In the novel’s prologue, the purported modern-day “author” writes: “I cannot help but wonder if a curse was visited upon our institution, dooming us to repeat the past. When an institution is born in crisis, as was ours, this must leave its mark on the very fabric of the place. . . .” Further, he wonders whether the school’s current troubles are “the morbid legacy of two physicians who lived more than two centuries ago.” Morgan and Shippen appear as themselves in the prologue and are quoted, and at one point Morgan’s actions in the founding of the medical school are characterized as a “betrayal.” Well, if a fervent admirer of Morgan had written the novel, perhaps the account would be somewhat different. The third and fourth faculty members appointed professors in the young medical school were Adam Kuhn and Benjamin Rush. Rush, whose fame as a physician and author was to surpass that of Morgan and Shippen, was clearly on the side of Morgan. According to Corner, Rush “hated the Shippens,” both William Jr. and his father, also a prominent medical practitioner. In 1781, Rush declared the younger Shippen “unfit to teach in the University because of his alleged maladministration as director general of hospitals” – even though Shippen had been acquitted of the charges! Despite the differences between Morgan and Shippen, these two extremely talented physicians were both there at the birth of the first medical school in America. Each has a claim as a founder. But Morgan’s name, it appears, should come first. SUMMER 2015
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The Power of Green? By Mark Gaige
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FEATURE
A recent study finds that being near greened vacant lots lowers the heart rates of neighborhood residents.
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he greening of vacant lots may be associated with biologic reductions in stress, according to a new study from the Perelman School of Medicine. Residents who walked near newly greened vacant lots had significantly lower heart rates than those who walked near blighted vacant lots. The goal of the study “was to scientifically explore the connection between city environments and stress,” says its lead author, Eugenia C. South, M.D., M.H.S.P., a physician in the Department of Emergency Medicine. “We used heart rate as a physiologic marker of acute stress, and the reduction we found suggests a biological link between urban blight reduction strategies – like vacant lot greening – and reductions in stress.” The study, published online by the American Journal of Public Health, is the first known walking trial in a neighborhood in which a physiological marker was measured in real time for residents in their own communities. To measure the stress response in study participants in two randomly selected Philadelphia neighborhoods, the researchers fitted them with heart-rate monitors with GPS as they went on a prescribed walk around their neighborhoods. Some vacant lots in one neighborhood randomly received a greening treatment, while the other neighborhood served as a control and received no treatment. Participants walked past vacant lots before the greening treatment of randomly selected lots and then three months after the treatment. The greening treatment, performed by the Pennsylvania Horticulture Society, is a low-cost environmental improvement that includes cleaning and removing debris, planting grass and trees, and installing a low wooden post-and-rail fence. The average reduction in heart rates attributable to the walkers’ being in view of the greened lots was more than five beats per minute (bpm) lower than when the walkers were near the lots that had not been greened. In contrast, at the control site, there was minimal change in heart rate between the pre-time and post-time period when walking past control lots. In a second analysis, the total net reduction of heart rate when walkers were near and in view of greened vacant lots was more than 15 bpm. Walks ranged from about 1,500 to 2,000 feet in length.
These data support the conclusion that proximity to greened lots results in lower heart rates than proximity to trash-strewn lots. In response to an acute stressor, the body activates the sympathetic nervous system, which results in the release of epinephrine; that in turn increases heart rate. Thus, higher heart rates at unexpected moments and because of urban blight, which can be ubiquitous in some city neighborhoods, can be inferred to be evidence of stress. Changing heart rate has been used in a few previous studies to evaluate responses to acute stress, although primarily in indoor laboratory settings. The current research builds on previously published findings by South and her colleagues, which found that residents living near greened vacant lots feel safer than those near sites that were not greened. “Our hypothesis in the earlier published work was that transforming vacant lots from being overrun with weeds and filled with trash to a clean and green space may make it difficult for people to hide weapons and conduct illegal activities such as drug use in or near the space,” says South. The lower heart-rate response the researchers found in the newly published study “may be tied to residents’ feeling safer and experiencing less stress from their environment.” The study’s senior author is Charles C. Branas, Ph.D., professor of epidemiology and director of Penn’s Urban Health Lab. The research on greening urban lots, he says, “provides an important scientific impetus for urban planners and city officials to take relatively low-cost steps toward improving health
“
The average reduction in heart rates attributable to the walkers’ being in view of the greened lots was more than five beats per minute (bpm) lower than when the walkers were near the lots that had not been greened.
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for their residents.” In his view, future trials that dynamically measure additional biological information – such as cortisol levels (another marker of stress) and blood pressure – are now warranted to advance understanding of the relationship between stress and blighted urban environments. An earlier Penn Medicine (Spring 2013) presented Branas’s belief that greened lots “may do much more than just lessen crime and gun use in a neighborhood,” thus removing a threat to health. The greening projects may also help reverse “the unhealthy hunkering down of whole communities” by drawing people back more fully into their neighborhoods. The other co-authors on the recent study are Michelle C. Kondo, Ph.D., who did her postdoctoral work at Penn and is now with the U.S. Department of Agriculture, and Rose A. Cheney, Ph.D., a Penn demographer. SUMMER 2015
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A Festive Weekend 250 YEARS IN THE MAKING
Medical Alumni Weekend happens every year – but this time around, the birthday of the Perelman School of Medicine made things more special.
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ajestic fireworks dazzled the night sky over the Philadelphia Museum of Art, where more than 1,200 people had come to celebrate. More alumni and families than ever before fanned out for parades and lectures on campus and reunion dinners throughout the city. An impersonator playing the role of John Morgan, the visionary behind the creation of Penn’s medical school, made the rounds in the crowd along with the 20
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By John Shea Photos by Daniel Burke
more traditional Ben Franklin impersonator. Faculty members explored some of the exciting trends in medicine, and visiting representatives from educational and professional institutions in Scotland, England, and Italy described some of what the enterprising and ambitious Dr. Morgan found as he traveled throughout Europe before returning to Philadelphia with his grand plans. Visitors packed the Henry A. Jordan M’62 Medical Education Center, one of the most forward-looking educational sites in the nation, for its official opening. During the gala at the art museum, Philadelphia’s mayor, Michael Nutter, a Wharton alumnus, made welcoming remarks, and Andrea Mitchell, a College alumna and chief foreign affairs correspondent for NBC news, served as master of ceremonies. And helping to enliven the mood were bagpipers, a choir, and Harry Connick Jr. with his band. The Perelman School of Medicine was celebrating a birthday. And not just any birthday – its 250th, more than any other medical school in America can claim. At the Museum of Art, J. Larry Jameson, M.D., Ph.D., dean of the school, aptly called it “a once-in-a-lifetime gala event.”
FEATURE
Some Important Trends in Medicine
The weekend’s faculty panel was “The Next 250 Years of Medicine,” featuring some of Penn Medicine’s most accomplished physicians and researchers. Fittingly, it was held in the Rubenstein Auditorium of the modern Smilow Center for Translational Research. After welcoming alumni back to campus, Dean Jameson cited the first four professors of the young school: John Morgan, William Shippen Jr., Benjamin Rush, and Adam Kuhn. “Those four professors and the subjects they taught encompassed every branch of medical knowledge known to John Morgan,” said Jameson. Then he added: “Fast-forward 250 years,” and today Penn Medicine has more than 2,000 faculty members in 28 basic science and clinical departments. The session’s moderator was Glen Gaulton, Ph.D., professor of pathology and laboratory medicine, who is soon to step down from his role as executive vice dean and chief scientific officer. The first topic he raised was “personalized” medicine – or “precision medicine,” which he said was a more accurate term. A major emphasis today at Penn Medicine, it promises to loom even larger in the years ahead. “How’s it playing out?” In response, Garret FitzGerald, M.D., the Robert L. McNeil Jr. Professor in Translational Medicine & Therapeutics, pointed out that medical researchers used to look for large, average effects in medicine. Now, however, treatments are becoming more individualized, given the detailed genomic and psychosocial information on patients that has become available. The movement is toward more linkages and more insights that were impossible in individual practices. On the other hand, with companies like 23 and Me actively seeking customers for genomic screening, he said, “it’s a bit like the wild west” in marketing. Two more very current areas of research are biological clocks and the individual’s microbiome. The “bugs” inside you can affect the drugs you take; and so can the time you take your drugs. Said Gaulton, “and if you’re taking statins” – and he paused as he pretended to peer into the audience – “looks like 50 percent?” Amid the laughs, he continued: “They work better at night.” Another booming area of medicine the panel touched on was gene therapy. Jean Bennett, M.D., Ph.D., the F. M. Kirby Professor of Ophthalmology, was called upon to relate her experience. “This is an incredibly exciting time for gene therapy,” she said, adding that “the eye has really taken the lead” in that field. Within a year, she continued, the first gene-therapy drug for blindness may be approved. After early success in restoring vision in dogs, it was only seven-and-a-half years ago that Bennett’s team, with members from The Children’s Hospital of Philadelphia, reported similar success with children born with Leber congenital amaurosis. The children’s behavior changed dramatically; one, she said, has cast aside the cane he used and even has his driver’s license. The treatment, Bennett emphasized, has a very high safety profile. Such progress in gene therapy, Gaulton noted, seems to take place with rare diseases, affecting smaller groups. When will similar therapy be offered for larger diseases, like age-related macular degeneration? “A very big question,” said Bennett. The risk-benefit ratio of new treatments is ideal for the smaller
groups. However, she added, “within a matter of two years or so” they could be testing for a larger population. Gene therapy, Gaulton said, might eventually provide a one-time treatment that fixes the problem. But how would such a new paradigm affect drug companies that rely on patients to take many drugs over many years? And how would the treatment be priced? He asked FitzGerald to comment. “It’s a time of promise, and it’s a time of challenges,” FitzGerald replied. There is a dynamic tension between the investments of the pharmaceutical firms “and what the country can afford to pay.”
John Morgan in Europe
Another of the weekend’s popular panels was “Inspiring History: The Founder’s Itinerary,” which brought together representatives from three of the major medical institutions that John Morgan visited during his years in Europe. Again, Dean
From left: Gail Morrison, M.D. ’71, G.M.E. ’76, Dennis Law, Ronald Law, Christopher Law, Jeremy Law, and Dean J. Larry Jameson.
For Service to School and Alumni
The Alumni Service Award recognizes recipients for their loyal and energetic dedication to the Perelman School and to Penn Medicine Development and Alumni Relations. This year’s recipients are from the same exceptional family. The Law brothers – Dennis, Ronald, Christopher, and Jeremy – each graduated from the Perelman School. Among the four of them, they hold seven Penn degrees. The eldest brother, Dennis, M.D. ’73, who led the family in settling in the Denver metropolitan region after his surgery residency, is a retired vascular and thoracic surgeon. Ronald, M.D. ’75, is a retired cardiologist; Christopher, M.D. ’82, is a cosmetic surgeon; and Jeremy, M.D. ’86, is an orthopaedic surgeon. The four brothers have volunteered as class agents, served on the Medical Alumni Advisory Council, and, in many ways, have been the focal point of the Penn Medicine alumni community in Colorado. In addition, they contribute to several health, civic, and cultural institutions and have established scholarships both at the Perelman School and other Penn schools. Together, the Law brothers made a naming gift for the Joseph and Loretta Law Auditorium and the Law Pavilion in the new Henry A. Jordan M’62 Medical Education Center. The auditorium is named in honor of their parents, strong advocates of education.
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Jameson welcomed the attendees, encouraging them to think deeply about the history of the medical school even as they looked to the future. “We have global roots as part of our history,” he said. In Morgan’s time, such places as Edinburgh, London, Paris, and Padua stood Gaetano Thiene, M.D., from out; today, Jameson the University of Padua continued, our multiple and varied connections include Botswana and Central and South America, and we are now embarking on a closer relationship with China. Victor A. Ferrari, M.D. ’86, a professor of medicine and radiology at Penn Medicine, was the session’s moderator. Ferrari, in fact, has previously done research on Morgan’s European travels and knowledge-seeking. In 2012, he delivered the keynote address at a historical conference at the University of Padua. The occasion: the 300th anniversary of Giovanni Morgagni’s appointment as professor at the university. And Morgagni was one of the teachers that Morgan sought out during his years in Europe. Ferrari characterized Morgan as “remarkably intellectually curious,” but also called him a tragic Greek figure – brilliant but flawed. In his travels after receiving his medical degree from the University of Edinburgh, Morgan made many stops and at one point traveled with the Duke of York (George III’s brother) and his party. Morgan also made a stop to visit Voltaire. According to Ferrari, at that time Morgan was in effect “the most famous American physician in the world!” Morgan came to Padua to communicate with the man known as the father of modern anatomy, Morgagni. As Gaetano Thiene, M.D., professor of pathology at the University of Padua School of Medicine, explained, the roots of his university can be traced back to 1222. Over time, it became the most important and desirable site to study anatomy. Students came because bodies were available for dissecting. In 1594, Padua established an anatomical theater – “the first laboratory of investigation in the history of medicine,” said Thiene. Morgan was impressed by the emphasis on pathology, and in his famous Discourse upon the Institution of Medical Schools in America, he noted how essential pathology was – linking the causes and effects of disease. In fact, Thiene asserted that even some phrasing of Morgagni’s found its way into the Discourse, written when Morgan returned to Philadelphia. Thiene referred to an entry in Morgan’s diary about his visit with the elderly Morgagni: “He received me with the greatest politeness imaginable.” The 82-year-old Paduan was still “alert.” The scholars exchanged gifts as well, and Thiene noted that a copy of Morgan’s thesis on pus, written at the University of Edinburgh, is still in the Padua collection. 22
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Neil Turner, Ph.D., head of Undergraduate Medical Education and professor of nephrology at the University of Edinburgh, began his presentation matter-of-factly: “Why did all these people travel halfway around the world” to Edinburgh? All four of Penn’s first medical professors were among them. In part, Turner answered his own question: the university was “a real magnet for intellectual characters,” including, in the era, Benjamin Franklin and Voltaire. Unlike other universities in the British isles, Edinburgh’s was not founded by a religious group. In addition, it became a center for anatomy – and on this matter Turner acknowledged the influence of Padua. It is no surprise that London, with its cultural institutions and its hospitals, was another irresistible attraction for people like Morgan. “The London Experience” was the topic of Linda Luxon, a professor in neuro-otology at University College London and treasurer of the Royal College of Physicians. The latter, she noted, was established in 1518, as its charter stated, to protect “the rude and credulous populace” from wicked men who would take advantage of their desire for medical help. William Fothergill, who earned his medical degree at the University of Edinburgh, settled in London, where he became a generous host to visiting Americans. He met both Morgan and William Shippen, as well as Benjamin Franklin, Thomas Bond, the founder of Pennsylvania Hospital, and Benjamin Rush. Another prominent Londoner at the time was William Hunter, who with his brother John taught anatomy and dissection there. Shippen enrolled in their course. Morgan, Luxon noted, presented his thesis on pus to William. It was nearing the time for John Morgan to return to Philadelphia – and make history.
Distinguished Indeed!
Moving 250 years ahead, in 2015 two alumni received one of the Perelman School of Medicine’s highest honors – the Distinguished Graduate Award, which recognizes alumni whose careers have received national and international acclaim. This year’s recipients are Patricia A. Gabow, M.D. ’69, G.M.E. ’73,
Patricia Gabow and her family.
FEATURE and Robert M. Wachter, M.D. ’83. The awards are traditionally presented during Medical Alumni Weekend. Gabow served for 20 years as CEO of Denver Health, retiring in 2012. She continues as a professor of medicine at the University of Colorado School of Medicine. Gabow is credited with having transformed a city department into a successful independent government body. This transformation earned Denver Health the Shingo Bronze Medallion for Operational Excellence, the first such recognition of a health-care entity. Her most recent book is The Lean Prescription: Powerful Medicine for Our Ailing Healthcare System (2014), written with Philip L. Goodman. Gabow has received several national and international honors, including the American Medical Association’s Nathan Davis Award for Outstanding Public
ment chairman. The hospitalist specialty is thought to be the fastest-growing in modern medical history. Wachter has written two books on safety, Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes (2005) with Kaveh Shojania, M.D., and Understanding Patient Safety (2007; 2nd edition 2012). He received the 2004 John M. Eisenberg Award, the nation’s highest honor in patient safety, presented by National Quality Forum and The Joint Commission. For the past six years, Modern Healthcare magazine has named him one of the 50 most influential physicians in the United States. His newest book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, was published in April, and his blog, www.wachtersworld.org, is one of the nation’s most popular health-care blogs. When the Hospital of the University of Pennsylvania added its first four hospitalists to its Division of General Internal Medicine in the summer of 1998, Penn Medicine (Fall 1998) featured an article on the new specialty. Wachter was featured as well, and the article noted that if his preliminary studies were borne out, “the addition of hospitalists should lead to shorter patient stays and more efficient use of resources.”
Cutting Ribbons and Reminiscing
Robert Wachter accepts his award from Dean Jameson
Servant, the National Healthcare Leadership Award, the David E. Rogers Award from the Association of American Medical Colleges, and the Health Quality Leader Award from the National Committee for Quality Assurance. In addition to receiving her award, Gabow was a panelist at another MAW session called “Front Row Seats: Penn Medicine Alumni Share Their View of Penn’s Leading Role in Medicine.” During that session, Gabow recalled the words of one of her former deans, Alfred Gellhorn, M.D., who pointed to the medical want in the midst of medical riches. While at Penn, Gabow helped treat the most vulnerable patients. That experience, she said, made her decide to work at a “safety net” hospital. Typically, 40 percent of the patients of Denver Health couldn’t pay, and 20 percent were homeless. That’s why, she said, medicine “was not a job but a calling.” As she put it in a profile in Penn Medicine (Fall 2006): “I started out as a doctor caring for one patient at a time. When I became medical director and CEO, I started thinking about caring for whole communities and populations of patients.” Robert Wachter is a professor and associate chair of the Department of Medicine at the University of California, San Francisco, where he directs the Division of Hospital Medicine. He coined the term “hospitalist” in 1996 and wrote a highly influential article in The New England Journal of Medicine on the emerging field with Lee Goldman, M.D., then his depart-
The Perelman School’s Lifetime Achievement Award is bestowed not every year but as merit warrants. It recognizes career-long and exceptional commitment, loyalty, and dedication to the School and to Penn Medicine’s development and alumni relations programs. This year, the late Henry A. Jordan, M.D. ’62, G.M.E. ’67, was named the recipient. His wife, Barrie Jordan, accepted the award in his honor during Medical Alumni Weekend. The Jordans established scholarships and contributed to the creation of the Jordan Center for Gynecological Cancer, housed in the Ruth and Raymond Perelman Center for Advanced Medicine. Extremely active as a volunteer, Henry Jordan served as chair of the Campaign for Penn Medicine and as co-chair of the University’s Making History campaign. He was the recipient of the first Medical Alumni Service Award and also received the University’s Alumni Award of Merit. As Dean Jameson said, “This year, there is no more fitting recipient than the late Henry Jordan, who was one of our most esteemed and engaged alumni.” The official ribbon-cutting for the Henry A. Jordan M’62 Medical Education Center took place during Medical Alumni Weekend. One other major award was presented at the 250th gala: the 2015 Dean’s Medal to Walter Gamble, M.D. ’57, a pediatric cardiologist, and his wife, Anne. Together they established the 21st Century Scholars Program at Penn. Starting in 1993, the fund was to cover the full four-year tuition at Penn’s school for six students in each class. Over the years, that total has increased to 14 Scholars in each class. To date, the scholarship program the Gambles created has provided more than 220 Penn medical students with full, four-year scholarships. For more on the Gambles, see pp. 32-33. SUMMER 2015
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Doing Well by Doing Harm By John Shea
An alumnus makes use of his experience and expertise to fashion a medical thriller.
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n the one hand, there is the associate professor of surgery at the Moores Cancer Center of the University of California, San Diego. A specialist in prostate cancer, benign prostatic hyperplasia, bladder cancer, and kidney cancer, he has published numerous scientific articles and served as an editor of four textbooks, including Handbook of Urology (WileyBlackwell, 2013) and Prostate Cancer: Principles and Practice, 1st edition, which weighs in at more than 1,000 pages. He has been course director for the urology sub-internship course at UCSD Medical School, a faculty presenter on renal cryosurgery, and an invited lecturer on preventing benign prostatic hypoplasia at Slovak Medical University and the University of Padua. He also found time to serve as president of the San Diego Urological Society. Meet J. Kellogg Parsons, M.D. ’97, M.H.S. On the other hand, there is the author of a gripping medical thriller with a major publisher, St. Martin’s Press. In Doing Harm, Dr. Steven Mitchell, chief resident in surgery at a fictional hospital, hopes for a job offer at the famous medical school that runs the hospital. Then things begin to go horrifyingly wrong. A patient that Mitchell operated on dies unexpectedly, shocking the confident – indeed, sometimes arrogant – Mitchell. But it turns out that the death was not the result of a medical error. A friend on the hospital’s Safety Committee grudgingly reveals that the concentration of potassium in the total parenteral nutrition that Mitchell had ordered for the patient “was at least a hundred times greater than the amount you had ordered for him.” In 24
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short, murder – but who did it and why? It is just the first of the deaths that disrupt the hospital and have Mitchell wondering about his own future. Only an insider – someone who knows the daily life of a hospital, who knows the ambitions of the medical professionals and the hopes and fears of their patients – could have created this evocative mix of characterization, specificity of place, and increasing sense of tension. Meet Kelly Parsons, novelist. In 2014, J. Kellogg Parsons published an article on prostate cancer and the therapeutic benefits of structured exercise in the Journal of Clinical Oncology. He was also lead author for an article in Contemporary Clinical Trials on one of his continuing research interests: whether diet can substantially alter the initiation and progress of prostate cancer. That same year, Kelly Parsons published the 351-page Doing Harm.
A Surgeon, Right Where He Wants to Be
When we first meet Steven Mitchell, he is nearly living the life of his dreams. His marriage is happy, he has two adorable daughters, and his work is going well, despite the often difficult hours: I love being a doctor; I especially love being a doctor here. Who wouldn’t? A sprawling, eclectic complex of sleek, modern high-rises interconnected with squat and sturdy nineteenth-century edifices located in the heart of Boston, University Hospital is the primary teaching hospital for uberprestigious University Medical School, and
FEATURE year after year is consistently ranked among the best hospitals in the world. . . . Not a day goes by when I don’t think about how special it is to be part of this place, or remember all of the years of soul-crushing academic labor it took for me to get here. . . . Only the best of the best are chosen to train here. And I’m one of them. In a scene that is a touch reminiscent of the famous statement by Lt. Col. Kilgore in Apocalypse Now (“I love the smell of napalm in the morning”), Mitchell describes one of his operations: As the tissue at the point of contact between the Bovie’s metal tip and the patient vaporizes, it produces a wisp of bluish-tinged smoke that carries a singular odor. The odor of burning human flesh. I pick up the Bovie and cauterize the bleeding vessels. The heat from the Bovie cooks the fat, and I inhale the familiar smell. God, I love operating. I can’t believe they pay me to do this.
and enter the bright yellow fat lying immediately underneath. The scalpel is sure and sharp. As I cut through the fat, which is packed full of small blood vessels, the bleeding starts, and my white gloves are immediately dappled with irregular splotches of bright red blood, which transform my hands into something resembling two moving Jackson Pollack canvases, working in sync to open Mr. Bernard’s belly and expose its contents to the outside world.” Later in the novel, the narrator
Here as throughout, Parsons pays close attention to details, aware not only of process but of colors and smells. As he has said, “The diseases, surgeries, and complications are about as real as I could make them.” But, as readers will expect, Mitchell’s world will soon change dramatically. Doing Harm has two halves. In the first, Dr. Mitchell tries to find out who the killer is and how the killings are done. In the second, once he’s discovered the ingenious killer’s identity and – however irrational – motives, Mitchell must try to bring the killer to justice while preserving his marriage and keeping his family safe. No small task! And his computer skills will come in handy. According to the reviewers’ sacred code, however, one cannot reveal too much more of the plot.
Plot and Prose Draw Attention
The most eye-catching bit of praise for Doing Harm comes from an author whose books have rarely skimped on corpses and violence, Stephen King. In a tweet dated April 14, 2014, he wrote: “DOING HARM, by Kelly Parsons: best damn medical thriller I’ve read in 25 years. Terrifying OR scenes, characters with real texture.” The book jacket comes with advance praise from such well-known novelists as Harlan Coben and Ridley Pearson. Publisher’s Weekly notes a “deft initial setup reminiscent of [John] Grisham’s The Firm.” Given such a reception, what are the chances of a movie deal? The author’s response: “The movie rights have been optioned, which is the first (and most important) step on a long and convoluted path to a movie. I’m delighted to have made it this far and cautiously optimistic we’ll make to the end.” The author’s attention to detail is evident in the description of how hospitals run, how surgeons do their extremely skilled work, how the politics of hospitals and medical schools can affect the people. But it does not mean the prose is entirely straightforward reporting. Here Parsons describes the beginning of the operation on Mr. Bernard: “I slice through the skin
ruminates on a different kind of surgery: “In minimally invasive surgery, we make small incisions through which we insert long, thin surgical instruments shaped like oversized chopsticks. . . . I think of it as high-tech robbery, stealing valuable objects out of patients without touching anything else, making clean getaways from the insides of their bodies as if we’d never been there.” Parsons has a knack for describing the characters by their looks – and their inclinations. The chairman of surgery, Dr. Collier, is described as the spitting image of the actor Charlton Heston, the “older, crankier, more blustery” version. “About the only non-Hestonesque thing about him is his musical preference in the operating room: show tunes. . . . Imagine watching Colonel Taylor from the original Planet of the SUMMER 2015
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FEATURE
The Long Journey from Idea to Book
When Surgeons Must Do Harm (from Doing Harm) Primum non nocere. I first heard it spoken during my first year of med school from one of my older professors who had a proclivity for bow ties and Grecian Formula. He spoke the words with great flourish, reverently lingering over each syllable, caressing the Latin pronunciation as lovingly as he would his children. . . . Primum non nocere. First, do no harm. Well, when a surgeon operates, he or she is doing harm. Sometimes massively so. Surgery is a violent art. It’s the act of healing through deliberate injury to the human body. Scalpels slice through healthy skin to allow access to the diseased organs hidden underneath. Otherwise robust muscles are unceremoniously pushed and pulled and shoved out of the way and held out of the surgeon’s working space – the “operative field” – for hours at a time with blunt metallic instruments called retractors. Normal blood vessels are burned and strangled with fine sterile threads called sutures and cut with scissors, innocent bystanders felled by the surgeon’s relentless march through the healthy parts of the body that invariably stand between the outside world and the site of the patient’s disease. In a way, then, the very act of surgery itself is a violation of one of the most fundamental ethical principles in the practice of medicine. . . . The surgeon wields the scalpel with the intent to heal. The violence wrought is controlled, calculated, and precise. But it’s still violence, nevertheless – pure and simple and primeval. Apes cut out somebody’s kidney while humming along to ‘I Feel Pretty,’ and you’ll have some idea of what it’s like to operate with Dr. Collier.” In contrast, Dr. Lassiter, a former All-American linebacker in college, is Mitchell’s mentor and favorite professor – at least until Mitchell makes a costly surgical mistake on one of Lassiter’s patients. Lassiter is partial to Led Zeppelin. The pounding rock of “Kashmir” contrasts with the ditty from West Side Story. 26
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Speaking about the origins of Doing Harm, Parson reports that he kept an informal journal when he was a resident – “not because I envisioned writing a book someday, but because writing helped me mentally and emotionally process the intense experiences of being a house officer. It was a healthy outlet. It helped me bring perspective to my work. The itch to write a novel developed toward the end of my residency. I gathered my notes and started work on the material that would eventually become Doing Harm in 2003, during my fellowship.” Parsons was a resident and fellow at The Brady Urological Institute of the Johns Hopkins School of Medicine. As Parsons tells it, he wrote a lot of stories when he was younger but stopped writing fiction in college “because I was afraid someone might tell me I wasn’t any good at it.” He grew up reading mostly science fiction, fantasy, and thrillers. He was 15 years old when he read Congo, a novel by another M.D., Michael Crichton, in one sitting, and it had an enormous impact. These days, his tastes are more eclectic, and he enjoys literary fiction and general nonfiction as well. How does writing novels fit into the busy schedule of a practitioner and researcher in a modern health-care institution? Minutes squeezed into the working week? During vacation? “Whenever I have a spare moment,” says Parsons. “I frequently get up early, while the house is still quiet, and write a few hours before breakfast.” How does he turn from one frame of mind to another? “I don’t have any particular ritual. But I’ve found that when I’m mentally fatigued from an academic activity – like writing a paper or grant – it’s useful for me to turn to creative writing. And vice versa. It’s like flexing different mental muscles.” Parsons has never taken a formal creative writing class, but he notes that he’s read several valuable books on writing. “I routinely recruit trusted confidants – family, friends, my agent, my editor – to read early outlines and drafts because I think it’s essential to the success of the writing process.” Once Parsons had a draft of the novel, he entered another phase: trying to find a literary agent. “I slogged through 18 months of rejections and dead ends before I found my agent; and then I spent another two years working with him to completely rewrite the manuscript before we took it to publishers.” The hardest part of the novel to write, Parsons notes, were the interactions between Mitchell and his wife, Sally. “I wanted their relationship to be believable.” As for Mitchell himself, Parson says: “I always conceived of Steve as a flawed guy who makes some poor choices and then ultimately ends up doing the right thing. But in my initial drafts, he was just a little too flawed, too weak, too unlikable. So I added some computer hacking skills and a little moral backbone.” The hard work has paid off. Even his colleagues have been, says Parsons, “overwhelmingly positive.” Fortunately for them, the hospital in the novel is thousands of miles from San Diego! Even better news: Under the Knife, another thriller involving a surgeon, will be published by St. Martin’s Press next spring. J. Kellogg Parsons, M.D., looks to be losing ground to his alter ego.
Technology for a Healthier World
FEATURE
By Katie Delach
Penn Medicine’s faculty and staff are creating and adapting information technology to serve clinicians, researchers, and patients more effectively.
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he physician has just checked the patient’s vital signs. How are they trending? She pulls out her smartphone and quickly navigates to an easy-to-read graph of the vital signs. This is not a scene from the future. Although it was inconceivable only a few years ago, clinicians are using new technology of this sort every day at Penn’s hospitals. Technology plays a crucial role in nearly every aspect of our daily lives, and for decades it has been changing the way most major industries operate. But it’s only recently that digital and mobile innovations have begun to transform health care. Now, with help from experts in health care IT, grants, and partnerships high-profile technology companies, researchers across disciplines at Penn Medicine are finding new ways to harness the power of mobile technology innovation and apply it to patient care. From big data and mobile apps, to social media platforms and software systems that can predict likely clinical outcomes, experts at Penn Medicine are at the forefront of the race to develop tools aimed at streamlining patient care, improving diagnostics, and furthering personalized medicine.
Better Heart Health, One Tweet at a Time
Cardiovascular disease affects more than 80 million adults and is the leading cause of death in the United States. In fact, more people die each year from cardiovascular disease than from all forms of cancer combined. Now, thanks to a first-of-its-kind, three-year grant for $1.5 million from the National Institutes of Health and the National Heart, Lung, and Blood Institute, researchers from the Penn Social Media and Health Innovation Lab will have more help in tackling the devastating disease. The other partner in the project may come as a surprise: Twitter, known as the world’s leading microblogging site. “This grant illustrates a groundswell of interest in connecting social media and big data to improve health outcomes,” says the project’s leader, Raina Merchant, M.D., M.S.H.P. ’09, an assistant professor of emer-
gency medicine and director of the Social Media and Health Innovation Lab. “Social media research in health care is still early compared to how it’s being used in other fields, but there is definitely a larger trend here.” The effort has several distinct goals: • To characterize tweets related to cardiovascular disease (such as what condition is being discussed and trace the associated symptoms, behaviors, and outcomes) • To measure the correlation between the known epidemiology (patterns, causes, and effects) of these conditions and those reported via Twitter • To conduct a randomized controlled trial to determine which Twitter messages resonate with patients with heart disease and can help to manage the disease. Previous projects at the intersection of social media and health care have done things like flag flu outbreaks, track sentiment about the Affordable Care Act, and predict heart disease or depression based on tweets, but, says Merchant, “This project is really focused on using Twitter more for intervention, not just passive learning.” Lyle Ungar, Ph.D., a professor of computer and information science in Penn’s School of Engineering and Applied Science, studies the use of social media to understand the psychology of individuals and communities. “We tend to think of health problems as being treated by drugs,” he says, “but people can do a lot to improve their health through behaviors.” In the short term, says Unger, who is also a member of the Graduate Group in Genomics and Computational Biology in the medical school, the focus has been on collecting data (that means culling through billions of tweets) and building the systems to SUMMER 2015
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automatically look for patterns. The long-term goal, however, is intervention — helping people improve their health. “The key to treatment is changing behaviors.”
Answering the Call to Participate
The growth of social media – with its potential as a public health tool – is only a small example of the broad impact of connected devices on medicine. According to the National Institutes of Health, there are more than 285 million wireless subscribers in the United States alone, and an estimated 67.6 percent of adults worldwide own cell phones. Given the laundry list of things we can do with a few swipes or taps of a finger – send Facebook messages to long-lost high-school friends, do our grocery shopping online, or conduct banking transactions – it may seem obvious to use mobile technology for recruiting research participants. But only recently has this been made a reality. Working with a team of doctors and software engineers across the country, Kathryn Schmitz, Ph.D., M.P.H., a professor
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In today’s world where we have technology in the palm of our hand that lets us watch live TV, set DVRs, and control home-security systems from anywhere in the world, it’s crazy that we’re still using paper flyers to conduct what is basically a series of simple surveys and questionnaires.
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of epidemiology whose interests include prevention, public health, and physical activity, is exploring new ways of conducting larger, more accurate research studies – and faster. “We’ve all seen the flyers people use when they are trying to sell furniture or looking for a new roommate – the ones with the pull-off tabs with a phone number to call if you’re interested. That’s what we’ve been using to recruit research participants for decades,” says Schmitz. “In today’s world where we have technology in the palm of our hand that lets us watch live TV, set DVRs, and control home-security systems from anywhere in the world, it’s crazy that we’re still using paper flyers to conduct what is basically a series of simple surveys and questionnaires.” ResearchKit was unveiled earlier this year by executives at Apple, Inc. Built as an open-source software framework, the kit makes it easy for researchers and developers to create apps that could greatly facilitate medical studies. Already the framework is being used by leading institutions across the country to study aspects of diseases, including Parkinson’s disease, cardiovascular disease, and breast cancer. With ResearchKit, researchers can create apps that take advantage of mobile phone features to gather new types of data on a scale never 28
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available before. What’s more, many of the apps built with ResearchKit will enable study participants to track their own data and potentially discover correlations between symptoms and daily actions such as diet or exercise. The breast cancer app, which was developed with guidance from a panel of experts that included Schmitz, is called Share the Journey. The app allows women living with breast cancer and survivors to answer questions about their health, perform activities related to clinical trials, and generate real-time data wherever they are, providing a source of information that is more objective than ever before. The goal of the study is to understand the symptoms and late effects that can follow treatment for breast cancer, why these symptoms vary over time, and what can be done to improve them. For an earlier research study on breast cancer, Schmitz’s team sent out more than 60,000 letters to recruit participants. Out of that total, they were able to enroll only 351 women. In contrast, with Share the Journey, there were more than 13,000 downloads within three days; 1,060 women consented to participate, and 1,020 of them are still enrolled in the study. For Schmitz, however, the picture is much bigger than a single study. “It’s not about a specific app or what we have chosen to track in a particular app,” she recently said in an interview with CNBC. “It’s about the platform, and the fact that researchers will be able to collaborate to be able to build whatever they want to track in patients. That’s what’s really exciting.” There’s no denying that more research is needed on the efficacy, accuracy, and ethics of using mobile apps to collect data, but for now, most experts see the continuing development of these software frameworks as a much-needed and long-awaited big break in the way research is conducted. According to William Hanson, M.D. ’83, vice president and chief medical information officer of the University of Pennsylvania Health System, studies that are done well and that permit patients to use smartphones as vehicles to enter and/or collect data “have the potential to broaden the scope and reach of research considerably.” “When we monitor and gather information in real time – whether it’s for a research study or to coordinate care – patients see the value in that.” But, he adds, he does not believe that most providers are yet prepared for “the data dump from everything their patients will be able to track.”
Real-time Patient Information in a Mobile-Friendly View
“As we move toward digital data, the big challenge is to understand how to take all of the info that’s now digitized and immediately available, and transform an industry which has historically been very paper-centric,” says Hanson. With the advent of electronic medical records (EMRs), patient information became as close as the nearest computer. But like research studies conducted on paper, securely logging in to a desktop and navigating EMR screens can be a lengthy process. As Roy Rosin, M.B.A., Penn Medicine’s chief innovation officer, explains, EMRs were not designed to collect or share data as part of population health management, which
FEATURE
makes it difficult for multidisciplinary care teams to collaborate and deliver streamlined care. “There’s great value in having EMRs as an organized, single point of health history, but it’s still too hard to get information in or out of them,” says Rosin. “One of the things we’re working on is developing flexible systems that will allow us to capture information and share it directly with the team making the decisions about a patient’s care.” First introduced to Penn Medicine late last year, Carelign (formerly known as Connexus) uses the latest advancements in technology to take clinical data to a new level. The “web app,” created by Information Services in partnership with the Office of the Chief Medical Information Officer and the Center for Health Care Innovation, provides real-time patient information in a mobile-friendly view. According to Hanson, “The site frees the provider from the need to log onto a computer or depend on out-of-date information from printouts produced hours earlier.” Carelign also presents the data in a format that “we as clinicians need to make medical decisions,” says Subha Airan-Javia, M.D., G.M.E. ’07, of Internal Medicine, who worked with Glenn Fala, senior director for Software Development, and the Information Services team to create the application. “I can easily see trends, such as a sudden spike in a value.” And, as she told Technically Philly last year, it’s 22 times faster to use the website on your phone than it is to log in to a computer! Carelign is a mobile web application, not an app, which means there is nothing to download. It is essentially a mobile-friendly web page that can be accessed from any mobile device that is connected to the Health System’s network. That connection ensures that the patient’s protected information displayed is secured behind the UPHS firewall. “We’re in the process of deploying smartphones to all clinical care faculty and staff across the health system, making it an essential part of the medical toolkit, analogous to a stethoscope,” says Hanson. He adds that via Carelign, providers will now be able to securely access patient data from anywhere. Providers can view a variety of clinical information on Carelign, including up-to-date vital signs, labs, radiology studies, and medical history reports. But its use goes well beyond just accessing EMR data. According to Airan-Javia, one of its best features is the ability to quickly find the names of each member of a patient’s care-provider team and to keep every-
one is in the loop, sharing information and up-to-date on evolving care situations. Carelign maps out the names of the patient’s attending physician, primary intern, covering intern, and nurse, as well as any other specialty services that are involved in the patient’s care. Even better: the clinician can click on any name on the list to immediately call or e-mail. Carelign has already impressed outsiders. In December, while still known as Connexus, it received a Fierce Innovation Award in the category of Clinical Information Management. “There’s a massive inefficiency in health care right now,” says Hanson. “Patients often need to go from one venue to the next, having tests repeated because information can’t be transferred efficiently. A lot of the money we spend on health care goes toward the administrative burden of getting records, information, etc. What we’re working on is essentially providing zone coverage.” If a patient needs to see different doctors, he notes, their information must be available. “Health care IT has the potential to address a lot of that.”
Unlimited Opportunities
It’s no surprise that Carelign is one of many endeavors Fala and his team are tackling. Over the past 15 years they have created more than 75 apps. The role of technology in health care clearly goes beyond apps and smartphones. Teams across the health system are working on a range of innovations. Sensor technology, such as sensors embedded in “smart” pill bottles to stream data on medication compliance and enable new high-impact interventions, is already showing great promise in improving health care efficiency and patient outcomes. In addition, as Rosin points out, new technology can limit the inevitable bias that has always been a problem in surveys of patients: “There’s a great value in subjective questions – what kind of pain they are experiencing, or what they are worried about.” But sensors, for example, are able to register patients’ compliance with taking medications, their activity, or their daily weights accurately and without requiring them to expend any additional effort. Researchers are also taking predictive software systems – similar to those used by Netflix and Amazon to suggest movies or books a user might enjoy – and integrating it in the doctor’s office. Once in place, these systems will allow care providers to better assess patients at risk for various conditions based on their current health as compared to similar populations. Regardless of the modality, it’s clear that technology is giving the health-care industry a much-needed upgrade. And the process will not slow down any time soon. As Hanson emphasizes, “Genomics will be transformative.” With the new and more precise information, textbooks will be rewritten. Today, he continues, we use terms like “heart failure,” which is a broad way of characterizing medical conditions. In the future, “we’ll be able to be even more precise, using genomics to understand what causes cancer, etc., to be able to intervene much earlier. You need health-care IT and computers to do anything with genomics because the information is massive.” Advances in computer science and genomics: in Hanson’s view, “all interwoven.” SUMMER 2015
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I. S. RAVDIN: LARGER –
AND SMALLER –
THAN LIFE By John Shea
P
enn Medicine’s legendary I. S. Ravdin, M.D. (1894-1972) had a very full and remarkable career. After earning his medical degree from Penn in 1918, he rose to become the first chair of the Harrison Department of Surgical Research and later the chair of the Department of Surgery; served as chief administrator of the 20th General Hospital in Assam, India, during World War II and was eventually promoted to major general; and was part of a team that performed a bypass procedure on President Dwight Eisenhower. In fact, in a slide presentation, Clyde F. Barker, M.D., G.M.E. ’59, one of Ravdin’s successors as chair of Surgery, has gone so far as to describe him as a “cult figure.” One suspects tongue was partially in cheek, but Barker illustrated his presentation and an earlier article in the Penn Surgery Society News (Fall 2013) with photographs of Ravdin in the company of President Eisenhower, President Lyndon Johnson and Lady Bird Johnson, Pope Pius XII, Gregory Peck, Noel Coward, 30
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and General Vinegar Joe Stillwell, Commander of the American Forces in the China-Burma-India Theater. But the number of famous and respected physicians who have been celebrated in the daily comics must be very few – indeed, Ravdin may be the only one! In October 1957, Steve Canyon, the nationally syndicated comic strip featuring the easygoing pilot-adventurer, ran a story line involving young Poteet Canyon, Steve’s ward, who is both an orphan and a cousin. Having fainted at a party, she is brought to “University Hospital”
where the unnamed doctor, referred to as “The Man” by his staff, takes charge of her care. Using not his surgical skills but his medical training and psychological insights, he makes a diagnosis. Says one staffer, “What’s such a big deal about anorexia nervosa? Can’t he order forced feeding and bring up her strength?” Replies the other: “Not ‘The Man’! That would be bush-league stuff to him!” The doctor mentions his wartime experience a couple of times. For example: “During the war my hospital was in a
Images courtesy of Archives of the University of Pennsylvania
miserable hut, but as long as the wounded kept coming, my experts worked as they would in a billion-dollar plant. . . .” Poteet is drawn to the doctor because of his directness, his concern, and his humanity. “I thought professors of medicine would be right gloomy – but you make me laugh!” To which the Ravdin figure replies: “Laughter is the greatest therapy! People – even whole nations – are in trouble if they lose their sense of humor!” What may surprise readers of a later generation or two is that the doctor is shown many times smoking a cigarette, even while walking down the hospital hall or in the patient’s room! But it was an age when doctors – or “doctors” – even appeared in advertisements. For example: “More doctors smoke Camels than any other cigarette.” Another campaign, for Lucky Strikes, claimed “20,679 physicians say ‘Luckies are less irritating’ ” – but whether these physicians personally smoked or examined patients who did is not clear.
"The Man" himself.
But how did I. S. Ravdin happen to find himself – or an obviously fictionalized version of himself – in Steve Canyon? Some readers of Ex-CBI Roundup, a magazine for and about those who
served in that theater during World War Two, wondered, and the magazine published a letter from someone who claimed to have “picked out the characteristic mannerisms of this University of Pennsylvania surgeon” in the comic strip (December 1957). In that same issue, the editor published a series of letters, starting with one from the artist and writer, Milton Caniff, who shared the others. As Caniff explained it, he was en route to Philadelphia to do a talk for the Boy Scouts “when a virus infection hit me suddenly and hard,” and he was rushed to HUP. “During this session I had the good fortune to get to know the doctor quite well and I was so moved by his fabulous personality, I resolved then and
there to portray him in the strip.” In this context, it is worth noting that Penn Medicine’s Master Clinician Award is named after Ravdin. It is also not clear whether Caniff was deliberately disguising the site of Poteet’s hospitalization. One of the larger Sunday strips – which ran in color – has a caption: “The head of the State University Medical School is called in on the case of the girl who will not eat . . .” The comic strip no doubt predates the anguished cry of later Penn students and alumni: “Not Penn State!” And perhaps Caniff decided to promote Ravdin along the way. As for “The Man,” Ravdin seemed to take his being turned into a comic strip character with good grace. In the letter Caniff forwarded to Ex-CBI Roundup, Ravdin wrote: “I had not realized that, during your convalescence, you were making a careful physical and psychological study of me. It has been so good that my fan mail has developed to such proportions that I have needed an extra secretary to answer it.”
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DEVELOPMENT MATTERS
250 Years Young, and Looking The 2015 Medical Alumni Weekend & the 250th Celebration Gala When people think of the future of medicine, they look to the students of Penn’s Perelman School: brilliant, driven, dedicated to solving the world’s greatest medical challenges. And more than ever before, Medical Alumni Weekend – featuring the School’s 250th celebration gala – was about supporting and celebrating those talented young minds. Recalling the School’s storied past constantly inspired a commitment to ensure its bright future . . . setting the stage for another 250 years of medical excellence.
HONORING A VISION FOR A TUITION-FREE MEDICAL SCHOOL . . .
Scholarships were in the spotlight – both at Medical Alumni Weekend and taking center stage at the Perelman School of Medicine’s 250th celebration gala. MAW 2015 kicked off with an evening reception celebrating the medical careers – and life-long friendships – that scholarship giving makes possible. “When the Perelman School of Medicine was founded 250 years ago, students were required to pay for tickets to a series of medical lectures,” explained Dean Larry Jameson. “So our first medical scholarships, created in 1821, consisted of professors donating those lecture tickets.” With medical school debt now topping $180,000, the collective power of alumni support has become more important than ever. As Dean Jameson told guests, “These funds have greater impact than you can imagine: They inspire our young physicians to ‘pay it forward,’ perpetuating the cycle of philanthropy.” That is exactly what Anne and Walter Gamble, M.D. ’57, hoped for when they publicly acknowledged having established 32
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to the Future:
the 21st Century Scholars Program – that fellow alumni and friends of Penn Medicine shared in their dream of a tuition-free Penn medical education. “We’ve always treasured our friendships with our students,” said Anne. “It’s a privilege to see them in their white coats or receiving their medical degrees at graduation, and we believe their stories are the most compelling proof of the importance of scholarships.”
After more than 20 years of giving, with more than 220 Gamble Scholars supported with $65 million, the Gambles’ generosity has been extraordinary. The Perelman School of Medicine bestowed its highest honor, the Dean’s Medal, to the remarkable couple during the spectacular 250th gala at the Philadelphia Museum of Art. “This award represents more than Penn Medicine’s deepest appreciation for all Anne and Walter have done for our students,” said Dean Jameson. “This medal also represents the love and gratitude from their wonderful extended family of students, as well as the countless patients and their families who will be forever impacted by their kindness.”
. . . AND CELEBRATING THE DAWN OF A NEW MEDICAL EDUCATION EXPERIENCE
One of the very special moments of Medical Alumni Weekend 2015 was the presentation of the Lifetime Achievement Award to the late Henry A. Jordan, M.D. ’62 – accepted by his wife, Barrie – and the opening of the Medical Education Center that bears his name. Hundreds of guests were able to see, firsthand, the new face of medical education at the Perelman School, more than a decade in planning and realization. They also fondly remembered one of the School’s most beloved alumni, Dr. Henry Jordan. Henry’s children and grandchildren shared in the festivities and surprised Barrie with the dedication of the Frog Hollow Lounge – named after the Jordan family farm. Jordan Scholar Tarik Asmerom, G.E.D. ’07, M.D ’15, was enthusiastic about the new opportunities the Jordan Center has already made possible. “Simply by having gathering spaces SUMMER 2015
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DEVELOPMENT MATTERS just outside our classrooms, I’ve seen and talked more with my classmates in the past few months than I have in all my previous years of medical school. The Jordan Medical Education Center is such a wonderful gift to us.” The celebratory luncheon included mini ribbon-cuttings for the many generously named spaces throughout the Center, and guests were also able to visit the Joseph and Loretta Law Auditorium and Law Pavilion. You can make a virtual visit to the Jordan Center on YouTube at https://youtu.be/KILnGqcX5vE.
2
WHEN THE STARS CAME OUT FOR THE PERELMAN SCHOOL’S 250TH
The Perelman School of Medicine was the proud host of a once-in-a-lifetime event at the Philadelphia Museum of Art – the focal point of so many of Philadelphia’s landmark celebrations. More than 1,200 guests enjoyed a lovely evening featuring Penn alumna and emcee Andrea Mitchell, the chief foreign affairs correspondent for NBC News, and musical entertainment from the multi-talented Harry Connick Jr. Fireworks lit up the sky over the largest tent ever erected on the famous steps. The focus of the evening was always toward the future: of the Perelman School of Medicine, its students, and the health of the nation. Proceeds from the gala are supporting medical scholarships. 1
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3
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1. Penn President Amy Gutmann with Raymond Perelman 2. City of Philadelphia Mayor Michael Nutter 3. Headline performer Harry Connick Jr. 4. Dr. Walter and Anne Gamble 5. Drs. Arthur Rubenstein and Peter Quinn 6. Department Chair George Cotsarelis, M.D. ’87, G.M.E. ’92, with fellow Dermatology faculty 7. Emcee and Penn alumna Andrea Mitchell 8. Benjamin Franklin with School of Medicine Founder Dr. John Morgan (as played by Howard Eisen, M.D. ’81) 4 7
5 7
8
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PROGRESS NOTES Send your progress notes and photos to: Donor Relations Penn Medicine Development and Alumni Relations 3535 Market Street, Suite 750 Philadelphia, PA 19104-3309 PennMedicine@alumni.upenn.edu
1980s Michael H. Levy, M.D., Ph.D., G.M.E. ’81, a professor and director of the Pain and Palliative Care Program at Fox Chase Cancer Center, has received the Lifetime
Achievement Award from the American Academy of Hospice and Palliative Medicine. Levy taught the first death and dying class at Jefferson Medical College, where he earned his medical degree. He was a senior resident in internal medicine and a fellow in medical oncology at HUP, where he helped form a palliative care service. In 1983, he was elected to the board of directors of the National Hospice Organization and since then has served as its treasurer and vice chairman. Levy was awarded the organization’s Person of the Year Award and its Heart of Hospice Clinician Award in 2003. Levy has also been president of the American Academy of Hospice and Palliative Medicine and chairs the Palliative Care Guideline Panel of the National Comprehensive Cancer Network. In 2014, he received the inaugural Excellence in Teaching Award from the American Society for Clinical Oncology.
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1990s Anne Rentoumis Cappola, M.D. ’94, Sc.M., associate professor in Penn’s Division of Endocrinology, Diabetes, and Metabolism in the Department of Medicine, was named co-director of Penn’s Clinical and Translational Research Center. She trained in internal medicine at Brigham and Women’s Hospital and in endocrinology at Massachusetts General Hospital and the Johns Hopkins Hospital. She joined the Division of Endocrinology, Diabetes, and Metabolism at Penn in 2003. Cappola is recognized as a leader in translational research at the intersection of endocrinology and geriatrics, combining population-based and mechanistic research studies to identify the hormonal underpinnings of human aging. Her scientific contributions have led to changes in treatment recommendations for thyroid disorders in older indi-
viduals. She has also pioneered studies in human subjects that seek to determine the role of endocrine abnormalities in age-associated frailty. She is an associate editor for the Journal of the American Medical Association.
2000s Dzung X. Vo, M.D. ’04, is a pediatrician specializing in adolescent medicine at British Columbia Children’s Hospital and a clinical assistant professor at the University of British Columbia in Vancouver. His medical practice,
and a visiting assistant professor of psychology at Haverford College, he formerly worked at Penn’s Center for the Treatment and Study of Anxiety.
OBITUARIES
1940s teaching, and research emphasize promoting resilience in young people to help them thrive in the face of stress and adversity. In partnership with Jake Locke, M.D., he developed MARS-A (Mindful Awareness and Resilience Skills for Adolescents), an eight-week mindfulness training program for adolescents with depressive symptoms, with or without chronic illness or chronic pain. In April, Vo’s book, The Mindful Teen: Powerful Skills to Help You Handle Stress One Moment at a Time, was issued by New Harbinger Publications. A student of Thich Nhat Hauh, a Zen Master, poet, scholar, and activist, Vo has noted that “my mindfulness training and practice has helped me to get through some difficult and intense periods in my own medical training and in my life.” Today, when teens are often overwhelmed with stress from school and families, Vo believes mindfulness can give them a tool to stop their habitual automatic reactions and rediscover their inner strength and resilience. Seth J. Gillihan, Ph.D. ’08, whose clinical practice is located in Haverford, Pa., is coauthor of Overcoming OCD: A Journey to Recovery, issued earlier this year by Rowman & Littlefield Publishers. Janet Singer recounts a mother’s moving quest to help her son recover from obsessive-compulsive disorder, and Gillihan provides expert commentary throughout. Gillihan specializes in cognitive-behavioral treatment for anxiety and depression and related conditions. A clinical assistant professor of psychology in Penn’s Department of Psychiatry
William W. Wilson, M.D. ’42, Wynnewood, Pa., a retired psychiatrist; April 27, 2014. After completing his residency in internal medicine at the U.S. Naval Hospital in Philadelphia in 1949, he taught neurology in Penn’s School of Medicine until 1958. He was the chief of neurology at Philadelphia General Hospital from 1949 until it closed in 1977. During World War II, he served as a Navy flight surgeon with the U.S. Navy in the Pacific, and received the Distinguished Flying Cross. Harry J. Fryer Jr., M.D. ’43, San Luis Obispo, Calif., a retired pediatrician who had maintained a practice there for 35 years; June 17, 2014. He had helped found Sierra Vista Hospital. During World War II, he served as a ship’s doctor in the Pacific. Bruce R. Marger, M.D. ’44, G.M. ’49, Allentown, Pa., former chief of medicine and cardiology at Sacred Heart Hospital in Norristown; April 18, 2014. During World War II, he served as a surgeon with the U.S. Army in Europe. A diplomat of the American College of Internal Medicine and a fellow in the American College of Cardiology, Marger had also been an attending physician/cardiologist at the Veterans Administration Clinic in Allentown. John E. Hopkins, M.D. ’46, Danville, Pa., a retired general surgeon at Lankenau Hospital who practiced there from 1950 to 1975; March 5, 2014. He served with the U.S. Army of Occupation in Japan with the Army Medical Corps. After his time at Lankenau, he worked in the emergency room at Memorial Hospital, Pottstown.
James R. Glessner Jr., M.D. ’47, Grand Rapids, Mich., a retired orthopaedic surgeon; May 1, 2014. He served in the U.S. Army during World War II and the Korean War, earning the Army’s Bronze Star medal as a captain in the Medical Corps. Elected to the Alpha Omega Alpha society at Penn, he did his orthopaedic residency at The Henry Ford Hospital in Detroit. He founded a Grand Rapids orthopaedic group that has evolved into River Valley Orthopedics. Lee H. Miller, M.D. ’47, Kingsport, Tenn., retired staff physician for Eastman Kodak; May 15, 2014. A veteran of the U.S. Army, he also had been employed by Bell Telephone, the University of Cincinnati College of Medicine, and Procter & Gamble. Robert Gilmore Pontius, M.D. ’47, G.M.E. ’54, Worcester, Mass., a retired heart surgeon in Pittsburgh; April 12, 2014. During World War II, he served in the Navy and participated in the Navy’s V-12 officer training program, attending Swarthmore College and Penn’s School of Medicine. He later served in Korea. Pontius did his surgical training at Baylor College of Medicine in Houston, where he worked with Michael Debakey and Denton Cooley, two surgeons and professional rivals who would become household names in the post-war field of heart surgery. At Harvard Medical School, Pontius trained under his uncle, Robert Gross of Children’s Hospital in Boston, another legend. A year after coming to Children’s Hospital of Pittsburgh in 1957 to be a pediatric cardiothoracic surgeon, Pontius performed the first successful open-heart operation using a pump-oxygenator, a new machine that did the work of both the heart and the lungs. Erwin A. Cohen, M.D. ’48, Huntingdon Valley, Pa., a retired surgeon; April 9, 2014. He was a veteran of the Korean War and attained the rank of captain in the U.S. Army.
Ralph E. Faucett, M.D., G.M. ’48, San Diego, a retired Navy physician; January 17, 2014. He served as a surgeon during the height of World War II. He crossed the South Pacific during some of the most intense fighting of the war, caring for soldiers throughout the Mariana Islands and Okinawa campaigns as well as during the postwar occupation of Japan. Faucett returned to Japan in 1962, serving as the chief of medicine for the naval hospital in Yokosuka. Later, he was named director of submarine medicine at the U.S. Naval Medical Research Laboratory. He retired from active duty in 1974 with the rank of rear admiral, having been in command of multiple naval hospitals throughout the country. After retiring, he was a consultant to the California Department of Health. Through his estate, he has provided more than $3 million to Indiana University School of Medicine, where he earned his medical degree, for a scholarship to support future generations of I.U. medical students. Robert W. Gibson, M.D. ’48, G.M.E. ’52, Parkton, Md., former president of the Sheppard & Enoch Pratt Hospital; March 8, 2014. He was instrumental in ending the hospital’s bankruptcy and overseeing desegregation of its facilities. A former president of the American Psychiatric Association, he published “Strategic Planning and Marketing of Mental Health Services” in Psychiatric Annals (December 1984). Robert E. Murto, M.D. ’48, G.M. ’50, Vero Beach, Fla., a retired ophthalmologist; March 20, 2014. During the Korean War, he served in a MASH unit with the 1st Marine Division. He was an early proponent of the intraocular lens. Karl F. Rugart Jr., M.D. ’48, G.M.E. ’52, Haverford, Pa., a retired obstetrician-gynecologist, affiliated with Pennsylvania Hospital, who had practiced from 1948 until 1998; April 30, 2014. A former associate professor at Penn, he has also worked at Booth Maternity Center in Overbrook until it closed in 1989 and at the former Pennsylvania Hospital In-
stitute, the Philadelphia Women’s Penitentiary, Graduate Hospital, and Presbyterian Hospital. Rugart claimed to have delivered nearly 7,000 babies during 50 years on the job. Early in his career, he was a Navy doctor at Fort Knox, Ky., and the Philadelphia Naval Hospital before being assigned to Lakehurst Naval Hospital in 1949. In 1954, he was decommissioned and joined Pennsylvania Hospital’s medical staff.
Medical Center and Crossville Medical Group and later served as medical director of the Life Care nursing home.
Jack J. Albom, M.D., G.M. ’49, New Haven, Conn., a retired dermatologist and former professor of medicine at Yale University; November 12, 2012. He was also a retired Army Air Force colonel. Upon retiring to Florida, he became a consultant of Dermatology at the VA Hospital in Pompano Beach.
Kenneth V. Dole, M.D. ’52, Palo Alto, Calif., a retired physician who maintained a practice there for many years; March 24, 2014.
Philip N. Sawyer, M.D. ’49, G.M.E. ’55, Brooklyn, N.Y., former chair of vascular surgery at Downstate Medical Center; April 4, 2014. He was founding editor of the Journal of Investigative Surgery. He served in the U.S. Navy during World War II and the Korean War.
1950s John Bono, M.D., G.M. ’50, Kittanning, Pa., a retired otorhinolaryngologist; April 4, 2014. He served in the U.S. Army until attending medical school at the University of Pittsburgh 19441948. He set up practice in Kittanning in 1952 and practiced 1952-1994, with a return to military service at Wright-Patterson Air Force Base in Dayton, Ohio, 1955-56. Earl Budin, M.D. ’50, Santa Barbara, Calif., a retired associate clinical professor of radiology at the UCLA Medical Center; January 13, 2014. Philip M. Deatherage, M.D. ’51, Crossville, Tenn., a retired general surgeon; February 28, 2014. He served with the U.S. Navy during the Vietnam War. He had been chief surgical resident at Allentown Hospital. After his private practice from 1958 to 1974, he practiced with Cumberland
Anthony J. Oropallo, M.D., G.M. ’51, Barrington, N.J., a retired ophthalmologist; February 20, 2014. Named Barrington Borough’s Citizen of the Year in 1973, he had also been a longtime member of the Barrington Fire Company.
L. Mario Garcia, M.D., G.M. ’52, Clermont, Fla., a retired surgeon who had practiced in Delaware for many years; July 29, 2012. Edwin J. Levy, M.D., G.M.E. ’52, Wynnewood, Pa., February 20, 2013. In addition to his private practice, he was a clinical professor of dermatology at the University of Pennsylvania. Harry W. Schoenberg, M.D. ’52, G.M.E. ’56, Sedona, Ariz., retired head of urology at the University of Chicago Pritzker School of Medicine, 1976-1993; November 19, 2013. He served two years in the U.S. Army in Germany following World War II. After completing his residency training at Penn, he joined its urology faculty. He served as chair of the Department of Urology at the University of St. Louis for four years before joining the University of Chicago. A former Sedona Citizen of the Year, he had also been chairman of the board of the Sedona Medical Center. David S. Masland, M.D., G.M. ’53, Carlisle, Pa., a retired physician who had maintained a practice there for many years; April 2, 2014. He was a veteran of the Korean War. In 1976, he was president of the Pennsylvania Medical Society. He had been a board member of the Central Pennsylvania Conservancy. Robert A. Wingerd, M.D. ’53, G.M.E. ’57, Chambersburg, Pa., a retired family practitioner; May 4, 2014.
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OBITUARIES Willard Aronson, M.D. ’54, Atlanta, a retired pathologist who had maintained a practice in Oklahoma City from 1972 to 1997; November 19, 2013. During World War II, he served as a pathologist with the U.S. Army in
Gerald M. Edelman, M.D. ’54, Ph.D., La Jolla, Calif.; May 17, 2014. Widely recognized as a father of modern immunology, he was a co-recipient of the Nobel Prize for Physiology or Medicine in 1972 for his early studies on the structure and diversity of antibodies. As a boy, Edelman studied violin and considered a career in music before graduating from Ursinus College with a B.A. degree in chemistry. After earning his medical degree, he spent a year at Penn’s Johnson Foundation for Medical Physics, followed by training at the Massachusetts General Hospital. He then served as a captain in the Army Medical Corps in Paris. He earned his Ph.D. degree at the Rockefeller Institute in 1960, where he spent many years, becoming the Vincent Astor Professor and founding director of the Neurosciences Institute. In 1992, Edelman moved to the Scripps Research Institute in La Jolla. After his work with antibodies, Edelman and his laboratory group focused on elucidating the role of cell adhesion molecules, proteins that connect cells to one another and to substrates during development. According to the late Leif H. Finkel, M.D. ’81, Ph.D. ’85, professor of bioengineering at Penn, Edelman’s discoveries in the lab “reshaped the field of developmental biology.”
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Europe. He was a clinical associate professor of pathology from 1997 to 2010 at the University of Oklahoma and received an award for teaching excellence. He was a fellow of the College of American Pathologists.
In a profile in Penn Medicine, Edelman described his work after receiving the Nobel Prize: “to try to understand morphologic evolution, to try to understand how genes work in an epigenetic world, and to try to understand how the most remarkable product of evolution, the brain, gives rise to the most remarkable property, consciousness” (Fall 1990). He rejected the prevalent notion that the best model for the brain was a computer – that is, hard-wired for certain capacities. Instead, he argued that it is shaped over time through experiences that strengthen neuronal connections. Edelman’s later writings – including books for general audiences – drew sharply opposing reviews from neuroscientists. The Remembered Present (1990) advanced a completely formulated biologically based theory of consciousness. His most recent book was Second Nature: Brains Science and Human Knowledge (2006). In addition to receiving the Nobel Prize, Edelman was elected to the National Academy of Sciences, the American Philosophical Society, and the Academy of Sciences, Institute of France. In 1973, the University of Pennsylvania awarded him an honorary degree; and in 1990, he was honored with the Distinguished Graduate Award of Penn’s School of Medicine.
Robert L. Perneski, M.D. ’54, G.M.E. ’64, St. Marys, Pa., a retired orthopaedic surgeon who had worked at Elk Regional Health Center for many years; May 5, 2014. He served in the U.S. Army during World War II. He was a former president of the Elk County Medical Society. Robert F. Crawford, M.D., G.M.E. ’55, Thomasville, Ga., a retired pediatrician; April 28, 2014. A former president of the Maricopa Medical Society and of the Arizona Pediatric Society, he also had served as a director of the Maricopa County Medical Society and as vice president of the Maricopa Foundation for Medical Care. He had been chair of pediatrics at Good Samaritan Hospital and at St. Joseph’s Hospital and Medical Center. Myint Myint Khin, M.D., G.M. ’55, Rangoon, Myanmar (Burma), former chair of the Department of Medicine at the Institute of Medicine in Mandalay; June 19, 2014. As an undergraduate at the University of Rangoon, she studied English language and literature, then pursued medicine at the same university. Her first posting was as civil assistant surgeon at Rangoon General Hospital. In 1953, she married San Baw, M.D., G.M. ’58, who would become chief of orthopaedic surgery at Mandalay General Hospital. After her time at Penn’s Graduate School of Medicine, Khin also trained at the Royal College of Physicians, Edinburgh. During the 1980s, she was a consultant in the World Health Organization’s Southeast Asia regional office in New Delhi, India, where she spent nearly seven years. After her return to Burma in 1992, she remained active until her death and was respectfully addressed as “Mummy Gyi,” or “our elder mummy.” According to a former colleague, she “built the strongest department of medicine in Burma, which produced hundreds and thousands of doctors meeting the international standard.” In addition, Myint Myint Khin did not hesitate to voice her opinions – including criticisms of the Burmese governments. In March 2013, her
book of collected poems written in English, Poetry For Me, was unveiled at a ceremony at the Myanmar Medical Association in Rangoon, Burma. Francis A. White, M.D., G.M. ’56, Worcester, Mass., retired chief of radiology at Worcester City Hospital and other hospitals in Worcester County; April 29, 2014. Richard D. Brobyn, M.D. ’57, Ph.D., G.M. ’61, Birch Bay, Wash., a retired clinical pharmacologist; March 19, 2014. During five years of active duty with the U.S. Navy, he worked in decompression and mixed gases. He then went on to spend 25 years in the Navy Reserves. Much of his medical career involved doing clinical trials and drug research. William Anthony Grattan, M.D., G.M.E. ’57, Troy, N.Y., a retired pediatrician; February 15, 2014. He had been a chief resident at the Children’s Hospital of Philadelphia. A former senior vice president for medical affairs at Seton Health System, he was appointed Albany County Health Commissioner in 1981 and served in that position for more than a decade. During his tenure at the health department he was a leader in developing smoking cessation programs and worked to abate lead paint in buildings throughout the county. He was appointed by the first Governor Cuomo as a member of the Maternal Child Block Grant Advisory Board, a group of physicians charged with allocating millions
LEGACY GIVING to programs for mothers and children across the state. His honors include the Dr. Hermann M. Biggs Memorial Award from the New York State Public Health Association and the New York State Association of County Health Officials Career Achievement Award in 2006.
1960s Chote Thumasathit, M.D., G.M. ’61, McKinney, Tex., a retired family practitioner; July 15, 2012. His wife is Bhoonsri Sathirapatya, M.D., G.M ’63. Nicholas J. Vincent, M.D. ’61, Santa Barbara, Calif., a retired ophthalmologist who had maintained a practice there for 31 years; February 24, 2014. He had been a counselor of the American Academy of Ophthalmology. Merrill N. Werblun, M.D. ’61, Henderson, Nev., a retired physician; October 26, 2013. He completed his training at Abington Memorial Hospital. After spending 10 years practicing rural medicine, he began a career in academia and administration. He was a professor of family medicine in the University of California system and at the University of Hawaii. At Queens Medical Center in Honolulu, Werblun was vice president of medical services. He was founding president of the Hawaii Center Credentialing Service and served as a physician surveyor for the Healthcare Facilities Accreditation Program. Rudolph J. Scrimenti, M.D., G.M. ’62, Mequon, Wis., a retired dermatologist; March 22, 2013. He had been a lecturer at the Medical College of Wisconsin. Ira B. Silverstein, M.D. ’64, Laguna Beach, Calif., a retired psychiatrist; October 9, 2013. He did an internship in medicine at Yale and completed a psychiatric residency at Columbia-Presbyterian Medical Center, where he was chief resident. After spending two years in the Air Force in Japan, in 1970 he returned to Man-
hattan, where he entered private practice in psychiatry and taught at Columbia University. In 1988, he relocated to South Orange County, Calif., continuing his private practice, teaching at University of California-Irvine, and attending at various hospitals. Kenneth C. Bovée, D.V.M., G.M.E. ’69, Stonington, Maine, emeritus professor of medicine and the first recipient of the Corinne R. and Henry Bowen Professorship in Medicine at Penn’s School of Veterinary Medicine; May 23, 2014. He joined the faculty as an assistant professor in 1964. He was chief of the section of medicine for 16 years and chair of the Department of Clinical Studies for six years, during the construction of and move (1981) into the new small animal hospital, now the Ryan Veterinary Hospital. Bovée was awarded the Ralston Purina Small Animal Research Award (1980), and he wrote Canine Nephrology (1984). Evelyn Wiener, M.D., G.M.E. ’00, Elkins Park, Pa., executive director of Penn’s Student Health Service; May 8, 2014. Earlier, she was an attending physician at Temple Hospital 1980-1987 and then at Penn Medicine, where she also taught. She was appointed associate director of Student Health in 1989 and became executive director in 2000. A recipient of the American College Health Association’s lifetime achievement award, Wiener was a former president of the Mid-Atlantic College Health Association.
FACULTY Kenneth C. Bovée. See Class of 1969. Karl F. Rugart Jr., M.D. See Class of 1948. Evelyn Wiener, M.D. See Class of 2000. William W. Wilson, M.D. See Class of 1942.
Annuities: A “Win-Win” to Support Tomorrow’s Leaders
Richard R. Bocchini, Ph.D., has served at Pennsylvania Hospital for 40 years, and from his dedication to this institution grew the desire to set up a planned gift benefiting the Psychology Internship Program. “I’ve personally seen how the knowledge and experience our students gain from the Psychology Internship Program is invaluable,” said Dr. Bocchini, who was the first director of Children and Family Services established at the Hall-Mercer Center on behalf of Pennsylvania Hospital’s Community Mental Health Program. “The in-depth training and supervision which they receive prepares them to become tomorrow’s leaders.” Over the 30-year history of the Psychology Internship Program, graduates have achieved the highest success across the field of mental health, obtaining clinical and leadership positions in top universities, medical schools, social and community agencies, and private practice. The program has achieved national recognition and has been approved by the American Psychological Association. Students compete to enter the program: fewer than 3% of approximately 200 applicants are accepted. The year-long program of intensive training and education traditionally serves as the final year of the doctoral graduate program and as an opportunity for postdoctoral graduates to develop the knowledge required for state licensure as a psychologist. Dr. Bocchini’s gift to support the program is a reflection of his professional interest in supporting psychologists early in their careers. He worked with the development office to set up a Charitable Gift Annuity. This option allows you to make a gift in exchange for an income tax deduction and life-long, guaranteed annuity payments. “This Charitable Gift Annuity is a win-win,” said Dr. Bocchini. “My gift guarantees some tax-free income for me, and I have the satisfaction of knowing that it will later benefit students by helping support their development as professional psychologists.” As you plan your financial future, the Office of Planned Giving is ready to assist in developing an appropriate strategy to incorporate your charitable objectives. Contact Christine S. Ewan, J.D., Executive Director of Planned Giving, at 215-898-9486 or cewan@upenn.edu.
For more information, please visit the website at: www.plannedgiving.med.upenn.edu. SUMMER 2015
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EDITOR’S NOTE
The Enduring Presence of Dr. Morgan Photo: Daniel Burke
The main festivities surrounding the 250th anniversary of the founding of the Perelman School of Medicine took place during Medical Alumni Weekend in mid-May. The celebratory year, however, continues for a few more months. In this issue, you’ll find an overview of some of the MAW events and plenty of photographs of alumni, families, faculty members, administrators, and a few celebrities. Our back cover shows the glorious fireworks display over the Philadelphia Museum of Art, where some 1,200 supporters of the Perelman School attended the birthday gala. All in all, it was a time to honor the past and commit to keeping the Perelman School one of the world’s greatest. But I began to notice the presence of a certain historical figure who was threatening to make this issue his own: John Morgan, M.D., whose vision was most responsible for the founding of our medical school. In “Founders . . . and Feuders,” Dr. Morgan is front and center. In fact, Graham Perry, the designer of Penn Medicine, neatly captured some of Morgan’s occasionally pugnacious personality by placing him squarely in a boxing ring. His opponent: the second professor of the medical school, William Shippen Jr., M.D., who perhaps would be able to use his expertise in anatomy to inflict telling blows. The one-time schoolmates at the Rev. Dr. Samuel Finley’s West Nottingham Academy had shared ideas for the founding of a medical school in Philadelphia. But later Shippen came to believe that he had been left out of the loop. Morgan reappears in the overview of Medical Alumni Weekend, being one of the topics of a historical panel. Three representatives of institutions and cities where Morgan studied or visited during his stay in Europe provided historical background and suggested how Morgan’s experiences helped shape his vision of a medical school in Philadelphia. Victor A. Ferrari, M.D. ’86, the moderator of the panel, cited Morgan’s remarkable intellectual curiosity, but he also called him “brilliant but flawed,” his stature eventually diminished by an interplay of hubris, politics, and jealousy.
From left: “Benjamin Franklin,” Penn President Amy Gutmann, “John Morgan,” and Dean J. Larry Jameson.
And that’s where I thought the Morgan presence ended – but I was wrong. Who do I glimpse helping to carry the Perelman School’s banner during a parade of alumni on campus (p. 20)? That three-cornered hat, that 18th-century jacket . . . it was indeed Dr. Morgan, or at least a John Morgan impersonator! And who do I find standing proudly beside the familiar figure of Ben Franklin later (p. 35)? Indeed, Dr. Morgan again, haunting the issue! As we take our leave, here is one last view: Morgan and Franklin in the presence of two other influential Philadelphians.
In the Fall Issue: One of the most important concerns for academic
medicine today is potential conflict of interest in its dealings with corporations. A recent conference sponsored by Penn’s Institute for Translational Medicine and Therapeutics examined several of the issues involved. Also, a profile of alumnus Robert Wachter, who has been named one of the 50 most influential physicians in the United States by Modern Healthcare. 40
PENN MEDICINE
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ONE LAST THOUGHT
Discovering
the Art in Science 2
3
1
A
s the winning entries in the 2015 “Art in Science” competition again demonstrate, Penn Med’s graduate students and postdoctoral trainees often keep an eye open for the elegant design, the engaging combination of shapes and colors, the arresting image. In the Postdoctoral Fellow Category, the winner is Rebekah S. Decker, Ph.D., in the laboratory of Maurizio Pacifici, Ph.D., director of orthopaedic research at The Children’s Hospital of Philadelphia. Decker’s image (1) is “Progenitor cells in the developing mouse synovial joint.” Two shared the top honor in the Graduate Student Category. Jonathan Madara is in the lab of Bruce D.
Freedman, V.M.D., Ph.D., associate professor in Penn’s School of Veterinary Medicine and a member of the faculty of the Perelman School’s Biomedical Graduate Studies program. Madara’s image (2) is “Ebola virus-like particle budding,” done in collaboration with Ronald A. Harty, Ph.D., professor of pathobiology and microbiology, and Gordon Ruthel, a resource technologist, both in the Veterinary Medicine school. The other graduate student winner is John Martin, M.S., in the lab of Robert Mauck, Ph.D., associate professor of orthopaedic surgery. Martin’s image (3) is “Stem-cell seeded engineered intervertebral disc in polarized light.” SUMMER 2015
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The celebration of the Perelman School of Medicine’s 250th birthday culminated in a gala at the Philadelphia Museum of Art.