FALL 2015

QUESTIONSABOUT...

Robert Wachter, Champion of Quality and Patient Safety

What Drew Them to Medicine? Members of the Class of 2019 Explain

THE PREP

Principles, Service, and Satisfaction

Each year at the White Coat Ceremony, a faculty

member who exemplifies the humanistic physician is

selected to speak to the incoming class. This year, it

was Jack Ludmir, M.D., G.M.E. ’87. Ludmir is chair of

Obstetrics and Gynecology at Pennsylvania Hospital.

An expert in maternal-fetal medicine, he has been

honored for his strong advocacy for assuring that the

underserved and uninsured receive maternal care. He

is one of the founders of Puentes de Salud and Latina

Clinic Health Services.

Ludmir began his talk by noting that medicine “is the

greatest profession and career choice in the world.” He

proceeded to share the principles that helped him to

have a more fulfilling career. His first principle: To be a

doctor is to have a privilege – use it well. Talk to your

patients, get their stories. Always keep in mind the way

you would want to be treated if you were a patient.

2. This profession is not about us but about our

patients. It is important to find a niche and to promote

yourself through research and scholarship. But remember

you’re starting this journey not to fulfill your professional

development but to make a difference in the well-being

of another person.

3. Intellectual curiosity and pursuit of new

knowledge. Don’t take dogma and repetition as the only

truth. Ludmir gave an example from his own career. For

many years, he prescribed absolute bed rest to pregnant

patients to decrease the risk of premature birth. But

recent randomized clinical trials have shown that bed rest

actually increases the risk.

4. Fight health inequalities and advocate for your

patients. Lack of access to health care and mental care

continues to be a problem, even in Philadelphia. Try to

understand the important role that the social

determinants of health play. You can fight for the just

thing – health for all regardless of the ability to pay or

legal status.

5. You are human and you will make mistakes. You

are here to learn and accept that medicine is not a

perfect science; sometimes adverse outcomes will occur

even with the best treatments. Don’t shy away from

them; instead learn, discuss, disclose.

6. Finally, resilience and perseverance. Find your own

way to constantly reinvigorate yourself, whether it’s family,

sports, arts, hobbies, etc. Remember that you can make

a difference in the life of a human being.

Photo by Daniel Burke

DEPARTMENTSTHE PREP Principles, Service, and Satisfaction VITAL SIGNSThe Physics of Cancer DEVELOPMENT MATTERSHonoring One of the Nation’s Greatest Cancer Pioneers ALUMNI NEWS Progress Notes and Obituaries EDITOR’S NOTECTE and Fracking: Back in the News ONE LAST THOUGHTZion Harvey Tests His Hands

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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/

FALL 2015 / VOLUME XXVI NUMBER 3

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8 Fracking and Public Health: Finding the Best Balance By Mark WolvertonThe experts in Penn’s Center of Excellence in Environmental Toxicology seek the facts that are essential for decisions that affect our environment. The center’s role is all the more important when there is controversy.

14 An Illuminated Mind Offers “Mind Illuminated” By John SheaGreg Dunn, a Penn Med Ph.D., combines his neuroscience training with his creativity and skill to create distinctive works of art. And he continues to experiment, taking his art in new directions.

17 Restoring Function . . . and Quality of Life By Sally Sapega and John Shea

American cancer survivors now number 14 million. Mously Le Blanc, M.D. ’06, has found a niche providing care for the late side effects of the therapies that cured them.

20 Welcome to Wachter’s World | By Marshall LedgerBob Wachter, a recent recipient of the Distinguished Graduate Award, is a professor, a hospitalist, an author, a blogger, a ruminator, an occasional performer . . . but his constant causes are quality and patient safety.

26 The Path to Penn Medicine | By John SheaAnother class of exceptional students has entered the medical school. Their experiences, college majors, and interests can vary greatly, despite their common urge to join the health professions. Here’s a look at some of these highly motivated young people.

33 In Equal Parts: Physician and Poet | By John SheaWilliam Carlos Williams, who distinguished himself in two very different fields, can be an inspiration for experienced physicians and medical students alike. His advice for both doctors and writers: deal in particulars.

STAFFJohn R. Shea, Ph.D.Editor

Graham P. Perry/NCS StudiosDesign / Art Direction

ADMINISTRATIONSusan E. PhillipsSenior Vice President forPublic Affairs

Holly Auer, M.B.E.Director of Communications

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PENN MEDICINE2

VITAL SIGNS

New Penn Center Will Investigate the Physics of Cancer

A five-year, $10 million grant award from the National In-stitutes of Health is supporting the creation of the Physical Sciences Oncology Center at Penn (PSOC@Penn). It is one of four centers the National Cancer Institute is funding across the country as part of its Physical Sciences in Oncology Net-work. The network was started in 2009 in recognition of the fact that perspectives rooted in physics, mathematics, chemis-try, and engineering can all contribute to cancer research.

Members of the Penn team will make fundamental physical measurements as they clarify mechanisms of how tumors be-come palpably distinct masses and also how such physical changes contribute to tumor growth. Their research will focus on liver cancer. More than 30,000 people in the United States

Lancaster General Health Joins Penn Medicine

Effective August 1, Lancaster General Health, Lancaster County’s largest health system, officially became part of Penn Medicine. The state and federal agencies concluded their re-view of the proposed deal. The combination joins one of the nation’s top academic medical centers with a health system that is nationally ranked for its clinical quality. Both are among the top five systems in Pennsylvania, as ranked by U.S. News & World Report.

“Joining the University of Pennsylvania Health System strengthens our region’s access to cost-effective, high-quality

care, will improve our communities’ health and well-being, and will strengthen our complementary teaching and research missions,” said Thomas E. Beeman, then serving as the presi-dent and CEO of LG Health.

Penn Medicine will provide for the health care needs of the LG Health community for as long as the system is affiliated with Penn Medicine. LG Health’s assets will continue to be used to advance the health and well-being of the LG Health community. Two of LGH’s 14 trustees will be selected by Penn Medicine and three LG Health trustees will join Penn Medicine’s board.

are diagnosed each year with liver cancer, according to the American Cancer Society, and the five-year survival rate is less than 15 percent. New methods to improve early detection and treatment of the disease are needed.

The Penn team is drawn from three University schools: the Perelman School of Medicine; the School of Engineering and Applied Science; and the School of Arts and Sciences. Head-ing the center is Dennis E. Discher, Ph.D., the Robert D. Bent Professor in SEAS. According to Discher, “A key challenge facing cancer research in this age of precision medicine is to deeply comprehend the molecular causes and consequences of tissue changes that are often first measured by clinicians in physical exams of tumors.”

Investigators representing the Perelman School are Rebecca G. Wells, M.D. (Medicine), Paul A. Janmey, Ph.D. (Physiol-ogy), Emma E. Furth, M.D. (Pathology), David E. Kaplan, M.D., MSc. ’07, (Gastroenterology & Immunology), Roger A. Greenberg, M.D., Ph.D. (Cancer Biology), and Mark A. Lem-mon, Ph.D. (Biochemistry and Biophysics).

“Many tumors are first detected as hard lumps of stiff tis-sue,” Wells said. “In some cases such as breast cancer, in-creased tissue stiffness appears to be a risk factor for cancer. Our research will focus on liver cancer because current clini-cal evidence suggests that liver stiffening may work in the same way, as a high-risk factor for developing that disease.”

The Center also aims to understand how the shape of the cell’s nucleus changes as part of a response to altered micro-environments. Whether and why such processes might also lead to damage of the DNA contained therein will be import-ant to quantify, because DNA damage is a likely cause of mu-tations that drive cancer.

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FALL 2015 3

Transitions

Thomas E. Beeman, Ph.D., formerly president and CEO of Lancaster General Health, was named the chief operating offi-cer of regional operations for Penn’s Health System. Jan Bergen succeeded him in both roles.

In his new role, Beeman will work closely with senior lead-ers of UPHS to guide its regional market and ambulatory strategy; facilitate system-wide integration across entities, starting with LG Health; and coordinate relationships with important partners across market regions. He will oversee LG Health and The Chester County Hospital and work closely

with Garry Scheib, the chief operating officer for Philadelphia operations. Beeman has more than 35 years of experience in health care and served as

HUP’s senior vice presi-dent for hospital opera-tions and executive direc-tor in the late 1990s.

Bergen has more than 30 years of experience in health care, including management of hospitals, ambulatory centers, and rehabilitation centers. In her 15 years as a leader at LG Health, she has been executive vice president and COO, as well as chief mission officer.

Frederic D. Bushman, Ph.D., a widely recognized leader in the fields of microbiology and gene therapy, was appointed chair of the Department of Microbiology. He holds a secondary appointment as a professor of pediatrics. Bushman was instru-mental in the formation of the Microbiome Program of Penn

and Children’s Hospital and serves as the pro-gram’s co-director. His early pioneering work in understanding how HIV reproduces by inserting its genetic material into the DNA of a host cell led to crucial advances in anti- retroviral therapy and gene-transfer technology. Today, many research projects in his lab utilize

deep-sequencing methods to investigate genetic mechanisms and DNA integration in human gene therapy. A fellow of both the American Academy of Microbiology and the American As-sociation for the Advancement of Science, Bushman received a Pioneer Award from Human Gene Therapy in 2014.

James M. Metz, M.D., G.M.E. ’00, the Morton M. Kligerman Professor of Radiation Oncology, was named chair of the Department of Radiation Oncology. Metz, who has served as interim chair since November 2014, has held a series of adminis-trative positions in the department, beginning in 2005 when he was ap-pointed director of clini-cal operations. Metz led the development of the Roberts Pro-ton Therapy Center and helped to establish it as one of the premier such centers in the world. He has been a pioneer in the use of online cancer survivorship plans and web-based cancer education and information. Metz was also the long-time editor-in-chief of OncoLink, the nationally recognized online source for cancer information, and now serves as its executive director.

Abramson Cancer Center ShinesThe Abramson Cancer Center has received an “exceptional” rating from the National Cancer Institute

during an extensive peer-review process for its five-year competitive research support grant. It is the highest rating possible for an NCI cancer center. The rating also signifies that Abramson’s status as a “comprehensive” center has been renewed. The designation means that the center demonstrates an added depth and breadth of multidisciplinary laboratory, clinical, and population-based research, as well as substantial transdisciplinary research that bridges these scientific areas.

“This is an exceptional cancer center and, importantly, one with a ‘soul’ and unmatched esprit de corps,” said Chi Van Dang, M.D., Ph.D., director of the center.

Since the last competitive renewal process in 2010, faculty physicians and researchers have amassed more than 5,000 cancer-related publications, and the center’s research initiatives have been buoyed by an increase in peer-reviewed funding from the NCI.

PENN MEDICINE4

VITAL SIGNS

“Wellcome” Support for Launching Biomedical Research Careers

Five researchers early in their careers have received fund-ing for five years from the Burroughs Wellcome Fund (BWF) for their excellence in biomedical research. Three are in the Perelman School: Rajan Jain, M.D., an instructor in the Department of Medicine; Matthew Stern Kayser, M.D. ’07, Ph.D., an assistant professor of psychiatry and neuro-science; and Rahul Manu Kohli, M.D., an assistant profes-sor of infectious diseases in the Department of Medicine.

Jain studies the mechanisms of genome organization and how that influences cardiac cell development and maturation in order to better understand heart disease. Specifically, he studies the protein network that surrounds the nucleus and how that is emerging as an important scaffold to organize large pieces of DNA that affect gene expression. Jain will receive $700,000 over five years.

Kayser studies the mechanisms by which sleep, a critical and highly conserved biological process, controls brain de-velopment. He aims to examine whether abnormal sleep early in life increases susceptibility to neurodevelopmental disorders and how sleep itself might be harnessed as a novel therapeutic modality. Kayser will receive $700,000.

Kohli studies new approaches to antibiotic-resistant bacteria. There is some evidence that when bacteria ex-perience stress, they can mutate at higher rates, which would facilitate their escape from antibiotics. Kohli plans to evaluate this possibility by generating bacteria strains to directly tune stress responses and determine how evo-lutionary dynamics are altered when the bacteria are challenged with antibiotics. Kohli will receive $500,000.

The other Penn researchers are Ann M. Hermundstad, Ph.D. a postdoctoral researcher in physics and astronomy in the School of Arts and Science, and Igor E. Brodsky, Ph.D., an assistant professor of pathobiology in the School of Vet-erinary Medicine.

Grading HighIn the annual U.S. News & World Report sur-

vey of hospitals, the combined enterprise of HUP and Penn Presbyterian Medical Center was ranked as the 9th best hospital in the United States and #1 in the region. According to the magazine’s editors, this distinction “signals both rare breadth and rare depth of medical ex-cellence.” Pennsylvania Hospital and Chester County Hospital were part of a four-way tie for #8 in the Philadelphia metro area. In all, Penn Medicine hospitals were recognized for their ex-cellence in 13 specialties. This year, U.S. News analyzed nearly 5,000 hospitals in the nation.

In addition, the University of Pennsylvania Health System has been ranked as one of the top academic medical centers by the Ambulatory Care Quality and Accountability Ranking

Looking EastwardPenn Medicine and Virtua

Health have formed a strate-gic alliance to jointly develop and coordinate programs to benefit both organizations across their respective mis-sion areas. Particular empha-sis will be on coordinating pa-tient management and deliv-ering high-quality and cost-effective patient-care services. Both organizations will continue to function in-dependently but expect to form expanded partnerships on certain initiatives, particu-larly in strengthening clinical programs in Virtua’s local mar-ket and improving access to tertiary and quaternary care pro-vided by Penn Medicine.

Located in Southern New Jersey, Virtua is an integrated de-livery system comprising three acute-care hospital, surgical centers, group-practice physician offices, urgent-care clinics, and rehabilitation centers. It has received Leapfrog “A” grades for all hospitals and a Press Ganey Award for Patient Satisfac-tion. Virtua is also listed on Information Week’s 500 list of technology innovators, manages an accountable care organi-zation, and has earned #1 Place to Work recognition.

At the start, the patient-care delivery areas for the strategic alliance will focus on cancer and neuroscience programs. Penn Medicine’s radiation oncology patient quality and safety program will be followed in all Virtua hospital sites. The orga-nizations will collaborate for the surgical and medical man-agement of neurological diseases. Beginning in January, Penn Medicine surgeons will perform surgery at Virtua’s hospitals. These programs will be branded jointly in the Southern New Jersey market.

of the University Health System Consortium. In this new ranking by the consortium, Penn’s system ranked #3 out of 46 academic medical centers that took part in the inaugural study. The new award honors AMCs that demon-strated excellence in five areas: access to care, capacity management and throughput, quality and efficiency, continuum of care, and equity.

Pennsylvania Hospital’s Emergency Depart-ment was one of four hospitals to receive this year’s Lantern Award. Only 58 of the more than 5,000 EDs in the country hold that dis-tinction. The award recognizes emergency de-

partments that exemplify exceptional practice and innovative performance in the core areas of leadership, practice, education, advocacy, and research.

FALL 2015 5

Honors & Awards

Peter C. Adamson, M.D., G.M.E. ’87, professor of pediat-rics and pharmacology and leading scientist at the Children’s Hospital of Philadelphia, had been appointed by President Obama to the National Cancer Advisory Board. He is the only pediatric oncologist currently on the board. In this role, Ad-amson will advise the U.S. Secretary of Health and Human Services, the director of the National Cancer Institute, and the president on a wide range of issues relating to the national cancer program. A recognized leader in drug development to combat pediatric cancer, Adamson has served as chair of the Children’s Oncology Group, the world’s largest organization devoted exclusively to childhood and adolescent cancer re-search. From 1999 to 2014, he was chief of the Division of Clinical Pharmacology and Therapeutics as CHOP.

Rinad Beidas, Ph.D., assistant professor of psychology in the Department of Psychiatry and a senior fellow in the Leon-ard Davis Institute of Health Economics, was honored by the Association for Behavioral and Cognitive Therapies. The President’s New Researcher Award recognizes her robust body of early research on the dissemination and implementa-tion of evidence-based practices – those practices proven to be most successful through clinical expertise, scientific re-search, and patient preference – in the treatment of youth with psychiatric disorders in community settings. Beidas also has clinical expertise in the cognitive-behavioral treatment of child and adolescent anxiety.

Steven Douglas, M.D., professor of pediatrics in the Perel-man School and chief of immunology at the Children’s Hospi-tal of Philadelphia, received the 2015 Paradigm Builder Lec-tureship award, presented by the International Society for NeuroVirology. He is recognized for his seminal and continu-ous contributions to the field of leukocyte biology, with em-phasis on monocyte/macrophage biology in HIV infection.

David Fajgenbaum, M.D. ’13, M.B.A. ’15, a research assis-tant professor in the Department of Medicine’s hematology/oncology division, has received the RARE Champion of Hope award for science. The honor recognizes his efforts in advanc-ing meaningful research for Castleman’s disease as a re-

searcher and for co-founding and serving as executive director of the Castleman Disease Collaborative Network, a global network of physi-cians, researchers, pa-tients, and loved ones dedicated to accelerating research and treatment for the disease. The award was presented by Global Genes, a patient

advocacy organization for the patients of rare diseases. The disease involves the body’s immune system becoming acti-vated and releasing inflammatory proteins that can shut down the liver, kidneys, and bone marrow. Fajgenbaum himself was diagnosed with idiopathic multicentric Castleman’s disease (iMCD) in 2010. He and his associates published a new model of pathogenesis for iMCD in Blood. The network is now fo-cused on identifying what triggers the immune activation, which immune cells are activated, and what existing or novel therapies may be effective for patients that do not respond to the only therapy approved by the Food and Drug Administration.

For his efforts, Fajgenbaum was also recognized in Forbes magazine’s “30 Under 30” list for health care. He has also re-cently accepted a position as associate director of patient im-pact for the Penn Orphan Disease Cent

Edna Foa, Ph.D., re-ceived the 2015 Distin-guished Scientific Contri-butions Award from the American Psychological Association. A professor of clinical psychology in the Department of Psy-chiatry and director of the Center for the Treat-ment and Study of Anxi-ety, Foa was recognized for her contribution to the theory and practice of psychology, specifically for the re-search and treatment of anxiety disorders. She is widely rec-ognized for her major contributions to the study of psycho-logical trauma and post-traumatic stress disorder (PTSD). Foa developed prolonged exposure therapy, a treatment for PTSD in which patients revisit the traumatic event in order to achieve long-term healing. She has also contributed to the understanding of the psychopathology and treatment of anxi-ety disorders, with a focus on obsessive-compulsive disorder, panic disorder, social anxiety disorder.

Emily Kramer-Golinkoff, M.B.E. ’13, manager of strategic initiatives and operations at the Penn Medicine Social Media and Health Innovation Lab, was one of nine “Champions of Change” honored at the White House in July for making a dif-ference in health treatment. A 30-year-old with ad-vanced-stage cystic fibrosis, she cofounded Emily’s Entourage to raise funds and awareness for new treatments and a cure for the rare form of her disease. Since its founding in 2011, Emily’s Entourage has raised more than $1.5 million and led worldwide efforts to fast-track research on rare “nonsense” cystic fibrosis mutations.

Caryn Lerman, Ph.D., a professor of psychology in the De-partment of Psychiatry, received the Outstanding Investigator Award of the National Cancer Institute, a new grant bestowed upon influential cancer researchers to provide long-term sup-

port for cancer research that has a beneficial im-pact. Lerman, whose re-search focuses on the in-terface between neurosci-ence and cancer preven-tion, will receive $6.5 mil-lion over a seven-year pe-riod. She is senior direc-tor of Penn’s Abramson Cancer Center and co-di-rector of the Penn Medi-cine Neuroscience Cen-ter. Tobacco use and obesity account for more than 45 percent of preventable cancer deaths, yet the cancer-risk behaviors are resistant to long-term change despite widespread knowledge of the risks. The new grant will support the premise of Ler-man’s research: that it is possible to enhance the brain’s capac-ity to override behavioral habits that contribute to obesity and cigarette smoking – and ultimately to cancer.

Harvey L. Nisenbaum, M.D., associate professor of radiol-ogy in the Perelman School and chair of the Department of Medical Imaging at Penn Presbyterian Medical Center, was elected president of the World Federation for Ultrasound in Medicine and Biology. The Federation has more than 50,000 members and involves more than 50 countries. One import-ant mission is to help bring sustainable ultra-sound programs to all the underserved areas of the world to help improve their health care.

At the graduation cere-monies of the Perelman School of Medicine in May, Nisenbaum was presented with a Special Dean’s Award. The honor recognizes outstanding achievements in medical education by the Perelman School’s faculty members, particu-larly in the development of new, innovative educational pro-grams. With the support of the school’s leaders and a gener-ous grant, Nisenbaum was able to help develop and imple-ment the school’s ultrasound curriculum. He believes the ap-propriate use of ultrasound has become a necessary skill for all future physicians.

Nancy A. Speck, Ph.D., a professor of cell and develop-mental biology, was honored with the 2015 Henry M. Stratton Medal for Basic Science for her seminal contributions in the area of hematology research. The award is presented by the American Society of Hematology. Speck, who is associate di-rector of Penn’s Institute for Regenerative Medicine, co-leads

the hematological malignancies program at the Abramson Cancer Center and is an investigator at the Abramson Family Cancer Institute. She is recognized for her important contri-butions to the understanding of developmental hematopoiesis as well as the translation of those findings into the study of leukemia.

John Q. Trojanowski, M.D., Ph.D., G.M.E. ’80, received the Award for Meritorious Contributions to Neuropathology from the American Association of Neuropathologists. He is a professor of pathology and laboratory medicine and serves as director of the Institute on Aging. He was recognized for his long career as a leader and pioneer in the research and treat-ment of neurodegenerative diseases. The association de-scribed his work as a steady contribution “that spans many diseases, disciplines, genes, and domains.” Trojanowski’s apti-tude for collaboration was also cited, and his most significant collaborator has been his wife, Virginia Lee, Ph.D., the John H. Ware 3rd Professor in Alzheimer’s Research. They are among the most widely cited researchers studying Alzheimer’s dis-ease. In addition to pursuing their own research, they founded Penn’s Center for Neurodegenerative Disease Research.

Kevin Volpp, M.D. ’98, Ph.D. ’98, professor of medicine and health-care management in the Perel-man School and the Wharton School, was honored with the Associ-ation for Clinical and Translational Science’s 2015 Distinguished Inves-tigator Award for Career Achievement. He also re-ceived the 2025 Matilda White Riley Award from the Office of Behavioral and Social Sciences of the National Institutes of Health. Volpp, whose re-search focuses on the impact of financial and organizational incentives on health outcomes, is the founding director of the Center for Health Incentives and Behavioral Economics and vice chair of health policy in the Department of Medical Eth-ics and Health Policy.

Jeremy Wilusz, Ph.D., assistant professor of biochemistry and biophysics, was awarded a $500,000 grant from the Rita Allen Foundation. He will receive $100,000 a year for five years as a 2015 Rita Allen Foundation Scholar. Wilusz studies circular RNAs, a recently discovered version of ribonucleic acid. He and his team seek to describe and understand how circular RNAs are generated and regulated and how they function. They also investigate whether circular RNAs are misregulated in various diseases, such as cancer, and if they can be therapeutically targeted against the diseases in which they may play a role.

PENN MEDICINE6

VITAL SIGNS

Honors & Awards Continued

FALL 2015 7

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Penn Medicine’s Preparations for Pope FrancisOur three Philadelphia hospitals stocked up and sta�ed up in preparation for the crowds and road closures that came with the ponti�’s historic visit to the City of Brotherly Love. Here’s a snapshot of what it took to be ready.

2,000+

staff sleeping at the hospital

DURING THE VISIT, WE HAD…

1,830 units

of blood products

560pounds of

chicken fingers

$1.25million worth of medication

80,000pounds of sheets,

towels and blankets

225translation phones for non-English-speaking patients

AND WE STOCKED UP ON….

25 babies born

4organ transplant surgeries

Statistics of NoteTwo researchers from the Center for Clinical Epidemiology

and Biostatistics were part of a team honored with the 2015 Outstanding Statistical Application Award from the American Statistical Association. The Penn authors of the recognized paper are Wensheng Guo, Ph.D., professor of biostatistics, and Anne R. Cappola, M.D. ’94, Sc.M., associate professor of

endocrinology in the Department of Medicine and an associ-ate scholar at the center. Their paper, titled “Modeling Bivariate Longitudinal Hormone Profiles by Hierarchical State Space Models,” was published in the Journal of the American Statis-tical Association. Guo and Cappola are the first faculty mem-bers from the Perelman School to receive this award.

Guo’s research interest is broad, including functional data analysis, time series analysis, and joint modeling of longitudi-nal and time-to-event data. Cappola’s research focuses on the hormonal alterations that occur with aging and the clinical impact of these changes.

Mary D. Sammel, Sc.D., a professor of professor of biosta-tistics and epidemiology at Penn, was also recently elected as a Fellow of the America Statistical Association. She was rec-ognized for her outstanding contributions in introducing and establishing statistical science as a core aspect of the field of women’s health and reproduction research; for achieving a relevant and important body of work in women’s health; for outstanding mentoring of women and junior researchers; and for major contributions in the development of statistical methodology.

Just a few years ago, the term fracking might have drawn a perplexed stare from most of the general population. But today, particularly in large parts of the United States such as rural Pennsylvania, the word isn’t just a figure of speech but a real and immediate curse word. Although fracking in common parlance has come to represent the entire range of unconven-tional gas and oil drilling activities, technically it refers only to

the technique of hydraulic fracturing or hydrofracturing: ex-tracting natural gas from deep within the Earth by cracking open rock layers with high pressure liquids.

It’s become one of the most contentious political and environ-mental issues of the past decade. It is a focus of bitter contro-versy, from the national news all the way down to the grassroots community level, as the lives and perhaps the health of residents in previously sleepy rural communities are disrupted and threatened. Meanwhile, gas well drilling in states such as Penn-sylvania and North Dakota continues to expand and accelerate at so fast a pace that the concerns of residents, environmen-talists, and other involved parties seem almost an afterthought.

That’s certainly true from a scientific and public health standpoint, particularly in Pennsylvania, where the prolifera-tion of well drilling seems to be inversely proportional to the available data on its environmental and health effects. At Penn Medicine, studying those effects falls under the aegis of the Center of Excellence in Environmental Toxicology (CEET). Part of the Perelman School of Medicine, CEET is also one of only twenty Environmental Health Sciences Core Centers

The experts in Penn’s Center of Excellence in Environmental Toxicology seek the facts that are essential for decisions that affect our environment.

FRACKING AND PUBLIC HEALTH: FINDING THE BEST BALANCEBy Mark Wolverton

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(EHSCCs) in the United States, as designated by the National Institute of Environmental Health Sciences (NIEHS). In collab-oration with the Mailman School of Public Health at Columbia University, Penn’s center recently published a major study identifying an association between fracking and increased hospitalization rates. Their work is already having a major impact on the fracking controversy, introducing some sorely needed facts into an issue too often muddied by passionate but ill-informed rhetoric on all sides.

As the only EHSCC in the Environmental Protection Agency’s Region III (Pennsylvania, Delaware, Maryland, Washington DC, Virginia, and West Virginia), Penn’s center could be ex-pected to take a particular interest in the fracking controversy. Most of those states lie firmly atop the Marcellus Shale forma-tion, one of the major sources of natural gas to be developed and explored in recent decades. Half of Pennsylvania’s land mass, in fact, rests under Marcellus Shale. At a 2012 meeting of all the EHSCCs, Trevor Penning, Ph.D., a professor in theDepartment of Systems Pharmacology and Translational Ther-apeutics and director of CEET, gave a presentation on potential public health impacts of hydraulic fracturing in Pennsylvania. “I made the point that this was such a com-plex issue that no single environ-mental sciences center could tackle this by itself. What we needed was to pool our resources so we could work collaboratively together. That led to the establishment of an in-ter-center working group on hy-draulic fracturing.”

And led as well to the recent study, published in the journal PLOS One in the summer of 2015. The lead author was Reynold A. Panettieri Jr., M.D. ’83, G.M.E. ’90, deputy director of CEET

and professor of medicine. The study, “Unconventional Gas and Oil Drilling is Associated with Increased Hospital Utiliza-tion Rates,” he notes, was rated among the journal’s top six viewed publications online, garnering about 14,000 views in

only a month and a half. “So it’s obviously a passionate area.”

Although the commotion and controversy over hydraulic frac-turing might be fairly recent, the practice itself is not. It was first used in Kansas in 1947. As men-tioned, it’s only one part of an elaborate process that includes the selection of the well site, pad construction, drilling, and encas-ing the borehole in concrete. A mile or more deep, the drilling

changes to a horizontal direction, into and along the shale lay-ers. Then the actual hydraulic fracturing process begins, in which the horizontal borehole is perforated by holes at vari-

ous spots and millions of gallons of fracturing flu-ids are pumped through them at high pressures. That forces the rock layers to crack and fractures to open, releasing their coveted stores of natural gas, to be recovered and stored back on the surface.

Why Fracking, Why Now?If fracking is nothing new, why is everyone sud-

denly so concerned about it? The main reason is that in the past, hydraulic fracturing tended to be done in places where oil and gas drilling were al-ready well established. But in recent years, the economics of energy production and demand, dwindling supplies of more “conventionally” ob-tained gas, the desire to reduce our reliance on dirtier carbon-based fuels such as coal, and the development of improved drilling techniques that make accessing formations such as the Marcellus Shale cheaper and more practical have all come together to spur a burgeoning new enterprise. That means that drilling is now being done in

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Trevor Penning doubts that banning hydraulic fracturing on a national

scale is practical. “The best we can do is identify the potential risks and manage them by having the industry

adopt safe practices.”

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Trevor Penning: striving for scrupulous scientific objectivity.

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thousands of locations that have never before seen anything more industrial than a passing diesel truck. Now these com-munities are being invaded by hundreds of trucks, heavy equipment, and noisy and smelly activities that used to hap-pen hundreds or thousands of miles away. All these develop-ments have literally brought home the oil and gas industry to many people who previously would encounter it only at their local gas stations.

“While hydraulic fracturing is not new,” Panettieri explains, “the magnitude of the drilling is certainly different. So we have to take that into account and the proximity to popula-tions which didn’t necessarily exist before. The other part of the equation obviously is, well, if we don’t use this fuel, we would simply continue to do coal burning. Isn’t this better than coal burning? That becomes a societal issue.”

Engineers and geologists prefer to use the term fracking (with a “k”) to mean the overall drilling process and the word fracing (or frac’ing) to refer solely to the hydraulic fracturing technique. They make that distinction because some phenom-ena that have been blamed on fracking, such as recent earth-quakes in Oklahoma, are not actually the result of hydraulic fracturing but other processes, such as the injection of waste water into deep underground wells. Whatever one’s preferred terminology, it’s the possible release of toxic materials into air or water that’s of prime concern, especially for the people liv-ing near well sites. A 2013 Wall Street Journal report esti-

mated that more than 15 million Americans live within one mile of a well drilled since the year 2000. In the rush to find and develop resources to satisfy America’s ever-increasing thirst for energy, the people most directly affected by it have more and more questions – but definitive answers remain frustratingly elusive.

“How do we have no data on an enterprise of this magnitude?” asks Aubrey K. Miller, M.D., M.P.H., a senior medical advisor at National Institute of Environmental Health Sciences. “How do we have 15 million people living within one mile of a well, and we can’t answer their questions?” The reassurances from the oil and gas industry that well operators are scrupulously observing best practices often ring hollow to mothers whose children have developed mysterious rashes and other ailments or homeowners who have found their drinking water wells contaminated by unknown substances. Anecdotes and horror stories abound, as do confident proclamations of safety, but with a dearth of hard data, it’s virtually impossible to sift out truth from the rhetoric.

Assessing the Risks“There are different ways to approach the problem,” Pen-

ning says. “One is a classical risk-assessment approach,” with four components. “Risk identification, meaning what are the hazards that we have to be concerned about as it relates to human health? I think we have a good handle on what the

HYDRAULIC FRACTURING PROCESS

Marcellus Shale Layer

Water Table

Well Head

Well Pipe

FRACTURING FLUID

GAS EXTRACTION

B

A. A perforating gun is used to make fractures in the shale and fracturing fluid is pumped into the well at high pressures forcing the fractures to crack open.

B. Fractures release the natural gas trapped in the rocks so it can rise to the surface.

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These maps illustrate the growth of gas producing wells in Pennsylvania between 2008 and 2014.

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possible air pollutants might be. We don’t have a strong han-dle on the pollutants that might contaminate the water sup-ply.” Although the hydraulic fracturing fluid used by well op-erators is about 99% water, the remainder is a mixture of other chemicals that varies among different companies, and the specific formulation of a company’s “fracking fluid” is con-sidered proprietary information – a trade secret to be pro-tected and guarded. “Therefore,” notes Penning, “we don’t know what we’re looking at.”

A second component of risk assessment is to establish a solid baseline of data to identify what’s normal and what’s not. “Because of the lack of baseline data both in air and water quality, it’s tough to attribute contamination or air pollution to the process itself, because there could be other sources,” Penning explains. That, of course, provides a convenient out for industry representatives to discount the complaints and concerns of local residents.

Once a particular hazard has been identified, it needs to be characterized. What are its effects? How much exposure is needed to induce what kind of responses? Again, in the frack-ing debate, answers to these questions are few and far be-tween. As Penning observes, “Most things follow a dose re-sponse curve, and you need to know what the margin of safety is between the exposure and the levels that would cause a health effect. And that’s also obviously very difficult when you can’t do the hazard identification in the first place.”

The final piece of risk assessment is figuring out how to mitigate risks and how to communicate information effectively both to policy makers and to residents. “So it’s a four-part ap-proach, but it’s also sequential,” Penning says. “And we’re stuck on one and two right now. That’s what led us to actually think about designing the PLOS One study. We felt we needed some kind of broad-stroke approach to determine whether there was a signal worth looking at.”

What’s Real and What Isn’t Real?The CEET/Columbia study looked at two counties in

northeastern Pennsylvania where unconventional oil and gas drilling has blossomed and is continuing (Bradford and Susquehanna) and one in which no active wells are located (Wayne). Researchers looked for any correlation between the density of wells in each area and the inpatient admission rates from 2007 to 2011. “Our whole approach is an unbiased ex-amination of the data,” says Panettieri. “What’s most import-ant is that we look at this with glasses off, what’s real and what isn’t real.”

Penning, Panettieri, and their collaborators were startled by what they found. Using data from 25 specific medical catego-ries (e.g., cardiology, dermatology, gynecology, gastroenterol-ogy, neurology), they examined hospitalization rates within each category and county, noting any association with well activity. They expected to find fairly stable rates, considering that they were working with a time span that was relatively short, in epidemiological terms.

Instead, the study found significant associations between inpatient admissions and fracking activity in a number of

medical categories, particularly for cardiology and neurology. Seeing such a strong statistical signal over such a short time is considered fairly remarkable. Says Panettieri, “It was shocking to us that we saw a signal after five years. Many epidemiological studies of toxic exposure take decades. This was fast and really speaks to maybe some major issues that need to be addressed.”

But just as with any other controversial public issue, people tend to hear what they want to hear, and nowhere is that more prevalent than with fracking. “Obviously when the data came out, we were embraced quickly by all of the pundits who were against fracking, while we made no friends in the oil industry,” says Panettieri with a laugh.

Careful scientists that they are, however, Panettieri and his colleagues emphasize the study’s limitations and caution against drawing premature and unfounded conclusions. The study states that “the precise cause for the increase in inpa-tient prevalence rates . . . remains unknown” and that “the clinical significance of the association remains to be shown.”

As Penning puts it, “This is just a drop in the ocean in terms of where we could go with this approach.” He points out that there are subcategories that need to be mined to see whether certain subsets of disease show up. In addition, he says, “so far we’ve only looked at hospitalization rates. We need to look at outpatient data as well.”

Weighing the Impact on Wells and SpringsAside from the CEET study, another draft report released

in 2015 has caused a mighty stir: a study by the U.S. Environ-mental Protection Agency that examines the potential impact of hydraulic fracturing on drinking water sources. It focused specifically on Bradford and Susquehanna Counties in Penn-sylvania, the same counties studied by CEET. Analyzing more than 225 water samples taken over a year and a half from about 40 different locations, the EPA found no evidence of any “widespread” impact on homeowner wells or springs from hydraulic fracturing, although it did find some evidence of fracking-associated methane and ethane in several wells.

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2010 2011 2013 2014

Unconventional Gas Drilling in the Marcellus Shale of Pennsylvania

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It was predictable that the EPA study (which remains to be finalized after review and public comment) was interpreted differently by pro- and anti-fracking camps. While those in industry saw themselves vindicated, fracking opponents criti-cized the EPA for pandering to oil and gas companies. The EPA has acknowledged some definite limitations in the study, and scientists such as Penning have criticized it on that score.

As he explains, “we sent in a 22-page commentary that was actually not too pleasant.” The CEET experts identified what they considered serious gaps in knowledge that should have been taken into account in the agency’s executive summary.

Even more emphatic is Marilyn V. Howarth, M.D., an ad-junct associate professor of emergency medicine and pharma-cology at the Perelman School who also serves as director of CEET’s Community Outreach and Engagement Core. “The EPA’s conclusions are premature,” she says. “Their retrospec-tive studies found impacts on drinking water such as in-creased sediment and problems with clarity. No one should be expected to drink water that contains debris whether or not the debris is toxic. In addition, there has been no prospec-

tive study on drinking water throughout the life of a nearby well. Water quality may significantly yet transiently change.” Howarth asserts that there is no data to determine if these changes are occur-ring and, if they are, what are the impacts on peo-ple’s health.

Still, Penning emphasizes that the best way to resolve such contentious issues is to strive for a scrupulous scientific objectivity, which means tak-ing biases into account, both conscious and un-conscious. Many studies are not adequately de-signed, or their results are exaggerated or misrep-resented by the press or overzealous advocates on both sides. “We get these one-liners, but you have to look at the details,” he observes. “One thing that made the PLOS One study so powerful is it’s unbiased. We didn’t have any preconception of what we should be measuring. Some of the other health studies have been focused on one or more particular health point that’s been pre-selected, so you don’t know if, based on that pre-selection, other things could have been missed.”

What Remains to Be Done?Because so much remains unknown and uncer-

tain, there’s much more work to be done. While many researchers are focusing on toxicological ef-fects of air and water pollution from hydraulic fracturing, little attention has been given as yet to the psychosocial aspects, which may be even more important in the long run.

Says Penning, “If you look at the PLOS One study, you’ll see there was a trend but not a specific association between psychological disorders as well, but specifically issues of depression, anxiety, and so on. I think psychosocial stress is a very im-

portant component of this, along with sleep deprivation.” As Panettieri points out, “These areas are pretty bucolic,

they’re rural. And in comes a lot of industry very quickly set-ting up camp, disrupting that lifestyle, and it engenders a lot of stress. We know that chronic stress can cause cardiovascu-lar disease and impair the immune system. We believe that with this short observation period and the rapidity and ro-bustness of the data, there’s a stress response from noise, dis-ruption of lifestyle, uncertainty, and air pollution from diesel truck exhaust. Our hypothesis is that a combination of chronic stress on top of air pollution rather than water pollu-tion might be responsible for our findings.”

What should be done now, while we continue to debate and study and assess and define the risks of hydraulic fracturing? It’s a question that depends heavily upon the political climate, which in Pennsylvania is undergoing a shift from the unabash-edly pro-industry stance of the administration of the former governor, Tom Corbett, to the apparently more cautious admin-istration of Governor Tom Wolf. One measure that CEET and other scientific and public health experts recommend is estab-

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Reynold Panettieri, here conferring with Christie Ojiaku, led the CEET study.

PENN MEDICINE12

lishing a health registry to track and monitor the health of residents living near fracking sites. But while the current Wolf budget has set aside funding for a registry, it’s not nearly enough.

“It was only funded to a level of $100,000 a year, which is basically one person at a computer,” Penning notes, adding, “a registry is not really a valuable tool unless there is appropriate exposure data to go with it.” That data, he says, should be based on a particular ill effect or symptom as diagnosed by a physician trained in taking exposure history. “Unfortunately, what we have in Pennsylvania – which is not unusual for the U.S. as a whole – is a lack of physicians that are actually trained in occupational environmental medicine.”

The Consensus: More Information Is Desperately Needed

Although the fervent advocates on both sides of the frack-ing controversy might consider the essential questions already settled, the only real scientific and public health consensus at the moment is that far more information is desperately needed. To the researchers at CEET and the other EHSCCs, it’s clear that something is going on. Says Panettieri, whose ex-pertise includes asthma and pulmonary disease, “I’m confi-dent that as time goes by, you’re going to see more and more studies showing health consequences rather than safety.”

But at this stage, specifics are hard to come by. As Panet-tieri noted at a 2014 CEET symposium on fracking and public health: “We can only get the right answers with the right questions and right tool set. We don’t have the tool set. We don’t know necessarily what we’re looking for. Mixed toxigen exposure is wildly complex. It’s multiple doses from a long pe-riod of time – air and water pollution together – that we’re seeing in hydrofracking. It could be synergistic, and we need to understand that.”

Marilyn Howarth points out that even when dealing with individual communities and patients who may be affected, doctors are often working in the dark. “The secrecy that has been codified into law that prevents doctors from quickly learning the chemicals that ill patients may have been exposed to is unprecedented.” She explains that although technically a pathway exists for obtaining information about exposure to

chemicals, the delay involved precludes its usefulness in mak-ing a diagnosis. “Exemptions to environmental laws are gener-ally reserved for processes that have been thoroughly re-searched and found to be safe. Hydraulic fracturing enjoys the exemption from major environmental laws without being thoroughly researched or having very many restrictions.”

With natural gas and oil drilling currently part of the U.S. energy picture, Penning is doubtful that banning hydraulic fracturing on a national scale is practical, even if individual communities and states such as New York choose to do so. “The best we can do is identify the potential risks and manage them by having the industry adopt safe practices. I also be-lieve that some in the industry would like to make sure that there are useful best practices, because they do not want the industry to become overregulated because of some bad ac-tors. There’s a middle ground, and I think by trying to reach that middle ground we end up being no one’s friend.”

In the meantime, Panettieri notes, “there has to be a con-certed effort and resource allocation to further research.” That includes facilities to better monitor air and water near frack-ing sites and more prospective studies that compare data be-fore and after drilling. “If oil companies have found sites that are going to be initiated for drilling, it would be very import-ant for a third party to do an assessment of health six months or a year before drilling, and then follow the health care con-sequence afterwards.”

“There are severe gaps in knowledge,” says Penning. “And the question becomes, who is best positioned to fill those gaps in knowledge? Is it the industry? Is it environmental ad-vocacy groups? Or is it trusted academic institutions?”

Perhaps Aubrey Miller of the National Institute of Environ-mental Health Sciences best sums up the attitudes of science and public health professionals: “Let’s not assume health and safety – let’s establish health and safety.”

The Funding DilemmaStriving for scientific objectivity in a public health issue as

volatile and polarized as fracking is a continuing problem. “We’ve been very careful in terms of accepting any money for our research,” says Trevor Penning, Ph.D., director of Penn’s Center of Excellence in Environmental and Toxicology. “We have been approached by the American Petroleum Institute, and we did not take money from them or from public advocacy groups. We don’t want to have our work pilloried because people feel it’s biased in some way.”

One way to avoid accusations of bias and undue influence is to keep funding sources independent. “We would love to be able to do a lot more,” Penning emphasizes. “We’ve been do-ing it on a shoestring, really, and when we think about what needs to be done, it means a large investment of dollars.”

Penn alumni who wish to contribute to the efforts of CEET to study not only hydraulic fracturing but also other pressing questions in environmental health and toxicology should contact Torren Blair, in Penn Medicine Development, at torrenb@upenn.edu or 215-898-7680 for more information.

Anecdotes and horror stories about the impact of fracking abound, as

do confident proclamations of safety, but with a dearth of hard data, it’s virtually impossible to sift out truth

from the rhetoric.

COVER STORY

FALL 2015 13

Greg Dunn has entered the third dimension. Or, to be precise, his art has, as can be seen in an exhibition at the Mütter Museum at the College of Physicians of Philadelphia.

A rare combination of artist and neuroscientist, Dunn be-gan showing his Asian-style paintings of neurons while en-rolled in the Perelman School’s Biomedical Graduate Studies program. One of his early shows was at the Burrison Gallery, in Penn’s Faculty Club, shortly before he earned his doctor-ate in neuroscience in 2011. The show was called, very ap-propriately, “Neurons and Nature,” displaying his work in enamel, gold and copper leaf, and ink. On display were ele-gant, colorful, but seemingly straightforward paintings. One depicted autumn branches; another showed stark, leafless trees with a reddish background that evoked sunset. But in the same show, you could see paintings of pyramidal neu-rons, with their long dendritic trees looking uncannily simi-lar to the “real” trees in the other works. Also included were

paintings on scrolls, in the style of the scroll and screen painting done in medieval Japan.

As Dunn has said, “it was a fine day when two of my pas-sions came together” – Asian art and neuroscience. But it was certainly not by chance, given his keen interest in both. Dunn realized that the elegant forms of neurons could be painted expressively in the Asian sumi-e style. “Neurons may be tiny in scale, but they possess the same beauty seen in traditional forms of the medium (trees, flowers, and animals).”

A New Process to Illustrate the Brain’s Complexity

At the time of that show, Dunn explained his attraction to gold leaf and copper leaf. Metal leaf “is a complicated medium to master,” but at the same time, “it brings the painting to life.” The effects of light on metal leaf, he pointed out, can change the painting in interesting ways. More recently, Dunn has taken another step, developing a new process – microetching – that makes his two-dimensional pieces of art appear to have depth. In many of his newer works, he has moved away from the simplicity he treasures in the Asian art in an attempt to suggest the brain’s immense complexity and constant activity. “Microetchings allow the viewer to clearly perceive complex images in a way that is impossible through two-dimensional renderings,” he says in connection with the current show. Now several of the artworks on display seem to be more alive – indeed, more “interesting,” to use Dunn’s deliberately under-stated adjective.

For example, as viewers move past Chaotic Connectome (2013), they perceive different parts of the image. In general, a connectome depicts the mapping of all neural connections within an organism’s nervous system, akin to a wiring dia-gram. It is no surprise that such an image looks busy, even chaotic. As viewers pass, what may have appeared first in gor-geous browns, pale yellows, and golds now takes on blues and reds. Different neurons seem to appear and disappear. As Dunn explains on his web site: Chaotic Connectome is illumi-

By John Shea

Greg Dunn combines his neuroscience training with his creativity and skill to create distinctive works of art. And he continues to experiment, taking his art in new directions.

AN ILLUMINATED MIND OFFERS “MIND ILLUMINATED”

PENN MEDICINE14

nated by three colors of light embedded within a custom shadowbox of dark wood. The shadowbox includes a fader to control the intensity of the illumination.

In Dunn’s career as an artist, Chaotic Connectome has a special place. It was his first microetching, which involves etching neurons on metal plates, making microscopic ridges at specific angles to catch light from different sources, then covering the surface with gold leaf. He developed the process with Brian Edwards, an artist and research scientist at Penn who earned his Ph.D. degree in electrical and systems engi-neering from the School of Engineering and Applied Sciences in 2009. As Dunn notes on a video on his web site, the micro-etchings “are likely the first of their kind in the world,” and Edwards shares the credit on those works. Like Dunn, Ed-wards has a practical side as well. As he puts it, “I have had the privilege of being one of the few experimentalists in a mostly theory-based group. It’s exciting to try to design, simu-late, and build nuts-and-bolts realizations of my colleagues theories.” Edwards even has some experience as a carpenter.

Another of the very eye-catching works on display at the Mutter Museum is a microetching called Pranayama. In San-

skrit, prana is the life force and pranayama means the exten-sion of the life force. Dunn and Edwards seek to suggest the movement of energy through the body, the inhaling and ex-haling. This piece is different from many of the ones on dis-play because it shows the entire human body, a man sitting as if in meditation – but without the covering of skin that would normally obscure the patterns of energy within the body. De-pending on which way viewers move, they see the density of energy entering the body as breath does or leaving the body. From a distance, this meditating man with the pale gold cur-rents swirling within and outside his body would not be out of place in a Marvel superhero comic book!

Dunn notes that the microetchings are designed to evolve based on the moving perspective of the viewer. As engaging as the still images are, they cannot capture the full experience of the microetchings.

A Very Tall Building and a Giant BrainOnly about half the works on exhibit are microetchings. An

earlier painting is One Liberty, depicting the familiar sky-scraper in Philadelphia. Done with gold, dye, and enamel on copper and aluminized panel, it’s an imposing six feet high. No neurons are visible, but Dunn explores the patterns of the different floors and windows, with golden clouds in the back-

FEATURE

AN ILLUMINATED MIND OFFERS “MIND ILLUMINATED”

Spiny Stellate (2015). Ink on 21K moon gold.

The Artist at Work

FALL 2015 15

ground. And the sides of the building, with all their straight lines, seem to be reflecting something more free, something less controlled. As the exhibition note puts it, One Liberty contrasts “the sleek angularity of this iconic building . . . with the chaotic connections and evolutions of the human mind that designed it.” Here Dunn clearly demonstrates that he can handle buildings as well as trees and neurons – and invest it with subtle meaning as well.

Dunn and Edwards are also recipients of a grant from the National Science Foundation. Their project: to produce a gi-ant (eight feet by 12 feet) reflective microetching of a sagittal section of the human brain. With the collaboration of neuro-scientists, artists, and engineers, they expect to complete it in 2016, and its ultimate home will be the Franklin Institute. Ac-cording to the artist-scientists: “This project will almost cer-tainly be the most complex and detailed artistic depiction of the brain ever created.” They have two primary goals, which seem characteristic of their dual interests. First, to use “the unique power of art” to inspire a new generation of neurosci-entists and to encourage the lay public to view the brain in a different light. Second, to provide a piece of art aimed at pro-fessional neuroscientists that is as close as possible to com-plete anatomical and functional correctness.

Since his show at the Burrison Gallery, Dunn has had his art on exhibit at the New York Hall of Science, had a detail of

one of his microetchings as the cover of American Scientist, been covered in Wired, The New York Times, and The Huff-ington Post, and appeared on Studio 360, a weekly public ra-dio program about the arts and culture produced by Public Radio International and WNYC in New York City. The jaunty title of that segment: “A Neuroscientist Throws Science Over-board for Art.” Viewers may beg to differ. Instead, it seems the very combination of neuroscience and art that makes the work of Greg Dunn stand out.

Dunn’s exhibition, “Mind Illuminated,” will run at the Mütter Museum through January 7, 2016.

On the back cover: Brainbow Hippocampus (2014), by Greg Dunn and Brian Edwards. This is a microetching of the cellu-lar structure of the rodent hippocampus, a region of the brain involved in learning, memory, and sensory integration.

Neural Migration (2015). 21K and 12K gold, ink, and dye on stainless steel.

Pranayama (2014). 22K gilded microetching. Greg Dunn and Brian Edwards.

PENN MEDICINE16

arm more than 90 degrees and thought it was connected to the injection,” Le Blanc says. “But the location of the injection site and where he had weakness didn’t add up.”

When the patient removed his shirt for examination, Le Blanc immediately knew the problem. “I asked him if he had been treated for cancer, and he told me he had both surgery and radiation for bilateral tonsillar cancer 13 years earlier.”

How did she know? The muscle tissue in that area had shrunk and looked contracted, tight from the radiation. And the shoulder blade was winging out, as opposed to lying flat as it normally does. “During head and neck surgery or radia-tion treatment, the spinal accessory nerve – a small nerve that lies near the surface – can be injured,” she explains. “This nerve stimulates the trapezoid muscle, which is a major shoulder stabilizer. Without the working nerve, the shoulder blade doesn’t move correctly and prevents the arm from mov-ing the full range of motion.”

Le Blanc prescribed a rehab program aimed at restoring muscular balance. “We worked on strengthening the compen-satory muscles, like the rhomboids and levator scapular, and

Mously Le Blanc, M.D. ’06, is a detective of sorts. As a cancer rehabilitation specialist – one of only a few in the country – she uses her knowledge of nerves, muscles, and bones to connect the dots between patients’ mysterious symptoms and the cancer treatments they received, often years before.

Take, for example, the 35-year-old patient with a weakness in his right shoulder. He came to see her two months after re-ceiving a Botox injection for neck pain. “He couldn’t raise his

With American cancer survivors now numbering 14 million, Mously Le Blanc fills an emerging niche, providing care for the late side effects of the therapies that cured them.

Restoring Function . . . and Quality of Life

By Sally Sapega and John Shea

Photos by Daniel Burke

Mously Le Blanc, M.D., examines cancer patient Sarah Happy.

FALL 2015 17

MORE PEOPLE SURVIVE CANCER

MILLION PEOPLE HAVE CANCER IN THE U.S. 14.4

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MILLION MAY DEVELOP SOME LATE EFFECTS 9.6

also stretching out the pectoral muscles,” she says. “After eight weeks, the patient had a full range of motion back on that side.”

Women who undergo treatment for breast cancer can expe-rience similar problems from radiation, which changes the structure of the muscles. “The muscles are no longer soft and tensile. They’re still and fibrotic,” Le Blanc says. “These women can become hunched over due to overactive pectoral muscles from the radiation. They’re scared to move their arms and avoid using that side.” As a result, they lose much of their range of motion.

Six months after one patient had a mastectomy, she couldn’t dress herself and was in significant pain. Anti-inflammatory drugs did not work; neither did physical therapy using just heat and massage. Le Blanc gave her a steroid joint injection and then put her on an aggressive physical therapy plan. As a result, the woman regained her full range of motion and is without pain.

“Radiation can affect all the muscles, bones, nerves, and lymphatics in the irradiated area, but the effects can occur years later,” she said. And when they do present, she explains, it is so long since the cancer that primary-care physicians do not consider any connection to the cancer treatment.

“We are now seeing what happened from the 1990s,” Le Blanc says, referring to the cancer treatments of the time. But more recently, as physicians have learned more about the ef-fects of radiation, treatments are changing. Doses have to be low enough to limit the possible side effects. She cites proton therapy as an example; it has the potential to minimize damage to healthy tissue that surrounds tumors.

Because of more successful therapies for cancer, a greater number of people are surviving the disease. There are an esti-mated 14 million in the United States alone. But as oncolo-

gists, reproductive endocrinologists, and cancer rehabilitation specialists now understand, cancer treatments are not without consequences. In the past, survivors have often been left to deal with these long-term effects with little or no guidance. In 2005, however, the Institute of Medicine published a detailed report on the state of cancer survivorship, calling attention to the need cancer survivors have for care plans beyond their immediate treatment – a summary of the treatments they re-ceived and the potential for late effects that may take years to manifest, plus tips on follow-up tests and screenings they may need. Subsequently the Commission on Cancer, an organization that accredits cancer centers, responded by requiring all ac-credited centers to provide such plans to their survivors.

“Survivorship care is ongoing and indefinite,” Le Blanc says. “It may require multiple decades.”

At Penn Medicine, the Abramson Cancer Center developed the first adult cancer survivorship program in the nation in 2001. It provides specialized care, addressing the wide array of physical and mental health problems that cancer survivors and their families experience. About two-thirds of cancer sur-vivors will experience a late effect, either physical or psycho-social, of chemotherapy or radiation that persists or develops more than five years from the time of diagnosis.

In addition, OncoLink, Penn Medicine’s award-winning cancer website, developed the first online program, OncoLife, to help patients with their physicians to chart out their health-care future after cancer. According to James M. Metz, M.D., G.M.E. 2000, executive director of OncoLink and chair of the Department of Radiation Oncology, “This is the most comprehensive survivorship plan tailored to the individual that’s out there. There’s a lot of available data, but patients are

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GENITOURINARY SYSTEMMUSCULOSKELETAL SYSTEMCOGNITIVE FUNCTION

ENDOCRINE SYSTEM HEAD AND NECK NEUROMUSCULAR SYSTEM

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FEATURE

not always getting it from their physicians.” Oncolife, he says, empowers patients to be active participants in their health care. To date, there have been more than 50,000 care plans created using OncoLink’s programs and products.

As progress of this sort continues, Le Blanc will likely treat fewer and fewer patients whose symptoms appear mysterious. But in the meantime, she does not lack for patients. Le Blanc practices at Penn Medicine Rittenhouse, Penn Medicine Rad-nor, and the Perelman Center for Advanced Medicine, where she is part of the Rena Rowan Breast Center. She is also direc-tor of cancer rehabilitation services within Penn Medicine’s Department of Physical Medicine and Rehabilitation. Accord-ing to Timothy Dillingham, M.D, chair of the department, “she has done a wonderful job at growing the awareness of the importance of exercise and rehabilitation for persons with cancer. As cancer becomes more and more a chronic disease, the holistic approach to survivorship and optimal function takes on greater importance.”

Le Blanc’s first mentor at Penn’s medical school was Andrea L. Cheville, M.D., then a professor of rehab medicine. (She is now at Mayo Clinic’s Cancer Center.) Cheville, says Le Blanc, “had an amazing bedside manner with patients.” Her spe-cialty was lymphedema, a painful swelling of the arm that of-ten results from breast cancer surgery or radiation. Even though Le Blanc fell in love with the specialty very early on, she paid attention to Cheville’s advice to learn all of rehab medicine. “In order to be a great cancer rehab doctor,” Le Blanc explains, “you have to be a great rehab doctor.” What drew her to the field? Dealing with the patients. “Every day, I just left clinical feeling really good.” She did not find rehab a grim setting. Despite the difficult situations the patients had been through, when they were with Le Blanc in rehab, “their defenses were down.” They were able to relax. “They’re so grateful for anything you can do for them.”

For her training, Le Blanc entered a combined program of Columbia University and Cornell University, rotating through several major hospitals. Along the way, she met Michael D. Stubblefield, M.D., then at Memorial Sloan Kettering Cancer Center, whom she considers another of her mentors. He is one of the authors of Cancer Rehabilitation: Principles and Practice (2009). Stubblefield “helped forge the field in physiatry,” Le Blanc says. “I’ve trained with two leaders in the field with different focuses.” Last year, she was one of the co-authors with Stub-blefield for a chapter on cancer rehabilitation in Current Diag-nosis and Treatment: Physical Medicine & Rehabilitation.

After such training, she believes, you often know “as soon as you walk in the room what the patient’s problem is.” One of the complications from cancer treatment that Le Blanc sees is post-mastectomy pain syndrome. It is frequently misdiag-nosed and, as a result, mistreated. This chronic pain can oc-cur after breast cancer surgeries – most prevalent after a lumpectomy – and removal of axillary lymph nodes. Both ra-diation and direct injury to the sensory nerves in the under-arm can cause the symptoms. As Le Blanc explains, “It’s like a stabbing, burning, squeezing that shoots across the chest in a band-like distribution.”

One of her patients, a young breast cancer survivor, was on high-dose narcotics but still was in pain and unable to have anything touch her chest area without severe discomfort. Le Blanc started her on a medication that specifically addressed the nerve pain. “After three weeks, the patient identified her pain as ‘level 2’ and was able to wear a bra and shirt.” But, more important, the patient was finally able to hold her baby close.

Le Blanc can also help patients before treatment, through “a prehabilitation program” to help minimize the risk that the patients will develop some of these complications. “If a patient is not tolerating treatment, it may need to be stopped,” she says. “If it’s better managed, the patient will stay on it.”

Aromatase inhibitors – which are estrogen blockers given to women with hormone responsive cancer to reduce the risk of recurrence – can also cause programs. At least one-third and possibly more of these patients develop symptoms very

similar to fibromyalgia, such as diffuse pain, fatigue, and “a foggy brain.” Joint pain associated with these drugs can be es-pecially crippling.

Daily activities, like walking, going down stairs, cooking, and cleaning, are now impossible without significant pain. “These women are often in their 30s or 40s but feel like they aged 20 to 30 years overnight. I hear that all the time,” Le Blanc says. “They go through physical therapy and pain medi-cation, but nothing helps.”

To relieve these symptoms, Le Blanc prescribes a neuro-pathic pain medication and an anti-inflammatory as needed, in combination with a specific program in physical therapy and occupational therapy. Often, when the women return for a follow-up visit three weeks later, “the difference is amazing.”

As Le Blanc emphasizes, aromatase inhibitors decrease the risk of that the cancer will recur, so it’s very important to stay on the medication. “Creating a plan to help them manage po-tential side effects can be lifesaving.”

“Oncologists save lives,” she says. “I help facilitate a return to a better quality of life.”

An ultrasound machine can visualize the tendons, ligaments, nerves, and bones that make up the shoulder joint.

FALL 2015 19

Robert M. Wachter, M.D. ’83, an internist and hospitalist, thinks he doesn’t take himself too seriously.

Some self-deprecating presentations bear him out.At the national convention of the Society of Hospitalist

Medicine last year, he donned a costume and wig, sat at a piano, and belted out his own words to the tune of Elton John’s “Your Song.” (“Sometime in the ’90s, / A new field was born, / Docs lived in the building / From nighttime ’til morn. / They called themselves ‘hospitalists’ — / Oh god, what a name! / But once they took over, / Nothing was the same.”)

The audience of some 3,600 gave him a standing ovation. When he received the Perelman School of Medicine’s

Distinguished Graduate Award in June, he spoke about how his own medical students gave him a comeuppance last year when he thought he’d shake them up a bit.

“You folks,” he intoned to them, “are entering a profession that will be profoundly different from when I entered medical school because you will be under relentless, unremitting pres-sure to deliver care of the highest quality, the highest safety, the highest patient satisfaction, and the lowest cost.”

Whereupon one of his charges raised his hand and said, “What exactly were you trying to do?”

He also recalled, three months into his own medical school career, meeting his first patient, at the Veterans Administration

Hospital: “So I said to the patient, ‘Why are you here?’ and he said, ‘I have gout,’ and I said, ‘What’s that?’”

His alumni audience roared at both stories. In his blog, Wachter’s World, he summed himself up by

recalling his undergraduate stint (B.A. ’79) as the Penn Quaker, mascot of the University of Pennsylvania: “I needed to be funny, quirky, ungraceful, and utterly without shame,” he wrote, adding, “These skills have served me well through my subsequent career.”

The other sideWachter does, however, take medicine seriously — “our sa-

cred charge,” he called it when receiving the alumni award. He is one of the creators of the term hospitalist, giving impetus to a nascent movement that has been hailed as the fastest-grow-ing specialty in medical history.

He edits two web sites for the Agency for Healthcare Research and Quality — AHRQ WebM&M, on confidentially reported medical errors, with commentary, and AHRQ PSNet, on pa-tient safety.

He is a professor of medicine at the University of California at San Francisco, where he holds the Marc and Lynne Benioff Chair in Hospital Medicine, serves as associate department chair (and interim chair, as of July), and heads both the medical

Bob Wachter is a professor, a hospitalist, an author, a blogger, a ruminator, an occasional performer . . . but his constant causes are quality and patient safety.

Welcome to Wachter’s World By Marshall A. Ledger

Photographs by Susan Merrell

PENN MEDICINE20

service at the UCSF Medical Center and the 60-plus-member Division of Hospital Medicine.

He was the first elected president of the Society of Hospital Medicine (1999-2000) and chaired the American Board of In-ternal Medicine from 2012 to 2013.

For these efforts, most others take his work – and him – seriously as well. He has won the nation’s top honor in patient safety, the John M. Eisenberg Award, from the National Qual-ity Forum, which serves to improve health care, and the Joint Commission, the U.S. accrediting organization for health care.

For seven years, Modern Healthcare magazine included him among the 50 most influential physician-executives in United States. In 2015, the magazine named him number one. A web site for health-care executives called him one of the “10 health-care bloggers we’re thankful for.”

In retrospect, Wachter’s career looks coherent, but it took him a while to discover how to integrate his interests in patients,

their care, health policy, systems thinking, and informatics. Happenstance often led him. Even he laughs and apologizes

when interviewing job candidates and asking about their five-year plans. He never had one.

Doctor and systemsGrowing up on Long Island, N.Y., Wachter knew his parents

would be proud if he became a physician, but he worried about that motivation. And despite volunteering at a local hospital, he felt he hardly knew what it was to be a doctor.

His parents, who socialized with doctors, admired them but also saw through them: “My dad would get dressed up for a cocktail party, and he’d look perfectly normal and about to go out, but he’d have his garage-door opener on his belt” — fitting in with, yet laughing at, the doctors, who had beepers.

As an undergraduate, Wachter took the science courses that medical schools required, but his intellectual heart was in his major, political science. He was drawn to “politics and the way systems worked and people thought and organizations did their thing.”

He credits John Eisenberg, M.D., G.M.E. ’77, for showing him how to weave these interests together. Eisenberg taught and practiced at Penn Med from 1975 to 1992, founded and led the Division of General Internal Medicine, and later headed AHRQ. In his work on physician practice patterns, patient safety, and health-care effectiveness, Wachter explains, he saw a way “to being a really good doctor and thinking about the way the system works.”

Even so, Wachter’s career started in a routine way. He vis-ited UCSF for a residency on a whim (Eastern Airlines had a $600 fly-anywhere-in-the-U.S.-for-a-month promotion); liked the more casual style of the West Coast; resisted the pull from his mother, “who thought even Philly was a little far”; and, in his fellowship period as a Robert Wood Johnson Clinical Scholar, began to think of fundable research projects and publications.

With a résumé that included peer-reviewed articles on the treatment of AIDS patients, he was appointed program direc-tor of the Sixth International Conference on AIDS, which UCSF hosted in 1990. Senior faculty members told him he’d learn “how the world works and how policy and politics work.”

He did learn that, but not because his advisers were prescient. AIDS activists, moved in part by the social advocate Larry

Kramer’s “Call to Riot,” descended upon the conference with “die-in” street protests. They heckled speakers and challenged the sedate expectations of the scientists and clinicians in at-tendance. The activists sought to change both attitudes about and government regulations against people with AIDS – and demanded to be included in the discovery processes toward treatment.

During the conference, Wachter kept notes, which he orga-nized into the 1991 book Fragile Coalition: Scientists, Activ-ists, and AIDS. Looking back, he calls it “an amazing and ulti-mately important story about this tension between experts and science and the community that’s affected by it and their efforts essentially to morph into one.”

FEATURE

The empowerment of patients and the questioning of scientific expertise will be part of the sociological land-scape for the 1990s, and not only in AIDS. Having our patients and our research subjects ask, or demand, to have an active voice in what we do and how we do it may be challenging, time-consuming, and even unpleas-ant. It is also undeniably right.

The Fragile Coalition (1991)

Bob Wachter as the Penn Quaker

FALL 2015 21

Reviewers credited Wachter for forging a relationship, how-ever tenuous, among the groups and pointing the way to non-adversarial health policy that includes patients.

Meanwhile, he turned his back on the standard research track, “the job you’re supposed to want,” he says. Ironically, it helped that a major proposal of his was turned down. It helped, too, that he felt “too social” to isolate himself while generating fundable ideas; he also realized he had organiza-tional skills. In 1992, he was made director of the residency program, yet he was feeling, in his words, “a little bit adrift.”

The hospitalist “thing”“Then the hospitalist thing happened,” he says. In 1995, his

new department chairman, Lee Goldman, M.D., M.P.H. (now head of the Columbia University Medical Center), appointed him to run the inpatient service at UCSF’s medical center and in particular to figure out how to re-organize it.

Goldman’s rationale: It hadn’t changed since he had been a resident there 20 years earlier, a sure sign of stagnancy.

In calls and conferences and visits to hospitals across the country, Wachter found an emerging model — an in-house doctor was taking over patient care. He thought it made sense, a generalist who was a specialist in care at one place.

When a UCSF colleague left to become a “hospital man-ager” across town, Wachter, struck by the odd title, inter-viewed him, then wrote about it and his other findings for the house-staff newsletter. Encouraged to redo the piece for a journal, he engaged Goldman as a co-author, and their semi-nal article, “The Emerging Role of ‘Hospitalists’ in the American Health Care System,” appeared in The New England Journal of Medicine in 1996.

The response was immediate – and sharply divided. Hospi-tal CEOs asked how to develop such a program. Doctors called, saying they had been doing the work for many years and thought they were the only ones. A group of family physicians in

Florida frankly didn’t want to manage their hospitalized patients and had just hired a young internist for that responsibility.

Among critics, primary-care doctors feared that patients would not want to be cared for by a physician they’d never seen, or the physicians simply wanted to continue caring for their hospitalized patients as in the past. Critical-care physicians saw a threat to their turf. Specialists feared fewer consultations.

Others worried that, without providing inpatient care, in-ternists would be indistinguishable from family physicians and nurse practitioners. Some suggested that hospitalists would become insular and miss advances emerging in medical specialties. Some worried about the continuity of care when patients left the hospital.

Wachter’s father happened to sum up the opposition’s bit-terness. As Wachter told Modern HealthCare, his proud fa-ther phoned to tell him excitedly about his tennis partner, a doctor: “He’d heard of you!” The senior Wachter paused, then added, “He hates you.”

“The article just gave voice to the idea that a trend was hap-pening,” says Bob Wachter. Primary-care doctors had little time to tend to their hospitalized patients; the worry about patients’ preferences “turned out not to be a big deal,” he says, although it’s still argued. Hospital administrators were trying to reduce length-of-stays and costs. Residents were less avail-able because their hours were being cut.

But health care’s path to computerization has been strewn with land mines, large and small. Medicine, our most intimately human profession, is being dehumanized by the entry of the computer into the exam room. While computers are preventing many medical errors, they are also causing new kinds of mistakes, some of them whop-pers. Sensors and monitors are throwing off mountains of data, often leading to more confusion than clarity. Pa-tients are now in the loop – many of them get to see their laboratory and pathology results before their physi-cian does; some are even reading their doctor’s notes – yet they remain woefully unprepared to handle their hard-fought empowerment.

While someday the computerization of medicine will surely be that long-awaited “disruptive innovation,” to-day it’s often just plain disruptive: of the doctor-patient relationship, of clinicians’ professional interactions and work flow, and of the way we measure and try to improve things. . . .

Before I go any further, it’s important that you under-stand that I am all for the wiring of health care.

The Digital Doctor (2015)

Decades of research, mostly from outside health care, have confirmed our own medical experience: Most errors are made by good but fallible people working in dysfunc-tional systems, which means that making care safer de-pends on buttressing the system to prevent or catch the inevitable lapses of mortals. This logical approach is common in other complex, high-tech industries, but it has been woefully ignored in medicine.

Instead, we have steadfastly clung to the view that an error is a moral failure by an individual, a posture that has left patients feeling angry and ready to blame, and pro-viders feeling guilty and demoralized. Most importantly, it hasn’t done a damn thing to make health care safer.

Internal Bleeding (2005)

PENN MEDICINE22

In early 1997, Wachter and others sketched out a specialty, with its own organization, journal, training programs, text-books, and conferences. “It just grew. I knew it would,” he says. But the field had to offer physicians something more lofty and inspiring than saving money. “I really worried quite deeply about that.”

The answer came when the Institute of Medicine, in 1999, issued To Err is Human: Building a Safer Health Care System. The report estimated that medical errors cause as many as 98,000 deaths in the United States annually.

“We need to own this,” Wachter recalls thinking. “We have the opportunity: a brand-new field — in hospitals, which are going to be the epicenters of improving quality and safety and where the hazards are the greatest. We have the opportunity to brand our field as being about improvement.”

The mantra became: “We have two sick patients: the person you take care of in the building and the system you’re in.” As Wachter observes, “That turned out to be a good call.”

When he was doing his study, there were an estimated 500 hospitalists. Today, according to the American Hospital Association, the number now approaches 50,000, defined in Wachter’s words as “physicians whose main professional focus is inpatient care.”

FEATURE

When I was a medical resident in the 1980s my col-leagues and I performed a daily ritual that we called “checking the shoebox.” All of our patients’ blood test results came back on flimsy slips that were filed, in rough alphabetical order, in a shoebox on a small card table outside the clinical laboratory. This system, like so many others in medicine, was wildly error-prone. Moreover, all the things you’d want your physician to be able to do with laboratory results — trend them over time; commu-nicate them to other doctors, patients, or families; be re-minded to adjust doses of relevant medications — were pipe dreams. . . .

For those of us whose formative years were spent rum-maging through shoeboxes, how could we help but greet health care’s reluctant, subsidized entry into the computer age with unalloyed enthusiasm?

The Digital Doctor (2015)

A professor of medicine at UCSF, Wachter also heads the medical service at its Medical Center.

FALL 2015 23

Some are well-placed, such as Patrick Conway, M.D., the chief medical officer of the Centers for Medicare & Medicaid Services (who earned an M.Sc. degree in health services re-search from Penn In 2007); and the U.S. Surgeon General, Vice Admiral Vivek H. Murthy, M.D. “And,” Wachter points out, “this is a pretty young field.”

According to Wachter, there is substantial evidence that care has become safer in the past several years, demonstrated by fewer adverse events; falling mortality rates in hospitals; and marked improvements in certain safety targets such as central line infections, sepsis, and falls. “I don’t know how much of that is due to hospitalists,” he adds, “but I think they have had a role — and they increasingly are taking on leader-ship roles in safety and quality because of their work in these areas.” At UCSF, for example, the chief quality officer, the chief patient-experience officer, the chief medical officer for adult care, and the chief medical information officer – four of the senior physician leaders in quality/safety/IT – are hospi-talists.

Yet the field hasn’t finished evolving and most likely won’t. For instance, Wachter still hears criticism that hospitalists create a “discontinuity” between patients and their prima-ry-care doctors. Wachter’s response: “You have to figure out how to make the communication work – but people who crit-icize it, I’m always fine with that, because it’s not perfect.”

“To me,” he says, “the touchstone is value. I’m relatively ag-nostic on whether it’s hospitalists or something else. It’s what system delivers the best care at the lowest cost. And that should win. Right now, hospitalists do that better than the old system. Will it be that way forever? Who knows?”

Becoming a better writer Since then, Wachter has mined the essentials of the spe-

cialty. He served as lead editor of the text Hospital Medicine

in 2005; wrote Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes (2005; with Kaveh G. Shojania, M.D.); and wrote both the primer Understanding Patient Safety (2007, 2012) and The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age (2015).

His topics are urgent, but even more, his writing is compel-ling (the word Terrifying was supplied by publisher). He draws from many fields, writes directly, and has an eye for everyday examples and an ear for humor and irony. He generalizes convincingly.

He understands sentence rhythms and plays them sharply or lyrically (or ornately, in a self-mocking way). He has a brawny ego yet is upfront about his shortcomings. An insider, he doesn’t write like one. He assumes that the physician reader appreci-ates good prose and the lay reader is intelligent – and both audiences respond.

He’s also open to advice. In 2002, The New York Times wrote about “The Wrong Patient,” a series on medical mis-takes that he edited for the Annals of Internal Medicine. A publisher called Wachter to propose a book on the subject. Wachter wrote three chapters in what he felt was honest and flowing prose on interesting cases.

The publisher replied in an e-mail with “I hope you’re sit-ting down” in the subject line. Over three pages, he faulted Wachter’s lack of candor. He found the text “dripping with caution.” He figured that Wachter didn’t want to annoy doc-tors or nurses or administrative leaders and concluded, “Ei-ther do this right or get out of my face.”

Wachter winced. “I haven’t been talked to that way very of-ten,” he says. Colleagues were only partly consoling. “He’s an ass,” they told him, “and he’s completely right.” Wachter dropped the caution. The result was Internal Bleeding, which readers praised for its style, warmth, and frankness (the au-thors described their own mistakes), as well as its message.

When I was a medical student in the 1980s, the beating heart of the Hospital of the University of Pennsylvania was not the hospital’s mahogany-lined executive suite, nor the dazzling operating room of L. Henry Edmunds Jr., HUP’s most famed cardiac surgeon. No, it was in the decidedly unglamorous, dimly lit Chest Reading Room, where all the x-rays were hung on a moving contraption called an alter-nator that resembled the one on which the clothes hang at your local dry cleaner. Controlled by a seated radiologist operating a foot pedal, the machine would cycle through panel after panel until it arrived at your films. The radiolo-gist took his foot off the pedal, the machine ground to a halt, and the dark x-ray sheets were brought to life by in-tense backlighting.

Saying that HUP’s epicenter was the Chest Reading Room is a bit unspecific. It really was in the seat of the late

Wallace Miller Sr., a crusty but endearing professor of ra-diology and one of the best teachers I’ve ever known. . . .

At Penn in the 1980s, everybody – and I mean everybody, from the lowliest student to the loftiest transplant surgeon – brought films to “The Wal” to decipher. For students like me, time spent with him was at once exhilarating and terri-fying. “What’s this opacity?” he asked me once, the mem-ory burned into my hippocampus by that cognitive curing process known as overwhelming anxiety. “A . . . a pneumo-nia?” I stammered. “Mooiaaa,” retorted The Oracle, an un-forgettable signature sound that was uttered as Miller smartly turned his head away in mock disgust. I loved it. We all did.

The Digital Doctor (2015)

PENN MEDICINE24

For The Digital Doctor, Wachter received sage guidance from his wife, Katie Hafner, who has written even more books than he (six) and who writes on health care for The New York Times. When he told her his idea, she replied, “The only way you’re going to get this story right, the only way it’s going to be interesting, is to go out and talk to people.”

“As soon as I started doing that,” he acknowledges, “it was immediately obvious that she was right.”

He interviewed 94 people (listed in the book), quarried his own experience, consulted history (tracing patient notes from their Greek origin to the present), and visited computer and other companies, physician practices, and hospitals, including his own, where the book’s centerpiece patient error occurred because of, not despite, the latest technology.

Computers, Wachter concludes in The Digital Doctor, pre-vent some mistakes of the past but create new ones. The error he explores was the result of bad software and a glut of false alerts to patients’ situations, which lulled hospital personnel from paying proper attention to genuine crises. Computers have

also distanced doctors from patients as well as from each other.He argues for “a thoughtful use of technology.” For instance,

better communication with software engineers for “user-cen-tered design.” Most people are good people trying to do the right thing, he says, but things can go wrong when those in-volved see only through their own lens. Another recommen-dation: doctors should get their heads out of their computer screens and back to facing their patients.

Enabling him to investigate and discuss a near-fatal error was “an act of incredible organizational bravery” on UCSF’s part, he says, and the feedback “has been universally good. It was the right thing to do.”

“On the other hand,” he adds, “we got a letter from the Joint Commission saying, ‘Can you tell us a little more about it?’ — as if UCSF’s actions and standards were problematic.

The Commission’s response “is a little disappointing,” Wachter says. “I would hope that the incentive system out there would be one in which this kind of thing is praised, be-cause that’s the way we’re going to get better.”

FEATURE

A physician and a blogger, Wachter encourages “a thoughtful use of technology.”

FALL 2015 25

THE PATH TO PENN MEDICINE

By John Shea

Photos by Peggy Peterson

She went to Egypt to become fluent in Arabic – then had to flee the country when a revolution broke out. He was a peer tutor in physics at Penn – and a disk jockey at the stu-dent-run radio station. She led a group of high-school girls to South Africa, where they interviewed people who had lived through the nation’s grim apartheid period. She was a cellist in her university’s orchestra. He was a member of the Yale Climbing Team. She was a co-captain of Fordham University’s varsity soccer team.

Members of the incoming class share the goals of advancing health care and biomedical research, but their backgrounds and experiences vary greatly.

Today, they are all members of the Perelman School’s Class of 2019. Not your typical background for aspiring physicians?

Each year at the White Coat Ceremony that officially wel-comes the new students into the medical profession, Gail Morrison, M.D. ’71, G.M.E. ’76, provides an overview of the entering class. This year’s class of 156 students is composed of slightly more men than women, ranging in age from 20 to 36 years old. About 15 percent plan to pursue a combined degree (M.D.-Ph.D.). Students come from 65 different undergraduate colleges and universities across 25 states. About 68 percent de-clared science as their college majors. Among the incoming students are campus leaders in government, political organiza-tions, and community groups. Many were varsity athletes, in sports ranging from soccer, football, and lacrosse to saber and gymnastics. Many have shown talent in diverse artistic and musical fields. Continuing a recent trend, many in the class took a year or more off from their formal studies after college. Some spent that time working at the National Institutes of Health or at top academic health centers; others worked in pharmaceutical and biotech industries. Significantly, most of the students, as Morrison put it, “have been extensively in-volved in community service both in the U.S. and abroad . . . to help the underserved populations of the world.”

PENN MEDICINE26

Here are brief accounts of how some members of the Class of 2019 found their way to the field of medicine and to Penn Medicine.

For Amanda Labora, who grew up in Miami, the desire to practice medicine was greatly influenced by her travels to some very different places. As a high-school student, she had taken part in an exchange program in Turkey because of her broad interest in the Middle East. Then, in 2011, as an under-graduate majoring in history at Brown University, she went abroad again – and got much more than she expected. At first, she was in Egypt, which she chose because she wanted to become fluent in colloquial Arabic. She was enrolled in an immersion-style course where the students were not allowed to speak any English. But when the revolution against the re-gime of President Hosni Mubarak began, there were violent clashes between protesters and government forces; police sta-tions were burned. Labora tried to con-tinue her education in Syria, but civil war was breaking out there as well, between President Bashar al-Assad’s government and several opposition groups. Today, she says, she could not return to the Da-

mascus that she knew – parts of the city where she had been were destroyed.

Back in the United States, Labora worked as a scribe at Rhode Island Hospital, the main teaching hospital for Brown University’s Warren Alpert Medical School. Medical scribes help with billing and discharge and document the procedures. That allows the physicians to be more focused on the patients and less concerned with charting. Labora found the experi-ence very useful: she learned some “medical lingo” and ob-served how the physicians could rule out certain underlying causes swiftly and why they would order certain tests. But she also had what she calls “the unfiltered view of what’s going

FEATURE

Traveler to the Middle East

FALL 2015 27

on.” Some patients had no insurance coverage, some were homeless, some fought drug and alcohol addictions. Labora found parallels between what had happened to the people in Egypt and Syria and what she saw with the people who came to the hospital’s emergency department. In particular, she was inspired by the physicians’ ability “to bear witness to suffering and provide compassion despite the chaos around them.”

As a dual citizen of Mexico and the United States, Labora appreciated the talk Jack Ludmir, M.D., G.M.E. ’87, gave at this year’s White Coat Ceremony: he spoke about giving back to the Latino community and trying to overcome the barriers to health care that many still face in our nation.

Sabrina Layne, originally from New York, came to Penn from Stanford University, where she majored in human biol-ogy. For her, medicine has always been a presence – both of her parents are physicians. She grew up in that environment and used to go on rounds with them. She found she loved sci-ence and explored plant biology and epigenetics for a while

but discovered she was more of a “people person.” As an un-dergraduate, she says, “I was all over the map” and considered history as a major, but she was ultimately drawn to health care through her experience volunteering at a student-run health clinic.

In high school, she heard a documentary filmmaker talk about her work on obstetric fistula, a hole in the birth canal that affects from 50,000 to 100,000 women worldwide. Layne felt what she called “an initial spark,” and she began to think beyond one-to-one patient interactions to broader global and public health issues. Some of the issues involved in global health, she has come to understand, are present “in our own backyard.” After her sophomore year at Stanford, she and a friend created their own qualitative research project, investi-gating public health services in Cape Town, South Africa. Coming face to face with the consequences of violence and abject poverty, they were inspired by the resilience of commu-

nity members. Interviews of community members and health workers provided the basis of Layne’s honor thesis, which fo-cused on access to health care.

During her busy undergraduate career, Layne played club tennis, volunteered at the Pacific Free Clinic, and was an advisor for Human Biology students, among other pursuits. Another item on her list of accomplishments: she served as an intern for a state senator in New York, analyzing health policy. While at Stanford, she was a teaching assistant for a course called Critical Issues in Child Health. After graduation, she remained there as a course associate, teaching Human Biology.

Michael Stephens, who majored in biology at Thomas More College in Kentucky, didn’t have a particular experience that set him on a path to medicine. In college, he had taken more analytical classes, like math, but he felt an innate desire to be able to help others, to be “more service-oriented.” Going into medicine seemed, he says, “a perfect intersection” of what he was good at and what he felt gave him a purpose. In addition to going to Guatemala to distribute donated clothing and tu-tor students, he was a research intern at Cincinnati Children’s Hospital. There he studied protein purification and shadowed some of its physicians, and he has an author’s credit for a sub-sequent article in PLOS One. Stephens earned a perfect score on the national American Chemistry Society exams.

What did he do when he was not studying or volunteering? He was president of the Thomas More College Student Gov-ernment Association – and played NCAA Division III tennis. One of the perks of going to a small liberal arts college, he

“She had an “unfiltered view of what’s going on.” Some patients had no insurance coverage, some were homeless, some fought drug and

alcohol addictions.”

Health Policy Analyst

Student Government President

PENN MEDICINE28

points out, is that he had many opportunities to try different things. And he apparently was very accomplished in several: he was a peer tutor in math, chemistry, physics – and, in a very different field, Latin as well.

When Claire Hirschmann says she took “a pretty nontradi-tional route” to medical school, she’s not exaggerating. Originally from Washington, she was an English major at Yale University. In addition to being captain of the Yale women’s Ultimate Frisbee

team, she became leader of Yale’s Freshman Outdoor Orienta-tion Trip program and taught sections on preventing substance abuse as a Yale community health educator. “I totally fell in love with teaching,” she says, particularly history and literature. But it was not precisely the kind of teaching familiar to most of us, where the class meets in a room. Hirschmann preferred a full immersion. With The Traveling School, a study-abroad program for high-school girls, she led students to South America and to South Africa, where the educational process involved interviewing people who had lived through South Af-rica’s apartheid and even restaging battles to further engage the students. Back in the United States, she earned a master’s degree at Harvard’s Graduate School of Education, focusing on school leadership and development. The next step was found-ing – with two other visionary women – The Field Academy, a traveling high-school program in Portland, Maine, that combines academics and place-based education. To explore what it means to be an American citizen, for example, Hirschmann brought students to Appalachia to see what it means to be a coal miner, what it means to be in a union, what happens when the top of a mountain is blown off to expose seams of coal. What may have been only cerebral to students, Hirschmann says, suddenly became real to them.

Hirschmann’s decision to apply to medical school, however, did not come out of the blue. Her father is a physician, her mother a former nurse practitioner. Hirschmann was a volun-teer with the Portland Trauma Intervention Program, on call with the police and fire departments and local emergency

room. Sometimes she dealt with the patients themselves, more often with their families. She learned how to ask sup-portive questions and serve as a go-between for the families. In many cases, she says, “there was no way to make it better, but you could make it potentially less bad.” When she enrolled in a post-baccalaureate program at Goucher College, she was also a volunteer with the University of Maryland Shock Trauma Center. She is certified as a Wilderness First Responder as well, which has led her to think about the fields of disaster relief medicine and adolescent medicine, which would also make use of her teaching experience.

The cello has played a major role in the life of Jee Yoon (“Gina”) Chang. She began lessons in second grade; performed during orchestra tours of Europe; gave private lessons on the instrument to underserved students; and became principal cellist for the orchestra at Washington University in St. Louis. Cello and Chang seemed a very natural fit, but it could have been much different! When she was first presented with a choice between violin and cello, she remembered that a friend of hers who played violin had to stand – and Chang thought playing sitting down made more sense. Despite all the demands during college, she learned how to budget her time and balance responsibilities, and she says playing the cello was calming and steadying.

At Washington University, Chang’s major was biology. She especially enjoyed a lab in neurophysiology, very hands-on,

FEATURE

Wilderness First Responder

CLASS OF 2019 STATISTICS

53% 47%Male Female

PA Residents

Underrepresented in MedicineIncluding: Black, Mexican American, Puerto Rican, American Indian, Native Hawaiian, Other Hispanic

85%Non PA Residents

15%

23% Asian28%

Non-Science Majors

For Combined Degree

32%Post-Baccalaureate

Studies

36%15%

FALL 2015 29

with animal models. She was also a teaching assistant her junior year for a sophomore biology course called “Physiological Con-trol Systems.” One of her responsibilities was doing the prob-lems with the students – “one of my favorite parts,” she says, getting feedback from them and becoming more comfortable with public speaking. Chang also worked in the lab of a neu-rologist, Beau Ances, M.D. ’01, Ph.D. ’00, who was particularly interested in the damaging neurological effects of HIV. But at the same time, she took many courses outside science and mi-nored in Ancient Studies, studying Greek and Roman history. One of her courses was “Magicians, Healers, and Holy Men.”

Like many of the new students in the Perelman School, Chang has had experience as a volunteer abroad. She was in

Peru and Argentina. In Argentina, she spent six weeks shadow-ing pediatric general surgeons. In Peru, she served as an inter-preter, instructed children how to brush their teeth correctly, and translated for a physical therapist. In the United States, she has taken part in the Clinton Global Initiative University, where college students meet to talk about world challenges and possible solutions. With her background, Chang is inter-ested in earning a master’s degree in public health.

Originally from Connecticut, David Steinmetz was a Bio-logical Basis of Behavior (BBB) student at Penn – and in fact he did research on the 8th floor of the Smilow Center for Translational Research. He had some sense of medicine from very early on. His father, an internist, “planted some seeds.” From him, the young Steinmetz learned, much to his relief, that doctors “aren’t there just to make people cry and give shots.” But his father died when Steinmetz was four years old. His mother became a role model, demonstrating positive spirituality throughout those difficult times. Then his mother was diagnosed with breast cancer when he was going to college,

“As a volunteer with an intervention program, on call with the police,

she learned how to ask supportive questions and serve as a go-between

for the families.”Principal Cellist

PENN MEDICINE30

and Steinmetz appreciated all the more that having good health and being “an agent of good health” was more important than seeking money and power.

As a Penn undergraduate, Steinmetz was a member of a Medical Emergency Response Team, a peer tutor in physics and statistics, and a research assistant in radiation oncology. Part of the research involved looking for new assays that would contribute to better prediction of risk and clinical man-agement of cancers. He was also named a Benjamin Franklin Scholar. According to the program’s site, the Scholars “are se-lected based on their interest in, and demonstrated capacity for, a deep engagement in the liberal arts and sciences, both as ends in themselves and as engines of change in the world.”

He appreciated the BBB major because it allowed students to range and try out different classes. One example he notes was a history of the American South, which intrigued him.

But Steinmetz also made time for non-academic pursuits. He played Club Ultimate Frisbee and was a disk jockey for Penn’s student-run radio station, WQHS. His specialty? Live recordings of the Grateful Dead.

Katherine – Katie – McDermott comes to the Perelman School from Arizona, by way of Fordham University. Her fa-ther and both of her grandfathers were doctors. As an under-graduate, she was captivated by psychology and she became interested in studying racial and socio-economic disparities, especially as they affected adolescents. She also was skilled enough to be a co-captain on the women’s varsity soccer team. Her early clinical experience came as a counselor at Planned Parenthood. McDermott provided women and girls the results of their urine pregnancy tests and counseled them on their options: continue the pregnancy and parent the baby, terminate the pregnancy, put the baby up for adoption, etc. “It was really jarring to see so many women without access to health care,” she says. Often, they were underprivileged, with no other place to go. McDermott notes that the experience

helped her learn how to talk to people who did not have a medical background.

In addition, she gained experience as a summer research assistant at the National Institutes of Mental Health. There she trained and accompanied research subjects in MRI scanning, recruited volunteers, acquired consent forms, and initiated a small genetic analysis. At Massachusetts General Hospital, she helped coordinate research trials investigating new treatments for autism spectrum disorders, bipolar disorder, and ADHD. She also handled correspondence with the hospital’s institutional review board as well as the FDA and the NIH. McDermott herself became a voting member of the IRB: she presented re-search protocols, assessed studies for safety and ethics, and voted if the research should be continued.

When she was convinced of her career direction, McDermott enrolled in the pre-med program at Bryn Mawr College. Penn Med named her a Harrison Surgical Scholar; the program was established to expose post-baccalaureate students to all aspects of clinical surgical research. Her experience working with Penn cardiac surgeons as a Harrison Scholar was a major factor in her decision to come to Perelman.

Matthew Kubicki was raised in Kentucky. His parents came to the United States from Poland in the 1980s and both became mathematics professors at the University of Louisville. Kubicki was drawn to “hard sciences” and was a Molecular Biophysics and Biochemistry major at Yale. But it was not all serious work: he was on the Yale Climbing Team and helped coordi-nate various intramural sports.

Kubicki was interested in service as well: he took part in a hypertension awareness and prevention program while at Yale, doing blood-pressure screenings and getting involved in community education. He also was an academic associate at the Yale Eye Center, where he helped with clinical studies and shadowed physicians. He vividly recalls one of his own experiences shadowing an ophthalmologist – on this occa-sion, the anesthesia used in the surgical procedure didn’t work. “That was really scary!” he says. Fortunately, the patient

FEATURE

Peer Tutor in Physics

Varsity Soccer Co-Captain

FALL 2015 31

recovered. While shadowing a pediatric surgeon, Kubicki says, “I understood the God complex for the first time.” Surrounded by music of his choice, indulging in some dark humor, the surgeon was operating on the five-year-old child’s spinal cord, “100 percent convinced” that the child would be walking fine in just a few weeks. But the experience helped inspire a per-sonal realization for Kubicki: science is great, math is great, research can help people in the long run – but this surgeon was changing someone’s life in a very short time.

Increasingly, Kubicki was drawn to “the more human side of medicine.” He recalls doing patient screenings in New Haven, working with the poor and the uninsured, “who sometimes didn’t want to have anything to do with us.” At a soup kitchen, he was impressed when a worker was able to calm an alcoholic visitor and listen to her troubles.

Kubicki comes to Perelman with a solid background in re-search. He started doing research after his first year at Yale and continued throughout his time there. After graduation, he studied the effects of mutation on protein function as an In-tramural Research Training Associate at the NIH.

Another member of the Class of 2019 who went through the pre-med program at Bryn Mawr College is Mariah Owusu- Agyei. While she was there, she was also volunteering at Bryn Mawr Hospital. “I love the way you get to help people,” she says. And like David Steinmetz, she already was familiar with the University of Pennsylvania, having majored here in eco-nomics. But she did have farther to travel to medical school than most of her classmates: she was born in Ghana, in West Africa. How did she come to the United States? “My family won the lottery!” she says, then explains about the Diversity Immi-grant Visa Program, administered annually by the Department of State. It provides a maximum of 55,000 Diversity Visas each fiscal year to be made available to persons from countries with low rates of immigration to the United States. Her mother was interviewed by the American authorities. She must have been persuasive, because the family received the visas. Owusu-Agyei

was seven years old when she left Ghana and arrived in the South Bronx. It was drastic change, but, she says, “I thought it was heaven.”

She was raised a Seventh-Day Adventist, and her family found a Ghanaian church of that denomination in the Bronx. She took part as a child, then, when she was older, became a leader. When she entered Penn as an undergraduate, she joined a similar church in Philadelphia and volunteered with the children. Among the activities, they produced a play based on the biblical story of the Good Samaritan. Owusu-Agyei did the writing – sticking to the Bible’s outline but dramatizing the story. The lesson, she says, was to underscore that people should help anybody in need, no matter what apparent differ-ences there may be.

Owusu-Agyei always wanted to be a doctor, she says. Her parents wanted that, too, and an older brother who came to the U.S. is now a doctor as well. But the financial crisis of

2007-08, when she was in high school, got her to thinking. She also took part in the High School Fed Challenge, a program of the Federal Reserve Bank of New York, in which students competed to offer ideas on financial actions that should be enacted. After her freshman year at Penn, she was an intern at the New York Stock Exchange. As a research assistant at Penn’s Leonard Davis Institute of Health Economics, she studied the Affordable Care Act, collecting data.. The experience, she says, was eye-opening, but it gave her a fuller sense of the im-pact of economics on health. Even after graduating from Penn, she was a financial analyst with Citigroup. But she came to realize “that’s not really what I wanted to do.”

What she did want to do is pursue medicine. In fact, her dream is her family’s dream as well. “My entire family is in-volved in health care in some way,” she says. One sister is a nurse practitioner. Another brother is an architect, and the family’s vision is to have him design a clinic in Ghana. There, the other siblings would provide services to those in need. In short, inform and empower the people and help them to heal.

Member of the Yale Climbing Team

Financial Analyst

PENN MEDICINE32

William Carlos Williams distin-guished himself in two very different fields. His example can be an inspiration for experienced physicians and medical students alike. His advice for both doctors and writers: deal in particulars.

By John Shea

In the 250 years since its founding as the first medical school in America, the Perelman School of Medicine has produced many alumni and trainees who have gone on to gain the high-est honors in a variety of medical fields. So far, however, there has been only one to achieve eminence in the field of litera-ture. A seemingly tireless writer who produced many volumes of poetry, prose, drama, and autobiography, William Carlos Williams, M.D. 1906, was posthumously awarded the Pulitzer Prize for Poetry in 1963 for Pictures from Brueghel and Other Poems. Along the way, he also received the Gold Medal for Poetry from the National Institute of Arts and Letters and the National Book Award for Poetry. And all the while, Williams maintained a long practice in pediatrics and general medicine and was for many years chief of pediatrics as what was then known as Passaic General Hospital in New Jersey.

In many ways, Williams, born in Rutherford, N.J., remained a Jersey boy. He entered Penn’s medical school in 1902, after a special examination, when he was only 18. After earning his

M.D. degree, he did internships at hospitals in New York City and traveled to the University of Leipzig for advanced study of pediatrics. But New Jersey drew him back and was his base for the rest of his life. For nearly 40 years, he served as chief of pediatrics at what was then Passaic General Hospital.

Although Williams had written some poems before enter-ing medical school, it was at Penn that he met one of the peo-ple who had the most influence on his writing. Ezra Pound, whose brilliant career as a poet was eventually overwhelmed by his fascist sympathies, was then an undergraduate. But the young Pound’s outspoken ambition and ideas on poetry and literature proved attractive to the young medical student. Wil-liams began to look beyond traditional verse of rhyme and meter and to try different forms. Despite Pound’s champion-ing of things European, Williams sought to develop a more “American” style, full of concrete images and details, sometimes using a more common American speech. He acknowledged the significance of a modernist poem such as T. S. Eliot’s

In Equal Parts: Physician and Poet

Excerpts by Williams from The Collected Poems of William Carlos Williams, Vol. 1, 1909-1939. Copyright New Directions Publishing Corp.

FALL 2015 33

The Waste Land, but Williams was determined to write po-ems that did not require, for example, knowledge of mythol-ogy. As he later phrased it: “No ideas but in things.”

What Is the Writer’s Business?It’s likely that Williams’s career as a physician had some-

thing to do with his artistic credo. An article on him in The New York Herald Tribune (January 18, 1932) began this way: “Medicine and literature make the best possible combination in a man’s life, according to Dr. William Carlos Williams.” Later in the piece, Williams is quoted: “It seems to me that writing complements the doctor’s life so well. When you are tormented by people’s illnesses, it is a relief to be able to write your emotions down. Even surgery has its poetic side.” The Herald Tribune also noted that he would sometimes jot down his poetic ideas on prescription pads between calls. Later, Williams said that he wanted to write about the people who were close to him, not in the abstract. “That is the poet’s busi-ness. Not to talk in vague categories but to write particularly, as a physician works, upon a patient, upon the things before him, in the particular to discover the universal.”

This does not mean that all of Williams’s work is crystal clear. Even Pound, in fact, criticized one of his books as “inco-herent.” Williams would also mix genres, which could throw some readers off. One of his more daunting works may be Pa-terson, eventually consisting of five volumes, all about the people, geography, and history of the New Jersey city. It even includes letters from another New Jersey poet who attained fame, Allen Ginsberg.

One of Williams’s poems that is often anthologized demon-strates his urge to avoid the grandiose and obscure, to speak more directly but artistically. “This Is Just to Say” could very well have been dashed off on a pad (not necessarily one for prescriptions) and stuck on a refrigerator:

I have eatenthe plumsthat were inthe icebox

and whichyou were probablysavingfor breakfast

Forgive methey were deliciousso sweetand so cold

A poem that seems to allude to his other profession appears in an early collection called Spring and All (1923). It begins “By the road to the contagious hospital.” Williams then evokes a rather bleak landscape, with cold winds, dried weeds, trees “with dead, brown leaves under them.” Then in the short poem comes the turn: “Lifeless in appearance, sluggish / dazed

spring approaches –” Spring is not yet an obvious powerful force, but there is a growing sense that things are starting to change. The last lines:

One by one objects are defined --It quickens: clarity, outline of leaf

But now the stark dignity ofentrance -- Still, the profound changehas come upon them: rooted theygrip down and begin to awaken

Here the lack of a period at the end of the poem seems quite functional!

A Legacy Lives OnThe University of Pennsylvania did not overlook Williams’s

achievements in his chosen fields. In 1952, he received an honorary degree. More recently, the poetry prize for the best original poems by a Penn graduate student (in any school) was named the William Carlos Williams Prize, presented jointly with the Academy of American Poets.

The spirit of Williams lives on at Penn Medicine in a differ-ent way as well. A fourth volume of Stylus, which describes it-self as “a medical humanities literary and art journal,” has re-cently been posted. Most of the contributors in the new issue are medical students and Ph.D. candidates here. The editors have connections with the University and with medicine. The founding editor, Yun Rose Li, is a fifth-year M.D.-Ph.D. candi-date at the Perelman School. She is finishing her clinical train-ing after having completed her doctoral dissertation in ge-nomics and computational biology. There are also pieces by an assistant professor of clinical neurology at HUP and a staff chaplain at HUP. The faculty advisors are Horace DeLisser, M.D. ’85, associate professor of Medicine and head of Penn Med’s Spirituality, Religion, and Medicine program, and Zach-ary Meisel, M.D., M.P.H., assistant professor of Emergency Medicine and a frequent columnist for Slate and for Time.com.

The form and topics of the new Stylus vary widely, and many catch your attention. One of the prose pieces that touches most directly on the practice of medicine is “Grey Zone of the White Coat,” by Avi Baehr, a medical student at the Perelman School who is completing a fellowship in health policy in Washington, D.C. Here she grapples with one of the inevitable responsibilities of the physician, being able to pick yourself up when a patient’s condition worsens and to prepare to face your next patient with full attention:

This was my first real taste of what it can mean to don the white coat and have the privilege of practicing medicine. It means seeing a horrible thing happen to a grandfather with a kind face. It means walking across the hall and plastering on a smile because I’ve committed not only to do-no-harm but to do good by that other patient, too. And he needs to have that re-assurance that my mind isn’t elsewhere. It means sitting down with a wife while her husband is in surgery and saying, “I’m so sorry this happened to you,” knowing she isn’t hearing a word

PENN MEDICINE34

FEATURE

that’s coming out of my mouth but hoping that she derives some small comfort from my stopping by in a crisp white coat with a stethoscope around my neck.

Dr. Williams would no doubt sympathize.Putting her piece in context, Baehr says, “While I’ve seen a

lot of really difficult things throughout my time in medical training, there have been a handful of experiences that have really stuck with me. I have found it incredibly cathartic to write about the experience. It’s something I do on the side in my free time, and mostly just for myself. However, I have sub-mitted these essays for publication a couple of times, when I think that the experience might resonate with others as well.”

Daniel Child is the author of “Blood,” which surprisingly combines some fairly precise medical terminology (isopropyl alcohol, the polypropylene parasite, clotting factor V) with al-lusions to medieval heresies (that fiend Cathar, auto-da-fé, inquisition). The youthful narrator expresses confidence that there is no trace in his blood of “the heretic / that infiltrated my family generations ago”; but then recalls that complacency “allowed the dissident’s influence to send my genetic prede-cessors to the hospital for their last time.”

Child is now in the Ph.D. phase of his M.D.-Ph.D. training, with an interest in genetics and gene regulation. “Most of my writing efforts over the past year have been directed to a sci-entific end,” he says. “Fortunately, I enjoy the process just as much as I enjoy writing creatively.” He has read and enjoyed many of Williams’s poems and short stories. “His works have taught me a deeper understanding of empathy and compas-sion, the magic of genuine human relationships, and the sa-credness of the individual.” These themes, Child acknowl-edges, are not unique to medicine, “but they are attributes that seem to define the caring physician.” For himself, Child

has found the creative process to be therapeutic: “Putting ex-periences and emotions onto paper enabled me to contend with challenges I didn’t realize I was facing.”

How Did Williams Do It?“Plastic Bags,” a poem by Ayoosh Pareek, makes use of a

ubiquitous and perhaps overly familiar object of contempo-rary life:

There is something fascinating about plastic bags, Floating in the stratosphere, symbols of plastic love,

discardable affection.

So begins the poem, which hints at dislocation, attempts to es-cape a reality, “drowning yourself,” “the inability to breathe.” One startling image that is both matter-of-fact and somewhat surreal: “Nothing resembles us more than a recently used ashtray.”

Pareek reports that “The Red Wheelbarrow,” one of William Carlos Williams’s most anthologized poems, was one of the first poems Pareek ever read. He enjoyed creative writing in high school and at Brown University, where he took a course taught by the poet laureate of Rhode Island. He also joined WORD!, a spoken word group at Brown, “because I thought I needed to explore other creative venues and expand my horizons.” Even in medical school, he has been typically writ-ing a poem every week. On the other hand, he’s not sure whether he will be able to continue writing while he pursues a career in orthopaedic surgery. “It’s hard for me to imagine how Williams did it,” Pareek notes, “especially being the pro-lific author that he was.”

But, like Williams, he hopes to be in it for the long haul.Sara Rendell is a medical students as well as a Ph.D. candi-

date in cultural anthropology. For her, Williams has been “a huge inspiration,” and she marvels about his ability to write in the midst of a busy career. Rendell wrote her poem “Brush Strokes” while taking a break from studying histology slides as a first-year medical student. She was, she says, “both en-tranced by the complexity and beauty of what I was learning and overwhelmed by how quickly my tenuous grasp of any chunk of information could evaporate.”

We do not memorize, we sweep details-- dust trapped in cobwebs, nestledbetween floor planks, abandonedin the cabinet’s shadow. . . .

Perhaps even more frightening for the writer are these lines from later in the poem: “Words we once saw fade from the facts / we know . . .”

Rendell writes fragments every day. “When my schedule is lighter, I write 1-2 pages in my journal each night.” And she hopes to continue writing as she pursues a medical career: “I think I would dry up and disintegrate if I could not write.”

Cover image: Brachial Graft, by Eo Trueblood, lead medical illustrator with Stream Studios at The Children’s Hospital of Philadelphia.

Stylusmedicine ◆ art ◆ literaturePenn Medicine | Vol. IV ◆ 2015

For a look at the most recent issue of Stylus, go to: http://www.themedicalstylus.com

FALL 2015 35

PENN MEDICINE36

DEVELOPMENT MATTERS

disease in 95% of treated CML patients and which has been approved to treat 10 different kinds of cancer. In 1998, Dr. Nowell shared the Albert Lasker Clinical Medical Research Award, the nation’s highest honor for biomedical research, with the Uni-versity of Pennsylvania’s Dr. Alfred G. Knudson Jr.

Dr. Nowell was first to show that bone marrow transplantation was effective in irradiated animals, and his work also helped to pave the way for the current revolutionary advancements in CAR T cancer immunotherapy that we are seeing today: He observed that a plant protein, known as PHA, was capable of stimulating mitosis. This knowledge later proved essential for culturing white blood cells – results arguably as important as the Philadelphia chromosome discovery. Later in his career, he developed the clonal evolution model of cancer: cancer cells incessantly accumulate mutations that yield a survival advan-tage and thus are regulated by natural selection.

In addition to his service as the first cancer center director at Penn, Dr. Nowell was chair of the Department of Pathology from 1967 to 1973. He championed scientific and medical educa-tion: achievements in which, as he has often said, he takes the greatest pride. He provided time in the lab, and held lab picnics for elementary and high school students – particularly those with less direct access to educational resources. He mentored several prominent faculty members and was known for turning every question or interaction into a learning experience – en-lightening rather than intimidating – and, in the process, model-ing how to be a complete physician-researcher and mentor to peers, fellows, and students.

The inaugural Nowell chair-holder, Dr. Kojo Elenitoba-Johnson, is an international leader in the field of hematopa-thology, molecular pathology, and mass spectrometry- driven proteomics. He is also the founding director of Penn Medicine’s Center for Person-alized Diagnostics and chief of the Division of Molecular and Genomic Pathology. His laboratory at the University of Michigan is credited with having identified several re-current genetic abnormalities linked to the development and progression of a number of lymphoma subtypes.

In a long-anticipated honor for Peter C. Nowell, M.D. ’52, the Lasker Award-winning Penn lumi-nary who co-discovered the Phila-delphia chromosome, an endowed professorship has been established in his name. Kojo S. Elenitoba- Johnson, M.D., will be the first to hold the Nowell chair. The chair

was made possible through a collaborative effort by faculty, some of whom trained with Dr. Nowell, and myriad donors coming together from a broad swath of the Penn community. Many donors are, in fact, long-time supporters of the Abramson Cancer Center, for which Dr. Nowell served as its first director beginning in 1973.

“I am deeply gratified that such stalwart supporters in our fight against cancer have chosen to honor the groundbreaking work that Dr. Nowell has contributed to oncology, innovations that shifted the cancer paradigm decades ago and that rever-berate now in cancer immunotherapy,” says Chi V. Dang, M.D., Ph.D., the John H. Glick, M.D., Abramson Cancer Center Di-rector’s Professor and director of the Abramson Cancer Center.

The 87-year-old Dr. Peter Nowell – who holds the Gaylord P. and Mary Louise Harnwell Emeritus Professorship of Pathol-ogy and Laboratory Medicine – along with his research partner, the late David Hungerford, Ph.D., discovered the Philadelphia chromosome in 1960. This finding, an abnormally small chro-mosome in the cancerous white blood cells of patients with chronic myeloid leukemia (CML), was considered a watershed moment in cancer research, demonstrating the genetic basis for cancer, which ran counter to prevailing thought at the time.

Their revolutionary work also formed the foundation for the clinical trials for Gleevec®, the Novartis Pharmaceuticals drug that received FDA approval in 2001 and has since stabilized

An Endowed Professorship Named for Peter C. Nowell, M.D.

Honoring One of the Nation’s Greatest Cancer Pioneers:

“A professorship honoring Peter Nowell is one of many deserved plaudits for a genuine giant in Penn

history and cancer discovery.” – Dr. David B. RothSimon Flexner Professor of Pathology and Laboratory Medicine Chair, Department of Pathology and Laboratory Medicine

Kojo S. Elenitoba-Johnson, M.D.

PENN MEDICINE36

Peter Nowell with David Hungerford (c. 1960).

“Dr. Elenitoba-Johnson is an outstanding investigator whose research has already had significant impact, and I am excited by the prospect of future innovations – as transformative as Dr. Nowell’s – arising from his work,” said J. Larry Jameson, M.D., Ph.D., executive vice president for the Health System and dean of the Perelman School of Medicine.

He has received several awards, including the Outstanding Teaching Award in Anatomic Pathology from the University of Utah (1999 and 2003), the Ramzi Cotran Young Investigator Award from the United States and Canadian Academy of Pa-thology, and the American Society for Investigative Pathology Outstanding Investigator Award. He was recognized in Best Doctors in America from 2003 to 2014 and is a member of the American Society for Clinical Investigation.

Dr. Elenitoba-Johnson earned his M.D. degree from the College of Medicine, University of Lagos, in Lagos, Nigeria. Subsequently,

THE PRESIDENT’S DISTINGUISHED PROFESSORSHIPS

Endowed chairs support the lifeblood of any great univer-sity: its eminent faculty. Providing the resources to recruit and retain the finest minds, funds from these chairs also protect vi-tal clinical, research, and education endeavors in times of fi-nancial uncertainty. Today, there is a new opportunity to estab-lish a fully endowed chair with a gift of only $2.25 million – rather than the usual full $3 million commitment.

In early 2014, Penn President Amy Gutmann announced an ambitious plan, as part of her Penn Compact 2020 Presidential Initiative, to establish 50 new endowed chairs. The goal of the President’s Distinguished Professorship Fund is to recruit and retain eminent multidisciplinary faculty.

Penn Medicine Trustee partners George Weiss, W’65, HON’14, and Richard Vague joined President Gutmann’s effort: to encourage new endowed chairs, they pledged $10 million to match gifts to create new distinguished professorships. The challenge contributes $750,000 to the endowment for each new chair, so donors can establish a Presidential Distinguished Professorship with a gift of $2.25 million.

We invite you to join President Gutmann, George Weiss, and Richard Vague in helping fuel Penn Medicine’s drive from excellence to eminence. To learn more, contact Penn Medicine Development and Alumni Relations at (215) 898-0578.

Honoring One of the Nation’s Greatest Cancer Pioneers:

“Dr. Elenitoba-Johnson is an inspired and ideal choice as the inaugural

Peter C. Nowell, M.D., Professor.” – Dean Jameson

he went to the Brown University School of Medicine for his residency in anatomic and clinical pathology and served as chief resident. He then moved on to the National Cancer Institute to complete a fellowship in hematopathology, as well as the Leadership Development for Physicians in Academic Health Centers program at the Harvard School of Public Health. Before arriving at Penn, he held the Henry C. Bryant Professorship at the University of Michigan and served as di-rector of the Molecular Diagnostics Laboratory there.

“Endowed chairs are a critical part of a thriving academic medical center,” explained Dean Jameson. “I am particularly delighted that the Nowell Chair has allowed us to attract a clinician-scientist of the caliber of Dr. Elenitoba-Johnson – who brings a natural continuation of Peter’s work – as well as honor Dr. Peter Nowell: the first face of cancer research at Penn, who ushered in the modern era of cancer research.”

Peter Nowell received the Benjamin Franklin Medal from the Franklin Institute in 2010.

FALL 2015 37

PENN MEDICINE38

Send your progress notes and photos to:Donor Relations Penn Medicine Development and Alumni Relations3535 Market Street, Suite 750 Philadelphia, PA 19104-3309 PennMedicine@alumni.upenn.edu

1960sPatricia A. Gabow, M.D. ’69, was elected to the board of trust-ees of Seton Hill University, where she earned her B.A. de-gree in biology. A national leader in hospital reform and the deliv-ery of public health care, Gabow also serves on the board of trust-ees of the Robert Wood Johnson Foundation. Listed as one of Modern Healthcare’s “50 Most Powerful Physician Executives in Health Care,” she currently serves on the federal Medicaid and CHIP Payment and Access Com-mission and the Health Advisory Board of the National Governors Association. A nephrologist by training, Gabow retired in 2012 after 20 years as chief executive officer of Denver Health and Hospital Authority.

1970sBarry J. Gertz, M.D. ’79, has joined Nuvelution Pharma Inc. as chief physician scientist. He is a venture partner at Clarus Ven-tures and chief medical advisor for Relay Pharmaceuticals Inc. Before joining Clarus, he was se-nior vice president of global clini-cal development at Merck. He was instrumental in the develop-ment and approval of more than 25 new drugs and vaccines, in-cluding six new approvals in 2014, and is an author of more than a hundred scientific publi-cations and articles.

1980sAlan F. List, M.D. ’80, was ap-pointed chair of the scientific ad-visory board of Cellular Biomed-icine Group Inc. He previously served as president and chief ex-

as the director of the Bureau of Epidemiology and acting physi-cian general for the Common-wealth of Pennsylvania.

Randall Patkin, M.D. ’85, G.M.E. ’89, is a comprehensive ophthalmologist specializing in cataract surgery, glaucoma, dia-betes, and routine eye care, based at the Eye Center of the Northshore in Salem, Mass. He received the Dr. Bennett I. Solo-mon Community Leadership Award at Cohen Hillel Acade-my’s 27th Annual Gala. Patkin has served on numerous com-mittees and is a board member of the North Shore Cataract and Laser Center.

1990sBruce A. Monaghan, M.D. ’90, G.M.E. ’95, an orthopaedic sur-geon, was named vice president of the 550-member medical staff of Inspira Medical Center Wood-bury, in New Jersey. He joined its medical staff in 1996 after com-pleting a fellowship in hand and microvascular surgery at the In-diana Hand Center in Indianapo-lis. A former vice president of the South Jersey Surgical Center in Mount Laurel, he currently serves as the chairman of the board of Gloucester County Sur-gical Center in Mullica Hill, a joint venture between physicians and Inspira Health Network. He is also president elect of the New Jersey Orthopaedic Society.

Steven Jay Perch, M.D. ’91, G.M.E. ’95, has joined the radia-tion oncology physician team at the Dale and Frances Hughes Cancer Center at Pocono Medi-cal Center.

Christina M. Coughlin, M.D. ’99, Ph.D. ’99, has been ap-pointed chief medical officer of Immunocore Limited, a biotech-nology company based in Ox-fordshire, U.K., that seeks to de-velop novel drugs to treat cancer, viral infections, and autoimmune diseases. She will oversee the company’s pre-clinical and clini-cal programs. Coughlin has led multiple programs across the full spectrum of drug development.

ecutive officer of Moffitt Cancer Center and Research Institute. Earlier, he was executive vice president and physician-in-chief, vice deputy physician-in-chief, and chief of the malignant he-matology division at Moffitt, where he holds the Morsani En-dowed Chair. Before joining Moffitt in 2003, he was a profes-sor of medicine at the University of Arizona, where he also served as director of the leukemia and blood and marrow transplant program and the translational/clinical research program.

Stephen Ostroff, M.D. ’81, is the acting commissioner of the Food and Drug Administration. Before being named to the position, Os-troff served as the FDA’s chief scientist. He led and coordinated its scientific and public health ef-forts, providing support for its regulatory science and innova-tion initiatives. Ostroff joined the FDA in 2013 as chief medical of-ficer in the Center for Food Safety and Applied Nutrition and as senior public health advisor to its Office of Foods and Veteri-nary Medicine. Earlier, he had been deputy director of the Na-tional Center for Infectious Dis-eases at the Centers for Disease Control and Prevention, where he was also acting director of the CDC’s Select Agent Program. While at the CDC, he focused on emerging infectious diseases, food safety, and coordination of

responses to complex outbreaks. He retired from the Commis-sioned Corps of the U.S. Public Health Service at the rank of Rear Admiral (Assistant Surgeon General). Ostroff has also served

Most recently, she supervised two early-development pro-grams at Novartis, leading the program’s teams in pre-clinical pharmacology, toxicology, clini-cal pharmacology, clinical devel-opment, biomarker develop-ment, and regulatory work. Pre-viously, Coughlin had studied patient responses to tumor anti-gens at Penn Medicine under the direction of Carl June, M.D.

2000s Rajiv J. Shah, M.D. ’02, Ph.D., was named to the board of direc-tors of Omeros Corporation, a Seattle-based biopharmaceutical company. From 2010 to 2015,

Shah served as administrator of the United States Agency for In-ternational Development. Before that, he was Under Secretary for Research, Education, and Eco-nomics and chief scientist at the U.S. Department of Agriculture. He has also worked in senior roles at the Bill & Melinda Gates Foundation. He is currently a dis-tinguished fellow at Georgetown University’s School of Foreign Service, where his work focuses on international development. He also sits on the board of di-rectors of Arcadia Biosciences Inc. and the board of trustees of the Rockefeller Foundation.

Jay R. Venkatesan, M.D. ’02, has become managing partner at Al-pine BioVentures, a venture-capi-tal firm based in Seattle. Most re-cently, he was executive vice president and general manager of

PROGRESS NOTES

a colleague, noting that “I’d studied the works of neurobiol-ogists at Penn and other institu-tions, who’d insisted there was a biological basis for violence, no matter if people didn’t want to admit it. . . . “We eventually showed that ripper encoded a dopamine transporter that localized to the amygdala region of the brain. It was a perfect culprit. Most peo-ple carry normal copies and as a result have normal transmission in the amygdala. . . . But in a small set of unfortunate individ-uals carrying two dysfunctional copies of the ripper gene, dopa-mine transporters are turned on like crazy, depleting the available dopamine in their brains and causing a signaling defect in their amygdala. They respond no differently whether they’re look-ing at a rabbit in a garden or a torture victim in a basement. . . . Anyway, my thesis showed that deficits in ripper gene function were present in more than sev-enty percent of the serial killers I tested. The prevalence in the normal, non-incarcerated hu-man population is around two percent.” For readers interested in what he calls “the controversial and in-triguing scientific premise” of his novel, Burczynski in his acknowl-edgments recommends The Anatomy of Violence (2013), by Adrian Raine, Ph.D. Raine is the Richard Perry University Profes-sor of Criminology & Psychiatry at Penn. Burczynski/Ransom is sched-uled to read at the Penn Bookstore on November 16, at 6:00 p.m.

Michael E. Burczynski, Ph.D. ’99, who earned his doctorate in pharmacology, is the author of The Ripper Gene, a medical thriller recently issued by Tor/Forge. A biomedical scientist and adjunct professor in the Perel-man School’s Department of Sys-tems Pharmacology and Transla-tional Therapeutics, Burczynski is also an executive director and head of biomarker technologies for a major pharmaceutical firm. He wrote The Ripper Gene under the pen name Michael Ransom. The novel tells the story of a neu-roscientist turned F.B.I. profiler, Dr. Lucas Madden, who se-quences the DNA of the world’s most notorious serial killers and proposes a controversial “damna-tion algorithm” that could predict the behavior of a serial killer us-ing DNA alone. Then a new murderer begins terrorizing women in the Mississippi Delta, and Madden’s former fiancée is kidnapped. Only by “entering” the killer’s mind will Madden have a chance of understanding the killer’s twisted rationale and ending his reign of terror. Part of Burczynski’s real-life re-search involves scanning the 3.2 billion nucleotides of the human body to identify tiny alterations that influence an individual’s sus-ceptibility to disease. He is also the editor of two scientific text-books: An Introduction to Toxi-cogenomics (2003) and Surrogate Tissue Analysis: Genomic, Pro-teomic, and Metabolomic Ap-proaches (2005). He uses his background in modern molecu-lar biology to bring cutting-edge science into his fiction. Early in The Ripper Gene, Madden explains his research to

FALL 2015 39

Oncothyreon Inc., which he joined after it was acquired by Alpine Biosciences. Previously, he was founder, portfolio man-ager, and managing director of Ayer Capital Management. He serves on the boards of Lion Bio-technologies and AuraSense Therapeutics.

Douglas C. Fisher, M.D. ’03, M.B.A., has resigned from his position as a director on the board of Sera Prognostics, a women’s health-care company based in Salt Lake City that is in the final stages of developing a novel proteomic predictor for pre-term birth risk. Fisher has now joined the company’s man-agement team as chief business officer. He is also an execu-tive-in-residence at InterWest Partners, a venture capital firm in Menlo Park, Calif. Through-out his career, Fisher has focused on biopharmaceutical, diagnos-tic, and medical device invest-ments, working in venture capi-tal, consulting, and pharmaceuti-cal industries.

OBITUARIES

1930sFrank R. Braden Jr., M.D ’33, Coraopolis, Pa., a retired physi-cian; May 19, 2014. He was at-tending physician in both the medical and surgical clinics of Allegheny General Hospital 1935-1941. In World War II, he served in the Medical Corps of the U.S. Army, rising from 1st Lt. to Lt. Col. The public schools of Coraopolis, Neville Island, and Moon Township employed him as medical examiner from 1945 to 1978. He served as president of the medical staff of Sewickley Valley Hospital and was on the board of directors for the Alle- gheny County Medical Society.

1940sEdward S. McCabe, M.D. ’42, Merion, Pa., a retired physician who was on staff at the old Pres-byterian Hospital for 35 years; June 1, 2014. He was an associate

professor of medicine at Temple University. During World War II, he served as a surgeon with the U.S Army in Europe.

George R. Wade, M.D. ’43, McKinney, Tex., a retired pedia-trician who had been chief of pe-diatrics at Paoli Memorial Hospi-tal from 1968 to 1981; February 11, 2014. He was president of its medical staff 1970-1972. The hospital’s nursery was named in his honor. During World War II, Wade served as a psychiatrist in the U.S. Navy, serving in the Pa-cific theater.

James Hickman Jr., M.D. ’45, Knoxville, Tenn., a retired physi-cian; August 31, 2015. He served in the U.S. Army as a medical of-ficer during World War II, leav-ing with a rank of captain. He was the medical director of BASF, the chemical company, in Morristown, Tennessee, retiring in 1986.

Ralph A. Jessar, M.D. ’46, G.M. ’50, a retired assistant clinical professor at the Perelman School of Medicine; April 15, 2015. He earned his B.A. degree in 1943 from Penn’s College of Arts & Sciences. He served in the U.S. Navy as a lieutenant, j.g. Jessar returned to Penn in 1953 as a re-search fellow in rheumatology and joined the teaching staff as an instructor the following year. As a rheumatologist, he was a member of the research team that developed the use of corti-costeroid injections for the treat-ment of rheumatoid arthritis. He also served as chief of rheuma-tology at Graduate Hospital be-fore retiring from Penn in 1986.

John M. Stevens Jr., M.D. ’46, Cornwall, Pa., a retired psychia-trist and psychoanalyst who had maintained a practice in Philadel-phia for many years; October 7, 2014. During World War II, he served as a medical officer in the U.S. Army. He had helped set up psychiatric counseling at Penn’s Student Health Center.

Robert P. Brundage, M.D. ’47, G.M. ’51, Archbald, Pa., a retired family physician; September 5, 2014. As an undergraduate at Penn, he was a member of the

PENN MEDICINE40

football team. He served in the U.S. Navy during World War II and the Korean War and re-ceived the Bronze Star for his service as a surgeon on the front lines in Korea.

Samuel Mickle Fox III, M.D. ’47, Bar Harbor, Maine, a retired cardiologist and former chief of the Heart Disease Control Pro-gram of the U.S. Public Health Service; April 22, 2015. His

photographic memory and knowledge of ships, as shown by an essay published in Naval Proceedings, attracted the U.S. Navy’s attention. He became a commissioned ensign of the U.S. Naval Reserve in 1942, later advancing to Commander, Medical Corps, U.S. Navy. He graduated from Haverford Col-lege in 1944. In medical school, he met Mary Alice Vann, also a student. They wed in 1949 and had four children. Fox was acting chief of gastro-enterology at the National Naval Medical Center, Bethesda, 1950-51, where he translated knowl-edge of heart rhythms obtained during endoscopy into an inter-est in cardiology. He then served at the Office of Naval Research in London for the Naval Forces in Europe, the Atlantic, and the Mediterranean; there, he became interested in physical activity and the prevention of heart disease. He became chief of the cardiol-ogy service at the Naval Medical Center and then head of the De-partment of Clinical Investiga-tion at the U.S. Naval Medical Research Unit in Cairo, 1954-56. His other positions included chief of cardiology at the U.S. Naval Hospital in Portsmouth, Va., and senior staff of the Cardi-

duced insulin in the early stages of type 2 diabetes, to the great benefit of his patients. Kyle pub-lished original research and re-view articles on the effects of dia-betes in pregnancy and pio-neered tight control of blood sugar in pregnancy before it be-came standard practice. Through the generosity of grateful pa-tients, friends, and colleagues, Kyle founded the Penn Rode-baugh Diabetes Center, which aims to treat diabetes and pre-vent its complications in a man-ner consistent with his exacting standards and brings together di-abetes specialists, nurses, podia-trists, nutritionists, and others skilled in managing various as-pects of the illness. An associate professorship at HUP was estab-lished in Kyle’s name.

Mary Alice V. Fox, M.D. ’48, G.M.E. ’52, Bar Harbor, Maine, a retired physician; April 25, 2011. She graduated from the Women’s College of North Carolina, Greensboro, in 1944, and at-tended the University of North Carolina, Chapel Hill. At Penn’s School of Medicine, she met her future husband, Samuel M. Fox III, M.D. ’47. She interned at the Hospital of the Medical College of Virginia and completed a resi-dency at the Children’s Hospital of Philadelphia. After accompa-nying her husband to London and Cairo, she established a pri-vate practice in Bethesda, Md., and also served in the Health Department of Montgomery County, Md. She later was Chief of Crippled Children’s Control for the State of Maryland and then went on to hold a similar position in Montgomery County. She retired in 1979.

George Henry Miller Jr., M.D. ’48, Livermore, Maine, a retired professor of urology; July 28, 2015. He served in the U.S. Navy briefly in World War II as a hos-pital corpsman and re-enlisted in 1951 as a lieutenant j.g. assigned to Great Lakes Naval Hospital. He served on the U.S.S. Consola-tion hospital ship in 1952, and was dispatched to Korea and Ja-pan for active duty. He entered the Naval Reserve in 1954. He was an instructor and assistant professor at the University of

odynamics Section at the Na-tional Heart Institute of NIH, Bethesda Naval Hospital, 1957-1962, where he developed an in-patient cardiac rehabilitation program. Fox also served as phy-sician for America’s first astro-nauts in NASA’s Project Mercury (1960-64) and monitored the first manned space mission from a tracking station in Zanzibar. During this time, he worked at the U.S. Public Health Service’s Heart Disease Control Program, where he soon became chief. After setting up Georgetown University Hospital’s Cardiac Re-habilitation Lab, he became pro-fessor and director of the Preven-tive Cardiology Program. A long-standing member of the Ameri-can College of Sports Medicine and eventually vice president, he edited Coronary Heart Disease: Prevention, Detection, Rehabilita-tion, with Emphasis on Exercise Testing (1974), a landmark refer-ence on cardiac disease and pre-vention. Fox was president of the American College of Cardiology and was named a Distinguished Fellow of the college. He received the 1974 Eleanor Naylor Dana Award for Preventive Medicine, presented by American Health Foundation. G. Clayton Kyle, M.D. ’47, G.M.E. ’51, an endocrinologist who specialized in diabetes; De-cember 24, 2014. He served with the C.I.A. in Munich from 1951 through 1953. A clinical associate professor when he retired from medicine, he spent his entire ca-reer at the Hospital of the Uni-versity of Pennsylvania and served as the chairman of its medical board from 1977 to 1979. Kyle resisted established norms and instead pioneered and taught innovative methods that reduced complications and extended the lives of hundreds of patients. In the early 1960s, he concluded that lowering blood glucose reduced the risk of com-plications, and he also made the observation that part of the un-derlying pathogenesis of type 2 diabetes included failure of the beta cell to produce adequate in-sulin. Because of this discovery, he was one of the first clinicians in the world to aggressively treat hyperglycemia; he also intro-

Chicago and the College of Med-icine at the University of Florida, where he founded its Division of Urology. He was promoted to as-sistant dean and full professor in 1968. From 1968 to 1976, he served as chief of staff at the VA Hospital in Gainesville, Fla. In 1976, he became chief of staff at the VA Hospital in Togus, Maine, where he remained until his re-tirement in 1990.

David P. Morris Jr., M.D. ’48, Matthews, N.C., a retired direc-tor of the U.S. Navy’s Aerospace Medical Research Development Facility; July 16, 2014. He had earlier served as head of launch-site medical operations at the NASA Manned Spacecraft Cen-ter, Cape Canaveral. Following his career in the Navy, he worked to treat alcoholism and chemical dependency at several treatment centers.

1950sJaime Asch, M.D., G.M. ’51, Mexico City, an otolaryngologist; March 3, 2014.

Stanley Masters, M.D., G.M. ’51, Floral Park, N.Y., a retired ophthalmologist; July 24, 2014. He had been associated with the Long Island College Hospital.

Melvin J. Chisum Jr., M.D. ’52, Philadelphia, a retired general practitioner who later became as-sociate medical director for the old Bell Telephone Company of Philadelphia; October 22, 2014. During World War II, he served with the U.S. Army in the Pacific as a chief warrant officer. Chisum had been a member of the board of overseers of the Penn Libraries.

Abraham L. Cohen, M.D., G.M.E. ’52, Upper Gwynedd, Pa., a retired physician; June 18, 2014. During World War II, he served in the U.S. Army Medical Corps.

James P. Geiger, M.D. ’52, San Rafael, Calif., retired chief of car-diothoracic surgery at the Walter Reed Army Medical Center; April 16, 2015. He served 23 years with the Medical Corps of the U.S. Army, receiving several awards and decorations, includ-

FALL 2015 41

ing the Legion of Merit twice. His Army career included service in Europe, the Philippines, Korea, Vietnam, and postings across the United States from West Point, N.Y., to San Francisco. After re-tiring from the military, Geiger continued his medical practice for 27 more years as a cardiotho-racic surgeon in San Francisco at St. Mary’s Medical Center and at Marin General Hospital.

Alexander Daniel Kovacs, M.D. ’52, Philadelphia, a retired physi-cian; August 30, 2015. He served in both the U.S. Navy and Army. He had lived in New Jersey, where he practiced as an obste-trician-gynecologist. In the early 1980s, he was president of the New Jersey AMA.

Buel S. Smith, M.D. ’52, Akron, Ohio., a retired surgeon; January 15, 2015. He served in the U.S. Army Medical Corps, European Command, at the U.S. Army Hospital in Versailles, France. He practiced orthopaedic sur-gery in Akron for more than 35 years. He had been chairman and director of the residency training program in the Department of Orthopaedic Surgery at Akron General Medical Center. In addi-tion, he served as president of the hospital’s staff and at Barber-ton Citizens Hospital, and he had been a professor and chairman of orthopaedic surgery at Northeast Ohio University College of Medi-cine. The Buel S. Smith Ortho-paedic Surgery In-Patient Center at Akron General Medical Cen-ter was dedicated in 2010. He was elected to the Society of Dis-tinguished Physicians at Akron General Medical Center and re-ceived the President’s Award.

A. Peter Batson, M.D. ’53, G.M.E. ’60, Norwich, Vt., a re-tired ophthalmologist who had maintained a practice there for 22 years; May 15, 2014. After his internship at Philadelphia Gen-eral Hospital, Batson joined the U.S. Air Force as a first lieu-tenant. He served for 23 years, as flight surgeon, ophthalmologist, chief of hospital services, and hospital commander, and was promoted to colonel in 1970. He received the Meritorious Service

president of the medical admin-istrative board at New England Deaconess Hospital. He was also a member of the physician advi-sory group for the Health Care Financing Administration (now known as Centers for Medicare and Medicaid Services). He was former president of the New En-gland Diabetes Association, had served on the board of directors of the Greater Boston YMCA, and had been president of the Massachusetts Society for Inter-nal Medicine. A former president of the American Society of Inter-nal Medicine, Roehrig also served for 12 years as editor of the organization’s monthly maga-zine, The Internist. He was elected a Master of the American College of Physicians.

Donald Vail Rhoads, M.D. ’54, a retired physician who had main-tained a family practice in Chest-nut Hill for many years; January 27, 2015. He completed a three-year fellowship in internal medi-cine at the Mayo Clinic in Roch-ester, Minn. A conscientious ob-jector during the Korean War, Rhoads served his alternative

service at Rochester State Hospi-tal. He was also an assistant clini-cal professor of medicine at Penn, where he taught senior medical students in the outpa-tient clinic. He had been a mem-ber of the staff of Northwestern Institute of Psychiatry and worked as a medical adviser to the American Friends Service Committee. He served for 31 years on the board of the Wistar Institute of Anatomy and Biol-ogy, which had been founded by

Medal, among many awards. When he retired from the Air Force in August 1976, Batson moved to Vermont and opened an ophthalmology office in Lebanon.

Frank Christian Greiss Jr., M.D. ’53, Lake Norman, N.C., a retired physician; July 23, 2015. He served as a U.S. Navy lieu-tenant at the dependents’ hospi-tal of the Charleston Navy Yard. In 1960, he joined the Depart-ment of Obstetrics and Gyne-cology at Bowman Gray, where he served as chairman. He re-ceived the Foundation Prize of the American Association of Obstetricians and Gynecologists as well as the Distinguished Service Award from the North Carolina Obstetrical and Gyne-cological Society.

Paul G. McKelvey Jr., M.D. ’53, Greensburg, Pa., a retired family physician; October 25, 2014. He served in the military during World War II as a member of the 159th Engineer Combat Battal-ion, which played a prominent role in the Battle of the Bulge. For his service, he was awarded the American Campaign Medal and the European-African-Mid-dle Eastern Campaign Medal, with five Bronze Stars and the World War II Victory Medal. In Greensburg, he maintained a pri-vate practice for 25 years. He then joined the staff of Latrobe Area Hospital as a teaching fac-ulty member in the Family Medi-cine Residency Program, in which he trained recent medical school graduates in the nuances of running a successful family practice. He also served as plant physician for the former ITE Corp., makers of circuit breakers, for 25 years.

C. Burns Roehrig, M.D., G.M. ’53, a retired internist and endo-crinologist, Hilton Head Island, S.C.; January 17, 2015. He re-ceived his medical degree from the University of Maryland and completed his residency in inter-nal medicine at the University of Pennsylvania. During the Korean War, he served as a flight sur-geon and captain in the U.S. Air Force. Roehrig had been chief of the general medical staff and

his great-uncle Isaac J. Wistar in 1892. Rhoads had also been a vice president of the board of di-rectors of Friends Hospital. One of his daughters is Caroline S. Rhoads, M.D. ’89.

Jay A. Desjardins, M.D. ’55, West Chester, Pa., a retired in-ternist; November 23, 2014. From 1956 to 1962, he served as a lieutenant commander in the U.S. Navy Medical Corps. He practiced internal medicine for 35 years in Havertown, Pa., and was an attending physician at Fitzgerald Mercy, Riddle Memo-rial, and Delaware County Me-morial hospitals. He was hon-ored in 2012 by Mercy Catholic Medical Center for 50 years of devoted service.

William S. Vaun, M.D. ’55, Nor-folk, Conn., a retired physician; December 1, 2014. From 1957 to 1959, he served as a captain in the U.S. Air Force, with concur-rent assignments at the Pentagon and at Andrews and Bolling Air Force bases in Washington, D.C. In 1965, he became director of medical education at Monmouth Medical Center. He oversaw a residency program that grew from 30 residents to more than 100 physicians-in-training and from four accredited residency programs to 10 upon his retire-ment. He was a fellow of the American College of Physicians, where he served on the commit-tee on hospitals, and of the Asso-ciation of Hospital Directors of Medical Education, where he had been vice president and chair-man of the program committee. Vaun also served on the legisla-tive council of the American Hospital Association. In 1987 he became a consultant at the Con-tinuing Medical Education com-plex at the University of Medi-cine and Dentistry of New Jersey.

Matthew A. Asbornsen, M.D. ’57, Stuyvesant, N.Y., a retired physician; August 21, 2011. After graduating from Rutgers Univer-sity, he worked for Brown Broth-ers Harriman, the banking firm, until drafted into the U.S. Army during the Korean War. He served his two years in a research

PENN MEDICINE42

laboratory at the Army Chemical Center. After earning his medical degree, he completed his training at the University Hospitals of Cleveland. He then joined the Rip Van Winkle Clinic in Colum-bia County, N.Y., before estab-lishing his own practice in Kin-derhook, where he practiced for 26 years. He was a former super-visor and councilman of Stuyve-sant and worked to initiate recy-cling throughout the county. As-bornsen was also instrumental in the preservation of five miles of Stuyvesant’s shoreland.

William L. Clovis, M.D. ’57, Philadelphia, a retired psychia-trist; July 31, 2014.

Wayne C. A. Hurtubise Jr., M.D. ’57, Haverford, Pa., a retired physician; November 10, 2014. He practiced medicine for 37 years, treating patients at the for-mer Haverford State Hospital and Bryn Mawr Hospital. He was doctor and team physician at the Episcopal Academy and Agnes Irwin School.

Thomas Mair Wilson Jr., M.D. ’57, Minneapolis, a retired neu-rologist; September 5, 2015. He served two years in the U.S. Air Force as a medical doctor and was stationed in the Philippines. He then moved to Minneapolis to join Midwestern Neurologic and Psychiatric Consultants and Abbott Northwestern Hospital.

Frederick F. Paustian, M.D., G.M.E. ’58, Omaha, emeritus professor of gastroenterology at the University of Nebraska; No-vember 2, 2014. He served as president of the Metropolitan Omaha Medical Society and of the Nebraska Medical Associa-tion. He had also been governor of Nebraska for the American College of Physicians, which in 1993 designated him a master. In 2006, he was named one of the first five “Legends of Medicine” at the University of Nebraska Medical Center.

James Schaller, M.D. ’58, West Chester, Pa., a retired obstetri-cian-gynecologist; August 8, 2015. He served for five years in the U.S. Army Medical Corps and was a general medical officer

6, 2014. He completed his post-graduate work at Geisinger Medical Center and served on Penn’s clinical faculty intermit-tently from 1981 until 2010. He was an internist at Penncare In-ternal Medical Associates of Del-aware County, from which he re-tired in 2011. At Riddle Memo-rial Hospital, he was on its active staff 1973-2011 and had served as chair of its subdivision of en-docrinology.

1970sJohn L. Currie, M.D., G.M.E. ’72, Asheville, N.C., former chair of the Department of Obstet-rics-Gynecology at Dart-mouth-Hitchcock Medical Cen-ter; April 22, 2015. He earned his M.D. degree in 1967 at the Uni-versity of North Carolina at Chapel Hill. After his training at Penn, he served in the U.S. Air Force for two years, then re-turned to join Chapel Hill OB-GYN. He later joined the medical faculty at the UNC-CH. Currie also served as chief of the divi-sion of gynecological oncology at Johns Hopkins before moving to Dartmouth-Hitchcock. He con-cluded his medical career by establishing a gyn-oncology practice at the John B. Amos Cancer Center in Columbus, Ga. In 2001, Curie graduated from Vermont Law School and en-tered the New Hampshire Bar.

1980sRichard A. Browning, M.D., G.M.E. ’85, Barrington, R.I., for-mer chief of anesthesia at Rhode Island Hospital and the Miriam Hospital; November 13, 2012. He also had been a clinical pro-fessor of anesthesia at Brown University.

Anna S. Lev-Toaff, M.D., G.M.E. ’86, professor of radiology at Penn; April 3, 2015. She earned her medical degree in 1979 from New York University. Early in her career, she was an instructor in radiology at the Perelman School of Medicine.. She was also on the faculty at Thomas Jefferson University for 18 years and at Temple Univer-

for the Supreme Headquarters of the Allied Powers in Europe at Versailles, France. He joined the Navy Reserve and was honorably discharged with the rank of cap-tain in 1959, then joined the staff at Nazareth Hospital in North-east Philadelphia. In 1982, he re-signed as chairman of obstetrics and gynecology at Nazareth to help train doctors at Mercy Catholic Medical Center in Darby Borough and at the Medi-cal College of Pennsylvania in East Falls.

1960sWilliam P. Calvert, M.D. ’60, Miami, a retired radiologist; Jan-uary 26, 2014. He served as a flight surgeon at Clark Air Force Base in the Philippines for two years during the Vietnam War. He practiced radiology for more than 25 years in Miami. During that time, he was chief of radiol-ogy at Larkin Hospital and the Community Health Center; spent time on the faculty of the University of Miami School of Medicine; and served as locum tenens radiologist at Mariners, Fishermen’s, and Keys Commu-nity hospitals in the Florida Keys. Calvert was also active in the Dade County Medical Asso-ciation and the South Miami Medical Forum.

Aaron M. Rosenthal, M.D., G.M. ’61, St. Louis, a retired phy-sician; November 29, 2013.

Karl D. Nolph, M.D. ’63, G.M.E. ’67, Columbia, Mo., the Board of Curators’ Emeritus Professor of Medicine at the University of Missouri; June 16, 2014. He had been chief medical resident at Bryn Mawr Hospital. A pioneer in the field of dialysis, he had been chief of nephrology at the school. The Chair of Nephrology at Missouri is named in his honor. Earlier, he served as a ma-jor in the U.S. Medical Corps for two years, as a research internist and renal consultant at Walter Reed General Hospital.

John N. Thurman, M.D. ’67, former clinical associate profes-sor of medicine in the Perelman School of Medicine; November

sity for four years. Lev-Toaff re-turned to Penn in 2008 as a pro-fessor of radiology and a member of the Clinical Practices of the University of Pennsylvania. She taught and practiced at Penn un-til 2014.

Joseph L. Mallon Jr., M.D. ’89, Philadelphia; September 9, 2015. He worked for 12 years as a gen-eral internist at Abington Memo-rial Hospital and for two years as a hospitalist physician at McLeod Hospital in Florence, S.C. He moved to the Lehigh Valley in 2007, working as a hospitalist physician at Lehigh Valley Hospi-tal in Allentown.

FACULTY

Stella Y. Botelho, M.D., emeri-tus professor of physiology, Blue Bell, Pa.; March 11, 2015. After earning a medical degree from the Woman’s Medical College, she became an instructor at Penn’s School of Medicine in 1949. She was promoted to pro-fessor in 1969 and retired in 1981. She taught courses in ap-plied and medical physiology. In her research lab, she studied re-

spiratory physiology, neuromus-cular physiology, the spinal cord, and secretions of exocrine glands. She was the principal in-vestigator on many scientific grants, and her research was funded by the Muscular Dystro-phy Association and the Na-tional Council to Combat Blind-ness. Botelho also sat on scien-tific review panels for the Na-tional Science Foundation, the

OBITUARIES

“Make the world a better place” is the personal philosophy of Janet Shapiro, who has lived a lifetime of volunteering – from working in a hospital snack shop in high school to knitting shawls for cancer patients in retirement – and who has added Penn Medicine to the list of charitable organizations she supports.

Mrs. Shapiro inherited her desire to help others from her par-ents, who held a strong personal belief in the importance of giving to charitable organizations, particularly in the field of medicine. She grew up sharing their tradition of charity. When she came to Penn as an undergraduate, she volunteered at the Hospital of the University of Pennsylvania. “There’s always a need for help,” she said, “and I always thought a hospital should use their funds to focus on patient care.”

“Penn Medicine is a place that makes such a positive differ-ence in health. I want to support the great work being done here.” Mrs. Shapiro worked with the development office to set up a Charitable Gift Annuity, which allows her to make a gift in exchange for life-long, guaranteed annuity payments and an in-come tax deduction. By designating her Charitable Gift Annuity to the Penn Medicine Friends Fund Endowment, Mrs. Shapiro will continue her lifetime tradition of annual, unrestricted giving to Penn Medicine for all time.

“Now, every time I read about the research being

done at the Penn, I know I’m making a difference now

and into the future,” she said. “I’m glad I can do my

part, and I hope it inspires others to do the same.”

Janet Shapiro chose one of a multitude of creative gift opportunities. As you plan your philanthropic 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.

Doing Her Part for Medical Research and Care

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National Research Council, and the National Institutes of Health. In 1968, she received the Alum-nae Award of Merit from Penn, where she had earned her un-dergraduate degree in chemistry in 1940.

Howard Holtzer, Ph.D., Phila-delphia, emeritus professor of cell and developmental biology; November 5, 2014. After serving in the Army in the Pacific during World War II, he graduated from

the University of Chicago, where he also earned his doctorate in 1952. In 1953, he joined what was then called Penn’s Depart-ment of Anatomy, continuing his research that provided the foun-dation of much of the molecular work on inductive signals be-tween tissues and how cells com-municate during development. At Penn, he applied a new tech-nique, fluorescent labeling of an-tibodies, to the study of myogen-esis. According to Jonathan Ep-stein, M.D., executive vice dean and chief scientific officer of the Perelman School, “From this new ability to examine much earlier stages of development came such creative ideas as cell lineages giv-ing rise to more and more re-stricted options until a terminally differentiated cell is produced (progressive lineage restriction).” Among his other discoveries: the existence of a new class of fila-ments, the intermediate fila-ments (including keratins, lamins, and neurofilaments). Holtzer was also known as a great colleague who trained many scientists. Holtzer’s research took him across the globe, to appoint-

ments at universities and insti-tutes in Tokyo, Beijing, London, Rome, Heidelberg, and Berlin. He won a Fulbright Scholarship and was a Guggenheim Fellow at Carlsberg Laboratories in Co-penhagen. Holtzer remained ac-tive in his research at Penn until a few years before his death. He is survived by his wife and re-search collaborator of 64 years, Sybil Holtzer.

Ralph A. Jessar, M.D. See Class of 1946.

Anna S. Lev-Toaff, M.D. See Class of 1986.

Donald Vail Rhoads, M.D. See Class of 1954.

John L. Sbarbaro Jr., M.D., St. Augustine, Fla., a retired assistant professor of orthopaedic surgery at Penn who had also been chief of orthopaedic surgery at the old Medical College of Pennsylvania; September 2, 2014. He was a vet-eran of the U.S. Navy. He devel-oped and patented the Sbarbaro Total Hip Prosthesis.

Heinz Schleyer, M.D., Haver-town, Pa., emeritus assistant pro-fessor of surgery in the Perelman School of Medicine; November 10, 2014. He joined Penn as a postdoctoral fellow in medical physics in 1961 and was ap-pointed an assistant professor of biophysics in 1970; emeritus sta-tus was conferred in 2004. He was known for his work on Cyto-chrome P-450, enzymes involved in drug metabolism.

John N. Thurman, M.D.. See Class of 1967.

Camillus L. Witzleben, M.D., Swarthmore, Pa., an emeritus professor of pathology and labo-ratory medicine; October 1, 2014. He joined the faculty in 1964 and was appointed emeri-tus in 1996. During his time at Penn, he also held a secondary appointment in pediatrics and was pathologist-in-chief at Chil-dren’s Hospital of Philadelphia for 25 years. An expert on pedi-atric liver disease, Witzleben was a former president of the Pediat-ric Pathology Society.

LEGACY GIVING

For more information, please visit the website at: www.plannedgiving.med.upenn.edu.

This summer, one of the National Football League’s most honored linebackers, Junior Seau, was inducted into the league’s Hall of Fame – posthumously. But only Seau’s family attended the induction: the retired player had killed him-self in 2012. Nine months later, the National Institutes of Health reported that he had a degenerative brain disease consistent with chronic traumatic encephalopathy (CTE), making him the most prominent player to be associated with the disease. This year’s induction brought renewed attention to the disease. The Fall 2014 issue of Penn Medicine looked at concussion and the growing recognition of the danger of CTE among football players. Unlike traumatic brain injury, which can re-sult from one or two very hard hits to the head, CTE seems to emerge after countless smaller shocks. As H. Branch Coslett, M.D. 1977, a professor of neurology, pointed out, it is not yet clear why some people who have received blows to the head get CTE while others do not. The article also noted

that the first positive diagnosis of CTE in a football player was published in 2005 by Bennet Omalu, M.D. The NFL, whose annual revenues are now about $10 bil-lion, was slow to deal with CTE or concussions. In fact, when Omalu published his first article on his discovery in the journal Neurosurgery, the league demanded that it be retracted. For several years, its own doctors continually dismissed Omalu’s findings as seriously flawed and purely speculative. Now there are rumors that the NFL has again stirred itself, in response to a movie set to open on

December 25: Concussion, starring Philadelphia’s own Will Smith as Dr. Omalu. Last month, The New York Times re-ported that the movie had been altered to avoid antago-nizing the NFL. The director of the new film, Peter Landes-man, disputed the report. “Anyone who sees the movie will know that it never once compromises the integrity and the power of the real story,” he said. The viewers, of course, will judge. The cover story of this issue of Penn Medicine looks at another controver-sial topic, fracking. It has been hailed as a cure for the nation’s economic woes and assailed as a health hazard. Penn experts have been studying the effects of fracking in recent years. In 2014, Penn’s Cen-ter of Excellence in Environmental Toxicology (CEET) spon-sored a conference that brought together scientists, physi-cians, corporate representatives, and citizens to examine the matter. Earlier this year, members of CEET and re-searchers from Columbia University’s Mailman School of Public Health published a major study in PLOS One. It identified an association between fracking and increased hospitalization rates in counties where “unconventional gas and oil drilling,” as the study puts it, has taken place. The article argues that rigorous science is all the more necessary when tension is high and divisions are wide. Sci-ence will establish whether fracking is the cause of the vari-ous illnesses and other negatives effects. If the studies point to fracking, policy makers and industry leaders will likely be called upon to compensate inhabitants of the affected re-gions – and the findings could halt the entire drilling process until safer procedures can be developed and proven.

PENN MEDICINE44

EDITOR’S NOTE

Concussion and Fracking: Examining the Controversies

john.shea@uphs.upenn.edu

Pennmed

@PennMedNews

pennmedicine

Keep in Touch:In the Winter Issue: More Penn Med students are recognizing the role of spirituality in the care of patients and learning how to listen better to patients and their families. A program in which the students shadow hospital chaplains is becoming more popular. Also, an alumna at Dana-Farber Cancer Institute has been instrumental in efforts to introduce newborn screening for sickle cell disease in Liberia and to offer treatment for affected children.

PENN MEDICINE44

One of the most heartwarming news stories of the year concerned an eight-year-old boy named Zion Harvey. At the age of two, Zion suffered a life-threatening infection that forced doctors to amputate both his hands and feet. In July, Zion became the first pediatric patient ever to receive a bilateral hand transplant. The operation, which lasted 10 hours, involved nearly two dozen people from Penn Medicine and the Children’s Hospital of Philadelphia, drawn from orthopaedic surgery, transplant, and plastic surgery. Leading the procedure was L. Scott Levin, M.D., chair of Penn’s Department of Orthopaedic Surgery. To prevent rejection, patients who undergo this kind of operation must take immune-suppressing drugs for the rest of their lives. Zion was a suitable candidate because he received a kidney from his mother when he was two and was already taking the anti-rejection drugs. Six weeks after he made history, Zion was finally ready to leave the hospital and complete his recovery back in his home city of Baltimore – but not before one last visit with Levin. He led Zion through a string of dexterity tests to see just how his new hands were coming along. Zion told Levin all about his plans for the future, which included doing what

he can to help out others in similar situations and writing to the parents of the child whose hands he received. As we posted on the Penn Medicine Facebook page, along with a gallery of these images on the day Zion went home from the hospital: “He’s a wonderful, brilliant child, and we are privileged to have been a part of his story.”

ONE LAST THOUGHT

45

Zion Tests His HandsPhotos by Rob Press

FALL 2015

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This colorful image is a microetching designed to illustrate a region of the brain. But whose brain?

Find out more on page 16.