PENN Medicine Magazine | Fall 2016

FALL 2016

DRUGS & DOLLARS: BENDING THE CURVE ON SOARING COSTS

Medical Students as Innovators and Entrepreneurs Yvonne Paterson: Scientist, Teacher, and Mentor

THE PREP Photos by Daniel Burke

The Necessity of Humanism At the Perelman School of Medicine’s White Coat Ceremony in August, Gail Morrison, M.D. ’71, G.M.E. ’76, the senior vice dean for education, stated that one of the primary reasons for the ceremony is to emphasize humanism. As she told the incoming students, humanism may be “the most important and fundamental value in medicine.” The annual ceremony, she continued, highlights “the primacy of the doctor-patient relationship.”

It was appropriate that Paul Lanken, M.D., G.M.E. ’77, delivered this year’s keynote address. He was Penn Medicine’s first associate dean for professionalism and humanism, named to the position in 2004. This year, he became an emeritus professor of medicine and stepped down from his administrative role. But he was a champion of those qualities long before he was associate dean. In his address, he mentioned that during his work in HUP’s Intensive Care Unit, he often encountered medical and ethical challenges.

It was evident to him that the struggles medical professionals were facing were not going to go away. Medical schools, he believed, should start ethical training as soon as possible.

In the mid-1990s, when Penn’s medical school began an extensive rethinking of its curriculum under the overall supervision of Dean Morrison, Lanken was instrumental in designing and implementing a new module on the professional development of the students. The ultimate goal: to underscore the importance of being a compassionate, empathetic, and caring physician.

Paul Lanken, M.D.

CLASS OF 2016 STATISTICS

50%

Male

50%

Female

21%

79%

PA Residents

Non PA Residents

26%

Underrepresented in Medicine

26%

36%

15%

29%

Including: Black, Mexican American, Puerto Rican, American Indian, Native Hawaiian, Other Hispanic

Non-Science Majors

For Combined Degree

Asian

Post-Baccalaureate Studies

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DEPARTMENTS

Left THE PREP The Necessity of Humanism 2 VITAL SIGNS “Stand Up to Cancer” Targets Pancreatic Cancer 36 DEVELOPMENT MATTERS Big Ideas Attract Big Investment 38 ALUMNI NEWS Progress Notes and Obituaries 44 EDITOR’S NOTE Health Costs and Innovators 45 ONE LAST THOUGHT The Healing Waves of Art

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The Cost of Drugs: An Increasing Burden | By Steve Graff 8 and Katie Delach Not all drug companies have raised prices through enormous hikes, but both patients and hospitals are struggling to deal with the rising cost of drugs. What can be done?

13 Parents and Teens Learn the Way to Safety | By Katie Delach As automobile crashes directly related to cellphone use by drivers have increased dramatically, a new study aims to keep drivers both young and old from being distracted.

14 Innovators, Inventors, Entrepreneurs . . . and Students

By Jon Caroulis

With help from Penn’s resources and connections, two medical students are preparing to put an innovative surgical device on the market. Playing water polo helped build their staying power.

19 Students Are Her Business | By John Shea

Penn Med’s Office of Student Affairs plays an important role in helping students through academic challenges and preparing them for the residency matching process.

22 The Nobelists Return to Campus | By John Shea

Two alumni who have won medicine’s most prestigious prize spoke of their early years at Penn, looked to the future, and encouraged future physician-scientists.

STAFF John R. Shea, Ph.D. Editor Graham P. Perry/NCS Studios Design / Art Direction

27 The Impact of Poverty on Health Care | By Richard A. Cooper, M.D. In a posthumously published book, Dr. “Buz” Cooper, a former faculty member at Penn, counters the prevailing explanations for excessive costs in health care.

30 A Citizen of the University: Yvonne Paterson | By Lisa Bain

In her nearly three decades at Penn, Dr. Paterson has been a teacher, a scientist, an administrator, and a mentor who has a special talent for bringing people and programs together.

ADMINISTRATION Susan E. Phillips Senior Vice President for Public Affairs Holly Auer, M.B.E. Director of Communications

Penn Medicine is published for the alumni and friends of Penn Medicine by the Office of Public Affairs. © 2016 by the Trustees of the University of Pennsylvania. All rights reserved. Address all correspondence to John Shea, Penn Medicine, 3535 Market Street, Suite 60 Mezzanine, Philadelphia, PA 19104-3309, or call (215) 662-4802, or e-mail john.shea@uphs.upenn.edu.

Visit Penn Medicine’s web site: http://www.uphs.upenn.edu/news/publications/PENNMedicine/

VITAL SIGNS “Stand Up to Cancer” Team Will Pit Immune System Against Pancreatic Cancer

A new three-year, $8.1 million grant from the Stand Up to Cancer (SU2C)-Lustgarten Foundation will support an innovative project led by Jeffrey Drebin, M.D., the John Rhea Barton Professor and chair of the Department of Surgery.

The project will investigate the use of powerful, new drug combinations to help jumpstart the immune system to better fight pancreatic cancer.

This is the fourth round of SU2C pancreatic cancer funding awarded to multi-institutional teams with Penn Jeffrey Drebin, M.D. Medicine at the helm, bringing the total amount to nearly $40 million since 2009. The new “Dream Team” effort involves researchers from Mount Sinai, the Fred Hutchinson Cancer Research Center, Harvard Medical School, and Memorial Sloan Kettering.

The new “Dream Team” will attempt to exploit the ability of vitamin D to infiltrate T cells into treated tumors by adding another player to the offensive line: checkpoint inhibitors.

The newer immunotherapy drug, called nivolumab, has been

They Said It

A family’s rapport with the nursing staff can improve the care a patient receives, but sometimes families can go too far in challenging medical expertise. “When families get stressed, they sometimes go outside their role,” Karen M. Anderson, R.N., M.S.N., told The Wall Street Journal. “They want to determine care or start trying to dictate things.” For example, according to Anderson, a clinical nurse specialist in patient- and family-centered care at HUP, family members may ask a nurse to increase a patient’s pain medication above the prescribed dose. “You have to trust the doctor had reasons, or the nurse knows when to increase the dose.”

Penn Alzheimer’s Disease Center to Receive $8.8 Million in NIH Funding

shown to activate T cells that successfully attack cancers, including melanoma and lung cancer.

“This project represents a novel team science approach to stimulating T cell immunity in pancreatic cancer patients,” Drebin said. “It will involve scientific principals from across the disciplines: clinical oncologists, basic and translational researchers, computational biologists and theoretical scientists.

It’s this type of approach that will help us uncover more about the intricate relationship between the pancreatic tumors and the microenvironment and the immune system. We’ve made great progress in this area in a relatively short time span, but there are still many unknowns, and potentially untapped resources, like immunotherapies, for us to explore.”

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The University of Pennsylvania’s Alzheimer’s Disease Core Center (ADCC) has been awarded an estimated $8.8 million over five years from the National Institute on Aging to continue its mission of investigating mechanisms, diagnostics, treatments and strategies for Alzheimer’s Disease (AD) and related dementias.

Discoveries from Penn’s center have advanced understanding of the development and progression of AD and related neurodegenerative dementias over the past 25 years, leading to national and international recognition of its research accomplishments.

“This funding will allow us to build on these successes,” said John Q. Trojanowski, M.D., Ph.D., G.M.E. ’80, the William Maul Measey-Truman G. Schnabel Jr., M.D., Professor of Geriatric Medicine and Gerontology. He is also a professor of pathology and laboratory medicine and founding director of the Penn ADCC.

Honors & Awards

Ronald M. Fairman, M.D., G.M.E. ’84, the Clyde F. Barker-William Maul Measey Professor of Surgery and chief of vascular surgery and endovascular therapy, was elected a member of the American Philosophical Society. The Philadelphia society promotes useful knowledge in the sciences and humanities and has played a role in American cultural and intellectual life for more than 250 years. Fairman, a professor of surgery in radiology at HUP, also serves as vice chairman for clinical affairs for the Department of Surgery. He has played a central role in shaping a new field of medicine, endovascular therapy, which helps patients afflicted with blood vessel disorders, such as aneurysms and arterial blockages. He is president of the Society for Vascular Surgery.

Harold I. Feldman, M.D., M.S.C.E. ’91, the George S. Pepper Professor of Public Health and Preventive Medicine, became president of the American College of Epidemiology in September.

The College is the professional organization of the nation’s epidemiologists – health professionals who examine patterns of diseases such as cancer, obesity, food poisoning, and influenza, and their causes, which range from lifestyle choices, to environmental exposures, to genetic factors. The chair of the Department of Biostatistics and Epidemiology and director of the Center for Clinical Epidemiology and Biostatistics, Feldman will also become editor in chief of the American Journal of Kidney Diseases, the official journal of the National Kidney Foundation.

Garret A. FitzGerald, M.D., chair of the Department of Systems Pharmacology and Translational Therapeutics and director of the Institute for Translational Medicine and Therapeutics, was elected to the Royal Irish Academy. It is considered the highest academic honor in Ireland. FitzGerald was recognized for his lifetime contributions to the study of cardiovascular health. He was instrumental in the discoveries relating to the use of low-dose aspirin in preventing cardiac disease.

His team was the first to predict and then mechanistically explain the cardiovascular hazard from NSAIDs, and his laboratory was also the first to discover a molecular clock in the cardiovascular system.

More recently, FitzGerald also received a 2016 Presidential Distinguished Service Award for the Irish Abroad. He is the first recipient in the new category of Science, Technology,

and Innovation. In addition to acknowledging FitzGerald’s research, the Service Award noted his work in promoting scientific endeavor in Ireland, including establishing the Center for Cardiovascular Science at University College, Dublin, and serving as founding advisor of Science Foundation Ireland.

Farzana Rashid Hossain, M.D., an assistant professor of clinical medicine and a gastroenterologist, was appointed by Mayor Jim Kenney to the Philadelphia Commission for Women. The commission’s goal is to build vital relationships and help create equitable opportunities for women at all levels of the Philadelphia workforce. Rashid Hossain said, “I hope to empower girls to follow their scientific passions and take an executive pathway from the lab to the boardroom and look forward to working with my new colleagues to demonstrate that capable women are essential in strategizing and executing long-lasting government policy matters that will enable equal rights for women.”

Her honors include the Health Care Heroes Award from Penn Medicine, and she serves on the board of the Self-Freedom Foundation, which funds projects in the areas of education, critical health care, and special situations that directly benefit underprivileged women and children in developing countries.

Martin G. St. John Sutton, M.B., B.S., a John W. Bryfogle Emeritus Professor of Cardiovascular Medicine, has received the 2016 Lifetime Achievement Award from the American Society of Echocardiography for his pioneering contributions to structural and functional ventricular remodeling and repair.

“Martin’s work codified the tools we now commonly use to quantify changes in size, shape, and function of the heart under many conditions, which has become the foundation for all subsequent studies of ventricular remodeling,” said Victor A. Ferrari, M.D. ’86, a Penn professor of cardiovascular medicine.

“His studies of reverse – or beneficial – remodeling using Cardiac Resynchronization Therapy were groundbreaking and led the field in a completely new direction.”

St. John Sutton directed Penn’s Cardiovascular Imaging Division from 1993 to 2014 and the Center for Quantitative Echocardiography for 20 years. Over the course of his career, he was also co-author of more than 320 peer-reviewed publications in heart failure, congenital heart disease, and echocardiography.

Raymond R. Townsend, M.D., a professor of medicine and director of the Hypertension Program, was named the 2016 Physician of the Year by the American Heart Association (AHA).

The award is presented to one person each year with direct patient care responsibilities who has demonstrated an exemplary commitment to furthering the association’s mission to build FALL 2016

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Honors & Awards Continued healthier lives, free of cardiovascular diseases and stroke.

“Having spent the majority of my career dedicated to hypertension, both in research and clinical practice, I have been actively involved in the AHA as their mission goes hand in hand with my career goals,” Townsend said.

He received his first award from the association in 1984, which was also his first-ever academic grant. Later, he became an AHA fellow, and he has been a reviewer and contributor for Hypertension, the association’s journal, for more than 20 years.

Douglas C. Wallace, PhD., a professor of pathology and laboratory medicine at Penn and director of the Center for Mitochondrial and Epigenomic Medicine at Children’s Hospital, was inducted into the Italian Academy of Sciences. Members have included such luminaries as the Italian scientists Volta, Golgi, and Avogadro and non-Italians Pasteur, Franklin, and Einstein. Wallace was recognized for his scientific contributions as the founder of the field of mitochondrial medicine. During the 1970s, he defined the genetics of the DNA located in the mitochondria, the “power plants” of the cell, including demonstrating that human mitochondrial DNA is exclusively maternally inherited. The mitochondrial DNA codes for the wiring diagram of the power plants. Wallace has proposed and synthesized evidence for a hypothesis that mitochondria are not just a useful tool to trace the history of evolution but may have played a critical role in shaping how predecessors of modern humans adapted to their environments.

E. John Wherry, Ph.D., a professor of microbiology, director of the Institute for Immunology, and co-director of the Parker Institute for Cancer Immunotherapy at Penn, received the 2016 Frederick W. Alt Award for New Discoveries in Immunology from the Cancer Research Institute (CRI). The award honors an outstanding former CRI-Irvington postdoctoral fellow. Wherry was a CRI-Irvington postdoctoral fellow from 2000 to 2003 at Emory University.

Wherry’s discoveries include insights into how changes in gene expression affect T cell exhaustion. Normally, during a short-term infection, such as the flu, immune cells handily eliminate the offending pathogen. But in long-term chronic infections such as hepatitis C, HIV, and malaria – and also in cancer – T cells and the opposing pathogen or malignancy engage in a continuous struggle, and over time the T cells become “exhausted,” giving cancer or the pathogen the edge.

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Appointments

Ramon Diaz-Arrastia, M.D., Ph.D., has been named the ninth Presidential Professor at the University of Pennsylvania.

A world-leading expert in traumatic brain injury, Diaz-Arrastia is the Presidential Professor of Neurology in the Perelman School of Medicine. “At the uncharted frontier of brain science and traumatic injury, few investigators have expanded our knowledge quite like Dr. Ramon Diaz-Arrastia,” said Penn president Amy Gutmann. “Ramon is a pioneering force in exploring the intricacies of neural damage and repair, and as Presidential Professor he will further strengthen Penn’s vital neurological research and exceptional clinical care.”

Diaz-Arrastia joins Penn from the Uniformed Services University of the Health Sciences in Bethesda, Md., where he also served as director of clinical research at the Center for Neuroscience and Regenerative Medicine, a partnership between the USUHS and the National Institutes of Health. His path-breaking research focuses on understanding the molecular, cellular, and tissue level mechanisms of secondary neuronal injury and neuroregeneration, especially through biomarker development. His most recent work explores using MRI, functional MRI, and PET scanning to characterize the multiple complex mechanisms involved in traumatic injury to the brain, as well as combining imaging, genomic, and tissue biomarkers to better predict

They Said It

Fatigue comes in different flavors. “There’s physical fatigue, but also emotional fatigue and psychological fatigue,” said Anne R. Cappola, M.D. ’94, Sc.M., a professor in the Division of Endocrinology, Diabetes, and Metabolism. As she told Prevention, “People underestimate the effects of psychological stress on energy levels, but in retrospect, after that stress is gone, they realize that was making them so tired.”

patient outcomes after traumatic brain injuries and to develop novel therapies.

Diaz-Arrastia earned his M.D. degree in 1988 and his doctorate in biochemistry in 1986 from Baylor College of Medicine.

Cunningham is currently principal investigator of an NIHfunded multi-site study aimed at developing knowledge and skills to support implementation of clinical trials. She was inducted into the American Academy of Nursing in 2014.

Regina Cunningham, Ph.D., R.N., was named senior vice president and chief nursing executive for the University of Pennsylvania Health System. She continues in her current role as the Hospital of the University of Pennsylvania’s chief nursing executive.

“Regina’s expanded portfolio reflects the broad impact and crucial importance of nursing as Penn Medicine continues to expand and innovate across the continuum of care,” said Ralph W. Muller, CEO of UPHS. “During her tenure thus far at Penn Medicine, Regina has forged strong partnerships to deepen nursing’s role across the health system.”

In her new role, Cunningham provides leadership to nursing colleagues from each entity throughout UPHS. Her close collaboration with Patrick J. Brennan, M.D., chief medical officer and senior vice president, to advance interprofessional collaborations across the system will continue, and she will partner with Antonia Villarruel, Ph.D., R.N., dean of Penn’s School of Nursing, to advance scholarly platforms for nursing across Penn Medicine.

Maria A. Oquendo, M.D., an internationally renowned expert in mood disorders, has been appointed the new chair of the Department of Psychiatry. Oquendo, who will begin her new role at Penn Medicine on January 1, 2017, is currently a faculty member at Columbia University, where she is vice chair for education and director of residency training at the New York State Psychiatric Institute. She is also the current president of the American Psychiatric Association.

Oquendo is an international leader in the treatment and neurobiology of mood disorders, with a special focus on suicide, as well as global mental health. As an investigator, Oquendo has been continuously funded by the National Institute of Mental Health since 1999 and has more than 300 peer-reviewed publications. In addition, she is president of the International Academy for Suicide Research.

Oquendo received her M.D. degree from the College of Physicians and Surgeons at Columbia University in 1984.

She completed her residency in psychiatry at the Payne Whitney Psychiatric Clinic at the New York Hospital-Cornell Medical Center.

Penn Medicine Researchers to Co-lead $23 Million HIV Cure Grant

HIV researchers at the Perelman School of Medicine and the Wistar Institute will co-lead a five-year, $23 million grant from the National Institutes of Health. It is part of the second iteration of the Martin Delaney Collaboratory: Towards an HIV-1 Cure program, which aims to advance basic medical science toward a cure for the disease.

James L. Riley, Ph.D., a research associate professor of microbiology, and Luis J. Montaner, D.V.M., D.Phil., director of the HIV-1 Immunopathogenesis Laboratory at the Wistar Institute Vaccine Center, will serve as co-principal investigators for the “BEAT-HIV: Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy” consortium, which includes 30 top HIV researchers from institutions across the nation, half of whom hail from Penn. The scientific team will work with government, non-profit, and industry partners to test combinations of several novel immunotherapies and gene therapies under new preclinical research and clinical trials. Other institutions include Philadelphia FIGHT, Rockefeller University, VA San Diego Healthcare System, Johns Hopkins University, the University of Nebraska-Lincoln, and the University of Utah.

Other Penn researchers include Faten Aberra, Katharine Bar, Michael Betts, Frederic Bushman, Susan Ellenberg, Ian Frank, Beatrice Hahn, George Shaw, Julie Jadlowsky, Carl June, David Metzger, Pamela Shaw, Pablo Tebas, and E. John Wherry.

FALL 2016

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VITAL SIGNS They Said It

Penn Software Helps to Identify Course of Cancer Metastasis

Individual cells within a tumor are not all the same. This may sound like a modern medical truism, but it wasn’t very long ago that oncologists assumed that taking a single biopsy from a patient’s tumor would be an accurate reflection of the physiological and genetic makeup of the entire mass. Researchers have come to realize that cancer is a disease driven by the same “survival of the fitter” forces that, according to Darwin, drove the evolution of life on Earth. In the case of tumors, however, individual cells are constantly evolving as a tumor’s stage advances. Mobile cancer cells causing metastasis are a deadly outcome of this process.

Tumors also differ among patients with the same type of cancer, so how is a physician able to prescribe a tailored regimen for the patient? To start to address this conundrum, an interdisciplinary team from the Perelman School of Medicine and the Wharton School developed Canopy, an approach to infer the evolutionary track of tumor cells by surveying two types of mutations – somatic copy number alterations and single-nucleotide alterations – derived from multiple samples taken from a single patient. The researchers demonstrated the approach on samples from leukemia and ovarian cancer, along with samples from a human breast cancer cell line.

The team – Yuchao Jiang, a doctoral student in the Genomics and Computational Biology program; Yu Qiu, Ph.D., a postdoctoral researcher in the lab of coauthor Andy J. Minn, M.D., Ph.D., an assistant professor of radiation oncology; and Nancy R. Zhang, Ph.D., an associate professor of statistics in the Wharton School – published its findings online in the early edition of the Proceedings of the National Academy of Sciences.

“The makeup of a tumor for a given patient is often a mixture of multiple distinct cell populations that differ in genetic makeup, gene expression, and physiology,” Jiang said. “This heterogeneity contributes to failures of targeted therapies and to drug resistance based on old thinking that tumors are homogenous masses.”

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“Everyone recognizes the problems that pervade end-of-life care and, because of that broad recognition, everyone is interested in a solution,” Scott D. Halpern, M.D. ’03, Ph.D. ’02, an associate professor of medicine, epidemiology, and medical ethics and health policy, told The Philadelphia Inquirer. A critical care physician, he also directs the FIELDS program, Fostering Improvement in End-of-life Decision Science. According to Halpern, the problem is that many people have jumped in with well-intended, intuitively appealing programs that may not work. Those could crowd out opportunities for more effective approaches. Among the popular programs that Halpern criticizes are Five Wishes, Respecting Choices, and the Conversation Project. “None of these things are backed by much evidence,” he said. Halpern is most critical of POLST (Physician Orders for Life-Sustaining Treatment) programs, arguing that they are inflexible while illness is unpredictable.

Penn Medicine Hospitals Shine

Penn Medicine hospitals have once again been ranked among the top 10 hospitals in the nation and #1 in Pennsylvania by U.S. News & World Report. Together, the combined enterprise of the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center is ranked as the 9th best hospital in the United States for the magazine’s 2016-2017 annual survey. Once again, the hospitals are also ranked #1 in the Philadelphia metro area.

Penn Medicine is among only 20 institutions – and the only one in the Philadelphia region – to be named to the publication’s 20162017 Honor Roll. The hospitals are also recognized for excellence in 11 specialties, including Cancer; Cardiology and Heart Surgery; Diabetes and Endocrinology; Ear, Nose & Throat; Gastroenterology & GI Surgery; Geriatrics; Nephrology; Neurology and Neurosurgery; Orthopedics; Pulmonology; and Urology.

Three other Penn Medicine hospitals also netted honors.

Pennsylvania Hospital is ranked #4 in Philadelphia and #7 in the state and is nationally ranked in Orthopedics. Chester County Hospital is ranked #6 in the Philadelphia region and 12th in the state. Lancaster General Health is ranked 5th in the state and nationally ranked in Gastroenterology & GI Surgery and Pulmonology.

LETTERS From Chaplains to Ants

I am a 1967 graduate of the School of Medicine, still love practicing internal medicine, and am the clinical advisor to the pastoral care program at Jeanes Hospital, where I was involved with the pastoral care residents before that program closed. Understandably, I loved David Lewellen’s piece on “Learning from Chaplains.”

Even more intriguing to me was Karen Kreeger’s piece, “When Majors Act Like Minors.” The interplay of genetics and epigenetics fascinates me and would seem to explain that old question of “is it nature or nurture?” What we eat, how we move our bodies, our relationships and feelings might be able to trigger molecular “tags.” May I ask you to forward this email to Dr. [Shelley] Berger, with the request that she email me some articles that speak to this subject?

Ronald Banner, M.D. ’67 Editor’s Note: We did – and Dr. Berger did.

Spirituality in Medicine

I am writing to express my gratitude for Penn Medicine and especially the article “Learning from Chaplains” in the Summer 2016 issue.

My wife and I are both trained and worked at Penn in anesthesia. I also trained and worked at CHOP as a pediatric critical care physician.

At the time I received the current issue, my wife was in the ICU on a ventilator as a patient and I was comforted by my interaction with the chaplain. I also appreciated the availability of alone time in their “spiritual sanctuary” (the chapel designed for families, friends, and staff of all faiths) and the special outside garden for personal reflection. I need to “go into the closet” to be calm and receptive to know God was in control of the care plan and guiding the care team.

When I was an anesthesia resident at CHOP (1973), I met Dr. [C. Everett] Koop behind the ether screen.

As you know, he was the pioneer of pediatric surgery which he developed at Penn with the support of Dr. [I. S.] Ravdin after WWII. He also worked with others to build CHOP as it is today. We immediately recognized a mutual spiritual bond and respect for the role of spirituality in medicine, and he invited me to his office for many private conversations. For the next 35+ years we met in person or by telephone regularly just when we needed to (I have many stories to tell).

The reason I am writing you right now is also because Dr. Koop would have been celebrating his 100th birthday in October 2106.

Allen I. Goldberg, M.D., G.M.E. ’75, M.B.A., is a former president of the American College of Chest Physicians. You can find his reflections on Dr. Koop here: http://bit.ly/2exY1Up

The Whole Issue

Usually I scan and sample the articles in Penn Medicine, but in the Summer 2016 issue I read every one.

Each was especially well written – clear, specific, focused, friendly, accessible. I will pass this issue to my granddaughter (18 years old), who will enter U. of PA this fall as a freshman.

Congratulations to you and your staff for an outstanding issue.

Janice Arrowsmith [who signed herself “layperson”]

Correction

During interviews for a story in the Summer 2015 issue of Penn Medicine magazine about my work at the Penn Center for Youth and Family Trauma Response and Recovery, I mischaracterized my involvement in efforts to help children who survived the tragedy that took place during the Sandy Hook Elementary School shooting in 2012. I was not, in fact, part of the on-site efforts. I deeply regret my responsibility for this portrayal in the article and request that the magazine run a correction of these facts.

Respectfully, Steven Berkowitz, M.D. Associate Professor of Clinical Psychiatry, Perelman School of Medicine Director, Penn Center for Youth and Family Trauma Response and Recovery FALL 2016

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THE COST OF DRUGS: AN INCREASING BURDEN

COVER STORY

W

hat does it take to become the most vilified drug company in America? Raise the price of your life-saving injection device more than 450 percent. Make it difficult for many users of the drug – including many children among the more than 3.6 million – to afford it. Defend your price hike, then equivocate in your public statements and arouse the fury of Congress as well as patients. The product is the EpiPen, made by Mylan N.V., which this summer surpassed Turing Pharmaceuticals and its brash CEO, Martin Shkreli, as the prime example of the drug company that puts profits – extravagant profits – first.

Since 2009, Maylan has steadily increased the price of its EpiPen, a necessity for millions of people with severe allergies. Originally, the two-pen pack cost a pharmacy $103.50. Since then, the price rose to $264.50 in July 2013; to $461 in May 2015; and this summer to $608.61. On August 21, a headline in Forbes.com read: “Why Did Mylan Hike EpiPen Prices 400%? Because They Could.” As with Turing’s Daraprim, the product that Mylan sells is decades old; the company bought it in 2007 and any research and development costs were recouped long ago. In Mylan’s case, it is maintaining the $608.61 for the “branded”

version but has announced a generic version of the EpiPen – but a hike from an original price of $100 in 2008 to $300 for the generic version is still steep.

Mylan and Turing Pharmaceuticals are by no means the first companies to increase the price of already-approved drugs, which often places them beyond patients’ reach.

According to an AARP Public Policy Institute report, drug prices have steadily increased and outpaced inflation for years now. Is it simply a case of capitalism at work? Or should there be a difference when the lives of people are at stake?

In this issue of Penn Medicine, we take a look at these issues from different perspectives. In one case, inside our hospitals, our physicians and pharmacists are helping patients find new ways to afford the rising costs of their drugs. In addition, a recent Penn Medicine study encourages physicians to select an equivalent generic drug instead of a brand-name drug when prescribing a medication.

We also check in with Ezekiel J. Emanuel, the chair of the Perelman School’s Department of Medical Ethics and Health Policy, a widely quoted expert whose background in both economics and ethics informs his analysis.

By Steve Graff and Katie Delach HUP’s Efforts to Soften the Blow

Like patients, hospitals have been struggling to deal with the rising cost of drugs. “This is becoming a huge problem,” says Richard Demers, M.S., R.Ph., director of pharmacy services at the Hospital of the University of Pennsylvania. “Companies are buying drugs and turning around and increasing the price by a lot – it’s a profit grab. There are multiple approved drugs out there today that have been hiked up.” And it’s costing both patients and hospitals, during a time when reimbursements from the Centers for Medicare and Medicaid Services have already been cut.

The issue is also relevant for newly developed drugs, particularly ones for cancer, which now frequently cost well over $100,000 a year. New biologic agents can do wonders for managing patients’ conditions, but improvements come with significant financial costs. Pharmaceutical companies argue that research endeavors and costly manufacturing justify the high price tags, but Demers asserts that pricing is ultimately guided by what the market can bear.

Some patients are able to shoulder the rising costs of outof-pocket medical expenses – which remain even after some of the most premium insurance plans pick up a share of the costs – through savings, loans, or financial assistance programs through charitable foundations and even the makers of the drugs. But others are ruined by these costs: Last year,

bankruptcies from unpaid medical bills were estimated to affect two million Americans. Those bills continue to be the most common reason people file for bankruptcy in this country. The customary response of the pharmaceutical industry is that spending for drugs accounts for only about 10 percent of the nation’s health care costs and that published list prices do not reflect the discounts and rebates that companies may offer. Even so, the out-of-pocket medical expenses can be devastating.

Every day at Penn Medicine, nurses, physicians, pharmacists, and financial counselors are working behind the scenes to ensure that patients can afford their lifesaving medical care.

Specialists coordinate and communicate with insurance companies on patients’ behalf, seek out sponsorships from pharmaceutical companies, and work with foundations that help subsidize medical bills for those in need.

“To help solve this problem, we all need to take a step back and work together to figure this out, so the person who is sick doesn’t have to go through these gyrations to get something that could save their lives,” Demers says. Penn has worked with hundreds of patients on their medical bills, helping to alleviate some of the burden and keeping them on track for care.

Of course, HUP is not alone in its efforts to keep drug costs down. A Washington Post article this spring (“Hospitals Rattled by Drug-price Increases”) pointed out that some hospitals FALL 2016

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are trying to manage their budgets by restricting or adjusting the medications they provide. For example, the list prices of two injectable heart medications, Nitropress and Isuprel, have risen more than 200 percent and 500 percent respectively. At the University Hospitals of Cleveland, when doctors sign into the electronic medical record to prescribe certain drugs, a row of five dollar signs pops up. The message, as the Post puts it, is clear: “Think twice before using this drug. Pick an alternative if possible.”

Can a “Nudge” Make a Significant Difference?

At Penn Medicine, a recently formed “nudge unit” – the world’s first such unit in a health system – is also attempting to influence how physicians prescribe. The approach, however, is somewhat more subtle.

In their book Nudge: Improving Decisions About Health, Wealth, and Happiness (2008), Richard Thaler, a behavioral economics expert at the University of Chicago, and Cass Sunstein, a legal scholar, describe how “small interventions in the environment or incentives can encourage people to make better decisions.” Decision-making of any kind is strongly influenced by how choices are presented and information is framed. While the basic principles of nudge theory aren’t exactly new, the evidence-based applications are. The successes of the first nudge units – such as the Behavioural Insights Team (BIT), created by former British Prime Minister David Cameron in 2010 in an attempt to improve public services and save money – are currently spurring worldwide efforts across many industries to find the most effective ways to influence how decisions are made. By applying seemingly insignificant “nudges” to standard operating procedures, the BIT

A recent Penn study sought to encourage physicians to prescribe more generic drugs instead of brand-name medications. In the study, when a physician prescribed a drug for a patient, the electronic medical record would default to an equivalent generic, if available. has produced notable results. For example, there has been an increase of 100,000 registered organ donors per year in England, and the number of army applicants has doubled.

What kind of small changes are involved? It could be as simple as requiring people to opt out of something instead of asking them to opt in. Or it could be requiring that people select “yes” or “no” to adding a dessert to their online pizza delivery order before allowing them to proceed to check out.

In the health care arena, researchers at Penn Medicine applied nudges to default prescription settings in electronic medical records. The goal was to encourage physicians to prescribe more generic drugs instead of brand-name medications. In their study, when a physician prescribed a drug for a patient, the electronic medical record would default to an equivalent generic, if available. When warranted, the physician could still prescribe the brand name by selecting the “dispense as written” checkbox. The researchers compared the prescribing rates before and after the addition of the opt-out checkbox. The results, published online in JAMA Internal Medicine in May, showed that by simply adding an opt-out checkbox to prescription default options, generic prescribing rates increased from 75 percent to 98 percent. In the long run, this seemingly small change could produce a significant cost savings for both patients and the health system.

“Systematic errors in decision-making – from what providers do (or fail to do) to choices patients make – often hinder our ability to deliver high-value care,” says Mitesh Patel, M.D., M.B.A. ’09, M.S. ’14. Director of the Penn Medicine Nudge Unit, he is an assistant professor of medicine in the Perelman School and of health care management in the Wharton School. “Applying principles from behavioral sciences to the way we design applications or systems in which decisions are made can steer us towards better decisions, higher value, and improved outcomes.”

Penn Medicine has a multidisciplinary group of experts in behavioral economics. Through the Center for Health Incentives and Behavioral Economics, it has been a national leader in applying and testing these concepts within real-world applications. However, how choices presented within digital en-

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WHY DO DRUG PRICES KEEP RISING?

Ezekiel J. Emanuel believes that drug prices are too high, but responsibility is shared.

Ezekiel J. Emanuel, M.S.C., M.D., Ph.D., is the chair of the Perelman School’s Department of Medical Ethics and Health Policy and the University’s vice provost for global initiatives.

For two years, however, he served as special advisor for health policy to the director of the Office of Management and Budget in the White House. He looks at the rising cost of drugs from the double perspective of economics and ethics.

The week that Emanuel spoke to Penn Medicine, Heather Bresch, the CEO of Mylan N.V., testified before Congress about the price of the EpiPen, which has increased from $100 for a two-pack in 2009 to $600 today. As Emanuel sees it, the high price of drugs is only part of the grim state of high health care costs in general. Emanuel was blunt: “It’s mind-boggling and outrageous. I sliced open my finger and went to an E.R. in New York.” There he was given a tetanus shot, and the whole treatment was over in about five minutes. “It was done by a nurse, not a doctor or nurse practitioner. They charged more than $1,000 just for that. That’s the kind of thing that the public is responding to.” As for the cost of drugs, he continued, “There’s been a steady stream of outrage. . . . Even drugs where there’s been no further research on them or changes of any kind, they are steadily raising the rates of those drugs.” That was the case with Mylan, which bought the EpiPen business in 2007.

Speaking about Mylan on CBS’s “Squawk Box” in late August, Emanuel argued that there is basically a monopoly in the drug business, and the companies exploit it to raise prices.

The only way to keep prices reasonable in such a situation is, he said then, “government regulation, unfortunately.”

On the other hand, as he told Penn Medicine, Emanuel sees no need to single out villains among the drug companies. “I don’t like to think of it that way – who we put in the public stockade.” Instead, he said, he is concerned that there are no incentives to actually save money. “Doctors aren’t paid in any way to bring total cost of care down. We need to provide in-

formation on how much does this drug versus that drug cost, or how much this specialist costs versus another in terms of what they do and the quality of care. Right now, there are no incentives, and that’s part of the reason why it’s so costly.”

Another problem he sees is drug pricing inflated by the middle men – “and drug companies are somewhat responsible for that. It’s really the system: there’s a game of discounts when you bundle drugs together. But doctors can have an effect on drug prices in deciding what they prescribe when they use price as a factor in that choice.” Most patients don’t receive that information about cost, but, Emanuel continued, there are many places that do provide it. In California, for example, “the guidelines for the practice require that drug orders are put through an affordability filter, and it chooses the drug that is most affordable unless there’s a specific reason. So you won’t get the fancy insulin – you’ll get the standard 70/30 insulin because it’s the more affordable option.”

Would doctors protest that their time is already so limited?

“There’s no excuse for not knowing,” Emanuel said emphatically. “If you treat hypertension, you start with the most affordable option. And if that doesn’t work, you escalate. It’s not rocket science.” He believes the same thinking should prevail with tests. “If you’re responsible for total cost of care for a pool of patients and order unnecessary tests, that’s going to work against them. You have to create a financial incentive for them not to order unnecessary tests.”

As for the patients themselves? “Patients make demands for specific drugs and more tests and more treatments that are not necessarily better,” Emanuel said. “I think we also need patients to be aware because their premiums go up and they see the bills coming in, and that is a reflection of the demand for services. But I don’t want to lay it on the patients, they are minor players in this. It’s more the doctors and the health care providers.”

– Dawn Fallik FALL 2016

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vironments affect the delivery of care has not been closely examined until now. The team at Penn is working to design, implement, and test various ways in which nudges can be used.

The Impact of “Financial Toxicity”

“If a simple, low-cost change like adding an opt-out check box to prescription settings can make a significant impact, there are likely other refinements that can be made just as easily that will also result in cost savings for patients and health systems,” says C. William Hanson, M.D. ’83, chief medical information officer at Penn Medicine and a member of the advisory board of its Nudge Unit. “It’s a valuable area of research to continue exploring.”

In addition to hurting patients’ bank accounts, the high costs of drugs can affect their health as well. Treatments may be delayed or stopped altogether, and patients’ quality of life can plummet during times of financial strain. The problem is pervasive enough that a relatively new term has been coined: “financial toxicity.” It’s described as the financial burden re-

lated to health care – and it seems to affect even wealthy patients and those with insurance. Like a more traditional side effect, this kind of toxicity may threaten a patient’s well-being.

A study published in Lancet Haematology by researchers at Penn’s Abramson Cancer Center (ACC) has documented these harmful effects on patients who have multiple myeloma.

The senior author was Edward Stadtmauer, M.D., chief of hematologic malignancies and a professor of hematology/oncology at the center. He and his colleagues found that even patients with multiple myeloma who have health insurance may be vulnerable to financial toxicity. And that includes those who earn more than $100,000 a year.

The costs of newly approved therapeutics for blood cancer have increased 10-fold during the past 15 years. Many agents 12

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are priced at $10,000 or more a month. Patients can be on them for months, even years.

Nearly half of the 100 patients surveyed in the ACC study dipped into their savings to pay for their care, and 17 percent reported delays in treatment because of costs. One in five bor-

Last year, bankruptcies from unpaid medical bills were estimated to affect two million Americans. Those bills continue to be the most common reason people file for bankruptcy in this country. rowed money, and 10 stopped treatment altogether. Surprisingly, the study included patients with demographic characteristics thought likely to protect against financial burden. All participants were insured, and all patients with Medicare fee-for-service coverage had supplemental insurance to assist with some outof-pocket costs. In addition, they had a median household income and education level above the national average.

“The treatments and clinical outcomes for our patients are really poised to change for the better,” said the study’s co-author, Scott Huntington, M.D., in a Lancet podcast. A former oncologist in the Abramson Cancer Center, he is now a faculty member at Yale University. But despite the promise of new cancer treatments, he went on to acknowledge what he calls “the untenable rise in costs.” As Huntington put it, “Patients with cancer are already at risk for financial burden related to lost wages or extraneous expenses that we can’t really control as health care providers. This really makes it that much more important for us as oncologists to confront these rising treatment costs in part to try to decrease this treatment-related financial toxicity.” If they fail to do so, he warned that widespread access to promising cancer treatments may be in jeopardy.

Indeed, the issue goes beyond blood cancers. A recent commentary in Mayo Clinic Proceedings pointed out that the cost of cancer drugs increased between 1995 and 2013 by an average of $8,500 a year, a spike that has many physicians speaking out more vigorously. The commentary, signed by more than 100 oncologists, noted that out-of-pocket costs now make up about 20 to 30 percent of the total cost of cancer treatment. For example, a patient with cancer who needs one cancer drug that costs $120,000 per year (the going rate for newly approved drugs) could have out-of-pocket expenses as high as $25,000 to $30,000.

That’s more than half the average household income – and possibly more than the median take-home pay for a year.

“This increase is causing harm to patients with cancer and their families,” the authors wrote. “The current pricing system is unsustainable.”

Parents and Teens Learn the Way to Safety

By Katie Delach

New studies aim to keep drivers young and old from cellphone distractions.

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istracted driving is responsible for more than 3,000 deaths and more than 400,000 injuries each year. Everyone knows it’s dangerous – who among us hasn’t yelled at the driver who drifts into our lane to “put the phone down!” or “pay attention!”? And how many of us have been that driver drifting into the other lane because we were doing something else when we should have had our attention focused on the road?

“Today, there are twice as many drivers actively using handheld electronic devices while driving as there were five years ago,” says M. Kit Delgado, M.D., M.S., an assistant professor of emergency medicine and epidemiology who is affiliated with Penn’s Center for Health Incentives and Behavioral Economics. “Not surprisingly, crashes directly related to cell phone use while driving increased by 38 percent during the same time period. This is not about increasing awareness of the risks – everyone already knows it’s dangerous.”

Any activity that diverts a driver’s attention away from the road – whether it’s eating, grooming, reading a map, or using a cell phone – endangers the driver, passengers, and bystanders.

But because texting involves both a physical act and mental attention, it is by far the most concerning distraction. In fact, according to the U.S. federal government’s “Healthy People 2020” objectives, motor vehicle crashes because of distracted driving is the number one emerging issue in injury prevention that requires more attention and research.

Given these alarming statistics, researchers from Penn Medicine, the School of Nursing, and the Center for Injury Research and Prevention at the Children’s Hospital of Philadelphia have teamed up to study the pervasive problem. Using windshield-mounted devices that communicate with a mobile app to measure cell phone use while vehicles are in motion, the team hopes the Way to Safety 2.0 and 3.0 studies will provide a better understanding of how technology can reduce distracted driving crashes and engage teens and their families in ways that promote better driving behavior.

Participants are given the windshield-mounted devices. When vehicles are in motion, the devices communicate with a mobile app to enact an automated “Car Mode” – similar to “Airplane Mode.” A “blocking” feature automatically activates when the vehicle reaches 10 miles per hour, locking the phone screen, silencing notifications, and sending automated responses to

incoming text messages. But an “opt-out” feature allows users to override the blocking.

Nearly complete, the Way to Safety 2.0 study focused specifically on novice teen drivers. But, while nearly half of U.S. high school students admit to texting or checking their phones while driving, research suggests that adult drivers might actually be worse when it comes to using phones. For that reason, the Way to Safety 3.0 study is for the whole family.

The Way to Safety Family Study is tackling cell phone use in drivers of all ages by enrolling teen drivers and their parents/ guardians as pairs. In the new study, if a teen chooses to override the blocking feature and use the phone while driving, the device will send a notification to the parent or guardian.

Would any teen sign up for that, you ask? Well, for half the participants, the study also tests the effect when the teens are notified that their parent/guardian overrides the blocking function. You might not want a little tattle-tale alerting your teen if you text while you’re driving, but the researchers hope that knowing your teen (or parent/guardian) will know if you’re breaking the rule will help hold all participants accountable for dangerous actions – or reduce the temptation to use the phones while driving at all.

In future research, Delgado is interested in seeing if frequently delivered behavioral incentives, such as discounts on insurance premiums, could facilitate adoption of these technological interventions and motivate drivers to stay engaged in using them as a way for the entire family to reduce cell phone distractions while driving.

“Strategies are needed to nip the impulse in the bud since we consistently act against our own best interests,” Delgado says. “It seems crazy to me that that there are government policies requiring the use of an Airplane Mode and there’s nothing similar for a ‘Car Mode,’ despite the epidemic of avoidable crashes and deaths that are being caused by operating a phone in the car.” He also points out that the researchers are testing ways to implement such a setting in ways that nudge drivers to be safer. “In this case, we’re using this setting to get around the ‘Do as I say, not as I do phenomenon’ with parents. Hopefully, this extra level of intrafamily accountability will keep everyone safer.”

Contributing writer: Sharlene George FALL 2016

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Innovators, Inventors, and Students

Photos by Graham Perry J. C. Lopez (left) and Alex Sotolongo were finalists in DevelUPmed, a competition to develop new medical devices.

FEATURE

With help from Penn’s resources and connections, two medical students are preparing to put an innovative surgical device on the market.

Sotolongo was at a dinner party with his wife, Beatrice. At the time, he was on a surgical rotation taking care of patients suffering from vascular disease. The patients were treated with state-of-the-art therapies, and the surgeons, Sotolongo says, were “highly trained and extraordinarily skilled.” Still, he notes, “there were often devastating complications.”

“I thought to myself, there has to be a better way, our patients deserve more.” For months, he pondered how the surgeries could be improved.

Then, at the dinner party, “an idea popped into my head, seemingly out of thin air.”

Fortunately for him, Beatrice is the CEO of a start-up company and has served as a sounding board for his frequent ideas.

“I pitched the idea to her, and to my surprise she responded with something along the lines of ‘This, surprisingly, isn’t crazy.’ That’s when I knew we were on to something, and I scribbled some rough sketches on a napkin.”

To move his idea from the napkin to the surgical suite, he reached out his water polo buddy. They had reconnected at Penn Preview, the second-look weekend for School of Medicine students. They communicated through Facebook when they saw they had both been admitted to the Perelman School.

Lopez had worked for Penn’s Center for Technology Transfer, which was then incorporated into the Penn Center for Innovation (PCI) when that was formed. He was part of the program during the transition and had 18 months of experience with technology transfer and market analysis in all. He picks up the story: “He reached out to me about his idea and wanted some input about the intellectual property around it.”

Using the skills he had developed, Lopez was able to determine that Sotolongo’s idea could amount to a viable product with respect to patent protection and financial opportunity.

As Lopez recalls, they started chatting about the idea together in December 2015 and then came across a momentous e-mail announcement from PCI. It concerned a competition, called DevelUPmed, to develop new medical devices. “We both thought, ‘What the hell, let’s give this competition a shot and see what can come of it.’ So, we submitted the idea.” They were selected as the only student-run team out of the three finalists in the competition, which received more than 50 submissions across Penn Medicine and the University.

Michael Dishowitz, Ph.D., is a portfolio manager for PCI’s new ventures program and director of DevelUPmed. The latter, he says, partnered with 20 investors, entrepreneurs, and industry experts to identify devices with the most promising commercial potential. “J. C. and Alex’s invention was at the top of the list in part because they proposed a novel solution that

Entrepreneurs . . .

By Jon Caroulis

T

hey first met as adversaries – in deep water. J. C. Lopez and Alex Sotolongo were playing against each other in a highschool water polo match in Miami. They became friendly and later competed together at national-level water polo matches, then went their separate ways to college. Both hoped to become doctors. The two reconnected when they were accepted into the Perelman School of Medicine. Now, as 4th-year students, they have teamed up to conceptualize something that could, as one experienced medical developer said, “improve efficiency in a commonly performed surgery.”

Their experience has been akin to pursuing their medical education while at the same time studying for another professional degree. Lopez and Sotolongo have had to educate themselves on the long and sometimes difficult process of procuring a patent, obtaining financing, writing proposals for grants, and finding partners and mentors. But both of them credit their time as water polo players with providing a foundation that gave them the mental and even physical power to keep at it.

And it all started with a drawing on a napkin.

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Lopez and Sotolongo have a base at Plexus, where they can test their ideas.

would simplify and shorten vascular anastomotic procedures” – usually surgical procedures joining two tubular structures like blood vessels.

Each team had mentors who advised them on forming a company through Penn’s UPstart or UPadvisors programs.

They also participated in the “customer-discovery” program run by Penn I-Corps, created by the National Science Foundation to increase the impact of research it has funded. In addition, Dishowitz points out, the teams were advised by experts on intellectual property, FDA regulatory affairs, and healthcare reimbursement. Each team in DevelUPmed also received $10,000 for prototyping its project.

Sotolongo puts it bluntly: “Without the resources and guidance that the PCI has provided to us, none of this would be possible.”

Forming a Company, Pursuing a Patent

Sotolongo and Lopez have now formed their own company, Angiio. All grants they’ve received for the project have been awarded to the company. They are the only full-time employees, and they had help from two interns over the summer.

One is a Penn undergraduate engineering student and the other a first-year Penn medical student.

“We’re now at the stage where we are finalizing our initial prototype as well as developing our overall business case for the product,” Lopez adds.

At the end of September, they and the other finalists made 16

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their formal “pitches” to a panel of judges. The team whose prototype was selected received $50,000 from the Ben Franklin Technology Partners of Southeastern Pennsylvania. Although theirs was not selected, Dishowitz says that Lopez and Sotolongo “are very talented individuals, and their company has the potential to really improve medical care.” He points out that the reviewers in the earlier competition were blinded to the identity of the applicants, “so it’s certainly impressive that their idea stood out.”

Their device would use magnetic forces in vascular surgery to improve the way arteries and veins are connected by speeding up the connection process and reducing complications. As Lopez explains, the magnet will help deploy sutures that then allow the surgeon to tie the arteries together in a faster way than currently offered techniques. According to the Angiio website: “Current solutions require hand-sewing grafts to vessels and are regularly complicated by leakage from suture holes as well as decreased oxygenation to the brain, kidneys, and bowels due to prolonged surgical times.” Lopez adds, “We are in the process of submitting our provisional patent and continuing to develop our initial proof-concept prototype.”

But there is a complication, the two partners point out. In the process of submitting their provisional patent, they cannot publicly describe the mechanism in greater detail. “If we did,” Lopez says, “it would constitute what is called a ‘public disclosure’ and essentially eliminate our ability to patent the device if the crucial aspects of it are made public prior to submission.”

FEATURE The device, now named Vesicon, will be 6 to 10 millimeters long, small enough to fit into various arteries. In theory, they say, a surgeon will insert their invention using another tool they’re developing that will serve as a “guide stick.” Lopez and Sotolongo haven’t yet figured out what material will be used to construct the magnet.

“We’ve begun testing our deployment mechanism with a makeshift electromagnet, made out of microwave parts, just to understand the physics behind the idea,” Lopez says. “As we continue to refine our product, we plan on testing it on vessels to ensure we can deploy the device through a vessel wall.”

Pooling Their Talents

It’s been eight years since Lopez and Sotolongo first met as adversaries in that Miami pool.

“Although my main goal was to always beat his team, I knew right away that I respected Alex as a goalie in water polo,” Lopez says. “I always came into those games with a strategy on how to score on him and knew I would have to bring my A-game whenever we played each other.”

Sotolongo calls Lopez “one of the fiercest competitors I faced in my athletic career, and what was most impressive about him was that he would be the first one to come over and joke around with the opposing squad, regardless of the outcome. As I have come to know him in medical school, I can still see that intense, competitive spirit permeating through all of his endeavors.” What most impresses him, he continues, “is his vision, diligence, and practicality. I can say with a high degree of confidence that we wouldn’t be anywhere close to where we are if it wasn’t for the skills and qualities he brings to the table.”

For his part, Lopez cites Sotolongo’s intellect and his ability to understand a problem.

“I think we have been quite complementary partners, with Alex focusing on the hard science and myself focusing on the other aspects of the business, such as legal issues, financing, fundraising, regulatory, and reimbursement.”

Sotolongo says he applied to Penn because of the resources available to students in addition to the superb clinical education it offered. According to Lopez, he applied for similar reasons – as well as for the opportunity to complete the dual-degree program with the Wharton School.

He started his studies there this fall. The experience of developing a product, he says, “has solidified my conviction to pursue a dual M.D.-M.B.A. degree. I have learned just how complex taking a simple idea such as ours from point A to Z can be.”

In addition, he appreciates the work he did at the Penn Center for Innovation office, which he says “taught me the basics of intellectual property and just how important it is to commercializing an idea.” He also learned the importance of reaching out to people to get their advice and solicit their help in making additional them help make further connections. In this regard, he adds, the Penn Med Alumni network “has been invaluable.”

Through the alumni network, Lopez and Sotolongo connected with Pitou Devgon, M.D., G.M.E. ’08, M.B.A. ’10, who did his residency in internal medicine at Penn, then earned an M.B.A. degree from Wharton in health care management.

Devgon now has a start-up company, Velano Vascular, which he co-founded with another Wharton alumnus, Eric Stone, M.B.A. ’07.

“I always enjoy helping entrepreneurs in the Penn community, especially when they are passionately trying to innovate,” Devgon says. “When I first saw their concept, it seemed highly compelling.” Although he, too, can’t provide specifics, he says, “It could improve efficiency in a commonly performed surgery.”

Devgon has worked primarily with Lopez on the strategy front, especially around the F.D.A. approval process and market development. “People don’t know how much blood, sweat, and tears go into developing even the simplest medical device. Putting together the right interdisciplinary team and raising money takes a huge amount of time,” Devgon says, “but that’s what lays the foundation for great technologies to be developed.”

The Path to Medicine

Although they are now immersed in the business of medicine and technology, Lopez and Sotolongo were on different paths to becoming physicians.

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“My interest in becoming a doctor started in my highschool chemistry class,” Lopez recalls. “It was then I realized I absolutely loved chemistry and more specifically biochemistry. After thinking about it, I knew the only career for me was to become a doctor.” At Stanford University, he majored in biology, with a minor in chemistry.

Sotolongo majored in biochemistry at George Washington University, where he worked with Ferid Murad, M.D., Ph.D., the recipient of the Nobel Prize in Physiology or Medicine in 1998. Sotolongo spent two years working in Murad’s laboratory. He also had the opportunity to be a co-author on several papers with Murad.

“For about as long as I can remember, I have known I wanted to be a physician,” Sotolongo says. “Since beginning medical school at Penn, the reasons for wanting to enter medicine have become clearer.” The most important factor: having the opportunity to interact with faculty members at Perelman and witnessing at first hand the impact they have on the lives of their patients and, more broadly, on our understanding of disease and on the practice of medicine. His goal is to become a cardiothoracic surgeon.

Lopez and Sotolongo might be budding entrepreneurs, but they never overlook the fact that they’re still students. Working on their project, says Lopez, “has definitely required a lot of extra effort on both our parts, but it has been an incredible learning experience. We have learned an incredible amount of practical, real-world skills in the past eight months from attempting to develop this device, and I know this has shaped how I view problems and solutions moving forward.”

Sotolongo admits that combining his classwork and working on their project is not easy, “but it’s what I came here to do.” He emphasizes that Penn “is extremely supportive of 18

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At the Pennovation building, Lopez and Sotolongo, representing Angiio, made their formal pitch to a panel of judges and mingled with other DevelUPmed finalists.

medical students’ pursuit of experiences in the basic and clinical sciences, as well as a host of other endeavors.”

It has been a long journey since Sotolongo and Lopez first encountered each other in a pool. But what started there, they agree, has been an important part of their lives.

“More than anything else, my involvement in athletics taught me the simple lesson that there is no substitute for relentless dedication to a singular goal,” Sotolongo says. “The most important lesson, however, is that it takes more than an individual effort to accomplish anything of extraordinary significance or importance.”

Lopez, too, believes his athletic career has shaped his work ethic. “Playing water polo taught me exactly how much hard work goes in to a single success,” he says. “More importantly, it taught me that there are many failures before one can achieve a great outcome.” That background has prepared him well for entrepreneurship, “which requires an extraordinary amount of dedication in the face of much adversity.”

Students Are Her Business

By John Shea

Barbara Wagner and Dr. Jon Morris at Match Day. Dean J. Larry Jameson observes.

be helping to keep things running smoothly. Or she might be the person being hugged by a grateful student she has helped along the way. Indeed, for Smith and countless other students over the last two decades and more, much of what Wagner has done for them has gone on behind the scenes. Wagner and the rest of the small Student Affairs staff have been available for counseling and advising, on matters academic, medical, and personal. Perhaps Jon B. Morris, M.D., the Ernest F. Rosato – William Maul Measey Professor in Surgical Education, puts it best: “When it comes to our PSOM students, it would be hard to find a more compassionate, supportive, loyal, sympathetic, articulate, calm, staunch advocate than Barb Wagner.” And Morris has had one of the best seats in the house: for the last dozen years, he’s been the associate dean for student affairs.

Wagner, who earned her B.A. degree in American Civilization at Penn in 1983, became associate director of student affairs in 1990, long before Penn’s medical school became the Perelman School of Medicine. Earlier, she had been working in the University’s Alumni Relations office. She cites two particular experiences from that period that helped her in her new role: she was the staff person working with the Alumni Relations Student Advisory Committee, and she had organized tours for Mask and Wig, Penn’s all-male student musical comedy troupe. She had even gone on some tours with the “Wiggers.” Both experiences, she says, “made me realize how much I loved working with students.”

In all, she has been director of Student Affairs under four deans, not counting those who served in interim roles!

One of the hidden advantages of Penn’s medical school has been the Office of Student Affairs, which plays an important role in helping students through the academic challenges and preparing them for the residency matching process.

“She’s always there. She’s always there!”

Robert Smith, who received his medical degree from the Perelman School of Medicine in May, was exaggerating – but only slightly. The person he was referring to was Barbara Wagner.

Imagine almost any official function that involves Penn’s medical students – for example, the White Coat Ceremony, Match Day, or Graduation – and the odds are excellent that she would be present. Not as the speaker or guest of honor, but as director of the Office of Student Affairs. Wagner might

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Wagner welcomes former students: from the left, Brian Harte (M.D. ’96), Jennifer Kogan (M.D. ’95), and Jonathan Stein (M.D. ’95).

Celebrating Wagner’s retirement with her are Erin Engelstad (center), formerly of Student Affairs, and Helene Weinberg, the Perelman School’s registrar.

At the end of September, however, Wagner retired – but not before the medical school held a reception in her honor.

The site was appropriate: the atrium on the fifth floor of the Henry A. Jordan M’62 Medical Education Center.

Learning from the Faculty

When she crossed to the medical side of Penn, Wagner became involved with student organizations and residency matching, and the responsibilities of the position continued to grow. She also earned a master’s degree from Penn in Organizational Dynamics. Since 1995, when Gail Morrison, M.D. ’71, G.M.E. ’76, became vice dean of education, Wagner has officially reported to her. In addition to Jon Morris, Wagner has worked closely with several associate deans for student affairs during her tenure. The first was Helen C. Davies, Ph.D., the beloved professor of microbiology, well known for the way she helped her students memorize a vast number of facts for exams by substituting new words to popular songs. Other associate deans were William W. Beck Jr., M.D. ’65, now an emeritus professor of obstetrics and gynecology, and Harvey Rubin, M.D., Ph.D., a professor of infectious disease and director of Penn’s Institute for Strategic Threat Analysis and Response (ISTAR).

“They were all wonderful people with very different styles,” Wagner says. There is a certain maternal aspect to the job, she learned, and Davies was a model in that way. “She gave 150 percent to the job,” Wagner says with a laugh. “But I also learned not to have students depend on you too much.” Instead, she has seen her role as helping them “to get to a point where they can be self-reliant.”

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Morris has shown her that “a sense of humor is so important.” He has what Wagner calls “an amazing way” of using humor to handle a difficult situation. Harvey Rubin she describes as “so amazingly brilliant and a lot of fun. He knows about everything and yet is still a student, too.” Bill Beck, who retired to Montana, still visits Penn and Wagner every year.

He showed a more paternal side to the students, Wagner says.

In effect, “my education has been on the job,” she says, drawing from the deans and from the students as well.

Trouble-shooting and Counseling

In Robert Smith’s words, for medical students, “Barb is your fairy godmother!” Wagner prefers to think of herself as something of a professional trouble-shooter. Her career has involved academic counseling (and dealing with students’ academic problems), career counseling, advising during the residency process, and personal counseling. “Medical school is hard enough, even if nothing else is happening,” she says. Every year, too, there are students who have family emergencies or illnesses. Wagner emphasizes that she and her staff do not do psychological counseling but refer students to the University’s Counseling and Psychological Services (CAPS), which is available to all Penn undergraduate, graduate, and professional students. But throughout her time as director, she has always made herself accessible. And that has been the primary meaning of “she’s always there,” in Smith’s words, who adds, “well beyond office hours.” When students get in touch, Wagner says, “most of the time, I just listen.” Usually, “students just want to be heard and get something off their chest.” And the problems they share with her run the gamut. At one extreme, a student once called Wagner to complain that there was a mouse in her apartment. At the other extreme, another told her “I’m really depressed and I’m not sure I can go on.”

Wagner has also dealt with what she calls “transition issues,” such as the move between college and medical school or between medical school and residency. Wagner and her staff try to help the students find their feet and learn how to balance their studies with the other parts of their lives. Many first-year medical students find the volume of work notably greater than what they faced during their undergraduate years. The transitions from the classroom to the clinical set-

FEATURE ting can also be challenging: students have to learn their place, learn how to act, learn when to leave and when not to, and learn to pick up on the social cues. “It’s often more difficult for the quieter students,” Wagner points out. In addition, the process of applying for residencies is very exciting, but at the same time, students know “the choice will influence the rest of their careers,” and they feel the pressure. The Student Affairs office also counsels students who are not sure they’ve made the right decisions.

Despite the rigors of medical education, the Perelman School of Medicine has a very low attrition rate, even among the first-year students. When a student considers quitting medical school, Wagner advises taking a leave of absence instead: “Sometimes the students need to put things in perspective and need time to decompress.” Wagner’s impressions of the typical Penn Med student are not surprising. She finds them remarkable, very bright, and idealistic. “They are superstars,” she asserts, but there is a great deal of stress on them as well – these days, she notes, more than ever before.

The Path to Match Day and Beyond

During Wagner’s time at Student Affairs, she witnessed the growth of the “M.D. plus” trend. Given the demands of medical school, some observers may wonder how today’s busy students manage to earn more than one degree or take a program outside their chosen fields. Wagner points to the flexibility of today’s medical curriculum. Students, she says, are happy to try different things, and about 40 percent now stay at

“Most of the time, I just listen.” Usually, “students just want to be heard and get something off their chest.”

Penn Med beyond the standard four years. Health care itself has broadened to include areas like global health and social justice. In addition, according to Wagner, more students today seek to use their medical education outside clinical areas. This past year, for example, eight Perelman students chose not to pursue a residency, preferring to focus on different paths, particularly in business. Some students have developed apps, some have earned joint M.D./M.B.A. degrees and founded companies. McKinsey & Company, the global management-consulting firm, comes by to recruit medical students.

Does that bother her? “No,” she replies. “I support students in any way – we don’t push them into a clinical path.” And she quotes her father, who used to say, “No education is wasted.”

To summarize her role, Wagner says, “It’s the job of the office to advocate for the students.”

Robert Smith, who explains that he got to know Wagner better when serving on the board of the medical school government, says she is probably best known for guiding students through the residency process. It is a long and anxiety-pro-

voking process, starting a few weeks after the previous year’s Match Day. “She always shows calm and composure through the peaks and valleys,” he says. Morris agrees, citing the “greatest emotional highs” of the academic year: the White Coat Ceremony, Match Day, and Graduation. “The fact that these three crucial events have for so long – year in and year out – come off so remarkably well is a testimony to the direct impact Barb has had at PSOM.” Penn’s medical students, he continues, “do exceptionally well in the Match, and this is no accident. Barb’s fingerprints are all over this: hours upon hours of counseling, reviewing applications and personal statements, and organizing and overseeing class meetings and workshops on the Match process.”

As evidence of Wagner’s unflagging interest in enhancing the status of medical students, Smith mentions two initiatives of recent years. One concerned the Gold Humanism Honor Society. A national organization, it seeks to recognize individuals who are exemplars of humanistic patient care and who can serve as role models, mentors, and leaders in medicine.

“Barb championed its coming to Penn,” Smith says. “It was very important to her to have a chapter here.” The other major project, still in progress, is developing virtual “houses” for the students, to help build stronger communities and foster interactions among classes. Each “house” has an advisory dean and a master clinician from the faculty. Wagner, he says, “sees we all have patterns of the same problems,” and it would be much better to be more aware of them in advance. Having the virtual houses would encourage peer-to-peer mentoring and show the students that they’re not so alone in their times of need.

The Personal Touch

Following students’ careers has been a tremendous highlight for Wagner, even the careers of those whose time at Penn preceded hers. For example, she heard Michael Brown, M.D. ’66, the Nobel Prize recipient, speak on campus three times over the years. But she particularly loves to meet the younger alumni who return during Medical Alumni Weekend.

Then she gets to catch up with the students she worked with so closely during their education. Wagner is keenly aware of “all the trials and tribulations” the students have gone through, and it makes meeting them again at various points in their careers all the more meaningful.

“I never really planned to become a Penn lifer,” she says, but it has certainly turned out that way. In her case, retirement will mean more travel for her and her husband – but it will also mean something very familiar. She intends to do some volunteer work: “Interacting with people is my greatest satisfaction.”

As she begins her retirement, it’s clear that Barb Wagner will not always be there – “there” in the Jordan Medical Education Center. Morris, who calls her “my Office of Student Affairs soul mate,” acknowledges that she will definitely be missed. But he also makes it clear that she has had a lasting effect on the office she directed for so long. “Barb has laid down the infrastructure . . . a standard of excellence. Our motto of the four A’s – availability, assessment, advocacy, and advising – will be preserved due to all of Barb’s hard work.”

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The Nobelists Return

By John Shea

FEATURE

Two alumni who have won medicine’s most prestigious prize spoke of their early years at Penn Med and looked to the future.

D

etermination, long hours, patience, insights: it’s no surprise that these would be essential for making scientific discoveries. What may be less expected in this rigorous realm is another element – luck. But Penn’s two living recipients of the Nobel Prize in Physiology or Medicine, Michael S. Brown, M.D. ’66, and Stanley B. Prusiner, M.D. ’68, both acknowledge that luck does play a role.

In a question and answer session with J. Larry Jameson, M.D., Ph.D., dean of the Perelman School of Medicine during

to Campus May’s Medical Alumni Weekend, Brown talked about the work that went into the prize-winning research he and his long-time colleague, Joseph L. Goldstein, M.D., performed.

In announcing that they had won the 1985 Nobel Prize, the press release from the Nobel Assembly at the Karolinska Institute stated: “Studies on patients with familial hypercholesterolemia (FH) by Michael S. Brown and Joseph L. Goldstein constitute founding stones for our present knowledge concerning the cholesterol metabolism.”

Reaching such insights, Brown emphasized, takes time and hard work. It also requires proving or disproving your hypotheses: “The problem is that 99% of your hypotheses turn out to be wrong,” he told the audience. “The ones you learn the most from are the ones that fail.” He also cited what he

called “the scientist’s foxtrot” – one step forward, one step back. Then, more surprisingly: “Luck has to play a role.”

Prusiner, who returned to campus in May as the first speaker at the Department of Medicine’s “Celebration of Research,” also acknowledged the amount of work involved in making discoveries. Prusiner was awarded the Nobel Prize in 1997 for his discovery of “prions,” a new biological principle of infection. When he began his studies of scrapie in sheep, it was, he said, “a heroic task” – it took one full year to assay a single sample. Advances in technology certainly made part of the research easier. In his book Madness and Memory: The Discovery of Prions (2104), Prusiner also addressed the topic of luck: “Any commentary on scientific discoveries must include a discussion of luck. Extremely intelligent men and women can toil for years in the vineyards of science and never be fortunate enough to make a great discovery. And then there are a few people (I include myself ) who are the recipients of a mammoth dose of good luck.”

What separates Brown and Prusiner from the rest of us, however, is what the discoverers can actually do with what luck may have provided. They have the ability to realize its potential.

Prusiner, who also earned his bachelor’s degree in chemistry from Penn in 1964, has been a professor of neurology and biochemistry at the University of California at San Francisco for many years. It is there that he also completed his clinical training. In addition, Prusiner is director of the UCSF Institute for Neurodegenerative Diseases. At the University of Texas Southwestern, Brown is a Regental Professor, the Paul J. Thomas Professor of Molecular Genetics, and director of the Jonsson Center for Molecular Genetics. He, too, was a chemistry major as a Penn undergraduate (Class of 1962) – when, that is, he wasn’t creating some controversy as an editor of The Daily Pennsylvanian.

A New View of Proteins

Appearing at the “Celebration of Research,” Prusiner described prions as alternatively folded proteins that undergo self-propagation. “We thought of proteins as static – but they change.” When he began to share his research, however, he had to withstand years of skepticism and even scorn in the scientific community. Now, however, prions are widely accepted as a new class of pathogen implicated in diseases marked by slow onset and progressive deterioration of the brain and the nervous system. One of the most common forms is mad cow disease, aka bovine spongiform encephalopathy. In sheep with scrapie, it manifests as abnormalities of gait, severe itching of the skin, and invariably death. In humans, prions cause Creutzfeldt-Jakob disease (resulting in progressive dementia) and kuru (characterized by tremors, lack of coordination, and death).

According to the Nobel Committee’s release in 1997, “Stanley Prusiner’s discovery provides important insights that may furnish the basis to understand the biological mechanisms underlying other types of dementia-related diseases, for example FALL 2016

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Alzheimer’s disease, and establishes a foundation for drug development and new types of medical treatment strategies.”

In his recent remarks at Penn, Prusiner pushed further.

There was “mounting evidence,” he said, that prions also cause most, if not all, neurodegenerative diseases.

Learning at Penn – and at the NIH

At the Celebration of Research, Prusiner began by stating how delighted he was to be back on campus: “I come back whenever I can. My time at Penn changed my life.” As he went on to explain, he would marvel at all the Penn professors doing research, and he soon discovered his calling. One of the scientists he worked with as a medical student was the late Britton Chance, Ph.D. ’40, the celebrated professor of biochemistry and biophysics. When Prusiner won the Nobel Prize, Chance called him “one of the most meritorious of winners, because he had to work against so much doubt and adversity.” In Madness and Memory, Prusiner recalls the stimulating classes at Penn and what he calls “the excitement of intellectual inquiry.”

One of his early mentors was Sidney Wolfson, G.M. ’59: “Beginning in the summer before my senior year at Penn, I studied brain swelling in rats with Sidney Wolfson, and the experience persuaded me to stay on at Penn and enter the medical school there. Wolfson showed me how to read scientific papers and analyze data. He taught me statistics and how to formulate a scientific problem. He spent an immense amount of time helping me delve into the fascinating world of scientific research.”

After earning his M.D. degree from Penn and taking a medical internship at UCSF, Prusiner joined the National Institutes of Health as a research associate and lieutenant commander in the U.S. Public Health Service. He spent the next three years in the laboratory of Earl Stadtman, a biochemist who specialized in enzymes. Another scientist Prusiner admired at the NIH was the late Louis Sokoloff, M.D. ’46, G.M.E. ’50, a pioneer in brain-scanning. As Prusiner puts it in his book, “Lou’s enthusiasm for neurochemistry was infectious, and I soon became a great admirer.” As it turned out, in Stadtman’s lab,

Honors

In addition to the Nobel Committee, both Stanley Prusiner and Michael Brown have been honored by many other scientific, professional, and educational organizations. As undergraduates at Penn, both were elected to Phi Beta Kappa; and as medical students, both were inducted into Alpha Omega Alpha Honor Medical Society. Each has won the Albert Lasker Basic Medical Research Award, the Lounsbery Award of the National Academy of Sciences, and the National Medal of Science. Each has also received an honorary degree from the University of Pennsylvania as well as the highest honor the Perelman School of Medicine bestows on its alumni – the Distinguished Graduate Award.

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Prusiner also worked for a time with a certain Michael Brown, who had been two years ahead of him at Penn.

The Water at Cheltenham?

For Brown, the return to Penn this May came about because of an anniversary he could not ignore – it would be 50 years since his medical class graduated. Even more, he was selected as the medical school’s graduation speaker. But before the graduation exercises, Brown sat down for a Medical Alumni Weekend Q. and A. with J. Larry Jameson, M.D., Ph.D., dean of the Perelman School. The chat was wide-ranging, informative, and often humorous.

“What is in the water at Cheltenham High School?” asked the dean, suggesting that many of the school’s alumni, like Brown, have gone on to make their marks in the world. He

“The problem is that 99% of your hypotheses turn out to be wrong. The ones you learn the most from are the ones that fail.” named two other Penn Med faculty members from the school: Lee Fleisher, M.D., chair of the Department of Anesthesiology and Critical Care, and L. Scott Levin, M.D., chair of the Department of Orthopaedic Surgery. Among those in the school’s official Hall of Fame are Michael and Randy Brecker, who both won Grammy Awards for jazz; Richard Levinson and William Link, Emmy Award-winning TV writers and producers; Mary Ellen Mark, described by The New York Times as “one of the premier documentary photographers of her generation”; and Benjamin Netanyahu, prime minister of Israel.

But Brown, parrying, replied, “the most famous graduate of Cheltenham High School is Reggie Jackson,” the baseball Hall of Famer. When Brown won the Nobel Prize in 1985, the current principal of the high school asked his permission to mount a plaque at its baseball field, with the legend “This is where Michael Brown, Nobel Laureate, played baseball.” Brown replied: “On one condition, that there be a similar plaque in the chemistry lab, noting that this is where Reggie Jackson took chemistry.” Neither plaque was placed. “I hate to admit this,” Brown continued, entering dangerous waters, “I wanted to go to Princeton.” He was accepted there but not offered a scholarship. So he came to Penn, which did offer him one.

During his chat with Dean Jameson, Brown recalled the influence of Samuel Gurin, Ph.D., a rarity among Penn Med deans because he did not have a medical degree. Brown also cited Albert I. Winegrad, M.D., a specialist in diabetes. “There were some very, very good people at Penn,” Brown said, “some really inspirational people.”

Talking about his time spent at The Daily Pennsylvanian, Brown noted that the period from 1958 to 1962 was the

FEATURE beginning of a social, economic, and scientific transition.

The staffers of the D.P., he said, “were pretty brutal in our criticisms of Penn traditions” – among them, the student government and . . . cheerleaders. Back then, there was a separate College for Women, and The Daily Pennsylvanian put out a parody issue of that school’s paper. It was no surprise that, as a result, the University administration closed the D.P. down. Not to be outdone, the student reporters got in touch with other newspapers and even local TV stations, complaining that Penn “was against freedom of speech.” In the tumult, Brown said, he almost lost his scholarship. But, as Dean Jameson pointed out, “you still got into med school.”

synthesis, increase LDL receptors, lower blood cholesterol, and prevent heart attacks. “Everyone in this room understands the importance of statins,” Jameson said.

There were some aspects to winning the Nobel Prize that didn’t appeal to Brown. For example, when he and Goldstein won the honor, they were invited to appear on Today and The

Finding a Collaborator

It was as an intern in internal medicine at Massachusetts General Hospital that Brown met the person who was to be his scientific collaborator, Joseph L. Goldstein, M.D. Goldstein had come from Southwest Medical School in Dallas. Brown, who had not ventured south at that time, said, “I thought it was a bible school!” But they became friends. Then both of them were accepted into the exclusive fellowship programs at the National Institutes of Health. During that time, Brown said, they saw two very sick children as patients. They had very elevated cholesterol, about 10 times normal. Brown recalled that they had angina and couldn’t run across the room without chest pain. There was, he and Goldstein decided, very little they could do for the children. Putting them on a zero-cholesterol diet was not successful. “The cholesterol,” Brown said, “didn’t go down one iota.” The physicians eventually realized it was a genetic issue. “We decided to work together to solve the problem.” At the end of their fellowships at the NIH, Goldstein was heading back to Southwestern Medical School in Dallas, where he had been promised a faculty position if he returned to establish a division of medical genetics. As Brown explained, he and his wife, Alice, who grew up in New York, were reluctant to join Goldstein in Dallas, especially when Brown had an option to go to San Francisco.

But ultimately he chose to continue his work with Goldstein.

As Jameson interjected, “It’s such a powerful stimulus” to try to solve unsolved problems.

The Road to Statins

What Brown and Goldstein went on to discover was the low-density lipoprotein (LDL) receptor, which controls cholesterol in blood and in cells. In people who have complete or partial lack of functional LDL receptors, the level of cholesterol in the blood increases; it may accumulate in the wall of arteries, causing atherosclerosis and eventually a heart attack or a stroke.

As the 1985 press release from the Nobel Assembly at the Karolinska Institute stated: “Studies on patients with familial hypercholesterolemia (FH) by Michael S. Brown and Joseph L. Goldstein constitute founding stones for our present knowledge concerning the cholesterol metabolism.” Their work laid the groundwork for the drugs called statins, that block cholesterol

Michael Brown delivered this year’s Graduation address.

Tonight Show. They turned down the opportunity for additional publicity – for themselves, but also, it seemed, for their Dallas base. According to Brown, they were rewarded with a headline in one of the Dallas newspapers, signaling its annoyance, along the lines of “Nobel Prize Winners Retire to Their Cells.”

What he is most proud of, Brown said, are his two partnerships: with his wife Alice and his colleague Goldstein. “Having a scientific partner is a great thing, he continued. It is a great feeling “being able to share the thrill of discovery.” At present, with students and postdocs doing the experiments, Brown and Goldstein still run their laboratory. “We never had the prize as our goal,” Brown said. “There are still lots of unsolved problems.”

“We’ve Got to Do More”

During Prusiner’s visit in May, he took a few moments to praise the research of Virginia Lee, Ph.D., and John Q. Trojanowski, M.D., Ph.D., who head Penn’s Center for Neurodegenerative Disease Research, and noted “a lot of work by many, many people” that has advanced the field. He also FALL 2016

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Where Will the Evidence Lead?

As noted, during his visit to Penn, Prusiner argued that there was increasing evidence that prions also cause most, if not all, neurodegenerative diseases – and he includes Alzheimer’s disease and frontotemporal dementia. In his book, he wrote that, after years of research, “we are now at the point where the burden of proof is beginning to shift from those who claim prions cause such common illnesses as Alzheimer’s and Parkinson’s to those who deny this etiology.” As comments on Alzforum a couple of years ago suggest, however, some scientists maintain the burden of proof remains on him, and he will probably have to produce more evidence to convince some of his scientific colleagues on that score as well.

But observers have certainly learned that Prusiner is a fighter who has faced, as he put it in his book, “a legion of naysayers” and stayed the course.

A passage in Madness and Memory that shows Prusiner’s grasp of the status of scientific research appears in the Acknowledgments section. In addition to thanking many individuals and agencies, he wrote: “I am very appreciative of the opportunities given to me by the American people, who through their generosity, wisdom, and taxes have supported our scientific investigations for more than three decades.”

The Need for More Research In 1998, Stanley Prusiner delivered the Distinguished Alumnus Address during Graduation.

pointed out how newer technology has affected that study.

When he began his studies of scrapie, it was “a heroic task” – it took one full year to assay a single sample. He also alluded to some of the recent tragedies involving neurodegenerative diseases: the suicide of Junior Seau, the National Football League star, and even the suicide of a Penn football player in 2010, whose family donated his brain for research. In both cases, there was evidence of chronic traumatic encephalopathy. Addressing the younger people in the auditorium, he said, “We’ve got to do more.”

But the talk was not all solemn. Referring to his white hair, Prusiner exclaimed: “I’m not an albino – when I was a college student and a medical student, I had brown hair!” And while still a medical student and considering a future as a cardiologist, he went to see an open-heart operation. To his dismay, as he put it, “A lot of surgery was involved!”

Prusiner also pointed out that there is still resistance to prions – to the name (which he coined) and to what it describes as well. Some researchers, he continued, choose to use different names for them: proteopathic seeds, transmissible protein, and self-propagating strains, to name a few. “This disingenuous behavior obscures progress in a field that is screaming for effective therapeutics.”

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In Prusiner’s epilogue, titled “The Quest for Therapeutics,” he reported that one of his friends admonished him for not offering a more optimistic outlook on the quest to cure Alzheimer’s. In response, Prusiner said that he “believed biomedical science would eventually come up with effective medications but that it is misleading to tell people that modifying their diet, doing crossword puzzles, or learning a foreign language would protect them from Alzheimer’s when there was no meaningful evidence to support such an assertion.” He also stated his unfavorable opinion about the drug Aricept, as he did during his Penn visit. Although Aricept and its copies “generate revenues of about $3 billion annually, these drugs do not retard the relentless progression of Alzheimer’s disease.”

But there is at least one topic on which all researchers who study neurodegenerative diseases can agree: the need for continued research – and for expanded support. Using a dramatic but effective metaphor, Prusiner wrote in his epilogue: “Imagine a foreign country assaulting our nation and killing 500,000 Americans. We would commit hundreds of billions of dollars to vanquish the enemy. Yet 500,000 Americans die of Alzheimer’s annually, and we continue to allocate only 1.5 percent of the budget of the National Institutes of Health to Alzheimer’s research. In contrast, cancer research consumes more than 22 percent of that budget.” As he put it, more accurate reporting would place Alzheimer’s among the top three killer diseases in America, and yet drug discovery for degenerative brain diseases lags far behind. A change is long overdue.

The Impact of Poverty on Health Care

In a posthumously published book, Dr. Richard “Buz” Cooper counters the prevailing explanations for excessive costs in health care.

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ichard “Buz” Cooper, M.D., who died on January 15, 2016, had two different stays at the University of Pennsylvania. He was a former chief of hematology in the Department of Medicine and a pioneering cancer researcher. Back then, he wrote the grant proposal to create what would become the University of Pennsylvania Cancer Center (now the Abramson Cancer Center) and served as its first director until 1985. He then became dean and vice president of the Medical College of Wisconsin. More recently, he returned to Penn as a senior fellow in the Leonard Davis Institute of Health Economics.

His focus had changed by that time, as his passionately but meticulously argued book, Poverty and the Myths of Health Care Reform, makes clear. In it, Cooper contends that the leading cause of the nation’s high health care costs is not physician-induced demand, waste, and fraud, as many influential organizations assert. Instead, he argues, it is poverty.

With the permission of the Johns Hopkins University Press, here is an excerpt from Cooper’s Introduction.

It seems fair to ask, how did I come to write this book? After all, I am a physician, a specialist in hematology, the study of blood diseases. I practiced medicine, led an academic he-

matology group, and conducted research for 25 years. In 1985, I returned to Milwaukee, the city of my birth, to become dean of the Medical College of Wisconsin, and that started the detour that led directly to this book.

As my deanship was drawing to an end, Bill and Hillary Clinton were developing their health care plan, and it was in this context that I was confronted by two questions that would redirect my career. The first concerned physician supply, and the second concerned poverty, which is the focus of this book. One led to the other, and understanding something about the first will help in understanding why I set out to answer the second. At issue was whether the United States would soon have too many physicians, as was projected by the federal Bureau of Health Professions (BHPr) and accepted by most policymakers. If so, action was necessary to avert a physician surplus.

The question confronting me was whether the projected physician surplus was valid, and the answer proved to be no.

The BHPr’s projections were wrong in two ways. First, they overestimated the future per capita supply of physicians because they had underestimated future population growth.

Second, they underestimated demand because future projecFALL 2016

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tions were based on care as it existed at the time, never considering that new therapies and procedures would require more physicians in the future. When these shortcomings were appreciated, it became apparent that, rather than a surplus of physicians, there were likely to be shortages soon after the turn of the century, only a decade ahead.

While forecasting the future demand for physicians was not difficult, it did prove difficult to change the minds of those who believed in surpluses. But the dominant view at the time was that there would be as many as 100,000 too many physicians in the year 2000.

Despite certainty within the policy community that surpluses would soon appear, the year 2000 was greeted by none, and the years that followed saw deepening shortages. In 2002, I published a paper in Academic Medicine entitled “There’s a Shortage of Specialists: Is Anyone Listening?” Those who were listening included not only a vast array of state medical and hospital associations but also the same professional organizations that only a few years earlier had called for caps on residency training. Even the Council on Graduate Medical Education, which had been a prime mover in popularizing the BHPr’s notion of surpluses, changed its long-standing position that there would be 100,000 too many physicians in 2020 to one stating that there would be almost 100,000 too few.

Most policymakers were not listening, however, which is why the “caps” have held firm, creating the shortages we have today. But the basis for holding firm ceased to be the BHPr’s erroneous projections of physician surpluses. Rather, it was a belief that physician practices are wasteful and inefficient and driven by supplier-induced demand – Roemer’s law – and therefore more physicians would be undesirable. It was supported by a growing body of data from the Dartmouth Institute that attributed geographic differences in health care spending among regions of the country to the unwarranted overuse of supply-sensitive services. This view was shared by a broad coalition of agencies, foundations, and academics.

Health Care Spending: Why Is It So High?

Initially, this second question was not associated with any national policy issue. It arose in the context of a pragmatic local concern. Why were health care costs much higher in Milwaukee than elsewhere in the upper Midwest? My colleagues and I explored many possible reasons, but it was only when we examined the distribution of costs, neighborhood by neighborhood, that the answer emerged. In the 30 years I had been away from Milwaukee, its black population had burgeoned and the city had become the most segregated in the North, more segregated than Detroit. Social problems were legion. We found that patients who resided in Milwaukee’s highly segregated “poverty corridor” had hospitalization rates much higher than among those living elsewhere, so much higher that they accounted for the entire excess utilization of care in the Milwaukee region as a whole.

The critical observation is that Milwaukee’s poorest were its sickest and used the most care. This proved to be the rule in other communities, as well. Chapter 1 takes a journey along two subway routes in New York City, where incomes swing 28

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from poverty to wealth and back to poverty over the course of only a few stops and where rates of disability and hospital utilization track poverty all the way. Chapter 3 provides a detailed view of Los Angeles, which has more poor people than most cities have people and where low-income patients lift health care costs to among the highest in the nation. In each case, poverty distinguishes areas where health care spending is high from others where it is low. But a word of caution. Don’t blame the victim! Poor patients do not use more health care because they wish to. They do so because their health is poorer and their social circumstances are weaker. The basis for their high health care spending is embedded in the fabric of their lives.

When my colleagues and I began to examine why health care costs were higher in Milwaukee, we thought we were addressing a local problem. However, it proved to be part of a national dialog that was unfolding from publication of the studies by John Wennberg and his colleagues, using their newly created Dartmouth Atlas of Health Care. The Atlas divided the United States into 306 hospital referral regions (HRRs), based on where most patients received most of their care. Dartmouth researchers documented marked differences in Medicare expenditures among these regions, and Milwaukee was among those with higher spending. However, the diagnosis made by the Dartmouth group was quite different from ours. Rather than attributing Milwaukee’s higher spending to poverty, they attributed it to the overuse of “supply-sensitive services,” reminiscent of the supplier-induced demand that Roemer had popularized.

Why did the Dartmouth group consistently fail to recognize the central role of poverty? After all, they acknowledged that low-income people are sicker and that sick people require more care. Yet they persistently claimed that “regional differences in poverty and income explain almost none of the variation.” Others concurred, including influential committees of the Institute of Medicine. However, the major methodological reason is that the Atlas aggregates all of the data from all of the people residing within each HRR. The approximately 1.6 million people in Manhattan and the 10 million in Los Angeles [County] are distilled into single numbers. Economic distinctions between places as different as Harlem and Park Avenue and South Los Angeles and Beverly Hills disappear. Indeed, it was only by disaggregating HRRs into their constituent zip codes that my colleagues and I were able to discern the enormous impact of poverty on health care utilization in these and other areas.

Silencing Poverty

The Dartmouth Atlas was not alone in ignoring poverty.

Poverty was not on the political agenda in the years leading up to Clinton’s Health Security Act, or in the 15 years between that and ObamaCare, or throughout President Obama’s first term. Instead, the president repeatedly pointed to the lower health care spending in small towns, like Green Bay, Wisconsin, and Grand Junction, Colorado, which are devoid of concentrated poverty, never mentioning the dense poverty and high burden of disease in other areas, such as on the south side

FEATURE

Household Income

Hospital Admissions

of Chicago where he had 300% Income and Hospital Admissions been a community organizer.

Along the A Train Line in Manhattan Seattle and Salt Lake City were offered as models for 250% the nation, while Los Ange$15,000 les, which has more poor people than these two cities 200% have people, was marked as a place of egregious waste. One $25,000 could not avoid hearing 150% Harlem Penn about the wonders of the Station Mayo Clinic, located in Sugar Upper West $40,000 Hill Rochester, Minnesota, al100% Side though it is the highest-cost facility in the otherwise low$80,000 cost upper Midwest, or about 50% the poor performance of the University of California, Los Angeles, which borders LA’s 0% dense urban poverty.

Adapted from Poverty and the Throughout this period, Manhattan Island Myths of Health Care Reform the silence about poverty was deafening. Its relationship to health care spending is not mentioned once in any of the more than 20 books on health care reform that grace The Challenge Ahead my library shelf. Yet every physician, nurse, and hospital ad It may be difficult to believe that poverty has been blotted ministrator knows how poverty affects health care utilization. from view. After all, ObamaCare is meant to help poor peoThey live it every day. ple, and it does. It expands Medicaid eligibility for many Beginning in the mid-1990s, John Billings, at the United who are poor, creates federally subsidized insurance exHospital Fund in New York, reported that hospital admission changes for others who are near-poor, and funds an expanrates for chronic conditions were four to five times higher sion of community health centers, which serve poor people. among patients from poor zip codes in New York than among But it was blind to the socioeconomic factors that underlie those from rich ones, and the same was true in other large high health care utilization. For example, it established penmetropolitan areas. And by the end of the 1990s, my colleagues alties for hospitals with “excessive” numbers of hospital reand I had uncovered the enormous contribution of poverty to admissions, ignoring the reality that most readmissions are the high health care spending in Milwaukee and, later, in Los of poor patients, and it imposed penalties for higher 30-day Angeles. Nonetheless, poverty was not on the radar screen of mortality rates, failing to recognize that it is the poorest health care reform as ObamaCare was being crafted. who have the highest rates. Indeed, instead of strengthening What policymakers did have on their radar screens was the ability of providers to care for poor patients, they are that deficiencies in clinical practice were the principal cause trying to restructure the health care system into something of excess spending and poor outcomes. The Institute of Mediit cannot be. cine further popularized the notion that 30% of U.S. health The inescapable conclusion is that the United States care spending is wasted. Curiously, it ignored the possibility will not be able to constrain its spiraling health care spendthat poverty may be a contributory factor. Indeed, in more ing without addressing the high costs of caring for patients than 1,500 pages of the IOM’s several reports, “poverty” was at the bottom of the economic ladder. But how? Greater not mentioned even once, while “waste” was mentioned more attention must be directed to activities that exist beyond than 250 times traditional health care, such as housing, transportation, and This body of work, flowing as it has from multiple respected social support, which have been shown to reduce costs and sources, has been taken as “evidence” that more specialists and improve outcomes. At a broader level, what is needed is a more spending add no value and that 30% of health care spendreduction in income inequality and the creation of a social ing is wasted. Yet when viewed through the lens of poverty, infrastructure that enables low-income families to exit from each line of “evidence” proves to be a manifestation of the inthe cycle of poverty. Without it, no amount of health care creased care required by patients who are poor. Call it waste if spending will permit all Americans to lead the long and you want. Treating a homeless man’s frostbitten toes is surely a healthy lives they desire, and health care spending will waste, when a pair of shoes could have prevented it. continue its unsustainable upward spiral.

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In her nearly three decades at Penn, Yvonne Paterson has been a teacher, a scientist, an administrator, and a mentor who has a special talent for bringing people and programs together.

B

y the age of four, Luke had twice had surgery to repair torn ligaments in his knees. So when the 120-pound German Shepherd started limping again two years later, his owners, Sherie and Dave Kerr, took him back to the orthopaedic surgeon. An x-ray revealed something much worse than a ligament tear: the doctor said he was 99.9 percent sure that Luke had osteosarcoma, the most common type of bone cancer found in dogs, particularly in large breeds like German Shepherds, Great Danes, and Golden Retrievers. “He said the only real treatment was amputation, but we did not want to put him through that after everything he had already been through,” Sherie said. They were sent home with pain medication and a prediction that Luke would survive only a few months.

Six weeks later, a co-worker asked Dave if he had seen the news the night before. Nicola Mason, Ph.D., an associate professor at Penn’s School of Veterinary Medicine (SVM), was re-

time in making its mark: That honor came more than a century after Paul Ehrlich first proposed that the immune system could be marshaled to treat cancer and nearly two decades since James Allison found a way to unblock the molecular brakes on T cells, thus stimulating them to attack tumors. Allison’s approach – called immune checkpoint blockade therapy – led in 2010 to the first immunotherapy drug of this class (ipilimumab) approved by the Food and Drug Administration (FDA) for the treatment of melanoma. Several other checkpoint inhibitors have subsequently been approved.

Along with other immunotherapies like personalized cellular therapies under development at Penn, they are extending the lives of some cancer patients in ways doctors could scarcely imagine just a few years ago. In 2015, one of these was credited with saving the life of former President Jimmy Carter, who had been diagnosed with stage 4 melanoma that had spread to his brain.

Paterson’s cancer vaccine uses a different approach to eliminate cancer. It starts with a common bacterium called Listeria monocytogenes (Lm), modified to not cause disease and to carry with it the proteins necessary to stimulate both the innate and adaptive arms of the immune system. Innate immunity refers to the rapid, non-specific response to an infection, such as inflammation. Adaptive immunity, by contrast, represents the targeted response to any antigen recognized as foreign or “non-self.” These foreign antigens may come from a virus, a bacterium, a cell from another person or species, or, in the case of cancer, a protein that is unique to the tumor, that is over-expressed by the tumor compared to normal tissue, or that has undergone sufficient mutations to look foreign to the immune system. Cancer vaccines are designed to make tumor antigens more immunogenic. They do so using viral or bacterial vectors, synthetic versions of tumor proteins,

Citizen of the University: cruiting dogs with osteosarcoma that had not undergone amputation. They would become part of a clinical trial of an experimental treatment that harnesses the patient’s own immune system to target and destroy cancer cells. After Luke went through a grueling 12-hour evaluation, Mason informed the Kerrs that she wanted him in the study.

The treatment Luke received – a cancer vaccine – was originally developed for humans by a small biotech company, Advaxis. It was founded in 2002 as a Penn startup by Yvonne Paterson, Ph.D., a professor of microbiology at Penn and a former associate dean for research at Penn’s School of Nursing. Cancer vaccines are one form of immunotherapy, a treatment approach dubbed the “breakthrough of the year” by the editors of Science magazine in 2013. The field had been a long 30

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weakened or killed cancer cells, or DNA or RNA from cancer cells to induce immune responses to cancers. The first therapeutic cancer vaccine was approved by the FDA in 2010 for the treatment of metastatic prostate cancer.

Around the World and Across Disciplines: A Circuitous Path to a Cancer Vaccine

Born in the United Kingdom, Paterson was the first in her family to finish high school. The other family members “were never interested,” she says. “For some reason, I was.” In 1979, she came to the United States from Australia, a single mother with a doctorate in biochemistry from Melbourne University and two young sons in tow. After three years at Cornell University – where she had continued to study protein folding, first as a post-

Yvonne Paterson

By Lisa J. Bain

Photos by Peggy Peterson

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Nicola Mason, Ph.D., of Penn’s School of Veterinary Medicine, and Paterson have joined forces to treat cancer in dogs.

Background: Martha A. Maloneyhuss, D.V.M., a resident in immuno-oncology.

doctoral fellow and later as a research associate – she had become bored. “I think I am a biologist at heart, so I decided I wanted to switch to immunology. What was I thinking?” she says with a laugh.

Switching fields was not a simple matter. Limiting her search to the West Coast to make it easier for her children to visit their father in Australia, Paterson began making the rounds of immunology labs. With no track record in the field, however, the opportunities were limited. Then she interviewed at The Scripps Research Institute in San Diego.

“Scripps kind of took a chance on me,” she says. The researchers were interested in her idea to apply the principles of protein chemistry to examine how antigen and antibody interacted. Their risk proved warranted. In 1986, she published the results of her research in Science. Four years later, after she had moved to Penn, she followed it with another Science article. “That was probably the last protein chemistry paper I published,” she says.

It was also during her time at Scripps that Paterson faced another unexpected challenge: she was diagnosed with breast cancer. “It was quite a shock,” she says. She had no relatives in the United States to lend support, and her two children were then 10 and 8 years old. Her overriding concern was “being around for them.” As she recalls, tumorectomies were still a new treatment, with little research supporting them. She opted for a mastectomy. The cancer, she adds, “didn’t have a huge impact on my research at the time” but “a lot of changes take place” in such a situation. For many years, Paterson received follow-up calls from a breast cancer research network 32

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based at the University of California at San Francisco, but her cancer never returned.

In 1988, Paterson was offered a tenured position at Penn in the Department of Microbiology. It was there that she crossed paths with another young assistant professor, Daniel Portnoy (now professor of biochemistry, biophysics, and structural biology at the University of California, Berkeley). Portnoy was studying Lm as a model system to understand how intracellular organisms spread from cell to cell and cause disease. Lm in its native stage is transmitted through contaminated milk products and can cause a serious illness called listeriosis.

Portnoy told Paterson that Lm produces a factor called listeriolysin O. When the bacteria are engulfed by macrophages or neutrophils – cells of the innate immune system that defend against infection by taking up and destroying pathogens – listerolysin O forms pores in cell membranes that allow the bacteria to escape into the cytosol (the fluid part in the interior of the cell). Paterson’s idea was to use that feature of Lm as a vector to stimulate an immune response. “We reasoned that if we could get Listeria to secrete a foreign protein into the interior of the cell, it would target that pathway and would elicit a strong killer T cell response,” says Paterson.

For the next few years, Paterson and Portnoy collaborated on a project to make a flu vaccine, and it was successful in protecting mice from infection. Then Paterson turned her attention to other projects, including trying to develop a prophylactic HIV vaccine. That effort got as far as monkey trials.

The influenza project triggered Paterson’s thinking about other diseases that could be treated by generating cytotoxic

FEATURE T cells. Around that time, immunotherapy for cancer was beginning to be considered. Early approaches focused on generating antibodies to the tumor, but it had become apparent that the best way to attack a tumor was by generating a cytotoxic T cell response, not just to antigens expressed on the surface of cancer cells but to any protein made in the cell. “I put two and two together,” Paterson says. “I had a perfect way of making cytotoxic T cells.” In 1995, in Nature Medicine, she published the first paper showing that Listeria could be used as an immunotherapeutic. “In mice, we actually made the tumors go away, just using Listeria and nothing else,” she says. “I think that was unprecedented at that time.”

Translating Discoveries to Therapies

Another lesson she had learned at Scripps was the importance of protecting one’s intellectual property before publishing a potentially translatable finding. So, before the paper came out, Paterson and Portnoy filed a patent for the use of Listeria for prophylactic vaccines for infectious diseases, and subsequently Paterson filed another patent for the immunotherapy of cancer using a live recombinant bacterial vaccine vector. Today, she says, she has 28 issued patents and another 12 are under consideration, all of them related to Listeria and its products.

According to Paterson, she never intended to start a company, but as her research progressed, it became more apparent that the Listeria-based cancer vaccine approach had potential for tackling human diseases. As a non-clinician, however, she needed collaborators to move forward. At Penn, investigators were more focused on other immunotherapy approaches. So to move the Listeria approach forward, she founded the company Advaxis in 2002. For the first few years,

the company existed in virtual space as Paterson and her co-founders raised money and recruited investigators. Today she remains a consultant for the company, which is based in New Jersey and employs more than 60 people. Advaxis recently initiated a phase 3 trial for advanced cervical cancer, using a strain of Lm created in Paterson’s lab by one of her graduate students, George Gunn III, Ph.D. ’01, now an associate scientific director at Johnson & Johnson. The company also has treatments in clinical trials for cancers of the head and neck, prostate, anus, and other solid tumors including osteosarcoma. Paterson’s work has been recognized with multiple awards: among them, she was named a fellow of the American Association for the Advancement of Science and selected as one of PharmaVOICE’s 100 most inspiring people in the life sciences. Awards to Advaxis for vaccines Paterson developed include the Medical Visionary Award from the Farah Fawcett Foundation for Collaborative Research in HPV-Associated Anal Cancer and the Vision of Hope award from the Sarcoma Foundation of America earlier this year for the canine osteosarcoma therapeutic vaccine.

The vaccine used to treat osteosarcoma – ADXS-HER2 – targets human epidermal growth factor receptor 2 (HER2), a molecule over-expressed by several solid-tumor cancers, including about 25 percent of breast cancers as well as ovarian, lung, stomach, pancreatic, and esophageal cancers. Cancers that over-express HER2 tend to be more aggressive than those that do not over-express it and are associated with an increased risk of metastasis and relapse and lower rates of survival. Human osteosarcoma is rare – only about 800 cases are reported each year in the United States, most often among children and teenagers. HER2 is expressed in about half of these osteosarcoma cases. In April 2016, ADXS-HER2 received fast-track designation by the FDA for the treatment of osteosarcoma. The fast-track program is designed to expedite the development and testing of new therapies that treat serious, life-threatening conditions, and address unmet medical needs.

Cross-School Collaborations

Paterson and Mason consider the next steps.

Osteosarcoma is also the most common type of bone cancer in dogs, and, according to Nicola Mason, a majority of canine cases over-express HER2. About five years ago, as a newly minted assistant professor of medicine and pathobiology at the SVM, Mason gave a talk to Paterson’s lab about osteosarcoma in dogs. She explained that, as with human osteosarcoma, the standard of care in dogs is amputation plus chemotherapy. Paterson, knowing that the human HER2 vaccine worked in mice and that canine HER2 was more similar to human than to mouse HER2, told her, “I’ve got a vaccine for that!” Together, and with support from Advaxis, they launched a trial of the vaccine in dogs. This first trial, conducted in dogs that had already undergone amputation and chemotherapy, was, Paterson says, “fabulous.” Whereas even with amputation and chemotherapy, dogs typically develop lung metastases and survive only about a year, some dogs with the vaccine have survived as long as four years. In 2013, Paterson and Mason, now an associate professor of medicine FALL 2016

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and pathobiology at the SVM, were named the inaugural co-recipients of the University of Pennsylvania One Health Award for their work in developing cancer immunotherapies for both humans and dogs. Penn’s participation in the One Health Initiative, a worldwide approach aimed at promoting human, animal, and environmental health, reflects the University’s commitment to improving public health through cross-disciplinary and multi-school collaborations.

Data from the first canine osteosarcoma trial led to a second trial in dogs such as Luke that had not had amputation.

The studies in dogs have also provided important information about how different components of the immune response fluctuate over time and the relationship of these changes to the clinical outcome. For example, by tracking the number of HER2-specific T cells in dogs over time, Mason has seen a few cases where the numbers remain normal for some time, then go up, and then down again. Although this study is too small for researchers to draw any conclusions, Mason hypothesized that the tumor may have started to regrow, waking up the immune system so that appropriately primed T-cells expanded and proliferated to go after the cancer and eliminate it.

Mason’s collaboration with Paterson reflects more than common scientific goals. Like Paterson before her, Mason decided to make a switch to immunology after already establishing herself in another discipline. An attending clinician at the SVM, she was admitted to the immunology graduate group at Penn in 1999, having never worked in a lab. Nonetheless, to get started she needed to find a lab that would take her for a rotation. “I must have trudged to four or five labs,” Mason says.

“And then I went to Yvonne’s lab. I was totally expecting to be told to come back after I had done my first or second rotation.”

But to her surprise, Paterson welcomed her to join the lab. “I told her, ‘I haven’t picked up a pipette, I don’t know what to do.’ And she said, ‘well, that’s why you’re here: to learn.’”

Mason completed her Ph.D. degree in another lab and then did a postdoctoral fellowship with Carl June, M.D., the Richard W. Vague Professor of Immunotherapy in Penn’s Department of Pathology and Laboratory Medicine. That was when she became interested in cancer immunotherapy, which led to her faculty position at the SVM. “And again – typical Yvonne – she called me up and said, ‘You’re new faculty, you need to get out there and talk to people. Why don’t you come to my lab and tell everybody what you do.’”

A Lifelong Passion: Mentoring

Paterson and Nobert Pardi, Ph.D., a research associate in the Department of Medicine, have a common interest: vaccine delivery.

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Indeed, mentoring, particularly of women and minorities, has long been a passion of Paterson. In 2001, in fact, she received the Elizabeth Bingham Women’s Mentoring Award from the Association for Women in Science. Paterson was the associate dean for postdoctoral research training at Penn from 2005 to 2010 and was the architect of the Postdoc Diversity Fellowships, which are now administered by the office of the Vice Provost of Research. Until 2015, she directed the PENN-Postdoctoral Opportunities in Research Training (PENN-PORT) program, funded by the NIH division of Minority Opportunities in Research at the National Institute of General Medical Sciences since 2007. PENN-PORT provides opportunities for postdoctoral fellows to teach at minority institutions to try to inspire students at those schools to pursue biomedical research careers.

Diversity is particularly near and dear to her heart. As a postdoc at Cornell University in Ithaca, supporting two children on a meager salary, she lived in a very poor section of town among an ethnically diverse population. Even before that, she says, she understood the value of racial and cultural diversity. “I come from a solid working class background. My father was a car body assembler when he was working, which wasn’t always,” she recalls. “He was a union man, organizing on the factory floor, and would bring home immigrants and other people for dinner. He instilled these beliefs of equality and egalitarianism in me, and I’ve carried it forward to my children.” Today, one of her sons is a union-side labor lawyer; the other son is a businessman in Melbourne, Australia, and very active in the Australian Labor Party.

Although she had established herself as a leader and visionary in the training and mentoring of students from all walks of life, it was still a bit of surprise when she was recruited by the

Paterson touches base with Stuart N. Isaacs, M.D., an associate professor of infectious diseases and associate dean for animal research in the Perelman School of Medicine.

School of Nursing to serve as its associate dean for research.

“When I was offered the position, I said, ‘I can’t do that. I don’t know anything about nursing!’” But, she notes, Afaf Meleis, Ph.D., professor of nursing and sociology and, at the time, dean of the School of Nursing, “doesn’t take no for an answer!”

According to Meleis, Paterson was a match for what the nursing school needed at the time. “She is an impeccable, well-established scientist, and her research is very much related to women and their health,” Meleis says. “She also knows how to motivate and inspire, mentor, and support.” Meleis also cites Paterson’s support for diversity in science as well as in terms of gender, cultural, and ethnic diversity. “She knows how to pick up talents from diverse backgrounds, nurture them, and invest in them.”

When Paterson took on the deanship at the SON, she decided to close her lab. Approaching the age of 70, she had already stopped taking students and had stopped renewing her grants. “I have all these people out there [former postdocs] who are professors themselves now, and they shouldn’t be competing with septuagenarians to get grants,” she says frankly. “And the other thing, too, was what I wanted next out of the work I’d been doing for the last 20 years – to see it cure people in the clinic.” That is now being done by Advaxis. “I think if I hadn’t had the company, I would have been much more reluctant to give it up.”

Not yet ready to retire and spend all her time with the nine grandchildren she shares with her husband of 23 years, pulmonologist Milton D. Rossman, M.D., a professor of medicine

at the Perelman School, Paterson is still active scientifically.

She publishes through collaborations with scientists – including several who trained in her lab – around the world. Her major driving ambition at this point, she says, is to see the first of her Listeria-based therapeutics approved by the FDA. “If they succeed, it will validate the whole platform, and I will feel like my life’s work has arrived.” The success of the osteosarcoma vaccine in dogs has provided additional hope. Two years after receiving his first dose of vaccine, Luke shows no signs of disease progression. Moreover, results from the canine osteosarcoma trials were used to convince Advaxis and regulators to proceed with a trial in humans with HER2-positive tumors. “To think Luke may be helping women with breast cancer is amazing,” said Sherie Kerr, who, like Paterson, is herself a breast cancer survivor.

Paterson believes that her pursuit of a cancer vaccine has been motivated, in part, by personal experience with cancer – not just her own breast cancer, which she was diagnosed with in 1983, but even more the loss of her father and sister-in-law, whose lives were cut short by colorectal and ovarian cancer.

Two laboratory colleagues, at both Scripps and Penn, also died of cancer. Always the teacher, Paterson uses her expertise as a cancer investigator to help other people with cancer, by researching techniques and explaining them to friends and family. “I like explaining stuff,” she says with a smile.

“Having gone through the psychological processing myself, I understand better how frightening and bewildering a cancer diagnosis can be.”

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DEVELOPMENT MATTERS BIG IDEAS ATTRACT BIG INVESTMENT

of Carl June, M.D., the Richard W. Vague Professor in Immunotherapy and director of translational research in the Abramson Cancer Center. Robert Vonderheide, M.D., D.Phil., the Hanna Wise Professor in Cancer Research and associate director of translational research in the Abramson Cancer Center, and E. John Wherry, Ph.D., the Richard and Barbara Schiffrin President’s Distinguished Professor and director of Penn’s Institute for Immunology, will serve PARKER INSTITUTE FOR as co-directors.

CANCER IMMUNOTHERAPY “We are at an inflection point in cancer research and now is the time to maximize immunotherapy’s unique potential to transform all cancers into manageable diseases, saving millions of lives,” said Sean Parker, president of The Parker Foundation. “We believe that the creation of a new funding and research model can overcome many of the obstacles that currently prevent research breakthroughs.”

. . . AND CELEBRATING THE FUTURE SCIENTISTS WHO KEEP THOSE BIG IDEAS COMING

sician-scientist in medicine or pediatrics. Benefiting from an integrated program that features the best medical training in traditional areas of laboratory research – as well as in biomedical engineering, health care economics, anthropology, and history of science – the Brown Award recipient joins the program’s more than 500 alumni, including successes like Adam Koppel, M.D. ’95, Ph.D. ’97, M.B.A. ‘00, Managing Director of Bain Capital Life Sciences. The Award was presented for the first time at May’s comNOBEL LAUREATE SUPPORTS mencement to SteNEW PHYSICIAN-SCIENTISTS ven Joseph Siegel, M.D., Ph.D., who has joined the Boston Combined Residency Program for Boston Children’s Hospital and Boston Medical Center.

“I am proud that Dr. Brown joins us in honoring our M.D./Ph.D. graduates who will continue to redefine the model of scientific discovery and patient care, and I am certain his outstanding example will resonate with fellow alumni,” said Dean J. Larry Jameson, M.D., Ph.D. – a fellow physician-scientist.

It’s hard to believe that it’s already been five years since Penn Medicine announced its breakthrough results in using immunotherapy to fight cancer. Not only have many patients continued to enjoy sustained remissions, but Penn Medicine’s efforts also are enjoying increasing national and international attention – with a particularly stunning development that unfolded in April of this year.

Backed by the Parker Foundation – founded by entrepreneur and philanthropist Sean Parker – Penn joined a first-ofits-kind research collaboration focused on using immunotherapy to fight cancer. Uniting six of the nation’s top medical schools and cancer centers, the Parker Institutes for Cancer Immunotherapy are backed by a $250 million gift from the Foundation, making it the largest single contribution ever made to the field of immunotherapy.

Total funding of $36 million has been awarded for the Parker Institute at Penn, which will be under the direction

The excitement of these fast-paced developments underscores the reality that the science of medicine has never been more complex or more essential. The passage of health care reform legislation emphasizes the critical need for a steady pipeline of physicians to ensure the safeguarding of our nation’s health.

The important value of training the next generation of medical scientists at the Perelman School of Medicine is something that alumnus Michael S. Brown, C ’62, M.D., ’66, HON ’86, appreciates quite well. A Nobel laureate, Brown described the regulation of cholesterol metabolism, which paved the way for life-saving statins. It’s those combined insights into biomedical research and clinical practice that will similarly help lead to the next breakthroughs in care – and Dr. Brown has chosen to celebrate the best and brightest who have pursued this challenging educational path.

The endowed Michael S. Brown, M.D., Award recognizes a graduating student from Penn’s renowned M.D./Ph.D. program who shows the greatest potential for a career as a phy-

Dean Jameson and his wife, Michele (not pictured), welcomed first-year students during a barbeque at their home in early June. Students were able to chat with Raymond Perelman, benefactor of the Perelman School of Medicine (photo at right, seated).

SHAPING A MEDICAL SCHOOL THAT MIRRORS THE RICH DIVERSITY OF OUR WORLD

Just as a Perelman School education must reflect the constantly evolving nature of research and care, so too does the School need to ensure that the strength of its faculty and student body is derived from a diverse and inclusive environment. As Benjamin Garcia, Ph.D., the Presidential Associate Professor of Biochemistry and Biophysics, noted, “When my basic science lab has been at its most diverse, it has also been the most creative.

And we’re getting into human health more than I ever thought we could, with more translational aspects to our work.”

Penn Medicine’s Office of Inclusion and Diversity was established in 2013 to foster just that kind of diverse and collab-

"We’re proud that the Perelman School outperforms the na­tional benchmark in providing access to opportunities."

meetings, and provides skills training to compete for grants focusing on health disparities.

“In terms of our student body, the number of students coming from groups underrepresented in medicine is encouraging and represents a peak at least in the last three years,” explained Vice Dean Higginbotham.

“There are many ways we can become even stronger, such as in enhancing awareness and diversity in terms of cultural competency,” she concluded, “and I’m excited to work with our philanthropic partners to advance our mission – whether it’s through supporting Presidential Professorships, our anchor programs, or student scholarships.

FIVE ANCHOR PROGRAMS BUILD THE DIVERSITY PIPELINE • Alliance of Minority Physicians. FACULTY LEAD: IRIS M. REYES, M.D.

– Inclusion & Diversity Vice Dean Higginbotham

•C enter of Excellence for Diversity in Health Education and Research. FACULTY LEAD: JERRY C. JOHNSON, M.D.

orative environment. Under the leadership of Vice Dean Eve J. Higginbotham, S.M., M.D., the office is charged with exploring new opportunities to embrace diversity and broaden access to people of all ethnicities, historical traditions and religions, economic backgrounds, genders and sexual orientations, disabilities, and veteran status.

The office leverages the work of a number of groups, contributes to faculty recruitment efforts for Presidential Professorships, fosters scholarships and presentations at national

•F OCUS on Health & Leadership for Women. FACULTY LEAD: STEPHANIE ABBUHL, M.D. • Penn Medicine Program for LGBT Health.

FACULTY LEADS: REBECCA HIRSH, M.D., AND JUDD D. FLESCH, M.D. •C enter for the Study of Sex and Gender in Behavioral Health. FACULTY LEADS: C. NEILL EPPERSON, M.D., AND TRACEY L. BALE, Ph.D.

OPENING OF SCHOOL YEAR IS A FAMILY AFFAIR

On August 12th, America’s oldest medical school welcomed its newest class of future doctors with “Parents & Partners,” an event which invites families to witness a day in the lives of their medical students. They toured the Henry A. Jordan, M ’62 Medical Education Center and watched presentations from Penn faculty on state-of-the-art medical simulation technology, the practice of Standardized Patients, and showcasing how Perelman students work in learning teams.

The day was capped off with the White Coat ceremony and recitation of the Hippocratic oath. And this year, a new “wrinkle” was added: alumni donors and parents penned messages of advice or encouragement for incoming students to be placed in the pockets of the white coats prior to the ceremony.

PROGRESS NOTES Send your progress notes and photos to: Donor Relations Penn Medicine Development and Alumni Relations 3535 Market Street, Suite 750 Philadelphia, PA 19104-3309 PennMedicine@alumni.upenn.edu

1960s Gordon G. Power, M.D. ’61, a professor of basic sciences at Loma Linda University, and a team of researchers from several other universities, have received a patent from the U.S. Patent and Trademark Office for the use of nitrite salts to treat specific cardiovascular conditions. The discovery was made through continuing research and support from the National Institutes of Health. The patent was awarded for methods that include treating patients with pulmonary hypertension by having them inhale a therapeutically effective amount of sodium nitrite in order to decrease pulmonary artery blood pressure. Phase II clinical trials are now under way. The unique feature of the treatment is that the sodium nitrite is inhaled as an aerosol, which confines its effects to the lungs and avoids side effects from systemic actions.

Bennett Lorber, M.D. ’68, the Thomas M. Durant Professor of Medicine in the Lewis Katz School of Medicine at Temple University, received the Lifetime Achievement Award from the Anaerobe Society of the Americas, an international scientific society, at its biennial meeting in

A First Book Raises Eyebrows . . . and Draws Praise Arlene Heyman, M.D. ’73, a psychiatrist/psychoanalyst who practices in New York City, has published Scary Old Sex (Bloomsbury, 2016). It is a collection of short stories that The New Yorker has described as “frank tales of conjugal relations among the old.” Although the book is her first, she had earned an M.F.A. degree after college and published some stories in national journals before she entered medical school. Her very first publication was in New American Review in 1968, and her stories have been listed twice in the honor rolls of The Best American Short Stories. Heyman has received Fulbright, Woodrow Wilson, Rockefeller, and Robert Wood Johnson fellowships.

The collection has been praised in The New York Times, The Guardian, and Vogue, among other places, and Heyman has been interviewed on NPR’s Fresh Air. According to the Times, “Not all of these stories are about sex. . . . Some are about illness and aging and caring for elderly parents and wayward adult children.” And Heyman can be both rueful and observant. In one of the stories, an older woman observes her secJuly. It is the second lifetime achievement award for Lorber, who was previously honored with the Alexander Fleming Lifetime Achievement Award by the Infectious Diseases Society of America in 2003. In May, he also received his 13th Golden Apple Teaching Award from Temple’s medical school.

1970s Richard D. Guyer, M.D. ’75, G.M. ’80, was appointed to the scientific advisory board of St. Teresa Medical, Inc. Guyer is a board-certified orthopaedic spine surgeon and a founder of Texas Back Institute, where he currently serves as its president.

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ond husband: “He came in naked and she remembered again why she did not like to make love in the daytime.” Doctors appear in some of the stories. In one, an obstetrician-gynecologist is awakened in the middle of the night and called to the home of his married father’s mistress. His father had died in her bed, and the son had had no inkling that his father was having an affair. In another story, a bench scientist is enraged after her study on rats’ salivary glands is rejected by a prestigious journal – and things just get worse after that!

During her years at Penn Med, Heyman met Philip Roth, who was then teaching literature at the University. She recalls taking him to the gross anatomy lab and showing him the cadavers.

The chairman of the board of directors for the Texas Back Institute Research Foundation, he has been director of the Spine Surgery Fellowship program since its inception in 1986. He was also recently appointed to the board of the American Board of Spinal Surgery.

Bartley S. Asner, M.D. ’76, has been appointed to the first physician advisory board of Surgical Care Affiliates, Inc. Asner is chief executive officer, chairman, and founder of Monarch HealthCare, now part of OptumCare, a division of UnitedHealth Group. He is also the current chair of CAPG, the leading U.S. trade association representing accountable physician organizations.

Steven J. Weisholtz, M.D. ’78, was named to the board of trustees of the Daughters of Miriam Center, which provides care for Jewish senior citizens. For the past 33 years, he has maintained an active internal medicine and consultative infectious disease practice in Englewood, N.J. His special interests are HIV, chronic viral hepatitis, osteomyelitis, and difficult diagnostic problems. He has been an active leader at the Englewood Hospital and Medical Center, serving as chief of the infectious disease division for many years. In addition, he has served as president of the medical staff and on the executive board of the hospital.

George M. Wohlreich, M.D. ’79, has been appointed a trustee of Knowles Science Teaching Foundation. Wohlreich is the inaugural incumbent of the Thomas W. Langfitt Chair as the president and chief executive officer of the College of Physicians of Philadelphia, one of the nation’s oldest professional medical organizations.

1980s Harry L. Leider, M.D. ’83, was named a clinical and commercial advisor at Sonde Health Inc., a company developing a voicebased technology platform for monitoring and diagnosing mental and physical medical conditions. Leider is the chief medical officer and group vice president of Walgreens. Before joining Walgreens, he was chief medical officer of Ameritox. He has served on the board of the Institute of Aging at the University of Pennsylvania. Lieder also served for six years as an attending physician at Brigham and Women’s Hospital and as a faculty member at Harvard Medical School; more recently, he was a faculty member at the Johns Hopkins Carey School of Business.

Richard S. Levy, M.D. ’83, G.M.E. ’86, has been appointed to the board of Madrigal Pharmaceuticals, Inc., a clinical-stage biopharmaceutical company focused on developing and commercializing innovative therapies

for cardiovascular, metabolic, and liver diseases. Levy served as executive vice president and chief drug development officer of Incyte Corporation from January 2009 until his retirement in April 2016. Before joining Incyte, he held positions of increasing responsibility in drug development, clinical research, and regulatory affairs at Celgene Corporation, DuPont Pharmaceuticals Company, and Sandoz (now part of Novartis). Previously, Levy was an assistant professor of medicine at the UCLA School of Medicine.

Jonathan A. Leff, M.D. ’84, has been named chief medical officer of Ascendis Pharma A/S, a clinical-stage biotechnology company. Most recently he served as InterMune’s executive vice president for research and development, where he led the development of Esbriet for the treatment of idiopathic pulmonary fibrosis through a successful Phase 3 trial, resubmission of a New Drug Application, and eventual approval from the Food and Drug Administration. Before his role at InterMune, he served as chief medical officer of KaloBios Pharmaceuticals and Halozyme Therapeutics. Leff began his industry career working in various clinical development and medical affairs roles at Merck and Co., Amgen, and Roche.

Scott D. Boden, M.D. ’86, was named chief medical advisor to Bone Biologics Corporation. A tenured professor of orthopaedic surgery at the Emory University School of Medicine, he serves as the director of the Emory Orthopaedics & Spine Center, vice chair of the Department of Orthopaedics, and chief medical officer/chief quality officer of The Emory University Orthopaedics & Spine Hospital. He is also the clinical director of the Whitesides Orthopaedic Research Laboratory. Most recently, Boden served as president of the American Orthopaedic Association.

Jay Mulaney, M.D., G.M.E. ’89, was named chairman of the board of directors of Lakeland Regional Health. A board-certified ophthalmologist with Cen-

tral Florida Eye Associates, he has served on the Lakeland Regional Medical Center/Lakeland Regional Health System board of directors since 2008. Mulaney has also served in numerous leadership roles in the medical profession, including as president of the Polk County Medical Association, president of the medical staff at Lakeland Regional Medical Center, and president of the Central Florida Physicians Alliance.

His community leadership roles have included the board chairman of Volunteers in Service to the Elderly.

1990s Adam C. Husney, M.D. ’90, was named chief medical officer of Healthwise, a nonprofit producer of health education, technology, and services. Husney’s role aligns him closely with hospitals, health plans, and health-care management organizations to develop solutions that help put people at the center of care. After joining Healthwise in 2000 as an associate medical director, he later served as medical director.

Brian J. Harte, M.D. ’96, was named the new president of Cleveland Clinic Akron General and the Southern Region. Harte, who has worked with the clinic since 2004, has been president of the Clinic’s Hillcrest Hospital in Mayfield Heights for the past three years. During his time at the helm, Hillcrest Hospital achieved Magnet designation, accomplished re-accreditation by the Joint Commission, and received recognitions for stroke, obstetrical, pediatric, and cardiac care. Before that, he served as president of the Clinic’s South Pointe Hospital in Warrensville Heights. Harte is also an associate professor of medicine in the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.

Natalie R. Sacks, M.D. ’96, G.M.E. ’02, has been named chief medical officer at Aduro Biotech, Inc. Previously, she was vice president of clinical development at Onyx Pharmaceuticals, where

she played an important role in the development and approval of Kyprolis® and in business development strategy. In addition to her industry experience, Sacks holds an active faculty appointment at the University of California, San Francisco, where she is an assistant clinical professor of medicine in the Division of Hematology/Oncology.

2000s Oliver Mayorga, M.D. ’02, became director of the Westerly Hospital Emergency Department in June. He continues to serve as director of the Emergency Department and Pediatric Emergencies at L+M Hospital in New London and Pequot Medical Center in Groton, positions he has held for about five years. In 2007, Mayorga spent six months as mass-casualty coordinator at a U.S. Air Force hospital in Balad, Iraq, where he cared for injured soldiers and civilians.

2010s Anthony Wilson, M.D. ’10, has joined the Plastic & Cosmetic Surgery Skin & Laser Center.

Wilson is a plastic and reconstructive surgeon with extensive training in a wide range of surgical and non-surgical treatments.

OBITUARIES

1940s Orel Friedman, M.D., G.M. ’41, Queensbury, N.Y., a retired audiologist who had founded the Audiology and Speech Clinic at Glens Falls Hospital; December 12, 2014.

James Grant Keller III, M.D. ’43, G.M. ’59, Woodbury, N.J.; November 12, 2015. He worked as a physician in Woodbury for many years and was on the staff at Underwood Memorial Hospital (now Inspira). He was also president of KGE Medical

Group. A physician with the New Jersey State Athletic Commission, he was a ringside physician for many professional boxing matches in Atlantic City. He also worked as the practice squad physician for the Philadelphia Eagles for a few years.

Rowan Crothers Pearce Jr., M.D. ’44, G.M. ’49, Lancaster, Pa., a retired otolaryngologist who had been on the staff of Cooper Medical Center in Camden for more than 35 years; January 4, 2016. He served as a medical officer in the Pacific Theater in World War II and also in the Korean War. After taking his internship at Lankenau Hospital, he completed residencies in otolaryngology at Pennsylvania Hospital and Geisinger Medical Center. He had been the first medical director of the Cooper Hospital Hearing & Speech Center. A diplomate of the American Board of Otolaryngology, Pearce was also a life fellow of the American Academy of Otolaryngology and a fellow of the American College of Physicians. He volunteered with several Christian medical organizations and provided medical services in Haiti, the Dominican Republic, and Nepal. He had also served on the board of Interserve USA. William H. Miller Sr., M.D. ’45, Ithaca, N.Y.; June 16, 2015. He was a captain in the Army Medical Corps 1943-1948. From 1955 until his retirement in 1983, he served as director of clinical laboratories and pathology at Mercy Catholic Medical Center in Darby, Pa. Samuel Clay Williams Jr., M.D. ’45, G.M.E. ’49, Winston-Salem, N.C., a retired internist; October 10, 2015. After earning his medical degree, he served two years in the U.S. Navy in Charleston, S.C. During his medical fellowship at Penn, he met his future wife, Mary Basher, a pediatric nurse at HUP. Williams had a private practice and also worked at Forsyth Hospital until 1985. In retirement, he continued to visit former patients to offer support; he also volunteered at Senior Services, Inc., making calls to

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elders living alone. A former Elder at First Presbyterian Church, he served on the boards of Salem College, Davidson College, and the North Carolina Stroke Association.

maica. He was a member of the American Board of Family Practice and a charter member of the Society of Teachers of Family Medicine.

Richard G. Lonsdorf, M.D. ’46, a retired psychiatrist; March 18, 2016. A professor of psychiatry and law at the University of Pennsylvania Law School, he was a nationally known expert on the insanity defense. In the aftermath of World War II, he served with the Navy Medical Corps in Fort Worth, Tex. Later, he ran a busy private psychiatry practice. In the 1950s, he helped Penn’s law school develop a course in forensic law, dealing with legal issues relating to the criminal mind.

The course became a mainstay of the curriculum, and Lonsdorf taught it for more than 40 years to generations of Philadelphia lawyers and judges. He often tes-

1950s Irvin C. Arno, M.D. ’51, Boynton Beach, Fla., a retired obstetrician-gynecologist; June 8, 2015.

He was a veteran of World War II. In his career, he delivered more than 8,000 babies.

tified in court and was a consulting psychiatrist in the legal challenges that followed the 1982 conviction of John Hinckley Jr. for the attempted assassination of President Ronald Reagan.

parts function together as a unified whole under physiologic and pathologic conditions. In 1981, Sokoloff received the Albert Lasker Clinical Medical Research Award for his role in developing what the Lasker Foundation described as the vivid color images that map brain function. According to the Foundation, the Sokoloff method “has facilitated the diagnosis, understanding, and possible future treatment of such disorders of the brain as schizophrenia, epilepsy, brain changes due to drug addiction and senile dementia.” Sokoloff had been a member of the National Academy of Sciences and the American Academy of Arts and Sciences and had served as president of the American Society for Neurochemistry. His honors include the Schmitt Medal in Neuroscience, the Perelman School’s Distinguished Graduate Award (1987), and an honorary degree from the University of Pennsylvania (1997).

Louis Sokoloff, M.D. ’46, G.M.E. ’50, Hon ’97, Silver Spring, Md., retired chief of the Laboratory of Cerebral Metabolism at the National Institute of Mental Health and a pioneer of positron emission tomography (PET) scanners; July 30, 2015. He joined the NIMH in 1953, recruited by his mentor, Seymour S. Kety, M.D. ’40, and became chief of the lab in 1968. In his early years there, he retained a faculty appointment at Penn’s medical school.

With colleagues both at the NIMH and at Penn, he developed a technique that allows researchers to look into the brain and to observe how its disparate

William Nelson Stecher, M.D. ’48, G.M.E. ’52, Waynesville, N.C., a retired family practitioner; May 20, 2015. He had graduated from Friends’ Central School and Swarthmore College before entering medical school.

A former flight surgeon for the United States Air Force, he was in private practice for 20 years in Shirley, Mass. He had also worked in the emergency room and had been a medical center physician on Cape Cod, where he retired. Stecher had served as president of the Massachusetts Academy of Family Physicians and as a consultant to the Ministry of Health in Kingston, Ja-

PENN MEDICINE

William H. Spencer Jr., M.D. ’50, G.M.E. ’55, Boise, Idaho, retired chief of anesthesiology at Newton Memorial Hospital, Newton, N.J.; October 7, 2014.

He took his residency in anesthesia after serving as a Naval Lieutenant at Coronado, Calif.

Olaf Victor Lindelow, M.D. ’51, Bismarck, N.D., a retired physician who had maintained a practice there for more than 40 years; May 23, 2015. He completed his internship and residency in internal medicine at Geisinger Memorial Hospital and Foss Clinic in Danville, Pa., and his fellowship at the Cleveland Clinic in Cleveland before moving back to North Dakota to practice medicine at the Missouri Valley Clinic (now Mid Dakota Clinic). He had served as governor of the North Dakota Chapter of the American College of Physicians and as president of the North Dakota Medical Association, from which he received the Physicians Distinguished Service award. He had been chief of medical services at St. Alexius Hospital and president of its hospital staff. His other appointments included president of the North Dakota Chapter of the Diabetes Association, chairman of the Blue Shield Board of Directors, and clinical associate professor of medicine for the University of North Dakota School of Medicine.

Leonidas B. Hayes Jr., M.D. ’52, Ellsworth, Me., a retired physician; January 7, 2016. He served as a country doctor for 18 years, running a small office and doing house calls at a time when a complete physical cost only $5.

In 1971, he joined the staff at Maine Coast Memorial Hospital and practiced internal medicine until he retired in 1999. He also helped to found the Ellsworth Free Clinic in his home office and served as its first medical director.

Harry Warren Slade, M.D., G.M.E. ’52, Waco, Tex.; November 6, 2015. He served as chief of neurosurgery at Cleveland City Hospital and chief of staff of University Hospitals of Cleveland.

He was also a member of the faculty at Case Western Reserve from 1953 to 1957. Moving to Waco, he opened his neurosurgical practice there. He was a fellow of the American College of Surgeons and a diplomate of the American Board of Neurological Surgery, the American Association of Neurological Surgery, and the Congress of Neurological Surgery.

Lawrence Claman, M.D. ’53, Austin, Tex., retired director of the child-psychiatry residency program at the University of Texas Southwestern Medical Center; June 16, 2015.

Stephen C. Cromwell Jr., M.D. ’53, Silver Spring, Md., a retired physician; May 31, 2015.

Francis A. Locke, M.D. ’53, Napa, Calif., a retired gynecologist; January 20, 2016. He served in the U.S. Army from 1944 to 1946 and was a naval flight surgeon in the U.S. Navy from 1953 to 1955. Returning to civilian life, he maintained a successful ObGyn medical practice. He held many leadership positions during his career, serving as president of the Lenawee County [Michigan] Medical Society and as chief of medical staff, chair of the Department of Ob-Gyn, and chair of the Department of Surgery at Bixby Medical Center. He also served more than 20 years as a member of the Michigan State Medical Society Committee of Maternal and Perinatal Health.

When he retired in 1995, he was cited with a special tribute by the governor of Michigan for his years of service.

Dene Thomas Walters, M.D. ’53, Wilmington, Del., former chair of the Department of Family Medicine at the Wilmington Medical Center; August 14, 2015. During World War II, he was part of the 94th Infantry Division as a Browning Automatic Rifleman. After earning his medical degree, he took his internship and residency years at the Wilmington Medical Center (now Christiana Care).

For 15 years, he was a family doctor in North Wilmington before being recruited by the Medical Center to start a Family Medicine Residency Program in 1971. He also served as chair of the Department of Family Medicine from 1971 to 1991 and continued as a preceptor and mentor for many years. In 1988, he was appointed a clinical professor of family medicine at Jefferson Medical College.

J. Elliott Blaydes Jr., M.D. ’54, Bluefield, W.Va., a retired ophthalmological surgeon; May 19, 2015.

Alfred W. Brody, M.D., G.M. ’55, Omaha, Neb., retired founding head of pulmonary medicine at Creighton University medical school and its hospital; April 12, 2015. During World War II, he served with the U.S. Army in Europe. His daughter is Betty Ann Brody, M.D. ’78.

Rupert O. Clark, M.D. ’55, Las Cruces, N.M., a retired family practitioner; February. 4, 2015.

Mendon R. MacDonald, M.D. ’55, Laconia, N.H., retired medical director of Blue Cross Blue Shield of New Hampshire; May 10, 2015. He had served on the board of the New Hampshire Medical Society.

Steven S. Spencer, M.D. ’55, Santa Fe, N.M., former medical director of the New Mexico Corrections Department; July 11, 2015. In the 1950s, he served as senior assistant surgeon and chief of outpatient services for the U.S. Public Health Service, based on the Navajo reservation.

In 1960 he seized an opportunity to work with a man he greatly admired, Dr. Albert Schweitzer,

and spent six months at Schweitzer’s Lambarene Hospital in the Gabon. In the 1960s, Spencer had a private practice of internal medicine in Flagstaff, Arizona, where he also established a coronary care unit in the Flagstaff Community Hospital. He was an associate professor at the University of Dar es Salaam, Department of Medicine, in Tanzania from 1970 to 1974 and headed the department for two years.

From 1974 to 1979, Spencer was on the medical faculty at the University of Arizona, Tucson, where he founded the C.U.P. Program (Commitment to Underserved People), a special educational and enrichment program for medical students. He later served as medical director at the Navajo Nation Health Foundation and Sage Memorial Hospital, in Ganado, Arizona, 1979-85.

Along with his wife, Joan, he was a founding member of the N.M. Coalition to Repeal the Death Penalty, which was instrumental in the ultimate repeal of the death penalty in New Mexico.

Charles M. Davis Jr., M.D. ’56 GM ’61, Tafton, Pa., a retired orthopaedic surgeon who had maintained practices in Bryn Mawr, Pa., then in Morgantown Va.; July 21, 2015. He had served on the faculty of the West Virginia University medical school.

Robert J. Reed III, M.D. ’56, Wheeling, W.Va., a retired physician; January 31, 2016. He served as a U.S. Army medic stationed in Germany during World War II. Returning to Wheeling to join his father’s medical practice, he was considered a medical pioneer in the region in the use of pacemakers and cardiovascular surgical procedures. He had been a staff member of the Ohio Valley Medical Center and several hospitals. Reed was instrumental in developing EMSTAR, the OVMC trauma unit, serving as its medical director and trauma surgeon until his retirement in 2000. In addition, he was medical director of the OVMC hyperbaric oxygen unit towards the end of his career and was active in the West Virginia Medical Society.

Peter J. Jannetta, M.D. ’57, G.M.E. ’64, Pittsburgh, a world-renowned neurosurgeon who served as head of neurosurgery for nearly 30 years at the University of Pittsburgh medical school; April 11, 2016. In 1966, he pioneered a novel procedure that relieved trigeminal neuralgia, a chronic facial disorder that causes excruciating pain. The process, known as microvascular decompression – more informally, the Jannetta procedure – does not damage or destroy the nerve. According to The New York Times, it took more than a decade for the procedure to win acceptance from the neurosurgery establishment. Jannetta’s work was the subject of a book, Working in a Very Small Space: The Making of a Neurosurgeon (W. W. Norton, 1989). Before joining the University of Pittsburgh in 1971, Jannetta was chief of surgery at Louisiana State University Medical Center in New Orleans. After a stint as Pennsylvania’s Secretary of Health 199596, he joined the staff of Allegheny General Hospital in 2000.

Among his many honors were the Herbert Olivecrona Award from the Karolinska Institute in Sweden, the time it was given to

a neurosurgeon; the Horatio Alger Award, which honors the achievements of outstanding individuals who have succeeded in spite of adversity; the Zulch Prize for basic neurological research, presented by the Max Planck Society; and the 2008 Distinguished Citizen of the Commonwealth Award from the

Pennsylvania Society. As an undergraduate at Penn, he was a member of the men’s swimming and lacrosse teams.

Robert A. Roosa, Ph.D. ’57, Wayne, Pa., a retired microbiologist who supported scientists as an administrator at the Wistar Institute; June 19, 2015. He served in the U.S. Navy as a pharmacist’s mate on a hospital ship in the Pacific from 1943 to 1946. After earning his doctorate in microbiology from Penn in 1957, he took a postdoctoral fellowship at the National Cancer Institute. In 1960 Roosa joined Wistar, where he did research on a range of topics, including drug resistance and cancer treatments. He also served as curator of the institute’s museum. According to William Wunner, Wistar’s director of academic affairs, Roosa had a passion for helping the institute’s scientists. “He always answered the calls of scientists to do their work,” Wunner said. “He wore Wistar on his sleeve. He was a true believer in his place of work.”

Max A. Stoner, M.D., G.M.E. ’58, Naples, Fla., retired director of rehabilitation at Polyclinic Hospital; April 26, 2015.

Carl E. Krill Jr., M.D. ’59, Akron, Ohio, a retired pediatric clinician; January 15, 2016. He served in the U.S. Navy from 1966 to 1968 and was discharged with the rank of commander. In Akron, he began a long association with Children’s Hospital Medical Center. As founding director of its Division of Hematology-Oncology, he coordinated the care of Akron-area children afflicted with hemophilia, sickle-cell anemia, and other blood disorders, including a special outreach to the Amish and Mennonite communities in Holmes County. As a pediatric clinician, Krill contributed to nationwide studies that improved patient treatment, and for more than 40 years he served in the Summit County Children Services clinic. In 2005, the American Cancer Society honored his compassionate, skillful care of children with leukemia with a Hope Award.

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PROGRESS NOTES William S. Masland, M.D. ’59 G.M.E. ’66, Tucson, Ariz., a neurologist who had served as medical director of drug and alcoholism treatment at St. Joseph’s Hospital; May 8, 2015. He was an assistant professor of neurology and physiology at Penn before moving to Tucson in 1971.

Herbert S. Mooney Jr., M.D. ’59, Longmont, Colo., a retired surgeon; February 26, 2016. He began his career by serving at Heidelberg Army Hospital in Germany. After a brief time in Los Angeles practicing with his father, he began his general surgical practice at the Longmont United Hospital and Loveland Memorial Hospital/McKee Medical Center. He was also a clinical professor at the University of Colorado School of Medicine.

Albert L. Sheffer, M.D., G.M. ’59, Weston, Mass.; December 22, 2015. He was appointed to Harvard Medical School in 1964 as a clinical professor of medicine and joined the Brigham and Women’s Hospital two years later. There, he helped establish the Allergy Clinic and launched the allergy training program that has educated more than 100 trainees, many of whom hold leadership positions in the specialty. In private practice from 1969 to 1993, he then became a full-time staff member of the Brigham and served as director of the allergy program until 1998. He had been president of the American Academy of Allergy and Immunology; the first chair of the expert panel that generated the National Heart, Lung, and Blood Institutes Guidelines for the Diagnosis and Treatment of Asthma; and co-chairman of the first Global Initiative for Asthma Committee. He also served on the United Nations Technical Options Committee, which annually allocated the world’s chlorofluorocarbon supply. He was a former director of Beth Israel Hospital Allergy Clinic as well as the New England Deaconess Hospital Allergy Section.

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PENN MEDICINE

1960s James J. Brod, M.D., G.M. ’60, Oneida, N.Y., a retired orthopaedic physician; December 31, 2015. He served in the U.S. Navy as the chief medical officer for the Underwater Ordnance Station in Newport, R.I., from 1954 to 1956. In 1965 he started Oneida’s first orthopaedic practice at Oneida City Hospital, serving as both chief of surgery and chief of staff at the hospital. He would maintain this orthopaedic practice for 30 years, also working as assistant professor of clinical orthopaedics at Upstate Medical Center and as team doctor for the Oneida High School football team. Committed to service, he spent time in the Dominican Republic, Pakistan, and Nicaragua, sharing his medical expertise.

Harold M. Friedman, M.D. ’60, Hanover, N.H., a retired physician; February 28, 2016. He worked as the head of the Department of Allergy and Immunology at the Dartmouth-Hitchcock Medical Center for 38 years. Named a master of the American College of Physicians, he served as governor of its New Hampshire chapter and earned the College’s Laureate Award. He was a former president of the New England Allergy Society and served on the board of directors of the Hitchcock Clinic. He taught at the Dartmouth Medical School and served on the admissions committee, which he led as its chair for 17 years.

LeRoy L. Johnson, M.D., G.M. ’60, Ames, Iowa, a retired vascular surgeon; May 5, 2015.

William P. Steffee, M.D. ’61, Cleveland, retired CEO and chair of AcroMed Corp., an orthopaedic implant firm; March 31, 2015.

Earlier, he had been chief of medicine at St. Vincent Charity Hospital.

James D. Tully, M.D., G.M.E. ’61, Wyckoff, N.J.; November 17, 2015. In 1956 he served two years in the United States Navy as a medical officer in Hingham, Mass. In 1961, he joined the staff

at Holy Name Hospital in Teaneck, N.J., as an anesthesiologist, retiring in 1993.

Harvey L. P. Resnik, M.D., G.M.E. ’62, Aurora, Colo., emeritus clinical professor of psychiatry at George Washington University; May 4, 2014.

Wayne W. Keller, M.D. ’65, G.M.E. ’69, Haverford, Pa., who had practiced for 41 years as a cardiologist at Bryn Mawr Hos-

Stephen J. Bednar, M.D. ’64, Lorton, Va., a retired physician who practiced family medicine and emergency medicine; April 29, 2015. During the Vietnam War, he was a medic in the U.S. Army.

Jacob J. Lokich, M.D. ’64, Newton, Mass., a retired oncologist; May 12, 2015. During the Vietnam War, he served as a medic in the U.S. Army.

Robert T. McKinlay Jr., M.D. ’64, Scottsdale, Ariz.; December 17, 2015. He operated his own ophthalmology practices for 25 years before retiring from Comprehensive Eyecare of Central Ohio, Inc., in 1999. He was a clinical associate professor of ophthalmology at The Ohio State University. He had been president of the Ohio Ophthalmological Society and the Columbus Ophthalmological & Otolaryngological Society and had held board positions in several other medical organizations. He served in the U.S. Navy, including as a naval ophthalmologist in Vietnam, and was honorably discharged as a commander in 1974 after 11 years of service. He later entered the U. S. Naval Reserves in Columbus, was promoted to captain, and retired in 1998. In his career, he was presented with numerous military decorations and awards.

B. Lawrence Brennan, M.D. ’65, Denver, a retired nephrologist; Nov. 8, 2014.

Gary A. Fields, M.D. ’65, G.M.E. ’70, Sacramento, Calif.; December 28, 2015. He served in the military at Fort Ord in California as an OB/GYN physician, then worked in private practice in Sacramento for 20 years. Until his death, he served as the medical director for Sutter Health.

pital; October 3, 2015. He had treated some of his patients for 30 years. According to his daughter, Mimi Drake, he was known for treating patients who could not afford to pay. “In Dad’s last days,” said Drake, “one patient wrote him and said that while she couldn’t give him much, she would happily give him her blood or bone marrow if that would help him.”

James S. McCaughan Jr., M.D., G.M. ’65, Galena, Ohio, a retired thoracic surgeon at Grant Hospital; May 18, 2015.

John H. Gundy, M.D., G.M.E. ’66, Corinth, Vt., a retired pediatrician; May 26, 2015.

1970s Kenneth P. Cicuto, M.D., G.M. ’72, Portland, Me; October 25, 2015. He was board certified in radiology and had been a fellow in the Society of Interventional Radiology. He worked in his practice at the Spectrum Medical Group for 35 years before retiring in 2013. Cicuto was also a contributing author to two publications in the Journal of Vascular and Interventional Radiology and the American Journal of Roentgenology.

LEGACY GIVING Philip Littman, M.D., G.M. ’73, New York, a retired physician; March 16, 2016. He was a diplomate of the American Board of Radiology, in therapeutic radiology. After a long academic career at the Perelman School of Medicine and then Brown University School of Medicine as a professor of radiation therapy, he opened – and became the primary physician at – the Southern Wisconsin Radiotherapy Center in Madison in 1987. Following his retirement in 2003, he worked as a locum tenens radiation oncology physician in various states.

At the age of 70, he re-trained himself to be a general practitioner so he could volunteer as a physician at the Volunteers in Medicine Clinic in Stuart, Fla. Frank A. Welsch, M.D. ’74, Doylestown, Pa., a retired pulmonologist who had maintained a practice there for many years; August 8, 2015.

Robert K. Kanter, M.D. ’76, Syracuse, N.Y; March 29, 2016.

He completed his pediatric residency at SUNY’s Upstate Medical Center under Frank Oski, M.D. ’58, a recipient of the Perelman School’s Distinguished Graduate Award. After completing a fellowship in pediatric critical care at Children’s Hospital National Medical Center in Washington, D.C., Kanter returned north to open the first pediatric intensive care unit in the Syracuse region. Among his many accomplishments, he served as division director of pediatric critical care medicine at SUNY Upstate Medical University, as professor of pediatrics at Upstate, as adjunct senior research scientist at the National Center for Disaster Preparedness at Columbia University, and as vice chair of the advisory committee of the emergency medical services for children in New York State’s Department of Health.

1980s Ralph M. Schrager, M.D. ’83, Elkins Park, Pa., a neonatologist; May 13, 2016. A specialist in the

care of fragile and seriously ill newborns, he joined the Abington Memorial Hospital staff in 2006 as an attending neonatologist. In a career lasting three decades, he saved the lives of thousands of babies, many of them born prematurely. In 1988, Schrager founded the intensive-care nursery at Frankford Torresdale Hospital and remained there as chief of neonatology until the maternity unit was closed in 2006.

2000s FACULTY Richard G. Lonsdorf, M.D. See Class of 1946.

Philip Littman, M.D. See Class of 1973.

William S. Masland. See Class of 1959.

George J. Merva, a retired laboratory administrator in the Department of Pathology & Laboratory Medicine; March 11, 2016.

He enlisted in the U.S. Marines toward the end of World War II; after the war, he was stationed at Philadelphia’s Navy Yard. He joined the Penn staff in 1953 while still in the reserves and finished his service as a second lieutenant. He earned his bachelor’s degree from Penn in 1955. A polymath for the laboratories in the John Morgan Building, Merva served on the Penn Med staff for 58 years, assisting in research administration and the education of medical students. For many years, he put together the course guide for Pathology 101 and was instrumental in creating the student course-evaluation forms (HAMSTER). Before the advent of computers, he collated all of the statistics by hand. He was a medical history buff: he was responsible for salvaging 19th-century wax anatomy models that are now part of the Mutter Museum of the College of Physicians.

Supporting Penn’s Alzheimer’s Research While Planning for Retirement To say that Frank Rasmus Jr. is a big fan of charitable gift annuities would be an understatement. So far, he’s created 129 of them, with 21 benefiting many different areas of Penn Medicine, as well as the Morris Arboretum and Penn’s School of Veterinary Medicine.

One of the more personally meaningful projects he is committed to is the work of the Alzheimer’s Research Fund at the Penn Center for Neurodegenerative Disease Research, led by Penn faculty members and married couple Virginia M.-Y. Lee, Ph.D., M.B.A., and John Q. Trojanowski, M.D., Ph.D. “I so admire the dedication, enthusiasm, skill, and work ethic that Drs. Lee and Trojanowski have applied for decades to improve treatment for Alzheimer’s disease, as well as other disabling neurodegenerative diseases,” Rasmus said.

“I watched my mother suffer from this disorder, which took her life in 1994. That led me to get involved in fundraising for Alzheimer’s research,” he said. “When I met Dr. Lee in 2007, I was just bowled over by her fervent desire to find a cure for this devastating disease.” Together, Drs. Lee and Trojanowski lead more than 50 University of Pennsylvania researchers on various projects ultimately aimed at developing drug therapies to treat neurodegenerative diseases.

Mr. Rasmus is a fan of gift annuities for a number of reasons but the ease in setting one up tops the list. With a gift of cash or stock, donors can set up a gift annuity that provides benefits both to the donor and to Penn Medicine. Mr. Rasmus appreciates this dual benefit that gift annuities provide – he receives guaranteed, lifetime payments from his charitable gift annuities with Penn now while he plans his future support of much-needed research. “I view gift annuities as essentially retirement income but with a tax-free portion,” Mr. Rasmus explained. “This way, I manage my retirement income and save on taxes while also laying the foundation of my future support of Penn’s great research.”

Planned Giving has sometimes been described by our donors as the final piece of a philanthropic puzzle. Figuring out how this important puzzle piece can work best for you, your family, and your philanthropic goals is what we do best. Speak with us to learn more about giving options to help you serve your charitable and income stream goals. Contact Christine S. Ewan, J.D., executive director of Planned Giving, at 215-898-9486 or cewan@upenn.edu.

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

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EDITOR’S NOTE

Health Costs and Innovators Several features in this issue of Penn Medicine consider health costs and health innovations. The cover article looks at how the cost of drugs has become an increasing burden for both patients and health care institutions. Ezekiel J. Emanuel, M.S.C., M.D., Ph.D., the chair of the Perelman School’s Department of Medical Ethics and Health Policy, concedes that there are some villains that could be singled out. But he is more concerned that there are no incentives in health care to actually save money. The article also explores the ways HUP and its physicians are trying to rein in the cost of drugs – especially with the rise of what has been termed “financial toxicity.” Last year, in fact, bankruptcies from unpaid medical bills were estimated to affect two million Americans.

A broader look at the cost of health care comes in an excerpt from Richard “Buz” Cooper, M.D., who died before his book was published. Cooper, who had two different stints at Penn, seeks to counter the prevailing explanation for excessive costs. He argues that it is not because of the unwarranted overuse of supply-sensitive services but because of poverty. In its simplest terms, low-income people are sicker and sick people require more care. Earlier, Cooper warned about a coming physician shortage when most experts predicted a surplus. Cooper was right on that score, so his views should not be dismissed as the nation grapples with health care costs.

As for innovators, two kinds are featured in this issue. J. C. Lopez and Alex Sotolongo, both 4th-year students in the medical school, have teamed up to conceptualize a device that could, as one experienced medical developer said, “improve efficiency in a commonly performed surgery.” In more general terms, the campus community had an opportunity this spring to see and hear Penn’s two living alumni recipients of the Nobel Prize in Physiology or Medicine: Michael Brown and Stanley Prusiner. Both made major medical discoveries.

Brown, teaming with Joseph Goldstein, discovered the low-density lipoprotein receptor, which controls cholesterol in blood and in cells. Their work laid the groundwork for the de-

velopment of statins. Prusiner discovered “prions,” pathogens implicated in neurodegeneration. But he also had to withstand years of doubt and even ridicule before his work was accepted. Perhaps it was an instance of innovation before the world was ready for it. Another innovator in this issue is Yvonne Paterson, a longtime professor of microbiology. She recognized how a common bacterium could be developed into an immunotherapy to combat cancer.

Taking Leave This issue of Penn Medicine is the last one I will edit. I am stepping down after 18 years as editor – 51 issues in all. I took over for my friend and mentor Marshall Ledger, Ph.D., who created the magazine when Edward Stemmler, M.D. ’60, was dean of the medical school. Over the years, Penn Medicine has had only two designers and art directors, the late Al Lewis and Graham Perry, who has also been an incredibly imaginative illustrator. (See this issue’s cover and the illustrations for the cover story, for a start.) Graham also took the magazine through a major redesign with the Fall 2014 issue, making it more lively and contemporary. I’ve been very fortunate to work with Al and Graham and with the many freelance writers and photographers whose work has brought the magazine to life.

Despite being separated by 49 issues, I’ve discovered some connections between my first issue (Summer 1998) and my last. The 1998 cover article was about John Q. Trojanowski and Virginia Lee, Penn’s acclaimed Alzheimer’s disease researchers. In the new issue, Trojanowski is quoted on page 2 about the large NIH grant the Alzheimer’s Disease Core Center was awarded. In looking back to the 1998 issue, who should I also find but Dr. Prusiner, who delivered the Distinguished Alumnus Address at Graduation. I did not recall that there he acknowledged the importance of luck for researchers, which he later did in his 2014 book, cited in the current article. As Prusiner put it in 1998: “I’m one of those genuinely lucky scientists.”

Writers sometimes can be a bit superstitious, perhaps even editors, too. On that note, I’ll take my leave. And I readily acknowledge that I, too, have john.shea@uphs.upenn.edu been lucky!

In the Winter Issue: Lytico-bodig, a neurodegenerative disease, was once the primary cause of death among Chamorro adults on the island of Guam. Researchers at Penn Medicine and elsewhere believe learning more about it would throw light on related diseases like Alzheimer’s, Parkinson’s, and other dementias.

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PENN MEDICINE

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ONE LAST THOUGHT

The Healing Waves of Art More than 200 feet of shining, twisting, flowing aluminum dance on strings suspended from the ceiling over the waiting area in the Cupp Lobby at Penn Presbyterian Hospital. Its name: Waves of Healing. The piece was created specifically for the 400 square foot space and its high ceiling, and it took nearly nine hours to install. The artist,

Richard Monteleone, points out that each curve and each inch of placement was made in accordance with how the light interacts with the aluminum used for the sculpture. He describes it as a “thank you” to the Penn Medicine care teams that saved both of his parents’ lives. Monteleone hopes that Waves of Healing will help

foster a calming and healing environment for families and loved ones of PPMC’s patients.

He knows all too well how important such an environment can be. Over the past three years, Monteleone spent more than 30 hours at PPMC. In 2014, his mother underwent a successful open-heart procedure. Then, earlier this year, he returned again after his father suffered a heart attack and also required open-heart surgery.

“Will he survive? What if he’s debilitated? Can my mom handle that?”

Monteleone wondered as he waited for their doctors to deliver the news.

“While we were waiting to hear about my dad’s surgery, I spent some time talking to other families who were waiting for their loved ones. All our stories were very similar. The waiting area is very important.”

The Cupp Lobby, which became so familiar to Monteleone, was built in 1982, long before the aesthetic value of hospitals was a consideration. But now, as more and more studies have shown the positive impact of art on the healing process, design has become a critical component of facility development. Across Penn Medicine’s facilities, art and medicine interact, creating environments that foster a sense of well-being and energy for patients, staff, and visitors. And that was what Monteleone was striving to create. As he put it, “I want to help counteract the grueling process of waiting for our loved ones with the beauty and spectacle of art.”

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A recent Penn study encouraged physicians to prescribe more generic drugs instead of brandname medications, which could cut costs significantly.

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