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 de­velopment 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 been lucky!

— John Shea

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