Left to right: Jonathan Epstein, M.D.; Ralph Muller; Glenn Dranoff, M.D., Novartis; Willam Ludwig, the first patient to receive CAR therapy; Bruce Levine, Ph.D.; Carl June, M.D.; Chi Van Dang, M.D., Ph.D; and J. Larry Jameson, M.D., Ph.D.

vital_4Novartis-Penn Center for Cellular Therapeutics Unveiled

Physicians, scientists, and leaders from the Perelman School of Medicine and Novartis, the global pharmaceutical company, gathered last month to unveil the Novartis-Penn Center for Advanced Cellular Therapeutics (CACT). Located on Penn Medicine’s campus amid both clinical care and labo­ratory facilities, the new center is poised to become a major site for research and early development of personalized cellu­lar therapies for cancer. It will expand on Penn’s groundbreak­ing research using Chimeric Antigen Receptor (CAR) tech­nology, through which patients’ own immune cells are repro­grammed outside of their bodies and re-infused to hunt for and potentially destroy their tumors. 

“In only a few years, we have generated significant achieve­ments that have moved the field of personalized cellular thera­pies forward, opening clinical trials to test these treatments not only for patients with blood cancers, but also those with solid tumors,” said Carl June, M.D., the Richard W. Vague Professor in Immunotherapy in the Department of Pathology and Labo­ratory Medicine and di­rector of the Center for Cellular Immunothera­pies in the Perelman School. “The CACT will allow us to leverage this progress to develop and test new approaches more quickly and ex­pand our ability to man­ufacture personalized cell therapies for a greater number of trials.” 

The new facility is a marquee component of Penn’s translational science efforts to expedite the development of novel therapies for many types of disease. The collaboration with Novartis was announced in August 2012, when the two organiza­tions entered an exclusive global research and licensing agree­ment to further study and commercialize novel CAR therapies. 

“The opening of the Novartis-Penn Center for Advanced Cellular Therapeutics is a significant milestone in our collaboration with Penn,” said Mark C. Fish­man, M.D., president of Novartis Institutes for BioMedical Research. “It is our hope that discover­ies will be made at this facility that could one day lead to new medicines to help cancer patients around the world.” 

– Holly Auer

Danger: Sugary Beverages!

Health warning labels similar to those found on tobacco prod­ucts may have a powerful effect on whether parents purchase sugar-sweetened beverages (SSB) for their children. That is the finding of a new study, the first of its kind, led by the Perelman School of Medicine. Results show that regardless of a parent’s level of education, they may be significantly less likely to pur­chase an SSB when there is a label warning that consuming bev­erages with added sugar may contribute to obesity, dia­betes, and tooth decay, compared to a label that only lists the calorie count, or no label at all. 

The results, published online in the journal Pediat­rics, show that SSBs – including soft drinks and juices marketed for children – contain as many as seven tea­spoons of sugar per 6.5 ounces. That is nearly twice the recommended daily serving of sugar for that age group.

“In light of the childhood obesity epidemic and stud­ies suggesting that more than half of children under the age of 11 drink SSBs on a daily basis, there is a growing concern about the health effects associated with consumption of these beverages,” said lead author Christina Roberto, Ph.D., an assistant professor in the Department of Medical Ethics & Health Policy.

While the specific text of the health warning labels did not affect a parent’s purchase choice, the presence of the label was significant. Overall, 40 percent of parents in the groups exposed to health warning labels said they would choose an SSB for their kids, compared to 60 percent of participants who saw no labels on the beverages, and 53 percent of parents who saw the calorie labels.

The study also evaluated consumer support for sug­ar-sweetened beverage warning labels and found that nearly 75 percent of participants would support adding them to the containers. 

– Katie Delach

Penn Medicine IT Among Top in Nation 

The American Association of Medical Colleges has awarded Penn Medicine’s Information Services team a Learning Health System Research Pioneer Award for its work to enhance and align the research and clinical domains of Penn Medicine. Dubbed Clinical Research+, the strategic set of projects lever­ages technology, processes, and people to analyze and share clinical and research data within Penn Medicine. 

“This prestigious award recognizes the significant achieve­ment Penn Medicine has made towards advancing our Preci­sion Medicine efforts,” said Michael Restuccia, vice president and chief information officer for Penn Medicine. (Restuccia was recently named one of Computerworld’s Premier 100 Technology Leaders for 2016.)
Initiatives under the Clinical Research+ umbrella include cen­tralized clinical and research data warehouses, centralized lab information management and clinical trials management sys­tems, and a center for personalized diagnostics. The common theme for these initiatives is the effort to enhance the value of clinical and research data by better enabling staff and faculty on both sides of Penn Medicine to access and utilize these data. 

Penn Medicine was one of four institutions awarded this honor. 

What Neighborhood Factors Are Linked to Urban Violence?

Gunshot violence is the leading cause of death among 10- to-24-year-old range African American males and the second leading cause of death among 10-to-24-year-olds males over­all in the United States. A new Penn Medicine study is the first to outline the details of how an individual’s location and activities influence that risk.

The research maps the 24-hour paths and activities of more than 600 males in the 10-to-24-year-old range, primarily Afri­can Americans. Of the group, 143 had been shot with a gun, 206 were injured with another weapon, and 283 were un­harmed controls. Those who had been assaulted were re­cruited after being cared for in the emergency departments of the Level 1 trauma centers at the Hospital of the University of Pennsylvania and the Children’s Hospital of Philadelphia.

Researchers asked the young men to recount the 24 hours before they had been attacked, and the control subjects de­scribed a random day within three days of their interview. Re­ported in the journal Epidemiology, the findings showed that what the subjects were doing and where they were either pro­tected them or dramatically increased their likelihood of as­sault. In effect, just one turn down a certain city street can in­crease the risk of being a victim of violent crime.

The risk of gun assaults was higher among those who were alone, those who had recently acquired a gun, and those lo­cated in an area with many vacant houses and/or a history of violence and vandalism. The risk for assaults not involving guns was higher near recreation centers, among individuals who had recently consumed alcohol, and in areas of high va­cancy, overall violence, and vandalism.

“Even once risks are pinpointed, it may be hard to get peo­ple to change behavior – to have them not walk down a cer­tain street or not carry a gun, for instance,” said the study’s lead author, Douglas J. Wiebe, Ph.D., an associate professor of epidemiology in the Department of Biostatistics and Epidemi­ology. “But if we can change urban environments to make them safer, we can protect all people who come into contact with those places.”

Areas where neighbors were more connected – where sub­jects reported that residents worked together on projects such as neighborhood watches and block parties – experienced lower rates of assaults. In addition, the control group spent more hours in their homes than the other participants did.

The research team developed an original geography soft­ware application to comprehensively plot out each subject’s location by latitude and longitude; then the researchers super­imposed a map layer that showed the characteristics – risky or protective – of the areas the subjects moved through. 

– Gregory Richter

vital_2The Impact of Trauma on the Teen Brain

Frances Jensen, M.D., chair of Penn’s Department of Neu­rology, epilepsy researcher, and neuroscientist, was a recent visitor to UNICEF’s headquarters in New York City. She is also the author of a New York Times bestseller, The Teenage Brain: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults, published in early 2015. Jensen was invited to share her expertise with the UNICEF staff, many of whom are engaged in projects and programs related to advocacy, dis­ease and abuse prevention, education, protection, gender equal­ity, and more for children and adolescents around the world.

Jensen’s book is one of the first directed to a lay audience that dissects the inner workings of the teenage brain and the science behind teen behavior. In it, Jensen debunks the long-held scientific hypothesis that the adolescent and teen brain is essentially an adult brain, only with fewer miles on it. At UNICEF, she presented the recent discoveries about the ef­fects of stress, environment, and physical and emotional vio­lence on brain development.

“This is profoundly important to our work,” said Anthony Lake, UNICEF’s executive director. He pointed out that if the organization can demonstrate “that when there is stress, there is a lack of learning and its effects can be permanent, not just for a short period,” UNICEF could have a greater impact through its work in parts of the world where living situations are difficult and complex. 

As Jensen explained, the brain’s frontal and prefrontal cor­tex – which controls executive functions such as decision-making, impulse control, and risk-taking behavior – are not yet fully connected in the teen and adolescent years. Connec­tion, or insulation of the brain’s neuronal tracks, starts in the back of the brain and works its way forward, and the process is not complete until sometime in an individual’s mid-to-late 20s. This long period may help explain why teens often seem to be lacking in insight and empathy. 

The teenage years, Jensen emphasized, are also a time of great synaptic plasticity, when the brain is molded by different situations and circumstances. Teenagers can learn a language faster than they would as adults and remember facts better, but the effects of behaviors can be much more permanent on the brain. Addiction is a form of learning, and this synaptic malleability means teenagers become addicted faster. Whether heavy drinking or drugs, habits formed during this period are imprinted in the teen’s brain and are much harder to break. Similarly, “environmental factors such as stress and violence can stall brain development,” Jensen told the audience. 

Synapses, or brain connections, operate on a “use them or lose them” basis. The brain needs to prune these connections natu­rally and customize itself for its surrounding environment. Fac­tors such as a lack of education will force the brain to prune im­portant synapses that will be deemed unnecessary by the brain; those synapses are never to be regained. In addition, the release of the stress hormone cortisol halts the development of synapses. 

The implications for UNICEF’s charges – the world’s most vulnerable children – are clear. Children and adolescents liv­ing in violence in Syria or elsewhere in the world who are ex­posed to negative stimuli and stressful situations, without the benefits of a well-connected frontal lobe, are at particularly high risk for negative outcomes. Their judgment is not devel­oped enough for the stimuli they face, which often leads to cycles of violent behavior continuing into the next generation. In addition, the negative stimuli constantly present in social media can be harmful to the developing brain.

The teenage years are also classically the time of onset for mental illness. “Adults need to be vigilant and tell the differ­ence between a moody or belligerent teen and a teen falling down the rabbit hole of mental illness or a life of addiction or violence before it’s too late,” Jensen said. 

The teen brain, she suggested, is like a Ferrari with no brakes. “There is no seven-year period that has a greater im­pact on a person’s life or society,” Jensen said in closing. 

(For more on Jensen, see “Honors & Awards.”) 

– Lee-Ann Donegan

Honors and Awards

National Academy of Medicine Elects Three from Penn

Three professors from the University of Pennsylvania have been elected to the National Academy of Medicine, one of the nation’s highest honors in biomedicine. Members of the acad­emy, originally the Institute of Medicine, are elected by their peers for distinguished contributions to medicine and health. The new members bring Penn Medicine’s total membership in the prestigious group to 66. 

vital_hennessyThe new members from the Perelman School of Medicine are Sean Hennessy, Pharm.D., Ph.D., a professor of epidemiol­ogy in the Department of Biostatistics and Epidemiology, and Frances E. Jensen, M.D., chair of the Department of Neurology.

Hennessey received his Pharm.D. degree in clinical phar­macy from the Philadelphia College of Pharmacy and Science and his Ph.D. degree in epidemiology from Penn. He is a former president of the International Society for Pharmacoepidemiology and has served on the FDA’s Drug Safety and Risk Manage­ment Advisory Committee. In 2015 he began a three-year term on the board of di­rectors of the American So­ciety for Clinical Pharmacology and Therapeutics. Hennessy is also a co-editor of two textbooks in the field. Among his honors is the 2013 Samuel Martin Health Evaluation Sciences Research Award from the Perelman School of Medicine. 

vital_jensenJensen, co-director of the Penn Medicine Neuroscience Center, received her medical degree from Cornell University and was chief resident in neurology at The Harvard Long­wood Neurology Training Program. She has investigated mechanisms of epilepsy as well as their age-dependent differences, with attention to the interactions between brain development, brain in­jury, epilepsy, and cognition. In addition to receiving the NIH Director’s Pioneer Award and the American Epilepsy Research Recogni­tion Award, she was presi­dent of the American Epi­lepsy Society. A fellow of the American College of Physicians, she is author of a widely acclaimed book, The Teenage Brain: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults (2015).

vital_discherThe third new member of the National Academy of Medi­cine is Dennis E. Discher, Ph.D., the Robert D. Bent Profes­sor of Chemical and Biomolecular Engineering in the School of Engineering and Applied Science. He received his Ph.D. degree jointly from the University of California at Berkeley and at San Fran­cisco. He is a member of graduate groups in cell and molecular biology, pharma­cology, and physics. His re­search has focused on stem cell differentiation in relation to mechanics of microenvironments that differ between tis­sues and in disease. Discher is the principal investigator at Penn of a Physical Sciences Oncology Center, funded by the National Cancer Institute, which fosters research into new physical principles in cancer development.

vital_abramsCharles S. Abrams, M.D., G.M.E. ’91, the Francis C. Wood Professor of Medicine, Pathology, and Laboratory Medicine, began his term as president of the American Society of He­matology (ASH) in Decem­ber. ASH is the world’s larg­est professional society of hematologists dedicated to furthering the understand­ing, diagnosis, treatment, and prevention of disorders affecting the blood.

At Penn Medicine, Abrams serves as vice chair for research and chief scien­tific officer of the Depart­ment of Medicine and director of the Blood Center for Patient Care & Discovery at Penn and The Children’s Hospital of Philadelphia. His clinical and research interests have focused on the role of platelets in bleeding and clotting disorders, in­flammation, and metastasis formation. Abrams has been elected to the American Society of Clinical Investigation.

vital_bavariaJoseph E. Bavaria, M.D., G.M.E. ’90, the Brooke Roberts – William Maul Measey Professor in Surgery, was elected the 2016 president of the Society of Thoracic Surgeons. The soci­ety represents more than 7,100 cardiothoracic surgeons, re­searchers, and allied health care professionals worldwide. Bavaria, a member since 1996, has served on the operating board of the society’s Council on Health Policy and Rela­tionships. A former chief resi­dent of surgery at HUP, he serves as director of the Perel­man School’s program in tho­racic aortic surgery.

vital_durbinDennis R. Durbin, M.D., M.S.C.E., G.M.E. ’96, a pro­fessor of pediatrics at the Children’s Hospital of Phila­delphia in the emergency medicine division and direc­tor of the hospital’s clinical and translational research, received the 2015 FOCUS Award for the Advancement of Women in Medicine. Durbin was recognized for his outstanding advocacy and dedicated mentorship on behalf of women faculty and train­ees as well as for his exemplary roles as researcher, educator, and a clinician dedicated to supporting the integration of work and life. 

Durbin’s research has focused on preventing motor vehicle injuries to children and preventing crashes by teen drivers. His research has contributed to enhancements in public pol­icy and safety technology that have led to substantial reduc­tions in the number of children killed in automobile crashes each year. 

Over the past two decades, he has been a mentor to more than 30 trainees and junior faculty members, many of whom are now thriving in independent research careers. He has de­veloped new training materials specifically focused on work-life integration. Durbin also established the Joanne Decker Memorial Work/Family Mentoring Award, in honor of his late wife, who was also a physician. The annual award honors a fe­male CHOP faculty member committed to academic success and work-life balance. 

vital_gadeTerence Peter Gade, M.D., Ph.D., G.M.E. ’15, an assistant professor of radiology and cancer biology, received a five-year, $2 million 2015 NIH Director’s Early Independence Award, part of the High-Risk, High-Reward Research program. The award supports “exceptional early career scientists with the intellect, scientific creativity, drive, and maturity to flour­ish independently by bypass­ing the traditional post-doc­toral training period.” 

Gade’s project deals with hepatocellular carcinoma, also known as liver cancer. This year, an estimated 35,660 adults in the United States will be diagnosed with primary liver cancer. Gade reports that liver cancer cells can adapt their metabolism to survive the severe metabolic stress caused by current treatments, and widely used imaging techniques, primarily MRI and CT, cannot detect these sur­viving cells. “By combining a better understanding of how surviving cancer cells adapt with novel imaging technology making use of carbon-13 based compounds, this study will take important steps toward the development of clinical im­aging that can detect surviving cancer cells. Detecting these cells is the vital first step in eradicating them.”

vital_holzbaurErika L. F. Holzbaur, Ph.D., a professor of physiol­ogy, received the 2015 F. E. Bennett Award. Presented an­nually by the American Neu­rological Association, it rec­ognizes an outstanding re­searcher and educator in neu­rology. Holzbaur is known for her research and teaching on molecular motors, which function as tiny machines to propel organelles within a cell. Inhibiting or enhancing their activity has potential therapeutic bene.ts, while transport de­fects can cause disease. Intracellular transport by molecular motors is particularly important in neurons, the impulse-con­ducting cells that comprise the brain, spinal column, and nerves in vertebrates.

Holzbaur is also the recipient of one of the Perelman School’s Awards of Excellence for 2015. She was honored with the Stanley N. Cohen Biomedical Research Award, which rec­ognizes a faculty member for a body of work with an empha­sis on biomedical research. According to the award citation: “her work is not only fascinating from a fundamental biology perspective, but has significant implications for understanding the etiologies of many diseases.” 

vital_rustgiAnil K. Rustgi, M.D., chief of the gastroenterology division in the Department of Medicine, has been hon­ored for a second time with a Research Professor Award from the American Cancer Society. The awards are given to outstanding scien­tists and clinician-scientists who have made seminal con­tributions to their fields, are thought leaders in their fields, and have made outstanding efforts in terms of service and mentoring. The society’s award comes with a grant of five years for Rustgi to continue to provide leadership in his re­search on the genetics and biology of gastrointestinal cancers, including those arising from the colon and pancreas. The Rustgi lab has long focused on the tumor microenvironment and how preneoplastic cells become neoplastic. 

Rustgi is the T. Grier Miller Professor of Medicine and Genetics. 


vital_ludmirJack Ludmir, M.D., G.M.E. ’87, who has served as chair of the Department of Obstetrics and Gynecology at Pennsylvania Hospital since 1998, will step down from that position in the Spring of 2016. During that time, he has also been vice chair of the Department for the Perelman School of Medi­cine. An expert in mater­nal-fetal medicine, he is known for his compassion in caring for the underserved and uninsured in the Greater Philadelphia area and in Latin America. He is a co-founder of both Puentes de Salud and the Latina Community Health Services.

Ludmir’s first faculty appointment was in 1987, when he was named an assistant professor of Ob-Gyn at Penn. A Fellow of the American College of Obstetricians and Gynecologists, he has received honorary degrees from two Peruvian universities and was named an Honorary Professor by a third. In addition, he has received several teaching honors, including the Excel­lence in Teaching Award from the Association of Professors of Gynecology and Obstetrics in 2002 and 2006. In 2007 he re­ceived the Alfred Stengel Health System Champion Award, which recognizes a Penn Medicine physician who has made significant contributions toward the clinical integration of the University of Pennsylvania Health System. In January, Women’s and Children’s Health Services at Pennsylvania Hospital was renamed the Ludmir Center for Women’s Health.

vital_speckNancy A. Speck, Ph.D., a leader in the field of blood cell de­velopment, was named chair of the Department of Cell and Developmental Biology. She is also the associate director of Penn’s Institute for Regenerative Medicine and an investigator in the Abramson Family Cancer Research Institute. 

Over the course of her more than 30-year career, Speck has made many important contributions toward our understand­ing of the formation and de­velopment of blood cells and has translated these findings to fighting leukemia. (Genes required for blood cell forma­tion and function are often mutated in human leukemia.) She has published more than 100 peer-reviewed articles in leading journals and has served on and chaired study sections at the National Institutes of Health, the American So­ciety of Hematology, and the Leukemia and Lymphoma Soci­ety. Her honors include the 2015 Henry M. Stratton Medal for Basic Science from the American Society of Hematology for her “seminal contributions in the area of hematology research.” 

Speck came to Penn Medicine from Dartmouth Medical School, where she held the James J. Carroll Chair of Oncology. She succeeds Jon Epstein, M.D., who has assumed the role of ex­ecutive vice dean and chief scientific officer of Penn Medicine.  

They Said It

There’s a widespread perception that the U.S. spends a tremendous amount on end-of-life care, but until now there’s never been a comparative study to put U.S. spending and resource utilization in con­text,” said Ezekiel J. Emanuel, M.D., Ph.D., vice provost for global initiatives, the Diane v.S. Levy and Robert M. Levy University Professor, and chair of the Department of Medical Ethics and Health Policy. “End-of-life care is intensive and expensive, and what we know now is that the U.S. does not have the worst end-of-life care and that no country is optimal. All countries have deficits.”

Emanuel is senior author of an international comparison of end-of-life care practices, published in JAMA in January.


Although most people know that exercise is good for their health, more than 50 percent of adults in the United States don’t get enough of it,” said Mitesh S. Patel, M.D., M.B.A. ’09, M.S. ’14, an assistant pro­fessor of medicine and health care management in the Perelman School of Medicine and the Wharton School. “Workplace wellness programs aimed at increasing physical activity and other healthy behaviors have also become increasingly popular, but there’s a lack of understanding about how to design incen­tives within these programs. Our findings suggest that these programs could result in better outcomes if they designed financial incentives based on principles from behavioral economics such as loss aversion.”

Patel is lead author of an article in the Annals of Internal Medicine published in February.

vital_31,000 and Counting

Last fall, Gordon Baltuch, M.D., Ph.D., reached an impressive landmark, per­forming his 1,000th deep brain stimulation surgery (DBS).

Around the world, the intricate surgery has helped more than 100,000 Parkin­son’s disease patients to reduce their tremors and involuntary movements when medications fail. Baltuch, professor of neurosurgery and director of the Center for Functional and Restorative Neurosurgery, is a pioneer in the treatment, having led a surgical team at Pennsylvania Hospital for all 1,000 cases.

DBS is performed by placing two insulated wires into the subthalamic nuclei, two structures the size of Rice Krispies, deep in the brain. The procedure renders these parts of the brain inactive without surgically destroying them. The wires connect to a stimulator that sits below the collar bone. As Baltuch explains, “We use electricity to modulate the brain’s circuitry in order to dial back the motor symptoms of Parkinson’s disease.”

Once implanted, the stimulator is “turned on” and programmed to achieve opti­mum results for each patient. “Our movement disorder neurologists program the stimulators and adjust patient’s medications,” Baltuch says.


What Fracking Balance?

Penn’s Center of Excellence in Envi­ronmental Toxicology (CEET), and its director, Dr. Trevor Penning, deserve kudos for seeking scientific truth sur­rounding unconventional gas and oil drilling, hydraulic fracturing (“Fracking and Public Health: Finding the Best Bal­ance,” by Mark Wolverton, Penn Medicine, Fall 2015). Indeed, a bright spotlight must be placed on this process, as, when conducted irresponsibly, potential irrevoca­ble environmental damage can be and has been foisted upon Pennsylvania and its population.

Honest illumination of the environmental and health ef­fects of fracking requires all players in the oil and gas industry to be forthright in divulging information that the public and CEET have a right to know, but the industry has, to date, been unwilling to provide, through obfuscation and subter­fuge, rendering CEET’s mission a high-stakes challenge.

Wolverton writes the dearth of “hard data” and the diffi­culty of procuring “proprietary” recipes for fracking fluid. He admits that “we don’t have a strong handle on the pollutants that might contaminate the water supply.” This is an under­statement! We know extraordinarily little about what is in fracking fluid when we should have a right to know. It has been postulated that there are carcinogens in the fluid. It is well known that the industry is refusing to permit third-party testing. There are approximately 280 unrelated chemicals that have been studied for environmental and public health effects. However, there are about 80,000 chemicals (not to mention the infinite interactions between them) that our bodies have to handle. How has this become acceptable? Wolverton writes that “Panettieri and his colleagues emphasize the study’s lim­itations and caution against drawing premature and un­founded conclusions.” While reasonable, a paralysis of analysis can lead to delayed necessary action. How much data is needed before a moratorium is set and the precautionary principle is followed to do nothing if one doesn’t know if something could be harmful? As a physician, I took the Hip­pocratic Oath to “above all do no harm.” Shouldn’t the natural gas extraction companies behave similarly? For some reason, those who pollute operate from the misconception that there is an “away” when, in actuality, many chemicals we toss into the heap (landfills, waterways, air . . .) eventually will come back and settle in our bodies naturally. All of these industries unfortunately pollute us.

Marilyn Howarth asserted “that there is no data to deter­mine if these changes are occurring and, if they are, what are the impacts on people’s health.” Dr. Panettieri was quoted, “I’m confident that as time goes by, you’re going to see more and more studies showing health consequences rather than safety.” The conundrum stems from gas extraction companies’ refusing public access for accurate scientific testing of the well heads and the streams below them on the property to show the true sources of any pollutants. After 30 years, most wells leak, according to available data.

Experts at CEET recommend “establishing a health registry to track and monitor the health of residents living near frack­ing sites. . . . That data . . . should be based on a particular ill effect or symptom as diagnosed by a physician trained in tak­ing exposure history. Unfortunately, . . . we have . . . a lack of physicians that are actually trained in occupational environ­mental medicine.” While this is true, it is not the whole issue. Natural gas extracting companies have insisted upon legisla­tion that gags physicians from asking about symptoms and as­sessing problems associated with fracking as well as reporting them. In addition, folks who live near the shale gas well sites suffer dropping property values and bankruptcy on a regular basis. The problem with this industry is not just pollution.

Mr. Wolverton quotes Marilyn Howarth: “Exemptions to environmental laws are generally reserved for processes that have been thoroughly researched and found to be safe. Hy­draulic fracturing enjoys the exemption from major environ­mental laws without being thoroughly researched or having very many restrictions.” Isn’t that a shame? Thanks go to Dick Cheney and his work with his cronies at Halliburton, during the Bush administration.

Dr. Penning thinks “the best we can do is identify the po­tential risks and manage them by having the industry adopt safe practices.” He thinks “that some in the industry would like to make sure that there are useful best practices, because they do not want the industry to become overregulated be­cause of some bad actors. There is a middle ground. . . .” Just who does Dr. Penning think will enforce these safe practices when these wealthy companies have teams of lawyers to facili­tate maximal profits during the gas gold rush? Overregula­tion? Seriously?

Unfortunately, millions of gallons of water are used for this process. This precious resource is therefore unavailable for other necessary uses. Noise pollution is also an issue with this process. We know we have energy needs but, to meet them, why don’t we rapidly expand those sources that don’t cost so much regarding the environment and public health? As much as we can, we need to leave fossil fuels in the ground. Accord­ing to the Union of Concerned Scientists, expansion of natu­ral gas is not the right way to address climate change. See for more information. China is leading the way in developing renewable energy and has even robustly moved forward with Cap and Trade with carbon pricing. We have no more time to waste in catching up. We could proba­bly decrease our energy use as country by 25-30% within a month’s time with rigorous efforts to eliminate waste of en­ergy. Turning off and using less is anathema to the American way, where many people suffer from “affluenza” and consume in excess. I would encourage your readers to view Gasland and Gasland 2, produced by Josh Fox. When you see these problems with your own eyes, will they be lying to you? Such a dirty process is permitted in our midst.

Indeed, procuring enough money to fund the scientific pro­cess that CEET is pursuing will be a challenge. The University of Pennsylvania has a multi-billion dollar endowment. I have personally given money to the process of learning more about fracking and I would encourage any alumnus or alumna to do the same. As you read this, the gas industry is desperately try­ing to turn Philadelphia into a major natural gas energy hub. You might wish to investigate this and have your voice heard. I look forward to more scientific output from CEET.

L. Matthew Schwartz, M.D., G.M.E. ’89, a specialist in physical medicine and rehabilitation, is affiliated with Chestnut Hill Hospital. He is on the National Advisory Board of the Union of Concerned Scientists.

Saluting Jonathan Rhoads

I wished to compliment Mr. Art Carey and Penn Medicine on your very percep­tive and truthful article on one of Penn Med’s greatest products and Christian human beings, Dr. Jonathan Evans Rhoads Sr. [Spring 2015]. His family saga with the Chu family was certainly not the only one of greatness in his mentor­ing. I would like to direct my contributions to Penn Med to the Harrison Dept. of Surgical Research, if that department still exists, in memory of Dr. Rhoads.

Frank E. Davis III, M.D., F.A.C.S, G.M.E. ’74

Editor’s Note: Dr. Rhoads was director of the Harrison Depart­ment of Surgical Research, which continues as the research arm of the Department of Surgery.

What About the Odor?

In his review of Dr. Kelly Parsons’s novel Doing Harm, John Shea quotes a passage wherein the main character describes a surgical procedure. “As the tissue at the point of contact between the Bovie’s metal tip and the patient vaporizes, it produces a wisp of bluish-tinged smoke that carries a singular odor. The odor of burning human flesh. I pick up the Bovie and cauterize the bleeding vessels. The heat of the Bovie cooks the fat, and I in­hale the familiar smell. God, I love operating.”

Doctors are often accused of playing God. In chapter 8 of Genesis, Noah “. . . offered burnt offerings on the altar. The Lord smelled the pleasing odor, and the Lord said to himself, ‘Never again will I doom the earth because of man’ . . .” The symbolism is so obvious it cannot possibly be inadvertent.

Elliot B. Werner, M.D. ’71

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