Tag Archives: CHOP

Back from the 50th Med School Reunion

Mostly some social notes from my 50th Med School reunion (Penn), but first some serious science.

I did two years of graduate work in chemistry between college and med school, and one of the guys I taught organic to is an academic research neurologist. He told me that they had some encouraging results using antisense oligonucleotides to remove the excessive repeat CTGs from myotonin, the gene defective in myotonic dystrophy. They were able to get it into cells, and even showed some clinical benefit in animal models. So he’s still using chemistry.

Myotonic dystrophy is one of the few triplet expansion diseases that makes sense to me, because unlike most of them, it affects a wide variety of tissues, not just the nervous system.

Just about everyone had a great time at the reunion. On entering med school I was told, that I’d know my classmates better than my spouse. Well, I certainly spent more time with them in the clinical years.

It was a happy time and yet sad as well, as we all knew that this was probably the last time we’d all see each other.

The previous post https://luysii.wordpress.com/2016/05/11/off-to-the-50th/ had a lot about (the lack of) minority representation back then.

Things have improved, as there is now an office of diversity (so Penn is now doing more than paying hypocritical lip service to it — vide Elizabeth Warren).

Our Nigerian classmate came back. He’d spent 17 years back home in Africa but left because he was unable to fight the corruption there, even as a native son. He hassled a black medical student from Africa, finding that she was of the Yoruba tribe, telling her to go back and serve her country (at least for a while).
So things have improved, but not enough. An an affair Friday night, all 5 or so of the blacks present were sitting at the same table. I barged in saying I was bringing some diversity to their table, and initially got some strange looks. But then I told them a few of the events of the previous post and they warmed up. At least the country is  now getting the benefit of their brains.

We’ll know things have really improved, when black physicians feel comfortable enough to mingle with the crowd.

About 65 of the 125 of us were back. Only 18 people were listed as having died, which seems like a very small number for a group of 125 26 year olds 50 years later. I do know of one unreported death of a classmate from AIDS.

This is actually nothing new — and here are my notes on a study done nearly 30 years ago. My speculation is that, docs get a lot of reinforcement, seeing the effects of negative health choices. I doubt that all of it is due to social or economic class, although some must be.

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[ J. Am. Med. Assoc. vol. 259 p. 3158 ’88 ] This is an overview of the Physicians’ Health study in which 22,000 American physicians took either aspirin or placebo in a double blind study. They were only taking 5 grains of aspirin every other day. Cardiovascular mortality was cut, but overall mortality was not. However the group experienced just 88 deaths when 733 would have been expected. . This may be due to a beneficial life style, or social class. Thus the EIGHTFOLD lower mortality throughout makes the study harder to interpret. Amazingly, the authors of the study don’t really focus on why the study group (even those on placebo) did so well, but whether the aspirin added anything extra. What we need is to reduce mortality in our patients eightfold and then worry about giving aspirin.

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Here is a tale of the bad old days for the feminists among you. There were under 10 women in our class of 125. One very bright woman wanted to be a surgeon. She asked Dr. Everett Koop about it. This was when Koop was basically inventing the specialty of pediatric surgery at Children’s Hospital of Philadelphia (CHOP), and long before he became Surgeon General.

He gave her some very hard and very honest advice (this was Koop after all). He told her that the first rate surgery residencies simply were not accepting women. To rise to the true level of her ability, she’d need to choose something else. She didn’t like this one bit, but did follow his advice, went into another field and became department chair at another Ivy League med school.

Lastly two stories about the All American basketball player in our Class (Jerry Gardner Kansas ’62). He’s about 6′ 2″ now, and using a cane as he’d had hip surgery a few months ago. He did note that back then Freshman weren’t allowed to play, so he still has a year of eligibility left. Jerry went to NIH after graduation and established a lab studying GI hormones.

Further proving that time does not heal all wounds, Jerry reminisced about the two foul shots he missed at the tail end of a game in the NCAA final (or semifinal) which might have won them the game. For further examples of the phenomenon see — https://luysii.wordpress.com/2010/10/25/time-does-not-heal-all-wounds/

Is a sea change taking place at the New York Times ?

The little kid started crying as I approached him with the syringe filled with yellow fluid. He knew that after he was held down and I injected him he would be violently sick and vomit repeatedly.

It was 1964 and this happened at the Children’s Hospital of Philadelphia (CHOP) and the kid had acute lymphatic leukemia, and the syringe was full of methotrexate, the antifolate drug in use at the time. I was a third year med student. Although Stanley Milgram had begun his “Obedience to Authority” experiments in 1961 http://en.wikipedia.org/wiki/Milgram_experiment, I was hardly a happy or willing participant in the proceedings. I had nightmares about it.

Like all the kids with leukemia at CHOP, the little boy was part of a ‘study’ run by an oncologist, with an accent right out of Boris Karloff. I thought he was a monster. He was so happy that the kids in his branch of the study survived a horrible 21 months, vs. the previous record of 18. I thought that the kids were being kept alive and suffering when they shouldn’t have been, in order to set a new survival record. The study randomized the kids between the new regimen and the current regimen showing the best survival.

Well, I was terribly wrong, and the oncologist was a hero not a monster. Presently the cure rate (not survival) of childhood leukemia is over 90%. We now worry about the long term side effects of the drugs (and radiation) used to cure it — cognitive problems, fertility problems. It was precisely because the new treatment was compared to the best previous treatment that we are where we are today.

What in the world does this have to do with the New York Times?

Simply this, on Monday 21 April the front page of the New York Times contained an article title “50 Years Later, Hardship Hits Back, Poorest Counties Are Still Losing in War on Want”. They don’t call it the “War on Poverty” until the 5th paragraph. Nonetheless, the article (without explicitly saying so) documents just what a failure it has been. Nowhere in the article, is there any mention of why it failed, but it’s clear that only more of the same has been tried — more food stamps, more medicaid, more free school lunches, etc. etc. It is claimed in the article that this lifted tens of thousands above a subsistence standard of living, yet 15% of the populace is still living in poverty and 47/300 million of us are on food stamps.

At least the Times is no longer pretending that the War on Poverty (started in 1964 when I was pushing methotrexate) is a success.

Another sign of a sea change at the Times appeared the day before on the Op-Ed page in an article titled “From Rags to Riches to Rags” in which the notion of a static top 1% in income was debunked. A study of 44 years of longitudinal data of people from 25 to 60 showed that 12% of all of them would be in the top 1% of income for at least one year, and that 39% will be in the top 5% of income for at least 1 year.

A third appeared on the 22nd in a front page article concerning a near lynching by Blacks in Detroit of a white man who hit a child with his car.

In recent years, I’ve thought that I’ve had to read the Times much as the Russians read Pravda during cold war I (and perhaps today). A friend has called it ‘advocacy driven journalism’. Perhaps there will be a shift in orientation from left to right, but, even so, I’m not a fan of having articles #1 and #3 any place other than Op – Ed page. Advocacy journalism is advocacy journalism whether it agrees with your political orientation or not. The 3 articles cited really aren’t news. That’s what the opinion page is for — opinion and background.

80+ years ago my future parents discovered that one of the first things they had in common was that they both read the Times. I grew up with it, and hopefully it will become a great newspaper again.

The failure to try anything new against poverty is a manifestation of the arrogance of the intelligent, about which there will be another post.