Does your child really need that antibiotic?


ImmunoXpert, a novel blood test developed in Israel, accurately distinguishes between bacterial and viral infections in children, according to a study recently published in The Lancet Infectious Diseases. The international study in children was led by researchers from the University Medical Center in Utrecht (The Netherlands).

ImmunoXpert, made by MeMed in Tirat Carmel, also was shown to outperform routine tests significantly.

“The results are beyond our expectations,” said principal investigator Dr. Louis J. Bont from the division of pediatric immunology and infectious disease at the Dutch medical center. “We independently confirmed that the test is highly accurate in children, with significantly better diagnosis compared to any of the routine tests we use today. It has the potential to significantly aid us in reducing antibiotic overuse and combating bacterial resistance. To our knowledge, this is the first prospective validation study for a diagnostic assay differentiating between bacterial and viral infections that was double-blinded.”

MeMed CEO Eran Eden said the company “took the unusual risk of allowing leading experts to independently evaluate its tests in a double-blind manner,” meaning that neither those taking part nor the researchers knew which participants belonged to the control group.

Eden continued, “We are excited that the new results corroborate the findings of our previous study,” published in March 2015 in PLOS One. “This is another important milestone in our continuous efforts to generate clinical evidence of the highest quality to support our tests.”

“Unlike most traditional diagnostics, which focus on identifying the disease-causing virus or bacteria, ImmunoXpert looks at the immune system where it identifies markers that indicate if the patient is fighting a bacterial or viral infection,” Dr. Kfir Oved, MeMed chief technology officer, said. “This immune system-based approach overcomes the inherent limitations of many traditional diagnostic tools. It is accurate and rapid and can diagnose infections that are not readily accessible, such as pneumonia.”

The study evaluated 577 children ages 2 to 60 months with lower respiratory tract infections or fever without a source. ImmunoXpert was accurate in distinguishing between clear bacterial and viral infections with a sensitivity of 88 percent, specificity of 93 percent and a negative predictive value of 98 percent. ImmunoXpert outperformed routine tests, reducing the number of cases in which viral infections were erroneously diagnosed as bacterial, by more than 50 percent.

ImmunoXpert is cleared for clinical use in the European Union, Switzerland and Israel. MeMed is collaborating on a series of multi-center clinical studies, enrolling more than 10,000 patients, and has plans to conduct clinical studies in the United States in 2017. The company is partnering with international stakeholders from industry and government to facilitate global availability of its tests.

Militants, weapons transit Gaza tunnels despite Egyptian crackdown


A third of the houses on the main street of this Bedouin town near Egypt's border with Gaza look derelict, but inside they buzz with the activity of tunnel smugglers scrambling to survive a security crackdown by the Egyptian army.

Smugglers and tunnel owners, who once publicly advertised their services, have taken over the nearly two dozen single-storey concrete structures and boarded up their doors and windows to avoid the attention of the authorities.

While tunnels used by Gaza's dominant Hamas militants to infiltrate Israel were a priority target of an Israeli offensive in the Palestinian enclave this summer, many smuggling conduits into Egypt have skirted detection.

That has allowed transports of weapons, building materials, medicine and food to continue to and from the small, coastal territory that is subject to blockade by both Israel and Egypt, tunnel operators say and Egyptian security sources acknowledge.

“During the Gaza war, business has flourished,” said a Bedouin guide who gave Reuters access to one of the tunnels and a rare look at how the illicit, lucrative industry has evolved since Egypt began trying to root out the passages in 2012.

Egypt sees a halt to the flow of weapons and fighters as important to its security, shaken in the past year by explosions and shootings by an Islamist insurgency based mainly in the Sinai Peninsula bordering Gaza and Israel.

Humanitarian supplies and building materials headed in the other direction have provided a vital lifeline to the 1.8 million Palestinians in Gaza who have been living under the Israeli-imposed blockade since Hamas seized the enclave in 2007.

Cairo mediated talks this month between Israel and Palestinian factions led by Hamas to try to end the war in Gaza but refused to discuss easing its tight control of the Rafah border crossing as part of the deal Hamas seeks.

A 10-day ceasefire expired on Tuesday without a deal to extend it indefinitely, with Israel resuming air strikes on Gaza and Hamas and other Islamist militants their rocket salvoes into the Jewish state.

The guide who accompanied Reuters and requested anonymity estimated the total number of functional tunnels in about 10 border villages like Al-Sarsouriya at nearly 500 – down from about 1,500 before the Egyptian clamp down began.

Most of the bigger tunnels – the kind that can accommodate cars and even trucks – have been destroyed by the Egyptians, but smaller ones ranging 1-2 meters (yards) in diameter survive.

The guide said that as many as 200 new tunnels had been built in the past two years, dodging Egyptian security sweeps, with new ones coming onboard each week.

The smaller tunnels are still big enough to allow weapons, building materials and humanitarian supplies to pass under the heavily guarded land crossing.

“Each day, about 3 or 4 people cross with weapons, and each one carries about 6 or 7 guns,” the Bedouin guide said, without specifying what type of arms were being transported.

A senior Egyptian security officer confirmed that while the biggest and longest tunnels were no more, smaller ones remain operational.

“The situation is much more controlled. It's not 100 percent but we are trying to reach this percentage,” he told Reuters. He said the army had achieved a noticeable reduction in smuggling of weapons, fuel, food and drugs over the past two years.

Egypt accuses the Islamist Hamas of supporting the Sinai insurgents, which Hamas denies. For its part, Israel has long wanted Egypt to end arms smuggling from Sinai to Gaza militants.

LUCRATIVE TUNNEL BUSINESS BEHIND SHOWER CURTAIN

A shower curtain is all that conceals the entrance ramp to the tunnel which Reuters visited. Two sheep and a cart in an adjacent room gave the impression that the house was abandoned, should security forces come searching.

The tunnel owner and his teenage son sat on cushions around a small wooden table beside the curtain. A photograph of the pair hung on the wall overlooking their cash cow.

The concrete-lined entrance to the 600-metre (0.37 miles) tunnel turns to dirt after a few steps. Posts support a wooden ceiling as deep as 10 meters (33 feet) below the surface, and energy-saving bulbs every few meters light the way.

The Egyptian owner accompanies passengers to the midpoint where a sentry checks on the security situation on the other side and then brings them to meet the Palestinian co-owner.

“This tunnel is a partnership between us,” said the Egyptian. “Building it cost us $300,000. He paid half and I paid half. The profit is split between us 50-50.”

The tunnel regularly brings the men profits of $200 a day. Shipping rates vary, starting at $12 for one-meter crates of medicine or food and topping out at $150 for weapons, building supplies or fuel.

People can pass for $50 each but the rate increases if they are armed. Most of the passengers are men, the owner said, but women and children also use the tunnels. Farm animals occasionally make the journey as well.

“If someone is passing with one or two guns, we charge $60 to $70. But if someone has more weapons, it's a special operation and might cost as much as $1,000 or $2,000 depending on the type of weapon,” the Egyptian owner told Reuters.

He said he does not check the identification of people who pass and even allows masked men to use his tunnel if his Palestinian partner vouches for them. “As long as they give me $50, I let them through,” he said.

The owner said he also does not seek to know the affiliation or destination of militants and weapons for fear that displeased customers will use another tunnel or report him to the security forces. “I just deliver the weapons and take the money,” he said. “I'm not concerned with where they're going.”

In Gaza, Hamas has disputed Israel's claim that it demolished all of the militants' infiltration tunnels during the current conflict, and granted a rare tour to a Reuters news team last week to back up its assertion.

Fake medicine


Counterfeit Drugs Kill People and Fund Terrorism in the Middle East

Caveat emptor means “buyer beware.” Fake medicines are now a multibillion-dollar industry affecting people in virtually every country in the world, and the problem is getting worse. It has been estimated that up to 15 percent of drugs sold worldwide are counterfeit, and in parts of Africa and Asia it can surpass 50 percent. We are also vulnerable in the United States even though we have a better-regulated pharmaceutical system. 

This problem became epidemic in the late 1990s with the globalization of pharmaceutical manufacturing, the commercialization of the Internet and the relatively new drug Viagra. By 2002, hundreds of thousands of fake Viagra pills flooded the market, and today birth control pills, hormone replacements, diabetes treatments, weight-loss aids, cancer and transplant drugs, schizophrenia medicines and HIV therapies have all been counterfeited. The list goes on. The selling occurs mostly through online pharmacies worldwide, but the manufacturing appears to focus mainly in loosely regulated countries like China and India. Unfortunately, medications that come in injectable forms, like insulin, are even easier to counterfeit than tablets. One can just use sterile water or even tap water. 

To create an online pharmacy is rather simple. Get the active pharmaceutical ingredients from China, put together a Web page, and you are ready to go. It literally could take 45 minutes to create your own. 

Accountability for these “pharmacies” is virtually nonexistent. Of 10,000 Internet drug outlets surveyed by the National Association of Boards of Pharmacy, 97 percent were out of compliance with legal or patient safety standards.

Historically, drug smugglers are often penalized by way of imprisonment if the drugs in question are heroin or cocaine. But those who produce or smuggle counterfeit medicines, by contrast, often face lax enforcement and light punishment. Some governments look at drug counterfeiting as a trivial offense. After all, everybody likes cheap “Viagra.” Recently, the pharmaceutical industry has persuaded several governments to stiffen regulations against fake drugs because counterfeit drugs can kill. Most are poorly made, containing the wrong dose of the active ingredient or a totally different ingredient, such as antifreeze or arsenic. Drug resistance against bacteria can occur because of ineffective antibacterial medications, particularly in Africa and Southeast Asia; it is estimated that up to 30 percent are fakes. The United Nations estimates that roughly half of the antimalarial drugs sold in Africa are counterfeits. The World Health Organization estimates that at least 100,000 people per year, mostly in poor countries, are killed as a result of fake medicines. It is estimated that the global market for fake medicines could be worth over $200 billion per year.

Although the United States has the Food and Drug Administration (FDA) to watch over us, according to the commissioner at this organization, 80 percent of the ingredient manufacturing sites for FDA-approved drugs sit outside our country — located in one of the 300,000 facilities in 150 different countries. These small companies export FDA-regulated products into the United States. Clearly, there are many weak points along this odyssey from which to steal or introduce adulterated and counterfeit products. You may recall that in 2007, 149 people died as a result of contaminated Heparin.

There have been some recent reports suggesting that terrorist organizations in the Middle East are using fake medicine to fund their heinous activities against Israel.

The Rise of Counterfeit Cancer Medication

The counterfeiters have recently moved from fake Viagra to making counterfeit cancer drugs, probably because of the larger profits. These illegal manufacturers have become more aggressive, as a vial of the cancer drug Avastin sells for $2,400 compared to $10 to $20 a tablet for Viagra. Although speculative, I also believe these very immoral thieves feel that the patients with cancer will probably die anyway, so no one can prove the fake drugs were causative.

The United States traced some of these drugs that originated from China, which then passed to Turkey through England, and then were transported to our country. These fakes contained starch, salt, cleaning solvents and other chemicals, but not the active ingredient, according to Roche, Avastin’s manufacturer. Bogus copies of the breast-cancer drug Tamoxifen also have entered our shores in recent months.

In China, the manufacturers are licensed as chemical companies, therefore they are not subject to regulation or inspection, as in our country. It is rare that anyone is arrested or convicted for these heinous crimes against humanity. 

Where Do We Go From Here?

Over the past 10 years, there have been some collaborations between national and international public health agencies, such as the FDA and the World Health Organization. Many counterfeit and illicit drugs have been confiscated, resulting in the arrest of more than 80 people, as well as the elimination of more than 18,000 illegal online pharmacies. The pharmaceutical manufacturers and the FDA are developing new anti-counterfeiting techniques, such as handheld counterfeit detection devices designed to analyze chemicals and potential tampering of these medicines. Also, some pharmaceutical companies have put identifying markers on drug packaging, which can be scanned, somewhat like radio-frequency identification. Some are more covert, using UV fibers woven into the packaging, inks and images. More recently, nanotechnological markers in DNA are being incorporated into the makeup of the drugs themselves to help prevent drug counterfeiting processes. 

Unfortunately, these new technologies, to detect counterfeiting, do not eliminate the problem, but only minimize it. The FDA has recently discovered that counterfeiters target some consumers through social media platforms like Facebook and Twitter. 

On an optimistic note, the government of Nigeria, where fake drugs are prevalent, has declared its intention to adopt a “war” against the counterfeiters. The Pharmaceutical Security Institute gives warning that this war will be hard to win. Hopefully, more obstacles developed by each country will raise the cost and complexity of manufacturing counterfeit drugs, thus the profit margin will diminish. Hopefully the “bad guys” may now choose to fake other objects instead of medication that cannot harm or kill anyone. 

Dr. Norman Lavin is a clinical professor of endocrinology and director of endocrinology education at UCLA Medical School.  He writes the Jewish Diseases blog at

Leon Morgenstern, first director of surgery and founder of Center for Healthcare Ethics at Cedars-Si


Dr. Leon Morgenstern, Cedars-Sinai’s inaugural director of surgery and founder of its Center for Healthcare Ethics, died on Dec. 23. He was 93.

Although born in Pittsburgh, Penn., in 1919, Morgenstern considered himself a New Yorker and earned his medical degree from New York University College of Medicine.

Following two years with the U.S. Army Medical Corps, Morgenstern served his internship, fellowship and surgical residency at Queens General Hospital.

Morgenstern came to Los Angeles in 1953, where he worked as a general surgeon and attending physician at Cedars of Lebanon and Mount Sinai. Morgenstern went on to become director of surgery at Cedars of Lebanon, a post he held until 1988, 18 years after Cedars and Mount Sinai merged to become Cedars-Sinai.

In 1995, Morgenstern established Cedars-Sinai’s Center for Healthcare Ethics, which helps patients, caregivers, policymakers and others with the ethics of how best to care for and treat patients as well as how to raise professionals’ awareness of ethics in their practices. He also held several academic appointments during his career, including clinical professor of surgery at UCLA School of Medicine and adjunct professor of ethics at the University of Judaism (now American Jewish University).

“Dr. Morgenstern was not only a brilliant surgeon, he also was our wise counselor, our impeccable visionary and professional, and above all a remarkable, values-driven compassionate physician,” said Dr. Shlomo Melmed, senior vice president for academic affairs at Cedars-Sinai. “His ethical standards will remain indelibly etched on our culture for decades to come.”

Morgenstern is survived by his wife, Laurie Mattlin; sons, David Ethan and Seth August; and five grandchildren.

Cedars-Sinai is planning a memorial in Morgenstern’s honor.

EU Parliament committee certifies Israeli pharmaceuticals


A committee of the European Parliament has endorsed measures to simplify the sale of Israeli pharmaceuticals within the European Union.

“EU-certified pharmaceuticals could be exported to Israel and vice-versa without requiring additional certification in the importing country under a mutual recognition deal endorsed by the International Trade Committee on Tuesday,” that committee said in a Sept. 18 statement.

To take effect, the move must be approved by the European Parliament plenary in October. Fifteen of the committee’s members voted in favour and 13 voted against the measure, which is part of the European Union’s Agreement on Conformity Assessment and Acceptance (ACAA) with Israel.

The European Council approved the agreement in March 2010, but its implementation has been blocked amid protests by pro-Palestinian organizations. The agreement was part of the of the 1995 EU-Israel trade contract, and is not a part of the upgrade in relations which Israel is seeking.

European Friends of Israel – a Brussels-based organization consisting of parliamentarians from across the continent – called the vote “a major step in improving the life of European consumers by reducing the costs of medicine and increasing the quality and quantity of medical products.”

Also on Tuesday, the Socialists and Democrats (S&D) grouping in the European Parliament, the parliament’s second largest group, said that goods manufactured in Israeli West Bank settlements “do not comply with EU law.”

S&D vice president Véronique de Keyser said in a statement that “products produced in the occupied territory cannot be considered ‘lawfully traded.’”

Palestinian Authority blames Gaza for deficit mess


Paying for the upkeep of the Gaza Strip while its political rival actively blocks revenues flowing back is taking its toll on the deficit-racked Palestinian Authority.

The Western-backed PA, many of whose top leaders belong to the mainstream Fatah movement, says it has poured around $7 billion into the Gaza Strip since its rival Hamas seized control in 2007, but complains that the Islamist group is stymieing its efforts to balance its books.

A barrage of mutual accusations in recent weeks has driven Hamas and Fatah ever further apart as stalled efforts at reconciliation and economic stagnation have jangled nerves on both sides.

Crippling power cuts in the small coastal enclave have only added to the acrimony and lifted the lid on often opaque Palestinian funding.

The PA says it spends $120 million a month, or more than 40 percent of its whole budget, on salaries and services in Gaza despite being driven out in a brief civil war with Hamas five years ago, anxious to show the world that despite the political divisions, the Palestinians remain one people with a single administrative core.

The PA, which continues to exercise limited self-rule in the Israeli-occupied West Bank, has never recognized Hamas’s rule in the Gaza Strip and still pays wages to former PA personnel in the enclave.

Israel maintains a tight blockade on the Gaza Strip with the help of neighboring Egypt.

“In return Hamas does not pay for any of the needs of the people in Gaza. On the contrary, it sells the medicine that we send for free, and keeps the money,” said Ahmad Assaf, a Fatah spokesperson in the West Bank.

Hamas denies this and says the PA is just funneling foreign donations ear-marked for the Palestinian people.

“Vital sectors like education and health do not get support from them … except for bits and pieces that arrive as donations from some countries,” Hamas spokesperson Sami Abu Zuhri said.

The PA, which relies overwhelmingly on foreign donor aid, mostly from the European Union, the United States and Arab nations, is facing a projected $1.3 billion deficit in 2012.

Although most Western countries shun Hamas over its refusal both to renounce violence and recognize Israel, they let the PA use their aid cash to help the Palestinians in Gaza.

The EU says it contributed 837 million euros ($1.1 billion) to the PA since 2008, 34 percent of which went to the Gaza Strip to cover civil servants’ salaries and pensions.

“According to our information, the Hamas government only pays for the salaries of their employees and for their security apparatus,” said an EU official, who declined to be named.

“We are convinced that we must continue paying this money because we know that if we didn’t the Hamas government would do nothing,” Fatah’s Assaf said.

Hamas has tried to build up its own finances by attracting funds from its own foreign allies, such as Iran, while looking to impose a taxation code of its own on trade and business within Gaza.

But analysts say it too faces a budget crunch and is far from ready to take care of Gaza’s 1.7 million-strong population, some 70 percent of whom live below the poverty line, according to U.N. statistics.

“Hamas wants to portray itself as being independent financially from the PA,” said Naser Abdelkarim, a professor of economics at Birzeit University in the West Bank.

“But that’s a myth. If the PA stops transferring money to the Strip, the reality in Gaza would deteriorate instantly.”

Hamas agrees it wouldn’t pay all the PA salaries, but says that’s because most of the people concerned don’t do any work after Fatah instructed its civil servants not to cooperate.

Another crucial issue for the PA is the taxes it should be collecting from Gaza. It says Hamas and Gazan traders systematically under-report the value of their imports to the Israeli authorities, which collect custom dues on behalf of the PA, costing the PA $400 million in “tax leakage” since 2007.

Palestinian Authority Prime Minister Salam Fayyad said Gaza raised 2 percent of all Palestinian tax returns in 2011 against 28 percent in 2005.

Hamas’s economy minister, Ala al Rafati, admitted the group was withholding some $95 million in custom tax forms that the PA needs in order to collect revenues and would continue to do so until the PA agreed to wire the money straight back to Gaza.

“These invoices have not been sent to Ramallah since the split,” al Rafati told Reuters by telephone from Gaza.

Palestinians’ long-running hope of founding a state incorporating both the West Bank and Gaza, territories divided by Israel, has often papered over feuds between rival factions.

The arguments over finances have come out into the open partly because of a fuel crisis that has left much of the enclave without power for several hours each day since early February, sparked by Egypt’s decision to clamp down on the flow of fuel smuggled into Gaza via a network of tunnels.

Critics of Hamas say it is at fault for the emergency for relying so heavily on cheap, illicit fuel, rather than working with the PA to secure alternative supplies.

The PA says it pays more than $50 million a month to an Israeli energy company that feeds power into Gaza, but Hamas refuses to hand over money from electricity bills.

“We have repeatedly asked Hamas to transfer the money they collect so that we can continue to provide them with fuel. But nothing gets sent,” said Omar Kittaneh, the head of the PA Power Authority.

The PA admits that nothing is going to change fast. As with many of the issues that bedevil Palestinian politics, the two sides are stuck in a rut.

“Contributing a large part of the PA budget to the Gaza Strip has become the status quo and this will not change any time soon,” said PA spokesman Ghassan al Khatib.

Additional reporting by Nidal al-Mughrabi in Gaza; Editing by Crispian Balmer and Sonya Hepinstall

Hernias difficult to diagnose in women


Martine Ehrenclou, 51, first noticed her lower abdomen pain in January 2010. She experienced severe discomfort if she sat at her desk for even 15 minutes, when she drove her car or any time that she pitched forward. Ehrenclou, who lives in Brentwood, describes the pain as “brutal.”

“I would have stabbing, sharp pain right in the center of where my C[aesarean]-section scar is,” she said. “It would start right above the scar, and it felt like it went very deep internally, and once that would happen, it would kick off a spasm that would radiate to every part of my pelvic area.”

Eventually, she said, the spasms happened every day, and she finally visited her doctor. But instead of a straightforward diagnosis, the visit marked the beginning of what would prove to be a year-and-a-half-long search for a cure.

“I saw 12 doctors of differing specialties, I underwent 15 tests and procedures, and I was put on 22 medications,” Ehrenclou said of the grueling road to a diagnosis.

It wasn’t until reading a newspaper article that Ehrenclou finally realized what she might have: a hernia. “I could not believe what I was reading,” she said; the complications that the woman in the article described matched Ehrenclou’s almost precisely.

Armed with this new information, Ehrenclou made an appointment with Dr. Shirin Towfigh, a surgeon at Cedars-Sinai Medical Center who specializes in treating women with hernias. After performing an MRI, Towfigh gave Ehrenclou the final verdict: two small belly button hernias and another one protruding through a muscle tear at the site of her C-section. One was pinching a nerve, likely causing the majority of Ehrenclou’s excruciating pain.

Towfigh performed a simple surgery on Ehrenclou, which, she said, is the only surefire way to treat a hernia. Within a few days, Ehrenclou was back on her feet, feeling “elated and grateful” that the pain she had been living with for so long was finally gone.

But unfortunately, Ehrenclou’s story is not uncommon.

Hernias, which occur when part of an internal organ or fatty tissue pushes through a hole in a muscle, are far more common in men than in women. As a result, many doctors don’t consider a hernia diagnosis when faced with a female patient.

“Hernias in women are not on the radar for most doctors,” Towfigh said, “and so many don’t ask the right questions to narrow it down.”

Adding to the problem, the most common type of hernia is in the groin area, and their symptoms mirror other pelvic problems that tend to plague women.

“Women have many more organs in that region than men do,” Towfigh said. “So when they come in with lower groin pain, it’s often mistaken for pelvic pain.”

Women with hernias may be misdiagnosed as having ovary-related problems, such as cysts or ruptures; complications from prior pelvic surgeries, such as Caesarean sections; endometriosis; or fibroids.

In Ehrenclou’s case, her incorrect diagnoses included interstitial cystitis, fibroids and neuropathy. But worse than the frustration of not knowing what was wrong, she said, were the invasive and sometimes painful tests and treatments she endured in the name of the wrong problem.

One such treatment involved painful steroid injections to her pelvic area. Another required her to be put under general anesthesia, injected with needles in her lower back, and then brought out of the anesthesia to have them electronically stimulated in order to isolate the origination point of the pain. 

“All these doctors did not have hernia in their purview,” she said.

Adding to the difficulty of diagnosing hernias in women, Towfigh says, is that they are often smaller than those seen in men. When a man with a hernia lies down, for instance, the hernia can generally be seen in the form of a bulge. But because of the differences in women’s bodies, a hernia may not be as prominent or even visible at all.

“Women’s pelvises are broader, and so the distribution where the hernias occur and how they present is a little different,” Towfigh said. “In men it protrudes, but in women it’s not as large, so it’s not commonly felt as a bulge.”

Because of the likelihood of confusion and misdiagnoses, Towfigh adds that the more information a patient has and the more forthcoming the patient is with that information, the more easily the diagnosis can be made. With Ehrenclou, for instance, her symptoms lined up clearly with those of hernia.

“Women will commonly tell you that they’re doing daily activities, like washing dishes or brushing their teeth, and it hurts them,” Towfigh said, “or anything that closes off that area, like coughing, sneezing or bending over.”

For her part, Ehrenclou encourages other women in her situation to be tenacious in seeking a cure. As difficult as it was, she says, she never stopped pushing for a diagnosis. If she had given up halfway through, “I probably would still be in pain.”

Two Jewish scientists win Nobel Prize for medicine


The Nobel Prize for medicine reportedly was awarded to two Jewish scientists, Ralph Steinman and Bruce Beutler.

The prize was given Monday for discoveries on the immune system, Israel National News reported. Half was awarded to Steinman, with the other half to be split between Beutler and biologist Jules Hoffman.

Steinman will receive the prize posthumously; he died three days before the Nobel committee made the announcement. Though he was diagnosed with pancreatic cancer four years ago, Steinman was able to prolong his life by using new dendritic cell-based immunotherapy—the same discovery for which he was awarded the prize.

Only living scientists typically are considered by the Nobel committee, but because its members were unaware of Steinman’s death when the winning names were released, no substitution winner will be announced.

‘House’ cast gets taste of Israeli medicine


On television Lisa Edelstein, a star of the hit Fox show “House,” and her fellow actors work medical miracles every episode. But at an Israeli hospital she stumbled trying her hand at simulated arthroscopic surgery.

“I’m so glad this is not a living person,” she said Wednesday, shifting the controls over a robotic dummy, eyes fixed on a computer screen that revealed her would-be patient’s internal organs. “I think I just mangled its liver.”

Edelstein and three other members of the “House” cast, along with David Shore, the show’s creator, are on a weeklong tour of Israel as part of a public relations effort to bring high-profile Americans on visits here.

Among their stops were two Tel Aviv-area hospitals—the first at the Israel Center for Medical Simulation at the Sheba Medical Center, the only simulation center of its scope internationally, where medical staff, students, and army medics and physicians from around the world undergo extensive training.

The cast members looked on as medical students re-enacted a particularly dramatic scene from the last season of the show in which a patient who was crushed under a falling building has his leg amputated and is rushed to the operating room.

Among the team of medical students was Yuval Lotan, an avowed fan of the Emmy Award-winning “House,” which stars Hugh Laurie (who was not available to come to Israel as he was touring elsewhere) as a curmudgeonly genius doctor who leads a team of young physicians in investigating mysterious infectious diseases and other ailments at a New Jersey hospital.

“The show is good entertainment, but at medical school we learn what not to do from it,” Lotan said. “After all, this is Hollywood we are talking about.”

The visiting cast—which also included Omar Epps, who plays Dr. Eric Foreman; Jesse Spencer, who plays Dr Robert Chase; and Amber Tamblyn, who will play Dr. Martha Masters in the upcoming seventh season—also visited the Wolfson Medical Center in Holon.

At Wolfson they visited the pediatric cardiology intensive care unit and met with children from the West Bank, Iraq, Africa and Romania, among other places. All of the children were brought to the hospital by an Israel-based humanitarian project called Save a Child’s Heart to receive life-saving treatment.

Save a Child’s Heart, also known as SACH, brings children with heart disease from the developing world for cardiac care in Israel while also working to improve cardiac care centers in their native countries, on average saving some 200 children’s lives a year.

“The work that Save a Child’s Heart is doing is an important reality check,” said Shore, who is Jewish and has two brothers living in Israel. “It’s good for the Jews, it’s good for Israel, but really it’s good for humanity.”

At the hospital, Edelstein played with two young girls from Zanzibar who had undergone surgery recently and spent time trying to connect with a girl from Iraq. Nearby, Tambly gave her sunglasses to a young Palestinian boy from the West Bank.

The trip was organized as part of a combined effort of America’s Voices in Israel, an arm of the Conference of Presidents of Major American Jewish Organizations, and Israel’s foreign and tourism ministries.

Irwin Katsof, director of America’s Voices in Israel, said the project’s purpose in bringing celebrities on such trips was to make them goodwill ambassadors when they go home.

“We want them to talk to their friends, perhaps do an interview to let people know Israel is more than just wars,” Katsof said. “These people have an impact. The amount of free publicity we get from them going back and speaking on a news show is phenomenal.”

The visit has coincided with Israel’s somber marking of Memorial Day, and the cast members described watching as Israelis came to a halt at the sound of a siren to stand in silence for those killed in the country’s wars.

“It was very emotional,” said Edelstein, who is Jewish and has relatives in Israel, including descendants of a great aunt who was a founder of Kibbutz Dafna on the border with Lebanon.

Memorial Day was followed by the abrupt shift into celebrations for Independence Day.

“You guys know how to party,” said Tamblyn, laughing in an exchange with reporters.

The group had stayed out late the night before exploring Tel Aviv’s vast club scene.

Also on the touring list were the Galilee (stopping off in a spa), Jerusalem and the ancient desert fortress of Masada.

And more actors who play doctors on TV are on their way. Katsof said the next delegation he is bringing is due here next month: members of the “Grey’s Anatomy” cast.

African AIDS fight uses Israeli circumcision skills


In a clinic in Swaziland, Israeli doctors have been training their counterparts in male circumcision, hoping expertise in the ancient technique will help in the battle against the modern scourge of AIDS.

The United Nations announced last year that the procedure could reduce the rate of HIV transmission by up to 60 percent. It was in Israel, with its experience performing adult male circumcision on a wide scale, that the international medical community found an unlikely partner in the global fight against AIDS.

“Israeli medicine and public health are positioned as a real asset in African countries,” said Dr. Inon Schenker, a director of Operation Abraham, the consortium that sent the doctors to Swaziland and plans to send more training teams to Africa. “They recognize the expertise and experience gained in Israel over the past decade, where close to 100,000 [adult] male circumcisions have been conducted.”

Israel’s accidental expertise in conducting large-scale numbers of adult male circumcisions came with the mass wave of immigration from the former Soviet Union, which brought with it a dramatic rise in men requesting the procedure.

To meet the demand, Israeli hospitals set up special circumcision clinics in five hospitals throughout the country. In turn, Israeli doctors gained unique experience in performing a high number of procedures efficiently.

It’s a model organization, such as the World Health Organization (WHO), and the United Nations would like to see it replicated in Africa as a tool for helping combat the spread of HIV.

Answering the call has been Operation Abraham, a team of Israeli doctors and AIDS educators — Jews, Muslims and Christians — who this year made three training trips to Swaziland, in what is considered a pilot program that they hope is just the start of their work. The organization has had requests to do a similar training program in Uganda, Lesotho, Namibia, Kenya and South Africa.

Their work is sponsored by the Jerusalem AIDS project and the Hadassah Medical Center, and they hope to recruit surgeons from abroad.

Dr. Eitan Gross, a pediatric surgeon at the Hadassah hospital in Ein Kerem, who was in Swaziland and is the medical director of Operation Abraham, said he was surprised initially to hear that surgery could play a role in preventing the spread of AIDS.

Research has shown that male circumcision reduces the chance of HIV infection. Experts say the scientific evidence has shown that specific cells on the penis foreskin appear to be targeted by the virus. It also has been found that an unremoved foreskin can trap the virus on the skin, making infection more likely.

Gross said he was moved by his time in Swaziland, which has one of the highest rates of HIV infection in the world. The average life expectancy in the country has plummeted to 31 years.

“People came of their own free will,” he said. “There was no publicity to draw them…. When we spoke to the men who came, many of them in their 20s and 30s, they told us about living amid the epidemic and what it’s like to see so many people die.”

Although nearly 30 percent of the world’s men are circumcised, the practice is quite rare in many southern African countries, where AIDS has become pandemic.

Dr. Jamal Garah, an Israeli Arab pediatrician, was among the Israeli doctors in Swaziland. He has experience in performing male circumcisions, usually on babies or young children in Israel’s Muslim community.

“It’s fitting that our project is named after Abraham,” he said. “It symbolizes a measure of unity to give the message to other people that we can work together.”

Officials from the WHO traveled to Jerusalem in 2006 to gather information on Israel’s expertise in the field.

“The circumstances in which adult male circumcision are done in some institutions in Israel are generally of a high standard with few complications,” said Dr. Tim Hargreave, a leading British urological surgeon and WHO technical adviser, explaining the organization’s interest in Israel’s experience.

Drawing in part on Israeli methodology, Hargreave helped author the WHO manual on male circumcision, which along with a teaching course, is being used as part of government male circumcision programs in several African countries.

Dr. Kiron Koshy was one of the doctors working in Swaziland who was trained by the Israeli team. He now conducts as many as 15 male circumcisions a week at a Catholic mission hospital near the Mozambique border — more than twice the rate he was performing previously.

“I have now learned the technique, and I can work faster,” Koshy said in a phone interview from Swaziland. “There are a lot of people coming in for the operation, and I think the numbers are only going to increase.”

Meanwhile, in San Francisco, Don Abramson, a former chairman of American Jewish World Service who has been advocating for the project, said he hopes it will help galvanize Diaspora Jewry to fight one of the world’s biggest problems. One of his ideas is to encourage Jews around the world to donate money to Operation Abraham whenever they attend a bris.

“My message to Jewish families is that a bris affirms the Divine covenant relationship with the child, but also demonstrates that their friends and family who care about the child celebrate that the child is healthy enough to have a bris,” Abramson said. “A contribution to Project Abraham demonstrates a desire for others to be alive and healthy, as well, and could be a life-saving act.”

UCLA’s new hospital takes technology to new frontiers


More than eight years and $829 million in the making, the new Ronald Reagan UCLA Medical Center is scheduled to open its doors to patients on June 29. The 10-story, 1-million-square-foot complex — which houses the The Ronald Reagan UCLA Medical Center, Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA and Mattel Children’s Hospital UCLA — features vast, light-drenched spaces and an airport terminal-sized corridor that connects the three centers.

But what’s more impressive about the new center are the elements that most visitors won’t see. Many of these features involve electronic gear and wireless technology, particularly in the hospital’s 23 operating rooms. Especially striking is how bare the operating rooms look. No equipment sits on the floor. Instead, it is suspended from the ceiling by movable booms. Two flat panel monitors, lights, an anesthesia station and a surgeon’s computer control panel all hang down from above.

During a procedure, surgeons can use a touch-screen panel or voice commands to display and control images, adjust room lighting, or phone a colleague. They can access patient histories, X-rays and lab results, and use their fingers on the console to draw — just like a football commentator — on images displayed on a screen.

Multiple cameras record activity in the room, the operating site, and — using an endoscopic camera when appropriate — the patient’s insides. These images can be saved on DVD, shared with a colleague in the next room or across the globe, or transmitted to medical students in a viewing theater two stories below. The fiber optics and other cables necessary for the room’s extensive connectivity fill a phone booth-sized box located against one wall.

The hospital was designed for “efficiency, control and connectivity,” said Dr. Peter Schulam, chief of the Division of Endourology and a member of the design committee for the operating rooms. He said the design process reflected an unusual collaboration between medical staff and equipment manufacturers.

“The companies we worked with were our partners in designing everything,” Schulam said. “Nothing was off-the-shelf.”

The new hospital replaces the one built in 1951 to herald the atomic era. That facility was designed and constructed at a time before CPR, kidney transplantation or open-heart bypass surgery, and without magnetic resonance imaging, laparoscopy or the Internet. Then, as now, planners had to anticipate the needs of the hospital decades into the future.

Schulam said it was challenging to plan a hospital that would take years to build, not to mention one able to adapt to future decades of technological innovation. To ensure that operating rooms can change as future needs dictate, they were designed to be physically and technologically flexible, allowing reconfiguration as needed.

Already, new developments have occurred since the planning process began.

“When we started design, high definition didn’t exist,” Schulam said.

Now four operating rooms feature HD, complete with 42-inch wall-mounted plasma screens.

He said that while UCLA can currently claim the most state-of-the-art hospital in the country, that will change when the next major teaching university builds a new facility.

“It’s a leap-frog effect,” he said, noting that UCLA benefited from observing previous new research hospitals.

The new medical center came about because of the 1994 Northridge earthquake. The university chose to rebuild, rather than retrofit, the hospital in order to meet new seismic safety requirements. The facility can not only withstand a magnitude 8.0 earthquake, but remain functional after doing so.

The Federal Emergency Management Agency provided $432 million in earthquake relief funding for the hospital, and the state kicked in another $44 million. Private donations accounted for nearly $300 million, and the balance came from hospital financing and bonds.

Reflecting input from more than 500 physicians, nurses and patients, the hospital was designed by celebrated architects I.M. Pei and his son C.C. Pei, along with a team headed by commercial architect design firm Perkins+Will, Pei Partnership Architects and RBB Architects.

Each of the 520 inpatient rooms boasts a sweeping view of Westwood or the UCLA campus, offers wireless Internet and features a fold-out sofa for overnight guests. The rooms can adapt to various levels of care, minimizing the need to transfer patients from one room to another. If patient transport becomes necessary, the patient’s bed — rather than a gurney — serves as the vehicle. Mobile units featuring medicines and IV fluids are also portable, and travel with the patient from one location to another.

A sophisticated electronic records system provides medical staff with immediate access to patient reports, lab results, clinical imaging and real-time vital sign monitoring from any hospital location.

But with all the technology it contains, the hospital is ultimately about the people it serves, according to Dr. James Atkinson, professor of surgery and senior medical director for the transition from the former facility to the new hospital.

In the medical center’s June 4 dedication ceremony program he stated, “Now that we have our building, it is time for us to breathe life into it. It’s up to us to walk the halls, to fire up the machines and to start doing what it is we do best here at UCLA: healing people. Once that happens — once we’ve saved our first life in the new building — we’ll have fully transformed our original vision into reality.”

A doctor’s visit


A visit with Dr. Eugene Gettelman, who celebrates his 100th birthday on June 17, shows how much medicine has gained and lost in the last half century.

We talked recently in the sitting room of his apartment at Westwood Horizons, an upscale retirement home near UCLA. His friend, Dr. Herb Levin, had suggested I do a column on Gettelman’s reaching the century mark.

I had met them when I was invited to speak at a monthly luncheon of retired physicians at Cedars-Sinai Medical Center. Occasionally, Gettelman, Levin and their friend, Dr. Fred Kahn, take me to lunch at the UCLA Faculty Center. They like to talk about politics. I’m interested in the old days of medical practice — at least their old days.

That’s what I wanted to talk about when Gettelman and I settled down for a chat. As a pediatrician practicing in the San Fernando Valley, he treated generations of children, starting from when he completed Navy service in the South Pacific during World War II. He is a lively man with a friendly and calm manner, undoubtedly reassuring to parents and children as well.

I asked him to repeat a story he had told me before, which I thought illustrated the sharp instincts, intelligence and guts that were so necessary to doctors working without today’s sophisticated diagnostic tools and drugs.

Gettelman was senior resident at Michael Reese Hospital in Chicago in the mid-1930s. In those days — hardly imaginable today — strep throat was a dread ailment that could affect the mastoid and turn into meningitis. For the children he was treating, “it was like a death certificate,” he said.

At the time, 100 Jewish physicians who had fled Hitler’s Germany were working at Reese, a Jewish hospital. One of them came to Gettelman with a German article telling how doctors there were using sulfa drugs to cure infections, a new treatment first tried in 1932.

Several children were dying in Reese Hospital from meningitis. “I had more guts than brains in those days,” Gettelman said. He called the manufacturer, Bayer, in Germany. The company air expressed a pound of a powdered version of the drug.

There were no directions with the package. The drug, Gettelman said, had never been used against meningitis. But he decided to try it.

He asked the parents. He told them their children were dying. The parents told him to go ahead. Gettelman mixed the powder with a solution in what he thought would be a safe proportion and injected it into the spine of one of the sick children.

“It worked,” Gettelman said. “With the first patient, the temperature came down.”

The story reminded me of House, television’s irascible high-risk doctor, who operates on instinct, experience and guts.

“Do you watch ‘House?'” I asked Gettelman.

“Sometimes,” he replied.

“House would have done what you did,” I said.

Gettelman smiled. “That’s exactly right,” he said.

In Gettelman’s younger days, doctors marched through the hospital in something called “grand rounds.” Held on Sunday mornings, when all the doctors were available, the rounds were led by the head of the department, dressed in morning coat and striped pants, followed by a procession of residents and interns from one hospital room to another.

They descended on patients, who must have been surprised, if not scared. The lowest-ranked intern would spell out the symptoms. The head doctor would question the usually nervous intern. Then the group would retreat to the hall, and the department chief would explain the lessons to be drawn from the case.

When he was practicing in the Valley, Gettelman visited patients at Encino Hospital in the morning, saw ill children in his office all afternoon and made house calls in the evening. Doctors knew their patients and watched for symptoms. They didn’t dismiss childhood headaches, Gettelman said. A headache could mean polio. “A belly ache could be appendicitis,” he said.

Those days are gone, he said, and with them the young doctors who opened solo offices and started treating patients one on one, becoming part of their lives. Today’s doctors’ offices are big. Some are well organized, others not.

“The personal relationship between the doctor and the patient has deteriorated,” he said.

But on the plus side, antibiotics have all but eliminated the crises Gettelman faced in his youth. These days, he wouldn’t have to play a hunch and order those sulfa drugs from Germany.

He noted approvingly that radiology has made possible huge advances in diagnosis. Gettelman keeps up on medical developments, and he attends frequent lectures and other sessions at Cedars and UCLA.

On Sunday, June 15, family and friends will gather at the UCLA Faculty Center to celebrate his birthday. Gettelman and his late wife, Rita, had two sons, Alan and Michael. There are five grandchildren and two great-grandchildren.

My interview was ending. We had talked for an hour, and it was lunch time. Gettelman walked to his closet and pondered which of his several sport coats to wear downstairs for lunch. He chose the camel hair.

A table had been reserved for him. He ordered the salad, and I had the turkey sandwich. We discussed politics, not agreeing all the time, but enjoying the conversation. After an hour, the dining room was emptying, and I stood up to leave.

As I drove home, I thought about all the changes Gettelman has seen and what a remarkable man he is. This was one visit to the doctor that actually made me feel good.

Until leaving the Los Angeles Times in 2001, Bill Boyarsky worked as a political correspondent, a Metro columnist for nine years and as city editor for three years. You can reach him at bw.boyarsky@verizon.net.

Winning Nobel Prizes seems to run in one family’s chemistry — and biology


You’ve heard of the nuclear family. But how about the deoxyribonucleic family?
Thirty-seven years after Arthur Kornberg won the Nobel Prize in medicine, his eldest son, Roger, took home this year’s prize in chemistry, receiving the call from Stockholm Oct. 3.

Not only are both Kornbergs biochemists, they also both work for Stanford Medical School. This is, amazingly, the sixth instance of a Nobel being awarded to the son of a previous winner.

“It was a family of science. My mother, who unfortunately passed away about 20 years ago, worked in the lab as a biochemist with my father. So biochemistry was a dinner table conversation,” recalled Roger Kornberg’s younger brother, Tom, himself a biochemist at UC San Francisco. The third Kornberg brother, Ken, is not a scientist but an architect — although he specializes in designing laboratories.

“Roger was uniquely focused on science from the time he was very, very young,” Tom Kornberg said. “He had no other ambition other than to be a scientist. He is notable even today for his single-minded dedication among scientists. His tenacity and determination is remarkable.”

Arthur Kornberg — who still has his own lab at Stanford Medical School at age 88 — grew up in an Orthodox Brooklyn household, where Yiddish was the first language. His future wife, Sylvy Levy, also grew up Orthodox, but the couple raised their children in a fairly secular environment.

Still, the family had a strong Jewish and pro-Israel identity, and Roger Kornberg is a consistent donor to the San Francisco-based Jewish Community Federation. Roger married an Israeli scientist, Yahli Lorch, a Stanford professor of structural biology, and they live almost half the year in their Jerusalem flat, where he leads his research team remotely via the Internet. He returned from Israel just before winning the prize, having delivered a lecture at the Hebrew University of Jerusalem on Sept. 26.

Roger Kornberg was honored for his study of transcription, a process of DNA replication. Instead of creating proteins directly from DNA, the DNA recreates itself in the form of RNA, which traverses from the nucleus to other cell locations where it kicks off protein production.

Kornberg has studied the vast intricacies of transcription since the early 1970s, fitting together the more than 30,000 atoms present in RNA polymerase, the enzyme that allows DNA to remake itself into RNA. Kornberg’s lab created the world’s first images of polymerase in action, enabling the zipperlike undoing and redoing of the double helix.

“We were astonished by the intricacy of the complex, the elegance of the architecture, and the way that such an extraordinary machine evolved to accomplish these important purposes,” Kornberg told a Stanford publication of the images he and his colleagues created. “RNA polymerase gives a voice to genetic information that, on its own, is silent.”

That voice doesn’t automatically make itself heard. Transcription occurs on a selective basis, and transcription among a cell’s tens of thousands of genes decrees whether it develops into a liver cell, a stem cell or a neuron. It also determines whether it develops healthily or cancerously.

Creating the groundbreaking images of RNA polymerase was a backbreaking task, requiring an expertise in an esoteric field combining chemistry, biology and physics called crystallography (the same technique that Francis Crick and James Watson utilized to discover the double helix).

To greatly simplify the work of Kornberg’s lab, a concentrated solution of a molecule was evaporated until all that was left behind were highly structured crystals reminiscent of the salt deposits left behind by vaporized seawater. Via intensely bright X-rays, scientists were then able to identify the exact location of individual atoms and generate a computer model of the molecule.

Kornberg’s tenacious feat of illustrating the 10 subunits of RNA polymerase in action was a task two decades in the making.

“It was a technical tour de force that took about 20 years of work to accomplish,” professor Joseph Puglisi, chair of the department of structural biology at the Stanford School of Medicine, told a Stanford publication.
“Like other great scientists, Roger doesn’t quit. He’s stubborn. A lot of scientists would have given up after five years.”

Each Nobel Prize includes a check for $1.4 million, a diploma and a medal, which will be awarded by Sweden’s King Carl XVI Gustaf at a ceremony in Stockholm on Dec. 10.

There’s a whole lotta shakin’ goin’ on over Power Plate


Remember those machines from the 1950s that used to jiggle a person’s fat in an attempt to rid the body of cellulite?

These days, a more sophisticated generation of those machines, which vibrate the entire body, is claiming it can do a lot more than eliminate cellulite.

Proponents say whole body vibration can increase muscle strength and flexibility, fight osteoporosis, improve balance and posture, increase circulation and reduce pain.

But skeptics say the claims are highly exaggerated, and that the machines might actually be dangerous. They want consumers to exercise caution if they’re going to use them.

Unlike those old-fashioned machines, the new technology relies on more aggressive vibration to stimulate muscles. One of the most popular, the Power Plate, features a vibrating platform that oscillates 30 to 50 times per second. Each time, it stimulates the nervous system and creates a reflex in the body that causes the muscles to contract.

Recent news reports say celebrities like Madonna and Heidi Klum are using it in their workouts, and the Power Plate Web site lists dozens of college and professional sports teams as using vibration training in their regimens, too.

“You’re getting a lot more muscular activity,” said Dennis Sall, a chiropractor in Mount Sinai, N.Y., who began using the Power Plate to train his patients about a year ago. “This is a great way to jump start the metabolism.”

Ultimately, he said, that causes the body to burn more calories.

Dr. Geoffrey Westrich, associate professor of orthopedic surgery at the Hospital for Special Surgery in Manhattan, said that’s true.

“There’s no doubt that the muscles are contracting, and you’re burning calories and strengthening muscles at the same time,” he said.

However, he thinks it needs a lot more research to back up the claims that the machine can do a lot more than just build muscle.

A quick glance at the “applications” portion of the Power Plate Web site indicates that the device can play a significant role in anti-aging, sports performance and rehabilitation. One section seems to imply that it can be used to treat everything from emphysema to multiple sclerosis to whiplash.

According to Scott Hopson, director of research, education and training for Power Plate USA, dozens of studies using Power Plate have been published in peer review journals, including the Journal of Bone and Mineral Research, the American Journal of Geriatrics Society and Medicine and Science in Sports and Exercise.

“It’s very effective for improving balance, strength and preventing the muscle and bone loss that comes with multiple sclerosis, Parkinson’s, fibromyalgia and cerebral palsy,” he said. “One of the biggest secondary impairments of degenerative diseases is loss of muscle fibers and the ability to use them.

Vibration is a great for fighting against that.”

Hopson added that studies have shown that vibration can increase blood flow to muscle, tendon and ligament tissues and stimulate the release of hormones that are needed for healing damaged tissues.

But Westrich said it’s not the quantity but the quality of the research that concerns him.

“If you go to their Web site and look at all their studies, there is not very good science behind it,” he said. “I found only a few randomized prospective studies. There is some basic science studies about vibration … but a lot of it has nothing to do with their particular device.”

For example, many of the studies on osteoporosis, which are cited in Power Plate’s information packet, were conducted by Clinton T. Rubin, a professor in the department of biomedical engineering at the State University of New York at Stony Brook.

Rubin, furious that his studies are being used by the company, said, “I’ve never studied the Power Plate at all, and the vibration magnitude we used was 50 times lower than what they are using.”

Rubin works with a different company that also makes a vibration machine but one that uses much less intensity. He said his research shows that minimal vibration can stimulate bone growth, but he said, “Power Plate misuses that.”

“I’m furious that what Power Plate is doing is dangerous to people,” Rubin said. “It’s dangerous because there is a huge scientific body of evidence that high vibration magnitudes can cause lower back pain, circulation disorders, hearing loss, balance problems and vision problems.”

Dr. Jeffrey Fine recently ordered two Power Plates for two hospitals that he works at.

“Physical medicine rehab is a specialty where we apply different types of physical energy for physiologic benefit,” he said. “We considered this a newly identified modality to treat a variety of different medical conditions.”

Currently, Fine is looking into how the Power Plate will help patients with impaired sensation from diabetic neuropathy. He pointed to studies conducted at Harvard University that demonstrated how other devices that incorporate vibration technology have proven useful in stimulating multiple joints and ultimately improving balance and gait problems.

Westrich still isn’t convinced vibration technology is for everybody. For one thing, he’s not sure how useful it would be to treat osteoporosis in his elderly patients.

“I’m not sure they can tolerate being vibrated like a piece of Jell-O,” he said.

Debbe Geiger is a freelance writer specializing in health and science.

Dr. Freud at 150


“Why,” Sigmund Freud once asked rhetorically, “did it [psychoanalysis] have to wait for an absolutely irreligious Jew?”

Why indeed?

Freud was born in Freiberg, in the Austrian empire, on May 6, 1856, 150 years ago this weekend. Three years after his birth, his family moved to Vienna. There, the reaction of Freud’s personality to the mix of cultural, political and scientific forces was such that — we may state in hindsight — psychoanalysis could not have been created by anyone else in any other time or place.

Already for 1,000 years, in the Islamic and Christian worlds, medicine had been a Jewish profession par excellence. In late 19th century Vienna, as well, a vastly disproportionate number of doctors were Jews, and they were contributing mightily to the explosive development of modern medical science.

But the Austrian political climate was souring. A few decades of liberalism (in the European sense of individual freedom) were followed by a reactionary wave of Austro-Germanic nationalism and anti-Jewish politicking.

In the new age of medical specializations, the prejudiced academic powers that be were channeling Jewish medical students away from the prestigious mainstream fields, like internal medicine and surgery, into marginalized specialities: dermatology, ophthalmology — and psychiatry.

Yet if some Jewish doctors were being pushed into psychiatry, many others were voluntarily drawn to it. For the Jews of late 19th century Vienna were facing mental pressures different from any in past Jewish history.

For centuries, Diaspora Jewish physicians and philosophers, such as Maimonides, had written on the means of attaining spiritual well-being, often in a sea of hostile humanity. Their compass was the age-old Jewish religious and cultural values.

Now, however, Jews were being set adrift in an era of modernity that they themselves were doing so much to create. Nowhere more so than in Vienna, as the 20th century approached — where Josef Popper-Lynkeus and Ludwig Wittgenstein were developing their radical philosophies of science and technology, and Arnold Schoenberg would soon experiment with daringly atonal music.

Little wonder that the pioneering psychiatrist-anthropologist Cesare Lombroso, author of “Man of Genius,” attributed the apparently high rates of insanity among his fellow Jews to “intellectual overactivity.”

Such was the atmosphere in which Freud found himself. No longer a Jew in the religious sense but of the rationalist tradition of Judaism (“free from many prejudices which restrict others in the use of their intellect,” as he put it), Freud first made important, if unrevolutionary, contributions to our understanding of aphasia (major speech impairment due to physical trauma or stroke).

By the 1890s, however, Freud became intrigued by more cryptic language disturbances as signs of neurotic conflicts caused by hypothesized unconscious forces: slips of the tongue in wakefulness, and the largely imagistic and apparently nonsensical — but in fact symbol-laden — “language” of dreams at night.

Freud famously called dreams “the royal road to knowledge of the unconscious.” And his own dreams and their analysis revealed to him a whirl of conflicts around his Jewish identity.

Thus to cite just one of many examples, Freud dreamt that he sat almost in tears beside a fountain at the Porta Romana in Italy. The children had to be moved to safety, and a boy who was but wasn’t Freud’s son said to him in farewell the nonsensical “auf ungeseres,” instead of the usual “auf wiedersehen.”

Among a labyrinth of free-associations the next morning, Freud recalled his actual viewing of the Porta Romana (the gateway to Rome and, by implication, the Roman Catholic Church) during a recent visit to Siena, where the Jewish director of a mental hospital had been forced to resign. Returning to Vienna, Freud had attended a play on the Jewish question called, “The New Ghetto.”

Freud linked the dream fountain to the refrain, “By the waters of Babylon … yea, we wept when we remembered Zion.” The seemingly nonsensical farewell, “auf ungeseres,” derived from the German word for unleavened bread and a Hebrew word for imposed suffering. Clearly, the life as a Jew in fin-de-si?cle Vienna was one of exile, with professional barriers and social burdens imposed on him and his children.

Such encumbrances could be relieved in a day with a splash of baptismal water and assimilation into Austria’s Roman Catholic majority. But Freud would have none of that.

“I considered myself German intellectually, until I noticed the growth of anti-Semitism. Since that time, I prefer to call myself a Jew,” he defiantly declared. “A Jew ought not to get himself baptized — it is essentially dishonest.”

If Freud’s view of dreams had been limited to analyzing them for various personal and cultural conflicts — some of which are lurking below the level of consciousness — it would have been a significant but unrevolutionary contribution to psychology.

But to repeat Lombroso’s term, the “intellectual overactivity” characteristic of so many modern Jews was part and parcel of Freud’s genius. Thus he went on to develop his psychoanalytic model with its Oedipus and Electra sexual complexes, supposedly laid down in early childhood, and continuing to dominate the unconscious id of the adult mind.

The libido, Freud theorized, ultimately supplies the driving force behind all dreams. A task of civilization was to channel such forces to higher goals. This, too, was part of the millennia of Jewish tradition.

“In his inner being, the Jew, the true Jew, feels only one eternal guide, one lawgiver, one law,” Freud proudly declared. “That is morality.”

Such radical theories faced a long uphill battle against the conservative medical establishment. But, as Freud told his B’nai B’rith lodge brothers, “As a Jew, I was prepared to join the opposition and to do without agreement with the ‘compact majority.'”

The psychoanalytic theory ultimately did gain much acceptance. It was Freud’s international reputation that allowed him to flee Vienna after the genocidal Nazis took control of Austria in 1938.

When Freud died in London two years later, he was more of an exile than even he would ever have dreamt when first developing his model of the mind. But disciples of his were in the Land of Zion — pursuing a Jewish dream that would become reality.

Dr. Frank Heynick’s most recent book is “Jews and Medicine: An Epic Saga” (KTAV, 2002), in which Sigmund Freud plays a prominent role.

 

The Circuit


Cleaning Up With Care

Long time L.A. drycleaner Barry Gershenson was named one of four national spokespersons for the FabriCare Foundation.

Gershenson, a third-generation dry cleaning veteran has more than 40 years experience as owner of Sterling Fine Cleaning in Los Angeles. As a spokesperson for the FabriCare Foundation, Gershenson’s role will be to educate consumers on the definition of a “professional” drycleaner, as well as the overall benefits of dry cleaning.

Gershenson lives in Los Angeles with his wife of 32 years, Sandy; and children, Lauren and David.

For more information, visit ” target=”_blank”>www.acsz.org.

 

Did You Know…?


  • Cedars-Sinai Medical Center spans over 24 acres and encompasses 1.5 million square feet.

  • Commits more than $71 million for community benefit, which includes more than 120 diverse community health programs and services.

  • Ranks among the top 10 non-university hospitals to receive research funding from the National Institutes of Health

Features:

  • 905 licensed beds

  • 137,581 outpatient visits (for the year 2001)

  • 77,347 visits to the emergency department (2001)

  • 6,824 babies delivered (2001)

  • 1,857 attending physicians

  • 8,609 employees

  • 2,000 volunteers

  • 2,500 meals served per day – including 50 kosher meals daily

  • According to city regulations, no city street in Los Angeles may be named after a living person. The exception is George Burns Road, at the northern end of Hamel Road, which was named after venerable comedian and Cedars-Sinai supporter George Burns on his 90th birthday in 1986. In 1995, in celebration of Burns’ 99th birthday, the city renamed the eastern end of Alden Drive "Gracie Allen Drive," in honor of Burns’ late wife/comic foil Gracie Allen.

"It’s good to be here at the corner of Burns and Allen," Burns said at the time. "At my age, it’s good to be anywhere!" 

The two streets cross each other off Third Street, just two blocks west of the Beverly Center. Although many celebrities died at Cedars-Sinai, Burns, as it turns out, passed away at his home in 1996.

  • The Neonatal Unit houses 40 beds, divided into four separate areas providing different levels of care. Maternity services include mother and baby programs and mother and baby care classes.

  • The place for the stars to deliver is apparently the Cedars-Sinai Medical Center Deluxe Maternity Suites. Leeza Gibbons’ son, Nathan, was the first baby born there in October 1997. Since then, the Suites have seen the births of Michael Jackson’s son, Prince; Jodie Foster’s son; Warren Beatty and Annette Bening’s baby girl; David Boreanaz ("Angel") and his wife, Jamie Bergman’s, baby boy, Jaden Rayne; and former "Wild On E!" hostess Brooke Burke gave birth to her second daughter, Sierra Sky Fisher on April 2 of this year.

  • Actress Kate Hudson was born at Cedars-Sinai on April 19, 1979 to actress Goldie Hawn and musician Bill Hudson.

  • Many celebrities have been treated at Cedars-Sinai. Dean Martin went in to be treated for lung tumors. Larry Hagman had his liver transplant there. O.J. Simpson, Elizabeth Taylor and Leonardo DiCaprio, who underwent knee surgery, were all patients at the center.

  • A number of Hollywood talents have passed away at Cedars-Sinai. Frank Sinatra died there in May of 1998. Other stars who passed away at Cedars-Sinai include entertainers Lucille Ball, Sammy Davis Jr., Sammy Cahn, Danny Thomas, Danny Kaye, Martha Raye, Chuck Connors; actresses Audrey Meadows and Eva Gabor; comedian Avery Schreiber; actor River Phoenix; gangsta rapper Eazy-E; and director John Frankenheimer.

Eulogies:Irwin M. Weinstein


Irwin M. Weinstein, one of the founders of the National Israel Cancer Research Fund (ICRF) and its Los Angeles chapter, died July 21 of a stroke and kidney failure. He was 76.

Weinstein’s career included a clinical practice, academic medicine, civic and political activities, and he achieved international distinction as a clinical hematologist. He brought his vision of harnessing educational and scientific resources to conquer cancer with ICRF, which has spawned major breakthroughs in the treatment of cancer.

In Los Angeles, he served in a variety of positions at Cedars-Sinai, including chief of staff from 1972-1974 and a member of their board of governors. At UCLA he was a professor of clinical medicine and served on their medical school admissions committee.

Among his many national accolades, Weinstein was appointed adviser to the National Health Care Reform Task Force and was recommended by President Bill Clinton for assistant secretary of health for policy and evaluation.

The Beverly Hills resident was born in Denver, Colo., and received his medical degree from the University of Denver. He served his residency at Montefiore Hospital in New York and was a resident in medicine at the University of Chicago before coming to Southern California.

He is survived by his wife, Judy; sons, David and Jim (Cynthia); grandchildren, Julian and Mara; brother, Gerald; and brothers-in-law, David and Zev Braun.

Contributions may be made to the Israel Cancer Research Fund, 8383 Wilshire Blvd., No. 341, Beverly Hills, CA 90211. — ICRF

Living Through Chemistry


The ancient rabbis practiced a relatively simple form of medicine: cabbage for sustenance, beets for healing.

It was easier then to prescribe, although harder to heal.

"Woe to the house through which vegetables are always passing," sums up the Talmud. There were no guarantees then as to what would work, the red or the green. This week, amid the controversy surrounding hormone replacement therapy, I’ve wondered how far past cabbages we’ve come.

When I first began taking the tiny pink estrogen/progestin mix, my doctor at the time assured me that it was safe.

"Would you take the pills yourself?" I asked.

"Absolutely."

But she was more than 10 years my junior, and her certainty had a distant ring, a bell that won’t soon toll for thee. I never confused her with God. If I continue to take the pill, it’s not because I don’t think yams might work as well. I trust western medicine, and I hate hysteria. I’ve been down this road before.

I’m a baby boomer, particularly blessed by an outpouring of biochemical industry that did indeed bring us better living through chemistry. Capsules, tablets and curatives of all kinds have graced my every life-cycle advance, should I want them. There are drugs developed for just about every condition that drove women of the past crazy — literally. If we feminist women have, at times, felt like guinea pigs, we have also been pioneers.

As for the hormone study, it showed only that the risks were slightly higher, not that the drug is unsafe. I’m not acting until I have a better grip on what I’m doing.

But if I want a grip, I get no help from the media, which is playing "blame the victim." Both Time and Newsweek, among others, were quick to suggest that hormone replacement was a silly dream to stop aging or otherwise "preserve their youth."

How wrong can you get? The press reacted as if menopause was mere vanity, another form of Botox. But medicine’s purpose has always been one part palliative, to comfort and relief of symptoms, even where there is no cure. And if there’s selfishness to hormone replacement, what does this tell us about Viagra?

Aging is hardly the big news of the hormone study. Lesson No. 1 is the need for a vigilant medical community. The National Institute of Health waited years before recognizing that previous data on hormone replacement was based on faulty premises. In Tuesday’s New York Times, Dr. Susan Love wrote, "We need to demand medicine based on solid evidence, not hunches or wishful thinking."

Especially in preventive medicine, it is important to take "the time to determine the safety and efficacy of a particular therapy before we embrace it." In other words, doctors, heal yourselves.

Lesson No. 2 is, if anything, equally important: that presented with difficult medical situations, patients must, against great pressure, think for themselves.

My hunch is that many of us are ready for this step. Mine is the first generation to take birth control pills. They gave us free love and arguably a better image, but also mood swings, not to mention five extra pounds. We determined that the side effects were worth it.

Once married, we took fertility drugs, which gave us yet more mood swings, not to mention teaching us more than we wanted to know about the population density of sperm. There, too, the costs were deemed worthwhile.

And then came menopause. In my own little group, there are women who take half the recommended dose of estrogen, every other day; others eat yams. Some took estrogen until halted by a family member who got breast cancer; others, who take no hormone replacement, work on their bone density with drugs like Fosamax.

Independent thinking is the key lesson for an aging population. One of the most difficult transitions I’ve made since receiving a diagnosis of lung cancer is that there is no right answer. There is no medical god in whom to put my faith. There are only doctors with alternative theories, and some of them make sense. The Internet guides me from step to step, defining the next level of confusion, so the right treatment can work its way.

Scientists promised better living through chemistry. What they deliver isn’t perfect, but it beats cabbage and beets.

The Trouble with Testing


As if we don’t have enough problems, it seems there’s an unlimited supply of horrific hereditary diseases just waiting to ensnare Jews and their children. Tay-Sachs cripples infants before their first birthday and eventually kills them, Gaucher disease erodes healthy bones and organs, Niemann-Pick, cystic fibrosis, Crohn’s, Canavan and dozens of others. And that’s just among Eastern-European Ashkenazi Jews. A host of other hereditary diseases affect Sephardic, Iraqi and Persian Jews. Does somebody up there hate us?

Not according to Dr. Jerome I. Rotter, co-director of the Medical Genetics-Birth Defects Center at Cedars-Sinai. “While the Jews are very special,” he says, “when we talk about the distribution of disease, they’re not all that special. Every population has a susceptibility to its own set of hereditary diseases.” It’s an important point to make, coming as it [did] at the conference “Genetic Medicine and the Jewish Population,” was held at Cedars-Sinai Medical Center on Oct. 24.

While science has made enormous strides in creating tools to fight the genetic diseases that afflict many Jews, the impact of those tools have a profound and intimate effect on all of us, Jews and non-Jews alike. And as a result, our society is now confronted with some of the most complex and difficult questions we’ve ever had to face.

Our genes are the code that stores all the information needed to build a human being. Occasionally, through the process of evolution, a single gene can mutate, confusing that information and rendering an individual susceptible to disease. Sometimes an individual is just a carrier, meaning he will never develop symptoms of the disease, but might pass on that susceptibility on to his children. For recessive diseases, like Tay-Sachs or Gaucher disease, both parents must be carriers, and both must pass on an abnormal gene for a child to develop the disease.

Over the last half-century, scientists have developed methods to pinpoint specific mutations on individual genes, allowing them to test individuals for genetic diseases. And although most of us are aware of this work, few of us seem to understand its profound implications: In a very real way, science can now tell the future. Suddenly, we’ve entered a brave new world of medicine, and the benefits we already reap from this new paradigm are great.

This is uniquely apparent in breast and ovarian cancer, two of Ashkenazi women’s most serious health concerns. While all women are susceptible to these diseases, Dr. Maren Scheuner, director of the GenRISK genetic testing and counseling program at Cedars-Sinai, says that when a family history of breast cancer is present, Jewish women are at a much greater risk than non-Jews of developing the disease.

While there are currently no easy cures, women who test positive for one of the genetic mutations that cause breast cancer can take steps to improve their chances of survival if the cancer does develop. “For high risk women, you’ll just have a higher suspicion and start all the screening much earlier, usually around 25,” says Scheuner. Now, most women begin screenings at age 40.

Genetic medicine’s new tools mean that we can screen entire populations to find healthy carriers of a disease and prevent that disease from spreading, eliminating the need for any treatment at all.

Dr. Kaback is intimately familiar with this process, being one of its pioneers. He began the first screenings for Tay-Sachs in Baltimore in 1969, and in Southern California in 1971. Since then, his program has voluntarily tested more than 1.4 million adults, identifying and counseling almost 1,400 couples at risk for bearing children with the disease. “These families have had over 3,200 pregnancies, and of those, 620 were Tay-Sachs-identified,” says Kaback. “With the exception of about 20 of them, the families elected to terminate the pregnancy.” Certainly, abortion is an extremely difficult decision, but many parents found it a better alternative to watching their child develop this disease by six months of age, deteriorate into mental and physical paralysis, and finally die before age 5.

It’s estimated that one in 25 Ashkenazi Jews is a Tay-Sachs carrier. Prior to genetic screening, the disease was so common among Jewish populations that hospitals across the country had special wards to care for these children. Today, only three to four Tay-Sachs babies are born in North America each year. Similar screening programs have been implemented to help prevent Gaucher disease, Canavan disease (a neurodegenerative disease) and cystic fibrosis, among other genetic diseases .

So genetic screening is wonderful, right? Not always. The process can quickly transform the most logical questions of science into sticky ethical dilemmas. Even such issues as a doctor’s responsibility become obscured. “If I know that my patient carries a certain genetic trait, he may not be at risk for that problem, but his sister may be at risk,” says Dr. Kaback. “Do I have an obligation to contact his sister? Suppose I don’t contact her, and she has a child affected with that condition. Do I have any legal responsibility in that context?”

And the questions get even more existential. “If I’m tested for a genetic trait and have it,” says Kaback. “Instantaneously the doctor who does that test knows that my brothers and sisters are at a 50 percent risk of having that same genetic trait. They know that my children have a 50 percent chance of having that trait. Who is the geneticist’s patient? Is it the client sitting across the desk, or is it their extended family? Or is it the entire population group from which that individual is derived?”

The problem is that genetic screening can tell us the future, and knowing the future is always a double-edged sword. When you screen healthy individuals, you may find a gene for a disease that won’t show up for years. “How does it affect the person’s self-image,” asks Dr. Kaback. “To know that they have a gene that’s going to possibly cause them to have cancer or mental illness or some neurological problem or heart disease later in life? How does it affect their upbringing? How many Willie Mayses or Sandy Koufaxes might never have achieved excellence athletically, if someone knew they had a predisposition to some illness later in life when they were children?”

Dr. David L. Rimoin, director of Cedars-Sinai’s Medical Genetics-Birth Defects Center, and one of the organizers of the conference would agree.

“The reality is that we can screen for every disease,” he says. “And every one of us in the population, of any population, will be found to be carriers of several genetic diseases.”

But Rimoin feels that this knowledge can do so much good, as it’s done with Tay-Sachs, that it shouldn’t be ignored. That’s why he organized the conference, and why he is trying to start a Jewish genetics center at Cedars-Sinai.

A New Lease on Life


About two-and-a-half years ago Michael Goldberg’s life was on the line. A diabetic since he was a teen-ager, his kidneys began to fail him at 36. The only hope for Michael’s survival was a kidney and pancreas transplant. Due to a shortage of organ donors throughout the country, Michael and his parents, Irv and Esther Goldberg, waited for 18 anxiety-filled months until doctors found a suitable match: the victim of a fatal automobile accident, who had previously consented to donate his organs. Michael now had the chance he needed to live. At that point, Irv and Esther Goldberg began their mission to increase organ donations and transplants among the Southern California Jewish community.

Irv created Transplant for Life, a grassroots movement dedicated to raising awareness in the Jewish community about the importance and permissibility of organ donation. Transplants for Life is busy mobilizing support for organ donation with help from religious leaders, who can impart to their congregations the importance of participating in the third annual National Donor Shabbat on Nov. 13-15. The event was organized by the U.S. Department of Health and Human Services, with the goal of raising awareness in all faiths of the critical need for organ donation. Fewer than 10 percent of Americans participated in the National Donor Shabbat in the past according to a recent survey.

Irv Goldberg attributes poor participation to misconceptions about organ donation.

“Some fear that it goes against their religion when in fact all major religions support it,” said Lynn Wegman, deputy director of the Division of Transplantation at the U.S. Department of Health and Human Services.

Goldberg said the Jewish community in particular is unaware that organ donation is not only permissible, but encouraged by all branches of Judaism.

“Jews disagree about many things, but this is one area in which people are united,” Goldberg said.

Transplant for Life has secured the support of important religious figures to help realize their mission, including a unanimous endorsement from the Board of Rabbis of Southern California. The Rabbinical Council of America (Orthodox), the Rabbinical Assembly (Conservative) and the Union of American Hebrew Congregations (Reform) all issued statements declaring organ donation as one of Judaism’s greatest mitzvot and pikuach nefesh, saving a life. Goldberg believes that congregation leaders should incorporate discussions about organ donation into services, particularly during National Donor Shabbat, in order to get more people involved.

“We are attempting for the first time to hold every rabbi and congregation accountable,” Goldberg said.

Transplant for Life, which works out of Kol Tikvah, a Reform congregation in Woodland Hills, intends to provide congregations with materials needed to educate their members — such as scriptural references and donor cards.

Goldberg and his supporters will also attempt to alleviate other concerns and fears that Jews may have about organ donation. Many do not want to contemplate their body parts existing in another person. Some do not want to make preparations for a day they hope remains in the distant future. Some worry about the condition of their body in an afterlife.

“The imperative to save lives supersedes the normal prohibitions against invading the integrity of one who has died out of honor for it,” said Kol Tikvah’s Rabbi Steven Jacobs in a Yom Kippur sermon. “And it definitely supersedes any worry about the condition of one’s body in a life after death.”

Even the procedure of organ donation, Goldberg said, should not deter anyone from possibly saving a life. The donation of the heart, liver, lung and pancreas occurs only after the donor is declared brain dead. The recovery of organs does not disfigure the body or alters its appearance in a casket.

Goldberg is receiving positive feedback. More than 50 percent of congregations that are members of the Board of Rabbis are participating in National Donor Shabbat. Goldberg hopes that Transplant for Life will serve as a model for all religious organizations throughout the country. The program is easy to implement, he said, and the cost of the program should not exceed $3,000.

Today, Michael Goldberg remains in good health and is expecting his first child with his wife, Elizabeth. When Irv Goldberg thinks about the 56,000 Americans who are on a waiting list for an organ, and the many who don’t get the chance that Michael did, his sense of urgency increases.

“This donor shortage must not be allowed to continue,” Goldberg said. “We must sweep ignorance and myths aside.”

Putting Heart


The rabbis-in-training were making the rounds at UCLA Medical Center. They stopped at bedsides to chat with patients, to inquire about their needs, to offer prayer and consolation. Then, unexpectedly, the sight of wires, tubes and surgical dressings took its toll. One student rabbi fainted.

Clearly, rabbis are not always at ease in a hospital setting, nor are they always knowledgeable about today’s medical practices. But for spiritual comfort in time of crisis, even the not-very-religious frequently turn to their rabbis.

A unique program at Hebrew Union College brings rabbinical students into the world of medicine so that they can better serve their future congregants. HUC’s chaplaincy training program, partially funded by a grant from Mr. and Mrs. Irving Kalsman, provides for student internships in hospitals throughout Southern California. The program’s innovative centerpiece is a one-semester course in which Dr. William Cutter (assisted this year by Rabbi Alan Henkin) uses Jewish texts to talk philosophically about illness and then brings students into the hospital to see for themselves what healing is all about.

The carefully selected student rabbis meet with doctors, make hospital rounds to visit patients, then keep personal journals of what they’ve learned.

“This class is a place where they really lose their innocence,” said Cutter, professor of education and literature at HUC and a rabbi, “and that is a wonderful thing.”

Some of the students (two men and five women) believe that, as ordained rabbis, they might gravitate toward a hospital chaplain’s post. Others have signed on as a way of countering painful memories.

“It was a chance for me to face reality,” said Daniel Treiser, who, as a boy, coped with his father’s heart attack. “I knew it was there, and I knew I wasn’t comfortable with it.”

Recognizing how much harder it is for a rabbi to help with healing than with celebration, Miriam Cotzin summed up a common view: “It’s about learning how to really be present for people in difficult and challenging moments.”

During the semester, these student rabbis have gained practical insight into the mitzvah of bikur holim (visiting the sick). Karen Shahon, who, as an HUC chaplaincy intern, spends more time at UCLA Medical Center than her fellow students, has discovered one good way to interact with the seriously ill: “It’s not always what you say but what you don’t say. The silent times really help people.”

While focusing on the illness of others, the students also gain new understanding of themselves. At the first session, the Rev. David Myler, head chaplain at UCLA Medical Center, warned the students that “it’s very important to learn what gets triggered in you and what kind of things push your buttons.”

Later, after a first round of visits to sickbeds, Susan Lippe wrote in her journal, “I need to learn to control my tears.” Fortunately, none of this semester’s student rabbis has fainted at the sight of blood and tubes. When Lippe recently spent an afternoon in the ICU, comforting a seriously ill patient and his loved ones, her main problem was that “it was hard to suppress my curiosity and be present only for the family.”

An important part of the HUC course is the informal lectures by top medical professionals. Dr. Leslie Eber, a cardiologist who has treated Cutter (who has had several major heart attacks), gave the students an in-depth look at heart disease. He then brought home to them the crucial importance of the rabbi within the healing process. When Eber’s own 90-year-old mother was recently hospitalized, a visit from a young female rabbi made all the difference. “It was like a beautiful, warm wind that came through that room. It helped her turn the corner emotionally.”

By the same token, in this era of HMO’s and medical cutbacks, the rabbi must take up the slack for doctors who are too angry and confused to pay attention to a patient’s emotional state. Eber told the rabbis-to-be: “We need you because we’re not doing our job anymore. We’re treating people on conveyor belts. I don’t think people are getting bad care. I think they’re getting heartless care.”

It’s the rabbis, then, who need to put heart back into the medical system.

Karen Shahon, an HUC chaplaincy intern, talks with a patient at UCLA Medical Center. Photo by Peter Halmagyi