July 2010

For generations of pre-med students, three things have been as certain as death and taxes: organic chemistry, physics and the Medical College Admission Test, known by its dread-inducing acronym, the MCAT.

Students in Mount Sinai’s Humanities and Medicine Program at the Metropolitan Museum of Art.

So it came as a total shock to Elizabeth Adler when she discovered, through a singer in her favorite a cappella group at Brown University, that one of the nation’s top medical schools admits a small number of students every year who have skipped all three requirements.

Until then, despite being the daughter of a physician, she said, “I was kind of thinking medical school was not the right track for me.”

Ms. Adler became one of the lucky few in one of the best kept secrets in the cutthroat world of medical school admissions, the Humanities and Medicine Program at the Mount Sinai medical school on the Upper East Side of Manhattan.

The program promises slots to about 35 undergraduates a year if they study humanities or social sciences instead of the traditional pre-medical school curriculum and maintain a 3.5 grade-point average.

For decades, the medical profession has debated whether pre-med courses and admission tests produce doctors who know their alkyl halides but lack the sense of mission and interpersonal skills to become well-rounded, caring, inquisitive healers.

That debate is being rekindled by a study published on Thursday in Academic Medicine, the journal of the Association of American Medical Colleges. Conducted by the Mount Sinai program’s founder, Dr. Nathan Kase, and the medical school’s dean for medical education, Dr. Robert Muller, the peer-reviewed study compared outcomes for 85 students in the Humanities and Medicine Program with those of 606 traditionally prepared classmates from the graduating classes of 2004 through 2009, and found that their academic performance in medical school was equivalent.

“There’s no question,” Dr. Kase said. “The default pathway is: Well, how did they do on the MCAT? How did they do on organic chemistry? What was their grade-point average?”

“That excludes a lot of kids,” said Dr. Kase, who founded the Mount Sinai program in 1987 when he was dean of the medical school, and who is now dean emeritus and a professor of obstetrics and gynecology. “But it also diminishes; it makes science into an obstacle rather than something that is an insight into the biology of human disease.”

Whether the study’s findings will inspire other medical schools to change admissions requirements remains to be seen.

Because MCAT scores are used by U.S. News and World Report and others to rank schools, the most competitive ones fear dropping the test, admissions officials said. And at least two recent studies found that MCAT scores were better than grade-point averages at predicting performance in medical school and on the series of licensing exams that medical students and doctors must take.

“You have to have the proper amount of moral courage to say ‘O.K., we’re going to skip over a lot of the huge barriers to a lot of our students,’ ” said Dr. David Battinelli, senior associate dean for education at Hofstra University School of Medicine.

But, Dr. Battinelli added, “Now let’s see how they’re doing 5 and 10 years down the road.” The Mount Sinai study did not answer the question.

There are a few other schools in the United States and Canada that admit students without MCAT scores, but Mount Sinai appears to have gone furthest in eschewing traditional science preparation, said Dr. Dan Hunt, co-secretary of the Liaison Committee on Medical Education, the medical school accrediting agency.

The students apply in their sophomore or junior years in college and agree to major in humanities or social science, rather than the hard sciences. If they are admitted, they are required to take only basic biology and chemistry, at a level many students accomplish through Advanced Placement courses in high school.

They forgo organic chemistry, physics and calculus — though they get abbreviated organic chemistry and physics courses during a summer boot camp run by Mount Sinai. They are exempt from the MCAT. Instead, they are admitted into the program based on their high school SAT scores, two personal essays, their high school and early college grades and interviews.

The study found that, by some measures, the humanities students made more sensitive doctors: they were more than twice as likely to train as psychiatrists (14 percent compared with 5.6 percent of their classmates) and somewhat more likely — though less so than Dr. Kase had expected — to go into primary care fields, like pediatrics and obstetrics and gynecology (49 percent compared with 39 percent). Conversely, they avoid some fields, like surgical subspecialties and anesthesiology.

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Frozen mice sold as reptile food have been linked to hundreds of cases of salmonella in the United States and Britain.

Take mice from freezer. Thaw (but not in the microwave, please). Feed to pet snakes.

“Snakes got to eat,” said Steve Gilfillan of Council Bluffs, Iowa, who buys frozen mice by the thousands for his pet reptiles.

And do not forget to wash your hands.

That is the message from public health officials in the wake of salmonella outbreaks that have sickened more than 400 people, many of them snake owners or their children, in the United States and Britain.

The illnesses have been traced to frozen mice sold over the Internet as food for exotic pets by a small Georgia company called MiceDirect.

The company announced this week a recall involving millions of frozen mice and said that it would begin irradiating future shipments to kill infectious bacteria. MiceDirect also recalled frozen rats and baby chickens used as pet food by reptile fanciers, although those products had not been linked to the salmonella outbreaks.

The recall drew back the curtain on a world of exotic pet enthusiasts for whom there is nothing unusual about keeping a dozen snakes in the living room and a few zippered bags of mice in the freezer.

“It’s so much more convenient for the reptile keeper to have a bag of rodents in their freezer,” said Justin Kobylka, who raises and sells pythons in Toccoa, Ga., not far from the breeding operation of MiceDirect in Cleveland, Ga.

Buying frozen rodents saves repeated trips to the local pet shop to buy live mice, he said, and it spares squeamish owners from having to watch pets kill their prey. “Some people aren’t ready to make that leap,” Mr. Kobylka said.

Health officials said that owners of reptiles should be mindful that such pets, including snakes and turtles, often carry salmonella and have been the cause of outbreaks in the past. Rodents carry similar risks, whether kept as pets or used as food for other animals. In humans, salmonella typically can cause diarrhea, vomiting and stomach cramps.

Snakes can become infected after eating tainted mice, although the snakes may show no signs of illness, said Dr. Casey Barton Behravesh, a veterinarian and epidemiologist with the Centers for Disease Control and Prevention. Snake owners can become sick from handling the frozen or thawed mice, handling infected snakes or cleaning feces from an enclosure.

Steve Gilfillan, a deputy sheriff in Council Bluffs, Iowa, keeps “a couple hundred” garter snakes in several neat rows of roomy enclosures in his basement. The snakes, he said, are like part of the family, which leads to a certain familiarity.

“As far as precautions, I don’t know,” said Mr. Gilfillan, 51, who said his three children helped feed and care for his pets. “Snakes got to eat and snakes got to poop and you got to clean it up. It’s just the nature of keeping them.”

Mr. Gilfillan said he bought 10,500 mice from MiceDirect early this year, delivered to his door. He keeps them in the freezer compartment of a basement refrigerator. He said he had not heard about the recall until a reporter called him on Wednesday.

“I never thought that a mouse could have salmonella,” he said. “It just never entered my mind.”

Mr. Gilfillan and many other snake owners thaw mice to serving temperature in warm water. Dr. Barton Behravesh said people should not use a microwave oven, because the bacteria could spread to other food.

She also said that mice and reptiles should be kept out of the kitchen and away from areas where food is served. Reptile cages should not be cleaned in the kitchen sink, she said, and mice should not be kept in a freezer with food for humans.

And she said that reptile owners should wash their hands thoroughly after handling their pets or the rodents the pets eat.

The first salmonella outbreak linked to MiceDirect began in Great Britain in August 2008. Since then, more than 400 people have fallen ill there, about two-thirds of them have been children under 10, according to Chris Lane, a senior epidemiologist of the Health Protection Agency’s Center for Infections in London. Although the shipments of tainted mice were halted last year, people continue to get sick there, Mr. Lane said.

The first case in the United States appeared in January 2010, according Dr. Barton Behravesh. The C.D.C. has identified more than 30 cases in 17 states with the same strain as the British outbreak. She said the cases were not concentrated in one region but spread across the country. Half the victims were under 12.

Accounts from both sides of the Atlantic suggest that American authorities were slow to react to indications of a problem.

British investigators looking into the outbreak found that many of the victims came from families where snakes were kept as pets. They eventually began looking at the frozen mice fed to the snakes and found shipments from MiceDirect that contained the same strain of salmonella as that isolated from the victims.

British officials contacted MiceDirect, Mr. Lane said, and the company promised to act to prevent further contamination.

Kristen Nordlund, a C.D.C. spokeswoman, said the British officials told the agency in May 2009 of the outbreak there and the connection to MiceDirect.

She said that the C.D.C. found no cases of infection in the United States at that time. But it did tell the Food and Drug Administration, which regulates pet food companies like MiceDirect, about the British investigation.

This spring the C.D.C. became aware of reports of salmonella and began an inquiry.

Siobhan DeLancey, an F.D.A. spokeswoman, said the agency was checking to see if it had a record of the 2009 contact from the C.D.C.. She said the F.D.A. was not told of the American outbreak until May and that investigators did not establish a likely connection with MiceDirect until the beginning of July.

It was not until July 6, however, that officials of the two agencies went to MiceDirect to conduct an inspection, according to a timeline provided by the F.D.A.

On July 21, the F.D.A. told the company that tests of its products and plant had found salmonella. Two days later, the agency said, MiceDirect agreed to a recall.

But the recall effort has been haphazard. The company’s recall notice was not prominently posted on its Web site until Thursday. And neither the company’s site nor the F.D.A.’s site gave clear instructions on what to do with mice that customers still had.

The owners of MiceDirect, John Callaham and Heath Biggers, did not return repeated phone calls from a reporter. In response to e-mails, they would not discuss details of the business but said affected customers should ship back unused products or destroy them.

Mr. Kobylka, the python breeder, is a friend of the company’s owners, and he posted a video of the operation on YouTube in February, showing a vast warehouse with row upon row of trays containing breeding mice and their babies. In the video, Mr. Biggers says the warehouse produces 80,000 mice a week. The recall covers more than a year’s production but the company did not say how many mice it had sold in that time.

Mr. Lane said the outbreak has persisted in Britain, perhaps because snake owners, unaware of the dangers, continue to use mice kept in their freezers.

“Bacterial infections don’t have borders,” Mr. Lane said. “Things can become contaminated and be exported very easily.”

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The vegetables that flavor this dish are cooked separately, then simmered for another 30 minutes with the beans. For added flavor, add a Parmesan rind when you cook the beans, or add it during the final simmer as instructed below. In summer, the dish is enjoyable just slightly warmed.

Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat.

1 pound Christmas limas or large white limas, cooked

2 tablespoons extra virgin olive oil

1 medium onion, finely chopped

1 medium carrot, diced

1 stalk celery, diced

Salt to taste

2 to 4 garlic cloves, finely chopped

1 pound ripe tomatoes, peeled, seeded and diced; or 1 can (14 ounces) diced tomatoes, drained

Freshly ground pepper

1 Parmesan rind (optional)

2 tablespoons slivered basil

Freshly grated Parmesan for serving (optional)

1. Bring the beans to a simmer over medium-low heat.

2. Heat the olive oil over medium heat in a medium saucepan or nonstick skillet, and add the onion, carrot and celery. Cook, stirring, until tender, five to eight minutes. Add the garlic and a generous pinch of salt, and continue to cook, stirring, until the garlic is fragrant, 30 seconds to a minute. Add the tomatoes, and turn up the heat slightly. Cook, stirring often, until they have cooked down to a fragrant sauce, 10 to 15 minutes. Season to taste with salt and pepper, and stir into the beans. Add the Parmesan rind, turn the heat to low, cover and simmer 30 minutes, stirring from time to time. Taste and adjust seasonings. Remove the Parmesan rind, stir in the basil and serve.

Yield: Serves four to six.

Advance preparation: The ragout will keep for five days in the refrigerator and freezes well.

Nutritional information per serving (four servings): 429 calories; 8 grams fat; 1 gram saturated fat; 0 milligrams cholesterol; 69 grams carbohydrates; 23 grams dietary fiber; 33 milligrams sodium (does not include salt added during preparation); 24 grams protein

Nutritional information per serving (six servings): 286 calories; 5 grams fat; 0 grams saturated fat; 0 milligrams cholesterol; 46 grams carbohydrates; 15 grams dietary fiber; 22 milligrams sodium (does not include salt added during preparation); 16 grams protein

Martha Rose Shulman can be reached at martha-rose-shulman.com.

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Sanofi-Aventis is likely to make an unsolicited offer of up to $70 a share for Genzyme, raising the stakes for what could become one of the year’s biggest deals, people briefed on the matter said Wednesday.

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Sanofi’s board met on Wednesday and agreed to let management make a formal proposal, one of these people said. At $70 a share, Sanofi’s bid would be worth about $18.6 billion.

Sanofi would most likely issue a bear hug letter that would outline its proposed bid, these people said. Such a letter is friendly on its surface, but signals a willingness to go hostile if necessary.

Such a move could put pressure on Genzyme’s directors, some of whom have been more receptive to Sanofi’s informal approach than others, these people said. A bear hug letter could also rally Genzyme shareholders.

Genzyme’s shares have climbed about 26 percent since reports surfaced last Friday of Sanofi’s approach.

Sanofi approached Genzyme earlier this year about a potential combination, one that would bolster Sanofi’s drug pipeline and significantly increase its presence in biopharmaceuticals.

Adding Genzyme, one of the four largest biotechnology companies and a maker of vaccines for genetic disorders, would be one of Sanofi’s largest deals to date. Genzyme’s market value last Thursday was about $14.5 billion, the day before reports of Sanofi’s approach.

If Sanofi continues to pursue Genzyme, it will need to deal with two formidable activist investors who have stakes in the biotech company: Carl C. Icahn and Ralph Whitworth, both of whom have representatives on the Genzyme board. Both have pushed Genzyme to take steps to increase its stock price.

Genzyme makes drugs like Cerezyme, a treatment for Gaucher’s disease, and Fabrazyme, for Fabry disease.

The company has struggled to improve its stock performance after it battled a viral contamination problem at its main production plant in Boston last year.

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Elizabeth Roach’s health is remotely monitored by her son. A screen on her end in Virginia displays e-mail, photos, games and her blood pressure.

IN the wee hours of July 14, Elizabeth Roach, a 70-year-old widow, got out of bed and went to the living room of her Virginia ranch home. She sat in her favorite chair for 15 minutes, then returned to bed.

Michael Murdoch remotely tracks the well-being of his mother, Elizabeth Roach, from his home in Aurora, Colo.

She rose again shortly after 6, went to the kitchen, plugged in the coffee pot, showered and took her weight and blood pressure. Throughout the morning, she moved back and forth between the kitchen and the living room. She opened her medicine cabinet at 12:21 and closed it at 12:22. Immediately afterward, she opened the refrigerator door for almost three minutes. At 1:36, she opened the kitchen door and went outside.

All this information — including her exact weight (126 pounds) and blood pressure reading (139/98) — was transmitted via the Internet to her 44-year-old son, Michael Murdock, who reviewed it from his home office in suburban Denver.

All was normal — meaning all was well.

“Right now she’s not home,” Mr. Murdock said. That he deduced because the sensors he had installed throughout his mother’s home told him that the kitchen door — which leads outside — had not been reopened since 1:36, more than an hour earlier. The opening of the medicine cabinet midday confirmed to him that his mother had taken her medicine. And he was satisfied that she had eaten lunch because the refrigerator door was open more than just a few seconds.

In the general scheme of life, parents are the ones who keep tabs on the children. But now, a raft of new technology is making it possible for adult children to monitor to a stunningly precise degree the daily movements and habits of their aging parents.

The purpose is to provide enough supervision to make it possible for elderly people to stay in their homes rather than move to an assisted-living facility or nursing home — a goal almost universally embraced as both emotionally and financially desirable. With that in mind, a vast spectrum of companies, from giants like General Electric to start-ups like iReminder of Westfield, N.J., which has developed a system to notify families if loved ones haven’t taken their medicine, are looking for a piece of the market of families with an aging relative.

Many of the systems are godsends for families. But, as with any parent-child relationship, all loving intentions can be tempered by issues of control, role-reversal, guilt and a little deception — enough loaded stuff to fill a psychology syllabus. For just as the current population of adults in their 30s and 40s have built a reputation for being a generation of hyper-involved, hovering parents to their own children, they now have the tools to micro-manage their aging mothers and fathers as well.

Wendy A. Rogers, a psychology professor at Georgia Tech, who has studied such systems and seniors’ reactions to them, recalled a man who went into high alert when a sensor system showed a high level of activity in a room of his mother’s home. He called her to find out what was wrong — and it turned out that she had decided to paint the sunroom.

“I think the critical question is: Is this something the parent wants?” said Nancy K. Schlossberg, a counseling psychologist and professor emerita at the University of Maryland. She compared monitoring technology for elderly people to the infamous “nanny cams” — hidden cameras some parents use to spy on their children’s baby sitters. “Big Brother is watching you — there’s something about it that’s very offensive,” she said.

The decision, she said, must ultimately be made by the aging parent. “It has to be negotiated with the parents,” Dr. Schlossberg said. “You want to keep the relationship co-equal. If it’s not an agreement with the parent, it can be a very destructive thing.”

The system Mr. Murdock persuaded his mother to install is called GrandCare, produced by a company of the same name based in West Bend, Wis. It allows families to place movement sensors throughout a house. Information — about when doors were opened, what time a person got into and out of bed, whether there’s been any movement in a room for a certain time period — is sent out via e-mail, text message or voice mail. He said his GrandCare system cost $8,000 to install — about as much as two months at the local assisted-living facility, Mr. Murdock said — plus monthly fees of about $75. The company says that costs vary depending on what features a client chooses.

In addition to giving him peace of mind that his mother is fine, the system helps assuage that midlife sense of guilt. “I have a large amount of guilt,” Mr. Murdock admitted. “I’m really far away. I’m not helping to take care of her, to mow her lawn, to be a good son.”

His mother, Mrs. Roach, was nervous at first when her son brought up the idea of using the system. “I didn’t want to be invaded,” she said. “I didn’t understand the system and was concerned about privacy.” Now that it’s in place, she said, she’s changed her mind: “I was all wrong. I’m not feeling like I’m being watched all day.” And she really enjoys the system’s feature that lets her play games and receive photos and messages from her children and grandchildren. (She never learned to use e-mail.)

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