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Media Mentions: DMS and DHMC in the News

Among the people and programs coming in for prominent media coverage in recent months was Professor of Psychiatry Matthew Friedman, M.D., Ph.D. When the New England Journal of Medicine published a study showing that, as USA Today put it, "nearly one out of five combat soldiers are leaving Iraq with a mental health problem, such as post-traumatic stress disorder," newspapers nationwide turned for expert commentary to Friedman, the executive director of the Veterans Affairs National Center for Post-Traumatic Stress Disorder. "Today's returning soldiers may recover more easily than Vietnam veterans," continued USA Today, "because the latter were more vilified at home, says psychiatrist Matthew Friedman." He was quoted in the Atlanta Journal- Constitution, too: "'The most disturbing thing, in my opinion, is the stigma, and people who are most severely affected are the ones least likely to seek treatment,' Friedman said." The New York Times and Wall Street Journal were among the other papers seeking his insight.

"Nothing to cough at" was the headline on a story on ABC.com about the "alarming resurgence" of whooping cough. "Whooping cough, or pertussis, is a highly contagious bacterial infection characterized by violent coughing fits. . . . 'Whooping cough is the only vaccine-preventable disease that has not been completely controlled by routine childhood immunization,' according to Dr. John Modlin, chair of pediatrics at Dartmouth. And officials now realize the need for added measures against the disease." Modlin recently stepped down after many years as chair of the federal Advisory Committee on Immunization Practices.

A faculty member who is coeditor of the Journal of Vascular Surgery found himself, and his journal, in the public eye recently. Here's what happened: Several researchers at the Food and Drug Administration (FDA) submitted a study about a stent graft—a device used to treat aneurysms— that was published in the journal's online edition. Then the device's manufacturer raised objections about the paper, and the FDA asked the journal to withdraw it. In the August issue of the journal's print edition, the editors refuted the manufacturer's claim that the paper contained confidential commercial information. The controversy was then explored in a long feature in the Wall Street Journal: "The paper concluded that by three years or more after treatment, the mortality rate for patients getting the AneuRx [stent graft] probably exceeded that for surgical patients. . . . 'As editors, we are responsible for preserving the rights of authors to communicate appropriately reviewed scientific information and for preventing corporate in- fluence of this process,' said Jack Cronenwett, a professor at Dartmouth and one of the editors of the journal. 'In this case we were unable to do so.'"

As many as 10 million women who have had their cervix removed are still getting routine Pap smears —the test used to screen for cervical cancer. The irony of the finding caught the attention of the Associated Press, the New York Times, the Today Show, and USA Today. Dr. Brenda Sirovich, an assistant professor of medicine who is based at the VA Medical Center in White River Junction, Vt., was the lead author of the paper. Reported USA Today: "While these tests are relatively inexpensive, these women are undergoing uncomfortable exams, doctors are being distracted from more important matters, and lab specialists are spending needless time analyzing specimens, Sirovich said." (See page 3 for more on her study.)

An opinion piece in the Boston Globe questioning the wisdom of a technological solution for every medical problem buttressed its argument with research from Dartmouth. Dr. Darshak Sanghavi, a clinical fellow at Harvard, urged expectant mothers to "decide whether EFM [electronic fetal monitoring] is right for them" rather than simply accepting it if it's offered. Then he gave a case in point: "At Dartmouth, for example, researchers had some patients who were considering back surgery watch a video about the operation's risks and benefits. Presumably better informed because of the video, the patients had 30% fewer surgeries. That doesn't mean that surgery was totally unnecessary— but that education empowers people to make personalized choices based on their own risk tolerance. Similar innovative strategies are needed" with EFM, he said. "Otherwise many mothers may choose an ounce of prevention—without sometimes realizing it can cause a pound of hurt."

In June, Dr. Gilbert Welch, a professor of medicine, faced off on NBC's Today Show against Dr. William Catalona of Northwestern University regarding the benefits and harms of prostate-cancer screening. Welch, the author of Should I Be Tested for Cancer? Maybe Not and Here's Why, recommends caution when it comes to cancer testing. Catalona, however, advocates widespread use of the prostate specific antigen (PSA) test, which has been shown recently to be less accurate than once thought. "It's important that we understand that cancer testing in general is a double-edged sword," Welch said on Today. "Tests like the PSA have made us rethink the nature of the word 'cancer.' We all think of cancer as sort of an aggressive disease that will kill you if you're left untreated. But there's another type of cancer, small collections of abnormal cells that will never bother patients in their lifetime. And the problem with cancer testing is we identify and treat these cells and subject [people] to the dangers of treatment."

"The dirty little secret about Social Security is that it's too small to transform the fiscal future. For all the books and seminars devoted to the subject, it is a side show" to the growth in the economy and in spending on health care, concluded the Washington Post in an editorial on current federal fiscal policies. "The United States currently spends 15% of GDP on staying well, fully six percentage points more than the average rich economies," wrote the Post. To support its argument that health care presents the greatest opportunity for economic reform, the Post noted that "Elliott Fisher of Dartmouth Medical School has demonstrated that some parts of the country spend twice as much as others per Medicare patient, even after adjusting for regional differences in patients' health status and the cost of medical care. Moreover, Dr. Fisher has shown that low-spending areas produced health outcomes at least as good as those in highspending ones. If all regions could emulate the most efficient fifth of the country, the cost of Medicare would fall by 30%."

In 2001, pediatricians were urged by the American Academy of Pediatrics "to relieve needless suffering by better anticipating and assessing pain, creating soothing environments in their offices, and getting parents more involved," explained a recent story in the Los Angeles Times. "A generation ago, many health-care providers bought into the misconception that children don't feel pain as adults do. But youngsters deserve—and parents now expect—better, said Dr. Joe Cravero, [director of the PainFree Program at the Children's Hospital at Dartmouth]. 'There's no reason a kid needs to be crying and screaming in the hospital,' he said. 'If you or I come in for an appendectomy, we get the anesthesia we need.'"

A DMS study showing a correlation between adolescent smoking and R-rated movies received sweeping press coverage this summer, including in the New York Times, the International Herald Tribune, and the Wall Street Journal. "The results are striking. Parents really can make a difference," pediatrician James Sargent, M.D., the lead author of the study, told the Toronto Star. The New York Times also reported on a substance abuse symposium that featured Sargent and research he's conducting on a similar correlation between movies and alcohol. "Dr. James Sargent . . . said his research shows that middle school students in Vermont and New Hampshire who watched lots of movie scenes depicting alcohol use were more than three times as likely to try drinking than those with little exposure. Although previous studies had looked at whether advertising affected teenagers' drinking behavior— with conflicting results—no one had ever looked at the impact of the entertainment industry, Sargent said."

Associated Press reported recently on "a hormonal disorder that some experts estimate affects as many as one in 10 women in this country" but that is often misdiagnosed —polycystic ovarian syndrome (PCOS). "It affects not only the body's reproductive function, but also many metabolic processes. . . . 'It's been around for a long time,' said Dr. Neal Mahutte, a reproductive endocrinologist at Dartmouth-Hitchcock Medical Center. 'But during the last 10 years it's become clearer that this is more than a reproductive disorder.' . . . According to Mahutte, weight management is often the linchpin in treatment. But he stressed that one-size treatment does not fit all: Not every woman who suffers from the syndrome is overweight. Not every woman will benefit in the same way from treatment, he said. 'It's easy to miss the syndrome.'"

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