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Vital Signs

Media Mentions

Among the people and programs coming in for prominent media coverage in recent months was DHMC's director of palliative medicine. "Dr. Ira Byock . . . says that physician-assisted suicide laws are really 'an apology for a failed medical system,'" noted Harper's magazine in an article about the right-to-die debate. "Byock advocates a change that he considers 'more controversial than assisted suicide,' " continued the article, "which is to require medical residents to do a rotation in palliative care and pain management" of at least 100 hours. "Physicians can graduate and be licensed and really have almost no training in pain management," Byock explained to Harper's.

"Fevered reaction to a recent warning from the National Institutes of Health that the over-thecounter painkiller Aleve might cause heart attacks may be overblown, some medical experts say," began a December Wall Street Journal article. One expert, "Dr. Elliot Fisher, director of health policy research at the Center for the Evaluative Clinical Sciences at Dartmouth, said he was troubled by the possibility that science wasn't behind the decision to halt the study and publicize the findings. 'I have not seen their numbers, but I would be disappointed if there were not careful thought given to the statistical significance of the differences that were found,'" he told the Journal.

"Toys that just light up, flash, or make noise for no reason may amuse very young children, but they don't foster development as well as toys that offer a cause-and-effect," began a January CBS News bulletin. "Those opinions come from one who should know, Dr. Carol Andrew, an occupational therapist and assistant professor of pediatrics at Dartmouth Medical School." Commented Andrew on CBS's Early Show, " 'We're very worried because there's a tremendous epidemic of children who are having difficulty learning language and having difficulty maintaining attention and, in part, we feel like it may be due to a lot of television and video exposure in the very young ages.' . . . Babies need to be challenged more, Andrew says."

The growing popularity of expensive, high-tech diagnostic scans prompted a federal advisory committee to suggest "that Medicare change the way it pays for such imaging tests, with an eye toward saving money," the Pittsburgh Post-Gazette reported. "The advisory committee studied whether Medicare recipients who received more scans . . . had better outcomes." They didn't. "That's not surprising to Dr. Jack Wennberg, director of the Center for the Evaluative Clinical Sciences at Dartmouth," the article said. "In general, increased spending on technology results in more tests being performed, not better outcomes for patients. ...'The people in high-cost, high-capacity regions have worse outcomes than those in low-cost, lowcapacity regions,' Wennberg said."

But more technology sometimes appears to be warranted. A recommendation from a federal task force was behind a bill introduced in Congress under which "most American men and women over 65 would be eligible to have Medicare pay for a simple ultrasound screening test for

potentially lethal abdominal aortic aneurysms," according to an article in the Wall Street Journal. " 'People with a family history, both sisters and brothers of people with aneurysms, are at the highest risk,' said Dr. Robert Zwolak, a Dartmouth Medical School professor of surgery who is leading the screening effort."

The New York Times reported on a brain-imaging study suggesting that people in persistent vegetative states may "in fact hear and register what is going on around them but be unable to respond." Experts warned that the new research "did not mean that unresponsive people with brain damage were more likely to recover," the Times noted, but "the study did open a window on a world that has been neglected by medical inquiry. 'This is an extremely important work, for that reason alone,' said Dr. James Bernat, a professor of neurology at Dartmouth." The Orlando Sentinel also turned to Bernat, for comment on a brain-damaged Florida woman kept alive against her husband's wishes. The Sentinel said that Bernat, the "former chair of the American Academy of Neurology's ethics committee, conceded physicians can only make reasonable judgments about a patient's awareness 'because we can't get into their minds.'"

A DHMC sleep specialist made the news several times in recent months. In the Pittsburgh Post-Gazette, "Dr. Michael Sateia, president of the American Academy of Sleep Medicine, noted that the American Academy of Pediatrics now recommends that pediatricians screen all children for snoring, which can be a sign of sleep problems. 'This is part of a growing recognition of the importance of healthy sleep and sleep disorders in childhood.' " Sateia was also quoted in the Los Angeles Times, on the danger of off-label antidepressant use to treat insomnia, and by United Press International (UPI), on the need for more research on insomnia. "Many challenges remain in the characterization, recognition, and treatment of insomnia," he told UPI.

In an article about consumer surveys of hospitals, the Wall Street Journal noted, "Dartmouth Medical School is also expanding distribution of its 'How's Your Health?' online survey, which has been used by groups including the military and state health departments for several years and will be offered more broadly through nonprofit and business groups to consumers later this year." Noted the Journal, "Dr. John Wasson, who developed the survey, says that users can also now create their own free portable medical record using the site."

"The years from 18 until 25 and even beyond have become a distinct and separate life stage, a strange, transitional never-never land between adolescence and adulthood, in which people stall for a few extra years." So said a recent Time magazine feature. Why are there so many twenty-somethings who refuse to grow up? the article wondered. "The human brain continues to grow and change into the early twenties, according to Dr. Abigail Baird, who runs the Laboratory for Adolescent Studies at Dartmouth. 'We as a society deem an individual at the age of 18 ready for adult responsibility,' " Baird told Time.

"'Yet recent evidence suggests that our neuropsychological development is many years from being complete.'"

In February, when the 2005 Academy Awards rekindled controversy over the way Hollywood glorifies smoking, the Associated Press noted that "a Dartmouth Medical School study last year found that children who watch movies in which actors smoke heavily are three times more likely to smoke themselves than those exposed to less on-screen smoking." Discover also referred to the research: " 'All things being equal, whether their friends or parents smoke, the amount of R-rated movie watching is a strong predictor of smoking among kids,' says Dr. James Sargent, the Dartmouth Medical School professor who led the study. . . . 'Kids imitate their heroes, and the movies supply heroes to kids.'"

Exploring why Spokane, Wash., "has one of the highest rates of hip replacement surgery in the nation, 50 percent higher than the national average," the Associated Press (AP) wrote that it "has more to do with the local doctors' preferences than with medical need, according to Dartmouth Medical School researchers who study regional variations in health care." AP went on to quote Dartmouth's chair of orthopaedic surgery. "Medicare pays for most hip replacements, which cost from $18,000 to $20,000, so regional variation is a public policy issue, said Dr. James Weinstein. . . . 'Joint replacement is one of the most effective procedures done in medicine,' Weinstein said. 'But just because it's really good, should it be overutilized?'"

A partnership between DHMC and an organization called the Upper Valley Trails Alliance caught the eye of the national press. "Just a few months old and already earning praise, the program involves several dozen doctors writing detailed, albeit symbolic, prescriptions for getting fit and then giving patients trail maps to accomplish it," wrote USA Today. " 'The idea is to make a more specific explanation,' said Dr. Charles Brackett, director of the program at Dartmouth- Hitchcock Medical Center in Lebanon, N.H. . . . Studies show that the more concrete a doctor's advice, the more likely a patient is to heed it."

"Is it possible that we place too much faith in pictures?" asked Malcolm Gladwell in the November issue of New Yorker magazine. He was referring to medical images and used mammography as one case in point. "Dr. Gilbert Welch," Gladwell wrote, "a medical-outcomes expert at Dartmouth, has pointed out that, given current breastcancer mortality rates, nine out of every thousand 60-year-old women will die of breast cancer in the next 10 years. If every one of those women had a mammogram every year, that number would fall to six. The radiologist seeing those thousand women, in other words, would read 10,000 x-rays over a decade in order to save three lives-and that's using the most generous possible estimate of mammography's effectiveness."

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