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Vital Signs

Media Mentions: DMS and DHMC in the News

Among the people and programs coming in for prominent media coverage in recent months was a Dartmouth expert on biological clocks. "Researchers have long known that bacteria, flies, worms, flowers, oak trees, and human beings all have tiny internal timepieces that keep them on a roughly 24-hour cycle, the time it takes the Earth to spin once on its axis," reported the Miami Herald. " 'Biological timekeeping is a core property of life on a revolving planet,' said Dr. Jay Dunlap, a biochemist at Dartmouth and the author of a book on the subject. 'Time organization is a vital part of the . . . normal functioning of every species.' "

Dr. Dean Ornish wrote in Newsweek about a recent study by Dr. Lisa Sutherland, a Dartmouth nutrition researcher. "I'd throw myself in front of a train if I thought it would save my son. Almost any parent would," Ornish wrote. "If that's true for you, then the results of a new study from Dartmouth might change your life, or at least your lifestyle. Researchers there used a toy grocery store to find out which foods preschool children would select when given a range of options. They found that children begin to assimilate and mimic their parents' food choices at a very young age (2!), even before they are able to fully appreciate the implications of these selections."

There is renewed talk nationally about health-care reform and thus increased coverage of the work of the Dartmouth Institute for Health Policy and Clinical Practice—including in the Wall Street Journal. " 'There's a growing sense of crisis that health care will be unaffordable . . . and that the little insurance we have will be increasingly worthless,' said Dr. Elliott Fisher, one of the main forces behind the Dartmouth Atlas, the bible of U.S. health-care irrationality." One reform effort should be aided by the economic stimulus bill. The Charlotte Observer reported that "some [stimulus funds] will be used for clinical trials making head-to-head comparisons of different treatments. . . . Dr. Elliott Fisher of Dartmouth Medical School said that new money would help researchers try to answer questions like these: Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise, and medications? What is the best combination of 'talk therapy' and prescription drugs to treat mild depression?"

The Associated Press (AP) talked to Dartmouth's Dr. David Axelrod about a recent study showing that the nationwide liver-transplant system may favor men over women. "The new system is based on three lab tests. Results are combined as a score that predicts a patient's risk of

death within three months. . . . 'One of the lab tests in the score may underestimate the severity of illness in women because of their smaller average size,' " Axelrod told the AP. " 'With a relatively minimal change, we can deal with that,' Axelrod said, suggesting a different weight-adjusted measurement."

The AP turned to another Dartmouth surgeon for a different story. "Patients often are ill-equipped to weigh increasingly complex medical options. Now there's a small but growing movement to get unbiased reports of the pros and cons of different tests and treatments into patients' hands," the AP reported. " 'No matter how hard I tried' to be objective, 'inevitably my personal biases got involved,' recalls breast surgeon Dr. Dale Collins of Dartmouth-Hitchcock Medical Center, which helped pioneer the concept that it calls shared decision-making. . . . At Dartmouth, every woman diagnosed with early-stage breast cancer now sees a . . . decision-aid video before meeting a surgeon."

"Aching backs . . . cost Americans more than $80 billion in health-care costs, time off from work, and other expenses," noted the Los Angeles Times. Surgery is a common treatment, the Times said, but "many physicians and surgeons are concerned that some of their colleagues may push expensive procedures because they have a stake in companies that produce the necessary equipment or devices," the paper said. "Dr. James Weinstein, a spinal surgeon at Dartmouth, cites as an example the metal cages for spinal fusion that came onto the market in 1996 and were touted to doctors in an aggressive ad campaign. Surgery rates soared."

"Prolonged use of low-dose aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) appears to reduce the risk of precancerous lesions that can lead to colorectal cancer," noted U.S. News & World Report. " 'It's increasingly clear, and arguably proven, that NSAID drugs do interfere with the development of cancer in the large bowel,' said study coauthor Dr. John Baron" of Dartmouth. " 'And this study . . . shows two things: One, if you take the NSAID drug for a while and then stop, you won't get a big rebound in terms of adenoma tumor risk. And two, if you don't stop taking an NSAID, but instead continue its use over time, the protective benefit will continue.'"

U.S. News & World Report also spoke—on the subject of preventive screenings—to Dartmouth's Dr. H. Gilbert Welch, the author of Should I Be Tested for Cancer? Maybe Not and Here's Why. "Experts generally agree that certain screening tests improve the overall health of the

population; blood pressure testing is one example. But there's controversy over the value of other tests." Welch told the magazine that "screening can, paradoxically, 'make the population less healthy because it leads to so many more diagnoses and to overtreatment.'"

Drs. Lisa Schwartz and Steven Woloshin were interviewed by the Chicago Tribune regarding their efforts to help the public understand health statistics. Schwartz told the newspaper that "drug ads and public service announcements often make 'strong claims about weak science. . . . People assume that whatever is being promoted works incredibly well, and that the problem is both common and dangerous.' " The Dartmouth researchers were also guests on National Public Radio's Talk of the Nation to promote their new book, Know Your Chances: Understanding Health Statistics. "We want you to understand what the numbers are behind the [health] message," Schwartz told host Ira Flatow, "and whether you should believe the numbers."

As runners from across Florida prepared recently for the Miami marathon, the Miami Herald wondered why anyone would voluntarily engage in 26.2 miles of vigorous exercise: "Isn't running a marathon a giant insult to the human body and mind?" The Herald spoke to "Dr. Kristine Karlson, of the Dartmouth-Hitchcock Sport Medicine Clinic," about some of the risks involved. "Runners who drink too little during a race can become dehydrated, which, at the extreme, can shut down a runner's kidneys, often with fatal results, says Karlson. 'It can also cause heat exhaustion.' " But, the article went on, "as counterintuitive as it seems to those who don't indulge, doctors, physiologists, and runners agree that the effects of marathon running are mainly positive. . . . 'Running is good for the heart and lungs because exercising any muscle makes it stronger,' " Karlson said.

The New York Times tapped Dr. Sohail Mirza, an orthopaedic surgeon, for comment on an increase in scanning. "In what is often an irresistible feedback loop," noted the Times, "patients who are in pain often demand scans hoping to find out what is wrong, doctors are tempted to offer scans to those patients, and then, once a scan is done, it is common for doctors and patients to assume that any abnormalities found are the reason for the pain." But some doctors have begun to include epidemiological data with scans. Mirza was quoted as saying that this is "very helpful information to have when talking to patients and very helpful for patients, to help them understand that the abnormalities were not catastrophic findings."

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