Media Mentions: DMS and DHMC in the News
Among the people and programs coming in for prominent media coverage in recent months was the author of a book titled Should I Be Tested for Cancer? Maybe Not and Here's Why. Reported the Canadian National Post: "Dr. Gilbert Welch knows his ideas border on blasphemy. . . . He says our unbridled, uncritical enthusiasm for cancer screening is not supported by science." The New York Times wrote: "Although Dr. Welch does not suggest that symptoms be ignored or that tests not be run, he does argue there is another side to trying to find cancer early. 'It can also hurt,' he writes. 'Tests can be wrong . . .'" And said the Times of London: "'My point is not that you should never be tested for cancer,' says Welch. 'A woman with a breast lump or a man with a mass on his testicles should be scanned at once. But if you are apparently healthy, the benefits are not nearly as clear as scanning supporters make out.'"
At the same time, a promising new method of detecting breast cancer was making the news. "Researchers at Dartmouth Medical School found new tests that measure water, oxygen, and other breast tissue properties are better able to detect cancerous tumors than mammograms," reported the CBS Morning News. The Canberra Times of Australia also reported on the new method, explaining that mammograms can "fail to distinguish between cancerous tumors and other thick matter, raising the risk of false positives." But, noted the Irish Times, "the study's lead author, Dr. Steven Poplack, said commercial versions of their tests were at least 10 years away." That's because, reported CNN.com, "'It's very important to know what normal is before you can begin to characterize what abnormal is,' Poplack, a radiology professor at Dartmouth, said in an interview."
An investigation by the federal government into the possibility that a bag of donated blood had been mislabeled was the subject of a story in the Atlanta Journal-Constitution. "Between one dozen and two dozen people in the United States die annually because they receive the wrong type of blood, usually in emergency and operating rooms because of staff mistakes, said Dr. James AuBuchon of Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and a board member on the American Association of Blood Banks. Infusing the wrong type of blood into a person can kill them quickly. . . . 'It can happen within minutes of a transfusion,' AuBuchon said, 'although it's not necessarily recognized right away.'"
"A simple ultrasound" to screen for "ruptureprone bulges called abdominal aortic aneurysms" has a proponent at Dartmouth, according to the Wall Street Journal: "Studies in Europe and the U.S. have shown that aneurysm screening saves lives and is economical," but "the federal Medicare insurance program doesn't pay for it. That may change. . . . 'Now, Medicare won't pay for aneurysm screening without signs and symptoms,' says Dartmouth Medical School vascular surgery professor Robert Zwolack, an organizer of the effort. 'But 99% of patients don't have signs and symptoms until they begin to rupture,'" he added.
The entire Sunday New York Times Magazine on April 18 was devoted to the subject of health care. And Dartmouth's eminence in the health-policy field came in for mention in the issue's cover article, by Senator Hillary Rodham Clinton. "A lot of the money Americans spend is wasted on care that doesn't improve health. A recent study by Dartmouth researchers argues that close to a third of the $1.6 trillion we now spend on health care goes to care that is duplicative, fails to improve patient health, or may even make it worse." The study she cited was the work of Dr. Elliott Fisher.
American Medical News, a weekly newspaper published by the American Medical Association, carried a recent feature on "shared decision-making . . . a trend that appears poised to follow informed consent as an important standard of care." The article quoted physicians at a few institutions that have established shared decision- making centers, including DHMC. Dr. Brooke Herndon said she refers patients to Dartmouth's Shared Decision-Making Center "especially when explaining prostate-cancer screening or screening for ovarian cancer- both of which can raise more questions than they answer. 'I'll initiate the discussion at a visit and ask patients to [look at material from the center] and then get back to me and we'll talk more,' Dr. Herndon says. Research has shown that follow-up discussions are greatly sharpened and focused when decision aids are used to cover the basics."
The Providence Journal wrote about "a trend that is being seen at small hospitals across the country"-no longer allowing vaginal births after a cesarean (VBAC), in other words, prohibiting women who have had Csections from delivering subsequent babies vaginally. The paper said some regions "have taken active steps to preserve this choice. The best example is the Northern New England Perinatal Quality Network [formed] three years ago [in Vermont and New Hampshire] when two baby doctors noticed more and more small hospitals were banning VBACs. That year, half of 35 hospitals in the two states no longer performed VBACs, said Dr. Michele Lauria, one of the founders of the network." (See page 20 in this issue for more on the project.)
The use of high-dose steroids to promote a muscular appearance, among both athletes and nonathletes, impelled the Dallas Morning News to explore the risks of anabolic steroids: "For example, megadoses of steroids clearly influence the activity of the brain molecule serotonin, involved in mood and aggression, Dartmouth steroid researchers Ann Clark and Leslie Henderson reported last year in Neuroscience and Behavioral Reviews. And the evidence indicates that steroid use alters the activity of a broad range of other signaling molecules in the brain."
The Wall Street Journal reported recently on an effort to integrate the concepts of palliative care into the nation's intensive care units, "which are largely dedicated to keeping patients alive-at any cost, discomfort, or prognosis. . . . 'We have lots of anecdotal evidence of people being kept on ventilators far longer than anybody feels is reasonable, mostly because nobody on the clinical team has had a discussion with the family,' says Dr. Ira Byock." He is the director of palliative care at DHMC and principal investigator of the nationwide Robert Wood Johnson Foundation's Promoting Excellence in End-of-Life Care Program.
A Dartmouth epidemiologist (and the subject of Dartmouth Medicine's Spring 2004 "Faculty Focus" profile) is a noted authority on the risks and benefits of aspirin. BBC News reported on a study by Harvard researchers that "regular long-term use of aspirin may be associated with an increased risk of pancreatic cancer. . . . The study was published in the Journal of the National Cancer Institute. In an accompanying editorial, Dr. John Baron of Dartmouth Medical School in New Hampshire said, 'There are no easy answers to the question of what aspirin and other NSAIDs [nonsteroidal anti-inflammatory drugs] do to pancreatic carcinogenesis. These findings are provocative and force us to think carefully.'"
The New York Times reported on differences of opinion about in vitro fertilization (IVF) and other methods of assisted reproduction among the 18 members of the President's Council on Bioethics. Five members of the panel, including Michael Gazzaniga, a Dartmouth neuroscientist, recently made public some of their concerns, said the Times. "'I have never understood why IVF work is being singled out for regulation and epidemiological analysis,' Dr. Gazzaniga said in an interview."
"Memory Loss in Chemotherapy Patients" was the headline on a Wall Street Journal story about an issue that is getting increasing attention. "Studies of breast-cancer patients show that nearly two-thirds of women treated with chemo develop some level of cognitive problems, though most recover on their own in the weeks or months after treatment stops. Still, as many as 20% to 25% of patients may develop lasting [memory] problems, says Tim Ahles, director of the Center for Psycho-oncology Research at Dartmouth Medical School, which has led most of the research on the subject."
Dr. John Birkmeyer, an adjunct professor of medicine and a nationally known expert on prevention of medical errors, was cited in Time magazine: "Surgeons who have performed a high number of certain difficult procedures have significantly better success rates than those who haven't, according to . . . Dr. John Birkmeyer." He was also interviewed, on National Public Radio's Morning Edition, regarding computerized prescription-writing systems. "One of the advantages of a computer order entry system," said Birkmeyer, "is to make sure the patients get the right drug. Doctors are not especially famous for the clarity of their handwriting. By making them type in their orders, the pharmacist isn't forced to guess the drug that was actually ordered."
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