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Dartmouth Medicine Fall 2007

Dear Reporter, Editor, or News Director:

In the Fall 2007 issue of Dartmouth Medicine, read about:

Making choice an option: Dartmouth is home to the nation's first Center for Shared Decision Making. The concept is catching on at other medical centers, as well as with patients and payors. See page 38.

Prion promise: When a Dartmouth lab published the first report of the spontaneous generation of infectious prions, it was exciting news, because studying the infection process in a test tube may lead to insights into how such infections arise naturally and cause devastating brain disorders. See page 4.

A hive of activity: Instead of bringing patients with complex problems back for multiple appointments with assorted specialists, Dartmouth-Hitchcock is collecting a group of specialists together so patients can come in once and see everyone they need to on the same day. It makes for a busy day-but better care. See page 15.

Seeking understanding about ALS: Though 5,000 Americans a year are diagnosed with amyotrophic lateral sclerosis -a progressive, fatal neurodegenerative disease-little is known about its cause. But a pair of Dartmouth researchers published a recent paper suggesting an important role for a pro-inflammatory molecule. See page 7.

Turning on the immune system: The head of Dartmouth's Bone Marrow Transplant Program got promising results in a Phase I/II trial that boosted the immune systems of patients with multiple myeloma. After they received the standard treatment for the disease-an autologous stem-cell transplant-they were given two substances known to stimulate the production of immune cells. See page 8.

Putting folate to the acid test: Folic acid, a B vitamin, has been hailed for reducing the incidence of spina bifida and other defects in newborns. Some scientists thought it might also prevent colorectal cancer in adults. But a multisite, double-blind trial run from Dartmouth has dashed that hope. In fact, the results of the 10-year study suggest that folate may even foster adenomas, precursors of colorectal cancer. See page 6.

Tricks of the (teaching) trade: The Dartmouth Center for the Advancement of Learning has turned to members of Dartmouth's medical faculty for inspiration in effective ways to teach. The center's director likened medical rounds, for example, to "a martial arts dojo," where learners at all levels interact with each other. See page 13.

The money-medicine mess: A forum cosponsored by Dartmouth and the Mayo Clinic brought together a diverse group of experts to examine the current U.S. health-care payment system and propose some possible fixes. The attendees represented many sides of the issue-from academe to the insurance industry, from patient advocacy groups to big corporations-but nevertheless they were able to agree on some key precepts. See page 14.

Better care at less cost: The Dartmouth-Hitchcock Clinic was one of 10 physician groups chosen to participate in a demonstration project funded by the federal Centers for Medicare and Medicaid Services. In the project's first year, Dartmouth exceeded 9 out of 10 quality targets and saved the feds $2.8 million. See page 18.

The pharm-freebie-free team: Dartmouth-Hitchcock joined a select group of academic medical centers this year when it set a new policy prohibiting the acceptance of all gifts, meals, and other "freebies" from drug and device companies, no matter how trivial. See page 19.

To pursue any of these stories, contact the Dartmouth Medical School/Dartmouth-Hitchcock Medical Center Media Relations Office at 603-653-1913 or Jason.Aldous@Hitchcock.org.

Dana Cook Grossman

Editor

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Geisel School of Medicine at DartmouthDartmouth-Hitchcock Medical CenterWhite River Junction VAMCNorris Cotton Cancer CenterDartmouth College