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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 surgeon who is leading a major back-surgery
study known as SPORT (Spine Patient Outcomes
Research Trial). In May, results comparing surgical
and nonsurgical treatment of spinal stenosis
were released. "Ateamled by James Weinstein of Dartmouth
Medical School in New Hampshire found
that fusing the bones to treat this degenerative
spondylolisthesis typically works
better than nonsurgical treatment,"
CNN.comreported. The
Los Angeles Times wrote, "'With
the results of this study, we can
now discussmuchmore fully the
surgical and nonsurgical options
available to our patients so that
they can make an informed choice,' Weinstein
said." CBS News commented on the first SPORT
study, released last year, saying that "Weinstein's
previous research on another common back problem—the herniated disc—showed surgery is not
necessarily better than other therapy. 'The question
we have to ask is are we actually making
those patients better?' Weinstein asks. 'And is
spending more money for all of these spine operations
making a difference in our health of our
country? I'm not convinced it is.'" (For more on
the latest SPORT study, see this article.)
In a CBS Morning News story on Medicare's plan
to "begin posting hospital scorecards on the web,"
reporterWyatt Andrews talked to an orthopaedic
surgeon at DHMC, where surgery
results have been posted on
the institution's website for
some time. "Dr. William Abdu says
the information has led to fewer
back surgeries," saidAndrews.
"Because we're basing our decisions
on patient preference, not
on surgeon preference," Abdu commented. "The
patients are educated about their options and
their outcomes based on those options."
Presidential candidate Hillary Clinton's visit to DHMC in August attracted media attention from all over the country. "Almost 15 years ago, First Lady Hillary Clinton came to Dartmouth-Hitchcock Medical Center to help launch the push for universal health-care coverage," wrote the Chicago Tribune. "Now years later, the former first lady is running for president and it was deja vu all over again as she returned to this state's premiere teaching hospital Thursday in her continued quest for a system of universal health care." The Wall Street Journal noted that "the New York Senator addressed about 200 health professionals, many of them in their white coats."
The Associated Press reported in June that a study
that found "high doses of folic acid do not prevent
precancerous colon polyps in people prone to
them and may actually increase
the risk of developing the
growths . . . surprised scientists.
Previous studies showed diets
low in folic acid led to a higher
risk of colon cancer. . . . 'You really
should not take folic acid to
prevent colorectal adenomas.
It's ineffective for that purpose,' said study coauthor
Bernard Cole of Dartmouth-Hitchcock Medical
Center." See this article for more on the study.
"Diabetics who are frustrated by clunky needles
and syringes are getting an injection of sleek new
devices called insulin pens," according to an article
in the Wall Street Journal. But
the new-fangled gadget hasn't
won over everyone. "Some doctors
say they still prefer syringes
because they're used to them
and don't know much about the
pens," observed the article,
which then quoted "Joel Lazar, a
family doctor and assistant professor of community
medicine at Dartmouth Medical School in
New Hampshire. 'In primary care, we have our
antenna up that when something is repackaged,
it's a marketing gimmick,'" Lazar said.
The Dartmouth Atlas of Heath Care, created by Dr. John Wennberg, got described in rather glowing terms recently. In an article on health-care costs, the New York Times explained that to get the statistics for the "wonderful Dartmouth Atlas, . . . researchers adjust the numbers to take into account age, race and sex, which is another way of saying that there is no good explanation for the huge variations they find." And the Atlas's website was recommended in a Wall Street Journal story on hospital selection as "a gold mine of information comparing hospital practices across regions and states."
In an Associated Press piece on recruiting,
training, and retaining rural doctors, "Dr.
Donald Kollisch of the Rural
Health Scholars program
at Dartmouth College in
New Hampshire said the
ratio of patients to doctors
is about twice as high in
rural areas as it is in urban
areas nationwide. He said
rural areas account for about 20 percent of
the country's populations but only have 10
percent of the nation's doctors."
A Discover magazine article on the spontaneous
remission of cancer included the story
of a Dartmouth patient—John, a 30-yearold
with cancer that had spread to his lung.
"His oncologist, Joseph O'Donnell, . . . urged him
to undergo immediate treatment." But John
"didn't follow his doctor's recommendation.
Instead, he took a month off to strengthen
his body for the treatment that he knew
wouldmost likely be a grueling
ordeal. He went on
long hikes in the mountains,
he ate healthy foods,
and he meditated." When
"O'Donnell repeated the
chest x-ray . . . instead of
the large cancerous lesion
in [the] lung, he saw . . . nothing. O'Donnell
recalls, 'When John came back a month later,
it was remarkable—the tumor on his
chest x-ray was gone. Gone, gone, gone.'"
The Chicago Tribune reported on a new web
site developed by the National Cancer Institute
"to help you sort through all the confusing
information out there about what
causes cancer and what you can do to protect
yourself (maybe). Essentially a primer
on risk and risk factors, it explains basic concepts
that science writers tend to gloss over,
as if everyone is born
knowing what it means to
have a '17 percent lifetime
risk [1 in 6]' of developing,
say, prostate cancer. The
concept of lifetime risk is
hard even for physicians to
wrap their heads around.
Medical risk experts Drs. Steven Woloshin [pictured
above] and Lisa Schwartz [pictured below]
of Dartmouth Medical School say it's easier
to grasp the risk in well-defined chunks of
time, as in, 'The average
50-year-old man has a 2
percent chance of being
diagnosed with prostate
cancer before his 60th
birthday.' (Another way of
expressing that 2 percent
risk is 1 in 43, although
Woloshin and Schwartz say '23 out of 1,000'
is more readily understood.)"
A "phenomenon known asmedical tourism"
is on the rise, according to an article in the
Oregonian. Increasing numbers of Americans
are traveling to other countries, "saving
money on procedures costing farmore in the
U.S." But some doctors urge caution. "Dr.
Aaron Kaplan, director of device development
at Dartmouth-Hitchcock Medical Center,
has written about the differing
medical regulatory
environments of the U.S.
and Europe. European officials
are concerned more
with the safety of medical
devices than with their effectiveness,
he reports. But
the [U.S.] FDA requires studies that demonstrate
devices are both safe and effective—a regulatory hurdle that takes more time.
In Europe, . . . . the reviewing is not extensive.
'The device you'll be getting, by its nature,
is new and not well evaluated—and
that has its risks,' says Dartmouth's Kaplan."
"A grocery store
chain based in
Maine declared
success yesterday for a
year-old experiment in using
a rating system to direct customers to
healthier food items," the New York Times
reported. The Hannaford Brothers Company
developed a system "called Guiding Stars
[that] rated the nutritional value of the grocery
items in the store on a
scale of zero to three stars,
with three representing
the most nutritional products.
After analyzing a
year's worth of sales data,
Hannaford found that customers
tended to buy leaner
cuts of meat" and other healthy items.
Sales of products with stars increased, while
sales of items with no stars declined. "'I have
to say, I'm thrilled,' said Lisa Sutherland, assistant
professor of pediatrics and a nutrition
scientist at DartmouthMedical School, who
was part of an advisory panel that devised
Hannaford's system. 'They were prettymuch
what I would have expected with an objective
system that wasn't designed to promote
or negate one food or another.'"
The Associated Press, reporting on a debate
over resources, wrote that "medical imaging
equipment makers are lobbying to overturn
Medicare cutbacks after weathering some of
the worst sales numbers in recent memory.
. . . [But] health-care experts that advise lawmakers
are not convinced thatmoremedical
technology translates into better health
care. 'We have communities
with half as many
scanners as those in other
parts of the country and
their outcomes are just as
good, and in some cases
better, than communities
spending twice asmuch on
imaging,' said Elliott Fisher, a professor at Dartmouth
Medical School, who consulted for
government advisors on the imaging issue."
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