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Vital Signs


Among the people and programs coming in for prominent media coverage in recent months was DMS's chair of orthopaedic surgery. He was quoted in a New York Times feature about the nation's rising incidence of back pain—and of costs to treat it. But, said the article, "studies find little evidence that patients are better off for all the treatment. . . . While there may appear to be more treatments than ever, Dr. James Weinstein adds, 'more isn't necessarily better.'" On the other hand, an article in Newsday focused on an undertreated subset of orthopaedic patients. "'We know that of the 70 million Americans who have arthritis and chronic joint pain, 32% are black,' said Dr. James Weinstein. 'And yet in every region of this country, black males were far below the norm for having [knee replacement] surgery.'"

"Experts believe they have found a molecular chink in the crippling lung disease known as cystic fibrosis," reported ABC News. "Infections by Pseudomonas aeruginosa are the leading cause of death from cystic fibrosis. . . . Antibiotics often cannot attack the bug because it is cocooned in a sugary 'biofilm' in the lungs. Researchers led by George O'Toole at Dartmouth Medical School believe they may have found a way into this armor."

A new protocol aimed at reducing the rate of postoperative complications for diabetic patients undergoing heart surgery was the focus of a feature in the New York Times. The protocol involves "a simple change in the way insulin is administered. . . . 'The paradigm has always been that the danger is in too low a glucose, and that there's safety in high glucoses,' said Dr. William Nugent of Dartmouth, who led the effort to put the Portland Protocol in place at his hospital last year."

The Dartmouth Atlas of Health Care has once again been in the news, most recently related to Florida's effort to grapple with sky-rocketing healthcare costs. "The average senior in Miami gets twice as many Medicare dollars spent on him as the senior in Minneapolis," reported the Miami Herald, "but lives no longer. 'There's huge overutilization in Miami,' says Megan Cooper, editor of the Dartmouth Atlas studies."

Health-care utilization was also a hot topic in Maryland—and Dartmouth expertise was again at the forefront. "Debate rages," was the Baltimore Sun headline, "over allowing hospitals to perform heart procedures." Said the article: "David Malenka, a cardiologist at Dartmouth, said he had reviewed national Medicare data covering nearly 350,000 non-emergency angioplasties. Among those done at hospitals without on-site surgical backup, he said, the patient died within 30 days 7.7% of the time—nearly triple the 2.8% mortality rate for angioplasties at hospitals that do heart surgery."

Another resource-related battle, in the Midwest, made the pages of the Wall Street Journal. The article said the big-three automakers had joined forces "to block two Michigan health systems from building two new hospitals in the Detroit suburbs. . . . Elliot Fisher, a professor of medicine at Dartmouth, says while the two Michigan health systems are merely transferring beds from one area to another, increased capacity in the suburbs would mimic a national trend in which extra capacity leads to more patients being put in hospital beds."

The Washington Post highlighted a fast-growing nationwide nonprofit program called "Casting for Recovery," which runs fly-fishing retreats for breast-cancer survivors to help them heal both physically and psychologically. "The vision for the program, now in its eighth year, came from its founder, psychiatrist and reconstructive breast surgeon Benita Walton of Dartmouth-Hitchcock Medical Center. An avid fly-fisher, Walton teamed up with fellow enthusiast Gwen Perkins, a member of the Orvis sporting equipment family, to help surgical patients learn the sport—which she believes reduces stress while providing physical benefits."

A DMS faculty member was a judge again this year in the nation's foremost highschool science contest—the Siemens Westinghouse Competition. Noted the New York Times, "Victor Ambros, a professor of genetics at Dartmouth Medical School, said that the top winners demonstrated that great science could take place in very different settings. 'The Schneider brothers worked essentially alone,' he said. 'And Li worked in the premier lab in the world in his field. But in both those contexts, the judges were able to see clear evidence of their own creativity and independence.'"

A Dartmouth ob-gyn is often quoted on the relative risks of vaginal births and cesarean sections. According to the Fort-Worth Star- Telegram, "Dr. Michele Lauria of Dartmouth- Hitchcock Medical Center [says], 'What we do know is that babies born by C-section have a higher incidence of respiratory complications.'" And USA Today reported on a new study, by a researcher at Ohio State, demonstrating that "the risk of complications from vaginal births after C-sections—known as VBACs—is actually quite small. . . . Dartmouth ob-gyn Michele Lauria, cofounder of the Vermont- New Hampshire VABC Project, called the new findings 'firm, indisputable data about the risks. I think it's wonderful for women.'"

With the FDA considering changes in direct- to-consumer drug ads, a DMS research team that has studied such ads' effects has been widely quoted. Wrote BusinessWeek: "'There is a public perception that the benefits of these drugs are large—and that the FDA only allows ads for very effective ones,' explains Dr. Lisa Schwartz, associate professor of medicine at Dartmouth." And reported the Washington Post: "'The ads are great on side effect info, but short on [information about] benefits—how well the drugs work,' says Steven Woloshin. . . . Woloshin and his wife and research partner, Lisa Schwartz, presented their views at the FDA hearing last fall. According to Woloshin, advertisers often show benefit data only in comparison to a placebo, not to other drugs."

Good Housekeeping carried a notice of Dartmouth research that may lead to a treatment for retinitis pigmentosa (RP), "an incurable hereditary eye disease [that] results in blindness. . . . 'We now have a molecular understanding of the abnormal proteins,' said lead author John Hwa. 'We can move ahead to the ultimate goal of designing effective drugs to delay the degeneration that occurs to people suffering from RP.'"

A DMS faculty member who coined the term "chemoprevention" was quoted several times in a long feature on cancer in a recent issue of Fortune magazine. According to "Michael Sporn, a professor of pharmacology at Dartmouth Medical School, . . . 'We've been stuck with this definition of what cancer is from 1890. It's what I was taught in medical school: "It's not cancer until there's invasion." That's like saying the barn isn't on fire until there are bright red flames coming out of the roof.' In fact, cancer begins much earlier than that. And therein lies the best strategy for containing it, believes Sporn, who was recently named an Eminent Scholar by the NCI: Let's aggressively find those embers that have been smoldering in many of us for years—and douse them before they become a full-fledged blaze." See page 23 in this issue for more about Sporn's Eminent Scholar appointment.

The validity of the dictum that the average person needs to drink eight eight-ounce glasses of water a day is back in the news. And reporters are turning once again to a definitive report on the subject issued two years ago by a Dartmouth expert. Asked the Times of London: "Where on earth did this idea come from? Dr. Heinz Valtin of Dartmouth Medical School tried to find out. In the American Journal of Physiology, he concluded that it had no basis at all." The renewed debate was also fodder for the Minneapolis Star-Tribune: "In 10 months of searching the medical literature and talking to specialists in fluids and thirst, Valtin came up dry. He found no scientific basis for drinking eight glasses of water a day."

In a four-part UPI report on "the state of smoking in America," one of the nation's best-known antismoking activists was cited several times. "Surgeon General C. Everett Koop decided in 1981 to up the ante in the tobacco war by calling for a smoke-free United States. . . . Yet the battle for the hearts and minds of smokers continues. 'We are on the cusp of a public health victory or defeat,' Koop told UPI in a telephone interview from his office at Dartmouth." He was also quoted about the 1997 tobacco settlement: "'If the money from the tobacco companies was used for its intended purpose,' Koop said, 'we would be able to get half the people who want to quit smoking —who realize they are addicts—to quit.'"

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