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Vital Signs
Media Mentions
Among the people and programs coming in for
prominent media coverage in recent months
was DHMC's director of palliative medicine. "Dr.
Ira Byock . . . says that physician-assisted suicide laws
are really 'an apology for a failed medical system,'"
noted Harper's magazine in an
article about the right-to-die debate.
"Byock advocates a change
that he considers 'more controversial
than assisted suicide,' "
continued the article, "which is
to require medical residents to
do a rotation in palliative care
and pain management" of at least 100 hours.
"Physicians can graduate and be licensed and really
have almost no training in pain management,"
Byock explained to Harper's.
"Fevered reaction to a recent warning from the National Institutes of Health that the over-thecounter painkiller Aleve might cause heart attacks may be overblown, some medical experts say," began a December Wall Street Journal article. One expert, "Dr. Elliot Fisher, director of health policy research at the Center for the Evaluative Clinical Sciences at Dartmouth, said he was troubled by the possibility that science wasn't behind the decision to halt the study and publicize the findings. 'I have not seen their numbers, but I would be disappointed if there were not careful thought given to the statistical significance of the differences that were found,'" he told the Journal.
"Toys that just light up, flash, or make noise for no
reason may amuse very young children, but they
don't foster development as well as toys that offer
a cause-and-effect," began a January CBS News
bulletin. "Those opinions come
from one who should know, Dr.
Carol Andrew, an occupational therapist
and assistant professor of
pediatrics at Dartmouth Medical
School." Commented Andrew
on CBS's Early Show,
" 'We're very worried because
there's a tremendous epidemic of children who are
having difficulty learning language and having
difficulty maintaining attention and, in part, we
feel like it may be due to a lot of television and
video exposure in the very young ages.' . . . Babies
need to be challenged more, Andrew says."
The growing popularity of expensive, high-tech diagnostic scans prompted a federal advisory committee to suggest "that Medicare change the way it pays for such imaging tests, with an eye toward saving money," the Pittsburgh Post-Gazette reported. "The advisory committee studied whether Medicare recipients who received more scans . . . had better outcomes." They didn't. "That's not surprising to Dr. Jack Wennberg, director of the Center for the Evaluative Clinical Sciences at Dartmouth," the article said. "In general, increased spending on technology results in more tests being performed, not better outcomes for patients. ...'The people in high-cost, high-capacity regions have worse outcomes than those in low-cost, lowcapacity regions,' Wennberg said."
But more technology sometimes appears to be warranted. A recommendation from a federal task force was behind a bill introduced in Congress under which "most American men and women over 65 would be eligible to have Medicare pay for a simple ultrasound screening test for
potentially lethal abdominal
aortic aneurysms," according
to an article in the Wall
Street Journal. " 'People with a
family history, both sisters and brothers of people
with aneurysms, are at the highest risk,' said Dr.
Robert Zwolak, a Dartmouth Medical School professor
of surgery who is leading the screening effort."
The New York Times reported on a brain-imaging study suggesting that people in persistent vegetative states may "in fact hear and register what is going on around them but be unable to respond." Experts warned that the new research "did not mean that unresponsive people with brain damage were more likely to recover," the Times noted, but "the study did open a window on a world that has been neglected by medical inquiry. 'This is an extremely important work, for that reason alone,' said Dr. James Bernat, a professor of neurology at Dartmouth." The Orlando Sentinel also turned to Bernat, for comment on a brain-damaged Florida woman kept alive against her husband's wishes. The Sentinel said that Bernat, the "former chair of the American Academy of Neurology's ethics committee, conceded physicians can only make reasonable judgments about a patient's awareness 'because we can't get into their minds.'"
A DHMC sleep specialist made the news
several times in recent months. In the Pittsburgh
Post-Gazette, "Dr. Michael Sateia, president
of the American Academy of Sleep
Medicine, noted that the American Academy
of Pediatrics now recommends
that pediatricians
screen all children
for snoring, which can be
a sign of sleep problems.
'This is part of a growing
recognition of the importance
of healthy sleep and
sleep disorders in childhood.' " Sateia was
also quoted in the Los Angeles Times, on the
danger of off-label antidepressant use to
treat insomnia, and by United Press International
(UPI), on the need for more research
on insomnia. "Many challenges remain
in the characterization, recognition,
and treatment of insomnia," he told UPI.
In an article about consumer surveys of hospitals, the Wall Street Journal noted, "Dartmouth Medical School is also expanding distribution of its 'How's Your Health?' online survey, which has been used by groups including the military and state health departments for several years and will be offered more broadly through nonprofit and business groups to consumers later this year." Noted the Journal, "Dr. John Wasson, who developed the survey, says that users can also now create their own free portable medical record using the site."
"The years from 18 until 25 and even beyond have become a distinct and separate life stage, a strange, transitional never-never land between adolescence and adulthood, in which people stall for a few extra years." So said a recent Time magazine feature. Why are there so many twenty-somethings who refuse to grow up? the article wondered. "The human brain continues to grow and change into the early twenties, according to Dr. Abigail Baird, who runs the Laboratory for Adolescent Studies at Dartmouth. 'We as a society deem an individual at the age of 18 ready for adult responsibility,' " Baird told Time.
"'Yet recent evidence suggests that our neuropsychological development is many years from being complete.'"
In February, when the 2005 Academy
Awards rekindled controversy over the way
Hollywood glorifies smoking, the Associated
Press noted that "a Dartmouth Medical
School study last year found that children
who watch movies in
which actors smoke heavily
are three times more
likely to smoke themselves
than those exposed to less
on-screen smoking." Discover
also referred to the
research: " 'All things being
equal, whether their friends or parents
smoke, the amount of R-rated movie watching
is a strong predictor of smoking among
kids,' says Dr. James Sargent, the Dartmouth
Medical School professor who led the study.
. . . 'Kids imitate their heroes, and the
movies supply heroes to kids.'"
Exploring why Spokane, Wash., "has one of the highest rates of hip replacement surgery in the nation, 50 percent higher than the national average," the Associated Press (AP) wrote that it "has more to do with the local doctors' preferences than with medical need, according to Dartmouth Medical School researchers who study regional variations in health care." AP went on to quote Dartmouth's chair of orthopaedic surgery. "Medicare pays for most hip replacements, which cost from $18,000 to $20,000, so regional variation is a public policy issue, said Dr. James Weinstein. . . . 'Joint replacement is one of the most effective procedures done in medicine,' Weinstein said. 'But just because it's really good, should it be overutilized?'"
A partnership between DHMC and an organization
called the Upper Valley Trails Alliance
caught the eye of the national press.
"Just a few months old and already earning
praise, the program involves
several dozen doctors
writing detailed, albeit
symbolic, prescriptions for
getting fit and then giving
patients trail maps to accomplish
it," wrote USA
Today. " 'The idea is to
make a more specific explanation,' said Dr.
Charles Brackett, director of the program at Dartmouth-
Hitchcock Medical Center in Lebanon,
N.H. . . . Studies show that the more
concrete a doctor's advice, the more likely a
patient is to heed it."
"Is it possible that we place too much faith
in pictures?" asked Malcolm Gladwell in the
November issue of New Yorker magazine. He
was referring to medical images and used
mammography as one case in point. "Dr.
Gilbert Welch," Gladwell wrote, "a medical-outcomes
expert at Dartmouth, has pointed out
that, given current breastcancer
mortality rates,
nine out of every thousand
60-year-old women will
die of breast cancer in the
next 10 years. If every one
of those women had a
mammogram every year,
that number would fall to six. The radiologist
seeing those thousand women, in other
words, would read 10,000 x-rays over a
decade in order to save three lives-and
that's using the most generous possible estimate
of mammography's effectiveness."
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