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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 the physician who pioneered the field of outcomes
research. "Data has been assembled by Dr.
Jack Wennberg and his associates at Dartmouth Medical
School for at least two decades," a guest on
National Public Radio's Talk of
the Nation noted, mentioning
that "states' spending per capita
on health varies enormously."
The Baltimore Sun cited Wennberg's
research, too, in an article
about a "new hypothesis" in
health care, in which "doing less
for patients might improve their health while
controlling costs." (See the Winter 2007 feature "Braveheart" for a recap of Wennberg's career.)
Two researchers who collaborate regularly with
Wennberg also showed up in the press—in the
Atlantic Monthly. The article, which was subtitled
"The health-care crisis no candidate is addressing?
Too many doctors," mentioned
that "Elliott Fisher, a physician
and researcher at the Center
for the Evaluative Clinical
Sciences at Dartmouth, quipped
at a recent gathering at the Institute
of Medicine, ‘If we sent
30 percent of the doctors in this
country to Africa, we might raise the level of
health on both continents.'" The article also noted
that "in a paper published last year in the journal
Health Affairs, David Goodman
and his colleagues at Dartmouth
examined care at academic
medical centers. . . . They tallied
the number of doctors" at
each and found not only that
"the variation was enormous"
but that hospitals that used
more doctors "did not produce better outcomes
than hospitals using relatively few doctors."
Several other publications cited work by Wennberg and his colleagues, including Consumer Reports, the New York Times, and the Miami Herald. "A 2003 Dartmouth study found that up to 30 percent of the $2 trillion spent in this country on medical care each year—including what's spent on Medicare and Medicaid—is wasted," Reader's Digest noted. And the Star-Telegram of Fort Worth, Tex., said, "Increased spending doesn't necessarily buy increased quality of care. A Dartmouth Medical School analysis of Medicare . . . found vast disparities in payments—but they varied based on geography rather than on how sick the patients were, or how good the treatment."
A Dartmouth surgeon spoke with the Pittsburgh
Tribune-Review about financial incentives that encourage
liver transplant centers to give organs to
healthier patients. " ‘No question,
if you're relatively healthy
coming in, you're going to cost
less and they're going to make
more money at a center,' said Dr.
David Axelrod, transplant surgery
chief at Dartmouth-Hitchcock
Medical Center. . . . ‘They're not
doing this just to make money, but the economics
are clearly driving a portion of this issue. There
are clearly economic benefits.'"
For perspective on a finding that uninsured patients are more apt to be
diagnosed with late-stage
cancer, the New York Times looked north. " ‘Do
these findings mean that patients without insurance
are being diagnosed too
late, or that insured patients are
being excessively diagnosed?'
said Dr. H. Gilbert Welch, a professor
at Dartmouth who studies the
usefulness of medical procedures."
And in a U.S. News &
World Report article about
women with ductal carcinoma in situ (DCIS),
"Welch argued that as mammography continues
to detect smaller and smaller DCIS lesions, there
can be a tendency to overtreat." Welch weighed
in on prostate cancer screening, too. "Many men
agree to prostate screening without thinking
much about it," he told MSNBC.
"Do cholesterol drugs do any good?" Business Week
asked in a January 17 cover story about statins.
Among the national experts tapped to answer this
question was a Dartmouth physician-researcher. "Difficult risk-benefit questions surround
most drugs, not just statins. One dirty little
secret of modern medicine
is that many drugs work
only in a minority of people.
‘There's a tendency to
assume drugs work really
well, but people would be
surprised by the actual
magnitude of the benefits,'
says Dr. Steven Woloshin, associate professor of
medicine at Dartmouth Medical School."
A story in the Washington Post, about a University
of Pennsylvania study which found
that radiation therapy doses can vary widely
among hospitals, quoted "Candice Aitken, assistant
professor of radiation oncology at
Dartmouth-Hitchcock
Medical Center." Aitken
explained that intensity modulated
radiation therapy
"can help us sculpt the
dos e a round an oddshaped
tumor next to a
critical structure." The
point of the study, said Aitken, "is that we
need to come up with methods of reporting
doses so that we can interpret studies performed
at different institutions better."
The New York Times cited a Dartmouth expert
on in vitro fertilization [IVF] in an article
about the effort to reduce multiple
births. "‘We have been getting better at IVF
over the years, and as success
rates go up, the number
[of embryos] we transfer
has to go down accordingly,'
said Dr. Judy Stern, director
of the human embryology
and andrology
lab at Dartmouth-Hitchcock
Medical Center. . . . ‘Where three embryos
used to work and give you mostly singletons,
now we transfer two, because we're
making better embryos and more of them
implant.' " (See the Summer 2007 article "More is not merrier in fertility clinics" for more on Stern's work.)
A Harvard study of aortic aneurysm repair "is likely to hasten the trend toward more procedures being done with a device called a stent-graft instead of the typical surgery," the Wall Street Journal recently reported. "Vascular surgeon Robert Zwolak of Dartmouth Medical School, who had read the study," told the Journalthat "‘surgical repair, even though it's a very good operation, has this instance of incisional hernias and bowel obstruction that somewhat tarnishes
it.' . . . The study showed
the difference in death
rates from surgery compared
with stent-grafts increased
with the patients'
age. Dr. Zwolak said he especially is inclined
to use stent-grafts in relatively older patients,
from 75 to 84 years old."
"Dr. Henry Bernstein, . . . chief of general academic
pediatrics at Dartmouth," answered
some questions recently in the Denver Post.
One reader asked if it's safe for children to
take adult vitamins. "Children older than
four years of age may have similar recommended
daily values for certain micronutrients
as adults," Bernstein explained. "However,
it's generally safest to
wait until age 12 before
giving an adult vitamin to
a child." Another reader
wondered about giving extra
vitamin C to a child.
"The ‘upper limit' of vitamin
C, meaning the most
your child should have in a day, is 400 milligrams
for 1- to 3-year-olds and 650 milligrams
for 4- to 8-year-olds," said Bernstein.
"Most dermatologists tell their patients that diet plays no role in acne," said the Boston Globe. "New research suggests that's wrong." Old research suggested it was wrong, too. A DMS adjunct professor, "Dr. William Danby, . . . from 1973 to 1980 kept a detailed log of his patients' diets in a quest to understand the root of their acne. . . . He noticed a trend: Those who consumed the most dairy also had the most severe acne." Another DMS adjunct was quoted, too. "Dr. Jeffrey Dover . . . finds the milk studies fascinating. ‘I have had some nice successes with suggesting to patients that they don't eat dairy,' he says, ‘and I've seen at least a handful of patients with very impressive improvement of their acne that was very stubborn up to that point.'"
USA Today looked into the rising use of
sleeping pills, noting that the number of prescriptions
is up 60% since 2000, while the
number of emergency
room visits due to the use
or misuse of a new class of
such pills is up 19% since
2005. "Michael Sateia, chief of
sleep medicine at Dartmouth,
says there are
many problems that may
give rise to insomnia. For example, a patient's
rest may be disrupted due to sleep apnea,
a sleep-related breathing disorder that
can actually be exacerbated by sleeping-pill
use. ‘An accurate diagnosis is critical to developing
a treatment plan,' he says."
The Times of London recently took on several
health myths, including the advice to
drink at least eight glasses of water daily.
"One academic, Heinz Valtin
of Dartmouth Medical
School, . . . has tried to
scotch the myth, without
success. In the American
Journal of Physiology, he
concluded that it had no
basis at all. Nor is it true,
he says, that caffeinated drinks do not count.
They do, and so do weak alcoholic drinks,
such as beer, in moderation. For healthy
adults living in a temperate climate leading
sedentary lives—just the kind of people never
seen without a plastic bottle—the injunction
to drink more water is nonsense."
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