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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 Dartmouth Institute for Health Policy
and Clinical Practice, which in April published
the newest edition of the Dartmouth Atlas of
Health Care. The volume showed that the amount
of money spent on end-of-life treatment varies
widely depending on location,
inspiring newspapers across the
country—including the Miami
Herald, the St. Louis Post-Dispatch,
and the Baltimore Sun—to find out where their local
hospitals ranked. The New York
Times asked "Dr. John Wennberg of
Dartmouth Medical School, the chief author of
the study" about the findings. "'Some chronically
ill and dying Americans are receiving too much
care—more than they and their families actually
want or benefit from,' Dr. Wennberg said."
Other authors of the Atlas were also in demand as
the media covered the findings. "Elliott Fisher, the report's
coauthor," told USA Today
that "the big differences between
hospital systems indicate
there is room to improve efficiency,
save money, and spare
some patients from what may be
unnecessary hospital stays.
'These are all high-quality medical
centers, but it's amazing the differences in
practices among them,' Fisher says." The San Luis
Obispo Tribune spoke to "Dr.
David Goodman. . . . Health care, he
said, is like sunshine. There are
limits to how much is good for
you." And the Wall Street Journal,
among other media outlets,
reported on a plan by Consumer
Reports to publish hospital ratings.
"The index is based on work from the Dartmouth
Atlas Project, a research effort developed
by researchers at Dartmouth."
Not everyone agrees with the Atlas's conclusions. In the Washington Post, one doctor argued that "to some, the Dartmouth data encourage the notion that if the supply of specialists and hospital beds were suddenly cut, doctors might reserve fancy care for patients who really needed it, and thus costs would fall. But . . . these cost controls will require hard choices—and, inevitably, haphazard rationing of health care." Others, however, were more convinced. "The Dartmouth researchers estimate that Medicare could save tens of billions of dollars annually," said a New York Times editorial. "That is a very good reason to change."
When a study in the British Medical Journal revealed
that the use of terminal sedation in the
Netherlands has risen since 2001, Time magazine
turned to a Dartmouth expert for commentary.
Terminal sedation "may sound
to many people as automatically
hastening a patient's death.
But that's not the case, says Dr.
Ira Byock, chair of palliative medicine
at Dartmouth Medical
School. . . .
'This is a practice,
when used correctly, that's only
done in the final stages of life. . . . At that point,
nutrition or antibiotics can usually do nothing to
prolong life.'" But in U.S. News & World Report,
Byock, "an end-of-life-care expert," warned that
sedation can be misused. " 'There is no distress
you're going to have that I cannot
alleviate with medications, but we don't
want that to be a substitute for good, comprehensive medical care.'"
Reuters highlighted a study led by Linda Titus-Ernstoff
on "women whose mothers were exposed to diethylstilbestrol
(DES) in the womb. . . . DES, a
synthetic form of estrogen, was introduced in
1941 as a drug that prevented miscarriage. An estimated
6 million women worldwide
took the drug before its use
during pregnancy was banned in
1971." Earlier research showed
that DES could cause cancer in
daughters of women who took
it, "and now it seems that the
hazard may have been passed to
granddaughters." Titus-Ernstoff found that "although
there was no overall increase in cancer,
there were three cases of ovarian cancer in daughters
of women exposed prenatally to DES—a figure
higher than would normally be expected."
The New York Times covered the use of
"slow medicine" at the Kendal at Hanover
retirement community. "The term slow
medicine was coined by Dr. Dennis McCullough, a
Dartmouth geriatrician, Kendal's founding
medical director, and author
of My Mother, Your
Mother: Embracing 'Slow
Medicine,' the Compassionate
Approach to Caring for
Your Aging Loved Ones. . . .
Grounded in research at
Dartmouth, slow medicine
encourages physicians to put on the brakes
when considering care that may have high
risks and limited rewards for the elderly."
"George O'Toole, an associate professor of microbiology
and immunology at Dartmouth,"
talked to U.S. News & World Report about
antimicrobial minerals in mud. "'The effort
to identify a new class of antibiotics is important,
because most of
the varieties we now use
have been around for the
last 40 years,' he noted.
'However, typically when
people look for new naturally
derived antibiotics,
they focus on living biological
material, like plants. So this is an interesting
idea . . . that here they're looking
instead at an inorganic source like mud.'"
U.S. News & World Report also covered a
study led by Yinong Young-Xu, a researcher at the
White River Junction-based National Center
for Post-Traumatic Stress Disorder. His
work "is the first observational study to examine
the effect of anxiety
or depression treatment
on a heart patient's risk
factors." People with coronary
heart disease "who
reduced or kept their anxiety
level steady were as
much as 60% less likely to
have a heart attack or die compared to those
who had an increase in anxiety level."
"Dr. James Bernat, a Dartmouth neurologist,"
spoke to the Boston Globe about organ donation
and the definition of death. According
to the Globe, "surgeons abide by a code
known as the 'dead donor rule,' which forbids
removing body parts from the living.
Yet a few outspoken medical ethicists say the
dead donor rule
is broken all the time—and, perhaps even more surprisingly, that the rule itself should be abandoned." Bernat is not so sure. "The dead donor rule helps to uphold public confidence in organ transplantation, which is 'somewhat shaky,'" Bernat told the Globe. "And breaking the taboo, he worries, could eventually lead ethically challenged doctors to take organs without patient consent."
After the FDA approved the first generic
drugs to treat restless legs syndrome (RLS),
GlaxoSmithKline pulled
all ads for Requip, its popular—and lucrative—RLS
drug. To find out why that
might be, an NBC station
in San Francisco interviewed
two Dartmouth researchers.
"Dr. Lisa Schwartz,
associate professor of community and family
medicine at Dartmouth, [said], 'It makes
you wonder whether there's a disease to be
treated.' Schwartz and her
husband, Dr. Steven Woloshin,
also at Dartmouth, say that
drug company promotions,
combined with uncritical
media reporting, have exaggerated
the prevalence
of restless legs syndrome
and led to over-diagnosis and over-treatment
with powerful brain-altering drugs."
According to a New York Times article about back pain, "for all the money sufferers spend on doctor visits, hospital stays, procedures, and drugs, backs are not improving." So is there anything a sufferer can do? "Dr. James Weinstein, editor of the journal Spine and chair of orthopaedic surgery at Dartmouth," told the Times that "'the best treatment for straightforward back pain without a specific diagnosis is reactivating yourself to what you normally do as fast as possible. . . . I think we are an overmedicated society, and I would not recommend narcotics for everyday back pain except for in most rare of circumstances.'"
The Los Angeles Times reported recently on
the availability of individual genome scans.
"Dr. H. Gilbert Welch, a professor
of medicine at Dartmouth
Medical School,"
told the Times that "he
thinks genome scans will
make matters worse, especially
because most doctors
have little genetics
training. 'I think a broad-spread application
of personalized genetic testing would create
havoc and would likely lead to more harm
than good,' he says. 'It will make people anxious,
and it would probably push doctors to
more aggressive interventions simply because
of a lack of information and a feeling
they had to do something.'"
"Hours in the sack may have more to do
with your weight than hours in the gym,"
reported MSNBC.com. A study has shown
that "those getting six
hours or less of shut-eye
nightly were more likely
to become overweight or
obese compared to those
getting a solid eight hours
of nightly slumber. And
surprisingly, those getting
nine or more hours of sleep were also more
likely to become overweight or obese. . . .
'This is a warning to the public that sleep is
critical to good health,' said Dr. Michael Sateia,
chief of sleep medicine at Dartmouth."
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