DMS in the News
October 2004

National/International Media

The Washington Post - October 18, 2004
Painful Withdrawal for Makers of Vioxx; Pulling of Arthritis Drug Raises Questions on Marketing, Safety Risks
Neaton and the three safety committee members spent several days studying the data, then held their regularly scheduled phone conference Sept. 17. They talked first with Merck representatives and the principal investigator for the colon polyp trial, John Baron of Dartmouth Medical School. [This article also appears in The Union Leader.]

Reuters - October 12, 2004
Newer polio vaccine ends rare US cases - report
"It is prudent to acquire a U.S. polio vaccine stockpile, despite the existing formidable barriers," wrote Dr. John Modlin of the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. [This article also appears in The Boston Globe.]

Newsweek - October 11, 2004
In The News: Instant Recall
Don't panic. Though a three-year study found that patients who had been taking Vioxx for more than 18 months increased their risk of heart attack and stroke, the overall incidence was small.
"The risk to any one patient was very low," says Dartmouth's Dr. John Baron, chair of the study's steering committee.

The Wall Street Journal and Dow Jones and Reuters - October 11, 2004
Personal Health (A Special Report) --- The Five Questions You Should Ask If You... Have Cancer; Are Worried About Heart Disease; Need Surgery
In the study, Dartmouth University researchers reviewed the cases of 474,108 patients who underwent one of eight cardiovascular or cancer procedures. In every case, the number of procedures a surgeon had performed made a dramatic difference in mortality rates. Compared with those who had surgery done by high-volume surgeons, a patient operated on by a low-volume surgeon was 65% more likely to die undergoing repair of abdominal aneurysm, 44% more likely to die during aortic valve replacement and 2.3 times as likely to die during surgery for esophageal cancer. [This article also appears in The San Francisco Chronicle.]

Big News Network.com [Australia] - October 9, 2004
Rural veterans' health is poorer
Researchers at the White River Junction VA Medical Center and Dartmouth Medical School surveyed more than 750,000 veterans who had received Veterans Administration healthcare between 1996 and 1999 -- a period when the VA was beginning to establish community-based outpatient clinics to provide primary care closer to home for rural vets.

CBSNews - October 8, 2004
Hospital Care Varies Greatly
"No matter how preeminent the institution, care varies all over the ballpark," says John E. Wennberg, MD, director of the Center for Evaluative Clinical Sciences at Dartmouth University, who authored one of several studies released Thursday by the journal Health Affairs.

The Washington Post - October 8, 2004 Studies Raise Questions On Value of Intensive Care Elderly patients with chronic illnesses who stay in the intensive care unit longer, receive more diagnostic tests or are treated by numerous specialists do not fare better than those who receive less intensive care, two studies conducted by Dartmouth Medical School found. "We know hospitals are dangerous places," said Elliott Fisher.
"Higher intensity patterns of practice are associated with no better quality and, if anything, worse quality." "It is clear that quality is inversely correlated with the intensity of care and that the better hospitals are using fewer resources and providing fewer hospitalizations and physician visits," said co-author John E. Wennberg, director of Dartmouth's Center for Evaluative Clinical Sciences.

Associated Press - October 7, 2004
Studies Question Ranking of Best Hospitals
Older patients with similar chronic conditions receive treatment that varies widely, even among the top-ranked hospitals, according to studies released Thursday that suggest more expensive and frequent intervention does not make for better care.
"No matter how pre-eminent the institution, the care varies all over the ballpark," said Dr. John Wennberg of the Dartmouth Medical School.

Washington Post - October 6, 2004 Health Care By the Numbers Saves Money I have seen the future of health care here at the Spine Center of the Dartmouth-Hitchcock Medical Center. It is not that Jim Weinstein and his colleagues have any breakthrough cures for back pain. What they do have is a revolutionary model for how doctors and patients interact that improves medical care while saving money. [This article also appears in the Kansas City Star.]

Reuters - October 4, 2004
Botox May Relieve Diabetic GI Complication
A previous study has shown that pressure in the lower portion of the stomach is elevated in patients with diabetic gastroparesis, lead author Dr. Brian E. Lacy, from Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, told Reuters Health. "So, we were interested in testing Botox as a way to bring down these pressures and, hopefully, improve gastric emptying."

Forbes - October 1, 2004
Behind Merck's Fall
On Sept. 24, John Baron, a professor of medicine at Dartmouth Medical School, called Merck (nyse: MRK - news - people ) to say a safety committee he headed had decided to halt a three-year study testing the arthritis treatment Vioxx as a cancer preventative. The results on preventing colon polyps, the aim of the study, aren't in. But in the 2,600 patient trial, patients taking Vioxx were twice as likely to have heart attacks and strokes as those on a sugar pill. The next morning, Merck executives got their first look at those results. "I was stunned by the data," says Peter Kim, Merck's research chief.

Other Media

Philadelphia Inquirer - October 28, 2004
Vioxx loss may hinder cancer fight
Dartmouth Medical School researcher John Baron, head of the Merck study's steering committee, said fear of cardiovascular risks may make some cancer patients reluctant to join other COX-2 cancer studies. "And some scientists are worried as well" that this would impair other cancer research, he said at a meeting last week of the American Association for Cancer Research in Seattle.

St. Louis Post-Dispatch - October 25, 2004
Vets in rural areas are in poorer health
"We need to think about veterans who live in rural settings as a special population, and we need to carefully consider their needs when designing health care delivery systems," said William B. Weeks, a researcher with the White River Junction Veterans Administration Medical Center and Dartmouth Medical School in Hanover, N.H.

Valley News - October 24, 2004
'Dresden High' Makes Historical Sense
Hoefnagel, a retired Dartmouth Medical School professor, and Close, a retired Dartmouth librarian, incorporated the initial article into Eleazar Wheelock and the Adventurous Founding of Dartmouth College, a biography of Wheelock published in 2002.

Modern Healthcare - October 18, 2004
Out of sight; Pharmaceutical industry temporarily replaces hospitals as target
After days of uncomfortable publicity regarding the Dartmouth Medical School reports on poor-quality hospital care and inexplicable deviations in treatment (Oct. 11, p. 6), the spotlight shifted to the pharmaceutical industry. Drugmakers, suppliers and federal regulators took turns in the dunk tank as the hardball questions began flying.

Valley News - October 17, 2004
Dr. Koop's Close Call
Last week, former U.S. Surgeon General C. Everett Koop celebrated his 88th birthday. But these days, Dr. Koop is thinking a lot about death. Speaking on Thursday in his office at Dartmouth Medical School, where he has been a resident scholar since 1991, Koop spoke candidly about his brush with death, his thoughts about mortality, even plans for his own memorial service, which have been agreed upon with his wife and children.

Concord Monitor - October 17, 2004
Former surgeon general is aware of his mortality - Koop celebrated his 88th birthday last week
Speaking on Thursday in his office at Dartmouth Medical School, where he has been a resident scholar since 1991, Koop spoke candidly about his brush with death, his thoughts about mortality, even plans for his own memorial service, which have been agreed upon with his wife and children.

Centre Daily Times [Pennsylvania] - October 16, 2004
Religion is quickly becoming a tonic for teenagers
Late last year, a commission convened by Dartmouth Medical School, among others, studied years of research on kids, including brain-imaging studies, and concluded that young people who are religious are better off in significant ways than their secular peers. They are less likely than nonbelievers to smoke and drink and more likely to eat well; less likely to commit crimes and more likely to wear seat belts; less likely to be depressed and more likely to be satisfied with their families and school.

The Arizona Republic - October 16, 2004
4 phrases that make a difference
They're phrases that shouldn't be reserved for times of dire illness or crisis, but repeated throughout our lives, according to Ira Byock, a physician who's worked in hospice for 25 years. "Please forgive me."
"I forgive you." "Thank you." "I love you." The words are the subject of his new book, The Four Things That Matter Most (2004, Free Press, $23 hardcover). Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., will discuss it at two free programs Friday in Phoenix.

The Baltimore Sun - October 15, 2004
More must be done about osteoporosis, surgeon general says Bone-thinning disease threatens 34 million as U.S. baby boomers age The Nation
"These numbers are going to grow as baby boomers age," said one of the report's authors, Dr. Anna Tosteson, a professor at Dartmouth Medical School and one of more than 100 experts who helped craft the document over 2 1/2 years.

U.S. Newswire - October 14, 2004
YMCA of USA Supports Lights On Afterschool as National Partner;Over 2,600 Local YMCA Events to Celebrate and Support Afterschool
A recent report commissioned by the YMCA of the USA, Dartmouth Medical School and the Institute for American Values provides scientific proof that what YMCAs do in afterschool and other programs is important and effective for kids and their families. The findings of
"Hardwired to Connect: The Scientific Case for Authoritative Communities" show that surrounding our kids with rich networks of nurturing relationships not only helps them thrive, but has been shown to significantly alter brain development and protect them from developing emotional disorders like depression and anxiety, and from participating in risk-taking behaviors like using drugs and consuming alcohol.

Seattle Post-Intelligencer - October 13, 2004
Seattle near the bottom in hospital care study
"In our research, the Northwest had some of the best performance and the lowest cost per capita, yet their outcomes are as good as anywhere else," said Elliott Fisher, a professor of medicine at Dartmouth Medical School.

Orlando Sentinel - October 12, 2004
When Less is More Our Position: Health Professionals Should Recognize the Harm of Providing Too Much Care
Indeed, across the nation, there are huge regional variations in medical practice. A Dartmouth Medical School team that studies geographic variation reported last week that even the most highly regarded teaching hospitals in the country vary wildly in the intensity of care. But the Dartmouth team says an increase in quantity of services does not offer better quality. In fact, it found that patients who underwent the most intensive treatment regimens had a small but real increase in mortality.

Modern Healthcare - October 11, 2004
Variations on a theme; Dartmouth studies suggest that more care isn't always better, with better hospitals using fewer resources, physician visits
"It is clear that quality is inversely correlated with the intensity of care and that the better hospitals are using fewer resources and providing fewer hospitalizations and physician visits,'' said John Wennberg, lead researcher and director of the Center for Evaluative Clinical Sciences at Dartmouth Medical School.

Modern Healthcare - October 11, 2004
Fall guys; Healthcare's new police dramas are about quality AND reality shows
The big fall blockbuster can be seen in the Web edition of Health Affairs. Studies and articles featured in the edition spotlight the enormous medical practice differences between providers in different facilities. The highlight of the issue is something that might be called "CSI: Medical Care." The research emanates from Dartmouth Medical School and was led by physician John Wennberg, who has spent decades documenting how a cold sufferer can go to the doctor in Missouri and be given an aspirin and go to Florida and get sinus surgery. In this episode, Wennberg and his fellow sleuths discover that they can use Medicare claims to analyze care at specific hospitals.

Pittsburgh Post-Gazette - October 10, 2004
The Solution to High Health-Care Costs is Right Here A Relentless Focus on Reducing Waste and Error Will Lower Cost While Improving Health, Says Karen Wolk Feinstein - and Efforts in Pittsburgh are a Model for the Nation
And Dr. Paul Uhlig of the Dartmouth Medical School declared that "health care will be transformed not by laws or regulations, but as it always has been -- by people working together in new ways to give better care to their patients." Other colleagues reached similar conclusions at the different programs hosted by Highmark, the Pennsylvania Health Care Cost Containment Council, the Pennsylvania Medical Society and the University of Pittsburgh Department of Pathology. Failures in basic service delivery go unrecognized -- even rewarded -- by the indifference of key stakeholders.

Valley News - October 9, 2004 Firefighters Learn How to React To Terrorist Attack in Hartford In addition to the rescue workers, Engineer Gerald Vezina of Dufresne-Henry in Springfield, Vt., and Dr. Rob Gougelet of Dartmouth-Hitchcock Medical Center participated.

Monterey County Herald [California] - October 8, 2004
Hospital quality varies; Care differs for Medicare patients
Two studies by Dartmouth Medical School found that the biggest variations in care were how often physicians visited patients, the number of diagnostic tests conducted and how often patients were admitted to the hospital or an intensive care unit. ''The significance of these findings is that for the first time we can use Medicare claims data to measure the performance of individual hospitals and identify those hospitals that appear to be doing a better job managing chronic illness and patient care,'' said Dr. John E. Wennberg, director of Dartmouth's Center for the Evaluative Clinical Sciences.

The Union Leader - October 8, 2004 Mount Major hike to aid cancer research Take-A-Hike will support the work of Norris Cotton Cancer Center oncologist and researcher Peter A. Kaufman, MD, who is working to understand the biologic and molecular basis of therapies for breast cancer and to develop new agents and chemotherapy medications for patients with both advanced and early-stage breast cancer.

The Union Leader - October 5, 2004
Frisbie hospital unveils cancer center expansion
Frisbie has also added Dr. Archana Bhargava to its oncology staff, bringing the number of clinical and support staff to 18, according to hospital representative Krysten Godfrey Maddocks. The expansion also allows for bone marrow biopsies.

Concord Monitor - October 3, 2004
High-tech parts rebuild bodies
"We do have strategies to replace the function of the kidney so we can do dialysis, but we don't have an implantable artificial kidney," said Dr. Richard Dow, chairman of surgery at Dartmouth-Hitchcock. "We do have external things to supplement the function of the liver and the lungs, but they aren't implantable." At the Dartmouth-Hitchcock Medical Center in Lebanon, Dr. Mitchell Stotland, who specializes in craniofacial reconstruction, can replace a skull that has been pulverized or infected in three ways -one of them is by splitting the remaining part of the skull in two... Even facial reconstruction still has its limits. "We can rebuild a face, but the difficult thing is really replacing skin in a seamless way," Stotland at Dartmouth-Hitchcock said.
"If someone shoots himself in the face with a shotgun we can rebuild the structure of the facial skeleton to cover it, but making it look scarless and seamless is virtually impossible."

The Star-Ledger [New Jersey] - October 1, 2004
Merck pulls Vioxx amid health risks - New Jersey drug giant's arthritis pill is linked to stroke and heart attack

Last Thursday evening, Peter Kim, Merck's head of research, spoke with John Baron, a Dartmouth Medical School professor who headed a committee overseeing the study. Baron broke the bad news: The risk of heart attacks and strokes was disturbing.

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