Author Interviews, Cost of Health Care, Dartmouth, JAMA, Pharmaceutical Companies / 09.01.2019

MedicalResearch.com Interview with: Steven Woloshin, MD, MS Professor Co-director of the Center for Medicine and Media The Dartmouth InstituteSteven Woloshin, MD, MS Professor Co-director of the Center for Medicine and Media The Dartmouth Institute MedicalResearch.com: What is the background for this study? What are the main findings? What influence does medical marketing have on medical care and drug prices? Response: There are published studies looking at promotional spending mostly for drugs (DTC and professional).  This paper is unique because it is such a broad look including not just drugs but also marketing of disease (in "awareness campaigns"), health services and laboratory tests. What is new here is the size and scope of marketing.  For context, $29.9 billion spent on promoting prescription drugs, disease awareness campaigns, health services, and laboratory tests corresponds approximately to $1000 per American.    For context, FDA's total budget is around $5 billion – and NIH's total budget is about $30 billion. This figure is up from $17.7 billion in 1997, with the most rapid increase in DTC promotion of prescription drugs and health services.   Pharmaceutical marketing to professionals (detailing visits and samples) accounted for most spending and remained high despite policies to limit industry influence. $30 billion is of an underestimate (egg, we did not include monies spent on professional marketing (detailing) of laboratory tests, health services or devices, the value of drug coupons/discounts/rebates, company marketing budgets, lobbying or campaign contributions). Further it is just the tip of the iceberg – marketing works so promotional spending is an important driver of why medical care is so expensive:  it leads to more – and more expensive - tests and treatments.
Author Interviews, Dartmouth, Lung Cancer, NEJM / 07.11.2014

William C. Black, MD Professor of Radiology Department of Radiology Dartmouth-Hitchcock Medical Center Lebanon, NH 03756MedicalResearch.com Interview with: William C. Black, MD Professor of Radiology Department of Radiology Dartmouth-Hitchcock Medical Center Lebanon, NH 03756 Medical Research: What is the background for this study? What are the main findings? Dr. Black: Lung cancer is the leading cause of cancer related death in the U.S., killing more people than cancers of the colon, breast, and prostate combined. In 2011, the National Lung Screening Trial (NLST) demonstrated that screening for lung cancer with low-dose CT could reduce lung cancer mortality by 20% in adults at high risk for the disease. Since then, several medical organizations have recommended that eligible adults be offered screening. The U.S. Preventive Services Task Force (USPSTF) released a grade B recommendation for low-dose CT screening in December 2012, which means that private insurers must cover the cost of screening by January 1, 2015. The Centers for Medicare and Medicaid (CMS) is expected to issue a final decision on national coverage for CT screening in February 2015 and a preliminary decision for public comment on November 10, 2014.
Author Interviews, Dartmouth, Mental Health Research / 18.10.2014

MedicalResearch.com Interview with: John A. Naslund, MPH – PhD Student at The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH Stuart W. Grande, PhD, MPA – Post–doctoral fellow at The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, NH Medical Research: What are the main findings of the study? Naslund: In this study we explored whether people with severe mental illness such as schizophrenia, schizoaffective disorder, or bipolar disorder, use a popular social media website like YouTube to naturally provide and receive peer support. We found that people with severe mental illness use YouTube to feel less alone and to find hope, to support and to defend each other, and to share personal stories and strategies for coping with day-to-day challenges.   Dr. Grande: They also sought to learn from the experiences of others about using medications and seeking mental health care.  YouTube appears to serve as a platform that helps these individuals to overcome fears associated with living with mental illness, and it also creates a sense of community among them.
Author Interviews, Cancer Research, Dartmouth, Melanoma, Nature / 12.09.2014

Dr. Constance Brinckerhoff Professor of Medicine Professor of Biochemistry Geisel School of Medicine at DartmouthMedicalResearch.com Interview with: Dr. Constance Brinckerhoff Professor of Medicine Professor of Biochemistry Geisel School of Medicine at Dartmouth Medical Research: What are the main findings of the study? Dr. Brinckerhoff: The genetic mutation BRAFV600E , frequently found in metastatic melanoma, not only secretes a protein that promotes the growth of melanoma tumor cells, but can also modify the network of normal cells around the tumor to support the disease’s progression. Targeting this mutation with Vemurafenib reduces this interaction, and suggests possible new treatment options for melanoma therapy.
Author Interviews, Dartmouth, Kidney Disease / 31.07.2014

MedicalResearch.com Interview with: Jeremiah R. Brown, PhD MS Assistant Professor of Health Policy and Clinical Practic The Dartmouth Institute Lebanon, NHMedicalResearch.com Interview with: Jeremiah R. Brown, PhD MS Assistant Professor of Health Policy and Clinical Practic The Dartmouth Institute Lebanon, NH   Medical Research: What are the main findings of the study? Dr. Brown: Using simple team-based quality improvement methods we prevented kidney injury in 20% of patients having a procedure in the cardiac catheterization lab.  Among patients with pre-existing kidney disease, we prevent kidney injury in 30% of patients. We believed that using a team-based approach and having teams at different medical centers in northern New England learn from one-another to provide the best care possible for their patients.  Some of the most innovative ideas came from these teams and identified simple solutions to protect patients from kidney injury from the contrast dye exposure; these included:
  • Getting patients to self-hydrate with water before the procedure (8 glasses of water before and after the procedure),
  • Allow patient to drink fluids up to 2-hours before the procedure (whereas before they were "NPO" for up to 12 hours and came in dehydrated),
  • Training the doctors to use less contrast in the procedure (which is good for the patient and saves the hospital money),
  • and creating stops in the system to delay a procedure if that patient had not received enough oral or IV fluids before the case (rather, they would delay the case until the patient received adequate fluids).Our success was really about hospital teams talking and innovating with one another instead of competing in the health care market, which resulted in simple, homegrown, easy to do solutions that improved patient safety.
Author Interviews, Dartmouth, Hospital Readmissions, Neurological Disorders, Neurology / 25.06.2014

MedicalResearch.com Interview with: Tracie A. Caller, MD , MPH Neurophysiology Fellow Dartmouth-Hitchcock Medical Center 1 Medical Center Dr., Lebanon NH 03756, USA MedicalResearch: What are the main findings of the study? Dr. Caller: We identified factors that appeared to increase the risk for a 30 day readmissions in the epilepsy population, which included refractory seizures but also coexistence of nonepileptic seizures and psychiatric comorbidities.
Author Interviews, Dartmouth, OBGYNE / 11.06.2014

Rachel Thompson PhD Postdoctoral Research Fellow The Dartmouth Center for Health Care Delivery Science Dartmouth CollegeMedicalResearch.com: Interview with Rachel Thompson PhD Postdoctoral Research Fellow The Dartmouth Center for Health Care Delivery Science Dartmouth College MedicalResearch: What are the main findings of the study? Dr. Thompson: This study, which surveyed 417 women aged 15-45 years and 188 contraceptive care providers in 2013, found important differences in what matters most to these two groups when it comes to discussing and deciding on a contraceptive method. Women’s most important question when choosing a contraceptive was “Is it safe?” – this was in the top three questions for 42% of women but only 21% of providers. Alternatively, providers’ most important question was “How is it used?”. Information on side effects and how a method actually works to prevent pregnancy was also a higher priority for women than for providers.
Author Interviews, Cancer Research, Dartmouth / 14.05.2014

Gregory J. Tsongalis, PhD, HCLD, CC, FNACB Professor of Pathology Director, Molecular Pathology Co-Director, Translational Research Program Department of Pathology Dartmouth Hitchcock Medical Center and The Audrey and Theodor Geisel School of Medicine at Dartmouth Lebanon, NH 03756MedicalResearch.com Interview with: Gregory J. Tsongalis, PhD, HCLD, CC, FNACB Professor of Pathology Director, Molecular Pathology Co-Director, Translational Research Program Department of Pathology Dartmouth Hitchcock Medical Center and The Audrey and Theodor Geisel School of Medicine at Dartmouth Lebanon, NH 03756 MedicalResearch: What are the main findings of the study? Dr. Tsongalis: This was the first study of its kind looking at multiple genes and multiple mutations in tumors of the appendix. Many of the identified mutations may be clinically actionable with respect to response to therapy or selection of therapy.
Dartmouth, General Medicine / 31.03.2014

dr_james_d_sargentMedicalResearch.com Interview with James D. Sargent, MD, Professor of Pediatrics Professor of Community and Family Medicine Professor of The Dartmouth Institute Co-Director, Cancer Control Research Program Norris Cotton Cancer Center Norris Cotton Cancer Center, Department of Pediatrics Geisel School of Medicine at Dartmouth Lebanon, New Hampshire MedicalResearch.com: What are the main findings of the study? Dr. Sargent: We showed children aged 3-7 years depictions of healthy foods in McDonald’s and Burger King television advertisements that aired in 2010-11.  Children were asked what they saw in the images and not prompted to respond specifically to any aspect of the images.  All images contained the two healthy foods—apples and milk—the companies purported to be advertising through the Children’s Food and Beverage Advertising Initiative.  Only 52% and 70% of children correctly identified McDonald’s and Burger King images of milk.  Whereas 80% correctly identified McDonald’s image of apples, only 10% identified the Burger King apples as apples.  Instead, 81% mistook them as french fries. Please see the video of children responding to the BK apples depiction at http://cancer.dartmouth.edu/about_us/newsdetail/66129/
Cost of Health Care, Dartmouth, Health Care Systems, Mental Health Research, Yale / 18.02.2014

MedicalResearch.com Interview with: Ellen R. Meara Associate Professor of The Dartmouth Institute Adjunct Associate Professor in Economics & Nelson A. Rockefeller Center for Public Policy, Dartmouth College Ellen R. Meara Associate Professor of The Dartmouth Institute Adjunct Associate Professor in Economics & Nelson A. Rockefeller Center for Public Policy, Dartmouth College MedicalResearch.com: What are the main findings of this study? Answer: When insurance coverage for young adults rose by over 15 percentage points following Massachusetts' 2006 health reform, use of inpatient care for mental illness and substance use disorders fell and emergency department visits for these conditions grew more slowly for 19 to 25 year olds in Massachusetts relative to other states. Also, their care was much more likely to be paid for by private or public insurance insurers.
Author Interviews, Breast Cancer, Dartmouth, Radiology / 27.01.2014

Michael Mastanduno Thayer School of Engineering, Dartmouth College 14 Engineering Dr. Hanover, NH 03755MedicalResearch.com Interview with: Michael Mastanduno Thayer School of Engineering, Dartmouth College 14 Engineering Dr. Hanover, NH 03755 MedicalResearch.com: What are the main findings of the study? Answer: The study was able to illustrate the design and clinical testing of an MRI breast coil for combined MRI and Near Infrared Spectroscopy. The coil was tested on 8 healthy volunteers spanning all bra cup sizes and mammographic density categories. In the past, MRI/NIRS imaging was only possible in C and D cup sized breasts. The system also will give researchers the ability to target lesions in hard-to-reach areas close to the chest wall. With the successful completion of this study, simultaneous MRI/NIRS is possible in all breast sizes, tissue compositions, and lesion locations.