Inside Dartmouth Medicine

A Mere Mortal Dr. Steven Schlozman wasn't terribly surprised when an insurance company rejected his request to prescribe a new treatment for a patient. And, as usual, he expected to spend personal time sitting on hold waiting to appeal the decision. But what startled him was the conversation that took place when he finally got through to a live human being. In this podcast, Schlozman—a 1994 graduate of the Brown-Dartmouth Program in Medicine—recounts what happened in this "rare and truly honest moment." This is a web extra to an article that appeared in the Spring 2009 issue of Dartmouth Medicine Magazine. To read the article, go to: http://dartmed.dartmouth.edu/summer09/html/point_of_view/

Dartmouth undergrad examines opioid death toll Conducting the first comprehensive analysis of prescription opioid-related deaths in New Hampshire presented some special challenges for Laura Hester, a geography major in the Dartmouth College Class of 2009. It involved driving an hour each way from Hanover, N.H., to the Chief Medical Examiner's Office in Concord almost every other day for two months in the winter. It required combing through the 1,500 death certificates from 2003 to 2007 that were loosely classified as involving "toxic substances" in order to find the 488 deaths that were due to prescription opioids. And since the certificates exist only in paper form, it required hours and hours of data entry. But all that hard work yielded a "high-quality" database, says her advisor, and an "excellent" and "very ambitious" senior honors thesis. This is a web extra to an article that appeared in the Spring 2009 issue of Dartmouth Medicine Magazine. To read the article, go to: http://dartmed.dartmouth.edu/summer09/html/vs_briefs/

Talking about health-care reform Everyone—from the Obama administration to your friends and neighbors—is talking about health-care reform. So in the Summer 2009 issue of Dartmouth Medicine magazine, alumni of Dartmouth Medical School from across the country answered questions about their practices and the changes they'd like to see made to the nation's health-care system. To find out more about what Americans who are patients rather than physicians are saying on this topic, Dartmouth Medicine spoke to people on the streets of White River Junction, Vt., and Hanover, N.H. They mentioned the wide array of medical challenges they face and discussed their priorities and concerns as the nation moves toward health-care reform. This is a web extra to an article that appeared in the Spring 2009 issue of Dartmouth Medicine Magazine. To read the article, go to: http://dartmed.dartmouth.edu/summer09/html/road_to_reform/

Surviving cancer P.J. Hamel, a senior editor at King Arthur Flour Company, headquartered in Norwich, Vt., describes herself professionally as a "baker and blogger." She writes the King Arthur catalog, creates recipes, has written cookbooks, and blogs about baking on the company's website. And personally Hamel is, among many other roles, a cancer survivor--she was diagnosed with breast cancer in 2001 and over the next nine months had surgery, chemotherapy, and radiation therapy at Dartmouth-Hitchcock Medical Center. She began blogging about cancer as well, shortly after her diagnosis. Writing, she says, is a thread that has run through her entire life. In a feature for the Spring 2009 issue of Dartmouth Medicine, titled "My Story," she shared the experiences and emotions of being diagnosed with and treated for cancer. This is a web extra to an article that appeared in the Spring 2009 issue of Dartmouth Medicine Magazine. To read the article, go to: http://dartmed.dartmouth.edu/spring09/html/my_story.php

A Patron of Positivity The summer after her first year of medical school, Dr. Julia Nordgren worked with Dr. Judy Frank, conducting research and shadowing Frank on rounds in the neonatal intensive care unit. What she learned from Frank changed her outlook on both medicine and life. "Judy Frank was clearly no ordinary woman in medicine," Nordgren says. In this podcast, originally published as an essay in the Spring 2009 issue of Dartmouth Medicine, Nordgren reflects on how her experiences that summer shaped her own career as a woman in medicine. This is a web extra to an article that appeared in the Spring 2009 issue of Dartmouth Medicine Magazine. To read the article, go to: http://dartmed.dartmouth.edu/spring09/html/point_of_view.php

Lee Witters discusses the discovery of insulin One early prescription for diabetes involved drinking a pint and a half of milk for breakfast, eating rancid meat for dinner, and using hog's lard as skin lotion. Actually, explains Dr. Lee Witters, this treatment did some good simply by causing patients to eat less (no one likes rancid meat, after all). The discovery of insulin, which paved the way for more effective diabetes treatments, was one of the great advances in medical history, and it makes for quite a story. In this video, Witters discusses diabetes in ancient societies, the first descriptions of the disease, the medical revolution that resulted from isolating insulin, and much more. The lecture in the video was originally delivered as a session in the Dartmouth Community Medical School (DCMS) and is presented as a Dartmouth Medicine web-extra with the kind permission of the DCMS. For more information about the Dartmouth Community Medical School, visit http://dms.dartmouth.edu/dcms/. This is a web extra to an article that appeared in the Winter 2008 issue of Dartmouth Medicine Magazine. To read the article, go to: http://dartmed.dartmouth.edu/winter08/html/diabetes_detectives.php

An interview with Dr. James Bernat, a history of DHMC's ethics committee, and more information on advance directives Dr. James Bernat, an internationally recognized medical ethicist, is a professor of neurology at Dartmouth Medical School and head of the Ethics Committee at Dartmouth-Hitchcock Medical Center. In 1997, and again in 2006, Bernat was one of several scholars invited to Rome to advise the Vatican on how to define death. Reporters from prominent media outlets--from the New York Times to People magazine--often ask him to comment on major ethics cases, especially those involving brain death. He was quoted widely, for example, on Terri Schiavo, the Florida woman who lived for 15 years in a permanent vegetative state. Her husband, her parents, and the courts fought a very public battle over whether to remove her feeding tube and let her die naturally. Terri Schiavo died in 2005. Dartmouth Medicine associate editor Laura Stephenson Carter spoke to Bernat about his work on medical ethics. This is a web extra to an article that appeared in the Winter 2008 issue of Dartmouth Medicine Magazine. To read the article, go to: http://dartmed.dartmouth.edu/winter08/html/other_hand.php

Discovering New Darwins Charles Darwin was lucky. Without the financial support of his family, all of his powers of observation and analysis might have gone for naught. Today, of course, most scientists do not depend on their families to fund their research. Instead, the U.S. federal government began investing heavily in science in the mid-20th century. As a result, says Dr. Ethan Dmitrovsky, the United States has been a leader in the biomedical revolution. Dmitrovsky, a DMS professor of pharmacology and toxicology, argues in this audio essay that lagging support for research in recent years risks ending the nation's tradition of scientific success. This is a web extra to an article that appeared in the Winter 2008 issue of Dartmouth Medicine Magazine. To read the article, go to: http://dartmed.dartmouth.edu/winter08/html/point_of_view.php

Getting, and getting used to, a cochlear implant Geneva Durgin was 13 months old when she heard sound for the first time through a cochlear implant. Before the implant, she couldn't hear anything, even with hearing aids. Although Geneva spent the first year of her life in silence, she thrived developmentally, thanks in large part to sign language instruction and early intervention from the Vermont Center for the Deaf and Hard of Hearing. Geneva's parents decided to get a cochlear implant for her because they thought it offered her the best chance at learning English and learning to talk. They also chose to continue signing with Geneva, in hopes of her learning two languages, English and American Sign Language. This is a web extra to an article that appeared in the Fall 2008 issue of Dartmouth Medicine Magazine. To read the article, go to: http://dartmed.dartmouth.edu/fall08/html/sound.php

José Conejo-Garcia talks about his discovery of PILAR The immune system protects us from a host of pathogens, but in some cases it's actually the cause of health problems. T cells, a type of white blood cell that is a key player in the immune system, become activated when they encounter antigens. Usually, those antigens are signs that a pathogen is trying to get a foothold in the body, so the response of T cells is essential to fighting off disease. But when the antigen is actually a self-antigen--when it is part of the host and not an invader--a response by T cells can result in swelling, inflammation, and pain. José Conejo-Garcia, a professor of microbiology and immunology, has discovered a receptor, which he named "PILAR," that helps to determine whether T cells respond to an antigen. This is a web extra to an article that appeared in the Fall 2008 issue of Dartmouth Medicine Magazine. To read the article, go to: http://dartmed.dartmouth.edu/fall08/html/disc_pilar.php