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White Coat Notes

Ranking medical schools based on their social mission

June 21, 2010

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Here’s a ranking of medical schools that doesn’t place Harvard at the top. When schools were evaluated based on their “social mission,’’ UMass scored in the top 20, Boston University in the bottom 20, and Tufts and Harvard in the middle of the pack. BU’s dean was “shocked’’ by the conclusions published last week, saying the criteria used by the researchers were too narrow.

Dr. Fitzhugh Mullan, professor of health policy and pediatrics at George Washington University, and his colleagues devised a scoring system that weighed how well the country’s 141 medical schools produced graduates who practiced primary care, worked in areas with a federally designated shortage of health professionals, and belonged to underrepresented minority groups. Their sample comprised more than 60,000 physicians who received their MDs between 1999 and 2001. This group was chosen because the doctors would have completed their residencies and other postgraduate training before settling on a medical specialty. The data came from the American Medical Association Physician Masterfile and the Association of American Medical Colleges and the Association of American Colleges of Osteopathic Medicine.

Across the country, public medical schools did better than private ones, largely because of their traditional focus on educating primary-care doctors. The Northeast was at the bottom of the list and three historically black medical schools — led by Morehouse College in Georgia — were at the top. ELIZABETH COONEY

The top 10 schools with the highest social mission scores
1. Morehouse School of Medicine
2. Meharry Medical College
3. Howard University
4. Wright State University Boonshoft School of Medicine
5. University of Kansas
6. Michigan State University College of Human Medicine
7. East Carolina University Brody School of Medicine
8. University of South Alabama
9. Ponce School of Medicine
10. University of Iowa Carver College of Medicine

The bottom 10 schools with the lowest social mission scores
132. Albert Einstein College of Medicine of Yeshiva University
133. Stony Brook University
134. Thomas Jefferson University
135. Uniformed Services University of the Health Sciences
136. University of Medicine and Dentistry of New Jersey
137. New York University
138. University of California, Irvine
139. Northwestern University Feinberg School of Medicine
140. University of Texas Southwestern
141. Vanderbilt University

Brown rice tops white in warding off type 2 diabetes

White rice, a traditional staple in the Asian diet, has been blamed for raising the risk of type 2 diabetes because it elevates blood sugar levels right after meals. But the picture has not been as clear in populations where rice isn’t consumed as often.

New research from Harvard pooling three large, long-running national studies shows that Americans who ate more white rice also had a moderately increased risk of diabetes, but Americans who ate brown rice had a slightly lower risk. Substituting brown rice or other whole grains for white rice could cut that risk by as much as 36 percent, the researchers conclude in an article published in last week’s Archives of Internal Medicine.

Dr. Qi Sun, who is now at Brigham and Women’s Hospital but did the research with colleagues at the Harvard School of Public Health, analyzed records from the Health Professionals Follow-up Study and the Nurses’ Health Study I and II. Data reviewed included diet, lifestyle, and disease information dating to 1984 for 39,000 men and 157,000 women.

People who ate white rice five or more days a week had a 17 percent higher risk of type 2 diabetes than people who ate white rice less than once a month. Eating brown rice twice a week or more was associated with an 11 percent lower risk of diabetes compared to eating less than one serving a month.

The observational study can’t show cause and effect for the relatively low risk of developing type 2 diabetes, but the researchers estimate that replacing one-third of a white rice serving per day with brown rice could lower that risk by 16 percent. Substituting other whole grains would reduce diabetes risk by 36 percent. The benefit stems from the higher nutrient content in complex-carbohydrate whole grains compared to refined grains.

Brown-rice eaters tended to have healthier habits than others in the study, weighing less and exercising more. But when those factors were the same, brown rice still accounted for the difference in developing type 2 diabetes.

“If a person truly loves to eat rice, we recommend substituting brown rice for white rice. For other people, we recommend substituting whole grains for other refined carbohydrates,’’ Sun said in an interview. E.C.

Pills prove preferable to IV drugs in study of lung patients

Less turned out to be more when patients were treated in the hospital for flare-ups of their lung disease, a new study shows.

Dr. Peter Lindenauer of Baystate Medical Center and his colleagues analyzed the records of almost 80,000 people who were admitted to 414 hospitals across the country with exacerbations of their chronic obstructive pulmonary disease, or COPD, and found that most were treated contrary to guidelines. Specialty groups recommend giving patients oral corticosteroids. More than 90 percent of the patients received the drugs intravenously during their first two days in the hospital. The other 8 percent got the same drugs by mouth. The IV drugs were 10 times as strong as the pills, but patients who took the pills fared just as well as patients who were given IV drugs. E.C.

Did medicate change boost pricier drugs?

When in 2003 Medicare changed the way it paid cancer doctors for intravenous drugs they give patients in their offices, problems were predicted.

Doctors said the new payment rates would not take their real costs into account, perhaps forcing patients to get treatments elsewhere. A government advisory commission worried that Medicare beneficiaries would have poorer access to drugs. But a new analysis from Harvard looking at lung cancer patients reports that chemotherapy treatments increased after the change, and that use of lower-cost drugs declined and higher-priced ones increased.

But Dr. Michael Anderson — head of the region’s largest community cancer network, Commonwealth Hematology-Oncology — said, “There are so many influences on how an oncologist chooses a drug regimen. I think it’s very simplistic of the authors to say it’s on the basis of cost.’’ E.C.

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