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To learn more about The Doctors Company’s medical ♦ professional liability insurance program in North Carolina, including the member dividend, call (866) 990-3001 ♦ or visit us at www.thedoctors.com. ♦ ♦ Publishers of the North Carolina Medical Journal The North Carolina Institute of Medicine In 1983 the North Carolina General Assembly chartered the North Carolina Institute of Medicine as an independent, quasi-state agency to serve as a nonpolitical source of analysis and advice on issues of relevance to the health of North Carolina’s population. The Institute is a convenor of persons and organizations with health-relevant expertise, a provider of carefully conducted studies of complex and often controversial health and health care issues, and a source of advice regarding available options for problem solution. The principal mode of addressing such issues is through the convening of task forces consisting of some of the state’s leading professionals, policymakers, and interest group representatives to undertake detailed analyses of the various dimensions of such issues and to identify a range of possible options for addressing them. The Duke Endowment The Duke Endowment, headquartered in Charlotte, NC, is one of the nation’s largest private foundations. Established in 1924 by industrialist James B. Duke, its mission is to serve the people of North Carolina and South Carolina by supporting programs of higher education, health care, children’s welfare and spiritual life. The Endowment’s health care grants provide assistance to not-for-profit hospitals and other related health care organizations in the Carolinas. Major focus areas include improving access to health care for all individuals, improving the quality and safety of the delivery of health care, and expanding preventative and early intervention programs. Since its inception, the Endowment has awarded $2.2 billion to organizations in North Carolina and South Carolina, including more than $750 million in the area of health care. 194 NC Med J May/June 2010, Volume 71, Number 3 Publisher Pam C. Silberman, JD, DrPH / NC Institute of Medicine, Morrisville Publisher Eugene W. Cochrane Jr / The Duke Endowment, Charlotte Editor-In-Chief Thomas C. Ricketts III, PhD, MPH / University of North Carolina, Chapel Hill Scientific Editor John W. Williams Jr, MD, MHS / Duke University Medical Center, Durham Assistant Scientific Editor Ben Powers, MD, MHS / Duke University Medical Center, Durham Editor Emeritus Gordon H. DeFriese, PhD / University of North Carolina, Chapel Hill Editor Emeritus Francis A. Neelon, MD / Duke University, Durham Associate Editor Dana D. Copeland, MD, PhD / WakeMed, Raleigh Associate Editor Mark Holmes, PhD / NC Institute of Medicine, Morrisville Associate Editor Mary L. Piepenbring / The Duke Endowment, Charlotte Associate Editor Charles F. Willson, MD / East Carolina University, Greenville Section Editor, Running the Numbers Robert E. Meyer, PhD / NC DHHS, Raleigh Managing Editor Christine Nielsen, MPH / NC Institute of Medicine, Morrisville Assistant Managing Editor Phyllis Blackwell / NC Institute of Medicine, Morrisville Business Manager Adrienne R. Parker / NC Institute of Medicine, Morrisville Founded by the North Carolina Medical Society in 1849 Published by the North Carolina Institute of Medicine and The Duke Endowment Do you want your Editorial Board Cynthia B. Archie, RN, MSN, EdD / Wayne Community College, Goldsboro message to reach William K. Atkinson II, PhD, MPH, MPA / WakeMed, Raleigh Steve Cline, DDS, MPH / Division of Public Health / NC DHHS, Raleigh North Carolina’s Fred M. Eckel, MS / NC Association of Pharmacists, Chapel Hill Elizabeth R. Gamble, MD, MSPH / Wake Forest University, Winston-Salem physicians, dentists, Ted W. Goins Jr / Lutheran Services for the Aging, Inc., Salisbury Beth A. Griffin, MHP, PA-C / New Hanover Community Health Center, Wilmington Blaine Paxton Hall, MHS-CL, PA-C / Durham Regional Hospital, Durham and pharmacists? Margaret N. Harker, MD / Family Practice, Morehead City Robert T. Harris, MD / Trust for America’s Health, Raleigh Olson Huff, MD / Action for Children North Carolina, Asheville Published since 1940, the Thomas G. Irons, MD / East Carolina University, Greenville Delma H. Kinlaw, DDS / NC Dental Society, Cary North Carolina Medical Julienne K. Kirk, PharmD / Wake Forest University, Winston-Salem Rick L. Langley, MD, MPH / Division of Public Health / NC DHHS, Raleigh Journal is the only Mark Massing, MD, PhD, MPH / The Carolinas Center for Medical Excellence, Cary Jane B. Neese, PhD, RN, CS / University of North Carolina, Charlotte M. Alec Parker, DMD / NC Dental Society, Fletcher publication about health Deborah Porterfield, MD, MPH / RTI International, Research Triangle Park Senator William R. Purcell, MD / NC General Assembly, Laurinburg care policy in North Dennis R. Sherrod, RN, EdD / Winston-Salem State University, Winston-Salem Polly Godwin Welsh, RN-C / NC Health Care Facilities Association, Raleigh Carolina written by health Joyce M. Young, MD, MPH / IBM Corporation, Research Triangle Park The North Carolina Medical Journal (ISSN 0029-2559) is published by the North Carolina Institute of Medicine care professionals. As the and The Duke Endowment under the direction of the Editorial Board. Copyright 2009 © North Carolina Institute of Medicine. Address manuscripts and communications regarding editorial matters to the managing editor. Address communications regarding advertising and reader services to the assistant managing editor. Opinions most widely distributed expressed in the North Carolina Medical Journal represent only the opinions of the authors and do not necessarily reflect the official policy of the North Carolina Medical Journal or the North Carolina Institute of Medicine. All advertisements are accepted subject to the approval of the editorial board. The appearance of an advertisement North Carolina-based in the North Carolina Medical Journal does not constitute any endorsement of the subject or claims of the advertisement. This publication is listed in PubMed. health-focused journal in the Managing Editor: Christine Nielsen, MPH, 919.401.6599, ext. 25 or christine_nielsen (at) nciom.org. Assistant Managing Editor: Phyllis A. Blackwell, 919.401.6599, ext. 27 or phyllis_blackwell (at) nciom.org. Graphic Design: Angie Dickinson, angiedesign (at) windstream.net. Printing: The Ovid Bell Press, Inc, 1201-05 Bluff Street, state, your message Fulton, MO 65251, 800.835.8919. Annual Subscriptions (6 issues): Individual $42.80 ($40 plus 7% NC tax). Institutional: $64.20 ($60 plus 7% NC tax). will be widely received. The North Carolina Medical Journal (ISSN 0029-2559) is published bimonthly: January/February, March/April, May/ June, July/August, September/October, and November/December. Periodicals postage paid at Morrisville, NC 27560 and at additional mailing offices.POSTMASTER: Send address changes to the North Carolina Medical Journal, Both classified and display 630 Davis Drive, Suite 100, Morrisville,