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This Week in JAMA
January 13, 2010

This Week in JAMA

JAMA. 2010;303(2):101. doi:10.1001/jama.2009.2013

In a 2005 JAMA article, Dorsey and colleagues Article reported that financial support of biomedical research doubled between 1994 and 2003. In this issue, they report results of an updated analysis of publicly available data on biomedical research funding by federal, state, and local governments; private not-for-profit entities; and industry sources. Among the authors' findings was that the rate of increase in research spending has slowed since 2005, with a compounded, inflation-adjusted annualized growth rate of 3.4% in 2003-2007 compared with 7.8% in 1994-2003. They also report that the inflation-adjusted absolute level of funding from the National Institutes of Health and the pharmaceutical, biotechnology, and medical device industries appears to have decreased by 2% in 2008. In an editorial, Boat Article discusses trends in biomedical research funding and implications of funding patterns and priorities for researchers, institutions, and the public.

Chronic Achilles tendinopathy—a degenerative condition characterized by pain, swelling, and decreased physical activity—is a relatively common athletic injury that responds poorly to conservative treatment. Several recent reports have suggested that tendon regeneration may be improved by injecting platelet-rich plasma—a source of various tissue growth factors. To systematically assess the potential benefit of this intervention on pain and functional outcome, de Vos and colleagues randomly assigned 54 patients with chronic midportion Achilles tendinopathy to receive an injection of platelet-rich plasma or placebo (saline) injection, both combined with an eccentric exercise program. At 24-week follow-up, the authors found that injection of platelet-rich plasma was not associated with significantly greater improvement in either pain or function compared with saline injection.

The cholesteryl ester transfer protein gene (CETP) is involved in central nervous system cholesterol homeostasis, and some evidence suggests a single-nucleotide polymorphism at the CETP codon 405 (isoleucine to valine; V405) is associated with exceptional longevity and a lower risk of dementia. Sanders and colleagues assessed whether this gene polymorphism would be associated with less age-associated memory decline and lower risk of incident dementia in a community-based sample of healthy older adults who did not have dementia at study enrollment and who completed annual standardized neuropsychological assessments. The authors report that CETP valine homozygosity was associated with slower age-associated memory decline and a lower risk of incident dementia, including Alzheimer disease.

In November 2009, the US Preventive Services Task Force (USPSTF) updated its recommendations for breast cancer screening and in doing so, recommended against routine screening mammography for women aged 40 to 49 years and against teaching women to perform breast self-examination. Four commentaries in this issue ArticleArticleArticleArticle offer perspectives on the USPSTF recommendations and highlight the guideline development process, benefits and harms of mammography screening, and the importance of individual patient-level decisions about breast cancer screening. In an editorial, DeAngelis and Fontanarosa Article discuss professional and public controversy generated by the updated recommendation statement and emphasize the importance of independent, objective assessment of evidence to guide patient care.

“Love has its own logic, and from our vantage point, marrying a fellow physician was incidental to finding our respective soul mates.” From “The Family Business.”

Scientists are identifying proteins that play key roles in the development and progression of cancers to use as targets for cancer prevention.

Two articles in the Archives of Surgery address patient safety issues. Livingston discusses strategies to improve patient safety, including physician-led initiatives, no-fault reporting of errors and near-misses, and the use of checklists.

Join Hussein Hollands, MD, MSc, Wednesday, January 20, from 2 to 3 PM to discuss acute-onset floaters and flashes and risk of retinal detachment. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

How would you care for an 86-year-old woman with progressive congestive heart failure and multiple chronic conditions who is contemplating suicide? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is January 24.

For your patients: Information about Achilles tendinopathy.