Untreated and undertreated pain is a persistent clinical problem. In
this study, Dr Bernabei and colleaguesArticle assessed a cohort of nursing home patients
with cancer and found that up to 38% had daily pain, but 26% of these patients
received no analgesics. Older patients and those of non-white race were more
likely to have untreated pain. In an accompanying editorial, Dr CleelandArticle explores
reasons for undertreating pain and ways to improve pain treatment.
Sexual misconduct by physicians is an uncommon but troubling event.
Ms Dehlendorf and Dr WolfeArticle found that from 1989 to 1996, the number of physicians
disciplined per year for sex-related offenses nationwide increased from 42
to 147, and the proportion of all disciplinary orders that were related to
sexual offenses increased from 2.1% to 4.4%. Nearly 75% of disciplinary orders
for sex-related offenses involved sexual contact with patients, and nearly
40% of physicians disciplined for sex-related offenses prior to 1994 were
licensed to practice in 1997.
See related editorial Article
Dr Morrison and Mr WickershamArticle examined disciplinary orders reported
by the Medical Board of California for 375 physicians disciplined for 465
offenses during an 18-month period. The most common causes for discipline
were negligence or incompetence (34%), substance abuse (14%), inappropriate
prescribing practices (11%), and inappropriate contact with patients (10%);
34% of disciplinary actions resulted in revocation or suspension of the physician's
Young adults may not have received as much attention previously as some
other groups with regard to risk for HIV infection. Dr Rosenberg and colleagues
present evidence suggesting that HIV incidence in this population due to homosexual
contact may be declining even as heterosexual contact is becoming a more important
mode of transmission.
In a randomized controlled trial, Dr Bethold and colleagues evaluated
the effect of a garlic oil preparation on serum lipoproteins. The preparation
had no effect on serum lipoprotein levels, cholesterol absorption, or cholesterol
Motor vehicle crashes are a leading cause of death and injury. This
report from the AMA Council on Scientific Affairs indicates that driver sleepiness
is a contributing factor in 1% to 3% of all US motor vehicle crashes, and
that 96% of sleep-related crashes involve drivers of passenger vehicles. The
council report reviews risk factors for sleep-related crashes, advises physicians
to counsel patients about the risks of driving while sleepy, and recommends
additional research on ways to counter the problem.
"The artist, as king, represents the soul of man and rules over the
subordinate world of matter." Max Beckmann, The King,
"Your heart, your mind, and your hands have in some way become my own."
Recent student shootings in school have physicians considering courses
of action to confront this public health issue.
The past and future of Blue Cross and Blue Shield.
For your patients: the problem of drivers falling asleep at the wheel.
This Week in JAMA. JAMA. 1998;279(23):1849. doi:10.1001/jama.279.23.1849