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This Week in JAMA
July 8, 1998

This Week in JAMA

JAMA. 1998;280(2):109. doi:10.1001/jama.280.2.109
Racial and Ethnic Differences Among Smokers

Blacks have been reported to have higher levels of serum cotinine than whites, providing a possible reason why blacks have more prevalent tobacco-related diseases. Dr Caraballo and colleaguesArticle examined serum cotinine levels in black, white, and Mexican American adults in relation to their self-reported smoking habit and environmental tobacco smoke (ETS) exposure. Black smokers had higher cotinine levels than whites or Mexican Americans, and these levels were not associated with number of cigarettes smoked or ETS exposure. In a related study, Dr Pérez-Stable and colleaguesArticle evaluate rates of metabolism and daily intake of nicotine in black and white smokers. Compared with white smokers, black smokers had slower total and nonrenal clearances of cotinine and took in 30% more nicotine per cigarette.

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Insulin Therapy and Weight Gain

Intensive insulin treatment for type 1 diabetes improves outcomes compared with conventional insulin therapy, but may also lead to weight gain. Dr Purnell and colleagues confirm that patients randomized to receive intensive insulin therapy have greater weight gain than those receiving conventional insulin therapy, and also developed worse cardiac risk profiles.

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Persistent Pain Is an International Problem

In this World Health Organization study of interviews of more than 5000 primary care patients at 15 centers in 14 countries, Dr Gureje and colleagues find that the combined prevalence of persistent (ie, lasting at least 6 months) pain was 22%. Persistent pain was associated with anxiety and depressive disorders.

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Life-Threatening Drug Interactions With Mibefradil

Mibefradil was withdrawn from the US market on June 8 because of multiple drug-drug interactions, so patients receiving mibefradil must be treated with new antihypertensive agents. In this report, released by JAMA June 18 because of public health importance, Dr Mullins and colleagues describe 4 patients who had been receiving mibefradil and a β-blocker, in whom mibefradil therapy was stopped and treatment with a dihydropyridine calcium channel blocker started. All 4 developed severe hypotension and bradycardia requiring intensive care; 1 patient died. The adverse reaction likely was due to mibefradil's long half-life. Based on these and other reports, the manufacturer has recommended a washout period of 7 days before starting most calcium channel blockers and 14 days for felodipine.

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High-Dose Methylprednisolone Therapy for ARDS

Glucocorticoid treatment has been shown to be of no benefit in early acute respiratory distress syndrome (ARDS), but in this randomized trial of patients with severe ARDS who had not improved after 7 days, Dr Meduri and colleagues showed improvement in lung injury scores and reduced mortality for those treated with high-dose, prolonged methylprednisolone therapy.

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The Cover

"The shapes and colors are in fact so simple as to be profound." Max Pechstein, Sunset, 1921, German.

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Contempo 1998

Advances in the early detection of prostate and colorectal cancer.

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Medical News & Perspectives

Viagra's no joke, but "sildenafil envy" leads other pharmaceutical firms to propose alternative erectile dysfunction treatments.

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Caring for the Critically Ill Patient

With new section editor Deborah J. Cook, MD, "Caring for the Critically Ill Patient" succeeds "Concepts in Emergency and Critical Care."

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Controversies

Are current FDA regulations for approval and monitoring of diagnostic testing devices appropriate and effective?

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JAMA Patient Page

For your patients: Living with diabetes.

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