Findings of a multicenter, prospective, controlled trial of estrogen
plus progestin in postmenopausal women with established coronary disease failed
to support the use of hormone replacement therapy for the secondary prevention
of heart disease, a practice that has been based on observational data. Dr
Hulley and colleaguesArticle found no differences in occurrence of myocardial infarction
or death from coronary heart disease between treatment and placebo groups
over an average follow-up of 4 years. In an editorial, Dr Petitti Article discusses
these new findings in relation to the observational data, along with clinical
considerations for the initiation and continued use of hormone replacement
Four genes are known to account for approximately 50% of the genetic
risk for all forms of Alzheimer disease, and a recent linkage analysis suggested
a new susceptibility gene on chromosome 12 for the common late-onset form
of the disease. Dr Rogaeva and colleaguesArticle examined chromosome 12 markers in
53 families with multiple members affected with Alzheimer disease and confirmed
the previously observed linkage. In contrast, Mr Wu and colleaguesArticle found no
evidence of linkage in this same region of chromosome 12 in their study of
230 families. In an editorial, Mr DalyArticle offers insights to reconcile these
apparently discrepant findings.
In a nationwide study, only 50% of eligible elderly patients were prescribed β-blockers
at hospital discharge after acute myocardial infarction. Dr Krumholz and colleagues
report that variation in prescription patterns was explained by regional differences
and physician specialty rather than by patient characteristics. They also
report that elderly patients who were prescribed β-blockers at discharge
had a 14% lower risk of mortality 1 year later.
Several million women used diethylstilbestrol to prevent spontaneous
abortion and premature delivery before the association of the drug with vaginal
and cervical clear cell adenocarcinoma in their daughters was recognized.
Dr Hatch and colleagues studied whether women exposed in utero to high estrogen
levels are also at increased risk of breast cancer and other cancers. They
confirmed the uncommon yet increased occurrence of clear cell adenocarcinoma
associated with in utero diethylstilbestrol exposure after an average of 15
years of follow-up. But they did not find an increased risk of all cancers
combined or of other individual cancers, including breast cancer.
Many physicians are likely to receive requests from patients for physician-assisted
suicide. Dr Emanuel presents an 8-step strategy for physicians to respond
to these challenging requests. This approach involves identification and treatment
of causes motivating the request and includes a plan for consistent application
of practical and principled clinical skills.
"The result was a near lyrical abstraction of forms, a new consideration
of reality itself." Claude-Oscar Monet, Water Lilies,
The 12th World AIDS Conference—a "new realism" of advances and
The serious problem of adolescent substance abuse.
Dr Joycelyn Elders and Ms Albert issue a grim reminder of the need to
rule out sexual abuse in pregnant teenagers.
"The contrast between the attitudes toward the dead that I have observed
in my religious communal life and in my professional life is striking." From
"The Holy Society."
An interview with Linda Headrick, MD, an academician in primary care,
who "is a quiet but constant warrior against complacency in the work of physicians."
For your patients: A primer on Alzheimer disease.
This Week in JAMA. JAMA. 1998;280(7):585. doi:10.1001/jama.280.7.585