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This Week in JAMA
September 9, 1998

This Week in JAMA

JAMA. 1998;280(10):863. doi:10.1001/jama.280.10.863
Controlling Recurrent Genital Herpes

Patients may find that episodic treatment with oral antiviral agents is unsatisfactory for frequent recurrences of genital herpes. Diaz-Mitoma and colleaguesArticle report the results of a multicenter trial in which the preventive use of daily oral famciclovir for 1 year significantly decreased the time to the first recurrence of genital herpes and the number of recurrences. In an editorial, EngelArticle cautions that successful suppression of genital herpes does not eliminate asymptomatic viral shedding or the possibility of disease transmission.

When Tobacco Control Programs Fail

Following the introduction of a community-wide comprehensive tobacco control program in California in 1989, the per capita consumption of cigarettes in California declined more rapidly than before the program and more rapidly than in the rest of the United States. But from 1994 through 1996, the program was curtailed and its effects began to dwindle. Pierce and coworkers analyze the economic, political, and tobacco industry factors that might explain the loss of effectiveness of this program.

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Curbside Consulting

Two surveys conducted independently in MassachusettsArticle and Rhode IslandArticle indicate that physicians in group practice, particularly those in managed care settings, are more likely to seek informal "curbside" consultations than physicians in solo practice. Generalist physicians perceived informal consultations to be of higher overall quality than did subspecialists. In an editorial, GolubArticle describes the communication errors that might undermine the quality of informal consultations. He recommends that physicians appraise informal consultations critically, like other sources of information, and that curbside consulting be evaluated by rigorous empirical study.

Cancer Mortality After Nonmelanoma Skin Cancer

In a prospective study of more than 1 million participants, Kahn and coworkers found that a history of nonmelanoma skin cancer was associated with an increased risk of mortality from other cancers after 12 years of follow-up. The highest cancer mortality risks in men and women were associated with melanoma, pharyngeal cancer, lung cancer, and non-Hodgkin lymphoma. This epidemiologic study underscores the complex association between environmental exposures, inherited and acquired genetic susceptibilities, and the risk of cancer.

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Imaging Studies and Coronary Artery Disease

Individual comparative studies have had limited power to detect differences in the performance of exercise echocardiography and exercise single-photon emission computed tomography for the detection and evaluation of coronary artery disease. In a meta-analysis that pooled data from 44 published studies, Fleischmann and colleagues show that both diagnostic tests have similar sensitivities, but exercise echocardiography has better specificity and higher overall discriminatory power.

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The Cover

"While man and machine may be in opposition, man is clearly master." George Ault, The Mill Room, 1923, American.

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A Piece of My Mind

"I know of physicians who have avoided treatment—perhaps because of fear of the lack of privacy afforded to other patients—and later committed suicide." From "A Challenge to Licensing Boards: The Stigma of Mental Health."

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Medical News & Perspectives

From sexual partners' viewpoint, is the new virility pill proving to be a pleasure or a problem?

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Contempo 1998

Reevaluating the role of antisecretory therapy in the treatment of bleeding peptic ulcer.

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Policy Perspectives

When ethical health care for the individual is unethical public policy.

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JAMA Patient Page

For your patients: Treatment of genital herpes.

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