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.
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.
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.
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.
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
"While man and machine may be in opposition, man is clearly
master." George Ault, The Mill Room, 1923, American.
"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."
From sexual partners' viewpoint, is the new virility pill proving to
be a pleasure or a problem?
Reevaluating the role of antisecretory therapy in the treatment of
bleeding peptic ulcer.
When ethical health care for the individual is unethical public policy.
For your patients: Treatment of genital herpes.
This Week in JAMA. JAMA. 1998;280(10):863. doi:10.1001/jama.280.10.863