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This Week in JAMA
November 1, 2000

This Week in JAMA

JAMA. 2000;284(17):2151. doi:10.1001/jama.284.17.2151
HIV-1 Immunogen Therapy and HIV Disease Progression

Early studies have suggested that administration of HIV-1 Immunogen, a whole, inactivated HIV isolate, might reduce HIV disease progression when added to antiretroviral therapies (ARTs) by enhancing the immunologic mechanism for viral recognition. In this multicenter trial, Kahn and colleagues found that after a mean follow-up of 120 weeks, HIV progression-free survival among patients who received ART plus HIV-1 Immunogen was not significantly different from the progression-free survival among patients who received ART and placebo.

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Conflicts of Interest in Industry-Sponsored Research

Private industry provides substantial funding for biomedical research at academic institutions unavailable from public sources, but studies suggest that industry sponsorship may bias research outcomes and influence dissemination of results. Cho and colleaguesArticle reviewed conflict of interest policies at 89 of the 100 US research institutions that received the most funding from the National Institutes of Health in 1998. Forty-nine policies required disclosures from all faculty, but most policies lacked specificity about the kinds of relationships with industry that are permitted or prohibited. Boyd and BeroArticle studied the financial relationships between faculty researchers and industry sponsors at the University of California, San Francisco. In 1999, 68 (7.6%) of 896 faculty investigators disclosed personal financial ties to industry sponsors. The most commonly disclosed relationships between December 1980 and October 1999 were paid speaking engagements, consulting positions, and positions on scientific advisory boards or boards of directors. KornArticle, in a commentary, suggests that academic institutions establish explicit limits on the financial relationships between faculty researchers and industry sponsors. In an editorial, DeAngelisArticle emphasizes that without institutional policies on conflicts of interest, public confidence and trust in biomedical research are threatened.

Treatment of Diabetic Polyneuropathy With rhNGF

Recent evidence suggests that reduced levels of nerve growth factor (NGF), a neurotrophic factor that promotes survival of small fiber sensory neurons and sympathetic neurons in the peripheral nervous system, may be important in the pathogenesis of diabetic polyneuropathy. In prior phase 2 trials, neuropathy was significantly improved among patients with diabetic polyneuropathy and patients with HIV-associated sensory neuropathy treated with recombinant human NGF (rhNGF) compared with placebo. In this 48-week phase 3 placebo-controlled trial, however, Apfel and colleagues found no significant benefit of rhNGF treatment on overall neuropathic impairment among patients with diabetes and sensory polyneuropathy.

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Lumbar Puncture in Presence of Thrombocytopenia

Clinical studies have not established whether thrombocytopenia increases the risk of neurologic complications after lumbar puncture (LP), and clinical practice regarding the use of prophylactic platelet transfusions varies. Howard and colleagues reviewed the records of children with newly diagnosed acute lymphoblastic leukemia who underwent LPs at diagnosis and for administration of intrathecal chemotherapy at a pediatric cancer center where prophylactic platelet transfusion is not routinely given for patients with thrombocytopenia. No serious complications occurred after 5223 LPs among 956 children undergoing remission induction or consolidation therapy regardless of platelet count, including 29 LPs performed at platelet counts of 10 x 109/L or less and 941 at platelet counts of 50 x 109/L or less.

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A 47-Year-Old Woman With Severe Asthma

Ms A has had chronic asthma since childhood. Over the past year, her symptoms have increased, especially with exertion and during the night, and she has increased her use of rescue inhaled albuterol and the dosages of some of her long-term control medications. Busse discusses recent trends in the epidemiology of asthma and related insights about the immunology of this condition, and diagnosis and treatment.

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A Piece of My Mind

"The culture of academic medical centers becomes a major determinant of professional behavior once students enter the clinical years and later when they become house officers." From "Financial Indigestion."

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Evolution of lesions from fire ant stings.

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Medical News & Perspectives

Because sleep problems can coexist with medical disorders in people of all ages, helping patients get a better night's rest may improve their overall health and quality of life.

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Essays examining consequences of direct-to-consumer advertising of prescription medications. Winning poems from this year's William Carlos Williams Poetry Contest.

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JAMA Patient Page

For your patients: A primer on neuropathy.

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