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.
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
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
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.
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.
"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."
Evolution of lesions from fire ant stings.
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.
Essays examining consequences of direct-to-consumer advertising of prescription
medications. Winning poems from this year's William Carlos Williams Poetry
For your patients: A primer on neuropathy.
This Week in JAMA. JAMA. 2000;284(17):2151. doi:10.1001/jama.284.17.2151